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Willoughby KL, Ang SG, Thomason P, Rutz E, Shore B, Buckland AJ, Johnson MB, Graham HK. Epidemiology of scoliosis in cerebral palsy: A population-based study at skeletal maturity. J Paediatr Child Health 2022; 58:295-301. [PMID: 34453468 PMCID: PMC9291795 DOI: 10.1111/jpc.15707] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 05/17/2021] [Revised: 07/26/2021] [Accepted: 08/09/2021] [Indexed: 11/27/2022]
Abstract
AIM This study investigated the prevalence of scoliosis in a large, population-based cohort of individuals with cerebral palsy (CP) at skeletal maturity to identify associated risk factors that may inform scoliosis surveillance. METHODS Young people with CP born between 1990 and 1992 were reviewed through routine orthopaedic review or a transition clinic. Classification of CP was recorded by movement disorder, distribution, gross and fine motor function. Clinical examination was undertaken and those with clinical evidence of scoliosis or risk factors had radiographs of the spine. Scoliosis severity was measured and categorised by Cobb angle. RESULTS Two hundred and ninety-two individuals were evaluated (78% of the birth cohort) at a mean age of 21 years, 4 months (range 16-29 years). Scoliosis (Cobb angle >10°) was found in 41%, with strong associations to the Gross Motor Function Classification System (GMFCS), Manual Abilities Classification System (MACS) and dystonic/mixed movement disorders. Those at GMFCS V were 23.4 times (95%CI 9.9-55.6) more likely to develop scoliosis than those at GMFCS I. Severe curves (Cobb >40°, 13% of the cohort) were found almost exclusively in those functioning at GMFCS IV and V, and were 18.2 times (95%CI 6.9-48.5) more likely to occur in those with dystonia than those with spasticity. CONCLUSIONS Scoliosis was very common in young people with CP, with prevalence and severity strongly associated with GMFCS and MACS level and dystonic movement disorder. Severe curves were almost exclusively found in non-ambulant children. Clinical screening for scoliosis should occur for all children with CP, with radiographic surveillance focusing on those functioning at GMFCS IV and V.
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Affiliation(s)
- Kate L Willoughby
- Orthopaedic DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia,Gait Lab and Orthopaedics Research GroupMurdoch Children's Research InstituteMelbourneVictoriaAustralia
| | - Soon Ghee Ang
- Orthopaedic DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia,Present address:
Mercy HealthMelbourneVictoriaAustralia
| | - Pam Thomason
- Gait Lab and Orthopaedics Research GroupMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Hugh Williamson Gait Analysis LaboratoryThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Erich Rutz
- Orthopaedic DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia,Gait Lab and Orthopaedics Research GroupMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Hugh Williamson Gait Analysis LaboratoryThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Benjamin Shore
- Orthopaedic DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia,Present address:
Orthopaedic DepartmentBoston Children's HospitalBostonMassachusettsUSA
| | - Aaron J Buckland
- Orthopaedic DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Michael B Johnson
- Orthopaedic DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia,Gait Lab and Orthopaedics Research GroupMurdoch Children's Research InstituteMelbourneVictoriaAustralia
| | - H Kerr Graham
- Orthopaedic DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia,Gait Lab and Orthopaedics Research GroupMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Hugh Williamson Gait Analysis LaboratoryThe Royal Children's HospitalMelbourneVictoriaAustralia,Department of PaediatricsThe University of MelbourneMelbourneVictoriaAustralia
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Gaume M, Hajj R, Khouri N, Johnson MB, Miladi L. One-Way Self-Expanding Rod in Neuromuscular Scoliosis: Preliminary Results of a Prospective Series of 21 Patients. JB JS Open Access 2021; 6:JBJSOA-D-21-00089. [PMID: 34934886 PMCID: PMC8683234 DOI: 10.2106/jbjs.oa.21.00089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Fusionless techniques for the treatment of neuromuscular early-onset scoliosis (EOS) are increasingly used to preserve spinal and thoracic growth and to postpone posterior spinal fusion (PSF). These techniques have greatly improved thanks to magnetically controlled growing rods, which allow the avoidance of repeated surgery. However, the surgery-related complication rate remains high. The objective of the current study was to report the preliminary outcomes of 21 patients with neuromuscular EOS who were treated with a 1-way self-expanding rod (OWSER). This device was designed to avoid repeated surgery and preserve spinal and thoracic growth thanks to its free rod sliding.
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Affiliation(s)
- M Gaume
- Department of Orthopaedic Surgery, Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, University of Paris, Paris, France
| | - R Hajj
- Department of Orthopaedic Surgery, Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, University of Paris, Paris, France
| | - N Khouri
- Department of Orthopaedic Surgery, Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, University of Paris, Paris, France
| | - M B Johnson
- Department of Orthopaedics, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - L Miladi
- Department of Orthopaedic Surgery, Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, University of Paris, Paris, France
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Mo AZ, Miller PE, Pizones J, Helenius I, Ruf M, El-Hawary R, de Oliveira RG, Ovadia D, Kawakami N, Crawford H, Odent T, Yazici M, Johnson MB, Miyanji F, Hedequist DJ. The reliability of the AOSpine Thoracolumbar Spine Injury Classification System in children: an international validation study. J Child Orthop 2021; 15:472-478. [PMID: 34858534 PMCID: PMC8582611 DOI: 10.1302/1863-2548.15.200188] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/03/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To evaluate the AOSpine Thoracolumbar Spine Injury Classification System and if it is reliable and reproducible when applied to the paediatric population globally. METHODS A total of 12 paediatric orthopaedic surgeons were asked to review MRI and CT imaging of 25 paediatric patients with thoracolumbar spine traumatic injuries, in order to determine the classification of the lesions observed. The evaluators classified injuries into primary categories: A, B and C. Interobserver reliability was assessed for the initial reading by Fleiss's kappa coefficient (kF) along with 95% confidence intervals (CI). For A and B type injuries, sub-classification was conducted including A0-A4 and B1-B2 subtypes. Interobserver reliability across subclasses was assessed using Krippendorff's alpha (αk) along with bootstrapped 95% CIs. A second round of classification was performed one-month later. Intraobserver reproducibility was assessed for the primary classifications using Fleiss's kappa and sub-classification reproducibility was assessed by Krippendorff's alpha (αk) along with 95% CIs. RESULTS In total, 25 cases were read for a total of 300 initial and 300 repeated evaluations. Adjusted interobserver reliability was almost perfect (kF = 0.74; 95% CI 0.71 to 0.78) across all observers. Sub-classification reliability was substantial (αk= 0.67; 95% CI 0.51 to 0.81), Adjusted intraobserver reproducibility was almost perfect (kF = 0.91; 95% CI 0.83 to 0.99) for both primary classifications and for sub-classifications (αk = 0.88; 95% CI 0.83 to 0.93). CONCLUSION The inter- and intraobserver reliability for the AOSpine Thoracolumbar Spine Injury Classification System was high amongst paediatric orthopaedic surgeons. The AOSpine Thoracolumbar Spine Injury Classification System is a promising option as a uniform fracture classification in children. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Andrew Z. Mo
- Department of Orthopaedic Surgery, Georgetown University Medical Center, Washington, District of Columbia, United States
| | - Patricia E. Miller
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, Massachusetts, United States
| | - Javier Pizones
- Spine Unit, Hospital Universitario La Paz, Madrid, Spain
| | - Ilkka Helenius
- Professor and Chairman, Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Michael Ruf
- Center for Spinal Surgery, Orthopedics, and Traumatology, SRH Klinikum Karlsbad-Langensteinbach, Karlsbad, Germany
| | | | | | - Dror Ovadia
- Dana Dwek Children’s Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Noriaki Kawakami
- Director of Spine & Scoliosis Center, Department of Orthopedic Surgery, Ichinomiyanishi Hospital, Ichinomiya, Japan
| | - Haemish Crawford
- Paediatric Orthopaedic Surgeon, Starship Children’s Hospital, Auckland, New Zealand
| | - Thierry Odent
- Service de Chirurgie Orthopédique Pédiatrique, Université François Rabelais de Tours, PRES Centre-Val de Loire Université, Hôpital Gatien-de-Clocheville, Tours, France
| | - Muharrem Yazici
- Hacettepe University, Faculty of Medicine, Orthopaedics, Ankara, Turkey
| | | | - Firoz Miyanji
- Department of Orthopedics, British Columbia Children’s Hospital, Pediatric Orthopedics and Spine Surgery, Vancouver, British Columbia, Canada
| | - Daniel J. Hedequist
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, Massachusetts, United States,Correspondence should be sent to Daniel J. Hedequist, Department of Orthopedic Surgery, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115United States. E-mail:
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Temby SE, Palmer GM, Penrose SP, Peachey DM, Johnson MB. Implementation of an enhanced recovery pathway in Australia after posterior spinal fusion for adolescent idiopathic scoliosis delivers improved outcomes. Spine Deform 2021; 9:1371-1377. [PMID: 33822322 DOI: 10.1007/s43390-021-00340-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 02/09/2021] [Accepted: 03/25/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Traditionally, spinal surgery for Adolescent Idiopathic Scoliosis (AIS) has seen long hospital length of stay (LOS) and slow mobility progression. Postoperative enhanced recovery pathways (ERP) for this population in North America and Asia have successfully reduced LOS and hospital costs without increasing complications. This study assessed if ERP introduced in an Australian center achieves similar results. METHODS A pre-post intervention study compared a historical AIS cohort having a posterior spinal fusion (PSF) who received conventional care (CC) (2013-2014) with prospectively assessed ERP recipients (2016-2018) separated by 1-year implementation period. Patient characteristics, surgical details, postoperative analgesia, mobilization, LOS and complication outcomes were collected. RESULTS The 32 CC and 61 ERP recipients had similar demographics. ERP recipients had 44% decreased LOS (mean LOS 3.5 ± 0.9 days vs. CC 6.3 ± 0.9 days, p < 0.001) as all ERP milestones were achieved sooner including transition to oral analgesia (MD - 2 days, 95% CI 1.8-2.3), oral intake (MD - 2.3 days, 95% CI 2.0-2.6) and mobilization, with fewer physiotherapy sessions (5.2 vs 8, p < 0.001). Postoperative in-hospital costs were 50.2% less for ERP vs CC (AUD $8234 vs $16,545). Due to small sample size, no differences between the groups were detectable for complications (4.9% vs 6.3%) or readmission (1.6% vs 3.1%). CONCLUSION An ERP for AIS after PSF in this Australian center improved functional recovery reducing LOS and by associated postoperative inpatient costs. Other Australian hospitals should consider an ERP for this population with larger-scale audit to assess impact upon complications. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Sarah E Temby
- Physiotherapy Department, The Royal Children's Hospital, Melbourne, VIC, Australia.
| | - Greta M Palmer
- Department of Anaesthesia and Pain Management Service, The Royal Children's Hospital, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia.,University of Melbourne, Melbourne, VIC, Australia
| | - Sueann P Penrose
- Department of Anaesthesia and Pain Management Service, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Donna M Peachey
- Department of Orthopaedics, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Michael B Johnson
- Department of Orthopaedics, The Royal Children's Hospital, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia
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Mahmood R, Johnson MB, Hillier AC. Massive Enhancement of Optical Transmission across a Thin Metal Film via Wave Vector Matching in Grating-Coupled Surface Plasmon Resonance. Anal Chem 2019; 91:8350-8357. [PMID: 31140785 DOI: 10.1021/acs.analchem.9b01148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We demonstrate how distinct surface plasmon resonance modes on opposite sides of a metal-coated grating can be coupled across the metal film. This coupling occurs by matching the resonance conditions on each side of the grating by tuning the refractive index directly adjacent to the metal film. In the first example, we deposited a high refractive index layer of tin oxide on top of the grating to red-shift the front side surface plasmon until it coupled with the backside surface plasmon across a semitransparent ∼45 nm thin silver grating. By shifting the resonance condition of the nearby surface plasmon, this high refractive index coating creates an effective matching of wave vectors across the metal film, allowing them to couple and enhance the optical response. A massive increase in the magnitude of enhanced transmission is observed, increasing from a 6-fold transmission enhancement through a bare silver grating to a near 100-fold enhancement after deposition of a tin oxide layer of appropriate thickness (∼310 nm). This optical transmission enhancement is then probed through computational modeling and by experiments with liquids of various refractive index values. The matched system shows an increased amplitude sensitivity with respect to refractive index changes and a waveguide like behavior within the tin oxide film. As an alternative configuration, we also demonstrate coupling the front and back-side plasmon modes by using a lower refractive index substrate in order to blue-shift the back-side surface plasmon. Coupling between the two plasmon modes is then demonstrated by introducing aqueous solutions of various refractive index values. Under the proper conditions, this matched system also shows a substantial enhancement in transmission. This technique of wave vector matching provides a route to substantially increasing the plasmon enhanced optical transmission through metal gratings, which has potential application in improved plasmonic sensing, spectroscopy, and plasmon-based optical devices.
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Affiliation(s)
- Russell Mahmood
- Department of Chemical and Biological Engineering , Iowa State University , Ames , Iowa 50011 , United States
| | - Michael B Johnson
- Department of Chemical and Biological Engineering , Iowa State University , Ames , Iowa 50011 , United States
| | - Andrew C Hillier
- Department of Chemical and Biological Engineering , Iowa State University , Ames , Iowa 50011 , United States
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Shafer S, Johnson MB, Thomas RB, Johnson PT, Fishman EK. Instagram as a Vehicle for Education: What Radiology Educators Need to Know. Acad Radiol 2018; 25:819-822. [PMID: 29751861 DOI: 10.1016/j.acra.2018.03.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 03/04/2018] [Accepted: 03/08/2018] [Indexed: 10/17/2022]
Abstract
Since its inception in 2010, Instagram has rapidly grown into one of the world's largest social media forums, with over 700 million registered users. In the field of medicine, Instagram has been used for professional development and is also being added to the armamentarium of social media vehicles for education. Utilization of Instagram for medical education lags behind Facebook and Twitter, as many educators may not recognize the potential role. The purpose of this manuscript is to describe unique features of Instagram that are not found on Facebook and Twitter, with the aim of facilitating use of Instagram for radiology education.
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de la Torre AN, Castaneda I, Ahmad M, Ekholy N, Tham N, Herrera IB, Beaty P, Malapero RJ, Ayoub F, Slim J, Johnson MB. Audio-computer-assisted survey interview and patient navigation to increase chronic viral hepatitis diagnosis and linkage to care in urban health clinics. J Viral Hepat 2017. [PMID: 28636784 DOI: 10.1111/jvh.12744] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Indexed: 12/23/2022]
Abstract
Intravenous drug use and sexual practices account for 60% of hepatitis C (HCV) and B (HBV) infection. Disclosing these activities can be embarrassing and reduce risk reporting, blood testing and diagnosis. In diagnosed patients, linkage to care remains a challenge. Audio-computer-assisted survey interview (Audio-CASI) was used to guide HCV and HBV infection testing in urban clinics. Risk reporting, blood testing and serology results were compared to historical controls. A patient navigator (PN) followed up blood test results and provided patients with positive serology linkage to care (LTC). Of 1932 patients surveyed, 574 (30%) were at risk for chronic viral hepatitis. A total of 254 (44.3%) patients were tested, 34 (13.5%) had serology warranting treatment evaluation, and 64% required HBV vaccination. Of 16 patients with infection, seven HCV and three HBV patients started treatment following patient LTC. Of 146 HBV-naïve patients, 70 completed vaccination. About 75% and 49% of HCV antibody and HBV surface antigen-positive patients were born between 1945 and 1965. Subsequently, automated HCV testing of patients born between 1945 and 1965 was built into our hospital electronic medical records. Average monthly HCV antibody testing increased from 245 (January-June) to 1187 (July-October). Patient navigator directed LTC for HCV antibody-positive patients was 61.6%. In conclusion, audio-CASI can identify patients at risk for HCV or HBV infection and those in need of HBV vaccination in urban medical clinics. Although blood testing once a patient is identified at risk for infection needs to increase, a PN is useful to provide LTC of newly diagnosed patients.
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Affiliation(s)
- A N de la Torre
- Liver Surgery, St Joseph's Medical Center, Paterson, NJ, USA.,Liver Surgery, New Jersey Medical School Rutgers University, Newark, NJ, USA
| | - I Castaneda
- Liver Surgery, St Joseph's Medical Center, Paterson, NJ, USA
| | - M Ahmad
- Hepatology, St Joseph's Medical Center, Paterson, NJ, USA
| | - N Ekholy
- Internal Medicine, St Joseph's Medical Center, Paterson, NJ, USA
| | - N Tham
- Segundo Ruiz Belvis Community Health Center - Gotham Health, Bronx, NY, USA
| | - I B Herrera
- Internal Medicine, New Jersey Medical School Rutgers University, Newark, NJ, USA
| | - P Beaty
- Metropolitan Family Health Network FQHC, Jersey City, NJ, USA
| | | | - F Ayoub
- Liver Surgery, St Joseph's Medical Center, Paterson, NJ, USA
| | - J Slim
- Division of Infectious Deceases, St. Michael's Medical Center, Newark, NJ, USA
| | - M B Johnson
- Family Medicine, Howard University, Washington, DC, USA
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Johnson PT, Schneider R, Lugo-Fagundo C, Johnson MB, Fishman EK. MDCT Angiography With 3D Rendering: A Novel Cinematic Rendering Algorithm for Enhanced Anatomic Detail. AJR Am J Roentgenol 2017; 209:309-312. [DOI: 10.2214/ajr.17.17903] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Pamela T. Johnson
- Russell H. Morgan Department of Radiology and Radiological Sciences, 601 N Caroline St, Rm 4223, Baltimore, MD 21287
| | - Robert Schneider
- Department of Diagnostic Imaging, Siemens Healthcare, Erlangen, Germany
| | - Carolina Lugo-Fagundo
- Russell H. Morgan Department of Radiology and Radiological Sciences, 601 N Caroline St, Rm 4223, Baltimore, MD 21287
| | - Michael B. Johnson
- Russell H. Morgan Department of Radiology and Radiological Sciences, 601 N Caroline St, Rm 4223, Baltimore, MD 21287
| | - Elliot K. Fishman
- Russell H. Morgan Department of Radiology and Radiological Sciences, 601 N Caroline St, Rm 4223, Baltimore, MD 21287
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Flanagan SE, Vairo F, Johnson MB, Caswell R, Laver TW, Lango Allen H, Hussain K, Ellard S. A CACNA1D mutation in a patient with persistent hyperinsulinaemic hypoglycaemia, heart defects, and severe hypotonia. Pediatr Diabetes 2017; 18:320-323. [PMID: 28318089 PMCID: PMC5434855 DOI: 10.1111/pedi.12512] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [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: 08/24/2016] [Revised: 01/16/2017] [Accepted: 01/31/2017] [Indexed: 01/31/2023] Open
Abstract
Congenital hyperinsulinaemic hypoglycaemia (HH) can occur in isolation or it may present as part of a wider syndrome. For approximately 40%-50% of individuals with this condition, sequence analysis of the known HH genes identifies a causative mutation. Identifying the underlying genetic aetiology in the remaining cases is important as a genetic diagnosis will inform on recurrence risk, may guide medical management and will provide valuable insights into β-cell physiology. We sequenced the exome of a child with persistent diazoxide-responsive HH, mild aortic insufficiency, severe hypotonia, and developmental delay as well as the unaffected parents. This analysis identified a de novo mutation, p.G403D, in the proband's CACNA1D gene. CACNA1D encodes the main L-type voltage-gated calcium channel in the pancreatic β-cell, a key component of the insulin secretion pathway. The p.G403D mutation had been reported previously as an activating mutation in an individual with primary hyper-aldosteronism, neuromuscular abnormalities, and transient hypoglycaemia. Sequence analysis of the CACNA1D gene in 60 further cases with HH did not identify a pathogenic mutation. Identification of an activating CACNA1D mutation in a second patient with congenital HH confirms the aetiological role of CACNA1D mutations in this disorder. A genetic diagnosis is important as treatment with a calcium channel blocker may be an option for the medical management of this patient.
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Affiliation(s)
- SE Flanagan
- Institute of Biomedical and Clinical ScienceUniversity of Exeter Medical SchoolExeterUK
| | - F Vairo
- Medical Genetics ServiceHospital de Clínicas de Porto AlegrePorto AlegreRSBrazil
| | - MB Johnson
- Institute of Biomedical and Clinical ScienceUniversity of Exeter Medical SchoolExeterUK
| | - R Caswell
- Institute of Biomedical and Clinical ScienceUniversity of Exeter Medical SchoolExeterUK
| | - TW Laver
- Institute of Biomedical and Clinical ScienceUniversity of Exeter Medical SchoolExeterUK
| | - H Lango Allen
- Institute of Biomedical and Clinical ScienceUniversity of Exeter Medical SchoolExeterUK
| | - K Hussain
- Developmental Endocrinology Research Group, Clinical and Molecular Genetics UnitUCL Institute of Child Health and Great Ormond Street HospitalLondonUK
| | - S Ellard
- Institute of Biomedical and Clinical ScienceUniversity of Exeter Medical SchoolExeterUK
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Buckland AJ, Bressan S, Jowett H, Johnson MB, Teague WJ. Heterogeneity in cervical spine assessment in paediatric trauma: A survey of physicians' knowledge and application at a paediatric major trauma centre. Emerg Med Australas 2016; 28:569-74. [PMID: 27474412 DOI: 10.1111/1742-6723.12650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 05/17/2016] [Accepted: 06/26/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Evidence-based decision-making tools are widely used to guide cervical spine assessment in adult trauma patients. Similar tools validated for use in injured children are lacking. A paediatric-specific approach is appropriate given important differences in cervical spine anatomy, mechanism of spinal injury and concerns over ionising radiation in children. The present study aims to survey physicians' knowledge and application of cervical spine assessment in injured children. METHODS A cross-sectional survey of physicians actively engaged in trauma care within a paediatric trauma centre was undertaken. Participation was voluntary and responses de-idenitified. The survey comprised 20 questions regarding initial assessment, imaging, immobilisation and perioperative management. Physicians' responses were compared with available current evidence. RESULTS Sixty-seven physicians (28% registrars, 17% fellows and 55.2% consultants) participated. Physicians rated altered mental state, intoxication and distracting injury as the most important contraindications to cervical spine clearance in children. Fifty-four per cent considered adequate plain imaging to be 3-view cervical spine radiographs (anterior-posterior, lateral and odontoid), whereas 30% considered CT the most sensitive modality for detecting unstable cervical spine injuries. Physicians' responses reflected marked heterogeneity regarding semi-rigid cervical collars and what constitutes cervical spine 'clearance'. Greater consensus existed for perioperative precautions in this setting. CONCLUSIONS Physicians actively engaged in paediatric trauma care demonstrate marked heterogeneity in their knowledge and application of cervical spine assessment. This is compounded by a lack of paediatric-specific evidence and definitions, involvement of multiple specialties and staff turnover within busy departments. A validated decision-making tool for cervical spine assessment will represent an important advance in paediatric trauma.
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Affiliation(s)
- Aaron J Buckland
- Department of Orthopaedics, The Royal Children's Hospital, Melbourne, Victoria, Australia.,NYU Langone Medical Center - Hospital for Joint Diseases, New York, New York, USA
| | - Silvia Bressan
- Trauma Service, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Emergency Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Woman's and Child's Health, University of Padova, Padova, Italy
| | - Helen Jowett
- Trauma Service, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Michael B Johnson
- Department of Orthopaedics, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Warwick J Teague
- Trauma Service, The Royal Children's Hospital, Melbourne, Victoria, Australia. .,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia. .,Surgical Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.
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11
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Patch SK, Kireeff Covo M, Jackson A, Qadadha YM, Campbell KS, Albright RA, Bloemhard P, Donoghue AP, Siero CR, Gimpel TL, Small SM, Ninemire BF, Johnson MB, Phair L. Thermoacoustic range verification using a clinical ultrasound array provides perfectly co-registered overlay of the Bragg peak onto an ultrasound image. Phys Med Biol 2016; 61:5621-38. [PMID: 27385261 DOI: 10.1088/0031-9155/61/15/5621] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The potential of particle therapy due to focused dose deposition in the Bragg peak has not yet been fully realized due to inaccuracies in range verification. The purpose of this work was to correlate the Bragg peak location with target structure, by overlaying the location of the Bragg peak onto a standard ultrasound image. Pulsed delivery of 50 MeV protons was accomplished by a fast chopper installed between the ion source and the cyclotron inflector. The chopper limited the train of bunches so that 2 Gy were delivered in [Formula: see text]. The ion pulse generated thermoacoustic pulses that were detected by a cardiac ultrasound array, which also produced a grayscale ultrasound image. A filtered backprojection algorithm focused the received signal to the Bragg peak location with perfect co-registration to the ultrasound images. Data was collected in a room temperature water bath and gelatin phantom with a cavity designed to mimic the intestine, in which gas pockets can displace the Bragg peak. Phantom experiments performed with the cavity both empty and filled with olive oil confirmed that displacement of the Bragg peak due to anatomical change could be detected. Thermoacoustic range measurements in the waterbath agreed with Monte Carlo simulation within 1.2 mm. In the phantom, thermoacoustic range estimates and first-order range estimates from CT images agreed to within 1.5 mm.
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Affiliation(s)
- S K Patch
- Department of Physics, UW-Milwaukee, 3135 N. Maryland Ave., Milwaukee, WI 53211, USA
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Raspal V, Awitor KO, Massard C, Feschet-Chassot E, Bokalawela RSP, Johnson MB. Nanoporous surface wetting behavior: the line tension influence. Langmuir 2012; 28:11064-11071. [PMID: 22746264 DOI: 10.1021/la301201k] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The aim of this work is to develop a physical model to describe the evolution of the apparent contact angle for four different liquids on nanotextured alumina surfaces with different pore radius. The nanoporous alumina templates were fabricated by anodization of Al foil in a 0.3 M oxalic acid solution. Scanning electron microscopy was used to characterize the morphology of the surfaces. The templates are approximately 400 nm in thickness and consist of a well-ordered hexagonal array of uniform radius pores spaced 105 nm apart with pore radii from 12 to 42 nm. The wettability of nanoporous alumina templates was investigated using contact-angle measurements. We measured the contact angles using four liquids: water, ethylene glycol, aniline, and a mixture of ethylene glycol and aniline. We developed a new theoretical model for the contact angle on nanoporous surfaces as a function of the pore radius. This model is based on energy considerations and involves liquid penetration into the nanopores driven by the capillarity (Laplace's law). Because the air is compressed inside the pores, this model also includes the effect of the line tension. This is important because the three-phase line length is greatly enhanced in our nanoporous structures. For example: for a millimeter-sized droplet, the three-phase line around the perimeter of the droplet is a few millimeters long, whereas the total three-phase line within the pores can reach several tens of meters. Using our model, the line-tension value for our nanopore samples is positive and ranges from 4 to 13 × 10(-9) N, which falls within the wide interval from 10(-11) to 10(-5) N quoted in the literature. Nanoporous surfaces may allow the effect of line tension to be visible for micro- to macrodroplets.
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Affiliation(s)
- V Raspal
- C-BIOSENSS-EA 4676, Clermont Université, Université d'Auvergne, Clermont-Ferrand, France
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Walkup J, Johnson MB, Simpson K, Rincon M, Allen D, White T, Subtirelu MM. The Triglyceride/HDL-Cholesterol Ratio as a Tool to Predict Insulin Resistance in Obese Pediatric Patients∗. J Clin Lipidol 2012. [DOI: 10.1016/j.jacl.2012.04.035] [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: 11/17/2022]
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14
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Van Emmerik REA, Remelius JG, Johnson MB, Chung LH, Kent-Braun JA. Postural control in women with multiple sclerosis: effects of task, vision and symptomatic fatigue. Gait Posture 2010; 32:608-14. [PMID: 20943393 DOI: 10.1016/j.gaitpost.2010.09.002] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Revised: 08/31/2010] [Accepted: 09/05/2010] [Indexed: 02/02/2023]
Abstract
People with multiple sclerosis (MS) often report problems with balance, which may be most apparent during challenging postural tasks such as leaning or reaching, and when relying on non-visual sensory systems. An additional obstacle facing people with MS is a high incidence of symptomatic fatigue (>70%). The purpose of this study was to investigate the changes in balance during upright stance in individuals with mild-to-moderate disability due to MS under normal and restricted vision and different levels of self-reported fatigue. Limb loading asymmetry, sway and magnitude of postural shift in center of pressure, and time-to-contact the stability boundary of the center of mass and center of pressure were assessed during quiet standing and maximal lean and reach tasks. Compared to controls, people with MS displayed greater postural sway, greater loading asymmetry, and shorter time-to-contact during quiet standing. In the postural perturbation tasks the MS group had smaller postural shifts and reduced stability compared to controls in the direction perpendicular to the lean and reach. Limiting vision increased loading asymmetry during quiet standing and postural instability during backward lean in the MS group. Inducing additional fatigue in the MS group did affect postural control in the more challenging balance conditions but had no impact during quiet upright standing. The results of this study indicate subtle changes in postural control during standing in people with mild-to-moderate impairments due to MS.
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Affiliation(s)
- R E A Van Emmerik
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA 01003, USA.
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15
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Johnson MB, Cappelli DP, Bradshaw BS, Mabry JC. Differences in pediatric dental services under general anesthesia for Medicaid and military dependent children. Pediatr Dent 2010; 32:289-294. [PMID: 20836947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
PURPOSE This study's purpose was to compare pediatric dental services provided for Medicaid and military dependent children to determine if differences in dental treatment choices exist based on site and payment method. METHODS Subjects included 120 Medicaid patients at the University of Texas Health Science Center at San Antonio and 120 military dependents at Lackland Air Force Base, Texas. Demographic data and treatment information were abstracted for children younger than 6 years old receiving dental treatment under general anesthesia between 2002 and 2006. Data was analyzed using Wilcoxon rank sum, Kruskal-Wallis, and Fisher's exact tests. RESULTS The Medicaid recipients were younger (40.2 vs 49.8 months, P<.001) and more likely to be Hispanic (78% vs 30%, P<.001). The means of decayed teeth, fillings, and stainless steel crowns did not differ between sites. Medicaid children received more composite fillings (P<.001), fewer amalgam fillings (P<.001), fewer pulp therapies (P<.001), more extractions (P=.01), and fewer sealants (P<.001). Age and gender did not affect decay rates, but those of Hispanic ethnicity did experience more decay than non-Hispanics (9.5 vs 8.6, P=.02). CONCLUSION This study found no difference in the number of less conservative, albeit more costly, procedures performed with Medicaid children at a university compared to military dependents at a military base.
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Affiliation(s)
- M B Johnson
- Department of Pediatric Dentistry, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
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16
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Johnson MB, Wen Z. Development of an attached microalgal growth system for biofuel production. Appl Microbiol Biotechnol 2009; 85:525-34. [DOI: 10.1007/s00253-009-2133-2] [Citation(s) in RCA: 274] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2009] [Revised: 06/08/2009] [Accepted: 07/07/2009] [Indexed: 11/24/2022]
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Abstract
This study examines the relationship between collective efficacy and performance in a single competition of adventure racing. Adventure racing is a team-based sport that requires the multidisciplinary tasks of trekking, mountain biking, canoeing, and climbing to navigate through a preplanned racecourse. Seventeen teams competing in an adventure race completed measures of prior performance, preparation effort, and a collective efficacy assessing perceptions of their team's functioning in six performance areas. Three in-race measures of collective efficacy and environmental factors-conditions are taken at various checkpoints. A correlational analysis indicates a positive relationship between preparation effort and initial perceptions of collective efficacy. A repeated measures analysis reveals the dynamic nature of collective efficacy and the reciprocal relationship between efficacy and performance. The results are consistent with D. L. Feltz and C. D. Lirgg's (1998) examination of collegiate teams and A. Bandura's (2000) contention that collective efficacy fosters a sense of motivational investment and an increased sense of staying power.
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Lehner AF, Petzinger E, Stewart J, Lang DG, Johnson MB, Harrison L, Seanor JW, Tobin T. ESI+ MS/MS confirmation of canine ivermectin toxicity. J Mass Spectrom 2009; 44:111-119. [PMID: 18853478 DOI: 10.1002/jms.1477] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Ivermectin is a semisynthetic macrocyclic lactone anthelmintic of the avermectin family derived from Streptomyces fermentation products. Avermectins are used as antiparasitic agents in domestic animals; although considered relatively safe, one must consider animal species, breed, weight, and age in dosage determinations.In January 2006, two canines were presented to the UK Livestock Disease Diagnostic Center after dying from suspected ivermectin overdoses [30-50 mg/kg body weight]. To confirm this clinical diagnosis we developed a rapid, sensitive semiquantitative ElectroSpray Ionization-Mass Spectrometry (ESI/MS) method for ivermectin in canine tissue samples. Pharmaceutical ivermectin contains two ivermectins differing by a single methyl group, and each compound forms interpretation-confounding adducts with tissue Na(+) and K(+) ions. We now report that ivermectin administration was clearly confirmed by comparison with standard and dosage forms of ivermectin, and simple proportionalities based on mass spectral intensity of respective molecular ions allowed semiquantitative estimates of injection site tissue concentrations of 20 and 40 microg/g tissue (wet weight) in these animals, consistent with the history of ivermectin administration and the clinical signs observed.There is a distinct need for both rapid detection and confirmation of toxic exposures in veterinary diagnostics, whether for interpretation of clinical cases antemortem or for forensic reasons postmortem. It is vital that interpreters of analytical results have appropriate guidance in the scientific literature and elsewhere so as to enable clear-cut answers. The method presented here is suitable for routine diagnostic work in that it allows rapid extraction of ivermectin from tissue samples, avoids the need for high-performance liquid chromatography and allows ready interpretation of the multiple ivermectin species seen by ESI(+) MS/MS in samples originating from veterinary dosage forms.
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Affiliation(s)
- A F Lehner
- Michigan State University, Diagnostic Center for Population and Animal Health, Lansing, MI 48910, USA.
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19
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Ruff JPC, Clancy JP, Bourque A, White MA, Ramazanoglu M, Gardner JS, Qiu Y, Copley JRD, Johnson MB, Dabkowska HA, Gaulin BD. Spin waves and quantum criticality in the frustrated XY pyrochlore antiferromagnet Er2Ti2O7. Phys Rev Lett 2008; 101:147205. [PMID: 18851568 DOI: 10.1103/physrevlett.101.147205] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Indexed: 05/26/2023]
Abstract
We report detailed measurements of the low temperature magnetic phase diagram of Er2Ti2O7. Heat capacity and time-of-flight neutron scattering studies of single crystals reveal unconventional low-energy states. Er3+ magnetic ions reside on a pyrochlore lattice in Er2Ti2O7, where local XY anisotropy and antiferromagnetic interactions give rise to a unique frustrated system. In zero field, the ground state exhibits coexisting short and long-range order, accompanied by soft collective spin excitations previously believed to be absent. The application of finite magnetic fields tunes the ground state continuously through a landscape of noncollinear phases, divided by a zero temperature phase transition at micro{0}H{c} approximately 1.5 T. The characteristic energy scale for spin fluctuations is seen to vanish at the critical point, as expected for a second order quantum phase transition driven by quantum fluctuations.
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Affiliation(s)
- J P C Ruff
- Department of Physics and Astronomy, McMaster University, Hamilton, Ontario, L8S 4M1, Canada
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Wang H, Zou M, Larson PR, Sanchez ES, Hobbs KL, Curtis ME, Johnson MB, Awitor OK. Nanomechanical properties of a Ni nanodot-patterned surface. Nanotechnology 2008; 19:295708. [PMID: 21730613 DOI: 10.1088/0957-4484/19/29/295708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Nanomechanical properties of a Ni nanodot-patterned surface (NDPS) on a Si substrate were investigated using nanoindentation. The Ni NDPS was fabricated by thermal evaporation of Ni through a porous anodized aluminum oxide template onto a Si substrate. Plan-view transmission electron microscopy and nanobeam diffraction were used to characterize the Ni nanodot crystal structure. Scanning electron microscopy and atomic force microscopy were used to characterize the morphology and deformation of the Ni nanodots before and after nanoindentation. The elastic modulus and hardness of the Ni nanodots were found to be 159 ± 22 and 7.7 ± 1.0 GPa, respectively. The critical shear stress for initiating plastic deformation in the Ni nanodot was estimated to be 8.3 ± 1.0 GPa, which is close to the theoretical shear strength of 7.6 GPa in dislocation-free single crystal Ni.
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Affiliation(s)
- H Wang
- Department of Mechanical Engineering, University of Arkansas, Fayetteville, AR 72701, USA
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21
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Clark MA, Johnson MB, Thway K, Fisher C, Thomas JM, Hayes AJ. Clear cell sarcoma (melanoma of soft parts): The Royal Marsden Hospital experience. Eur J Surg Oncol 2007; 34:800-4. [PMID: 18042498 DOI: 10.1016/j.ejso.2007.10.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Accepted: 10/12/2007] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Clear cell sarcoma (CCS) is a rare tumour with a propensity for local recurrence and nodal metastasis. About 300 cases have been reported, thus further clarification regarding the course and outcome of the disease is required. METHODS Patients with a histopathologic diagnosis of CCS were identified from prospective histopathology and sarcoma databases and supplemented with a retrospective analysis of the patients' hospital records. RESULTS Between 1990 and 2005, a total of 72 patients with a diagnosis of CCS were identified, 35 having been referred for management and 37 having been referred for histopathologic opinion. The median age was 39 years (range 5-90 years). Of the 35 patients referred to the Royal Marsden Hospital for management, 23% developed local recurrence or in-transit metastases at a median of 9 months (2-79 months) after resection of the primary, and nodal or distant metastatic disease was seen in 63% after 14 months (range 0-177 months). Five- and 10-year survival were 52% and 25%, respectively. CONCLUSIONS CCS has a number of similarities with melanoma, particularly in its peripheral distribution and propensity for nodal disease. Wide excision with clear margins offers the best chance of cure. Local recurrence and regional metastases are common, and are almost always followed by distant metastases and death.
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Affiliation(s)
- M A Clark
- Sarcoma and Melanoma Unit, Royal Marsden Hospital, Fulham Road, London SW36JJ, UK
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22
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Wang ZK, Lim HS, Liu HY, Ng SC, Kuok MH, Tay LL, Lockwood DJ, Cottam MG, Hobbs KL, Larson PR, Keay JC, Lian GD, Johnson MB. Spin waves in nickel nanorings of large aspect ratio. Phys Rev Lett 2005; 94:137208. [PMID: 15904029 DOI: 10.1103/physrevlett.94.137208] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2004] [Indexed: 05/02/2023]
Abstract
The spin dynamics of high-aspect-ratio nickel nanorings in a longitudinal magnetic field have been investigated by Brillouin spectroscopy and the results are compared with a macroscopic theory and three-dimensional micromagnetic simulations. Good agreement is found between the measured and calculated magnetic field dependence of the spin wave frequency. Simulations show that as the field decreases from saturation, the rings switch from a "bamboo" to a novel "twisted bamboo" state at a certain critical field, and predict a corresponding dip in the dependence of the spin wave frequency on the magnetic field.
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Affiliation(s)
- Z K Wang
- Department of Physics, National University of Singapore, Singapore 117542, Singapore
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23
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Zhao Q, Luo Y, Surthi S, Li Q, Mathur G, Gowda S, Larson PR, Johnson MB, Misra V. Redox-active monolayers on nano-scale silicon electrodes. Nanotechnology 2005; 16:257-261. [PMID: 21727432 DOI: 10.1088/0957-4484/16/2/013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Uniform arrays of nano-scale electrolyte-molecule-silicon capacitors have been successfully fabricated. This was done by a combination of reactive ion etch and a selective wet etch through an anodic aluminium oxide mask to form nano-holes in silicon oxide/silicon nitride insulator layers on silicon. Self-assembled monolayers of 4-ferrocenylbenzyl alcohol were then attached to the exposed silicon surfaces at the bottom of the nano-holes. Characterization by conventional capacitance and conductance techniques showed very high capacitance and conductance peaks near -0.6 V, that were attributed to the charging and discharging of electrons into and from discrete levels in the monolayer owing to the presence of the redox-active ferrocenes.
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Affiliation(s)
- Qian Zhao
- Department of Electrical and Computer Engineering, North Carolina State University, Raleigh, NC 27695, USA
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Abstract
Thirty-four patients with ambulatory spastic diplegia (ages 10-19.8 years) who were part of a prospective study of selective dorsal rhizotomy (SDR) had standardized radiographs before and after SDR. Follow-up ranged from 5 to 11.6 years after surgery. Two different surgical approaches were used: laminectomy (14 patients) and laminoplasty (20 patients). Radiographs were measured for coronal and sagittal balance. Thirty patients had a spinal deformity at long-term follow-up compared with 10 patients before surgery. Seventeen patients (50%) developed lumbar hyperlordosis greater than 60 degrees. Six patients (18%) developed grade 1 spondylolisthesis, Scoliosis occurred de novo in eight patients (24%) and progressed by greater than 5 degrees in two patients with preoperative scoliosis. No significant differences were found between laminoplasty and laminectomy patients. None of the patients have undergone any surgical intervention for spinal deformity. There was a higher incidence of spinal deformity after SDR than in normals and an historical control population, which warrants clinical and radiographic long-term follow-up.
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Affiliation(s)
- Michael B Johnson
- Department of Orthopaedics, Royal Children's Hospital, Parkville, Victoria, Australia.
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25
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Weisz JL, McMahon WM, Moore JC, Augustine NH, Bohnsack JF, Bale JF, Johnson MB, Morgan JF, Jensen J, Tani LY, Veasy LG, Hill HR. D8/17 and CD19 expression on lymphocytes of patients with acute rheumatic fever and Tourette's disorder. Clin Diagn Lab Immunol 2004; 11:330-6. [PMID: 15013984 PMCID: PMC371196 DOI: 10.1128/cdli.11.2.330-336.2004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
D8/17, an alloantigen found on B lymphocytes, has been reported to be elevated in patients susceptible to rheumatic fever and may be associated with autoimmune types of neuropsychiatric disorders. The pediatric-autoimmune-neuropsychiatric-disorders-associated-with-streptococci model is a putative model of pathogenesis for a group of children whose symptoms of obsessive-compulsive disorder and Tourette's disorder (TD) are abrupt and may be triggered by an infection with group A streptococci. As a test of this model, we have examined D8/17 levels on the B cells of patients with TD and acute rheumatic fever (ARF) along with those on the B cells of normal controls by flow cytometry. We have utilized several different preparations of D8/17 antibody along with a variety of secondary antibodies but have been unable to show an association with an elevated percentage of D8/17-positive, CD19-positive B cells in either ARF or TD. We did find, however, that the percentages of CD19-positive B cells in ARF and TD patients were significantly elevated compared to those in normal controls. Group A streptococcal pharyngitis patients also had an elevated percentage of CD19 B cells, however. These studies failed to confirm the utility of determining the percentage of B cells expressing the D8/17 alloantigen in ARF patients or our sample of TD patients. In contrast, the percentage of CD19-positive B cells was significantly elevated in ARF and TD patients, as well as group A streptococcal pharyngitis patients, suggesting a role for inflammation and/or autoimmunity in the pathogenesis of these disorders.
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Affiliation(s)
- Julie L Weisz
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA
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Egelhoff WF, Stiles MD, Pappas DP, Pierce DT, Byers JM, Johnson MB, Jonker BT, Alvarado SF, Gregg JF, Bland JAC, Buhrman RA. Spin polarization of injected electrons. Science 2002; 296:1195; discussion 1195. [PMID: 12016273 DOI: 10.1126/science.296.5571.1195a] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- W F Egelhoff
- National Institute of Standards and Technology, Gaithersburg, MD 20899, USA
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English WP, Johnson MB, Borman KR, Turner WW. Mesenteric ischemia: an unusual presentation of traumatic intrahepatic arterioportal fistula. Am Surg 2001; 67:865-7. [PMID: 11565765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Traumatic hepatic arterioportal fistulae (APF) are described infrequently as sequelae of hepatic trauma. These anomalies are usually associated with blunt hepatic trauma or iatrogenic injury. The majority of APF present within weeks to months of injury with gastrointestinal hemorrhage, hemobilia, abdominal pain, and diarrhea. When presenting remotely APFs are associated with portal hypertension, heart failure, gastrointestinal hemorrhage, ascites, and splenomegaly. We report an unusual case of mesenteric ischemia due to an APF that resulted from a penetrating liver injury 20 years before presentation. Successful treatment of the APF was achieved by intravascular catheter occlusion resulting in resolution of symptoms.
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Affiliation(s)
- W P English
- Department of Surgery, University of Mississippi School of Medicine, Jackson, 39216, USA
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Abstract
Acid-sensing ion channels (ASICs) are ligand-gated cation channels that respond to acidic stimuli. They are expressed throughout the mammalian nervous system. In the peripheral nervous system, ASICs act as nociceptors, responding to the tissue acidosis that accompanies ischemic and inflammatory conditions. The function of ASICs in the central nervous system is not known. In this article, the authors present evidence that transient global ischemia induces ASIC 2a protein expression in neurons that survive ischemia. Western blot analysis with an anti-ASIC 2a antibody revealed up-regulation of an 80 kD protein in ischemic rat brain. Immunohistochemical analysis showed that ASIC 2a protein expression increased in neurons of the hippocampus and cortex. Klenow fragment-mediated labeling of DNA strand breaks determined that ASIC 2a induction did not occur in cells with detectable DNA damage. The current results suggest a possible role for ASICs in mediating a cellular response to ischemia.
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Affiliation(s)
- M B Johnson
- R.S. Dow Neurobiology Laboratories, Legacy Research, Portland, Oregon 97232, USA
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Johnson MB, Kopeliovich BZ, Potashnikova IK, McGaughey PL, Moss JM, Peng JC, Garvey GT, Leitch MJ, Adams MR, Alde DM, Baer HW, Barlett ML, Brown CN, Cooper WE, Carey TA, Danner G, Hoffmann GW, Hsiung YB, Kaplan DM, Klein A, Lee C, Lillberg JW, McCarthy RL, Mishra CS, Wang MJ. Energy loss of fast quarks in nuclei. Phys Rev Lett 2001; 86:4483-4487. [PMID: 11384264 DOI: 10.1103/physrevlett.86.4483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2000] [Revised: 10/16/2000] [Indexed: 05/23/2023]
Abstract
We report an analysis of the nuclear dependence of the yield of Drell-Yan dimuons from the 800 GeV/c proton bombardment of 2H, C, Ca, Fe, and W targets. Employing a new formulation of the Drell-Yan process in the rest frame of the nucleus, this analysis examines the effect of initial-state energy loss and shadowing on the nuclear-dependence ratios versus the incident proton's momentum fraction and dimuon effective mass. The resulting energy loss per unit path length is -dE/dz = 2.32+/-0.52+/-0.5 GeV/fm. This is the first observation of a nonzero energy loss of partons traveling in a nuclear environment.
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Affiliation(s)
- M B Johnson
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
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Moorehead RA, Fata JE, Johnson MB, Khokha R. Inhibition of mammary epithelial apoptosis and sustained phosphorylation of Akt/PKB in MMTV-IGF-II transgenic mice. Cell Death Differ 2001; 8:16-29. [PMID: 11313699 DOI: 10.1038/sj.cdd.4400762] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2000] [Revised: 07/27/2000] [Accepted: 08/07/2000] [Indexed: 11/09/2022] Open
Abstract
IGF-II is a growth factor implicated in human cancers and animal tumor models. While the mitogenic properties of IGF-II are well documented, its ability to suppress apoptosis in vivo has never been proven. We generated independent MMTV-IGF-II transgenic mice to examine the control of epithelial apoptosis at the morphological, cellular and molecular levels during the physiological event of postlactation mammary involution. Transgenic IGF-II expression was achieved in mammary epithelium and increased IGF-II bioactivity was confirmed by phosphorylation of the insulin receptor substrate-1, a signaling molecule downstream of the type I IGF receptor. IGF-II overexpression induced a delay in mammary involution, as evident by increased mammary gland to body weight ratios and persistence of both functionally intact lobulo-alveoli and mammary epithelial cellularity. The delayed mammary involution resulted from a significant reduction in mammary epithelial apoptosis, and not from increased epithelial proliferation. Recombinant IGF-II pellets implanted into involuting mammary glands of wild-type mice provided further evidence that IGF-II protein inhibited local epithelial apoptosis. At the molecular level, phosphorylated Akt/PKB, but not Erk1 or Erk2, persisted in IGF-II overexpressors and temporally correlated with reduced epithelial apoptosis. Levels of the phosphatase PTEN were unaltered in the transgenic tissue suggesting that the maintenance of Akt/PKB phosphorylation resulted from sustained phosphorylation rather than altered dephosphorylation of PIP-3. Together, this data reveal that IGF-II inhibits apoptosis in vivo and this effect correlates with prolonged phosphorylation of Akt/PKB
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Affiliation(s)
- R A Moorehead
- Department of Medical Biophysics, Ontario Cancer Institute/University Health Network, University of Toronto, Toronto, Ontario, M5G 2M9, Canada
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Johnson MB, Wilkinson ID, Wattam J, Venables GS, Griffiths PD. Comparison of Doppler ultrasound, magnetic resonance angiographic techniques and catheter angiography in evaluation of carotid stenosis. Clin Radiol 2000; 55:912-20. [PMID: 11124070 DOI: 10.1053/crad.2000.0518] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM To compare the accuracy of ultrasound and two magnetic resonance (MR) angiographic techniques with catheter angiography in assessing atherosclerosis at the carotid bifurcation. MATERIALS AND METHODS Forty patients with symptomatic carotid stenosis were studied by Doppler ultrasound, time-of-flight MR angiography, contrast-enhanced MR angiography and conventional catheter angiography. The degree of stenosis found on ultrasound and MR angiography was compared with the results of catheter angiography. Four different assessment methods were conducted for the MR angiographic data. Kappa, sensitivity and specificity (with confidence intervals) values were calculated for the US and MR angiography results compared to catheter angiography. RESULTS Catheter angiography showed 12 internal carotid artery occlusions (15%), 34 severe (44%), 12 moderate (15%) and 20 mild stenoses (26%), using NASCET criteria. Ultrasound showed 65% sensitivity and 95% specificity in detecting surgically amenable lesions, whilst the MR angiographic techniques had sensitivities varying from 82-100%, and specificities from 95-100%.A moderate kappa value was calculated for the US data, whilst all MR techniques were found to show very good agreement with catheter angiography. CONCLUSION This data suggests that MR angiography is more accurate than Doppler ultrasound in defining surgical lesions and has comparable accuracy to catheter angiography. The use of contrast-enhanced MR angiography is useful in certain situations but is not essential in all cases.
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Affiliation(s)
- M B Johnson
- Section of Academic Radiology, University of Sheffield, Royal Hallamshire Hospital, Sheffield, U.K
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Affiliation(s)
- M B Johnson
- Alfred Hospital, Prahran, Victoria, Australia
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Saraj AJ, Wilcox JG, Najmabadi S, Stein SM, Johnson MB, Paulson RJ. Resolution of hormonal markers of ectopic gestation: a randomized trial comparing single-dose intramuscular methotrexate with salpingostomy. Obstet Gynecol 1998; 92:989-94. [PMID: 9840564 DOI: 10.1016/s0029-7844(98)00324-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate resolution of serum hCG and progesterone in patients with ectopic pregnancy receiving single-dose intramuscular (IM) methotrexate as compared with those undergoing laparoscopic salpingostomy. METHODS In this prospective randomized clinical trial, 75 hemodynamically stable women with a diagnosis of ectopic pregnancy were randomized to treatment with single-dose IM methotrexate (1 mg/kg) or laparoscopic salpingostomy. All women had initial, day 4, and weekly serum hCG and progesterone measurements taken until hCG levels were less than 15 mIU/mL. Methotrexate therapy was repeated if posttreatment day 7 hCG levels did not decrease by 15%, as compared with day 4 levels. Success rate was defined as ectopic resolution without the need for the alternate mode of therapy. RESULTS Thirty-eight women were randomized to treatment with methotrexate and 37 to laparoscopic salpingostomy. The mean (+/-standard deviation) time required for serum progesterone concentrations to decrease to less than 1.5 ng/mL was significantly less for laparoscopic salpingostomy than for treatment with methotrexate: 7.8+/-1.7 and 17.6+/-2.2 days, respectively (P < .01). Within each treatment group, serum progesterone levels resolved (less than 1.5 ng/mL) more rapidly than did hCG levels (less than 15 mIU/mL) (P < .01). No further treatment was required once serum progesterone levels had decreased to less than 1.5 ng/mL. Success rates were similar in both groups: 94.7% (36 of 38) for methotrexate and 91.4% (33 of 36) for laparoscopic salpingostomy. Mean time required for hCG concentrations to decrease to less than 15 mIU/mL was significantly less for laparoscopic salpingostomy than for methotrexate therapy: 20.2+/-2.7 and 27.2+/-2.3 days, respectively (P < .05). Additional methotrexate injections were required in 15.8% (6 of 38) of women randomized to methotrexate therapy. Initial serum hCG levels for patients receiving additional methotrexate doses were 4830+/-1588 mIU/mL as compared with 2133+/-393 mIU/mL for women receiving only one dose (P = .07). CONCLUSION Serum progesterone levels of less than 1.5 ng/mL are a good predictor of ectopic pregnancy resolution regardless of treatment, and because its return to normal values occurs more rapidly than that of hCG levels, serum progesterone may be a better marker for predicting successful treatment. Although laparoscopic salpingostomy leads to faster resolution of hormonal markers of ectopic gestation, methotrexate is equally successful for treating small unruptured ectopic pregnancies. Initial hCG levels may be a marker for women requiring additional doses of methotrexate.
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Affiliation(s)
- A J Saraj
- Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Women's and Children's Hospital, Los Angeles, USA
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Abstract
Selected functional and spectroscopic properties of two human hemoglobin (HbA0) derivatives that were site-specifically cross-linked in the cleft between beta-chains where 2, 3-bisphosphoglycerate normally binds have been determined to assess the effects of the cross-linking on the behavior of the protein. Trimesoyl tris(3,5-dibromosalicylate) (TTDS) cross-links Hb between beta82Lys residues. The resulting TTDS-Hb exhibits a slower rate of oxygen dissociation and an increased rate of carbon monoxide association than observed for HbA0. The electron paramagnetic resonance (EPR) spectrum of TTDS-HbNO does not exhibit the hyperfine structure that is indicative of significant conformational change despite the fact that the 2,3-bisphosphoglycerate binding site is occupied by the cross-linking reagent. The reactivity of the beta93Cys residues of TTDS-Hb is only slightly decreased relative to that of HbA0. On the other hand, cross-linking Hb between Lys82 and the amino-terminal beta1Val group with trimesoyl tris(methyl phosphate) (TMMP) increases the rate of oxygen dissociation and reduces the rate of CO association relative to the rates observed for HbA0. In addition, the EPR spectrum of the TMMP-HbNO exhibits the three-line hyperfine structure that results from disruption of the proximal His-Fe bond of the alpha-chains, and the accessibility of the betaCys93 residues in this derivative is decreased fourfold. The present results are consistent with the conclusion that the quaternary structure of TTDS-Hb is shifted toward the R state whereas the quaternary structure of TMMP-Hb is shifted toward the T state and provides additional evidence that the identity of the residues involved in intramolecular cross-linking of hemoglobin within the 2,3-bisphosphoglycerate binding site between beta-chains can have a significant influence on the conformational and functional properties of the protein.
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Affiliation(s)
- M B Johnson
- Department of Biochemistry and Molecular Biology and the Protein Engineering Network of Centres of Excellence, University of British Columbia, Vancouver, British Columbia V6T 1Z3
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Das SK, Johnson MB, Runnels S, Cohly HH. Short-term macrophage interleukin-1 response to injected silicone in a rat model. Res Commun Mol Pathol Pharmacol 1998; 101:289-96. [PMID: 9874287] [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] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The short-term effects of silicone particles on the ability of splenic and peritoneal macrophages to produce Interleukin-1 (IL-1) were assessed. Lewis rats were divided into three groups. Group 1 animals (n=12) were injected subcutaneously with 2.5 ml of sterile saline; Group 2 animals (n=12) received 2.5 ml of Freund's Complete Adjuvant (FCA); Group 3 animals (n=12) received subcutaneous injections (2.5 ml) of a sonicated slurry comprised of equal parts of FCA and silicone. At days 1, 4, and 7 single-cell suspensions of splenic (10(8) cells/ml) and peritoneal (10(6) cells/ml) macrophages of four animals from each group were prepared. The supernatants from macrophages cultured in the presence or absence of lipopolysaccharide (LPS) were added to IL-1 dependent mouse thymocytes for 72 hrs, and subsequently pulsed with 3H-thymidine. Radioactivity incorporation was determined after 18 hrs. Peritoneal macrophage culture supernatants had significantly higher activity than splenic macrophages and all macrophages stimulated with LPS had significantly higher activity. At days 1 and 7, there were no significant differences in 3H-thymidine uptake. At day 4 there was an elevation of 3H-thymidine uptake from supernatant of peritoneal macrophages treated with FCA/silicone suggesting subcutaneous silicone injection has short-term effects.
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Affiliation(s)
- S K Das
- Dept. of Surgery, University of Mississippi Medical Center, Jackson 39216, USA
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Martin S, Jensen R, Daly L, Jergenson C, Johnson MB, Buell T. Comparison of two methods of bedside blood glucose screening in the NICU: evaluation of accuracy and reliability. Neonatal Netw 1997; 16:39-43. [PMID: 9087010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Bedside whole blood glucose screening in the NICU has been an accepted method of care for several years. Meters or visually read reagent strips are used in bedside screening, but the reliability and accuracy of these methods are not always established before they are implemented as routine practice in the NICU. A study was conducted to determine which method of bedside whole blood glucose screening was the more accurate: visually read Chemstrip bG reagent strips or the One Touch II meter method. The values obtained were compared with lab analysis of serum glucose, and a correlation study was performed to compare the accuracy and reliability of the values produced by the two methods. One hundred samples were obtained from 38 NICU infants; 63 percent of the 100 samples were compared with lab values. Results revealed that the One Touch II method was more reliable (r = .92) than the Chemstrip bG method (r = .87). Furthermore, the One Touch II results correlated better with lab values when the meter was not operated in the neonatal mode. This study revealed that the One Touch II method appears to provide safe and accurate screening of bedside blood glucose in a high-risk neonatal population.
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Affiliation(s)
- S Martin
- Sioux Valley Hospital, Sioux Falls, SD 57117-5039, USA
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Johnson MB. A piece of my mind. Three pictures, one child. JAMA 1996; 275:834. [PMID: 8596210 DOI: 10.1001/jama.275.11.834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Johnson MB, Koenraad PM, Salemink HW, Wolter JH. Be Delta-Doped Layers in GaAs Imaged with Atomic Resolution Using Scanning Tunneling Microscopy. Phys Rev Lett 1995; 75:1606-1609. [PMID: 10060340 DOI: 10.1103/physrevlett.75.1606] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Abstract
We reviewed a series of 83 catfish sting cases from inland hospitals (Belzoni and Indianola) and a coastal hospital (Pascagoula) to identify the type and severity of injury, as well as the type of treatment and its effectiveness. Oral cephalosporin was adequate in treating early infections.
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Affiliation(s)
- S K Das
- Department of Surgery, University of Mississippi Medical Center, Jackson 39216, USA
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Chen CM, Ernst DJ, Jiang MF, Johnson MB. Pion-nucleus scattering and baryon resonances in the nuclear medium. Phys Rev C Nucl Phys 1995; 52:R485-R489. [PMID: 9970622 DOI: 10.1103/physrevc.52.r485] [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: 05/22/2023]
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Stein SM, Laifer-Narin S, Johnson MB, Roman LD, Muderspach LI, Tyszka JM, Ralls PW. Differentiation of benign and malignant adnexal masses: relative value of gray-scale, color Doppler, and spectral Doppler sonography. AJR Am J Roentgenol 1995; 164:381-6. [PMID: 7839975 DOI: 10.2214/ajr.164.2.7839975] [Citation(s) in RCA: 99] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate prospectively the relative usefulness of color Doppler, spectral Doppler, and gray-scale sonography in differentiating benign from malignant adnexal masses. SUBJECTS AND METHODS A total of 170 adnexal masses in 161 patients were classified prospectively as suggestive of or not suggestive of malignant tumor on the basis of gray-scale morphology, internal flow versus peripheral or no flow, and spectral Doppler pulsatility, as measured by a pulsatility index (PI) threshold of 1.0 and a resistive index (RI) threshold of 0.4. RESULTS Surgical pathology revealed 123 benign masses and 46 malignant masses. One malignant mass was confirmed by cytologic evaluation of ascitic fluid. On gray-scale analysis, 46 of the 47 malignant masses were classified as suggestive of tumor, and 76 of the 123 benign masses were classified as not suggestive of tumor (sensitivity, 98%; specificity, 62%; negative predictive value [NPV], 99%; and positive predictive value [PPV], 50%). The use of internal color flow as a predictor of malignant tumor yielded a sensitivity of 77%, a specificity of 69%, an NPV of 89%, and a PPV of 49%. The PI and RI values were significantly lower (p < .0001) in malignant masses than in benign masses, although the values overlapped considerably. For a PI of less than 1.0, sensitivity was 67%, specificity was 66%, NPV was 83%, and PPV was 46%. For an RI of less than 0.4, sensitivity was 24%, specificity was 90%, NPV was 73%, and PPV was 50%. CONCLUSION In our series, a gray-scale prediction of benignity was reliable (NPV = 99%), and a prediction of malignancy was unreliable (PPV = 50%). Internal color flow was not useful as a predictor of malignancy (PPV = 49%). Although the absence of internal or peripheral color flow suggested benignity (NPV = 94%), only 17 (16 benign) of the masses (about 10%) had no flow. Spectral Doppler analysis with RI and PI was not useful, as no reliable discriminatory value with both high sensitivity and high specificity could be found for either parameter because of the overlap in values obtained for benign and malignant masses.
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Affiliation(s)
- S M Stein
- Department of Radiology, University of Southern California School of Medicine, Los Angeles 90033
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Johnson MB, Bowman JD. Microscopic, model-space approach to parity nonconservation in compound nuclei. Phys Rev C Nucl Phys 1995; 51:999-1013. [PMID: 9970142 DOI: 10.1103/physrevc.51.999] [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: 05/22/2023]
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Khankhasayev MK, Sarafian H, Johnson MB, Kurmanov ZB. Effect of pion external distortion on low-energy pion double charge exchange. Phys Rev C Nucl Phys 1994; 50:1424-1435. [PMID: 9969804 DOI: 10.1103/physrevc.50.1424] [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: 05/22/2023]
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Abstract
Preserving the integrity of high quality care in a financially restricted environment is the primary challenge facing healthcare providers. The critical question is which delivery system will use limited resources most efficiently without jeopardizing quality of care? Case management has been identified as a solution that offers the most promise. The case management model at Sioux Valley Hospital was developed to deal proactively with resource-intensive patients with chronic illnesses who have frequent admissions and who create financial risk for the hospital. The authors describe the fiscal and clinical outcomes of these select patients.
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Affiliation(s)
- S J Gibson
- Center for Case Management, Sioux Valley Hospital, SD
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Bartel J, Johnson MB, Singham M, Stocker W. Microscopic coupled-channel description of pion inelastic scattering from rotational nuclei. Phys Rev C Nucl Phys 1994; 49:2592-2601. [PMID: 9969508 DOI: 10.1103/physrevc.49.2592] [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: 05/22/2023]
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Abstract
Recent investigations suggest a role for antioxidants in preventing IDDM. MDL 29,311 (4,4'-[methylenebis(thio)]bis](1,1- dimethylethyl)]-phenol) is an analogue of the antioxidant probucol. Administered as a 1% dietary admixture to female nonobese diabetic mice from 4 to 24 wk of age, MDL reduced the prevalence of diabetes from 49 to 4% at 24 wk of age (n = 50-61/group). Discontinuation of treatment at 24 wk of age did not result in a rapid onset of diabetes. Probucol (1%) did not prevent diabetes. Initiating MDL treatment at 4 or 8 wk of age was more effective (19 and 17%, respectively, compared with 60% in control mice) than initiating treatment at 12 wk of age (30% diabetic; n = 28-35/group). A lower dose of MDL (0.1%), started at 4 wk of age, decreased the prevalence of diabetes to 36%. Histopathology indicated that MDL did not prevent insulitis. MDL (0.1%) also was evaluated in combination with immunosuppressants. Compared with control mice (65% diabetic), the combination of MDL and deflazacort was more effective (21% diabetic) than either agent alone (39% diabetic for MDL and 59% diabetic for deflazacort), whereas the effectiveness of MDL, cyclosporin, and MDL plus cyclosporin was similar (39, 38, and 34% diabetic, respectively). In another model of IDDM, the multiple-low-dose streptozocin-injected mouse, MDL (1%) also reduced the prevalence of diabetes when administered beginning 8 wk before streptozocin (55% diabetic vs. 100% of control mice; n = 20-25/group). Probucol (1%) was ineffective. MDL appears effective in preventing the onset of disease in two mouse models of IDDM.
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Affiliation(s)
- E W Heineke
- Marion Merrell Dow Research Institute, Cincinnati, OH 45215
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Sarafian H, Johnson MB, Siciliano ER. Medium modification of meson propagation between two nucleons in finite nuclei. Phys Rev C Nucl Phys 1993; 48:1988-1998. [PMID: 9969042 DOI: 10.1103/physrevc.48.1988] [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: 05/22/2023]
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