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Ko T, Choi R, Issa K, Gupta R, Llinas E, Morey L, Finlay JB, Goldstein BJ. Polycomb repressive complex 2 regulates basal cell fate during adult olfactory neurogenesis. Stem Cell Reports 2023; 18:2283-2296. [PMID: 37832538 PMCID: PMC10679661 DOI: 10.1016/j.stemcr.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 10/15/2023] Open
Abstract
Adult neurogenesis occurs in the mammalian olfactory epithelium to maintain populations of neurons that are vulnerable to injury yet essential for olfaction. Multipotent olfactory basal stem cells are activated by damage, although mechanisms regulating lineage decisions are not understood. Using mouse lesion models, we focused on defining the role of Polycomb repressive complexes (PRCs) in olfactory neurogenesis. PRC2 has a well-established role in developing tissues, orchestrating transcriptional programs via chromatin modification. PRC2 proteins are expressed in olfactory globose basal cells (GBCs) and nascent neurons. Conditional PRC2 loss perturbs lesion-induced neuron production, accompanied by altered histone modifications and misexpression of lineage-specific transcription factors in GBCs. De-repression of Sox9 in PRC2-mutant GBCs is accompanied by increased Bowman's gland production, defining an unrecognized role for PRC2 in regulating gland versus neuron cell fate. Our findings support a model for PRC2-dependent mechanisms promoting sensory neuronal differentiation in an adult neurogenic niche.
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Affiliation(s)
- Tiffany Ko
- Department of Neurobiology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Rhea Choi
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC 27710, USA
| | - Khalil Issa
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC 27710, USA
| | - Rupali Gupta
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC 27710, USA
| | - Edward Llinas
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC 27710, USA
| | - Lluis Morey
- Sylvester Comprehensive Cancer Center and Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - John B Finlay
- Medical Scientist Training Program, Duke University School of Medicine, Durham, NC 27710, USA
| | - Bradley J Goldstein
- Department of Neurobiology, Duke University School of Medicine, Durham, NC 27710, USA; Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC 27710, USA.
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Licht DJ, Jacobwitz M, Lynch JM, Ko T, Boorady T, Devarajan M, Heye KN, Mensah‐Brown K, Newland JJ, Schmidt A, Schwab P, Winters M, Nicolson SC, Montenegro LM, Fuller S, Mascio C, Gaynor JW, Yodh AG, Gebb J, Vossough A, Choi GH, Putt ME. Impaired Maternal-Fetal Environment and Risk for Preoperative Focal White Matter Injury in Neonates With Complex Congenital Heart Disease. J Am Heart Assoc 2023; 12:e025516. [PMID: 36974759 PMCID: PMC10122900 DOI: 10.1161/jaha.122.025516] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 01/24/2022] [Accepted: 02/23/2023] [Indexed: 03/29/2023]
Abstract
Background Infants with congenital heart disease (CHD) are at risk for white matter injury (WMI) before neonatal heart surgery. Better knowledge of the causes of preoperative WMI may provide insights into interventions that improve neurodevelopmental outcomes in these patients. Methods and Results A prospective single-center study of preoperative WMI in neonates with CHD recorded data on primary cardiac diagnosis, maternal-fetal environment (MFE), delivery type, subject anthropometrics, and preoperative care. Total maturation score and WMI were assessed, and stepwise logistic regression modeling selected risk factors for WMI. Among subjects with severe CHD (n=183) who received a preoperative brain magnetic resonance imaging, WMI occurred in 40 (21.9%) patients. WMI prevalence (21.4%-22.1%) and mean volumes (119.7-160.4 mm3) were similar across CHD diagnoses. Stepwise logistic regression selected impaired MFE (odds ratio [OR], 2.85 [95% CI, 1.29-6.30]), male sex (OR, 2.27 [95% CI, 1.03-5.36]), and older age at surgery/magnetic resonance imaging (OR, 1.20 per day [95% CI, 1.03-1.41]) as risk factors for preoperative WMI and higher total maturation score values (OR, 0.65 per unit increase [95% CI, 0.43-0.95]) as protective. A quarter (24.6%; n=45) of subjects had ≥1 components of impaired MFE (gestational diabetes [n=12; 6.6%], gestational hypertension [n=11; 6.0%], preeclampsia [n=2; 1.1%], tobacco use [n=9; 4.9%], hypothyroidism [n=6; 3.3%], and other [n=16; 8.7%]). In a subset of 138 subjects, an exploratory analysis of additional MFE-related factors disclosed other potential risk factors for WMI. Conclusions This study is the first to identify impaired MFE as an important risk factor for preoperative WMI. Vulnerability to preoperative WMI was shared across CHD diagnoses.
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Affiliation(s)
- Daniel J. Licht
- Department of Pediatrics, Division of NeurologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Marin Jacobwitz
- Department of Pediatrics, Division of NeurologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Jennifer M. Lynch
- Department of Anesthesia and Critical Care, Division of Cardiac AnesthesiaThe Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Tiffany Ko
- Department of Pediatrics, Division of NeurologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Timothy Boorady
- Department of Pediatrics, Division of NeurologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Mahima Devarajan
- Department of Pediatrics, Division of NeurologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Kristina N. Heye
- Department of Pediatrics, Division of NeurologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Kobina Mensah‐Brown
- Department of Pediatrics, Division of NeurologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - John J. Newland
- Department of Pediatrics, Division of NeurologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Alexander Schmidt
- Department of Pediatrics, Division of NeurologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Peter Schwab
- Department of NeurologyThe University of PennsylvaniaPennsylvaniaPA
| | - Madeline Winters
- Department of Pediatrics, Division of NeurologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Susan C. Nicolson
- Department of Anesthesia and Critical Care, Division of Cardiac AnesthesiaThe Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Lisa M. Montenegro
- Department of Anesthesia and Critical Care, Division of Cardiac AnesthesiaThe Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Stephanie Fuller
- Department of Surgery, Division of Cardiothoracic SurgeryThe Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Christopher Mascio
- Department of Surgery, Division of Cardiothoracic SurgeryThe Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - J. William Gaynor
- Department of Surgery, Division of Cardiothoracic SurgeryThe Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Arjun G. Yodh
- Department of Physics and AstronomyUniversity of PennsylvaniaPhiladelphiaPA
| | - Juliana Gebb
- Department of Surgery, Richard D. Wood Jr Center for Fetal Diagnosis & Treatment in the Division of Pediatric General, Thoracic and Fetal SurgeryThe Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Arastoo Vossough
- Department of RadiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Grace H. Choi
- Department of Biostatistics, Epidemiology and InformaticsUniversity of PennsylvaniaPhiladelphiaPA
- CHOP/Penn Intellectual and Developmental Disabilities Research CenterPhiladelphiaPA
| | - Mary E. Putt
- Department of Biostatistics, Epidemiology and InformaticsUniversity of PennsylvaniaPhiladelphiaPA
- CHOP/Penn Intellectual and Developmental Disabilities Research CenterPhiladelphiaPA
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Ko T, Jou C, Grau-Perales A, Reynders M, Fenton A, Trauner D. A Photoactivated Protein Degrader for Optical Control of Synaptic Function. bioRxiv 2023:2023.02.13.528397. [PMID: 36824807 PMCID: PMC9949324 DOI: 10.1101/2023.02.13.528397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Hundreds of proteins determine the function of synapses, and synapses define the neuronal circuits that subserve myriad brain, cognitive, and behavioral functions. It is thus necessary to precisely manipulate specific proteins at specific sub-cellular locations and times to elucidate the roles of particular proteins and synapses in brain function. We developed PHOtochemically TArgeting Chimeras (PHOTACs) as a strategy to optically degrade specific proteins with high spatial and temporal precision. PHOTACs are small molecules that, upon wavelength-selective illumination, catalyze ubiquitylation and degradation of target proteins through endogenous proteasomes. Here we describe the design and chemical properties of a PHOTAC that targets Ca 2+ /calmodulin-dependent protein kinase II alpha (CaMKIIα), which is abundant and crucial for baseline synaptic function of excitatory neurons. We validate the PHOTAC strategy, showing that the CaMKIIα-PHOTAC is effective in mouse brain tissue. Light activation of CaMKIIα-PHOTAC removed CaMKIIα from regions of the mouse hippocampus only within 25 μm of the illuminated brain surface. The optically-controlled degradation decreases synaptic function within minutes of light activation, measured by the light-initiated attenuation of evoked field excitatory postsynaptic potential (fEPSP) responses to physiological stimulation. The PHOTACs methodology should be broadly applicable to other key proteins implicated in synaptic function, especially for evaluating their precise roles in the maintenance of long-term potentiation and memory within subcellular dendritic domains.
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Affiliation(s)
- T. Ko
- Department of Chemistry, University of Pennsylvania, 231 South 34th Street Philadelphia, PA 19104-6323, USA
- Department of Chemistry, New York University, 100 Washington Square East, New York, NY 10003, USA
| | - C. Jou
- Department of Psychology, Hunter College, 695 Park Avenue, New York, NY, 10065, USA
| | - A.B. Grau-Perales
- Center for Neural Science, New York University, 4 Washington Place, New York, NY 10003, USA
| | - M. Reynders
- Department of Chemistry, New York University, 100 Washington Square East, New York, NY 10003, USA
| | - A.A. Fenton
- Center for Neural Science, New York University, 4 Washington Place, New York, NY 10003, USA
| | - D. Trauner
- Department of Chemistry, University of Pennsylvania, 231 South 34th Street Philadelphia, PA 19104-6323, USA
- Department of Chemistry, New York University, 100 Washington Square East, New York, NY 10003, USA
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Choi R, Ko T, Finlay JB, Hachem RA, Jang D, Goldstein BJ. Preparation of Human Olfactory Epithelial Biopsies for Downstream Analysis. Methods Mol Biol 2023; 2710:121-129. [PMID: 37688729 DOI: 10.1007/978-1-0716-3425-7_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2023]
Abstract
The olfactory mucosa, lining a portion of the nasal cavity, houses the primary olfactory sensory neurons responsible for odor transduction, along with supporting cell populations. Tremendous advances have come from studying the peripheral olfactory system in animal models, especially the mouse. However, acquired human olfactory disorders lack effective therapies, and many of these conditions involve pathology in the olfactory mucosa. Thus, the ability to obtain human olfactory biopsy samples from subjects with olfactory dysfunction, or controls, may be of value. Here, we describe established techniques for collecting olfactory tissue from human subjects and preparing samples for downstream assays such as immunohistochemistry, flow cytometry, single-cell RNA-sequencing, or chromatin studies.
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Affiliation(s)
- Rhea Choi
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Tiffany Ko
- Department of Neurobiology, Duke University School of Medicine, Durham, NC, USA
| | - John B Finlay
- Medical Scientist Training Program, Duke University School of Medicine, Durham, NC, USA
| | - Ralph Abi Hachem
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
| | - David Jang
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Bradley J Goldstein
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA.
- Department of Neurobiology, Duke University School of Medicine, Durham, NC, USA.
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Finlay JB, Brann DH, Abi-Hachem R, Jang DW, Oliva AD, Ko T, Gupta R, Wellford SA, Moseman EA, Jang SS, Yan CH, Matusnami H, Tsukahara T, Datta SR, Goldstein BJ. Persistent post-COVID-19 smell loss is associated with immune cell infiltration and altered gene expression in olfactory epithelium. Sci Transl Med 2022; 14:eadd0484. [PMID: 36542694 PMCID: PMC10317309 DOI: 10.1126/scitranslmed.add0484] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [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: 12/24/2022]
Abstract
SARS-CoV-2 causes profound changes in the sense of smell, including total smell loss. Although these alterations are often transient, many patients with COVID-19 exhibit olfactory dysfunction that lasts months to years. Although animal and human autopsy studies have suggested mechanisms driving acute anosmia, it remains unclear how SARS-CoV-2 causes persistent smell loss in a subset of patients. To address this question, we analyzed olfactory epithelial samples collected from 24 biopsies, including from nine patients with objectively quantified long-term smell loss after COVID-19. This biopsy-based approach revealed a diffuse infiltrate of T cells expressing interferon-γ and a shift in myeloid cell population composition, including enrichment of CD207+ dendritic cells and depletion of anti-inflammatory M2 macrophages. Despite the absence of detectable SARS-CoV-2 RNA or protein, gene expression in the barrier supporting cells of the olfactory epithelium, termed sustentacular cells, appeared to reflect a response to ongoing inflammatory signaling, which was accompanied by a reduction in the number of olfactory sensory neurons relative to olfactory epithelial sustentacular cells. These findings indicate that T cell-mediated inflammation persists in the olfactory epithelium long after SARS-CoV-2 has been eliminated from the tissue, suggesting a mechanism for long-term post-COVID-19 smell loss.
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Affiliation(s)
- John B. Finlay
- Medical Scientist Training Program, Duke University School of Medicine, Durham, NC 27710
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC 27710
| | - David H. Brann
- Harvard Medical School Department of Neurobiology, Boston, MA 02115
| | - Ralph Abi-Hachem
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC 27710
| | - David W. Jang
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC 27710
| | - Allison D. Oliva
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC 27710
| | - Tiffany Ko
- Department of Neurobiology, Duke University School of Medicine, Durham, NC 27710
| | - Rupali Gupta
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC 27710
| | | | - E. Ashley Moseman
- Department of Immunology, Duke University School of Medicine, Durham, NC 27710
| | - Sophie S. Jang
- Department of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, CA 92037
| | - Carol H. Yan
- Department of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, CA 92037
| | - Hiroaki Matusnami
- Department of Neurobiology, Duke University School of Medicine, Durham, NC 27710
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC 27710
- Duke Institute for Brain Sciences, Duke University School of Medicine, Durham, NC 27710
| | | | | | - Bradley J. Goldstein
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC 27710
- Department of Neurobiology, Duke University School of Medicine, Durham, NC 27710
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Yamada S, Ko T, Ito M, Sassa T, Nomura S, Komuro I. Aberrant interaction between TEAD1 and Lamin A/C causes cardiomyopathy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Mutations in the LMNA gene encoding Lamin A/C, a major component of the nuclear lamina, cause laminopathies including dilated cardiomyopathy (DCM). DCM patients with LMNA mutations have particularly severe clinical courses such as heart transplantation and death due to heart failure. However, underlying mechanisms of LMNA-induced DCM remains elusive.
Methods and results
We identified LMNA Q353R mutation in a DCM family with severe heart failure. We generated Q353R heterozygous knock-in mice, which showed sarcomere dysplasia and perinatal lethality. Integrative single-cell analyses of the fetal murine hearts and patient-specific induced pluripotent stem cell-derived cardiomyocytes (iPSCMs) revealed that transcriptional regulation of cardiomyocyte maturation/development genes governed by TEAD1 was impaired in LMNA mutant cardiomyocytes. Protein array and immunostaining uncovered increased binding of TEAD1 to mutant Lamin A/C protein and abnormal localization of TEAD1 at the nuclear periphery. Furthermore, TT-10, a Hippo pathway inhibitor, rescued the dysregulation of cardiac developmental genes in LMNA mutant cardiomyocytes. Single-cell RNA-seq of cardiac tissues from DCM patients with the LMNA Q353R mutation confirmed the dysregulated expression of TEAD1 and its target genes. These results demonstrated abnormal interaction between TEAD1 and mutant Lamin A/C impairs structural maturation of cardiomyocytes and suggests that LMNA Q353R-related DCM can be treated through intervention in the Hippo pathway.
Conclusion
TEAD1 trapped by mutant Lamin A/C protein at the nuclear membrane perturbs transcriptional maturation in LMNA Q353R-related DCM.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Yamada
- The University of Tokyo , Tokyo , Japan
| | - T Ko
- The University of Tokyo , Tokyo , Japan
| | - M Ito
- The University of Tokyo , Tokyo , Japan
| | - T Sassa
- The University of Tokyo , Tokyo , Japan
| | - S Nomura
- The University of Tokyo , Tokyo , Japan
| | - I Komuro
- The University of Tokyo , Tokyo , Japan
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Lee H, Ko T, Park J, Kim H, Woo S. P-233 Deep ensembles-based AI as a tool to support embryo grading and clinical pregnancy prediction. Hum Reprod 2022. [DOI: 10.1093/humrep/deac106.060] [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: 11/13/2022] Open
Abstract
Abstract
Study question
Can deep learning accurately evaluate embryo grades and predict clinical pregnancy while providing relevant clinical evidence, not just results from a black box?
Summary answer
The sophisticated ensemble method can improve the predictive performance for embryo grades and clinical pregnancy, while providing clinically relevant evidence.
What is known already
Previous studies have shown that AI can predict the IVF outcomes by analyzing the images of embryos. In many literature, AI outperformed human because AI could identify features human eyes could not easily detect. However, clinicians have been cautious to adopt the AI technology due to the black box nature of AI algorithms. In this study, we increased the predictive power of AI as well as providing evidence of the prediction by using deep ensembles and Grad-CAM images.
Study design, size, duration
We performed a retrospective study of single static images of 727 Day 5 blastocysts from 270 patients who underwent single embryo transfer at a single in vitro fertilization (IVF) clinic between January 2015 and March 2021. The images were collected from standard optical light microscopes and matched with metadata such as embryo grades and pregnancy outcomes.
Participants/materials, setting, methods
Two different models were designed: an automatic embryo grading model and a pregnancy prediction model. Embryologists labeled a day 5 embryo “GEM,” a good embryo if 4AA/AB or above in the Gardner system and pregnancy was defined as the presence of a fetal heartbeat (FHB). Deep ensembles were applied by training four convolutional neural networks (CNNs) and Grad-CAM images were extracted from the last layer and reviewed by experts.
Main results and the role of chance
Under several single CNNs, the highest AUROCs of the embryo grading model and the pregnancy prediction model were 0.80 and 0.67, respectively. After applying deep ensembles, the AUROCs of the two models increased to 0.84 and 0.72, respectively. When the F1-score for the positive cases were maximized by adjusting the threshold of ensembles, accuracy, sensitivity and specificity of the embryo grading model were 88.1%, 92.9% and 62.5% respectively. For the pregnancy prediction model, accuracy, sensitivity and specificity were 66.3%, 77.1% and 55.6% respectively. The accuracy of GEM predicting pregnancy for the embryologists and the embryo grading AI model was 47.3% and 59.2%, respectively. It is noteworthy that the AI pregnancy prediction model outperformed the embryologists while successfully auto-grading embryos, a strong evidence that AI considered more features for prediction than what was used for grading. It was also noted from the review of the Grad-CAM images that the both AI models were focusing on the ICM, TE and hatching. Although their area of focus was the same, the pregnancy prediction model was able to make better predictions than the embryologists and the embryo grading model.
Limitations, reasons for caution
This study has limitations as it is a retrospective study performed on embryo images from a single IVF center. In addition, including other variables such as clinical data may enhance the models.
Wider implications of the findings
We showed that deep learning can automatically grade embryos and more accurately predict pregnancy than embryologists. Furthermore, the embryologists confirmed the model was looking at key features like ICM, TE and hatching. Sharing such evidence with clinicians can be a necessary step for AI to be adopted for clinical practice.
Trial registration number
not applicable
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Affiliation(s)
- H.J Lee
- Kai Health, Chief Executive Officer , Seoul, Korea- South
- Seoul National University, Obstetrics and Gynecology , Seoul, Korea- South
| | - T Ko
- The Catholic University of Korea, Department of Medical Informatics , Seoul, Korea- South
| | - J.H Park
- Miraewaheemang hospital, IVF clinic , Seoul, Korea- South
| | - H.M Kim
- The Catholic University of Korea, Department of Medical Informatics , Seoul, Korea- South
| | - S Woo
- Kai Health, Artificial intelligence , Seoul, Korea- South
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Senthil K, Hefti MM, Singh LN, Morgan RW, Mavroudis CD, Ko T, Gaudio H, Nadkarni VM, Ehinger J, Berg RA, Sutton RM, McGowan FX, Kilbaugh TJ. Transcriptome and metabolome after porcine hemodynamic-directed CPR compared with standard CPR and sham controls. Resusc Plus 2022; 10:100243. [PMID: 35592874 PMCID: PMC9111986 DOI: 10.1016/j.resplu.2022.100243] [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: 01/27/2022] [Revised: 04/07/2022] [Accepted: 04/24/2022] [Indexed: 11/18/2022] Open
Abstract
Objective The effect of cardiac arrest (CA) on cerebral transcriptomics and metabolomics is unknown. We previously demonstrated hemodynamic-directed CPR (HD-CPR) improves survival with favorable neurologic outcomes versus standard CPR (Std-CPR). We hypothesized HD-CPR would preserve the cerebral transcriptome and metabolome compared to Std-CPR. Design Randomized pre-clinical animal trial. Setting Large animal resuscitation laboratory at an academic children’s hospital. Subjects Four-week-old female piglets (8–11 kg). Interventions Pigs (1-month-old), three groups: 1) HD-CPR (compression depth to systolic BP 90 mmHg, vasopressors to coronary perfusion pressure 20 mmHg); 2) Std-CPR and 3) shams (no CPR). HD-CPR and Std-CPR underwent asphyxia, induced ventricular fibrillation, 10–20 min of CPR and post-resuscitation care. Primary outcomes at 24 h in cerebral cortex: 1) transcriptomic analysis (n = 4 per treatment arm, n = 8 sham) of 1727 genes using differential gene expression and 2) metabolomic analysis (n = 5 per group) of 27 metabolites using one-way ANOVA, post-hoc Tukey HSD. Measurements and main results 65 genes were differentially expressed between HD-CPR and Std-CPR and 72 genes between Std-CPR and sham, but only five differed between HD-CPR and sham. Std-CPR increased the concentration of five AA compared to HD-CPR and sham, including the branched chain amino acids (BCAA), but zero metabolites differed between HD-CPR and sham. Conclusions In cerebral cortex 24 h post CA, Std-CPR resulted in a different transcriptome and metabolome compared with either HD-CPR or sham. HD-CPR preserves the transcriptome and metabolome, and is neuroprotective. Global molecular analyses may be a novel method to assess efficacy of clinical interventions and identify therapeutic targets. Institutional protocol number IAC 16-001023.
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Affiliation(s)
- Kumaran Senthil
- Children’s Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Department of Anesthesiology and Critical Care Medicine, United States
- Corresponding author at: Children’s Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States.
| | - Marco M. Hefti
- University of Iowa, Division of Pathology, United States
| | - Larry N. Singh
- Children’s Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Department of Anesthesiology and Critical Care Medicine, United States
| | - Ryan W. Morgan
- Children’s Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Department of Anesthesiology and Critical Care Medicine, United States
| | - Constantine D. Mavroudis
- Children’s Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Department of Cardiothoracic Surgery, United States
| | - Tiffany Ko
- Children’s Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Department of Neurology, United States
| | - Hunter Gaudio
- Children’s Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Department of Anesthesiology and Critical Care Medicine, United States
| | - Vinay M. Nadkarni
- Children’s Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Department of Anesthesiology and Critical Care Medicine, United States
| | - Johannes Ehinger
- Lund University, Mitochondrial Medicine, Sweden
- Skåne University Hospital, Department of Otorhinolaryngology, Head and Neck Surgery, Sweden
| | - Robert A. Berg
- Children’s Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Department of Anesthesiology and Critical Care Medicine, United States
| | - Robert M. Sutton
- Children’s Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Department of Anesthesiology and Critical Care Medicine, United States
| | - Francis X. McGowan
- Children’s Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Department of Anesthesiology and Critical Care Medicine, United States
| | - Todd J. Kilbaugh
- Children’s Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Department of Anesthesiology and Critical Care Medicine, United States
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Finlay JB, Brann DH, Abi-Hachem R, Jang DW, Oliva AD, Ko T, Gupta R, Wellford SA, Moseman EA, Jang SS, Yan CH, Matusnami H, Tsukahara T, Datta SR, Goldstein BJ. Persistent post-COVID-19 smell loss is associated with inflammatory infiltration and altered olfactory epithelial gene expression. bioRxiv 2022:2022.04.17.488474. [PMID: 35478953 PMCID: PMC9044903 DOI: 10.1101/2022.04.17.488474] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Most human subjects infected by SARS-CoV-2 report an acute alteration in their sense of smell, and more than 25% of COVID patients report lasting olfactory dysfunction. While animal studies and human autopsy tissues have suggested mechanisms underlying acute loss of smell, the pathophysiology that underlies persistent smell loss remains unclear. Here we combine objective measurements of smell loss in patients suffering from post-acute sequelae of SARS-CoV-2 infection (PASC) with single cell sequencing and histology of the olfactory epithelium (OE). This approach reveals that the OE of patients with persistent smell loss harbors a diffuse infiltrate of T cells expressing interferon-gamma; gene expression in sustentacular cells appears to reflect a response to inflammatory signaling, which is accompanied by a reduction in the number of olfactory sensory neurons relative to support cells. These data identify a persistent epithelial inflammatory process associated with PASC, and suggests mechanisms through which this T cell-mediated inflammation alters the sense of smell.
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Mavroudis CD, Ko T, Volk LE, Smood B, Morgan RW, Lynch JM, Davarajan M, Boorady TW, Licht DJ, Gaynor JW, Mascio CE, Kilbaugh TJ. Does supply meet demand? A comparison of perfusion strategies on cerebral metabolism in a neonatal swine model. J Thorac Cardiovasc Surg 2022; 163:e47-e58. [PMID: 33485668 PMCID: PMC8862716 DOI: 10.1016/j.jtcvs.2020.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 11/29/2020] [Accepted: 12/02/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE We aimed to determine the effects of selective antegrade cerebral perfusion compared with other perfusion strategies on indices of cerebral blood flow, oxygenation, cellular stress, and mitochondrial function. METHODS One-week-old piglets (n = 41) were assigned to 5 treatment groups. Thirty-eight were placed on cardiopulmonary bypass. Of these, 30 were cooled to 18°C and underwent deep hypothermic circulatory arrest (n = 10), underwent selective antegrade cerebral perfusion at 10 mL/kg/min (n = 10), or remained on continuous cardiopulmonary bypass (deep hypothermic cardiopulmonary bypass, n = 10) for 40 minutes. Other subjects remained on normothermic cardiopulmonary bypass (n = 8) or underwent sham surgery (n = 3). Novel, noninvasive optical measurements recorded cerebral blood flow, cerebral tissue oxyhemoglobin concentration, oxygen extraction fraction, total hemoglobin concentration, and cerebral metabolic rate of oxygen. Invasive measurements of cerebral microdialysis and cerebral blood flow were recorded. Cerebral mitochondrial respiration and reactive oxygen species generation were assessed after the piglets were killed. RESULTS During hypothermia, deep hypothermic circulatory arrest piglets experienced increases in oxygen extraction fraction (P < .001), indicating inadequate matching of oxygen supply and demand. Deep hypothermic cardiopulmonary bypass had higher cerebral blood flow (P = .046), oxyhemoglobin concentration (P = .019), and total hemoglobin concentration (P = .070) than selective antegrade cerebral perfusion, indicating greater oxygen delivery. Deep hypothermic circulatory arrest demonstrated worse mitochondrial function (P < .05), increased reactive oxygen species generation (P < .01), and increased markers of cellular stress (P < .01). Reactive oxygen species generation was increased in deep hypothermic cardiopulmonary bypass compared with selective antegrade cerebral perfusion (P < .05), but without significant microdialysis evidence of cerebral cellular stress. CONCLUSIONS Selective antegrade cerebral perfusion meets cerebral metabolic demand and mitigates cerebral mitochondrial reactive oxygen species generation. Excess oxygen delivery during deep hypothermia may have deleterious effects on cerebral mitochondria that may contribute to adverse neurologic outcomes. We describe noninvasive measurements that may help guide perfusion strategies.
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Affiliation(s)
- Constantine D. Mavroudis
- Division of Cardiothoracic Surgery, Department of Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pa;,Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Tiffany Ko
- Division of Neurology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pa
| | - Lindsay E. Volk
- Division of Cardiothoracic Surgery, Department of Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pa
| | - Benjamin Smood
- Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Ryan W. Morgan
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pa
| | - Jennifer M. Lynch
- Department of Anesthesiology, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Mahima Davarajan
- Division of Neurology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pa
| | - Timothy W. Boorady
- Division of Neurology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pa
| | - Daniel J. Licht
- Division of Neurology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pa
| | - J. William Gaynor
- Division of Cardiothoracic Surgery, Department of Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pa;,Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Christopher E. Mascio
- Division of Cardiothoracic Surgery, Department of Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pa;,Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Todd J. Kilbaugh
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pa
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11
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Volk LE, Mavroudis CD, Ko T, Hallowell T, Delso N, Roberts AL, Starr J, Landis W, Lin Y, Hefti M, Morgan RW, Melchior RW, Rosenthal TM, Chappell A, Fisher D, Dreher M, Licht DJ, Chen J, Gaynor JW, Mascio CE, Kilbaugh TJ. Increased cerebral mitochondrial dysfunction and reactive oxygen species with cardiopulmonary bypass. Eur J Cardiothorac Surg 2021; 59:1256-1264. [PMID: 33367535 DOI: 10.1093/ejcts/ezaa439] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/26/2020] [Accepted: 11/04/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Neurodevelopmental injury after cardiac surgery using cardiopulmonary bypass (CPB) for congenital heart defects is common, but the mechanism behind this injury is unclear. This study examines the impact of CPB on cerebral mitochondrial reactive oxygen species (ROS) generation and mitochondrial bioenergetics. METHODS Twenty-three piglets (mean weight 4.2 ± 0.5 kg) were placed on CPB for either 1, 2, 3 or 4 h (n = 5 per group) or underwent anaesthesia without CPB (sham, n = 3). Microdialysis was used to measure metabolic markers of ischaemia. At the conclusion of CPB or 4 h of sham, brain tissue was harvested. Utilizing high-resolution respirometry, with simultaneous fluorometric analysis, mitochondrial respiration and ROS were measured. RESULTS There were no significant differences in markers of ischaemia between sham and experimental groups. Sham animals had significantly higher mitochondrial respiration than experimental animals, including maximal oxidative phosphorylation capacity of complex I (OXPHOSCI) (3.25 ± 0.18 vs 4-h CPB: 1.68 ± 0.10, P < 0.001) and maximal phosphorylating respiration capacity via convergent input through complexes I and II (OXPHOSCI+CII) (7.40 ± 0.24 vs 4-h CPB: 3.91 ± 0.20, P < 0.0001). At 4-h, experimental animals had significantly higher ROS related to non-phosphorylating respiration through complexes I and II (ETSCI+CII) than shams (1.08 ± 0.13 vs 0.64 ± 0.04, P = 0.026). CONCLUSIONS Even in the absence of local markers of ischaemia, CPB is associated with decreased mitochondrial respiration relative to shams irrespective of duration. Exposure to 4 h of CPB resulted in a significant increase in cerebral mitochondrial ROS formation compared to shorter durations. Further study is needed to improve the understanding of cerebral mitochondrial health and its effects on the pathophysiology of neurological injury following exposure to CPB.
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Affiliation(s)
- Lindsay E Volk
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Constantine D Mavroudis
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Tiffany Ko
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Thomas Hallowell
- Division of Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nile Delso
- Division of Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Anna L Roberts
- Division of Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jonathan Starr
- Division of Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - William Landis
- Division of Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Yuxi Lin
- Division of Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Marco Hefti
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Ryan W Morgan
- Division of Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Richard W Melchior
- Division of Perfusion Services, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Tami M Rosenthal
- Division of Perfusion Services, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alexander Chappell
- Division of Perfusion Services, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Douglas Fisher
- Division of Perfusion Services, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Molly Dreher
- Division of Perfusion Services, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Daniel J Licht
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jonathan Chen
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - J William Gaynor
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christopher E Mascio
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Todd J Kilbaugh
- Division of Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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12
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Senthil K, Morgan RW, Hefti MM, Karlsson M, Lautz AJ, Mavroudis CD, Ko T, Nadkarni VM, Ehinger J, Berg RA, Sutton RM, McGowan FX, Kilbaugh TJ. Haemodynamic-directed cardiopulmonary resuscitation promotes mitochondrial fusion and preservation of mitochondrial mass after successful resuscitation in a pediatric porcine model. Resusc Plus 2021; 6:100124. [PMID: 34223382 PMCID: PMC8244484 DOI: 10.1016/j.resplu.2021.100124] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 04/02/2021] [Accepted: 04/05/2021] [Indexed: 01/09/2023] Open
Abstract
Objective Cerebral mitochondrial dysfunction is a key mediator of neurologic injury following cardiac arrest (CA) and is regulated by the balance of fusion and fission (mitochondrial dynamics). Under stress, fission can decrease mitochondrial mass and signal apoptosis, while fusion promotes oxidative phosphorylation efficiency. This study evaluates mitochondrial dynamics and content in brain tissue 24 h after CA between two cardiopulmonary resuscitation (CPR) strategies. Interventions Piglets (1 month), previously randomized to three groups: (1) Std-CPR (n = 5); (2) HD-CPR (n = 5; goal systolic blood pressure 90 mmHg, goal coronary perfusion pressure 20 mmHg); (3) Shams (n = 7). Std-CPR and HD-CPR groups underwent 7 min of asphyxia, 10 min of CPR, and standardized post-resuscitation care. Primary outcomes: (1) cerebral cortical mitochondrial protein expression for fusion (OPA1, OPA1 long to short chain ratio, MFN2) and fission (DRP1, FIS1), and (2) mitochondrial mass by citrate synthase activity. Secondary outcomes: (1) intra-arrest haemodynamics and (2) cerebral performance category (CPC) at 24 h. Results HD-CPR subjects had higher total OPA1 expression compared to Std-CPR (1.52; IQR 1.02-1.69 vs 0.67; IQR 0.54-0.88, p = 0.001) and higher OPA1 long to short chain ratio than both Std-CPR (0.63; IQR 0.46-0.92 vs 0.26; IQR 0.26-0.31, p = 0.016) and shams. Citrate synthase activity was lower in Std-CPR than sham (11.0; IQR 10.15-12.29 vs 13.4; IQR 12.28-15.66, p = 0.047), but preserved in HD-CPR. HD-CPR subjects had improved intra-arrest haemodynamics and CPC scores at 24 h compared to Std-CPR. Conclusions Following asphyxia-associated CA, HD-CPR exhibits increased pro-mitochondrial fusion protein expression, preservation of mitochondrial mass, improved haemodynamics and superior neurologic scoring compared to Std-CPR. Institutional protocol number IAC 16-001023.
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Affiliation(s)
- Kumaran Senthil
- Children's Hospital of Philadelphia and Perelman School of Medicine at University of Pennsylvania, Department of Anesthesiology and Critical Care Medicine, United States
| | - Ryan W Morgan
- Children's Hospital of Philadelphia and Perelman School of Medicine at University of Pennsylvania, Department of Anesthesiology and Critical Care Medicine, United States
| | - Marco M Hefti
- University of Iowa, Division of Pathology, United States
| | | | - Andrew J Lautz
- Cincinnati Children's Hospital Medical Center, Division of Critical Care Medicine, United States
| | - Constantine D Mavroudis
- Department of Neurosurgery, Righospitalet, Copenhagen, Denmark.,Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Division of Cardiothoracic Surgery, United States
| | - Tiffany Ko
- Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Division of Neurology, United States
| | - Vinay M Nadkarni
- Children's Hospital of Philadelphia and Perelman School of Medicine at University of Pennsylvania, Department of Anesthesiology and Critical Care Medicine, United States
| | | | - Robert A Berg
- Children's Hospital of Philadelphia and Perelman School of Medicine at University of Pennsylvania, Department of Anesthesiology and Critical Care Medicine, United States
| | - Robert M Sutton
- Children's Hospital of Philadelphia and Perelman School of Medicine at University of Pennsylvania, Department of Anesthesiology and Critical Care Medicine, United States
| | - Francis X McGowan
- Children's Hospital of Philadelphia and Perelman School of Medicine at University of Pennsylvania, Department of Anesthesiology and Critical Care Medicine, United States
| | - Todd J Kilbaugh
- Children's Hospital of Philadelphia and Perelman School of Medicine at University of Pennsylvania, Department of Anesthesiology and Critical Care Medicine, United States
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13
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White BR, Padawer-Curry JA, Ko T, Baker W, Breimann J, Cohen AS, Licht DJ, Yodh AG. Wavelength censoring for spectroscopy in optical functional neuroimaging. Phys Med Biol 2021; 66:065026. [PMID: 33326946 DOI: 10.1088/1361-6560/abd418] [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] [Indexed: 11/12/2022]
Abstract
Optical neuromonitoring provides insight into neurovascular physiology and brain structure and function. These methods rely on spectroscopy to relate light absorption changes to variation of concentrations of physiologic chromophores such as oxy- and deoxyhemoglobin. In clinical or preclinical practice, data quality can vary significantly across wavelengths. In such situations, standard spectroscopic methods may perform poorly, resulting in data loss and limiting field-of-view. To address this issue, and thereby improve the robustness of optical neuromonitoring, we develop, in this manuscript, novel methods to perform spectroscopy even when data quality exhibits wavelength-dependent spatial variation. We sought to understand the impact of spatial, wavelength-based censoring on the physiologic accuracy and utility of hemoglobin spectroscopy. The principles of our analysis are quite general, but to make the methodology tangible we focused on optical intrinsic signal imaging of resting-state functional connectivity in mice. Starting with spectroscopy using four sources, all possible subset spectroscopy matrices were assessed theoretically, using simulated data, and using experimental data. These results were compared against the use of the full spectroscopy matrix to determine which subsets yielded robust results. Our results demonstrated that accurate calculation of changes in hemoglobin concentrations and the resulting functional connectivity network maps was possible even with censoring of some wavelengths. Additionally, we found that the use of changes in total hemoglobin (rather than oxy- or deoxyhemoglobin) yielded results more robust to experimental noise and allowed for the preservation of more data. This new and rigorous image processing method should improve the fidelity of clinical and preclinical functional neuroimaging studies.
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Affiliation(s)
- Brian R White
- Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd., Pediatric Cardiology-8NW, Philadelphia, PA 19104, United States of America
| | - Jonah A Padawer-Curry
- Division of Neurology, Department of Pediatrics, The Children's Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, United States of America
| | - Tiffany Ko
- Division of Neurology, Department of Pediatrics, The Children's Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, United States of America
| | - Wesley Baker
- Division of Neurology, Department of Pediatrics, The Children's Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, United States of America
| | - Jake Breimann
- Division of Neurology, Department of Pediatrics, The Children's Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, United States of America
| | - Akiva S Cohen
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia. 3615 Civic Center Blvd., Abramson Research Center, Room 816-H, Philadelphia, PA 19104, United States of America
| | - Daniel J Licht
- Division of Neurology, Department of Pediatrics, The Children's Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, United States of America
| | - Arjun G Yodh
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104, United States of America
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14
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Kirschen MP, Morgan RW, Majmudar T, Landis WP, Ko T, Balu R, Balasubramanian S, Topjian A, Sutton RM, Berg RA, Kilbaugh TJ. The association between early impairment in cerebral autoregulation and outcome in a pediatric swine model of cardiac arrest. Resusc Plus 2020; 4:100051. [PMID: 34223325 PMCID: PMC8244245 DOI: 10.1016/j.resplu.2020.100051] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/03/2020] [Accepted: 11/08/2020] [Indexed: 12/26/2022] Open
Abstract
AIMS Evaluate cerebral autoregulation (CAR) by intracranial pressure reactivity index (PRx) and cerebral blood flow reactivity index (CBFx) during the first four hours following return of spontaneous circulation (ROSC) in a porcine model of pediatric cardiac arrest. Determine whether impaired CAR is associated with neurologic outcome. METHODS Four-week-old swine underwent seven minutes of asphyxia followed by ventricular fibrillation induction and hemodynamic-directed CPR. Those achieving ROSC had arterial blood pressure, intracranial pressure (ICP), and microvascular cerebral blood flow (CBF) monitored for 4 h. Animals were assigned an 8 -h post-ROSC swine cerebral performance category score (1 = normal; 2-4=abnormal neurologic function). In this secondary analytic study, we calculated PRx and CBFx using a continuous, moving correlation coefficient between mean arterial pressure (MAP) and ICP, and between MAP and CBF, respectively. Burden of impaired CAR was the area under the PRx or CBFx curve using a threshold of 0.3 and normalized as percentage of monitoring duration. RESULTS Among 23 animals, median PRx was 0.14 [0.06,0.25] and CBFx was 0.36 [0.05,0.44]. Median burden of impaired CAR was 21% [18,27] with PRx and 30% [17,40] with CBFx. Neurologically abnormal animals (n = 10) did not differ from normal animals (n = 13) in post-ROSC MAP (63 vs. 61 mmHg, p = 0.74), ICP (15 vs. 14 mmHg, p = 0.78) or CBF (274 vs. 397 Perfusion Units, p = 0.12). CBFx burden was greater among abnormal than normal animals (45% vs. 24%, p = 0.001), but PRx burden was not (25% vs. 20%, p = 0.38). CONCLUSION CAR is impaired early after ROSC. A greater burden of CAR impairment measured by CBFx was associated with abnormal neurologic outcome.CHOP Institutional Animal Care and Use Committee protocol 19-001327.
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Affiliation(s)
- Matthew P Kirschen
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, USA
- Department of Pediatrics, Children’s Hospital of Philadelphia, USA
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, USA
| | - Ryan W. Morgan
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, USA
- Department of Pediatrics, Children’s Hospital of Philadelphia, USA
| | - Tanmay Majmudar
- School of Biomedical Engineering, Science and Health Systems, Drexel University, USA
| | - William P. Landis
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, USA
| | - Tiffany Ko
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, USA
| | - Ramani Balu
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, USA
| | | | - Alexis Topjian
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, USA
- Department of Pediatrics, Children’s Hospital of Philadelphia, USA
| | - Robert M. Sutton
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, USA
- Department of Pediatrics, Children’s Hospital of Philadelphia, USA
| | - Robert A. Berg
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, USA
- Department of Pediatrics, Children’s Hospital of Philadelphia, USA
| | - Todd J. Kilbaugh
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, USA
- Department of Pediatrics, Children’s Hospital of Philadelphia, USA
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15
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Slovis JC, Morgan RW, Landis WP, Roberts AL, Marquez AM, Mavroudis CD, Lin Y, Ko T, Nadkarni VM, Berg RA, Sutton RM, Kilbaugh TJ. The physiologic response to rescue therapy with vasopressin versus epinephrine during experimental pediatric cardiac arrest. Resusc Plus 2020; 4:100050. [PMID: 34223324 PMCID: PMC8244440 DOI: 10.1016/j.resplu.2020.100050] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 11/26/2022] Open
Abstract
Aim Compare vasopressin to a second dose of epinephrine as rescue therapy after ineffective initial doses of epinephrine in diverse models of pediatric in-hospital cardiac arrest. Methods 67 one- to three-month old female swine (10−30 kg) in six experimental cohorts from one laboratory received hemodynamic-directed CPR, a resuscitation method where high quality chest compressions are provided and vasopressor administration is titrated to coronary perfusion pressure (CoPP) ≥20 mmHg. Vasopressors are given when CoPP is <20 mmHg, in sequences of two doses of 0.02 mg/kg epinephrine separated by minimum one-minute, then a rescue dose of 0.4 U/kg vasopressin followed by minimum two-minutes. Invasive measurements were used to evaluate and compare the hemodynamic and neurologic effects of each vasopressor dose. Results Increases in CoPP and cerebral blood flow (CBF) were greater with vasopressin rescue than epinephrine rescue (CoPP: +8.16 [4.35, 12.06] mmHg vs. + 5.43 [1.56, 9.82] mmHg, p = 0.02; CBF: +14.58 [-0.05, 38.12] vs. + 0.00 [-0.77, 18.24] perfusion units (PFU), p = 0.005). Twenty animals (30%) failed to achieve CoPP ≥20 mmHg after two doses of epinephrine; 9/20 (45%) non-responders achieved CoPP ≥20 mmHg after vasopressin. Among all animals, the increase in CBF was greater with vasopressin (+14.58 [-0.58, 38.12] vs. 0.00 [-0.77, 18.24] PFU, p = 0.005). Conclusions CoPP and CBF rose significantly more after rescue vasopressin than after rescue epinephrine. Importantly, CBF increased after vasopressin rescue, but not after epinephrine rescue. In the 30% that failed to meet CoPP of 20 mmHg after two doses of epinephrine, 45% achieved target CoPP with a single rescue vasopressin dose.
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Affiliation(s)
- Julia C Slovis
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 3401 Civic Center Boulevard, Division of Critical Care Medicine - 6 Wood, Philadelphia, PA 19104, US
| | - Ryan W Morgan
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 3401 Civic Center Boulevard, Division of Critical Care Medicine - 6 Wood, Philadelphia, PA 19104, US
| | - William P Landis
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 3401 Civic Center Boulevard, Division of Critical Care Medicine - 6 Wood, Philadelphia, PA 19104, US
| | - Anna L Roberts
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 3401 Civic Center Boulevard, Division of Critical Care Medicine - 6 Wood, Philadelphia, PA 19104, US
| | - Alexandra M Marquez
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 3401 Civic Center Boulevard, Division of Critical Care Medicine - 6 Wood, Philadelphia, PA 19104, US
| | - Constantine D Mavroudis
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 3401 Civic Center Boulevard, Division of Critical Care Medicine - 6 Wood, Philadelphia, PA 19104, US
| | - Yuxi Lin
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 3401 Civic Center Boulevard, Division of Critical Care Medicine - 6 Wood, Philadelphia, PA 19104, US
| | - Tiffany Ko
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 3401 Civic Center Boulevard, Division of Critical Care Medicine - 6 Wood, Philadelphia, PA 19104, US
| | - Vinay M Nadkarni
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 3401 Civic Center Boulevard, Division of Critical Care Medicine - 6 Wood, Philadelphia, PA 19104, US
| | - Robert A Berg
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 3401 Civic Center Boulevard, Division of Critical Care Medicine - 6 Wood, Philadelphia, PA 19104, US
| | - Robert M Sutton
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 3401 Civic Center Boulevard, Division of Critical Care Medicine - 6 Wood, Philadelphia, PA 19104, US
| | - Todd J Kilbaugh
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 3401 Civic Center Boulevard, Division of Critical Care Medicine - 6 Wood, Philadelphia, PA 19104, US
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16
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Kwak S, Everett R, Ko T, Lee H, Lee W, Treibel T, Chin C, Captur G, Schulz-Menger J, Newby D, Greenwood J, Moon J, Dweck M, Lee S. Stratifying the prognostic capability of cardiovascular magnetic resonance in severe aortic stenosis: a machine learning approach. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiovascular magnetic resonance (CMR) demonstrates promise in improving patient risk stratification in aortic stenosis (AS). We explored whether machine learning might provide further insights into the prognostic capability of CMR parameters.
Methods
Severe AS patients (n=440) undergoing AVR were prospectively enrolled across 10 international sites, and CMR performed prior to AVR. A machine learning prediction model using a random survival forest (RSF) was trained with 29 variables, including 13 CMR, 4 echocardiography, and 12 clinical parameters, using post-AVR mortality as an outcome. The impact of the important variables on the outcome (partial dependency) was examined.
Results
The most predictive CMR parameters in the RSF model were the extracellular volume fraction (ECV%), followed by right ventricular ejection fraction (RVEF), late gadolinium enhancement (LGE%), and indexed left ventricular end-diastolic volume (LVEDVi). Regarding the partial effects, the predicted mortality increased strongly once the ECV% exceeded 26.5% (Figure 1A). The LGE% was associated with an increased risk of mortality, which reached a plateau beyond the level of 2% (Figure 1C). There were U-shaped relationships between mortality and both RVEF and LVEDVi, with the lowest mortality seen at RVEF 70% and LVEDVi 68ml/m2 (Figure 1B, D). These trends of predicted outcomes by each variable were verified in the Kaplan-Meier curves and Cox analyses (Table). In both Cox and RSF models, the predictability was substantially increased when these four CMR parameters were added to conventional clinical risk factors. An AS-CMR risk score comprised of these four parameters presented a stepwise increase in mortality with increasing adverse CMR features (p<0.001).
Conclusions
Our machine learning analysis using RSF has identified ECV%, RVEF, LGE%, and LVEDVi as key prognostic markers in severe AS with a nonlinear influence of each parameter on mortality post-AVR.
Figure 1
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): This study was supported by grants from the Korean Health Technology R & D Project, Ministry of Health, Welfare & Family Affairs, Republic of Korea (HI16C0225 and HI15C0399) and the National Institute for Health Research (NIHR) infrastructure at Leeds.
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Affiliation(s)
- S Kwak
- Seoul National University Hospital, Seoul, Korea (Republic of)
| | - R Everett
- University of Edinburgh, Edinburgh, United Kingdom
| | - T Ko
- Seoul National University Hospital, Seoul, Korea (Republic of)
| | - H Lee
- Seoul National University Hospital, Seoul, Korea (Republic of)
| | - W Lee
- Seoul National University Hospital, Seoul, Korea (Republic of)
| | - T Treibel
- Barts Health NHS Trust, London, United Kingdom
| | - C Chin
- National Heart Centre Singapore, Singapore, Singapore
| | - G Captur
- Royal Free Hospital, London, United Kingdom
| | | | - D Newby
- University of Edinburgh, Edinburgh, United Kingdom
| | | | - J Moon
- Barts Health NHS Trust, London, United Kingdom
| | - M.R Dweck
- University of Edinburgh, Edinburgh, United Kingdom
| | - S.P Lee
- Seoul National University Hospital, Seoul, Korea (Republic of)
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Marquez AM, Morgan RW, Ko T, Landis WP, Hefti MM, Mavroudis CD, McManus MJ, Karlsson M, Starr J, Roberts AL, Lin Y, Nadkarni V, Licht DJ, Berg RA, Sutton RM, Kilbaugh TJ. Oxygen Exposure During Cardiopulmonary Resuscitation Is Associated With Cerebral Oxidative Injury in a Randomized, Blinded, Controlled, Preclinical Trial. J Am Heart Assoc 2020; 9:e015032. [PMID: 32321350 PMCID: PMC7428577 DOI: 10.1161/jaha.119.015032] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Hyperoxia during cardiopulmonary resuscitation (CPR) may lead to oxidative injury from mitochondrial‐derived reactive oxygen species, despite guidelines recommending 1.0 inspired oxygen during CPR. We hypothesized exposure to 1.0 inspired oxygen during CPR would result in cerebral hyperoxia, higher mitochondrial‐derived reactive oxygen species, increased oxidative injury, and similar survival compared with those exposed to 21% oxygen. Methods and Results Four‐week‐old piglets (n=25) underwent asphyxial cardiac arrest followed by randomization and blinding to CPR with 0.21 (n=10) or 1.0 inspired oxygen (n=10) through 10 minutes post return of spontaneous circulation. Sham was n=5. Survivors received 4 hours of protocolized postarrest care, whereupon brain was obtained for mitochondrial analysis and neuropathology. Groups were compared using Kruskal‐Wallis test, Wilcoxon rank‐sum test, and generalized estimating equations regression models. Both 1.0 and 0.21 groups were similar in systemic hemodynamics and cerebral blood flow, as well as survival (8/10). The 1.0 animals had relative cerebral hyperoxia during CPR and immediately following return of spontaneous circulation (brain tissue oxygen tension, 85% [interquartile range, 72%–120%] baseline in 0.21 animals versus 697% [interquartile range, 515%–721%] baseline in 1.0 animals; P=0.001 at 10 minutes postarrest). Cerebral mitochondrial reactive oxygen species production was higher in animals treated with 1.0 compared with 0.21 (P<0.03). Exposure to 1.0 oxygen led to increased cerebral oxidative injury to proteins and lipids, as evidenced by significantly higher protein carbonyls and 4‐hydroxynoneals compared with 0.21 (P<0.05) and sham (P<0.001). Conclusions Exposure to 1.0 inspired oxygen during CPR caused cerebral hyperoxia during resuscitation, and resultant increased mitochondrial‐derived reactive oxygen species and oxidative injury following cardiac arrest.
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Affiliation(s)
- Alexandra M Marquez
- Division of Critical Care Medicine Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia PA
| | - Ryan W Morgan
- Division of Critical Care Medicine Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia PA
| | - Tiffany Ko
- Division of Neurology Department of Pediatrics Children's Hospital of Philadelphia PA
| | - William P Landis
- Division of Critical Care Medicine Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia PA
| | - Marco M Hefti
- Department of Pathology University of Iowa Iowa City IA
| | - Constantine D Mavroudis
- Division of Cardiothoracic Surgery Department of Surgery Children's Hospital of Philadelphia PA
| | - Meagan J McManus
- Division of Critical Care Medicine Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia PA
| | | | - Jonathan Starr
- Division of Critical Care Medicine Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia PA
| | - Anna L Roberts
- Division of Critical Care Medicine Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia PA
| | - Yuxi Lin
- Division of Critical Care Medicine Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia PA
| | - Vinay Nadkarni
- Division of Critical Care Medicine Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia PA
| | - Daniel J Licht
- Division of Neurology Department of Pediatrics Children's Hospital of Philadelphia PA
| | - Robert A Berg
- Division of Critical Care Medicine Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia PA
| | - Robert M Sutton
- Division of Critical Care Medicine Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia PA
| | - Todd J Kilbaugh
- Division of Critical Care Medicine Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia PA
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18
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Schwartz N, Wang L, Cochran J, Ko T, He L, Baker W, Abramson K, Busch D, Kavuri V, Parry S, Yodh A. 231: High-sensitivity, integrated near-infrared optical probe non-invasively measures human placental tissue oxygenation. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.247] [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: 10/25/2022]
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Affiliation(s)
- B Mezuk
- University of Michigan, Ann Arbor, Michigan, United States
| | - T Ko
- University of Michgan School of Public Health, Ann Arbor, MI, USA
| | - V Kalesnikava
- University of Michgan School of Public Health, Ann Arbor, MI, USA
| | - D Jurgens
- University of Michgan School of Information, Ann Arbor, MI, USA
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20
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Park L, Chang S, Ko T, Rhee K, Anker J, Bhave M, Davis A, Cruz M, Iams W, Zou L, Wang V, Chuang J, Chae Y. P1.04-01 Impact of Chromatin Remodeling Genes Including SMARCA2 and PBRM1 on Neoantigen and Immune Landscape of NSCLC. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.716] [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: 10/28/2022]
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21
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Chae Y, Chang S, Ko T, Rhee K, Cruz M, Bhave M, Anker J, Davis A, Iams W, Wang V, Chuang J, Park L. P1.04-25 The Implication of Frameshift Mutation Burden in Neoantigen and Immune Cell Landscape in Non-Small Cell Lung Cancer (NSCLC). J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.740] [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: 11/26/2022]
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22
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Chu C, Chang C, Lin C, Ko T. ISQUA18-2405Sharing Decision Making (SDM) Approach Applicable to Whole Hospital - A Medical Center in Northern Taiwan. Int J Qual Health Care 2018. [DOI: 10.1093/intqhc/mzy167.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C Chu
- Cathay general hospital, Taipei, Taiwan
| | - C Chang
- Cathay general hospital, Taipei, Taiwan
| | - C Lin
- Cathay general hospital, Taipei, Taiwan
| | - T Ko
- Cathay general hospital, Taipei, Taiwan
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Ko T, Nomura S, Fujita T, Satoh M, Fujita K, Harada M, Toko H, Aburatani H, Komuro I. 1429Single-cell analysis of non-cardiomyocytes in heart reveals a critical regulator of cardiac homeostasis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1429] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T Ko
- University of Tokyo Hospital, Cardiovascular Medicine, Tokyo, Japan
| | - S Nomura
- University of Tokyo Hospital, Cardiovascular Medicine, Tokyo, Japan
| | - T Fujita
- University of Tokyo, Laboratory for Systems Biology and Medicine, Genome Science, Tokyo, Japan
| | - M Satoh
- Chiba University Graduate School of Medicine, Cardiology, Chiba, Japan
| | - K Fujita
- University of Tokyo Hospital, Cardiovascular Medicine, Tokyo, Japan
| | - M Harada
- University of Tokyo Hospital, Cardiovascular Medicine, Tokyo, Japan
| | - H Toko
- University of Tokyo Hospital, Cardiovascular Medicine, Tokyo, Japan
| | - H Aburatani
- University of Tokyo, Laboratory for Systems Biology and Medicine, Genome Science, Tokyo, Japan
| | - I Komuro
- University of Tokyo Hospital, Cardiovascular Medicine, Tokyo, Japan
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Satoh M, Nomura S, Fujita T, Ko T, Tobita T, Ito M, Fujita K, Aburatani H, Kobayashi Y, Komuro I. 4926High-throughput single-molecule RNA imaging analysis reveals spatial heterogeneity in heart failure. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.4926] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Satoh
- Chiba University Graduate School of Medicine, Department of Cardiovascular Medicine, Chiba, Japan
| | - S Nomura
- University of Tokyo, Department of Cardiovascular Medicine, Tokyo, Japan
| | - T Fujita
- University of Tokyo, Genome Science Laboratory, Tokyo, Japan
| | - T Ko
- University of Tokyo, Department of Cardiovascular Medicine, Tokyo, Japan
| | - T Tobita
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - M Ito
- University of Tokyo, Department of Cardiovascular Medicine, Tokyo, Japan
| | - K Fujita
- University of Tokyo, Department of Cardiovascular Medicine, Tokyo, Japan
| | - H Aburatani
- University of Tokyo, Genome Science Laboratory, Tokyo, Japan
| | - Y Kobayashi
- Chiba University Graduate School of Medicine, Department of Cardiovascular Medicine, Chiba, Japan
| | - I Komuro
- University of Tokyo, Department of Cardiovascular Medicine, Tokyo, Japan
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25
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Mavroudis CD, Karlsson M, Ko T, Hefti M, Gentile JI, Morgan RW, Plyler R, Mensah-Brown KG, Boorady TW, Melchior RW, Rosenthal TM, Shade BC, Schiavo KL, Nicolson SC, Spray TL, Sutton RM, Berg RA, Licht DJ, Gaynor JW, Kilbaugh TJ. Cerebral mitochondrial dysfunction associated with deep hypothermic circulatory arrest in neonatal swine. Eur J Cardiothorac Surg 2018; 54:162-168. [PMID: 29346537 PMCID: PMC7448940 DOI: 10.1093/ejcts/ezx467] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 11/15/2017] [Accepted: 12/02/2017] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES Controversy remains regarding the use of deep hypothermic circulatory arrest (DHCA) in neonatal cardiac surgery. Alterations in cerebral mitochondrial bioenergetics are thought to contribute to ischaemia-reperfusion injury in DHCA. The purpose of this study was to compare cerebral mitochondrial bioenergetics for DHCA with deep hypothermic continuous perfusion using a neonatal swine model. METHODS Twenty-four piglets (mean weight 3.8 kg) were placed on cardiopulmonary bypass (CPB): 10 underwent 40-min DHCA, following cooling to 18°C, 10 underwent 40 min DHCA and 10 remained at deep hypothermia for 40 min; animals were subsequently rewarmed to normothermia. 4 remained on normothermic CPB throughout. Fresh brain tissue was harvested while on CPB and assessed for mitochondrial respiration and reactive oxygen species generation. Cerebral microdialysis samples were collected throughout the analysis. RESULTS DHCA animals had significantly decreased mitochondrial complex I respiration, maximal oxidative phosphorylation, respiratory control ratio and significantly increased mitochondrial reactive oxygen species (P < 0.05 for all). DHCA animals also had significantly increased cerebral microdialysis indicators of cerebral ischaemia (lactate/pyruvate ratio) and neuronal death (glycerol) during and after rewarming. CONCLUSIONS DHCA is associated with disruption of mitochondrial bioenergetics compared with deep hypothermic continuous perfusion. Preserving mitochondrial health may mitigate brain injury in cardiac surgical patients. Further studies are needed to better understand the mechanisms of neurological injury in neonatal cardiac surgery and correlate mitochondrial dysfunction with neurological outcomes.
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Affiliation(s)
- Constantine D Mavroudis
- Department of Cardiothoracic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michael Karlsson
- Department of Anesthesia and Critical Care Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Tiffany Ko
- Department of Neurology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Marco Hefti
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Javier I Gentile
- Department of Cardiothoracic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ryan W Morgan
- Department of Anesthesia and Critical Care Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ross Plyler
- Department of Anesthesia and Critical Care Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kobina G Mensah-Brown
- Department of Neurology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Timothy W Boorady
- Department of Neurology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Richard W Melchior
- Department of Perfusion Services, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Tami M Rosenthal
- Department of Perfusion Services, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Brandon C Shade
- Department of Perfusion Services, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kellie L Schiavo
- Department of Perfusion Services, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Susan C Nicolson
- Department of Anesthesia and Critical Care Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Thomas L Spray
- Department of Cardiothoracic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Robert M Sutton
- Department of Anesthesia and Critical Care Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Robert A Berg
- Department of Anesthesia and Critical Care Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Daniel J Licht
- Department of Neurology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - J William Gaynor
- Department of Cardiothoracic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Todd J Kilbaugh
- Department of Anesthesia and Critical Care Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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26
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Lynch JM, Ko T, Busch DR, Newland JJ, Winters ME, Mensah-Brown K, Boorady TW, Xiao R, Nicolson SC, Montenegro LM, Gaynor JW, Spray TL, Yodh AG, Naim MY, Licht DJ. Preoperative cerebral hemodynamics from birth to surgery in neonates with critical congenital heart disease. J Thorac Cardiovasc Surg 2018; 156:1657-1664. [PMID: 29859676 DOI: 10.1016/j.jtcvs.2018.04.098] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [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: 05/22/2017] [Revised: 04/19/2018] [Accepted: 04/24/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Hypoxic-ischemic white matter brain injury commonly occurs in neonates with critical congenital heart disease. Recent work has shown that longer time to surgery is associated with increased risk for this injury. In this study we investigated changes in perinatal cerebral hemodynamics during the transition from fetal to neonatal circulation to ascertain mechanisms that might underlie this risk. METHODS Neonates with either transposition of the great arteries (TGA) or hypoplastic left heart syndrome (HLHS) were recruited for preoperative noninvasive optical monitoring of cerebral oxygen saturation, cerebral oxygen extraction fraction, and cerebral blood flow using diffuse optical spectroscopy and diffuse correlation spectroscopy, 2 noninvasive optical techniques. Measurements were acquired daily from day of consent until the morning of surgery. Temporal trends in these measured parameters during the preoperative period were assessed with a mixed effects model. RESULTS Forty-eight neonates with TGA or HLHS were studied. Cerebral oxygen saturation was significantly and negatively correlated with time, and oxygen extraction fraction was significantly and positively correlated with time. Cerebral blood flow did not significantly change with time during the preoperative period. CONCLUSIONS In neonates with TGA or HLHS, increasing cerebral oxygen extraction combined with an abnormal cerebral blood flow response during the time between birth and heart surgery leads to a progressive decrease in cerebral tissue oxygenation The results support and help explain the physiological basis for recent studies that show longer time to surgery increases the risk of acquiring white matter injury.
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Affiliation(s)
- Jennifer M Lynch
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Penn.
| | - Tiffany Ko
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pa; Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pa
| | - David R Busch
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pa; Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - John J Newland
- Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Madeline E Winters
- Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Kobina Mensah-Brown
- Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Timothy W Boorady
- Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Rui Xiao
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pa
| | - Susan C Nicolson
- Division of Cardiothoracic Anesthesia, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Lisa M Montenegro
- Division of Cardiothoracic Anesthesia, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - J William Gaynor
- Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Thomas L Spray
- Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Arjun G Yodh
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pa
| | - Maryam Y Naim
- Division of Cardiac Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Daniel J Licht
- Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pa
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Ko T, Fujita K, Nomura S, Tsuji M, Nitta D, Maki H, Hosoya Y, Amiya E, Hatano M, Ono M, Komuro I. Quantification of DNA Damage in Heart Tissue as a Novel Prediction Tool for Therapeutic Prognosis. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.578] [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: 11/17/2022] Open
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28
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Golder V, Ooi JJY, Antony AS, Ko T, Morton S, Kandane-Rathnayake R, Morand EF, Hoi AY. Discordance of patient and physician health status concerns in systemic lupus erythematosus. Lupus 2017; 27:501-506. [PMID: 28764617 DOI: 10.1177/0961203317722412] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objectives To compare the health status concerns of patients with systemic lupus erythematosus (SLE) and of their physicians. Methods Cross-sectional questionnaire study of SLE patients and their treating physicians at a tertiary disease-specific outpatient clinic. Patients and physicians completed a questionnaire regarding their concern about specific disease manifestations and impact on quality of life. For each item, degree of concern was rated on a five-point Likert scale and summarized as median (interquartile range). Ratings between patients and physicians were compared using Mann-Whitney U tests. Results A total of 84 patients and 21 physicians participated. Patients' predominant concerns centred on function and fatigue, whereas physicians' concerns focused on SLE-related organ complications. Of the 10 highest ranked patient concerns, only two were common to the 10 highest ranked physician concerns, while physicians rated seven significantly differently; all 10 highest ranked physician concerns were rated significantly lower by patients. The three highest ranked patient concerns (fatigue, pain and feeling worn out) were routinely assessed by 47.6%, 42.9% and 9.5% of physicians, respectively. Conclusion There was significant discordance between SLE patient and physician health status concerns. Items which were ranked highly by patients were not assessed consistently by physicians, highlighting a significant gap in healthcare communication.
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Affiliation(s)
- V Golder
- 1 School of Clinical Sciences, Monash University, Australia.,2 Department of Rheumatology, Monash Health, Clayton, Australia
| | - J J Y Ooi
- 1 School of Clinical Sciences, Monash University, Australia.,3 Alfred Health, Melbourne, Australia
| | - A S Antony
- 2 Department of Rheumatology, Monash Health, Clayton, Australia
| | - T Ko
- 2 Department of Rheumatology, Monash Health, Clayton, Australia
| | - S Morton
- 2 Department of Rheumatology, Monash Health, Clayton, Australia
| | | | - E F Morand
- 1 School of Clinical Sciences, Monash University, Australia.,2 Department of Rheumatology, Monash Health, Clayton, Australia
| | - A Y Hoi
- 1 School of Clinical Sciences, Monash University, Australia.,2 Department of Rheumatology, Monash Health, Clayton, Australia
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Ko T, He L, Kavuri VC, Parthasarathy A, Morano VC, Cochran J, Baker WB, Seigal J, Yodh AG, Licht DJ, Schwartz N. 283: Quantifying placental oxygenation using ultrasound-guided frequency-domain near-infrared spectroscopy (FD-NIRS). Am J Obstet Gynecol 2017. [DOI: 10.1016/j.ajog.2016.11.189] [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]
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Antony A, Kandane-Rathnayake RK, Ko T, Boulos D, Hoi AY, Jolly M, Morand EF. Validation of the Lupus Impact Tracker in an Australian patient cohort. Lupus 2016; 26:98-105. [PMID: 27516435 DOI: 10.1177/0961203316664593] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 07/25/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The objective of this article is to validate the Lupus Impact Tracker (LIT), a disease-specific patient-reported outcome (PRO) tool, in systemic lupus erythematosus (SLE) patients in a multi-ethnic Australian cohort. METHODS Patients attending the Monash Lupus Clinic were asked to complete the LIT, a 10-item PRO. Psychometric testing assessing criterion validity, construct validity, test-retest reliability (TRT) and internal consistency reliability (ICR) were performed. We compared the LIT scores across patient characteristics, and correlations between LIT scores and SLEDAI-2k, PGA, and SLICC-SDI were examined. RESULTS LIT data were obtained from 73 patients. Patients were 84% female with a median age of 41 years, and 34% were Asian. The cohort had mild-moderate disease activity with a median (IQR) Systemic Lupus Erythematosus Disease Activity Index-2000 (SLEDAI-2k) of 4 (IQR 2-6). The median LIT score was 32.5 (IQR 17.5-50). LIT demonstrated criterion validity against SLEDAI-2k and SDI. Construct validity assessed by confirmatory factor analysis demonstrated an excellent fit (Goodness of fit index 0.95, Comparative Fit Index 1, Root Mean Square Error of Approximation <0.0001). The LIT demonstrated TRT with an overall intraclass correlation coefficient of 0.986 (95% CI 0.968-0.995). ICR was demonstrated with a Cronbach's alpha of 0.838. Patients with disability, low socioeconomic status, or higher disease activity had significantly worse LIT scores. CONCLUSION The LIT demonstrated properties consistent with its being valid in this population. Lower socioeconomic status appears to have a significant impact on patient-reported health-related quality of life in SLE.
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Affiliation(s)
- A Antony
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - R K Kandane-Rathnayake
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - T Ko
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - D Boulos
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - A Y Hoi
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - M Jolly
- Rush University Medical Centre, Chicago, IL, USA
| | - E F Morand
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
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Wang D, Parthasarathy AB, Baker WB, Gannon K, Kavuri V, Ko T, Schenkel S, Li Z, Li Z, Mullen MT, Detre JA, Yodh AG. Fast blood flow monitoring in deep tissues with real-time software correlators. Biomed Opt Express 2016; 7:776-97. [PMID: 27231588 PMCID: PMC4866455 DOI: 10.1364/boe.7.000776] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 01/20/2016] [Accepted: 01/21/2016] [Indexed: 05/19/2023]
Abstract
We introduce, validate and demonstrate a new software correlator for high-speed measurement of blood flow in deep tissues based on diffuse correlation spectroscopy (DCS). The software correlator scheme employs standard PC-based data acquisition boards to measure temporal intensity autocorrelation functions continuously at 50 - 100 Hz, the fastest blood flow measurements reported with DCS to date. The data streams, obtained in vivo for typical source-detector separations of 2.5 cm, easily resolve pulsatile heart-beat fluctuations in blood flow which were previously considered to be noise. We employ the device to separate tissue blood flow from tissue absorption/scattering dynamics and thereby show that the origin of the pulsatile DCS signal is primarily flow, and we monitor cerebral autoregulation dynamics in healthy volunteers more accurately than with traditional instrumentation as a result of increased data acquisition rates. Finally, we characterize measurement signal-to-noise ratio and identify count rate and averaging parameters needed for optimal performance.
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Affiliation(s)
- Detian Wang
- Dept. of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104
USA
- Interdisciplinary Laboratory of Physics and Biomedicine, Institute of Fluid Physics, China Academy of Engineering Physics, Mianyang 621900,
China
| | | | - Wesley B. Baker
- Dept. of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104
USA
| | - Kimberly Gannon
- Div. of Stroke and Neurocritical Care, Hospital of the University of Pennsylvania, Philadelphia, PA 19104
USA
| | - Venki Kavuri
- Dept. of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104
USA
| | - Tiffany Ko
- Dept. of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104
USA
| | - Steven Schenkel
- Dept. of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104
USA
| | - Zhe Li
- Dept. of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104
USA
- State Key Laboratory of Precision Measurement Technology and Instruments, Tianjin University, Tianjin 300072,
China
| | - Zeren Li
- Interdisciplinary Laboratory of Physics and Biomedicine, Institute of Fluid Physics, China Academy of Engineering Physics, Mianyang 621900,
China
| | - Michael T. Mullen
- Div. of Stroke and Neurocritical Care, Hospital of the University of Pennsylvania, Philadelphia, PA 19104
USA
| | - John A. Detre
- Div. of Stroke and Neurocritical Care, Hospital of the University of Pennsylvania, Philadelphia, PA 19104
USA
| | - Arjun G. Yodh
- Dept. of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104
USA
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Busch DR, Lynch JM, Winters ME, McCarthy AL, Newland JJ, Ko T, Cornaglia MA, Radcliffe J, McDonough JM, Samuel J, Matthews E, Xiao R, Yodh AG, Marcus CL, Licht DJ, Tapia IE. Cerebral Blood Flow Response to Hypercapnia in Children with Obstructive Sleep Apnea Syndrome. Sleep 2016; 39:209-16. [PMID: 26414896 DOI: 10.5665/sleep.5350] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 04/28/2015] [Accepted: 08/07/2015] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Children with obstructive sleep apnea syndrome (OSAS) often experience periods of hypercapnia during sleep, a potent stimulator of cerebral blood flow (CBF). Considering this hypercapnia exposure during sleep, it is possible that children with OSAS have abnormal CBF responses to hypercapnia even during wakefulness. Therefore, we hypothesized that children with OSAS have blunted CBF response to hypercapnia during wakefulness, compared to snorers and controls. METHODS CBF changes during hypercapnic ventilatory response (HCVR) were tested in children with OSAS, snorers, and healthy controls using diffuse correlation spectroscopy (DCS). Peak CBF changes with respect to pre-hypercapnic baseline were measured for each group. The study was conducted at an academic pediatric sleep center. RESULTS Twelve children with OSAS (aged 10.1 ± 2.5 [mean ± standard deviation] y, obstructive apnea hypopnea index [AHI] = 9.4 [5.1-15.4] [median, interquartile range] events/hour), eight snorers (11 ± 3 y, 0.5 [0-1.3] events/hour), and 10 controls (11.4 ± 2.6 y, 0.3 [0.2-0.4] events/hour) were studied. The fractional CBF change during hypercapnia, normalized to the change in end-tidal carbon dioxide, was significantly higher in controls (9 ± 1.8 %/mmHg) compared to OSAS (7.1 ± 1.5, P = 0.023) and snorers (6.7 ± 1.9, P = 0.025). CONCLUSIONS Children with OSAS and snorers have blunted CBF response to hypercapnia during wakefulness compared to controls. Noninvasive DCS blood flow measurements of hypercapnic reactivity offer insights into physiopathology of OSAS in children, which could lead to further understanding about the central nervous system complications of OSAS.
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Affiliation(s)
- David R Busch
- Division of Neurology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.,Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA
| | - Jennifer M Lynch
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA
| | - Madeline E Winters
- Division of Neurology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | | | - John J Newland
- Division of Neurology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Tiffany Ko
- Department of Biomedical Engineering, University of Pennsylvania, Philadelphia, PA
| | - Mary Anne Cornaglia
- The Sleep Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Jerilynn Radcliffe
- Clinical and Translational Research Center, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Joseph M McDonough
- The Sleep Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - John Samuel
- The Sleep Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Edward Matthews
- The Sleep Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Rui Xiao
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA
| | - Arjun G Yodh
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA
| | - Carole L Marcus
- The Sleep Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Daniel J Licht
- Division of Neurology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Ignacio E Tapia
- The Sleep Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Winters ME, McCarthy AL, Lynch JM, Ko T, Bixler E, Griffith K, Busch DR, Xiao R, Gaynor W, Nicholson S, Montenegro LM, Naim MY, Licht DJ. Abstract T MP63: Cardiac Diagnosis is the Major Risk for Stroke in Neonates with Complex Congenital Heart Defects. Stroke 2015. [DOI: 10.1161/str.46.suppl_1.tmp63] [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
Background and Objectives:
Complex congenital heart defects (CHD), which occur in approximately 3 out of 1000 neonates, require invasive open-heart surgery during the first year of life. In a recent prospective study of infants with various forms of complex CHD, 40% of neonates acquired post-operative brain injury including stroke and periventricular leukomalacia (PVL). However, studies identifying specific risk factors of post-operative stroke have been limited. Herein we examine risk factors for post-operative stroke in a mixed cohort of infants with critical CHD.
Methods:
Term neonates born with critical CHD from 2009 to present were identified from a single-center prospective study. Exclusion criteria included birth weight less than 2 kg, neonatal depression, perinatal seizures, and evidence of end-organ injury. Magnetic resonance imaging (MRI) to assess pre- and post-operative brain injury was performed immediately prior to and within 10 days after surgery.
Results:
Of 102 subjects enrolled, 85 neonates were imaged both pre- and post-operatively. Neonates were diagnosed with either hypoplastic left heart syndrome (HLHS, n=41), transposition of the great arteries (TGA, n=29) or other (n=15). A total of 9 arterial ischemic strokes were observed (10.6%), of which 7/9 were post-operative only. The incidence of stroke was significantly higher in infants with HLHS (6/41, 14.6%) than in infants with TGA (0/29, p=0.03). Time-to-surgery, head circumference, birth weight, duration of deep hypothermic circulatory arrest, and volume of pre- or post-operative PVL were not significantly correlated with incidence of stroke.
Conclusion:
Neonates with HLHS have a higher prevalence of post-operative embolic stroke compared to infants with TGA. Although infants with HLHS have been shown to be at a high risk for both post-operative stroke and PVL, incidence of post-operative stroke is not correlated with volume of post-operative PVL.
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Affiliation(s)
| | - Ann L McCarthy
- Div of Neurology, Children's Hosp of Philadelphia, Philadelphia, PA
| | - Jennifer M Lynch
- Dept of Physics and Astronomy, Univ of Pennsylvania, Philadelphia, PA
| | - Tiffany Ko
- Bioengineering, Univ of Pennsylvania, Philadelphia, PA
| | | | | | - David R Busch
- Dept of Physics and Astronomy, Univ of Pennsylvania, Philadelphia, PA
| | - Rui Xiao
- Biostatistics, Children's Hosp of Philadelphia, Philadelphia, PA
| | - William Gaynor
- Div of Cardiothoracic Surgery, Children's Hosp of Philadelphia, Philadelphia, PA
| | - Susan Nicholson
- Div of Cardiac Anesthesia, Children's Hosp of Philadelphia, Philadelphia, PA
| | - Lisa M Montenegro
- Div of Cardiac Anesthesia, Children's Hosp of Philadelphia, Philadelphia, PA
| | - Maryam Y Naim
- Div of Critical Care Medicine, Children's Hosp of Philadelphia, Philadelphia, PA
| | - Daniel J Licht
- Div of Neurology, Children's Hosp of Philadelphia, Philadelphia, PA
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Alawadi Z, Lew D, Reddy N, Kao L, Ko T, Wray C. Quality of Time-to-Event Reporting in Oncology Literature. J Surg Res 2014. [DOI: 10.1016/j.jss.2013.11.919] [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: 11/16/2022]
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Affiliation(s)
- N Venugopal
- Division of Materials Science and EngineeringInha University, 253 Yonghyun-dong, Nam-gu, Incheon 402-751, Korea
| | - B-C Yang
- Division of Materials Science and EngineeringInha University, 253 Yonghyun-dong, Nam-gu, Incheon 402-751, Korea
| | - T Ko
- Division of Materials Science and EngineeringInha University, 253 Yonghyun-dong, Nam-gu, Incheon 402-751, Korea
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Wakida N, Kitamura K, Tuyen DG, Maekawa A, Miyoshi T, Adachi M, Shiraishi N, Ko T, Ha V, Nonoguchi H, Tomita K. Inhibition of prostasin-induced ENaC activities by PN-1 and regulation of PN-1 expression by TGF-beta1 and aldosterone. Kidney Int 2006; 70:1432-8. [PMID: 16941024 DOI: 10.1038/sj.ki.5001787] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Prostasin has been shown to regulate sodium handling in the kidney. Recently, a serine protease inhibitor, protease nexin-1 (PN-1), was identified as an endogenous inhibitor for prostasin. Therefore, we hypothesized that PN-1 may regulate sodium reabsorption by reducing prostasin activity, and that expression of PN-1 was regulated by transforming growth factor-beta1 (TGF-beta1) or aldosterone, like prostasin. cRNAs for epithelial sodium channel (ENaC), prostasin, and PN-1 were expressed in Xenopus oocytes, and the amiloride-sensitive sodium currents (I(Na)) were measured. The effect of TGF-beta1 and aldosterone on the mRNA and protein abundance of PN-1 and ENaC was detected by real-time polymerase chain reaction and immunoblotting in M-1 cells. Expression of PN-1 substantially decreased prostasin-induced I(Na) by approximately 68% in oocytes. Treatment of M-1 cells with 20 ng/ml TGF-beta1 significantly increased protein expression of PN-1 by 3.8+/-0.5-fold, whereas administration of 10(-6) M aldosterone markedly decreased protein expression of PN-1 to 53.7+/-6.7%. Basolateral, but not apical, application of TGF-beta1 significantly reduced I(eq). To elucidate the involvement of PN-1 in basal ENaC activity, we silenced the expression of PN-1 by using short-interfering RNA. This increased I(eq) by 1.6+/-0.1-fold. Our study indicates that PN-1 could have a natriuretic role by inhibiting prostasin activity and suggests the possibility that aldosterone and TGF-beta reciprocally regulate the expression of PN-1 in renal epithelial cells contributing to salt retention or natriuresis, respectively by an additional mechanism. PN-1 could represent a new factor that contributes to regulation of ENaC activity in the kidney.
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Affiliation(s)
- N Wakida
- Department of Nephrology, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
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Chen C, Ko T, Ma H, Wu H, Xiao X, Li J, Chang C, Wu P, Han J, Yu C, Jeng K, Hu C, Tao M. P.081 Long-term inhibition of hepatitis B virus in transgenic mice by pseudotyped adeno-associated virus-mediated RNA interference. J Clin Virol 2006. [DOI: 10.1016/s1386-6532(06)80264-7] [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: 11/27/2022]
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Tebb K, Ko T, SantaMaria B, Neuhaus J, Wibbelsman C, Tipton A, Miller K, Shafer M. 377 ESTIMATING SEXUAL ACTIVITY RATES IN TEENS AND THE IMPACT ON CHLAMYDIAL SCREENING RATES: HEALTH PLAN EMPLOYER DATA INFORMATION SET ADMINISTRATIVE DATA VERSUS ANONYMOUS SURVEYS. J Investig Med 2005. [DOI: 10.2310/6650.2005.00005.376] [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: 11/18/2022]
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Bourquin S, Aguirre A, Hartl I, Hsiung P, Ko T, Fujimoto J, Birks T, Wadsworth W, Bünting U, Kopf D. Ultrahigh resolution real time OCT imaging using a compact femtosecond Nd:Glass laser and nonlinear fiber. Opt Express 2003; 11:3290-3297. [PMID: 19471457 DOI: 10.1364/oe.11.003290] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Ultrahigh resolution, real time OCT imaging is demonstrated using a compact femtosecond Nd:Glass laser that is spectrally broadened in a high numerical aperture single mode fiber. A reflective grating phase delay scanner enables broad bandwidth, high-speed group delay scanning. We demonstrate in vivo, ultrahigh resolution, real time OCT imaging at 1 microm center wavelength with <5 microm axial resolution in free space (<4 microm in tissue). The light source is robust, portable, and well suited for in vivo imaging studies.
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Abstract
OBJECTIVE The aim was to determine the extent of and the correlates of the distress and impact of care families of patients with first episode psychosis were experiencing when they first came for treatment. METHOD Subjects were 238 individuals who had presented with a first episode of psychosis and their family members. Family members were assessed with the Psychological General Well-Being Scale, and the Experience of Caregiving Inventory. Patient data included assessment of positive and negative symptoms, depression, quality of life, and substance use. RESULTS Family members of these first-episode patients were experiencing distress and difficulties. It was the family's appraisal of the impact of the illness that was associated with their psychological well-being. CONCLUSION As the majority of these first episode families are keen to be involved early and have engaged in an intervention programme, the next step should be an evaluation of their involvement to determine if it is effective.
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Affiliation(s)
- J Addington
- Department of Psychiatry, University of Calgary, Alberta, Canada.
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Abstract
Bleaching is an effective method for restoring the colour of discoloured vital teeth. Power bleaching, in particular, in which a bleaching solution containing 35% hydrogen peroxide is activated by a strong light source using a plasma arc, makes it possible to bleach teeth effectively in a short time. The purpose of this study was to determine how polishing or power bleaching the tooth surface affects tooth colour. The subjects selected were patients who had slightly discoloured teeth. The colour of precisely identified sites on six anterior teeth was measured before treatment, after polishing and after bleaching, to ascertain changes in colour. The measurements revealed that tooth colour changes slightly after polishing, but it shows a much greater change after bleaching, and that the post-bleaching change in tooth colour was caused both by elevation of lightness and reduction of yellowness. They also revealed that the colour difference between pre-treatment and post-bleaching does not depend on the type of tooth. These results suggested that power bleaching is an effective technique for improving slightly discoloured vital teeth, regardless of the type of tooth.
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Affiliation(s)
- T Nakamura
- Department of Fixed Prosthodontics, Osaka University Faculty of Dentistry, Osaka, Japan.
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Kramer MS, Chalmers B, Hodnett ED, Sevkovskaya Z, Dzikovich I, Shapiro S, Collet JP, Vanilovich I, Mezen I, Ducruet T, Shishko G, Zubovich V, Mknuik D, Gluchanina E, Dombrovsky V, Ustinovitch A, Ko T, Bogdanovich N, Ovchinikova L, Helsing E. Promotion of breastfeeding intervention trial (PROBIT): a cluster-randomized trial in the Republic of Belarus. Design, follow-up, and data validation. Adv Exp Med Biol 2001; 478:327-45. [PMID: 11065083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
This paper summarizes the objectives, design, follow-up, and data validation of a cluster-randomized trial of a breastfeeding promotion intervention modeled on the WHO/UNICEF Baby-Friendly Hospital Initiative (BFHI). Thirty-four hospitals and their affiliated polyclinics in the Republic of Belarus were randomized to receive BFHI training of medical, midwifery, and nursing staffs (experimental group) or to continue their routine practices (control group). All breastfeeding mother-infant dyads were considered eligible for inclusion in the study if the infant was singleton, born at > or = 37 weeks gestation, weighed > or = 2500 grams at birth, and had a 5-minute Apgar score > or = 5, and neither mother nor infant had a medical condition for which breastfeeding was contraindicated. One experimental and one control site refused to accept their randomized allocation and dropped out of the trial. A total of 17,795 mothers were recruited at the 32 remaining sites, and their infants were followed up at 1, 2, 3, 6, 9, and 12 months of age. To our knowledge, this is the largest randomized trial ever undertaken in area of human milk and lactation. Monitoring visits of all experimental and control maternity hospitals and polyclinics were undertaken prior to recruitment and twice more during recruitment and follow-up to ensure compliance with the randomized allocation. Major study outcomes include the occurrence of > or = 1 episode of gastrointestinal infection, > or = 2 respiratory infections, and the duration of breastfeeding, and are analyzed according to randomized allocation ("intention to treat"). One of the 32 remaining study sites was dropped from the trial because of apparently falsified follow-up data, as suggested by an unrealistically low incidence of infection and unrealistically long duration of breastfeeding, and as confirmed by subsequent data audit of polyclinic charts and interviews with mothers of 64 randomly-selected study infants at the site. Smaller random audits at each of the remaining sites showed extremely high concordance between the PROBIT data forms and both the polyclinic charts and maternal interviews, with no evident difference in under- or over-reporting in experimental vs control sites. Of the 17,046 infants recruited from the 31 participating study sites, 16,491 (96.7%) completed the study and only 555 (3.3%) were lost to follow-up. PROBIT's results should help inform decision-making for clinicians, hospitals, industry, and governments concerning the support, protection, and promotion of breastfeeding.
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Affiliation(s)
- M S Kramer
- Department of Pediatrics, McGill University Faculty of Medicine
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Yang L, Yang J, Venkateswarlu S, Ko T, Brattain MG. Autocrine TGFbeta signaling mediates vitamin D3 analog-induced growth inhibition in breast cells. J Cell Physiol 2001; 188:383-93. [PMID: 11473365 DOI: 10.1002/jcp.1125] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.5] [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: 11/07/2022]
Abstract
In this study, we address whether TGFbeta signaling mediates vitamin D3 analog-induced growth inhibition in nonmalignant and malignant breast cells. Normal mammary epithelial cells (184), immortalized nonmalignant mammary epithelial cells (184A1 and MCF10A), and breast cancer cells (early passage MCF7: MCF7E) were sensitive to the inhibitory effects of vitamin D3 analogs (EB1089 and MC1288) while late passage MCF7 breast cancer (MCF7L) cells were relatively resistant. A similar pattern of sensitivity to TGFbeta was observed with these cells. Thus, the sensitivity to the vitamin D3 analogs correlated with the sensitivity to TGFbeta. MCF7L TGFbetaRII-transfected cells, which have autocrine TGFbeta activity, were more sensitive to EB1089 than MCF7L cells. TGFbeta neutralizing antibody was found to block the inhibitory effects of these analogs. These results are consistent with the idea that autocrine TGFbeta signaling mediates the anti-proliferative effects of the vitamin D3 analogs in these cells. The expression of TGFbeta isoforms and/or TGFbeta receptors was induced by the analogs in the vitamin D3 and TGFbeta sensitive cells. Vitamin D3 analogs did not induce TGFbeta or TGFbeta receptor expression in the resistant MCF7L cells. Therefore, EB1089 induces autocrine TGFbeta activity through increasing expression of TGFbeta isoforms and/or TGFbeta receptors. In addition, EB1089 induced nuclear VDR protein levels in the sensitive 184A1 cells but not in the resistant MCF7L cells. 184A1 cells were more sensitive to EB1089-induced VDR-dependent transactivation than MCF7L cells as measured by a luciferase reporter construct containing the VDRE, indicating a defect of VDR signaling in MCF7L cells. Smad3, a TGFbeta signaling mediator, coactivated VDR-dependent transactivation in 184A1 cells but not in MCF7L cells. These results indicate that Smad3 coactivates VDR to further enhance TGFbeta signaling and vitamin D3 signaling in the sensitive 184A1 cells. The results also indicate that Smad3 is not of itself sufficient to coactivate VDR in TGFbeta/vitamin D3 resistant MCF7L cells and other factors are required. We found that the PI 3-kinase pathway inhibitor LY29004 inhibited the synergy of TGFbeta and EB1089 on VDR-dependent transactivation activity. This indicates that the crosstalk between TGFbeta and vitamin D signaling is also PI 3-kinase pathway dependent.
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Affiliation(s)
- L Yang
- Department of Surgery, University of Texas Health Science Center, San Antonio, San Antonio, Texas 78229, USA
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Abstract
We describe a miniature optical coherence tomography (OCT) imaging needle that can be inserted into solid tissues and organs to permit interstitial imaging of their internal microstructures with micrometer scale resolution and minimal trauma. A novel rotational coupler with a glass capillary tube is also presented that couples light from a rotating single-mode fiber to a stationary one. A prototype needle with a 27-gauge (approximately 410-microm) outer diameter has been developed and is demonstrated for in vivo imaging. The OCT needle can be integrated with standard excisional biopsy devices and used for OCT-guided biopsy.
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Affiliation(s)
- X Li
- Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
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Lee C, Han Y, Lee K, Kim J, Cho W, Ko T, Han I. Study on the nutritive value of dextrin as a
carbohydrate source for pigs weaned at 21 days
of age. J Anim Feed Sci 2000. [DOI: 10.22358/jafs/68115/2000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Muramatsu T, Ko T, Honoki K, Hatoko M, Shirai T, Vnittanakom P. Intraepidermal expression of basement membrane components in the lesional skin of a patient with dystrophic epidermolysis bullosa. J Dermatol 1999; 26:106-10. [PMID: 10091480 DOI: 10.1111/j.1346-8138.1999.tb03519.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The patient was a 15-year-old male. Since birth, he had developed blistering and erosion of the skin. Biopsy skin specimen of the bullous lesions showed subepidermal blister formation. Electron microscopic examination revealed that tissue separation had occurred at the sublamina densa level. By indirect immunofluorescence using antibodies specific for alpha 6 integrin, laminin 5, type IV collagen, and type VII collagen, all of these basement membrane components were detected as coarse granular intracytoplasmic deposits only in the basal and suprabasal cells of the blister roof. In the non-blistered regions, these basement membrane components showed a linear pattern similar to that seen in normal skin. These findings suggest that intraepidermal expression of basement membrane components was closely related to the blister formation. The biological meaning of intraepidermal expression of basement membrane components were also discussed.
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Affiliation(s)
- T Muramatsu
- Department of Dermatology, Nara Medical University, Japan
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Bachmann GA, Trattler B, Ko T, Tweddel G. Operational improvement of gynecologic laparoscopic operating room services: an internal review. Obstet Gynecol 1998; 92:142-4. [PMID: 9649110] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND To reorganize reusable laparoscopic instrumentation to promote instrument accessibility, minimize instrument breakage, eliminate infrequently used instruments on permanent trays, and help control maintenance costs. TECHNIQUE The Robert Wood Johnson University Hospital Gynecologic Steering Committee evaluated during a 5-month period the storage, use, and maintenance of gynecologic laparoscopic instrument sets used in the surgical suite. Acting on this data, the committee oversaw the following changes. Infrequently used instruments were removed from permanent trays and separately packaged. Two types of gynecologic laparoscopy trays were prepared: one for laparoscopic bilateral tubal ligations and one for both diagnostic and operative laparoscopy. A double-decker compartmentalized tray in which instruments were sterilized and stored replaced the extant single-layer ones in which instruments were stacked on each other. To facilitate instrument identification and function, a surgical manual was compiled with photographs of each instrument and a description of its use. EXPERIENCE After implementation of these changes, maintenance and sterilization costs for a 10-month period were compared with those for the previous 10 months. There was a savings of $13,889. The ratio of total costs divided by number of cases performed during the two study periods was also compared. There was a savings of $31 per case. CONCLUSION Savings were achieved by reorganizing this operating room's handling of reusable gynecologic laparoscopy equipment. By eliminating infrequently used instruments from the permanent trays and by using a double decker compartmentalized tray that was used during surgery, sterilization, and storage, both sterilization costs and maintenance costs were reduced.
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Affiliation(s)
- G A Bachmann
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, New Brunswick 08901-1977, USA
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Sakamoto M, Haku H, Kimura M, Ko T. [Attrition of goiter and elimination of autoantibody to the thyroid caused by treatment of acromegaly: a case study]. Nihon Naika Gakkai Zasshi 1997; 86:835-7. [PMID: 9280771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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