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Fahey, Thomas J. "Department of Surgery, New York Presbyterian Hospital–Weill Cornell Medical Center." Archives of Surgery 141, no. 5 (May 1, 2006): 435. http://dx.doi.org/10.1001/archsurg.141.5.435.
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Moneke, Ngozi, Wynklett Parsons, Mary Moran, and Annette Davidek. "Promoting CCRN Certification at New York Presbyterian Hospital–Weill Cornell Medical Center." Critical Care Nurse 34, no. 2 (April 1, 2014): 77–79. http://dx.doi.org/10.4037/ccn2014718.
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New, M. I. "Profile of the Pediatric Endocrine Clinic at New York-Presbyterian Hospital, New York Weill Cornell Center." Journal of Clinical Endocrinology & Metabolism 84, no. 12 (December 1, 1999): 4444–49. http://dx.doi.org/10.1210/jc.84.12.4444.
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Hottensen, Dory. "Bereavement: Caring for Families and Friends after a Patient Dies." OMEGA - Journal of Death and Dying 67, no. 1-2 (August 2013): 121–26. http://dx.doi.org/10.2190/om.67.1-2.n.
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New York-Presbyterian Hospital/Weill Cornell Medical Center is a large academic medical center that provided minimal, if any, bereavement support to families and loved ones of patients who died in the hospital. A comprehensive bereavement program was developed and implemented which included sending condolence cards to family members and friends, follow-up phone calls to screen for complicated grief, individual counseling, bereavement support groups, community referrals, and an annual memorial service for families and staff to provide an opportunity for shared mourning during the grieving process.
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Seley, Jane Jeffrie, and Katie Weinger. "The State of the Science on Nursing Best Practices for Diabetes Self-Management." Diabetes Educator 33, no. 4 (July 2007): 616–26. http://dx.doi.org/10.1177/0145721707305121.
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Jane Jeffrie Seley is a diabetes nurse practitioner at New York Presbyterian—Weill Cornell Medical Center, New York City. She is a contributing editor and the column coordinator for Diabetes Under Control in the American Journal of Nursing. Katie Weinger is an investigator in behavioral and mental health research, director of the Center of Innovation in Diabetes Education and of the Office of Research Fellow Affairs at Joslin Diabetes Center, and an assistant professor of psychiatry at Harvard Medical School, all in Boston. She has received a grant from the National Institutes of Health (NIDDK60115) to study breaking down barriers to diabetes self-care. Contact author: Jane Jeffrie Seley, diabetesnp@gmail.com. Seley serves on the advisory boards of Abbott Diabetes Care, Amylin Pharmaceuticals, Sanofi-Aventis Pharmaceuticals, Pfizer Pharmaceuticals, Roche Diagnostics, Bayer Diabetes Care, Novo Nordisk Pharmaceuticals, and GlaxoSmithKline Pharmaceuticals, several of which provided funding for the project discussed in this article. The authors have no other significant ties, financial or otherwise, to any company that might have an interest in the publication of this educational activity.
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Pilato, Tara C., Faten Taki, Kaitlyn Sbrollini, Amanda Purington Drake, Brian Maley, Stephen Yale-Loehr, Jane L. Powers, Natalya N. Bazarova, Aparajita Bhandari, and Gunisha Kaur. "Knowledge of legal rights as a factor of refugee and asylum seekers’ health status: a qualitative study." BMJ Open 13, no. 2 (February 2023): e063291. http://dx.doi.org/10.1136/bmjopen-2022-063291.
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ObjectivesTo examine health behaviours of refugees and asylum seekers, in relation to their knowledge of public benefits and legal rights.DesignQualitative study, utilising an open-ended, semi-structured interview guide to ensure information-rich data collection. Thematic content was analysed using qualitative research software.SettingParticipants were drawn from the Weill Cornell Center for Human Rights (WCCHR) in New York City, a single-center, human rights clinic with a globally representative patient population. All interviews were conducted at the Weill Cornell Medicine Clinical and Translational Science Center, a multidisciplinary space within an urban academic medical center.ParticipantsTwenty-four refugees and asylum seekers currently living in the greater New York City area. Eligible participants were 18 years of age or older and had previously sought services from the WCCHR. The recruitment rate was 55%.Primary and secondary outcome measuresThemes and concepts in participants’ health, knowledge, perceptions of and experiences with accessing healthcare and public benefits programmes.ResultsTwenty-four participants represented 18 countries of origin and 11 primary languages. Several impediments to accessing healthcare and public benefits were identified, including pragmatic barriers (such as prohibitive costs or lack of insurance), knowledge gaps and mistrust of healthcare systems.ConclusionsThere is low health engagement by refugees and asylum seekers, as a result of multiple, complex factors impeding the ability of refugee and asylum seekers to access healthcare and other public benefits for which they are eligible—with resultant detrimental health effects. However, there is an opportunity to utilise novel approaches, such as digital technologies, to communicate relevant information regarding legal rights and public benefits to advance the health of vulnerable individuals such as refugees and asylum seekers.
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Rogers, Wesley, Laura Kirkman, Matthew Simon, and Lars Westblade. "932. Clinical Characteristics of Persistent and Relapsing Babesiosis at an Academic Medical Center in New York City, 2015-2020." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S558—S559. http://dx.doi.org/10.1093/ofid/ofab466.1127.
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Abstract Background Current guidelines recommend at least 6 weeks of therapy for immunocompromised babesiosis patients; however, limited data exists to guide management in this population. We describe our institutional experience with immunocompromised babesiosis patients. Methods We reviewed all adult patients reported to the New York City Department of Health and Mental Hygiene with a diagnosis of babesiosis at New York-Presbyterian (NYP)/Weill Cornell Medical Center and NYP/Lower Manhattan Hospital between 2015 and 2020. We compared characteristics and outcomes between patients receiving prolonged treatment (≥ 6 weeks; “cases”) and standard treatment (7-10 days; “controls”). Variables were compared using Fishers exact test or Wilcoxon Rank Sum test. Results Among 35 patients diagnosed with babesiosis, 10 (29%) received at least 6 weeks of therapy. 5/10 (50%) received extended treatment due to persistent and/or relapsing parasitemia, evidence of hemolysis and/or clinical symptoms at 6 weeks from diagnosis (Table 1). The median age was 67 years and immunocompromising conditions included: anti-CD 20 therapy (40%), history of stem cell transplant (20%), anti-TNF alpha (10%), beta-thalassemia (10%), Waldenstrom’s macroglobulinemia (10%). Among case patients, the median treatment duration was 53 days (IQR 42-153) and 100% of patients received azithromycin/atovaquone based regimens with adjunctive agents including doxycycline (60%), clindamycin (20%) and proguanil (20%). Compared to control patients, case patients had higher frequency of blood transfusions (50% vs 12%; p=0.03), however, there was no difference in median peak parasitemia (1.13% vs 0.6%), rates of hospital admission (80% vs 88%), length of stay (6 vs 4 days), organ dysfunction (10% vs 4%) and mortality (0% vs 0%) (Table 2). Conclusion We found a high frequency (29%) of babesiosis patients at our medical center received at least a 6-week treatment course due to immunocompromising conditions. Although immunocompromised patients received longer treatment courses and had more severe anemia, in contrast to prior studies, we found other complications such as hospitalization rates, length of stay, organ dysfunction and mortality were comparable between both patient groups. Disclosures Lars Westblade, PhD, Accelerate Diagnostics Inc (Grant/Research Support)BioFire Diagnostics (Grant/Research Support)Hardy Diagnostics (Grant/Research Support)Roche (Consultant, Advisor or Review Panel member)Shionogi Inc (Advisor or Review Panel member)Talis Biomedical (Advisor or Review Panel member)
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Bales, Michael E., Jifeng Zhu, Farid Aboharb, Neville Dusaj, Lior Shtayer, Venkatesh Balaji, Allegra Keeler, et al. "56326 Heart to Heart: An Interdisciplinary Community Collaboration to Address Health Disparities Through Cardiovascular Disease Risk Assessments in Underserved Urban Neighborhoods." Journal of Clinical and Translational Science 5, s1 (March 2021): 135. http://dx.doi.org/10.1017/cts.2021.745.
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ABSTRACT IMPACT: Leveraging partnerships with faith-based institutions and community centers in at-risk NYC neighborhoods, the H2H Program breaks down barriers to engaging with the medical establishment and addresses the increasing burden of diabetes and CVD risk factors in the most vulnerable individuals. OBJECTIVES/GOALS: Screening for modifiable risk factors is critical for cardiovascular disease (CVD) risk reduction. Low-income, urban communities often encounter barriers to care. Community-academic outreach partnerships are vital in addressing such disparities and promoting health equity and culturally targeted interventions among high-risk populations. METHODS/STUDY POPULATION: In 2010, the Weill Cornell Clinical and Translational Science Center along with Weill Cornell Medicine (WCM) and Hunter-Bellevue School of Nursing (HBSON) launched Heart to Heart (H2H), a community outreach program partnering with faith-based centers to offer free health screenings and education to some of New York City’s (NYC) most vulnerable communities. Participants work with undergraduate, nursing, medical and dietician students to complete a demographics and health questionnaire followed by vital signs and point-of-care blood testing. Participants then receive personalized health education, nutrition and lifestyle counseling by student volunteers, precepted by WCM Primary Care and HBSON faculty. Participants are provided information on local free or low-cost clinics as necessary for follow-up. RESULTS/ANTICIPATED RESULTS: To date H2H held 125 events and 5,952 screenings. Mean age of the participants was 54.3 (SD 39.6) and 3,682 (63.1%) were female. 74.2% identified as non-white. 42.1% were uninsured. 32.3% reported annual income of less than $20k. 18.3% of participants reported not having seen a doctor in the past year. 40.7% reported preexisting hypertension, of which 74.5% were on medication and 78% with sub-optimal control. 15.7% had been previously diagnosed with diabetes, of which 75.8% were on medication and 41.4% with sub-optimal control (HbA1c <7). 37.7% had been diagnosed with dyslipidemia previously, of which 47.4% were on medication and 62.1% with sub-optimal control. Screenings revealed, 56.9% had undiagnosed hypertensive blood pressures, 4.7% had an elevated HbA1c >6.5, and 49.2% had dyslipidemia. DISCUSSION/SIGNIFICANCE OF FINDINGS: H2H screening revealed significant cardiovascular health disparities, many of which were poorly controlled or newly discovered. Cross-institutional academic partnerships can empower communities with knowledge of their health status and help facilitate access to medical care to further address health risk factors.
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Romero, Alicia Del Carmen Becerra, Jagath lal Gangadharan, Evan D. Bander, Yves Pierre Gobin, Vijay K. Anand, and Theodore H. Schwartz. "Managing Arterial Injury in Endoscopic Skull Base Surgery: Case Series and Review of the Literature." Operative Neurosurgery 13, no. 1 (December 14, 2016): 138–49. http://dx.doi.org/10.1227/neu.0000000000001180.
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Abstract BACKGROUND: The most feared complications following endoscopic endonasal skull base surgery are arterial vascular injuries. Previously published literature is restricted to internal carotid artery injuries. The ideal method for controlling arterial bleeding during this kind of procedure is debated, and a variety of techniques have been advocated. OBJECTIVE: To evaluate the management and outcome following intraoperative arterial injury during endoscopic endonasal skull base surgery. METHODS: We performed a retrospective review of a prospectively acquired database of consecutive endonasal endoscopic surgeries at the New York-Presbyterian Hospital/Weill Cornell Medical Center from December 2003 to June 2015 and identified all cases of arterial injury. RESULTS: Of 800 cases, there were 4 arterial injuries (0.5%), of which only one involved the internal carotid artery (ICA), for a risk of 0.125%. The other 3 involved the ophthalmic artery, anterior communicating artery, and A1 segment of the anterior cerebral artery. In all cases, definitive treatment involved occlusion of the artery either through endovascular means (3 cases) or direct surgical ligation (1 case). Neurological examinations were unchanged after arterial repair with only 1 small asymptomatic stroke. Literature review identified 7336 patients, of which there were 25 arterial injuries, of which 19 were of the ICA. Hence, the total rate of arterial injury was 0.34% and the rate of ICA injury was 0.26%. Arterial sacrifice was the only reliable method for managing arterial injury. CONCLUSION: Arterial injury is an uncommon event after endoscopic endonasal surgery. Attempts at arterial repair are rarely successful, and vessel sacrifice is the most reliable technique at this point.
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Balogun, O., N. Karamyan, S. Formenti, H. Brereton, and M. Botteghi. "Development and Implementation of a Telemedicine Platform for Radiation Oncology Training and Peer Review." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 91s. http://dx.doi.org/10.1200/jgo.18.61900.
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Background: Telemedicine has been posited as a potential means of bolstering radiation therapy delivery in developing nations. World Aid Exchange (WaidX) is an innovative intercontinental telemedicine platform oriented to oncology specialties. This platform, devoted to reducing the digital divide on health practice, provides telecommunication services between health care facilities in developed and developing countries. It conveys the ability to safely share radiologic images and patient medical records for diagnostic and care purposes. It was successfully piloted in Mwanza, Tanzania in 2015. Since then, it has been implemented in varied settings such as Ethiopia, Djibouti and Brazil. After conducting a site visit and a focused needs assessment, we recognized the need for teleconferencing with the Radiation Department of National Center of Oncology, Yerevan, Armenia, to share expertises in general patient management and contouring and planning for radiotherapy. Aim: To develop a TeleRadiotherapy platform that enables: 1: Conference calling for tumor boards to review radiotherapy plans, discuss disease management and conduct remote quality control 2: Real-time sharing of diagnostic images to guide clinical decision making 3: E-contouring activity performed by parties in Yerevan and New York on radiographic images, with minimization of time lag in contouring 4: Generation of a database for clinical data (i.e., radiation dose, toxicity, disease stage) that serves as a departmental registry and a tool for future research use 5: Access to lectures delivered by physicians, nurses, therapists and physicists both in Yerevan and New York on varied aspects of radiotherapy Methods: The initiative was funded through a competitive grant established within the Department of Radiation Oncology at Cornell. The TeleRadiotherapy system is comprised of 2 physical units, equipped to support networking and telephony integration. An application was used to establish a simplified direct connection between mobile phones in New York and fixed phone extensions in Yerevan. A customized version of Veyon was used for remote connection to a contouring station. Zoom was used to establish the teleconference. Remote operators in Weill Cornell Medicine were trained for using the system. Results: The first teleradiotherapy interaction between Yerevan and New York occurred on February 7th, 2018. Demonstration of contouring on the Oncentra treatment planning system in Yerevan revealed ease of use. The brush tool displayed less drag time than the point-by-point contouring tools. Diagnostic images were easily shared without compromise of the image resolution. Conference call quality was high. This conference has opened a series of biweekly chart rounds, between the two institutions. Conclusion: Teleradiotherapy is feasible with excellent voice quality, image sharing capability and real-time contouring. The database is under construction. We are developing a new model for learning, training and collaboration in radiotherapy using WaidX, to enable rapid knowledge and technology transfer for a more equitable access to high-quality cancer care worldwide.
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Fasano, Genevieve A., Solange Bayard, Yalei Chen, Jennifer Marti, Rache Simmons, Alexander Swistel, Jessica Bensenhaver, et al. "Abstract P3-20-08: Does contralateral prophylactic mastectomy improve survival in triple negative breast cancer?" Cancer Research 82, no. 4_Supplement (February 15, 2022): P3–20–08—P3–20–08. http://dx.doi.org/10.1158/1538-7445.sabcs21-p3-20-08.
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Abstract Background: Despite increased incidence of contralateral prophylactic mastectomy (CPM), there is insufficient evidence that it improves survival in women at average risk for breast cancer. In addition to BRCA1/2 mutation carriers, patients with estrogen-receptor negative tumors have been examined as a subgroup that may seek to benefit from CPM. In this study, we sought to investigate whether CPM improves survival in patients with triple negative breast cancer (TNBC).Study Design: Survival outcomes were evaluated for all TNBC patients from a multi-institutional database from 1999-2018 at New York Presbyterian - Weill Cornell Medical Center and Henry Ford Health System. Median follow-up time was 44.4 months.Results: 802 TNBC patients were evaluated. The median age was 57 years. 17% patients underwent CPM. Factors associated with CPM were White American race, younger age, presence of lymphovascular invasion (LVI), lack of mammography screen-detection, mastectomy surgery, postoperative adjuvant radiotherapy, and having had genetic testing. A borderline significant trend was observed in improved overall survival among patients undergoing CPM versus those not having CPM (5-year OS 95.1% vs. 85.0%; p = 0.05). Subset analysis of patients younger than 50 years of age at diagnosis demonstrated no improvement in overall survival for patients undergoing CPM versus those that declined CPM (94.3% v. 88.7%; p = 0.21). Conclusion: Our data demonstrate a trend in improved 5-year overall survival in TNBC patients undergoing CPM. However, in patients younger than 50 years at diagnosis, CPM did not confer a survival advantage. Citation Format: Genevieve A Fasano, Solange Bayard, Yalei Chen, Jennifer Marti, Rache Simmons, Alexander Swistel, Jessica Bensenhaver, S David Nathanson, Lindsay Petersen, Erica Proctor, Melissa Davis, Lisa Newman. Does contralateral prophylactic mastectomy improve survival in triple negative breast cancer? [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-20-08.
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Dayton, Jeffrey D., Alan M. Groves, Julie S. Glickstein, and Patrick A. Flynn. "Effectiveness of echocardiography simulation training for paediatric cardiology fellows in CHD." Cardiology in the Young 28, no. 4 (January 8, 2018): 611–15. http://dx.doi.org/10.1017/s104795111700275x.
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AbstractSimulation is used in many aspects of medical training but less so for echocardiography instruction in paediatric cardiology. We report our experience with the introduction of simulator-based echocardiography training at Weill Cornell Medicine for paediatric cardiology fellows of the New York–Presbyterian Hospital of Columbia University and Weill Cornell Medicine. Knowledge of CHD and echocardiographic performance improved following simulation-based training. Simulator training in echocardiography can be an effective addition to standard training for paediatric cardiology trainees.
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&NA;. "The New York Hospital-Cornell Medical Center." American Journal of Nursing 96 (January 1996): 62. http://dx.doi.org/10.1097/00000446-199601001-00042.
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Scaradavou, Andromachi, Bonnie Woo, B. M. R. Woloski, Susanna Cunningham-Rundles, Lawrence J. Ettinger, Louis M. Aledort, and James B. Bussel. "Intravenous Anti-D Treatment of Immune Thrombocytopenic Purpura: Experience in 272 Patients." Blood 89, no. 8 (April 15, 1997): 2689–700. http://dx.doi.org/10.1182/blood.v89.8.2689.
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Abstract We report the results of intravenous anti-D (WinRho, WinRho SD) therapy in 261 non-splenectomized patients treated at the New York Hospital-Cornell Medical Center over the period from 1987 to 1994. Children (n = 124) and adult patients (n = 137) with classic immune thrombocytopenic purpura (ITP; n = 156) or human immunodeficiency virus (HIV) related thrombocytopenia (n = 105) and acute (n = 75) or chronic (n = 186) disease at the time of the initial anti-D treatment were studied. In addition, 11 previously splenectomized patients were treated as a separate group. Our objectives were to evaluate the following. (1) Efficacy of anti-D: The response after the initial infusion was analyzed according to clinical parameters, such as patient's age, HIV status, gender, disease duration, pretreatment platelet count, and hemoglobin value, as well as treatment-related factors, including the dose of anti-D, the solvent detergent treatment of the preparation, and the type of administration. (2) Use of anti-D as maintenance therapy: The duration of response after the initial infusion and the results of subsequent treatments were evaluated. (3) Safety/toxicity of anti-D: Postinfusion reactions and hemoglobin decrease after treatment were studied. Anti-D is a safe treatment providing a hemostatic platelet increase in greater than 70% of the Rh+ non-splenectomized patients. The group with the best results is HIV− children, but all patient groups respond and the effect lasts more than 21 days in 50% of the responders. Duration of response is not influenced by HIV status; furthermore, HIV+ patients show no adverse effects on hemoglobin decrease or HIV disease progression. Patients with chronic ITP after splenectomy have minimal or no response to intravenous anti-D.
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Evans, J. A. "Radiology: the New York Hospital-Cornell Medical Center." American Journal of Roentgenology 163, no. 4 (October 1994): 983–86. http://dx.doi.org/10.2214/ajr.163.4.8092047.
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Kaplan, S. M. "Re: Radiology: the New York Hospital-Cornell Medical Center." American Journal of Roentgenology 165, no. 1 (July 1995): 227–28. http://dx.doi.org/10.2214/ajr.165.1.7503858.
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Pianko, Matthew J., Timothy Tiutan, Jessica Flynn, Sean M. Devlin, Insara Jaffer-Sathick, Adriana C. Rossi, Steven P. Salvatore, et al. "Treatment Outcomes in Monoclonal Immunoglobulin Deposition Disease (MIDD): A Two Center Experience." Blood 132, Supplement 1 (November 29, 2018): 5591. http://dx.doi.org/10.1182/blood-2018-99-112110.
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Abstract Background: Monoclonal immunoglobulin deposition disease (MIDD) is a rare complication of plasma cell dyscrasias in which deposition of immunoglobulin light and/or heavy chains results in organ dysfunction, most commonly affecting the kidneys. MIDD can present with new onset hypertension, hematuria, renal insufficiency and proteinuria. The rarity of MIDD contributes to the uncertainty regarding optimal therapy (typically targeting the clonal plasma cells), and the relationship between hematologic response and renal outcome. We report here the experience at Memorial Sloan Kettering Cancer Center and New York Presbyterian Hospital/Weill Cornell Medical Center. Methods: An electronic query of pathology records was performed to identify patients with a biopsy-proven diagnosis of MIDD. Patients were eligible for inclusion in this analysis if they had received treatment and had been subsequently followed at either institution. A retrospective review of clinical records extracted patients' baseline characteristics and treatment history. Hematologic responses were assessed according to International Myeloma Working Group uniform response criteria (Kumar, S. et al 2016 Lancet Oncol 17(8): e328-346) and renal organ responses were evaluated based on changes in serum creatinine (SCr), and proteinuria, a modification of criteria previously reported (Kourelis, T. V., et al 2016, Am J Hematol 91(11): 1123-1128.; Nasr, S.H. et al. 2009, J Am Soc Nephrol 20(9): 2055-2064. The primary objective was to determine the rate of hematologic response after initial therapy. Secondary objectives included: (i) Estimation of renal response rate; (ii) Identification of risk factors associated with renal response using the Wilcoxon Rank Sum and Fisher's Exact Tests. Results: Among 54 patients identified who were diagnosed and started treatment between 1/1999 and 1/2016, 29 met criteria for inclusion. Baseline characteristics at diagnosis included: Median age of 50 (range, 32-79); 17 (59%) were male; 22 (75%) had hypertension. Renal parameters at diagnosis: median SCr of 2.4 mg/dl (range, 0.4-19), median CrCl 23 ml/min (range, 4-131), median proteinuria 2383.7mg/24h (range 4.7-13,000), nephrotic-range proteinuria syndrome in 13 (45%), hematuria in 4/25 pts (16%; 4 unknown), 7 were on hemodialysis (HD) prior to initiation of therapy, and 26 (90%) patients had monoclonal kappa light chain deposits. Hematologic parameters included median free light chain ratio of 67.9 (2.8-1179.0), detectable M-spike in 11 pts with a mean level of 0.6 g/dL and median bone marrow plasmacytosis of 20% (range, 0-90%). Induction treatment regimens included bortezomib in 18 (62%), lenalidomide in 6 (21%), cyclophosphamide in 8 (28%), and 21 (73%) underwent autologous stem cell transplant (ASCT) during the course of their treatment. Outcomes are shown in Table 1. Hematologic response among the 29 pts at completion of first line therapy included an overall response rate (ORR) of 93% with sCR (N=14, 48%); CR (N=5, 17%), VGPR (N=6, 20%), PR (N=2, 6.9%), Not available (N=2, 7%). Renal response (Table 1) among 29 patients included CR (N=9, 31%), PR (N=14, 48%) and End Stage Renal Disease (ESRD) (N=6, 21%). Among 7 patients on HD at baseline, 3 remained on HD despite treatment, while 4 stopped HD after treatment, 2 as a result of the treatment and 2 after renal transplant. 3 patients progressed to ESRD and required HD during treatment. Baseline beta-2 microglobulin (B2M), SCr, and eGFR at diagnosis were factors associated with renal response (p<0.05). Hematologic response (CR vs. non-CR) was not associated with renal response (p=0.68) in this cohort. Conclusions: In this cohort, we observed a high rate of hematologic response (65.5% reaching CR) to upfront treatment regimens. A majority of patients received bortezomib-based regimens and ASCT. We observed a large proportion of patients whose renal impairment from MIDD improved significantly after receiving therapy directed at the underlying clonal neoplasm, with 75.8% reaching PR or better, nearly a third of patients achieving a renal CR, and 2/7 patients on HD at diagnosis discontinuing HD after treatment. Our experience presented here serves to inform the treatment approach of patients with MIDD. Given the scarcity of outcome data in MIDD, especially in the era of novel anti-myeloma therapy, prospective studies to optimize the management of these patients are needed. Disclosures Rossi: Celgene: Consultancy. Smith:Celgene: Consultancy, Patents & Royalties: CAR T cell therapies for MM, Research Funding. Korde:Amgen: Research Funding. Mailankody:Janssen: Research Funding; Juno: Research Funding; Physician Education Resource: Honoraria; Takeda: Research Funding. Lesokhin:Squibb: Consultancy, Honoraria; Bristol-Myers Squibb: Consultancy, Honoraria, Research Funding; Takeda: Consultancy, Honoraria; Genentech: Research Funding; Janssen: Research Funding; Serametrix, inc.: Patents & Royalties: Royalties. Landgren:Janssen: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Karyopharm: Consultancy; Merck: Membership on an entity's Board of Directors or advisory committees; Pfizer: Consultancy; Celgene: Consultancy, Research Funding; Amgen: Consultancy, Research Funding; Takeda: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding. Hassoun:Oncopeptides AB: Research Funding.
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Yamazaki, Takahiro, Erik Wennerberg, Michal Hensler, Aitziber Buqué Martinez, Jeffrey Kraynak, Jitka Fucikova, Xi Zhou, et al. "560 Immunotherapeutic and antimetastatic activity of LTX-315 in preclinical models of ICI-resistant breast cancer." Journal for ImmunoTherapy of Cancer 9, Suppl 2 (November 2021): A589. http://dx.doi.org/10.1136/jitc-2021-sitc2021.560.
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BackgroundOncolytic peptides are attractive tools for the development of novel anticancer regimens [1]. LTX-315 is a synthetic peptide with a marked capacity to elicit tumor-targeting immunity in preclinical cancer models [2]. Indeed, LTX-315 has been shown to elicit immunogenic cell death (ICD) in malignant cells [3, 4] and to deplete immunosuppressive cells such as CD4+CD25+FOXP3+ TREG cells and myeloid-derived suppressor cells (MDSCs) from the tumor microenvironment (TME) [5]. Accordingly, LTX-315 synergized with immunogenic chemotherapeutics or immune checkpoint inhibitors (ICIs) in preclinical tumor models [5, 6]. Moreover, recent findings from a Phase I clinical trial in patients with advanced solid tumors (NCT01986426) indicate that intratumoral LTX-315 is safe, clinically active, and elicits alterations in the TME that support the initiation of anticancer immunity [7, 8]. However, the dependency of LTX-315 therapeutic effects on the immune system in preclinical models of breast cancer has not been mechanistically investigated.MethodsWe harnessed three distinct mouse models of ICI-resistant breast cancer, namely hormone receptor (HR)-positive TS/A established and triple-negative breast cancer (TNBC) 4T1 cells established in immunocompetent syngeneic BALB/c mice, as well as medroxyprogesterone acetate (MPA, M)-initiated, 7,12-dimethylbenz[a]anthracene (DMBA, D)-driven mammary carcinomas evolving in C57BL/6 mice to assess the immunotherapeutic effects of LTX-315 optionally combined with radiation therapy (RT), based on the primary tumor growth, metastatic dissemination and overall survival (depending on model). Multilesion models, rechallenge assays, antibody-mediated depletion experiments as well as experiments in Rag1-/- mice were employed to elucidate the mechanistic involvement of the immune system.ResultsIn the multilesion TS/A models, intratumoral LTX-315 to one lesion combined with hypofractionated RT to another lesion resulted in superior systemic disease control as manifested by eradication of a 3rd untreated lesion in up to 50% of mice, which were protected from a subsequent rechallenge with living TS/A cells. In the single lesion 4T1 model, LTX-315 mediated enable robust local and metastatic disease control, which could be enhanced (only locally) with RT and dependent on natural killer (NK) cells, but less so on T lymphocytes (as determined with anti-asialo GM1 antibodies and Rag1-/- hosts). In the M/D-driven model, LTX-315 considerably controlled the growth of primary tumors and delayed relapse, an effect that depended on NK cells (as demonstrated with anti-NK1.1 antibodies).ConclusionsLTX-315, alone and combined with RT, mediates robust immunotherapeutic effects in multiple models of ICI-resistant breast cancer. Intriguingly, NK cells appear to be required for such effects, potentially linked to the emergence of immunological memory.AcknowledgementsWe are indebted to Dr. Fred Miller (Karmanos Cancer Center, Detroit, MI) for the kind gift of 4T1 cells, as well as to Dr. Karsten A. Pilones (Weill Cornell Medicine, New York, NY) and Maria E. Rodriguez-Ruiz (University of Navarra, Pamplona, Spain) for help with clonogenic assays. This work has been sponsored by a research grant by Lytix Biopharma (Oslo, Norway) to S.D. and L.G.ReferencesKepp, O. et al. (2020) Oncolysis without viruses - inducing systemic anticancer immune responses with local therapies. Nat Rev Clin Oncol 17 (1), 49–64.Vitale, I. et al. (2021) Targeting Cancer Heterogeneity with Immune Responses Driven by Oncolytic Peptides. Trends Cancer 7 (6), 557–572.Eike, L.M. et al. (2015) The oncolytic peptide LTX-315 induces cell death and DAMP release by mitochondria distortion in human melanoma cells. Oncotarget 6 (33), 34910–23.Zhou, H. et al. (2016) The oncolytic peptide LTX-315 triggers immunogenic cell death. Cell Death Dis 7 (3), e2134.Yamazaki, T. et al. (2016) The oncolytic peptide LTX-315 overcomes resistance of cancers to immunotherapy with CTLA4 checkpoint blockade. Cell Death Differ 23 (6), 1004–15.Camilio, K.A. et al. (2019) Combining the oncolytic peptide LTX-315 with doxorubicin demonstrates therapeutic potential in a triple-negative breast cancer model. Breast Cancer Res 21 (1), 9.Jebsen, N.L. et al. (2019) Enhanced T-lymphocyte infiltration in a desmoid tumor of the thoracic wall in a young woman treated with intratumoral injections of the oncolytic peptide LTX-315: a case report. J Med Case Rep 13 (1), 177.Spicer, J. et al. (2021) Safety, Antitumor Activity, and T-cell Responses in a Dose-Ranging Phase I Trial of the Oncolytic Peptide LTX-315 in Patients with Solid Tumors. Clin Cancer Res 27 (10), 2755–2763.Ethics ApprovalThis study was approved by Weill Cornell Medical College’s Ethics Board; approval number 2015-0028, 2018-0002.
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Pandey, Saumya, and Chandravati Chandravati. "Robotic Prostatectomy in Urological Surgery: An Observership at Weill Medical College of Cornell University, New York." Asian Pacific Journal of Cancer Prevention 14, no. 8 (August 30, 2013): 4945. http://dx.doi.org/10.7314/apjcp.2013.14.8.4945.
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Harden, Cynthia L. "Introducing New Guidelines on Sudden Unexpected Death in Epilepsy." US Endocrinology 13, no. 02 (2017): 65. http://dx.doi.org/10.17925/use.2017.13.02.65.
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Cynthia L Harden, MD, received her medical degree at the University of Wisconsin. She trained in internal medicine at Mount Sinai St Luke’s Hospital and neurology at Mount Sinai Hospital, both in New York City, and in clinical neurophysiology at Albert Einstein College of Medicine in the Bronx. She served most of her career at Weill Cornell College of Medicine, where she became Professor of Neurology. Dr Harden serves as Chair of the Guideline Development, Dissemination and Implementation Subcommittee of the American Academy of Neurology (AAN). In 2016, she was also elected Chair of AAN’s Epilepsy Section for a 2-year term.
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Harden, Cynthia L. "Introducing New Guidelines on Sudden Unexpected Death in Epilepsy." US Neurology 13, no. 02 (2017): 65. http://dx.doi.org/10.17925/usn.2017.13.02.65.
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Cynthia L Harden, MD, received her medical degree at the University of Wisconsin. She trained in internal medicine at Mount Sinai St Luke’s Hospital and neurology at Mount Sinai Hospital, both in New York City, and in clinical neurophysiology at Albert Einstein College of Medicine in the Bronx. She served most of her career at Weill Cornell College of Medicine, where she became Professor of Neurology. Dr Harden serves as Chair of the Guideline Development, Dissemination and Implementation Subcommittee of the American Academy of Neurology (AAN). In 2016, she was also elected Chair of AAN’s Epilepsy Section for a 2-year term.
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Afdhal, Nezam H., Douglas T. Dieterich, Paul J. Pockros, Eugene R. Schiff, Mitchell L. Shiffman, Mark S. Sulkowski, Teresa Wright, et al. "Epoetin alfa maintains ribavirin dose in HCV-infected patients: a prospective, double-blind, randomized controlled study1 1The other PROACTIVE Study Group investigators included the following: Vijayan Balan, M.D., Mayo Clinic Scottsdale, Scottsdale, Arizona; Norbert Bräu, M.D., Bronx VA Medical Center, Bronx, New York; Robert Brown, M.D., M.P.H., NY Presbyterian Medical Center, New York, New York; William Carey, M.D., Cleveland Clinic Foundation, Cleveland, Ohio; Andrea Duchini, M.D., Baylor College of Medicine, Houston, Texas; Greg Everson, M.D., University of Colorado Health Sciences Center, Denver, Colorado; Michael Fried, M.D., University of North Carolina, Chapel Hill, North Carolina; Robert Gish, M.D., California Pacific Medical Center, San Francisco, California; Ira Jacobson, M.D., Weill Medical College of Cornell University, New York, New York; John W. King, LSU Health Sciences Center, Shreveport, LA; Raymond Koff, M.D., University of Massachusetts Memorial Health Care, Worcester, Massachusetts; William Lee, M.D., University of Texas Southwestern Medical Center, Dallas, Texas; Mark A. Levstik, M.D., The University of Tennessee, Memphis, Tennessee; John G. McHutchison, M.D., Scripps Clinic, La Jolla, California; Marion Peters, M.D., University of California San Francisco, San Francisco, California; Kenneth Sherman, M.D., Ph.D., University of Cincinnati College of Medicine, Cincinnati, Ohio; Coleman Smith, M.D., Minnesota Clinical Research Center, St. Paul, MN; Ronald Wasserman, M.D., Hepatitis Resource Center, Walnut Creek, California." Gastroenterology 126, no. 5 (May 2004): 1302–11. http://dx.doi.org/10.1053/j.gastro.2004.01.027.
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Silvert, Mark. "The famous case of Alice Cooper – psychiatry in pictures." British Journal of Psychiatry 207, no. 4 (October 2015): 285. http://dx.doi.org/10.1192/bjp.bp.112.116376.
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Alice Cooper, the infamous theatrical rock star, real name Vincent Furnier, was suffering with depression and life-threatening alcohol addiction at the height of his success, when he was drinking well over a bottle of whiskey a day. This comic depicting Alice being committed to hospital was published in 1979 by Marvel Comics to coincide with Alice's album ‘From the Inside’. It was co-written with Elton John's well-known lyricist Bernie Taupin. It describes when Alice Cooper voluntarily incarcerated himself into Cornell Medical Centre in White Plains, New York.
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Bascon, Ivan, Paul J. Christos, and Maria Teresa De Sancho. "Risk Factors, Clinical Manifestations, Treatment Duration and Outcomes in Carriers of Severe Inherited Thrombophilias." Blood 134, Supplement_1 (November 13, 2019): 3657. http://dx.doi.org/10.1182/blood-2019-132248.
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Background Severe Inherited thrombophilia comprisses deficiencies of natural anticoagulants (antithrombin (AT), protein C (PC), and protein S (PS), and homozygosity for factor V Leiden (FVL) or prothrombin gene mutation (PGM) or double heterozygosity or other combined thrombophilia. Carriers of AT, PC and PS have a high risk of thrombosis starting at a young age, usually several members of the same family are affected and thrombosis may occur at unusual locations. Conversely homozygotes for either FVL, PGM or double heterozygotes may not have a family history of thrombosis and the first thrombotic event may present later on life. It is also unclear what is the duration and type of anticoagulation and long-term outcomes of these carriers. The purpose of this study was to compare risk factors, clinical manifestations, type and duration of anticoagulation and clinical outcomes between carriers of anticoagulant deficiencies and those with gain of function mutations (homozygosity or double heterozygosity for FVL and PGM). Methods Retrospective evaluation of electronic medical records of patients with severe inherited thrombophilia referred to the Center for Blood Disorders at Weill Cornell Medicine-New York Presbyterian Hospital between January 2009 and June 2019. Severe deficiencies of AT, PC and PS were defined and (AT ≤ 60%, PC ≤ 50% and PS ≤ 40% (2). Patients without confirmatory laboratory results for the anticoagulant deficiencies were excluded from the study. We collected demographic data, risk factors for thrombosis, family history, type of thrombotic events, pregnancy complications in females, type and duration of anticoagulant and outcomes. Statistical analysis was performed using descriptive statistics and chi-square test was applied for comparison of variables between anticoagulant deficiency carriers and gain of function mutation carriers. Results Of a total of 107 patients identified,17 were excluded due to absence of confirmatory results. A total of 90 patients were analyzed; 70 (78%) females; mean age and range 44 (22- 82). There were 34 (38%)patients with anticoagulant deficiencies (10 AT, 6 PC and 18 PS) and 56 (62%) homozygotes for FVL, PGM or double heterozygote. Of those, 23 (39%) homozygote for FVL with one also heterozygote for the PGM, 2 (3.6%) homozygote PGM and 31(55.4%) double heterozygote. Overall risk factors for thrombosis were similar in both groups. There were no identified thrombosis risk factors in 12 and 19 patients in the anticoagulant deficiency and gain of function mutation respectively. The most common type of clinical presentation in both groups was deep vein thrombosis and pulmonary embolism. A positive family history of either thrombosis of thrombophilia in a first degree family member was equal in both groups. Likewise age less than 40 at first thrombotic event was similar. The most frequent anticoagulant prescribed in the patients with anticoagulant deficiency was a direct oral anticoagulant in 26.%% and vitamin K antagonists 22.3% in the ones with gain of function mutation. More patients with anticoagulant deficiencies remain on anticoagulation for more than 1 year than the ones with a gain of function mutation (88.5% vs 64%) and had more recurrent thrombotic events (20.6% vs.5.4%). Within the 70 female patients, 5 (7%) had first trimester pregnancy loss and 14 (20%) had multiple pregnancy losses. Conclusions: Our results suggest that patients with severe inherited antithrombin, protein C and S deficiencies have worse outcomes despite longer duration of anticoagulation than patients homozygote or double heterozygote for gain of function mutations. Disclosures De Sancho: Apellis Pharmaceuticals: Other: Advisory Board; BPL: Other: Advisory Board.
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Ritchie, Ellen K., Danielle C. Marshall, Molly D. Greenberg, Tania J. Curcio, Ashley E. Giambrone, Paul Christos, Eric J. Feldman, Joseph M. Scandura, and Gail J. Roboz. "Comprehensive Geriatric Assessment Does Not Predict Overall Survival in Older Patients with Acute Myeloid Leukemia (AML)." Blood 124, no. 21 (December 6, 2014): 3689. http://dx.doi.org/10.1182/blood.v124.21.3689.3689.
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Abstract Background Age and cytogenetics are the strongest predictors of overall survival (OS) in older patients with acute myeloid leukemia (AML), but practitioners recognize that outcomes are also affected by medical comorbidities, physical function and a variety of psychosocial factors. Recent data suggest that geriatric assessment, including measures of physical, cognitive and psychological function, may be predictive of OS and helpful for risk stratification in AML (Klepin 2013). We evaluated the ability of a comprehensive geriatric assessment (CGA) to predict overall survival in newly diagnosed older patients with AML. Patients and Methods All newly diagnosed AML patients age ≥60 years treated at Weill Cornell Medical Center and The New York Presbyterian Hospital completed a CGA including the OARS Physical Health Section, Mental Health Inventory (MHI-17), MOS Social Activity Survey, Activities of Daily Living (ADL) subscale of the MOS Physical Health, OARS Instrumental ADL subscale, Timed Up & Go, Blessed-Orientation-Memory-Concentration Test, and Karnofsky Performance Status (KPS). Laboratory data, medications, transfusions and days of hospitalization were also collected. Comorbidities were assessed using the Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI). OS was estimated by the Kaplan-Meier method and the log-rank test was used to compare survival profiles. The independent effects of the CGA and clinical risk factor variables on OS were estimated using hazard ratios in an adjusted Cox regression model. Results In total, 126 patients were evaluated (median age 74, range 60-90). Fifty-one percent of patients had a HCT-CI score >1, with the most common comorbidities being a history of cancer (28.57%), cardiac disease (20.6%), and psychiatric disturbances (17.5%). Half of the patients had prior hematologic disorders and 29% had poor-risk cytogenetics. Most patients (84.9%) received decitabine-based induction strategies; 44 of these patients (34.9%) subsequently received intensive salvage regimens (median age 69). The other 19 patients (15.1%) were treated with standard induction chemotherapy, and 29 patients (21%) underwent allogeneic stem cell transplantation (median age 68). One hundred twenty-three patients (96.6%) completed the CGA with a mean time to completion of 26 minutes (± 8.9 minutes). Thirty-five percent of patients did not complete the entire assessment and only 61.1% completed the follow up CGA. Median OS was 11.1 months (range 0.36-52.64), with 1-year survival of 47.6%, complete remission (CR) rate of 39.8%, and 30-day mortality of 2.4%. In univariate analysis, age (P=0.0289), physician-assigned KPS (P=0.0031), sex (P=0.0074), ELN cytogenetic risk (P=0.0194), creatinine (P=0.027), albumin (P=0.0052), white blood cell (WBC) count (P=0.0135), LDH (P=0.0004), and treatment response (P=0.0001) were significant clinical predictors of OS. Significant CGA variables included Blessed Orientation-Memory-Concentration score (P=0.0035), Bend-Kneel-Stoop (P=0.0239), “someone to prepare your meals” (P=0.0253) and self-reporting of heart disease (P<0.001). In a multivariate analysis controlling for age and cytogenetic risk, physician-assigned KPS (HR, 1.804; 95% CI 1.175 to 2.768), self-reported cardiac history (HR, 2.290; 95% CI 1.383 to 3.794), and WBC count <11.2/ul (HR, 2.360; 95% CI 1.415 to 3.936) were the only independent prognostic factors for overall survival. Conclusion In this study, age and cytogenetics remain the strongest predictors of OS in older patients with AML. While completion of the CGA was feasible, only performance status (KPS) was predictive of OS. Many measures previously reported as significant predictors of outcome, including impaired physical function (Klepin 2013), medication intake (Hurria 2011), pain (Sherman 2013), and HCT-CI score (Sorror 2005, 2009) were not predictive in our study population. The role of the CGA as a predictor of OS in AML requires further evaluation. The utility of the CGA in predicting functional performance and/or quality of life for older AML patients throughout treatment should also be investigated. Disclosures Ritchie: Celgene, Incyte: Speakers Bureau. Feldman:Ariad: Honoraria, Speakers Bureau; Novartis: Honoraria, Research Funding, Speakers Bureau.
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Richie, Jerome P. "Commentary on “Successful treatment of post-chemotherapy azoospermia with microsurgical testicular sperm extraction: The Weill Cornell experience.” Hsiao W, Stahl PJ, Osterberg EC, Nejat E, Palermo GD, Rosenwaks Z, Schlegel PN, Weill Cornell Medical College, James Buchanan Brady Foundation, New York, New York." Urologic Oncology: Seminars and Original Investigations 30, no. 1 (January 2012): 112. http://dx.doi.org/10.1016/j.urolonc.2011.11.006.
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Giulino, Lisa B., Susan Mathew, Wayne Tam, Amy Chadburn, Gianna Ballon, Sharon Barouk, Giuseppina Antonicelli, Lorenzo Leoncini, and Ethel Cesarman. "TNFAIP3 (A20) Genetic Alterations In EBV Associated AIDS Related Lymphomas." Blood 116, no. 21 (November 19, 2010): 802. http://dx.doi.org/10.1182/blood.v116.21.802.802.
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Abstract Abstract 802 Introduction: AIDS related lymphomas (ARL) are a heterogeneous group of lymphoproliferative disorders that are frequently associated with Epstein Barr virus (EBV) infection. EBV expresses latent viral oncoproteins that constitutively activate the transcription factor NF-κB, a potent inducer of genes involved in B cell survival and proliferation (Keller SA et al, Blood 2006). Lymphomas that are not associated with EBV can also display increased NF-κB activity and recent reports have described mutations in regulators of NF-κB in subsets of B cell lymphomas. One of the frequently mutated regulatory genes is TNFAIP3, which encodes A20, an ubiquitin modifying enzyme involved in the termination of NF-κB signaling. Mutations resulting in the inactivation of A20 have been found in a significant proportion of marginal zone lymphoma (Novak U et al, Blood 2009), classical Hodgkin lymphoma, primary mediastinal B cell lymphoma (Schmitz R et al, J Exp Med 2009), and diffuse large B cell lymphoma (Compagno M et al, Nature 2009). In ARL the incidence of alterations in A20 and the relationship with EBV infection has not been described. Materials and Methods: We evaluated archival formalin fixed paraffin embedded tissue samples of ARL for genetic alterations in A20. Tissue was collected through an international collaboration between Weill Cornell Medical College in New York, USA and Siena University in Siena, Italy. A tissue microarray with 46 cases of ARL was prepared and characterization of lymphoma subtype and EBV viral status were determined by immunohistochemistry and in situ hybridization for Epstein-Barr encoded RNA. Fluorescent in situ hybridization (FISH) was used to evaluate for genomic deletions in A20, and translocations of cMYC, BCL-2 and BCL-6. Direct sequencing of the coding region and splice sites of A20 was performed to evaluate for additional genetic alterations. Immunohistochemistry was used to evaluate for the presence of A20 protein. Results: Fluorescent in situ hybridization revealed A20 monoallelic or biallelic deletion in 6 of 25 cases (24%). A20 point mutations were found in 3 of 23 cases (13%). Nonsense mutations coding for a premature stop codon in exon 2 were seen in 2 cases. The third case was found to have a missense mutation in exon 7 resulting in an amino acid change. Two of the 3 cases with an A20 point mutation had A20 deletion in the complementary allele indicating biallelic alteration of the A20 gene. Immunohistochemistry for A20 was performed and is reported for the first time in this abstract. Absence of A20 protein was demonstrated in 4 of 33 samples (12%). Included among the cases negative for A20 on immunohistochemistry is the single case with biallelic A20 deletion demonstrated by FISH. In total 10 of 39 (26%) cases with adequate sample for evaluation were determined to have inactivation of A20 by FISH, sequencing, immunohistochemistry, or a combination. A20 inactivation was seen among all histologic subtypes of ARL including Burkitt lymphoma (n=2), diffuse large B cell lymphoma of the germinal center B cell (n=2) and non-germinal center B cell (n=2), plasmablastic lymphoma (n=3) and B cell lymphoma, unclassifiable, intermediate between BL and diffuse large B cell lymphoma (n=1). Interestingly, the incidence of EBV infection was higher in cases with A20 inactivation than in those with intact A20. EBV was present in 6/10 cases with A20 alteration (60%) vs. 8/29 cases with intact A20 (28%). The EBV latent viral protein LMP-1, which activates NF-κB, was not expressed in cases with A20 alteration. Conclusions: This is the first report to demonstrate A20 inactivation in EBV-associated lymphoma. A20 molecular analysis has been previously reported in Hodgkin Lymphoma (HL) where A20 inactivation and EBV infection were found to be almost mutually exclusive (Schmitz R et al, J Exp Med 2009). The EBV gene expression pattern differs in HL and ARL. In HL EBV expresses the viral oncoprotein LMP-1, which leads to constitutive activation of NF-κB. In ARL viral gene expression is more heterogeneous and in this cohort of ARL, LMP-1 was not expressed in any of the cases with EBV infection and A20 loss. Our data indicate that A20 may represent a tumor suppressor gene in a significant subset of ARL and that A20 inactivation may be associated with positive EBV status. In EBV related lymphoma inactivation of A20 may be an alternative mechanism of NF-κB upregulation in the absence of LMP-1. Disclosures: No relevant conflicts of interest to declare.
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Kaner, Justin D., Nuria Mencia-Trinchant, Ariel Schaap, Gail J. Roboz, Sangmin Lee, Pinkal Desai, Michael Samuel, et al. "Acute Myeloid Leukemia (AML) with Somatic Mutations in PTPN11 Is Associated with Treatment Resistance and Poor Overall Survival." Blood 132, Supplement 1 (November 29, 2018): 2760. http://dx.doi.org/10.1182/blood-2018-99-110319.
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Abstract Introduction: PTPN11 encodes the protein tyrosine phosphatase SHP 2, which relays signals from growth factor receptors to RAS and other effectors. Germline and somatic mutations in PTPN11 are well described in the pediatric population and associated with Noonan Syndrome and Juvenile Myelomonocytic Leukemia (JMML). Pathogenesis of JMML specifically appears to be through activation of the RAS-RAF-MAP kinase pathway leading to dysregulated myeloid differentiation. There are also data to suggest that somatic PTPN11 mutations portend a poor prognosis in MDS patients (pts) receiving hypomethylating agents. The significance of PTPN11 when sporadically mutated in adults with AML remains controversial as several analyses have thus far failed to show any clinical relevance. This study evaluated the clinical significance of somatic PTPN11 mutations in a single center cohort. Methods: From 7/2015-7/2018, data from an AML database at New York Presbyterian/Weill-Cornell Medical Center was queried for the presence or absence of mutations in the PTPN11 gene as well as on all pts with TP53 mutations to use as a surrogate, given its well-known status as a poor prognostic factor. Log-rank tests were used to compare survival data, while Fisher-exact test was used to compare non-survival data (i.e. CR rates). For multivariate analysis, linear regression was performed and looked at mutational status, age, cytogenetics (CG), and controlled for age and European Leukemia Net (ELN) risk. Results: 256 AML pts with complete evaluable data. 30 were found to harbor mutations in PTPN11 at diagnosis. Within the PTPN11 mutated cohort, median age was 70, 15 were female and 15 were male. 1st cycle complete response (CR) rate was 30% (9/30) and one additional pt (4.8%) achieved a salvage CR. Hematopoietic stem cell transplantation (HSCT) was provided to 3/30 (10%) and of those, 1/3 (33.3%) relapsed, within 8 months. In the pts who achieved a CR, 4/10 (40%) relapsed. Median overall survival (OS) of the PTPN11 mutated cohort was 9 months (mo). Four patients (13.3%) are alive and in a CR >6 mo at time of censor. DNMT3A, NPM1, K/NRAS, RUNX1, TP53 and IDH1/2 were commonly co-mutated (n=12,9,7,7,6, and 6 respectively, table 2) with PTPN11 mutations. DNMT3A, NPM1 and PTPN11 were commonly mutated together in pts, n=8 (26.7%). The PTPN11 mutation was a single mutation in 2 pts. Common CG findings include normal (n=9), complex (n=4), trisomy 8 (n=4), chr. 3 abnormalities (n=7), chr. 5 (n=7) and chr. 7 (n=8). When comparing the PTPN11 mutated pts to all AML pts diagnosed at this center during the same time period without a PTPN11 mutation (table 1), 1st cycle CR rate (30% vs 57.5%, p=0.006), any CR (33.3% vs 71.4%, p=0.001), HSCT (10% vs 41.6%, p<0.001), Median OS (9.0 mo vs 28.3 mo, log-rank p,<0.001, figure 1) and proportion of pts alive at censor (30% vs 58%, p=0.008) were all significantly different between the two groups. Neither choice of initial induction regimen (proportion of high dose cytarabine based therapy) nor proportions of pts with adverse risk AML by ELN differed between the two groups (46.7% vs 48.2%, p=0.86 and 63.3% vs 44.2, p=0.054). Numbers were too small to compare relapse free survival, however, relapse rates were not significantly different. In a multivariate analysis of the full cohort of 256 pts, PTPN11,TP53 and Age were all independently associated with increased risk of death compared to the full cohort, with a HR of 2.00, CI 1.16-3.44 p=0.01, HR 1.9, CI 1.04-3.46, p=0.04, HR 1.05, CI 1.03-1.07, p<0.001, respectively. We also compared the OS of PTPN11 mutated AML to TP53 mutated AML and found that while there was a small difference in median OS (9.0 mo vs 9.8 mo) it was not significant, p=0.77. Discussion: This comparison of PTPN11 mutant to PTPN11 wild-type AML is the largest single center analysis and the first to show a significant chemotherapy response and survival difference that is similar to AML with a TP53 mutation. The multivariate analysis showed PTPN11 carried a poor prognosis (HR for death of 2.00). Mutations in DNMT3A and NPM1 with PTPN11 was common in our cohort, confirming previous work. Conclusion: These data suggest that the presence of PTPN11 is associated with an aggressive disease with poor outcome and treatment resistance. Pre-clinical investigation has been initiated to explore a mechanistic role for these clinical findings, with the hope of testing novel therapeutics on an animal model of AML with PTPN11 mutations. Disclosures Roboz: Cellectis: Research Funding; Daiichi Sankyo: Consultancy; Eisai: Consultancy; Celltrion: Consultancy; Bayer: Consultancy; Sandoz: Consultancy; Janssen Pharmaceuticals: Consultancy; Celltrion: Consultancy; Celgene Corporation: Consultancy; Otsuka: Consultancy; Janssen Pharmaceuticals: Consultancy; Pfizer: Consultancy; Roche/Genentech: Consultancy; Argenx: Consultancy; Novartis: Consultancy; Pfizer: Consultancy; AbbVie: Consultancy; Aphivena Therapeutics: Consultancy; Cellectis: Research Funding; Celgene Corporation: Consultancy; Eisai: Consultancy; Jazz Pharmaceuticals: Consultancy; Sandoz: Consultancy; Astex Pharmaceuticals: Consultancy; Astex Pharmaceuticals: Consultancy; Argenx: Consultancy; Orsenix: Consultancy; Bayer: Consultancy; AbbVie: Consultancy; Otsuka: Consultancy; Jazz Pharmaceuticals: Consultancy; Novartis: Consultancy; Aphivena Therapeutics: Consultancy; Daiichi Sankyo: Consultancy; Orsenix: Consultancy; Roche/Genentech: Consultancy. Lee:AstraZeneca: Consultancy; Clinipace: Consultancy; Karyopharm Therapeutics Inc: Consultancy; LAM Therapeutics: Research Funding; Amgen: Consultancy. Desai:Argenx: Consultancy; Cellerant Inc: Consultancy. Guzman:Cellectis: Research Funding. Ritchie:Incyte: Consultancy, Speakers Bureau; NS Pharma: Research Funding; Bristol-Myers Squibb: Research Funding; Astellas Pharma: Research Funding; ARIAD Pharmaceuticals: Speakers Bureau; Novartis: Consultancy, Other: Travel, Accommodations, Expenses, Research Funding, Speakers Bureau; Pfizer: Consultancy, Research Funding; Celgene: Consultancy, Other: Travel, Accommodations, Expenses, Speakers Bureau.
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Scholl, Jessica, and Stephen Chasen. "The Use of Ultrasound as a Potential Adjunct to Cell-Free Fetal DNA Screening for Aneuploidy at Weill Cornell Medical College, New York, USA." Surgery Journal 04, no. 01 (January 2018): e1-e6. http://dx.doi.org/10.1055/s-0038-1624564.
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Objective To evaluate the utility of ultrasound in identifying fetuses with uncommon chromosomal abnormalities that would be considered not detectable by cell-free fetal deoxyribonucleic acid (cfDNA). Study Design We performed a retrospective study of fetuses with chromosomal abnormalities that would be undetectable by cfDNA, who underwent an 11- to 14-week ultrasound from 2006 to 2016. Results There were 43 pregnancies included. First-trimester ultrasound revealed a fetal abnormality in 19 (44.2%) cases, of which 13 (30.2%) had a thickened nuchal translucency. There were an additional four fetuses with second-trimester sonographic abnormalities. Overall, 23 (53.5%) fetuses were found to have a major anomaly diagnosed by ultrasound. The rate of first-trimester sonographic abnormalities varied widely based on category of chromosomal abnormalities with high rates seen with triploidy (87.5%) and autosomal trisomy (80%) and lower rates seen with structurally abnormal chromosomes (33.3%), trisomy mosaicism (27.3%), other forms of mosaicism (11.1%), and deletions or duplications (25.0%), p < 0.001. Conclusion The majority of fetuses with uncommon chromosomal abnormalities in our cohort had major sonographic anomalies. The use of first-trimester ultrasound with nuchal translucency measurement may offer utility in identifying fetuses with risk of aneuploidy that would not be detectable with cfDNA.
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Barst, Robin J., Jeffrey R. Fineman, Michael A. Gatzoulis, and Richard A. Krasuski. "Pulmonary Arterial Hypertension in Adults with Congenital Heart Disease." Advances in Pulmonary Hypertension 6, no. 3 (August 1, 2007): 142–48. http://dx.doi.org/10.21693/1933-088x-6.3.142.
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This discussion was moderated by Robyn J. Barst, MD, Professor of Pediatrics, Divisions of Pediatric Cardiology at Columbia University College of Physicians and Surgeons and Cornell Medical Center, and Director of New York Presbyterian Pulmonary Hypertension Center at Columbia University Medical Center, New York, New York. Panel members included Jeffrey R. Fineman, MD, Pediatric Critical Care Specialist and Associate Investigator of the Cardiovascular Research Institute, University of California, San Francisco; John Granton, MD, Assistant Professor of Medicine, University of Toronto, Pulmonary Arterial Hypertension Programme, University Health Network, Toronto, Ontario; Michael A. Gatzoulis, MD, PhD, Professor of Cardiology, Congenital Heart Disease, and Consultant Cardiologist and Director of the Adult Congenital Heart Centre at the Royal Brompton Hospital and the National Heart and Lung Institute, Imperial College School of Medicine, London, UK; and Richard A. Krasuski, MD, Director of Adult Congenital Heart Disease Services, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
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Wierzbowska, Agnieszka, Agnieszka Pluta, Marta Antonina Libura, Anna Czyz, Sebastian Giebel, Piotr Stelmach, Magdalena Czemerska, et al. "A Polish Acute Leukemia Group Prospective Multicenter Clinical Trial to Compare the Efficacy of Two Standard Induction Therapies (DA-90 vs DAC) and Two Standard Salvage Regimens (FLAG-IDA vs CLAG-M) in Acute Myeloid Leukemia (AML) Patients ≤ 60 Years Old (PALG-AML1/2016)." Blood 136, Supplement 1 (November 5, 2020): 3–4. http://dx.doi.org/10.1182/blood-2020-140694.
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Background: AML is the most common acute leukemia in adults. While most adults < 60 years achieve complete remission (CR) with intensive induction chemotherapy, approximately one third have primary refractory disease and, overall, the majority of AML patients still relapse despite having attained initial remission (Dohner et al, Blood 2017). The combination of an anthracycline and cytarabine has been the mainstay of intensive AML induction for more than 50 years. Combined with cytarabine (AraC), high-dose daunorubicin (90 mg/m2) in induction (DA-90) resulted in a higher rate of CR (70.6% vs. 57.3%, P<0.001) and improved overall survival (OS) (median 23.7 vs. 15.7 months; P = 0.003), without increased serious adverse events compared with DA-45 (Fernandez et al, NEJM, 2009). In two PALG randomized trials, the combination of cladribine with DA (DAC regimen) also resulted in significantly increased CR after a single induction course, compared with the standard two-drug induction (DA-60) (Holowiecki et al, Leukemia, 2004 and JCO 2012). Both regimens have a recommendation from the National Cancer Comprehensive Network (NCCN) for routine use. For patients with primary refractory disease, the commonly used FLAG-IDA (fludarabine, cytarabine, idarubicin, GCSF) regimen results in a CR rate of 52% (Pastore et al, Ann Hem, 2003). Two previous PALG studies confirmed that another standard regimen, CLAG-M (a combination of cladribine, Ara-C, G-CSF and mitoxantrone) is also effective with tolerable toxicity in refractory/relapsed AML patients (Robak et al Leuk Lymph, 2000; Wrzesień-Kuś et al, Eur J Haematol 2003; Wrzesień-Kuś et al, Ann Hematol, 2005; Wierzbowska et al, Eur J Haematol ,2008; Jaglal et al, Leuk Res, 2014). PALG-AML1/2016 aims to compare the safety and efficacy of two commonly used induction and salvage regimens in AML. This trial is also the first international randomized trial in AML induction to prospectively evaluate the impact of measurable residual disease (MRD) on overall survival, using multi-modality testing (flow-cytometry, next-generation sequencing, and PCR) of serial samples. The study is conducted in accordance with the principles of the "Declaration of Helsinki". Study Design and Methods: PALG-AML1/2016 is a multicenter, randomized, Phase III study which will include 582 patients with newly-diagnosed AML treated at multiple centers across Poland and at Weill Cornell Medicine and The New York Presbyterian Hospital in New York City. This will allow a 10% difference in CR rate between the DAC and DA-90 induction regimens to be confirmed with a power of 80% and level of significance 0.05. Eligible patients must be 18 to 60 years of age with untreated AML, Eastern Cooperative Oncology Group performance status 0-2 and HCT-CI Index of comorbidities, ≤ 3. As midostaurin treatment has become approved and available the study was amended with an exclusion of FLT3-mutated patients. The trial schema is shown in Figure 1. The trial was initiated in July 2017 and 279 patients have been enrolled to date and accrual is ongoing. Preliminary safety and efficacy data were reviewed by the data safety monitoring committee after 194 patients and the recommendation was to proceed without changes. Serial samples for MRD are being collected from all patients at multiple time points and analysis is ongoing. ClinicalTrials.gov Identifier: NCT03257241 Figure 1 Disclosures Wierzbowska: Janssen: Honoraria; Celgen/BMS: Honoraria; Novartis: Honoraria; Abbvie: Honoraria, Membership on an entity's Board of Directors or advisory committees; Jazz: Honoraria, Research Funding. Pluta:Angelini: Research Funding; Celgene/BMS: Honoraria. Libura:Novartis: Honoraria. Wrobel:Janssen-Cilag: Honoraria, Research Funding, Speakers Bureau. Zaucha:Abbvie: Honoraria; Sandoz: Consultancy, Honoraria; Cellgene: Other: travel, accomodations, expenses; Novartis: Consultancy; BMS: Consultancy; Takeda: Consultancy, Honoraria, Other: travel, accomodations, expenses; Roche: Consultancy, Honoraria, Other: travel, accomodations, expenses. Robak:AstraZeneca: Honoraria, Research Funding; Janssen: Consultancy, Honoraria, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company), Research Funding; GSK: Research Funding; Bristol Meyers Squibb: Research Funding; Novartis: Honoraria, Research Funding; Morphosys: Research Funding; UCB: Honoraria, Research Funding; Roche: Consultancy, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company), Research Funding; UTX-TGR: Research Funding; BioGene: Honoraria, Research Funding; Acerta: Research Funding; Momenta: Consultancy; Pfizer: Research Funding; Sandoz: Consultancy, Honoraria; Octapharma: Honoraria; AbbVie: Consultancy, Honoraria, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company), Research Funding; Pharmacyclics LLC, an AbbVie Company: Honoraria, Research Funding; Medical University of Lodz: Current Employment; Takeda: Consultancy. Lee:BMS: Consultancy; Helsinn: Other: Member -DSMB; AstraZeneca: Consultancy; Jazz: Consultancy; Roche Molecular Systems: Consultancy. Ritchie:Novartis: Honoraria; Incyte: Speakers Bureau; Sierra Oncology: Honoraria; Abbvie: Honoraria; Pfizer: Honoraria, Research Funding; Jazz pharmaceuticals: Honoraria, Research Funding. Guzman:Cellectis: Research Funding; SeqRx: Honoraria. Roboz:Agios: Consultancy; Amphivena: Consultancy; Astex: Consultancy; Pfizer: Consultancy; Abbvie: Consultancy; Array BioPharma: Consultancy; Bayer: Consultancy; Celltrion: Consultancy; Eisai: Consultancy; Jazz: Consultancy; Roche/Genentech: Consultancy; Sandoz: Consultancy; Actinium: Consultancy; Argenx: Consultancy; Astellas: Consultancy; Daiichi Sankyo: Consultancy; AstraZeneca: Consultancy; Orsenix: Consultancy; Otsuka: Consultancy; Takeda: Consultancy; Trovagene: Consultancy; Cellectis: Research Funding; Jasper Therapeutics: Consultancy; Epizyme: Consultancy; Helsinn: Consultancy; MEI Pharma: Consultancy; Celgene: Consultancy; Janssen: Consultancy; Novartis: Consultancy. OffLabel Disclosure: cladribine - in induction regimen in AML
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New, M. I. "Prevention of ambiguous genitalia by prenatal treatment with dexamethasone in pregnancies at risk for congenital adrenal hyperplasia." Pure and Applied Chemistry 75, no. 11-12 (January 1, 2003): 2013–22. http://dx.doi.org/10.1351/pac200375112013.
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Congenital adrenal hyperplasia (CAH) refers to a family of monogenic inherited disorders of adrenal steroidogenesis most often caused by a deficiency of the 21-hydroxylase enzyme. In the classic forms of CAH (simple virilizing and salt-wasting), androgen excess causes external genital ambiguity in newborn females and progressive postnatal virilization in males and females. Prenatal treatment of CAH with dexamethasone has been successfully utilized for over a decade. This article reports on 595 pregnancies prenatally diagnosed using amniocentesis or chorionic villus sampling between 1978 and 2002 at the New York Presbyterian Hospital-Weill Medical College of Cornell University. No significant or enduring side effects were noted in the fetuses, indicating that dexamethasone treatment is safe. Prenatally treated newborns did not differ in weight from untreated, unaffected newborns. Based on our experience, prenatal diagnosis and treatment of 21-hydroxylase deficiency is effective in significantly reducing or eliminating virilization in the newborn female. Prevention of genital virilization in female newborns with classic CAH avoids the risk of sex misassignment and diminishes the need for corrective surgery and the resulting psychological impact that may extend into adulthood.
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Walters, Michelle J., Joanna Sterling, Crystal Quinn, Christine Ganzer, Ricardo S. Osorio, Randolph D. Andrews, Dawn C. Matthews, et al. "Associations of lifestyle and vascular risk factors with Alzheimer’s brain biomarker changes during middle age: a 3-year longitudinal study in the broader New York City area." BMJ Open 8, no. 11 (November 2018): e023664. http://dx.doi.org/10.1136/bmjopen-2018-023664.
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ObjectiveTo investigate the associations between lifestyle and vascular risk factors and changes in Alzheimer’s disease (AD) biomarkers (beta-amyloid load via 11C-PiB PET, glucose metabolism via 18F-FDG PET and neurodegeneration via structural MRI) and global cognition in middle-aged asymptomatic participants at risk for AD.DesignProspective, longitudinal.SettingThe study was conducted at New York University Langone/Weill Cornell Medical Centres in New York City.ParticipantsSeventy cognitively normal participants from multiple community sources, aged 30–60 years with lifestyle measures (diet, intellectual activity and physical activity), vascular risk measures and two imaging biomarkers visits over at least 2 years, were included in the study.Outcome measuresWe examined MRI-based cortical thickness, fluoro-deoxy-glucose (FDG) glucose metabolism and PiB beta-amyloid in AD-vulnerable regions. A global cognitive z-score served as our summary cognition measure. We used regression change models to investigate the associations of clinical, lifestyle and vascular risk measures with changes in AD biomarkers and global cognition.ResultsDiet influenced changes in glucose metabolism, but not amyloid or cortical thickness changes. With and without accounting for demographic measures, vascular risk and baseline FDG measures, lower adherence to a Mediterranean-style diet was associated with faster rates of FDG decline in the posterior cingulate cortex (p≤0.05) and marginally in the frontal cortex (p=0.07). None of the other lifestyle variables or vascular measures showed associations with AD biomarker changes. Higher baseline plasma homocysteine was associated with faster rates of decline in global cognition, with and without accounting for lifestyle and biomarker measures (p=0.048). None of the lifestyle variables were associated with cognition.ConclusionsDiet influenced brain glucose metabolism in middle-aged participants, while plasma homocysteine explained variability in cognitive performance. These findings suggest that these modifiable risk factors affect AD risk through different pathways and support further investigation of risk reduction strategies in midlife.
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Arias, Valerie, Ehsan Shabbir, Daniel Victorio, Emily Sperling, Naznin Haq, and James B. Bussel. "A Survey of the Etiology of Immune Thrombocytopenia (ITP)." Blood 120, no. 21 (November 16, 2012): 2239. http://dx.doi.org/10.1182/blood.v120.21.2239.2239.
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Abstract Abstract 2239 Introduction: Socioeconomic, environmental, lifestyle and genetic factors play a role in the etiology of ITP but are poorly understood. A self-reported questionnaire was designed to study these relationships and how these factors prior to the diagnosis of ITP relate to treatment response and disease progression in order to gain insight into the etiology of ITP. Methods: To design the questionnaire that would address topics of interest: 1) 60 ITP patient interviews were performed and 2) the questionnaire was reviewed by project coordinators, nurse practitioners, Platelet Disorder Support Association (PDSA) members, and hematologists. The input was incorporated into a further-revised questionnaire, which was then administered to both “pediatric” (patients <18 years of age at the time of diagnosis) and adult ITP patients from the Platelet Disorders Center at Weill Cornell - New York Presbyterian Hospital. Formal statistical analysis to relate responses to one question to responses of another to define sub-groups of patients is ongoing. Results: 109 patients were enrolled. Ages ranged from 2–78 years of age; median age was 55 years, with 21 females and 33 “pediatric” patients. The most frequent environmental exposures in adults were automotive exhaust (n=14) and Teflon (n=12). In pediatrics, preservatives and insecticides (n=8) and Teflon (n=7) were most common. The most prevalent hazardous substances in both groups were cleaning supplies (n=16 adults, n=9 “pediatric”) and chlorinated water (n=13 adult, n=9 “pediatric”). 13 adults also had exposure to gasoline or diesel fumes. Refer to figure 1. 51(47%) patients reported at least one infection prior to diagnosis with ITP. The most common were Strep throat (n=12); influenza (n=9), and respiratory tract infections (n=8). Twenty-four (22%) patients reported at least one autoimmune disease, including celiac (n=2) and discoid lupus (n=2).Twenty-one patients reported a family history of Type II diabetes, 12 Type I diabetes, 13 osteoarthritis and 10 rheumatoid arthritis. Eight (7%) patients reported at least one inflammatory disease including: Crohn's disease (n=3), Inflammatory bowel disease (n=7), Systemic lupus erythematous and Vitiligo(each n=1). Thirty-seven (34%) patients reported surgeries prior to diagnosis of ITP, especially: appendectomy (n=8) and tonsil removal (n=8). Twenty-three patients traveled close to date of diagnosis, 58 patients reported more stress than usual (i.e. death of a relative, loss of employment); 13 patients reported a drastic change in diet (i.e. decreasing calories (n=7) or becoming vegetarian (n=5)). Vitamin supplementation for vitamin C and D (each n=17), E (n=12) and B (n=11) were common. In addition, 11 vitamin deficiencies were reported, vitamin D (n=5), vitamin B12 (n=3) and other (n=3). The most frequent allergic reactions included: 31 (28%) patients with hay fever, 9 patients with allergies to milk, 7 patients with poison ivy or skin irritation, 6 patients with eczema, and 4 with allergic rhinitis. Other medical conditions reported were: hypothyroidism (n=10), hyperthyroidism (n=9), high blood pressure (N=16), high cholesterol (N=14), and anemia (N=13) [9 additional patients included 4 with iron deficiency anemia and 5 with a family history of iron deficiency anemia]. Seven patients reported a lack of prenatal care in their mothers' pregnancy and 7 were premature. Medications reported include: acetaminophen (n=53), antibiotics (n=36), antihistamines (n=22), and hormone therapy (n=17). Vaccinations received close to date of diagnosis include: flu vaccine (n=10) and T-dap (n=9). Prednisone was reported most frequently as both the best therapy to minimize symptoms (n=18) and the worst (n=16). Conclusion: Our pilot study intended to capture critical information and to further development of the questionnaire. We can see if there are groups of patients in whom onset and other characteristics relate to outcomes including response to treatment. Following formal statistical analysis of the material acquired (in progress and anticipated by early September), the next step will be for a final updated version of the questionnaire to be posted on the PDSA web site in order to accrue responses from a much larger number of patients. The questionnaire will also be given to a non-ITP patient population to serve as controls. Disclosures: Bussel: Amgen: Family owns Amgen stock Other, Membership on an entity's Board of Directors or advisory committees, Research Funding; Cangene: Research Funding; GlaxoSmithKline: Family owns GSK stock, Family owns GSK stock Other, Membership on an entity's Board of Directors or advisory committees, Research Funding; Genzyme: Research Funding; IgG of America: Research Funding; Immunomedics: Research Funding; Ligand: Membership on an entity's Board of Directors or advisory committees, Research Funding; Eisai: Membership on an entity's Board of Directors or advisory committees, Research Funding; Shionogi: Membership on an entity's Board of Directors or advisory committees, Research Funding; Sysmex: Research Funding; Portola: Consultancy. Off Label Use: The use of romiplostim in pediatric patients was examined in this study.
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DAVIS, L. J., H. L. ROBERTS, D. D. JURANEK, S. R. FRAMM, and R. SOAVE. "A survey of risk factors for cryptosporidiosis in New York City: drinking water and other exposures." Epidemiology and Infection 121, no. 2 (October 1998): 357–67. http://dx.doi.org/10.1017/s095026889800123x.
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We conducted a survey to determine the prevalence of known and theoretical exposure risks for cryptosporidiosis among selected New York City residents. Subjects were recruited from outpatients attending either a practice for persons with HIV infection (n=160), or other medical practices (n=153), at The New York Hospital–Cornell Medical Center. Despite a greater concern for waterborne infection, 82% of HIV-infected subjects reported consuming municipal tap water compared to 69% of subjects from other medical clinics (OR 2·1, 95% CI 1·2–3·6, P=0·006). Although 18% and 31% of subjects, respectively, denied any tap water consumption at home or work, all but one from each cohort responded positively to having at least one possible alternate source of tap water ingestion such as using tap water to brush teeth or drinking tap water offered in a restaurant. 78% and 76% of subjects, respectively, had at least one potential risk for exposure other than municipal water consumption, such as swimming in pools or contact with animals. Our findings indicate that it is possible to stratify the population into subsets by the amount of tap water consumed. This suggests that an observational epidemiologic study of the risk of contracting cryptosporidiosis from everyday tap water consumption is feasible.
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Crystal, Ronald G., Andrea Mastrangeli, Abraham Sanders, Joseph Cooke, Thomas King, Fred Gilbert, Claudia Henschke, et al. "Evaluation of Repeat Administration of a Replication Deficient, Recombinant Adenovirus Containing the Normal Cystic Fibrosis Transmembrane Conductance Regulator cDNA to the Airways of Individuals with Cystic Fibrosis. New York Hospital–Cornell Medical Center, New York, New York." Human Gene Therapy 6, no. 5 (May 1995): 667–703. http://dx.doi.org/10.1089/hum.1995.6.5-667.
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Butler, Javed, Daniel E. Forman, William T. Abraham, Stephen S. Gottlieb, Evan Loh, Barry M. Massie, Christopher M. O'Connor, et al. "Relationship between heart failure treatment and development of worsening renal function among hospitalized patients11Guest Editor for this manuscript was Peter M. Okin, MD, New York Hosptial-Cornell Medical Center, New York, NY." American Heart Journal 147, no. 2 (February 2004): 331–38. http://dx.doi.org/10.1016/j.ahj.2003.08.012.
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Leng, Lewis Z., Jeffrey P. Greenfield, Mark M. Souweidane, Vijay K. Anand, and Theodore H. Schwartz. "Endoscopic, Endonasal Resection of Craniopharyngiomas." Neurosurgery 70, no. 1 (September 20, 2011): 110–24. http://dx.doi.org/10.1227/neu.0b013e31822e8ffc.
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Abstract BACKGROUND The endoscopic, endonasal, extended transsphenoidal approach is a minimal-access technique for managing craniopharyngiomas. Outcome measures such as return to employment and body mass index (BMI) have not been reported and are necessary for comparison with open transcranial approaches. Most prior reports of the endoscopic, endonasal approach have reported unacceptably high cerebrospinal fluid (CSF) leak rates. OBJECTIVE To assess the outcome of endoscopic, endonasal surgery in a consecutive series of craniopharyngiomas with special attention to extent of resection, CSF leak, return to employment, and BMI. METHODS Twenty-six surgeries were performed on 24 patients at Weill Cornell Medical College-New York Presbyterian Hospital. Five patients had recurrent lesions. Gross-total resection (GTR) was attempted in 21 surgeries. Indications for intended subtotal resection were advanced age, medical comorbidities, preservation of pituitary function, and hypothalamic invasion. RESULTS Mean tumor diameter was 2.9 cm. GTR (18 surgeries) or near-total (>95%) resection (2 surgeries) was achieved in 95% when GTR was the goal. Seven patients received postoperative radiation therapy. Mean follow-up was 35 months with no recurrences in GTR cases and stable disease in all patients at last follow-up. Vision improved in 77%. Diabetes insipidus and panhypopituitarism developed in 42% and 38%, respectively. A more than 9% increase in BMI occurred in 39%; 69% returned to their preoperative profession/schooling. The postoperative CSF leak rate was 3.8%. CONCLUSION Minimal-access, endoscopic, endonasal surgery for craniopharyngioma can achieve high rates of GTR with low rates of CSF leak. Return to employment and obesity rates are comparable to microscope-assisted transcranial and transsphenoidal reports.
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Brown, John M. "Ronald Charles David Breslow. 14 March 1931—25 October 2017." Biographical Memoirs of Fellows of the Royal Society 66 (March 20, 2019): 53–77. http://dx.doi.org/10.1098/rsbm.2018.0039.
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Ronald Breslow was one of the leading organic chemists of his generation. He had received the perfect start in gaining a Harvard doctorate at the age of 24 supervised by the legendary Bob Woodward, followed by a year of postdoctoral work in Cambridge with the equally legendary, but scientifically distinct, Alexander Todd. An academic career of 62 years at Columbia University followed, starting in 1955, and scientific success arose quickly. He was a physical organic chemist, using this discipline as a vehicle for tackling all manner of scientific problems and venturing as needed into biology, physics or medicine. He prepared the simplest aromatic species, solved the mechanism of action of Vitamin B1, built bridges between organic chemistry and enzymology, and developed an anti-cancer drug with a distinct enzyme target. Rewards, honours and prestigious lecture invitations arrived throughout his career, in recognition of the scope and originality of his achievements. He met Esther at Harvard, and they married on completion of his PhD. After returning to the USA, she pursued a successful career in biochemistry at Weill Cornell Medical School in New York. They raised two daughters, Stephanie and Karen, who both became successful attorneys. He had strong family values and was very proud of all their achievements. Towards his co-workers, he was open, eager to engage in discussion and committed to supporting them, both during time at Columbia and thereafter. His warmth encouraged positive responses to his style of supervision, and lively discussions. He was an accomplished classical and jazz pianist, the family cook, and they scuba-dived on annual vacations.
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P Brockway, Julia, Keerti Murari, Alexandra Rosenberg, Orit Saigh, Matthew J. Press, and Jenny J. Lin. "Differences in primary care providers’ and oncologists’ views on communication and coordination of care during active treatment of patients with cancer and comorbidities." International Journal of Care Coordination 22, no. 2 (June 2019): 51–57. http://dx.doi.org/10.1177/2053434519857582.
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Introduction Management of comorbid diseases in patients with cancer is often unclear. The purpose of our study was to identify differences and similarities between primary care providers and oncologists’ knowledge, attitudes, and beliefs regarding coordination of care and comorbid disease management for patients undergoing active cancer treatment. Methods We conducted a cross-sectional study using an anonymous self-administered survey which was available to approximately 600 providers in primary care and medical oncology practicing in both outpatient and inpatient settings from March to December 2014 at three academic hospitals in New York City (Mount Sinai Hospital, Mount Sinai Beth Israel, and Weill Cornell). Our survey instrument assessed physician knowledge, attitudes, and beliefs using a clinical vignette of a cancer patient undergoing active treatment. Descriptive statistics were used to summarize the demographic and practice details of survey responses, and univariate analyses were used to assess differences in responses between primary care providers and oncologists. Results The survey was completed by 203 providers, including 127 primary care providers (62.5%), 32 medical oncologists (15.8%), 11 palliative care physicians (5.4%), and 33 nurse practitioners or physician assistants (16.3%). Medical oncologists admitted more uncertainty regarding who should manage preventive care as compared to primary care providers (34.4% vs. 16.5%, p = 0.02), whereas primary care providers were more concerned about duplicated care (22.8% vs. 6.3%, p = 0.03). Both primary care providers and medical oncologists agreed that diabetes should be actively managed during cancer treatment. More primary care providers felt less strict glycemic control was allowable (56.8% vs. 37.5%, p = 0.05) and that it is allowable for patients to miss some diabetes-related visits (80.6% vs. 56.3%, p = 0.01). Discussion Primary care providers and medical oncologists differ in their knowledge, attitudes, and beliefs regarding coordination of care and management of comorbid conditions in patients undergoing cancer treatment. These differences reflect systemic challenges to provision of care to cancer patients and the need for a model of care coordination.
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Norman, Sofya, and Rupa Juthani. "COVD-27. THE COVID-19 PANDEMIC AND NEURO-ONCOLOGICAL PATIENTS." Neuro-Oncology 22, Supplement_2 (November 2020): ii26. http://dx.doi.org/10.1093/neuonc/noaa215.108.
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Abstract INTRODUCTION The Coronavirus disease 2019 (COVID-19) pandemic has uprooted healthcare systems worldwide, disrupting care and increasing dependence on alternative forms of health care delivery. It is yet to be determined how the pandemic affected neuro-oncology patient outcomes, given that the majority of even “elective” neurosurgical oncology procedures are time-sensitive. This study quantifies changes in neuro-oncological care during the height of the pandemic in New York City and investigates patient outcomes in 2020 compared to a historical control. METHODS We performed a retrospective review of patients with brain tumor diagnoses (primary or secondary) who were seen at the Weill Cornell Brain and Spine Center between March 13, 2020 and May 1, 2020. A control cohort from the corresponding time period in 2019 was also reviewed. Alterations in care, including shift from in-person to telehealth, delays in evaluation and intervention, and treatment modifications were evaluated. These variables were analyzed with respect to brain tumor control and mortality. RESULTS 114 patients from 2020 and 171 patients from 2019 were included, with no significant difference in baseline demographics between the groups. There was no significant difference in outcomes between the cohorts, despite significantly more treatment delays (p= 0.0154) and use of telehealth (p< 0.0001) in 2020. For patients treated during the pandemic in 2020, patients who experienced delays in care did not suffer from worse outcomes compared to those without delays. Patients who utilized telehealth visits had significantly more stable tumor control (P = 0.0027), consistent with appropriate use of in-person visits for patients with progression. CONCLUSION Our study showed that use of telehealth and selective alterations in neuro-oncological care during the COVID-19 pandemic did not lead to adverse patient outcomes. This suggests that adaptive physician-led changes during the pandemic were successful and effective. Further studies are needed to evaluate impact on long-term survival.
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Alshaibani, Alfadel, Christina Lee, Sarah Camp Rutherford, Kah Poh Loh, Andrea M. Baran, Carla Casulo, Paul M. Barr, Jonathan W. Friedberg, and Patrick Michael Reagan. "High risk patients with diffuse large B cell lymphoma are not enrolled on clinical trials." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e19058-e19058. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e19058.
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e19058 Background: Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma. In this study, we explore reasons for non-enrollment in clinical trials for DLBCL and implications on trial design and interpretation. Methods: This is a retrospective analysis of patients (pts) with a pathological diagnosis of DLBCL or high grade B-cell lymphoma (HGBL) at University of Rochester (4/14-6/16) and New York-Presbyterian Hospital/Weill Cornell Medicine (NYP/WCM) (4/14-4/17).Ten clinical trials were opened during this time. Participants were divided into 3 groups: those treated in trial, those not enrolled in trial because of need for urgent treatment, and those not enrolled in trial for any other reason. We used a center-stratified Cox proportional hazards model to estimate association of trial enrollment with progression-free survival (PFS; time from start of treatment until progression/death or the last date the pt was known to be progression free) and overall survival (OS). Results: We identified 263 pts; 17% (n = 45) enrolled in a trial. Reasons for non-enrollment included not meeting eligibility criteria (n = 98), physician choice (n = 50), and pt choice (n = 38). For 32 pts, reasons were unclear. Of the 50 pts who were not enrolled because of physician choice, the primary reason for non-enrollment was the need for urgent treatment (n = 46). Pts who needed urgent treatment had higher risk clinical features compared with pts in trial (Table). Compared with those treated in trial and those not enrolled in trial for any other reason, those not enrolled in trial due to need for urgent treatment had an inferior PFS (HR 2.61, 95% CI 1.23–5.16) and OS (HR 2.27, 95% CI 1.21–4.06). Conclusions: At 2 academic institutions, 52% of patients with DLBCL or HGBL required urgent chemotherapy and failed to enroll on trials. Exclusion of such patients limits the applicability and generalizability of clinical trials in DLBCL. This barrier must be overcome so clinical trials may better reflect true DLBCL demographics. [Table: see text]
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McCarthy, Matthew W., Katelyn R. Keyloun, Patrick Gillard, Justin J. Choi, Ronald Copp, and Thomas J. Walsh. "456. Dalbavancin, a Long-Acting Lipoglycopeptide Antimicrobial Agent, Reduces Length of Stay and Improves Patient Work Productivity in a Hospital Critical Pathway for Acute Bacterial Skin and Skin Structure Infections (ABSSSI)—the ENHANCE ABSSSI Trial." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S223—S224. http://dx.doi.org/10.1093/ofid/ofz360.529.
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Abstract Background Prolonged admissions for acute bacterial skin and skin structure infections (ABSSSI) present an opportunity to improve efficiency and quality of care. A primary reason for admission for ABSSSI is to receive intravenous (IV) antibiotics, where multiple guidelines support shifting care to outpatient settings for appropriate patients. A hospital pathway for ABSSSI that leverages long-acting IV antibiotic therapy, such as dalbavancin, may reduce the length of stay (LOS). The ENHANCE ABSSSI trial (NCT03233438) sought to quantify LOS vs. that of usual care after implementing a new ABSSSI pathway. Methods A single-center, pre- vs. post-period pragmatic trial at Weill-Cornell Medical Center assessed usual care for consecutively enrolled ABSSSI patients during an observational period (pre-period). A new ABSSSI pathway was implemented in the post-period, which included (1) identification of eligible admitted ABSSSI patients and (2) treatment with dalbavancin. Those with life-threatening infections, requiring multiple antibiotics/intensive care, or with unstable comorbidities were excluded. Outcomes were assessed over a 44-day follow-up period. Results Of 48 and 43 patients enrolled in pre- and post-periods (Figure 1), mean infection-related LOS was reduced in the post-period (3.2 days vs. 4.8 days; P = 0.003; Figure 2 and 3). Similar results were found in an adjusted LOS analysis. Work productivity and activity impairment outcomes significantly improved in the post-period, apart from absenteeism, while quality of life was similar between periods (Figure 4). Complete response to treatment was similar between periods: 50% (pre-period) and 57% (post-period). A greater proportion of total adverse events (AEs) occurred in the post-period (n = 20; 48%) vs. pre-period (n = 3; 6%) with most AEs being mild in severity and not related to antibiotic use; few AEs were serious (7% [n = 3] post-period vs. 2% [n = 1] pre-period). The most common AEs were unrelated infection in the pre-period and fever in the post-period. Conclusion After implementing the ENHANCE ABSSSI pathway among eligible patients, LOS was significantly reduced by almost 2 days, with potential improvements in work productivity and the ability to complete daily activities. Disclosures All authors: No reported disclosures.
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Li, Baoqing, Alexander Michael Stessin, and Dattatreyudu Nori. "The role of post-cystectomy radiation in treatment of squamous cell carcinoma of the bladder: A combined retrospective analysis." Journal of Clinical Oncology 31, no. 6_suppl (February 20, 2013): 259. http://dx.doi.org/10.1200/jco.2013.31.6_suppl.259.
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259 Background: Squamous cell carcinoma (SCC) is the most common nonurothelial histology in bladder cancers. Given the high locoregional recurrence as the primary cause of death, radiation therapy (RT) is often recommended in the post-operative setting. Large-scale randomized trials that are dedicated to bladder SCC would be difficult to accrue to adequate numbers. Therefore, we utilized the Surveillance, Epidemiology, and End Results (SEER) database. Methods: The SEER (1998-2007) was queried for patients with muscle-invasive (stage II-IV) squamous cell carcinoma of the urinary bladder who underwent complete cystectomy. Kaplan-Meier survival analysis and Cox regressions were used to assess survival outcomes. Additionally, records were reviewed for patients treated at New York Presbyterian Hospital-Weill Cornell Medical College (NYP-WCMC) between 1991 and 2010. Results: A total of 331 patients from the SEER were included in the analysis; Majority were received cystectomy alone (n=297), while 10% (n=34) received post-operative RT. Factors associated with post-operative RT were younger age (p=0.03) and more advanced stage at diagnosis (p<0.001). Median survival was 40 months for patients treated with surgery alone and 18 months for post-operative RT (p<0.05). In the institutional record review, 17 patients underwent cystectomy; of these, 5 received post-cystectomy RT. Those who underwent post-operative RT had better performance status (80% vs 25%) and a higher rate of positive surgical margins (67% vs 20%). Median survival was 38 months for patients treated with surgery alone and 22 months for post-op RT. Conclusions: RT has been employed as a post-operative treatment for some patients with muscle-invasive SCC of the urinary bladder. Younger age, better performance status, advanced stage, and positive margins may prompt the use of post-operative RT. However, both SEER and single institution retrospective analyses failed to show any survival advantage associated with the use of post-operative therapy. Further studies are needed to identify any subsets of patients with bladder SCC who may benefit from post-cystectomy radiation.
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Balachandar, Sadana, Rachel Randolph, Dorothy A. Kleinert, Sujit Sheth, Patricia Giardina, and Maria G. Vogiatzi. "The Effect of Vitamin D Supplementation On Calcium Excretion in Thalassemia." Blood 120, no. 21 (November 16, 2012): 1029. http://dx.doi.org/10.1182/blood.v120.21.1029.1029.
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Abstract Abstract 1029 Purpose of study: Transfusion dependent thalassemia (TM) patients are routinely supplemented with vitamin D due to their increased risk of developing osteoporosis. Recent studies from North America have found that these patients have high rates of vitamin D “deficiency” and “insufficiency,” despite supplementation. The amount of vitamin D supplementation required to raise serum 25 hydroxy-vitamin D (25-OHD) to optimal levels is not known in these patients. Recent studies have linked 25-OHD levels to hypercalciuria and nephrolithiasis in patients with TM. The purpose of this study is to determine the effect of various doses of vitamin D supplementation on vitamin D stores and calcium excretion in TM patients. Description of project: Prospective, single-blind, placebo-controlled study of TM patients followed in the transfusion center at Weill Cornell/New York Presbyterian Hospital. Patients with 25-OHD concentrations between 15–29 ng/mL were eligible for this 3-month study. Subjects were assigned in a block type of enrollment to the “high dose” equivalent of 2,000 IU of vitamin D per day versus placebo. Results: 14 subjects were enrolled, with 8 assigned to the “high dose” group and 6 assigned to the placebo group. The “high dose” group consisted of 6 females, aged 15.2–45.5 years with an average baseline 25-OHD level of 22.4 ng/mL (15–26). The “placebo” group consisted of 4 females, aged 22.5–45.7 years with an average baseline 25-OHD level of 19.8 ng/mL (16–24). After the 3 month study period, hypercalciuria developed more frequently in those treated in the “high dose” group. In the placebo group, hypercalciuria was noted in 1/6 (16.7%) spot urine calcium/creatinine tests and 0/3 (0%) 24 hour urine calcium estimations. In the “high dose” group, the corresponding number of patients based on the same methods of testing were 5/8 (62.5%) and 2/5 (40%). No episodes of hypocalcemia, hypercalcemia or nephrolithiasis occurred in either group. Conclusion: Our findings suggest that “high dose” vitamin D supplementation results in higher rates of hypercalciuria in TM patients. Further studies are necessary to determine the optimal dose of vitamin D supplementation to minimize the risk of osteoporosis while preventing nephrolithiasis in TM patients. Disclosures: No relevant conflicts of interest to declare.
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Alhomoud, Mohammad, Alexandra Gomez-Arteaga, Sebastian A. Mayer, Jingmei Hsu, Adrienne A. Phillips, Tsiporah B. Shore, and Koen van Besien. "Screening Chest CT Prior to Allogenic Transplantation - High Rates of Occult Abnormalities." Blood 138, Supplement 1 (November 5, 2021): 1777. http://dx.doi.org/10.1182/blood-2021-153811.
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Abstract Introduction: Pulmonary complications constitute a major cause of morbidity and mortality in the post-hematopoietic cell transplant (HCT) period. While Chest X-ray (CXR) is customarily used for screening, we have utilized chest computed tomography (CT) within one month of transplant. Here we aim to characterize the prevalence of abnormalities and their impact on the eligibility for allogenic (allo) HCT and outcomes post-transplant. Methodology: We conducted a single center retrospective study of all patients who were evaluated for allogenic HCT from January 2013 through December 2020 in New York Presbyterian Hospital - Weill Cornell Medicine (NYP-WCM). All patients who had chest CT as part of their pre-transplant evaluation were included for analysis. Results: We identified 478 patients who had Chest CT screening. In 396 CT chest was normal or confirmed previous abnormalities. Eighty-two patients (17%) had previously undetected abnormalities (Figure 1). The most frequent abnormalities were pulmonary nodules (defined as nodules of 4 mm or greater) in 27 patients (31%), ground-glass opacities (GGO) in 21 patients (25%), Pneumonia in 18 patients (21%). Miscellaneous findings not related to the primary disease were found in 12 patients (14%) including thyroid nodules, breast nodules and hemangioma of the liver. A new malignancy was found in 6 patients (7%) and incidental pulmonary embolism (PE) in 2 patients (2%) (Figure 2). There were 5 (6%) patients who were ultimately excluded from transplant due to CT chest findings (simultaneous CXR showed abnormalities in only 1 out of 5). Three of those patients were found to have invasive fungal infection, and the other two had unrecognized metastatic lung cancer. For 19 patients (23%), transplant was delayed for diagnostic procedure and/or treatment of pulmonary findings (CXR showed abnormalities in only 3 patients out of 19). The most common reason for delay was lung infection requiring treatment. Thirty-two patients (41%) out of 77 patients with abnormal CT scan who eventually underwent transplant, have died . Sixteen died after relapse, and 16 from non-relapse mortality (NRM) with pulmonary complications playing a role in 13 patients (Figure 3). Conclusion: 17% of patients who had a pre-transplant CT chest had abnormalities that warranted further evaluation. In 23% of these patients, these findings led to a delay in transplant for further optimization. Six percent were deemed ineligible for transplant due to absolute contraindications that were incidentally discovered on chest CT. Initial screening CXR failed to identify a significant number of abnormalities. Our data suggests that chest CT imaging should be part of the routine pre-transplant evaluation. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.
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Arar, Celine, Valerie Reyna, Marshall J. Glesby, and Justin J. Choi. "1431. Evaluating Physician Decision Making in Inpatient Antibiotic Prescription for Suspected Urinary Tract Infection." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S797. http://dx.doi.org/10.1093/ofid/ofab466.1623.
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Abstract Background Physicians are constantly asked to evaluate inpatients for possible antibiotic treatment. As part of antibiotic stewardship it is imperative to understand the decision-making process behind a physician’s choice to prescribe antibiotics appropriately in an inpatient setting. Fuzzy Trace Theory (FTT) suggests that physicians use one of two methods in medical decision making; verbatim, employing a comprehensive risk benefit analysis, and gist, considering a bottom line analysis. Methods Seventy-six hospitalists at Weill Cornell Medicine in Manhattan, New York received a survey with two reminders to evaluate their decision-making process. Five basic demographic questions regarding participant gender, race, background, age, and years in practice were asked. A clinical vignette describing an inpatient with a possible urinary tract infection (UTI) was followed with statements framing hypothetical antibiotic prescription. A seven point Likert scale with response choices from Strongly Disagree scored as one to Strongly Agree scored as seven was used to assess degree of participant agreement with each statement. Questions were presented in a random order to eliminate possible effects of questions clusters or question order. Results Twenty-six hospitalists completed the survey. Consistent with previous literature, the hospitalists surveyed displayed a gist interpretation of the risks and benefits of antibiotics, with a mean Likert scale score of 5.54 agreeing that there are benefits to antibiotic prescription, and a mean Likert scale score of 6.04, agreeing that there are risks to antibiotic prescription. . However, the clinicians surveyed ultimately found antibiotics to be a necessary risk given the possible benefit of improving patient health. The hospitalists surveyed also did not view antibiotic prescription to be a product of pressure from patient families, agreeing by a mean Likert scale score of 5.08 that the patient’s family will trust their physician to prescribe antibiotics if needed. Conclusion These findings suggest that physician education to reduce overprescribing of antibiotics should underscore possible antibiotic risk, despite potential benefit. Disclosures Marshall J. Glesby, MD, Enzychem (Consultant)Gilead (Grant/Research Support)ReAlta Life Sciences (Consultant)Regeneron (Consultant, Grant/Research Support)Sobi (Consultant)Springer (Other Financial or Material Support, Royalties)UpToDate (Other Financial or Material Support, Royalties) Justin J. Choi, MD, Allergan (Consultant, Grant/Research Support)Roche (Consultant, Grant/Research Support)
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Kamat, Ashish. "Commentary on “Impact of statin use on oncologic outcomes in patients with urothelial carcinoma of the bladder treated with radical cystectomy.” da Silva RD, Xylinas E, Kluth L, Crivelli JJ, Chrystal J, Chade D, Guglielmetti GB, Pycha A, Lotan Y, Karakiewicz PI, Sun M, Fajkovic H, Zerbib M, Scherr DS, Shariat SF, Department of Urology and Division of Medical Oncology, Weill Cornell Medical College, New York - Presbyterian Hospital, New York, New York 10065, USA." Urologic Oncology: Seminars and Original Investigations 33, no. 1 (January 2015): 47–48. http://dx.doi.org/10.1016/j.urolonc.2014.03.022.
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Shin, Sandra J., and Paul Peter Rosen. "Excisional Biopsy Should Be Performed if Lobular Carcinoma In Situ Is Seen on Needle Core Biopsy." Archives of Pathology & Laboratory Medicine 126, no. 6 (June 1, 2002): 697–701. http://dx.doi.org/10.5858/2002-126-0697-ebsbpi.
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Abstract Context.—Percutaneous image-guided core biopsy is increasingly becoming the method of choice to evaluate impalpable breast lesions presenting with mammographically detected calcifications or as a mammographically detected mass. Infrequently, a diagnosis of a primary lobular lesion is rendered by needle core biopsy. Although lobular carcinoma in situ (LCIS) and atypical lobular hyperplasia (ALH) are not themselves detectable by mammography, they can be associated with calcifications. The management of patients with a primary diagnosis of LCIS or ALH on needle core biopsy is uncertain. Recommendations include excisional biopsy, tamoxifen citrate therapy, mammographic surveillance, or a combination of these approaches. Objective.—The purpose of this study was to report the histologic findings of excisional biopsies performed after ALH or LCIS was found in a needle core biopsy. Design.—Hematoxylin-eosin–stained slides of 20 needle core biopsy specimens from patients with a primary diagnosis of LCIS or ALH were retrieved from the consultation and surgical pathology files of New York Presbyterian Hospital–Weill Medical College of Cornell University. Histologic diagnoses were confirmed in all cases. Results.—Fourteen cases of primary LCIS and 6 cases of ALH found on needle core biopsy were identified. Subsequent excisional biopsy of the 14 LCIS cases revealed the following: LCIS, ductal carcinoma in situ, invasive carcinoma (1 patient; 7%); LCIS, infiltrating lobular carcinoma (1 patient; 7%); LCIS, ductal carcinoma in situ (1 patient; 7%); LCIS (8 patients; 57%); and ALH with or without atypical ductal hyperplasia (3 patients; 21%). Among the 6 patients with ALH on needle core biopsy, 1 had infiltrating lobular carcinoma and LCIS and 2 had LCIS in subsequent excision; other excisions for ALH were benign. Overall, 3 (21%) of 14 patients with a primary diagnosis of LCIS on needle core biopsy had a more significant lesion (ductal carcinoma in situ or invasive carcinoma) in a subsequent excisional biopsy. Conclusions.—Data obtained in this study and in previously published reports lead us to conclude that excisional biopsy may be indicated and should be considered when LCIS is found on needle core biopsy in order to more fully examine the biopsy site for coexistent, clinically inapparent intraductal or invasive carcinoma that may be present in about 25% of these patients. The small number of ALH cases studied produced inconclusive results. We recommend that excisional biopsy be considered if atypical ductal hyperplasia is present with ALH in a needle core biopsy or if the diagnosis of the biopsy specimen is discordant with the mammographic findings.
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Crystal, Ronald G., Edward Hirschowitz, Michael Lieberman, John Daly, Elias Kazam, Claudia Henschke, David Yankelevitz, et al. "Phase I Study of Direct Administration of a Replication Deficient Adenovirus Vector Containing the E. coli Cytosine Deaminase Gene to Metastatic Colon Carcinoma of the Liver in Association with the Oral Administration of the Pro-Drug 5-Fluorocytosine. The New York Hospital-Cornell Medical Center, New York, NY." Human Gene Therapy 8, no. 8 (May 20, 1997): 985–1001. http://dx.doi.org/10.1089/hum.1997.8.8-985.
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