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Waldrop MA, Chagat S, Storey M, Meyer A, Iammarino M, Reash N, Alfano L, Lowes L, Noritz G, Prochoroff A, Rossman I, Ginsberg M, Mosher K, Broomall E, Bass N, Gushue C, Kotha K, Paul G, Shell R, Tsao CY, Mendell JR, Connolly AM. Continued safety and long-term effectiveness of onasemnogene abeparvovec in Ohio. Neuromuscul Disord 2024; 34:41-48. [PMID: 38142474 DOI: 10.1016/j.nmd.2023.11.010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/01/2023] [Accepted: 11/27/2023] [Indexed: 12/26/2023]
Abstract
5q spinal muscular atrophy (SMA) is an autosomal recessive neurodegenerative disease caused by absence of the SMN1 gene with three FDA approved genetic therapies which significantly improve outcomes. The AAV9 mediated gene replacement therapy, onasemnogene abeparvovec, has the greatest potential for side effects. Here we report the safety and outcomes from 46 children treated with onasemnogene abeparvovec in the state of Ohio between December 2018 and January 2023. In our cohort, onasemnogene abeparvovec treatment remained safe and no child experienced any significant adverse events, including thrombotic microangiopathy, liver failure or death. All children experienced benefit, although the benefit in those with 2 copies of SMN2 was variable. 79 % of the children treated when symptomatic had a SMN2 modifying therapy added on. With careful screening and post treatment monitoring, onasemnogene abeparvovec is safe and effective for children with SMA in the state of Ohio, but more work needs to be done to ensure optimal outcomes for all children with 2 copies of SMN2.
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Affiliation(s)
- Megan A Waldrop
- Center for Gene Therapy, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus OH, 43205, USA; Departments of Pediatrics and Neurology, Ohio State University Wexner Medical Center, Columbus OH, 43205, USA.
| | - Shannon Chagat
- Department of Neurology, Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Michael Storey
- Department of Pharmacy, Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Alayne Meyer
- Center for Gene Therapy, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus OH, 43205, USA
| | - Megan Iammarino
- Center for Gene Therapy, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus OH, 43205, USA
| | - Natalie Reash
- Center for Gene Therapy, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus OH, 43205, USA
| | - Lindsay Alfano
- Center for Gene Therapy, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus OH, 43205, USA
| | - Linda Lowes
- Center for Gene Therapy, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus OH, 43205, USA
| | - Garey Noritz
- Department of Pediatrics, Nationwide Children's hospital, Columbus, OH 43205, USA
| | - Andre Prochoroff
- Department of Pediatric Neurology, Metro Health, Cleveland OH, USA
| | - Ian Rossman
- Department of Pediatric Neurology, Akron Children's Hospital, Akron OH, USA
| | - Matthew Ginsberg
- Department of Pediatric Neurology, Akron Children's Hospital, Akron OH, USA
| | - Kathryn Mosher
- Department of Pediatric Physiatry, Akron Children's Hospital, Akron OH, USA
| | - Eileen Broomall
- Department of Pediatric Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati OH, USA
| | - Nancy Bass
- Division of Pediatric Neurology, Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland OH, USA
| | - Courtney Gushue
- Departments of Pediatrics and Pulmonology, Ohio State University Wexner Medical Center, Columbus OH 43205, USA
| | - Kavitha Kotha
- Departments of Pediatrics and Pulmonology, Ohio State University Wexner Medical Center, Columbus OH 43205, USA
| | - Grace Paul
- Departments of Pediatrics and Pulmonology, Ohio State University Wexner Medical Center, Columbus OH 43205, USA
| | - Richard Shell
- Departments of Pediatrics and Pulmonology, Ohio State University Wexner Medical Center, Columbus OH 43205, USA
| | - Chang-Yong Tsao
- Departments of Pediatrics and Neurology, Ohio State University Wexner Medical Center, Columbus OH, 43205, USA
| | - Jerry R Mendell
- Center for Gene Therapy, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus OH, 43205, USA; Departments of Pediatrics and Neurology, Ohio State University Wexner Medical Center, Columbus OH, 43205, USA
| | - Anne M Connolly
- Center for Gene Therapy, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus OH, 43205, USA; Departments of Pediatrics and Neurology, Ohio State University Wexner Medical Center, Columbus OH, 43205, USA
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Lee J, Husami A, Arora K, Zhang W, Kadri F, Yarlagadda S, Moon C, Mun KS, Zhang K, Huang Y, Liyanage P, Brewington J, Clancy JP, Shaikhkhalil A, Paul G, Naren AP. A personalized medicine approach to optimize care for a pediatric cystic fibrosis patient with atypical clinical symptoms. Pediatr Pulmonol 2024; 59:229-232. [PMID: 37818777 PMCID: PMC10842517 DOI: 10.1002/ppul.26719] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/13/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023]
Affiliation(s)
- Jesun Lee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Cedars-Sinai Hospital Medical Center, Los Angeles, California, USA
| | - Ammar Husami
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kavisha Arora
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Cedars-Sinai Hospital Medical Center, Los Angeles, California, USA
| | - Weiqiang Zhang
- USDA-ARS, Pollinator Health in Southern Crop Ecosystem Research Unit, Stoneville, Mississippi, USA
| | - Ferdous Kadri
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Cedars-Sinai Hospital Medical Center, Los Angeles, California, USA
| | - Sunitha Yarlagadda
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Changsuk Moon
- Decibel Therapeutics, Inc., Boston, Massachusetts, USA
| | - Kyu Shik Mun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Cedars-Sinai Hospital Medical Center, Los Angeles, California, USA
| | - Kejian Zhang
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Yunjie Huang
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Pramodha Liyanage
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Cedars-Sinai Hospital Medical Center, Los Angeles, California, USA
| | - John Brewington
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | - Ala Shaikhkhalil
- Departments of Pulmonary and Gastrointestinal Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Grace Paul
- Departments of Pulmonary and Gastrointestinal Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Anjaparavanda P Naren
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Cedars-Sinai Hospital Medical Center, Los Angeles, California, USA
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Sheikh S, Ho ML, Eisner M, Gushue C, Paul G, Holtzlander M, Johnson T, McCoy KS, Lind M. Elexacaftor-Tezacaftor-Ivacaftor Therapy for Chronic Sinus Disease in Cystic Fibrosis. JAMA Otolaryngol Head Neck Surg 2023; 149:1075-1082. [PMID: 37676668 PMCID: PMC10485743 DOI: 10.1001/jamaoto.2023.2701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/10/2023] [Indexed: 09/08/2023]
Abstract
Importance Cystic fibrosis (CF) is a multiorgan genetic disease with progressive upper and lower airway involvement. The effects of CF transmembrane conductance regulator (CFTR) modifier therapies on CF-related upper airway disease, specifically chronic rhinosinusitis (CRS), are not characterized. Objective To determine the outcome of elexacaftor-tezacaftor-ivacaftor (ETI) on CRS as measured by changes in sinus computed tomography (CT) metrics and on clinical parameters in individuals with CF. Design, Setting, and Participants This prospective longitudinal cohort study was conducted at the CF center of a tertiary care hospital between October 1, 2019, and July 31, 2021. A total of 64 participants with CF were included in the analysis. Intervention Sinus CT was obtained within 1 month of initiation of ETI therapy (baseline), and within 1 month of 1 year of ETI therapy. Images were independently analyzed by pulmonology, radiology, and otolaryngology physicians, using the Lund-Mackay and Sheikh-Lind scoring systems. Percent predicted forced expiratory volume in 1 second (ppFEV1), body mass index (BMI), and microbiologic data collected at initiation of ETI therapy and 3-month intervals for 1 year were also measured. Main Outcomes and Measures The study hypothesis was that ETI therapy will improve CRS as measured by changes in sinus CT at initiation and 1 year after ETI therapy and clinical parameters in individuals with CF. Results Among the 64 participants (39 [60.9%] female; median age, 18.5 [IQR, 16.0-28.5] years; 64 [100%] White), improvement in CRS was noted by improvements in sinus CT scans using both sinus CT scoring systems after 1 year of ETI therapy. The reduction in the median total score using the Lund-Mackay sinus CT scoring system (from 5.8 [IQR, 5.0-7.0] to 3.3 [IQR, 2.6-4.2]) and the Sheikh-Lind scoring system (from 3.8 [IQR, 3.0-5.0] to 2.2 [IQR, 2.0-2.5]) was noted. Increases in ppFEV1 and BMI were also observed by 3 months of ETI therapy with persistent improvement through 1 year of treatment. Similarly, after 1 year of ETI therapy, participants with CF had reductions in positivity for Pseudomonas aeruginosa and Staphylococcus aureus in oropharyngeal cultures. Conclusion and Relevance This cohort study found that use of ETI therapy was associated with improved CRS outcomes in participants with CF as quantified by improved sinus CT scans measured by 2 radiographic scoring systems and was also associated with improved clinical outcomes. Despite improvement in CT scan scores, most people with CF continue to have scores that indicate severe sinus disease.
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Affiliation(s)
- Shahid Sheikh
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
- Division of Pulmonary Medicine, Nationwide Children’s Hospital, Columbus, Ohio
- Nationwide Children’s Hospital, Columbus, Ohio
| | - Mai-Lan Ho
- Nationwide Children’s Hospital, Columbus, Ohio
- Department of Radiology, The Ohio State University College of Medicine, Columbus
| | - Mariah Eisner
- Nationwide Children’s Hospital, Columbus, Ohio
- Biostatistics Resource, Nationwide Children’s Hospital, Columbus, Ohio
| | - Courtney Gushue
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
- Division of Pulmonary Medicine, Nationwide Children’s Hospital, Columbus, Ohio
- Nationwide Children’s Hospital, Columbus, Ohio
| | - Grace Paul
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
- Division of Pulmonary Medicine, Nationwide Children’s Hospital, Columbus, Ohio
- Nationwide Children’s Hospital, Columbus, Ohio
| | - Melissa Holtzlander
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
- Division of Pulmonary Medicine, Nationwide Children’s Hospital, Columbus, Ohio
- Nationwide Children’s Hospital, Columbus, Ohio
| | - Terri Johnson
- Division of Pulmonary Medicine, Nationwide Children’s Hospital, Columbus, Ohio
- Nationwide Children’s Hospital, Columbus, Ohio
| | - Karen S. McCoy
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
- Division of Pulmonary Medicine, Nationwide Children’s Hospital, Columbus, Ohio
- Nationwide Children’s Hospital, Columbus, Ohio
| | - Meredith Lind
- Nationwide Children’s Hospital, Columbus, Ohio
- Department of Otolaryngology, The Ohio State University College of Medicine, Columbus
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Paul P, Shah M, Sridivya Chowdary V, Anusha Raaj A, Paul G. Suture-fixation of a levonorgestrel-releasing intrauterine device under hysteroscopic guidance. Facts Views Vis Obgyn 2023; 15:355-358. [PMID: 38128094 PMCID: PMC10832649 DOI: 10.52054/fvvo.15.4.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Background Abnormal uterine bleeding (AUB) is a common gynaecological condition. The levonorgestrel-releasing Intrauterine device (LNG-IUD) is an effective medical treatment. option which carries a small risk of device expulsion. For those who experience expulsion, some may benefit from a more robust surgical approach. Objectives To demonstrate the technique for suture fixation of an LNG-IUD under hysteroscopic guidance. Materials and methods: Stepwise video demonstration of the technique using a 5mm hysteroscope and a 3mm laparoscopic needle holder. The Institutional Ethical Committee was consulted, and the requirement for approval was waived because the video described a modified surgical technique. Informed consent was obtained from the patient. Main outcome measures A 35yr old parous woman with a nine-month history of AUB and severe dysmenorrhoea had an LNG-IUD sited with effective symptom relief. Unfortunately, the device was expelled six months after insertion, and she responded poorly to other medical treatments. Transvaginal ultrasonography (TVUS) suggested posterior wall adenomyosis. Considering her relief of symptoms with the LNG-IUD and history of expulsion, the patient was counselled regarding suture-fixation of the LNG-IUD. Results She was followed-up at 6 months post insertion. The LNG-IUD was noted in the uterine cavity without displacement or expulsion. Conclusion Hysteroscopy-guided suture fixation of an LNG-IUD is a minimally invasive, effective option for patients with a history of expulsion of an IUD. However, further studies are required to establish the safety and efficacy of this approach. Learning Objective To demonstrate LNG -IUD suture fixation technique using hysteroscopy for patients diagnosed with AUB and a history of device expulsion.
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Affiliation(s)
- P.G. Paul
- Paul’s Hospital, Centre for Advanced Endoscopy and Infertility, Vattekkattu Road, Kaloor, Kochi, Kerala, India
| | - M Shah
- Paul’s Hospital, Centre for Advanced Endoscopy and Infertility, Vattekkattu Road, Kaloor, Kochi, Kerala, India
| | - V Sridivya Chowdary
- Paul’s Hospital, Centre for Advanced Endoscopy and Infertility, Vattekkattu Road, Kaloor, Kochi, Kerala, India
| | - A Anusha Raaj
- Paul’s Hospital, Centre for Advanced Endoscopy and Infertility, Vattekkattu Road, Kaloor, Kochi, Kerala, India
| | - G Paul
- Paul’s Hospital, Centre for Advanced Endoscopy and Infertility, Vattekkattu Road, Kaloor, Kochi, Kerala, India
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Zampoli M, Morrow BM, Paul G. Real-world disparities and ethical considerations with access to CFTR modulator drugs: Mind the gap! Front Pharmacol 2023; 14:1163391. [PMID: 37050905 PMCID: PMC10083423 DOI: 10.3389/fphar.2023.1163391] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 03/09/2023] [Indexed: 03/29/2023] Open
Abstract
The third Sustainable Development Goal (SDG), to ensure healthy lives and promote well-being for all at all ages, has particular relevance and implementation challenges amongst people living with rare diseases such as cystic fibrosis (CF). Although the treatment and projected outcome of CF has significantly improved with the advent of CF transmembrane conductance regulator protein modulator (CFTRm) therapy, there remains significant global inequality with regards to access to these life-saving and life-altering drugs. Elexacaftor, tezacaftor, and ivacaftor (ETI) triple combination therapy, first licensed in the United States in 2019, has rapidly become the standard of care for children aged 6 years and older in most high-income countries for individuals with CFTR variants responsive to ETI. Negotiated agreements for access to ETI are currently in place in North America,Europe, Israel ,Australia and New Zealand. However, less priority has been given to negotiate agreements for access to CFTRm in low-middle income countries(LMIC) with significant CF populations such as Central and South America, India, the Middle East, and Southern Africa. These countries and individuals living with CF are therefore effectively being left behind, in direct conflict with the stated principle of the 2030 SDGs. In this review, we highlight the current global inequity in access to CFTRm drugs and its impact on widening disparities between high-income countries and LMIC in CF outcomes and survival. We further discuss the reasons for this inequity and explore the ethical- and human rights-based principles and dilemmas that clinicians, families, governments, and healthcare funders must consider when prioritizing fair and affordable access to expensive CFTRm drugs. Lastly, we propose possible solutions to overcoming the barriers to accessing affordable CFTRm drugs in LMIC and illustrate with examples how access to drug therapies for other conditions have been successfully negotiated in LMIC through innovative partnerships between governments and pharmaceutical industries.
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Affiliation(s)
- M. Zampoli
- Department of Paediatrics and Child Health and Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
- *Correspondence: M. Zampoli,
| | - B. M Morrow
- Department of Paediatrics and Child Health and Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
| | - G Paul
- Division of Pulmonary Medicine, Nationwide Children’s Hospital, Columbus, OH, United States
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Paul G, Bartels L, Bueno FGB, Law G, Heard T, Chapman N, Buchmann G, Lim J, Gloag R. Shifting range in a stingless bee leads to pre-mating reproductive interference between species. CONSERV GENET 2023. [DOI: 10.1007/s10592-023-01512-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
Abstract
AbstractHuman-induced shifts in species’ ranges can increase contact between closely related species and lead to reproductive interference. In Australia, climate change and trade in stingless bee colonies is increasing the range overlap of two cryptic species: Tetragonula carbonaria and T. hockingsi. To investigate reproductive interactions between these species, we validated a diagnostic-PCR test based on the mitochondrial gene COI to ID field specimens to species. We then assessed the likelihood of reproductive interference in four ways. First, we imaged the male genitalia of each species and found no evidence of reproductive character displacement. Second, we assessed species composition of mating aggregations in an area of sympatry (Southeast Queensland) and confirmed that some males join the mating aggregations of interspecific colonies. Third, we translocated T. hockingsi colonies into the southern range of T. carbonaria (Sydney) and tracked their ability to requeen. These translocated colonies attracted mating aggregations comprised almost entirely of interspecific males, but never formed hybrid colonies; instead, queens either mated with their brothers, or the colony failed to requeen at all. Finally, we presented T. carbonaria males with either conspecific or interspecific virgin queens and found that males attempted to mate only with their own species’ queens. In all, we conclude that reproductive barriers between these species are complete with respect to “short-range” mating cues, but not for “long-range” mate attraction cues. Our study highlights that hive movements can increase some forms of pre-mating reproductive interference between managed bee species, even where the species do not actually mate or hybridize.
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Kumar M, Danda S, Reddy H, S J, Paul G, Varkki S. 158: Late diagnosis of cystic fibrosis after first decade of life: Clinical observations of a milder phenotype in India. J Cyst Fibros 2021. [PMCID: PMC8518449 DOI: 10.1016/s1569-1993(21)01583-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Huang Y, Lee J, Yarlagadda S, McCoy K, Paul G, Naren A. 575: Improved clinical outcome in an N1303K-CFTR patient treated with elexacaftor/tezacaftor/ivacaftor based on in vitro experimental evidence. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01998-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Aaron R, Chapla A, Kumar M, Paul G, Danda S, Varkki S. 657: Importance of screening for splice site and deep intronic variants—Insights from cystic fibrosis genetic testing on patients from the Indian subcontinent. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)02080-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sheikh SI, Ryan-Wenger NA, Pitts J, Britt R, Paul G, Ulrich L. Impact of guideline adherence and race on asthma control in children. World J Pediatr 2021; 17:500-507. [PMID: 34586609 DOI: 10.1007/s12519-021-00458-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Asthma control in African Americans (AA) is considered more difficult to achieve than in Caucasian Americans (CA). The aim of this study was to compare asthma control over time among AA and CA children whose asthma is managed per NAEPP (EPR-3) guidelines. METHODS This was a one-year prospective study of children referred by their primary care physicians for better asthma care in a specialty asthma clinic. All children received asthma care per NAEPP guidelines. Results were compared between CA and AA children at baseline and then at three-month intervals for one year. RESULTS Of the 345 children, ages 2-17 years (mean = 6.2 ± 4), 220 (63.8%) were CA and 125 (36.2%) were AA. There were no significant differences in demographics other than greater pet ownership in CA families. At baseline, AA children had significantly more visits to the Emergency Department for acute asthma symptoms (mean = 2.3 [Formula: see text] compared to CA (1.4 ± 2.3, P = 0.003). There were no other significant differences in acute care utilization, asthma symptoms (mean days/month), or mean asthma control test (ACT) scores at baseline. Within 3-6 months, in both groups, mean ACT scores, asthma symptoms and acute care utilization significantly improved (P < 0.05 for all) and change over time in both groups was comparable except for a significantly greater decrease in ED visits in AA children compared to CA children (P = 002). CONCLUSION Overall, improvement in asthma control during longitudinal assessment was similar between AA and CA children because of consistent use of NAEPP asthma care guidelines.
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Affiliation(s)
- Shahid I Sheikh
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA. .,Section of Pulmonary Medicine, Nationwide Children's Hospital, ED 544 Education Building, 700 Children's Drive, Columbus, OH, USA.
| | - Nancy A Ryan-Wenger
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Judy Pitts
- Section of Pulmonary Medicine, Nationwide Children's Hospital, ED 544 Education Building, 700 Children's Drive, Columbus, OH, USA
| | - Rodney Britt
- Department of Perinatal Research, Wexner Research Center, Columbus, OH, USA
| | - Grace Paul
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Section of Pulmonary Medicine, Nationwide Children's Hospital, ED 544 Education Building, 700 Children's Drive, Columbus, OH, USA
| | - Lisa Ulrich
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Section of Pulmonary Medicine, Nationwide Children's Hospital, ED 544 Education Building, 700 Children's Drive, Columbus, OH, USA
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Huang Y, Paul G, Lee J, Yarlagadda S, McCoy K, Naren AP. Elexacaftor/Tezacaftor/Ivacaftor Improved Clinical Outcomes in an N1303K-CFTR Patient Based on in vitro Experimental Evidence. Am J Respir Crit Care Med 2021; 204:1231-1235. [PMID: 34379998 DOI: 10.1164/rccm.202101-0090le] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Yunjie Huang
- Cincinnati Children's Hospital Medical Center, 2518, Division of Pulmonary Medicine, Cincinnati, Ohio, United States
| | - Grace Paul
- Nationwide Children's Hospital, 2650, Division of Pulmonary and Sleep Medicine, Columbus, Ohio, United States
| | - Jesun Lee
- Cincinnati Children's Hospital Medical Center, 2518, Division of Pulmonary Medicine, Cincinnati, Ohio, United States
| | - Sunitha Yarlagadda
- Cincinnati Children\'s Hospital Medical Center, 2518, Division of Pulmonary Medicine, Cincinnati, Ohio, United States
| | - Karen McCoy
- Nationwide Children's Hospital, 2650, Division of Pulmonary and Sleep Medicine, Columbus, Ohio, United States
| | - Anjaparavanda P Naren
- Cincinnati Children's Hospital Medical Center, 2518, Division of Pulmonary Medicine, Cincinnati, Ohio, United States;
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Paul G, Meißner A, Neuneier J, Neuschmelting V, Grau S, Yagdiran A, Scheyerer MJ, Malin JJ, Suárez I, Lehmann C, Exner M, Wiesmüller GA, Higgins PG, Seifert H, Fätkenheuer G, Zweigner J, Jung N. Outbreak of Pseudomonas aeruginosa infections after CT-guided spinal injections. J Hosp Infect 2021; 116:1-9. [PMID: 34298033 DOI: 10.1016/j.jhin.2021.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Meningitis and spinal infections with Gram-negative bacteria after local injections for treatment of chronic back pain are rare. This study investigated an outbreak of Pseudomonas aeruginosa infections following computed tomography (CT)-guided spinal injections (SI). METHODS A case was defined as a spinal infection or meningitis with P. aeruginosa after SI between 10th January and 1st March 2019 in the same outpatient clinic. Patients without microbiological evidence of P. aeruginosa but with a favourable response to antimicrobial therapy active against P. aeruginosa were defined as probable cases. FINDINGS Twenty-eight of 297 patients receiving CT-guided SI during the study period developed meningitis or spinal infections. Medical records were available for 19 patients. In 15 patients, there was microbiological evidence of P. aeruginosa, and four patients were defined as probable cases. Two of 19 patients developed meningitis, while the remaining 17 patients developed spinal infections. The median time from SI to hospital admission was 8 days (interquartile range 2-23 days). Patients mainly presented with back pain (N=18; 95%), and rarely developed fever (N=3; 16%). Most patients required surgery (N=16; 84%). Seven patients (37%) relapsed and one patient died. Although the source of infection was not identified microbiologically, documented failures in asepsis when performing SI probably contributed to these infections. CONCLUSIONS SI is generally considered safe, but non-adherence to asepsis can lead to deleterious effects. Spinal infections caused by P. aeruginosa are difficult to treat and have a high relapse rate.
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Affiliation(s)
- G Paul
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; Department of Gastroenterology, Hepatology, Pneumology and Infectious Diseases, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany.
| | - A Meißner
- Department of Hospital Hygiene and Infection Control, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - J Neuneier
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - V Neuschmelting
- Centre for Neurosurgery, Department of General Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - S Grau
- Centre for Neurosurgery, Department of General Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - A Yagdiran
- Department of Orthopaedics and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - M J Scheyerer
- Department of Orthopaedics and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - J J Malin
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; German Centre for Infection Research, Partner Site Cologne-Bonn, Cologne, Germany
| | - I Suárez
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; German Centre for Infection Research, Partner Site Cologne-Bonn, Cologne, Germany
| | - C Lehmann
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; German Centre for Infection Research, Partner Site Cologne-Bonn, Cologne, Germany
| | - M Exner
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | - G A Wiesmüller
- Abteilung Infektions- and Umwelthygiene, Gesundheitsamt der Stadt Köln, Germany
| | - P G Higgins
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; German Centre for Infection Research, Partner Site Cologne-Bonn, Cologne, Germany
| | - H Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; German Centre for Infection Research, Partner Site Cologne-Bonn, Cologne, Germany
| | - G Fätkenheuer
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; German Centre for Infection Research, Partner Site Cologne-Bonn, Cologne, Germany
| | - J Zweigner
- Department of Hospital Hygiene and Infection Control, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - N Jung
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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Bhogal P, Paul G, Collins G, Jaffer O. Letter in response to: circulating von Willebrand factor and high molecular weight multimers as markers of endothelial injury predict COVID-19 in-hospital mortality. Angiogenesis 2021; 24:413-415. [PMID: 34101095 PMCID: PMC8186348 DOI: 10.1007/s10456-021-09790-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/03/2021] [Indexed: 12/25/2022]
Affiliation(s)
- P Bhogal
- Department of Interventional Neuroradiology, The Royal London Hospital, Barts NHS Trust, Whitechapel Road, London, E1 1BB, UK.
| | - G Paul
- Department, of Gastroenterology, Hepatology, Pneumology and Infectious Diseases, Katharinenhospital, Klinikum Stuttgart, Krigesbergstraße 60, 70174, Stuttgart, Germany
| | - G Collins
- Department of Cardiology, St. Bartholomew's Hospital, Barts NHS Trust, London, UK
| | - O Jaffer
- Department of Interventional Radiology, The Royal London Hospital, Barts NHS Trust, London, UK
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14
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Gao L, Miletto I, Ivaldi C, Paul G, Marchese L, Coluccia S, Jiang F, Gianotti E, Pera-Titus M. Rational design of bifunctional hierarchical Pd/SAPO-5 for the synthesis of tetrahydrofuran derivatives from furfural. J Catal 2021. [DOI: 10.1016/j.jcat.2021.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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15
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Benjamin J, Roy K, Paul G, Kumar S, Charles E, Miller E, Narsi-Prasla H, Mahan JD, Thammasitboon S. Improving Resident Self-Efficacy in Tracheostomy Management Using a Novel Curriculum. MedEdPORTAL 2020; 16:11010. [PMID: 33204834 PMCID: PMC7666842 DOI: 10.15766/mep_2374-8265.11010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 06/16/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Patients receiving pediatric tracheostomy have significant risk for mortality due to compromised airway. Timely management of airway emergencies in children with tracheostomies is an important clinical skill for pediatricians. We developed this curriculum to improve residents' self-efficacy with tracheostomy management. METHODS We collected baseline data on 67 residents from two hospitals while creating a blended curriculum with video-based instruction on routine tracheostomy change and team management of tracheostomy emergency. Forty residents enrolled in the curriculum. During an ICU rotation, they received face-to-face instruction on routine tracheostomy change in small groups, followed by assessment of managing a tracheostomy emergency during a simulation. A video completed prior to the simulation took 9 minutes, the routine tracheostomy change didactic session took 15 minutes, and the simulation instruction was completed in 10-15 minutes. We collected feedback on the effectiveness of the curriculum from the participants. RESULTS All 107 residents from the baseline and intervention groups completed the self-efficacy survey. The intervention group had significantly higher changes in scores across all self-efficacy domains than the baseline group. On the curriculum feedback survey, residents rated the curriculum very highly, between 4.4 and 4.8 on a 5-point Likert scale. DISCUSSION Our blended curriculum increased learners' self-efficacy and promoted learner competence in tracheostomy management. Residents scored more than 80% across all aspects of simulation assessment and reported higher self-efficacy scores following our curricular intervention.
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Affiliation(s)
- J. Benjamin
- Assistant Professor, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital
| | - K. Roy
- Medical Director-TICU, Baylor College of Medicine and Texas Children's Hospital; Assistant Professor of Pediatrics, Department of Pediatric ICU, Texas Children's Hospital and Baylor College of Medicine
| | - G. Paul
- Assistant Professor, Department of Pulmonology, Nationwide Children's Hospital and the Ohio State University College of Medicine
| | - S. Kumar
- Instructor, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital
| | - E. Charles
- Nurse Practitioner, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital
| | - E. Miller
- Nurse Practitioner, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital
| | - H. Narsi-Prasla
- Nurse Practitioner, Department of Otolaryngology, Baylor College of Medicine and Texas Children's Hospital
| | - J. D. Mahan
- Associate Director, Center for Faculty Advancement, Mentoring and Engagement (FAME), the Ohio State University College of Medicine; Professor, Department of Pediatrics, Nationwide Children's Hospital and the Ohio State University College of Medicine; Program Director, Pediatric Nephrology Fellowship Programs, Nationwide Children's Hospital and the Ohio State University College of Medicine
| | - S. Thammasitboon
- Associate Professor and Director, Center for Research, Innovation and Scholarship (CRIS) in Medical Education, Baylor College of Medicine and Texas Children's Hospital
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16
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Paul G, Wesselmann J, Adzic D, Malin JJ, Suarez I, Priesner V, Kümmerle T, Wyen C, Jung N, van Bremen K, Schlabe S, Wasmuth JC, Boesecke C, Fätkenheuer G, Rockstroh J, Schwarze-Zander C, Lehmann C. Predictors of serofast state after treatment for early syphilis in HIV-infected patients. HIV Med 2020; 22:165-171. [PMID: 33128333 DOI: 10.1111/hiv.12985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 04/21/2020] [Revised: 07/25/2020] [Accepted: 09/23/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Non-treponemal serological tests are used to monitor treatment response during syphilis infection. Syphilis- and HIV-coinfected patients may experience incomplete resolution in non-treponemal titres, which is referred to as the serofast state. The goal of this study was to evaluate risk factors for serofast state in HIV-infected patients. METHODS From November 2015 to June 2018, 1530 HIV-positive patients were tested for syphilis using a Treponema pallidum particle agglutination (TPPA) assay. Among TPPA-positive patients, medical records were reviewed for early syphilis infection. Serofast state was defined as a less than four-fold decrease in non-treponemal antibody titres during a 6-month follow-up period in the absence of symptoms of syphilis. Baseline characteristics were tested as predictive factors of serological response. RESULTS In all, 515 patients (33.7%) tested positive in TPPA assays, and in 163 patients at least one previous syphilis infection was documented. A total of 61 out of 163 patients (37.4%) were in a serofast state. A history of previous syphilis infection (61 vs. 43%; P = 0.04) was more common in serofast patients than in patients with serological cure after 6 months. Non-treponemal titres ≥ 1:32 before therapy (47 vs. 25%; P = 0.005) and adjunctive corticosteroids to prevent the Jarisch-Herxheimer reaction (35% vs 15%; P = 0.006) were associated with serological cure after 6 months, but corticosteroid therapy had no influence at 12 months. The intensity of syphilis treatment did not affect serological cure. CONCLUSION Corticosteroids for prevention of the Jarisch-Herxheimer reaction were associated with earlier serological cure. Although serological response is the accredited surrogate method to monitor syphilis treatment, the biological significance of the serofast state remains unclear.
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Affiliation(s)
- G Paul
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany.,Department of Gastroenterology, Hepatology, Pneumology and Infectious Diseases, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany
| | - J Wesselmann
- Department of Medicine I, Bonn University Hospital, Bonn, Germany
| | - D Adzic
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - J J Malin
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - I Suarez
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - V Priesner
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - T Kümmerle
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - C Wyen
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - N Jung
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - K van Bremen
- Department of Medicine I, Bonn University Hospital, Bonn, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - S Schlabe
- Department of Medicine I, Bonn University Hospital, Bonn, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - J-C Wasmuth
- Department of Medicine I, Bonn University Hospital, Bonn, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - C Boesecke
- Department of Medicine I, Bonn University Hospital, Bonn, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - G Fätkenheuer
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - J Rockstroh
- Department of Medicine I, Bonn University Hospital, Bonn, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - C Schwarze-Zander
- Department of Medicine I, Bonn University Hospital, Bonn, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - C Lehmann
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
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Frazer K, Paul G, Kroll T. Learning from Nightingale’s engagement with complex systems: 21st-century public health issues of homelessness and achieving Sustainable Development Goals. Perspect Public Health 2020; 140:139-140. [DOI: 10.1177/1757913920914653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- K Frazer
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin 4, Ireland
| | - G Paul
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - T Kroll
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Affiliation(s)
- E. Suhir
- Portland State University, Portland, OR, USA
- Vienna Institute of Technology, Vienna, Austria
- James Cook University, Mackay, QLD, Australia
- ERS Co, Los Altos, CA, USA
| | - G. Paul
- James Cook University, Mackay, QLD, Australia
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19
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Waldrop M, Lowes L, Toops J, Alfano L, Miller N, Iammarino M, Kotha K, Paul G, Moore-Clingenpeel M, Tsao C, Noritz G, Shell R, Flanigan K. P.365Clinical outcomes in patients with spinal muscular atrophy type 1, 2 or 3 after 1 year of nusinersen therapy. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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20
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Lee JD, Eftekari H, Paul G, Zhupaj A, Panikker S, Dhanjal T, Yusuf S, Hayat S, Osman F. P6561Diagnostic yield of implantable loop recorders: a comparison of arrhythmia nurse specialists versus clinicians. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Implantable loop recorders (ILR) are recommended in guidelines to determine symptom-rhythm correlation. Arrhythmia Nurse Specialists (ANS) play a critical role in the assessment of such patients. Their effectiveness at risk stratification for ILR implantation is unknown. The ESC 2018 Syncope guidelines recommend more research in this field.
Aim
To evaluate the diagnostic yield of consecutive ILR implants at a tertiary centre over a 2year period and compare ANS versus Clinicians.
Methods
A retrospective study of all patients undergoing ILR implant between April 2016 and April 2018. Data collected included baseline patient demographics, referral source and management changes made by ILR findings.
Results
305 patients had an ILR; median age was 71yrs (interquartile range 52–81), 55% male. Median follow-up time was 15months. Referrals were from general cardiology (GC) = 98 (32%), electrophysiology (EP) = 105 (34%), and ANS-led syncope clinic = 102 (34%). Indications for ILR implant were syncope = 203 (65.9%), palpitation = 21 (6.9%), pre-syncope = 16 (5.2%), cryptogenic stroke = 35 (11.5%) and others 7 (8.9%) (falls, channelopathies). Of the entire cohort, 102 (34.0%) experienced arrhythmias recorded on the ILR that resulted in a change of management. This included: pacemaker implant = 49 (16.1%), complex-device implant = 7 (2.3%), AF=28 (9.2%), SVT=14 (4.6%), VT=1 (0.3%). Of those with a syncope indication (n=203), findings on ILR altered management in 73patients (36.0%) over a median follow-up of 18months; a pacing indication in this syncope group was present in 44 (21.9%) patients (median time to diagnosis: 2.7 months) with 24 receiving a pacemaker indication within 3 months of ILR insertion. ANS had a higher pacemaker implant rate. Overall, an ILR resulted in a diagnostic yield of 34.1% (n=104). Specialist nurse referral resulted in an overall greater trend towards change of management in 38.2% of patients compared with GC (32.7%) and EP (31.0%) (p=0.593 nurse vs. consultant).
Conclusion
The overall diagnostic yield of ILR insertion was 34% in our study. ANS had a trend towards a greater diagnostic yield compared with clinicians, and significantly more pacemaker indications. Our data suggests that ANS patient selection for ILR insertion are at least comparable to clinicians.
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Affiliation(s)
- J D Lee
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - H Eftekari
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - G Paul
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - A Zhupaj
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - S Panikker
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - T Dhanjal
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - S Yusuf
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - S Hayat
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - F Osman
- University Hospital Coventry and Warwickshire NHS Trust, and Warwick Medical School, Coventry, United Kingdom
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21
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Paul B, Paul G, Singh G. Gender association of impulse control disorders (ICD-RBS) in patients with Parkinson's disease and its impact on quality of life. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.1442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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22
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Battegazzore D, Lavaselli M, Cheng B, Li D, Yang R, Frache A, Paul G, Marchese L. Reactive extrusion of sol-gel silica as fire retardant synergistic additive in ethylene-vinyl acetate copolymer (EVA) composites. Polym Degrad Stab 2019. [DOI: 10.1016/j.polymdegradstab.2019.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Chorea is a rare manifestation of poisoning. We report an index case of a young woman who developed generalized chorea following propiconazole toxin ingestion. As large series on neurological complications of toxic compounds are difficult to be compiled, it is of interest to report our experience. This report adds one more compound to the increasing list of toxic chorea.
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Affiliation(s)
- B S Paul
- Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - G Paul
- Department of Critical Care Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - J Kaur
- Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - G Singh
- Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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24
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Al-Zaidy S, Pickard AS, Kotha K, Alfano LN, Lowes L, Paul G, Church K, Lehman K, Sproule DM, Dabbous O, Maru B, Berry K, Arnold WD, Kissel JT, Mendell JR, Shell R. Health outcomes in spinal muscular atrophy type 1 following AVXS-101 gene replacement therapy. Pediatr Pulmonol 2019; 54:179-185. [PMID: 30548438 PMCID: PMC6590370 DOI: 10.1002/ppul.24203] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 11/04/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Spinal Muscular Atrophy type 1 (SMA1) is a rare genetic neuromuscular disease where 75% of SMA1 patients die/require permanent-ventilation by 13.6 months. This study assessed the health outcomes of SMA1 infants treated with AVXS-101 gene replacement therapy. METHODS Twelve genetically confirmed SMA1 infants with homozygous deletions of the SMN1 gene and two SMN2 gene copies received a one-time intravenous proposed therapeutic dose of AVXS-101 in an open label study conducted between December 2014 and 2017. Patients were followed for 2-years post-treatment for outcomes including (1) pulmonary interventions; (2) nutritional interventions; (3) swallow function; (4) hospitalization rates; and (5) motor function. RESULTS All 12 patients completed the study. Seven infants did not require noninvasive ventilation (NIV) by study completion. Eleven patients had stable or improved swallow function, demonstrated by the ability to feed orally; 11 patients were able to speak. The mean proportion of time hospitalized was 4.4%; the mean unadjusted annualized hospitalization rate was 2.1 (range = 0, 7.6), with a mean length of stay/hospitalization of 6.7 (range = 3, 12.1) days. Eleven patients achieved full head control and sitting unassisted and two patients were walking independently. CONCLUSIONS AVXS-101 treatment in SMA1 was associated with reduced pulmonary and nutritional support requirements, improved motor function, and decreased hospitalization rate over the follow-up period. This contrasts with the natural history of progressive respiratory failure and reduced survival. The reduced healthcare utilization could potentially alleviate patient and caregiver burden, suggesting an overall improved quality of life following gene replacement therapy. TRIAL REGISTRATION ClinicalTrials.gov number, NCT02122952.
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Affiliation(s)
- Samiah Al-Zaidy
- Department of Pediatrics, Ohio State University, Columbus, Ohio.,Center for Gene Therapy Nationwide Children's Hospital, Columbus, Ohio
| | - A Simon Pickard
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois, Chicago, Illinois
| | - Kavitha Kotha
- Center for Gene Therapy Nationwide Children's Hospital, Columbus, Ohio
| | - Lindsay N Alfano
- Department of Pediatrics, Ohio State University, Columbus, Ohio.,Center for Gene Therapy Nationwide Children's Hospital, Columbus, Ohio
| | - Linda Lowes
- Department of Pediatrics, Ohio State University, Columbus, Ohio.,Center for Gene Therapy Nationwide Children's Hospital, Columbus, Ohio
| | - Grace Paul
- Center for Gene Therapy Nationwide Children's Hospital, Columbus, Ohio
| | - Kathleen Church
- Department of Pediatrics, Ohio State University, Columbus, Ohio.,Center for Gene Therapy Nationwide Children's Hospital, Columbus, Ohio
| | - Kelly Lehman
- Center for Gene Therapy Nationwide Children's Hospital, Columbus, Ohio
| | | | | | | | - Katherine Berry
- Department of Pediatrics, Ohio State University, Columbus, Ohio.,Center for Gene Therapy Nationwide Children's Hospital, Columbus, Ohio
| | - W David Arnold
- Department of Neurology, Ohio State University, Columbus, Ohio
| | - John T Kissel
- Department of Pediatrics, Ohio State University, Columbus, Ohio
| | - Jerry R Mendell
- Department of Pediatrics, Ohio State University, Columbus, Ohio.,Center for Gene Therapy Nationwide Children's Hospital, Columbus, Ohio.,Department of Neurology, Ohio State University, Columbus, Ohio
| | - Richard Shell
- Department of Pediatrics, Ohio State University, Columbus, Ohio
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25
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Shell R, Al-Zaidy S, Arnold W, Rodino-Klapac L, Prior T, Kotha K, Paul G, Lowes L, Alfano L, Berry K, Church K, Kissel J, Nagendran S, Ogrinc F, Sproule D, Wells C, Meyer K, Likhite S, Kaspar B, Mendell J. SMA THERAPIES I. Neuromuscul Disord 2018. [DOI: 10.1016/j.nmd.2018.06.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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26
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Iftikhar IH, Albisher E, Challapallisri V, Paul G. Physical Activity and Insomnia, Short Sleep and Insulin Resistance, and Effect of Poor Sleep on Children's Academic Performance. Am J Respir Crit Care Med 2018; 193:1058-60. [PMID: 26840801 DOI: 10.1164/rccm.201512-2347rr] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Imran H Iftikhar
- Sleep Medicine Fellowship, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Essa Albisher
- Sleep Medicine Fellowship, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Vaishnavi Challapallisri
- Sleep Medicine Fellowship, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Grace Paul
- Sleep Medicine Fellowship, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
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27
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Gatti G, Costenaro D, Vittoni C, Paul G, Crocellà V, Mangano E, Brandani S, Bordiga S, Cossi M, Marchese L, Bisio C. CO 2 adsorption on different organo-modified SBA-15 silicas: a multidisciplinary study on the effects of basic surface groups. Phys Chem Chem Phys 2018; 19:14114-14128. [PMID: 28524206 DOI: 10.1039/c6cp08048k] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Hybrid organic-inorganic SBA-15 silicas functionalized with increasing amounts of amino groups were studied in this work aiming to evaluate the effects of their physico-chemical properties on CO2 capture ability. Three different amino-silane species were used: 3-aminopropyltriethoxysilane (APTS), 3-(2-aminoethyl)aminopropyltrimethoxysilane (EAPTS) and 3-[2-(2-aminoethyl)aminoethyl] aminopropyltrimethoxysilane (PAPTS). More specifically, samples were prepared by using two methods, following a post-synthesis grafting procedure and a one-pot preparation method. Experimental and computational techniques were used to study the structural and textural properties of the obtained samples and their surface species in relation to the adopted preparation method. For the most reactive samples, additional hints on the interactions of organosilane species with the silica surface were obtained by a combination of IR and SS-NMR spectroscopy, with particular emphasis on the effects of the silane chain length on the mobility of the organic species. Advanced complementary solid-state NMR techniques provided deeper information on the interactions of organosilane species with the silica surface. Finally, the amount of CO2 adsorbed was estimated by comparing the classical microcalorimetric analysis method with a new type of screening test, the Zero Length Column analysis, which is able to evaluate small amounts of samples in a very short time and the adsorption properties of the adsorbents. The reactivity of the amino-modified silica samples is deeply influenced by both the preparation route and by the type of organosilane used for the functionalization of the materials. In particular, samples prepared by the post-synthesis grafting procedure and containing higher amount of amino groups in the chain are more reactive, following the order PAPTS > EAPTS > APTS.
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Affiliation(s)
- G Gatti
- Dipartimento di Scienze e Innovazione Tecnologica and "Centro interdisciplinare Nano-SiSTeMI", Università del Piemonte Orientale, via T. Michel 11, 15121 Alessandria, Italy.
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Padwick A, Osman F, Paul G, Jones G, Hayat S, Eftekhari H. 9Implementation of opportunistic screening at Pre-Assessment Clinics for upgrade/downgrade of cardiac devices. Europace 2017. [DOI: 10.1093/europace/eux283.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Eftekhari HR, Osman F, Paul G, Padwick A, Hayat S. 103How is our local AF management? The management of atrial fibrillation (af) in coventry and rugby clinical commissioning group (ccg), england compared to national data and nice (national institute for clinical excellence) 2014. Europace 2017. [DOI: 10.1093/europace/eux283.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Draeger D, Zahn T, Berenberg-Goßler P, Paul G, Neuwirth J, Kuhlmey A. GENDER-SPECIFIC PREVALENCE OF COMORBIDITIES AND USE OF HEALTH CARE SERVICES IN GERMAN CENTENARIANS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D. Draeger
- Charite - Universitätsmedizin Berlin, Berlin, Germany,
| | - T. Zahn
- GeWINO Institut der AOK Nordost, Berlin, Germany
| | | | - G. Paul
- Charite - Universitätsmedizin Berlin, Berlin, Germany,
| | - J. Neuwirth
- GeWINO Institut der AOK Nordost, Berlin, Germany
| | - A. Kuhlmey
- Charite - Universitätsmedizin Berlin, Berlin, Germany,
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Gatti G, Vittoni C, Costenaro D, Paul G, Mangano E, Brandani S, Marchese L, Bisio C. The influence of particle size of amino-functionalized MCM-41 silicas on CO2 adsorption. Phys Chem Chem Phys 2017; 19:29449-29460. [DOI: 10.1039/c7cp05177h] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The effect of the particle size of hybrid organic–inorganic MCM-41 silicas on the CO2 adsorption properties has been investigated.
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Affiliation(s)
- G. Gatti
- Dipartimento di Scienze e Innovazione Tecnologica and “Centro interdisciplinare Nano-SiSTeMI”, Università del Piemonte Orientale
- Alessandria
- Italy
| | - C. Vittoni
- Dipartimento di Scienze e Innovazione Tecnologica and “Centro interdisciplinare Nano-SiSTeMI”, Università del Piemonte Orientale
- Alessandria
- Italy
| | - D. Costenaro
- Dipartimento di Scienze e Innovazione Tecnologica and “Centro interdisciplinare Nano-SiSTeMI”, Università del Piemonte Orientale
- Alessandria
- Italy
| | - G. Paul
- Dipartimento di Scienze e Innovazione Tecnologica and “Centro interdisciplinare Nano-SiSTeMI”, Università del Piemonte Orientale
- Alessandria
- Italy
| | - E. Mangano
- Scottish Carbon Capture and Storage, School of Engineering, University of Edinburgh
- Edinburgh
- UK
| | - S. Brandani
- Scottish Carbon Capture and Storage, School of Engineering, University of Edinburgh
- Edinburgh
- UK
| | - L. Marchese
- Dipartimento di Scienze e Innovazione Tecnologica and “Centro interdisciplinare Nano-SiSTeMI”, Università del Piemonte Orientale
- Alessandria
- Italy
| | - C. Bisio
- Dipartimento di Scienze e Innovazione Tecnologica and “Centro interdisciplinare Nano-SiSTeMI”, Università del Piemonte Orientale
- Alessandria
- Italy
- ISTM-CRN Istituto di Scienze e Tecnologie Molecolari
- Milano
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Rezaienia MA, Paul G, Avital EJ, Mozafari S, Rothman M, Korakianitis T. In-vitro investigation of the hemodynamic responses of the cerebral, coronary and renal circulations with a rotary blood pump installed in the descending aorta. Med Eng Phys 2016; 40:2-10. [PMID: 28040435 DOI: 10.1016/j.medengphy.2016.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 07/08/2016] [Revised: 11/02/2016] [Accepted: 11/13/2016] [Indexed: 02/08/2023]
Abstract
This study investigates the hemodynamic responses of the cardiovascular system when a rotary blood pump is operating in the descending aorta, with a focus on the cerebral, coronary and renal autoregulation, using our in-house cardiovascular emulator. Several improvements have been made from our previous studies. A novel coronary system was developed to replicate the native coronary perfusion. Three pinch valves actuated by stepper motors were used to simulate the regional autoregulation systems of the native cerebral, coronary and renal circulations. A rotary pump was installed in the descending aorta, in series with the heart, and the hemodynamic responses of the cardiovascular system were investigated with a focus on cerebral, coronary and renal circulation over a wide range of pump rotor speeds. Experiments were performed twice, once with the autoregulation systems active and once with the autoregulation systems inactive, to reflect that there will be some impairment of autoregulatory systems in a patient with heart failure. It was shown that by increasing the rotor speed to 3000 rpm, the cardiac output was improved from 2.9 to 4.1 L/min as a result of an afterload reduction induced by the pressure drop upstream of the pump. The magnitudes of changes in perfusion in the cerebral, coronary and renal circulations were recorded with regional autoregulation systems active and inactive.
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Affiliation(s)
- M A Rezaienia
- School of Engineering and Materials Science, Queen Mary University of London, London E1 4NS, UK
| | - G Paul
- School of Engineering and Materials Science, Queen Mary University of London, London E1 4NS, UK
| | - E J Avital
- School of Engineering and Materials Science, Queen Mary University of London, London E1 4NS, UK
| | - S Mozafari
- School of Engineering and Materials Science, Queen Mary University of London, London E1 4NS, UK
| | - M Rothman
- Department of Cardiology, London Chest Hospital, Barts and the London NHS Trust, London E2 9JX, UK
| | - T Korakianitis
- Parks College of Engineering, Aviation and Technology, Saint Louis University, St. Louis, Missouri 63103, USA.
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Miller CG, Bogado CC, Nino AJ, Northcutt AR, Yu HJ, Lewiecki EM, Paul G, Cobitz AR, Wooddell MJ, Bilezikian JP, Fitzpatrick LA. Evaluation of Quantitative Computed Tomography Cortical Hip Quadrant in a Clinical Trial With Rosiglitazone: A Potential New Study Endpoint. J Clin Densitom 2016; 19:485-491. [PMID: 27052635 DOI: 10.1016/j.jocd.2016.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 06/22/2015] [Revised: 02/22/2016] [Accepted: 02/24/2016] [Indexed: 11/28/2022]
Abstract
UNLABELLED Quantitative computed tomography (QCT) measurements have been used extensively to ascertain information about bone quality and density due to the 3-dimensional information provided and the ability to segment out trabecular and cortical bones. QCT imaging helps to improve our understanding of the role that each bone compartment plays in the pathogenesis and prognosis of fracture. This study was conducted to explore longitudinal changes in femoral neck (FN) cortical bone structure using both volumetric bone mineral density (vBMD) and cortical shell thickness assessments via QCT in a double-blind, randomized, multicenter clinical trial in postmenopausal women with type 2 diabetes mellitus. This study also examined whether treatment-associated changes in the cortical bone vBMD and thickness in femoral neck quadrants could be evaluated. Subjects were randomized to rosiglitazone (RSG) or metformin (MET) for 52 wk followed by 24 wk of open-label MET. A subset of 87 subjects underwent QCT scans of the hip at baseline, after 52 wk of double-blind treatment, and after 24 wk of treatment with MET using standard full-body computed tomography scanners. All scans were evaluated and analyzed centrally. Cortical vBMD at the FN was precisely segmented from trabecular bone and used to assess a possible therapeutic effect on this bone compartment. QCT analysis showed reductions in adjusted mean percentage change in vBMD and in absolute cortical thickness occurred with RSG treatment from baseline to week 52, whereas changes with MET were generally minimal. The reductions observed during RSG treatment for 1 yr appeared to partially reverse during the open-label MET phase from weeks 52 to 76. The femoral neck quadrant may provide utility as a potential endpoint in clinical trials for the understanding of the therapeutic effect of new entities on cortical bone vs trabecular bone; however, further clinical validation is needed. TRIAL REGISTRATION The protocol (GSK study number AVD111179) was registered on ClinicalTrials.gov as NCT00679939.
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Affiliation(s)
| | - Cesar C Bogado
- Instituto Investigaciones Metabolicas, Buenos Aires, Argentina
| | - Antonio J Nino
- Research and Development, GlaxoSmithKline, King of Prussia, PA, USA.
| | | | - Hui Jing Yu
- Medical Affairs, BioClinica Inc., Princeton, NJ, USA
| | - E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - G Paul
- Research and Development, GlaxoSmithKline, King of Prussia, PA, USA
| | | | | | - John P Bilezikian
- College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Martins Estevão B, Cucinotta F, Hioka N, Cossi M, Argeri M, Paul G, Marchese L, Gianotti E. Rose Bengal incorporated in mesostructured silica nanoparticles: structural characterization, theoretical modeling and singlet oxygen delivery. Phys Chem Chem Phys 2016; 17:26804-12. [PMID: 26396040 DOI: 10.1039/c5cp03564c] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Rose Bengal (RB), a xanthene dye, incorporated into mesostructured silica nanoparticles (MSNs) exhibits efficient singlet oxygen ((1)O2) generation when illuminated with 540 nm green light which is particularly promising for PDT applications. Several systems with different RB loadings were synthesized and fully characterized by means of spectroscopic techniques in combination with a computational study, to optimize the amount of RB in order to avoid the formation of aggregates that is detrimental for a high (1)O2 delivery.
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Affiliation(s)
- B Martins Estevão
- Department of Science and Technological Innovation and Nano-SiSTeMI Centre, Università del Piemonte Orientale, Viale T. Michel 11, 15121 Alessandria, Italy.
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Kopp BT, Nicholson L, Paul G, Tobias J, Ramanathan C, Hayes D. The Geographic Impact on Hospitalization in Patients with Cystic Fibrosis. J Pediatr 2016; 170:246-52.e1-4. [PMID: 26690850 DOI: 10.1016/j.jpeds.2015.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 04/27/2015] [Revised: 09/08/2015] [Accepted: 11/05/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess whether geographic location influences hospitalizations for pulmonary exacerbations for patients with cystic fibrosis (CF) in the US, as there is no existing literature regarding this subject. STUDY DESIGN The CF Foundation Patient Registry was analyzed during the years 2007-2012 via geographic grouping of states. The impact of geographic region on recovery from hospitalization, hospitalization length, and time to next hospitalization were analyzed using multivariate models. RESULTS Posthospitalization lung function and nutritional measures were similar among regions for 1 year following hospitalization. The West region was associated with risk of longer hospital stays (OR 1.60, CI 1.45-1.77), however, dornase alfa use (OR 3.85, CI 1.15-12.92) was the only specific factor. History of allergic bronchopulmonary aspergillosis (OR 1.58, CI 1.11-2.25) and adult age (OR 2.48, CI 1.17-5.25) in the Northeast, chronic macrolide use in the South (OR 1.36, CI 1.03-1.79), and infection with Candida albicans (OR 1.47, CI 1.18-1.82) and Pseudomonas aeruginosa (OR 1.44, CI 1.02-2.04) in the Midwest were associated with increased hospitalization length. There was a significantly decreased risk for subsequent hospitalizations in the Northeast compared with other regions (P = .038). Sociodemographic analysis identified Caucasians in the South having a significantly lower risk of future hospitalization compared with African Americans (hazard ratio 0.79, CI 0.69-0.91, P = .0009). CONCLUSIONS There is significant regional variability in hospitalization length and risks for subsequent hospitalizations for patients with CF in the US. Regional variation should be subject to further study to determine if benchmarking standards can be achieved nationally.
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Affiliation(s)
- Benjamin T Kopp
- Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH; Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital, Columbus, OH.
| | - Lisa Nicholson
- Institute for Population Research, The Ohio State University, Columbus, OH
| | - Grace Paul
- Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Joseph Tobias
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Chandar Ramanathan
- Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Don Hayes
- Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH
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Paul G, Kempa A, Bosse A, Zoller W. Pulmonale Filariose als seltene Ursache einer chronischen Pneumonie. Pneumologie 2016. [DOI: 10.1055/s-0036-1572227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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37
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Kovalenko S, Paul G, Matyash N, Kozyakov A. P107. EJC Suppl 2015. [DOI: 10.1016/j.ejcsup.2015.08.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Kopp BT, Nicholson L, Paul G, Tobias J, Ramanathan C, Hayes D. Geographic variations in cystic fibrosis: An analysis of the U.S. CF Foundation Registry. Pediatr Pulmonol 2015; 50:754-62. [PMID: 25825016 DOI: 10.1002/ppul.23185] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 12/29/2014] [Accepted: 01/23/2015] [Indexed: 11/12/2022]
Abstract
BACKGROUND Emerging evidence suggests that the prevalence of pathogens common in cystic fibrosis (CF) may be unevenly distributed across the United States (U.S.). However, very little is known regarding the U.S. distribution of other CF modifiers such as medication usage and patient demographics. Therefore, we sought to determine if regional differences exist in the distribution of demographic variables and patient disease characteristics in the U.S. that may play a role in differential CF outcomes. METHODS Data were analyzed from the 30,896 subjects in the U.S. CF Foundation Patient Registry during the years 2007-2012, via geographical grouping of states based upon the Nationwide Inpatient Sample classification. RESULTS Significant differences in racial distribution were seen, including half of the total U.S. African-American CF population residing in the South. Both African-Americans and Hispanics had increased Medicaid usage (52.2%, 41.8%, respectively). Culture-reported pathogens were markedly different across the U.S., with the highest percentage of patients with Methicillin-resistant Staphylococcus aureus (41.9%), Pseudomonas aeruginosa (71.2%), and non-tuberculous mycobacterium (10.0%) in the South. The South region also had the lowest mean body mass index and forced expiratory volume in one second. Chronic medication usage such as inhaled tobramycin or macrolides followed P. aeruginosa distribution, while inhaled dornase alfa was most used in the West (84.7%). Co-morbid conditions varied, with the highest percentage of depressed subjects in the Midwest (18.3%). Mean regional mortality rates were not statistically different among regions, although highest in each age grouping of the South. CONCLUSIONS The U.S. has significant regional variations in CF demographics, insurance, pathogens, medication usage, and co-morbidities, without an overall impact on regional mortality. Regional variations in care practices should be studied further based on the findings.
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Affiliation(s)
- Benjamin T Kopp
- Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio.,Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Lisa Nicholson
- Institute for Population Research, The Ohio State University, Columbus, Ohio
| | - Grace Paul
- Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Joseph Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Chandar Ramanathan
- Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Don Hayes
- Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio
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Loete T, Paul G, Ismail E. A preliminary investigation of the dynamic viscoelastic relaxation of bovine cortical bone. EPJ Web of Conferences 2015. [DOI: 10.1051/epjconf/20159403004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Choudhuri NC, Paul G, Kundu A, Kundu MS, De AK, Ram N. Evaluation of egg quality traits of endangered Nicobari fowl and its crosses under intensive and backyard system of Andaman and Nicobar Islands, India. Vet World 2014. [DOI: 10.14202/vetworld.2014.693-697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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De Vleeschauwer AR, Lefebvre DJ, Willems T, Paul G, Billiet A, Murao LE, Neyts J, Goris N, De Clercq K. A Refined Guinea Pig Model of Foot-and-Mouth Disease Virus Infection for Assessing the Efficacy of Antiviral Compounds. Transbound Emerg Dis 2014; 63:e205-12. [DOI: 10.1111/tbed.12255] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Indexed: 11/28/2022]
Affiliation(s)
- A. R. De Vleeschauwer
- Unit of Vesicular and Exotic Diseases; OD Viral Diseases; CODA-CERVA; Veterinary and Agrochemical Research Centre; Brussel Belgium
| | - D. J. Lefebvre
- Unit of Vesicular and Exotic Diseases; OD Viral Diseases; CODA-CERVA; Veterinary and Agrochemical Research Centre; Brussel Belgium
| | - T. Willems
- Unit of Vesicular and Exotic Diseases; OD Viral Diseases; CODA-CERVA; Veterinary and Agrochemical Research Centre; Brussel Belgium
| | - G. Paul
- MSD Animal Health; Intervet International GmbH; Köln Germany
| | | | | | - J. Neyts
- Aratana Therapeutics NV; Leuven Belgium
- Department of Microbiology and Immunology; Rega Institute for Medical Research; Katholieke Universiteit Leuven; Leuven Belgium
| | - N. Goris
- Aratana Therapeutics NV; Leuven Belgium
| | - K. De Clercq
- Unit of Vesicular and Exotic Diseases; OD Viral Diseases; CODA-CERVA; Veterinary and Agrochemical Research Centre; Brussel Belgium
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Cloete TJ, Paul G, Ismail EB. Hopkinson bar techniques for the intermediate strain rate testing of bovine cortical bone. Philos Trans A Math Phys Eng Sci 2014; 372:20130210. [PMID: 24711493 PMCID: PMC3982653 DOI: 10.1098/rsta.2013.0210] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Detailed knowledge of the dynamic viscoelastic properties of bone is required to understand the mechanisms of macroscopic bone fracture in humans, and other terrestrial mammals, during impact loading events (e.g. falls, vehicle accidents, etc.). While the dynamic response of bone has been studied for several decades, high-quality data remain limited, and it is only within the last decade that techniques for conducting dynamic compression tests on bone at near-constant strain rates have been developed. Furthermore, there appears to be a lack of published bone data in the intermediate strain rate (ISR) range (i.e. 1-100 s(-1)), which represents a regime in which many dynamic bone fractures occur. In this paper, preliminary results for the dynamic compression of bovine cortical bone in the ISR regime are presented. The results are obtained using two Hopkinson-bar-related techniques, namely the conventional split Hopkinson bar arrangement incorporating a novel cone-in-tube striker design, and the recently developed wedge bar apparatus. The experimental results show a rapid transition in the strain rate sensitive behaviour of bovine cortical bone in the ISR range. Finally, a new viscoelastic model is proposed that captures the observed transition behaviour.
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Affiliation(s)
- T. J. Cloete
- Blast Impact and Survivability Research Unit (BISRU), University of Cape Town, Private bag X3, Rondebosch 7701, South Africa
- Department of Mechanical Engineering, University of Cape Town, Private bag X3, Rondebosch 7701, South Africa
| | - G. Paul
- Blast Impact and Survivability Research Unit (BISRU), University of Cape Town, Private bag X3, Rondebosch 7701, South Africa
- Department of Mechanical Engineering, University of Cape Town, Private bag X3, Rondebosch 7701, South Africa
| | - E. B. Ismail
- Blast Impact and Survivability Research Unit (BISRU), University of Cape Town, Private bag X3, Rondebosch 7701, South Africa
- Department of Mechanical Engineering, University of Cape Town, Private bag X3, Rondebosch 7701, South Africa
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Abstract
Respiratory syncytial virus (RSV) is an important respiratory pathogen in infants and children worldwide. Although RSV typically causes mild upper respiratory infections, it frequently causes severe morbidity and mortality, especially in premature infants and children with other chronic diseases. Treatment of RSV is limited by a lack of effective antiviral treatments; however, ribavirin has been used in complicated cases, along with the addition of intravenous immune globulin in specific patients. Vaccination strategies for RSV prevention are heavily studied, but only palivizumab (Synagis®) has been approved for use in the United States in very select patient populations. Research is ongoing in developing additional vaccines, along with alternative therapies that may help prevent or decrease the severity of RSV infections in infants and children. To date, we have not seen a decrement in RSV morbidity and mortality with our current options; therefore, there is a clear need for novel RSV preventative and therapeutic strategies. In this review, we discuss the current and evolving trends in RSV treatment for infants and children.
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Affiliation(s)
- Tiffany L Turner
- Department of Pediatrics, Ohio State University College of Medicine, Columbus, OH, USA
| | - Benjamin T Kopp
- Department of Pediatrics, Ohio State University College of Medicine, Columbus, OH, USA
| | - Grace Paul
- Department of Pediatrics, Ohio State University College of Medicine, Columbus, OH, USA
| | | | - Don Hayes
- Department of Pediatrics, Ohio State University College of Medicine, Columbus, OH, USA
| | - Rohan Thompson
- Department of Pediatrics, Ohio State University College of Medicine, Columbus, OH, USA
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Paul G, Kempa A, Zoller W. Seltener Fall einer Larynxtuberkulose, mit kompletter Destruktion der Epiglottis. Pneumologie 2014. [DOI: 10.1055/s-0034-1367897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Paul G, Zachrisson O, Varrone A, Almqvist P, Jerling M, Lindh G, Rehncrona S, Linderoth B, Bjartmarz H, Svensson M, Mercer KJ, Forsberg A, Shafer L, Lang AJ, Halldin C, Svenningsson P, Widner H, Frisen J, Pålhagen S, Haegerstrand A. Safety and efficacy of recombinant human platelet derived growth factor (Rhpdgf) in Parkinson's disease. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Paul BS, Singh G, Bansal RK, Paul G. Author reply: To PMID 23793316. J Postgrad Med 2013; 59:248-249. [PMID: 24156125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
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Sacchetto V, Gatti G, Paul G, Braschi I, Berlier G, Cossi M, Marchese L, Bagatin R, Bisio C. The interactions of methyl tert-butyl ether on high silica zeolites: a combined experimental and computational study. Phys Chem Chem Phys 2013; 15:13275-87. [DOI: 10.1039/c3cp51684a] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Paul BS, Bansal R, Singh G, Paul G. Diffusion weighted MR imaging of 5-fluorouracil and oxaliplatin-induced leukoencephalopathy. J Postgrad Med 2013; 59:135-7. [DOI: 10.4103/0022-3859.113845] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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49
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Sirker A, Paul G, Dworakowski R, Melikian N, Byrne J. 020 Comparison of fractional flow reserve measurements obtained using central vs distal peripheral intravenous adenosine infusion to induce hyperaemia. Heart 2012. [DOI: 10.1136/heartjnl-2012-301877b.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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50
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Al-Dirini RMA, Thewlis D, Paul G. A comprehensive literature review of the pelvis and the lower extremity FE human models under quasi-static conditions. Work 2012; 41 Suppl 1:4218-29. [PMID: 22317369 DOI: 10.3233/wor-2012-1039-4218] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Finite Element Modeling (FEM) has become a vital tool in the automotive design and development processes. FEM of the human body is a technique capable of estimating parameters that are difficult to measure in experimental studies with the human body segments being modeled as complex and dynamic entities. Several studies have been dedicated to attain close-to-real FEMs of the human body (Pankoke and Siefert 2007; Amann, Huschenbeth et al. 2009; ESI 2010). The aim of this paper is to identify and appraise the state-of-the art models of the human body which incorporate detailed pelvis and/or lower extremity models. Six databases and search engines were used to obtain literature, and the search was limited to studies published in English since 2000. The initial search results identified 636 pelvis-related papers, 834 buttocks-related papers, 505 thigh-related papers, 927 femur-related papers, 2039 knee-related papers, 655 shank-related papers, 292 tibia-related papers, 110 fibula-related papers, 644 ankle-related papers, and 5660 foot-related papers. A refined search returned 100 pelvis-related papers, 45 buttocks-related papers, 65 thigh-related papers, 162 femur-related papers, 195 knee-related papers, 37 shank-related papers, 80 tibia-related papers, 30 fibula-related papers and 102 ankle-related papers and 246 foot-related papers. The refined literature list was further restricted by appraisal against a modified LOW appraisal criteria. Studies with unclear methodologies, with a focus on populations with pathology or with sport related dynamic motion modeling were excluded. The final literature list included fifteen models and each was assessed against the percentile the model represents, the gender the model was based on, the human body segment/segments included in the model, the sample size used to develop the model, the source of geometric/anthropometric values used to develop the model, the posture the model represents and the finite element solver used for the model. The results of this literature review provide indication of bias in the available models towards 50th percentile male modeling with a notable concentration on the pelvis, femur and buttocks segments.
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