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Gueye-Ndiaye S, Tully M, Tsou PY, Amin R, Baldassari CM, Chervin RD, Cielo CM, George A, Hassan F, Ibrahim S, Ishman SL, Kirkham EM, Mitchell RB, Naqvi K, Prero M, Rueschman M, Tapia IE, Sendon C, Wang R, Redline S, Ross K. The effect of adenotonsillectomy on asthma symptoms in the Pediatric Adenotonsillectomy Trial for Snoring (PATS). Pediatr Pulmonol 2024. [PMID: 38656626 DOI: 10.1002/ppul.27022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 04/10/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Seyni Gueye-Ndiaye
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Meg Tully
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Po-Yang Tsou
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Raouf Amin
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Cristina M Baldassari
- Division of Sleep Medicine, Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Children's Hospitals of The King's Daughters, Norfolk, Virginia, USA
| | - Ronald D Chervin
- Department of Neurology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Christopher M Cielo
- Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alisha George
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Fauziya Hassan
- Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Sally Ibrahim
- Rainbow Babies and Children's Hospital and University Hospitals, Cleveland, Ohio, USA
| | - Stacey L Ishman
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Erin M Kirkham
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Ron B Mitchell
- Children's Medical Center of Dallas and UT Southwestern Medical Center, Dallas, Texas, USA
| | - Kamal Naqvi
- Children's Medical Center of Dallas and UT Southwestern Medical Center, Dallas, Texas, USA
| | - Moshe Prero
- Rainbow Babies and Children's Hospital and University Hospitals, Cleveland, Ohio, USA
| | - Michael Rueschman
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ignacio E Tapia
- University of Miami Health System and Miller School of Medicine, Miami, Florida, USA
| | - Carlos Sendon
- Division of Sleep Medicine, Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Children's Hospitals of The King's Daughters, Norfolk, Virginia, USA
| | - Rui Wang
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Susan Redline
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kristie Ross
- Rainbow Babies and Children's Hospital and University Hospitals, Cleveland, Ohio, USA
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Gueye-Ndiaye S, Tully M, Amin R, Baldassari CM, Chervin RD, Cole M, Ibrahim S, Kirkham EM, Mitchell RB, Naqvi K, Ross K, Rueschman M, Tapia IE, Williamson AA, Wei Z, Rosen CL, Wang R, Redline S. Neighborhood Disadvantage, Quality of Life, and Symptom Burden in Children with Mild Sleep-disordered Breathing. Ann Am Thorac Soc 2024; 21:604-611. [PMID: 38241286 PMCID: PMC10995551 DOI: 10.1513/annalsats.202307-653oc] [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: 07/28/2023] [Accepted: 01/18/2024] [Indexed: 01/21/2024] Open
Abstract
Rationale: Neighborhood disadvantage (ND) has been associated with sleep-disordered breathing (SDB) in children. However, the association between ND and SDB symptom burden and quality of life (QOL) has not yet been studied.Objectives: To evaluate associations between ND with SDB symptom burden and QOL.Methods: Cross-sectional analyses were performed on 453 children, ages 3-12.9 years, with mild SDB (habitual snoring and apnea-hypopnea index < 3/h) enrolled in the PATS (Pediatric Adenotonsillectomy Trial for Snoring) multicenter study. The primary exposure, neighborhood disadvantage, was characterized by the Child Opportunity Index (COI) (range, 0-100), in which lower values (specifically COI ⩽ 40) signify less advantageous neighborhoods. The primary outcomes were QOL assessed by the obstructive sleep apnea (OSA)-18 questionnaire (range, 18-126) and SDB symptom burden assessed by the Pediatric Sleep Questionnaire-Sleep-related Breathing Disorder (PSQ-SRBD) scale (range, 0-1). The primary model was adjusted for age, sex, race, ethnicity, maternal education, recruitment site, and season. In addition, we explored the role of body mass index (BMI) percentile, environmental tobacco smoke (ETS), and asthma in these associations.Results: The sample included 453 children (16% Hispanic, 26% Black or African American, 52% White, and 6% other). COI mean (standard deviation [SD]) was 50.3 (29.4), and 37% (n = 169) of participants lived in disadvantaged neighborhoods. Poor SDB-related QOL (OSA-18 ⩾ 60) and high symptom burden (PSQ-SRBD ⩾ 0.33) were found in 30% (n = 134) and 75% (n = 341) of participants, respectively. In adjusted models, a COI increase by 1 SD (i.e., more advantageous neighborhood) was associated with an improvement in OSA-18 score by 2.5 points (95% confidence interval [CI], -4.34 to -0.62) and in PSQ-SRBD score by 0.03 points (95% CI, -0.05 to -0.01). These associations remained significant after adjusting for BMI percentile, ETS, or asthma; however, associations between COI and SDB-related QOL attenuated by 23% and 10% after adjusting for ETS or asthma, respectively.Conclusions: Neighborhood disadvantage was associated with poorer SDB-related QOL and greater SDB symptoms. Associations were partially attenuated after considering the effects of ETS or asthma. The findings support efforts to reduce ETS and neighborhood-level asthma-related risk factors and identify other neighborhood-level factors that contribute to SDB symptom burden as strategies to address sleep-health disparities.Clinical trial registered with www.clinicaltrials.gov (NCT02562040).
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Affiliation(s)
- Seyni Gueye-Ndiaye
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Meg Tully
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Raouf Amin
- Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Cristina M. Baldassari
- Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, Virginia
- Department of Pediatric Sleep Medicine, Children’s Hospital of The King’s Daughters, Norfolk, Virginia
| | | | - Melissa Cole
- Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Sally Ibrahim
- Rainbow Babies and Children’s Hospital and University Hospitals, Cleveland, Ohio
| | | | - Ron B. Mitchell
- Children’s Medical Center of Dallas and UT Southwestern Medical Center, Dallas, Texas
| | - Kamal Naqvi
- Children’s Medical Center of Dallas and UT Southwestern Medical Center, Dallas, Texas
| | - Kristie Ross
- Rainbow Babies and Children’s Hospital and University Hospitals, Cleveland, Ohio
| | - Michael Rueschman
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ignacio E. Tapia
- Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ariel A. Williamson
- The Ballmer Institute for Children’s Behavioral Health, University of Oregon, Eugene, Oregon
| | - Zhuoran Wei
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carol L. Rosen
- Case Western Reserve University School of Medicine, Cleveland, Ohio; and
| | - Rui Wang
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Rivera-Rincón N, Altindag UH, Amin R, Graze RM, Appel AG, Stevison LS. "A comparison of thermal stress response between Drosophila melanogaster and Drosophila pseudoobscura reveals differences between species and sexes". J Insect Physiol 2024; 153:104616. [PMID: 38278288 PMCID: PMC11048572 DOI: 10.1016/j.jinsphys.2024.104616] [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] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 01/28/2024]
Abstract
The environment is changing faster than anticipated due to climate change, making species more vulnerable to its impacts. The level of vulnerability of species is influenced by factors such as the degree and duration of exposure, as well as the physiological sensitivity of organisms to changes in their environments, which has been shown to vary among species, populations, and individuals. Here, we compared physiological changes in fecundity, critical thermalmaximum (CTmax), respiratory quotient (RQ), and DNA damage in ovaries in response to temperature stress in two species of fruit fly, Drosophila melanogaster (25 vs. 29.5 °C) and Drosophila pseudoobscura (20.5 vs. 25 °C). The fecundity of D. melanogaster was more affected by high temperatures when exposed during egg through adult development, while D. pseudoobscura was most significantly affected when exposed to high temperatures exclusively during egg through pupal development. Additionally, D. melanogaster males exhibited a decrease of CTmax under high temperatures, while females showed an increase of CTmax when exposed to high temperatures during egg through adult development. while D. pseudoobscura females and males showed an increased CTmax only when reared at high temperatures during egg through pupae development. Moreover, both species showed an acceleration in oogenesis and an increase in apoptosis due to heat stress. These changes can likely be attributed to key differences in the geographic range, thermal range, development time, and other different factors between these two systems. Through this comparison of variation in physiology and developmental response to thermal stress, we found important differences between species and sexes that suggest future work needs to account for these factors separately in understanding the effects of constant increased temperatures.
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Affiliation(s)
- N Rivera-Rincón
- Department of Biological Sciences, Auburn University, Auburn, AL USA
| | - U H Altindag
- Department of Biological Sciences, Auburn University, Auburn, AL USA
| | - R Amin
- Department of Biological Sciences, Auburn University, Auburn, AL USA
| | - R M Graze
- Department of Biological Sciences, Auburn University, Auburn, AL USA
| | - A G Appel
- Department of Biological Sciences, Auburn University, Auburn, AL USA
| | - L S Stevison
- Department of Biological Sciences, Auburn University, Auburn, AL USA.
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4
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Mitchell RB, Cook K, Garetz S, Tapia IE, Elden LM, Kirkham EM, Shah J, Otteson T, Zopf D, Amin R, Ishman S, Baldassari CM, Chervin RD, Hassan F, Naqvi K, Wang R, Redline S. Clinical Characteristics of Primary Snoring vs Mild Obstructive Sleep Apnea in Children: Analysis of the Pediatric Adenotonsillectomy for Snoring (PATS) Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg 2024; 150:99-106. [PMID: 38095903 PMCID: PMC10722386 DOI: 10.1001/jamaoto.2023.3816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/20/2023] [Indexed: 12/17/2023]
Abstract
Importance It is unknown whether children with primary snoring and children with mild obstructive sleep apnea (OSA) represent populations with substantially different clinical characteristics. Nonetheless, an obstructive apnea-hypopnea index (AHI) of 1 or greater is often used to define OSA and plan for adenotonsillectomy (AT). Objective To assess whether a combination of clinical characteristics differentiates children with primary snoring from children with mild OSA. Design, Setting, and Participants Baseline data from the Pediatric Adenotonsillectomy Trial for Snoring (PATS) study, a multicenter, single-blind, randomized clinical trial conducted at 6 academic sleep centers from June 2016 to January 2021, were analyzed. Children aged 3.0 to 12.9 years with polysomnography-diagnosed (AHI <3) mild obstructive sleep-disordered breathing who were considered candidates for AT were included. Data analysis was performed from July 2022 to October 2023. Main Outcomes and Measures Logistic regression models were fitted to identify which demographic, clinical, and caregiver reports distinguished children with primary snoring (AHI <1; 311 patients [67.8%]) from children with mild OSA (AHI 1-3; 148 patients [32.2%]). Results A total of 459 children were included. The median (IQR) age was 6.0 (4.0-7.5) years, 230 (50.1%) were female, and 88 (19.2%) had obesity. A total of 121 (26.4%) were Black, 75 (16.4%) were Hispanic, 236 (51.5%) were White, and 26 (5.7%) were other race and ethnicity. Black race (odds ratio [OR], 2.08; 95% CI, 1.32-3.30), obesity (OR, 1.80; 95% CI, 1.12-2.91), and high urinary cotinine levels (>5 µg/L) (OR, 1.88; 95% CI, 1.15-3.06) were associated with greater odds of mild OSA rather than primary snoring. Other demographic characteristics, clinical examination findings, and questionnaire reports did not distinguish between primary snoring and mild OSA. A weighted combination of the statistically significant clinical predictors had limited ability to differentiate children with mild OSA from children with primary snoring. Conclusions and Relevance In this analysis of baseline data from the PATS randomized clinical trial, primary snoring and mild OSA were difficult to distinguish without polysomnography. Mild OSA vs snoring alone did not identify a clinical group of children who may stand to benefit from AT for obstructive sleep-disordered breathing. Trial Registration ClinicalTrials.gov Identifier: NCT02562040.
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Affiliation(s)
- Ron B. Mitchell
- Children’s Medical Center of Dallas and University of Texas Southwestern Medical Center, Dallas
| | - Kaitlyn Cook
- Departments of Medicine and Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Program in Statistical and Data Sciences, Smith College, Northampton, Massachusetts
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
| | - Susan Garetz
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
| | - Ignacio E. Tapia
- Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia
| | - Lisa M. Elden
- Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia
| | - Erin M. Kirkham
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
| | - Jay Shah
- Department of Otolaryngology, University Hospitals Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, Ohio
| | - Todd Otteson
- Department of Otolaryngology, University Hospitals Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, Ohio
| | - David Zopf
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
| | - Raouf Amin
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Stacey Ishman
- Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Cristina M. Baldassari
- Department of Otolaryngology, Eastern Virginia Medical School, Children’s Hospital of The King’s Daughters, Norfolk
| | - Ronald D. Chervin
- Sleep Disorders Center and Department of Neurology, University of Michigan, Ann Arbor
| | - Fauziya Hassan
- Sleep Disorders Center and Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor
| | - Kamal Naqvi
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas
| | - Rui Wang
- Departments of Medicine and Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Susan Redline
- Departments of Medicine and Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Xiao Q, Ignatiuk D, McConnell K, Gunatilaka C, Schuh A, Fleck R, Ishman S, Amin R, Bates A. The interaction between neuromuscular forces, aerodynamic forces, and anatomical motion in the upper airway predicts the severity of pediatric OSA. J Appl Physiol (1985) 2024; 136:70-78. [PMID: 37942529 DOI: 10.1152/japplphysiol.00071.2023] [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: 02/06/2023] [Revised: 10/16/2023] [Accepted: 11/07/2023] [Indexed: 11/10/2023] Open
Abstract
Upper airway neuromuscular response to air pressure during inhalation is an important factor in assessing pediatric subjects with obstructive sleep apnea (OSA). The neuromuscular response's strength, timing, and duration all contribute to the potential for airway collapses and the severity of OSA. This study quantifies these factors at the soft palate, tongue, and epiglottis to assess the relationship between neuromuscular control and OSA severity in 20 pediatric subjects with and without trisomy 21, under dexmedetomidine-induced sedation. The interaction between neuromuscular force and airflow pressure force was assessed based on power transferred between the airway wall and airflow calculated from airway wall motion (from cine magnetic resonance images) and air pressure acting on the airway wall (from computational fluid dynamics simulations). Airway wall motion could be asynchronous with pressure forces due to neuromuscular activation, or synchronous with pressure forces, indicating a passive response to airflow. The obstructive apnea-hypopnea index (oAHI) quantified OSA severity. During inhalation, the normalized work done through asynchronous dilation of the airway at the soft palate, tongue, and epiglottis correlated significantly with oAHI (Spearman's ρ = 0.54, 0.50, 0.64; P = 0.03, 0.03, 0.003). Synchronous collapse at the epiglottis correlated significantly with oAHI (ρ = 0.52; P = 0.02). Temporal order of synchronous and asynchronous epiglottis motion during inhalation predicted the severity of OSA (moderate vs. severe) with 100% sensitivity and 70% specificity. Subjects with severe OSA and/or trisomy 21 have insufficient neuromuscular activation during inhalation, leading to collapse and increased neuromuscular activation. Airflow-driven airway wall motion during late inhalation likely is the main determinant of OSA severity.NEW & NOTEWORTHY This is the first study that combines cine MRI and computational fluid dynamics with in vivo synchronous respiratory flow measurement to quantify the interaction between airway neuromuscular forces, aerodynamic forces, and airway anatomy noninvasively in pediatric patients with obstructive sleep apnea (OSA). The results indicate power transfer predicts OSA severity.
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Affiliation(s)
- Qiwei Xiao
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Daniel Ignatiuk
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Keith McConnell
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Chamindu Gunatilaka
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | | | - Robert Fleck
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Stacey Ishman
- Department of Otolaryngology, Head & Neck Surgery, University of Cincinnati, Cincinnati, Ohio, United States
| | - Raouf Amin
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, United States
| | - Alister Bates
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, United States
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio, United States
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Redline S, Cook K, Chervin RD, Ishman S, Baldassari CM, Mitchell RB, Tapia IE, Amin R, Hassan F, Ibrahim S, Ross K, Elden LM, Kirkham EM, Zopf D, Shah J, Otteson T, Naqvi K, Owens J, Young L, Furth S, Connolly H, Clark CAC, Bakker JP, Garetz S, Radcliffe J, Taylor HG, Rosen CL, Wang R. Adenotonsillectomy for Snoring and Mild Sleep Apnea in Children: A Randomized Clinical Trial. JAMA 2023; 330:2084-2095. [PMID: 38051326 PMCID: PMC10698619 DOI: 10.1001/jama.2023.22114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 10/04/2023] [Indexed: 12/07/2023]
Abstract
Importance The utility of adenotonsillectomy in children who have habitual snoring without frequent obstructive breathing events (mild sleep-disordered breathing [SDB]) is unknown. Objectives To evaluate early adenotonsillectomy compared with watchful waiting and supportive care (watchful waiting) on neurodevelopmental, behavioral, health, and polysomnographic outcomes in children with mild SDB. Design, Setting, and Participants Randomized clinical trial enrolling 459 children aged 3 to 12.9 years with snoring and an obstructive apnea-hypopnea index (AHI) less than 3 enrolled at 7 US academic sleep centers from June 29, 2016, to February 1, 2021, and followed up for 12 months. Intervention Participants were randomized 1:1 to either early adenotonsillectomy (n = 231) or watchful waiting (n = 228). Main Outcomes and Measures The 2 primary outcomes were changes from baseline to 12 months for caregiver-reported Behavior Rating Inventory of Executive Function (BRIEF) Global Executive Composite (GEC) T score, a measure of executive function; and a computerized test of attention, the Go/No-go (GNG) test d-prime signal detection score, reflecting the probability of response to target vs nontarget stimuli. Twenty-two secondary outcomes included 12-month changes in neurodevelopmental, behavioral, quality of life, sleep, and health outcomes. Results Of the 458 participants in the analyzed sample (231 adenotonsillectomy and 237 watchful waiting; mean age, 6.1 years; 230 female [50%]; 123 Black/African American [26.9%]; 75 Hispanic [16.3%]; median AHI, 0.5 [IQR, 0.2-1.1]), 394 children (86%) completed 12-month follow-up visits. There were no statistically significant differences in change from baseline between the 2 groups in executive function (BRIEF GEC T-scores: -3.1 for adenotonsillectomy vs -1.9 for watchful waiting; difference, -0.96 [95% CI, -2.66 to 0.74]) or attention (GNG d-prime scores: 0.2 for adenotonsillectomy vs 0.1 for watchful waiting; difference, 0.05 [95% CI, -0.18 to 0.27]) at 12 months. Behavioral problems, sleepiness, symptoms, and quality of life each improved more with adenotonsillectomy than with watchful waiting. Adenotonsillectomy was associated with a greater 12-month decline in systolic and diastolic blood pressure percentile levels (difference in changes, -9.02 [97% CI, -15.49 to -2.54] and -6.52 [97% CI, -11.59 to -1.45], respectively) and less progression of the AHI to greater than 3 events/h (1.3% of children in the adenotonsillectomy group compared with 13.2% in the watchful waiting group; difference, -11.2% [97% CI, -17.5% to -4.9%]). Six children (2.7%) experienced a serious adverse event associated with adenotonsillectomy. Conclusions In children with mild SDB, adenotonsillectomy, compared with watchful waiting, did not significantly improve executive function or attention at 12 months. However, children with adenotonsillectomy had improved secondary outcomes, including behavior, symptoms, and quality of life and decreased blood pressure, at 12-month follow-up. Trial Registration ClinicalTrials.gov Identifier: NCT02562040.
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Affiliation(s)
- Susan Redline
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kaitlyn Cook
- Program in Statistical and Data Sciences, Smith College, Northampton, Massachusetts
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
| | - Ronald D. Chervin
- Sleep Disorders Center and Department of Neurology, University of Michigan, Ann Arbor
| | - Stacey Ishman
- Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Cristina M. Baldassari
- Department of Otolaryngology, Eastern Virginia Medical School, Children’s Hospital of The King’s Daughters, Norfolk
| | - Ron B. Mitchell
- Departments of Otolaryngology-Head and Neck Surgery and Neurology Sleep Disorders Center, UT Southwestern Medical Center, Children’s Medical Center, Dallas
| | - Ignacio E. Tapia
- Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Raouf Amin
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Fauziya Hassan
- Sleep Disorders Center and Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor
| | - Sally Ibrahim
- Department of Pediatrics, University Hospitals Rainbow Babies & Children’s Hospital, Cleveland, Ohio
| | - Kristie Ross
- Department of Pediatrics, University Hospitals Rainbow Babies & Children’s Hospital, Cleveland, Ohio
| | - Lisa M. Elden
- Division of Pediatric Otolaryngology, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Erin M. Kirkham
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
| | - David Zopf
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
| | - Jay Shah
- Department of Otolaryngology, University Hospitals Rainbow Babies
- University Hospitals Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, Ohio
| | - Todd Otteson
- Department of Otolaryngology, University Hospitals Rainbow Babies
- University Hospitals Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, Ohio
| | - Kamal Naqvi
- Department of Pediatrics, UT Southwestern Medical Center, Dallas
| | - Judith Owens
- Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lisa Young
- Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Susan Furth
- Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Heidi Connolly
- Department of Pediatrics, University of Rochester, Rochester, New York
| | - Caron A. C. Clark
- Department of Educational Psychology, University of Nebraska-Lincoln
| | - Jessie P. Bakker
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Susan Garetz
- Department of Otolaryngology–Head and Neck Surgery and Department of Neurology-Sleep Disorders Center, University of Michigan, Ann Arbor
| | - Jerilynn Radcliffe
- Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - H. Gerry Taylor
- Abigail Wexner Research Institute at Nationwide Children’s Hospital and The Ohio State University, Columbus
| | - Carol L. Rosen
- Case Western Reserve University School of Medicine, Department of Pediatrics, Cleveland, Ohio
| | - Rui Wang
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Soltani A, Schworer EK, Amin R, Hoffman EK, Esbensen AJ. Executive Functioning, Language, and Behavioral Abilities Related to Obstructive Sleep Apnea in Down Syndrome. J Dev Behav Pediatr 2023; 44:e429-e435. [PMID: 37099648 PMCID: PMC10524295 DOI: 10.1097/dbp.0000000000001189] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 03/20/2023] [Indexed: 04/28/2023]
Abstract
OBJECTIVES Obstructive sleep apnea (OSA) is highly prevalent among individuals with Down syndrome (DS), and the nonphysiological consequences of OSA require examination to inform treatment planning. This study aimed to investigate the association between OSA and aspects of language, executive functioning, behavioral, social abilities, and sleep problems in youth with DS aged 6 to 17 years. METHODS Multivariate analysis of covariance was used to compare 3 groups adjusted for age, participants with DS with untreated OSA (n = 28), participants with DS without OSA (n = 38), and participants with DS with treated OSA (n = 34). To be eligible for the study, participants had to have an estimated mental age of 3 years. No children were excluded based on estimated mental age. RESULTS After adjusting for age, participants with untreated OSA showed a common pattern of lower estimated marginal mean scores than those with treated OSA and those with no OSA in expressive and receptive vocabulary and higher estimated marginal mean scores with executive functions, everyday memory, attention, internalizing and externalizing behavior, social behavior, and sleep problems. However, only the group differences for executive function (emotional regulation) and internalizing behavior were statistically significant. CONCLUSION Study findings corroborate and extend prior findings related to OSA and clinical outcomes for youth with DS. The study highlights the importance of OSA treatment in youth with DS and provides clinical recommendations for this population. Additional studies are necessary to control the effects of health and demographic variables.
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Affiliation(s)
- Amanallah Soltani
- Department of Educational Psychology, Kerman Branch, Islamic Azad University, Kerman, Iran
| | - Emily K. Schworer
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- University of Wisconsin-Madison, Waisman Center, Madison, WI, USA
| | - Raouf Amin
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Emily K. Hoffman
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Anna J. Esbensen
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Xiao Q, Stewart N, Willmering M, McConnell K, Woods J, Fleck R, Amin R, Bates A. Phase Contrast MRI of Inhaled Xenon Reveals the Relationship Between Airflow and Obstruction in OSA. Am J Respir Crit Care Med 2023. [PMID: 37094098 PMCID: PMC10395714 DOI: 10.1164/rccm.202208-1574im] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Affiliation(s)
- Qiwei Xiao
- Cincinnati Children's Hospital Medical Center, 2518, Division of Pulmonary Medicine, Cincinnati, Ohio, United States
- Cincinnati Children's Hospital Medical Center, 2518, Center for Pulmonary Imaging Research, Cincinnati, Ohio, United States
| | - Neil Stewart
- The University of Sheffield, 7315, Imaging Sciences, Infection, Immunity & Cardiovascular Disease, Sheffield, United Kingdom of Great Britain and Northern Ireland
| | - Matthew Willmering
- Cincinnati Children's Hospital Medical Center, 2518, Cincinnati, Ohio, United States
| | - Keith McConnell
- Cincinnati Children's Hospital Medical Center, Pulmonary Medicine, Cincinnati, Ohio, United States
| | - Jason Woods
- Cincinnati Children's Hospital Medical Center, Pediatrics & Radiology, Cincinnati, Ohio, United States
| | - Robert Fleck
- Cincinnati Children's Hospital Medical Center, Radiology, Cincinnati, Ohio, United States
| | - Raouf Amin
- Cincinnati Children's Hospital Medical Center, Pulmonary Medicine, Cincinnati, Ohio, United States
| | - Alister Bates
- Cincinnati Children's Hospital Medical Center, 2518, Division of Pulmonary Medicine, Cincinnati, Ohio, United States;
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9
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Sherman E, Lee JL, Debruyne PR, Keam B, Shin SJ, Gramza A, Caro I, Amin R, Shah K, Yan Y, Huddart R, Powles T. Safety and efficacy of cobimetinib plus atezolizumab in patients with solid tumors: a phase II, open-label, multicenter, multicohort study. ESMO Open 2023; 8:100877. [PMID: 36947985 PMCID: PMC10163002 DOI: 10.1016/j.esmoop.2023.100877] [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: 09/08/2022] [Revised: 12/21/2022] [Accepted: 01/16/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Although introduction of immune checkpoint inhibitors has revolutionized the treatment of cancer, their response rates are generally low. Preclinical and early phase clinical data suggest that MEK inhibition may sensitize tumors to immune checkpoint inhibitors by upregulating tumor antigen expression, programmed death-ligand 1 (PD-L1) expression, and tumor T-cell infiltration. We evaluated the efficacy and safety of cobimetinib plus atezolizumab in patients with advanced solid tumors in the open-label, multicohort phase II COTEST study. PATIENTS AND METHODS This analysis of the COTEST trial included patients from cohorts 1-4 [1-3: anti-programmed cell death protein 1 (PD-1)/PD-L1 treatment-naive patients; 4: patients with disease progression on anti-PD-1/anti-PD-L1 treatment] who received cobimetinib 60 mg once daily for the first 21 days and intravenous infusions of atezolizumab 840 mg on days 1 and 15 of each 28-day cycle. Efficacy endpoints included objective response rate, overall survival, progression-free survival (PFS), and disease control rate. RESULTS Overall, 77 patients were enrolled in cohorts 1-4 (78% male; median age 62.8 years). Objective response rate was 20% in cohort 1 [squamous cell carcinoma of the head and neck (SCCHN)], 30% in cohort 2 (urothelial carcinoma), and 18% in cohort 3 (renal cell carcinoma); there were no responders among 20 patients in cohort 4 (SCCHN). The disease control rates in cohorts 1-4 were 50%, 40%, 24%, and 25%, respectively. The median PFS was 5.5, 3.4, 3.4, and 3.6 months in cohorts 1-4, respectively, and the median overall survival was 16.8, 18.7, 21.7, and 7.7 months, respectively. Most adverse events were of grade 1/2 and were manageable. CONCLUSIONS Cobimetinib plus atezolizumab had moderate activity in patients with anti-PD-1/PD-L1 treatment-naive SCCHN and urothelial carcinoma, and weak activity in anti-PD-1/PD-L1 treatment-naive renal cell carcinoma, and no activity in checkpoint inhibitor-treated patients.
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Affiliation(s)
- E Sherman
- Memorial Sloan Kettering Cancer Center, Head and Neck Oncology Service, New York, USA.
| | - J L Lee
- University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - P R Debruyne
- Kortrijk Cancer Centre, AZ Groeninge, Kortrijk, Belgium; Anglia Ruskin University, School of Life Sciences, Cambridge, UK
| | - B Keam
- Seoul National University Hospital, Department of Internal Medicine, Seoul
| | - S J Shin
- Yonsei Cancer Center, Department of Internal Medicine, Seoul, South Korea
| | - A Gramza
- Georgetown University Medical Center, Division of Hematology and Oncology, Washington DC
| | - I Caro
- Genentech, Inc, South San Francisco, USA
| | - R Amin
- Genentech, Inc, South San Francisco, USA
| | - K Shah
- Genentech, Inc, South San Francisco, USA
| | - Y Yan
- Genentech, Inc, South San Francisco, USA
| | - R Huddart
- The Royal Marsden, Royal Marsden Hospital Fulham, Urology Unit, Chelsea, London. https://twitter.com/robert_huddart
| | - T Powles
- Barts & London School of Medicine, Garrod Building, London, UK. https://twitter.com/tompowles1
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10
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Durand M, Amin R. Peripheral Chemoreceptor Activity in Infants Less than 29 Weeks of Gestation? Am J Respir Crit Care Med 2023; 207:508-509. [PMID: 36315632 PMCID: PMC10870906 DOI: 10.1164/rccm.202210-1977ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Manuel Durand
- Department of Pediatrics Keck School of Medicine University of Southern California Los Angeles, California
| | - Raouf Amin
- Department of Pediatrics Cincinnati Children's Hospital Medical Center Cincinnati, Ohio
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11
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Boat T, Hente E, Hardie W, Szczesniak R, Gecili E, Zhou G, Taylor J, Amin R. Body composition and functional correlates of CF youth experiencing pulmonary exacerbation and recovery. Pediatr Pulmonol 2023; 58:457-464. [PMID: 36271603 DOI: 10.1002/ppul.26207] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 09/22/2022] [Accepted: 10/11/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Youth with cystic fibrosis (CF) and pulmonary exacerbation (PEx) often experience weight loss, then rapid weight gain. Little is known about body composition and its relationship to functional outcomes during this critical period. METHODS Twenty CF youth experiencing PEx were assessed on the day following admission and 7-17 days later at discharge for body mass index (BMI), fat mass index (FMI), lean mass index (LMI), skeletal muscle mass index (SMMI), and functional measures: percent predicted forced expiratory volume in 1 second (FEV1) (ppFEV1), maximal inspiratory and expiratory pressures (MIPs and MEPs), and handgrip strength (HGS). Changes from admission to discharge and correlations among body composition indices and functional measures at both times are reported. RESULTS Upon admission, participant BMI percentile and ppFEV1 varied from 2 to 97 and 29 to 113, respectively. Thirteen had an LMI below the 25th percentile and nine had a percent body fat above the 75th percentile. BMI and FMI increased significantly (p = 0.03, 0.003) during hospitalization. LMI and SMMI did not change. FEV1 and MIPS increased (p = 0.0003, 0.007), independent of weight gain, during treatment. HGS did not improve. CONCLUSIONS Many youth with CF, independent of BMI, frequently carried a small muscle mass and disproportionate fat at the time of PEx. During hospital treatment, weight gain largely represented fat deposition; muscle mass and strength did not improve. A need for trials of interventions designed to augment muscle mass and function, and limit fat mass accretion, at the time of PEx is suggested by these observations.
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Affiliation(s)
- Thomas Boat
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Elizabeth Hente
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - William Hardie
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Rhonda Szczesniak
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Division of Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Emrah Gecili
- Division of Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Grace Zhou
- Division of Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jacqueline Taylor
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Raouf Amin
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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12
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Kanbar LJ, Dexheimer JW, Zahner J, Burrows EK, Chatburn R, Messinger A, Baker CD, Schuler CL, Benscoter D, Amin R, Pajor N. Standardizing electronic health record ventilation data in the pediatric long-term mechanical ventilator-dependent population. Pediatr Pulmonol 2023; 58:433-440. [PMID: 36226360 DOI: 10.1002/ppul.26204] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/22/2022] [Accepted: 10/08/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Sharing data across institutions is critical to improving care for children who are using long-term mechanical ventilation (LTMV). Mechanical ventilation data are complex and poorly standardized. This lack of data standardization is a major barrier to data sharing. OBJECTIVE We aimed to describe current ventilator data in the electronic health record (EHR) and propose a framework for standardizing these data using a common data model (CDM) across multiple populations and sites. METHODS We focused on a cohort of patients with LTMV dependence who were weaned from mechanical ventilation (MV). We extracted and described relevant EHR ventilation data. We identified the minimum necessary components, termed "Clinical Ideas," to describe MV from time of initiation to liberation. We then utilized existing resources and partnered with informatics collaborators to develop a framework for incorporating Clinical Ideas into the PEDSnet CDM based on the Observational Medical Outcomes Partnership (OMOP). RESULTS We identified 78 children with LTMV dependence who weaned from ventilator support. There were 25 unique device names and 28 unique ventilation mode names used in the cohort. We identified multiple Clinical Ideas necessary to describe ventilator support over time: device, interface, ventilation mode, settings, measurements, and duration of ventilation usage per day. We used Concepts from the SNOMED-CT vocabulary and integrated an existing ventilator mode taxonomy to create a framework for CDM and OMOP integration. CONCLUSION The proposed framework standardizes mechanical ventilation terminology and may facilitate efficient data exchange in a multisite network. Rapid data sharing is necessary to improve research and clinical care for children with LTMV dependence.
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Affiliation(s)
- Lara J Kanbar
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Judith W Dexheimer
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Janet Zahner
- Department of Information Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Evanette K Burrows
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Robert Chatburn
- Program Manager Enterprise Research for Respiratory Care, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amanda Messinger
- Department of Pediatrics, Section of Pulmonary and Sleep Medicine, University of Colorado, Denver, Colorado, USA
| | - Christopher D Baker
- Department of Pediatrics, Section of Pulmonary and Sleep Medicine, University of Colorado, Denver, Colorado, USA
| | - Christine L Schuler
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Division of Hospital Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Dan Benscoter
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Raouf Amin
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Nathan Pajor
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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13
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Kayode A, Adrish S, Muhammad A, Amin R, Muhammad D, Rida Z, Alabi G, Okumede G, Kayode O. Therapeutic Uses of Medical Cannabis: An Overview of its Functions in Disease Management. J of Medical Sciences 2023. [DOI: 10.3923/jms.2023.32.39] [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: 04/07/2023] Open
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14
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Ignatiuk D, Xiao Q, McConnell K, Fleck R, Schuler C, Schuh A, Amin R, Bates A. Computational assessment of upper airway muscular activity in obstructive sleep apnea - In vitro validation. J Biomech 2022; 144:111304. [PMID: 36170766 PMCID: PMC9664483 DOI: 10.1016/j.jbiomech.2022.111304] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 03/22/2022] [Revised: 08/28/2022] [Accepted: 09/09/2022] [Indexed: 11/25/2022]
Abstract
Neuromuscular control of the upper airway contributes to obstructive sleep apnea (OSA). An accurate, non-invasive method to assess neuromuscular function is needed to improve surgical treatment outcomes. Currently, surgical approaches for OSA are based on airway anatomy and are often not curative. When the airway surface moves, the power transferred between air in the airway lumen and the structures of the upper airway may be a measure of airway neuromuscular activity. The aim of this study was to validate power transfer as a measure of externally applied forces, representing neuromuscular activity, through cine computed tomography (CT) imaging and computational fluid dynamics (CFD) analysis in a 3D-printed airway model. A hollow elastic airway model was manufactured. An insufflation/exsufflation device generated airflow within the model lumen. The model was contained in an airtight chamber that could be positively or negatively pressurized to represent muscular forces. These forces were systematically applied to dilate and collapse the model. Cine CT imaging captured airway wall movement during respiratory cycles with and without externally applied forces. Power transfer was calculated from the product of wall movement and internal aerodynamic pressure forces using CFD simulations. Cross-correlation peaks between power transfer and changes in externally applied pressure during exhalation and inhalation were -0.79 and 0.95, respectively. Power transfer calculated via cine CT imaging and CFD was an accurate surrogate measure of externally applied forces representing airway muscular activity. In the future, power transfer may be used in clinical practice to phenotype patients with OSA and select personalized therapies.
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Affiliation(s)
- Daniel Ignatiuk
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States; Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Qiwei Xiao
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Keith McConnell
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Robert Fleck
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Christine Schuler
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States; Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | | | - Raouf Amin
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
| | - Alister Bates
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States; Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, United States.
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15
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Amin R, Geirsdottir G, Mittendorfer-Rutz E, Björkenstam E, Chen L, Dorner T. Differences in labour market marginalisation among young immigrant groups and Swedish-born youth. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac130.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
There is a knowledge gap regarding the risk for labour market marginalisation among younger cohorts of refugees and non-refugee immigrants. We investigated if the risk of long-term unemployment (LTU) and disability pension (DP) differs between young refugees and non-refuge immigrants compared to the Swedish-born. The role of age at arrival, duration of residency and morbidity in this association was also investigated.
Methods
All 19- to 25-year-olds residing in Sweden on 31 December 2004 (1691 refugees who were unaccompanied by a parent at arrival, 24,697 accompanied refugees, 18,762 non-refugee immigrants and 621,455 Swedish-born individuals) were followed from 2005 to 2016 regarding LTU (>180 days annually) and DP using nationwide register data. Cox regression models were used to estimate crude and multivariate-adjusted (adjusted for several socio-demographic, labour market and health-related covariates) hazard ratios (aHRs) with 95% confidence intervals.
Results
Compared to the Swedish-born, all migrant groups had around a 1.8-fold higher risk of LTU (range aHR=1.71-1.83) and around a 30% lower risk of DP (range aHR=0.66-0.76). Older age at arrival was associated with a higher risk of LTU only for non-refugee immigrants. Both older age at arrival and a shorter duration of residency were associated with a lower risk of DP for all migrant groups. Psychiatric morbidity had the strongest effect on subsequent DP, with no significant differences between migrant groups and the Swedish-born (range aHR=5.1-6.1).
Conclusions
Young immigrants had a higher risk of LTU and a lower risk of DP than their Swedish-born peers. No differences between the different immigrant groups were found. Age at arrival, psychiatric morbidity and duration of residency are strong determinants of being granted DP.
Key messages
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Affiliation(s)
- R Amin
- Department of Clinical Neuroscience, Karolinska Institutet , Stockholm, Sweden
| | - G Geirsdottir
- Department of Clinical Neuroscience, Karolinska Institutet , Stockholm, Sweden
| | - E Mittendorfer-Rutz
- Department of Clinical Neuroscience, Karolinska Institutet , Stockholm, Sweden
| | - E Björkenstam
- Department of Clinical Neuroscience, Karolinska Institutet , Stockholm, Sweden
| | - L Chen
- Department of Clinical Neuroscience, Karolinska Institutet , Stockholm, Sweden
| | - T Dorner
- Department of Clinical Neuroscience, Karolinska Institutet , Stockholm, Sweden
- Karl-Landsteiner Institute, Health Promotion Research , Vienna, Austria
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16
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Amoakon J, Lee J, Mylavarapu G, Amin R, Naren A. 654 Mechanism of pulmonary vascular dysfunction in cystic fibrosis. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)01344-3] [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: 11/07/2022]
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17
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Geirsdottir G, Mittendorfer-Rutz E, Amin R. Risk of suicide attempt and suicide in young adult refugees compared to their Swedish-born peers: a register-based cohort study. Eur Psychiatry 2022. [PMCID: PMC9565294 DOI: 10.1192/j.eurpsy.2022.825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Refugees, especially minors, who often have experienced traumatic events, are a vulnerable group regarding poor mental health. Little is known, however, of their risk of suicidal behaviour as young adults. Objectives We aimed to investigate the risk of suicidal behaviour for young adult refugees who migrated as minors. The moderating role of education and history of mental disorders in this association was also investigated. Methods In this register linkage study, all 19-30-year-old Swedish-born (n = 1,149,855) and refugees (n = 51,098) residing in Sweden on December 31st, 2009 were included. The follow-up period covered 2010-2016. Cox models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). The multivariate models were adjusted for socio-demographic, labour market marginalisation and health-related factors. Results Compared to Swedish-born, the risk of suicide attempt was lower for all refugees (HR 0.78, 95% CI 0.70-0.87), and accompanied refugee minors (HR 0.77, 95% CI 0.69-0.87), but estimates did not differ for unaccompanied refugee minors (HR 0.83, 95% CI 0.62-1.10). Low education and previous mental disorders increased the risk of suicide attempt in both refugees and Swedish-born, with lower excess risks in refugees. Findings for suicide were similar to those of suicide attempt. Conclusions Young adult refugees have a lower risk of suicidal behaviour than their Swedish-born peers, even if they have low educational level or have mental disorders. Young refugees who entered Sweden unaccompanied do not seem to be equally protected and need specific attention. Disclosure No significant relationships.
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18
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Amin R, Mittendorfer-Rutz E, Mehlum L, Runeson B, Helgesson M, Tinghög P, Björkenstam E, Holmes E, Qin P. Does country of resettlement influence the risk of suicide in refugees? A case-control study in Sweden and Norway. Eur Psychiatry 2022. [PMCID: PMC9564977 DOI: 10.1192/j.eurpsy.2022.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Little is known regarding how the risk of suicide in refugees relates to their host country. Specifically, to what extent, inter-country differences in structural factors between the host countries may explain the association between refugee status and subsequent suicide is lacking in previous literature. Objectives We aimed to investigate the risk of suicide among refugees in Sweden and Norway according to their sex, age, region/country of birth and duration of residence. Methods Each suicide case between the age of 18-64 years during 1998 and 2018 (17,572 and 9,443 cases in Sweden and Norway, respectively) was matched with up to 20 population-based controls, by sex and age. Multivariate-adjusted conditional logistic regression models yielding adjusted odds ratios (aORs) with 95% confidence intervals (95% CI) were used to test the association between refugee status and suicide. Results
The aORs for suicide in refugees in Sweden and Norway were 0.5 (95% CI: 0.5-0.6) and 0.3 (95% CI: 0.3-0.4), compared with the Swedish-born and Norwegian-born individuals, respectively. Stratification by region/country of birth showed similar statistically significant lower odds for most refugee groups in both host countries except for refugees from Eritrea (aOR 1.0, 95% CI: 0.7-1.6) in Sweden. The risk of suicide did not vary much across refugee groups by their duration of residence, sex and age. Conclusions
The findings of almost similar suicide mortality advantages among refugees in two host countries may suggest that resiliency and culture/religion-bound attitudes could be more influential for suicide risk among refugees than other post-migration environmental and structural factors in the host country. Disclosure No significant relationships.
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Denizot Y, Braza MS, Amin R. Editorial: B Cell Non-Hodgkin’s Lymphoma & Tumor Microenvironment Crosstalk: An Epigenetic Matter? Front Genet 2022; 13:912737. [PMID: 35664310 PMCID: PMC9161633 DOI: 10.3389/fgene.2022.912737] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/07/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Y Denizot
- UMR CNRS 7276, INSERM U1262, Equipe Labellise LIGUE 2018, Universite de Limoges, CBRS, Limoges, France
| | - MS Braza
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - R Amin
- Department of Biochemistry, University of Nebraska at Lincoln, Lincoln, NE, United States
- *Correspondence: R Amin,
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Amin R, Julia Calvo J, Mccready J, Silberbauer J, Mann I. Utilising the pericardial CO2 insufflation technique to facilitate endo-epicardial AF ablation, achieving linear radiofrequency lesion sets, for persistent atrial fibrillation. Europace 2022. [DOI: 10.1093/europace/euac053.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
High rates of persistent atrial fibrillation (PsAF) recurrence have been attributed to conduction gaps, non-transmural linear lesion sets and epicardial substrate. Hybrid thorascopic endo-epicardial AF ablation has been shown to reduce PsAF recurrence when compared to endocardial ablation alone, however with higher complication rates.
Aim
We propose that the percutaneous pericardial CO2 insufflation technique to access the pericardial space can be safely and effectively used for epicardial mapping and ablation of the left atrium (LA).
Methods
In a single centre, 15 patients with PsAF (6 with longstanding PsAF) and previous pulmonary vein isolation (PVI), underwent concurrent endo-epicardial AF ablation, using the subxiphoid percutaneous pericardial CO2 insufflation technique, whilst on uninterrupted anticoagulation. Endo-epicardial geometry and bipolar voltage maps were undertaken, and endocardial LA ablation performed comprising a roof, inferior and anterior mitral line (AML) (target LSI 5 for the inferior line and 6 on the roof and AML). If required, additional epicardial ablation was undertaken to establish PVI and linear lesion block.
Results
Epicardial access was achieved in all patients without acute bleeding complication. Epicardial mapping of the LA, in both transverse and oblique pericardial sinuses, was successful in all patients (Figure 1A, B). Excluding one roof line, all other linear lesions were blocked (44/45). Endocardial ablation alone achieved block in 67% (10 of 15) of roof lines, 87% (13 of 15) of inferior lines and 27% (4 of 15) of AMLs despite extensive endocardial ablation. Of AMLs requiring epicardial ablation, in 91% (10/11) block was achieved with ablation on the upper third of AML via the transverse sinus (Figure 1C). Epicardial ablation directly on the roof line via the transverse sinus was required to achieve block in 3 cases, and block achieved remotely on the upper third of the AML in another. Epicardial ablation on the mid inferior line was required in 2 cases to achieve block. Six patients had arrhythmia recurrence during the blanking period with 5 patients requiring DCCV and 1 patient chemically cardioverting. With a mean follow up time of 225 days, 2 patients have had paroxysmal self-terminating episodes of atrial arrhythmia with all patients off anti-arrhythmic medication.
Conclusion
Use of the subxiphoid percutaneous pericardial CO2 insufflation technique to achieve epicardial access for LA mapping and ablation is feasible and safe whilst on uninterrupted anticoagulation. Limited success in ablation for PsAF beyond PVI may be due to difficulty in creating trans-mural linear lesions. Epicardial ablation can be safely performed to achieve linear block in the roof, anterior and inferior LA. Epicardial fibrous structures such as the septopulmonary bundle and Bachmann’s bundle likely contribute to difficulty blocking roof lines and AMLs endocardially.
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Affiliation(s)
- R Amin
- Sussex Cardiac Centre, Brighton, United Kingdom of Great Britain & Northern Ireland
| | - J Julia Calvo
- Sussex Cardiac Centre, Brighton, United Kingdom of Great Britain & Northern Ireland
| | - J Mccready
- Sussex Cardiac Centre, Brighton, United Kingdom of Great Britain & Northern Ireland
| | - J Silberbauer
- Sussex Cardiac Centre, Brighton, United Kingdom of Great Britain & Northern Ireland
| | - I Mann
- Sussex Cardiac Centre, Brighton, United Kingdom of Great Britain & Northern Ireland
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21
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Amin R, Bari MA, Parvin T, Aditya G, Rahman MS, Thakur AK, Kamal AM, Ahmed SM. Association of Body Mass Index with Angiographic Severity of Coronary Artery disease in patients with Acute Coronary Syndrome. Mymensingh Med J 2022; 31:326-332. [PMID: 35383745] [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: 06/14/2023]
Abstract
Coronary artery disease (CAD) is the leading cause of death in developed and developing countries. Associated co-morbidities like diabetes, hypertension and obesity are making the situation worse. WHO enlisted obesity as an epidemic which also affects a great number of young population. Some recent studies showed the presence of an apparent paradoxical relationship between obesity and cardiovascular prognosis in certain subsets of patents. As BMI is an established marker of obesity; an attempt has been made to assess relationship between BMI and angiographic severity of coronary artery disease in Acute Coronary Syndrome (ACS) patients of Bangladeshi origin. To assess the association between body mass index and angiographic severity of coronary artery disease in patients with acute coronary syndrome; this cross sectional analytical study was conducted in the Department of Cardiology, Mymensingh Medical College Hospital (MMCH) and Bangabandhu Sheikh Mujib Medical University (BSMMU) from December 2016 to February 2018 among purposively selected 65 patients. Relevant ethical issues were taken into consideration. Coronary angiogram was done in the same index hospitalization period. After coronary angiogram performed patients were grouped into two groups according to their BMI. Patients with BMI <25kg/m² as Group I and those ≥25kg/m² as Group II. Angiographic severity of coronary artery disease was assessed by vessel score and Syntax score. Mean age of Group I was 54.45±10.42 years, while in Group II it was 50.76±8.89 years reflecting the early presentation of higher BMI patients. Male to female ratio was 12:1. Mean BMI of Group I and Group II was 22.56±1.59 and 28.67±2.64 respectively. In Group I, 10(25.0%) had single vessel lesion, 15(37.5%) had double vessel lesion and 14(35.0%) had triple vessel lesion, while in Group II, 6(24.0%) had single vessel lesion, 12(48.0%) had double vessel lesion and 5(20.0%) had triple vessel lesion. Mean Syntax score of Group I and Group II was 13.18±8.45 and 10.42±7.14 respectively. Patients in the increasing BMI class had a higher prevalence of diabetes, hypertension and dyslipidaemia. A negative correlation was observed between BMI and angiographic severity (Vessel score, Syntax score and HRCA e.g. LM disease) of CAD indicating that patients with higher BMI had a lower coronary artery disease (CAD) severity than their normal BMI counterparts. Patients with high BMI have a lower CAD severity than usually expected. After adjustment for co-morbidities, BMI was not found as an independent predictor of severity of coronary artery disease.
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Affiliation(s)
- R Amin
- Dr Ruhul Amin, Resident, Department of Cardiology, Mymensingh Medical College (MMC), Mymensingh, Bangladesh; E-mail:
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22
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Amin R. Beyond the Retrotrapezoid Nucleus in Congenital Central Hypoventilation Syndrome. Am J Respir Crit Care Med 2021; 205:271-272. [PMID: 34905719 PMCID: PMC8886996 DOI: 10.1164/rccm.202111-2602ed] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Raouf Amin
- Cincinnati Children's Hospital Medical Center, Pulmonary Medicine, Cincinnati, Ohio, United States;
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23
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Amorim MR, Amin R, Polotsky VY. Of Mice and Babies: PHOX2B and Obstructive Apneas in Congenital Central Hypoventilation Syndrome. Am J Respir Crit Care Med 2021; 204:1128-1130. [PMID: 34634223 PMCID: PMC8759302 DOI: 10.1164/rccm.202108-1989ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Mateus Ramos Amorim
- Department of Medicine Johns Hopkins University School of Medicine Baltimore, Maryland
| | - Raouf Amin
- Division of Pulmonary Medicine Cincinnati Children's Hospital Medical Center Cincinnati, Ohio
- Department of Pediatrics University of Cincinnati College of Medicine Cincinnati, Ohio
| | - Vsevolod Y Polotsky
- Department of Medicine Johns Hopkins University School of Medicine Baltimore, Maryland
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24
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Mylavarapu G, Gutmark E, Shott S, Fleck R, Mahmoud M, McConnell K, Szczesniak R, Hossain MM, Huang G, Tadesse DG, Schuler CL, Khosla S, Amin R. Predicting critical closing pressure in children with obstructive sleep apnea using fluid-structure interaction. J Appl Physiol (1985) 2021; 131:1629-1639. [PMID: 34528458 PMCID: PMC8616603 DOI: 10.1152/japplphysiol.00694.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 08/04/2021] [Accepted: 08/30/2021] [Indexed: 11/22/2022] Open
Abstract
Surgical treatment of obstructive sleep apnea (OSA) in children requires knowledge of upper airway dynamics, including the closing pressure (Pcrit), a measure of airway collapsibility. We applied a flow-structure interaction (FSI) computational model to estimate Pcrit in patient-specific upper airway models obtained from magnetic resonance imaging (MRI) scans. We sought to examine the agreement between measured and estimated Pcrit from FSI models in children with Down syndrome. We hypothesized that the estimated Pcrit would accurately reflect measured Pcrit during sleep and therefore reflect the severity of OSA as measured by the obstructive apnea-hypopnea index (AHI). All participants (n = 41) underwent polysomnography and sedated sleep MRI scans. We used Bland-Altman plots to examine the agreement between measured and estimated Pcrit. We determined associations between estimated Pcrit and OSA severity, as measured by AHI, using regression models. The agreement between passive and estimated Pcrit showed a fixed bias of -1.31 [confidence interval (CI) = -2.78, 0.15] and a nonsignificant proportional bias. A weaker agreement with active Pcrit was observed. A model including AHI, gender, an interaction term for AHI, and gender and neck circumference explained the largest variation (R2 = 0.61) in the relationship between AHI and estimated Pcrit (P < 0.0001). Overlap between the areas of the airway with the lowest stiffness, and areas of collapse on dynamic MRI, was 77.4 ± 30% for the nasopharyngeal region and 78.6 ± 33% for the retroglossal region. The agreement between measured and estimated Pcrit and the significant association with AHI supports the validity of Pcrit estimates from the FSI model.NEW & NOTEWORTHY We present a noninvasive method for estimating critical closing pressure (Pcrit) using fluid-structure interaction (FSI) simulations and magnetic resonance imaging (MRI) scans in patients with obstructive sleep apnea (OSA). We used patient-specific stiffness measures in our FSI model to account for any individual variability in the elasticity of soft tissues surrounding the upper airway. We validated this model by measuring the degree of agreement between measured and estimated Pcrit.
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Affiliation(s)
- Goutham Mylavarapu
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Ephraim Gutmark
- Department of Aerospace Engineering and Engineering Mechanics, University of Cincinnati, Cincinnati, Ohio
- Department of Otolaryngology, University of Cincinnati, Cincinnati, Ohio
| | - Sally Shott
- Division of Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Robert Fleck
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Mohamed Mahmoud
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Keith McConnell
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Rhonda Szczesniak
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Md Monir Hossain
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Guixia Huang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Dawit G Tadesse
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Christine L Schuler
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Sid Khosla
- Department of Otolaryngology, University of Cincinnati, Cincinnati, Ohio
| | - Raouf Amin
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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25
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Helgesson M, Rahman S, Björkenstam E, Gustafsson K, Amin R, Taipale H, Tanskanen A, Ekselius L, Mittendorfer-Rutz E. Trajectories of labour market marginalisation among young adults with newly diagnosed attention-deficit/hyperactivity disorder (ADHD). Epidemiol Psychiatr Sci 2021; 30:e67. [PMID: 35275514 PMCID: PMC8546500 DOI: 10.1017/s2045796021000536] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 11/06/2022] Open
Abstract
AIMS Labour market marginalisation (LMM), i.e. severe problems in finding and keeping a job, is common among young adults with attention-deficit/hyperactivity disorder (ADHD). This study aimed to disentangle the extent of LMM as well as the heterogeneity in patterns of LMM among young adults with ADHD and what characterises those belonging to these distinct trajectories of LMM. METHODS This population-based register study investigated all 6287 young adults, aged 22-29 years, who had their first primary or secondary diagnosis of ADHD in Sweden between 2006 and 2011. Group-based trajectory (GBT) models were used to estimate trajectories of LMM, conceptualised as both unemployment and work disability, 3 years before and 5 years after the year of an incident diagnosis of ADHD. Odds ratios (ORs) with 95% confidence intervals (CIs) for the association between individual characteristics and the trajectory groups of LMM were estimated by multinomial logistic regression. RESULTS Six distinct trajectories of LMM were found: 'increasing high' (21% belonged to this trajectory group) with high levels of LMM throughout the study period, 'rapidly increasing' (19%), 'moderately increasing' (21%), 'constant low' (12%) with low levels of LMM throughout the study period, 'moderately decreasing' (14%) and finally 'fluctuating' (13%), following a reversed u-shaped curve. Individuals with the following characteristics had an increased probability of belonging to trajectory groups of increasing LMM: low educational level (moderately increasing: OR: 1.4; CI: 1.2-1.8, rapidly increasing: OR: 1.7; CI: 1.3-2.1, increasing high: OR: 2.9; CI: 2.3-3.6), single parents (moderately increasing: OR: 1.6; CI: 1.1-2.4, rapidly increasing: OR: 2.0; CI: 1.3-3.0), those born outside the European Union/the Nordic countries (rapidly increasing: OR: 1.7; CI: 1.1-2.5, increasing high: OR: 2.1; CI: 1.4-3.1), persons living in small cities/villages (moderately increasing: OR: 2.4; CI: 1.9-3.0, rapidly increasing: OR: 2.1; CI: 1.6-2.7, increasing high: OR: 2.6; CI: 2.0-3.3) and those with comorbid mental disorders, most pronounced regarding schizophrenia/psychoses (rapidly increasing: OR: 6.7; CI: 2.9-19.5, increasing high: OR: 12.8; CI: 5.5-37.0), autism spectrum disorders (rapidly increasing: OR: 4.6; CI: 3.1-7.1, increasing high: OR: 9.6; CI: 6.5-14.6), anxiety/stress-related disorders (moderately increasing: OR: 1.3; CI: 1.1-1.7, rapidly increasing: OR: 2.0; CI: 1.6-2.5, increasing high: OR: 1.8; CI: 1.5-2.3) and depression/bipolar disorder (moderately increasing: OR: 1.3; CI: 1.0-1.6, rapidly increasing: OR: 1.7; CI: 1.4-2.2, increasing high: OR: 1.5; CI: 1.2-1.9). CONCLUSIONS About 61% of young adults were characterised by increasing LMM after a diagnosis of ADHD. To avoid marginalisation, attention should especially be given to young adults diagnosed with ADHD with a low educational level, that are single parents and who are living outside big cities. Also, young adults with comorbid mental disorders should be monitored for LMM early in working life.
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Affiliation(s)
- M. Helgesson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-17177Stockholm, Sweden
| | - S. Rahman
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-17177Stockholm, Sweden
| | - E. Björkenstam
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-17177Stockholm, Sweden
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - K. Gustafsson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-17177Stockholm, Sweden
| | - R. Amin
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-17177Stockholm, Sweden
| | - H. Taipale
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-17177Stockholm, Sweden
- Department of Forensic Psychiatry, Niuvanniemi Hospital, Kuopio, Finland
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - A. Tanskanen
- Department of Forensic Psychiatry, Niuvanniemi Hospital, Kuopio, Finland
| | - L. Ekselius
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - E. Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-17177Stockholm, Sweden
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Kashem TS, Begum NAS, Sayed A, Arefin S, Alam K, Amin R, Rashid HU. An unusual and late presentation of urinary leak post-kidney transplantation requiring ureteroureterostomy at the single tertiary center of Bangladesh: a case report. Korean Journal of Transplantation 2021. [DOI: 10.4285/atw2021.or-1196] [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: 11/04/2022] Open
Affiliation(s)
| | - NAS Begum
- Department of Nephrology, Kidney Foundation Hospital, Dhaka, Bangladesh
| | - A Sayed
- Department of Nephrology, Kidney Foundation Hospital, Dhaka, Bangladesh
| | - S Arefin
- Department of Nephrology, Kidney Foundation Hospital, Dhaka, Bangladesh
| | - K Alam
- Department of Nephrology, Kidney Foundation Hospital, Dhaka, Bangladesh
| | - R Amin
- Department of Nephrology, Kidney Foundation Hospital, Dhaka, Bangladesh
| | - HU Rashid
- Department of Nephrology, Kidney Foundation Hospital, Dhaka, Bangladesh
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27
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Rahman MS, Bari MA, Ahmed SM, Sharif JU, Bhowmick K, Chowdhury MS, Abdullah M, Amin R, Shakil SS. Role of High Neutrophil Lymphocyte Ratio as an Independent Predictor of Adverse In-Hospital Outcomes in Patients with First Attack of ST-Elevation Myocardial Infarction Thrombolysed with Streptokinase. Mymensingh Med J 2021; 30:921-928. [PMID: 34605457] [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: 06/13/2023]
Abstract
Atherosclerosis is the pathognomic sign of ischaemic heart disease. Inflammation of the coronary artery contributes to the development of atherosclerosis. Neutrophil-to-lymphocyte ratio (NLR) has been reported to predict the risk of CAD and associated events in patients with ST-Segment elevation myocardial infarction (STEMI). This study was done to investigate the role of neutrophil-to-lymphocyte ratio (NLR) in predicting in-hospital adverse cardiac events in patients with STEMI thrombolysed with streptokinase (STK). This cross sectional descriptive type of study was conducted in the Department of Cardiology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from August, 2017 to October, 2018. The STEMI patients, thrombolysed with STK had blood samples at admission, analyzed for complete blood counts and NLR calculated. They were grouped into two, low and high NLR, taking 4.50 as cut-off value. Chi square test was used to compare rate of adverse events and death in hospital stay. Logistic regression analysis was used to estimate predictive ability of NLR for in-hospital cardiac events. A total of 87 (39.90%) patients had complications. Patients in high NLR group had higher rate of complications (48.3% vs. 22.5%, p<0.001) in hospital than those in low NLR group. Arrhythmias (21.1% vs. 9.9%, p<0.041), heart failure (27.9% vs. 14.1%, p=0.024), cardiogenic shock (16.3% vs. 4.2%, p<0.011), death (6.8% vs. 2.8%, p=0.227), re-infarction /post MI angina (4.1% vs. 0.0% p=0.084) occurred more in high NLR group. Mean NLR was significantly different between Group I and Group II (3.11±0.84 vs. 10.20±6.08, p<0.0001). Multivariate regression analysis showed NLR an independent predictor of in-hospital adverse cardiac events (p<0.0001). High on admission NLR is an independent predictor for in-hospital adverse cardiac events in patients with STEMI thrombolysed with streptokinase.
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Affiliation(s)
- M S Rahman
- Dr Md Saidur Rahman, Junior Consultant (Cardiology), Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh; E-mail:
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Beattie E, Dowling J, Chardon JW, Kothary R, Lintern S, Amin R, Buffone T, Brais B, Campbell C, Gagnon C, Gonorazky H, Karamchandani J, Korngut L, McMillan H, Oskoui M, Osman H, Selby K, Wojtal D, Worsfold N, Lochmüller H. REGISTRIES AND CARE OF NMD. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kanannejad Z, Alyasin S, Esmaeilzadeh H, Nabavizadeh H, Amin R. Asthma and COVID-19 pandemic: focused on the eosinophil count and ACE2 expression. Eur Ann Allergy Clin Immunol 2021; 54:284-289. [PMID: 34503323 DOI: 10.23822/eurannaci.1764-1489.233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Summary Currently, the world is engaged with a coronavirus disease 2019 (COVID-19) caused by acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection. The Center for Disease Control and Prevention (CDC) has proposed moderate to severe asthma as a risk factor for COVID-19 susceptibility and severity. However, current evidences have not identified asthma in the top 10 comorbidities associated with COVID-19 fatalities. It raises the question that why patients with different type of asthma are not more vulnerable to SARS-CoV-2 infection like other respiratory infection. Increased number of eosinophils and elevated angiotensin-converting enzyme 2 (ACE2) expressions in asthma are supposed as two mechanisms which associated with decreased COVID-19 susceptibility in asthmatics. Some studies have been performed to evaluate two mentioned factors in asthmatic patients compared with healthy individuals. Herein, we address these mechanisms and investigate whether ACE2 and eosinophil could protect asthmatic patients against SARS-CoV-2 infection.
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Affiliation(s)
- Z Kanannejad
- Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - S Alyasin
- Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Allergy and Clinical Immunology, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - H Esmaeilzadeh
- Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Allergy and Clinical Immunology, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - H Nabavizadeh
- Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Allergy and Clinical Immunology, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - R Amin
- Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Allergy and Clinical Immunology, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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30
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Rashad M, Shaalan N, Abd-Elmageed A, Amin R, Hafiz M, Abu-Sehly A. The effects of different dopant on the optical parameters for selenium tellurium thin films. Optik 2021; 241:166102. [DOI: 10.1016/j.ijleo.2020.166102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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31
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Borschuk AP, Williams SE, McClure JM, Kendall M, Mack L, Coleman M, Gurbani N, Benscoter D, Amin R, Stark LJ. A novel behavioral health program for family caregivers of children admitted to a transitional chronic ventilator unit. Pediatr Pulmonol 2021; 56:1635-1643. [PMID: 33647193 DOI: 10.1002/ppul.25327] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND The care of mechanically ventilated pediatric patients is complex and burdensome. It is essential to adequately support the family caregivers of these children to optimize outcomes; however, there is no literature describing interventions for caregivers in this population. RESEARCH QUESTION This study described a novel behavioral health program and examined its impact on family caregiver engagement and psychological distress on a pediatric inpatient chronic ventilator unit. STUDY DESIGN AND METHODS Electronic chart review was completed with retrospective and prospective participant enrollment for the purposes of longitudinal evaluation of caregiver engagement. For analytic purposes, participants were grouped into three categories: (1) preprogram, (2) postprogram, and (3) postprogram with completion of psychotherapy. RESULTS The behavioral health program was associated with increased caregiver participation in rounds, t = 7.76, p = < .001. Parents who completed a course of psychotherapy within the behavioral health program demonstrated reduced time to training completion (F = 5.89; p < .01), higher staff-rated caregiver engagement (F = 3.69; p < .05), and significantly reduced levels of caregiver distress (t = 2.09; p < .05).
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Affiliation(s)
- Adrienne P Borschuk
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Sara E Williams
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jessica M McClure
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Megan Kendall
- Division of Social Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lisa Mack
- Division of Patient Services Administration, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Michelle Coleman
- Division of Patient Services Administration, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Neepa Gurbani
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Dan Benscoter
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Raouf Amin
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lori J Stark
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Brufsky A, Kim S, Zvirbule Ž, Eniu A, Mebis J, Sohn J, Wongchenko M, Chohan S, Amin R, Yan Y, McNally V, Miles D, Loi S. A phase II randomized trial of cobimetinib plus chemotherapy, with or without atezolizumab, as first-line treatment for patients with locally advanced or metastatic triple-negative breast cancer (COLET): primary analysis. Ann Oncol 2021; 32:652-660. [DOI: 10.1016/j.annonc.2021.01.065] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 01/18/2021] [Accepted: 01/23/2021] [Indexed: 01/28/2023] Open
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Rashad M, Shaalan N, Abd-Elmageed A, Amin R, Hafiz M, Abu-Sehly A. Extensive thermal study of sulfur dopants effects on the selenium tellurium glasses. Journal of Non-Crystalline Solids 2021; 558:120630. [DOI: 10.1016/j.jnoncrysol.2020.120630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Al Shareef W, Sayed S, Kamel S, Alkaf H, Bahaj A, Amin R, Al Herabi A. Locally advanced tongue squamous cell carcinoma in epidermolysis simplex bullosa patient: a therapeutic conundrum. Ann R Coll Surg Engl 2021; 103:e85-e87. [PMID: 33645266 DOI: 10.1308/rcsann.2020.7080] [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: 11/22/2022] Open
Abstract
Epidermolysis bullosa simplex (EBS) is a debilitating condition affecting the skin and mucous membranes that is characterised by frequent ulceration and blistering on trivial trauma. In EBS, oral cavity mucosal injuries lead to a high propensity for developing squamous cell carcinomas. Locally advanced tongue carcinoma arising in this background presents a challenging therapeutic conundrum. To our knowledge, this is the first case of aggressive locally advanced tongue carcinoma that has developed sporadically in a patient with EBS and no family history. Routine screening of oral mucosal lesions will lead to early detection and timely management of this debilitating condition.
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Affiliation(s)
- W Al Shareef
- Head and Neck & Skull Base Centre, King Abdullah Medical City, Mecca, Saudi Arabia
| | - S Sayed
- Head and Neck & Skull Base Centre, King Abdullah Medical City, Mecca, Saudi Arabia
| | - S Kamel
- Head and Neck & Skull Base Centre, King Abdullah Medical City, Mecca, Saudi Arabia
| | - H Alkaf
- Head and Neck & Skull Base Centre, King Abdullah Medical City, Mecca, Saudi Arabia
| | - A Bahaj
- Head and Neck & Skull Base Centre, King Abdullah Medical City, Mecca, Saudi Arabia
| | - R Amin
- Head and Neck & Skull Base Centre, King Abdullah Medical City, Mecca, Saudi Arabia
| | - A Al Herabi
- Head and Neck & Skull Base Centre, King Abdullah Medical City, Mecca, Saudi Arabia
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Abstract
The world will never be the same after the current COVID-19 pandemic. We may have to live with the coronavirus for a long time. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has resulted in a major burden on the global health system and economy. This report describes the current COVID-19 landscape and its socioeconomic implications. Despite the concerns for second waves of infection, gradual lifting of lockdown restrictions has occurred worldwide to relieve economic pressures and likely contributes towards possibly surging of outbreak although region wise variation exists due to several other biological factors, such as testing capacity and basic healthcare facilities among susceptible population within that region. Different prediction models have been put forth to forecast the spread of the current outbreak. However, it is challenging to perceive the precise changes happening in the real world as every time dynamics differ same as other epidemics cannot possibly be exactly superimposed to COVID-19. Currently, to decrypt the conundrum for effective antiviral drug against SARS-CoV-2 is in full swing. Due to high rate of mortality and it expeditiously spread is it decisive to understand the biological properties, clinical characteristics, epidemiology, evolution, pathogenesis for vaccine development and pathogenicity studies against the viral curb. Instant diagnostic and adequate therapeutics serve as a major intervention for the management of pandemic containment. Our study aims to analyze the impact of current measures and to suggest appropriate administrative strategic planning rather than to make somewhat authentic prediction in relation to the current scenario. Our predictive analysis study should be helpful against prevention, cure and control of the current outbreak of COVID-19 till the availability of cure or vaccine.
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Affiliation(s)
- A Khurshid
- DOW Research Institute of Biotechnology and Biomedical Sciences, DOW College of Biotechnology, DOW University of Health Sciences, Karachi, Pakistan.
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Saini S, Agrawal S, Stockford B, Bruce R, Amin R, Shaikh S, Katato G, Pansare M. P406 SURVEY EXPLORING BARRIERS TO ALLERGY CLINIC VISITS IN AN URBAN PEDIATRIC SUBSPECIALTY CENTER. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.155] [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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Abu-Sehly A, Rashad M, Hafiz M, Abd-Elmageed A, Amin R. Tuning optical properties of thin films based on selenium tellurium. Optical Materials 2020; 109:110291. [DOI: 10.1016/j.optmat.2020.110291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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38
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Amin R, Khoo M. Loop gain in paediatric sleep-disordered breathing: A different story from adults. Respirology 2020; 25:1119-1120. [PMID: 32602225 DOI: 10.1111/resp.13897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/03/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Raouf Amin
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Michael Khoo
- Center for Sleep Health using Bioengineering, University of Southern California, Los Angeles, CA, USA
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Amrani FA, Amin R, Chiang J, Boyd J, Vajsar J, Dowling J, Gonorazky H. SMA - CLINICAL. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.095] [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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Amburgey K, Dowling J, Chardon JW, Kothary R, Stead-Coyle B, Brais B, Campbell C, Gagnon C, McMillan H, Selby K, Korngut L, Oskoui M, Amin R, Esler P, Worsfold N, Buffone T, Wojtal D, Osman H, Lochmüller H. REGISTRIES, CARE, QUALITY OF LIFE, MANAGEMENT OF NMD. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.344] [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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41
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Essehli R, Maher K, Amin R, Abouimrane A, Mahmoud A, Muralidharan N, Petla RK, Yahia HB, Belharouak I. Iron-Doped Sodium Vanadium Oxyflurophosphate Cathodes for Sodium-Ion Batteries-Electrochemical Characterization and In Situ Measurements of Heat Generation. ACS Appl Mater Interfaces 2020; 12:41765-41775. [PMID: 32809791 DOI: 10.1021/acsami.0c11616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Sodium-ion batteries (NaIBs) are increasingly being envisioned for grid-scale energy-storage systems because of cost advantages. However, implementation of this vision has been challenged by the low-energy densities delivered by most NaIB cathodes. Toward addressing this challenge, the authors report the synthesis and characterization of a new iron-doped Na3Fe0.3V1.7O(PO4)2F2 cathode using a novel facile hydrothermal route. The synthesized material was characterized using scanning electron microscopy, X-ray diffraction, and Mössbauer spectroscopy techniques. The obtained discharge capacity in the half-cell configuration lies from 119 to 125 to 130 mA h/g at C/10 while tested using three different electrolyte formulations, dimethyl carbonate-ethylene carbonate (EC)-propylene carbonate (PC), diethyl carbonate-EC, and EC-PC, respectively. The synthesized cathodes were also evaluated in full-cell configurations, which delivered an initial discharge capacity of 80 mA h/g with NaTi2(PO4)3MWCNT as the anode. Ionic diffusivity and interfacial charge transfer kinetics were also evaluated as a function of temperature and sodium concentration, which revealed that electrochemical rate performances in this material were limited by charge-transfer kinetics. To understand the heat generation mechanism of the Na/Na3Fe0.3V1.7O(PO4)2F2 half-cell during charge and discharge processes, an electrochemical isothermal calorimetry measurement was carried out at different current rates for two different temperatures (25 and 45 °C). The results showed that the amount of heat generated was strongly affected by the operating charge/discharge state, C-rate, and temperature. Overall, this work provides a new synthesis route for the development of iron-doped Na3Fe0.3V1.7O(PO4)2F2-based high-performance sodium cathode materials aimed at providing a viable pathway for the development and deployment of large-scale energy-storage based on sodium battery systems.
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Affiliation(s)
- R Essehli
- Energy and Transportation Science Division, Oak Ridge National Laboratory, Oak Ridge Tennessee 37830, United States
| | - K Maher
- Qatar Environment and Energy Research Institute (QEERI), Hamad Bin Khalifa University, Qatar Foundation, 34110 Doha, Qatar
| | - R Amin
- Energy and Transportation Science Division, Oak Ridge National Laboratory, Oak Ridge Tennessee 37830, United States
| | - A Abouimrane
- Qatar Environment and Energy Research Institute (QEERI), Hamad Bin Khalifa University, Qatar Foundation, 34110 Doha, Qatar
| | - Abdelfattah Mahmoud
- GREENMAT, CESAM Research Unit, University of Liege, Chemistry Institute B6, Quartier Agora, Allée du 6 août, 13, B-4000 Liege, Belgium
| | - N Muralidharan
- Energy and Transportation Science Division, Oak Ridge National Laboratory, Oak Ridge Tennessee 37830, United States
| | - Ramesh Kumar Petla
- Qatar Environment and Energy Research Institute (QEERI), Hamad Bin Khalifa University, Qatar Foundation, 34110 Doha, Qatar
| | - H B Yahia
- Qatar Environment and Energy Research Institute (QEERI), Hamad Bin Khalifa University, Qatar Foundation, 34110 Doha, Qatar
| | - I Belharouak
- Energy and Transportation Science Division, Oak Ridge National Laboratory, Oak Ridge Tennessee 37830, United States
- Bredesen Center for Interdisciplinary Research and Graduate Education, Knoxville, Tennessee 37996, United States
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Byars KC, Chini B, Hente E, Amin R, Boat T. Sleep disturbance and sleep insufficiency in primary caregivers and their children with cystic fibrosis. J Cyst Fibros 2020; 19:777-782. [DOI: 10.1016/j.jcf.2020.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 02/26/2020] [Accepted: 04/13/2020] [Indexed: 12/27/2022]
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Sawnani H, Mayer OH, Modi AC, Pascoe JE, McConnell K, McDonough JM, Rutkowski AM, Hossain MM, Szczesniak R, Tadesse DG, Schuler CL, Amin R. Randomized trial of lung hyperinflation therapy in children with congenital muscular dystrophy. Pediatr Pulmonol 2020; 55:2471-2478. [PMID: 32658385 PMCID: PMC9047443 DOI: 10.1002/ppul.24954] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/07/2020] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Respiratory compromise in congenital muscular dystrophy (CMD) occurs, in part, from chest wall contractures. Passive stretch with hyperinsufflation therapy could reduce related costo-vertebral joint contractures. We sought to examine the impact of hyperinsufflation use on lung function and quality of life in children with CMD. STUDY DESIGN We conducted a randomized controlled trial on hyperinsufflation therapy in children with CMD at two centers. An individualized hyperinsufflation regimen of 15 minutes twice daily using a cough assist device over a 12 months period was prescribed. We measured lung function, quality of life, and adherence. To demonstrate reproducibility, pulmonary function was measured twice on the same day. A mixed-effects regression model adjusting for confounders was used to assess the effects of hyperinsufflation. RESULTS We enrolled 34 participants in the study; 31 completed the trial (n = 17 treatment group and n = 14 controls). Participants in the treatment group demonstrated a relative gain in lung volume measured at 4 and 8 months, but not at 12 months. The control group required increases in the maximum insufflation pressures to achieve maximum lung volumes while the treatment group did not. Adherence was best early in the study, peaking at the first visit and decreasing at subsequent visits. Caregiver-reported quality of life was higher in the treatment group. CONCLUSION Hyperinsufflation therapy is effective in increasing and sustaining lung volume over time. Adherence, however, was inconsistent and difficult to maintain. Further research should determine if improved adherence leads to sustained benefits of hyperinsufflation.
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Affiliation(s)
- Hemant Sawnani
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Oscar H Mayer
- Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Avani C Modi
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Division of Behavioral Medicine and Clinical Psychology, Center for Treatment Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - John E Pascoe
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Keith McConnell
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Joseph M McDonough
- Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Md Monir Hossain
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Division of Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Rhonda Szczesniak
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Division of Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Dawit G Tadesse
- Division of Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Christine L Schuler
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Raouf Amin
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Elhafez M, Yehia N, Amin R, Emam W, Hamouda S, El-Magd M. Quality enhancement of frozen Nile tilapia fillets using rosemary and thyme oil. ARQ BRAS MED VET ZOO 2020. [DOI: 10.1590/1678-4162-11855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT The food industry and the frozen fish sector in particular have benefitted greatly from advancements in food processing technologies. This study investigated the effect of adding natural antioxidants such as rosemary and thyme oil to frozen fillets of Nile tilapia (Oreochromis niloticus) in order to preserve their quality for consumers. Fillets were treated with rosemary and thyme at two concentrations (1% and 1.5%) and then were stored at 4°C. Samples were analyzed over 4 days for bacteriological (aerobic plate count, psychotropic count, and coliform count), chemical (determination of pH, thiobarbituric acid reactive substances-TBARS, and total volatile base nitrogen-TVB-N), and sensory quality examination (color, texture, and odor). Significant differences (P<0.05) were observed among different groups in terms of aerobic plate count, psychotropic count, and coliform count during the storage. Moreover, pH, TVB-N, and TBARS mean values in the treated groups were lower than those in the untreated group. The best sensory quality was obtained at the highest concentrations (1.5%) of thyme and rosemary oil.
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Affiliation(s)
| | | | | | - W. Emam
- University of Stirling, United Kingdom
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He Z, Armoni Domany K, Nava-Guerra L, Khoo MCK, Difrancesco M, Xu Y, Mcconnell K, Hossain MM, Amin R. Phenotype of ventilatory control in children with moderate to severe persistent asthma and obstructive sleep apnea. Sleep 2020; 42:5512962. [PMID: 31175805 DOI: 10.1093/sleep/zsz130] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 02/01/2019] [Indexed: 12/12/2022] Open
Abstract
STUDY OBJECTIVES To examine the role of ventilatory control in asthmatic children with obstructive sleep apnea (OSA) and the relationships between measures of ventilatory control, OSA severity, and pulmonary function. METHODS Five- to 18-year-old children with persistent asthma and nightly snoring were enrolled in the study. Children had physical examination, pulmonary function test, and polysomnography. Loop and controller gains were derived from 5 min segments which included a sigh during nonrapid eye movement sleep by applying a mathematical model that quantifies ventilatory control from the ensuing responses to the sighs. Plant gain was derived from 5 min segments of spontaneous breathing (i.e. without sighs). Nonparametric statistical tests were used for group comparisons. Cluster analysis was performed using Bayesian profile regression. RESULTS One hundred thirty-four children were included in the study, 77 with and 57 without OSA. Plant gain was higher in children with OSA than in those without OSA (p = 0.002). A negative correlation was observed between plant gain and forced expiratory volume in 1 second (p = 0.048) and the ratio of f forced expiratory volume to forced vital capacity (p = 0.02). Plant gain correlated positively with severity of OSA. Cluster analysis demonstrated that children with more severe OSA and abnormal lung function had higher plant gain and a lower controller gain compared with the rest of the population. CONCLUSIONS Children with OSA and persistent asthma with abnormal lung function have phenotypic characteristics which consist of diminished capacity of the lungs to maintain blood gas homeostasis reflected by an increase in plant gain and decreased chemoreceptor sensitivity.
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Affiliation(s)
- Zhihui He
- Department of Pediatric Respiration, Chongqing Ninth People's Hospital, Chongqing, China.,Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Keren Armoni Domany
- Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,Department of Pediatric Pulmonology, Critical Care and Sleep Medicine Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Leonardo Nava-Guerra
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA
| | - Michael C K Khoo
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA
| | - Mark Difrancesco
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Yuanfang Xu
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Keith Mcconnell
- Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Md Monir Hossain
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Raouf Amin
- Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Ahmed SM, Hoque AM, Rahman MS, Thakur AK, Amin R, Dhar S, Asaduzzaman M, Hasan MN, Islam MN. Correlation of Mean Platelet Volume with ST Segment Resolution after Thrombolytic Therapy in Patients with ST Elevation Myocardial Infarction. Mymensingh Med J 2020; 29:553-559. [PMID: 32844793] [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: 06/11/2023]
Abstract
Acute occlusive thrombosis of the coronary artery is the principal cause of myocardial infarction where platelets play an important role. Large size platelets, easily measured by mean platelets volume (MPV) are thrombogenic and commonly seen after ST-segment elevation myocardial infarction (STEMI). ST segment resolution has been shown as a simple non-invasive marker that reflects both epicardial and myocardial reperfusion following thrombolysis. The present study intended to investigate whether MPV on admission correlated with ST segment resolution following thrombolysis in STEMI patient. This cross-sectional analytical study was conducted in the department of cardiology, Mymensingh Medical College and Hospital (MMCH), Mymensingh, Bangladesh from December, 2016 to June, 2018. Total 284 patients with first attack of STEMI were included after considering inclusion and exclusion criteria. Sample population was divided into two groups, Group I - Patients with successful ST segment resolution (≥50%). Group II - Patients with impaired ST segment resolution (<50%). MPV on admission was estimated during estimation of Complete Blood Count (CBC) by Automated Haematology Analyzer & compared between two groups. Successful ST segment resolution (≥50%) was seen in 67% of patients after thrombolysis. Admission MPV was higher in patients with impaired ST segment resolution (<50%) group than patients with ≥50% ST-segment resolution group (12.42±0.89fl vs.10.35±0.77fl respectively, p=0.001). Statistically significant strong negative correlation between MPV and ST segment resolution percentage (r = -0.742, p=0.001) suggesting that the higher the level of MPV, the lower the ST segment resolution percentage in first attack of STEMI patients. Multivariate regression analysis found MPV level on admission as an independent predictor of ST segment resolution. The study concluded that high MPV on admission correlate with impaired ST segment resolution following thrombolysis in STEMI patients.
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Affiliation(s)
- S M Ahmed
- Dr Sayed Mainuddin Ahmed, Resident, Department of Cardiology, Mymensingh Medical College (MMC), Mymensingh, Bangladesh; E-mail:
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Khoo MCK, Hu WH, Amin R. Effects of Ventilation-Perfusion Mismatch on Severity of Obstructive Sleep Apnea: A Modeling Study. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2020:2792-2795. [PMID: 33018586 DOI: 10.1109/embc44109.2020.9175297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Plant gain quantifies the extent and rapidity with which arterial blood gases change following hypopneic or hyperpneic events. High plant gain, acting in concert with a highly collapsible upper airway and low arousal threshold, may contribute significantly towards increasing the severity of obstructive sleep apnea (OSA), even when controller gain is low. Elevated plant gain may be a manifestation of abnormal gas exchange resulting from ventilation-perfusion mismatch in the lungs. Using a mathematical model, we explore in this paper how ventilation-perfusion mismatch can affect plant gain, as well as the severity of OSA.
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48
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Kumar PR, Essehli R, Yahia HB, Amin R, Belharouak I. Electrochemical studies of a high voltage Na4Co3(PO4)2P2O7–MWCNT composite through a selected stable electrolyte. RSC Adv 2020; 10:15983-15989. [PMID: 35493634 PMCID: PMC9052416 DOI: 10.1039/d0ra02349c] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/03/2020] [Indexed: 11/21/2022] Open
Abstract
Na4Co3(PO4)2P2O7–MWCNT composites in 1 M NaPF6 in EC:DMC electrolytes deliver stable discharge capacities of 80 mA h g−1 and 78 mA h g−1 at normal and elevated temperatures, respectively. In a full cell configuration vs. NaTi2(PO4)3–MWCNT, they deliver an initial discharge capacity of 78 mA h g−1 at 0.2C rate.
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Affiliation(s)
- P. Ramesh Kumar
- Qatar Environment and Energy Research Institute (QEERI)
- Hamad Bin Khalifa University
- Qatar Foundation
- Doha
- Qatar
| | - R. Essehli
- Energy and Transportation Science Division
- Oak Ridge National Laboratory
- Oak Ridge
- USA
| | - H. B. Yahia
- Qatar Environment and Energy Research Institute (QEERI)
- Hamad Bin Khalifa University
- Qatar Foundation
- Doha
- Qatar
| | - R. Amin
- Energy and Transportation Science Division
- Oak Ridge National Laboratory
- Oak Ridge
- USA
| | - I. Belharouak
- Energy and Transportation Science Division
- Oak Ridge National Laboratory
- Oak Ridge
- USA
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Fishman H, Massicotte C, Li R, Zabih W, McAdam L, Al-Saleh S, Amin R. The accuracy of an ambulatory level III sleep study compared to a level I sleep study for the diagnosis of sleep-disordered breathing in children with neuromuscular disease. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Eyerly-Webb S, Nicolas CT, Watson D, Dion E, Amin R, Wagner AJ, Lampland A, Bendel-Stenzel E, Macardle CA, Kunisaki SM, Jorgenson A, Lillegard J, Feltis B. Dynamic discriminant model for predicting respiratory distress at birth based on mass volume ratio in fetuses with congenital lung malformation. Ultrasound Obstet Gynecol 2019; 54:759-766. [PMID: 30834623 DOI: 10.1002/uog.20255] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/13/2019] [Accepted: 02/22/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES The congenital lung malformation volume ratio (CVR) is a prenatal ultrasound measurement that parameterizes congenital lung malformation (CLM) size. The aims of this study were to use serial measurements to create estimated growth curves of fetal CVR for asymptomatic and symptomatic neonates with CLM and to investigate whether a discriminant prognostic model based on these measurements could predict accurately which fetuses with CLM will require invasive respiratory support at delivery and should therefore be delivered at a tertiary-care facility. METHODS This was a retrospective study of fetuses diagnosed prenatally with CLM at three tertiary-care children's hospitals between 2009 and 2016. Those with two or more sonographic measurements of CVR were included. Serial fetal CVR measurements were used to create estimated growth curves for neonates with and those without respiratory symptoms at delivery, defined as requiring invasive respiratory support for the first 24 h after delivery. A discriminant model based on serial CVR measurements was used to calculate the dynamic probability of the need for invasive respiratory support. The performance of this model overall and in preterm and term neonates was compared with those using maximum CVR thresholds of 1.0 and 1.6. RESULTS Of the 147 neonates meeting the inclusion criteria, 16 (10.9%) required postnatal invasive respiratory support. The estimated CVR growth curve models showed different growth trajectories for asymptomatic and symptomatic neonates, with significantly higher CVR in symptomatic neonates, and values peaking late in the second trimester at around 25 weeks' gestation in asymptomatic neonates. All prognostic methods had high accuracy for the prediction of the need for invasive respiratory support in term neonates, but the discriminant model had the best performance overall (area under the receiver-operating characteristics curve (AUC) = 0.88) and in the preterm population (AUC = 0.85). CONCLUSIONS The estimated CVR growth curves showed different growth patterns in asymptomatic and symptomatic neonates with CLM. The dynamic discriminant model performed well overall and particularly in neonates that were carried to term. Development of an externally validated clinical tool based on this analysis could be useful in determining the site of delivery for fetuses with CLM. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- S Eyerly-Webb
- Children's Hospitals and Clinics of Minnesota, Midwest Fetal Care Center, Minneapolis, MN, USA
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - C T Nicolas
- Children's Hospitals and Clinics of Minnesota, Midwest Fetal Care Center, Minneapolis, MN, USA
- Mayo Clinic, Division of General Surgery Research, Rochester, MN, USA
| | - D Watson
- Children's Hospitals and Clinics of Minnesota, Research Design and Analytics, Minneapolis, MN, USA
| | - E Dion
- Children's Hospitals and Clinics of Minnesota, Midwest Fetal Care Center, Minneapolis, MN, USA
| | - R Amin
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - A J Wagner
- Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - A Lampland
- Children's Hospitals and Clinics of Minnesota, Midwest Fetal Care Center, Minneapolis, MN, USA
| | - E Bendel-Stenzel
- Children's Hospitals and Clinics of Minnesota, Midwest Fetal Care Center, Minneapolis, MN, USA
| | - C A Macardle
- St Joseph Mercy Health System, Ypsilanti, MI, USA
| | - S M Kunisaki
- Johns Hopkins Children's Center, Baltimore, MD, USA
| | - A Jorgenson
- Children's Hospitals and Clinics of Minnesota, Midwest Fetal Care Center, Minneapolis, MN, USA
| | - J Lillegard
- Children's Hospitals and Clinics of Minnesota, Midwest Fetal Care Center, Minneapolis, MN, USA
- Mayo Clinic, Division of General Surgery Research, Rochester, MN, USA
- Pediatric Surgical Associates, Minneapolis, MN, USA
| | - B Feltis
- Children's Hospitals and Clinics of Minnesota, Midwest Fetal Care Center, Minneapolis, MN, USA
- Pediatric Surgical Associates, Minneapolis, MN, USA
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