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D'Antonio ND, Lambrechts MJ, Heard JC, Siegel N, Karamian BA, Huang A, Canseco JA, Woods B, Kaye ID, Hilibrand AS, Kepler CK, Vaccaro AR, Schroeder GD. The Effect of Preoperative Marijuana Use on Surgical Outcomes, Patient-Reported Outcomes, and Opioid Consumption Following Lumbar Fusion. Global Spine J 2024; 14:568-576. [PMID: 35849499 PMCID: PMC10802534 DOI: 10.1177/21925682221116819] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective Cohort Study. OBJECTIVES To (1) investigate the effect of marijuana use on surgical outcomes following lumbar fusion, (2) determine how marijuana use affects patient-reported outcomes measures (PROMs), and (3) determine if marijuana use impacts the quantity of opioids prescribed. METHODS Patients > 18 years of age who underwent primary one- or two-level lumbar fusion with preoperative marijuana use at our institution were identified. A 3:1 propensity match incorporating patient demographics and procedure type was conducted to compare preoperative marijuana users to non-marijuana users. Patient demographics, surgical characteristics, surgical outcomes (90-day all-cause and 90-day surgical readmissions, reoperations, and revision surgeries), pre- and postoperative narcotic usage, and PROMs were compared between groups. Multivariate regression models were created to determine the effect of marijuana on surgical reoperations patient-reported outcomes (PROMs) 1-year postoperatively. RESULTS Of the 259 included patients, 65 used marijuana preoperatively. Multivariate logistic regression analysis demonstrated that marijuana use (OR = 2.28, P = .041) significantly increased the likelihood of having a spine reoperation. No other surgical outcome was found to be significantly different between groups. Multivariate linear regression analysis showed that marijuana use was not significantly associated with changes in 1-year postoperative PROMs (all, P > .05). The quantity of pre- and postoperative opioids prescriptions was not significantly different between groups (all, P > .05). CONCLUSIONS Preoperative marijuana use increased the likelihood of a spine reoperation for any indication following lumbar fusion, but it was not associated with 90-day all cause readmission, surgical readmission, the magnitude of improvement in PROMs, or differences in opioid consumption. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Nicholas D D'Antonio
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Mark J Lambrechts
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Jeremy C Heard
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Nicholas Siegel
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Brian A Karamian
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Angela Huang
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Barrett Woods
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Ian David Kaye
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Eribes E, Votruba C, Tinkham T, Huang A, Ilges D, Kunze K, Hudson M. Tixagevimab/cilgavimab for the prevention of COVID-19 in solid organ transplant recipients. Clin Transplant 2024; 38:e15261. [PMID: 38375915 DOI: 10.1111/ctr.15261] [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: 10/09/2023] [Revised: 12/27/2023] [Accepted: 01/29/2024] [Indexed: 02/21/2024]
Abstract
Tixagevimab/cilgavimab (tix/cil) received emergency use authorization in December 2021 for pre-exposure prophylaxis against COVID-19 in moderately to severely immunocompromised patients. Our study aimed to describe the incidence of COVID-19 infection and assess the immunologic risks associated with tix/cil in kidney, pancreas, liver, and heart transplant recipients. Retrospective chart review was completed to provide descriptive analysis. Outcomes data included COVID-19 infection, severity of COVID-19 infection, graft function, and rejection. Safety outcomes included cardiovascular (CV) and hypersensitivity events post tix/cil administration. A total of 410 transplant patients were included in the analysis: 20 heart, 92 liver, 243 kidney, 25 simultaneous pancreas/kidney, 23 simultaneous liver/kidney, and seven simultaneous heart/kidney. Twenty-seven (6.5%) patients tested positive for COVID-19 via PCR or antigen test post tix/cil. No apparent difference was observed in patients testing positive for COVID-19 by type of organ transplant (p = .122). Twenty-five of the 27 patients testing positive for COVID-19 reported symptomatic infection, only nine of whom were hospitalized. No patients were mechanically ventilated and no deaths due to COVID-19 occurred. No significant changes in graft function were observed. Clinically significant rejection was diagnosed and treated in four patients. COVID-19 breakthrough infection rates remained low in immunocompromised solid organ transplant recipients who received tix/cil. No significant immunologic risks were observed.
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Affiliation(s)
- Emily Eribes
- Department of Solid Organ Transplant, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Cassandra Votruba
- Department of Solid Organ Transplant, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Tyler Tinkham
- Department of Solid Organ Transplant, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Angela Huang
- Department of Solid Organ Transplant, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Dan Ilges
- Department of Solid Organ Transplant, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Katie Kunze
- Department of Solid Organ Transplant, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Madeline Hudson
- Department of Solid Organ Transplant, Mayo Clinic Arizona, Phoenix, Arizona, USA
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Zhao J, Huang A, Zeller J, Peter K, McFadyen JD. Decoding the role of platelets in tumour metastasis: enigmatic accomplices and intricate targets for anticancer treatments. Front Immunol 2023; 14:1256129. [PMID: 38106409 PMCID: PMC10722285 DOI: 10.3389/fimmu.2023.1256129] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/15/2023] [Indexed: 12/19/2023] Open
Abstract
The canonical role of platelets as central players in cardiovascular disease by way of their fundamental role in mediating thrombosis and haemostasis is well appreciated. However, there is now a large body of experimental evidence demonstrating that platelets are also pivotal in various physiological and pathophysiological processes other than maintaining haemostasis. Foremost amongst these is the emerging data highlighting the key role of platelets in driving cancer growth, metastasis and modulating the tumour microenvironment. As such, there is significant interest in targeting platelets therapeutically for the treatment of cancer. Therefore, the purpose of this review is to provide an overview of how platelets contribute to the cancer landscape and why platelets present as valuable targets for the development of novel cancer diagnosis tools and therapeutics.
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Affiliation(s)
- Jessie Zhao
- Department of Clinical Haematology, Alfred Hospital, Melbourne, VI, Australia
- Australian Centre for Blood Diseases, Monash University, Melbourne, VI, Australia
| | - Angela Huang
- Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VI, Australia
| | - Johannes Zeller
- Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VI, Australia
- Department of Plastic and Hand Surgery, Medical Center – University of Freiburg, Medical Faculty of the University of Freiburg, Freiburg, Germany
| | - Karlheinz Peter
- Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VI, Australia
- Department of Cardiology, Alfred Hospital, Melbourne, VI, Australia
- Department of Cardiometabolic Health, The University of Melbourne, Parkville, VI, Australia
- Department of Medicine, Monash University, Melbourne, VI, Australia
| | - James D. McFadyen
- Department of Clinical Haematology, Alfred Hospital, Melbourne, VI, Australia
- Australian Centre for Blood Diseases, Monash University, Melbourne, VI, Australia
- Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VI, Australia
- Department of Cardiometabolic Health, The University of Melbourne, Parkville, VI, Australia
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Schumacher K, Aridgides PD, Gossett J, Kang G, Huang A, Merchant TE, Mazewski C. Outcomes Following Radiation Therapy (RT) for Very Young Age CNS Embryonal Tumors on COG ACNS0334 According to Molecular-Confirmed Diagnosis. Int J Radiat Oncol Biol Phys 2023; 117:S76. [PMID: 37784570 DOI: 10.1016/j.ijrobp.2023.06.390] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The outcomes of upfront or relapse radiation therapy (RT) for the Children's Oncology Group ACNS0334 protocol based on molecular diagnosis were assessed. Therapy included maximal safe surgery, high-dose chemotherapy with stem cell rescue, randomization for inclusion of high dose methotrexate (MTX) and optional RT. MATERIALS/METHODS There were 24 patients that received RT on COG ACNS0334 of 77 evaluable patients with a diagnosis of either high-risk medulloblastoma (MB) or supratentorial primitive neuroectodermal tumor (SPNET). RT was a recommendation (M0: Focal, M+: CSI 18 Gy) given young patient age <36 months at enrollment. Seven RT patients were excluded for ineligible pathology (1 ATRT, 1 HGG) or insufficient tissue. The aim of this report is to review outcomes of 17 patients on ACNS0334 receiving RT (8 Upfront, 9 at relapse) with a molecular diagnosis that included MB, Pineoblastoma (PB), or Embryonal tumor with multilayered rosettes (ETMR). RESULTS In the MB group, there were 9 patients irradiated with MB (Group 3 = 8, SHH = 1). 5-year OS for MB Group 3 receiving RT (median primary dose 54 Gy) was 62.5% with no difference observed comparing 6 patients treated with upfront RT versus 2 treated at relapse (p = 0.27). All upfront RT for MB Group 3 had initial partial response (PR) to 0334 chemotherapy. RT delivery for upfront RT MB Group 3 included craniospinal radiation (CSI) in 5 patients and 1 patient who received focal RT to the primary (50 Gy) and metastatic site (44 Gy). Eighty percent of CSI for upfront RT in Group 3 was 18 Gy or 23.4 Gy. Relapse RT for MB Group 3 (2 patients) utilized full dose CSI (36 Gy, 39.6 Gy) and both patients are survivors with 5+ years follow-up. CSI dose for Group 3 MB was higher for relapse RT (mean 37.8 Gy) as compared to upfront RT (mean 19.8 Gy, p = 0.013). Use of MTX was 50% in both upfront RT and relapse RT Group 3 MB cohorts. One patient with MB SHH (classic histology) underwent upfront focal RT (54 Gy) after initial PR to systemic therapy (without MTX) and is surviving 5+ years. PB: Of 4 PB patients (median primary dose 48.8 Gy) 1 had RT upfront (CSI 18 Gy) and 3 had RT at relapse (1 patient received CSI, 21 Gy). All patients with PB expired within 2 years. MTX was given in 75% (including 1 upfront RT PB). Two of 3 patients treated at relapse had prior complete response (CR). ETMR: All 4 patients (median primary dose 54 Gy) with ETMR were treated at relapse, with CSI given in 1 patient (23.4 Gy). All patients with ETMR expired within 2 years, and 2 (50%) had received MTX. Two patients (50%) had initial CR. CONCLUSION The RT cohort for Group 3 MB on ACNS0334 exhibited long-term survival both for both upfront and relapse RT, however relapsed Group 3 MB received higher dose CSI. RT upfront for MB, including one surviving MB SHH patient receiving focal RT, was solely given for incomplete initial chemotherapy response. There were no survivors for either PB or ETMR when the majority (88%) were treated at relapse.
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Affiliation(s)
| | | | - J Gossett
- St Jude Childrens Research Hospital, Memphis, TN
| | - G Kang
- St. Jude Children's Research Hospital, Memphis, TN
| | - A Huang
- Division of Haematology/Oncology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - T E Merchant
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - C Mazewski
- Emory University School of Medicine, Atlanta, GA
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5
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Shum S, Huang A, Slinger P. Hypoxaemia during one lung ventilation. BJA Educ 2023; 23:328-336. [PMID: 37600211 PMCID: PMC10435364 DOI: 10.1016/j.bjae.2023.05.006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 08/22/2023] Open
Affiliation(s)
- S. Shum
- Toronto General Hospital, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - A. Huang
- Toronto General Hospital, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - P. Slinger
- Toronto General Hospital, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
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Cahill C, Jegatheesan P, Song D, Cortes M, Adams M, Narasimhan SR, Huang A, Angell C, Stemmle M. Implementing Higher Phototherapy Thresholds for Jaundice in Healthy Infants 35 Plus Weeks. Hosp Pediatr 2023; 13:857-864. [PMID: 37635692 DOI: 10.1542/hpeds.2022-007098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
OBJECTIVES To determine the impact of higher bilirubin thresholds on testing and treatment of healthy infants during the neonatal period. METHODS This quality improvement study included infants born at ≥35 weeks gestation and admitted to the well-baby nursery between July 2018 and December 2020. We assessed the transition from infants treated according to the 2004 AAP guidelines (pregroup) with those following the Northern California Neonatal Consortium guidelines (postgroup). We examined the proportion of infants receiving phototherapy and total serum bilirubin (TSB) assessments as outcome measures. We examined critical hyperbilirubinemia (TSB above 25 mg/dL or TSB within 2 mg/dL of threshold for exchange transfusion), exchange transfusion, and readmission for jaundice as balancing measures. We compared the differences in outcomes over time using Statistical Process Control p charts. Balancing measures between the pre and postgroups were compared using χ square tests and t-tests. RESULTS In our population of 6173 babies, there was a significant shift in the proportion receiving phototherapy from 6.4% to 4%. There were no significant changes in incidences of bilirubin >25 mg/dL (0 of 1472 vs 7 of 4709, P = .37), bilirubin within 2 mg/dL of exchange transfusion thresholds (4 of 1472 vs 5 of 4709, P = .15), exchange transfusion (0 of 1472 vs 1 of 4709, P = .70) or readmission for phototherapy (2.9% versus 2.4%, P = .30), between the 2 groups. CONCLUSIONS Higher thresholds for phototherapy treatment of neonatal hyperbilirubinemia can decrease the need for phototherapy without increasing critical hyperbilirubinemia or readmission rate.
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Affiliation(s)
- Chris Cahill
- Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Priya Jegatheesan
- Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Dongli Song
- Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Maria Cortes
- Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California
| | - Marian Adams
- Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California
| | - Sudha Rani Narasimhan
- Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Angela Huang
- Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California
| | - Cathy Angell
- Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California
| | - Monica Stemmle
- Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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Jegatheesan P, Narasimhan SR, Huang A, Nudelman M, Song D. Higher NICU admissions in infants born at ≥35 weeks gestational age during the COVID-19 pandemic. Front Pediatr 2023; 11:1206036. [PMID: 37484778 PMCID: PMC10360125 DOI: 10.3389/fped.2023.1206036] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/23/2023] [Indexed: 07/25/2023] Open
Abstract
Background Increasing evidence has shown that the COVID-19 pandemic has had a profound negative impact on vulnerable populations and a significant effect on maternal and neonatal health. We observed an increase in the percentage of infants admitted to NICU from 8% to 10% in the first year of the pandemic. This study aimed to compare the delivery room outcomes, NICU admissions and interventions, and neonatal outcomes two years before and during the pandemic. Methods This was a retrospective study in a public hospital between pre-COVID-19 (April 2018-December 2019) and COVID-19 (April 2020-December 2021). Data were obtained from all live births at ≥35 weeks gestation (GA). Maternal and neonatal demographics, delivery room (DR), and NICU neonatal outcomes were compared between the study periods using simple bivariable generalized estimating equations (GEE) regression. Multivariable GEE logistic regression analysis was performed to adjust for the effects of baseline differences in demographics on the outcomes. Results A total of 9,632 infants were born ≥35 weeks gestation during the study period (pre-COVID-19 n = 4,967, COVID-19 n = 4,665). During the COVID-19 period, there was a small but significant decrease in birth weight (33 g); increases in maternal diabetes (3.3%), hypertension (4.1%), and Hispanic ethnicity (4.7%). There was a decrease in infants who received three minutes (78.1% vs. 70.3%, p < 0.001) of delayed cord clamping and increases in the exclusive breastfeeding rate (65.9% vs. 70.1%, p < 0.001), metabolic acidosis (0.7% vs. 1.2%, p = 0.02), NICU admission (5.1% vs. 6.4%, p = 0.009), antibiotic (0.7% vs. 1.7%, p < 0.001), and nasal CPAP (1.2% vs. 1.8%, p = 0.02) use. NICU admissions and nasal CPAP were not significantly increased after adjusting for GA, maternal diabetes, and hypertension; however, other differences remained significant. Maternal hypertension was an independent risk factor for all these outcomes. Conclusion During the COVID-19 pandemic period, we observed a significant increase in maternal morbidities, exclusive breastfeeding, and NICU admissions in infants born at ≥35 weeks gestation. The increase in NICU admission during the COVID-19 pandemic was explained by maternal hypertension, but other adverse neonatal outcomes were only partly explained by maternal hypertension. Socio-economic factors and other social determinants of health need to be further explored to understand the full impact on neonatal outcomes.
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Affiliation(s)
- Priya Jegatheesan
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, United States
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
| | - Sudha Rani Narasimhan
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, United States
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
| | - Angela Huang
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Matthew Nudelman
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, United States
- Neonatology/Pediatrics, Mountain Health Network, Marshall University, Huntington, WV, United States
| | - Dongli Song
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, United States
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
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8
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Song D, Narasimhan SR, Huang A, Jegatheesan P. Increased newborn NICU admission for evaluation of hypoxic-ischemic encephalopathy during COVID-19 pandemic in a public hospital. Front Pediatr 2023; 11:1206137. [PMID: 37456571 PMCID: PMC10338929 DOI: 10.3389/fped.2023.1206137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/19/2023] [Indexed: 07/18/2023] Open
Abstract
Background Prenatal and perinatal care of pregnant mothers has been adversely affected during the COVID-19 pandemic. Hypoxic-ischemic encephalopathy (HIE) is a leading cause of neonatal death and long-term neurological disabilities. Therapeutic hypothermia is effective for neonatal HIE. This study evaluated the effect of the pandemic on neonatal HIE. Methods This retrospective single-center study compared neonatal HIE evaluation and hypothermia treatment between pre-COVID-19 pandemic (1 January 2018-31 December 2019) and COVID-19 pandemic (1 January 2020-31 December 2021) periods. Infants with abnormal neurological examination and or significant metabolic acidosis were admitted to NICU for evaluation of HIE and therapeutic hypothermia. Demographics, NICU admission and interventions, and neonatal outcomes were compared between infants born during the two periods using χ2, t-test, and Wilcoxon rank-sum test as appropriate. Statistical Process Control charts show the yearly proportion of infants evaluated for HIE and those treated with therapeutic hypothermia. Results From the pre-pandemic to the pandemic period, the proportion of infants that met HIE screening criteria increased from 13% to 16% (p < 0.0001), the proportion of infants admitted to NICU for HIE evaluation increased from 1% to 1.4% (p = 0.02), and the maternal hypertension rates of the admitted infants increased from 30% to 55% (p = 0.006). There was no difference in the proportions of the infants diagnosed with HIE (0.7% vs. 0.9%, p = 0.3) or treated with therapeutic hypothermia (0.2% vs. 0.3%, p = 0.3) between the two periods. There were no differences in the HIE severity and outcomes of the infants treated with therapeutic hypothermia between the two periods. Conclusion During the COVID-19 pandemic, we observed a significant increase in NICU admission for HIE evaluation. While we did not find significant increases in neonatal HIE and the need for therapeutic hypothermia, larger studies are needed for a comprehensive assessment of the impact of the COVID-19 pandemic on neonatal HIE.
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Affiliation(s)
- Dongli Song
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, United States
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
| | - Sudha Rani Narasimhan
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, United States
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
| | - Angela Huang
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Priya Jegatheesan
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, United States
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
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Lambrechts MJ, Schroeder GD, Tran K, Li S, Huang A, Chu J, Karamian BA, Canseco JA, Hilibrand AS, Oner C, Dvorak M, Schnake K, Kepler CK, Vaccaro AR. Validation of the AO Spine Thoracolumbar Injury Classification System Treatment Algorithm: Should it be used to Guide Fracture Management? Spine (Phila Pa 1976) 2023:00007632-990000000-00329. [PMID: 37141491 DOI: 10.1097/brs.0000000000004693] [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] [Received: 07/05/2022] [Accepted: 09/17/2022] [Indexed: 05/06/2023]
Abstract
STUDY DESIGN Retrospective Cohort Study. OBJECTIVE To determine how historical management of thoracolumbar spine injuries compares to the recently proposed AO Spine Thoracolumbar Injury Classification System treatment algorithm. SUMMARY OF BACKGROUND DATA Classifications of the thoracolumbar spine are not uncommon. The frequent advent of new classifications is typically due to previous classifications being primarily descriptive or unreliable. Thus, AO Spine created a classification with an associated treatment algorithm to guide injury classification and management. METHODS Thoracolumbar spine injuries were retrospectively identified from a prospectively collected spine trauma database at a single, urban, academic medical center during the years 2006-2021. Each injury was classified and assigned points based on the AO Spine Thoracolumbar Injury Classification System injury severity score. Patients were grouped into scores of three or less (preferred initial conservative treatment) and greater than six (preferred initial surgical intervention). Either operative or non-operative treatment was considered appropriate for injury severity scores of four or five. RESULTS A total of 815 patients (TL AOSIS 0-3: 486, TL AOSIS 4-5: 150, TL AOSIS 6+: 179) met inclusion status. Injury severity scores of 0-3 were more likely to undergo non-operative management compared to scores of 4-5 or 6+ (99.0% vs. 74.7% vs. 13.4%, P<0.001). Thus, guideline congruent treatment was 99.0%, 100%, and 86.6%, respectively (P<0.001). Most injuries determined to be a 4 or 5 were treated non-operatively (74.7%). Based on the treatment algorithm, 97.5% of patients who received operative treatment and 96.1% who received non-operative treatment were managed in accordance with the algorithm. Of the 29 patients who did not receive algorithm congruent treatment, 5 (17.2%) were treated surgically. CONCLUSIONS A retrospective review of thoracolumbar spine injuries at our urban academic medical center identified that patients are historically treated in accordance with the proposed AO Spine Thoracolumbar Injury Classification System treatment algorithm.
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Affiliation(s)
- Mark J Lambrechts
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Khoa Tran
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Sandy Li
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Angela Huang
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Justin Chu
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Brian A Karamian
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Jose A Canseco
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Alan S Hilibrand
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Cumhur Oner
- Department of Orthopedic Surgery, University Medical Center, University of Utrecht, Utrecht, the Netherlands
| | - Marcel Dvorak
- University of British Columbia, Vancouver, BC, Canada
| | - Klaus Schnake
- Center for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany
- Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany
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Walsh APG, Yu E, McFadyen JD, Bongcaron V, Moon M, Huang A, Arthur J, Muir I, Rayzman V, Panousis C, Wang X, Peter K. Activated Coagulation FXII (Factor XII): A Unique Target for In Vivo Molecular Imaging. Arterioscler Thromb Vasc Biol 2023; 43:1031-1040. [PMID: 37078286 DOI: 10.1161/atvbaha.122.318883] [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
BACKGROUND Current clinical imaging of thromboembolic diseases often relies on indirect detection of thrombi, which may delay diagnosis and ultimately the institution of beneficial, potentially lifesaving treatment. Therefore, the development of targeting tools that facilitate the rapid, specific, and direct imaging of thrombi using molecular imaging is highly sought after. One potential molecular target is FXIIa (factor XIIa), which initiates the intrinsic coagulation pathway but also activates the kallikrein-kinin system, thereby initiating coagulation and inflammatory/immune responses. As FXII (factor XII) is dispensable for normal hemostasis, its activated form (FXIIa) represents an ideal molecular target for diagnostic and therapeutic approaches, the latter combining diagnosis/identification of thrombi and effective antithrombotic therapy. METHODS We conjugated an FXIIa-specific antibody, 3F7, to a near-infrared (NIR) fluorophore and demonstrated binding to FeCl3-induced carotid thrombosis with 3-dimensional fluorescence emission computed tomography/computed tomography and 2-dimensional fluorescence imaging. We further demonstrated ex vivo imaging of thromboplastin-induced pulmonary embolism and detection of FXIIa in human thrombi produced in vitro. RESULTS We demonstrated imaging of carotid thrombosis by fluorescence emission computed tomography/computed tomography and measured a significant fold increase in signal between healthy and control vessels from mice injected with 3F7-NIR compared with mice injected with nontargeted probe (P=0.002) ex vivo. In a model of pulmonary embolism, we measured increased NIR signal in lungs from mice injected with 3F7-NIR compared with mice injected with nontargeted probe (P=0.0008) and healthy lungs from mice injected with 3F7-NIR (P=0.021). CONCLUSIONS Overall, we demonstrate that FXIIa targeting is highly suitable for the specific detection of venous and arterial thrombi. This approach will allow direct, specific, and early imaging of thrombosis in preclinical imaging modalities and may facilitate monitoring of antithrombotic treatment in vivo.
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Affiliation(s)
- Aidan P G Walsh
- Molecular Imaging and Theranostics Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia. (A.P.G.W., E.Y., V.B., X.W.)
- Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia. (A.P.G.W., E.Y., J.D.M., V.B., M.M., A.H., K.P.)
- Department of Medicine, Monash University, Melbourne, VIC, Australia (A.P.G.W., E.Y., J.D.M., X.W., K.P.)
- Clinical Haematology Department, Alfred Hospital, Melbourne, VIC, Australia (J.D.M.)
- Department of Cardiometabolic Health, University of Melbourne, VIC, Australia (J.D.M., M.M., X.W., K.P.)
| | - Eefang Yu
- Molecular Imaging and Theranostics Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia. (A.P.G.W., E.Y., V.B., X.W.)
- Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia. (A.P.G.W., E.Y., J.D.M., V.B., M.M., A.H., K.P.)
- Department of Medicine, Monash University, Melbourne, VIC, Australia (A.P.G.W., E.Y., J.D.M., X.W., K.P.)
| | - James D McFadyen
- Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia. (A.P.G.W., E.Y., J.D.M., V.B., M.M., A.H., K.P.)
- Department of Medicine, Monash University, Melbourne, VIC, Australia (A.P.G.W., E.Y., J.D.M., X.W., K.P.)
| | - Viktoria Bongcaron
- Molecular Imaging and Theranostics Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia. (A.P.G.W., E.Y., V.B., X.W.)
- Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia. (A.P.G.W., E.Y., J.D.M., V.B., M.M., A.H., K.P.)
| | - Mitchell Moon
- Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia. (A.P.G.W., E.Y., J.D.M., V.B., M.M., A.H., K.P.)
- Department of Cardiometabolic Health, University of Melbourne, VIC, Australia (J.D.M., M.M., X.W., K.P.)
| | - Angela Huang
- Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia. (A.P.G.W., E.Y., J.D.M., V.B., M.M., A.H., K.P.)
| | - Jane Arthur
- CSL, Ltd, Bio21 Institute, Parkville, Melbourne, VIC, Australia (J.A., I.M., V.R., C.P.)
| | - Ineke Muir
- CSL, Ltd, Bio21 Institute, Parkville, Melbourne, VIC, Australia (J.A., I.M., V.R., C.P.)
| | - Veronika Rayzman
- CSL, Ltd, Bio21 Institute, Parkville, Melbourne, VIC, Australia (J.A., I.M., V.R., C.P.)
| | - Con Panousis
- CSL, Ltd, Bio21 Institute, Parkville, Melbourne, VIC, Australia (J.A., I.M., V.R., C.P.)
| | - Xiaowei Wang
- Molecular Imaging and Theranostics Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia. (A.P.G.W., E.Y., V.B., X.W.)
- Department of Medicine, Monash University, Melbourne, VIC, Australia (A.P.G.W., E.Y., J.D.M., X.W., K.P.)
- Department of Cardiometabolic Health, University of Melbourne, VIC, Australia (J.D.M., M.M., X.W., K.P.)
- Department of Cardiovascular Research, Translation and Implementation, La Trobe University, Melbourne, VIC, Australia (X.W., K.P.)
| | - Karlheinz Peter
- Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia. (A.P.G.W., E.Y., J.D.M., V.B., M.M., A.H., K.P.)
- Department of Medicine, Monash University, Melbourne, VIC, Australia (A.P.G.W., E.Y., J.D.M., X.W., K.P.)
- Department of Cardiometabolic Health, University of Melbourne, VIC, Australia (J.D.M., M.M., X.W., K.P.)
- Department of Cardiovascular Research, Translation and Implementation, La Trobe University, Melbourne, VIC, Australia (X.W., K.P.)
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Huang A, Sanches D. Abstract 4853: Evaluating the role of melatonin in thyroid cancer cell (MDA-T41) apoptosis and metabolism modulation. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-4853] [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: 04/07/2023]
Abstract
Abstract
Melatonin, a hormone produced by the pineal gland, is typically known for its modulation of a number of physiological functions, alongside its ability to synchronize the sleep-wake rhythms. In recent years, however, its interactions with cancerous cells and role in prevention and treatment have been increasingly studied. It has been demonstrated that melatonin can improve the efficacy of chemotherapeutic drugs and directly inhibit tumorigenesis in experimental models of neoplasia. In addition, while melatonin typically displays anti-apoptotic effects in normal cells, it holds pro-apoptotic effects in cancer cells. Despite this, the mechanisms by which melatonin affects cell death and metabolism remain unclear due to the seeming difference from cell to cell. We aim to better understand the role of melatonin in regulating thyroid cancer cell apoptosis and metabolism. The MDA-T41 thyroid cancer cell line was cultured with varying quantities of melatonin. Steady volumes of staurosporine (an inductor of apoptotic cell death) were applied to cultures, and cell death levels were subsequently measured using the Realtime-Glo Annexin V Apoptosis and Necrosis assay. Our results showed that melatonin provided anti-apoptotic effects to MDA-T41 cells treated with staurosporine. Both apoptosis and necrosis were reduced by 50% in melatonin-treated cells 24 hours after staurosporine-induced cell death. Our next steps will be to evaluate the mechanisms and further signaling pathways involved in this apoptosis inhibition through Bcl-2 and p53 protein expression.
Citation Format: Angela Huang, Daniel Sanches. Evaluating the role of melatonin in thyroid cancer cell (MDA-T41) apoptosis and metabolism modulation. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4853.
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Huang A, Saxena A, Patel M. Abstract 2202: Role of FadA secreting Fusobacterium nucleatum in initiation and progression of colorectal cancer. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-2202] [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: 04/07/2023]
Abstract
Abstract
Colorectal cancer (CRC) is a global disease with poor prognosis. There is an alarming increase in incidence of CRC in younger patients along with well recognized racial disparities. Recent data implicate a role of microbiome in initiation and progression of CRC. Fusobacterium nucleatum (Fn), an oral opportunistic pathogen, has emerged as one of the common pathogens associated with CRC. Fn transformation from commensal to pathogen requires expression of amyloid-like FadA adhesin that plays a key role in its attachment to the colonic mucosal cells resulting in inflammatory, oncogenic, and metastatic changes. CRC initiates as polyps that go on to invade the mucosal layers and metastasize. This study analyzed the significance of Fn as a biomarker in CRC as well as to understand the etiology and metastasis of CRC. Deidentified and delinked formalin fixed paraffin embedded tissue sections from cancerous, precancerous and non-cancerous colorectal biopsies were analyzed for Fn presence and markers in epithelial to mesenchymal transition (EMT) in CRC through immunofluorescence. EMT was studied through biomarkers such as E-cadherin, which is an epithelial cell surface protein, vimentin as an intracellular filament protein normally expressed in mesenchymal cells, and N-cadherin, a cell adhesion molecule that is shown to express aberrantly in some solid tumor cells undergoing EMT. As expected, E-cadherin was abundantly expressed on the surface of epithelial cells while vimentin was found in the stromal cells in the non-cancerous tissue sections. Interestingly, the E-cadherin expression was lower in the cancerous tissue and some cancerous specimens also exhibited the vimentin positive foci within epithelial cells signifying partial EMT. N-cadherin expression was not observed in any of the specimens. The presence of Fn as analyzed through the FadA staining correlated with decline in the E-cadherin expression in some cancer specimens. To further analyze the significance of Fn, a meta-analytic study was conducted from 20 studies that indicated a significant presence of Fn not only in CRC tissues but also in fecal specimens from patients with CRC. A whole genome sequencing analysis corroborated with the abundance of Fn in CRC tissue specimens. These data suggest that analysis for Fn presence offers an attractive opportunity for intervention and targeted treatment for chemo resistant tumors. EMT analysis provides an additional corroboration in early detection of cancer progression which is pivotal in successful treatment of CRC.
Citation Format: Angela Huang, Anjana Saxena, Mintoo Patel. Role of FadA secreting Fusobacterium nucleatum in initiation and progression of colorectal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 2202.
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Affiliation(s)
| | - Anjana Saxena
- 2Brooklyn College and The Graduate Center, City University of New York, New York, NY
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Anderson Enni JB, Narasimhan SR, Huang A, Jegatheesan P. Screening and diagnosis of neonatal hypoglycaemia in at-risk late preterm and term infants following AAP recommendations: a single centre retrospective study. BMJ Paediatr Open 2023; 7:10.1136/bmjpo-2022-001766. [PMID: 36941020 PMCID: PMC10030920 DOI: 10.1136/bmjpo-2022-001766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/22/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND There is a lack of consensus regarding the definition and treatment threshold for neonatal hypoglycaemia. The American Academy of Pediatrics (AAP) has a published clinical report making recommendations on practice guidelines. There is limited literature discussing the impact of these guidelines. In this study, we evaluated the screening and diagnosis of neonatal hypoglycaemia following the AAP guidelines. METHODS Infants born ≥35 weeks gestational age and admitted to the well-baby nursery between January and December 2017 were included in this study. Our hypoglycaemia policy was based on the AAP clinical report for hypoglycaemia management in newborns. Chart review was done to obtain infant hypoglycaemia risk factors and blood glucose values in the first 24 hours. Data analysis was conducted using Stata V.14.2 (StataCorp). RESULTS Of 2873 infants born and admitted to the well-baby nursery, 32% had at least one hypoglycaemia risk factor and 96% of them were screened for hypoglycaemia. Screened infants were more likely to be born at a lower gestational age, via C-section, and to a multiparous older mother. Screened infants and hypoglycaemic infants had lower exclusive breastfeeding rates compared with those who were not screened or not hypoglycaemic, respectively. Sixteen per cent of screened infants were diagnosed with hypoglycaemia; 0.8% of at-risk screened infants and 5% of hypoglycaemic infants were admitted to the NICU for treatment of hypoglycaemia. Thirty-one per cent of preterm infants, 15% of large for gestational age infants, 13% of small for gestational age infants and 15% of infants of diabetic mothers were hypoglycaemic. Hypoglycaemic infants were more likely to be born preterm and via C-section. CONCLUSION Using the AAP time-based definitional blood glucose cut-off values, our incidence of hypoglycaemia found in those who were screened for risk factors was lower compared with other studies. Future long-term follow-up studies will be important.
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Affiliation(s)
| | - Sudha Rani Narasimhan
- Pediatrics/Neonatology, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Angela Huang
- Pediatrics/Neonatology, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Priya Jegatheesan
- Pediatrics/Neonatology, Santa Clara Valley Medical Center, San Jose, California, USA
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Taheri N, Huang A. Gender and menopausal status correlate with success of maxillomandibular advancement surgery for sleep apnea. Int J Oral Maxillofac Surg 2023. [DOI: 10.1016/j.ijom.2022.09.025] [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: 01/31/2023]
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Panebianco CJ, Dutta P, Frost JR, Huang A, Kim OS, Iatridis JC, Vernengo AJ, Weiser JR. Teaching Tissue Repair Through an Inquiry-Based Learning Bioadhesives Module. Biomed Eng Educ 2023; 3:61-74. [PMID: 37200536 PMCID: PMC10187775 DOI: 10.1007/s43683-022-00087-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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/27/2022] [Indexed: 05/20/2023]
Abstract
Bioadhesives are an important class of biomaterials for wound healing, hemostasis, and tissue repair. To develop the next generation of bioadhesives, there is a societal need to teach trainees about their design, engineering, and testing. This study designed, implemented, and evaluated a hands-on, inquiry-based learning (IBL) module to teach bioadhesives to undergraduate, master's, and PhD/postdoctoral trainees. Approximately 30 trainees across three international institutions participated in this IBL bioadhesives module, which was designed to last approximately 3 h. This IBL module was designed to teach trainees about how bioadhesives are used for tissue repair, how to engineer bioadhesives for different biomedical applications, and how to assess the efficacy of bioadhesives. The IBL bioadhesives module resulted in significant learning gains for all cohorts; whereby, trainees scored an average of 45.5% on the pre-test assessment and 69.0% on the post-test assessment. The undergraduate cohort experienced the greatest learning gains of 34.2 points, which was expected since they had the least theoretical and applied knowledge about bioadhesives. Validated pre/post-survey assessments showed that trainees also experienced significant improvements in scientific literacy from completing this module. Similar to the pre/post-test, improvements in scientific literacy were most significant for the undergraduate cohort since they had the least amount of experience with scientific inquiry. Instructors can use this module, as described, to introduce undergraduate, master's, and PhD/postdoctoral trainees to principles of bioadhesives.
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Affiliation(s)
- Christopher J. Panebianco
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Poorna Dutta
- Department of Chemical Engineering, The Cooper Union for the Advancement of Science and Art, 41 Cooper Square, New York, NY 10003, USA
| | - Jillian R. Frost
- Department of Chemical Engineering, The Cooper Union for the Advancement of Science and Art, 41 Cooper Square, New York, NY 10003, USA
| | - Angela Huang
- Department of Chemical Engineering, The Cooper Union for the Advancement of Science and Art, 41 Cooper Square, New York, NY 10003, USA
| | - Olivia S. Kim
- Department of Chemical Engineering, The Cooper Union for the Advancement of Science and Art, 41 Cooper Square, New York, NY 10003, USA
| | - James C. Iatridis
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrea J. Vernengo
- Regenerative Orthopaedics Program, AO Research Institute, Clavadelerstrasse 8, 7270 Davos, Switzerland
| | - Jennifer R. Weiser
- Department of Chemical Engineering, The Cooper Union for the Advancement of Science and Art, 41 Cooper Square, New York, NY 10003, USA
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Abdelwahab M, Hong Y, Taheri N, Huang A, Fleury T, Marques S, Liu S, Capasso R. Value of Surgical and Non-surgical Treatment for Sleep Apnea: A Closer Look At Healthcare Utilization. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.778] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Fleury Curado T, Pham L, Freire C, Amorim M, Abdelwahab M, Huang A, Taheri N, Hong Y, Dedhia R, Liu S, Capasso R, Polotsky V, Eisele D, Schwartz A. Changes in Tongue Morphology Predict Responses in Pharyngeal Patency to Selective Hypoglossal Nerve Stimulation. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.647] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Huang A, Hong Y, Abdelwahab M, Taheri N, Liu S, Lee K, Fleury T. Skeletal Surgery in Treating Obstructive Sleep Apnea: Gender Specific Outcomes. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.739] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abdelwahab M, Chang C, Huang A, Liu S. Outcome of OSA Subjects Undergoing Both Maxillomandibular Advancement and Hypoglossal Nerve Stimulation. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.708] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Abdelwahab M, Ibrahim B, Huang A, Yoon A, Chou C, Liu S. Precision in Performing Distraction Osteogenesis Maxillary Expansion For OSA. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.723] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Huang A, Abdelwahab M, Capasso R, Liu S, Oliveira F. Improving CPAP Compliance: Transcutaneous Nasal Valve Stabilization. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.683] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Abdelwahab M, Chou C, Huang A, Liu S. Perception of Nasal Function and Cosmesis after Maxillomandibular advancement for obstructive sleep apnea. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.712] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Taheri N, Hong Y, Abdelwahab M, Huang A, Fleury T, Lee K, Liu S. Gender and Menopausal Status Correlate with Sleep Surgery Outcome. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.676] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Taheri N, Hong Y, Abdelwahab M, Huang A, Fleury T, Liu S, Cheng A. Achieving Reduced Treatment Time for Obstructive Sleep Apnea Utilizing Surgery First Approach: A Comparison of Traditional versus Novel Techniques. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.627] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Curado TF, Pho H, Freire C, Amorim M, Sennes LU, Taheri N, Hong Y, Abdelwahab M, Huang A, Fishbein K, Liu S, Capasso R, Schwartz A, Fuller D, Polotsky V. Designer Receptors Exclusively Activated by Designer Drugs Treatment of Sleep-disordered Breathing. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.657] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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He K, Osorio N, Barsoumian H, Leyton CK, Hu Y, Voss T, Huang A, Cortez M, Lopes J, Losey H, Winquist R, Welsh J. Selective Agonism of Intermediate-Affinity IL-2 Receptor Promotes Systemic Antitumor Responses in Combination with Radiotherapy in Metastatic Lung Cancer. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.576] [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: 10/31/2022]
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Bono K, Palmeri M, Huang A, Gunther J, Mattes M. Assessment of Medical Student Research Mentorship Based on Publications in ASTRO Journals. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1771] [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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Zhang W, Gong S, Cottrell K, Briggs K, Tonini M, Gu L, Whittington D, Yuan H, Gotur D, Jahic H, Huang A, Maxwell J, Mallender W. Biochemical characterization of TNG908 as a novel, potent MTA-cooperative PRMT5 inhibitor for the treatment of MTAP-deleted cancers. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)00872-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Briggs K, Cottrell K, Tsai A, Zhang M, Tonini M, Yoda S, Lombardo S, Teng T, Davis C, Whittington D, DiBenedetto H, Huang A, Maxwell J. TNG908 is a brain-penetrant, MTA-cooperative PRMT5 inhibitor for the treatment of MTAP-deleted cancer. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01021-8] [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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Briggs K, Tsai A, Zhang M, Tonini M, Haines B, Huang A, Cottrell K. TNG462 is a potential best-in-class MTA-cooperative PRMT5 inhibitor for the treatment of peripheral MTAP-deleted solid tumors. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01022-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nguyen J, Huang A, Fleming J, MacGregor D, Wilks D. 074 ALK-positive desmoplastic Spitz naevus in a patient with corresponding ALK-positive anaplastic large cell lymphoma. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.009] [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: 11/30/2022]
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Li R, Zhu X, Liu S, Zhang X, Xie C, Fu Z, Huang A, Sun L, Liu D, Zhao J, Wu L, Qin Z, Li S, Liu Y, Li Z. LB0005 ORELABRUTINIB, AN IRREVERSIBLE INHIBITOR OF BRUTON’S TYROSINE KINASE (BTK), FOR THE TREATMENT OF SYSTEMIC LUPUS ERYTHEMATOSUS (SLE): RESULTS OF A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED, PHASE IB/IIA DOSE-FINDING STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5086a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundOrelabrutinib is an oral, highly-selective, irreversible inhibitor of Bruton’s tyrosine kinase (BTK). Orelabrutinib has been approved for the treatment of B cell malignancies in China. Two distinct lupus animal models showed significant efficacy of orelabrutinib in reducing disease activity, which supported the clinical development of orelabrutinib in Systemic Lupus Erythematosus (SLE).ObjectivesThis phase Ib/IIa, randomized, double-blind, placebo-controlled, dose-finding study aimed to evaluate the safety, tolerability, pharmacokinetics (PK), pharmacodynamics (PD), preliminary efficacy and biomarkers of orelabrutinib in patients with mild to moderate SLE who received standard of care (SoC) therapy.MethodsPatients diagnosed with SLE by the ACR classification criteria for ≥ 6 months, who had a SLEDAI-2K score ≥5 at screening, and were autoantibody-positive, were randomized 1:1:1:1 to receive oral orelabrutinib at 50mg, 80mg, 100mg or placebo once daily for 12 weeks, respectively.ResultsThis study randomized 60 patients with 55 patients who completed 12-week treatment. Age at baseline was 33.7±9.8 years and 96.7% were female. Baseline disease characteristics were generally balanced across treatment groups. Adverse events (AEs) were reported in 80%, 93.3% and 100% of orelabrutinib treated patients at doses of 50mg, 80mg and 100mg QD respectively versus 85.5% in placebo group. AEs were mostly mild or moderate. Treatment-related SAEs were reported in 3 patients treated with orelabrutinib, only 1 of which was grade 3. No deaths were reported. The plasma exposure of orelabrutinib (AUC and Cmax) was proportionally increased with doses. Nearly complete BTK occupancy was achieved at all dose levels, and the occupancy lasted for 24 hours without any decrease compared to that at 4 hour post-dosing. In all evaluable patients, the SLE Response Index (SRI)-4 response rates at week 12 were 50.0%, 61.5% and 64.3% in patients treated with orelabrutinib at 50mg (n=14), 80mg (n=13) and 100mg (n=14) respectively, compared with 35.7% in patients treated with placebo (n=14), which indicated the trend of dose-dependent improvement. Among the subgroup of patients with SLEDAI-2K≥8 at screening, SRI-4 response occurred in 70%, 70% and 66.7% of patients treated with orelabrutinib at 50mg (n=10), 80mg (n=10) and 100mg (n=9), respectively, compared with 30% who received placebo (n=10). Trends of reduced proteinuria, anti-dsDNA and IgG, total B cells and increased complements C4 were also observed following orelabrutinib treatment.ConclusionOrelabrutinib was generally safe and well tolerated in patients with SLE. Preliminary results also suggested encouraging efficacy which supports further development of orelabrutinib in larger and longer trials for SLE.Table 1.Efficacy results at week 12.All Evaluable PatientsPlaceboOrelabrutinibOrelabrutinibOrelabrutinib50 mg80 mg100 mgN=5514141314SRI-4 response, n (%)5 (35.7%)7 (50.0%)8 (61.5%)9 (64.3%)Treatment difference vs. PBO (%)14.3%25.8%28.6%SLEDAI-2K≥8, N=391010109SRI-4 response, n (%)3 (30.0%)7 (70.0%)7 (70.0%)6 (66.7%)Treatment difference vs. PBO (%)40.0%40.0%36.7%Note: All evaluable patients at week 12 efficacy data were included in the efficacy analysis.Figure 1.SRI-4 response rates at week 12.Disclosure of InterestsRu Li: None declared, Xiaoxia Zhu: None declared, Shengyun Liu: None declared, Xiao Zhang: None declared, Changhao Xie: None declared, Zili Fu: None declared, Anbin Huang: None declared, Lingyun Sun: None declared, Dongzhou Liu: None declared, Jinxia Zhao: None declared, Lin Wu: None declared, Zhoushuai Qin Employee of: InnoCare Pharma Limited., Sichen Li Employee of: InnoCare pharma Limited., Yaorong Liu Employee of: InnoCare pharma Limited., Zhanguo Li: None declared
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Warne MSJ, Turner RDR, Davis AM, Smith R, Huang A. Temporal variation of imidacloprid concentration and risk in waterways discharging to the Great Barrier Reef and potential causes. Sci Total Environ 2022; 823:153556. [PMID: 35104522 DOI: 10.1016/j.scitotenv.2022.153556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/22/2022] [Accepted: 01/26/2022] [Indexed: 06/14/2023]
Abstract
The widely used neonicotinoid insecticide imidacloprid has emerged as a significant risk to surface waters and the diverse aquatic and terrestrial fauna these ecosystems support. While herbicides have been the focus of research on pesticides in Australia's Great Barrier Reef catchment area, imidacloprid has been monitored in catchments across the region since 2009. This study assessed the spatial and temporal dynamics of imidacloprid in 14 waterways in Queensland, Australia over seven years in relation to land use and concentration trends. Imidacloprid could be quantified (i.e., concentrations were greater than the limit of reporting) in approximately 54% of all samples, but within individual waterways imidacloprid was quantified in 0 to 99.7% of samples. The percent of each catchment used to grow bananas, sugar cane and urban explained approximately 45% of the variation in imidacloprid concentrations and waterway discharge accounted for another 18%. In six waterways there were significant increases in imidacloprid concentrations and the frequency and magnitude of exceedances of aquatic ecosystem protection guidelines over time. Overall, the risk posed by imidacloprid was low with 74% of samples protecting at least 99% of species but it was estimated that upto 42% of aquatic species would experience harmful chronic effects. Potential explanations of the changes in imidacloprid were examined. Not surprisingly, the only plausible explanation of the increases was increased use of imidacloprid. While field-based measurement of the effects of imidacloprid are limited in the Great Barrier Reef Catchment Area (GBRCA) the risk assessment indicates that biological harm to aquatic organisms is highly likely. Action to reduce imidacloprid concentrations in the GBRCA waterways is urgently required to reverse the current trends and mitigate environmental impacts.
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Affiliation(s)
- Michael St J Warne
- Reef Catchments Science Partnership, School of Earth and Environmental Sciences, University of Queensland, Brisbane, Queensland 4108, Australia; Water Quality and Investigations, Environmental Monitoring and Assessment Science, Science Delivery, Department of Environment and Science, Brisbane, Queensland 4102, Australia; Centre for Agroecology, Water and Resilience, Coventry University, Coventry, United Kingdom.
| | - Ryan D R Turner
- Reef Catchments Science Partnership, School of Earth and Environmental Sciences, University of Queensland, Brisbane, Queensland 4108, Australia; Water Quality and Investigations, Environmental Monitoring and Assessment Science, Science Delivery, Department of Environment and Science, Brisbane, Queensland 4102, Australia; Managing for Resilient Landscapes, Institute for Future Environments, Queensland University of Technology, Brisbane, Queensland 4000, Australia.
| | - Aaron M Davis
- Centre for Tropical Water and Aquatic Ecosystem Research (TropWATER), School of Marine and Tropical Biology, James Cook University, Townsville, Queensland 4811, Australia.
| | - Rachael Smith
- Office of the Great Barrier Reef, Department of Environment and Science, Brisbane, Queensland 4102, Australia.
| | - A Huang
- School of Mathematics and Physics, University of Queensland, Brisbane, Queensland 4108, Australia.
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Affiliation(s)
- Angela Huang
- Natural ScienceSouth Florida State CollegeAvon ParkFL
| | | | | | - Anjana Saxena
- BiologyBrooklyn College and The Graduate Center, City University of New YorkBrooklynNY
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Rudoler D, Kurdyak P, Gomes T, Huang A, Jones W, Littleford S, Paracha N, Fischer B. Evaluating the population-level effects of oxycodone restrictions on prescription opioid utilization in Ontario. Pharmacoepidemiol Drug Saf 2022; 31:769-778. [PMID: 35470515 DOI: 10.1002/pds.5442] [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] [Received: 11/03/2021] [Revised: 03/11/2022] [Accepted: 04/12/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE To investigate the impact of restrictions on access to long acting oxycodone on prescription opioid use and opioid-related harms. METHODS Administrative health data from Ontario, Canada was used to measure differences in opioids dispensed and ED visits for opioid-related overdose, poisoning or substance use following provincial restrictions on access to publicly insured OxyContin (February 29, 2012) and OxyNeo (February 28, 2013). This study focused on the cohort of provincial drug insurance eligible people (people 65+ and select low-income populations) who were dispensed oxycodone prior to the restrictions. Difference-in-differences models with a propensity score matched comparison group of people who were dispensed non-oxycodone opioids were used to estimate the main effects. RESULTS In the six months following the delisting of OxyContin, MMEs per person per week for all opioids fell by an average of 7.5% in people dispensed oxycodone relative to the comparison group, and an average of 13.8% in chronic recipients of oxycodone. In the six months following the restrictions on OxyNeo, MMEs per person per week fell by an average of 3.1% in all people dispensed oxycodone, and 25.2% in chronic oxycodone recipients. The decline in oxycodone dispensing amongst chronic oxycodone recipients corresponded with an increase in dispensing of other opioid formulations, particularly hydromorphone and fentanyl. No important differences were observed for ED visits related to opioid poisoning, overdose, or substance use disorder. CONCLUSIONS Province-wide restrictions on access to long acting oxycodone had an impact on quantities of all opioids dispensed to chronic recipients of oxycodone, but small impacts on the full population of people dispensed oxycodone; the decline in use was partially offset by increases in use of other publicly-funded opioid formulations. This study suggests that policies limiting access to specific prescription opioids led to overall reductions in publicly-funded prescription opioid use, particularly in chronic oxycodone recipients, without immediate evidence of changes in opioid-related ED visits. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- D Rudoler
- Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada.,Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - P Kurdyak
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - T Gomes
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - A Huang
- ICES, Toronto, Ontario, Canada
| | - W Jones
- Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Suite 2400 515 W. Hastings Street, Vancouver, British Columbia, Canada
| | - S Littleford
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - N Paracha
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - B Fischer
- Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, New Zealand.,Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Suite 2400 515 W. Hastings Street, Vancouver, British Columbia, Canada.,Department of Psychiatry, University of Toronto, 250 College Street 8th floor, Toronto, Ontario, Canada.,Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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Dix C, McFadyen J, Huang A, Chunilal S, Chen V, Tran H. Understanding vaccine-induced thrombotic thrombocytopenia (VITT). Intern Med J 2022; 52:717-723. [PMID: 35446471 PMCID: PMC9111818 DOI: 10.1111/imj.15783] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 01/10/2023]
Abstract
Vaccine‐induced thrombotic thrombocytopenia (VITT) is a rare, but serious, syndrome characterised by thrombocytopenia, thrombosis, a markedly raised D‐dimer and the presence of anti‐platelet factor‐4 (PF4) antibodies following COVID‐19 adenovirus vector vaccination. VITT occurs at a rate of approximately 2 per 100 000 first‐dose vaccinations and appears exceedingly rare following second doses. Our current understanding of VITT pathogenesis is based on the observations that patients with VITT have antibodies that bind to PF4 and have the ability to form immune complexes that induce potent platelet activation. However, the precise mechanisms that lead to pathogenic VITT antibody development remain a source of active investigation. Thrombosis in VITT can manifest in any vascular bed and affect multiple sites simultaneously. While there is a predilection for splanchnic and cerebral venous sinus thrombosis, VITT also commonly presents with deep vein thrombosis and pulmonary embolism. Pillars of management include anticoagulation with a non‐heparin anticoagulant, intravenous immunoglobulin and ‘rescue’ therapies, such as plasma exchange for severe cases. VITT can be associated with a high mortality rate and significant morbidity, but awareness and optimal therapy have significantly improved outcomes in Australia. A number of questions remain unanswered, including why VITT is so rare, reasons for the predilection for thrombosis in unusual sites, how long pathological antibodies persist, and the optimal duration of anticoagulation. This review will provide an overview of the presentation, diagnostic workup and management strategies for patients with VITT.
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Affiliation(s)
- Caroline Dix
- Department of Clinical Haematology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - James McFadyen
- Department of Clinical Haematology, The Alfred Hospital, Melbourne, Victoria, Australia.,Australian Centre for Blood Diseases, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Angela Huang
- Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Sanjeev Chunilal
- Department of Haematology, Monash Health, Melbourne, Victoria, Australia
| | - Vivien Chen
- Department of Haematology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.,ANZAC Research Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Huyen Tran
- Department of Clinical Haematology, The Alfred Hospital, Melbourne, Victoria, Australia.,Australian Centre for Blood Diseases, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Smith HS, Blumenthal-Barby JS, Chatterjee R, Hindera O, Huang A, Kothari R, Vlaev I. A Review of the MINDSPACE Framework for Nudging Health Promotion During Early Stages of the COVID-19 Pandemic. Popul Health Manag 2022; 25:487-500. [PMID: 35353613 DOI: 10.1089/pop.2021.0269] [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: 11/13/2022] Open
Abstract
The coronavirus disease (COVID-19) pandemic has highlighted the link between individual behavior and public health, along with the importance of evidence-based efforts to promote prosocial individual behavior. Insights from behavioral science can inform the design of effective behavior change techniques, or nudges, to influence individual behavior. The MINDSPACE framework organizes 9 behavioral science principles that can be used to guide policy design: Messenger, Incentives, Norms, Defaults, Salience, Priming, Affect, Commitments, and Ego. Using MINDSPACE as an organizing framework, this article provides a review of the literature on nudges to influence prosocial behaviors relevant during a pandemic: handwashing, avoidance of social gatherings, self-isolation and social distancing, and sharing public health messages. Additionally, empirical evidence on the use of nudges during the first several months of the COVID-19 pandemic in 2020 is summarized. Recommendations regarding the use of nudges to achieve public health policy goals during pandemics are provided. Organizational leaders, policymakers, and practitioners can use nudges to promote public health when mandates are not politically feasible or enforceable.
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Affiliation(s)
- Hadley Stevens Smith
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | | | - Ritodhi Chatterjee
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Olivia Hindera
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Angela Huang
- Internal Medicine Residency Program, University of Washington Boise, Boise, Idaho, USA
| | - Rishabh Kothari
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Ivo Vlaev
- Warwick Business School, University of Warwick, Coventry, United Kingdom
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Briggs K, Corriea G, Tsai A, Zhang M, Tonini M, Wilker E, Davis C, Cottrell K, Maxwell J, Huang A. 24P Evidence for synergy between TNG908, an MTAPnull-selective PRMT5 inhibitor, and sotorasib in an MTAPnull/KRASG12C xenograft model. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.01.032] [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: 11/01/2022] Open
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Rodriguez K, Nudelman MJ, Jegatheesan P, Huang A, Devarajan K, Haas JE, Cervantes R, Falbo K, Narasimhan SR, Cormier M, Stewart MB, Patel R, Govindaswami B. Are preterm birth and very low birth weight rates altered in the early COVID (2020) SARS-CoV-2 era? Front Pediatr 2022; 10:1093371. [PMID: 36699310 PMCID: PMC9869366 DOI: 10.3389/fped.2022.1093371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/05/2022] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE We evaluated the prevalence of preterm birth (PTB) and very low birth weight (VLBW) during Jan-Dec 2,020 (early COVID era) at 5 hospitals (2 in West Virginia, 3 in California) compared to Jan 2017-Dec 2019 (pre-COVID) inclusive of 2 regional perinatal centers (1 in Huntington, WV and 1 in San Jose, CA) and 3 community hospitals (1 each in Cabell, Los Angeles and Santa Clara counties). DESIGN/METHODS We examined PTB and VLBW rates of live births at 5 US hospitals from Jan 2017-Dec 2020. We compared PTB and VLBW rates in 2020 to 2017-2019 using Poisson regression and rate ratio with a 95% confidence interval. We stratified live births by gestational age (GA) (<37, 33-36, and <33 weeks) and birth weight (≤1,500 g, >1,001 g to ≤1,500 g, ≤1,000 g). We examined PTB rates at 4 of the hospitals during Jan-Dec 2020 and compared them to the prior period of Jan 2017-Dec 2019 using Statistical Process Control (SPC) for quarterly data. RESULTS We examined PTB and VLBW rates in 34,599 consecutive live births born Jan 2017-Dec 2019 to rates of 9,691 consecutive live births in 2020. There was no significant change in PTB (<37 weeks GA) rate, 10.6% in 2017-2019 vs. 11.0% in 2020 (p = 0.222). Additionally, there was no significant change when comparing VLBW rates in 2017-2019 to 2020, 1.4% in 2017-2019 vs. 1.5% in 2020 (p = 0.832). CONCLUSION We found no significant change in the rates of PTB or VLBW when combining the live birth data of 5 US hospitals in 3 different counties.
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Affiliation(s)
- Kayla Rodriguez
- Neonatology/Pediatrics, Mountain Health Network, Marshall University, Huntington, WV, United States.,Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY, United States
| | - Matthew J Nudelman
- Neonatology/Pediatrics, Mountain Health Network, Marshall University, Huntington, WV, United States.,Neonatology/Pediatrics, Santa Clara Valley Healthcare, San Jose, CA, United States
| | - Priya Jegatheesan
- Neonatology/Pediatrics, Santa Clara Valley Healthcare, San Jose, CA, United States
| | - Angela Huang
- Neonatology/Pediatrics, Santa Clara Valley Healthcare, San Jose, CA, United States
| | - Kamakshi Devarajan
- Neonatology/Pediatrics, St. Francis Medical Center, Lynwood, CA, United States.,Utilization Managment and Population Health, Silversummit Health Plan, Nevada Subsidiary of Centene Corporation, Las Vegas, Nevada, MO, United States
| | - Jessica E Haas
- Neonatology/Pediatrics, Mountain Health Network, Marshall University, Huntington, WV, United States
| | - Rosemarie Cervantes
- Neonatology/Pediatrics, St. Francis Medical Center, Lynwood, CA, United States
| | - Kelle Falbo
- Neonatology/Pediatrics, St. Francis Medical Center, Lynwood, CA, United States
| | | | - Machelnil Cormier
- Neonatology/Pediatrics, Santa Clara Valley Healthcare, San Jose, CA, United States
| | - Mary Beth Stewart
- Neonatology/Pediatrics, Mountain Health Network, Marshall University, Huntington, WV, United States
| | - Rupalee Patel
- Neonatology/Pediatrics, Santa Clara Valley Healthcare, San Jose, CA, United States
| | - Balaji Govindaswami
- Neonatology/Pediatrics, Mountain Health Network, Marshall University, Huntington, WV, United States.,Neonatology/Pediatrics, Santa Clara Valley Healthcare, San Jose, CA, United States.,VMC Foundation, San Jose, CA, United States
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Pham TH, Huang A, Hall ST, Huang V. 121. Evaluation of Multifaceted Antimicrobial Stewardship in Optimizing Antimicrobial Usage in Intraabdominal Infection at a Community Hospital. Open Forum Infect Dis 2021. [PMCID: PMC8645061 DOI: 10.1093/ofid/ofab466.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Treatment of intraabdominal infections (IAI) commonly involves broad spectrum antimicrobials based on the severity and etiology of infections as well as the underlying medical conditions. However, the overuse of broad-spectrum agents has driven selection for Gram-negative and -positive resistance, as well as collateral consequences such as Clostridioides difficile colitis. We sought to evaluate the utilization of a pharmacy-driven multifaceted antimicrobial stewardship (AMS) intervention to optimize empiric antimicrobial therapy by risk stratification among IAI patients and reduce the number of antibiotic treatment days. Methods This is a single-center case observation study in hospitalized adult IAI patients on antimicrobial therapy from Dec 2019-Feb 2020 compared to patients from Dec 2020-Feb 2021 after initiation of AMS with daily prospective audit and feedback. The composite primary outcome is reduction of antibiotic treatment days and de-escalation from broad spectrum antibiotics (fluoroquinolones, piperacillin/tazobactam, and carbapenems) to cephalosporins. Results We identified 40 patients each in the baseline (pre-AMS group) and post-AMS group via electronic medical record. Baseline characteristics were well-matched between groups. The majority of patients were diagnosed with community-acquired IAIs such as appendicitis, diverticulitis, and cholecystitis. Fluoroquinolone use as empiric therapy was significantly lower in the post-AMS group vs. pre-AMS group (2.5% vs. 25%, p< 0.001), while non-Pseudomonas cephalosporin use was increased (25% post-AMS vs. 0% pre-AMS, p< 0.001). Oral fluoroquinolone use at discharge was significantly decreased in the post-AMS group (p< 0.001). Antibiotic treatment days remained unchanged. There was no statistical difference between the two groups in 30-day mortality, 30-day readmission, relapse, and C. difficile colitis. Conclusion A multifaceted antimicrobial therapy intervention successfully reduced the use of fluoroquinolones in patients with community-acquired IAI during hospitalization and discharge. No differences in mortality, readmission, or relapse rates were observed. Disclosures All Authors: No reported disclosures
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Affiliation(s)
- Tho H Pham
- Midwestern University College of Pharmacy-Glendale Campus, Glendale, Arizona
| | | | - Scott T Hall
- Mayo Clinic Health System-Franciscan Healthcare, La Crosse, Wisconsin
| | - Vanthida Huang
- Midwestern University College of Pharmacy - Glendale, Glendale, Arizona
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Keilty D, Khandwala M, Liu Z, Papioannou V, Bouffet E, Hodgson D, Yee R, Laperriere N, Ahmed S, Mabbott D, Cushing S, Ramaswamy V, Tabori U, Huang A, Bartels U, Tsang D. Hearing Loss After Radiation and Chemotherapy for Central Nervous System and Head and Neck Tumors in Children. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Searle AK, Chen YC, Wallert M, McFadyen J, Maluenda A, Noonan J, Kanellakis P, Zaldivia MT, Huang A, Lioe H, Biondo M, Nolte MW, Rossato P, Bobik A, Panousis C, Wang X, Hosseini H, Peter K. Pharmacological inhibition of Factor XIIa attenuates abdominal aortic aneurysm, reduces atherosclerosis, and stabilizes atherosclerotic plaques. Thromb Haemost 2021; 122:196-207. [PMID: 34619795 PMCID: PMC8820844 DOI: 10.1055/a-1663-8208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background
3F7 is a monoclonal antibody targeting the enzymatic pocket of activated factor XII (FXIIa), thereby inhibiting its catalytic activity. Given the emerging role of FXIIa in promoting thromboinflammation, along with its apparent redundancy for hemostasis, the selective inhibition of FXIIa represents a novel and highly attractive approach targeting pathogenic processes that cause thromboinflammation-driven cardiovascular diseases.
Methods
The effects of FXIIa inhibition were investigated using three distinct mouse models of cardiovascular disease—angiotensin II-induced abdominal aortic aneurysm (AAA), an ApoE
−/−
model of atherosclerosis, and a tandem stenosis model of atherosclerotic plaque instability. 3F7 or its isotype control, BM4, was administered to mice (10 mg/kg) on alternate days for 4 to 8 weeks, depending on the experimental model. Mice were examined for the development and size of AAAs, or the burden and instability of atherosclerosis and associated markers of inflammation.
Results
Inhibition of FXIIa resulted in a reduced incidence of larger AAAs, with less acute aortic ruptures and an associated fibro-protective phenotype. FXIIa inhibition also decreased stable atherosclerotic plaque burden and achieved plaque stabilization associated with increased deposition of fibrous structures, a >2-fold thicker fibrous cap, increased cap-to-core ratio, and reduction in localized and systemic inflammatory markers.
Conclusion
Inhibition of FXIIa attenuates disease severity across three mouse models of thromboinflammation-driven cardiovascular diseases. Specifically, the FXIIa-inhibiting monoclonal antibody 3F7 reduces AAA severity, inhibits the development of atherosclerosis, and stabilizes vulnerable plaques. Ultimately, clinical trials in patients with cardiovascular diseases such as AAA and atherosclerosis are warranted to demonstrate the therapeutic potential of FXIIa inhibition.
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Affiliation(s)
- Amy K Searle
- Atherothrombosis and Vascular Biology, Baker Heart Research Institute - BHRI, Melbourne, Australia
| | - Yung Chih Chen
- Atherothrombosis and Vascular Biology, Baker Heart Research Institute - BHRI, Melbourne, Australia
| | - Maria Wallert
- Atherothrombosis and Vascular Biology, Baker Heart Research Institute - BHRI, Melbourne, Australia
| | - James McFadyen
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Ana Maluenda
- Atherothrombosis and Vascular Biology, Baker Heart Research Institute - BHRI, Melbourne, Australia
| | - Jonathan Noonan
- Atherothrombosis and Vascular Biology, Baker Heart Research Institute - BHRI, Melbourne, Australia
| | - Peter Kanellakis
- Atherosclerosis and Cell Biology, Baker Heart Research Institute - BHRI, Melbourne, Australia
| | - Maria Tk Zaldivia
- Atherothrombosis and Vascular Biology, Baker Heart Research Institute - BHRI, Melbourne, Australia
| | - Angela Huang
- Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Hadi Lioe
- Bio21 Institute, CSL Limited, Parkville, Australia
| | - Mark Biondo
- Bio21 Institute, CSL Limited, Parkville, Australia
| | | | | | - Alex Bobik
- Atherosclerosis and Cell Biology, Baker Heart Research Institute - BHRI, Melbourne, Australia
| | - Con Panousis
- Bio21 Institute, CSL Limited, Parkville, Australia
| | - Xiaowei Wang
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Hamid Hosseini
- Atherothrombosis and Vascular Biology, Baker Heart Research Institute - BHRI, Melbourne, Australia
| | - Karlheinz Peter
- Atherothrombosis and Vascular Biology, Baker Heart Research Institute - BHRI, Melbourne, Australia
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Jacob L, Agari K, Wlodarczyk J, Huang A, Hammoudeh J. Maxillomandibular Development after Mandibular Distraction Osteogenesis in Isolated Pierre Robin Sequence Patients. J Oral Maxillofac Surg 2021. [DOI: 10.1016/j.joms.2021.08.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Jacob L, Agari K, Wlodarczyk J, Huang A, Hammoudeh J. Maxillomandibular Development after Mandibular Distraction Osteogenesis in Isolated Pierre Robin Sequence Patients. J Oral Maxillofac Surg 2021. [DOI: 10.1016/j.joms.2021.08.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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45
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Gao H, Ma X, Apple S, Cirrone G, Huang A, Kabariti S, Saad A, Yucel R, Gustafson D, Motov S. 50 Depression in Emergency Department Healthcare Workers During the COVID-19 Outbreak in Brooklyn, NY. Ann Emerg Med 2021. [PMCID: PMC8536266 DOI: 10.1016/j.annemergmed.2021.09.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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46
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Li G, Zhao Y, Jiang Y, Yang Q, Huang A, Chen Y, Han D. 777P A prospective, single-arm, open-label study of camrelizumab, apatinib and nab-paclitaxel in patients with advanced cervical cancer. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1219] [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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47
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Song D, Prahl M, Gaw SL, Narasimhan SR, Rai DS, Huang A, Flores CV, Lin CY, Jigmeddagva U, Wu A, Warrier L, Levan J, Nguyen CBT, Callaway P, Farrington L, Acevedo GR, Gonzalez VJ, Vaaben A, Nguyen P, Atmosfera E, Marleau C, Anderson C, Misra S, Stemmle M, Cortes M, McAuley J, Metz N, Patel R, Nudelman M, Abraham S, Byrne J, Jegatheesan P. Passive and active immunity in infants born to mothers with SARS-CoV-2 infection during pregnancy: prospective cohort study. BMJ Open 2021; 11:e053036. [PMID: 34234001 PMCID: PMC8264915 DOI: 10.1136/bmjopen-2021-053036] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 06/16/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To investigate maternal immunoglobulins' (IgM, IgG) response to SARS-CoV-2 infection during pregnancy and IgG transplacental transfer, to characterise neonatal antibody response to SARS-CoV-2 infection, and to longitudinally follow actively and passively acquired antibodies in infants. DESIGN A prospective observational study. SETTING Public healthcare system in Santa Clara County (California, USA). PARTICIPANTS Women with symptomatic or asymptomatic SARS-CoV-2 infection during pregnancy and their infants were enrolled between 15 April 2020 and 31 March 2021. OUTCOMES SARS-CoV-2 serology analyses in the cord and maternal blood at delivery and longitudinally in infant blood between birth and 28 weeks of life. RESULTS Of 145 mothers who tested positive for SARS-CoV-2 during pregnancy, 86 had symptomatic infections: 78 with mild-moderate symptoms, and 8 with severe-critical symptoms. The seropositivity rates of the mothers at delivery was 65% (95% CI 0.56% to 0.73%) and the cord blood was 58% (95% CI 0.49% to 0.66%). IgG levels significantly correlated between the maternal and cord blood (Rs=0.93, p<0.0001). IgG transplacental transfer ratio was significantly higher when the first maternal positive PCR was 60-180 days before delivery compared with <60 days (1.2 vs 0.6, p<0.0001). Infant IgG seroreversion rates over follow-up periods of 1-4, 5-12, and 13-28 weeks were 8% (4 of 48), 12% (3 of 25), and 38% (5 of 13), respectively. The IgG seropositivity in the infants was positively related to IgG levels in the cord blood and persisted up to 6 months of age. Two newborns showed seroconversion at 2 weeks of age with high levels of IgM and IgG, including one premature infant with confirmed intrapartum infection. CONCLUSIONS Maternal SARS-CoV-2 IgG is efficiently transferred across the placenta when infections occur more than 2 months before delivery. Maternally derived passive immunity may persist in infants up to 6 months of life. Neonates are capable of mounting a strong antibody response to perinatal SARS-CoV-2 infection.
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Affiliation(s)
- Dongli Song
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, California, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Mary Prahl
- Department of Pediatrics, Division of Pediatric Infectious Diseases and Global Health, University of California San Francisco, San Francisco, California, USA
| | - Stephanie L Gaw
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Sudha Rani Narasimhan
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, California, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Daljeet S Rai
- Department of Family Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Angela Huang
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Claudia V Flores
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Christine Y Lin
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Unurzul Jigmeddagva
- Department of Pediatrics, Division of Pediatric Infectious Diseases and Global Health, University of California San Francisco, San Francisco, California, USA
| | - Alan Wu
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Lakshmi Warrier
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Justine Levan
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Catherine B T Nguyen
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Perri Callaway
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Lila Farrington
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Gonzalo R Acevedo
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Veronica J Gonzalez
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Anna Vaaben
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Phuong Nguyen
- Department of Pathology, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Elda Atmosfera
- Department of Pathology, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Constance Marleau
- Department of Pathology, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Christina Anderson
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, California, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Sonya Misra
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, California, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Monica Stemmle
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Department of Pediatrics, Division of Pediatric Hospital Medicine, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Maria Cortes
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Jennifer McAuley
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Nicole Metz
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Rupalee Patel
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Matthew Nudelman
- Department of Pediatrics, Marshall University, Huntington, West Virginia, USA
| | - Susan Abraham
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Department of Pediatrics, Division of Pediatric Hospital Medicine, Santa Clara Valley Medical Center, San Jose, California, USA
| | - James Byrne
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Santa Clara Valley Medical Center, San Jose, California, USA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
| | - Priya Jegatheesan
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, California, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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Shi JY, Yang Y, Huang A, Xu JX, Cheng Y, Li YK, Gu J. [A challenge for colorectal surgeons: pathogenesis, progression and management of the secondary tumors of the ovary]. Zhonghua Wei Chang Wai Ke Za Zhi 2021; 24:550-556. [PMID: 34148321 DOI: 10.3760/cma.j.issn.441530-20210506-00192] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A common clinical problem encountered by colorectal surgeons is the secondary tumors of the ovary (STO), particularly in young female patients. Most STO are from the digestive tract, and the known possible metastatic mechanisms include lymphatic, hematogenous, and intraperitoneal spreading. The molecular and histopathological characteristics of STO from different sites are diverse. It is particularly important to correctly identify the origin and feature of STO, which should be clarified by combining medical history, histopathology, immunohistochemistry, molecular biology, imaging and other means. The prognosis of patients with STO is poor in general. Comprehensive therapies based on surgical resection can benefit some patients. There is no specific treatment for STO at present, but not giving up easily on these patients is the right choice that every surgeon should understand.
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Affiliation(s)
- J Y Shi
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Y Yang
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - A Huang
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - J X Xu
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Y Cheng
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Y K Li
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - J Gu
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142, China Department of Gastrointestinal Surgery, Peking University Shougang Hospital, Beijing 100144, China Peking-Tsinghua Center for Life Science, Beijing 100142, China
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Song D, Prahl M, Gaw SL, Narasimhan S, Rai D, Huang A, Flores C, Lin CY, Jigmeddagva U, Wu AH, Warrier L, Levan J, Nguyen CB, Callaway P, Farrington L, Acevedo GR, Gonzalez VJ, Vaaben A, Nguyen P, Atmosfera E, Marleau C, Anderson C, Misra S, Stemmle M, Cortes M, McAuley J, Metz N, Patel R, Nudelman M, Abraham S, Byrne J, Jegatheesan P. Passive and active immunity in infants born to mothers with SARS-CoV-2 infection during pregnancy: Prospective cohort study. medRxiv 2021:2021.05.01.21255871. [PMID: 33972953 PMCID: PMC8109203 DOI: 10.1101/2021.05.01.21255871] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To investigate maternal immunoglobulins' (IgM, IgG) response to SARS-CoV-2 infection during pregnancy and IgG transplacental transfer, to characterize neonatal antibody response to SARS-CoV-2 infection, and to longitudinally follow actively- and passively-acquired SARS-CoV-2 antibodies in infants. DESIGN A prospective observational study. SETTING A public healthcare system in Santa Clara County (CA, USA). PARTICIPANTS Women with SARS-CoV-2 infection during pregnancy and their infants were enrolled between April 15, 2020 and March 31, 2021. OUTCOMES SARS-CoV-2 serology analyses in the cord and maternal blood at delivery and longitudinally in infant blood between birth and 28 weeks of life. RESULTS Of 145 mothers who tested positive for SARS-CoV-2 during pregnancy, 86 had symptomatic infections: 78 with mild-moderate symptoms, and eight with severe-critical symptoms. Of the 147 newborns, two infants showed seroconversion at two weeks of age with high levels of IgM and IgG, including one premature infant with confirmed intrapartum infection. The seropositivity rates of the mothers at delivery was 65% (95% CI 0.56-0.73) and the cord blood was 58% (95% CI 0.49-0.66). IgG levels significantly correlated between the maternal and cord blood (Rs= 0.93, p< 0.0001). IgG transplacental transfer ratio was significantly higher when the first maternal positive PCR was 60-180 days before delivery compared to <60 days (1.2 vs. 0.6, p=<0.0001). Infant IgG negative conversion rate over follow-up periods of 1-4, 5-12, and 13-28 weeks were 8% (4/48), 12% (3/25), and 38% (5/13), respectively. The IgG seropositivity in the infants was positively related to IgG levels in the cord blood and persisted up to six months of age. CONCLUSIONS Maternal SARS-CoV-2 IgG is efficiently transferred across the placenta when infections occur more than two months before delivery. Maternally-derived passive immunity may protect infants up to six months of life. Neonates mount a strong antibody response to perinatal SARS-CoV-2 infection.
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Affiliation(s)
- Dongli Song
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Mary Prahl
- Department of Pediatrics, Division of Pediatric Infectious Diseases and Global Health, University of California, San Francisco, CA, USA
| | - Stephanie L. Gaw
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - SudhaRani Narasimhan
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Daljeet Rai
- Department of Family Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Angela Huang
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Claudia Flores
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Christine Y. Lin
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Unurzul Jigmeddagva
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Alan H.B. Wu
- Department of Laboratory Medicine, University of California, San Francisco, CA, USA
| | - Lakshmi Warrier
- Department of Medicine, University of California San Francisco, CA, USA
| | - Justine Levan
- Department of Medicine, University of California San Francisco, CA, USA
| | | | - Perri Callaway
- Department of Medicine, University of California San Francisco, CA, USA
| | - Lila Farrington
- Department of Medicine, University of California San Francisco, CA, USA
| | | | - Veronica J. Gonzalez
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Anna Vaaben
- Department of Medicine, University of California San Francisco, CA, USA
| | - Phuong Nguyen
- Department of Pathology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Elda Atmosfera
- Department of Pathology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Constance Marleau
- Department of Pathology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Christina Anderson
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Sonya Misra
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Monica Stemmle
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Maria Cortes
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Jennifer McAuley
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Nicole Metz
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Rupalee Patel
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Matthew Nudelman
- Department of Pediatrics, Marshall University, Huntington, WV, USA
| | - Susan Abraham
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - James Byrne
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Santa Clara Valley, CA, USA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Priya Jegatheesan
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
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50
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Hawker J, Cisneros O, Huang A, Patel D, Morrissey N, Woods G, Patel M, Duffy I. TGFß family receptors ALK‐1, ALK‐5, Endoglin, TGFßRII, and BMPRII are expressed on endothelial cells and show differing biological responses to different TGFß family ligands. FASEB J 2021. [DOI: 10.1096/fasebj.2021.35.s1.04593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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