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Gupta VF, Halpern SE, Pontula A, Krischak MK, Reynolds JM, Klapper JA, Hartwig MG, Haney JC. Short-term outcomes after third-time lung transplantation: A single institution experience. J Heart Lung Transplant 2024; 43:771-779. [PMID: 38141895 DOI: 10.1016/j.healun.2023.12.010] [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: 07/25/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 12/25/2023] Open
Abstract
BACKGROUND Reoperative lung transplantation (LTx) survival has improved over time such that a growing number of patients may present for third-time LTx (L3Tx). To understand the safety of L3Tx, we evaluated perioperative outcomes and 3-year survival after L3Tx at a high-volume US LTx center. METHODS This retrospective study included all patients who underwent bilateral L3Tx at our institution. Using an optimal matching technique, a primary LTx (L1Tx) cohort was matched 1:2 and a second-time LTx (L2Tx) cohort 1:1. Recipient, operative, and donor characteristics, perioperative outcomes, and 3-year survival were compared among L1Tx, L2Tx, and L3Tx groups. RESULTS Eleven L3Tx, 11 L2Tx, and 22 L1Tx recipients were included. Among L3Tx recipients, median age at transplant was 37 years and most (73%) had cystic fibrosis. L3Tx was performed median 6.0 and 10.6 years after L2Tx and L1Tx, respectively. Compared to L1Tx and L2Tx recipients, L3Tx recipients had greater intraoperative transfusion requirements, a higher incidence of postoperative complications, and a higher rate of unplanned reoperation. Rates of grade 3 primary graft dysfunction at 72 hours, extracorporeal membrane oxygenation at 72 hours, reintubation, and in-hospital mortality were similar among groups. There were no differences in 3-year patient (log-rank p = 0.61) or rejection-free survival (log-rank p = 0.34) after L1Tx, L2Tx, and L3Tx. CONCLUSIONS At our institution, L3Tx was associated with similar perioperative outcomes and 3-year patient survival compared to L1Tx and L2Tx. L3Tx represents the only safe treatment option for patients with allograft failure after L2Tx; however, further investigation is needed to understand the long-term survival and durability of L3Tx.
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Affiliation(s)
- Vikram F Gupta
- Duke University School of Medicine, Durham, North Carolina.
| | - Samantha E Halpern
- Duke University School of Medicine, Durham, North Carolina; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Arya Pontula
- University of Manchester Medical School, Manchester, UK; Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Madison K Krischak
- Duke University School of Medicine, Durham, North Carolina; Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - John M Reynolds
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Jacob A Klapper
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Matthew G Hartwig
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - John C Haney
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
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Robblee J, Hakim SM, Reynolds JM, Monteith TS, Zhang N, Barad M. Nonspecific oral medications versus anti-calcitonin gene-related peptide monoclonal antibodies for migraine: A systematic review and meta-analysis of randomized controlled trials. Headache 2024. [PMID: 38634515 DOI: 10.1111/head.14693] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 02/22/2024] [Accepted: 02/22/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE To compare calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) versus nonspecific oral migraine preventives (NOEPs). BACKGROUND Insurers mandate step therapy with NOEPs before approving CGRP mAbs. METHODS Databases were searched for class I or II randomized controlled trials (RCTs) comparing CGRP mAbs or NOEPs versus placebo for migraine prevention in adults. The primary outcome measure was monthly migraine days (MMD) or moderate to severe headache days. RESULTS Twelve RCTs for CGRP mAbs, 5 RCTs for topiramate, and 3 RCTs for divalproex were included in the meta-analysis. There was high certainty that CGRP mAbs are more effective than placebo, with weighted mean difference (WMD; 95% confidence interval) of -1.64 (-1.99 to -1.28) MMD, which is compatible with small effect size (Cohen's d -0.25 [-0.34 to -0.16]). Certainty of evidence that topiramate or divalproex is more effective than placebo was very low and low, respectively (WMD -1.45 [-1.52 to -1.38] and -1.65 [-2.30 to -1.00], respectively; Cohen's d -1.25 [-2.47 to -0.03] and -0.48 [-0.67 to -0.29], respectively). Trial sequential analysis showed that information size was adequate and that CGRP mAbs had clear benefit versus placebo. Network meta-analysis showed no statistically significant difference between CGRP mAbs and topiramate (WMD -0.19 [-0.56 to 0.17]) or divalproex (0.01 [-0.73 to 0.75]). No significant difference was seen between topiramate or divalproex (0.21 [-0.45 to 0.86]). CONCLUSIONS There is high certainty that CGRP mAbs are more effective than placebo, but the effect size is small. When feasible, CGRP mAbs may be prescribed as first-line preventives; topiramate or divalproex could be as effective but are less well tolerated. The findings of this study support the recently published 2024 position of the American Headache Society on the use of CGRP mAbs as the first-line treatment.
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Affiliation(s)
- Jennifer Robblee
- Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Sameh M Hakim
- Department of Anesthesiology, Intensive Care, and Pain Management, Ain Shams University Faculty of Medicine, Cairo, Egypt
| | - John M Reynolds
- The Louis Calder Memorial Library, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Teshamae S Monteith
- Division of Headache, Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Niushen Zhang
- Department of Neurology & Neurological Sciences, Stanford Health Care, Stanford, California, USA
| | - Meredith Barad
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford Health Care, Stanford, California, USA
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Tam PCK, Hardie R, Alexander BD, Yarrington ME, Lee MJ, Polage CR, Messina JA, Maziarz EK, Saullo JL, Miller R, Wolfe CR, Arif S, Reynolds JM, Haney JC, Perfect JR, Baker AW. Risk factors, management, and clinical outcomes of invasive Mycoplasma and Ureaplasma infections after lung transplantation. Am J Transplant 2024; 24:641-652. [PMID: 37657654 PMCID: PMC10902193 DOI: 10.1016/j.ajt.2023.08.019] [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: 03/06/2023] [Revised: 08/08/2023] [Accepted: 08/24/2023] [Indexed: 09/03/2023]
Abstract
Mollicute infections, caused by Mycoplasma and Ureaplasma species, are serious complications after lung transplantation; however, understanding of the epidemiology and outcomes of these infections remains limited. We conducted a single-center retrospective study of 1156 consecutive lung transplants performed from 2010-2019. We used log-binomial regression to identify risk factors for infection and analyzed clinical management and outcomes. In total, 27 (2.3%) recipients developed mollicute infection. Donor characteristics independently associated with recipient infection were age ≤40 years (prevalence rate ratio [PRR] 2.6, 95% CI 1.0-6.9), White race (PRR 3.1, 95% CI 1.1-8.8), and purulent secretions on donor bronchoscopy (PRR 2.3, 95% CI 1.1-5.0). Median time to diagnosis was 16 days posttransplant (IQR: 11-26 days). Mollicute-infected recipients were significantly more likely to require prolonged ventilatory support (66.7% vs 21.4%), undergo dialysis (44.4% vs 6.3%), and remain hospitalized ≥30 days (70.4% vs 27.4%) after transplant. One-year posttransplant mortality in mollicute-infected recipients was 12/27 (44%), compared to 148/1129 (13%) in those without infection (P <.0001). Hyperammonemia syndrome occurred in 5/27 (19%) mollicute-infected recipients, of whom 3 (60%) died within 10 weeks posttransplant. This study highlights the morbidity and mortality associated with mollicute infection after lung transplantation and the need for better screening and management protocols.
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Affiliation(s)
- Patrick C K Tam
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA.
| | - Rochelle Hardie
- Division of Infectious Diseases, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Barbara D Alexander
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA; Duke University Clinical Microbiology Laboratory, Durham, North Carolina, USA
| | - Michael E Yarrington
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA; Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA
| | - Mark J Lee
- Duke University Clinical Microbiology Laboratory, Durham, North Carolina, USA
| | - Chris R Polage
- Duke University Clinical Microbiology Laboratory, Durham, North Carolina, USA
| | - Julia A Messina
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | - Eileen K Maziarz
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jennifer L Saullo
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rachel Miller
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | - Cameron R Wolfe
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sana Arif
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | - John M Reynolds
- Department of Medicine, Transplant Pulmonology, Duke University School of Medicine, Durham, North Carolina, USA
| | - John C Haney
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - John R Perfect
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | - Arthur W Baker
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA; Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA.
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Vincent N, Ravipati A, Reynolds JM, Kaufman J. Efficacy of Botulinum Toxin in the Treatment of Cutaneous Flushing: A Systematic Review and Meta-Analysis. Dermatol Surg 2024; 50:354-359. [PMID: 38232350 DOI: 10.1097/dss.0000000000004073] [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] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
BACKGROUND Flushing is a common dermatologic complaint and can be resistant to many treatments. As the utility of botulinum toxin continues to expand, recent data suggest that it may also be a therapeutic option for flushing. OBJECTIVE To evaluate the efficacy of botulinum toxin for the treatment of cutaneous flushing. MATERIALS AND METHODS A systematic search of Medline, Embase, Cochrane CENTRAL, CINAHL, Scopus, and Web of Science databases was conducted to identify studies evaluating the effect of botulinum toxin on flushing 1 month after treatment. Prespecified outcome measures included a clinical flushing score, dermatology life quality index (DLQI), and erythema index (EI). Meta-analysis was performed to calculate the mean differences in these outcomes before and after treatment at 1-month follow-up. RESULTS Nine studies (132 patients) were included in the analysis of this study (2 randomized controlled trials and 7 nonrandomized studies). All studies had a low risk of bias (high quality). The most frequent outcome reported was a clinical flushing score, which significantly decreased by 1.25 points overall (95% confidence interval [CI]: -2.47; -0.04) 1 month after treatment with botulinum toxin. Mean DLQI scores decreased (i.e., improved) by 9.02 points (95% CI: -19.81; 1.77) 1 month after botulinum toxin injections. The EI (measured by Mexameter) before and after botulinum toxin was evaluated in 2 studies; however, not enough statistical information was provided to analyze with meta-analytic techniques. CONCLUSION Based on this meta-analysis, botulinum toxin significantly improves clinical flushing scores 1 month after treatment.
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Affiliation(s)
- Natalie Vincent
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery
| | | | - John M Reynolds
- Calder Memorial Library, University of Miami Miller School of Medicine, Miami, Florida
| | - Joely Kaufman
- Skin Associates of South Florida, Coral Gables, Florida
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Meizoso JP, Cotton BA, Lawless RA, Kodadek LM, Lynde JM, Russell N, Gaspich J, Maung A, Anderson C, Reynolds JM, Haines KL, Kasotakis G, Freeman JJ. Whole Blood Resuscitation for Injured Patients Requiring Transfusion: A Systematic Review, Meta-Analysis, and Practice Management Guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg 2024:01586154-990000000-00680. [PMID: 38531812 DOI: 10.1097/ta.0000000000004327] [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: 03/28/2024]
Abstract
INTRODUCTION Whole blood resuscitation has reemerged as a resuscitation strategy for injured patients. However, the effect of whole blood-based resuscitation on outcomes has not been established. The primary objective of this guideline was to develop evidence-based recommendations on whether whole blood should be considered in civilian trauma patients receiving blood transfusions. METHODS An EAST working group performed a systematic review and meta-analysis utilizing the GRADE methodology. One PICO question was developed to analyze the effect of whole blood resuscitation in the acute phase on mortality, transfusion requirements, infectious complications, and ICU length of stay. English language studies including adult civilian trauma patients comparing in-hospital whole blood to component therapy were included. Medline, Embase, Cochrane CENTRAL, CINAHL Plus, and Web of Science were queried. GRADEpro was used to assess quality of evidence and risk of bias. The study was registered on PROSPERO (#CRD42023451143). RESULTS A total of 21 studies were included. Most patients were severely injured and required blood transfusion, massive transfusion protocol activation, and/or a hemorrhage control procedure in the early phase of resuscitation. Mortality was assessed separately at the following intervals: early (i.e., ED, 3-, or 6-hour), 24-hour, late (i.e., 28- or 30-day), and in-hospital. On meta-analysis, whole blood was not associated with decreased mortality. Whole blood was associated with decreased 4-hour RBC (mean difference -1.82, 95% CI -3.12 to -0.52), 4-hour plasma (mean difference -1.47, 95% CI -2.94 to 0), and 24-hour RBC transfusions (mean difference -1.22, 95% CI -2.24 to -0.19) compared to component therapy. There were no differences in infectious complications or ICU length of stay between groups. CONCLUSION We conditionally recommend WB resuscitation in adult civilian trauma patients receiving blood transfusions, recognizing that data are limited for certain populations, including women of childbearing age, and therefore this guideline may not apply to these populations. LEVEL OF EVIDENCE Level III, Guidelines.
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Affiliation(s)
| | | | | | - Lisa M Kodadek
- Department of Surgery, Yale School of Medicine, New Haven, CT
| | | | - Nicole Russell
- Burnett School of Medicine, Texas Christian University, Fort Worth, TX
| | | | - Adrian Maung
- Department of Surgery, Yale School of Medicine, New Haven, CT
| | | | - John M Reynolds
- Louis Calder Memorial Library, University of Miami Miller School of Medicine, Miami, FL
| | - Krista L Haines
- Department of Surgery, Duke University School of Medicine, Durham, NC
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Ross EJ, Williams RS, Viamonte M, Reynolds JM, Duncan DT, Paul RH, Carrico AW. Overamped: Stimulant Use and HIV Pathogenesis. Curr HIV/AIDS Rep 2023; 20:321-332. [PMID: 37971597 DOI: 10.1007/s11904-023-00672-y] [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: 10/09/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE OF REVIEW In the era of HIV treatment as prevention (TasP), more clarity is needed regarding whether people with HIV who use stimulants (i.e., methamphetamine, powder cocaine, and crack cocaine) display elevated HIV viral load and greater immune dysregulation. RECENT FINDINGS Although rates of viral suppression have improved in the TasP era, stimulant use was independently associated with elevated viral load in 23 of 28 studies included in our review. In the 12 studies examining other HIV disease markers, there was preliminary evidence for stimulant-associated alterations in gut-immune dysfunction and cellular immunity despite effective HIV treatment. Studies generally focused on documenting the direct associations of stimulant use with biomarkers of HIV pathogenesis without placing these in the context of social determinants of health. Stimulant use is a key barrier to optimizing the effectiveness of TasP. Elucidating the microbiome-gut-brain axis pathways whereby stimulants alter neuroimmune functioning could identify viable targets for pharmacotherapies for stimulant use disorders. Examining interpersonal, neighborhood, and structural determinants that could modify the associations of stimulant use with biomarkers of HIV pathogenesis is critical to guiding the development of comprehensive, multi-level interventions.
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Affiliation(s)
- Emily J Ross
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Renessa S Williams
- University of Miami School of Nursing and Health Sciences, Coral Gables, FL, USA
| | | | - John M Reynolds
- Calder Memorial Library, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dustin T Duncan
- Columbia University Mailman School of Public Health, New York City, NY, USA
| | - Robert H Paul
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Adam W Carrico
- Robert Stempel College of Public Health and Social Work, Florida International University, 11200 S.W. 8th Street, AHC5, #407, Miami, FL, 33199, USA.
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Steinbrink JM, Byrns J, Berg C, Kappus M, King L, Ellis MJ, Sanoff S, Agarwal R, DeVore AD, Reynolds JM, Hartwig MG, Milano C, Sudan D, Maziarz EK, Saullo J, Alexander BD, Wolfe CR. Real-world Experiences in the Transplantation of Hepatitis C-NAAT-positive Organs. Transplant Direct 2023; 9:e1539. [PMID: 37829247 PMCID: PMC10567032 DOI: 10.1097/txd.0000000000001539] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 08/12/2023] [Indexed: 10/14/2023] Open
Abstract
Background Hepatitis C virus (HCV) nucleic acid amplification test (NAAT)-positive donors have increased the organ pool. Direct-acting antivirals (DAAs) have led to high rates of treatment success and sustained virologic response (SVR) in recipients with donor-derived HCV infection without significant adverse effects, although variability remains in the timing and duration of antivirals. Methods This retrospective study analyzed all adult HCV-NAAT-negative transplant recipients who received an organ from HCV-NAAT-positive donors from November 24, 2018, to March 31, 2022, at Duke University Medical Center with protocolized delay of DAA initiation until after hospital discharge, with at least 180-d follow-up on all patients. Transplant and HCV-related outcomes were analyzed. Results Two hundred eleven transplants (111 kidneys, 41 livers, 34 hearts, and 25 lungs) were performed from HCV-NAAT-positive donors to HCV-NAAT-negative recipients. Ninety percent of recipients became viremic within 7 d posttransplant. Ninety-nine percent of recipients were initiated on pangenotypic DAAs in the outpatient setting a median of 52 d posttransplant, most commonly with 12-wk courses of sofosbuvir-velpatasvir (lungs) and glecaprevir-pibrentasvir (heart, kidney, and liver). Ninety-seven percent of recipients had SVR after a first-line DAA; all ultimately achieved SVR at 12 wk after subsequent treatment courses. The median peak HCV RNA for all organ systems was 2 436 512 IU/mL; the median time from antiviral to undetectable RNA was 48 d, although differences were noted between organ groups. No patient deaths or graft losses were directly attributable to HCV infection. Conclusions One hundred percent of transplant recipients of HCV-NAAT-positive organs ultimately developed SVR without significant adverse effects when HCV antivirals were initiated in the outpatient setting after transplant hospitalization, suggesting that this real-world treatment pathway is a viable option.
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Affiliation(s)
- Julie M. Steinbrink
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC
| | - Jennifer Byrns
- Department of Pharmacy, Duke University Hospital, Durham, NC
| | - Carl Berg
- Division of Gastroenterology, Duke University School of Medicine, Durham, NC
| | - Matthew Kappus
- Division of Gastroenterology, Duke University School of Medicine, Durham, NC
| | - Lindsay King
- Division of Gastroenterology, Duke University School of Medicine, Durham, NC
| | - Matthew J. Ellis
- Division of Nephrology, Duke University School of Medicine, Durham, NC
| | - Scott Sanoff
- Division of Nephrology, Duke University School of Medicine, Durham, NC
| | - Richa Agarwal
- Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - Adam D. DeVore
- Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - John M. Reynolds
- Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, NC
| | - Matthew G. Hartwig
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, NC
| | - Carmelo Milano
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, NC
| | - Debra Sudan
- Division of Abdominal Transplant Surgery, Duke University School of Medicine, Durham, NC
| | - Eileen K. Maziarz
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC
| | - Jennifer Saullo
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC
| | | | - Cameron R. Wolfe
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC
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Goldsby J, Beermann K, Frankel C, Parish A, Stauffer N, Schandert A, Erkanli A, Reynolds JM. Preemptive immune globulin therapy in sensitized lung transplant recipients. Transpl Immunol 2023; 80:101904. [PMID: 37499884 PMCID: PMC10631014 DOI: 10.1016/j.trim.2023.101904] [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: 03/15/2023] [Revised: 07/17/2023] [Accepted: 07/22/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Sensitized lung transplant recipients are at increased risk of developing donor-specific antibodies, which have been associated with acute and chronic rejection. Perioperative intravenous immune globulin has been used in sensitized individuals to down-regulate antibody production. METHODS We compared patients with a pre-transplant calculated panel reactive antibody ≥25% who did not receive preemptive immune globulin therapy to a historical control that received preemptive immune globulin therapy. Our cohort included 59 patients, 17 patients did not receive immune globulin therapy and 42 patients received therapy. RESULTS Donor specific antibody development was numerically higher in the non-immune globulin group compared to the immune globulin group (58.8% vs 33.3%, respectively, odds ratio 2.80, 95% confidence interval [0.77, 10.79], p = 0.13). Median time to antibody development was 9 days (Q1, Q3: 7, 19) and 28 days (Q1, Q3: 7, 58) in the non-immune globulin and immune globulin groups, respectively. There was no significant difference between groups in the incidence of primary graft dysfunction at 72 h post-transplant or acute cellular rejection, antibody-mediated rejection, and chronic lung allograft dysfunction at 12 months. CONCLUSION These findings are hypothesis generating and emphasize the need for larger, randomized studies to determine association of immune globulin therapy with clinical outcomes.
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Affiliation(s)
- Jessica Goldsby
- Department of Pharmacy, Duke Health, DUHS Box 3089, Durham, NC 27710, United States
| | - Kristi Beermann
- Department of Pharmacy, Duke Health, DUHS Box 3089, Durham, NC 27710, United States.
| | - Courtney Frankel
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke Health, 330 Trent Drive, Box 102352, Durham, NC 27710, United States
| | - Alice Parish
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, 2424 Erwin Road, Suite 1102, Hock Plaza Box 2721, Durham, NC 27710, United States
| | - Nicolas Stauffer
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, 2424 Erwin Road, Suite 1102, Hock Plaza Box 2721, Durham, NC 27710, United States
| | - Amanda Schandert
- Department of Pharmacy, Duke Health, DUHS Box 3089, Durham, NC 27710, United States
| | - Alaattin Erkanli
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, 2424 Erwin Road, Suite 1102, Hock Plaza Box 2721, Durham, NC 27710, United States
| | - John M Reynolds
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke Health, 330 Trent Drive, Box 102352, Durham, NC 27710, United States
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Al-Qudsi O, Reynolds JM, Haney JC, Welsby IJ. Voxelotor as a Treatment of Persistent Hypoxia in the ICU. Chest 2023; 164:e1-e4. [PMID: 37423700 DOI: 10.1016/j.chest.2023.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/17/2023] [Accepted: 01/23/2023] [Indexed: 07/11/2023] Open
Abstract
Hypoxia is encountered frequently in the ICU as a result of a wide range of pathologic characteristics. The oxygen-hemoglobin dissociation curve describes hemoglobin's affinity for a given Po2 and factors affecting uptake and offload. Research in manipulating this relationship between hemoglobin and oxygen is sparing. Voxelotor is a hemoglobin oxygen-affinity modulator that is approved by the US Food and Drug Association for use in the management of sickle cell disease. We present two patients without sickle cell disease who underwent treatment with this novel agent to assist with chronic hypoxia and weaning of mechanical support.
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Affiliation(s)
- Omar Al-Qudsi
- Department of Anesthesiology, Duke University Medical Center, Durham, NC.
| | - John M Reynolds
- Division of Transplant Pulmonology, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - John C Haney
- Division of Thoracic Transplant Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC
| | - Ian J Welsby
- Department of Anesthesiology, Duke University Medical Center, Durham, NC
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Todd JL, Weber JM, Kelly FL, Neely ML, Nagler A, Carmack D, Frankel CW, Brass DM, Belperio JA, Budev MM, Hartwig MG, Martinu T, Reynolds JM, Shah PD, Singer LG, Snyder LD, Weigt SS, Palmer SM. Early posttransplant reductions in club cell secretory protein associate with future risk for chronic allograft dysfunction in lung recipients: results from a multicenter study. J Heart Lung Transplant 2023; 42:741-749. [PMID: 36941179 DOI: 10.1016/j.healun.2023.02.1495] [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: 09/30/2022] [Revised: 02/15/2023] [Accepted: 02/20/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Chronic lung allograft dysfunction (CLAD) increases morbidity and mortality for lung transplant recipients. Club cell secretory protein (CCSP), produced by airway club cells, is reduced in the bronchoalveolar lavage fluid (BALF) of lung recipients with CLAD. We sought to understand the relationship between BALF CCSP and early posttransplant allograft injury and determine if early posttransplant BALF CCSP reductions indicate later CLAD risk. METHODS We quantified CCSP and total protein in 1606 BALF samples collected over the first posttransplant year from 392 adult lung recipients at 5 centers. Generalized estimating equation models were used to examine the correlation of allograft histology or infection events with protein-normalized BALF CCSP. We performed multivariable Cox regression to determine the association between a time-dependent binary indicator of normalized BALF CCSP level below the median in the first posttransplant year and development of probable CLAD. RESULTS Normalized BALF CCSP concentrations were 19% to 48% lower among samples corresponding to histological allograft injury as compared with healthy samples. Patients who experienced any occurrence of a normalized BALF CCSP level below the median over the first posttransplant year had a significant increase in probable CLAD risk independent of other factors previously linked to CLAD (adjusted hazard ratio 1.95; p = 0.035). CONCLUSIONS We discovered a threshold for reduced BALF CCSP to discriminate future CLAD risk; supporting the utility of BALF CCSP as a tool for early posttransplant risk stratification. Additionally, our finding that low CCSP associates with future CLAD underscores a role for club cell injury in CLAD pathobiology.
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Affiliation(s)
- Jamie L Todd
- Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
| | - Jeremy M Weber
- Duke Clinical Research Institute, Durham, North Carolina
| | - Francine L Kelly
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Megan L Neely
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Andrew Nagler
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Dylan Carmack
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Courtney W Frankel
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - David M Brass
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - John A Belperio
- David Geffen School of Medicine, University of California, Los Angeles, California
| | | | - Matthew G Hartwig
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Tereza Martinu
- Toronto General Hospital Research Institute, Toronto, Ontario, Canada
| | - John M Reynolds
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Pali D Shah
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lianne G Singer
- Toronto General Hospital Research Institute, Toronto, Ontario, Canada
| | - Laurie D Snyder
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - S Sam Weigt
- David Geffen School of Medicine, University of California, Los Angeles, California
| | - Scott M Palmer
- Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
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11
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Tam PC, Alexander BD, Lee MJ, Hardie RG, Reynolds JM, Haney JC, Waites KB, Baker AW. 632. Donor-Derived Mollicute Infections in Lung Transplant Recipients: a Prospective Study of Donor Respiratory Tract Screening and Recipient Outcomes. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.684] [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: 12/23/2022] Open
Abstract
Abstract
Background
Mollicutes, such as Mycoplasma hominis and Ureaplasma spp, are fastidious bacteria that can cause invasive donor-derived infections in lung transplant recipients. Best practices for donor screening and recipient surveillance for Mollicute infections are unknown. This study assessed the performance of donor respiratory tract screening for Mollicutes.
Methods
We prospectively analyzed all lung transplant surgeries performed 10/5/20 – 9/25/21 at a single transplant center. Donor bronchoalveolar lavage (BAL) performed at time of procurement was tested for presence of urogenital Mycoplasmas and Ureaplasma spp. using culture and PCR. Treating clinicians were blinded to these results.
Post-transplant recipient evaluation was performed at the discretion of the treating clinicians, who maintained a high index of suspicion for Mollicute infection. Mollicute cases were defined as recipients with any post-transplant culture or PCR that detected a Mollicute. We analyzed recipient outcomes and assessed the performance of donor BAL screening in predicting recipient Mollicute cases.
Results
In total, 115 patients underwent lung transplant. Of this cohort, 99 (86%) donors had adequate BAL samples for Mollicute testing via both culture and PCR. 8/99 (8%) donors had culture-positive samples, and 15/99 (15%) had PCR-positive samples for Mollicutes. Among the 99 corresponding recipients, 9 (9%) patients met the Mollicute case definition (Figure 1). These recipients were diagnosed a median of 6 days after transplant (IQR 4-15 days). 6 patients had pulmonary Mollicute detection alone, and 3 had invasive extrapulmonary thoracic infections. The only death was unrelated (Table 1).
Donor BAL culture sensitivity was 6/9 (67%) in predicting recipient Mollicute cases, and sensitivity of PCR was 5/9 (56%). Positive predictive value (PPV) was 6/8 (75%) for donor culture and 5/15 (33%) for PCR (Table 2). Figure 1Clinical courses of 9 lung transplant recipients who acquired post-transplant Mycoplasma hominis or Ureaplasma species.
Table 1 Characteristics of 9 lung transplant recipients who acquired post-transplant Mycoplasma hominis or Ureaplasma species.
Table 2 Performance of donor bronchoalveolar lavage screening methods in predicting Mollicute acquisition among 99 lung transplant recipients.
Conclusion
In our single center cohort, donor BAL screening via culture predicted all serious recipient Mollicute infections and had better PPV than PCR. Given limitations of either screening method, clinicians should maintain a high index of suspicion for Mollicute infection after lung transplant to facilitate early diagnosis and effective treatment.
Disclosures
Barbara D. Alexander, MD, Astellas: Advisor/Consultant|HealthtrackRx: Advisor/Consultant|HealthtrackRx: Grant/Research Support|Scynexis: Grant/Research Support|UpToDate: Advisor/Consultant Arthur W. Baker, MD, MPH, Medincell: Advisor/Consultant.
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Affiliation(s)
- Patrick C Tam
- Duke University School of Medicine , Durham, North Carolina
| | | | - Mark J Lee
- Duke University School of Medicine , Durham, North Carolina
| | | | | | - John C Haney
- Duke University School of Medicine , Durham, North Carolina
| | - Ken B Waites
- University of Alabama at Birmingham , Birmingham, Alabama
| | - Arthur W Baker
- Duke University School of Medicine , Durham, North Carolina
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12
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Pavlisko EN, Neely ML, Kopetskie H, Hwang DM, Farver CF, Wallace WD, Arrossi A, Illei P, Sever ML, Kirchner J, Frankel CW, Snyder LD, Martinu T, Shino MY, Zaffiri L, Williams N, Robien MA, Singer LG, Budev M, Tsuang W, Shah PD, Reynolds JM, Weigt SS, Belperio JA, Palmer SM, Todd JL. Prognostic implications of and clinical risk factors for acute lung injury and organizing pneumonia after lung transplantation: Data from a multicenter prospective cohort study. Am J Transplant 2022; 22:3002-3011. [PMID: 36031951 PMCID: PMC9925227 DOI: 10.1111/ajt.17183] [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: 02/17/2022] [Revised: 08/05/2022] [Accepted: 08/21/2022] [Indexed: 01/28/2023]
Abstract
We determined prognostic implications of acute lung injury (ALI) and organizing pneumonia (OP), including timing relative to transplantation, in a multicenter lung recipient cohort. We sought to understand clinical risks that contribute to development of ALI/OP. We analyzed prospective, histologic diagnoses of ALI and OP in 4786 lung biopsies from 803 adult lung recipients. Univariable Cox regression was used to evaluate the impact of early (≤90 days) or late (>90 days) posttransplant ALI or OP on risk for chronic lung allograft dysfunction (CLAD) or death/retransplantation. These analyses demonstrated late ALI/OP conferred a two- to threefold increase in the hazards of CLAD or death/retransplantation; there was no association between early ALI/OP and these outcomes. To determine risk factors for late ALI/OP, we used univariable Cox models considering donor/recipient characteristics and posttransplant events as candidate risks. Grade 3 primary graft dysfunction, higher degree of donor/recipient human leukocyte antigen mismatch, bacterial or viral respiratory infection, and an early ALI/OP event were significantly associated with increased late ALI/OP risk. These data from a contemporary, multicenter cohort underscore the prognostic implications of ALI/OP on lung recipient outcomes, clarify the importance of the timing of these events, and identify clinical risks to target for ALI/OP prevention.
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Affiliation(s)
| | - Megan L. Neely
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | | | - David M. Hwang
- Sunnybrook Health Sciences Centre, Ontario, Canada
- University Health Network, University of Toronto, Ontario, Canada
| | | | - W. Dean Wallace
- University of Southern California, Los Angeles, CA
- University of California Los Angeles, Los Angeles, CA
| | | | | | - Michelle L. Sever
- Rho, Durham, NC
- PPD Government and Public Health Services, Morrisville, NC
| | - Jerry Kirchner
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Courtney W. Frankel
- Duke University Medical Center, Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Durham, NC
| | - Laurie D. Snyder
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
- Duke University Medical Center, Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Durham, NC
| | - Tereza Martinu
- University Health Network, University of Toronto, Ontario, Canada
| | | | - Lorenzo Zaffiri
- Duke University Medical Center, Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Durham, NC
| | - Nikki Williams
- National Institute of Allergy and Infectious Diseases, Washington, DC
| | - Mark A. Robien
- National Institute of Allergy and Infectious Diseases, Washington, DC
| | - Lianne G. Singer
- University Health Network, University of Toronto, Ontario, Canada
| | | | | | | | - John M. Reynolds
- Duke University Medical Center, Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Durham, NC
| | - S. Sam Weigt
- University of California Los Angeles, Los Angeles, CA
| | | | - Scott M. Palmer
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
- Duke University Medical Center, Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Durham, NC
| | - Jamie L. Todd
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
- Duke University Medical Center, Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Durham, NC
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13
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Villavicencio A, Ebisu Y, Raja M, Sanchez‐Covarrubias AP, Reynolds JM, Natori Y. Adverse events after SARS-CoV-2 vaccination in solid organ transplant recipients: A systematic review. Transpl Infect Dis 2022; 24:e13936. [PMID: 36067062 PMCID: PMC9538206 DOI: 10.1111/tid.13936] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/15/2022] [Indexed: 01/14/2023]
Affiliation(s)
- Aasith Villavicencio
- Division of Internal MedicineDepartment of MedicineUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Yosuke Ebisu
- Division of Infectious DiseaseDepartment of MedicineUniversity of Miami Miller School of MedicineMiamiFloridaUSA,Kameda Medical CenterChibaJapan
| | - Mohammed Raja
- Division of Infectious DiseaseDepartment of MedicineUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Alex P. Sanchez‐Covarrubias
- Division of Gynecologic OncologyDepartment of Obstetrics, Gynecology and Reproductive Sciences, University of MiamiMiller School of MedicineMiamiFloridaUSA
| | - John M. Reynolds
- Department of Health Informatics, Calder Memorial LibraryUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Yoichiro Natori
- Division of Infectious DiseaseDepartment of MedicineUniversity of Miami Miller School of MedicineMiamiFloridaUSA,Miami Transplant Institute, Jackson Health SystemMiamiFloridaUSA
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14
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Shino MY, Todd JL, Neely ML, Kirchner J, Frankel CW, Snyder LD, Pavlisko EN, Fishbein GA, Schaenman JM, Mason K, Kesler K, Martinu T, Singer LG, Tsuang W, Budev M, Shah PD, Reynolds JM, Williams N, Robien MA, Palmer SM, Weigt SS, Belperio JA. Plasma CXCL9 and CXCL10 at allograft injury predict chronic lung allograft dysfunction. Am J Transplant 2022; 22:2169-2179. [PMID: 35634722 PMCID: PMC9427677 DOI: 10.1111/ajt.17108] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 01/25/2023]
Abstract
Histopathologic lung allograft injuries are putative harbingers for chronic lung allograft dysfunction (CLAD). However, the mechanisms responsible are not well understood. CXCL9 and CXCL10 are potent chemoattractants of mononuclear cells and potential propagators of allograft injury. We hypothesized that these chemokines would be quantifiable in plasma, and would associate with subsequent CLAD development. In this prospective multicenter study, we evaluated 721 plasma samples for CXCL9/CXCL10 levels from 184 participants at the time of transbronchial biopsies during their first-year post-transplantation. We determined the association between plasma chemokines, histopathologic injury, and CLAD risk using Cox proportional hazards models. We also evaluated CXCL9/CXCL10 levels in bronchoalveolar lavage (BAL) fluid and compared plasma to BAL with respect to CLAD risk. Plasma CXCL9/CXCL10 levels were elevated during the injury patterns associated with CLAD, acute rejection, and acute lung injury, with a dose-response relationship between chemokine levels and CLAD risk. Importantly, there were strong interactions between injury and plasma CXCL9/CXCL10, where histopathologic injury associated with CLAD only in the presence of elevated plasma chemokines. We observed similar associations and interactions with BAL CXCL9/CXCL10 levels. Elevated plasma CXCL9/CXCL10 during allograft injury may contribute to CLAD pathogenesis and has potential as a minimally invasive immune monitoring biomarker.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Nikki Williams
- National Institute of Allergy and Infectious Diseases; Washington DC
| | - Mark A. Robien
- National Institute of Allergy and Infectious Diseases; Washington DC
| | | | - S. Sam Weigt
- University of California Los Angeles; Los Angeles, CA
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15
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Urréchaga EM, Kodadek LM, Bugaev N, Bauman ZM, Shah KH, Abdel Aziz H, Beckman MA, Reynolds JM, Soe-Lin H, Crandall ML, Rattan R. Full-face motorcycle helmets to reduce injury and death: A systematic review, meta-analysis, and practice management guideline from the Eastern Association for the Surgery of Trauma. Am J Surg 2022; 224:1238-1246. [PMID: 35821175 DOI: 10.1016/j.amjsurg.2022.06.018] [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: 05/05/2022] [Revised: 06/11/2022] [Accepted: 06/23/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND While motorcycle helmets reduce mortality and morbidity, no guidelines specify which is safest. We sought to determine if full-face helmets reduce injury and death. METHODS We searched for studies without exclusion based on: age, language, date, or randomization. Case reports, professional riders, and studies without original data were excluded. Pooled results were reported as OR (95% CI). Risk of bias and certainty was assessed. (PROSPERO #CRD42021226929). RESULTS Of 4431 studies identified, 3074 were duplicates, leaving 1357 that were screened. Eighty-one full texts were assessed for eligibility, with 37 studies (n = 37,233) eventually included. Full-face helmets reduced traumatic brain injury (OR 0.40 [0.23-0.70]); injury severity for the head and neck (Abbreviated Injury Scale [AIS] mean difference -0.64 [-1.10 to -0.18]) and face (AIS mean difference -0.49 [-0.71 to -0.27]); and facial fracture (OR 0.26 [0.15-0.46]). CONCLUSION Full-face motorcycle helmets are conditionally recommended to reduce traumatic brain injury, facial fractures, and injury severity.
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Affiliation(s)
| | | | | | | | - Kaushal H Shah
- Department of Emergency Medicine, Weill Cornell Medicine, USA.
| | | | | | | | - Hahn Soe-Lin
- Department of Surgery, St. Joseph's Medical Center, USA.
| | - Marie L Crandall
- Department of Surgery, University of Florida, Jacksonville, USA.
| | - Rishi Rattan
- Department of Surgery, University of Miami, USA.
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16
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Viamonte M, Ghanooni D, Reynolds JM, Grov C, Carrico AW. Running with Scissors: a Systematic Review of Substance Use and the Pre-exposure Prophylaxis Care Continuum Among Sexual Minority Men. Curr HIV/AIDS Rep 2022; 19:235-250. [PMID: 35701713 PMCID: PMC9279195 DOI: 10.1007/s11904-022-00608-y] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 11/26/2022]
Abstract
Purpose of Review Patterns of sexualized drug use, including stimulants (e.g., methamphetamine) and chemsex drugs, are key drivers of HIV incidence among sexual minority men (SMM). Although pre-exposure prophylaxis (PrEP) mitigates HIV risk, there is no consensus regarding the associations of substance use with the PrEP care continuum. Recent Findings SMM who use substances are as likely or more likely to use PrEP. Although SMM who use stimulants experience greater difficulties with daily oral PrEP adherence, some evidence shows that SMM who use stimulants or chemsex drugs may achieve better adherence in the context of recent condomless anal sex. Finally, SMM who use substances may experience greater difficulties with PrEP persistence (including retention in PrEP care). Summary SMM who use stimulants and other substances would benefit from more comprehensive efforts to support PrEP re-uptake, adherence, and persistence, including delivering behavioral interventions, considering event-based dosing, and providing injectable PrEP.
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Affiliation(s)
- Michael Viamonte
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St., Office 1010, Miami, FL, 33136, USA
| | - Delaram Ghanooni
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St., Office 1010, Miami, FL, 33136, USA
| | - John M Reynolds
- Calder Memorial Library, University of Miami, FL, Miami, USA
| | - Christian Grov
- City University of New York Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Adam W Carrico
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St., Office 1010, Miami, FL, 33136, USA.
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17
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Saullo JL, Baker AW, Snyder LD, Reynolds JM, Zaffiri L, Eichenberger EM, Ferrari A, Steinbrink JM, Maziarz EK, Bacchus M, Berry H, Kakoullis SA, Wolfe CR. Cytomegalovirus prevention in thoracic organ transplantation: A single-center evaluation of letermovir prophylaxis. J Heart Lung Transplant 2021; 41:508-515. [PMID: 35031206 PMCID: PMC9121640 DOI: 10.1016/j.healun.2021.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 06/09/2021] [Revised: 11/23/2021] [Accepted: 12/14/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Cytomegalovirus (CMV) infection is common following thoracic organ transplantation and causes substantial morbidity and mortality. Letermovir is a novel antiviral agent used off-label in this population for CMV prevention. Our goal was to understand patterns of letermovir use and effectiveness when applied for CMV prophylaxis after thoracic transplantation. METHODS We retrospectively evaluated letermovir use among thoracic transplant recipients at an academic transplant center who initiated letermovir from January 2018 to October2019 for CMV prophylaxis. We analyzed indication, timing, and duration of prophylaxis; tolerability; and occurrence of breakthrough CMV DNAemia and disease. RESULTS Forty-two episodes of letermovir prophylaxis occurred in 41 patients, including 37 lung and 4 heart transplant recipients. Primary prophylaxis (26/42, 61.9%) was utilized mainly due to myelosuppression (25/26, 96.2%) and was initiated a median of 315 days post-transplant (interquartile range [IQR] 125-1139 days). Sixteen episodes of secondary prophylaxis (16/42, 38.1%) were initiated a median of 695 days post-transplant (IQR 537-1156 days) due to myelosuppression (10/16, 62.5%) or prior CMV resistance (6/16, 37.5%). Median duration of letermovir prophylaxis was 282 days (IQR 131-433 days). Adverse effects required letermovir cessation in 5/42 (11.9%) episodes. Only one episode (2.4%) was complicated by clinically significant breakthrough CMV infection. Transient low-level CMV DNAemia (<450 IU/ml) occurred in 15 episodes (35.7%) but did not require letermovir cessation. CONCLUSIONS Letermovir was well tolerated and effective during extended prophylactic courses with only one case of breakthrough CMV infection in this cohort of thoracic transplant recipients. Further prospective trials of letermovir prophylaxis in this population are warranted.
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Affiliation(s)
- Jennifer L Saullo
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina.
| | - Arthur W Baker
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina; Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina
| | - Laurie D Snyder
- Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina
| | - John M Reynolds
- Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina
| | - Lorenzo Zaffiri
- Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina
| | - Emily M Eichenberger
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina
| | - Alana Ferrari
- Department of Pharmacy, University of Virginia Medical Center, Charlottesville, Virginia
| | - Julie M Steinbrink
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina
| | - Eileen K Maziarz
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina
| | - Melissa Bacchus
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina
| | - Holly Berry
- Department of Pharmacy, Duke University Medical Center, Durham, North Carolina
| | - Stylianos A Kakoullis
- Division of Pulmonary and Intensive Care Medicine, European University of Cyprus School of Medicine, Engomi, Nicosia Cyprus
| | - Cameron R Wolfe
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina
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18
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Ghadimi K, Cappiello J, Cooter-Wright M, Haney JC, Reynolds JM, Bottiger BA, Klapper JA, Levy JH, Hartwig MG. Inhaled Pulmonary Vasodilator Therapy in Adult Lung Transplant: A Randomized Clinical Trial. JAMA Surg 2021; 157:e215856. [PMID: 34787647 DOI: 10.1001/jamasurg.2021.5856] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Inhaled nitric oxide (iNO) is commonly administered for selectively inhaled pulmonary vasodilation and prevention of oxidative injury after lung transplant (LT). Inhaled epoprostenol (iEPO) has been introduced worldwide as a cost-saving alternative to iNO without high-grade evidence for this indication. Objective To investigate whether the use of iEPO will lead to similar rates of severe/grade 3 primary graft dysfunction (PGD-3) after adult LT when compared with use of iNO. Design, Setting, and Participants This health system-funded, randomized, blinded (to participants, clinicians, data managers, and the statistician), parallel-designed, equivalence clinical trial included 201 adult patients who underwent single or bilateral LT between May 30, 2017, and March 21, 2020. Patients were grouped into 5 strata according to key prognostic clinical features and randomized per stratum to receive either iNO or iEPO at the time of LT via 1:1 treatment allocation. Interventions Treatment with iNO or iEPO initiated in the operating room before lung allograft reperfusion and administered continously until cessation criteria met in the intensive care unit (ICU). Main Outcomes and Measures The primary outcome was PGD-3 development at 24, 48, or 72 hours after LT. The primary analysis was for equivalence using a two one-sided test (TOST) procedure (90% CI) with a margin of 19% for between-group PGD-3 risk difference. Secondary outcomes included duration of mechanical ventilation, hospital and ICU lengths of stay, incidence and severity of acute kidney injury, postoperative tracheostomy placement, and in-hospital, 30-day, and 90-day mortality rates. An intention-to-treat analysis was performed for the primary and secondary outcomes, supplemented by per-protocol analysis for the primary outcome. Results A total of 201 randomized patients met eligibility criteria at the time of LT (129 men [64.2%]). In the intention-to-treat population, 103 patients received iEPO and 98 received iNO. The primary outcome occurred in 46 of 103 patients (44.7%) in the iEPO group and 39 of 98 (39.8%) in the iNO group, leading to a risk difference of 4.9% (TOST 90% CI, -6.4% to 16.2%; P = .02 for equivalence). There were no significant between-group differences for secondary outcomes. Conclusions and Relevance Among patients undergoing LT, use of iEPO was associated with similar risks for PGD-3 development and other postoperative outcomes compared with the use of iNO. Trial Registration ClinicalTrials.gov identifier: NCT03081052.
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Affiliation(s)
- Kamrouz Ghadimi
- Department of Anesthesiology & Critical Care, Duke University School of Medicine, Durham, North Carolina
| | - Jhaymie Cappiello
- Department of Respiratory Care Services, Duke University Medical Center, Durham, North Carolina
| | - Mary Cooter-Wright
- Department of Anesthesiology & Critical Care, Duke University School of Medicine, Durham, North Carolina
| | - John C Haney
- Department of Surgery, Thoracic Transplant Surgery, Duke University School of Medicine, Durham, North Carolina
| | - John M Reynolds
- Department of Medicine, Transplant Pulmonology, Duke University School of Medicine, Durham, North Carolina
| | - Brandi A Bottiger
- Department of Anesthesiology & Critical Care, Duke University School of Medicine, Durham, North Carolina
| | - Jacob A Klapper
- Department of Surgery, Thoracic Transplant Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Jerrold H Levy
- Department of Anesthesiology & Critical Care, Duke University School of Medicine, Durham, North Carolina
| | - Matthew G Hartwig
- Department of Surgery, Thoracic Transplant Surgery, Duke University School of Medicine, Durham, North Carolina
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19
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Shino MY, Li N, Todd JL, Neely ML, Kopetskie H, Sever ML, Kirchner J, Frankel CW, Snyder LD, Pavlisko EN, Martinu T, Singer LG, Tsuang W, Budev M, Shah PD, Reynolds JM, Williams N, Robien MA, Palmer SM, Weigt SS, Belperio JA. Correlation between BAL CXCR3 chemokines and lung allograft histopathologies: A multicenter study. Am J Transplant 2021; 21:3401-3410. [PMID: 33840162 PMCID: PMC8502500 DOI: 10.1111/ajt.16601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 12/10/2020] [Revised: 03/28/2021] [Accepted: 03/28/2021] [Indexed: 01/25/2023]
Abstract
The histopathologic diagnosis of acute allograft injury is prognostically important in lung transplantation with evidence demonstrating a strong and consistent association between acute rejection (AR), acute lung injury (ALI), and the subsequent development of chronic lung allograft dysfunction (CLAD). The pathogenesis of these allograft injuries, however, remains poorly understood. CXCL9 and CXCL10 are CXC chemokines induced by interferon-γ and act as potent chemoattractants of mononuclear cells. We hypothesized that these chemokines are involved in the mononuclear cell recruitment associated with AR and ALI. We further hypothesized that the increased activity of these chemokines could be quantified as increased levels in the bronchoalveolar lavage fluid. In this prospective multicenter study, we evaluate the incidence of histopathologic allograft injury development during the first-year post-transplant and measure bronchoalveolar CXCL9 and CXCL10 levels at the time of the biopsy. In multivariable models, CXCL9 levels were 1.7-fold and 2.1-fold higher during AR and ALI compared with "normal" biopsies without histopathology. Similarly, CXCL10 levels were 1.6-fold and 2.2-fold higher during these histopathologies, respectively. These findings support the association of CXCL9 and CXCL10 with episodes of AR and ALI and provide potential insight into the pathogenesis of these deleterious events.
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Affiliation(s)
| | - Ning Li
- University of California Los Angeles; Los Angeles, CA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Nikki Williams
- National Institute of Allergy and Infectious Diseases; Washington DC
| | - Mark A. Robien
- National Institute of Allergy and Infectious Diseases; Washington DC
| | | | - S. Sam Weigt
- University of California Los Angeles; Los Angeles, CA
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20
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Williams NM, Rojas KD, Reynolds JM, Kwon D, Shum-Tien J, Jaimes N. Assessment of Diagnostic Accuracy of Dermoscopic Structures and Patterns Used in Melanoma Detection: A Systematic Review and Meta-analysis. JAMA Dermatol 2021; 157:1078-1088. [PMID: 34347005 DOI: 10.1001/jamadermatol.2021.2845] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Importance Dermoscopy increases the diagnostic accuracy for melanoma. However, the accuracy of individual structures and patterns used in melanoma detection has not been systematically evaluated. Objective To assess the diagnostic accuracy of individual dermoscopic structures and patterns used in melanoma detection. Data Sources A search of Ovid Medline, Embase, Cochrane CENTRAL, Scopus, and Web of Science was conducted from inception to July 2020. Study Selection Studies evaluating the dermoscopic structures and patterns among melanomas in comparison with nonmelanoma lesions were included. Excluded were studies with fewer than 3 patients, studies in languages other than English or Spanish, studies not reporting dermoscopic structures per lesion type, and studies assessing only nail, mucosal, acral, facial, or metastatic melanomas or melanomas on chronically sun-damaged skin. Multiple reviewers applied these criteria, and 0.7% of studies met selection criteria. Data Extraction and Synthesis The Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline and Meta-analysis of Observational Studies in Epidemiology reporting guideline were followed. Guidelines were applied via independent extraction by multiple observers. Data were pooled using a random-effects model. Main Outcomes and Measures The prespecified outcome measures were diagnostic accuracy (sensitivity and specificity) and risk (odds ratio [OR]) of melanoma for the following dermoscopic structures/patterns: atypical dots/globules, atypical network, blue-white veil, negative network, off-centered blotch, peripheral-tan structureless areas, atypical vessels (eg, linear irregular, polymorphous), pseudopods, streaks, regression (ie, peppering, scarlike areas), shiny white structures, angulated lines, irregular pigmentation, and a multicomponent pattern. Results A total of 40 studies including 22 796 skin lesions and 5736 melanomas were evaluated. The structures and patterns with the highest ORs were shiny white structures (OR, 6.7; 95% CI, 2.5-17.9), pseudopods (OR, 6.7; 95% CI, 2.7-16.1), irregular pigmentation (OR, 6.4; 95% CI, 2.0-20.5), blue-white veil (OR, 6.3; 95% CI, 3.7-10.7), and peppering (OR, 6.3; 95% CI, 2.4-16.1). The structures with the highest specificity were pseudopods (97.3%; 95% CI, 94.3%-98.7%), shiny white structures (93.6%; 95% CI, 85.6%-97.3%), peppering (93.4%; 95% CI, 81.9%-97.8%), and streaks (92.1%; 95% CI, 88.4%-94.7%), whereas features with the highest sensitivity were irregular pigmentation (62.3%; 95% CI, 31.2%-85.8%), blue-white veil (60.6%; 95% CI, 46.7%-72.9%), atypical network (56.8%; 95% CI, 43.6%-69.2%), and a multicomponent pattern (53.7%; 95% CI, 40.4%-66.4%). Conclusions and Relevance The findings of this systematic review and meta-analysis support the diagnostic importance of dermoscopic structures associated with melanoma detection (eg, shiny white structures, blue-white veil), further corroborate the importance of the overall pattern, and may suggest a hierarchy in the significance of these structures and patterns.
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Affiliation(s)
- Natalie M Williams
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Kristina D Rojas
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - John M Reynolds
- Department of Health Informatics, Calder Memorial Library, University of Miami Miller School of Medicine, Miami, Florida
| | - Deukwoo Kwon
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Jackie Shum-Tien
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Natalia Jaimes
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, Florida
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21
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Yeh DD, Reynolds JM, Pust GD, Sleeman D, Meizoso JP, Menzel C, Horkan D, Lineberry M, Yudkowsky R, Park YS. Publication Inaccuracies Listed in General Surgery Residency Training Program Applications. J Am Coll Surg 2021; 233:545-553. [PMID: 34384872 DOI: 10.1016/j.jamcollsurg.2021.07.002] [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: 04/27/2021] [Revised: 07/11/2021] [Accepted: 07/12/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND - Professionalism is a core competency which is difficult to assess. We examined the incidence of publication inaccuracies in Electronic Residency Application Service (ERAS) applications to our training program as potential indicators of unprofessional behavior. STUDY DESIGN - We reviewed all 2019-2020 NRMP Match applicants being considered for interview. Applicant demographics recorded including standardized exam scores, gender, medical school, and medical school ranking (2019 US News and World Report). Publication verification by a medical librarian was performed for Peer Reviewed Journal Articles/Abstracts, Peer Reviewed Book Chapters, and Peer Reviewed Online Publications. Inaccuracies were classified as "non-serious" (incorrect author order without author rank promotion) or "serious" (miscategorization, non-peer reviewed journal, incorrect author order with author rank promotion, non-authorship of cited existing publication, and unverifiable publication). Multivariate logistic regression analysis was performed for demographic characteristics to identify predictors of overall inaccuracy and serious inaccuracy. RESULTS - Of 319 applicants, 48 applicants (15%) had a total of 98 inaccuracies; after removing non-serious inaccuracies, there remained 37 (12%) with serious inaccuracies. Seven publications were reported in predatory open access journals. In the regression model, none of the variables (US vs. non-US medical school, gender, or medical school ranking) were significantly associated with overall inaccuracy or serious inaccuracy. CONCLUSION - One in eight (12%) applicants interviewing at a general surgery residency program were found to have a serious inaccuracy in publication reporting on their ERAS application. These inaccuracies may represent inattention to detail or professionalism transgressions.
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Affiliation(s)
- Daniel Dante Yeh
- Ryder Trauma Center / Jackson Memorial Hospital / University of Miami Miller School of Medicine, Miami, FL.
| | | | - Gerd Daniel Pust
- Ryder Trauma Center / Jackson Memorial Hospital / University of Miami Miller School of Medicine, Miami, FL
| | - Danny Sleeman
- Ryder Trauma Center / Jackson Memorial Hospital / University of Miami Miller School of Medicine, Miami, FL
| | - Jonathan P Meizoso
- Ryder Trauma Center / Jackson Memorial Hospital / University of Miami Miller School of Medicine, Miami, FL
| | | | - Davis Horkan
- Ryder Trauma Center / Jackson Memorial Hospital / University of Miami Miller School of Medicine, Miami, FL
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22
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O'Hearn K, MacDonald C, Tsampalieros A, Kadota L, Sandarage R, Jayawarden SK, Datko M, Reynolds JM, Bui T, Sultan S, Sampson M, Pratt M, Barrowman N, Nama N, Page M, McNally JD. Evaluating the relationship between citation set size, team size and screening methods used in systematic reviews: a cross-sectional study. BMC Med Res Methodol 2021; 21:142. [PMID: 34238247 PMCID: PMC8264476 DOI: 10.1186/s12874-021-01335-5] [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: 01/20/2021] [Accepted: 06/19/2021] [Indexed: 11/26/2022] Open
Abstract
Background Standard practice for conducting systematic reviews (SRs) is time consuming and involves the study team screening hundreds or thousands of citations. As the volume of medical literature grows, the citation set sizes and corresponding screening efforts increase. While larger team size and alternate screening methods have the potential to reduce workload and decrease SR completion times, it is unknown whether investigators adapt team size or methods in response to citation set sizes. Using a cross-sectional design, we sought to understand how citation set size impacts (1) the total number of authors or individuals contributing to screening and (2) screening methods. Methods MEDLINE was searched in April 2019 for SRs on any health topic. A total of 1880 unique publications were identified and sorted into five citation set size categories (after deduplication): < 1,000, 1,001–2,500, 2,501–5,000, 5,001–10,000, and > 10,000. A random sample of 259 SRs were selected (~ 50 per category) for data extraction and analysis. Results With the exception of the pairwise t test comparing the under 1000 and over 10,000 categories (median 5 vs. 6, p = 0.049) no statistically significant relationship was evident between author number and citation set size. While visual inspection was suggestive, statistical testing did not consistently identify a relationship between citation set size and number of screeners (title-abstract, full text) or data extractors. However, logistic regression identified investigators were significantly more likely to deviate from gold-standard screening methods (i.e. independent duplicate screening) with larger citation sets. For every doubling of citation size, the odds of using gold-standard screening decreased by 15 and 20% at title-abstract and full text review, respectively. Finally, few SRs reported using crowdsourcing (n = 2) or computer-assisted screening (n = 1). Conclusions Large citation set sizes present a challenge to SR teams, especially when faced with time-sensitive health policy questions. Our study suggests that with increasing citation set size, authors are less likely to adhere to gold-standard screening methods. It is possible that adjunct screening methods, such as crowdsourcing (large team) and computer-assisted technologies, may provide a viable solution for authors to complete their SRs in a timely manner. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-021-01335-5.
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Affiliation(s)
| | - Cameron MacDonald
- School of Engineering and Applied Sciences, McMaster University, Hamilton, ON, Canada
| | | | - Leo Kadota
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Ryan Sandarage
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Michele Datko
- ECRI Information Center, ECRI, Plymouth Meeting, PA, USA
| | - John M Reynolds
- Calder Memorial Library, University of Miami Miller School of Medicine, MLIS, Miami, FL, USA
| | - Thanh Bui
- Faculty of Arts & Science, University of Toronto, Toronto, ON, Canada
| | - Shagufta Sultan
- Therapeutic Products Directorate, Health Canada, Ottawa, ON, Canada
| | | | | | | | - Nassr Nama
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Matthew Page
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - James Dayre McNally
- CHEO Research Institute, Ottawa, ON, Canada. .,Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada. .,Department of Pediatrics, CHEO, 401 Smyth Road, ON, K1H 8L1, Ottawa, Canada.
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23
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Fitch ZW, Doberne J, Reynolds JM, Jamieson I, Haney JC, Klapper JA, Hartwig MG. Expanding donor availability in lung transplantation: A case report of 5000 miles traveled. Am J Transplant 2021; 21:2269-2272. [PMID: 33675176 DOI: 10.1111/ajt.16556] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 12/17/2020] [Revised: 01/22/2021] [Accepted: 02/05/2021] [Indexed: 01/25/2023]
Abstract
We present the case of a 41-year-old female who underwent bilateral lung transplantation after the donor lungs were placed on a normothermic ex vivo lung perfusion and ventilation device and flown nearly 5000 miles from Honolulu, Hawaii to Durham, North Carolina. The patient experienced no primary graft dysfunction. One year after transplantation she has remained rejection-free and exhibits excellent pulmonary function. This case highlights the challenge that active organ preservation systems pose to questions of organ allocation and geographic sharing.
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Affiliation(s)
- Zachary W Fitch
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Julie Doberne
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University, Durham, North Carolina, USA
| | - John M Reynolds
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Ian Jamieson
- Duke University Hospital, Duke University, Durham, North Carolina, USA
| | - John C Haney
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Jacob A Klapper
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Matthew G Hartwig
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University, Durham, North Carolina, USA
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24
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Young KA, Ali HA, Beermann KJ, Reynolds JM, Snyder LD. Lung Transplantation and the Era of the Sensitized Patient. Front Immunol 2021; 12:689420. [PMID: 34122454 PMCID: PMC8187850 DOI: 10.3389/fimmu.2021.689420] [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] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
Long term outcomes in lung transplant are limited by the development of chronic lung allograft dysfunction (CLAD). Within the past several decades, antibody-mediated rejection (AMR) has been recognized as a risk factor for CLAD. The presence of HLA antibodies in lung transplant candidates, "sensitized patients" may predispose patients to AMR, CLAD, and higher mortality after transplant. This review will discuss issues surrounding the sensitized patient, including mechanisms of sensitization, implications within lung transplant, and management strategies.
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Affiliation(s)
- Katherine A Young
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Hakim A Ali
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Kristi J Beermann
- Department of Pharmacy, Duke University Hospital, Durham, NC, United States
| | - John M Reynolds
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Laurie D Snyder
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
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25
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Baker AW, Maziarz EK, Arnold CJ, Johnson MD, Workman AD, Reynolds JM, Perfect JR, Alexander BD. Invasive Fungal Infection After Lung Transplantation: Epidemiology in the Setting of Antifungal Prophylaxis. Clin Infect Dis 2021; 70:30-39. [PMID: 30801642 DOI: 10.1093/cid/ciz156] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [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: 10/22/2018] [Accepted: 02/21/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Lung transplant recipients commonly develop invasive fungal infections (IFIs), but the most effective strategies to prevent IFIs following lung transplantation are not known. METHODS We prospectively collected clinical data on all patients who underwent lung transplantation at a tertiary care academic hospital from January 2007-October 2014. Standard antifungal prophylaxis consisted of aerosolized amphotericin B lipid complex during the transplant hospitalization. For the first 180 days after transplant, we analyzed prevalence rates and timing of IFIs, risk factors for IFIs, and data from IFIs that broke through prophylaxis. RESULTS In total, 156 of 815 lung transplant recipients developed IFIs (prevalence rate, 19.1 IFIs per 100 surgeries, 95% confidence interval [CI] 16.4-21.8%). The prevalence rate of invasive candidiasis (IC) was 11.4% (95% CI 9.2-13.6%), and the rate of non-Candida IFIs was 8.8% (95% CI 6.9-10.8%). First episodes of IC occurred a median of 31 days (interquartile range [IQR] 16-56 days) after transplant, while non-Candida IFIs occurred later, at a median of 86 days (IQR 40-121 days) after transplant. Of 169 IFI episodes, 121 (72%) occurred in the absence of recent antifungal prophylaxis; however, IC and non-Candida breakthrough IFIs were observed, most often representing failures of micafungin (n = 16) and aerosolized amphotericin B (n = 24) prophylaxis, respectively. CONCLUSIONS Lung transplant recipients at our hospital had high rates of IFIs, despite receiving prophylaxis with aerosolized amphotericin B lipid complex during the transplant hospitalization. These data suggest benefit in providing systemic antifungal prophylaxis targeting Candida for up to 90 days after transplant and extending mold-active prophylaxis for up to 180 days after surgery.
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Affiliation(s)
- Arthur W Baker
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina.,Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina
| | - Eileen K Maziarz
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina
| | - Christopher J Arnold
- Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville
| | - Melissa D Johnson
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina.,Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina
| | - Adrienne D Workman
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina
| | - John M Reynolds
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, North Carolina
| | - John R Perfect
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina
| | - Barbara D Alexander
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina.,Duke University Clinical Microbiology Laboratory, Durham, North Carolina
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26
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Raja MA, Mendoza MA, Villavicencio A, Anjan S, Reynolds JM, Kittipibul V, Fernandez A, Guerra G, Camargo JF, Simkins J, Morris MI, Abbo LA, Natori Y. COVID-19 in solid organ transplant recipients: A systematic review and meta-analysis of current literature. Transplant Rev (Orlando) 2021; 35:100588. [PMID: 33246166 PMCID: PMC7666542 DOI: 10.1016/j.trre.2020.100588] [Citation(s) in RCA: 140] [Impact Index Per Article: 46.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/07/2020] [Accepted: 11/09/2020] [Indexed: 02/08/2023]
Abstract
Severe acute respiratory virus syndrome 2 (SARS-CoV-2) has led to a worldwide pandemic. Early studies in solid organ transplant (SOT) recipients suggested a wide variety of presentations, however, there remains a paucity of robust data in this population. We conducted a systematic review and meta-analysis of SOT recipients with SARS-CoV-2 infection from January 1st t October 9th, 2020. Pooled incidence of symptoms, treatments and outcomes were assessed. Two hundred and fifteen studies were included for systematic review and 60 for meta-analysis. We identified 2,772 unique SOT recipients including 1,500 kidney, 505 liver, 141 heart and 97 lung. Most common presenting symptoms were fever and cough in 70.2% and 63.8% respectively. Majority (81%) required hospital admission. Immunosuppressive medications, especially antimetabolites, were decreased in 76.2%. Hydroxychloroquine and interleukin six antagonists were administered in59.5% and 14.9% respectively, while only few patients received remdesivir and convalescent plasma. Intensive care unit admission was 29% from amongst hospitalized patients. Only few studies reported secondary infections. Overall mortality was 18.6%. Our analysis shows a high incidence of hospital admission in SOT recipients with SARS-CoV-2 infection. As management of SARS-CoV-2 continues to evolve, long-term outcomes among SOT recipients should be assessed in future studies.
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Affiliation(s)
- Mohammed A Raja
- Department of Medicine, Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Maria A Mendoza
- Department of Medicine, Division of Internal Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Aasith Villavicencio
- Department of Medicine, Division of Internal Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Shweta Anjan
- Department of Medicine, Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, FL, USA; Miami Transplant Institute, Jackson Health System, Miami, FL, USA
| | - John M Reynolds
- Department of Health Informatics, Calder Memorial Library, University of Miami Miller School of Medicine Miami, FL, USA
| | - Veraprapas Kittipibul
- Department of Medicine, Division of Internal Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Anmary Fernandez
- Department of Medicine, Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Giselle Guerra
- Miami Transplant Institute, Jackson Health System, Miami, FL, USA; Department of Medicine, Division of Nephrology, University of Miami Miller School of Medicine Miami, FL, USA
| | - Jose F Camargo
- Department of Medicine, Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jacques Simkins
- Department of Medicine, Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, FL, USA; Miami Transplant Institute, Jackson Health System, Miami, FL, USA
| | - Michele I Morris
- Department of Medicine, Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lilian A Abbo
- Department of Medicine, Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, FL, USA; Miami Transplant Institute, Jackson Health System, Miami, FL, USA
| | - Yoichiro Natori
- Department of Medicine, Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, FL, USA; Miami Transplant Institute, Jackson Health System, Miami, FL, USA.
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27
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Halpern SE, Olaso DG, Krischak MK, Reynolds JM, Haney JC, Klapper JA, Hartwig MG. Lung transplantation during the COVID-19 pandemic: Safely navigating the new "normal". Am J Transplant 2020; 20:3094-3105. [PMID: 32894641 PMCID: PMC9800716 DOI: 10.1111/ajt.16304] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 06/11/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 01/25/2023]
Abstract
In the United States, an overall national decline in organ transplants has accompanied the substantial burden of COVID-19. Amidst significant regional variations in COVID-19, lung transplantation (LTx) remains a critical life-saving operation. Our LTx practice during the early pandemic may provide a blueprint for managing LTx in an era of continued community prevalence. Patients who underwent LTx at our institution between March 1 and May 20, 2020 were included. Recipient, operative, and donor characteristics were compared to those from our program in 2019, and COVID-19 testing practices were evaluated for March, April, and May to understand how our practice adapted to the pandemic. Our program performed 36 LTx, 33% more than the same period in 2019. Recipient, operative, and donor characteristics during COVID-19 were similar to those in 2019. By April 1, all donors and recipients underwent pretransplant COVID-19 testing, all returning negative results. To date, no recipients have developed posttransplant COVID-19. At our institution, pretransplant COVID-19 testing, use of local donor lungs, and avoidance of donors from areas of increased community penetration supported a safe and effective LTx practice during the early COVID-19 pandemic. Continued follow-up is required to ensure the long-term safety of these newly transplanted patients.
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Key Words
- asts, american society of transplant surgeons
- bal, bronchoalveolar lavage
- covid-19, coronavirus disease 2019
- ct, computed tomography
- ecmo, extracorporeal membrane oxygenation
- evlp, ex-vivo lung perfusion
- fev1, forced expiratory volume in 1 second
- fvc, forced vital capacity
- icu, intensive care unit
- iqr, interquartile range
- ird, increased risk for disease transmission
- ishlt, international society for heart and lung transplantation
- las, lung allocation score
- los, length of stay
- ltx, lung transplantation
- opo, organ procurement organization
- p/f, pao2/fio2
- pcr, polymerase chain reaction
- pgd, primary graft dysfunction
- sars-cov-2, severe acute respiratory syndrome coronavirus 2
- unos, united network for organ sharing
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Affiliation(s)
- Samantha E. Halpern
- School of Medicine, Duke University, Durham, NC, USA,Correspondence Samantha E. Halpern
| | | | | | - John M. Reynolds
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - John C. Haney
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Jacob A. Klapper
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Matthew G. Hartwig
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
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28
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Chu MC, Smith PJ, Reynolds JM, Palmer SM, Snyder LD, Gray AL, Blumenthal JA. Depression, Immunosuppressant Levels, and Clinical Outcomes in Postlung Transplant Recipients. Int J Psychiatry Med 2020; 55:421-436. [PMID: 32052665 DOI: 10.1177/0091217420906637] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 02/04/2023]
Abstract
OBJECTIVE Posttransplant depression has been linked to increased risk for adverse outcomes in lung transplant patients. Maintaining target serum immunosuppressant levels is also essential for optimal lung transplant clinical outcome and may be a crucial predictor of outcomes. Because depression could affect medication nonadherence, resulting in out-of-range immunosuppressant levels, we examined the relationship between posttransplant depression, immunosuppressant medication trough level variability, indexed by out-of-range values on clinical outcomes and coefficient of variability, and clinical outcomes. METHOD A consecutive series of 236 lung transplant recipients completed the Center for Epidemiological Studies-Depression two-month posttransplant. Immunosuppressant trough levels (i.e., tacrolimus or cyclosporine) within the range of individualized immunosuppressant targets were obtained at three-, six-, nine-month follow-up clinic visits. Clinical outcomes including hospitalizations and mortality were obtained from medical records. RESULTS Fourteen percent of patients were classified as depressed (Center for Epidemiological Studies-Depression ≥16), 144 (61%) of patients had at least 25% out-of-range immunosuppressant values, and the average coefficient of variability was 36%. Over a median of 2.6 years (interquartile range = 1.2), 32 participants died (14%) and 144 (61%) had at least one unplanned, transplant-related hospitalization. Both depression (hazard ratio = 1.45 (1.19, 1.76), p < . 01) and immunosuppressant variation (immunosuppressant out-of-range: hazard ratio = 1.41 (1.10, 1.81), p < .01) independently predicted more frequent hospitalizations and higher mortality. CONCLUSIONS Early posttransplant depression was associated with significantly worse clinical outcomes. While immunosuppressant level variability is also related to adverse outcomes, such variability does not account for increased risk observed with depression.
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Affiliation(s)
- Michael C Chu
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Patrick J Smith
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - John M Reynolds
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Scott M Palmer
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Laurie D Snyder
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Alice L Gray
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - James A Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
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Todd JL, Neely ML, Kopetskie H, Sever ML, Kirchner J, Frankel CW, Snyder LD, Pavlisko EN, Martinu T, Tsuang W, Shino MY, Williams N, Robien MA, Singer LG, Budev M, Shah PD, Reynolds JM, Palmer SM, Belperio JA, Weigt SS. Risk Factors for Acute Rejection in the First Year after Lung Transplant. A Multicenter Study. Am J Respir Crit Care Med 2020; 202:576-585. [PMID: 32379979 PMCID: PMC7427399 DOI: 10.1164/rccm.201910-1915oc] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 10/04/2019] [Accepted: 05/07/2020] [Indexed: 11/16/2022] Open
Abstract
Rationale: Acute rejection, manifesting as lymphocytic inflammation in a perivascular (acute perivascular rejection [AR]) or peribronchiolar (lymphocytic bronchiolitis [LB]) distribution, is common in lung transplant recipients and increases the risk for chronic graft dysfunction.Objectives: To evaluate clinical factors associated with biopsy-proven acute rejection during the first post-transplant year in a present-day, five-center lung transplant cohort.Methods: We analyzed prospective diagnoses of AR and LB from over 2,000 lung biopsies in 400 newly transplanted adult lung recipients. Because LB without simultaneous AR was rare, our analyses focused on risk factors for AR. Multivariable Cox proportional hazards models were used to assess donor and recipient factors associated with the time to the first AR occurrence.Measurements and Main Results: During the first post-transplant year, 53.3% of patients experienced at least one AR episode. Multivariable proportional hazards analyses accounting for enrolling center effects identified four or more HLA mismatches (hazard ratio [HR], 2.06; P ≤ 0.01) as associated with increased AR hazards, whereas bilateral transplantation (HR, 0.57; P ≤ 0.01) was associated with protection from AR. In addition, Wilcoxon rank-sum analyses demonstrated bilateral (vs. single) lung recipients, and those with fewer than four (vs. more than four) HLA mismatches demonstrated reduced AR frequency and/or severity during the first post-transplant year.Conclusions: We found a high incidence of AR in a contemporary multicenter lung transplant cohort undergoing consistent biopsy sampling. Although not previously recognized, the finding of reduced AR in bilateral lung recipients is intriguing, warranting replication and mechanistic exploration.
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Affiliation(s)
- Jamie L. Todd
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine
- Duke Clinical Research Institute, and
| | | | | | | | | | - Courtney W. Frankel
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine
| | - Laurie D. Snyder
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine
- Duke Clinical Research Institute, and
| | | | - Tereza Martinu
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Nikki Williams
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland; and
| | - Mark A. Robien
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland; and
| | - Lianne G. Singer
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | - John M. Reynolds
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine
| | - Scott M. Palmer
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine
- Duke Clinical Research Institute, and
| | | | - S. Sam Weigt
- University of California Los Angeles, Los Angeles, California
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30
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Snyder LD, Belperio J, Budev M, Frankel C, Kirchner J, Martinu T, Neely ML, Reynolds JM, Shah P, Singer LG, Todd JL, Tsuang W, Weigt S, Palmer SM. Highlights from the clinical trials in organ transplantation (CTOT)-20 and CTOT-22 Consortium studies in lung transplant. Am J Transplant 2020; 20:1489-1494. [PMID: 32342596 PMCID: PMC7323580 DOI: 10.1111/ajt.15957] [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] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/10/2020] [Accepted: 04/17/2020] [Indexed: 01/25/2023]
Abstract
Long-term survival after lung transplant lags behind that of other commonly transplanted organs, reflecting the current incomplete understanding of the mechanisms involved in the development of posttransplant lung injury, rejection, infection, and chronic allograft dysfunction. To address this unmet need, 2 ongoing National Institute of Allergy and Infectious Disease funded studies through the Clinical Trials in Organ Transplant Consortium (CTOT) CTOT-20 and CTOT-22 were dedicated to understanding the clinical factors and biological mechanisms that drive chronic lung allograft dysfunction and those that maintain cytomegalovirus polyfunctional protective immunity. The CTOT-20 and CTOT-22 studies enrolled 800 lung transplant recipients at 5 North American centers over 3 years. Given the number and complexity of subjects included, CTOT-20 and CTOT-22 utilized innovative data transfers and capitalized on patient-entered data collection to minimize site manual data entry. The data were coupled with an extensive biosample collection strategy that included DNA, RNA, plasma, serum, bronchoalveolar lavage fluid, and bronchoalveolar lavage cell pellet. This Special Article describes the CTOT-20 and CTOT-22 protocols, data and biosample strategy, initial results, and lessons learned through study execution.
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Affiliation(s)
| | | | | | | | - Jerry Kirchner
- Duke Clinical Research institute, Durham, North Carolina
| | | | | | | | - Pali Shah
- Johns Hopkins University, Baltimore, Maryland
| | | | | | | | - Samuel Weigt
- University of California, Los Angeles, California
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31
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Zhang CYK, Ahmed M, Huszti E, Levy L, Hunter SE, Boonstra KM, Moshkelgosha S, Sage AT, Azad S, Zamel R, Ghany R, Yeung JC, Crespin OM, Frankel C, Budev M, Shah P, Reynolds JM, Snyder LD, Belperio JA, Singer LG, Weigt SS, Todd JL, Palmer SM, Keshavjee S, Martinu T. Bronchoalveolar bile acid and inflammatory markers to identify high-risk lung transplant recipients with reflux and microaspiration. J Heart Lung Transplant 2020; 39:934-944. [PMID: 32487471 DOI: 10.1016/j.healun.2020.05.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 04/20/2020] [Accepted: 05/11/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) is a risk factor for chronic lung allograft dysfunction. Bile acids-putative markers of gastric microaspiration-and inflammatory proteins in the bronchoalveolar lavage (BAL) have been associated with chronic lung allograft dysfunction, but their relationship with GERD remains unclear. Although GERD is thought to drive chronic microaspiration, the selection of patients for anti-reflux surgery lacks precision. This multicenter study aimed to test the association of BAL bile acids with GERD, lung inflammation, allograft function, and anti-reflux surgery. METHODS We analyzed BAL obtained during the first post-transplant year from a retrospective cohort of patients with and without GERD, as well as BAL obtained before and after Nissen fundoplication anti-reflux surgery from a separate cohort. Levels of taurocholic acid (TCA), glycocholic acid, and cholic acid were measured using mass spectrometry. Protein markers of inflammation and injury were measured using multiplex assay and enzyme-linked immunosorbent assay. RESULTS At 3 months after transplantation, TCA, IL-1β, IL-12p70, and CCL5 were higher in the BAL of patients with GERD than in that of no-GERD controls. Elevated TCA and glycocholic acid were associated with concurrent acute lung allograft dysfunction and inflammatory proteins. The BAL obtained after anti-reflux surgery contained reduced TCA and inflammatory proteins compared with that obtained before anti-reflux surgery. CONCLUSIONS Targeted monitoring of TCA and selected inflammatory proteins may be useful in lung transplant recipients with suspected reflux and microaspiration to support diagnosis and guide therapy. Patients with elevated biomarker levels may benefit most from anti-reflux surgery to reduce microaspiration and allograft inflammation.
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Affiliation(s)
- Chen Yang Kevin Zhang
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Musawir Ahmed
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Ella Huszti
- Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
| | - Liran Levy
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Sarah E Hunter
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Kristen M Boonstra
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Sajad Moshkelgosha
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Andrew T Sage
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Sassan Azad
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Ricardo Zamel
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Rasheed Ghany
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Jonathan C Yeung
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Oscar M Crespin
- Division of General Surgery, University Health Network, University of Toronto, Toronto, Canada
| | | | | | - Pali Shah
- Johns Hopkins University Hospital, Baltimore, Maryland
| | | | | | | | - Lianne G Singer
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | | | - Jamie L Todd
- Duke University Medical Center, Durham, North Carolina
| | | | - Shaf Keshavjee
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Tereza Martinu
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada.
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32
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Turner MN, Hernandez DO, Cade W, Emerson CP, Reynolds JM, Best TM. The Role of Resistance Training Dosing on Pain and Physical Function in Individuals With Knee Osteoarthritis: A Systematic Review. Sports Health 2019; 12:200-206. [PMID: 31850826 DOI: 10.1177/1941738119887183] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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] Open
Abstract
CONTEXT Dosing parameters are needed to ensure the best practice guidelines for knee osteoarthritis. OBJECTIVE To determine whether resistance training affects pain and physical function in individuals with knee osteoarthritis, and whether a dose-response relationship exists. Second, we will investigate whether the effects are influenced by Kellgren-Lawrence grade or location of osteoarthritis. DATA SOURCES A search for randomized controlled trials was conducted in MEDLINE, Embase, and CINAHL, from their inception dates, between November 1, 2018, and January 15, 2019. Keywords included knee osteoarthritis, knee joint, resistance training, strength training, and weight lifting. STUDY SELECTION Inclusion criteria were randomized controlled trials reporting changes in pain and physical function on humans with knee osteoarthritis comparing resistance training interventions with no intervention. Two reviewers screened 471 abstracts; 12 of the 13 studies assessed were included. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level 2. DATA EXTRACTION Mean baseline and follow-up Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and standard deviations were extracted to calculate the standard mean difference. Articles were assessed for methodological quality using the CONSORT (Consolidated Standards of Reporting Trials) 2010 scale and Cochrane Collaboration tool for assessing risk of bias. RESULTS The 12 included studies had high methodological quality. Of these, 11 studies revealed that resistance training improved pain and/or physical function. The most common regimen was a 30- to 60-minute session of 2 to 3 sets of 8 to 12 repetitions with an initial resistance of 50% to 60% of maximum resistance that progressed over 3 sessions per week for 24 weeks. Seven studies reported Kellgren-Lawrence grade, and 4 studies included osteoarthritis location. CONCLUSION Resistance training improves pain and physical function in knee osteoarthritis. Large effect sizes were associated with 24 total sessions and 8- to 12-week duration. No optimal number of repetitions, maximum strength, or frequency of sets or repetitions was found. No trends were identified between outcomes and location or Kellgren-Lawrence grade of osteoarthritis.
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Affiliation(s)
- Meredith N Turner
- University of Miami Sport Medicine Institute, University of Miami Leonard M. Miller School of Medicine, Miami, Florida.,Department of Family Medicine and Community Health, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Daniel O Hernandez
- Department of Family Medicine and Community Health, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - William Cade
- University of Miami Sport Medicine Institute, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Christopher P Emerson
- University of Miami Sport Medicine Institute, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - John M Reynolds
- Louis Calder Memorial Library, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Thomas M Best
- University of Miami Sport Medicine Institute, University of Miami Leonard M. Miller School of Medicine, Miami, Florida.,Department of Family Medicine and Community Health, University of Miami Leonard M. Miller School of Medicine, Miami, Florida.,Department of Orthopedic Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
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33
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Baker AW, Messina JA, Maziarz EK, Saullo J, Miller R, Miller R, Wolfe CR, Arif S, Reynolds JM, Perfect JR, Alexander BD. 1758. Epidemiology of Invasive Mycoplasma and Ureaplasma Infections Early after Lung Transplantation. Open Forum Infect Dis 2019. [PMCID: PMC6808825 DOI: 10.1093/ofid/ofz360.1621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Indexed: 11/29/2022] Open
Abstract
Background Mycoplasma and Ureaplasma species can cause invasive infections early after lung transplant that are difficult to diagnose and associated with substantial morbidity, including hyperammonemia syndrome. Data on the epidemiology and clinical outcomes of these infections are needed to inform clinical management and screening protocols for donors and recipients. Methods We retrospectively collected clinical data on all patients who underwent lung transplantation at our hospital from January 1, 2010 to April 15, 2019 and subsequently had positive cultures or PCR studies for M. hominis or Ureaplasma spp. Patients with positive studies from only the genitourinary tract were excluded. We analyzed donor and recipient clinical characteristics, treatment courses, and outcomes for up to 2 years after transplant. Results Of 1055 total lung transplant recipients, 20 (1.9%) patients developed invasive infection with M. hominis or Ureaplasma spp. M. hominis caused the first 10 infections (2010–2016), and Ureaplasma spp. caused 10 subsequent infections (2017–2019). Date of first positive culture or PCR study occurred a median of only 19 days after transplant (range, 4–90 days). Median donor age was 31 years (range, 18–45 years), and chest imaging for 16 (80%) donors revealed airspace disease compatible with aspiration. Infection outside of the respiratory tract was confirmed for 13 (65%) recipients, including 8 patients with M. hominis empyemas (Figure 1). Ten (50%) patients developed altered mental status that was temporally associated with infection; 8 (80%) of these patients had elevated serum ammonia levels, including 3 patients with M. hominis infection. Median duration of therapy was 6 weeks (IQR, 4–9 weeks), consisting of combination antimicrobial regimens for nearly all patients. Additional postoperative complications were common, and 11 (55%) patients died within 1 year after transplant (median, 117 days; IQR, 65–255 days) (Figure 2). Conclusion Ureaplasma and M. hominis infections occurred early after lung transplant and were associated with substantial morbidity and mortality. Transplant clinicians should have low thresholds for performing specific diagnostic testing for these organisms. Protocols for donor and recipient screening and management need to be developed. ![]()
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Disclosures Rachel Miller, MD, Synexis: Research Grant.
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Affiliation(s)
- Arthur W Baker
- Duke University School of Medicine; Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina
| | | | | | | | | | | | | | - Sana Arif
- Duke University Medical Center, Durham, North Carolina
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Anacona PI, Kinney J, Schaefer M, Harrison S, Wilson R, Segovia A, Mazzorana B, Guerra F, Farías D, Reynolds JM, Glasser NF. Glacier protection laws: Potential conflicts in managing glacial hazards and adapting to climate change. Ambio 2018; 47:835-845. [PMID: 29536432 PMCID: PMC6230326 DOI: 10.1007/s13280-018-1043-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 02/08/2018] [Accepted: 03/01/2018] [Indexed: 08/18/2023]
Abstract
The environmental, socioeconomic and cultural significance of glaciers has motivated several countries to regulate activities on glaciers and glacierized surroundings. However, laws written to specifically protect mountain glaciers have only recently been considered within national political agendas. Glacier Protection Laws (GPLs) originate in countries where mining has damaged glaciers and have been adopted with the aim of protecting the cryosphere from harmful activities. Here, we analyze GPLs in Argentina (approved) and Chile (under discussion) to identify potential environmental conflicts arising from law restrictions and omissions. We conclude that GPLs overlook the dynamics of glaciers and could prevent or delay actions needed to mitigate glacial hazards (e.g. artificial drainage of glacial lakes) thus placing populations at risk. Furthermore, GPL restrictions could hinder strategies (e.g. use of glacial lakes as reservoirs) to mitigate adverse impacts of climate change. Arguably, more flexible GPLs are needed to protect us from the changing cryosphere.
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Affiliation(s)
- Pablo Iribarren Anacona
- Instituto de Geografía, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
- Instituto de Ciencias de la Tierra, Universidad Austral, Edificio Pugin, Campus Isla Teja, Valdivia, Chile
| | - Josie Kinney
- Robert D. Clark Honors College, University of Oregon, Eugene, OR 97403 USA
- 2618 NW Marken StreetBend, Bend, OR 97703 USA
| | - Marius Schaefer
- Instituto de Ciencias Físicas y Matemáticas, Universidad Austral, Edificio Pugin 4° piso, Campus Isla Teja, Valdivia, Chile
| | - Stephan Harrison
- Department of Geography, University of Exeter, Cornwall Campus, Penryn, Cornwall TR10 9EZ UK
- College of Life and Environmental Sciences, University of Exeter, Exeter, EX4 4RJ UK
| | - Ryan Wilson
- Department of Geography and Earth Sciences, Institute of Geography, History, Politics and Psychology, Aberystwyth University, Aberystwyth, Ceredigion SY23 3DB Wales, UK
| | - Alexis Segovia
- Facultad de Ciencias Forestales y Conservación de la Naturaleza, Universidad de Chile, Fray Camilo Henriquez 364, Santiago of Chile, 8330207 Santiago, Chile
| | - Bruno Mazzorana
- Instituto de Ciencias de la Tierra, Universidad Austral, Edificio Pugin, Campus Isla Teja, Valdivia, Chile
| | - Felipe Guerra
- Observatorio Ciudadano, Antonio Varas 428, Temuco, Chile
| | - David Farías
- Institute of Geography and Geosciences, University of Erlangen-Nürnberg, Wetterkreuz 15, 91058 Erlangen, Germany
| | - John M. Reynolds
- Reynolds International Ltd, Suite 2, Broncoed House, Broncoed Business Park, Mold, Flintshire CH7 1HP UK
| | - Neil F. Glasser
- Department of Geography and Earth Sciences, Institute of Geography, History, Politics and Psychology, Aberystwyth University, Aberystwyth, Ceredigion SY23 3DB Wales, UK
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Philo SE, Anderson BD, Costa SF, Henshaw N, Lewis SS, Reynolds JM, Jayakumar J, Su YCF, Gray GC. Adenovirus Type 21 Outbreak Among Lung Transplant Patients at a Large Tertiary Care Hospital. Open Forum Infect Dis 2018; 5:ofy188. [PMID: 30151413 PMCID: PMC6105090 DOI: 10.1093/ofid/ofy188] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 07/27/2018] [Indexed: 12/20/2022] Open
Abstract
Here we summarize an April 2016, 7-patient cluster of human adenovirus (HAdV) infections in a cardiothoracic surgery intensive care unit. We show that the patients were infected with a single HAdV21b type. Rapid HAdV typing diagnostics and effective antiviral interventions are needed for immunocompromised patients suffering from HAdV infections.
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Affiliation(s)
- Sarah E Philo
- Division of Infectious Disease, School of Medicine, Duke University, Durham, North Carolina.,Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Benjamin D Anderson
- Division of Infectious Disease, School of Medicine, Duke University, Durham, North Carolina.,Duke Global Health Institute, Duke University, Durham, North Carolina.,Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Sylvia F Costa
- Division of Infectious Disease, School of Medicine, Duke University, Durham, North Carolina
| | - Nancy Henshaw
- Department of Pathology, School of Medicine, Duke University, Durham, North Carolina
| | - Sarah S Lewis
- Division of Infectious Disease, School of Medicine, Duke University, Durham, North Carolina
| | - John M Reynolds
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Hospital, Durham, North Carolina
| | - Jayanthi Jayakumar
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore
| | - Yvonne C F Su
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore
| | - Gregory C Gray
- Division of Infectious Disease, School of Medicine, Duke University, Durham, North Carolina.,Duke Global Health Institute, Duke University, Durham, North Carolina.,Global Health Research Center, Duke Kunshan University, Kunshan, China.,Program in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore
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36
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Farquhar JM, Smith PJ, Snyder L, Gray AL, Reynolds JM, Blumenthal JA. Patterns and predictors of pain following lung transplantation. Gen Hosp Psychiatry 2018; 50:125-130. [PMID: 29190571 DOI: 10.1016/j.genhosppsych.2017.11.007] [Citation(s) in RCA: 9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 11/16/2017] [Accepted: 11/18/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Our objective was to examine variability in pain levels following lung transplantation, and examine individual biopsychosocial factors influencing changes in pain. METHOD We performed a retrospective study of a cohort of 150 patients transplanted and discharged from Duke University Hospital between January 2015 and September 2016. During hospitalization and at clinic visits up to two months after discharge, subjective pain ratings were obtained using a 0-10 Numeric Rating Scale. Psychiatric diagnoses of anxiety and depression and Center for Epidemiological Studies - Depression (CES-D) scores collected after hospital discharge were examined as predictors of post-surgery pain. Medical and surgical variables were examined as covariates. RESULTS During hospitalization, pain ratings decreased over time (p<0.001). Predictors of higher pain levels included pre-transplant history of depression (p=0.001) and anxiety (p=0.04), bilateral lung transplant (p=0.03), and lower six-minute walk distance (p=0.02). Two months after discharge, 18% of patients reported continued pain and 34% remained on opioid pain medications. Two months after discharge, more frequent post-operative complications predicted higher pain levels in a univariate analysis (p=0.02) although this relationship was attenuated after adjustment for depression. In a multivariate analysis, elevated CES-D scores (p=0.002), and greater opioid use (p=0.031) predicted higher pain levels 2-months post-discharge. CONCLUSION We conclude that patients with psychiatric comorbidities may be at risk for greater pain, and may require additional strategies for more effective pain management.
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Affiliation(s)
- Julia M Farquhar
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Patrick J Smith
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Laurie Snyder
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Alice L Gray
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - John M Reynolds
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - James A Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
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Baker AW, Lewis SS, Alexander BD, Chen LF, Wallace RJ, Brown-Elliott BA, Isaacs PJ, Pickett LC, Patel CB, Smith PK, Reynolds JM, Engel J, Wolfe CR, Milano CA, Schroder JN, Davis RD, Hartwig MG, Stout JE, Strittholt N, Maziarz EK, Saullo JH, Hazen KC, Walczak RJ, Vasireddy R, Vasireddy S, McKnight CM, Anderson DJ, Sexton DJ. Two-Phase Hospital-Associated Outbreak of Mycobacterium abscessus: Investigation and Mitigation. Clin Infect Dis 2017; 64:902-911. [PMID: 28077517 DOI: 10.1093/cid/ciw877] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [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: 09/20/2016] [Accepted: 01/03/2017] [Indexed: 12/17/2022] Open
Abstract
Background Nontuberculous mycobacteria (NTM) commonly colonize municipal water supplies and cause healthcare-associated outbreaks. We investigated a biphasic outbreak of Mycobacterium abscessus at a tertiary care hospital. Methods Case patients had recent hospital exposure and laboratory-confirmed colonization or infection with M. abscessus from January 2013 through December 2015. We conducted a multidisciplinary epidemiologic, field, and laboratory investigation. Results The incidence rate of M. abscessus increased from 0.7 cases per 10000 patient-days during the baseline period (January 2013-July 2013) to 3.0 cases per 10000 patient-days during phase 1 of the outbreak (August 2013-May 2014) (incidence rate ratio, 4.6 [95% confidence interval, 2.3-8.8]; P < .001). Thirty-six of 71 (51%) phase 1 cases were lung transplant patients with positive respiratory cultures. We eliminated tap water exposure to the aerodigestive tract among high-risk patients, and the incidence rate decreased to baseline. Twelve of 24 (50%) phase 2 (December 2014-June 2015) cases occurred in cardiac surgery patients with invasive infections. Phase 2 resolved after we implemented an intensified disinfection protocol and used sterile water for heater-cooler units of cardiopulmonary bypass machines. Molecular fingerprinting of clinical isolates identified 2 clonal strains of M. abscessus; 1 clone was isolated from water sources at a new hospital addition. We made several water engineering interventions to improve water flow and increase disinfectant levels. Conclusions We investigated and mitigated a 2-phase clonal outbreak of M. abscessus linked to hospital tap water. Healthcare facilities with endemic NTM should consider similar tap water avoidance and engineering strategies to decrease risk of NTM infection.
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Affiliation(s)
- Arthur W Baker
- Duke Program for Infection Prevention and Healthcare Epidemiology, Duke University Hospital, Durham, North Carolina.,Division of Infectious Diseases, Duke University Hospital, Durham, North Carolina
| | - Sarah S Lewis
- Duke Program for Infection Prevention and Healthcare Epidemiology, Duke University Hospital, Durham, North Carolina.,Division of Infectious Diseases, Duke University Hospital, Durham, North Carolina
| | - Barbara D Alexander
- Division of Infectious Diseases, Duke University Hospital, Durham, North Carolina.,Duke University Clinical Microbiology Laboratory, Durham, North Carolina
| | - Luke F Chen
- Duke Program for Infection Prevention and Healthcare Epidemiology, Duke University Hospital, Durham, North Carolina.,Division of Infectious Diseases, Duke University Hospital, Durham, North Carolina
| | - Richard J Wallace
- Duke University Clinical Microbiology Laboratory, Durham, North Carolina
| | | | - Pamela J Isaacs
- Duke Program for Infection Prevention and Healthcare Epidemiology, Duke University Hospital, Durham, North Carolina
| | - Lisa C Pickett
- Division of Trauma and Critical Care, Duke University Hospital, Durham, North Carolina
| | - Chetan B Patel
- Division of Cardiology, Duke University Hospital, Durham, North Carolina
| | - Peter K Smith
- Division of Cardiovascular and Thoracic Surgery, Duke University Hospital, Durham, North Carolina
| | - John M Reynolds
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Hospital, Durham, North Carolina
| | - Jill Engel
- Duke University Hospital, Durham, North Carolina
| | - Cameron R Wolfe
- Division of Infectious Diseases, Duke University Hospital, Durham, North Carolina
| | - Carmelo A Milano
- Division of Cardiovascular and Thoracic Surgery, Duke University Hospital, Durham, North Carolina
| | - Jacob N Schroder
- Division of Cardiovascular and Thoracic Surgery, Duke University Hospital, Durham, North Carolina
| | - Robert D Davis
- Division of Cardiovascular and Thoracic Surgery, Duke University Hospital, Durham, North Carolina
| | - Matthew G Hartwig
- Division of Cardiovascular and Thoracic Surgery, Duke University Hospital, Durham, North Carolina
| | - Jason E Stout
- Division of Infectious Diseases, Duke University Hospital, Durham, North Carolina
| | - Nancy Strittholt
- Duke Program for Infection Prevention and Healthcare Epidemiology, Duke University Hospital, Durham, North Carolina
| | - Eileen K Maziarz
- Division of Infectious Diseases, Duke University Hospital, Durham, North Carolina
| | - Jennifer Horan Saullo
- Duke Program for Infection Prevention and Healthcare Epidemiology, Duke University Hospital, Durham, North Carolina
| | - Kevin C Hazen
- Division of Infectious Diseases, Duke University Hospital, Durham, North Carolina
| | - Richard J Walczak
- Perfusion Services, Duke University Hospital, Durham, North Carolina
| | - Ravikiran Vasireddy
- Mycobacteria/Nocardia Research Laboratory, Department of Microbiology, University of Texas Health Science Center, Tyler
| | - Sruthi Vasireddy
- Mycobacteria/Nocardia Research Laboratory, Department of Microbiology, University of Texas Health Science Center, Tyler
| | - Celeste M McKnight
- Duke University Clinical Microbiology Laboratory, Durham, North Carolina
| | - Deverick J Anderson
- Duke Program for Infection Prevention and Healthcare Epidemiology, Duke University Hospital, Durham, North Carolina.,Division of Infectious Diseases, Duke University Hospital, Durham, North Carolina
| | - Daniel J Sexton
- Duke Program for Infection Prevention and Healthcare Epidemiology, Duke University Hospital, Durham, North Carolina.,Division of Infectious Diseases, Duke University Hospital, Durham, North Carolina
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Abstract
CONTEXT A significant contribution to the success of lung transplantation is the recipient's ability to self-manage a multidrug regimen and follow complex instructions. Effective education has always been an integral component of the process of preparing patients to care for themselves post lung transplant. Impaired cognition, anxiety, and psychological distress, however, can decrease the retention of posttransplant care information provided during education sessions. OBJECTIVE This quality improvement project evaluated whether a multimedia education method compared to standard education method improves posttransplant care knowledge, anxiety, and satisfaction with the education experience in lung transplant patients and their caregivers. METHODS Two education methods groups, comprised of transplant patients and their primary caregivers, were compared: (1) historic control group who received the standard education (n = 19 dyads) and (2) multimedia group who received the new multimedia education (n = 18 dyads). Knowledge of posttransplant care was evaluated in both groups before and after receiving the education. A satisfaction survey was administered at the end of the education program. RESULTS A significantly higher percentage of patients receiving the multimedia method reported gains in posttransplant care knowledge ( P = .05), less anxiety about the transplant surgery ( P = .02), and satisfaction with the education method ( P = .02) when compared to those receiving the standard method. Caregivers and transplant team member also indicated that the multimedia method was more effective than the standard method. CONCLUSION Multimedia methods decrease anxiety and increase satisfaction with the education experience when preparing patients for lung transplantation.
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Affiliation(s)
- Sandra L Gerity
- 1 Lung Transplant Program, Duke Transplant Center, Duke University Health System, Durham, NC, USA.,2 Duke University School of Nursing, Durham, NC, USA
| | - Susan G Silva
- 2 Duke University School of Nursing, Durham, NC, USA.,3 Duke University Department of Psychiatry and Behavioral Sciences, Durham, NC, USA
| | - John M Reynolds
- 4 Division of Pulmonary, Allergy and Critical Care, Duke University Department of Medicine, Durham, NC, USA
| | - Benson Hoffman
- 3 Duke University Department of Psychiatry and Behavioral Sciences, Durham, NC, USA
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Chen DF, Reynolds JM. P085 Lung re-transplant with repeated mismatch HLA antigens. Hum Immunol 2017. [DOI: 10.1016/j.humimm.2017.06.145] [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: 10/18/2022]
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Baker AW, Lewis SS, Alexander BD, Isaacs PJ, Pickett LC, Wallace RJ, Brown-Elliott BA, Strittholt N, Hazen KC, Wolfe CR, Maziarz EK, Saullo JH, Davis RD, Reynolds JM, Anderson D, Sexton DJ, Chen LF. A Cluster of Mycobacterium abscessus Among Lung Transplant Patients: Investigation and Mitigation. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv131.50] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Smith PJ, Rivelli SK, Waters AM, Hoyle A, Durheim MT, Reynolds JM, Flowers M, Davis RD, Palmer SM, Mathew JP, Blumenthal JA. Delirium affects length of hospital stay after lung transplantation. J Crit Care 2014; 30:126-9. [PMID: 25307975 DOI: 10.1016/j.jcrc.2014.09.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [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: 05/29/2014] [Revised: 08/12/2014] [Accepted: 09/14/2014] [Indexed: 01/15/2023]
Abstract
BACKGROUND Delirium is relatively common after lung transplantation, although its prevalence and prognostic significance have not been systematically studied. The purpose of the present study was to examine pretransplant predictors of delirium and the short-term impact of delirium on clinical outcomes among lung transplant recipients. METHODS Participants underwent pretransplant cognitive testing using the Repeatable Battery for the Assessment of Neuropsychological Status and the Trail Making Test. After transplant, delirium was assessed using the Confusion Assessment Method until discharge. RESULTS Sixty-three patients were transplanted between March and November 2013, of which 23 (37%) developed delirium. Among transplanted patients, 48 patients completed pretransplant cognitive testing. Better pretransplant cognitive function was associated with lower risk of delirium (odds ratio, 0.69 [95% confidence interval 0.48, 0.99], P = .043); and demographic and clinical features including native disease (P = .236), the Charlson comorbidity index (P = .581), and the lung allocation score (P = .871) were unrelated to risk of delirium, although there was a trend for women to experience delirium less frequently (P = .071). The presence (P = .006) and duration (P = .027) of delirium were both associated with longer hospital stays. CONCLUSION Delirium occurs in more than one-third of patients after lung transplantation. Delirium was associated with poorer pretransplant cognitive functioning and longer hospital stays, after accounting for other medical and demographic factors.
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Affiliation(s)
- P J Smith
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, Durham, NC.
| | - S K Rivelli
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, Durham, NC
| | - A M Waters
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, Durham, NC
| | - A Hoyle
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, Durham, NC
| | - M T Durheim
- Duke University Medical Center, Department of Medicine, Durham, NC
| | - J M Reynolds
- Duke University Medical Center, Department of Medicine, Durham, NC
| | - M Flowers
- Duke University Medical Center, Department of Medicine, Durham, NC
| | - R D Davis
- Duke University Medical Center, Department of Surgery, Durham, NC
| | - S M Palmer
- Duke University Medical Center, Department of Medicine, Durham, NC
| | - J P Mathew
- Duke University Medical Center, Department of Anesthesiology, Durham, NC
| | - J A Blumenthal
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, Durham, NC
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Todd JL, Jain R, Pavlisko EN, Finlen Copeland CA, Reynolds JM, Snyder LD, Palmer SM. Impact of forced vital capacity loss on survival after the onset of chronic lung allograft dysfunction. Am J Respir Crit Care Med 2014; 189:159-66. [PMID: 24325429 DOI: 10.1164/rccm.201306-1155oc] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
RATIONALE Emerging evidence suggests a restrictive phenotype of chronic lung allograft dysfunction (CLAD) exists; however, the optimal approach to its diagnosis and clinical significance is uncertain. OBJECTIVES To evaluate the hypothesis that spirometric indices more suggestive of a restrictive ventilatory defect, such as loss of FVC, identify patients with distinct clinical, radiographic, and pathologic features, including worse survival. METHODS Retrospective, single-center analysis of 566 consecutive first bilateral lung recipients transplanted over a 12-year period. A total of 216 patients developed CLAD during follow-up. CLAD was categorized at its onset into discrete physiologic groups based on spirometric criteria. Imaging and histologic studies were reviewed when available. Survival after CLAD diagnosis was assessed using Kaplan-Meier and Cox proportional hazards models. MEASUREMENTS AND MAIN RESULTS Among patients with CLAD, 30% demonstrated an FVC decrement at its onset. These patients were more likely to be female, have radiographic alveolar or interstitial changes, and histologic findings of interstitial fibrosis. Patients with FVC decline at CLAD onset had significantly worse survival after CLAD when compared with those with preserved FVC (P < 0.0001; 3-yr survival estimates 9% vs. 48%, respectively). The deleterious impact of CLAD accompanied by FVC loss on post-CLAD survival persisted in a multivariable model including baseline demographic and clinical factors (P < 0.0001; adjusted hazard ratio, 2.73; 95% confidence interval, 1.86-4.04). CONCLUSIONS At CLAD onset, a subset of patients demonstrating physiology more suggestive of restriction experience worse clinical outcomes. Further study of the biologic mechanisms underlying CLAD phenotypes is critical to improving long-term survival after lung transplantation.
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Affiliation(s)
- Jamie L Todd
- 1 Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine
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Reynolds JM, Hodges DB, Salam A, Shaw ET, Magoon V, Werlang-Perurena AM, Singh HB, Speights VO, Ruud CO, Bhat A. Abstract P1-06-11: Tumor-associated macrophages: CD206 expression and patient outcomes in locally advanced breast cancer. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p1-06-11] [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
Abstract
Introduction
The ability of a tumor to recur is related to the complex molecular biology of the tumor cells and the surrounding microenvironment. Tumor-associated macrophages (TAMs) account for up to 50% of the cell mass within a breast tumor, and the M2 macrophage phenotype has been reported to have pro-tumor activity. The mannose receptor, CD206, is a transmembrane receptor expressed predominantly in macrophages and shown in mouse studies to promote M2/TAM activity. This study evaluates CD206 expression in the tumor stroma with patient outcomes in locally advanced breast cancer.
Methods
The Scott & White tumor registry was queried for consecutive cases of women diagnosed with stage 3, HER-2 negative breast cancer between January 1999 and December 2006. To meet inclusion criteria, all biopsies must have been performed at S&W and patients must have had at least 5 years of follow up in our system documenting status of cancer (complete remission vs. metastatic recurrence). Archived formalin fixed and paraffin embedded tissue breast tissue from initial surgical biopsies was obtained from the Scott & White Pathology Department. Sections were cut at 4 microns thick and slides were stained for CD206. Two pathologists without knowledge of the patients’ clinical backgrounds reviewed each slide. The hot spot method was employed at 20x power to identify the 3 spots in tumor stroma that stained most heavily. The number of CD206+ cells in each of 3 hot spots was counted, and the mean number of CD206+ cells per hot spot reported by two independent pathologists was averaged for analysis.
Results
65 patients met inclusion criteria, of these 31 had a recurrence within 5 years of diagnosis. There was no correlation between likelihood of recurrence or overall survival and CD206 expression. In the 31 patients that had a recurrence, a high CD206 count of greater than or equal to 15 was associated with a shorter time to recurrence than a CD206 count of less than 15 (14.8 months vs. 22 months, respectively, p = 0.028). Mean age at diagnosis in the recurrence group was 59.6 vs. 60 years, and 15 (60%) vs. 2(33%) patients were ER positive in the low CD206 (<15) vs. high CD206 ( = >15) groups, respectively.
Conclusion
High expression of CD206 in the tumor stroma was associated with a shorter time to recurrence in patients with stage 3, HER-2 negative breast cancer; however, there were more ER negative tumors in the high CD 206 group. Our research supports in vitro data that high CD206 expression in macrophages may represent a more aggressive tumor phenotype. Future studies focusing on studying CD206 expression in HER-2 positive breast tumors along with histological stratification are needed to confirm this finding.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-06-11.
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Affiliation(s)
- JM Reynolds
- Scott & White Healthcare; Texas A&M Graduate Medical Education, Temple, TX; The University of Texas at Tyler, Tyler, TX; Odyssey Hospice, Austin, TX
| | - DB Hodges
- Scott & White Healthcare; Texas A&M Graduate Medical Education, Temple, TX; The University of Texas at Tyler, Tyler, TX; Odyssey Hospice, Austin, TX
| | - A Salam
- Scott & White Healthcare; Texas A&M Graduate Medical Education, Temple, TX; The University of Texas at Tyler, Tyler, TX; Odyssey Hospice, Austin, TX
| | - ET Shaw
- Scott & White Healthcare; Texas A&M Graduate Medical Education, Temple, TX; The University of Texas at Tyler, Tyler, TX; Odyssey Hospice, Austin, TX
| | - V Magoon
- Scott & White Healthcare; Texas A&M Graduate Medical Education, Temple, TX; The University of Texas at Tyler, Tyler, TX; Odyssey Hospice, Austin, TX
| | - AM Werlang-Perurena
- Scott & White Healthcare; Texas A&M Graduate Medical Education, Temple, TX; The University of Texas at Tyler, Tyler, TX; Odyssey Hospice, Austin, TX
| | - HB Singh
- Scott & White Healthcare; Texas A&M Graduate Medical Education, Temple, TX; The University of Texas at Tyler, Tyler, TX; Odyssey Hospice, Austin, TX
| | - VO Speights
- Scott & White Healthcare; Texas A&M Graduate Medical Education, Temple, TX; The University of Texas at Tyler, Tyler, TX; Odyssey Hospice, Austin, TX
| | - CO Ruud
- Scott & White Healthcare; Texas A&M Graduate Medical Education, Temple, TX; The University of Texas at Tyler, Tyler, TX; Odyssey Hospice, Austin, TX
| | - A Bhat
- Scott & White Healthcare; Texas A&M Graduate Medical Education, Temple, TX; The University of Texas at Tyler, Tyler, TX; Odyssey Hospice, Austin, TX
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Mack CM, Smith PA, Athanacio JR, Xu K, Wilson JK, Reynolds JM, Jodka CM, Lu MGW, Parkes DG. Glucoregulatory effects and prolonged duration of action of davalintide: a novel amylinomimetic peptide. Diabetes Obes Metab 2011; 13:1105-13. [PMID: 21733060 DOI: 10.1111/j.1463-1326.2011.01465.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [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: 11/28/2022]
Abstract
AIMS Davalintide is a second-generation amylinomimetic peptide possessing enhanced pharmacological properties over rat amylin to reduce food intake in preclinical models. The current experiments in rats describe additional glucoregulatory actions of davalintide consistent with amylin agonism, and explore the duration of action of these effects. METHODS Subcutaneous (SC) injection of davalintide slowed gastric emptying with equal potency to amylin (ED₅₀'s = 2.3 and 4.1 µg/kg). This effect was maintained for 8 h with davalintide, but not amylin. Intraperitoneal injection of davalintide also reduced food intake with a potency similar to amylin (ED₅₀'s = 5.0 and 11.3 µg/kg). Consistent with amylin agonism, davalintide (10 µg/kg, SC) suppressed the plasma glucagon response over 90 min following an intravenous arginine bolus in anaesthetized rats. The elimination t(½) of davalintide (200 µg/kg, SC) was 26 min, similar to the t(½) of amylin, suggesting that pharmacokinetic-independent mechanisms contribute to davalintide's enhanced duration of action. Binding kinetic studies using ¹²⁵I davalintide revealed no appreciable dissociation from the amylin nucleus accumbens receptor after 7 h while ¹²⁵I rat amylin did dissociate from this receptor (K(off) = 0.013/min). Sustained SC infusion of davalintide (275 µg/kg/day) or amylin (300) decreased plasma glucose after an oral glucose challenge at 2 weeks (by 27 and 31%) and suppressed gastric emptying at 3 weeks (by 29 and 47%), demonstrating durable glucoregulatory actions of both peptides. CONCLUSIONS These data show glucoregulatory properties of davalintide consistent with amylin agonism and suggest that slowed receptor dissociation plays a role in davalintide's prolonged pharmacodynamic actions.
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Affiliation(s)
- C M Mack
- Amylin Pharmaceuticals, Inc., San Diego, CA, USA
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Diamond JM, Lederer DJ, Kawut SM, Lee J, Ahya VN, Bellamy S, Palmer SM, Lama VN, Bhorade S, Crespo M, Demissie E, Sonett J, Wille K, Orens J, Shah PD, Weinacker A, Weill D, Kohl BA, Deutschman CC, Arcasoy S, Shah AS, Belperio JA, Wilkes D, Reynolds JM, Ware LB, Christie JD. Elevated plasma long pentraxin-3 levels and primary graft dysfunction after lung transplantation for idiopathic pulmonary fibrosis. Am J Transplant 2011; 11:2517-22. [PMID: 21883907 PMCID: PMC3206646 DOI: 10.1111/j.1600-6143.2011.03702.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [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: 01/25/2023]
Abstract
Primary graft dysfunction (PGD) after lung transplantation may result from ischemia reperfusion injury (IRI). The innate immune response to IRI may be mediated by Toll-like receptor and IL-1-induced long pentraxin-3 (PTX3) release. We hypothesized that elevated PTX3 levels were associated with PGD. We performed a nested case control study of lung transplant recipients with idiopathic pulmonary fibrosis (IPF) or chronic obstructive pulmonary disease (COPD) from the Lung Transplant Outcomes Group cohort. PTX3 levels were measured pretransplant, and 6 and 24 h postreperfusion. Cases were subjects with grade 3 PGD within 72 h of transplantation and controls were those without grade 3 PGD. Generalized estimating equations and multivariable logistic regression were used for analysis. We selected 40 PGD cases and 79 non-PGD controls. Plasma PTX3 level was associated with PGD in IPF but not COPD recipients (p for interaction < 0.03). Among patients with IPF, PTX3 levels at 6 and 24 h were associated with PGD (OR = 1.6, p = 0.02 at 6 h; OR = 1.4, p = 0.008 at 24 h). Elevated PTX3 levels were associated with the development of PGD after lung transplantation in IPF patients. Future studies evaluating the role of innate immune activation in IPF and PGD are warranted.
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Affiliation(s)
- Joshua M. Diamond
- Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - David J. Lederer
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Steven M. Kawut
- Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania School of Medicine, Philadelphia, PA,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA,Penn Cardiovascular Institute, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - James Lee
- Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Vivek N. Ahya
- Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Scarlett Bellamy
- Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Scott M. Palmer
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Raleigh-Durham, North Carolina
| | - Vibha N. Lama
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
| | - Sangeeta Bhorade
- Division of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois
| | - Maria Crespo
- Division of Pulmonary, Allergy, and Critical Care, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ejigayehu Demissie
- Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania School of Medicine, Philadelphia, PA,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Joshua Sonett
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - Keith Wille
- Division of Pulmonary and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jonathan Orens
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Johns Hopkins University Hospital, Baltimore, Maryland
| | - Pali D. Shah
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ann Weinacker
- Division of Pulmonary and Critical Care Medicine, Stanford University, Palo Alto, California
| | - David Weill
- Division of Pulmonary and Critical Care Medicine, Stanford University, Palo Alto, California
| | - Benjamin A. Kohl
- Department of Anesthesia and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Clifford C. Deutschman
- Department of Anesthesia and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Selim Arcasoy
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Ashish S. Shah
- Department of Surgery, Johns Hopkins University Hospital, Baltimore, Maryland
| | - John A. Belperio
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - David Wilkes
- Division of Pulmonary, Allergy, Critical Care, and Occupational Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - John M. Reynolds
- Division of Pulmonary, Allergy, Critical Care, and Occupational Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Lorraine B. Ware
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jason D. Christie
- Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania School of Medicine, Philadelphia, PA,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA
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Fridell JA, Wozniak TC, Reynolds JM, Powelson JA, Hollinger EF, Duncan MW, Sannuti A, Milgrom ML. Bilateral sequential lung and simultaneous pancreas transplant: A new approach for the recipient with cystic fibrosis. J Cyst Fibros 2008; 7:280-284. [DOI: 10.1016/j.jcf.2007.10.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2007] [Revised: 10/19/2007] [Accepted: 10/24/2007] [Indexed: 11/25/2022]
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Kaye JJ, Reynolds JM. Carpal tunnel syndrome: using self-report measures of disease to predict treatment response. Am J Orthop (Belle Mead NJ) 2007; 36:E59-62. [PMID: 17703268] [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] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Initial self-report assessments of symptom severity in patients with carpal tunnel syndrome was retrospectively examined. At initial evaluation, 86 patients completed a self-administered questionnaire previously shown to be reproducible, internally consistent, and responsive to clinical change. Within the next 2 years, 50 patients underwent carpal tunnel release; of the other 36 patients, 23 were managed adequately with conservative treatment alone, and 13 were lost to follow-up. Initial mean symptom severity scores were statistically significantly higher for the surgery group (P = .000012). Significantly higher symptom severity scores on self-administered questionnaires at initial evaluation from patients who eventually undergo carpal tunnel release may be of value in planning treatment.
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Hage CA, Reynolds JM, Durkin M, Wheat LJ, Knox KS. Plasmalyte as a cause of false-positive results for Aspergillus galactomannan in bronchoalveolar lavage fluid. J Clin Microbiol 2006; 45:676-7. [PMID: 17166959 PMCID: PMC1829015 DOI: 10.1128/jcm.01940-06] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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50
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Tucker SP, Reynolds JM, Wickman DC, Hines CJ, Perkins JB. Development of sampling and analytical methods for concerted determination of commonly used chloroacetanilide, chlorotriazine, and 2,4-D herbicides in hand-wash, dermal-patch, and air samples. Appl Occup Environ Hyg 2001; 16:698-707. [PMID: 11414520 DOI: 10.1080/10473220116794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Sampling and analytical methods were developed for commonly used chloroacetanilide, chlorotriazine, and 2,4-D herbicides in hand washes, on dermal patches, and in air. Eight herbicides selected for study were alachlor, atrazine, cyanazine, 2,4-dichlorophenoxyacetic acid (2,4-D), metolachlor, simazine, and two esters of 2,4-D, the 2-butoxyethyl ester (2,4-D, BE) and the 2-ethylhexyl ester (2,4-D, EH). The hand-wash method consisted of shaking the worker's hand in 150 mL of isopropanol in a polyethylene bag for 30 seconds. The dermal-patch method entailed attaching a 10-cm x 10-cm x 0.6-cm polyurethane foam (PUF) patch to the worker for exposure; recovery of the herbicides was achieved by extraction with 40 mL of isopropanol. The air method involved sampling with an OVS-2 tube (which contained an 11-mm quartz fiber filter and two beds of XAD-2 resin) and recovery with 2 mL of 10:90 methanol:methyl t-butyl ether. Analysis of each of the three sample types was performed by gas chromatography with an electron-capture detector. Diazomethane in solution was employed to convert 2,4-D as the free acid to the methyl ester in each of the three methods for ease of gas chromatography. Silicic acid was added to sample solutions to quench excess diazomethane. Limits of detection for all eight herbicides were matrix-dependent and, generally, less than 1 microgram per sample for each matrix. Sampling and analytical methods met NIOSH evaluation criteria for all herbicides in hand-wash samples, for seven herbicides in air samples (all herbicides except cyanazine), and for six herbicides in dermal-patch samples (all herbicides except cyanazine and 2,4-D). Speciation of 2,4-D esters and simultaneous determination of 2,4-D acid were possible without losses of the esters or of other herbicides (acetanilides and triazines) being determined.
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Affiliation(s)
- S P Tucker
- National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
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