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1.
ESC Heart Fail ; 11(3): 1602-1611, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38378979

ABSTRACT

AIMS: The aim of this study is to evaluate and compare the impact of the bicaval technique versus the biatrial technique (by Lower and Shumway) in paediatric heart transplant patients. Only a few studies investigate this matter regarding the long-term outcome after paediatric heart transplantation. We compared the two surgical methods regarding survival, the necessity of pacemaker implantation. METHODS AND RESULTS: All 134 patients (aged <18 years) - (group-1) biatrial (n = 84), versus (group-2) bicaval (n = 50), who underwent heart transplantation between October 1988 and December 2021, were analysed. Freedom from events were estimated using the Kaplan-Meier method. Potential differences were analysed using the log rank test and Cox proportional hazard models. Mean ± standard deviation: Bypass time (per minutes) was higher in the group 1 as compared with group 2 (P = 0.050). Survival was not significantly different (P = 0.604) in either groups. Eighteen patients required permanent pacemaker implantation in the group 1 and only one patient required it in the group 2 (P = 0.001). CONCLUSIONS: Paediatric heart transplantation using bicaval technique results similar long-term survival compared with the biatrial technique. The incidence of atrial rhythm disorders was significantly higher in the biatrial group, requiring a higher frequency of pacemaker implantation in this group. As a results, the bicaval technique has replaced the biatrial technique in our centre.


Subject(s)
Heart Transplantation , Humans , Heart Transplantation/methods , Male , Female , Child , Retrospective Studies , Follow-Up Studies , Time Factors , Child, Preschool , Adolescent , Survival Rate/trends , Treatment Outcome , Infant , Postoperative Complications/epidemiology
2.
Int J Cardiol ; 356: 45-50, 2022 06 01.
Article in English | MEDLINE | ID: mdl-35395286

ABSTRACT

OBJECTIVES: We analyzed the early and long-term survival after ABO-compatible heart transplantation in children under 3 years of age from 1991 to 2021 at our center. This retrospective and descriptive study aimed to identify serious adverse events associated with mortality after pediatric heart transplantation. PATIENTS AND METHODS: 46 patients with congenital heart failure (37%) in end-stage heart failure have undergone a pediatric heart transplantation. Primary outcome of interest was survival at follow-up time. RESULTS: Median (IQR) follow-up time (y), age (y), body-weight (kg) and BMI (kg/cm2) were 13.2 (5.7-19.5), 0.9 (0.2-2.0), 6.8 (4.3-10.0) and 14.2 (12.3-15.7). Twenty-four (52%) patients were male. 15 patients (33%) had a single ventricle physiology. At 30- days survival rate was 94 ± 4%. Survival rate at 1, 5, 10 and 15 years post HTx was 87 ± 5%, 84 ± 6%, 79 ± 6% and 63 ± 8%. One child underwent re-transplantation after 4 years, and another one after 11 years - in both cases due to graft failure. Higher early mortality in patients under 3 months of age and in patients with single ventricle physiology. Transplant free survival at 15 years was in children with cardiomyopathy better (71 ± 10%) than in those with congenital heart disease (50 ± 13%). One or more previous heart surgeries prior to HTx (n = 21) were associated to more mortality. CONCLUSION: Pediatric heart transplantation has acceptable long-term results and is still the best therapeutic option in children with end-stage cardiac failure. Underlying anomalies and single ventricle physiology, age below 3 months had a significant impact on survival.


Subject(s)
Cardiomyopathies , Heart Defects, Congenital , Heart Failure , Heart Transplantation , Child , Child, Preschool , Female , Heart Defects, Congenital/diagnosis , Heart Defects, Congenital/surgery , Heart Failure/diagnosis , Heart Failure/surgery , Humans , Infant , Male , Retrospective Studies , Treatment Outcome
3.
Eur J Neurol ; 26(2): 246-e18, 2019 02.
Article in English | MEDLINE | ID: mdl-30169897

ABSTRACT

BACKGROUND AND PURPOSE: Dementia in Parkinson's disease (PD) is common and disabling. Identification of modifiable risk factors for it is essential. Vascular risk factors (VRFs) may be associated with cognitive decline in early PD. Biomarkers that serve as surrogates of the long-term effect of VRFs on PD are needed. To that end, we aimed to quantitate white matter hyperintensities (WMH) in early PD, measure associations with VRFs and examine relationships between WMH and longitudinal cognition. METHODS: Participants in the Parkinson's Progression Markers Initiative study (141 patients with PD, 63 healthy controls) with adequate baseline structural brain magnetic resonance imaging data were included. Hypertension and diabetes history, and body mass index were combined to create a vascular risk score. WMH were quantitated via automated methods. Cognition was assessed annually with a comprehensive test battery. RESULTS: In the PD group, vascular risk score was associated with WMH for total brain (ß = 0.210; P = 0.021), total white matter (ß = 0.214; P = 0.013), frontal (ß = 0.220; P = 0.002) and temporal (ß = 0.212; P = 0.002) regions. Annual rate of change in global cognition was greater in those with higher vascular risk score (ß = -0.040; P = 0.007) and greater WMH (ß = -0.029; P = 0.049). Higher temporal WMH burden was associated with great decline over time in verbal memory (ß = -0.034; P = 0.031). CONCLUSIONS: In early PD, modifiable VRFs are associated with WMH on brain magnetic resonance imaging. Temporal WMH burden predicts decline in verbal memory. WMH may serve as a surrogate marker for the effect of VRFs on cognitive abilities in PD.


Subject(s)
Brain/pathology , Cognition Disorders/etiology , Cognition/physiology , Cognitive Dysfunction/etiology , Leukoencephalopathies/etiology , Parkinson Disease/complications , White Matter/pathology , Aged , Cognition Disorders/pathology , Cognition Disorders/psychology , Cognitive Dysfunction/pathology , Cognitive Dysfunction/psychology , Disease Progression , Female , Humans , Leukoencephalopathies/pathology , Leukoencephalopathies/psychology , Magnetic Resonance Imaging , Male , Middle Aged , Neuropsychological Tests , Parkinson Disease/pathology , Parkinson Disease/psychology , Risk Factors
4.
Clin Genet ; 84(3): 251-7, 2013 Sep.
Article in English | MEDLINE | ID: mdl-23167775

ABSTRACT

The Genetic Information Nondiscrimination Act (GINA) of 2008 was the first US legislation to address genetic discrimination. We sought to assess understanding of GINA among individuals affected by the autosomal dominant condition, Huntington disease (HD). We conducted a cross-sectional survey of individuals with varying risk of HD to assess their familiarity with GINA. As a control, individuals were surveyed about their familiarity with the Health Insurance Portability and Accountability Act (HIPAA). Those who reported familiarity with GINA were asked about their knowledge of specific provisions of the legislation. The survey was offered to 776 participants and completed by 410 (response rate 53%). Respondents across all groups were less familiar with GINA (41% slightly, somewhat, or very familiar) than with HIPAA (65%; p < 0.0001). Of individuals with or at risk for HD who reported some familiarity with GINA, less than half correctly identified GINA's protections, and less than 15% correctly identified its limitations. Thus, among individuals affected by HD, familiarity with and knowledge of GINA are low. The effectiveness of the legislation may be limited by this lack of knowledge.


Subject(s)
Genetic Privacy , Health Knowledge, Attitudes, Practice , Huntington Disease , Social Discrimination , Adult , Female , Genetic Privacy/legislation & jurisprudence , Health Surveys , Humans , Huntington Disease/genetics , Male , Middle Aged , Social Discrimination/legislation & jurisprudence
5.
Clin Exp Allergy ; 38(2): 298-304, 2008 Feb.
Article in English | MEDLINE | ID: mdl-18070154

ABSTRACT

RATIONALE: Several studies have evaluated the associations between cord blood cellular responses and atopic diseases in children, but the results of these studies are inconsistent. Variations in blood processing factors and maternal and infant characteristics are typically not accounted for and may contribute to these inconsistencies. METHODS: Cord blood samples were obtained from 287 subjects participating in the Childhood Origins of ASThma project, a prospective study of children at high risk for the development of asthma/allergies. Mononuclear cells were stimulated with phytohaemagglutinin (PHA), phorbal myristate acetate/ionomycin or a suspension of killed staphylococcus, and IFN-gamma, IL-10 and IL-13 were quantitated by ELISA. Cell yields and cytokine production were related to processing factors and maternal and infant characteristics. RESULTS: The strongest relationships between independent variables and cell yield or cytokine responses occurred with the season of birth. The highest median cell yields were seen in fall, and the lowest in summer (difference of 47%, P=0.0027). Furthermore, PHA-induced IL-5 and IL-13 responses were approximately 50% higher in spring and summer than in fall or winter (P<0.0001). Clots in the cord blood samples were associated with a reduced median cell yield (42% reduction, P<0.0001), and an increased PHA-induced IL-10 secretion (27% increase, P=0.004). CONCLUSIONS: These data suggest that season of collection, and to a lesser extent clotting in samples, affect cord blood mononuclear cell yield and cytokine responses. Careful documentation and analysis of processing and environmental variables are important in understanding biological relationships with cytokine responses, and also lead to greater comparability among studies using these techniques.


Subject(s)
Asthma/immunology , Cytokines/blood , Fetal Blood/immunology , Maternal-Fetal Exchange/immunology , Respiratory Hypersensitivity/immunology , Seasons , Female , Humans , Infant, Newborn , Interleukin-10/analysis , Interleukin-10/metabolism , Interleukin-13/analysis , Interleukin-13/metabolism , Interleukin-15/analysis , Interleukin-15/metabolism , Leukocytes, Mononuclear/drug effects , Leukocytes, Mononuclear/immunology , Male , Phytohemagglutinins/pharmacology , Pregnancy
6.
Water Sci Technol ; 49(2): 33-9, 2004.
Article in English | MEDLINE | ID: mdl-14982161

ABSTRACT

Approximately 40,000 km of the drinking water network in The Netherlands consists of asbestos cement water pipes. The number of fractures in these pipes has increased greatly in recent years. This is due to corrosion of the asbestos cement (AC) which affects the condition of the pipe. Every time a fracture occurs, the question is raised of whether the pipe in question has to be replaced or repaired. A relatively simple destructive technique and non-destructive tests are used on a large scale to assess the condition of the AC pipes in use. Not only is corrosion detrimental to the pipes themselves, it also influences the water quality. Corrosion of the inner walls of cement-containing pipes involves the leaching of hydroxides. This causes pH changes resulting in scaling in water mains and domestic installations. Monitoring techniques have been developed to determine the effects of leaching on water quality. The large-scale use of the relatively simple techniques at water companies increases insight into the condition of the drinking water network, the life expectancy of the pipes and the effects of corrosion on the water quality. Applying these techniques enables those involved to make decisions on pipe replacement and to provide solutions for reducing the effects of leaching.


Subject(s)
Environmental Monitoring/instrumentation , Manufactured Materials , Water Supply , Corrosion , Materials Testing , Quality Control , Water/chemistry
7.
Sleep Med ; 2(4): 323-332, 2001 Jul.
Article in English | MEDLINE | ID: mdl-11438249

ABSTRACT

Objectives and background: Given that non-selective gamma-aminobutyric acid (GABA) agonist hypnotics impair performance and potentiate the disruptive effects of ethanol, this study was done to determine the performance-impairing and ethanol-potentiating effects of zaleplon, a new selective GABA agonist hypnotic.Methods: Eighteen healthy men (12) and women (six), 31.5+/-5.6 years old, were studied. Each underwent six treatments of 2 days in duration, presented in a Latin square design with 2-12 recovery days between. The treatments were: placebo-placebo; placebo-ethanol; triazolam-placebo; triazolam-ethanol; zaleplon-placebo; and zaleplon-ethanol; with triazolam (0.25 mg) or placebo administered at 08:30 h, zaleplon (10 mg) or placebo at 09:00 h, and ethanol (0.75 g/kg) or placebo consumed from 09:30 h. Performance tests were completed each day at 10:30, 12:00 and 14:30 h.Results: Breath ethanol concentration (BrEC), tested 0.5, 2.0, 4.5 and 6 h post consumption, did not differ among treatments and peaked at 0.052%, declining to 0.037, 0.009 and 0.001%. Triazolam with and without ethanol impaired digit symbol substitution, symbol copying, simple and complex reaction times and divided attention performance relative to placebo-placebo treatment. It did so consistently at 10:30 and 12:00 h, and less consistently at 14:30 h. Zaleplon without ethanol impaired only digit symbol substitution and divided attention tracking, and only at 10:30 h. Zaleplon with ethanol impaired most measures at 10:30 and 12:00 h, but not at 14:30 h. Zaleplon without ethanol consistently differed from triazolam without ethanol in the extent of performance impairment. Zaleplon with ethanol began to differ from triazolam with ethanol in performance impairment on the 12:00 and 14:30 h test sessions. Ethanol itself impaired most measures at 10:30 h, fewer at 12:00 h and none at 14:30 h. All active drug treatments increased self-rated sleepiness compared with placebo-placebo. Triazolam without ethanol produced greater self-rated sleepiness than zaleplon without ethanol. The addition of ethanol to both drugs generally produced comparable levels of self-rated sleepiness.Conclusions: In an absolute sense, zaleplon produced less performance impairment and a shorter period of ethanol potentiation than triazolam.

8.
J Invasive Cardiol ; 13(5): 406-8, 2001 May.
Article in English | MEDLINE | ID: mdl-11385158

ABSTRACT

INTRODUCTION: Despite advances in technology, problems with effective ventricular endocardial sensing continue to arise and to result in inappropriate implantable cardioverter defibrillator (ICD) therapies. METHODS AND RESULTS: The patient is a 79-year-old man with ischemic cardiomyopathy and ventricular tachycardia (VT) who received inappropriate ICD therapies due to lead-related noise detection. Noise was created by the distal helix, which was not fully deployed, intermittently contacting the internal guidepost of the lead (CPI, Guidant, model 0155). After the complete deployment of the helix the problem resolved and the pacing parameters remained stable. CONCLUSION: To our knowledge, this is the first confirmed case report of non-physiologic sensing secondary to the incompletely deployed helix of an active fixation defibrillation lead. A design flaw with this lead led to its redesign to avoid noise over-sensing.


Subject(s)
Defibrillators, Implantable/adverse effects , Aged , Arrhythmias, Cardiac/complications , Arrhythmias, Cardiac/therapy , Electrocardiography , Humans , Male , Tachycardia, Ventricular/etiology
9.
Psychopharmacology (Berl) ; 155(1): 11-7, 2001 Apr.
Article in English | MEDLINE | ID: mdl-11374329

ABSTRACT

RATIONALE AND OBJECTIVES: Previous studies have shown that insomniacs self-administer hypnotics at high nightly rates. This study determined whether prior experience with different treatment regimens (i.e., instructions and capsule availability) would alter the previously observed high hypnotic self-administration rates. METHODS: Sixty-four healthy men and women with (n = 32) and without (n = 32) insomnia, 21-55 years, self administered placebo or triazolam (0.25 mg) after different prior treatment regimens. They received one of three different treatment regimens enforced for 11 nights: a capsule each night, a capsule as needed, or a capsule every third night. On 14 subsequent nights they choose to self-administer a capsule or not, placebo during 1 week and triazolam (0.25 mg) the other (counterbalanced in order). RESULTS: Insomniacs self-administered more capsules than normals and triazolam was self-administered more than placebo. For both groups, treatment regimen had a minimal effect on capsule self-administration. During the treatment phase, triazolam improved self-ratings of sleep relative to placebo. During the choice phase, nightly variations in self-rated sleep predicted self-administration of a capsule on the following night, regardless of whether the capsule was active drug or placebo. CONCLUSIONS: The data of this study are consistent with the view that hypnotic self-administration by insomniacs is therapy-seeking behavior and not drug abuse.


Subject(s)
Anti-Anxiety Agents/administration & dosage , Hypnotics and Sedatives/administration & dosage , Self Administration/psychology , Sleep Initiation and Maintenance Disorders/drug therapy , Triazolam/administration & dosage , Adult , Analysis of Variance , Capsules , Female , Humans , Logistic Models , Male , Middle Aged , Self Administration/statistics & numerical data , Sleep Initiation and Maintenance Disorders/psychology
10.
Sleep Med ; 2(3): 243-248, 2001 May.
Article in English | MEDLINE | ID: mdl-11311688

ABSTRACT

Objective: The aim of this study was to determine the level of sleepiness/alertness among different chronotypes.Background: The Horne-Ostberg Morningness-Eveningness Questionnaire (MEQ) has allowed the characterization of chronotypes that are associated with a number of biological factors including: body temperature, cortisol rhythm, sleep patterns, and architecture.Methods: Fifty-six consecutive normal volunteers underwent an 8-h polysomnogram followed by a multiple sleep latency test (MSLT). Each subject also completed the MEQ and the Sleep/Wake Activity Inventory.Results: Evening types (ET) reported significantly later bedtimes and risetimes than both morning types (MT) and neither types (NT, P<0.05). On nocturnal polysomnography, the ET documented significantly longer latencies to stage 1 and persistent sleep when compared to both the NT and MT (P<0.01). There were no significant differences in the level of sleepiness on the MSLT across the different chronotypes. However, the pattern of sleepiness differed among them. While ET and NT showed differential sleep latencies across nap opportunities, MT showed no evidence of circadian variation on their level of sleepiness.Conclusions: There were no overall differences in daytime sleepiness/alertness across chronotypes. However, a differential pattern of sleep latencies was noted on the MSLT.

11.
J Occup Environ Med ; 43(2): 94-100, 2001 Feb.
Article in English | MEDLINE | ID: mdl-11227638

ABSTRACT

The number of railroad events reported to the Agency for Toxic Substances and Disease Registry's Hazardous Substances Emergency Events Surveillance system increased from 84 in 1993 to 177 in 1998. Comparisons of data on railroad and non-railroad events were made. The results overall indicated a greater potential impact of railroad events on public health. A median number of 2039 persons were living within a 1-mile radius of railroad events versus 982 for non-railroad events. The percentage of events during times when people are more likely to be home was also greater for railroad events. Railroad event victims were more likely to need hospital treatment than non-railroad event victims, which suggested the need for better community planning, reevaluation of current federal regulations and priorities for railroad hazardous material transport, and enhanced railroad industry commitment to safety.


Subject(s)
Accidents , Disasters , Hazardous Substances , Railroads , Emergencies , Humans , Public Health
12.
Sleep Med ; 2(2): 153-157, 2001 Mar.
Article in English | MEDLINE | ID: mdl-11226864

ABSTRACT

Objectives: To determine the prevalence of sleepiness in a cohort of insomnia subjects. We evaluated if differential levels of subjective sleepiness predict systematic differences in the polysomnographic characteristics of these subjects.Background: Insomnia is prevalent among the adult population. While it has been speculated that sleepiness may be an important daytime consequence of insomnia, this has not been demonstrated.Methods: Sixty-two subjects with complaints of insomnia for at least 6 months were polysomnographically evaluated. Subjects were asked to self-report their level of sleepiness based on their experiences for the previous 7 days. Subjects were divided into three groups based on their level of sleepiness. Sleepiness was determined using the excessive daytime sleepiness scale of the Sleep/Wake Activity Inventory (SWAI-EDS).Results: Twenty-two percent of insomnia subjects were found to be sleepy on the EDS scale of the SWAI. The level of sleepiness was also found to predict difficulty initiating sleep both on the nocturnal scale of the SWAI, and on nocturnal polysomnography.Conclusions: This study established a base rate of sleepiness among a cohort of insomnia subjects. It also demonstrated a wide spectrum of sleepiness/alertness among subjects with insomnia. Differential levels of sleepiness were found to predict nocturnal sleep latencies.

13.
Am J Respir Cell Mol Biol ; 24(1): 74-82, 2001 Jan.
Article in English | MEDLINE | ID: mdl-11152653

ABSTRACT

After parainfluenza type 1 (Sendai) virus infection as weanlings, Brown Norway (BN), unlike Fischer 344 (F344), rats develop an asthma-like phenotype. Reduced postinfection interferon (IFN)-gamma levels in bronchoalveolar lavage fluid from BN weanlings and the prevention of chronic airway sequelae in BN rats by IFN-gamma treatment led to the hypothesis that cells from BN weanlings have a reduced ability to secrete IFN-gamma. After stimulation with Sendai virus or interleukin (IL)-12, splenocytes from uninfected BN weanlings secreted significantly less IFN-gamma than did splenocytes from F344 weanlings (P < 0.005), as determined by enzyme-linked immunosorbent assay. Because levels of potential IFN-gamma-secreting cells in the spleen differed between the strains, natural killer (NK) cells, an important IFN-gamma source during early antiviral responses, were purified from spleens of uninfected weanlings. When stimulated with IL-12, BN NK cells secreted significantly less IFN-gamma than did F344 NK cells (P < 0.001). Incubation of NK cells from either strain with IL-12 and IL-18 resulted in synergistic increases in IFN-gamma production, but BN cells still secreted significantly less IFN-gamma than did F344 cells (P < 0.05). Similarly, after incubation with either IFN-alpha or IFN-alpha plus IL-18, BN NK cells secreted significantly less IFN-gamma than did F344 NK cells (P < 0.05). Therefore, reduced IFN-gamma secretion by NK cells in BN weanlings may play a role in the development of postviral chronic airway dysfunction.


Subject(s)
Interferon-gamma/metabolism , Killer Cells, Natural/immunology , Killer Cells, Natural/metabolism , Lung Diseases, Obstructive/immunology , Proto-Oncogene Proteins , Respirovirus Infections/immunology , Animals , Bronchoalveolar Lavage Fluid/chemistry , Cells, Cultured , DNA-Binding Proteins/biosynthesis , Disease Susceptibility/immunology , Disease Susceptibility/metabolism , Interferon-alpha/pharmacology , Interferon-gamma/analysis , Interleukin-12/analysis , Interleukin-12/metabolism , Interleukin-12/pharmacology , Interleukin-18/pharmacology , Janus Kinase 2 , Killer Cells, Natural/cytology , Leukocyte Count , Lung Diseases, Obstructive/virology , Male , Phosphorylation , Protein Biosynthesis , Protein Isoforms/biosynthesis , Protein-Tyrosine Kinases/biosynthesis , Rats , Rats, Inbred BN , Rats, Inbred F344 , Receptors, Interleukin/biosynthesis , Receptors, Interleukin-12 , Respirovirus/immunology , STAT4 Transcription Factor , Specific Pathogen-Free Organisms , Spleen/cytology , Spleen/immunology , Spleen/metabolism , Spleen/virology , T-Lymphocytes/cytology , TYK2 Kinase , Trans-Activators/biosynthesis
14.
Laryngoscope ; 111(12): 2144-6, 2001 Dec.
Article in English | MEDLINE | ID: mdl-11802013

ABSTRACT

OBJECTIVE: To determine the extent to which gastroesophageal reflux (GER)-initiated laryngeal chemoreflexes contribute to obstructive sleep apnea (OSA). METHODS: Prospective, nonrandomized clinical trial of an antireflux treatment protocol as a means of reducing the severity of OSA. Population consisted of 10 males aged 20 to 64 years with confirmed OSA (by overnight polysomnography) and GER (by ambulatory pH probe monitoring). Patients were treated with omeprazole and standard antireflux protocol for 30 days and pre- and posttreatment polysomnography variables were compared. RESULTS: Mean apnea index declined 31% (45-31, P = .04); mean respiratory disturbance index declined 25% (62-46, P = .06). Three patients (30%) are "treatment responders" as defined by traditional OSA treatment definitions. CONCLUSIONS: These results suggest a potential relationship between OSA and GER, the treatment of which may be an effective adjunctive in those with both disorders. Treatment of GER may significantly impact OSA in select individuals.


Subject(s)
Gastroesophageal Reflux/complications , Sleep Apnea Syndromes/etiology , Adult , Chemoreceptor Cells/physiopathology , Gastroesophageal Reflux/drug therapy , Gastroesophageal Reflux/physiopathology , Humans , Larynx/physiopathology , Male , Middle Aged , Omeprazole/therapeutic use , Polysomnography , Reflex/physiology , Risk Factors , Sleep Apnea Syndromes/physiopathology , Treatment Outcome
15.
Sleep ; 23(7): 911-3, 2000 Nov 01.
Article in English | MEDLINE | ID: mdl-11083600

ABSTRACT

STUDY OBJECTIVES: To determine intrarater and interrater scoring reliability of the multiple sleep latency test (MSLT) in a population of sleep clinic patients. DESIGN: N/A. SETTING: Urban sleep center. PATIENTS: 200 consecutive sleep center patients (diagnoses included: obstructive sleep apnea, narcolepsy, periodic-limb-movement, and individuals with no diagnosis). INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: MSLTs were recorded and scored according to standard clinical procedures. One of four clinical polysomnographers and one of seven polysomnographic technologists scored each MSLT. All MSLTs were then rescored by the same polysomnographer. The intrarater reliability coefficient for mean MSLT score was .87 and interrater reliability was .90. Coefficients for the mean number of REM onsets during the MSLT were .81 for intrarater and .88 for interrater reliability. Intrarater and interrater agreement (kappa coefficients) for the presence of at least one REM onset during the MSLT was .78 and .86, respectively. For the presence of greater than one REM onset, a kappa of .78 was obtained for intrarater agreement and .91 for interrater agreement. CONCLUSIONS: The clinical MSLT displays excellent interrater and intrarater reliability estimates for both sleep latency and REM onset scores in a sleep-disordered population.


Subject(s)
Polysomnography/methods , Sleep Stages/physiology , Adolescent , Adult , Aged , Disorders of Excessive Somnolence/epidemiology , Female , Humans , Male , Middle Aged , Narcolepsy/diagnosis , Nocturnal Myoclonus Syndrome/diagnosis , Observer Variation , Reaction Time , Reproducibility of Results , Sleep Apnea, Obstructive/diagnosis , Sleep, REM/physiology
16.
Otolaryngol Head Neck Surg ; 123(3): 179-82, 2000 Sep.
Article in English | MEDLINE | ID: mdl-10964287

ABSTRACT

OBJECTIVES: Uvulopalatopharyngoplasty (UPPP) is widely used as a first-step procedure for the surgical management of obstructive sleep apnea (OSA) syndrome but best manages obstruction occurring at the level of the oropharynx alone and not the hypopharynx. Previous publications have noted mediocre results with use of this procedure in unselected patients with OSA, but less clear is the effectiveness of this procedure in the unselected patient with mild OSA (respiratory event index [REI] 5-25). Using objective and subjective criteria, we retrospectively analyzed the results of UPPP in patients with mild OSA. METHODS: We examined 37 patients with mild OSA (REI 13.5 +/- 5.1, range 5.6-23.1) who had been operated on during 1996 with UPPP with or without tonsillectomy and/or septoplasty. Follow-up polysomnography was obtained in 25 (68%) an average of 40.5 weeks after surgery and compared with findings before surgery. Subjective assessment of sleepiness was performed with the Sleep-Wake Activity Inventory. RESULTS: Ten patients (40%) had a postoperative reduction in the REI of more than 50%, comparable with the improvements reported in those with more severe apnea. Those who did not have a reduction in REI after surgery actually saw an increase in average REI from 16.6 +/- 5 to 26.7 +/- 18.4. Similarly, subjective assessment of sleepiness with the Sleep-Wake Activity Inventory showed no statistically significant improvement after surgery. CONCLUSION: Overall, these results indicate that UPPP alone in the unselected patient provides little benefit in the management of mild OSA, similar to findings for more severe OSA. Surgeons must use great care in discerning the level of obstruction in the patient with mild OSA to tailor the appropriate retropalatal and/or retrolingual procedures and thereby achieve excellent surgical outcomes.


Subject(s)
Palate/surgery , Pharynx/surgery , Sleep Apnea, Obstructive/surgery , Uvula/surgery , Adult , Aged , Female , Humans , Male , Middle Aged , Otorhinolaryngologic Surgical Procedures , Polysomnography , Retrospective Studies , Treatment Outcome
18.
Psychol Rep ; 86(3 Pt 1): 727-37, 2000 Jun.
Article in English | MEDLINE | ID: mdl-10876320

ABSTRACT

The validity of traditional intelligence tests for cultural groups that differ from those for whom the tests were normed has come under scrutiny. This is particularly the case for the previously disadvantaged black majority in South Africa. The Kaufman Assessment Battery for Children (K-ABC) is reportedly a relatively nondiscriminatory test of intellectual functioning. This study compared the performance of 21 black and 35 white third-grade South African children on the K-ABC and the Wechsler Intelligence Scale--Revised (WISC-R) at two schools for children with learning problems. While the WISC-R Verbal and Full Scale IQ of black children were significantly lower than that of whites, there was no significant difference between these groups on the K-ABC. Teachers' ratings for white and black pupils were acceptably concordant with students' performance on the K-ABC but not on the WISC-R. Support is provided for the usefulness of the K-ABC as a relatively nondiscriminatory alternative to the WISC-R for South African children.


Subject(s)
Black or African American/psychology , Intelligence Tests/statistics & numerical data , Wechsler Scales/statistics & numerical data , White People/psychology , Black People , Child , Cross-Cultural Comparison , Female , Humans , Learning Disabilities/diagnosis , Learning Disabilities/psychology , Male , Psychometrics , Reproducibility of Results , South Africa
19.
Sleep Med ; 1(3): 215-220, 2000 Jul 01.
Article in English | MEDLINE | ID: mdl-10828432

ABSTRACT

Objectives: To determine continuous positive airway pressure (CPAP) treatment compliance and reversal of excessive daytime sleepiness in patients with mild OSA.Background: CPAP therapy is the most widely accepted and used intervention in patients with a diagnosis of obstructive sleep apnea (OSA). There are, however, no widely accepted protocols to help guide the rational use of CPAP therapy. Patients with mild OSA (respiratory event index (REI) >5 or

20.
J Clin Virol ; 16(3): 203-13, 2000 May.
Article in English | MEDLINE | ID: mdl-10738139

ABSTRACT

BACKGROUND: Human herpesvirus 8 (HHV-8) has been implicated in the etiology of Kaposi's sarcoma (KS), a highly angiogenic tumor of complex histology, and two lymphoproliferative diseases, primary effusion lymphoma (PEL) and multicentric Castleman's disease (MCD). A number of HHV-8 encoded genes have been proposed to be involved in the pathogenesis of KS and PEL and a few have been shown to be oncogenic in heterologous systems (Reyes GR, LaFemina R, Hayward SD, Hayward GS. Morphological transformation by DNA fragments of human herpesviruses: evidence for two distinct transforming regions in herpes simplex virus types 1 and 2 and lack of correlation with biochemical transfer of the thymidine kinase gene. Cold Spring Harbor Symp Quant Biol 1980;44:629-641; Moore PS, Boshoff C, Weiss RA, Chang Y. Molecular mimicry of human cytokine and cytokine response pathway genes by KSHV. Science 1996;274:1739-1744; Cheng EH, Nicholas J, Bellows DS, Hayward GS, Guo HG, Reitz MS, Hardwick JM. A Bcl-2 homolog encoded by Kaposi sarcoma-associated virus, human herpesvirus 8, inhibits apoptosis but does not heterodimerize with Bax or Bak. Proc Natl Acad Sci USA 1997;94:690-694; Li M, Lee H, Yoon DW, Albrecht JC, Fleckenstein B, Neipel F, Jung JU. Kaposi's sarcoma-associated herpesvirus encodes a functional cyclin. J Virol 1997;71:1984-1991; Neipel F, Albrecht J-C, Fleckenstein B. Cell-homologous genes In the Kaposi's sarcoma-associated rhadinovirus human herpesvirus 8: determinants of its pathogenicity? J Virol 1997;71:4187-4192; Nicholas J, Ruvolo VR, Burns WH, Sandford G, Wan X, Ciufo D, Hendrickson SB, Guo HG, Hayward GS, Reitz MS. Kaposi's sarcoma-associated human herpesvirus-8 encodes homologues of macrophage inflammatory protein-1 and interleukin-6. Nat Med 1997;3:287-292; Nicholas J, Zong J, Alcendor DJ, Ciufu DM, Poole LJ, Sarisky RT, Chiuo C, Zhang X, Wan X, Guo H, Reitz MS, Hayward GS. Novel organizational features, captured cellular genes, and strain variability within the genome of KSHV/HHV-8. JNCI Monographs 1998;23:79-88; Muralidhar S, Pumfery AM, Hassani M, Sadaie MR, Azumi N, Kishishita M, Brady JN, Doniger J, Medveczky P, Rosenthal LJ. Identification of kaposin (ORF K12) as a human herpesvirus 8 (Kaposi's sarcoma associated herpesvirus) transforming gene. J Virol 1998;72:4980-4988). The kaposin gene (ORF K12) encoded by the abundant latency-associated HHV-8 transcript, T0.7, has been previously shown to induce tumorigenic transformation of Rat-3 cells (Muralidhar S, Pumfery AM, Hassani M, Sadaie MR, Azumi N, Kishishita M, Brady JN, Doniger J, Medveczky P, Rosenthal LJ. Identification of kaposin (ORF K12) as a human herpesvirus 8 (Kaposi's sarcoma associated herpesvirus) transforming gene. J Virol 1998;72:4980-4988). The current study is a further characterization of kaposin protein. OBJECTIVES: Characterization of kaposin expression in transformed and tumor-derived Rat-3 cells as well as PEL cell lines, BCBL-1, BC-3 and KS-1 and analysis of mechanism(s) of transformation. DESIGN: The presence of kaposin DNA in transformed cells was determined by fluorescent in situ hybridization (FISH). Expression of kaposin protein was analyzed by Western blot analysis and indirect immunofluorescence assay (IFA). (ABSTRACT TRUNCATED)


Subject(s)
Herpesvirus 8, Human/genetics , Oncogene Proteins, Viral/genetics , Oncogene Proteins, Viral/metabolism , Sarcoma, Kaposi/virology , Animals , Blotting, Western , Cell Line, Transformed , DNA, Viral/analysis , Fluorescent Antibody Technique, Indirect , Golgi Apparatus/metabolism , Herpesvirus 8, Human/metabolism , Humans , In Situ Hybridization, Fluorescence , Protein Serine-Threonine Kinases/metabolism , Rats , Tumor Cells, Cultured
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