Bridgeport, CT, United States
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Song W.-L.,University of Pennsylvania | Song W.-L.,Bridgeport Hospital | FitzGerald G.A.,University of Pennsylvania
Journal of Lipid Research | Year: 2013

Niacin (nicotinic acid) has been used for decades as a lipid-lowering drug. The clinical use of niacin to treat dyslipidemic conditions is limited by its side effects. Niacin, along with fibrates, are the only approved drugs which elevate high density lipoprotein cholesterol (HDLc) along with its effects on low density lipoprotein cholesterol (LDLc) and triglycerides. Whether niacin has a beneficial role in lowering cardiovascular risk on the background of well-controlled LDLc has not been established. In fact, it remains unclear whether niacin, either in the setting of well-controlled LDLc or in combination with other lipid-lowering agents, confers any therapeutic benefit and if so, by which mechanism. The results of recent trials reject the hypothesis that simply raising HDLc is cardioprotective. However, in the case of the clinical trials, structural limitations of trial design complicate their interpretation. This is also true of the most recent Heart Protection Study 2-Treatment of HDLc to Reduce the Incidence of Vascular Events (HPS2-THRIVE) trial in which niacin is combined with an antagonist of the D prostanoid (DP) receptor. Human genetic studies have also questioned the relationship between cardiovascular benefit and HDLc. It remains to be determined whether niacin may have clinical utility in particular subgroups, such as statin intolerant patients with hypercholesterolemia or those who cannot achieve a sufficient reduction in LDLc. It also is unclear whether a potentially beneficial effect of niacin is confounded by DP antagonism in HPS2-THRIVE. Copyright © 2013 by the American Society for Biochemistry and Molecular Biology, Inc.

Dr. Anke Ott Young, Plastic Surgeon, Norma F. Pfriem Breast Cancer Center, has joined The Expert Network©, an invitation-only service for distinguished professionals. Dr. Young has been chosen as a Distinguished Doctor™ based on peer reviews and ratings, numerous recognitions, and accomplishments achieved throughout her career. Dr. Young outshines others in her field due to her extensive educational background, recognitions, and career longevity. After earning her medical degree from Saarland University in Saarbrücken, Germany, Dr. Young went on to complete an internship and residency at the Ear, Nose, and Throat Hospital at the University of Homburg where she also earned her doctorate in forensic psychiatry. She continued her training in medicine stateside with a general surgery residency at Long Island Jewish Hospital, followed by a plastic surgery residency and a fellowship in reconstructive microsurgery at the Memorial Sloan-Kettering Cancer Center. With 24 years dedicated to medicine, Dr. Young brings a wealth of knowledge to her industry and, in particular, to her area of expertise, plastic reconstructive and oncoplastic surgery. When asked why she decided to pursue a career in medicine, Dr. Young said: "I always had a very keen interest for the science of medicine and helping people. My grandmothers and great-grandmothers and great-great-grandmothers all were midwives, so I think I had some of that in my blood. For me, I think surgery is instant gratification. You see the results right away which works for my temperament. I also like doing things with my hands. My mother is a seamstress so I grew up knitting and doing all kinds of craftwork so it fits right in." Dr. Young currently practices with Yale New Haven Health’s Bridgeport Hospital and splits her time between the Norma F. Pfriem Breast Cancer Center in Fairfield, Connecticut and her office in Garden City, New York where she focuses Minimally Invasive Breast Cancer Reconstruction. As a thought-leader in her specialty, Dr. Young keeps a close eye on prevailing trends in plastic surgery in order to be able to provide her patients with the most advanced care available. Always at the forefront of her methodology is providing her patients with superlative care and comfort, which has contributed to and maintained her interest in microsurgery. Recently, Dr. Young has seen an increasing shift toward this emerging field, as well as toward other minimally invasive procedures. She noted: "The trend is to make surgeries less and less invasive. I have implemented this in my own practice. Breast reconstruction has traditionally never really been a minimally invasive procedure; for example, a traditional mastectomy reconstruction has always resulted in broken muscle and skin for the sake of adding a new breast. But now, technology is getting increasingly better and so breast surgery is as well. This new technology that specializes in breast surgery allows us to spare muscle and connective tissue as well as make skin incisions in the way that works for the plastic surgeon and patient. With the cooperation between the specialties we get much better results with much less invasive surgery." Dr. Young is a member of the American Medical Association, the Association of Plastic Surgeons, and the Northeastern Society of Plastic Surgeons. For more information, visit Dr. Young's profile on the Expert Network here:,-md,-phd/0f8a17151273cb72 The Expert Network© has written this news release with approval and/or contributions from Dr. Anke Ott Young. The Expert Network© is an invitation-only reputation management service that is dedicated to helping professionals stand out, network, and gain a competitive edge. The Expert Network© selects a limited number of professionals based on their individual recognitions and history of personal excellence.

Plataki M.,Bridgeport Hospital | Sands S.A.,Brigham and Women's Hospital | Malhotra A.,Brigham and Women's Hospital
Respiratory Physiology and Neurobiology | Year: 2013

Control of ventilation dictates various breathing patterns. The respiratory control system consists of a central pattern generator and several feedback mechanisms that act to maintain ventilation at optimal levels. The concept of loop gain has been employed to describe its stability and variability. Synthesizing all interactions under a general model that could account for every behavior has been challenging. Recent insight into the importance of these feedback systems may unveil therapeutic strategies for common ventilatory disturbances. In this review we will address the major mechanisms that have been proposed as mediators of some of the breathing patterns in health and disease that have raised controversies and discussion on ventilatory control over the years. © 2013 Elsevier B.V.

Dainiak N.,Bridgeport Hospital | Dainiak N.,Yale University
Health Physics | Year: 2010

Treatment of the hematopoietic syndrome includes replacement with blood products, stem cell transplantation, and the use of hematopoietic cytokines. Cytokines have predictable effects based upon their mechanism of action. Those acting on early hematopoietic stem/progenitor cells have multilineage effects, while those acting upon more differentiated progenitor cells have lineage restricted activity. The selection of cytokines for treatment of acute hematopoietic toxicity in man is largely based upon results of experiments in non-human primates and canines. Since randomized controlled trials are unable to be performed in man after accidental radiation exposure, recommendations for therapy are largely based upon expert opinion. There is general agreement that granulocyte colony-stimulating factor (G-CSF) is an acceptable choice for treatment of individuals receiving a whole-body dose of 3 Gy or more, or 2 Gy or more in the presence of mechanical trauma and/or burns (i.e., combined injury). G-CSF is available in radiation stockpiles that have been developed in the U.S. and by the World Health Organization. Copyright © 2010 Health Physics Society.

This article outlines a new rhytidectomy technique, developed by the author, that utilizes bidirectional self-retaining (barbed) sutures for superficial musculoaponeurotic system (SMAS) plication and, in some instances, skin closures. Short-scar and traditional versions of the procedure are presented, and the history of purse-string SMAS plication and the advantages for using self-retaining sutures in this application are discussed. © 2015 The American Society for Aesthetic Plastic Surgery, Inc.

Sharma P.,Bridgeport Hospital
Blood Coagulation and Fibrinolysis | Year: 2016

Paget-Schroetter syndrome or effort thrombosis is characterized by spontaneous thrombosis of the upper extremity venous system, commonly seen in a young healthy patient after repetitive use of the upper extremities. It is rarely associated with coagulopathy and thus, hypercoagulable work-up is not usually a part of the investigation. We present a first case of a young woman, who was diagnosed with left upper extremity effort thrombosis following a dental procedure. Interestingly, she was also noted to be heterozygous for factor V Leiden mutation. Copyright © 2016 YEAR Wolters Kluwer Health, Inc. All rights reserved.

Majumdar S.K.,Bridgeport Hospital | Inzucchi S.E.,Yale University
Endocrine | Year: 2013

As the pandemic of type 2 diabetes spreads globally, clinicians face many challenges in treating an increasingly diverse patient population varying in age, comorbidities, and socioeconomic status. Current therapies for type 2 diabetes are often unable to alter the natural course of the disease and provide durable glycemic control, and side effects in the context of individual patient characteristics often limit treatment choices. This often results in the progression to insulin use and complex regimens that are difficult to maintain. Therefore, a number of agents are being developed to better address the pathogenesis of type 2 diabetes and to overcome limitations of current therapies. The hope is to provide more options for glucose lowering and complication reduction with less risk for hypoglycemia and other adverse effects. These agents include newer incretin-based therapies and PPAR agonists, as well as new therapeutic classes such as sodium-coupled glucose cotransporter 2 inhibitors, free fatty acid receptor agonists, 11-β-hydroxysteroid dehydrogenase type 1 inhibitors, glucokinase activators, and several others that may enter clinical use over the next decade. Herein we review these agents that are advancing through clinical trials and describe the rationale behind their use, mechanisms of action, and potential for glucose lowering, as well as what is known of their limitations. © 2013 Springer Science+Business Media New York.

Grewal Y.,Bridgeport Hospital
Connecticut medicine | Year: 2011

To determine whether Medicaid patients have ready access to subspecialty care. A survey was administered to training program directors and federal clinic chiefs to ascertain, for each medical and surgical subspecialty, whether their patients had access to care "never, rarely, sometimes, usually, or always." Seventeen respondents indicated that, on average, subspecialty care in Connecticut was available "never, rarely or sometimes," 36% of the time. Results of a smaller national sample, mirrored Connecticut responses. Despite government mandates, Medicaid patients have insufficient access to subspecialty care.

Panda B.,Harvard University | Stiller R.,Bridgeport Hospital | Panda A.,Yale University
Journal of Maternal-Fetal and Neonatal Medicine | Year: 2011

Background. The Center for Disease Control and Prevention (CDC) and the American College of Obstetricians and Gynecologists (ACOG) recommend influenza vaccination for all pregnant women during the influenza season. However, the actual rate of vaccination is substantially below the target levels. Given the recent emergence of novel influenza strains, there is an important need to address knowledge gaps in women and their healthcare providers to improve vaccination coverage for pregnant women during inter-pandemic and pandemic periods. This study attempted to identify potentially remediable attitudinal factors among women and their physicians that may present barriers to influenza vaccination and then assess the impact of interventions to increase the influenza vaccination rate in pregnant women. Methods. This prospective study initially analyzed patient and physician knowledge regarding the influenza vaccine in pregnancy and then examined the impact of several interventions aimed to increase immunization rates implemented over the following year. Influenza vaccination rates were assessed before and after the interventions. Results. Five hundred twenty patients were enrolled in the study during the influenza season 2007/2008. Only 19% of those patients reported receiving the influenza vaccination and only 28% recalled that the vaccine was offered. Following this, in the summer and fall of 2008, we performed a physician education program and distributed posters advertising the influenza vaccine to all offices offering prenatal care in our area in order to increase patient awareness of the need for the vaccine. In the following influenza season, we again reassessed the vaccination rate and patient's knowledge and awareness of the vaccine in 480 postpartum women. Influenza vaccination rates increased from 19% to 31%. After the intervention, 51% of patients recalled that the vaccine was offered to them during the pregnancy as opposed to only 28% the year prior. Conclusion. Understanding the specific barriers to vaccination that our population faced was helpful in designing the interventions to improve knowledge and acceptance of influenza vaccination in pregnancy, which led to an increased vaccination rates in women. © 2011 Informa UK, Ltd.

Zarich S.W.,Bridgeport Hospital
Current Diabetes Reports | Year: 2010

Despite a clear epidemiologic relationship between hemoglobin A 1c levels and the risk of cardiovascular (CV) disease in patients with type 2 diabetes mellitus (T2DM), prospective studies examining the benefit of intensive glucose lowering in reducing CV events have yielded conflicting results. Controversy over the choice of antidiabetic therapy for lowering macrovascular events has existed for nearly four decades, beginning with the potential risk of increased CV mortality with sulfonylurea use. Although sulfonylureas were subsequently felt to be safe, a more recent controversy was raised as to whether rosiglitazone use was associated with an increased risk of CV events. Additionally, early positive results for metformin in reducing macrovascular events have not been clearly substantiated. Because a typical patient with T2DM may live 20 to 40 years with the disease, long-term prevention of CV events is very important. An evidenced-based review of choice of antidiabetic therapy to reduce CV events in T2DM is discussed below. © 2010 Springer Science+Business Media, LLC.

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