Felicia L Trachtenberg

New England Research Institutes, Watertown, Massachusetts, United States

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Publications (95)394.73 Total impact

  • British Journal of Haematology 05/2014; · 4.94 Impact Factor
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    ABSTRACT: Because of internet searches, advice from friends, and pharmaceutical advertising, especially direct-to-consumer advertising, patients are increasingly activated to request medications during a physician encounter.
    Medical care. 04/2014; 52(4):294-9.
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    ABSTRACT: Thalassemia, a chronic blood disease, necessitates life-long adherence to blood transfusions and chelation therapy to reduce iron overload. We examine stability of health-related quality of life (HRQOL) in thalassemia and adherence to chelation therapy over time, especially after changes in chelator choice. Thalassemia Longitudinal Cohort participants in the USA, UK, and Canada completed the SF-36v2 (ages 14+) and the PF-28 CHQ (parents of children <14 years). Chelation adherence was defined as self-reported percent of doses administered in the last 4 weeks. Two hundred and fifty-eight adults/adolescents (mean 29.7 years) and 133 children (mean 8.5 years) completed a mean of 2.8-years follow-up. Children made few chelator changes, whereas a mean of 2.2 changes was observed among the 37 % of adults/adolescents who made chelator changes, mainly due to patient preference or medical necessity. Physical HRQOL improved among those with lower iron burden (better health status) at baseline who made a single change in chelator, but declined among participants with multiple changes and/or high iron burden (worse health status). Mental health improved among participants with lower iron burden, but iron overload was negatively associated with social functioning. Adherence did not significantly change over follow-up except for an increase after a change from deferoxamine (DFO) infusion to oral deferasirox (p = 0.03). Predictors of lower adherence for adults/adolescents at follow-up included side effects, smoking, younger age, problems preparing DFO, increased number of days per week DFO prescribed, and lower physical quality of life . Strategies to balance medical needs with family, work, and personal life may assist in adherence.
    Quality of Life Research 03/2014; · 2.41 Impact Factor
  • F L Trachtenberg, P Shrader, L Barregard, N N Maserejian
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    ABSTRACT: Objective To examine whether greater exposure to resin-based composite materials, which may intra-orally release bisphenol A (BPA), is associated with worse renal function outcomes in children.Design Prospective multi-centre study.Setting Community health dental clinics in Boston and Maine from 1997-2005.Subjects and methods Five hundred and thirty-four New England Children's Amalgam Trial participants aged six to ten years were randomised to treatment with amalgam or resin-based composite restorations over five years of follow-up.Interventions Restorations were placed according to treatment arm, and sealants placed per standard of care. Cumulative composite exposure was calculated using surface-years (each treated surface weighted by number years present).Main outcome measures Urinary excretion of albumin, gamma-glutamyl transpeptidase (gamma-GT), and N-acetyl-β-D-glucosaminidase (NAG) were available for 417 children.Results Analysis of covariance showed no association between exposure to dental composites, polyacid-modified compomer, or flowable composite dental sealants and preventative resin restorations with levels of renal function. There was no association between composite materials and thresholds indicating renal damage in logistic regression models.Conclusions This study found no harmful associations between dental composite materials and renal function in children. Therefore, concerns about renal function need not be a consideration in the choice of dental restoration material or placement of preventative dental sealants.
    British dental journal official journal of the British Dental Association: BDJ online 01/2014; 216(2):E4. · 1.09 Impact Factor
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    ABSTRACT: To examine whether medical decisions regarding evaluation and management of musculoskeletal pain conditions varied systematically by characteristics of the patient or provider. We conducted a balanced factorial experiment among primary care physicians in the US. Physicians (n = 192) viewed 2 videos of different patients (actors) presenting with pain: undiagnosed sciatica symptoms or diagnosed knee osteoarthritis. Systematic variations in patient gender, socioeconomic status, and race and physician gender and experience (<20 versus ≥20 years in practice) permitted estimation of unconfounded effects. Analysis of variance was used to evaluate associations between patient or provider attributes and clinical decisions. Quality of decisions was defined based on the current recommendations of the American College of Rheumatology, American Pain Society, and clinical expert consensus. Despite current recommendations, less than one-third of physicians would provide exercise advice (30.2% for osteoarthritis and 32.8% for sciatica). Physicians with fewer years in practice were more likely to provide advice on lifestyle changes, particularly exercise (P ≤ 0.01), and to prescribe nonsteroidal antiinflammatory drugs for pain relief, both of which were appropriate and consistent with current recommendations for care. Newer physicians ordered fewer tests, particularly basic laboratory investigations or urinalysis. Test ordering decreased as organizational emphasis on business or profits increased. Patient factors and physician gender had no consistent effects on pain evaluation or treatment. Physician education on disease management recommendations regarding exercise and analgesics and implementation of quality measures may be useful, particularly for physicians with more years in practice.
    Arthritis care & research. 01/2014; 66(1):147-56.
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    ABSTRACT: Dental sealant materials may intraorally release their components, including bisphenol-A (BPA), but long-term health effects are uncertain. The New England Children's Amalgam Trial (NECAT) found that composite restorations were associated with psychosocial, but not neuropsychological or physical, outcomes. The previous analysis did not consider sealants and preventive resin restorations (PRRs), which were routinely placed. The purpose of this analysis was to examine sealant/PRR exposure in association with psychosocial and other health outcomes. NECAT recruited 534 six- to 10-year-olds and provided dental care during a five-year follow-up. Annually, examiners conducted psychosocial and neuropsychological tests and measured body mass index (BMI) and fat percentage (BF%). Associations between surface years (SY) of sealants/PRRs and outcomes were tested using multivariable models. Cumulative exposure level to sealants and/or PRRs was not associated with psychosocial assessments (eg, total problems: Child Behavior Checklist, 10-SY β=-0.2±0.3, P=.60) or neuropsychological tests (eg, full-scale IQ, 10-SY β=0.1±0.2, P=.60). There were no associations for changes in BMI-for-age z-score (P=.40), BF% (girls 10-SY β=-0.2±0.3; boys 10-SY β=-0.1±0.3), or menarche (10-SY hazard ratio=0.91, 95% confidence interval=0.83-1.01, P=.08). This study showed no associations between exposure level of dental sealants or PRRs and behavioral, neuropsychological, or physical development in children over 5-years.
    Pediatric dentistry. 01/2014; 36(1):68-75.
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    ABSTRACT: OBJECTIVE:Sudden and unexplained death is a leading cause of infant mortality. Certain characteristics of the sleep environment increase the risk for sleep-related sudden and unexplained infant death. These characteristics have the potential to generate asphyxial conditions. We tested the hypothesis that infants may be exposed to differing degrees of asphyxia in sleep environments, such that vulnerable infants with a severe underlying brainstem deficiency in serotonergic, γ-aminobutyric acid-ergic, or 14-3-3 transduction proteins succumb even without asphyxial triggers (eg, supine), whereas infants with intermediate or borderline brainstem deficiencies require asphyxial stressors to precipitate death.METHODS:We classified cases of sudden infant death into categories relative to a "potential asphyxia" schema in a cohort autopsied at the San Diego County Medical Examiner's Office. Controls were infants who died with known causes of death established at autopsy. Analysis of covariance tested for differences between groups.RESULTS:Medullary neurochemical abnormalities were present in both infants dying suddenly in circumstances consistent with asphyxia and infants dying suddenly without obvious asphyxia-generating circumstances. There were no differences in the mean neurochemical measures between these 2 groups, although mean measures were both significantly lower (P < .05) than those of controls dying of known causes.CONCLUSIONS:We found no direct relationship between the presence of potentially asphyxia conditions in the sleep environment and brainstem abnormalities in infants dying suddenly and unexpectedly. Brainstem abnormalities were associated with both asphyxia-generating and non-asphyxia generating conditions. Heeding safe sleep messages is essential for all infants, especially given our current inability to detect underlying vulnerabilities.
    PEDIATRICS 11/2013; · 4.47 Impact Factor
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    ABSTRACT: Resins used in dental composites, derived from bisphenol-A (BPA), have been shown to alter immune cells. The objective of this study was to explore children's immune function changes in relation to resin composite treatment. We conducted secondary data analysis of the New England Children's Amalgam Trial immune function substudy (N = 59). Immune function was measured pre-treatment and up to five times post-treatment through 5-year follow-up. Multivariable generalized linear regression models were used to estimate the association between three classes of resin composites (bisphenol-A-diglycidyl-dimethacrylate [BisGMA]-based flowables used for preventive sealants; urethane dimethacrylate [UDMA]-based compomer restorations; bisGMA-based restorations) and changes in immune function markers measured annually. Total white blood cell counts and responsiveness of T cells or neutrophils were not appreciably altered by composite treatment levels. Changes in B cell responsiveness were greater throughout follow-up among children with more bisGMA-based composite restorations, which opposed findings for amalgam treatment levels. Monocyte responsiveness changes were decreased at 6 months with greater treatment, but not over longer follow-up. Results of this analysis showed no overt immune function alterations associated with resin composites. Additional research regarding lymphocyte activation may be warranted given the consistency of results within these analyses and with a prior study showing increased B cell activation.
    International Journal of Paediatric Dentistry 09/2013; · 0.92 Impact Factor
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    ABSTRACT: Improved survival in thalassemia has refocused attention on quality of life, including family planning. Understanding the issues associated with infertility and adverse pregnancy outcomes may impact clinical care of patients with thalassemia. We report the number and outcomes of pregnancies among subjects enrolled in Thalassemia Clinical Research Network (TCRN) registries and examine variables associated with successful childbirth. We identified 129 pregnancies in 72 women among the 264 women, age 18 years or older in our dataset. Over 70% of pregnancies resulted in live births and 73/83 (88%) of live births occurred at full term. Most pregnancies (78.2%) were conceived without reproductive technologies. Most (59.3%) pregnancies occurred while on chronic transfusion programs, however only 38.9% were on iron chelation. Four women developed heart problems. Iron burden in women who had conceived was not significantly different from age- and diagnosis-matched controls that had never been pregnant. There was also no difference in pregnancy outcomes associated with diagnosis, transfusion status, diabetes or Hepatitis C infection. Pregnancies occurred in 27.3% of women with thalassemia of child-bearing age in the TCRN registries, a notable increase from our previous 2004 report. With optimal health maintenance, successful pregnancies may be achievable.
    American Journal of Hematology 09/2013; 88(9):771-773. · 4.00 Impact Factor
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    ABSTRACT: Pain reports have become increasingly common and problematic in thalassemia. As patients are living lon-ger, there is a growing need to study pain and to explore its impact on patient lives. The Brief Pain Inventory (BPI) was used quarterly to assess pain and pain interference in patients with thalassemia in North America. The Medical Outcomes Study 36-Item Short Form Health Survey and the Hospital Anxiety and Depression Scale were used to assess quality of life, anxiety and depression. Of the 252 participants, 56% reported pain at least once over the course of this study, with 32% reporting severe pain (7/10); 16% reported pain at all four visits. Increased pain severity significantly interfered with daily life (P < 0.001; regression analysis) and participants with more sites of pain showed an increase in the amount of daily activities affected by pain (P 5 0.001). Participants reporting more visits with pain reported a significantly higher impact on affective and physical function (P < 0.001). Physical quality of life decreased with increasing numbers of visits with pain (P < 0.001). Those who reported one or more sites of pain showed increased symptoms of both depres-sion (P < 0.001) and anxiety (P 5 0.003). Participants reporting at least two visits with pain had higher symp-toms of anxiety (P 5 0.002) and those with at least three visits reported higher symptoms of depression (P 5 0.003). Pain is prevalent in thalassemia and is often a chronic condition that interferes with life. The study highlights the significance of pain in thalassemia and its impact, which should be considered in future research and treatments. Am. J. Hematol. 88:939–943, 2013. V C 2013 Wiley Periodicals, Inc. Introduction Thalassemia is a group of inherited blood disorders that decrease hemoglobin production, which can lead to mild or severe anemia [1]. Because of the wide variability in clinical severity, patients may require no intervention, whereas others need chronic blood transfusions and iron chelation therapy to remove excess iron in the body [1]. The accu-mulation of tissue iron is the leading cause of morbidity and mortality in thalassemia [2]. New developments in transfusion strategies, diagnostic testing and iron chelation therapies have resulted in extended life spans for patients with thalassemia [1–4]. Once known as a fatal disease, thalassemia has evolved into a chronic illness [4]. Effective disease management has increased survival into adulthood and has given patients the opportunity to achieve personal goals [1,4–6]. However, pro-longed life expectancy has also revealed problems that are not well understood [1,3,6]. Pain has become increasingly common and an emergent complication of thalassemia [5,7]. There are a limited number of studies that have observed pain as a significant problem in thalassemia. Scalone et al. [8] identified 62% of patients with thalassemia on chelation reporting pain, although only 1% reported extreme pain. About 34% of participants reported bone pain in the Low Bone Mass Cross-Sectional Observational Study [9]. Data from the Thalassemia Longitudinal Cohort (TLC) study showed 56% of children experience pain, with 11% reporting frequent pain in a 4-week period [7]. Pain increased signifi-cantly with age, with 69% of the adults/adolescents reporting bodily pain in the past 4 weeks, and 28% of those reporting at least moderate pain [7]. Although these reports support that pain is problematic in thalassemia, the data describe pain at one point in time. Unlike these analyses, this pilot study examined pain longitudinally, at four time points, which solely focused on pain and its effects on quality of life. Quality of life is known as an important indicator of overall well-being and has become a valuable tool in measuring the impact chronic illness has on everyday life [10,11]. Assess-ing quality of life makes it possible to measure disease bur-den and can be used to help to determine risk factors that may lead to poor quality of life [10,11]. Published reports have shown that quality of life is significantly impaired in patients with hemoglobinopathies [1,10–13]. According to the PISCES study, patients with sickle cell disease experi-ence poorer quality of life than the general U.S. population [12]. Studies conducted in patients with thalassemia have also described poor quality of life often associated with depression and anxiety. Sobota et al. [10] reported that patients with thalassemia had significantly lower quality of life in comparison with the U.S. population; older patients and those with more disease complications reported the low-est quality of life. Mednick et al. [14] found that 32% of patients with thalassemia indicated experiencing symptoms of anxiety and 11% experiencing symptoms of depression, with more symptoms noted in the older patients. These reports have helped to provide an increased awareness into the burden of chronic health conditions and its impact on everyday life. However, this study was designed to observe the comorbidity of pain and demonstrate its effects on quality of life, as well as lifetime achievements of education, employ-ment and marital status.
    American Journal of Hematology 08/2013; 88:939-943. · 4.00 Impact Factor
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    ABSTRACT: BACKGROUND: Established heart failure in thalassaemia major has a poor prognosis and optimal management remains unclear. METHODS: A 1 year prospective study comparing deferoxamine (DFO) monotherapy or when combined with deferiprone (DFP) for patients with left ventricular ejection fraction (LVEF) <56% was conducted by the Thalassemia Clinical Research Network (TCRN). All patients received DFO at 50--60 mg/kg 12--24 hr/day sc or iv 7 times weekly, combined with either DFP 75 at mg/kg/day (combination arm) or placebo (DFO monotherapy arm). The primary endpoint was the change in LVEF by CMR. RESULTS: Improvement in LVEF was significant in both study arms at 6 and 12 months (p = 0.04), normalizing ventricular function in 9/16 evaluable patients. With combination therapy, the LVEF increased from 49.9% to 55.2% (+5.3% p = 0.04; n = 10) at 6 months and to 58.3% at 12 months (+8.4% p = 0.04; n = 7). With DFO monotherapy, the LVEF increased from 52.8% to 55.7% (+2.9% p = 0.04; n = 6) at 6 months and to 56.9% at 12 months (+4.1% p = 0.04; n = 4). The LVEF trend did not reach statistical difference between study arms (p = 0.89). In 2 patients on DFO monotherapy during the study and in 1 patient on combined therapy during follow up, heart failure deteriorated fatally. The study was originally powered for 86 participants to determine a 5% difference in LVEF improvement between treatments. The study was prematurely terminated due to slow recruitment and with the achieved sample size of 20 patients there was 80% power to detect an 8.6% difference in EF, which was not demonstrated. Myocardial T2* improved in both arms (combination +1.9 +/- 1.6 ms p = 0.04; and DFO monotherapy +1.9 +/- 1.4 ms p = 0.04), but with no significant difference between treatments (p = 0.65). Liver iron (p = 0.03) and ferritin (p < 0.001) both decreased significantly in only the combination group. CONCLUSIONS: Both treatments significantly improved LVEF and myocardial T2*. Although this is the largest and only randomized study in patients with LV decompensation, further prospective evaluation is needed to identify optimal chelation management in these high-risk patients.
    Journal of Cardiovascular Magnetic Resonance 05/2013; 15(1):38. · 4.44 Impact Factor
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    ABSTRACT: Pulmonary hypertension is a common but often overlooked complication associated with thalassemia syndromes. There is limited data on the safety and efficacy of selective pulmonary vasodilators in this at-risk population. We therefore designed a 12-week open-label phase 1/2 pilot-scale proof-of-principle trial of sildenafil therapy in 10 patients with beta-thalassemia and increased risk for pulmonary hypertension based upon an elevated tricuspid regurgitant jet velocity >2.5 m/s on Doppler-echocardiography. Variables measured include Doppler-echocardiography, 6-minute walk distance, Borg Dyspnea Score, New York Heart Association functional class, pulmonary function testing, and laboratory analyses compared at baseline and after 12 weeks of sildenafil. Treatment with sildenafil resulted in a significant decrease in tricuspid regurgitant jet velocity by 13.3% (3.0+/-0.7 vs. 2.6+/-0.5m/s, p=0.04), improved left ventricular end systolic/diastolic volume, and a trend towards a improved New York Heart Association functional class. No significant change in six-minute walk distance was noted. Sildenafil was well tolerated, although minor anticipated adverse events were commonly reported. Total dose amount of sildenafil (mg) taken strongly correlated with % change in nitric oxide metabolite concentration in the plasma (ρ =0.80, p=0.01). A significant increase in plasma and erythrocyte arginine concentration also occurred. Our study suggests that sildenafil is safe and may improve pulmonary hemodynamics in patients at risk for pulmonary hypertension; however efficacy with respect to 6-minute walk distance was not demonstrated. Clinical trials are needed to identify the best treatment strategy for pulmonary hypertension in beta-thalassemia. (clinicaltrials.gov identifier: NCT00872170).
    Haematologica 04/2013; · 5.94 Impact Factor
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    ABSTRACT: Pulmonary hypertension is a common but often overlooked complication associated with thalassemia syndromes. There is limited data on the safety and efficacy of selective pulmonary vasodilators in this at-risk population. We therefore designed a 12-week open-label phase 1/2 pilot-scale proof-of-principle trial of sildenafil therapy in 10 patients with beta-thalassemia and increased risk for pulmonary hypertension based upon an elevated tricuspid regurgitant jet velocity >2.5 m/s on Doppler-echocardiography. Variables measured include Doppler-echocardiography, 6-minute walk distance, Borg Dyspnea Score, New York Heart Association functional class, pulmonary function testing, and laboratory analyses compared at baseline and after 12 weeks of sildenafil. Treatment with sildenafil resulted in a significant decrease in tricuspid regurgitant jet velocity by 13.3% (3.0+/-0.7 vs. 2.6+/-0.5m/s, p=0.04), improved left ventricular end systolic/diastolic volume, and a trend towards a improved New York Heart Association functional class. No significant change in six-minute walk distance was noted. Sildenafil was well tolerated, although minor anticipated adverse events were commonly reported. Total dose amount of sildenafil (mg) taken strongly correlated with % change in nitric oxide metabolite concentration in the plasma (ρ =0.80, p=0.01). A significant increase in plasma and erythrocyte arginine concentration also occurred. Our study suggests that sildenafil is safe and may improve pulmonary hemodynamics in patients at risk for pulmonary hypertension; however efficacy with respect to 6-minute walk distance was not demonstrated. Clinical trials are needed to identify the best treatment strategy for pulmonary hypertension in beta-thalassemia. (clinicaltrials.gov identifier: NCT00872170).
    Haematologica 04/2013; · 5.94 Impact Factor
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    ABSTRACT: Pain is not a symptom generally associated with thalassaemia. However, providers have noted increasing patient reports of pain, creating an impetus for this prospective, observational assessment of pain in thalassaemia patients. The primary study goals were to assess pain prevalence, severity, location, and potential risk factors. This was a multicentre, prospective study of thalassaemia patients receiving care at 12 Thalassaemia Clinical Research Network sites. Pain was assessed using the Brief Pain Inventory. Two hundred and fifty-two thalassaemia patients ranging in age from 12 to 71 years (mean 28·8) were enrolled. Sixty-four per cent reported experiencing pain during the last 4 weeks, 22% of whom reported pain on a daily basis. Ordinal regression analysis of pain ratings demonstrated significant (P < 0·001) correlation of increased age with increased pain, irrespective of diagnosis, transfusion status, gender, bone density, chelator type or iron overload. Eighty-one per cent reported having pain for 1 year or longer and 31% reported pain for five or more years. Pain is a major cause of morbidity and an unrecognized problem for patients with thalassaemia. Age is the strongest predictor of frequency and severity. Little else is known about the aetiology and predictors of this pain syndrome.
    British Journal of Haematology 12/2012; · 4.94 Impact Factor
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    ABSTRACT: BACKGROUND: Understanding patients' views about medication is crucial to maximize adherence. Thalassemia is a congenital blood disorder requiring chronic blood transfusions and daily iron chelation therapy. METHODS: The Beliefs in Medicine Questionnaire (BMQ) was used to assess beliefs in chelation in thalassemia patients from North America and London in the Thalassemia Longitudinal Cohort (TLC) of the Thalassemia Clinical Research Network (TCRN). Chelation adherence was based on patient report of doses administered out of those prescribed in the last four weeks. RESULTS: Of 371 patients (ages 5-58y, mean 24y), 93% were transfused and 92% receiving chelation (26% deferoxamine (DFO; a slow subcutaneous infusion via portable pump), 63% oral, 11% combination). Patients expressed high "necessity" for transfusion (96%), DFO chelation (92%) and oral chelation (89%), with lower "concern" about treatment (48%, 39%, 19% respectively). Concern about oral chelation was significantly lower than that of DFO (p<0.001). Self-reported adherence to chelation was not associated with views about necessity or concerns, but negatively correlated with perceived sensitivity to DFO (Sensitive Soma scale; r=-0.23, p=0.01) and side effects of oral chelation (r=-0.14, p=0.04). High ferritin iron levels, potentially indicating lower adherence, were found in 41% of patients reporting low necessity of oral chelation compared to 24% reporting high necessity (p=0.048). Concerns about treatment were associated with lower quality of life and more symptoms of anxiety and depression. CONCLUSIONS: Despite their requirement for multimodal therapy, thalassemia patients have positive views about medicine, more so than in other disease populations. Patients may benefit from education about the tolerability of chelation and strategies to effectively cope with side effects, both of which might be beneficial in lowering body iron burden.Clinicaltrials.gov identifierNCT00661804.
    Health and Quality of Life Outcomes 12/2012; 10(1):148. · 2.27 Impact Factor
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    ABSTRACT: This exploratory study assessed apoptosis in peripheral blood leucocytes (PBL) from β-thalassaemia patients receiving chronic transfusions and chelation therapy (deferasirox or deferoxamine) at baseline, 1, 6, and 12 months. At baseline, thalassaemic PBLs presented 50% greater levels of Bax (BAX), 75% higher caspase-3/7, 48% higher caspase-8 and 88% higher caspase-9 activities and 428% more nucleosomal DNA fragmentation than control subjects. Only neutrophils correlated significantly with apoptotic markers. Previously, we showed that over the treatment year, hepatic iron declined; we now show that the ratio of Bax/Bcl-2 (BCL2), (-27·3%/year), and caspase-9 activity (-13·3%/year) declined in both treatment groups, suggesting that chelation decreases body iron and indicators of PBL apoptosis.
    British Journal of Haematology 12/2012; · 4.94 Impact Factor
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    ABSTRACT: Background:In neonatal rodents, serotonin (5-HT) neurons are critical for successful autoresuscitation. We hypothesized that caffeine, a respiratory stimulant, would hasten gasping and improve the autoresuscitation of 5-HT-deficient, Pet-1(-/-) mice.Methods:Using a head-out system and ECG, we measured respiratory and heart rate (HR) responses of Pet-1(-/-) and littermates during episodic asphyxia. After a baseline recording, we injected vehicle or caffeine (i.p.) at doses of 1, 5, or 10 mg/kg. We then administered 10 brief (~30 s) episodes of asphyxia, each interspersed with 5 min of room air to allow autoresuscitation. In addition to survival, we measured the duration of hypoxic apnea (time to initiate gasping) and time to recover eupnea and HR.Results:Caffeine dose-dependently hastened gasping and recovery of breathing and heart rate (HR) in Pet-1(-/-), but not wild-type, improving survival across asphyxic episodes. Increased survival was strongly correlated with hastened gasping.Conclusions:Our data suggest that caffeine reduces mortality related to asphyxia and 5-HT deficiency. These findings may be relevant for efforts to reduce the incidence of the sudden infant death syndrome (SIDS), in that SIDS is associated with failed autoresuscitation and reduced brainstem 5-HT.Pediatric Research (2012); doi:10.1038/pr.2012.142.
    Pediatric Research 10/2012; · 2.67 Impact Factor
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    ABSTRACT: Resin-based composite dental restoration materials may release bisphenol-A, an endocrine-disrupting chemical. Using secondary analysis of a randomized clinical safety trial of amalgam vs. composites, we tested the hypothesis that dental restoration materials affect children's growth. Children (N = 218 boys, N = 256 girls) aged 6 to 10 yrs at baseline with ≥ 2 decayed posterior teeth were randomized to amalgam or composites (bisphenol-A-diglycidyl-dimethacrylate composite for permanent teeth, urethane-dimethacrylate compomer for primary teeth) for treatment of posterior caries throughout follow-up. Primary outcomes for this analysis were 5-year changes in BMI-for-age z-scores, body fat percentage (BF%), and height velocity; exploratory analyses (n = 113) examined age at menarche. Results showed no significant differences between treatment assignment and changes in physical development in boys [(composites vs. amalgam) BF%, 4.9 vs. 5.7, p = 0.49; (BMI-z-score) 0.13 vs. 0.25, p = 0.36] or girls (8.8 vs. 7.7, p = 0.95; 0.36 vs. 0.21, p = 0.49). Children with more treatment on primary teeth had greater increases in BF% regardless of material type. Girls assigned to composites had lower risk of menarche during follow-up (hazard ratio = 0.57, 95% CI 0.35-0.95). Overall, there were no significant differences in physical development over 5 years in children treated with composites or amalgam. Additional studies examining these restoration materials in relation to age at menarche are warranted (clinicaltrials.gov number NCT00065988).
    Journal of dental research 09/2012; 91(11):1019-25. · 3.46 Impact Factor
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    ABSTRACT: Aim: To assess the feasibility of collecting electronic pain data from thalassaemia patients, based on its acceptability and convenience to the participants and study team. Methods: Participants in the Thalassemia Clinical Research Network Assessment of Pain Survey Study completed the Brief Pain Inventory (BPI) quarterly by paper or phone interview. Participants in a substudy completed the BPI Short Form daily over three non-consecutive transfusion cycles through an automated telephone system. Results: The consent rate for the main study was 93%, with 93% retention. The substudy had 75% retention, with more than 75% of scheduled calls completed. Regular monitoring of enrolment, missed calls, data quality, and the performance of the subcontractor for the automated system was crucial to fulfillment of the study goals. Conclusions: Use of electronic data collection for patient-reported outcomes was convenient for both patients and study personnel but required human interactions beyond the automated system to maximise data quantity and quality.
    International journal of palliative nursing 09/2012; 18(9):441-5.
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    ABSTRACT: Resin-based dental restorations may intra-orally release their components and bisphenol A. Gestational bisphenol A exposure has been associated with poorer executive functioning in children. To examine whether exposure to resin-based composite restorations is associated with neuropsychological development in children. Secondary analysis of treatment level data from the New England Children's Amalgam Trial, a 2-group randomized safety trial conducted from 1997 to 2006. Children (N=534) aged 6-10 y with ≥2 posterior tooth caries were randomized to treatment with amalgam or resin-based composites (bisphenol-A-diglycidyl-dimethacrylate-composite for permanent teeth; urethane dimethacrylate-based polyacid-modified compomer for primary teeth). Neuropsychological function at 4- and 5-year follow-up (N=444) was measured by a battery of tests of executive function, intelligence, memory, visual-spatial skills, verbal fluency, and problem-solving. Multivariable generalized linear regression models were used to examine the association between composite exposure levels and changes in neuropsychological test scores from baseline to follow-up. For comparison, data on children randomized to amalgam treatment were similarly analyzed. With greater exposure to either dental composite material, results were generally consistent in the direction of slightly poorer changes in tests of intelligence, achievement or memory, but there were no statistically significant associations. For the four primary measures of executive function, scores were slightly worse with greater total composite exposure, but statistically significant only for the test of Letter Fluency (10-surface-years β=-0.8, SE=0.4, P=0.035), and the subtest of color naming (β=-1.5, SE=0.5, P=0.004) in the Stroop Color-Word Interference Test. Multivariate analysis of variance confirmed that the negative associations between composite level and executive function were not statistically significant (MANOVA, P=0.18). Results for greater amalgam exposure were mostly nonsignificant in the opposite direction of slightly improved scores over follow-up. Dental composite restorations had statistically insignificant associations of small magnitude with impairments in neuropsychological test change scores over 4- or 5-years of follow-up in this trial.
    NeuroToxicology 08/2012; 33(5):1291-7. · 2.65 Impact Factor

Publication Stats

2k Citations
394.73 Total Impact Points

Institutions

  • 2004–2014
    • New England Research Institutes
      Watertown, Massachusetts, United States
  • 2013
    • Ann & Robert H. Lurie Children's Hospital of Chicago
      Chicago, Illinois, United States
    • University of Sioux Falls
      Sioux Falls, South Dakota, United States
  • 2010–2013
    • Children's Hospital & Research Center Oakland
      Oakland, California, United States
  • 2004–2012
    • Boston Children's Hospital
      • • Department of Pathology
      • • Department of Neurology
      Boston, MA, United States
  • 2011
    • University of Toronto
      Toronto, Ontario, Canada
    • Children's Memorial Hospital
      Chicago, Illinois, United States
  • 2009
    • Johns Hopkins Bloomberg School of Public Health
      • Department of International Health
      Baltimore, MD, United States
  • 2008
    • Sahlgrenska University Hospital
      Goeteborg, Västra Götaland, Sweden
  • 2007
    • Harvard University
      • Department of Environmental Health
      Boston, MA, United States
  • 2004–2005
    • Harvard Medical School
      • Department of Pathology
      Boston, MA, United States