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Chen Y, Li C, Fan Y, Jiao L, Silverman M, Ishimaru M, Wang J, Van Pelt AJ, Wang R. Associations of oral health status and swallowing function with cognitive impairment in the aging population: a cross-sectional study. BMC Oral Health 2023; 23:912. [PMID: 37993856 PMCID: PMC10666324 DOI: 10.1186/s12903-023-03640-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/08/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND The purpose of this study was to investigate the relationships of oral health status and swallowing function with cognitive impairment in community-dwelling older adults from Changsha, Hunan Province, China. METHODS In this cross-sectional study, we analyzed the data of 215 participants aged ≥ 50 years which were retrieved from the Xiangya and Panasonic mild cognitive impairment (MCI) Study, a community-based study conducted among the residents of the urban areas of Hunan province in China. Demographic information of all participants was collected. We determined oral function by evaluating oral hygiene, oral dryness, occlusal force, tongue pressure, chewing function, swallowing function, remaining teeth number, and other indicators. The mini-mental state examination (MMSE) was used to screen for cognitive function. The relationship between each oral function evaluation item and cognitive function was investigated using correlation analysis. The associations between oral health status and swallowing function with cognitive impairment were inferred using multiple regression analysis. RESULTS The general characteristics of participants showed statistically significant correlation coefficients in number of teeth remaining (p = 0.003) and number of teeth lost (p < 0.0001). Almost half of the 25 participants (48%) were aged from 70-80 years. Only 25 older adults (11.6% of the participants) were determined to have cognitive impairment by MMSE sores less than 24. Tongue pressure in male participants was the only significant independent variable that was associated with cognitive impairment (p = 0.01971). The results indicate that male participants with lower MMSE scores had a relative deficiency in tongue pressure. CONCLUSIONS In this cross-sectional study, the oral health status and swallowing function of participants were in relatively good condition and showed low correlations with cognitive impairment. However, lower tongue pressures were associated with lower MMSE scores in males, indicating it could serve as a novel oral function index for evaluating cognitive impairment.
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Affiliation(s)
- Yong Chen
- Laboratory of Food Oral Processing, School of Food Science & Biotechnology, Zhejiang Gongshang University, Hangzhou, Zhejiang, China
| | - Canyang Li
- Rehabilitation Medicine Department, Speech and Language Pathology Therapy Section, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yongmei Fan
- Rehabilitation Medicine Department, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Lili Jiao
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, of Central South University, Changsha, Hunan, China
| | - Matthew Silverman
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | | | - Jing Wang
- College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, Zhejiang, China
| | - Alice J Van Pelt
- Section of Gastroenterology, Jr. VA Hospital, Edward Hines, Hines, IL, USA
- Division of Gastroenterology and Nutrition, Loyola University Stritch School of Medicine, Maywood, IL, USA
| | - Rumi Wang
- Rehabilitation Medicine Department, Speech and Language Pathology Therapy Section, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
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Silverman M, Zwolinski N, Wang E, Lockwood N, Ancuta M, Jin E, Li J. Regional Analgesia for Cesarean Delivery: A Narrative Review Toward Enhancing Outcomes in Parturients. J Pain Res 2023; 16:3807-3835. [PMID: 38026463 PMCID: PMC10644837 DOI: 10.2147/jpr.s428332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/28/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction With the current surge on peripheral nerve blocks in post-cesarean pain management and the historical lack of unequivocal evidence supporting its universal use, this review intended to re-examine the extended scope of literature on regional anesthesia and postoperative analgesia in low-transverse cesarean section. Methods A literature search was conducted up to April 2023 using PubMed to identify articles relevant to our search words "cesarean section", "neuraxial morphine", "post-cesarean analgesia", as well as the name of each individual nerve block. The literature search was ultimately narrowed to systematic reviews and randomized controlled trials published between 2012 and 2023. We define, describe, and discuss the evidence surrounding each individual regional anesthetic technique in the presence and absence of intrathecal morphine, which is used as the gold standard when appropriate. Results In the absence of neuraxial morphine, all regional anesthetic techniques have some level of analgesic benefit in the post-cesarean analgesia. Transversus Abdominis Plane blocks continue to have the most studies in their use. Newer fascia plane blocks including the anterior Quadratus Lumborum, and Erector Spinae Plane blocks provide significant analgesia. In addition, direct comparison among peripheral nerve blocks consistently favors the more proximal, centralized techniques. Conversely, in the presence of neuraxial morphine, no peripheral anesthetic technique has reliably and reproducibly demonstrated an added analgesic benefit regardless of the peripheral nerve block technique or location of local anesthetic injection in the post-cesarean population. Conclusion Neuraxial morphine continues to be the gold standard for post-cesarean section analgesia, the benefit of additional single injection regional anesthetic is currently not evidence supported. In cases where neuraxial opioids have not or cannot be given, there is overwhelming evidence that regional anesthetic techniques improve post-cesarean section analgesia and decrease post-operative opioid consumption. Even though there is no consensus on the optimal peripheral nerve block, emerging evidence suggests more centralized abdominal fascia plane block trends towards better analgesia.
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Affiliation(s)
- Matthew Silverman
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
| | - Nicholas Zwolinski
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
| | - Ethan Wang
- Yale University School of Medicine, New Haven, CT, USA
| | - Nishita Lockwood
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
| | - Michael Ancuta
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
| | - Evan Jin
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
| | - Jinlei Li
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
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Zhang C, Pang W, Gong T, Jiang JJ, Silverman M, Li G. 5-Aminolevulinic Acid-Mediated Photodynamic Therapy Improves Vocal Fold Wound Healing in Rats. Laryngoscope 2023; 133:1943-1951. [PMID: 36278803 DOI: 10.1002/lary.30427] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/14/2022] [Accepted: 09/22/2022] [Indexed: 07/20/2023]
Abstract
OBJECTIVE Studies showed that photodynamic therapy (PDT) might be able to prevent vocal fold scar formation when treating laryngeal lesions. We aim to investigate if PDT improves vocal wound healing and reduces scar formation in both prophylactic and remodeling procedures performed in vivo. STUDY DESIGN In vivo. METHODS Vocal fold stripping was performed in Sprague-Dawley rats. PDT was performed with intraperitoneal injection of 100 mg/kg 5-Aminolevulinic Acid (5-ALA) and 635 nm laser irradiation of 20, 40, and 60 J/cm2 . PDT was performed immediately after surgery to study the prophylactic effect and 4 weeks after surgery to study the remodeling effect. Gene expression was evaluated with real-time PCR at 1 week after PDT. Histologic evaluations were performed 12 weeks after PDT, including hematoxylin-eosin, Masson, Alcian blue staining, and immunohistochemical staining of collagen I and III. RESULTS PDT induced similar effects on the vocal fold wound healing outcomes in both prophylactic and remodeling procedures. Expression of MMP8, MMP13, HAS2, and TGFβ1 was significantly elevated. Histologic evaluation revealed significantly increased thickness, decreased density of collagen, and increased deposition of hyaluronic acid in the lamina propria. Immunohistochemistry also revealed better distribution and reduced density of collagen I and III. The most obvious changes were seen in the 60 J/cm2 PDT group. CONCLUSION PDT could significantly improve vocal wound healing by providing both prophylactic effects and remodeling effects. It may be a minimally invasive treatment for vocal fold lesions with slight vocal scarring, and may be used to treat acute or chronic vocal injury to reduce vocal scarring. LEVEL OF EVIDENCE N/A Laryngoscope, 133:1943-1951, 2023.
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Affiliation(s)
- Chi Zhang
- From the Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
- The Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China
| | - Wenting Pang
- From the Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ting Gong
- The Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China
| | - Jack J Jiang
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Matthew Silverman
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Gelin Li
- From the Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
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Zhang C, Zhong J, Jiang JJ, Hou Q, Ren H, Silverman M, Li G. Office-Based Photodynamic Therapy Using Locally Applied 5-aminolevulinic Acid and 635 nm Laser for Laryngeal Leukoplakia. Otolaryngol Head Neck Surg 2023; 168:805-813. [PMID: 36939544 DOI: 10.1002/ohn.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/24/2022] [Accepted: 09/10/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Photodynamic therapy (PDT) is a minimally invasive method with strong tissue selectivity and nonthermal effects. We aim to investigate the efficacy of an in-office method utilizing PDT with local application of 5-aminolevulinic acid (ALA) and 635 nm diode laser for treating laryngeal leukoplakia. STUDY DESIGN Retrospective cohort study. SETTING Outpatient clinic-tertiary medical center. METHODS This study reviewed 32 patients with laryngeal leukoplakia, including 11 recurrent cases after surgery. All the procedures were performed in an office setting under topical anesthesia. Fifteen percent ALA solution was locally applied to the lesion through a flexible laryngoscope. Light illumination was performed using a 635 nm diode laser through a 400 μm optic fiber. The power density was 165 mW/cm2 to reach 100 J/cm2 . Results of laryngostroboscopy and voice evaluation during follow-up were collected. RESULTS The mean follow-up was 7.91 ± 4.83 (3-18) months. Thirty-nine procedures were performed, including 1 session for 27 patients, 2 sessions for 3 patients, and 3 sessions for 2 patients. The total response rate was 96.875% (31/32), including complete responses in 26 (81.25%) patients, partial responses in 5 patients (15.625%), and no response in 1 patient (3.125%). It appeared that PDT selectively eliminated the leukoplakia without affecting lamina propria and the surrounding normal mucosa remained unharmed. Scores of Voice Handicap Index-10, jitter, shimmer, and harmonic-to-noise ratio were significantly improved after PDT. CONCLUSION Office-based PDT is an effective, repeatable, and practical method for treating laryngeal leukoplakia. Local application of ALA is sufficient to achieve photodynamic reactions. PDT could eliminate laryngeal leukoplakia selectively while protecting the normal laryngeal structure.
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Affiliation(s)
- Chi Zhang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jingting Zhong
- Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jack J Jiang
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Qian Hou
- Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hui Ren
- Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Matthew Silverman
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Gelin Li
- Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Xu X, Wang Y, Silverman M, Liu L, Jiang JJ, Li X, Zhuang P. Glottic Insufficiency in the Vertical Plane in Patients With Unknown-Source Unilateral Vocal Fold Hypomobility. J Voice 2022:S0892-1997(22)00098-4. [PMID: 35469727 DOI: 10.1016/j.jvoice.2022.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/25/2022] [Accepted: 03/25/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To observe the laryngeal CT and strobe laryngoscopy signs of unilateral vocal fold hypomobility (UVFHM) in patients with well-closed glottises in the horizontal plane. METHODS A retrospective analysis was performed on 18 subjects with well-closed glottises in the horizontal plane using strobe laryngoscopy, 9 patients diagnosed with unilateral vocal fold hypomobility with an unknown etiology were enrolled in the UVFHM group, and 9 healthy matched subjects with symmetrical bilateral vocal fold movement were enrolled in the control group. Vertical plane distances of bilateral vocal folds and three-dimensional structural parameters of vocal folds were measured through laryngeal CT. Glottic insufficiency in the vertical plane and reflux findings scores (RFS) were assessed under laryngeal CT and strobe laryngoscopy. Reflux symptom index (RSI) were collected. SPSS25.0 software was used for statistical analysis. RESULTS The height differences in vertical plane and thicknesses of bilateral vocal folds in the UVFHM group were larger than those in the control (P < 0.05), while the length, width and subglottic convergence angle of the vocal folds were not statistically significant between the two groups (P > 0.05). In the UVFHM group, laryngeal CT showed that 77.78% of patients (7/9) had glottic insufficiency in the vertical plane, with height differences ranging from 0.3 to 1.9 mm and a mean of 0.76mm. However, strobe laryngoscopy showed that 33.33% (3/9) had glottic insufficiency in the vertical plane. The proportion of patients with glottic insufficiency in vertical plane in the UVFHM group was significantly higher than that in the control group (P < 0.05). RSI and RFS scores of the UVFHM group were higher than those of the control group (P < 0.05). CONCLUSION Glottic insufficiency in the vertical plane often occurred in patients with UVFHM with an unknown cause of hoarseness, so the presence of glottic insufficiency in the vertical plane should be considered when hoarseness is detected by clinicians. Laryngeal dynamic CT can enhance the diagnostic rate compared to strobe laryngoscopy. Unexplained UVFHM patients have higher RSI and RFS compared to control subjects, warranting further research about the relationship between UVFHM and laryngopharyngeal reflux.
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Affiliation(s)
- Xinlin Xu
- Department of Otolaryngology, Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China; Department of Voice, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Yong Wang
- Department of Radiology, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Matthew Silverman
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Liying Liu
- Department of Voice, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Jack J Jiang
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Xiangping Li
- Department of Otolaryngology, Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Peiyun Zhuang
- Department of Voice, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
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Fang Y, Zhao Y, Pan W, Silverman M, Shu Y, Chen B. Whether cochlea involvement on CT in otosclerosis patients impacts the effect of stapedotomy. Acta Otolaryngol 2021; 141:915-920. [PMID: 34633897 DOI: 10.1080/00016489.2021.1980225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The success rate of stapedotomy in otosclerosis patients with cochlea involvement was unknown. AIMS/OBJECTIVES To determine the difference of surgical outcomes and symptomatology in otosclerosis patients with or without cochlea involvement on CT. MATERIAL AND METHODS 79 otosclerosis patients were included and grouped by HRCT, including cochlear-involved otosclerosis (C-group) or non-cochlear-involved otosclerosis (NC-group, control group). Patients were defined as NC-group in the presence of normal or solely fenestral involvement, or C-group if the hypodensities involve other parts of the labyrinthine bone Patients in the control group were collected at a 2:1 ratio to the C-group with similar follow-up times. Detailed complaints and surgical outcomes were compared between these groups. RESULTS Chief complaints were similar in the C-group and NC-group. Although postoperative AC, BC, and ABG decreased significantly in both groups, the success rate was significantly higher in C-group regarding the postoperative ABG ≤10 dB. Furthermore, diffuse lesions may indicate a more severe disease and a poorer prognosis. CONCLUSIONS AND SIGNIFICANCE Stapedotomy was effective for clinical otosclerosis. The surgical outcome was inferior favorable for cochlea involvement patients, especially for cases with widely involvement. There was no difference in chief complaints among patients with different CT degree of otosclerosis.
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Affiliation(s)
- Yanqing Fang
- ENT Institute and Department of Otorhinolaryngology, State Key Laboratory of Medical Neurobiology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
| | - Yu Zhao
- ENT Institute and Department of Otorhinolaryngology, State Key Laboratory of Medical Neurobiology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
| | - Wei Pan
- ENT Institute and Department of Otorhinolaryngology, State Key Laboratory of Medical Neurobiology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
| | - Matthew Silverman
- Laryngeal Physiology Laboratory, University of Wisconsin – Madison, Madison, WI, USA
| | - Yilai Shu
- ENT Institute and Department of Otorhinolaryngology, State Key Laboratory of Medical Neurobiology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
| | - Bing Chen
- ENT Institute and Department of Otorhinolaryngology, State Key Laboratory of Medical Neurobiology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
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Okoli M, Silverman M, Abboudi J, Jones C, Kirkpatrick W, Liss F, Takei TR, Wang M, Ilyas AM. Radiographic Healing and Functional Outcomes of Untreated Ulnar Styloid Fractures Following Volar Plate Fixation of Distal Radius Fractures: A Prospective Analysis. Hand (N Y) 2021; 16:332-337. [PMID: 31286791 PMCID: PMC8120582 DOI: 10.1177/1558944719855445] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Ulnar styloid fractures (USFs) are common concomitant injuries associated with distal radius fractures (DRFs). Recent studies have found conflicting evidence on whether these fractures treated or untreated effect pain and functional outcomes. The purpose of this study was to prospectively evaluate pain and function outcomes of consecutively untreated USFs in surgically repaired DRFs. The study hypothesis was that there would be no difference in outcomes whether an USF is present or not, with all cases left untreated. Methods: A prospective study at a single institution of consecutive DRF treated surgically with volar locked plating was undertaken. No patients underwent fixation of an USF if present. There were no treated USF that were excluded. Patients with associated ulnar neck and shaft fractures were excluded. Functional outcome measures were analyzed using the Quick Disabilities of the Arm, Shoulder, and Hand score (QDASH) and the Patient-Rated Wrist Evaluation (PRWE) scores. Outcome measures were collected at 3 months and 1 year postoperatively. Results: There was an incidence of 52.2% (n = 70/134) USF associated with surgically treated DRF. By location, there were 52.9% (n = 37/70) ulnar styloid tip fractures and 46.1% (33/70) ulnar styloid base. There were 75.7% of USF (53/70) still not healed by 1-year follow-up. When comparing patients with a DRF without an USF versus DRF with an associated USF at 12 months, there was no statistical difference in the QDASH score (6.7 vs 8.4, P = .47) or the PRWE total score (4.8 vs 7.5, P = .24). Similarly, subgroup analysis showed no statistical difference in QDASH or PRWE scores at final follow-up in united USF versus nonunited USF subjects (QDASH 14.2 vs 6.8, P = .112; PRWE 14.8 vs 5.4, P = .185). Conclusions: USFs are a common concomitant injury occurring in nearly half of DRFs treated surgically. Our prospective cohort analysis showed that neither the presence, type, nor bony union status of a concomitant USF has any significant effect on patient outcomes or reoperations at 1-year postoperatively. Our study confirms our hypothesis that USF of the tip and base should be left untreated.
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Affiliation(s)
- Michael Okoli
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Matthew Silverman
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Jack Abboudi
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Christopher Jones
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Frederic Liss
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - T. Robert Takei
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Mark Wang
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Asif M. Ilyas
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA,Asif M. Ilyas, Rothman Institute at Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA 19107, USA.
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AL QA'QA' S, Rodriguez S, Albert L, Silverman M, Avila-Casado C. POS-447 A CHALLENGING CASE OF LUPUS-LIKE IMMUNE-COMPLEX MEDIATED GLOMERULONEPHRITIS ASSOCIATED WITH SINUSOIDAL OBSTRUCTIVE SYNDROME. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.473] [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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Mekaeil V, Wiener D, Silverman M, Miller I, Dittus E, Eskin B, Allegra J. 39 Emergency Department Visits for Serious and Painful Conditions Markedly Decreased after the Arrival of COVID-19. Ann Emerg Med 2020. [PMCID: PMC7598895 DOI: 10.1016/j.annemergmed.2020.09.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bella S, Biggs D, Silverman M, Walsh B, Gaudio C. 384 Does a Peripheral Eosinophil Count Predict Low Risk for Mortality in Patients With Clostridium Difficile Infection? Ann Emerg Med 2020. [DOI: 10.1016/j.annemergmed.2020.09.400] [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: 10/23/2022]
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11
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Muller J, Alizadeh M, Li L, Thalheimer S, Matias C, Tantawi M, Miao J, Silverman M, Zhang V, Yun G, Romo V, Mohamed FB, Wu C. Feasibility of diffusion and probabilistic white matter analysis in patients implanted with a deep brain stimulator. Neuroimage Clin 2019; 25:102135. [PMID: 31901789 PMCID: PMC6948366 DOI: 10.1016/j.nicl.2019.102135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/27/2019] [Accepted: 12/13/2019] [Indexed: 01/03/2023]
Abstract
Deep brain stimulation (DBS) for Parkinson's disease (PD) is an established advanced therapy that produces therapeutic effects through high frequency stimulation. Although this therapeutic option leads to improved clinical outcomes, the mechanisms of the underlying efficacy of this treatment are not well understood. Therefore, investigation of DBS and its postoperative effects on brain architecture is of great interest. Diffusion weighted imaging (DWI) is an advanced imaging technique, which has the ability to estimate the structure of white matter fibers; however, clinical application of DWI after DBS implantation is challenging due to the strong susceptibility artifacts caused by implanted devices. This study aims to evaluate the feasibility of generating meaningful white matter reconstructions after DBS implantation; and to subsequently quantify the degree to which these tracts are affected by post-operative device-related artifacts. DWI was safely performed before and after implanting electrodes for DBS in 9 PD patients. Differences within each subject between pre- and post-implantation FA, MD, and RD values for 123 regions of interest (ROIs) were calculated. While differences were noted globally, they were larger in regions directly affected by the artifact. White matter tracts were generated from each ROI with probabilistic tractography, revealing significant differences in the reconstruction of several white matter structures after DBS. Tracts pertinent to PD, such as regions of the substantia nigra and nigrostriatal tracts, were largely unaffected. The aim of this study was to demonstrate the feasibility and clinical applicability of acquiring and processing DWI post-operatively in PD patients after DBS implantation. The presence of global differences provides an impetus for acquiring DWI shortly after implantation to establish a new baseline against which longitudinal changes in brain connectivity in DBS patients can be compared. Understanding that post-operative fiber tracking in patients is feasible on a clinically-relevant scale has significant implications for increasing our current understanding of the pathophysiology of movement disorders, and may provide insights into better defining the pathophysiology and therapeutic effects of DBS.
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Affiliation(s)
- J Muller
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, PA, United States; Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United States.
| | - M Alizadeh
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, PA, United States; Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United States
| | - L Li
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, PA, United States; Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United States
| | - S Thalheimer
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, PA, United States; Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United States
| | - C Matias
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United States
| | - M Tantawi
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United States
| | - J Miao
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United States
| | - M Silverman
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United States
| | - V Zhang
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United States
| | - G Yun
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United States
| | - V Romo
- Department of Anesthesiology, Thomas Jefferson University, Philadelphia, PA, United States
| | - F B Mohamed
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, PA, United States
| | - C Wu
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, PA, United States; Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United States
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Said J, Abboudi J, Gallant G, Jones C, Kirkpatrick W, Liss F, Rivlin M, Takei RR, Wang M, Silverman M, Foltz C, Ilyas AM. Prospective evaluation of sleep improvement after cubital tunnel decompression surgery. J Shoulder Elbow Surg 2019; 28:e144-e149. [PMID: 30685275 DOI: 10.1016/j.jse.2018.11.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 10/28/2018] [Accepted: 11/09/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Compromised sleep is a known phenomenon with compressive neuropathies such as carpal tunnel syndrome. However, the prevalence of sleep disturbance with cubital tunnel syndrome (CuTS) and the effect on sleep after ulnar nerve decompression are not well understood. We hypothesized that CuTS results in sleep disturbances and that decompression surgery would result in improvement in overall sleep quality. METHODS Consecutive patients with electrodiagnostic-proven CuTS indicated for decompression were prospectively enrolled. Demographic data, McGowan grade, electrodiagnostic (electromyography) severity, visual analog scale pain score, the 11-item version of the Disabilities of the Arm, Shoulder and Hand questionnaire, and the Insomnia Severity Index scale data were collected preoperatively and at 2 weeks and 3 months postoperatively. RESULTS There were 145 patients enrolled, with 97% available at 2 weeks and 72% available at the final 3-month follow-up. Surgical decompression procedures consisted of 102 in situ releases and 43 transpositions. The average preoperative Insomnia Severity Index score for the entire cohort was 10.7, above the threshold for a diagnosis of insomnia, which subsequently improved to 4.1 by final follow-up postoperatively, consistent with resolution of the insomnia. There was no difference in the extent of sleep improvement between in situ decompression and transposition. Similarly, electromyography severity and McGowan grade also did not appear to significantly affect the extent of sleep improvement. CONCLUSION CuTS decompression surgery, irrespective of surgical type and preoperative severity, resulted in improvement in sleep by the 3 month postoperative visit.
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Affiliation(s)
- Joseph Said
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Jack Abboudi
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Gregory Gallant
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christopher Jones
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Frederic Liss
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael Rivlin
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - R Robert Takei
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mark Wang
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Matthew Silverman
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Carol Foltz
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Asif M Ilyas
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
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13
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Gautam R, Xiang Y, Lamstein J, Liang Y, Bezryadina A, Liang G, Hansson T, Wetzel B, Preece D, White A, Silverman M, Kazarian S, Xu J, Morandotti R, Chen Z. Optical force-induced nonlinearity and self-guiding of light in human red blood cell suspensions. Light Sci Appl 2019; 8:31. [PMID: 30886708 PMCID: PMC6414597 DOI: 10.1038/s41377-019-0142-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 05/23/2023]
Abstract
Osmotic conditions play an important role in the cell properties of human red blood cells (RBCs), which are crucial for the pathological analysis of some blood diseases such as malaria. Over the past decades, numerous efforts have mainly focused on the study of the RBC biomechanical properties that arise from the unique deformability of erythrocytes. Here, we demonstrate nonlinear optical effects from human RBCs suspended in different osmotic solutions. Specifically, we observe self-trapping and scattering-resistant nonlinear propagation of a laser beam through RBC suspensions under all three osmotic conditions, where the strength of the optical nonlinearity increases with osmotic pressure on the cells. This tunable nonlinearity is attributed to optical forces, particularly the forward-scattering and gradient forces. Interestingly, in aged blood samples (with lysed cells), a notably different nonlinear behavior is observed due to the presence of free hemoglobin. We use a theoretical model with an optical force-mediated nonlocal nonlinearity to explain the experimental observations. Our work on light self-guiding through scattering bio-soft-matter may introduce new photonic tools for noninvasive biomedical imaging and medical diagnosis.
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Affiliation(s)
- Rekha Gautam
- Department of Physics and Astronomy, San Francisco State University, San Francisco, CA 94132 USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37240 USA
| | - Yinxiao Xiang
- Department of Physics and Astronomy, San Francisco State University, San Francisco, CA 94132 USA
- MOE Key Lab of Weak-Light Nonlinear Photonics, TEDA Applied Physics Institute and School of Physics, Nankai University, Tianjin, 300457 China
| | - Josh Lamstein
- Department of Physics and Astronomy, San Francisco State University, San Francisco, CA 94132 USA
| | - Yi Liang
- Department of Physics and Astronomy, San Francisco State University, San Francisco, CA 94132 USA
- Guangxi Key Lab for Relativistic Astrophysics, Guangxi Colleges and Universities Key Lab of Novel Energy Materials and Related Technology, School of Physical Science and Technology, Guangxi University, Nanning, Guangxi 530004 China
| | - Anna Bezryadina
- Department of Physics and Astronomy, San Francisco State University, San Francisco, CA 94132 USA
- Department of Physics and Astronomy, California State University Northridge, Northridge, CA 91330 USA
| | - Guo Liang
- Department of Physics and Astronomy, San Francisco State University, San Francisco, CA 94132 USA
| | - Tobias Hansson
- Institut National de la Recherche Scientifique, Université du Québec, Varennes, QC J3X 1S2 Canada
- Department of Physics, Chemistry and Biology, Linköping University, Linköping, SE-581 83 Sweden
| | - Benjamin Wetzel
- Institut National de la Recherche Scientifique, Université du Québec, Varennes, QC J3X 1S2 Canada
- School of Mathematical and Physical Sciences, University of Sussex, Sussex House, Falmer, Brighton, BN1 9RH UK
| | - Daryl Preece
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA USA
| | - Adam White
- Department of Physics and Astronomy, San Francisco State University, San Francisco, CA 94132 USA
| | - Matthew Silverman
- Clinical Laboratory Science Program, San Francisco State University, San Francisco, CA 94132 USA
| | - Susan Kazarian
- Clinical Laboratory Science Program, San Francisco State University, San Francisco, CA 94132 USA
| | - Jingjun Xu
- MOE Key Lab of Weak-Light Nonlinear Photonics, TEDA Applied Physics Institute and School of Physics, Nankai University, Tianjin, 300457 China
| | - Roberto Morandotti
- Institut National de la Recherche Scientifique, Université du Québec, Varennes, QC J3X 1S2 Canada
- Institute of Fundamental and Frontier Sciences, University of Electronic Science and Tech. of China, Chengdu, 610054 China
- ITMO University, Saint Petersburg, 197101 Russia
| | - Zhigang Chen
- Department of Physics and Astronomy, San Francisco State University, San Francisco, CA 94132 USA
- MOE Key Lab of Weak-Light Nonlinear Photonics, TEDA Applied Physics Institute and School of Physics, Nankai University, Tianjin, 300457 China
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Hozack BA, Abboudi J, Gallant G, Jones CM, Kirkpatrick W, Liss FE, Rivlin M, Takei TR, Wang ML, Silverman M, Foltz C, Ilyas AM. Prospective Evaluation of Opioid Consumption Following Cubital Tunnel Decompression Surgery. Hand (N Y) 2019; 14:42-47. [PMID: 30269520 PMCID: PMC6346364 DOI: 10.1177/1558944718800732] [Citation(s) in RCA: 7] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Managing postoperative pain is important for patients and surgeons. However, there is concern over opioid dependency. Cubital tunnel decompression is among the most common upper extremity surgeries. Our study aimed to analyze opioid use after cubital tunnel decompression to guide postoperative opioid prescribing. METHODS We prospectively collected opioid consumption for 16 consecutive months (February 2016 to June 2017) for cubital tunnel decompression patients. Data on demographics, insurance type, surgery performed, functional questionnaires (Quick Disabilities of the Arm, Shoulder and Hand [QuickDASH]), and electrodiagnostics (electromyography) were collected. Opioid consumption was reported at first postoperative visits. RESULTS One hundred patients consumed a mean of 50 morphine equivalent units (MEUs) (range, 0-300), or 7 oxycodone 5-mg pills, postoperatively. Cubital tunnel release (CuTR) patients consumed fewer than ulnar nerve transposition (UNT) patients (40.4 vs 62.5 MEUs or 5.4 vs 8.3 pills, P = .08). Patients undergoing submuscular UNT consumed more than CuTR (115.0 vs 40.4 MEUs or 15.3 vs 5.4 pills, p = 0.003) and more than subcutaneous UNT patients (37.8 MEU or 5.0 pills, p = 0.03). Medicare patients consumed less than privately insured (42.7 vs 54.1 MEUs, 5.7 vs 7.2 pills, P = .02) and less than workers' compensation patients (76.8 MEU or 10.2 pills, P = .04). Older patients consumed fewer than younger patients ( P = .03). Postoperative QuickDASH score was positively related to opioid intake ( P = .009). CONCLUSIONS Patients consumed 7 oxycodone 5-mg pills after cubital tunnel decompression. Younger, privately insured, and workers' compensation patients, and those with worse functional scores and those undergoing UNT (specifically the submuscular technique) consumed more opioids.
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Affiliation(s)
- Bryan A. Hozack
- Rothman Institute at Thomas Jefferson
University Hospital, Philadelphia, PA, USA
| | - Jack Abboudi
- Rothman Institute at Thomas Jefferson
University Hospital, Philadelphia, PA, USA
| | - Gregory Gallant
- Rothman Institute at Thomas Jefferson
University Hospital, Philadelphia, PA, USA
| | - Christopher M. Jones
- Rothman Institute at Thomas Jefferson
University Hospital, Philadelphia, PA, USA
| | - William Kirkpatrick
- Rothman Institute at Thomas Jefferson
University Hospital, Philadelphia, PA, USA
| | - Frederic E. Liss
- Rothman Institute at Thomas Jefferson
University Hospital, Philadelphia, PA, USA
| | - Michael Rivlin
- Rothman Institute at Thomas Jefferson
University Hospital, Philadelphia, PA, USA
| | - T. Robert Takei
- Rothman Institute at Thomas Jefferson
University Hospital, Philadelphia, PA, USA
| | - Mark L. Wang
- Rothman Institute at Thomas Jefferson
University Hospital, Philadelphia, PA, USA
| | - Matthew Silverman
- Rothman Institute at Thomas Jefferson
University Hospital, Philadelphia, PA, USA
| | - Carol Foltz
- Rothman Institute at Thomas Jefferson
University Hospital, Philadelphia, PA, USA
| | - Asif M. Ilyas
- Rothman Institute at Thomas Jefferson
University Hospital, Philadelphia, PA, USA,Asif M. Ilyas, Rothman Institute at Thomas
Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA
19107, USA.
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Gerber L, Mansky P, Chesney M, Silverman M, Chan L, Yao K, Stoddard S, Baranova, Birerdinc A. Results of a randomized trial comparing aerobic exercise and tai chi on cardiovascular function, cytokines and metabolic markers in survivors of solid tumors. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.663] [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: 11/29/2022]
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16
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Cherniak W, Ehrenkranz R, Davidson M, Pradhan A, Lee T, Krass P, Fisher N, Meaney C, Krueger P, Silverman M, Anguyo G. The impact of parental obesity on pediatric malnutrition in rural
Uganda–a household survey. Ann Glob Health 2016. [DOI: 10.1016/j.aogh.2016.04.618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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17
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Cochrane CN, Spycher BD, Granell R, Sterne JAC, Silverman M, Pescatore AM, Gaillard EA, Kuehni CE, Henderson J. S16 Outcomes of multiple trigger wheeze and exclusive viral wheeze in early childhood: A comparison across two population cohorts. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.22] [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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18
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Gabrail N, Ghamande S, Silverman M, Smith C, Ho H, Huang C, Hsueh S, Lin C. 330 First-in-man study of gemcitabine hydrochloride oral formulation (D07001-F4) in patients with malignant tumors. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30194-0] [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: 11/26/2022]
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19
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Mohr TB, Juneja VK, Thippareddi HH, Schaffner DW, Bronstein PA, Silverman M, Cook LV. Assessing the Performance of Clostridium perfringens Cooling Models for Cooked, Uncured Meat and Poultry Products. J Food Prot 2015; 78:1512-26. [PMID: 26219365 DOI: 10.4315/0362-028x.jfp-15-015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Heat-resistant spores of Clostridium perfringens may germinate and multiply in cooked meat and poultry products when the rate and extent of cooling does not occur in a timely manner. Therefore, six cooling models (PMP 7.0 broth model; PMIP uncured beef, chicken, and pork models; Smith-Schaffner version 3; and UK IFR ComBase Perfringens Predictor) were evaluated for relative performance in predicting growth of C. perfringens under dynamic temperature conditions encountered during cooling of cooked, uncured meat and poultry products. The predicted growth responses from the models were extensively compared with those observed in food. Data from 188 time-temperature cooling profiles (176 for single-rate exponential cooling and 12 for dual-rate exponential cooling) were collected from 17 independent sources (16 peer-reviewed publications and one report) for model evaluation. Data were obtained for a variety of cooked products, including meat and poultry slurries, ground meat and poultry products with and without added ingredients (e.g., potato starch, sodium triphosphate, and potassium tetrapyrophosphate), and processed products such as ham and roast beef. Performance of the models was evaluated using three sets of criteria, and accuracy was defined within a 1- to 2-log range. The percentages of accurate, fail-safe, or fail-dangerous predictions for each cooling model differed depending on which criterion was used to evaluate the data set. Nevertheless, the combined percentages of accurate and fail-safe predictions based on the three performance criteria were 34.66 to 42.61% for the PMP 7.0 beef broth model, 100% for the PMIP cooling models for uncured beef, uncured pork and uncured chicken, 80.11 to 93.18% for the Smith-Schaffner cooling model, and 74.43 to 85.23% for the UK IFR ComBase Perfringens Predictor model during single-rate exponential chilling. Except for the PMP 7.0 broth model, the other five cooling models (PMIP, Smith-Schaffner, and UK IFR ComBase) are useful and reliable tools that food processors and regulatory agencies can use to evaluate the safety of cooked or heat-treated uncured meat and poultry products exposed to cooling deviations or to develop customized cooling schedules.
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Affiliation(s)
- T B Mohr
- U.S. Department of Agriculture, Food Safety and Inspection Service, Office of Public Health Science, Science Staff, 530 Center Street N.E., Suite 401, Salem, Oregon 97301, USA.
| | - V K Juneja
- U.S. Department of Agriculture, Agricultural Research Service, Eastern Regional Research Center, 600 East Mermaid Lane, Wyndmoor, Pennsylvania 19038, USA
| | - H H Thippareddi
- Department of Food Science and Technology, University of Nebraska-Lincoln, Lincoln, Nebraska 68583, USA
| | - D W Schaffner
- Department of Food Science, School of Environmental and Biological Sciences, Rutgers University, New Brunswick, New Jersey 08901, USA
| | - P A Bronstein
- U.S. Department of Agriculture, Food Safety and Inspection Service, Office of Public Health Science, Science Staff, Patriots Plaza III, Suite 9-225B, Washington, D.C. 20250, USA
| | - M Silverman
- U.S. Department of Agriculture, Food Safety and Inspection Service, Office of Policy and Program Development, Risk, Innovations, and Management Division, Patriots Plaza III, Suite 8-124A, Washington, D.C. 20250, USA
| | - L V Cook
- SafetyTaste Solutions LLC, Burke, Virginia 22015, USA
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20
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Škrtić M, Lytvyn Y, Yang GK, Yip P, Lai V, Silverman M, Cherney DZI. Glomerular haemodynamic profile of patients with Type 1 diabetes compared with healthy control subjects. Diabet Med 2015; 32:972-9. [PMID: 25662770 DOI: 10.1111/dme.12717] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2015] [Indexed: 11/28/2022]
Abstract
AIMS To evaluate the glomerular haemodynamic profile of patients with Type 1 diabetes with either renal hyperfiltration (GFR ≥ 135 ml/min/1.73 m2 ) or renal normofiltration (GFR 90-134 ml/min/1.73 m2 ) during euglycaemic and hyperglycaemic conditions, and to compare this profile with that of a similar group of healthy control subjects. METHODS Gomez's equations were used to derive afferent and efferent arteriolar resistances, glomerular hydrostatic pressure and filtration pressure. RESULTS At baseline, during clamped euglycaemia, patients with Type 1 diabetes and hyperfiltration had lower mean ± sd afferent arteriolar resistance than both those with Type 1 diabetes and normofiltration (914 ± 494 vs. 2065 ± 597 dyne/s/cm5 ; P < 0.001) and healthy control subjects (1676 ± 707 dyne/s/cm(5) ; p < 0.001). By contrast, efferent arteriolar resistance was similar in the three groups. Patients with Type 1 diabetes and hyperfiltration also had higher mean ± sd glomerular hydrostatic pressure than both healthy control subjects and patients with Type 1 diabetes and normofiltration (66 ± 6 vs. 60 ± 3 vs. 55 ± 3 mmHg; P < 0.05). Similar findings for afferent arteriolar resistance, efferent arteriolar resistance, glomerular hydrostatic pressure and filtration pressure were observed during clamped hyperglycaemia. CONCLUSION Hyperfiltration in Type 1 diabetes is primarily driven by alterations in afferent arteriolar resistance rather than efferent arteriolar resistance. Renal protective therapies should focus on afferent renal arteriolar mechanisms through the use of pharmacological agents that target tubuloglomerular feedback, including sodium-glucose cotransporter 2 inhibitors and incretins.
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Affiliation(s)
- M Škrtić
- Department of Medicine, Division of Nephrology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Y Lytvyn
- Department of Medicine, Division of Nephrology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - G K Yang
- Department of Medicine, Division of Nephrology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - P Yip
- University Health Network, Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - V Lai
- Department of Medicine, Division of Nephrology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - M Silverman
- Department of Medicine, Division of Nephrology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - D Z I Cherney
- Department of Medicine, Division of Nephrology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
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21
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Cherniak W, Latham E, Astle B, Anguyo G, Standish K, Myser C, Eichbaum Q, Silverman M, Evert J. Interprofessional host perspectives on global health competencies. Ann Glob Health 2015. [DOI: 10.1016/j.aogh.2015.02.557] [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: 11/29/2022] Open
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22
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Cherniak W, Pace R, Kong LY, Malhalme I, Silverman M, Anguyo G. Outreach, portable ultrasound, and radio – a novel method of improving antenatal turnout and maternal/child health in rural Uganda. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku163.073] [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: 11/14/2022] Open
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23
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Shih R, Silverman M, Mayer C. A 5-Year Study of Emergency Medicine Intern-Objective Structured Clinical Examination (OSCE) Performance Does Not Correlate With Emergency Medicine Faculty Evaluation of Resident Performance. Ann Emerg Med 2013. [DOI: 10.1016/j.annemergmed.2013.06.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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24
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Shih R, Mayer C, Silverman M, Walsh B. 8 Three-Year Study of Emergency Medicine Intern Performance on Objective Structured Clinical Examination (OSCE). Ann Emerg Med 2012. [DOI: 10.1016/j.annemergmed.2012.07.031] [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: 11/28/2022]
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25
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Wudhikarn K, Gingrich R, Leopold C, Silverman M. Venous Thromboembolism in Allogeneic Hematopoeitic Stem Cell Transplantation – the Incidence, Characteristics and Management – a Single Institution Experience. Biol Blood Marrow Transplant 2012. [DOI: 10.1016/j.bbmt.2011.12.222] [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: 12/01/2022]
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26
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Strippoli MPF, Spycher BD, Pescatore AM, Beardsmore CS, Silverman M, Kuehni CE. Viral wheezing is virus specific and not just host specific. Eur Respir J 2011. [DOI: 10.1183/09031936.00163411] [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: 11/05/2022]
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27
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Levinoff Roth S, Patel S, Kestenbaum S, Silverman J, Kopinska A, Scolnik D, Aronson L, Ortuoste B, Fernandes F, Low D, Silverman M. 054 Association of S. Pyogenes Dna from Throat Swabs of Asymptomatic Children and Very High Prevalence of Rheumatic Heart Disease in Rural South America. Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.07.051] [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: 10/16/2022] Open
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28
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Strippoli MPF, Spycher BD, Pescatore AM, Beardsmore CS, Silverman M, Kuehni CE. Exclusive viral wheeze and allergic wheeze: evidence for discrete phenotypes. Eur Respir J 2011; 38:472-4. [DOI: 10.1183/09031936.00004111] [Citation(s) in RCA: 5] [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: 11/05/2022]
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29
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Lyons D, Gormley N, Zulfiquar W, Silverman M, Philpot M. CPR in the nursing home: fool's errand or looming dilemma? Ir J Med Sci 2011; 180:673-8. [PMID: 21431395 DOI: 10.1007/s11845-011-0704-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Accepted: 03/07/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND The indications for CPR (cardiopulmonary resuscitation) have expanded greatly since the technique was introduced and theoretically it can be attempted on all prior to death. Policy initiatives (such as the British Medical Association/Royal College of Nursing guidelines) have attempted to provide a clinical rationale for the withholding of inappropriate CPR. Traditionally a care home was felt to be an inappropriate environment to attempt CPR but increased use of advance directives may bring the issue to the fore in this setting. AIMS We elicited the views of managers of care homes regarding resuscitation strategies in hypothetical situations and in actual practice. METHOD A purpose designed questionnaire in two parts was compiled, gathering factual information and employing a Likert scale to gauge opinion about this issue. The survey was conducted among 187 continuing care homes in South London the subjects being the care managers of the homes surveyed. RESULTS AND CONCLUSION Responses were obtained from 86 care homes. Care managers would resuscitate 66% of cases of witnessed cardiac arrest but few efforts were reported. Policies in assigning 'Do not resuscitate' orders were referred to by only 9% of homes but 80% of facilities would welcome them, yet 50% would exclude the patient from this discussion. Clear policy guidelines are required for continuing care homes, and advance statements about CPR as part of residents care plans could reduce inappropriate resuscitative efforts and hospital transfers.
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Affiliation(s)
- D Lyons
- St. Patrick's Hospital, James's Street, Dublin 8, Ireland.
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30
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Bartlett DH, Wright ME, Silverman M. Variable expression of extracellular polysaccharide in the marine bacterium Pseudomonas atlantica is controlled by genome rearrangement. Proc Natl Acad Sci U S A 2010; 85:3923-7. [PMID: 16593937 PMCID: PMC280332 DOI: 10.1073/pnas.85.11.3923] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Production of extracellular polysaccharide by the marine bacterium Pseudomonas atlantica is a variable trait. Strains that produce extracellular polysaccharide (EPS(+)) have a mucoid colony phenotype, but during cultivation in the laboratory nonmucoid, EPS(-) variants arise that have a crenated colony morphology. This change is reversible since crenated variants rapidly switch to the original mucoid phenotype. We have cloned the locus (eps) controlling variable expression of EPS production by screening a recombinant cosmid library for clones that restore EPS production in the crenated variant. By using eps as a probe of genomic structure in variant strains, expression of EPS production was found to be controlled by a specific DNA rearrangement. Insertion of a 1.2-kilobase-pair DNA sequence in the eps locus results in EPS(-), whereas excision of the sequence restores the EPS(+) phenotype. Properties of the rearrangement suggest the involvement of a mobile genetic element. The possible significance of this DNA rearrangement to the survival of P. atlantica in the ocean is discussed.
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Affiliation(s)
- D H Bartlett
- The Agouron Institute, 505 Coast Boulevard South, La Jolla, CA 92037
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Abstract
It has been suggested that there are several distinct phenotypes of childhood asthma or childhood wheezing. Here, we review the research relating to these phenotypes, with a focus on the methods used to define and validate them. Childhood wheezing disorders manifest themselves in a range of observable (phenotypic) features such as lung function, bronchial responsiveness, atopy and a highly variable time course (prognosis). The underlying causes are not sufficiently understood to define disease entities based on aetiology. Nevertheless, there is a need for a classification that would (i) facilitate research into aetiology and pathophysiology, (ii) allow targeted treatment and preventive measures and (iii) improve the prediction of long-term outcome. Classical attempts to define phenotypes have been one-dimensional, relying on few or single features such as triggers (exclusive viral wheeze vs. multiple trigger wheeze) or time course (early transient wheeze, persistent and late onset wheeze). These definitions are simple but essentially subjective. Recently, a multi-dimensional approach has been adopted. This approach is based on a wide range of features and relies on multivariate methods such as cluster or latent class analysis. Phenotypes identified in this manner are more complex but arguably more objective. Although phenotypes have an undisputed standing in current research on childhood asthma and wheezing, there is confusion about the meaning of the term 'phenotype' causing much circular debate. If phenotypes are meant to represent 'real' underlying disease entities rather than superficial features, there is a need for validation and harmonization of definitions. The multi-dimensional approach allows validation by replication across different populations and may contribute to a more reliable classification of childhood wheezing disorders and to improved precision of research relying on phenotype recognition, particularly in genetics. Ultimately, the underlying pathophysiology and aetiology will need to be understood to properly characterize the diseases causing recurrent wheeze in children.
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Affiliation(s)
- B D Spycher
- Swiss Paediatric Respiratory Research Group, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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Shih R, Silverman M. 393: Objective Structured Clinical Examination Performance Versus Faculty Evaluation of Resident Performance. Ann Emerg Med 2009. [DOI: 10.1016/j.annemergmed.2009.06.432] [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: 11/26/2022]
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Ghamande S, Silverman M, Gold M. A Phase 2, randomized, double-blind, placebo-controlled trial of clinical activity and safety of subcutaneous A6 in women with asymptomatic CA125 progression after first-line chemotherapy of epithelial ovarian cancer. Gynecol Oncol 2009. [DOI: 10.1016/j.ygyno.2009.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Brand PLP, Baraldi E, Bisgaard H, Boner AL, Castro-Rodriguez JA, Custovic A, de Blic J, de Jongste JC, Eber E, Everard ML, Frey U, Gappa M, Garcia-Marcos L, Grigg J, Lenney W, Le Souëf P, McKenzie S, Merkus PJFM, Midulla F, Paton JY, Piacentini G, Pohunek P, Rossi GA, Seddon P, Silverman M, Sly PD, Stick S, Valiulis A, van Aalderen WMC, Wildhaber JH, Wennergren G, Wilson N, Zivkovic Z, Bush A. Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach. Eur Respir J 2009; 32:1096-110. [PMID: 18827155 DOI: 10.1183/09031936.00002108] [Citation(s) in RCA: 493] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There is poor agreement on definitions of different phenotypes of preschool wheezing disorders. The present Task Force proposes to use the terms episodic (viral) wheeze to describe children who wheeze intermittently and are well between episodes, and multiple-trigger wheeze for children who wheeze both during and outside discrete episodes. Investigations are only needed when in doubt about the diagnosis. Based on the limited evidence available, inhaled short-acting beta(2)-agonists by metered-dose inhaler/spacer combination are recommended for symptomatic relief. Educating parents regarding causative factors and treatment is useful. Exposure to tobacco smoke should be avoided; allergen avoidance may be considered when sensitisation has been established. Maintenance treatment with inhaled corticosteroids is recommended for multiple-trigger wheeze; benefits are often small. Montelukast is recommended for the treatment of episodic (viral) wheeze and can be started when symptoms of a viral cold develop. Given the large overlap in phenotypes, and the fact that patients can move from one phenotype to another, inhaled corticosteroids and montelukast may be considered on a trial basis in almost any preschool child with recurrent wheeze, but should be discontinued if there is no clear clinical benefit. Large well-designed randomised controlled trials with clear descriptions of patients are needed to improve the present recommendations on the treatment of these common syndromes.
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Affiliation(s)
- P L P Brand
- Princess Amalia Children's Clinic, Isala klinieken, Zwolle, The Netherlands.
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Robertson S, Silverman M, Antonello C, Cotaras C, Murata L, Robertson C, Kelly O. Comparing the performance of a joint psychiatry/endocrinology clinic to a community endocrinology clinic for management of weight gain, impaired glucose tolerance and type 2 diabetes in patients with schizophrenia. Can J Diabetes 2009. [DOI: 10.1016/s1499-2671(09)33326-2] [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: 10/27/2022]
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Kuehni CE, Strippoli MPF, Low N, Brooke AM, Silverman M. Wheeze and asthma prevalence and related health-service use in white and south Asian pre-schoolchildren in the United Kingdom. Clin Exp Allergy 2008; 37:1738-46. [PMID: 18028098 DOI: 10.1111/j.1365-2222.2007.02784.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Epidemiological data for south Asian children in the United Kingdom are contradictory, showing a lower prevalence of wheeze, but a higher rate of medical consultations and admissions for asthma compared with white children. These studies have not distinguished different asthma phenotypes or controlled for varying environmental exposures. OBJECTIVE To compare the prevalence of wheeze and related health-service use in south Asian and white pre-schoolchildren in the United Kingdom, taking into account wheeze phenotype (viral and multiple wheeze) and environmental exposures. METHODS A postal questionnaire was completed by parents of a population-based sample of 4366 white and 1714 south Asian children aged 1-4 years in Leicestershire, UK. Children were classified as having viral wheeze or multiple trigger wheeze. RESULTS The prevalence of current wheeze was 35.6% in white and 25.5% in south Asian 1-year-olds (P<0.001), and 21.9% and 20.9%, respectively, in children aged 2-4 years. Odds ratios (ORs) (95% confidence interval) for multiple wheeze and for viral wheeze, comparing south Asian with white children, were 2.21 (1.19-4.09) and 1.43 (0.77-2.65) in 2-4-year-olds after controlling for socio-economic conditions, environmental exposures and family history. In 1-year-olds, the respective ORs for multiple and viral wheeze were 0.66 (0.47-0.92) and 0.81 (0.64-1.03). Reported GP consultation rates for wheeze and hospital admissions were greater in south Asian children aged 2-4 years, even after adjustment for severity, but the use of inhaled corticosteroids was lower. CONCLUSIONS South Asian 2-4-year-olds are more likely than white children to have multiple wheeze (a condition with many features of chronic atopic asthma), after taking into account ethnic differences in exposure to some environmental agents. Undertreatment with inhaled corticosteroids might partly explain their greater use of health services.
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Affiliation(s)
- C E Kuehni
- Institute of Social and Preventive Medicine, Swiss Paediatric Respiratory Research Group, University of Bern, Bern, Switzerland.
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Edelstein M, Pitchforth E, Asres G, Silverman M, Kulkarni N. Awareness of health effects of cooking smoke among women in the Gondar Region of Ethiopia: a pilot survey. BMC Int Health Hum Rights 2008; 8:10. [PMID: 18644103 PMCID: PMC2491593 DOI: 10.1186/1472-698x-8-10] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/10/2007] [Accepted: 07/18/2008] [Indexed: 11/10/2022]
Abstract
BACKGROUND The burning of biomass fuels results in exposure to high levels of indoor air pollution, with consequent health effects. Possible interventions to reduce the exposure include changing cooking practices and introduction of smoke-free stoves supported by health education. Social, cultural and financial constraints are major challenges to implementation and success of interventions. The objective of this study is to determine awareness of women in Gondar, Ethiopia to the harmful health effects of cooking smoke and to assess their willingness to change cooking practices. METHODS We used a single, administered questionnaire which included questions on household circumstances, general health, awareness of health impact of cooking smoke and willingness to change. We interviewed 15 women from each of rural, urban-traditional and middle class backgrounds. RESULTS Eighty percent of rural women cooked indoors using biomass fuel with no ventilation. Rural women reported two to three times more respiratory disease in their children and in themselves compared to the other two groups. Although aware of the negative effect of smoke on their own health, only 20% of participants realised it caused problems in children, and 13% thought it was a cause for concern. Once aware of adverse effects, women were willing to change cooking practices but were unable to afford cleaner fuels or improved stoves. CONCLUSION Increasing the awareness of the health-effects of indoor biomass cooking smoke may be the first step in implementing a programme to reduce exposure.
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Affiliation(s)
- M Edelstein
- Hemel Hemspead General Hospital, Hillfield Road, Hemel Hemspead, UK.
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Gingrich R, Thomas A, Smith BJ, Silverman M. Autologous stem cell transplantation (ASCT) for locally advanced breast cancer (LABC) and inflammatory breast cancer (IBC): University of Iowa (UI) experience 1992–2007. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.11511] [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: 11/20/2022] Open
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Spycher BD, Silverman M, Brooke AM, Minder CE, Kuehni CE. Distinguishing phenotypes of childhood wheeze and cough using latent class analysis. Eur Respir J 2008; 31:974-81. [PMID: 18216047 DOI: 10.1183/09031936.00153507] [Citation(s) in RCA: 139] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Airway disease in childhood comprises a heterogeneous group of disorders. Attempts to distinguish different phenotypes have generally considered few disease dimensions. The present study examines phenotypes of childhood wheeze and chronic cough, by fitting a statistical model to data representing multiple disease dimensions. From a population-based, longitudinal cohort study of 1,650 preschool children, 319 with parent-reported wheeze or chronic cough were included. Phenotypes were identified by latent class analysis using data on symptoms, skin-prick tests, lung function and airway responsiveness from two preschool surveys. These phenotypes were then compared with respect to outcome at school age. The model distinguished three phenotypes of wheeze and two phenotypes of chronic cough. Subsequent wheeze, chronic cough and inhaler use at school age differed clearly between the five phenotypes. The wheeze phenotypes shared features with previously described entities and partly reconciled discrepancies between existing sets of phenotype labels. This novel, multidimensional approach has the potential to identify clinically relevant phenotypes, not only in paediatric disorders but also in adult obstructive airway diseases, where phenotype definition is an equally important issue.
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Affiliation(s)
- B D Spycher
- Swiss Paediatric Respiratory Research Group, Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, CH-3012, Bern, Switzerland
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Pillai SG, Tang Y, van den Oord E, Klotsman M, Barnes K, Carlsen K, Gerritsen J, Lenney W, Silverman M, Sly P, Sundy J, Tsanakas J, von Berg A, Whyte M, Ortega HG, Anderson WH, Helms PJ. Factor analysis in the Genetics of Asthma International Network family study identifies five major quantitative asthma phenotypes. Clin Exp Allergy 2008; 38:421-9. [PMID: 18177490 DOI: 10.1111/j.1365-2222.2007.02918.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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Asthma is a clinically heterogeneous disease caused by a complex interaction between genetic susceptibility and diverse environmental factors. In common with other complex diseases the lack of a standardized scheme to evaluate the phenotypic variability poses challenges in identifying the contribution of genes and environments to disease expression. OBJECTIVE To determine the minimum number of sets of features required to characterize subjects with asthma which will be useful in identifying important genetic and environmental contributors. Methods Probands aged 7-35 years with physician diagnosed asthma and symptomatic siblings were identified in 1022 nuclear families from 11 centres in six countries forming the Genetics of Asthma International Network. Factor analysis was used to identify distinct phenotypes from questionnaire, clinical, and laboratory data, including baseline pulmonary function, allergen skin prick test (SPT). RESULTS Five distinct factors were identified:(1) baseline pulmonary function measures [forced expiratory volume in 1 s (FEV(1)) and forced vital capacity (FVC)], (2) specific allergen sensitization by SPT, (3) self-reported allergies, (4) symptoms characteristic of rhinitis and (5) symptoms characteristic of asthma. Replication in symptomatic siblings was consistent with shared genetic and/or environmental effects, and was robust across age groups, gender, and centres. Cronbach's alpha ranged from 0.719 to 0.983 suggesting acceptable internal scale consistencies. Derived scales were correlated with serum IgE, methacholine PC(20), age and asthma severity (interrupted sleep). IgE correlated with all three atopy-related factors, the strongest with the SPT factor whereas severity only correlated with baseline lung function, and with symptoms characteristic of rhinitis and of asthma. CONCLUSION In children and adolescents with established asthma, five distinct sets of correlated patient characteristics appear to represent important aspects of the disease. Factor scores as quantitative traits may be better phenotypes in epidemiological and genetic analyses than those categories derived from the presence or absence of combinations of +ve SPTs and/or elevated IgE.
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Affiliation(s)
- S G Pillai
- Medical Genetics, GlaxoSmithKline, Research Triangle Park, NC, USA
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Abstract
BACKGROUND Studies of immigrants suggest that the environment during fetal life and duration of residence in the host country might influence the development of asthma. Little is known about the importance of the timing of the exposure in the host country and whether migrants might be especially vulnerable in certain age windows. OBJECTIVE We compared the reported prevalence of asthma between young white and south Asian women in the United Kingdom, and investigated associations with country of birth and age at immigration. METHODS A questionnaire on atopic disorders was posted to 2380 south Asian and 5796 white young mothers randomly sampled in Leicestershire. Data on ethnicity were also available from maternity records. Data were analysed using multivariable logistic regression and a propensity score approach. Results The reported prevalence of asthma was 10.9% in south Asian and 21.8% in white women. South Asian women who migrated to the United Kingdom aged 5 years or older reported less asthma (6.5%) than those born in the United Kingdom or who migrated before age 5 (16.0%), with an adjusted odds ratio of 0.38 [95% Confidence Interval 0.23-0.64, P<0.001]. For those who migrated aged over 5 years, the prevalence did not alter with the duration of residence in the United Kingdom. Current exposure to common environmental risk factors had relatively little effect on prevalence estimates. CONCLUSION These data from a large population-based study support the hypothesis that early life environmental factors influence the risk of adult asthma.
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Affiliation(s)
- C E Kuehni
- Swiss Paediatric Respiratory Research Group, Department of Social and Preventive Medicine, University of Berne, Berne, Switzerland.
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Ghamande S, Silverman M, Gold M, Huh W, Behbakht K, Ball G, Cuasay L, Brunner N. A phase II randomized, double-blind, placebo-controlled trial of clinical activity and safety of Å6 in patients with asymptomatic CA 125 progression of epithelial ovarian, fallopian tube, or primary peritoneal cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.16014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
16014 Background: Patients (pts) with epithelial ovarian cancer (EOC) often relapse and rising CA 125 levels predate clinical or radiological appearance of tumor. High tumor and serum levels of urokinase plasminogen activator (uPA) in EOC correlate to adverse outcomes. Å6 is a novel peptide derived from human uPA that down-regulates the uPA system and has anti-angiogenic and anti-metastatic activity in animals. Methods: Pts with EOC, fallopian tube, or primary peritoneal cancer in clinical remission after first line chemotherapy had to have 2 consecutive rises of CA 125 levels above normal with no disease on physical examination or imaging studies. Pts were randomized to receive daily subcutaneous injections of placebo, 150 mg Å6, or 300 mg Å6 until disease progression. The primary objectives were to assess safety and clinical activity of Å6 by the effect on the onset of disease progression. Results: 48 pts were planned for the study. The trial ended early with 24 patients {12 pts (50%) placebo, 8 pts (33%) low dose Å6, 4 pts (17%) high dose Å6} randomized, treated and followed for up to 9 months. Despite early study termination and small sample size, A6 therapy was associated with a statistically significant progression free survival (PFS) (log rank p value=0.01) with a median PFS of 100 days (95% CI 64,168) compared to 49 days (95% CI 29,67) in pts who received the placebo. The treatments were well tolerated with one serious adverse event (transient nausea and dyspnea ) possibly related to study drug. Treatment was not associated with CA 125 response (Fisher exact test p value= 0.44). Conclusions: Å6 therapy increases PFS of patients with EOC and asymptomatic progression of CA 125. This therapy is novel, safe, feasible and deserves further investigation [Table: see text]
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Affiliation(s)
- S. Ghamande
- Medical College of Georgia (MCG), Augusta, GA; Angstrom Pharmaceuticals, Solana Beach, CA; University of Oklahoma Health Sciences Center, Oklahoma city, OK; University of Alabama, Birmingham, AL; University of Colorado at Denver, Denver, CO; Westat, Houston, TX; University of Copenhagen, Copenhagen, Denmark
| | - M. Silverman
- Medical College of Georgia (MCG), Augusta, GA; Angstrom Pharmaceuticals, Solana Beach, CA; University of Oklahoma Health Sciences Center, Oklahoma city, OK; University of Alabama, Birmingham, AL; University of Colorado at Denver, Denver, CO; Westat, Houston, TX; University of Copenhagen, Copenhagen, Denmark
| | - M. Gold
- Medical College of Georgia (MCG), Augusta, GA; Angstrom Pharmaceuticals, Solana Beach, CA; University of Oklahoma Health Sciences Center, Oklahoma city, OK; University of Alabama, Birmingham, AL; University of Colorado at Denver, Denver, CO; Westat, Houston, TX; University of Copenhagen, Copenhagen, Denmark
| | - W. Huh
- Medical College of Georgia (MCG), Augusta, GA; Angstrom Pharmaceuticals, Solana Beach, CA; University of Oklahoma Health Sciences Center, Oklahoma city, OK; University of Alabama, Birmingham, AL; University of Colorado at Denver, Denver, CO; Westat, Houston, TX; University of Copenhagen, Copenhagen, Denmark
| | - K. Behbakht
- Medical College of Georgia (MCG), Augusta, GA; Angstrom Pharmaceuticals, Solana Beach, CA; University of Oklahoma Health Sciences Center, Oklahoma city, OK; University of Alabama, Birmingham, AL; University of Colorado at Denver, Denver, CO; Westat, Houston, TX; University of Copenhagen, Copenhagen, Denmark
| | - G. Ball
- Medical College of Georgia (MCG), Augusta, GA; Angstrom Pharmaceuticals, Solana Beach, CA; University of Oklahoma Health Sciences Center, Oklahoma city, OK; University of Alabama, Birmingham, AL; University of Colorado at Denver, Denver, CO; Westat, Houston, TX; University of Copenhagen, Copenhagen, Denmark
| | - L. Cuasay
- Medical College of Georgia (MCG), Augusta, GA; Angstrom Pharmaceuticals, Solana Beach, CA; University of Oklahoma Health Sciences Center, Oklahoma city, OK; University of Alabama, Birmingham, AL; University of Colorado at Denver, Denver, CO; Westat, Houston, TX; University of Copenhagen, Copenhagen, Denmark
| | - N. Brunner
- Medical College of Georgia (MCG), Augusta, GA; Angstrom Pharmaceuticals, Solana Beach, CA; University of Oklahoma Health Sciences Center, Oklahoma city, OK; University of Alabama, Birmingham, AL; University of Colorado at Denver, Denver, CO; Westat, Houston, TX; University of Copenhagen, Copenhagen, Denmark
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Zhu G, Vestbo J, Lenney W, Silverman M, Whyte M, Helms P, Anderson WH, Pillai SG. Association of PTGDR gene polymorphisms with asthma in two Caucasian populations. Genes Immun 2007; 8:398-403. [PMID: 17538632 DOI: 10.1038/sj.gene.6364399] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The prostanoid DP receptor (PTGDR) is shown to be involved in the asthma patho-physiology and the results from the published genetic association studies are inconsistent. Four single nucleotide polymorphisms (SNPs) in PTGDR were genotyped in 342 and 294 families from UK and Denmark respectively. Asthma and asthma-related phenotypes were analyzed using family-based association analyses. In the UK families, a promoter polymorphism (-731A/G) showed significant associations with asthma (P=0.0022), atopic asthma (P=0.0044), bronchial hyperreactivity or BHR (P=0.00120) and strict asthma (P=0.0008). The P-values for asthma, BHR and strict asthma were significant even after the most stringent correction for the number of markers and the number of phenotypes analyzed (<0.0031). An intronic polymorphism (+6651C/T) also showed significant associations with asthma (P=0.0302), atopic asthma (P=0.0131), BHR (P=0.0249) and strict asthma (P=0.0261). In the Danish families, an intronic polymorphism (+6541C/T) showed significant associations with asthma (P=0.0071), atopic asthma (P=0.0348), BHR (P=0.0033) and strict asthma (P=0.0381). The results of haplotype analyses supported the ones of the single SNP analyses. Thus, we demonstrated significant evidence of association between polymorphisms in PTGDR with asthma phenotypes in the two Caucasian populations.
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Affiliation(s)
- G Zhu
- Medical Genetics, Glaxo SmithKline, Research Triangle Park, NC 27709, USA
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Kuehni CE, Michel G, Strippoli MPF, Zwahlen M, Brooke AM, Grigg J, Silverman M. From the authors. Eur Respir J 2007. [DOI: 10.1183/09031936.00009507] [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: 11/05/2022]
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Fiesseler F, Shih R, Silverman M, Eskin B, Clement M, Szucs P, Allegra J. Prednisone for Migraine Headaches: An Emergency Department Randomized Double-Blind Placebo-Controlled Trial. Acad Emerg Med 2007. [DOI: 10.1197/j.aem.2007.03.896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Tüscher O, Root J, Pan H, Epstein J, Altemus M, Cloitre M, Silverman M, Furman D, LeDoux J, McEwen B, Stern E, Silbersweig D. Association between frontolimbic function and cortisol levels in response to traumatic stimuli in normal subjects. Akt Neurol 2007. [DOI: 10.1055/s-2007-987685] [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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Reynolds DL, Gillis F, Kitai I, Deamond SL, Silverman M, King SM, Matlow AG, Crockett M. Transmission of Mycobacterium tuberculosis from an infant. Int J Tuberc Lung Dis 2006; 10:1051-6. [PMID: 16964800] [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: 05/11/2023] Open
Abstract
SETTING This report investigates the unusual transmission of Mycobacterium tuberculosis from a 12-week-old infant with nosocomially acquired tuberculosis (TB). Compliance with recommendations on the post-exposure management of young children is described. DESIGN Contacts of an infant case of TB were identified and recommended to undergo baseline and post-exposure tuberculin skin tests (TST) as per Canadian TB standards. TST conversion was measured at least 8 weeks post exposure. Children aged <6 years were recommended to initiate preventive treatment with isoniazid (INH) until their post-exposure TST. Information on TST results and adherence to therapy were analysed from existing medical records. RESULTS Overall, 17 TST conversions were documented among 732 contacts: both parents, two health care workers (HCWs) who provided close care, and several patients, visitors and one staff member without obvious close contact. Of 65 eligible children, 46% completed post-exposure therapy as recommended. The most common reasons for treatment failure were concern about side effects, perception of low risk and lack of physician support. CONCLUSION This investigation suggests that all children, including infants, with cough and numerous bacilli or extensive pulmonary disease should be considered infectious. Health care provider education is necessary to resolve the observed low compliance with current post-exposure management guidelines.
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Affiliation(s)
- D L Reynolds
- Durham Region Health Department, Whitby, Ontario, Canada.
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Abstract
The current study aimed to assess prevalence and distribution of use of asthma medication for wheeze in pre-school children in the community. We sent a postal questionnaire to the parents of a random population-based sample of 4,277 UK children aged 1-5 years; 3,410 participated (children of south Asian decent were deliberately over-represented). During the previous 12 months, 18% of the children were reported to have received bronchodilators, 8% inhaled corticosteroids (ICS) and 3% oral corticosteroids. Among current wheezers these proportions were 55%, 25%, and 12%, respectively. Use of ICS increased with reported severity of wheeze, but did not reach 60% even in the most severe category. In contrast, 42% of children receiving ICS reported no or very infrequent recent wheeze. Among children with the episodic viral wheeze phenotype, 17% received ICS compared with 40% among multiple-trigger wheezers. Use of ICS by current wheezers was less common in children of South Asian ethnicity and in girls. Although a high proportion of pre-school children in the community used asthma inhalers, treatment seemed to be insufficiently adjusted to severity or phenotype of wheeze, with relative under-treatment of severe wheeze with ICS, especially in girls and South Asian children, but apparent over-treatment of mild and episodic viral wheeze and chronic cough.
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Affiliation(s)
- E S Chauliac
- Department of Social and Preventive Medicine, Swiss Paediatric Respiratory Research Group, University of Bern, Bern, Switzerland
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