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Machamer J, Temkin N, Dikmen S, Nelson LD, Barber J, Hwang P, Boase K, Stein MB, Sun X, Giacino J, McCrea MA, Taylor SR, Jain S, Manley G. Symptom Frequency and Persistence in the First Year after Traumatic Brain Injury: A TRACK-TBI Study. J Neurotrauma 2022; 39:358-370. [PMID: 35078327 PMCID: PMC8892966 DOI: 10.1089/neu.2021.0348] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [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: 02/01/2023] Open
Abstract
Symptom endorsement after traumatic brain injury (TBI) is common acutely post-injury and is associated with other adverse outcomes. Prevalence of persistent symptoms has been debated, especially in mild TBI (mTBI). A cohort of participants ≥17 years with TBI (n = 2039), 257 orthopedic trauma controls (OTCs), and 300 friend controls (FCs) were enrolled in the TRACK-TBI study and evaluated at 2 weeks and 3, 6, and 12 months post-injury using the Rivermead Post-Concussion Symptoms Questionnaire (RPQ). TBI participants had significantly higher symptom burden than OTCs or FCs at all times, with average scores more than double. TBI cases showed significant decreases in RPQ score between each evaluation (p < 0.001), decreasing ∼1.7 points per month between 2 weeks and 3 months and 0.2 points per month after that. More than 50% of the TBI sample, including >50% of each of the mild and moderate/severe TBI subsamples, continued to endorse three or more symptoms as worse than pre-injury through 12 months post-injury. A majority of TBI participants who endorsed a symptom at 3 months or later did so at the next evaluation as well. Contrary to reviews that report symptom resolution by 3 months post-injury among those with mTBI, this study of participants treated at level 1 trauma centers and having a computed tomography ordered found that persistent symptoms are common to at least a year after TBI. Additionally, although symptom endorsement was not specific to TBI given that they were also reported by OTC and FC participants, TBI participants endorsed over twice the symptom burden compared with the other groups.
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Affiliation(s)
- Joan Machamer
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Nancy Temkin
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.,Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Sureyya Dikmen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Lindsay D Nelson
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Phillip Hwang
- Department of Anatomy and Neurobiology, Boston University, Boston, Massachusetts, USA
| | - Kim Boase
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Murray B Stein
- Department of Psychiatry and Herbert Wertheim School of Public Health, Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, California, USA
| | - Xiaoying Sun
- Biostatistics Research Center, Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, California, USA
| | - Joseph Giacino
- Department of Rehabilitation Medicine, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Michael A McCrea
- Department of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sabrina R Taylor
- Brain and Spinal Injury Center, San Francisco, California, USA.,Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Sonia Jain
- Biostatistics Research Center, Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, California, USA
| | - Geoff Manley
- Brain and Spinal Injury Center, San Francisco, California, USA.,Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
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Bang Y, Van Cutsem E, Fuchs C, Ohtsu A, Tabernero J, Ilson D, Hyung W, Strong V, Goetze T, Yoshikawa T, Tang L, Hwang P, Shitara K. A phase 3 study of chemotherapy + pembrolizumab vs chemotherapy + placebo as neoadjuvant/adjuvant treatment for patients with gastric or gastroesophageal junction (G/GEJ) cancer: KEYNOTE-585 - Trial in progress. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.095] [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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Gane E, Nahass R, Luketic V, Asante-Appiah E, Hwang P, Robertson M, Wahl J, Barr E, Haber B. Efficacy of 12 or 18 weeks of elbasvir plus grazoprevir with ribavirin in treatment-naïve, noncirrhotic HCV genotype 3-infected patients. J Viral Hepat 2017; 24:895-899. [PMID: 28470815 DOI: 10.1111/jvh.12719] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 01/05/2017] [Accepted: 04/03/2017] [Indexed: 12/13/2022]
Abstract
Elbasvir (EBR; HCV NS5A inhibitor) and grazoprevir (GZR; HCV NS3/4A protease inhibitor) are approved as a fixed-dose combination to treat patients chronically infected with HCV genotypes 1 and 4. During the development programme and supported by in vitro potency, the efficacy of EBR+GZR was assessed in HCV GT3-infected patients. This study's aim was to determine the efficacy and tolerability of 12 or 18 weeks of EBR+GZR with ribavirin (RBV) in treatment-naïve, noncirrhotic HCV GT3-infected patients. Randomized patients received open-label EBR (50 mg once daily) + GZR (100 mg once daily) + RBV. The primary efficacy objective was to evaluate the sustained virologic response rates 12 weeks after the end of all study therapy (SVR12). SVR12 rates (95% confidence interval) were 45.0% (23.1, 68.5) and 57.1% (34.0, 78.2) after treatment with EBR+GZR+RBV for 12 weeks or 18 weeks, respectively. On-treatment virologic failure was observed in 41% (17 of 41) of patients. At virologic failure, resistance-associated substitutions (RASs) with a >five-fold shift in potency occurred in the NS3 region in six (35%) patients and in the NS5A region in 16 (94%) patients. The most common RAS at virologic failure was Y93H in NS5A which was identified in 13 of 17 (76%) patients. The efficacy of EBR+GZR+RBV was suboptimal in HCV GT3-infected patients due to a high rate of on-treatment virologic failure and treatment-emergent RASs which demonstrates an inadequate barrier to the development of GT3 resistance. However, rapid viral clearance demonstrated the antiviral activity of EBR+GZR+RBV in GT3-infected patients.clinicaltrials.gov: NCT01717326.
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Affiliation(s)
- E Gane
- Auckland Clinical Studies, Grafton, Auckland, New Zealand
| | | | - V Luketic
- Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.,Hunter Holmes McGuire Department of Veterans Affairs Medical Center, Richmond, VA, USA
| | | | - P Hwang
- Merck & Co., Inc., Kenilworth, NJ, USA
| | | | - J Wahl
- Merck & Co., Inc., Kenilworth, NJ, USA
| | - E Barr
- Merck & Co., Inc., Kenilworth, NJ, USA
| | - B Haber
- Merck & Co., Inc., Kenilworth, NJ, USA
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Reau N, Robertson M, Feng H, Caro L, Yeh W, Nguyen B, Wahl J, Barr E, Hwang P, Klopfer S. P64 Concomitant proton pump inhibitor use does not reduce the efficacy of elbasvir/grazoprevir. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30805-0] [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: 10/23/2022] Open
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Gane E, Ben Ari Z, Mollison L, Zuckerman E, Bruck R, Baruch Y, Howe AYM, Wahl J, Bhanja S, Hwang P, Zhao Y, Robertson MN. Efficacy and safety of grazoprevir + ribavirin for 12 or 24 weeks in treatment-naïve patients with hepatitis C virus genotype 1 infection. J Viral Hepat 2016; 23:789-97. [PMID: 27291249 DOI: 10.1111/jvh.12552] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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] [Received: 02/29/2016] [Accepted: 04/10/2016] [Indexed: 12/11/2022]
Abstract
Grazoprevir (GZR) is a second-generation hepatitis C virus NS3/4A protease inhibitor. The aim of this study was to evaluate GZR plus ribavirin (RBV) in patients with HCV GT1 infection. Noncirrhotic, IL28B CC patients with HCV genotype 1 infection were randomized to GZR 100 mg once daily and RBV for 12 or 24 weeks. Patients in the 12-week arm with detectable HCV RNA at treatment week 4 (TW4) had treatment extended to 24 weeks (response-guided therapy, RGT). The primary endpoint was sustained virologic response (SVR12) at follow-up week 12 (HCV RNA <25 IU/mL) in the per-protocol (PP) population (excluding patients with important protocol deviations). Twenty-six patients were randomized and 22 were included in the PP population. SVR12 was 58.3% (7 of 12) and 90% (9 of 10) in the RGT and 24-week arms, respectively. Seven PP patients had virologic failure, including one patient in the 24-week arm who relapsed after follow-up week 12. All three breakthrough patients had wild-type (WT) virus at baseline and developed breakthrough at TW6 or TW12 with Y56H, A156T and D168A/N mutations. Of the five relapse patients, four had WT at baseline (at relapse three had WT and one had V55A and D168A), and one had S122A/T at baseline and S122T at relapse. There were no serious adverse events (AEs), discontinuations due to AEs or grade 3/4 elevations in total and/or direct bilirubin. Grazoprevir plus RBV was associated with a rapid and sustained suppression of HCV RNA. These results support further evaluation of grazoprevir-based regimens (NCT01716156; protocol P039).
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Affiliation(s)
- E Gane
- Auckland Clinical Studies, Auckland, New Zealand.
| | - Z Ben Ari
- Liver Disease Center, Sheba Medical Center, Ramat Gan, Israel.,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - L Mollison
- Fremantle Hepatitis Services, Fremantle Hospital, Fremantle, WA, Australia
| | - E Zuckerman
- Liver Unit, Carmel Medical Center Technion Faculty of Medicine, Haifa, Israel
| | - R Bruck
- Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Y Baruch
- Liver Unit, Rambam Healthcare Campus and the Technion Faculty of Medicine, Haifa, Israel
| | | | - J Wahl
- Merck & Co., Inc., Kenilworth, NJ, USA
| | - S Bhanja
- Merck & Co., Inc., Kenilworth, NJ, USA
| | - P Hwang
- Merck & Co., Inc., Kenilworth, NJ, USA
| | - Y Zhao
- Merck & Co., Inc., Kenilworth, NJ, USA
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Lagging M, Brown A, Mantry PS, Ramji A, Weilert F, Vierling JM, Howe A, Gendrano IN, Hwang P, Zhang B, Wahl J, Robertson M, Mobashery N. Grazoprevir plus peginterferon and ribavirin in treatment-naive patients with hepatitis C virus genotype 1 infection: a randomized trial. J Viral Hepat 2016; 23:80-8. [PMID: 26353843 DOI: 10.1111/jvh.12464] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 06/29/2015] [Accepted: 08/12/2015] [Indexed: 12/30/2022]
Abstract
UNLABELLED Grazoprevir (MK-5172, Merck & Co., Inc.) is a selective inhibitor of the hepatitis C virus (HCV) NS3/4a protease. The aim of this study was to evaluate the safety and efficacy of grazoprevir at doses of 25-100 mg/day in combination with peginterferon and ribavirin (PEG-IFN/RBV). In this randomized, dose-ranging, multicentre trial, treatment-naive adults with chronic HCV genotype 1 infection received once-daily grazoprevir 25 mg, 50 mg or 100 mg plus PEG-IFN/RBV for 12 weeks. Patients with quantifiable HCV RNA (≥25 IU/mL) at week 4 received an additional 12 weeks of PEG-IFN/RBV. The primary endpoint was sustained virologic response (HCV RNA <25 IU/mL 12 weeks after completing therapy [SVR12]). Eighty-seven patients were randomly assigned and received ≥1 dose of therapy. Median time to undetectable HCV RNA was 16 days in the 100-mg arm and 22 days in the 25- and 50-mg arms. All patients except one had HCV RNA undetectable or unquantifiable at week 4 and received 12 weeks of therapy. SVR12 was achieved by 13 of 24 (54.2%), 21 of 25 (84.0%) and 23 of 26 (88.5%) patients in the 25-, 50- and 100-mg arms, respectively (per-protocol analysis). Three patients discontinued as a result of nonserious adverse events (AEs) and three patients experienced serious AEs. Transaminase elevations occurred in two patients (one each in the 25- and 100-mg arms). CONCLUSION These data support further study of the grazoprevir 100-mg dose. Phase 3 studies of grazoprevir 100 mg in combination with elbasvir are currently ongoing (NCT01710501; protocol P038).
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Affiliation(s)
- M Lagging
- Institute of Biomedicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - A Brown
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - P S Mantry
- The Liver Institute at Methodist Dallas Medical Center, Dallas, TX, USA
| | - A Ramji
- University of British Columbia, Vancouver, BC, Canada
| | - F Weilert
- Waikato District Health Board, Hamilton, New Zealand
| | | | - A Howe
- Merck & Co. Inc., Kenilworth, NJ, USA
| | | | - P Hwang
- Merck & Co. Inc., Kenilworth, NJ, USA
| | - B Zhang
- Merck & Co. Inc., Kenilworth, NJ, USA
| | - J Wahl
- Merck & Co. Inc., Kenilworth, NJ, USA
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Poordad F, Lawitz E, Gutierrez J, Evans B, Howe A, Feng HP, Li J, Hwang P, Robertson M, Wahl J, Barr E, Haber B. O006 : C-swift: grazoprevir/elbasvir + sofosbuvir in cirrhotic and noncirrhotic, treatment-naive patients with hepatitis C virus genotype 1 infection, for durations of 4, 6 or 8 weeks and genotype 3 infection for durations of 8 or 12 weeks. J Hepatol 2015. [DOI: 10.1016/s0168-8278(15)30013-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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Shamji M, Moon ES, Glennie R, Soroceanu A, Lin C, Bailey C, Simmonds A, Fehlings M, Dodwell E, Dold A, El-Hawary R, Hashem M, Dold A, Dold A, Jones S, Bailey C, Karadimas S, Whitehurst D, Norton J, Norton J, Manson N, Kesani A, Bednar D, Lundine K, Hartig D, Fichadi A, Fehlings M, Kim S, Harris S, Lin C, Gill J, Abraham E, Shamji M, Choi S, Goldstein C, Wang Z, McCabe M, Noonan V, Nadeau M, Ferrara S, Kelly A, Melnyk A, Arora D, Quateen A, Dea N, Ranganathan A, Zhang Y, Casha S, Rajamanickam K, Santos A, Santos A, Wilson J, Wilson J, Street J, Wilson J, Lewis R, Noonan V, Street J, El-Hawary R, Egge N, Lin C, Schouten R, Lin C, Kim A, Kwon B, Huang E, Hwang P, Allen K, Jing L, Mata B, Gabr M, Richardson W, Setton L, Karadimas S, Fehlings M, Fleming J, Bailey C, Gurr K, Bailey S, Siddiqi F, Lawendy A, Sanders D, Staudt M, Canacari E, Brown E, Robinson A, McGuire K, Chrysostoum C, Rampersaud YR, Dvorak M, Thomas K, Boyd M, Gurr K, Bailey S, Nadeau M, Fisher C, Batke J, Street J, Boyd M, Dvorak M, Fisher C, Kwon B, Paquette S, Vaccaro A, Chapman J, Arnold P, Shaffrey C, Kopjar B, Snyder B, Wright J, Lewis S, Zeller R, El-Hawary R, Moroz P, Bacon S, Jarzem P, Hedden D, Howard J, Sturm P, Cahill P, Samdani A, Vitale M, Gabos P, Bodin N, d’Amato C, Harris C, Smith J, Parent E, Hill D, Hedden D, Moreau M, Mahood J, Lewis S, Bodrogi A, Abbas H, Goldstein S, Bronstein Y, Bacon S, Chua S, Magana S, Van Houwelingen A, Halpern E, Jhaveri S, Lewis S, Lim A, Leelapattana P, Fleming J, Siddiqqi F, Bailey S, Gurr K, Moon ES, Satkunendrarajah K, Fehlings M, Noonan V, Dvorak M, Bryan S, Aronyk K, Fox R, Nataraj A, Pugh J, Elliott R, McKeon M, Abraham E, Fleming J, Gurr K, Bailey S, Siddiqi F, Bailey C, Davis G, Rogers M, Staples M, Quan G, Batke J, Boyd M, Dvorak M, Fisher C, Kwon B, Paquette S, Street J, Shamji M, Hurlbert R, Jacobs W, Duplessis S, Casha S, Jha N, Hewson S, Massicotte E, Kopjar B, Mortaz S, Coyte P, Rampersaud Y, Rampersaud Y, Goldstein S, Andrew B, Modi H, Magana S, Lewis S, Roffey D, Miles I, Wai E, Manson N, Eastwood D, Elliot R, McKeon M, Bains I, Yong E, Sutherland G, Hurlbert R, Rampersaud Y, Chan V, Persaud O, Koshkin A, Brull R, Hassan N, Petis S, Kowalczuk M, Petrisor B, Drew B, Bhandari M, DiPaola C, Boyd M, Dvorak M, Fisher C, Kwon B, Paquette S, Street J, McLachlin S, Bailey S, Gurr K, Bailey C, Dunning C, Fehlings M, Vaccaro A, Wing P, Itshayek E, Biering-Sorensen F, Dvorak M, McLachlin S, Bailey S, Gurr K, Dunning C, Bailey C, Bradi A, Pokrupa R, Batke J, Boyd M, Dvorak M, Fisher C, Kwon B, Paquette S, Street J, Kelly A, Wen T, Kingwell S, Chak J, Singh V, Cripton P, Fisher C, Dvorak M, Oxland T, Wali Z, Yen D, Alfllouse A, Alzahrani A, Jiang H, Mahood J, Kortbeek F, Fox R, Nataraj A, Street J, Boyd M, Paquette S, Kwon B, Batke J, Dvorak M, Fisher C, Reddy R, Rampersaud R, Hurlbert J, Yong W, Casha S, Zygun D, McGowan D, Bains I, Yong V, Hurlbert R, Mendis B, Chakraborty S, Nguyen T, Tsai E, Chen A, Atkins D, Noonan V, Drew B, Tsui D, Townson A, Dvorak M, Chen A, Atkins D, Noonan V, Drew B, Dvorak M, Craven C, Ford M, Ahn H, Drew B, Fehlings M, Kiss A, Vaccaro A, Harrop J, Grossman R, Frankowski R, Guest J, Dvorak M, Aarabi B, Fehlings M, Noonan V, Cheung A, Sun B, Dvorak M, Vaccaro A, Harrop J, Massicotte E, Dvorak M, Fisher C, Rampersaud R, Lewis S, Fehlings M, Marais L, Noonan V, Queyranne M, Fehlings M, Dvorak M, Atkins D, Hurlbert R, Fox R, Fourney D, Johnson M, Fehlings M, Ahn H, Ford M, Yee A, Finkelstein J, Tsai E, Bailey C, Drew B, Paquet J, Parent S, Christie S, Dvorak M, Noonan V, Cheung A, Sun B, Dvorak M, Sturm P, Cahill P, Samdani A, Vitale M, Gabos P, Bodin N, d’Amato C, Harris C, Smith J, Lange J, DiPaola C, Lapinsky A, Connolly P, Eck J, Rabin D, Zeller R, Lewis S, Lee R, Boyd M, Dvorak M, Fisher C, Kwon B, Paquette S, DiPaola C, Street J, Bodrogi A, Goldstein S, Sofia M, Lewis S, Shin J, Tung K, Ahn H, Lee R, Batke J, Ghag R, Noonan V, Dvorak M, Goyal T, Littlewood J, Bains I, Cho R, Thomas K, Swamy G. Canadian Spine Society abstracts1.1.01 Supraspinal modulation of gait abnormalities associated with noncompressive radiculopathy may be mediated by altered neurotransmitter sensitivity1.1.02 Neuroprotective effects of the sodium-glutamate blocker riluzole in the setting of experimental chronic spondylotic myelopathy1.1.03 The effect of timing to decompression in cauda equina syndrome using a rat model1.2.04 Intraoperative waste in spine surgery: incidence, cost and effectiveness of an educational program1.2.05 Looking beyond the clinical box: the health services impact of surgical adverse events1.2.06 Brace versus no brace for the treatment of thoracolumbar burst fractures without neurologic injury: a multicentre prospective randomized controlled trial1.2.07 Adverse event rates in surgically treated spine injuries without neurologic deficit1.2.08 Functional and quality of life outcomes in geriatric patients with type II odontoid fracture: 1-year results from the AOSpine North America Multi-Center Prospective GOF Study1.3.09 National US practices in pediatric spinal fusion: in-hospital complications, length of stay, mortality, costs and BMP utilization1.3.10 Current trends in the surgical treatment of adolescent idiopathic scoliosis in Canada1.3.11 Sagittal spinopelvic parameters help predict the risk of proximal junctional kyphosis for children treated with posterior distraction-based implants1.4.12 Correlations between changes in surface topography and changes in radiograph measurements from before to 6 months after surgery in adolescents with idiopathic scoliosis1.4.13 High upper instrumented vertebra (UIV) sagittal angle is associated with UIV fracture in adult deformity corrections1.4.14 Correction of adult idiopathic scoliosis using intraoperative skeletal traction1.5.01 Cauda equina: using management protocols to reduce delays in diagnosis1.5.02 Predicting the need for tracheostomy in patients with acute traumatic spinal cord injury1.5.03 A novel animal model of cervical spondylotic myelopathy: an opportunity to identify new therapeutic targets1.5.04 A review of preference-based measures of health-related quality of life in spinal cord injury research1.5.05 Predicting postoperative neuropathic pain following surgery involving nerve root manipulation based on intraoperative electromyographic activity1.5.06 Detecting positional injuries in prone spinal surgery1.5.07 Percutaneous thoracolumbar stabilization for trauma: surgical morbidity, clinical outcomes and revision surgery1.5.08 Systemic inflammatory response syndrome in spinal cord injury patients: Does its presence at admission affect patient outcomes?2.1.15 One hundred years of spine surgery — a review of the evolution of our craft and practice in the spine surgical century [presentation]2.1.16 Prevalence of preoperative MRI findings of adjacent segment disc degeneration in patients undergoing anterior cervical discectomy and fusion2.1.17 Adverse event rates of surgically treated cervical spondylopathic myelopathy2.1.18 Morphometricand dynamic changes in the cervical spine following anterior cervical discectomy and fusion and cervical disc arthroplasty2.1.19 Is surgery for cervical spondylotic myelopathy cost-effective? A cost–utility analysis based on data from the AO Spine North American Prospective Multicentre CSM Study2.2.20 Cost–utility of lumbar decompression with or without fusion for patients with symptomatic degenerative lumbar spondylolisthesis (DLS)2.2.21 Minimally invasive surgery lumbar fusion for low-grade isthmic and degenerative spondylolisthesis: 2- to 5-year follow-up2.2.22 Results and complications of posterior-only reduction and fusion for high-grade spondylolisthesis2.3.23 Fusion versus no fusion in patients with central lumbar spinal stenosis and foraminal stenosis undergoing decompression surgery: comparison of outcomes at baseline and follow-up2.3.24 Two-year results of interspinous spacers (DIAM) as an alternative to arthrodesis for lumbar degenerative disorders2.3.25 Treatment of herniated lumbar disc by sequestrectomy or conventional discectomy2.4.26 No sustained benefit of continuous epidural analgesia for minimally invasive lumbar fusion: a randomized double-blinded placebo controlled study2.4.27 Evidence and current practice in the radiologic assessment of lumbar spine fusion2.4.28 Wiltse versus midline approach for decompression and fusion of the lumbar spine2.5.09 The effect of soft tissue restraints following type II odontoid fractures in the elderly — a biomechanical study2.5.10 Development of an international spinal cord injury (SCI) spinal column injury basic data set2.5.11 Evaluation of instrumentation techniques for a unilateral facet perch and fracture using a validated soft tissue injury model2.5.12 Decreasing neurologic consequences in patients with spinal infection: the testing of a novel diagnostic guideline2.5.13 Prospective analysis of adverse events in surgical treatment of degenerative spondylolisthesis2.5.14 Load transfer characteristics between posterior fusion devices and the lumbar spine under anterior shear loading: an in vitro investigation2.5.15 Preoperative predictive clinical and radiographic factors influencing functional outcome after lumbar discectomy2.5.16 A Thoracolumbar Injury Classification and Severity Score (TLICS) of 4: What should we really do?3.1.29 Adverse events in emergent oncologic spine surgery: a prospective analysis3.1.30 En-bloc resection of primary spinal and paraspinal tumours with critical vascular involvement3.1.31 The treatment impact of minocycline on quantitative MRI in acute spinal cord injury3.1.32 Benefit of minocycline in spinal cord injury — results of a double-blind randomized placebo-controlled study3.2.33 Improvement of magnetic resonance imaging correlation with unilateral motor or sensory deficits using diffusion tensor imaging3.2.34 Comparing care delivery for acute traumatic spinal cord injury in 2 Canadian centres: How do the processes of care differ?3.2.35 Improving access to early surgery: a comparison of 2 centres3.3.36 The effects of early surgical decompression on motor recovery after traumatic spinal cord injury: results of a Canadian multicentre study3.3.37 A clinical prediction model for long-term functional outcome after traumatic spinal cord injury based on acute clinical and imaging factors3.3.38 Effect of motor score on adverse events and quality of life in patients with traumatic spinal cord injury3.4.39 The impact of facet dislocation on neurologic recovery after cervical spinal cord injury: an analysis of data on 325 patients from the Surgical Trial in Acute Spinal Cord Injury Study (STASCIS)3.4.40 Toward a more precise understanding of the epidemiology of traumatic spinal cord injury in Canada3.4.41 Access to care (ACT) for traumatic SCI: a survey of acute Canadian spine centres3.4.42 Use of the Spine Adverse Events Severity (SAVES) instrument for traumatic spinal cord injury3.5.17 Does the type of distraction-based growing system for early onset scoliosis affect postoperative sagittal alignment?3.5.18 Comparison of radiation exposure during thoracolumbar fusion using fluoroscopic guidance versus anatomic placement of pedicle screws3.5.19 Skeletal traction for intraoperative reduction in adolescent idiopathic scoliosis3.5.20 Utility of intraoperative cone-beam computed tomography (O-ARM) and stereotactic navigation in acute spinal trauma surgery3.5.21 Use of a central compression rod to reduce thoracic level spinal osteotomies3.5.22 ICD-10 coding accuracy for spinal cord injured patients3.5.23 Feasibility of patient recruitment in acute SCI trials3.5.24 Treatment of adult degenerative scoliosis with DLIF approaches. Can J Surg 2012. [DOI: 10.1503/cjs.012212] [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: 11/01/2022] Open
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Wu Z, Jiao P, Huang X, Feng B, Feng Y, Yang S, Hwang P, Du J, Nie Y, Xiao G, Xu H. MAPK phosphatase-3 promotes hepatic gluconeogenesis through dephosphorylation of forkhead box O1 in mice. J Clin Invest 2010; 120:3901-11. [PMID: 20921625 DOI: 10.1172/jci43250] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 08/18/2010] [Indexed: 11/17/2022] Open
Abstract
Insulin resistance results in dysregulated hepatic gluconeogenesis that contributes to obesity-related hyperglycemia and progression of type 2 diabetes mellitus (T2DM). Recent studies show that MAPK phosphatase-3 (MKP-3) promotes gluconeogenic gene transcription in hepatoma cells, but little is known about the physiological role of MKP-3 in vivo. Here, we have shown that expression of MKP-3 is markedly increased in the liver of diet-induced obese mice. Consistent with this, adenovirus-mediated MKP-3 overexpression in lean mice promoted gluconeogenesis and increased fasting blood glucose levels. Conversely, shRNA knockdown of MKP-3 in both lean and obese mice resulted in decreased fasting blood glucose levels. In vitro experiments identified forkhead box O1 (FOXO1) as a substrate for MKP-3. MKP-3-mediated dephosphorylation of FOXO1 at Ser256 promoted its nuclear translocation and subsequent recruitment to the promoters of key gluconeogenic genes. In addition, we showed that PPARγ coactivator-1α (PGC-1α) acted downstream of FOXO1 to mediate MKP-3-induced gluconeogenesis. These data indicate that MKP-3 is an important regulator of hepatic gluconeogenesis in vivo and suggest that inhibition of MKP-3 activity may provide new therapies for T2DM.
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Affiliation(s)
- Zhidan Wu
- Cardiovascular and Metabolism, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts 02139, USA.
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10
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Abstract
AIM The aim of the present study was to explore the variation of parents' descriptions and experiences of their child that was recently identified to have an intellectual disability (ID). METHODS The study applied interpretative phenomenological analysis and analysis of narrative style looking at content and form of parental narratives. Data was collected from nine fathers and eight mothers through semi-structured interviews within 6 months following diagnosis. RESULTS Analysis revealed three factors indicating the parents' level of processing: (1) emotional expressions regarding the child - varying between limited (distanced or idealized) and balanced/affectionate; (2) experience of the disability - varying between preoccupation and acceptance; and (3) time orientation - varying in terms of flexibility and temporal focus. CONCLUSIONS Although parents of children with ID describe negative emotions in relation to the child and the disability, most of these parents also describe positive emotions that seemed to balance the negative experiences.
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Affiliation(s)
- P K Boström
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden.
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11
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Tanimoto K, Le T, Zhu L, Witkowska HE, Robinson S, Hall S, Hwang P, Denbesten P, Li W. Reduced amelogenin-MMP20 interactions in amelogenesis imperfecta. J Dent Res 2008; 87:451-5. [PMID: 18434575 DOI: 10.1177/154405910808700516] [Citation(s) in RCA: 13] [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: 11/16/2022] Open
Abstract
Amelogenin with a proline 41 to threonine mutation (P41T) is hydrolyzed at a lower rate by matrix metalloproteinase 20 (MMP20), resulting in an inherited tooth enamel defect, amelogenesis imperfecta (AI). The aim of this study was to elucidate the effect of P41T on the interactions between amelogenin and MMP20, which may contribute to the formation of this type of AI. The interactions of a recombinant wild-type human amelogenin and its P41T mutant with recombinant human MMP20 were compared by substrate competition assay, pull-down assay, and surface plasmon resonance (SPR). The results showed that the binding of the P41T mutant amelogenin for MMP20 was significantly lower than that of wild-type amelogenin. Our study supports a model in which the P41T mutation reduces the interactions between amelogenin and MMP20, leading to decreased degradation of amelogenin by MMP20, and resulting in AI.
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Affiliation(s)
- K Tanimoto
- Department of Orofacial Sciences, School of Dentistry, University of California at San Francisco, San Francisco, CA 94143, USA
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12
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13
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Long Ho C, Hwang P, Yeak S, Seow J. Endoscopic Transnasal Approach to Clival Lesions. Skull Base 2005. [DOI: 10.1055/s-2005-916429] [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: 10/19/2022]
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14
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Shirhan MD, Moochhala SM, Ng PY, Lu J, Ng KC, Teo AL, Yap E, Ng I, Hwang P, Lim T, Sitoh YY, Rumpel H, Jose R, Ling E. Spermine reduces infarction and neurological deficit following a rat model of middle cerebral artery occlusion: a magnetic resonance imaging study. Neuroscience 2004; 124:299-304. [PMID: 14980380 DOI: 10.1016/j.neuroscience.2003.10.050] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2003] [Indexed: 10/26/2022]
Abstract
The role of nitric oxide (NO) in post-ischemic cerebral infarction has been extensively examined, but few studies have investigated its role on the neurological deficit. In the present study, we investigated the effect of spermine on the temporal evolution of infarct volume, NO production and neurological deficit using magnetic resonance imaging in a model of permanent focal cerebral ischemia in rats. Spermine given at 10 mg/kg 2 h after ischemia reduced the infarct volume by 40% and abolished brain NO production and improved the neurological score 24 h, 48 h and 72 h after ischemia. Spermine also reduced the neurological deficit as evaluated by rotamex, grip strength and neurological severity score tests.
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Affiliation(s)
- M D Shirhan
- Department of Pharmacology, National University of Singapore, Singapore
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15
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Fratzoglou M, Grunert P, Leite dos Santos A, Hwang P, Fries G. Symptomatic Cysts of the Cavum Septi Pellucidi and Cavum Vergae: The Role of Endoscopic Neurosurgery in the Treatment of Four Consecutive Cases. ACTA ACUST UNITED AC 2003; 46:243-9. [PMID: 14506571 DOI: 10.1055/s-2003-42351] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Cavum septi pellucidi and cavum vergae are generally asymptomatic fluid collections between the leaves of the septum pellucidum and are present in approximately 15 % of adult brains. These cavities rarely enlarge and become symptomatic causing significant neurological dysfunction as a result of obstruction of the interventricular foramina, distortion of the vascular structures of the deep venous system or compression of the hypothalamoseptal triangle. The authors present a series of four patients with symptoms related directly to pressure effects from the cyst wall to the neighbouring deep brain structures. There were two females and two males with a mean age of 47.5 years. All four patients underwent endoscopic cyst fenestration with a rigid endoscope. In 2 patients frameless neuronavigation was accomplished with the optical tracking system (Radionics, Burlington, USA). All symptoms related to pressure effect resolved after surgery. Endoscopic pellucidotomy of symptomatic cysts of the septum pellucidum produces immediate relief of the mass effect of the cyst and resolution of associated symptoms. Additionally, frameless neuronavigation is a useful tool in planning and realizing the approach and improving intraoperative orientation.
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Affiliation(s)
- M Fratzoglou
- Department of Neurosurgery, Medical School, University of Patras, Greece.
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16
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Abstract
Oceanic waves have been found to contribute enhanced back-scattering in the direction of the illumination source in studies that assumed the ocean surface to be a random sum of waves. Here we investigate enhanced back-scattering by coherent capillary-gravity wave trains that co-exist near the crests of short gravity waves in the ocean. We find that the enhanced back-scattering effect is intensified relative to that of a random surface and that the effect is observed at larger angles. This effect may not only affect active sensors such as lidar, which have a viewing angle close to that of the source but possibly passive sensors as well. This effect is likely to result in biases when attempting closure between radiative transfer models that do not include realistic representation of the ocean surface and observed water leaving radiance.
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17
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Wickberg B, Hwang P. [Do not minimize signs of postpartum depression! Early intervention essential to prevent negative consequences for the child]. Lakartidningen 2001; 98:1534-8. [PMID: 11330150] [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: 02/19/2023]
Abstract
Recent clinical research reveals that postnatal depression is associated with disturbances in the mother-infant relationship. These disturbances have in turn an adverse impact on the child's cognitive and emotional development. Postnatal depression affects 8-15 percent of women in the first months after delivery. The use of the Edinburgh Postnatal Depression Scale (EPDS) has proven useful in Swedish child health care to help nurses identify mothers with symptoms of depression. Weekly counselling visits by trained nurses are effective as the first treatment of choice for most women with postnatal depression.
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Affiliation(s)
- B Wickberg
- Psykologiska institutionen, Göteborgs universitet.
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18
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Blumenthal RL, Campbell DE, Hwang P, DeKruyff RH, Frankel LR, Umetsu DT. Human alveolar macrophages induce functional inactivation in antigen-specific CD4 T cells. J Allergy Clin Immunol 2001; 107:258-64. [PMID: 11174191 DOI: 10.1067/mai.2001.112845] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Alveolar macrophages (AMCs) are the most abundant phagocytic cells in the lung, but they present antigen poorly to T cells. OBJECTIVES The objectives of our studies were to more clearly define the mechanisms by which AMCs present antigen to T cells and to determine whether AMCs actively inhibit T-cell activation. METHODS We studied purified human CD4 T cells and compared the capacity of allogeneic AMCs and peripheral blood monocytes to induce T-cell proliferation and cytokine production. RESULTS We previously demonstrated that human AMCs fail to upregulate expression of B7-1 and B7-2 on stimulation with IFN-gamma. We now demonstrate that AMCs actively induce T-cell unresponsiveness (functional inactivation) in an antigen-specific manner and reduce the capacity of CD4 T cells to respond on secondary stimulation. The induction of unresponsiveness was reversed by the addition of CD28 costimulation or IL-2. However, interruption of Fas/Fas ligand interactions or of B7/CTLA-4 interactions did not prevent unresponsiveness, indicating that neither CTLA-4 triggering nor Fas-induced apoptosis was involved in the induction of T-cell unresponsiveness. CONCLUSIONS These studies indicate that AMCs actively tolerize CD4 T cells in an antigen-specific fashion. We propose that AMCs mediate a form of immune privilege in the lungs that effectively limits immune responses in the pulmonary compartment but has little effect on systemic immunity.
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Affiliation(s)
- R L Blumenthal
- Division of Immunology and Allergy, Department of Pediatrics, Stanford University, Calif 94305-5208, USA
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19
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Graveline C, Young N, Hwang P. Disability evaluation in children with hemidecorticectomy: use of the activity scales for kids and the pediatric evaluation disability inventory. J Child Neurol 2000; 15:7-14. [PMID: 10641602 DOI: 10.1177/088307380001500102] [Citation(s) in RCA: 8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study is to investigate the level of disability of children who are either candidates for or have undergone a hemidecorticectomy. The Activity Scales for Kids and the Pediatric Evaluation Disability Inventory were demonstrated to be useful measurement tools yielding comparative results between subgroups. Overall, children with congenital disease seemed less autonomous postoperatively than were preoperative patients or children with acquired disease. Age at surgery and the interval between seizure onset and surgery are potentially important predictors of disability. This could reflect the importance of timing of surgery, development, environment, and possibly brain plasticity processes in this population.
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Affiliation(s)
- C Graveline
- Department of Rehabilitation Services, The Hospital for Sick Children, Toronto, ON, Canada.
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20
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Tougas G, Chen Y, Hwang P, Liu MM, Eggleston A. Prevalence and impact of upper gastrointestinal symptoms in the Canadian population: findings from the DIGEST study. Domestic/International Gastroenterology Surveillance Study. Am J Gastroenterol 1999; 94:2845-54. [PMID: 10520832 DOI: 10.1111/j.1572-0241.1999.01427.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The prevalence and impact of upper gastrointestinal (GI) symptoms in the general population are poorly defined. Most data are obtained from selected samples derived from patients presenting to health care providers. As part of a larger international effort (The DIGEST study), we examined the prevalence of upper GI symptoms among the general Canadian population, as well as their psychosocial and economic impact. METHODS A sample of 1036 adults was studied, its demographic characteristics closely matching those of the general Canadian population. A validated detailed questionnaire measured the prevalence, severity, and frequency of 15 digestive symptoms, as well as demographic information, use of medication and medical resources, other illnesses, and dietary habits. The Psychological General Well-Being Index, a self-administered questionnaire, assessed the individual's subjective sense of well-being. RESULTS Of the sample population, 28.6% reported substantial symptoms in the preceding 3 months, the majority (111/153 subjects) for >1 yr; 34.1% reported having never experienced significant GI symptoms. The most bothersome symptoms were primarily related to dysmotility-like symptoms in 54.9% of those with chronic symptoms, ulcer-like symptoms in 12.4%, and related to heartburn in 42.5%. Chronic upper GI symptoms were associated with a highly significant (p < 0.001) decrease in all facets of the Psychological General Well Being Index. CONCLUSIONS Upper GI symptoms are very prevalent in the general Canadian population and substantially affect the quality-of-life and psychological well-being of those affected. Dysmotility-like symptoms, rather than heartburn, are the most common chronic upper gastrointestinal symptoms in the general population.
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Affiliation(s)
- G Tougas
- Intestinal Diseases Research Programme and Division of Gastroenterology, McMaster University, Hamilton, Ontario, Canada
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21
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Hwang P, Auclair B, Beechinor D, Diment M, Einarson T. Efficacy of Pentosan Polysulfate in the Treatment of Interstitial Cystitis: A Meta-Analysis. J Urol 1999. [DOI: 10.1016/s0022-5347(05)68907-0] [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: 11/28/2022]
Affiliation(s)
- P. Hwang
- Department of Clinical Pharmacology, Hospital for Sick Children, Wellesley Hospital and Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Jannsen-Ortho Canada, Ltd. and Faculty of Pharmacy, University of Montreal, Montreal, Quebec and Canadian Military Hospital, Langley, Vancouver, British Columbia, Canada
| | - B. Auclair
- Department of Clinical Pharmacology, Hospital for Sick Children, Wellesley Hospital and Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Jannsen-Ortho Canada, Ltd. and Faculty of Pharmacy, University of Montreal, Montreal, Quebec and Canadian Military Hospital, Langley, Vancouver, British Columbia, Canada
| | - D. Beechinor
- Department of Clinical Pharmacology, Hospital for Sick Children, Wellesley Hospital and Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Jannsen-Ortho Canada, Ltd. and Faculty of Pharmacy, University of Montreal, Montreal, Quebec and Canadian Military Hospital, Langley, Vancouver, British Columbia, Canada
| | - M. Diment
- Department of Clinical Pharmacology, Hospital for Sick Children, Wellesley Hospital and Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Jannsen-Ortho Canada, Ltd. and Faculty of Pharmacy, University of Montreal, Montreal, Quebec and Canadian Military Hospital, Langley, Vancouver, British Columbia, Canada
| | - T.R. Einarson
- Department of Clinical Pharmacology, Hospital for Sick Children, Wellesley Hospital and Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Jannsen-Ortho Canada, Ltd. and Faculty of Pharmacy, University of Montreal, Montreal, Quebec and Canadian Military Hospital, Langley, Vancouver, British Columbia, Canada
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22
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Graveline C, Hwang P, Bone G, Shikolka C, Wade S, Crawley A, Mikulis D. Evaluation of gross and fine motor functions in children with hemidecortication: predictors of outcomes and timing of surgery. J Child Neurol 1999; 14:304-15. [PMID: 10342598 DOI: 10.1177/088307389901400507] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study is three-fold: First, to determine the levels of gross and fine motor functions in children before and after hemidecortication, using standardized measurement tools; second, to investigate if predictors of these outcomes can be characterized; and third, to explore if both clinical measures and functional magnetic resonance imaging (MRI) potentially can identify optimal timing of surgery. The Gross Motor Function Measure and the Quality of Upper Extremity Skills Test are shown to be comprehensive, standardized outcome measures of movement performance in affected children. Age at surgery and interval between age at seizure onset and age at surgery could be the most reliable predictors of clinical outcomes. Functional MRI studies are valuable in exploring the potential of the cortical reorganization that sustains residual sensorimotor function. The combination of clinical measures with functional MRI is a promising method of inquiry into developmental and plasticity processes.
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Affiliation(s)
- C Graveline
- Department of Rehabilitation Services, The Hospital for Sick Children, Toronto, ON, Canada.
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23
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Guerreiro MM, Andermann F, Andermann E, Palmini A, Hwang P, Hoffman HJ, Otsubo H, Bastos A, Dubeau F, Snipes GJ, Olivier A, Rasmussen T. Surgical treatment of epilepsy in tuberous sclerosis: strategies and results in 18 patients. Neurology 1998; 51:1263-9. [PMID: 9818843 DOI: 10.1212/wnl.51.5.1263] [Citation(s) in RCA: 117] [Impact Index Per Article: 4.5] [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: 11/15/2022] Open
Abstract
BACKGROUND Seizures in patients with tuberous sclerosis complex (TSC) are often intractable to antiepileptic medications and searching investigation may provide evidence that surgical treatment can be considered. OBJECTIVE To review the results of investigation and surgical therapy, a treatment modality not generally considered in patients with medically refractory seizures and TSC. METHODS We report 18 patients (9 male) with TSC who underwent surgical treatment of medically refractory epilepsy. Twelve patients had a well-localized epileptogenic lesion and were treated by lesionectomy or focal resection. Resections were: 7 frontal, 4 temporal, 1 frontotemporal, 1 occipital, and 1 frontoparietal. Four patients underwent more than one operation. Six patients had corpus callosotomy (CC). RESULTS Follow-up ranged from 1 month to 47 years. Outcome of the patients treated by resection was excellent in 7 (5 were seizure-free and 2 had auras only), good in 1, fair in 3, and 1 was lost to follow-up. Best outcome was obtained in patients who had focal seizures and good imaging and EEG correlation, although they might have multiple seizure types, other imaging abnormalities, and multifocal or generalized EEG findings. When there was no such correlation, CC was found to be an option as five patients had at least some improvement and only one showed no change. CONCLUSION Surgical treatment of patients with TSC and intractable epilepsy is most effective when a single tuber or epileptogenic area can be identified as the source of seizures and resected. This may be possible even when other tubers or diffuse EEG abnormalities are present. In patients with unlocalizable epileptic abnormalities, palliation may be obtained by CC.
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Affiliation(s)
- M M Guerreiro
- Department of Neurology and Neurosurgery, and Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada
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Abstract
Primary brain tumors with prominent desmoplasia include the gliofibroma, desmoplastic infantile ganglioglioma (DIG), pleomorphic xanthoastrocytoma (PXA), and desmoplastic cerebral astrocytoma. In the present report, we describe unusual pathological appearances in two successive resections of a left temporal tumor in a patient with complex partial seizures. Both tumors showed focal astroglial and very prominent neuronal differentiation. In the first resection at age 11 years, the tumor showed only focal desmoplastic areas and prominent neuronal differentiation with bizarre atypical giant cells. In the second resection at age 14 years, the morphology was dramatically different. Now the tumor showed marked desmoplasia with tumor cells coexpressing neuronal and glial markers. Electron microscopy showed prominent neuronal differentiation in both resections and presence of basal lamina around tumor cells. Our case represents a unique example of an extraordinary degree of neuronal differentiation in a desmoplastic cerebral tumor. While cellular pleomorphism in a desmoplastic tumor traditionally suggests the diagnosis of PXA, we wish to underscore that many cells exhibiting marked cytologic atypia may in fact be of neuronal rather than of glial origin as in our case.
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Affiliation(s)
- V Jay
- Division of Pathology, Hospital for Sick Children, Toronto, Ontario, Canada
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25
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Abstract
Mucosal changes have been well described in chronic sinusitis, yet little is known about the underlying bone, despite clinical and experimental evidence suggesting that bone may be involved in chronic sinusitis. Techniques of undecalcified bone analysis were used for detailed histologic examination of ethmoid bone in chronic sinusitis compared with controls. Bone synthesis, resorption, and inflammatory cell presence were specifically assessed. Additionally, histomorphometry techniques were used to determine ethmoid bone physiology in individuals undergoing surgery for chronic sinusitis. Overall, individuals undergoing surgery for chronic sinusitis were found to have evidence of marked acceleration in bone physiology with histologic changes including new bone formation, fibrosis, and presence of inflammatory cells. These findings are compared with osteomyelitis in long bone and the jaw. The suggestion that underlying bone may serve as a catalyst for chronic sinusitis is supported and implications for therapy are discussed.
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Affiliation(s)
- D W Kennedy
- Department of Otorhinolaryngology--Head and Neck Surgery, University of Pennsylvania Medical Center, Philadelphia, USA
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26
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Jay V, Hwang P, Hoffman HJ, Becker LE, Zielenska M. Intractable seizure disorder associated with chronic herpes infection. HSV1 detection in tissue by the polymerase chain reaction. Childs Nerv Syst 1998; 14:15-20. [PMID: 9548334 DOI: 10.1007/s003810050167] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We describe the pathological findings and report the detection of herpes simplex virus 1 (HSV1) in the brain in three patients who presented with intractable seizures. All three patients had a previous history of HSV1 encephalitis and went on to develop a medically refractory seizure disorder necessitating surgical intervention. HSV1 encephalitis was clinically diagnosed and treated at 6 months, 3 years, and 7 months and surgical resection was done at 8.5 years, 6 years, and 3 years, in cases 1, 2 and 3, respectively. Pathological examination revealed chronic encephalitis in all three cases, with microglial nodules, intraparenchymal, perivascular and meningeal lymphocytic infiltrates, and gliosis. While immunohistochemical and ultrastructural studies were negative for viral pathogens, polymerase chain reaction (PCR) analysis revealed HSV1 genome. These cases represent examples of chronic herpes encephalitis and seizure disorder with presence of viral genome in the brain long after the initial episode of treated herpes encephalitis.
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Affiliation(s)
- V Jay
- Bloorview Epilepsy Program, University of Toronto, Ontario, Canada.
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27
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Gorodischer R, Burtin P, Verjee Z, Hwang P, Koren G. Is saliva suitable for therapeutic monitoring of anticonvulsants in children: an evaluation in the routine clinical setting. Ther Drug Monit 1997; 19:637-42. [PMID: 9421104 DOI: 10.1097/00007691-199712000-00006] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [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: 02/05/2023]
Abstract
Studies performed in the research setting suggested that saliva instead of blood may be used for therapeutic drug monitoring (TDM) of anticonvulsants in children. This is an attractive alternative because its collection is painless, and simpler and cheaper than blood drawing. Citric acid stimulation of saliva secretion facilitates sampling in the youngest patients. The aim of the study was to evaluate the suitability of saliva in routine TDM of anticonvulsants in infants and children with epilepsy. Blood and saliva samples were obtained simultaneously during routine TDM in 170 patients on chronic anticonvulsant drug therapy attending a neurology clinic. Saliva, plasma total, and plasma free concentrations of anticonvulsants were measured by high-performance liquid chromatography and enzyme multiplied immunoassay technique. Strong and highly significant correlations between saliva and plasma concentrations were found over a wide range of concentrations for carbamazepine, phenytoin, clobazam, and desmethylclobazam, and for phenobarbital in children > or = 8 years of age (r = 0.90 to 0.97; p < 0.001). Correlations between saliva and plasma concentrations were poor for phenobarbital in children < 8 years of age and for valproate. Correlations between saliva and plasma-free anticonvulsant concentrations were equal or only slightly better than between saliva and plasma total concentrations. Citric acid-stimulated saliva constitutes a convenient alternative for TDM of carbamazepine and phenytoin therapy in pediatric patients and of phenobarbital in children > or = 8 years of age.
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Affiliation(s)
- R Gorodischer
- Division of Clinical Pharmacology, The Hospital for Sick Children and University of Toronto, Ontario, Canada
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28
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Chattergoon DS, McGuigan MA, Koren G, Hwang P, Ito S. Multiorgan dysfunction and disseminated intravascular coagulation in children receiving lamotrigine and valproic acid. Neurology 1997; 49:1442-4. [PMID: 9371937 DOI: 10.1212/wnl.49.5.1442] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.4] [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: 02/05/2023] Open
Abstract
Two children developed multiorgan dysfunction with disseminated intravascular coagulation 9 days after lamotrigine was added to their antiepileptic therapy, which included valproic acid. During the episodes, rhabdomyolysis was detected in one of them, while being seizure-free, suggesting that this adverse reaction may involve muscular tissue.
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Affiliation(s)
- D S Chattergoon
- Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, Ontario, Canada
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29
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Jay V, Squire J, Blaser S, Hoffman HJ, Hwang P. Intracranial and spinal metastases from a ganglioglioma with unusual cytogenetic abnormalities in a patient with complex partial seizures. Childs Nerv Syst 1997; 13:550-5. [PMID: 9403205 DOI: 10.1007/s003810050136] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We describe an unusual clinical presentation of a ganglioglioma in a patient with complex partial seizures. The patient underwent a right temporal lobectomy with subtotal tumor resection at age 15 years, followed by a complete resection 1 year later. Follow-up MRI scan a year later documented recurrence and leptomeningeal dissemination. Another biopsy was performed. Pathological examination revealed similar histology in all three resections, with a ganglioglioma showing no evidence of anaplasia. The tumor exhibited a number of karyotypic abnormalities, notably, a paracentric inversion of chromosome 7. In summary, despite lacking anaplastic features by conventional histological criteria, this ganglioglioma showed an unsusual karyotype and demonstrated radiological evidence of widespread dissemination.
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Affiliation(s)
- V Jay
- Division of Pathology, Hospital for Sick Children, University of Toronto, Ontario, Canada
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30
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Abstract
OBJECTIVES To determine the efficacy of pentosan polysulfate (Elmiron) compared to placebo in the treatment of interstitial cystitis. METHODS The data sources used were MEDLINE, Excerpta Medica, and International Pharmaceutical Abstracts databases, and the manufacturer. Bibliographies of articles obtained were reviewed. The keywords used were pentosanpolysulfate, pentosanpolysulfate sodium, and pentosan. Inclusion criteria were blinded selection of English language, prospective, randomized, placebo-controlled comparative trials; > or = 8 weeks' duration; > or = 300 mg daily; adult humans with > or = 1 symptoms including pain, urgency, frequency, and nocturia; symptoms for > or = 12 months; normal urinalysis; negative findings for urine culture and cytology. Exclusion criteria were hemorrhagic cystitis; drug-, microbial-, or radiation-induced cystitis; carcinoma in situ; other influencing diseases. The outcome of success was defined as a > or = 50% decrease in pain, urgency, frequency, and nocturia. The number of successes was extracted by blinded investigators, treating withdrawals as failures. The percentage difference in success rates of pentosan polysulfate and placebo, and the number needed to treat (NNT) were determined for each variable; P values and 95% confidence intervals (CIs) were determined for combined data. Homogeneity of effect was determined by calculating Q (chi-squared). Article quality was assessed using the Chalmers scale to determine if quality affected outcome. Effective inter-rater reliability was determined using Rosenthal's method. Significance was set at P < 0.05. RESULTS Four studies were included. Data were extracted from all four studies for pain (n = 398), three for urgency (n = 306), two for frequency (n = 160), and one study for nocturia (n = 106). The differences (95% confidence limits) were pain: 16.6% (95% CI 8%, 25%), NNT = 7; urgency: 13.0% (1.0%, 25%), NNT = 7.5; frequency: 16.7% (2.3%, 31.1%), NNT = 6; nocturia: -1% (-19.8%, 21.8%). P values from homogeneity tests were not significant. Mean quality scores were 63.8%, 48.1%, 50.4%, and 65.6%, respectively, in the four studies; the effective inter-rater reliability was 0.96. Results did not differ when weighted by quality score. CONCLUSIONS Pentosan polysulfate is more efficacious than placebo in the treatment of pain, urgency, and frequency associated with interstitial cystitis. Pentosan polysulfate is not significantly different from placebo in treating nocturia associated with interstitial cystitis.
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Affiliation(s)
- P Hwang
- Faculty of Pharmacy, University of Toronto, ON, Canada
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31
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Abstract
Clobazam is a 1,5-benzodiazepine effective in antiepileptic therapy of children and adults. Presently it is mainly used as adjuvant therapy for intractable seizures. Our objective was to evaluate the effect of clobazam on the apparent clearance of other antiepileptic drugs at steady state, and to determine the factors that determine the plasma levels of clobazam and its active metabolite N-desmethylclobazam. Patients were 74 children with intractable seizures who received treatment with clobazam at our institution as part of the Canadian Cooperative Clobazam Study Group during the years 1987 to 1991. Serum concentrations of clobazam, N-desmethylclobazam, and of concomitant antiepileptic drugs were monitored and prospectively collected. The effect of clobazam treatment on the apparent clearance steady state of the other antiepileptic drugs was determined by statistical comparison of the clearances of each drug before and after initiation of clobazam treatment using Wilcoxon's signed rank test. The effects of dosage, age, and concomitant antiepileptic therapy on the levels of clobazam and N-desmethylclobazam was assessed by multivariate analysis. Response to treatment and incidence of adverse effects were evaluated for each conventional antiepileptic drug to possibly identify favorable or unfavorable combinations with clobazam. Whereas the clearances of most conventional antiepileptics are not affected by cotherapy with clobazam, the apparent clearances of valproic acid and primidone are significantly reduced in the presence of clobazam. Serum concentrations of clobazam increased with dosage and age, and decreased with phenobarbital cotherapy. Serum concentrations of N-desmethylclobazam significantly correlated with clobazam serum levels, age, or clobazam dosage and were significantly increased by cotherapy with phenytoin or carbamazepine. None of the concomitantly used drugs were associated with increased or decreased rate of seizure control. Twelve patients experienced mild adverse drug effects that were not associated with particular cotherapy, clobazam dose, or plasma concentrations. When clobazam is added to a therapy regimen that includes valproic acid, the patient should be closely followed for possible adverse drug reactions caused by elevated valproic acid serum concentrations, and monitoring of valproate serum levels should be considered. When clobazam doses are gradually increased to achieve an optimal clinical effect, the interactions with phenobarbital, carbamazepine, and phenytoin do not necessitate therapeutic drug monitoring of clobazam or N-desmethylclobazam, because there is a large therapeutic window and a poor correlation between plasma concentrations and therapeutic efficacy.
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Affiliation(s)
- J G Theis
- Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, Ontario, Canada
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32
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Stapleton SR, Kiriakopoulos E, Mikulis D, Drake JM, Hoffman HJ, Humphreys R, Hwang P, Otsubo H, Holowka S, Logan W, Rutka JT. Combined utility of functional MRI, cortical mapping, and frameless stereotaxy in the resection of lesions in eloquent areas of brain in children. Pediatr Neurosurg 1997; 26:68-82. [PMID: 9419036 DOI: 10.1159/000121167] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We studied 16 children with lesions in the eloquent brain to determine if the amalgamation of information from functional magnetic resonance imaging (fMRI), frameless stereotaxy, and direct cortical mapping and recording could facilitate the excision of these lesions while minimizing potential neurological deficits. The mean age of the children was 10 years. Fourteen children presented with seizures. All lesions were located in or near eloquent cerebral cortex. fMRI was successful in all patients in delineating the relationship between the lesion and regions of task-activated cortex. The ISG wand was utilized in all cases for scalp and bone flap placement, and for intraoperative localization of the lesion. Direct cortical stimulation or recording of phase reversals with somatosensory evoked potentials helped delineate the central sulcus and language cortex in patients with lesions near the motor or language cortex. Intraoperative electrocorticography (ECoG) was utilized in all patients who presented with seizures to guide the extent of resection of the epileptiform cortex. Ten children had benign cerebral neoplasms, nine of which were totally resected. The other diagnoses included vascular malformations, Sturge-Weber, tuberous sclerosis, Rasmussen's encephalitis, and primitive neuroectodermal tumor. Only 1 patient with a left Rolandic AVM developed a new neurological deficit postoperatively. Thirteen of fourteen patients who presented with seizure disorders were rendered either seizure free or improved in terms of seizure control postoperatively. Follow-up has ranged from 12 to 18 months, with a mean follow-up of 15 months. We conclude that the techniques of fMRI, frameless stereotaxy, direct cortical stimulation and recording can be utilized in sequence to accurately localize intracerebral lesions in eloquent brain, and to reduce the morbidity of resecting these lesions in children.
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Affiliation(s)
- S R Stapleton
- Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Ont., Canada
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33
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Jay V, Otsubo H, Hwang P, Hoffman HJ, Blaser S, Zielenska M. Coexistence of hemimegalencephaly and chronic encephalitis. Detection of cytomegalovirus by the polymerase chain reaction. Childs Nerv Syst 1997; 13:35-41. [PMID: 9083700 DOI: 10.1007/s003810050037] [Citation(s) in RCA: 9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We report the extraordinary association of hemimegalencephaly with chronic encephalitis and cytomegalovirus (CMV) positivity in a 5-month-old infant with intractable seizures and a left hemisphere resection. Microscopy revealed a severe neuronal migration disorder (NMD) with fusion of gyri, marked disarray of neuronal lamination, neuronal gigantism and extensive neuronal heterotopias. Also widespread were microglial nodules, gliosis and nodular calcifications and some foci of frank necrosis with calcification. Occasional perivascular and leptomentingeal lymphocytic infiltrates were present. No viral inclusions were identifiable. Polymerase chain reaction on multiple specimens showed unequivocal CMV positivity. In intrauterine CMV infection. NMDs such as polymicrogyria are well recognized, but the association of hemimegalencephaly with CMV infection has not previously been described. Our finding of chronic encephalitis with CMV positivity and hemimegalencephaly in the same patient raises questions about the role of CMV in the etiopathogenesis of the NMD.
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Affiliation(s)
- V Jay
- Department of Pathology, Hospital for Sick Children, Toronto, Ontario, Canada
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34
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Abstract
PURPOSE To determine whether the localization of focal cerebral lesions affects age of onset of infantile spasms (IS). METHODS We reviewed 216 cases of IS and identified patients with focal cerebral lesions confined to frontal, centrotemporoparietal, or occipital regions. The age of onset of spasms in each of the three groups was analyzed. RESULTS Ninety-three patients were found to have focal cerebral lesions confined to one of the three regions previously described. The mean age of onset of IS was 3.36 +/- 1.71 months in patients with occipital lesions, 6.26 +/- 2.68 months in centrotemporoparietal lesions, and 9.83 +/- 2.56 in frontal lesions. CONCLUSIONS Occipital lesions are found to be associated with earliest onset of spasms, whereas frontal lesions are rare and associated with latest spasms onset. The age distribution pattern of spasms onset according to localization of cortical lesion is in close correlation with that of normal sequence of brain maturation. This supports the hypothesis that cerebral lesions located in critical areas of brain maturation have a role in the genesis of infantile spasms.
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Affiliation(s)
- B Koo
- Neurology Division, Children's Hospital of Michigan, Wayne State University, Detroit, USA
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35
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Chuang SH, Otsubo H, Hwang P, Orrison WW, Lewine JD. Pediatric magnetic source imaging. Neuroimaging Clin N Am 1995; 5:289-303. [PMID: 7640889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Magnetic source imaging has changed the perspective of managing pediatric patients with epilepsy since its introduction into clinical imaging in the pediatric population. Magnetic source imaging can be important in understanding pediatric functional neuroanatomy and for epileptic surgery in children with intractable seizures. The use and efficacy of magnetic source imaging for surgical planning and patient management is demonstrated by case reports presented in this article.
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Affiliation(s)
- S H Chuang
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada
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36
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Jay V, Becker LE, Otsubo H, Cortez M, Hwang P, Hoffman HJ, Zielenska M. Chronic encephalitis and epilepsy (Rasmussen's encephalitis): detection of cytomegalovirus and herpes simplex virus 1 by the polymerase chain reaction and in situ hybridization. Neurology 1995; 45:108-17. [PMID: 7824098 DOI: 10.1212/wnl.45.1.108] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.5] [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] Open
Abstract
We made a pathologic diagnosis of chronic encephalitis on surgical resections or autopsy material in 10 patients with intractable seizures and studied the specimens by immunohistochemistry for herpes simplex virus (HSV) 1 and 2 and cytomegalovirus (CMV) as well as by the polymerase chain reaction (PCR) for viral DNA sequences (HSV1, HSV2, and CMV). We also assessed eight patients (nonepileptic) with pathologically documented or clinically suspected encephalitis and five resections from epileptics without encephalitis. Immunohistochemistry for viral antigens was negative in all cases. Using PCR assay, CMV was present in six and HSV1 in two of 10 epilepsy patients with chronic encephalitis. We demonstrated CMV by in situ hybridization in two of the six patients positive for CMV by PCR. We found no viral sequences by PCR in five epileptics without encephalitis. Of the eight patients (nonepileptic) with clinically suspected or pathologically confirmed encephalitis, two cases showed CMV sequences by PCR. These observations suggest that PCR allows detection of viral sequences in some cases of chronic encephalitis associated with epilepsy that may be missed by in situ hybridization.
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Affiliation(s)
- V Jay
- Department of Pathology (Neuropathology Division), Hospital for Sick Children, University of Toronto, ON, Canada
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37
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Jay V, Becker LE, Blaser S, Hwang P, Hoffman HJ, Humphreys R, Zielenska M. Pathology of chronic herpes infection associated with seizure disorder: a report of two cases with tissue detection of herpes simplex virus 1 by the polymerase chain reaction. Pediatr Pathol Lab Med 1995; 15:131-46. [PMID: 8736603 DOI: 10.3109/15513819509026945] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Although uncommon, the association of chronic encephalitis with epilepsy is well recognized. While a viral etiology has been suspected based on the morphology, to date no virus has been successfully cultured from the brain in patients with Rasmussen's encephalitis. We describe the pathologic findings and report the detection of herpes simplex virus 1 (HSV1) in the brain in two patients who presented primarily with intractable seizures. In the first patient, an intrauterine infection was suspected as the underlying basis for the seizure disorder and the extensive cerebral calcification and gliosis. The second patient (with presumed HSV1 encephalitis at age 7 months) underwent a temporal lobectomy for medically refractory seizures at the age of 3 years and pathologic examination revealed a chronic encephalitis. While immunohistochemical, ultrastructural, and culture studies were negative for viral pathogens, molecular analysis by the polymerase chain reaction (PCR) revealed HSV1 DNA sequences in both cases. Thus our cases represent two examples of chronic encephalitis associated with a seizure disorder, where a definitive viral etiology was documented by PCR.
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Affiliation(s)
- V Jay
- Division of Neuropathology, Hospital for Sick Children, Toronto, Ontario, Canada
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38
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Gorodischer R, Burtin P, Hwang P, Levine M, Koren G. Saliva versus blood sampling for therapeutic drug monitoring in children: patient and parental preferences and an economic analysis. Ther Drug Monit 1994; 16:437-43. [PMID: 7846740 DOI: 10.1097/00007691-199410000-00001] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The objective of this study was to conduct an assessment of patient and parental preferences and an economic analysis of hospital costs in sampling blood and saliva for therapeutic drug monitoring (TDM). Costs and preferences were evaluated in the course of a study, which compared anticonvulsant concentrations in blood routinely drawn for therapeutic monitoring and in saliva in infants and children attending a pediatric neurology clinic. Parents of 84.8% of children, and half of the children, indicated a preference for saliva sampling over venous blood drawing. Children who had been on medications that required therapeutic monitoring for < 2 years were more likely to prefer saliva sampling as compared to those who were under treatment for > or = 2 years. Computation, based upon a basic assumption that a registered nurse obtained blood and a medical technician or a registered nurse assistant sampled saliva, indicated that for every 1,000 cases of changing from blood to saliva sampling, total cost savings would amount to $1,930 for cooperative children and $1,660 for infants and uncooperative children. This saving is equivalent to approximately 100 h of a registered nurse's initial salary. The important contributions to the differential cost were derived from the requirements for more highly trained individuals to take the blood sample and from the doubling time required for the procedure.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- R Gorodischer
- Division of Clinical Pharmacology, Hospital for Sick Children, Toronto, Ontario, Canada
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39
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Yang KC, Hwang P, Henley M, Kisslinger LS. Erratum: QCD sum rules and neutron-proton mass difference. Phys Rev D Part Fields 1994; 49:6247-6248. [PMID: 10021663 DOI: 10.1103/physrevd.49.6247.2] [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: 05/23/2023]
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40
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Hart YM, Cortez M, Andermann F, Hwang P, Fish DR, Dulac O, Silver K, Fejerman N, Cross H, Sherwin A. Medical treatment of Rasmussen's syndrome (chronic encephalitis and epilepsy): effect of high-dose steroids or immunoglobulins in 19 patients. Neurology 1994; 44:1030-6. [PMID: 8208394 DOI: 10.1212/wnl.44.6.1030] [Citation(s) in RCA: 137] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
We treated 19 patients with Rasmussen's syndrome (chronic encephalitis and epilepsy)--a rare progressive disorder of unknown etiology causing focal epilepsy, hemiparesis, and intellectual deterioration--with intravenous immunoglobulins, high-dose steroids, or both, to control seizures and improve the end point of the disease. Ten of 17 patients receiving steroids, and eight of nine patients receiving immunoglobulins, had some reduction of seizure frequency in the short term. Improvement in hemiparesis was slight. The effect of these drugs in ameliorating the end point of the disease in the long term remains unknown, and further multicenter studies with standardized protocols are warranted.
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Affiliation(s)
- Y M Hart
- Montreal Neurological Institute and Hospital, PQ, Canada
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41
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Jay V, Becker LE, Otsubo H, Hwang P, Hoffman HJ, Armstrong DC. Neuronal heterotopia with capillary penetration of neurons and cortical dysplasia in a patient with complex partial seizures. Case report. J Neurosurg 1993; 78:654-7. [PMID: 8450340 DOI: 10.3171/jns.1993.78.4.0654] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [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: 01/30/2023]
Abstract
Unusual pathological findings were encountered in a temporal lobectomy specimen from a 9-year-old boy with intractable complex partial seizures. Magnetic resonance imaging revealed an enlarged left temporal lobe, with diffuse high signal intensity over the cortex and poor gray-white differentiation on T2-weighted imaging; single-photon emission computerized tomography showed decreased blood flow. Active epileptiform discharges were identified in the left temporal lobe with focal slow waves and generalized epileptiform paroxysms. Pathologically, the cortex revealed changes of focal cortical dysplasia with extensive disorganization of neuronal morphology, layering, and orientation as well as focal polymicrogyria. The cortical-white matter junction was indistinct with extensive neuronal heterotopias in the white matter. Large pale balloon cells akin to those seen in tuberous sclerosis were found scattered within the cortex and white matter. The most striking finding was that of a heterotopic nodule in the white matter, which revealed abnormal neurons with penetration of cell bodies by capillaries. Ultrastructurally, there were no degenerative changes in these neurons, and this unusual phenomenon is attributed to a developmental disturbance affecting neuronal, glial, and vascular elements.
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Affiliation(s)
- V Jay
- Department of Pathology, Hospital for Sick Children, University of Toronto, Ontario, Canada
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42
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Robieux I, Eliopoulos C, Hwang P, Greenberg M, Blanchette V, Olivieri N, Klein N, Koren G. Pain perception and effectiveness of the eutectic mixture of local anesthetics in children undergoing venipuncture. Pediatr Res 1992; 32:520-3. [PMID: 1480451 DOI: 10.1203/00006450-199211000-00004] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The emulsion of lidocaine and prilocaine (EMLA) is effective in preventing the pain of venipuncture in children. It is therefore important to identify children who could benefit the most from EMLA. We studied the safety and feasibility of two methods of application of EMLA (patch and cream) in a randomized, open-label trial of EMLA patch versus EMLA cream in 160 children with chronic diseases undergoing venipuncture. EMLA patch or cream was applied 60 to 120 min before puncture. Pain was assessed by the children using a visual analogue score. Children also scored the pain of their last puncture and the pain of removing the tape. EMLA patch and cream had similar efficacy (visual analogue scores for the venipuncture were 8.5 +/- 16 and 9.5 +/- 17 out of 100, respectively). Side effects occurred in similar frequencies in the two groups. Adhesiveness of the patch was less effective than that of the cream with Tegaderm. Age was a major determinant of pain perception; younger children recalled more severe pain in their previous puncture. Children recently diagnosed had higher visual analogue scores than those with a long history of chronic disease. We concluded that EMLA patch and cream have a similar efficacy in children undergoing venipuncture. Young children recently diagnosed with chronic disease are most likely to benefit from EMLA.
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Affiliation(s)
- I Robieux
- Division of Clinical Pharmacology, University of Toronto, Canada
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43
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Camfield P, Hwang P, Camfield C, Fraser A, Soldin S, al-Quadah AK. The pharmacology of chewable versus regular carbamazepine in chronically treated children with epilepsy. Neurol Sci 1992; 19:204-7. [PMID: 1623447] [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: 12/27/2022]
Abstract
We report the first comparison of Chewable and Regular Carbamazepine (CBZ) tablets in children with epilepsy. Forty-four children receiving chronic monotherapy CBZ participated. In month 1 children received regular CBZ; in month 2, the same dose of Chewable CBZ. Once per week fasting predose CBZ and CBZ epoxide serum levels were determined. In a subset of 15 children, at the end of each month serum levels were obtained every 2 hours for 12 hours beginning pre-dose. Standards for CBZ and CBZ epoxide were tested in each centre. Overall, weekly levels showed no consistent differences between the month on chewable CBZ and regular CBZ. Seizure control and rates of reported side effects were similar. In five patients chewable CBZ produced higher peak CBZ levels while five had higher peaks with regular CBZ. In conclusion, regular and chewable CBZ often have unpredictable differences in peak but not trough levels of CBZ suggesting that peak level side effects with one form of CBZ might be alleviated by changing to the other.
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Affiliation(s)
- P Camfield
- IWK Children's Hospital, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
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44
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Erpel T, Hwang P, Craik CS, Fletterick RJ, McGrath ME. Physical map location of the new Escherichia coli gene eco, encoding the serine protease inhibitor ecotin. J Bacteriol 1992; 174:1704. [PMID: 1537814 PMCID: PMC206573 DOI: 10.1128/jb.174.5.1704.1992] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- T Erpel
- Department of Biochemistry and Biophysics, University of California, San Francisco 94143-0446
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45
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Casson EJ, Osako M, Johnson CA, Hwang P. Temporal and spatial response properties of optic neuritis patients manifesting statokinetic dissociation. Appl Opt 1991; 30:2136-2142. [PMID: 20700188 DOI: 10.1364/ao.30.002136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Statokinetic dissociation (SKD) refers to a greater reduction in sensitivity to stationary visual stimuli relative to similar targets in motion. We evaluated SKD perimetrically in nine optic neuritis (ON) patients and in nine normals by measuring the difference between static and 4 degrees /s kinetic thresholds for a size I target (0.11 degrees ) along the four oblique meridians. To assess temporal response characteristics, we used flicker perimetry to measure the sensitivity to 2-, 8-, and 20-Hz sinusoidal flicker at 5 degrees intervals along the oblique meridians. The ON patients' sensitivity to all three flicker frequencies was reduced at all eccentricities. In a number of cases, flicker sensitivity was unmeasurable to one or more frequencies within the region where kinetic targets were detectable. This was particularly marked at 20-25 degrees , where in half the cases there was no measurable sensitivity to a flickering target although a moving target could be seen. These results indicate that SKD in these patients may not be due to a selective loss of mechanisms sensitive to low frequency temporal modulation with a relative sparing of mechanisms sensitive to high-frequency temporal modulation as has been previously suggested [A. Safran and J. Glaser, "Statokinetic Dissociation in Lesions of Anterior Visual Pathways," Arch. Ophthalmol. 98, 291-295 (1980)]. We hypothesize that SKD may be due in part to differences in spatial summation in these patients, making a moving target, which has a greater spatial extent, more detectable than a stationary target. Thus ON patients exhibiting SKD should show great improvement in static perimetry thresholds as the target size is increased. We compared the results of standard 30-2 Humphrey perimetry for size III (0.43 degrees ) and size V (1.72 degrees ) targets for normals and ON patients and found that the patients showed a larger sensitivity difference between size III and size V targets than normals.
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46
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Abstract
When probes throughout the McArdle disease (myophosphorylase) gene region were used to search for DNA polymorphisms, only an MspI polymorphism was found in 94 enzyme-probe combinations. Along with an insertion/deletion polymorphism more 3' to the gene locus, these polymorphisms will be informative in 75% of at-risk patients. These results contrast strikingly to the six polymorphic sites detected in 15 enzyme-probe combinations in the homologous Her's disease (liver phosphorylase) gene region. This single MspI polymorphic site includes a CpG sequence of known increased mutability suggesting that DNA regions with rare polymorphisms will have most polymorphic sites at sequences with enhanced mutability. Fluorescence in situ hybridization sublocalized this gene to proximal band 11q13, establishing a point of cross-reference between the physical and genetic maps.
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Affiliation(s)
- R V Lebo
- Department of Obstetrics, Gynecology, University of California, San Francisco 94143-0720
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47
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Broberg A, Lamb ME, Hwang P. Inhibition: its stability and correlates in sixteen- to forty-month-old children. Child Dev 1990; 61:1153-63. [PMID: 2209185] [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: 12/30/2022]
Abstract
Inhibition was assessed in 144 Swedish children when they averaged 16 months of age using a composite measure tapping sociability toward strange adults, noninvolvement in peer play, and parental ratings of fearfulness. 91 children entered out-of-home care within 2 weeks of these initial assessments. Children were observed in this setting playing with peers; teachers and parents also rated children's adjustment to the out-of-home care settings. 1 and 2 years later, the children were assessed again, both at home and in the alternative care settings. Results showed that individual differences in inhibition were stable over the 2 years of the study. Inhibited children engaged in less high-quality peer play both at home and in the alternative care settings, and they were less able to play alone in their mothers' absence. On contemporaneous but not subsequent ratings, inhibited children had more difficulty adjusting to out-of-home care. Inhibition was not itself affected by out-of-home care experiences, and there were no sex differences in inhibition.
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Affiliation(s)
- A Broberg
- Department of Psychology, University of Göteborg, Sweden
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48
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Danielsson B, Hwang P. [Vibroacoustic treatment of infants with colic has no effect]. Lakartidningen 1989; 86:1985-6. [PMID: 2733513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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49
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Abstract
A sensitive method has been developed for visualizing eukaryotic cells in mitosis (M) phase. It employs Zenker's fixative, which makes the plasma membrane but not the nuclear envelope permeable to immunoglobulins. Zenker's-fixed cells are exposed to an antibody which recognizes a major constituent of chromatin. In this case the antibody is a monoclonal (MC 21) which recognizes histone H2b. Because cells in M phase do not have an intact nuclear envelope, the antibody has access to and interacts with their chromatin. The presence of a nuclear envelope in Zenker's-fixed interphase cells precludes access of the antibody to the nuclear chromatin. Consequently, this indirect immunofluorescence procedure selectively labels M-phase cells. At high enough magnification some details of the chromatin figures are revealed. MC 21 recognizes the chromatin of cells of many different species. With appropriate fixation it can be used effectively on cells in culture. With some procedural modifications it can also be used with more complex tissue systems. Detailed mitotic patterns for chick embryos up to Day 3 of development have been obtained by this method.
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Affiliation(s)
- H Y Kim
- Department of Biochemistry, University of Kansas, Lawrence 66045
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Abstract
In a review of 48 children who underwent temporal lobectomy for temporal lobe epilepsy, 16 patients had mass lesions in the temporal lobe. These mass lesions consisted of 12 tumors, 3 vascular malformations, and 1 arachnoid cyst. In 9 of 10 patients where the hippocampus was present in the pathological specimen and was not involved by tumor, there was concomitant mesial temporal sclerosis. All 16 patients have been followed for more than 1 year. Nine are free of seizures, with 4 of these 9 still on medication. Seven patients have had a greater than 50% reduction in seizures.
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Affiliation(s)
- J Drake
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario
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