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Park JY, Young IS, Baudhuin LM. A Year in Review: 2023. Clin Chem 2023; 69:1327-1328. [PMID: 37883600 DOI: 10.1093/clinchem/hvad178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 10/28/2023]
Affiliation(s)
- Jason Y Park
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, United States
- McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Ian S Young
- Centre for Public Health, Institute for Global Food Security, Queen's University Belfast, Northern Ireland, United Kingdom
| | - Linnea M Baudhuin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
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Firan M, Timmons CF, Park JY, Mitui Mha M, Luu HS. Hemoglobin β-Globin Variants In Hispanic Patients: An Institutional Experience From Dallas, Texas. Hemoglobin 2023; 47:167-171. [PMID: 37782073 DOI: 10.1080/03630269.2023.2263356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/20/2023] [Indexed: 10/03/2023]
Abstract
Hemoglobinopathies are the most common single-gene disorders in humans. There are 1,424 variants of human hemoglobin described with 951 involving the β-globin gene. Ancestry and geography play a significant role in the incidence and nature of hemoglobinopathies, with African, Asian, and Mediterranean populations and their descendants being amongst the most affected. Investigation of variants in individuals of Hispanic descent is needed to reflect the changing demographics of the United States. Hemoglobin β-globin evaluation through gel electrophoresis, high-performance liquid chromatography, and HBB gene sequencing was performed on patients from Texas hospitals between 2010 and 2015 and demographic parameters (age, sex, ethnicity) was subsequently analyzed. A total of 846 patients underwent hemoglobinopathy evaluation. A β chain variant was detected in 628 of the 846 total patients. Hispanic patients represented 37% (314/846 patients), which were equally distributed between females (50%; 156/314) and males (50%; 156/314). A β-globin chain variant was found in 67% of Hispanic patients with a distribution across 10 variants seen in greater than 1% of patients. For hemoglobin variants, an understanding of the regional and ethnic prevalence will improve patient care through more effective screening and identification of the variant, early diagnosis, and appropriate treatment if necessary, and better genetic counseling.
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Affiliation(s)
- Mihail Firan
- Department of Pathology, Cook Children's Health Care System, Fort Worth TX, USA
| | - Charles F Timmons
- Department of Pathology, University of TX Southwestern Medical Center, Dallas, TX, USA
- Department of Pathology, Children's Health, Dallas, TX, USA
| | - Jason Y Park
- Department of Pathology, University of TX Southwestern Medical Center, Dallas, TX, USA
- Department of Pathology, Children's Health, Dallas, TX, USA
- Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas, TX USA
| | | | - Hung S Luu
- Department of Pathology, University of TX Southwestern Medical Center, Dallas, TX, USA
- Department of Pathology, Children's Health, Dallas, TX, USA
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Huh SN, Indelicato DJ, Holtzman AL, Dagan R, Park JY, Brooks ED, Alghamdi A, Rutenberg MS. Low Tesla MR Imaging for Spine with Hardware. Int J Radiat Oncol Biol Phys 2023; 117:e674. [PMID: 37785987 DOI: 10.1016/j.ijrobp.2023.06.2124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Acquiring MR images with minimized susceptibility artifacts is essential for spines with medical hardware to delineate clinical target volumes (CTVs) in radiation therapy for chordomas, chondrosarcomas, and other sarcomas. Since it can be more challenging to visualize the primary structures in high-tesla MR images due to metal-induced artifacts, we optimized imaging parameters to acquire high-quality, low-tesla MR images for clinical use. MATERIALS/METHODS OptimalMR imaging parameters were investigated under general guidelines for artifact reduction techniques by testing several 3D spin echo and gradient echo sequences in a 0.23-T MR scanner. A customized spine phantom was developed to acquire MR images for bony materials which included, 4-6 industrial titanium screws, an aluminum plate, and a superflab bolus. While the 3D b-FFE sequence was used to acquire MR images with a high signal-to-noise ratio, the other 3D T1-FFE, THRIVE, and DTSE sequences were applied to reduce susceptible artifacts to the medical hardware. The optimized parameters determined in the phantom test were applied to the 15 clinical cases, including patients with residual spinal tumors and fusion hardware. The low-tesla MR imaging technique was also used to scan sarcomas of the extremities and re-irradiation cases of spinal metastases. RESULTS The optimized low-tesla MR images in the spine were noticeably useful to guide CTV delineations for patients with medical hardware, especially for residual or recurrent tumors. The imaging technique to minimize susceptibility artifacts enabled a more defined separation of each hardware component from the spinal cord and CTVs. In spine metastasis cases, pre-irradiated target volumes were determined, reflecting property changes in the bone marrow. CONCLUSION The MR images acquired using the optimized parameters showed minimal artifacts to scan spine patients with hardware. By using the low-tesla MR images, spinal chordoma and chondrosarcoma patients could be treated to improve tumor control probabilities with minimized complications.
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Affiliation(s)
- S N Huh
- University of Florida Health Proton Therapy Institute, Jacksonville, FL; Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL
| | - D J Indelicato
- University of Florida Health Proton Therapy Institute, Jacksonville, FL; Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL
| | - A L Holtzman
- University of Florida Health Proton Therapy Institute, Jacksonville, FL; Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL
| | - R Dagan
- University of Florida Health Proton Therapy Institute, Jacksonville, FL; Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL
| | - J Y Park
- University of Florida Health Proton Therapy Institute, Jacksonville, FL; Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL
| | - E D Brooks
- University of Florida Health Proton Therapy Institute, Jacksonville, FL; Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL
| | - A Alghamdi
- Queen's University, Kingston, ON, Canada
| | - M S Rutenberg
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
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Huh SN, Zhang Y, Park JY, Indelicato DJ. Development of a Filtimator for Pediatric Image-Guided Radiation Therapy with Low Imaging Dose. Int J Radiat Oncol Biol Phys 2023; 117:S178. [PMID: 37784441 DOI: 10.1016/j.ijrobp.2023.06.2521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) We propose to use the filtimator (a filter and a collimator) for CBCT-based image-guided radiation therapy (IGRT) optimized for pediatric patients to minimize the imaging dose but not to sacrifice the imaging quality required for bony-based image fusion. MATERIALS/METHODS The filtimator was made of Tin (0.6 - 1 mm) and Cu sheets (0.6 to 1.2mm) for filter and collimation with adjustable collimation with 4 to 6 cm fields at the isocenter. The thickness of the filter in the central and the peripheral regions were determined using vendor-provided image registration software and to ensure that the rigid image registration results from the CBCT were with and without the filtimator. The image quality of the filtered CBCT was compared with the regular CBCTs. Image registration accuracy was investigated by creating a < 2° shift in pitch, roll, and rotation and < 3 cm shifts in the lateral, vertical, and longitudinal directions, using commercial head and house-made phantoms. The imaging dose reduction factor of the filtimator was measured using a CT dose index phantom. RESULTS The contrast-to-noise ratio substantially improved in the opening region of the filter, which provided better visualization of normal anatomy and target volumes. The slim filter reduced the imaging dose by > 98% in the filtered region, and the visualization of bony structures was well preserved, allowing for accurate rigid image registration with the filter. The imaging registration difference was < 0.2° shift in pitch, roll, and rotation and < 0.5 mm shift in the lateral, vertical, and longitudinal directions compared to the regular CBCT. CONCLUSION The proposed dose reduction with the filtimator was demonstrated to be efficient and effective in considerably reducing the patient imaging dose while yielding accurate registration results. This novel technique can become a valuable tool for generating 3- and 4-dimensional images with a much-reduced dose to improve the precision of target localization in radiation therapy.
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Affiliation(s)
- S N Huh
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL; University of Florida Health Proton Therapy Institute, Jacksonville, FL
| | - Y Zhang
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL; University of Florida Health Proton Therapy Institute, Jacksonville, FL
| | - J Y Park
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL; University of Florida Health Proton Therapy Institute, Jacksonville, FL
| | - D J Indelicato
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL; University of Florida Health Proton Therapy Institute, Jacksonville, FL
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Jung J, Moon SM, Kim DY, Kim SH, Lee WJ, Heo ST, Park JY, Bae S, Lee MJ, Kim B, Park SY, Jeong HW, Kim Y, Kwak YG, Song KH, Park KH, Park SH, Kim YK, Kim ES, Kim HB. Appropriateness of antibiotic use for patients with asymptomatic bacteriuria or urinary tract infection with positive urine culture: a retrospective observational multi-centre study in Korea. J Hosp Infect 2023; 140:79-86. [PMID: 37562596 DOI: 10.1016/j.jhin.2023.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/24/2023] [Accepted: 07/29/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Antibiotic resistance threatens public health worldwide, and inappropriate use of antibiotics is one of the main causes. AIM To evaluate qualitative use of antibiotics in asymptomatic bacteriuria (ABU) and urinary tract infection (UTI). METHODS Cases of positive urine culture (≥105 colony-forning units/mL) performed in inpatient, outpatient and emergency departments in April 2021 were screened in 26 hospitals in the Republic of Korea. The cases were classified as ABU, lower UTI and upper UTI. The appropriateness of antibiotic use was evaluated retrospectively by infectious disease specialists using quality indicators based on clinical guidelines for ABU and UTI. RESULTS This study included a total of 2697 patients with ABU or UTI. The appropriateness of antibiotic use was assessed in 1157 patients with ABU, and in 677 and 863 patients with lower and upper UTI, respectively. Among the 1157 patients with ABU, 251 (22%) were prescribed antibiotics without appropriate indications. In 66 patients with ABU in which antibiotics were prescribed with appropriate indications, the duration was adequate in only 23 (34.8%) patients. The appropriateness of empirical and definite antibiotics was noted in 527 (77.8%) and 353 (68.0%) patients with lower UTI, and 745 (86.3%) and 583 (78.2%) patients with upper UTI, respectively. The duration of antibiotics was adequate in 321 (61.8%) patients with lower UTI and 576 (78.7%) patients with upper UTI. CONCLUSIONS This nationwide qualitative assessment of antibiotic use in ABU and UTI revealed that antibiotics were often prescribed inappropriately, and the duration of antibiotics was unnecessarily prolonged.
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Affiliation(s)
- J Jung
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - S M Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - D Y Kim
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - S-H Kim
- Division of Infectious Diseases, Samsung Changwon Hospital, Sungkyunkwan University, Changwon, Republic of Korea
| | - W J Lee
- Department of Internal Medicine, Hallym Hospital, Incheon, Republic of Korea
| | - S T Heo
- Division of Infectious Disease, Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - J Y Park
- Department of Paediatrics, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - S Bae
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - M J Lee
- Department of Internal Medicine, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
| | - B Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - S Y Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea; Department of Hospital Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea; Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea; Centres for Digital Health, Yongin Severance Hospital, Yonsei University Health System, Yongin, Republic of Korea
| | - H W Jeong
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea; Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Y Kim
- Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Republic of Korea
| | - Y G Kwak
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - K-H Song
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - K-H Park
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - S H Park
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Y K Kim
- Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
| | - E S Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - H B Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Málaga I, Avila A, Primeaux S, Park JY, Pascual JM. A concise study of acetazolamide in glucose transporter type 1 deficiency (G1D) epilepsy. Epilepsia 2023; 64:e184-e189. [PMID: 37335529 DOI: 10.1111/epi.17684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/10/2023] [Accepted: 06/13/2023] [Indexed: 06/21/2023]
Abstract
Epilepsy constitutes the most common paroxysmal manifestation of glucose transporter type 1 deficiency (G1D) and is generally considered medication-refractory. It can also prove therapeutic diet-resistant. We examined acetazolamide effects in G1D motivated by several longstanding and recent observations: First, the electrographic spike-waves characteristic of absence seizures often resemble those of G1D and, since the 1950s, they have occasionally been treated successfully with acetazolamide, well before G1D was segregated from absence epilepsy as a distinct syndrome. Second, synaptic inhibitory neuron failure characterizes G1D and, in other experimental models, this can be ameliorated by drugs that modify cellular chloride gradient such as acetazolamide. Third, acetazolamide potently stimulates model cell glucose transport in vitro. Seventeen antiepileptic drug or therapeutic diet-refractory individuals with G1D treated with acetazolamide were thus identified via medical record review complemented by worldwide individual survey. Acetazolamide was tolerated and decreased seizures in 76% of them, with 58% of all persons studied experiencing seizure reductions by more than one-half, including those who first manifested myoclonic-astatic epilepsy or infantile spams. Eighty-eight percent of individuals with G1D continued taking acetazolamide for over 6 months, indicating sustained tolerability and efficacy. The results provide a novel avenue for the treatment and mechanistic investigation of G1D.
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Affiliation(s)
- Ignacio Málaga
- Rare Brain Disorders Program, Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Adrian Avila
- Rare Brain Disorders Program, Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sharon Primeaux
- Rare Brain Disorders Program, Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jason Y Park
- Department of Pathology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Eugene McDermott Center for Human Growth & Development/Center for Human Genetics, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Juan M Pascual
- Rare Brain Disorders Program, Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Eugene McDermott Center for Human Growth & Development/Center for Human Genetics, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Physiology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Ostmeyer J, Park JY, von Itzstein MS, Hsiehchen D, Fattah F, Gwin M, Catalan R, Khan S, Raj P, Wakeland EK, Xie Y, Gerber DE. T-cell tolerant fraction as a predictor of immune-related adverse events. J Immunother Cancer 2023; 11:e006437. [PMID: 37580069 PMCID: PMC10432621 DOI: 10.1136/jitc-2022-006437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Immune checkpoint inhibitor (ICI) therapies may cause unpredictable and potentially severe autoimmune toxicities termed immune-related adverse events (irAEs). Because T cells mediate ICI effects, T cell profiling may provide insight into the risk of irAEs. Here we evaluate a novel metric-the T-cell tolerant fraction-as a predictor of future irAEs. METHODS We examined T-cell receptor beta (TRB) locus sequencing from baseline pretreatment samples from an institutional registry and previously published studies. For each patient, we used TRB sequences to calculate the T-cell tolerant fraction, which was then assessed as a predictor of future irAEs (classified as Common Terminology Criteria for Adverse Event grade 0-1 vs grade ≥2). We then compared the tolerant fraction to TRB clonality and diversity. Finally, the tolerant fraction was assessed on (1) T cells enriched against napsin A, a potential autoantigen of irAEs; (2) thymic versus peripheral blood T cells; and (3) TRBs specific for various infections and autoimmune diseases. RESULTS A total of 77 patients with cancer (22 from an institutional registry and 55 from published studies) receiving ICI therapy (43 CTLA4, 19 PD1/PDL1, 15 combination CTLA4+PD1/PDL1) were included in the study. The tolerant fraction was significantly lower in cases with clinically significant irAEs (p<0.001) and had an area under the receiver operating curve (AUC) of 0.79. The tolerant fraction was lower for each ICI treatment category, reaching statistical significance for CTLA4 (p<0.001) and demonstrating non-significant trends for PD1/PDL1 (p=0.21) and combination ICI (p=0.18). The tolerant fraction for T cells enriched against napsin A was lower than other samples. The tolerant fraction was also lower in thymic versus peripheral blood samples, and lower in some (multiple sclerosis) but not other (type 1 diabetes) autoimmune diseases. In our study cohort, TRB clonality had an AUC of 0.62, and TRB diversity had an AUC of 0.60 for predicting irAEs. CONCLUSIONS Among patients receiving ICI, the baseline T-cell tolerant fraction may serve as a predictor of clinically significant irAEs.
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Affiliation(s)
- Jared Ostmeyer
- Peter O'Donnell School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jason Y Park
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mitchell S von Itzstein
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - David Hsiehchen
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Harold C Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Farjana Fattah
- Harold C Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mary Gwin
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Rodrigo Catalan
- Harold C Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Shaheen Khan
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Prithvi Raj
- Department of Immunology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Edward K Wakeland
- Department of Immunology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Yang Xie
- Peter O'Donnell School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Harold C Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - David E Gerber
- Peter O'Donnell School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Harold C Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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He L, Arvisais-Anhalt S, Araj E, Yin H, Reimold SC, Sanghavi R, Park JY. Trends in physician Medicare payments by gender and specialty. Am J Med Sci 2023; 366:79-81. [PMID: 37094631 DOI: 10.1016/j.amjms.2023.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 04/18/2023] [Indexed: 04/26/2023]
Affiliation(s)
- Lin He
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Simone Arvisais-Anhalt
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Ellen Araj
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Helen Yin
- Department of Physiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sharon C Reimold
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rina Sanghavi
- Department of Pediatrics, Division of Pediatric Gastroenterology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jason Y Park
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Avila A, Málaga I, Sirsi D, Kayani S, Primeaux S, Kathote GA, Jakkamsetti V, Kallem RR, Putnam WC, Park JY, Shinnar S, Pascual JM. Combination of triheptanoin with the ketogenic diet in Glucose transporter type 1 deficiency (G1D). Sci Rep 2023; 13:8951. [PMID: 37268656 DOI: 10.1038/s41598-023-36001-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/27/2023] [Indexed: 06/04/2023] Open
Abstract
Fuel influx and metabolism replenish carbon lost during normal neural activity. Ketogenic diets studied in epilepsy, dementia and other disorders do not sustain such replenishment because their ketone body derivatives contain four carbon atoms and are thus devoid of this anaplerotic or net carbon donor capacity. Yet, in these diseases carbon depletion is often inferred from cerebral fluorodeoxyglucose-positron emission tomography. Further, ketogenic diets may prove incompletely therapeutic. These deficiencies provide the motivation for complementation with anaplerotic fuel. However, there are few anaplerotic precursors consumable in clinically sufficient quantities besides those that supply glucose. Five-carbon ketones, stemming from metabolism of the food supplement triheptanoin, are anaplerotic. Triheptanoin can favorably affect Glucose transporter type 1 deficiency (G1D), a carbon-deficiency encephalopathy. However, the triheptanoin constituent heptanoate can compete with ketogenic diet-derived octanoate for metabolism in animals. It can also fuel neoglucogenesis, thus preempting ketosis. These uncertainties can be further accentuated by individual variability in ketogenesis. Therefore, human investigation is essential. Consequently, we examined the compatibility of triheptanoin at maximum tolerable dose with the ketogenic diet in 10 G1D individuals using clinical and electroencephalographic analyses, glycemia, and four- and five-carbon ketosis. 4 of 8 of subjects with pre-triheptanoin beta-hydroxybutyrate levels greater than 2 mM demonstrated a significant reduction in ketosis after triheptanoin. Changes in this and the other measures allowed us to deem the two treatments compatible in the same number of individuals, or 50% of persons in significant beta-hydroxybutyrate ketosis. These results inform the development of individualized anaplerotic modifications to the ketogenic diet.ClinicalTrials.gov registration NCT03301532, first registration: 04/10/2017.
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Affiliation(s)
- Adrian Avila
- Rare Brain Disorders Program, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Mail Code 8813, Dallas, TX, 75390, USA
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Ignacio Málaga
- Rare Brain Disorders Program, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Mail Code 8813, Dallas, TX, 75390, USA
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Deepa Sirsi
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
- Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Saima Kayani
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
- Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Sharon Primeaux
- Rare Brain Disorders Program, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Mail Code 8813, Dallas, TX, 75390, USA
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Gauri A Kathote
- Rare Brain Disorders Program, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Mail Code 8813, Dallas, TX, 75390, USA
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Vikram Jakkamsetti
- Rare Brain Disorders Program, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Mail Code 8813, Dallas, TX, 75390, USA
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Raja Reddy Kallem
- Department of Pharmacy Practice and Clinical Pharmacology, Experimental Therapeutics Center, Texas Tech University Health Sciences Center, Dallas, TX, 75235, USA
| | - William C Putnam
- Department of Pharmacy Practice and Clinical Pharmacology, Experimental Therapeutics Center, Texas Tech University Health Sciences Center, Dallas, TX, 75235, USA
- Department of Pharmaceutical Science, Texas Tech University Health Sciences Center, Dallas, TX, 75235, USA
| | - Jason Y Park
- Department of Pathology, The University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Shlomo Shinnar
- Departments of Neurology and Pediatrics, Albert Einstein College of Medicine, Bronx, NY, 10467, USA
| | - Juan M Pascual
- Rare Brain Disorders Program, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Mail Code 8813, Dallas, TX, 75390, USA.
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA.
- Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA.
- Department of Physiology, The University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA.
- Eugene McDermott Center for Human Growth & Development/Center for Human Genetics, The University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA.
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Palsgrove DN, Manucha V, Park JY, Bishop JA. A Low-grade Sinonasal Sarcoma Harboring EWSR1::BEND2: Expanding the Differential Diagnosis of Sinonasal Spindle Cell Neoplasms. Head Neck Pathol 2023; 17:571-575. [PMID: 36646985 PMCID: PMC10293148 DOI: 10.1007/s12105-023-01527-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/07/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND Molecular diagnostics has greatly refined sinonasal tumor pathology over the past decade. While much of the attention has focused on carcinomas, it is becoming clear that there are emerging mesenchymal neoplasms which have previously defied classification. METHODS Here, we present a 33-year-old woman with a multiply recurrent sinonasal spindle cell tumor exhibiting distinctive features, and not easily classifiable into a specific category. RESULTS The hypercellular tumor was composed of plump spindled cells, with uniform vesicular chromatin arranged as vague fascicles around a prominent hemangiopericytoma-like vasculature. The mitotic rate was brisk at 10 per 10 high power fields. By immunohistochemistry, it was only positive for EMA (focal) and SATB2 (diffuse, weak). Fusion analysis uncovered EWSR1::BEND2, a fusion which is best known for being seen in astroblastoma, but which has not yet been reported in sarcomas. CONCLUSION This case underscores the utility of fusion analysis when confronted with a sinonasal spindle cell neoplasm which does not neatly fit into any specific category. It remains to be seen if EWSR1::BEND2 sinonasal sarcoma represents a distinct entity.
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Affiliation(s)
- Doreen N Palsgrove
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Varsha Manucha
- Department of Pathology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Jason Y Park
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Justin A Bishop
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
- Department of Pathology, University of Texas Southwestern Medical Center, 6201 Harry Hines Blvd Room UH04.250, 75390, Dallas, TX, USA.
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11
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Kanter J, Gordon SM, Mani S, Sokalska A, Park JY, Senapati S, Huh DD, Mainigi M. Hormonal stimulation reduces numbers and impairs function of human uterine natural killer cells during implantation. Hum Reprod 2023; 38:1047-1059. [PMID: 37075311 PMCID: PMC10501469 DOI: 10.1093/humrep/dead069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/05/2023] [Indexed: 04/21/2023] Open
Abstract
STUDY QUESTION How does an altered maternal hormonal environment, such as that seen during superovulation with gonadotropins in ART, impact human uterine immune cell distribution and function during the window of implantation? SUMMARY ANSWER Hormonal stimulation with gonadotropins alters abundance of maternal immune cells including uterine natural killer (uNK) cells and reduces uNK cell ability to promote extravillous trophoblast (EVT) invasion. WHAT IS KNOWN ALREADY An altered maternal hormonal environment, seen following ART, can lead to increased risk for adverse perinatal outcomes associated with disordered placentation. Maternal immune cells play an essential role in invasion of EVTs, a process required for proper establishment of the placenta, and adverse perinatal outcomes have been associated with altered immune cell populations. How ART impacts maternal immune cells and whether this can in turn affect implantation and placentation in humans remain unknown. STUDY DESIGN, SIZE, DURATION A prospective cohort study was carried out between 2018 and 2021 on 51 subjects: 20 from natural cycles 8 days after LH surge; and 31 from stimulated IVF cycles 7 days after egg retrieval. PARTICIPANTS/MATERIALS, SETTING, METHODS Endometrial biopsies and peripheral blood samples were collected during the window of implantation in subjects with regular menstrual cycles or undergoing superovulation. Serum estradiol and progesterone levels were measured by chemiluminescent competitive immunoassay. Immune cell populations in blood and endometrium were analyzed using flow cytometry. uNK cells were purified using fluorescence-activated cell sorting and were subjected to RNA sequencing (RNA-seq). Functional changes in uNK cells due to hormonal stimulation were evaluated using the implantation-on-a-chip (IOC) device, a novel bioengineered platform using human primary cells that mimics early processes that occur during pregnancy in a physiologically relevant manner. Unpaired t-tests, one-way ANOVA, and pairwise multiple comparison tests were used to statistically evaluate differences. MAIN RESULTS AND THE ROLE OF CHANCE Baseline characteristics were comparable for both groups. As expected, serum estradiol levels on the day of biopsy were significantly higher in stimulated (superovulated) patients (P = 0.0005). In the setting of superovulation, we found an endometrium-specific reduction in the density of bulk CD56+ uNK cells (P < 0.05), as well as in the uNK3 subpopulation (P = 0.025) specifically (CD103+ NK cells). In stimulated samples, we also found that the proportion of endometrial B cells was increased (P < 0.0001). Our findings were specific to the endometrium and not seen in peripheral blood. On the IOC device, uNK cells from naturally cycling secretory endometrium promote EVT invasion (P = 0.03). However, uNK cells from hormonally stimulated endometrium were unable to significantly promote EVT invasion, as measured by area of invasion, depth of invasion, and number of invaded EVTs by area. Bulk RNA-seq of sorted uNK cells from stimulated and unstimulated endometrium revealed changes in signaling pathways associated with immune cell trafficking/movement and inflammation. LIMITATIONS, REASONS FOR CAUTION Patient numbers utilized for the study were low but were enough to identify significant overall population differences in select immune cell types. With additional power and deeper immune phenotyping, we may detect additional differences in immune cell composition of blood and endometrium in the setting of hormonal stimulation. Flow cytometry was performed on targeted immune cell populations that have shown involvement in early pregnancy. A more unbiased approach might identify changes in novel maternal immune cells not investigated in this study. We performed RNA-seq only on uNK cells, which demonstrated differences in gene expression. Ovarian stimulation may also impact gene expression and function of other subsets of immune cells, as well as other cell types within the endometrium. Finally, the IOC device, while a major improvement over existing in vitro methods to study early pregnancy, does not include all possible maternal cells present during early pregnancy, which could impact functional effects seen. Immune cells other than uNK cells may impact invasion of EVTs in vitro and in vivo, though these remain to be tested. WIDER IMPLICATIONS OF THE FINDINGS These findings demonstrate that hormonal stimulation affects the distribution of uNK cells during the implantation window and reduces the proinvasive effects of uNK cells during early pregnancy. Our results provide a potential mechanism by which fresh IVF cycles may increase risk of disorders of placentation, previously linked to adverse perinatal outcomes. STUDY FUNDING/COMPETING INTEREST(S) Research reported in this publication was supported by the University of Pennsylvania University Research Funding (to M.M.), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (P50HD068157 to M.M., S.S., and S.M.), National Center for Advancing Translational Sciences of the National Institutes of Health (TL1TR001880 to J.K.), the Institute for Translational Medicine and Therapeutics of the Perelman School of Medicine at the University of Pennsylvania, the Children's Hospital of Philadelphia Research Institute (to S.M.G.), and the National Institute of Allergy and Infectious Diseases (K08AI151265 to S.M.G.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. All authors declare no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- J Kanter
- Division of Reproductive Endocrinology and Infertility, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - S M Gordon
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - S Mani
- Division of Reproductive Endocrinology and Infertility, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - A Sokalska
- Division of Reproductive Endocrinology and Infertility, Stanford University, Stanford, CA, USA
| | - J Y Park
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - S Senapati
- Division of Reproductive Endocrinology and Infertility, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - D D Huh
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
- NSF Science and Technology Center for Engineering Mechanobiology, University of Pennsylvania, Philadelphia, PA, USA
| | - M Mainigi
- Division of Reproductive Endocrinology and Infertility, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Agharokh L, Mamola K, Yu AG, Medina AL, Gurram B, Fuller J, Park JY, Chen W, Rajaram V, Hammer MR, Waugh JL. Cachexia, chorea, and pain in chronic nonbacterial osteitis and inflammatory bowel disease: a case report. J Med Case Rep 2023; 17:237. [PMID: 37254165 DOI: 10.1186/s13256-023-03894-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 03/17/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Inflammatory bowel disease is an inflammatory disorder that primarily impacts the gastrointestinal tract, leading to malnutrition and chronic microscopic intestinal blood loss. Uncontrolled systemic inflammation can impact other parts of the body, known as extraintestinal manifestations. Up to 25% of patients with inflammatory bowel disease are reported to have these complications in their skin, joints, bones, eyes, liver, lung, and pancreas (Rogler et al. in Gastroenterology 161(4):1118-1132, 2021). Neurologic involvement as extraintestinal manifestations are less common, reported at 3-19%, including neuropathies, demyelination, and cerebrovascular events (Morís in World J Gastroenterol. 20(5):1228-1237, 2014). CASE PRESENTATION A 13-year-old Caucasian boy presented with 1 month of progressive lower-extremity pain, weakness, and weight loss. His physical examination was notable for cachexia, lower-extremity weakness, and chorea. Labs revealed normocytic anemia and systemic inflammation. Imaging revealed symmetric abnormal marrow signal in the pelvis and upper femurs. Pathologic examination of the bone revealed chronic inflammation consistent with chronic nonbacterial osteitis. Endoscopy revealed colonic inflammation consistent with inflammatory bowel disease. CONCLUSIONS Children and adolescents with musculoskeletal pain lasting more than 2 weeks with systemic signs or symptoms like weight loss should prompt evaluation for systemic inflammatory disorders such as chronic nonbacterial osteitis, which can occur in isolation or associated with inflammatory bowel disease. This patient also had a nonspecific neurologic abnormality, chorea, which resolved with treatment of underlying inflammatory disorder. These extraintestinal manifestations may be concurrent with or precede intestinal inflammation, requiring a high index of suspicion when investigating nonspecific systemic inflammation.
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Affiliation(s)
- Ladan Agharokh
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Texas Health Science Center at Houston, 6431 Fannin St., Suite JJL 210-D, Houston, TX, 77030, USA.
| | - Katherine Mamola
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Texas-Southwestern Medical Center, Dallas, TX, USA
| | - Andrew G Yu
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Texas-Southwestern Medical Center, Dallas, TX, USA
| | - Annette L Medina
- Division of Pediatric Gastroenterology, Department of Pediatrics, Nicklaus Children's Hospital, Miami, FL, USA
| | - Bhaskar Gurram
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of Texas-Southwestern Medical Center, Dallas, TX, USA
| | - Julie Fuller
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Texas-Southwestern Medical Center, Dallas, TX, USA
| | - Jason Y Park
- Department of Pathology, University of Texas-Southwestern Medical Center, Dallas, TX, USA
| | - Weina Chen
- Department of Pathology, University of Texas-Southwestern Medical Center, Dallas, TX, USA
| | - Veena Rajaram
- Department of Pathology, University of Texas-Southwestern Medical Center, Dallas, TX, USA
| | - Matthew R Hammer
- Division of Pediatric Radiology, Department of Radiology, University of Texas-Southwestern Medical Center, Dallas, TX, USA
| | - Jeff L Waugh
- Division of Child Neurology, Department of Pediatrics, University of Texas-Southwestern Medical Center, Dallas, TX, USA
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13
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Rakheja D, Park JY, Yang MS, Martinez DP, Koduru P, Wilson KS, Garcia R, Uddin N. Rhabdomyosarcoma With Epithelioid Features And NSD3::FOXO1 Fusion: Evidence For Reconsideration Of Previously Reported FOXO1::FGFR1 Fusion. Int J Surg Pathol 2023; 31:213-220. [PMID: 35502835 DOI: 10.1177/10668969221098084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Epithelioid rhabdomyosarcoma is a rare rhabdomyosarcoma variant for which no diagnostic recurrent driver genetic events have been identified. Here we report a rapidly progressive and widely metastatic rhabdomyosarcoma with epithelioid features that arose in the thigh of a male infant. Conventional cytogenetics revealed a t(8;13)(p11.2;q14) translocation. Fluorescence in situ hybridization studies showed rearrangement of FOXO1 and amplification of its 3" end, and rearrangement of NSD3 and amplification of its 5` end. Next generation sequencing identified a NSD3::FOXO1 fusion, which is a previously unreported gene fusion. We also review the historic report of a FOXO1::FGFR1 fusion in a solid variant of alveolar rhabdomyosarcoma and propose that NSD3::FOXO1 fusion may have been the more appropriate interpretation of the data presented in that report.
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Affiliation(s)
- Dinesh Rakheja
- Department of Pathology, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA.,Children's Health, Dallas, TX, USA
| | - Jason Y Park
- Department of Pathology, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA.,Children's Health, Dallas, TX, USA
| | - Mary S Yang
- Children's Health, Dallas, TX, USA.,Department of Radiology, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Diana P Martinez
- Department of Pathology, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Prasad Koduru
- Department of Pathology, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kathleen S Wilson
- Department of Pathology, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rolando Garcia
- Department of Pathology, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Naseem Uddin
- Department of Pathology, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA.,Children's Health, Dallas, TX, USA
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14
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Gross DJ, Robboy SJ, Cohen MB, Vernon L, Park JY, Crawford JM, Karcher DS, Wheeler TM, Black-Schaffer WS. Strong Job Market for Pathologists: Results From the 2021 College of American Pathologists Practice Leader Survey. Arch Pathol Lab Med 2023; 147:434-441. [PMID: 35776913 DOI: 10.5858/arpa.2022-0023-cp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/06/2022]
Abstract
CONTEXT.— There has long been debate about whether and when there may be a shortage of pathologists in the United States. One way to assess this is to survey the hiring experiences of pathology practices. A 2018 survey revealed a strong demand for pathologists, with expectations of continued strength. This study updates that prior analysis using data from a 2021 survey of pathology practice leaders. OBJECTIVE.— To assess the US pathologist job market and examine implications. DESIGN.— We analyzed data from the 2021 College of American Pathologists Practice Leader Survey. This survey queried practice leaders, including regarding the hiring of pathologists, the level of experience being sought, success in filling positions, and expectations for hiring in the next 3 years. RESULTS.— Among the 375 surveyed practice leaders (about one-third of all US pathology practices), 282 provided information about pathologist hiring in 2021. A total of 157 of these 282 practices (55.7%) sought to hire at least 1 pathologist in 2021, up from 116 of 256 practices (45.3%) in 2017; the mean number of pathologists hired per practice also increased. In 2021, a total of 175 of 385 positions (45.5%) were to fill new positions, compared with 95 of 249 positions (38.2%) in 2017. Most practice leaders were comfortable hiring pathologists with less than 2 years of posttraining experience. Practice leaders anticipated continued strong demand for hiring pathologists during the next 3 years. CONCLUSIONS.— Our analysis confirms that the demand in pathologist hiring is strong and much increased from 2017. We believe, in combination with other job market indicators, that demand may outstrip the supply of pathologists, which is limited by the number of trainees and has remained constant during the past 20 years.
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Affiliation(s)
- David J Gross
- From the Policy Roundtable, College of American Pathologists, Washington, District of Columbia (Gross)
| | - Stanley J Robboy
- The Department of Pathology, Duke University Medical Center, Durham, North Carolina (Robboy)
| | - Michael B Cohen
- The Department of Pathology, Wake Forest Medical Center, Winston-Salem, North Carolina (Cohen)
| | - Lori Vernon
- Research and Insights, Market Analysis, College of American Pathologists, Northfield, Illinois (Vernon)
| | - Jason Y Park
- The Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Park)
| | - James M Crawford
- The Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Crawford)
| | - Donald S Karcher
- The Department of Pathology, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia (Karcher)
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15
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Kathote G, Ma Q, Angulo G, Chen H, Jakkamsetti V, Dobariya A, Good LB, Posner B, Park JY, Pascual JM. Identification of Glucose Transport Modulators In Vitro and Method for Their Deep Learning Neural Network Behavioral Evaluation in Glucose Transporter 1-Deficient Mice. J Pharmacol Exp Ther 2023; 384:393-405. [PMID: 36635085 DOI: 10.1124/jpet.122.001428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 12/07/2022] [Accepted: 12/27/2022] [Indexed: 01/14/2023] Open
Abstract
Metabolic flux augmentation via glucose transport activation may be desirable in glucose transporter 1 (Glut1) deficiency syndrome (G1D) and dementia, whereas suppression might prove useful in cancer. Using lung adenocarcinoma cells that predominantly express Glut1 relative to other glucose transporters, we screened 9,646 compounds for effects on the accumulation of an extracellularly applied fluorescent glucose analog. Five drugs currently prescribed for unrelated indications or preclinically characterized robustly enhanced intracellular fluorescence. Additionally identified were 37 novel activating and nine inhibitory compounds lacking previous biologic characterization. Because few glucose-related mechanistic or pharmacological studies were available for these compounds, we developed a method to quantify G1D mouse behavior to infer potential therapeutic value. To this end, we designed a five-track apparatus to record and evaluate spontaneous locomotion videos. We applied this to a G1D mouse model that replicates the ataxia and other manifestations cardinal to the human disorder. Because the first two drugs that we examined in this manner (baclofen and acetazolamide) exerted various impacts on several gait aspects, we used deep learning neural networks to more comprehensively assess drug effects. Using this method, 49 locomotor parameters differentiated G1D from control mice. Thus, we used parameter modifiability to quantify efficacy on gait. We tested this by measuring the effects of saline as control and glucose as G1D therapy. The results indicate that this in vivo approach can estimate preclinical suitability from the perspective of G1D locomotion. This justifies the use of this method to evaluate our drugs or other interventions and sort candidates for further investigation. SIGNIFICANCE STATEMENT: There are few or no activators and few clinical inhibitors of glucose transport. Using Glut1-rich cells exposed to a glucose analog, we identified, in highthroughput fashion, a series of novel modulators. Some were drugs used to modify unrelated processes and some represented large but little studied chemical compound families. To facilitate their preclinical efficacy characterization regardless of potential mechanism of action, we developed a gait testing platform for deep learning neural network analysis of drug impact on Glut1-deficient mouse locomotion.
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Affiliation(s)
- Gauri Kathote
- Rare Brain Disorders Program, Department of Neurology (G.K., Q.M., G.A., V.J., A.D., L.B.G., J.M.P.), Department of Biochemistry (H.C., B.P.), Department of Pathology (J.Y.P.), Department of Physiology (J.M.P.), Department of Pediatrics (J.M.P.), and Eugene McDermott Center for Human Growth & Development/Center for Human Genetics (J.Y.P., J.M.P.), University of Texas Southwestern Medical Center, Dallas, Texas
| | - Qian Ma
- Rare Brain Disorders Program, Department of Neurology (G.K., Q.M., G.A., V.J., A.D., L.B.G., J.M.P.), Department of Biochemistry (H.C., B.P.), Department of Pathology (J.Y.P.), Department of Physiology (J.M.P.), Department of Pediatrics (J.M.P.), and Eugene McDermott Center for Human Growth & Development/Center for Human Genetics (J.Y.P., J.M.P.), University of Texas Southwestern Medical Center, Dallas, Texas
| | - Gustavo Angulo
- Rare Brain Disorders Program, Department of Neurology (G.K., Q.M., G.A., V.J., A.D., L.B.G., J.M.P.), Department of Biochemistry (H.C., B.P.), Department of Pathology (J.Y.P.), Department of Physiology (J.M.P.), Department of Pediatrics (J.M.P.), and Eugene McDermott Center for Human Growth & Development/Center for Human Genetics (J.Y.P., J.M.P.), University of Texas Southwestern Medical Center, Dallas, Texas
| | - Hong Chen
- Rare Brain Disorders Program, Department of Neurology (G.K., Q.M., G.A., V.J., A.D., L.B.G., J.M.P.), Department of Biochemistry (H.C., B.P.), Department of Pathology (J.Y.P.), Department of Physiology (J.M.P.), Department of Pediatrics (J.M.P.), and Eugene McDermott Center for Human Growth & Development/Center for Human Genetics (J.Y.P., J.M.P.), University of Texas Southwestern Medical Center, Dallas, Texas
| | - Vikram Jakkamsetti
- Rare Brain Disorders Program, Department of Neurology (G.K., Q.M., G.A., V.J., A.D., L.B.G., J.M.P.), Department of Biochemistry (H.C., B.P.), Department of Pathology (J.Y.P.), Department of Physiology (J.M.P.), Department of Pediatrics (J.M.P.), and Eugene McDermott Center for Human Growth & Development/Center for Human Genetics (J.Y.P., J.M.P.), University of Texas Southwestern Medical Center, Dallas, Texas
| | - Aksharkumar Dobariya
- Rare Brain Disorders Program, Department of Neurology (G.K., Q.M., G.A., V.J., A.D., L.B.G., J.M.P.), Department of Biochemistry (H.C., B.P.), Department of Pathology (J.Y.P.), Department of Physiology (J.M.P.), Department of Pediatrics (J.M.P.), and Eugene McDermott Center for Human Growth & Development/Center for Human Genetics (J.Y.P., J.M.P.), University of Texas Southwestern Medical Center, Dallas, Texas
| | - Levi B Good
- Rare Brain Disorders Program, Department of Neurology (G.K., Q.M., G.A., V.J., A.D., L.B.G., J.M.P.), Department of Biochemistry (H.C., B.P.), Department of Pathology (J.Y.P.), Department of Physiology (J.M.P.), Department of Pediatrics (J.M.P.), and Eugene McDermott Center for Human Growth & Development/Center for Human Genetics (J.Y.P., J.M.P.), University of Texas Southwestern Medical Center, Dallas, Texas
| | - Bruce Posner
- Rare Brain Disorders Program, Department of Neurology (G.K., Q.M., G.A., V.J., A.D., L.B.G., J.M.P.), Department of Biochemistry (H.C., B.P.), Department of Pathology (J.Y.P.), Department of Physiology (J.M.P.), Department of Pediatrics (J.M.P.), and Eugene McDermott Center for Human Growth & Development/Center for Human Genetics (J.Y.P., J.M.P.), University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jason Y Park
- Rare Brain Disorders Program, Department of Neurology (G.K., Q.M., G.A., V.J., A.D., L.B.G., J.M.P.), Department of Biochemistry (H.C., B.P.), Department of Pathology (J.Y.P.), Department of Physiology (J.M.P.), Department of Pediatrics (J.M.P.), and Eugene McDermott Center for Human Growth & Development/Center for Human Genetics (J.Y.P., J.M.P.), University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Juan M Pascual
- Rare Brain Disorders Program, Department of Neurology (G.K., Q.M., G.A., V.J., A.D., L.B.G., J.M.P.), Department of Biochemistry (H.C., B.P.), Department of Pathology (J.Y.P.), Department of Physiology (J.M.P.), Department of Pediatrics (J.M.P.), and Eugene McDermott Center for Human Growth & Development/Center for Human Genetics (J.Y.P., J.M.P.), University of Texas Southwestern Medical Center, Dallas, Texas.
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16
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Thaker AI, Smith J, Pathak M, Park JY. Challenges in Inter-rater Agreement on Lamina Propria Fibrosis in Esophageal Biopsies. Pediatr Dev Pathol 2023; 26:106-114. [PMID: 36755427 DOI: 10.1177/10935266221147084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND Mucosal biopsies in eosinophilic esophagitis (EoE) can exhibit lamina propria (LP) fibrosis, which may portend stenotic complications; however, the histologic diagnosis of LP fibrosis is subjective. We sought to assess and improve the consistency of LP fibrosis diagnosis among our pathologist group. METHODS At a large pediatric hospital, 25 esophageal biopsy slides from 19 patients (16 with EoE) exhibiting a wide spectrum of LP area, artifacts, and fibrosis severity were scanned into whole-slide images. Staff pediatric pathologists (n = 8) separate from the authors classified each biopsy by LP adequacy and fibrosis severity 1 month before and after completion of an educational tutorial. Consensus was defined as >70% agreement. RESULTS At baseline, 16/25 (64%) cases reached consensus for no fibrosis (n = 3), fibrosis (n = 7), or inadequate LP (n = 6); agreement was fair (α = 0.34). Post-tutorial, 13/25 (52%) cases reached consensus for no fibrosis (n = 2), fibrosis (n = 7), or inadequate LP (n = 4); agreement was again fair (α = 0.33). There was moderate agreement in grading of fibrosis severity (α = 0.54). CONCLUSION We document only fair-to-moderate agreement in the diagnosis of esophageal LP fibrosis and adequacy in a large pediatric pathologist group despite targeted education, highlighting a challenge in incorporating this feature into EoE research and clinical decision-making.
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Affiliation(s)
- Ameet I Thaker
- Division of Pediatric Pathology, UT Southwestern/Children's Health, Dallas, TX, USA
| | - Jacob Smith
- Division of Pediatric Pathology, UT Austin/Dell Children's Medical Center, Austin, TX, USA
| | - Mona Pathak
- Department of Population and Data Sciences, UT Southwestern, Dallas, TX, USA
| | - Jason Y Park
- Division of Pediatric Pathology, UT Southwestern/Children's Health, Dallas, TX, USA
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17
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Dirvanskyte P, Gurram B, Bolton C, Warner N, Jones KDJ, Griffin HR, Park JY, Keller KM, Gilmour KC, Hambleton S, Muise AM, Wysocki C, Uhlig HH. Chromosomal Numerical Aberrations and Rare Copy Number Variation in Patients with Inflammatory Bowel Disease. J Crohns Colitis 2023; 17:49-60. [PMID: 35907265 PMCID: PMC9880952 DOI: 10.1093/ecco-jcc/jjac103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND AIMS Inflammatory bowel diseases [IBD] have a complex polygenic aetiology. Rare genetic variants can cause monogenic intestinal inflammation. The impact of chromosomal aberrations and large structural abnormalities on IBD susceptibility is not clear. We aimed to comprehensively characterise the phenotype and prevalence of patients with IBD who possess rare numerical and structural chromosomal abnormalities. METHODS We performed a systematic literature search of databases PubMed and Embase; and analysed gnomAD, Clinvar, the 100 000 Genomes Project, and DECIPHER databases. Further, we analysed international paediatric IBD cohorts to investigate the role of IL2RA duplications in IBD susceptibility. RESULTS A meta-analysis suggests that monosomy X [Turner syndrome] is associated with increased expressivity of IBD that exceeds the population baseline (1.86%, 95% confidence interval [CI] 1.48 to 2.34%) and causes a younger age of IBD onset. There is little evidence that Klinefelter syndrome, Trisomy 21, Trisomy 18, mosaic Trisomy 9 and 16, or partial trisomies contribute to IBD susceptibility. Copy number analysis studies suggest inconsistent results. Monoallelic loss of X-linked or haploinsufficient genes is associated with IBD by hemizygous or heterozygous deletions, respectively. However, haploinsufficient gene deletions are detected in healthy reference populations, suggesting that the expressivity of IBD might be overestimated. One duplication that has previously been identified as potentially contributing to IBD risk involves the IL2RA/IL15R loci. Here we provide additional evidence that a microduplication of this locus may predispose to very-early-onset IBD by identifying a second case in a distinct kindred. However, the penetrance of intestinal inflammation in this genetic aberration is low [<2.6%]. CONCLUSIONS Turner syndrome is associated with increased susceptibility to intestinal inflammation. Duplication of the IL2RA/IL15R loci may contribute to disease risk.
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Affiliation(s)
- Paulina Dirvanskyte
- Translational Gastroenterology Unit and Biomedical Research Centre, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Bhaskar Gurram
- Department of Pediatrics, UT Southwestern Medical Center, Dallas TX, USA
| | - Chrissy Bolton
- Institute of Child Health, University College London, London, UK
- Paediatric Gastroenterology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Neil Warner
- SickKids Inflammatory Bowel Disease Centre, Hospital for Sick Children, Toronto, ON, Canada
| | - Kelsey D J Jones
- Paediatric Gastroenterology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Helen R Griffin
- Primary Immunodeficiency Group, Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK
| | | | - Jason Y Park
- Department of Pathology and the Eugene McDermott Center for Human Growth and Development. UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Kimberly C Gilmour
- Laboratory of Immunology and Cellular Therapy, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Sophie Hambleton
- Primary Immunodeficiency Group, Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK
| | - Aleixo M Muise
- SickKids Inflammatory Bowel Disease Centre, Hospital for Sick Children, Toronto, ON, Canada
- Department of Biochemistry, University of Toronto, Toronto, ON, Canada
- Cell Biology Program, Sick Kids Research Institute, Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Christian Wysocki
- Department of Pediatrics, and Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Holm H Uhlig
- Translational Gastroenterology Unit and Biomedical Research Centre, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Biomedical Research Centre, University of Oxford, Oxford, UK
- Department of Paediatrics, John Radcliffe Hospital, Oxford, UK
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18
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Park JY, Baudhuin LM, Young IS. Evolutions in Clinical Chemistry. Clin Chem 2023; 69:1-2. [PMID: 36598548 DOI: 10.1093/clinchem/hvac184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Jason Y Park
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Linnea M Baudhuin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Ian S Young
- Centre for Public Health, Institute for Global Food Security, Queen's University Belfast, Northern Ireland, UK
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19
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Manuel M, Patel V, Filkins LM, Filkins LM, Park JY, Nadeem S. Urinary Predictors of Bacteremia in Febrile Infants with Urinary Tract Infection. Journal of Scientific Innovation in Medicine 2022. [DOI: 10.29024/jsim.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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20
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Park JY, Pardosi JF, Islam MS, Respati T, Chowdhury K, Seale H. What does family involvement in care provision look like across hospital settings in Bangladesh, Indonesia, and South Korea? BMC Health Serv Res 2022; 22:922. [PMID: 35841023 PMCID: PMC9286761 DOI: 10.1186/s12913-022-08278-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 06/30/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Family members provide care whilst staying in the patient's room across a range of cultural settings, irrespective of resource availability in many Asian countries. This has been reported as a contributing factor to the spread of several outbreaks, including COVID-19. Despite these reports, very little is known about the risk of healthcare-associated infection (HAI) transmission related to the involvement of family and private carers in the clinical setting. As a starting point to understanding this issue, this study aimed to provide insights regarding the patient care activities undertaken by family and private carers and the guidance provided to these carers around infection control measures in hospitals located in Bangladesh, Indonesia, and South Korea. METHOD A qualitative study involving 57 semi-structured interviews was undertaken in five tertiary level hospitals across the selected countries. Two groups of individuals were interviewed: (1) patients and their family carers and private carers; and (2) healthcare workers, including doctors, nurses, hospital managers and staff members. Drawing upon the principles of grounded theory, an inductive approach to data analysis using thematic analysis was adopted. RESULTS Five main themes were generated from the analysis of the data: (1) expectation of family carers staying with a patient; (2) residing in the patient's environment: (3) caring activities undertaken by family carers; (4) supporting and educating family carers and (5) communication around healthcare-associated infection and infection prevention and control. CONCLUSION Based on the types of activities being undertaken, coupled with the length of time family and private carers are residing within the clinical setting, coupled with an apparent lack of guidance being given around IPC, more needs to be done to ensure that these carers are not being inadvertently exposed to HAI's or other occupational risks.
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Affiliation(s)
- J Y Park
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
| | - J F Pardosi
- School of Public Health & Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - M S Islam
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - T Respati
- Faculty of Medicine, Universitas Islam Bandung, Bandung, Indonesia
| | - K Chowdhury
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - H Seale
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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21
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Yang K, Han J, Gill JG, Park JY, Sathe MN, Gattineni J, Wright T, Wysocki C, de la Morena MT, Yan N. The mammalian SKIV2L RNA exosome is essential for early B cell development. Sci Immunol 2022; 7:eabn2888. [PMID: 35658009 DOI: 10.1126/sciimmunol.abn2888] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The SKIV2L RNA exosome is an evolutionarily conserved RNA degradation complex in the eukaryotes. Mutations in the SKIV2L gene are associated with a severe inherited disorder, trichohepatoenteric syndrome (THES), with multisystem involvement but unknown disease mechanism. Here, we reported a THES patient with SKIV2L mutations showing severe primary B cell immunodeficiency, hypogammaglobulinemia, and kappa-restricted plasma cell dyscrasia but normal T cell and NK cell function. To corroborate these findings, we made B cell-specific Skiv2l knockout mice (Skiv2lfl/flCd79a-Cre), which lacked both conventional B-2 and innate-like B-1 B cells in the periphery and secondary lymphoid organs. This was linked to a requirement of SKIV2L RNA exosome activity in the bone marrow during early B cell development at the pro-B cell to large pre-B cell transition. Mechanistically, Skiv2l-deficient pro-B cells exhibited cell cycle arrest and DNA damage. Furthermore, loss of Skiv2l led to substantial out-of-frame V(D)J rearrangement of immunoglobulin heavy chain and severely reduced surface expression of μH, both of which are crucial for pre-BCR signaling and proliferative burst during early B cell development. Together, our data demonstrated a crucial role for SKIV2L RNA exosome in early B cell development in both human and mice by ensuring proper V(D)J recombination and Igh expression, which serves as the molecular basis for immunodeficiency associated with THES.
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Affiliation(s)
- Kun Yang
- Department of Immunology, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Microbiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jie Han
- Department of Immunology, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Microbiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jennifer G Gill
- Department of Dermatology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jason Y Park
- Department of Pathology and the Eugene McDermott Center for Human Growth and Development, UT Southwestern Medical Center, Dallas, TX, USA
| | - Meghana N Sathe
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jyothsna Gattineni
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Tracey Wright
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Christian Wysocki
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - M Teresa de la Morena
- Department of Pediatrics, University of Washington and, Seattle, WA, USA.,Seattle Children's Hospital, Seattle, WA, USA
| | - Nan Yan
- Department of Immunology, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Microbiology, UT Southwestern Medical Center, Dallas, TX, USA
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22
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He L, Cornish TC, Kricka LJ, Vandergriff TW, Yancey K, Nguyen K, Park JY. Trends in dermatology eponyms. JAAD Int 2022; 7:137-143. [PMID: 35497637 PMCID: PMC9043396 DOI: 10.1016/j.jdin.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 10/28/2022] Open
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23
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Nadeem S, Manuel MM, Oke OK, Patel V, Filkins LM, Badawy MK, Park JY, Hennes HM. Association of Pyuria with Uropathogens in Young Children. J Pediatr 2022; 245:208-212.e2. [PMID: 35120990 DOI: 10.1016/j.jpeds.2022.01.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 01/08/2022] [Accepted: 01/26/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To examine the association between uropathogens and pyuria in children <24 months of age. STUDY DESIGN A retrospective study of children <24 months of age evaluated in the emergency department for suspected urinary tract infection (UTI) with paired urinalysis and urine culture during a 6-year period. Bagged urine specimens or urine culture growing mixed/multiple urogenital organisms were excluded. Analysis was limited to children with positive urine culture as defined by the American Academy of Pediatrics clinical practice guideline culture thresholds. RESULTS Of 30 462 children, 1916 had microscopic urinalysis and positive urine culture. Urine was obtained by transurethral in-and-out catheterization in 98.3% of cases. Pyuria (≥5 white blood cells per high-powered field) and positive leukocyte esterase (small or more) on the urine dipstick were present in 1690 (88.2%) and 1692 (88.3%) of the children respectively. Children with non-Escherichia coli species were less likely to exhibit microscopic pyuria than children with E coli (OR 0.24, 95% CI 0.17-0.34) with more pronounced effect on Enterococcus and Klebsiella (OR 0.08, 95% CI 0.03-0.18 and OR 0.18, 95% CI 0.11-0.27 respectively). Similarly, positive leukocyte esterase was less frequently seen in non-E coli uropathogens compared with E coli. CONCLUSIONS Pyuria and leukocyte esterase are not sensitive markers to identify non-E coli UTI in young children. More sensitive screening biomarkers are needed to identify UTI with these uropathogens.
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Affiliation(s)
| | - Matthias M Manuel
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Vatsal Patel
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Laura M Filkins
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Mohamed K Badawy
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jason Y Park
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Halim M Hennes
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
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24
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Willis KR, Sathe AA, Xing C, Koduru P, Artunduaga M, Butler EB, Park JY, Kurmasheva RT, Houghton PJ, Chen KS, Rakheja D. Extrarenal Anaplastic Wilms Tumor: A Case Report With Genomic Analysis and Tumor Models. J Pediatr Hematol Oncol 2022; 44:147-154. [PMID: 35129140 PMCID: PMC9035038 DOI: 10.1097/mph.0000000000002413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/29/2021] [Indexed: 11/25/2022]
Abstract
Primary extrarenal Wilms tumors are rare neoplasms that are presumed to arise from metanephric or mesonephric remnants outside of the kidney. Their pathogenesis is debated but has not been studied, and there are no reports of genomic descriptions of extrarenal Wilms tumors. We describe a diffusely anaplastic extrarenal Wilms tumor that occurred in the lower abdomen and upper pelvis of a 10-year-old boy. In addition to the clinical, histopathologic, and radiologic features, we describe the cytogenetic changes and exomic profile of the tumor. The tumor showed loss of the tumor suppressor AMER1, loss of chromosome regions 1p, 16q, and 22q, gain of chromosome 8, and loss of function TP53 mutation-findings known to occur in renal Wilms tumors. This is the first description of the exomic profile of a primary extrarenal Wilms tumor. Our data indicate that primary extrarenal Wilms tumors may follow the same pathogenetic pathways that are seen in renal Wilms tumors. Finally, we describe the establishment of first ever tumor models (primary cell line and patient-derived xenograft) from an extrarenal Wilms tumor.
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Affiliation(s)
| | - Adwait A Sathe
- Eugene McDermott Center for Human Growth and Development
| | - Chao Xing
- Eugene McDermott Center for Human Growth and Development
- Division of Pediatric Radiology, Department of Radiology
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Texas Southwestern Medical Center
| | | | - Maddy Artunduaga
- Division of Pediatric Radiology, Department of Radiology
- Children's Health System of Texas, Dallas
| | - Erin B Butler
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Texas Southwestern Medical Center
| | - Jason Y Park
- Departments of Pathology
- Children's Health System of Texas, Dallas
| | - Raushan T Kurmasheva
- Greehey Children's Cancer Research Institute
- Department of Molecular Medicine, University of Texas Health at San Antonio, San Antonio, TX
| | - Peter J Houghton
- Greehey Children's Cancer Research Institute
- Department of Molecular Medicine, University of Texas Health at San Antonio, San Antonio, TX
| | - Kenneth S Chen
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Texas Southwestern Medical Center
- Children's Health System of Texas, Dallas
| | - Dinesh Rakheja
- Departments of Pathology
- Children's Health System of Texas, Dallas
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25
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Rakheja D, Park JY, Alhasan M, Uddin N. Spindle Cell/Sclerosing Rhabdomyosarcoma With PAX8::PPARG Fusion. Int J Surg Pathol 2022; 30:950-955. [DOI: 10.1177/10668969221095170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The spindle cell/sclerosing subtype of rhabdomyosarcoma is classified based on genetic features into the three categories of MYOD1-mutated, gene fusion-driven, and a subset without a currently identified genetic driver event. The gene fusion-driven spindle cell/sclerosing rhabdomyosarcomas are heterogenous and characterized by increasing numbers of gene fusions, the most common gene partners being VGLL2, NCOA2, and TFCP2. Here we report a spindle cell/sclerosing rhabdomyosarcoma that arose in the orbit of a 4-year-old male. This tumor harbored a unique PAX8::PPARG fusion. PAX8::PPARG fusions have previously only been described in follicular thyroid carcinoma and follicular variant of papillary thyroid carcinoma. Our report adds to the growing number of gene fusions in spindle cell/sclerosing rhabdomyosarcomas.
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Affiliation(s)
- Dinesh Rakheja
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Children’s Health, Dallas, TX, USA
| | - Jason Y. Park
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Children’s Health, Dallas, TX, USA
| | - Mustafa Alhasan
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Children’s Health, Dallas, TX, USA
| | - Naseem Uddin
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Children’s Health, Dallas, TX, USA
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26
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Shi G, Xu J, Barnes SF, Farooqi MS, Luu HS, Gotway G, Park JY. Chromosomal Microarray Reinterpretation: Applications to Pediatric Practice. J Pediatr 2022; 243:219-223. [PMID: 34953820 DOI: 10.1016/j.jpeds.2021.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/16/2021] [Accepted: 12/13/2021] [Indexed: 12/01/2022]
Abstract
Chromosomal microarray analysis (CMA) frequently yields inconclusive results. We reexamined inconclusive CMA results from 33 previously tested patients and reached a definitive diagnosis in 3 (9.1%) and identified the need for additional testing in 4 (12.1%). Reinterpretation may resolve inconclusive CMA results.
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Affiliation(s)
- Guanglu Shi
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jing Xu
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Shirelle F Barnes
- Department of Pathology, Children's Medical Center Dallas, Dallas, TX; Department of Genetics, Children's Medical Center Dallas, Dallas, TX
| | - Midhat S Farooqi
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO
| | - Hung S Luu
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Pathology, Children's Medical Center Dallas, Dallas, TX
| | - Garrett Gotway
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX; Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jason Y Park
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Pathology, Children's Medical Center Dallas, Dallas, TX; Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas, TX.
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27
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von Itzstein MS, Gonugunta AS, Sheffield T, Homsi J, Dowell JE, Koh AY, Raj P, Fattah F, Wang Y, Basava VS, Khan S, Park JY, Popat V, Saltarski JM, Gloria-McCutchen Y, Hsiehchen D, Ostmeyer J, Xie Y, Li QZ, Wakeland EK, Gerber DE. Association between Antibiotic Exposure and Systemic Immune Parameters in Cancer Patients Receiving Checkpoint Inhibitor Therapy. Cancers (Basel) 2022; 14:cancers14051327. [PMID: 35267634 PMCID: PMC8909108 DOI: 10.3390/cancers14051327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 01/19/2023] Open
Abstract
Antibiotic administration is associated with worse clinical outcomes and changes to the gut microbiome in cancer patients receiving immune checkpoint inhibitors (ICI). However, the effects of antibiotics on systemic immune function are unknown. We, therefore, evaluated antibiotic exposure, therapeutic responses, and multiplex panels of 40 serum cytokines and 124 antibodies at baseline and six weeks after ICI initiation, with p < 0.05 and false discovery rate (FDR) < 0.2 considered significant. A total of 251 patients were included, of whom the 135 (54%) who received antibiotics had lower response rates and shorter survival. Patients who received antibiotics prior to ICI initiation had modestly but significantly lower baseline levels of nucleolin, MDA5, c-reactive protein, and liver cytosol antigen type 1 (LC1) antibodies, as well as higher levels of heparin sulfate and Matrigel antibodies. After ICI initiation, antibiotic-treated patients had significantly lower levels of MDA5, CENP.B, and nucleolin antibodies. Although there were no clear differences in cytokines in the overall cohort, in the lung cancer subset (53% of the study population), we observed differences in IFN-γ, IL-8, and macrophage inflammatory proteins. In ICI-treated patients, antibiotic exposure is associated with changes in certain antibodies and cytokines. Understanding the relationship between these factors may improve the clinical management of patients receiving ICI.
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Affiliation(s)
- Mitchell S. von Itzstein
- Department of Internal Medicine, Division of Hematology-Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (M.S.v.I.); (J.H.); (J.E.D.); (D.H.)
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (F.F.); (V.S.B.); (J.M.S.); (Y.G.-M.); (Y.X.)
| | - Amrit S. Gonugunta
- School of Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (A.S.G.); (V.P.)
| | - Thomas Sheffield
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (T.S.); (Y.W.); (J.O.)
| | - Jade Homsi
- Department of Internal Medicine, Division of Hematology-Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (M.S.v.I.); (J.H.); (J.E.D.); (D.H.)
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (F.F.); (V.S.B.); (J.M.S.); (Y.G.-M.); (Y.X.)
| | - Jonathan E. Dowell
- Department of Internal Medicine, Division of Hematology-Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (M.S.v.I.); (J.H.); (J.E.D.); (D.H.)
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (F.F.); (V.S.B.); (J.M.S.); (Y.G.-M.); (Y.X.)
| | - Andrew Y. Koh
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA;
| | - Prithvi Raj
- Department of Immunology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (P.R.); (S.K.); (Q.-Z.L.); (E.K.W.)
| | - Farjana Fattah
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (F.F.); (V.S.B.); (J.M.S.); (Y.G.-M.); (Y.X.)
| | - Yiqing Wang
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (T.S.); (Y.W.); (J.O.)
| | - Vijay S. Basava
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (F.F.); (V.S.B.); (J.M.S.); (Y.G.-M.); (Y.X.)
| | - Shaheen Khan
- Department of Immunology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (P.R.); (S.K.); (Q.-Z.L.); (E.K.W.)
| | - Jason Y. Park
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA;
| | - Vinita Popat
- School of Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (A.S.G.); (V.P.)
| | - Jessica M. Saltarski
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (F.F.); (V.S.B.); (J.M.S.); (Y.G.-M.); (Y.X.)
| | - Yvonne Gloria-McCutchen
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (F.F.); (V.S.B.); (J.M.S.); (Y.G.-M.); (Y.X.)
| | - David Hsiehchen
- Department of Internal Medicine, Division of Hematology-Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (M.S.v.I.); (J.H.); (J.E.D.); (D.H.)
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (F.F.); (V.S.B.); (J.M.S.); (Y.G.-M.); (Y.X.)
| | - Jared Ostmeyer
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (T.S.); (Y.W.); (J.O.)
| | - Yang Xie
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (F.F.); (V.S.B.); (J.M.S.); (Y.G.-M.); (Y.X.)
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (T.S.); (Y.W.); (J.O.)
| | - Quan-Zhen Li
- Department of Immunology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (P.R.); (S.K.); (Q.-Z.L.); (E.K.W.)
| | - Edward K. Wakeland
- Department of Immunology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (P.R.); (S.K.); (Q.-Z.L.); (E.K.W.)
| | - David E. Gerber
- Department of Internal Medicine, Division of Hematology-Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (M.S.v.I.); (J.H.); (J.E.D.); (D.H.)
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (F.F.); (V.S.B.); (J.M.S.); (Y.G.-M.); (Y.X.)
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (T.S.); (Y.W.); (J.O.)
- Correspondence:
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28
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Rakheja D, Park JY, Fernandes NJ, Watt TC, Laetsch TW, Collins RRJ. Pediatric Non-Myofibroblastic Primitive Spindle Cell Tumors with ALK Gene Rearrangements and Response to Crizotinib. Int J Surg Pathol 2022; 30:706-715. [PMID: 35164578 DOI: 10.1177/10668969221080072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
We describe two poorly differentiated, non-myofibroblastic (SMA-, S100+, CD34±), spindle cell neoplasms with immunohistochemical positivity for ALK and with ALK gene rearrangements leading to PLEKHH2::ALK and CLTC::ALK fusions, respectively. ALK protein overexpression and/or gene fusions should be evaluated in poorly differentiated spindle cell neoplasms, even when there is an absence of a myofibroblastic phenotype. A positive ALK evaluation has therapeutic implications as both tumors responded to single-agent treatment with the tyrosine kinase inhibitor crizotinib.
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Affiliation(s)
- Dinesh Rakheja
- Department of Pathology, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA.,Children's Health, Dallas, TX, USA
| | - Jason Y Park
- Department of Pathology, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA.,Children's Health, Dallas, TX, USA
| | - Neil J Fernandes
- Children's Health, Dallas, TX, USA.,Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tanya C Watt
- Children's Health, Dallas, TX, USA.,Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Theodore W Laetsch
- Division of Oncology, 6567Children's Hospital of Philadelphia and Perelman School of Medicine and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca R J Collins
- Department of Pathology, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA.,Children's Health, Dallas, TX, USA
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29
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Jacobs JW, Peabody Lever JE, Lee YS, Bryan KM, Booth GS, Njoku IO, Arvisais-Anhalt S, Araj E, Park JY. The Importance of Accurately Defining Gender and Sex in Pathology. Am J Clin Pathol 2022; 158:153. [PMID: 35150126 PMCID: PMC9391684 DOI: 10.1093/ajcp/aqac008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - Ellen Araj
- UT Southwestern Medical Center, Dallas, TX, USA,UT Southwestern Medical Center, Dallas, TX, USA
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30
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Arvisais-Anhalt S, Lehmann CU, Bishop JA, Balani J, Boutte L, Morales M, Park JY, Araj E. Searching Full-Text Anatomic Pathology Reports Using Business Intelligence Software. J Pathol Inform 2022; 13:100014. [PMID: 35251753 PMCID: PMC8892022 DOI: 10.1016/j.jpi.2022.100014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 01/24/2023] Open
Abstract
Although the laboratory information system has largely solved the problem of storing anatomic pathology reports and disseminating their contents across the healthcare system, the retrospective query of anatomic pathology reports remains an area for improvement across laboratory information system vendors. Our institution desired the ability to query our repository of anatomic pathology reports for clinical, operational, research, and educational purposes. To address this need, we developed a full-text anatomic pathology search tool using the business intelligence software, Tableau. Our search tool allows users to query the 333,685 anatomic pathology reports from our institutional clinical relational database using the business intelligence tool's built-in regular expression functionality. Users securely access the search tool using any web browser, thereby avoiding the cost of installing or maintaining software on users' computers. This tool is laboratory information system vendor agnostic and as many institutions already subscribe to business intelligence software, we believe this solution could be easily reproduced at other institutions and in other clinical departments.
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Affiliation(s)
- Simone Arvisais-Anhalt
- Department of Hospital Medicine and Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Christoph U. Lehmann
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Justin A. Bishop
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jyoti Balani
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Laurie Boutte
- Health System Quality & Operational Excellence, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Marjorie Morales
- Health System Quality & Operational Excellence, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jason Y. Park
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ellen Araj
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA,Corresponding author at: Department of Pathology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9072, USA.
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31
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Yang K, Han J, Asada M, Gill JG, Park JY, Sathe MN, Gattineni J, Wright T, Wysocki CA, de la Morena MT, Garza LA, Yan N. Cytoplasmic RNA quality control failure engages mTORC1-mediated autoinflammatory disease. J Clin Invest 2022; 132:146176. [PMID: 35040435 PMCID: PMC8759780 DOI: 10.1172/jci146176] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 10/27/2021] [Indexed: 12/23/2022] Open
Abstract
Inborn errors of nucleic acid metabolism often cause aberrant activation of nucleic acid sensing pathways, leading to autoimmune or autoinflammatory diseases. The SKIV2L RNA exosome is cytoplasmic RNA degradation machinery that was thought to be essential for preventing the self-RNA–mediated interferon (IFN) response. Here, we demonstrate the physiological function of SKIV2L in mammals. We found that Skiv2l deficiency in mice disrupted epidermal and T cell homeostasis in a cell-intrinsic manner independently of IFN. Skiv2l-deficient mice developed skin inflammation and hair abnormality, which were also observed in a SKIV2L-deficient patient. Epidermis-specific deletion of Skiv2l caused hyperproliferation of keratinocytes and disrupted epidermal stratification, leading to impaired skin barrier with no appreciable IFN activation. Moreover, Skiv2l-deficient T cells were chronically hyperactivated and these T cells attacked lesional skin as well as hair follicles. Mechanistically, SKIV2L loss activated the mTORC1 pathway in both keratinocytes and T cells. Both systemic and topical rapamycin treatment of Skiv2l-deficient mice ameliorated epidermal hyperplasia and skin inflammation. Together, we demonstrate that mTORC1, a classical nutrient sensor, also senses cytoplasmic RNA quality control failure and drives autoinflammatory disease. We also propose SKIV2L-associated trichohepatoenteric syndrome (THES) as a new mTORopathy for which sirolimus may be a promising therapy.
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Affiliation(s)
- Kun Yang
- Department of Immunology and.,Department of Microbiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Jie Han
- Department of Immunology and.,Department of Microbiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Mayumi Asada
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Jason Y Park
- Department of Pathology and the Eugene McDermott Center for Human Growth and Development
| | | | | | | | - Christian A Wysocki
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - M Teresa de la Morena
- Department of Pediatrics, University of Washington and.,Seattle Children's Hospital, Seattle, Washington, USA
| | - Luis A Garza
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nan Yan
- Department of Immunology and.,Department of Microbiology, UT Southwestern Medical Center, Dallas, Texas, USA
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32
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Luu HS, Filkins LM, Park JY, Rakheja D, Tweed J, Menzies C, Wang VJ, Mittal V, Lehmann CU, Sebert ME. Harnessing the Electronic Health Record and Computerized Provider Order Entry Data for Resource Management During the COVID-19 Pandemic: Development of a Decision Tree. JMIR Med Inform 2021; 9:e32303. [PMID: 34546942 PMCID: PMC8525625 DOI: 10.2196/32303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/18/2021] [Accepted: 09/19/2021] [Indexed: 11/23/2022] Open
Abstract
Background The COVID-19 pandemic has resulted in shortages of diagnostic tests, personal protective equipment, hospital beds, and other critical resources. Objective We sought to improve the management of scarce resources by leveraging electronic health record (EHR) functionality, computerized provider order entry, clinical decision support (CDS), and data analytics. Methods Due to the complex eligibility criteria for COVID-19 tests and the EHR implementation–related challenges of ordering these tests, care providers have faced obstacles in selecting the appropriate test modality. As test choice is dependent upon specific patient criteria, we built a decision tree within the EHR to automate the test selection process by using a branching series of questions that linked clinical criteria to the appropriate SARS-CoV-2 test and triggered an EHR flag for patients who met our institutional persons under investigation criteria. Results The percentage of tests that had to be canceled and reordered due to errors in selecting the correct testing modality was 3.8% (23/608) before CDS implementation and 1% (262/26,643) after CDS implementation (P<.001). Patients for whom multiple tests were ordered during a 24-hour period accounted for 0.8% (5/608) and 0.3% (76/26,643) of pre- and post-CDS implementation orders, respectively (P=.03). Nasopharyngeal molecular assay results were positive in 3.4% (826/24,170) of patients who were classified as asymptomatic and 10.9% (1421/13,074) of symptomatic patients (P<.001). Positive tests were more frequent among asymptomatic patients with a history of exposure to COVID-19 (36/283, 12.7%) than among asymptomatic patients without such a history (790/23,887, 3.3%; P<.001). Conclusions The leveraging of EHRs and our CDS algorithm resulted in a decreased incidence of order entry errors and the appropriate flagging of persons under investigation. These interventions optimized reagent and personal protective equipment usage. Data regarding symptoms and COVID-19 exposure status that were collected by using the decision tree correlated with the likelihood of positive test results, suggesting that clinicians appropriately used the questions in the decision tree algorithm.
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Affiliation(s)
- Hung S Luu
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Laura M Filkins
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Jason Y Park
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Dinesh Rakheja
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Jefferson Tweed
- Department of Advanced Analytics and Informatics, Children's Health, Dallas, TX, United States
| | - Christopher Menzies
- Department of Advanced Analytics and Informatics, Children's Health, Dallas, TX, United States
| | - Vincent J Wang
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Vineeta Mittal
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Christoph U Lehmann
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, TX, United States.,Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States.,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States.,Lyda Hill Department of Bioinformatics, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Michael E Sebert
- Division of Infectious Diseases, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States
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33
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Kim BY, Park JY, Cho KJ, Bae JH. The potential cytotoxic effects of urban particle matter on olfaction. Rhinology 2021; 59:528-537. [PMID: 34636368 DOI: 10.4193/rhin21.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Urban particulate matter (UPM) in ambient air is implicated in a variety of human health issues worldwide, however, few studies exist on the effect of UPM on the olfactory system. This study aimed to identify the factors affecting the destruction of the olfactory system in a mouse model following UPM exposure. METHODS Mice were divided into: control and four UPM-exposed groups (200 µg UPM at 1 and 2 weeks, and 400 µg UPM at 1 and 2 weeks [standard reference material 1649b; average particle diameter 10.5 μm]). The olfactory neuroepithelium was harvested for histologic examination, gene ontology, quantitative real-time polymerase chain reaction, and western blotting. RESULTS Compared to the control group, olfactory marker protein, Olfr1507, ADCY3, and GNAL mRNA levels were lower, and S-100, CNPase, NGFRAP1, BDNF, and TACR3 mRNA levels were higher in the olfactory neuroepithelium of the UPM groups. Moderately positive correlation was present between the 1- and 2-week groups. After analyzing the 200 and 400 UPM groups separately, the strength of the association between the 200 UPM 1- and 2-week groups was moderately positive. No differences was present in the neuroepithelial inflammatory marker levels between the UPM and control groups. CONCLUSIONS UPM could have cytotoxic effects on the olfactory epithelium. The exposure time and particular concentration of UPM exposure could affect the degree of destruction of the olfactory neuroepithelium. The olfactory regeneration mechanism could be related to the neurotrophic factors, olfactory ensheathing cell stimulation, and trigeminal nerve support.
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Affiliation(s)
- B-Y Kim
- Department of Otorhinolaryngology, School of Medicine, Ewha Womans University of Korea, Seoul, South-Korea
| | - J Y Park
- Department of clinical laboratory, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu City, Gyeonggi-do, South-Korea
| | - K J Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu City, Gyeonggi-do, South-Korea
| | - J H Bae
- Department of Otorhinolaryngology, School of Medicine, Ewha Womans University of Korea, Seoul, South-Korea
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34
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Choi H, Ko Y, Lee CY, Chung SJ, Kim HI, Kim JH, Park S, Hwang YI, Jang SH, Jung KS, Kim YK, Park JY. Impact of COVID-19 on TB epidemiology in South Korea. Int J Tuberc Lung Dis 2021; 25:854-860. [PMID: 34615583 DOI: 10.5588/ijtld.21.0255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING: Five referral hospitals, South Korea.OBJECTIVE: To assess epidemiological changes in TB before and during the COVID-19 pandemic.DESIGN: This was a multicentre cohort study of 3,969 patients diagnosed with TB.RESULTS: We analysed 3,453 patients diagnosed with TB prior to the COVID-19 pandemic (January 2016-February 2020) and 516 during the pandemic (March-November 2020). During the pandemic, the number of patients visits declined by 15% from the previous 4-year average, and the number of patients diagnosed with TB decreased by 17%. Patients diagnosed during the pandemic were older than those diagnosed before the pandemic (mean age, 60.2 vs. 56.6 years, P < 0.001). The proportion of patients to have primary TB at a younger age (births after 1980) among those diagnosed with TB was significantly lower during the pandemic than before (17.8% in 2020 vs. 23.5% in 2016, 24.0% in 2017, 22.5% in 2018, 23.5% in 2019; P = 0.005).CONCLUSIONS: The COVID-19 pandemic resulted in a reduction in the number of visits to respiratory departments, leading to fewer patients being diagnosed with TB. However, our results suggest that universal personal preventive measures help to suppress TB transmission in regions with intermediate TB burden.
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Affiliation(s)
- H Choi
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea, Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea
| | - Y Ko
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea, Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - C Y Lee
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea, Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - S J Chung
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea, Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Dongtan, Korea
| | - H I Kim
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea, Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - J-H Kim
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea, Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - S Park
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea, Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Y I Hwang
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea, Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - S H Jang
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea, Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - K-S Jung
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea, Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Y K Kim
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - J Y Park
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea, Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
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Abstract
Eponyms are common in medicine; however, their usage has varied between specialties and over time. A search of specific eponyms will reveal the frequency of usage within a medical specialty. While usage of eponyms can be studied by searching PubMed, manual searching can be time-consuming. As an alternative, we modified an existing Biopython method for searching PubMed. In this method, a list of disease eponyms is first manually collected in an Excel file. A Python script then creates permutations of the eponyms that might exist in the cited literature. These permutations include possessives (e.g., ‘s) as well as various forms of combining multiple surnames. PubMed is then automatically searched for this permutated library of eponyms, and duplicate citations are removed. The final output file may then be sorted and enumerated by all the data fields which exist in PubMed. This method will enable rapid searching and characterization of eponyms for any specialty of medicine. This method is agnostic to the type of terms searched and can be generally applied to the medical literature including non-eponymous terms such as gene names and chemical compounds.Custom Python scripts using Biopython's Bio.Entrez module automate the search for medical eponyms. This method can be more broadly used to search for any set of terms existing in PubMed.
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Affiliation(s)
- Toby C Cornish
- Department of Pathology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Larry J Kricka
- Department of Pathology & Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jason Y Park
- Department of Pathology and the Eugene McDermott Center for Human Growth and Development, Children's Medical Center, and University of Texas Southwestern Medical School, Dallas, TX, USA
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Medina AL, Troendle DM, Park JY, Thaker A, Dunbar KB, Cheng E. Eosinophilic esophagitis, Barrett's esophagus and esophageal neoplasms in the pediatric patient: a narrative review. Transl Gastroenterol Hepatol 2021; 6:32. [PMID: 34423153 DOI: 10.21037/tgh-20-223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/31/2020] [Indexed: 01/07/2023] Open
Abstract
There are several esophageal disorders that can occur in the pediatric population. Eosinophilic esophagitis (EoE) is an eosinophil predominant inflammatory disease of the esophagus that was first characterized in the early 1900's. EoE is the most common pediatric esophageal inflammatory condition after gastroesophageal reflux disease (GERD). Longstanding GERD is a known risk factor for the development of Barrett's esophagus (BE) in both children and adults. BE is associated with the development of dysplasia and, if left undiagnosed, may progress to the development of esophageal adenocarcinoma (EAC). EAC and esophageal squamous cell carcinoma (ESCC) comprise the majority of childhood esophageal malignant neoplasms. The prevalence of EoE continues to rise within the pediatric population. On the other hand, both BE and esophageal neoplasms remain extremely rare in children. The relationship between a chronic inflammatory condition like EoE to BE and/or esophageal neoplasms remains unclear. The current research of these disease entities is prioritized to further understanding the disease pathogenesis and disease progression, exploring new diagnostic modalities, and developing novel treatments or less invasive therapeutic options. The focus of the following narrative review is to provide a summary of the current clinical practices, future research and their implications on these various esophageal disorders.
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Affiliation(s)
- Annette L Medina
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Children's Health Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - David M Troendle
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Children's Health Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jason Y Park
- Department of Pathology, Children's Health Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ameet Thaker
- Department of Pathology, Children's Health Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kerry B Dunbar
- Division of Gastroenterology and Hepatology, Department of Medicine, Esophageal Diseases Center, Dallas VA Medical Center, VA North Texas Healthcare System, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Edaire Cheng
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Children's Health Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Ahn JW, Jang SK, Jo BR, Kim HS, Park JY, Park HY, Yoo YM, Joo SS. A therapeutic intervention for Alzheimer's disease using ginsenoside Rg3: its role in M2 microglial activation and non-amyloidogenesis. J Physiol Pharmacol 2021; 72. [PMID: 34374655 DOI: 10.26402/jpp.2021.2.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/30/2021] [Indexed: 11/03/2022]
Abstract
Previously, we have reported that ginsenoside Rg3 has typical activities for neuroprotection and Aβ42 clearance by modulating microglia. In this study, we determined the pivotal role of ginsenoside Rg3 in microglia and neuronal cells. In human microglia, Rg3 and its stereoisomers significantly restored inflammatory M1 to normal M0 state and promoted M2 activation by up-regulating acute cytokines such as interleukin-10 and Arginase 1. Moreover, scavenger receptor type A (SRA) was significantly elevated in the presence of ginsenoside Rg3 and 20(S)-Rg3. This indicated that ginsenoside Rg3 could play a crucial role in Aβ uptake and clearance under activated M2 state. We also observed that soluble amyloid precursor protein-alpha (sAPPα) and ADAM10 levels were increased in APP swe-transfected Nuro-2a neuronal cells, whereas sAPPβ was not processed, suggesting that ginsenoside Rg3 was involved in non-amyloidogenic processing. In immunocytochemistry, SRA and a disintegrin and metalloproteinase 10 (desintegrin and metalloproteinase-containing protein 10, ADAM10) were coincidently upregulated in the presence of ginsenoside Rg3 and its stereoisomers compared to those in normal control. Taken together, these results suggested that ginsenoside Rg3 could boost acute activation of microglia, promote Aβ uptake, and elevate the sAPPα processing under activated M2 state. Although in vivo studies need to be performed, it is certain that ginsenoside Rg3 is highly involved in ameliorating the pathogenesis of neurodegeneration and can be a promising candidate for treating Alzheimer's disease as a new therapeutic intervention.
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Affiliation(s)
- J W Ahn
- College of Life Science, Gangneung-Wonju National University, Gangneung, Gangwon, Republic of Korea
| | - S K Jang
- College of Life Science, Gangneung-Wonju National University, Gangneung, Gangwon, Republic of Korea.,Huscion MAJIC R&D Center, Seongnam, Gyeonggi, Republic of Korea
| | - B R Jo
- College of Life Science, Gangneung-Wonju National University, Gangneung, Gangwon, Republic of Korea
| | - H S Kim
- College of Life Science, Gangneung-Wonju National University, Gangneung, Gangwon, Republic of Korea
| | - J Y Park
- Department of Chemical Engineering, Fergana Korea International University, Fergana, Uzbekistan
| | - H Y Park
- College of Pharmacy, Chung-Ang University, Dongjak-gu, Seoul, Republic of Korea
| | - Y-M Yoo
- College of Life Science, Gangneung-Wonju National University, Gangneung, Gangwon, Republic of Korea
| | - S S Joo
- College of Life Science, Gangneung-Wonju National University, Gangneung, Gangwon, Republic of Korea. .,Huscion MAJIC R&D Center, Seongnam, Gyeonggi, Republic of Korea
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38
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Ebigbo N, Park JY, Cheng E, Gurram B. Esophagitis Dissecans Superficialis in Children. J Pediatr Gastroenterol Nutr 2021; 73:e30-e34. [PMID: 33938522 DOI: 10.1097/mpg.0000000000003154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Esophagitis dissecans superficialis (EDS) is a desquamative disorder of the superficial esophageal epithelium with variable clinical characteristics. Endoscopically, there is an appearance of superficial peeling of sheets of epithelium. Histologically there is 2-toned epithelium with coagulative necrosis of the superficial epithelium. Currently, there is paucity of data regarding this condition in children. METHODS A 10-year retrospective search of the pathology information system was performed for cases with a pathologic diagnosis of EDS in a tertiary care pediatric center. Demographic data, clinical history, endoscopic findings, and histopathologic reports were reviewed. RESULTS Thirteen patients (9 girls; ages 3-18 years), were identified with histologic findings of EDS. Esophageal food impaction, dysphagia, vomiting, and abdominal pain were the most common presenting symptoms. Sixty-nine percentage of the patients had underlying comorbidities and 76% were on at least 1 medication chronically. Eosinophilic esophagitis (23%), inflammatory bowel disease (23%), and gastroesophageal reflux disease (GERD) (15%) were the most common associated diagnoses. Of the 13 patients, 5 had repeat endoscopies showing complete resolution of EDS with no complications. CONCLUSIONS EDS is an under-recognized entity that endoscopists should be familiar with. In our series, the most prevalent associations were with food impaction and eosinophilic esophagitis (EoE). Contact injury and/or inflammation may precede the development of EDS. Pediatric EDS appears to be an incidental finding without significant morbidity or mortality.
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Affiliation(s)
- Nonyelum Ebigbo
- Division of Pediatric Gastroenterology, Childrens Medical Center
- Department of Pediatrics
| | - Jason Y Park
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Edaire Cheng
- Division of Pediatric Gastroenterology, Childrens Medical Center
- Department of Pediatrics
| | - Bhaskar Gurram
- Division of Pediatric Gastroenterology, Childrens Medical Center
- Department of Pediatrics
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Kulak O, Gurram B, Montgomery EA, Park JY. Pediatric autoimmune gastritis: clinical correlates and histologic features. Hum Pathol 2021; 116:31-38. [PMID: 34284050 DOI: 10.1016/j.humpath.2021.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/07/2021] [Accepted: 07/10/2021] [Indexed: 11/24/2022]
Abstract
Autoimmune gastritis is a well-known pathologic entity, but there are few studies that examine its clinical and histologic presentation in children. This is a single institution, retrospective study performed on patients diagnosed from 2011 through 2019. Patients were identified by their pathologic diagnosis within the laboratory information system. The electronic medical record and archived slides were reviewed. Twenty-two children (3 months to 18 years; median, 10.9 years) with autoimmune gastritis were diagnosed of a total of 14,257 nonconsultation gastric biopsies from unique patients (0.15% prevalence). Patients with autoimmune gastritis were diagnosed at an average age of 10.9 years and were mostly female (68.2% women, 31.8% men). The majority had extragastric immune disorders (13/22; 59.1%). All patients in the study had gastric body mucosa with enterochromaffin-like cell hyperplasia, atrophy, and histologic features of chronic injury. Most biopsies showed gastric body metaplasia (n = 19) or active gastric inflammation. However, antral atrophy was also observed in 12 patients, and antral metaplasia was identified in one patient; four patients had active chronic antral gastritis. All biopsies were negative for Helicobacter pylori. Pediatric autoimmune gastritis is a rare disorder that should be recognized because of its systemic effects with long-term morbidity. In addition, the possibility of tandem extragastric immune disorders should be considered when a diagnosis of pediatric autoimmune gastritis is established.
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Affiliation(s)
- Ozlem Kulak
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX 75235, United States.
| | - Bhaskar Gurram
- Division of Pediatric Gastroenterology, UT Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX 75235, United States.
| | - Elizabeth A Montgomery
- Department of Pathology, University of Miami Miller School of Medicine, Miami, FL 33101, United States.
| | - Jason Y Park
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX 75235, United States; Eugene McDermott Center for Human Growth and Development, UT Southwestern Medical Center, Dallas, TX 75235, United States; Department of Pathology and Laboratory Medicine, Children's Medical Center of Dallas, Dallas, TX 75235, United States.
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von Itzstein MS, Smith ML, Railey E, White CB, Dieterich JS, Garrett-Mayer L, Bruinooge SS, Freedman AN, De Moor J, Gray SW, Park JY, Yan J, Hoang AQ, Zhu H, Gerber DE. Accessing Targeted Therapies: A Potential Roadblock to Implementing Precision Oncology? JCO Oncol Pract 2021; 17:e999-e1011. [PMID: 33970688 PMCID: PMC8462665 DOI: 10.1200/op.20.00927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/01/2021] [Accepted: 04/14/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Advances in genomic techniques have led to increased use of next-generation sequencing (NGS). We evaluated the extent to which these tests guide treatment decisions. METHODS We developed and distributed a survey assessing NGS use and outcomes to a survey pool of ASCO members. Comparisons between groups were performed with Wilcoxon two-sample, chi-square, and Fisher's exact tests. RESULTS Among 178 respondents, 62% were male, 54% White, and 67% affiliated with academic centers. More than half (56%) indicated that NGS provided actionable information to a moderate or great extent. Use was highest (median ≥ 70% of cases) for lung and gastric cancer, and lowest (median < 25% of cases) in head and neck and genitourinary cancers. Approximately one third of respondents reported that, despite identification of an actionable molecular variant, patients were sometimes or often unable to access the relevant US Food and Drug Administration-approved therapy. When NGS did not provide actionable results, individuals reporting great or moderate guidance overall from NGS in treatment recommendations were more likely to request the compassionate use of an unapproved drug (P < .001), enroll on a clinical trial (P < .01), or treat off-label with a drug approved for another indication (P = .02). CONCLUSION When NGS identifies an actionable result, a substantial proportion of clinicians reported encountering challenges obtaining approved therapies on the basis of these results. Perceived overall impact of NGS appears associated with clinical behavior unrelated to actionable NGS test results, including pursuing off-label or compassionate use of unapproved therapies or referring to a clinical trial.
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Affiliation(s)
- Mitchell S. von Itzstein
- Division on Hematology and Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX
| | | | | | - Carol B. White
- Research Advocacy Network, Plano, TX
- CBWhite, Evanston, IL
| | | | | | | | | | | | - Stacy W. Gray
- Department of Population Sciences and Medical Oncology, City of Hope, Duarte, CA
| | - Jason Y. Park
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX
| | - Jingsheng Yan
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX
| | - Anh Quynh Hoang
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX
| | - Hong Zhu
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX
| | - David E. Gerber
- Division on Hematology and Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX
- Research Advocacy Network, Plano, TX
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX
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Ahmed M, von Itzstein MS, Sheffield T, Khan S, Fattah F, Park JY, Popat V, Saltarski JM, Gloria-McCutchen Y, Hsiehchen D, Ostmeyer J, Khan SA, Sultana N, Xie Y, Li QZ, Wakeland EK, Gerber DE. Association between body mass index, dosing strategy, and efficacy of immune checkpoint inhibitors. J Immunother Cancer 2021; 9:jitc-2021-002349. [PMID: 34127546 PMCID: PMC8237749 DOI: 10.1136/jitc-2021-002349] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2021] [Indexed: 12/12/2022] Open
Abstract
Background Increased body mass index (BMI) has been associated with improved response to immune checkpoint inhibitors (ICIs) in multiple cancer types. We evaluated associations between BMI, ICI dosing strategy, and clinical outcomes. Methods We abstracted clinical data on patients with cancer treated with ICI, including age, sex, cancer type, BMI, ICI type, dosing strategy (weight-based or fixed), radiographic response, overall survival (OS), and progression-free survival (PFS). We compared clinical outcomes between low-BMI and high-BMI populations using Kaplan-Meier curves, Cox regressions, and Pearson product-moment correlation coefficients. Results A total of 297 patients were enrolled, of whom 40% were women and 59% were overweight (BMI≥25). Of these, 204 (69%) received fixed and 93 (31%) received weight-based ICI dosing. In the overall cohort, overweight BMI was associated with improved PFS (HR 0.69; 95% CI 0.51 to 0.94; p=0.02) and had a trend toward improved OS (HR 0.77; 95% CI 0.57 to 1.04; p=0.08). For both endpoints, improved outcomes in the overweight population were limited to patients who received weight-based ICI dosing (PFS HR 0.53; p=0.04 for weight-based; vs HR 0.79; p=0.2 for fixed dosing) (OS HR 0.56; p=0.03 for weight-based; vs HR 0.89; p=0.54 for fixed dosing). In multivariable analysis, BMI was not associated with PFS or OS. However, the interaction of BMI≥25 and weight-based dosing had a trend toward association with PFS (HR 0.53; 95% CI 0.26 to 1.10; p=0.09) and was associated with OS (HR 0.50; 95% CI 0.25 to 0.99; p=0.05). Patients with BMI<25 tended to have better outcomes with fixed-dose compared with weight-based ICI, while patients with BMI≥25 tended to have better outcomes with weight-based ICI, although these differences did not achieve statistical significance. There was no association between radiographic response and BMI with fixed-dose ICI (p=0.97), but a near-significant trend with weight-based ICI (p=0.1). In subset analyses, the association between BMI, ICI dosing strategy, and clinical outcomes appeared limited to men. Conclusions The clinical benefit of ICI in high-BMI populations appears limited to individuals receiving weight-based ICI dosing. Further research into optimal ICI dosing strategies may be warranted.
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Affiliation(s)
- Murtaza Ahmed
- School of Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mitchell S von Itzstein
- Department of Internal Medicine (Division of Hematology-Oncology), The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Thomas Sheffield
- Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Shaheen Khan
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Farjana Fattah
- Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jason Y Park
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Vinita Popat
- School of Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jessica M Saltarski
- Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Yvonne Gloria-McCutchen
- Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - David Hsiehchen
- Department of Internal Medicine (Division of Hematology-Oncology), The University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jared Ostmeyer
- Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Saad A Khan
- Department of Internal Medicine (Division of Hematology-Oncology), The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Nazima Sultana
- Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Yang Xie
- Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Quan-Zhen Li
- Department of Immunology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - Edward K Wakeland
- Department of Immunology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - David E Gerber
- Department of Internal Medicine (Division of Hematology-Oncology), The University of Texas Southwestern Medical Center, Dallas, Texas, USA .,Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Choo F, Rakheja D, Davis LE, Davare M, Park JY, Timmons CF, Neff T, Beadling C, Corless CL, Davis JL. GAB1-ABL1 fusions in tumors that have histologic overlap with NTRK-rearranged spindle cell tumors. Genes Chromosomes Cancer 2021; 60:623-630. [PMID: 34036664 DOI: 10.1002/gcc.22972] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/09/2021] [Accepted: 05/13/2021] [Indexed: 12/16/2022] Open
Abstract
Fibroblastic spindle cell tumors are a heterogeneous group of rare soft tissue tumors that are increasingly recognized as associated with a variety of kinase gene fusions. We report two cases of GAB1-ABL1 fusions in spindle cell tumors that histologically overlap with neurotrophic tyrosine receptor kinase (NTRK)-rearranged spindle cell tumors. The first case occurred in a 76-year-old female who had a large deep-seated spindle cell tumor composed of monotonous ovoid to spindle cells in a background of thick stromal collagen bands with prominent hyalinized vessels and inconspicuous mitoses (<1/10 HPF). Immunohistochemical stains showed co-expression of S100 and CD34. A GAB1-ABL1 fusion was detected by whole transcriptome RNA sequencing. The patient had a partial response to imatinib. The second case was previously described as a solitary fibrous tumor, occurring in a 9-year-old female with a cellular spindle cell tumor with patchy CD34 immunoexpression but no expression of S100. Upon clinicopathologic re-review, including anchored multiplex next-generation sequencing, a GAB1-ABL1 fusion was identified. In summary, we report the first two cases of spindle cell tumors with variable expression of CD34 and/or S100, driven by GAB1-ABL1 gene fusions with histologic overlap with NTRK-rearranged spindle cell tumors, suggesting that ABL-fusions may also be oncogenic drivers within this spectrum of tumors. These cases highlight the evolving understanding of fibroblastic spindle cell tumor biology and the utility of sequencing in identifying a targetable alteration.
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Affiliation(s)
- Florence Choo
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
| | - Dinesh Rakheja
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Children's Health, Dallas, Texas, USA
| | - Lara E Davis
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA.,Division of Hematology and Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA.,Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Monika Davare
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA.,Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Jason Y Park
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Children's Health, Dallas, Texas, USA
| | - Charles F Timmons
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Children's Health, Dallas, Texas, USA
| | - Tanaya Neff
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Carol Beadling
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Christopher L Corless
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA.,Department of Pathology, Oregon Health & Science University, Portland, Oregon, USA
| | - Jessica L Davis
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA.,Department of Pathology, Oregon Health & Science University, Portland, Oregon, USA
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Kricka LJ, Park JY. Dry Reagent Tests in the 1880s-Dr Pavy's Pellets and Dr Oliver's Papers. J Appl Lab Med 2021; 6:1025-1031. [PMID: 34060611 DOI: 10.1093/jalm/jfab023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/05/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND In the 1880s, concern over the inconvenience of hazardous chemical solutions used for bedside urinalysis sparked an interest in the development of dry reagents for a range of common urine tests. CONTENT This article examines the history of Dr Pavy's Pellets and Dr Oliver's Papers, 2 different dry reagent systems developed in the 1880s for bedside urine testing. It sets these developments in the context of the earlier dry chemistry work (e.g., indicator papers) and the subsequent work that led to modern day reagent tablets and dipstick devices. SUMMARY Tests based on dry reagents can be traced back to the 1st century, but active development, in the form of indicator papers, dates from the 1600s. In the 1880s, spurred by dissatisfaction with liquid-based bedside urine testing among clinicians, Dr Frederick William Pavy and Dr George Oliver developed dry reagent tests, based on pellets (Dr Pavy's Pellets) and chemically impregnated papers (Dr Oliver's Papers) for urine sugar and urine albumin. These reagents were commercialized by a number of companies and provided in convenient cases (Physician's Pocket Reagent Case). Eventually, these tests lost popularity and were replaced by the type of tablets and dipsticks developed by both Eli Lilly, and the Ames Division of Miles Laboratories (subsequently Bayer, and currently Siemens Healthineers) during the 1940s and 1950s.
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Affiliation(s)
- Larry J Kricka
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, PA, USA
| | - Jason Y Park
- Department of Pathology, Eugene McDermott Center for Human Growth and Development, Children's Medical Center, University of Texas Southwestern Medical School, Dallas, TX, USA
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Kulak O, Drobysheva A, Wick N, Arvisais-Anhalt S, Germans SK, Timmons CF, Park JY. Smart Glasses as a Surgical Pathology Grossing Tool. Arch Pathol Lab Med 2021; 145:457-460. [PMID: 32823276 DOI: 10.5858/arpa.2020-0090-oa] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Smart glasses are a wearable technology that enable hands-free data acquisition and entry. OBJECTIVE.— To develop a surgical pathology grossing application on a smart glass platform. DESIGN.— An existing logistics software for the Google Glass Enterprise smart glass platform was used to create surgical pathology grossing protocols. The 2 grossing protocols were developed to simulate grossing a complex (heart) and a simple (kidney) specimen. For both protocols, users were visually prompted by the smart glass device to perform each task, record measurements, or document the field of view. In addition to measuring the total time of the protocol performance, each substep within the protocol was automatically recorded. Subsequently, a report was generated that contained the dictation, images, voice recordings, and the timing of each step. The application was tested by 3 users using the 2 grossing protocols. The users were tracked across 3 grossing procedures for each protocol. RESULTS.— For the complex specimen grossing the average time across repeated procedures was not significantly different between users (P > .99). However, when grossing times of the complex specimen were compared for repeated performances of the same user, a significant reduction in grossing times was observed with each repetition (P = .002). For the simple specimen, the average grossing time across multiple attempts was different among users (P = .03); however, no improvement in grossing time was observed with repeated performance (P = .499). CONCLUSIONS.— Augmented reality based grossing applications can provide automated data collection to track the changes in grossing performance over time.
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Affiliation(s)
- Ozlem Kulak
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Kulak, Wick, Arvisais-Anhalt, Germans, Timmons, Park). Kulak and Drobysheva contributed equally to this work
| | - Anastasia Drobysheva
- From the Department of Pathology, Boston Children's Hospital, Boston, Massachusetts (Drobysheva)
| | - Neda Wick
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Kulak, Wick, Arvisais-Anhalt, Germans, Timmons, Park). Kulak and Drobysheva contributed equally to this work
| | - Simone Arvisais-Anhalt
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Kulak, Wick, Arvisais-Anhalt, Germans, Timmons, Park). Kulak and Drobysheva contributed equally to this work
| | - Sharon Koorse Germans
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Kulak, Wick, Arvisais-Anhalt, Germans, Timmons, Park). Kulak and Drobysheva contributed equally to this work
| | - Charles F Timmons
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Kulak, Wick, Arvisais-Anhalt, Germans, Timmons, Park). Kulak and Drobysheva contributed equally to this work
| | - Jason Y Park
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Kulak, Wick, Arvisais-Anhalt, Germans, Timmons, Park). Kulak and Drobysheva contributed equally to this work
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Wheeler SE, Peck Palmer OM, Greene DN, Park JY, Winston-McPherson G, Amukele TK, Pérez-Stable EJ. Examining Laboratory Medicine's Role in Eliminating Health Disparities. Clin Chem 2021; 66:1266-1271. [PMID: 32888006 DOI: 10.1093/clinchem/hvaa174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/29/2020] [Indexed: 11/13/2022]
Affiliation(s)
- Sarah E Wheeler
- Assistant Professor of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA.,Medical Director of UPMC Mercy and UPMC Children's Hospital Automated Testing Laboratories, Associate Director of UPMC Presbyterian Clinical Immunopathology Laboratory, Pittsburgh, PA
| | - Octavia M Peck Palmer
- Associate Professor of Pathology, Critical Care Medicine and Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, PA.,Medical Director, UPMC Presbyterian and Shadyside Automated Testing Laboratories, Pittsburgh, PA
| | - Dina N Greene
- Technical Director, Kaiser Permanente Washington Laboratories, Portland, OR.,Clinical Associate Professor University of Washington, Department of Laboratory Medicine, Seattle, WA
| | - Jason Y Park
- Associate Professor of Pathology and the Eugene McDermott Center for Human Growth and Development, UT Southwestern Medical School, Dallas, TX
| | | | - Timothy K Amukele
- Associate Professor of Pathology Johns Hopkins School of Medicine, Chief of Pathology Clinical Laboratories, Johns Hopkins Bayview Medical Center, Baltimore, MD
| | - Eliseo J Pérez-Stable
- Director of the National Institute on Minority Health and Health Disparities (NIMHD), National Institutes of Health, Bethesda, MD
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Kricka LJ, Park JY. Obituary for the Subject Index (1955-1993). Clin Chem 2021; 66:1470-1471. [PMID: 33141906 DOI: 10.1093/clinchem/hvaa153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Larry J Kricka
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, PA
| | - Jason Y Park
- Department of Pathology and the Eugene McDermott Center for Human Growth and Development, Children's Medical Center, University of Texas Southwestern Medical School, Dallas, TX
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Abstract
OBJECTIVE The detection of gene fusion events is important for the diagnosis and management of malignancies. In this study, we describe the validation of a next-generation sequencing assay for multiplex detection of gene fusions. METHODS Based on previously described gene fusion events that occur in pediatric oncology, a custom anchored multiplex next-generation sequencing assay was designed to target 93 genes. RESULTS A total of 24 previously characterized specimens were examined. Twenty specimens had 1 or more previously described fusion events, and 4 specimens were negative for fusion events. The accuracy across specimens was 100% (20 of 20 specimens). The analytical sensitivity and specificity were both 100%. Interday reproducibility for fusion events was 94%; in comparison, intraday reproducibility was 90%. CONCLUSION This multiple-gene fusion assay demonstrated appropriate sensitivity, specificity, and accuracy for clinical use. We anticipate that this assay will improve the diagnosis and management of patients with pediatric solid tumors.
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Affiliation(s)
- Rolando García
- Department of Pathology, UT Southwestern Medical Center.,Department of Pathology, Children's Medical Center
| | - Nirav Patel
- Department of Pathology, Children's Medical Center
| | - Naseem Uddin
- Department of Pathology, UT Southwestern Medical Center.,Department of Pathology, Children's Medical Center
| | - Jason Y Park
- Department of Pathology, UT Southwestern Medical Center.,Department of Pathology, Children's Medical Center.,Eugene McDermott Center for Human Growth and Development, UT Southwestern Medical Center, Dallas, TX
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Filkins L, SoRelle JA, Schoggins J, Park JY. Laboratory Action Plan for Emerging SARS-CoV-2 Variants. Clin Chem 2021; 67:720-723. [PMID: 33515256 DOI: 10.1093/clinchem/hvab020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 01/19/2021] [Indexed: 12/19/2022]
Affiliation(s)
- Laura Filkins
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX.,Department of Pathology and Laboratory Medicine, Children's Health System of Texas, Dallas, TX
| | - Jeffrey A SoRelle
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX.,Department of Pathology and Laboratory Medicine, Children's Health System of Texas, Dallas, TX
| | - John Schoggins
- Department of Microbiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jason Y Park
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX.,Department of Pathology and Laboratory Medicine, Children's Health System of Texas, Dallas, TX.,McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas, TX
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Abstract
BACKGROUND In January 2019, the Centers for Medicare & Medicaid Services (CMS) required hospitals to list their standard charges (chargemasters) publicly in an effort to increase price transparency in health care. Surveying hospital chargemasters may be informative to assess the implementation of this rule and its utility to consumers. OBJECTIVE We aimed to compare hospital chargemaster data within a local hospital market where patients would reasonably try to shop or compare services. METHODS We identified and aggregated Dallas County hospital chargemasters available in a database compatible format in May 2019. We manually examined a convenience sampling of 10 common laboratory tests, medications, and procedures. RESULTS Thirteen hospital chargemasters were identified. Eleven hospitals had chargemasters available in a database compatible format (xlsx or csv). These 11 chargemasters were aggregated into a single file containing 155,576 chargeable items, prices, and descriptions. We observed heterogeneous names and descriptions of synonymous items across institutions, preventing automated comparisons. The examined items revealed a high variation in charges. The largest charge variation for laboratory tests examined included a 2,606% difference (partial thromboplastin time: $18.70-506.00), for medications an 18,617% difference (5-mg tablet of amlodipine: $0.23-43.05), and for procedures a 2,889% difference (circumcision: $252.00-7,532.10). One institution accounted for 27% of the lowest prices and another accounted for 60% of the highest prices. CONCLUSION Chargemaster data presentation varied among the hospitals surveyed, making automatic comparison impossible. Chargemaster data are difficult to interpret for health care decisions. Refining the minimum requirements for publishing chargemaster data could increase their utility.
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Affiliation(s)
- Simone Arvisais-Anhalt
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Samuel McDonald
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States.,Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Jason Y Park
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, United States.,Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Kandice Kapinos
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, United States.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States.,RAND Corporation, Arlington, Virginia, United States
| | - Christoph U Lehmann
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, United States.,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, United States.,Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, United States.,Lyda Hill Department of Biostatistics, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Mujeeb Basit
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, United States.,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, United States
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Arvisais-Anhalt S, Araj E, Park JY. Medicare Trends in Pathologist Participation, Service Utilization, and Payments. Am J Clin Pathol 2021; 155:674-679. [PMID: 33210114 DOI: 10.1093/ajcp/aqaa167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Quantifying pathologist participation in Medicare services may be informative for the prediction of future workforce needs and reimbursement. METHODS A retrospective examination was performed of pathologist professional (Part B) Medicare billings and payments from 2012 to 2017. The Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File was the primary data source. RESULTS From 2012 to 2017, there was an increase (3.7%; 11,215 up to 11,627) in pathologists providing Medicare Part B services. Female pathologists increased from 36.10% to 40.8% of pathologists during this time period. Normalized per pathologist, there was an increase (7.8%; 1,382 up to 1,489) in beneficiaries served as well as an increase (4.1%; 2,442 up to 2,543) in services performed. The top 10 pathology Part B services performed in a facility were all surgical pathology. Although services increased, the overall payment of Part B pathology services decreased (3%; $996,519,358 down to $966,615,856) during the study period. CONCLUSIONS Although there is increasing pathologist participation in Medicare, the workload per pathologist has increased.
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Affiliation(s)
| | | | - Jason Y Park
- Department of Pathology
- Eugene McDermott Center for Human Growth and Development, UT Southwestern Medical Center, Dallas, TX
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