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Akhtar W, Baston VR, Berman M, Bhagra S, Chue C, Deakin CD, Dalzell JR, Dunning J, Dunning J, Gardner RS, Kiff K, Kore S, Lim S, MacGowan G, Naldrett I, Ostermann M, Pinto S, Pettit S, Gil FR, Rosenberg A, Rubino A, Sayeed R, Sequeira J, Swanson N, Tsui S, Walker C, Webb S, Woods A, Ventkateswaran R, Bowles CT. British societies guideline on the management of emergencies in implantable left ventricular assist device recipients in transplant centres. Intensive Care Med 2024; 50:493-501. [PMID: 38526578 PMCID: PMC11018667 DOI: 10.1007/s00134-024-07382-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 02/29/2024] [Indexed: 03/26/2024]
Abstract
An implantable left ventricular assist device (LVAD) is indicated as a bridge to transplantation or recovery in the United Kingdom (UK). The mechanism of action of the LVAD results in a unique state of haemodynamic stability with diminished arterial pulsatility. The clinical assessment of an LVAD recipient can be challenging because non-invasive blood pressure, pulse and oxygen saturation measurements may be hard to obtain. As a result of this unusual situation and complex interplay between the device and the native circulation, resuscitation of LVAD recipients requires bespoke guidelines. Through collaboration with key UK stakeholders, we assessed the current evidence base and developed guidelines for the recognition of clinical deterioration, inadequate circulation and time-critical interventions. Such guidelines, intended for use in transplant centres, are designed to be deployed by those providing immediate care of LVAD patients under conditions of precipitous clinical deterioration. In summary, the Joint British Societies and Transplant Centres LVAD Working Group present the UK guideline on management of emergencies in implantable LVAD recipients for use in advanced heart failure centres. These recommendations have been made with a UK resuscitation focus but are widely applicable to professionals regularly managing patients with implantable LVADs.
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Affiliation(s)
- Waqas Akhtar
- Harefield Hospital, London, UK.
- Faculty of Intensive Care Medicine, London, UK.
| | | | | | | | - Colin Chue
- University Hospitals Birmingham, Birmingham, UK
| | | | | | - Joel Dunning
- Cardiac Advanced Resuscitation Education, Festus, MO, USA
| | | | - Roy S Gardner
- Golden Jubilee National Hospital, Glasgow, UK
- British Society of Heart Failure, London, UK
| | | | | | - Sern Lim
- University Hospitals Birmingham, Birmingham, UK
| | | | - Ian Naldrett
- British Association of Critical Care Nurses, Newcastle, UK
| | | | | | | | | | | | | | - Rana Sayeed
- Society for Cardiothoracic Surgery in Great Britain & Ireland, London, UK
| | | | | | - Steven Tsui
- Society for Cardiothoracic Surgery in Great Britain & Ireland, London, UK
| | | | | | | | - Rajamiyer Ventkateswaran
- Wythenshawe Hospital, Manchester, UK
- Society for Cardiothoracic Surgery in Great Britain & Ireland, London, UK
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2
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Rinkenberger N, Rosenberg A, Radke JB, Bhushan J, Tomita T, Weiss LM, Sibley LD. Susceptibility of Toxoplasma gondii to autophagy in human cells relies on multiple interacting parasite loci. mBio 2024; 15:e0259523. [PMID: 38095418 PMCID: PMC10790690 DOI: 10.1128/mbio.02595-23] [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: 09/22/2023] [Accepted: 11/06/2023] [Indexed: 01/04/2024] Open
Abstract
IMPORTANCE Autophagy is a process used by cells to recycle organelles and macromolecules and to eliminate intracellular pathogens. Previous studies have shown that some stains of Toxoplasma gondii are resistant to autophagy-dependent growth restriction, while others are highly susceptible. Although it is known that autophagy-mediated control requires activation by interferon gamma, the basis for why parasite strains differ in their susceptibility is unknown. Our findings indicate that susceptibility involves at least five unlinked parasite genes on different chromosomes, including several secretory proteins targeted to the parasite-containing vacuole and exposed to the host cell cytosol. Our findings reveal that susceptibility to autophagy-mediated growth restriction relies on differential recognition of parasite proteins exposed at the host-pathogen interface, thus identifying a new mechanism for cell-autonomous control of intracellular pathogens.
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Affiliation(s)
- Nicholas Rinkenberger
- Department of Molecular Microbiology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Alex Rosenberg
- Department of Molecular Microbiology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Joshua B. Radke
- Department of Molecular Microbiology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Jaya Bhushan
- Department of Molecular Microbiology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Tadakimi Tomita
- Department of Pathology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Louis M. Weiss
- Department of Pathology, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - L. David Sibley
- Department of Molecular Microbiology, Washington University School of Medicine, St Louis, Missouri, USA
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Henry B, Sibley LD, Rosenberg A. A Combination of Four Nuclear Targeted Effectors Protects Toxoplasma Against Interferon Gamma Driven Human Host Cell Death During Acute Infection. bioRxiv 2023:2023.12.24.573224. [PMID: 38234811 PMCID: PMC10793417 DOI: 10.1101/2023.12.24.573224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
In both mice and humans, Type II interferon-gamma (IFNγ) is crucial for regulation of Toxoplasma gondii (T. gondii) infection, during acute or chronic phases. To thwart this defense, T. gondii secretes protein effectors hindering the hosťs immune response. For example, T. gondii relies on the MYR translocon complex to deploy soluble dense granule effectors (GRAs) into the host cell cytosol or nucleus. Recent genome-wide loss-of-function screens in IFNγ-primed primary human fibroblasts identified MYR translocon components as crucial for parasite resistance against IFNγ driven vacuole clearance. However, these screens did not pinpoint specific MYR-dependent GRA proteins responsible for IFNγ signaling blockade, suggesting potential functional redundancy. Our study reveals that T. gondii depends on the MYR translocon complex to prevent host cell death and parasite premature egress in human cells stimulated with IFNγ postinfection, a unique phenotype observed in various human cell lines but not in murine cells. Intriguingly, inhibiting parasite egress did not prevent host cell death, indicating this mechanism is distinct from those described previously. Genome-wide loss-of-function screens uncovered TgIST, GRA16, GRA24, and GRA28 as effectors necessary for a complete block of IFNγ response. GRA24 and GRA28 directly influenced IFNγ driven transcription, GRA24's action depended on its interaction with p38 MAPK, while GRA28 disrupted histone acetyltransferase activity of CBP/p300. Given the intricate nature of the immune response to T. gondii, it appears that the parasite has evolved equally elaborate mechanisms to subvert IFNγ signaling, extending beyond direct interference with the JAK/STAT1 pathway, to encompass other signaling pathways as well.
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Affiliation(s)
- Brittany Henry
- Department of Infectious Diseases, Center for Tropical and Emerging Infectious Diseases, University of Georgia, Athens, Georgia, USA
| | - L. David Sibley
- Department of Molecular Microbiology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Alex Rosenberg
- Department of Infectious Diseases, Center for Tropical and Emerging Infectious Diseases, University of Georgia, Athens, Georgia, USA
- Department of Molecular Microbiology, Washington University School of Medicine, St Louis, Missouri, USA
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Yusuff H, Chawla S, Sato R, Dugar S, Bangash MN, Antonini MV, Shelley B, Valchanov K, Roscoe A, Scott J, Akhtar W, Rosenberg A, Dimarakis I, Khorsandi M, Zochios V. Mechanisms of Acute Right Ventricular Injury in Cardiothoracic Surgical and Critical Care Settings: Part 2. J Cardiothorac Vasc Anesth 2023; 37:2318-2326. [PMID: 37625918 DOI: 10.1053/j.jvca.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 07/05/2023] [Accepted: 07/17/2023] [Indexed: 08/27/2023]
Abstract
The right ventricle (RV) is intricately linked in the clinical presentation of critical illness; however, the basis of this is not well-understood and has not been studied as extensively as the left ventricle. There has been an increased awareness of the need to understand how the RV is affected in different critical illness states. In addition, the increased use of point-of-care echocardiography in the critical care setting has allowed for earlier identification and monitoring of the RV in a patient who is critically ill. The first part of this review describes and characterizes the RV in different perioperative states. This second part of the review discusses and analyzes the complex pathophysiologic relationships between the RV and different critical care states. There is a lack of a universal RV injury definition because it represents a range of abnormal RV biomechanics and phenotypes. The term "RV injury" (RVI) has been used to describe a spectrum of presentations, which includes diastolic dysfunction (early injury), when the RV retains the ability to compensate, to RV failure (late or advanced injury). Understanding the mechanisms leading to functional 'uncoupling' between the RV and the pulmonary circulation may enable perioperative physicians, intensivists, and researchers to identify clinical phenotypes of RVI. This, consequently, may provide the opportunity to test RV-centric hypotheses and potentially individualize therapies.
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Affiliation(s)
- Hakeem Yusuff
- Department of Cardiothoracic Critical Care Medicine and ECMO Unit, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom.
| | - Sanchit Chawla
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Ryota Sato
- Division of Critical Care Medicine, Department of Medicine, The Queen's Medical Center, Honolulu, HI
| | - Siddharth Dugar
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH; Cleveland Clinic Lerner College of Medicine, Case Western University Reserve University, Cleveland, OH
| | - Mansoor N Bangash
- Liver Intensive Care Unit, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham, United Kingdom; Birmingham Liver Failure Research Group, Institute of Inflammation and Ageing, College of Medical and Dental sciences, University of Birmingham, Birmingham, United Kingdom; Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, College of Medical and Dental sciences, University of Birmingham, Birmingham, United Kingdom
| | - Marta Velia Antonini
- Anesthesia and Intensive Care Unit, Bufalini Hospital, AUSL della Romagna, Cesena, Italy; Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy
| | - Benjamin Shelley
- Department of Cardiothoracic Anesthesia and Intensive Care, Golden Jubilee National Hospital, Clydebank, United Kingdom; Anesthesia, Perioperative Medicine and Critical Care research group, University of Glasgow, Glasgow, United Kingdom
| | - Kamen Valchanov
- Department of Anesthesia and Perioperative Medicine, Singapore General Hospital, Outram Road, Singapore
| | - Andrew Roscoe
- Department of Anesthesia and Perioperative Medicine, Singapore General Hospital, Outram Road, Singapore; Department of Anesthesiology, Singapore General Hospital, National Heart Centre Singapore, Singapore
| | - Jeffrey Scott
- Jackson Health System / Miami Transplant Institute, Miami, FL
| | - Waqas Akhtar
- Royal Brompton and Harefield Hospitals, Part of Guys and St. Thomas's National Health System Foundation Trust, London, United Kingdom
| | - Alex Rosenberg
- Royal Brompton and Harefield Hospitals, Part of Guys and St. Thomas's National Health System Foundation Trust, London, United Kingdom
| | - Ioannis Dimarakis
- Division of Cardiothoracic Surgery, University of Washington Medical Center, Seattle, WA
| | - Maziar Khorsandi
- Division of Cardiothoracic Surgery, University of Washington Medical Center, Seattle, WA
| | - Vasileios Zochios
- Department of Cardiothoracic Critical Care Medicine and ECMO Unit, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
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Zochios V, Shelley B, Antonini MV, Chawla S, Sato R, Dugar S, Valchanov K, Roscoe A, Scott J, Bangash MN, Akhtar W, Rosenberg A, Dimarakis I, Khorsandi M, Yusuff H. Mechanisms of Acute Right Ventricular Injury in Cardiothoracic Surgical and Critical Care Settings: Part 1. J Cardiothorac Vasc Anesth 2023; 37:2073-2086. [PMID: 37393133 DOI: 10.1053/j.jvca.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 05/21/2023] [Accepted: 06/07/2023] [Indexed: 07/03/2023]
Affiliation(s)
- Vasileios Zochios
- Department of Cardiothoracic Critical Care Medicine and ECMO Unit, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom.
| | - Benjamin Shelley
- Department of Cardiothoracic Anesthesia and Intensive Care, Golden Jubilee National Hospital, Clydebank, United Kingdom; Anesthesia, Perioperative Medicine and Critical Care research group, University of Glasgow, Glasgow, United Kingdom
| | - Marta Velia Antonini
- Anesthesia and Intensive Care Unit, Bufalini Hospital, AUSL della Romagna, Cesena, Italy; Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy
| | - Sanchit Chawla
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Ryota Sato
- Division of Critical Care Medicine, Department of Medicine, The Queen's Medical Center, Honolulu, HI
| | - Siddharth Dugar
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH; Cleveland Clinic Lerner College of Medicine, Case Western University Reserve University, Cleveland, OH
| | - Kamen Valchanov
- Department of Anesthesia and Perioperative Medicine, Singapore General Hospital, Singapore
| | - Andrew Roscoe
- Department of Anesthesia and Perioperative Medicine, Singapore General Hospital, Singapore; Department of Anesthesiology, Singapore General Hospital, National Heart Center, Singapore
| | - Jeffrey Scott
- Jackson Health System, Miami Transplant Institute, Miami, FL
| | - Mansoor N Bangash
- Liver Intensive Care Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom; Birmingham Liver Failure Research Group, Institute of Inflammation and Ageing, College of Medical and Dental sciences, University of Birmingham, Birmingham, United Kingdom; Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, College of Medical and Dental sciences, University of Birmingham, Birmingham, United Kingdom
| | - Waqas Akhtar
- Royal Brompton and Harefield Hospitals, Part of Guys and St. Thomas's National Health System Foundation Trust, London, United Kingdom
| | - Alex Rosenberg
- Royal Brompton and Harefield Hospitals, Part of Guys and St. Thomas's National Health System Foundation Trust, London, United Kingdom
| | - Ioannis Dimarakis
- Division of Cardiothoracic Surgery, University of Washington Medical Center, Seattle, WA
| | - Maziar Khorsandi
- Division of Cardiothoracic Surgery, University of Washington Medical Center, Seattle, WA
| | - Hakeem Yusuff
- Department of Cardiothoracic Critical Care Medicine and ECMO Unit, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
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Paul N, Grunow JJ, Rosenthal M, Spies CD, Page VJ, Hanison J, Patel B, Rosenberg A, von Haken R, Pietsch U, Schrag C, Waydhas C, Schellongowski P, Lobmeyr E, Sander M, Piper SK, Conway D, Totzeck A, Weiss B. Enhancing European Management of Analgesia, Sedation, and Delirium: A Multinational, Prospective, Interventional Before-After Trial. Neurocrit Care 2023:10.1007/s12028-023-01837-8. [PMID: 37697129 DOI: 10.1007/s12028-023-01837-8] [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: 05/10/2023] [Accepted: 08/08/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND The objective of this study was to analyze the impact of a structured educational intervention on the implementation of guideline-recommended pain, agitation, and delirium (PAD) assessment. METHODS This was a prospective, multinational, interventional before-after trial conducted at 12 intensive care units from 10 centers in Germany, Austria, Switzerland, and the UK. Intensive care units underwent a 6-week structured educational program, comprising online lectures, instructional videos, educational handouts, and bedside teaching. Patient-level PAD assessment data were collected in three 1-day point-prevalence assessments before (T1), 6 weeks after (T2), and 1 year after (T3) the educational program. RESULTS A total of 430 patients were included. The rate of patients who received all three PAD assessments changed from 55% (107/195) at T1 to 53% (68/129) at T2, but increased to 73% (77/106) at T3 (p = 0.003). The delirium screening rate increased from 64% (124/195) at T1 to 65% (84/129) at T2 and 77% (82/106) at T3 (p = 0.041). The pain assessment rate increased from 87% (170/195) at T1 to 92% (119/129) at T2 and 98% (104/106) at T3 (p = 0.005). The rate of sedation assessment showed no signficiant change. The proportion of patients who received nonpharmacological delirium prevention measures increased from 58% (114/195) at T1 to 80% (103/129) at T2 and 91% (96/106) at T3 (p < 0.001). Multivariable regression revealed that at T3, patients were more likely to receive a delirium assessment (odds ratio [OR] 2.138, 95% confidence interval [CI] 1.206-3.790; p = 0.009), sedation assessment (OR 4.131, 95% CI 1.372-12.438; p = 0.012), or all three PAD assessments (OR 2.295, 95% CI 1.349-3.903; p = 0.002) compared with T1. CONCLUSIONS In routine care, many patients were not assessed for PAD. Assessment rates increased significantly 1 year after the intervention. Clinical trial registration ClinicalTrials.gov: NCT03553719.
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Affiliation(s)
- Nicolas Paul
- Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Julius J Grunow
- Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Max Rosenthal
- Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Claudia D Spies
- Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Valerie J Page
- Department of Anaesthesia, Watford General Hospital, Watford, Hertfordshire, UK
| | - James Hanison
- Manchester Royal Infirmary, Manchester University National Health Service Foundation Trust, Manchester, UK
| | - Brijesh Patel
- Division of Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, London, UK
| | - Alex Rosenberg
- Royal Brompton and Harefield National Health Service Foundation Trust, London, UK
| | - Rebecca von Haken
- Department of Anesthesiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Urs Pietsch
- Department of Anesthesiology and Intensive Care Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Claudia Schrag
- Clinic of Intensive Care Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Christian Waydhas
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
- Medical Faculty, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | | | - Elisabeth Lobmeyr
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Michael Sander
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Giessen, UKGM, Justus-Liebig University Giessen, Giessen, Germany
| | - Sophie K Piper
- Berlin Institute of Health, Berlin, Germany
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Daniel Conway
- Manchester Royal Infirmary, Manchester University National Health Service Foundation Trust, Manchester, UK
| | - Andreas Totzeck
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Essen, Germany
| | - Björn Weiss
- Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
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7
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Kongsomboonvech AK, García-López L, Njume F, Rodriguez F, Souza SP, Rosenberg A, Jensen KDC. Variation in CD8 T cell IFNγ differentiation to strains of Toxoplasma gondii is characterized by small effect QTLs with contribution from ROP16. Front Cell Infect Microbiol 2023; 13:1130965. [PMID: 37287466 PMCID: PMC10242045 DOI: 10.3389/fcimb.2023.1130965] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 04/17/2023] [Indexed: 06/09/2023] Open
Abstract
Introduction Toxoplasma gondii induces a strong CD8 T cell response characterized by the secretion of IFNγ that promotes host survival during infection. The initiation of CD8 T cell IFNγ responses in vitro differs widely between clonal lineage strains of T. gondii, in which type I strains are low inducers, while types II and III strains are high inducers. We hypothesized this phenotype is due to a polymorphic "Regulator Of CD8 T cell Response" (ROCTR). Methods Therefore, we screened F1 progeny from genetic crosses between the clonal lineage strains to identify ROCTR. Naïve antigen-specific CD8 T cells (T57) isolated from transnuclear mice, which are specific for the endogenous and vacuolar TGD057 antigen, were measured for their ability to become activated, transcribe Ifng and produce IFNγ in response to T. gondii infected macrophages. Results Genetic mapping returned four non-interacting quantitative trait loci (QTL) with small effect on T. gondii chromosomes (chr) VIIb-VIII, X and XII. These loci encompass multiple gene candidates highlighted by ROP16 (chrVIIb-VIII), GRA35 (chrX), TgNSM (chrX), and a pair of uncharacterized NTPases (chrXII), whose locus we report to be significantly truncated in the type I RH background. Although none of the chromosome X and XII candidates bore evidence for regulating CD8 T cell IFNγ responses, type I variants of ROP16 lowered Ifng transcription early after T cell activation. During our search for ROCTR, we also noted the parasitophorous vacuole membrane (PVM) targeting factor for dense granules (GRAs), GRA43, repressed the response suggesting PVM-associated GRAs are important for CD8 T cell activation. Furthermore, RIPK3 expression in macrophages was an absolute requirement for CD8 T cell IFNγ differentiation implicating the necroptosis pathway in T cell immunity to T. gondii. Discussion Collectively, our data suggest that while CD8 T cell IFNγ production to T. gondii strains vary dramatically, it is not controlled by a single polymorphism with strong effect. However, early in the differentiation process, polymorphisms in ROP16 can regulate commitment of responding CD8 T cells to IFNγ production which may have bearing on immunity to T. gondii.
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Affiliation(s)
- Angel K. Kongsomboonvech
- Department of Molecular and Cell Biology, University of California, Merced, Merced, CA, United States
- Quantitative Systems Biology Graduate Program, University of California, Merced, Merced, CA, United States
| | - Laura García-López
- Department of Molecular and Cell Biology, University of California, Merced, Merced, CA, United States
- Quantitative Systems Biology Graduate Program, University of California, Merced, Merced, CA, United States
| | - Ferdinand Njume
- Department of Molecular and Cell Biology, University of California, Merced, Merced, CA, United States
| | - Felipe Rodriguez
- Department of Molecular and Cell Biology, University of California, Merced, Merced, CA, United States
| | - Scott P. Souza
- Department of Molecular and Cell Biology, University of California, Merced, Merced, CA, United States
- Quantitative Systems Biology Graduate Program, University of California, Merced, Merced, CA, United States
| | - Alex Rosenberg
- The Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, GA, United States
| | - Kirk D. C. Jensen
- Department of Molecular and Cell Biology, University of California, Merced, Merced, CA, United States
- Health Sciences Research Institute, University of California, Merced, Merced, CA, United States
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8
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Cvetkovic M, Antonini MV, Rosenberg A, Meadows CI, Dąbrowski M, Puslecki M, Fawzy Hassan I, Fowles JA, O'Callaghan M, Stefaniak S, Riera J, Barrett NA, Bělohlávek J, Di Nardo M, Hoskote A, Swol J. "Bridging the Gap" international ECLS training and simulation - evaluation of the 10th educational corner on EuroELSO congress 2022 in London, United Kingdom. Perfusion 2023; 38:3-12. [PMID: 37078917 DOI: 10.1177/02676591231157273] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
Introduction: Simulation training offers an authentic team-based learning opportunity without risk to real patients. The Educational Corner at the annual congress of the European Branch of Extracorporeal Life Support Organisation (EuroELSO) provided an opportunity for multiple simulation training sessions facilitated by experts from all over the world.Aim: We aimed to review the educational impact of EuroELSO Educational Corner and whether it provides a quality ECLS training to a wide spectrum of multidisciplinary international attendees utilising high and low fidelity simulation, workshops and hands on sessions.Methods: During the congress, 43 sessions were conducted dedicated to ECLS education with identified educational objectives. The sessions focused on management of adults and children on V-V or V-A ECMO. Adult sessions covered emergencies on mechanical circulatory support with management of LVAD and Impella, managing refractory hypoxemia on V-V ECMO, emergencies on ECMO, renal replacement therapy on ECMO, V-V ECMO, ECPR cannulation and performing perfect simulation. Paediatric sessions covered ECPR neck and central cannulation, renal replacement on ECMO, troubleshooting, cannulation workshop, V-V recirculation, ECMO for single ventricle, PIMS-TS and CDH, ECMO transport and neurological injury.Results: The Educational Corner was attended by more than 400 participants over the two congress days. Majority of responders (88%) reported that training sessions met the set educational goals and objectives and that this would change their current practice. Almost all (94%) reported that they received useful information and 95% would recommend the session to their colleagues.Conclusion: The Educational Corner, as an integral component of the annual EuroELSO congress, achieved the set educational goals and provided quality education based on the recipient survey. Structured multidisciplinary ECLS education with standardised curriculum and feedback is an important key step in delivering quality training to an international audience. Standardisation of European ECLS education remains an important focus of the EuroELSO.
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Affiliation(s)
- Mirjana Cvetkovic
- Heart and Lung Division, Cardiac Intensive Care Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Marta V Antonini
- Anesthesia and Intensive Care Unit, Bufalini Hospital, AUSL della Romagna, Cesena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy
| | - Alex Rosenberg
- Intensive Care Unit, Royal Brompton and Harefield Hospitals, Part of Guys and St Thomas's NHS Foundation Trust, Harefield, UK
| | - Christopher Is Meadows
- Department of Critical Care, Guy's & St Thomas' NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Marek Dąbrowski
- Katedra i Zakład Edukacji Medycznej, Uniwersytet Medyczny im. Karola Marcinkowskiego w Poznaniu, Poznań, Poland
- Chair and Department of Medical Education, Poznan University of Medical Sciences, Poznan, Poland
| | - Mateusz Puslecki
- Department of Medical Rescue, Poznan University of Medical Sciences, Poznan, Poland
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Ibrahim Fawzy Hassan
- Clinical Medicine, Weill Cornell Medical College, New York, NY, USA
- ECMO Program Director, Hamad Medical Corporation, Doha, Qatar
| | - Jo-Anne Fowles
- Intensive Care Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Maura O'Callaghan
- Heart and Lung Division, Cardiac Intensive Care Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Sebastian Stefaniak
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Jordi Riera
- Critical Care Department, Vall d´Hebron University Hospital; SODIR, Vall d´Hebron Research Institute, Barcelona, Spain
| | - Nicholas A Barrett
- Department of Critical Care, Guy's & St Thomas' NHS Foundation Trust, London, UK
- Division of Centre of Human Applied Physiological Sciences, King's College London, London, UK
| | - Jan Bělohlávek
- Second Department of Medicine, Cardiovascular Medicine, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Matteo Di Nardo
- Pediatric Intensive Care Unit, IRCCS, Children's Hospital Bambino Gesù, Rome, Italy
| | - Aparna Hoskote
- Heart and Lung Division, Cardiac Intensive Care Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Justyna Swol
- Department of Respiratory Medicine, Paracelsus Medical University Nuremberg, Germany
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9
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Akhtar W, Pinto S, Gerlando E, Pitt T, Banya W, Dunning J, Bowles CT, Rosenberg A. Mechanical life support algorithm for emergency management of patient receiving extracorporeal membrane oxygenation. Perfusion 2023:2676591231168291. [PMID: 36990441 DOI: 10.1177/02676591231168291] [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] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
BACKGROUND There are limited practical advanced life support algorithms to aid teams in the management of cardiac arrest in patients on extracorporeal membrane oxygenation (ECMO). METHODS In our specialist tertiary referral centre we developed, by iteration, a novel resuscitation algorithm for ECMO emergencies which we validated through simulation and assessment of our multi-disciplinary team. A Mechanical Life Support course was established to provide theoretical and practical education combined with simulation to consolidate knowledge and confidence in algorithm use. We assessed these measures using confidence scoring, a key performance indicator (the time taken to resolve gas line disconnection) and a multiple choice question (MCQ) examination. RESULTS Following this intervention the median confidence scores increased from 2 (Interquartile range IQR 2, 3) to 4 (IQR 4, 4) out of maximum 5 (n = 53, p < 0.0001). Theoretical knowledge assessed by median MCQ score increased from 8 (6, 9) to 9 (7, 10) out of maximum 11 (n = 53, p0.0001). The use of the ECMO algorithm reduced the time taken by teams in a simulated emergency to identify a gas line disconnection and resolve the problem from median 128 s (65, 180) to 44 s (31, 59) (n = 36, p 0.001) and by a mean of 81.5 s (CI 34, 116, p = 0.001). CONCLUSIONS We present an evidence based practical ECMO resuscitation algorithm that provides guidance to clinical teams responding to cardiac arrest in ECMO patients covering both patient and ECMO troubleshooting.
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Affiliation(s)
- Waqas Akhtar
- Harefield Hospital, Royal Brompton and Harefield Hospitals, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Sofia Pinto
- Harefield Hospital, Royal Brompton and Harefield Hospitals, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Emanuele Gerlando
- Harefield Hospital, Royal Brompton and Harefield Hospitals, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Timothy Pitt
- Harefield Hospital, Royal Brompton and Harefield Hospitals, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Winston Banya
- Harefield Hospital, Royal Brompton and Harefield Hospitals, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - John Dunning
- Harefield Hospital, Royal Brompton and Harefield Hospitals, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Christopher T Bowles
- Harefield Hospital, Royal Brompton and Harefield Hospitals, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Alex Rosenberg
- Harefield Hospital, Royal Brompton and Harefield Hospitals, Guys and St Thomas' NHS Foundation Trust, London, UK
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10
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Barbera M, Perera D, Matton A, Mangialasche F, Rosenberg A, Middleton L, Ngandu T, Solomon A, Kivipelto M. Multimodal Precision Prevention - A New Direction in Alzheimer's Disease. J Prev Alzheimers Dis 2023; 10:718-728. [PMID: 37874092 DOI: 10.14283/jpad.2023.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
At least 40% of all dementia has been linked to modifiable risk factors suggesting a clear potential for preventative approaches targeting these factors. Despite the recent promising findings from anti-amyloid monoclonal antibodies, a limited proportion of patients are expected to be eligible for these novel AD treatments. Given the heterogeneous nature of AD and the complex multi-level pathological processes leading to dementia (involving, e.g., shared risk factors, interaction of different pathology mechanisms, and their putative synergistic effects on cognition), targeting a single pathology may not be sufficient to halt or significantly impact disease progression. With exponentially increasing numbers of patients world-wide, in parallel to the unprecedented population ageing, new multimodal therapy approaches targeting several modifiable risk factors and disease mechanisms simultaneously are urgently required. Developing the next generation of combination therapies with lifestyle intervention and pharmacological treatments, implementing the right interventions for the right people at the right time, and defining accessible and sustainable strategies worldwide are crucial. Here, we summarize the state-of-the-art multimodal lifestyle-based approaches, especially findings and lessons learned from the FINGER trial, for prevention and risk reduction of cognitive impairment and dementia. We also discuss some emerging underlying biological mechanisms and the current development of precision prevention approaches. We present an example of a novel trial design combining healthy lifestyle changes with a repurposed putative disease-modifying drug and place this study in the context of the World-Wide FINGERS, the first interdisciplinary network of multimodal trials dedicated to the prevention and risk reduction of cognitive impairment and dementia.
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Affiliation(s)
- M Barbera
- Miia Kivipelto, Address: Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Karolinska Vägen 37A, 171 64 Solna, Sweden, , Phone: +46 73-994-0922
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11
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Corner EJ, Zhang X, Van Willigen Z, Tatam K, Camilleri M, Monkhouse A, Bear DE, Hemsley A, Puthucheary Z, Rosenberg A, McRae J, Harvey A, Ford D, Firshman P, Norris M. Mixed methods evaluation of the impact of the COVID-19 ICU remote-learning rehabilitation course for frontline health professionals during the COVID-19 pandemic in the UK. J Intensive Care Soc 2022; 23:485-491. [PMID: 36751346 PMCID: PMC9679894 DOI: 10.1177/17511437211043043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Optimising outcomes for critically ill patients with COVID-19 patients requires early interdisciplinary rehabilitation. As admission numbers soared through the pandemic, the redeployed workforce needed rapid, effective training to deliver these rehabilitation interventions. Methods The COVID-19 ICU Remote-Learning Rehab Course (CIRLC-rehab) is a one-day interdisciplinary course developed after the success of CIRLC-acute. The aim of CIRLC-rehab was to rapidly train healthcare professionals to deliver physical, nutritional and psychological rehabilitation strategies in the ICU/acute setting. The course used blended learning with interactive tutorials delivered by shielding critical care professionals. CIRLC-rehab was evaluated through a mixed-methods approach, including questionnaires, and follow-up semi-structured interviews to evaluate perceived impact on clinical practice. Quantitative data are reported as n (%) and means (SD). Inductive descriptive thematic analysis with methodological triangulation was used to analyse the qualitative data from the questionnaires and interviews. Results 805 candidates completed CIRLC-rehab. 627 (78.8%) completed the post-course questionnaire. 95% (n = 596) found CIRLC-rehab extremely or very useful and 96.0% (n = 602) said they were very likely to recommend the course to colleagues. Overall confidence rose from 2.78/5 to 4.14/5. The course promoted holistic and humanised care, facilitated informal networks, promoted interdisciplinary working and equipped the candidates with practical rehabilitation strategies that they implemented into clinical practice. Conclusion This pragmatic solution to educating redeployed staff during a pandemic increased candidates' confidence in the rehabilitation of critically ill patients. There was also evidence of modifications to clinical care utilising learning from the course that subjectively facilitated holistic and humanised rehabilitation, combined with the importance of recognising the humanity, of those working in ICU settings themselves. Whilst these data are self-reported, we believe that this work demonstrates the real-term benefits of remote, scalable and rapid educational delivery.
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Affiliation(s)
- Evelyn J Corner
- Department of Health Sciences, Brunel University
London, Uxbridge, London, UK,Imperial College NHS Healthcare
Trust, Fulham Palace Road, London, UK,33N Ltd, London, UK,Clinically-Led WorkforcE and Activity
Redesign (CLEAR) Programme, Health Education England, London, UK,Eve Corner, Department of Health Sciences,
Brunel University London, Kingston Lane, Uxbridge, London, UK.
| | - Xiaoxi Zhang
- Department of Anaesthesia, Hillingdon Hospital, London, UK
| | - Zoe Van Willigen
- Therapy Services Department, University Hospital Southampton NHS
Foundation Trust, Southampton, UK
| | - Kate Tatam
- Derriford Hospital, University Hospitals Plymouth NHS
Trust, Plymouth, UK
| | - Matthew Camilleri
- 33N Ltd, London, UK,Clinically-Led WorkforcE and Activity
Redesign (CLEAR) Programme, Health Education England, London, UK,Anaesthetics Department, Peterborough City
Hospital, Peterborough, UK
| | - Alex Monkhouse
- 33N Ltd, London, UK,Clinically-Led WorkforcE and Activity
Redesign (CLEAR) Programme, Health Education England, London, UK
| | - Danielle E Bear
- Departments of Nutrition and
Dietetics and Critical Care, Guy’s and St Thomas’ NHS Foundation
Trust, London, UK
| | - Alex Hemsley
- Physiotherapy Department, Newcastle Upon Tyne Hospitals NHS
Foundation Trust, Newcastle Upon Tyne, UK
| | - Zudin Puthucheary
- Anaesthetics Department, St Bartholomew’s
Hospital, London, UK,William Harvey Research
Institute, Queen Mary University of
London, London, UK,Critical Care and Perioperative
Medicine Research Group, The Royal London
Hospital, London, UK
| | - Alex Rosenberg
- Critical Care and Cardiothoracic
Services, Royal Brompton and Harefield
Hospitals, Guys and St Thomas’s NHS Trust, London, UK
| | - Jackie McRae
- Adult Speech and Language Therapy
Department, University College Hospitals NHS
Foundation Trust, London, UK
| | - Alex Harvey
- Department of Health Sciences, Brunel University
London, Uxbridge, London, UK
| | - Debbie Ford
- Staff Psychology, Royal Brompton and Harefield
Hospitals, Guys and St Thomas’s NHS Trust, London, UK
| | | | - Meriel Norris
- Department of Health Sciences, Brunel University
London, Uxbridge, London, UK
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12
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Pearson A, Muzaffar J, Bellile E, Worden F, Chung C, Rosenberg A, Vokes E, Fidler M, Brenner J, Zhai Y, Fu T, Winkler R, Swiecicki P. Phase I/II study of a novel MDM-2 inhibitor (APG-115) in TP53 wild type salivary gland cancers. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01011-5] [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: 11/03/2022]
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13
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Akhtar W, Gamble B, Kiff K, Wypych-Zych A, Raj B, Takata J, Gil FR, Hurtado A, Rosenberg A, Bowles CT. Mechanical life support algorithm developed by simulation for inpatient emergency management of recipients of implantable left ventricular assist devices. Resusc Plus 2022; 10:100254. [PMID: 35669526 PMCID: PMC9162943 DOI: 10.1016/j.resplu.2022.100254] [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: 03/31/2022] [Revised: 04/23/2022] [Accepted: 05/16/2022] [Indexed: 12/01/2022] Open
Abstract
Background Published guidance concerning emergency management of left ventricular assist device (LVAD) recipients is both limited and lacking in consensus which increases the risk of delayed and/or inappropriate actions. Methods In our specialist tertiary referral centre we developed, by iteration, a novel in-hospital resuscitation algorithm for LVAD emergencies which we validated through simulation and assessment of our multi-disciplinary team. A Mechanical Life Support course was established to provide theoretical and practical education combined with simulation to consolidate knowledge and confidence in algorithm use. We assessed these measures using confidence scoring, a key performance indicator (the time taken to restart LVAD function) and a multiple-choice question (MCQ) examination. Results The mean baseline staff confidence score in management of LVAD emergencies was 2.4 ± 1.2 out of a maximum of 5 (n = 29). After training with simulation, mean confidence score increased to 3.5 ± 0.8 (n = 13). Clinical personnel who were provided with the novel resuscitation algorithm were able to reduce time taken to restart LVAD function from a mean value of 49 ± 8.2 seconds (pre-training) to 20.4 ± 5 seconds (post-training) (n = 42, p < 0.0001). The Mechanical Life Support course increased mean confidence from 2.5 ± 1.2 to 4 ± 0.6 (n = 44, p < 0.0001) and mean MCQ score from 18.7 ± 3.4 to 22.8 ± 2.6, out of a maximum of 28 (n = 44, p < 0.0001). Conclusion We present a simplified LVAD Advanced Life Support algorithm to aid the crucial first minutes of resuscitation where basic interventions are likely to be critical in assuring good patient outcomes.
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Key Words
- ALS, Advanced Life Support
- Advanced life support
- CALS, Cardiac Advanced Life Support
- CPR, Cardio-Pulmonary Resuscitation
- Cardiac arrest
- DNAR, do not attempt resuscitation order
- ECMO, Extracorporeal Membrane Oxygenation
- ETCO2, End Tidal Carbon Dioxide, kPa Kilopascal
- LVAD
- LVAD, Left Ventricular Assist Device
- Left ventricular assist device
- MAP, Mean Arterial Pressure
- MCQ, multiple-choice exam
- MDT, multi-disciplinary team
- MLS, Mechanical Life Support
- Mechanical circulatory support
- Resuscitation
- VF, Ventricular Fibrillation
- VT, Ventricular Tachycardia
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Affiliation(s)
- Waqas Akhtar
- Harefield Hospital, Hill End Road, Harefield, Uxbridge UB96JH, United Kingdom
| | - Brigitte Gamble
- Harefield Hospital, Hill End Road, Harefield, Uxbridge UB96JH, United Kingdom
| | - Kristine Kiff
- Harefield Hospital, Hill End Road, Harefield, Uxbridge UB96JH, United Kingdom
| | | | - Binu Raj
- Harefield Hospital, Hill End Road, Harefield, Uxbridge UB96JH, United Kingdom
| | - Junko Takata
- Harefield Hospital, Hill End Road, Harefield, Uxbridge UB96JH, United Kingdom
| | - Fernando Riesgo Gil
- Harefield Hospital, Hill End Road, Harefield, Uxbridge UB96JH, United Kingdom
| | - Ana Hurtado
- Harefield Hospital, Hill End Road, Harefield, Uxbridge UB96JH, United Kingdom
| | - Alex Rosenberg
- Harefield Hospital, Hill End Road, Harefield, Uxbridge UB96JH, United Kingdom
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14
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Sindi S, Thunborg C, Rosenberg A, Andersen P, Andrieu S, Broersen LM, Coley N, Couderc C, Duval CZ, Faxen-Irving G, Hagman G, Hallikainen M, Håkansson K, Lehtisalo J, Levak N, Mangialasche F, Pantel J, Kekkonen E, Rydström A, Stigsdotter-Neely A, Wimo A, Ngandu T, Soininen H, Hartmann T, Solomon A, Kivipelto M. Multimodal Preventive Trial for Alzheimer's Disease: MIND-ADmini Pilot Trial Study Design and Progress. J Prev Alzheimers Dis 2022; 9:30-39. [PMID: 35098971 PMCID: PMC8783958 DOI: 10.14283/jpad.2022.4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Indexed: 12/14/2022]
Abstract
Background Interventions simultaneously targeting multiple risk factors and mechanisms are most likely to be effective in preventing cognitive impairment. This was indicated in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) testing a multidomain lifestyle intervention among at-risk individuals. The importance of medical food at the early symptomatic disease stage, prodromal Alzheimer’s disease (AD), was emphasized in the LipiDiDiet trial. The feasibility and effects of multimodal interventions in prodromal AD are unclear. Objectives To evaluate the feasibility of an adapted FINGER-based multimodal lifestyle intervention, with or without medical food, among individuals with prodromal AD. Methods MIND-ADmini is a multinational proof-of-concept 6-month randomized controlled trial (RCT), with four trial sites (Sweden, Finland, Germany, France). The trial targeted individuals with prodromal AD defined using the International Working Group-1 criteria, and with vascular or lifestyle-related risk factors. The parallel-group RCT includes three arms: 1) multimodal lifestyle intervention (nutritional guidance, exercise, cognitive training, vascular/metabolic risk management and social stimulation); 2) multimodal lifestyle intervention+medical food (Fortasyn Connect); and 3) regular health advice/ care (control group). Primary outcomes are feasibility and adherence. Secondary outcomes are adherence to the individual intervention domains and healthy lifestyle changes. Results Screening began on 28 September 2017 and was completed on 21 May 2019. Altogether 93 participants were randomized and enrolled. The intervention proceeded as planned. Conclusions For the first time, this pilot trial tests the feasibility and adherence to a multimodal lifestyle intervention, alone or combined with medical food, among individuals with prodromal AD. It can serve as a model for combination therapy trials (non-pharma, nutrition-based and/or pharmacological interventions).
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Affiliation(s)
- S Sindi
- Professor Miia Kivipelto, MD, PhD, Karolinska Institutet, Dept NVS, Division of Clinical Geriatrics, Center for Alzheimer Research QA32, Karolinska vägen 37 A, SE-171 64 Solna, Sweden; Mobile: +46 (0)73 99 409 22,
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15
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Abstract
Given the importance of epigenetic modification, pathogens have found a variety of ways to alter chromatin and affect host gene expression. The apicomplexan parasite Toxoplasma gondii expresses two nuclear targeted secreted effectors TgIST and TgNSM that target the activity of host histone deacetylase regulating corepressor complexes NuRD and NCoR/SMRT, respectively. TgIST and TgNSM are crucial for blocking the host interferon response protecting both the acute and latent stages of the infection. T. gondii represents a unique model organism to study the significance of epigenetic modifications in the regulation of interferon responses and other transcriptional responses at the interface of host-pathogen interaction.
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Affiliation(s)
- Alex Rosenberg
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri 63110, United States
| | - L David Sibley
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri 63110, United States
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16
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Czerwińska-Jelonkiewicz K, Beneria A, Bañeras J, Kwasiborski P, Velagapudi P, Ijioma N, Trêpa M, Fekadu C, Vandenbriele C, Stratinaki M, Tun HN, Garaygordobil DA, Verdoia M, Moscatelli S, Shchendrygina A, Wood A, Johnson V, Reinstadler S, Aleksic M, Pazdernik M, Rosenberg A. Psychological burden of the COVID-19 pandemic 6 months after the outbreak - the voice of the young doctors' generation: An international survey. Kardiol Pol 2022; 80:485-488. [PMID: 35235998 DOI: 10.33963/kp.a2022.0065] [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] [Received: 03/02/2022] [Accepted: 03/02/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Katarzyna Czerwińska-Jelonkiewicz
- Cardiothoracic Intensive Care Unit, Harefield Hospital, Royal Brompton and Harefield hospitals NHS Foundation Trust, London, United Kingdom. .,Andrzej Frycz Modrzewski Krakow University, Kraków, Poland.
| | - Anna Beneria
- Department of Psychiatry, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Jordi Bañeras
- Acute Cardiovascular Care Unit, Department of Cardiology, Centre de Simulacio´ Clı´nica Avancada VHISCA, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Przemysław Kwasiborski
- 3rd Department of Internal Diseases and Cardiology, Warsaw Medical University, Warsaw, Poland
| | | | | | - Maria Trêpa
- Cardiology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Chala Fekadu
- Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| | | | - Maria Stratinaki
- Department of Cardiology, General Hospital Venizeleio, Heraklion, Crete, Greece
| | - Han Naung Tun
- Heart and Vascular Centre, Victoria Hospital, Yangon, Myanmar and Tufts Medical Center, Boston, US
| | | | - Monica Verdoia
- Cardiology and ICU, Ospedale degli Infermi, ASL Biella, Università del Piemonte Orientale, Biella, Italy
| | - Sara Moscatelli
- Department of Pediatric Cardiology, Royal Brompton and Harefield hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Alice Wood
- Cardiology Department, Glenfield Hospital, University Hospitals of Leicester, Leicester, United Kingdom
| | | | - Sebastian Reinstadler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Milica Aleksic
- Department of Cardiology, University Hospital Medical Center Bezanijska kosa Belgrade, Serbia
| | - Michał Pazdernik
- Department of Cardiology, Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Alex Rosenberg
- Cardiothoracic Intensive Care Unit, Harefield Hospital, Royal Brompton and Harefield hospitals NHS Foundation Trust, London, United Kingdom
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17
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Shen C, Frakes J, Niu J, Rosenberg A, Weiss J, Caudell J, Jameson K, Said P, Seiwert T. MA03.03 NBTXR3 Activated by SBRT Combined with Nivolumab or Pembrolizumab in Patients With Advanced Cancers: Phase I Trial. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.119] [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: 12/01/2022]
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18
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Altan M, Patnaik A, Barve M, Dunn L, Cobb P, Rosenberg A, Sharma S, Sukari A, Lee Z, Marcondes M, Zalevsky J, Tagliaferri M, Kotzin B, Sacco A. 1026TiP A phase Ib/II, open-label, multicenter, dose-escalation and dose-expansion study of NKTR-255 plus cetuximab as a salvage regimen in patients with solid tumors. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1410] [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] Open
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19
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Rosenberg A, Agrawal N, Gooi Z, Blair E, Pearson A, Juloori A, Portugal L, Chin J, Cursio J, Lingen M, Haraf D, Vokes E. 867P A phase I trial of nab-paclitaxel-based induction followed by nab-paclitaxel-based concurrent chemotherapy and re-irradiation in previously treated head and neck squamous cell carcinoma. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1277] [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
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20
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Vivar O, Shen C, Frakes J, Niu J, Rosenberg A, Weiss J, Caudell J, Jameson K, Said P, Seiwert T. PH-0053 NBTXR3 activated by SBRT combined with nivolumab or pembrolizumab in advanced cancers: phase I trial. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07235-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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21
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Rosenberg A, Sibley LD. Toxoplasma gondii secreted effectors co-opt host repressor complexes to inhibit necroptosis. Cell Host Microbe 2021; 29:1186-1198.e8. [PMID: 34043960 PMCID: PMC8711274 DOI: 10.1016/j.chom.2021.04.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [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: 08/31/2020] [Revised: 02/22/2021] [Accepted: 04/28/2021] [Indexed: 02/06/2023]
Abstract
Toxoplasma gondii translocates effector proteins into its host cell to subvert various host pathways. T. gondii effector TgIST blocks the transcription of interferon-stimulated genes to reduce immune defense. Interferons upregulate numerous genes, including protein kinase R (PKR), which induce necrosome formation to activate mixed-lineage-kinase-domain-like (MLKL) pseudokinase and induce necroptosis. Whether these interferon functions are targeted by Toxoplasma is unknown. Here, we examine secreted effectors that localize to the host cell nucleus and find that the chronic bradyzoite stage secretes effector TgNSM that targets the NCoR/SMRT complex, a repressor for various transcription factors, to inhibit interferon-regulated genes involved in cell death. TgNSM acts with TgIST to block IFN-driven expression of PKR and MLKL, thus preventing host cell necroptotic death and protecting the parasite's intracellular niche. The mechanism of action of TgNSM uncovers a role of NCoR/SMRT in necroptosis, assuring survival of intracellular cysts and chronic infection.
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Affiliation(s)
- Alex Rosenberg
- Department of Molecular Microbiology, Washington University School of Medicine in St. Louis, St. Louis, MO 63130, USA
| | - L David Sibley
- Department of Molecular Microbiology, Washington University School of Medicine in St. Louis, St. Louis, MO 63130, USA.
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22
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Rosenberg A, Mangialasche F, Ngandu T, Solomon A, Kivipelto M. Multidomain Interventions to Prevent Cognitive Impairment, Alzheimer's Disease, and Dementia: From FINGER to World-Wide FINGERS. J Prev Alzheimers Dis 2021; 7:29-36. [PMID: 32010923 PMCID: PMC7222931 DOI: 10.14283/jpad.2019.41] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Alzheimer’s disease (AD) and dementia are a global public health priority, and prevention has been highlighted as a pivotal component in managing the dementia epidemic. Modifiable risk factors of dementia and AD include lifestyle-related factors, vascular and metabolic disorders, and psychosocial factors. Randomized controlled clinical trials (RCTs) are needed to clarify whether modifying such factors can prevent or postpone cognitive impairment and dementia in older adults. Given the complex, multifactorial, and heterogeneous nature of late-onset AD and dementia, interventions targeting several risk factors and mechanisms simultaneously may be required for optimal preventive effects. The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) is the first large, long-term RCT to demonstrate that a multidomain lifestyle-based intervention ameliorating vascular and lifestyle-related risk factors can preserve cognitive functioning and reduce the risk of cognitive decline among older adults at increased risk of dementia. To investigate the multidomain intervention in other populations and diverse cultural and geographical settings, the World-Wide FINGERS (WW-FINGERS) network was recently launched (https://alz.org/wwfingers). Within this network, new FINGER-type trials with shared core methodology, but local culture and context-specific adaptations, will be conducted in several countries. The WW-FINGERS initiative facilitates international collaborations, provides a platform for testing multidomain strategies to prevent cognitive impairment and dementia, and aims at generating high-quality scientific evidence to support public health and clinical decision-making. Furthermore, the WW-FINGERS network can support the implementation of preventive strategies and translation of research findings into practice.
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Affiliation(s)
- A Rosenberg
- Miia Kivipelto, Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Karolinska Universitetssjukhuset, Karolinska Vägen 37 A, QA32, 171 64 Solna, Sweden, Phone: +46 (0)73 99 40 922,
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Bibi M, Murphy S, Benhamou RI, Rosenberg A, Ulman A, Bicanic T, Fridman M, Berman J. Combining Colistin and Fluconazole Synergistically Increases Fungal Membrane Permeability and Antifungal Cidality. ACS Infect Dis 2021; 7:377-389. [PMID: 33471513 PMCID: PMC7887753 DOI: 10.1021/acsinfecdis.0c00721] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Indexed: 12/17/2022]
Abstract
The increasing emergence of drug-resistant fungal pathogens, together with the limited number of available antifungal drugs, presents serious clinical challenges to treating systemic, life-threatening infections. Repurposing existing drugs to augment the antifungal activity of well-tolerated antifungals is a promising antifungal strategy with the potential to be implemented rapidly. Here, we explored the mechanism by which colistin, a positively charged lipopeptide antibiotic, enhances the antifungal activity of fluconazole, the most widely used orally available antifungal. In a range of susceptible and drug-resistant isolates and species, colistin was primarily effective at reducing fluconazole tolerance, a property of subpopulations of cells that grow slowly in the presence of a drug and may promote the emergence of persistent infections and resistance. Clinically relevant concentrations of colistin synergized with fluconazole, reducing fluconazole minimum inhibitory concentration 4-fold. Combining fluconazole and colistin also increased survival in a C. albicans Galleria mellonella infection, especially for a highly fluconazole-tolerant isolate. Mechanistically, colistin increased permeability to fluorescent antifungal azole probes and to intracellular dyes, accompanied by an increase in cell death that was dependent upon pharmacological or genetic inhibition of the ergosterol biosynthesis pathway. The positive charge of colistin is critical to its antifungal, and antibacterial, activity: colistin directly binds to several eukaryotic membrane lipids (i.e., l-α-phosphatidylinositol, l-α-phosphatidyl-l-serine, and l-α-phosphatidylethanolamine) that are enriched in the membranes of ergosterol-depleted cells. These results support the idea that colistin binds to fungal membrane lipids and permeabilizes fungal cells in a manner that depends upon the degree of ergosterol depletion.
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Affiliation(s)
- Maayan Bibi
- Shmunis
School of Biomedical and Cancer Research, George S. Wise Faculty of
Life Sciences, Tel Aviv University, Ramat Aviv 6997801, Israel
| | - Sarah Murphy
- Institute
for Infection and Immunity, St George’s
University, Cranmer Terrace, London SW17 0RE, United Kingdom
| | - Raphael I. Benhamou
- School
of Chemistry, Raymond and Beverly Sackler Faculty of Exact Sciences, Tel Aviv University, Ramat Aviv 6997801, Israel
| | - Alex Rosenberg
- Shmunis
School of Biomedical and Cancer Research, George S. Wise Faculty of
Life Sciences, Tel Aviv University, Ramat Aviv 6997801, Israel
| | - Adi Ulman
- Shmunis
School of Biomedical and Cancer Research, George S. Wise Faculty of
Life Sciences, Tel Aviv University, Ramat Aviv 6997801, Israel
| | - Tihana Bicanic
- Institute
for Infection and Immunity, St George’s
University, Cranmer Terrace, London SW17 0RE, United Kingdom
- Clinical
Academic Group in Infection, St George’s
Hospital NHS Trust, London SW17 0QT, United Kingdom
| | - Micha Fridman
- School
of Chemistry, Raymond and Beverly Sackler Faculty of Exact Sciences, Tel Aviv University, Ramat Aviv 6997801, Israel
| | - Judith Berman
- Shmunis
School of Biomedical and Cancer Research, George S. Wise Faculty of
Life Sciences, Tel Aviv University, Ramat Aviv 6997801, Israel
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Abstract
While use of mechanical circulatory support is increasing, knowledge of its fundamental role and limitations remains poorly understood by many medical professionals. This article summarises the main types of mechanical circulatory support and how they work, particularly focusing on the key information medical professionals should know should they encounter them in hospital. Mechanical circulatory support can be an effective treatment modality in selected pathologies, including myocardial ischaemia, pulmonary congestion, massive pulmonary embolic disease, postcardiotomy cardiogenic shock with failure to wean off bypass, right ventricular failure, bridge to heart and lung transplant and, increasingly, extracorporeal cardiopulmonary resuscitation. Intra-aortic balloon pumps increase coronary perfusion and reduce myocardial oxygen demand in a variety of cardiac conditions. Extracorporeal membrane oxygenation can provide both respiratory and circulatory support to patients. Ventricular assist devices can provide support for not only patients with acute cardiogenic shock, but also for ambulant patients in the community setting.
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Affiliation(s)
- Jonny Coppel
- Department of Intensive Care Medicine, Barnet Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Alex Rosenberg
- Department of Intensive Care Medicine, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Edward Gilbert-Kawai
- Department of Intensive Care Medicine, The Royal London Hospital, Barts Health NHS Trust, London, UK
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Drori Y, Pando R, Sefty H, Rosenberg A, Mendelson E, Keinan-Boker L, Shohat T, Mandelboim M, Glatman-Freedman A. Influenza vaccine effectiveness against laboratory-confirmed influenza in a vaccine-mismatched influenza B-dominant season. Vaccine 2020; 38:8387-8395. [PMID: 33243633 DOI: 10.1016/j.vaccine.2020.10.074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 10/21/2020] [Accepted: 10/23/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The 2017-2018 influenza season in Israel was characterized by the predominance of influenza B Yamagata, with a lesser circulation of influenza A(H1N1)pdm09 and influenza A(H3N2). We estimated vaccine effectiveness (VE) of the inactivated influenza vaccine which was selected for use that season. METHODS End-of-season VE and 95% confidence intervals (CI) against laboratory-confirmed influenza-like illness (ILI) were estimated by means of the test-negative design. Age-specific VE analysis was carried out using a moving age interval. RESULTS Specimen were obtained from 1,453 community ILI patients; 610 (42.0%) were influenza-positive, among which 69.7% were B, 17.2% A(H1N1)pdm09 and 13.4% A(H3N2). A 98.6% of molecularly characterized influenza B belonged to the Yamagata lineage. Of the sampled individuals, 1320 were suitable for VE analysis. Of those vaccinated, 90.6% received the inactivated trivalent influenza vaccine (TIV) containing a Victoria lineage influenza B-like virus. VE against influenza A differed by age, with the highest VE of 72.9% (95%CI 31.9-89.2%) observed in children 0.5-14 years old, while all ages VE was 46.6% (95%CI 10.4-68.2%). All ages VE against influenza B was 23.2% (95%CI -10.1-46.4%) with age-specific analysis showing non-significant VE estimates. Utilizing a moving age interval of 15 years, afforded a detailed age-specific insight into influenza VE against the influenza viruses circulating during the 2017-2018 season. CONCLUSIONS The moderate-high 2017-2018 influenza A VE among children and adolescents, supports seasonal influenza vaccination at a young age. The low VE against influenza B in Israel, is most likely the result of influenza B/TIV-mismatch.
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Affiliation(s)
- Y Drori
- Central Virology Laboratory, Chaim Sheba Medical Center, Israel Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - R Pando
- Central Virology Laboratory, Chaim Sheba Medical Center, Israel Ministry of Health, Tel-Hashomer, Ramat Gan, Israel; Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Ramat Gan, Israel
| | - H Sefty
- Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Ramat Gan, Israel
| | - A Rosenberg
- Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Ramat Gan, Israel
| | - E Mendelson
- Central Virology Laboratory, Chaim Sheba Medical Center, Israel Ministry of Health, Tel-Hashomer, Ramat Gan, Israel; School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - L Keinan-Boker
- Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Ramat Gan, Israel; School of Public Health, University of Haifa, Haifa, Israel
| | - T Shohat
- Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Ramat Gan, Israel; School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Mandelboim
- Central Virology Laboratory, Chaim Sheba Medical Center, Israel Ministry of Health, Tel-Hashomer, Ramat Gan, Israel; School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Glatman-Freedman
- Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Ramat Gan, Israel; School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Seldon C, Shrivastava G, Jarboe J, Fine J, Conway S, Pretell J, Freedman L, Wolfson A, Zhao W, Kwon D, Rosenberg A, Trent J, Yechieli R. Tumor Necrosis Following Multi-Modality Neoadjuvant Therapy for Sarcoma: A Single Institution Series. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ayub S, Al-Duwal Z, Sellers D, Rosenberg A. Primary Cutaneous Follicle Center Lymphoma (PCFCL) with Parotid Gland Involvement. Am J Clin Pathol 2020. [DOI: 10.1093/ajcp/aqaa161.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction/Objective
Primary cutaneous follicle center lymphoma (PCFCL) is the most common primary cutaneous B-cell lymphoma. It arises from mature germinal center B lymphocytes. Here we report two cases of PCFCL with parotid gland involvement.
Methods
First case is a 66-year-old male with an enlarging forehead mass for nine months and a painless nodule on the right pre-auricular skin. Second is a 39-year-old male with a history of a recurring scalp spindle cell B-cell lymphoma now presenting with an enlarging lesion on the scalp and “fullness” in the right neck. There was no nodal or other extranodal involvement found in either case. Skin and parotid gland biopsies were obtained in both cases.
Results
Case one: The skin and parotid gland demonstrated sheets of predominantly medium sized infiltrating lymphoma cells, positive for CD20, Bcl-6, CD5 (dim) and Bcl-2 (dim), and negative for CD10, Bcl-1, and MUM-1. The epidermis was spared.
Case two demonstrated medium sized, spindle shaped lymphoma cells. The skin showed a vague follicular growth pattern, sparing the epidermis. The parotid gland showed diffuse infiltration by lymphoma cells, positive for CD20 and Bcl-6, Bcl-2 (dim) and no definite positivity for CD10.
Fluorescent in situ hybridization for t(14;18) translocation was absent in both cases.
Conclusion
Dissemination of PCFCL to extracutaneous sites is uncommon (~10% of cases) and to our knowledge, has not been reported in the parotid gland. Here we present two unique cases, which in the absence of nodal disease, prove the diagnosis of PCFCL with parotid gland involvement.
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Affiliation(s)
- S Ayub
- Pathology, The MetroHealth System, Cleveland, Ohio, UNITED STATES
| | - Z Al-Duwal
- Pathology, The MetroHealth System, Cleveland, Ohio, UNITED STATES
| | - D Sellers
- Pathology, The MetroHealth System, Cleveland, Ohio, UNITED STATES
| | - A Rosenberg
- Dermatology, The MetroHealth System, Cleveland, Ohio, UNITED STATES
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Iantorno S, Baghramian A, Rosenberg A, Lin S. TRANSUDATIVE CHYLOTHORAX IN LIVER CIRRHOSIS: A RARE MANIFESTATION OF PORTAL HYPERTENSION. Chest 2020. [DOI: 10.1016/j.chest.2020.08.1738] [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] Open
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Le X, Gluck I, Maurice-Dror C, Panwar A, Gold K, Berlin J, Dai T, Grewal J, Nagasaka M, Rosenberg A, Haigentz M, Le Tourneau C, Moreno I, McDevitt M, Patel M, Da Costa D, Lambert S, Li Y, Blaney M, Gillison M. 975TiP Phase Ib trial of ABBV-368 + tilsotolimod in combination with nab-paclitaxel and/or budigalimab (ABBV-181) in patients with recurrent/metastatic head and neck squamous cell carcinoma. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1090] [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: 10/23/2022] Open
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Do W, Elzerman T, de Bree R, Rosenberg A, Forouzanfar T, Van Cann EM. Is low or high body mass index in patients operated for oral squamous cell carcinoma associated with the perioperative complication rate? Int J Oral Maxillofac Surg 2020; 50:591-597. [PMID: 32861557 DOI: 10.1016/j.ijom.2020.07.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 06/01/2019] [Revised: 05/25/2020] [Accepted: 07/22/2020] [Indexed: 10/23/2022]
Abstract
The aim of this study was to analyse the effect of body mass index (BMI), both low and high values, on the perioperative complication rate in patients with oral squamous cell carcinoma (OSCC). The medical records of 259 patients operated between 2014 and 2017 for OSCC were reviewed. Univariate and multivariate analyses were performed. Sixty of the 259 patients developed 87 complications. Low or high BMI was not associated with the perioperative complication rate. A longer operating time and increased blood loss were associated with a higher perioperative complication rate and higher Clavien-Dindo grade. Low BMI, American Society of Anesthesiologists score 2 and 3, a longer operating time, and increased blood loss were associated with a longer hospital stay. Low BMI was associated with a longer hospital stay. Neither low nor high BMI was associated with the perioperative complication rate. A longer operating time and increased blood loss were associated with a higher perioperative complication rate and higher Clavien-Dindo grade.
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Affiliation(s)
- W Do
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Center for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, the Netherlands
| | - T Elzerman
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Center for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, the Netherlands
| | - R de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - A Rosenberg
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, the Netherlands
| | - T Forouzanfar
- Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Center for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands
| | - E M Van Cann
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Center for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, the Netherlands.
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Arachchillage DJ, Remmington C, Rosenberg A, Xu T, Passariello M, Hall D, Laffan M, Patel BV. Anticoagulation with argatroban in patients with acute antithrombin deficiency in severe COVID-19. Br J Haematol 2020; 190:e286-e288. [PMID: 32516429 PMCID: PMC7300519 DOI: 10.1111/bjh.16927] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Deepa J Arachchillage
- Royal Brompton &, Harefield NHS Foundation Trust and Imperial College London, London, UK.,Department of Haematology, Imperial College Healthcare NHS Trust, London, UK.,Department of Inflammation and Immunity, Centre for Haematology, Imperial College London, London, UK
| | - Christopher Remmington
- Royal Brompton &, Harefield NHS Foundation Trust and Imperial College London, London, UK
| | - Alex Rosenberg
- Royal Brompton &, Harefield NHS Foundation Trust and Imperial College London, London, UK
| | - Tina Xu
- Royal Brompton &, Harefield NHS Foundation Trust and Imperial College London, London, UK
| | - Maurizio Passariello
- Royal Brompton &, Harefield NHS Foundation Trust and Imperial College London, London, UK
| | - Donna Hall
- Royal Brompton &, Harefield NHS Foundation Trust and Imperial College London, London, UK
| | - Mike Laffan
- Department of Inflammation and Immunity, Centre for Haematology, Imperial College London, London, UK
| | - Brijesh V Patel
- Royal Brompton &, Harefield NHS Foundation Trust and Imperial College London, London, UK.,Division of Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, London, UK
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32
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Monteagudo Vela M, Simon A, Riesgo Gil F, Rosenberg A, Dalby M, Kabir T, García Saez D, Panoulas V. Clinical Indications of IMPELLA Short-Term Mechanical Circulatory Support in a Tertiary Centre. Cardiovascular Revascularization Medicine 2020; 21:629-637. [DOI: 10.1016/j.carrev.2019.12.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 11/15/2019] [Accepted: 12/03/2019] [Indexed: 10/25/2022]
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Rosenberg A, Uwinshuti FZ, Dworkin M, Nsengimana V, Kankindi E, Niyonsaba M, Uwitonze JM, Kabagema I, Dushime T, Krebs E, Jayaraman S. The epidemiology and prehospital care of motorcycle crashes in a sub-Saharan African urban center. Traffic Inj Prev 2020; 21:488-493. [PMID: 32678676 PMCID: PMC7500827 DOI: 10.1080/15389588.2020.1785623] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 05/22/2020] [Accepted: 06/17/2020] [Indexed: 05/21/2023]
Abstract
OBJECTIVE Road traffic crashes (RTCs) are common among motorcyclists in Kigali, Rwanda. The Service d'Aide Medicale Urgente (SAMU), a prehospital ambulance service, responds to many of these crashes. We aimed to describe motorcycle-related RTCs managed by SAMU. METHODS SAMU clinical data including demographic information, injury characteristics, and management details were analyzed descriptively for all motorcycle crashes occurring between December 2012 and July 2016. RESULTS Every patient included in this study was injured. These patients all called the ambulance for their injuries after a motorcycle crash. There were 2,912 motorcycle-related RTCs over the study period, representing 26% of all patients managed by SAMU. The incidence of motorcycle crashes in Kigali was 258 crashes per 100,000 people over the 3.5-year study period. The average age was 30 years and 80% were males. The most common injuries were to the lower extremities (n = 958, 33%), head (n = 878, 30%), or upper extremities (n = 453, 16%). Injuries often resulted in fractures of extremities (n = 740, 25%) and external hemorrhage anywhere in the body (unspecified region; n = 660, 23%), yet few were severe based on the Kampala Trauma Score (n = 23, 2%) and Glasgow Coma Scale (n = 42, 1.5%). The most common interventions were provision of diclofenac (n = 1,526, 52.5%), peripheral intravenous (IV) access (n = 1,217, 42%), and administration of IV fluids (n = 1,048, 36%). CONCLUSION Motorcycle-related RTCs represent a large burden of disease for patients treated by SAMU in Kigali, Rwanda. Young men are most at risk of injury, which imposes a financial strain on society. Though injuries occurred frequently, critical trauma cases from motorcycle crashes were uncommon. This may be a result of several initiatives in Rwanda to improve road safety.
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Affiliation(s)
- A Rosenberg
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - F Z Uwinshuti
- Service d'Aide Medicale Urgente, Rwanda Ministry of Health, Kigali, Rwanda
| | - M Dworkin
- School of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - V Nsengimana
- Department of Emergency Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - E Kankindi
- Service d'Aide Medicale Urgente, Rwanda Ministry of Health, Kigali, Rwanda
| | - M Niyonsaba
- Service d'Aide Medicale Urgente, Rwanda Ministry of Health, Kigali, Rwanda
| | - J M Uwitonze
- Service d'Aide Medicale Urgente, Rwanda Ministry of Health, Kigali, Rwanda
| | - I Kabagema
- Service d'Aide Medicale Urgente, Rwanda Ministry of Health, Kigali, Rwanda
| | - T Dushime
- Service d'Aide Medicale Urgente, Rwanda Ministry of Health, Kigali, Rwanda
| | - E Krebs
- School of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
- Department of Emergency Medicine, Thomas Jefferson University School of Medicine, Philadelphia, Pennsylvania
| | - S Jayaraman
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
- Program for Global Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia
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Rosenberg A, Luth MR, Winzeler EA, Behnke M, Sibley LD. Evolution of resistance in vitro reveals mechanisms of artemisinin activity in Toxoplasma gondii. Proc Natl Acad Sci U S A 2019; 116:26881-26891. [PMID: 31806760 PMCID: PMC6936365 DOI: 10.1073/pnas.1914732116] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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] [Indexed: 12/11/2022] Open
Abstract
Artemisinins are effective against a variety of parasites and provide the first line of treatment for malaria. Laboratory studies have identified several mechanisms for artemisinin resistance in Plasmodium falciparum, including mutations in Kelch13 that are associated with delayed clearance in some clinical isolates, although other mechanisms are likely involved. To explore other potential mechanisms of resistance in parasites, we took advantage of the genetic tractability of Toxoplasma gondii, a related parasite that shows moderate sensitivity to artemisinin. Resistant populations of T. gondii were selected by culture in increasing concentrations and whole-genome sequencing identified several nonconservative point mutations that emerged in the population and were fixed over time. Genome editing using CRISPR/Cas9 was used to introduce point mutations conferring amino acid changes in a serine protease homologous to DegP and a serine/threonine protein kinase of unknown function. Single and double mutations conferred a competitive advantage over wild-type parasites in the presence of drug, despite not changing EC50 values. Additionally, the evolved resistant lines showed dramatic amplification of the mitochondria genome, including genes encoding cytochrome b and cytochrome c oxidase I. Prior studies in yeast and mammalian tumor cells implicate the mitochondrion as a target of artemisinins, and treatment of wild-type parasites with high concentrations of drug decreased mitochondrial membrane potential, a phenotype that was stably altered in the resistant parasites. These findings extend the repertoire of mutations associated with artemisinin resistance and suggest that the mitochondrion may be an important target of inhibition of resistance in T. gondii.
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Affiliation(s)
- Alex Rosenberg
- Department of Molecular Microbiology, Washington University School of Medicine in St. Louis, St. Louis, MO 63110
| | - Madeline R. Luth
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA 92093
| | - Elizabeth A. Winzeler
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA 92093
| | - Michael Behnke
- Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803
| | - L. David Sibley
- Department of Molecular Microbiology, Washington University School of Medicine in St. Louis, St. Louis, MO 63110
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35
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Rosenberg A, Uwinshuti FZ, Dworkin M, Nsengimana V, Kankindi E, Niyonsaba M, Uwitonze JM, Kabagema I, Dushime T, Jayaraman S, Krebs E. Data-driven prehospital training to decrease motorcycle crash deaths in a Sub-Saharan African urban center. Traffic Inj Prev 2019; 20:S207-S208. [PMID: 32296289 PMCID: PMC7158746 DOI: 10.1080/15389588.2019.1665438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- A Rosenberg
- Virginia Commonwealth University Department of Surgery
| | - F Z Uwinshuti
- Service d'Aide Medicale Urgente- Rwanda Ministry of Health
| | - M Dworkin
- Thomas Jefferson University, Sidney Kimmel Medical College
| | | | - E Kankindi
- Service d'Aide Medicale Urgente- Rwanda Ministry of Health
| | - M Niyonsaba
- Service d'Aide Medicale Urgente- Rwanda Ministry of Health
| | - J M Uwitonze
- Service d'Aide Medicale Urgente- Rwanda Ministry of Health
| | - I Kabagema
- Service d'Aide Medicale Urgente- Rwanda Ministry of Health
| | - T Dushime
- Service d'Aide Medicale Urgente- Rwanda Ministry of Health
| | - S Jayaraman
- Virginia Commonwealth University Department of Surgery
| | - E Krebs
- Thomas Jefferson University, Sidney Kimmel Medical College
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Vandenbriele C, Azzu A, Gambaro A, Morosin M, Arachchillage D, Trimlett R, Rosenberg A, Ledot S, Patel B, Price S. P1716Dual antiplatelet therapy on veno arterial ECMO to bleed or not to bleed? Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Patients presenting with INTERMACS-1 cardiogenic shock and necessitating VA-ECMO, often undergo coronary angiography and percutaneous coronary intervention (PCI). Therefore, a substantial subset of VA-ECMO patients will have an indication for dual antiplatelet therapy (DAPT) plus unfractionated heparin (UFH). According to atrial fibrillation registry data, bleeding incidence on DAPT combined with oral anticoagulation is significantly higher as compared to anticoagulation alone. Although it has been reported that the addition of low dose aspirin to UFH did not increase bleeding or transfusion in VenoVenous (VV)-ECMO patients, it remains to be elucidated whether the addition of DAPT to UFH on VA-ECMO-therapy enhances bleeding.
Methods
We report single center data for 100 VA-ECMO patients between 2011 and 2019. VA-ECMO-patients post-surgery were excluded. Patient demographics, blood product transfusions and reported/radiographically diagnosed bleeding or thrombotic complications were analysed. All VA-ECMO patients received UFH, aiming for an anti-Xa levels of at least 0,3 U/ml. Targets were hemoglobin 7 g/dl, fibrinogen 100 mg/dl (or 150 mg/dl when active bleeding) and platelet counts above 50/fL. DAPT-patients were on a low dose aspirin plus a P2Y12-inhibitor (clopidogrel or ticagrelor).
Results
51% Of the VA-ECMO-group received DAPT (59% clopidogrel and 41% ticagrelor). UFH-levels were comparable between both groups. Patients on DAPT were significantly older (DAPT 52.8 vs. Control 41.3; p<0.001) and predominantly male (DAPT 76% vs. Control 63%). Total bleedings (DAPT 52% vs. Control 55%; p=0,68) and major bleedings (BARC score of 3 or more; DAPT 41% vs. Control 45%; p=0,71) did not differ significantly. We observed a significant lower number of clinically or radiographically overt arterial/venous thromboses (DAPT 13.7% vs. Control 36.2%; p=0,02) in the DAPT-group. When comparing fresh frozen plasma (FFP), red blood cell and platelet pool transfusions between both groups, only FFP-tranfusion (DAPT 0.47 units/day vs. Control 1.18 units/day; p=0,047) intends to be lower for the DAPT-group.
DAPT (plus UFH) vs control (plus UFH)
Conclusions
Haemorrhage is frequent during extracorporeal support. However, in our cohort, DAPT on top of UFH in the treatment of VA-ECMO-supported ischemic cardiogenic shock does not increase the risk of major bleeding. Therefore, DAPT should not necessarily be witheld in the setting of VA-ECMO. Interestingly, our data support a lower incidence of overt thromboses and a trend towards less FFP-transfusion. These findings suggest DAPT-induced platelet inhibition being protective against both thrombotic events and posibly consumptive coagulopathy without paying a price for major bleeding.
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Affiliation(s)
- C Vandenbriele
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - A Azzu
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - A Gambaro
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - M Morosin
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - D Arachchillage
- Royal Brompton and Harefield NHS Foundation Trust, Haematology, London, United Kingdom
| | - R Trimlett
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - A Rosenberg
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - S Ledot
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - B Patel
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - S Price
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
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Vandenbriele C, Wilson J, Baker A, Azzu A, Gambaro A, Morosin M, Arachchillage D, Rosenberg A, Davies S, Trimlett R, Ledot S, Price S. P1718Veno-arterial ECMO versus Left Impella bleeding complications in cardiogenic shock patients on dual antiplatelet therapy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Selective groups of patients, presenting with INTERMACS-1 cardiogenic shock due to acute ischaemic heart failure, may benefit from mechanical circulatory support (MCS). Patients with biventricular failure, severe septic shock or oxygenation problems should be selected for VA-ECMO, although the left Impella-CP heart pump can be considered as a less invasive alternative in supporting predominantly left ventricular failure. Bleeding issues are a major concern in patients on MCS, especially in this group where triple anticoagulation therapy (unfractionated heparin (UFH) for prevention of pump thrombosis and dual antiplatelet therapy (DAPT) after coronary stenting) is necessitated. We aim to investigate the bleeding and transfusion rate in DAPT-patients on VA-ECMO versus Impella.
Methods
We report single center data for 51 VA-ECMO and 8 Impella patients between 2011 and 2019. Indication for MCS was acute ischaemic cardiogenic shock. Patient demographics, transfusions and reported/radiographically diagnosed bleeding (BARC-classification) complications were analyzed. All patients received UFH and low dose aspirin plus clopidogrel or ticagrelor. Impella flow was at least 2.5 L/min. Transfusion targets were Hb >7 g/dl, fibrinogen >100 mg/dl (or >150 mg/dl when active bleeding) and platelet count >50/fL.
Results
Impella patients were significantly older (VA-ECMO 52.8 vs. Impella 62.4; p=0.02) as compared to the VA-ECMO group. Anti-Xa-levels and length of the MCS-run (mean 7.9 VA-ECMO vs. 6.4 days Impella) were comparable in both groups. Occurrences of minor bleeds was comparable between both groups (mainly oozing from the insertion site in the ImpellaTM group 63% vs. VA-ECMO 72%; p>0.05) but major bleedings with BARC score of 3 or more were significantly lower in the Impella group (13% vs. VA-ECMO 65%; p=0.005). Platelet and red blood cell transfusions were significantly lower in the Impella group (0.1 units of platelets per day vs. 1.1 units of platelets per day on VA-ECMO; p=0.002 and 0.8 units of RBCs per day vs. 2.6 units of RBCs per day on VA-ECMO; p=0.02).
Bleeding/transfusion VA-ECMO vs Impella
Conclusions
Bleeding is a frequent complication of MCS. However, in our cohort, triple anticoagulation in acute cardiogenic shock due to ischaemic left ventricle failure resulted in a lower major bleeding rate when support was given by the left Impella device as compared with VA-ECMO therapy group. As a result, platelet and red blood cell transfusions were lower in the Impella group. These findings are likely to be partly explained by the increased number and size of cannulas in VA-ECMO, as well as the increased risk of haemolysis and consumptive coagulopathy due to the complexity and extensive foreign body surface of the ECMO-circuit. We conclude that Impella support should be considered as a safer option than VA-ECMO with regards to bleeding in patients with ischaemic left ventricular failure who require DAPT and MCS as a bridge to recovery or other definitive therapy.
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Affiliation(s)
- C Vandenbriele
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - J Wilson
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - A Baker
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - A Azzu
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - A Gambaro
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - M Morosin
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - D Arachchillage
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - A Rosenberg
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - S Davies
- Royal Brompton and Harefield NHS Foundation Trust, Cardiology, London, United Kingdom
| | - R Trimlett
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - S Ledot
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - S Price
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
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Shrivastava G, Jarboe J, Ahmed A, Conway S, Pretell J, Wolfson A, Freedman L, Rosenberg A, Trent J, Yechieli R. Pathologic Response Rates after Neoadjuvant Therapy For Sarcoma. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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39
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Jarvinen-Seppo KM, Phillips JT, Fridy S, Martina C, Allen M, Seppo AE, Stahlhut R, Rosenberg A, Kobie J, Looney RJ. A Low Prevalence of Pediatric Food Allergy (FA) Among Older Order Mennonites (OOM) Is Related to Robust IgA Production in Early Life. J Allergy Clin Immunol 2019. [DOI: 10.1016/j.jaci.2018.12.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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40
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Lighthouse JK, Burke RM, Velasquez LS, Dirkx RA, Aiezza A, Moravec CS, Alexis JD, Rosenberg A, Small EM. Exercise promotes a cardioprotective gene program in resident cardiac fibroblasts. JCI Insight 2019; 4:92098. [PMID: 30626739 DOI: 10.1172/jci.insight.92098] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 12/07/2016] [Accepted: 11/20/2018] [Indexed: 02/06/2023] Open
Abstract
Exercise and heart disease both induce cardiac remodeling, but only disease causes fibrosis and compromises heart function. The cardioprotective benefits of exercise have been attributed to changes in cardiomyocyte physiology, but the impact of exercise on cardiac fibroblasts (CFs) is unknown. Here, RNA-sequencing reveals rapid divergence of CF transcriptional programs during exercise and disease. Among the differentially expressed programs, NRF2-dependent antioxidant genes - including metallothioneins (Mt1 and Mt2) - are induced in CFs during exercise and suppressed by TGF-β/p38 signaling in disease. In vivo, mice lacking Mt1/2 exhibit signs of cardiac dysfunction in exercise, including cardiac fibrosis, vascular rarefaction, and functional decline. Mechanistically, exogenous MTs derived from fibroblasts are taken up by cultured cardiomyocytes, reducing oxidative damage-dependent cell death. Importantly, suppression of MT expression is conserved in human heart failure. Taken together, this study defines the acute transcriptional response of CFs to exercise and disease and reveals a cardioprotective mechanism that is lost in disease.
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Affiliation(s)
- Janet K Lighthouse
- Aab Cardiovascular Research Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Ryan M Burke
- Aab Cardiovascular Research Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Lissette S Velasquez
- Aab Cardiovascular Research Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Ronald A Dirkx
- Aab Cardiovascular Research Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Alessandro Aiezza
- Aab Cardiovascular Research Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | | | | | - Alex Rosenberg
- Department of Allergy, Immunology, and Rheumatology Research, and
| | - Eric M Small
- Aab Cardiovascular Research Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.,Department of Medicine.,Department of Pharmacology and Physiology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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Rosenberg A, Kircher S, Hahn E, Rademaker A, Bilimoria K, Wayne J, Agulnik M. Perceptions of clinical trial enrollment in patients with bone and soft tissue sarcoma. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy299.033] [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: 11/14/2022] Open
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42
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Rosenberg A, Zochios V. A Perspective in Critical Care Medicine: To Be a Mature Specialty We Must Move Our Focus Beyond Mortality. J Cardiothorac Vasc Anesth 2018; 33:80-81. [PMID: 30243868 DOI: 10.1053/j.jvca.2018.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Alex Rosenberg
- Department of Anesthesia and Critical Care Medicine, Royal Brompton and Harefield National Health Service Foundation Trust Harefield, Middlesex, UK
| | - Vasileios Zochios
- Department of Critical Care Medicine, University Hospitals Birmingham National Health Service Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK; Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, Centre of Translational Inflammation Research, University of Birmingham, Birmingham, UK
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43
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Santucci NR, Hyman PE, Karpinski A, Rosenberg A, Garguilo D, Rein LE, Amado-Feeley A, Stoops E, Herdes RE, van Tilburg MAL. Development and validation of a childhood self-efficacy for functional constipation questionnaire. Neurogastroenterol Motil 2018; 30. [PMID: 28980378 DOI: 10.1111/nmo.13222] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 06/20/2017] [Accepted: 09/07/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Children with functional constipation fear painful bowel movements leading to stool withholding behavior. Self-efficacy is the belief that an individual can accomplish a given goal. If children with constipation avoid defecation because they think that they are unable defecate comfortably, this low self-efficacy may prevent treatment success. The aim of the current study was to develop and validate a constipation specific self-efficacy scale. METHODS The self-efficacy for functional constipation questionnaire (SEFCQ) was developed by the authors and evaluated by 10 children and seven experts. Ninety-nine healthy children and 122 children with functional constipation completed the SEFCQ and three other questionnaires measuring related constructs. KEY RESULTS Minor changes were made in wording based on feedback from experts and children. Factor analysis showed two scales, a 7 item Action scale (Cronbach's α = 0.88) and a 7 item Emotion scale (Cronbach α = 0.86). The SEFCQ total scale correlated positively with general self-efficacy (r = .32, P < .001) and quality of life (r = .20; P < .01) and negatively with anxiety (r = -.15; P < .05). Scores on the SEFCQ were higher in children without functional constipation compared to those with functional constipation (53.33 + 3.38 vs 39.34 + 7.19, P < .001). CONCLUSIONS & INFERENCES We developed a constipation specific self-efficacy questionnaire with good initial internal reliability, excellent face validity and adequate content validity. A low self-efficacy for defecation, may make the child resist their physical urge to defecate and hence, the need for further studies to assess its effect on treatment outcomes.
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Affiliation(s)
- N R Santucci
- Pediatric Gastroenterology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - P E Hyman
- Pediatric Gastroenterology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - A Karpinski
- School of Administration, Kent State University, Kent, OH, USA
| | - A Rosenberg
- Pediatric Gastroenterology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - D Garguilo
- Department of Pediatric Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - L E Rein
- Pediatric Gastroenterology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - A Amado-Feeley
- Pediatric Gastroenterology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - E Stoops
- Pediatric Gastroenterology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - R E Herdes
- Pediatric Gastroenterology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - M A L van Tilburg
- College of Pharmacy & Health Sciences, Campbell University, Buies Creek, NC, USA.,Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.,School of Social Work, University of Washington, Seattle, WA, USA
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Lighthouse JK, Burke R, Velasquez LS, Dirkx RA, Moravec CS, Alexis JD, Rosenberg A, Small EM. Abstract 108: Exercise Promotes a Cardioprotective Gene Program in Resident Cardiac Fibroblasts. Circ Res 2017. [DOI: 10.1161/res.121.suppl_1.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Exercise and disease both induce hypertrophic cardiac growth, but only disease results in fibrosis and compromised heart function. Transcriptional profiling of resident cardiac fibroblasts (CFs), the primary cellular source of fibrosis, was used to define the gene expression programs (GEP) underlying this divergent functional outcome. Bioinformatic analyses revealed distinct transcriptional responses to exercise and disease, including induction of Rho- and SRF-dependent remodeling genes in disease and NRF2-dependent antioxidant genes in exercise. The expression of a number of antioxidant genes, including metallothioneins (Mt1 and Mt2), are specifically maintained in CFs after exercise and lost in disease. Mice lacking Mt1/2 show signs of cardiac dysfunction after exercise, including cardiac fibrosis, vascular rarefaction, and reduced heart function. Importantly, Mt levels are also reduced in human heart failure (HF) patients, suggesting a potentially conserved cardioprotective role in humans. Non-canonical TGF-β1-mediated p38-MAPK signaling has previously been implicated in HF, therefore we tested the role of p38 signaling in Mt regulation. Pharmacological inhibition of p38 in human HF fibroblasts restores Mt1 and Mt2 expression and blunts the pathological fibroblast phenotype. Taken together, our study defines the transcriptional response of CFs to exercise and disease and reveals a cardioprotective mechanism that is lost in disease.
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Check J, Rosenberg A, Check D, DiAntonio A, Rui H, Cohen R, DiAntonio G. Serum levels of the immunomodulatory protein, the progesterone induced blocking factor (PIBF) which is found in high levels during pregnancy is not higher in women with progesterone (P) receptor (R) positive vs. negative breast cancer. CLIN EXP OBSTET GYN 2017. [DOI: 10.12891/ceog3315.2017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Swain DW, Carter MD, Wilson JR, Ryan PM, Wilgen JB, Hosea J, Rosenberg A. Loading and Asymmetry Measurements and Modeling for the National Spherical Torus Experiment Ion Cyclotron Range of Frequencies System. Fusion Science and Technology 2017. [DOI: 10.13182/fst03-a297] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- D. W. Swain
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831-8071
| | - M. D. Carter
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831-8071
| | - J. R. Wilson
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08544
| | - P. M. Ryan
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831-8071
| | - J. B. Wilgen
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831-8071
| | - J. Hosea
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08544
| | - A. Rosenberg
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08544
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Abstract
Acute right ventricular failure remains an immensely challenging clinical condition associated with a high mortality rate. In this narrative review, we highlight the pathophysiological mechanisms underlying right ventricular failure and suggest an initial diagnostic approach to this critically ill group of patients. Based on the best available evidence and our cumulative clinical experience as a national cardiothoracic centre, we summarize the basic principles of medical management and mechanical salvage therapy, finalizing with a series of recommendations for the management of right ventricular failure in specific clinical scenarios.
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Affiliation(s)
- Ignacio de Asua
- Department of Intensive Care, Harefield Hospital, London, UK
| | - Alex Rosenberg
- Department of Intensive Care, Harefield Hospital, London, UK
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Check JH, Rosenberg A, Check DL, DiAntonio A, Rui H, Cohen R, DiAntonio G. Serum levels of the immunomodulatory protein, the progesterone induced blocking factor (PIBF) which is found in high levels during pregnancy is not higher in women with progesterone (P) receptor (R) positive vs. negative breast cancer. CLIN EXP OBSTET GYN 2017; 44:187-189. [PMID: 29746019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE To determine if serum levels of the immunomodulatory protein, the progesterone induced blocking factor (PIBF), which is present in high levels during normal pregnancy, is present in higher levels in women with breast cancer positive for progesterone receptors. The study would also determine whether the presence or absence of the estrogen receptor in any way modifies PIBF expression. MATERIALS AND METHODS PIBF using a research ELISA was evaluated in the follicular phase in 21 women with receptor status as follows: seven with estrogen receptor (ER)+ and progesterone receptor (PR)+, seven with ER- and PR+, and seven with ER+ and PR. RESULTS The results showed no differences in serum PIBF in the three groups. The serum PIBF levels were no different than historical controls in the follicular phase. CONCLUSIONS Measurement of serum PIBF does not seem to be an important marker to use to either detect women with breast cancer or to help determine tumor virulence or potential specific therapies. If PIBF plays a role in helping cancer cells to escape immune surveillance, it seems that the intracytoplasmic PIBF would be the form most likely operative.
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Berrondo C, Flax J, Kucherov V, Siebert A, Osinski T, Rosenberg A, Fucile C, Beckham C. PD38-10 BLADDER CANCER EXOSOMES FROM HIGH-GRADE MUSCLE INVASIVE BLADDER CANCER CONTAIN LONG NON-CODING RNA AND MESSENGER RNA. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.1490] [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: 11/17/2022]
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50
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Berrondo C, Flax J, Siebert A, Kucherov V, Rosenberg A, Fucile C, Beckham C. Abstract B31: Bladder cancer patient urinary exosomes and tumors contain long noncoding RNA that may serve as therapeutic targets and biomarkers. Cancer Res 2016. [DOI: 10.1158/1538-7445.nonrna15-b31] [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
Abstract
While long non-coding RNA (lncRNA) play important roles in tumor biology including bladder cancer (BC), no previous studies have shown that lncRNAs in BC patient urinary exosomes (UEs) can function as biomarkers of disease. Exosomes are 30-150nm secreted membrane-bound vesicles that contain active biomolecules like: messenger(m)RNA, micro(mi)RNA, lncRNA and proteins generated from their cells of origin. In this study, we identified a panel of lncRNAs and mRNAs enriched in the UEs and tumors of BC patients, including the well-characterized lncRNA, HOTAIR. In order to elucidate if HOTAIR has a functional role in BC, we knocked it down in BC cell lines. Loss of HOTAIR resulted in reduced expression of known HOTAIR epithelial-to-mesenchyme transition (EMT) target genes, as well as reduced migration, and invasion using trans-well and 3-D culture assays. These data suggest that HOTAIR may serve as both a biomarker in UEs and as a potential therapeutic target. Critically, we RNA-Sequenced primary tumors, distal normal tissue (DNT) and UEs of BC patients and UEs from healthy volunteers (HV) to identify two novel lncRNAs, LINC00477 and LINC00940 enriched in BC patients' UEs and tumors. These candidate lncRNAs were confirmed with quantitative real time (qRT-PCR). Taken together, UE lncRNA content reflect the lncRNA content of BC tumors and may serve as biomarkers of disease. Further investigation is needed to validate the use of the lncRNAs presented in this study as biomarkers and putative therapeutic targets in relevant patient populations.
Citation Format: Claudia Berrondo, Jonathan Flax, Aisha Siebert, Victor Kucherov, Alex Rosenberg, Christopher Fucile, Carla Beckham. Bladder cancer patient urinary exosomes and tumors contain long noncoding RNA that may serve as therapeutic targets and biomarkers. [abstract]. In: Proceedings of the AACR Special Conference on Noncoding RNAs and Cancer: Mechanisms to Medicines ; 2015 Dec 4-7; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2016;76(6 Suppl):Abstract nr B31.
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