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Neul JL, Benke TA, Marsh ED, Lane JB, Lieberman DN, Skinner SA, Glaze DG, Suter B, Heydemann PT, Beisang AA, Standridge SM, Ryther RCC, Haas RH, Edwards LJ, Ananth A, Percy AK. Distribution of hand function by age in individuals with Rett syndrome. Ann Child Neurol Soc 2023; 1:228-238. [PMID: 38496825 PMCID: PMC10939125 DOI: 10.1002/cns3.20038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/14/2023] [Indexed: 03/19/2024]
Abstract
Objective To determine the longitudinal distribution of hand function skills in individuals with classic Rett Syndrome (RTT), an X-linked dominant neurodevelopmental disorder, and correlate with MECP2 variants. Method We conducted a longitudinal study of 946 girls and young women with typical RTT seen between 2006 and 2021 in the US Natural History Study (NHS) featuring a structured clinical evaluation to assess the level of hand function skills. The specific focus in this study was to assess longitudinal variation of hand skills from age 2 through age 18 years in relation to specific MECP2 variant groups. Results Following the initial regression period, hand function continues to decline across the age spectrum in individuals with RTT. Specific differences are noted with steeper declines in hand function among those with milder variants (Group A: R133C, R294X, R306C, and C-terminal truncations) compared to groups composed of individuals with more severe variants. Conclusions These temporal variations in hand use represent specific considerations which could influence the design of clinical trials that test therapies aiming to ameliorate specific functional limitations in individuals with RTT. Furthermore, the distinct impact of specific MECP2 variants on clinical severity, especially related to hand use, should be considered in such interventional trials.
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Affiliation(s)
| | - Tim A. Benke
- University of Colorado, School of Medicine, Children’s Hospital Colorado, Aurora, CO
| | - Eric D. Marsh
- Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Jane B. Lane
- University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | | | | | | | | | | | | | - Lloyd J. Edwards
- University of Alabama at Birmingham, School of Public Health, Birmingham, AL
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Buchanan CB, Stallworth JL, Joy AE, Dixon RE, Scott AE, Beisang AA, Benke TA, Glaze DG, Haas RH, Heydemann PT, Jones MD, Lane JB, Lieberman DN, Marsh ED, Neul JL, Peters SU, Ryther RC, Skinner SA, Standridge SM, Kaufmann WE, Percy AK. Anxiety-like behavior and anxiolytic treatment in the Rett syndrome natural history study. J Neurodev Disord 2022; 14:31. [PMID: 35568815 PMCID: PMC9107202 DOI: 10.1186/s11689-022-09432-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 02/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rett syndrome (RTT) is a neurodevelopmental disorder most often related to a pathogenic variant in the X-linked MECP2 gene. Internalizing behaviors appear to be common, but standard methods of diagnosing anxiety are not readily applied in this population which typically has cognitive impairment and limited expressive language. This study aims to describe the frequency of anxiety-like behavior and anxiolytic treatments along with associated clinical features in individuals with RTT. METHODS Parental reports and medication logs provided data from 1380 females with RTT participating in two iterations of the multicenter U.S. RTT Natural History Study (RNHS) from 2006 to 2019. RESULTS Most participants with RTT (77.5%) had at least occasional anxious or nervous behavior. Anxiety was reported to be the most troublesome concern for 2.6%, and within the top 3 concerns for 10.0%, of participants in the second iteration. Parents directly reported treatment for anxious or nervous behavior in 16.6% of participants in the second iteration with most reporting good control of the behavior (71.6%). In the medication logs of both RNHS iterations, the indication of anxiety was listed for a similar number of participants (15% and 14.5%, respectively). Increased use of anxiolytics and selective serotonin reuptake inhibitors (SSRIs) was related to more frequent anxiety-like behaviors (P < 0.001), older age (P < 0.001), and mild MECP2 variants (P = 0.002). CONCLUSION Anxiety-like behavior is frequent at all ages and is a significant parental concern in RTT. Older individuals and those with mild MECP2 variants are more likely to be treated with medications. Better diagnosis and treatment of anxiety in RTT should be a goal of both future studies and clinical care. TRIAL REGISTRATION NCT00299312 and NCT02738281.
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Affiliation(s)
- Caroline B. Buchanan
- grid.418307.90000 0000 8571 0933Greenwood Genetic Center, 106 Gregor Mendel Circle, Greenwood, SC 29649 USA
| | - Jennifer L. Stallworth
- grid.418307.90000 0000 8571 0933Greenwood Genetic Center, 106 Gregor Mendel Circle, Greenwood, SC 29649 USA
| | - Aubin E. Joy
- grid.418307.90000 0000 8571 0933Greenwood Genetic Center, 106 Gregor Mendel Circle, Greenwood, SC 29649 USA
| | - Rebekah E. Dixon
- grid.418307.90000 0000 8571 0933Greenwood Genetic Center, 106 Gregor Mendel Circle, Greenwood, SC 29649 USA
| | - Alexandra E. Scott
- grid.418307.90000 0000 8571 0933Greenwood Genetic Center, 106 Gregor Mendel Circle, Greenwood, SC 29649 USA
| | - Arthur A. Beisang
- grid.429065.c0000 0000 9002 4129Gillette Children’s Hospital, St. Paul, MN USA
| | - Timothy A. Benke
- grid.241116.10000000107903411Children’s Hospital Colorado, University of Colorado at Denver, Denver, CO USA
| | - Daniel G. Glaze
- grid.39382.330000 0001 2160 926XBaylor College of Medicine, Houston, TX USA
| | - Richard H. Haas
- grid.266100.30000 0001 2107 4242Rady Children’s Hospital-San Diego, University of California, San Diego, CA USA
| | - Peter T. Heydemann
- grid.240684.c0000 0001 0705 3621Rush University Medical Center, Chicago, IL USA
| | - Mary D. Jones
- grid.414016.60000 0004 0433 7727UCSF Benioff Children’s Hospital of Oakland, Oakland, CA USA
| | - Jane B. Lane
- grid.265892.20000000106344187Civitan International Research Center, University of Alabama at Birmingham, Birmingham, AL USA
| | - David N. Lieberman
- grid.38142.3c000000041936754XBoston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Eric D. Marsh
- grid.25879.310000 0004 1936 8972Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA USA
| | - Jeffrey L. Neul
- grid.412807.80000 0004 1936 9916Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN USA
| | - Sarika U. Peters
- grid.412807.80000 0004 1936 9916Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN USA
| | - Robin C. Ryther
- grid.4367.60000 0001 2355 7002Washington University School of Medicine in St. Louis, St. Louis, MO USA
| | - Steve A. Skinner
- grid.418307.90000 0000 8571 0933Greenwood Genetic Center, 106 Gregor Mendel Circle, Greenwood, SC 29649 USA
| | - Shannon M. Standridge
- grid.239573.90000 0000 9025 8099Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,grid.24827.3b0000 0001 2179 9593Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Walter E. Kaufmann
- grid.254567.70000 0000 9075 106XUniversity of South Carolina School of Medicine, Columbia, SC USA ,grid.189967.80000 0001 0941 6502Emory University School of Medicine, Atlanta, GA USA
| | - Alan K. Percy
- grid.265892.20000000106344187Civitan International Research Center, University of Alabama at Birmingham, Birmingham, AL USA
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Merbler AM, Byiers BJ, Hoch J, Dimian AC, Barney CC, Feyma TJ, Beisang AA, Bartolomucci A, Symons FJ. Preliminary Evidence That Resting State Heart Rate Variability Predicts Reactivity to Tactile Stimuli in Rett Syndrome. J Child Neurol 2020; 35:42-48. [PMID: 31552776 PMCID: PMC7098209 DOI: 10.1177/0883073819875915] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients with Rett syndrome may manifest altered pain perception/experience and are vulnerable to conditions associated with chronic pain. Pain response is difficult to measure, however, because of severe communicative impairment. There is also documented autonomic dysfunction, including decreased heart rate variability. Given the relation between pain and the autonomic nervous system, we tested the feasibility of using resting heart rate variability to predict nonverbal pain/discomfort behavior during a standardized modified quantitative sensory test in Rett syndrome. All stimulus applications resulted in increased behavioral reactivity compared to baseline, with repeated von Frey significantly greater than all other stimuli. Resting heart rate variability predicted behavioral reactivity to repeated von Frey. These preliminary findings provide feasibility evidence for an integrated autonomic-sensory measurement approach and are consistent at a construct level with preclinical evidence in Rett syndrome. Further work is needed to determine how heart rate variability changes during stimulus application.
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Affiliation(s)
- Alyssa M. Merbler
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Breanne J. Byiers
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, USA
| | - John Hoch
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Adele C Dimian
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Chantel C. Barney
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, USA,Gillette Children’s Specialty Healthcare, St. Paul, MN, USA
| | | | | | - Alessandro Bartolomucci
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN, USA
| | - Frank J. Symons
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, USA
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Byiers BJ, Merbler AM, Barney CC, Frenn KA, Panoskaltsis-Mortari A, Ehrhardt MJ, Feyma TJ, Beisang AA, Symons F. Evidence of altered salivary cytokine concentrations in Rett syndrome and associations with clinical severity. Brain Behav Immun Health 2020; 1:100008. [PMID: 38377412 PMCID: PMC8474566 DOI: 10.1016/j.bbih.2019.100008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/11/2019] [Accepted: 10/13/2019] [Indexed: 11/17/2022] Open
Abstract
Background Immune dysregulation may play a role in the development of Rett syndrome (RTT), a neurodevelopmental disorder caused by mutations of the MECP2 gene. Abnormal cytokine concentrations have been documented in the serum of individuals with RTT. Measurement of salivary cytokines has been investigated as a potential alternative approach to measurement in blood and serum, but it is unclear whether salivary cytokine concentrations can provide valid information about systemic immune function in neurodevelopmental disorders. The goal of this study was to evaluate the potential validity of salivary cytokines as biomarkers of immune dysregulation in RTT. Methods Saliva samples from 16 individuals with RTT (all female; age range 2-40 years) and 16 healthy control females (age range 2-40 years) were analyzed for concentrations of 12 cytokines. Between-group differences in concentrations, and correlations with clinical severity in the RTT group were evaluated. Results Concentrations of several salivary cytokines (IL-1β, IL-6, IL-8, IL-10, GM-CSF, TNF-α, and VEGF) were increased in RTT compared to controls. The same cytokines showed significant positive correlations with clinical severity scores. There were no differences in concentrations of IL-2, IL-4, IL-5, IL-12p70, and IFN-γ. Conclusion The results suggest that salivary cytokines may be a possible indicator of immune dysregulation in RTT. Future research should investigate whether these results can be applied to other neurodevelopmental disorders.
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Affiliation(s)
- Breanne J. Byiers
- Department of Educational Psychology, 56 E River Rd, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Alyssa M. Merbler
- Department of Educational Psychology, 56 E River Rd, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Chantel C. Barney
- Gillette Children’s Specialty Healthcare, 200 University Ave E, St. Paul, Minnesota, 55101, USA
| | - Kristin A. Frenn
- Gillette Children’s Specialty Healthcare, 200 University Ave E, St. Paul, Minnesota, 55101, USA
| | - Angela Panoskaltsis-Mortari
- Cancer Center and Department of Pediatrics, Division of Blood and Marrow Transplantation, 2450 Riverside Ave, University of Minnesota, Minneapolis, MN, 55454, USA
| | - Michael J. Ehrhardt
- Cancer Center and Department of Pediatrics, Division of Blood and Marrow Transplantation, 2450 Riverside Ave, University of Minnesota, Minneapolis, MN, 55454, USA
| | - Timothy J. Feyma
- Gillette Children’s Specialty Healthcare, 200 University Ave E, St. Paul, Minnesota, 55101, USA
| | - Arthur A. Beisang
- Gillette Children’s Specialty Healthcare, 200 University Ave E, St. Paul, Minnesota, 55101, USA
| | - Frank Symons
- Department of Educational Psychology, 56 E River Rd, University of Minnesota, Minneapolis, MN, 55455, USA
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Abstract
OBJECTIVE Over 2 million adolescents participate in summer-camp experiences, placing themselves at risk for mosquito-borne illness. Insect repellent is recommended but often not used. It is unknown whether permethrin treatment of a location, such as a campsite, provides passive prophylaxis reducing mosquito bites among all persons in the immediate vicinity. METHODS This randomized, double-blind controlled trial used 0.4% permethrin (2.5% permethrin diluted by 7 parts water) sprayed once onto the external surface of canvas tents at a Boy Scout summer camp. During a 9-week period, subjects (n = 545) completed nightly mosquito-bite and -landing counts for 5 minutes at dusk and recorded insect-repellent use within 2 hours of counting. Weekly mosquito sampling with CO2-baited Centers for Disease Control and Prevention traps occurred at study campsites. The primary outcome measure was the number of mosquito bites per 5 minutes. RESULTS A total of 1614 person nights averaged 5.1 +/- 7.2 (+/- SD) mosquito bites per 5 minutes. The permethrin-treated campsites had decreased mosquito landings and bites (relative risk reduction [RRR] 44%; 95% CI 34% to 55%; P < .001) compared with controls. Insect repellent was used only 32% of nights, decreasing bites by 36% (RRR 36%; 95% CI 25% to 47%; P < .001). Permethrin was superior to insect repellent alone (RRR 20%; 95% CI 4% to 37%; P = .01). CONCLUSIONS Permethrin treatment of tents is an effective, inexpensive public health measure to reduce mosquito bites. Permethrin is effective among all individuals in a camping setting and was more effective than topical insect repellent alone, which, although recommended, was inconsistently used.
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Affiliation(s)
- David R Boulware
- Division of Infectious Disease and International Medicine, University of Minnesota, MMC 250, 420 Delaware St SE, Minneapolis, MN 55455, USA.
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Abstract
The development of small, textured implant particles suspended in a hydrogel has allowed for subdermal injection therapy to fill tissue defects. The microimplant particles were placed subdermally into the ears of white New Zealand rabbits in order to characterize the foreign body response and the permanence of the implant. Serial micrometer readings were performed on the implant sites to determine any change in thickness of the augmentation following baseline measurement. An initial increase in the thickness was noted approximately 20-30 days postimplantation, as expected. A stable thickness was noted for the remainder of the experiment. Serial histological sections were performed at irregular intervals from one week to one year. Histology demonstrated a mild foreign body response with collagen surrounding each individual microimplant particle. The response was stable after 30-40 days and has remained stable for over one year. It was determined that the histology demonstrated a Boros 1A type, or nonimmunogenic, low-turnover foreign body reaction.
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Affiliation(s)
- A A Beisang
- Department of Pediatric Immunology, University of Minnesota, Minneapolis 55455
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Abstract
The search for prosthetic materials that are biocompatible, nontoxic, and permanent led the authors to develop a micronized, inert, biphasic polymer particle for permanent soft tissue augmentation which neither migrates nor is absorbed by the body. Placed in a bioexcretable gel carrier, these textured microparticles are easily implanted using a specially designed blunt-tipped cannula with local anesthesia on an outpatient basis. Research using this implant material, Bioplastique (Bioplasty, St. Paul, MN), in rabbits has shown that when the textured particle size is maintained within a critical range, neither particle migration nor storage disease occurs. The gel carrier is rapidly phagocytized and replaced by fibrin matrix within a few days. Host collagen then gradually forms a fibrotic capsule around each textured particle, making use of the naturally occurring foreign body reaction to create a stable inplant. After being followed for over two years, Bioplastique has proven to be useful in many clinical applications with few complications.
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Affiliation(s)
- R A Ersek
- Park St. David Hospital, Austin, TX 78705
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Abstract
The successful use of silicone breast implants is complicated by their interference with mammography. We have evaluated clinically available implant filling materials and found that a new Bio-Oncotic gel approximates the radiolucency of normal breast tissue. Silicone implants completely obscure areas of the breast in mammography. Recently proposed as a filler material, peanut oil is significantly more radiolucent than normal tissue. Physiologic saline solution compares favorably as a tissue-density-simulating substance. However, saline's lack of lubricating properties results in leakage, making it less than optimal. Bio-Oncotic gel is biologically compatible. We conclude that this gel is the most appropriate filler for breast prostheses. Clinical studies are indicated.
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Affiliation(s)
- A A Beisang
- Department of Pediatrics, University of Minnesota Hospitals, Minneapolis
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Ersek RA, Beisang AA. Bioplastique: a new textured copolymer microparticle promises permanence in soft-tissue augmentation. Plast Reconstr Surg 1991; 87:693-702. [PMID: 2008467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Migration, absorption, or toxicity of prosthetic materials has always plagued the plastic surgeon attempting to ameliorate soft-tissue deficiencies and other contour abnormalities. Our previous work to develop textured-surface breast prostheses has led to the development of micronized, inert, biphasic copolymer particles that neither migrate nor become absorbed by the body. These particles are textured, of critical dimension, and, when mixed with a bioexcretable gel vehicle, can be implanted using a special blunt-tipped cannula. Our experimentation in rabbit ears has shown that the bioexcretable gel component is rapidly phagocytized and is replaced by fibrin-like matrix within 3 days. The fibrin is then replaced by host collagen that gradually converts into a fibrotic encasement around each texturized particle. Clinical use of the substance in a variety of soft-tissue deficiencies has been generally effective, with only a few complications, when followed for 1 year.
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Affiliation(s)
- R A Ersek
- Department of Plastic and Reconstructive Surgery, Southwest Texas State University, San Marcos
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Ersek RA, Beisang AA. Physiologic tissue gel equivalent. Plast Reconstr Surg 1990; 86:611. [PMID: 2385691 DOI: 10.1097/00006534-199009000-00070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Ersek RA, Hart WG, Greer D, Beisang AA, Flynn PJ, Denton DR. Processed bovine cartilage: an improved biosynthetic implant for contour defects. Ann Plast Surg 1984; 12:397-409. [PMID: 6742723 DOI: 10.1097/00000637-198405000-00001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Irradiated human cartilage has been found to be a superior implant material for correction of contour defects; however, availability problems have prevented this material from gaining wide acceptance. Implantation of processed irradiated bovine cartilage in primates and rabbits, as described here, provides strong evidence that this material performs like irradiated allograft cartilage antigenically and has certain cosmetic advantages over allograft cartilage. Our studies in primates have shown that there is no systemically measurable antibody-antigen reaction, either cellular or noncellular, to irradiated processed bovine cartilage. Neither primary nor second-set provocative implantations produced any measurable rejection. In rabbits, composite grafts of two pieces of irradiated bovine cartilage adjacent to each other were also well tolerated, with no measurable absorption and with capsule formation typical of a foreign body reaction to an inert object.
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Beisang AA, Feemster J, Dietzman RH, Uchida H, Carter JE, Graham EF, Lillehei RC. Damage assay of kidneys frozen by intraarterial perfusion with a fluorocarbon. Fed Proc 1970; 29:1782-8. [PMID: 4917613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Carter JE, Schellpfeffer DA, Beisang AA, Graham EF, Lillehei RC. The effect of storage temperature and media on the activity of lactic dehydrogenase and glutamic oxalacetic transaminase in perfusates from frozen canine kidneys. Cryobiology 1970; 6:533-41. [PMID: 5433139 DOI: 10.1016/s0011-2240(70)80005-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Beisang AA, Graham EF, Lillehei RC, Dietzman RH, Carter JE. Enzyme levels in the effluent perfusates from frozen canine kidneys. Transplant Proc 1969; 1:862-81. [PMID: 4939680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Loken MK, Beisang AA, Johnson EA, Mosser DG. The Relative Biological Effectiveness of Cobalt-60 Gamma Rays and 220-Kvp X-Rays on the Viability of Chicken Eggs. Radiat Res 1960. [DOI: 10.2307/3570702] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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