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Article: Pharmacokinetics of apixaban in patients undergoing pancreaticoduodenectomy (PAP-UP).

Zheng, Richard / Lam, Edwin / Altshuler, Peter / Crutcher, Madison / Lavu, Harish / Yeo, Charles J / Stickle, Douglas / Leiby, Benjamin / Kraft, Walter K

International journal of clinical pharmacology and therapeutics

2024

Abstract: Objective: The impact of pancreaticoduodenectomy on absorption of drugs in the duodenum remains largely unknown. We aim to characterize the pharmacokinetics of apixaban in patients who had previously undergone pancreaticoduodenectomy.: Materials and ... ...

Abstract	Objective: The impact of pancreaticoduodenectomy on absorption of drugs in the duodenum remains largely unknown. We aim to characterize the pharmacokinetics of apixaban in patients who had previously undergone pancreaticoduodenectomy. Materials and methods: A single 10-mg dose of apixaban was administered to 4 volunteers who underwent pancreaticoduodenectomy at least 6 months prior. The maximum plasma apixaban concentration (C Results: In pancreaticoduodenectomy patients, AUC Conclusion: The pharmacokinetic characteristics of apixaban in subjects who had undergone pancreaticoduodenectomy are not significantly different from those of healthy controls. Though the sample size of this study is small, results suggest that no change to apixaban dose regimen is needed in patients who have had a pancreaticoduodenectomy.
Language	English
Publishing date	2024-04-25
Publishing country	Germany
Document type	Journal Article
ZDB-ID	124384-6
ISSN	0946-1965 ; 0340-0026 ; 0300-9718 ; 0174-4879
ISSN	0946-1965 ; 0340-0026 ; 0300-9718 ; 0174-4879
DOI	10.5414/CP204502
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Article: Pericardial Effusion: A Novel Presentation of Aplastic Anemia.

Hall, Robert J / Leach, Daniel F / Altshuler, Ellery / Seifert, Robert P / Al-Mansour, Zeina A

Cureus

2023 Volume 15, Issue 1, Page(s) e33276

Abstract: Pericardial effusion is defined as the accumulation of fluid between the visceral and parietal pericardium. The underlying etiology varies as any pathology that causes pericarditis or involves the pericardium can cause effusion. In practice, the majority ...

Abstract	Pericardial effusion is defined as the accumulation of fluid between the visceral and parietal pericardium. The underlying etiology varies as any pathology that causes pericarditis or involves the pericardium can cause effusion. In practice, the majority of pericarditis cases are idiopathic, although these are assumed to be secondary to occult viral infection or inflammatory phenomena. Malignancy, particularly the metastatic spread of noncardiac primary tumors, has been implicated as a differential in the diagnosis of pericardial effusion. Though commonly seen in solid malignancies, effusion has been reported in hematologic malignancies such as myelodysplastic syndrome (MDS), acute leukemia, and lymphoma. Nonetheless, pericardial effusions associated with hematologic conditions are extremely rare with only one case report published describing pericardial effusion secondary to immune thrombocytopenia (ITP). We herein report the first documented case, to our knowledge, of pericardial effusion as an initial clinical manifestation of aplastic anemia in a middle-aged male presenting with pancytopenia.
Language	English
Publishing date	2023-01-02
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.33276
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Article: Facial Diplegia: A Rare, Atypical Variant of Guillain-Barré Syndrome and Ad26.COV2.S Vaccine.

Jain, Esha / Pandav, Krunal / Regmi, Pratima / Michel, George / Altshuler, Ida

Cureus

2021 Volume 13, Issue 7, Page(s) e16612

Abstract: This potentially life-threatening disease poses an interesting perspective on adverse events that can occur or can be exacerbated following the Ad26.COV2.S (Johnson & Johnson) vaccine. The authors report findings in a 65-year-old female patient who ... ...

Abstract	This potentially life-threatening disease poses an interesting perspective on adverse events that can occur or can be exacerbated following the Ad26.COV2.S (Johnson & Johnson) vaccine. The authors report findings in a 65-year-old female patient who experienced facial diplegia, an atypical variant of Guillain-Barré syndrome, two weeks after receiving the Ad26.COV2.S vaccine against coronavirus disease 2019. Post-approval pharmacovigilance of each vaccine helps better understand the long-term outcomes, and reporting adverse events is crucial for advancements in medical knowledge.
Language	English
Publishing date	2021-07-25
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.16612
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Article ; Online: Elevated risk of recurrence and retreatment for silent pituitary adenomas.

Gupta, Saksham / Hoffman, Samantha E / Mehta, Neel H / Hauser, Blake / Altshuler, Marcelle / Bernstock, Joshua D / Smith, Timothy R / Arnaout, Omar / Laws, Edward R

Pituitary

2024 Volume 27, Issue 2, Page(s) 204–212

Abstract: ... in median diameter than FPAs (2.1 cm vs. 1.2 cm, p < 0.001). The most frequent subtypes of SPA were ... resections and 86.0% of FPA resections (p < 0.001). SPAs had a higher likelihood of recurring (hazard ratio ...

Abstract	Purpose: Pituitary adenomas are the most common tumor of the pituitary gland and comprise nearly 15% of all intracranial masses. These tumors are stratified into functional or silent categories based on their pattern of hormone expression and secretion. Preliminary evidence supports differential clinical outcomes between some functional pituitary adenoma (FPA) subtypes and silent pituitary adenoma (SPA) subtypes. Methods: We collected and analyzed the medical records of all patients undergoing resection of SPAs or FPAs from a single high-volume neurosurgeon between 2007 and 2018 at Brigham and Women's Hospital. Descriptive statistics and the Mantel-Cox log-rank test were used to identify differences in outcomes between these cohorts, and multivariate logistic regression was used to identify predictors of radiographic recurrence for SPAs. Results: Our cohort included 88 SPAs and 200 FPAs. The majority of patients in both cohorts were female (48.9% of SPAs and 63.5% of FPAs). SPAs were larger in median diameter than FPAs (2.1 cm vs. 1.2 cm, p < 0.001). The most frequent subtypes of SPA were gonadotrophs (55.7%) and corticotrophs (30.7%). Gross total resection (GTR) was achieved in 70.1% of SPA resections and 86.0% of FPA resections (p < 0.001). SPAs had a higher likelihood of recurring (hazard ratio [HR] 3.2, 95% confidence interval [95%CI] 1.6-7.2) and a higher likelihood of requiring retreatment for recurrence (HR 2.5; 95%CI 1.0-6.1). Subset analyses revealed that recurrence and retreatment were more both likely for subtotally resected SPAs than subtotally resected FPAs, but this pattern was not observed in SPAs and FPAs after GTR. Among SPAs, recurrence was associated with STR (odds ratio [OR] 9.3; 95%CI 1.4-64.0) and younger age (OR 0.92 per year; 95%CI 0.88-0.98) in multivariable analysis. Of SPAs that recurred, 12 of 19 (63.2%) were retreated with repeat surgery (n = 11) or radiosurgery (n = 1), while the remainder were observed (n = 7).There were similar rates of recurrence across different SPA subtypes. Conclusion: Patients undergoing resection of SPAs should be closely monitored for disease recurrence through more frequent clinical follow-up and diagnostic imaging than other adenomas, particularly among patients with STR and younger patients. Several patients can be observed after radiographic recurrence, and the decision to retreat should be individualized. Longitudinal clinical follow-up of SPAs, including an assessment of symptoms, endocrine function, and imaging remains critical.
MeSH term(s)	Humans ; Male ; Female ; Pituitary Neoplasms/diagnostic imaging ; Pituitary Neoplasms/surgery ; Pituitary Neoplasms/metabolism ; Retrospective Studies ; Neoplasm Recurrence, Local/epidemiology ; Adenoma/pathology ; Retreatment ; Treatment Outcome
Language	English
Publishing date	2024-02-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	1385151-2
ISSN	1573-7403 ; 1386-341X
ISSN (online)	1573-7403
ISSN	1386-341X
DOI	10.1007/s11102-024-01382-3
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Article: Learning from Others' Disasters? A Comparative Study of SARS/MERS and COVID-19 Responses in Five Polities.

Feitelson, Eran / Plaut, Pnina / Salzberger, Eli / Shmueli, Deborah / Altshuler, Alex / Amir, Smadar / Ben-Gal, Michal

International journal of disaster risk reduction : IJDRR

2022 Volume 74, Page(s) 102913

Abstract: The ability to successfully manage disasters is a function of the extent to which lessons are learned from prior experience. We focus on the extent to which lessons from SARS/MERS have been learned and implemented during the first wave of COVID-19, and ... ...

Abstract	The ability to successfully manage disasters is a function of the extent to which lessons are learned from prior experience. We focus on the extent to which lessons from SARS/MERS have been learned and implemented during the first wave of COVID-19, and the extent to which the source affects governance learning: from a polity's own experience in previous episodes of the same disaster type; from the experience of other polities with regard to the same disaster type; or by cross-hazard learning - transferring lessons learned from experience with other types of disasters. To assess which types of governance learning occurred we analyze the experience of four East Asian polities that were previously affected by SARS/MERS: South Korea, Taiwan, Singapore and Hong-Kong. Their experience is compared with that of Israel. Having faced other emergencies but not a pandemic, Israel could have potentially learned from its experience with other emergencies, or from the experience of others with regard to pandemics before the onset of COVID-19. We find that governance learning occurred in the polities that experienced either SARS or MERS, but not cross-hazard or cross-polity learning. The consequences in the 5 polities at the end of the first six months of Covid-19, reflected by the numbers of infected and deaths, on one hand, and by the level of disruption to normal life, on the other, verifies these findings. Research insights point to the importance of modifying governance structures to establish effective emergency institutions and necessary legislation as critical preparation for future unknown emergencies.
Language	English
Publishing date	2022-03-25
Publishing country	England
Document type	Journal Article
ZDB-ID	2695877-6
ISSN	2212-4209
ISSN	2212-4209
DOI	10.1016/j.ijdrr.2022.102913
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Article: Outcomes of Cytomegalovirus Viremia Treatment in Critically Ill Patients With COVID-19 Infection.

Schoninger, Scott / Dubrovskaya, Yanina / Marsh, Kassandra / Altshuler, Diana / Prasad, Prithiv / Louie, Eddie / Weisenberg, Scott / Hochman, Sarah / Fridman, David / Trachuk, Polina

Open forum infectious diseases

2022 Volume 9, Issue 7, Page(s) ofac286

Abstract: Background: Patients with coronavirus disease 2019 (COVID-19) admitted to the intensive care unit (ICU) have poor outcomes and frequently develop comorbid conditions, including cytomegalovirus (CMV) reactivation. The implications of CMV reactivation in ... ...

Abstract	Background: Patients with coronavirus disease 2019 (COVID-19) admitted to the intensive care unit (ICU) have poor outcomes and frequently develop comorbid conditions, including cytomegalovirus (CMV) reactivation. The implications of CMV reactivation in this setting are unknown. We aimed to investigate if treatment of CMV viremia improved in-hospital mortality in ICU patients with COVID-19. Methods: In this single-center retrospective study, we analyzed clinical outcomes in patients diagnosed with COVID-19 pneumonia and CMV viremia admitted to an ICU from March 1, 2020, to April 30, 2021, who either received treatment (ganciclovir and/or valganciclovir) or received no treatment. The primary outcome was all-cause in-hospital mortality. Secondary outcomes were total hospital length of stay (LOS), ICU LOS, requirement for extracorporeal membrane oxygenation (ECMO) support, duration of mechanical ventilation (MV), and predictors of in-hospital mortality. Results: A total of 80 patients were included, 43 patients in the treatment group and 37 in the control group. Baseline characteristics were similar in both groups. CMV-treated patients were more likely to test positive for CMV earlier in their course, more likely to be on ECMO, and received higher total steroid doses on average. In-hospital mortality was similar between the 2 groups (37.2% vs 43.2.0%; Conclusions: Treatment of CMV viremia did not decrease in-hospital mortality in ICU patients with COVID-19, but the sample size was limited. CMV viremia was significantly associated with total steroid dose received and longer ICU stay.
Language	English
Publishing date	2022-06-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	2757767-3
ISSN	2328-8957
ISSN	2328-8957
DOI	10.1093/ofid/ofac286
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Article ; Online: DNN Intellectual Property Extraction Using Composite Data

Itay Mosafi / Eli (Omid) David / Yaniv Altshuler / Nathan S. Netanyahu

Entropy, Vol 24, Iss 349, p

2022 Volume 349

Abstract: ... numbers of AI-based products and services, the incentive for “copying them” (i.e ...

Abstract	As state-of-the-art deep neural networks are being deployed at the core level of increasingly large numbers of AI-based products and services, the incentive for “copying them” (i.e., their intellectual property, manifested through the knowledge that is encapsulated in them) either by adversaries or commercial competitors is expected to considerably increase over time. The most efficient way to extract or steal knowledge from such networks is by querying them using a large dataset of random samples and recording their output, which is followed by the training of a student network, aiming to eventually mimic these outputs, without making any assumption about the original networks. The most effective way to protect against such a mimicking attack is to answer queries with the classification result only, omitting confidence values associated with the softmax layer. In this paper, we present a novel method for generating composite images for attacking a mentor neural network using a student model. Our method assumes no information regarding the mentor’s training dataset, architecture, or weights. Furthermore, assuming no information regarding the mentor’s softmax output values, our method successfully mimics the given neural network and is capable of stealing large portions (and sometimes all) of its encapsulated knowledge. Our student model achieved 99% relative accuracy to the protected mentor model on the Cifar-10 test set. In addition, we demonstrate that our student network (which copies the mentor) is impervious to watermarking protection methods and thus would evade being detected as a stolen model by existing dedicated techniques. Our results imply that all current neural networks are vulnerable to mimicking attacks, even if they do not divulge anything but the most basic required output, and that the student model that mimics them cannot be easily detected using currently available techniques.
Keywords	deep learning ; cybersecurity ; artificial intelligence ; swarm intelligence ; adversarial AI ; information theory ; Science ; Q ; Astrophysics ; QB460-466 ; Physics ; QC1-999
Subject code	006
Language	English
Publishing date	2022-02-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: A rare cause of hypoglycemia in adults

G. R. Avetisian / Z. R. Tsinoeva / N. E. Altshuler / E. R. Moskalets / P. A. Glazunov / S. S. Bunova / E. V. Zhilyayev

Klinicist, Vol 16, Iss 4, Pp 39-

2023 Volume 44

Abstract: The aim of the study was to describe a clinical case of noninsulinoma pancreatogenous hypoglycemia (NIPH).Materials and methods. Patient R. 42 years old, woman, was admitted with complaints on spastic abdominal pain, heartburn, flatulence, bloating. The ... ...

Abstract	The aim of the study was to describe a clinical case of noninsulinoma pancreatogenous hypoglycemia (NIPH).Materials and methods. Patient R. 42 years old, woman, was admitted with complaints on spastic abdominal pain, heartburn, flatulence, bloating. The patient had a history of cramping pains in the upper abdomen, episodes of hypoglycemia up to once a day, periodically diarrhea with undigested food up to 3 times a day, and frequent weakness during last 9 years. In 2013, she was diagnosed with a neuroendocrine tumor of the pancreas, and therefore distal pancreatectomy was performed that year. According to histological and immuno-histochemical studies, foci of islet-cell hyperplasia (nesidioblastosis) were noted in the tail of the pancreas against the background of tissue fibrosis. Non-insulinoma pancreatogenous hypoglycemia of adults (NIPH) was diagnosed, enzyme replacement therapy and Octreotide-depo were prescribed. Relapses were noted twice. Two weeks before admission, the patient noted episodes of hypoglycemia. Upon admission, the patient had state of moderate severity, irregular stools up to 3–4 times a day. Antibacterial treatment was carried out, enzyme replacement therapy, octreotide was continued.Results. On the 7th day of hospitalization, the patient was stabilized: the level of glycemia was 4.5–4.9 mmol / l, the frequency and consistency of stool normalized. No data for decompensation of the disease has been received. The patient was discharged in a satisfactory condition.Conclusion. This clinical case demonstrates the influence of NIPH on the patient’s quality of life and the need for constant vigilance against the recurrence of hypoglycemic episodes, despite the treatment. This case can improve the awareness about this rare but important disease.
Keywords	noninsulinomic pancreatogenic hypoglycemia ; nezidioblastosis ; hyperinsulinism ; diabetic hyperglycemia ; postprandial hypoglycemia ; enzyme replacement therapy ; hormone therapy ; pancreatic resection ; pancreatectomy ; diffuse pancreatic lesion ; Medicine ; R
Subject code	610
Language	Russian
Publishing date	2023-02-01T00:00:00Z
Publisher	ABV-press
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: yupi: Generation, tracking and analysis of trajectory data in Python

Reyes, Abilio / Viera-López, G. / Morgado-Vega, J.J. / Altshuler, E.

Environmental Modelling and Software. 2023 May, v. 163 p.105679-

2023

Abstract: Studying trajectories is often a core task in several research fields. In environmental modeling, trajectories are crucial to study fluid pollution, animal migrations, oil slick patterns or land movements. This contribution addresses the lack of ... ...

Abstract	Studying trajectories is often a core task in several research fields. In environmental modeling, trajectories are crucial to study fluid pollution, animal migrations, oil slick patterns or land movements. This contribution addresses the lack of standardization and integration existing in current approaches to handle trajectory data. Within this scenario, challenges extend from the extraction of a trajectory from raw sensor data to the application of mathematical tools for modeling or making inferences about populations and their environments. We introduce a framework that addresses the problem as a whole. It contains a tracking module aiming at making data acquisition handy, artificial generation of trajectories powered by different stochastic models to aid comparisons among experimental and theoretical data, a statistical kit for analyzing patterns in groups of trajectories and other resources to speed up data pre-processing. We validate the software by reproducing key results from published research related to environmental modeling applications.
Keywords	animals ; computer software ; data collection ; oil spills ; pollution ; Trajectory analysis ; Modeling ; Tracking ; Python
Language	English
Dates of publication	2023-05
Publishing place	Elsevier Ltd
Document type	Article ; Online
ISSN	1364-8152
DOI	10.1016/j.envsoft.2023.105679
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: Digital cough monitoring - A potential predictive acoustic biomarker of clinical outcomes in hospitalized COVID-19 patients.

Altshuler, Ellery / Tannir, Bouchra / Jolicoeur, Gisèle / Rudd, Matthew / Saleem, Cyrus / Cherabuddi, Kartikeya / Doré, Dominique Hélène / Nagarsheth, Parav / Brew, Joe / Small, Peter M / Glenn Morris, J / Grandjean Lapierre, Simon

Journal of biomedical informatics

2023 Volume 138, Page(s) 104283

Abstract: Purpose: Recent developments in the field of artificial intelligence and acoustics have made it possible to objectively monitor cough in clinical and ambulatory settings. We hypothesized that time patterns of objectively measured cough in COVID-19 ... ...

Abstract	Purpose: Recent developments in the field of artificial intelligence and acoustics have made it possible to objectively monitor cough in clinical and ambulatory settings. We hypothesized that time patterns of objectively measured cough in COVID-19 patients could predict clinical prognosis and help rapidly identify patients at high risk of intubation or death. Methods: One hundred and twenty-three patients hospitalized with COVID-19 were enrolled at University of Florida Health Shands and the Centre Hospitalier de l'Université de Montréal. Patients' cough was continuously monitored digitally along with clinical severity of disease until hospital discharge, intubation, or death. The natural history of cough in hospitalized COVID-19 disease was described and logistic models fitted on cough time patterns were used to predict clinical outcomes. Results: In both cohorts, higher early coughing rates were associated with more favorable clinical outcomes. The transitional cough rate, or maximum cough per hour rate predicting unfavorable outcomes, was 3·40 and the AUC for cough frequency as a predictor of unfavorable outcomes was 0·761. The initial 6 h (0·792) and 24 h (0·719) post-enrolment observation periods confirmed this association and showed similar predictive value. Interpretation: Digital cough monitoring could be used as a prognosis biomarker to predict unfavorable clinical outcomes in COVID-19 disease. With early sampling periods showing good predictive value, this digital biomarker could be combined with clinical and paraclinical evaluation and is well adapted for triaging patients in overwhelmed or resources-limited health programs.
MeSH term(s)	Humans ; COVID-19 ; Cough ; Artificial Intelligence ; Acoustics ; Biomarkers
Chemical Substances	Biomarkers
Language	English
Publishing date	2023-01-09
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2057141-0
ISSN	1532-0480 ; 1532-0464
ISSN (online)	1532-0480
ISSN	1532-0464
DOI	10.1016/j.jbi.2023.104283
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