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Moskowitzova K, Naus AE, Kycia I, Dang TT, Shroff YV, Bletsas E, Mullin K, Zurakowski D, Fauza DO. Comparative Effects on Fetal Hematopoiesis and Placental Inflammation From Mesenchymal and Hematopoietic Stem Cells as Agents of Transamniotic Stem Cell Therapy (TRASCET) in a Syngeneic Model of Intrauterine Growth Restriction. J Pediatr Surg 2024:S0022-3468(24)00162-3. [PMID: 38575446 DOI: 10.1016/j.jpedsurg.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/01/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE We compared transamniotic stem cell therapy (TRASCET) using either mesenchymal (MSCs) or hematopoietic (HSCs) stem cells on fetal hematopoiesis in a syngeneic model of intrauterine growth restriction (IUGR). METHODS Lewis dams exposed to cycling hypoxia (10.5% O2) in late gestation had their fetuses (n = 83) either receiving no intervention (untreated; n = 9), or intra-amniotic injections of either HSCs (HSC; n = 34), MSCs primed to an enhanced anti-inflammatory phenotype (primed-MSC; n = 28), or saline (sham; n = 12). Normal controls (n = 18) were also studied. Complete peripheral blood counts and placental ELISA for inflammation and angiogenesis markers were performed at term. RESULTS Overall survival from hypoxia was 41% (34/83). Red blood count (RBC), hematocrit (Hct) and hemoglobin levels (Hb) were all significantly decreased from normal in all hypoxia groups. TRASCET with primed-MSC had significantly higher RBC, Hct, and Hb levels than sham (p = 0.01-0.03, pairwise), though not than untreated (which had no surgical blood loss). The HSC group had only significantly higher Hb levels than sham (p = 0.005). TRASCET with primed-MSC had significantly lower levels of placental TNF-α than sham (p = 0.04), but not untreated. CONCLUSIONS MCSs seem more effective than HSCs in enhancing hematopoiesis when used as donor cells for TRASCET in a syngeneic model of IUGR. LEVEL OF EVIDENCE N/A (animal and laboratory study).
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Affiliation(s)
- Kamila Moskowitzova
- Department of Surgery, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Abbie E Naus
- Department of Surgery, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Ina Kycia
- Department of Surgery, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Tanya T Dang
- Department of Surgery, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Yash V Shroff
- Department of Surgery, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Emilia Bletsas
- Department of Surgery, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Kaitlin Mullin
- Department of Surgery, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - David Zurakowski
- Department of Surgery, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Dario O Fauza
- Department of Surgery, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, USA.
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Ilkhani S, Naus AE, Pinkes N, Rafaqat W, Grobman B, Valverde MD, Sanchez SE, Hwabejire JO, Ranganathan K, Scott JW, Herrera-Escobar JP, Salim A, Anderson GA. The Invisible Scars: Unseen Financial Complications Worsen Every Aspect of Long-Term Health in Trauma Survivors. J Trauma Acute Care Surg 2024:01586154-990000000-00616. [PMID: 38227675 DOI: 10.1097/ta.0000000000004247] [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: 01/18/2024]
Abstract
INTRODUCTION Trauma survivors are susceptible to experiencing financial toxicity (FT). Studies have shown the negative impact of FT on chronic illness outcomes. However, there is a notable lack of data on FT in the context of trauma. We aimed to better understand prevalence, risk factors, and impact of FT on trauma long-term outcomes. METHODS Adult trauma patients with an Injury severity score (ISS) ≥9 treated at level-1 trauma centers were interviewed 6-14 months after discharge. FT was considered positive if patients reported any of the following due to the injury: income loss, lack of care, newly applied/qualified for governmental assistance, new financial problems, or work loss. The Impact of FT on Patient Reported Outcome Measure Index System (PROMIS) health domains was investigated. RESULTS Of 577 total patients, 44% (254/567) suffered some form of FT. In the adjusted model, older age (OR 0.4 [95% CI: 0.2 - 0.81]) and stronger social support networks (OR 0.44 [ 95% CI: 0.26 - 0.74]) were protective against FT. In contrast, having two or more comorbidities (OR 1.81 [1.01 - 3.28), lower education levels (OR = 1.95, [CI 95%: 1.26 - 3.03]), and injury mechanisms, including road accidents (OR 2.69 [1.51 -4.77]) and intentional injuries (OR 4.31 [1.44 -12.86]) were associated with higher toxicity. No significant relationship was found with ISS, sex, or single-family household. Patients with FT had worse outcomes across all domains of health. There was a negative linear relationship between the severity of FT and worse mental and physical health scores. CONCLUSION FT is associated with long-term outcomes. Incorporating FT risk assessment into recovery care planning may help to identify patients most in need of mitigative interventions across the trauma care continuum to improve trauma recovery. Further investigations to better understand, define, and address FT in trauma care are warranted. LEVEL OF EVIDENCE Prognostic cohort study, level III.
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Affiliation(s)
- Saba Ilkhani
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Abbie E Naus
- Beth Israel Lahey Health, Lahey Hospital and Medical Center, Burlington, MA
| | - Nathaniel Pinkes
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Wardah Rafaqat
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ben Grobman
- School of Medicine, Harvard Medical School, Boston, MA
| | | | - Sabrina E Sanchez
- Division of Trauma, Acute Care Surgery & Surgical Critical Care, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - John O Hwabejire
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - John W Scott
- Department of Surgery, University of Washington, Harborview Medical Center. Seattle, WA
| | | | - Ali Salim
- Division of Trauma, Burn, and Surgical Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Zaigham M, Bryce-Alberti M, Campos LN, Forbes C, Naus AE, Pigeolet M, Hill SK, Sana H, Ehsan AN, Samad L, Uribe-Leitz T, McClain CD, Juran S. Protecting pregnant women from climate disasters: Strategies in the aftermath of Pakistan's devastating flood. Int J Gynaecol Obstet 2023; 163:348-351. [PMID: 37272595 DOI: 10.1002/ijgo.14896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 05/07/2023] [Accepted: 05/15/2023] [Indexed: 06/06/2023]
Abstract
SynopsisSudden‐onset climate events can have a significant impact on maternal health care systems, particularly in low‐ and middle‐income countries where resources are limited. We outline strategic policies that can help anticipate and plan for such disasters and help minimize negative maternal outcomes.
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Affiliation(s)
- Mehreen Zaigham
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Obstetrics and Gynecology Institution of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mayte Bryce-Alberti
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Letícia Nunes Campos
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Faculty of Medical Science, Universidade de Pernambuco, Recife, Prince Edward Island, Brazil
| | - Callum Forbes
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
| | - Abbie E Naus
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Manon Pigeolet
- Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Sarah K Hill
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Hamaiyal Sana
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Bolan Medical Complex Hospital, Quetta, Pakistan
| | - Anam N Ehsan
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Lubna Samad
- Center for Essential Surgical and Acute Care, IRD Global, Karachi, Pakistan
| | - Tarsicio Uribe-Leitz
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Department of Plastic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
- Epidemiology, Department of Sport and Health Sciences, Technical University Munich, Munich, Germany
| | - Craig D McClain
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Sabrina Juran
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
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Zaigham M, Bryce-Alberti M, Calderon C, Campos LN, Raguveer V, Nuss S, Dutta R, Naus AE, Forbes C, Park KB, McClain CD. The time to act is now: a call to action on planetary health and sustainable surgical systems. Lancet Planet Health 2022; 6:e931-e932. [PMID: 36370731 DOI: 10.1016/s2542-5196(22)00261-3] [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: 10/11/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Mehreen Zaigham
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA; Obstetrics and Gynecology Institution of Clinical Sciences Lund, Lund University, Lund, Sweden.
| | - Mayte Bryce-Alberti
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA; Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Chrystal Calderon
- Faculty of Medical Sciences, University of the West Indies, St Augustine, Trinidad and Tobago
| | - Letícia Nunes Campos
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA; Faculty of Medical Sciences, Universidade de Pernambuco, Recife, Brazil
| | - Vanitha Raguveer
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA; University of Illinois College of Medicine, Chicago, IL, USA
| | - Sarah Nuss
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA; Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Rohini Dutta
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA; Mary Horigan Connor's Centre for Gender and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA
| | - Abbie E Naus
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA; Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Callum Forbes
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA; University of Global Health Equity, Kigali, Rwanda
| | - Kee B Park
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA
| | - Craig D McClain
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA; Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
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