Our current clinical research is focused on cough, sickle cell disease, asthma, lung cancer, and sleep. We are also monitoring respiratory symptoms and diseases in a large cohort of emergency rescue workers from FDNY. Some examples of specific current interests include:

* Simon Spivack, MD, MPH [pubmed]

Focusing diagnostics and therapeutics on those most likely to benefit is a key to success at both the public health and clinical levels. The goal of the Spivack laboratory is to identify individuals at particularly high risk for lung malignancy, and selected non-malignant lung diseases, upon whom to focus smoking/toxin exposure cessation (primary prevention), chemoprevention (secondary prevention), and early disease detection efforts. The laboratory is currently exploring individual susceptibility markers by exploring quantitative gene (mRNA) expression phenotypes, and DNA sequence, methylation and other epigenetic features potentially underlying those expression phenotypes, in vitro and in human populations, in the setting of tobacco, air pollutant, as well as chemopreventive agent exposures. There are both mechanistic and translational components to the studies.

Mechanistically, the role of promoter sequence and epigenetic variation in promoter regions in the 5' regulatory region of carcinogenesis and oxidant pathway genes is being explored in vitro, using human genomic DNA reporter constructs, and native gene regulation models. Technologies include the realtime quantitation of native mRNA by the laboratory's RNA-specific strategy (patent pending), along with the laboratory's recently-developed tagged-bisulfite genomic sequencing strategy to determine CpG methylation status (tBGS, patent pending). Mechanisms of sequence-defined individual differences in chemopreventive responsiveness are being explored. Whole genome approaches to identifying selected early molecular events in lung cells upon various exposures are underway. Additionally, a recent endeavor is participation in the development of a comprehensive strategy for assaying microRNA and mRNA in parallel, initiated by collaborators, for determining the role of miRNA in candidate gene regulation and carcinogenesis.

Translationally, biomarkers are being established by pairing laser capture microdissected lung and several unique, non-invasively collected surrogate specimens developed in the laboratory, such as mRNA from brush-exfoliated buccal mucosa cells, and DNA from exhaled breath condensate. These specimens continue to accrue from a sampling (currently n>500) of a population assembled in a lung cancer case-control context. The specimens are being studied for quantitative gene expression in the carcinogen and oxidant metabolism, and cell cycle regulatory pathways, by both our RNA-specific RT-PCR approach and by the tBGS DNA methylation approach. These expression, genetic, and epigenetic data are being linked to precise plasma measurements of tobacco exposure, and downstream DNA adduction and mutation events, as an approach to putting a metric to gene-environment interaction. Testing of chemopreventive mixture and individual compounds for antimutagen and antioxidant activity is underway. The overall aim is to develop informative non-invasive risk profiling, preventive, and early disease detection strategies for the lung in human populations.

* Peter Dicpinigaitis, MD [pubmed]

For the past 12 years, I have been active in the field of cough research. Specifically, we have developed methods of cough reflex sensitivity measurement with the tussive agent capsaicin that have been adopted in international guidelines as the proposed standard method of cough challenge testing. Using this methodology, we have performed numerous studies to evaluate potential antitussive drugs; to evaluate the effect of non-pharmacological interventions such as cigarette smoking on cough reflex sensitivity; as well as to evaluate ethnic and gender differences in the cough reflex.

Currently funded studies include the evaluation of tiotropium bromide (Spiriva; Boehringer-Ingelheim) as a potential antitussive in acute viral cough, as well as an evaluation of combination antitussive products against acute viral cough (Adams Respiratory Therapeutics).

* David Prezant, MD [pubmed]

Chief Medical Officer, Office of Medical Affairs, Fire Department of the City of New York (FDNY)
Co-Director World Trade Center Medical Monitoring and Treatment Programs, FDNY
Professor of Medicine, Pulmonary Division, Albert Einstein College of Medicine, Montefiore Med. Ctr.

Fire Department of the City of New York (FDNY)
9 Metrotech Center
Brooklyn, New York 11201
718-999-2696
Fax 718-999-2696
prezand@fdny.nyc.gov

Dr. David Prezant is the Chief Medical Officer at the Office of Medical Affairs for the Fire Department of the City of New York (FDNY), Dr. Prezant directs all medical protocol development for both day to day operations and homeland security issues. He is also Co-Director of the FDNY World Trade Center Medical Monitoring Program and the Senior Pulmonary Consultant for FDNY. Dr. Prezant is a member of the Institute of Medicine's Committee on Personal Protective Equipment in the Workplace, the National Fire Protection Association's Health and Safety Committee and the International Association of Firefighters Redmond Medical Advisory Board. He is a Professor of Medicine at the Albert Einstein College of Medicine; Director of Albert Einstein Medical School's Pulmonary Course for medical students and the Research Director for their Unified Pulmonary Division.

Dr. Prezant responded on 9/11/01 to the World Trade Center and was present during the collapse and its aftermath. Since that day he along with Dr. Kelly (FDNY's Chief Medical Officer at the Bureau of Health Services) has initiated a multi-million dollar medical monitoring and treatment program for FDNY firefighters funded by FDNY, the Centers for Disease Control and Prevention (CDC) and the National Institute for Occupational Safety and Health (NIOSH). He is the Principal Investigator for the FDNY Data Coordinating Center for the WTC Medical Monitoring Program and is on the Steering Committee for the WTC Medical Monitoring Program. He served as a member of the EPA WTC Technical Advisory Committee, the NYC Dept of Health WTC Registry Scientific Advisory Board, the NYS Governor's WTC panel and the NYC Mayorâ s medical advisory board. Dr. Prezant has written extensively on pulmonary physiology, firefighter health and safety and since 9/11 on the health impact of World Trade Center Collapse on NYC Firefighters and EMS rescue workers. Dr. Prezant's group was the first to describe WTC Cough Syndrome (New England Journal of Medicine 2002) and has published extensively on this subject in the CDC - MMWR, American Journal of Respiratory and Critical Care Medicine, Chest and Environmental Health Perspectives. His major research interest is in determining the mechanisms responsible for accelerated decline in longitudinal pulmonary function and/or airway hyperreactivity in firefighters after WTC exposure. Other interests are in determining the mechanisms responsible for the increased incidence of sarcoidosis in firefighters after WTC exposure.

* Andrew Berman, MD [pubmed]

  • Co-PI on recently funded grant from the American Cancer Society entitled,
    "Determinants of Disparities in Diagnosis and Treatment of Lung Cancer."
    The long-term goal of this study is to improve the outcomes of minority lung cancer patients. Towards this goal, we will explore the underlying reasons for the observed disparities in stage at diagnosis, treatment, and end-of-life care of minority patients. Accordingly, the specific aims of the study are to:

    a) Assess the relative contribution of patient, provider, and system-level factors on racial and ethnic differences in the stage at presentation of lung cancer.
    b) Evaluate reasons for disparities in lung cancer treatment, including the potential role of patient, provider, and system-related factors.
    c) Assess the role of end-of-life beliefs, terminal care attitudes, medical mistrust, and communication barriers as determinants of racial and ethnic disparities in end-of-life care of patients with advanced lung cancer.

  • Collaborative study with Dept of Pathology investigating the outcomes of patients with pulmonary granulomatous inflammation who do not have clinically detectable Mtb. This is a retrospective study of patients with pulmonary granulomatous inflammation as identified from surgical pathology and autopsy specimens at Moses and Weiler hospitals.
    We will investigate if there are any adverse clinical outcomes in patients with pulmonary granulomatous inflammation who have neither stain-positive nor culture-positive evidence of infectious organisms, are not treated for Mtb infection, and are shown to harbor no Mtb using high-sensitivity techniques.
  • Bronchoprovocation studies as a tool to evaluate the mechanisms of airway inflammation in asthma.
  • Case reports

* Chang Shim, MD [pubmed]

  • Treatment of troublesome cough in hospitalized acute asthma patients.
  • Physical therapy for reversal of lobar atelectasis in hospitalized patients.
  • Fibrinolysis for management of complicated pleural effusions.
  • Pleurodesis for management of symptomatic malignant pleural effusions.
  • Adverse effects of systemic corticosteroids in diabetic patients hospitalized for acute exacerbations of COPD.

* Thomas K. Aldrich, MD [pubmed]

  • Clinical and research interests include respiratory mechanics, respiratory muscle physiology, pulmonary complications of sickle cell disease, and the development of new instruments in pulmonary function testing.

    Current projects include:
  • Nocturnal hypoxemia in sickle cell disease, measured by overnight pulse oximetry at home and correlated with clinical severity of sickle cell complications.
  • Noninvasive positive pressure breathing as adjunctive therapy for pain crisis of sickle cell disease.
  • The oxygen affinity of sickle hemoglobin---variation by severity of hypoxemia.
  • Development of a four-LED pulse oximeter for measurements of carboxy- and met-hemoglobins, as well as oxyhemoglobin.

* William D. Appel, MD

1)    Use of a snoring scale and bedside pharyngeal volume measurements to predict obstructive sleep apnea and cpap pressure to treat it prior to the performance of any sleep studies

2)     A: Sleep and cough

    a) the effect of sleep apnea on awake cough response
    b) the effect of treatment of sleep apnea on awake cough response
    c) measurement of cough response during sleep among normals/ effect of sleep stage
    d) cough response during sleep among people with sleep apnea

       B: Sleep and Gastroespohageal reflux among people with obstructive sleep apnea
       C: Obstructive sleep apnea and aspiration

3)    A: Restless Leg Syndrome among post-gastric bypass patients

       B: Relation between Restless Leg Syndrome and H. pylori
       C: Relation between Restless Leg Syndrome and use of proton pump inhibitors

4) Obstructive sleep apnea and anemia of aging. Is hepcidin a factor?

5) Obstructive sleep apnea and congestive heart failure among African Americans.

         
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