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Palo Alto, PA, United States

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Objective: We tested the hypothesis that there are readily classifiable electroencephalographic (EEG) phenotypes of early postanoxic multifocal myoclonus (PAMM) that develop after cardiac arrest. Methods: We studied a cohort of consecutive comatose patients treated after cardiac arrest from January 2012 to February 2015. For patients with clinically evident myoclonus before awakening, 2 expert physicians reviewed and classified all EEG recordings. Major categories included: Pattern 1, suppression-burst background with high-amplitude polyspikes in lockstep with myoclonic jerks; and Pattern 2, continuous background with narrow, vertex spike-wave discharges in lockstep with myoclonic jerks. Other patterns were subcortical myoclonus and unclassifiable. We compared population characteristics and outcomes across these EEG subtypes. Results: Overall, 401 patients were included, of whom 69 (16%) had early myoclonus. Among these patients, Pattern 1 was the most common, occurring in 48 patients (74%), whereas Pattern 2 occurred in 8 patients (12%). The remaining patients had subcortical myoclonus (n = 2, 3%) or other patterns (n = 7, 11%). No patients with Pattern 1, subcortical myoclonus, or other patterns survived with favorable outcome. By contrast, 4 of 8 patients (50%) with Pattern 2 on EEG survived, and 4 of 4 (100%) survivors had favorable outcomes despite remaining comatose for 1 to 2 weeks postarrest. Interpretation: Early PAMM is common after cardiac arrest. We describe 2 distinct patterns with distinct prognostic significances. For patients with Pattern 1 EEGs, it may be appropriate to abandon our current clinical standard of aggressive therapy with conventional antiepileptic therapy in favor of early limitation of care or novel neuroprotective strategies. Ann Neurol 2016. © 2016 American Neurological Association.


PubMed | The Surgical Clinic of Central Arkansas, North Texas Surgery, Ihde Surgical Group, PA and 3 more.
Type: Comparative Study | Journal: American journal of surgery | Year: 2015

Endoscopic fundoplication requires accurate evaluation of the gastroesophageal junction (GJ) to determine if hiatal hernia repair is necessary before fundoplication. We compared the endoscopic and laparoscopic evaluations of the GJ.A total of 53 patients with gastroesophageal reflux disease underwent a laparoscopic repair of a hiatal defect before endoscopic fundoplication. The video of the preoperative endoscopic evaluation was compared with the laparoscopic video (n = 44). Nine patients were excluded because both endoscopic and laparoscopic videos were not available. A 2-tailed paired t test was used to assess the difference between the 2 study groups.The greatest transverse dimension of the hiatus assessed endoscopically was 3.30cm 1.00 vs 3.88cm 1.03 assessed laparoscopically, P < .001. In 22.8%, the average endoscopic Hill grade was lower than the estimated Hill grade when viewed laparoscopically. In 11.1% (range, 6% to 15%) of cases, the endoscopic view indicated a hiatal hernia repair was unnecessary when the matching laparoscopic view indicated hiatal repair would be needed.Endoscopic evaluation of the GJ may underestimate the radial size of the hiatal defect.


Brown J.M.,University of California at San Diego | Barbe M.F.,University of California at San Diego | Albo M.E.,Anatomy and Cell Biology | Lai H.H.,University of Washington | And 3 more authors.
Journal of Neurosurgery: Spine | Year: 2012

Object. Nerve transfers are effective for restoring control to paralyzed somatic muscle groups and, recently, even to denervated detrusor muscle in a canine model. A pilot project was performed in cadavers to examine the feasibility of transferring somatic nerves to vesical branches of the pelvic nerve as a method for potentially restoring innervation to control the detrusor muscle in humans. Methods. Eleven cadavers were dissected bilaterally to expose intercostal, ilioinguinal, and iliohypogastric nerves, along with vesical branches of the pelvic nerve. Ease of access and ability to transfer the former 3 nerves to the pelvic vesical nerves were assessed, as were nerve cross-sectional areas. Results. The pelvic vesical nerves were accessed at the base of the bladder, inferior to the ureter and accompanied by inferior vesical vessels. The T-11 and T-12 intercostal nerves were too short for transfer to the pelvic vesical nerves without grafting. Ilioinguinal and iliohypogastric nerves (L-1 origin) were identified retroperitoneally and, with full dissection, were easily transferred to the pelvic vesical nerves intraabdominally. The mean cross-sectional area of the dominant pelvic vesical branch was 2.60 ± 0.169 mm2; ilioinguinal and iliohypogastric branches at the suggested transection site were 2.38 ± 0.32 mm2 (the means are expressed ± SEM). Conclusions. Use of the ilioinguinal or iliohypogastric nerves for heterotopic transfer to pelvic vesical nerves is surgically feasible, based on anatomical location and cross-sectional areas.


Montes J.,Columbia University | McDermott M.P.,University of Rochester | Martens W.B.,University of Rochester | Dunaway S.,Columbia University | And 11 more authors.
Neurology | Year: 2010

Background: In spinal muscular atrophy (SMA), weakness, decreased endurance, and fatigue limit mobility. Scales have been developed to measure function across the wide spectrum of disease severity. However, these scales typically are observer dependent, and scores are based on sums across Likert-scaled items. The Six-Minute Walk Test (6MWT) is an objective, easily administered, and standardized evaluation of functional exercise capacity that has been proven reliable in other neurologic disorders and in children. Methods: To study the performance of the 6MWT in SMA, 18 ambulatory participants were evaluated in a cross-sectional study. Clinical measures were 6MWT, 10-m walk/run, Hammersmith Functional Motor Scale-Expanded (HFMSE), forced vital capacity, and handheld dynamometry. Associations between the 6MWT total distance and other outcomes were analyzed using Spearman correlation coefficients. A paired t test was used to compare the mean distance walked in the first and sixth minutes. Results: The 6MWT was associated with the HFMSE score (r = 0.83, p < 0.0001), 10-m walk/run (r =-0.87, p < 0.0001), and knee flexor strength (r = 0.62, p = 0.01). Gait velocity decreased during successive minutes in nearly all participants. The average first minute distance (57.5 m) was significantly more than the sixth minute distance (48 m) (p = 0.0003). Conclusion: The Six-Minute Walk Test (6MWT) can be safely performed in ambulatory patients with spinal muscular atrophy (SMA), correlates with established outcome measures, and is sensitive to fatigue-related changes. The 6MWT is a promising candidate outcome measure for clinical trials in ambulatory subjects with SMA. Copyright © 2010 by AAN Enterprises, Inc.


News Article | October 31, 2016
Site: www.prnewswire.com

BOSTON, Oct. 31, 2016 /PRNewswire-USNewswire/ -- New Emerson College polls in five battleground states show a tightening presidential race, with Hillary Clinton leading Donald Trump in four states, by margins that range from 6 points (in Wisconsin, 48% to 42%) to 1 point (Florida, 46% to...


Xu C.-F.,Glaxosmithkline | Reck B.H.,NC | Goodman V.L.,Oncology Research and Development | Xue Z.,NC | And 7 more authors.
Journal of Hepatology | Year: 2011

Background & Aims: Pazopanib has demonstrated clinical benefit in patients with advanced renal cell carcinoma (RCC) and is generally well tolerated. However, transaminase elevations have commonly been observed. This 2-stage study sought to identify genetic determinants of alanine transaminase (ALT) elevations in pazopanib-treated white patients with RCC. Methods: Data from two separate clinical studies were used to examine the association of genetic polymorphisms with maximum on-treatment ALT levels. Results: Of 6852 polymorphisms in 282 candidate genes examined in an exploratory dataset of 115 patients, 92 polymorphisms in 40 genes were significantly associated with ALT elevation (p <0.01). Two markers (rs2858996 and rs707889) in the HFE gene, which are not yet known to be associated with hemochromatosis, showed evidence for replication. Because of multiple comparisons, there was a 12% likelihood the replication occurred by chance. These two markers demonstrated strong linkage disequilibrium (r2 = 0.99). In the combined dataset, median (25-75th percentile) maximum ALT values were 1.2 (0.7-1.9), 1.1 (0.8-2.5), and 5.4 (1.9-7.6) × ULN for rs2858996 GG (n = 148), GT (n = 82), and TT (n = 1 2) genotypes, respectively. All 12 TT patients had a maximum ALT >ULN, and 8 (67%) had ALT ≥3 × ULN. The odds ratio (95% CI) for ALT ≥3 × ULN for TT genotype was 39.7 (2.2-703.7) compared with other genotypes. As a predictor of ALT ≥3 × ULN, the TT genotype had a negative predictive value of 0.83 and positive predictive value of 0.67. No TT patients developed liver failure. Conclusions: The rs2858996/rs707889 polymorphisms in the HFE gene may be associated with reversible ALT elevation in pazo-panib-treated patients with RCC. © 2010 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.


Horzempa J.,pa | Shanks R.M.Q.,pa | Shanks R.M.Q.,University of Pittsburgh | Brown M.J.,pa | And 4 more authors.
Journal of Microbiological Methods | Year: 2010

We engineered an efficient system to make Francisella tularensis deletion mutations using an unstable, poorly maintained plasmid to enhance the likelihood of homologous recombination. For counterselection, we adapted a strategy using I-SceI, which causes a double-stranded break in the integrated suicide vector, forcing a second recombination to mediate allelic replacement. © 2009 Elsevier B.V. All rights reserved.


Abrams M.,pa
Penn State Environmental Law Review | Year: 2010

Vegetation change is brought about by natural and anthropogenic processes, as well as an interaction of the two. Natural processes that impact vegetation include climate change, ecological disturbances, insect and disease outbreaks, extreme weather events, geologic phenomenon, and plant succession. The magnitude of anthropogenic disturbances in North American forests changed dramatically following European settlement. These included extensive logging and land clearing, often associated with catastrophic fire, followed by the onset of the fire control era in the early 20th century, and the introduction of exotic insects and diseases. In contrast, fire suppression policy during the Smokey Bear era appears to be leading to the demise of many historically dominant trees in the eastern US. Another important indication of humans' role in the ecology of eastern North America is the long-term persistence of disturbance- dependent vegetation types where natural disturbances are not particularly inherent to the system.


News Article | December 16, 2016
Site: www.prnewswire.com

HARRISBURG, Pa., Dec. 16, 2016 /PRNewswire-USNewswire/ -- Today, the Pennsylvania Department of Labor & Industry released its employment situation report for November 2016. Pennsylvania's unemployment rate was down one-tenth of a percentage point from October to 5.7 percent....


News Article | November 18, 2016
Site: www.prnewswire.com

HARRISBURG, Pa., Nov. 18, 2016 /PRNewswire-USNewswire/ -- Today, the Pennsylvania Department of Labor & Industry released its employment situation report for October 2016. Pennsylvania's unemployment rate was up one-tenth of a percentage point from September to 5.8 percent....

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