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Tofts LJ, Simmonds J, Schwartz SB, Richheimer RM, O'Connor C, Elias E, Engelbert R, Cleary K, Tinkle BT, Kline AD, Hakim AJ, van Rossum MAJ, Pacey V. Pediatric joint hypermobility: a diagnostic framework and narrative review. Orphanet J Rare Dis 2023; 18:104. [PMID: 37143135 PMCID: PMC10157984 DOI: 10.1186/s13023-023-02717-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 02/21/2023] [Accepted: 04/30/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Hypermobile Ehlers-Danlos syndrome (hEDS) and hypermobility spectrum disorders (HSD) are debilitating conditions. Diagnosis is currently clinical in the absence of biomarkers, and criteria developed for adults are difficult to use in children and biologically immature adolescents. Generalized joint hypermobility (GJH) is a prerequisite for hEDS and generalized HSD. Current literature identifies a large proportion of children as hypermobile using a Beighton score ≥ 4 or 5/9, the cut off for GJH in adults. Other phenotypic features from the 2017 hEDS criteria can arise over time. Finally, many comorbidities described in hEDS/HSD are also seen in the general pediatric and adolescent population. Therefore, pediatric specific criteria are needed. The Paediatric Working Group of the International Consortium on EDS and HSD has developed a pediatric diagnostic framework presented here. The work was informed by a review of the published evidence. OBSERVATIONS The framework has 4 components, GJH, skin and tissue abnormalities, musculoskeletal complications, and core comorbidities. A Beighton score of ≥ 6/9 best identifies children with GJH at 2 standard deviations above average, based on published general population data. Skin and soft tissue changes include soft skin, stretchy skin, atrophic scars, stretch marks, piezogenic papules, and recurrent hernias. Two symptomatic groups were agreed: musculoskeletal and systemic. Emerging comorbid relationships are discussed. The framework generates 8 subgroups, 4 pediatric GJH, and 4 pediatric generalized hypermobility spectrum disorders. hEDS is reserved for biologically mature adolescents who meet the 2017 criteria, which also covers even rarer types of Ehlers-Danlos syndrome at any age. CONCLUSIONS This framework allows hypermobile children to be categorized into a group describing their phenotypic and symptomatic presentation. It clarifies the recommendation that comorbidities should be defined using their current internationally accepted frameworks. This provides a foundation for improving clinical care and research quality in this population.
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Affiliation(s)
| | - Jane Simmonds
- Great Ormond Street Institute of Child Health, University College London, London, UK
- London Hypermobility Unit, Central Health Physiotherapy, London, UK
| | - Sarah B Schwartz
- Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Roberto M Richheimer
- Centro Médico ABC, Carlos Graef Fernández 154-1A, Col. Tlaxala, Alc. Cuajimalpa de Morelos, 05300, Mexico City, CDMX, Mexico
| | - Constance O'Connor
- Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Ellen Elias
- University of Colorado School of Medicine, Denver, USA
- Ehlers-Danlos Center for Excellence and Special Care Clinic, Children's Hospital Colorado Special Care Clinic, Aurora, CO, USA
| | - Raoul Engelbert
- Department of Rehabilitation Medicine, Amsterdam University Medical Center (AMC), Meiberg Dreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Katie Cleary
- Ocean Kids Physio, Unit 1/2-8 Peninsula Blvd, Seaford, VIC, 3198, Australia
| | - Brad T Tinkle
- Peyton Manning Children's Hospital, 8402 Harcourt Rd, Ste 300, Indianapolis, IN, 46260, USA
| | - Antonie D Kline
- Greater Baltimore Medical Center, Harvey Institute for Human Genetics, 6701 N. Charles St., Suite 2326, Baltimore, MD, 21204, USA
| | - Alan J Hakim
- The Harley Street Clinic, HCA Healthcare, 16 Devonshire Street, London, UK.
| | | | - Verity Pacey
- Macquarie University, 75 Talavera Rd, Sydney, NSW, 2109, Australia
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Damseh N, Dupuis L, O'Connor C, Oh RY, Wang YW, Stavropoulos DJ, Schwartz SB, Mendoza-Londono R. Diagnostic outcomes for molecular genetic testing in children with suspected Ehlers-Danlos syndrome. Am J Med Genet A 2022; 188:1376-1383. [PMID: 35128800 DOI: 10.1002/ajmg.a.62672] [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: 06/28/2021] [Revised: 11/11/2021] [Accepted: 11/28/2021] [Indexed: 11/06/2022]
Abstract
Ehlers-Danlos syndrome (EDS) is a heterogeneous group of connective tissue disorders characterized by hyperextensible skin, hypermobile joints, easy bruisability, and fragility of the connective tissues. The diagnosis is based on clinical assessment and phenotype-guided genetic testing. Most EDS subtypes can be confirmed by genetic testing except for hypermobile EDS. This study explored the utility of applying the 2017 EDS classification criteria and molecular genetic testing in establishing an EDS diagnosis in children. In this retrospective study, we reviewed 72 patients referred to a tertiary care center for evaluation of EDS who underwent one or more forms of genetic testing. Eighteen patients (18/72, 25%) met the clinical criteria for one of the EDS subtypes and of these, 15 (15/18, 83%) were confirmed molecularly. Fifty-four patients (54/72, 75%) had features that overlapped EDS and other syndromes associated with joint hypermobility but did not fully meet clinical criteria. Twelve of them (12/54, 22%) were later shown to have a positive molecular genetic diagnosis of EDS. Different molecular genetic tests were performed on the cohort of 72 patients (EDS panel, n = 44; microarray, n = 25; whole exome sequencing [WES], n = 9; single gene sequencing, n = 3; familial variant testing, n = 10; other genetic panels n = 3). EDS panel was completed in 44 patients (61%), and a molecular diagnosis was confirmed in nine of the patients who satisfied criteria for one of the EDS subtypes (9/12, 75%) and in nine of the patients who did not fully meet criteria (9/32, 28%). We observed a correlation between generalized joint hypermobility, poor healing, easy bruising, atrophic scars, skin hyperextensibility, and developmental dysplasia of the hip with a positive molecular result. This study provides guidance for the use of molecular genetic testing in combination with the 2017 clinical diagnostic criteria in children presenting with EDS characteristics.
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Affiliation(s)
- Nadirah Damseh
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lucie Dupuis
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Constance O'Connor
- Division of Paediatric Medicine, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rachel Youjin Oh
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Yi Wen Wang
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Dimitri James Stavropoulos
- Genome Diagnostics, Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sarah B Schwartz
- Division of Paediatric Medicine, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Roberto Mendoza-Londono
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
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Yama BA, Hodgins M, Boydell K, Schwartz SB. A qualitative exploration: questioning multisource feedback in residency education. BMC Med Educ 2018; 18:170. [PMID: 30041635 PMCID: PMC6057061 DOI: 10.1186/s12909-018-1270-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 10/30/2017] [Accepted: 06/27/2018] [Indexed: 06/01/2023]
Abstract
BACKGROUND Multisource feedback (MSF), involves the collection of feedback from multiple groups of assessors, including those without a traditional hierarchal responsibility to evaluate doctors. Allied healthcare professionals (AHCPs), administrative staff, peers, patients and their families may all contribute to the formative assessment of physicians. Theoretically, this feedback provides a thorough view of physician performance; however, the ability of MSF programs to consistently impact physician behavior remains in question. Therefore, the objective of this study was to explore perceptions and prerequisites to an effective MSF program in postgraduate medical education from the perspectives of both pediatric residents and AHCPs. METHODS This exploratory study was conducted in a pediatric inpatient unit prior to implementation of a MSF program. Focus groups were conducted with purposefully recruited participants from three distinct groups: junior pediatric residents, senior pediatric residents, and AHCPs. Discussions were audio recorded, transcribed verbatim and analyzed using thematic analysis. RESULTS Both residents and AHCPs expressed a strong interest in the concept of MSF. However, more in depth discussions identified barriers to residents' acceptance of, and AHCPs' provision of feedback. Roles and responsibilities, perceptions of expertise, hospital culture/interprofessionalism and power dynamics were identified as barriers to the acceptance and provision of feedback. All groups expressed interest in opportunities to engage in bi-directional feedback. CONCLUSIONS The identified barriers and prerequisites to providing and accepting MSF suggest limits to the efficacy of the MSF process. Our findings suggest that these factors should be considered in the design and implementation of MSF programs.
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Affiliation(s)
- Brie A. Yama
- Department of Paediatrics, The University of Toronto, Toronto, ON Canada
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON Canada
| | | | - Katherine Boydell
- Black Dog Institute, University of New South Wales, Randwick, NSW Australia
| | - Sarah B. Schwartz
- Department of Paediatrics, The University of Toronto, Toronto, ON Canada
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON Canada
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Bennett MB, Wrede C, Brown BA, Liddick SN, Pérez-Loureiro D, Bardayan DW, Chen AA, Chipps KA, Fry C, Glassman BE, Langer C, Larson NR, McNeice EI, Meisel Z, Ong W, O'Malley PD, Pain SD, Prokop CJ, Schatz H, Schwartz SB, Suchyta S, Thompson P, Walters M, Xu X. Isospin Mixing Reveals ^{30}P(p,γ)^{31}S Resonance Influencing Nova Nucleosynthesis. Phys Rev Lett 2016; 116:102502. [PMID: 27015475 DOI: 10.1103/physrevlett.116.102502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Indexed: 06/05/2023]
Abstract
The thermonuclear ^{30}P(p,γ)^{31}S reaction rate is critical for modeling the final elemental and isotopic abundances of ONe nova nucleosynthesis, which affect the calibration of proposed nova thermometers and the identification of presolar nova grains, respectively. Unfortunately, the rate of this reaction is essentially unconstrained experimentally, because the strengths of key ^{31}S proton capture resonance states are not known, largely due to uncertainties in their spins and parities. Using the β decay of ^{31}Cl, we have observed the β-delayed γ decay of a ^{31}S state at E_{x}=6390.2(7) keV, with a ^{30}P(p,γ)^{31}S resonance energy of E_{r}=259.3(8) keV, in the middle of the ^{30}P(p,γ)^{31}S Gamow window for peak nova temperatures. This state exhibits isospin mixing with the nearby isobaric analog state at E_{x}=6279.0(6) keV, giving it an unambiguous spin and parity of 3/2^{+} and making it an important l=0 resonance for proton capture on ^{30}P.
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Affiliation(s)
- M B Bennett
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
- Joint Institute for Nuclear Astrophysics, Michigan State University, East Lansing, Michigan 48824, USA
| | - C Wrede
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
| | - B A Brown
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
| | - S N Liddick
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
- Department of Chemistry, Michigan State University, East Lansing, Michigan 48824, USA
| | - D Pérez-Loureiro
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
| | - D W Bardayan
- Department of Physics, University of Notre Dame, Notre Dame, Indiana 46556, USA
| | - A A Chen
- Department of Physics and Astronomy, McMaster University, Hamilton, Ontario L8S 4M1, Canada
| | - K A Chipps
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - C Fry
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
- Joint Institute for Nuclear Astrophysics, Michigan State University, East Lansing, Michigan 48824, USA
| | - B E Glassman
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
| | - C Langer
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
- Joint Institute for Nuclear Astrophysics, Michigan State University, East Lansing, Michigan 48824, USA
| | - N R Larson
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
- Department of Chemistry, Michigan State University, East Lansing, Michigan 48824, USA
| | - E I McNeice
- Department of Physics and Astronomy, McMaster University, Hamilton, Ontario L8S 4M1, Canada
| | - Z Meisel
- Joint Institute for Nuclear Astrophysics, Michigan State University, East Lansing, Michigan 48824, USA
- Department of Physics, University of Notre Dame, Notre Dame, Indiana 46556, USA
| | - W Ong
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
- Joint Institute for Nuclear Astrophysics, Michigan State University, East Lansing, Michigan 48824, USA
| | - P D O'Malley
- Department of Physics, University of Notre Dame, Notre Dame, Indiana 46556, USA
| | - S D Pain
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - C J Prokop
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
- Department of Chemistry, Michigan State University, East Lansing, Michigan 48824, USA
| | - H Schatz
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
- Joint Institute for Nuclear Astrophysics, Michigan State University, East Lansing, Michigan 48824, USA
| | - S B Schwartz
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
- Department of Geology and Physics, University of Southern Indiana, Evansville, Indiana 47712, USA
| | - S Suchyta
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
- Department of Chemistry, Michigan State University, East Lansing, Michigan 48824, USA
| | - P Thompson
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - M Walters
- Department of Physics and Astronomy, McMaster University, Hamilton, Ontario L8S 4M1, Canada
| | - X Xu
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
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Bennett MB, Wrede C, Chipps KA, José J, Liddick SN, Santia M, Bowe A, Chen AA, Cooper N, Irvine D, McNeice E, Montes F, Naqvi F, Ortez R, Pain SD, Pereira J, Prokop C, Quaglia J, Quinn SJ, Schwartz SB, Shanab S, Simon A, Spyrou A, Thiagalingam E. Classical-NOVA CONTRIBUTION to the Milky Way's ²⁶Al abundance: exit channel of the key ²⁵Al(p,γ) ²⁶Si resonance. Phys Rev Lett 2013; 111:232503. [PMID: 24476263 DOI: 10.1103/physrevlett.111.232503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 10/07/2013] [Indexed: 06/03/2023]
Abstract
Classical novae are expected to contribute to the 1809-keV Galactic γ-ray emission by producing its precursor 26Al, but the yield depends on the thermonuclear rate of the unmeasured 25Al(p,γ)26Si reaction. Using the β decay of 26P to populate the key J(π)=3(+) resonance in this reaction, we report the first evidence for the observation of its exit channel via a 1741.6±0.6(stat)±0.3(syst) keV primary γ ray, where the uncertainties are statistical and systematic, respectively. By combining the measured γ-ray energy and intensity with other experimental data on 26Si, we find the center-of-mass energy and strength of the resonance to be E(r)=414.9±0.6(stat)±0.3(syst)±0.6(lit.) keV and ωγ=23±6(stat)(-10)(+11)(lit.) meV, respectively, where the last uncertainties are from adopted literature data. We use hydrodynamic nova simulations to model 26Al production showing that these measurements effectively eliminate the dominant experimental nuclear-physics uncertainty and we estimate that novae may contribute up to 30% of the Galactic 26Al.
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Affiliation(s)
- M B Bennett
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA and National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
| | - C Wrede
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA and National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - K A Chipps
- Department of Physics, Colorado School of Mines, Golden, Colorado 08401, USA
| | - J José
- Departament Física i Enginyeria Nuclear (UPC) and Institut d'Estudis Espacials de Catalunya (IEEC), E-08034 Barcelona, Spain
| | - S N Liddick
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA and Department of Chemistry, Michigan State University, East Lansing, Michigan 48824, USA
| | - M Santia
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA and National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
| | - A Bowe
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA and National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA and Physics Department, Kalamazoo College, Kalamazoo, Michigan 49006, USA
| | - A A Chen
- Department of Physics and Astronomy, McMaster University, Hamilton, Ontario L8S 4M1, Canada
| | - N Cooper
- Department of Physics and Wright Nuclear Structure Laboratory, Yale University, New Haven, Connecticut 06520, USA
| | - D Irvine
- Department of Physics and Astronomy, McMaster University, Hamilton, Ontario L8S 4M1, Canada
| | - E McNeice
- Department of Physics and Astronomy, McMaster University, Hamilton, Ontario L8S 4M1, Canada
| | - F Montes
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA and Joint Institute for Nuclear Astrophysics, Michigan State University, East Lansing, Michigan 48824, USA
| | - F Naqvi
- Department of Physics and Wright Nuclear Structure Laboratory, Yale University, New Haven, Connecticut 06520, USA
| | - R Ortez
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA and National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - S D Pain
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - J Pereira
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA and Joint Institute for Nuclear Astrophysics, Michigan State University, East Lansing, Michigan 48824, USA
| | - C Prokop
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA and Department of Chemistry, Michigan State University, East Lansing, Michigan 48824, USA
| | - J Quaglia
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA and Joint Institute for Nuclear Astrophysics, Michigan State University, East Lansing, Michigan 48824, USA and Department of Electrical Engineering, Michigan State University, East Lansing, Michigan 48824, USA
| | - S J Quinn
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA and National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA and Joint Institute for Nuclear Astrophysics, Michigan State University, East Lansing, Michigan 48824, USA
| | - S B Schwartz
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA and National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA and Geology and Physics Department, University of Southern Indiana, Evansville, Indiana 47712, USA
| | - S Shanab
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA and National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
| | - A Simon
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA and Joint Institute for Nuclear Astrophysics, Michigan State University, East Lansing, Michigan 48824, USA
| | - A Spyrou
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA and National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA and Joint Institute for Nuclear Astrophysics, Michigan State University, East Lansing, Michigan 48824, USA
| | - E Thiagalingam
- Department of Physics and Astronomy, McMaster University, Hamilton, Ontario L8S 4M1, Canada
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Affiliation(s)
- Sarah B Schwartz
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
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Aleman TS, Lam BL, Cideciyan AV, Sumaroka A, Windsor EAM, Roman AJ, Schwartz SB, Stone EM, Jacobson SG. Genetic heterogeneity in autosomal dominant retinitis pigmentosa with low-frequency damped electroretinographic wavelets. Eye (Lond) 2008; 23:230-3. [PMID: 18704120 DOI: 10.1038/eye.2008.264] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To define molecular and ophthalmic features of a rare phenotype in autosomal dominant (ad) retinitis pigmentosa (RP). METHODS A 32-year-old woman (proband) with adRP and the low-frequency damped electroretinographic (ERG) wavelet phenotype and her mother were studied with optical coherence tomography (OCT), chromatic perimetry and ERG. A previously reported adRP patient with this ERG phenotype (Lam et al) was also studied with OCT. Genotype in the two families was determined with DNA sequencing. RESULTS ERGs from the proband were identical to those reported previously. Chromatic perimetry and ERG stimulus intensity series indicated that there can be severely reduced rod function in addition to substantial cone dysfunction. A heterozygous deletion in peripherin/RDS (Met152del3 atGAA) was present in the patient and the affected mother. There were foveal cystoid changes and pericentral splitting of the inner nuclear layer. ONL thickness and vision tapered with eccentricity, and 'blind' regions without discernible ONL showed a thickened, delaminated inner retina. Similar OCT findings were present in the reported adRP patient with this ERG; the patient was heterozygous for a 4-bp deletion (Leu107del4 ctGAGT) in PRPF31. CONCLUSIONS The low-frequency damped ERG wavelet phenotype is genetically heterogeneous. Inner retinal structural abnormalities are also present in this rare disease expression.
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Affiliation(s)
- T S Aleman
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Schwartz SB, McCampbell B, Garone R, Vodslon Z, Tokarcsik E, Coico J, Staiano‐Coico L. 025 Modulation of Wound Repair in the Obese Diabetic Mouse: a Role for VEGF Gene Transfer. Wound Repair Regen 2004. [DOI: 10.1111/j.1067-1927.2004.0abstractz.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rudge MRH, Schwartz SB. The ionization of complex ions by electron impact: I. Ionization cross sections for Fe XV and Fe XVI. ACTA ACUST UNITED AC 2002. [DOI: 10.1088/0370-1328/88/3/304] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hyde TB, Gilbert M, Schwartz SB, Zell ER, Watt JP, Thacker WL, Talkington DF, Besser RE. Azithromycin prophylaxis during a hospital outbreak of Mycoplasma pneumoniae pneumonia. J Infect Dis 2001; 183:907-12. [PMID: 11237807 DOI: 10.1086/319258] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2000] [Revised: 11/17/2000] [Indexed: 11/04/2022] Open
Abstract
Outbreaks of Mycoplasma pneumoniae (MP) in closed communities can have a high attack rate and can last several months. Azithromycin chemoprophylaxis has not been evaluated as a means of limiting transmission. This randomized, double-blinded placebo-controlled trial of azithromycin was conducted among asymptomatic hospital employees during an MP outbreak. Oropharyngeal swabs were obtained for detection of MP by polymerase chain reaction, and questionnaires were administered to assess clinical illness. Of the 147 employees who were enrolled, 73 received azithromycin and 74 received placebo. Carriage was similar within and between groups at weeks 1 and 6 (9.6% vs. 6.7% and 10.3% vs. 13.2%, respectively). Four episodes of clinically significant respiratory illness occurred in the azithromycin group versus 16 episodes in the placebo group (protective efficacy, 75%; 95% confidence interval, 28%-91%). Use of azithromycin prophylaxis in asymptomatic persons during an MP outbreak in a closed setting may be of value in reducing clinical illness.
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Affiliation(s)
- T B Hyde
- Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, and Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
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Staiano-Coico L, Higgins PJ, Schwartz SB, Zimm AJ, Goncalves J. Wound fluids: a reflection of the state of healing. Ostomy Wound Manage 2000; 46:85S-93S; quiz 94S-95S. [PMID: 10732643] [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] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Analyzing acute and chronic wound fluids provides an important and intriguing insight into the wound milieu. This review outlines some of the salient features of wound repair and the wound fluid environment. Most studies support the premise that the contents of the wound fluid reflect the status of the wound and can be indicative of whether a wound is on the course of a normal or impaired response to injury. For example, chronic wound fluids often differ from acute wound fluids in their proliferative effects on cells active in healing as well as their proteolytic effects. The authors discuss various cytokines, growth factors, proteinases, and protease inhibitors within wound fluids as well as their effect on wound repair. This review also presents confounding factors affecting interpretation of wound fluid studies, suggesting that further studies need to elucidate mechanisms whereby wound fluids either enhance or inhibit wound repair. So far, wound fluid analysis has yielded tantalizing glimpses of the teeming wound environment. What wound fluid contents tell us about the wound or its clinical care is not yet certain.
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Affiliation(s)
- L Staiano-Coico
- Department of Surgery, Joan and Sanford I. Weill Medical College of Cornell University, New York, NY 10021, USA
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16
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Abstract
The interaction between hosts and the viruses that infect them is a dynamic one, and a growing literature documents the fact that many viruses have developed mechanisms designed to avoid elimination by the host immune system. One of the immune strategies used by the host and targeted by virus proteins is apoptosis triggered by the cytokine tumor necrosis factor (TNF). Mouse fibroblast LM cells are spontaneously sensitive to TNF. When the wild-type E6 protein from the human papillomavirus type 16 (HPV 16) was expressed in LM cells, the cells became resistant to TNF. This resistance was examined by several means, including cell morphology, the dose- and time-independent response to TNF in a cell death ELISA, trypan blue exclusion, and cell proliferation. The level of p53 did not rise in TNF-treated cells prior to apoptosis, suggesting a p53-independent mechanism. Significant, though not complete, resistance to TNF was also observed following transfection of a plasmid expressing a mutant E6 protein, which is unable to mediate rapid degradation of the p53 tumor suppressor. These results indicate that the HPV 16 E6 protein can protect LM cells from TNF-triggered apoptosis and likely does so by a mechanism other than mediation of p53 degradation.
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Affiliation(s)
- P J Duerksen-Hughes
- Department of Biology, Georgia State University, Atlanta, Georgia 30302, USA.
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17
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Yaari E, Yafe-Zimerman Y, Schwartz SB, Slater PE, Shvartzman P, Andoren N, Branski D, Kerem E. Clinical manifestations of Bordetella pertussis infection in immunized children and young adults. Chest 1999; 115:1254-8. [PMID: 10334136 DOI: 10.1378/chest.115.5.1254] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES The incidence and prevalence of pertussis in adults have increased in recent years. It has been shown that previously immunized adults and adolescents are the main sources of transmission of Bordetella pertussis. The aim of this study was to describe the clinical presentation and the clinical course of pertussis in children and young adults who were immunized previously against B pertussis. DESIGN Retrospective study. SUBJECTS Children and young adults who were reported by local physicians to the Department of Epidemiology in the Israeli Ministry of Health with serologically confirmed pertussis and who were immunized previously were included. Information sought included personal data, epidemiologic data, signs and symptoms, laboratory results, initial diagnosis, and treatment. RESULTS In the 95 previously immunized patients with serologically confirmed pertussis (mean age [+/- SD], 8.9 +/- 4.4 years old; range, 5 to 30 years old), the mean duration from onset of symptoms until the final diagnosis of pertussis was 23 +/- 15 days. The disease was usually atypical and generally mild. All the described patients had cough, usually prolonged, lasting 4 +/- 3.6 weeks. Only 6% had the classic whoop. The mean WBC count was 8.7 +/- 2.6 cells/mm6, and the lymphocyte count was 40 +/- 12%. Two patients were admitted to the hospital for severe pneumonia. Among the reported cases, the proportion of patients between the ages of 10 and 45 years increased from 6.5% during the period from 1971 to 1980, to 26% during the period from 1980 to 1990, and to 38% during a 1989 outbreak. CONCLUSIONS Pertussis in previously immunized individuals is usually characterized by an atypical and relatively mild clinical course. Patients suffer mainly from a prolonged and persistent cough. Early diagnosis may lead to prompt administration of therapy. Prophylaxis of exposed persons might be effective in decreasing both severity and transmission of the disease.
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Affiliation(s)
- E Yaari
- Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
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18
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Abstract
Corticosteroids continue to be used by many physicians to treat infants with bronchiolitis. The aim of this study was to examine the short-term and long-term efficacy of oral corticosteroid therapy when added to beta2-agonists in infants with mild to moderate bronchiolitis (defined as the first episode of wheezing associated with low grade fever, rhinitis, tachypnea, and increased respiratory effort in a previously healthy infant during the winter months). Infants with mild to moderate bronchiolitis, were randomly assigned to receive either oral prednisone (2 mg/kg/day) or placebo for 3 days. All patients received nebulized albuterol q.i.d. during this period. Upon admission and after 3 days of therapy, a clinical score was assigned based on respiratory rate, use of accessory muscle, and the presence of wheeze. Oxygen saturation (SaO2) was also measured. On day 7, we inquired as to the well-being of each child. Two years later, the development of chronic respiratory symptoms was assessed. Thirty-eight infants were enrolled in the study; 20 received prednisone and 18 received placebo. Both groups were similar in terms of age, duration of illness prior to enrollment, pretrial medication use, clinical severity of bronchiolitis, history of atopy, and family history of atopy. After 3 and 7 days of treatment, both groups showed similar clinical improvement and there were no statistically significant differences between the two groups in the clinical score or in the SaO2. No major side effects were observed. Two years later, 32% of the infants continued to suffer from chronic respiratory symptoms, with a similar prevalence in both groups. We conclude that a 3-day course of oral corticosteroids is of no benefit to infants with mild to moderate bronchiolitis who are also treated with an inhaled beta2-agonist.
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Affiliation(s)
- I Berger
- Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
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19
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Philips MF, Schwartz SB, Soutter AD, Sutton LN. Ventriculofemoroatrial shunt: a viable alternative for the treatment of hydrocephalus. Technical note. J Neurosurg 1997; 86:1063-6. [PMID: 9171192 DOI: 10.3171/jns.1997.86.6.1063] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Children with shunted hydrocephalus often have a myriad of other medical conditions. When these concomitant problems involve the pleura, peritoneum, and/or the venous system, placement of the distal catheter may prove to be problematic. This report presents preliminary results in three hydrocephalic children following ventriculofemoroatrial shunt placement. The peritoneal and pleural cavities in each of these children were compromised and there was no vascular access into the superior vena cava due to intercurrent disease. An alternative technique for ventriculoperitoneal shunt placement was performed via the femoral vein. Fluoroscopic guidance was used to confirm the intraatrial position of the distal end of the shunt catheter. Follow-up review to date shows no complications. This newly described technique provides a feasible alternative to distal shunt catheter placement in patients in whom more traditional sites are unavailable.
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Affiliation(s)
- M F Philips
- Department of Surgery, Children's Hospital of Philadelphia, Pennsylvania 19104-4399, USA
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20
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Bollerman S, Schwartz SB. Change ... taking giant steps. J AHIMA 1995; 66:50-2. [PMID: 10142913] [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] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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21
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22
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Schwartz SB, Higgins PJ, Rajasekaran AK, Staiano-Coico L. The 1994 Moyer Award. Growth and differentiation of normal human keratinocytes in culture: modulation of gelsolin expression. J Burn Care Rehabil 1994; 15:478-85. [PMID: 7852450] [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] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- S B Schwartz
- Department of Surgery, Cornell University Medical College, New York, NY 10021
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23
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Schwartz SB, Higgins PJ, Rajasekaran AK, Staiano-Coico L. Gelsolin expression in normal human keratinocytes is a function of induced differentiation. Adv Exp Med Biol 1994; 358:169-81. [PMID: 7801803 DOI: 10.1007/978-1-4615-2578-3_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- S B Schwartz
- Department of Surgery, Cornell University Medical College, New York, NY 10021
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24
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Abstract
This article describes the management of burn injuries in children. It begins with an epidemiologic description of pediatric burns. Attention is given to emergency care, burn wound evaluation, operative management, and rehabilitative goals.
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Affiliation(s)
- J L Finkelstein
- Burn Center, Cornell University Medical College, New York Hospital, New York
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25
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Frank Y, Schwartz SB, Epstein NE, Beresford HR. Chronic dysphagia, vomiting and gastroesophageal reflux as manifestations of a brain stem glioma: a case report. Pediatr Neurosci 1989; 15:265-8. [PMID: 2488955 DOI: 10.1159/000120480] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Brain stem glioma is the third most common childhood brain tumor, comprising 10-15% of this group of neoplasms. Typical presenting symptoms include ataxia, diplopia and headache, while signs of increased intracranial pressure occur later in the clinical course. Although prolonged failure to thrive, characterized by cachexia and vomiting are rare manifestations of brain stem lesions, in this study we report a 9.5-year-old boy with failure to thrive since infancy which remitted after excision of a brain stem astrocytoma.
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Affiliation(s)
- Y Frank
- Department of Pediatrics, North Shore University Hospital, Manhasset, N.Y
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