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Melvin J, Beesley H, Pernar LI, Richman A, Hess DT. Intern Experience Reflects Information Gathered During the Virtual Interview Process. J Surg Educ 2023; 80:1544-1551. [PMID: 37563002 DOI: 10.1016/j.jsurg.2023.07.012] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 06/15/2023] [Accepted: 07/10/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE The onset of the coronavirus 2019 (COVID-19) pandemic brought many changes to the residency application process including transitioning to a virtual interview platform, which continues today. The transition brought many concerns from general surgery applicants about their ability to obtain adequate information about a program virtually. We sought to characterize how information presented by programs during the first ever virtual interview cycle matched the experience of general surgery interns after training at a program for 1 year. DESIGN, SETTING, AND PARTICIPANTS In May of 2022, a survey was distributed to 243 program directors who were asked to forward it to their general surgery categorical interns who matched during the 2021 virtual match cycle. Demographics, resources used to determine an impression of a program, and correlations between information presented virtually and what was subsequently experienced as an intern were collected. RESULTS Forty-six program directors confirmed forwarding the survey to their categorical interns. A total of 102 general surgery interns completed the survey. Most interns (88.2%) agreed that their experience matched expectations based on information received through the virtual interview process and 98% of interns were satisfied with their experience at their training program. Interviews with faculty (40.0%), residents (68.0%) and the program web site (29.0%) were the top 3 resources used to create the most accurate impression of a program. Interns felt they were well informed during the virtual interview experience about support from fellow residents (84.3%), culture (73.0%), surgical volume (72.5%), and intern operative experience (71.6%). In addition, 65.7% of participants thought they were able to obtain a good understanding of the program's culture from the virtual process. However, 16.7% thought that their program unintentionally misrepresented aspects of the training program. CONCLUSIONS The faculty and residency interviews were the most important factors in program ranking and most participants agreed that their virtual interview experience matched their expectations during their intern year. Most interns felt they were able to obtain a good understanding of the program's culture from the virtual process. In addition, a majority of interns felt well informed during the interview on aspects ranging from surgical volume, autonomy, and work hours to support from faculty and residents. If virtual interviews are to continue, residents can be satisfied that information gathered virtually will match the reality of their training. Programs should continue to make every effort to present their program realistically.
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Affiliation(s)
- Jeffrey Melvin
- Avedisian School of Medicine, Boston University Chobanian, Boston, Massachusetts; Department of Surgery, Boston Medical Center, Boston, Massachusetts
| | - Hassan Beesley
- Avedisian School of Medicine, Boston University Chobanian, Boston, Massachusetts
| | - Luise I Pernar
- Avedisian School of Medicine, Boston University Chobanian, Boston, Massachusetts; Department of Surgery, Boston Medical Center, Boston, Massachusetts
| | - Aaron Richman
- Avedisian School of Medicine, Boston University Chobanian, Boston, Massachusetts; Department of Surgery, Boston Medical Center, Boston, Massachusetts
| | - Donald T Hess
- Avedisian School of Medicine, Boston University Chobanian, Boston, Massachusetts; Department of Surgery, Boston Medical Center, Boston, Massachusetts.
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Armbruster C, Marshall C, Garber A, Melvin J, Zemke A, Moore J, Zamora P, DePas W, Lee S, Cooper V, Bomberger J. 408: Pseudomonas aeruginosa adapts and evolves toward host restriction in the sinuses of people with cystic fibrosis. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01832-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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3
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Welp A, Melvin J, Thibodeau P, Bomberger J. 474: Altered nutritional environment during respiratory viral co-infection affects Pseudomonas aeruginosa biofilm formation and interspecies interactions. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01898-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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4
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Liveris A, Parsikia A, Melvin J, Chao E, Reddy SH, Teperman S, Stone ME. Is There an Age Cutoff for Intracranial Pressure Monitoring?: A Propensity Score Matched Analysis of the National Trauma Data Bank. Am Surg 2021; 88:1163-1171. [PMID: 33522254 DOI: 10.1177/0003134821991985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite mostly favorable past evidence for use of intracranial pressure monitoring (ICPM), more recent data question not only the indications but also the utility of ICPM. The Fourth Edition Brain Trauma Foundation guidelines offer limited indications for ICPM. Evidence supports ICPM for reducing mortality in patients with severe traumatic brain injury (TBI) and cites decreased survival in elderly patients. METHODS All patients ≥ 18 years of age with isolated TBI, head Abbreviated Injury Scale (AIS) ≥ 3, and a Glasgow Coma Scale (GCS) ≤ 8 between 2008 and 2014 were included from the National Trauma Data Bank. Exclusion criteria were head AIS = 6 and death within 24 hours. Patients with and without ICPM were compared using TBI-specific variables. Patients were then matched via propensity-score matching (PSM), and the odds ratio (OR) of death with ICPM was determined using logistic regression modeling for 8 different age strata. RESULTS A total of 23,652 patients with a mean age of 56 years, median head AIS of 4, median GCS of 3, and overall mortality of 29.2% were analyzed. After PSM, ICPM was associated with death beginning at the age stratum of 56-65 years. Intracranial pressure monitoring was associated with survival beginning at the age-group 36-45 years. DISCUSSION Based on a large propensity-matched sample of TBI patients, ICPM was not associated with improved survival for TBI patients above 55 years of age. Until level 1 evidence is available, this age threshold should be considered for further prospective study in determining indications for ICPM.
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Affiliation(s)
- Anna Liveris
- Department of Surgery, 24502Jacobi Medical Center, Bronx, NY, USA
| | - Afshin Parsikia
- Department of Surgery, 24502Jacobi Medical Center, Bronx, NY, USA
| | | | - Edward Chao
- Department of Surgery, 24502Jacobi Medical Center, Bronx, NY, USA.,Albert Einstein College of Medicine, Bronx, NY, USA
| | - Srinivas H Reddy
- Department of Surgery, 24502Jacobi Medical Center, Bronx, NY, USA.,Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sheldon Teperman
- Department of Surgery, 24502Jacobi Medical Center, Bronx, NY, USA.,Albert Einstein College of Medicine, Bronx, NY, USA
| | - Melvin E Stone
- Department of Surgery, 24502Jacobi Medical Center, Bronx, NY, USA.,Albert Einstein College of Medicine, Bronx, NY, USA
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Torabi J, Melvin J, Rechnitzer A, Rocca JP, Ajaimy M, Lirano-Ward L, Azzi Y, Pynadath C, Alani O, Akalin E, Graham JA. High terminal creatinine donors should not preclude simultaneous kidney and pancreas transplantation. Am J Surg 2020; 221:677-680. [PMID: 33012501 DOI: 10.1016/j.amjsurg.2020.09.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 09/10/2020] [Accepted: 09/23/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Simultaneous pancreas and kidney transplantation (SPK) in the setting of end-stage renal disease offers unmatched outcomes in insulin dependent diabetic patients. Donor pool expansion through the transplantation of kidneys with acute kidney injury (AKI) is controversial. METHODS 59 SPK transplants were classified by presence of donor AKI, defined as donor terminal creatinine ≥ 1.5x the initial creatinine or donor terminal creatinine > 4.0 mg/dL. Endpoints included graft and patient survival, delayed graft function (DGF), serum creatinine, glomerular filtration rate (GFR), Hemoglobin A1c (HbA1c) and acute rejection. RESULTS The donor AKI group (n = 35) had significantly higher rates of DGF (38 v. 9%, p = 0.01). There was no difference in creatinine or GFR at 1, 3, 6 and 12 months. HbA1c was comparable at 3, 6 and 12 months. There was no significant difference in the percentage of patients that required anti-diabetic agents after transplant (14 v. 4%, p = 0.56). CONCLUSIONS We observed increased rates of DGF in SPK recipients with donor AKI. However, equivalent outcomes of pancreas and kidney function in both groups were observed.
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Affiliation(s)
- Julia Torabi
- Albert Einstein College of Medicine, Bronx, NY, USA
| | | | | | - Juan P Rocca
- Albert Einstein College of Medicine, Bronx, NY, USA; Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
| | - Maria Ajaimy
- Albert Einstein College of Medicine, Bronx, NY, USA; Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
| | - Luz Lirano-Ward
- Albert Einstein College of Medicine, Bronx, NY, USA; Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
| | - Yorg Azzi
- Albert Einstein College of Medicine, Bronx, NY, USA; Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
| | - Cindy Pynadath
- Albert Einstein College of Medicine, Bronx, NY, USA; Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
| | - Omar Alani
- Albert Einstein College of Medicine, Bronx, NY, USA; Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
| | - Enver Akalin
- Albert Einstein College of Medicine, Bronx, NY, USA; Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
| | - Jay A Graham
- Albert Einstein College of Medicine, Bronx, NY, USA; Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA.
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Torabi J, Rocca JP, Ajaimy M, Melvin J, Campbell A, Akalin E, Liriano LE, Azzi Y, Pynadath C, Greenstein SM, Le M, Goldstein DY, Fox AS, Carrero J, Weiss JM, Powell T, Racine AD, Reinus JF, Kinkhabwala MM, Graham JA. Commercial insurance delays direct-acting antiviral treatment for hepatitis C kidney transplantation into uninfected recipients. Transpl Infect Dis 2020; 23:e13449. [PMID: 32810315 DOI: 10.1111/tid.13449] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/28/2020] [Accepted: 08/11/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The advent of direct-acting antivirals (DAAs) has created an avenue for transplantation of hepatitis C virus (HCV)-infected donors into uninfected recipients (D+/R-). The donor transmission of HCV is then countered by DAA administration during the post-operative period. However, initiation of DAA treatment is ultimately dictated by insurance companies. METHODS A retrospective chart review of 52 D+/R- kidney recipients who underwent DAA treatment post-transplant was performed. Patients were grouped according to their prescription coverage plans, managed by either commercial or government pharmacy benefit managers (PBMs). RESULTS Thirty-nine patients had government PBMs and 13 had commercial PBMs. Demographics were similar between the two groups. All patients developed HCV viremia, but cleared the virus after treatment with DAA. Patients with government PBMs were treated earlier compared to those with commercial PBMs (11 days vs 26 days, P = .01). Longer time to DAA initiation resulted in higher peak viral loads (β = 0.39, R2 = .15, P = .01) and longer time to HCV viral load clearance (β = 0.41, R2 = .17, P = .01). CONCLUSIONS D+/R- transplantation offers patients an alternative strategy to increase access. However, treatment can be profoundly delayed by a third-party payer authorization process that may be subjecting patients to unnecessary risks and worsened outcomes.
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Affiliation(s)
- Julia Torabi
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Juan P Rocca
- Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
| | - Maria Ajaimy
- Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
| | | | - Alesa Campbell
- Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
| | - Enver Akalin
- Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
| | - Luz E Liriano
- Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
| | - Yorg Azzi
- Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
| | - Cindy Pynadath
- Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
| | - Stuart M Greenstein
- Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
| | - Marie Le
- Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
| | - Doctor Y Goldstein
- Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Pathology, Montefiore Medical Center, Bronx, NY, USA
| | - Amy S Fox
- Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Pathology, Montefiore Medical Center, Bronx, NY, USA
| | - Jin Carrero
- Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
| | - Jeffrey M Weiss
- Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Tia Powell
- Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore-Einstein Center for Bioethics, Montefiore Medical Center, Bronx, NY, USA
| | - Andrew D Racine
- Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Pediatrics, Montefiore Medical Center, Bronx, NY, USA
| | - John F Reinus
- Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
| | - Milan M Kinkhabwala
- Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
| | - Jay A Graham
- Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
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Chen H, Palisano R, Silfies S, Melvin J, Li J, Smith S. Test-retest reliability, minimal detectable change and convergent validity of the performance-based balance scale (PBS) in community-living older adults. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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8
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Gutenbrunner C, Bickenbach J, Melvin J, Lains J, Nugraha B. Strengthening health-related rehabilitation services at national levels. J Rehabil Med 2018; 50:317-325. [DOI: 10.2340/16501977-2217] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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9
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Gutenbrunner C, Bickenbach J, Borg K, Nugraha B, Melvin J, Stucki G. Scaling up rehabilitation - Towards an international policy agenda. J Rehabil Med 2018; 50:307-308. [DOI: 10.2340/16501977-2317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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10
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Rana V, Lim H, Melvin J, Glimm J, Cheng B, Sharp DH. Mixing with applications to inertial-confinement-fusion implosions. Phys Rev E 2017; 95:013203. [PMID: 28208418 DOI: 10.1103/physreve.95.013203] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Indexed: 11/07/2022]
Abstract
Approximate one-dimensional (1D) as well as 2D and 3D simulations are playing an important supporting role in the design and analysis of future experiments at National Ignition Facility. This paper is mainly concerned with 1D simulations, used extensively in design and optimization. We couple a 1D buoyancy-drag mix model for the mixing zone edges with a 1D inertial confinement fusion simulation code. This analysis predicts that National Ignition Campaign (NIC) designs are located close to a performance cliff, so modeling errors, design features (fill tube and tent) and additional, unmodeled instabilities could lead to significant levels of mix. The performance cliff we identify is associated with multimode plastic ablator (CH) mix into the hot-spot deuterium and tritium (DT). The buoyancy-drag mix model is mode number independent and selects implicitly a range of maximum growth modes. Our main conclusion is that single effect instabilities are predicted not to lead to hot-spot mix, while combined mode mixing effects are predicted to affect hot-spot thermodynamics and possibly hot-spot mix. Combined with the stagnation Rayleigh-Taylor instability, we find the potential for mix effects in combination with the ice-to-gas DT boundary, numerical effects of Eulerian species CH concentration diffusion, and ablation-driven instabilities. With the help of a convenient package of plasma transport parameters developed here, we give an approximate determination of these quantities in the regime relevant to the NIC experiments, while ruling out a variety of mix possibilities. Plasma transport parameters affect the 1D buoyancy-drag mix model primarily through its phenomenological drag coefficient as well as the 1D hydro model to which the buoyancy-drag equation is coupled.
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Affiliation(s)
- V Rana
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, New York 11794-3600, USA
| | - H Lim
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, New York 11794-3600, USA
| | - J Melvin
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, New York 11794-3600, USA
| | - J Glimm
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, New York 11794-3600, USA
| | - B Cheng
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - D H Sharp
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
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Hoffman C, Eby J, Gray M, Heath Damron F, Melvin J, Cotter P, Hewlett E. Bordetella adenylate cyclase toxin interacts with filamentous haemagglutinin to inhibit biofilm formation in vitro. Mol Microbiol 2016; 103:214-228. [PMID: 27731909 DOI: 10.1111/mmi.13551] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2016] [Indexed: 12/19/2022]
Abstract
Bordetella pertussis, the causative agent of whooping cough, secretes and releases adenylate cyclase toxin (ACT), which is a protein bacterial toxin that targets host cells and disarms immune defenses. ACT binds filamentous haemagglutinin (FHA), a surface-displayed adhesin, and until now, the consequences of this interaction were unknown. A B. bronchiseptica mutant lacking ACT produced more biofilm than the parental strain; leading Irie et al. to propose the ACT-FHA interaction could be responsible for biofilm inhibition. Here we characterize the physical interaction of ACT with FHA and provide evidence linking that interaction to inhibition of biofilm in vitro. Exogenous ACT inhibits biofilm formation in a concentration-dependent manner and the N-terminal catalytic domain of ACT (AC domain) is necessary and sufficient for this inhibitory effect. AC Domain interacts with the C-terminal segment of FHA with ∼650 nM affinity. ACT does not inhibit biofilm formation by Bordetella lacking the mature C-terminal domain (MCD), suggesting the direct interaction between AC domain and the MCD is required for the inhibitory effect. Additionally, AC domain disrupts preformed biofilm on abiotic surfaces. The demonstrated inhibition of biofilm formation by a host-directed protein bacterial toxin represents a novel regulatory mechanism and identifies an unprecedented role for ACT.
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Affiliation(s)
- Casandra Hoffman
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Joshua Eby
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Mary Gray
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - F Heath Damron
- Department of Microbiology, Immunology and Cell Biology, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Jeffrey Melvin
- School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Peggy Cotter
- School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Erik Hewlett
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, VA, USA
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Brooks JM, Bravington A, Hardy B, Melvin J, King N. “ IT'S NOT JUST ABOUT THE PATIENT, IT'S THE FAMILIES TOO”: END-OF-LIFE CARE IN THE HOME ENVIRONMENT. BMJ Support Palliat Care 2015. [DOI: 10.1136/bmjspcare-2014-000838.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Noble B, King N, Woolmore A, Hughes P, Winslow M, Melvin J, Brooks J, Bravington A, Ingleton C, Bath PA. Can comprehensive specialised end-of-life care be provided at home? Lessons from a study of an innovative consultant-led community service in the UK. Eur J Cancer Care (Engl) 2014; 24:253-66. [PMID: 24735122 PMCID: PMC4359037 DOI: 10.1111/ecc.12195] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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] [Accepted: 02/23/2014] [Indexed: 11/29/2022]
Abstract
The Midhurst Macmillan Specialist Palliative Care Service (MMSPCS) is a UK, medical consultant-led, multidisciplinary team aiming to provide round-the-clock advice and care, including specialist interventions, in the home, community hospitals and care homes. Of 389 referrals in 2010/11, about 85% were for cancer, from a population of about 155 000. Using a mixed method approach, the evaluation comprised: a retrospective analysis of secondary-care use in the last year of life; financial evaluation of the MMSPCS using an Activity Based Costing approach; qualitative interviews with patients, carers, health and social care staff and MMSPCS staff and volunteers; a postal survey of General Practices; and a postal survey of bereaved caregivers using the MMSPCS. The mean cost is about 3000 GBP (3461 EUR) per patient with mean cost of interventions for cancer patients in the last year of life 1900 GBP (2192 EUR). Post-referral, overall costs to the system are similar for MMSPCS and hospice-led models; however, earlier referral avoided around 20% of total costs in the last year of life. Patients and carers reported positive experiences of support, linked to the flexible way the service worked. Seventy-one per cent of patients died at home. This model may have application elsewhere.
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Affiliation(s)
- B Noble
- Academic Unit of Supportive Care, Department of Oncology, University of Sheffield, Sheffield, UK
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Meyer T, Gutenbrunner C, Kiekens C, Skempes D, Melvin J, Schedler K, Imamura M, Stucki G. ISPRM discussion paper: Proposing a conceptual description of health-related rehabilitation services. J Rehabil Med 2014; 46:1-6. [DOI: 10.2340/16501977-1251] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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15
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Imamura M, Gutenbrunner C, Stucki G, Li J, Lains J, Frontera W, Olver J, Özçakar L, DeLisa J, Battistella L, Melvin J. The International Society of Physical and Rehabilitation Medicine: The way forward – II. J Rehabil Med 2014; 46:97-107. [DOI: 10.2340/16501977-1277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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16
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Meyer T, Gutenbrunner C, Bickenbach J, Cieza A, Melvin J, Stucki G. Towards a conceptual description of rehabilitation as a health strategy. J Rehabil Med 2011; 43:765-9. [DOI: 10.2340/16501977-0865] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Steemans P, Herisse AL, Melvin J, Miller MA, Paris F, Verniers J, Wellman CH. Origin and Radiation of the Earliest Vascular Land Plants. Science 2009; 324:353. [DOI: 10.1126/science.1169659] [Citation(s) in RCA: 199] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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18
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Patel NM, Wong M, Little E, Ramos AX, Kolli G, Fox KM, Melvin J, Moore A, Manch R. Vibrio cholerae non-O1 infection in cirrhotics: case report and literature review. Transpl Infect Dis 2008; 11:54-6. [PMID: 18811633 DOI: 10.1111/j.1399-3062.2008.00339.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Vibrio species are ubiquitous in the marine environment and can cause severe infections in cirrhotic patients. Patients with liver disease should be warned about the potential dangers of consuming raw or undercooked seafood, and avoiding exposure of wounds to seawater. We report a case of severe sepsis from Vibrio cholerae non-O1 in a patient with cirrhosis awaiting orthotopic liver transplant. This case is aimed to advise clinicians about the importance of V. cholerae subtypes, and non-cholera Vibrio species infections in cirrhotic patients, highlighting the need to educate these patients to stay away from undercooked seafood.
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Affiliation(s)
- N M Patel
- Banner Good Samaritan Medical Center, Banner Liver Disease Center, Phoenix, Arizona, USA.
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Stucki G, Reinhardt JD, Grimby G, Melvin J. Developing research capacity in human functioning and rehabilitation research from the comprehensive perspective based on the ICF-model. Eur J Phys Rehabil Med 2008; 44:343-351. [PMID: 18762743] [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: 05/26/2023]
Abstract
With the International Classification of Functioning, Disability and Health (ICF) the World Health Organization (WHO) has prepared the ground for a comprehensive understanding of Human Functioning and Rehabilitation Research integrating the biomedical perspective on impairment with the social model of disability. This poses a number of old and new challenges regarding the enhancement of adequate research capacity. Here the authors will summarize approaches to address these challenges with respect to three areas: the organization of Human Functioning and Rehabilitation Research into distinct scientific fields, the development of suitable academic training programs and the building of university centres and collaboration networks.
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Affiliation(s)
- G Stucki
- Department of Physical Medicine and Rehabilitation, Ludwig-Maximilian University Munich, Germany.
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Marsh H, Akitt JW, Hurley JM, Melvin J, Warburton AP. Formation of graphitisable carbons from gilsonite pitch and polyvinyl chloride-a mass spectrometric and N.M.R. study. ACTA ACUST UNITED AC 2007. [DOI: 10.1002/jctb.5020210903] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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21
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Valencia I, Miles DK, Melvin J, Khurana D, Kothare S, Hardison H, Legido A. Relapse of herpes encephalitis after acyclovir therapy: report of two new cases and review of the literature. Neuropediatrics 2004; 35:371-6. [PMID: 15627947 DOI: 10.1055/s-2004-830372] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Relapse of herpes simplex virus (HSV) encephalitis following acyclovir therapy has been reported infrequently in children beyond the neonatal period. The pathogenic mechanism of the recurrence is not fully understood. We report two new cases that support a mechanism of latent HSV infection with reactivation of the disease. Our patients were 2 years (#1) and 8 months (#2) old at initial infection. Both presented with fever, lethargy, focal seizures, and focal motor abnormalities. Serum HSV antibodies (Abs) were negative. The patients were treated with acyclovir for 14 and 21 days, respectively. They were readmitted at 1 month, and 4 days after discharge, respectively, with recurrent lethargy, seizures, and choreo-athetoid movements. Serum and CSF HSV Abs were significantly increased. CSF PCR was positive. In patient # 2 acyclovir-sensitive HSV was isolated from a brain biopsy. Both patients were re-treated with acyclovir, but progressed to a neurovegetative state. In our cases, latent HSV infection and reactivation is the most likely explanation for recurrent encephalitis. The immuno-pathogenic mechanisms of the infection recurrence are discussed. Based on the reported cases in the literature, patients younger than 2 years of age and with lower total dose of acyclovir treatments have a higher risk of recurrence.
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Affiliation(s)
- I Valencia
- Section of Neurology, Department of Pediatrics, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA 19134, USA.
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23
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Oleszak EL, Lin WL, Legido A, Melvin J, Hardison H, Hoffman BE, Katsetos CD, Platsoucas CD. Presence of oligoclonal T cells in cerebrospinal fluid of a child with multiphasic disseminated encephalomyelitis following hepatitis A virus infection. Clin Diagn Lab Immunol 2001; 8:984-92. [PMID: 11527815 PMCID: PMC96183 DOI: 10.1128/cdli.8.5.984-992.2001] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We have investigated the clonality of beta-chain T-cell receptor (TCR) transcripts from the cerebrospinal fluid (CSF) and peripheral blood from a 7-year old child who developed a multiphasic disseminated encephalomyelitis following an infection with hepatitis A virus. We amplified beta-chain TCR transcripts by nonpalindromic adaptor (NPA)-PCR-Vbeta-specific PCR. TCR transcripts from only five Vbeta families (Vbeta13, Vbeta3, Vbeta17, Vbeta8, and Vbeta20) were detected in CSF. The amplified products were combined, cloned, and sequenced. Sequence analysis revealed in the CSF substantial proportions of identical beta-chain of TCR transcripts, demonstrating oligoclonal populations of T cells. Seventeen of 35 (48%) transcripts were 100% identical, demonstrating a major Vbeta13.3 Dbeta2.1 Jbeta1.3 clonal expansion. Six of 35 (17%) transcripts were also 100% identical, revealing a second Vbeta13 clonal expansion (Vbeta13.1 Dbeta2.1 Jbeta1.2). Clonal expansions were also found within the Vbeta3 family (transcript Vbeta3.1 Dbeta2.1 Jbeta1.5 accounted for 5 of 35 transcripts [14%]) and within the Vbeta20 family (transcript Vbeta20.1 Dbeta1.1 Jbeta2.4 accounted for 3 of 35 transcripts [8%]). These results demonstrate the presence of T-cell oligoclonal expansions in the CSF of this patient following infection with hepatitis A virus. Analysis of the CDR3 motifs revealed that two of the clonally expanded T-cell clones exhibited substantial homology to myelin basic protein-reactive T-cell clones. In contrast, all Vbeta TCR families were expressed in peripheral blood lymphocytes. Oligoclonal expansions of T cells were not detected in the peripheral blood of this patient. It remains to be determined whether these clonally expanded T cells are specific for hepatitis A viral antigen(s) or host central nervous system antigen(s) and whether molecular mimicry between hepatitis A viral protein and a host protein is responsible for demyelinating disease in this patient.
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Affiliation(s)
- E L Oleszak
- Department of Anatomy and Cell Biology, Fels Institute for Cancer Research and Molecular Biology, Temple University School of Medicine, 3307 North Broad St., Philadelphia, PA 19140, USA.
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Abstract
BACKGROUND The leukodystrophies constitute a wide spectrum of cerebral disorders of varying etiology. The imaging appearances on CT and MRI are recognizable as abnormalities of white matter; however, it may be impossible to arrive at the correct diagnosis based on imaging studies alone. PATIENTS AND METHODS Three patients of varying age and clinical symptomatology diagnosed with metachromatic leukodystrophy (MLD) had remarkably similar MRI appearances. A "tigroid" or "leopard-skin" appearance was demonstrated within deep white matter in each case. RESULTS All of the patients had biochemical confirmation of MLD. CONCLUSION Although the "tigroid" pattern previously was considered to be pathognomonic of Pelizaeus-Merzbacher disease, the diagnosis of MLD must now be considered when these MRI appearances are encountered.
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Affiliation(s)
- E N Faerber
- Department of Radiology, St. Christopher's Hospital for Children, MCP. Hahnemann School of Medicine, Erie Avenue and Front Street, Philadelphia, PA 19134-1095, USA
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Hlatky MA, Charles ED, Nobrega F, Gelman K, Johnstone I, Melvin J, Ryan T, Wiens R, Pitt B, Reeder G. Initial functional and economic status of patients with multivessel coronary artery disease randomized in the Bypass Angioplasty Revascularization Investigation (BARI). Am J Cardiol 1995; 75:34C-41C. [PMID: 7892821] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Randomized trials of coronary angioplasty and bypass surgery have hypothesized that these procedures will have equivalent long-term rates of death and myocardial infarction. Functional status, quality of life, employment, and healthcare cost will therefore be critical measures of the efficacy of these alternative revascularization procedures. Patients at 7 sites in the Bypass Angioplasty Revascularization Investigation (BARI) were enrolled in an ancillary Study of Economics and Quality of Life (SEQOL). Physical function was assessed by the Duke Activity Status Index and emotional status by the Mental Health Inventory. Employment patterns and health care utilization were also measured at study entry and at 3-month intervals in follow-up. The 934 patients enrolled in SEQOL were similar to the 895 remaining BARI randomized patients. Most patients (63%) aged < or = 64 years were working, and almost all working patients (96%) intended to return to work. Patients aged > or = 65 years had lower household incomes but better health insurance coverage. Overall health ratings were significantly correlated with both physical and emotional status (p < 0.001). Patients enrolled in SEQOL are representative of the overall BARI population. Data collected in SEQOL will provide a detailed picture of the physical, emotional, and economic well-being after coronary angioplasty and bypass surgery.
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Affiliation(s)
- M A Hlatky
- Department of Health Research and Policy, Stanford University School of Medicine, California
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Lamon EW, Parrish J, Marshall G, McKissack R, Williams B, Melvin J, Jiang XL, Li G. Synergistic induction of thermotolerance in murine natural killer cells by interferon alpha and mild heat shock. Radiat Res 1994; 139:364-9. [PMID: 8073121] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Splenic lymphocytes from C3H/HeN mice were primed in vivo or in vitro with the interferon inducer poly inosine:cytosine (Poly IC) or in vitro with interferon alpha (IFN alpha) and evaluated for their natural killer (NK) activity after exposure to hyperthermia for defined periods. Lytic activity against cells of the NK-susceptible Moloney lymphoma cell line YAC by Poly I:C- or IFN alpha-primed spleen cells exhibited thermotolerance to 41, 42 and 43 degrees C exposure compared to unprimed cells. Spleen cells were also incubated for 1 h at 40 or 37 degrees C prior to exposure to 42 degrees C. Incubation at 40 degrees C produced a modest increase in thermal resistance to 42 degrees C by otherwise unprimed spleen cells. Spleen cells that had been primed by Poly I:C or IFN alpha followed by 1 h at 40 degrees C were rendered even more resistant to hyperthermia at 42 degrees C. These data suggest that two host responses to viral infection, fever and production of IFN alpha, may endow cells involved in the inflammatory response (in this case NK cells) with resistance to more severe stress. Further, IFN alpha and fever may synergize in this protective mechanism.
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Affiliation(s)
- E W Lamon
- Birmingham VA Medical Center, Alabama
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Burckhardt CS, Lorig K, Moncur C, Melvin J, Beardmore T, Boyd M, Boutaugh M. Arthritis and musculoskeletal patient education standards. Arthritis Foundation. Arthritis Care Res 1994; 7:1-4. [PMID: 7918719 DOI: 10.1002/art.1790070102] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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28
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Melvin J. Rodriguez vs. Attorney General of Canada (trial court opinion). Issues Law Med 1993; 9:309-321. [PMID: 8106238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Hall D, Smith DJ, Melvin J. Facial fracture tolerances revisited. Plast Reconstr Surg 1989; 84:708-9. [PMID: 2637687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Wertsch JJ, Melvin J. Median nerve anatomy and entrapment syndromes: a review. Arch Phys Med Rehabil 1982; 63:623-7. [PMID: 6756339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Clinicians commonly observe upper extremity signs and symptoms which result from median nerve entrapment and can develop at multiple sites along this nerve. Median nerve entrapment may occur at the distal humerus when the rarely present ligament of Struthers connects an anomalous bony spur of the humeral shaft to its medial epicondyle. The pronator syndrome refers to compromise of the median nerve in the proximal forearm region. This may result from entrapment between the 2 heads of the pronator teres, between the pronator teres and the flexor digitorum sublimis, or by the lacertus fibrosus extension from the biceps tendon. The anterior interosseous branch of the median nerve is subject to compromise near its origin. As a motor nerve it produces signs of weakness as indicators of anterior interosseous syndrome. This syndrome usually occurs spontaneously, but can be caused by fractures and fibrous bands. The carpal tunnel is a narrow fibro-osseous tunnel through which the median nerve passes with 9 tendons. Carpal tunnel syndrome is the most common of the median nerve entrapments. Its causes are many: anything which increases the volume of the tunnel contents or decreases the size of the tunnel. Electrodiagnostic abnormalities exist more frequently when this entrapment is present than for other median nerve entrapments. Anatomic variations of the median nerve occur frequently and may lead to diagnostic confusion if not recognized. Successful diagnosis and treatment of median nerve entrapment syndromes require awareness of possible involved sites and detailed knowledge of related anatomy.
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Mitz M, Prakash AS, Melvin J, Piering W. Motor nerve conduction indicators in uremic neuropathy. Arch Phys Med Rehabil 1980; 61:45-8. [PMID: 7356822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Eighty-four patients with primary end stage renal disease (ESRD) of varying duration and severity were investigated by a single determination of facial nerve latency and determination of motor nerve conduction velocities of the peroneal, median, and ulnar nerves. Electrophysiologic evidence of motor neuropathy was found in 72 patients. In the facial nerve, conduction was abnormal in 82% of the patients; in the peroneal nerve it was abnormal in 68%; in the median nerve it was abnormal in 36%; and in the ulnar nerve it was abnormal in 22%. The facial nerve was the most sensitive indicator of uremic neuropathy of the 4 motor nerves studied. Information obtained from monitoring the facial nerve in patients with chronic renal failure will add significantly to the data used to identify uremic neuropathy. Combined studies of the facial, peroneal, and median nerves should identify most patients with uremic neuropathy.
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36
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Melvin J. Underwater Blast Injuries. West J Med 1945. [DOI: 10.1136/bmj.1.4383.24-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Melvin J. Medical Recruitment in a National Emergency. West J Med 1936. [DOI: 10.1136/bmj.1.3932.1022-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Melvin J. REPAIR OF PERINEAL TEARS: A SIMPLE TECHNIQUE. West J Med 1935; 1:415-6. [DOI: 10.1136/bmj.1.3869.415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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