1
|
Rehm HL, Alaimo JT, Aradhya S, Bayrak-Toydemir P, Best H, Brandon R, Buchan JG, Chao EC, Chen E, Clifford J, Cohen ASA, Conlin LK, Das S, Davis KW, Del Gaudio D, Del Viso F, DiVincenzo C, Eisenberg M, Guidugli L, Hammer MB, Harrison SM, Hatchell KE, Dyer LH, Hoang LU, Holt JM, Jobanputra V, Karbassi ID, Kearney HM, Kelly MA, Kelly JM, Kluge ML, Komala T, Kruszka P, Lau L, Lebo MS, Marshall CR, McKnight D, McWalter K, Meng Y, Nagan N, Neckelmann CS, Neerman N, Niu Z, Paolillo VK, Paolucci SA, Perry D, Pesaran T, Radtke K, Rasmussen KJ, Retterer K, Saunders CJ, Spiteri E, Stanley C, Szuto A, Taft RJ, Thiffault I, Thomas BC, Thomas-Wilson A, Thorpe E, Tidwell TJ, Towne MC, Zouk H. The landscape of reported VUS in multi-gene panel and genomic testing: Time for a change. Genet Med 2023; 25:100947. [PMID: 37534744 PMCID: PMC10825061 DOI: 10.1016/j.gim.2023.100947] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 04/24/2023] [Revised: 07/20/2023] [Accepted: 07/26/2023] [Indexed: 08/04/2023] Open
Abstract
PURPOSE Variants of uncertain significance (VUS) are a common result of diagnostic genetic testing and can be difficult to manage with potential misinterpretation and downstream costs, including time investment by clinicians. We investigated the rate of VUS reported on diagnostic testing via multi-gene panels (MGPs) and exome and genome sequencing (ES/GS) to measure the magnitude of uncertain results and explore ways to reduce their potentially detrimental impact. METHODS Rates of inconclusive results due to VUS were collected from over 1.5 million sequencing test results from 19 clinical laboratories in North America from 2020 to 2021. RESULTS We found a lower rate of inconclusive test results due to VUSs from ES/GS (22.5%) compared with MGPs (32.6%; P < .0001). For MGPs, the rate of inconclusive results correlated with panel size. The use of trios reduced inconclusive rates (18.9% vs 27.6%; P < .0001), whereas the use of GS compared with ES had no impact (22.2% vs 22.6%; P = ns). CONCLUSION The high rate of VUS observed in diagnostic MGP testing warrants examining current variant reporting practices. We propose several approaches to reduce reported VUS rates, while directing clinician resources toward important VUS follow-up.
Collapse
Affiliation(s)
- Heidi L Rehm
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA; Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA; Pathology, Harvard Medical School, Boston, MA.
| | - Joseph T Alaimo
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO; Department of Pediatrics, School of Medicine, University of Missouri, Kansas City, MO; Genomic Medicine Center, Children's Mercy Hospital, Kansas City, MO
| | - Swaroop Aradhya
- Invitae, San Francisco, CA; Department of Pathology, Stanford University School of Medicine, Palo Alto, CA
| | - Pinar Bayrak-Toydemir
- ARUP Laboratories, Salt Lake City, UT; Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT
| | - Hunter Best
- ARUP Laboratories, Salt Lake City, UT; Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT
| | | | - Jillian G Buchan
- Genetics Division, Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | | | | | | | - Ana S A Cohen
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO; Department of Pediatrics, School of Medicine, University of Missouri, Kansas City, MO; Genomic Medicine Center, Children's Mercy Hospital, Kansas City, MO
| | - Laura K Conlin
- Division of Genomic Diagnostics, Children's Hospital of Philadelphia, Philadelphia, PA; Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA
| | - Soma Das
- Human Genetics, University of Chicago, Chicago, IL
| | | | | | - Florencia Del Viso
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO
| | | | - Marcia Eisenberg
- Women's Health and Genetics, Labcorp, Research Triangle Park, NC
| | - Lucia Guidugli
- Rady Children's Institute for Genomic Medicine, San Diego, CA
| | - Monia B Hammer
- Rady Children's Institute for Genomic Medicine, San Diego, CA
| | | | | | | | | | - James M Holt
- HudsonAlpha Clinical Services Lab, LLC, Huntsville, AL
| | - Vaidehi Jobanputra
- Molecular Diagnostics, New York Genome Center, New York, NY; Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY
| | | | - Hutton M Kearney
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | - Jacob M Kelly
- HudsonAlpha Clinical Services Lab, LLC, Huntsville, AL
| | - Michelle L Kluge
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | | | - Lynette Lau
- Division of Genome Diagnostics, Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Matthew S Lebo
- Pathology, Harvard Medical School, Boston, MA; Laboratory for Molecular Medicine, Mass General Brigham, Cambridge, MA
| | - Christian R Marshall
- Division of Genome Diagnostics, Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | | | | | - Yan Meng
- Fulgent Genetics, Temple City, CA
| | | | | | | | - Zhiyv Niu
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Vitoria K Paolillo
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO
| | - Sarah A Paolucci
- Genetics Division, Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | | | | | | | - Kristen J Rasmussen
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | - Carol J Saunders
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO; Genomic Medicine Center, Children's Mercy Hospital, Kansas City, MO; Department of Pediatrics and Pathology, School of Medicine, University of Missouri, Kansas City, MO
| | | | | | - Anna Szuto
- Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Isabelle Thiffault
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO; Department of Pediatrics, School of Medicine, University of Missouri, Kansas City, MO; Genomic Medicine Center, Children's Mercy Hospital, Kansas City, MO
| | | | | | | | | | | | - Hana Zouk
- Pathology, Harvard Medical School, Boston, MA; Laboratory for Molecular Medicine, Mass General Brigham, Cambridge, MA
| |
Collapse
|
2
|
Pogue JA, Hotsinpiller WS, Cardenas C, Stanley C, Belliveau JG, Popple RA, Stanley DN, Boggs H, Harms J. kV-CBCT-Guided Daily Adaptation Improves Target Coverage and Spares Normal Tissue for Accelerated Partial Breast Irradiation. Int J Radiat Oncol Biol Phys 2023; 117:e706-e707. [PMID: 37786069 DOI: 10.1016/j.ijrobp.2023.06.2199] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Linear accelerator based accelerated partial breast irradiation (APBI) in early-stage breast cancer necessitates a reduction in non-target breast tissue to decrease long term toxicity and adverse cosmetic outcome. In particular, lumpectomy cavity seromas may decrease in size and deform in shape during the course of short course APBI. Online adaptive RT (oART) offers considerable prospect for treating mobile targets through pendulous breast anatomy. However, there are limited studies outlining the methods and outcomes of CBCT-based oART for APBI. Here we present a retrospective, single institutional study analyzing the treatment process for patients receiving stereotactic kV-CBCT guided oART APBI. MATERIALS/METHODS Fourteen patients were treated to 30 Gy in 5 fractions for a total of 70 fractions. Time between simulation and treatment, change in gross tumor volume (GTV), and differences in DVH metrics with adaption were analyzed. The Wilcoxon paired, non-parametric test was utilized to test for DVH metric differences between the scheduled plans (initial plans recalculated on daily CBCT anatomy) and treated plans, which were either the scheduled or adapted plan (initial plans re-optimized using daily anatomy), depending on the preference of the treating physician or physicist. RESULTS Median (inter-quartile range) time from simulation to first treatment was 28 days (21-33 days). During this same time, GTV volume reduced to 72.5% (57.8-87.3%) of the simulation lumpectomy cavity volume. Adaptive treatments required 31.1 min (27.2-37.1 min) from start of CBCT to treatment session end. Table 1 summarizes differences between scheduled and treated plan metrics for 70 fractions, 62 (89%) of which were treated adaptively and 8 (11%) of which were treated using the scheduled plan. Significant improvement in prescription planning target volume coverage (p = 0.003), significant reduction in 5/6 organ-at-risk metrics evaluated (p ≤ 0.003), and significant improvement in conformity index and high dose spillage (p ≤ 0.001) were realized with adaption. Table 1: Scheduled versus treated plan metrics. CONCLUSION APBI using oART decreased most organs at risk DVH metrics, improved plan quality metrics, and increased target coverage, justifying the use of kV-CBCT-guided oART for APBI.
Collapse
Affiliation(s)
- J A Pogue
- University of Alabama at Birmingham, Birmingham, AL
| | | | - C Cardenas
- University of Alabama at Birmingham Department of Radiation Oncology, Birmingham, AL
| | - C Stanley
- University of Alabama at Birmingham, Birmingham, AL
| | | | - R A Popple
- University of Alabama at Birmingham, Birmingham, AL
| | - D N Stanley
- University of Alabama at Birmingham, Birmingham, AL
| | - H Boggs
- University of Alabama at Birmingham Department of Radiation Oncology, Birmingham, AL
| | - J Harms
- University of Alabama at Birmingham, Birmingham, AL
| |
Collapse
|
3
|
Kaplun L, Krautz-Peterson G, Neerman N, Stanley C, Hussey S, Folwick M, McGarry A, Weiss S, Kaplun A. ONT long-read WGS for variant discovery and orthogonal confirmation of short read WGS derived genetic variants in clinical genetic testing. Front Genet 2023; 14:1145285. [PMID: 37152986 PMCID: PMC10160624 DOI: 10.3389/fgene.2023.1145285] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/05/2023] [Indexed: 05/09/2023] Open
Abstract
Technological advances in Next-Generation Sequencing dramatically increased clinical efficiency of genetic testing, allowing detection of a wide variety of variants, from single nucleotide events to large structural aberrations. Whole Genome Sequencing (WGS) has allowed exploration of areas of the genome that might not have been targeted by other approaches, such as intergenic regions. A single technique detecting all genetic variants at once is intended to expedite the diagnostic process while making it more comprehensive and efficient. Nevertheless, there are still several shortcomings that cannot be effectively addressed by short read sequencing, such as determination of the precise size of short tandem repeat (STR) expansions, phasing of potentially compound recessive variants, resolution of some structural variants and exact determination of their boundaries, etc. Therefore, in some cases variants can only be tentatively detected by short reads sequencing and require orthogonal confirmation, particularly for clinical reporting purposes. Moreover, certain regulatory authorities, for example, New York state CLIA, require orthogonal confirmation of every reportable variant. Such orthogonal confirmations often involve numerous different techniques, not necessarily available in the same laboratory and not always performed in an expedited manner, thus negating the advantages of "one-technique-for-all" approach, and making the process lengthy, prone to logistical and analytical faults, and financially inefficient. Fortunately, those weak spots of short read sequencing can be compensated by long read technology that have comparable or better detection of some types of variants while lacking the mentioned above limitations of short read sequencing. At Variantyx we have developed an integrated clinical genetic testing approach, augmenting short read WGS-based variant detection with Oxford Nanopore Technologies (ONT) long read sequencing, providing simultaneous orthogonal confirmation of all types of variants with the additional benefit of improved identification of exact size and position of the detected aberrations. The validation study of this augmented test has demonstrated that Oxford Nanopore Technologies sequencing can efficiently verify multiple types of reportable variants, thus ensuring highly reliable detection and a quick turnaround time for WGS-based clinical genetic testing.
Collapse
|
4
|
Kandasamy R, White E, Strycharz JP, Hansen S, Hamby C, Waterhouse S, Salkeld A, Mannke K, Valliere C, Phillips S, Ramaraj N, Stanley C, Ananth U, Deochand S, Veksler R, Lauterman T, Afterman D, Tavassoly I, Oklander B, Zviran A. Lab validation of an ultrasensitive ctDNA pan-cancer MRD assay using whole-genome sequencing. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e13582] [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: 11/20/2022] Open
Abstract
e13582 Background: Minimal residual disease (MRD) monitoring using liquid biopsy for solid tumors requires a highly sensitive and specific assay that can overcome the limitation of low abundance cfDNA in a standard blood draw. We developed a whole-genome sequencing (WGS)-based assay to detect the presence of circulating tumor DNA (ctDNA) in plasma. The C2i assay is a tumor-informed assay that uses personalized tumor signature, advanced noise models, and artificial intelligence (AI) modalities to interrogate plasma for the presence of ctDNA longitudinally. Methods: The C2i test was developed in accordance with CAP/CLIA and New York state validation principles. We used contrived samples to establish analytical validation of the assay performance, which was then validated with a large clinical cohort of early-stage patients across various cancer types. Briefly, aggregated tumor signatures derived from cancer cell lines were fragmented and spiked into a contrived healthy plasma pool; the mixed samples were used to assess the presence of tumor DNA signature down to tumor fractions of 10e-4. Positive samples are identified by tumor-derived variants detected above the noise levels. Noise modeling was established using a panel of normal (PON) approach. We assessed the analytical sensitivity, specificity, and accuracy using 348 contrived samples derived from five different cancer cell lines. Reproducibility and precision were assessed with multiple replicates, and statistical concordance was reported. This validation was complemented by a cohort of 200 patients and ̃1000 plasma samples across a variety of cancer types including, NSCLC, MIBC, CRC, GBM, Breast Cancer, and a mixture of other cancer types. Results: Cancer cell lines, representing the five most prevalent disease indications, used for determining analytical sensitivity are as follows: CRC HT-29, Breast SK-BR3, Bladder HT-1376, Lung HCI-H526, and Prostate LNCaP. The cell line DNA was enzymatically fragmented and size-selected to mimic ctDNA. This ctDNA was spiked into cfDNA extracted from healthy volunteers at various dilution levels, varying from 10e0 to 10e-4. The 95% probability of detecting ctDNA was established at 10e-4. The reproducibility of tumor signature between replicates was assessed to be greater than 90%. The assay was performed using both normal and maximum input amounts. These performance estimates were then validated on a cohort of plasma collected from early-stage (stage I-III) patients across various cancer types. Conclusions: C2i MRD test is an ultrasensitive pan-cancer MRD monitoring assay used in several clinical trials across the world. We present an extensive analytical and clinical validation of the assay supporting its high performance.
Collapse
|
5
|
Metz KA, Teng X, Coppens I, Lamb HM, Wagner BE, Rosenfeld JA, Chen X, Zhang Y, Kim HJ, Meadow ME, Wang TS, Haberlandt ED, Anderson GW, Leshinsky-Silver E, Bi W, Markello TC, Pratt M, Makhseed N, Garnica A, Danylchuk NR, Burrow TA, Jayakar P, McKnight D, Agadi S, Gbedawo H, Stanley C, Alber M, Prehl I, Peariso K, Ong MT, Mordekar SR, Parker MJ, Crooks D, Agrawal PB, Berry GT, Loddenkemper T, Yang Y, Maegawa GHB, Aouacheria A, Markle JG, Wohlschlegel JA, Hartman AL, Hardwick JM. KCTD7 deficiency defines a distinct neurodegenerative disorder with a conserved autophagy-lysosome defect. Ann Neurol 2018; 84:766-780. [PMID: 30295347 DOI: 10.1002/ana.25351] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 08/27/2018] [Accepted: 09/23/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Several small case series identified KCTD7 mutations in patients with a rare autosomal recessive disorder designated progressive myoclonic epilepsy (EPM3) and neuronal ceroid lipofuscinosis (CLN14). Despite the name KCTD (potassium channel tetramerization domain), KCTD protein family members lack predicted channel domains. We sought to translate insight gained from yeast studies to uncover disease mechanisms associated with deficiencies in KCTD7 of unknown function. METHODS Novel KCTD7 variants in new and published patients were assessed for disease causality using genetic analyses, cell-based functional assays of patient fibroblasts and knockout yeast, and electron microscopy of patient samples. RESULTS Patients with KCTD7 mutations can exhibit movement disorders or developmental regression before seizure onset, and are distinguished from similar disorders by an earlier age of onset. Although most published KCTD7 patient variants were excluded from a genome sequence database of normal human variations, most newly identified patient variants are present in this database, potentially challenging disease causality. However, genetic analysis and impaired biochemical interactions with cullin 3 support a causal role for patient KCTD7 variants, suggesting deleterious alleles of KCTD7 and other rare disease variants may be underestimated. Both patient-derived fibroblasts and yeast lacking Whi2 with sequence similarity to KCTD7 have impaired autophagy consistent with brain pathology. INTERPRETATION Biallelic KCTD7 mutations define a neurodegenerative disorder with lipofuscin and lipid droplet accumulation but without defining features of neuronal ceroid lipofuscinosis or lysosomal storage disorders. KCTD7 deficiency appears to cause an underlying autophagy-lysosome defect conserved in yeast, thereby assigning a biological role for KCTD7. Ann Neurol 2018;84:774-788.
Collapse
Affiliation(s)
- Kyle A Metz
- Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Xinchen Teng
- Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.,Jiangsu Key Laboratory of Neuropsychiatric Diseases and College of Pharmaceutical Sciences, Soochow University, Suzhou, Jiangsu Province, People's Republic of China
| | - Isabelle Coppens
- Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Heather M Lamb
- Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Bart E Wagner
- Histopathology Department, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Jill A Rosenfeld
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX
| | - Xianghui Chen
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and College of Pharmaceutical Sciences, Soochow University, Suzhou, Jiangsu Province, People's Republic of China
| | - Yu Zhang
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and College of Pharmaceutical Sciences, Soochow University, Suzhou, Jiangsu Province, People's Republic of China
| | - Hee Jong Kim
- Department of Biological Chemistry, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Michael E Meadow
- Department of Biological Chemistry, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Tim Sen Wang
- Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.,Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Edda D Haberlandt
- Clinical Department of Pediatrics I, Innsbruck Medical University, Innsbruck, Austria.,Department of Child and Youth Health, Hospital of Dornbirn, Dornbirn, Austria
| | - Glenn W Anderson
- Histopathology Department, Great Ormond Street Hospital for Children, London, United Kingdom
| | | | - Weimin Bi
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX
| | - Thomas C Markello
- NIH Undiagnosed Diseases Program, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Marsha Pratt
- Department of Pediatrics, University of Oklahoma College of Medicine, Oklahoma City, OK
| | - Nawal Makhseed
- Department of Pediatrics, Jahra Hospital, Ministry of Health, Al Jahra, Kuwait
| | - Adolfo Garnica
- Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR
| | - Noelle R Danylchuk
- Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR
| | - Thomas A Burrow
- Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR
| | - Parul Jayakar
- Division of Genetics and Metabolism, Nicklaus Children's Hospital, Miami, FL
| | | | - Satish Agadi
- Department of Neurology, Texas Children's Hospital, Houston, TX
| | | | | | - Michael Alber
- Pediatric Neurology and Developmental Medicine, University of Tübingen, Tübingen, Germany
| | | | - Katrina Peariso
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Min Tsui Ong
- Department of Paediatric Neurology, Sheffield Children's National Health Service Foundation Trust, Sheffield, United Kingdom
| | - Santosh R Mordekar
- Department of Paediatric Neurology, Sheffield Children's National Health Service Foundation Trust, Sheffield, United Kingdom
| | - Michael J Parker
- Sheffield Clinical Genetics Service, Sheffield Children's National Health Service Foundation Trust, Sheffield, United Kingdom
| | - Daniel Crooks
- Department of Neuropathology, Walton Centre National Health Service Foundation Trust, Liverpool, United Kingdom
| | - Pankaj B Agrawal
- Division of Genetics and Genomics, Manton Center for Orphan Disease Research, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Gerard T Berry
- Division of Genetics and Genomics, Manton Center for Orphan Disease Research, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | | | - Yaping Yang
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX
| | - Gustavo H B Maegawa
- Department of Pediatrics/Genetics and Metabolism, University of Florida, Gainesville, FL
| | - Abdel Aouacheria
- Montpellier Institute of Evolution Sciences, University of Montpellier, CNRS, EPHE, IRD, Montpellier, France
| | - Janet G Markle
- Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - James A Wohlschlegel
- Department of Biological Chemistry, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Adam L Hartman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - J Marie Hardwick
- Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.,Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
6
|
Saade D, Lee M, Bharucha-Goebel D, Donkervoort S, Neuhaus S, Alter K, Zampieri C, Stanley C, Matsubara J, Nickolls A, Micheil Innes A, Mah J, Grosmann C, Nascimento A, Colomer J, Munell F, Haliloglu G, Foley A, Chesler A, Bönnemann C. CONGENITAL MYOPATHIES: GENERAL AND RYR1. Neuromuscul Disord 2018. [DOI: 10.1016/j.nmd.2018.06.068] [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: 10/28/2022]
|
7
|
Sharifabadi AD, Korevaar DA, McGrath TA, van Es N, Frank RA, Cherpak L, Dang W, Salameh JP, Nguyen F, Stanley C, McInnes MDF. Reporting bias in imaging: higher accuracy is linked to faster publication. Eur Radiol 2018; 28:3632-3639. [PMID: 29564596 DOI: 10.1007/s00330-018-5354-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 10/25/2017] [Revised: 12/28/2017] [Accepted: 01/24/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate whether higher reported accuracy estimates are associated with shorter time to publication among imaging diagnostic accuracy studies. METHODS We included primary imaging diagnostic accuracy studies, included in meta-analyses from systematic reviews published in 2015. For each primary study, we extracted accuracy estimates, participant recruitment periods and publication dates. Our primary outcome was the association between Youden's index (sensitivity + specificity - 1, a single measure of diagnostic accuracy) and time to publication. RESULTS We included 55 systematic reviews and 781 primary studies. Study completion dates were missing for 238 (30%) studies. The median time from completion to publication in the remaining 543 studies was 20 months (IQR 14-29). Youden's index was negatively correlated with time from completion to publication (rho = -0.11, p = 0.009). This association remained significant in multivariable Cox regression analyses after adjusting for seven study characteristics: hazard ratio of publication was 1.09 (95% CI 1.03-1.16, p = 0.004) per unit increase for logit-transformed estimates of Youden's index. When dichotomizing Youden's index by a median split, time from completion to publication was 20 months (IQR 13-33) for studies with a Youden's index below the median, and 19 months (14-27) for studies with a Youden's index above the median (p = 0.104). CONCLUSION Imaging diagnostic accuracy studies with higher accuracy estimates were weakly associated with a shorter time to publication. KEY POINTS • Higher accuracy estimates are weakly associated with shorter time to publication. • Lag in time to publication remained significant in multivariate Cox regression analyses. • No correlation between accuracy and time from submission to publication was identified.
Collapse
Affiliation(s)
| | - D A Korevaar
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands
| | - T A McGrath
- Department of Radiology-Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - N van Es
- Department of Vascular Medicine, Academic Medical Center, Room F4-139, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - R A Frank
- Department of Radiology-Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - L Cherpak
- Department of Radiology-Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - W Dang
- Department of Radiology-Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - J P Salameh
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - F Nguyen
- Department of Radiology-Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - C Stanley
- Dalhousie University, Halifax, NS, Canada
| | - M D F McInnes
- Department of Radiology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Room c159 Ottawa Hospital Civic Campus, 1053 Carling Ave., Ottawa, ON, K1Y 4E9, Canada.
| |
Collapse
|
8
|
Stanley C, Igala S. Effect of Different Storage Conditions on the Stability and Efficacy of Some Reconstituted Oral Antibiotic Suspensions Sold in Port Harcourt, Nigeria. JPRI 2018. [DOI: 10.9734/jpri/2017/38553] [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: 11/09/2022]
|
9
|
Kalsner L, Twachtman-Bassett J, Tokarski K, Stanley C, Dumont-Mathieu T, Cotney J, Chamberlain S. Genetic testing including targeted gene panel in a diverse clinical population of children with autism spectrum disorder: Findings and implications. Mol Genet Genomic Med 2017; 6:171-185. [PMID: 29271092 PMCID: PMC5902398 DOI: 10.1002/mgg3.354] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 10/20/2017] [Accepted: 10/24/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Genetic testing of children with autism spectrum disorder (ASD) is now standard in the clinical setting, with American College of Medical Genetics and Genomics (ACMGG) guidelines recommending microarray for all children, fragile X testing for boys and additional gene sequencing, including PTEN and MECP2, in appropriate patients. Increasingly, testing utilizing high throughput sequencing, including gene panels and whole exome sequencing, are offered as well. METHODS We performed genetic testing including microarray, fragile X testing and targeted gene panel, consistently sequencing 161 genes associated with ASD risk, in a clinical population of 100 well characterized children with ASD. Frequency of rare variants identified in individual genes was compared with that reported in the Exome Aggregation Consortium (ExAC) database. RESULTS We did not diagnose any conditions with complete penetrance for ASD; however, copy number variants believed to contribute to ASD risk were identified in 12%. Eleven children were found to have likely pathogenic variants on gene panel, yet, after careful analysis, none was considered likely causative of disease. KIRREL3 variants were identified in 6.7% of children compared to 2% in ExAC, suggesting a potential role for KIRREL3 variants in ASD risk. Children with KIRREL3 variants more often had minor facial dysmorphism and intellectual disability. We also observed an increase in rare variants in TSC2. However, analysis of variant data from the Simons Simplex Collection indicated that rare variants in TSC2 occur more commonly in specific racial/ethnic groups, which are more prevalent in our population than in the ExAC database. CONCLUSION The yield of genetic testing including microarray, fragile X (boys) and targeted gene panel was 12%. Gene panel did not increase diagnostic yield; however, we found an increase in rare variants in KIRREL3. Our findings reinforce the need for racial/ethnic diversity in large-scale genomic databases used to identify variants that contribute to disease risk.
Collapse
Affiliation(s)
- Louisa Kalsner
- Connecticut Children's Medical Center, Farmington, CT, USA.,University of Connecticut School of Medicine, Farmington, CT, USA
| | | | - Kristin Tokarski
- University of Connecticut School of Medicine, Farmington, CT, USA
| | | | - Thyde Dumont-Mathieu
- Connecticut Children's Medical Center, Farmington, CT, USA.,University of Connecticut School of Medicine, Farmington, CT, USA
| | - Justin Cotney
- University of Connecticut School of Medicine, Farmington, CT, USA
| | | |
Collapse
|
10
|
Platzer K, Yuan H, Schütz H, Winschel A, Chen W, Hu C, Kusumoto H, Heyne HO, Helbig KL, Tang S, Willing MC, Tinkle BT, Adams DJ, Depienne C, Keren B, Mignot C, Frengen E, Strømme P, Biskup S, Döcker D, Strom TM, Mefford HC, Myers CT, Muir AM, LaCroix A, Sadleir L, Scheffer IE, Brilstra E, van Haelst MM, van der Smagt JJ, Bok LA, Møller RS, Jensen UB, Millichap JJ, Berg AT, Goldberg EM, De Bie I, Fox S, Major P, Jones JR, Zackai EH, Abou Jamra R, Rolfs A, Leventer RJ, Lawson JA, Roscioli T, Jansen FE, Ranza E, Korff CM, Lehesjoki AE, Courage C, Linnankivi T, Smith DR, Stanley C, Mintz M, McKnight D, Decker A, Tan WH, Tarnopolsky MA, Brady LI, Wolff M, Dondit L, Pedro HF, Parisotto SE, Jones KL, Patel AD, Franz DN, Vanzo R, Marco E, Ranells JD, Di Donato N, Dobyns WB, Laube B, Traynelis SF, Lemke JR. GRIN2B encephalopathy: novel findings on phenotype, variant clustering, functional consequences and treatment aspects. J Med Genet 2017; 54:460-470. [PMID: 28377535 DOI: 10.1136/jmedgenet-2016-104509] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 02/14/2017] [Accepted: 02/16/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND We aimed for a comprehensive delineation of genetic, functional and phenotypic aspects of GRIN2B encephalopathy and explored potential prospects of personalised medicine. METHODS Data of 48 individuals with de novo GRIN2B variants were collected from several diagnostic and research cohorts, as well as from 43 patients from the literature. Functional consequences and response to memantine treatment were investigated in vitro and eventually translated into patient care. RESULTS Overall, de novo variants in 86 patients were classified as pathogenic/likely pathogenic. Patients presented with neurodevelopmental disorders and a spectrum of hypotonia, movement disorder, cortical visual impairment, cerebral volume loss and epilepsy. Six patients presented with a consistent malformation of cortical development (MCD) intermediate between tubulinopathies and polymicrogyria. Missense variants cluster in transmembrane segments and ligand-binding sites. Functional consequences of variants were diverse, revealing various potential gain-of-function and loss-of-function mechanisms and a retained sensitivity to the use-dependent blocker memantine. However, an objectifiable beneficial treatment response in the respective patients still remains to be demonstrated. CONCLUSIONS In addition to previously known features of intellectual disability, epilepsy and autism, we found evidence that GRIN2B encephalopathy is also frequently associated with movement disorder, cortical visual impairment and MCD revealing novel phenotypic consequences of channelopathies.
Collapse
Affiliation(s)
- Konrad Platzer
- Institute of Human Genetics, University of Leipzig Hospitals and Clinics, Leipzig, Germany
| | - Hongjie Yuan
- Department of Pharmacology, Emory University School of Medicine, Rollins Research Center, Atlanta, Georgia, USA.,Center for Functional Evaluation of Rare Variants (CFERV), Emory University School of Medicine, Atlanta, Georgia, USA
| | - Hannah Schütz
- Department of Neurophysiology and Neurosensory Systems, Technical University Darmstadt, Darmstadt, Hessen, Germany
| | - Alexander Winschel
- Department of Neurophysiology and Neurosensory Systems, Technical University Darmstadt, Darmstadt, Hessen, Germany
| | - Wenjuan Chen
- Department of Pharmacology, Emory University School of Medicine, Rollins Research Center, Atlanta, Georgia, USA
| | - Chun Hu
- Department of Pharmacology, Emory University School of Medicine, Rollins Research Center, Atlanta, Georgia, USA
| | - Hirofumi Kusumoto
- Department of Pharmacology, Emory University School of Medicine, Rollins Research Center, Atlanta, Georgia, USA
| | - Henrike O Heyne
- Institute of Human Genetics, University of Leipzig Hospitals and Clinics, Leipzig, Germany
| | - Katherine L Helbig
- Division of Clinical Genomics, Ambry Genetics, Aliso Viejo, California, USA
| | - Sha Tang
- Division of Clinical Genomics, Ambry Genetics, Aliso Viejo, California, USA
| | - Marcia C Willing
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Brad T Tinkle
- Advocate Children's Hospital, Park Ridge, Illinois, USA
| | - Darius J Adams
- Genetics and Metabolism, Goryeb Children's Hospital, Atlantic Health System, Morristown, New Jersey, USA
| | - Christel Depienne
- INSERM, U 1127, Sorbonne Universités, UPMC Université Paris 06, CNRS, UMR 7225, Institut du cerveau et de la moelle épinière (ICM), Paris, France.,Département de Génétique, Centre de Référence des Déficiences Intellectuelles de Causes Rares, GRC UPMC "Déficiences Intellectuelles et Autisme", Hôpital de la Pitié-Salpêtrière, Paris, France.,UMR 7104/INSERM U964/Université de Strasbourg, Illkirch, France.,Laboratoire de cytogénétique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Boris Keren
- INSERM, U 1127, Sorbonne Universités, UPMC Université Paris 06, CNRS, UMR 7225, Institut du cerveau et de la moelle épinière (ICM), Paris, France.,Département de Génétique, Centre de Référence des Déficiences Intellectuelles de Causes Rares, GRC UPMC "Déficiences Intellectuelles et Autisme", Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Cyril Mignot
- Département de Génétique, Centre de Référence des Déficiences Intellectuelles de Causes Rares, GRC UPMC "Déficiences Intellectuelles et Autisme", Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Eirik Frengen
- Department of Medical Genetics, Oslo University Hospitals and University of Oslo, Oslo, Norway
| | - Petter Strømme
- Department of Pediatrics, Oslo University Hospitals and University of Oslo, Oslo, Norway
| | - Saskia Biskup
- Practice for Human Genetics and CeGaT GmbH, Tübingen, Germany
| | - Dennis Döcker
- Practice for Human Genetics and CeGaT GmbH, Tübingen, Germany
| | - Tim M Strom
- Institute of Human Genetics, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Heather C Mefford
- Department of Pediatrics, Division of Genetic Medicine, University of Washington, Seattle, Washington, USA
| | - Candace T Myers
- Department of Pediatrics, Division of Genetic Medicine, University of Washington, Seattle, Washington, USA
| | - Alison M Muir
- Department of Pediatrics, Division of Genetic Medicine, University of Washington, Seattle, Washington, USA
| | - Amy LaCroix
- Department of Pediatrics, Division of Genetic Medicine, University of Washington, Seattle, Washington, USA
| | - Lynette Sadleir
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Ingrid E Scheffer
- Department of Medicine, University of Melbourne, Austin Health and Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Eva Brilstra
- Department of Genetics, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Mieke M van Haelst
- Department of Genetics, Utrecht University Medical Center, Utrecht, The Netherlands
| | | | - Levinus A Bok
- Department of Paediatrics, Màxima Medical Centre, Veldhoven, The Netherlands
| | - Rikke S Møller
- The Danish Epilepsy Centre Filadelfia, Dianalund, Denmark.,Institute for Regional Health Services, University of Southern Denmark, Odense, Denmark
| | - Uffe B Jensen
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
| | - John J Millichap
- Departments of Pediatrics, Epilepsy Center and Division of Neurology Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Anne T Berg
- Departments of Pediatrics, Epilepsy Center and Division of Neurology Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ethan M Goldberg
- Division of Neurology, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Isabelle De Bie
- Department of Medical Genetics, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
| | - Stephanie Fox
- Department of Medical Genetics, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
| | - Philippe Major
- Department of Neurological Sciences, Université de Montréal, CHU Ste-Justine, Montreal, Canada
| | - Julie R Jones
- Greenwood Genetic Center, Greenwood, South Carolina, USA
| | - Elaine H Zackai
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Rami Abou Jamra
- Institute of Human Genetics, University of Leipzig Hospitals and Clinics, Leipzig, Germany.,Centogene AG, Rostock, Germany
| | | | - Richard J Leventer
- Department of Neurology, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute and Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - John A Lawson
- Department of Neurology, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | | | - Floor E Jansen
- Department of Child Neurology, Brain Center Rudolf Magnus, University Medical Center, Utrecht, The Netherlands
| | - Emmanuelle Ranza
- Service of Genetic Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Christian M Korff
- Department of Child and Adolescent, Neurology Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - Anna-Elina Lehesjoki
- The Folkhälsan Institute of Genetics, University of Helsinki, Helsinki, Finland.,Research Programs Unit, Molecular Neurology and Neuroscience Center, University of Helsinki, Helsinki, Finland
| | - Carolina Courage
- The Folkhälsan Institute of Genetics, University of Helsinki, Helsinki, Finland.,Research Programs Unit, Molecular Neurology and Neuroscience Center, University of Helsinki, Helsinki, Finland
| | - Tarja Linnankivi
- Department of Pediatric Neurology, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | | | - Mark Mintz
- The Center for Neurological and Neurodevelopmental Health and the Clinical Research Center of New Jersey, Voorhees, New Jersey, USA
| | | | | | - Wen-Hann Tan
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Mark A Tarnopolsky
- Department of Pediatrics, McMaster University Children's Hospital, Hamilton, Ontario, Canada
| | - Lauren I Brady
- Department of Pediatrics, McMaster University Children's Hospital, Hamilton, Ontario, Canada
| | - Markus Wolff
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tubingen, Germany
| | - Lutz Dondit
- Department of Pediatric Neurology and Center for Developmental Medicine, Olgahospital Stuttgart, Stuttgart, Germany
| | - Helio F Pedro
- Hackensack University Medical Center, Hackensack, New Jersey, USA
| | | | - Kelly L Jones
- Department of Pediatrics, Division of Medical Genetics, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Anup D Patel
- Nationwide Children's Hospital, Columbus, Ohio, USA.,The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - David N Franz
- Department of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Rena Vanzo
- Lineagen, Inc., Salt Lake City, Utah, USA
| | - Elysa Marco
- Department of Neurology, University of San Francisco School of Medicine, San Francisco, California, USA
| | - Judith D Ranells
- Department of Pediatrics, University of South Florida, Tampa, Florida, USA
| | - Nataliya Di Donato
- Institute for Clinical Genetics, Carl Gustav Carus Faculty of Medicine, TU Dresden, Dresden, Germany
| | - William B Dobyns
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington, USA.,Department of Pediatrics, University of Washington, Seattle, Washington, USA.,Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Bodo Laube
- Department of Neurophysiology and Neurosensory Systems, Technical University Darmstadt, Darmstadt, Hessen, Germany
| | - Stephen F Traynelis
- Department of Pharmacology, Emory University School of Medicine, Rollins Research Center, Atlanta, Georgia, USA.,Center for Functional Evaluation of Rare Variants (CFERV), Emory University School of Medicine, Atlanta, Georgia, USA
| | - Johannes R Lemke
- Institute of Human Genetics, University of Leipzig Hospitals and Clinics, Leipzig, Germany
| |
Collapse
|
11
|
Ezenna E, Stanley H, Stanley C. Spoilage Bacteria Associated with Selected Body Lotions Commonly Used amongst Students of the University of Port Harcourt, Nigeria. JPRI 2017. [DOI: 10.9734/jpri/2017/33478] [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: 11/09/2022]
|
12
|
Makov M, Chodick G, Mohnike K, Otonkoski T, Huopio H, Banerjee I, Cave H, Polak M, Christesen HT, Hussain K, Deleon D, Stanley C, Cappa M, Ramos O, Zangen D, Laron Z. Congenital hyperinsulinism, neonatal diabetes and the risk of malignancies: an international collaborative study. Preliminary communication. Diabet Med 2015; 32:701-3. [PMID: 25494966 DOI: 10.1111/dme.12670] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2014] [Indexed: 11/28/2022]
Affiliation(s)
- M Makov
- Endocrinology and Diabetes Research Unit, Schneider Children's Medical Center, Rabin Campus, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Garland CJ, Smirnov SV, Bagher P, Lim CS, Huang CY, Mitchell R, Stanley C, Pinkney A, Dora KA. TRPM4 inhibitor 9-phenanthrol activates endothelial cell intermediate conductance calcium-activated potassium channels in rat isolated mesenteric artery. Br J Pharmacol 2014; 172:1114-23. [PMID: 25323322 DOI: 10.1111/bph.12985] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 10/08/2014] [Accepted: 10/09/2014] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND AND PURPOSE Smooth muscle transient receptor potential melastatin 4 (TRPM4) channels play a fundamental role in the development of the myogenic arterial constriction that is necessary for blood flow autoregulation. As TRPM4 channels are present throughout the vasculature, we investigated their potential role in non-myogenic resistance arteries using the TRPM4 inhibitor 9-phenanthrol. EXPERIMENTAL APPROACH Pressure and wire myography were used to assess the reactivity of rat arteries, the latter in combination with measurements of smooth muscle membrane potential. Immunohistochemistry (IHC) and endothelial cell (EC) calcium changes were assessed in pressurized vessels and patch clamp measurements made in isolated ECs. KEY RESULTS The TRPM4 inhibitor 9-phenanthrol reversibly hyperpolarized mesenteric arteries to circa EK and blocked α1 -adrenoceptor-mediated vasoconstriction. Hyperpolarization was abolished and vasoconstriction re-established by damaging the endothelium. In mesenteric and cerebral artery smooth muscle, 9-phenanthrol hyperpolarization was effectively blocked by the KCa 3.1 inhibitor TRAM-34. 9-Phenanthrol did not increase mesenteric EC [Ca(2+)]i , and Na(+) substitution with N-methyl-D-glucamine only increased the muscle resting potential by 10 mV. Immunolabelling for TRPM4 was restricted to the endothelium and perivascular tissue. CONCLUSIONS AND IMPLICATIONS These data reveal a previously unrecognized action of the TRPM4 inhibitor 9-phenanthrol - the ability to act as an activator of EC KCa 3.1 channels. They do not indicate a functionally important role for TRPM4 channels in the reactivity of non-myogenic mesenteric arteries.
Collapse
Affiliation(s)
- C J Garland
- Department of Pharmacology, University of Oxford, Oxford, OX1 3QT, UK
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Naldrett AJ, Kinnaird J, Wilson A, Yudovskaya M, McQuade S, Chunnett G, Stanley C. Chromite composition and PGE content of Bushveld chromitites: Part 1 – the Lower and Middle Groups. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/174327509x12550990458004] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
15
|
Stanley C. Frustrated at changed EN scope. Nurs N Z 2011; 17:3-4. [PMID: 22283047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
16
|
Thorpe A, Cortez S, Miles D, Stanley C, Molpus K. Management of a Uterine Artriovenous Malformation Following Miscarriage. J Minim Invasive Gynecol 2011. [DOI: 10.1016/j.jmig.2011.08.581] [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: 10/17/2022]
|
17
|
Wilson S, Lane A, Rosedale R, Stanley C. Concentration of Mycobacterium tuberculosis from sputum using ligand-coated magnetic beads. Int J Tuberc Lung Dis 2010; 14:1164-1168. [PMID: 20819263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
SETTING Direct sputum smear microscopy is usually less sensitive than the indirect approach using concentration by centrifugation, but laboratories often do not have access to appropriate equipment. An alternative method of sample concentration has been developed based on magnetic beads coated with a polymeric ligand that binds mycobacteria species. The 'TB-Beads' technology allows manual sample preparation using simple magnetic separation equipment prior to microscopy. OBJECTIVE 1) To evaluate TB-Beads, in combination with fluorescent auramine staining, on a blind panel of 129 frozen samples from the Special Programme for Research & Training in Tropical Diseases (TDR), the World Health Organization sputum bank; and 2) to compare the microscopy results to indirect microscopy, culture and the clinical data already available on these samples. RESULTS The correlation between the TB-Beads protocol and indirect microscopy was 96.1% (124/129). The TB-Beads protocol was 89.4% (76/85) sensitive compared to culture and 77.8% (77/99) sensitive compared to clinical diagnosis. CONCLUSION Capture by magnetic particles yields a concentrated sample that is immobilised over a defined area of the slide, thereby aiding microscopic analysis. TB-Beads allow laboratories that currently perform comparatively insensitive direct microscopy to implement a concentration method that has the potential to improve TB detection rates.
Collapse
Affiliation(s)
- S Wilson
- Microsens Medtech Ltd, London, UK
| | | | | | | |
Collapse
|
18
|
Turcinov D, Stanley C, Canchola JA, Rutherford GW, Novotny TE, Begovac J. Dyslipidemia and adherence to the Mediterranean diet in Croatian HIV-infected patients during the first year of highly active antiretroviral therapy. Coll Antropol 2009; 33:423-30. [PMID: 19662759 PMCID: PMC2844082] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We investigated the association of adherence to the Mediterranean diet and other risk factors for dyslipidemia in HIV-infected Croatian patients during the first year of highly active antiretroviral therapy (HAART). Adherence to the Mediterranean diet was determined by a 150-item questionnaire; a 0 to 9-point diet scale was created that stratified respondents as having low adherence (<4 points) and moderate to high adherence (> or = 4 points). We interviewed 117 participants between May 2004 and June 2005 and abstracted their serum lipid measurements taken during the first year of HAART The values of total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides increased most prominently in the first 3 to 6 months after initiation of HAART (average increase at 3 months: 25% for total cholesterol, 22% for LDL-cholesterol, 18% for HDL-cholesterol and 43% for triglycerides). A Mediterranean diet and physical activity had no effect on serum lipids. The mean total cholesterol was higher in participants receiving a combination of a non-nucleoside reverse transcriptase inhibitor and a protease inhibitor compared to participants receiving a combination of nucleoside analogs with a non-nucleoside analog or a combination of nucleoside analogs and a protease inhibitor Among individual drug treatments, indinavir/ritonavir had the most unfavorable lipid profile. We conclude that adherence to a Mediterranean diet does not influence serum lipid profiles during the first year of HAART.
Collapse
Affiliation(s)
- Drago Turcinov
- University Hospital for Infectious Diseases, Zagreb, Croatia
| | | | | | | | | | | |
Collapse
|
19
|
Hoffman TL, Blanco E, Lane A, Galvin-Parton P, Gadi I, Santer R, DeLeón D, Stanley C, Wilson TA. Glucose metabolism and insulin secretion in a patient with ABCC8 mutation and Fanconi-Bickel syndrome caused by maternal isodisomy of chromosome 3. Clin Genet 2007; 71:551-7. [PMID: 17539904 DOI: 10.1111/j.1399-0004.2007.00802.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Fanconi-Bickel syndrome (FBS) is a rare disorder of glucose transport caused by autosomal recessive mutations in GLUT2. Clinically, FBS results in growth failure, hepatomegaly, renal Fanconi syndrome, and abnormal glucose homeostasis. We report a 23 month old female with FBS characterized by more severe and refractory hypoglycemia than typically seen in this disorder. Although previous reports indicate that FBS patients have diminished insulin secretion, our patient showed evidence of hyperinsulinism (HI). Sequence analysis showed that the patient was homozygous for a known null mutation in GLUT2, confirming the clinical diagnosis of FBS. Parental genotyping showed that the mother was heterozygous for the GLUT2 mutation, while the father was wild type. Tandem repeat marker analysis showed that the patient inherited the GLUT2 mutation via maternal isodisomy of chromosome 3. Further molecular testing showed that the patient was heterozygous for a mutation in ABCC8, a known cause of congenital HI. We discuss the patient's biochemical responses in light of the molecular findings.
Collapse
Affiliation(s)
- T L Hoffman
- Division of Human Genetics and Birth Defects, Department of Pediatrics, University of California, Irvine, CA 92697-2300, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Jarad N, Stanley C, Gunasekera W, Webster S. 137 Concordance between intravenous antibiotics (IV) and in vitro susceptibility of sputum bacteria does not influence the outcome of pulmonary exacerbations in adult cystic fibrosis patients. J Cyst Fibros 2007. [DOI: 10.1016/s1569-1993(07)60123-4] [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: 11/24/2022]
|
21
|
Parris RJ, Schlosenberg J, Stanley C, Maurice S, Clarke SFJ. Emergency department follow-up of bereaved relatives: an audit of one particular service. Emerg Med J 2007; 24:339-42. [PMID: 17452701 PMCID: PMC2658479 DOI: 10.1136/emj.2006.042671] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2007] [Indexed: 11/04/2022]
Abstract
BACKGROUND Although much has been written about the treatment of bereaved relatives in emergency departments, very little has been published about their follow-up after they have left the department. METHODS One model of follow-up is described, in which relatives are invited to a meeting in the department 4-6 weeks after their loss. In this model, it is emphasised that the follow-up is not a counselling session but an opportunity to ask questions, and an audit of the service is presented. RESULTS AND CONCLUSION It is suggested that the provision of information is theoretically beneficial to the bereavement process.
Collapse
Affiliation(s)
- R J Parris
- Emergency Department, Royal Bolton Hospital, Bolton NHS Trust, Bolton, UK
| | | | | | | | | |
Collapse
|
22
|
Weir RE, Black GF, Nazareth B, Floyd S, Stenson S, Stanley C, Branson K, Sichali L, Chaguluka SD, Donovan L, Crampin AC, Fine PEM, Dockrell HM. The influence of previous exposure to environmental mycobacteria on the interferon-gamma response to bacille Calmette-Guérin vaccination in southern England and northern Malawi. Clin Exp Immunol 2007; 146:390-9. [PMID: 17100757 PMCID: PMC1810413 DOI: 10.1111/j.1365-2249.2006.03222.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We report a large study of the effect of BCG vaccination on the in vitro 6-day whole blood interferon-gamma (IFN-gamma) response to antigens from eight species of mycobacteria among schoolchildren in south-eastern England, where bacille Calmette-Guérin (BCG) vaccination is highly protective against pulmonary tuberculosis, and among young adults in northern Malawi, where BCG vaccination is not protective. In the UK children, BCG induced an appreciable increase in IFN-gamma response to antigens from most species of mycobacteria. The degree of change was linked to the relatedness of the species to Mycobacterium bovis BCG, and provides further evidence of the cross-reactivity of mycobacterial species in priming of the immune system. IFN-gamma responses to purified protein derivatives (PPDs) from M. tuberculosis and environmental mycobacteria were more prevalent in the Malawian than the UK group prior to vaccination; BCG vaccination increased the prevalence of responses to these PPDs in the UK group to a level similar to that in Malawi. There was no evidence that the vaccine-induced change in IFN-gamma response was dependent upon the magnitude of the initial response of the individual to environmental mycobacteria in the United Kingdom or in Malawi. These observations should assist the development and interpretation of human clinical trials of new vaccines against M. tuberculosis in areas of both low and high exposure to environmental mycobacteria.
Collapse
Affiliation(s)
- R E Weir
- Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
de Lonlay P, Giurgea I, Sempoux C, Touati G, Jaubert F, Rahier J, Ribeiro M, Brunelle F, Nihoul-Fékété C, Robert JJ, Saudubray JM, Stanley C, Bellanné-Chantelot C. Dominantly inherited hyperinsulinaemic hypoglycaemia. J Inherit Metab Dis 2005; 28:267-76. [PMID: 15868462 DOI: 10.1007/s10545-005-7057-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Congenital hyperinsulinism (HI), the most important cause of hypoglycaemia in early infancy, is a heterogeneous disease with two types of histological lesions, focal and diffuse, with major consequences in terms of surgical approaches. In contrast to focal islet-cell hyperplasia, always sporadic to our knowledge, diffuse hyperinsulinism is a heterogeneous disorder involving several genes, various mechanisms of pathogenic mutations and different transmissions: (i) channelopathy involving the genes encoding the sulphonylurea receptor (SUR1) or the inward-rectifying potassium channel (Kir6.2) in recessively inherited HI or more rarely dominantly inherited HI; (ii) metabolic disorders implicating the short-chain L-3-hydroxyacyl-CoA dehydrogenase (SCHAD) enzyme inrecessively inherited HI, the glucokinase gene (GK), the glutamate dehydrogenase gene (GLUD1) when hyperammonemia is associated, dominant exercise-induced HI with still-unknown mechanism, and more recently the human insulin receptor gene in dominantly inherited hyperinsulinism. Thus, dominant HI disorders always correspond to diffuse HI, where most hypoglycaemia occur in infancy, and are sensitive to medical treatment. Channel causes could be due to dominant negative mutation with one abnormality in channels composed of four Kir6.2 subunits and four SUR1 subunits, leading to a complete destruction of the channel structure or function, or due to haploinsufficiency with only one functional allele, leading to 50% of functional protein, which is not sufficient to obtain enough opened channels to maintain the membrane depolarized. Metabolic causes are due to a gain of function of enzyme activity (deregulated enzymes), except for physical exercise-induced hyperinsulinaemic hypoglycaemia, of still-unknown cause. Congenital hyperinsulinism (HI) is the most important cause of hypoglycaemia in early infancy (Aynsley-Green et al 2000; Cornblath et al 1990; Pagliara et al 1973; Thomas et al 1977). The inappropriate oversecretion of insulin is responsible for profound hypoglycaemia that requires aggressive treatment to prevent severe and irreversible brain damage (Volpe 1995). HI is a heterogeneous disease associated with several genes, various mechanisms of pathogenic mutations and different transmissions (Dunne et al 2004).
Collapse
Affiliation(s)
- P de Lonlay
- INSERM U393 and Department of Pediatrics, Hôpital Necker Enfants Malades, Paris, France.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Harris J, Joules C, Stanley C, Thomas P, Clarke RW. Glutamate and tachykinin receptors in central sensitization of withdrawal reflexes in the decerebrated rabbit. Exp Physiol 2004; 89:187-98. [PMID: 15123548 DOI: 10.1113/expphysiol.2003.002646] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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: 11/08/2022]
Abstract
This study assessed the involvement of NMDA and group I metabotropic glutamate receptors, and tachykinin NK1 and NK3 receptors, in central sensitization of withdrawal reflexes in the decerebrated rabbit. Reflexes evoked in the ankle flexor tibialis anterior and the knee flexor semitendinosus by electrical stimulation at the base of the toes were enhanced for 29-63 min after application of 20% mustard oil to the tips of the toes. Selective antagonists of mGlu1, mGlu5, NMDA and NR2B-subunit-containing NMDA glutamate receptors, as well as NK1, and NK3 receptors, and a non-selective blocker of all tachykinin receptors, were assessed for their effects on the magnitude and duration of the increase in reflexes induced by mustard oil. Dizocilpine, an antagonist of all NMDA receptors (1 mg intrathecal) abolished facilitation of tibialis anterior reflexes and significantly reduced the magnitude and duration of increase of the semitendinosus response. The NR2B-subtype selective antagonist CP-101,606 decreased the magnitude of facilitation of both reflexes but had no effect on duration of enhancement. Selective antagonists for the mGlu1 (CPCCOEt, 1-3 mg intrathecal), mGlu5 (MPEP, 0.2-1 mg intrathecal), NK1 (L-733,060, 0.3 mg intrathecal) or NK3 (SR 142,801, 1 mg kg(-1) i.v.) receptors had no effect on the amplitude or duration of sensitization. However, the non-selective tachykinin receptor blocker ZD-6021 (0.3 mg intrathecal) reduced the amplitude but not the duration of sensitization in the flexor reflexes. Combination of ZD-6021 with CP-101,606 (doses as above) decreased both aspects of the sensitization response. Dizocilpine reduced reflexes evoked from the heel per se, and dizocilpine, CP-101,606 and ZD-6021 reduced arterial blood pressure. Otherwise the drugs used had no effects on baseline variables. The present data confirm the importance of NMDA receptors as a critical part of the process of central sensitization, provide no evidence for a role of metabotropic glutamate receptors, and show that simultaneous blockade of all tachykinin receptors is required to reveal their role in hyperalgesia. The data further indicate that a combined pharmacological approach offers a potential way forward for the development of new antihyperalgesic agents.
Collapse
Affiliation(s)
- J Harris
- Division of Animal Physiology, School of Biosciences and Institute of Neuroscience, University of Nottingham, Sutton Bonington Campus, Loughborough, LE12 5RD, UK
| | | | | | | | | |
Collapse
|
25
|
Weir RE, Fine PEM, Nazareth B, Floyd S, Black GF, King E, Stanley C, Bliss L, Branson K, Dockrell HM. Interferon-gamma and skin test responses of schoolchildren in southeast England to purified protein derivatives from Mycobacterium tuberculosis and other species of mycobacteria. Clin Exp Immunol 2003; 134:285-94. [PMID: 14616789 PMCID: PMC1808851 DOI: 10.1046/j.1365-2249.2003.02272] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The immune responses of schoolchildren in southeast England to Mycobacterium tuberculosis and other species of mycobacteria were studied prior to vaccination with bacille Calmette-Guérin (BCG). Data are presented for tuberculin (Heaf) skin test and interferon-gamma (IFN-gamma) responses to M. tuberculosis purified protein derivative (PPD), and IFN-gamma responses to PPDs from eight other environmental mycobacteria, measured in 424 schoolchildren (13-15 years of age). Responses to M. tuberculosis PPD were detected in 27% of schoolchildren by in vitro IFN-gamma response and in 20% by the Heaf test. IFN-gamma responses were more prevalent to PPDs from species of mycobacteria other than M. tuberculosis, predominantly those of the MAIS complex and M. marinum (45-60% responders). Heaf test and IFN-gamma responses were associated (P<0.001) for M. tuberculosis, MAIS and M. marinum. These findings have implications for appropriate implementation of vaccination against tuberculosis.
Collapse
Affiliation(s)
- R E Weir
- Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Heller AJ, Stanley C, Shaia WT, Sismanis A, Spencer RF, Wolf B. Localization of biotinidase in the brain: implications for its role in hearing loss in biotinidase deficiency. Hear Res 2002; 173:62-8. [PMID: 12372635 DOI: 10.1016/s0378-5955(02)00609-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Biotinidase deficiency is an autosomal recessively inherited disorder characterized by neurological and cutaneous features, including sensorineural hearing loss. Although many of the features of the disorder are reversible following treatment with biotin, the hearing loss appears to be irreversible. To better characterize the nature of the hearing loss in this disorder, location of the expression and presence of biotinidase within the brain was examined using Northern blot analysis, in vitro hybridization of a cDNA panel, and immunohistochemical staining. Results indicate low, but detectable expression of biotinidase throughout the brain, but increased concentrations of biotinidase within the dorsal cochlear nucleus, ventral cochlear nucleus, and superior olivary complex of the brainstem, as well as, in the hair cells and spiral ganglion of the cochlea. These findings suggest that biotinidase and possibly biotin plays an important role in hearing.
Collapse
Affiliation(s)
- Andrew J Heller
- Department of Otolaryngology, Medical College of Virginia of Virginia Commonwealth University, Richmond 23298, USA
| | | | | | | | | | | |
Collapse
|
27
|
Worrell TW, Karst G, Adamczyk D, Moore R, Stanley C, Steimel B, Steimel S. Influence of joint position on electromyographic and torque generation during maximal voluntary isometric contractions of the hamstrings and gluteus maximus muscles. J Orthop Sports Phys Ther 2001; 31:730-40. [PMID: 11767248 DOI: 10.2519/jospt.2001.31.12.730] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Repeated measures analysis of joint angle effects on hip and knee muscle electromyographic (EMG) activity. OBJECTIVES To simultaneously determine angle-dependent changes in maximal voluntary isometric contraction (MVIC) torque and EMG activity during hip extension and knee flexion. BACKGROUND Procedures for normalizing EMG data and for determining torque-angle relationships for various joint motions both entail asking subjects to exert an MVIC. The implicit assumption in these paradigms is that magnitude of the EMG response is at a constant, maximum level so that observed angle-dependent variations in torque are due to mechanical factors, such as muscle length and muscle moment arm. METHODS AND MEASURES Fifty subjects (25 men and 25 women) participated in this study (age, 23.5 +/- 4.6 y; range, 18-38 y). Subjects performed maximal isometric knee flexion at 4 knee angles and maximal isometric hip extension at 4 hip angles. The dependent variables were normalized root-mean-square EMG and torque. The process for normalizing EMG and torque data consisted of determining the largest mean value for each subject across testing positions for the muscle of interest. That value was designated as corresponding to 100% MVIC, and all other data for that muscle were expressed as a percentage of the MVIC value. Repeated measures was used to determine angle-dependent changes in normalized MVIC-torque and MVIC-EMG values for each muscle group. RESULTS Mean torque-angle relationships were generally consistent with previous reports, though considerable intersubject variability was observed. There were significant angle-dependent differences in maximal EMG for both the hamstring and gluteus maximus muscles. Mean percentages of hamstring MVIC-EMG at knee angles of 30 degrees (81 +/- 19) and 60 degrees (82 +/- 22) were greater than at 0 degrees (68 +/- 20) or 90 degrees (74 +/- 20). The mean percentage of gluteus maximus MVIC-EMG at a hip angle of 0 degrees (94 +/- 10) was greater than at 30 degrees (84 +/- 13), 60 degrees (80 +/- 14), or 90 degrees (64 +/- 20), and gluteus maximus maximal voluntary isometric EMG at 90 degrees was less than at all other angles. These differences could not be explained solely by muscle length-dependent effects on EMG amplitude, suggesting that despite instructions for maximal effort, motor unit activation was not maintained at a constant, maximal level throughout the range of motion. The form of the EMG/angle relationships differed markedly from the torque-angle relationships. CONCLUSIONS These findings have implications for the use of MVIC-EMG for reference values in EMG normalization procedures and for the interpretation of mechanisms underlying the torque-angle relationships observed in vivo.
Collapse
Affiliation(s)
- T W Worrell
- Division of Physical Therapy, Community Family Medicine, Duke University Medical Center, Durham, NC 27710, USA.
| | | | | | | | | | | | | |
Collapse
|
28
|
Sturgill GK, Stanley C, Rezac ME, Beckham HW. Solid-State Complexes of Hexafluoro-2-propanol with Benzophenone-Containing Polyimides. Macromolecules 2001. [DOI: 10.1021/ma002072g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- G. K. Sturgill
- School of Chemical Engineering and School of Textile and Fiber Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332
| | - C. Stanley
- School of Chemical Engineering and School of Textile and Fiber Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332
| | - M. E. Rezac
- School of Chemical Engineering and School of Textile and Fiber Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332
| | - H. W. Beckham
- School of Chemical Engineering and School of Textile and Fiber Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332
| |
Collapse
|
29
|
Goodman M, Gringlas M, Baumgart S, Stanley C, Desai SA, Turner M, Streletz LJ, Graziani LJ. Neonatal electroencephalogram does not predict cognitive and academic achievement scores at early school age in survivors of neonatal extracorporeal membrane oxygenation. J Child Neurol 2001; 16:745-50. [PMID: 11669348 DOI: 10.1177/088307380101601007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [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] [Indexed: 11/15/2022]
Abstract
Extracorporeal membrane oxygenation is an effective rescue treatment for severe cardiorespiratory failure in term or near-term neonates, although a wide range of neurologic sequelae have been noted in a substantial minority of survivors. The objective of the present study was to determine the value of the neonatal electroencephalogram (EEG) for predicting Wechler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R), Wide Range Achievement Test, and Wide Range Assessment of Memory and Language scores at early school age in 66 testable survivors of extracorporeal membrane oxygenation who were not severely brain damaged. Technically satisfactory EEG recordings were obtained at least twice following admission to our nursery and prior to discharge. The EEGs were classified and graded according to standard criteria. The developmental test results of those who had only normal or mildly abnormal neonatal EEGs (group 1, n = 9) were compared with those who had at least one moderately or markedly abnormal recording (group 2, n = 57). School-age test and subtest scores were not statistically significantly worse in group 2 versus group 1 infants. No child in group 1 and five children in group 2 had WPPSI-R Full-Scale IQ scores of less than 70. Of the nine children in group 2 who had at least one markedly abnormal neonatal EEG recording (graded as burst suppression or as electrographic seizure), only two had abnormally low WPPSI-R Full-Scale IQ scores. We conclude that EEG recordings obtained during the neonatal course of neonates treated with extracorporeal membrane oxygenation do not predict cognitive and academic achievement test results in survivors at early school age who were testable and not severely brain damaged.
Collapse
Affiliation(s)
- M Goodman
- Department of Pediatrics, Thomas Jefferson University, Jefferson Medical College, Philadelphia, PA 19107, USA.
| | | | | | | | | | | | | | | |
Collapse
|
30
|
De Lonlay P, Benelli C, Fouque F, Ganguly A, Aral B, Dionisi-Vici C, Touati G, Heinrichs C, Rabier D, Kamoun P, Robert JJ, Stanley C, Saudubray JM. Hyperinsulinism and hyperammonemia syndrome: report of twelve unrelated patients. Pediatr Res 2001; 50:353-7. [PMID: 11518822 DOI: 10.1203/00006450-200109000-00010] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Hyperinsulinism and hyperammonemia syndrome has been reported as a cause of moderately severe hyperinsulinism with diffuse involvement of the pancreas. The disorder is caused by gain of function mutations in the GLUD1 gene, resulting in a decreased inhibitory effect of guanosine triphosphate on the glutamate dehydrogenase (GDH) enzyme. Twelve unrelated patients (six males, six females) with hyperinsulinism and hyperammonemia syndrome have been investigated. The phenotypes were clinically heterogeneous, with neonatal and infancy-onset hypoglycemia and variable responsiveness to medical (diazoxide) and dietary (leucine-restricted diet) treatment. Hyperammonemia (90-200 micromol/L, normal <50 micromol/L) was constant and not influenced by oral protein, by protein- and leucine-restricted diet, or by sodium benzoate or N-carbamylglutamate administration. The patients had mean basal GDH activity (18.3 +/- 0.9 nmol/min/mg protein) not different from controls (17.9 +/- 1.8 nmol/min/mg protein) in cultured lymphoblasts. The sensitivity of GDH activity to inhibition by guanosine triphosphate was reduced in all patient lymphoblast cultures (IC(50), or concentrations required for 50% inhibition of GDH activity, ranging from 140 to 580 nM, compared with control IC(50) value of 83 +/- 1.0 nmol/L). The allosteric effect of ADP was within the normal range. The activating effect of leucine on GDH activity varied among the patients, with a significant decrease of sensitivity that was correlated with the negative clinical response to a leucine-restricted diet in plasma glucose levels in four patients. Molecular studies were performed in 11 patients. Heterozygous mutations were localized in the antenna region (four patients in exon 11, two patients in exon 12) as well as in the guanosine triphosphate binding site (two patients in exon 6, two patients in exon 7) of the GLUD1 gene. No mutation has been found in one patient after sequencing the exons 5-13 of the gene.
Collapse
Affiliation(s)
- P De Lonlay
- Departments of Pediatrics, Hôpital Necker-Enfants malades, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Abstract
STUDY OBJECTIVE To evaluate the ability of circulating nurses to estimate input and outgo of irrigating fluids used during hysteroscopic procedures in a hospital operating room. DESIGN Simulation of intraoperative measurements (Canadian Task Force classification II-1). SETTING Operating room. Intervention. Circulating nurses estimated fluid volumes under circumstances simulating actual conditions of hysteroscopic ablative or resection procedures. MEASUREMENTS AND MAIN RESULTS Three-liter glycine irrigation bags were overfilled by an average of 2.8% (62-125 ml). Estimates of fluid remaining in partially emptied bags were in error by an average ranging from 4% to 50%/bag (largest error 10-55%, 157-401 ml). Estimates of fluid in kick buckets were in error by an average of 10% to 39% (largest error 22-66%, 232-903 ml). Visual estimates of fluid on the operating room floor were in error by an average of 56% to 67% (largest error 65-81%, 182-840 ml). Estimates of fluid in suction canisters were consistent among nurses. The accuracy of measurements for partially filled suction canisters primarily depended on the accuracy of canister calibration. Volume contained in cascaded suction canisters from an actual surgical procedure was grossly different from rated capacity. CONCLUSION Accurate tracking of irrigation fluid during hysteroscopic procedures is difficult. Even with a mechanical measuring system, fluid lost on the floor can introduce sizable errors. Estimation errors can easily and quickly accumulate to clinically significant volumes. Use of an automated mechanical fluid-tracking system with devices to capture fluid lost from the surgical field is recommended.
Collapse
Affiliation(s)
- H R Boyd
- 6490 Excelsior Boulevard E104, St. Louis Park, MN 55426, USA
| | | |
Collapse
|
32
|
Green J, Stanley C, Smith V, Goldwyn R. A new method of evaluating attachment representations in young school-age children: the Manchester Child Attachment Story Task. Attach Hum Dev 2000; 2:48-70. [PMID: 11707892 DOI: 10.1080/146167300361318] [Citation(s) in RCA: 186] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
We describe a new instrument, using a doll-play vignette completion method, which applies concepts and methodologies from infant and adult attachment research to enable identification and detailed classification of internal representations of attachment relationships in young school-age children. Validation of the Manchester Child Attachment Story Task (MCAST) in a normal population (N = 53) shows good interrater reliability and content validity. Patterns of attachment representation identified show stability over time. Comparisons are made with existing methodologies, and potential applications of the instrument and directions for future research are discussed.
Collapse
Affiliation(s)
- J Green
- Department of Child and Family Psychiatry, Booth Hall Children's Hospital, Charlestown Road, Blackley, Manchester M9 7AA, UK.
| | | | | | | |
Collapse
|
33
|
Abstract
The Manchester Attachment Story Task (MCAST) is a new method for eliciting the internal working model (IWM) of attachment representations in children between 5 and 7 years. The instrument is described in the companion paper, 'A New Method of Evaluating Attachment Representations'. This paper reports initial findings on a non-clinical sample comparing the MCAST with concurrent maternal attachment representation, measures of child temperament and behaviour, and concurrent ratings on the Separation Anxiety Test (SAT). Ratings of disorganized attachment on the MCAST show association with Unresolved status on concurrent maternal Adult Attachment Interview (AAI) and with independent teacher ratings of classroom behaviour. Child temperament shows an effect on the style of engagement with the interview but not the attachment ratings. Possible alternative explanations for the phenomena seen are discussed, along with potential applications of the instrument and directions for future research.
Collapse
Affiliation(s)
- R Goldwyn
- Department of Child and Family Psychiatry, Booth Hall Children's Hospital, Charlestown Road, Blackey, Manchester M9 7AA, UK.
| | | | | | | |
Collapse
|
34
|
Desai SA, Stanley C, Gringlas M, Merton DA, Wolfson PJ, Needleman L, Graziani LJ, Baumgart S. Five-year follow-up of neonates with reconstructed right common carotid arteries after extracorporeal membrane oxygenation. J Pediatr 1999; 134:428-33. [PMID: 10190916 DOI: 10.1016/s0022-3476(99)70199-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Serial Doppler ultrasonography and long-term neurodevelopmental follow-up outcomes were evaluated prospectively in neonates whose right common carotid artery (RCCA) was reconstructed after extracorporeal membrane oxygenation (ECMO). METHODS Children with RCCA reconstruction (n = 34) were monitored for 3.5 to 4.5 years by Doppler ultrasonography for arterial patency, and 28 had IQ testing by 5 years. A comparison group consisted of 35 infants who had RCCA ligation after ECMO. Neonatal electroencephalograms and computed tomography/magnetic resonance imaging scans were also compared. RESULTS Reconstructions were successful (<50% RCCA stenosis by Doppler ultrasonography) in 26 (76%) of 34 children, 3 (9%) had >/=50% stenosis, and 5 (15%) had occlusion. No significant differences were seen between reconstructed and ligated groups in neonatal complications or ECMO courses. Occurrence of marked neonatal electroencephalographic abnormalities did not differ between groups. Abnormalities on computed tomography/magnetic resonance imaging scans (4 of 31 vs 11 of 29, P =.025) and cerebral palsy (0 of 34 vs 5 of 35, P =.054) were more common in infants with RCCA ligation. No differences were seen in developmental or IQ scores between the 2 groups, and 4 in each group had cognitive handicaps (at least 1 IQ score <70). CONCLUSIONS Most RCCA reconstructions remained patent, with 24% showing significant stenosis or occlusion. Compared with a historical control group, patients with RCCA reconstruction had fewer brain scan abnormalities and tended to be less likely to have cerebral palsy. RCCA reconstruction after venoarterial ECMO may improve outcome.
Collapse
Affiliation(s)
- S A Desai
- Department of Pediatrics, Divisions of Neonatology and Child Development and Neurology, Wilmington, Deleware, USA
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Hunter DD, Castranova V, Stanley C, Dey RD. Effects of silica exposure on substance P immunoreactivity and preprotachykinin mRNA expression in trigeminal sensory neurons in Fischer 344 rats. J Toxicol Environ Health A 1998; 53:593-605. [PMID: 9572158 DOI: 10.1080/009841098159051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Trigeminal sensory neurons innervate the nasal cavity and may release substance P (SP) upon exposure to inhaled irritants. The purpose of this study was to determine if silica dust, an occupational irritant causing inflammation, activates sensory neurons supplying the nasal cavity. Male Fischer 344 rats were placed in inhalation chambers and exposed daily to 2 mg/m3 of fresh silica (average diameter 1 microm) for 6 mo. Following exposure, the trigeminal ganglia (TG) were removed and prepared for SP immunocytochemistry and for preprotachykinin (PPT) autoradiographic in situ hybridization. The SP-like immunofluorescence in TG neurons was subjectively categorized as high, moderate, or low (background) intensity. In situ hybridization autoradiographs were quantified on the basis of grain density using digital imaging analysis. The SP immunoreactivity and PPT mRNA expression in the TG neurons were significantly increased after silica inhalation. The proportion of highly positive SP-immunoreactive neurons shifted from 1.30 +/- 0.58% in controls to 11.30 +/- 1.15% after silica treatment. The neurons exhibiting high grain density for PPT mRNA increased from 1.50 +/- 0.87% in controls to 11.67 +/- 0.58% in the silica group. Thus, inhalation of silica causes upper airway irritation resulting in increased levels of immunoreactive neuronal SP and PPT mRNA. These findings suggest that silica activates sensory pathways that may be involved in nasal inflammation.
Collapse
Affiliation(s)
- D D Hunter
- Department of Anatomy, West Virginia University, Morgantown, USA
| | | | | | | |
Collapse
|
36
|
Yacovone J, Stanley C. The report of a survey of dental assistant needs in the Rhode Island Dental Association. R I Dent J 1998; 29:11-2. [PMID: 9495913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
37
|
Graziani LJ, Baumgart S, Desai S, Stanley C, Gringlas M, Spitzer AR. Clinical antecedents of neurologic and audiologic abnormalities in survivors of neonatal extracorporeal membrane oxygenation. J Child Neurol 1997; 12:415-22. [PMID: 9373797 DOI: 10.1177/088307389701200702] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Extracorporeal membrane oxygenation is an effective rescue treatment for severe cardiorespiratory failure in term or near term neonates, although cerebral palsy, mental retardation, and sensorineural hearing loss are observed in 10 to 20% of survivors. The objective of the present study was to identify potential risk factors that may explain the neurologic and audiologic sequelae noted in 19% of 181 survivors of neonatal extracorporeal membrane oxygenation from our hospital. Our results suggest the following findings in survivors of severe cardiorespiratory failure treated with neonatal extracorporeal membrane oxygenation: (1) hypotension or the need for cardiopulmonary resuscitation before extracorporeal membrane oxygenation significantly increases the risk of spastic cerebral palsy, (2) profound hypocarbia before extracorporeal membrane oxygenation is associated with a significantly increased risk of hearing loss, (3) mental retardation in the absence of spastic cerebral palsy is unexplained except when due to abnormal fetal brain development, and (4) hypoxemia in the absence of hypotension does not increase the risk of neurologic or audiologic sequelae.
Collapse
Affiliation(s)
- L J Graziani
- Department of Pediatrics, Thomas Jefferson University, Jefferson Medical College, Philadelphia, PA, USA
| | | | | | | | | | | |
Collapse
|
38
|
Allen PS, Matheson GO, Zhu G, Gheorgiu D, Dunlop RS, Falconer T, Stanley C, Hochachka PW. Simultaneous 31P MRS of the soleus and gastrocnemius in Sherpas during graded calf muscle exercise. Am J Physiol 1997; 273:R999-1007. [PMID: 9321879 DOI: 10.1152/ajpregu.1997.273.3.r999] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The observation that the amount of lactate formed during hypobaric hypoxia decreases with the severity of hypoxia has become known as the "lactate paradox." We used noninvasive 31P magnetic resonance spectroscopy (MRS) to further probe this problem and explore the nature of muscle metabolism during rest-exercise-recovery transitions in Sherpas indigenous to the high Himalayas of Nepal. MRS data were obtained using a whole body 1-m bore, 1.5-T Phillips Gyroscan spectrometer. Muscle-specific localization of MRS data acquisition was achieved by means of a modified image-selected in vivo spectroscopy sequence (ISIS). The spectra acquired from the medial and lateral gastrocnemius muscle, rich in fast-twitch fibers, were well constrained by selective excitation and by the boundary of the leg. The spectra from a third region contained signals predominantly from the soleus, a muscle formed mainly of slow-twitch fibers. We quantified relative concentration changes in phosphocreatine (PCr), Pi, and ATP during a series of calf muscle work bouts; free ADP concentrations were calculated on the assumption that the creatine phosphokinase reaction was always essentially at equilibrium. Hydrogen ion concentrations were calculated from the chemical shift of Pi, which represents the equilibrium between mono- and diprotonated phosphate. Plantar flexion was quantified using a calf muscle ergometer designed for operation within a 1-m whole body magnet. We found that the concentration of ATP was rigorously regulated and thus did not change despite large changes in ATP turnover rates required through exercise. The relative concentrations of PCr and Pi were linear functions of the percent maximum work rate of the lateral and medial gastrocnemius, but on transition to exercise the fractional concentration changes in these metabolites were much less than the fractional change in muscle ATP turnover rates. The relationship between muscle ATP turnover rate and free ADP concentration was complex; again, a kinetic order of 1 was not observed. In contrast to the gastrocnemius, the soleus muscle sustained much smaller changes in the concentrations of these crucial metabolites during rest-work-recovery transitions. Unlike the situation in most other muscles rich in fast-twitch fibers characterized by lactate-associated acidosis during muscle work, the intracellular pH in gastrocnemius of Sherpas was stable through these protocols, which is consistent with the low lactate production (i.e., with the lactate paradox) observed in indigenous highlanders.
Collapse
Affiliation(s)
- P S Allen
- Department of Biomedical Engineering Sciences in Medicine, University of Alberta, Edmonton, Canada
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Desai S, Kollros PR, Graziani LJ, Streletz LJ, Goodman M, Stanley C, Cullen J, Baumgart S. Sensitivity and specificity of the neonatal brain-stem auditory evoked potential for hearing and language deficits in survivors of extracorporeal membrane oxygenation. J Pediatr 1997; 131:233-9. [PMID: 9290609 DOI: 10.1016/s0022-3476(97)70159-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [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] [Indexed: 02/05/2023]
Abstract
OBJECTIVE We determined the sensitivity and specificity of neonatal brain-stem auditory evoked potentials (BAEP) as markers for subsequent hearing impairment and for developmental problems found later in infancy and childhood. METHODS BAEP studies were performed before discharge in infants treated with extracorporeal membrane oxygenation (ECMO), and two specific abnormalities were analyzed: elevated threshold and delayed central auditory conduction. Behavioral audiometry was repeated during periodic follow-up until reliable responses were obtained for all frequencies, and standardized developmental testing was also conducted. The sensitivity and specificity of an elevated threshold on the neonatal BAEP for detecting subsequent hearing loss, and the relationship of any neonatal BAEP abnormality to language or developmental disorders in infancy, were calculated. RESULTS Test results for 46 ECMO-treated infants (57.5%) were normal, and those for 34 infants (42.5%) were abnormal, with either elevated wave V threshold, prolonged wave I-V interval, or both on neonatal BAEP recordings. Most significantly, 7 (58%) of the 12 children with subsequent sensorineural hearing loss had left the hospital after showing normal results on threshold tests. There was no significant difference in the frequency of hearing loss between subjects with abnormal (5/21, or 24%) and those with normal BAEP thresholds (7/59, or 12%; Fisher Exact Test, p = 0.28). Therefore the sensitivity of neonatal BAEP testing for predicting subsequent hearing loss was only 42%. Neonatal BAEP specificity for excluding subsequent hearing loss was 76%. In contrast, on language development testing, 19 children demonstrated receptive language delay. Of these children, 12 (63%) had abnormal neonatal BAEP recordings and 7 (37%) had a normal BAEP threshold, normal central auditory conduction test results, or both (p = 0.04). CONCLUSIONS Neonatal BAEP threshold recordings were of limited value for predicting subsequent hearing loss common in ECMO-treated survivors. However, an abnormal neonatal BAEP significantly increased the probability of finding a receptive language delay during early childhood, even in those with subsequently normal audiometry findings. Because neonatal ECMO is associated with a high risk of hearing and receptive language disorders, parents should be counseled that audiologic and developmental follow-up evaluations in surviving children are essential regardless of the results of neonatal BAEP testing.
Collapse
Affiliation(s)
- S Desai
- Department of Pediatrics, Thomas Jefferson University, Jefferson Medical College, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Hutzell RR, Halverson S, Burke T, Carpenter B, Hecke A, Wooldridge H, Stanley C, Chambers T, Hooper R. A multimodal, second generation, posttraumatic stress disorder rehabilitation program. J Trauma Stress 1997; 10:109-16. [PMID: 9018681 DOI: 10.1023/a:1024864531634] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Second Generation posttraumatic stress disorder (PTSD) treatment programs were recently proposed as one component of a model of treatment of chronic PTSD. While First Generation PTSD programs emphasized trauma work, Second Generation programs emphasize skills for the present/future ability to adapt within society. The present paper describes a functioning Second Generation PTSD treatment program for Vietnam combat veterans. The guiding principles underlying this multimodal and vocational rehabilitation program are outlined.
Collapse
Affiliation(s)
- R R Hutzell
- VA Medical Center, Knoxville, Iowa 50138, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Wiswell TE, Graziani LJ, Kornhauser MS, Stanley C, Merton DA, McKee L, Spitzer AR. Effects of hypocarbia on the development of cystic periventricular leukomalacia in premature infants treated with high-frequency jet ventilation. Pediatrics 1996; 98:918-24. [PMID: 8909486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Previous data from our institution indicate that mechanically ventilated premature infants are at increased risk for cystic periventricular leukomalacia (CPVL), particularly if hypocapnia occurs. High-frequency jet ventilation (HFJV) may produce substantial hypocapnia. We sought to investigate whether hypocapnia during HFJV is associated with the development of CPVL. METHODS Sixty-seven premature infants (mean gestational age, 27.2 weeks; mean birth weight, 1001 g) underwent HFJV for a mean of 44 (range, 8 to 70) hours during the first 3 days of life. All infants were followed with serial neurosonograms at least weekly until 6 to 8 weeks of age and every 2 to 4 weeks thereafter until discharge. To assess the cumulative effects of hypotension, acidosis, hypoxemia, and hypocarbia during the first 3 days of life on the development of PVL, we developed a quantitative assessment in which we assigned threshold levels at particular critical values of these parameters (such as a mean PaCO2 of 20 mm Hg) and calculated an area above the curve between longitudinally connected values of these parameters and the threshold levels. RESULTS Nine of the 67 infants died before 21 days of life. Of the 58 who survived beyond 21 days, large CPVL (> 5 mm in size) developed in 18 infants. Infants with cysts were similar in birth weight, gestational age, and virtually all other antepartum, intrapartum, and postpartum parameters compared with the 40 neonates in whom CPVL did not develop. However, infants with CPVL were significantly more likely to have moderate or severe periventricular echodensities preceding development of CPVL and periventricular echodensities that persisted for a longer period. We did not find an effect of hypotension, acidosis, or hypoxemia on the development of CPVL. There were no differences in the mean PaCO2, the absolute low PaCO2 values, the ranges of low PaCO2 between groups, or area above the curve measurements at threshold levels of 15 and 20 mm Hg, respectively. However, logistic regression analysis revealed that infants with CPVL were independently significantly more likely to have greater cumulative hypocarbia below a threshold level of 25 mm Hg during the first day of life (odds ratio, 5.43; 95% confidence interval, 1.33 to 22.2). CONCLUSIONS Hypocarbia produced by treatment with HFJV during the first 3 days of life is associated with the subsequent development of CPVL. The mechanisms for the development of CPVL among premature infants treated with HFJV need to be established.
Collapse
Affiliation(s)
- T E Wiswell
- Department of Pediatrics, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | |
Collapse
|
42
|
Hochachka PW, Clark CM, Monge C, Stanley C, Brown WD, Stone CK, Nickles RJ, Holden JE. Sherpa brain glucose metabolism and defense adaptations against chronic hypoxia. J Appl Physiol (1985) 1996; 81:1355-61. [PMID: 8889774 DOI: 10.1152/jappl.1996.81.3.1355] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The brain of hypoxia-tolerant vertebrates is known to survive extreme oxygen limitation at least in part because of very low rats of ATP utilization and ATP production. To asses whether similar adaptations are involved in healthy humans during hypoxia adaptation over generational time, we initially used positron-emission tomography measurements of glucose metabolic rates in the brain of Quechuas, whose ancestors have been indigenous to the Andes at altitudes between approximately 3,300 and 4,500 m for several hundred years. Workers in this field generally believe that the lineage of Sherpas has been indigenous to the Himalayas for even longer and that Sherpas and other peoples indigenous to the Tibetan plateau are perhaps the most exquisitely hypoxia adapted of all humans. For this reason, in this study we extended our database to include Sherpas. With the use of the same protocol as before, two metabolic states were analyzed: 1) the presumed normal (hypoxia-adapted) state, monitored as soon as possible after subjects left the Himalayas and 2) the deacclimated state, monitored after 3 wk at low altitudes. Positron-emission tomography measurements of 2-[18F]deoxy-2-fluoro-D-glucose metabolic rates, quantified in 26 regions of the brain, indicated that the Sherpas' brain metabolism differed significantly from that of Quechuas but was essentially identical to that of lowlanders. Region-by-region patterns were similar in all three groups, indicating that the regional organization of glucose metabolism in the brain is a conservative, relatively constant characteristic.
Collapse
Affiliation(s)
- P W Hochachka
- Department of Zoology, University of British Columbia, Vancouver, Canada
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Hochachka PW, Clark CM, Holden JE, Stanley C, Ugurbil K, Menon RS. 31P magnetic resonance spectroscopy of the Sherpa heart: a phosphocreatine/adenosine triphosphate signature of metabolic defense against hypobaric hypoxia. Proc Natl Acad Sci U S A 1996; 93:1215-20. [PMID: 8577743 PMCID: PMC40059 DOI: 10.1073/pnas.93.3.1215] [Citation(s) in RCA: 80] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Of all humans thus far studied, Sherpas are considered by many high-altitude biomedical scientists as most exquisitely adapted for life under continuous hypobaric hypoxia. However, little is known about how the heart is protected in hypoxia. Hypoxia defense mechanisms in the Sherpa heart were explored by in vivo, noninvasive 31P magnetic resonance spectroscopy. Six Sherpas were examined under two experimental conditions [normoxic (21% FiO2) and hypoxic (11% FiO2) and in two adaptational states--the acclimated state (on arrival at low-altitude study sites) and the deacclimating state (4 weeks of ongoing exposure to low altitude). Four lowland subjects were used for comparison. We found that the concentration ratios of phosphocreatine (PCr)/adenosine triphosphate (ATP) were maintained at steady-state normoxic values (0.96, SEM = 0.22) that were about half those found in normoxic lowlanders (1.76, SEM = 0.03) monitored the same way at the same time. These differences in heart energetic status between Sherpas and lowlanders compared under normoxic conditions remained highly significant (P < 0.02) even after 4 weeks of deacclimation at low altitudes. In Sherpas under acute hypoxia, the heart rate increased by 20 beats per min from resting values of about 70 beats per min, and the percent saturation of hemoglobin decreased to about 75%. However, these perturbations did not alter the PCr/ATP concentration ratios, which remained at about 50% of the values expected in healthy lowlanders. Because the creatine phosphokinase reaction functions close to equilibrium, these steady-state PCr/ATP ratios presumably coincided with about 3-fold higher free adenosine diphosphate (ADP) concentrations. Higher ADP concentrations (i.e., lower [PCr]/[ATP] ratios) were interpreted to correlate with the Km values for ADP-requiring kinases of glycolysis and to reflect elevated carbohydrate contributions to heart energy needs. This metabolic organization is postulated as advantageous in hypobaria because the ATP yield per O2 molecule is 25-60% higher with glucose than with free fatty acids (the usual fuels utilized in the human heart in postfasting conditions).
Collapse
Affiliation(s)
- P W Hochachka
- Department of Zoology, University of British Columbia, Vancouver, Canada
| | | | | | | | | | | |
Collapse
|
44
|
Abstract
A large group of infants of primiparous women who were at high risk fo r postnatal depression (N=188) and a smaller group of those at low risk (N=43) were assessed in the neonatal period using the Neonatal Behavioural Assessment Scale. Poor motor scores and high irritability were strongly predictive of the onset of maternal depression by eight weeks postpartum. These effects obtained after taking account of both maternal mood in the neonatal period and maternal perceptions of infant temperament. Poor motor scores and high levels of infant irritability in the neonatal period also predicted less optimal infant behaviour in face-to-face interactions with the mother at two months postpartum. Neonatal behaviour did not predict the persistence of depression, nor did it predict the quality of maternal behaviour in interaction with the infant.
Collapse
Affiliation(s)
- L Murray
- University of Cambridge Clinical School, UK
| | | | | | | | | |
Collapse
|
45
|
Boué DR, Stanley C, Baergen RN. Placental pathology casebook. Long umbilical cord with torsion and diffuse chorionic surface vein thrombosis: multiple associated congenital abnormalities including destructive encephalopathy. J Perinatol 1995; 15:429-31. [PMID: 8576766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- D R Boué
- Department of Pathology, University of California, San Diego, USA
| | | | | |
Collapse
|
46
|
Orum H, Nielsen PE, Jørgensen M, Larsson C, Stanley C, Koch T. Sequence-specific purification of nucleic acids by PNA-controlled hybrid selection. Biotechniques 1995; 19:472-80. [PMID: 7495562] [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: 01/25/2023] Open
Abstract
Using an oligohistidine peptide nucleic acids (oligohistidine-PNA) chimera, we have developed a rapid hybrid selection method that allows efficient, sequence-specific purification of a target nucleic acid. The method exploits two fundamental features of PNA. First, that PNA binds with high affinity and specificity to its complementary nucleic acid. Second, that amino acids are easily attached to the PNA oligomer during synthesis. We show that a (His)6-PNA chimera exhibits strong binding to chelated Ni2+ ions without compromising its native PNA hybridization properties. We further show that these characteristics allow the (His)6-PNA/DNA complex to be purified by the well-established method of metal ion affinity chromatography using a Ni(2+)-NTA (nitrilotriactic acid) resin. Specificity and efficiency are the touchstones of any nucleic acid purification scheme. We show that the specificity of the (His)6-PNA selection approach is such that oligonucleotides differing by only a single nucleotide can be selectively purified. We also show that large RNAs (2224 nucleotides) can be captured with high efficiency by using multiple (His)6-PNA probes. PNA can hybridize to nucleic acids in low-salt concentrations that destabilize native nucleic acid structures. We demonstrate that this property of PNA can be utilized to purify an oligonucleotide in which the target sequence forms part of an intramolecular stem/loop structure.
Collapse
Affiliation(s)
- H Orum
- PNA Diagnostics A/S, Copenhagen, Denmark
| | | | | | | | | | | |
Collapse
|
47
|
Stanley C. The healing touch. Nurs Times 1995; 91:36-8. [PMID: 7630817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
|
48
|
Holden JE, Stone CK, Clark CM, Brown WD, Nickles RJ, Stanley C, Hochachka PW. Enhanced cardiac metabolism of plasma glucose in high-altitude natives: adaptation against chronic hypoxia. J Appl Physiol (1985) 1995; 79:222-8. [PMID: 7559223 DOI: 10.1152/jappl.1995.79.1.222] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.0] [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] [Indexed: 01/25/2023] Open
Abstract
The metabolism of glucose in mammalian heart is 25-50% more O2 efficient than the metabolism of free fatty acids. To assess the role of substrate preference in adaptations to chronic hypoxia, positron emission tomographic measurements of heart regional glucose uptake rates after an overnight fast were made in volunteer Quechua subjects and in Sherpa subjects, both indigenous to altitudes of over 3,000 m, and in a group of lowlander volunteers. Highest uptake rates were found in the Quechuas on arrival and in the Sherpas after a 3-wk period at low altitude, intermediate rates in Quechuas after a 3-wk period at low altitude and in the lowlanders, and lowest rates in Sherpas on arrival. These low values were probably related to the stress of travel to the site of the experiments. Measured plasma catecholamines, hormones, and substrates indicated that glucose concentrations correlated best with observed variations in glucose uptake, with a negative correlation for the control subjects and a positive correlation for the Quechuas and Sherpas. Uptake values in Quechuas declined significantly after a 3-wk period at low altitude, but the positive correlation with glucose levels persisted. We conclude that an elevated glucose preference in heart is a true metabolic adaptation in humans adapted over generations to chronic hypoxia.
Collapse
Affiliation(s)
- J E Holden
- Department of Medical Physics, University of Wisconsin-Madison 53706, USA
| | | | | | | | | | | | | |
Collapse
|
49
|
Stanley C, Lihme A. A high-performance upgrade for ELISAs. Am Clin Lab 1995; 14:22. [PMID: 10151080] [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]
|
50
|
Abstract
Neonates undergoing cardiac surgery at The Children's Hospital of Philadelphia frequently developed metabolic acidemia as they passively cooled prior to the start of cardiopulmonary bypass. This study was performed in an attempt to identify the mechanism for this acidemia. After receiving an initial dose of fentanyl (10 micrograms/kg) and pancuronium, 22 neonates were randomly assigned to maintain normothermia by active warming (Group I), or to permit passive cooling (Group II) before surgery. Arterial blood samples were obtained prior to, and at 10 and 45 min after entering the operating room for the analysis of pH, gas tensions, lactate, pyruvate, plasma free fatty acids, acetoacetate, beta-hydroxybutyrate, total CO2, and glucose concentrations. In the last 11 patients studied, the observation period was extended to 75 min at which time another arterial blood sample was obtained. There was a steady decrease in heart rate as the Group II patients cooled; however, arterial blood pressure did not change in either group. There were no changes in blood values measured in Group I neonates. In the Group II patients, there was a progressive decline in calculated base excess, total CO2, and an increase in serum lactate as the patients cooled. The metabolic acidemia that develops in neonates represents lactate accumulation as a consequence of surface cooling prior to surgery and the institution of cardiopulmonary bypass. Whether lactate accumulates as a result of anaerobic metabolism in underperfused tissue beds or reduced hepatic clearance could not be distinguished in this study. Since neither clinically significant hemodynamic changes nor differences in outcome were found between the two groups, the authors believe this mild lactic acidemia is inconsequential and does not require therapy.
Collapse
Affiliation(s)
- S A Stayer
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine
| | | | | | | | | | | |
Collapse
|