Academic literature on the topic 'Lyndhurst (Tarrytown, N.Y.)'

13537 Background: Recently, a high expression of TIMP-1 was demonstrated by immunohistochemistry in colorectal cancer (CRC). TIMP-1 can also be detected in plasma of those patients (pts). We investigated the longitudinal concentrations of TIMP-1 in 37 pts with advanced CRC and correlated the monitoring performance of TIMP-1 to CEA and CA 19–9 as established markers of tumor load in CRC. In addition, the plasma level of TuM2-PK as novel marker of disease activity was integrated into the analysis. Methods: Plasma TIMP-1 (Bayer Diagnostics/Oncogene Science, Tarrytown/Boston, USA) and TuM2-PK (Schebo Biotech, Giessen, Germany) levels were measured using standardized ELISA assays while serum CEA and CA 19–9 were determined using chemiluminescence immunoassays (Bayer Diagnostics, Tarrytown/NY). The nonparametric analysis of variance for repeated measurements by Brunner was used to test for time effects between the selected 3 time points: 1. baseline at initiation of systemic chemotherapy for metastatic disease; 2: best response; 3: later progression. Results: We grouped 37 pts with regard to best response to chemotherapy as follows: complete or partial remission (CR/PR): n=10; stable disease (SD): n=21; primary progressive disease (PD): n=6. TIMP-1 and TuM2-PK concentrations increased significantly from baseline to progression (p<0.001 and p=0.003, respectively). The plasma levels of patients with objective response (CR/PR) dropped significantly for TuM2-PK (p=0.001) and TIMP-1 (p=0.001), while CA 19–9 and CEA did not change (p=0.94 and p=0.10, respectively). No significant change could be demonstrated in the SD group for TuM2-PK (p=0.26), TIMP-1 (p=0.69) and for CEA (p=0.25), whereas CA 19–9 concentrations decreased significantly (p=0.04). Conclusions: Innovative markers like TIMP-1 and TuM2-PK provided a much higher monitoring quality than established markers like CEA and CA 19–9 in advanced CRC. As the later cancer-associated proteins are recommended by internationally acknowledged guidelines, larger comparative trials are warranted asking the important question whether a replacement of CEA by one or a panel of new markers may provide additional clinical information. No significant financial relationships to disclose.

Objectives To develop SCI-FX, a risk score to estimate 5-year lower extremity fragility fracture risk among patients living with chronic spinal cord injury (cSCI). Methods Adults with traumatic cSCI (n = 90) participated in a 2-year prospective longitudinal cohort study describing bone mineral density (BMD) change and fracture incidence conducted at the Lyndhurst Centre (University Health Network), University of Waterloo, and Physical Disability Rehabilitation Institute of Québec City. Prior publication and clinical intuition were used to identify fragility fracture risk factors including prior fragility fracture, years post-injury, motor complete injury (AIS A/B), benzodiazepine use, opioid use, and parental osteoporosis. We conducted bivariate analyses to identify variables associated with fracture. Multiple logistic regressions were performed using fragility fracture incidence as the dependent variable and all variables from the univariate analyses with a highly liberal p value at 0.2. Using the odds ratios (ORs) from the multiple logistic regression model, a point system for fragility fracture risk score was developed, and the odds of fracture for each point was estimated. Results All initial variables, with the exception of benzodiazepine exposure, were included in the final model. Conclusion We identified a simple preliminary model for clinicians to estimate 5-year fracture risk among patients with cSCI based on their total score.

Background Following a traumatic spinal cord injury (tSCI), patients prioritize being able to manage their bowels independently. A reduction of independence can impact an individual’s quality of life. The current study investigates the relationships between sphincter control, level of independence and quality of life. We hypothesized that sphincter control would relate strongly to levels of independence and quality of life. Methods Adults with tSCI who consented to participate in the Rick Hansen Spinal Cord Injury Registry at the Lyndhurst Rehabilitation Centre completed community follow-up interviews from 2014-2021. Data was collected at baseline, year 1, 2 and 5 (n = 330). Descriptive data and neurological level of injury (NLI) were collected, along with the Life Satisfaction Questionnaire (LiSAT-11), 36-item Short Form Survey Quality of Life measures (SF-36v2) and the Spinal Cord Independence Measure III (SCIM). Separate analyses were conducted for NLI C1-T10 (upper motor neuron [UMN] [n=280]), and T11-S5 (lower motor neuron [LMN] [n=50]). Associations between sphincter management and life satisfaction were calculated using Spearman’s correlation coefficient, adjusted for age and sex. Results SCIM had a moderate, yet significant relationship with LiSAT-11 (r2=0.48, p&lt;0.001) for LMN, but no relationship for UMN (r2= 0.17, p&lt;0.001). A weak relationship was observed between SCIM and SF-36v2 for LMN (r2=0.30, p=0.014) but no relationship for UMN (r2=0.01, p=0.59). Conclusion Sphincter management scores after rehabilitation discharge are not a strong predictor of life satisfaction following tSCI suggesting that a multifaceted approach is required to assess an individuals’ quality of life post tSCI.

Background It is essential that individuals with spinal cord injury set their goals prior to their peripheral nerve transfer (PNT) surgery. Goal setting is a significant factor in pre-operative planning and is one way in which we can track performance and outcomes for these patients. Objectives To describe goal types identified by patients managed in the PNT-SCI rehab program at Lyndhurst-UHN. Cite and report the COPM outcomes in the domains of Self-care and Productivity. Methods A retrospective case series was conducted (n=14), charts were reviewed for type of goals and patient’s perception of goal attainment using COPM for a case series of three patients with tetraplegia who received PNT-SCI surgery and comprehensive rehabilitation. The changes in COPM are reported from baseline to 12 months post-surgery. Each patient identified three goals pre-surgery; their goals and the COPM were used to measure change over time. Results Ninety two percent of the identified goals were in the area of Self Care, and 8% were in the Productivity areas. Two of the patients who received PNT-SCI rehabilitation had an increase of 1 on the COPM, while one individual regressed by 2 points. That individual did not receive comprehensive rehabilitation. Conclusion It is known that recovery after PNT-SCI surgery can take 24 or more months. We reported COPM change scores at 12 months post surgery. The MCID is two points for COPM, ideally over 24 months we will see MCID of three or higher.

A retrospective chart review was conducted of patients who underwent cardiopulmonary bypass (CPB) to compare the quantities of heparin administered, postoperative blood loss, and homologous blood products transfused during their procedure and subsequent stay in the intensive care unit. The primary purpose of this review was to determine if any difference in heparin administration resulted when two different devices were used for dosing and monitoring heparin. Postoperative blood loss and amount of blood products transfused were also quantified, as any differences would potentially be a result of a difference in administration of heparin. The first group (n = 341) underwent CPB using the Hepcon® HMS, Medtronic Inc., Minneapolis, MN, for heparin dosing and monitoring. The Rapid Point™ Coag, Bayer Healthcare LLC, Tarrytown, NY was used for the second group (n = 345). The two populations were compared for similarity on: age, body surface area (BSA), CPB time (minutes), aortic-cross clamp time (minutes), baseline activated clotting time, and baseline hematocrit. No significant difference was found between the two groups. The second group, using the Rapidpoint™ Coag, received less heparin during CPB than the group using the Hepcon® HMS. In addition, there were decreases in amounts of some blood products transfused as well as mediastinal drainage from the Hepcon® HMS to the Rapidpoint™ Coag group. A summary of the findings can be found in Table 1. A secondary purpose of this study was to determine the influence of hemodilution on the Heparin Management Test (HMT®). Citrated whole blood was diluted to varying degrees at various concentrations to determine whether hemodilution with crystalloid would alter the HMT® measurements. At all heparin levels and degrees of dilution, the HMT® remained stable, with coefficients of variation (CV) of less than 5% at all heparin levels even while incorporating excessive crystalloid dilution (up to 75%).

Awareness of the range of additional parameters offered by many modern hematology analysers is increasing and some have found applications in today’s clinical diagnostic laboratories. In order to determine the white blood cell (WBC) count and differential, the Advia 120 (Bayer Diagnostics, Tarrytown, NY) uses low angle (0–5°) and high angle (5–15°) light scatter measurements to determine size and density of the cellular nuclei following removal of the cytoplasm by phthalic acid, as well as a cytochemical reaction involving hydrogen peroxide and a substrate (4-chloro-1-naphthol) to measure peroxidase activity in white blood cells. The latter are then displayed visually as 2-dimensional cytograms. The utility of these parameters to provide an early indication of the presence of leukemic cells was assessed retrospectively in 25 newly presenting cases of acute myeloid leukemia (AML) without peripheral blood pancytopenia. Using the French-American-British (FAB) classification, the cases comprised M0 (n=1), M1 (n=2), M2 (n=2), M3 (n=2), M4 (n=1), M5 (a+b) (n=4), and M6 (n=1). The remaining 12 patients were unclassified AML (although not M3). Using the classification system described by d’Onofrio (Bloodline Reviews2001; 2-R: 3–6), peroxidase activity was scored from P0 (peroxidase negative) to P6 (intense peroxidase positivity), and nuclear density was scored as D0 (normal profile) or D1 (abnormal mononuclear cell population shifted down and to the left - a region corresponding to the presence of blast cells). 23 out of 25 cases were correctly classified as probable AML (92%), comparing well with the findings of d’Onofrio (95.2%). 21 out of these 23 cases were also categorised correctly according to probable FAB type (91%). Of the 2 cases incorrectly classified, 1 case was classified as probable acute lymphoblastic leukemia (ALL), and 1 case was classified as probable myelodysplastic syndrome (MDS). Of note, only cases of M3 AML are allocated to the P6/D1 classification category. Both cases of M3 AML in this study were P6/D1and none of the remaining cases were misclassified into this category. The risk of associated coagulopathy and the unique response to treatment with all-trans retinoic acid (ATRA) makes prompt detection particularly important within this AML patient subgroup. Although not diagnostic in itself, the use of peroxidase activity and nuclear density analysis cytograms in routine complete blood counts (CBC) provides a valuable early indication of a possible case of AML, allowing the prompt initiation of confirmatory tests.

ObjectivesStage B heart failure (HF) is defined as an asymptomatic abnormality of the heart structure or function. The circulating level of N-terminal pro-B-type natriuretic peptide (NT-proBNP) is elevated in symptomatic patients with left ventricular (LV) dysfunction caused by a structural or functional abnormality. This study investigated the association of the NT-proBNP level with echocardiography-detected cardiac structural or diastolic abnormalities in asymptomatic subjects with preserved LV systolic function (ejection fraction >50%).MethodsWe retrospectively studied 652 health examinees who underwent echocardiography and an NT-proBNP test at a health-promotion centre in Seoul, between January 2016 and September 2018. The left ventricular mass index (LVMI) and the left atrial dimension (LAD) were used as markers for structural abnormalities, and the mean e’ velocity and mitral early flow velocity/early diastolic tissue velocity (E/e’) ratio were used as markers for diastolic dysfunction. The plasma NT-proBNP level was measured using electrochemiluminescence immunoassay (DPC Immulite 2000 XPi, Siemens Healthcare Diagnostics, Tarrytown, New York, USA).ResultsSubjects with preclinical structural abnormalities were older and had a higher body mass index (BMI), higher blood pressure, lower high-density lipoprotein cholesterol level, higher NT-proBNP level, and higher E/e’ (p<0.05). Multivariate regression analysis indicated that the factors associated with a higher NT-proBNP level were older age, female sex, lower BMI, higher creatinine level, higher LVMI and higher LAD (p<0.01).ConclusionDiastolic dysfunction is not associated with higher NT-proBNP levels, whereas preclinical cardiac structural abnormalities, as well as older age, female sex, lower BMI, and higher creatinine level, are associated with higher NT-proBNP levels.

Background: Serum creatinine (SCr) levels are decreased following traumatic amputation, leading to the overestimation of glomerular filtration rate (GFR). β-Trace protein (BTP) and β2-microglobulin (B2M) strongly correlate with measured GFR and have not been studied following amputation. We hypothesized that BTP and B2M would be unaffected by traumatic amputation. Methods: We used the Department of Defense Serum Repository to compare pre- and post-traumatic amputation serum BTP and B2M levels in 33 male soldiers, via the N Latex BTP and B2M nephelometric assays (Siemens Diagnostics, Tarrytown, N.Y., USA). Osterkamp estimation using DEXA scan measurements was used to establish percent estimated body weight loss (%EBWL). Results were analyzed for small (3-5.9% EBWL), medium (6-13.5%), and large (>13.5%) amputation subgroups; and for a control group matched 1:1 to the 12 large amputation subjects. Paired Student's t test was used for comparisons. Results: Mean serum BTP levels were unchanged in controls, all amputees, and the small and medium amputation subgroups. BTP appeared to decrease following large %EBWL amputation (p = 0.05). Mean serum B2M levels were unchanged in controls, all amputees, and the small and medium amputation subgroups. B2M appeared to increase following large %EBWL amputation (p = 0.05). Conclusions: BTP and B2M levels are less affected than SCr by amputation, and should be considered for future study of GFR estimation. BTP and B2M changes following large %EBWL amputation require validation and may offer insight into non-GFR BTP and B2M determinants as well as increased cardiovascular disease and mortality following amputation. This is a work of the US Government and is not subject to copyright protection in the USA. Foreign copyrights may apply. Published by S. Karger AG, Basel

Background:Anemia is a common comorbidity in patients with rheumatoid arthritis (RA).Objectives:Assess whether low hemoglobin (Hb) identifies a subgroup of patients at increased risk of joint damage progression, and investigate whether sarilumab modulates this risk.Methods:The 52-week, double-blind, Phase 3 MOBILITY trial (NCT01061736) in patients with active RA and inadequate response to methotrexate (n = 1197) demonstrated the tolerability and efficacy (clinical and radiographic) of subcutaneous sarilumab 150 and 200 mg every 2 weeks versus placebo, both in combination with methotrexate (MTX). In thispost hocanalysis, baseline characteristics and radiographic outcomes in MOBILITY were analyzed by baseline Hb category (low or normal) according to World Health Organization criteria, with low Hb defined as <120 g/L for women and <130 g/L for men. NominalPvalues are presented.Results:A total of 414 patients (35%) had low Hb at baseline. Patients with low Hb were more likely than patients with normal Hb to be female (86% vs 79%, respectively), Asian (14% vs 5%), younger (mean age 49 vs 51 years), and to have lower body weight (mean 69 vs 77 kg); all nominalP<0.01. Duration of RA, prior biologic use, rheumatoid factor positivity, and baseline tender and swollen joint counts were similar between patients with low and normal baseline Hb, but there was a nominally significant difference in C-reactive protein (mean 30.2 [SD 28.5] vs 17.3 [18.5] mg/L;P<0.0001). Patients with low Hb generally exhibited more joint damage progression over 52 weeks than patients with normal Hb (Table). In the sarilumab + MTX groups, joint damage progression was mitigated compared with placebo + MTX in patients with low Hb and in patients with normal Hb. Mean change from baseline in Hb at 52 weeks in the placebo + MTX, sarilumab 150 mg + MTX, and sarilumab 200 mg + MTX groups was +3.7 (SD 10.8), +14.7 (12.1), and +14.0 (10.5) g/L, respectively, in patients with low Hb at baseline, and –2.5 (9.9), +6.2 (9.3), and +8.0 (9.9) g/L in patients with normal Hb at baseline.Table.Mean change from baseline (SD) in radiographic measures of joint damagePlacebo+ MTXSarilumab 150 mg+ MTXSarilumab 200 mg+ MTXLow Hb (n = 140)Normal Hb (n = 258)Low Hb (n = 145)Normal Hb (n = 255)Low Hb (n = 129)Normal Hb (n = 270)mTSS3.75 (9.00)2.29 (6.98)1.20*** (5.58)0.73** (4.07)0.60*** (4.13)0.08*** (4.83)Joint space narrowing1.52 (3.71)1.22 (3.92)0.79* (3.17)0.30** (2.70)0.50** (2.93)0.06*** (3.33)Erosion score2.24 (6.24)1.07 (3.91)0.41*** (3.18)0.44* (2.05)0.10*** (2.13)0.02*** (2.19)NominalP*<0.05, **<0.01, ***<0.001 versus placebo by rank ANCOVA model stratified by prior biologic use and region; mTSS, modified total Sharp scoreConclusion:Overall, sarilumab slowed joint damage progression in patients with RA. Additionally, in those patients with low Hb, who may suffer greater damage than those with normal Hb, sarilumab also increased Hb.Acknowledgments:Study funding and medical writing support (Matt Lewis, PhD, of Adelphi Communications Ltd, Macclesfield, UK) were provided by Sanofi Genzyme (Cambridge, MA, USA) and Regeneron Pharmaceuticals, Inc. (Tarrytown, NY, USA) in accordance with Good Publication Practice (GPP3) guidelines.Disclosure of Interests:Gerd Rüdiger Burmester Consultant of: AbbVie Inc, Eli Lilly, Gilead, Janssen, Merck, Roche, Pfizer, and UCB Pharma, Speakers bureau: AbbVie Inc, Eli Lilly, Gilead, Janssen, Merck, Roche, Pfizer, and UCB Pharma, Jean-Pierre Morello Shareholder of: Regeneron Pharmaceuticals, Inc., Employee of: Regeneron Pharmaceuticals, Inc., Owen Hagino Shareholder of: Sanofi, Employee of: Sanofi, Amy Praestgaard Employee of: Sanofi Genzyme, Stefano Fiore Shareholder of: Sanofi, Employee of: Sanofi, Mark C. Genovese Grant/research support from: Abbvie, Eli Lilly and Company, EMD Merck Serono, Galapagos, Genentech/Roche, Gilead Sciences, Inc., GSK, Novartis, Pfizer Inc., RPharm, Sanofi Genzyme, Consultant of: Abbvie, Eli Lilly and Company, EMD Merck Serono, Genentech/Roche, Gilead Sciences, Inc., GSK, Novartis, RPharm, Sanofi Genzyme

Abstract Laboratory workup of the cause of anemia requires clinical staff to develop a differential diagnosis based on routine CBC parameters and to subsequently order confirmatory tests. The number of parameters to be reviewed and the complexity of calculations which are performed by individuals on a routine basis is necessarily limited. The wealth of information in the many novel parameters and the complex patterns provided by modern hematology analyzers are frequently not utilized in routine clinical care. The use of computers for pre-classification of common RBC disorders would provide immediate information to order reflex confirmatory tests on the first sample, thereby improving patient care and allowing significant cost savings. Eleven European sites collected 2,303 data files from hematologically normal patients and individuals diagnosed with at least one of 36 RBC disorders. Samples were run on the ADVIA 120 Hematology System (Bayer HealthCare LLC, Diagnostics Division, Tarrytown, NY), an automated cell counter used in routine clinical hematology laboratories worldwide. Based on their representation within this database, a subset of 5 diseases (β-thalassemia heterozygote, β-thalassemia homozygote, Hb S homozygote, Hb SC, and hereditary spherocytosis; n=779 samples) and 123 normal cases were selected and used to develop a neural-network based computer program, the Computer Assisted RBC Disorder (CARD) Classification tool. The CARD utilizes hundreds of routine and novel CBC, differential and reticulocyte parameters available from the ADVIA 120 and 2120 Hematology Systems to determine possible causes of a patient’s anemia. We evaluated the CARD by using it to classify 273 new cases from 9 worldwide centers. The program correctly identified 93% of the cases. The majority of misidentifications were due to normal cases being classified as abnormal. 2 Hb S homozygote and one β-thalassemia heterozygote samples were misidentified as Hb SC. Only 2 of 137 abnormal cases, which were β-thalassemia heterozygote, were misclassified as normal. The performance of the tool for the presence of any hemoglobinopathy/thalassemia investigated was: sensitivity: 99%; specificity: 90%; PPV: 90%, NPV: 98%. This neural network-based computer program has demonstrated excellent performance with a validation set of samples and demonstrates the potential for using information from automated hematology analyzers to screen for the presence of certain hemoglobinopathies and to provide real-time information to direct an anemia workup. CARD TOOL ACCURACY # Correct # Incorrect Normal 122 14 β-Thalassemia Heterozygote 99 3 β-Thalassemia Homozygote 18 0 Hb S Homozygote 11 2 Hb SC 2 0 Hereditary Spherocytosis 2 0 TOTAL 254 (93%) 19 (7%)