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Hallaj S, Wong JC, Hock LE, Kolomeyer NN, Shukla AG, Pro MJ, Moster MR, Myers JS, Razeghinejad R, Lee D. Long-Term Surgical Outcomes of Glaucoma Drainage Implants in Eyes with Preoperative Intraocular Pressure Less than 19 mmHg. J Ophthalmol 2024; 2024:6624021. [PMID: 38304290 PMCID: PMC10830923 DOI: 10.1155/2024/6624021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/02/2023] [Accepted: 01/08/2024] [Indexed: 02/03/2024] Open
Abstract
Background This retrospective review reports on patients who underwent glaucoma drainage implant (GDI) surgery and had baseline intraocular pressure (IOP) of ≤18 mmHg with at least one year of follow-up. Methods Clinical data of 67 eyes of 67 patients were collected from patients' charts, and the outcomes of GDI were evaluated until 7 years. GDI failure was defined as IOP reduction of less than 20% from the baseline at two consecutive visits three months after surgery, decline to no light perception, or if additional glaucoma surgery was performed. Results The average age was 65.9 ± 13.2 years. Most cases were male (52.2%), White (53.7%), and had primary open-angle glaucoma (62.7%). Forty-four eyes had prior glaucoma surgery (68.6%) and 46 (68.6%) had severe glaucoma. Though postoperative (postop) IOP changes were insignificant, the average postop number of medications dropped from 2.4 ± 1.4 to 1.9 ± 1.2 medications two years after surgery (p = 0.0451). Postop complications (23.9%) included GDI exposure (7.5%), inflammation (4.5%), shallow anterior chamber (4.5%), and strabismus (1.5%). Hypotony was observed in 4 eyes (5.9%), none of which developed hypotony maculopathy. The cumulative one-year failure rate was 56.7%, most of which were due to failure to lower IOP. Conclusion In patients with baseline IOP ≤18 mmHg who had GDI surgery, though the change in IOP was not statistically significant, the number of medications dropped and visual field progression slowed in a subset of patients with adequate perimetric data. Due to a relatively high rate of complications and limited effectiveness in lowering IOP, GDI should be cautiously used in these eyes.
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Affiliation(s)
- Shahin Hallaj
- Glaucoma Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Jae-Chiang Wong
- Glaucoma Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Lauren E. Hock
- Glaucoma Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Natasha Nayak Kolomeyer
- Glaucoma Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Aakriti G. Shukla
- Glaucoma Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Michael J. Pro
- Glaucoma Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Marlene R. Moster
- Glaucoma Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Jonathan S. Myers
- Glaucoma Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Reza Razeghinejad
- Glaucoma Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Daniel Lee
- Glaucoma Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA
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Shalaby WS, Wong JC, Zhang TZ, Hallaj S, Lam SS, Dale EA, Pro MJ, Kolomeyer NN, Shukla AG, Lee D, Myers JS, Razeghinejad R, Moster MR. Early Postoperative Aqueous Suppression Therapy and Surgical Outcomes of Ahmed Tube Shunts in Refractory Glaucoma. Ophthalmol Glaucoma 2024; 7:47-53. [PMID: 37558051 DOI: 10.1016/j.ogla.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/20/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE To compare early vs. delayed use of aqueous suppressants on Ahmed glaucoma valve (AGV) outcomes. DESIGN Single-center retrospective comparative case series. PARTICIPANTS Patients who underwent AGV surgery at Wills Eye Hospital in the period between 2016 and 2021. METHODS Retrospective review of AGV surgery at Wills Eye Hospital 2016 to 2021 for refractory glaucoma. Two groups were created: group 1 or those who received early aqueous suppressant therapy in the first 2 weeks postoperatively whenever the intraocular pressure (IOP) was > 10 mmHg, and group 2 or those who received delayed treatment after 2 weeks whenever the IOP exceeded the target pressure. Aqueous suppressant therapy included topical beta blockers, carbonic anhydrase inhibitors, and/or alpha agonists. MAIN OUTCOME MEASURES The primary outcome measures were the frequency of hypertensive phase (HP) defined as IOP > 21 mmHg in first 3 months after an initial reduction to 21 mmHg or less in the first postoperative week not caused by tube obstruction or retraction, and month-12 surgical failure defined as 5 ≥ IOP > 21 mmHg on 2 consecutive visits, vision decline to no light perception (NLP), or glaucoma reoperation. Secondary outcome measures included changes in visual acuity (VA), IOP, and glaucoma medications at 12 months. Predictive factors for surgical failure were also identified. RESULTS A total of 407 eyes of 391 patients (260 in group 1, 147 in group 2) with similar baseline characteristics were included. Hypertensive phase was more common in group 2 than 1 (41.5% vs. 18.5%; P < 0.001). At month 12 (N = 303 eyes), group 1 was less likely to fail than group 2 (21.2% vs. 36.8%, P = 0.003). Multivariate regression analysis showed that HP (odds ratio [OR] = 10.47, P < 0.001), delayed aqueous suppression use (OR = 2.17, P = 0.003), and lower baseline VA (OR = 1.56, P = 0.015) were the strongest predictors of month-12 failure. CONCLUSIONS Early use of aqueous suppressants may lower the risk of HP and improve AGV outcomes. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Wesam Shamseldin Shalaby
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania; Tanta Medical School, Tanta University, Tanta, Gharbia, Egypt.
| | - Jae-Chiang Wong
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania
| | - Tony Zhehao Zhang
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania
| | - Shahin Hallaj
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania
| | - Sophia S Lam
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania
| | - Elizabeth A Dale
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania
| | - Michael J Pro
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania
| | | | | | - Daniel Lee
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania
| | - Jonathan S Myers
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania
| | - Reza Razeghinejad
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania
| | - Marlene R Moster
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania
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Hallaj S, Wong JC, Shalaby WS, Ayres BD, Moster MR. Persistent Mydriasis Following Gonioscopy-Assisted Transluminal Trabeculotomy. J Glaucoma 2024; 33:55-58. [PMID: 37523651 DOI: 10.1097/ijg.0000000000002283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 07/08/2023] [Indexed: 08/02/2023]
Abstract
Herein we describe 2 cases of persistent mydriasis after gonioscopy-assisted transluminal trabeculotomy for open angle glaucoma. Both surgeries were uneventful, but the patients experienced postoperative hyphema and intraocular pressure elevation. They then developed persistent fixed and dilated pupils resistant to pilocarpine that led to intolerable photosensitivity and glare. An iris cerclage pupilloplasty was performed with adequate relief of symptoms in one case.
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Affiliation(s)
- Shahin Hallaj
- Glaucoma Service, Will Eye Hospital
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Jae-Chiang Wong
- Glaucoma Service, Will Eye Hospital
- Westchester Medical Center Department of Ophthalmology, New York Medical College, Valhalla, NY
| | - Wesam Shamseldin Shalaby
- Glaucoma Service, Will Eye Hospital
- Tanta Medical School, Tanta University, Tanta, Gharbia, Egypt
| | - Brandon D Ayres
- Cornea Service, Wills Eye Hospital
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
- Tanta Medical School, Tanta University, Tanta, Gharbia, Egypt
| | - Marlene R Moster
- Glaucoma Service, Will Eye Hospital
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
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Myers JS, Lamrani R, Hallaj S, Lee D, Wong JC. 10-Year Clinical Outcomes of Tube Shunt Surgery at a Tertiary Care Center. Am J Ophthalmol 2023; 253:132-141. [PMID: 37072075 DOI: 10.1016/j.ajo.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/05/2023] [Accepted: 04/05/2023] [Indexed: 04/20/2023]
Abstract
PURPOSE To report 10-year clinical outcomes of tube shunt (TS) surgery at a tertiary care center. DESIGN Retrospective cohort study. METHODS Eyes were included that underwent a first TS surgery between January 2005 and December 2011 at a tertiary referral eye hospital and with at least 10 years of follow-up. Demographic and clinical data were collected. Failure was defined as reoperation to lower intraocular pressure (IOP), IOP > 80% of baseline for two consecutive visits, or progression to no light perception. RESULTS Eighty-five eyes of 78 patients were included in the Study Group; 89 eyes were selected as a Comparison Group. Mean follow-up was 11.9 ± 1.7 years. Fifty-one valved (60%), 25 non-valved (29%), and nine unknown (11%) TS were placed. At the final visit, mean IOP was reduced from 29.2 ± 10.4 mmHg on 3.1 ± 1.2 medications to 12.6 ± 5.8 mmHg on 2.2 ± 1.4 (p<0.001 for each). Forty-eight eyes (56%) failed; 29 eyes (34%) underwent additional glaucoma surgery; eight eyes (10%) progressed to no light perception; and 34 eyes (40%) also required TS revision. Best corrected visual acuity (BCVA) logMAR (minimal angle of resolution) worsened from 0.8 ± 0.7 (20/125) to 1.4 ± 1.0 (20/500) at the last visit (p<0.001). Average visual field MD was -13.9 ± 7.5 dB at baseline and -17.0 ± 7.0 dB at last follow-up (P=0.0605). CONCLUSIONS Many eyes maintained IOP control 10 years following TS, but 56% met failure criteria, 39% had substantial vision loss, and 34% underwent additional surgery. Outcomes did not differ with TS model. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Affiliation(s)
- Jonathan S Myers
- From Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA (J.S.M, S.H, D.L, J-C.W); Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA (J.S.M, D.L).
| | - Ryan Lamrani
- Eastern Virginia Medical School, Norfolk, VA, USA (R.L)
| | - Shahin Hallaj
- From Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA (J.S.M, S.H, D.L, J-C.W)
| | - Daniel Lee
- From Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA (J.S.M, S.H, D.L, J-C.W); Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA (J.S.M, D.L)
| | - Jae-Chiang Wong
- From Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA (J.S.M, S.H, D.L, J-C.W); Rowan University School of Osteopathic Medicine, Stratford, NJ, USA (J-C.J)
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Wu CM, Zheng CX, Kuley B, Wong JC, Lin MM, Moster SJ, Moster MR, Schmidt C, Pro MJ, Lee D. Outcomes of Selective Laser Trabeculoplasty After Prior Incisional Surgery for Open Angle Glaucoma. J Glaucoma 2023; 32:474-479. [PMID: 36847694 DOI: 10.1097/ijg.0000000000002196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/12/2023] [Indexed: 03/01/2023]
Abstract
PRCIS This retrospective case series of patients with open angle glaucoma and prior trabeculectomy or tube shunt surgery found that selective laser trabeculoplasty (SLT) resulted in significant intraocular pressure (IOP) reductions in the intermediate follow-up period in select cases. PURPOSE The purpose of this study was to assess the IOP-lowering effect and tolerability of SLT after prior trabeculectomy or tube shunt surgery. MATERIALS AND METHODS Open angle glaucoma patients at Wills Eye Hospital who previously underwent incisional glaucoma surgery and subsequently received SLT between 2013 and 2018 were included, along with an age-matched control group. Baseline characteristics, procedural data, and post-SLT data were recorded at 1, 3, 6, 12 months, and most recent visit. The primary success of SLT treatment was defined as IOP reduction of 20% or greater without the use of additional glaucoma medications compared to pre-SLT IOP. Secondary success was defined as IOP reduction ≥20% with the use of additional glaucoma medications compared to pre-SLT IOP. RESULTS There were 45 eyes in the study group and 45 eyes in the control group. In the study group, IOP decreased from a baseline of 19.5±4.7 mm Hg on 2.2±1.2 medications to 16.7±5.2 mm Hg ( P =0.002) on 2.2±1.1 glaucoma medications ( P =0.57). In the control group, IOP decreased from 19.5±4.2 mm Hg on 2.4±1.0 medications to 16.4±5.2 mm Hg ( P =0.003) on 2.1±1.3 medications ( P =0.36). There was no difference in IOP reduction or change in number of glaucoma medications after SLT at any postoperative visit between the 2 groups ( P ≥0.12 for all). Primary success rates at 12 months were 24.4% for the control group and 26.7% for the prior incisional glaucoma surgery group with no significant difference between the groups ( P =0.92). There were no persistent complications after SLT treatment in either group. CONCLUSION SLT may effectively lower IOP in patients with open angle glaucoma who have had previous incisional glaucoma surgery and should be considered in select cases.
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Affiliation(s)
- Connie M Wu
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA
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Wong JC, Savsani E, Mahmoudzadeh R, Salabati M, Razeghinejad R, Lee D, Shukla AG, Myers JS, Pro MJ, Moster MR, Dunn JP, Kolomeyer NN. Glaucoma Surgical Outcomes in Patients with a History of Scleritis. Ocul Immunol Inflamm 2023:1-7. [PMID: 36802353 DOI: 10.1080/09273948.2023.2177678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 01/24/2023] [Accepted: 02/02/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE To assess the outcomes of glaucoma surgery in patients with a history of scleritis at a tertiary medical center. METHODS The retrospective case series included patients with a history of scleritis who required glaucoma surgery between 4/2006 and 8/2021. RESULTS Two hundred and eighty-one eyes of 259 patients had glaucoma and scleritis with 28 eyes (10%) of 25 patients requiring glaucoma surgery. Post-operatively, one eye (4%) had infectious scleritis. Eleven (39%) surgeries failed: 5 tube shunts, 5 cyclophotocoagulation, and 1 gonioscopy-assisted transluminal trabeculotomy. Five (18%) eyes required tube revisions due to tube exposures without infection (3), iris blocking the tube (1), or to shorten tube length (1). CONCLUSIONS Patients with a history of scleritis have a low risk of scleritis recurrence or scleral perforation after glaucoma surgery but should be counseled appropriately on the higher risk of reoperation.
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Affiliation(s)
- Jae-Chiang Wong
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
- Rowan University School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - Esika Savsani
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Raziyeh Mahmoudzadeh
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - Mirataollah Salabati
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - Reza Razeghinejad
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Daniel Lee
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Aakriti G Shukla
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jonathan S Myers
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael J Pro
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Marlene R Moster
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - James P Dunn
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - Natasha Nayak Kolomeyer
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Wong JC, Shiuey EJ, Razeghinejad R, Shukla AG, Kolomeyer NN, Myers JS, Pro MJ, Lee D. The effectiveness and tolerability of fixed-dose combination netarsudil 0.02%/latanoprost 0.005% at a tertiary glaucoma center. Graefes Arch Clin Exp Ophthalmol 2023; 261:193-200. [PMID: 35904596 DOI: 10.1007/s00417-022-05780-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 07/12/2022] [Accepted: 07/19/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To assess real-world effectiveness and tolerability of fixed-dose combination netarsudil 0.02%/latanoprost 0.005% (FCNL) in management of glaucoma patients in a tertiary eye care center. METHODS This retrospective cohort study included glaucoma patients initiated on FCNL from January 2018 to July 2021 with at least 1-month follow-up. Demographic and clinical data were collected at baseline and at follow-up visits through 12 months. Patient-solicited side effects were recorded at each visit. Maximum glaucoma pharmacotherapy was defined as surgery/laser being the next treatment option following an intensive pharmacotherapy regimen, or when pharmacotherapy could not be increased due to allergy/intolerance or all pharmacologic mechanisms already being in use. RESULTS Seventy-nine eyes of 47 patients were included. Mean age was 67.7 ± 14.7 years. Baseline IOP was 18.7 ± 4.9 mmHg; mean change in IOP (∆IOP) each study visit compared to baseline ranged from - 1.6 ± 3.5 to - 4.4 ± 4.1 mmHg (all p < 0.05). The eyes on maximum glaucoma pharmacotherapy (73.4%) had similar ∆IOP compared to those on non-maximal therapy at each visit (p > 0.2 for all). Forty-three (54.4%) eyes were switched from a prostaglandin analog alone, producing a 1-month IOP reduction of - 4.7 ± 3.9 mmHg at 1 month which remained significant at each visit for the 12-month study period (all p < 0.05). Across all study visits, conjunctival hyperemia was documented in 26 (32.9%) eyes. Subjective blurry vision was reported in 22 (27.8%) eyes without significant worsening of visual acuity at any visit (all p > 0.05). Six (7.6%) and 7 (8.9%) eyes required further medical or surgical/laser intervention, respectively. Kaplan-Meier analysis revealed no significant difference in the need for subsequent medical or surgical intervention between those on maximum and non-maximal pharmacotherapy (p > 0.4). CONCLUSION FCNL was well-tolerated and demonstrated a significant and sustained reduction in IOP, even as last-line therapy before incisional or laser surgery in those on maximum glaucoma pharmacotherapy. FCNL is a viable treatment option for glaucomatous eyes before consideration of surgical intervention.
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Affiliation(s)
- Jae-Chiang Wong
- Glaucoma Research Center, Wills Eye Hospital, 840 Walnut Street, Suite 1100, Philadelphia, PA, 19107, USA.,Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Eric J Shiuey
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Reza Razeghinejad
- Glaucoma Research Center, Wills Eye Hospital, 840 Walnut Street, Suite 1100, Philadelphia, PA, 19107, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Aakriti G Shukla
- Glaucoma Research Center, Wills Eye Hospital, 840 Walnut Street, Suite 1100, Philadelphia, PA, 19107, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Natasha N Kolomeyer
- Glaucoma Research Center, Wills Eye Hospital, 840 Walnut Street, Suite 1100, Philadelphia, PA, 19107, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jonathan S Myers
- Glaucoma Research Center, Wills Eye Hospital, 840 Walnut Street, Suite 1100, Philadelphia, PA, 19107, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael J Pro
- Glaucoma Research Center, Wills Eye Hospital, 840 Walnut Street, Suite 1100, Philadelphia, PA, 19107, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Daniel Lee
- Glaucoma Research Center, Wills Eye Hospital, 840 Walnut Street, Suite 1100, Philadelphia, PA, 19107, USA. .,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
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Salabati M, Mahmoudzadeh R, Wong JC, Patel D, Patel SN, Obeid A, Sivalingam A, Vander JF, Garg SJ, Ho AC, Regillo CD, Hsu J. Outcomes of eyes with retinal vein occlusion that are lost to follow-up after antivascular endothelial growth factor therapy. Br J Ophthalmol 2021; 106:1742-1747. [PMID: 34183325 DOI: 10.1136/bjophthalmol-2021-319180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/15/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS To evaluate the outcomes of eyes with macular oedema due to retinal vein occlusion (RVO) that are lost to follow-up (LTFU) after antivascular endothelial growth factor (VEGF) injections. METHOD A retrospective, single-centre, consecutive case series of RVO patients receiving injections who were LTFU >6 months was conducted. Data were collected from the visit before LTFU; return visit; 3 months, 6 months and 12 months after return; and the final visit. RESULTS Ninety eyes of 83 patients were included. Fifty (55.5%) eyes had branch RVO and 40 (44.5%) had central RVO. Mean LTFU duration was 277.8 days with additional mean follow-up for 748.1 days after return. Mean logarithm of the minimum angle of resolution visual acuity (VA) (Snellen) at the visit before LTFU was 0.72 (20/105) which worsened on return [1.04 (20/219), p<0.001) and remained worse at all timepoints after return: 0.92 (20/166) at 3 months (p<0.001), 0.97 (20/187) at 6 months (p<0.001), 0.94 (20/174) at 12 months (p<0.001) and 1.01 (20/205) at final visit (p<0.001). Mean central foveal thickness (CFT) increased from 252 µm at the visit before LTFU to 396 µm at the return visit (p<0.001). No difference in CFT was noted by 3 months (258 µm, p=0.71), 6 months (241 µm, p=0.54) or 12 months after return (250 µm, p=0.95). CFT was thinner at the final visit (215 µm, p=0.018). CONCLUSION RVO patients receiving anti-VEGF injections who were LTFU experienced a decline in VA that did not return to the levels seen before LTFU despite improvement in CFT after restarting therapy, underscoring the importance of ongoing treatment.
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Affiliation(s)
- Mirataollah Salabati
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - Raziyeh Mahmoudzadeh
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - Jae-Chiang Wong
- Rowan University School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - Dillan Patel
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Samir N Patel
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - Anthony Obeid
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - Arunan Sivalingam
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - James F Vander
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - Sunir J Garg
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - Allen C Ho
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - Carl D Regillo
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - Jason Hsu
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
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DiMeglio LA, Kanapka LG, DeSalvo DJ, Anderson BJ, Harrington KR, Hilliard ME, Laffel LM, Tamborlane WV, Van Name MA, Wadwa RP, Willi SM, Woerner S, Wong JC, Miller KM. Time spent outside of target glucose range for young children with type 1 diabetes: a continuous glucose monitor study. Diabet Med 2020; 37:1308-1315. [PMID: 32096282 PMCID: PMC9065795 DOI: 10.1111/dme.14276] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2020] [Indexed: 12/19/2022]
Abstract
AIM To assess the associations between demographic and clinical characteristics and sensor glucose metrics in young children with type 1 diabetes, using masked, continuous glucose monitoring data from children aged 2 to < 8 years. RESEARCH DESIGN AND METHODS The analysis included 143 children across 14 sites in the USA, enrolled in a separate clinical trial. Eligibility criteria were: age 2 to <8 years; type 1 diabetes duration ≥3 months; no continuous glucose monitoring use for past 30 days; and HbA1c concentration 53 to <86 mmol/mol (7.0 to <10.0%). All participants wore masked continuous glucose monitors up to 14 days. RESULTS On average, participants spent the majority (13 h) of the day in hyperglycaemia (>10.0 mmol/l) and a median of ~1 h/day in hypoglycaemia (<3.9 mmol/l). Participants with minority race/ethnicity and higher parent education levels spent more time in target range, 3.9-10.0 mmol/l, and less time in hyperglycaemia. More time in hypoglycaemia was associated with minority race/ethnicity and younger age at diagnosis. Continuous glucose monitoring metrics were similar in pump and injection users. CONCLUSIONS Given that both hypo- and hyperglycaemia negatively impact neurocognitive development, strategies to increase time in target glucose range for young children are needed.
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Affiliation(s)
- L A DiMeglio
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - L G Kanapka
- Jaeb Center for Health Research, Tampa, FL, USA
| | - D J DeSalvo
- Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - B J Anderson
- Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - K R Harrington
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | - M E Hilliard
- Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - L M Laffel
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | | | | | - R P Wadwa
- Barbara Davis Center for Childhood Diabetes, Aurora, CO, USA
| | - S M Willi
- Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - S Woerner
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - J C Wong
- University of California San Francisco, San Francisco, CA, USA
| | - K M Miller
- Jaeb Center for Health Research, Tampa, FL, USA
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10
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Varni JW, Delamater AM, Hood KK, Raymond JK, Chang NT, Driscoll KA, Wong JC, Yi-Frazier JP, Grishman EK, Faith MA, Corathers SD, Kichler JC, Miller JL, Doskey EM, Aguirre VP, Heffer RW, Wilson DP. Pediatric Quality of Life Inventory (PedsQL) 3.2 Diabetes Module for youth with Type 2 diabetes: reliability and validity. Diabet Med 2019; 36:465-472. [PMID: 30343524 DOI: 10.1111/dme.13841] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2018] [Indexed: 12/26/2022]
Abstract
AIM To test the measurement properties of the revised and updated Pediatric Quality of Life Inventory (PedsQL) 3.2 Diabetes Module originally developed in Type 1 diabetes in youth with Type 2 diabetes. METHODS The PedsQL 3.2 Diabetes Module and PedsQL Generic Core Scales were administered in a field test study to 100 young people aged 9-25 years with Type 2 diabetes. Factor analysis was conducted to determine the factor structure of the items. RESULTS The 15-item Diabetes Symptoms Summary Score and 12-item Type 2-specific Diabetes Management Summary Score were empirically derived through factor analysis. The Diabetes Symptoms and Type 2-specific Diabetes Management Summary Scores showed acceptable to excellent reliability across the age groups tested (α = 0.85-0.94). The Diabetes Symptoms and Type 2-specific Diabetes Management Summary Scores evidenced construct validity through large effect size correlations with the Generic Core Scales Total Scale Score (r = 0.67 and 0.57, respectively). HbA1c was correlated with the Diabetes Symptoms and Type 2-specific Diabetes Management Summary Scores (r = -0.13 and -0.22). Minimal clinically important difference (MCID) scores were 5.91 and 7.39 for the Diabetes Symptoms and Type 2-specific Diabetes Management Summary Scores. CONCLUSIONS The PedsQL 3.2 Diabetes Module Diabetes Symptoms Summary Score and Type 2-specific Diabetes Management Summary Score exhibited satisfactory measurement properties for use as youth self-reported diabetes symptoms and diabetes management outcomes for clinical research and clinical practice for young people with Type 2 diabetes.
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Affiliation(s)
- J W Varni
- Department of Pediatrics, College of Medicine and Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, College Station, TX
| | - A M Delamater
- Department of Pediatrics, Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, FL
| | - K K Hood
- Division of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, CA
| | - J K Raymond
- Center for Endocrinology, Diabetes, & Metabolism, Children's Hospital Los Angeles, Los Angeles, CA
| | - N T Chang
- Center for Endocrinology, Diabetes, & Metabolism, Children's Hospital Los Angeles, Los Angeles, CA
| | - K A Driscoll
- Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado Denver, Denver, CO
| | - J C Wong
- The Madison Clinic for Pediatric Diabetes and Department of Pediatrics, Division of Endocrinology, University of California San Francisco, San Francisco, CA
| | | | - E K Grishman
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Texas Southwestern Medical Center, Dallas, TX
| | - M A Faith
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Texas Southwestern Medical Center, Dallas, TX
| | - S D Corathers
- Department of Pediatrics, Division of Endocrinology, Cincinnati, OH
| | - J C Kichler
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
| | - J L Miller
- Division of Pediatric Endocrinology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - E M Doskey
- Department of Educational Psychology, Texas A&M University, College Station, College Station, TX
| | - V P Aguirre
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, College Station, TX
| | - R W Heffer
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, College Station, TX
| | - D P Wilson
- Cook Children's Medical Center, Fort Worth, TX, USA
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11
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Wong JC, Visanji NP, Dabek MK, Laposa RR, Hazrati LN. Dendritic spine density is altered in a mouse model of Cockayne syndrome. Neuropathol Appl Neurobiol 2013; 39:437-40. [PMID: 23039087 DOI: 10.1111/j.1365-2990.2012.01305.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 09/26/2012] [Indexed: 01/13/2023]
Affiliation(s)
- J C Wong
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
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12
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Yuan R, Hogg JC, Paré PD, Sin DD, Wong JC, Nakano Y, McWilliams AM, Lam S, Coxson HO. Prediction of the rate of decline in FEV(1) in smokers using quantitative Computed Tomography. Thorax 2009; 64:944-9. [PMID: 19734130 DOI: 10.1136/thx.2008.112433] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND A study was undertaken to determine if quantitative CT estimates of lung parenchymal overinflation and airway dimensions in smokers with a normal forced expiratory volume in 1 s (FEV(1)) can predict the rapid decline in FEV(1) that leads to chronic obstructive pulmonary disease (COPD). METHODS Study participants (n = 143; age 45-72 years; 54% male) were part of a lung cancer screening trial, had a smoking history of >30 pack years and a normal FEV(1) and FEV(1)/forced vital capacity (FVC) at baseline (mean (SD) FEV(1) 99.4 (12.8)%, range 80.2-140.7%; mean (SD) FEV(1)/FVC 77.9 (4.4), range 70.0-88.0%). An inspiratory multislice CT scan was acquired for each subject at baseline. Custom software was used to measure airway lumen and wall dimensions; the percentage of the lung inflated beyond a predicted maximal lung inflation, the low attenuation lung area with an x ray attenuation lower than -950 HU and the size distribution of the overinflated lung areas and the low attenuation area were described using a cluster analysis. Multiple regression analysis was used to test the hypothesis that these CT measurements combined with other baseline characteristics might identify those who would develop an excessive annual decline in FEV(1). RESULTS The mean (SD) annual change in FEV(1) was -2.3 (4.7)% predicted (range -23.0% to +8.3%). Multiple regression analysis revealed that the annual change in FEV(1)%predicted was significantly associated with baseline percentage overinflated lung area measured on quantitative CT, FEV(1)% predicted, FEV(1)/FVC and gender. CONCLUSION Quantitative CT scan evidence of overinflation of the lung predicts a rapid annual decline in FEV(1) in smokers with normal FEV(1).
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Affiliation(s)
- R Yuan
- University of British Columbia James Hogg iCAPTURE Centre for Cardiovascular and Pulmonary Research and the Providence Heart + Lung Institute, St Paul's Hospital, British Columbia, Canada
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13
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de Jong PA, Long FR, Wong JC, Merkus PJ, Tiddens HA, Hogg JC, Coxson HO. Computed tomographic estimation of lung dimensions throughout the growth period. Eur Respir J 2006; 27:261-7. [PMID: 16452578 DOI: 10.1183/09031936.06.00070805] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of the current study was to use computed tomography (CT) to estimate airway wall and lumen, and arterial and parenchyma dimensions in children throughout the growth period, and to provide normative data to study alterations caused by pulmonary disease. Clinical CT scans reported as normal that were performed in children for nonpulmonary and noncardiac reasons were analysed for lung weight, gas volume, lung expansion, lung surface/volume ratio, airway wall area, airway lumen area, airway lumen perimeter, arterial area and airway surface length/area ratio. The age range of the 50 subjects was 0-17.2 yrs. The data showed only little increase in lung expansion throughout childhood (n = 32). There was substantial variability in lung expansion between subjects. Airway wall and lumen and arterial area were exponentially associated with subjects' height (n = 50). Airway surface length/area ratio was linearly associated to alveolar surface/volume ratio. The data from the current study provide normative computed tomography estimates of airway wall and lumen, and arterial and parenchyma dimensions throughout the growth period that may be useful for the study of alterations in disease.
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Affiliation(s)
- P A de Jong
- Erasmus MC-Sophia, Dept of Paediatric Pulmonology and Allergology, Rotterdam, The Netherlands
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14
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Wong JC, Lambert RJ, Wurtzel ET, Rocheford TR. QTL and candidate genes phytoene synthase and zeta-carotene desaturase associated with the accumulation of carotenoids in maize. Theor Appl Genet 2004; 108:349-59. [PMID: 14523521 DOI: 10.1007/s00122-003-1436-4] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2003] [Accepted: 08/12/2003] [Indexed: 05/23/2023]
Abstract
Carotenoids are a class of fat-soluble antioxidant vitamin compounds present in maize ( Zea mays L.) that may provide health benefits to animals or humans. Four carotenoid compounds are predominant in maize grain: beta-carotene, beta-cryptoxanthin, zeaxanthin, and lutein. Although beta-carotene has the highest pro-vitamin A activity, it is present in a relatively low concentration in maize kernels. We set out to identify quantitative trait loci (QTL) affecting carotenoid accumulation in maize kernels. Two sets of segregating families were evaluated-a set of F2:3 lines derived from a cross of W64a x A632, and their testcross progeny with AE335. Molecular markers were evaluated on the F2:3 lines and a genetic linkage map created. High-performance liquid chromatography was performed to measure beta-carotene, beta-cryptoxanthin, zeaxanthin, and lutein on both sets of materials. Composite interval mapping identified chromosome regions with QTL for one or more individual carotenoids in the per se and testcross progenies. Notably QTL in the per se population map to regions with candidate genes, yellow 1 and viviparous 9, which may be responsible for quantitative variation in carotenoids. The yellow 1 gene maps to chromosome six and is associated with phytoene synthase, the enzyme catalyzing the first dedicated step in the carotenoid biosynthetic pathway. The viviparous 9 gene maps to chromosome seven and is associated with zeta-carotene desaturase, an enzyme catalyzing an early step in the carotenoid biosynthetic pathway. If the QTL identified in this study are confirmed, particularly those associated with candidates genes, they could be used in an efficient marker-assisted selection program to facilitate increasing levels of carotenoids in maize grain.
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Affiliation(s)
- J C Wong
- Department of Crop Sciences, University of Illinois, Urbana, IL 61801, USA
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15
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Sternson SM, Wong JC, Grozinger CM, Schreiber SL. Synthesis of 7200 small molecules based on a substructural analysis of the histone deacetylase inhibitors trichostatin and trapoxin. Org Lett 2001; 3:4239-42. [PMID: 11784187 DOI: 10.1021/ol016915f] [Citation(s) in RCA: 122] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Seventy-two hundred potential inhibitors of the histone deacetylase (HDAC) enzyme family, based on a 1,3-dioxane diversity structure, were synthesized on polystyrene macrobeads. The compounds were arrayed for biological assays in a "one bead-one stock solution" format. Metal-chelating functional groups were used to direct the 1,3-dioxanes to HDAC enzymes, which are zinc hydrolases. Representative structures from this library were tested for inhibitory activity and the 1,3-dioxane structure was shown to be compatible with HDAC inhibition. [structure: see text]
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Affiliation(s)
- S M Sternson
- Howard Hughes Medical Institute (HHMI), Institute of Chemistry and Cell Biology (ICCB), Department of Chemistry & Chemical Biology, Harvard University, Cambridge, MA 02138, USA
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16
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Abstract
The purpose of this study was to determine annual occupational exposure to UV radiation by measurement and derive ambient exposure fractions for an entire year that could be applied in the human exposure model. Using polysulphone the daily occupational erythema effective solar ultraviolet radiation exposure at selected body sites of Australia Post mail delivery personnel and physical education teachers were measured over an 18-mo period on a daily basis in the Rockhampton (lat. 23.5 degrees S) region. The daily exposures were summed to estimate an annual exposure for these occupations in this region. For the Australia Post mail delivery personnel, who had very little change to the posture or route during delivery, the annual mean estimates of exposure to erythema effective solar irradiance for the chest, hands, and back were in the range of 192+/-27 kJ m(-2), 388+/-45 kJ m(-2), and 283+/-32 kJ m(-2), respectively. Physical education teachers had varied duties on a day-to-day basis and many changes in their posture and outdoor locations where the exposure occurred. Their annual mean exposure on the vertex (hat), chest, shoulder, thigh, and back were in the range 340+/-71 kJ m(-2), 140+/-28 kJ m(-2), 180+/-40 kJ m(-2), 129+/-24 kJ m(-2), and 212+/-42 kJ m(-2), respectively. The annual exposure range for erythema effective solar irradiance at different body sites during the experimental period was between 120 and 440 kJ m(-2) for the two occupational groups. These exposures greatly exceed the National Health and Medical Research Council occupational standard limit of 30 J m(-2) for daily exposure, which indicates the need for additional protective measures. The ambient exposure was also measured and used to compute ambient exposure fractions for the different body sites over an entire year, which are useful for model calculations on human exposure and assess increase in risk of n on melanoma skin cancer.
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Affiliation(s)
- D Vishvakarman
- James Goldston Faculty of Engineering and Physical Systems, Central Queensland University. Rockhampton, Australia
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17
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Provenzale JM, Petrella JR, Cruz LC, Wong JC, Engelter S, Barboriak DP. Quantitative assessment of diffusion abnormalities in posterior reversible encephalopathy syndrome. AJNR Am J Neuroradiol 2001; 22:1455-61. [PMID: 11559490 PMCID: PMC7974581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
BACKGROUND AND PURPOSE Previous studies have shown that lesions in posterior reversible encephalopathy syndrome are often isointense on diffusion-weighted MR images. We hypothesized that 1) apparent diffusion coefficient (ADC) maps using various thresholds would show larger abnormalities in posterior white matter (WM) and 2) isointense appearance of lesions on isotropic diffusion-weighted images results from a balance of T2 prolongation effects and diffusibility effects. METHODS T2-weighted MR images from 11 patients were reviewed. Hyperintense lesions were located in both anterior and posterior WM in eight patients and solely in posterior WM in three patients. The ADC maps were produced by use of ADC values > or = 3 SD and > or = 10 SD above the mean value of normal WM. Lesions on diffusion-weighted images were classified as isointense or hypointense. ADC values within lesions (ADC(L)) were compared with those of normal WM (ADC(N)), and compared for isointense lesions and hypointense lesions. RESULTS The distribution of lesions with ADC values > or = 3 SD was essentially identical to that on T2-weighted images. Regions with ADC values > or = 10 SD were found in both anterior WM and posterior WM in two patients and solely in posterior WM in nine patients. On diffusion-weighted images, lesions appeared isointense in seven patients and hypointense in four patients. Mean ADC(L)/ADC(N) for all lesions was 1.81; for hypointense lesions, 2.30. CONCLUSION Vasogenic edema was more severe in posterior WM. Isointense lesions result from a balance of T2 effects and increased water diffusibility. Hypointense lesions have higher ADC values, which are not balanced by T2 effects.
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Affiliation(s)
- J M Provenzale
- Department of Radiology, Duke University Medical Center, Durham, North Carolina 27710, USA
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18
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Haynes SL, Wong JC, Torella F, Dalrymple K, Pilsworth L, McCollum CN. The influence of homologous blood transfusion on immunity and clinical outcome in aortic surgery. Eur J Vasc Endovasc Surg 2001; 22:244-50. [PMID: 11506518 DOI: 10.1053/ejvs.2001.1408] [Citation(s) in RCA: 22] [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: 11/11/2022]
Abstract
OBJECTIVES To evaluate the influence of homologous blood transfusion on immune responses and post-operative morbidity in aortic surgery. DESIGN Analysis of the effects of homologous blood transfusion in 128 patients in a prospective randomised trial evaluating homologous and autologous blood transfusion in aortic surgery. MATERIALS AND METHODS Blood sampled before and at five times after surgery was assayed for C-reactive protein (CRP), neutrophil elastase, TNF-alpha and IL-6. Transfusions, morbidity and mortality were recorded; factors associated with poor outcome were identified by logistic regression. RESULTS homologous transfusion during surgery was required in 32 patients and precipitated an increase in neutrophil elastase (p=0.008) and TNF-alpha (p=0.015) but not IL-6 and CRP. Elastase peaked early in transfused patients at 41.27 (13.92-52.11) Deltang/ml by 2 h compared to a peak of 21.51 (10.64-31.13) Deltang/ml by 24 h in those who were not transfused. TNF-alpha peaked at 1.2 (0-4.33) Deltapg/ml by wound closure in transfused patients and at -0.1 (-2.05-2.52) Deltapg/ml by 2 h without transfusion. Intra-operative homologous transfusion was associated with increased mortality (p=0.01) and prolonged intensive care stay (p=0.03). Mortality increased with age (p=0.003) and was inversely related to the CRP peak (p=0.007). Prolonged surgery predicted post-operative complications (p=0.025). CONCLUSION Homologous transfusion increased the inflammatory response to aortic surgery and was associated with mortality.
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Affiliation(s)
- S L Haynes
- Academic Surgery Unit, South Manchester University Hospital, Manchester, West Didsbury, M20 2LR, UK
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19
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Parisi AV, Kimlin MG, Wong JC, Wilson M. Solar ultraviolet exposures at ground level in tree shade during summer in south east Queensland. Int J Environ Health Res 2001; 11:117-127. [PMID: 11382345 DOI: 10.1080/09603120020047500] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Data are presented on the effect of the tree canopy transmittance in the visible waveband (VT), canopy width, height and height of the start of the tree canopy (CH) on the solar UV in tree shade on a horizontal plane at ground level during a Southern Hemisphere summer. Of these factors, the VT and CH have an influence on the UV irradiances in the tree shade. The shade ratios (UV in tree shade to that in full sun) for erythemal UV ranged from 0.71 to 0.42, 0.54 to 0.29 and 0.63 to 0.41 for morning, noon and afternoon, respectively, for the VT range of 0.4-1.0. Over the same VT range, the shade ratios for UVA ranged from 0.61 to 0.28, 0.50 to 0.22 and 0.49 to 0.29 for morning, noon and afternoon, respectively. The UV exposures in the tree shade decreased with the VT with a marginally higher decrease in the irradiances for the UVA compared to the erythemal UV. Despite the protection by the tree shade, significant UV in the tree shade of approximately 4 MED (minimum erythemal dose) were received for the latitude in this research on a cloud free summer day on a horizontal plane over a 2-h period centred about solar noon.
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Affiliation(s)
- A V Parisi
- Centre for Astronomy and Atmospheric Research, University of Southern Queensland, Toowoomba, 4350, Australia.
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20
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Parisi AV, Wong JC, Kimlin MG, Turnbull D, Lester R. Comparison between seasons of the ultraviolet environment in the shade of trees in Australia. Photodermatol Photoimmunol Photomed 2001; 17:55-9. [PMID: 11338402 DOI: 10.1034/j.1600-0781.2001.017002055.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND/PURPOSE This paper has considered the erythemal UV (UVery), UVA and visible irradiances in the shade of Australian trees for each season at a sub-tropical southern hemisphere site. METHODS The irradiances in tree shade have been measured with radiometers as a percentage of the irradiances in the sun for each season of the year. RESULTS Although the solar irradiances are lower in winter, the percentages of the UV in tree shade compared to the UV in full sun are marginally higher (by up to 7%) in the winter compared to summer. The range of percentages for UVery was up to double that of the percentages of the visible waveband. The percentages for UVery were also higher than for the UVA waveband. The percentages of the irradiances in the tree shade compared to full sun are 8-14% lower at noon compared to the morning and afternoon for the UVery waveband. The ratio of UVA to UVery is lower in the tree shade compared to the full sun. CONCLUSIONS The UVA to UVery ratio is expected to be even lower in the tree shade as a result of ozone depletion. This, combined with the visible irradiances in the tree shade not being a reliable indication of the biologically damaging UV irradiances, has consequences for public health and skin cancer prevention.
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Affiliation(s)
- A V Parisi
- Centre for Astronomy and Atmospheric Research, Faculty of Sciences, University of Southern Queensland, Toowoomba, Australia
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21
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Chen YM, Huang KL, Jen I, Chen SC, Liu YC, Chuang YC, Wong JC, Tsai JJ, Lan YC. Temporal trends and molecular epidemiology of HIV-1 infection in Taiwan from 1988 to 1998. J Acquir Immune Defic Syndr 2001; 26:274-82. [PMID: 11242201 DOI: 10.1097/00042560-200103010-00011] [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] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Eight hundred and seventy-nine HIV-1-infected patients (comprising 46% of reported HIV-1/AIDS cases in Taiwan) were recruited for this study of the molecular epidemiology of HIV-1 in Taiwan from 1988 to 1998. HIV-1 subtypes were determined using a modified peptide-enzyme immunoassay complemented with DNA sequencing and phylogenetic analysis. Of the 807 HIV-1 infected men, 68.2% were infected with HIV-1B, 29.5% with HIV-1 circulating recombinant form (CRF)01_AE and 2.3% with other subtypes. Of the 72 HIV-1-infected women, 72.2% were infected with HIV-1 CRF01_AE, 13.9% with HIV-1B, and 13.9% with other subtypes. All of 8 foreign-born, Southeast Asian women and 6 of 7 (85.7%) Taiwan-native female commercial sex workers were infected with HIV-1 CRF01_AE. Fourteen of the 33 (42.4%) heterosexual married men with CRF01_AE had transmitted HIV-1 to their wives, whereas only 1 of 17 (5.9%) men with HIV-1 B had transmitted HIV-1 to their spouses (p < .01). Of 18 heterosexual male injecting drug users, 1 of 12 (8.5%) with HIV-1B and 5 of 6 (83.3%) with HIV-1 CRF01_AE had had sexual contact with female commercial sex workers (p < .01). Therefore, in this population, CRF01_AE was preferentially associated with heterosexual risk groups, a finding compatible with differences in transmission capability between B and non-B subtypes.
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Affiliation(s)
- Y M Chen
- AIDS Prevention and Research Center, National Yang-Ming University, Taipei, Taiwan.
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Sternson SM, Louca JB, Wong JC, Schreiber SL. Split--pool synthesis of 1,3-dioxanes leading to arrayed stock solutions of single compounds sufficient for multiple phenotypic and protein-binding assays. J Am Chem Soc 2001; 123:1740-7. [PMID: 11456775 DOI: 10.1021/ja0036108] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.4] [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: 11/29/2022]
Abstract
Diversity-oriented organic synthesis offers the promise of advancing chemical genetics, where small molecules are used to explore biology. While the split--pool synthetic method is theoretically the most effective approach for the production of large collections of small molecules, it has not been widely adopted due to numerous technical and analytical hurdles. We have developed a split--pool synthesis leading to an array of stock solutions of single 1,3-dioxanes. The quantities of compounds are sufficient for hundreds of phenotypic and protein-binding assays. The average concentration of these stock solutions derived from a single synthesis bead was determined to be 5.4 mM in 5 microL of DMSO. A mass spectrometric strategy to identify the structure of molecules from a split--pool synthesis was shown to be highly accurate. Individual members of the 1,3-dioxane library have activity in a variety of phenotypic and protein-binding assays. The procedure developed in this study allows many assays to be performed with compounds derived from individual synthesis beads. The synthetic compounds identified in these assays should serve as useful probes of cellular and organismal processes.
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Affiliation(s)
- S M Sternson
- Harvard Institute of Chemistry and Cell Biology, Harvard Medical School, Boston, Massachusetts 02115, USA
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Khamsi F, Yavas Y, Roberge S, Wong JC, Lacanna IC, Endman M. Intracytoplasmic sperm injection increased fertilization and good-quality embryo formation in patients with non-male factor indications for in vitro fertilization: a prospective randomized study. Fertil Steril 2001; 75:342-7. [PMID: 11172837 DOI: 10.1016/s0015-0282(00)01674-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the fertilization rate and formation of good-quality embryos with conventional IVF and ICSI in patients with non-male factor infertility. DESIGN Prospective controlled study. SETTING Infertility clinic. PATIENT(S) Thirty-five patients with non-male factor infertility. INTERVENTION(S) Retrieved sibling oocytes were randomly assigned to conventional IVF or ICSI. Of sibling oocytes assigned to ICSI, only metaphase II oocytes were injected with sperm. MAIN OUTCOME MEASURE(S) Fertilization rate and formation of good-quality embryos per retrieved oocyte. RESULT(S) Per retrieved oocyte, ICSI resulted in better fertilization rate compared with conventional IVF (71.3% [134 of 188] vs. 57.2% [107 of 187]). Per retrieved oocyte, ICSI also resulted in better formation of good-quality embryos at 48 hours after retrieval compared with conventional IVF (64.4% [121 of 188] vs. 47.1% [88 of 187]). CONCLUSION(S) In IVF patients with non-male factor infertility, subjecting some sibling oocytes to ICSI increased the fertilization rate and formation of good-quality embryos per retrieved oocyte. It also avoided the problem of total fertilization failure in almost all cases.
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Affiliation(s)
- F Khamsi
- Toronto Fertility Sterility Institute, 66 Avenue Road, Toronto, Ontario, Canada, M5R 3N8.
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Khamsi F, Yavas Y, Lacanna IC, Roberge S, Endman M, Wong JC. Exposure of human oocytes to endometrioma fluid does not alter fertilization or early embryo development. J Assist Reprod Genet 2001; 18:106-9. [PMID: 11285976 PMCID: PMC3455555 DOI: 10.1023/a:1026586709554] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Extensive endometriosis causes a mechanical disturbance in the pelvis leading to obstructive-type infertility. However, minimal or mild endometriosis is suspected to cause infertility, possibly through a humoral agent. Previous studies reported the presence of a factor in the serum of patients with endometriosis which reduced fertilization and early embryo formation in a rat IVF model. METHODS In the present article, we report a comparison of oocytes exposed to endometrioma fluid and oocytes not exposed (controls) in the context of a human IVF setting. We have been in the practice of aspirating oocytes into prewarmed 60-ml syringes containing culture medium. We have shown previously that this technique reduces the length of oocyte retrieval without compromising success. In 14 women undergoing oocyte retrieval, we inadvertently entered an endometrioma. This resulted in retrieved oocytes that were either exposed or not exposed to endometrioma fluid. RESULTS In contrast to previous reports, we found no difference in fertilization or early embryo development between the two groups. The fertilization rate for oocytes exposed to an endometrioma was 60%, versus 56% for controls. The good-quality embryo formation rate for oocytes exposed to an endometrioma was 45%, versus 46% for controls.
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Affiliation(s)
- F Khamsi
- Toronto Fertility Sterility Institute, 66 Avenue Rd, Toronto, Ontario, Canada M5R 3N8
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25
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Abstract
UNLABELLED Anorexia nervosa (AN) can lead to osteoporosis and fractures. OBJECTIVE This study evaluated adolescent females with AN diagnosed within the previous 12 months to determine whether there is bone mass reduction and to investigate relationships between nutritional indices (weight, body mass index [BMI], lean mass, fat mass, and percentage fat) and total body (TB) and lumbar spine (LS) bone mineral densities (BMD) and content (BMC). METHOD TB and LS BMD and BMC and body composition were measured in 24 adolescent females with AN. RESULTS There was no significant reduction in TB or LS BMD. Regression analysis shows significant correlation (p < 0.001) between lean mass and TB BMD (r = +0.83), TB BMC (r = +0.92), LS BMD (r = +0.81), and LS BMC (r = +0.92). There was also a significant relationship between weight percentile and LS BMD z score (p < 0.005; r = +0.60). DISCUSSION Adolescent females with early AN do not appear to have reduced bone mass. Lean mass is correlated to BMD and BMC.
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Affiliation(s)
- J C Wong
- Department of Nuclear Medicine and Bone Mineral Densitometry, Royal Brisbane Hospital, Brisbane, Australia.
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26
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Abstract
A case is presented of vertebral osteomyelitis in an elderly confused patient with poorly localizing signs. The lesion was not diagnosed on the initial MRI study of the spine due to poor targeting. The abnormality was detected on a bone scan the following day. This was confirmed with a gallium scan 3 days later, and also a repeat MRI study 11 days after the first MRI, using an optimized protocol over the region of interest established by the bone scan.
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Affiliation(s)
- L McEwan
- Nuclear Medicine Department, Royal Brisbane Hospital, Herston, Queensland, Australia.
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Khamsi F, Yavas Y, Roberge S, Lacanna IC, Wong JC, Endman M. The status of controlled prospective clinical trials for efficacy of intracytoplasmic sperm injection in in vitro fertilization for non-male factor infertility. J Assist Reprod Genet 2000; 17:504-7. [PMID: 11155323 PMCID: PMC3455263 DOI: 10.1023/a:1009441808115] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Intracytoplasmic sperm injection (ICSI) of some sibling oocytes may have a beneficial effect in couples going through in vitro fertilization for causes of infertility not related to the male factor. Our purpose was to critically appraise the randomized controlled studies done in this area and arrive at some recommendations. METHODS The four controlled trials done so far have utilized similar methodology, i.e., they randomly allotted sibling oocytes to ICSI versus standard insemination in patients going through in vitro fertilization and embryo transfer. RESULTS In the first trial reported in 1995 there was no difference in fertilization rate, whereas the later trials reported in 1997, 1999, and 2000 showed improvement with ICSI that reached statistically significant level in the last two studies. CONCLUSIONS Total fertilization failure of an in vitro fertilization cycle can be prevented and fertilization can be improved if half of sibling oocytes are subjected to ICSI.
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Affiliation(s)
- F Khamsi
- Toronto Fertility Sterility Institute, Toronto, Canada
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28
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Wong JC, Alon N, Norga K, Kruyt FA, Youssoufian H, Buchwald M. Cloning and analysis of the mouse Fanconi anemia group A cDNA and an overlapping penta zinc finger cDNA. Genomics 2000; 67:273-83. [PMID: 10936049 DOI: 10.1006/geno.2000.6252] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [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
Despite the cloning of four disease-associated genes for Fanconi anemia (FA), the molecular pathogenesis of FA remains largely unknown. To study FA complementation group A using the mouse as a model system, we cloned and characterized the mouse homolog of the human FANCA cDNA. The mouse cDNA (Fanca) encodes a 161-kDa protein that shares 65% amino acid sequence identity with human FANCA. Fanca is located at the distal region of mouse chromosome 8 and has a ubiquitous pattern of expression in embryonic and adult tissues. Expression of the mouse cDNA in human FA-A cells restores the cellular drug sensitivity to normal levels. Thus, the expression pattern, protein structure, chromosomal location, and function of FANCA are conserved in the mouse. We also isolated a novel zinc finger protein, Zfp276, which has five C(2)H(2) domains. Interestingly, Zfp276 is situated in the Fanca locus, and the 3'UTR of its cDNA overlaps with the last four exons of Fanca in a tail-to-tail manner. Zfp276 is expressed in the same tissues as Fanca, but does not complement the mitomycin C (MMC)-sensitive phenotype of FA-A cells. The overlapping genomic organization between Zfp276 and Fanca may have relevance to the disease phenotype of FA.
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Affiliation(s)
- J C Wong
- Program in Genetics and Genomics Biology, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
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29
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Parisi AV, Meldrum LR, Kimlin MG, Wong JC, Aitken J, Mainstone JS. Evaluation of differences in ultraviolet exposure during weekend and weekday activities. Phys Med Biol 2000; 45:2253-62. [PMID: 10958193 DOI: 10.1088/0031-9155/45/8/314] [Citation(s) in RCA: 33] [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: 11/11/2022]
Abstract
The weekday UV exposures to anatomical sites were evaluated for outdoor workers, home workers, adolescents, indoor workers, school staff and students in south-east Queensland, Australia. Additionally, the UV exposures at weekends of school staff, school students, indoor workers and outdoor workers were evaluated. The weekday exposures per day ranged from 1.0 to 11.0 SED for winter to summer respectively. During spring, the ratios of the personal exposures divided by the ambient exposures at the weekend to the personal exposures divided by the ambient exposures on the weekdays to the neck, hand and left arm were at least 3.4, 2.0 and 0.67 for the indoor workers, school staff and students and outdoor workers respectively. The same ratios for the erythemal UV exposures over the year, estimated from the exposures on four days in each of the four seasons, were at least 2.3 for the school staff and at least 1.3 for the 13 to 19 year old school students. These results reinforce the importance of targeting prevention programmes to both weekend and weekday exposures.
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Affiliation(s)
- A V Parisi
- Centre for Astronomy and Atmospheric Research, Faculty of Sciences, University of Southern Queensland, Toowoomba, Australia
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30
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Affiliation(s)
- J C Wong
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
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31
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Abstract
A spectrum evaluator based on four different dosimeter materials has been employed to estimate the spectral irradiances of solar radiation for exposed humans. The result is used to calculate the biologically effective irradiance using the erythemal action spectrum and a fish melanoma action spectrum. Measurements are made in winter at a sub-tropical site on the chest and shoulder of subjects during normal daily activities. Up to 95% of the total UV exposure received is in the UV-A waveband (320-400 nm). The UV-A waveband is found to contribute approximately 14% of the erythemal UV and 93% of the biologically effective UV for fish melanoma. Extrapolation to humans suggests that exposure to the UV-A band will contribute to photodamage in human skin during exposure to solar radiation.
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Affiliation(s)
- A V Parisi
- Centre for Astronomy and Atmospheric Research, Department of Biological and Physical Sciences, University of Southern Queensland, Toowoomba, Australia.
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32
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Parisi AV, Meldrum LR, Wong JC, Aitken J, Fleming RA. Effect of childhood and adolescent ultraviolet exposures on cumulative exposure in South East Queensland schools. Photodermatol Photoimmunol Photomed 2000; 16:19-24. [PMID: 10721860 DOI: 10.1034/j.1600-0781.2000.160106.x] [Citation(s) in RCA: 25] [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] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Quantitative estimates of the childhood and adolescent erythemal ultraviolet (UV) exposure received in South East Queensland schools are provided in this paper for age groups 0 to 6, 7 to 12 and 13 to 19 years. For the neck, hand and lower arm, sites of high UV exposure that are generally not covered by clothing, 13 to 19 year olds received the highest exposure of the three age groups, followed by 7 to 12 year olds. Exposure for 13 to 19 year olds contributed up to 44% of cumulative exposure to 20 years of age, and exposures for the 7 to 12 year olds contributed up to 31%. If the annual UV exposure for these two age groups were reduced to the average of all the age groups, cumulative erythemal UV exposure from 0 to 20 years would be reduced by up to 16%. On the other hand, if mothers can protect their babies by reducing the level of annual exposure to 30% of the annual UV exposure of the 7 to 12 year olds for the first four years then cumulative exposure to UV to age 20 would be reduced by up to 19%. These data confirm the importance of targeting young age groups in public campaigns for sun protection.
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Affiliation(s)
- A V Parisi
- Centre for Astronomy and Atmospheric Research, Faculty of Sciences, University of Southern Queensland, Toowoomba, Australia
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Abstract
The first set of quantitative data of diffuse erythemal UV and UV-A radiation in tree shade at a sub-tropical Southern Hemisphere latitude is presented. Over the summer, approximately 60% of the erythemal UV radiation in tree shade is due to the diffuse component. Similarly, approximately 56% of the UV-A radiation in tree shade is due to the diffuse component. In tree shade these diffuse UV percentages are relatively constant from the morning to noon to afternoon periods. In comparison, in full sun, there is a decrease in the percentage of diffuse UV from morning to noon to afternoon. The exposures to diffuse UV on a horizontal plane in tree shade between 9:00 EST and 15:00 EST are of the order of 4 MED (minimum erythemal dose) and 14 J cm(-2) for erythemal UV and UV-A, respectively. The high diffuse UV component in the shade may result in high UV exposures not only to unprotected parts of the body on a horizontal plane, but also in equally high UV irradiances to parts of the body, including the eyes and face, that are not UV protected.
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Affiliation(s)
- A V Parisi
- Centre for Astronomy and Atmospheric Research, University of Southern Queensland, Toowoomba, Australia.
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34
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Abstract
The personal radiant exposure distribution of solar erythemal UV in tree shade for an upright posture was measured, with measurements over the whole summer for a total of 17 trees. For each tree, the personal radiant exposure distribution was measured for both the morning and afternoon periods. The exposure ratios averaged over all the trees and over the morning and afternoon periods ranged from 0.16 to 0.49 for the different anatomical sites. A numerical model was employed to estimate the UV radiant exposure to humans in tree shade over the entire summer. The body sites with the higher exposure ratios in the tree shade were the vertex of the head, shoulders and forearms with radiant exposures over the summer of 1300 MED to the vertex of the head and 1100 MED to the shoulders and forearms. These radiant exposures in the shade are substantially higher than the ambient erythemal UV measured in full sun on a horizontal plane over a full summer at a more temperate northern hemisphere latitude. The average radiant exposures per day to each anatomical site for a complete day in the tree shade ranged from 4.6 to 14.6 MED. This research has provided new data that is essential to quantify human UV exposure during outdoor activities.
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Affiliation(s)
- A V Parisi
- Centre for Astronomy and Atmospheric Research, University of Southern Queensland, Toowoomba, Australia.
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35
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Sim EK, Grignani RT, Wong ML, Quek SC, Wong JC, Yip WC, Lee CN. Influence of surgery on aortic valve prolapse and aortic regurgitation in doubly committed subarterial ventricular septal defect. Am J Cardiol 1999; 84:1445-8, A8. [PMID: 10606121 DOI: 10.1016/s0002-9149(99)00594-9] [Citation(s) in RCA: 22] [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: 11/21/2022]
Abstract
Doubly committed subarterial ventricular septal defects should be closed surgically once aortic valve deformity is present before the onset of aortic regurgitation.
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Affiliation(s)
- E K Sim
- Cardiac Department National University Hospital, Singapore, Singapore.
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36
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Parisi AV, Meldrum LR, Wong JC, Aitken J, Fleming RA. Lifetime ultraviolet exposure estimates for selected population groups in south-east Queensland. Phys Med Biol 1999; 44:2947-53. [PMID: 10616147 DOI: 10.1088/0031-9155/44/12/307] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The lifetime erythemal UV exposures received by selected population groups in southeast Queensland from birth up to an age of 55 years have been quantitatively estimated. A representative sample of teachers and other school workers received (64 +/- 22) x 10(5) J m(-2) to the neck compared with (4.1 +/- 1.4) x 10(5) J m(-2) to the upper leg. A sample of indoor workers (bank officers, solicitors and psychologists) received approximately 2% less and a sample of outdoor workers (carpenters, tilers, electricians and labourers) received approximately 10% more to the neck than the school workers. These differences in erythemal UV exposures may influence the risk of non-melanoma skin cancer.
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Affiliation(s)
- A V Parisi
- Centre for Astronomy and Atmospheric Research, Faculty of Sciences, University of Southern Queensland, Toowoomba, Australia
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Abstract
Several furanonaphthoquinones have shown useful activity in a yeast assay for DNA-damaging agents and cytotoxicity in mammalian cell culture assays. These results, together with the planar aromatic character of the furanonaphthoquinones, suggested that they might be acting as DNA intercalators. In an attempt to improve this activity, various analogues containing a hydroxyamino side chain have been synthesized. The analogues were prepared by standard methods, but some unexpected reactions were observed nonetheless. Thus, 8-formyl-5-methoxy-4,9-dihydronaphtho[2,3-b]furan-4,9-dione (24) showed an unusual reactivity toward reductive amination, with the reaction proceeding further to give one of two different cyclized products, depending on the amination reagent used. Bioassay results indicated that only simple furanonaphthoquines showed activity in a yeast assay for DNA-damaging agents; compounds with a substituted hydroxyamino side chain were uniformly inactive in this assay. Most of the compounds with a substituted hydroxyamino side chain on the furan ring did, however, show cytotoxicity, although none of them was any more active than the simple aldehyde 2-formyl-4, 9-dihydronaphtho[2,3-b]furan-4,9-dione (14). This evidence tends to suggest that the furanonaphthoquinones do not serve primarily as DNA intercalators, because if this were the case, they would have been expected to show an increased activity on conversion to their hydroxyamino side chain derivatives.
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Affiliation(s)
- C Wu
- Department of Chemistry, Virginia Polytechnic Institute and State University, Blacksburg, Virginia 24061-0212, USA
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38
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Wong JC. Further study on the effects of histamine H2 receptor agonist and antagonists on restraint-induced antinociception in mice. Methods Find Exp Clin Pharmacol 1999; 21:403-7. [PMID: 10445232 DOI: 10.1358/mf.1999.21.6.541920] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In previous studies, histamine was shown to affect the antinociceptive activity induced by stress in mice. The present work was carried out to further examine the role of histamine in this phenomenon. Restraint for 1 h induced significant antinociceptive activity as assessed by the hot plate test in both male and female mice. The antinociceptive activity was enhanced by prior administration of the histamine H2 receptor agonist dimaprit (6.0 mg/kg s.c.) 15 min before restraint. Furthermore, the induction of antinociceptive activity by restraint was antagonized by prior administration of histamine H2 receptor antagonists (10.0 mg/kg s.c.), cimetidine or zolantidine. In the male mice, naloxone (4.0 mg/kg s.c.) administered 10 min before or immediately after restraint did not affect the antinociception induced by restraint. In addition, the potentiating effect of dimaprit and the inhibitory effect of cimetidine and zolantidine were not affected by administration of naloxone. However, in female mice, naloxone given 10 min before restraint completely abolished the induction of antinociceptive activity by restraint and the effects of histamine H2 receptor agonist and antagonists on restraint induced antinociception were not observed. Moreover, the antinociceptive activity induced by restraint and the dimaprit-induced potentiation of antinociceptive activity were diminished by naloxone administered immediately after the restraint. The present findings further support our previous studies which suggested that the histamine H2 receptor most probably is involved in enhancing the intensity of stress in restraint-induced antinociception thus altering the degree of antinociception observed.
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Affiliation(s)
- J C Wong
- Neuropharmacology Research Group, School of Pharmacy and Biomedical Sciences, University of Portsmouth, United Kingdom.
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39
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Abstract
The penetration of solar erythemal ultraviolet radiation has been measured in the shade of a gum (Eucalyptus sp.) and a she oak (Casaurina) tree, both on a horizontal plane and with polysulphone dosimeters to human anatomical sites. This has provided new data useful for protection strategies against harmful ultraviolet radiation. For larger solar zenith angles, the relative penetration of solar erythemal ultraviolet in the shade of the trees is higher. On a horizontal plane, at noon, in winter, the shade erythemal ultraviolet ranged from 44 to 55% of that in the sun whereas in spring it ranged from 29 to 37% of the irradiances in the sun. Similarly, at 9:00 EST and 15:00 EST, the shade erythemal ultraviolet in winter ranged from 51 to 81% of the irradiances in the sun whereas in spring and summer they ranged from 35 to 51% of the unshaded irradiances. The shade ratios for specific body sites provided by the shade of the two trees were 0.05 to 0.45 for the solar zenith angles in this research. The shade ratios ranged from 0.14 to 0.45 for the gum tree and from 0.05 to 0.28 for the she oak. The denser foliage of the she oak provided higher ultraviolet protection compared to that of the gum tree.
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Affiliation(s)
- A V Parisi
- Centre for Astronomy and Atmospheric Research, University of Southern Queensland, Toowoomba, Australia
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40
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Abstract
BACKGROUND From 1986 to March 1997, 128 patients diagnosed to have doubly committed subarterial ventricular septal defects (VSD) were reviewed. Patients with aortic regurgitation (AR), and aortic valve (AV) deformity or a large left-to-right shunt across the VSD were offered operation. Forty-five patients (27 men, 18 women) agreed to surgical closure of their VSDs. METHODS Thirty-eight patients had VSD closure alone, and 7 had an additional AV repair. Other associated defects corrected at operation were closure of atrial septal defects, closure of other ventricular septal defects, ligation of patent ductus arteriosus, and repair of ruptured sinus Valsalva aneurysm. RESULTS There was no mortality nor major morbidity associated with operation. In the 26 patients with AR and AV deformity preoperatively, valve repair was performed in 6 patients. The condition of AR improved in 4, and remained unchanged in 22 patients. In the 10 patients with a deformity of the AV and no AR preoperatively, the condition remained unchanged in 5 patients, from whom 1 had valve operation, but progressed in 5 patients postoperatively at a mean follow-up of 6.4 years. In 9 patients with no deformity of the AV and no AR preoperatively, there was no postoperative AR and no progress of valve deformity. CONCLUSIONS Excellent results were obtained with VSD closure and AV repair. Surgical closure of VSD, if performed before the onset of AV deformity, may prevent progressive AR. If AV repair is performed after the onset of AV deformity, progressive AR may not always be prevented.
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Affiliation(s)
- E K Sim
- Cardiac Department, National University Hospital, and Gleneagles Medical Centre, Singapore
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Wong ML, Sim EK, Goh JJ, Quek SC, Wong JC, Yip WC, Lee CN. Bidirectional cavopulmonary anastomosis. Ann Acad Med Singap 1999; 28:237-40. [PMID: 10497674] [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: 02/14/2023]
Abstract
The Fontan operation has been used to palliate patients with a functional single ventricle. In many such patients the operative risk for a Fontan procedure is high. The bidirectional cavopulmonary anastomosis (BCPA) is a useful intermediate palliative procedure before Fontan correction. It may reduce the deleterious sequelae of chronic hypoxaemia and long-term ventricular overload, thus yielding a more suitable Fontan candidate. We reviewed our experience of 9 patients with univentricular hearts who were at the time of the BCPA not considered suitable candidates for conventional Fontan operation. Two patients had double inlet right ventricle (DIRV) with pulmonary stenosis (PS) and ventricular septal defect (VSD), 2 had univentricular heart, 4 had tricuspid atresia (TA) and hypoplastic right ventricle (RV), 1 patient had atrioventricular septal defect (AVSD) with double outlet right ventricle (DORV) with hypoplastic RV. Two of the 9 patients had bilateral superior vena cavae. All except one had undergone prior palliative operations. The mean age at BCPA was 4.7 years (range 1.5 years to 6 years) and the mean weight at surgery was 15 kg (range 7 to 22 kg). There were no operative deaths. The mean hospitalization stay was 8.5 days (range 5 to 13 days) with a mean follow up of 14 months. Median oxygen saturation improved from 78.7 +/- 6.3% to 85.9 +/- 3.9%. The BCPA is a useful palliative procedure to stage Fontan type reconstruction in selected patients with univentricular hearts.
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Affiliation(s)
- M L Wong
- Department of Paediatrics, National University Hospital, Singapore
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Craig DB, Wong JC, Polakowski R, Dovichi NJ. General protease assay method coupling solid-phase substrate extraction and capillary electrophoresis. Anal Chem 1998; 70:3824-7. [PMID: 9751024 DOI: 10.1021/ac9801061] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Capillary electrophoresis with laser-induced fluorescence detection was used to develop a universal, highly specific protease assay. In this method, a peptide, biotinylated at the N-terminus, is labeled with fluorescein at a lysine residue near the C-terminus. Impurities are removed from the fluorescence labeling mixture by solid-phase extraction of the substrate on immobilized streptavidin, followed by extensive washing. The purified fluorescent substrate is dissociated from the streptavidin and incubated with the protease. The peptide sequence between the biotin and fluorescent label contains the cleavage sequence of the protease of interest. After cleavage, the fluorescent product does not contain a biotin group. A second solid-phase extraction is used to remove unreacted substrate to dramatically lower the background signal. The product is detected by capillary electrophoresis, which provides powerful discrimination against products generated by nonspecific proteases. With chymotrypsin as a test protease, product was detected with as little as 10 pg/mL (4.6 x 10(-13) M) chymotrypsin, or 5 amol of enzyme in the 10-microL sample volume.
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Affiliation(s)
- D B Craig
- Department of Chemistry, University of Alberta, Edmonton, Canada
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43
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Abstract
The vowel "eh" was used to study auditory-nerve responses at high sound levels (60-110 dB). By changing the playback sampling rate of the stimulus, the second formant (F2) frequency was set at best frequency (BF) for fibers with BFs between 1 and 3 kHz. For vowel stimuli, auditory-nerve fibers tend to phase-lock to the formant component nearest the fiber's BF. The responses of fibers with BFs near F2 are captured by the F2 component, meaning that fibers respond as if the stimulus consisted only of the F2 component. These narrowband responses are seen up to levels of 80-100 dB, above which a response to F1 emerges. The F1 response grows, at the expense of the F2 response, and is dominant at the highest levels. The level at which the F1 response appears is BF dependent and is higher at lower BFs. This effect appears to be suppression of the F2 response by F1. At levels near 100 dB, a component 1/component 2 transition is observed. All components of the vowel undergo the transition simultaneously, as judged by the 180 degrees phase inversion that occurs at the C2 transition. Above the C2 threshold, a broadband response to many components of the vowel is observed. These results demonstrate that the neural representation of speech in normal ears is degraded at high sound levels, such as those used in hearing aids.
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Affiliation(s)
- J C Wong
- Center for Hearing Sciences and Department of Biomedical Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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44
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Craig DB, Polakowski RM, Arriaga E, Wong JC, Ahmadzadeh H, Stathakis C, Dovichi NJ. Sodium dodecyl sulfate-capillary electrophoresis of proteins in a sieving matrix utilizing two-spectral channel laser-induced fluorescence detection. Electrophoresis 1998; 19:2175-8. [PMID: 9761200 DOI: 10.1002/elps.1150191222] [Citation(s) in RCA: 19] [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] [Indexed: 11/10/2022]
Abstract
We report a method for protein labeling, separation by capillary electrophoresis in a polymer sieving matrix, and detection by laser-induced fluorescence. Different dyes are used to label standard and sample proteins. A two-spectral channel detector resolves fluorescence from the sample and standards. Comparison of the migration time of the sample and standards permits the precise determination of molecular weight, irrespective of variations in run-to-run migration times.
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Affiliation(s)
- D B Craig
- Department of Chemistry, University of Alberta, Edmonton, Canada
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45
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Cook GJ, Wong JC, Smellie WJ, Young AE, Maisey MN, Fogelman I. [11C]Methionine positron emission tomography for patients with persistent or recurrent hyperparathyroidism after surgery. Eur J Endocrinol 1998; 139:195-7. [PMID: 9724076 DOI: 10.1530/eje.0.1390195] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [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: 11/08/2022]
Abstract
OBJECTIVE Reoperation in patients with recurrent hyperparathyroidism usually requires localisation of abnormal glands. Current imaging techniques are not always successful in this group of patients. An evaluation of [11C]methionine positron emission tomography (PET) has been made to assess the ability of the technique to localise abnormal glands in patients with hyperparathyroidism after previous surgery. SUBJECTS AND METHODS Eight patients (five with primary, and three with tertiary hyperparathyroidism) who had undergone one to three previous surgical explorations were studied. [11C]methionine PET scans of the neck and mediastinum were performed in all patients. All had recent technetium-99m (99mTc)-labelled sestamibi (n = 7) or thallium-201 (201Tl)/99mTc subtraction (n = 1) parathyroid scans available for comparison. Subsequent surgical correlation was available in all cases. RESULTS [11C]methionine PET correctly located an abnormal site of uptake in all five patients with primary hyperparathyroidism compared with only one when conventional nuclear medicine methods were used. In the patients with tertiary hyperparathyroidism, [11C]methionine PET correctly located one, confirmed the absence of cervical or mediastinal abnormality in a patient with an autotransplanted forearm autonomous gland, and failed to demonstrate an abnormality in a third. 99mTc-labelled sestamibi scans were negative in all three patients. CONCLUSION [11C]methionine PET correctly locates abnormal parathyroid glands in the majority of patients with persistent or recurrent hyperparathyroidism after surgery in whom conventional non-invasive nuclear medicine imaging has failed.
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Affiliation(s)
- G J Cook
- Clinical PET Centre, Guy's Hospital, United Medical and Dental Schools, London, UK
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Lucas JD, O'Doherty MJ, Wong JC, Bingham JB, McKee PH, Fletcher CD, Smith MA. Evaluation of fluorodeoxyglucose positron emission tomography in the management of soft-tissue sarcomas. J Bone Joint Surg Br 1998; 80:441-7. [PMID: 9619933 DOI: 10.1302/0301-620x.80b3.8232] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We performed a retrospective analysis to evaluate the ability of whole-body F-fluorodeoxyglucose positron emission tomography (FDG PET) to identify local recurrence and pulmonary metastases in patients with soft-tissue tumours after treatment. We compared the results of FDG PET with those of MRI for the detection of local recurrence, and with CT of the chest for pulmonary metastases. We assessed 62 patients of mean age 51 years, who had 15 types of soft-tissue sarcoma, after a mean follow-up of 3 years 2 months. For the detection of local disease, 71 comparisons showed that the sensitivity and specificity of FDG PET were 73.7% and 94.3%, respectively; there were 14 true-positive and five false-negative results. MRI had a sensitivity and specificity of 88.2% and 96.0% respectively. For the identification of lung metastases, 70 comparisons showed that the sensitivity and specificity of FDG PET were 86.7% and 100%, with 13 true-positive results and two false-negative results. CT of the chest had a sensitivity and specificity of 100% and 96.4%. Thirteen other sites of metastases were identified by FDG PET. FDG PET can identify both local and distant recurrence of tumour as a one-step procedure and will detect other metastases. It seems that all three methods of imaging are needed to define accurately the extent of disease, both at initial staging and during follow-up.
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Affiliation(s)
- J D Lucas
- UMDS and Guy's and St Thomas' Hospital Trust, St Thomas' Hospital, London, England, UK
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Abstract
A simultaneous comparison of human exposure to solar ultraviolet radiation at two locations was performed to study the effect of environmental factors and human attitudes on personal ultraviolet exposure. The study took place on 29 October 1996 in Toowoomba (27.5 degrees S, 151.9 degrees E) and Brisbane (27.4 degrees S, 153.1 degrees E), Queensland, Australia. From the data collected by calibrated ambient ultraviolet monitoring stations located in Toowoomba and Brisbane, Toowoomba received 68% more UVA (320-400 nm) and 61% more UVB (280-320 nm) than Brisbane from 07:00 to 10:00 Australian Eastern Standard Time (EST). From 10:00 to 17:00 EST Toowoomba received 5% more UVA and 20% less UVB than Brisbane. High ambient ultraviolet levels recorded by ultraviolet stations were reinforced by measurement of the personal ultraviolet exposure of human subjects wearing polysulfone dosimeters. Contrary to the common belief that the ultraviolet exposure to the human body is higher near the beach (i.e., coastal areas) than the inland area, the average erythemal weighted ultraviolet exposure on the chest and shoulder of each subject in the inland city of Toowoomba (127 km to the west of Brisbane) was 30% higher than in the coastal city of Brisbane from 07:00 to 17:00 EST. Evidence is also presented to suggest a relationship between altitude, climatic conditions, the human attitude, and the level of personal exposure to ultraviolet radiation.
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Affiliation(s)
- M G Kimlin
- Centre for Medical and Health Physics, Queensland University of Technology, Brisbane, Australia
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Kimlin MG, Parisi AV, Wong JC. Quantification of personal solar UV exposure of outdoor workers, indoor workers and adolescents at two locations in Southeast Queensland. Photodermatol Photoimmunol Photomed 1998; 14:7-11. [PMID: 9582080 DOI: 10.1111/j.1600-0781.1998.tb00002.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Quantification of human exposure to solar ultraviolet (UV) radiation at two locations was performed to study the effect of occupation (outdoor workers, schoolchildren and home workers) and location on personal UV exposure. The study took place on 13 and 14 February 1997 in Toowoomba (27.5 degrees S, 151.9 degrees E) and Brisbane (27.4 degrees S, 153.1 degrees E) in Southeast Queensland, Australia. From the data collected by calibrated ambient UV monitoring stations located in Toowoomba and Brisbane, Toowoomba received 16% more UVB (280-320 nm) than Brisbane from 07:00 to 17:00 Australian Eastern Standard Time (EST) on the 13 February, 1997 and 10% more UVB on the 14 February 1997. All groups, regardless of occupation, in this study received a median erythemal UV exposure of over 2 MED on the shoulder over the 2 day period. The highest median erythemal UV exposure to the shoulder over the 2 day period was 6 MED in Toowoomba outdoor workers. The median 2 day erythemal exposure to the shoulder was 33% higher in Toowoomba than in Brisbane for the outdoor workers, 50% higher in Toowoomba compared to Brisbane for the schoolchildren and 25% higher in Toowoomba than Brisbane for the home workers.
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Affiliation(s)
- M G Kimlin
- Centre for Medical and Health Physics, School of Physical Sciences, Queensland University of Technology, Brisbane, Australia
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Abstract
This paper presents a method for the evaluation of the distribution of the facial erythemal UV exposure and the erythemal UV exposure per unit area of the face using only eight dosimeters located on the vertex of the head, forehead, nose, chin, left and right ears and left and right cheeks. An overall picture of the parts of the face receiving high UV exposures is provided. The distribution of the erythemal UV exposure to the human face at a subtropical latitude was shown to change with time of year and with cloud cover. On two days with similar solar zenith angles, the ratio of the erythemal UV exposure to the nose compared with that on a horizontal plane changed from 0.47 to 0.84 with increased cloud cover. At the same time, the total erythemal exposure per unit area of the face dropped from 122 to 56 ml cm-2. Although the absolute exposures decreased, the nose received a relatively high exposure.
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Affiliation(s)
- M G Kimlin
- Centre for Astronomy and Atmospheric Research, Faculty of Sciences, University of Southern Queensland, Toowoomba, Australia
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50
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Abstract
Erythemal ultraviolet (UV)-radiation exposure to the right hand, mid-arm, shoulder, chin, nose and left and right sides of the face has been evaluated in a car from a large family class and a car from a small car class. In the small car, the site with highest exposure received 2.2 times more radiation than the site with the highest exposure in the larger car. In both cars, highest erythemal exposures were to the right shoulder, arm, and hand. Over a 6 h period, erythemal exposure to the right shoulder of a person in the driver's seat of the small car was 3.1 mJ x cm(-2).
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Affiliation(s)
- A V Parisi
- Centre for Astronomy and Atmospheric Research, University of Southern Queensland, Toowoomba, Australia
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