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Yarur AJ, Abreu MT, Deepak P, Beniwal-Patel P, Papamichael K, Vaughn B, Bruss A, Sekhri S, Moosreiner A, Gu P, Kennedy W, Dubinsky M, Cheifetz A, Melmed GY. Patients With Inflammatory Bowel Diseases and Higher Visceral Adipose Tissue Burden May Benefit From Higher Infliximab Concentrations to Achieve Remission. Am J Gastroenterol 2023; 118:2005-2013. [PMID: 37207314 PMCID: PMC10720850 DOI: 10.14309/ajg.0000000000002330] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/27/2023] [Indexed: 05/21/2023]
Abstract
INTRODUCTION In patients with inflammatory bowel diseases (IBDs), high visceral adipose tissue (VAT) burden is associated with a lower response to infliximab, potentially through alterations in volume distribution and/or clearance. Differences in VAT may also explain the heterogeneity in target trough levels of infliximab associated with favorable outcomes. The aim of this study was to assess whether VAT burden may be associated with infliximab cutoffs associated with efficacy in patients with IBD. METHODS We conducted a prospective cross-sectional study of patients with IBD receiving maintenance infliximab therapy. We measured baseline body composition parameters (Lunar iDXA), disease activity, trough levels of infliximab, and biomarkers. The primary outcome was steroid-free deep remission. The secondary outcome was endoscopic remission within 8 weeks of infliximab level measurement. RESULTS Overall, 142 patients were enrolled. The optimal trough levels of infliximab cutoffs associated with steroid-free deep remission and endoscopic remission were 3.9 mcg/mL (Youden Index [J]: 0.52) for patients in the lowest 2 VAT % quartiles (<1.2%) while optimal infliximab level cutoffs associated with steroid-free deep remission for those patients in the highest 2 VAT % quartiles was 15.3 mcg/mL (J: 0.63). In a multivariable analysis, only VAT % and infliximab level remained independently associated with steroid-free deep remission (odds ratio per % of VAT: 0.3 [95% confidence interval: 0.17-0.64], P < 0.001 and odds ratio per μg/mL: 1.11 [95% confidence interval: 1.05-1.19], P < 0.001). DISCUSSION The results may suggest that patients with higher visceral adipose tissue burden may benefit from achieving higher infliximab levels to achieve remission.
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Affiliation(s)
- Andres J. Yarur
- Division of Gastroenterology and Hepatology, Center for Inflammatory Bowel Diseases, Cedars Sinai Medical Center, Los Angeles, California, USA
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Maria T. Abreu
- Center for Inflammatory Bowel Diseases, Division of Gastroenterology and Hepatology, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Parakkal Deepak
- Division of Gastroenterology and Hepatology, Washington University, St Louis, Missouri, USA
| | - Poonam Beniwal-Patel
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Konstantinos Papamichael
- Center for Inflammatory Bowel Diseases, Division of Gastroenterology, Beth-IsraelDeaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Byron Vaughn
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
| | - Alexandra Bruss
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Shaina Sekhri
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Andrea Moosreiner
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Phillip Gu
- Division of Gastroenterology and Hepatology, Center for Inflammatory Bowel Diseases, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - William Kennedy
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Marla Dubinsky
- Division of Pediatric Gastroenterology and Nutrition, Mount Sinai Kravis Children's Hospital, Icahn School of Medicine Mount Sinai, New York, USA.
| | - Adam Cheifetz
- Center for Inflammatory Bowel Diseases, Division of Gastroenterology, Beth-IsraelDeaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Gil Y. Melmed
- Division of Gastroenterology and Hepatology, Center for Inflammatory Bowel Diseases, Cedars Sinai Medical Center, Los Angeles, California, USA
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Petrik M, Palmer B, Khoruts A, Vaughn B. Psychological Features in the Inflammatory Bowel Disease-Irritable Bowel Syndrome Overlap: Developing a Preliminary Understanding of Cognitive and Behavioral Factors. Crohns Colitis 360 2021; 3:otab061. [PMID: 36776665 PMCID: PMC9802046 DOI: 10.1093/crocol/otab061] [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: 06/07/2021] [Indexed: 11/15/2022] Open
Abstract
Background Inflammatory bowel disease (IBD) patients in clinical remission may experience ongoing symptoms, such as diarrhea and abdominal pain, attributed to IBD-irritable bowel syndrome (IBS) overlap. This study aims to characterize the psychosocial needs of patients with IBD-IBS overlap, particularly in regard to cognitive and behavioral functioning. Methods Adults with an established IBD diagnosis were recruited from a gastroenterology clinic. Participants completed self-report questionnaires about psychological functioning and quality of life. The Rome IV Diagnostic Questionnaire for Adults-IBS Module assessed IBS criteria. The treating gastroenterologist completed a clinician rating of IBD activity to determine clinical disease activity. Biomarkers of inflammation collected in routine care within 90 days of the research encounter were obtained via medical record review to further contextualize IBD activity status. Participants were separated into the following groups: "inactive IBD" (IBD activity rating indicating inactive disease and no IBS criteria met), "active IBD" (IBD activity rating indicating mild, moderate, or severe regardless of IBS criteria), or "IBD-IBS overlap" (IBD activity rating indicating inactive disease and IBS criteria met). Results One hundred and seventeen participants were recruited. Those with IBD-IBS overlap reported no significant differences in ratings of anxiety, depression, somatization, catastrophic thinking patterns, and behavioral avoidance, to patients with active IBD whereas participants with inactive IBD reported significantly lower ratings on these factors. However, a significant portion of participants with IBD-IBS overlap who were rated as inactive on IBD activity measures had laboratory or endoscopic findings indicating mild inflammation within 90 days of the research encounter. Conclusions The study findings provide preliminary evidence that suggests patients with IBD-IBS overlap display similar rates of psychological distress, catastrophic thinking, and avoidance behaviors as those with active IBD. Those with mild ongoing inflammation despite meeting a definition for clinical remission may have similar psychological needs compared to those with moderate-to-severely active IBD. Incorporating a mental health provider with training in psychogastroenterology can help a patient with IBD learn how to effectively with these cognitive and behavioral patterns.
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Affiliation(s)
- Megan Petrik
- University of Minnesota Medical School, Department of Medicine, Division of General Internal Medicine, Minneapolis, Minnesota, USA,Address correspondence to: Megan Petrik, PhD, LP, MMC 741, 420 Delaware Street SE, Minneapolis, MN 55455, USA ()
| | - Brooke Palmer
- University of Minnesota Medical School, Department of Medicine, Division of General Internal Medicine, Minneapolis, Minnesota, USA
| | - Alexander Khoruts
- University of Minnesota Medical School, Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Minneapolis, Minnesota, USA
| | - Byron Vaughn
- University of Minnesota Medical School, Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Minneapolis, Minnesota, USA
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Laique SN, Hayat U, Sarvepalli S, Vaughn B, Ibrahim M, McMichael J, Qaiser KN, Burke C, Bhatt A, Rhodes C, Rizk MK. Application of optical character recognition with natural language processing for large-scale quality metric data extraction in colonoscopy reports. Gastrointest Endosc 2021; 93:750-757. [PMID: 32891620 PMCID: PMC8794764 DOI: 10.1016/j.gie.2020.08.038] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 09/25/2018] [Accepted: 08/27/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Colonoscopy is commonly performed for colorectal cancer screening in the United States. Reports are often generated in a non-standardized format and are not always integrated into electronic health records. Thus, this information is not readily available for streamlining quality management, participating in endoscopy registries, or reporting of patient- and center-specific risk factors predictive of outcomes. We aim to demonstrate the use of a new hybrid approach using natural language processing of charts that have been elucidated with optical character recognition processing (OCR/NLP hybrid) to obtain relevant clinical information from scanned colonoscopy and pathology reports, a technology co-developed by Cleveland Clinic and eHealth Technologies (West Henrietta, NY, USA). METHODS This was a retrospective study conducted at Cleveland Clinic, Cleveland, Ohio, and the University of Minnesota, Minneapolis, Minnesota. A randomly sampled list of outpatient screening colonoscopy procedures and pathology reports was selected. Desired variables were then collected. Two researchers first manually reviewed the reports for the desired variables. Then, the OCR/NLP algorithm was used to obtain the same variables from 3 electronic health records in use at our institution: Epic (Verona, Wisc, USA), ProVation (Minneapolis, Minn, USA) used for endoscopy reporting, and Sunquest PowerPath (Tucson, Ariz, USA) used for pathology reporting. RESULTS Compared with manual data extraction, the accuracy of the hybrid OCR/NLP approach to detect polyps was 95.8%, adenomas 98.5%, sessile serrated polyps 99.3%, advanced adenomas 98%, inadequate bowel preparation 98.4%, and failed cecal intubation 99%. Comparison of the dataset collected via NLP alone with that collected using the hybrid OCR/NLP approach showed that the accuracy for almost all variables was >99%. CONCLUSIONS Our study is the first to validate the use of a unique hybrid OCR/NLP technology to extract desired variables from scanned procedure and pathology reports contained in image format with an accuracy >95%.
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Affiliation(s)
- Sobia Nasir Laique
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, Arizona
| | - Umar Hayat
- Division of Gastroenterology, University of Minnesota, Minneapolis, Minnesota
| | - Shashank Sarvepalli
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, Ohio,Department of Bioinformatics, Vanderbilt University, Nashville, Tennessee
| | - Byron Vaughn
- Division of Gastroenterology, University of Minnesota, Minneapolis, Minnesota
| | - Mounir Ibrahim
- Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | - John McMichael
- Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Carol Burke
- Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | - Amit Bhatt
- Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | - Colin Rhodes
- eHealth Technology, West Henrietta, New York, New York, USA
| | - Maged K. Rizk
- Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
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Roy A, Davis CW, Vaughn B, Dayno JM, Dauvilliers Y, Schwartz J. 0768 Time Course Of Improvement In Excessive Daytime Sleepiness And Cataplexy During Treatment With Pitolisant In Patients With Narcolepsy. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
This analysis evaluated the efficacy of pitolisant over time in three 7- to 8-week, randomized, placebo-controlled studies of adults with narcolepsy.
Methods
Patients in all 3 studies (HARMONY-1, HARMONY-1bis, HARMONY-CTP) experienced excessive daytime sleepiness (EDS) at study baseline; patients in HARMONY-CTP also experienced ≥3 cataplexy attacks/week. Pitolisant was titrated to a maximum dose of 35.6 mg/day (HARMONY-1, HARMONY-CTP) or 17.8 mg/day (HARMONY-1bis). Change from baseline in mean Epworth Sleepiness Scale (ESS) score (3 studies) and mean weekly rate of cataplexy (WRC; 1 study) was compared for pitolisant versus placebo.
Results
In the higher-dose HARMONY-1 (pitolisant, n=31; placebo, n=30) and HARMONY-CTP (pitolisant, n=54; placebo, n=51) studies, ESS score improvement was significantly greater with pitolisant versus placebo beginning at Week 2 (LS mean difference, -2.8; P=0.015) and Week 3 (LS mean difference, -2.0; P=0.005), respectively. In the lower-dose HARMONY-1bis study (pitolisant, n=66; placebo, n=32), significant separation from placebo was first observed at Week 7 (LS mean difference, -2.3; P=0.044). At end-of-treatment, LS mean difference in ESS score change from baseline was -3.1 (P=0.022) in HARMONY-1, -3.4 (P<0.001) in HARMONY-CTP, and -2.2 (P=0.030) in HARMONY-1bis. In HARMONY-CTP, LS mean WRC with pitolisant was 11.7 at baseline, 4.6 at end-of-treatment, and 5.1 after a 1-week, placebo-washout period. Improvement in WRC was significantly greater with pitolisant versus placebo beginning at Week 2 (LS mean difference, -5.3; P=0.004) and continued through end-of-treatment (LS mean difference, -6.2; P<0.001); there was no evidence of rebound cataplexy after placebo-washout (LS mean difference, -4.9; P=0.027).
Conclusion
During pitolisant treatment, improvement in EDS occurred sooner (within first few weeks) and was more robust in studies that permitted titration to the maximum recommended dose (35.6 mg/day). The rate of cataplexy attacks decreased early during treatment, with no evidence of rebound when pitolisant was withdrawn.
Support
Bioprojet Pharma and Harmony Biosciences, LLC.
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Affiliation(s)
- A Roy
- Ohio Sleep Medicine Institute, Dublin, OH
| | - C W Davis
- Harmony Biosciences, LLC, Plymouth Meeting, PA
| | | | - J M Dayno
- Harmony Biosciences, LLC, Plymouth Meeting, PA
| | - Y Dauvilliers
- National Reference Center for Narcolepsy, Montpellier, FRANCE
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Davis CW, Kallweit U, Krahn LE, Vaughn B, Thorpy MJ. 0762 Efficacy Of Pitolisant In Patients With High Burden Of Narcolepsy Symptoms. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Recent literature suggests that histamine may play an important role in narcolepsy. This post hoc analysis evaluates the efficacy of pitolisant, a histamine 3 (H3)-receptor antagonist/inverse agonist, in patients with high burden of the main narcolepsy symptoms.
Methods
Data were pooled from 2 randomized, placebo-controlled, 7- and 8-week studies of pitolisant (individually titrated; maximum dose, 35.6 mg/day) in adults with narcolepsy. Analyses included 3 independent patient subgroups: baseline score of >16 on the Epworth Sleepiness Scale (ESS), sleep latency of ≤8 minutes on the Maintenance of Wakefulness Test (MWT), and ≥15 cataplexy attacks per week.
Results
The analysis populations included 108 patients for the ESS (pitolisant, n=54; placebo, n=54), 105 for the MWT (pitolisant, n=59; placebo, n=46), and 31 for cataplexy (pitolisant, n=20; placebo, n=11). Mean change in ESS from baseline was significantly greater for pitolisant (-6.1) compared with placebo (-2.6; P=0.0002). A significantly greater percentage of pitolisant-treated patients were classified as treatment responders: for ESS score reduction ≥3, 68.5% in the pitolisant group versus 35.2% in the placebo group (P=0.0006); for final ESS score ≤10, 35.2% versus 9.3%, respectively (P=0.0026). Mean increase in sleep latency on the MWT was significantly greater for pitolisant (7.0 minutes) compared with placebo (3.4 minutes; P=0.0089). Decrease in mean weekly rate of cataplexy was significantly greater for pitolisant (baseline, 21.8; final, 3.9) compared with placebo (baseline, 20.9; final, 18.2); the rate ratio was 0.35 (95% CI, 0.26‒0.47; P<0.001). The adverse event profile in the analysis populations was consistent with the known safety profile for pitolisant; headache was the most common adverse event in pitolisant-treated patients (10.0%-20.4%).
Conclusion
In patients with severe symptom burden, pitolisant produced significantly greater improvements in excessive daytime sleepiness and cataplexy compared with placebo, highlighting the important role of histamine in narcolepsy.
Support
Bioprojet Pharma and Harmony Biosciences, LLC.
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Affiliation(s)
- C W Davis
- Harmony Biosciences, LLC, Plymouth Meeting, PA
| | - U Kallweit
- Universität Witten/Herdecke, Center for Narcolepsy and Hypersomnias, Institute of Immunology, and Center for Biomedical Education and Research, Witten, GERMANY
| | | | | | - M J Thorpy
- Albert Einstein College of Medicine, Bronx, NY
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6
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Davis C, Krahn L, Vaughn B, Thorpy M. Efficacy of pitolisant in patients with high burden of narcolepsy symptoms. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.238] [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: 10/25/2022]
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Reinecke K, Vaughn B, Fan Z, Perry M, Roth H. 0818 Sleep and ADHD in Children: Are Pediatric Residents Considering Sleep Problems When Diagnosing ADHD? Sleep 2018. [DOI: 10.1093/sleep/zsy061.817] [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: 11/13/2022] Open
Affiliation(s)
- K Reinecke
- University of North Carolina, Chapel Hill, NC
| | - B Vaughn
- University of North Carolina, Chapel Hill, NC
| | - Z Fan
- University of North Carolina, Chapel Hill, NC
| | - M Perry
- University of North Carolina, Chapel Hill, NC
| | - H Roth
- University of North Carolina, Chapel Hill, NC
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Boyle MP, Moss AC, O'Toole AM, Vaughn B, Cheifetz AS. C-reactive protein as a predictor of low trough infliximab concentrations in patients who lose response to infliximab. J Dig Dis 2017; 18:678-683. [PMID: 29119722 DOI: 10.1111/1751-2980.12560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 03/13/2017] [Revised: 10/27/2017] [Accepted: 11/05/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Low serum infliximab concentrations are associated with an increased risk of loss of response in inflammatory bowel disease (IBD). The objective of this study was to evaluate the test characteristics of C-reactive protein (CRP) in identifying low serum infliximab concentrations in patients with IBD. METHODS We measured serum infliximab concentrations and CRP levels in patients who experienced deteriorating symptoms while on infliximab (the reactive cohort). Receiver operating characteristic (ROC) curves were used to determine the CRP concentration threshold that identified an infliximab concentration <3 μg/mL at the time of loss of response. These CRP thresholds for infliximab concentration <3 μg/mL were then tested in a separate validation cohort. RESULTS The reactive cohort contained 111 patients and the validation cohort contained 139 patients. In 41% of participants, serum infliximab concentration was <3 μg/mL. In the reactive cohort, the area under the ROC curve for CRP to identify an infliximab concentration <3 μg/mL was 0.70 (95% confidence interval [CI] 0.50-0.80, P = 0.02). A CRP level above 12 mg/L in the preceding 90 days provided a 90% specificity for the later detection of infliximab concentration <3 μg/mL. These test characteristics were similar in the validation cohort. CONCLUSION CRP levels over 12 mg/L exhibit a high specificity for identifying patients with an infliximab concentration <3 μg/mL. CRP may be cost-effective for identifying patients with low concentrations of infliximab at the time of, or at risk of, loss of response.
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Affiliation(s)
- Marie P Boyle
- Division of Gastroenterology, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, Massachusetts, USA
| | - Alan C Moss
- Division of Gastroenterology, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, Massachusetts, USA
| | - Aoibhlinn M O'Toole
- Division of Gastroenterology, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, Massachusetts, USA
| | - Byron Vaughn
- Division of Gastroenterology, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, Massachusetts, USA
| | - Adam S Cheifetz
- Division of Gastroenterology, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, Massachusetts, USA
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Longhi MS, Vuerich M, Kalbasi A, Kenison JE, Yeste A, Csizmadia E, Vaughn B, Feldbrugge L, Mitsuhashi S, Wegiel B, Otterbein L, Moss A, Quintana FJ, Robson SC. Bilirubin suppresses Th17 immunity in colitis by upregulating CD39. JCI Insight 2017; 2:92791. [PMID: 28469075 DOI: 10.1172/jci.insight.92791] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [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: 01/13/2017] [Accepted: 03/23/2017] [Indexed: 12/21/2022] Open
Abstract
Unconjugated bilirubin (UCB), a product of heme oxidation, has known immunosuppressant properties but the molecular mechanisms, other than antioxidant effects, remain largely unexplored. We note that UCB modulates T helper type 17 (Th17) immune responses, in a manner dependent upon heightened expression of CD39 ectonucleotidase. UCB has protective effects in experimental colitis, where it enhances recovery after injury and preferentially boosts IL-10 production by colonic intraepithelial CD4+ cells. In vitro, UCB confers immunoregulatory properties on human control Th17 cells, as reflected by increased levels of FOXP3 and CD39 with heightened cellular suppressor ability. Upregulation of CD39 by Th17 cells is dependent upon ligation of the aryl hydrocarbon receptor (AHR) by UCB. Genetic deletion of CD39, as in Entpd1-/- mice, or dysfunction of AHR, as in Ahrd mice, abrogates these UCB salutary effects in experimental colitis. However, in inflammatory bowel disease (IBD) samples, UCB fails to confer substantive immunosuppressive properties upon Th17 cells, because of decreased AHR levels under the conditions tested in vitro. Immunosuppressive effects of UCB are mediated by AHR resulting in CD39 upregulation by Th17. Boosting downstream effects of AHR via UCB or enhancing CD39-mediated ectoenzymatic activity might provide therapeutic options to address development of Th17 dysfunction in IBD.
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Affiliation(s)
- Maria Serena Longhi
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Marta Vuerich
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Alireza Kalbasi
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Jessica E Kenison
- Center for Neurologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ada Yeste
- Center for Neurologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Eva Csizmadia
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Byron Vaughn
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Linda Feldbrugge
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Shuji Mitsuhashi
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Barbara Wegiel
- Division of Transplantation, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Leo Otterbein
- Division of Transplantation, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Alan Moss
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Francisco J Quintana
- Center for Neurologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Simon C Robson
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Ewing T, Ahn M, Kumar K, Vaughn B, Roth H, Fan Z. 0865 SLEEP PARAMETERS OF PATIENTS WITH DUCHENNE MUSCULAR DYSTROPHY. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kamieniecki R, Vaughn B, Danielson J, Bonnie K, Carter M, Mihic T, Williams S, Puyat J. Characterizing the inpatient care of young adults experiencing early psychosis. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.02.409] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction/objectivesThe available literature suggests that treatments and health services for psychosis are considered to be poorly organized and highly variable. Little is known, however, about how inpatient care is provided to individuals experiencing early psychosis. To facilitate quality improvement activities, we characterized the care this patient group receives in an inner city hospital.MethodsWe performed chart reviews of individuals admitted to psychiatric inpatient units at St. Paul's Hospital, Vancouver, British Columbia between 01/04/2014 and 31/03/2016. Those who were 17–25 years of age and hospitalized for psychotic symptoms at the time of admission were included. Demographic and health service use were summarized using descriptive characteristics.ResultsWe identified 73 inpatients (mean age = 22; males = 78%; Caucasian = 41%) that met study inclusion criteria, having a combined total of 102 care episodes and an average length of stay of 30.7 days (median = 18; min = 3; max = 268). Half of the care episodes were repeat admissions, with up to 30% of the patients readmitted within 28 days of discharge. Physical and mental status examinations (MSE) were performed in virtually all care episodes, although frequency is low (31.4% had daily physical examinations and 18.6% had MSE every nursing shift). In 49% and 50% of care episodes, patients were given oral antipsychotics and discharged on depot medications. Even when indicated, not all care episodes had follow-up appointments (60%) or referrals to income assistance (35%), community mental health teams (61%), and housing support (38%).ConclusionsSpecific programs are needed to address current gaps in inpatient care for patients with early psychosis.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Gendreau R, Arnold L, Clauw D, Gendreau J, Vaughn B, Daugherty B, Lederman S. THU0560 TNX-102 SL for The Treatment of fibromyalgia: Comparison of 30% Pain Responder Analysis with Omeract Draft Composite Responder Endpoint Analyses:. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1327] [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: 11/04/2022]
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13
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Tapper EB, Patwardhan V, Mazer LM, Vaughn B, Piatkowski G, Evenson AR, Malik R. Predictors of negative intraoperative findings at emergent laparotomy in patients with cirrhosis. J Gastrointest Surg 2014; 18:1777-83. [PMID: 25091839 PMCID: PMC5557345 DOI: 10.1007/s11605-014-2599-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 07/16/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Emergent surgery in the setting of decompensated cirrhosis is highly morbid. We sought to determine the clinical factors associated with negative intraoperative findings at emergent laparotomy. METHODS We performed a retrospective cohort study of consecutive inpatients with a diagnosis of cirrhosis (ICD-9 571) admitted to the Beth Israel Deaconess Medical Center (Boston, MA) who underwent emergent, nonhepatic, abdominal surgery between May 6, 2005 and September 3, 2012. RESULTS Eighty-six patients with cirrhosis were included with a mean model for end-stage liver disease score of 21.3 ± 7.95 and a 90-day mortality rate of 39.5%. Twelve (16.2%) patients had negative laparotomies. Negative intraoperative findings were independently associated with (1) paracentesis prior to a preoperative diagnosis of perforated viscus (P = 0.006), (2) development of an indication for emergent surgery after 24 h into hospital admission for another reason (P = 0.020), and (3) a preoperative diagnosis of bowel ischemia (P = 0.005), with odds ratios of 10.1 (CI 1.92-66.83), 5.80 (CI 1.32-33.39), and 11.1 (CI 2.08-77.4), respectively. Free air on computed tomography (CT) imaging was found in 64.3% (9/14) of patients who had a paracentesis within the preceding 48 h compared to 10.1% (7/72) among patients who did not undergo a paracentesis (P < 0.001). Only 45% of patients with free air following a paracentesis had positive findings at laparotomy compared to 100% in those without a preceding paracentesis (P = 0.038). Negative laparotomy was independently predictive of in-hospital mortality (OR 4.7; P = 0.034). CONCLUSION The possibility of a negative laparotomy is suggested by preoperative clinical factors. In particular, free air following a paracentesis does not necessarily indicate that operative intervention is required. Consideration of close observation before laparotomy in these patients is reasonable.
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Affiliation(s)
- Elliot B. Tapper
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA. Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Vilas Patwardhan
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Laura M. Mazer
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Byron Vaughn
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Gail Piatkowski
- Decision Support, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Amy R. Evenson
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Raza Malik
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
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Abstract
Purinergic signalling is involved in both the physiology and pathophysiology of the liver. Hepatocytes, Kupffer cells, vascular endothelial cells and smooth muscle cells, stellate cells and cholangiocytes all express purinoceptor subtypes activated by adenosine, adenosine 5'-triphosphate, adenosine diphosphate, uridine 5'-triphosphate or UDP. Purinoceptors mediate bile secretion, glycogen and lipid metabolism and indirectly release of insulin. Mechanical stress results in release of ATP from hepatocytes and Kupffer cells and ATP is also released as a cotransmitter with noradrenaline from sympathetic nerves supplying the liver. Ecto-nucleotidases play important roles in the signalling process. Changes in purinergic signalling occur in vascular injury, inflammation, insulin resistance, hepatic fibrosis, cirrhosis, diabetes, hepatitis, liver regeneration following injury or transplantation and cancer. Purinergic therapeutic strategies for the treatment of these pathologies are being explored.
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Affiliation(s)
- Geoffrey Burnstock
- Autonomic Neuroscience Centre, University College Medical School, Rowland Hill Street, London, NW3 2PF, UK,
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Frohlich F, Sellers K, Boyle M, Ali M, Cordle A, Vaughn B, Gilmore J. OP 9. Tailoring transcranial current stimulation to modulate cortical oscillations in computer simulations, ferrets, and humans. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.04.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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16
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Abstract
Purinergic signaling has been postulated as a mechanism of cellular signaling since the early 1970s. Cellular responses triggered by extracellular nucleotides and nucleosides occur by defined adenosine (P1) and ATP (P2) receptors, respectively, and play a prominent role in many aspects of health and disease, including those involving the liver. In normal physiology, extracellular nucleotides modulate many of the normal biologic and hepatic metabolic processes such as gluconeogenesis and insulin responsiveness. Further, in multiple disease states, ATP and certain nucleotides serve as danger signals and are involved in heightened purinergic receptor activation in a myriad of pathologic processes. Recently, others and we have shown the regulation of purinergic signaling by ectonucleotidases to play an important role in the acute vascular pathobiology of liver inflammation, regeneration, and immunity, as in ischemia reperfusion and transplantation. Increased understanding into mechanisms of extracellular ATP metabolism by such ecto enzymes has also led to novel insights into the exquisite balance of nucleotide P2-receptor and adenosinergic P1-receptor signaling in those chronic hepatic diseases characterized by steatosis, fibrosis, and malignancy. This review will explore the developing role of purinergic signaling in the pathophysiology of liver disease and comment on potential future clinical applications.
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Affiliation(s)
| | - Simon C. Robson
- Corresponding Author: Simon C Robson MD PhD, Division of Gastroenterology, CLS 612, Beth Israel Deaconess Medical Centre/Harvard Medical School, Boston MA 02215 USA. tel - 617 735 2921, fax - 617 735 2930,
| | - Geoffrey Burnstock
- Autonomic Neuroscience Centre University College Medical School, Royal Free Campus, London, UK
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17
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Cullen G, Vaughn B, Ahmed A, Peppercorn MA, Smith MP, Moss AC, Cheifetz AS. Abdominal phlegmons in Crohn's disease: outcomes following antitumor necrosis factor therapy. Inflamm Bowel Dis 2012; 18:691-6. [PMID: 21648022 DOI: 10.1002/ibd.21783] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [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: 04/08/2011] [Accepted: 04/29/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND An abdominal phlegmon is an inflammatory mass that can develop in the setting of penetrating Crohn's disease (CD). Anti-tumor necrosis factor (TNF) antibody therapy is typically avoided in CD complicated by phlegmon because of concern for peritoneal infection but may offer an effective alternative to surgical resection after infection has been controlled with antibiotics. The aim of this study was to examine outcomes for patients with CD who developed an abdominal phlegmon that was subsequently treated with an anti-TNF antibody. METHODS We retrospectively reviewed the records of all CD patients attending Beth Israel Deaconess Medical Center between 2004 and 2010 with an abdominal phlegmon who were treated with an anti-TNF antibody in order to evaluate the safety and efficacy of this treatment regimen. RESULTS There were 13 patients with CD complicated by a phlegmon treated with antibiotics and an anti-TNF antibody at our center between 2004 and 2010. Ten were male. Median time (interquartile range) from diagnosis to development of the phlegmon was 5.9 (1.9-22.7) years. The phlegmon was associated with an abscess in 12 patients. In addition to anti-TNF therapy, all patients were treated with broad-spectrum antibiotics. Anti-TNF therapy was effective without complications in all subjects. Two patients eventually had surgery more than a year after initiating anti-TNF treatment. CONCLUSIONS Penetrating CD complicated by phlegmon formation may be safely and effectively managed with a combination of antibiotics and anti-TNF therapy. Larger, prospective trials are required to confirm these initial findings.
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Affiliation(s)
- Garret Cullen
- Center for Inflammatory Bowel Disease, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts 02215, USA.
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18
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Tian L, Yao T, MacClune K, White JWC, Schilla A, Vaughn B, Vachon R, Ichiyanagi K. Stable isotopic variations in west China: A consideration of moisture sources. ACTA ACUST UNITED AC 2007. [DOI: 10.1029/2006jd007718] [Citation(s) in RCA: 370] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Lide Tian
- Laboratory of Land Surface Processes Monitoring; Institute of Tibetan Plateau Research; Beijing China
- Stable Isotope Laboratory, Institute of Arctic and Alpine Research; University of Colorado; Boulder Colorado USA
- Key Laboratory of Cryosphere and Environment, Cold and Arid Regions Environment and Engineering Research Institute; Chinese Academy of Science; Lanzhou China
| | - Tandong Yao
- Laboratory of Land Surface Processes Monitoring; Institute of Tibetan Plateau Research; Beijing China
| | - K. MacClune
- Stable Isotope Laboratory, Institute of Arctic and Alpine Research; University of Colorado; Boulder Colorado USA
| | - J. W. C. White
- Stable Isotope Laboratory, Institute of Arctic and Alpine Research; University of Colorado; Boulder Colorado USA
| | - A. Schilla
- Stable Isotope Laboratory, Institute of Arctic and Alpine Research; University of Colorado; Boulder Colorado USA
| | - B. Vaughn
- Stable Isotope Laboratory, Institute of Arctic and Alpine Research; University of Colorado; Boulder Colorado USA
| | - R. Vachon
- Stable Isotope Laboratory, Institute of Arctic and Alpine Research; University of Colorado; Boulder Colorado USA
| | - K. Ichiyanagi
- Institute of Observational Research for Global Change; Yokosuka Japan
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19
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Sever M, Arbes S, Zeldin D, Schal C, Santangelo R, Gore J, Vaughn B, Mitchell H. Cockroach Allergen Reduction by Extermination Alone in Low-Income, Urban Homes-A Randomized Control Trial. J Allergy Clin Immunol 2007. [DOI: 10.1016/j.jaci.2006.11.554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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20
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Sever M, Arbes S, Gore J, Santangelo R, Vaughn B, Mitchell H, Schal C, Zeldin D. Cockroach Allergen Reduction by Extermination Alone in Low-Income, Urban Homes-A Randomized Control Trial. J Allergy Clin Immunol 2006. [DOI: 10.1016/j.jaci.2005.12.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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21
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Sever M, Arbes S, Vaughn B, Mehta J, Lynch J, Mitchell H, Hoppin J, Spencer H, Sandler D, Zeldin D. Feasibility of using subject-collected dust samples in epidemiological and clinical studies of indoor allergens. J Allergy Clin Immunol 2005. [DOI: 10.1016/j.jaci.2004.12.400] [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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22
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Masarie KA, Langenfelds RL, Allison CE, Conway TJ, Dlugokencky EJ, Francey RJ, Novelli PC, Steele LP, Tans PP, Vaughn B, White JWC. NOAA/CSIRO Flask Air Intercomparison Experiment: A strategy for directly assessing consistency among atmospheric measurements made by independent laboratories. ACTA ACUST UNITED AC 2001. [DOI: 10.1029/2000jd000023] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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23
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DeGiorgio CM, Schachter SC, Handforth A, Salinsky M, Thompson J, Uthman B, Reed R, Collins S, Tecoma E, Morris GL, Vaughn B, Naritoku DK, Henry T, Labar D, Gilmartin R, Labiner D, Osorio I, Ristanovic R, Jones J, Murphy J, Ney G, Wheless J, Lewis P, Heck C. Prospective long-term study of vagus nerve stimulation for the treatment of refractory seizures. Epilepsia 2000; 41:1195-200. [PMID: 10999559 DOI: 10.1111/j.1528-1157.2000.tb00325.x] [Citation(s) in RCA: 314] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the long-term efficacy of vagus nerve stimulation (VNS) for refractory seizures. VNS is a new treatment for refractory epilepsy. Two short-term double-blind trials have demonstrated its safety and efficacy, and one long-term study in 114 patients has demonstrated a cumulative improvement in efficacy at 1 year. We report the largest prospective long-term study of VNS to date. METHODS Patients with six or more complex partial or generalized tonic-clonic seizures enrolled in the pivotal EO5 study were prospectively evaluated for 12 months. The primary outcome variable was the percentage reduction in total seizure frequency at 3 and 12 months after completion of the acute EO5 trial, compared with the preimplantation baseline. Subjects originally randomized to low stimulation (active-control group) were crossed over to therapeutic stimulation settings for the first time. Subjects initially randomized to high settings were maintained on high settings throughout the 12-month study. RESULTS The median reduction at 12 months after completion of the initial double-blind study was 45%. At 12 months, 35% of 195 subjects had a >50% reduction in seizures, and 20% of 195 had a >75% reduction in seizures. CONCLUSIONS The efficacy of VNS improves during 12 months, and many subjects sustain >75% reductions in seizures.
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Affiliation(s)
- C M DeGiorgio
- Olive View/UCLA Medical Center and UCLA Department of Neurology, Los Angeles, California 91342, USA.
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24
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Johnson MM, Vaughn B, Triggiani M, Swan DD, Fonteh AN, Chilton FH. Role of arachidonyl triglycerides within lipid bodies in eicosanoid formation by human polymorphonuclear cells. Am J Respir Cell Mol Biol 1999; 21:253-8. [PMID: 10423409 DOI: 10.1165/ajrcmb.21.2.3489] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Increasing evidence suggests that the subcellular and glycerolipid localization of esterified arachidonic acid (AA) is a key factor in regulating its availability to lipases. The goal of the current study was to determine the potential of AA stored in triglycerides (TG) to serve as a substrate for lipases and 5-lipoxygenase during neutrophil (polymorphonuclear leukocytes, PMN) activation. PMN containing high concentrations of AA in TG were generated by culturing PMN in vitro with high concentrations of exogenous AA (eAA) for 12 h. Cellular AA increased 2- and 4-fold in PMNs incubated with 5 and 20 microM AA, respectively, and this increase was almost exclusively observed in neutral lipids (NL). Further analysis revealed that 88% of the AA in the NL fraction was associated with TG. Subsequent experiments were designed to determine whether this AA in TG could be mobilized and metabolized to eicosanoids during cell activation. TG pools of AA were increased as previously described and then PMN were stimulated with ionophore, A23187. In contrast to the 43-fold increase in TG AA after eAA loading (20 microM), free AA increased by only 1.9-fold after cell stimulation. Similarly, leukotriene (LT)B(4) production increased only 2-fold after loading TG with large quantities of AA. The magnitude of increase in free AA released and in LTB(4) formation was similar to the magnitude of increase in AA mass in phospholipase (PL), suggesting that PL, and not TG, served as the source of released AA and subsequent product generation. To confirm that AA in TG did not serve as a source for eicosanoid production, cellular pools of AA were differentially labeled with [(14)C]AA and [(3)H]AA, and the [(3)H]AA-to-[(14)C]AA ratio of LTB(4) and 20-hydroxyl LTB(4) produced during cell stimulation was measured. The [(3)H]AA/[(14)C]AA ratios of LTs were markedly different from the ratios in TG, thus providing further evidence that AA pools in TG are not a major source of AA for LT generation.
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Affiliation(s)
- M M Johnson
- Department of Medicine, Mayo Clinic Jacksonville, Jacksonville, Florida, USA.
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25
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Vaughn B. Clinical review of 1996. Nurs Stand 1996; 11:39. [PMID: 9000942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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26
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Verdi CJ, Garewal HS, Koenig LM, Vaughn B, Burkhead T. A double-blind, randomized, placebo-controlled, crossover trial of pentoxifylline for the prevention of chemotherapy-induced oral mucositis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995; 80:36-42. [PMID: 7552860 DOI: 10.1016/s1079-2104(95)80014-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Oral mucositis is a frequent side effect of cancer therapy. No effective method of prophylaxis is currently available. We conducted a randomized, double-blind, placebo-controlled, crossover trial of pentoxifylline to evaluate its potential in preventing mucositis in cancer patients receiving chemotherapy. Ten cancer patients were randomized for treatment with a 15-day course of 400 mg of pentoxifylline given orally four times daily. Concurrent chemotherapy consisted of bolus cisplatin and infusional 5-fluorouracil. Mucositis was evaluated with the use of the Oral Assessment Guide developed at the University of Nebraska. Patients completing two cycles of chemotherapy--one with pentoxifylline and one with placebo--were evaluated for prophylaxis efficacy. Comparison of the oral assessment scores of the two cycles with a two-sided Student's t test failed to demonstrate a cytoprotective effect for pentoxifylline over placebo. We conclude that pentoxifylline as given in this study is ineffective for preventing mucositis in patients receiving cisplatin and 5-FU.
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Affiliation(s)
- C J Verdi
- Section of Hematology/Oncology, Tucson Veteran's Affairs Medical Center, Ariz., USA
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27
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Abstract
Freud (1905, 1917, 1937) throughout his lifetime sought empirical scientific confirmation of the validity of his discoveries. In pursuit of this goal, he persistently emphasized the importance of establishing agreement between analytic reconstructions and the results of naturalistic child observation. The same objective lead Lichtenberg (1983), Emde (1981, 1985), and Stern (1985) to produce detailed evaluations of the impact of infant research findings on analytic developmental propositions. The present paper examines the relation among clinical reconstructions from an analysis developed through transference interpretations, empirical observations originating in the analytic patient's daughter's psychotherapy, and the results of empirical infant research that was being concurrently conducted by two of the authors. The findings from the clinical analysis of the mother, the psychotherapy of the daughter, and empirical infant research all converged on the same larger causative factor for the daughter's psychopathology--a type of maternal deprivation. Such a confluence of different sources of evidence, each identified by a different method of investigation, provides one kind of validation for psychoanalytic reconstructions, making it possible to provide that "satisfactory degree of certainty" which Freud (1937) called for in the attempt to integrate the patient's "psychic truth" with "actual" or historical truth.
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Affiliation(s)
- P Barglow
- Department of Psychiatry, Michael Reese Hospital, Chicago
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28
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Vaughn B, Seifer R, Lefever G, Smith C. Relations among mastery assessed during problem solving, attachment security, and free-play behavior. Infant Behav Dev 1986. [DOI: 10.1016/s0163-6383(86)80395-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Cartwright PS, Vaughn B, Tuttle D. Culdocentesis and ectopic pregnancy. J Reprod Med 1984; 29:88-91. [PMID: 6708032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Seventy-seven patients with ectopic pregnancy underwent culdocentesis; the tap was positive in 70%, negative in 10% and inadequate in 20%. A positive tap was significantly associated with a low hematocrit but was often obtained in patients without hypotension, tachycardia, peritoneal irritation or tubal rupture. While patients with peritoneal irritation were significantly more likely to have a large hemoperitoneum, many with 500 ml or more of hemoperitoneum did not have peritoneal irritation, hypotension, tachycardia, low hematocrit or tubal rupture. Culdocentesis is valuable for evaluating the patient suspected of having an ectopic pregnancy, and the absence of tachycardia, hypotension, low hematocrit or peritoneal irritation should not dissuade one from performing the test. A positive tap does not indicate tubal rupture, and a large hemoperitoneum may accumulate in its absence.
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30
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Redmond SR, Spitz S, Vaughn B. Mumps, bumps, and vaccination policy. Lancet 1983; 2:1311-2. [PMID: 6139657 DOI: 10.1016/s0140-6736(83)91195-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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31
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Farber EA, Vaughn B, Egeland B. The relationship of prenatal maternal anxiety to infant behavior and mother-infant interaction during the first six months of life. Early Hum Dev 1981; 5:267-77. [PMID: 7261990 DOI: 10.1016/0378-3782(81)90034-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The IPAT Anxiety Scale was administered to a large sample of primiparous women from an economically disadvantaged population in their third trimester of pregnancy. At birth and at three and six months postpartum, the infants and mothers were assessed using a variety of behavioral and standardized procedures. Results indicate that anxiety was not a factor in the incidence of pregnancy and delivery complications or infant anomalies. Neonatal behavior and mother-infant interaction did differ among the high anxious and the low anxious groups. These differences, however, were only significant for female infants. Results are discussed in terms of practical implications and future research.
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Abstract
The present study reports data concerning the discriminant validity of the Carey Infant Temperament Questionnaire. Subjects were 187 primiparous women who completed a battery of psychologic tests prior to the births of their infants. They also filled out the ITQ at three and six months after the baby was born. Nine of the 20 variables derived from the prenatal test battery discriminated mothers whose babies were diagnosed as temperamentally "difficult" from those whose infants were diagnosed as temperamentally "easy" based on three-month ITQ scores. Seven of the prenatal variables similarly discriminated these two groups on the six-month ITQ. The implications of these findings for uses of the ITQ are discussed.
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Vaughn B, Egeland B, Sroufe LA, Waters E. Individual differences in infant-mother attachment at twelve and eighteen months: stability and change in families under stress. Child Dev 1979; 50:971-5. [PMID: 535447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
100 economically disadvantaged mothers and their infants were observed in the Ainsworth and Wittig "strange situation" at 12 and 18 months. Infants were classified as secure, anxiously attached/avoidant, or anxiously attached/resistant. In addition, mothers reported occurrence of stressful events related to the stability of the caretaking environment during the 12--18 month period by completing a 44-item checklist concerning work, finances, family, neighbors, health, etc. 62 infants were assigned to the same attachment classification at both 12 and 18 months (p less than .01). Despite this stability, significantly more infants changes classification than in a recent study of stable middle-class families. With the present sample, anxious attachment was associated with less stable caretaking environments than secure attachment; change from secure to anxious attachment was associated with higher stressful-event scores than stable secure attachment.
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34
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Vaughn B, Sroufe LA. The temporal relationship between infant heart rate acceleration and crying in an aversive situation. Child Dev 1979; 50:565-7. [PMID: 487890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The temporal relationship between heart rate (HR) acceleration and crying was examined in 16 8-16-month-old infants. Consistently, the HR acceleration began well before the onset of crying, suggesting that such acceleration is not merely a by-product of crying. The accelerations observed were above and beyond a return to baseline following orienting. The crying itself validates the association between these instances of HR acceleration and negative effect.
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