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Shi Y, Wang Y, Meng W, Brigance RP, Ryono DE, Bolton S, Zhang H, Chen S, Smirk R, Tao S, Tino JA, Williams KN, Sulsky R, Nielsen L, Ellsworth B, Wong MKY, Sun JH, Leith LW, Sun D, Wu DR, Gupta A, Rampulla R, Mathur A, Chen BC, Wang A, Fuentes-Catanio HG, Kunselman L, Cap M, Zalaznick J, Ma X, Liu H, Taylor JR, Zebo R, Jones B, Kalinowski S, Swartz J, Staal A, O'Malley K, Kopcho L, Muckelbauer JK, Krystek SR, Spronk SA, Marcinkeviciene J, Everlof G, Chen XQ, Xu C, Li YX, Langish RA, Yang Y, Wang Q, Behnia K, Fura A, Janovitz EB, Pannacciulli N, Griffen S, Zinker BA, Krupinski J, Kirby M, Whaley J, Zahler R, Barrish JC, Robl JA, Cheng PTW. Discovery of a Partial Glucokinase Activator Clinical Candidate: Diethyl ((3-(3-((5-(Azetidine-1-carbonyl)pyrazin-2-yl)oxy)-5-isopropoxybenzamido)-1 H-pyrazol-1-yl)methyl)phosphonate (BMS-820132). J Med Chem 2022; 65:4291-4317. [PMID: 35179904 DOI: 10.1021/acs.jmedchem.1c02110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Glucokinase (GK) is a key regulator of glucose homeostasis, and its small-molecule activators represent a promising opportunity for the treatment of type 2 diabetes. Several GK activators have been advanced into clinical trials and have demonstrated promising efficacy; however, hypoglycemia represents a key risk for this mechanism. In an effort to mitigate this hypoglycemia risk while maintaining the efficacy of the GK mechanism, we have investigated a series of amino heteroaryl phosphonate benzamides as ''partial" GK activators. The structure-activity relationship studies starting from a "full GK activator" 11, which culminated in the discovery of the "partial GK activator" 31 (BMS-820132), are discussed. The synthesis and in vitro and in vivo preclinical pharmacology profiles of 31 and its pharmacokinetics (PK) are described. Based on its promising in vivo efficacy and preclinical ADME and safety profiles, 31 was advanced into human clinical trials.
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Affiliation(s)
- Yan Shi
- Fibrosis Chemistry, Small Molecule Drug Discovery, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Ying Wang
- Fibrosis Chemistry, Small Molecule Drug Discovery, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Wei Meng
- Fibrosis Chemistry, Small Molecule Drug Discovery, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Robert P Brigance
- Fibrosis Chemistry, Small Molecule Drug Discovery, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Denis E Ryono
- Fibrosis Chemistry, Small Molecule Drug Discovery, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Scott Bolton
- Fibrosis Chemistry, Small Molecule Drug Discovery, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Hao Zhang
- Fibrosis Chemistry, Small Molecule Drug Discovery, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Sean Chen
- Fibrosis Chemistry, Small Molecule Drug Discovery, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Rebecca Smirk
- Fibrosis Chemistry, Small Molecule Drug Discovery, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Shiwei Tao
- Fibrosis Chemistry, Small Molecule Drug Discovery, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Joseph A Tino
- Cancer Resistance and Neuroscience Chemistry, Small Molecule Drug Discovery, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Kristin N Williams
- Fibrosis Chemistry, Small Molecule Drug Discovery, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Richard Sulsky
- Fibrosis Chemistry, Small Molecule Drug Discovery, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Laura Nielsen
- Fibrosis Chemistry, Small Molecule Drug Discovery, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Bruce Ellsworth
- Fibrosis Chemistry, Small Molecule Drug Discovery, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Michael K Y Wong
- Department of Discovery Synthesis, Small Molecule Drug Discovery, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Jung-Hui Sun
- Department of Discovery Synthesis, Small Molecule Drug Discovery, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Leslie W Leith
- Department of Discovery Synthesis, Small Molecule Drug Discovery, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Dawn Sun
- Department of Discovery Synthesis, Small Molecule Drug Discovery, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Dauh-Rurng Wu
- Department of Discovery Synthesis, Small Molecule Drug Discovery, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Anuradha Gupta
- Department of Discovery Synthesis, Small Molecule Drug Discovery, Research & Early Development, Biocon-Bristol Myers Squibb Research & Development Center, Bangalore 560099, India
| | - Richard Rampulla
- Department of Discovery Synthesis, Small Molecule Drug Discovery, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Arvind Mathur
- Department of Discovery Synthesis, Small Molecule Drug Discovery, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Bang-Chi Chen
- Department of Discovery Synthesis, Small Molecule Drug Discovery, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Aiying Wang
- Cardiovascular & Fibrosis Discovery Biology, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Helen G Fuentes-Catanio
- Cardiovascular & Fibrosis Discovery Biology, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Lori Kunselman
- Cardiovascular & Fibrosis Discovery Biology, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Michael Cap
- Cardiovascular & Fibrosis Discovery Biology, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Jacob Zalaznick
- Cardiovascular & Fibrosis Discovery Biology, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Xiaohui Ma
- Cardiovascular & Fibrosis Discovery Biology, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Heng Liu
- Cardiovascular & Fibrosis Discovery Biology, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Joseph R Taylor
- Cardiovascular & Fibrosis Discovery Biology, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Rachel Zebo
- Cardiovascular & Fibrosis Discovery Biology, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Beverly Jones
- Cardiovascular & Fibrosis Discovery Biology, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Stephen Kalinowski
- Cardiovascular & Fibrosis Discovery Biology, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Joann Swartz
- Cardiovascular & Fibrosis Discovery Biology, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Ada Staal
- Cardiovascular & Fibrosis Discovery Biology, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Kevin O'Malley
- Lead Evaluation, Small Molecule Drug Discovery, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Lisa Kopcho
- Lead Evaluation, Small Molecule Drug Discovery, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Jodi K Muckelbauer
- Molecular Structure & Design, Small Molecule Drug Discovery, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Stanley R Krystek
- Molecular Structure & Design, Small Molecule Drug Discovery, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Steven A Spronk
- Molecular Structure & Design, Small Molecule Drug Discovery, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Jovita Marcinkeviciene
- Lead Evaluation, Small Molecule Drug Discovery, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Gerry Everlof
- Pharmaceutics, Preclinical Candidate Optimization, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Xue-Qing Chen
- Pharmaceutics, Preclinical Candidate Optimization, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Carrie Xu
- Pharmaceutics, Preclinical Candidate Optimization, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Yi-Xin Li
- Pharmaceutics, Preclinical Candidate Optimization, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Robert A Langish
- Pharmaceutics, Preclinical Candidate Optimization, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Yanou Yang
- Pharmaceutics, Preclinical Candidate Optimization, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Qi Wang
- Pharmaceutics, Preclinical Candidate Optimization, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Kamelia Behnia
- Pharmaceutics, Preclinical Candidate Optimization, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Aberra Fura
- Pharmaceutics, Preclinical Candidate Optimization, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Evan B Janovitz
- Drug Development and Preclinical Studies, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Nicola Pannacciulli
- Clinical Pharmacology, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Steven Griffen
- Clinical Pharmacology, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Bradley A Zinker
- Cardiovascular & Fibrosis Discovery Biology, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - John Krupinski
- Cardiovascular & Fibrosis Discovery Biology, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Mark Kirby
- Cardiovascular & Fibrosis Discovery Biology, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Jean Whaley
- Cardiovascular & Fibrosis Discovery Biology, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Robert Zahler
- Fibrosis Chemistry, Small Molecule Drug Discovery, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Joel C Barrish
- Fibrosis Chemistry, Small Molecule Drug Discovery, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Jeffrey A Robl
- Fibrosis Chemistry, Small Molecule Drug Discovery, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Peter T W Cheng
- Fibrosis Chemistry, Small Molecule Drug Discovery, Research & Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
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Gittelsohn J, Jock B, Poirier L, Wensel C, Pardilla M, Fleischhacker S, Bleich S, Swartz J, Trude ACB. Implementation of a multilevel, multicomponent intervention for obesity control in Native American communities (OPREVENT2): challenges and lessons learned. Health Educ Res 2020; 35:228-242. [PMID: 32413105 PMCID: PMC7243725 DOI: 10.1093/her/cyaa012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 04/20/2020] [Indexed: 05/03/2023]
Abstract
OPREVENT2 was a multilevel, multicomponent (MLMC) adult obesity prevention that sought to improve access and demand for healthier food and physical activity opportunities in six Native American communities in the Southwest and Midwest. OPREVENT2 worked with worksites, food stores, schools (grades 2-6), through social media and mailings, and with a local community action committee (CAC), in each of the three intervention communities, and was implemented in six phases. We conducted a process evaluation to assess implementation of each intervention component in terms of reach, dose delivered and fidelity. Implementation of each component was classified as high, medium or low according to set standards, and reported back at the end of each phase, allowing for improvements. The school and worksite components were implemented with high reach, dose delivered and fidelity, with improvement over time. The school program had only moderate reach and dose delivered, as did the social media component. The CAC achieved high reach and dose delivered. Overall, study reach and dose delivered reached a high implementation level, whereas fidelity was medium. Great challenges exist in the consistent implementation of MLMC interventions. The detailed process evaluation of the OPREVENT2 trial allowed us to carefully assess the relative strengths and limitations of each intervention component.
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Affiliation(s)
- J Gittelsohn
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - B Jock
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - L Poirier
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - C Wensel
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - M Pardilla
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | | | - S Bleich
- Department of Health Policy and Management, Harvard TH Chan School of Public Health, Boston, MA 02115, USA
| | - J Swartz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Angela C B Trude
- Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, MD 21201, USA
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3
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Stewart P, Swartz J, Tapscott B, Davis B. C-36 Montreal Cognitive Assessment for Dementia Severity Rating in a Diagnostically Heterogeneous Clinical Cohort. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
The Mini Mental State Exam (MMSE) has enjoyed widespread use as a dementia severity staging instrument (Perneczky et al., 2006). More recently, the Montreal Cognitive Assessment (MoCA; Nasreddine, 2005) has been advanced as a potentially superior measure with enhanced sensitivity to Mild Cognitive Impairment (MCI). To the authors’ knowledge, there are no published guidelines for staging dementia severity with the MoCA. The aim of this study was to evaluate the utility of the MoCA for dementia severity staging.
Method
Participants (N = 162) were drawn from a diagnostically heterogeneous retrospective sample of referrals to a multidisciplinary memory clinic. Participants were categorized as MCI, mild dementia, or moderate dementia using the Quick Dementia Rating System (QDRS) sum of boxes score. Receiver operating characteristics of the MoCA were calculated using MATLAB and optimal cutpoints were determined using Youden’s Index.
Results
The MoCA demonstrated some utility in differentiating MCI from all severity dementia as defined by the QDRS, with an optimal cutpoint of 17 (AUC = .75). Cut points of 17 and 14 best separated MCI from mild dementia (AUC = .72) and mild from moderate dementia (AUC = .66), respectively. These cutpoints were associated with modest sensitivity (.50 - .53) and reasonable specificity (.76 - .87). Average diagnostic accuracy was 69.5%.
Conclusions
This study suggests that the MoCA has some utility for dementia severity staging. Future work should replicate these findings in other clinical cohorts. The use of the QDRS (an informant report measure) as the severity criterion is a significant limitation of the present study.
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Herring W, Snyder E, Bliwise D, Ancoli-Israel S, Budd K, Hutzelmann J, Dam T, Michelson D, Swartz J. Design of a clinical trial for assessing the orexin receptor antagonist suvorexant in treating insomnia in patients with Alzheimer's disease. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.944] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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5
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Herring W, Snyder E, Snavely D, Lines C, Michelson D, Swartz J. Effects of suvorexant on the insomnia severity index in patients with insomnia: analysis of pooled phase-3 data. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.945] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Swartz J, Bremermann H. Discussion of parameter estimation in biological modelling: Algorithms for estimation and evaluation of the estimates. J Math Biol 2017; 1:241-257. [PMID: 28303308 DOI: 10.1007/bf01273746] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/1974] [Indexed: 11/28/2022]
Abstract
This paper is concerned with the estimation of parameters when mathematical models are fitted to data. Two new algorithms are presented. The first is fast (economical in computation time), requires no initial estimates, but is not so accurate. The second requires more computation time, and fairly accurate initial estimates, but achieves high accuracy. The models discussed consist of sets of coupled, non-linear differential equations, but the second algorithm is applicable to wider classes of models as well.The accuracy of the computed values of the parameters depends on the number of data points, and the errors in the data. The sensitivity of the different parameters to errors may differ by orders of magnitude. A method of calculating the expected errors in the parameters is described, and the results of some applications of the method are presented.
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Affiliation(s)
- J Swartz
- School of Public Health Environmental Health Sciences, University of California, 94720, Berkeley, CA, USA
| | - H Bremermann
- Department of Mathematics, University of California, 94720, Berkeley, CA, USA
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Redmond L, Pardilla M, Swartz J, Eckmann T, Gittelsohn J. Multi-level, Multi-component Obesity Intervention Leads to Health Behavior Change in American Indian Communities. J Acad Nutr Diet 2016. [DOI: 10.1016/j.jand.2016.06.078] [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: 10/21/2022]
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8
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Swartz J, Scholl J, McNamara C, Kott A. Is live face-to-face UPDRS part III training more effective than remote training methodology in Parkinson'/INS;s disease clinical trials? J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.454] [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: 10/26/2022]
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Abstract
BACKGROUND Several cross-sectional studies indicate that an anthroposophic lifestyle reduces the risk of allergy in children. We initiated the Assessment of Lifestyle and Allergic Disease During Infancy (ALADDIN) birth cohort to elucidate the role of specific factors supposed to mediate this effect. The aims of this study are to describe the ALADDIN cohort and to report patterns of exposure and allergic sensitization during the first years of life. METHODS The ALADDIN study is a prospective birth cohort study of 330 children from families with an anthroposophic, partly anthroposophic, or nonanthroposophic lifestyle. The children and their parents were following an extensive data collection scheme, including repeated questionnaires and biological samples. Blood samples were collected from the parents and from the child at birth as well as at 6, 12, and 24 months of age. RESULTS Several lifestyle factors differed between the groups, such as diet, medication, and place of delivery. Children of families with an anthroposophic lifestyle had a markedly decreased risk of sensitization during the first 2 years of life compared with children of nonanthroposophic families with adjusted OR 0.25 (95% CI 0.10-0.64) and P-value 0.004. A similar situation held true for children from families with a partly anthroposophic lifestyle, adjusted OR 0.31 (95% CI 0.15-0.54), and P-value 0.002. CONCLUSIONS The anthroposophic lifestyle comprises several factors of interest for allergy development and is here shown to be associated with reduced risk of IgE sensitization already in infancy. Identifying the factors responsible for this association would be of significant clinical importance.
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Affiliation(s)
- F Stenius
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Sachs' Children's Hospital, Stockholm, Sweden.
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Ublagger E, Schreuer M, Eder W, von Mutius E, Benz MR, Braun-Fahrländer C, Moeller A, Brunekreef B, Schram D, Wickman M, Swartz J, Pershagen G, Riedler J. Validation of questions on asthma and wheeze in farming and anthroposophic children. Clin Exp Allergy 2006; 35:1033-9. [PMID: 16120085 DOI: 10.1111/j.1365-2222.2005.02308.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND In most epidemiological surveys the estimated prevalence of asthma is based on questionnaire responses, which may depend on the individual's perception as well as medical consulting habits in a given population. Therefore, measurement of bronchial hyper-responsiveness as a key feature of asthma has been suggested as an objective parameter for asthma. OBJECTIVE The aim of the present study was to validate questionnaire responses on asthma and wheeze against bronchial response to hypertonic saline (HS) (4.5%) in populations previously shown to have a lower prevalence of asthma and allergies: farmers' children and children from anthroposophic families. METHODS Children whose parents had completed a written questionnaire in the cross-sectional PARSIFAL-study were drawn from the following four subgroups: 'farm children' (n=183), 'farm reference children' (n=173), 'Steiner schoolchildren' (n=243) and 'Steiner reference children' (n=179). Overall, 319 children with wheeze in the last 12 months and 459 children without wheeze in the last 12 months performed an HS challenge. RESULTS Odds ratios, sensitivity, specificity, likelihood ratios and measures of association did not differ significantly between the four subgroups. The correlation between the bronchial response to HS and wheeze and asthma questions was moderate and similar for farm children, farm reference children, Steiner schoolchildren and Steiner reference children (kappa for 'wheeze': 0.25, 0.33, 0.31, 0.35, respectively, P=0.754, kappa for 'doctor's diagnosis of asthma': 0.33, 0.19, 0.33, 032, respectively, P=0.499). CONCLUSION The findings from this study suggest that the reliabilitiy of questionnaire responses on asthma and wheeze is comparable between farmers' children, children raised in families with anthroposophic lifestyle and their respective peers.
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Affiliation(s)
- E Ublagger
- Children's Hospital Salzburg, Salzburg, Austria.
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11
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Arey BJ, Seethala R, Ma Z, Fura A, Morin J, Swartz J, Vyas V, Yang W, Dickson JK, Feyen JHM. A novel calcium-sensing receptor antagonist transiently stimulates parathyroid hormone secretion in vivo. Endocrinology 2005; 146:2015-22. [PMID: 15637285 DOI: 10.1210/en.2004-1318] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [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: 11/19/2022]
Abstract
Circulating calcium (Ca(2+)) is a primary regulator of bone homeostasis through its action on PTH secretion. Extracellular Ca(2+) modulates PTH secretion through a cell surface G protein-coupled receptor, the calcium-sensing receptor (CaR). The expression of the CaR suggests a critical role in cellular regulation by calcium in various organs, including parathyroid gland, bone, and kidney. Despite an obvious pharmacological utility for CaR antagonists in the treatment of disease, only a limited number of such classes of compounds exist. We have identified a novel class of small molecules with specific activity at the CaR. This class of compounds is represented by compound 1. It possesses potent antagonist activity at the human CaR with IC(50) values of 64 nm and 230 nm in inhibiting intracellular Ca(2+) flux and inositol phosphate generation in vitro, respectively. When administered to male rats in vivo, compound 1 robustly increased serum PTH levels. The stimulation of PTH secretion was rapid and transient when administered either iv or orally. The pharmacokinetic profile of compound 1 after oral administration revealed that maximal plasma levels of compound were reached within 1 h and the half-life of the compound to be approximately 2 h in rats. These data describe a representative compound of a novel chemical class than previously described allosteric modulators that offer a new avenue for the development of improved treatments of osteoporosis.
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Affiliation(s)
- Brian J Arey
- Metabolic and Cardiovascular Drug Discovery, Bristol-Myers Squibb Co., 311 Pennington-Rocky Hill Road, Pennington, New Jersey 08534, USA
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12
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Staal A, Frith JC, French MH, Swartz J, Güngör T, Harrity TW, Tamasi J, Rogers MJ, Feyen JHM. The ability of statins to inhibit bone resorption is directly related to their inhibitory effect on HMG-CoA reductase activity. J Bone Miner Res 2003; 18:88-96. [PMID: 12510809 DOI: 10.1359/jbmr.2003.18.1.88] [Citation(s) in RCA: 128] [Impact Index Per Article: 6.1] [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: 11/18/2022]
Abstract
Statins, which are inhibitors of 3-hydroxy-3-glutaryl-coenzyme A (HMG-CoA) reductase, decrease the hepatic biosynthesis of cholesterol by blocking the mevalonate pathway. Nitrogen-containing bisphosphonate drugs also inhibit the mevalonate pathway, preventing the production of the isoprenoids, which consequently results in the inhibition of osteoclast formation and osteoclast function. Therefore, we hypothesized that statins could affect bone metabolism in vivo through effects on osteoclastic bone resorption. In vitro, cerivastatin inhibited the parathyroid hormone (PTH)-stimulated bone resorption. Using a panel of 40 statin analogs, which showed variable effects on HMG-CoA reductase activity, we found that the ability of compounds to inhibit bone resorption is directly related to HMG-CoA reductase activity. However, in the thyro-parathyrodectomy (TPTX) model for bone resorption in the rat in vivo, cerivastatin did not prevent experimentally induced increases in bone resorption. The lack of effect of cerivastatin in this model is not related to a limited penetration of the target tissue (bone marrow), because a significant effect on HMG-CoA reductase activity was demonstrated in the total rat bone marrow cell extracts of rats posttreatment in vivo. Furthermore, cerivastatin inhibited protein prenylation in osteoclasts isolated from the rabbit bone marrow of rabbits after treatment in vivo. In contrast to other studies, none of the statins tested showed anabolic effects in parietal bone explant cultures. Taken together, we conclude that statins inhibit bone resorption in vitro, which correlates directly with the potency of the compounds for inhibition of HMG-CoA reductase activity. However, cerivastatin does not affect bone resorption in the rat TPTX model in vivo.
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Affiliation(s)
- Ada Staal
- Osteoporosis Research, Metabolic and Cardiovascular Drug Discovery, Pharmaceutical Research Institute, Bristol-Myers Squibb Company, Pennington, New Jersey 08534, USA
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14
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Abstract
Recombinant E. coli fermentations were observed to undergo regular, reproducible oscillations in oxygen uptake for several hours during a controlled fermentation process. Culture growth slowed during the period of oscillations, delaying induction of recombinant protein production. The oscillations were similar in 10-L and 1,000-L fermentors and also occurred with different feed control algorithms. Both observations support the hypothesis that the oscillations are metabolic in nature. Analysis of amino acid, ATP, and GTP pools suggests that the oscillations result from aberrant regulation of isoleucine biosynthesis leading to repeated starvation events in which protein synthesis and growth are impaired. Both a nutritional solution, isoleucine feeding, and a genetic solution, repair of an ilvG frameshift mutation in E. coli K-12 strains, were found to eliminate the oscillations, further supporting the proposed mechanism for the behavior. These results illustrate the interesting and complicated physiological behavior which can be displayed in metabolic networks and provide another example of surprising problems that can arise in growing recombinant organisms in fermentors.
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Affiliation(s)
- D C Andersen
- Cell Culture & Fermentation Research & Development, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA.
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Wyttenbach A, Swartz J, Kita H, Thykjaer T, Carmichael J, Bradley J, Brown R, Maxwell M, Schapira A, Orntoft TF, Kato K, Rubinsztein DC. Polyglutamine expansions cause decreased CRE-mediated transcription and early gene expression changes prior to cell death in an inducible cell model of Huntington's disease. Hum Mol Genet 2001; 10:1829-45. [PMID: 11532992 DOI: 10.1093/hmg/10.17.1829] [Citation(s) in RCA: 206] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Huntington's disease (HD) is one of 10 known diseases caused by a (CAG)(n) trinucleotide repeat expansion that is translated into an abnormally long polyglutamine tract. We have developed stable inducible neuronal (PC12) cell lines that express huntingtin exon 1 with varying CAG repeat lengths under doxycycline (dox) control. The expression of expanded repeats is associated with aggregate formation, caspase-dependent cell death and decreased neurite outgrowth. Post-mitotic cells expressing mutant alleles were more prone to cell death compared with identical cycling cells. To determine early metabolic changes induced by this mutation in cell models, we studied changes in gene expression after 18 h dox induction, using Affymetrix arrays, cDNA filters and adapter-tagged competitive PCR (ATAC-PCR). At this time point there were low rates of inclusion formation, no evidence of mitochondrial compromise and no excess cell death in the lines expressing expanded compared with wild-type repeats. The expression profiles suggest novel targets for the HD mutation and were compatible with impaired cAMP response element (CRE)-mediated transcription, which we confirmed using CRE-luciferase reporter assays. Reduced CRE-mediated transcription may contribute to the loss of neurite outgrowth and cell death in polyglutamine diseases, as these phenotypes were partially rescued by treating cells with cAMP or forskolin.
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Affiliation(s)
- A Wyttenbach
- Wellcome Trust Centre for Molecular Mechanisms in Disease, Cambridge Institute for Medical Research, Wellcome Trust/MRC Building, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2XY, UK
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Affiliation(s)
- J Swartz
- Department of Chemical Engineering, Stanford University, Stanford, CA 94305, USA.
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Abstract
BACKGROUND Huntington's disease (HD) is a fatal neurodegenerative disorder with an autosomal dominant mode of inheritance. It leads to progressive dementia, psychiatric symptoms and an incapacitating choreiform movement disorder, culminating in premature death. HD is caused by an increased CAG repeat number in a gene coding for a protein with unknown function, called huntingtin. The trinucleotide CAG codes for the amino acid glutamine and the expanded CAG repeats are translated into a series of uninterrupted glutamine residues (a polyglutamine tract). METHODS This review describes the epidemiology, clinical symptomatology, neuropathological features and genetics of HD. The main aim is to examine important findings from animal and cellular models and evaluate how they have enriched our understanding of the pathogenesis of HD and other diseases caused by expanded polyglutamine tracts. RESULTS Selective death of striatal and cortical neurons occurs. It is likely that the HD mutation confers a deleterious gain of function on the protein. Neuronal intranuclear inclusions containing huntingtin and ubiquitin develop in patients and transgenic mouse models of HD. Other proposed mechanisms contributing to neuropathology include excitotoxicity, oxidative stress, impaired energy metabolism, abnormal protein interactions and apoptosis. CONCLUSIONS Although many interesting findings have accumulated from studies of HD and other polyglutamine diseases, there remain many unresolved issues pertaining to the exact roles of intranuclear inclusions and protein aggregates, the mechanisms of selective neuronal death and delayed onset of illness. Further knowledge in these areas will inspire the development of novel therapeutic strategies.
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Affiliation(s)
- L W Ho
- Department of Medical Genetics, Wellcome Trust Centre for the Study of Molecular Mechanisms in Disease, Cambridge Institute of Medical Research, Addenbrooke's Hospital
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Wyttenbach A, Carmichael J, Swartz J, Furlong RA, Narain Y, Rankin J, Rubinsztein DC. Effects of heat shock, heat shock protein 40 (HDJ-2), and proteasome inhibition on protein aggregation in cellular models of Huntington's disease. Proc Natl Acad Sci U S A 2000; 97:2898-903. [PMID: 10717003 PMCID: PMC16027 DOI: 10.1073/pnas.97.6.2898] [Citation(s) in RCA: 275] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Huntington's disease (HD), spinocerebellar ataxias types 1 and 3 (SCA1, SCA3), and spinobulbar muscular atrophy (SBMA) are caused by CAG/polyglutamine expansion mutations. A feature of these diseases is ubiquitinated intraneuronal inclusions derived from the mutant proteins, which colocalize with heat shock proteins (HSPs) in SCA1 and SBMA and proteasomal components in SCA1, SCA3, and SBMA. Previous studies suggested that HSPs might protect against inclusion formation, because overexpression of HDJ-2/HSDJ (a human HSP40 homologue) reduced ataxin-1 (SCA1) and androgen receptor (SBMA) aggregate formation in HeLa cells. We investigated these phenomena by transiently transfecting part of huntingtin exon 1 in COS-7, PC12, and SH-SY5Y cells. Inclusion formation was not seen with constructs expressing 23 glutamines but was repeat length and time dependent for mutant constructs with 43-74 repeats. HSP70, HSP40, the 20S proteasome and ubiquitin colocalized with inclusions. Treatment with heat shock and lactacystin, a proteasome inhibitor, increased the proportion of mutant huntingtin exon 1-expressing cells with inclusions. Thus, inclusion formation may be enhanced in polyglutamine diseases, if the pathological process results in proteasome inhibition or a heat-shock response. Overexpression of HDJ-2/HSDJ did not modify inclusion formation in PC12 and SH-SY5Y cells but increased inclusion formation in COS-7 cells. To our knowledge, this is the first report of an HSP increasing aggregation of an abnormally folded protein in mammalian cells and expands the current understanding of the roles of HDJ-2/HSDJ in protein folding.
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Affiliation(s)
- A Wyttenbach
- Department of Medical Genetics, Wellcome Trust Centre for the Study of Molecular Mechanisms in Disease, Cambridge Institute for Medical Research, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 2XY, United Kingdom
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Swartz J. Staying on track: the benefits of exercise combined with healthful eating. J Am Diet Assoc 2000; 100:15. [PMID: 10671110 DOI: 10.1016/s0002-8223(00)00005-5] [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] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
BACKGROUND Increased prevalence of atopic disorders in children may be associated with changes in types of childhood infections, vaccination programmes, and intestinal microflora. People who follow an anthroposophic way of life use antibiotics restrictively, have few vaccinations, and their diet usually contains live lactobacilli, which may affect the intestinal microflora. We aimed to study the prevalence of atopy in children from anthroposophic families and the influence of an anthroposophic lifestyle on atopy prevalence. METHODS In a cross-sectional study, 295 children aged 5-13 years at two anthroposophic (Steiner) schools near Stockholm, Sweden, were compared with 380 children of the same age at two neighbouring schools in terms of history of atopic and infectious diseases, use of antibiotics and vaccinations, and social and environmental variables. Skin-prick tests were done for 13 common allergens, and we took blood samples from children and their parents for analysis of allergen-specific serum IgE-antibodies. FINDINGS At the Steiner schools, 52% of the children had had antibiotics in the past, compared with 90% in the control schools. 18% and 93% of children, respectively, had had combined immunisation against measles, mumps, and rubella, and 61% of the children at the Steiner schools had had measles. Fermented vegetables, containing live lactobacilli, were consumed by 63% of the children at Steiner schools, compared with 4.5% at the control schools. Skin-prick tests and blood tests showed that the children from Steiner schools had lower prevalence of atopy than controls (odds ratio 0.62 [95% CI 0.43-0.91]). There was an inverse relation between the number of characteristic features of an anthroposophic lifestyle and risk of atopy (p for trend=0.01). INTERPRETATION Prevalence of atopy is lower in children from anthroposophic families than in children from other families. Lifestyle factors associated with anthroposophy may lessen the risk of atopy in childhood.
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Affiliation(s)
- J S Alm
- Department of Laboratory Medicine, Karolinska Institute and Hospital, Stockholm, Sweden.
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Hamilton KJ, Satoh M, Swartz J, Richards HB, Reeves WH. Influence of microbial stimulation on hypergammaglobulinemia and autoantibody production in pristane-induced lupus. Clin Immunol Immunopathol 1998; 86:271-9. [PMID: 9557160 DOI: 10.1006/clin.1997.4481] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Pristane induces a lupus-like syndrome characterized by autoantibody production and glomerulonephritis in nonautoimmune strains of mice. Although it has been suggested that this syndrome results from nonspecific immune activation, there is little evidence so far that B cells are activated nonspecifically by pristane or that this promotes autoimmunity. In this study, we examined whether polyclonal hypergammaglobulinemia occurs in pristane-induced lupus, and its relationship to the production of anti-DNA, nRNP/Sm, and Su autoantibodies. In conventionally housed mice, there was a marked increase in total IgM and IgG3 2 weeks after i.p. pristane injection, followed by increased IgG1, IgG2a, and IgG2b levels. IgM levels were higher in pristane-treated specific pathogen-free (SPF) mice than in conventionally housed mice, whereas IgG and IgA levels were reduced. Pristane induced anti-nRNP/Sm and Su autoantibodies in SPF mice, but their onset was delayed and levels were lower than those in conventionally housed mice. There was no consistent relationship between total IgG1, 2a, and 2b hypergammaglobulinemia and production of anti-nRNP/Sm and Su autoantibodies. Moreover, the total Ig levels were similar in the anti-nRNP/Sm-positive and -negative groups. In contrast, production of IgM anti-ssDNA antibodies paralleled IgM hypergammaglobulinemia in some, but not all, mice. These studies indicate that pristane-induced lupus is associated with marked hypergammaglobulinemia, the magnitude of which is influenced by the microbial environment. However, anti-nRNP/Sm and Su autoantibody production is at least partly independent of polyclonal B cell activation. The data strongly suggest that pristane-induced lupus is not exclusively the consequence of nonspecific immune stimulation. They also point to the importance of microbial stimulation in the development of hypergammaglobulinemia in this inducible lupus model.
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Affiliation(s)
- K J Hamilton
- Department of Medicine, Thurston Arthritis Research Center, University of North Carolina, Chapel Hill 27599-7280, USA
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22
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Esfandiari A, Swartz J, Teklehaimanot S. Clustering of giardiosis among AIDS patients in Los Angeles County. Cell Mol Biol (Noisy-le-grand) 1997; 43:1077-83. [PMID: 9449541] [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: 02/05/2023]
Abstract
The purpose of this study was to determine the mode of the spread of the enteric parasitic infections among HIV+/AIDS patients attending the AIDS clinic of the King/Drew Medical Center in Los Angeles. Two hundred forty three patients diagnosed with HIV+/AIDS agreed to participate. The study was conducted by several interviews, questionnaires and stool sample collections over a one year period. Stool samples were processed for protozoan cysts and Helminth Ova using standard stool concentration and staining techniques. An indirect immunofluorescence monoclonal antibody technique was also used as an alternate to detect the parasites in samples. Forty three cases were positive for Giardia Lamblia (17.7%) and 10 cases were positive for Cryptosporidium (4%). No Helminth Ova were detected. The majority of the participants were African-American (72.6%) and 27.6% were Hispanic. Clustering studies were performed to determine the mechanism of spread of the parasites among the population study. The Nearest Neighbor Clustering Technique (NNT) was used to determine if there was spatial clustering of positive cases. Geocoding with the MapInfo Program was performed to determine the precise coordinates of the residence of the subjects. Application of the NNT showed a high degree of clustering for Giardia. The NNT statistic for Giardia was significant with the p value for 0.020 using the Simes multiple comparisons correction. Examination of the map plots indicated that there were two areas with high Giardia prevalence, one in Hollywood region, the other in South-Central Los Angeles. The odds ratio for sexual orientation was 14.2 (for homosexuals vs heterosexuals) with a p value of less than 0.001. These findings strongly suggest that male homosexual contact was the main mode of transmission of observed Giardia cases.
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Affiliation(s)
- A Esfandiari
- Department of Otolaryngology, Charles Drew University of Medicine and Science, Los Angeles, CA 90059, USA
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Fiala M, Swartz J, Teklehaimanot S, Kermani V, Funnye AS, Sayre JW, Gornbein JA. Zidovudine therapy, CD4+ and CD8+ counts are associated with a longer survival following AIDS onset. Lymphology 1997; 30:128-36. [PMID: 9313205] [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: 02/05/2023]
Abstract
In 60 patients followed from the onset of acquired immunodeficiency syndrome (AIDS) to death, survival was determined by Cox Proportional Hazards Analysis in relationship to seven variables: time-dependent CD4+ and CD8+ peripheral lymphocyte counts, zidovudine treatment, cytomegalovirus (CMV) retinitis, time from AIDS onset, calendar year of AIDS onset (cohort effect), and age. Two significant prognostic variables were identified: zidovudine therapy and either CD4+ or CD8+ counts (the latter could not be distinguished due to concomitant high correlation). Treatment with zidovudine reduced the death rate by 75% compared to no treatment. When included in a proportional hazards regression with all covariates except for the other T lymphocyte count, every increase in CD4+ count of 10 cells was equivalent to a decline in the mortality rate by 13% (p = 0.046), and every increase in CD8+ count of 10 cells lowered the mortality by 1.4% (p = 0.0031). Patients treated with zidovudine and without CMV retinitis showed the slowest decline of both CD4+ and CD8+ counts. Both CD4+ and CD8+ levels are useful predictors of survival in patients with AIDS.
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Affiliation(s)
- M Fiala
- Department of Medicine, UCLA School of Medicine, USA
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Johnson GA, Cates G, Chen XJ, Cofer GP, Driehuys B, Happer W, Hedlund LW, Saam B, Shattuck MD, Swartz J. Dynamics of magnetization in hyperpolarized gas MRI of the lung. Magn Reson Med 1997; 38:66-71. [PMID: 9211381 DOI: 10.1002/mrm.1910380111] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The magnetization in hyperpolarized gas (HP) MRI is generated by laser polarization that is independent of the magnet and imaging process. As a consequence, there is no equilibrium magnetization during the image acquisition. The competing processes of gas inflow and depolarization of the spins lead to large changes in signal as one samples k-space. A model is developed of dynamic changes in polarization of hyperpolarized 3He during infusion and in vivo imaging of the lung and verified experimentally in a live guinea pig. Projection encoding is used to measure the view-to-view variation with temporal resolution < 4 ms. Large excitation angles effectively sample the magnetization in the early stages of inflow, highlighting larger airways, while smaller excitation angles produce images of the more distal spaces. The work provides a basis for pulse sequences designed to effectively exploit HP MRI in the lung.
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Affiliation(s)
- G A Johnson
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, North Carolina 27710, USA
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Abstract
The basic constraints on the working range of CCD-based bar code readers are analyzed. A comprehensive model that allows the calculation of the optimal working range and its corresponding optical system parameters is derived. Experimental results are found to be in good agreement with theoretical calculations. Finally, comparisons between bar code laser scanners and CCD readers are presented.
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Abstract
BACKGROUND Preterm and ex-preterm infants are at risk for life-threatening apnea after general anesthesia. The authors attempted to define the postconceptual age beyond which apnea is less likely to occur and to identify the factors that predispose to postanesthetic apnea. METHODS Ninety-one infants younger than 60 weeks postconceptual age undergoing 101 general anesthetics were prospectively studied. All infants were admitted to the hospital for cardiorespiratory monitoring overnight. The presence of coexistent medical conditions that could influence the incidence of apnea was determined by a review of current and previous medical records and by history. RESULTS Of 38 procedures performed in 35 infants younger than 44 weeks postconceptual age, 10 (26.3%) procedures in 9 infants were associated with postanesthetic apnea. In eight of these, apnea did not resolve spontaneously: four infants required stimulation, and four required continuous positive airway pressure by face mask. Apnea occurred after 2 of 63 procedures performed in infants 44 weeks postconceptual age or older. Both episodes occurred in one patient who had neurologic disease. Of the remaining 61 procedures in the latter age group, 7 were associated with episodes of bradycardia (lowest heart rate was 79 beats/min) postoperatively without apnea. These episodes lasted up to 5 s, were not associated with apnea or cyanosis, and resolved spontaneously in all cases. All infants with postanesthetic apnea and/or bradycardia experienced their first episode within 12 h after surgery. CONCLUSIONS Ex-preterm infants younger than 44 weeks postconceptual age are at greater risk for apnea after general anesthesia than are infants older than 44 weeks postconceptual age. Based on these results, the maximum long-run risk of postanesthetic apnea in preterm infants older than 44 weeks postconceptual age is 5% with 95% confidence.
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Affiliation(s)
- S Malviya
- Department of Anaesthesia, Hospital for Sick Children, University of Toronto, Ontario, Canada
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Swartz J, Clapp R. New cancer theories:. New Solut 1992; 2:17-21. [PMID: 22910703 DOI: 10.2190/ns2.4.f] [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: 06/01/2023]
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Swartz J. Psychology and women subject of Toronto conference. CMAJ 1992; 147:102-4. [PMID: 1393877 PMCID: PMC1336136] [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: 12/26/2022] Open
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Korzeniewski P, Lang SA, Grant R, Loader C, Vaghadia H, Wong D, Waters T, Merrick P, Ali MJ, Dobkowski W, Cornelius T, Hawkins R, Varkey GP, Claffey L, Plourde G, Trahan M, Morris J, Dean DM, Yamaguchi H, Harukuni I, Naito H, Chan VWS, Mati N, Seyone C, Evans D, Chung F, Joffe D, Plourde G, Villemurc C, Hong M, Milne B, Loomis C, Jhamandas K, Priddy R, Archer D, Tang T, Sabourin M, Samanini N, Cuillerier DJ, Schuben A, Awad IA, Perez-Trepichio AD, Ebrahim ZY, Bloomfield EL, Zexu F, Zhengnua G, Qing Z, Balhua S, Miller DR, Martineau RJ, Wynands JE, Hill JD, Knill RL, Skinner MI, Novick TV, McLean RF, Kolton M, Noble WH, Sullivan PJ, Cheng DCH, Chapman KR, Ong D, Roraanelli J, Smallman B, Nathan HJ, Murphy JT, Hall RI, Moffitt EA, Hudson RJ, Pascoe EA, Anderson BA, Thomson IR, Kassum DA, Shanks A, Rosenbloom M, Sidi A, Gehrig TR, Fool JM, Rush W, Martin AJ, Cooper PD, Maltby JR, Johnson D, Hurst T, Mayers I, Wigglesworth DF, Rose DK, Kay JC, Mazer CD, Yang H, Beattie WS, Doyle DJ, Demajo W, Comfort VK, Code WE, Rooney ME, Clark FJS, Sutton IR, Mutch WAC, Thomson IR, Teskey JM, Thiessen OB, Rosanbloom M, Tang TKK, Robblee JA, Nathan HJ, Wynands JE, Eagle CJ, Belenkle I, Chan KL, Tyberg JV, Stockwell M, Zintel T, Gallagher G, Kavanagh B, Sandier A, Lawson S, Chung F, Ong D, Isabel L, Trépanier CA, Campbell DC, Randall TE, Growe GH, Scarth I, Sawchuk CWT, Ong B, Unruh H, Horan T, Greengrass R, Mark D, Kitts JB, Curran MJ, Lindsay P, Polis T, Coté S, Socci M, Wiesel S, Conway JB, Seyone C, Goldberg J, Chung F, Rose DK, Cohen MM, Rogers KH, Duncan PG, Pope WDB, Tweed WA, Biehl D, Novick TV, Skinner MI, Mathieu A, Villeneuve E, Goldsmith CH, Allen GC, Smith CE, Pinchak AC, Hagen JF, Hudson JC, Gennings C, Tyler BL, Keenan RL, Chung F, Seyone C, Matl N, Ong D, Powell P, Tessler MJ, Kleiman SJ, Wiesel S, Tetzlaff JE, Yoon HJ, Baird B, Walsh M, Hondorp G, Wassef MR, Munshi C, Brooks J, Nimphius N, Tweed WA, Lee TL, Tweed WA, Phua WT, Chong KY, Lim E, Finegan BA, Coulson C, Lopaschuk GD, Clanachan AS, Fournier L, Cloutier R, Major D, Sharpe MD, Wexler HR, Dhamee MS, Rooney R, Ong SK, O’Leary E, McCarroll M, Phelan D, Young T, Coghlan D, O’Leary E, Blunnie WP, Splinter WM, Splinter WM, Ryan T, Maguire M, Bouchier-Hayes D, Cunningham AJ, Kamath MV, Fallen EL, Murkin JM, Shannon NA, Montgomery CJ, Karl HW, Raymond J, Drolet P, Tanguay M, Blaise G, Garceau D, Dumont L, Omri A, Sharkawi M, Billard V, Bourgain JL, Panos A, Mazer CD, Lichtenstein SV, Bevan JC, Popovic V, Baxter MRN, Donati F, Bevan DR, Bachman C, Kopelow M, Donen N, Umôn DT, Kemp S, Hartley E, Sikich N, Roy WL, Lerman J, Cooper RM, Yentis SM, Bissonnette B, Halpern L, Roy L, Burrows FA, Fear DW, Hillier S, Sloan M, Crawford M, Blssonnette B, Sikich N, Friedlander M, Sandier AN, Panos L, Winton T, Benureof J, Karski J, Teasdale S, Cruise C, Skala R, Zulys V, Ong D, Chow F, Packota G, Yip R, Bradley J, Arellano R, Sussman G, Sosis M, Braverman B, Sosis M, Ivankovich AD, Manganas M, Lephay A, Fournier T, Kadri N, Ossart M, Sandier AN, Turner KE, Wick V, Wherrett C, Sullivan PJ, Dyck JB, Varvel J, Shafer SL, Fiset P, Balendran P, Meistelman C, Lira E, Sloan M, Nigrovic V, Banoub M, Splinter WM, Roberts DW, Rhine EJ, MacNeill HB, Bonn GE, Clarke WM, Noel LP, Ryan T, Moriarty J, Bouchier-Hayes D, Cunningham AJ, Sandier AN, Baxter AD, Norman P, Samson B, Hull K, Chung F, Mali N, Evans D, Cruise C, Shumka D, Seyone C, Leung PT, Badner NH, Komar WE, Rajasingham M, Farren B, Vaillancourt G, Cournoyer S, Hollmann C, Breen TW, Janzen JA, Crochetiere CT, McMorland GH, Douglas MJ, Kamani AA, Arora SK, Tunstall M, Ross J, Mayer DC, Weeks SK, Norman P, Daley D, Sandier A, Guay J, Gaudreault P, Boulanger A, Tang A, Lortie L, Dupuis C, Backman SB, Bachoo M, Polosa C, Moudgil GC, Frame B, Blajchman HA, Singal DP, Albert JF, Ratcliff A, Law JC, Varvel J, Hung O, Shafer SL, Fiset P, Balendran P, Burgess PM, Doak GJ, Duke PC, Sloan PA, Mather LE, McLean CF, Rutten AJ, Nation RL, Milne RW, Runciman WB, Somoggi AA, Haack C, Shafer SL, Irish CL, Weisleider L, Mazer CD, Bell RS, Dejonckheere M, Levarlet M, d’Hollander A, Taylor RH, Sikich N, Campbell F, McLeod ME, Swartz J, Spahr-Schopfer I, McIntyre BG, Roy WL, Laycock GJA, Mitchell IM, Morton NS, Logan RW, Campbell F, Yentis SM, Fear D, Halpem L, Sloan M, Badgwell JM, Kleinman S, Yentis SM, Britton JT, Hannallah RS, Schafer PO, Norden JM, Splinter WM, Menard EA, Derdamezi JB, Ghurch JG, Britt BA, Radde IC, Sosis M, Kao YJ, Norton RG, Volgyesi GA, Spahr-Schopfer I, Sosis M, Plum M, Sosis M, Smith CE, Pinchak AC, Hancock DE, Owen P, McMeekin J, Hanson S, Cujec B, Feindel CM, Cruz J, Boylen P, Ong D, Murphy JT, Dupuis JY, Nathan HJ, Cattran C, Wynands JE, Murphy JT, Kinley CE, Sulliyan JA, Landymore RW, Robblee JA, Labow R, Buckley DN, Sharpe MD, Guiraudon G, Klein G, Yee R, Black J, Devitt JH, McLellan BA, Dubbin J, Ehrlich LE, Ralley FE, Robbins GR, Symcs JF, Bourke M, Nathan H, Wynands JE. Abstracts. Can J Anaesth 1991. [DOI: 10.1007/bf03008442] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
There is little data directly comparing steroid-tipped permanent pacemaker leads to otherwise state-of-the-art porous platinum leads. Eighteen patients receiving unipolar generators capable of low voltage outputs were randomized at the time of implant to receive either steroid-tipped leads or porous platinum leads. All leads were unipolar, tined, passive fixation, and placed in the right ventricular apex or atrial appendage. This study is single center. At implant, threshold pulse width was determined at 3 voltages (2.5, 1.5, and 0.8 V). Follow-up thresholds were determined at weeks 1, 2, 3, and 4, and at 3 and 6 months. There was no difference in implant thresholds or amplitudes for sensing. By 2 weeks postimplant, lower thresholds were noted for the steroid leads, and this discrepancy grew more significant with time. There was no significant postimplant rise in threshold for steroid-tipped leads. At 6 months, the average threshold pulse width for ventricular steroid leads at 0.8 V was 0.3 +/- 0.1 msec. In contrast, five patients with standard leads did not capture at maximum pulse width at 0.8 V (P less than 0.0001). There was no significant difference in the amplitude of the chronic atrial electrogram. This study shows steroid-tipped leads to offer a significant advantage in reducing thresholds early postimplant and chronically.
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Affiliation(s)
- M Wish
- Department of Medicine, VA Medical Center, Washington, DC
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Abstract
This case report describes intraoperative anaphylaxis occurring in a fourteen-year-old female with spina bifida in which latex surgical gloves were incriminated as the aetiologic agent. The patient was non-atopic but since eight years of age she had developed localized angioedema and urticarial skin reactions on exposure to rubber. She had previously undergone several uneventful surgical procedures. Forty-five minutes following induction of anaesthesia and during laparotomy for elective cholecystectomy she experienced sudden onset of increased airway pressure, oxygen desaturation, tachycardia, profound hypotension and erythema consistent with an anaphylactic reaction. Resuscitation with manual ventilation and oxygen, intravenous fluids and an epinephrine infusion was successful. Subsequent investigations for allergies demonstrated a strongly positive skin prick test and RAST to latex antigen, with negative results to anaesthetic agents, antibiotics and inhalant allergens. During two later operations prophylaxis consisting of diphenhydramine, ranitidine and hydrocortisone appeared to prevent further reactions. Latex should be considered as a cause of life-threatening intraoperative allergic reactions in patients with a history of rubber allergy or frequent exposure to latex products.
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Affiliation(s)
- J Swartz
- Department of Anaesthesia, Hospital for Sick Children, Toronto, Ontario, Canada
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33
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Taylor RH, Malviya S, Swartz J, Lerman J. Does the haemoglobin concentration predict post-op apnea in ex-preterm infants? Can J Anaesth 1990; 37:S100. [PMID: 2361240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- R H Taylor
- Department of Anaesthesia, Hospital for Sick Children, University of Toronto, Ontario
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34
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Lerman J, Strong HA, LeDez KM, Swartz J, Rieder MJ, Burrows FA. Effects of age on the serum concentration of alpha 1-acid glycoprotein and the binding of lidocaine in pediatric patients. Clin Pharmacol Ther 1989; 46:219-25. [PMID: 2758731 DOI: 10.1038/clpt.1989.129] [Citation(s) in RCA: 66] [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] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We determined the effect of age on the serum concentration of alpha 1-acid glycoprotein (alpha 1-AGP) in venous blood from 134 subjects who ranged in age from preterm neonates to 18-year-old adolescents. The mean (+/- SD) serum concentration of alpha 1-AGP, determined by radial immunodiffusion, increased significantly with age: the concentration found in neonates was less than that found in infants which, in turn, was less than that found in older children (p less than 0.001). In addition, we determined the effect of alpha 1-AGP on the free fraction of lidocaine in four groups of infants and children who received intravenous lidocaine (1.5 mg/kg). The percentage of free lidocaine correlated inversely and linearly with the serum alpha 1-AGP concentration (r2 = 0.617; p less than 0.001). The percentage of free lidocaine in the five neonates exceeded that in the older age groups. We conclude that the serum concentration of alpha 1-AGP increases while the free fraction of lidocaine decreases from early infancy to adolescence.
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Affiliation(s)
- J Lerman
- Department of Anaesthesia, Hospital for Sick Children, Toronto, Ontario, Canada
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35
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Swartz J. The doctor's office: poor design may cost you patients. CMAJ 1989; 140:320-1. [PMID: 2914246 PMCID: PMC1268633] [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: 01/03/2023] Open
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36
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Swartz J. After lean years group therapy making comeback, conference told. CMAJ 1989; 140:318-9. [PMID: 2914245 PMCID: PMC1268632] [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: 01/03/2023] Open
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37
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Abstract
Ventricular tachycardia in man can be eliminated by relatively small lesions in the reentrant circuit. This report includes a review of available energy sources, and methods for localizing arrhythmias. Methods to assure contact and prevent perforation using low frequency electrograms are presented including the new finding of reverse ST deflection with contact. Experience with laser energy in dogs showed discrete homogenous lesions. When compared with DC shock the animals showed far less arrhythmia and the lack of far field effect greatly reduced echo abnormalities in the post shock period. Studies with radiofrequency show ability to produce localized lesions similar to the laser but with a more flexible catheter. Localization requires a correlation of techniques including pacemapping, activation maps and pacing during tachycardia. Early activation (less than -60 ms) at times 180-320 ms, with comparable pace to QRS during tachycardia with no change in morphology best localized the slow zone of the reentrant circuit. The low frequency unipolar electrogram from the tip and immediately proximal electrode revealed contact with ST deviation. The distal deviation was always greater than the proximal RV free wall and posterior basal produced depression rather than elevation of the electrogram. While the mechanism of ST reversal with contact is not understood and may relate to the type of indifferent reference used (Wilson central terminal), the ST depression reveals the same information about contact that elevation does in most areas of the heart studied in our patients.
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Affiliation(s)
- R Fletcher
- Section of Cardiology, Veterans Administration Medical Center, Washington, D.C. 20422
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38
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Swartz J. In Reply: CO2 Reduction and Reforestation. Science 1988; 242:1494. [PMID: 17788413 DOI: 10.1126/science.242.4885.1494] [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: 11/02/2022]
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39
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Swartz J. Abuse of elderly subject of Toronto conference. CMAJ 1988; 138:261-2. [PMID: 3337995 PMCID: PMC1267594] [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: 01/05/2023] Open
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40
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Abstract
The following study in pregnant ewes was done to examine the effects of ketamine-oxygen anaesthesia on the fetal lamb made acidotic by partial occlusion of the umbilical cord. Fifteen pregnant ewes were instrumented under general anaesthesia to allow continuous measurement of maternal and fetal mean arterial pressure and pulse rate and for withdrawal of arterial blood samples for blood gas analysis. An occlusion loop was loosely secured around the umbilical cord. Following a recovery period of 48 hours, a tracheostomy was performed on each ewe. After a control period, the umbilical occlusion loop was slowly inflated until fetal pH had decreased to 7.12-7.15. Following inflation the animals were divided into groups A and B. Group A received no anaesthesia. In Group B, the ewes received ketamine 3 mg X kg-1 intravenously and controlled ventilation with FIO2 of 1.0. After ten minutes ketamine 1 mg X kg-1 was given. In both groups radioactive microspheres were injected into the fetus at 0, 5, and 15 minutes. Ketamine anaesthesia in the pregnant ewe abolished the fetal hypertension and bradycardia produced by partial cord occlusion. All fetuses survived the 15 minutes of ketamine anaesthesia and there were no significant changes in arterial blood gases or pH. Blood flows determined by the microsphere method to the brain, heart, and kidneys were not significantly altered by ketamine. We conclude that ketamine-oxygen anaesthesia does not cause further deterioration in the acidotic fetal lamb.
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41
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Welsh NH, Swartz J, Martin C, Salmenson BD, James SH, Zwi S. Retinal complications in the acquired immunodeficiency syndrome. A case report. S Afr Med J 1987; 71:394-6. [PMID: 3563780] [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: 01/06/2023] Open
Abstract
Increasing numbers of patients with the acquired immunodeficiency syndrome (AIDS) are being reported. In the US literature the eye complications have been well documented but because so few cases of AIDS have been reported in South Africa, the retinal complications are largely unknown to those treating these patients. The retinal complications are due to cytomegalovirus (CMV) retinitis. The patient described here developed the typical signs in both eyes. It is essential to examine the fundi of AIDS patients regularly. The presence of cotton-wool spots always precedes CMV retinitis, which leads to blindness; it is also of prognostic significance since all reported patients with CMV retinitis have died.
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42
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Donati F, Swartz J, Bevan JC, Leighton KM, Breen PH. Book reviews. Can J Anaesth 1986. [DOI: 10.1007/bf03027138] [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: 10/21/2022] Open
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44
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Swartz J. Runaways often sexually abused: symposium. CMAJ 1986; 134:944-6, 948. [PMID: 3955490 PMCID: PMC1490936] [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: 01/08/2023] Open
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45
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46
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Swartz J, Cummings M, Pucci W, Biehl D. The effects of general anaesthesia on the asphyxiated foetal lamb in utero. Can Anaesth Soc J 1985; 32:577-82. [PMID: 4075213 DOI: 10.1007/bf03011402] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The effects of anaesthetic agents, per se, on the asphyxiated foetus are difficult to quantitate clinically. Anaesthesia is often necessary in foetal distress, however, to effect a rapid delivery. To investigate the effect of general anaesthetic agents commonly used for Caesarean section we administered these agents to 18 chronically prepared pregnant ewes with asphyxiated foetuses in utero. The foetuses were asphyxiated by partial occlusion of the umbilical cord until foetal arterial pH had decreased from 7.30 to a range of 7.08-7.13. The animals were divided into three groups: Group A which received no anaesthesia and thus served as a control, Group B which received thiopentone (3 mg . kg-1) intravenously followed by 50 per cent nitrous oxide and 0.5 per cent halothane in oxygen for 15 minutes, and Group C which received thiopentone (3 mg . kg-1) followed by one per cent halothane in oxygen for 15 minutes. Foetal cerebral, myocardial, and renal blood flows were measured by injection of radioactive microspheres after production of asphyxia and after 5 and 15 minutes of anaesthesia. General anaesthesia in both groups B and C abolished the hypertension and bradycardia produced by foetal asphyxia secondary to umbilical cord occlusion. There were no significant differences between Groups B and C in foetal pH, PCO2, or PO2. Two foetuses in the nitrous oxide group died after ten minutes of anesthesia, but the aetiology of the sudden demise is unclear. We conclude that general anaesthesia abolishes the foetal response to umbilical cord occlusion and does not improve foetal oxygenation or acid-base status.
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47
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Swartz J. Hypnosis: with legitimacy comes questions. CMAJ 1985; 133:795-6. [PMID: 4042065 PMCID: PMC1346472] [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: 01/08/2023] Open
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48
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Kozody R, Swartz J, Palahniuk RJ, Biehl DR, Wade JG. Spinal cord blood flow following sub-arachnoid lidocaine. Can Anaesth Soc J 1985; 32:472-8. [PMID: 4041949 DOI: 10.1007/bf03010795] [Citation(s) in RCA: 35] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Twelve mongrel dogs were randomized into two equal groups. Cervical, thoracic and lumbosacral spinal cord and spinal dural blood flows were measured using the radioactive microsphere technique. Blood flow determinations were made prior to and 20 and 40 minutes following lumbar subarachnoid injection of: two per cent lidocaine (100 mg) or two per cent lidocaine (100 mg) with 1/25,000 epinephrine (200 micrograms). Dogs receiving subarachnoid lidocaine demonstrated a decrease in mean arterial blood pressure of 23 per cent and 14 per cent (p less than 0.05), while dogs receiving lidocaine with epinephrine had a decrease of 38 and 34 per cent (p less than 0.05) at 20 and 40 minutes respectively. Cardiac index was not significantly changed in either group. Lumbar subarachnoid lidocaine (100 mg) produced a rapid regional dural hyperemia (observed at 20 minutes postinjection) and a delayed regional spinal cord hyperemia (observed at 40 minutes postinjection) which were not observed following the addition of epinephrine (200 micrograms).
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49
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Swartz J. Physicians grapple with suicide. Can Med Assoc J 1985; 133:143-5. [PMID: 4005762 PMCID: PMC1346033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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50
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Swartz J. Is there a virologist in the house? Can Med Assoc J 1985; 132:290-3. [PMID: 3967165 PMCID: PMC1346717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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