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author:("Yin, waning")
1.  Risk Factors for Osteonecrosis of the Jaws 
Journal of Dental Research  2011;90(4):439-444.
Case reports and cohort studies have linked bisphosphonate therapy and osteonecrosis of the jaws (ONJ), but neither causality nor specific risks for lesion development have been clearly established. We conducted a 1:3 case-control study with three dental Practice-based Research Networks, using dentist questionnaires and patient interviews for collection of data on bisphosphonate therapy, demographics, co-morbidities, and dental and medical treatments. Multivariable logistic regression analyses tested associations between bisphosphonate use and other risk factors with ONJ. We enrolled 191 ONJ cases and 573 controls in 119 dental practices. Bisphosphonate use was strongly associated with ONJ (odds ratios [OR] 299.5 {95%CI 70.0-1282.7} for intravenous [IV] use and OR = 12.2 {4.3-35.0} for oral use). Risk markers included local suppuration (OR = 7.8 {1.8-34.1}), dental extraction (OR = 7.6 {2.4-24.7}), and radiation therapy (OR = 24.1 {4.9-118.4}). When cancer patients (n = 143) were excluded, bisphosphonate use (OR = 7.2 {2.1-24.7}), suppuration (OR = 11.9 {2.0-69.5}), and extractions (OR = 6.6 {1.6-26.6}) remained associated with ONJ. Higher risk of ONJ began within 2 years of bisphosphonate initiation and increased four-fold after 2 years. Both IV and oral bisphosphonate use were strongly associated with ONJ. Duration of treatment > 2 years; suppuration and dental extractions were independent risk factors for ONJ.
PMCID: PMC3144129  PMID: 21317246
osteonecrosis; jaws; bisphosphonates; risk factors
2.  Outcomes in Children Transplanted for Autoimmune Hepatitis 
The outcomes of 113 children with autoimmune hepatitis (AIH), registered with Studies of Pediatric Liver Transplantation and transplanted between 1995 and 2006, were compared with those transplanted for other diagnoses (non-AIH). 4.9% of liver transplants were for AIH. 81% had AIH type 1 and most were transplanted for complications of chronic disease (60%), the majority in females (72%). Transplantation for fulminant AIH was more common in males (52.5% vs. 47.5% chronic, p=0.042). AIH patients differed from non-AIH by: age (13.0±0.4 vs. 4.6±0.1 years, p<0.0001), sex (64.6% female vs.52.9%, p=0.016), ethnicity (48.7% white vs. 58.2%, p<0.0001), initial immunosuppression (tacrolimus based: 72.6% vs. 62.6%, p=0.045; MMF use: 31.0% vs. 21.6 %, p=0.02) and immunosuppression at two years post-transplant (monotherapy: 51.9% vs.17.3%, p<0.0001). Late (>3 months), but not steroid-resistant or chronic rejection, was more common in AIH (log-rank p=0.0015). 5-year post-transplant survival for AIH was 86% (95%CI 73–93). Patient and graft survival, infectious and metabolic complications and re-transplantation rates did not differ between AIH and non-AIH groups. In conclusion, the higher risk for late acute rejection and greater degree of immunosuppression does not compromise outcomes of liver transplantation for AIH. Children transplanted for AIH in North America are typically female adolescents with complications of chronic AIH type 1 and include more children of African-American or Latino-American origin compared to the overall liver transplant population. These observations may inform detection, treatment and surveillance strategies designed to reduce the progression of autoimmune hepatitis and subsequently, the need for transplantation.
PMCID: PMC3078725  PMID: 21445922
Liver transplantation; Pediatrics; Late rejection; Outcome
Immunoreconstitution of HIV-infected (HIV+) patients after treatment with highly antiretroviral therapy (HAART) appears to provoke inflammatory diseases.
Determine whether HIV+ children on HAART (HIV+ HAART+) have a higher incidence of asthma than HIV+ children not on HAART (HIV+ HAART−).
To investigate this possibility, 2,664 children (193 HIV+, 2,471 HIV−) born to HIV+ women were evaluated for the incidence and prevalence of asthma (i.e., asthma medication use), and change of CD4+ T cell percentage with time.
The HIV+ HAART+ children had higher CD4+ T cell percentages, lower CD8+ T cell percentages, and lower viral burdens than the HIV+ HAART− children (P≤0.05 to P≤0.01). The cumulative incidence of asthma medication use in HIV+ HAART+ children at 13.5 year rose to 33.5% vs. 11.5% in HIV+ HAART− children (hazard ratio=3.34, P=0.01) and was equal to that in the HIV− children. In children born prior to the HAART era, the prevalence of asthma medication use for HIV+ HAART+ children at 11 years of age was 10.4% vs. 3.8% for HIV+ HAART− children (odds ratio=3.38, P=0.02) and was equal to that of the HIV− children. The rate of change of CD4+ T cells (percent/year) around the time of first asthma medication for HIV+ HAART+ vs. HIV+ HAART− children was 0.81 vs. −1.43 (P=0.01).
The increased incidence of asthma in HIV+ HAART+ children may be driven by immunoreconstitution of CD4+ T cells.
This HIV model of pediatric asthma may yield clues to help explain the epidemic of asthma in the general pediatric population.
PMCID: PMC3246282  PMID: 18547627
pediatric HIV infection; CD4+ T cell mediated induction of asthma; HAART-produced immunoreconstitution
4.  School outcomes in children registered in the Studies for Pediatric Liver Transplant (SPLIT) consortium 
School performance is an important aspect of functional outcomes for pediatric liver transplant (LT) recipients. This longitudinal analysis conducted through the Studies of Pediatric Liver Transplantation (SPLIT) research consortium examines several indicators of school function in these patients. Thirty-nine centers participated in data collection using a semi-structured questionnaire designed specifically for this study. The survey queried school attendance, performance and educational outcomes including the need for special educational services. Participants included 823/1133 (73%) of eligible patients, mean age 11.34±3.84, 53% female, median age at LT 4.6 (range 0.05-17.8) years, and mean interval from transplant was 5.42±2.79. Overall, 34% of patients were receiving special educational services and 20% had repeated a grade, with older participants more likely to have been held back (p=0.0007). Missing more than 10 days of school per year was reported by one third of the group with this level of absence being more common in older participants (p=0.0024) and children with shorter intervals from LT (<0.0001). Multivariate analysis revealed the following factors were associated with the need for special educational services; type of immunosuppression at six months post-LT, CSA (OR 1.8, CI:1.1-3.1), or other (OR 4.9, CI:1.4-17.6) versus tacrolimus, symptomatic CMV infection within 6 months of LT (OR 3.1:CI 1.6-6.1), and pre-transplant special educational services (OR 22.5, CI:8.6-58.4).
PMCID: PMC2936718  PMID: 20818741
Liver transplantation; special education; health outcomes; learning disabilities

Results 1-4 (4)