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Stewart CM, Bates RE, Smith GE. Does performance on school-administered mock boards predict performance on a dental licensure exam? J Dent Educ 2004; 68:426-32. [PMID: 15112919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Many dental schools consider the successful completion of a state or regional dental licensure examination as one of the significant benchmarks for assessing effectiveness of the curriculum. At the University of Florida College of Dentistry (UFCD), performance on the state dental licensure examination is monitored and compared with senior year mock board performance and clinical productivity to identify factors that may contribute to state board "pass" rates. A retrospective analysis was conducted of "first-time" performance on the Florida Dental Licensure Exam for graduates from classes 1996 to 2003. Using ANOVA, licensure exam performance data was analyzed and compared with performance on the senior mock board exam and clinical productivity, determined by numbers of procedures completed in each discipline. Significant relationships were noted between four of thirteen aspects of mock board performance and clinical productivity data and performance on the Florida Dental Licensure Exam. First, a significant relationship (p<0.05) was found between passing the senior mock board fixed prosthodontic preparation and successful completion of that procedure on the state licensure exam. Second, a significant relationship (p<0.05) was noted between the clinical (patient-based) Class II amalgam on the senior mock board and passing that procedure on the state licensure exam. Third, a significant relationship was noted (p<0.05) between the number of Class IV clinical composite procedures completed during dental school and passing the licensure exam Class IV manikin composite procedure. Fourth, there was a significant relationship (p<0.01) between the number of clinical Class II amalgam procedures completed during the junior and senior years and passing the state licensure exam clinical amalgam procedure. No significance was found between the remaining five mock board procedures (Class II composites, Class IV composites, pin amalgams, endodontic, and periodontal scaling/root planing) and performance on the like procedures on the licensure exam. Likewise, no significance was found between the remaining four productivity measures (numbers of Class II composites, endodontic teeth treated, crowns and abutments completed, and quadrants of periodontal scaling/root planing) and performance of these procedures on the state licensure exam.
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Nolan CL, Moore GJ, Madden R, Farchione T, Bartoi M, Lorch E, Stewart CM, Rosenberg DR. Prefrontal cortical volume in childhood-onset major depression: preliminary findings. ARCHIVES OF GENERAL PSYCHIATRY 2002; 59:173-9. [PMID: 11825139 DOI: 10.1001/archpsyc.59.2.173] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Abnormalities in the prefrontal cortex have been implicated in the pathogenesis of major depressive disorder (MDD). To our knowledge, no prior study has examined prefrontal cortical anatomy in pediatric patients with MDD near the onset of illness before receiving treatment. METHODS Volumetric magnetic resonance imaging studies were conducted in 22 psychotropic-naive patients with MDD, aged 9 to 17 years (10 males and 12 females), and 22 case-matched healthy comparison control subjects. Twelve of the 22 patients with MDD had at least 1 first-degree relative with MDD (familial MDD), whereas 10 had no clear family history of MDD (nonfamilial MDD). RESULTS Patients with nonfamilial MDD had significantly larger left-sided but not right-sided prefrontal cortical volumes than patients with familial MDD (17% larger) and controls (11% larger). Left-sided and right-sided prefrontal cortical volumes did not differ significantly between patients with familial MDD and controls. CONCLUSIONS These results provide new evidence of prefrontal cortical alterations in pediatric MDD that may differ in familial and nonfamilial subtypes of MDD. Our findings must be considered preliminary, however, in view of the small sample size.
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Bolton J, Moore GJ, MacMillan S, Stewart CM, Rosenberg DR. Case study: caudate glutamatergic changes with paroxetine persist after medication discontinuation in pediatric OCD. J Am Acad Child Adolesc Psychiatry 2001; 40:903-6. [PMID: 11501689 DOI: 10.1097/00004583-200108000-00011] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Proton magnetic resonance spectroscopy (1H-MRS) was used to examine glutamatergic (Glx) abnormalities in the caudate nucleus in pediatric obsessive-compulsive disorder (OCD), associated with severity of illness and response to acute (12 weeks) treatment with paroxetine. In this report, OCD symptoms improved markedly in an 8-year-old girl treated for 14 months with the selective serotonin reuptake inhibitor paroxetine (titrated from 10 to 40 mg/day). Paroxetine dose was then decreased in 10-mg decrements and discontinued without symptom recurrence. Serial 1H-MRS examinations were acquired before and after 12 weeks of paroxetine treatment (40 mg/day) and 3 months after medication discontinuation. A striking decrease in caudate Glx was observed after 12 weeks of treatment which persisted after medication discontinuation. These data provide further support for a reversible glutamatergically mediated dysfunction of the caudate nucleus in OCD that may serve as a pathophysiological and treatment response marker.
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Rogers MA, Small D, Buchan DA, Butch CA, Stewart CM, Krenzer BE, Husovsky HL. Home monitoring service improves mean arterial pressure in patients with essential hypertension. A randomized, controlled trial. Ann Intern Med 2001; 134:1024-32. [PMID: 11388815 DOI: 10.7326/0003-4819-134-11-200106050-00008] [Citation(s) in RCA: 181] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Technological advances in the distribution of information have opened new avenues for patient care. Few trials, however, have used telemedicine to improve blood pressure in patients with essential hypertension. OBJECTIVE To determine the efficacy of a telecommunication service in reducing blood pressure. DESIGN Randomized, controlled trial. SETTING University-affiliated primary care outpatient clinics. PATIENTS 121 adults with essential hypertension who were under evaluation for a change in antihypertensive therapy. INTERVENTION A home service consisting of automatic transmission of blood pressure data over telephone lines, computerized conversion of the information into report forms, and weekly electronic transmission of the report forms to physicians and patients. MEASUREMENTS 24-hour ambulatory blood pressure monitoring at baseline and exit. The primary end point was change in mean arterial pressure from baseline to exit. RESULTS Mean arterial pressure decreased by 2.8 mm Hg in patients receiving the home service and increased by 1.3 mm Hg in patients receiving usual care (P = 0.013 for the difference). Mean diastolic blood pressure decreased by 2.0 mm Hg for home service but increased by 2.1 mm Hg for usual care (P = 0.012 for the difference). Mean systolic blood pressure decreased by 4.9 mm Hg for home service and 0.1 mm Hg for patients receiving usual care (P = 0.047 for the difference). Among African-American patients, mean arterial pressure decreased by 9.6 mm Hg in those receiving home service and increased by 5.25 mm Hg in those receiving usual care (P = 0.047). Part of the decrease in blood pressure for home service was due to more frequent changes in the type or dose of antihypertensive medications. CONCLUSION This telecommunication service was efficacious in reducing the mean arterial pressure of patients with established essential hypertension.
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Stewart CM, Cole MB, Legan JD, Slade L, Vandeven MH, Schaffner DW. Modeling the growth boundary of Staphylococcus aureus for risk assessment purposes. J Food Prot 2001; 64:51-7. [PMID: 11198441 DOI: 10.4315/0362-028x-64.1.51] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Knowing the precise boundary for growth of Staphylococcus aureus is critical for food safety risk assessment, especially in the formulation of safe, shelf-stable foods with intermediate relative humidity (RH) values. To date, most studies and resulting models have led to the presumption that S. aureus is osmotolerant. However, most studies and resulting models have focused on growth kinetics using NaCl as the humectant. In this study, glycerol was used to investigate the effects of a glass-forming nonionic humectant to avoid specific metabolic aspects of membrane ion transport. The experiments were designed to produce a growth boundary model as a tool for risk assessment. The statistical effects and interactions of RH (84 to 95% adjusted by glycerol), initial pH (4.5 to 7.0 adjusted by HC1), and potassium sorbate (0, 500, or 1,000 ppm) or calcium propionate (0, 500, or 1,000 ppm) on the aerobic growth of a five-strain S. aureus cocktail in brain heart infusion broth were explored. Inoculated broths were distributed into microtiter plates and incubated at 37 degrees C over appropriate saturated salt slurries to maintain RH. Growth was monitored by turbidity during a 24-week period. Toxin production was explored by enterotoxin assay. The 1,280 generated data points were analyzed by SAS LIFEREG procedures, which showed all studied parameters significantly affected the growth responses of S. aureus with interactions between RH and pH. The resulting growth/no growth boundary is presented.
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Rosenberg DR, MacMaster FP, Keshavan MS, Fitzgerald KD, Stewart CM, Moore GJ. Decrease in caudate glutamatergic concentrations in pediatric obsessive-compulsive disorder patients taking paroxetine. J Am Acad Child Adolesc Psychiatry 2000; 39:1096-103. [PMID: 10986805 DOI: 10.1097/00004583-200009000-00008] [Citation(s) in RCA: 277] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To measure in vivo neurochemical changes in the caudate nucleus in pediatric obsessive-compulsive disorder (OCD) before and after treatment. METHOD Single-voxel proton magnetic resonance spectroscopic (1H-MRS) examinations of the left caudate were conducted in 11 psychotropic drug-naive children, aged 8 to 17 years, with OCD before and after 12 weeks of monotherapy with the selective serotonin reuptake inhibitor paroxetine (10-60 mg/day) and 11 healthy children aged 8 to 17 years. A different sample of 8 pediatric OCD patients and 8 healthy children had a 1H-MRS examination of occipital cortex. RESULTS Caudate glutamatergic concentrations (Glx) were significantly greater in treatment-naive OCD patients than in controls but declined significantly after paroxetine treatment to levels comparable with those of controls. Decrease in caudate Glx was associated with decrease in OCD symptom severity. Occipital Glx did not differ between OCD patients and controls. CONCLUSIONS These preliminary findings provide new evidence of Glx abnormalities in the caudate nucleus in pediatric OCD and suggest that paroxetine treatment may be mediated by a serotonergically modulated reduction in caudate Glx.
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Ris HB, Im Hof V, Stewart CM, Mettler D, Altermatt HJ. Endobronchial photodynamic therapy: comparison of mTHPC and polyethylene glycol-derived mTHPC on human tumor xenografts and tumor-free bronchi of minipigs. Lasers Surg Med 2000; 23:25-32. [PMID: 9694147 DOI: 10.1002/(sici)1096-9101(1998)23:1<25::aid-lsm4>3.0.co;2-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVE Photodynamic therapy (PDT) with mTHPC and polyethylene glycol-derived mTHPC (pegylated mTHPC) was compared on nude mice bearing human squamous cell carcinoma and adenocarcinoma xenografts. The same treatment regimens were applied to the bronchi of tumor-free minipigs to assess injury to normal tissue. STUDY DESIGN/MATERIALS AND METHODS Laser light (652 nm, 20 J/cm2) was delivered as surface radiation to the xenografts 4 days after intraperitoneal administration of 0.1 mg/kg mTHPC or an equimolar dose of pegylated mTHPC, respectively. The extent of tumor necrosis was assessed by histomorphometry. Endobronchial PDT was performed on the bronchi of minipigs with the same drug and light doses at drug-light intervals ranging from 12-96 hr. RESULTS Both sensitizers produced larger necrosis of squamous cell carcinoma and adenocarcinoma xenografts than was observed in untreated controls (P < 0.005). Pegylated mTHPC led to larger tumor necrosis than mTHPC in squamous cell carcinoma (P < 0.001), but not in adenocarcinoma xenografts. mTHPC-PDT resulted in ulceration and necrosis of bronchial mucosa in minipigs at drug-light intervals ranging from 12-48 hr, which was not observed after use of pegylated mTHPC. CONCLUSIONS In this setting, pegylated mTHPC had advantages as a photosensitiser compared to mTHPC.
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Gilbert AR, Moore GJ, Keshavan MS, Paulson LA, Narula V, Mac Master FP, Stewart CM, Rosenberg DR. Decrease in thalamic volumes of pediatric patients with obsessive-compulsive disorder who are taking paroxetine. ARCHIVES OF GENERAL PSYCHIATRY 2000; 57:449-56. [PMID: 10807485 DOI: 10.1001/archpsyc.57.5.449] [Citation(s) in RCA: 208] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Thalamic dysfunction has been implicated in obsessive-compulsive disorder (OCD). While OCD frequently has its onset during childhood, to our knowledge, no prior study has measured neuroanatomical changes in the thalamus of patients with OCD near the onset of illness, and before and after treatment. METHODS Volumetric magnetic resonance imaging studies were conducted in 21 psychotropic drug-naive children, aged 8 to 17 years, with OCD and 21 case-matched healthy comparison subjects. Magnetic resonance imaging studies were also conducted in 10 of the 21 patients with OCD after 12 weeks of monotherapy with the selective serotonin reuptake inhibitor, paroxetine hydrochloride. RESULTS Thalamic volumes were significantly greater in treatment-naive patients with OCD than in controls but declined significantly after paroxetine monotherapy to levels comparable with those of controls. Decrease in thalamic volume in patients with OCD was associated with reduction in OCD symptom severity. CONCLUSIONS Our findings provide new evidence of thalamic abnormalities in pediatric OCD and further suggest that paroxetine treatment may be paralleled by a reduction in thalamic volume. These reductions may, however, not be specific to paroxetine treatment and could be due to a more general treatment response, and/or spontaneous improvement in symptoms. Our findings are preliminary given the small sample size and our inability to measure discrete thalamic nuclei.
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Fitzgerald KD, Moore GJ, Paulson LA, Stewart CM, Rosenberg DR. Proton spectroscopic imaging of the thalamus in treatment-naive pediatric obsessive-compulsive disorder. Biol Psychiatry 2000; 47:174-82. [PMID: 10682215 DOI: 10.1016/s0006-3223(99)00286-3] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Neurobiological abnormalities in the thalamus, particularly the dorsomedial nucleus of the thalamus, are believed to be involved in the pathophysiology of obsessive-compulsive disorder. Although obsessive-compulsive disorder commonly arises in childhood and adolescence, no prior study has examined the thalamus in pediatric obsessive-compulsive disorder patients. METHODS In this study, N-acetyl-aspartate, a putative marker of neuronal viability, creatine/phosphocreatine, and choline levels were measured in the lateral and medical subregions of the left and right thalami using a multislice proton magnetic resonance spectroscopic imaging sequence in 11 treatment-naive, nondepressed obsessive-compulsive disorder outpatients, 8-15 years old, and 11 case-matched control subjects. RESULTS A significant reduction in N-acetyl-aspartate/choline and N-acetyl-aspartate/(creatine/phosphocreatine + choline) was observed in both the right and left medial thalami in obsessive-compulsive disorder patients compared with control subjects. The N-acetyl-aspartate/choline and N-acetyl-aspartate/(creatine/phosphocreatine + choline) levels did not differ significantly between case-control pairs in either the left or the right lateral thalamus. Reduction in N-acetyl-aspartate levels in the left medial thalamus was inversely correlated with increased obsessive-compulsive disorder symptom severity. CONCLUSIONS These findings provide new evidence of localized functional neurochemical marker abnormalities in the thalamus in pediatric obsessive-compulsive disorder. Our results must be considered preliminary, however, given the small sample size.
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Rosenberg DR, Stewart CM, Fitzgerald KD, Tawile V, Carroll E. Paroxetine open-label treatment of pediatric outpatients with obsessive-compulsive disorder. J Am Acad Child Adolesc Psychiatry 1999; 38:1180-5. [PMID: 10504818 DOI: 10.1097/00004583-199909000-00024] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Paroxetine is a selective serotonin reuptake inhibitor with demonstrated efficacy in treating obsessive-compulsive disorder (OCD) in adults. This study evaluates the safety and effectiveness of paroxetine in pediatric OCD patients. METHOD In a 12-week, open-label trial of paroxetine, 20 OCD outpatients, aged 8 to 17 years, were treated for OCD with daily doses ranging from 10 to 60 mg. Target symptoms were rated at regular intervals with the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS), the Children's Global Assessment Scale, the Clinical Global Impression Scale, the Hamilton Anxiety Rating Scale, and the Yale Global Tic Severity Scale. RESULTS Paroxetine proved relatively safe in this brief trial with a small sample and appeared to be effective in patients with OCD; mean CY-BOCS scores decreased significantly (z = 3.49, p = .0005) from 30.6 +/- 3.5 to 21.6 +/- 6.8 on medication. The most common side effects (n > or = 2) were hyperactivity/behavioral activation, headache, insomnia, nausea, and anxiety. Paroxetine did not have to be discontinued in any of the patients because of side effects; the most serious side effects included hyperactivity/behavioral activation in 3 younger patients (< 10 years) necessitating dosage reduction but not discontinuation. CONCLUSIONS Preliminary evidence suggests that short-term treatment of pediatric OCD outpatients with paroxetine may be relatively safe and effective.
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Fitzgerald KD, Stewart CM, Tawile V, Rosenberg DR. Risperidone augmentation of serotonin reuptake inhibitor treatment of pediatric obsessive compulsive disorder. J Child Adolesc Psychopharmacol 1999; 9:115-23. [PMID: 10461822 DOI: 10.1089/cap.1999.9.115] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In this case series, risperidone augmentation of treatment with a serotonin reuptake inhibitor (SRI) is described in four pediatric patients diagnosed with obsessive compulsive disorder (OCD). An improved treatment response was observed in all cases, albeit in different ways. All four of the patients had failed prior SRI monotherapy. Comorbid tics were observed in two cases and aggressive behavior or violent images were seen in three. Possible predictors of response to risperidone in patients with OCD and future research avenues are explored.
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Stewart CM, Jones AC, Bates RE, Sandow P, Pink F, Stillwell J. Comparison between saliva stimulants and a saliva substitute in patients with xerostomia and hyposalivation. SPECIAL CARE IN DENTISTRY 1998; 18:142-8. [PMID: 10218061 DOI: 10.1111/j.1754-4505.1998.tb01136.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to assess patient preference and product efficacy of three non-prescription products for the symptomatic relief of xerostomia. The study group consisted of 80 individuals with a complaint of chronic (> six months) xerostomia and an unstimulated salivary flow rate of < 0.1 mL/min. The three products--a sorbitol/xylitol-sweetened chewing gum, a sorbitol-sweetened sour lemon lozenge, and a sorbitol/xylitol-sweetened artificial saliva substitute spray--were assigned in a permuted block randomization scheme. Each product was used for two weeks with an interval of one week between trials. The study did not identify any product to be statistically significant in terms of patient preference. Kruskal-Wallis testing revealed no statistical significance (P > 0.589) among the products. No product demonstrated marked efficacy in stimulating salivary output. ANOVA analysis followed by Tukey HSD testing revealed no significant difference between the baseline paraffin-stimulated mean flow rate and the gum- and lozenge-stimulated flow rates.
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Nanni JM, Nguyen KH, Alford CE, Robinson CP, Stewart CM, Maeda N, Humphreys-Beher MG. Assessment of bromhexine as a treatment regimen in Sjögren's syndrome-like disease in the NOD (non-obese diabetic) mouse. Clin Exp Rheumatol 1997; 15:515-21. [PMID: 9307859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Bromhexine has been reported to alleviate the xerostomia and xerophthalmia associated with secondary Sjögren's syndrome. The aim of this study was to determine if it might prove useful in the treatment of Sjögren's syndrome-like disease of the NOD mouse model for autoimmune sialoadenitis. METHODS Groups of mice were divided into sets receiving 60 mg/kg bromhexine in drinking water and control pair-fed animals. The efficacy of drug treatment was assessed by weekly measurement of stimulated saliva volumes, protein concentration, and amylase activity. At termination (20 weeks) submandibular and lacrimal glands were removed to assess the levels of lymphocytic infiltration by histological evaluation under light microscopy. RESULTS Control and bromhexine-treated groups of mice showed no difference in the loss or rate of reduction in stimulated saliva flow over the 12 weeks of treatment. No differences were noted in the protein concentration and amylase loss with increasing age of the animals. Similar temporal changes in total protein profiles and aberrant expression of the 20 kDa parotid secretory protein isoform were observed by SDS-polyacrylamide gel profiles and Western bolt analysis. Histological evaluation of exocrine gland sections failed to detect any reduction in focal lymphocyte infiltration. CONCLUSION Bromhexine therapy did not alter the development or severity of Sjögren's syndrome-like disease in the NOD mouse model for autoimmune sialoadenitis.
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Stewart CM. Allergic to latex? RDH 1996; 16:22-3, 47. [PMID: 9442686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Ris HB, Altermatt HJ, Nachbur B, Stewart CM, Wang Q, Lim CK, Bonnett R, Althaus U. Intraoperative photodynamic therapy with m-tetrahydroxyphenylchlorin for chest malignancies. Lasers Surg Med 1996; 18:39-45. [PMID: 8850464 DOI: 10.1002/(sici)1096-9101(1996)18:1<39::aid-lsm5>3.0.co;2-s] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND OBJECTIVE Since there is no satisfactory treatment modality for diffuse malignant mesothelioma of the chest, we assessed surgical tumor resection followed by intraoperative photodynamic therapy with mTHPC in a phase I study. STUDY DESIGN/MATERIALS AND METHODS Since 1990, eight patients have undergone intraoperative photodynamic therapy with m-tetrahydroxyphenylchlorin (mTHPC-PDT) following thoracotomy and surgical tumor resection. RESULTS mTHPC-PDT-mediated tumor necrosis was characterized by tumor infarction due to tumor vessel necrosis and thrombosis, and its extent depended on drug-light conditions; 650 nm light delivered at 0.1 W/cm2 for 10 J/cm2 48 h after iv administration of 0.3 mg mTHPC/kg resulted in a 10-mm-deep complete tumor necrosis. Skin photosensitivity was related to the drug dose applied and occurred up to 17 days after iv administration of 0.3 mg mTHPC/kg, mTHPC-PDT of brachial plexus infiltrated by mesothelioma resulted in pain relief without deterioration of nerve function. CONCLUSION Tumor resection and intraoperative mTHPC-PDT of the chest cavity is feasible under clinical conditions and offers local tumor control of sites involved. However, distant tumor spread was not prevented by this combined treatment modality and optimization of mTHPC-PDT is warranted for further intraoperative application.
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Fergusson RJ, Stewart CM, Wathen CG, Moffat R, Crompton GK. Effectiveness of nebulised salbutamol administered in ambulances to patients with severe acute asthma. Thorax 1995; 50:81-2. [PMID: 7886656 PMCID: PMC473719 DOI: 10.1136/thx.50.1.81] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Nebulised salbutamol can now be administered by ambulance personnel to patients with severe acute asthma en route to hospital. This treatment, however, is not yet available in all ambulances. The safety and effectiveness of allowing ambulance crews to initiate treatment with nebulised salbutamol has been assessed in patients with acute severe asthma. METHODS After a basic training course in the assessment of asthma and the use of a nebuliser, ambulance crews initiated treatment with nebulised salbutamol in asthmatic patients under the age of 40 years. Airflow obstruction was measured before and after treatment with a peak flow meter. A subjective assessment of any change in the patient's condition was also made. RESULTS Nebuliser treatment was associated with a significant increase in peak flow in almost 80% of patients who had recordable values before and after treatment. The mean percentage increase in peak flow was 56.5%. Subjective assessments correlated well with peak flow measurements. No unwanted side effects were recorded. CONCLUSIONS Nebulised salbutamol is an effective and safe treatment for acute asthma when administered by ambulance personnel after a short training course.
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Jones AC, Migliorati CA, Stewart CM. Oral cytology: indications, contraindications, and technique. GENERAL DENTISTRY 1995; 43:74-7; quiz 79-80. [PMID: 7758928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Stewart CM, Jones AC, Bates RE, Boeff D, Migliorati C, Bentrup K. Percutaneous and mucous membrane exposure protocol in a southeastern dental school. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1994; 78:401-7. [PMID: 7970606 DOI: 10.1016/0030-4220(94)90076-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A southeastern dental educational institution formalized a Percutaneous and Mucous Membrane Exposure Protocol in 1990. This article outlines the development, implementation, and administration of the protocol including risk assessment and rationale for testing health care workers and source persons. Pretest and posttest counseling for HIV testing is also discussed.
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Bates RE, Gremillion HA, Stewart CM. Degenerative joint disease. Part II: Symptoms and examination findings. Cranio 1994; 12:88-92. [PMID: 8055593 DOI: 10.1080/08869634.1994.11678000] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
From a pool of 1,279 consecutive patients referred to the Parker E. Mahan Facial Pain Center for complaints of head/neck pain, a subset of 215 patients with the diagnosis of osteoarthrosis of the temporomandibular joint (TMJ-DJD) have been identified. Data regarding patient age and sex, reported symptoms and examination results are presented from this subset of TMJ-DJD patients. From this data, common signs and symptoms of TMJ-DJD are proposed.
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Jones AC, Pink FE, Sandow PL, Stewart CM, Migliorati CA, Baughman RA. The Cytobrush Plus cell collector in oral cytology. ACTA ACUST UNITED AC 1994. [DOI: 10.1016/s0030-4220(06)80117-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Jones AC, Pink FE, Sandow PL, Stewart CM, Migliorati CA, Baughman RA. The Cytobrush Plus cell collector in oral cytology. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1994; 77:95-9. [PMID: 8108108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The Cytobrush Plus cell collector (cytobrush) was compared with the wooden tongue depressor during oral exfoliative cytology. The degree of patient discomfort, the convenience to the clinician, and the quantity and distribution of epithelial cells collected were evaluated. Two-factor analysis of variance and parametric and nonparametric analyses were performed. Because of the favorable findings revealed in this study, we recommend that the cytobrush be considered for use when obtaining diagnostic cytologic smears from the oral mucosa.
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Bates RE, Gremillion HA, Stewart CM. Degenerative joint disease. Part I: Diagnosis and management considerations. Cranio 1993; 11:284-90. [PMID: 8118899 DOI: 10.1080/08869634.1993.11677980] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Degenerative joint disease, primarily in the form of osteoarthrosis, affects the temporomandibular joints (TMJs) with symptoms similar to those found in other body joints. These symptoms include stiffness, pain, restriction of movement, inflammation, crepitus and radiographic changes. Symptoms can occur in both males and females at any age, starting with pre-adolescent, but most often occur in females age 30 and over. Most symptoms will last nine to 18 months (followed by remission) and are managed using anti-inflammatory medications, physical therapy, occlusal splints and dietary changes. Major areas for consideration in this article include epidemiology, signs and symptoms, radiography, etiopathology and symptom management.
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Ris HB, Altermatt HJ, Stewart CM, Schaffner T, Wang Q, Lim CK, Bonnett R, Althaus U. Photodynamic therapy with m-tetrahydroxyphenylchlorin in vivo: optimization of the therapeutic index. Int J Cancer 1993; 55:245-9. [PMID: 8370622 DOI: 10.1002/ijc.2910550213] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The therapeutic index of meta-tetrahydroxyphenylchlorin-mediated photodynamic therapy (mTHPC-PDT) was assessed in BALB/c nude mice bearing human malignant mesothelioma xenografts. Equal doses of 650 nm laser light were delivered to the tumour and to an equal-sized area of the hind leg (control site) after i.p. administration of mTHPC. Twenty-one groups of 6 animals each were treated under various drug-light conditions and at drug-light intervals ranging from 4 hr to 6 days. After light delivery the extent of tumour necrosis and the depth of alterations in normal tissue were assessed by light microscopy of standardized histological sections. A therapeutic index (TI) of mTHPC-PDT was defined as the cross-sectional area of tumour necrosis per depth of visible tissue injury at the control site. This TI was strongly related to the conditions of treatment. In particular, it was increased by prolonging the drug-light interval up to 5 days and by increasing the dose of light for any dose of drug. The most profound increase of TI was obtained by increasing the intensity of light administered at the chosen interval while reducing the dose of drug. Our findings suggest that threshold conditions operate in PDT and have important implications for clinical application of the treatment.
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Croy BA, Stewart CM, McBey BA, Kiso Y. An immunohistologic analysis of murine uterine T cells between birth and puberty. J Reprod Immunol 1993; 23:223-33. [PMID: 8350298 DOI: 10.1016/0165-0378(93)90044-i] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Murine uterine T cells were analysed on the basis of surface phenotype expression from birth to adulthood. T cells were rare in the uterus from birth until 2 weeks of age. In genetically immunocompetent mice, mature T cells expressing either TCR alpha/beta or TCR gamma/delta were first present as a major cell population at 3 weeks of age. The ratio of TCR alpha/beta to TCR gamma/delta was 1:1 at 3 weeks of age and this ratio did not change during sexual maturation. Almost all uterine T cells were CD8+ and the majority of these cells expressed CD8 alpha/beta rather than CD8 alpha/alpha. Cells expressing Thy1.2 were less frequent than cells expressing CD3 while cells expressing CD5 were rare. No major changes in T cell subsets occurred at puberty. Further, the microbial flora of the mice did not alter the time of appearance, frequency or subset distribution of uterine TCR+ cells. In the uteri of immunodeficient mice of genotype scid/scid TCR+ cells were found in low numbers and the initial appearance of TCR+ cells was delayed until 5 weeks of age.
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Livingstone MB, Coward WA, Prentice AM, Davies PS, Strain JJ, McKenna PG, Mahoney CA, White JA, Stewart CM, Kerr MJ. Daily energy expenditure in free-living children: comparison of heart-rate monitoring with the doubly labeled water (2H2(18)O) method. Am J Clin Nutr 1992; 56:343-52. [PMID: 1636613 DOI: 10.1093/ajcn/56.2.343] [Citation(s) in RCA: 192] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Total energy expenditure (TEE) was measured simultaneously in 36 free-living children aged 7, 9, 12, and 15 y over 10-15 d by the doubly labeled water (DLW) method and for 2-3 separate days by heart-rate (HR) monitoring. The 95% confidence limits of agreement (mean difference +/- 2SD) were -1.99 to +1.44 MJ/d. HR TEE discrepancies ranged from -16.7% to +18.8% with 23 values lying within +/- 10% of DLW TEE estimates. Boys and girls spent 462 +/- 108 and 318 +/- 120 min/d, respectively, in total physical activity (P less than 0.01). Time spent in moderate and vigorous physical activity (MVPA) was 68 +/- 37 min/d by younger children (7-9 y) and 34 +/- 24 min/d by older children (12-15 y) (P less than 0.001). Younger boys engaged in MVPA (91 +/- 33 min/d) and vigorous physical activity (VPA) (35 +/- 15 min/d) significantly longer than younger girls (MVPA, 39 +/- 16 min/d, P less than 0.001; VPA, 10 +/- 4 min/d, P less than 0.01) as did older boys (MVPA, 52 +/- 21 min/d; VPA, 30 +/- 18 min/d) compared with older girls (MVPA, 15 +/- 10 min/d; VPA, 8 +/- 5 min/d). HR monitoring provides a close estimation of the TEE of population groups and objective assessment of associated patterns of physical activity.
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