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Park G, Kadyan S, Hochuli N, Pollak J, Wang B, Salazar G, Chakrabarty P, Efron P, Sheffler J, Nagpal R. A modified Mediterranean-style diet enhances brain function via specific gut-microbiome-brain mechanisms. Gut Microbes 2024; 16:2323752. [PMID: 38444392 PMCID: PMC10936641 DOI: 10.1080/19490976.2024.2323752] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 02/22/2024] [Indexed: 03/07/2024] Open
Abstract
Alzheimer's disease (AD) is a debilitating brain disorder with rapidly mounting prevalence worldwide, yet no proven AD cure has been discovered. Using a multi-omics approach in a transgenic AD mouse model, the current study demonstrated the efficacy of a modified Mediterranean-ketogenic diet (MkD) on AD-related neurocognitive pathophysiology and underlying mechanisms related to the gut-microbiome-brain axis. The findings revealed that MkD induces profound shifts in the gut microbiome community and microbial metabolites. Most notably, MkD promoted growth of the Lactobacillus population, resulting in increased bacteria-derived lactate production. We discovered elevated levels of microbiome- and diet-derived metabolites in the serum as well, signaling their influence on the brain. Importantly, these changes in serum metabolites upregulated specific receptors that have neuroprotective effects and induced alternations in neuroinflammatory-associated pathway profiles in hippocampus. Additionally, these metabolites displayed strong favorable co-regulation relationship with gut-brain integrity and inflammatory markers, as well as neurobehavioral outcomes. The findings underscore the ameliorative effects of MkD on AD-related neurological function and the underlying gut-brain communication via modulation of the gut microbiome-metabolome arrays.
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Affiliation(s)
- Gwoncheol Park
- The Gut Biome Lab, Department of Health, Nutrition, and Food Sciences, College of Education, Health, and Human Science, Florida State University, Tallahassee, FL, USA
- Department of Health, Nutrition, and Food Sciences, College of Education, Health, and Human Science, Florida State University, Tallahassee, FL, USA
| | - Saurabh Kadyan
- The Gut Biome Lab, Department of Health, Nutrition, and Food Sciences, College of Education, Health, and Human Science, Florida State University, Tallahassee, FL, USA
- Department of Health, Nutrition, and Food Sciences, College of Education, Health, and Human Science, Florida State University, Tallahassee, FL, USA
| | - Nathaniel Hochuli
- The Gut Biome Lab, Department of Health, Nutrition, and Food Sciences, College of Education, Health, and Human Science, Florida State University, Tallahassee, FL, USA
- Department of Health, Nutrition, and Food Sciences, College of Education, Health, and Human Science, Florida State University, Tallahassee, FL, USA
| | - Julie Pollak
- Department of Chemistry and Chemical Engineering, Florida Institute of Technology, Melbourne, FL, USA
| | - Bo Wang
- Department of Chemistry and Chemical Engineering, Florida Institute of Technology, Melbourne, FL, USA
| | - Gloria Salazar
- Department of Health, Nutrition, and Food Sciences, College of Education, Health, and Human Science, Florida State University, Tallahassee, FL, USA
| | - Paramita Chakrabarty
- Center for Translational Research in Neurodegenerative Diseases, Department of Neuroscience, University of Florida, Gainesville, FL, USA
| | - Philip Efron
- Sepsis and Critical Illness Research Center, Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Julia Sheffler
- Center for Translational Behavioral Science, Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, USA
| | - Ravinder Nagpal
- The Gut Biome Lab, Department of Health, Nutrition, and Food Sciences, College of Education, Health, and Human Science, Florida State University, Tallahassee, FL, USA
- Department of Health, Nutrition, and Food Sciences, College of Education, Health, and Human Science, Florida State University, Tallahassee, FL, USA
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2
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Munley J, Nagpal R, Hanson N, Mirzaie A, Laquian L, Mohr A, Efron P, Arnaoutakis D, Cooper M. Chronic Mesenteric Ischemia Intestinal Dysbiosis Resolves After Revascularization. J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2022.06.041] [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: 11/29/2022]
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3
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Madushani RWMA, Patel V, Loftus T, Ren Y, Li HJ, Velez L, Wu Q, Adhikari L, Efron P, Segal M, Ozrazgat-Baslanti T, Rashidi P, Bihorac A. Early Biomarker Signatures in Surgical Sepsis. J Surg Res 2022; 277:372-383. [PMID: 35569215 PMCID: PMC9827429 DOI: 10.1016/j.jss.2022.04.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 03/20/2022] [Accepted: 04/08/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Sepsis has complex, time-sensitive pathophysiology and important phenotypic subgroups. The objective of this study was to use machine learning analyses of blood and urine biomarker profiles to elucidate the pathophysiologic signatures of subgroups of surgical sepsis patients. METHODS This prospective cohort study included 243 surgical sepsis patients admitted to a quaternary care center between January 2015 and June 2017. We applied hierarchical clustering to clinical variables and 42 blood and urine biomarkers to identify phenotypic subgroups in a development cohort. Clinical characteristics and short-term and long-term outcomes were compared between clusters. A naïve Bayes classifier predicted cluster labels in a validation cohort. RESULTS The development cohort contained one cluster characterized by early organ dysfunction (cluster I, n = 18) and one cluster characterized by recovery (cluster II, n = 139). Cluster I was associated with higher Acute Physiologic Assessment and Chronic Health Evaluation II (30 versus 16, P < 0.001) and SOFA scores (13 versus 5, P < 0.001), greater prevalence of chronic cardiovascular and renal disease (P < 0.001) and septic shock (78% versus 17%, P < 0.001). Cluster I had higher mortality within 14 d of sepsis onset (11% versus 1.5%, P = 0.001) and within 1 y (44% versus 20%, P = 0.032), and higher incidence of chronic critical illness (61% versus 30%, P = 0.001). The Bayes classifier achieved 95% accuracy and identified two clusters that were similar to development cohort clusters. CONCLUSIONS Machine learning analyses of clinical and biomarker variables identified an early organ dysfunction sepsis phenotype characterized by inflammation, renal dysfunction, endotheliopathy, and immunosuppression, as well as poor short-term and long-term clinical outcomes.
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Affiliation(s)
- R W M A Madushani
- University of Florida, Intelligent Critical Care Center, Gainesville, FL; Department of Medicine, Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, Florida
| | - Vishal Patel
- Department of Medicine, Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, Florida
| | - Tyler Loftus
- University of Florida, Intelligent Critical Care Center, Gainesville, FL; Department of Surgery, University of Florida, Gainesville, Florida
| | - Yuanfang Ren
- University of Florida, Intelligent Critical Care Center, Gainesville, FL; Department of Medicine, Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, Florida
| | - Han Jacob Li
- Department of Medicine, Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, Florida
| | - Laura Velez
- Department of Medicine, Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, Florida
| | - Quran Wu
- Department of Surgery, University of Florida, Gainesville, Florida; Sepsis and Critical Illness Research Center, University of Florida, Gainesville, Florida
| | - Lasith Adhikari
- University of Florida, Intelligent Critical Care Center, Gainesville, FL; Department of Medicine, Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, Florida
| | - Philip Efron
- Department of Surgery, University of Florida, Gainesville, Florida; Sepsis and Critical Illness Research Center, University of Florida, Gainesville, Florida
| | - Mark Segal
- Department of Medicine, Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, Florida; Sepsis and Critical Illness Research Center, University of Florida, Gainesville, Florida
| | - Tezcan Ozrazgat-Baslanti
- University of Florida, Intelligent Critical Care Center, Gainesville, FL; Department of Medicine, Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, Florida; Sepsis and Critical Illness Research Center, University of Florida, Gainesville, Florida
| | - Parisa Rashidi
- University of Florida, Intelligent Critical Care Center, Gainesville, FL; J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida
| | - Azra Bihorac
- University of Florida, Intelligent Critical Care Center, Gainesville, FL; Department of Medicine, Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, Florida; Sepsis and Critical Illness Research Center, University of Florida, Gainesville, Florida.
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4
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Filiberto AC, Ozrazgat-Baslanti T, Loftus TJ, Peng YC, Datta S, Efron P, Upchurch GR, Bihorac A, Cooper MA. Optimizing predictive strategies for acute kidney injury after major vascular surgery. Surgery 2021; 170:298-303. [PMID: 33648766 DOI: 10.1016/j.surg.2021.01.030] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/18/2021] [Accepted: 01/23/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Postoperative acute kidney injury is common after major vascular surgery and is associated with increased morbidity, mortality, and cost. High-performance risk stratification using a machine learning model can inform strategies that mitigate harm and optimize resource use. It is hypothesized that incorporating intraoperative data would improve machine learning model accuracy, discrimination, and precision in predicting acute kidney injury among patients undergoing major vascular surgery. METHODS A single-center retrospective cohort of 1,531 adult patients who underwent nonemergency major vascular surgery, including open aortic, endovascular aortic, and lower extremity bypass procedures, was evaluated. The validated, automated MySurgeryRisk analytics platform used electronic health record data to forecast patient-level probabilistic risk scores for postoperative acute kidney injury using random forest models with preoperative data alone and perioperative data (preoperative plus intraoperative). The MySurgeryRisk predictions were compared with each other as well as with the American Society of Anesthesiologists physical status classification. RESULTS Machine learning models using perioperative data had greater accuracy, discrimination, and precision than models using either preoperative data alone or the American Society of Anesthesiologists physical status classification (accuracy: 0.70 vs 0.64 vs 0.62, area under the receiver operating characteristics curve: 0.77 vs 0.68 vs 0.61, area under the precision-recall curve: 0.70 vs 0.58 vs 0.48). CONCLUSION In predicting acute kidney injury after major vascular surgery, machine learning approaches that incorporate dynamic intraoperative data had greater accuracy, discrimination, and precision than models using either preoperative data alone or the American Society of Anesthesiologists physical status classification. Machine learning methods have the potential for real-time identification of high-risk patients who may benefit from personalized risk-reduction strategies.
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Affiliation(s)
| | - Tezcan Ozrazgat-Baslanti
- Department of Medicine, University of Florida, Gainesville, FL; Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville FL
| | - Tyler J Loftus
- Department of Surgery, University of Florida, Gainesville, FL; Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville FL
| | - Ying-Chih Peng
- Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville FL
| | - Shounak Datta
- Department of Medicine, University of Florida, Gainesville, FL; Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville FL
| | - Philip Efron
- Department of Surgery, University of Florida, Gainesville, FL; Department of Anesthesia, University of Florida, Gainesville, FL
| | | | - Azra Bihorac
- Department of Medicine, University of Florida, Gainesville, FL; Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville FL
| | - Michol A Cooper
- Department of Surgery, University of Florida, Gainesville, FL.
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5
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Mankowski R, Anton S, Ghita G, Leeuwenburgh C, Moldawer L, Efron P, Brakenridge S, Moore F. Older Sepsis Survivors Suffer Persistent Disability Burden and Poor Long-Term Survival. Innov Aging 2020. [PMCID: PMC7740927 DOI: 10.1093/geroni/igaa057.454] [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: 11/12/2022] Open
Abstract
As in-hospital sepsis mortality has decreased, more “sepsis survivors” are progressing into poorly characterized long-term outcomes. The purpose of this study was to describe the current epidemiology of sepsis in older adults compared to middle-aged and young adults. Design: Prospective longitudinal study with patients categorized into young (≤ 45 years), middle-aged (46-64 years) and older (≥ 65 years) patient groups. 328 sepsis patients were characterized by a) baseline demographics and predisposition factors, b) septic event, c) hospital outcomes and discharge disposition, d) 12-month mortality and e) Zubrod Performance status, physical function and cognitive function at three, six and 12-month follow-up. Follow-up visits were not completed due to death (in 68) and withdrawal of consent (in 32). Compared to young and middle-aged patients, older patients had: 1) significantly more comorbidities at presentation (example chronic renal disease 6% vs 12 % vs 21%), intra-abdominal infections (14% vs 25% vs 37%), septic shock (12% vs 25% vs 36%) and organ dysfunctions, 2) higher 30 day mortality (6% vs 4% vs 17%) and fewer ICU free days (median 25 vs 23 vs 20), 3) more progression into CCI (22%, vs 34% vs 42%) with higher poor disposition discharge to non-home destinations (19% vs 40% vs 62%), 4) worse 12-month mortality (11% vs 14 % vs 33%) and, 5) poorer Zubrod Performance status and objectively-measured physical and cognitive functions with slight improvement over 12 month follow-up. Conclusion: Compared to younger patients, older sepsis survivors suffer with both a higher persistent disability burden and 12-month mortality.
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Affiliation(s)
| | - Stephen Anton
- Aging and Geriatric Research, Gainesville, United States
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Filiberto AC, Ozrazgat-Baslanti T, Peng YC, Datta S, Efron P, Bihorac A, Huber T, Cooper M. Perioperative Acute Kidney Injury in Vascular Surgery Patients: Prevalence and Predictive Strategies. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.04.420] [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]
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Sharma AK, Elder C, Su G, Lu G, Qi X, Jiang Z, Moldawer LL, Efron P, Upchurch GR. Myeloid-derived suppressor cells modulate aortic aneurysm formation via CXCR2 and IL-17 signaling. The Journal of Immunology 2020. [DOI: 10.4049/jimmunol.204.supp.146.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Aortic aneurysm formation is associated with vascular inflammation and remodeling mediated via CD4+ T cell-secreted IL-17A production. Our hypothesis is that innate myeloid-derived suppressor cells (MDSCs), which are a heterogeneous population of myeloid precursor and progenitor cells, exhibit an immunoregulatory role in the progression of aortic inflammation during abdominal aortic aneurysm (AAA) formation. The trafficking and migration of MDSCs to the aortic tissue and role of CXCR2 and programmed death-1 (PD-1) receptor signaling was deciphered using an in vivo elastase-treatment model of AAA as well as in vitro co-culture experiments. We used an established murine AAA model of topical elastase-treatment in the present study. Preliminary data showed that elastase-treatment of C57BL/6 (wild-type; WT) mice resulted in significant increase in infrarenal aortic diameter causing AAA formation on day 14 that was significantly inhibited by a combined treatment with anti-CXCR2 and PD-1 antibodies. A multi-fold increase in MDSCs (CD11b+Gr-1+) in aortic tissue of elastase-treated WT mice on days 7 and 14 occurred compared to controls. Co-culture of MDSCs with aortic endothelial cells in the presence of anti-CXCR2 antibody inhibited the transmigration of MDSCs through the endothelial barrier. Moreover, transient elastase treatment of co-cultures of anti-CD3/CD28 treated mononuclear cells with MDSCs significantly enhanced IL-17A secretion compared to cultures without MDSCs. Our results indicate that MDSCs may play a contributory role in aortic inflammation by trafficking in a CXCR2-dependent manner and promotion of IL-17A secretion, signifying the importance of MDSC-mediated immunoregulation of aortic aneurysms.
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Elfasi A, Mankowski RT, Moore FA, Ghita GL, Villani K, Anton SD, Brackenridge SC, Brumback B, Efron P, Leeuwenburgh C, Moldawer LL, Simpkins AN. Abstract TMP91: Pre-Sepsis P-wave Terminal Force in Lead V1 (PTFV1) as a Predictor of Atrial Fibrillation, In-Hospital Mortality, and Cognition in Sepsis Patients. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.tmp91] [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
Introduction:
Enlarged P-wave terminal force in lead V1 (PTFV1) >5000 μV*ms is a long-term predictor of the left atrial abnormality such as atrial fibrillation (AF), cognitive dysfunction, and stroke at age ≤ 60. Sepsis patients are at high risk of cardiac dysfunction, AF, stroke, and impaired cognition acutely and longitudinally, but predictive value pre-sepsis PTFV1 has not been studied.
Hypothesis:
Higher PTFV1 before sepsis onset is associated with AF events, left atrial enlargement, mortality, and 1-year cognitive impairment in patients who developed sepsis.
Methods:
Patients with acute sepsis were prospectively screened and enrolled in an observational study years 2015-2019. Of the 360 consented, 287 had pre-sepsis electrocardiograms (ECG), and 272 were evaluable. PTFV1 was measured using the Mitutoyo 500-195-30CAL Absolute Digimatic Caliper. Left atrial diameter index (LADI) pre-sepsis and post enrollment were recorded (median of 2 days [interquartile range (IQR) 1-13]). Occurrence of AF was assessed on the next available ECG, 3 days [IQR 1-11] post-enrollment. Cognitive function at 1-year follow-up was assessed by the mini-mental state examination (MMSE) and the Hopkins Verbal Learning test (HVLT). Statistical significance was evaluated using linear and logistic univariate regression.
Results:
In this cohort, the median age was 63 years [IQR 53-71], 44% women. The median PTVF1, LADI at pre-sepsis and follow up were 3219 μV*ms [IQR 0 - 5487], 1.86 cm/mm
2
[IQR 1.58 - 2.14], and 1.89 cm/mm
2
[IQR 1.59 - 2.17], respectively. Pre-sepsis PTFV1 was > 5,000 μV*ms in 32%. Elevated PTFV1 at age ≥ 60 was not associated with AF (p=0.06) or in-hospital mortality (p=0.17). Similarly, high PTFV1 at age < 60 was not associated in-hospital mortality (p=0.50), and only 3 in this cohort had AF. There was no association with pre-sepsis LADI (p=0.55), follow-up LADI (p=0.70), MMSE (p=0.35), or HVLT (p=0.78) and PTFV1.
Conclusions:
Here, PTFV1 values were not associated with AF or measures of cognitive impairment. While our findings differ from other longitudinal studies, the early time interval and setting of sepsis in our study is unique. Future studies will include multivariate analysis and evaluation of long term outcome measures linked to PTFV1 such as stroke.
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Affiliation(s)
| | | | | | | | - Katelyn Villani
- Dept of Applied Physiology and Kinesiology, Univ of Florida, Gainesville, FL
| | - Stephen D Anton
- Div of Clinical Rsch, Dept of Aging and Geriatric Rsch, Univ of Florida Col, Univ of Florida, Gainesville, FL
| | - Scott C Brackenridge
- Dept of Surgery, Univ of Florida College of Medicine, Univ of Florida, Gainesville, FL
| | | | - Philip Efron
- Dept of Surgery, Univ of Florida, Gainesville, FL
| | | | | | - Alexis N Simpkins
- Div Vascular Neurology, Dept Neurology, Univ of Florida, Gainesville, FL
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9
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Osuchowski MF, Ayala A, Bahrami S, Bauer M, Boros M, Cavaillon JM, Chaudry IH, Coopersmith CM, Deutschman C, Drechsler S, Efron P, Frostell C, Fritsch G, Gozdzik W, Hellman J, Huber-Lang M, Inoue S, Knapp S, Kozlov AV, Libert C, Marshall JC, Moldawer LL, Radermacher P, Redl H, Remick DG, Singer M, Thiemermann C, Wang P, Wiersinga WJ, Xiao X, Zingarelli B. Minimum Quality Threshold in Pre-Clinical Sepsis Studies (MQTiPSS): an international expert consensus initiative for improvement of animal modeling in sepsis. Infection 2019; 46:687-691. [PMID: 30105433 PMCID: PMC6182493 DOI: 10.1007/s15010-018-1183-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Purpose Pre-clinical animal studies precede the majority of clinical trials. While the clinical sepsis definitions and recommended treatments are regularly updated, a systematic review of pre-clinical models of sepsis has not been done and clear modeling guidelines are lacking. To address this deficit, a Wiggers-Bernard Conference on pre-clinical sepsis modeling was held in Vienna in May, 2017. The conference goal was to identify limitations of pre-clinical sepsis models and to propose a set of guidelines, defined as the “Minimum Quality Threshold in Pre-Clinical Sepsis Studies” (MQTiPSS), to enhance translational value of these models. Methods 31 experts from 13 countries participated and were divided into 6 thematic Working Groups (WG): (1) Study Design, (2) Humane modeling, (3) Infection types, (4) Organ failure/dysfunction, (5) Fluid resuscitation and (6) Antimicrobial therapy endpoints. As basis for the MQTiPSS discussions, the participants conducted a literature review of the 260 most highly cited scientific articles on sepsis models (2002–2013). Results Overall, the participants reached consensus on 29 points; 20 at “recommendation” (R) and 9 at “consideration” (C) strength. This Executive Summary provides a synopsis of the MQTiPSS consensus (Tables 1, 2 and 3). Conclusions We believe that these recommendations and considerations will serve to bring a level of standardization to pre-clinical models of sepsis and ultimately improve translation of pre-clinical findings. These guideline points are proposed as “best practices” that should be implemented for animal sepsis models. In order to encourage its wide dissemination, this article is freely accessible in Shock, Infection and Intensive Care Medicine Experimental.
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Affiliation(s)
- Marcin F Osuchowski
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in the AUVA Research Center, Donaueschingenstrasse 13, 1200, Vienna, Austria.
| | - Alfred Ayala
- Rhode Island Hospital and Alpert School of Medicine at Brown University, Providence, RI, USA
| | - Soheyl Bahrami
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in the AUVA Research Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | | | - Mihaly Boros
- Institute of Surgical Research, University of Szeged, Szeged, Hungary
| | | | - Irshad H Chaudry
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | | | - Clifford Deutschman
- Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Susanne Drechsler
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in the AUVA Research Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - Philip Efron
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Claes Frostell
- Division of Anaesthesia and Intensive Care, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Gerhard Fritsch
- AUVA Traumacenter, Vienna, Austria
- Paracelsus Medical University, Salzburg, Austria
| | | | - Judith Hellman
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Markus Huber-Lang
- Institute of Clinical and Experimental Trauma-Immunology, University Hospital of Ulm, Ulm, Germany
| | - Shigeaki Inoue
- Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sylvia Knapp
- Department of Medicine 1, Medical University Vienna, Vienna, Austria
| | - Andrey V Kozlov
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in the AUVA Research Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - Claude Libert
- Center for Inflammation Research, VIB, Ghent, Belgium
- University Ghent, Ghent, Belgium
| | - John C Marshall
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Lyle L Moldawer
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Peter Radermacher
- Institute of Anaesthesiological Pathophysiology and Process Development, University Hospital of Ulm, Ulm, Germany
| | - Heinz Redl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in the AUVA Research Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | | | - Mervyn Singer
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, UK
| | - Christoph Thiemermann
- The William Harvey Research Institute, Barts and London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ping Wang
- Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - W Joost Wiersinga
- Division of Infectious Diseases, and Center for Experimental and Molecular Medicine, the Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Xianzhong Xiao
- Xiangya School of Medicine, Central South University, Chagnsha, Hunan, China
| | - Basilia Zingarelli
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
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10
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Miller E, Apple C, Gardner A, Kannan K, Wu Q, Ghita G, Wang Z, Brumback B, Anton S, Leeuwenburgh C, Efron P, Moldawer L, Moore F, Brakenridge S, Mohr A. 1580. Crit Care Med 2019. [DOI: 10.1097/01.ccm.0000552322.25921.02] [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: 11/25/2022]
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11
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Zingarelli B, Coopersmith CM, Drechsler S, Efron P, Marshall JC, Moldawer L, Wiersinga WJ, Xiao X, Osuchowski MF, Thiemermann C. Part I: Minimum Quality Threshold in Preclinical Sepsis Studies (MQTiPSS) for Study Design and Humane Modeling Endpoints. Shock 2019; 51:10-22. [PMID: 30106874 PMCID: PMC6296871 DOI: 10.1097/shk.0000000000001243] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [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: 12/15/2022]
Abstract
Preclinical animal studies are mandatory before new treatments can be tested in clinical trials. However, their use in developing new therapies for sepsis has been controversial because of limitations of the models and inconsistencies with the clinical conditions. In consideration of the revised definition for clinical sepsis and septic shock (Sepsis-3), a Wiggers-Bernard Conference was held in Vienna in May 2017 to propose standardized guidelines on preclinical sepsis modeling. The participants conducted a literature review of 260 most highly cited scientific articles on sepsis models published between 2003 and 2012. The review showed, for example, that mice were used in 79% and euthanasia criteria were defined in 9% of the studies. Part I of this report details the recommendations for study design and humane modeling endpoints that should be addressed in sepsis models. The first recommendation is that survival follow-up should reflect the clinical time course of the infectious agent used in the sepsis model. Furthermore, it is recommended that therapeutic interventions should be initiated after the septic insult replicating clinical care. To define an unbiased and reproducible association between a new treatment and outcome, a randomization and blinding of treatments as well as inclusion of all methodological details in scientific publications is essential. In all preclinical sepsis studies, the high standards of animal welfare must be implemented. Therefore, development and validation of specific criteria for monitoring pain and distress, and euthanasia of septic animals, as well as the use of analgesics are recommended. A set of four considerations is also proposed to enhance translation potential of sepsis models. Relevant biological variables and comorbidities should be included in the study design and sepsis modeling should be extended to mammalian species other than rodents. In addition, the need for source control (in case of a defined infection focus) should be considered. These recommendations and considerations are proposed as "best practices" for animal models of sepsis that should be implemented.
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Affiliation(s)
- Basilia Zingarelli
- Department of Pediatrics, Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | | | - Susanne Drechsler
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in the AUVA Research Center, Vienna, Austria
| | - Philip Efron
- Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, Florida
| | - John C Marshall
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Lyle Moldawer
- Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, Florida
| | - W Joost Wiersinga
- Division of Infectious Diseases, Center for Experimental and Molecular Medicine, The Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Xianzhong Xiao
- Xiangya School of Medicine, Central South University, Chagnsha, Hunan, China
| | - Marcin F Osuchowski
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in the AUVA Research Center, Vienna, Austria
| | - Christoph Thiemermann
- The William Harvey Research Institute, Barts and London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom
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Osuchowski MF, Ayala A, Bahrami S, Bauer M, Boros M, Cavaillon JM, Chaudry IH, Coopersmith CM, Deutschman CS, Drechsler S, Efron P, Frostell C, Fritsch G, Gozdzik W, Hellman J, Huber-Lang M, Inoue S, Knapp S, Kozlov AV, Libert C, Marshall JC, Moldawer LL, Radermacher P, Redl H, Remick DG, Singer M, Thiemermann C, Wang P, Wiersinga WJ, Xiao X, Zingarelli B. Minimum Quality Threshold in Pre-Clinical Sepsis Studies (MQTiPSS): An International Expert Consensus Initiative for Improvement of Animal Modeling in Sepsis. Shock 2018; 50:377-380. [PMID: 30106875 PMCID: PMC6133201 DOI: 10.1097/shk.0000000000001212] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/22/2018] [Accepted: 04/19/2018] [Indexed: 12/29/2022]
Abstract
Preclinical animal studies precede the majority of clinical trials. While the clinical definitions of sepsis and recommended treatments are regularly updated, a systematic review of preclinical models of sepsis has not been done and clear modeling guidelines are lacking. To address this deficit, a Wiggers-Bernard Conference on preclinical sepsis modeling was held in Vienna in May, 2017. The goal of the conference was to identify limitations of preclinical sepsis models and to propose a set of guidelines, defined as the "Minimum Quality Threshold in Preclinical Sepsis Studies" (MQTiPSS), to enhance translational value of these models. A total of 31 experts from 13 countries participated and were divided into six thematic Working Groups: Study Design, Humane modeling, Infection types, Organ failure/dysfunction, Fluid resuscitation, and Antimicrobial therapy endpoints. As basis for the MQTiPSS discussions, the participants conducted a literature review of the 260 most highly cited scientific articles on sepsis models (2002-2013). Overall, the participants reached consensus on 29 points; 20 at "recommendation" and nine at "consideration" strength. This Executive Summary provides a synopsis of the MQTiPSS consensus. We believe that these recommendations and considerations will serve to bring a level of standardization to preclinical models of sepsis and ultimately improve translation of preclinical findings. These guideline points are proposed as "best practices" for animal models of sepsis that should be implemented. To encourage its wide dissemination, this article is freely accessible on the Intensive Care Medicine Experimental and Infection journal websites. In order to encourage its wide dissemination, this article is freely accessible in Shock, Infection, and Intensive Care Medicine Experimental.
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Affiliation(s)
- Marcin F. Osuchowski
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in the AUVA Research Center, Vienna, Austria
| | - Alfred Ayala
- Rhode Island Hospital and Alpert School of Medicine at Brown University, Providence, Rhode Island
| | - Soheyl Bahrami
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in the AUVA Research Center, Vienna, Austria
| | | | - Mihaly Boros
- Institute of Surgical Research, University of Szeged, Szeged, Hungary
| | | | - Irshad H. Chaudry
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | | | | | - Susanne Drechsler
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in the AUVA Research Center, Vienna, Austria
| | - Philip Efron
- University of Florida College of Medicine, Gainesville, Florida
| | - Claes Frostell
- Division of Anaesthesia and Intensive Care, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Gerhard Fritsch
- AUVA Trauma Center, Vienna, Austria
- Paracelsus Medical University, Salzburg, Austria
| | | | - Judith Hellman
- University of California School of Medicine, San Francisco, California
| | - Markus Huber-Lang
- Institute of Clinical and Experimental Trauma-Immunology, University Hospital of Ulm, Ulm, Germany
| | - Shigeaki Inoue
- Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sylvia Knapp
- Medical University Vienna, Department of Medicine 1, Vienna, Austria
| | - Andrey V. Kozlov
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in the AUVA Research Center, Vienna, Austria
| | - Claude Libert
- Center for Inflammation Research, VIB, Ghent, Belgium
- University Ghent, Ghent, Belgium
| | - John C. Marshall
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, University of Toronto, Canada
| | | | - Peter Radermacher
- Institute of Anaesthesiological Pathophysiology and Process Development, University Hospital of Ulm, Ulm, Germany
| | - Heinz Redl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in the AUVA Research Center, Vienna, Austria
| | | | - Mervyn Singer
- Bloomsbury Institute of Intensive Care Medicine, University College London, UK
| | - Christoph Thiemermann
- The William Harvey Research Institute, Barts and London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ping Wang
- Feinstein Institute for Medical Research, Manhasset, New York
| | - W. Joost Wiersinga
- Division of Infectious Diseases, and Center for Experimental and Molecular Medicine, the Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Xianzhong Xiao
- Xiangya School of Medicine, Central South University, Chagnsha, Hunan, China
| | - Basilia Zingarelli
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, Ohio
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Osuchowski MF, Ayala A, Bahrami S, Bauer M, Boros M, Cavaillon JM, Chaudry IH, Coopersmith CM, Deutschman C, Drechsler S, Efron P, Frostell C, Fritsch G, Gozdzik W, Hellman J, Huber-Lang M, Inoue S, Knapp S, Kozlov AV, Libert C, Marshall JC, Moldawer LL, Radermacher P, Redl H, Remick DG, Singer M, Thiemermann C, Wang P, Wiersinga WJ, Xiao X, Zingarelli B. Minimum quality threshold in pre-clinical sepsis studies (MQTiPSS): an international expert consensus initiative for improvement of animal modeling in sepsis. Intensive Care Med Exp 2018; 6:26. [PMID: 30112605 PMCID: PMC6093828 DOI: 10.1186/s40635-018-0189-y] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 07/18/2018] [Indexed: 12/16/2022] Open
Abstract
Background Pre-clinical animal studies precede the majority of clinical trials. While the clinical definitions of sepsis and recommended treatments are regularly updated, a systematic review of pre-clinical models of sepsis has not been done and clear modeling guidelines are lacking. Objective To address this deficit, a Wiggers-Bernard Conference on pre-clinical sepsis modeling was held in Vienna in May 2017. The goal of the conference was to identify limitations of pre-clinical sepsis models and to propose a set of guidelines, defined as the “Minimum Quality Threshold in Pre-Clinical Sepsis Studies” (MQTiPSS), to enhance translational value of these models. Methods A total of 31 experts from 13 countries participated and were divided into 6 thematic working groups (WG): (1) study design, (2) humane modeling, (3) infection types, (4) organ failure/dysfunction, (5) fluid resuscitation, and (6) antimicrobial therapy endpoints. As basis for the MQTiPSS discussions, the participants conducted a literature review of the 260 most highly cited scientific articles on sepsis models (2002–2013). Results Overall, the participants reached consensus on 29 points; 20 at “recommendation” (R) and 9 at “consideration” (C) strength. This executive summary provides a synopsis of the MQTiPSS consensus (Tables 1, 2, and 3). Detailed commentaries to all Rs and Cs are simultaneously published in three separate full-length papers. Conclusions We believe that these recommendations and considerations will serve to bring a level of standardization to pre-clinical models of sepsis and ultimately improve translation of pre-clinical findings. These guideline points are proposed as “best practices” for animal models of sepsis that should be implemented. In order to encourage its wide dissemination, this article is freely accessible in Shock, Infection and Intensive Care Medicine Experimental.
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Affiliation(s)
- Marcin F Osuchowski
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in the AUVA Research Center, Donaueschingenstrasse 13, A-1200, Vienna, Austria.
| | - Alfred Ayala
- Rhode Island Hospital & Alpert School of Medicine at Brown University, Providence, RI, USA
| | - Soheyl Bahrami
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in the AUVA Research Center, Donaueschingenstrasse 13, A-1200, Vienna, Austria
| | | | - Mihaly Boros
- Institute of Surgical Research, University of Szeged, Szeged, Hungary
| | | | - Irshad H Chaudry
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | | | - Clifford Deutschman
- Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Susanne Drechsler
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in the AUVA Research Center, Donaueschingenstrasse 13, A-1200, Vienna, Austria
| | - Philip Efron
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Claes Frostell
- Division of Anaesthesia and Intensive Care, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Gerhard Fritsch
- AUVA Traumacenter, Vienna, Austria.,Paracelsus Medical University, Salzburg, Austria
| | | | - Judith Hellman
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Markus Huber-Lang
- Institute of Clinical and Experimental Trauma-Immunology, University Hospital of Ulm, Ulm, Germany
| | - Shigeaki Inoue
- Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sylvia Knapp
- Department of Medicine 1, Medical University Vienna, Vienna, Austria
| | - Andrey V Kozlov
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in the AUVA Research Center, Donaueschingenstrasse 13, A-1200, Vienna, Austria
| | - Claude Libert
- Center for Inflammation Research, VIB, Ghent, Belgium.,University Ghent, Ghent, Belgium
| | - John C Marshall
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Lyle L Moldawer
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Peter Radermacher
- Institute of Anaesthesiological Pathophysiology and Process Development, University Hospital of Ulm, Ulm, Germany
| | - Heinz Redl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in the AUVA Research Center, Donaueschingenstrasse 13, A-1200, Vienna, Austria
| | | | - Mervyn Singer
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, UK
| | - Christoph Thiemermann
- The William Harvey Research Institute, Barts and London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Ping Wang
- Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Willem Joost Wiersinga
- Division of Infectious Diseases, and Center for Experimental and Molecular Medicine, the Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Xianzhong Xiao
- Xiangya School of Medicine, Central South University, Chagnsha, Hunan, China
| | - Basilia Zingarelli
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
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Stortz J, Brakenridge S, Efron P, Moldawer L, Moore F. MP10-17 COMPARATIVE ANALYSIS OF OUTCOMES BETWEEN UROSEPSIS AND INTRA-ABDOMINAL SEPSIS PATIENTS. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Affiliation(s)
- Annette Rebel
- Department of Anesthesiology, University of Kentucky, Lexington, Kentucky
| | - Adam Beck
- Department of Surgery, University Florida, Gainesville, Florida
| | - Philip Efron
- Department of Surgery, University Florida, Gainesville, Florida
| | - Anthony A. Bavry
- Department of Medicine, University of Florida, Gainesville, Florida
| | - Darwin Ang
- Department of Surgery, University of South Florida, Tampa, Florida Ocala Regional Medical Center, Ocala, Florida
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Rebel A, Beck A, Efron P, Bavry AA, Ang D. Successful Rescue Therapy for Severe Acute Anemia: Managing the Critically Ill Jehovah's Witness. Am Surg 2015; 81:E263-E265. [PMID: 26031262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Annette Rebel
- Department of Anesthesiology, University of Kentucky, Lexington, Kentucky, USA
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Vaught A, Findlay R, Davis R, Lanz J, Moore F, Marker P, Tommolino K, Lemon S, Voils S, Ozrazgat-Baslanti T, Bihorac A, Leclaire A, Efron P. Gram stain can be used to safely discontinue vancomycin therapy for early pneumonia in the trauma intensive care unit. Am Surg 2014; 80:1277-1279. [PMID: 25513932 PMCID: PMC4307788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Arthur Vaught
- Department of Anesthesia, University of Florida College of Medicine, Gainesville, Florida, USA
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18
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Vaught A, Findlay R, Davis R, Lanz J, Moore F, Marker P, Tommolino K, Lemon S, Voils S, Ozrazgat-Baslanti T, Bihorac A, Leclaire A, Efron P. Gram Stain Can be Used to Safely Discontinue Vancomycin Therapy for Early Pneumonia in the Trauma Intensive Care Unit. Am Surg 2014. [DOI: 10.1177/000313481408001235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Arthur Vaught
- Department of Anesthesia University of Florida College of Medicine Gainesville, Florida
| | - Russell Findlay
- Department of Pharmacology University of Florida College of Medicine Gainesville, Florida
| | - Ruth Davis
- Department of Surgery University of Florida College of Medicine Gainesville, Florida
| | - Jennifer Lanz
- Department of Surgery University of Florida College of Medicine Gainesville, Florida
| | - Frederick Moore
- Department of Surgery University of Florida College of Medicine Gainesville, Florida
| | - Peggy Marker
- Department of Nursing University of Florida College of Medicine Gainesville, Florida
| | - Karly Tommolino
- Department of Pharmacology University of Florida College of Medicine Gainesville, Florida
| | - Stephen Lemon
- Department of Pharmacology University of Florida College of Medicine Gainesville, Florida
| | - Stacy Voils
- Department of Pharmacology University of Florida College of Medicine Gainesville, Florida
| | | | - Azra Bihorac
- Department of Anesthesia University of Florida College of Medicine Gainesville, Florida
| | - Aimee Leclaire
- Department of Pharmacology University of Florida College of Medicine Gainesville, Florida
| | - Philip Efron
- Department of Surgery University of Florida College of Medicine Gainesville, Florida
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Armbruster M, Grimley E, Rodriguez J, Nacionales D, Efron P, Moldawer L, Papadopoulos K, Ungaro R, Cuenca A, Simpkins C. Soybean oil: a potentially new intravascular perfusate. Perfusion 2012; 28:160-6. [PMID: 23257679 DOI: 10.1177/0267659112469643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
BACKGROUND Given that micelles of lipids are colloids, the hypothesis was generated that the rapid administration of large volumes of soybean oil micelles would be an effective perfusion fluid. We also hypothesized that oxygen loading would be enhanced due to the greater solubility of oxygen in lipids compared to water. METHODS A 100% lethal mouse model of blood loss was used to compare the ability of soybean oil micelles to that of Ringer's lactate, blood and other fluids, with respect to raising and maintaining the blood pressure for one hour. Oxygen on- and off-loading of various concentrations of soybean oil micelles was determined using mass spectroscopy. Nitric oxide uptake by micelles was also determined in a similar fashion. RESULTS A 20% soybean oil emulsion was superior to Ringer's lactate in raising and maintaining blood pressure. A 20% soybean oil emulsion with 5% albumin added was superior to shed blood as well as solutions comprised of 5% albumin added to either normal saline or Ringer's lactate. There was a linear relationship between oxygen content and micelle concentration between 10% and 30%. Off-loading of oxygen from the micelles was nearly as fast as off-loading from water. Nitric oxide also loaded preferentially onto soybean oil micelles. CONCLUSIONS (1) Soybean oil emulsions were superior to other fluids in restoring and maintaining the blood pressure; (2) oxygen-carrying ability of soybean oil micelles exceeds that of water and follows Henry's law between 10% and 30% w/v oil content; (3) nitric oxide was carried by the micelles; (4) animals receiving soybean oil micelles did not exhibit fat embolization; (5) colloids comprised of soybean oil-containing micelles may be used to replace blood loss and may be used to deliver oxygen and other potentially therapeutic gases such as nitric oxide to tissues.
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Affiliation(s)
- M Armbruster
- University of Florida College of Medicine, Gainesville, FL, USA
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Findlay R, Efron P, Bozeman C, Vaught A, O’Brien K, Marker P, Moore F, LeClaire A. 419. Crit Care Med 2012. [DOI: 10.1097/01.ccm.0000424637.84262.d8] [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: 11/25/2022]
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21
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Miggins M, Hasan A, Hohmann S, Southwick F, Casella G, Schain D, Liu H, Bihorac A, Moldawer L, Efron P, Ang D. The potential influence of common viral infections diagnosed during hospitalization among critically ill patients in the United States. PLoS One 2011; 6:e18890. [PMID: 21573031 PMCID: PMC3091021 DOI: 10.1371/journal.pone.0018890] [Citation(s) in RCA: 26] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 03/24/2011] [Indexed: 11/26/2022] Open
Abstract
Viruses are the most common source of infection among immunocompetent individuals, yet they are not considered a clinically meaningful risk factor among the critically ill. This work examines the association of viral infections diagnosed during the hospital stay or not documented as present on admission to the outcomes of ICU patients with no evidence of immunosuppression on admission. This is a population-based retrospective cohort study of University HealthSystem Consortium (UHC) academic centers in the U.S. from the years 2006 to 2009. The UHC is an alliance of over 90% of the non-profit academic medical centers in the U.S. A total of 209,695 critically ill patients were used in this analysis. Eight hospital complications were examined. Patients were grouped into four cohorts: absence of infection, bacterial infection only, viral infection only, and bacterial and viral infection during same hospital admission. Viral infections diagnosed during hospitalization significantly increased the risk of all complications. There was also a seasonal pattern for viral infections. Specific viruses associated with poor outcomes included influenza, RSV, CMV, and HSV. Patients who had both viral and bacterial infections during the same hospitalization had the greatest risk of mortality RR 6.58, 95% CI (5.47, 7.91); multi-organ failure RR 8.25, 95% CI (7.50, 9.07); and septic shock RR 271.2, 95% CI (188.0, 391.3). Viral infections may play a significant yet unrecognized role in the outcomes of ICU patients. They may serve as biological markers or play an active role in the development of certain adverse complications by interacting with coincident bacterial infection.
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Affiliation(s)
- Makesha Miggins
- Department of Surgery, University of Florida, Gainesville, Florida, United States of America
| | - Anjum Hasan
- Department of Infectious Disease, University of Florida, Gainesville, Florida, United States of America
| | - Samuel Hohmann
- University HealthSystem Consortium, Gainesville, Florida, United States of America
| | - Frederick Southwick
- Department of Infectious Disease, University of Florida, Gainesville, Florida, United States of America
| | - George Casella
- Department of Statistics, University of Florida, Gainesville, Florida, United States of America
| | - Denise Schain
- Department of Infectious Disease, University of Florida, Gainesville, Florida, United States of America
| | - Huazhi Liu
- Department of Surgery, University of Florida, Gainesville, Florida, United States of America
| | - Azra Bihorac
- Department of Anesthesiology, University of Florida, Gainesville, Florida, United States of America
- Critical Care, University of Florida, Gainesville, Florida, United States of America
| | - Lyle Moldawer
- Department of Surgery, University of Florida, Gainesville, Florida, United States of America
| | - Philip Efron
- Department of Surgery, University of Florida, Gainesville, Florida, United States of America
- Critical Care, University of Florida, Gainesville, Florida, United States of America
| | - Darwin Ang
- Department of Surgery, University of Florida, Gainesville, Florida, United States of America
- Critical Care, University of Florida, Gainesville, Florida, United States of America
- * E-mail:
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22
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Lainée P, Efron P, Tschoeke SK, Elies L, De Winter H, Lorré K, Moldawer LL. Delayed neutralization of interferon-gamma prevents lethality in primate Gram-negative bacteremic shock. Crit Care Med 2005; 33:797-805. [PMID: 15818108 DOI: 10.1097/01.ccm.0000159090.80228.57] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [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: 11/26/2022]
Abstract
OBJECTIVE Whether anticytokine therapies have a place in the treatment of severe sepsis and septic shock remains a question. Although a number of preclinical studies have shown efficacy in primate models of bacteremic shock when administered prophylactically, these same therapies have a significantly diminished effectiveness when administered therapeutically. This study investigated whether delayed administration of a novel anti-human interferon-gamma monoclonal antibody could improve outcome and reduce organ injury in a lethal model of Escherichia coli bacteremia, when administered after the onset of shock. DESIGN Randomized, prospective, double-blinded intervention study. SUBJECTS Cynomolgus monkeys. INTERVENTIONS Treatment with a humanized monoclonal antibody directed against human interferon-gamma (INNO 202), administered after the onset of shock, induced by the infusion of live E. coli. MEASUREMENTS AND MAIN RESULTS Five of the six vehicle-treated monkeys died or were killed within 24-72 hrs after E. coli administration, and all died within 5 days. In contrast, six of the eight animals treated with the anti-interferon-gamma survived for 7 days, and three of the eight animals survived 14 days (p = .013 vs. vehicle). Delayed treatment with the anti-interferon-gamma monoclonal antibody did not restore hemodynamics or reduce the amount of crystalloid-containing fluid required to resuscitate the animals but did attenuate renal failure (p < .05) and the magnitude of the inflammatory cytokine response (p < .05). CONCLUSIONS In a primate model of E. coli bacteremic shock, delayed neutralization of interferon-gamma after the onset of shock improved survival and attenuated the pathologic changes associated with the development of organ dysfunction. These findings suggest that interferon-gamma blockade represents a potentially effective mode of late intervention in lethal septic shock.
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Abstract
Sepsis is a syndrome of significant morbidity and mortality. Unlike the advances made in other diseases processes, improvements in outcome from sepsis, severe sepsis, and septic shock have been modest. Current research has altered our understanding of sepsis pathogenesis such that present models and definitions are still evolving. One relatively novel cell type, the dendritic cell, is the subject of much current investigation in sepsis. Although our present understanding of dendritic cell biology is incomplete, growing evidence supports the importance of this antigen-presenting cell in the normal and maladaptive responses to microbial invasion and tissue injury. A better understanding of this cell's basic biology as well as its potential as a therapeutic target will undoubtedly play increasing roles in the development of new strategies for the treatment of the septic patient.
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Affiliation(s)
- Philip Efron
- Department of Surgery, University of Florida College of Medicine, Gainesville 32610, USA
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Matsumoto T, Efron P, Tsujimoto H, Tschoeke S, Ungaro R, Fujita S, Foley D, Hemming A, Moldawer L. SPLENIC TRANSPOSITION SUPERIOR TO CAUDAL SHUNT FOR MURINE TOTAL HEPATIC ISCHEMIA. Shock 2004. [DOI: 10.1097/00024382-200406002-00176] [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: 11/25/2022]
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Schreiber J, Efron P, Park J, Moldawer L, Barbul A. 043 I??B Adenoviral Gene Transfer Improves Wound Healing. Wound Repair Regen 2004. [DOI: 10.1111/j.1067-1927.2004.0abstractap.x] [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]
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Abstract
Isosulfan blue is a commonly used agent in the detection of sentinel lymph nodes during cancer surgery. Similar to any drug, it is possible to have an allergic reaction to this increasingly popular chemical during breast cancer operations. We present one case of anaphylactic shock in response to injection of isosulfan blue for the purpose of localizing the sentinel node and review the medical literature. A thorough knowledge of possible isosulfan blue side effects, including their presentation and subsequent therapy, is essential for the modern breast surgeon.
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Affiliation(s)
- Philip Efron
- Department of Surgery, Shands Hospital, University of Florida, Gainsville, FL 32610, USA
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