35 results on '"M. Bridget Zimmerman"'
Search Results
2. Rural residence is related to shorter survival in epithelial ovarian cancer patients
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Susan K. Lutgendorf, Mary E. Charlton, Michael J. Goodheart, Edgardo Ramirez, Sharaf Zia, Mark C. Valentine, Andrew Schrepf, M. Bridget Zimmerman, Anil K. Sood, and Premal H. Thaker
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Adult ,Rural Population ,Carcinoma, Ovarian Epithelial ,Rurality ,Health care ,medicine ,Humans ,Healthcare Disparities ,Aged ,Proportional Hazards Models ,Aged, 80 and over ,Ovarian Neoplasms ,business.industry ,Obstetrics and Gynecology ,Cancer ,Middle Aged ,medicine.disease ,Health equity ,Educational attainment ,Oncology ,Censoring (clinical trials) ,Educational Status ,Female ,Residence ,Ovarian cancer ,business ,Demography - Abstract
Objective Rural residence has been related to health disparities and greater mortality risk in cancer patients, including gynecologic cancer patients. Lower survival rates for rural cancer survivors have been attributed to limited access to specialized healthcare, including surgery. Here, we examined whether a rural/urban survival gap existed in ovarian cancer patients receiving surgery at tertiary-care facilities, and potential causes for this gap, including educational attainment. Methods Rural and urban patients with high grade invasive ovarian cancer (n = 342) seeking treatment at two midwestern tertiary-care university hospitals were recruited pre-surgery and followed until death or censoring date. Rural/urban residence was categorized using the USDA Rural-Urban Continuum Codes. Stratified Cox proportional hazards regression analyses, with clinical site as strata, adjusting for clinical and demographic covariates, were used to examine the effect of rurality on survival. Results Despite specialized surgical care, rural cancer survivors showed a higher likelihood of death compared to their urban counterparts, HR = 1.39 (95% CI: 1.04, 1.85) p = 0.026, adjusted for covariates. A rurality by education interaction was observed (p = 0.027), indicating significantly poorer survival in rural vs. urban patients among those with trade school/some college education, adjusted HR = 2.49 (95% CI: 1.44, 4.30), p = 0.001; there was no rurality survival disparity for the other 2 levels of education. Conclusions Differences in ovarian cancer survival are impacted by rurality, which is moderated by educational attainment even in patients receiving initial care in tertiary settings. Clinicians should be aware of rurality and education as potential risk factors for adverse outcomes and develop approaches to address these possible risks.
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- 2021
3. Racial disparities in survival outcomes following pediatric in-hospital cardiac arrest
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Marina Del Rios, M. Bridget Zimmerman, Dianne L. Atkins, Saket Girotra, Sarah E. Haskell, Raina M. Merchant, and Yunshu Zhou
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Adult ,Male ,Resuscitation ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,Emergency Nursing ,Return of spontaneous circulation ,Black race ,Article ,White People ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Overall survival ,Hospital discharge ,Humans ,Medicine ,Registries ,Child ,business.industry ,030208 emergency & critical care medicine ,Mean age ,Shockable rhythm ,Cardiopulmonary Resuscitation ,Patient Discharge ,United States ,Heart Arrest ,Black or African American ,Child, Preschool ,Emergency Medicine ,Female ,Racial differences ,Cardiology and Cardiovascular Medicine ,business - Abstract
BACKGROUND: Among adults with in-hospital cardiac arrest (IHCA), overall survival is lower in black patients compared to white patients. Data regarding racial differences in survival for pediatric IHCA are unknown. METHODS: Using 2000–2017 data from the American Heart Association Get With the Guidelines-Resuscitation® registry, we identified children >24 hours and < 18 years of age with IHCA due to an initial pulseless rhythm. We used generalized estimation equation to examine the association of black race with survival to hospital discharge, return of spontaneous circulation (ROSC), and favorable neurologic outcome at discharge. RESULTS: Overall, 2940 pediatric patients (898 black, 2042 white) at 224 hospitals with IHCA were included. The mean age was 3.0 years, 57% were male and 16% had an initial shockable rhythm. Age, sex, interventions in place at the time of arrest and cardiac arrest characteristics did not differ significantly by race. The overall survival to discharge was 36.9%, return of spontaneous circulation (ROSC) was 73%, and favorable neurologic survival was 20.8%. Although black race was associated with lower rates of ROSC compared to white patients (69.5% in blacks vs. 74.6% in whites; risk-adjusted OR 0.79, 95% CI 0.67 – 0.94, P= 0.016), black race was not associated with survival to discharge (34.7% in blacks vs. 37.8% in whites; risk-adjusted OR 0.96, 95% CI 0.80 – 1.15, P=0.68) or favorable neurologic outcome (18.7% in blacks vs. 21.8% in whites, risk-adjusted OR 0.98, 95% CI 0.80–1.20, p=0.85). CONCLUSIONS: In contrast to adults, we did not find evidence for racial differences in survival outcomes following IHCA among children.
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- 2021
4. OUTCOME DISPARITIES BETWEEN RURAL AND URBAN SINGLE VENTRICLE INFANTS
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Janelle Buysse, Trudy Pierick, M Bridget Zimmerman, and Benjamin E. Reinking
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Cardiology and Cardiovascular Medicine - Published
- 2023
5. Home-based versus office-based biofeedback therapy for constipation with dyssynergic defecation: a randomised controlled trial
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Satish S.C. Rao, M. Bridget Zimmerman, Shaheen Hamdy, Xuelian Xiang, Catherine S. Bradley, and Jessica Valestin
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Adult ,Male ,medicine.medical_specialty ,Constipation ,Manometry ,Cost effectiveness ,Cost-Benefit Analysis ,medicine.medical_treatment ,Anal Canal ,Biofeedback ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Pressure ,medicine ,Humans ,Defecation ,cost-effectiveness ,Pelvic floor ,Intention-to-treat analysis ,Hepatology ,business.industry ,Gastroenterology ,Biofeedback, Psychology ,constipation ,Health Care Costs ,Pelvic Floor ,medicine.disease ,anorectal function ,Exercise Therapy ,Intention to Treat Analysis ,Self Care ,medicine.anatomical_structure ,Sensory Thresholds ,030220 oncology & carcinogenesis ,Physical therapy ,Functional constipation ,Female ,030211 gastroenterology & hepatology ,medicine.symptom ,business ,dyssynergic defecation ,Home Biofeedback therapy - Abstract
Background: Office-based biofeedback therapy is effective for constipation with dyssynergic defecation, but must be performed by skilled staff, is only available in selected centres, and requires multiple visits. The efficacy of home-based biofeedback therapy is unknown. We compared clinical and subjective outcomes with home-based and office-based approaches. Methods: In this randomised controlled trial, eligible patients were adult outpatients (age 18–80 years) who met the Rome III criteria for functional constipation and who had been referred to a tertiary-care centre after non-response to routine management, and who had dyssynergic defecation. Patients were randomly assigned according to a schedule generated in advance by the study biostatistician, in permuted blocks of four, to receive office-based or home-based biofeedback therapy. Office-based biofeedback comprised therapist-guided pelvic floor training for six sessions over 3 months (visits every 2 weeks). Home-based biofeedback comprised 20 min self-training sessions twice per day, in which a self-inserted probe was used to provide visual feedback via a handheld monitoring device of anal sphincter pressure and push effort. Patients recorded in diaries the time of each defecation attempt, stool consistency, straining effort, feeling of incomplete evacuation, need for digital assistance with stooling, and satisfaction with bowel function, from 1 week before enrolment to the end of follow-up. Treatment responders were defined post hoc as those with normalisation of dyssynergic defecation and an increase in the number of complete spontaneous bowel movements per week by 3 months. Cost outcomes calculated from health-care costs and loss of salary were assessed from hospital billing and medical records and questionnaires. Primary outcome measures were the presence of a dyssynergic pattern during attempted defecation, balloon expulsion time, the number of complete spontaneous bowel movements per week, and satisfaction with bowel function, assessed by intention to treat (non-inferiority) and per protocol. This trial is registered with ClinicalTrials.gov, number NCT03202771. Findings: Of 300 patients screened we enrolled 100, from Jan 7, 2005, to Jan 31, 2010. 83 patients completed training (38 [76%] of 50 in the home-based biofeedback group and 45 [90%] of 50 in the office-based biofeedback group). 34 (68%) patients in the home-based group and 35 (70%) in the office-based group were classified as responders. All primary outcomes improved significantly from baseline in the two treatment groups (all p
- Published
- 2018
6. Reduction in movement-evoked pain and fatigue during initial Transcutaneous Electrical Nerve Stimulation treatment predicts responders in women with fibromyalgia
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Barbara A. Rakel, Katharine M. Geasland, M. Bridget Zimmerman, Leslie J. Crofford, Dana L. Dailey, Ruth L. Chimenti, Carol G.T. Vance, Kathleen A. Sluka, Meenakshi Golchha, and Jon Williams
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medicine.medical_specialty ,business.industry ,Number needed to harm ,medicine.disease ,Logistic regression ,Transcutaneous electrical nerve stimulation ,law.invention ,Evoked pain ,Anesthesiology and Pain Medicine ,Neurology ,law ,Fibromyalgia ,Number needed to treat ,Physical therapy ,Marital status ,Medicine ,Neurology (clinical) ,business ,Adverse effect - Abstract
Transcutaneous Electrical Nerve Stimulation (TENS) is a safe, economical non-pharmacological adjunctive intervention. Using data from the Fibromyalgia Activity Study with TENS (FAST) we performed a responder analysis to identify predictors of reduced pain and fatigue after 1-month of daily TENS use in women with FM. Women with FM were randomly assigned to active-TENS (2-125Hz; highest-tolerable intensity), placebo-TENS, or no-TENS for 1-month. After the randomized phase, placebo-TENS and no-TENS groups received active-TENS for 1-month. Responders to TENS were defined as those achieving a 30% reduction in movement-evoked pain and/or 20% reduction in movement-evoked fatigue., The predictor model was developed using data from the randomized phase of the active-TENS group (n=103) and validated using data from the placebo-TENS and no-TENS groups after active-TENS for 1 month (n=155). Participant characteristics, and changes in pain, fatigue, and function were assessed as potential predictors using a logistic regression model. Number needed to treat (NNT), and number needed to harm (NNH) calculations were made comparing the active-TENS group to the placebo-TENS and no-TENS groups using an intention-to-treat analysis. Predictors of clinical improvement in pain at 1-month follow-up were initial decrease in pain during the first TENS use and widespread pain index (AUC=0.80; 95%CI: 0.73,0.87). Predictors of clinical improvement in fatigue at 1-month follow-up were marital status, sleep impairment and initial decrease in fatigue during the first TENS use (AUC=0.67; 95%CI: 0.58,0.75). NNT for pain and fatigue ranged between 3.3-5.3. NNH ranged from 20-100 for minor TENS-related adverse events. The current study shows that 1 in 3 women with FM will experience a clinically significant reduction in pain, while 1 in 5 will experience a clinically significant reduction in fatigue with minimal harms. How a person responds to the first TENS treatment predicts response to daily use over of a 1-month period. Trial Number: NCT01888640, Funded by NIH UM1 AR06338, NIH UM1 AR063381-S1, T32 NS045549-12, and K99AR071517.
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- 2021
7. Relationship between community-level variables and number of general dentists
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Mark Pooley, Raymond A. Kuthy, Susan C. McKernan, and M. Bridget Zimmerman
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Adult ,media_common.quotation_subject ,Dentists ,Population ,Students, Dental ,Negative binomial distribution ,Predictor variables ,03 medical and health sciences ,0302 clinical medicine ,Fluoridation ,Urbanization ,Humans ,Health Workforce ,030212 general & internal medicine ,education ,General Dentistry ,Practical implications ,media_common ,education.field_of_study ,Community level ,Variables ,030206 dentistry ,Iowa ,Observational study ,Psychology ,Demography - Abstract
Background. This study uses observational data (2014) to evaluate the association between the number of general dentists and several community characteristics. Methods. Researchers collected community level characteristics from secondary sources for all 947 Iowa incorporated communities (N = 947) to study their relationships with mean number of general dentists per 1000 population per square mile (population density), the dependent variable. Researchers used zero-inflated negative binomial models to examine the association between the dependent and predictor variables. Results. Only 23% of communities had a dentist. Urban, young, well educated, fluoridated communities with at least one elementary school had the highest estimated mean concentration of dentists. Isolated communities with older, less educated adults and lacking fluoridation and an elementary school had the fewest dentists. Conclusions. Although population is an important determinant for where a dentist practices, other variables such as urbanization, demographics, fluoridation status, and presence of at least one elementary school are also predictors of the number of dentists in a community. Practical Implications. These findings provide dental students and young practitioners useful information by highlighting community characteristics that are associated with office locations.
- Published
- 2018
8. Acceptance and Commitment Training for Veterans with Polytrauma: A randomized controlled trial protocol
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Alexandra Price, M. Bridget Zimmerman, Ricardo E. Jorge, Lilian Dindo, Ken Woods, Merlyn Rodrigues, Tracey L. Smith, Dakota Broadway, Raquel D. Gonzalez, and Alex Uzdavines
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medicine.medical_specialty ,Acceptance and commitment therapy ,Article ,law.invention ,Randomized controlled trial ,law ,medicine ,Humans ,Pharmacology (medical) ,Pandemics ,Depression (differential diagnoses) ,Randomized Controlled Trials as Topic ,Veterans ,Multiple Trauma ,SARS-CoV-2 ,business.industry ,Chronic pain ,COVID-19 ,General Medicine ,medicine.disease ,Polytrauma ,humanities ,Distress ,Physical therapy ,Brief intervention ,business ,Psychopathology - Abstract
Background Mild traumatic brain injury (mTBI) is a signature wound of Veterans of operations in Iraq and Afghanistan (i.e., OIF/OEF/OND). Most Veterans with mTBI also experience stress-based psychopathology (e.g., depression, posttraumatic stress disorder) and chronic pain. This combination – referred to as polytrauma - results in detrimental long-term effects on social, occupational, and community reintegration. This study will compare the efficacy of a one-day Acceptance and Commitment Training plus Education, Resources, and Support (ACT+ERS) workshop to a one-day active control group (ERS) on symptoms of distress and social, occupational, and community reintegration. We will also examine mediators and moderators of treatment response. Methods This is an ongoing randomized clinical trial. 212 OIF/OEF/OND Veterans with polytrauma are being recruited. Veterans are randomly assigned to a one-day ACT+ERS or a one-day ERS workshop with two individualized booster sessions approximately two- and four-weeks post-workshop. Veterans complete assessments prior to the workshop and again at six weeks, three months, and six months post-workshop. Of note, workshops were converted to a virtual format due to the COVID-19 pandemic. Results The primary outcomes are symptoms of distress and reintegration; secondary outcomes are post-traumatic stress disorder symptoms and pain interference. Secondary analyses will assess whether changes in avoidance at three months mediate changes in distress and reintegration at six months. Conclusion Facilitating the psychological adjustment and reintegration of Veterans with polytrauma is critical. The results of this study will provide important information about the impact of a brief intervention for Veterans with these concerns.
- Published
- 2021
9. Incidence and Outcomes of Positive Donor Corneoscleral Rim Fungal Cultures after Keratoplasty
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M. Bridget Zimmerman, Michael D. Wagoner, Gregory A. Schmidt, Cynthia R. Reed, Benjamin T. Aldrich, Jessica M. Skeie, Mark A. Greiner, Kenneth M. Goins, and Jesse M. Vislisel
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Keratitis ,Cornea ,Young Adult ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,medicine ,Humans ,Fungal keratitis ,Antibiotic prophylaxis ,Young adult ,Child ,Aged ,Retrospective Studies ,Aged, 80 and over ,Endophthalmitis ,business.industry ,Incidence ,Incidence (epidemiology) ,Fungi ,Retrospective cohort study ,Antibiotic Prophylaxis ,Middle Aged ,Eye infection ,medicine.disease ,Tissue Donors ,Anti-Bacterial Agents ,Surgery ,Ophthalmology ,Descemet Stripping Endothelial Keratoplasty ,030221 ophthalmology & optometry ,Regression Analysis ,Female ,business ,Eye Infections, Fungal ,Keratoplasty, Penetrating ,Sclera ,030217 neurology & neurosurgery - Abstract
Purpose To determine the incidence of positive corneoscleral donor rim fungal cultures after keratoplasty and to report clinical outcomes of grafts with culture-positive donor rims. Design Retrospective cohort study. Participants Consecutive donor corneas and keratoplasty recipients at a single tertiary referral center over 20 years. Methods Patient charts were reviewed to determine the incidence of positive donor rim fungal cultures and clinical outcomes of all grafts using contaminated tissue. Main Outcome Measures The primary outcome measures were positive donor rim fungal culture results and the development of postkeratoplasty fungal infection using corresponding corneal tissue. The secondary outcome measure was the impact of postoperative prophylaxis on donor tissue-associated infections. Results A total of 3414 keratoplasty cases were included in the statistical analysis. Seventy-one cases (2.1%) were associated with a fungal culture-positive donor rim. Candida species were cultured in 40 cases (56.3%). There was a higher incidence of positive rim cultures over the last 5 years of the analytic period compared with the first 15 years ( P = 0.018). Fungal keratitis developed in 4 cases (5.6%), and all patients required further surgical intervention to achieve cure. There were no cases of fungal endophthalmitis. Empiric antimycotic prophylaxis initiated at the time of positive culture result reduced the incidence of keratitis from 15.8% in untreated cases to 1.9% in treated cases ( P = 0.056). Conclusions Positive donor rim fungal cultures are uncommon, but carry an unacceptably high risk of postoperative fungal infection. This risk may be reduced with prophylactic antimycotic therapy when culture-positive donor rims are identified.
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- 2017
10. Measured cup weights of ten raw leafy vegetables are lower than weights previously reported
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M. Bridget Zimmerman, Catherine A. Chenard, Megan M. Anderson, and Lisa L. Brooks
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0303 health sciences ,genetic structures ,030309 nutrition & dietetics ,010401 analytical chemistry ,Nutrition facts label ,01 natural sciences ,Measuring cup ,0104 chemical sciences ,03 medical and health sciences ,Animal science ,sense organs ,Leafy vegetables ,Food Science ,Mathematics - Abstract
Raw dark-green leafy vegetables (LVs) are excellent sources of vitamins A, C, K, folate and manganese. LV intake is reported in cups in the United States (US) and inaccurate cup weights could impact calculated nutrient composition. This project measured the cup weight of ten raw LVs purchased in Coralville, Iowa, compared them to weights reported in two US databases and the Nutrition Facts Label, and assessed changes in nutrient levels for a two-cup serving (one cup-equivalent, c-eq). Six individuals measured one package/head/bunch of each LV. Loosely/moderately packed pieces were weighed in a measuring cup to the nearest 0.1 g. Ready-to-eat produce was measured as purchased; heads/bunches were cut/torn into 2.5-cm pieces. All cup weights were significantly lower than weights previously reported (p
- Published
- 2019
11. A Multicenter Analysis of the Ophthalmic Knowledge Assessment Program and American Board of Ophthalmology Written Qualifying Examination Performance
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M. Bridget Zimmerman, Susan M. Culican, Jeremiah P. Tao, Thomas A. Oetting, Sonal S. Tuli, Darrell WuDunn, Martha M. Wright, Chandrasekharan Krishnan, Ayman Naseri, Leah Levi, Andrew G. Lee, Ingrid U. Scott, Geoffrey E. Bradford, Carolyn E. Kloek, Steven E. Rubin, Preston H. Blomquist, and Andreas K. Lauer
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Knowledge assessment ,medicine.medical_specialty ,Receiver operating characteristic ,business.industry ,Outcome measures ,MEDLINE ,Internship and Residency ,Logistic regression ,United States Medical Licensing Examination ,United States ,Test (assessment) ,Ophthalmology ,Primary outcome ,ROC Curve ,Education, Medical, Graduate ,Family medicine ,Humans ,Medicine ,Clinical Competence ,Curriculum ,Educational Measurement ,business ,Delivery of Health Care ,Societies, Medical - Abstract
Objective To compare the performance on the American Board of Ophthalmology Written Qualifying Examination (WQE) with the performance on step 1 of the United States Medical Licensing Examination (USMLE) and the Ophthalmic Knowledge Assessment Program (OKAP) examination for residents in multiple residency programs. Design Comparative case series. Participants Fifteen residency programs with 339 total residents participated in this study. The data were extracted from the 5-year American Board of Ophthalmology report to each participating program in 2009 and included residency graduating classes from 2003 through 2007. Residents were included if data were available for the USMLE, OKAP examination in ophthalmology years 1 through 3, and the WQE score. Residents were excluded if one or more of the test scores were not available. Methods Two-sample t tests, logistic regression analysis, and receiver operating characteristic (ROC) curves were used to examine the association of the various tests (USMLE, OKAP examination year 1, OKAP examination year 2, OKAP examination year 3, and maximum OKAP examination score) as a predictor for a passing or failing grade on the WQE. Main Outcome Measures The primary outcome measure of this study was first time pass rate for the WQE. Results Using ROC analysis, the OKAP examination taken at the third year of ophthalmology residency best predicted performance on the WQE. For the OKAP examination taken during the third year of residency, the probability of passing the WQE was at least 80% for a score of 35 or higher and at least 95% for a score of 72 or higher. Conclusions The OKAP examination, especially in the third year of residency, can be useful to residents to predict the likelihood of success on the high-stakes WQE examination. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
- Published
- 2012
12. Inflammatory mediators in fluid extracted from the coronal occlusal dentine of trimmed teeth
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Kim A. Brogden, Mary M. Hogan, David H. Pashley, Teresa A. Morgan, M. Bridget Zimmerman, Yalan Li, Saulo Geraldeli, and Leo Tjäderhane
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Male ,Molar ,Oral infection ,Dentistry ,Dental Caries ,engineering.material ,Article ,Dentinal Fluid ,stomatognathic system ,Dentin ,medicine ,Humans ,General Dentistry ,Analysis of Variance ,Enamel paint ,business.industry ,Chemistry ,Cell Biology ,General Medicine ,Amalgam (dentistry) ,stomatognathic diseases ,Odontoblast ,medicine.anatomical_structure ,Otorhinolaryngology ,Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization ,visual_art ,Coronal plane ,engineering ,visual_art.visual_art_medium ,Female ,Inflammation Mediators ,business - Abstract
Background Chemokines and cytokines may occur in dentinal fluids in response to local infection and inflammation. To test this hypothesis, we assessed the presence and concentration of inflammatory mediators in fluid extracted from the coronal occlusal dentine of trimmed teeth. Design Freshly extracted sound, carious, and restored molars were trimmed through the enamel to expose the underlying dentine, etched with 35% phosphoric acid, and rinsed. Fluid was extracted from the coronal occlusal dentine of these trimmed teeth by centrifugation at 2750 × g for 30 min. Results When assessed by MALDI-TOF, fluid extracted from the coronal occlusal dentine from 16 molars contained at least 117 peaks with different masses suggesting that this fluid was rich with molecules within the appropriate mass range of potential mediators. Indeed, when assessed for chemokines and cytokines, fluid extracted from the coronal occlusal dentine from 25 extracted molars with caries lesions, 10 extracted restored molars with occlusal amalgam, and 77 extracted sound molars contained IL-1β, TNF-α, IL-6, IL-8, IL-12(p70), and IL-10. A significant elevation was found for TNF-α ( p = 0.041) in extracted fluid from teeth restored with amalgam fillings. Conclusions Overall, fluid extracted from the coronal occlusal dentine of trimmed teeth may be useful in identifying proteins and other molecules in dentine and pulpal fluids and determining their role as mediators in the pathogenesis of oral infection and inflammation.
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- 2012
13. A Survey Study of Musculoskeletal Disorders Among Eye Care Physicians Compared with Family Medicine Physicians
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Anna S. Kitzmann, David J. Hackbarth, Karen M. Gehrs, Nathan B. Fethke, M. Bridget Zimmerman, and Keith H. Baratz
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Adult ,Male ,medicine.medical_specialty ,Cumulative Trauma Disorders ,Cross-sectional study ,Posture ,MEDLINE ,Physicians ,Surveys and Questionnaires ,Prevalence ,Back pain ,Humans ,Medicine ,Musculoskeletal Diseases ,Socioeconomic status ,Response rate (survey) ,Academic Medical Centers ,Career Choice ,business.industry ,Case-control study ,Physicians, Family ,Human factors and ergonomics ,Health Surveys ,Iowa ,Occupational Diseases ,Ophthalmology ,Cross-Sectional Studies ,Family medicine ,Physical therapy ,Female ,Ergonomics ,medicine.symptom ,business ,Body mass index ,Stress, Psychological ,Optometry - Abstract
To evaluate the prevalence of musculoskeletal disorders among eye care physicians compared with family medicine physicians.Case control study.Ophthalmologists and optometrists at the University of Iowa and Mayo Clinic (participants) and family medicine physicians at the University of Iowa and Mayo Clinic (controls).An electronic survey was e-mailed to all subjects.The prevalence of musculoskeletal symptoms between eye care providers and family medicine physicians (control group).One hundred eight-six surveys were completed by 94 eye care physicians and 92 family medicine physicians with a response rate of 99% and 80%, respectively. There were no significant differences between the 2 groups with regard to mean age, gender, body mass index, years with current employer, or years in practice. Eye care providers, compared with their family medicine colleagues, reported a higher prevalence of neck (46% vs 21%; P0.01), hand/wrist pain (17% vs 7%; P = 0.03), and lower back pain (26% vs 9%; P0.01). A greater proportion of eye care physicians classified their job as a high-strain job (high demand, low control; 31% vs 20%) and a lower proportion classified their job as an active job (high demand, high control; 24% vs 47%; p = 0.01). Several job factors reported by eye care providers to contribute to musculoskeletal symptoms included performing the same task repeatedly, working in awkward/cramped positions, working in the same position for long periods, and bending/twisting the back (all P0.01).In this survey, the study group, composed of ophthalmologists and optometrists, had a higher prevalence of neck, hand/wrist, and lower back pain compared with family medicine physicians; repetitive tasks, prolonged or awkward/cramped positions, and bending/twisting were contributory factors. Given the ramifications of these findings, future efforts should concentrate on modifications to the eye care providers' work environment to prevent or alleviate musculoskeletal disorders and their personal and socioeconomic burden.
- Published
- 2012
14. Central and Hemicentral Retinal Vein Occlusion
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Patricia Podhajsky, M. Bridget Zimmerman, and Sohan Singh Hayreh
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Aspirin ,medicine.medical_specialty ,Visual acuity ,genetic structures ,business.industry ,Odds ratio ,medicine.disease ,eye diseases ,Dipyridamole ,Ophthalmology ,Central retinal vein occlusion ,Anesthesia ,medicine ,Platelet aggregation inhibitor ,medicine.symptom ,Prospective cohort study ,business ,Macular edema ,medicine.drug - Abstract
Objective To investigate systematically the role of anti–platelet-aggregating drugs or anticoagulants in central retinal vein occlusion (CRVO) and hemi-CRVO. Design Cohort study. Participants Six hundred eighty-six consecutive patients with CRVO (567 patients, 585 eyes) and nonischemic hemi-CRVO (119 patients, 122 eyes). Methods At first visit, all patients had a detailed ophthalmic and medical history (including the use of anti–platelet aggregating drugs or anticoagulants), and comprehensive ophthalmic and retinal evaluation. Visual evaluation was carried out by recording visual acuity, using the Snellen visual acuity chart, and visual fields with a Goldmann perimeter. The same ophthalmic evaluation was performed at each follow-up visit. At the initial visit, CRVO and hemi-CRVO were classified as nonischemic and ischemic. Main Outcome Measures Visual acuity, visual fields, and severity of retinal hemorrhages. Results All 3 types of CRVO, showed a significantly greater severity of retinal hemorrhages among aspirin users than nonusers ( P P = 0.020). Of those whose macular edema resolved, overall cumulative visual acuity outcome also suggested a higher percentage with deterioration among aspirin users, odds ratio for deterioration of 3.62 (95% CI, 0.97–13.54; P = 0.05) for aspirin users relative to nonusers. For the nonischemic CRVO patients with 20/70 or worse visual acuity at the initial visit, after resolution of macular edema, improvement in visual acuity was less likely in the aspirin users than in nonusers (odds ratio, 0.18; 95% CI, 0.04–0.72; P = 0.016). Conclusions Findings of this study indicate that, for patients with CRVO and hemi-CRVO, the use of aspirin, other anti–platelet aggregating agents, or anticoagulants was associated with a worse visual outcome and no apparent benefit. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
- Published
- 2011
15. Affect-related behaviors in mice misexpressing the RNA editing enzyme ADAR2
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Minati Singh, Alan Kim Johnson, M. Bridget Zimmerman, and Terry G. Beltz
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Male ,Genetically modified mouse ,medicine.medical_specialty ,Elevated plus maze ,Genotype ,Adenosine Deaminase ,Mice, Transgenic ,Experimental and Cognitive Psychology ,Motor Activity ,Article ,Mice ,Behavioral Neuroscience ,chemistry.chemical_compound ,Corticosterone ,Internal medicine ,medicine ,Animals ,Affective Symptoms ,Maze Learning ,Swimming ,5-HT receptor ,Analysis of Variance ,Behavior, Animal ,Body Weight ,RNA-Binding Proteins ,Tail suspension test ,Mice, Inbred C57BL ,Disease Models, Animal ,Endocrinology ,Hindlimb Suspension ,chemistry ,RNA editing ,Exploratory Behavior ,Female ,RNA Editing ,Serotonin ,Psychology ,Behavioural despair test - Abstract
Misediting of the serotonin (5HT) 2C receptor (5HT 2C R) has been implicated in both depression and anxiety. The adenosine deaminases that act on double stranded RNAs (ADARs) are reported to modify the 5HT 2C R by RNA editing. Transgenic mice misexpressing the RNA editing enzyme ADAR2 show an adult onset obese phenotype due to chronic hyperphagia, but little more than this is known about the behavior of these animals. The present experiments examined whether affect-associated behaviors are also altered in ADAR2 transgenic mice. Age- and weight-matched transgenic mice misexpressing ADAR2 were tested for signs of behavioral despair with the forced swim (FST) and tail suspension (TST) tests, and for anxiety by evaluating spontaneous exploration in a novel environment and by elevated plus maze performance. Plasma corticosterone was also determined by radioimmunoassay. Transgenic mice of both sexes displayed indications of increased behavioral despair on first exposures to the TST and the FST. Behavioral despair persisted in ADAR2 mice in that it was also observed in the FST in tests administered 24 h and 1 week following the initial TST and FST. ADAR2 transgenic mice also displayed behaviors associated with anxiety as indicated by decreased entry into the open arms in an elevated plus maze test. Both sexes of ADAR2 transgenic mice displayed elevated plasma corticosterone. Taken together, the results suggest that ADAR2 transgenic mice represent a novel rodent model of endogenous behavioral despair and anxiety accompanied by elevated hypothalamo-pituitary adrenal axis activity.
- Published
- 2009
16. Nonarteritic Anterior Ischemic Optic Neuropathy and Tobacco Smoking
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M. Bridget Zimmerman, Sohan Singh Hayreh, and Jost B. Jonas
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Eye disease ,Population ,Myocardial Ischemia ,Cohort Studies ,Optic neuropathy ,Age Distribution ,Risk Factors ,Internal medicine ,Diabetes mellitus ,Diabetes Mellitus ,Prevalence ,medicine ,Humans ,Optic Neuropathy, Ischemic ,Sex Distribution ,Risk factor ,education ,Aged ,Aged, 80 and over ,Arteritis ,education.field_of_study ,business.industry ,Smoking ,Middle Aged ,medicine.disease ,Former Smoker ,Surgery ,Cerebrovascular Disorders ,Ophthalmology ,Hypertension ,Anterior ischemic optic neuropathy ,Female ,business ,Cohort study - Abstract
To evaluate whether tobacco smoking may be a risk factor for development of nonarteritic anterior ischemic optic neuropathy (NA-AION).Cohort study.Six hundred twenty-four consecutive patients with NA-AION who fulfilled our inclusion criteria.All patients provided a detailed ocular, medical, and smoking history, and underwent a comprehensive ophthalmic evaluation. For data analysis, patients were divided into current, former, and never smokers. The prevalence for current smoking in the NA-AION patients was compared to the corresponding race-, gender-, age-, and period-matched subgroup of the U.S. population.Association between NA-AION and tobacco smoking.Of the 624 patients, 369 (59.1%) were men, and mean (+/- standard deviation) age was 61.0+/-12.3 years. Of all the patients, 151 (24.2%) were current smokers, 160 (25.6%) former smokers, and 313 (50.2%) had never smoked. The prevalence of smoking in NA-AION patients was not significantly different from the prevalence in the period-matched U.S. population and the period matched Iowa population. In contrast, the prevalence of diabetes mellitus, ischemic heart disease, arterial hypertension, and cerebrovascular disease in NA-AION patients was significantly higher compared to the prevalence of these chronic conditions in the matched U.S. population (P0.0001). There was no significant difference in initial visual acuity (P = 0.97) or the amount of initial visual field loss (P = 0.31) among nonsmokers, former smokers, and current smokers. Current smokers had NA-AION in the first eye at a significantly younger age (57.8+/-11.7 years) than former smokers (64.0+/-10.2 years; P0.0001), and nonsmokers (60.4+/-13.5 years; P = 0.032). Comparison of the distribution of the time to develop NA-AION in the fellow eye showed no significant difference among the 3 groups (log-rank test P = 0.186).Our study showed no association between NA-AION and tobacco smoking.
- Published
- 2007
17. Bariatric surgery trends: an 18-year report from the International Bariatric Surgery Registry
- Author
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Isaac Samuel, M. Bridget Zimmerman, Yu-Hui Huang, Edward E. Mason, Mohammad Jamal, and Kathleen E. Renquist
- Subjects
Adult ,Male ,medicine.medical_specialty ,Gastroplasty ,Gastric bypass ,Gastric Bypass ,Bariatric Surgery ,Morbid obesity ,medicine ,Humans ,Registries ,Laparoscopy ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Retrospective cohort study ,General Medicine ,Patient data ,Length of Stay ,Biliopancreatic Diversion ,Endoscopy ,Surgery ,Trend analysis ,Linear Models ,Female ,business ,Body mass index - Abstract
Background: The epidemic of morbid obesity has increased bariatric procedures performed. Trend analyses provide important information that may impact individual practices. Methods: Patient data from 137 surgeons were examined from 1987 to 2004 (41,860 patients) using Cochran-Armitage Trend test and Generalized Linear Model. Results: Over an 18-year period, surgeon preference for combined restrictive-malabsorptive procedures increased from 33% to 94%, while simple gastric restriction decreased correspondingly (P
- Published
- 2006
18. Central retinal artery occlusion
- Author
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Ashish Sanon, Alan Kimura, M. Bridget Zimmerman, and Sohan Singh Hayreh
- Subjects
medicine.medical_specialty ,Retina ,genetic structures ,medicine.diagnostic_test ,Retinal Artery Occlusion ,business.industry ,Retinal ,medicine.disease ,eye diseases ,Sensory Systems ,Surgery ,Cellular and Molecular Neuroscience ,Ophthalmology ,chemistry.chemical_compound ,medicine.anatomical_structure ,chemistry ,Occlusion ,medicine ,Optic nerve ,Central retinal artery occlusion ,sense organs ,business ,Electroretinography ,Photopic vision - Abstract
Purpose . To investigate the retinal survival time following central retinal artery occlusion (CRAO). Methods . In 38 elderly, atherosclerotic and hypertensive rhesus monkeys, transient CRAO (varying from 97 to 240 min) was produced by temporarily clamping the CRA at its site of entry into the optic nerve. Stereoscopic color fundus photography, fluorescein fundus angiography, electroretinography (ERG), and visual evoked potential (VEP) recording were performed before and during CRA clamping, after unclamping, and serially thereafter. After unclamping of the CRA, the animals were followed for variable lengths of time (median duration 8·14 weeks). Finally, the eyes and optic nerves were examined histologically. The data on ERG changes were analyzed in the following four time frames: (1) baseline before CRA clamping, (2) during CRA clamping, (3) immediately after unclamping, and (4) at the end of follow-up. Duration of CRAO was divided into four groups: 97, 105–120, 150–165, and ≥180 min. Results . A ‘negative ERG’ appeared during CRA clamping. With removal of the CRA clamp, there was b-wave recovery, with differential rates of recovery of ERG-eyes with shorter CRAO recovered sooner than those with longer occlusion. On removal of clamp, recovery was seen in scotopic 24 dB b-wave, photopic 0 dB single flash b-wave and 30 Hz flicker, with the b/a ratio of the combined rod and cone response and selective rod response showing statistically significant differences amongst the shorter and longer periods of CRAO. A delayed normalization of the depressed b/a ratio immediately after CRA reperfusion may indicate high-grade ischemic damage. At the final follow-up test session, no clear-cut derangement of any ERG parameter was seen for any group, with subtotal b-wave amplitude recovery for all groups. Longer CRAO produced incomplete VEP recovery. On histology, in the macular retina, eyes with CRAO for 97 min showed practically no damage, but duration of CRAO was found to be significantly associated with the amount of damage in the ganglion cell layer ( p =0·009) and inner nuclear layer ( p =0·017). Outer nuclear and plexiform layers and photoreceptors showed no damage at all with CRAO. There was no significant association of the ERG measures and histologic changes with any of the residual retinal circulation variables. Conclusions . Our electrophysiologic, histopathologic and morphometric studies showed that the retina of old, atherosclerotic, hypertensive rhesus monkeys suffers no detectable damage with CRAO of 97 min but above that level, the longer the CRAO, the more extensive the irreversible damage. The study suggests that CRAO lasting for about 240 min results in massive irreversible retinal damage.
- Published
- 2004
19. Triphasic waveforms are superior to biphasic waveforms for transthoracic defibrillation
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Richard E. Kerber, Janice L. Jones, Imran M Bawaney, Kimberly A. Boddicker, R.S Ramabadran, Loyd R. Davies, Yi Zhang, Scott Alan Wuthrich, and M. Bridget Zimmerman
- Subjects
medicine.medical_specialty ,Pulse (signal processing) ,business.industry ,Defibrillation ,medicine.medical_treatment ,Treatment outcome ,Biphasic waveform ,medicine.disease ,Part iii ,Internal medicine ,Anesthesia ,Ventricular fibrillation ,medicine ,Cardiology ,Asystole ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objectives Our objective was to evaluate the efficacy of triphasic waveforms for transthoracic defibrillation in a swine model. Background Triphasic shocks have been found to cause less post-shock dysfunction than biphasic shocks in chick embryo studies. Methods After 30 s of electrically induced ventricular fibrillation (VF), each pig in part I (n = 32) received truncated exponential biphasic (7.2/7.2 ms) and triphasic (4.8/4.8/4.8 ms) transthoracic shocks. Each pig in part II (n = 14) received biphasic (5/5 ms) and triphasic shocks (5/5/5 ms). Three selected energy levels (50, 100, and 150 J) were tested for parts I and II. Pigs in part III (n = 13) received biphasic (5/5 ms) and triphasic (5/5/5 ms) shocks at a higher energy (200 and 300 J). Although the individual pulse durations of these shocks were equal, the energy of each pulse varied. Nine pigs in part I also received shocks where each individual pulse contained equal energy but was of a different duration (biphasic 3.3/11.1 ms; triphasic 2.0/3.2/9.2 ms). Results Triphasic shocks of equal duration pulses achieved higher success than biphasic shocks at delivered low energies: Conclusions Triphasic transthoracic shocks composed of equal duration pulses were superior to biphasic shocks for VF termination at low energies and caused less VT and asystole.
- Published
- 2003
20. Pupil light reflex in normal and diseased eyes
- Author
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Oliver Bergamin, Randy H. Kardon, and M. Bridget Zimmerman
- Subjects
medicine.medical_specialty ,genetic structures ,business.industry ,Retinal ganglion ,Pupil ,Visual field ,PUPILLOGRAPH ,Ophthalmology ,Light intensity ,Optics ,Pupillary reflex ,medicine ,Reflex ,Pupillography ,sense organs ,business - Abstract
Objective To evaluate changes in pupil size (corresponding to neuronal firing) within different time windows of the pupil light reflex in patients and normal subjects to understand which segments of the pupil waveform are best able to differentiate normal from abnormal subjects. Design Comparative, observational case series. Participants Forty-nine normal subjects and 25 patients with known unilateral or asymmetric visual field damage were tested. Methods A dual-channel infrared pupillograph was used to simultaneously record the right and left pupil diameters at a rate of 60 Hz. Each eye was stimulated alternately (30° full-field, 200 milliseconds duration every 3 seconds) over 10 different stimulus intensities. The recorded waveform of the pupil light reflex was subdivided into six time windows based on landmarks corresponding to contraction onset, maximum contraction velocity, peak contraction, and maximum dilation velocity to assess which portion was most affected by disease. Main outcome measures The linear correlation between pupil contractions elicited by right versus left full-field stimulation at different light intensities provided diagnostic parameters (slope, intercept, and correlation coefficient R 2 ) that were useful for differentiating normal subjects from patients and for categorizing disease. Sensitivity and specificity of the time windows were evaluated with receiver-operator curve analysis. Results The diagnosis of asymmetric disease was greatest at time windows that included pupil contraction but not dilation. When the contraction phase was subdivided into an early phase and into a late phase, the late phase was the most diagnostic compared with the entire phase of contraction amplitude (onset to peak contraction). Conclusions By use of a range of light intensity, the change in pupil size measured between the time at which maximum contraction velocity occurs and the time to peak contraction provided the best response parameter for objective diagnosis of asymmetric disease of the anterior visual pathway. The waveform of the pupil light reflex may be an expression of the firing of retinal ganglion cells. Therefore, understanding which segment of the pupil light reflex provides maximal diagnostic power may give insight into how disease affects the pattern of neuronal firing rate.
- Published
- 2003
21. A case-control comparison of the clinical characteristics of glaucoma and ocular hypertensive patients with and without the myocilin Gln368Stop mutation11Internet Advance publication at ajo.com Sept 6, 2002
- Author
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Young H. Kwon, Wallace L.M. Alward, Edwin M. Stone, Thomas A Graul, M. Bridget Zimmerman, Val C. Sheffield, and Chang-sik Kim
- Subjects
Intraocular pressure ,medicine.medical_specialty ,education.field_of_study ,Visual acuity ,genetic structures ,business.industry ,Eye disease ,Population ,Ocular hypertension ,Glaucoma ,medicine.disease ,eye diseases ,Ophthalmology ,Medicine ,sense organs ,Age of onset ,medicine.symptom ,business ,education ,Myocilin - Abstract
PURPOSE: To determine whether primary open-angle glaucoma (POAG) and ocular hypertensive (OHT) patients who harbor the myocilin Gln368Stop mutation differ in phenotype or clinical course from patients without the mutation. DESIGN: Case-control study. METHODS: A retrospective case-control study compared all known POAG patients (n = 18) and OHT patients (n = 4) harboring the Gln368Stop mutation evaluated by the University of Iowa Glaucoma Service with control patients from the same population. Patients and control subjects were matched for diagnosis, age, sex, and race and were compared for phenotype and clinical course. RESULTS: Mean age of disease onset and mean peak intraocular pressures (IOPs) of cases were similar to those reported by other studies. There was no statistically significant difference between cases and controls for the following variables: age at onset, peak intraocular pressure, Snellen visual acuity, number of medications, Humphrey visual field (HVF) mean deviation, HVF pattern deviation, number of filtering surgeries performed, time intervals from diagnosis to argon laser trabeculoplasty (ALT), diagnosis to first filtering surgery, ALT to first filtering surgery, and percent change in IOP after ALT and after first filtering surgery. CONCLUSIONS: There is no statistically significant difference between the onset and clinical course of POAG and OHT caused by the Gln368Stop mutation and POAG and OHT not associated with the mutation.
- Published
- 2002
22. Rate and pattern of visual field decline in primary open-angle glaucoma
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Young H. Kwon, M. Bridget Zimmerman, Mary Lucy M Pereira, Sohan Singh Hayreh, Chang-sik Kim, and Wallace L.M. Alward
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Adult ,Male ,medicine.medical_specialty ,Visual acuity ,genetic structures ,Open angle glaucoma ,Eye disease ,Vision Disorders ,Visual Acuity ,Glaucoma ,Ophthalmology ,medicine ,Humans ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Blind spot ,Retrospective cohort study ,Middle Aged ,medicine.disease ,eye diseases ,Visual field ,medicine.anatomical_structure ,Visual Field Tests ,Optometry ,Female ,sense organs ,Visual Fields ,medicine.symptom ,business ,Glaucoma, Open-Angle ,Follow-Up Studies ,Optic disc - Abstract
Purpose To study the rate and pattern of visual field decline in primary open-angle glaucoma. Design Retrospective observational case series. Participants Forty eyes of 40 patients with primary open-angle glaucoma that were followed longitudinally with serial Goldmann visual fields for a minimum period of 8 years in an academic institution. Eyes with any other ocular disease except for mild cataract were excluded. Methods Visual fields obtained with worse than 20/50 Snellen visual acuity from cataract were excluded from analysis. In the remainder (671 Goldmann visual fields), the I4e isopter was quantified manually using a grid template previously described by Esterman. The visual field was divided into central and peripheral, superior and inferior, and nasal and temporal regions, all centered at the blind spot. The rate of visual field decline was estimated for each visual field region (including the four quadrants: superonasal [SN], superotemporal [ST], inferotemporal [IT], and inferonasal [IN]) using linear regression. Asymmetry of visual field progression was determined by comparing the rates of progression among the four quadrants. Pertinent clinical factors were evaluated for association with the asymmetry of visual field progression. Main outcome measures Rates of visual field decline for the entire visual field and each region. Long-term clinical outcome measures, including visual acuity, cataract and cup-to-disc ratio progression, intraocular pressures, and medical and surgical interventions were also studied. Results The rate of visual field change was −1.3% per year for the entire visual field. The rates of visual field section change (in % per year) were −1.3 (central), −1.4 (peripheral), −1.5 (superior), −1.2 (inferior), −1.4 (nasal), −1.2 (temporal), −1.8 (SN), −1.3 (IT), −1.2 (IN), and −1.1 (ST). About half the patients showed symmetric visual field decline, whereas others showed a more asymmetric pattern. Asymmetric visual field progression was associated with the presence of disc hemorrhage, overall rate of visual field progression, and surgical intervention for glaucoma. Conclusions In this group of selected patients with primary open-angle glaucoma with a long-term follow-up, all sections of the visual field declined over time. Disc hemorrhage was associated with more asymmetric visual field progression, implicating focal damage to the optic disc.
- Published
- 2002
23. Body weight is a predictor of biphasic shock success for low energy transthoracic defibrillation
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Gudjon Karlsson, Yi Zhang, M. Bridget Zimmerman, Craig B. Clark, Richard E. Kerber, and L.Ray Davies
- Subjects
medicine.medical_specialty ,Swine ,Defibrillation ,business.industry ,medicine.medical_treatment ,Body Weight ,Electric Countershock ,Biphasic waveform ,Emergency Nursing ,Body weight ,medicine.disease ,Predictive factor ,Surgery ,Low energy ,Shock (circulatory) ,Internal medicine ,Ventricular fibrillation ,Emergency Medicine ,Cardiology ,medicine ,Animals ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,A determinant - Abstract
Transthoracic impedance and current flow are determinants of defibrillation success with monophasic shocks. Whether transthoracic impedance, either independently or via its association with body weight, is a determinant of biphasic waveform shock success has not been determined.We studied 22 swine, weighing 18-41 kg. After 15 s of ventricular fibrillation, each pig received transthoracic truncated exponential biphasic shocks (5/5 ms), 70-360 J. Shock success was strongly associated individually with body weight, leading-edge transthoracic impedance and current at low energy levels (70 and 100 J, all P0.001). Multiple logistic regression analysis showed a significant association of body weight with shock success after adjusting for the effect of leading-edge impedance (odds ratio of success for 1 kg decrease in weight at 70 J was 1.29, 95% CI: 1.05-1.59, P=0.02; and at 100 J was 1.30, 95% CI: 1.14-1.49, P0.0001). The same result was observed after adjusting for the effect of leading-edge current. At 150 J or higher energy levels, no significant association was observed.Body weight is a determinant of shock success with biphasic waveforms at low energy levels in this swine model.
- Published
- 2002
24. Factors that predict low hematocrit levels in the postpartum patient after vaginal delivery
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Linda A. Petersen, Almira T. Hinton, M. Bridget Zimmerman, Deborah S. Lindner, Jerome Yankowitz, and Charmaine Kleiber
- Subjects
Adult ,medicine.medical_specialty ,Blood transfusion ,Anemia ,medicine.medical_treatment ,Hematocrit ,Dizziness ,Lacerations ,Pregnancy ,Risk Factors ,Ethnicity ,Hematocrit Measurement ,Humans ,Medicine ,Blood Transfusion ,Risk factor ,Retrospective Studies ,Gynecology ,medicine.diagnostic_test ,business.industry ,Vaginal delivery ,Postpartum Hemorrhage ,Racial Groups ,Age Factors ,Obstetrics and Gynecology ,Retrospective cohort study ,Hispanic or Latino ,Puerperal Disorders ,Delivery, Obstetric ,medicine.disease ,Logistic Models ,Vagina ,Female ,business - Abstract
The purpose of this study was to provide a viable alternative to routine postpartum hematocrit measurement, by a determination of the clinical risk factors that identify patients with anemia and an examination of the resulting cost savings.In this retrospective review, cases (postpartum hematocrit level,26%; subgroup hematocrit level,23%) and control subjects were culled from the records of all vaginal deliveries from February 1997 to July 1998. Charts were reviewed for demographic characteristics, medical history, nursing assessments, and postpartum hematocrit measurements. Logistic regression modeling determined the best set of risk factors for the identification of low postpartum hematocrit levels.From 1484 vaginal deliveries, 117 of the women (8%) had postpartum hematocrit levels of26%. Estimated blood loss of500 mL, Hispanic ethnicity, dizziness, or third- or fourth-degree laceration were the factors that identified 82.9% of the women with hematocrit levels of26% and identified 97.4% of the women with hematocrit levels of23%. Only 39.3% of the women would have required postpartum hematocrit measurement to obtain these detection rates.Four risk factors (estimated blood loss of500 mL, Hispanic ethnicity, dizziness, and third- or fourth-degree laceration) can safely determine the necessity of a postpartum hematocrit measurement.
- Published
- 2002
25. Rate of visual field loss and long-term visual outcome in primary open-angle glaucoma
- Author
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Wallace L.M. Alward, Young H. Kwon, Chang-sik Kim, M. Bridget Zimmerman, and Sohan Singh Hayreh
- Subjects
Adult ,Male ,Intraocular pressure ,Visual acuity ,genetic structures ,Open angle glaucoma ,Eye disease ,Vision Disorders ,Visual Acuity ,Glaucoma ,Cohort Studies ,medicine ,Humans ,Intraocular Pressure ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Retrospective cohort study ,Middle Aged ,medicine.disease ,eye diseases ,Visual field ,Ophthalmology ,Linear Models ,Visual Field Tests ,Optometry ,Female ,sense organs ,Visual Fields ,medicine.symptom ,business ,Glaucoma, Open-Angle ,Cohort study - Abstract
PURPOSE: To evaluate long-term visual field outcome in primary open-angle glaucoma. METHODS: In this retrospective cohort study, 40 eyes of 40 patients with primary open-angle glaucoma with elevated intraocular pressure and a minimum of 8-year longitudinal series of visual fields were plotted with Goldmann perimeter. Eyes with any other ocular disease except cataract were excluded. Manual grid templates were used to quantify the visual fields. Linear regression was performed to estimate the rate of visual field decline. Pertinent clinical factors were evaluated for statistical association with the rate of decline. Long-term clinical outcome including visual acuity, rate of legal blindness, and rate of medical and surgical interventions was also measured. RESULTS: In the 40 eyes studied, with a mean follow-up of 14 years, the visual field score decreased at the rate of −1.5% per year. Overall, 68% showed significant decrease, and the rate of decrease among these eyes was −2.1% per year. Five eyes became legally blind from glaucoma; the cumulative rate of blindness from glaucoma was 19% at 22 years. Higher intraocular pressure and greater number of antiglaucoma medications on initial presentation were associated with faster and slower deterioration of visual field (compared with the average), respectively. CONCLUSIONS: With standard glaucoma therapy, the rate of visual field loss in primary open-angle glaucoma is slow. Lower intraocular pressure and more antiglaucoma medications are associated with slower visual field decline. Legal blindness from glaucoma is 19% over a follow-up of 22 years.
- Published
- 2001
26. Beta-blocker eyedrops and nocturnal arterial hypotension
- Author
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M. Bridget Zimmerman, Sohan Singh Hayreh, and Patricia Podhajsky
- Subjects
Adult ,Male ,Intraocular pressure ,medicine.medical_specialty ,Ambulatory blood pressure ,genetic structures ,medicine.drug_class ,Adrenergic beta-Antagonists ,Glaucoma ,Blood Pressure ,Optic neuropathy ,Heart Rate ,Internal medicine ,Heart rate ,medicine ,Humans ,Optic Neuropathy, Ischemic ,Prospective Studies ,Beta blocker ,Aged ,Aged, 80 and over ,business.industry ,Middle Aged ,medicine.disease ,eye diseases ,Betaxolol ,Circadian Rhythm ,Ophthalmology ,Blood pressure ,Anesthesia ,Timolol ,Cardiology ,Anterior ischemic optic neuropathy ,Female ,sense organs ,Hypotension ,Ophthalmic Solutions ,Visual Fields ,business ,Glaucoma, Open-Angle - Abstract
PURPOSE: To investigate the effects of topical beta-blocker eyedrops on nocturnal arterial hypotension and heart rate and on visual field deterioration. METHODS: We prospectively investigated 275 white patients, 161 with glaucomatous optic neuropathy and 114 with nonarteritic anterior ischemic optic neuropathy, by 24-hour ambulatory blood pressure monitoring and diurnal curve of intraocular pressure, in addition to detailed ophthalmic evaluation. Of the patients with glaucomatous optic neuropathy, 131 had normal-tension glaucoma and 30 had primary open-angle glaucoma. Of the 275 patients, 114 were using topical beta-blocker eyedrops twice daily (76 with normal-tension glaucoma, 26 with primary open-angle glaucoma, and 12 with anterior ischemic optic neuropathy). RESULTS: Hourly average blood pressure data analyses showed overall a drop in blood pressure as well as heart rate during sleep, and a significantly greater drop in mean diastolic blood pressure ( P = .009) at night in normal-tension glaucoma than in anterior ischemic optic neuropathy. Also, patients using beta-blocker eyedrops experienced a significantly greater percentage drop in diastolic blood pressure at night ( P = .028), lower minimum nighttime diastolic blood pressure ( P = .072), and lower minimum nighttime heart rate ( P = .002) than did those not using them. In normal-tension glaucoma, eyes receiving beta-blocker eyedrops showed visual field progression significantly ( P = .0003) more often than those not receiving beta-blockers. CONCLUSIONS: The findings of our studies, as well as those of others, suggest that any factor that increases nocturnal arterial hypotension is a potential risk factor in vulnerable individuals with glaucomatous optic neuropathy or anterior ischemic optic neuropathy. The present study suggests that the use of beta-blocker eyedrops, by aggravating nocturnal arterial hypotension and reducing the heart rate, may be a potential risk factor in susceptible individuals.
- Published
- 1999
27. Obesity and Cardiopulmonary Bypass-Associated Acute Kidney Injury: Authors’ Reply
- Author
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Avinash B. Kumar, M. Bridget Zimmerman, and Manish Suneja
- Subjects
Male ,medicine.medical_specialty ,Cardiopulmonary Bypass ,business.industry ,Acute kidney injury ,Acute Kidney Injury ,medicine.disease ,Obesity ,law.invention ,Postoperative Complications ,Anesthesiology and Pain Medicine ,law ,medicine ,Cardiopulmonary bypass ,Humans ,Female ,Cardiac Surgical Procedures ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business - Published
- 2015
28. A Thyroid Hormone Analog Stimulates Angiogenesis in the Post-infarcted Rat Heart
- Author
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Robert J. Tomanek, Gregory D. Pennock, Steven Goldman, M. Bridget Zimmerman, Padma R. Suvarna, and Eugene Morkin
- Subjects
Male ,medicine.medical_specialty ,Diiodothyronines ,Myocardial Infarction ,Neovascularization, Physiologic ,Infarction ,Rats, Sprague-Dawley ,Internal medicine ,Ventricular Dysfunction ,medicine ,Animals ,cardiovascular diseases ,Interventricular septum ,Myocardial infarction ,Molecular Biology ,Analysis of Variance ,business.industry ,Thyroid ,medicine.disease ,Stimulation, Chemical ,Rats ,medicine.anatomical_structure ,Endocrinology ,Ventricle ,cardiovascular system ,Cardiology ,Hormone analog ,Propionates ,Cardiology and Cardiovascular Medicine ,business ,Perfusion ,Hormone - Abstract
In view of the evidence that thyroid hormone administration has angiogenic effects on the hypertrophic myocardium, we tested the hypothesis that the capillary supply in the hypertrophic myocardium surviving infarction would be improved by administration of the thyroid hormone analog, diiodothyroproprionic acid (DITPA). We administered DITPA (MI-DITPA) or saline (MI-saline), s.c., to rats for 10 days following experimental infarction of the left ventricle (LV). Morphometric methods were used to assess capillarity and myocyte cross-sectional area in three regions of the left ventricle: (1) border (next to the scar of infarction); (2) adjacent (next to the border); and (3) remote (interventricular septum). Infarct size ranged from 20–85% of the LV free-wall, and both groups had similar mean infarct size. Capillary length density (L v ) was significantly higher in the remote region of the treated group than in the MI-saline rats. L v in the border region, which experienced the most marked increase in cardiocyte cross-sectional area, was not significantly lower than in the other regions, indicating a more marked angiogenic response. In hearts with large infarcts (≥40%) L v in the border region was higher in the DITPA group than in the non-treated rats. In the MI-DITPA group, cardiocyte size in the border region was positively correlated with that of the other regions, which contrasts with the negative correlations noted for the MI-saline rats. These data suggest that DITPA therapy (1) may improve maximal perfusion potential of the hypertrophied myocardium surviving a myocardial infarction, and (2) is selectively effective in the border region of hearts with large infarcts.
- Published
- 1998
29. Incidence of Various Types of Retinal Vein Occlusion and Their Recurrence and Demographic Characteristics
- Author
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Patricia Podhajsky, M. Bridget Zimmerman, and Sohan Singh Hayreh
- Subjects
Adult ,Male ,medicine.medical_specialty ,Retinal Vein ,Adolescent ,Eye disease ,Age Distribution ,Central retinal vein occlusion ,Recurrence ,Risk Factors ,Ophthalmology ,Retinal Vein Occlusion ,Occlusion ,medicine ,Humans ,Sex Distribution ,Vein ,Aged ,Demography ,Probability ,Aged, 80 and over ,Retina ,business.industry ,Incidence ,Middle Aged ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Branch retinal vein occlusion ,Female ,business ,Follow-Up Studies ,Retinopathy - Abstract
We analyzed data on 1,108 patients (1,229 eyes) with various types of retinal vein occlusion. Retinal vein occlusion was classified into six distinct clinical types: (I) nonischemic and (II) ischemic central retinal vein occlusion, (III) nonischemic and (IV) ischemic hemicentral retinal vein occlusion, and (V) major and (VI) macular branch retinal vein occlusion. Retinal vein occlusion occurred more often in men than women. The age range of patients was between 14 and 92 years, with 570 of 1,108 patients (51%) 65 years or older; however, 99 of 620 (16%), 15 of 154 (10%), and 17 of 375 (5%) of the patients with central, hemicentral, and branch retinal vein occlusion, respectively, were younger than 45 years. The cumulative probability of developing a second episode of the same or a different type of retinal vein occlusion in the same eye was 0.9% within two years and 2.5% within four years, and in the fellow eye was 7.7% and 11.9%, respectively. The cumulative probability of conversion of nonischemic to ischemic central retinal vein occlusion at six months and 18 months was 13.2% and 18.6%, respectively, in persons 65 years of age or older and 6.7% and 8.1%, respectively, in persons 45 to 64 years of age.
- Published
- 1994
30. Tu1497 Risk Factors and Disease Burden in Pediatric Acute Recurrent and Chronic Pancreatitis: Report From the INSPPIRE Consortium
- Author
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Sohail Z. Husain, Steven L. Werlin, Cheryl E. Gariepy, Melvin B. Heyman, Aliye Uc, M. Bridget Zimmerman, Matthew J. Giefer, John F. Pohl, Melena D. Bellin, Peter R. Durie, Mark E. Lowe, Douglas Russo, Douglas S. Fishman, Veronique D. Morinville, David M. Troendle, Chee Y. Ooi, Michael Wilschanski, Steven D. Freedman, Ryan Himes, Soma Kumar, Tanja Gonska, Sarah Jane Schwarzenberg, and Bradley A. Barth
- Subjects
medicine.medical_specialty ,Hepatology ,business.industry ,Gastroenterology ,Medicine ,Pancreatitis ,business ,medicine.disease ,Intensive care medicine ,Disease burden - Published
- 2015
31. 1 Assessment of Health Literacy and Asthma Outcomes in the Primary Care Setting
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M. Bridget Zimmerman, Mary Beth Fasano, and Mark Stevens
- Subjects
medicine.medical_specialty ,Nursing ,business.industry ,Family medicine ,Immunology ,Health care ,Immunology and Allergy ,Medicine ,Health literacy ,Primary care ,business ,medicine.disease ,Asthma - Published
- 2013
32. Branch Retinal Artery Occlusion
- Author
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Patricia Podhajsky, M. Bridget Zimmerman, and Sohan Singh Hayreh
- Subjects
medicine.medical_specialty ,Visual acuity ,genetic structures ,Retinal Artery Occlusion ,medicine.diagnostic_test ,business.industry ,Blind spot ,medicine.disease ,Fluorescein angiography ,eye diseases ,Surgery ,Ophthalmology ,Giant cell arteritis ,Branch retinal artery occlusion ,Medicine ,Artery occlusion ,medicine.symptom ,business ,Prospective cohort study - Abstract
Objective To investigate systematically the natural history of visual outcome in branch retinal artery occlusion (BRAO). Design Cohort study. Participants We included 199 consecutive untreated patients (212 eyes) with BRAO, first seen in our clinic from 1973 to 2000. Methods At first visit, all patients had a detailed ophthalmic and medical history, and comprehensive ophthalmic evaluation. Visual evaluation was done by recording visual acuity, using the Snellen visual acuity chart, and visual fields with a Goldmann perimeter. The same ophthalmic evaluation was performed at each follow-up visit. Main Outcome Measures Visual acuity and visual fields. Results We classified BRAO into permanent (133 eyes) and transient (18 eyes) and cilioretinal artery occlusion (CLRAO; 61 eyes). In eyes with permanent BRAO, of the 61 eyes seen within 7 days of onset, initial visual acuity was ≥20/40 in 74%, central scotoma in 20%, central inferior altitudinal defect in 13%, and inferior nasal and superior sector defects in 29% and 24%, respectively. Of those with follow-up, in the eyes with visual acuity Conclusions These findings show that a visual acuity of ≥20/40 is seen initially in 74% of cases of permanent BRAO, 94% of transient BRAO, and 73% of nonarteritic CLRAO alone; and finally on follow-up, in 89%, 100%, and 100% of cases, respectively. The effectiveness of various treatment modalities for visual outcome has to be judged against this background. Financial Disclosure(s) The authors have no proprietary or commercial interest in any materials discussed in this article.
- Published
- 2009
33. T1183 Environmental and Dietary Risk Factors in Microscopic Colitis: A Case-Control Study
- Author
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Phyllis J. Stumbo, Laura D. Aker, Frank A. Mitros, Cyrus P. Tamboli, and M. Bridget Zimmerman
- Subjects
medicine.medical_specialty ,Microscopic colitis ,Hepatology ,Dietary risk ,business.industry ,Internal medicine ,Gastroenterology ,medicine ,Case-control study ,business ,medicine.disease - Published
- 2008
34. Nonarteritic Anterior Ischemic Optic Neuropathy
- Author
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M. Bridget Zimmerman and Sohan Singh Hayreh
- Subjects
medicine.medical_specialty ,Visual acuity ,genetic structures ,business.industry ,Eye disease ,medicine.disease ,eye diseases ,Surgery ,Visual field ,Arteritic anterior ischemic optic neuropathy ,Optic neuropathy ,Ophthalmology ,Medicine ,Anterior ischemic optic neuropathy ,Cranial nerve disease ,medicine.symptom ,business ,Papilledema - Abstract
Objective To investigate systematically the natural history of visual outcome in nonarteritic anterior ischemic optic neuropathy (NAION). Design Cohort study. Participants Three hundred forty consecutive untreated patients (386 eyes) with NAION, first seen in our clinic from 1973 to 2000. Methods At first visit, all patients gave a detailed ophthalmic and medical history and underwent a comprehensive ophthalmic evaluation. Visual evaluation was done by recording visual acuity, using the Snellen visual acuity chart, and visual fields with a Goldmann perimeter. The same ophthalmic evaluation was performed at each follow-up visit. Main Outcome Measures Natural history of visual acuity and visual field outcome in NAION. Results Of the 386 eyes, 332 had 8 weeks or more of follow-up from the initial visit. At the initial visit, in eyes seen ≤2 weeks from onset of symptoms, 49% had visual acuity of ≥20/30 and 23% had ≤20/200; in these eyes, 38% had minimal to mild visual field defect and 43% marked to severe defect. In those who were first seen ≤2 weeks after onset with visual acuity ≤20/70, there was improvement in 41% at 6 months and in 42% at 1 year after the initial visit. Two years after the initial visit, there was deterioration in 9% of eyes with initial visual acuity of ≥20/60, and in 18% of those with initial visual acuity of ≤20/70. In those who were first seen ≤2 weeks of onset with moderate to severe visual field defect, there was improvement in 26% at 6 months and 27% at 1 year after the initial visit. Two years after the initial visit, 27% of eyes with initial minimal to mild field defects showed worsening, as did 19% of those with moderate to severe defects. Conclusions About half of the eyes with NAION presented with almost normal visual acuity (20/15 to 20/30) at the initial visit. Thus, the presence of normal visual acuity does not rule out NAION. Visual acuity and visual fields showed improvement or further deterioration mainly up to 6 months, with no significant change after that.
- Published
- 2008
35. Corneal Transplant Survival after Onset of Severe Endothelial Rejection
- Author
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Rola Ba-Abbad, John E. Sutphin, Michael D. Wagoner, and M. Bridget Zimmerman
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Adult ,Graft Rejection ,Male ,medicine.medical_specialty ,Time Factors ,Graft failure ,Adolescent ,Administration, Topical ,Prednisolone ,Single Center ,Cornea ,Risk Factors ,Patient age ,medicine ,Humans ,Child ,Glucocorticoids ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Medical record ,Endothelium, Corneal ,Graft Survival ,Infant ,Corneal Transplant ,Middle Aged ,Surgery ,Transplantation ,Ophthalmology ,medicine.anatomical_structure ,Child, Preschool ,Female ,Complication ,business ,Keratoplasty, Penetrating - Abstract
To evaluate corneal graft survival after onset of severe endothelial rejection after penetrating keratoplasty (PK).Retrospective case series.One hundred fifty-six patients (161 PKs) treated at a single center.Retrospective review of the medical records of every case of severe endothelial rejection admitted to the King Khaled Eye Specialist Hospital (KKESH) between January 1, 1998 and December 31, 2002. Patients for whom PK had been performed at KKESH between June 1, 1983 and December 31, 2002 and in whom at least 3 months of follow-up was available were included in the statistical analysis.Graft survival.One hundred fifty-seven PKs (152 patients) met the inclusion criteria and were included in the statistical analysis. Four PKs (4 patients) were excluded from the statistical analysis due to inadequate follow-up. The rejection episode was reversed during the first 3 months in 90 grafts (57.3%). By Kaplan-Meier analysis, graft survivals were 42.6% at 1 year and 36.1% at 3 years. The surgical indication for PK significantly correlated with likelihood of reversibility (P0.001) and long-term graft survival (P0.001). Risk factors associated with an increased risk of postrejection graft failure included increasing donor age (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.04-1.24; P = 0.004), increasing patient age (OR, 1.23; 95% CI, 1.11-1.35; P0.001), and history of rejection episodes (P = 0.002).Endothelial rejection is a serious complication of PK, with a high risk of graft failure.
- Published
- 2007
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