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Ali N, Schierholz E, Reed D, Hightower H, Johnson BA, Gupta R, Gray M, Ades A, Wetzel EA. Identifying Gaps in Resuscitation Practices Across Level-IV Neonatal Intensive Care Units. Am J Perinatol 2024; 41:e180-e186. [PMID: 35617959 DOI: 10.1055/a-1863-2312] [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: 11/01/2022]
Abstract
OBJECTIVES This study aimed to describe resuscitation practices in level-IV neonatal intensive care units (NICUs) and identify possible areas of improvement. STUDY DESIGN This study was a cross-sectional cohort survey and conducted at the Level-IV NICUs of Children's Hospital Neonatal Consortium (CHNC). The survey was developed with consensus from resuscitation and education experts in the CHNC and pilot tested. An electronic survey was sent to individual site sponsors to determine unit demographics, resuscitation team composition, and resuscitation-related clinical practices. RESULTS Of the sites surveyed, 33 of 34 sites responded. Unit average daily census ranged from less than 30 to greater than 100, with the majority (72%) of the sites between 30 and 75 patients. A designated code response team was utilized in 18% of NICUs, only 30% assigned roles before or during codes. The Neonatal Resuscitation Program (NRP) was the exclusive algorithm used during codes in 61% of NICUs, and 34% used a combination of NRP and the Pediatric Advanced Life Support (PALS). Most (81%) of the sites required neonatal attendings to maintain NRP training. A third of sites (36%) lacked protocols for high-acuity events. A code review process existed in 76% of participating NICUs, but only 9% of centers enter code data into a national database. CONCLUSION There is variability among units regarding designated code team presence and composition, resuscitation algorithm, protocols for high-acuity events, and event review. These inconsistencies in resuscitation teams and practices provide an opportunity for standardization and, ultimately, improved resuscitation performance. Resources, education, and efforts could be directed to these areas to potentially impact future neonatal outcomes of the complex patients cared for in level-IV NICUs. KEY POINTS · Resuscitation practice is variable in level-IV NICUs.. · Resuscitation algorithm training is not uniform. · Standardized protocols for high-acuity low-occurrence (HALO) events are lacking.
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Affiliation(s)
- Noorjahan Ali
- Division of Perinatal-Neonatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Elizabeth Schierholz
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, School of Medicine, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Danielle Reed
- Division of Perinatal-Neonatal Medicine, Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, Missouri
| | - Hannah Hightower
- Division of Neonatology, Department of Pediatrics, Children's of Alabama, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Beth A Johnson
- Division of Neonatology and Pulmonary Biology, Department of Pediatrics, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ruby Gupta
- Division of Neonatal/Perinatal Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Megan Gray
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Anne Ades
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Elizabeth A Wetzel
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
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2
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Floyd N, Hassan MT, Tang Z, Krivoš M, Blatnik M, Cude-Woods C, Clayton SM, Holley AT, Ito TM, Johnson BA, Liu CY, Makela M, Morris CL, Navazo ASC, O'Shaughnessy CM, Renner EL, Pattie RW, Young AR. Scintillation characteristics of the EJ-299-02H scintillator. Rev Sci Instrum 2024; 95:045108. [PMID: 38573050 DOI: 10.1063/5.0179451] [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] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 03/04/2024] [Indexed: 04/05/2024]
Abstract
A study of the dead layer thickness and quenching factor of a plastic scintillator for use in ultracold neutron (UCN) experiments is described. Alpha spectroscopy was used to determine the thickness of a thin surface dead layer to be 630 ± 110 nm. The relative light outputs from the decay of 241Am and Compton scattering of electrons were used to extract Birks' law coefficient, yielding a kB value of 0.087 ± 0.003 mm/MeV, consistent with some previous reports for other polystyrene-based scintillators. The results from these measurements are incorporated into the simulation to show that an energy threshold of (∼9 keV) can be achieved for the UCNProBe experiment. This low threshold enables high beta particle detection efficiency and the indirect measurement of UCN. The ability to make the scintillator deuterated, accompanied by its relatively thin dead layer, gives rise to unique applications in a wide range of UCN experiments, where it can be used to trap UCN and detect charged particles in situ.
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Affiliation(s)
- N Floyd
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
- University of Kentucky, Lexington, Kentucky 40506, USA
| | - Md T Hassan
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - Z Tang
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - M Krivoš
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - M Blatnik
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
- W. K. Kellogg Radiation Laboratory, California Institute of Technology, Pasadena, California 91125, USA
| | - C Cude-Woods
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
- North Carolina State University, Raleigh, North Carolina 27695, USA
| | - S M Clayton
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - A T Holley
- Tennessee Technological University, Cookeville, Tennessee 38505, USA
| | - T M Ito
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - B A Johnson
- Indiana University, Bloomington, Indiana 47405, USA
| | - C-Y Liu
- University of Illinois, Champaign, Illinois 61820, USA
| | - M Makela
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - C L Morris
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - A S C Navazo
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | | | - E L Renner
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - R W Pattie
- East Tennessee State University, Johnson City, Tennessee 37614, USA
| | - A R Young
- North Carolina State University, Raleigh, North Carolina 27695, USA
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3
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An P, Awe C, Barbeau PS, Becker B, Belov V, Bernardi I, Bock C, Bolozdynya A, Bouabid R, Brown A, Browning J, Cabrera-Palmer B, Cervantes M, Conley E, Daughhetee J, Detwiler J, Ding K, Durand MR, Efremenko Y, Elliott SR, Fabris L, Febbraro M, Gallo Rosso A, Galindo-Uribarri A, Germer AC, Green MP, Hakenmüller J, Heath MR, Hedges S, Hughes M, Johnson BA, Johnson T, Khromov A, Konovalov A, Kozlova E, Kumpan A, Kyzylova O, Li L, Link JM, Liu J, Mahoney M, Major A, Mann K, Markoff DM, Mastroberti J, Mattingly J, Mueller PE, Newby J, Parno DS, Penttila SI, Pershey D, Prior CG, Rapp R, Ray H, Raybern J, Razuvaeva O, Reyna D, Rich GC, Ross J, Rudik D, Runge J, Salvat DJ, Sander J, Scholberg K, Shakirov A, Simakov G, Sinev G, Skuse C, Snow WM, Sosnovtsev V, Subedi T, Suh B, Tayloe R, Tellez-Giron-Flores K, Tsai YT, Ujah E, Vanderwerp J, van Nieuwenhuizen EE, Varner RL, Virtue CJ, Visser G, Walkup K, Ward EM, Wongjirad T, Yoo J, Yu CH, Zawada A, Zettlemoyer J, Zderic A. Measurement of Electron-Neutrino Charged-Current Cross Sections on ^{127}I with the COHERENT NaIνE Detector. Phys Rev Lett 2023; 131:221801. [PMID: 38101357 DOI: 10.1103/physrevlett.131.221801] [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] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/02/2023] [Accepted: 11/08/2023] [Indexed: 12/17/2023]
Abstract
Using an 185-kg NaI[Tl] array, COHERENT has measured the inclusive electron-neutrino charged-current cross section on ^{127}I with pion decay-at-rest neutrinos produced by the Spallation Neutron Source at Oak Ridge National Laboratory. Iodine is one the heaviest targets for which low-energy (≤50 MeV) inelastic neutrino-nucleus processes have been measured, and this is the first measurement of its inclusive cross section. After a five-year detector exposure, COHERENT reports a flux-averaged cross section for electron neutrinos of 9.2_{-1.8}^{+2.1}×10^{-40} cm^{2}. This corresponds to a value that is ∼41% lower than predicted using the MARLEY event generator with a measured Gamow-Teller strength distribution. In addition, the observed visible spectrum from charged-current scattering on ^{127}I has been measured between 10 and 55 MeV, and the exclusive zero-neutron and one-or-more-neutron emission cross sections are measured to be 5.2_{-3.1}^{+3.4}×10^{-40} and 2.2_{-0.5}^{+0.4}×10^{-40} cm^{2}, respectively.
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Affiliation(s)
- P An
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - C Awe
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - P S Barbeau
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - B Becker
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - V Belov
- National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow 115409, Russian Federation
- National Research Center "Kurchatov Institute," Moscow, 123182, Russian Federation
| | - I Bernardi
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - C Bock
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - A Bolozdynya
- National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow 115409, Russian Federation
| | - R Bouabid
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - A Brown
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Mathematics and Physics, North Carolina Central University, Durham, North Carolina 27707, USA
| | - J Browning
- Department of Physics, North Carolina State University, Raleigh, North Carolina 27695, USA
| | | | - M Cervantes
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
| | - E Conley
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
| | - J Daughhetee
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - J Detwiler
- Center for Experimental Nuclear Physics and Astrophysics and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - K Ding
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - M R Durand
- Center for Experimental Nuclear Physics and Astrophysics and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - Y Efremenko
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - S R Elliott
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - L Fabris
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - M Febbraro
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - A Gallo Rosso
- Department of Physics, Laurentian University, Sudbury, Ontario P3E 2C6, Canada
| | - A Galindo-Uribarri
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - A C Germer
- Department of Physics, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA
| | - M P Green
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics, North Carolina State University, Raleigh, North Carolina 27695, USA
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - J Hakenmüller
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
| | - M R Heath
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - S Hedges
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - M Hughes
- Department of Physics, Indiana University, Bloomington, Indiana 47405, USA
| | - B A Johnson
- Department of Physics, Indiana University, Bloomington, Indiana 47405, USA
| | - T Johnson
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - A Khromov
- National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow 115409, Russian Federation
| | - A Konovalov
- National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow 115409, Russian Federation
| | - E Kozlova
- National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow 115409, Russian Federation
| | - A Kumpan
- National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow 115409, Russian Federation
| | - O Kyzylova
- Center for Neutrino Physics, Virginia Tech, Blacksburg, Virginia 24061, USA
| | - L Li
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - J M Link
- Center for Neutrino Physics, Virginia Tech, Blacksburg, Virginia 24061, USA
| | - J Liu
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - M Mahoney
- Department of Physics, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA
| | - A Major
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
| | - K Mann
- Department of Physics, North Carolina State University, Raleigh, North Carolina 27695, USA
| | - D M Markoff
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Mathematics and Physics, North Carolina Central University, Durham, North Carolina 27707, USA
| | - J Mastroberti
- Department of Physics, Indiana University, Bloomington, Indiana 47405, USA
| | - J Mattingly
- Department of Nuclear Engineering, North Carolina State University, Raleigh, North Carolina 27695, USA
| | - P E Mueller
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - J Newby
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - D S Parno
- Department of Physics, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA
| | - S I Penttila
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - D Pershey
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
| | - C G Prior
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - R Rapp
- Washington & Jefferson College, Washington, Pennsylvania 15301, USA
| | - H Ray
- Department of Physics, University of Florida, Gainesville, Florida 32611, USA
| | - J Raybern
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
| | - O Razuvaeva
- National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow 115409, Russian Federation
- National Research Center "Kurchatov Institute," Moscow, 123182, Russian Federation
| | - D Reyna
- Sandia National Laboratories, Livermore, California 94550, USA
| | - G C Rich
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - J Ross
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Mathematics and Physics, North Carolina Central University, Durham, North Carolina 27707, USA
| | - D Rudik
- National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow 115409, Russian Federation
| | - J Runge
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - D J Salvat
- Department of Physics, Indiana University, Bloomington, Indiana 47405, USA
| | - J Sander
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - K Scholberg
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
| | - A Shakirov
- National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow 115409, Russian Federation
| | - G Simakov
- National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow 115409, Russian Federation
- National Research Center "Kurchatov Institute," Moscow, 123182, Russian Federation
| | - G Sinev
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
| | - C Skuse
- Department of Physics, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA
| | - W M Snow
- Department of Physics, Indiana University, Bloomington, Indiana 47405, USA
| | - V Sosnovtsev
- National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow 115409, Russian Federation
| | - T Subedi
- Center for Neutrino Physics, Virginia Tech, Blacksburg, Virginia 24061, USA
- Department of Physical and Environmental Sciences, Concord University, Athens, West Virginia 24712, USA
| | - B Suh
- Department of Physics, Indiana University, Bloomington, Indiana 47405, USA
| | - R Tayloe
- Department of Physics, Indiana University, Bloomington, Indiana 47405, USA
| | | | - Y-T Tsai
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - E Ujah
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Mathematics and Physics, North Carolina Central University, Durham, North Carolina 27707, USA
| | - J Vanderwerp
- Department of Physics, Indiana University, Bloomington, Indiana 47405, USA
| | - E E van Nieuwenhuizen
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - R L Varner
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - C J Virtue
- Department of Physics, Laurentian University, Sudbury, Ontario P3E 2C6, Canada
| | - G Visser
- Department of Physics, Indiana University, Bloomington, Indiana 47405, USA
| | - K Walkup
- Center for Neutrino Physics, Virginia Tech, Blacksburg, Virginia 24061, USA
| | - E M Ward
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - T Wongjirad
- Department of Physics and Astronomy, Tufts University, Medford, Massachusetts 02155, USA
| | - J Yoo
- Department of Physics and Astronomy, Seoul National University, Seoul, 08826, Korea
| | - C-H Yu
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - A Zawada
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - J Zettlemoyer
- Department of Physics, Indiana University, Bloomington, Indiana 47405, USA
| | - A Zderic
- Center for Experimental Nuclear Physics and Astrophysics and Department of Physics, University of Washington, Seattle, Washington 98195, USA
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Clark JD, Albers EL, Albert JE, Berkman ER, Englund JA, Farris RWD, Johnson BA, Lewis‐Newby M, McGuire J, Rogers M, Thompson HM, Wagner TA, Wells C, Yanay O, Zerr DM, Limaye AP. SARS-CoV-2 RNA positive pediatric organ donors: A case report. Pediatr Transplant 2023; 27:e14452. [PMID: 36518025 PMCID: PMC9878170 DOI: 10.1111/petr.14452] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/23/2022] [Accepted: 10/24/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Preliminary evidence suggests that non-lung organ donation from resolved, asymptomatic or mildly symptomatic SARS-CoV-2 infected adults may be safe. However, several biological aspects of SARS-CoV-2 infection differ in children and the risk for transmission and outcomes of recipients from pediatric donors with SARS-CoV-2 infection are not well described. METHODS We report two unvaccinated asymptomatic pediatric non-lung organ deceased donors who tested positive for SARS-CoV-2 RNA by RT-PCR. Donor One unexpectedly had SARS-CoV-2 RNA detected in nasopharyngeal swab and plasma specimens at autopsy despite several negative tests (upper and lower respiratory tract) in the days prior to organ recovery. Donor Two had SARS-CoV- 2 RNA detected in multiple nasopharyngeal swabs but not lower respiratory tract specimens (endotracheal aspirate and bronchoalveolar lavage) during routine surveillance prior to organ recovery and was managed with remdesivir and monoclonal antibodies prior to organ recovery. RESULTS Two hearts, two livers and four kidneys were successfully transplanted into seven recipients. No donor to recipient transmission of SARS-CoV-2 was observed and graft function of all organs has remained excellent for up to 7 months of followup. CONCLUSIONS Due to the persistent gap between organ availability and the number of children waiting for transplants, deceased pediatric patients with non-disseminated SARS-CoV-2 infection, isolated to upper and/or lower respiratory tract, should be considered as potential non-lung organ donors.
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Affiliation(s)
- Jonna D. Clark
- Division of Bioethics and Palliative Care, Department of PediatricsUniversity of Washington School of MedicineSeattleWashingtonUSA
- Treuman Katz Center for Pediatric BioethicsSeattle Children's Hospital and Research InstituteSeattleWashingtonUSA
- Division of Pediatric Critical Care MedicineUniversity of Washington, Seattle Children's Research InstituteSeattleWashingtonUSA
| | - Erin L. Albers
- Division of Pediatric CardiologyUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Jesselle E. Albert
- Division of Pediatric Critical Care MedicineUniversity of Washington, Seattle Children's Research InstituteSeattleWashingtonUSA
| | - Emily R. Berkman
- Division of Bioethics and Palliative Care, Department of PediatricsUniversity of Washington School of MedicineSeattleWashingtonUSA
- Treuman Katz Center for Pediatric BioethicsSeattle Children's Hospital and Research InstituteSeattleWashingtonUSA
- Division of Pediatric Critical Care MedicineUniversity of Washington, Seattle Children's Research InstituteSeattleWashingtonUSA
| | - Janet A. Englund
- Division of Pediatric Infectious DiseasesUniversity of Washington, Seattle Children's Research InstituteSeattleWashingtonUSA
| | - Reid W. D. Farris
- Division of Pediatric Critical Care MedicineUniversity of Washington, Seattle Children's Research InstituteSeattleWashingtonUSA
| | | | - Mithya Lewis‐Newby
- Division of Bioethics and Palliative Care, Department of PediatricsUniversity of Washington School of MedicineSeattleWashingtonUSA
- Treuman Katz Center for Pediatric BioethicsSeattle Children's Hospital and Research InstituteSeattleWashingtonUSA
- Division of Pediatric Critical Care MedicineUniversity of Washington, Seattle Children's Research InstituteSeattleWashingtonUSA
| | - John McGuire
- Division of Pediatric Critical Care MedicineUniversity of Washington, Seattle Children's Research InstituteSeattleWashingtonUSA
| | | | | | - Thor A. Wagner
- Division of Pediatric Infectious DiseasesUniversity of Washington, Seattle Children's Research InstituteSeattleWashingtonUSA
| | | | - Ofer Yanay
- Division of Pediatric Critical Care MedicineUniversity of Washington, Seattle Children's Research InstituteSeattleWashingtonUSA
| | - Danielle M. Zerr
- Division of Pediatric Infectious DiseasesUniversity of Washington, Seattle Children's Research InstituteSeattleWashingtonUSA
| | - Ajit P. Limaye
- Department of Medicine, Division of Allergy and Infectious DiseasesUniversity of WashingtonSeattleWashingtonUSA
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5
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Tang Z, Watkins EB, Clayton SM, Currie SA, Fellers DE, Hassan MT, Hooks DE, Ito TM, Lawrence SK, MacDonald SWT, Makela M, Morris CL, Neukirch LP, Saunders A, O'Shaughnessy CM, Cude-Woods C, Choi JH, Young AR, Zeck BA, Gonzalez F, Liu CY, Floyd NC, Hickerson KP, Holley AT, Johnson BA, Lambert JC, Pattie RW. Ultracold neutron properties of the Eljen-299-02D deuterated scintillator. Rev Sci Instrum 2021; 92:023305. [PMID: 33648127 DOI: 10.1063/5.0030972] [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] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 01/19/2021] [Indexed: 06/12/2023]
Abstract
In this paper, we report studies of the Fermi potential and loss per bounce of ultracold neutrons (UCNs) on a deuterated scintillator (Eljen-299-02D). These UCN properties of the scintillator enable its use in a wide variety of applications in fundamental neutron research.
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Affiliation(s)
- Z Tang
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - E B Watkins
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - S M Clayton
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - S A Currie
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - D E Fellers
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - Md T Hassan
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - D E Hooks
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - T M Ito
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - S K Lawrence
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - S W T MacDonald
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - M Makela
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - C L Morris
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - L P Neukirch
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - A Saunders
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | | | - C Cude-Woods
- North Carolina State University, Raleigh, North Carolina 27695, USA
| | - J H Choi
- North Carolina State University, Raleigh, North Carolina 27695, USA
| | - A R Young
- North Carolina State University, Raleigh, North Carolina 27695, USA
| | - B A Zeck
- North Carolina State University, Raleigh, North Carolina 27695, USA
| | - F Gonzalez
- Indiana University, Bloomington, Indiana 47405, USA
| | - C Y Liu
- Indiana University, Bloomington, Indiana 47405, USA
| | - N C Floyd
- University of Kentucky, Lexington, Kentucky 40506, USA
| | - K P Hickerson
- W. K. Kellogg Radiation Laboratory, California Institute of Technology, Pasadena, California 91125, USA
| | - A T Holley
- Tennessee Technological University, Cookeville, Tennessee 38505, USA
| | - B A Johnson
- Utah State University, Logan, Utah 84322, USA
| | - J C Lambert
- Utah State University, Logan, Utah 84322, USA
| | - R W Pattie
- East Tennessee State University, Johnson City, Tennessee 37614, USA
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6
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Brijkumar J, Johnson BA, Zhao Y, Edwards J, Moodley P, Pathan K, Pillay S, Castro KG, Sunpath H, Kuritzkes DR, Moosa MYS, Marconi VC. A packaged intervention to improve viral load monitoring within a deeply rural health district of South Africa. BMC Infect Dis 2020; 20:836. [PMID: 33176715 PMCID: PMC7659110 DOI: 10.1186/s12879-020-05576-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 11/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The KwaZulu-Natal (KZN) province of South Africa has the highest prevalence of HIV infection in the world. Viral load (VL) testing is a crucial tool for clinical and programmatic monitoring. Within uMkhanyakude district, VL suppression rates were 91% among patients with VL data; however, VL performance rates averaged only 38·7%. The objective of this study was to determine if enhanced clinic processes and community outreach could improve VL monitoring within this district. METHODS A packaged intervention was implemented at three rural clinics in the setting of the KZN HIV AIDS Drug Resistance Surveillance Study. This included file hygiene, outreach, a VL register and documentation revisions. Chart audits were used to assess fidelity. Outcome measures included percentage VL performed and suppressed. Each rural clinic was matched with a peri-urban clinic for comparison before and after the start of each phase of the intervention. Monthly sample proportions were modelled using quasi-likelihood regression methods for over-dispersed binomial data. RESULTS Mkuze and Jozini clinics increased VL performance overall from 33·9% and 35·3% to 75·8% and 72·4%, respectively which was significantly greater than the increases in the comparison clinics (RR 1·86 and 1·68, p < 0·01). VL suppression rates similarly increased overall by 39·3% and 36·2% (RR 1·84 and 1·70, p < 0·01). The Chart Intervention phase showed significant increases in fidelity 16 months after implementation. CONCLUSIONS The packaged intervention improved VL performance and suppression rates overall but was significant in Mkuze and Jozini. Larger sustained efforts will be needed to have a similar impact throughout the province.
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Affiliation(s)
- J Brijkumar
- University of KwaZulu Natal, Nelson R Mandela School of Medicine, Durban, South Africa
| | | | - Y Zhao
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - J Edwards
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - P Moodley
- School of Laboratory Medicine and Medical Sciences, National Health Laboratory Service, University of KwaZulu-Natal, Durban, South Africa
| | - K Pathan
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - S Pillay
- University of KwaZulu Natal, Nelson R Mandela School of Medicine, Durban, South Africa
| | - K G Castro
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - H Sunpath
- University of KwaZulu Natal, Nelson R Mandela School of Medicine, Durban, South Africa
| | - D R Kuritzkes
- Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - M Y S Moosa
- University of KwaZulu Natal, Nelson R Mandela School of Medicine, Durban, South Africa
| | - V C Marconi
- Emory University Rollins School of Public Health, Atlanta, GA, USA.
- Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA.
- Emory Vaccine Center, Atlanta, USA.
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7
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Johnson BA, Frostig RD. Long, intrinsic horizontal axons radiating through and beyond rat barrel cortex have spatial distributions similar to horizontal spreads of activity evoked by whisker stimulation. Brain Struct Funct 2015; 221:3617-39. [PMID: 26438334 DOI: 10.1007/s00429-015-1123-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 05/06/2015] [Accepted: 09/23/2015] [Indexed: 01/11/2023]
Abstract
Stimulation of a single whisker evokes a peak of activity that is centered over the associated barrel in rat primary somatosensory cortex, and yet the evoked local field potential and the intrinsic signal optical imaging response spread symmetrically away from this barrel for over 3.5 mm to cross cytoarchitectonic borders into other "unimodal" sensory cortical areas. To determine whether long horizontal axons have the spatial distribution necessary to underlie this activity spread, we injected adeno-associated viral vectors into barrel cortex and characterized labeled axons extending from the injection site in transverse sections of flattened cortex. Combined qualitative and quantitative analyses revealed labeled axons radiating diffusely in all directions for over 3.5 mm from supragranular injection sites, with density declining over distance. The projection pattern was similar at four different cortical depths, including infragranular laminae. Infragranular vector injections produced patterns similar to the supragranular injections. Long horizontal axons were detected both using a vector with a permissive cytomegalovirus promoter to label all neuronal subtypes and using a calcium/calmodulin-dependent protein kinase II α vector to restrict labeling to excitatory cortical pyramidal neurons. Individual axons were successfully reconstructed from series of supragranular sections, indicating that they traversed gray matter only. Reconstructed axons extended from the injection site, left the barrel field, branched, and sometimes crossed into other sensory cortices identified by cytochrome oxidase staining. Thus, radiations of long horizontal axons indeed have the spatial characteristics necessary to explain horizontal activity spreads. These axons may contribute to multimodal cortical responses and various forms of cortical neural plasticity.
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Affiliation(s)
- B A Johnson
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, 92697-4550, USA
| | - R D Frostig
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, 92697-4550, USA. .,Department of Biomedical Engineering and Center for the Neurobiology of Learning and Memory, University of California, Irvine, Irvine, CA, 92697, USA.
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8
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Corcoran TE, Niven R, Verret W, Dilly S, Johnson BA. Lung deposition and pharmacokinetics of nebulized cyclosporine in lung transplant patients. J Aerosol Med Pulm Drug Deliv 2013; 27:178-84. [PMID: 23668548 DOI: 10.1089/jamp.2013.1042] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Inhaled cyclosporine (CsA) is being investigated as a prophylaxis for lung transplant rejection. Lung deposition and systemic exposure of nebulized CsA in lung transplant patients was evaluated as part of the Phase 3 cyclosporine inhalation solution (CIS) trial (CYCLIST). METHODS Ten patients received 300 mg of CIS (62.5 mg/mL CsA in propylene glycol) admixed with 148 MBq of Tc-DTPA (technetium-99m bound to diethylenetriaminepentaacetic acid) administered using a Sidestream(®) disposable jet nebulizer. Deposition was assessed using a dual-headed gamma camera. Blood samples were collected over a 24-hr time period after aerosol dosing and analyzed for CsA levels. A pharmacokinetic analysis of the resulting blood concentration versus time profiles was performed. RESULTS The average total deposited dose was 53.7 ± 12.7 mg. Average pulmonary dose was 31.8 ± 16.3 mg, and stomach dose averaged 15.5 ± 11.1 mg. Device performance was consistent, with breathing maneuvers influencing dose variation. Predose coaching with five of 10 patients reduced stomach deposition (22.6 ± 11.2 vs. 8.3 ± 5.2 mg; p=0.03). Blood concentrations declined quickly from a maximum of 372 ± 140 ng/mL to 15.3 ± 9.7 ng/mL at 24 hr post dose. Levels of AUC(0-24) [area under the concentration vs. time curve from 0 to 24 hr] averaged 1,493 ± 746 ng hr/mL. On a three times per week dose regimen, this represents <5% of the weekly systemic exposure of twice per day oral administration. CONCLUSIONS Substantial doses of CsA can be delivered to the lungs of lung transplant patients by inhaled aerosol. Systemic levels are small relative to typical oral CsA administration.
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Affiliation(s)
- T E Corcoran
- 1 Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh , Pittsburgh, PA 15213
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9
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McElroy JP, Krupp LB, Johnson BA, McCauley JL, Qi Z, Caillier SJ, Gourraud PA, Yu J, Nathanson L, Belman AL, Hauser SL, Waubant E, Hedges DJ, Oksenberg JR. Copy number variation in pediatric multiple sclerosis. Mult Scler 2012; 19:1014-21. [PMID: 23239789 DOI: 10.1177/1352458512469696] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pediatric onset multiple sclerosis (MS) accounts for 2-4% of all MS. It is unknown whether the disease shares the same underlying pathophysiology found in adult patients or an extreme early onset phenotype triggered by distinct biological mechanisms. It has been hypothesized that copy number variations (CNVs) may result in extreme early onset diseases because CNVs can have major effects on many genes in large genomic regions. OBJECTIVES AND METHODS The objective of the current research was to identify CNVs, with a specific focus on de novo CNVs, potentially causing early onset MS by competitively hybridizing 30 white non-Hispanic pediatric MS patients with each of their parents via comparative genomic hybridization (CGH) analysis on the Agilent 1M CGH array. RESULTS AND DISCUSSION We identified 10 CNVs not overlapping with any CNV regions currently reported in the Database of Genomic Variants (DGV). Fifty-five putatively de novo CNVs were also identified: all but one common in the DGV. We found the single rare CNV was a private variation harboring the SACS gene. SACS mutations cause autosomal-recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) disease. Additional clinical review revealed that the patient with the SACS gene CNV shared some features of both MS and ARSACS. CONCLUSIONS This is the first reported study analyzing pediatric MS CNVs. While not yielding causal variation in our initial pediatric dataset, our approach confirmed diagnosis of an ARSACS-like disease in addition to MS in the affected individual, which led to a more complete understanding of the patient's disease course and prognosis.
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Affiliation(s)
- J P McElroy
- Department of Neurology, University of California at San Francisco, USA.
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Abstract
A new antibiotic "bacitracin" has been recovered from a strain of the B. subtilis group of organisms. It is neutral, water-soluble, non-toxic and relatively heat stable. In vitro it is active chiefly against Grampositive organisms, but the gonococcus and meningococcus are susceptible to its action. It is also active in vivo against experimentally produced hemolytic streptococcal infections in mice and gas gangrene infections in guinea pigs. Clinical use in hemolytic streptococcal and staphylococcal infections in man have given encouraging results.
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Johnson BA, Wang J, Taylor EM, Caillier SJ, Herbert J, Khan OA, Cross AH, De Jager PL, Gourraud PAF, Cree BCA, Hauser SL, Oksenberg JR. Multiple sclerosis susceptibility alleles in African Americans. Genes Immun 2010; 11:343-50. [PMID: 19865102 PMCID: PMC2880217 DOI: 10.1038/gene.2009.81] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Revised: 09/11/2009] [Accepted: 09/15/2009] [Indexed: 12/24/2022]
Abstract
Multiple sclerosis (MS) is an autoimmune demyelinating disease characterized by complex genetics and multifaceted gene-environment interactions. Compared to whites, African Americans have a lower risk for developing MS, but African Americans with MS have a greater risk of disability. These differences between African Americans and whites may represent differences in genetic susceptibility and/or environmental factors. SNPs from 12 candidate genes have recently been identified and validated with MS risk in white populations. We performed a replication study using 918 cases and 656 unrelated controls to test whether these candidate genes are also associated with MS risk in African Americans. CD6, CLEC16a, EVI5, GPC5, and TYK2 contained SNPs that are associated with MS risk in the African American data set. EVI5 showed the strongest association outside the major histocompatibility complex (rs10735781, OR=1.233, 95% CI=1.06-1.43, P-value=0.006). In addition, RGS1 seems to affect age of onset whereas TNFRSF1A seems to be associated with disease progression. None of the tested variants showed results that were statistically inconsistent with the effects established in whites. The results are consistent with shared disease genetic mechanisms among individuals of European and African ancestry.
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Affiliation(s)
- B A Johnson
- Department of Neurology, University of California, San Francisco, CA 94143, USA
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12
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Gaxiola DL, Keith JM, King JA, Johnson BA. Nielsen thermal conductivity model for single filler carbon/polypropylene composites. J Appl Polym Sci 2009. [DOI: 10.1002/app.30484] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Pobiel RS, Schellhas KP, Eklund JA, Golden MJ, Johnson BA, Chopra S, Broadbent P, Myers ME, Shrack K. Selective cervical nerve root blockade: prospective study of immediate and longer term complications. AJNR Am J Neuroradiol 2009; 30:507-11. [PMID: 19193762 DOI: 10.3174/ajnr.a1415] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Selective cervical nerve root blockade (SCNRB) is a useful procedure for evaluating and treating patients with cervical radiculopathy. Reports of complications related to injections within the cervical nerve root foramen have raised serious doubts regarding the safety of this procedure. This study was performed to prospectively evaluate the safety of fluoroscopically guided outpatient diagnostic and therapeutic SCNRB. MATERIALS AND METHODS Eight hundred two consecutive fluoroscopically guided diagnostic and/or therapeutic SCNRBs in 659 patients were performed during a 14-month period (November 2006-December 2007) at affiliated outpatient imaging centers. Each examination was performed by 1 of 8 experienced procedural radiologists by using an anterior oblique approach, with the needle position confirmed with radiographic contrast before injection of an admixture of local anesthetic and steroid. All patients were assessed immediately and at 30 minutes following the procedure. Additionally, 460 patients were called by telephone 30 days following the procedure. All complications were recorded. RESULTS Of the 802 attempted procedures, 799 were successfully completed. Three procedures were aborted due to anxiety, challenging body habitus, or persistent venous opacification observed during contrast injection and despite needle repositioning. There were no serious complications, such as stroke, spinal cord insult, permanent nerve root deficit, infection, or significant hematoma. There were 33 minor complications occurring within 30 minutes of the procedure; the most common was vasovagal symptoms. Three hundred forty-five patients were successfully contacted by telephone at 30 days postinjection, 9 of whom reported increased or new pain symptoms. CONCLUSIONS With our technique, fluoroscopically guided SCNRB is a safe outpatient procedure with a low immediate and delayed complication rate.
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Affiliation(s)
- R S Pobiel
- Center for Diagnostic Imaging, St Louis Park, MN 55416, USA.
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15
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Johnson BA, Mussatto K, Uhing MR, Zimmerman H, Tweddell J, Ghanayem N. Variability in the preoperative management of infants with hypoplastic left heart syndrome. Pediatr Cardiol 2008; 29:515-20. [PMID: 18034198 DOI: 10.1007/s00246-007-9022-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [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] [Received: 06/08/2007] [Accepted: 06/13/2007] [Indexed: 11/27/2022]
Abstract
Infants with hypoplastic left heart syndrome (HLHS) commonly undergo initial surgical palliation during the first week of life. Few data exist on optimal preoperative management strategies; therefore, the management of these infants prior to surgery is anecdotal and variable. To more fully define this variability in preoperative care of infants with HLHS, a survey was designed to describe current preoperative management practices in the infant with HLHS. The questionnaire explored management styles as well as preoperative monitoring techniques and characteristics of the respondent's health care institution. The responses were compiled and are reported. A striking lack of consistency in preoperative management techniques for infants with HLHS is apparent. The impact of these preoperative strategies is unknown. Despite challenges in anatomic and hemodynamic variability at presentation, a prospective randomized controlled trial comparing ventilatory management techniques, enteral feeding strategies, and the utility of various monitoring tools on short- and long-term outcome is needed.
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Affiliation(s)
- B A Johnson
- Department of Pediatrics, Division of Cardiology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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16
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Schellhas KP, Pollei SR, Johnson BA, Golden MJ, Eklund JA, Pobiel RS. Selective cervical nerve root blockade: experience with a safe and reliable technique using an anterolateral approach for needle placement. AJNR Am J Neuroradiol 2007; 28:1909-14. [PMID: 17905892 PMCID: PMC8134229 DOI: 10.3174/ajnr.a0707] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [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: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE [corrected] Our aim was to evaluate the safety and clinical utility of a fluoroscopically guided anterolateral oblique approach technique for outpatient diagnostic and therapeutic selective cervical nerve root blockade (SCNRB). MATERIALS AND METHODS During a 13-year period (1994 through February 2007), 4612 patients underwent fluoroscopically guided diagnostic and/or therapeutic extraforaminal SCNRB by using an anterior oblique approach at affiliated outpatient imaging centers. Each procedure was performed by 1 of 6 procedural radiologists, all highly experienced in and actively performing spinal injections on a full-time basis in clinical practice. All of the proceduralists were thoroughly experienced with lumbar injections before endeavoring to perform SCNRBs. Nonionic contrast was injected in nearly all patients (except isolated patients with contrast allergy), and a minimum of 2 projection filming procedures were performed to document the accuracy of needle placement and contrast dispersal before the injection of therapeutic substances. All clinically significant complications beyond skin discoloration and temporary exacerbation of symptoms were recorded. RESULTS There were no serious neurologic complications, such as stroke, spinal cord insult, or permanent nerve root deficit. One life-threatening anaphylactic reaction occurred and was attributed to the injected materials and not the specific procedure itself. Another patient had a 3- to 4-minute grand mal seizure, from which he fully recovered within 30 minutes. There were no infections. CONCLUSION The technique we describe for fluoroscopically guided SCNRB is a useful and safe outpatient procedure when performed by skilled and experienced proceduralists.
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Affiliation(s)
- K P Schellhas
- Center for Diagnostic Imaging, St Louis Park, MN 55416, USA.
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Johnson BA, Meleney FL. THE ANTISEPTIC AND DETOXIFYING ACTION OF ZINC PEROXIDE ON CERTAIN SURGICAL AEROBIC, ANAEROBIC AND MICRO-AEROPHILIC BACTERIA. Ann Surg 2007; 109:881-911. [PMID: 17857377 PMCID: PMC1391281 DOI: 10.1097/00000658-193906000-00001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Pobiel RS, Schellhas KP, Pollei SR, Johnson BA, Golden MJ, Eklund JA. Diskography: infectious complications from a series of 12,634 cases. AJNR Am J Neuroradiol 2006; 27:1930-2. [PMID: 17032869 PMCID: PMC7977892] [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: 05/12/2023]
Abstract
BACKGROUND AND PURPOSE Diskography is commonly performed to investigate pain of suspected diskogenic origin. Although uncommon, diskitis is a feared complication of this procedure. We reviewed the incidence of diskitis and other infectious complications following diskography in a large busy outpatient practice and discuss technical aspects that may contribute to infection prevention. METHODS We reviewed the electronic records of all diskograms obtained at our institution during a 12.25-year period, looking for all cases of procedure-related infection. All diskograms had been obtained by skilled and experienced procedural radiologists in dedicated spine-injection suites with specialized technical staff. RESULTS There were 12,634 examinations performed on 10,663 patients for a total of 37,135 disk levels. Of the disk levels, 5981 were cervical; 3083, thoracic; and 28,071, lumbar. Two cases of confirmed lumbar diskitis and no cases of either cervical or thoracic diskitis were seen in our series. No other infectious complications were found. The incidence of diskitis was 0.016% per examination and 0.0054% per disk level. CONCLUSION In skilled and experienced hands using proper technique, diskography is a safe outpatient procedure with an extremely low incidence of diskitis and other procedure-related infections.
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Affiliation(s)
- R S Pobiel
- Center for Diagnostic Imaging, St. Louis Park, MN 55416, USA.
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Tan LH, Johnson BA, Mawad ME, Chang AC. Neonate with vein of Galen malformation and heart failure: serial changes in plasma B-type natriuretic peptide following endovascular embolization. Pediatr Cardiol 2006; 27:276-8. [PMID: 16501882 DOI: 10.1007/s00246-005-1088-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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] [Received: 05/05/2005] [Indexed: 10/25/2022]
Abstract
We report a neonate with vein of Galen malformation (VGM) who developed congestive heart failure (CHF) early after birth. Serial changes in plasma B-type natriuretic peptide (BNP) following an endovascular embolization procedure for VGM were mirrored in his clinical CHF status. The plasma BNP level markedly increased to 1800 pg/ml (normal, <100 pg/ml) in accordance with the severity of CHF. It rapidly decreased to 356 pg/ml during the first week after endovascular embolization for VGM. In the following 3 weeks there was an unexpected upward trend in plasma BNP despite echocardiography revealing normal biventricular function. After additional evaluation and treatment for CHF, BNP decreased again and the patient's clinical status concurrently improved. The patient was discharged with a normal BNP level. Monitoring serial plasma BNP provides valuable information regarding the need for additional evaluation or treatment of newborns with CHF and may be used to document improvement.
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Affiliation(s)
- L H Tan
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030, USA
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Iacono AT, Corcoran TE, Griffith BP, Grgurich WF, Smith DA, Zeevi A, Smaldone GC, McCurry KR, Johnson BA, Dauber JH. Aerosol cyclosporin therapy in lung transplant recipients with bronchiolitis obliterans. Eur Respir J 2004; 23:384-90. [PMID: 15065826 DOI: 10.1183/09031936.04.00058504] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [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: 11/05/2022]
Abstract
The majority of patients who develop bronchiolitis obliterans, after lung transplantation, die within 2-3 yrs after onset since treatment with conventional immunosuppression is typically ineffective. A case/control study was conducted in lung transplant recipients with biopsy-documented bronchiolitis obliterans to determine whether aerosol cyclosporin use contributed to increased survival. The cases comprised 39 transplant recipients who received open-label aerosol cyclosporin treatment in addition to conventional immunosuppression. The controls were transplant recipients treated with conventional immunosuppression alone. There were 51 controls from the University of Pittsburgh Medical Center and 100 from a large multicentric database (Novartis Lung Transplant Database). Forced expiratory volume in one second expressed as a percentage of the predicted value was an independent predictor of survival in all patients with bronchiolitis obliterans. Cox proportional-hazards analysis revealed a survival advantage for aerosol cyclosporin cases compared to the Pittsburgh control group. A survival advantage was also seen when comparing study cases to multicentric controls. Aerosol cyclosporin, given with conventional immunosuppression to lung transplant recipients with bronchiolitis obliterans, provides a survival advantage over conventional therapy alone.
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Affiliation(s)
- A T Iacono
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
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Burns KEA, Johnson BA, Iacono AT. Diagnostic properties of transbronchial biopsy in lung transplant recipients who require mechanical ventilation. J Heart Lung Transplant 2003; 22:267-75. [PMID: 12633693 DOI: 10.1016/s1053-2498(02)00563-6] [Citation(s) in RCA: 13] [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: 10/27/2022] Open
Abstract
INTRODUCTION Bronchoscopy with transbronchial biopsy (TBBx) and bronchoalveolar lavage is useful and safe for diagnosing acute rejection and infection in lung transplant recipients. However, its role is less well defined in determining the etiology of allograft dysfunction in the setting of respiratory failure necessitating mechanical ventilation. METHODS We retrospectively identified 41 mechanically ventilated patients with respiratory failure in whom 42 TBBx were followed within a 10 day period by surgical lung biopsy (SLBx) to determine the sensitivity, specificity, and positive and negative predictive values of TBBx compared with SLBx. RESULTS The sensitivity, specificity, and positive and negative predictive values of TBBx for all episodes of acute rejection and for significant episodes of acute cellular rejection were 53.3% and 36.0%; 91.7% and 94.1%; 94.1% and 90.0%; 44.0% and 50.0%, respectively. A significantly higher histologic grade was noted on SLBx compared with TBBx specimens obtained within a 10-day period (2.39 +/- 1.02 vs 0.97 +/- 0.11, p <or= 0.0001). Performing SLBx in this setting increased histopathologic diagnoses by 33% and resulted in treatment changes in 15 of 41 (37%) patients. CONCLUSIONS Transbronchial biopsy has low sensitivity, high specificity, and high positive predictive value for diagnosing acute rejection. We found a significant tendency for TBBx to underestimate the presence and severity of clinically significant grades of rejection while simultaneously overestimating the presence of clinically insignificant rejection. Adding SLBx is valuable in lung transplant recipients with respiratory failure who require mechanical ventilation.
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Affiliation(s)
- K E A Burns
- Division of Pulmonary Transplantation, University of Pittsburgh Medical Center-Presbyterian Hospital, Pittsburgh, Pennsylvania 15261, USA
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Wang XS, Giralt SA, Mendoza TR, Engstrom MC, Johnson BA, Peterson N, Broemeling LD, Cleeland CS. Clinical factors associated with cancer-related fatigue in patients being treated for leukemia and non-Hodgkin's lymphoma. J Clin Oncol 2002; 20:1319-28. [PMID: 11870175 DOI: 10.1200/jco.2002.20.5.1319] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [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: 11/20/2022] Open
Abstract
PURPOSE To describe fatigue severity, fatigue interference, and associated factors in hematologic malignancies. PATIENTS AND METHODS Patients being treated for leukemia and non-Hodgkin's lymphoma (n = 228) completed the Brief Fatigue Inventory to rate fatigue severity and functional interference caused by fatigue. Data on patient demographics, Eastern Cooperative Oncology Group performance status, other physical symptoms, current treatments, and laboratory values were also collected. Descriptive statistics, bivariate correlation, and logistic regression were used for data analysis. RESULTS Fifty percent of the sample reported severe fatigue, which was defined as a "fatigue worst" rating of 7 or greater. More patients with acute leukemia (61%) reported severe fatigue compared with those with chronic leukemia (47%) and non-Hodgkin's lymphoma (46%). Increased fatigue severity significantly compromised patients' general activity, work, enjoyment of life, mood, walking, and relationships with others. Fatigue severity was strongly associated with performance status, use of opioids, blood transfusions, gastrointestinal symptoms, and sleep disturbance items, as well as with low serum hemoglobin and albumin levels. Regression analysis indicated that nausea was the significant clinical predictor of severe fatigue (odds ratio, 13), and low serum albumin was the significant laboratory value predictor (odds ratio, 3.8). CONCLUSION Disabling fatigue occurs with high frequency in hematologic malignancy, supporting a need to develop better methods of fatigue management. Better control of gastrointestinal and other symptoms may be of benefit. The mechanism and relationship between low albumin and severe fatigue needs to be investigated further, and longitudinal studies of the effects of treatment, host factors, and other symptoms are needed.
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Affiliation(s)
- Xin Shelley Wang
- Department of Symptom Research, Division of Anesthesiology and Critical Care, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
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Linster C, Johnson BA, Yue E, Morse A, Xu Z, Hingco EE, Choi Y, Choi M, Messiha A, Leon M. Perceptual correlates of neural representations evoked by odorant enantiomers. J Neurosci 2001; 21:9837-43. [PMID: 11739591 PMCID: PMC6763025] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Spatial activation patterns within the olfactory bulb are believed to contribute to the neural representation of odorants. In this study, we attempted to predict the perceptions of odorants from their evoked patterns of neural activity in the olfactory bulb. We first describe the glomerular activation patterns evoked by pairs of odorant enantiomers based on the uptake of [(14)C]2-deoxyglucose in the olfactory bulb glomerular layer. Using a standardized data matrix enabling the systematic comparison of these spatial odorant representations, we hypothesized that the degree of similarity among these representations would predict their perceptual similarity. The two enantiomers of carvone evoked overlapping but significantly distinct regions of glomerular activity; however, the activity patterns evoked by the enantiomers of limonene and of terpinen-4-ol were not statistically different from one another. Commensurate with these data, rats spontaneously discriminated between the enantiomers of carvone, but not between the enantiomers of limonene or terpinen-4-ol, in an olfactory habituation task designed to probe differences in olfactory perception.
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Affiliation(s)
- C Linster
- Department of Neurobiology and Behavior, Cornell University, Ithaca, New York 14853, USA.
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Johnson BA. Test your knowledge of the physician self-referral law. An FAQ on Stark law requirements for designated health services. MGMA Connex 2001; 1:56-9. [PMID: 11757162] [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: 02/23/2023]
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Johnson BA, Welter RT. Stark reality: what services are and are not covered by the self-referral law. MGMA Connex 2001; 1:64-7. [PMID: 11706648] [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: 02/22/2023]
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Abstract
BACKGROUND The aim of this study was to evaluate the severity and patterns of fatigue during preoperative chemoradiation therapy for locally advanced rectal cancer and determine whether there are predictors for patients who develop severe fatigue. METHODS Seventy-two patients with resectable rectal cancer received chemoradiation (total radiation dose, 45 gray/25 fractions to the pelvis; continuous infusion of 5-fluorouracil [300 mg/m(2)]). The Brief Fatigue Inventory (BFI), a measure that categorizes fatigue severity on a 0-10 scale, was administered weekly during treatment. Severe fatigue was defined as 7-10 on the "worst level of fatigue" item. Demographics, disease information, toxicities, and blood counts were collected. Descriptive statistics, repeated measure analysis of variance, and multiple regression were used to examine fatigue and its correlates. RESULTS Fatigue increased in 67% of patients during chemoradiation (CTX/XRT). The mean fatigue score increased from 3.16 before treatment to 4.62 at the end of treatment. A significant linear trend suggested that fatigue progressively got worse during CTX/XRT (F = 16.497, P < 0.001). However, 18% of patients experienced severe fatigue before CTX/XRT; this was predicted by uncontrolled pain (r(2) = 0.321; F = 16.52; P < 0.001). During CTX/XRT, uncontrolled diarrhea was the only predictor for increased fatigue (r(2) = 0.182; F = 7.77; P < 0.01). Approximately one-third of patients had severe fatigue, which impaired their function at the end of CTX/XRT. CONCLUSIONS Preoperative chemoradiation therapy for patients with rectal cancer was associated with progressive fatigue during therapy. Based on identified predictors for fatigue, more active pain management before CXT/XRT and bowel management during CTX/XRT might reduce cancer-related fatigue in these patients.
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Affiliation(s)
- X S Wang
- Pain Research Group,The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA
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Abstract
Cancer-related fatigue is now the most prevalent symptom of cancer, occurring in 60-90% of patients. Fatigue has been identified by cancer patients as a factor influencing functionality and quality of life. Our objectives in developing a fatigue specialty clinic at The University of Texas M. D. Anderson Cancer Center were to improve our patients' quality of life by decreasing fatigue; educate health care providers, patients, and patients' families about cancer-related fatigue; develop an appropriate clinical and diagnostic evaluation for this symptom; correlate objective measures of fatigue with its clinical evaluation; and develop innovative treatment plans for cancer-related fatigue. This article describes the general clinic design and operations and the preliminary analysis of the first 40 patients evaluated in the fatigue clinic.
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Affiliation(s)
- C P Escalante
- Department of General Internal Medicine, Ambulatory Treatment and Emergency Care, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
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Abstract
OBJECTIVE The authors reviewed the pathogenesis of cocaine-related cerebral ischemia, appraised current knowledge of its sequelae, and assessed the role of putative therapeutic agents, particularly dihydropyridine-class calcium channel antagonists. METHOD The authors performed an OVID-based literature review of all indexed journals between 1966 and 2000. RESULTS Cocaine abuse significantly increases the risk of ischemic stroke. The principal mechanism of cocaine-induced cerebral ischemia is vasospasm of large cranial arteries or within the cortical microvasculature. Increased levels of extracellular monoamines, particularly dopamine, mediate vasospasm. Neuroanatomical and labeling studies also have shown that dopamine-innervated neurons may regulate cerebral blood flow. Indeed, dopamine-rich brain regions appear to be relatively specific targets for cocaine-induced cerebral ischemia. Neuroimaging studies show that cocaine-induced hypoperfusion can persist even after 6 months of abstinence. Hypoperfusion can result in deficits on complex and simple psychomotor tasks but perhaps not on memory or attention. Severe cerebral ischemia can directly precipitate neuronal death and degradation, a condition exacerbated by liberation of the excitatory amino acid glutamate. Dihydropyridine-class calcium channel antagonists inhibit cocaine-mediated dopamine release on neurons involved in vasospasm and the control of cortical circulation. Other causes of cerebral ischemia include thrombogenesis and vasculitis. Although antithrombotic agents have potential in alleviating cocaine's neurotoxic effects, their use may be limited by the risk of spontaneous hemorrhage. CONCLUSIONS Cocaine abuse can result in stroke, neuroischemia, and cognitive deficits that can persist even after prolonged abstinence. Dihydropyridine-class calcium channel antagonists, such as isradipine, show promise as therapeutic agents for preventing cocaine-induced cerebral ischemia.
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Affiliation(s)
- B A Johnson
- Department of Psychiatry and Pharmacology, University of Texas Health Science Center at San Antonio, TX 78229, USA.
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Ait-Daoud N, Johnson BA, Javors M, Roache JD, Zanca NA. Combining ondansetron and naltrexone treats biological alcoholics: corroboration of self-reported drinking by serum carbohydrate deficient transferrin, a biomarker. Alcohol Clin Exp Res 2001; 25:847-9. [PMID: 11410720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
BACKGROUND Recently, we showed by using self-report that combining ondansetron (4 microg/kg twice a day) and naltrexone (25 mg twice a day) was effective at reducing drinking and increasing abstinence among early-onset alcoholics (EOAs), who are characterized by a range of antisocial behaviors and high biological and familial disease predisposition. Here, we investigated whether the self-reported differences in drinking would be corroborated by measurements of serum carbohydrate-deficient transferrin (CDT) level, a sensitive, reliable, and well-validated marker of transient alcohol consumption. METHOD An 8-week double-blind clinical trial was performed in which 20 EOAs were randomized to receive ondansetron (4 microg/kg twice a day) and naltrexone (25 mg twice a day) or placebo as an adjunct to weekly standardized cognitive behavioral therapy. Serum CDT was assessed at weeks 0 (baseline), 4, and 8. RESULTS Log serum CDT was significantly lower in the ondansetron and naltrexone group (group mean, 1.44 +/- 0.076) compared with the placebo group (group mean, 1.82 +/- 0.113), as evidenced by a main effect of group [F(1,15) = 7.2, p = 0.017; effect size = 0.32], visit [F(1,16) = 11.2, p = 0.004; effect size = 0.41], and an interaction between group and visit [F(1,16) = 27.54, p < 0.001; effect size = 0.63]. CONCLUSIONS The combination of ondansetron plus naltrexone was superior to placebo at reducing serum CDT. This corroborated our self-reported drinking data and demonstrated that the medication combination is an effective treatment for EOAs.
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Affiliation(s)
- N Ait-Daoud
- Department of Psychiatry and the Southwest Texas Addiction Research and Technology (START) Center, University of Texas Health Science Center at San Antonio, San Antonio 78229-3900, Texas, USA.
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Wang QC, Johnson BA. Fingertip injuries. Am Fam Physician 2001; 63:1961-6. [PMID: 11388710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
The family physician often provides the first and only medical intervention for fingertip injuries. Proper diagnosis and management of fingertip injuries are vital to maintaining proper function of the hand and preventing permanent disability. A subungual hematoma is a painful condition that involves bleeding beneath the nail, usually after trauma. Treatment requires subungual decompression, which is achieved by creating small holes in the nail. A nail bed laceration is treated by removing the nail and suturing the injured nail bed. Closed fractures of the distal phalanx may require reduction but usually are minimally displaced and stable, and can be splinted. Open or intra-articular fractures of the distal phalanx may warrant referral. Patients with mallet finger cannot extend the distal interphalangeal joint because of a disruption of the extensor mechanism. Radiographs help to differentiate between tendinous and bony mallet types. Most mallet finger injuries heal with six to eight weeks of splinting, but some require referral. Flexor digitorum profundus avulsion always requires referral. Dislocations of the distal interphalangeal joint are rare and usually occur dorsally.
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Affiliation(s)
- Q C Wang
- Kaiser Permanente, Long Beach, California, USA
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Abstract
A 35-year-old woman experienced symptomatic calf pain while taking a combination of fenfluramine and phentermine. All symptoms resolved when the medications were stopped, but pain returned when fenfluramine was restarted. Laboratory evaluation revealed mild elevations of aspartate aminotransferase and lactate dehydrogenase and a remarkably shortened prothrombin time (6.3 seconds). Additional studies revealed that the clots were composed of very thin fibrin fibers. All laboratory abnormalities, including the abnormal fibrin structure, completely resolved when fenfluramin was stopped. Direct addition of fenfluramine or phentermine to normal plasma did not alter either coagulation kinetics or fibrin structure, supporting the concept that the induced changes may have originated at the hepatic level. Clots composed of thin fibers are much more resistant to fibrinolysis, and could potentially put such patients at risk for thrombotic complications. This is the first report of clotting abnormalities associated with fenfluramine use. Subsequent to its use in this patient, fenfluramine was removed from clinical use due to reports of acquired valvular heart disease.
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Affiliation(s)
- M E Carr
- Department of Internal Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond 23298-0230, USA
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Neylon TA, Johnson BA, Laroche RA. Use of the lapidus bunionectomy in first ray insufficiency. Clin Podiatr Med Surg 2001; 18:365-75. [PMID: 11417162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Surgical management of first ray insufficiency in HAV or hallux limitus is crucial to long-term success. Although technically demanding, the Lapidus fusion serves to address the deformity at its apex and restores normal weight bearing to the foot. This arthrodesis offers predictable, durable results in addressing various first ray deformities and occupies an important place in the foot and ankle surgeon's armamentarium. The authors' technique is described herein for the interest of and evaluation by surgeons performing this procedure. As clinicians recognize the importance of addressing proximal components of the HAV deformity, the Lapidus and other procedures will likely see increased use in the surgical management of first ray deformities.
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Affiliation(s)
- T A Neylon
- Department of Orthopaedic Surgery, Wilford Hall Medical Center, Lackland Air Force Base, Texas, USA
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Johnson BA, Cloninger CR, Roache JD, Bordnick PS, Ruiz P. Age of onset as a discriminator between alcoholic subtypes in a treatment-seeking outpatient population. Am J Addict 2001; 9:17-27. [PMID: 10914290 DOI: 10.1080/10550490050172191] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.2] [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: 10/17/2022] Open
Abstract
Subtyping alcoholics may provide a more accurate guide as to the course and character of the disease. Classifications of different ages of onset of problem drinking have so far resulted in categorical inconsistencies. In the past, hospital-based alcoholics have over-represented those most severely ill, and comprehensive evaluations of psychopathology for discriminating between alcoholic subtypes have been infrequent. In a heterogeneous treatment-seeking, outpatient, alcoholic population, we tested the hypothesis that age of onset represents a continuum of disease, and that greater severity of psychopathology is associated with lower ages of onset. Using a standard questionnaire, 253 male and female treatment-seeking alcoholics were stratified according to specific ages of onset: a) < 20 years; b) 20-25 years, and c) > 25 years. These age of onset groups were compared on alcohol severity and craving, family history, childhood behavior, personality, hostility, overt aggression, mood, and social functioning. Symptom severity and age of onset were negatively correlated, and the 20-25-year onset group usually had intermediate scores. The < 20 year onset group was characterized by greater severity of alcohol-related problems, family history, childhood behavioral problems, craving, hostility, antisocial traits, mood disturbance, and poor social functioning. Alcoholics with an earlier age of onset have relatively greater psychopathology than those of later onset. While the preponderance of psychopathology among those in the < 20-year onset group could be conceptualized as a clinical "subtype," such a characterization would not define an entirely homogeneous category. Yet, this clinical characterization would be clinically important if specific age of onset levels were found to be differentially sensitive to pharmacological and/or psychological treatments.
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Affiliation(s)
- B A Johnson
- Department of Psychiatry, University of Texas, San Antonio 78284-7792, USA.
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Ait-Daoud N, Johnson BA, Prihoda TJ, Hargita ID. Combining ondansetron and naltrexone reduces craving among biologically predisposed alcoholics: preliminary clinical evidence. Psychopharmacology (Berl) 2001; 154:23-7. [PMID: 11292002 DOI: 10.1007/s002130000607] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [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: 10/27/2022]
Abstract
RATIONALE Previously, we have reported that the combination of ondansetron (a 5-HT3 antagonist) and naltrexone (a mu opioid antagonist) appears to act synergistically at improving the drinking outcomes of early onset alcoholics (EOA). a subtype of alcoholic characterized by developing problem-drinking earlier, antisocial behaviors, high familial loading, and biological disease predisposition. Presumably, this medication combination counteracts the interaction between activated central 5-HT3 receptors and the endogenous opioid system during the mediation of alcohol-induced reward. We now hypothesize further that an important mechanism by which the combination diminishes alcohol consumption is through a reduction in craving. OBJECTIVE To determine whether the combination of naltrexone and ondansetron is superior to a placebo at reducing craving among EOA, and the relationship between craving and drinking behavior in both treatment groups. METHODS We conducted an 8-week double-blind placebo-controlled clinical trial in which 10 EOA were randomized to receive ondansetron (4 microg/kg b.i.d.) + naltrexone (25 mg b.i.d.) and 10 EOA had a placebo (total n=20) as an adjunct to weekly standardized group cognitive behavioral therapy. Craving was measured by using the obsessive compulsive drinking scale (OCDS). RESULTS Craving ratings were scored on four subscales which where derived empirically by principal component structure analysis of the OCDS. EOA who received the medication combination, compared with the placebo, had significantly lower scores on "automaticity of drinking" and "alcohol consumption ". Reduction in automaticity of drinking was correlated with self-reported drinking for only the medication combination group. CONCLUSIONS By reducing automaticity of drinking, the medication combination presumably decreased drinking salience and intensity. Larger scale studies testing these medications, both alone and together, among alcoholic subtypes are needed to establish and extend these promising findings.
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Affiliation(s)
- N Ait-Daoud
- Treatment Research Center, Department of Psychiatry, University of Texas, Health Science Center at San Antonio, 78229-3900, USA.
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Abstract
Ductography of the breast is an underused procedure that often helps define the cause of unilateral, single-pore, spontaneous nipple discharge. Since nipple discharge may be caused by benign tumors, such as papillomas, or by carcinoma, such as ductal carcinoma in situ, identification of intraductal abnormalities with ductography is important. Further, diagnostic ductography and preoperative ductography help guide accurate surgical intervention. Without prior ductography, central duct excision may not result in removal of the abnormal ductal tissue or may result in removal of only a portion of the abnormal ductal system, causing the extent of disease to be effectively understaged. Once fundamental ductographic principles are learned, the procedure is easy to perform. If extravasation occurs, ductography is rescheduled for 7-14 days later. Elimination of air bubbles from the cannula, syringe, and extension tubing is vital. When reflux occurs, radiologists must be aware of a possible tumor in the distal-most duct. When ductal ectasia or fibrocystic changes are the cause of the discharge, conservative follow-up may be considered. Diagnostic radiologists who learn the technique of ductography and include it in their evaluation of nipple discharge will improve their interdisciplinary approach to this important sign of breast cancer.
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Affiliation(s)
- S H Slawson
- Susan G. Komen Breast Center, 4911 Executive Dr., Peoria, IL 61614, USA.
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Abstract
BACKGROUND Vitamin D deficiency is associated with bone loss and bone fractures, and the identification of vulnerable populations is important to clinical practice and public health. OBJECTIVE The objectives of this study were to determine the prevalence of vitamin D deficiency and to examine associated risk factors for vitamin D deficiency in older women. DESIGN We measured serum concentrations of 25-hydroxyvitamin D [25(OH)D], 1,25-dihydroxyvitamin D [1, 25(OH)(2)D], intact parathyroid hormone (PTH), osteocalcin, and ionized calcium in women aged >/=65 y who were participating in the Women's Health and Aging Study I, an observational study of women representing the approximately one-third most disabled women living in the community, and women aged 70-80 y who were participating in the Women's Health and Aging Study II, an observational study of women among the two-thirds least disabled women living in the community in Baltimore. RESULTS The women were classified into 4 domains of physical disability. Among 371 women with 0 or 1 domain of disability and 682 women with >/=2 domains of disability, 6.2% and 12.6%, respectively, had vitamin D deficiency [serum concentrations of 25(OH)D < 25 nmol/L]. In univariate analyses, risk factors for vitamin D deficiency included increasing age, black race, low educational level, high body mass index, high triceps skinfold thickness, increasing level of disability, winter season, and elevated creatinine concentration. In multivariate models, black race had a strong association with vitamin D deficiency when other risk factors were adjusted for. CONCLUSIONS Vitamin D deficiency, a preventable disorder, is a common and important public health problem for older disabled women living in the community; black women are at higher risk than are white women.
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Affiliation(s)
- R D Semba
- Johns Hopkins Medical Institutions, Baltimore, and the Epidemiology, Demography, and Biometry Program, National Institute on Aging, Bethesda, MD, USA.
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Johnson BA. Integration of student-health physicians into U.S. medical schools and their affiliated teaching hospitals. Acad Med 2000; 75:1125-1129. [PMID: 11078675 DOI: 10.1097/00001888-200011000-00021] [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] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE To determine whether physicians in the student health services (SHSs) at U.S. medical schools and their affiliated teaching hospitals, referred to here as academic medical centers (AMCs), have unique opportunities for integration into AMCs that do not exist for physician-faculty at SHSs on purely academic campuses. METHOD A survey of SHS offices at the 124 U.S. medical schools was conducted in the spring of 1999. The questionnaire asked about the reporting relationships of the SHS within the AMC, whether the student-health physicians had academic appointments within the AMC, and whether these physicians participated in the AMC's clinical services, administration, research, or teaching activities. RESULTS There were 116 (94%) responses (not all responses were complete and eight were excluded because their campuses offered no formal SHS). Approximately half of the SHSs (52/107, 49%) reported to their AMCs. Student-health physicians with career-track appointments were more likely to be found at SHSs reporting to AMCs (35/58, 60%) than at SHSs reporting solely to a division of student affairs (20/58, 34%). Having a career-track appointment increased the likelihood of the student-health physicians' attending on the wards (34/59, 58%), seeing private patients in an AMC's faculty practice (40/59, 68%), participating in administrative activities for an AMC (50/56, 89%), and participating in research activities (36/57, 63%). CONCLUSIONS Student health services that reported to their AMCs were more likely to have faculty with career-track appointments, and these appointments were more likely to result in the integration of student-health physicians into their AMC's clinical services, administration, and research activities. Career-track appointments, however, had no influence on whether teaching activities occurred within the SHS. Fully integrating student-health physicians into the AMC's activities enhances outcomes for both the SHS and its AMC.
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Affiliation(s)
- B A Johnson
- Division of General Medicine, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
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Abstract
Organic acid odorants of differing carbon number produce systematically different spatial patterns of [(14)C]2-deoxyglucose uptake in the glomerular layer of the olfactory bulb. Because increasing carbon number correlates with progressive increases in several molecular features, including hydrophobicity, length, and volume, we determined which of these properties was most associated with systematic changes in the location of an anterior, dorsomedial module responding to fatty acids. We exposed groups of rats to two series of organic acids that each had the same number of carbons, but differed in their hydrocarbon structures. These straight-chained, branched, cyclic, and double-bonded molecules differed independently in hydrophobicity, length, and volume. The only molecular property that was strongly correlated with the location of the module was molecular length, suggesting that this molecular feature is the principal determinant of the chemotopic organization of glomeruli within the module. We also found that distinct hydrocarbon structures produced large differences in spatial patterns of 2-deoxyglucose uptake in posterior parts of the bulb. Even subtly distinct structural isomers evoked posterior responses that differed greatly. The odorant 2-methylbutyric acid evoked much greater uptake in the posterior bulb than did its structural isomer 3-methylbutyric acid (isovaleric acid). These data suggest that posterior portions of the bulb may encode specific steric features of odorant molecules and that some odorant features may have an inherent or acquired greater representation than do others.
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Affiliation(s)
- B A Johnson
- Department of Neurobiology and Behavior, University of California, Irvine, California 92697-4550, USA.
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Johnson BA, Nunley JR. Use of systemic agents in the treatment of acne vulgaris. Am Fam Physician 2000; 62:1823-30, 1835-6. [PMID: 11057839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Effective treatment of acne vulgaris can prevent emotional and physical scarring. Therapy varies according to the severity of the disease. Topical medication is generally adequate in clearing comedonal acne, while inflammatory acne usually requires the addition of oral medication. Systemic antibiotics are used most frequently and can be highly effective. Newer formulations of combined oral contraceptives are also helpful in modulating sebum production in the female patient. Severe nodulocystic acne that does not respond to topical retinoids and systemic antibiotics may be treated with isotretinoin. However, the side effect profile of this medication is extensive, and physicians should be well-versed in its potential adverse effects.
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Affiliation(s)
- B A Johnson
- Virginia Commonwealth University Medical College of Virginia School of Medicine, Richmond 23298-0230, USA
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Johnson BA. Serotonergic agents and alcoholism treatment: rebirth of the subtype concept--an hypothesis. Alcohol Clin Exp Res 2000; 24:1597-601. [PMID: 11045870] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- B A Johnson
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, USA.
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McIvor ZJ, Heyworth CM, Johnson BA, Pearson S, Fiegler H, Hampson L, Dexter TM, Cross MA. A transient assay for regulatory gene function in haemopoietic progenitor cells. Br J Haematol 2000; 110:674-81. [PMID: 10997980 DOI: 10.1046/j.1365-2141.2000.02214.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This work aimed to provide a means of assaying directly the effects of transient expression of introduced genes on the survival, proliferation, lineage commitment and differentiation of haemopoietic progenitor cells. For this purpose, we have developed a system that allows isolation of productively transfected, mulitipotent haemopoietic cells within a few hours of the introduction of test genes. We have shown that FDCP-mix cells productively transfected with expression plasmids encoding green fluorescent protein (GFP) differentiate normally and retain colony-forming potential. We constructed an expression vector consisting of a bicistronic cassette in which a GFP marker gene and a test gene are driven from the same promoter. The vector design has been optimized for co-expression and the test gene was shown to be biologically active. The expression profile from a transiently transfected template under different growth conditions reveals that active expression continues for at least 2 d after transfection. The transient transfection of FDCP-mix cells with the vectors described provides a powerful tool for analysis of the immediate early effects of test gene overexpression during haemopoietic differentiation.
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Affiliation(s)
- Z J McIvor
- Laboratory of Molecular Medicine, IZKF University of Leipzig, Leipzig, Germany.
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Johnson BA, Roache JD, Javors MA, DiClemente CC, Cloninger CR, Prihoda TJ, Bordnick PS, Ait-Daoud N, Hensler J. Ondansetron for reduction of drinking among biologically predisposed alcoholic patients: A randomized controlled trial. JAMA 2000; 284:963-71. [PMID: 10944641 DOI: 10.1001/jama.284.8.963] [Citation(s) in RCA: 273] [Impact Index Per Article: 11.4] [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: 01/30/2023]
Abstract
CONTEXT Early-onset alcoholism differs from late-onset alcoholism by its association with greater serotonergic abnormality and antisocial behaviors. Thus, individuals with early-onset alcoholism may be responsive to treatment with a selective serotonergic agent. OBJECTIVE To test the hypothesis that drinking outcomes associated with early vs late-onset alcoholism are differentially improved by the selective 5-HT(3) (serotonin) antagonist ondansetron. DESIGN Double-blind, randomized, placebo-controlled clinical trial. SETTINGS University of Texas Health Science Center in Houston (April 1995-June 1998) and University of Texas Health Science Center in San Antonio (July 1998-December 1999). PARTICIPANTS A total of 321 patients with diagnosed alcoholism (mean age, 40.6 years; 70.5% male; 78.6% white) were enrolled, 271 of whom proceeded to randomization. INTERVENTIONS After 1 lead-in week of single-blind placebo, patients were randomly assigned to receive 11 weeks of treatment with ondansetron, 1 microg/kg (n = 67), 4 microg/kg (n = 77), or 16 microg/kg (n = 71) twice per day; or identical placebo (n = 56). All patients also participated in weekly standardized group cognitive behavioral therapy. MAIN OUTCOME MEASURES Self-reported alcohol consumption (drinks per day, drinks per drinking day, percentage of days abstinent, and total days abstinent per study week); and plasma carbohydrate deficient transferrin (CDT) level, an objective and sensitive marker of transient alcohol consumption. RESULTS Patients with early-onset alcoholism who received ondansetron (1, 4, and 16 microg/kg twice per day) compared with those who were administered placebo, had fewer drinks per day (1.89, 1.56, and 1.87 vs 3.30; P =.03, P =.01, and P =.02, respectively) and drinks per drinking day (4.75, 4.28, and 5.18 vs 6.90; P =.03, P =.004, and P =.03, respectively). Ondansetron, 4 microg/kg twice per day, was superior to placebo in increasing percentage of days abstinent (70.10 vs 50.20; P =.02) and total days abstinent per study week (6.74 vs 5.92; P =.03). Among patients with early-onset alcoholism, there was a significant difference in the mean log CDT ratio between those who received ondansetron (1 and 4 microg/kg twice per day) compared with those who received the placebo (-0.17 and -0.19 vs 0.12; P =.03 and P =.01, respectively). CONCLUSION Our results suggest that ondansetron (particularly the 4 microg/kg twice per day dosage) is an effective treatment for patients with early-onset alcoholism, presumably by ameliorating an underlying serotonergic abnormality. JAMA. 2000;284:963-971
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Affiliation(s)
- B A Johnson
- Department of Psychiatry, University of Texas Health Science Center, 7703 Floyd Curl Dr, Mail Stop 7792, San Antonio, TX 78229-3900, USA.
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Johnson BA. First patient. Pharos Alpha Omega Alpha Honor Med Soc 2000; 63:31-3. [PMID: 10918800] [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: 02/17/2023]
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Johnson BA. Image-guided epidural injections. Neuroimaging Clin N Am 2000; 10:479-91. [PMID: 11083014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Epidural steroid injection is a safe outpatient procedure, which is performed best using image guidance in conjunction with epidurography. Using the techniques described earlier, complications are minimized, and serious complications can be avoided, in experienced hands. The author has performed several thousand procedures in an outpatient setting without any serious complications. Optimal safety and efficacy require an excellent working knowledge of the radiographic anatomy, and the imaging equipment used to perform these procedures. Several studies have demonstrated the difficulty and uncertainty of obtaining an accurate injection without imaging guidance. Radiologists who are well trained in the performance of image-guided percutaneous injection procedures are thus armed with the background to perform these procedures in a safe and efficacious manner. In addition, referral of these procedures to a third party (radiologist) without economic incentives reduces the potential abuse of self-referral--which may occur (or be suspected by payors) when the primary clinician recommends, and then performs, pain management procedures. The use of sedation to perform these procedures is unnecessary, and deep sedation may be dangerous when injections are performed in the vicinity of the spinal cord. The author's experience, which includes clinical feedback and formal trials, shows the technique described in this article to be performed safely without sedation in an outpatient setting, with a high success rate for alleviating pain symptoms. When properly performed, epidural steroid injections have a clinically established role in the management of neck and back pain.
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Affiliation(s)
- B A Johnson
- Department of Radiology, University of Minnesota Medical School, Minneapolis, USA
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Abstract
To study the mechanism whereby odorants are encoded in the nervous system, we studied the glomerular-layer activity patterns in the rat olfactory bulb evoked by closely related odorants from different chemical families. These odorants had a common straight-chain hydrocarbon structure, but differed systematically in their functional groups. Neural activity was mapped across the entire glomerular layer by using the ¿(14)C2-deoxyglucose method. Group responses were averaged and compared by using data matrices. The glomerular activity patterns that resulted from this analysis were comprised of modules. Unique combinations of modules were activated by each odorant, demonstrating what may be part of the neural code for odorants. Most of the modules were clustered together in the bulb, perhaps providing for enhanced contrast between related chemicals by means of lateral inhibition. We also determined whether changes in odorant concentration would affect spatial patterns of glomerular activity. Two odorants, pentanal and 2-hexanone, evoked different patterns at increased concentrations, with additional glomeruli being recruited at a great distance from glomeruli in which activity was evoked at lower concentrations. Humans report that both of these odorants change in perceived odor with increasing concentration. Three other odorants (pentanoic acid, methyl pentanoate, and pentanol) did not recruit new areas of glomerular activation with increasing concentration, and humans do not report a changed odor across concentrations of these odorants. The results suggest that changes in modular glomerular activity patterns could underlie altered odor perception across odorant concentrations, and they provide additional support for a combinatorial, spatially based code in the olfactory system.
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Affiliation(s)
- B A Johnson
- Department of Neurobiology and Behavior, University of California, Irvine, California 92697-4550, USA.
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Erukhimov JA, Tang ZL, Johnson BA, Donahoe MP, Razzack JA, Gibson KF, Lee WM, Wasserloos KJ, Watkins SA, Pitt BR. Actin-containing sera from patients with adult respiratory distress syndrome are toxic to sheep pulmonary endothelial cells. Am J Respir Crit Care Med 2000; 162:288-94. [PMID: 10903256 DOI: 10.1164/ajrccm.162.1.9806088] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.3] [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: 11/16/2022] Open
Abstract
Actin released from damaged cells after a variety of tissue injuries appears to be involved in multiple organ dysfunction syndrome. Under experimental conditions, when the quantity of actin present in plasma is made to exceed the protective capacity of the actin-scavenging mechanism, microembolism and pulmonary vascular angiopathy have been noted in rats. It remains to be determined whether this injury is a result of a direct toxic effect or occurs indirectly via platelet activation or fibrin interactions. We examined the effect of sera from patients with adult respiratory distress syndrome (ARDS), as well as G-actin added to normal serum, on the viability, morphology, and function of cultured sheep pulmonary artery endothelial cells (SPAEC). Both patient sera and normal sera to which actin was added were toxic in the cell culture model; this toxicity could be abrogated, at least partially, by preincubation with gelsolin, which is known to complex with actin. A significant portion of the toxicity of sera from patients with ARDS was sensitive to heat (56 degrees C), suggesting an important role of complement. Sera from patients with ARDS were shown to contain filaments of F-actin by immunoblot and rhodamine phalloidin staining after ultracentrifugation. Thus, saturation of the actin-scavenging system by addition of exogenous G-actin to plasma produces direct pulmonary endothelial cell injury. Furthermore, plasma from patients with ARDS secondary to bacterial pneumonia is toxic to SPAEC, and a small but significant contributory role of actin is apparent in these studies.
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Affiliation(s)
- J A Erukhimov
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Pharmacology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261, USA
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Hasso AN, Drayer BP, Anderson RE, Braffman B, Davis PC, Deck MD, Johnson BA, Masaryk T, Pomeranz SJ, Seidenwurm D, Tanenbaum L, Masdeu JC. Vertigo and hearing loss. American College of Radiology. ACR Appropriateness Criteria. Radiology 2000; 215 Suppl:471-8. [PMID: 11037458] [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] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- A N Hasso
- University of California Irvine Medical Center, Orange, USA
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Deck MD, Drayer BP, Anderson RE, Braffman B, Davis PC, Hasso AN, Johnson BA, Masaryk T, Pomeranz SJ, Seidenwurm D, Tanenbaum L, Masdeu JC. Imaging of intracranial infections. American College of Radiology. ACR Appropriateness Criteria. Radiology 2000; 215 Suppl:535-45. [PMID: 11037464] [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] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- M D Deck
- Cornell Medical Center, New York, NY, USA
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Masaryk T, Drayer BP, Anderson RE, Braffman B, Davis PC, Deck MD, Hasso AN, Johnson BA, Pomeranz SJ, Seidenwurm D, Tanenbaum L, Masdeu JC. Cerebrovascular disease. American College of Radiology. ACR Appropriateness Criteria. Radiology 2000; 215 Suppl:415-35. [PMID: 11037455] [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] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- T Masaryk
- Cleveland Clinic Foundation, Ohio, USA
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Tanenbaum L, Drayer BP, Anderson RE, Braffman B, Davis PC, Deck MD, Hasso AN, Johnson BA, Masaryk T, Pomeranz SJ, Seidenwurm D, Masdeu JC. Epilepsy. American College of Radiology. ACR Appropriateness Criteria. Radiology 2000; 215 Suppl:459-70. [PMID: 11037457] [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] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- L Tanenbaum
- New Jersey Neuroscience Institute/JFK Medical Center, Edison, USA
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