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Richmond M, DeVore EK, Song PC. Esophageal Dysphagia in Adults: When It Sticks. Otolaryngol Clin North Am 2024:S0030-6665(24)00041-0. [PMID: 38604886 DOI: 10.1016/j.otc.2024.02.027] [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: 04/13/2024]
Abstract
Esophageal dysphagia is a common yet difficult to diagnose condition. This article underscores the role of detailed patient history and physical examinations, including prompt endoscopic evaluation, for accurate differentiation between esophageal and oropharyngeal dysphagia. The authors discuss the heightened importance of early intervention in certain patient groups, such as elderly individuals and patients with head and neck cancer, to mitigate the risk of malnutrition and infection. The authors delve into etiologic factors highlighting the complexity of clinical presentations and the significance of tailored management strategies.
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Affiliation(s)
- Miller Richmond
- Georgetown School of Medicine, 3900 Reservoir Road, NW, Washington, DC 20057, USA
| | - Elliana Kirsh DeVore
- Department of Otolaryngology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Division of Laryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA
| | - Phillip C Song
- Department of Otolaryngology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Division of Laryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA.
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Geller A, Baciu A, Aidoo R, Alemayehu S, Andrada CI, Chen E, Dao A, Flattum-Riemers T, Forbes C, Gabriel A, Garcia JL, Gardiner C, Gonyea O, Graydon E, Henry-Smith C, Hughes K, Jammes C, Jones JH, Jeong EK(G, Lammers J, Lu Y, Mason E, McIntyre M, Mencke J, Mielke S, Moye C, O’Brien E, Okoroajuzie A, Po M, Richmond M, Sadel J, Scott R, Sharma A, Southwick F, Theard P, Wanek A, Wasson K, Yo S, Yo S. Eighth Annual DC Public Health Case Challenge: Addressing Infectious Diseases Using a Population Health Approach: Prevention and Control of Bacterial Sexually Transmitted Infections in Young Adults 18-24. NAM Perspect 2022; 2022:202208a. [PMID: 36713774 PMCID: PMC9875853 DOI: 10.31478/202208a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Amy Geller
- National Academies of Sciences, Engineering, and Medicine
| | - Alina Baciu
- National Academies of Sciences, Engineering, and Medicine
| | | | | | | | | | - Amanda Dao
- Uniformed Services University of the Health Sciences
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- Uniformed Services University of the Health Sciences
| | | | | | | | | | | | | | | | - Remle Scott
- Uniformed Services University of the Health Sciences
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Bansal N, Jeewa A, Richmond M, Watanabe K, Lorts A, Rosenthal D, Taylor K, O'Shea C, Smyth L, Koehl D, Zhao H, Hollander S. Reducing Donor Acceptance Practice Variation- Learnings from a Discussion Forum. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1288] [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: 11/27/2022] Open
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Lynch A, Ahuja S, Miron A, Nakano S, Howard T, Villa C, Armstrong K, Kaufman B, Gardin L, Whitehill R, Parent J, Godown J, Henderson H, Aziz P, Colan S, Seshadri B, Kantor P, Russell M, Lal A, Butts R, Richmond M, Conway J, Weintraub R, Rossano J, Mital S. Sudden Cardiac Death and ICD Use in Rasopathy-Associated Hypertrophic Cardiomyopathy. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1821] [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: 11/30/2022] Open
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Dooley AA, Jackson JH, Gatti ML, Fanous H, Martinez C, Prue DC, Phull G, Richmond M, Weinstein NA, Chorvinsky E, Shukla PJ, Pillai DK. Pediatric sleep questionnaire predicts more severe sleep apnea in children with uncontrolled asthma. J Asthma 2020; 58:1589-1596. [PMID: 32878527 DOI: 10.1080/02770903.2020.1818775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE While up to 35% of children with asthma have evidence of sleep disordered breathing (SDB), it is unclear if nocturnal symptoms stem from asthma itself or SDB. The Pediatric Sleep Questionnaire (PSQ) is a validated tool for identifying SDB in childhood asthma. We hypothesize children with asthma and abnormal PSQ demonstrate decreased asthma control and are at higher risk of obstructive sleep apnea (OSA). METHODS We performed a retrospective, chart review of children and young adults referred to our tertiary children's hospital severe asthma clinic. Data collection included age, gender, BMI percentile, spirometry, PSQ, asthma control questionnaires, asthma severity, control, and impairment. These data were evaluated in the context of polysomnography, when available. RESULTS 205 inner-city children were included; 37.2% female, median age 6.4 y, and mean BMI of 71.3%ile. Rhinitis (p = 0.028), eczema (p = 0.002), and reflux (p = 0.046) were associated with abnormal PSQ; however, overweight/obese status, spirometry, asthma severity, and serologic markers were not. After correcting for comorbidities, abnormal PSQ score was associated with poor asthma control based on validated measures (p < 0.001). In patients with polysomnography, we confirmed abnormal PSQ was associated with increased OSA severity (apnea-hypopnea index 9.1/hr vs. 3.6/hr; p = 0.027). CONCLUSIONS In pediatric asthma, positive PSQ was associated with significantly decreased asthma control. Additionally, children with normal PSQ demonstrated mild OSA, while children with abnormal PSQ had increased severity of OSA. This demonstrates that PSQ can be used to screen children for more severe sleep apnea.
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Affiliation(s)
- Amy A Dooley
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, Washington, DC, USA
| | - J Hunter Jackson
- University of South Carolina School of Medicine Greenville, Greenville, SC, USA
| | - Meagan L Gatti
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, Washington, DC, USA
| | - Hani Fanous
- Division of Pediatric Pulmonology, University of Miami, Miami, FL, USA
| | - Claudia Martinez
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, Washington, DC, USA
| | - Dominique C Prue
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, Washington, DC, USA
| | - Gurpreet Phull
- Division of Pulmonary and Sleep Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Miller Richmond
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, Washington, DC, USA
| | - Noa A Weinstein
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, Washington, DC, USA
| | - Elizabeth Chorvinsky
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, Washington, DC, USA
| | - Prateek J Shukla
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, Washington, DC, USA
| | - Dinesh K Pillai
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, Washington, DC, USA.,Department of Genomics and Precision Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Parikh K, Richmond M, Lee M, Fu L, McCarter R, Hinds P, Teach SJ. Outcomes from a pilot patient-centered hospital-to-home transition program for children hospitalized with asthma. J Asthma 2020; 58:1384-1394. [PMID: 32664809 DOI: 10.1080/02770903.2020.1795877] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate a multi-component hospital-to-home (H2H) transition program for children hospitalized with an asthma exacerbation. METHODS A pilot prospective randomized clinical trial of guideline-based asthma care with and without a patient-centered multi-component H2H program among children enrolled in K-8th grade on Medicaid hospitalized for an asthma exacerbation. H2H program includes 5 components: medications in-hand at discharge, school-based asthma therapy (SBAT) for controller medications, referral for home trigger assessments, communication with the primary care provider (PCP), and patient navigator support. Primary outcomes included feasibility and acceptability. Secondary outcomes included healthcare utilization, asthma morbidity, and caregiver quality of life. RESULTS A total of 32 children were enrolled and randomized. Feasibility outcomes in the intervention group included: medications in-hand at discharge (100%); SBAT for controller medication initiated (100%); home visit referrals made (100%) and home visits completed within 4 weeks of discharge (44%); PCP communication (100%); patient navigator communication at 3 days (81.3%) and 14 days (46.7%). Acceptability outcomes in the intervention group included: 87.5% of families continued SBAT, and 87.5% of families reported it was extremely helpful to have the home visit referral. Adjusting for baseline differences in age, asthma severity and control, there was no significant difference in healthcare utilization outcomes. CONCLUSION These pilot data suggest that comprehensive care coordination initiated during the inpatient stay is feasible and acceptable. A larger trial is justified to determine if the intervention may reduce healthcare utilization for urban, minority children with asthma.
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Affiliation(s)
- Kavita Parikh
- Division of Hospital Medicine, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Miller Richmond
- Center for Translational Research, Children's National Research Institute, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Michael Lee
- Center for Translational Research, Children's National Research Institute, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Linda Fu
- Division of General and Community Pediatrics, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Robert McCarter
- Center for Translational Research, Department of Biostatistics and Research Methodology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Pamela Hinds
- Department of Nursing Science, Professional Practice & Quality, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Stephen J Teach
- Center for Translational Research, Children's National Research Institute, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Richmond M, Lee Son N, McIlwaine M, Chilvers M. P355 Inhaled medication challenges in cystic fibrosis: can we constrict our practice? J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30647-2] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Mahle W, Mason K, Dipchand A, Richmond M, Canter C, Hsu D, Singh T, Shaddy R, Armstrong B, Zeevi A, Ikle D, Diop H, Odim J, Webber S. Hospital Readmission Following Pediatric Heart Transplantation. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.040] [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] Open
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9
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Stanford N, McAllister J, Addonizio L, Richmond M, Law S, Lee T, Farr M, Gibbons M, Jensen K, Lee H, Rothkopf A, Jackson R, Zuckerman W. Lifetime Achievement and Quality of Life in Adult Survivors of Pediatric Heart Transplant. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.432] [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: 11/29/2022] Open
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McIlwaine M, Lee Son N, Richmond M, Chilvers M. WS16.4 Objective measurement of adherence to airway clearance in cystic fibrosis. J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30252-7] [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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Butts R, Boyle G, Deshpande S, Gambetta K, Knecht K, Prada Ruiz C, Richmond M, West S, Lal A. Pediatric Myocarditis in a Contemporary Multi-Center Cohort. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.1186] [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: 10/22/2022] Open
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12
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McIlwaine M, Lee Son N, Richmond M, Chilvers M. WS21.1 Evaluation of the use of IPV for the treatment of atelectasis in cystic fibrosis. J Cyst Fibros 2015. [DOI: 10.1016/s1569-1993(15)30121-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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McIlwaine M, Richmond M, Agnew J, Alarie N, Lands L, Chilvers M, Ratjen F. WS5.6 Cost-effectiveness of performing positive expiratory pressure versus high frequency chest wall oscillation. J Cyst Fibros 2014. [DOI: 10.1016/s1569-1993(14)60036-9] [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: 10/25/2022]
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McIlwaine M, Chilvers M, Lee Son N, Richmond M. WS14.4 Analysis of expiratory flow rates used in autogenic drainage. Are they sufficiently high to mobilize secretions? J Cyst Fibros 2014. [DOI: 10.1016/s1569-1993(14)60091-6] [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: 10/25/2022]
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16
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Ramey J, Starc T, Zuckerman W, Singh R, Addonizio L, Richmond M. Incidence and Importance of New Postoperative Right Bundle Branch Block after Pediatric Orthotopic Heart Transplantation. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.473] [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: 11/29/2022] Open
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17
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Kaplan B, Cohen M, Kranker L, Richmond M, Fagan J, Lowenstein S, Broderick K. 91 EMF Brief Screen for Patient Prescription Drug Misuse in an Emergency Department and Urgent Care Center. Ann Emerg Med 2012. [DOI: 10.1016/j.annemergmed.2012.06.370] [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: 10/27/2022]
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Abstract
PURPOSE To evaluate the intrinsic characteristics of a new high resolution, large area, small bezel, digital imager developed for a dedicated SPECT-CT system for fully-3D mammotomographic imaging applications. METHODS A new flat panel digital imager was developed having 127μm pixels (identical to those in the Paxscan 2520) with an active 40×30cm area and 3200×2304 total pixels, which is well suited for pendant breast imaging close to the chest wall. The readout and driver ASIC TAB bonding pads were arranged on only two sides of the imager plate, to eliminate dead edge spacing. A special housing was developed to accommodate this imaging plate providing very narrow 8mm edges (bezels) on two orthogonal sides The TFT array imager was coated with 600μm thick micro-columnar CsI, which provides >90% absorption in the breast CT (60-80kVp) x-ray energy range. It provides better than 70% absorption for RQA5 (70kVp 21mm Al filter) x- ray radiation. The readout ASICs are connected to 14 bit A/D converters, and special readout ASICs with gain switching feature, which provide an additional 4bit virtual (2-3 effective) dynamic range. RESULTS The MTF is ∼7.5% at the 3.9 lp/mm Nyquist frequency. The NPS curves continuously decrease with increasing spatial frequencies, characteristic of scintillator based imagers. The excellent DQE (0) measured at RQA5 is ∼75% in the 0.1-1mR dose range and ∼10% at the Nyquist frequency. The imager has excellent linearity over the full dynamic range, and high contrast images are readily acquired. CONCLUSIONS The new 4030 flat panel imager is a high resolution, state of the art detector, ideal for breast imaging and other applications. This detector is included in the SPECT-CT device in development.
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Affiliation(s)
- G Zentai
- Varian Medical Systems, Mountain View, CA.,Varian Medical Systems, Mountain View, CA.,Varian Medical Systems, Mountain View, CA.,Duke University, Durham, NC.,Duke University, Durham, NC
| | - M Richmond
- Varian Medical Systems, Mountain View, CA.,Varian Medical Systems, Mountain View, CA.,Varian Medical Systems, Mountain View, CA.,Duke University, Durham, NC.,Duke University, Durham, NC
| | - L Partain
- Varian Medical Systems, Mountain View, CA.,Varian Medical Systems, Mountain View, CA.,Varian Medical Systems, Mountain View, CA.,Duke University, Durham, NC.,Duke University, Durham, NC
| | - J Shah
- Varian Medical Systems, Mountain View, CA.,Varian Medical Systems, Mountain View, CA.,Varian Medical Systems, Mountain View, CA.,Duke University, Durham, NC.,Duke University, Durham, NC
| | - M Tornai
- Varian Medical Systems, Mountain View, CA.,Varian Medical Systems, Mountain View, CA.,Varian Medical Systems, Mountain View, CA.,Duke University, Durham, NC.,Duke University, Durham, NC
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Broderick K, Diedrich R, Richmond M. 18: Impact of an Urban Screening, Brief Intervention, and Referral to Treatment Program. Ann Emerg Med 2010. [DOI: 10.1016/j.annemergmed.2010.06.044] [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: 10/19/2022]
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Singh R, Richmond M, Giblin T, Rodriguez R, Chen J, Addonizio L. 252: The Successful Use of Oral Sildenafil in Right Ventricular Dysfunction and High Pulmonary Vascular Resistance after Pediatric Heart Transplantation. J Heart Lung Transplant 2010. [DOI: 10.1016/j.healun.2009.11.264] [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: 11/15/2022] Open
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Ringelberg D, Richmond M, Foley K, Reynolds C. Utility of lipid biomarkers in support of bioremediation efforts at army sites. J Microbiol Methods 2008; 74:17-25. [PMID: 17714813 DOI: 10.1016/j.mimet.2007.07.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [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: 06/25/2007] [Revised: 07/16/2007] [Accepted: 07/16/2007] [Indexed: 11/22/2022]
Abstract
Lipid biomarker analysis has proven valuable in testing the hypothesis that attributes of the extant microbiota can directly reflect the occurrence of contaminant biodegradation. Two past research efforts have demonstrated this utility and are described here. A 4.5 m vertical core was obtained from a diesel fuel oil contamination plume. Core material was assayed for total petroleum hydrocarbons (TPH) and bacterial membrane phospholipids (PLFA) via a single solvent extraction. Microbial viable biomass and the relative abundance of Gram-negative bacterial PLFA biomarkers were found to be significantly correlated with TPH concentration. The core TPH profile also revealed two distinct areas where the average TPH level of 3,000 microg g(-1) fell to near detection limits. Both areas were characterized by a three-fold decrease in the hexadecane/pristane ratio, indicating alkane biodegradation, and a distinct PLFA profile that showed a close similarity to the uncontaminated surface soil. Low-order, incomplete detonations can deposit hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX) into training range surface soils. Since surface soils are exposed to temporal and diurnal moisture cycles, we investigated the effect two very different soil moisture tensions had on the in situ microbiota and RDX biodegradation. Saturated soils were characterized by rapid RDX biodegradation, 4 day half-life, a decrease in number of species detected and increase in PLFA biomarkers for Gram-negative proteobacteria (n16:1omega7c, n18:1omega9c, and n18:1omega7c) and Gram-positive firmicutes (i15:0 and a15:0). Terminal restriction fragment length polymorphism (T-RFLP) profiles of endpoint microbial communities indicated a shift from 18 to 36% firmicutes, the loss of gamma-proteobacteria and the emergence of alpha-proteobacteria. These two past research efforts demonstrated the utility of the lipid biomarker analysis in identifying microbial community characteristics that were associated with two very different soil contaminants. Lipid biomarkers defined areas of TPH biodegradation and identified community shifts as a result of soil conditions that affected explosives fate. Information like this can be used to enhance the predictive power of ecological models such as the Army Training and Testing Area Carrying Capacity for munitions model [ATTACC].
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Affiliation(s)
- D Ringelberg
- U.S. Army ERDC-CRREL, 72 Lyme Rd., Hanover, NH 03755, United States.
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Herrold K, Herrold EM, Bograd AJ, Richmond M, Flynn PA, Cooper RS, Chen JM. The malignant course of acute rheumatic Fever in the modern era: implications for early surgical intervention in cases of bivalvular insufficiency with impaired ventricular function. Pediatr Cardiol 2008; 29:297-300. [PMID: 17786374 DOI: 10.1007/s00246-007-9070-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2007] [Revised: 07/16/2007] [Accepted: 08/14/2007] [Indexed: 10/22/2022]
Abstract
In recent years, the incidence of acute rheumatic fever (ARF) has drastically decreased in the United States while remaining common in developing nations. However, immigration to the United States from developing nations has resulted in the continued prevalence of ARF. Patients with ARF face the potential development of significant valvular insufficiency and rheumatic carditis, which are associated with significant morbidity and mortality. Potentially adverse outcomes may be avoided with advanced interventions such as aortic and/or mitral valve replacement or repair, the use of inotropic agents, and ventricular assist devices for mechanical circulatory support. This report describes a series of three ARF carditis cases. This series serves not only to emphasize proper ARF prevention, but also to demonstrate the need for timely surgical intervention once medical therapy has failed.
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Affiliation(s)
- K Herrold
- Division of Cardiovascular Pathophysiology, Department of Medicine, Weill Medical College of Cornell University, New York, NY 10021, USA
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Thakkar SG, Isada C, Smith J, Karam MA, Reed J, Tomford JW, Englund K, Richmond M, Licata A, Hatch C, Hussein MA. Jaw Complications Associated with Bisphosphonate Use in Patients with Plasma Cell Dyscrasias. Med Oncol 2006; 23:51-6. [PMID: 16645229 DOI: 10.1385/mo:23:1:51] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [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: 10/20/2005] [Revised: 11/30/1999] [Accepted: 10/21/2005] [Indexed: 11/11/2022]
Abstract
Osteonecrosis of the jaw has been linked with bisphosphonate use in breast cancer and multiple myeloma patients. We report 17 cases of patients with plasma cell dyscrasia being treated with bisphosphonate who developed osteonecrosis/osteomyelitis of the jaw. Seventeen patients evaluated at our institution between 1998 and 2005 are reported. All were being treated with bisphosphonates for a median of 5 mo prior to the onset of jaw symptoms. Sixteen of the 17 patients are 51 yr or older. None of the patients had been irradiated in the jaw nor had obvious osseous manifestation of multiple myeloma in the jaw. Thirteen patients were receiving zoledronic acid and four patients were receiving pamidronate at the onset of jaw symptoms. Six of the 17 did receive both agents at some time and all of these individuals were receiving zoledronic acid at diagnosis. Microorganisms were isolated in 7/17 patients with the most common organism being actinomycosis. We have initiated the following guidelines in an effort to ameliorate the incidence of this complication. Patients should have a full dental examination at the time of diagnosis of the plasma cell dyscrasia especially if bisphosphonates are to be considered as part of the therapy. In addition, bisphosphonates are held for a period of 3 mo prior to invasive dental procedures to allow for the osteoclastic recovery, therefore enhanced debris removal and lessening the chance of creating a fertile bacterial medium. Following the dental procedure we would re-introduce bisphosphonates only after the healing process is complete. Finally, multiple myeloma patients diagnosed with jaw osteonecrosis probably have a concurrent infection and should be aggressively treated with antibiotics.
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Affiliation(s)
- S G Thakkar
- Multiple Myeloma Multidisciplinary Clinical Research Program-R35, Cleveland Clinic Foundation 9500 Euclid Avenue, OH 44195,
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Kastner JH, Richmond M, Grosso N, Weintraub DA, Simon T, Frank A, Hamaguchi K, Ozawa H, Henden A. An X-ray outburst from the rapidly accreting young star that illuminates McNeil's nebula. Nature 2004; 430:429-31. [PMID: 15269761 DOI: 10.1038/nature02747] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2004] [Accepted: 06/14/2004] [Indexed: 11/08/2022]
Abstract
Young, low-mass stars are luminous X-ray sources whose powerful X-ray flares may exert a profound influence over the process of planet formation. The origin of the X-ray emission is uncertain. Although many (or perhaps most) recently formed, low-mass stars emit X-rays as a consequence of solar-like coronal activity, it has also been suggested that X-ray emission may be a direct result of mass accretion onto the forming star. Here we report X-ray imaging spectroscopy observations which reveal a factor approximately 50 increase in the X-ray flux from a young star that is at present undergoing a spectacular optical/infrared outburst (this star illuminates McNeil's nebula). The outburst seems to be due to the sudden onset of a phase of rapid accretion. The coincidence of a surge in X-ray brightness with the optical/infrared eruption demonstrates that strongly enhanced high-energy emission from young stars can occur as a consequence of high accretion rates. We suggest that such accretion-enhanced X-ray emission from erupting young stars may be short-lived, because intense star-disk magnetospheric interactions are quenched rapidly by the subsequent flood of new material onto the star.
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Affiliation(s)
- J H Kastner
- Rochester Institute of Technology, Rochester, New York 14623-5604, USA.
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Aster R, MacIntosh W, Kyle P, Esser R, Bartel B, Dunbar N, Johnson J, Karstens R, Kurnik C, McGowan M, McNamara S, Meertens C, Pauly B, Richmond M, Ruiz M. Real-time data received from Mount Erebus Volcano, Antarctica. ACTA ACUST UNITED AC 2004. [DOI: 10.1029/2004eo100001] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Cheong YC, Shelton JB, Laird SM, Richmond M, Kudesia G, Li TC, Ledger WL. IL-1, IL-6 and TNF-alpha concentrations in the peritoneal fluid of women with pelvic adhesions. Hum Reprod 2002; 17:69-75. [PMID: 11756364 DOI: 10.1093/humrep/17.1.69] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Pelvic adhesions are a significant cause of morbidity and are associated with infertility and pain. The three pro-inflammatory cytokines interleukin (IL)-1, IL-6 and tumour necrosis factor (TNF)-alpha are involved in adhesion formation/reformation. METHODS The concentration of these three cytokines was examined in the peritoneal fluid of women undergoing laparoscopy, in order to examine the factors affecting their concentrations, with specific reference to the presence or absence of adhesions. RESULTS We found that the concentration of TNF-alpha in the peritoneal fluid was significantly correlated to the menstrual cycle day (P < 0.01), with increasing concentration as the menstrual cycle progressed from the follicular to the luteal phase. In contrast, IL-1 and IL-6 levels did not show any variation throughout the menstrual cycle. Increased TNF-alpha was found in patients with pelvic adhesions compared with those with normal pelvis; the concentration of TNF-alpha was highest in mild compared with severe adhesions. In contrast, IL-1 concentration was higher in the presence of severe adhesions. IL-6 levels were significantly correlated with the grade of endometriosis (P < 0.05), but there were no significant correlations of either TNF-alpha or IL-1 concentrations with the various grades of endometriosis. CONCLUSION The exact role of TNF-alpha and IL-1 in adhesion formation is still unknown, but the results from this study suggest that their concentration in the peritoneal fluid is associated with the degree of adhesions present.
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Affiliation(s)
- Y C Cheong
- The Jessop Wing, Central Sheffield University Hospitals, Tree Root Walk, Sheffield, S10 2PS, UK.
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Abstract
Ruminative coping has been shown to heighten the risk and severity of depression. The authors hypothesized that ruminators who smoke would experience greater depressive symptoms than ruminators who do not. The rationale is that, by heightening attentional focus, nicotine may increase ruminators' ability to focus on negative thoughts, augmenting depressed mood. Participants (N = 145) self-reported smoking status, rumination, and current and lifetime depressive symptoms, including depressed mood. Results showed that rumination accounted for a larger amount of variance in current and past depressed mood and severity of lifetime depressive symptoms among smokers than nonsmokers. Noncorrelational, experimental research should directly test whether nicotine worsens depressed mood among ruminative smokers. Such evidence would be surprising because it would contradict the assumption that nicotine dispels negative moods.
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Affiliation(s)
- M Richmond
- Department of Psychology, University of Illinois at Chicago, 60607, USA
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Kupersmith MJ, Speira R, Langer R, Richmond M, Peterson M, Speira H, Mitnick H, Paget S. Visual function and quality of life among patients with giant cell (temporal) arteritis. J Neuroophthalmol 2001; 21:266-73. [PMID: 11756857 DOI: 10.1097/00041327-200112000-00008] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate patient perception of visual and systemic disability associated with giant cell arteritis (GCA) and whether the perceived disability can be correlated with visual performance measures. METHODS We prospectively evaluated and compared the visual performance and quality of life survey for 20 patients with GCA after 4 to 5 weeks of corticosteroid therapy and after one year of therapy. We measured visual acuity, contrast sensitivity, and threshold perimetry and patients completed the Activities of Daily Vision Scale (ADVS) and the short-form of the Health Survey (SF-36). The results were grouped by GCA affected or unaffected eye or by better or worse eye and reported as a decimal and percent impairment for acuity, log units for contrast, mean deviation and the Advanced Glaucoma Intervention Study (AGIS) score for perimetry. The results for patients with and without visual loss were compared. Correlation analyses between ADVS categories and visual performance measures, SF-36 categories and the presence of visual loss, total corticosteroid dose, systemic symptoms, secondary hypertension or diabetes mellitus, the presence of vertebral fracture, and visual performance were performed. RESULTS Day driving was the only ADVS category significantly reduced at baseline in patients with visual loss (62.5) compared with those without visual loss (96.3, P = 0.04). Modest to moderate correlations between ADVS categories were most frequent for percent binocular acuity impairment with day driving (r = -0.62, P = 0.017), with distance vision (r = -0.5, P = 0.02), and with glare (r = -0.59, P = 0.006); and the AGIS score of the worse eye with day driving (r = -0.66, P = 0.01), with near vision (r = -0.49, P = 0.03), and with glare (r = -0.48, P = 0.04). The baseline SF-36 scores did not correlate with the presence of vision loss at baseline or systemic complications. The ADVS and SF-36 scores were similar at one year. The total dose of corticosteroids only had a modest correlation with the one-year mental health score (r = -0.45, P = 0.05), but there was no correlation between SF-36 scores and other systemic side effects of steroid therapy. CONCLUSION Except for the day driving score, the ADVS did not differ between patients with and without visual loss. The SF-36 did not distinguish between patients with and without visual loss and did not reveal significant trends. The ADVS and SF-36 did not reveal significant disability in GCA patients and there were no strong correlations with any visual performance or systemic measures.
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Affiliation(s)
- M J Kupersmith
- Hyman-Newman Institute for Neurology and Neurosurgery at Beth Israel Medical Center, New York, New York 10128, USA.
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Abstract
Ruminative coping has been shown to heighten the risk and severity of depression. The authors hypothesized that ruminators who smoke would experience greater depressive symptoms than ruminators who do not. The rationale is that, by heightening attentional focus, nicotine may increase ruminators' ability to focus on negative thoughts, augmenting depressed mood. Participants (N = 145) self-reported smoking status, rumination, and current and lifetime depressive symptoms, including depressed mood. Results showed that rumination accounted for a larger amount of variance in current and past depressed mood and severity of lifetime depressive symptoms among smokers than nonsmokers. Noncorrelational, experimental research should directly test whether nicotine worsens depressed mood among ruminative smokers. Such evidence would be surprising because it would contradict the assumption that nicotine dispels negative moods.
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Affiliation(s)
- M Richmond
- Department of Psychology, University of Illinois at Chicago, 60607, USA
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Spiera RF, Mitnick HJ, Kupersmith M, Richmond M, Spiera H, Peterson MG, Paget SA. A prospective, double-blind, randomized, placebo controlled trial of methotrexate in the treatment of giant cell arteritis (GCA). Clin Exp Rheumatol 2001; 19:495-501. [PMID: 11579707] [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: 02/21/2023]
Abstract
OBJECTIVE To determine if methotrexate has disease-controlling and corticosteroid (cs)-sparing effects in the treatment of giant cell arteritis (GCA). METHODS This was a randomized, controlled, double-blind trial comparing methotrexate versus placebo in addition to corticosteroid therapy in patients with newly diagnosed giant cell arteritis. Patients with giant cell arteritis were enrolled and treated with high dose corticosteroids as well as methotrexate starting at 7.5 mg/week or placebo. Corticosteroids were tapered by the treating physician as guided by the clinical picture, with methotrexate or placebo dose increased by 2.5 mg/week for disease flare with a maximum allowable dose of 20 mg/week. After a clinically-defined remission and steroid discontinuation, methotrexate or placebo was tapered monthly to zero by 2.5 mg/week. RESULTS Twenty-one patients were enrolled, 12 randomized to methotrexate, 9 to placebo. Baseline characteristics (age, height, weight, sedimentation rate, bone mineral density, total corticosteroid dose prior to randomization, and quality of life as measured by SF-36 and function as measured by AIMS) were comparable between groups. At completion, there was no significant difference between methotrexate- and placebo-treated patients with regard to the cumulative corticosteroid dose (6469 mg and 5908 mg respectively, p = 0.6), number of weeks to completion of steroids (68 and 60 respectively, p = 0.5), time (weeks) to taper prednisone to less than 10 mg prednisone/day (23 and 25 respectively, p = 0.5), bone mineral density in lumbar spine (p = 0.2) or hip (p = 0.4) at one year, or functional status as measured by AIMS and quality of life as measured by SF36. There was no late vision loss in either group, and only one major treatment-responsive relapse in a methotrexate-treated patient. There were few major corticosteroid-related side effects and these did not significantly differ between groups. CONCLUSION With this study design, no corticosteroid-sparing benefit could be attributed to the combination of methotrexate with corticosteroid therapy for the treatment of patients with giant cell arteritis. Both groups did well, with few major corticosteroid-related side effects, and most patients were safely tapered off corticosteroids sooner than reported in many series. The shorter overall duration of steroid treatment in this study probably contributed to the remarkably low frequency of side effects, without increased ischemic risk for the patient.
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Affiliation(s)
- R F Spiera
- Hospital for Special Surgery, New York, New York, USA.
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Kuhn A, French P, Hand DP, Blewett IJ, Richmond M, Jones JD. Preparation of Fiber Optics for the Delivery of High-Energy High-Beam-Quality Nd:YAG Laser Pulses. Appl Opt 2000; 39:6136-6143. [PMID: 18354619 DOI: 10.1364/ao.39.006136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Recent improvements in design have made it possible to build Nd:YAG lasers with both high pulse energy and high beam quality. These lasers are particularly suited for percussion drilling of holes of as much as 1-mm diameter thick (a few millimeters) metal parts. An example application is the production of cooling holes in aeroengine components for which 1-ms duration, 30-J energy laser pulses produce holes of sufficient quality much more efficiently than with a laser trepanning process. Fiber optic delivery of the laser beam would be advantageous, particularly when one is processing complex three-dimensional structures. However, lasers for percussion drilling are available only with conventional bulk-optic beam delivery because of laser-induced damage problems with the small-diameter (approximately 200-400-mum) fibers that would be required for preserving necessary beam quality. We report measurements of beam degradation in step-index optical fibers with an input beam quality corresponding to an M(2) of 22. We then show that the laser-induced damage threshold of 400-mum core-diameter optical fibers can be increased significantly by a CO(2) laser treatment step following the mechanical polishing routine. This increase in laser-induced damage threshold is sufficient to propagate 25-J, 1-ms laser pulses with a 400-mum core-diameter optical fiber and an output M(2) of 31.
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Aoki H, Richmond M, Izumo S, Sadoshima J. Specific role of the extracellular signal-regulated kinase pathway in angiotensin II-induced cardiac hypertrophy in vitro. Biochem J 2000; 347 Pt 1:275-84. [PMID: 10727428 PMCID: PMC1220957] [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: 02/15/2023]
Abstract
Although MAP (mitogen-activated protein) kinases are implicated in cell proliferation and differentiation in many cell types, the role of MAP kinases in cardiac hypertrophy remains unclear. We examined the role of extracellular signal-regulated protein kinase (ERK), c-Jun N-terminal kinase (JNK) and p38 MAP kinase in angiotensin II (Ang II)-induced hypertrophy compared with phenylephrine-induced hypertrophy in neonatal rat cardiac myocytes. Both Ang II and phenylephrine activated ERKs to a similar extent, whereas phenylephrine caused stronger and more sustained activation of JNK and p38 than Ang II. PD98059, a specific inhibitor of MAPK/ERK kinase (MEK),inhibited Ang II-induced, but not phenylephrine-induced, expression of atrial natriuretic factor (ANF) at both the mRNA and polypeptide levels. SB203580, a specific inhibitor of p38 and some JNK isoforms, did not show significant effects on ANF expression induced by Ang II or phenylephrine. Although PD98059 and dominant-negative MEK1 blocked Ang II-induced activation of the ANF promoter, SB203580 or dominant-negative MEK kinase 1 (MEKK1) showed no effect. Phenylephrine-induced ANF promoter activation was significantly inhibited by SB203580 and dominant-negative MEKK1, but not by PD98059 or dominant-negative MEK1. Dominant-negative Ras inhibited both ERK activation and ANF up-regulation by Ang II, whereas constitutively active forms of Ras and MEK were sufficient to activate the ANF promoter. Dominant-negative Ras also partly inhibited the phenylephrine-induced activation of ANF promoter. PD98059 did not affect other markers of Ang II-induced hypertrophy, such as skeletal alpha-actin and c-fos expression, increases in the rate of protein synthesis or rapid sarcomeric actin organization. These results suggest that Ang II uses ERK for ANF expression, whereas phenylephrine uses other pathways. The Ras/ERK pathway selectively mediates ANF expression in various phenotypes observed in Ang II-induced hypertrophy. The ERK pathway mediates an agonist-specific and phenotype-specific response in cardiac hypertrophy.
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Affiliation(s)
- H Aoki
- Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue SL-201, Boston, MA 02215, USA
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Pouzet B, Feldon J, Veenman CL, Yee BK, Richmond M, Nicholas J, Rawlins P, Weiner I. The effects of hippocampal and fimbria-fornix lesions on prepulse inhibition. Behav Neurosci 1999; 113:968-81. [PMID: 10571479 DOI: 10.1037/0735-7044.113.5.968] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The present experiments tested the effects of conventional (dorsal aspiration and electrolytic) and excitotoxic (N-methyl-D-aspartate [NMDA]) hippocampal lesions and fimbria-fornix (FF) transection on prepulse inhibition (PPI) of startle response and on open-field activity. Activity was increased by FF transection and by conventional but not excitotoxic hippocampal lesions; complete NMDA lesion increased amphetamine-induced activity. Whereas dorsal hippocampal aspiration lesion disrupted PPI, the phenomenon was not affected by dorsal hippocampal electrolytic lesion, partial or complete excitotoxic (NMDA) hippocampal lesions, or complete FF transection, which interrupted the cholinergic input to the hippocampus as well as the hippocampal-subicular input to the nucleus accumbens. Systemic apomorphine disrupted PPI in both FF-transected rats and their controls. It is suggested that the hippocampus is essential for PPI disruption rather than for PPI expression.
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Affiliation(s)
- B Pouzet
- Behavioural Biology Laboratory, Swiss Federal Institute of Technology Zurich, Schwerzenbach
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Kupersmith MJ, Langer R, Mitnick H, Spiera R, Spiera H, Richmond M, Paget S. Visual performance in giant cell arteritis (temporal arteritis) after 1 year of therapy. Br J Ophthalmol 1999; 83:796-801. [PMID: 10381666 PMCID: PMC1723121 DOI: 10.1136/bjo.83.7.796] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To determine if patients with giant cell arteritis (GCA) treated with corticosteroids develop delayed visual loss or drug related ocular complications. METHODS In a multicentre prospective study patients with GCA (using precise diagnostic criteria) had ophthalmic evaluations at predetermined intervals up to 1 year. The dose of corticosteroid was determined by treating physicians, often outside the study, with the daily dose reduced to the equivalent of 30-40 mg of prednisone within 5 weeks. Subsequently, treatment guidelines suggested that the dose be reduced as tolerated or the patient was withdrawn from steroids in a period not less than 6 months. RESULTS At presentation, of the 22 patients enrolled, seven patients had nine eyes with ischaemic injury. Four eyes had improved visual acuity by two lines or more within 1 month of starting corticosteroids. No patients developed late visual loss as the steroid dose was reduced. At 1 year the visual acuity, contrast sensitivity, colour vision, and threshold perimetry were not significantly different from the 4-5 week determinations. At 1 year, there were no significant cataractous or glaucomatous changes. At 2 months, there was no difference in systemic complications between patients who received conventional dose (60-80 mg per day) or very high doses (200-1000 mg per day) of corticosteroids at the start or early in the course. CONCLUSIONS Patients with GCA related visual loss can improve with treatment. Corticosteroids with starting doses of 60-1000 mg per day, with reduction to daily doses of 40-50 mg per day given for 4-6 weeks, and gradual dose reduction thereafter, as clinically permitted, did not result in delayed visual loss. There were no significant drug related ophthalmic complications.
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Affiliation(s)
- M J Kupersmith
- INN at Beth Israel Medical Center, New York, NY 10128, USA
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Abstract
Laparoscopic surgery has many advantages but it is not without complications. The complexity of the surgery significantly influences the complication rate. Laparoscopic surgeons ought to be aware of the possible complications and how they could be prevented, recognized without delay, and managed safely and efficiently. Important complications include injuries to the vessels, bowel and urinary tract. Incisional hernia ought to be reduced by careful closure of the fascia whenever a trocar > or =10 mm is used at the extraumbilical site. Gas embolism is a rare but potentially life threatening complication. Shoulder pain is a minor complication but is exceedingly common; it is less likely to occur if as much gas as possible is removed at the end of the operation while the patient is still in head down Trendelenburg position. Rare complications include pneumothorax, subcutaneous and pre-peritoneal emphysema, cardiac arrhythmia, nerve injury and venous thrombosis. Laparoscopic surgeons should also understand the principles of electrosurgery and how to avoid complications arising from the use of electrical energy including capacitative coupling, direct coupling and insulation failure.
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Affiliation(s)
- T C Li
- Jessop Hospital for Women, Sheffield, UK
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Affiliation(s)
- M Richmond
- Science and Engineering Research Council, Swindon, UK
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Thompson CL, Richmond M. Teaching home care for ventilator-dependent patients: the patients' perception. Heart Lung 1990; 19:79-83. [PMID: 2298596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
An increasing number of ventilator-dependent patients are being transferred from hospitals to their homes. Discharge teaching has been based on health professionals' perception of what patients need to know and how they can learn best. In this study we asked ventilator-dependent patients who were living at home (N = 13) to complete a questionnaire concerning their perceptions of ideal discharge teaching. Most respondents believed that teaching should occur (1) at the bedside, (2) with one or two family members, (3) with only the team member doing the teaching, (4) for a 30-minute session, (5) using demonstration technique. Subjects thought that teaching regarding the lung disease process was less important than other content. The patients' criteria for learning mostly agree with those identified by health care professionals, and can be met easily in most settings.
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Affiliation(s)
- C L Thompson
- College of Nursing, University of Tennessee, Memphis 38163
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Kovach G, Richmond M. Developing an orientation advisory committee. Dimens Crit Care Nurs 1987; 6:184-9. [PMID: 3647869 DOI: 10.1097/00003465-198705000-00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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Abstract
Rates of body water turnover in free-ranging pine voles exceeded those reported for a large number of similarly sized mammals. Concentrations of urine obtained from free-ranging pine voles were significantly lower than values published for other free-ranging mammals and also for laboratory-maintained members of this species. Rates of body water turnover in this species were not correlated with seasonal changes in soil temperatures.
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Abstract
A 2-year-old boy developed classical signs and symptoms of the central anticholinergic syndrome after ingesting twenty 4-mg tablets of the antihistamine cyproheptadine (Periactin). His symptoms were dramatically reversed by the intravenous administration of physostigmine. The physiology of the anticholinergic system and physostigmine are discussed along with the indications, toxicity, and dosing of physostigmine.
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Abstract
Mesenchyme in the hind limbs of Rana pipiens tadpoles may serve as an important influence on the development of specific neural structures involved in limb innervation. Thus a histological quantification of mesenchyme was undertaken to identify landmark stages with respect to mesenchyme presence and neural events. Mesenchyme remained as a high percentage of the limb tissue until stage V (Taylor-Kollros stages, '46), after which it declined dramatically until its virtual absence after stage XI. The volume of mesenchyme, however, was greatest at stages VIII-IX. Periods of high and low mesenchyme content were correlated in time with potential limb involvement in regulating limb innervation and motor neuron loss from the lateral motor columns. This provides additional evidence for developmental relationships between events of the limb and neural tissues.
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Abstract
Crohn's disease of the duodenum is uncommon, occurring in approximately 2% of patients with Crohn's disease. Approximately 165 cases have been reported in small series in the literature. Our report includes 36 patients, most of whom had symptoms of duodenal disease coincident with or after obvious disease elsewhere in the gastrointestinal tract, although occasionally duodenal disease developed first and rarely disease was confined to the duodenum. Upper abdominal pain and symptoms of gastroduodenal obstruction are the commonest patterns of presentation. Significant weight loss is common, and occasionally major upper gastrointestinal bleeding occurs. The commonest pattern of involvement was contiguous disease of the proximal duodenum and distal stomach. Endoscopically, diffuse granularity, nodularity, and ulceration are seen accompanied by lack of distensibility of the involved area. Granulomas are rarely found in endoscopic biopsies. A bypass procedure was carried out on 18 patients, 15 of whom continue to be free of symptoms with an average follow-up of 6-6 years. When symptoms of obstruction dictate, operative bypass is accompanied by favourable long-term results in the large majority of patients.
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Richmond M. Some unfinished business. N Z Nurs J 1974; 67:7-10. [PMID: 4526583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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