Marlyn Woo - Academia.edu (original) (raw)

Papers by Marlyn Woo

The Journal of pediatrics, Jan 18, 2015

To evaluate several alternative measures of forced expiratory volume in 1 second percent predicte... more To evaluate several alternative measures of forced expiratory volume in 1 second percent predicted (FEV1 %pred) variability as potential predictors of future FEV1 %pred decline in patients with cystic fibrosis. We included 13 827 patients age ≥6 years from the Epidemiologic Study of Cystic Fibrosis 1994-2002 with ≥4 FEV1 %pred measurements spanning ≥366 days in both a 2-year baseline period and a 2-year follow-up period. We predicted change from best baseline FEV1 %pred to best follow-up FEV1 %pred and change from baseline to best in the second follow-up year by using multivariable regression stratified by 4 lung-disease stages. We assessed 5 measures of variability (some as deviations from the best and some as deviations from the trend line) both alone and after controlling for demographic and clinical factors and for the slope and level of FEV1 %pred. All 5 measures of FEV1 %pred variability were predictive, but the strongest predictor was median deviation from the best FEV1 %pred...

A53. CYSTIC FIBROSIS: CLINICAL PEDIATRIC STUDIES, 2010

Current Opinion in Pulmonary Medicine, 2001

Clinical Reviews in Allergy & Immunology, 2008

Although significant gains have been made in improving lung function and survival in cystic fibro... more Although significant gains have been made in improving lung function and survival in cystic fibrosis (CF), ultimately respiratory failure is the leading cause of mortality in these patients. For CF patients with end stage lung disease, lung transplantation is an option for treatment. The field of lung transplantation has progressed markedly in the last 20 years. Nonetheless it remains a technically complex and challenging procedure, and patients are at risk for numerous short term and long term complications. Potential transplant recipients must be physically and psychologically prepared for the arduous process involved in lung transplantation. This article will review the history of lung transplantation, indications for transplantation, surgical techniques, and complications of transplantation. Keywords Lung transplant. Solid organ transplant. Surgery Historical background Research on transplant surgical techniques and immunology during the early part of the twentieth century paved the way for the first attempts at lung transplantation. In 1906, Charles Guthrie and Alexis Carrel successfully placed the heart and lungs of a kitten into the neck of a cat (a heterotopic transplant) [1]. Further animal lung transplant surgery (using canine lobes and whole lungs) was carried out over the next 50 years. Surgical technique development coincided with immunological research in the 1920s and 1930s. These early studies helped delineate the important role of immunosuppression medications in graft survival. The first human lung transplant was performed in 1963 by Dr. James Hardy at the University of Mississippi [2]. The patient was an adult man with severe emphysema and a left lung carcinoma. It was felt that the patient could not survive lung resection for treatment of the carcinoma. A single lung transplant was successfully performed, but the patient died of renal failure and malnutrition on postoperative day 18. After Hardy's groundbreaking surgery, there were other attempts at human lung transplantation. These attempts included lobar transplantation in 1968 by Shinoi et al. [3] at the Tokyo Medical College and the first heart-lung transplant (in an infant; the first pediatric lung transplant) by Denton Cooley at the Texas Heart Institute in Houston in 1968 [4]. However, none of these lung transplant surgeries achieved long-term patient survival. However, these attempts did advance the knowledge of

Pediatric Solid Organ Transplantation, 2007

The outcome after intestinal transplantation has improved markedly over the past decade. Initiall... more The outcome after intestinal transplantation has improved markedly over the past decade. Initially considered as an experimental procedure, it is now accepted as a life-saving method in the treatment of patients with intestinal failure. However, the postoperative management after intestinal ...

Pediatric Allergy, Immunology, and Pulmonology, 2012

The 6 Minute Walk Test (6 MWT) has been shown to be a better test for submaximal exercise capacit... more The 6 Minute Walk Test (6 MWT) has been shown to be a better test for submaximal exercise capacity than other submaximal exercise tests. The cystic fibrosis (CF) Health-Related Quality of Life Cystic Fibrosis Questionnaire-Revised (CFQ-R) has been used in CF patients in order to assess the quality of life. There are a few studies that examine measurements of multiple endpoints simultaneously [e.g., pulmonary function test (PFT), exercise capacity, CFQ-R] with treatment in CF pulmonary exacerbation. We hypothesize that the 6MWT is safe to perform during pulmonary exacerbation, and that 6 MWT, CFQ-R, and PFT improve with treatment in CF pulmonary exacerbation. We further hypothesized that the improvements in 6MWT, CFQ-R, and PFT are related. We performed 6 MWT, PFT, and CFQ-R in 21 CF subjects (age 7-20 years) admitted for pulmonary exacerbation. 6 MWT, PFT, and CFQ-R were completed at admission, at the end of week 1, and at the end of week 2. No complications were noted during the 6MWT.The 6MWT, PFT [forced expiratory volume in one second (FEV 1), FVC and forced expiratory flow 25%-75% (FEF 25%-75%)], and CFQ-R domains (Respiratory and Physical) improved significantly at week 2. The physical domain change correlated with the 6MWT improvement, whereas the respiratory domain change correlated with the FEF 25%-75% improvement at week 2. There was no significant relationship observed between the 6MWT and PFT improvements. In conclusion, 6MWT is a safe and well-tolerated test, and it can be utilized as an adjunct or alternative outcome measure to PFT in acute CF pulmonary exacerbation. In addition, multiple outcome measures, including 6MWT and HRQOL, should be utilized to assess the efficacy of treatment in CF pulmonary exacerbation.

Respiratory care, 2018

The population of children requiring home mechanical ventilation has evolved over the years and h... more The population of children requiring home mechanical ventilation has evolved over the years and has grown to include a variety of diagnoses and needs that have led to changes in the care of this unique population. The purpose of this study was to provide a descriptive analysis of pediatric patients requiring home mechanical ventilation after hospitalization and how the evolution of this technology has impacted their care. A retrospective, observational, longitudinal analysis of 164 children enrolled in a university-affiliated home mechanical ventilation program over 26 years was performed. Data included each child's primary diagnosis, date of tracheostomy placement, duration of mechanical ventilation during hospitalization that consisted of home mechanical ventilator initiation, total length of pediatric ICU stay, ventilator settings at time of discharge from pediatric ICU, and disposition (home, facility, or died). Univariate, bivariate, and regression analysis was used as appr...

Progress in Pediatric Cardiology, 1993

Pulmonary Manifestations of Pediatric Diseases, 2009

B73. PEDIATRIC SLEEP, 2011

Pediatric research, 1992

Heart rate variability was assessed in 12 patients with congenital central hypoventilation syndro... more Heart rate variability was assessed in 12 patients with congenital central hypoventilation syndrome (CCHS) and in age- and sex-matched controls using SD of time intervals between R waves (R-R intervals), R-R interval histograms, spectral analysis, and Poincaré plots of sequential R-R intervals over a 24-h period using ambulatory monitoring. Mean heart rates in patients with CCHS were 103.3 +/- 17.7 SD and in controls were 98.8 +/- 21.6 SD (p greater than 0.5, NS). SD analysis of R-R intervals showed similar results in both groups (CCHS 102.2 +/- 36.0 ms versus controls 126.1 +/- 43.3 ms; p greater than 0.1, NS). Spectral analysis revealed that, for similar epochs sampled during quiet sleep and wakefulness, the ratios of low-frequency band to high-frequency band spectral power were increased for 11 of 12 patients with CCHS during sleep, whereas a decrease in these ratios was consistently observed in all controls during comparable sleep states (chi 2 = 20.31; p less than 0.000007). Du...

Pediatric Research, 2005

Congenital Central Hypoventilation Syndrome (CCHS) patients show partial retention of peripheral ... more Congenital Central Hypoventilation Syndrome (CCHS) patients show partial retention of peripheral chemoreception despite impaired ventilatory responses to CO 2 and hypoxia. The condition allows examination of central responses to hyperoxia, which minimizes afferent traffic from peripheral chemoreceptors. We used functional magnetic resonance imaging to assess blood oxygen level-dependent signals over the brain during a baseline and subsequent 2-min hyperoxia (100% O 2 ) period in 14 CCHS and 15 control subjects. After partitioning gray matter and correcting for global effects, the images were analyzed using volume-of-interest time trends followed by repeated-measures ANOVA and conventional cluster analyses. Respiratory rates initially (first 20 s) fell in CCHS, but rose in control subjects; CCHS heart rate increased in the first minute, and then decreased in the second minute, as in controls, but with muted rise and extent of decline. Multiple sites within the cerebellum, midbrain, and pons responded similarly to the challenge in both groups. Response patterns differed early in the right amygdala, paralleling initial respiratory pattern deficits, and late in the right insula, concomitant with cardiac rate differences. Signals also differed between groups in the medial and anterior cingulate, hippocampus, head of caudate, and lentiform nuclei, as well as pontine and midbrain structures and regions within the superior temporal and inferior frontal cortical gyri. The findings emphasize that structures that can alter respiratory timing, such as the amygdala, and modulate sympathetic outflow, such as the right insula, are deficient in CCHS. Medullary and pontine areas targeted by PHOX2B expression are also affected. (Pediatr Res 57: 510-518, 2005) Abbreviations BOLD, blood oxygen level dependent CCHS, Congenital Central Hypoventilation Syndrome EPI, echo planar imaging fMRI, functional magnetic resonance imaging FOV, field of view MNI, Montreal Neurological Institute MRI, magnetic resonance imaging NTS, nucleus of the solitary tract RMANOVA, repeated measures ANOVA SE, standard error TE, time to echo TR, repetition time VOI, volumes of interest ABSTRACT 510