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Biomedical subjects

James Kelly

Publications and source records attributed to James Kelly.

At least 19 recordsLinked to original sources
PubMed2006

Behavior, neurocognition and quality-of-life in children with sleep-disordered breathing.

OBJECTIVES: To summarize current evidence that sleep-disordered breathing in children is associated with behavioral, neurocognitive and quality-of-life problems and to suggest new lines of investigation for future research on sleep-disordered breathing and behavior. METHODS: A comprehensive review of the medical literature between January 1990 and December 2004 was performed using the National Library of Medicine's PUBMED database. RESULTS: Analysis revealed 33 articles that satisfied the inclusion and exclusion criteria. The total study population in these articles was 22,255 children. Sample sizes per study ranged from 12 to 5728 children. The age range was 2-18 years (mean 6.8+/-2.8). The majority of studies examined behavior, neurocognition or quality-of-life as a single outcome measure. Behavioral problems included reduced attention, hyperactivity, increased aggression, irritability, emotional and peer problems, and somatic complaints. The following neurocognitive skills were affected: memory; immediate recall; visual-spatial functions; attention and vigilance; mental flexibility; and intelligence. The quality-of-life of children with sleep-disordered breathing was similar that of children with asthma or rheumatoid arthritis. Improvements in behavior, neurocognition and quality-of-life scores for children with sleep-disordered breathing were seen after adenotonsillectomy. CONCLUSIONS: There is compelling evidence that sleep-disordered breathing in children is associated with behavioral and neurocognitive problems and leads to reduced quality-of-life. In addition to improvements in sleep, adenotonsillectomy is associated with improvements in behavior, neurocognition and quality-of-life in these children. However, the lack of uniform criteria for the diagnosis of sleep-disordered breathing in children and variation in methods used to assess the outcome of surgical therapy limit our current knowledge and should be addressed by future research. The high prevalence of sleep-disordered breathing in children should make this research a public health priority.

Brain↗
PubMed2006

Long-term changes in behavior after adenotonsillectomy for obstructive sleep apnea syndrome in children.

OBJECTIVE: To study long-term changes in behavior after adenotonsillectomy for obstructive sleep apnea syndrome (OSAS) in children. DESIGN AND SETTING: Prospective study at the University of New Mexico Children's Hospital, Albuquerque, NM. METHODS: Children with polysomnography-proven OSAS underwent adenotonsillectomy. The Behavior Assessment System for Children (BASC) was completed before surgery, within 6 months and 9 to 18 months after surgery. Scores were compared using a paired t test. A P value < or =0.05 was considered significant. RESULTS: The study population included 23 children. Preoperative mean BASC T scores were >50. Children showed significant improvement after adenotonsillectomy in aggression, atypicality, depression, hyperactivity, and somatization within 6 months and 9 to 18 months after surgery (P < or = 0.05). The differences within 6 months and 9 to 18 months after surgery were not statistically significant. CONCLUSIONS: Caregivers report abnormalities in the behavior of children with OSAS. Behavioral abnormalities improve significantly after adenotonsillectomy and are maintained in the long-term. EBM RATING: C-4.

Adenoidectomy↗
PubMed2006

Community exposure to asbestos from a vermiculite exfoliation plant in NE Minneapolis.

Western Mineral Products/W. R. Grace operated a vermiculite plant in a mixed industrial/residential area of northeast Minneapolis from 1936 to 1989. The plant processed vermiculite ore contaminated with amphibole asbestos from a mine in Libby, MT. Air monitoring in the early 1970s found fiber concentrations in excess of 10 fibers per cubic centimeter of air (f/cc), indicating that worker exposure to asbestos was occasionally 100 times the current occupational standard. Residents of the surrounding community also had direct contact with vermiculite processing wastes (containing up to 10% amphibole asbestos) that were made freely available. Children played on waste piles and neighborhood residents hauled the wastes away for home use. In total, 259 contaminated residential properties have been found to date. Reported emission factors and plant process data were used as inputs to model airborne emissions from the plant over several operating scenarios using the U.S. Environmental Protection Agency (EPA) ISC-Prime model. Results estimate short-term air concentrations of asbestos fibers in residential areas nearest the plant may have at times exceeded current occupational standards. Exposure estimates for other pathways were derived primarily from assessments done in Libby by the U.S. EPA. The Northeast Minneapolis Community Vermiculite Investigation (NMCVI) was conducted by the Minnesota Department of Health to identify and characterize the exposures of a cohort of over 6000 people who live or lived in Northeast Minneapolis and may have been exposed to asbestos. This cohort is now being investigated in a respiratory health screening study conducted by the University of Minnesota and the Minnesota Department of Health.

Aluminum Silicates↗
PubMed2006

Comparison of plate-screw systems used in mandibular fracture reduction: finite element analysis.

A finite element model of the human dentate mandible has been developed to provide a comparison of fixation systems used currently for fracture reduction. Volume domains for cortical bone, cancellous bone, and teeth were created and meshed in ANSYS 8.0 based on IGES curves created from computerized tomography data. A unilateral molar clench was loaded on the model with a fracture gap simulated along the symphysis. Results based on Von Mises stress in cortical and cancellous bone surrounding the screws, and on fracture surface spatial fixation, show some relative differences between different screw-plate systems, yet all were judged to be appropriate in their reduction potential.

Adult↗
PubMed2005

Outcome of adenotonsillectomy for obstructive sleep apnea in children under 3 years.

OBJECTIVE: To study the outcome of adenotonsillectomy for obstructive sleep apnea (OSA) in children less than 3 years of age. DESIGN AND SETTING: Prospective study at the University of New Mexico Children's Hospital. Children with OSA underwent pre- and postoperative full-night polysomnography (PSG). Scores were compared using a paired t test. A P -value <0.05 was considered significant. RESULTS: The study population included 20 children. Fifteen (75 %) were male. The mean age was 2.2 years (range, 1.1 to 3.0). Sixteen (80%) children had medical comorbidities. Over 25% of children had postoperative complications including laryngospasm and marked desaturations. The mean preoperative respiratory distress index (RDI) was 34.1 and the mean postoperative RDI was 12.2 ( P < 0.0001). After surgery, 7 (35%) children had an RDI < 5. Thirteen (65%) had a postoperative RDI > or = 5 indicating persistent OSA. CONCLUSION AND SIGNIFICANCE: Children under 3 years show significant improvement in RDI after adenotonsillectomy for OSA, but they may develop complications after surgery. Postoperative PSG is recommended for children under 3 years of age to monitor the severity of persistent OSA. EBM RATING: B-2.

Adenoidectomy↗
PubMed2005

Quality of life after adenotonsillectomy for SDB in children.

OBJECTIVE: To evaluate the relationship between quality of life and the relative severity of sleep-disordered breathing (SDB) and to compare changes in quality of life after adenotonsillectomy in children with similar demographics but with either obstructive sleep apnea syndrome (OSAS) or with milder forms of SDB. STUDY DESIGN AND SETTING: All study participants underwent polysomnography to document the severity of SDB. The effectiveness of adenotonsillectomy for the relief of SDB was evaluated by using the OSA-18 quality of life survey (OSA-18). Preoperative and postoperative OSA-18 scores for each group of children (OSAS and mild SDB) were compared by using a repeated measures ANOVA. Changes between the 2 groups were compared by using an analysis of covariance with the preoperative score as a covariate. RESULTS: The study population included 61 children, 43 with OSAS and 18 with mild SDB. The demographics in the 2 groups were similar. The mean apnea-hypopnea index for children with OSAS was 21 (range, 5-46), and for children with mild SDB, it was 3 (range 0-4.9). The total OSA-18 score and the scores for all domains showed significant improvement after surgery for both groups of children (P < .001). A comparison of mean difference in total and domain scores for the 2 groups of children was not significant. CONCLUSIONS AND SIGNIFICANCE: Preoperative values for the OSA-18 total and domain scores are high in children with either OSAS or mild SDB. Both groups of children show a dramatic improvement in quality of life after adenotonsillectomy and the degree of improvement is similar. Fortunately, surgical therapy with adenotonsillectomy is associated with marked improvement in quality of life for children with either OSAS or mild SDB.

Adenoidectomy↗
PubMed2005

Child behavior after adenotonsillectomy for obstructive sleep apnea syndrome.

OBJECTIVE: To study the behavior of children with obstructive sleep apnea syndrome (OSAS) before and after adenotonsillectomy using a standardized behavioral rating scale completed by caregivers. DESIGN AND SETTING: Prospective study of children with OSAS at the University of New Mexico Children's Hospital, Albuquerque, New Mexico. METHODS: Children between 2.5 and 18 years of age were included in the study and underwent adenotonsillectomy if the results of polysomnography showed an obstructive apnea/hypopnea index (AHI) of 5 or greater. Caregivers completed the Behavior Assessment System for Children (BASC) before surgery and a second time within 6 months of surgery. Pre- and postoperative BASC t scores were compared using a paired t test. Repeated measures analysis of variance was used to evaluate the contributions of several covariants to these change scores. RESULTS: The study population included 52 children. The mean age was 7.1 (range 2.5-14.9) years, and the mean AHI was 16.2 (range 5.0-88.0). Preoperative mean BASC t scores for all behavioral scales and composites were greater than 50. The behavioral scales that showed significant improvement after adenotonsillectomy were aggression, atypicality, depression, hyperactivity, and somatization (p < or = .001). Age, ethnicity, parental education, parental income, and AHI were not correlated with changes in BASC scores. CONCLUSIONS: A high proportion of children with OSAS have externalizing (hyperactivity and aggression) and internalizing (anxiety, depression, and somatization) behavioral problems. These problems improve significantly after adenotonsillectomy. The improvement is dramatic regardless of sex, age, ethnicity, parental education, parental income, or the relative severity of OSAS.

Adenoidectomy↗
PubMed2004

Quality of life after adenotonsillectomy for obstructive sleep apnea in children.

OBJECTIVE: To study changes in quality of life in children after adenotonsillectomy for obstructive sleep apnea (OSA) documented by full-night polysomnography. DESIGN AND SETTING: Prospective study of children with OSA at the University of New Mexico Children's Hospital, Albuquerque. METHODS: Caregivers for children were asked to complete the OSA-18 quality of life survey prior to polysomnography. Children who met inclusion criteria and had a respiratory distress index higher than 1 were enrolled in the study and underwent adenotonsillectomy. Caregivers completed a second OSA-18 survey within 6 months of surgery. Scores from the preoperative and postoperative surveys were compared using the paired t test. RESULTS: The study population included 60 children (mean age, 7.1 [range, 3-12] years), of whom 43 (72%) were male and 30 (50%) were younger than 6 years. Forty-seven children (78%) had a respiratory distress index of 10 or higher. The mean interval between the 2 surveys was 126 days. The mean total OSA-18 score was 71.4 before surgery and 35.8 after surgery. The domain with the greatest change in mean score was sleep disturbance, which improved by 11.5. The changes in total score, in the scores for each domain, and for each item of the OSA-18 survey were highly significant (P<.002). CONCLUSIONS: Children without significant comorbidities show a marked improvement in the domains of sleep disturbance, physical symptoms, emotional symptoms, and daytime functioning as reported by their caregivers after adenotonsillectomy for OSA.

Adenoidectomy↗
PubMed2004

Long-term changes in quality of life after surgery for pediatric obstructive sleep apnea.

OBJECTIVE: To study long-term changes in quality of life in children after adenotonsillectomy for obstructive sleep apnea (OSA) documented by polysomnography. DESIGN AND SETTING: Prospective study of children with OSA at the University of New Mexico Children's Hospital, Albuquerque. METHODS: Children who met inclusion criteria underwent adenotonsillectomy. Caregivers were asked to complete the OSA-18 quality of life survey prior to surgery (survey 1), within 7 months after surgery (short-term) (survey 2), and between 9 and 24 months after surgery (long-term) (survey 3). Scores from the preoperative and postoperative surveys were compared using the paired t test. RESULTS: The study population included 34 children, 27 (79%) of whom were male. The mean age of the children at the time of inclusion in the study was 6.7 years (range, 3.0-16.8 years). The mean total score for survey 1 (76.7) was significantly higher (P<.001) than the mean total score for survey 2 (32.0) or for survey 3 (40.9). However, the domains of sleep disturbance and physical suffering were significantly lower (P<or=.005) in survey 2 than in survey 3. The differences in the domains of emotional distress, daytime problems, and caregiver concerns between survey 2 and survey 3 were not statistically significant. CONCLUSIONS: Caregivers perceive a long-term improvement in quality of life after adenotonsillectomy for OSA although these improvements are more pronounced in the short-term than in the long-term and are not uniform across all domains of the OSA-18 survey.

Adenoidectomy↗
PubMed2004

Outcome of adenotonsillectomy for severe obstructive sleep apnea in children.

OBJECTIVE: To study changes in sleep behavior and quality of life in children after adenotonsillectomy for severe obstructive sleep apnea identified by a respiratory distress index > or = 30. METHODS: Children enrolled in the study underwent adenotonsillectomy and had both pre- and post-operative polysomnography. Caregivers also completed an OSA-18 quality of life survey prior to polysomnography and within 6 months of surgery. Paired Student's t-tests were used to compare pre- and post-operative scores. RESULTS: The study population included 29 children. The mean age was 7.1 years (range 1.4-17.0). The most common comorbidities were obesity, asthma and allergic disease. The mean pre-operative RDI was 63.9 and the mean post-operative RDI was 14.2 (P < .0001). The mean total OSA-18 score before surgery was 77.6 and after surgery was 33.2. The differences in pre- and post-operative OSA-18 total scores and domain scores were significant (P < .0001). CONCLUSION: Children with severe OSA who undergo adenotonsillectomy show a significant improvement in RDI and in quality of life over a period of several months after surgery. However, OSA does not resolve in the majority of these children and post-operative PSG is recommended to identify those who may require additional therapy.

Adenoidectomy↗
PubMed2004

Adenotonsillectomy for obstructive sleep apnea in obese children.

OBJECTIVE: To study changes in sleep behavior and quality of life in obese children after adenotonsillectomy for obstructive sleep apnea. Study design and setting Prospective study at the University of New Mexico Children's Hospital. METHODS: Children who met inclusion criteria and had a respiratory distress index (RDI) greater than 5 were enrolled in the study and underwent adenotonsillectomy. All children underwent preoperative and postoperative full-night polysomnography. Age- and gender-specific percentile BMI was recorded at the time of polysomnography. Caregivers were asked to complete an OSA-18 quality of life survey prior to polysomnography and a second survey within 6 months of surgery. Scores from preoperative and postoperative polysomnography and OSA-18 surveys were compared using the paired Student's t test. RESULTS: The study population included 30 children. Twenty-six children (86%) were male. The mean age of the children at the time of inclusion in the study was 9.3 years; range, 3.0 to 17.2. The mean preoperative BMI was 28.6 (range, 19.2 to 47.1) and the mean postoperative BMI was 27.9 (range, 17.8 to 27.9). A 2-tailed paired t test showed that this difference is not statistically significant (P = 0.06). The mean preoperative RDI was 30.0 and the mean postoperative RDI was 11.6 (P < 0.001). The preoperative mean total OSA-18 score was 78.2 and the postoperative mean total score was 39.8 (P < 0.001). CONCLUSION: Obese children with OSA who undergo adenotonsillectomy show a marked improvement in RDI and in quality of life with no change in BMI. However, in the majority of children, OSA does not resolve.

Adenoidectomy↗
PubMed2004

Microcoblation: nonablative skin rejuvenation.

Microcoblation is the application of a controlled high-energy plasma field to intact aging skin. The treatment is nonablative and yields predictable, reversible histological changes in the epidermis, which result in skin rejuvenation. Recovery time and side effects are minimal. Although the mechanism of action is different, patient satisfaction with microcoblation compares very favorably with microdermabrasion, the traditional method of superficial skin rejuvenation.

Adult↗
PubMed2003

Infiltrating immune cells, but not tumour cells, express FasL in non-small cell lung cancer: No association with prognosis identified in 3-year follow-up.

Non-small cell lung cancer (NSCLC) remains a difficult disease to treat and independent prognostic markers other than tumour stage and histology have not emerged. The immune cell content of solid tumours has been associated with tumour regression and at times, tumour progression. The involvement of immune cells in prognosis of NSCLC is poorly described. Poor immune responses within solid tumours have been linked with tumour production of immunosuppressive cytokines. Tumour expression of FasL is thought to disarm responses through the transduction of a death signal in Fas-expressing T cells. The existence of the 'tumour counterattack' in vivo has been questioned. We undertook to measure T cell and macrophage infiltration of the tumour bed in NSCLC and report the association between immune cell content and prognosis in a limited, 3-year analysis of survival (n = 113). In addition we investigated FasL expression (n = 45). T cells and macrophages were found to frequently infiltrate lung tumours, albeit in small numbers. Generally there were more T cells infiltrating than macrophages. T cell and macrophage numbers were not associated with prognosis. Lung tumours were found not to express FasL, although occasional immune cells surrounding tumour cells were strongly positive. FasL expression was not associated with prognosis in this series. Thus, immune cells infiltrating NSCLC are not capable of suppressing tumour growth, nor are they associated with tumour progression. We report that lung tumours do not express the FasL, and that although some immune cells are FasL positive, this is not a reflection of general immune cell activation.

Adenocarcinoma↗
PubMed2003

Diagnosis and therapy for airway obstruction in children with Down syndrome.

OBJECTIVES: To document the causes of upper airway obstruction in a population of children with Down syndrome and to highlight the role of associated comorbidities. DESIGN AND SETTING: Review of 23 cases involving children with Down syndrome who were referred for upper airway obstruction over a 2(1/2)-year period to the Pediatric Otolaryngology Service of the University of New Mexico, Albuquerque. METHODS: Data on the following variables were obtained: reason for referral, demographics, diagnosis, surgical procedures, complications, and comorbidities. RESULTS: The children ranged in age from 1 day to 10.2 years (mean age, 1.8 years; median age, 6 months). Thirteen children were male and 10 were female. None of the children had subglottic stenosis. Laryngomalacia was the primary diagnosis in 10 children (43%), 8 of whom were younger than 1 month. Obstructive sleep apnea was the primary diagnosis in 11 children (48%), 8 of whom were older than 2 years. All children with obstructive sleep apnea and 4 children with laryngomalacia had a secondary ear, nose, and throat disorder. Gastroesophageal reflux was a comorbidity in 14 children (61%). CONCLUSIONS: The causes, severity, and presentation of upper airway obstruction in children with Down syndrome are related to the age of the child and to associated comorbidities. The treatment of comorbidities and secondary ear, nose, and throat disorders is an integral component of the surgical management of upper airway obstruction in such cases.

Age Factors↗
PubMed2003

The relationship between acute ischaemic stroke and plasma D-dimer levels in patients developing neither venous thromboembolism nor major intercurrent illness.

The true relationship between plasma D-dimers and acute ischaemic stroke (AIS) is uncertain as previous studies investigating this have not screened for subclinical deep vein thrombosis. We addressed this as part of a study in which we screened AIS patients for venous thromboembolism (VTE). We also assessed the performance characteristics of two D-dimer assays as exclusionary tests for VTE in these patients. One hundred and two unselected AIS patients were screened for VTE using magnetic resonance direct thrombus imaging. D-dimers were analysed on days 2, 9, 14 and 21 using the VIDAS immunofluorescent assay (cut-off >or= 500 ng/ml) and the IL test D-dimer immunoturbidimetric assay (cut-off >or= 255 ng/ml). The relationship between D-dimers and AIS was examined in 52 patients neither developing VTE nor intercurrent illness. D-dimers were elevated throughout the study. Median values at the four time points were 652, 692, 737 and 686 ng/ml (VIDAS assay) and 260.5, 268.5, 273 and 283 ng/ml (IL assay). D-dimers were higher in patients aged older than 70 years, with severe stroke or with total anterior circulation infarcts: only age older than 70 years was significantly associated with D-dimer values greater than the median on univariate and multivariable analysis. Both assays were 100% sensitive for VTE. Specificities were 30% (VIDAS assay) and 34% (IL assay). Specificity was adversely affected by age older than 70 and severe versus non-severe stroke. D-dimers are elevated in the first 3 weeks post-AIS after eliminating the confounding effect of subclinical deep vein thrombosis. The VIDAS and IL assays remained sensitive tests for VTE but the specificity was low, limiting their exclusionary efficiency in these patients.

Acute Disease↗