1
|
Shuptrine CW, Chen Y, Miriyala J, Lenz K, Moffett D, Nguyen TA, Michaux J, Campbell K, Smith C, Morra M, Rivera-Molina Y, Murr N, Cooper S, McGuire A, Makani V, Oien N, Zugates JT, de Silva S, Schreiber TH, de Picciotto S, Fromm G. Lipid-encapsulated mRNAs encoding complex fusion proteins potentiate anti-tumor immune responses. Cancer Res 2024:734797. [PMID: 38381555 DOI: 10.1158/0008-5472.can-23-2875] [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: 09/25/2023] [Revised: 12/22/2023] [Accepted: 02/14/2024] [Indexed: 02/23/2024]
Abstract
Lipid nanoparticle (LNP)-encapsulated mRNA has been used for in vivo production of several secreted protein classes, such as IgG, and has enabled the development of personalized vaccines in oncology. Establishing the feasibility of delivering complex multi-specific modalities that require higher-order structures important for their function could help expand the use of mRNA/LNP biologic formulations. Here, we evaluated whether in vivo administration of mRNA/LNP formulations of SIRPα-Fc-CD40L and TIGIT-Fc-LIGHT could achieve oligomerization and extend exposure, on-target activity, and anti-tumor responses comparable to that of the corresponding recombinant fusion proteins. Intravenous infusion of the formulated LNP-encapsulated mRNAs led to rapid and sustained production of functional hexameric proteins in vivo, which increased the overall exposure relative to the recombinant protein controls by ~28-140 fold over 96 hours. High concentrations of the mRNA-encoded proteins were also observed in secondary lymphoid organs and within implanted tumors, with protein concentrations in tumors up to 134-fold greater than with the recombinant protein controls 24 hours after treatment. In addition, SIRPα-Fc-CD40L and TIGIT-Fc-LIGHT mRNAs induced a greater increase in antigen-specific CD8+ T cells in the tumors. These mRNA/LNP formulations were well tolerated and led to a rapid increase in serum and intratumoral IL-2, delayed tumor growth, extended survival, and outperformed the activities of benchmark monoclonal antibody controls. Furthermore, the mRNA/LNPs demonstrated improved efficacy in combination with anti-PD-L1 relative to the recombinant fusion proteins. These data support the delivery of complex oligomeric biologics as mRNA/LNP formulations, where high therapeutic expression and exposure could translate into improved patient outcomes.
Collapse
|
2
|
Lai AY, Gonzalez LE, Murr N, Lenz K, Franklin D, Campbell K, Brewer F, Patel A, Evans K, Hussein M, Wilson K, Fromm G, Schreiber TH, de Silva S. Abstract 1815: Rapid serial killing of target cells by Vγ9Vδ2 T Cells in cynomolgus macaques and humanized mice treated with a CD20-directed heterodimeric butyrophilin 2A1/3A1 fusion protein. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-1815] [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: 04/07/2023]
Abstract
Abstract
CD3-directed T cell engagers provide clinical benefit in a variety of hematologic cancers, but it remains unclear whether γδ T cells (GDT) are present at sufficient numbers to be similarly harnessed because they represent only 1-5% of the total T cell pool. The Vγ9Vδ2 T cell receptor is activated by a butyrophilin 2A1 and 3A1 (2A1/3A1) heterodimer as “signal 1”, together with costimulatory signaling through CD28 or NKG2D as “signal 2”. Here we evaluated the ability of a GDT engager (GADLEN) comprising the extracellular domains of 2A1/3A1 adjoined via an Fc to an antibody fragment targeting the CD20 antigen, to mediate target-cell depletion in vivo at physiologically relevant frequencies of GDT. A humanized mouse model was developed wherein human peripheral blood mononuclear cells (PBMC) were engrafted to NSG-IL15 mice and a high degree of human chimerism persisted for over 3 weeks, including a circulating pool of human GDT comprising 0.5 to 3% of total T cells. Across different human donors, the GDT effector to target B cell ratio varied from 1:1 to 1:46. Following treatment with a B cell-targeted GADLEN, rapid and dose-dependent depletion of over 95% of human B cells was achieved in the peripheral blood and spleen, even at E:T ratios of 1:46. Based on these data, a repeat-dose toxicology study was conducted in cynomolgus macaques across a dose range of 0.1 to 25 mg/kg with the CD20-targeted GADLEN. This study also demonstrated dose-dependent B cell depletion within 2 hours of infusion. Durable receptor occupancy was observed on CD20+ cells for over 7 days, whereas transient occupancy was observed on circulating cynomolgus Vγ9Vδ2 T cells. GDT represented approximately 1-3% of total T cells in cynomolgus macaques, and E:T ratios ranged from 1:7 to 1:49. All treatments were well tolerated, and no evidence of cytokine release syndrome nor any other toxicities were observed. Interestingly, in both humanized mice and non-human primates, the proliferation of GDT was not required to achieve B cell depletion. In fact, over several weeks, the circulating frequencies of cynomolgus Vγ9Vδ2 T cells remained stable, and no evidence of either proliferation or migration out of the blood was observed. These observations, together with the speed at which B cell depletion occurred, suggest that the Vγ9Vδ2 T cells eliminated the B cell pool by serial killing following treatment with the GADLEN. Despite a GDT frequency of less than 5% of total T cells in all these studies, Vγ9Vδ2 T cells achieved rapid depletion of target cells following treatment with the GADLEN, without evidence of toxicity, even at high doses. Collectively, these results indicate that low frequencies of GDT can be harnessed to achieve similar target-cell killing potential as the broader CD3+ T cell pool but with potentially less toxicity.
Citation Format: Anne Y. Lai, Louis E. Gonzalez, Noah Murr, Karen Lenz, Derek Franklin, Kristen Campbell, Faraha Brewer, Arpita Patel, Kinsley Evans, Mahmud Hussein, Keith Wilson, George Fromm, Taylor H. Schreiber, Suresh de Silva. Rapid serial killing of target cells by Vγ9Vδ2 T Cells in cynomolgus macaques and humanized mice treated with a CD20-directed heterodimeric butyrophilin 2A1/3A1 fusion protein [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1815.
Collapse
|
3
|
Kyriakopoulos C, Taleb I, Wever-Pinzon O, Selzman C, Bonios M, Dranow E, Wever-Pinzon J, Yin M, Tseliou E, Stehlik J, Alharethi R, Kfoury A, Hanff T, Fang J, Koliopoulou A, Sideris K, Krauspe E, Nelson M, Elmer A, Singh R, Psotka M, Birks E, Slaughter M, Koenig S, Kyvernitakis A, Hoffman K, Guglin M, Kotter J, Campbell K, Silvestry S, Vidic A, Raval N, Mehra M, Cowger J, Kanwar M, Shah P, Drakos S. Multicenter Development and Validation of a Machine Learning Model to Predict Myocardial Recovery During LVAD Support: The UCAR Score. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1519] [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: 04/05/2023] Open
|
4
|
Carlson JM, Tannis A, Woodworth KR, Reynolds MR, Shinde N, Anderson B, Hobeheidar K, Praag A, Campbell K, Carpentieri C, Willabus T, Burkhardt E, Torrone E, O’Callaghan KP, Miele K, Meaney-Delman D, Gilboa SM, Olsen EO, Tong VT. Substance Use Among Persons with Syphilis During Pregnancy - Arizona and Georgia, 2018-2021. MMWR Morb Mortal Wkly Rep 2023; 72:63-67. [PMID: 36656787 PMCID: PMC9869742 DOI: 10.15585/mmwr.mm7203a3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Despite universal prenatal syphilis screening recommendations and availability of effective antibiotic treatment, syphilis prevalence during pregnancy and the incidence of congenital syphilis have continued to increase in the United States (1,2). Concurrent increases in methamphetamine, injection drug, and heroin use have been described in women with syphilis (3). CDC used data on births that occurred during January 1, 2018-December 31, 2021, from two states (Arizona and Georgia) that participate in the Surveillance for Emerging Threats to Pregnant People and Infants Network (SET-NET) to describe the prevalence of substance use among pregnant persons with syphilis by congenital syphilis pregnancy outcome (defined as delivery of a stillborn or live-born infant meeting the surveillance case definition for probable or confirmed congenital syphilis). The prevalence of substance use (e.g., tobacco, alcohol, cannabis, illicit use of opioids, and other illicit, nonprescription substances) in persons with a congenital syphilis pregnancy outcome (48.1%) was nearly double that among those with a noncongenital syphilis pregnancy outcome (24.6%). Persons with a congenital syphilis pregnancy outcome were six times as likely to report illicit use of opioids and four times as likely to report using other illicit, nonprescription substances during pregnancy than were persons with a noncongenital syphilis pregnancy outcome. Approximately one half of persons who used substances during pregnancy and had a congenital syphilis pregnancy outcome had late or no prenatal care. Tailored interventions should address barriers and facilitators to accessing screening and treatment for syphilis among persons who use substances. The need for syphilis screening and treatment should be addressed at any health care encounter during pregnancy, especially among persons who use substances.
Collapse
|
5
|
Porteous M, Lanthier M, Tavakoli P, Boafo A, Campbell K, De Koninck J, Robillard R. Correlations between sleep architecture and emotional inhibition processing during a suicidal crisis: Preliminary findings in hospitalized adolescents. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.574] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
6
|
Harris RA, Campbell K, Calderbank T, Dooley P, Aspero H, Maginnis J, O’Donnell N, Coviello D, French R, Bao Y, Mandell DS, Bogner HR, Lowenstein M. Integrating peer support services into primary care-based OUD treatment: Lessons from the Penn integrated model. Healthc (Amst) 2022; 10:100641. [PMID: 35785613 PMCID: PMC9933784 DOI: 10.1016/j.hjdsi.2022.100641] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 11/04/2022]
Abstract
Opioid use disorder (OUD) is a major public health emergency in the United States. In 2020, 2.7 million individuals had an OUD. Medication for opioid use disorder is the evidence-based, standard of care for treating OUD in outpatient settings, especially buprenorphine because it is effective and has low toxicity. Buprenorphine is increasingly prescribed in primary care, a setting that provides greater anonymity and convenience than substance use disorder treatment centers. Yet two-thirds of people who begin buprenorphine treatment discontinue within the first six months. Treatment dropout elevates the risks of return to use, infections, higher levels of medical care and related costs, justice system involvement, and death. One promising form of retention support is peer service programs. Peers combine their lived experience of substance use and recovery with formal training to help patients engage and persist in OUD treatment. They provide a range of services, including health education, encouragement and empathy, coping skills, recovery modeling, and concrete assistance in overcoming the situational barriers to retention. However, guidance is needed to define the peer role in primary care, the specific tasks peers should perform, the competencies those tasks require, training and professional development needs, and peer performance standards. Guidance also is needed to integrate peers into the care team, allocate and coordinate responsibilities among care team members, manage peer operations and workflow, and facilitate effective team communication. Here we describe a peer support program in the University of Pennsylvania Health System (UPHS or Penn Medicine) network of primary care practices. This paper details the program's core components, values, and activities. We also report the organizational challenges, unresolved questions, and lessons for the field in administering a peer support program to meet the needs of patients served by a large, urban medical system with an extensive suburban and rural catchment area. CLINICAL TRIALS REGISTRATION: www.clinicaltrials.gov registration: NCT04245423.
Collapse
Affiliation(s)
- Rebecca Arden Harris
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, 19104, USA.
| | - Kristen Campbell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Tara Calderbank
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Patrick Dooley
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Heather Aspero
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Jessica Maginnis
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Nicole O’Donnell
- Center for Addiction Medicine and Policy, University of Pennsylvania, Philadelphia, PA, USA
| | - Donna Coviello
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Rachel French
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, 19104, USA,School of Nursing, University of Pennsylvania, Philadelphia, PA, 19104, USA,National Clinician Scholars Program, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Yuhua Bao
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, 10065, USA
| | - David S. Mandell
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, 19104, USA,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Hillary R. Bogner
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Margaret Lowenstein
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, 19104, USA,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| |
Collapse
|
7
|
Campbell K, Afseth J, Dunham M. CN32 Cancer nurses' experiences and perceptions of potential occupational exposure to cytotoxic drugs: Systematic review utilising framework analysis. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
8
|
Kirkpatrick S, Campbell K. CN59 A scoping review to establish the utility of patient reported outcome measures in blood cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
9
|
Kimble M, Allers S, Campbell K, Chen C, Jackson LM, King BL, Silverbrand S, York G, Beard K. medna-metadata: an open-source data management system for tracking environmental DNA samples and metadata. Bioinformatics 2022; 38:4589-4597. [PMID: 35960154 PMCID: PMC9524998 DOI: 10.1093/bioinformatics/btac556] [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: 05/09/2022] [Revised: 07/23/2022] [Accepted: 08/09/2022] [Indexed: 12/24/2022] Open
Abstract
MOTIVATION Environmental DNA (eDNA), as a rapidly expanding research field, stands to benefit from shared resources including sampling protocols, study designs, discovered sequences, and taxonomic assignments to sequences. High-quality community shareable eDNA resources rely heavily on comprehensive metadata documentation that captures the complex workflows covering field sampling, molecular biology lab work, and bioinformatic analyses. There are limited sources that provide documentation of database development on comprehensive metadata for eDNA and these workflows and no open-source software. RESULTS We present medna-metadata, an open-source, modular system that aligns with Findable, Accessible, Interoperable, and Reusable guiding principles that support scholarly data reuse and the database and application development of a standardized metadata collection structure that encapsulates critical aspects of field data collection, wet lab processing, and bioinformatic analysis. Medna-metadata is showcased with metabarcoding data from the Gulf of Maine (Polinski et al., 2019). AVAILABILITY AND IMPLEMENTATION The source code of the medna-metadata web application is hosted on GitHub (https://github.com/Maine-eDNA/medna-metadata). Medna-metadata is a docker-compose installable package. Documentation can be found at https://medna-metadata.readthedocs.io/en/latest/?badge=latest. The application is implemented in Python, PostgreSQL and PostGIS, RabbitMQ, and NGINX, with all major browsers supported. A demo can be found at https://demo.metadata.maine-edna.org/. SUPPLEMENTARY INFORMATION Supplementary data are available at Bioinformatics online.
Collapse
Affiliation(s)
- M Kimble
- To whom correspondence should be addressed.
| | - S Allers
- Department of Molecular and Biomedical Sciences, University of Maine, Orono, ME 04469, USA
| | - K Campbell
- School of Computing and Information Science, University of Maine, Orono, ME 04469, USA
| | - C Chen
- School of Computing and Information Science, University of Maine, Orono, ME 04469, USA
| | - L M Jackson
- Advanced Research Computing, Security and Information Management, University of Maine, Orono, ME 04469, USA,Maine EPSCoR, University of Maine, Orono, ME 04469, USA
| | - B L King
- Department of Molecular and Biomedical Sciences, University of Maine, Orono, ME 04469, USA
| | - S Silverbrand
- School of Marine Sciences, University of Maine, Orono, ME 04469, USA
| | - G York
- Environmental DNA Laboratory, Coordinated Operating Research Entities, University of Maine, Orono, ME 04469, USA
| | - K Beard
- School of Computing and Information Science, University of Maine, Orono, ME 04469, USA
| |
Collapse
|
10
|
Yoo KJ, Johannes K, González LE, Patel A, Shuptrine CW, Opheim Z, Lenz K, Campbell K, Nguyen TA, Miriyala J, Smith C, McGuire A, Tsai YH, Rangwala F, de Silva S, Schreiber TH, Fromm G. LIGHT (TNFSF14) Costimulation Enhances Myeloid Cell Activation and Antitumor Immunity in the Setting of PD-1/PD-L1 and TIGIT Checkpoint Blockade. J Immunol 2022; 209:510-525. [PMID: 35817517 PMCID: PMC10580117 DOI: 10.4049/jimmunol.2101175] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/20/2022] [Indexed: 06/15/2023]
Abstract
Coinhibition of TIGIT (T cell immunoreceptor with Ig and ITIM domains) and PD-1/PD-L1 (PD-1/L1) may improve response rates compared with monotherapy PD-1/L1 blockade in checkpoint naive non-small cell lung cancer with PD-L1 expression >50%. TIGIT mAbs with an effector-competent Fc can induce myeloid cell activation, and some have demonstrated effector T cell depletion, which carries a clinical liability of unknown significance. TIGIT Ab blockade translates to antitumor activity by enabling PVR signaling through CD226 (DNAM-1), which can be directly inhibited by PD-1. Furthermore, DNAM-1 is downregulated on tumor-infiltrating lymphocytes (TILs) in advanced and checkpoint inhibition-resistant cancers. Therefore, broadening clinical responses from TIGIT blockade into PD-L1low or checkpoint inhibition-resistant tumors, may be induced by immune costimulation that operates independently from PD-1/L1 inhibition. TNFSF14 (LIGHT) was identified through genomic screens, in vitro functional analysis, and immune profiling of TILs as a TNF ligand that could provide broad immune activation. Accordingly, murine and human bifunctional fusion proteins were engineered linking the extracellular domain of TIGIT to the extracellular domain of LIGHT, yielding TIGIT-Fc-LIGHT. TIGIT competitively inhibited binding to all PVR ligands. LIGHT directly activated myeloid cells through interactions with LTβR (lymphotoxin β receptor), without the requirement for a competent Fc domain to engage Fcγ receptors. LIGHT costimulated CD8+ T and NK cells through HVEM (herpes virus entry mediator A). Importantly, HVEM was more widely expressed than DNAM-1 on T memory stem cells and TILs across a range of tumor types. Taken together, the mechanisms of TIGIT-Fc-LIGHT promoted strong antitumor activity in preclinical tumor models of primary and acquired resistance to PD-1 blockade, suggesting that immune costimulation mediated by LIGHT may broaden the clinical utility of TIGIT blockade.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Yi-Hsuan Tsai
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | | | | | | | | |
Collapse
|
11
|
Friedman NR, Meier M, Tholen K, Crowder R, Hoefner-Notz R, Nguyen T, Derieg S, Campbell K, McLeod L. Tonsillectomy for Obstructive Sleep-Disordered Breathing: Should They Stay, or Could They Go? Laryngoscope 2022; 132:1675-1681. [PMID: 34672364 DOI: 10.1002/lary.29909] [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: 06/11/2021] [Revised: 10/05/2021] [Accepted: 10/12/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Children who do not require oxygen beyond 3 hours after surgery and pass a sleep room air challenge (SRAC) are safe for discharge regardless of polysomnogram (PSG) results or comorbidities. STUDY DESIGN Cross-sectional prospective study. METHODS All children observed overnight undergoing an adenotonsillectomy for obstructive sleep-disordered breathing were prospectively recruited. Demographic, clinical, and PSG characteristics were stratified by whether the patient had required oxygen beyond 3 hours postoperatively (prolonged oxygen requirement [POR]) and compared using t test, chi-squared test, or Fisher's exact test depending on distribution. Optimal cut points for predicting POR postsurgery were calculated using receiver operating characteristic curves. The primary analysis was performed on the full cohort via logistic regression using POR as the outcome. Significant characteristics were analyzed in a logistic regression model, with significance set at P < .05. RESULTS A total of 484 participants met the inclusion criteria. The mean age was 5.65 (standard deviation = 4.02) years. Overall, 365 (75%) did not have a POR or any other adverse respiratory event. In multivariable logistic regression, risk factors for POR were an asthma diagnosis (P < .001) and an awake SpO2 <96% (P = .005). The probability of a POR for those without asthma and a SpO2 ≥ 96% was 18% (95% confidence interval: 14-22). Age, obesity, and obstructive apnea/hypopnea index were not associated with POR. CONCLUSIONS In conclusion, all children in our study who are off oxygen within 3 hours of surgery and passed a SRAC were safe for discharge from a respiratory standpoint regardless of age, obesity status, asthma diagnosis, and obstructive apnea/hypopnea index. Additional investigations are necessary to confirm our findings. LEVEL OF EVIDENCE 3 Laryngoscope, 132:1675-1681, 2022.
Collapse
Affiliation(s)
- Norman R Friedman
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
- Division of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, Colorado, U.S.A
| | - Maxene Meier
- The Center for Research in Outcomes for Children's Surgery, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Kaitlyn Tholen
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
- Division of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, Colorado, U.S.A
| | - Renee Crowder
- University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Regina Hoefner-Notz
- Perioperative Services, Children's Hospital Colorado, Aurora, Colorado, U.S.A
| | - Thanh Nguyen
- Division of Pediatric Anesthesia, Children's Hospital Colorado, Aurora, Colorado, U.S.A
- Department of Anesthesiology, School of Medicine, University of Colorado, Aurora, Colorado, U.S.A
| | - Sarah Derieg
- Ambulatory Services, Children's Hospital Colorado, Aurora, Colorado, U.S.A
| | - Kristen Campbell
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Lisa McLeod
- Pediatric Center of Excellence, Global Product Development, Pfizer, Inc., New York, New York, U.S.A
| |
Collapse
|
12
|
Loring Z, Holmqvist F, Sze E, Alenezi F, Campbell K, Koontz JI, Velazquez EJ, Atwater BD, Bahnson TD, Daubert JP. Acute echocardiographic and hemodynamic response to his-bundle pacing in patients with first-degree atrioventricular block. Ann Noninvasive Electrocardiol 2022; 27:e12954. [PMID: 35445488 PMCID: PMC9296787 DOI: 10.1111/anec.12954] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/02/2022] [Accepted: 03/14/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Atrial pacing and right ventricular (RV) pacing are both associated with adverse outcomes among patients with first-degree atrioventricular block (1°AVB). His-bundle pacing (HBP) provides physiological activation of the ventricle and may be able to improve both atrioventricular (AV) and inter-ventricular synchrony in 1°AVB patients. This study evaluates the acute echocardiographic and hemodynamic effects of atrial, atrial-His-bundle sequential (AH), and atrial-ventricular (AV) sequential pacing in 1°AVB patients. METHODS Patients with 1°AVB undergoing atrial fibrillation ablation were included. Following left atrial (LA) catheterization, patients underwent atrial, AH- and AV-sequential pacing. LA/left ventricular (LV) pressure and echocardiographic measurements during the pacing protocols were compared. RESULTS Thirteen patients with 1°AVB (mean PR 221 ± 26 ms) were included. The PR interval was prolonged with atrial pacing compared to baseline (275 ± 73 ms, p = .005). LV ejection fraction (LVEF) was highest during atrial pacing (62 ± 11%), intermediate with AH-sequential pacing (59 ± 7%), and lowest with AV-sequential pacing (57 ± 12%) though these differences were not statistically significant. No significant differences were found in LA or LV mean pressures or LV dP/dT. LA and LV volumes, isovolumetric times, electromechanical delays, and global longitudinal strains were similar across pacing protocols. CONCLUSION Despite pronounced PR prolongation, the acute effects of atrial pacing were not significantly different than AH- or AV-sequential pacing. Normalizing atrioventricular and/or inter-ventricular dyssynchrony did not result in acute improvements in cardiac output or loading conditions.
Collapse
Affiliation(s)
- Zak Loring
- Division of CardiologyDepartment of MedicineDuke UniversityDurhamNorth CarolinaUSA
- Duke Clinical Research InstituteDurhamNorth CarolinaUSA
| | - Fredrik Holmqvist
- Division of CardiologyDepartment of MedicineDuke UniversityDurhamNorth CarolinaUSA
- Department of CardiologyLund UniversityLundSweden
| | - Edward Sze
- Division of CardiologyDepartment of MedicineDuke UniversityDurhamNorth CarolinaUSA
- Maine Medical CenterPortlandMaineUSA
| | - Fawaz Alenezi
- Division of CardiologyDepartment of MedicineDuke UniversityDurhamNorth CarolinaUSA
| | - Kristen Campbell
- Maine Medical CenterPortlandMaineUSA
- Department of PharmacyDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Jason I. Koontz
- Division of CardiologyDepartment of MedicineDuke UniversityDurhamNorth CarolinaUSA
| | - Eric J. Velazquez
- Division of CardiologyDepartment of MedicineDuke UniversityDurhamNorth CarolinaUSA
- Section of Cardiovascular MedicineDepartment of Internal MedicineYale UniversityNew HavenConnecticutUSA
| | - Brett D. Atwater
- Division of CardiologyDepartment of MedicineDuke UniversityDurhamNorth CarolinaUSA
- Section of Cardiac ElectrophysiologyInova Heart and Vascular InstituteFairfaxVirginiaUSA
| | - Tristram D. Bahnson
- Division of CardiologyDepartment of MedicineDuke UniversityDurhamNorth CarolinaUSA
| | - James P. Daubert
- Division of CardiologyDepartment of MedicineDuke UniversityDurhamNorth CarolinaUSA
| |
Collapse
|
13
|
Yoo KJ, Gonzalez L, Johannes K, Miriyala J, Lenz K, Campbell K, de Silva S, Schreiber TH, Fromm GJ. Abstract 4214: LIGHT (TNFSF14) costimulation with TIGIT blockade broadens the activity of checkpoint inhibitors (CPIs) into CPI refractory and resistant tumors through targeted myeloid cell and effector lymphocyte activation. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-4214] [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
Although increased TIGIT expression on TILs is associated with poor survival in patients with cancer, monotherapy TIGIT antibody blockade has not yet demonstrated significant clinical activity. PD-1 is commonly co-expressed on TILs, and PD-1 mediated SHP-2 signaling inhibits DNAM-1 (CD226), preventing PVR co-stimulation in the setting of TIGIT blockade. The interaction between PD-1 and CD226 explains why TIGIT blockade only translates to clinical benefit in the setting of co-blockade of PD-1/L1, however does not explain why co-blockade of TIGIT and PD-1/L1 does not provide benefit in advanced and PD-1/L1 resistant tumors. In advanced and PD-1/L1 resistant tumors, progressive downregulation of CD226 has been reported. Thus, we hypothesized that the lack of CD226 may underlie the lack of clinical responses to combined TIGIT/PD-1/L1 blockade in PD-1/L1 experienced tumors and we sought to identify alternative costimulatory receptors with high-expression. Analysis of TCGA, as well as single-cell RNASeq from TILs, identified HVEM and LTβR as two costimulatory receptors with higher expression in advanced cancers as compared to CD226. HVEM and LTβR directly activate CD8+ T, natural killer (NK), and myeloid cells when bound by their TNF superfamily ligand, known as LIGHT. LIGHT potentiates effector lymphocyte function through signaling that obviates the co-stimulatory role of DNAM-1. We demonstrated that when the extracellular domain (ECD) of LIGHT is combined with the ECD of TIGIT on a TIGIT-Fc-LIGHT bi-functional fusion protein, the simultaneous blockade of PVR, PVRL2, PVRL3, and Nectin-4 and immune co-stimulation by LIGHT increased CD8+ T and NK infiltration into tumors. This translated into tumor cell killing, regression of established tumors, and improved survival in preclinical models of checkpoint primary and acquired resistance. The translation of TIGIT-Fc-LIGHT activity was evaluated in cynomolgus macaques and was well tolerated at doses up to 40 mg/kg. A series of adaptive immune and proinflammatory cytokines, including IL-2, CCL2, CCL4, IL-10, CXCL10, and CCL17, were induced within two hours of TIGIT-Fc-LIGHT infusion. Additionally, receptor engagement led to the rapid margination of HVEM+CD8+ T cells from the periphery into secondary immune tissues. This network of cytokines and post-dose immune cell margination identified in the monkey, was identical to findings in murine models that ultimately translated into significant anti-tumor responses. Lastly, the combination of TIGIT-Fc-LIGHT with anti-PD(L)1 broadened anti-tumor activity of the checkpoint antibodies in aggressive CPI-resistant tumors. These results suggest that LIGHT could be the differentiator that extends the clinical activity of conventional CPIs into PD-L1 low or CPI acquired resistance tumors.
Citation Format: Kyung Jin Yoo, Louis Gonzalez, Kellsey Johannes, Jayalakshmi Miriyala, Karen Lenz, Kristen Campbell, Suresh de Silva, Taylor H. Schreiber, George J. Fromm. LIGHT (TNFSF14) costimulation with TIGIT blockade broadens the activity of checkpoint inhibitors (CPIs) into CPI refractory and resistant tumors through targeted myeloid cell and effector lymphocyte activation [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 4214.
Collapse
|
14
|
Milgrom S, Koo J, Foreman N, Liu A, Campbell K, Dorris K, Green A, Dahl N, Donson A, Vibhakar R, Mulcahy-Levy J. RONC-05. Peri-transplant Radiation Therapy for Young Children Treated with High-Dose Chemotherapy for Primary Brain Tumors. Neuro Oncol 2022. [PMCID: PMC9165012 DOI: 10.1093/neuonc/noac079.659] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
PURPOSE: The role of peri-transplant radiation therapy (RT) in young children with primary brain tumors is unclear. We characterized our institutional practice patterns and patient outcomes. MATERIALS AND METHODS: The cohort included all patients treated with high-dose chemotherapy for primary brain tumors at our institution from 2011-2017. Rates of local control (LC), progression-free survival (PFS), overall survival (OS), and radiation-associated injury were assessed. RESULTS: Of 37 eligible patients, 29 (78%) received peri-transplant RT at a median age of 4 years. Patients treated with RT were more likely to have metastatic (p=0.0121) and incompletely resected (p=0.056) disease, and to have high-risk histologies including atypical teratoid rhabdoid tumor, nongerminomatous germ cell tumor, pineoblastoma, primitive neuro-ectodermal tumor, glioneuronal tumor and group 3 medulloblastoma. Of those treated with RT, 13 (45%) received craniospinal irradiation (CSI) and 16 (55%) received focal RT. The median CSI dose was 23.4 Gy (IQR: 18-36; boost median 54 Gy [IQR: 53.7-55.8]) and focal RT dose was 50.4 Gy (IQR: 50.4-54.5). Compared to the focal RT group, patients treated with CSI were older (p=0.0499) and more likely to have metastatic disease (p=0.0004). For the complete cohort, at a median follow-up of 3.8 years, the 2-year rate of LC was 82% (95% CI: 70-96%), PFS was 63% (95% CI: 49-81%), and OS was 65% (95% CI: 51-82%). These rates did not differ significantly between patients treated with and without peri-transplant RT. Two cases of fatal myelopathy were observed after spinal cord doses within the highest tertile (41.4 CGE and 36 Gy); both cases occurred in patients who received RT before high-dose chemotherapy. CONCLUSION: Peri-transplant RT was used for high-risk disease. Oncologic outcomes after RT were encouraging. However, 2 cases of grade 5 myelopathy were observed. If used cautiously, RT may contribute to durable remission in patients at high risk of relapse.
Collapse
Affiliation(s)
- Sarah Milgrom
- University of Colorado School of Medicine , Aurora, CO , USA
| | - Jane Koo
- Cincinnati Children’s Hospital Medical Center , Cincinnati, OH , USA
| | | | - Arthur Liu
- University of Colorado Health, Fort Collins , CO , USA
| | | | - Kathleen Dorris
- University of Colorado School of Medicine , Aurora, CO , USA
| | - Adam Green
- University of Colorado School of Medicine , Aurora, CO , USA
| | - Nathan Dahl
- University of Colorado School of Medicine , Aurora, CO , USA
| | - Andrew Donson
- University of Colorado School of Medicine , Aurora, CO , USA
| | - Rajeev Vibhakar
- University of Colorado School of Medicine , Aurora, CO , USA
| | | |
Collapse
|
15
|
Zhang Y, Clarke A, Regan KH, Campbell K, Donaldson S, Crowe J, Rossi AG, Hill AT. Isolated IgG2 deficiency is an independent risk factor for exacerbations in bronchiectasis. QJM 2022; 115:292-297. [PMID: 33970283 PMCID: PMC9086763 DOI: 10.1093/qjmed/hcab129] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/26/2021] [Accepted: 05/06/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Immunoglobulin G (IgG) subclass 2 deficiency is the most frequent IgG subclass deficiency identified in patients with bronchiectasis, but its clinical significance is not known. AIM To analyse if bronchiectasis patients with isolated IgG2 deficiency at risk of recurrent exacerbations and/or hospitalization? Do patients with IgG2 deficiency have worse disease progression? DESIGN AND METHODS This is a retrospective study (2015-20) exploring independent risk factors for recurrent exacerbations (3 or more per year) and/or hospitalization with bronchiectasis exacerbations using multivariable models using binary logistic regression. There was no patient with IgG deficiency, IgG 1, 3 or 4 deficiency, or IgA or IgM deficiency included. In this model, the authors included: serum IgG2 level; lung function; body mass index; MRC breathlessness scale; age; sex; number of bronchiectatic lobes; bacterial colonization; comorbidities; and the use of long-term immunosuppressant drugs or antibiotics for more than 28 days. Analysing 2-year longitudinal data, one-way ANOVA and Mann-Whitney U-test were used to compare bronchiectasis severity between patients with different IgG2 levels. RESULTS Serum IgG2 levels (<2.68 g/l, 2.68-3.53 g/l and 3.54-4.45 g/l); hospital admission in the preceding 2 years; bacterial colonization with potentially pathogenic organisms and asthma were independent predictors for three or more bronchiectasis exacerbations. Those with low IgG2 levels (<2.68 g/l and 2.68-3.53 g/l), had worsening progression of their bronchiectasis, using the Bronchiectasis Severity Index, over 1 year compared with those who were IgG2 replete (>4.45 g/l) (P = 0.003, 0.013). CONCLUSION Reduced IgG2 levels were an independent predictor for bronchiectasis exacerbations and have increased disease progression.
Collapse
Affiliation(s)
- Y Zhang
- The Centre for Inflammation Research at the University of Edinburgh, Queen’s Medical Research Institute, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK
| | - A Clarke
- The Centre for Inflammation Research at the University of Edinburgh, Queen’s Medical Research Institute, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK
- Department of Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - K H Regan
- The Centre for Inflammation Research at the University of Edinburgh, Queen’s Medical Research Institute, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK
- Department of Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - K Campbell
- Department of Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - S Donaldson
- The Centre for Inflammation Research at the University of Edinburgh, Queen’s Medical Research Institute, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK
- Department of Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - J Crowe
- Department of Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - A G Rossi
- The Centre for Inflammation Research at the University of Edinburgh, Queen’s Medical Research Institute, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK
| | - A T Hill
- Address correspondence to Prof A.T. Hill, Department of Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK.
| |
Collapse
|
16
|
Stoner B, Cao X, Kolodziej A, Villegas-Galaviz J, Campbell K, Thompson M, Birks E, Vaidya G. Bedside Ultrasound of Internal Jugular Vein for Right Ventricular Function Assessment. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1119] [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: 12/01/2022] Open
|
17
|
Frankel DS, Dechert-Crooks BE, Campbell K, DeSimone CV, Etheridge S, Harvey M, Lampert R, Nayak HM, Saliba WI, Shea J, Thomas J, Zado E, Daubert JP. 2021 HRS Educational Framework for Clinical Cardiac Electrophysiology. Heart Rhythm O2 2022; 3:120-132. [PMID: 35496459 PMCID: PMC9043382 DOI: 10.1016/j.hroo.2022.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
|
18
|
Campbell K, Velazquez O, Sullivan J, Lipshultz L. Finasteride-Associated Suicide and Depression in Men Treated for Hypogonadism and Impotence. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
19
|
Campbell K, Velazquez O, Sullivan J, Lipshultz L. Is Testosterone Really Your Sex Hormone: Sexual practices as Defined by Testosterone Concentration. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.01.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
20
|
Milgrom SA, Koo J, Foreman N, Liu AK, Campbell K, Dorris K, Green AL, Dahl N, Donson AM, Vibhakar R, Levy JMM. Radiation Therapy for Young Children Treated with High-Dose Chemotherapy and Autologous Stem Cell Transplantation for Primary Brain Tumors. Adv Radiat Oncol 2022; 7:100945. [PMID: 35814855 PMCID: PMC9260126 DOI: 10.1016/j.adro.2022.100945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/09/2022] [Indexed: 10/25/2022] Open
|
21
|
Maddux AB, Campbell K, Woodruff AG, LaVelle J, Lutmer J, Kennedy CE, Malakooti M, McGuire JK, Shekerdemian L, Harris ZL, McCrory MC, Carpenter TC. The Impact of Strict Public Health Restrictions on Pediatric Critical Illness. Crit Care Med 2021; 49:2033-2041. [PMID: 34259665 PMCID: PMC8594504 DOI: 10.1097/ccm.0000000000005200] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
OBJECTIVES To characterize the impact of public health interventions on the volume and characteristics of admissions to the PICU. DESIGN Multicenter retrospective cohort study. SETTING Six U.S. referral PICUs during February 15, 2020-May 14, 2020, compared with the same months during 2017-2019 (baseline). PATIENTS PICU admissions excluding admissions for illnesses due to severe acute respiratory syndrome coronavirus 2 and readmissions during the same hospitalization. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Primary outcome was admission volumes during the period of stay-at-home orders (March 15, 2020-May 14, 2020) compared with baseline. Secondary outcomes were hospitalization characteristics including advanced support (e.g., invasive mechanical ventilation), PICU and hospital lengths of stay, and mortality. We used generalized linear mixed modeling to compare patient and admission characteristics during the stay-at-home orders period to baseline. We evaluated 7,960 admissions including 1,327 during March 15, 2020-May 14, 2020. Daily admissions and patients days were lower during the period of stay-at-home orders compared with baseline: median admissions 21 (interquartile range, 17-25) versus 36 (interquartile range, 30-42) (p < 0.001) and median patient days 93.0 (interquartile range, 55.9-136.7) versus 143.6 (interquartile range, 108.5-189.2) (p < 0.001). Admissions during the period of stay-at-home orders were less common in young children and for respiratory and infectious illnesses and more common for poisonings, endocrinopathies and for children with race/ethnicity categorized as other/unspecified. There were no differences in hospitalization characteristics except fewer patients received noninvasive ventilation during the period of stay-at-home orders. CONCLUSIONS Reductions in PICU admissions suggest that much of pediatric critical illness in younger children and for respiratory and infectious illnesses may be preventable through targeted public health strategies.
Collapse
Affiliation(s)
- Aline B Maddux
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
- Section of Pediatric Critical Care Medicine, Children's Hospital Colorado, Aurora, CO
| | - Kristen Campbell
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Alan G Woodruff
- Department of Anesthesiology, Section of Pediatric Critical Care Medicine, Wake Forest School of Medicine, Winston Salem, NC
| | - Jaime LaVelle
- Section of Pediatric Critical Care Medicine, Children's Hospital Colorado, Aurora, CO
| | - Jeffrey Lutmer
- Nationwide Children's Hospital, Columbus, OH
- Department of Pediatrics, Section of Pediatric Critical Care Medicine, The Ohio State University College of Medicine, Columbus, OH
| | - Curt E Kennedy
- Baylor College of Medicine, Houston, TX
- Texas Children's Hospital, Houston, TX
| | - Marcelo Malakooti
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - John K McGuire
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Lara Shekerdemian
- Baylor College of Medicine, Houston, TX
- Texas Children's Hospital, Houston, TX
| | - Z Leah Harris
- Department of Pediatrics, The University of Texas at Austin and Dell Children's Medical Center, Austin, TX
| | - Michael C McCrory
- Department of Anesthesiology, Section of Pediatric Critical Care Medicine, Wake Forest School of Medicine, Winston Salem, NC
| | - Todd C Carpenter
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
- Section of Pediatric Critical Care Medicine, Children's Hospital Colorado, Aurora, CO
| |
Collapse
|
22
|
Deshayes S, Leite Ferreira D, Madelaine J, Oulkhouir Y, Campbell K, Fouquet H, Teulier S, Magnier R, Heyndrickx M, Lerouge D, Bergot E, Justet A. [D-CBP study: Evaluation of lung cancer management times]. Rev Mal Respir 2021; 38:894-903. [PMID: 34756617 DOI: 10.1016/j.rmr.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 07/28/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Lung cancer is the leading cause of cancer-related death. Delays may have an impact on patient survival. The objective of this study was to evaluate the diagnostic and therapeutic management times for patients admitted for lung cancer treatment in the Respiratory Department of CHU de Caen Normandie. MATERIALS AND METHODS This is a retrospective, single-center and observational study, conducted on all patients treated for lung cancer from June 2017 to January 2018 in our department of pneumology in the Caen Normandie CHU. The main median times were investigated were: Global Time (abnormal imaging-treatment), Diagnosis time (abnormal imaging-diagnosis) and Treatment Time (diagnosis-treatment). RESULTS One hundred and twenty-seven (127) patients were included. Median global time was 55.5 days [31,25; 393], median diagnosis time was 22 days [13; 49], and median treatment time was 24.5 days [12,25; 45]. DISCUSSION Our treatment times are consistent with those previously published. Areas for improvement are being developed in accordance with the 2014-2019 cancer plan, in particularly the creation in our institution of a specific care pathway for patients with lung cancer.
Collapse
Affiliation(s)
- S Deshayes
- Service de Pneumologie et d'Oncologie Thoracique, CHU de Caen, 14000 Caen, France
| | - D Leite Ferreira
- Service de Pneumologie et d'Oncologie Thoracique, CHU de Caen, 14000 Caen, France
| | - J Madelaine
- Service de Pneumologie et d'Oncologie Thoracique, CHU de Caen, 14000 Caen, France
| | - Y Oulkhouir
- Service de Pneumologie et d'Oncologie Thoracique, CHU de Caen, 14000 Caen, France
| | - K Campbell
- Service de Pneumologie et d'Oncologie Thoracique, CHU de Caen, 14000 Caen, France
| | - H Fouquet
- Service de Pneumologie et d'Oncologie Thoracique, CHU de Caen, 14000 Caen, France
| | - S Teulier
- Service de Pneumologie et d'Oncologie Thoracique, CHU de Caen, 14000 Caen, France
| | - R Magnier
- Service de Pneumologie et d'Oncologie Thoracique, CHU de Caen, 14000 Caen, France
| | - M Heyndrickx
- Service de Chirurgie Thoracique, CHU de Caen, 14000 Caen, France
| | - D Lerouge
- Service de Radiothérapie, Centre de Lutte contre le Cancer François Baclesse, 14000 Caen, France
| | - E Bergot
- Service de Pneumologie et d'Oncologie Thoracique, CHU de Caen, 14000 Caen, France; ISTCT, UMR6030-CNRS-CEA-Université de Caen, 14000 Caen, France
| | - A Justet
- Service de Pneumologie et d'Oncologie Thoracique, CHU de Caen, 14000 Caen, France; ISTCT, UMR6030-CNRS-CEA-Université de Caen, 14000 Caen, France.
| |
Collapse
|
23
|
Buschur EO, Campbell K, Pyle L, Garcetti R, Joshee P, Demmitt JK, Snell-Bergeon JK, Polsky S. Exploratory Analysis of Glycemic Control and Variability Over Gestation Among Pregnant Women with Type 1 Diabetes. Diabetes Technol Ther 2021; 23:768-772. [PMID: 34115946 PMCID: PMC9009588 DOI: 10.1089/dia.2021.0138] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In exploratory analyses, we evaluated glycemic variability (GV) and gestational outcomes in pregnant women (n = 28) with type 1 diabetes (T1D). Gestational age at delivery was higher for women with lower glycemic measures, including estimated HbA1c (eHbA1c) (0.14% decrease in HbA1c per 1-week greater gestational age, P = 0.0035), mean sensor glucose (-3.9 mg/dL P = 0.0039), time spent >140 mg/dL (-3.1%, P = 0.0029), and higher time in range (TIR) of 63-140 mg/dL (3.2%, P = 0.0029). Third trimester measured HbA1c was significantly associated with gestational age at delivery (P = 0.0081). Preeclampsia was associated with less TIR in first (50.5% vs. 69.9%, P = 0.0034) and second trimesters (47.1% vs. 66.7%, P = 0.0025), but not with measured HbA1c. There were significant differences in other markers of GV (continuous overall net glycemic action, high blood glucose index, J-index, mean amplitude of glycemic excursions) with infant birth weight and gestational age at delivery. Thus, multiple markers of glycemia and GV were associated with gestational health outcomes in T1D pregnancies in this pilot study. Clinical Trial Registration number: NCT02556554.
Collapse
Affiliation(s)
- Elizabeth O. Buschur
- Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Kristen Campbell
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Laura Pyle
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Rachel Garcetti
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
| | - Prakriti Joshee
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
| | - Jamie K. Demmitt
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
| | - Janet K. Snell-Bergeon
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
| | - Sarit Polsky
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
- Address correspondence to: Sarit Polsky, MD, MPH, Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
| |
Collapse
|
24
|
Blaivas M, Blaivas L, Campbell K, Liu Y. 139 Creating an Automated Artificial Intelligence Left Ventricular Ejection Fraction Estimator for Parasternal Long Axis Scans from Unrelated Apical Window Echo Videos. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.149] [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: 10/20/2022]
|
25
|
Dufva MJ, Ivy D, Campbell K, Lam A, Rauff A, Breeman KTN, Douwes JM, Berger RMF, Kheyfets VO, Hunter K. Ventricular-vascular coupling is predictive of adverse clinical outcome in paediatric pulmonary arterial hypertension. Open Heart 2021; 8:openhrt-2021-001611. [PMID: 34583983 PMCID: PMC8479945 DOI: 10.1136/openhrt-2021-001611] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 08/27/2021] [Indexed: 11/25/2022] Open
Abstract
Aims Ventricular–vascular coupling, the ratio between the right ventricle’s contractile state (Ees) and its afterload (Ea), may be a useful metric in the management of paediatric pulmonary arterial hypertension (PAH). In this study we assess the prognostic capacity of the ventricular–vascular coupling ratio (Ees/Ea) derived using right ventricular (RV) pressure alone in children with PAH. Methods One hundred and thirty paediatric patients who were diagnosed with PAH via right heart catheterisation were retrospectively reviewed over a 10-year period. Maximum RV isovolumic pressure and end-systolic pressure were estimated using two single-beat methods from Takeuchi et al (Ees/Ea_(Takeuchi)) and from Kind et al (Ees/Ea_(Kind)) and used with an estimate of end-systolic pressure to compute ventricular–vascular coupling from pressure alone. Patients were identified as either idiopathic/hereditary PAH or associated PAH (IPAH/HPAH and APAH, respectively). Haemodynamic data, clinical functional class and clinical worsening outcomes—separated into soft (mild) and hard (severe) event categories—were assessed. Adverse soft events included functional class worsening, syncopal event, hospitalisation due to a proportional hazard-related event and haemoptysis. Hard events included death, transplantation, initiation of prostanoid therapy and hospitalisation for atrial septostomy and Pott’s shunt. Cox proportional hazard modelling was used to assess whether Ees/Ea was predictive of time-to-event. Results In patients with IPAH/HPAH, Ees/Ea_(Kind) and Ees/Ea_(Takeuchi) were both independently associated with time to hard event (p=0.003 and p=0.001, respectively) and when adjusted for indexed pulmonary vascular resistance (p=0.032 and p=0.013, respectively). Neither Ees/Ea_(Kind) nor Ees/Ea_(Takeuchi) were associated with time to soft event. In patients with APAH, neither Ees/Ea_(Kind) nor Ees/Ea_(Takeuchi) were associated with time to hard event or soft event. Conclusions Ees/Ea derived from pressure alone is a strong independent predictor of adverse outcome and could be a potential powerful prognostic tool for paediatric PAH.
Collapse
Affiliation(s)
- Melanie J Dufva
- Bioengineering, University of Colorado Denver - Anschutz Medical Campus, Aurora, Colorado, USA .,Cardiology, Children's Hospital Colorado, Aurora, Colorado, USA.,Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Dunbar Ivy
- Cardiology, Children's Hospital Colorado, Aurora, Colorado, USA.,Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Kristen Campbell
- Cardiology, Children's Hospital Colorado, Aurora, Colorado, USA.,Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Aimee Lam
- Bioengineering, University of Colorado Denver - Anschutz Medical Campus, Aurora, Colorado, USA.,Cardiology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Adam Rauff
- Bioengineering, University of Colorado Denver - Anschutz Medical Campus, Aurora, Colorado, USA.,Department of Bioengineering, University of Utah Health, Salt Lake City, Utah, USA
| | - Karel T N Breeman
- Cardiology, Children's Hospital Colorado, Aurora, Colorado, USA.,Paediatric Cardiology, University Medical Center Groningen Department of Cardiology, Groningen, The Netherlands
| | - Johannes M Douwes
- Paediatric Cardiology, University Medical Center Groningen Department of Cardiology, Groningen, The Netherlands
| | - Rolf M F Berger
- Paediatric Cardiology, University Medical Center Groningen Department of Cardiology, Groningen, The Netherlands
| | - Vitaly Oleg Kheyfets
- Bioengineering, University of Colorado Denver - Anschutz Medical Campus, Aurora, Colorado, USA.,Cardiology, Children's Hospital Colorado, Aurora, Colorado, USA.,Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Kendall Hunter
- Bioengineering, University of Colorado Denver - Anschutz Medical Campus, Aurora, Colorado, USA.,Cardiology, Children's Hospital Colorado, Aurora, Colorado, USA.,Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| |
Collapse
|
26
|
Campbell K. CN25 The haemato-oncology patient experience of the process of palliative care: A constructivist grounded theory study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
27
|
Macaruso N, Campbell K, Cost C, Sopfe J. Provider Documentation of Tinnitus in Childhood Cancer Survivors. J Pediatr Hematol Oncol 2021; 43:e642-e647. [PMID: 33065711 DOI: 10.1097/mph.0000000000001966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/02/2020] [Indexed: 11/25/2022]
Abstract
Tinnitus is a known complication of treatment for childhood cancer and potentially reduces the quality of life for childhood cancer survivors (CCS). Although current guidelines recommend annual surveillance in CCS at risk for tinnitus, current screening practices among pediatric oncology survivorship providers are unknown. The authors performed a retrospective cohort study to assess the adequacy of current tinnitus screening in survivorship care. The 5.6% prevalence of tinnitus reported by the Childhood Cancer Survivorship Study, the largest ongoing follow-up cohort of CCS, served as the baseline for comparison for our rate of documented positive screening for tinnitus. Survivorship providers identified tinnitus in 3 of 624 (0.48%) eligible CCS, which was significantly lower than the prevalence in the Childhood Cancer Survivorship Study (P<0.0001). Survivorship providers documented any screening for tinnitus (positive or negative) in 15 of 624 (2.4%) CCS. Screening practices significantly differed by ototoxic exposure history and age at follow-up. This study demonstrates that screening and detection of tinnitus are underdocumented by survivorship providers, raising concern for inadequate screening practices. Improved screening may facilitate the recognition and treatment of this late effect, improving the quality of life for CCS.
Collapse
Affiliation(s)
- Natalie Macaruso
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | | | | | | |
Collapse
|
28
|
Monnin K, Lofton AM, Naclerio C, Buchanan CL, Campbell K, Tenenbaum RB, Steinberg Christofferson E. Understanding Substance use Policies and Associated Ethical Concerns: A survey of Pediatric Transplant Centers. Pediatr Transplant 2021; 25:e13984. [PMID: 33580580 DOI: 10.1111/petr.13984] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/16/2021] [Accepted: 01/22/2021] [Indexed: 12/22/2022]
Abstract
Psychosocial risk factors, such as substance use, have been linked to poor post-transplant outcomes for solid organ transplant patients, including poor medication adherence, increased risk for rejection, and even graft failure. Despite universal consensus that substance use is an increasing problem among youth, many pediatric transplant centers do not have policies in place to address substance use and no universal guidelines exist regarding assessment during the pre-transplant evaluation in this population. An online survey was administered via REDCap™ and directed toward medical leaders (ie, medical and surgical directors) of national heart, kidney, and liver transplant centers. Questions examined the following: perspectives on the need for a universal transplant center policy on pediatric substance use, abuse, and dependence; timing and frequency of evaluation for substance use; specific substances which would elicit respondents' concerns; and ethical concerns surrounding substance use. Data were analyzed using descriptive statistics. Data were collected from 52 respondents from 38 transplant centers, with the majority (n = 40; 77%) reporting no substance use policy in place for pediatric transplant patients. However, many endorsed concerns if a pediatric patient was found to be using specific substances. Our findings further highlight the need for a universal substance use policy across pediatric solid organ transplant centers. The results from the distributed survey will help to provide guidelines and best practices when establishing a universal policy for substance use.
Collapse
Affiliation(s)
- Kara Monnin
- Pediatric Mental Health Institute, Children's Hospital Colorado, Aurora, CO, USA
| | - Amie M Lofton
- Integrated Care Division, Department of Behavioral Health, Kaiser Permanente, Lafayette, CO, USA
| | - Catherine Naclerio
- Pediatric Mental Health Institute, Children's Hospital Colorado, Aurora, CO, USA.,Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Cindy L Buchanan
- Pediatric Mental Health Institute, Children's Hospital Colorado, Aurora, CO, USA.,Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kristen Campbell
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Rachel B Tenenbaum
- Pediatric Mental Health Institute, Children's Hospital Colorado, Aurora, CO, USA
| | - Elizabeth Steinberg Christofferson
- Pediatric Mental Health Institute, Children's Hospital Colorado, Aurora, CO, USA.,Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|
29
|
Messer LH, Campbell K, Pyle L, Forlenza GP. Basal-IQ technology in the real world: satisfaction and reduction of diabetes burden in individuals with type 1 diabetes. Diabet Med 2021; 38:e14381. [PMID: 32767401 DOI: 10.1111/dme.14381] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 07/08/2020] [Accepted: 07/28/2020] [Indexed: 12/21/2022]
Abstract
AIM To describe person-reported outcomes of the Basal-IQ predictive low-glucose-suspend system (Tandem Diabetes Care, San Diego, CA, USA) in real-world use. METHODS Adults with type 1 diabetes/caregivers of minors with type 1 diabetes completed the Diabetes Impact and Device Satisfaction questionnaire (11 items scored on 10-point Likert scales) prior to Basal-IQ system initiation, and at 2, 4 and 6 months post-initiation. Analysis was stratified by previous insulin treatment method. Beta mixed models were used to measure change in device satisfaction (e.g. trust, ease of use) and diabetes impact (e.g. hypoglycaemia fear, poor sleep) scores between time points, adjusting for baseline covariates. RESULTS A total of 967 adults and caregivers [54% women, mean (sd) age 36 (17) years, 57% Tandem pump users, 27% non-Tandem pump users, 17% multiple daily injection users] completed surveys. Device satisfaction significantly increased from baseline to 2 months in all groups (P<0.001 multiple daily injection and non-Tandem pump users; P=0.048 Tandem pump users), and was sustained from 2 to 6 months in all groups. Diabetes impact decreased significantly from baseline to 2 months in all groups (P<0.001 for all), was sustained from 2 to 6 months in multiple daily injection and Tandem pump users, and increased slightly at 4 months/decreased at 6 months in non-Tandem users. CONCLUSION The Basal-IQ system increased device satisfaction and reduced diabetes impact in all users in the first 2 months of use, and satisfaction was sustained over 6 months, with small fluctuations.
Collapse
Affiliation(s)
- L H Messer
- Barbara Davis Center, University of Colorado Anschutz, Aurora, CO, USA
| | - K Campbell
- Barbara Davis Center, University of Colorado Anschutz, Aurora, CO, USA
| | - L Pyle
- Barbara Davis Center, University of Colorado Anschutz, Aurora, CO, USA
| | - G P Forlenza
- Barbara Davis Center, University of Colorado Anschutz, Aurora, CO, USA
| |
Collapse
|
30
|
Ehrmann DE, Leopold DK, Campbell K, Silveira L, Gist KM, Phillips R, Shahi N, Moulton SL, Kim JS. Lessons Learned From the First Pilot Study of the Compensatory Reserve Index After Congenital Heart Surgery Requiring Cardiopulmonary Bypass. World J Pediatr Congenit Heart Surg 2021; 12:176-184. [PMID: 33684010 DOI: 10.1177/2150135120972013] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Early warning systems that utilize dense physiologic data and machine learning may aid prediction of decompensation after congenital heart surgery (CHS). The Compensatory Reserve Index (CRI) analyzes changing features of the pulse waveform to predict hemodynamic decompensation in adults, but it has never been studied after CHS. This study sought to understand the feasibility, safety, and potential utility of CRI monitoring after CHS with cardiopulmonary bypass (CPB). METHODS A single-center prospective pilot cohort of patients undergoing pulmonary valve replacement was studied. Compensatory Reserve Index was continuously measured from preoperative baseline through the first 24 postoperative hours. Average CRI values during selected procedural phases were compared between patients with an intensive care unit (ICU) length of stay (LOS) <3 days versus LOS ≥3 days. RESULTS Twenty-three patients were enrolled. On average, 17,445 (±3,152) CRI data points were collected and 0.33% (±0.40) of data were missing per patient. There were no adverse events related to monitoring. Five (21.7%) patients had an ICU LOS ≥3 days. Compared to the ICU LOS <3 days group, the ICU LOS ≥3 days group had a greater decrease in CRI from baseline to immediately after CPB (-0.3 ± 0.1 vs -0.1 ± 0.2, P = .003) and were less likely to recover to baseline CRI during the monitoring period (20% vs 83%, P = .017). CONCLUSIONS Compensatory Reserve Index monitoring after CHS with CPB seems feasible and safe. Early changes in CRI may precede meaningful clinical outcomes, but this requires further study.
Collapse
Affiliation(s)
- Daniel E Ehrmann
- Division of Cardiology, Department of Pediatrics, 12225University of Colorado School of Medicine, Aurora, CO, USA
| | - David K Leopold
- Department of Anesthesia, 12225University of Colorado School of Medicine, Aurora, CO, USA.,Division of Pediatric Surgery, Department of Surgery, 12225University of Colorado School of Medicine, Aurora, CO, USA
| | - Kristen Campbell
- Department of Pediatrics, 12225University of Colorado School of Medicine, Aurora, CO, USA
| | - Lori Silveira
- Department of Pediatrics, 12225University of Colorado School of Medicine, Aurora, CO, USA
| | - Katja M Gist
- Division of Cardiology, Department of Pediatrics, 12225University of Colorado School of Medicine, Aurora, CO, USA
| | - Ryan Phillips
- Division of Pediatric Surgery, Department of Surgery, 12225University of Colorado School of Medicine, Aurora, CO, USA
| | - Niti Shahi
- Division of Pediatric Surgery, Department of Surgery, 12225University of Colorado School of Medicine, Aurora, CO, USA
| | - Steven L Moulton
- Division of Pediatric Surgery, Department of Surgery, 12225University of Colorado School of Medicine, Aurora, CO, USA
| | - John S Kim
- Division of Cardiology, Department of Pediatrics, 12225University of Colorado School of Medicine, Aurora, CO, USA
| |
Collapse
|
31
|
Harris RA, Mandell DS, Kampman KM, Bao Y, Campbell K, Cidav Z, Coviello DM, French R, Livesey C, Lowenstein M, Lynch KG, McKay JR, Oslin DW, Wolk CB, Bogner HR. Collaborative care in the treatment of opioid use disorder and mental health conditions in primary care: A clinical study protocol. Contemp Clin Trials 2021; 103:106325. [PMID: 33631356 PMCID: PMC8117118 DOI: 10.1016/j.cct.2021.106325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/14/2021] [Accepted: 02/16/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND People with opioid use disorder (OUD) often have a co-occurring psychiatric disorder, which elevates the risk of morbidity and mortality. Promising evidence supports the use of collaborative care for treating people with OUD in primary care. Whether collaborative care interventions that treat both OUD and psychiatric disorders will result in better outcomes is presently unknown. METHODS The Whole Health Study is a 3-arm randomized controlled trial designed to test collaborative care treatment for OUD and the psychiatric disorders that commonly accompany OUD. Approximately 1200 primary care patients aged ≥18 years with OUD and depression, anxiety, or PTSD will be randomized to one of three conditions: (1) Augmented Usual Care, which consists of a primary care physician (PCP) waivered to prescribe buprenorphine and an addiction psychiatrist to consult on medication-assisted treatment; (2) Collaborative Care, which consists of a waivered PCP, a mental health care manager trained in psychosocial treatments for OUD and psychiatric disorders, and an addiction psychiatrist who provides consultation for OUD and mental health; or (3) Collaborative Care Plus, which consists of all the elements of the Collaborative Care arm plus a Certified Recovery Specialist to help with treatment engagement and retention. Primary outcomes are six-month rates of opioid use and six-month rates of remission of co-occurring psychiatric disorders. DISCUSSION The Whole Health Study will investigate whether collaborative care models that address OUD and co-occurring depression, anxiety, or PTSD will result in better patient outcomes. The results will inform clinical care delivery during the current opioid crisis. CLINICAL TRIALS REGISTRATION www.clinicaltrials.gov registration: NCT04245423.
Collapse
Affiliation(s)
- Rebecca Arden Harris
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - David S Mandell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kyle M Kampman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Yuhua Bao
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY 10065, USA
| | - Kristen Campbell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Zuleyha Cidav
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Donna M Coviello
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Rachel French
- School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Cecilia Livesey
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Margaret Lowenstein
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kevin G Lynch
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - James R McKay
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA
| | - David W Oslin
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA
| | - Courtney Benjamin Wolk
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Hillary R Bogner
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA 19104, USA
| |
Collapse
|
32
|
Herrmann BW, Campbell K, Meier M, Haemer M, Crowder R, Tholen K, Hoefner-Notz R, Nguyen T, Friedman NR. Parental Perception of Weight Status for Adenotonsillectomy Patients. Laryngoscope 2021; 131:2121-2125. [PMID: 33569790 DOI: 10.1002/lary.29445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/21/2021] [Accepted: 01/27/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Weight status can affect outcomes in pediatric adenotonsillectomy performed for obstructive sleep disordered breathing. Parents frequently underestimate their child's weight and are unaware weight status may affect adenotonsillectomy success. Accurate understanding of a child's weight status is important for shared decision making with the family and perioperative care. The purpose of this study is to analyze the accuracy of the parent's perception of their child's weight status. METHODS A retrospective analysis was performed of prospective data collected from families of children undergoing adenotonsillectomy from June 2018 through June 2019. RESULTS A total of 522 children met the inclusion criteria. Two hundred and thirty-two children were either overweight (n = 46, 9%) or obese (n = 186, 36%). Among parents of this cohort whose children were overweight or obese, 74 (32%) erroneously reported that their child was normal weight. For the 290 nonoverweight children, 99% of parents accurately reported weight status. After adjusting for ethnicity, race, BMI%, and sex, for every 1-year increase in age of the child, the odds of the parent correctly identifying their child as overweight increased by a factor of 1.18 (95% CI: 1.09, 1.27). CONCLUSION One-third of families with children who were overweight or obese undergoing adenotonsillectomy for obstructive sleep disordered breathing underestimated their child's weight. This study highlights the need to facilitate family understanding of weight status' potential impact on both obstructive sleep disordered breathing severity and adenotonsillectomy success, especially for younger children. LEVEL OF EVIDENCE 4 Laryngoscope, 131:2121-2125, 2021.
Collapse
Affiliation(s)
- Brian W Herrmann
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado, U.S.A.,Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, Colorado, U.S.A
| | - Kristen Campbell
- University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Maxene Meier
- The Center for Research in Outcomes for Children's Surgery, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Matthew Haemer
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Renee Crowder
- University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Kaitlyn Tholen
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado, U.S.A.,Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, Colorado, U.S.A
| | - Regina Hoefner-Notz
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Thanh Nguyen
- University of Colorado School of Medicine, Aurora, Colorado, U.S.A.,Division of Pediatric Anesthesia, Children's Hospital Colorado, Aurora, Colorado, U.S.A
| | - Norman R Friedman
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado, U.S.A.,Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, Colorado, U.S.A
| |
Collapse
|
33
|
Davis S, Wiebe C, Campbell K, Anobile C, Aubrey M, Stites E, Grafals M, Pomfret E, Nickerson P, Cooper JE. Adequate tacrolimus exposure modulates the impact of HLA class II molecular mismatch: a validation study in an American cohort. Am J Transplant 2021; 21:322-328. [PMID: 32888256 PMCID: PMC7821185 DOI: 10.1111/ajt.16290] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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: 05/13/2020] [Revised: 08/07/2020] [Accepted: 08/24/2020] [Indexed: 02/06/2023]
Abstract
Clinicians have few tools to predict the risk of alloimmune injury that would guide immunosuppression management in renal transplant patients. We evaluated human leukocyte antigen (HLA)-DR/DQ molecular mismatch to predict de novo donor-specific antibodies (DSAs) during the first year of transplant and explored how differences in tacrolimus exposure may modulate this risk. HLA-DR and -DQ eplet mismatches were determined between 444 donor-recipient pairs in Denver, Colorado between 2007 and 2013. Previously defined mismatch thresholds stratified recipients into low- (N = 119), intermediate- (N = 153), and high- (N = 172) risk categories. The area under the curve for DSA at 1 year was 0.84 and 0.82 for HLA-DR and HLA-DQ eplet mismatches, respectively. Compared to low-risk patients, there was a graded increase in risk of DR/DQ DSA in intermediate (HR 15.39, 95% CI 2.01-118.09, p = .009) and high-risk (HR 23.81, 95% CI 3.17-178.66, p = 0.002) categories. Intermediate- and high-risk patients with a mean tacrolimus <6 ng/ml versus >8 ng/ml had increased risk of DR/DQ DSA at 1 year (HR 2.34, 95% CI 1.05-5.22, p = .04). HLA molecular mismatch represents a reproducible, objective, and clinically relevant tool to stratify patients by alloimmune risk and may help guide personalized immunosuppression management.
Collapse
Affiliation(s)
- Scott Davis
- Department of MedicineUniversity of ColoradoAuroraColoradoUSA
| | - Christopher Wiebe
- Department of MedicineRady Faculty of Health SciencesWinnipegManitobaUSA
| | | | | | | | - Erik Stites
- Department of MedicineUniversity of ColoradoAuroraColoradoUSA
| | - Monica Grafals
- Department of MedicineUniversity of ColoradoAuroraColoradoUSA
| | | | - Peter Nickerson
- Department of MedicineRady Faculty of Health SciencesWinnipegManitobaUSA
| | - James E. Cooper
- Department of MedicineUniversity of ColoradoAuroraColoradoUSA
| |
Collapse
|
34
|
Greer H, Campbell K, Samay S, Green A. IMMU-21. INVESTIGATION OF WHITE BLOOD CELL CHARACTERISTICS IN CSF SAMPLES AT PEDIATRIC BRAIN TUMOR DIAGNOSIS. Neuro Oncol 2020. [PMCID: PMC7715671 DOI: 10.1093/neuonc/noaa222.377] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND There has been a recent surge in investigation of immunity and immunotherapy, but their role in pediatric brain tumors is incompletely defined. We hypothesized that investigating an understudied dataset, WBC and differential results in CSF drawn at the time of pediatric brain tumor diagnosis to look for microscopic metastases, would provide insight into the role of immunology and potential for immunotherapy in these diseases and correlate with prognosis and/or metastasis. METHODS We conducted a retrospective comparison analysis of CSF values in 349 patients at our institution from samples drawn within 60 days of initial CNS tumor diagnosis from 1998–2018. We examined total nucleated cell count, absolute counts and percentages for WBC subtypes. We compared CSF values by tumor cell presence, patient vital status, and disease group: atypical teratoid rhabdoid tumor, ependymoma, germinoma, high-grade glioma (HGG), low-grade glioma (LGG), medulloblastoma, non-germinomatous germ cell tumor, and other embryonal tumors (OET). We used Wilcoxon and Kruskal-Wallis tests for comparisons. RESULTS Overall, higher lymphocyte percentage (p=0.002) and lower monocyte percentage (p=0.007) were associated with survival. WBC characteristics did not differ significantly based on tumor cell presence. Compared to medulloblastoma, ependymoma showed a more active CSF immune response, while LGG, HGG, and OET showed a less active response, based on total WBC and/or absolute neutrophil count (p=0.001–0.007). CONCLUSIONS Higher lymphocyte and lower monocyte percentages in CSF correlated with better prognosis overall; causality requires further investigation. Tumor subtypes varied in their immune stimulation, offering potential insight into which will be amenable to immunotherapy.
Collapse
Affiliation(s)
- Hunter Greer
- The Morgan Adams Foundation Pediatric Brain Tumor Research Program, University of Colorado School of Medicine/Children’s Hospital Colorado, Aurora, CO, USA
| | - Kristen Campbell
- Department of Pediatrics, School of Medicine University of Colorado, Aurora, CO, USA
| | - Sadaf Samay
- Research Informatics, Children’s Hospital Colorado, Aurora, CO, USA
| | - Adam Green
- The Morgan Adams Foundation Pediatric Brain Tumor Research Program, University of Colorado School of Medicine/Children’s Hospital Colorado, Aurora, CO, USA
| |
Collapse
|
35
|
Kuerbitz J, Madhavan M, Ehrman LA, Kohli V, Waclaw RR, Campbell K. Temporally Distinct Roles for the Zinc Finger Transcription Factor Sp8 in the Generation and Migration of Dorsal Lateral Ganglionic Eminence (dLGE)-Derived Neuronal Subtypes in the Mouse. Cereb Cortex 2020; 31:1744-1762. [PMID: 33230547 DOI: 10.1093/cercor/bhaa323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/07/2020] [Accepted: 10/07/2020] [Indexed: 12/29/2022] Open
Abstract
Progenitors in the dorsal lateral ganglionic eminence (dLGE) are known to give rise to olfactory bulb (OB) interneurons and intercalated cells (ITCs) of the amygdala. The dLGE enriched transcription factor Sp8 is required for the normal generation of ITCs as well as OB interneurons, particularly the calretinin (CR)-expressing subtype. In this study, we used a genetic gain-of-function approach in mice to examine the roles Sp8 plays in controlling the development of dLGE-derived neuronal subtypes. Misexpression of Sp8 throughout the ventral telencephalic subventricular zone (SVZ) from early embryonic stages, led to an increased generation of ITCs which was dependent on Tshz1 gene dosage. Additionally, Sp8 misexpression impaired rostral migration of OB interneurons with clusters of CR interneurons seen in the SVZ along with decreased differentiation of calbindin OB interneurons. Sp8 misexpression throughout the ventral telencephalon also reduced ventral LGE neuronal subtypes including striatal projection neurons. Delaying Sp8 misexpression until E14-15 rescued the striatal and amygdala phenotypes but only partially rescued OB interneuron reductions, consistent with an early window of striatal and amygdala neurogenesis and ongoing OB interneuron generation at this late stage. Our results demonstrate critical roles for the timing and neuronal cell-type specificity of Sp8 expression in mouse LGE neurogenesis.
Collapse
Affiliation(s)
- J Kuerbitz
- Divisions of Developmental Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.,Medical-Scientist Training Program, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - M Madhavan
- Divisions of Developmental Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - L A Ehrman
- Divisions of Developmental Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.,Divisions of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - V Kohli
- Divisions of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - R R Waclaw
- Divisions of Developmental Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.,Divisions of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - K Campbell
- Divisions of Developmental Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.,Divisions of Neurosurgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| |
Collapse
|
36
|
Sopfe J, Campbell K, Keating AK, Pyle L, Liu AK, Verneris MR, Giller RH, Forlenza GP. Glycemic variability is associated with poor outcomes in pediatric hematopoietic stem cell transplant patients. Pediatr Blood Cancer 2020; 67:e28626. [PMID: 33480469 DOI: 10.1002/pbc.28626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/23/2020] [Accepted: 07/15/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Among pediatric hematopoietic stem cell transplant (HSCT) recipients, abnormal glycemic control is shown to be associated with increased risk of transplant-related mortality, death from any cause, risk of infection, increased hospitalized, and intensive care days. Independent effects of higher glycemic variability, a component of glycemic control, have not been described. This study aimed to characterize risk factors for, and consequences of, higher glycemic variability in HSCT patients. PROCEDURE Medical records for a cohort of 344 patients, age 0-30 years, who underwent first HSCT from 2007 to 2016 at Children's Hospital Colorado were retrospectively reviewed. Glucose coefficients of variation (CV) were analyzed for HSCT days -14 to 0 and 0-30, and patients were assessed for potential risk factors and outcomes. RESULTS Roughly one-third of patients had pre-HSCT and day 0-30 glucose CV above the reported healthy adult range. Independent of HSCT type, doubling of pre-HSCT glucose CV was associated with a 4.91-fold (95% confidence interval [CI], 1.40-17.24) increased hazard of infection, as well as increased risk for intensive care hospitalization for allogenic HSCT patients. Multivariable analysis demonstrated that allogeneic HSCT patients had a 1.40- and 1.38-fold (95% CI, 0.98-1.99 and 1.00-1.91) increased hazard of death for every doubling of pre-HSCT and day 0-30 glucose CV, respectively. CONCLUSIONS Just as with higher mean glucose, higher glycemic variability in the pediatric HSCT population is independently associated with significantly increased morbidity. Additional research is required to evaluate the utility of glucose control to mitigate these relationships and improve HSCT outcomes.
Collapse
Affiliation(s)
- Jenna Sopfe
- Bone Marrow Transplant Program, Center for Cancer and Blood Disorders, Department of Pediatrics, University of Colorado School of Medicine, Colorado
| | - Kristen Campbell
- Department of Pediatrics, University of Colorado School of Medicine, Colorado
| | - Amy K Keating
- Bone Marrow Transplant Program, Center for Cancer and Blood Disorders, Department of Pediatrics, University of Colorado School of Medicine, Colorado
| | - Laura Pyle
- Department of Pediatrics, University of Colorado School of Medicine, Colorado.,Department of Biostatistics and Informatics, University of Colorado, Colorado
| | - Arthur K Liu
- Department of Radiation Oncology, University of Colorado School of Medicine, Colorado
| | - Michael R Verneris
- Bone Marrow Transplant Program, Center for Cancer and Blood Disorders, Department of Pediatrics, University of Colorado School of Medicine, Colorado
| | - Roger H Giller
- Bone Marrow Transplant Program, Center for Cancer and Blood Disorders, Department of Pediatrics, University of Colorado School of Medicine, Colorado
| | - Gregory P Forlenza
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Colorado
| |
Collapse
|
37
|
Davidson N, Campbell K, Foroughi F, Tayal V, Lynar S, Crawford LC, Kidd SE, Baird R, Davies J, Meumann EM. Disseminated Saksenaea infection in an immunocompromised host associated with a good clinical outcome: a case report and review of the literature. BMC Infect Dis 2020; 20:755. [PMID: 33054720 PMCID: PMC7559758 DOI: 10.1186/s12879-020-05459-9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 09/29/2020] [Indexed: 11/24/2022] Open
Abstract
Background Saksenaea species (spp.) are uncommon causes of mucormycosis but are emerging pathogens mostly associated with trauma and soil contamination often in immunocompetent hosts. Due to lack of sporulation in the laboratory, diagnosis and susceptibility testing is difficult so optimal treatment regimens are unknown. Case presentation A 67 year-old man from the Northern Territory in Australia, with a history of eosinophilic granulomatosis with polyangiitis, developed disseminated Saksenaea infection after initially presenting with symptoms consistent with bacterial pyelonephritis. Despite a delay in diagnosis; with aggressive surgical management and dual therapy with amphotericin B and posaconazole, he survived. Conclusions We describe an unusual case of disseminated infection with a favourable outcome to date.
Collapse
Affiliation(s)
- N Davidson
- Division of Medicine, Royal Darwin Hospital, Darwin, Australia. .,Sullivan and Nicolaides Pathology, Brisbane, Australia.
| | - K Campbell
- Division of Medicine, Royal Darwin Hospital, Darwin, Australia
| | - F Foroughi
- Department of Pathology, Royal Darwin Hospital, Darwin, Australia
| | - V Tayal
- Division of Medicine, Royal Darwin Hospital, Darwin, Australia
| | - S Lynar
- Division of Medicine, Royal Darwin Hospital, Darwin, Australia.,Global and Tropical Health Division, Charles Darwin University, Menzies School of Health Research, Darwin, Australia
| | - L C Crawford
- National Mycology Reference Centre, Microbiology and Infectious Diseases, SA Pathology, Frome Road, Adelaide, South Australia, Australia
| | - S E Kidd
- National Mycology Reference Centre, Microbiology and Infectious Diseases, SA Pathology, Frome Road, Adelaide, South Australia, Australia
| | - R Baird
- Department of Pathology, Royal Darwin Hospital, Darwin, Australia
| | - J Davies
- Division of Medicine, Royal Darwin Hospital, Darwin, Australia.,Global and Tropical Health Division, Charles Darwin University, Menzies School of Health Research, Darwin, Australia
| | - E M Meumann
- Division of Medicine, Royal Darwin Hospital, Darwin, Australia.,Global and Tropical Health Division, Charles Darwin University, Menzies School of Health Research, Darwin, Australia
| |
Collapse
|
38
|
Nakano TA, Lau BW, Dickerson KE, Wlodarski M, Pollard J, Shimamura A, Hofmann I, Sasa G, Elghetany T, Cada M, Dror Y, Ding H, Allen SW, Hanna R, Campbell K, Olson TS. Diagnosis and treatment of pediatric myelodysplastic syndromes: A survey of the North American Pediatric Aplastic Anemia Consortium. Pediatr Blood Cancer 2020; 67:e28652. [PMID: 32779892 DOI: 10.1002/pbc.28652] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/29/2020] [Accepted: 08/02/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Myelodysplastic syndromes (MDS) represent a group of clonal hematopoietic stem cell disorders that commonly progress to acute myeloid leukemia (AML). The diagnostics, prognostics, and treatment of adult MDS are established but do not directly translate to children and adolescents. Pediatric MDS is a rare disease, characterized by unique cytogenetics and histology compared with adult MDS, and often arises secondary to germline predisposition or cytotoxic exposures. Our objective was to highlight aspects of diagnosis/management that would benefit from further systematic review toward the development of clinical practice guidelines for pediatric MDS. PROCEDURE The North American Pediatric Aplastic Anemia Consortium (NAPAAC) is composed of collaborative institutions with a strong interest in pediatric bone marrow failure syndromes and hematologic malignancies. The NAPAAC MDS working group developed a national survey distributed to 35 NAPAAC institutions to assess data on (1) clinical presentation of pediatric MDS, (2) diagnostic evaluation, (3) criteria for diagnosis, (4) supportive care and treatment decisions, and (5) role of hematopoietic stem cell transplantation (HSCT). RESULTS Twenty-eight of 35 institutions returned the survey. Most centers agreed on a common diagnostic workup, though there was considerable variation regarding the criteria for diagnosis. Although there was consensus on supportive care, treatment strategies, including the role of cytoreduction and HSCT, varied across centers surveyed. CONCLUSIONS There is lack of national consensus on diagnosis and treatment of pediatric MDS. This survey identified key aspects of MDS management that will warrant systematic review toward the goal of developing national clinical practice guidelines for pediatric MDS.
Collapse
Affiliation(s)
- Taizo A Nakano
- University of Colorado School of Medicine, Aurora, Colorado
| | - Bonnie W Lau
- Dartmouth Geisel School of Medicine, Lebanon, New Hampshire
| | | | | | - Jessica Pollard
- Dana-Farber/Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Akiko Shimamura
- Dana-Farber/Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Inga Hofmann
- University of Wisconsin School of Medicine, Madison, Wisconsin
| | | | | | - Michaela Cada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Yigal Dror
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hilda Ding
- Rady Children's Hospital, University of California, San Diego, San Diego, California
| | - Steven W Allen
- University Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rabbi Hanna
- Taussing Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Timothy S Olson
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| |
Collapse
|
39
|
Nolan P, Auer S, Spehar A, Oplatowska-Stachowiak M, Campbell K. Evaluation of Mass Sensitive Micro-Array biosensors for their feasibility in multiplex detection of low molecular weight toxins using mycotoxins as model compounds. Talanta 2020; 222:121521. [PMID: 33167231 DOI: 10.1016/j.talanta.2020.121521] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/03/2020] [Accepted: 08/05/2020] [Indexed: 12/22/2022]
Abstract
Mycotoxins produced by Fusarium species including trichothecenes, zearalenone and fumonisins, can co-contaminate food and feed throughout the supply chain, including cereal grains and animal feeds. There is an increasing demand to enhance global food security by improving the monitoring of mycotoxins throughout our food supply chain. For time and cost-efficient analysis, rapid tests capable of detecting multiple toxins from a single sample are ideal. Considering these current trends in mycotoxin testing, this project examined the feasibility of using both a portable and non-portable mass-based biosensor for multiplex mycotoxin detection. The biosensor was a mass sensitive microarray (MSMA) which consisted of 4 × 16 miniaturized mass sensitive transducer pixels based on solidly mounted resonator (SMR) technology. Functionalisation of individual pixels on the sensor surface using nano-spotting technology for the simultaneous and semi-quantitative detection of three regulated mycotoxins: T2-toxin (T2) zearalenone (ZEN), and fumonisin B1 (FumB1) was examined. With the integration of portable and non-portable microfluidic devices for antibody and standard sample injections, competitive inhibition assays were developed followed by singleplex and multiplex calibration curves. The characteristics and performance of the MSMA were evaluated including sensitivity which was determined as the concentration causing 50% inhibition. Sensitivity of singleplex assays using the portable microfluidic device (PMD) were 1.3 ng/ml, 2.0 ng/ml and 6.8 ng/ml for T2, FumB1 and ZEN, respectively. Sensitivity of the multiplex assay again using the PMD was 6.1 ng/ml, 3.6 ng/ml and 2.4 ng/ml for T2, FumB1 and ZEN, respectively. The PMD was an easy to use and highly sensitive screening tool which has been demonstrated for the multiplex detection of three regulated mycotoxins. Analysis was in real time and results were fully digital. Since detection of analytes was by mass it was both a label-free and cost-efficient method proposed method of analysis for mycotoxins.
Collapse
Affiliation(s)
- P Nolan
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, 19 Chlorine Gardens, Belfast, UK, BT9 5DL
| | - S Auer
- BioMensio Limited, Hermiankatu 6-8H, 33720, Tampere, Finland
| | - A Spehar
- BioMensio Limited, Hermiankatu 6-8H, 33720, Tampere, Finland
| | - M Oplatowska-Stachowiak
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, 19 Chlorine Gardens, Belfast, UK, BT9 5DL
| | - K Campbell
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, 19 Chlorine Gardens, Belfast, UK, BT9 5DL.
| |
Collapse
|
40
|
Ehrmann DE, Leopold DK, Phillips R, Shahi N, Campbell K, Ross M, Zablah JE, Moulton SL, Morgan G, Kim JS. The Compensatory Reserve Index Responds to Acute Hemodynamic Changes in Patients with Congenital Heart Disease: A Proof of Concept Study. Pediatr Cardiol 2020; 41:1190-1198. [PMID: 32474738 DOI: 10.1007/s00246-020-02374-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 05/22/2020] [Indexed: 12/17/2022]
Abstract
Patients with congenital heart disease (CHD) who undergo cardiac procedures may become hemodynamically unstable. Predictive algorithms that utilize dense physiologic data may be useful. The compensatory reserve index (CRI) trends beat-to-beat progression from normovolemia (CRI = 1) to decompensation (CRI = 0) in hemorrhagic shock by continuously analyzing unique sets of features in the changing pulse photoplethysmogram (PPG) waveform. We sought to understand if the CRI accurately reflects changing hemodynamics during and after a cardiac procedure for patients with CHD. A transcatheter pulmonary valve replacement (TcPVR) model was used because left ventricular stroke volume decreases upon sizing balloon occlusion of the right ventricular outflow tract (RVOT) and increases after successful valve placement. A single-center, prospective cohort study was performed. The CRI was continuously measured to determine the change in CRI before and after RVOT occlusion and successful TcPVR. Twenty-six subjects were enrolled with a median age of 19 (interquartile range (IQR) 13-29) years. The mean (± standard deviation) CRI decreased from 0.66 ± 0.15 1-min before balloon inflation to 0.53 ± 0.16 (p = 0.03) 1-min after balloon deflation. The mean CRI increased from a pre-valve mean CRI of 0.63 [95% confidence interval (CI) 0.56-0.70] to 0.77 (95% CI 0.71-0.83) after successful TcPVR. In this study, the CRI accurately reflected acute hemodynamic changes associated with TcPVR. Further research is justified to determine if the CRI can be useful as an early warning tool in patients with CHD at risk for decompensation during and after cardiac procedures.
Collapse
Affiliation(s)
- Daniel E Ehrmann
- Division of Cardiology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, B100, Aurora, CO, 80045, USA.
| | - David K Leopold
- Department of Anesthesia, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ryan Phillips
- Division of Pediatric Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Niti Shahi
- Division of Pediatric Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kristen Campbell
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Michael Ross
- Division of Pediatric Cardiology, University of North Carolina, Chapel Hill, NC, USA
| | - Jenny E Zablah
- Division of Cardiology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, B100, Aurora, CO, 80045, USA
| | - Steven L Moulton
- Division of Pediatric Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Gareth Morgan
- Division of Cardiology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, B100, Aurora, CO, 80045, USA
| | - John S Kim
- Division of Cardiology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, B100, Aurora, CO, 80045, USA
| |
Collapse
|
41
|
Van Tiggelen H, LeBlanc K, Campbell K, Woo K, Baranoski S, Chang Y, Dunk A, Gloeckner M, Hevia H, Holloway S, Idensohn P, Karadağ A, Koren E, Kottner J, Langemo D, Ousey K, Pokorná A, Romanelli M, Santos V, Smet S, Tariq G, Van den Bussche K, Van Hecke A, Verhaeghe S, Vuagnat H, Williams A, Beeckman D. Standardizing the classification of skin tears: validity and reliability testing of the International Skin Tear Advisory Panel Classification System in 44 countries. Br J Dermatol 2020; 183:146-154. [PMID: 31605618 PMCID: PMC7384145 DOI: 10.1111/bjd.18604] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Skin tears are acute wounds that are frequently misdiagnosed and under-reported. A standardized and globally adopted skin tear classification system with supporting evidence for diagnostic validity and reliability is required to allow assessment and reporting in a consistent way. OBJECTIVES To measure the validity and reliability of the International Skin Tear Advisory Panel (ISTAP) Classification System internationally. METHODS A multicountry study was set up to validate the content of the ISTAP Classification System through expert consultation in a two-round Delphi procedure involving 17 experts from 11 countries. An online survey including 24 skin tear photographs was conducted in a convenience sample of 1601 healthcare professionals from 44 countries to measure diagnostic accuracy, agreement, inter-rater reliability and intrarater reliability of the instrument. RESULTS A definition for the concept of a 'skin flap' in the area of skin tears was developed and added to the initial ISTAP Classification System consisting of three skin tear types. The overall agreement with the reference standard was 0·79 [95% confidence interval (CI) 0·79-0·80] and sensitivity ranged from 0·74 (95% CI 0·73-0·75) to 0·88 (95% CI 0·87-0·88). The inter-rater reliability was 0·57 (95% CI 0·57-0·57). The Cohen's Kappa measuring intrarater reliability was 0·74 (95% CI 0·73-0·75). CONCLUSIONS The ISTAP Classification System is supported by evidence for validity and reliability. The ISTAP Classification System should be used for systematic assessment and reporting of skin tears in clinical practice and research globally. What's already known about this topic? Skin tears are common acute wounds that are misdiagnosed and under-reported too often. A skin tear classification system is needed to standardize documentation and description for clinical practice, audit and research. What does this study add? The International Skin Tear Advisory Panel Classification System was psychometrically tested in 1601 healthcare professionals from 44 countries. Diagnostic accuracy was high when differentiating between type 1, 2 and 3 skin tears using a set of validated photographs.
Collapse
|
42
|
Nellan A, Wright E, Campbell K, Davies KD, Donson AM, Amani V, Judd A, Hemenway MS, Raybin J, Foreman NK, Rush S, Dorris K. Retrospective analysis of combination carboplatin and vinblastine for pediatric low-grade glioma. J Neurooncol 2020; 148:569-575. [PMID: 32506370 DOI: 10.1007/s11060-020-03549-x] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/29/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Low-grade glioma (LGG) represent the most common pediatric central nervous system tumor. When total surgical resection is not feasible, chemotherapy is first-line therapy in children. Multiple pediatric LGG chemotherapy regimens have been investigated with variable 2-year event free survival (EFS) rates of 39-69%. To date, treatment of pediatric LGG with a carboplatin and vinblastine (C/VBL) chemotherapy regimen has only been evaluated in a phase 1 dose-finding study. METHODS A retrospective review of pediatric patients with LGG who were treated with C/VBL at Children's Hospital of Colorado or Akron Children's Hospital from 2011 to 2017 was conducted. Data collected included patient demographics, tumor location, disease response, neurofibromatosis 1 (NF1) status, therapy duration and toxicities. Response to therapy was determined by objective findings on imaging and treating physicians' evaluation. RESULTS Forty-six patients were identified for analysis, all of whom were chemotherapy-naive. Only five patients treated in this cohort had NF1. BRAF fusion was identified in 65% (22/34) of tested tumors. Best therapy response was partial response in nine patients and stable disease in twenty-five patients. Twelve patients had progressive disease. One-year, 3-year, and 5-year EFS probabilities for all patients were 69.6%, 39.4%, and 34.5%, respectively. Nine patients had admissions for febrile neutropenia and seven patients experienced one delay in chemotherapy due to neutropenia. Only two patients had to discontinue this chemotherapy regimen because of treatment-related toxicities [carboplatin allergy (n = 1) and vinblastine neuropathy (n = 1)]. CONCLUSION C/VBL achieves similar EFS rates to other single-agent and combination cytotoxic chemotherapy regimens for pediatric LGG with manageable toxicities.
Collapse
Affiliation(s)
- Anandani Nellan
- Department of Pediatrics, Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. .,Center for Cancer and Blood Disorders, Morgan Adams Foundation Pediatric Brain Tumor Research Program, University of Colorado School of Medicine, 13123 East 16th Avenue, Box B115, Aurora, CO, 80045, USA.
| | - Erin Wright
- Division of Hematology Oncology, Akron Children's Hospital, One Perkins Square, Akron, OH, 44308, USA
| | - Kristen Campbell
- Department of Pediatrics, Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kurtis D Davies
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Andrew M Donson
- Department of Pediatrics, Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Vladimir Amani
- Department of Pediatrics, Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Alexis Judd
- Division of Hematology Oncology, Akron Children's Hospital, One Perkins Square, Akron, OH, 44308, USA
| | - Molly S Hemenway
- Department of Pediatrics, Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jennifer Raybin
- Department of Pediatrics, Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Nicholas K Foreman
- Department of Pediatrics, Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sarah Rush
- Division of Hematology Oncology, Akron Children's Hospital, One Perkins Square, Akron, OH, 44308, USA
| | - Kathleen Dorris
- Department of Pediatrics, Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|
43
|
Zhang L, Fekete N, Campbell K. 3D MSC Culture in Saint-Gobain VueLife® FEP Bags Using Microcarriers. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.04.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
44
|
Mann SE, Zhou Z, Landry LG, Anderson AM, Alkanani AK, Fischer J, Peakman M, Mallone R, Campbell K, Michels AW, Nakayama M. Multiplex T Cell Stimulation Assay Utilizing a T Cell Activation Reporter-Based Detection System. Front Immunol 2020; 11:633. [PMID: 32328071 PMCID: PMC7160884 DOI: 10.3389/fimmu.2020.00633] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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] [Received: 01/10/2020] [Accepted: 03/19/2020] [Indexed: 12/14/2022] Open
Abstract
Recent advancements in single cell sequencing technologies allow for identification of numerous immune-receptors expressed by T cells such as tumor-specific and autoimmune T cells. Determining antigen specificity of those cells holds immense therapeutic promise. Therefore, the purpose of this study was to develop a method that can efficiently test antigen reactivity of multiple T cell receptors (TCRs) with limited cost, time, and labor. Nuclear factor of activated T cells (NFAT) is a transcription factor involved in producing cytokines and is often utilized as a reporter system for T cell activation. Using a NFAT-based fluorescent reporter system, we generated T-hybridoma cell lines that express intensely fluorescent proteins in response to antigen stimulation and constitutively express additional fluorescent proteins, which serve as identifiers of each T-hybridoma expressing a unique TCR. This allows for the combination of multiple T-hybridoma lines within a single reaction. Sensitivity to stimulation is not decreased by adding fluorescent proteins or multiplexing T cells. In multiplexed reactions, response by one cell line does not induce response in others, thus preserving specificity. This multiplex assay system will be a useful tool for antigen discovery research in a variety of contexts, including using combinatorial peptide libraries to determine T cell epitopes.
Collapse
Affiliation(s)
- Sarah E. Mann
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO, United States
| | - Zhicheng Zhou
- CNRS, INSERM, Institut Cochin, Université de Paris, Paris, France
| | - Laurie G. Landry
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO, United States
| | - Amanda M. Anderson
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO, United States
| | - Aimon K. Alkanani
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO, United States
| | - Jeremy Fischer
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO, United States
| | - Mark Peakman
- Department of Immunobiology, School of Immunology & Microbial Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Roberto Mallone
- CNRS, INSERM, Institut Cochin, Université de Paris, Paris, France
- Assistance Publique - Hôpitaux de Paris, Service de Diabétologie et Immunologie Clinique, Cochin Hospital, Paris, France
| | - Kristen Campbell
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States
| | - Aaron W. Michels
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO, United States
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States
| | - Maki Nakayama
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO, United States
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States
- Department of Immunology & Microbiology, University of Colorado School of Medicine, Aurora, CO, United States
| |
Collapse
|
45
|
Taleb I, Wever-Pinzon O, Yin M, Kfoury A, Caine W, Stehlik J, Catino A, Wever-Pinzon J, Bonios M, McKellar S, Alharethi R, Koliopoulou A, Fang J, Selzman C, Dranow E, Shah P, Singh R, Psotka M, Zhu W, Slaughter M, Birks E, Koenig S, Kanwar M, Kyvernitakis A, Hoffman K, Guglin M, Kotter J, Campbell K, Drakos S. Predicting Cardiac Structural and Functional Improvement Induced by Mechanical Unloading in Chronic Heart Failure: A Derivation-Validation Multicenter Study. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1052] [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: 10/24/2022] Open
|
46
|
Abstract
Hand and foot burns in children are difficult to dress. The authors have developed a soft casting technique to manage burns to these areas. The aim of this study is to report the outcomes using weekly dressing changes with a soft casting technique to manage pediatric hand and foot burns in the outpatient setting. A retrospective chart review was performed on children with burns to the hands or feet, who underwent dressing changes with a soft casting technique at the Children's Hospital Colorado Burn Center. Soft casting was performed by placing antibiotic ointment-impregnated nonadherent gauze over the burn wound(s), wrapping the extremity using rolled gauze, applying soft cast pad, plaster, soft cast tape, and an elastic bandage. This was changed weekly. Two hundred ninety-eight children with hand burns had a mean age of 16.8 ± 2 months. Two hundred forty-eight children had partial thickness burn injuries (83%), 50 had full thickness burn injuries (17%), and the mean total body surface area (TBSA) was 1 ± 2.4%. The mean time to heal was 10.1 ± 1.7 days for all subjects. Sixty-six children with foot burns were identified with a mean age of 24 ± 2.6 months. Forty-six children had partial thickness injuries (70%), 20 had full thickness burn injuries (30%), and the mean TBSA was 2.3 ± 2.9%. The mean time to heal was 14.1 ± 2.2 days for all subjects. Weekly dressing changes using a soft casting technique are effective for the outpatient management of pediatric hand and foot burns. This method avoids costly inpatient hospital care, reduces the number of painful dressing changes, and allows children to heal in their own environment.
Collapse
Affiliation(s)
- Young Mee Choi
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado.,Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Cindy Nederveld
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Kristen Campbell
- University of Colorado School of Public Health, Aurora, Colorado
| | - Steven Moulton
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado.,Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| |
Collapse
|
47
|
Pérez-Díaz IM, Dickey AN, Fitria R, Ravishankar N, Hayes J, Campbell K, Arritt F. Modulation of the bacterial population in commercial cucumber fermentations by brining salt type. J Appl Microbiol 2020; 128:1678-1693. [PMID: 31997433 DOI: 10.1111/jam.14597] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/06/2020] [Accepted: 01/21/2020] [Indexed: 11/28/2022]
Abstract
AIMS Differences in the bacterial population of cucumber fermentations brined with no salt, 100 mmol l-1 (1·1%) calcium chloride (CaCl2 ) or 1·03 mol l-1 (6%) sodium chloride (NaCl) were studied. METHODS AND RESULTS Changes in the microbiology and chemistry of commercial and laboratory scale cucumber fermentations occurring as a function of time were monitored using colony counts and metagenetic analysis, and a pH probe and high-performance liquid chromatography analysis respectively. Dissolved oxygen and carbon dioxide content were monitored in commercial fermentations. Fermentations brined with calcium chloride (CaCl2 ) or no salt sustained faster microbial growth and reduction in pH than those brined with 1·03 mol l-1 NaCl. Leuconostoc, Lactococcus and Weissella dominated in fermentations brined with no salt or 100 mmol l-1 CaCl2 on day 1 as compared to Weissella and enterobacteria in fermentations containing 1·03 mol l-1 NaCl. Lactobacilli dominated all fermentations by the third day, regardless of salt type, and was followed, in relative abundance by Pediococcus, Leuconostoc, Lactococcus and Weissella. From 84 to 96% of the population was composed of Lactobacillus by day 7 of the fermentations, except in the no salt fermentations in which a mixed population of LAB remained. The population of LAB found in commercial cucumber fermentations brined with 100 mmol l-1 CaCl2 (n = 18) or 1·03 mol l-1 NaCl (n = 9) mimicked that of laboratory fermentations. A declining population of aerobes was detected in commercial fermentations brined with CaCl2 on day 1. CONCLUSION A reduced NaCl content in cucumber fermentation enhances microbial diversity. SIGNIFICANCE AND IMPACT OF THE STUDY This study fills a knowledge gap and aids in the design of improved reduced NaCl cucumber fermentations.
Collapse
Affiliation(s)
- I M Pérez-Díaz
- Food Science Research Unit, USDA-Agricultural Research Service, SEA, Raleigh, NC, USA
| | - A N Dickey
- Bioinformatics Research Center, North Carolina State University, Raleigh, NC, USA
| | - R Fitria
- Department of Food, Bioprocessing, and Nutrition Sciences, North Carolina State University, Raleigh, NC, USA
| | - N Ravishankar
- Department of Food, Bioprocessing, and Nutrition Sciences, North Carolina State University, Raleigh, NC, USA
| | - J Hayes
- Food Science Research Unit, USDA-Agricultural Research Service, SEA, Raleigh, NC, USA
| | - K Campbell
- Mount Olive Pickle Company, Mount Olive, NC, USA
| | - F Arritt
- Mount Olive Pickle Company, Mount Olive, NC, USA
| |
Collapse
|
48
|
Tinkle CL, Campbell K, Han Y, Li Y, Bianski B, Broniscer A, Khan RB, Merchant TE. Radiation dose response of neurologic symptoms during conformal radiotherapy for diffuse intrinsic pontine glioma. J Neurooncol 2020; 147:195-203. [PMID: 32016716 DOI: 10.1007/s11060-020-03415-w] [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: 12/16/2019] [Revised: 01/26/2020] [Accepted: 01/28/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE To estimate the rate and magnitude of neurologic symptom change during radiation therapy (RT) and impact of symptom change on survival outcomes in patients with diffuse intrinsic pontine glioma (DIPG). METHODS From 2006 to 2014, 108 patients with newly diagnosed DIPG were treated with conventionally fractionated radiation therapy (RT) to 54 Gy (median) at our institution. The presence and severity of neurologic symptoms related to cranial neuropathy (CN) and cerebellar (CB) and long-tract (LT) signs was reviewed before and weekly during RT for each patient. The rate and magnitude of change for each symptom category was evaluated according to accumulated RT dose. The impact of clinical factors and radiation dose-volume parameters was determined using Cox proportional hazards models. RESULTS Median dose to first sign of symptomatic improvement was 16.2 Gy (CN), 19.8 Gy (LT) and 21.6 Gy (CB). Most patients showed an improvement by 20 Gy. Larger uninvolved brainstem volume, alone or normalized to total brain (TB) or posterior fossa volume (PF), was associated with shorter time to LT sign improvement (P = 0.044, P = 0.033, and P = 0.05, respectively). Patients with any improvement in CN experienced significantly, yet modestly, prolonged progression-free survival (PFS) and overall survival (OS) (P = 0.002 and P = 0.008, respectively). Tumor volume, with or without normalization to TB or PF, was not significantly associated with PFS or OS. CONCLUSIONS Low cumulative RT doses resulted in neurologic improvement in most patients with DIPG. The volume of brainstem spared by tumor influenced time to symptomatic improvement. Neurologic improvement during RT was associated with superior survival.
Collapse
Affiliation(s)
- Christopher L Tinkle
- Departments of Radiation Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 210, Memphis, TN, USA.
| | - Kristen Campbell
- Departments of Radiation Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 210, Memphis, TN, USA.,College of Medicine, University of Tennessee Health Science Center, Knoxville, TN, USA
| | - Yuanyuan Han
- Departments of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Yimei Li
- Departments of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Brandon Bianski
- Departments of Radiation Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 210, Memphis, TN, USA
| | - Alberto Broniscer
- Departments of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Raja B Khan
- Departments of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.,Division of Neurology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Thomas E Merchant
- Departments of Radiation Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 210, Memphis, TN, USA
| |
Collapse
|
49
|
Tsagkaris A, Nelis J, Ross G, Jafari S, Guercetti J, Kopper K, Zhao Y, Rafferty K, Salvador J, Migliorelli D, Salentijn G, Campbell K, Marco M, Elliot C, Nielen M, Pulkrabova J, Hajslova J. Critical assessment of recent trends related to screening and confirmatory analytical methods for selected food contaminants and allergens. Trends Analyt Chem 2019. [DOI: 10.1016/j.trac.2019.115688] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
|
50
|
Abstract
We evaluated the efficacy of 670 G HCL on changes in HbA1c and continuous glucose monitor (CGM)-based glucose metrics at 3 and 6 months between five adults with T1D with gastroparesis and nine age-, sex-, and diabetes duration-matched T1D without gastroparesis. At baseline, there were no differences in age, gender, diabetes duration, and total daily insulin requirement between two groups. Median duration of gastroparesis diagnosis was 4.3 years (interquartile range [IQR]: 3.7, 5.9 years). Reduction in HbA1c [difference in HbA1c from baseline to 6 months, median (IQR): 0.3% (0.3%, 0.3%) vs. 0.5% (0.3%, 0.9%); P = 0.20] and CGM time spent in normoglycemia at 6 months [median (IQR): 73% (68%, 80%) vs. 67% (64%, 74%); P = 0.24] were not different between the groups. HCL has similar efficacy in glucose control in adults with T1D with gastroparesis and appears to be safe in this population.
Collapse
Affiliation(s)
- Harsahiba Kaur
- Sunrise Health Consortium, Southern Hills Hospital Family Medicine GME, Las Vegas, Nevada
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Nicole Schneider
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Laura Pyle
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Department of Biostatistics and Informatics, School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kristen Campbell
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Halis K Akturk
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Viral N Shah
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| |
Collapse
|