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Ramirez-Ortiz M.A.,Hospital Infantil de Mexico Federico Gomez | Ponce-Castaneda M.V.,Instituto Mexicano Of Seguro Social | Cabrera-Munoz M.L.,Hospital Infantil de Mexico Federico Gomez | Medina-Sanson A.,Hospital Infantil de Mexico Federico Gomez | And 2 more authors.
Cancer Epidemiology Biomarkers and Prevention | Year: 2014

Background: More invasive retinoblastoma, characterized by increased morbidity and mortality, with lower rates of eye salvage and higher rates of extraocular dissemination, seems more prevalent in resource-poor countries. The relationship of diagnostic delay (lag time) and sociodemographic factors on the extent of disease at diagnosis has not been examined separately for unilateral and bilateral retinoblastoma. Methods: At diagnosis, consenting parents of 179 Mexican children with retinoblastoma were interviewed about initial symptoms and household demographic characteristics. Clinical presentation was classified using St. Jude's, International Staging System (ISS), and International Intraocular Retinoblastoma Classification (IIRC) criteria. Lag time (delay between noting symptoms and diagnosis) and sociodemographic factors were examined as predictors for higher stage at diagnosis and overall survival (OS). Results: In bilateral disease, lag time predicts stage at diagnosis using St. Jude's, and ISS criteria (P < 0.005 in multivariate regression), and OS (P < 0.05, Cox hazards), but not extent of intraocular disease (by IIRC). In unilateral disease, lag time predicts neither extent of disease (using ISS, St Jude's, and IIRC), nor OS. Indicators of prenatal poverty, including lower maternal education and the presence of dirt flooring in the home, predict more advanced disease by IIRC for bilateral retinoblastoma, and for unilateral by ISS, and St Jude's (P < 0.001) as well as OS (P < 0.05). Conclusion: These results suggest unilateral and bilateral retinoblastoma differs in factors governing progression and extraretinal extension, possibly reflecting underlying biologic heterogeneity. Impact: This demonstrates differing effect of social factors on extent of intra- and extraocular disease depending on laterality with implications for screening strategies. © 2014 American Association for Cancer Research. Source


Kelly M.A.,New York State Psychiatric Institute | Kelly M.A.,Columbia University | Pavlicova M.,Columbia University | Glass A.,22 West 168th Street | And 10 more authors.
Drug and Alcohol Dependence | Year: 2014

Background and aims: Cannabis-dependent participants with depressive disorder are less likely to achieve abstinence with venlafaxine-XR (VEN-XR) treatment. Individuals on VEN-XR reported more severe withdrawal, despite not reducing their smoking behavior. We hypothesized that withdrawal-like symptoms, likely medication side effects, led to continued marijuana smoking in this group. Methods: We conducted a secondary analysis using Marijuana Withdrawal Checklist (MWC) scores and urine THC to test whether severity of withdrawal-like symptoms mediates the relationship between VEN-XR treatment and continued marijuana smoking. We included 103 participants (VEN-XR. =. 51, Placebo. =. 52). Marijuana use was dichotomized into smoking (THC. >. 100. ng/ml) and non-smoking (THC. ≤. 100. ng/ml) weeks. MWC scores were obtained weekly. We used three models in a regression based mediation analysis. Results: The estimated risk of smoking marijuana was greater for individuals on VEN-XR in weeks 7-9, even when controlling for MWC scores (week 7 Risk Difference (RD). =. 0.11, p=. 0.034; week 8 RD. =. 0.20, p=. 0.014), and higher scores mediated this effect. In weeks 10 and 11, the estimated effect was stronger (week 10 RD. =. 0.03, p=. 0.380; week 11 RD. =. 0.07, p=. 0.504), and worse withdrawal-like symptoms more fully accounted for continued marijuana smoking in the VEN-XR group, according to the models. Conclusions: Individuals treated with VEN-XR had more severe withdrawal-like symptoms, which mediated their continued marijuana smoking. Noradrenergic agents, such as VEN-XR, may negatively impact treatment outcomes in cannabis-dependent patients attempting to reduce or stop their use. © 2014 Elsevier Ireland Ltd. Source


Johnson C.K.,22 West 168th Street | Cabreriza S.E.,22 West 168th Street | Sahar R.L.,22 West 168th Street | Rusanov A.,22 West 168th Street | And 5 more authors.
ASAIO Journal | Year: 2012

Biventricular pacing (BiVP) improves cardiac output (CO) and mean arterial pressure (MAP) after cardiopulmonary bypass (CPB) in selected patients at risk for acute left heart failure after cardiac surgery. Optimization of atrioventricular delay (AVD) and interventricular delay (VVD) to maximize the hemodynamic effect of pacing requires rapid and accurate data processing. Conventional post hoc data processing (PP) is accurate but time-consuming, and infeasible in the intraoperative setting. We created a customized, real-time data processing (RTP) system to improve data processing efficiency, while maintaining accuracy. Biventricular pacing optimization was performed within 1 hour of the conclusion of CPB in 10 patients enrolled in the Biventricular Pacing After Cardiac Surgery trial. Cardiac output, measured by an electromagnetic flow meter, and arterial pressure were recorded as AVD was randomly varied across seven settings and VVD across nine settings. Post hoc data processing values calculated by two observers were compared to RTP-generated outputs for CO and MAP. Interexaminer reliability coefficients were generated to access the dependability of RTP. Interexaminer reliability coefficient values ranged from 0.997 to 0.999, indicating RTP is as reliable as PP for optimization. Real-time data processing is instantaneous and therefore is more practical in a clinical setting than the PP method. Real-time data processing is useful for guiding intraoperative BiVP optimization and merits further development. Copyright © 2012 by the American Society for Artificial Internal. Source


Landry D.W.,22 West 168th Street | Oliver J.A.,30 West 168th Street
Critical Care | Year: 2010

Vasopressin is becoming a widely used pressor in conditions with severe hypotension. Like several other hormones important in cardiovascular and extracellular fluid control, however, vasopressin can activate several receptors that when pharmacologically or pathologically stimulated may result in conflicting effects. In the present issue of Critical Care, Rehberg and colleagues examined the hypothesis that blockade of vasopressin V2 receptor during septic shock may be beneficial. Their tantalizing results indicate that future work must consider the precise vasopressin receptors that are stimulated and/or inhibited. © 2010 BioMed Central Ltd. Source


Friedman A.M.,22 West 168th Street | Ananth C.V.,22 West 168th Street | Lu Y.-S.,22 West 168th Street | D'Alton M.E.,22 West 168th Street | Wright J.D.,22 West 168th Street
Obstetrics and Gynecology | Year: 2013

OBJECTIVE:: To characterize contemporary practice patterns for postcesarean thromboembolism prophylaxis and determine whether opportunities to substantially decrease maternal mortality and morbidity in this clinical setting are being missed. METHODS:: A commercial hospitalization database that includes procedure and diagnosis codes, health care provider and hospital information, and patient demographic data were used to analyze use of venous thromboembolism prophylaxis after cesarean delivery in the United States between 2003 and 2010. The analysis evaluated whether patients received pharmacologic prophylaxis, mechanical prophylaxis, combined prophylaxis, or no prophylaxis. Hospital-level factors and patient characteristics were included in multivariable regression models evaluating prophylaxis administration. RESULTS:: We identified 1,263,205 women who underwent cesarean delivery. Within the cohort, 75.7% (n=955,787) received no thromboembolism prophylaxis, 22.1% (n=278,669) received mechanical prophylaxis alone, 1.3% (n=16,639) received pharmacologic prophylaxis, and 1.0% (n=12,110) received combination prophylaxis. The rate of prophylaxis increased from 8.4% in 2003 to 41.6% in 2010. Prophylaxis rates varied significantly by geographic region. Medical risk factors for thromboembolism were associated with only modest increases in prophylaxis. CONCLUSION:: Although our findings demonstrated increased adoption of postcesarean venous thromboembolism prophylaxis, fewer than half of patients received recommended care as of 2010, and significant variation was present. Thromboembolism prophylaxis is underused and represents a major opportunity to reduce maternal morbidity and mortality. Risk assessment tools and thromboprophylaxis guidelines are needed to assure high-quality, uniform care. © 2013 by The American College of Obstetricians and Gynecologists. Published by Lippincott Williams & Wilkins. Source

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