Showing papers by "University of Medicine and Dentistry of New Jersey published in 2019"
TL;DR: Vascular comorbidities or device design may limit the traditional iliofemoral access route for acute mechanical circulatory support devices, and large bore access for the deployment of these devices through the axillary artery is feasible and safe when appropriate vascular access and closure techniques are used.
Abstract: Introduction: Use of acute mechanical circulatory support (MCS) devices for high-risk cardiac intervention, cardiogenic shock, and advanced heart failure is growing. Alternate vascular access options for these devices remains a clinical challenge. Building on experience from trans-aortic valve replacement procedures, the axillary artery is becoming a common access route for acute MCS and represents an important advance in the development of acute MCS technologies. Areas covered: Authors review the clinical data and technical aspect of acute MCS deployment via the axillary artery. Axillary access is particularly useful for patients: 1) with severe peripheral vascular disease, 2) with hostile femoral access due to infection, indwelling endovascular devices, or obesity, and 3) to provide early mobility and ambulation. In this review, we discuss the deployment, technical issues and hemostasis regarding the use of intraaortic balloon pump, specifically, axillary intraaortic balloon pumps, trans-valvular left ventricular Impella pumps and arterial outflow of VA-ECMO. Expert opinion: Vascular comorbidities or device design may limit the traditional iliofemoral access route for acute mechanical circulatory support devices. Large bore access for the deployment of these devices through the axillary artery is feasible and safe when appropriate vascular access and closure techniques are used.
15 citations
11 citations
University of Ottawa1, University of Michigan2, Virginia Commonwealth University3, University of Oklahoma Health Sciences Center4, University of Vermont5, Touro College of Osteopathic Medicine6, Loyola University Chicago7, Cleveland Clinic8, University of Texas Health Science Center at San Antonio9, University of Medicine and Dentistry of New Jersey10, Carolinas Medical Center11
TL;DR: The accreditation expectations and standards, available assessment tools for learner wellbeing, existing programs to teach well-being and some key elements for curriculum development are presented.
9 citations
7 citations
TL;DR: A case of a patient who presented in a hospital emergency department, with Addisonian crisis and predominant neuropsychiatric manifestation, with a diagnosis of Addison’s disease was established.
Abstract: Addison's disease (AD), also known as primary adrenal insufficiency, is a rare autoimmune disorder affecting males and females equally. The most common cause of AD is autoimmune adrenalitis and other causes include metastatic cancers, tuberculosis and acquired immunodeficiency syndrome. AD presents with a wide variety of signs and symptoms and thus, making a diagnosis challenging. The common symptoms of this disease include weakness and fatigability, orthostatic hypotension, nausea, vomiting, diarrhea, anorexia and weight loss. Addison's disease often presented with other autoimmune disorders, such as autoimmune polyglandular syndrome. We herein report a case of a patient who presented in a hospital emergency department, with Addisonian crisis and predominant neuropsychiatric manifestation. On review of the patient's history, combined with biochemical testing, a diagnosis of Addison's disease was established. This type of presentation is relatively uncommon.
7 citations
16 Sep 2019
TL;DR: Antagonists such as aprepitant and fosaprepitant were approved by FDA and EMA, in combination with other antiemetic agents, for the prevention of nausea and vomiting associated with emetogenic cancer chemotherapy.
Abstract: Tachykinin receptors (provisional nomenclature as recommended by NC-IUPHAR [90]) are activated by the endogenous peptides substance P (SP), neurokinin A (NKA; previously known as substance K, neurokinin α, neuromedin L), neurokinin B (NKB; previously known as neurokinin β, neuromedin K), neuropeptide K and neuropeptide γ (N-terminally extended forms of neurokinin A). The neurokinins (A and B) are mammalian members of the tachykinin family, which includes peptides of mammalian and nonmammalian origin containing the consensus sequence: Phe-x-Gly-Leu-Met. Marked species differences in in vitro pharmacology exist for all three receptors, in the context of nonpeptide ligands. Antagonists such as aprepitant and fosaprepitant were approved by FDA and EMA, in combination with other antiemetic agents, for the prevention of nausea and vomiting associated with emetogenic cancer chemotherapy.
5 citations
Loyola University Chicago1, University of Texas Health Science Center at San Antonio2, Virginia Commonwealth University3, Carolinas Medical Center4, University of Oklahoma Health Sciences Center5, Touro College of Osteopathic Medicine6, University of Ottawa7, Cleveland Clinic8, University of Michigan9, University of Medicine and Dentistry of New Jersey10, University of Vermont11
TL;DR: How to develop as an academic medical educator in obstetrics and gynecology is described, providing tips on how to start, advance, and succeed in an academic career, and an overview of available resources and opportunities are provided.
4 citations
TL;DR: While the CVLT II appears to be sensitive to overall cognitive dysfunction, the OT-SRT is more sensitive to focal learning and memory impairments.
Abstract: We compared the California Learning Verbal Test II (CVLT II) and the Open Trial-Selective Reminding Test (OT-SRT) in assessing learning in persons with Multiple Sclerosis. One-hundred and twelve participants with multiple sclerosis performed the OT-SRT and the CVLT II on two different days. All participants completed additional cognitive tests assessing information processing speed (IPS), working memory (WM), and executive functions (EF). By definition, all participants were identified as having impaired learning on the OT-SRT (i.e., z score <-1.0); however, only 38 participants (33.9%) were identified as having impaired learning on the CVLT II (i.e., a z score <-1 total correct responses trials 1-5). The sample was thus divided into two groups, those who failed both tests (Fail-2) and those who failed only one (Fail-1). The Fail-2 group showed poorer performance on EF, WM and IPS in comparison with the Fail-1 group. On the CVLT II, the Fail-1 group showed a significantly greater improvement between trials 1 and 5, as compared with the Fail-2 group. However, the two groups performed similarly on the OT-SRT. Correlation analysis showed that EF is positively correlated with CVLT II learning slope but not with OT-SRT learning slope. The CVLT II and the OT-SRT are not equivalent tests: while the CVLT II appears to be sensitive to overall cognitive dysfunction, the OT-SRT is more sensitive to focal learning and memory impairments.
4 citations
University of Michigan1, University of Toronto2, Stanford University3, University of Minnesota4, Georgetown University5, University of Pittsburgh6, Boston University7, University of California, Los Angeles8, University of Utah9, University of Medicine and Dentistry of New Jersey10, University of Western Ontario11, University of Texas Health Science Center at Houston12, University of Pennsylvania13, Medical University of South Carolina14, Columbia University15, Cleveland Clinic16, Ohio State University17, University of Florence18, University of Zurich19
TL;DR: ABA was well tolerated with comparable adverse events (AEs), serious AEs, and AEs of special interest (e.g., infections and malignancies) between treatments and Escape therapy was allowed at 6 months for worsening SSc.
Abstract: Background Abatacept (ABA) is a recombinant fusion protein including extracellular domain of human CTLA4 and hinge– CH2–CH3 of the Fc domain of human IgG. Objectives This phase 2 trial assessed the safety and efficacy of ABA 125 mg subcutaneous (SC) versus placebo SC given every week on skin fibrosis using the modified Rodnan skin score (mRSS) in diffuse cutaneous SSc (dcSSc; clinicaltrials.gov NCT02161406). Methods A 12-month, investigator-initiated, multicenter double-blind, randomized placebo-controlled trial was conducted between September 2014 and February 2018 at 27 US, Canadian and UK sites. Eligible subjects were randomized in a 1:1 ratio to either ABA or matching placebo, stratified by duration of dcSSc (≤18 vs >18 to ≤36 months). Key inclusion criteria included dcSSc with disease duration of ≤ 36 months (defined as first non−Raynaud phenomenon) and mRSS ≥ 10 and ≤ 35 units for disease duration of ≤ 18 months and mRSS ≥ 15 and ≤ 45 units with evidence of active disease for disease duration of >18-36 months. Escape therapy was allowed at 6 months for worsening SSc. Primary outcomes include safety and change in mRSS over 12 months (ΔmRSS). Secondary endpoints include ΔFVC%, ΔHAQ-DI, Δpatient and Δphysician global assessment, and ACR CRISS1 (composite measure in dcSSc). The primary endpoint of ΔmRSS was assessed using a linear mixed model (see Table) with primary end point data censored after initiation of escape therapy. Results 88 subjects were randomized (44/group) and formed the mITT group; 34 (77%) and 35 (80%) completed the 12-month double-blind treatment period in ABA and placebo groups, respectively. At baseline, the mean age was 49 years, 75% were female, mean disease duration was 1.59 years, 60% had disease duration ≤ 18 months, mRSS was 22.4, mean FVC% was 84.3%, and mean HAQ-DI was 1.0. Compliance with both drugs was >98%. ABA was well tolerated with comparable adverse events (AEs), serious AEs, and AEs of special interest (e.g., infections and malignancies) between treatments. There were 3 deaths during the treatment— 2 in ABA (both scleroderma renal crisis-days 11 and 46) and 1 in placebo (sudden cardiac arrest- day 310). The primary endpoint showed an adjusted mean improvement of mRSS of -6.24 in ABA vs. -4.49 in placebo, p= 0.28 (Table). The secondary outcome measures were statistically significant and clinically meaningful (HAQ-DI and physician global assessment) or showed numerical results favoring ABA (Table). A larger proportion of placebo subjects required escape immunosuppressive therapy vs. ABA (36% vs. 16%, p=0.03). Estimates are from a linear mixed model with treatment group, month (3, 6, and 12), treatment x month interaction, duration of dcSSc (≤18 vs >18 to ≤36 months), and baseline outcome measure as fixed effects and participant as a random effect (except for ACR CRISS). For ACR CRISS, treatment differences were assessed by the non-parametric Van Elteren test. Multiple imputation was used for ACR CRISS analysis. Conclusion In patients with early dcSSc, ABA was well tolerated, but ΔmRSS was not statistically significant. Secondary outcome measures showed evidence in favor of ABA, including greater requirement of escape therapy in the placebo group. mRSS showed large variability, despite recruiting an early dcSSc population. References [1] Khanna D, et al. Arthritis Rheumatol2016, 68:299-311 Acknowledgement Project was supported by NIH/NIAID Clinical ACE grant (5UM1AI110557-05) and an investigator-initiated grant by Bristol-Myers Squibb. Disclosure of Interests Dinesh Khanna Shareholder of: Eicos Sciences, Inc, Grant/research support from: Bayer, BMS, Pfizer, Horizon, Consultant for: Actelion Acceleron, Arena, Bayer, BI, BMS, CSL Behring, Corbus, Cytori, GSK, Genentech/Roche, Galapagos, Employee of: Elcos Sciences, Inc, Cathie Spino: None declared, Erica Bush: None declared, Sindhu Johnson: None declared, Lorinda Chung Grant/research support from: United Therapeutics, Consultant for: Reata, Bristol Meyers Squibb, Boehringer Ingelheim, Mitsubishi Tanabe, Eicos, Christopher Denton Grant/research support from: GlaxoSmithKline, Inventiva, CSF Behring, Consultant for: Roche-Genentech, Actelion, GlaxoSmithKline, Sanofi Aventis, Inventiva, CSL Behring, Boehringer Ingelheim, Bayer, Jerry Molitor Grant/research support from: Pfizer, Consultant for: Boehringer Ingelheim, Amgen, Viginia Steen Consultant for: CSL Behring, Corbus and Bayer, Paid instructor for: Advisory Board: CSL Behring, Roach, Bayer and Reata, Robert Lafyatis Grant/research support from: Kiniksa, Elpidera, Regeneron, PRISM biolab, Consultant for: Sanofi, Genentech, Formation, Biocon, Bristol Meyers Squibb, Merck, Robert Simms: None declared, Suzanne Kafaja: None declared, Tracy Frech: None declared, Vivian Hsu: None declared, Robin Domsic Consultant for: Eicos Sciences Inc/Civi Biopharma and Boehringer-Ingelheim., Janet Pope Consultant for: Eli Lilly and Company, Jessica Gordon Grant/research support from: Corbus Pharmaceuticals Cumberland Pharmaceuticals, Maureen Mayes Grant/research support from: Maureen Mayes is a clinical trial investigator for Boehringer-Ingelheim; Galapagos, Reata, Sanofi, Merck-Serono, Consultant for: Maureen Mayes is a member of scientific advisory boards for Galapagos NV (Pharma), Boehringer-Ingelheim, Mitsubishi-Tanabe, Astellas: Grant Review Board for Actelion., Speakers bureau: Maureen Mayes received personal fees for being a conference speaker on the use of autoantibodies in connective tissue diseases for Medtelligence, Elena Schiopu Grant/research support from: Bristol Meyers Squibb and Bayer, Amber Young: None declared, Nora Sandorfi: None declared, Jane Park: None declared, Faye Hant: None declared, Elana Bernstein Grant/research support from: I have an investigator-initiated research grant from the Pfizer ASPIRE Rheumatology Program., Consultant for: I am the medical monitor for SLS III, which is sponsored by Genentech, Soumya Chatterjee: None declared, Flavia Castelino Consultant for: Genentech, Boehringer, Ali Ajam Consultant for: Focus Point Global, Yannick Allanore Grant/research support from: Inventiva, F Hoffman La-Roche, Sanofi, BMS, Pfizer, Consultant for: Actelion, Bayer, BMS, Boehringer, Roche, Sanofi, Marco Matucci-Cerinic Grant/research support from: Actelion, MSD, Pfizer, BMS, Chemomab, Sanipedia, Speakers bureau: Actelion, BMS; MSD, Janssen, Oliver Distler Grant/research support from: Prof. Distler received research funding from Actelion, Bayer, Boehringer Ingelheim and Mitsubishi Tanabe to investigate potential treatments of scleroderma and its complications, Consultant for: Prof. Distler has/had consultancy relationship within the last 3 years with Actelion, AnaMar, Bayer, Boehringer Ingelheim, ChemomAb, espeRare foundation, Genentech/Roche, GSK, Inventiva, Italfarmaco, iQvia, Lilly, medac, MedImmune, Mitsubishi Tanabe Pharma, Pharmacyclics, Novartis, Pfizer, Sanofi, Serodapharm and UCB in the area of potential treatments of scleroderma and its complications. In addition, he had/has consultancy relationship within the last 3 years with A. Menarini, Amgen, Abbvie, GSK, Mepha, MSD, Pfizer and UCB in the field of arthritides and related disorders, Ora Gewurz-Singer: None declared, David Fox Grant/research support from: Regeneron, Gilead, Seattle Genetics, Consultant for: Grant reviewer for Pfizer, Daniel Furst Grant/research support from: F. Hoffmann-La Roche, Genentech
2 citations
TL;DR: A revised policy statement to address health care changes that impact procedural and visit coding and valuation as well as the incorporation of coding principles into innovative, newer payment models is provided.
Abstract: The American Academy of Pediatrics provides this technical report as supplemental background to the accompanying coding and valuation system policy statement. The rapid evolution in health care payment modeling requires that clinicians have a current appreciation of the mechanics of service representation and valuation. The accompanying policy statement provides recommendations relevant to this area, and this technical report provides a format to outline important concepts that allow for effective translation of bedside clinical events into physician payment.
2 citations
04 Oct 2019
TL;DR: A therapeutic note has been written in an attempt to call the attention of the neurosurgical community to the Ventriculosubgaleal shunt and to spark the interest of colleagues in this technique.
Abstract: A literature review following the heading “Ventriculosubgaleal shunt” for the last ten years, revealed that currently the Ventriculosubgaleal shunt (VSGS) is been mainly employed for the treatment of posthemorrhagic hydrocephalus of the premature6,8,13,16. While his use in that context has shown encouraging results, VSGS has significant advantages in the treatment of quite a few other conditions, for which it does not seem is currently been utilized. This therapeutic note has been written in an attempt to call the attention of the neurosurgical community to this situation and to spark the interest of our colleagues in this technique.
01 May 2019
09 Dec 2019
13 Sep 2019
TL;DR: Clinical results of this therapeutic regimen are presented and if compared with other series where chronic subdural hematomas were treated without the addition of glucocorticoids, it would appear that glucocortsicoids deserve a place in the management of chronicSubdural Hematoma.
Abstract: Fifty-three consecutive adult patients treated for chronic subdural hematoma with the addition of glucocorticoids in their managementare reviewed. The current understanding of the pathogenesis of chronic subdural hematoma and the mechanism by which glucocorticoids might improve its prognosis is discussed. Clinical results of this therapeutic regimen are presented and if compared with other series where chronic subdural hematomas were treated without the addition of glucocorticoids, it would appear that glucocorticoids deserve a place in the management of chronic subdural hematoma.
TL;DR: In this paper, the authors elaborated Stern's theory of the formation, growth, and development of the self to explain how the threat of dissolution of self can result instead in adaptive transformation.
Abstract: I have elaborated Stern’s theory of the formation, growth, and development of the self to explain how the threat of dissolution of self can result instead in adaptive transformation. His theory als...
TL;DR: A range of cell lines from different species are investigated for their susceptibility to infection by pseudotyped viruses (PV) bearing bat H17 and/or N10 envelope glycoproteins and the identification of HLA-DR as an H17N10 entry mediator will contribute to a better understanding of the tropism of the virus and will elucidate its zoonotic transmission.
Abstract: Bats are notorious reservoirs of diverse, potentially zoonotic viruses, exemplified by the evolutionarily distinct, influenza A-like viruses H17N10 and H18N11 (BatIVs). The surface glycoproteins [haemagglutinin (H) and neuraminidase (N)] of BatIVs neither bind nor cleave sialic acid receptors, which suggests that these viruses employ cell attachment and entry mechanisms that differ from those of classical influenza A viruses (IAVs). Identifying the cellular factors that mediate entry and determine susceptibility to infection will help assess the host range of BatIVs. Here, we investigated a range of cell lines from different species for their susceptibility to infection by pseudotyped viruses bearing bat H17 and/or N10 envelope proteins. We show that a number of human haematopoietic cancer cell lines and the canine kidney MDCK II (but not MDCK I) cells are susceptible to H17-pseudotypes (H17-PV). We observed with microarrays and qRT-PCR that the dog leukocyte antigen DLA-DRA mRNA is overexpressed in late passaged parental MDCK and commercial MDCK II cells, compared to early passaged parental MDCK and MDCK I cells, respectively. The human orthologue HLA-DRA encodes the alpha subunit of the MHC class II HLA-DR antigen-binding heterodimer. Small interfering RNA- or neutralizing antibody-targeting HLA-DRA, drastically reduced the susceptibility of Raji B cells to H17-PV. Conversely, overexpression of HLA-DRA and its paralogue HLA-DRB1 on the surface of the unsusceptible HEK293T/17 cells conferred susceptibility to H17-PV. The identification of HLA-DR as an H17N10 entry mediator will contribute to a better understanding of the tropism of the virus and will elucidate its zoonotic transmission.