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Rosner W.,Roosevelt University | Hankinson S.E.,University of Massachusetts Amherst | Hankinson S.E.,Brigham and Womens Hospital | Sluss P.M.,Harvard University | And 3 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2013

Objective: The objective of the study wastoevaluate thecurrent state of clinical assays for estradiol in the context of their applications. Participants: The participants were appointedbythe Council of The Endocrine Society and charged with attaining the objective using published data and expert opinion. Evidence: Data were gathered from published sources via online databases (principally PubMed, Ovid MEDLINE, Google Scholar), and the clinical and laboratory experience of the participants. Consensus Process: The statement was an effort of the committee and was reviewed by each member. The Clinical Affairs Committee, the Council of The Endocrine Society, and JCEM reviewers reviewed the manuscript and made recommendations. Conclusions: The measurement of estradiol in biological fluidsisimportant inhuman biology from cradleto grave. In addition to its centrality in sexual development, ithas significant effectson skin, blood vessels, bone, muscle, coagulation, hepatic cells, adipose tissue, the kidney, the gastrointestinal tract, brain, lung, and pancreas. Alterations in its plasma concentration have been implicated in coronary artery disease, stroke, and breast cancer. Although modern immunoassays and liquid chromatography/tandem mass spectrometry-based methods for estradiol are reasonably well suited to the diagnosis and management of infertility (nonetheless, imprecision and method-to-method differences remain problematic), the very low concentrations that appear to be crucial in nonreproductive tissues are a separate and more difficult issue. Such levels of estradiol are too low to be routinely measured accurately or precisely, and further evolution of analytical methods and the way in which estradiol is standardized is needed. Copyright © 2013 by The Endocrine Society.

Aragam K.G.,Massachusetts General Hospital | Dai D.,Duke University | Neely M.L.,Duke University | Bhatt D.L.,Harvard University | And 3 more authors.
Journal of the American College of Cardiology | Year: 2015

Background Rates of referral to cardiac rehabilitation after percutaneous coronary intervention (PCI) have been historically low despite the evidence that rehabilitation is associated with lower mortality in PCI patients. Objectives This study sought to determine the prevalence of and factors associated with referral to cardiac rehabilitation in a national PCI cohort, and to assess the association between insurance status and referral patterns. Methods Consecutive patients who underwent PCI and survived to hospital discharge in the National Cardiovascular Data Registry between July 1, 2009 and March 31, 2012 were analyzed. Cardiac rehabilitation referral rates, and patient and institutional factors associated with referral were evaluated for the total study population and for a subset of Medicare patients presenting with acute myocardial infarction. Results Patients who underwent PCI (n = 1,432,399) at 1,310 participating hospitals were assessed. Cardiac rehabilitation referral rates were 59.2% and 66.0% for the overall population and the AMI/Medicare subgroup, respectively. In multivariable analyses, presentation with ST-segment elevation myocardial infarction (odds ratio 2.99; 95% confidence interval: 2.92 to 3.06) and non-ST-segment elevation myocardial infarction (odds ratio: 1.99; 95% confidence interval: 1.94 to 2.03) were associated with increased odds of referral to cardiac rehabilitation. Models adjusted for insurance status showed significant site-specific variability in referral rates, with more than one-quarter of all hospitals referring <20% of patients. Conclusions Approximately 60% of patients undergoing PCI in the United States are referred for cardiac rehabilitation. Site-specific variation in referral rates is significant and is unexplained by insurance coverage. These findings highlight the potential need for hospital-level interventions to improve cardiac rehabilitation referral rates after PCI. © 2015 American College of Cardiology Foundation.

Tyler K.L.,Aurora University | Tyler K.L.,Denver Veterans Affairs Medical Center
Current Opinion in Neurology | Year: 2014

PURPOSE OF REVIEW: West Nile virus (WNV) is the most important cause of epidemic encephalitis in the United States. We review articles published in the last 18 months related to the epidemiology, immunology, clinical features, and treatment of this disease. RECENT FINDINGS: There was a resurgence in WNV disease in the United States in 2012. The WNV strain now predominant in the United States (NA/WN02) differs from the initial emergent isolate in 1999 (NY99). However, differences in the genetics of currently circulating United States WNV strains do not explain variations in epidemic magnitude or disease severity. Innate and acquired immunity are critical in control of WNV, and in some cases pathways are central nervous system specific. The clinical features of infection are now well understood, although nonconfirmed observations of chronic viral excretion in urine remain controversial. There is no specific antiviral therapy for WNV, but studies of antivirals specific for other flaviviruses may identify agents with promise against WNV. Phase I and II human WNV vaccine clinical trials have established that well tolerated and immunogenic WNV vaccines can be developed. SUMMARY: WNV remains an important public health problem. Although recent studies have significantly increased our understanding of host immune and genetic factors involved in control of WNV infection, no specific therapy is yet available. Development of a well tolerated, immunogenic, and effective vaccine against WNV is almost certainly feasible, but economic factors and the lack of predictability of the magnitude and location of outbreaks are problematic for designing phase III trials and ultimate licensure. © © 2014 Wolters Kluwer Health | Lippincott Williams &Wilkins.

Kozora E.,National Jewish Health | Kozora E.,University of Colorado at Denver | Filley C.M.,University of Colorado at Denver | Filley C.M.,Denver Veterans Affairs Medical Center
Journal of the International Neuropsychological Society | Year: 2011

Brain abnormalities have been documented by neuropsychological assessment as well as a variety of neuroimaging techniques in patients with systemic lupus erythematosus (SLE). Conventional neuroimaging in patients with neuropsychiatric disease (NPSLE) typically discloses periventricular white matter (WM) hyperintensities, infarcts, hemorrhages, and cerebral atrophy. In SLE patients with none of these findings, sophisticated neuroimaging techniques have recently supported associations between microstructural WM abnormalities and abnormal attention, executive function, and processing speed. This mild cognitive dysfunction in SLE (MCD-SLE), which may result from early myelinopathy, precedes the more severe cognitive dysfunction of NPSLE, related to more obvious WM and neuronal damage. © 2011 The International Neuropsychological Society.

Filley C.M.,Aurora University | Filley C.M.,Denver Veterans Affairs Medical Center | Bernick C.,Cleveland Clinic
Neurology | Year: 2015

As even any casual American sports enthusiast can attest, the football season occupies a special position in the popular imagination. Fans flock to stadiums and televisions to watch their teams perform in this increasingly violent contact sport, and among these fans, children may come to idolize star players and be almost irresistibly drawn to the gridiron. Parents and coaches may also exert substantial pressure on children to take up the sport. Whereas the benefits of physical exercise are undeniable for the promotion of cardiovascular health and psychological well-being, participation in football may result in neurologic sequelae ranging from mild traumatic brain injury (mTBI)1 to death,2 and repetitive mTBI has been associated with a degenerative dementia in later life known as chronic traumatic encephalopathy (CTE).3 Football has the highest injury rate among team sports, and given that 70% of all football players in the United States are under the age of 14 and that every child aged 9-12 can be exposed to 240 head impacts during a single football season,4 a better understanding of neurobehavioral sequelae among children who play football is urgently needed. Wide gaps exist in our knowledge, but an area of particularly limited information is the long-term outcome of repetitive mTBI among children in whom recovery from the acute event was apparently complete. © 2015 American Academy of Neurology.

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