313 results on '"Mitchell RB"'
Search Results
2. Modulation of Mammalian O6-Alkylguanine-DNA Alkyltransferase in vivo by O6-Benzylguanine and its Effect on the Sensitivity of a Human Glioma Tumor to l-(2-chloroethyl)-3-(4-methylcyclohexyl)-l-nitrosourea
- Author
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Moschel Rc, Dolan Me, Mitchell Rb, Stine L, and Anthony E. Pegg
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Cancer Research ,Nitrosourea ,Methyltransferase ,medicine.medical_treatment ,Intraperitoneal injection ,O-6-methylguanine-DNA methyltransferase ,Hamster ,Pharmacology ,O6-Benzylguanine ,chemistry.chemical_compound ,chemistry ,In vivo ,medicine ,Alkyltransferase - Abstract
Experiments were carried out in mice and hamsters to determine whether the activity of the DNA repair protein, O6-alkylguanine-DNA alkyltransferase, in tissues and tumors was reduced by treatment with O6-benzylguanine in vivo. Following intraperitoneal injection of O6-benzylguanine, there was a rapid and complete loss of alkyltransferase activity in both livers and kidneys of mice and hamsters. The activity in mouse tissues was slowly restored, reaching pretreatment activities at 16 hr and 72 hr after injection of O6-benzylguanine at 10 mg/kg or 126 mg/kg, respectively. The activity in hamster liver was restored at a significantly lower rate, reaching less than 20% pretreatment activity 72 hr after treatment with 100 mg/kg of O6-benzylguanine. The efficient reduction of alkyltransferase activity by O6-benzylguanine was in sharp contrast to the inability of O6-methylguanine to bring about similar reductions. Activities dropped to about 55% of pretreatment activities in several mouse organs 4 hr after treatment with 126 mg/kg of O6-methylguanine compared to a more than 90% reduction in activity in animals after treatment with O6-benzylguanine. The sensitivity of SF767 cells to meCCNU after treatment with O6-benzylguanine was increased substantially. Furthermore, treatment of nude mice carrying SF767 tumor with 60 mg/kg of O6-benzylguanine prior to either 7.5 or 15 mg/kg of meCCNU led to significant inhibition of tumor growth. These studies indicate that O6-benzylguanine is a suitable compound for use in experiments to examine the role of the alkyltransferase protein in vivo in counteracting the effects of alkylating agents.(ABSTRACT TRUNCATED AT 250 WORDS)
- Published
- 1990
3. Switchgrass for Biofuels: Insights through Microscopy
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Sarath, G, primary, Baird, LM, additional, Hou, G, additional, Mitchell, RB, additional, and Vogel, KP, additional
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- 2008
- Full Text
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4. POTT'S PUFFY TUMOUR: A RARE CAUSE OF FOREHEAD SWELLING IN A CHILD
- Author
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Hore, I, primary, Mitchell, RB, additional, Radcliffe, G, additional, and De Casso Moxo, C, additional
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- 2000
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5. Adenotonsillectomy outcomes in treatment of obstructive sleep apnea in children: a multicenter retrospective study.
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Bhattacharjee R, Kheirandish-Gozal L, Spruyt K, Mitchell RB, Promchiarak J, Simakajornboon N, Kaditis AG, Splaingard D, Splaingard M, Brooks LJ, Marcus CL, Sin S, Arens R, Verhulst SL, and Gozal D
- Abstract
Rationale: The overall efficacy of adenotonsillectomy (AT) in treatment of obstructive sleep apnea syndrome (OSAS) in children is unknown. Although success rates are likely lower than previously estimated, factors that promote incomplete resolution of OSAS after AT remain undefined. Objectives: To quantify the effect of demographic and clinical confounders known to impact the success of AT in treating OSAS. Methods: A multicenter collaborative retrospective review of all nocturnal polysomnograms performed both preoperatively and postoperatively on otherwise healthy children undergoing AT for the diagnosis of OSAS was conducted at six pediatric sleep centers in the United States and two in Europe. Multivariate generalized linear modeling was used to assess contributions of specific demographic factors on the post-AT obstructive apnea-hypopnea index (AHI). Measurements and Main Results: Data from 578 children (mean age, 6.9 +/- 3.8 yr) were analyzed, of which approximately 50% of included children were obese. AT resulted in a significant AHI reduction from 18.2 +/- 21.4 to 4.1 +/- 6.4/hour total sleep time (P < 0.001). Of the 578 children, only 157 (27.2%) had complete resolution of OSAS (i.e., post-AT AHI <1/h total sleep time). Age and body mass index z-score emerged as the two principal factors contributing to post-AT AHI (P < 0.001), with modest contributions by the presence of asthma and magnitude of pre-AT AHI (P < 0.05) among nonobese children. Conclusions: AT leads to significant improvements in indices of sleep-disordered breathing in children. However, residual disease is present in a large proportion of children after AT, particularly among older (>7 yr) or obese children. In addition, the presence of severe OSAS in nonobese children or of chronic asthma warrants post-AT nocturnal polysomnography, in view of the higher risk for residual OSAS. [ABSTRACT FROM AUTHOR]
- Published
- 2010
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6. Adenotonsillectomy for obstructive sleep apnea in children: outcome evaluated by pre- and postoperative polysomnography.
- Author
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Mitchell RB
- Published
- 2007
7. Behavioral changes in children with mild sleep-disordered breathing or obstructive sleep apnea after adenotonsillectomy.
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Mitchell RB and Kelly J
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- 2007
8. Vibrio vulnificus infection: diagnosis and treatment.
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Bross MH, Soch K, Morales R, and Mitchell RB
- Abstract
Vibrio vulnificus infection is the leading cause of death related to seafood consumption in the United States. This virulent, gram-negative bacterium causes two distinct syndromes. The first is an overwhelming primary septicemia caused by consuming raw or undercooked seafood, particularly raw oysters. The second is a necrotizing wound infection acquired when an open wound is exposed to warm seawater with high concentrations of V. vulnificus. Most patients, including those with primary infection, develop sepsis and severe cellulitis with rapid development to ecchymoses and bullae. In severe cases, necrotizing fasciitis can develop. Case-fatality rates are greater than 50 percent for primary septicemia and about 15 percent for wound infections. Treatment of V vulnificus infection includes antibiotics, aggressive wound therapy, and supportive care. Most patients who acquire the infection have at least one predisposing immunocompromising condition. Physician awareness of risk factors for V. vulnificus infection combined with prompt diagnosis and treatment can significantly improve patient outcomes. (Am Fam Physic [ABSTRACT FROM AUTHOR]
- Published
- 2007
9. Behavior and obstructive sleep apnea in children: is obesity a factor?
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Rudnick EF and Mitchell RB
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- 2007
10. Orbital sequelae of rhinosinusitis after cochlear implantation in children.
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Rudnick EF, Chu MW, Sismanis A, Dodson KM, and Mitchell RB
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- 2006
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11. Child behavior after adenotonsillectomy for obstructive sleep apnea syndrome.
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Mitchell RB and Kelly J
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- 2005
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12. Dog bites of the scalp, face, and neck in children.
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Mitchell RB, Nañez G, Wagner JD, and Kelly J
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- 2003
13. Ear, nose and throat disorders in children with Down syndrome.
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Mitchell RB, Call E, and Kelly J
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- 2003
14. The Relation of the Tricarboxylic Acid Cycle to Bacterial Infection: I. The Effect of Malonate on Salmonella Typhimurium Infections in Mice
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Mitchell Rb and Berry Lj
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Salmonella typhimurium ,chemistry.chemical_classification ,medicine.drug_class ,Citric Acid Cycle ,Antibiotics ,Bacterial Infections ,Antimycin A ,Biology ,medicine.disease_cause ,Malonates ,Microbiology ,Citric acid cycle ,Mice ,chemistry.chemical_compound ,Infectious Diseases ,Malonate ,Enzyme ,chemistry ,medicine ,Influenza A virus ,Animals ,Immunology and Allergy ,Fluoroacetate ,Typhoid Fever ,Citric acid - Abstract
citric acid in the lungs, due to a blockage of the tricarboxylic acid cycle, and, under the same conditions, inhibit the synthesis of influenza A virus administered by nasal insufflation. He previously had reported (1951b) that viral synthesis by tissues growing in vitro is inhibited by sodium malonate and by antimycin A, an antibiotic that inhibits the enzyme succinic dehydrogenase (Ahmad et al, 1950). A similar inhibition in the synthesis of the Lansing strain of poliomyelitis virus in mice given sublethal doses of fluoroacetate was reported by Ainslie (1952). If, according to Cohen (1949), viruses reproduce at the expense of the synthetic abilities of the parasitized cells, then the results of Ackermann and of Ainslie tie the Krebs cycle to this process and imply that energy made available by reactions of the cycle is utilized for synthesis of virus protein. These workers did not, however, determine whether the reduction of viral propagation following sublethal doses of fluoroacetate
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- 1953
15. Effect of Acclimatization to Altitude on Susceptibility of Mice to Influenza A Virus Infection
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Rubenstein D, Berry Lj, and Mitchell Rb
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Acclimatization ,Altitude ,Significant difference ,Physiology ,Metabolism ,Biology ,medicine.disease_cause ,General Biochemistry, Genetics and Molecular Biology ,Virus ,Mice ,Simulated altitude ,Influenza A virus ,Influenza, Human ,Immunology ,medicine ,Animals ,Humans ,Disease Susceptibility ,Lung tissue - Abstract
Summary1. Mice acclimatized to a simulated altitude of approximately 20,000 feet for 3 weeks are more resistant to artificially induced infection with the PR8 strain of influenza A virus than (a) normal control mice, (b) mice similarly exposed to altitude but given three weeks of recovery at normal atmospheric pressures prior to infection, and (c) mice made anemic by standardized hemorrhage, the latter 3 groups showing no significant difference in susceptibility. 2. Altitude acclimatized mice maintained at simulated altitude for the postinfection period are significantly more resistant than those maintained at normal atmospheric pressures. 3. There is some indication that these results are due to a metabolic disturbance which accompanies adaptation to altitude as shown by a reduction in the citric acid content of lung tissue of these animals compared to that of normal mice which reduces the animal's capacity for virus synthesis.
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- 1955
16. Some Metabolic Aspects of Host-Parasite Interaction Using the Albino Mouse and Salmonella Typhimurium
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Berry Lj and Mitchell Rb
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Salmonella typhimurium ,Salmonella ,Host (biology) ,Albino mouse ,Metabolic aspects ,Spleen ,Metabolism ,Biology ,medicine.disease_cause ,Host-Parasite Interactions ,Microbiology ,Mice ,Infectious Diseases ,medicine.anatomical_structure ,Biochemistry ,Salmonella Infections ,medicine ,Animals ,Humans ,Immunology and Allergy ,Parasite hosting - Published
- 1954
17. The Relation of the Tricarboxylic Acid Cycle to Bacterial Infection: II. The Effect of Fluoroacetate, Arsenite, Citrate, and Succinate on Salmonella Typhimurium Infections In Mice
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Mitchell Rb and Berry Lj
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Salmonella typhimurium ,Salmonella ,Sodium arsenite ,Arsenites ,Fluoroacetates ,Citric Acid Cycle ,Succinic Acid ,Biology ,medicine.disease_cause ,Citric Acid ,Arsenic ,Microbiology ,Mice ,chemistry.chemical_compound ,medicine ,Animals ,Immunology and Allergy ,Citrates ,Typhoid Fever ,Arsenite ,Succinates ,Bacterial Infections ,Malaria ,Citric acid cycle ,Infectious Diseases ,chemistry ,Biochemistry ,Fluoroacetate ,Sodium fluoroacetate - Published
- 1953
18. Sleep-disordered breathing in children: survey of current practice.
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Mitchell RB, Pereira KD, and Friedman NR
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- 2006
19. Effect of Malonate on Bacteremia Developed in Mice Artificially Infected with Salmonella typhimurium
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Mitchell Rb and Berry Lj
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Salmonella typhimurium ,Salmonella ,medicine.medical_treatment ,Bacteremia ,Biology ,medicine.disease_cause ,medicine.disease ,Malonates ,General Biochemistry, Genetics and Molecular Biology ,Microbiology ,Mice ,chemistry.chemical_compound ,Malonate ,chemistry ,Sepsis ,Salmonella Infections ,medicine ,Animals ,Saline - Abstract
ConclusionsThese experiments show that malonate injections in mice artificially infected with S. typhimurium results in the development of a bacteremia more than 100 times as severe as that found within the same time period in control mice injected with equal volumes of saline. Malonate injections in the same mice also reduce survival time, apparently because of the fulminating infection which results. The increased severity of the bacteremia accompanying the malonate injections could be due to a) an impairment of the mouse's defense against bacterial infection, b) the establishment of an internal environment within the mouse which favors bacterial reproduction along the lines postulated by Lewis (6), or c) a combination of (a) and (b). The need for additional experiments thus becomes evident.
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- 1954
20. Pediatric functional endoscopic sinus surgery: is a second look necessary?
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Mitchell RB, Pereira KD, Younis RT, Lazar RH, Mitchell, R B, Pereira, K D, Younis, R T, and Lazar, R H
- Abstract
Functional endoscopic sinus surgery (FESS) has become the surgical procedure of choice for the treatment of chronic sinusitis that is refractory to medical treatment. It has become routine to perform endoscopy in children under general anesthesia 2 to 3 weeks after FESS to facilitate examination and cleaning of the operative site. We compared the clinical outcome of 50 children who underwent FESS without a second-look endoscopy with 50 children who underwent a routine second look. Patients with systemic disease (cystic fibrosis, immotile ciliary syndrome, immunoglobulin deficiency) or undergoing a revision procedure were excluded from the study. The results show that the postoperative improvement in nasal obstruction, nasal drainage, and chronic cough was the same for both groups. We conclude that in the vast majority of children without systemic disease and not undergoing a revision procedure, a second endoscopic procedure may not offer any apparent advantage. [ABSTRACT FROM AUTHOR]
- Published
- 1997
21. Outpatient adenotonsillectomy: is it safe in children younger than 3 years?
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Mitchell RB, Pereira KD, Friedman NR, and Lazar RH
- Published
- 1997
22. Peritonsillar abscess in early childhood. Presentation and management.
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Friedman NR, Mitchell RB, Pereira KD, Younis RT, and Lazar RH
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- 1997
23. Pediatric turbinate reduction by coblation.
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Mitchell RB
- Abstract
Enlargement of the inferior turbinates is a common cause of nasal obstruction in children. Inferior turbinate reduction by coblation is an effective, safe, and minimally invasive surgical procedure in children. The indications for this surgery are being evaluated and expanded. It can be performed in addition to an adenoidectomy, adenotonsillectomy, functional endoscopic sinus surgery, or septoplasty. It can also be performed as an isolated procedure for nasal obstruction due to chronic rhinitis after medical treatment has failed to provide adequate relief. This article will provide the reader with a detailed description of the current indications and the technique of inferior turbinate reduction by coblation. Copyright © 2009 by Elsevier Inc. [ABSTRACT FROM AUTHOR]
- Published
- 2009
- Full Text
- View/download PDF
24. The relation of the tricarboxylic acid cycle to bacterial infection. IV. The effect of three metabolic inhibitors and Salmonella typhimurium on the citric acid content of mouse tissues
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Berry Lj, Mitchell Rb, and Kathryn H. Ehlers
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Salmonella typhimurium ,Salmonella ,Citric Acid Cycle ,Metabolism ,Bacterial Infections ,Biology ,medicine.disease_cause ,Virus ,Citric Acid ,Microbiology ,Citric acid cycle ,chemistry.chemical_compound ,Mice ,Infectious Diseases ,chemistry ,Biochemistry ,Salmonella Infections ,medicine ,Immunology and Allergy ,Animals ,Citrates ,Citric acid ,Sodium fluoroacetate - Abstract
Experiments to determine the effect of changes in metabolism induced by means of specific inhibitors upon the response to infection were first reported by Ackermann (1951). He administered to mice sublethal doses of sodium fluoroacetate, which blocks the tricarboxylic acid cycle and causes citric acid to accumulate in the lungs. Under these conditions, the propagation of type A influenza virus, artificially introduced into the mice by nasal insufflation, was markedly inhibited. More recently experiments have been conducted (Berry and Mitchell, 1953a and b) which show that mice are more susceptible to bacterial infection when the citric acid cycle is partially blocked. The administration of three inhibitors
- Published
- 1954
25. The relation of the tricarboxylic acid cycle to bacterial infection. III. Comparison of survival time of mice infected with different pathogens and given Krebs cycle inhibitors and intermediates
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Penelope Merritt, Berry Lj, and Mitchell Rb
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Salmonella ,Citric Acid Cycle ,Berry ,Metabolism ,Bacterial Infections ,Biology ,biology.organism_classification ,medicine.disease_cause ,Infections ,Sodium salt ,Microbiology ,Citric acid cycle ,chemistry.chemical_compound ,Mice ,Infectious Diseases ,Biochemistry ,chemistry ,Sodium citrate ,medicine ,Immunology and Allergy ,Animals ,Sodium succinate ,Citrates ,Bacteria - Abstract
The survival time of infected mice is dramatically reduced by certain substances capable of interfering with, or altering, the "normal" functioning of the Krebs cycle (Berry and Mitchell 1953a, b, and c). A relationship of this type was postulated (Berry and Mitchell, 1953d) in an effort to account for the increased susceptibility to typhoid in mice exposed to simulated high altitude, since this greater susceptibility could not be explained by any demonstrable change in cellular defense or humoral defense. This postulate led to the experiments in which the Krebs cycle was modified by injecting, at appropriate intervals, sublethal amounts of one of three inhibitors or one of two intermediates (Berry and Mitchell, 1953b and c). The sodium salts of malonic, fluoroacetic, and arsenious acids were used as inhibitors, and sodium citrate and sodium succinate were used as intermediates. Infections with a standardized suspension of Salmonella typhimurium were artificially induced by injecting the bacteria into the abdominal cavity of the mice. Control animals similarly infected were administered a volume of isotonic sodium chloride solution equal to the volume in which the inhibitor or intermediate was carried. Thus, the one variable be
- Published
- 1954
26. Pediatric otolaryngology clinic. Congenital/infantile fibrosarcoma in a 3-week-old boy.
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Costa DJ, Mitchell RB, and Brink DS
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- 2008
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27. In reference to orbital sequelae of rhinosinusitis after cochlear implantation in children.
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Hoffman RA, Parisier SC, Roland JT Jr., Rudnick EF, Sismanis A, Dodson KM, Chu MW, and Mitchell RB
- Published
- 2007
28. Clinical practice guideline: tonsillectomy in children.
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Baugh RF, Archer SM, Mitchell RB, Rosenfeld RM, Amin R, Burns JJ, Darrow DH, Giordano T, Litman RS, Li KK, Mannix ME, Schwartz RH, Setzen G, Wald ER, Wall E, Sandberg G, Patel MM, and American Academy of Otolaryngology-Head and Neck Surgery Foundation
- Published
- 2011
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29. Information from your family doctor. Vibrio vulnificus infection: what you should know.
- Author
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Bross MH, Soch K, Morales R, and Mitchell RB
- Published
- 2007
30. Introduction.
- Author
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Mitchell RB and Pereira KD
- Published
- 2009
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31. Bedsharing sleep characteristics in children with mild sleep-disordered breathing.
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Ibrahim S, Ievers-Landis CE, Taylor HG, Tapia IE, Williamson AA, Cole MC, Gurbani N, Chervin RD, Hassan F, Mitchell RB, Naqvi K, Baldassari C, Edlund W, Wang R, Wei Z, Li D, Redline S, and Rosen CL
- Abstract
Study Objectives: Examine sleep patterns in children with sleep-disordered breathing (SDB) who habitually bedshare., Methods: We evaluated associations of bedsharing with parent-reported (n=457) and actigraphy-based (n=258) sleep patterns in a diverse child sample (mean age 6.6±2.3 years, range 3.0-12.9) with mild SDB using baseline data from the Pediatric Adenotonsillectomy Trial for Snoring. Multivariable linear regressions examined associations between sleep patterns and bedsharing, adjusting for sociodemographic, child, and parent/environmental factors. Moderation effects were investigated using interaction terms. Analyses were stratified by age, categorizing children as younger (<6) and older (≥6) years., Results: Bedsharing rates were 38%, with higher rates in younger (48%) vs. older (30%) children (p<0.001). In adjusted models, bedsharing was associated with about 30 minutes shorter actigraphy-derived nocturnal sleep duration (p=0.005) and parent-reported later sleep midpoint (p< 0.005) in younger children. In older children, associations of bedsharing with shorter parent-reported sleep duration were more pronounced in children with greater SDB symptom burden (p=0.02), and in children with higher ratings of anxiety (p=0.048) and depressive symptoms (p=0.02)., Conclusions: In children with mild SDB, bedsharing is associated with shorter sleep duration and later sleep timing in younger children. In older children, these relationships were modified by child factors, including SDB symptom burden and internalizing symptoms. These findings suggest that whereas age and parenting factors may play a greater role in the younger group, SDB and internalizing symptoms may play more of a role in older children who bedshare, suggesting the need to address co-occurring medical and emotional problems in children with SDB., Clinical Trial Registration: Registry: ClinicalTrials.gov; Name: Pediatric Adenotonsillectomy for Snoring (PATS); Identifier: NCT02562040., (© 2024 American Academy of Sleep Medicine.)
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- 2024
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32. Responses of Wheat ( Triticum aestivum ) Constitutively Expressing Four Different Monolignol Biosynthetic Genes to Fusarium Head Blight Caused by Fusarium graminearum .
- Author
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Funnell-Harris DL, Sattler SE, Dill-Macky R, Wegulo SN, Duray ZT, O'Neill PM, Gries T, Masterson SD, Graybosch RA, and Mitchell RB
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- Trichothecenes metabolism, Plants, Genetically Modified microbiology, Disease Resistance genetics, Methyltransferases genetics, Methyltransferases metabolism, Plant Proteins genetics, Plant Proteins metabolism, Sorghum microbiology, Sorghum genetics, Coenzyme A Ligases genetics, Coenzyme A Ligases metabolism, Gene Expression Regulation, Plant, Fusarium genetics, Fusarium physiology, Triticum microbiology, Triticum genetics, Plant Diseases microbiology, Plant Diseases immunology
- Abstract
The Fusarium head blight (FHB) pathogen Fusarium graminearum produces the trichothecene mycotoxin deoxynivalenol and reduces wheat yield and grain quality. Spring wheat ( Triticum aestivum ) genotype CB037 was transformed with constitutive expression (CE) constructs containing sorghum ( Sorghum bicolor ) genes encoding monolignol biosynthetic enzymes caffeoyl coenzyme A (CoA) 3- O -methyltransferase ( SbCCoAOMT ), 4-coumarate-CoA ligase ( Sb4CL ), or coumaroyl shikimate 3-hydroxylase ( SbC3'H ) or monolignol pathway transcriptional activator SbMyb60 . Spring wheats were screened for type I (resistance to initial infection, using spray inoculations) and type II (resistance to spread within the spike, using single-floret inoculations) resistances in the field (spray) and greenhouse (spray and single floret). Following field inoculations, disease index, percentage of Fusarium -damaged kernels (FDK), and deoxynivalenol measurements of CE plants were similar to or greater than those of CB037. For greenhouse inoculations, the area under the disease progress curve (AUDPC) and FDK were determined. Following screens, focus was placed on two each of SbC3'H and SbCCoAOMT CE lines because of trends toward a decreased AUDPC and FDK observed following single-floret inoculations. These four lines were as susceptible as CB037 following spray inoculations. However, single-floret inoculations showed that these CE lines had a significantly reduced AUDPC ( P < 0.01) and FDK ( P ≤ 0.02) compared with CB037, indicating improved type II resistance. None of these CE lines had increased acid detergent lignin compared with CB037, indicating that lignin concentration may not be a major factor in FHB resistance. The SbC3'H and SbCCoAOMT CE lines are valuable for investigating phenylpropanoid-based resistance to FHB., Competing Interests: The author(s) declare no conflict of interest.
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- 2024
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33. Perioperative Delta Weight and Pediatric Obstructive Sleep Apnea Resolution after Adenotonsillectomy.
- Author
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Dang QL, Ulualp S, Mitchell RB, and Johnson RF
- Subjects
- Humans, Male, Female, Child, Retrospective Studies, Child, Preschool, Adolescent, Body Mass Index, Treatment Outcome, Weight Gain, Sleep Apnea, Obstructive surgery, Tonsillectomy, Adenoidectomy, Polysomnography
- Abstract
Objective(s): The first-line treatment for pediatric obstructive sleep apnea (OSA) is adenotonsillectomy. Post-operative weight gain is a well-documented phenomenon. We hypothesized that higher peri-adenotonsillectomy delta weight correlates with lower rates of OSA resolution in pediatric patients., Methods: This was a retrospective cohort study consisting of 250 patients from 2 to 17 years of age at a tertiary academic medical center between January 2021 and December 2022. Polysomnography results and body mass index (BMI) changes were collected through the electronic health record. Univariate and multivariate logistical regression analyses were performed, adjusting for confounding factors., Results: Perioperative delta weight and pre-operative baseline AHI values were significant predictors of residual OSA. For every 1-kilogram gain in weight, the odds of residual OSA (AHI >5) increase by 6.0% (OR = 1.06, 95% CI = 1.02-1.10, p < 0.002), and the odds of residual severe OSA (AHI > 10) increase by 8% (OR = 1.08, 95% CI = 1.04-1.12, p < 0.001). Increased AHI, Black/African American race, and male sex were also factors associated with incomplete OSA resolution., Conclusions: Increased peri-adenotonsillectomy delta weight is associated with higher rates of residual OSA in children. Patients and families should be counseled about appropriate weight loss and control methods before adenotonsillectomy., Level of Evidence: IV Laryngoscope, 134:4141-4147, 2024., (© 2024 The American Laryngological, Rhinological and Otological Society, Inc.)
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- 2024
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34. Postoperative Respiratory Complications After Adenotonsillectomy in Children With High-Risk Obstructive Sleep Apnea.
- Author
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Kou YF, Korpon JR, Dabbous H, Johnson RF, Mitchell RB, Wani A, and Chorney SR
- Abstract
Objective: Identify patient characteristics and polysomnogram (PSG) parameters associated with postoperative respiratory complications after adenotonsillectomy (AT) among children with high-risk obstructive sleep apnea (OSA)., Study Design: Case series with chart review., Setting: Tertiary care children's hospital., Methods: Pediatric patients (<18 years) with high-risk OSA (any 1 of: apnea-hypopnea index [AHI] >30, O
2 nadir <80% and peak CO2 >60 mm Hg) on overnight PSG from 2019 to 2021 were included. Primary outcomes were major respiratory intervention during the postoperative admission, prolonged hospitalization, and intensive care unit (ICU) stay., Results: A total of 307 patients met inclusion criteria. Median age was 6.5 years and 63% were male. Twenty-five (8.1%) required major respiratory intervention and 29 (9.7%) required ICU admission after AT. Major interventions and ICU admissions were significantly associated with neuromuscular disease (P < .01), higher obstructive apnea-hypopnea index (oAHI), higher CO2 peak, and lower O2 nadir. Prolonged admission had similar findings except oAHI was not significantly associated. Younger children were significant more likely to require ICU admission or prolonged admission., Conclusion: Increased oAHI and worsening O2 and CO2 parameters on preoperative PSG were associated with postoperative respiratory complications in children with high-risk OSA. Children with neuromuscular disease and age 0 to 2 had higher risk of ICU stay and prolonged hospitalization. Clinicians should recognize the importance of parameters beyond oAHI when anticipating postoperative monitoring., (© 2024 The Author(s). Otolaryngology–Head and Neck Surgery published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology–Head and Neck Surgery Foundation.)- Published
- 2024
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35. Weight Gain After Adenotonsillectomy in Children With Mild Obstructive Sleep-Disordered Breathing: Exploratory Analysis of the PATS Randomized Clinical Trial.
- Author
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Kirkham EM, Ishman S, Baldassari CM, Mitchell RB, Naqvi SK, Tapia IE, Elden LM, Hassan F, Ibrahim S, Ross K, Cen M, Wang R, Redline S, and Chervin RD
- Abstract
Importance: It is unknown whether adenotonsillectomy causes undesirable weight gain in children with mild obstructive sleep-disordered breathing (oSDB)., Objective: To compare changes in anthropometric measures in children with mild oSDB treated with adenotonsillectomy vs watchful waiting., Design, Setting, and Participants: This was an exploratory analysis of the Pediatric Adenotonsillectomy Trial for Snoring (PATS) randomized clinical trial of adenotonsillectomy vs watchful waiting for mild oSDB (snoring with obstructive apnea-hypopnea index of <3 events/hour) that took place at 7 pediatric tertiary care centers across the US and included 458 children aged 3.0 to 12.9 years with mild oSDB. Participants were recruited from June 29, 2016, to February 1, 2021. Anthropomorphic measures taken at baseline and 12 months after randomization were standardized for age and sex, including each participant's percentage of the 95th body mass index percentile (%BMIp95). Data analyses were performed from March 15, 2023, to April 1, 2024., Intervention: Early adenotonsillectomy (eAT) vs watchful waiting with supportive care (WWSC)., Main Outcomes and Measures: Twelve-month change in %BMIp95 from baseline and undesirable weight gain (defined as any weight gain in a child who already had overweight or obesity or an increase from baseline normal weight/underweight to overweight/obesity) at follow-up assessment., Results: The study analysis included 375 children (mean [SD] age, 6.1 [2.3] years; 188 [50.2%] females), of whom 143 (38%) had overweight or obesity at baseline. At 12 months, children in the eAT group experienced a 1.25-point increase in %BMIp95 compared with a 0.59-point increase in the WWSC group (mean difference, 0.93; 95% CI, -0.39 to 2.25). Undesirable weight gain was also similar between the eAT (n = 120; 32%) and WWSC (n = 101; 27%) groups (mean difference, 4%; 95% CI, 5% to 14%)., Conclusions and Relevance: The findings of this exploratory analysis of the PATS trial indicate that adenotonsillectomy was not independently associated with an increased risk of undesirable weight gain in children with mild oSDB. However, one-third of the children gained undesirable weight during the study, which suggests that there is an opportunity to address healthy weight management during the evaluation and treatment of children with mild oSDB., Trial Registration: ClinicalTrials.gov Identifier: NCT02562040.
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- 2024
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36. Pediatric obstructive sleep apnea: a prospective observational study of respiratory events in the immediate recovery period after adenotonsillectomy.
- Author
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Efune PN, Pinales P, Park J, Poppino KF, Mitchell RB, and Szmuk P
- Subjects
- Humans, Female, Male, Prospective Studies, Child, Child, Preschool, Infant, Adolescent, Risk Factors, Cohort Studies, Respiratory Insufficiency etiology, Respiratory Insufficiency epidemiology, Anesthesia Recovery Period, Airway Obstruction etiology, Airway Obstruction epidemiology, Incidence, Tonsillectomy adverse effects, Sleep Apnea, Obstructive epidemiology, Adenoidectomy adverse effects, Postoperative Complications epidemiology, Postoperative Complications etiology
- Abstract
Background: Adenotonsillectomy is often curative for pediatric obstructive sleep apnea, yet children remain at high risk of respiratory complications in the postoperative period. We sought to determine the incidence and risk factors for respiratory depression and airway obstruction, as well as clinically apparent respiratory events in the post-anesthesia care unit (PACU) in high-risk children after adenotonsillectomy., Methods: In this prospective cohort study, we enrolled 60 high-risk children having adenotonsillectomy. Our primary outcome was respiratory depression and airway obstruction in the PACU measured using a noninvasive respiratory volume monitor (RVM) and defined by episodes of predicted minute ventilation less than 40% for at least 2 min. We measured clinically apparent respiratory events using continuous observation by trained study staff., Results: The median (range) age of our sample was 4 years (1, 16) and 27 (45%) were female. Black and Hispanic race children comprised 80% (n = 48) of our cohort. Thirty-nine (65%) had at least one episode of PACU respiratory depression or airway obstruction measured using the RVM, while only 21 (35%) had clinically apparent respiratory events. Poisson regression demonstrated the following associations with an increase in episodes of respiratory depression and airway obstruction: BMI Z-score less than -1 (estimate 3.91; [95%CI 1.49-10.23]), BMI Z-score 1-2 (estimate 2.04; [1.20-3.48]), and two or more comorbidities (estimate 1.96; [1.11-3.46])., Conclusions: Respiratory volume monitoring in the immediate postoperative period after pediatric high-risk adenotonsillectomy identifies impaired ventilation more frequently than is clinically apparent., (Copyright © 2024 Société française d'anesthésie et de réanimation (Sfar). All rights reserved.)
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- 2024
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37. Genomic prediction of regional-scale performance in switchgrass (Panicum virgatum) by accounting for genotype-by-environment variation and yield surrogate traits.
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Tilhou NW, Bonnette J, Boe AR, Fay PA, Fritschi FB, Mitchell RB, Rouquette FM Jr, Wu Y, Jastrow JD, Ricketts M, Maher SD, Juenger TE, and Lowry DB
- Abstract
Switchgrass is a potential crop for bioenergy or carbon capture schemes, but further yield improvements through selective breeding are needed to encourage commercialization. To identify promising switchgrass germplasm for future breeding efforts, we conducted multi-site and multi-trait genomic prediction with a diversity panel of 630 genotypes from 4 switchgrass subpopulations (Gulf, Midwest, Coastal, and Texas), which were measured for spaced plant biomass yield across 10 sites. Our study focused on the use of genomic prediction to share information among traits and environments. Specifically, we evaluated the predictive ability of cross-validation (CV) schemes using only genetic data and the training set, (cross validation 1: CV1), a subset of the sites (cross validation 2: CV2), and/or with two yield surrogates (flowering time and fall plant height). We found that genotype-by-environment interactions were largely due to the north-south distribution of sites. The genetic correlations between yield surrogates and biomass yield were generally positive (mean height r=0.85; mean flowering time r=0.45) and did not vary due to subpopulation or growing region (North, Middle, South). Genomic prediction models had cross-validation predictive abilities of -0.02 for individuals using only genetic data (CV1) but 0.55, 0.69, 0.76, 0.81, and 0.84 for individuals with biomass performance data from one, two, three, four and five sites included in the training data (CV2), respectively. To simulate a resource-limited breeding program, we determined the predictive ability of models provided with: one site observation of flowering time (0.39), one site observation of flowering time and fall height (0.51), one site observation of fall height (0.52), one site observation of biomass (0.55), and five site observations of biomass yield (0.84). The ability to share information at a regional scale is very encouraging but further research is required to accurately translate spaced plant biomass to commercial-scale sward biomass performance., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Genetics Society of America.)
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- 2024
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38. An Unusual Parotid Mass in a 14-Year-Old Female.
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Leavitt T, Shah AT, Singh V, Mitchell RB, and Liu CC
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- Humans, Female, Adolescent, Parotid Gland pathology, Parotid Gland diagnostic imaging, Parotid Diseases pathology, Parotid Neoplasms pathology
- Abstract
Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2024
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39. The effect of adenotonsillectomy on asthma symptoms in the Pediatric Adenotonsillectomy Trial for Snoring (PATS).
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Gueye-Ndiaye S, Tully M, Tsou PY, Amin R, Baldassari CM, Chervin RD, Cielo CM, George A, Hassan F, Ibrahim S, Ishman SL, Kirkham EM, Mitchell RB, Naqvi K, Prero M, Rueschman M, Tapia IE, Sendon C, Wang R, Redline S, and Ross K
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- Humans, Child, Female, Male, Treatment Outcome, Child, Preschool, Adolescent, Tonsillectomy methods, Adenoidectomy, Snoring surgery, Asthma surgery
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- 2024
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40. Influence of Economic Connectedness on Pediatric Obstructive Sleep Apnea Severity and Adenotonsillectomy Outcomes.
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Kim J, Nwaogu C, Mitchell RB, and Johnson RF
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Objective: To examine the influence of economic connectedness (EC), a measure of social capital, on obstructive sleep apnea (OSA) severity and adenotonsillectomy outcomes in children., Study Design: Retrospective study., Setting: Single tertiary medical center., Methods: The study population included 286 children who were referred for full-night polysomnography for OSA and underwent adenotonsillectomy. The primary outcome was the relationship between EC and the presence of severe OSA, and secondary outcomes included postoperative emergency room visits and residual OSA after adenotonsillectomy. Linear regression, Kruskal-Wallis test, Pearson's χ
2 test, and multiple logistic regression were used for categorical and continuous data as appropriate., Results: In this population, the median age was 9.0 (interquartile range [IQR] = 6.9-11.7) and 144 (50.3%) were male. The majority were white (176, 62.0%), black (60, 21.1%), and/or of Hispanic ethnicity (173, 60.9%). The median EC of this population was 0.64 (IQR = 0.53-0.86). Higher EC was associated with decreased odds of having severe OSA (odds ratio: 0.17, 95% confidence interval = 0.05-0.61). However, EC was not associated with either postoperative emergency room visits or residual OSA., Conclusion: EC was significantly associated with severe OSA (ie, apnea-hypopnea index ≥ 10) but not with postoperative emergency room visits or residual OSA after adenotonsillectomy. Further research is needed to understand the effects of various social capital measures on pediatric OSA and adenotonsillectomy outcomes., (© 2024 American Academy of Otolaryngology–Head and Neck Surgery Foundation.)- Published
- 2024
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41. Skip Polysomnography Before Adenotonsillectomy for Snoring?-Reply.
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Mitchell RB, Baldassari CM, and Redline S
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- Humans, Preoperative Care methods, Tonsillectomy methods, Adenoidectomy, Snoring surgery, Polysomnography
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- 2024
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42. A Case of Unilateral Simultaneous Preauricular Sinus and Postauricular Sinus in an Adult.
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Ko SY, Mitchell RB, Lee KH, and Cho HS
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Preauricular sinuses are relatively common congenital anomalies of the soft tissues of the ear. By strict definition, when they connect 2 separate spaces, they are referred to as a preauricular fistula. This clinical entity was first described by Heusinger in 1864. Most preauricular sinuses have a small opening located anterior to the root of the helix. In rare cases, they are found posterior to the tragus, near the crus of the helix, and the ear lobule. The latter is the variant type preauricular sinus, also referred to as the "postauricular sinus," as the sinus tract opens posterior to the auricle. Recurrent infections or persistent discharge may require surgical excision which is ideally performed at a time when there is no inflammation. There are a variety of techniques for excision. Regardless of the surgical approach taken, it is of critical importance to remove the subcutaneous sac completely. We present a very rare case involving the co-occurrence of a preauricular sinus and postauricular sinus in a 33-year-old woman. We report this case with a review of the literature., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2024
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43. Obstructive sleep apnea in children with cystic fibrosis on highly effective modulator therapy.
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Shakkottai A, Kim S, and Mitchell RB
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Introduction: Obstructive sleep apnea (OSA) is common in children with cystic fibrosis (CF). Highly effective modulator therapies (HEMT) have led to improved sinopulmonary disease, but whether this translates to a lower frequency of OSA is unknown., Methods: We conducted a single center retrospective review of polysomnographic (PSG) data from 2012 to 2023 in patients aged 0-18 years with CF to assess frequency of OSA. Participants were classified based on HEMT status. Logistic regression was used to quantify the association between HEMT and OSA with p < .05 considered significant., Results: Forty-nine children underwent PSG during the study period. Ten percent were of non-White race and 24% were of Hispanic ethnicity. Twenty-one children (43%) were on HEMT. These children were older than those not on modulators (11.6 vs. 6.4 years; p = .0001) but no different with respect to gender, race, nutritional status, or lung function. Twenty-eight (57%) children had OSA. Odds of having OSA were higher in the HEMT group (odds ratio [OR] = 4.3; 95% confidence interval [CI]: 1.2-14.9; p = .02). Tonsillar hypertrophy was associated with an increased odds of having OSA independent of modulator status (OR: 6.6; 95% CI: 1.2-37.9; p = .03)., Conclusions: OSA is frequently diagnosed in the post-HEMT era in this large, racially diverse group of children with CF. Children on HEMT were older and more likely to have OSA as compared to those not on modulators but similar in nutritional status, lung function, and presence of upper airway pathology. Prospective studies are needed to further clarify the relationship between HEMT and OSA in children with CF., (© 2024 The Authors. Pediatric Pulmonology published by Wiley Periodicals LLC.)
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- 2024
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44. Chronic Granulomatous Disease of the Upper Airway.
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Bradshaw B, Jaffal H, Wysocki CA, Grover LA, Mitchell RB, Ulualp S, Shah GB, and Chorney SR
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- Humans, Granulomatous Disease, Chronic complications, Granulomatous Disease, Chronic diagnosis
- Abstract
Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2024
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45. Neighborhood Disadvantage, Quality of Life, and Symptom Burden in Children with Mild Sleep-disordered Breathing.
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Gueye-Ndiaye S, Tully M, Amin R, Baldassari CM, Chervin RD, Cole M, Ibrahim S, Kirkham EM, Mitchell RB, Naqvi K, Ross K, Rueschman M, Tapia IE, Williamson AA, Wei Z, Rosen CL, Wang R, and Redline S
- Subjects
- Child, Humans, Snoring epidemiology, Snoring complications, Quality of Life, Symptom Burden, Cross-Sectional Studies, Neighborhood Characteristics, Surveys and Questionnaires, Sleep Apnea Syndromes, Sleep Apnea, Obstructive complications, Asthma epidemiology, Asthma complications
- Abstract
Rationale: Neighborhood disadvantage (ND) has been associated with sleep-disordered breathing (SDB) in children. However, the association between ND and SDB symptom burden and quality of life (QOL) has not yet been studied. Objectives: To evaluate associations between ND with SDB symptom burden and QOL. Methods: Cross-sectional analyses were performed on 453 children, ages 3-12.9 years, with mild SDB (habitual snoring and apnea-hypopnea index < 3/h) enrolled in the PATS (Pediatric Adenotonsillectomy Trial for Snoring) multicenter study. The primary exposure, neighborhood disadvantage, was characterized by the Child Opportunity Index (COI) (range, 0-100), in which lower values (specifically COI ⩽ 40) signify less advantageous neighborhoods. The primary outcomes were QOL assessed by the obstructive sleep apnea (OSA)-18 questionnaire (range, 18-126) and SDB symptom burden assessed by the Pediatric Sleep Questionnaire-Sleep-related Breathing Disorder (PSQ-SRBD) scale (range, 0-1). The primary model was adjusted for age, sex, race, ethnicity, maternal education, recruitment site, and season. In addition, we explored the role of body mass index (BMI) percentile, environmental tobacco smoke (ETS), and asthma in these associations. Results: The sample included 453 children (16% Hispanic, 26% Black or African American, 52% White, and 6% other). COI mean (standard deviation [SD]) was 50.3 (29.4), and 37% ( n = 169) of participants lived in disadvantaged neighborhoods. Poor SDB-related QOL (OSA-18 ⩾ 60) and high symptom burden (PSQ-SRBD ⩾ 0.33) were found in 30% ( n = 134) and 75% ( n = 341) of participants, respectively. In adjusted models, a COI increase by 1 SD (i.e., more advantageous neighborhood) was associated with an improvement in OSA-18 score by 2.5 points (95% confidence interval [CI], -4.34 to -0.62) and in PSQ-SRBD score by 0.03 points (95% CI, -0.05 to -0.01). These associations remained significant after adjusting for BMI percentile, ETS, or asthma; however, associations between COI and SDB-related QOL attenuated by 23% and 10% after adjusting for ETS or asthma, respectively. Conclusions: Neighborhood disadvantage was associated with poorer SDB-related QOL and greater SDB symptoms. Associations were partially attenuated after considering the effects of ETS or asthma. The findings support efforts to reduce ETS and neighborhood-level asthma-related risk factors and identify other neighborhood-level factors that contribute to SDB symptom burden as strategies to address sleep-health disparities.Clinical trial registered with www.clinicaltrials.gov (NCT02562040).
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- 2024
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46. Management of Persistent, Post-adenotonsillectomy Obstructive Sleep Apnea in Children: An Official American Thoracic Society Clinical Practice Guideline.
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Ehsan Z, Ishman SL, Soghier I, Almeida FR, Boudewyns A, Camacho M, Carno MA, Coppelson K, Ersu RH, Ho ATN, Kaditis AG, Machado AJ Jr, Mitchell RB, Resnick CM, Swaggart K, and Verhulst S
- Subjects
- Child, Humans, Adenoidectomy, Sleep, Societies, United States, Systematic Reviews as Topic, Sleep Apnea, Obstructive surgery, Tonsillectomy
- Abstract
Background: Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder. Although adenotonsillectomy is first-line management for pediatric OSA, up to 40% of children may have persistent OSA. This document provides an evidence-based clinical practice guideline on the management of children with persistent OSA. The target audience is clinicians, including physicians, dentists, and allied health professionals, caring for children with OSA. Methods: A multidisciplinary international panel of experts was convened to determine key unanswered questions regarding the management of persistent pediatric OSA. We conducted a systematic review of the relevant literature. The Grading of Recommendations, Assessment, Development, and Evaluation approach was used to rate the quality of evidence and the strength of the clinical recommendations. The panel members considered the strength of each recommendation and evaluated the benefits and risks of applying the intervention. In formulating the recommendations, the panel considered patient and caregiver values, the cost of care, and feasibility. Results: Recommendations were developed for six management options for persistent OSA. Conclusions: The panel developed recommendations for the management of persistent pediatric OSA based on limited evidence and expert opinion. Important areas for future research were identified for each recommendation.
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- 2024
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47. Clinical Characteristics of Primary Snoring vs Mild Obstructive Sleep Apnea in Children: Analysis of the Pediatric Adenotonsillectomy for Snoring (PATS) Randomized Clinical Trial.
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Mitchell RB, Cook K, Garetz S, Tapia IE, Elden LM, Kirkham EM, Shah J, Otteson T, Zopf D, Amin R, Ishman S, Baldassari CM, Chervin RD, Hassan F, Naqvi K, Wang R, and Redline S
- Subjects
- Child, Female, Humans, Male, Adenoidectomy, Obesity, Single-Blind Method, Snoring etiology, Snoring surgery, Child, Preschool, Sleep Apnea, Obstructive diagnosis, Sleep Apnea, Obstructive surgery, Tonsillectomy
- Abstract
Importance: It is unknown whether children with primary snoring and children with mild obstructive sleep apnea (OSA) represent populations with substantially different clinical characteristics. Nonetheless, an obstructive apnea-hypopnea index (AHI) of 1 or greater is often used to define OSA and plan for adenotonsillectomy (AT)., Objective: To assess whether a combination of clinical characteristics differentiates children with primary snoring from children with mild OSA., Design, Setting, and Participants: Baseline data from the Pediatric Adenotonsillectomy Trial for Snoring (PATS) study, a multicenter, single-blind, randomized clinical trial conducted at 6 academic sleep centers from June 2016 to January 2021, were analyzed. Children aged 3.0 to 12.9 years with polysomnography-diagnosed (AHI <3) mild obstructive sleep-disordered breathing who were considered candidates for AT were included. Data analysis was performed from July 2022 to October 2023., Main Outcomes and Measures: Logistic regression models were fitted to identify which demographic, clinical, and caregiver reports distinguished children with primary snoring (AHI <1; 311 patients [67.8%]) from children with mild OSA (AHI 1-3; 148 patients [32.2%])., Results: A total of 459 children were included. The median (IQR) age was 6.0 (4.0-7.5) years, 230 (50.1%) were female, and 88 (19.2%) had obesity. A total of 121 (26.4%) were Black, 75 (16.4%) were Hispanic, 236 (51.5%) were White, and 26 (5.7%) were other race and ethnicity. Black race (odds ratio [OR], 2.08; 95% CI, 1.32-3.30), obesity (OR, 1.80; 95% CI, 1.12-2.91), and high urinary cotinine levels (>5 µg/L) (OR, 1.88; 95% CI, 1.15-3.06) were associated with greater odds of mild OSA rather than primary snoring. Other demographic characteristics, clinical examination findings, and questionnaire reports did not distinguish between primary snoring and mild OSA. A weighted combination of the statistically significant clinical predictors had limited ability to differentiate children with mild OSA from children with primary snoring., Conclusions and Relevance: In this analysis of baseline data from the PATS randomized clinical trial, primary snoring and mild OSA were difficult to distinguish without polysomnography. Mild OSA vs snoring alone did not identify a clinical group of children who may stand to benefit from AT for obstructive sleep-disordered breathing., Trial Registration: ClinicalTrials.gov Identifier: NCT02562040.
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- 2024
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48. Adolescent Tracheostomy for COVID-19 Respiratory Failure.
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Leavitt T, Brooks RL, Mitchell RB, Johnson RF, and Chorney SR
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- Humans, Adolescent, Child, Tracheostomy, Infectious Disease Transmission, Patient-to-Professional, Personal Protective Equipment, COVID-19, Respiratory Insufficiency etiology, Respiratory Insufficiency therapy
- Abstract
Pediatric tracheostomy for COVID-19 infections is uncommon and requires age-appropriate adaptations. This case adds to a limited body of literature related to tracheostomy placement and management in an adolescent. Thoughtful planning and communication by a dedicated tracheostomy team was crucial in obtaining a successful outcome., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2024
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49. Adenotonsillectomy for Snoring and Mild Sleep Apnea in Children: A Randomized Clinical Trial.
- Author
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Redline S, Cook K, Chervin RD, Ishman S, Baldassari CM, Mitchell RB, Tapia IE, Amin R, Hassan F, Ibrahim S, Ross K, Elden LM, Kirkham EM, Zopf D, Shah J, Otteson T, Naqvi K, Owens J, Young L, Furth S, Connolly H, Clark CAC, Bakker JP, Garetz S, Radcliffe J, Taylor HG, Rosen CL, and Wang R
- Subjects
- Child, Female, Humans, Polysomnography, Quality of Life, Sleep Apnea, Obstructive diagnosis, Sleep Apnea, Obstructive etiology, Sleep Apnea, Obstructive surgery, Male, Child, Preschool, Treatment Outcome, Follow-Up Studies, Sleep Apnea Syndromes diagnosis, Sleep Apnea Syndromes etiology, Sleep Apnea Syndromes surgery, Snoring etiology, Snoring surgery, Tonsillectomy adverse effects, Tonsillectomy methods, Adenoidectomy adverse effects, Adenoidectomy methods, Watchful Waiting
- Abstract
Importance: The utility of adenotonsillectomy in children who have habitual snoring without frequent obstructive breathing events (mild sleep-disordered breathing [SDB]) is unknown., Objectives: To evaluate early adenotonsillectomy compared with watchful waiting and supportive care (watchful waiting) on neurodevelopmental, behavioral, health, and polysomnographic outcomes in children with mild SDB., Design, Setting, and Participants: Randomized clinical trial enrolling 459 children aged 3 to 12.9 years with snoring and an obstructive apnea-hypopnea index (AHI) less than 3 enrolled at 7 US academic sleep centers from June 29, 2016, to February 1, 2021, and followed up for 12 months., Intervention: Participants were randomized 1:1 to either early adenotonsillectomy (n = 231) or watchful waiting (n = 228)., Main Outcomes and Measures: The 2 primary outcomes were changes from baseline to 12 months for caregiver-reported Behavior Rating Inventory of Executive Function (BRIEF) Global Executive Composite (GEC) T score, a measure of executive function; and a computerized test of attention, the Go/No-go (GNG) test d-prime signal detection score, reflecting the probability of response to target vs nontarget stimuli. Twenty-two secondary outcomes included 12-month changes in neurodevelopmental, behavioral, quality of life, sleep, and health outcomes., Results: Of the 458 participants in the analyzed sample (231 adenotonsillectomy and 237 watchful waiting; mean age, 6.1 years; 230 female [50%]; 123 Black/African American [26.9%]; 75 Hispanic [16.3%]; median AHI, 0.5 [IQR, 0.2-1.1]), 394 children (86%) completed 12-month follow-up visits. There were no statistically significant differences in change from baseline between the 2 groups in executive function (BRIEF GEC T-scores: -3.1 for adenotonsillectomy vs -1.9 for watchful waiting; difference, -0.96 [95% CI, -2.66 to 0.74]) or attention (GNG d-prime scores: 0.2 for adenotonsillectomy vs 0.1 for watchful waiting; difference, 0.05 [95% CI, -0.18 to 0.27]) at 12 months. Behavioral problems, sleepiness, symptoms, and quality of life each improved more with adenotonsillectomy than with watchful waiting. Adenotonsillectomy was associated with a greater 12-month decline in systolic and diastolic blood pressure percentile levels (difference in changes, -9.02 [97% CI, -15.49 to -2.54] and -6.52 [97% CI, -11.59 to -1.45], respectively) and less progression of the AHI to greater than 3 events/h (1.3% of children in the adenotonsillectomy group compared with 13.2% in the watchful waiting group; difference, -11.2% [97% CI, -17.5% to -4.9%]). Six children (2.7%) experienced a serious adverse event associated with adenotonsillectomy., Conclusions: In children with mild SDB, adenotonsillectomy, compared with watchful waiting, did not significantly improve executive function or attention at 12 months. However, children with adenotonsillectomy had improved secondary outcomes, including behavior, symptoms, and quality of life and decreased blood pressure, at 12-month follow-up., Trial Registration: ClinicalTrials.gov Identifier: NCT02562040.
- Published
- 2023
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50. Intraoperative Bleeding in Pediatric Otolaryngology: Trends and Future Perspectives.
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Maniaci A, Cocuzza S, Mitchell RB, La Mantia I, and La Via L
- Abstract
A significant challenge that ENT surgeons often encounter is managing intraoperative bleeding, a task that requires precision, adept judgment, and a thorough knowledge of the latest techniques and procedures [...].
- Published
- 2023
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- View/download PDF
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