830 Harrison Ave Moakley, 3Rd Floor
Boston MA 02118
Medical School: Yale University School Of Medicine - 1983
Accepts Medicare: Yes
Participates In eRX: Yes
Participates In PQRS: Yes
Participates In EHR: No
License #: 55760
Taxonomy Codes:207R00000X 207RX0202X
Request Appointment Information
Awards & Recognitions
Dr. Adam Lerner is associated with these group practices
|HCPCS Code||Description||Average Price||Average Price
Allowed By Medicare
|HCPCS Code:99223||Description:Initial hospital care||Average Price:$524.00||Average Price Allowed
|HCPCS Code:99205||Description:Office/outpatient visit new||Average Price:$439.00||Average Price Allowed
|HCPCS Code:99215||Description:Office/outpatient visit est||Average Price:$291.00||Average Price Allowed
|HCPCS Code:99233||Description:Subsequent hospital care||Average Price:$273.00||Average Price Allowed
|HCPCS Code:99239||Description:Hospital discharge day||Average Price:$277.00||Average Price Allowed
|HCPCS Code:38221||Description:Bone marrow biopsy||Average Price:$211.00||Average Price Allowed
|HCPCS Code:99214||Description:Office/outpatient visit est||Average Price:$206.00||Average Price Allowed
|HCPCS Code:99213||Description:Office/outpatient visit est||Average Price:$134.00||Average Price Allowed
HCPCS Code Definitions
- Bone marrow; biopsy, needle or trocar
- Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family.
- Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 15 minutes are spent face-to-face with the patient and/or family.
- Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 25 minutes are spent face-to-face with the patient and/or family.
- Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 40 minutes are spent face-to-face with the patient and/or family.
- Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of high severity. Typically, 70 minutes are spent at the bedside and on the patient's hospital floor or unit.
- Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is unstable or has developed a significant complication or a significant new problem. Typically, 35 minutes are spent at the bedside and on the patient's hospital floor or unit.
- Hospital discharge day management; more than 30 minutes
Medical Malpractice Cases
Medical Board Sanctions
Cardiovascular Disease (Cardiology)
*These referrals represent the top 10 that Dr. Lerner has made to other doctors
Effect of cAMP signaling on expression of glucocorticoid receptor, Bim and Bad in glucocorticoid-sensitive and resistant leukemic and multiple myeloma cells. - Frontiers in pharmacology
Stimulation of cAMP signaling induces apoptosis in glucocorticoid-sensitive and resistant CEM leukemic and MM.1 multiple myeloma cell lines, and this effect is enhanced by dexamethasone in both glucocorticoid-sensitive cell types and in glucocorticoid-resistant CEM cells. Expression of the mRNA for the glucocorticoid receptor alpha (GR) promoters 1A3, 1B and 1C, expression of mRNA and protein for GR, and the BH3-only proapoptotic proteins, Bim and Bad, and the phosphorylation state of Bad were examined following stimulation of the cAMP and glucocorticoid signaling pathways. Expression levels of GR promoters were increased by cAMP and glucocorticoid signaling, but GR protein expression was little changed in CEM and decreased in MM.1 cells. Stimulation of these two signaling pathways induced Bim in CEM cells, induced Bad in MM.1 cells, and activated Bad, as indicated by its dephosphorylation on ser112, in both cell types. This study shows that leukemic and multiple myeloma cells, including those resistant to glucocorticoids, can be induced to undergo apoptosis by stimulating the cAMP signaling pathway, with enhancement by glucocorticoids, and the mechanism by which this occurs may be related to changes in Bim and Bad expression, and in all cases, to activation of Bad.
Postoperative Lactate Levels and Hospital Length of Stay After Cardiac Surgery. - Journal of cardiothoracic and vascular anesthesia
The objective of this study was to characterize the association between lactate levels and hospital length of stay (LOS) after cardiac surgery.A retrospective study using prospectively collected data from the Society of Thoracic Surgeons adult cardiac surgery database.A tertiary-care hospital.Patients in the database who presented for major cardiac surgery between 2002 and 2014 and whose lactate level was measured within 3 hours after skin closure.None.The authors performed multivariable linear regression with adjustment for more than 30 variables to assess the association between postoperative lactate levels and hospital LOS. The study included 1,208 patients whose median LOS was 6 days (quartiles: 5, 9). Median LOS in the low-, moderate-, and high-lactate groups was 5 days (quartiles: 4, 7), 6 days (quartiles: 5, 9) and 9 days (quartiles: 6, 17), respectively; p<0.001. In multivariable analysis, patients with a moderate lactate level had a 1.08 times (95% CI: 1.00-1.17; p = 0.04) longer LOS compared with those with a low lactate level. Patients with a high lactate level had a 1.12 times (95% CI: 1.00-1.26; p = 0.04) longer LOS compared with those with a low lactate level. Lactate levels also were associated with intensive care unit LOS and nonsurgical postoperative complications.Postoperative lactate levels are associated with increased hospital LOS for patients undergoing major cardiac surgery.Copyright Â© 2015 Elsevier Inc. All rights reserved.
Clinically significant responses achieved with romidepsin across disease compartments in patients with cutaneous T-cell lymphoma. - Leukemia & lymphoma
Cutaneous T-cell lymphoma (CTCL) is a rare heterogeneous group of non-Hodgkin lymphomas that arises in the skin but can progress to systemic disease (lymph nodes, blood, viscera). Historically, in clinical trials of CTCL there has been little consistency in how responses were defined in each disease "compartment"; some studies only assessed responses in the skin. The histone deacetylase inhibitor romidepsin is approved by the US Food and Drug Administration for the treatment of CTCL in patients who have received at least one prior systemic therapy. Phase II studies that led to approval used rigorous composite end points that incorporated disease assessments in all compartments. The objective of this analysis was to thoroughly examine the activity of romidepsin within each disease compartment in patients with CTCL. Romidepsin was shown to have clinical activity across disease compartments and is suitable for use in patients with CTCL having skin involvement only, erythroderma, lymphadenopathy and/or blood involvement.
Interrelationship of preoperative anemia, intraoperative anemia, and red blood cell transfusion as potentially modifiable risk factors for acute kidney injury in cardiac surgery: a historical multicentre cohort study. - Canadian journal of anaesthesia = Journal canadien d'anestheÌsie
Acute kidney injury (AKI) is a potentially serious complication of cardiac surgery. Anemia and red blood cell (RBC) transfusion have individually been identified as potentially modifiable risk factors, but their interrelationship with AKI has not been clearly defined. The purpose of this study was to explore the interrelationship of preoperative anemia, intraoperative anemia, and RBC transfusion on the day of surgery with AKI in cardiac surgery.This historical cohort study included 16 hospitals, each contributing data on approximately 100 consecutive patients who underwent cardiac surgery with cardiopulmonary bypass. Acute kidney injury was defined as a >Â 50% increase in creatinine levels during the first postoperative week. Multivariable regression was used to identify the interrelationship between preoperative anemia (hemoglobinÂ <Â 130Â gÂ·L(-1) in males andÂ <Â 120Â gÂ·L(-1) in females), intraoperative anemia (hemoglobinÂ <Â 80Â gÂ·L(-1) during cardiopulmonary bypass), RBC transfusion on the day of surgery, and their interaction terms, after adjusting for site and baseline AKI risk.Of the 1,444 patients included in the study, 541 (37%) had preoperative anemia, 501 (35%) developed intraoperative anemia, 619 (43%) received RBC transfusions, and 238 (16%) developed AKI. After risk-adjustment, an individual with the combination of these three risk factors had a 2.6-fold (95% confidence interval 2.0 to 3.3) increase in the relative risk of AKI over an individual with none of these risk factors.Preoperative anemia, intraoperative anemia, and RBC transfusion on the day of surgery are interrelated risk factors for AKI after cardiac surgery. Targeting these risk factors may reduce the burden of AKI.
Inhibition of type 4 cyclic nucleotide phosphodiesterase blocks intracellular TLR signaling in chronic lymphocytic leukemia and normal hematopoietic cells. - Journal of immunology (Baltimore, Md. : 1950)
A subset of chronic lymphocytic leukemia (CLL) BCRs interacts with Ags expressed on apoptotic cells, suggesting that CLL BCRs have the potential to internalize apoptotic cell RNA- or DNA-containing fragments with resultant activation of TLR7 or TLR9, respectively. By blocking cAMP degradation, type 4 cAMP phosphodiesterase (PDE4) inhibitors activate cAMP-mediated signaling and induce apoptosis in CLL cells. In this study, we show that autologous irradiated leukemic cells induce proliferation in CLL cells and that such proliferation is blocked by a TLR7/8/9 inhibitor, by DNase, and by the PDE4 inhibitor rolipram. Rolipram also inhibited CLL cell proliferation induced by synthetic TLR7 and TLR9 agonists, as well as TLR agonist-induced costimulatory molecule expression and TNF-a (but not IL-6 or IL-10) production. Whereas treatment with a TLR9 agonist protected IgH V region unmutated, but not mutated, CLL cells from apoptosis, PDE4 inhibitors augmented apoptosis in both subtypes, suggesting that cAMP-mediated signaling may abrogate a TLR9-mediated survival signal in prognostically unfavorable IGHV unmutated CLL cells. Rolipram inhibited both TLR7/8- and TLR9-induced IFN regulatory factor 5 and NF-kB p65 nuclear translocation. PDE4 inhibitors also blocked TLR signaling in normal human immune cells. In PBMC and CD14-positive monocytes, PDE4 inhibitors blocked IFN-a or TNF-a (but not IL-6) production, respectively, following stimulation with synthetic TLR agonists or RNA-containing immune complexes. These results suggest that PDE4 inhibitors may be of clinical utility in CLL or autoimmune diseases that are driven by TLR-mediated signaling.
A Phase II trial of Belinostat (PXD101) in patients with relapsed or refractory peripheral or cutaneous T-cell lymphoma. - British journal of haematology
Belinostat is a pan-histone deacetylase inhibitor with antitumour and anti-angiogenic properties. An open label, multicentre study was conducted in patients with peripheral T-cell lymphoma (PTCL) or cutaneous T-cell lymphoma (CTCL) who failed â‰¥1 prior systemic therapy and were treated with belinostat (1000Â mg/m(2) intravenously Ã—5Â d of a 21-d cycle). The primary endpoint was objective response rate (ORR). Patients with PTCL (nÂ =Â 24) had received a median of three prior systemic therapies (range 1-9) and 40% had stage IV disease. Patients with CTCL (nÂ =Â 29) had received a median of one prior skin-directed therapy (range 0-4) and four prior systemic therapies (range 1-9); 55% had stage IV disease. The ORRs were 25% (PTCL) and 14% (CTCL). Treatment-related adverse events occurred in 77% of patients; nausea (43%), vomiting (21%), infusion site pain (13%) and dizziness (11%) had the highest incidence. Treatment-related serious adverse events were Grade 5 ventricular fibrillation; Grade 4 thrombocytopenia; Grade 3 peripheral oedema, apraxia, paralytic ileus and pneumonitis; and Grade 2 jugular vein thrombosis. Belinostat monotherapy was well tolerated and efficacious in patients with recurrent/refractory PTCL and CTCL. This trial was registered at www.clinicaltrials.gov as NCT00274651.Â© 2014 John Wiley & Sons Ltd.
Tolerability to romidepsin in patients with relapsed/refractory T-cell lymphoma. - Biomarker research
Histone deacetylase inhibitor romidepsin has demonstrated durable clinical responses and tolerability in patients with relapsed/refractory peripheral and cutaneous T-cell lymphoma (PTCL, CTCL). Selection of novel drug therapies for patients with relapsed/refractory aggressive lymphoma requires not only considerations regarding efficacy but also careful evaluation of toxicities as well as overall clinical benefit. The purpose of this analysis was to examine common adverse events (AEs) reported in pivotal trials of romidepsin in relapsed/refractory PTCL or CTCL and to more clearly define the overall AE profile in these populations.Patients with relapsed/refractory PTCL or CTCL were treated with romidepsin at 14 mg/m(2) as a 4-hour intravenous infusion on days 1, 8, and 15 of 28-day cycles for up to 6 cycles; patients with at least stable disease could extend therapy until progressive disease or another withdrawal criterion was met. All enrolled patients who receivedâ€‰â‰¥â€‰1 dose of romidepsin were included in the AE analyses.Overall, safety profiles of common AEs were similar, although patients with relapsed/refractory PTCL had more frequent hematologic toxicities and gradeâ€‰â‰¥â€‰3 infections. In both patient populations, the greatest incidence of gradeâ€‰â‰¥â€‰3 AEs and the majority of discontinuations due to AEs occurred during cycles 1-2. Early discontinuations were primarily related to infection, thrombocytopenia, or electrocardiogram abnormalities, confirming the need to closely monitor patients with poor bone marrow reserve or other comorbidities. Despite this, 28% of patients with relapsed/refractory PTCL and 36% of patients with relapsed/refractory CTCL continued on romidepsin treatment forâ€‰â‰¥â€‰6 cycles.This study demonstrates that patients with relapsed/refractory PTCL or CTCL have similar AE profiles with romidepsin treatment, although patients with PTCL experienced more frequent and more severe hematologic toxicities and more frequent gradeâ€‰â‰¥â€‰3 infections. The greatest incidence of gradeâ€‰â‰¥â€‰3 AEs and the majority of discontinuations due to AEs occurred during treatment cycles 1-2. Extended dosing of romidepsin can be tolerated in responding patients.NCT00426764,NCT00106431.
Target DNA detection and quantitation on a single cell with single base resolution. - Technology
In this report, we present a new method for sensitive detection of short DNA sites in single cells with single base resolution. The method combines peptide nucleic acid (PNA) openers as the tagging probes, together with isothermal rolling circle amplification (RCA) and fluorescence-based detection, all performed in a cells-in-flow format. Bis-PNAs provide single base resolution, while RCA ensures linear signal amplification. We applied this method to detect the oncoviral DNA inserts in cancer cell lines using a flow-cytometry system. We also demonstrated quantitative detection of the selected signature sites within single cells in microfluidic nano-liter droplets. Our results show single-nucleotide polymorphism (SNP) discrimination and detection of copy-number variations (CNV) under isothermal non-denaturing conditions. This new method is ideal for many applications in which ultra-sensitive DNA characterization with single base resolution is desired on the level of single cells.
Increased glycemic variability in patients with elevated preoperative HbA1C predicts adverse outcomes following coronary artery bypass grafting surgery. - Anesthesia and analgesia
In the setting of protocolized glycemic control, the relationship between postoperative glycemic variability on major adverse events (MAEs) after cardiac surgery is unknown for patients with increased preoperative hemoglobin A1C (HbA1C >6.5%). In this study, we sought to establish (a) whether postoperative glycemic variability is associated with MAEs after CABG surgery and (b) whether preoperative HbA1C could identify patients at increased risk of postoperative glycemic variability.Patients undergoing coronary artery bypass grafting with or without valvular surgery from January 2008 to May 2011 were enrolled in this prospective, single-center, observational cohort study. Demographic, intraoperative, and postoperative outcome data were obtained from institutional data collected for the Society of Thoracic Surgery (STS) database. The primary outcome, MAE was a composite of in-hospital death, myocardial infarction (MI), reoperations, sternal infection, cardiac tamponade, pneumonia, stroke, or renal failure. Glycemic variability in the postoperative period was assessed by the coefficient of variation (CV). CV was used as quartiles for the multivariate logistic regression. Variable selection in multivariable modeling was based on clinical and statistical significance and was performed in a hierarchical fashion.Of the 1461 patients enrolled, 9.8% had an MAE. Based on the established target of HbA1C <6.5% for the diagnosis of diabetes mellitus, we considered HbA1C as a binary variable (<6.5% and â‰¥6.5%) in our primary analysis. Multivariate logistic regression analyses for the preoperative variables only revealed that preoperative HbA1C (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1-2.3; P = 0.02), history of MI (OR, 1.9; 95% CI, 1.3-2.8; P = 0.001), and STS risk score per quartile (OR, 1.7; 95% CI, 1.4-2.1; P < 0.001) were associated with MAEs. When postoperative variables were included in the analyses, postoperative glycemic variability (CV per quartile) in the intensive care unit (OR, 1.3; 95% CI, 1.1-1.5; P = 0.03), mean glucose levels averaged over the first 4 postoperative hours (OR, 1.2; 95% CI, 1.0-1.4; P = 0.03), history of MI (OR, 1.8; 95% CI, 1.2-2.6; P = 0.004), and STS risk score per quartile (OR, 1.6; 95% CI, 1.3-2.0; P < 0.001) were associated with MAEs. Glycemic variability as assessed by CV was increased postoperatively in patients with preoperative HbA1C â‰¥6.5% (0.20 Â± 0.09 vs 0.16 Â± 0.07, P < 0.001).Postoperative glycemic variability is associated with MAEs after cardiac surgery. Glycemic variability is only measured when the patient leaves the intensive care unit, and there is no opportunity to intervene earlier. Preoperative HbA1C identifies risk for postoperative glycemic variability and may provide a more rational guide for targeting measures to reduce variability.
Echocardiographic anatomy of the mitral valve: a critical appraisal of 2-dimensional imaging protocols with a 3-dimensional perspective. - Journal of cardiothoracic and vascular anesthesia
To highlight the limitations of traditional 2-dimensional (2D) echocardiographic mitral valve (MV) examination methodologies, which do not account for patient-specific transesophageal echocardiographic (TEE) probe adjustments made during an actual clinical perioperative TEE examination.Institutional quality-improvement project.Tertiary care hospital.Attending anesthesiologists certified by the National Board of Echocardiography.Using the technique of multiplanar reformatting with 3-dimensional (3D) data, ambiguous 2D images of the MV were generated, which resembled standard midesophageal 2D views. Based on the 3D image, the MV scallops visualized in each 2D image were recognized exactly by the position of the scan plane. Twenty-three such 2D MV images were created in a presentation from the 3D datasets. Anesthesia staff members (n = 13) were invited to view the presentation based on the 2D images only and asked to identify the MV scallops. Their responses were scored as correct or incorrect based on the 3D image.The overall accuracy was 30.4% in identifying the MV scallops. The transcommissural view was identified correctly >90% of the time. The accuracy of the identification of A1, A3, P1, and P3 scallops was <50%. The accuracy of the identification of A2P2 scallops was â‰¥50%.In the absence of information on TEE probe adjustments performed to acquire a specific MV image, it is possible to misidentify the scallops.Copyright Â© 2012 Elsevier Inc. All rights reserved.
Map & Directions
830 Harrison Ave Moakley, 3Rd Floor Boston, MA 02118
850 Harrison Ave Yacc 4
850 Harrison Ave, Dow 7 S Boston Medical Center
850 Harrison Ave Yacc, 3Rd Floor
725 Albany St Shapiro 6, Suite A