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King AA, Rodeghier MJ, Panepinto JA, Strouse JJ, Casella JF, Quinn CT, Dowling MM, Sarnaik SA, Thompson AA, Woods GM, Minniti CP, Redding-Lallinger RC, Kirby-Allen M, Kirkham FJ, McKinstry R, Noetzel MJ, White DA, Kwiatkowski JK, Howard TH, Kalinyak KA, Inusa B, Rhodes MM, Heiny ME, Fuh B, Fixler JM, Gordon MO, DeBaun MR. Silent cerebral infarction, income, and grade retention among students with sickle cell anemia. Am J Hematol 2014; 89:E188-92. [PMID: 25042018 DOI: 10.1002/ajh.23805] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 07/10/2014] [Accepted: 07/11/2014] [Indexed: 11/11/2022]
Abstract
Children with sickle cell anemia have a higher-than-expected prevalence of poor educational attainment. We test two key hypotheses about educational attainment among students with sickle cell anemia, as measured by grade retention and use of special education services: (1) lower household per capita income is associated with lower educational attainment; (2) the presence of a silent cerebral infarct is associated with lower educational attainment. We conducted a multicenter, cross-sectional study of cases from 22 U.S. sites included in the Silent Infarct Transfusion Trial. During screening, parents completed a questionnaire that included sociodemographic information and details of their child's academic status. Of 835 students, 670 were evaluable; 536 had data on all covariates and were used for analysis. The students' mean age was 9.4 years (range: 5-15) with 52.2% male; 17.5% of students were retained one grade level and 18.3% received special education services. A multiple variable logistic regression model identified that lower household per capita income (odds ratio [OR] of quartile 1 = 6.36, OR of quartile 2 = 4.7, OR of quartile 3 = 3.87; P = 0.001 for linear trend), age (OR = 1.3; P < 0.001), and male gender (OR, 2.2; P = 0.001) were associated with grade retention; silent cerebral infarct (P = 0.31) and painful episodes (P = 0.60) were not. Among students with sickle cell anemia, household per capita income is associated with grade retention, whereas the presence of a silent cerebral infarct is not. Future educational interventions will need to address both the medical and socioeconomic issues that affect students with sickle cell anemia.
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Affiliation(s)
- Allison A. King
- Program in Occupational Therapy and Department of Pediatrics, Hematology/Oncology, Washington University School of Medicine; St. Louis Missouri
| | | | - Julie Ann Panepinto
- Division of Hematology/Oncology; Department of Pediatrics; Medical College of Wisconsin; Milwaukee Wisconsin
| | - John J. Strouse
- Division of Hematology/Oncology; Department of Pediatrics; Hematology/Oncology; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - James F. Casella
- Division of Hematology/Oncology; Department of Pediatrics; Hematology/Oncology; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Charles T. Quinn
- Division of Hematology/Oncology; Department of Pediatrics; Cincinnati Children's Hospital Medical Center and University of Cincinnati; Cincinnati Ohio
| | - Michael M. Dowling
- Departments of Pediatrics; Neurology; and Neurotherapeutics; University of Texas Southwestern Medical School; Dallas Texas
| | - Sharada A. Sarnaik
- Division of Hematology/Oncology; Department of Pediatrics; Wayne State University; Detroit Michigan
| | - Alexis A. Thompson
- Division of Hematology/Oncology; Department of Pediatrics; Northwestern University; Chicago Illinois
| | - Gerald M. Woods
- Division of Hematology/Oncology; Department of Pediatrics; University of Missouri-Kansas City; Kansas City Missouri
| | - Caterina P. Minniti
- National Heart; Lung and Blood Institute; National Institutes of Health; Bethesda Maryland
| | - Rupa C. Redding-Lallinger
- Division of Hematology/Oncology; Department of Pediatrics; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | | | - Fenella J. Kirkham
- Neurosciences Unit; Institute of Child Health; University College London; London United Kingdom
| | - Robert McKinstry
- Department of Radiology; Washington University School of Medicine; St. Louis Missouri
| | - Michael J. Noetzel
- Departments of Neurology and Pediatrics; Washington University School of Medicine; St. Louis Missouri
| | - Desiree A. White
- Department of Psychology; Washington University; St. Louis Missouri
| | - Janet K. Kwiatkowski
- Division of Hematology/Oncology; Department of Pediatrics; University of Pennsylvania, Children's Hospital of Philadelphia; Philadelphia Pennsylvania
| | - Thomas H. Howard
- Division of Hematology/Oncology; Department of Pediatrics; University of Alabama at Birmingham; Birmingham Alabama
| | - Karen A. Kalinyak
- Division of Hematology/Oncology; Department of Pediatrics; Cincinnati Children's Hospital Medical Center and University of Cincinnati; Cincinnati Ohio
| | - Baba Inusa
- Department of Paediatrics; Evelina Children's Hospital; St Thomas' Hospital National Health Service Trust; London United Kingdom
| | - Melissa M. Rhodes
- Division of Hematology/Oncology; Department of Pediatrics; The Ohio State University; Columbus Ohio
| | - Mark E. Heiny
- Division of Hematology/Oncology; Department of Pediatrics; Indiana University-Purdue University Indiana; Indianapolis Indiana
| | - Ben Fuh
- Division of Hematology/Oncology; Department of Pediatrics; Brody School of Medicine; Greenville North Carolina
| | - Jason M. Fixler
- Division of Hematology/Oncology; Department of Pediatrics; Sinai Hospital; Baltimore Maryland
| | - Mae O. Gordon
- Department of Ophthalmology and Visual Sciences; Biostatistics; Washington University School of Medicine; St. Louis Missouri
| | - Michael R. DeBaun
- Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease; Division of Hematology/Oncology; Department of Pediatrics; Vanderbilt University; Nashville Tennessee
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DeBaun MR, Gordon M, McKinstry RC, Noetzel MJ, White DA, Sarnaik SA, Meier ER, Howard TH, Majumdar S, Inusa BPD, Telfer PT, Kirby-Allen M, McCavit TL, Kamdem A, Airewele G, Woods GM, Berman B, Panepinto JA, Fuh BR, Kwiatkowski JL, King AA, Fixler JM, Rhodes MM, Thompson AA, Heiny ME, Redding-Lallinger RC, Kirkham FJ, Dixon N, Gonzalez CE, Kalinyak KA, Quinn CT, Strouse JJ, Miller JP, Lehmann H, Kraut MA, Ball WS, Hirtz D, Casella JF. Controlled trial of transfusions for silent cerebral infarcts in sickle cell anemia. N Engl J Med 2014; 371:699-710. [PMID: 25140956 PMCID: PMC4195437 DOI: 10.1056/nejmoa1401731] [Citation(s) in RCA: 350] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Silent cerebral infarcts are the most common neurologic injury in children with sickle cell anemia and are associated with the recurrence of an infarct (stroke or silent cerebral infarct). We tested the hypothesis that the incidence of the recurrence of an infarct would be lower among children who underwent regular blood-transfusion therapy than among those who received standard care. METHODS In this randomized, single-blind clinical trial, we randomly assigned children with sickle cell anemia to receive regular blood transfusions (transfusion group) or standard care (observation group). Participants were between 5 and 15 years of age, with no history of stroke and with one or more silent cerebral infarcts on magnetic resonance imaging and a neurologic examination showing no abnormalities corresponding to these lesions. The primary end point was the recurrence of an infarct, defined as a stroke or a new or enlarged silent cerebral infarct. RESULTS A total of 196 children (mean age, 10 years) were randomly assigned to the observation or transfusion group and were followed for a median of 3 years. In the transfusion group, 6 of 99 children (6%) had an end-point event (1 had a stroke, and 5 had new or enlarged silent cerebral infarcts). In the observation group, 14 of 97 children (14%) had an end-point event (7 had strokes, and 7 had new or enlarged silent cerebral infarcts). The incidence of the primary end point in the transfusion and observation groups was 2.0 and 4.8 events, respectively, per 100 years at risk, corresponding to an incidence rate ratio of 0.41 (95% confidence interval, 0.12 to 0.99; P=0.04). CONCLUSIONS Regular blood-transfusion therapy significantly reduced the incidence of the recurrence of cerebral infarct in children with sickle cell anemia. (Funded by the National Institute of Neurological Disorders and Stroke and others; Silent Cerebral Infarct Multi-Center Clinical Trial ClinicalTrials.gov number, NCT00072761, and Current Controlled Trials number, ISRCTN52713285.).
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Affiliation(s)
- Michael R DeBaun
- From the Department of Pediatrics, Division of Hematology-Oncology, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University School of Medicine, Nashville (M.R.D.); Department of Ophthalmology and Visual Sciences, Division of Biostatistics (M.G.), Departments of Radiology and Pediatrics (R.C.M.), Neurology and Pediatrics (M.J.N.), and Psychology (D.A.W.), the Program in Occupational Therapy and Department of Pediatrics Hematology-Oncology (A.A.K.), and the Division of Biostatistics and Department of Internal Medicine (J.P.M.), Washington University School of Medicine, St. Louis; Department of Pediatrics, Division of Hematology-Oncology, Wayne State University, Detroit (S.A.S.); Center for Cancer and Blood Disorders, Children's National Medical Center, Department of Pediatrics, George Washington University Medical Center (E.R.M.), and Department of Pediatrics, Division of Hematology-Oncology, Georgetown University Hospital (C.E.G.) - all in Washington, DC; Department of Pediatrics, Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham (T.H.H.); Department of Pediatrics, Division of Hematology-Oncology, University of Mississippi Medical Center, Jackson (S.M.); Department of Paediatrics, Evelina Children's Hospital, St. Thomas' Hospital NHS Trust (B.P.D.I.), Department of Pediatric Hematology, Royal London Hospital, Barts Health NHS Trust (P.T.T.), and the Neurosciences Unit, Institute of Child Health, University College London (F.J.K.) - all in London; Hospital for Sick Children, Department of Paediatrics, Haematology-Oncology, University of Toronto, Toronto (M.K.-A.); Division of Hematology-Oncology, Department of Pediatrics, UT Southwestern Medical Center, Dallas (T.L.M.C.); Département Pédiatrie, Hôpital Intercommunal de Creteil, Creteil, France (A.K.); Department of Pediatrics, Division of Hematology-Oncology, Baylor College of Medicine, Houston (G.A.); Department of Pediatrics, Hematology-Oncology, Univer
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Johal SC, Garg BP, Heiny ME, Williams LS, Saha C, Walsh LE, Golomb MR. Family history is a poor screen for prothrombotic genes in children with stroke. J Pediatr 2006; 148:68-71. [PMID: 16423600 DOI: 10.1016/j.jpeds.2005.08.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2005] [Revised: 07/07/2005] [Accepted: 08/03/2005] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate family history of early pathological thrombosis as a screen for genetic prothrombotic risk factors in children with stroke. STUDY DESIGN A 5-year retrospective review of standardized pediatric stroke clinic evaluations of children with arterial ischemic stroke (AIS) or sinovenous thrombosis (SVT). A family history of early pathological thrombosis was defined as stroke, heart attack, or deep venous thrombosis before 50 years of age or multiple miscarriages in the parents or grandparents of the patient. We evaluated the association between family history and the presence of the Factor V Leiden mutation (FVL) and/or Prothrombin G20210A mutation (PTG) in these children. RESULTS The study included 68 children. Thirteen (19.1%) had a positive family history of early pathological thrombosis, nine (13.2%) were heterozygous for FVL, and one (1.5%) was heterozygous for PTG. Family history was not associated with the presence of FVL (p = .36) or FVL combined with PTG (p = .40). For FVL, family history had a positive predictive value of 23.1% and a negative predictive value of 89.1%. CONCLUSION A family history of early thrombosis is not associated with the presence of FVL or PTG in children with stroke. We recommend that all children with stroke receive a prothrombotic workup regardless of family history.
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Affiliation(s)
- Sheila C Johal
- Department of Medical Genetics, Division of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA
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Kokoska ER, West KW, Carney DE, Engum SE, Heiny ME, Rescorla FJ. Risk factors for acute chest syndrome in children with sickle cell disease undergoing abdominal surgery. J Pediatr Surg 2004; 39:848-50. [PMID: 15185210 DOI: 10.1016/j.jpedsurg.2004.02.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND/PURPOSE The reported incidence of acute chest syndrome (ACS) in children with sickle cell disease (SCD) is 15% to 20%. Our current objective was to assess risk factors and morbidity associated with ACS. METHODS The authors reviewed the outcome of children with SCD undergoing abdominal surgery over a 10-year period. RESULTS From 1991 to 2003, 60 children underwent laparoscopic cholecystectomy (LC; n = 29), laparoscopic splenectomy (LS; n = 28), or both (LB; n = 3). Mean age was 8.6 (0.7 to 20) years, and 35 (58%) were boys. Fifty-four (90%) had a preoperative hemoglobin greater than 10 g/dL, but only 22 (37%) received routine oxygen after surgery. No surgery was converted to an open procedure. Four children (6.6%), all of whom underwent either LS or LB, had ACS associated with an increased length of stay (7.4 +/- 2.4 days) but no mortality. Factors associated with the development of ACS were age (3.0 +/- 1.7 v 9.4 +/- 5.7 years; P =.03), weight (12.1 +/- 3.0 v 32.6 +/- 18.2 kg; P =.04), operative blood loss (3.2 +/- 0.5 v 1.4 +/- 1.2 mL/kg; P =.03), and final temperature in the operating room (OR; 36.2 +/- 0.4 v 37.6 +/- 0.4 degrees C; P =.01). ACS was not significantly related to duration of surgery, OR fluids, or oxygen usage. CONCLUSIONS Younger children with greater blood and heat loss during surgery appear more prone to ACS. Splenectomy also seems to increase the risk of ACS. The authors' current incidence (6.6%) of ACS in children with SCD undergoing abdominal surgery is much lower than previously reported. This may be explained by the aggressive use of preoperative blood transfusion or more routine use of laparoscopy.
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Affiliation(s)
- E R Kokoska
- Division of Pediatric Surgery, J.W. Riley Children's Hospital, Indianapolis, IN 46202, USA
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Yamaguchi Y, Heiny ME, Suzuki M, Gitlin JD. Biochemical characterization and intracellular localization of the Menkes disease protein. Proc Natl Acad Sci U S A 1996; 93:14030-5. [PMID: 8943055 PMCID: PMC19489 DOI: 10.1073/pnas.93.24.14030] [Citation(s) in RCA: 163] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Menkes disease is a fatal neurodegenerative disorder of childhood due to the absence or dysfunction of a putative copper-transporting P-type ATPase encoded on the X chromosome. To elucidate the biosynthesis and subcellular localization of this protein, polyclonal antisera were generated against a bacterial fusion protein encoding the 4th to 6th copper-binding domains in the amino terminus of the human Menkes protein. RNA blot analysis revealed abundant Menkes gene expression in several cell lines, and immunoblotting studies utilizing this antiserum readily detected a 178-kDa protein in lysates from these cells. Pulse-chase studies indicate that this protein is synthesized as a single-chain polypeptide which is modified by N-linked glycosylation to a mature endoglycosidase H-resistant form. Sucrose gradient fractionation of HeLa cell lysates followed by immunoblotting of individual fractions with antibodies to proteins of known intracellular location identified the Menkes ATPase in fractions similar to those containing the cation-independent mannose-6-phosphate receptor. Consistent with this observation, confocal immunofluorescence studies of these same cells localized this protein to the trans-Golgi network and a vesicular compartment with no expression in the nucleus or on the plasma membrane. Taken together, these data provide a unique model of copper transport into the secretory pathway of mammalian cells which is compatible with clinical observations in affected patients and with recent data on homologous proteins identified in prokaryotes and yeast.
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Affiliation(s)
- Y Yamaguchi
- Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110, USA
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Abstract
Long-Evans Cinnamon rats develop a necrotizing hepatitis characterized by excessive hepatic copper accumulation, defective holoceruloplasmin biosynthesis and impaired biliary copper excretion. To elucidate the molecular basis of this defect, a cDNA clone encoding the rat Wilson disease gene was isolated and used to examine gene expression in selected tissues from normal and Long-Evans Cinnamon rats. Although this cDNA readily detects Wilson transcripts in liver and other tissues from normal rats, such transcripts are entirely absent from tissues derived from the Long-Evans Cinnamon rat strain. These data therefore identify the Long-Evans Cinnamon rat as the first bona fide animal model of Wilson disease and suggest that this rat strain may be a valuable resource in the study of this genetic disorder.
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Affiliation(s)
- Y Yamaguchi
- Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110
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Abstract
The putative copper and ATP-binding domains of the human Menkes disease gene were used as probes to screen a human liver cDNA library at reduced stringency. Sixty-five clones which remained positive after tertiary screening were subcloned and sequenced. One of these cDNA clones contains an open reading frame with 65% amino acid homology to the Menkes protein. Southern blot analysis localizes this cDNA to the region of the Wilson disease locus on chromosome 13. This cDNA detects a 7.5 kB transcript which is present in human liver and cell lines devoid of the Menkes transcript and which is absent in liver from a patient with Wilson disease. These data suggest that this cDNA is a candidate gene for Wilson disease and that the protein encoded at this locus is a member of the P-type ATPase family.
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Affiliation(s)
- Y Yamaguchi
- Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110
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Takahashi N, Takahashi Y, Heiny ME, Putnam FW. Purification of hemopexin and its domain fragments by affinity chromatography and high-performance liquid chromatography. J Chromatogr A 1985; 326:373-85. [PMID: 3928667 DOI: 10.1016/s0021-9673(01)87463-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A method is described for the preparation of apohemopexin from Cohn Fraction IV-4 of human serum by one-step affinity chromatography on a heme-agarose column and separation of its tryptic domain fragments by high-performance liquid chromatography (HPLC). Limited tryptic digestion cleaved human apohemopexin after Arg-216 into half molecules and the N-terminal half was degraded very rapidly, whereas heme-saturated hemopexin was cleaved after Lys-101. These results suggest that hemopexin is composed of two domains that are connected by an exposed histidine-rich hinge-like region in apohemopexin which becomes inaccessible to trypsin in heme-saturated hemopexin. Also described is the preparation of apohemopexin from whole rabbit serum in two steps, heme-affinity chromatography and ion-exchange HPLC, and separation of its tryptic domain fragments by HPLC. Limited tryptic digestion also cleaves rabbit apohemopexin into half-molecules but the N-terminal half is more stable than the C-terminal half in this case. This lends support to the idea of functional differences between domains.
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