Yale University School Research Articles

Adjunctive Drug Lengthens Abstinence in Buprenorphine Therapy

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessAdjunctive Drug Lengthens Abstinence in Buprenorphine TherapyAaron LevinAaron LevinSearch for more papers by this authorPublished Online:16 Apr 2015https://doi.org/10.1176/appi.pn.2015.4b7AbstractStress-related lapses in drug treatment are unlinked from craving with adjunctive medication.Adding a commonly used drug to buprenorphine treatment increased the duration of abstinence for opioid-dependent patients, according to a study by researchers at the National Institute on Drug Abuse (NIDA) published online March 18 in AJP in Advance.The study drug, clonidine, is often used to dampen symptoms of opioid withdrawal and does not have special prescribing requirements, as buprenorphine and methadone do.Overall, clonidine lengthened the time to opioid lapse (defined as a positive or missing urine test), but not significantly. However, after controlling the results for cocaine use, the researchers found that taking clonidine “significantly increased the time to initial opioid lapse.”Both the average effect of clonidine and the percentage of people who derived a sizable benefit from it are important, says NIDA’s Kenzie Preston, Ph.D.NIDA“The average effect—a nine-day increase in time to lapse—was not huge, but we think of it in terms of a principle that one of our behavioral-psychologist colleagues sometimes expresses as ‘abstinence begets abstinence,’ ” said study director Kenzie Preston, Ph.D., a senior investigator at NIDA’s Clinical Pharmacology and Therapeutics Research Branch in Baltimore, in an interview with Psychiatric News. “The longer you can be abstinent from a drug of abuse for any reason, the better you’ll do in the long run.”In addition, the average time to lapse didn’t tell the full story, said Preston.Only four of 57 people on placebo stayed abstinent for more than 50 days, compared with 21 of 61 people on clonidine. Also, 10 of those 21 participants remained abstinent for the full 12 weeks they were taking clonidine. “We think it’s exciting that even a substantial minority of people seemed to get a large benefit from clonidine maintenance,” she said.“We want to prevent relapse, and we want people to stay in treatment and return to good functional levels—and relapse can jeopardize that,” said Rajita Sinha, Ph.D., a professor of psychiatry, neurobiology, and child study at Yale University School of Medicine. “Here’s a tool we can use to help sustain that recovery for heroin- and opioid-dependent individuals.”The 118 participants began the trial on buprenorphine. Once abstinent from opioids for two weeks, they were randomized to either clonidine or placebo. Time to relapse (two or more lapses) was not extended significantly, possibly because of the priming effect of the drug use in the first lapse.As part of the trial protocol, participants received small electronic devices that prompted them four times a day to record stress, mood, craving, and any drug-related cues around them.This “ecological momentary assessment” (EMA) has been increasingly used over the last decade in clinical settings and was applied in this study as a way to overcome recall bias. Craving for drugs often intensifies as stress increases, but ecological momentary assessment permitted a decoupling of at least moderately high levels of stress from craving.“They may feel stressed, but they don’t have the same urgency for using drugs,” Sinha said of the subjects.The NIDA researchers are looking at EMA and other data to predict who is at risk of lapse and when it happens.Use of the EMA also added to evidence supporting animal models of stress and drug use and may help individualize treatment by identifying patients who lapse because of stress rather than drug cues or priming doses.“We can’t recommend EMA for routine clinical use in addiction at this point, but we’re working to get it there and to make it the basis of interventions as well,” said Preston.Clonidine is an alpha-2 adrenoreceptor agonist whose side effects include hypotension and sedation. However, those effects may be manageable over a longer time if patients are coming into the clinic regularly, as they are in buprenorphine treatment, said Sinha.“We do not now have any medications in the addiction field that specifically target stress and that are also really effective with craving,” she said. “So this is a novel and important study.” ■An abstract of “Clonidine Maintenance Prolongs Opioid Abstinence and Decouples Stress From Craving in Daily Life: A Randomized, Controlled Trial With Ecological Momentary Assessment” can be accessed here. ISSUES NewArchived

Cost effectiveness of transoral robotic surgery for the treatment of oropharyngeal squamous cell carcinoma: a systematic review

Cost effectiveness of transoral robotic surgery for the treatment of oropharyngeal squamous cell carcinoma: a systematic review Nicole L Aaronson, Paul D Neubauer, Benjamin L Judson Yale Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA Abstract: Since the first transoral use of the da Vinci robotic surgical system in 2005 and the subsequent FDA approval for the system's use in 2009, there has been a large uptick in the number of transoral robotic surgery (TORS) procedures performed in the United States. The most common use of TORS has been in the treatment of oropharyngeal squamous cell carcinoma (OPSCC). The rise in TORS cases for OPSCC is driven in part by the epidemic of human papilloma virus (HPV)-associated OPSCC. The advantage of TORS is that it allows transoral resection of tumors previously requiring open approaches associated with longer hospitalization and recovery, and higher functional morbidity. In addition to oncologic and functional outcomes, the cost of treatments using the robot is also a consideration in determining what role TORS should have in the treatment of OPSCC. A systematic review of the literature was performed by searching for articles addressing the cost-effectiveness of TORS. We have analyzed the articles obtained and report that analysis here. The results include case series and other analyses. They suggest that TORS for OPSCC is cost-effective compared to other available modalities due to decreased hospital stay, increased chance of finding an unknown primary and thereby avoiding some adjuvant treatment, and decreased rates of gastrostomy tube and tracheotomy. The methods used for calculating costs varied widely, and studies universally lack long-term follow-up. Further studies are needed, which define and measure costs and compare TORS with open surgery and non-surgical treatments. Keywords: oropharyngeal cancer, transoral robotic surgery, da Vinci robot, cost

Communication Commentary: Obsessive-Compulsive and Related Disorders: From Compulsions to Communication: Forming a Therapeutic Alliance With Individuals Diagnosed With Obsessive-Compulsive Disorder

Communication Commentary: Obsessive-Compulsive and Related Disorders: From Compulsions to Communication: Forming a Therapeutic Alliance With Individuals Diagnosed With Obsessive-Compulsive Disorder

Editorial introductions

Editorial introductions

Editorial introductions

Editorial introductions

The effect of a bidirectional exchange on faculty and institutional development in a global health collaboration.

PurposeThe MUYU Collaboration is a partnership between Mulago Hospital-Makerere University College of Health Sciences (M-MakCHS), in Kampala, Uganda, and the Yale University School of Medicine. The program allows Ugandan junior faculty to receive up to 1 year of subspecialty training within the Yale hospital system. The authors performed a qualitative study to assess the effects of this program on participants, as well as on M-MakCHS as an institution.MethodsData was collected via semi-structured interviews with exchange participants. Eight participants (67% of those eligible as of 4/2012) completed interviews. Study authors performed data analysis using standard qualitative data analysis techniques.ResultsAnalysis revealed themes addressing the benefits, difficulties, and opportunities for improvement of the program. Interviewees described the main benefit of the program as its effect on their fund of knowledge. Participants also described positive effects on their clinical practice and on medical education at M-MakCHS. Most respondents cited financial issues as the primary difficulty of participation. Post-participation difficulties included resource limitations and confronting longstanding institutional and cultural habits. Suggestions for programmatic improvement included expansion of the program, ensuring appropriate management of pre-departure expectations, and refinement of program mentoring structures. Participants also voiced interest in expanding post-exchange programming to ensure both the use of and the maintenance of new capacity.ConclusionsThe MUYU Collaboration has benefitted both program participants and M-MakCHS, though these benefits remain difficult to quantify. This study supports the assertion that resource-poor to resource-rich exchanges have the potential to provide significant benefits to the resource-poor partner.

Functional and GI Motility Disorders

Yale University School of Medicine, Section of Digestive Diseases, New Haven, CT The author declares that there is nothing to disclose.

Multidimensional Clinical Profile (MDCP) for the Functional Gastrointestinal Disorders First Edition

Yale University School of Medicine, Section of Digestive Diseases, New Haven, CT The author declares that there is nothing to disclose.

Nutrition, Gut Microbiota, and Immunity

Yale University School of Medicine, Section of Digestive Diseases, New Haven, CT The author declares that he has nothing to disclose.

What are the Consequences of Volume Expansion in Chronic Dialysis Patients?: The Consequences of Fluid overload in AKI.

Seminars in DialysisVolume 28, Issue 3 p. 247-249 Opinion What are the Consequences of Volume Expansion in Chronic Dialysis Patients? The Consequences of Fluid overload in AKI Ranil Gajanayaka, Ranil Gajanayaka Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USASearch for more papers by this authorSteven Coca, Corresponding Author Steven Coca Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USAAddress correspondence to: Steven Coca, DO, MS, Division of Nephrology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1243, New York, NY 10029, USA, Tel.: 212-241-6633, or e-mail: [email protected].Search for more papers by this author Ranil Gajanayaka, Ranil Gajanayaka Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USASearch for more papers by this authorSteven Coca, Corresponding Author Steven Coca Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USAAddress correspondence to: Steven Coca, DO, MS, Division of Nephrology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1243, New York, NY 10029, USA, Tel.: 212-241-6633, or e-mail: [email protected].Search for more papers by this author First published: 09 February 2015 https://doi.org/10.1111/sdi.12352Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume28, Issue3May–June 2015Pages 247-249 RelatedInformation

Advances in exercise, physical activity, and diabetes mellitus.

Advances in exercise, physical activity, and diabetes mellitus.

Editorial introductions

Editorial introductions

Introduction to Fire Ecology of the Northeast: Restoring Native and Cultural Ecosystems

This special issue is composed of papers presented at a conference hosted jointly by the Yale University School of Forestry and Environmental Studies (New Haven, Connecticut) and Tall Timbers Research Station and Land Conservancy (Tallahassee, Florida) to address the history, ecology, and current need for prescribed fire in native and cultural ecosystems in the Northeast region of the United States and eastern Canada. The conference was held at the Yale University campus on February 20–22, 2014 and involved participants from universities, government agencies, nongovernment organizations, and private business. This special issue presents evidence that the fire history and ecology of the Northeast are strongly context-dependent and result from complex interactions of climate, human land use, and physiography, that certain species within the region are truly fire-adapted, and that synergies between fire management for ecological restoration and public welfare can and should be pursued on the modern landscape. A summary of all conference presentations and syntheses of panel discussions has been published as a Yale Forest Forum Review.

Communication Commentary: Bipolar Disorder: The Roller Coaster Ride: Optimizing the Therapeutic Alliance with Patients with Bipolar Disorder

Communication Commentary: Bipolar Disorder: The Roller Coaster Ride: Optimizing the Therapeutic Alliance with Patients with Bipolar Disorder

Mutations in EDA and EDAR Genes in a Large Mexican Hispanic Cohort with Hypohidrotic Ectodermal Dysplasia.

Mutations in EDA and EDAR Genes in a Large Mexican Hispanic Cohort with Hypohidrotic Ectodermal Dysplasia.

262: Heparin stimulates placental release and increases circulating levels of amyloid-like aggregates in women with prophylactic anticoagulation

262 Heparin stimulates placental release and increases circulating levels of amyloid-like aggregates in women with prophylactic anticoagulation Katherine Rodewald Millen, Catalin Buhimschi, Guomao Zhao, Sammy Tabbah, Stephen Thung, Michael Paidas, Edmund Funai, Irina Buhimschi The Ohio State University College of Medicine, Department of Obstetrics and Gynecology, Columbus, OH, Nationwide Children’s Hospital, Center for Perinatal Research, Columbus, OH, Yale University School of Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, New Haven, CT OBJECTIVE: Heparin interacts with amyloidogenic proteins, modifying their propensity to aggregate. Heparin’s stabilizing fibril property carries a powerful anti-cytotoxic effect. The clinical implication of these observations is that heparin could serve as a potential therapeutic target for severe placental-mediated pregnancy complications. We sought to determine whether heparin alters maternal circulating levels of amyloid-like aggregates in women receiving anticoagulation during pregnancy as measured by Thioflavin T (ThT) fluorescence. STUDY DESIGN: We analyzed serial serum samples from 42 pregnant women followed longitudinally across gestation. Heparin anticoagulation was clinically indicated in 21 women with a history of thrombophilia and/or antiphospholipid syndrome. Each woman was matched to a control (CRL) that delivered at term without complications (n1⁄421). Anticoagulation level was assessed by Factor Xa activity. To determine whether heparin’s effects were confounded by the disease, we used a villous explant system (term CS, n1⁄45) to measure levels of ThT-induced fluorescence preand postincubation with either unfractionated (UFH) or low-molecular weight (LMW) heparin, at doses relevant for human treatment (0.5, 5, 50 U/mL). RESULTS: 1) In-vivo, beyond 34 weeks, heparin significantly increased serum ThT-induced fluorescence (P<0.001, Figure A); 2) A heparin typeand dose-dependent increase in ThT-induced fluorescence was observed in-vitro for both UFH and LMW heparin (P1⁄40.004, Figure B). CONCLUSION: Cumulative exposure to heparin results in increased ThT-induced fluorescence, both in-vivo and in-vitro. Our study provides evidence that a potential beneficial effect of anticoagulation could be the result of improved protein folding in the placenta.

A remote wireless sensor network/electrocardiographic approach to discriminating cocaine use

s / Drug and Alcohol Dependence 146 (2015) e202–e284 e209 Conclusions: These data indicate that there is an interactive relationship between mPFC 5-HT2AR and 5-HT2CR that may drive impulsive phenotypes. Methylation patterns of these genes maymediate a gene× environment interaction to control inherent impulsivity, such that high impulsivity associates with higher 5HT2CR methylation in a critical brain region linked to impulsivity. Thus, we have uncovered potential neurobiological mechanisms of importance in driving inherent impulsivity. Financial support: DA033374, UL1T71, DA024157, DA020087. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.035 Workforce attitudes regarding the implementation of extended release naltrexone to treat opioid dependence Laura Andrich1, Katherine T. Garvey1, Elias M. Klemperer2,1, Traci R. Rieckmann1 1 Oregon Health & Science University, Portland, OR, United States 2 University of Vermont, Burlington, VT, United States Aims: Prior research indicates that organizational and workforce characteristics influence the implementation of evidencebased treatments. This study examined the workforce’s response to the utilization of extended release naltrexone to treat opioid addiction at time one (n=36) and time two (n=30). It explores staff opinions toward the implementation of a new medicated assisted treatment (MAT) for opioid addiction and documents the integration of an FDA approved treatment in an in-patient addictions facility. Methods: A mixed-methods approach was employed using semi-structured interviews and a quantitative survey with the staff at the addictions facility. Participants were support staff who interacted with patients. The quantitative survey was administered early in the new MAT program implementation (n=36) and again six months later (n=30). Data were analyzed using STATA and included descriptive statistics, correlations t-tests, and analyses of variance. Atlas-ti software was used to analyze codes in the qualitative data regarding attitudes and opinions about MAT. Results: Data from the survey suggest that over time,workforce knowledge about the new MAT increased (33.33–77.78%). There was also a slight increase inworkforce opinion that their coworkers supported the use of the newMAT (11.11–51.85%) as well as opinion that their supervisors supported the newMAT (48.57–70.37%), indicating an increase in perceived social support. The qualitative data indicate the importance of housing and peer support to successful recovery. Conclusions: Our findings indicate that counselors and support staff play a critical role in the adoption of efficacious MATs, with perceived social support at time two ranging from 51.85% for supervisors and 77.78% for coworkers. Greater attention to staff attitudes and perspectives when working to accelerate utilization of medications are recommended for improved patient outcomes. Financial support: This work was supported by the Hooper Detoxification Stabilization Center Vivitrol® Pilot Program State Funded Evaluation Project. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.036 A remote wireless sensor network/electrocardiographic approach to discriminating cocaine use Gustavo A. Angarita1, Annamalai Natarajan2, Edward C. Gaiser1, Abhinav Parate2, Benjamin Marlin2, Ralitza Gueorguieva3, Deepak Ganesan2, Robert T. Malison1 1 Psychiatry, Yale University School of Medicine, New Haven, CT, United States 2 School of Computer Science, University of Massachusetts, Amherst, MA, United States 3 Biostatistics, Yale University School of Medicine, New Haven, CT, United States Aims: To establish the sensitivity/specificity of a RWSN/ECG approach for discriminating cocaine use from other cardiovascular stimulants. Hypothesis: Wearable “on body” sensors will reliably distinguish cocaine-induced ECG changes from those induced by methylphenidate (MPH) and exercise. Methods: Subjects: Five experienced cocaine users (4 male/1 female; 41±8 years; lifetime cocaine use =17±9 years). Procedures: Subjects wore the Zephyr BioHarness 3 chest band (left mid-axillary line) during 180min of self-regulated IV cocaine administration (8, 16, and 32mg/70kg), for 90min after a single 45mg dose of oral MPH, and during 15–30min of aerobic exercise (ping pong or stationary bike) on an inpatient research unit. Statistical Analyses: 1. A computational pipeline was used to preprocess ECG data and identify ECG (P, Q, R, S and T) peaks. We extracted two types of features: one, PQRSTwaves (waveform features); two, all morphological (AM) features (PR, QRS, QT and QTc intervals), following which a binary classification model (logistic regression) was assessed for its ability to distinguish between conditions (cocaine vs. MPH; cocaine vs. exercise). Classifier performance was expressed as Area Under Receiver Operating Characteristics curve (AUROC). Results: Classifiers consistently distinguished cocaine use from exercise (N=5) andMPH(N=4)withmeanAUROCof >0.9 and>0.95 for AM and waveforms, respectively. Conclusions: If sensitivity/specificity of RWSN/ECG approach (>90%) is confirmed in larger outpatient cohorts, suchmethodsmay be of value in medication development efforts (i.e., clinical trials) for cocaine. Financial support: Supported by R01 DA03373301 and CTSA Grant Number UL1 RR024139. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.037 Comparison of synthetic substances: Diffusion of innovation framework Cynthia L. Arfken1, Cheryl Madeja1, Darlene Owens2 1 Wayne State University, Detroit, MI, United States 2 Southeast Michigan Community Alliance, Taylor,

Hepatitis C virus infection, HIV and pain sensitivity in opioid-dependent patients

s / Drug and Alcohol Dependence 146 (2015) e2–e33 e7 did not see amain effect for HIV or an interaction effect. Additional analyses will examine the potential moderating role of markers of HIV disease progression. Financial support: K23 DA-028660, T32 AI-007392. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.699 Predictors of substance use outcomes in mentorship for addiction problems Kathlene Tracy1, Mark Burton1, Matthew Warren1, Deborah Guzman1, Marc Galanter1, Theresa Babuscio2, Charla Nich2 1 Psychiatry, New York University School of Medicine, New York, NY, United States 2 Psychiatry, Yale University School of Medicine, New Haven, CT, United States Aims: We conducted a Stage Ia pilot to develop a new intervention, Mentorship for Addiction Problems (MAP), for individuals with substance use disorders in community treatment programsby pilot/feasibility testing, manual writing, training program development, and adherence/competence measure construction. We examined intervention and participant predictors of substance use outcomes. Methods: TenMentors participated for 6months in a piloting of MAP until 30 Mentees received MAP for 12 weeks. Behavioral and biological measures were conducted at baseline, weekly, monthly, and termination.Aseriesofbivariate regressionswereconducted to determine whether any treatment process or participant variables were associated with substance use outcomes. Results: Intervention Predictors. Mentor group supervision attendance was predictive of Mentee percentage of days abstinent from drugs and alcohol for Mentee weeks in treatment, R2 = .790, F(1, 8) = 30.13, p 3months). The independent variablewas HCV status (uninfected controls; mono-infected HCV+; or co-infected HCV+/HIV+). Chisquare and Kruskal-Willis tests were conducted. Results: The sample included 77 opioid-dependent adults: 23 uninfected controls, 35 HCV+, and 19 HCV+/HIV+. Mean age was 44 (SD±9) years, 48% were female, 32% non-white. Median duration on OAT was 2 years (range 1 month to 10 years), the majority (83%) were treated with buprenorphine. No significant differences were detected across groups for both primary and secondary outcomes. Median cold pain tolerance was 22 (controls) vs. 30 (HCV+) vs. 19 (HCV+/HIV+) s, (p=0.63).No significant effectswere found for cold pain thresholds or wind-up ratio. Chronic pain appearedmore prevalent among HCV+ (82%) compared to HCV+/HIV+ participants (63%) and controls (65%), though differences were not statistically significant (p=0.21). Conclusions: Among opioid dependent adults treated with OAT, we did not detect an association between HCV infection and increased pain sensitivity. Chronic pain may be more common amongHCVmono-infected individuals, however thismerits further investigation. Financial support: This study is supported by NIH/NIDA grant K23DA027367. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.701 Who in the world buys ARVs on the black market? The impact of drug use and ARV diversion on adherence Kiyomi Tsuyuki, Hilary Surratt, Maria A. Levi Minzi, Catherine L. O’Grady Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Miami, FL, United States Aims: Anti-retroviral (ARV) adherence is the most important predictor of regimen success and HIV viral suppression. HIVpositive drug users are found to have less access to ARV treatment and to initiate treatment at more advanced stages of infection than non-drug users. Recent studies also identify ARV diversion as a factor that may affect ARV adherence in drug users. This study

Drug-induced impairment of renal function.

Pharmaceutical agents provide diagnostic and therapeutic utility that are central to patient care. However, all agents also carry adverse drug effect profiles. While most of these are clinically insignificant, some drugs may cause unacceptable toxicity that impacts negatively on patient morbidity and mortality. Recognizing adverse effects is important for administering appropriate drug doses, instituting preventive strategies, and withdrawing the offending agent due to toxicity. In the present article, we will review those drugs that are associated with impaired renal function. By focusing on pharmaceutical agents that are currently in clinical practice, we will provide an overview of nephrotoxic drugs that a treating physician is most likely to encounter. In doing so, we will summarize risk factors for nephrotoxicity, describe clinical manifestations, and address preventive and treatment strategies.

REVIEW –A LIFE FOR NOBEL PRIZE, REMEMBER GEORGE EMIL PALADE

In 2012 were accomplished 100 years from birth of George Emil Palade. He was born in Iași, Romania, in November 19, 1912, and after high school, in 1929 he was admitted in “Carol Davila” Medicine Faculty from Bucharest. During university years, he was especially interested in anatomy and biochemistry. After university, he made and sustained the PhD thesis, which had the subject: “Urinary tube in cetacean Delphynus delphy ” and he obtained the title of Doctor in medicine and surgery in 1940. After six years, as assistant and then associate professor in Anatomy Department, G.E. Palade emigrated in USA to continue his post-doctorate studies. He will became USA citizen in 1952. In a first period of 26 years (1947-1973), G.E. Palade made his researches in Rockefeller Institute for Medical Research, having as main preoccupations the cells’ fractioning method and researches of animal and vegetal tissues in electronic microscope. He improved these methods conceiving the Palade fixing solution, ultracentrifugation in sucrose density gradient, the “pulse-chase” process in experiments with radioactive isotopes and the autoradiography in electronic microscopy. For the first time, in cellular ultrastructure and physiology, he described the mitochondria, nervous fibers of C type, interneuronal and neuromuscular synapses, the ribosomes (Palade granules), the role of rough endoplasmic reticullum in protein synthesis, the atrial specific granules, the messangial cells from renal corpuscles, the different types of intercellular junctions, the plasmalemal vesicles from endothelial cells and the transcytosis phenomenon, the Weibel-Palade corpuscles from endothelia, the peripheral vesicles of Golgi complex and intracellular vectorial transport of secretion proteins, the nature of zymogene granules, membranes’ biogenesis etc. In 1973, G.E. Palade accepted the proposal of Yale University School of Medicine to establish the “Yale Center Molecular Medicine”. Here, he continues the research of secretion process in pancreas exocrine cells. In 1974, the Nobel Prize for Medicine and Physiology was assigned to three researchers from Cellular Biology domain -Albert Claude, Christian De Duve and George Emil Palade. The Nobel Committee motivation was: “for discoveries concerning the functional organization of the cell that were seminal events in the development of modern cell biology”. In 1990, G.E. Palade go to University of California, in San Diego School of Medicine La Jolla, where he continues the study of intracellular vectorial transport of proteins using the immune-isolation procedure for subcellular components’ isolation. In biologic research domain, G.E. Palade was the partisan of multidisciplinary approach and has collaborators from specialization as biochemistry, physics, medicine, zoology, botany etc. He always considered that researches from cellular and molecular biomedicine would be useful to elucidate numerous diseases from cellular pathology domain. George Emil Palade died in October 7, 2008.