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Rachmilewitz E.A.,Wolfson Medical Center | Giardina P.J.,New York Presbyterian Hospital
Blood | Year: 2011

The purpose of this article is to set forth our approach to diagnosing and managing the thalassemias, including β-thalassemia intermedia and β-thalassemia major. The article begins by briefly describing recent advances in our understanding of the pathophysiology of thalassemia. In the discussion on diagnosing the condition, we cover the development of improved diagnostic tools, including the use of very small fetal DNA samples to detectsingle point mutations with great reliability for prenatal diagnosis of homozygous thalassemia. In our description of treatment strategies, we focus on how we deal with clinical manifestations and long-term complications using the most effective current treatment methods for β-thalassemia. The discussion of disease management focuses on our use of transfusion therapy and the newly developed oral iron chelators, deferiprone and deferasirox.We also deal with splenectomy and how we manage endocrinopathies and cardiac complications. In addition, we describe our use of hematopoietic stem cell transplantation, which has produced cure rates as high as 97%, and the use of cord blood transplantation. Finally, we briefly touch on therapies that might be effective in the near future, including new fetal hemoglobin inducers and gene therapy. © 2011 by The American Society of Hematology.

News Article | February 15, 2017

Altium Wealth Management, LLC is pleased to announce that Jean Marie Connolly has joined the firm as Senior Director of Client Relations and Development, effective January 3, 2017. Jean Marie is an experienced corporate leader and has gained the trust and respect of her clients throughout her 30 years of relationship management. She has a history of successful organizational planning combined with broad work experience on corporate mergers, management, sales and marketing. Anthony DeStefano, Managing Director and cofounding Partner of Altium, commented: “Jean Marie embodies Altium’s values through her client advocacy, business leadership and involvement in the not-for-profit community. Her dedication, experience and reputation is a welcome addition to our firm.” Jean Marie added: “I am excited to join the Altium team, where we strive to ensure that each client receives the clarity, confidence and control needed to create meaningful wealth solutions for their life.” Prior to joining Altium, Jean Marie was a Senior Wealth Director at BNY Mellon Wealth Management providing investment management, fiduciary services and private banking to high net worth families, corporate executives and business owners. Previous to joining the Wealth Management group, Jean Marie was the Regional Manager of Connecticut’s Consumer Banking Region at Bank of New York. Jean Marie is active in the not-for-profit community and serves on various boards and committees for charitable organizations throughout the region. She serves on the Board for Food Bank for Westchester and sits as Vice Chair, Business Development on the Board of Directors for The Business Council of Westchester. Additionally, she serves on the Community Advisory Board for New York Presbyterian Hospital and the Advisory Board for Hope’s Door. Jean Marie works closely with the Westchester Woman’s Bar Association and is an active member of the Westchester County Bar Association where she serves on the Events Committee. She has chaired large scale events including the Westchester/Fairfield American Heart Association’s Go Red for Women, Go Red Society, Hope’s Door, Arts Westchester and Food Bank for Westchester. Altium Wealth Management, LLC is a wealth advisory firm with principal offices at 2500 Westchester Avenue in Purchase, New York. The firm also has a satellite office in Bergen County, New Jersey. The firm's primary clients are high net worth families. This firm is a Registered Investment Advisor (RIA) with the U.S. Securities and Exchange Commission. Any references to the terms “registered investment adviser” or “registered,” do not imply that Altium Wealth Management or any person associated with the firm have achieved a certain level of skill or training. For more information about Altium Wealth Management please visit, the Investment Adviser Public Disclosure web site (, or send an inquiry to us at info(at)altiumwealth(dot)com.

News Article | February 15, 2017

Dr. Ben Talei of The Beverly Hills Center for Plastic & Laser Surgery is a distinguished double-board certified facial plastic surgeon who is known for his dedication to use the most natural and minimally invasive techniques available. His mission is to deliver outstanding results in facial plastic surgery that portray natural beauty as well as provide valued sustainability. His patients have certainly recognized his excellence in facial plastic and reconstructive surgery, as they have posted a number of superior reviews and five-star rating across multiple credible online sources. This has led Find Local Doctors to feature Dr. Talei as a 2017 Top Patient Rated Plastic Surgeon for Beverly Hills. Find Local Doctors is an online directory that helps consumers connect with qualified and reputable physicians in their area. Dr. Ben Talei’s plastic and reconstructive surgery practice in Beverly Hills offers a full menu of facial plastic surgery procedures and cosmetic treatments, including advanced facelift procedures, rhinoplasty, eyebrow lifts, non-surgical skin rejuvenation and more. Dr. Talei has pioneered numerous techniques in facial plastic surgery to improve patient experience, recovery and results. These include a lip lift method that offers faster healing and more natural results than past surgical methods as well as an awake and painless deep plane facelift technique that Dr. Talei calls the Auralyft. Dr. Talei is also an industry-leading physician in the field of birthmark removal surgery for babies through adults. He carries remarkable training and expertise, including a dual fellowship training in Facial Cosmetic and Reconstructive Surgery, Vascular Birthmarks and Congenital Anomalies with Laser Surgery. The practice is committed to approaching patient care with complete transparency, sincerity and honesty. “We judge our success not by how we view our outcomes but by how our patients view their results. Therefore, because this award is based on actual patient reviews it represents a significant achievement for us,” says Dr. Ben Talei of The Beverly Hills Center for Plastic & Laser Surgery. The Beverly Hills Center for Plastic & Laser Surgery is now serving patients in a new, state-of-the-art facility located at 465 N. Roxbury Drive in Beverly Hills, CA 90210. About Dr. Ben Talei:     A native of California, Dr. Benjamin Talei graduated from the University of California, Los Angeles with a degree in Physiological Sciences. He received his medical degree at the University of California, San Diego School of Medicine. Dr. Talei then went on to complete his residency training in Head and Neck Surgery at Columbia University and Cornell University Medical Centers, New York Presbyterian Hospital. Following his residency program, Dr. Talei became one of the only surgeons in the country to complete two separate fellowships in Facial & Plastic and Reconstructive Surgery including a fellowship at the Vascular Birthmark Institute of New York. In addition, Dr. Talei is a respected author, speaker and humanitarian. If you would like to get more information about Dr. Ben Talei or his plastic and reconstructive surgery centers, please visit their website at or call (310) 288-0641.

News Article | February 17, 2017

(Reuters Health) - Postmenopausal women who intentionally lost weight over the course of three years had a much lower risk of endometrial cancer up to 11 years later compared to women whose weight didn’t change, a U.S. study finds. Overall, women who intentionally lost 5 percent or more of their body weight had 29 percent lower risk of developing endometrial cancer during the study period, and the effect was most pronounced for obese women, whose risk dropped by 66 percent with weight loss. “We decided to do the study because we realized that, although obesity increases the risk of endometrial cancer, research couldn’t say if intentional weight loss, especially among older persons, could reduce that risk,” lead author Juhua Luo, of the School of Public Health at Indiana University in Bloomington, told Reuters health in an email. Endometrial cancer is the most common gynecologic cancer in the U.S. and the fourth most common cancer among women. About 2.8 percent of American women will be diagnosed with endometrial cancer at some point during their lifetime, according to the National Cancer Institute. Body fat is thought to increase risk of this hormone-sensitive cancer by increasing the amount of estrogen a woman produces, the researchers write in Journal of Clinical Oncology. For their study, Luo and her colleagues analyzed data on more than 36,000 women between the ages of 50 and 79 who participated in the larger, long-term Women’s Health Initiative study. All the women were weighed at the beginning of the study period and again three years later when they were also asked if they had intentionally tried to lose weight in the previous few years. The study team followed the women for an average of 11 more years and found that 566 women were diagnosed with endometrial cancer during that time. With women whose weight remained stable as the reference point, researchers found that women who dropped pounds were significantly less likely to develop endometrial cancer, and those who gained weight saw an 8 percent to 23 percent increase in risk. For women who had not used hormone replacement therapy for menopausal symptoms and gained weight, risk rose by 30 percent. “It is not too late to lose weight to reduce cancer risk, even if you are older,” Luo said. The study only looked at older women, but Luo said she thinks it is reasonable to think the effects might apply to younger women too, and more research is indicated. “The majority of women with endometrial cancer are diagnosed with early-stage tumors that are associated with a high cure rate. However, despite this paradigm, not only is the incidence of endometrial cancer increasing, but the number of women who die as a result of the disease also is increasing,” Dr. Jason Wright, chief of gynecologic oncology at Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, writes in an editorial accompanying the study. In 2016, the number of deaths from endometrial cancer in the United States reached 10,170, which is a 25 percent increase compared with just five years earlier, he writes. Luo’s findings suggest that weight loss, even by a modest amount, can lower a woman’s risk of endometrial cancer, Wright told Reuters Health by email. “Fatty tissue releases estrogen which can stimulate the endometrium and increase a woman’s risk of endometrial cancer,” Wright said. At present, the only women for whom screening is recommended are those with Lynch syndrome, a genetic abnormality that predisposes women to the development of endometrial and colorectal cancer among other cancer types, Wright noted. “Most endometrial cancers will have symptoms early such as vaginal bleeding. Women with vaginal bleeding should consult with their physician for evaluation,” he said.

Kernberg O.,New York Presbyterian Hospital
International Journal of Psychoanalysis | Year: 2010

The main proposal of this paper is that normal mourning is not completed after six months to a year or two as suggested in earlier literature, but may bring about a permanent alteration of psychological structures that affect various aspects of the mourning persons' lives. These structural consequences of mourning consist in the setting up of a persistent internalized object relationship with the lost object that affects ego and superego functions. The persistent internalized object relationship develops in parallel to the identification with the lost object, and the superego modification includes the internalization of the value systems and life project of the lost object. A new dimension of spiritual orientation, the search for transcendental value systems, is one consequence of this superego modification. © 2010 Institute of Psychoanalysis.

Halmi K.A.,New York Presbyterian Hospital
BMC Psychiatry | Year: 2013

Background: Treatment resistance is an omnipresent frustration in eating disorders. Attempts to identify the features of this resistance and subsequently develop novel treatments have had modest effects. This selective review examines treatment resistant features expressed in core eating disorder psychopathology, comorbidities and biological features. Novel treatments addressing resistance are discussed.Description: The core eating disorder psychopathology of anorexia nervosa becomes a coping mechanism likely via vulnerable neurobiological features and conditioned learning to deal with life events. Thus it is reinforcing and ego syntonic resulting in resistance to treatment. The severity of core features such as preoccupations with body image, weight, eating and exercising predicts greater resistance to treatment. Bulimia nervosa patients are less resistant to treatment with treatment failure related to greater body image concerns, impulsivity, depression, severe diet restriction and poor social adjustment. For those with binge eating disorder overweight in childhood and high emotional eating predicts treatment resistance. There is suggestive data that a diagnosis of an anxiety disorder and severe perfectionism may confer treatment resistance in anorexia nervosa and substance use disorders or personality disorders with impulse control problems may produce resistance to treatment in bulimia nervosa. Traits such as perfectionism, cognitive inflexibility and negative affect with likely genetic influences may also affect treatment resistance. Pharmacotherapy and novel therapies have been developed to address treatment resistance. Atypical antipsychotic drugs have shown some effect in treatment resistant anorexia nervosa and topiramate and high doses of SSRIs are helpful for treatment of resistant binge eating disorder patients. There are insufficient randomized controlled trials to evaluate the novel psychotherapies which are primarily based on the core psychopathological features of the eating disorders.Conclusion: Treatment resistance in eating disorders is usually predicted by the severity of the core eating disorder psychopathology which develops from an interaction between environmental risk factors with genetic traits and a vulnerable neurobiology. Future investigations of the biological features and neurocircuitry of the core eating disorders psychopathology and behaviors may provide information for more successful treatment interventions. © 2013 Halmi; licensee BioMed Central Ltd.

Jones D.W.,New York Presbyterian Hospital
Journal of the American Heart Association | Year: 2013

Patients with peripheral arterial disease often experience treatment failure from restenosis at the site of a prior peripheral endovascular intervention (PVI) or lower extremity bypass (LEB). The impact of these treatment failures on the utilization and outcomes of secondary interventions is poorly understood. In our regional vascular quality improvement collaborative, we compared 2350 patients undergoing primary infrainguinal LEB with 1154 patients undergoing secondary infrainguinal LEB (LEB performed after previous revascularization in the index limb) between 2003 and 2011. The proportion of patients undergoing secondary LEB increased by 72% during the study period (22% of all LEBs in 2003 to 38% in 2011, P<0.001). In-hospital outcomes, such as myocardial infarction, death, and amputation, were similar between primary and secondary LEB groups. However, in both crude and propensity-weighted analyses, secondary LEB was associated with significantly inferior 1-year outcomes, including major adverse limb event-free survival (composite of death, new bypass graft, surgical bypass graft revision, thrombectomy/thrombolysis, or above-ankle amputation; Secondary LEB MALE-free survival = 61.6% vs primary LEB MALE-free survival = 67.5%, P=0.002) and reintervention or amputation-free survival (composite of death, reintervention, or above-ankle amputation; Secondary LEB RAO-free survival = 58.9% vs Primary LEB RAO-free survival 64.1%, P=0.003). Inferior outcomes for secondary LEB were observed regardless of the prior failed treatment type (PVI or LEB). In an era of increasing utilization of PVI, a growing proportion of patients undergo LEB in the setting of a prior failed PVI or surgical bypass. When caring for patients with peripheral arterial disease, physicians should recognize that first treatment failure (PVI or LEB) affects the success of subsequent revascularizations.

Kernbauer E.,New York University | Ding Y.,New York Presbyterian Hospital | Ding Y.,New York University | Cadwell K.,New York University
Nature | Year: 2014

Intestinal microbial communities have profound effects on host physiology. Whereas the symbiotic contribution of commensal bacteria is well established, the role of eukaryotic viruses that are present in the gastrointestinal tract under homeostatic conditions is undefined. Here we demonstrate that a common enteric RNA virus can replace the beneficial function of commensal bacteria in the intestine. Murine norovirus (MNV) infection of germ-free or antibiotic-treated mice restored intestinal morphology and lymphocyte function without inducing overt inflammation and disease. The presence of MNV also suppressed an expansion of group 2 innate lymphoid cells observed in the absence of bacteria, and induced transcriptional changes in the intestine associated with immune development and type I interferon (IFN) signalling. Consistent with this observation, the IFN-α receptor was essential for the ability of MNV to compensate for bacterial depletion. Importantly, MNV infection offset the deleterious effect of treatment with antibiotics in models of intestinal injury and pathogenic bacterial infection. These data indicate that eukaryotic viruses have the capacity to support intestinal homeostasis and shape mucosal immunity, similarly to commensal bacteria. © 2014 Macmillan Publishers Limited.

Brodie D.,Columbia University | Brodie D.,New York Presbyterian Hospital | Bacchetta M.,Columbia University | Bacchetta M.,New York Presbyterian Hospital
New England Journal of Medicine | Year: 2011

A 41-year-old woman presents with severe community-acquired pneumococcal pneumonia. Chest radiography reveals diffuse bilateral infiltrates, and hypoxemic respiratory failure develops despite appropriate antibiotic therapy. She is intubated and mechanical ventilation is initiated with a volume- and pressure-limited approach for the acute respiratory distress syndrome (ARDS). Over the ensuing 24 hours, her partial pressure of arterial oxygen (PaO 2) decreases to 40 mm Hg, despite ventilatory support with a fraction of inspired oxygen (FIO 2) of 1.0 and a positive end-expiratory pressure (PEEP) of 20 cm of water. She is placed in the prone position and a neuromuscular blocking agent is administered, without improvement in her PaO 2. An intensive care specialist recommends the initiation of extracorporeal membrane oxygenation (ECMO). Copyright © 2011 Massachusetts Medical Society.

Mann S.J.,New York Presbyterian Hospital
Journal of Clinical Hypertension | Year: 2011

Despite the availability of many effective antihypertensive drugs, the drug therapy for resistant hypertension remains a prominent problem. Reviews offer only the general recommendations of increasing dosage and adding drugs, offering clinicians little guidance with respect to the specifics of selecting medications and dosages. A simplified decision tree for drug selection that would be effective in most cases is needed. This review proposes such an approach. The approach is mechanism-based, targeting treatment at three hypertensive mechanisms: (1) sodium/volume, (2) the renin-angiotensin system (RAS), and (3) the sympathetic nervous system (SNS). It assumes baseline treatment with a 2-drug combination directed at sodium/volume and the RAS and recommends proceeding with one or both of just two treatment options: (1) strengthening the diuretic regimen, possibly with the addition of spironolactone, and/or (2) adding agents directed at the SNS, usually a β-blocker or combination of an α- and a β-blocker. The review calls for greater research and clinical attention directed to: (1) assessment of clinical clues that can help direct treatment toward either sodium/volume or the SNS, (2) increased recognition of the role of neurogenic (SNS-mediated) hypertension in resistant hypertension, (3) increased recognition of the effective but underutilized combination of α- + β-blockade, and (4) drug pharmacokinetics and dosing. © 2010 Wiley Periodicals, Inc.

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