1
|
Balliu B, Douglas C, Seok D, Shenhav L, Wu Y, Chatzopoulou D, Kaiser W, Chen V, Kim J, Deverasetty S, Arnaudova I, Gibbons R, Congdon E, Craske MG, Freimer N, Halperin E, Sankararaman S, Flint J. Personalized mood prediction from patterns of behavior collected with smartphones. NPJ Digit Med 2024; 7:49. [PMID: 38418551 PMCID: PMC10902386 DOI: 10.1038/s41746-024-01035-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/09/2024] [Indexed: 03/01/2024] Open
Abstract
Over the last ten years, there has been considerable progress in using digital behavioral phenotypes, captured passively and continuously from smartphones and wearable devices, to infer depressive mood. However, most digital phenotype studies suffer from poor replicability, often fail to detect clinically relevant events, and use measures of depression that are not validated or suitable for collecting large and longitudinal data. Here, we report high-quality longitudinal validated assessments of depressive mood from computerized adaptive testing paired with continuous digital assessments of behavior from smartphone sensors for up to 40 weeks on 183 individuals experiencing mild to severe symptoms of depression. We apply a combination of cubic spline interpolation and idiographic models to generate individualized predictions of future mood from the digital behavioral phenotypes, achieving high prediction accuracy of depression severity up to three weeks in advance (R2 ≥ 80%) and a 65.7% reduction in the prediction error over a baseline model which predicts future mood based on past depression severity alone. Finally, our study verified the feasibility of obtaining high-quality longitudinal assessments of mood from a clinical population and predicting symptom severity weeks in advance using passively collected digital behavioral data. Our results indicate the possibility of expanding the repertoire of patient-specific behavioral measures to enable future psychiatric research.
Collapse
Affiliation(s)
- Brunilda Balliu
- Departments of Computational Medicine, University of California Los Angeles, Los Angeles, USA.
- Departments of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, USA.
- Department of Biostatistics, University of California Los Angeles, Los Angeles, USA.
| | - Chris Douglas
- Department of Psychiatry and Biobehavioral Science, University of California Los Angeles, Los Angeles, USA
| | - Darsol Seok
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, USA
| | - Liat Shenhav
- Department of Computer Science, University of California Los Angeles, Los Angeles, USA
| | - Yue Wu
- Department of Computer Science, University of California Los Angeles, Los Angeles, USA
| | - Doxa Chatzopoulou
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, USA
| | - William Kaiser
- Department of Electrical Engineering, University of California Los Angeles, Los Angeles, USA
| | - Victor Chen
- Department of Electrical Engineering, University of California Los Angeles, Los Angeles, USA
| | - Jennifer Kim
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, USA
| | - Sandeep Deverasetty
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, USA
| | - Inna Arnaudova
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, USA
| | - Robert Gibbons
- Departments of Medicine, Public Health Sciences and Comparative Human Development, University of Chicago, Chicago, USA
| | - Eliza Congdon
- Department of Psychiatry and Biobehavioral Science, University of California Los Angeles, Los Angeles, USA
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, USA
| | - Michelle G Craske
- Department of Psychiatry and Biobehavioral Science, University of California Los Angeles, Los Angeles, USA
- Department of Psychology, University of California Los Angeles, Los Angeles, USA
| | - Nelson Freimer
- Department of Psychiatry and Biobehavioral Science, University of California Los Angeles, Los Angeles, USA
- Department of Human Genetics, University of California Los Angeles, Los Angeles, USA
| | - Eran Halperin
- Department of Computer Science, University of California Los Angeles, Los Angeles, USA
| | - Sriram Sankararaman
- Departments of Computational Medicine, University of California Los Angeles, Los Angeles, USA
- Department of Computer Science, University of California Los Angeles, Los Angeles, USA
- Department of Human Genetics, University of California Los Angeles, Los Angeles, USA
| | - Jonathan Flint
- Department of Psychiatry and Biobehavioral Science, University of California Los Angeles, Los Angeles, USA.
- Department of Human Genetics, University of California Los Angeles, Los Angeles, USA.
| |
Collapse
|
2
|
Ramawad HA, Toloui A, Chen V, Sun Y. Cerebellar Leukoencephalopathy following Fentanyl Intoxication. A case report and review of the literature. Qatar Med J 2024; 2023:36. [PMID: 38187991 PMCID: PMC10770733 DOI: 10.5339/qmj.2023.36] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/09/2023] [Indexed: 01/09/2024] Open
Abstract
The opioid crisis has become a significant public health concern in recent years. Although respiratory depression and overdose are the most reported side effects of fentanyl, there have been rare cases of cerebellar leukoencephalopathy (CLE) following fentanyl intoxication. A 29-year-old man with a history of opioid use disorder and intravenous drug use presented to the emergency room with significant ataxia and dysarthria following fentanyl intoxication. According to the patient, the symptoms began four days prior after "chasing the dragon" with "pure fentanyl", and he reported experiencing nausea and dizziness, particularly during ambulation. Neurological examination revealed a positive Romberg test, ataxia, and delayed speech. Brain magnetic resonance imaging (MRI) indicated there was toxic degeneration of the cerebellar white matter that extended into the posterior limbs of the internal capsule. Urine drug screening was positive for opioids, making fentanyl-induced cerebellar leukoencephalopathy the most likely diagnosis in this case. This case of opioid-induced CLE underscores the critical significance of early recognition, which is vital for enhancing a patient's recovery and averting the development of severe neurological complications.
Collapse
Affiliation(s)
- Hamzah Adel Ramawad
- NYC Health & Hospital, South Brooklyn Health, Brooklyn, New York, USA ORCID iD: 0000-0002-9687-3599
| | | | - Victor Chen
- New York Institute of Technology College of Osteopathic Medicine, New York, USA ORCID iD: 0000-0002-9687-3599
| | - Yan Sun
- NYC Health & Hospital, South Brooklyn Health, Brooklyn, New York, USA ORCID iD: 0000-0002-9687-3599
| |
Collapse
|
3
|
Abraham DL, Lichvar AB, Brubaker AL, Haste N, Chen V, Abeles S, Aslam S, Yam N, Horton L, Chen B, Binkin N, Law N. Risk factors for breakthrough COVID-19 infections in solid organ transplant recipients receiving tixagevimab/cilgavimab for pre-exposure prophylaxis. Transpl Infect Dis 2023; 25:e14125. [PMID: 37594213 DOI: 10.1111/tid.14125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/01/2023] [Indexed: 08/19/2023]
Affiliation(s)
- Dana L Abraham
- Department of Pharmacy, University of California San Diego Health, La Jolla, California, USA
| | - Alicia B Lichvar
- Department of Pharmacy, University of California San Diego Health, La Jolla, California, USA
- Center for Transplantation, University of California San Diego Health, La Jolla, California, USA
| | - Aleah L Brubaker
- Center for Transplantation, University of California San Diego Health, La Jolla, California, USA
| | - Nina Haste
- Department of Pharmacy, University of California San Diego Health, La Jolla, California, USA
| | - Victor Chen
- Department of Pharmacy, University of California San Diego Health, La Jolla, California, USA
| | - Shira Abeles
- Division of Transplant and Hepatobiliary Surgery, Department of Surgery, University of California San Diego Health, La Jolla, California, USA
| | - Saima Aslam
- Division of Transplant and Hepatobiliary Surgery, Department of Surgery, University of California San Diego Health, La Jolla, California, USA
| | - Nancy Yam
- Department of Pharmacy, University of California San Diego Health, La Jolla, California, USA
| | - Lucy Horton
- Division of Transplant and Hepatobiliary Surgery, Department of Surgery, University of California San Diego Health, La Jolla, California, USA
| | - Benjamin Chen
- Division of Transplant and Hepatobiliary Surgery, Department of Surgery, University of California San Diego Health, La Jolla, California, USA
| | - Nancy Binkin
- Herbert Wertheim School of Public Health and Human Longevity, University of California San Diego, La Jolla, California, USA
| | - Nancy Law
- Division of Transplant and Hepatobiliary Surgery, Department of Surgery, University of California San Diego Health, La Jolla, California, USA
- Division of Infectious Diseases and Global Health, University of California San Diego Health, La Jolla, California, USA
| |
Collapse
|
4
|
Zhao X, Stein KR, Chen V, Griffin ME, Lairson LL, Hang HC. Chemoproteomics reveals microbiota-derived aromatic monoamine agonists for GPRC5A. Nat Chem Biol 2023; 19:1205-1214. [PMID: 37248411 DOI: 10.1038/s41589-023-01328-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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] [Received: 12/16/2021] [Accepted: 04/06/2023] [Indexed: 05/31/2023]
Abstract
The microbiota generates diverse metabolites to modulate host physiology and disease, but their protein targets and mechanisms of action have not been fully elucidated. To address this challenge, we explored microbiota-derived indole metabolites and developed photoaffinity chemical reporters for proteomic studies. We identified many potential indole metabolite-interacting proteins, including metabolic enzymes, transporters, immune sensors and G protein-coupled receptors. Notably, we discovered that aromatic monoamines can bind the orphan receptor GPRC5A and stimulate β-arrestin recruitment. Metabolomic and functional profiling also revealed specific amino acid decarboxylase-expressing microbiota species that produce aromatic monoamine agonists for GPRC5A-β-arrestin recruitment. Our analysis of synthetic aromatic monoamine derivatives identified 7-fluorotryptamine as a more potent agonist of GPRC5A. These results highlight the utility of chemoproteomics to identify microbiota metabolite-interacting proteins and the development of small-molecule agonists for orphan receptors.
Collapse
Affiliation(s)
- Xiaohui Zhao
- Department of Immunology and Microbiology, Scripps Research, La Jolla, CA, USA
| | - Kathryn R Stein
- Department of Immunology and Microbiology, Scripps Research, La Jolla, CA, USA
| | - Victor Chen
- Laboratory of Chemical Biology and Microbial Pathogenesis, The Rockefeller University, New York City, NY, USA
| | - Matthew E Griffin
- Department of Immunology and Microbiology, Scripps Research, La Jolla, CA, USA
| | - Luke L Lairson
- Department of Chemistry, Scripps Research, La Jolla, CA, USA
| | - Howard C Hang
- Department of Immunology and Microbiology, Scripps Research, La Jolla, CA, USA.
- Department of Chemistry, Scripps Research, La Jolla, CA, USA.
| |
Collapse
|
5
|
McSwain LF, Pillsbury CE, Haji-Seyed-Javadi R, Rath SK, Chen V, Huang T, Shahab SW, Kunhiraman H, Ross J, Price GA, Dey A, Hambardzumyan D, MacDonald T, Yu DS, Porter CC, Kenney AM. Author Correction: YB1 modulates the DNA damage response in medulloblastoma. Sci Rep 2023; 13:9717. [PMID: 37322047 DOI: 10.1038/s41598-023-36594-3] [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: 06/17/2023] Open
Affiliation(s)
- Leon F McSwain
- Department of Pediatrics, Emory University, 1760 Haygood Dr., Atlanta, GA, 30322, USA
| | - Claire E Pillsbury
- Department of Pediatrics, Emory University, 1760 Haygood Dr., Atlanta, GA, 30322, USA
| | | | | | - Victor Chen
- Department of Biology, Emory University, Atlanta, GA, 30322, USA
| | - Tiffany Huang
- Department of Biology, Emory University, Atlanta, GA, 30322, USA
| | - Shubin W Shahab
- Department of Pediatrics, Emory University, 1760 Haygood Dr., Atlanta, GA, 30322, USA
| | - Haritha Kunhiraman
- Department of Pediatrics, Emory University, 1760 Haygood Dr., Atlanta, GA, 30322, USA
| | - James Ross
- Department of Microbiology and Immunology, Emory Vaccine Center, Emory University, Atlanta, GA, USA
| | - Gabrielle A Price
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Abhinav Dey
- Department of Pediatrics, Emory University, 1760 Haygood Dr., Atlanta, GA, 30322, USA
| | - Dolores Hambardzumyan
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Tobey MacDonald
- Department of Pediatrics, Emory University, 1760 Haygood Dr., Atlanta, GA, 30322, USA
- Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - David S Yu
- Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Christopher C Porter
- Department of Pediatrics, Emory University, 1760 Haygood Dr., Atlanta, GA, 30322, USA
- Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Anna M Kenney
- Department of Pediatrics, Emory University, 1760 Haygood Dr., Atlanta, GA, 30322, USA.
- Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA.
| |
Collapse
|
6
|
McSwain LF, Pillsbury CE, Haji-Seyed-Javadi R, Rath SK, Chen V, Huang T, Shahab SW, Kunhiraman H, Ross J, Price GA, Dey A, Hambardzumyan D, MacDonald T, Yu DS, Porter CC, Kenney AM. YB1 modulates the DNA damage response in medulloblastoma. Sci Rep 2023; 13:8087. [PMID: 37208357 DOI: 10.1038/s41598-023-35220-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 05/15/2023] [Indexed: 05/21/2023] Open
Abstract
Y-box binding protein 1 (YBX1 or YB1) is a therapeutically relevant oncoprotein capable of RNA and DNA binding and mediating protein-protein interactions that drive proliferation, stemness, and resistance to platinum-based therapies. Given our previously published findings, the potential for YB1-driven cisplatin resistance in medulloblastoma (MB), and the limited studies exploring YB1-DNA repair protein interactions, we chose to investigate the role of YB1 in mediating radiation resistance in MB. MB, the most common pediatric malignant brain tumor, is treated with surgical resection, cranio-spinal radiation, and platinum-based chemotherapy, and could potentially benefit from YB1 inhibition. The role of YB1 in the response of MB to ionizing radiation (IR) has not yet been studied but remains relevant for determining potential anti-tumor synergy of YB1 inhibition with standard radiation therapy. We have previously shown that YB1 drives proliferation of cerebellar granular neural precursor cells (CGNPs) and murine Sonic Hedgehog (SHH) group MB cells. While others have demonstrated a link between YB1 and homologous recombination protein binding, functional and therapeutic implications remain unclear, particularly following IR-induced damage. Here we show that depleting YB1 in both SHH and Group 3 MB results not only in reduced proliferation but also synergizes with radiation due to differential response dynamics. YB1 silencing through shRNA followed by IR drives a predominantly NHEJ-dependent repair mechanism, leading to faster γH2AX resolution, premature cell cycle re-entry, checkpoint bypass, reduced proliferation, and increased senescence. These findings show that depleting YB1 in combination with radiation sensitizes SHH and Group 3 MB cells to radiation.
Collapse
Affiliation(s)
- Leon F McSwain
- Department of Pediatrics, Emory University, 1760 Haygood Dr., Atlanta, GA, 30322, USA
| | - Claire E Pillsbury
- Department of Pediatrics, Emory University, 1760 Haygood Dr., Atlanta, GA, 30322, USA
| | | | | | - Victor Chen
- Department of Biology, Emory University, Atlanta, GA, 30322, USA
| | - Tiffany Huang
- Department of Biology, Emory University, Atlanta, GA, 30322, USA
| | - Shubin W Shahab
- Department of Pediatrics, Emory University, 1760 Haygood Dr., Atlanta, GA, 30322, USA
| | - Haritha Kunhiraman
- Department of Pediatrics, Emory University, 1760 Haygood Dr., Atlanta, GA, 30322, USA
| | - James Ross
- Department of Microbiology and Immunology, Emory Vaccine Center, Emory University, Atlanta, GA, USA
| | - Gabrielle A Price
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Abhinav Dey
- Department of Pediatrics, Emory University, 1760 Haygood Dr., Atlanta, GA, 30322, USA
| | - Dolores Hambardzumyan
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Tobey MacDonald
- Department of Pediatrics, Emory University, 1760 Haygood Dr., Atlanta, GA, 30322, USA
- Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - David S Yu
- Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Christopher C Porter
- Department of Pediatrics, Emory University, 1760 Haygood Dr., Atlanta, GA, 30322, USA
- Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Anna M Kenney
- Department of Pediatrics, Emory University, 1760 Haygood Dr., Atlanta, GA, 30322, USA.
- Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA.
| |
Collapse
|
7
|
Chen V, Perez Pablos I, Chen JM. Acoustic characterization of nanofibers for optimization with porous substrate. J Acoust Soc Am 2023; 153:40. [PMID: 36732239 DOI: 10.1121/10.0016811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 12/12/2022] [Indexed: 06/18/2023]
Abstract
Nanofiber-porous systems comprising a porous substrate overlaid with nanofiber weave offer the potential for higher acoustic absorption than the substrate alone with negligible increase in thickness. The characterization of nanofibers from acoustic measurements is investigated in this work, and a regression model for predicting their acoustic properties from a single physical parameter is proposed to enable the design of nanofiber-porous systems directly from fabrication parameters. Characterization as a resistive screen via Johnson-Champoux-Allard and lumped element models for transfer matrix computations of absorption coefficient for nanofiber-porous systems exhibited good agreement with the measured spectra. The lumped element model was chosen as it was defined by fewer parameters and did not require nanofiber layer thickness measurements, eliminating the associated uncertainty. A regression model for lumped element parameters vs areal density established a design tool based on a single, easily measured physical property for optimized absorption at target frequencies without prior acoustic characterization of the nanofiber layer, enabling the analysis of complex acoustic networks incorporating nanofiber-porous systems. Practical considerations of applying adhesives at the nanofiber-porous interface were studied to evaluate possible enhancement of acoustic performance. For comparison with prior work by others, flow resistances from physical measurement and acoustic characterization were compared.
Collapse
Affiliation(s)
- Victor Chen
- RDD Research, Dyson Technology Ltd., Malmesbury, United Kingdom
| | | | - Jer-Ming Chen
- Science, Maths and Technology (SMT), Singapore University of Technology and Design, Singapore, Singapore
| |
Collapse
|
8
|
Chen B, Haste N, Binkin N, Law N, Horton LE, Yam N, Chen V, Abeles S. Real world effectiveness of tixagevimab/cilgavimab (Evusheld) in the Omicron era. PLoS One 2023; 18:e0275356. [PMID: 37104498 PMCID: PMC10138227 DOI: 10.1371/journal.pone.0275356] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 04/13/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Pre-exposure prophylaxis for COVID-19 with tixagevimab/cilgavimab (T/C) received Emergency Use Authorization (EUA) based on results of a clinical trial conducted prior to the emergence of the Omicron variant. The clinical effectiveness of T/C has not been well described in the Omicron era. We examined the incidence of symptomatic illness and hospitalizations among T/C recipients when Omicron accounted for virtually all local cases. METHODS Through retrospective electronic medical record chart review, we identified patients who received T/C between January 1 -July 31, 2022 within our quaternary referral health system. We determined the incidence of symptomatic COVID-19 infections and hospitalizations due to or presumed to be caused by early Omicron variants before and after receiving T/C (pre-T/C and post-T/C). Chi square and Mann-Whitney Wilcoxon two-sample tests were used to examine differences between the characteristics of those who got COVID-19 before or after T/C prophylaxis, and rate ratios (RR) and 95% confidence intervals (CI) were calculated to assess differences in hospitalization rates for the two groups. RESULTS Of 1295 T/C recipients, 105 (8.1%) developed symptomatic COVID-19 infection before receiving T/C, and 102 (7.9%) developed symptomatic disease after receiving it. Of the 105 patients who developed symptomatic infection pre-T/C, 26 (24.8%) were hospitalized, compared with six of the 102 patients (5.9%) who were diagnosed with COVID-19 post-T/C (RR = 0.24; 95% CI = 0.10-0.55; p = 0.0002). Seven of the 105 (6.7%) patients infected pre-T/C, but none of the 102 infected post-T/C required ICU care. No COVID-related deaths occurred in either group. The majority of COVID-19 cases among those infected pre-T/C treatment occurred during the Omicron BA.1 surge, while the majority of post-T/C cases occurred when Omicron BA.5 was predominant. In both groups, having at least one dose of vaccine strongly protected against hospitalization (pre-T/C group RR = 0.31, 95% CI = 0.17-0.57, p = 0.02; post-T/C group RR = 0.15; 95% CI = 0.03-0.94; p = 0.04). CONCLUSION We identified COVID-19 infections after T/C prophylaxis. Among patients who received T/C at our institution, COVID-19 Omicron cases occurring after T/C were one-fourth as likely to require hospitalization compared to those with Omicron prior to T/C. However, due to the presence of changing vaccine coverage, multiple therapies, and changing variants, the effectiveness of T/C in the Omicron era remains difficult to assess.
Collapse
Affiliation(s)
- Benjamin Chen
- Department of Medicine, Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, United States of America
| | - Nina Haste
- Department of Pharmacy, University of California San Diego, La Jolla, California, United States of America
| | - Nancy Binkin
- The Herbert Wertheim School of Public Health and Human Longevity, University of California San Diego, La Jolla, California, United States of America
| | - Nancy Law
- Department of Medicine, Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, United States of America
| | - Lucy E Horton
- Department of Medicine, Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, United States of America
| | - Nancy Yam
- Department of Pharmacy, University of California San Diego, La Jolla, California, United States of America
| | - Victor Chen
- Department of Pharmacy, University of California San Diego, La Jolla, California, United States of America
| | - Shira Abeles
- Department of Medicine, Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, United States of America
| |
Collapse
|
9
|
Guo Y, Cowman K, Bao H, Chen V, Kim M, Xie X, Chang MH, Bartash R, Azeem M, Nori P. 276. Factors Predicting Bacterial Coinfection in Hospitalized COVID-19 Patients. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Despite multiple studies indicating a low prevalence of bacterial coinfection in coronavirus disease 2019 (COVID-19) patients, the majority of hospitalized COVID-19 patients receive one or more antibiotics. Patients with coinfection usually have multiple risk factors and poor clinical outcomes.
Methods
A retrospective case control study was conducted comparing clinical characteristics and antimicrobial use in hospitalized adult COVID-19 patients with bacterial co-infections vs. randomly selected patients without co-infections (matched on month of admission). The study was conducted at three hospitals within the Montefiore Medical Center, Bronx, NY between March 1, 2020 and October 31, 2020. A multivariable logistic regression model was developed to assess the relationship of each predictor variable with coinfection status. Secondary outcomes included hospital mortality, antibiotic days of therapy (DOT), and C. difficile infection.
Results
A total of 150 patients with coinfection and 150 patients without co-infection were included in the analysis. Table 1 summarized baseline characteristics and risk factors. The multivariable logistic regression model indicated that presence of a central line (OR=5.4, 95% CI: 2.7-11.1), prior antibiotic exposure within 30 days (OR=5.3, 95% CI: 2.8-10.0), prior ICU admission (OR=3.6, 95% CI: 1.7-7.6), steroid use (OR=2.7, 95% CI: 1.4-4.9), and any comorbid condition (OR=2.7, 95% CI: 1.4-5.2) were significantly associated with the development of coinfection (table 2). Mortality was higher in patients with coinfection (56% vs. 11%, p < 0.0001) (table 3). Average antibiotic DOT was 10.5 in coinfected patients compared to 4 in non-coinfected patients, (p < 0.0001). Forty-one percent of coinfected patients had a multidrug resistant organism isolated. C. difficile rate was higher in coinfected patients (4% vs. 0%, p=0.03).
Conclusion
As the healthcare community contends with a 3rd year of COVID-19 pandemic, understanding risk factors most predictive of bacterial coinfection can guide empiric antimicrobial therapy and targeted stewardship interventions. Ideally, co-infection risk scores are developed which may be useful for future inpatient surges.
Disclosures
Yi Guo, PharmD, BCIDP, Merck: Grant/Research Support Kelsie Cowman, MPH, Merck: Grant/Research Support.
Collapse
Affiliation(s)
- Yi Guo
- Montefiore Medical Center , Bronx, New York
| | | | | | - Victor Chen
- University of California San Diego , San Diego, California
| | - Mimi Kim
- Albert Einstein College of Medicine , Bronx, New York
| | - Xianhong Xie
- Albert Einstein College of Medicine , Bronx, New York
| | | | | | - Meena Azeem
- Robert Wood Johnson University Hospital , Rutgers/RWJMS, New Brunswick, New Jersey
| | - Priya Nori
- Montefiore Medical Center , Bronx, New York
| |
Collapse
|
10
|
Yang X, Zhao X, Chen V, Hang HC. Chemical proteomic analysis of bile acid-protein targets in Enterococcus faecium. RSC Chem Biol 2022; 3:1397-1402. [PMID: 36544573 PMCID: PMC9709779 DOI: 10.1039/d2cb00178k] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/19/2022] [Indexed: 12/24/2022] Open
Abstract
Bile acids are important gut microbiota metabolites that regulate both host and microbial functions. To identify the direct protein targets of bile acids in Enterococcus, we synthesized and validated the activity of a lithocholic acid (LCA) photoaffinity reporter, x-alk-LCA-3. Chemical proteomics of x-alk-LCA-3 in E. faecium Com15 reveals many candidate LCA-interacting proteins, which are involved in cell well synthesis, transcriptional regulation and metabolism. To validate the utility of bile acid photoaffinity labeling, we characterized a putative bile salt hydrolase (BSH) crosslinked by x-alk-LCA-3, and demonstrated that this BSH was effective in converting taurolithocholic acid (TLCA) to LCA in E. faecium and in vitro. Chemical proteomics should afford new opportunities to characterize bile acid-protein targets and mechanisms of action in the future.
Collapse
Affiliation(s)
- Xinglin Yang
- Department of Immunology and Microbiology, Scripps Research La Jolla California 92037 USA
| | - Xiaohui Zhao
- Department of Immunology and Microbiology, Scripps Research La Jolla California 92037 USA
| | - Victor Chen
- Laboratory of Chemical Biology and Microbial Pathogenesis, The Rockefeller University New York New York 10065 USA
| | - Howard C Hang
- Department of Immunology and Microbiology, Scripps Research La Jolla California 92037 USA
- Department of Chemistry, Scripps Research La Jolla California 92037 USA
| |
Collapse
|
11
|
Lagage V, Chen V, Uphoff S. Adaptation delay causes a burst of mutations in bacteria responding to oxidative stress. EMBO Rep 2022; 24:e55640. [PMID: 36397732 PMCID: PMC9827559 DOI: 10.15252/embr.202255640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 11/19/2022] Open
Abstract
Understanding the interplay between phenotypic and genetic adaptation is a focus of evolutionary biology. In bacteria, the oxidative stress response prevents mutagenesis by reactive oxygen species (ROS). We hypothesise that the stress response dynamics can therefore affect the timing of the mutation supply that fuels genetic adaptation to oxidative stress. We uncover that sudden hydrogen peroxide stress causes a burst of mutations. By developing single-molecule and single-cell microscopy methods, we determine how these mutation dynamics arise from phenotypic adaptation mechanisms. H2 O2 signalling by the transcription factor OxyR rapidly induces ROS-scavenging enzymes. However, an adaptation delay leaves cells vulnerable to the mutagenic and toxic effects of hydroxyl radicals generated by the Fenton reaction. Resulting DNA damage is counteracted by a spike in DNA repair activities during the adaptation delay. Absence of a mutation burst in cells with prior stress exposure or constitutive OxyR activation shows that the timing of phenotypic adaptation directly controls stress-induced mutagenesis. Similar observations for alkylation stress show that mutation bursts are a general phenomenon associated with adaptation delays.
Collapse
Affiliation(s)
| | - Victor Chen
- Department of BiochemistryUniversity of OxfordOxfordUK
| | | |
Collapse
|
12
|
McSwain L, Chen V, Huang T, Zhou G, Kenney A. DNAR-14. Y-BOX BINDING PROTEIN 1 REGULATES MEDULLOBLASTOMA TUMOR BIOLOGY AND THERAPEUTIC RESPONSE. Neuro Oncol 2022. [PMCID: PMC9661173 DOI: 10.1093/neuonc/noac209.346] [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] Open
Abstract
Abstract
BACKGROUND
Medulloblastoma (MB) is the most common pediatric brain tumor. MB can be dividing into 4 genetically distinct subgroups (Sonic Hedgehog (SHH), Wingless (WNT), Group 3, and Group 4). Most patients receive radiation and cisplatin backbone therapy. SHH and Group3 patients demonstrate poor prognosis, especially in cases of MYC amplification or p53 mutation. Given the continued reliance on DNA damage therapies, and our groups previous findings that YB1 regulates IGF2 transcription in SHH MB, we chose to investigate the role of YB1 in the DNA damage response and we performed RIPseq to understand mRNAs regulated by YB1 that may be targeted as novel therapeutics.
METHODS
Cell lines include primary MBCs derived from NeuroD2-SmoA1 SHH mice, ONS-76 human SHH, Daoy human SHH, D341 and D425 Human Group 3. YB1 overexpression or knockdown followed by radiation and assessment of yH2AX (a marker of DNA de-condensation following damage), Comet assay (a marker of physical damage), and proliferation time courses were used to assess effects of YB1 modulation on radiation response. RIPseq and YB1 knockdown were used to assess the effects of YB1 on PLXND1 levels. Scratch assay and western blotting of EMT markers were used to assess effects of PLXND1 silencing on migration.
RESULTS
(Radiation Studies) Overexpression of YB1 in primary MBCs followed by allograft into BL6 mice results in decreased overall survival. YB1 silencing followed by radiation results in faster resolution of yH2AX, faster resolution of damage, and lack of pRPA32 accumulation. YB1 silencing sensitizes cells to radiation resulting in substantial decreases in proliferation. (RNA Binding Protein Studies) YB1 binds and positively regulates PLXND1 translation. Silencing PLXND1 results in decreased migration and EMT mark expression.
CONCLUSIONS
YB1 drives a more error prone non-homologous End-Joining based mechanism of repair and binds and regulates PLXND1 post-transcriptionally. PLXND1 drives a migratory phenotype in SHH MB.
Collapse
|
13
|
Nway N, Arora A, Tun MM, Mainali A, Aryal B, KC N, Chen V, Dufresne A. Abstract P041: Spontaneous Coronary Artery Dissection In A Patient With Polycystic Ovary Syndrome. Hypertension 2022. [DOI: 10.1161/hyp.79.suppl_1.p041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Women with Polycystic Ovary Syndrome (PCOS) have classic risk factors for cardiovascular disease such as obesity, hypertension, hypercholesterolemia, insulin resistance, and metabolic syndrome. Studies have demonstrated that they have increased markers of cardiovascular disease, including endothelial dysfunction, coronary artery calcification, and increased arterial stiffness leading to myocardial infarction, angina, stroke, and rarely coronary artery dissection. We present a case of a young female with PCOS without any other major classic cardiovascular risk factors except hypertension who presented with chest pain, later found to have myocardial infarction due to dissection of the right coronary artery.
Case:
A 33year old female presented with lightheadedness and intermittent dull mid-sternal chest pain. It became progressively worse in 5-6 hours. Past medical history was relevant for hypertension, insulin resistance, PCOS, and overweight. She was noncompliant with her medications. Family history was significant for hypertension, diabetes, coronary artery disease, and negative for any connective tissue disorders. Electrocardiogram showed ST-T elevation in leads II, III, and aVF and depression in leads I and aVL. Troponin level was significantly high at 0.378 ng/ml. Dual antiplatelet therapy was initiated. The patient underwent an emergency cardiac catheterization that revealed focal 85% flow limiting dissection in the proximal right coronary artery with a long 35% lesion in the mid right coronary artery and 40% focal lesion in the right posterior descending artery. Percutaneous intervention with a drug-eluting stent was placed successfully. She was discharged later with dual antiplatelet therapy, beta-blocker, angiotensin receptor blocker, and statin.
Conclusion:
Spontaneous coronary artery dissection in young females is usually associated with hormonal therapy or in the postpartum state. However, our case report highlights that physicians should have a high index of suspicion for spontaneous coronary artery dissection in a young female with PCOS.
Collapse
Affiliation(s)
| | | | | | | | | | - Nabin KC
- One Brooklyn Health, Brooklyn, NY
| | | | | |
Collapse
|
14
|
Sigler R, Chen V, Law N. Evolution of Clinical Care in COVID-Infected Solid Organ Transplant Recipients. Curr Transplant Rep 2022; 9:185-198. [PMID: 35669887 PMCID: PMC9154200 DOI: 10.1007/s40472-022-00368-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 12/15/2022]
Abstract
Purpose of Review In this review, we aim to summarize the evolution of care for the solid organ transplant recipient (SOTR) with COVID-19 disease, based on the current published guidelines and our center’s experience. Recent Findings Oral antiviral medications and monoclonal antibodies are now used with the goal to prevent severe disease. Immunomodulating drugs in addition to antivirals have been used in the treatment of severe COVID-19. Summary With the ongoing pandemic and unique challenges posed by the SOTR, understanding the risk and advancing management and treatment of COVID-19 infections are imperative to the successful care of a transplant recipient. There are many ongoing clinical trials being conducted in hopes of developing novel therapeutics towards COVID-19.
Collapse
Affiliation(s)
- Rachel Sigler
- Division of Infectious Diseases and Global Public Health, University of California San Diego, 9444 Medical Center Drive, MC 0879, La Jolla, CA 92093-0879 USA
| | - Victor Chen
- Department of Pharmacy, University of California San Diego, La Jolla, CA USA
| | - Nancy Law
- Division of Infectious Diseases and Global Public Health, University of California San Diego, 9444 Medical Center Drive, MC 0879, La Jolla, CA 92093-0879 USA
| |
Collapse
|
15
|
Chen V, Choudhury N, Zhang Y. Caffeine Induces Spontaneous Ventricular Tachyarrhythmias and Bidirectional Ventricular Tachycardia: Increased Vulnerability with Aging. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r2515] [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: 11/11/2022]
Affiliation(s)
- Victor Chen
- Department of Biomedical ScienceNew York Institute of Technology College of Osteopathic MedicineOld WestburyNY
| | - Nibras Choudhury
- Department of Biomedical ScienceNew York Institute of Technology College of Osteopathic MedicineOld WestburyNY
| | - Youhua Zhang
- Department of Biomedical ScienceNew York Institute of Technology College of Osteopathic MedicineOld WestburyNY
| |
Collapse
|
16
|
Chen V, Roby LC, Wentzel S, Li M, Jones N. Acquired hemophilia A in the setting of dual anticoagulation therapy and lupus anticoagulant: a case report. J Med Case Rep 2022; 16:177. [PMID: 35501873 PMCID: PMC9063298 DOI: 10.1186/s13256-022-03402-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acquired hemophilia A is a disorder caused by autoantibodies against coagulation factor VIII that may present with severe bleeding. We report a rare case of acquired hemophilia A presenting with coexisting lupus anticoagulant. CASE PRESENTATION An 81-year-old Caucasian female presented with large ecchymoses over the torso and extremities in the setting of an enoxaparin bridge to warfarin. Anticoagulation was held, but she continued to develop bruises with significant anemia and prolonged coagulation studies that failed to correct with mixing. Workup revealed factor VIII activity < 1% and a positive lupus anticoagulant. Initial testing for a factor VIII inhibitor was confounded by the presence of lupus anticoagulant, requiring a chromogenic Bethesda assay to confirm the presence of the inhibitor, establishing the diagnosis of acquired hemophilia A. The patient was initially treated with oral prednisone 80 mg daily and factor VIII inhibitor bypassing activity 25 units/kg twice daily before transitioning to susoctocog alfa 50 units/kg twice daily after placement of a tunneled line for outpatient rituximab infusions. On discharge, the patient's ecchymoses were resolving and factor VIII levels improved. Following completion of rituximab therapy, the patient's factor VIII activity normalized and factor VIII inhibitor was suppressed. CONCLUSIONS Diagnosis of acquired hemophilia A can be confounded by other causes of abnormal coagulation studies and may require specialized testing, such as a chromogenic Bethesda assay, to confirm the presence of a factor VIII inhibitor.
Collapse
Affiliation(s)
- Victor Chen
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Lauren C Roby
- The Ohio State University College of Medicine, Columbus, OH, USA
| | | | - Mingjia Li
- The Ohio State University Hematology-Oncology Fellowship, Columbus, OH, USA
| | - Nicholas Jones
- Division of Hospital Medicine, Department of Internal Medicine, The Ohio State University, M112 Starling Loving Hall, 320 W. 10th Avenue, Columbus, OH, 43210, USA.
| |
Collapse
|
17
|
Jin X, Ng V, Zhao M, Liu L, Higashimoto T, Lee ZH, Chung J, Chen V, Ney G, Kandarpa M, Talpaz M, Li Q. Epigenetic downregulation of Socs2 contributes to mutant N-Ras-mediated hematopoietic dysregulation. Dis Model Mech 2022; 15:274899. [PMID: 35352806 PMCID: PMC9092650 DOI: 10.1242/dmm.049088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 03/18/2022] [Indexed: 11/21/2022] Open
Abstract
RAS mutations occur in a broad spectrum of human hematopoietic malignancies. Activating Ras mutations in blood cells leads to hematopoietic malignancies in mice. In murine hematopoietic stem cells (HSCs), mutant N-RasG12D activates Stat5 to dysregulate stem cell function. However, the underlying mechanism remains elusive. In this study, we demonstrate that Stat5 activation induced by a hyperactive Nras mutant, G12D, is dependent on Jak2 activity. Jak2 is activated in Nras mutant HSCs and progenitors (HSPCs), and inhibiting Jak2 with ruxolitinib significantly decreases Stat5 activation and HSPC hyper-proliferation in vivo in NrasG12D mice. Activation of Jak2-Stat5 is associated with downregulation of Socs2, an inhibitory effector of Jak2/Stat5. Restoration of Socs2 blocks NrasG12D HSC reconstitution in bone marrow transplant recipients. SOCS2 downregulation is also observed in human acute myeloid leukemia (AML) cells that carry RAS mutations. RAS mutant AML cells exhibited suppression of the enhancer active marker H3K27ac at the SOCS2 locus. Finally, restoration of SOCS2 in RAS mutant AML cells mitigated leukemic growth. Thus, we discovered a novel signaling feedback loop whereby hyperactive Ras signaling activates Jak2/Stat5 via suppression of Socs2. Summary: Jak2/Stat5 is often considered to be parallel to or upstream of Ras signaling. We have discovered a novel signaling feedback loop whereby hyperactive Ras signaling activates Jak2/Stat5 via suppression of Socs2.
Collapse
Affiliation(s)
- Xi Jin
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Victor Ng
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Meiling Zhao
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Lu Liu
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Tomoyasu Higashimoto
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Zheng Hong Lee
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Jooho Chung
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Victor Chen
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Gina Ney
- Department of Pediatrics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Malathi Kandarpa
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Moshe Talpaz
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Qing Li
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA.,Department of Cell and Developmental Biology, University of Michigan, Ann Arbor, MI 48109, USA
| |
Collapse
|
18
|
Pata R, Nway N, Lutaya I, Chen V. Disseminated Histoplasmosis Presenting as Acute Respiratory Distress Syndrome and Disseminated Intravascular Coagulation in an HIV Positive Immigrant from Central America. Cureus 2022; 14:e21942. [PMID: 35273883 PMCID: PMC8901384 DOI: 10.7759/cureus.21942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2022] [Indexed: 11/21/2022] Open
Abstract
Histoplasmosis rarely causes significant illness in immunocompetent patients. In endemic areas such as the Midwestern United States and Central America, most people are infected, but are rarely symptomatic, with variable presentation. The illness is usually self-limited in immunocompetent individuals. However, in immunocompromised patients, Histoplasma capsulatum can disseminate to various organs and should be suspected especially in the endemic areas or if there is a significant travel history involving these areas. We present a case of a 65-year-old male originally from Central America with no known past medical history presenting with Acute Respiratory Distress Syndrome complicated by disseminated intravascular coagulation due to acute histoplasmosis and incidentally found to have HIV/AIDS.
Collapse
|
19
|
Bao H, Guo Y, Cowman K, Chen V, Nori P, Nori P. 522. Evaluation of Three COVID-19 Monoclonal Antibody Regimens in the Context of Rising B.1.526 Prevalence in New York City. Open Forum Infect Dis 2021. [PMCID: PMC8644702 DOI: 10.1093/ofid/ofab466.721] [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] [Indexed: 11/14/2022] Open
Abstract
Background Monoclonal antibodies were given emergency use authorization (EUA) by the Food and Drug Administration for the treatment of high-risk, outpatient COVID-19 infection. In New York City (NYC), the emergence and rapid growth of the B.1.526 variant of concern (VOC) possessing the E484K mutation was first noted in February 2021. In-vitro studies subsequently confirmed attenuated monoclonal antibody neutralization against VOCs. At our institution, bamlanivimab (BAM) alone or with etesevimab (B/E) and casirivimab/imdevimab (C/I) were utilized at different phases of the pandemic. The objective of this study was to assess their comparative efficacies in a highly variant prevalent setting. Methods This retrospective analysis was conducted at an urban hospital in the Bronx, NY and evaluated adult monoclonal antibody recipients from any of our infusion sites. Patients initially received BAM but given the high prevalence of variants, treatment was transitioned to first B/E and then C/I exclusively. We compared BAM versus combination therapy as well as B/E versus C/I individually. The primary outcome was all-cause hospital admission within 30 days post infusion. Results From February 1 to March 7, 2021, 358 patients received BAM and from March 17 to May 9, 2021, 86 and 179 patients received B/E and C/I, respectively. Compared to any combination infusion, patients who received BAM were significantly older, more likely to possess ≥ 2 qualifying EUA criteria, and less likely to be vaccinated for COVID-19 prior to infusion (Table 1). Following B/E and C/I, 4.5% of patients were admitted versus 10.1% for BAM, p=0.011. There were no significant differences in admission between B/E and C/I recipients, p=0.485. After excluding fully vaccinated patients (n=14) and adjusting for age and ≥ 2 EUA criteria, combination therapy remained associated with decreased odds of hospitalization compared to BAM (odds ratio, 0.48; 95% confidence interval, 0.24-0.94). ![]()
Conclusion Combination therapy may be associated with fewer hospital admissions following infusion, although there were no statistically significant differences between the individual combination infusions. We suggest similar studies be conducted by other sites to understand the clinical impact of local SARS-CoV-2 variants on antibody efficacy. Disclosures Yi Guo, PharmD, BCIDP, Merck (Research Grant or Support) Kelsie Cowman, MPH, Merck (Research Grant or Support) Priya Nori, MD, Merck (Grant/Research Support) Priya Nori, MD, Nothing to disclose
Collapse
Affiliation(s)
- Hongkai Bao
- Montefiore Medical Center, The Bronx, New York
| | - Yi Guo
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Kelsie Cowman
- Montefiore Medical Center and Albert Einstein College of Medicine, New York, NY
| | | | - Priya Nori
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Priya Nori
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| |
Collapse
|
20
|
Chen V, Allen L, Bao H, Cowman K, Nori P, Nori P, Guo Y. 114. Optimization of Inpatient Antibiotic Use via an Electronic Antimicrobial Stewardship Module and an Infectious Diseases Pharmacy Resident. Open Forum Infect Dis 2021. [PMCID: PMC8644158 DOI: 10.1093/ofid/ofab466.316] [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] [Indexed: 11/18/2022] Open
Abstract
Background Antibiotic resistance is a public health crisis and antimicrobial stewardship (AMS) pharmacists serve a crucial role in preventing inappropriate use. At Montefiore Medical Center (1,500-bed hospital), a new electronic medical record AMS module was implemented with assistance from an infectious diseases (ID) pharmacy resident in October 2020. The module utilizes a dynamic scoring system to assist in prioritizing interventions, including bug-drug mismatches, insufficient coverage, or de-escalation. The AMS module is operationalized by ID pharmacists during the week and an ID pharmacy resident every other weekend. The objective of this study was to assess the impact of an ID pharmacy resident performing AMS module interventions on broad spectrum antibiotic use. Methods An observational study of AMS module interventions on antibiotic use (AU) in days of therapy per 1,000 days present and standardized antimicrobial administration ratio (SAAR) was performed. AU data for piperacillin-tazobactam (P/T) and SAAR prior to (October 2019– December 2019) and after (October 2020 – December 2020) the integration of an ID pharmacy resident and the AMS module was compared. Additional data collected included total number and type of interventions. Results A total of 539 interventions were made by AMS pharmacists and 36.5% of these were completed by the ID pharmacy resident. Across 6 different units, there was a statistically significant decrease in the SAAR for broad spectrum antibacterial agents (Figure 1), and a decrease of at least 10% in P/T use during the two different time periods (Table 1). An estimated P/T cost reduction of 26% of (&48,708 to &36,235.80) was observed. AMS pharmacists made 63 interventions in respective units. The top three intervention types were dose/frequency/duration recommendations, pharmacokinetic vancomycin dosing/monitoring, and de-escalation. The acceptance rate of interventions was 99% (534 accepted interventions/539 total interventions). Figure 1. SAAR Comparison of Broad-Spectrum Agents ![]()
Table 1. AU Rate of Piperacillin-tazobactam ![]()
Conclusion Overall, there was a statistically significant impact on SAARs and a >10% change in P/T AU rate with an estimated cost reduction >25% on select units after implementation of the AMS module with an ID pharmacy resident. Disclosures Kelsie Cowman, MPH, Merck (Research Grant or Support) Priya Nori, MD, Merck (Grant/Research Support) Priya Nori, MD, Nothing to disclose Yi Guo, PharmD, BCIDP, Merck (Research Grant or Support)
Collapse
Affiliation(s)
| | | | | | - Kelsie Cowman
- Montefiore Medical Center and Albert Einstein College of Medicine, New York, NY
| | - Priya Nori
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Priya Nori
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Yi Guo
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| |
Collapse
|
21
|
Dong K, Chen V, Shannon C, Tebbutt S, Ng R, Quon B. 533: Whole-blood transcriptome biomarkers of pulmonary exacerbations in cystic fibrosis. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01957-3] [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]
|
22
|
Girard N, Wermke M, Ledin E, Kim DW, Ghiringhelli F, Bennouna J, Lesimple T, Felip E, Berz D, Lee JS, Jeanson A, Mascaux C, Voskoboynik M, Serwatowski P, Burger M, Landsteiner H, Chen V, Jayadeva G, Alt J, Hackanson B. 532P Phase Ib study evaluating BI 836880 (VEGF/Ang2 nanobody) in combination with ezabenlimab (BI 754091; anti-PD-1 antibody) in patients with solid tumours. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1054] [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] Open
|
23
|
Cowman K, Guo Y, Pirofski LA, Wong D, Bao H, Chen V, Hopkins U, Andrews E, Hamel J, Keller M, Bellin E, Thota R, Davis P, Rodriguez ET, Suthar P, Allen L, Rossi J, Haviland A, Orner E, Szymczak W, Shujauddin S, McCarthy J, Binder B, Pushparaj V, Bard L, Pierino VF, Alsina L, Esses D, McCaskie A, Campbell C, Madzura T, Wollowitz A, Basset K, White D, Ruiz R, Sosnowski F, Nori P. Post-severe Acute Respiratory Syndrome Coronavirus 2 Monoclonal Antibody Treatment Hospitalizations as a Sentinel for Emergence of Viral Variants in New York City. Open Forum Infect Dis 2021; 8:ofab313. [PMID: 34458391 PMCID: PMC8391090 DOI: 10.1093/ofid/ofab313] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 04/15/2021] [Accepted: 06/09/2021] [Indexed: 11/12/2022] Open
Abstract
We partnered with the US Department of Health and Human Services to treat high-risk, nonadmitted coronavirus disease 2019 (COVID-19) patients with bamlanivimab in the Bronx, New York per Emergency Use Authorization criteria. Increasing posttreatment hospitalizations were observed monthly between December 2020 and March 2021 in parallel to the emergence of severe acute respiratory syndrome coronavirus 2 variants in New York City.
Collapse
Affiliation(s)
- Kelsie Cowman
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Yi Guo
- Department of Pharmacy, Montefiore Medical Center, Bronx, New York, USA
| | - Liise-anne Pirofski
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - David Wong
- Medical Officer, COVID-19 Therapeutics Team, US Department of Health and Human Services, Rockville, MD, USA
| | - Hongkai Bao
- Department of Pharmacy, Montefiore Medical Center, Bronx, New York, USA
| | - Victor Chen
- Department of Pharmacy, Montefiore Medical Center, Bronx, New York, USA
| | - Una Hopkins
- Department of Nursing, Montefiore Medical Center, Bronx, New York, USA
| | - Erin Andrews
- Network Performance Group, Montefiore Medical Center, Bronx, New York, USA
| | - Joseph Hamel
- Office of Strategy, Planning, Policy and Requirements, Assistant Secretary for Preparedness and Response, US Department of Health and Human Services, Washington, DC, USA
| | - Marla Keller
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Eran Bellin
- Department of Epidemiology, Population Health and Medicine Albert Einstein College of Medicine, Montefiore Health System, Bronx, New York, USA
| | - Raja Thota
- Network Performance Group, Montefiore Medical Center, Bronx, New York, USA
| | - Patricia Davis
- Department of Nursing, Montefiore Medical Center, Bronx, New York, USA
| | - Edwin Torres Rodriguez
- Division of Endocrinology, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Pooja Suthar
- Department of Pharmacy, Montefiore Medical Center, Bronx, New York, USA
| | - Lauren Allen
- Department of Pharmacy, Montefiore Medical Center, Bronx, New York, USA
| | - James Rossi
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Adam Haviland
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Erika Orner
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Wendy Szymczak
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Sadahf Shujauddin
- Department of Pediatric Cardiology, Children’s Hospital at Montefiore, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - James McCarthy
- Department of Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Barbara Binder
- Department of Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Vanitha Pushparaj
- Faculty Practice Group, Montefiore Health System, Bronx, New York, USA
| | - Linda Bard
- Faculty Practice Group, Montefiore Health System, Bronx, New York, USA
| | | | - Leslie Alsina
- Faculty Practice Group, Montefiore Health System, Bronx, New York, USA
| | - David Esses
- Department of Emergency Medicine Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Alicia McCaskie
- Department of Emergency Medicine Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Caron Campbell
- Department of Emergency Medicine Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Tabitha Madzura
- Department of Emergency Medicine Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Andrew Wollowitz
- Department of Emergency Medicine Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Kelly Basset
- Department of Emergency Medicine Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Deborah White
- Department of Emergency Medicine Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Rafael Ruiz
- Network Performance Group, Montefiore Medical Center, Bronx, New York, USA
| | - Frank Sosnowski
- Department of Pharmacy, Montefiore Medical Center, Bronx, New York, USA
| | - Priya Nori
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| |
Collapse
|
24
|
McSwain L, Kenney A, Chen V, Huang T. EMBR-24. YB1 IS CRITICAL FOR MEDULLOBLASTOMA TUMOR MAINTENANCE AND DNA REPAIR FOLLOWING THERAPEUTIC INTERVENTION. Neuro Oncol 2021. [PMCID: PMC8263155 DOI: 10.1093/neuonc/noab090.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Medulloblastoma (MB) is the most common pediatric central nervous system malignancy. Although the current standard of care leads to ~70% patient survival, the therapies are highly toxic, leading to life-long side effects, and recurrence due to therapeutic resistance is fatal. We sought to investigate mediators of radiation response in mouse models for the Sonic hedgehog (SHH) subgroup MB as well as human cell lines. We previously identified Y-box binding protein 1 (YB1) as a downstream effector of YAP-mediated MB radiation resistance. YB1 is a crucial, yet understudied, protein highly expressed across all 4 subgroups of MB. Through its DNA- and RNA-binding cold shock domain, YB1 mediates both transcriptional and translational changes important for tumor maintenance and therapeutic response. We show that following ionizing radiation, YB1 mediates DNA repair through PARP and that PARP inhibition abrogates YB1-mediated DNA repair in cells overexpressing YB1. Additionally, through its inhibitory effects on p53, YB1 is capable of mediating anti-apoptotic effects in response to genotoxic insult. By targeting YB1 with short hairpin RNA, we show that cells are more amenable to ionizing radiation induced double strand breaks. Additionally, we utilize RNA binding protein immunoprecipitation sequencing to investigate post transcriptional regulation of RNAs bound by YB1. We show that YB1 binds numerous transcripts critical for the identity of early cerebellar progenitor cells, the putative cell of origin for SHH subgroup tumors, in addition to transcripts important for cell cycling and migration.
Collapse
|
25
|
Gowda P, Chen V, Durr N, Weiss C. Abstract No. 443 A proposed device for the prediction of a quantitative endpoint for transarterial embolization from real-time pressure measurements. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
26
|
Chen V, Stone R, Burgess J, Strbo N, Pastar I, Tomic-Canic M. 646 Antimicrobial Perforin-2 in chronic wounds correlates with healing outcomes. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
27
|
Trachuk P, Hemmige V, Eisenberg R, Cowman K, Chen V, Weston G, Gendlina I, Ferguson N, Dicpinigaitis P, Berger J, Pirofski LA, Sarwar UN. Evaluation of Clinical Outcomes After Introduction of a Dedicated Infectious Diseases-Critical Care Medicine Service in Critical Care Units. Open Forum Infect Dis 2021; 8:ofab182. [PMID: 34322562 PMCID: PMC8312519 DOI: 10.1093/ofid/ofab182] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/14/2021] [Indexed: 12/04/2022] Open
Abstract
Background Infection is a leading cause of admission to intensive care units (ICUs), with critically ill patients often receiving empiric broad-spectrum antibiotics. Nevertheless, a dedicated infectious diseases (ID) consultation and stewardship team is not routinely established. An ID–critical care medicine (ID-CCM) pilot program was designed at a 400-bed tertiary care hospital in which an ID attending was assigned to participate in daily rounds with the ICU team, as well as provide ID consultation on select patients. We sought to evaluate the impact of this dedicated ID program on antibiotic utilization and clinical outcomes in patients admitted to the ICU. Methods In this single-site retrospective study, we analyzed antibiotic utilization and clinical outcomes in patients admitted to an ICU during the postintervention period from January 1 to December 31, 2017, and compared it to antibiotic utilization in the same ICUs during the preintervention period from January 1 to December 31, 2015. Results Our data showed a statistically significant reduction in usage of most frequently prescribed antibiotics including vancomycin, piperacillin-tazobactam, and cefepime during the intervention period. When compared to the preintervention period there was no difference in-hospital mortality, hospital length of stay, and readmission. Conclusions With this multidisciplinary intervention, we saw a decrease in the use of the most frequently prescribed broad-spectrum antibiotics without a negative impact on clinical outcomes. Our study shows that the implementation of an ID-CCM service is a feasible way to promote antibiotic stewardship in the ICU and can be used as a strategy to reduce unnecessary patient exposure to broad-spectrum agents.
Collapse
Affiliation(s)
- Polina Trachuk
- Division of Pulmonary, Critical Care Medicine and Sleep Medicine, Department of Medicine, New York University School of Medicine, New York, New York, USA.,Division of Infectious Diseases and Immunology, Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - Vagish Hemmige
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Ruth Eisenberg
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Kelsie Cowman
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Victor Chen
- Department of Pharmacy, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Gregory Weston
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Inessa Gendlina
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Nadia Ferguson
- Department of Pharmacy, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Peter Dicpinigaitis
- Division of Critical Care Medicine, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Jay Berger
- Division of Critical Care Medicine, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA.,Department of Anesthesiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Liise-Anne Pirofski
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Uzma N Sarwar
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| |
Collapse
|
28
|
Jia X, Burugula BB, Chen V, Lemons RM, Jayakody S, Maksutova M, Kitzman JO. Massively parallel functional testing of MSH2 missense variants conferring Lynch syndrome risk. Am J Hum Genet 2021; 108:163-175. [PMID: 33357406 PMCID: PMC7820803 DOI: 10.1016/j.ajhg.2020.12.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 12/03/2020] [Indexed: 12/20/2022] Open
Abstract
The lack of functional evidence for the majority of missense variants limits their clinical interpretability and poses a key barrier to the broad utility of carrier screening. In Lynch syndrome (LS), one of the most highly prevalent cancer syndromes, nearly 90% of clinically observed missense variants are deemed “variants of uncertain significance” (VUS). To systematically resolve their functional status, we performed a massively parallel screen in human cells to identify loss-of-function missense variants in the key DNA mismatch repair factor MSH2. The resulting functional effect map is substantially complete, covering 94% of the 17,746 possible variants, and is highly concordant (96%) with existing functional data and expert clinicians’ interpretations. The large majority (89%) of missense variants were functionally neutral, perhaps unexpectedly in light of its evolutionary conservation. These data provide ready-to-use functional evidence to resolve the ∼1,300 extant missense VUSs in MSH2 and may facilitate the prospective classification of newly discovered variants in the clinic.
Collapse
|
29
|
Gnanenthiran S, Pennings G, Reddel C, Campbell H, Kochx M, Hamilton J, Chen V, Kritharides L. Identification of A Distinct Platelet Phenotype in the Elderly: ADP Hypersensitivity Co-exists With Platelet Protease-Activated-receptor (PAR)-1 and PAR-4 Mediated Thrombin Resistance. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.293] [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]
|
30
|
Valenzano MC, Rybakovsky E, Chen V, Leroy K, Lander J, Richardson E, Yalamanchili S, McShane S, Mathew A, Mayilvaganan B, Connor L, Urbas R, Huntington W, Corcoran A, Trembeth S, McDonnell E, Wong P, Newman G, Mercogliano G, Zitin M, Etemad B, Thornton J, Daum G, Raines J, Kossenkov A, Fong LY, Mullin JM. Zinc Gluconate Induces Potentially Cancer Chemopreventive Activity in Barrett's Esophagus: A Phase 1 Pilot Study. Dig Dis Sci 2021; 66:1195-1211. [PMID: 32415564 PMCID: PMC7677901 DOI: 10.1007/s10620-020-06319-x] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 05/02/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Chemopreventive effects of zinc for esophageal cancer have been well documented in animal models. This prospective study explores if a similar, potentially chemopreventive action can be seen in Barrett's esophagus (BE) in humans. AIMS To determine if molecular evidence can be obtained potentially indicating zinc's chemopreventive action in Barrett's metaplasia. METHODS Patients with a prior BE diagnosis were placed on oral zinc gluconate (14 days of 26.4 mg zinc BID) or a sodium gluconate placebo, prior to their surveillance endoscopy procedure. Biopsies of Barrett's mucosa were then obtained for miRNA and mRNA microarrays, or protein analyses. RESULTS Zinc-induced mRNA changes were observed for a large number of transcripts. These included downregulation of transcripts encoding proinflammatory proteins (IL32, IL1β, IL15, IL7R, IL2R, IL15R, IL3R), upregulation of anti-inflammatory mediators (IL1RA), downregulation of transcripts mediating epithelial-to-mesenchymal transition (EMT) (LIF, MYB, LYN, MTA1, SRC, SNAIL1, and TWIST1), and upregulation of transcripts that oppose EMT (BMP7, MTSS1, TRIB3, GRHL1). miRNA arrays showed significant upregulation of seven miRs with tumor suppressor activity (-125b-5P, -132-3P, -548z, -551a, -504, -518, and -34a-5P). Of proteins analyzed by Western blot, increased expression of the pro-apoptotic protein, BAX, and the tight junctional protein, CLAUDIN-7, along with decreased expression of BCL-2 and VEGF-R2 were noteworthy. CONCLUSIONS When these mRNA, miRNA, and protein molecular data are considered collectively, a cancer chemopreventive action by zinc in Barrett's metaplasia may be possible for this precancerous esophageal tissue. These results and the extensive prior animal model studies argue for a future prospective clinical trial for this safe, easily-administered, and inexpensive micronutrient, that could determine if a chemopreventive action truly exists.
Collapse
Affiliation(s)
- M C Valenzano
- The Lankenau Institute for Medical Research, 100 Lancaster Avenue, Wynnewood, PA, 19096, USA
| | - E Rybakovsky
- The Lankenau Institute for Medical Research, 100 Lancaster Avenue, Wynnewood, PA, 19096, USA
| | - V Chen
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA
| | - K Leroy
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA
| | - J Lander
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA
| | - E Richardson
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA
| | - S Yalamanchili
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA
| | - S McShane
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA
| | - A Mathew
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA
| | - B Mayilvaganan
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA
| | - L Connor
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA
| | - R Urbas
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA
| | - W Huntington
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA
| | - A Corcoran
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA
| | - S Trembeth
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA
| | - E McDonnell
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA
| | - P Wong
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA
| | - G Newman
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA
| | - G Mercogliano
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA
| | - M Zitin
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA
| | - B Etemad
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA
| | - J Thornton
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA
| | - G Daum
- The Department of Pathology, Lankenau Medical Center, Wynnewood, USA
| | - J Raines
- The Lankenau Institute for Medical Research, 100 Lancaster Avenue, Wynnewood, PA, 19096, USA
| | | | - L Y Fong
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, PA, USA
| | - J M Mullin
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA.
- The Lankenau Institute for Medical Research, 100 Lancaster Avenue, Wynnewood, PA, 19096, USA.
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA.
| |
Collapse
|
31
|
Nori P, Szymczak W, Puius Y, Sharma A, Cowman K, Gialanella P, Fleischner Z, Corpuz M, Torres-Isasiga J, Bartash R, Felsen U, Chen V, Guo Y. Emerging Co-Pathogens: New Delhi Metallo-beta-lactamase producing Enterobacterales Infections in New York City COVID-19 Patients. Int J Antimicrob Agents 2020; 56:106179. [PMID: 32987104 PMCID: PMC7518801 DOI: 10.1016/j.ijantimicag.2020.106179] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/14/2020] [Accepted: 09/20/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Priya Nori
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Bronx NY, USA.
| | - Wendy Szymczak
- Department of Microbiology, Albert Einstein College of Medicine, Bronx NY, USA
| | - Yoram Puius
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Bronx NY, USA
| | - Anjali Sharma
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Bronx NY, USA; Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx NY, USA
| | - Kelsie Cowman
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Bronx NY, USA
| | - Philip Gialanella
- Department of Microbiology, Albert Einstein College of Medicine, Bronx NY, USA
| | - Zachary Fleischner
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Bronx NY, USA
| | - Marilou Corpuz
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Bronx NY, USA
| | - Julian Torres-Isasiga
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Bronx NY, USA
| | - Rachel Bartash
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Bronx NY, USA
| | - Uriel Felsen
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Bronx NY, USA
| | - Victor Chen
- Department of Pharmacy, Albert Einstein College of Medicine, Bronx NY, USA
| | - Yi Guo
- Department of Pharmacy, Albert Einstein College of Medicine, Bronx NY, USA.
| |
Collapse
|
32
|
Birnbaum ML, Kulkarni PP, Van Meter A, Chen V, Rizvi AF, Arenare E, De Choudhury M, Kane JM. Utilizing Machine Learning on Internet Search Activity to Support the Diagnostic Process and Relapse Detection in Young Individuals With Early Psychosis: Feasibility Study. JMIR Ment Health 2020; 7:e19348. [PMID: 32870161 PMCID: PMC7492982 DOI: 10.2196/19348] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/20/2020] [Accepted: 07/23/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Psychiatry is nearly entirely reliant on patient self-reporting, and there are few objective and reliable tests or sources of collateral information available to help diagnostic and assessment procedures. Technology offers opportunities to collect objective digital data to complement patient experience and facilitate more informed treatment decisions. OBJECTIVE We aimed to develop computational algorithms based on internet search activity designed to support diagnostic procedures and relapse identification in individuals with schizophrenia spectrum disorders. METHODS We extracted 32,733 time-stamped search queries across 42 participants with schizophrenia spectrum disorders and 74 healthy volunteers between the ages of 15 and 35 (mean 24.4 years, 44.0% male), and built machine-learning diagnostic and relapse classifiers utilizing the timing, frequency, and content of online search activity. RESULTS Classifiers predicted a diagnosis of schizophrenia spectrum disorders with an area under the curve value of 0.74 and predicted a psychotic relapse in individuals with schizophrenia spectrum disorders with an area under the curve of 0.71. Compared with healthy participants, those with schizophrenia spectrum disorders made fewer searches and their searches consisted of fewer words. Prior to a relapse hospitalization, participants with schizophrenia spectrum disorders were more likely to use words related to hearing, perception, and anger, and were less likely to use words related to health. CONCLUSIONS Online search activity holds promise for gathering objective and easily accessed indicators of psychiatric symptoms. Utilizing search activity as collateral behavioral health information would represent a major advancement in efforts to capitalize on objective digital data to improve mental health monitoring.
Collapse
Affiliation(s)
- Michael Leo Birnbaum
- The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
- Hofstra Northwell School of Medicine, Hempstead, NY, United States
| | | | - Anna Van Meter
- The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
- Hofstra Northwell School of Medicine, Hempstead, NY, United States
| | - Victor Chen
- Georgia Institute of Technology, Atlanta, GA, United States
| | - Asra F Rizvi
- The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Elizabeth Arenare
- The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | | | - John M Kane
- The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
- Hofstra Northwell School of Medicine, Hempstead, NY, United States
| |
Collapse
|
33
|
Park IU, Fakile YF, Chow JM, Gustafson KJ, Jost H, Schapiro JM, Novak-Weekley S, Tran A, Nomura JH, Chen V, Beheshti M, Tsai T, Hoover K, Bolan G. Performance of Treponemal Tests for the Diagnosis of Syphilis. Clin Infect Dis 2020; 68:913-918. [PMID: 29986091 DOI: 10.1093/cid/ciy558] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/07/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Treponemal immunoassays are increasingly used for syphilis screening with the reverse sequence algorithm. There are few data describing performance of treponemal immunoassays compared to traditional treponemal tests in patients with and without syphilis. METHODS We calculated sensitivity and specificity of 7 treponemal assays: (1) ADVIA Centaur (chemiluminescence immunoassay [CIA]); (2) Bioplex 2200 (microbead immunoassay); (3) fluorescent treponemal antibody absorption test (FTA-ABS); (4) INNO-LIA (line immunoassay); (5) LIAISON CIA; (6) Treponema pallidum particle agglutination assay (TPPA); and (7) Trep-Sure (enzyme immunoassay [EIA]), using a reference standard combining clinical diagnosis and serology results. Sera were collected between May 2012-January 2013. Cases were characterized as: (1) current clinical diagnosis of syphilis: primary, secondary, early latent, late latent; (2) prior treated syphilis only; (3) no evidence of current syphilis, no prior history of syphilis, and at least 4 of 7 treponemal tests negative. RESULTS Among 959 participants, 262 had current syphilis, 294 had prior syphilis, and 403 did not have syphilis. FTA-ABS was less sensitive for primary syphilis (78.2%) than the immunoassays or TPPA (94.5%-96.4%) (all P ≤ .01). All immunoassays were 100% sensitive for secondary syphilis, 95.2%-100% sensitive for early latent disease, and 86.8%-98.5% sensitive in late latent disease. TPPA had 100% specificity. CONCLUSIONS Treponemal immunoassays demonstrated excellent sensitivity for secondary, early latent, and seropositive primary syphilis. Sensitivity of FTA-ABS in primary syphilis was poor. Given its high specificity and superior sensitivity, TPPA is preferred to adjudicate discordant results with the reverse sequence algorithm over the FTA-ABS.
Collapse
Affiliation(s)
- Ina U Park
- Sexually Transmitted Disease Control Branch, Division of Communicable Disease Control, California Department of Public Health, Richmond.,Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yetunde F Fakile
- Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joan M Chow
- Sexually Transmitted Disease Control Branch, Division of Communicable Disease Control, California Department of Public Health, Richmond
| | - Kathleen J Gustafson
- Sexually Transmitted Disease Control Branch, Division of Communicable Disease Control, California Department of Public Health, Richmond
| | - Heather Jost
- Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Susan Novak-Weekley
- Southern California Permanente Medical Group Regional Reference Laboratory, North Hollywood
| | - Anthony Tran
- San Francisco Department of Public Health, California
| | - Jim H Nomura
- Southern California Permanente Medical Group, California
| | - Victor Chen
- Southern California Permanente Medical Group, California
| | - Manie Beheshti
- Southern California Permanente Medical Group, California
| | - Townson Tsai
- Southern California Permanente Medical Group, California
| | - Karen Hoover
- Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gail Bolan
- Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
34
|
Chen V, Long K, Woodburn EV. When weighing universal precautions, filtration efficiency is not universal. J Hosp Infect 2020; 105:S0195-6701(20)30207-3. [PMID: 32339617 PMCID: PMC7194634 DOI: 10.1016/j.jhin.2020.04.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 11/23/2022]
Affiliation(s)
- V Chen
- Carle Illinois College of Medicine, Champaign, Champaign, IL, USA
| | - K Long
- University of Illinois College of Medicine at Urbana - Champaign, Champaign, IL, USA
| | - E V Woodburn
- Carle Illinois College of Medicine, Champaign, Champaign, IL, USA.
| |
Collapse
|
35
|
McCullen M, Grosskopf C, Jafary S, Chan P, Chen V. P270 Using a rabbit model to observe corticospinal contributions of noninvasive electrical stimulation. Clin Neurophysiol 2020. [DOI: 10.1016/j.clinph.2019.12.380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
36
|
Lei I, Tian S, Chen V, Zhao Y, Wang Z. SWI/SNF Component BAF250a Coordinates OCT4 and WNT Signaling Pathway to Control Cardiac Lineage Differentiation. Front Cell Dev Biol 2020; 7:358. [PMID: 32039194 PMCID: PMC6987383 DOI: 10.3389/fcell.2019.00358] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 12/10/2019] [Indexed: 12/30/2022] Open
Abstract
Dissecting epigenetic mechanisms controlling early cardiac differentiation will provide insights into heart regeneration and heart disease treatment. SWI/SNF complexes remodel nucleosomes to regulate gene expression and play a key role in organogenesis. Here, we reported a unique function of BAF250a in regulating the physical interaction of OCT4 and β-CATENIN during cardiac lineage differentiation from human ESCs. BAF250a deletion greatly reduced the physical interaction between OCT4 and β-CATENIN but did not alter the expression of β-CATENIN and OCT4 in the mesodermal progenitor cells. BAF250a ablation led to decreased recruitment of OCT4 and β-CATENIN at promoters of key mesodermal lineage genes, such as MESP1 and EOMES. Subsequently, the expression of lineage-specific genes was downregulated, whereas the expression of pluripotent genes was upregulated. In parallel, BAF250a ablation also altered recruitments of OCT4 and β-CATENIN to the promoter of CCND2 and CCND3, two key genes for S phase entry during cell cycle. Consequently, BAF250a deletion led to prolonged S phase in Mesp1+ cardiac progenitor cells, which in turn inhibited efficient differentiation of Mesp1+ to Isl1+ cells. Furthermore, BAF250a deletion abolished the interaction of OCT4 and BRG1 in mesoderm, suggesting that BAF250a is the key component in SWI/SNF complex that determines the interaction of Oct4/β-catenin in mesoderm. In contrast, we found that BAF250a did not regulate the OCT4/β-CATENIN interaction during neuroectoderm differentiation. Altogether, our results suggest that BAF250a specifically controls proper cardiac mesoderm differentiation by reorganizing the binding of OCT4/β-CATENIN and regulates both key lineage differentiation genes and cell cycle genes that coincided in response to WNT/β-CATENIN signal.
Collapse
Affiliation(s)
- Ienglam Lei
- Faculty of Health Sciences, University of Macau, Taipa, China.,Department of Cardiac Surgery, Cardiovascular Center, University of Michigan, Ann Arbor, MI, United States
| | - Shuo Tian
- Department of Cardiac Surgery, Cardiovascular Center, University of Michigan, Ann Arbor, MI, United States
| | - Victor Chen
- Department of Cardiac Surgery, Cardiovascular Center, University of Michigan, Ann Arbor, MI, United States
| | - Yong Zhao
- Henan Provincial People's Hospital, Fuwai Central China Cardiovascular Hospital, Key Laboratory of Cardiac Regenerative Medicine, National Health and Family Planning Commission, Central China Branch of National Center for Cardiovascular Diseases Henan Province, Zhengzhou, China
| | - Zhong Wang
- Department of Cardiac Surgery, Cardiovascular Center, University of Michigan, Ann Arbor, MI, United States
| |
Collapse
|
37
|
|
38
|
Trachuk P, Hemmige V, Chen V, Weston G, Cowman K, Berger J, Sarwar UN. 1877. Evaluation of Antibiotic Utilization After Introduction of a Dedicated Infectious Diseases-Critical Care Medicine Service in Critical Care Units. Open Forum Infect Dis 2019. [PMCID: PMC6808670 DOI: 10.1093/ofid/ofz359.107] [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] [Indexed: 11/16/2022] Open
Abstract
Background Infection is a leading cause of admission to intensive care units (ICU), with critically ill patients often receiving a high volume of empiric broad-spectrum antibiotics. Nevertheless, a dedicated infectious diseases (ID) consultation and stewardship team is not routinely implemented. An ID-Critical Care Medicine (ID-CCM) pilot program was designed at a large tertiary hospital in which an ID attending was assigned to participate in daily rounds with the ICU team, as well as provide an ID consult on select patients. We sought to evaluate the impact of this dedicated ID consultation and stewardship program on antibiotic utilization in the ICU. Methods This is an IRB-approved single-site retrospective study. We analyzed antibiotic utilization in the ICU during the post-intervention period from January 1, 2017 to December 31, 2017 and compared it to antibiotic utilization in the same ICU during the pre-intervention period from January 1, 2015 to December 31, 2015. Using Poisson regression analysis, we evaluated antibiotic utilization of each agent, expressed as days of therapy (DOT) per 1,000 patient-days, between the two groups. Results The six most commonly used broad-spectrum antibiotic agents were included in the final analysis. During the intervention period, statistically significant reductions were seen in cefepime (131 vs. 101 DOT per 1,000 patient-days, P = 0.01), piperacillin-tazobactam (268 vs. 251 DOT per 1,000 patient-days, P = 0.02) and vancomycin (265 vs. 228 DOT per 1,000 patient-days, P = 0.01). The utilization of other antibiotics including daptomycin, linezolid, and meropenem did not differ significantly (Figure 1). Conclusion With this multidisciplinary intervention, we saw a decrease in the use of the most frequently administered broad-spectrum antibiotics. Our study shows that the implementation of an ID-CCM service is a feasible way to promote antibiotic stewardship in the ICU and can be used as a strategy to reduce unnecessary patient exposure to broad-spectrum agents. ![]()
Disclosures All Authors: No reported Disclosures.
Collapse
Affiliation(s)
| | | | - Victor Chen
- Montefiore Medical Center, Brooklyn, New York
| | - Gregory Weston
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | | | - Jay Berger
- Montefiore Medical Center, Brooklyn, New York
| | - Uzma N Sarwar
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| |
Collapse
|
39
|
Cowman K, Chen V, Saraiya N, Guo Y, Bartash R, Nori P. 1017. Scratching the Surface with NHSN Data: Defining High Impact Stewardship Targets in Critical Care. Open Forum Infect Dis 2019. [PMCID: PMC6811161 DOI: 10.1093/ofid/ofz360.881] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The National Healthcare Safety Network (NHSN) provides risk-adjusted Standardized Antimicrobial Administration Ratios (SAAR) as a benchmark for medical and surgical intensive care units (ICU). Antibiotic use (AU) data does not provide patient-level information (e.g., antibiotic appropriateness, indications, durations, etc.). However, we hypothesize that AU data can help define high impact stewardship targets, particularly in the context of critical care Clostridioides difficile rates.
Methods
Units with high rates of AU and hospital-onset (HO) C. difficile were selected for review. A monthly AU and C. difficile dashboard was created for ICU providers, inclusive of data from May 2018 onwards. We also performed chart audits for indication, duration, and location of initiation for all medical intensive care unit (MICU) patients receiving piperacillin/tazobactam (P/T) or vancomycin (Van) during February 2019 per request of ICU stakeholders. Data were used to obtain stewardship buy-in from local MICU champions.
Results
AU data indicated that (1) all 3 MICUs consistently had SAARs >1 for broad-spectrum categories and (2) Van and P/T were the highest volume agents on these units (Figure 1). Chart audit of 135 MICU patients showed that 17 patients received P/T, 34 Van, and 84 (62%) both agents; median duration was 2 days for Van and 3 days for P/T (Figure 2). Approximately half of initiations occurred in the emergency department (ED) (50% Van, 47% P/T); most common indications were “respiratory tract infection” and “severe sepsis/septic shock” for both P/T (77%) and Van (74%) (Figure 2). HO C. difficile in MICUs accounted for 6%, 13%, and 16% of total HO C. difficile cases in campuses A, B, and C, respectively during the time frame (Figure 1).
Conclusion
We feel that NHSN data scratches the surface of the deep-rooted challenges of ICU stewardship. However, it can identify AU trends and most frequently prescribed antibiotics in the context of unit-specific C. difficile rates. Intensive stewardship audit can further uncover areas for intervention, such as ED Van and P/T overprescribing. We suggest presenting clinical stakeholders with a quarterly “stewardship dashboard” combining AU rates, patient-level data, and C. difficile rates to maximize the impact of stewardship endeavors.
Disclosures
All authors: No reported disclosures.
Collapse
Affiliation(s)
| | - Victor Chen
- Montefiore Medical Center, New York, New York
| | | | - Yi Guo
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Rachel Bartash
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Priya Nori
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| |
Collapse
|
40
|
Begnoche B, Chen V, Saraiya N, Guo Y. 1983. Adherence vs. Non-adherence: Clinical Outcomes of an Antimicrobial Stewardship Directed Treatment Protocol for Clostridioides difficile Infection. Open Forum Infect Dis 2019. [PMCID: PMC6809338 DOI: 10.1093/ofid/ofz360.1663] [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] [Indexed: 11/13/2022] Open
Abstract
Background The 2018 Infectious Diseases Society of America (IDSA) C. difficile infection (CDI) treatment guideline no longer recommends metronidazole as first-line therapy in adults, instead recommending vancomycin or fidaxomicin. At our 1500-bed academic medical center, a new CDI treatment protocol was initiated by the antimicrobial stewardship program (ASP) to guide treatment based on disease severity and risk factors for recurrence. In this study, we compared the clinical cure rate and 30-day recurrence rate in patients who are adherent and non-adherent to our institutional CDI treatment protocol. Methods Patients with CDI between September-December 2018 were identified using electronic health record (EHR) reports. A retrospective chart review was conducted to collect the following information: baseline demographics, white blood cell count, CDI severity, and risk factors, etc. Outcome measures included clinical cure rate, 30-day recurrence rate, and global cure rate, stratified by whether treatment was adherent or non-adherent to institutional protocol. Student’s t-test was used for continuous variables. Fisher exact test or Chi-square test was used for categorical variables. Results A total of 188 patients (adherent group n = 100; non-adherent group n = 88) were included. Patient demographics and baseline risk factors did not differ between groups. Clinical cure rate was higher in adherent group (P < 0.05), while no significant differences were observed in recurrence and global cure rates between the two groups (Figure 1). The overall protocol adherence rate was 53%. The most common reasons for non-adherence are inappropriate vancomycin dose for fulminant CDI (69%) and insufficient duration of treatment (27%). Conclusion An ASP directed new CDI treatment protocol was successfully implemented at our institution. Patients treated according to our institutional protocol resulted in a higher overall cure rate than those non-adherent. Global cure and 30-day recurrence rates were similar. An overall protocol adherence rate of 53% is consistent with previously published literature. Future direction to develop an EHR order set with targeted recommendations is anticipated to further improve adherence and clinical outcomes. ![]()
Disclosures All authors: No reported disclosures.
Collapse
Affiliation(s)
| | | | | | - Yi Guo
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| |
Collapse
|
41
|
Gonzalez B, Zhang J, Han G, Zhang J, Dong J, Watson W, Sors T, Chen V, Jiang W. CryoVR: virtual reality training and outreach tools for cryo-EM. Acta Crystallogr A Found Adv 2019. [DOI: 10.1107/s0108767319099331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
42
|
Gershman B, Maroni P, Tilburt JC, Volk RJ, Konety B, Bennett CL, Kutikov A, Smaldone MC, Chen V, Kim SP. A national survey of radiation oncologists and urologists on prediction tools and nomograms for localized prostate cancer. World J Urol 2019; 37:2099-2108. [PMID: 30671637 DOI: 10.1007/s00345-019-02637-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 01/10/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Although prediction tools for prostate cancer (PCa) are essential for high-quality treatment decision-making, little is known about the degree of confidence in existing tools and whether they are used in clinical practice from radiation oncologists (RO) and urologists (URO). Herein, we performed a national survey of specialists about perceived attitudes and use of prediction tools. METHODS In 2017, we invited 940 URO and 911 RO in a national survey to query their confidence in and use of the D'Amico criteria, Kattan Nomogram, and CAPRA score. The statistical analysis involved bivariate association and multivariable logistic regression analyses to identify physician characteristics (age, gender, race, practice affiliation, specialty, access to robotic surgery, ownership of linear accelerator and number of prostate cancer per week) associated with survey responses and use of active surveillance (AS) for low-risk PCa. RESULTS Overall, 691 (37.3%) specialists completed the surveys. Two-thirds (range 65.6-68.4%) of respondents reported being "somewhat confident", but only a fifth selected "very confident" for each prediction tool (18.0-20.1%). 19.1% of specialists in the survey reported not using any prediction tools in clinical practice, which was higher amongst URO than RO (23.9 vs. 13.4%; p < 0.001). Respondents who reported not using prediction tools were also associated with low utilization of AS in their low-risk PCa patients (adjusted OR 2.47; p = 0.01). CONCLUSIONS While a majority of RO and URO view existing prediction tools for localized PCa with some degree of confidence, a fifth of specialists reported not using any such tools in clinical practice. Lack of using such tools was associated with low utilization of AS for low-risk PCa.
Collapse
Affiliation(s)
- Boris Gershman
- Department of Urology, Brown University, Providence, RI, USA
| | - Paul Maroni
- Division of Urology, University of Colorado, Denver, CO, USA
| | - Jon C Tilburt
- Biomedical Ethics Research Program, Division of General Internal Medicine, Department of Medicine and the Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Robert J Volk
- Division of Cancer Prevention and Population Sciences, Department of Health Services Research, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Badrinath Konety
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Charles L Bennett
- College of Pharmacy, University of South Carolina, Columbia, SC, USA
| | - Alexander Kutikov
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Marc C Smaldone
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Victor Chen
- Department of Urology , Loyola University Medical Center , Maywood, IL, USA
| | - Simon P Kim
- Division of Urology, University of Colorado, Denver, CO, USA.
- Division of Urology, University of Colorado Anschutz Medical Center, University of Colorado School of Medicine, 12631 E. 17th Avenue, M/S 319, Aurora, CO, 80045, USA.
| |
Collapse
|
43
|
Nguyen P, Makris A, Hennessy A, Jayanti S, Wang A, Park K, Chen V, Nguyen T, Lo S, Xuan W, Leung M, Badie T, Xu J, Kadappu K, Kachwalla H, Gibbs O, Faour A, Kee A, Rajaratnam R, Leung D, French J, Juergens C. Standard Versus Ultrasound-Guided Radial and Femoral Access (SURF) - A Randomised Controlled Trial. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
44
|
Nguyen P, Makris A, Hennessy A, Park K, Chen V, Jayanti S, Juergens C. Ultrasonic Assessment of Subclinical Radial Artery Stenosis After Transradial Angiography. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.706] [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: 10/26/2022]
|
45
|
Nguyen P, Makris A, Hennessy A, Jayanti S, Wang A, Park K, Chen V, Juergens C. Outcomes in Femoral Access Patients with Large Abdominal Circumference. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.660] [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]
|
46
|
Jia X, Jia L, Mo L, Yuan S, Zheng X, He J, Chen V, Guo Q, Zheng L, Yuan Q, Xu X, Zhou X. Berberine Ameliorates Periodontal Bone Loss by Regulating Gut Microbiota. J Dent Res 2018; 98:107-116. [PMID: 30199654 DOI: 10.1177/0022034518797275] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Postmenopausal osteoporosis (PMO) is a risk factor for periodontitis, and current therapeutics against PMO prevent the aggravated alveolar bone loss of periodontitis in estrogen-deficient women. Gut microbiota is recognized as a promising therapeutic target for PMO. Berberine extracted from Chinese medicinal plants has shown its effectiveness in the treatment of metabolic diseases such as obesity and diabetes via regulating gut microbiota. Here, we hypothesize that berberine ameliorates periodontal bone loss by improving the intestinal barriers by regulating gut microbiota under an estrogen-deficient condition. Experimental periodontitis was established in ovariectomized (OVX) rats, and the OVX-periodontitis rats were treated with berberine for 7 wk before sacrifice for analyses. Micro–computed tomography and histologic analyses showed that berberine treatment significantly reduced alveolar bone loss and improved bone metabolism of OVX-periodontitis rats as compared with the vehicle-treated OVX-periodontitis rats. In parallel, berberine-treated OVX-periodontitis rats harbored a higher abundance of butyrate-producing gut microbiota with elevated butyrate generation, as demonstrated by 16S rRNA sequencing and high-performance liquid chromatography analysis. Berberine-treated OVX-periodontitis rats consistently showed improved intestinal barrier integrity and decreased intestinal paracellular permeability with a lower level of serum endotoxin. In parallel, IL-17A-related immune responses were attenuated in berberine-treated OVX-periodontitis rats with a lower serum level of proinflammatory cytokines and reduced IL-17A+ cells in alveolar bone as compared with vehicle-treated OVX-periodontitis rats. Our data indicate that gut microbiota is a potential target for the treatment of estrogen deficiency–aggravated periodontal bone loss, and berberine represents a promising adjuvant therapeutic by modulating gut microbiota.
Collapse
Affiliation(s)
- X. Jia
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - L. Jia
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - L. Mo
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - S. Yuan
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - X. Zheng
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - J. He
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - V. Chen
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Columbia University, New York, NY, USA
| | - Q. Guo
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - L. Zheng
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Q. Yuan
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Dental Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - X. Xu
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - X. Zhou
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| |
Collapse
|
47
|
Lyu J, Wen X, Kumar U, You Y, Chen V, Joshi RK. Separation and purification using GO and r-GO membranes. RSC Adv 2018; 8:23130-23151. [PMID: 35540136 PMCID: PMC9081616 DOI: 10.1039/c8ra03156h] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [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: 04/13/2018] [Accepted: 06/14/2018] [Indexed: 11/28/2022] Open
Abstract
Many materials with varied characteristics have been used for water purification and separation applications. Recently discovered graphene oxide (GO), a two-dimensional derivative of graphene has been considered as a promising membrane material for water purification due to its excellent hydrophilicity, high water permeability, and excellent ionic/molecular separation properties. This review is focussed on the possible versatile applicability of GO membranes. It is also known that selective reduction of GO results in membranes with a pore size of ∼0.35 nm, ideally suited for desalination applications. This article presents the applicability of graphene-based membranes for multiple separation applications. This is indeed the first review article outlining a comparison of GO and r-GO membranes and discussing the suitability for applications based on the porosity of the membranes. This review article outlines a comparison of GO and r-GO membranes for separation and purification applications.![]()
Collapse
Affiliation(s)
- J. Lyu
- SMaRT Centre
- School of Materials Science and Engineering
- University of New South Wales
- Sydney
- Australia
| | - X. Wen
- SMaRT Centre
- School of Materials Science and Engineering
- University of New South Wales
- Sydney
- Australia
| | - U. Kumar
- SMaRT Centre
- School of Materials Science and Engineering
- University of New South Wales
- Sydney
- Australia
| | - Y. You
- SMaRT Centre
- School of Materials Science and Engineering
- University of New South Wales
- Sydney
- Australia
| | - V. Chen
- School of Chemical Engineering
- University of New South Wales
- Sydney
- Australia
| | - R. K. Joshi
- SMaRT Centre
- School of Materials Science and Engineering
- University of New South Wales
- Sydney
- Australia
| |
Collapse
|
48
|
Costello CM, Phillipsen MB, Hartmanis LM, Kwasnica MA, Chen V, Hackam D, Chang MW, Bentley WE, March JC. Microscale Bioreactors for in situ characterization of GI epithelial cell physiology. Sci Rep 2017; 7:12515. [PMID: 28970586 PMCID: PMC5624909 DOI: 10.1038/s41598-017-12984-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [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: 02/07/2017] [Accepted: 09/14/2017] [Indexed: 02/08/2023] Open
Abstract
The development of in vitro artificial small intestines that realistically mimic in vivo systems will enable vast improvement of our understanding of the human gut and its impact on human health. Synthetic in vitro models can control specific parameters, including (but not limited to) cell types, fluid flow, nutrient profiles and gaseous exchange. They are also “open” systems, enabling access to chemical and physiological information. In this work, we demonstrate the importance of gut surface topography and fluid flow dynamics which are shown to impact epithelial cell growth, proliferation and intestinal cell function. We have constructed a small intestinal bioreactor using 3-D printing and polymeric scaffolds that mimic the 3-D topography of the intestine and its fluid flow. Our results indicate that TEER measurements, which are typically high in static 2-D Transwell apparatuses, is lower in the presence of liquid sheer and 3-D topography compared to a flat scaffold and static conditions. There was also increased cell proliferation and discovered localized regions of elevated apoptosis, specifically at the tips of the villi, where there is highest sheer. Similarly, glucose was actively transported (as opposed to passive) and at higher rates under flow.
Collapse
Affiliation(s)
- Cait M Costello
- Department of Biological and Environmental Engineering, Cornell University, Ithaca, USA
| | - Mikkel B Phillipsen
- Department of Biological and Environmental Engineering, Cornell University, Ithaca, USA
| | - Leonard M Hartmanis
- Department of Biological and Environmental Engineering, Cornell University, Ithaca, USA
| | - Marek A Kwasnica
- Department of Biological and Environmental Engineering, Cornell University, Ithaca, USA
| | - Victor Chen
- Department of Biological and Environmental Engineering, Cornell University, Ithaca, USA
| | - David Hackam
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University, Baltimore, USA
| | - Matthew W Chang
- Department of Biochemistry, Yong Loo Lin School of Medicine, NUS, Singapore, Singapore
| | - William E Bentley
- Institute for Biomedical Devices, University of Maryland, Maryland, USA
| | - John C March
- Department of Biological and Environmental Engineering, Cornell University, Ithaca, USA.
| |
Collapse
|
49
|
Reid M, Lomas-Francis C, Daniels G, Chen V, Shen J, Ho Y, Hare V, Batts R, Yacob M, Smart E, Green C. Expression of the Erythrocyte
Antigen Henshaw (He; MNS6):
Serological and
Immunochemical Studies. Vox Sang 2017. [DOI: 10.1159/000462924] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
50
|
Singh A, Shannon C, Assadian S, Toma M, Chen V, Dai L, Lam K, Hollander Z, Ng R, Tebbutt S, McManus B. Multi-Omic Biomarker Signatures Are Predictive of 9-Month Patient Outcomes in Subjects with Advanced Heart Failure. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|