136 results on '"Elmo, M"'
Search Results
102. 14C2H4 Metabolism in Morning Glory Flowers
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Beyer, Elmo M., primary and Sundin, Olof, additional
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- 1978
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103. Mechanism of Ethylene Action
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Beyer, Elmo M., primary
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- 1972
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104. The Development of a Well Completion System for Deep Permafrost
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Blount, Elmo M., additional and Prueger, Nick J., additional
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- 1971
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105. A Method for Determining the Concentration of Ethylene in the Gas Phase of Vegetative Plant Tissues
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Beyer, Elmo M., primary and Morgan, Page W., additional
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- 1970
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106. Abscission
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Beyer, Elmo M., primary
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- 1973
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107. A Mechanical Device for the Rapid Sexing of Aedes aegypti Pupae 1
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Mccray, Elmo M., primary
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- 1961
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108. Ethylene Modification of an Auxin Pulse in Cotton Stem Sections
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Beyer, Elmo M., primary and Morgan, Page W., additional
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- 1969
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109. Effect of Ethylene on the Uptake, Distribution, and Metabolism of Indoleacetic Acid-1-14C and -2-14C and Naphthaleneacetic Acid-1-14C
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Beyer, Elmo M., primary and Morgan, Page W., additional
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- 1970
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110. Abscission
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Beyer, Elmo M., primary and Morgan, Page W., additional
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- 1971
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111. Mist Application of Chemosterilants to Adult Male Culex pipiens quinquefasciatus1
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McCray, Elmo M., primary and Schoof, Herbert F., additional
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- 1967
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112. Auxin Transport: A New Synthetic Inhibitor
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Beyer, Elmo M., primary
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- 1972
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113. Method for Overcoming the Antiethylene Effects of Ag+
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Elmo M. Beyer
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Ethylene ,biology ,Physiology ,food and beverages ,Plant Science ,biology.organism_classification ,Ion ,Pisum ,chemistry.chemical_compound ,Sativum ,Acetylene ,chemistry ,Genetics ,Organic chemistry ,Salt formation ,Nuclear chemistry - Abstract
A technique is described for eliminating the antiethylene effects of the Ag+ ion in the intact pea plant (Pisum sativum). The technique is based on the ability of the ethylene mimic, acetylene, to negate the antiethylene effect of Ag+, presumably through salt formation, and subsequently to induce the ethylene response.
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- 1978
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114. A Mechanical Device for the Rapid Sexing of Aedes aegypti Pupae 1
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Elmo M. Mccray
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Pupa ,Larva ,Ecology ,biology ,chemistry ,Insect Science ,Zoology ,chemistry.chemical_element ,General Medicine ,Aedes aegypti ,Sexing ,biology.organism_classification ,Mercury (element) - Published
- 1961
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115. A.60 - A simplified intensity-modulated radiotherapy technique for the breast to reduce posterior part of the axilla irradiation.
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Di Benedetto, R., Guida, C., Barzaghi, D., Cristiano, O., Elmo, M., Ancona, S., Buonavita, A., Iacobelli, A., Lampognara, V., Spiniello, D., and Iervolino, C.
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- 2016
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116. Consequences of the COVID-19 pandemic on admissions to general hospital psychiatric wards in Italy: Reduced psychiatric hospitalizations and increased suicidality
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Boldrini, Tommaso, Girardi, Paolo, Clerici, Massimo, Conca, Andreas, Creati, Chiara, Di Cicilia, Giuseppe, Ducci, Giuseppe, Durbano, Federico, Maci, Carlo, Maone, Antonio, Nicolò, Giuseppe, Oasi, Osmano, Percudani, Mauro, Polselli, Gian Marco, Pompili, Maurizio, Rossi, Alessandro, Salcuni, Silvia, Tarallo, Federica, Vita, Antonio, Lingiardi, Vittorio, Barlati, Stefano, Bertoldi, De, Francesco, Carnaghi, Giulia, Chiesa, Giovanni, Lelli, Dell'Erba, Alice, Elmo, Maria Giuseppa, Malvini, Lara, Monaco, Leonardo, Erbuto, Denise, Pessina, Rodolfo Luigi, Pontillo, Maria, Riggio, Francesco, Rossi, Chiara, Santorelli, Mario, Schiano Lomoriello, Arianna, Tamorri, Stefano Maria, Venturini, Paola, Vicari, Stefano, Boldrini, T, Girardi, P, Clerici, M, Conca, A, Creati, C, Di Cicilia, G, Ducci, G, Durbano, F, Maci, C, Maone, A, Nicolo, G, Oasi, O, Percudani, M, Polselli, G, Pompili, M, Rossi, A, Salcuni, S, Tarallo, F, Vita, A, Lingiardi, V, Barlati, S, de Bertoldi, F, Carnaghi, G, Chiesa, G, Dell'Erba, A, Elmo, M, Malvini, L, Monaco, L, Erbuto, D, Pessina, R, Pontillo, M, Riggio, F, Rossi, C, Santorelli, M, Lomoriello, A, Tamorri, S, Venturini, P, and Vicari, S
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Settore M-PSI/01 - Psicologia Generale ,Adult ,Male ,Settore M-PSI/07 - PSICOLOGIA DINAMICA ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,COVID-19 ,Emergency psychiatric department ,General hospital psychiatric ward ,Hospital admission ,Psychiatric hospitalization ,Suicidality ,Psychiatric Department, Hospital ,Article ,Suicidal Ideation ,symbols.namesake ,Hospital ,Young Adult ,Older patients ,Pandemic ,medicine ,Humans ,In patient ,Poisson regression ,General hospital ,Young adult ,Psychiatry ,Suicidal ideation ,Biological Psychiatry ,Aged ,Pharmacology ,business.industry ,Settore M-PSI/03 - Psicometria ,Age Factors ,Length of Stay ,Middle Aged ,Hospitalization ,Italy ,Communicable Disease Control ,Female ,Psychiatric Department ,symbols ,medicine.symptom ,business - Abstract
Aims: The present investigation aimed at evaluating differences in psychiatric hospitalizations in Italy during and after the lockdown due to the novel coronavirus disease 2019 (COVID-19), compared to the same periods in 2018 and 2019. Methods: We obtained and analyzed anonymized data on psychiatric admissions (n = 4550) from 12 general hospital psychiatric wards (GHPWs) in different Italian regions (catchment area = 3.71 millions of inhabitants). Using a mixed-effects Poisson regression model, we compared admission characteristics across three periods: (a) March 1–June 30, 2018 and 2019; (b) March 1–April 30, 2020 (i.e., lockdown); and (c) May 1–June 30, 2020 (i.e., post-lockdown). Results: During the COVID-19 lockdown, there was a 41% reduction (IRR = 0.59; p < 0.001, CI: 0.45–0.79) in psychiatric admissions in the enrolled GHPWs with respect to the 2018 and 2019 control period. Conversely, admission rates in the post-lockdown period were similar to those observed in the control period. Notably, a consistent and significant reduction in psychiatric hospitalizations of older patients (aged >65 years) was observed in the lockdown (40%; IRR = 0.60; 95% CI: 0.44–0.82) and post-lockdown (28%; IRR = 0.72; 95% CI: 0.54–0.96) periods. Long-stay admissions (>14 days) increased (63%; IRR = 1.63; 95% CI: 1.32–2.02) during the lockdown and decreased by 39% thereafter (IRR = 0.61; 95% CI: 0.49–0.75). A significant 35% increase in patients reporting suicidal ideation was observed in the post-lockdown period, compared to the rate observed in the 2018 and 2019 control period (IRR = 1.35; 95% CI: 1.01–1.79). Conclusion: The COVID-19 lockdown was associated with changes in the number of psychiatric admissions, particularly for older patients and long-stay hospitalizations. Increased admission of patients reporting suicidal ideation in the post-lockdown period merits special attention. Further studies are required to gain insight into the observed phenomena.
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- 2021
117. Trends in Consultations for Schizophrenia and Non-affective Psychoses in Italian Emergency Departments During and After the 2020 COVID-19 Lockdown
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Claudio Mencacci, Paola Rucci, Marco Toscano, Vincenzo Villari, Filippo Dragogna, Giuseppe Ducci, Maria Giuseppa Elmo, Matteo Balestrieri, Marco Vaggi, Maria Da Re, Giancarlo Cerveri, Alberto Vitalucci, Giulio Castelpietra, Davide Amendola, Lucio Ghio, Emi Bondi, Federico Grasso, Leonardo Monaco, Miki Bonizzoni, Chiara Colli, Clara Locatelli, Alessandra Nicotra, Giulia Piccinini, Balestrieri, M., Rucci, P., Amendola, D., Bonizzoni, M., Cerveri, G., Colli, C., Da Re, M., Dragogna, F., Ducci, G., Elmo, M. G., Ghio, L., Grasso, F., Locatelli, C., Mencacci, C., Monaco, L., Nicotra, A., Piccinini, G., Toscano, M., Vaggi, M., Villari, V., Vitalucci, A., Castelpietra, G., and Bondi, E.
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medicine.medical_specialty ,AcademicSubjects/MED00800 ,Pandemic ,Coronavirus disease 2019 (COVID-19) ,Acute treatment ,Aftermath of lockdown ,Sedative drugs ,Sui cidality ,pandemic ,Schizophrenia (object-oriented programming) ,suicidality ,Sedative drug ,acute treatment ,Regular Article ,aftermath of lockdown ,Psychiatry and Mental health ,sedative drugs ,medicine ,Psychology ,Psychiatry - Abstract
Aims To analyze the hospital emergency department (HED) consultations for schizophrenia-spectrum disorders in nine Italian hospitals during the 2020 lockdown and postlockdown periods, compared to the equivalent periods in 2019. Methods Characteristics of consultations, patients, and drug prescriptions were analyzed. Joinpoint models were used to identify changes in the weekly trend of consultations. Results During the 2020 lockdown the overall number of HED consultations for schizophrenia decreased by 40.7% and after the lockdown by 12.2% compared with 2019. No difference was found in the proportion of consultations that led to GHPU admissions or compulsory admissions. Suicidality rates did not differ across the two years, with the exception of ideations and plans (+5.9%) during the postlockdown period. We found an increase in benzodiazepine prescriptions in 2020 during the lockdown and postlockdown periods (+10.6% and +20.8%, respectively), and a decrease of prescriptions for short-acting sedative agents in the postlockdown period (–7.9%). An increase in the weekly trend of consultations occurred from March 11 to 17 (week 11) till June 26 to 30 (week 26). As a result, the initial gap in the number of consultations between the 2 years canceled out at the end of June. Conclusions HED consultation rate for schizophrenia-spectrum disorders declined consistent with that of other psychiatric disorders. In the postlockdown period, the growth of suicidal ideation/planning and increase in the prescriptions of anxiolytic-sedating drugs may foreshadow that for some schizophrenia patients the exit from the lockdown period is not liberating, but rather a source of agitation or perturbation.
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- 2021
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118. Emergency Psychiatric Consultations During and After the COVID-19 Lockdown in Italy. A Multicentre Study
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Matteo Balestrieri, Davide Amendola, Maria Giuseppa Elmo, Alberto Vitalucci, Alessandra Nicotra, Paola Rucci, Marco Toscano, Vincenzo Villari, Livia Pischiutta, Chiara Colli, Emi Bondi, Federico Grasso, Claudio Mencacci, Giulio Castelpietra, Marco Vaggi, Giuseppe Ducci, Lucio Ghio, Miki Bonizzoni, Leonardo Monaco, Clara Locatelli, Giancarlo Cerveri, Giulia Piccinini, Filippo Dragogna, Balestrieri, M., Rucci, P., Amendola, D., Bonizzoni, M., Cerveri, G., Colli, C., Dragogna, F., Ducci, G., Elmo, M. G., Ghio, L., Grasso, F., Locatelli, C., Mencacci, C., Monaco, L., Nicotra, A., Piccinini, G., Pischiutta, L., Toscano, M., Vaggi, M., Villari, V., Vitalucci, A., Castelpietra, G., Bondi, E., Balestrieri M., Rucci P., Amendola D., Bonizzoni M., Cerveri G., Colli C., Dragogna F., Ducci G., Elmo M.G., Ghio L., Grasso F., Locatelli C., Mencacci C., Monaco L., Nicotra A., Piccinini G., Pischiutta L., Toscano M., Vaggi M., Villari V., Vitalucci A., Castelpietra G., and Bondi E.
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2019-20 coronavirus outbreak ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,emergency department ,medicine.medical_treatment ,RC435-571 ,COVID-19 ,psychiatric consultations ,psychotropic drugs ,suicidal ideation ,Clinical history ,Medicine ,Medical prescription ,Antipsychotic ,Psychiatry ,Suicidal ideation ,Original Research ,business.industry ,psychiatric consultation ,Emergency department ,Mental health ,Psychiatry and Mental health ,Gradual increase ,Substance use ,medicine.symptom ,business ,Mania ,psychotropic drug - Abstract
Aims: The aim of this study was to analyse the trend and characteristics of psychiatric consultations in 9 Italian hospital emergency departments (HEDs) during the lockdown and post-lockdown periods of 2020, compared with the equivalent periods in 2019. Methods: Information on HEDs psychiatric consultations of patients was collected between March 9, 2020 and June 30, 2020 and during the same period of the previous year. We investigated changes between the two years in the number of consultations, in the characteristics of patients accessing HEDs and in the drug prescriptions dispensed. Joinpoint models were used to identify changes in the weekly trend of HED psychiatric consultations over the same year and between years. Results: As compared with 2019, a 37.5% decrease number of psychiatric consultations was found in the lockdown period and 17.9% decrease after the lockdown. The number of individual patients seen in HEDs for psychiatric consultations decreased by 34.9% during the lockdown and 11.2% after the lockdown. Such decreases occurred in all but one centre. The analysis of the weekly trend of consultations in 2020 revealed a significant percentage change in the number of consultations occurring from March 11, 2020 (week 11) to May 5, 2020 (week 18), followed by a more gradual, non-significant increase. The demographic characteristics and the clinical history of patients were similar in the years 2020 and 2019, except for a higher percentage of patients with previous admissions to acute psychiatric wards (GPHUs) during the lockdown period (61.1% vs 56.3%; p=0.019) and a lower percentage after the lockdown (59.7% vs 64.7%; p =0.034). As to psychiatrist report after the consultation, during the lockdown there was a sharp increase in the diagnosis of substance use disorders, while after the lockdown a higher manic episodes and suicidal ideation or attempts was found. In particular, a 3.4% decline was observed in suicidal ideation and planning during the lockdown, followed by an upward rebound of the same after the lockdown (+3.4%), accompanied by an increase in suicide attempts (+2.3%). Lastly, during the lockdown the prescriptions of antipsychotics increased by 5.2% and that of benzodiazepines by 4.1%, with a similar trend after the lockdown. Notably, after the lockdown, the number of compulsory admissions were substantially higher than the equivalent period in 2019. Conclusions: Our results show a relevant decline in the number of psychiatric consultations during and after the lockdown, compared with the corresponding periods of 2019. An increase in consultations for mania and suicidality problems occurred at the end of the restriction period, suggesting that the attention of mental health services should remain high.
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- 2021
119. Energy loss for electrons in the Heliosphere and local interstellar spectrum for solar modulation
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S. Pensotti, C. Consolandi, E. Memola, Mauro Tacconi, D. Grandi, G. Boella, Matteo Boschini, Massimo Gervasi, Karel Kudela, Davide Rozza, P. G. Rancoita, M. Elmo, Pavol Bobik, S. Della Torre, Giani, S, Leroy, C, Rancoita, PG, Bobik, P, Boella, G, Boschini, M, Consolandi, C, Della Torre, S, Gervasi, M, Grandi, D, Elmo, M, Kudela, K, Memola, E, Pensotti, S, Rancoita, P, Rozza, D, and Tacconi, M
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Physics ,energy losses ,solar modulation ,Astrophysics::High Energy Astrophysical Phenomena ,Bremsstrahlung ,heliosphere ,Flux ,Cosmic ray ,Electron ,Magnetic field ,Computational physics ,FIS/05 - ASTRONOMIA E ASTROFISICA ,FIS/01 - FISICA SPERIMENTALE ,Ionization ,Atomic physics ,Adiabatic process ,Heliosphere ,cosmic ray - Abstract
Galactic Cosmic Rays (GCR) entering the Heliosphere are affected by the solar modulation, which is a combination of diffusion, convection, magnetic drift, and adiabatic energy losses usually seen as a decrease of the flux at low energies (less than 10 GeV). We improved a quasi time-dependent 2D Stochastic Simulation code describing such effects. We focused our attention on the electron modulation, adding energy losses mechanisms in the Heliosphere that can be neglected for protons and ions: inverse Compton, ionization, synchrotron, and bremsstrahlung. These effects have been evaluated in the region affected by the solar magnetic field, up to 100 AU, where the environment conditions are not constant, especially the magnetic field intensity, and the photon density. In our calculation the inverse compton energy losses are dominant, but they contribute only a few percent in comparison with the adiabatic losses. We also compared the Local Interstellar Spectrum (LIS) of primary electrons with experimental data collected in the past years at energies 20 GeV. We found that, inside one standard deviation, LIS fits the data and can be used in a Monte carlo code reproducing CR propagation in the Heliosphere.
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- 2011
120. Assessment of small intestinal damage in patients treated with pelvic radiotherapy
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B. Daniele, L. de Magistris, M. Secondulfo, S Pignata, M Elmo, G. Silvestro, F S Sasso, P. Frezza, R. Carratù, L D'Agostino, Carratu', R, Secondulfo, M, DE MAGISTRIS, Laura, Daniele, B, Pignata, S, D'Agostino, L, Frezza, P, Elmo, M, Silvestro, G, and Sasso, Fs
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Diarrhea ,Male ,Cancer Research ,medicine.medical_specialty ,Cellobiose ,medicine.medical_treatment ,Uterus ,Rectum ,Uterine Cervical Neoplasms ,Gastroenterology ,Pelvis ,Capillary Permeability ,Internal medicine ,Intestine, Small ,medicine ,Humans ,Mannitol ,Intestinal Mucosa ,Radiation Injuries ,Aged ,Intestinal permeability ,business.industry ,Rectal Neoplasms ,Nausea ,General Medicine ,Pelvic cavity ,Middle Aged ,medicine.disease ,Small intestine ,Surgery ,Radiation therapy ,Intestinal Diseases ,medicine.anatomical_structure ,Oncology ,In utero ,Female ,Amine Oxidase (Copper-Containing) ,Complication ,business - Abstract
Pelvic radiotherapy almost always induces intestinal symptoms. We investigated the radiation-induced damage to the small intestinal mucosa and evaluated its relationship with symptoms, using cellobiose/mannitol permeability test (CE/MA) and plasma postheparin diamine oxidase test (PHD) in 20 patients treated with pelvic radiotherapy. The symptoms developed during radiotherapy were noted. Intestinal permeability significantly (p=0.013) increased from 0.021 +/- 0.026 to 0.047 +/- 0.055 (mean +/- SD) after 15 days of radiotherapy, while it returned to normal values (0.010 0.015) at the end of radiotherapy. PHD values did not change. All patients developed intestinal symptoms. These findings indicate that pelvic radiotherapy induces an early small bowel mucosa damage followed by mucosal adaptation. Acute intestinal symptoms during pelvic radiotherapy may not depend only on small intestinal mucosal damage.
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- 1998
121. Observational study of early diaphragm pacing in cervical spinal cord injured patients to decrease mechanical ventilation during the COVID-19 pandemic.
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Onders RP, Elmo M, Young B, and Tinkoff G
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- Humans, Male, Middle Aged, Female, Respiration, Artificial, Pandemics prevention & control, Diaphragm, Retrospective Studies, Prospective Studies, Electrodes, Implanted, Cervical Cord, Wounds, Gunshot, Electric Stimulation Therapy, COVID-19, Spinal Cord Injuries therapy
- Abstract
Background: Decreasing the burden of mechanical ventilation for spinal cord injuries was never more relevant than during the COVID-19 pandemic. Data have shown diaphragm pacing can replace mechanical ventilation, decrease wean times, improve respiratory mechanics, and decrease hospital costs for patients with spinal cord injuries. This is the largest report of diaphragm pacing during the pandemic., Methods: This is a retrospective analysis of prospective Institutional Review Board approved databases of nonrandomized interventional experience at a single institution. Subgroup analysis limited to traumatic cervical spinal cord injuries that were implanted laparoscopically with diaphragm electrodes within 30 days of injury., Results: For the study group of early implanted traumatic cervical spinal cord injuries, 13 subjects were identified from a database of 197 diaphragm pacing implantations from January 1, 2020, to December 31, 2022, for all indications. All subjects were male with an average age of 49.3 years (range, 17-70). Injury mechanisms included falls (6), motor vehicle accident (4), gunshot wound (2), and diving (1). Time from injury to diaphragm pacing averaged 11 days (range, 3-22). Two patients are deceased and neither weaned from mechanical ventilation. Nine of the remaining 11 patients weaned from mechanical ventilation. Four patients never had a tracheostomy and 3 additional patients had tracheostomy decannulation. Three of these high-risk pulmonary compromised patients survived COVID-19 infections utilizing diaphragm pacing., Conclusion: Diaphragm pacing successfully weaned from mechanical ventilation 82% of patients surviving past 90 days. Forty-four percent of this group never underwent a tracheostomy. Only 22% of the weaned group required long term tracheostomies. Early diaphragm pacing for spinal cord injuries decreases mechanical ventilation usage and tracheostomy need which allows for earlier placement for rehabilitation., (Copyright © 2022 Elsevier Inc. All rights reserved.)
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- 2023
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122. Spinal cord injury level and Phrenic Nerve Conduction Studies do not predict diaphragm pacing success or failure- all patients should undergo diagnostic laparoscopy.
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Onders RP, Elmo M, Stepien C, and Katirji B
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- Humans, Predictive Value of Tests, Reaction Time, Respiration, Artificial, Respiratory Paralysis etiology, Retrospective Studies, Spinal Cord Injuries complications, Treatment Outcome, Laparoscopy, Neural Conduction physiology, Phrenic Nerve physiopathology, Respiratory Paralysis therapy, Spinal Cord Injuries physiopathology, Spinal Cord Stimulation
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Background: Diaphragm Pacing(DP) demonstrates benefits over mechanical ventilation(MV) for spinal cord injured(SCI) patients. The hypothesis of this report is that phrenic nerve conduction study(PNCS) results cannot differentiate success or failure in selection of patients for DP. Direct surgical evaluation of the diaphragm should be performed., Methods: Observational report of prospective databases of patients undergoing laparoscopic evaluation of their diaphragms to assess for ability to stimulate to cause contraction for ventilation., Results: In 50 SCI patients who could not be weaned from MV, PNCS results showed latencies in stimulated patients (n = 44) and non-stimulated(n = 6) overlapped (7.8 ± 2.5 ms vs 9.4 ± 2.8 ms) and the null hypothesis cannot be rejected (p-value>0.05). Amplitudes overlapped (0.4 ± 0.2 mV vs 0.2 ± 0.2 mV) and the null hypotheses cannot be rejected (P-value >0.05). In 125 non SCI patients with diaphragm paralysis, there were 78(62.4%) with false negative PNCS., Conclusion: PNCS are inadequate pre-operative studies. Direct laparoscopic evaluation should be offered for all SCI patients to receive the benefit of DP., (Copyright © 2020 Elsevier Inc. All rights reserved.)
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- 2021
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123. Long-term experience with diaphragm pacing for traumatic spinal cord injury: Early implantation should be considered.
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Onders RP, Elmo M, Kaplan C, Schilz R, Katirji B, and Tinkoff G
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- Adolescent, Adult, Aged, Cervical Vertebrae, Child, Child, Preschool, Female, Humans, Infant, Infant, Newborn, Male, Middle Aged, Respiration, Artificial, Respiratory Insufficiency etiology, Respiratory Insufficiency mortality, Retrospective Studies, Spinal Cord Injuries mortality, Treatment Outcome, Young Adult, Diaphragm, Electric Stimulation Therapy, Electrodes, Implanted, Laparoscopy, Respiratory Insufficiency therapy, Spinal Cord Injuries complications
- Abstract
Background: Cervical spinal cord injury can result in catastrophic respiratory failure requiring mechanical ventilation with high morbidity, mortality, and cost. Diaphragm pacing was developed to replace/decrease mechanical ventilation. We report the largest long-term results in traumatic cervical spinal cord injury., Methods: In this retrospective review of prospective institutional review board protocols, all patients underwent laparoscopic diaphragm mapping and implantation of electrodes for diaphragm strengthening and ventilator weaning., Results: From 2000 to 2017, 92 patients out of 486 diaphragm pacing implants met the criteria. The age at time of injury ranged from birth to 74 years (average: 27 years). Time on mechanical ventilation was an average of 47.5 months (range, 6 days to 25 years, median = 1.58 years). Eighty-eight percent of patients achieved the minimum of 4 hours of pacing. Fifty-six patients (60.8%) used diaphragm pacing 24 hours a day. Five patients had full recovery of breathing with subsequent diaphragm pacing removal. Median survival was 22.2 years (95% confidence interval: 14.0-not reached) with only 31 deaths. Subgroup analysis revealed that earlier diaphragm pacing implantation leads to greater 24-hour use of diaphragm pacing and no need for any mechanical ventilation., Conclusion: Diaphragm pacing can successfully decrease the need for mechanical ventilation in traumatic cervical spinal cord injury. Earlier implantation should be considered., (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Published
- 2018
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124. Completed FDA feasibility trial of surgically placed temporary diaphragm pacing electrodes: A promising option to prevent and treat respiratory failure.
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Onders RP, Markowitz A, Ho VP, Hardacre J, Novitsky Y, Towe C, Elmo M, Kaplan C, and Schilz R
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- Adult, Aged, Aged, 80 and over, Electromyography, Feasibility Studies, Female, Humans, Male, Middle Aged, Muscular Atrophy prevention & control, Prospective Studies, Treatment Outcome, Diaphragm pathology, Diaphragm physiology, Electrodes, Implanted, Respiratory Insufficiency therapy
- Abstract
Background: Etiologies contributing to failure to wean from mechanical ventilation (MV) are multiple, resulting in morbid and costly outcomes. Diaphragm pacing (DP) is used in spinal cord injury to replace MV. Temporary DP could be utilized in acute respiratory failure to reduce MV., Methods: A prospective FDA feasibility trial evaluated temporary DP electrodes implanted in each hemi-diaphragm during a subject's primary procedure. Objectives included: ability to provide ventilation, stability analysis with diaphragm electromyography, and adverse event monitoring., Results: Twelve patients underwent successful implantation via median sternotomy, laparoscopy or laparotomy. Electrode stimulation exceeded ideal tidal volumes by an average of 37% (0%-95%) confirming ability to prevent atrophy. Daily electromyography confirmed stability of placement and was useful in evaluating hypoventilation. There were no complications and all 48 study electrodes remained intact until complete removal., Conclusion: This trial demonstrates ease of placement, removal, functionality and safety of temporary DP electrodes which therapeutically decreases diaphragm atrophy., (Copyright © 2017 Elsevier Inc. All rights reserved.)
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- 2018
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125. Identification of unexpected respiratory abnormalities in patients with amyotrophic lateral sclerosis through electromyographic analysis using intramuscular electrodes implanted for therapeutic diaphragmatic pacing.
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Onders RP, Elmo M, Kaplan C, Katirji B, and Schilz R
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- Amyotrophic Lateral Sclerosis physiopathology, Follow-Up Studies, Humans, Respiratory Insufficiency etiology, Respiratory Insufficiency therapy, Retrospective Studies, Treatment Outcome, Amyotrophic Lateral Sclerosis complications, Electric Stimulation Therapy methods, Electrodes, Implanted, Electromyography methods, Respiratory Insufficiency physiopathology
- Abstract
Background: Amyotrophic lateral sclerosis patients have significant respiratory abnormalities with incomplete understanding of respiratory control. This study analyzes electromyography (EMG) of the diaphragm (dEMG) using implanted diaphragm pacing (DP) electrodes., Methods: Retrospective analysis of dEMG data were obtained during Institutional Review Board and US Food and Drug Administration approved trials. The electrodes were used to analyze epochs of dEMG during multiple respiratory cycles., Results: Fifty-three patients were implanted. Thirty-six had bilateral dEMG assessments, 18 had continuous overnight readings with pulse oximetry, and 19 had serial analysis. Several findings revealed an alteration in the central respiratory drive including central apnea, hypoventilation, and hypercarbia. The electrodes showed unilateral dysfunction and demonstrated noninvasive ventilation suppression of diaphragm activity. DP can be used for serial monitoring, to decrease hypercarbia, improve sleep, and decrease atrophy., Conclusions: Multiple abnormalities of respiratory control can be seen in amyotrophic lateral sclerosis patients using dEMG through therapeutic DP electrodes. DP is used to overcome instability of respiratory control when there are intact diaphragm motor units leading to improved survival., (Copyright © 2015 Elsevier Inc. All rights reserved.)
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- 2015
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126. Extended use of diaphragm pacing in patients with unilateral or bilateral diaphragm dysfunction: a new therapeutic option.
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Onders RP, Elmo M, Kaplan C, Katirji B, and Schilz R
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- Adult, Aged, Diaphragm surgery, Female, Follow-Up Studies, Humans, Laparoscopy, Male, Middle Aged, Respiratory Paralysis diagnosis, Retrospective Studies, Treatment Outcome, Diaphragm physiopathology, Electric Stimulation Therapy instrumentation, Electric Stimulation Therapy methods, Implantable Neurostimulators, Respiratory Paralysis therapy
- Abstract
Background: Diaphragm dysfunction (DD) can cause sleep abnormalities, dyspnea, atelectasis, and respiratory failure. Historical treatments, including positive pressure ventilation or diaphragm plication, may alleviate symptoms but do not restore physiologic diaphragm function. Diaphragm pacing (DP) is approved for spinal cord-injured patients and in amyotrophic lateral sclerosis. We report a series of DD patients undergoing use of DP outside of these initial indications., Methods: This report involves a prospective, nonrandomized, interventional trial under institutional review board approval at a single institution. DP involves laparoscopic motor point mapping with implantation of intramuscular electrodes in each hemidiaphragm. Postoperatively, diaphragm conditioning ensues., Results: Twenty-seven patients were evaluated; all patients had symptomatic and objective hypoventilation for an average of 36 months of symptoms. Causes included idiopathic (n = 13), chest surgery (n = 5), shoulder surgery or trauma (n = 6), and others (n = 3); 17 had bilateral involvement, 6 had nonstimulable diaphragms and were not implanted, and 21 were implanted. Thirteen (62%) had substantial clinically relevant respiratory improvements. Four ventilator patients were weaned completely. Four had partial improvement, 3 had no improvement, and 1 patient was lost to follow-up for objective analysis., Conclusion: This is the first report of DP being used to treat diverse causes of DD. Eighty-one percent of implanted patients experienced improvements. This success suggests a potential for a wider use of DP and areas for future research., (Copyright © 2014 Elsevier Inc. All rights reserved.)
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- 2014
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127. Final analysis of the pilot trial of diaphragm pacing in amyotrophic lateral sclerosis with long-term follow-up: diaphragm pacing positively affects diaphragm respiration.
- Author
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Onders RP, Elmo M, Kaplan C, Katirji B, and Schilz R
- Subjects
- Adult, Aged, Amyotrophic Lateral Sclerosis physiopathology, Diaphragm innervation, Electrodes, Implanted, Female, Follow-Up Studies, Humans, Laparoscopy, Male, Middle Aged, Phrenic Nerve physiopathology, Pilot Projects, Prospective Studies, Respiratory Insufficiency etiology, Amyotrophic Lateral Sclerosis complications, Diaphragm surgery, Electric Stimulation Therapy, Respiratory Insufficiency therapy
- Abstract
Background: Respiratory insufficiency is the major cause of mortality in patients with amyotrophic lateral sclerosis or Lou Gehrig's disease. This is the final report of the diaphragm pacing (DP) pilot trial., Methods: Patients underwent laparoscopic diaphragm electrode implantations and subsequent conditioning of diaphragms. Serial respiratory function tests were performed in the initial year and followed until death., Results: Sixteen patients were implanted with no perioperative or unanticipated device-related adverse events. There were 452 implant-months of follow-up. DP allowed greater movement of the diaphragm under fluoroscopy, increased muscle thickness, and decreased the decline in forced vital capacity. Median survival from implant was 19.7 months with the cause of death respiratory in only 31%., Conclusions: Long-term analysis of DP in amyotrophic lateral sclerosis showed no safety issues and can positively influence diaphragm physiology and survival. This formed the initial basis for subsequent US Food and Drug Administration approval., (Copyright © 2014 Elsevier Inc. All rights reserved.)
- Published
- 2014
- Full Text
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128. Combination of radiotherapy and targeted therapies in the treatment of locally advanced non-small cell lung cancer.
- Author
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Sacco PC, Maione P, Rossi A, Bareschino MA, Schettino C, Guida C, Elmo M, Ambrosio R, Barbato V, Zeppa R, Palazzolo G, and Gridelli C
- Subjects
- Cancer Vaccines therapeutic use, Carcinoma, Non-Small-Cell Lung drug therapy, Carcinoma, Non-Small-Cell Lung pathology, Carcinoma, Non-Small-Cell Lung radiotherapy, Combined Modality Therapy, Humans, Lung Neoplasms drug therapy, Lung Neoplasms pathology, Lung Neoplasms radiotherapy, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Carcinoma, Non-Small-Cell Lung therapy, Lung Neoplasms therapy, Molecular Targeted Therapy methods
- Abstract
Lung cancer is the most common cancer in the world. One third of patients with non-small cell lung cancer (NSCLC) are diagnosed with locally or regionally advanced unresectable disease at presentation. Currently, in this stage of disease, a combination of chemotherapy and radiotherapy is the standard treatment approach for patients with good performance status, and concomitant chemo-radiotherapy has demonstrated to be the best therapeutic approach. However, despite improvements in treatment, local tumor control remains suboptimal and distant metastases remain the major site of failure. The diversity of molecular abnormalities in NSCLC may partly contribute to its resistance to therapy. It is therefore widely accepted that one approach to improve the efficacy of cancer therapy is the development of rational combinations of anticancer agents that may exhibit synergistic interactions. The introduction of several biologic agents represents an important advance in the management of NSCLC and some of them have shown to have a synergistic effect when given in combination with radiotherapy and chemotherapy in preclinical and in clinical models. In the present review we discuss the rationale and the feasibility of these combinations and the first results available from clinical trials.
- Published
- 2011
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129. First reported experience with intramuscular diaphragm pacing in replacing positive pressure mechanical ventilators in children.
- Author
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Onders RP, Ponsky TA, Elmo M, Lidsky K, and Barksdale E
- Subjects
- Adolescent, Child, Child, Preschool, Controlled Clinical Trials as Topic, Electrodes, Implanted, Family Health, Female, Humans, Laparoscopy instrumentation, Male, Neuromuscular Junction physiology, Quadriplegia therapy, Respiration, Artificial adverse effects, Respiratory Insufficiency therapy, Respiratory Paralysis therapy, Spinal Cord Injuries therapy, Ventilator Weaning adverse effects, Diaphragm innervation, Diaphragm physiology, Laparoscopy methods, Phrenic Nerve physiology, Positive-Pressure Respiration statistics & numerical data, Ventilator Weaning methods
- Abstract
Purpose: Diaphragm pacing (DP) has been shown to successfully replace mechanical ventilators for adult tetraplegic patients with chronic respiratory insufficiency. This is the first report of DP in ventilator-dependent children., Methods: This was a prospective interventional experience under institutional review board approval. Diaphragm pacing involves outpatient laparoscopic diaphragm motor point mapping to identify the site where stimulation causes maximum diaphragm contraction with implantation of 4 percutaneous intramuscular electrodes. Diaphragm conditioning ensues to wean the child from the ventilator., Results: Six children were successfully implanted ranging from 5 to 17 years old with the smallest 15 kg in weight. Length of time on mechanical ventilation ranged from 11 days to 7.6 years with an average of 3.2 years. In all patients, DP provided tidal volumes above basal needs. Five of the patients underwent a home-based weaning program, whereas one patient who was implanted only 11 days post spinal cord injury never returned to the ventilator with DP use. Another patient was weaned from the ventilator full time but died of complications of his underlying brain stem tumor. The remaining patients weaned from the ventilator for over 14 hours a day and/or are actively conditioning their diaphragms., Conclusion: Diaphragm pacing successfully replaced mechanical ventilators, which improves quality of life., (Copyright © 2011 Elsevier Inc. All rights reserved.)
- Published
- 2011
- Full Text
- View/download PDF
130. Complete worldwide operative experience in laparoscopic diaphragm pacing: results and differences in spinal cord injured patients and amyotrophic lateral sclerosis patients.
- Author
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Onders RP, Elmo M, Khansarinia S, Bowman B, Yee J, Road J, Bass B, Dunkin B, Ingvarsson PE, and Oddsdóttir M
- Subjects
- Adolescent, Adult, Aged, Amyotrophic Lateral Sclerosis physiopathology, Diaphragm innervation, Electric Stimulation Therapy instrumentation, Female, Humans, Laparoscopy statistics & numerical data, Male, Middle Aged, Postoperative Complications, Prospective Studies, Respiration, Artificial, Respiratory Paralysis etiology, Spinal Cord Injuries physiopathology, Young Adult, Amyotrophic Lateral Sclerosis complications, Diaphragm physiopathology, Electric Stimulation Therapy methods, Electrodes, Implanted, Laparoscopy methods, Respiratory Paralysis therapy, Spinal Cord Injuries complications
- Abstract
Background: Diaphragm movement is essential for adequate ventilation, and when the diaphragm is adversely affected patients face lifelong positive-pressure mechanical ventilation or death. This report summarizes the complete worldwide multicenter experience with diaphragm pacing stimulation (DPS) to maintain and provide diaphragm function in ventilator-dependent spinal cord injury (SCI) patients and respiratory-compromised patients with amyotrophic lateral sclerosis (ALS). It will highlight the surgical experiences and the differences in diaphragm function in these two groups of patients., Methods: In prospective Food and Drug Administration (FDA) trials, patients underwent laparoscopic diaphragm motor point mapping with intramuscular electrode implantation. Stimulation of the electrodes ensued to condition and strengthen the diaphragm., Results: From March of 2000 to September of 2007, a total of 88 patients (50 SCI and 38 ALS) were implanted with DPS at five sites. Patient age ranged from 18 to 74 years. Time from SCI to implantation ranged from 3 months to 27 years. In 87 patients the diaphragm motor point was mapped with successful implantation of electrodes with the only failure the second SCI patient who had a false-positive phrenic nerve study. Patients with ALS had much weaker diaphragms identified surgically, requiring trains of stimulation during mapping to identify the motor point at times. There was no perioperative mortality even in ALS patients with forced vital capacity (FVC) below 50% predicted. There was no cardiac involvement from diaphragm pacing even when analyzed in ten patients who had pre-existing cardiac pacemakers. No infections occurred even with simultaneous gastrostomy tube placements for ALS patients. In the SCI patients 96% were able to use DPS to provide ventilation replacing their mechanical ventilators and in the ALS studies patients have been able to delay the need for mechanical ventilation up to 24 months., Conclusion: This multicenter experience has shown that laparoscopic diaphragm motor point mapping, electrode implantation, and pacing can be safely performed both in SCI and in ALS. In SCI patients it allows freedom from ventilator and in ALS patients it delays the need for ventilators, increasing survival.
- Published
- 2009
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- View/download PDF
131. Amyotrophic lateral sclerosis: the Midwestern surgical experience with the diaphragm pacing stimulation system shows that general anesthesia can be safely performed.
- Author
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Onders RP, Carlin AM, Elmo M, Sivashankaran S, Katirji B, and Schilz R
- Subjects
- Adult, Aged, Diaphragm innervation, Female, Humans, Male, Middle Aged, Pilot Projects, Respiratory Paralysis etiology, Amyotrophic Lateral Sclerosis complications, Anesthesia, General, Electric Stimulation Therapy, Respiratory Paralysis therapy
- Abstract
Background: There is a paucity of literature concerning general anesthesia and surgery in patients with amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease). This report summarizes the largest series of surgical cases in ALS during multicenter prospective trials of the laparoscopic diaphragm pacing system (DPS) to delay respiratory failure., Method: The overall strategy outlined includes the use of rapidly reversible short-acting analgesic and amnestic agents with no neuromuscular relaxants., Results: Fifty-one patients were implanted from March 2005 to March 2008 at 2 sites. Age at implantation ranged from 42 to 73 years and the percent predicted forced vital capacity (FVC) ranged from 20% to 87%. On preoperative blood gases, Pco(2) was as high as 60. Using this protocol, there were no failures to extubate or 30-day mortalities. The DPS system increases the respiratory system compliance by decreasing posterior lobe atelectasis and can stimulate respirations at the end of each case., Conclusions: Laparoscopic surgery with general anesthesia can be safely performed in patients with ALS undergoing DPS.
- Published
- 2009
- Full Text
- View/download PDF
132. Combined chemo-radiotherapy for locally advanced non-small cell lung cancer: current status and future development.
- Author
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Guida C, Maione P, Rossi A, Bareschino M, Schettino C, Barzaghi D, Elmo M, and Gridelli C
- Subjects
- Carcinoma, Non-Small-Cell Lung mortality, Combined Modality Therapy methods, Humans, Lung Neoplasms mortality, Carcinoma, Non-Small-Cell Lung drug therapy, Carcinoma, Non-Small-Cell Lung radiotherapy, Lung Neoplasms drug therapy, Lung Neoplasms radiotherapy
- Abstract
Currently, combinations of chemotherapy and radiotherapy are the standard treatment approach for locally advanced NSCLC patients. Concomitant chemo-radiotherapy, although associated with increased acute toxicity, has demonstrated to be the better strategy over sequential chemoradiotherapy, and it is to be considered a standard approach in patients with good performance status (0-1). However, the approach to locally advanced NSCLC and to chemo-radiotherapy regimens remains heterogeneous among oncologists, and clinical outcomes are yet disappointing. Thus, the search of new strategies is mandatory. The main fields of research aiming at improving the survival of locally advanced NSCLC patients are: the addition of further combination chemotherapy as induction or consolidation to concurrent chemo-radiotherapy, and the integration of molecularly targeted therapies into conventional chemo-radiotherapy regimens.
- Published
- 2008
- Full Text
- View/download PDF
133. Phrenic nerve conduction studies in spinal cord injury: applications for diaphragmatic pacing.
- Author
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Alshekhlee A, Onders RP, Syed TU, Elmo M, and Katirji B
- Subjects
- Action Potentials physiology, Adult, Electric Stimulation, Electrodiagnosis, Female, Fluoroscopy, Humans, Laparoscopy, Male, Middle Aged, Motor Neurons physiology, Respiration, Artificial, Survival Analysis, Treatment Outcome, Diaphragm physiology, Neural Conduction physiology, Phrenic Nerve physiology, Spinal Cord Injuries physiopathology
- Abstract
The diaphragm pacing system (DPS) is a minimally invasive alternative to mechanical ventilation in patients with quadriplegia due to cervical myelopathy primarily caused by high cervical spinal cord injury. We evaluated 36 patients, 29 of whom had traumatic spinal cord injury, two who had a history of remote meningitis and demyelinating disease, and five who had cervical myelopathies of unknown etiology. Phrenic nerve conduction studies were performed with simultaneous fluoroscopic observation of diaphragm excursion to assess diaphragm viability. In the preoperative evaluation, diaphragm compound muscle action potentials (CMAPs) were recorded only when the diaphragm moved on fluoroscopy with ipsilateral stimulation. Twenty-six patients who were determined to have a viable diaphragm underwent DPS. Following DPS the primary outcome was the time (hours per day) that patients were able to pace and stay off the ventilator. Of 26 implanted patients, 96% (25 patients) were able to pace and tolerate being off the ventilator for more than 4 h per day. This study demonstrates that the presence of a diaphragm CMAP is associated with diaphragm movement observed by fluoroscopy in cervical myelopathy. In addition, DPS can help patients with cervical spinal cord injury to breathe unassisted by a ventilator.
- Published
- 2008
- Full Text
- View/download PDF
134. Combined multistep approach in a locally advanced rectal cancer with sacral invasion: case report.
- Author
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Delrio P, Fazioli F, Di Marzo M, Avallone A, Elmo M, Pecori B, Ravo V, Idà DN, Bianchi P, Cremona F, De Rosa V, and Parisi V
- Subjects
- Adult, Bone Neoplasms pathology, Combined Modality Therapy, Humans, Male, Neoplasm Invasiveness, Rectal Neoplasms pathology, Bone Neoplasms therapy, Rectal Neoplasms therapy, Sacrum
- Abstract
Composite pelvic resection with sacrectomy may provide good local control in case of locally advanced rectal cancer infiltrating the sacral bone. A combined multidisciplinary approach including chemotherapy and radiotherapy is here presented for a case of rectal tumor invading the sacrum.
- Published
- 2005
135. Compliance and toxicity of adjuvant CMF in elderly breast cancer patients: a single-center experience.
- Author
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De Maio E, Gravina A, Pacilio C, Amabile G, Labonia V, Landi G, Nuzzo F, Rossi E, D'Aiuto G, Capasso I, Rinaldo M, Morrica B, Elmo M, Di Maio M, Perrone F, and de Matteis A
- Subjects
- Aged, Antineoplastic Combined Chemotherapy Protocols adverse effects, Breast Neoplasms radiotherapy, Chemotherapy, Adjuvant, Cyclophosphamide adverse effects, Cyclophosphamide therapeutic use, Disease-Free Survival, Female, Fluorouracil adverse effects, Fluorouracil therapeutic use, Hematologic Diseases chemically induced, Humans, Methotrexate adverse effects, Methotrexate therapeutic use, Middle Aged, Radiotherapy, Adjuvant, Retrospective Studies, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Breast Neoplasms drug therapy, Patient Compliance
- Abstract
Background: Few data are available on compliance and safety of adjuvant chemotherapy when indicated in elderly breast cancer patients; CMF (cyclophosphamide, methotrexate, fluorouracil) can be reasonably considered the most widely accepted standard of treatment., Methods: We retrospectively reviewed compliance and safety of adjuvant CMF in patients older than 60. The treatment was indicated if patients had no severe comorbidity, a high-risk of recurrence, and were younger than 75. Toxicity was coded by NCI-CTC. Toxicity and compliance were compared between two age subgroups (< 65, > or = 65) by Fisher exact test and exact Wilcoxon rank-sum test., Results: From March 1991 to March 2002, 180 patients were identified, 100 older than 60 and younger than 65, and 80 aged 65 or older. Febrile neutropenia was more frequent among older patients (p = 0.05). Leukopenia, neutropenia, nausea, cardiac toxicity and thrombophlebitis tended to be more frequent or severe among elderlies, while mucositis tended to be more evident among younger patients, all not significantly. Almost one half (47%) of the older patients receiving concomitant radiotherapy experienced grade 3-4 haematological toxicity. Compliance was similar in the two groups, with 6 cycles administered in 86% and 79%, day-8 chemotherapy omitted at least once in 36% and 39%, dose reduction in 27% and 38%, prolonged treatment duration (> or = 29 weeks) in 10% and 11% and need of G-CSF in 9% and 18%, among younger and older patients, respectively., Conclusion: Our data show that, in a highly selected population of patients 65 or more years old, CMF is as feasible as in patients older than 60 and younger than 65, but with a relevant burden of toxicity. We suggest that prospective trials in elderly patients testing less toxic treatment schemes are mandatory before indicating adjuvant chemotherapy to all elderly patients with significant risk of breast cancer recurrence.
- Published
- 2005
- Full Text
- View/download PDF
136. Radiotherapy in patients with cerebral metastases.
- Author
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Iuliano G, Sasso FS, Saponiero R, Di Domenico G, Elmo M, and Catalano E
- Subjects
- Adult, Aged, Aged, 80 and over, Brain Neoplasms radiotherapy, Breast Neoplasms radiotherapy, Female, Humans, Lung Neoplasms radiotherapy, Male, Middle Aged, Neoplasms, Unknown Primary, Brain Neoplasms secondary
- Published
- 1988
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