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Mehta N, Pokharna P, Shetty SR. Unwinding the potentials of vitamin C in COVID-19 and other diseases: An updated review. Nutr Health 2023; 29:415-433. [PMID: 36445072 PMCID: PMC9713540 DOI: 10.1177/02601060221139628] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background: The discovery of vitamin C (ascorbic acid) is related to the ancient history of persistent research on the origins of the haemorrhagic disease scurvy. Vitamin C is an important nutrient that aids in a variety of biological and physiological processes. Scientists have been researching the function of vitamin C in the prevention and ailment of sepsis and pneumonia for decades. This has created a potential platform for applying these results to individuals suffering from severe coronavirus infection (COVID-19). Vitamin C's ability to activate and enhance the immune system makes it a promising treatment in the present COVID-19 pandemic. Vitamin C also aids in the activation of vitamin B, the production of certain neurotransmitters, and the transformation of cholesterol into bile acids. Hence, vitamin C is used for the treatment of many diseases. Aim: This review highlights the Vitamin C investigations that are performed by various researchers on patients with COVID 19 infection, the clinical studies and their observations. The authors have additionally updated information on the significance of vitamin C insufficiency, as well as its relevance and involvement in diseases such as cancer, wound healing, iron deficiency anaemia, atherosclerosis and neurodegenerative disorders. Here, we discuss them with the references. Methods: The method used in order to perform literature search was done using SciFinder, PubMed and ScienceDirect. Results: There is a potential role of vitamin C in various diseases including neurodegenerative disorders, COVID-19 and other diseases and the results are highlighted in the review with the help of clinical and preclinical data. Conclusion: More research on vitamin C and the undergoing clinical trials might prove a potential role of vitamin C in protecting the population from current COVID-19 pandemic.
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Affiliation(s)
- Nikhil Mehta
- Department of Pharmaceutics, Shobhaben Pratapbhai Patel School of Pharmacy and Technology Management, SVKMs NMIMS. Mumbai, India
| | - Purvi Pokharna
- Department of Pharmaceutics, Shobhaben Pratapbhai Patel School of Pharmacy and Technology Management, SVKMs NMIMS. Mumbai, India
| | - Saritha R Shetty
- Department of Pharmaceutics, Shobhaben Pratapbhai Patel School of Pharmacy and Technology Management, SVKMs NMIMS. Mumbai, India
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2
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Zhang H, Qin B, Zhao Y, Zhang R, Zhang G. Effects of vitamin C combined with rbFGF on inflammatory factors and oxygen environment in patients with high-voltage electrical burns. Int Wound J 2023; 20:2649-2656. [PMID: 37118938 PMCID: PMC10410347 DOI: 10.1111/iwj.14138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 04/30/2023] Open
Abstract
To investigate the effect of vitamin C combined with recombinant basic fibroblast growth factor (rbFGF) on inflammatory factors and oxygen environment in patients with high-voltage electrical burns. A retrospective analysis of 98 patients with high-voltage electrical burns admitted to our hospital from January 2021 to April 2022. A total of 98 patients were divided into research group and control group, including 49 cases treated with vitamin C combined with rbFGF and 49 cases treated with only rbFGF. The disappearance time of clinical symptoms, wound healing rate, area of granulation tissue growth, level of inflammatory factors, oxygen environment were compared between two groups after one and three courses of treatment. After treatment, the disappearance time of erythema, pain, swelling, blisters, exudate symptoms, wound healing time, scab formation time, and hospitalisation time in the research group were significantly better than those in control group (P < .05). There was no significant difference in the wound healing rate and area of granulation tissue growth between the two groups after one course of treatment (P > .05), while it is significantly better than those in control group after three courses of treatment (P < .05). The inflammatory factors, succinate dehydrogenase (SDH), lactate dehydrogenase (LDH) scores in research group were significantly better than that in control group after three courses of treatment (P < .05). Vitamin C combined with rbFGF may be worthy to reduce inflammatory factors, regulate oxygen environment, which can be popularised and applied in clinical practice.
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Affiliation(s)
- Han Zhang
- Department of Burn and Plastic SurgeryThe First Hospital of Hebei Medicai UniversityShijiazhuangChina
| | - Beibei Qin
- Department of Burn and Plastic SurgeryThe First Hospital of Hebei Medicai UniversityShijiazhuangChina
| | - Yankai Zhao
- Department of Gastrointestinal SurgeryThe First Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Rongpin Zhang
- Intensive Care UnitXinji City Second HospitalXinjiChina
| | - Guihua Zhang
- Department of Burn and Plastic SurgeryThe First Hospital of Hebei Medicai UniversityShijiazhuangChina
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3
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Zhao B, Li M, Sun W, Li J, Liu L, Wang Y, Sun S, Xu L, Qi X, Xie M, Zhou Y, Ni T, Yao Y, Chen P, Yu M, Jiang W, Ning N, Sheng H, Chen E, Wang R, Tong C, Cao Y, Sun M, Mao E. High-dose vitamin C on sepsis: Protocol of a prospective, multi-centered, double-blinded, randomized, and placebo-controlled superiority study. Front Med (Lausanne) 2022; 9:950246. [PMID: 36186784 PMCID: PMC9520308 DOI: 10.3389/fmed.2022.950246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 08/17/2022] [Indexed: 11/21/2022] Open
Abstract
Background Sepsis is an inflammatory syndrome with life-threatening organ dysfunction and high mortality. In the recent 10 years, high-dose intravenous injection of vitamin C, the first-line antioxidant of humans, has received highlighted attention in the field of critical care. The study aims to examine the efficacy and safety of high-dose intravenous injection of vitamin C in the treatment of sepsis. Methods and design Here, we are conducting a prospective, multi-centered, double-blinded, randomized, and placebo-controlled superiority study named High-Dose Vitamin C on Sepsis (HDVCOS). A total of 620 participants diagnosed with sepsis in four participating sites across China that satisfy the eligibility criteria will be randomized at a ratio of 1:1 to receive treatment with a high-dose intravenous injection of vitamin C (200 mg/kg/24 h) or placebo (saline) for 4 days. The primary outcome is 28 days of mortality. The secondary outcomes include the incidence of organ failure, Sequential Organ Failure Assessment (SOFA) score change, organ support, the relationship between plasma vitamin C concentration and outcomes, and adverse events. Conclusion The findings of this study will provide potential evidence for high-dose intravenous injection of vitamin C in the treatment of sepsis. Clinical trial registration [http://www.chictr.org.cn/showprojen.aspx?proj=29851], identifier [ChiCTR1800017633].
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Affiliation(s)
- Bing Zhao
- Department of Emergency of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mengjiao Li
- Department of Emergency of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenwu Sun
- Department of Emergency of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian Li
- Department of The Clinical Research, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Leshan Liu
- Department of The Clinical Research, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yihui Wang
- Department of Emergency of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Silei Sun
- Department of Emergency of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lili Xu
- Department of Emergency of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xing Qi
- Department of Emergency of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mengqi Xie
- Department of Emergency of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuhua Zhou
- Department of Emergency of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tongtian Ni
- Department of Emergency of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Yao
- Department of Emergency of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peili Chen
- Department of Emergency of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Meiling Yu
- Department of Emergency of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weisong Jiang
- Department of Emergency of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ning Ning
- Department of Emergency of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huiqiu Sheng
- Department of Emergency of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Erzhen Chen
- Department of Emergency of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruilan Wang
- Department of Critical Care, First People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Ruilan Wang,
| | - Chaoyang Tong
- Department of Emergency, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
- Chaoyang Tong,
| | - Yu Cao
- Department of Emergency, West China Hospital, Sichuan University, Sichuan, China
- Yu Cao,
| | - Mingwei Sun
- Department of Emergency, Sichuan Provincial People’s Hospital, Sichuan, China
- Mingwei Sun,
| | - Enqiang Mao
- Department of Emergency of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Enqiang Mao,
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Roudi F, Saghi E, Ayoubi SS, Pouryazdanpanah M. Clinical nutrition approach in medical management of COVID-19 hospitalized patients: A narrative review. Nutr Health 2022; 28:357-368. [PMID: 35581719 PMCID: PMC9117992 DOI: 10.1177/02601060221101696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: Malnutrition in COVID-19 hospitalized patients is associated with a high-risk
condition to increase disease severity and prolonging the recovery period.
Therefore, nutritional therapy, including supplements plays a critical role
to reduce disease-related complications and the length of hospital stay. Aim: To review the latest evidence on nutritional management options in COVID-19
hospitalized patients, as well as possibly prescribed supplements.
Methods: This review was conducted by considering the
latest recommendations, using the guidelines of the American Society of
Enteral and Parenteral (ASPEN) and the European Society of Enteral and
Parenteral (ESPEN), and searching Web of Science, PubMed/Medline, ISI, and
Medline databases. The relevant articles were found using a mix of related
mesh terms and keywords. We attempted to cover all elements of COVID-19
hospitalized patients’ dietary management. Results: Energy
demand in COVID-19 patients is a vital issue. Indirect Calorimetry (IC) is
the recommended method to measure resting energy expenditure. However, in
the absence of IC, predictive equations may be used. The ratio of
administered diet for the macronutrients could be based on the phase and
severity of Covid-19 disease. Moreover, there are recommendations for taking
micronutrient supplements with known effects on improving the immune system
or reducing inflammation. Conclusions: Nutritional treatment of
COVID-19 patients in hospitals seems to be an important element of their
medical care. Enteral nutrition would be the recommended feeding method for
early nutrition support. However, data in the COVID-19 nutritional domain
relating to micronutrient supplementation are still fragmentary and
disputed, and further study is required.
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Affiliation(s)
- Fatemeh Roudi
- Department of Nutrition, Faculty of Medicine, 37552Mashhad University of Medical Sciences, Mashhad, Iran
| | - Effat Saghi
- Department of Nutrition, Faculty of Medicine, 37552Mashhad University of Medical Sciences, Mashhad, Iran
| | - Samaneh Sadat Ayoubi
- Department of Nutrition, Faculty of Medicine, 37552Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdieh Pouryazdanpanah
- Department of Nutrition, Public Health School, Kerman University of Medical Sciences, Kerman, Iran
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Abstract
OBJECTIVES To evaluate the presence of vitamin C deficiency in critically ill children admitted to the PICU. DESIGN Single-center prospective observational cohort study. SETTING A 28-bed PICU and a pediatric outpatient sedation room of a tertiary-care teaching hospital. PATIENTS Two pediatric patient groups 0-21 years old were studied: a PICU group and a group receiving deep sedation for elective outpatient procedures (noncritical care group). INTERVENTIONS Vitamin C level was drawn for the PICU group within 24 hours of admission. Vitamin C level was drawn prior to start of deep sedation for the noncritical group. MEASUREMENT AND MAIN RESULTS Vitamin C deficiency was present in 11/60 (18%) in the PICU group and 0/21 (0%) of the noncritical group (p < 0.05). CONCLUSIONS Vitamin C deficiency was prevalent in our patients admitted to PICU.
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Hayashi K, Noguchi-Shinohara M, Sato T, Hosomichi K, Kannon T, Abe C, Domoto C, Yuki-Nozaki S, Mori A, Horimoto M, Yokogawa M, Sakai K, Iwasa K, Komai K, Ishimiya M, Nakamura H, Ishida N, Suga Y, Ishizaki J, Ishigami A, Tajima A, Yamada M. Effects of functional variants of vitamin C transporter genes on apolipoprotein E E4-associated risk of cognitive decline: The Nakajima study. PLoS One 2021; 16:e0259663. [PMID: 34780525 PMCID: PMC8592483 DOI: 10.1371/journal.pone.0259663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 10/22/2021] [Indexed: 01/28/2023] Open
Abstract
Apolipoprotein E E4 (APOE4) is a risk factor for cognitive decline. A high blood vitamin C (VC) level reduces APOE4-associated risk of developing cognitive decline in women. In the present study, we aimed to examine the effects of functional variants of VC transporter genes expressed in the brain (SLC2A1, SLC2A3, and SLC23A2) on APOE4-associated risk of developing cognitive decline. This case–control study involved 393 Japanese subjects: 252 cognitively normal and 141 cognitively impaired individuals (87 mild cognitive impairment and 54 dementia). Database searches revealed that rs1279683 of SLC23A2, and rs710218 and rs841851 of SLC2A1 are functional variants that are significantly associated with the altered expression of the respective genes and genotyped as three single nucleotide variants (SNVs). When stratified by SNV genotype, we found a significant association between APOE4 and cognitive decline in minor allele carriers of rs1279683 (odds ratio [OR] 2.02, 95% CI, 1.05–3.87, p = 0.035) but not in the homozygote carriers of the major allele. Significant associations between APOE4 and cognitive decline were also observed in participants with major allele homozygotes of rs710218 (OR 2.35, 95% CI, 1.05–5.23, p = 0.037) and rs841851 (OR 3.2, 95% CI, 1.58–6.46, p = 0.0012), but not in minor allele carriers of the respective SNVs. In contrast, the three functional SNVs showed no significant effect on cognitive decline. Our results imply that functional SNVs of VC transporter genes can affect APOE4-associated risk of developing cognitive decline via altered VC levels in the brain.
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Affiliation(s)
- Koji Hayashi
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
- Department of Bioinformatics and Genomics, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Moeko Noguchi-Shinohara
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
- Department of Preemptive Medicine for Dementia, Kanazawa University Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Takehiro Sato
- Department of Bioinformatics and Genomics, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Kazuyoshi Hosomichi
- Department of Bioinformatics and Genomics, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Takayuki Kannon
- Department of Bioinformatics and Genomics, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Chiemi Abe
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Chiaki Domoto
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Sohshi Yuki-Nozaki
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Ayaka Mori
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Mai Horimoto
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Masami Yokogawa
- Department of Physical Therapy, Division of Health Sciences, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Kenji Sakai
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Kazuo Iwasa
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
- Ishikawa Prefectural Nursing University, Kahoku, Japan
| | - Kiyonobu Komai
- Department of Neurology, Iou Hospital National Hospital Organization, Kanazawa, Japan
| | - Mai Ishimiya
- Department of Oral and Maxillofacial Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Hiroyuki Nakamura
- Department of Oral and Maxillofacial Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
- Department of Oral and Maxillofacial Surgery, Ryukyu University Hospital, Nishihara, Japan
| | - Natsuko Ishida
- Clinical Pharmacy and Healthcare Sciences, Faculty of Pharmacy, Institute of Medical, Pharmaceutical & Health Science, Kanazawa University, Kanazawa, Japan
| | - Yukio Suga
- Clinical Pharmacy and Healthcare Sciences, Faculty of Pharmacy, Institute of Medical, Pharmaceutical & Health Science, Kanazawa University, Kanazawa, Japan
| | - Junko Ishizaki
- Clinical Pharmacy and Healthcare Sciences, Faculty of Pharmacy, Institute of Medical, Pharmaceutical & Health Science, Kanazawa University, Kanazawa, Japan
| | - Akihito Ishigami
- Molecular Regulation of Aging, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Atsushi Tajima
- Department of Bioinformatics and Genomics, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
- * E-mail: (AT); (MY)
| | - Masahito Yamada
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
- * E-mail: (AT); (MY)
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Dacoreggio MV, Santetti GS, Inácio HP, Kempka AP, de Mello Castanho Amboni RD. A Comprehensive Review of Eugenia Pyriformis Cambess: Reported Bioactivities and Health Effects. FOOD REVIEWS INTERNATIONAL 2021. [DOI: 10.1080/87559129.2021.1958226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Marina Volpato Dacoreggio
- Departamento de Ciência e Tecnologia de Alimentos, Universidade Federal de Santa Catarina, Florianópolis, Brasil
| | - Gabriela Soster Santetti
- Departamento de Ciência e Tecnologia de Alimentos, Universidade Federal de Santa Catarina, Florianópolis, Brasil
| | - Heloísa Patrício Inácio
- Departamento de Ciência e Tecnologia de Alimentos, Universidade Federal de Santa Catarina, Florianópolis, Brasil
| | - Aniela Pinto Kempka
- Departamento de Engenharia de Alimentos e Engenharia Química, Universidade do Estado de Santa Catarina, Pinhalzinho, Brasil
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Martínez Leo EE, Peñafiel AM, Hernández Escalante VM, Cabrera Araujo ZM. Ultra-processed diet, systemic oxidative stress, and breach of immunologic tolerance. Nutrition 2021; 91-92:111419. [PMID: 34399404 DOI: 10.1016/j.nut.2021.111419] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 06/24/2021] [Accepted: 07/13/2021] [Indexed: 12/28/2022]
Abstract
In recent years, consumption of ultra-processed food around the world has been increasing. The nutritional profile of an ultra-processed diet is associated with the development of cellular alterations that lead to oxidative stress. The chronic prooxidative state leads to an environment that influences the proliferation, apoptosis, and signaling pathways of immune cells. Likewise, the decrease in the transcription factor NRF2, owing to exacerbated production of reactive oxygen species, leads to changes in immune function and response to infections. This review aims to analyze the connection between an ultra-processed diet, systemic oxidative stress, and immune tolerance, as a contribution to the scientific evidence on the impact of oxidative stress on health and the possible risk of infections-an important consideration in the association of eating pattern and the immune response.
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Affiliation(s)
- Edwin E Martínez Leo
- Research Department, University Latino, Merida, Mexico; School of Medicine, Autonomous University of Yucatan, Merida, Mexico.
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9
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Witkamp RF. Nutrition to Optimise Human Health-How to Obtain Physiological Substantiation? Nutrients 2021; 13:2155. [PMID: 34201670 PMCID: PMC8308379 DOI: 10.3390/nu13072155] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/19/2021] [Accepted: 06/21/2021] [Indexed: 12/12/2022] Open
Abstract
Demonstrating in an unambiguous manner that a diet, let alone a single product, 'optimizes' health, presents an enormous challenge. The least complicated is when the starting situation is clearly suboptimal, like with nutritional deficiencies, malnutrition, unfavourable lifestyle, or due to disease or ageing. Here, desired improvements and intervention strategies may to some extent be clear. However, even then situations require approaches that take into account interactions between nutrients and other factors, complex dose-effect relationships etc. More challenging is to substantiate that a diet or a specific product optimizes health in the general population, which comes down to achieve perceived, 'non-medical' or future health benefits in predominantly healthy persons. Presumed underlying mechanisms involve effects of non-nutritional components with subtle and slowly occurring physiological effects that may be difficult to translate into measurable outcomes. Most promising strategies combine classical physiological concepts with those of 'multi-omics' and systems biology. Resilience-the ability to maintain or regain homeostasis in response to stressors-is often used as proxy for a particular health domain. Next to this, quantifying health requires personalized strategies, measurements preferably carried out remotely, real-time and in a normal living environment, and experimental designs other than randomized controlled trials (RCTs), for example N-of-1 trials.
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Affiliation(s)
- Renger F Witkamp
- Division of Human Nutrition and Health, Wageningen University & Research (WUR), 6700 AA Wageningen, The Netherlands
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10
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Xing X, Xu M, Yang L, Zhang W, Niu X, Gao D. The efficacy of intravenous vitamin C in critically ill patients: A meta-analysis of randomized controlled trials. Clin Nutr 2021; 40:2630-2639. [PMID: 33933729 DOI: 10.1016/j.clnu.2021.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/18/2021] [Accepted: 03/08/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND & AIMS A large number of clinical studies have shown that intravenous vitamin C supplementation is beneficial for critically ill patients, but current research conclusions are controversial. This meta-analysis included high-quality randomized controlled trials (RCTs) to evaluate the efficacy of intravenous vitamin C in critically ill patients. METHODS We searched PubMed, EMBASE and the Cochrane Library from inception to August 15, 2020 to identify published reports of RCTs evaluating the role of intravenous vitamin C in critically ill patients. Risk ratios values (RRs) and 95% confidence intervals (CIs) were calculated by random-effects meta-analysis. Trial sequential analysis (TSA), meta-regression, subgroup analyses and sensitivity analyses were also performed. RESULTS Our meta-analysis included 18 RCTs involving 2001 patients (1005 with vitamin C treatment and 996 control treatment). Intravenous vitamin C administration reduced the intensive care unit (ICU) length of stay (LOS) (MD = -0.36, 95% CI: -0.60 to -0.11, P = 0.004) and hospital LOS (MD = -1.50, 95% CI: -2.64 to -0.35, P = 0.01) but had no significant effect on the longest follow-up mortality, hospital or ICU mortality and change in Sequential Organ Failure Assessment (SOFA) score. TSAs for mortality, ICU and hospital LOS were inconclusive. CONCLUSIONS Intravenous vitamin C administration may shorten ICU LOS and hospital LOS. It had no effect on mortality and organ failure. All TSAs were inconclusive, and the value of vitamin C for critically ill patients needs to be demonstrated in more high-quality RCTs.
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Affiliation(s)
- Xin Xing
- Department of Cardiology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China
| | - Min Xu
- Department of Cardiology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China
| | - Lijun Yang
- Department of Cardiology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China
| | - Wenqian Zhang
- Department of Cardiology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China
| | - Xiaolin Niu
- Department of Cardiology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China; Department of Cardiology, Meishan Brach of the Third Affiliated Hospital, Yanan University School of Medical, Meishan, Sichuan, PR China.
| | - Dengfeng Gao
- Department of Cardiology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China.
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11
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COVID-19 Drives Consumer Behaviour and Agro-Food Markets towards Healthier and More Sustainable Patterns. SUSTAINABILITY 2020. [DOI: 10.3390/su12208366] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This study examines the extant state of research into our understanding of the impact of the coronavirus pandemic in its early stages on food-purchasing behaviour. As such, it includes a summary and categorisation of the findings, extending to consumption preferences worldwide. After the indiscriminate stockpiling of food, which was witnessed in many countries following the implementation of the lockdown, the impact of COVID-19 (COronaVIrus Disease-2019) on consumer habits has inversely varied in function of personal attitudes, individual and household experiences, and characteristics. Specific contexts, and the financial, economic, and logistic nature of these contexts, have also been found to be of relevance in examining the research relating to the coronavirus pandemic and food-purchasing behaviour. Concurrent with the pandemic, some worldwide trends have emerged—home cooking has been rediscovered, leading to an increase in the demand for staple foodstuffs, and purchases from small, local retailers and online food shopping have been accorded preferential treatment. Despite price volatility and concern about future household incomes, a significant proportion of consumers have shifted to buying healthier, more sustainable food. Moreover, food wastage has seen a notable decrease in volume. Such an occasion should be strategically exploited by manufacturers and retailers in satisfying this consumer demand. Finally, the COVID-19 crisis would seem to offer an unparalleled opportunity to re-engineer the agro-food market by driving the transition toward more sustainable supply and production patterns. Thus, stronger and more equitable partnerships between farmers, manufacturers, retailers, and citizens may be in the process of being forged.
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12
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Scarmozzino F, Visioli F. Covid-19 and the Subsequent Lockdown Modified Dietary Habits of Almost Half the Population in an Italian Sample. Foods 2020; 9:E675. [PMID: 32466106 PMCID: PMC7278864 DOI: 10.3390/foods9050675] [Citation(s) in RCA: 311] [Impact Index Per Article: 77.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/06/2020] [Accepted: 05/18/2020] [Indexed: 12/11/2022] Open
Abstract
The Covid-19 pandemic led to lockdowns in several parts of the world and, hence, changed some daily habits, including social interactions, the ability to perform sports, and-possibly-diet. The Italian government established and promulgated lockdown policies on 9 March 2020. We aim at assessing the effects of Covid-19-induced confinement policies on self-reported food consumption of self-selected Italians by means of a questionnaire that was created and diffused by the Internet. Nearly half, i.e., 49.6% of responders did not substantially modify their diet during the lockdown; however, 46.1% of them reported that they were eating more during confinement, and 19.5% gained weight. In particular, we report an increase in "comfort food" consumption, notably chocolate, ice-cream, and desserts (42.5%) and salty snacks (23.5%). In addition, 42.7% percent of this cohort attributed this increase to higher anxiety levels. Related to this, 36.8% of responders reported a decrease in alcohol consumption, even though 10.1% of them reported an increase. Interestingly, 21.2% of responders increased their consumption of fresh fruit and vegetables. Only 33.5% of those who declared decreased consumption attributed this change of diet to lower availability and ease of purchasing such items. Equally interesting, over half of responders, i.e., 56.2%, admitted that fruit and vegetables did not appeal to them while in lockdown. Purchases of ready-made meals were reduced by nearly 50%. Future large-scale similar studies should be undertaken worldwide and will help public health authorities shape their reactions to future, unavoidable pandemics.
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Affiliation(s)
- Federico Scarmozzino
- Department of Molecular Medicine, University of Padova, Viale G. Colombo 3, 35121 Padova, Italy;
| | - Francesco Visioli
- Department of Molecular Medicine, University of Padova, Viale G. Colombo 3, 35121 Padova, Italy;
- IMDEA-Food, CEI UAM + CSIC, 28049 Madrid, Spain
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Honore PM, Spapen HD, Marik P, Boer W, Oudemans-van Straaten H. Dosing vitamin C in critically ill patients with special attention to renal replacement therapy: a narrative review. Ann Intensive Care 2020; 10:23. [PMID: 32052229 PMCID: PMC7016079 DOI: 10.1186/s13613-020-0640-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 02/06/2020] [Indexed: 01/02/2023] Open
Abstract
Rationale/methods The primary aim of the present contribution is to find a literature-based agreement on dose adjustments of vitamin C in critically ill patients undergoing renal replacement therapy (RRT). Available data/study results Critical illness is frequently accompanied by severe vitamin C deficiency. High-dose supplementation beneficially affects clinical outcome in small cohorts of patients with sepsis, burn injury, and trauma. There are no specific data on clinical outcomes in patients receiving renal replacement therapy (RRT). Vitamin C plasma concentrations in patients on RRT are comparable to critically ill patients not receiving RRT. Vitamin C is cleared from the circulation during RRT at a rate dependent on the plasma concentration, dose and duration of RRT. Sieving coefficient is about 1. While the dose of RRT is lower than normal renal function, tubular reabsorption is absent. Sparse evidence suggests that vitamin C dosing during continuous RRT should not exceed the dose administered to critically ill patients not receiving continuous RRT. Low plasma concentrations are expected during prolonged RRT because of persistent extracorporeal removal, absent renal reabsorption and enhanced metabolic loss due to circuit-induced oxidative stress. A dosage of twice 1 g vitamin C daily may be necessary to achieve normal plasma concentrations during RRT, but more studies are needed. There is no available evidence that high doses of vitamin C administered over a short period can induce oxalate stones or has pro-oxidant effects. Conclusions Supplementing vitamin C 1 g twice daily to critically ill patients has a solid pathophysiological rationale and a good safety profile. Patients on RRT probably need similar doses as critically ill patients not receiving RRT. Intravenous vitamin C in a dose of 2 g/day may be necessary to achieve normal plasma concentrations during RRT. However, data on dose adjustment of vitamin C during intermittent or chronic RRT are sparse and require more thorough pharmacokinetic and dose–response studies.
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Affiliation(s)
- Patrick M Honore
- ICU Dept, Centre Hospitalier Universitaire Brugmann/Brugmann University Hospîtal, Place Van Gehuchtenplein, 4, 1020, Brussels, Belgium.
| | - Herbert D Spapen
- Development, Ageing & Pathology Research Department, Vrije Universiteit Brussel, Brussels, Belgium
| | - Paul Marik
- Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, 825 Fairfax Av, Suite 410, Norfolk, VA, 23507, USA
| | - Willem Boer
- Dept. of Anesthesiology, Intensive Care Medicine, Emergency Medicine & Pain Medicine, Ziekenhuis Oost-Limburg Genk, Genk, Belgium
| | - Heleen Oudemans-van Straaten
- Department of Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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15
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Weiss SL, Peters MJ, Alhazzani W, Agus MSD, Flori HR, Inwald DP, Nadel S, Schlapbach LJ, Tasker RC, Argent AC, Brierley J, Carcillo J, Carrol ED, Carroll CL, Cheifetz IM, Choong K, Cies JJ, Cruz AT, De Luca D, Deep A, Faust SN, De Oliveira CF, Hall MW, Ishimine P, Javouhey E, Joosten KFM, Joshi P, Karam O, Kneyber MCJ, Lemson J, MacLaren G, Mehta NM, Møller MH, Newth CJL, Nguyen TC, Nishisaki A, Nunnally ME, Parker MM, Paul RM, Randolph AG, Ranjit S, Romer LH, Scott HF, Tume LN, Verger JT, Williams EA, Wolf J, Wong HR, Zimmerman JJ, Kissoon N, Tissieres P. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med 2020; 46:10-67. [PMID: 32030529 PMCID: PMC7095013 DOI: 10.1007/s00134-019-05878-6] [Citation(s) in RCA: 275] [Impact Index Per Article: 68.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To develop evidence-based recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with septic shock and other sepsis-associated organ dysfunction. DESIGN A panel of 49 international experts, representing 12 international organizations, as well as three methodologists and three public members was convened. Panel members assembled at key international meetings (for those panel members attending the conference), and a stand-alone meeting was held for all panel members in November 2018. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. Teleconferences and electronic-based discussion among the chairs, co-chairs, methodologists, and group heads, as well as within subgroups, served as an integral part of the guideline development process. METHODS The panel consisted of six subgroups: recognition and management of infection, hemodynamics and resuscitation, ventilation, endocrine and metabolic therapies, adjunctive therapies, and research priorities. We conducted a systematic review for each Population, Intervention, Control, and Outcomes question to identify the best available evidence, statistically summarized the evidence, and then assessed the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. We used the evidence-to-decision framework to formulate recommendations as strong or weak, or as a best practice statement. In addition, "in our practice" statements were included when evidence was inconclusive to issue a recommendation, but the panel felt that some guidance based on practice patterns may be appropriate. RESULTS The panel provided 77 statements on the management and resuscitation of children with septic shock and other sepsis-associated organ dysfunction. Overall, six were strong recommendations, 49 were weak recommendations, and nine were best-practice statements. For 13 questions, no recommendations could be made; but, for 10 of these, "in our practice" statements were provided. In addition, 52 research priorities were identified. CONCLUSIONS A large cohort of international experts was able to achieve consensus regarding many recommendations for the best care of children with sepsis, acknowledging that most aspects of care had relatively low quality of evidence resulting in the frequent issuance of weak recommendations. Despite this challenge, these recommendations regarding the management of children with septic shock and other sepsis-associated organ dysfunction provide a foundation for consistent care to improve outcomes and inform future research.
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Affiliation(s)
- Scott L Weiss
- Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Mark J Peters
- Great Ormond Street Hospital for Children, London, UK
| | - Waleed Alhazzani
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods and Impact, McMaster University, Hamilton, ON, Canada
| | - Michael S D Agus
- Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | | | - Luregn J Schlapbach
- Paediatric Critical Care Research Group, The University of Queensland and Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Robert C Tasker
- Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrew C Argent
- Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa
| | - Joe Brierley
- Great Ormond Street Hospital for Children, London, UK
| | | | | | | | | | - Karen Choong
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods and Impact, McMaster University, Hamilton, ON, Canada
| | - Jeffry J Cies
- St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | | | - Daniele De Luca
- Paris South University Hospitals-Assistance Publique Hopitaux de Paris, Paris, France
- Physiopathology and Therapeutic Innovation Unit-INSERM U999, South Paris-Saclay University, Paris, France
| | | | - Saul N Faust
- University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
| | | | - Mark W Hall
- Nationwide Children's Hospital, Columbus, OH, USA
| | | | | | | | - Poonam Joshi
- All India Institute of Medical Sciences, New Delhi, India
| | - Oliver Karam
- Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | | | - Joris Lemson
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Graeme MacLaren
- National University Health System, Singapore, Singapore
- Royal Children's Hospital, Melbourne, VIC, Australia
| | - Nilesh M Mehta
- Department of Anesthesiology, Critical Care and Pain, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | | | - Akira Nishisaki
- Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Mark E Nunnally
- New York University Langone Medical Center, New York, NY, USA
| | | | - Raina M Paul
- Advocate Children's Hospital, Park Ridge, IL, USA
| | - Adrienne G Randolph
- Department of Anesthesiology, Critical Care and Pain, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | | | | | - Judy T Verger
- Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- College of Nursing, University of Iowa, Iowa City, IA, USA
| | | | - Joshua Wolf
- St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | | | | | - Pierre Tissieres
- Paris South University Hospitals-Assistance Publique Hopitaux de Paris, Paris, France
- Institute of Integrative Biology of the Cell-CNRS, CEA, Univ Paris Sud, Gif-Sur-Yvette, France
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16
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Weiss SL, Peters MJ, Alhazzani W, Agus MSD, Flori HR, Inwald DP, Nadel S, Schlapbach LJ, Tasker RC, Argent AC, Brierley J, Carcillo J, Carrol ED, Carroll CL, Cheifetz IM, Choong K, Cies JJ, Cruz AT, De Luca D, Deep A, Faust SN, De Oliveira CF, Hall MW, Ishimine P, Javouhey E, Joosten KFM, Joshi P, Karam O, Kneyber MCJ, Lemson J, MacLaren G, Mehta NM, Møller MH, Newth CJL, Nguyen TC, Nishisaki A, Nunnally ME, Parker MM, Paul RM, Randolph AG, Ranjit S, Romer LH, Scott HF, Tume LN, Verger JT, Williams EA, Wolf J, Wong HR, Zimmerman JJ, Kissoon N, Tissieres P. Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children. Pediatr Crit Care Med 2020; 21:e52-e106. [PMID: 32032273 DOI: 10.1097/pcc.0000000000002198] [Citation(s) in RCA: 478] [Impact Index Per Article: 119.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To develop evidence-based recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with septic shock and other sepsis-associated organ dysfunction. DESIGN A panel of 49 international experts, representing 12 international organizations, as well as three methodologists and three public members was convened. Panel members assembled at key international meetings (for those panel members attending the conference), and a stand-alone meeting was held for all panel members in November 2018. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. Teleconferences and electronic-based discussion among the chairs, co-chairs, methodologists, and group heads, as well as within subgroups, served as an integral part of the guideline development process. METHODS The panel consisted of six subgroups: recognition and management of infection, hemodynamics and resuscitation, ventilation, endocrine and metabolic therapies, adjunctive therapies, and research priorities. We conducted a systematic review for each Population, Intervention, Control, and Outcomes question to identify the best available evidence, statistically summarized the evidence, and then assessed the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. We used the evidence-to-decision framework to formulate recommendations as strong or weak, or as a best practice statement. In addition, "in our practice" statements were included when evidence was inconclusive to issue a recommendation, but the panel felt that some guidance based on practice patterns may be appropriate. RESULTS The panel provided 77 statements on the management and resuscitation of children with septic shock and other sepsis-associated organ dysfunction. Overall, six were strong recommendations, 52 were weak recommendations, and nine were best-practice statements. For 13 questions, no recommendations could be made; but, for 10 of these, "in our practice" statements were provided. In addition, 49 research priorities were identified. CONCLUSIONS A large cohort of international experts was able to achieve consensus regarding many recommendations for the best care of children with sepsis, acknowledging that most aspects of care had relatively low quality of evidence resulting in the frequent issuance of weak recommendations. Despite this challenge, these recommendations regarding the management of children with septic shock and other sepsis-associated organ dysfunction provide a foundation for consistent care to improve outcomes and inform future research.
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Affiliation(s)
- Scott L Weiss
- Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Mark J Peters
- Great Ormond Street Hospital for Children, London, United Kingdom
| | - Waleed Alhazzani
- Department of Medicine, Division of Critical Care, and Department of Health Research Methods and Impact, McMaster University, Hamilton, ON, Canada
| | - Michael S D Agus
- Department of Pediatrics (to Dr. Agus), Department of Anesthesiology, Critical Care and Pain (to Drs. Mehta and Randolph), Boston Children's Hospital and Harvard Medical School, Boston, MA
| | | | | | | | - Luregn J Schlapbach
- Paediatric Critical Care Research Group, The University of Queensland and Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Robert C Tasker
- Department of Pediatrics (to Dr. Agus), Department of Anesthesiology, Critical Care and Pain (to Drs. Mehta and Randolph), Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Andrew C Argent
- Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa
| | - Joe Brierley
- Great Ormond Street Hospital for Children, London, United Kingdom
| | | | | | | | | | - Karen Choong
- Department of Medicine, Division of Critical Care, and Department of Health Research Methods and Impact, McMaster University, Hamilton, ON, Canada
| | - Jeffry J Cies
- St. Christopher's Hospital for Children, Philadelphia, PA
| | | | - Daniele De Luca
- Paris South University Hospitals-Assistance Publique Hopitaux de Paris, Paris, France.,Physiopathology and Therapeutic Innovation Unit-INSERM U999, South Paris-Saclay University, Paris, France
| | - Akash Deep
- King's College Hospital, London, United Kingdom
| | - Saul N Faust
- University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, United Kingdom
| | | | - Mark W Hall
- Nationwide Children's Hospital, Columbus, OH
| | | | | | | | - Poonam Joshi
- All India Institute of Medical Sciences, New Delhi, India
| | - Oliver Karam
- Children's Hospital of Richmond at VCU, Richmond, VA
| | | | - Joris Lemson
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Graeme MacLaren
- National University Health System, Singapore, and Royal Children's Hospital, Melbourne, VIC, Australia
| | - Nilesh M Mehta
- Department of Pediatrics (to Dr. Agus), Department of Anesthesiology, Critical Care and Pain (to Drs. Mehta and Randolph), Boston Children's Hospital and Harvard Medical School, Boston, MA
| | | | | | | | - Akira Nishisaki
- Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | | | | | | | - Adrienne G Randolph
- Department of Pediatrics (to Dr. Agus), Department of Anesthesiology, Critical Care and Pain (to Drs. Mehta and Randolph), Boston Children's Hospital and Harvard Medical School, Boston, MA
| | | | | | | | - Lyvonne N Tume
- University of the West of England, Bristol, United Kingdom
| | - Judy T Verger
- Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.,College of Nursing, University of Iowa, Iowa City, IA
| | | | - Joshua Wolf
- St. Jude Children's Research Hospital, Memphis, TN
| | | | | | - Niranjan Kissoon
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Pierre Tissieres
- Paris South University Hospitals-Assistance Publique Hopitaux de Paris, Paris, France.,Institute of Integrative Biology of the Cell-CNRS, CEA, Univ Paris Sud, Gif-sur-Yvette, France
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