1
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Ebach DR, Jester TW, Galanko JA, Firestine AM, Ammoury R, Cabrera J, Bass J, Minar P, Olano K, Margolis P, Sandberg K, Linnville TM, Kaplan J, Pitch L, Steiner SJ, Bass D, Moses J, Adler J, Gulati AS, Wali P, Pashankar D, Ivanova A, Herfarth H, Wohl DA, Benkov KJ, Strople J, Sullivan J, Tung J, Molle-Rios Z, Saeed SA, Bousvaros A, Kappelman MD. High Body Mass Index and Response to Anti-Tumor Necrosis Factor Therapy in Pediatric Crohn's Disease. Am J Gastroenterol 2024:00000434-990000000-01056. [PMID: 38445644 DOI: 10.14309/ajg.0000000000002741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/14/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION Obesity is common among patients with pediatric Crohn's disease (PCD). Some adult studies suggest obese patients respond less well to anti-tumor necrosis factor (TNF) treatment. This study sought compares anti-TNF response and anti-TNF levels between pediatric patients with normal and high body mass index (BMI). METHODS The COMBINE trial compared anti-TNF monotherapy with combination therapy with methotrexate in patients with PCD. In this secondary analysis, a comparison of time-to-treatment failure among patients with normal BMI vs BMI Z -score >1, adjusting for prescribed anti-TNF (infliximab [IFX] or adalimumab [ADA]), trial treatment assignment (combination vs monotherapy), and relevant covariates. Median anti-TNF levels across BMI category was also examined. RESULTS Of 224 participants (162 IFX initiators and 62 ADA initiators), 111 (81%) had a normal BMI and 43 (19%) had a high BMI. High BMI was associated with treatment failure among ADA initiators (7/10 [70%] vs 12/52 [23%], hazard ratio 0.29, P = 0.007) but not IFX initiators. In addition, ADA-treated patients with a high BMI had lower ADA levels compared with those with normal BMI (median 5.8 vs 12.8 μg/mL, P = 0.02). IFX trough levels did not differ between BMI groups. DISCUSSION Overweight and obese patients with PCD are more likely to experience ADA treatment failure than those with normal BMI. Higher BMI was associated with lower drug trough levels. Standard ADA dosing may be insufficient for overweight children with PCD. Among IFX initiators, there was no observed difference in clinical outcomes or drug levels, perhaps due to weight-based dosing and/or greater use of proactive drug monitoring.
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Affiliation(s)
- Dawn R Ebach
- Division of Gastroenterology, Hepatology, Pancreatology, and Nutrition, University of Iowa, Iowa City, Iowa, USA
| | - Traci W Jester
- Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Joseph A Galanko
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ann M Firestine
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rana Ammoury
- Department of Pediatrics, Children's Hospital of The King's Daughters, Norfolk, Virginia, USA
| | - Jose Cabrera
- Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA
| | - Julie Bass
- Department of Pediatrics, Children's Mercy Medical Center, UMKC School of Medicine, Kansas City, Missouri, USA
| | - Phillip Minar
- Department of Pediatrics, Cincinnati Children's Medical Center, Cincinnati, Ohio, USA
| | - Kelly Olano
- Department of Pediatrics, Cincinnati Children's Medical Center, Cincinnati, Ohio, USA
| | - Peter Margolis
- Department of Pediatrics, Cincinnati Children's Medical Center, Cincinnati, Ohio, USA
| | - Kelly Sandberg
- Boonshoft School of Medicine, Wright State University and Department of Medical Affairs, Dayton Children's Hospital, Dayton, Ohio, USA
| | - Tiffany M Linnville
- Department of Pediatrics, Atrium Health Levine Children's Hospital, Charlotte, North Carolina, USA
| | - Jess Kaplan
- Division of Pediatric Gastroenterology, Mass General Hospital for Children, Boston, Massachusetts, USA
| | | | - Steven J Steiner
- Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Dorsey Bass
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford Medicine Children's Health, Palo Alto, California, USA
| | - Jonathan Moses
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford Medicine Children's Health, Palo Alto, California, USA
| | - Jeremy Adler
- Department of Pediatrics, University of Michigan-C.S. Mott Children's Hospital, Ann Arbor, Michigan, USA
| | - Ajay S Gulati
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Prateek Wali
- Karjoo Family Center for Pediatric Gastroenterology, Hepatology, and Nutrition, Upstate Golisano Children's Hospital, SUNY Upstate Medical Center, Syracuse, New York, USA
| | - Dinesh Pashankar
- Pediatric Gastroenterology and Hepatology, Yale New Haven Children's Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - Anastasia Ivanova
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Hans Herfarth
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - David A Wohl
- University of North Carolina Institute of Global Health and Infectious Diseases, Chapel Hill, North Carolina, USA
| | - Keith J Benkov
- Division of Pediatric Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jennifer Strople
- Division of Pediatric Gastroenterology, Ann & Robert Lurie Children's Hospital, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jillian Sullivan
- Children's Hospital of Vermont, University of Vermont, Burlington, Vermont, USA
| | - Jeanne Tung
- Oklahoma Children's Hospital, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | | | - Shehzad A Saeed
- Boonshoft School of Medicine, Wright State University and Department of Medical Affairs, Dayton Children's Hospital, Dayton, Ohio, USA
| | - Athos Bousvaros
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Michael D Kappelman
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Edwards CS, Baudino MN, Roberts CM, Basile NL, Dattilo TM, Gamwell KL, Jacobs NJ, Edwards DS, Tung J, Parker CV, Chaney JM. The contributions of clinical disease activity, functional disability, and illness intrusiveness to depressive symptoms in pediatric inflammatory bowel disease. J Pediatr Gastroenterol Nutr 2024; 78:77-84. [PMID: 38291697 DOI: 10.1002/jpn3.12056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/13/2023] [Accepted: 09/29/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Clinical disease activity associated with inflammatory bowel disease (IBD) can place physical limitations on youths' activities of daily living. In turn, functional limitations potentially contribute to youths' heightened experience of IBD-induced intrusions on a wide range of routine and valued activities (i.e., illness intrusiveness), which can increase their risk for depressive symptoms. The present study examined the contributions of clinical disease activity, functional disability, and illness intrusiveness to depressive symptoms in youth with IBD. METHODS Youth (N = 180) completed the Functional Disability Inventory (FDI), Illness Intrusiveness Scale-Child (IIS-C), and Children's Depression Inventory-2 (CDI-2). Physicians completed the Physicians Global Assessment of disease activity (PGA). RESULTS Results revealed a mediating effect for functional disability in the association between disease activity and depressive symptoms (PGA → FDI → CDI-2); illness intrusiveness mediated the association between functional disability and depressive symptoms (i.e., FDI → IIS-C → CDI-2). Serial mediation revealed that clinical disease activity conferred an indirect effect on youth depressive symptoms through the sequential effects of functional disability and illness intrusiveness (i.e., PGA → FDI → IIS-C → CDI-2). CONCLUSIONS Taken together, these findings indicate that youth who encounter more physical limitations as a function of clinical disease activity are more likely to experience an amplified sense of IBD-related intrusions on their ability to participate in meaningful activities. In turn, heightened illness intrusiveness increases the likelihood of depressive symptoms. Clinical interventions that help youth maintain adequate functional ability in the face of IBD disease activity and encourage involvement in positively valued activities could decrease the negative impact of IBD on youths' emotional adjustment.
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Affiliation(s)
- Clayton S Edwards
- Center for Pediatric Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Marissa N Baudino
- Baylor College of Medicine - Texas Children's Hospital, Houston, Texas, USA
| | - Caroline M Roberts
- Baylor College of Medicine - Texas Children's Hospital, Houston, Texas, USA
| | - Nathan L Basile
- Center for Pediatric Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Taylor M Dattilo
- Center for Pediatric Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Kaitlyn L Gamwell
- School of Medicine, University of South Carolina, Columbia, South Carolina, USA
| | - Noel J Jacobs
- Department of Psychology, Oklahoma City University, Oklahoma City, Oklahoma, USA
| | - Desti S Edwards
- Pediatric Gastroenterology, Oklahoma Children's Hospital OU Health, Oklahoma City, Oklahoma, USA
| | - Jeanne Tung
- Pediatric Gastroenterology, Oklahoma Children's Hospital OU Health, Oklahoma City, Oklahoma, USA
| | - Colton V Parker
- Center for Pediatric Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - John M Chaney
- Center for Pediatric Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
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Singh N, Steiner SJ, Fauth R, Moosmann D, Arnold J, Elkadri A, Marinoni D, Molloy L, Johnson Rescola B, Tung J, Utterson EC. IBD Camp Oasis: A look at Participants' Social-Emotional Well-Being and Protective Factors During Camp and Beyond. Crohns Colitis 360 2023; 5:otad042. [PMID: 37691728 PMCID: PMC10486186 DOI: 10.1093/crocol/otad042] [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: 03/29/2023] [Indexed: 09/12/2023] Open
Abstract
Background Camp Oasis is an annual week-long camp serving children with inflammatory bowel disease (IBD) and hosted by the Crohn's and Colitis Foundation. Youth with IBD are at increased risk for mental health challenges, with Camp Oasis potentially mitigating these risks. The aim of this study is to measure change in and predictors of social-emotional well-being and protective factors of self-worth as a result of attending Camp Oasis. Methods Between 2012 and 2019, a voluntary survey was administered to participants and their caregivers to reflect on their perceptions of social/emotional well-being and protective factors related to chronic disease. T-tests compared change in participants' and caregivers' perceptions before and after camp; path analyses examined the key predictors of social-emotional well-being. Results A total of 6011 online surveys were analyzed. Participants and caregivers reported consistently positive perceptions of participants' experiences during and after camp. Significant improvements in confidence, independence, activity, comfort around others, being more open about disease, and taking medication as expected were observed. Being new to Camp Oasis was one of the strongest predictors of both disease-related self-efficacy and social connections after camp. Conclusions The uniformly high rates of participants' perceptions during camp suggest camp is a life-changing experience for youth with IBD, reduces disease-related stigma, and enhances confidence and social skills. Participants' positive experiences appear to foster notable benefits after camp in terms of openness, their sense of belonging, connections, and confidence.
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Affiliation(s)
- Namita Singh
- CoDirector of Pediatric IBD Center, Assistant Professor of Pediatrics, University of Washington–School of Medicine, Seattle, USA
| | - Steven J Steiner
- Professor of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, USA
| | - Rebecca Fauth
- Research Associate Professor, Co-Director, Tufts Interdisciplinary Evaluation Research (TIER), EliotPearson Department of Child Study and Human Development, Tufts University, Medford, USA
| | - Danyel Moosmann
- Project Manager | Tufts Interdisciplinary Evaluation Research (TIER), Tufts University, Medford, USA
| | - Janis Arnold
- Clinical Social Worker, Division of Gastroenterology, Hepatology, Boston, USA
| | - Abdul Elkadri
- Pediatric Gastroenterology, Assistant Professor, the Medical College of Wisconsin, Milwaukee, USA
| | - Daniel Marinoni
- Associate Director, Camp Oasis, Crohn’s & Colitis Foundation, New York, USA
| | - Laurel Molloy
- Technical Advisor, Camp Oasis, Crohn’s & Colitis Foundation, New York, USA
| | - Becky Johnson Rescola
- Vice President, Education & Community Engagement, Crohn’s & Colitis Foundation, New York, USA
| | - Jeanne Tung
- Associate Professor, Pediatric Gastroenterology, the University of Oklahoma College of Medicine, Oklahoma City, USA
| | - Elizabeth C Utterson
- Associate Professor, Pediatrics, Division of Pediatric Gastroenterology Director of Procedures, Washington University Physicians, St Louis, USA
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Kaplan JL, Liu C, King EC, Bass JA, Patel AS, Tung J, Chen S, Lissoos T, Candela N, Saeed S, Colletti RB. Use, Durability, and Risks for Discontinuation of Initial and Subsequent Biologics in a Large Pediatric-Onset IBD Cohort. J Pediatr Gastroenterol Nutr 2023; 76:566-575. [PMID: 36804501 PMCID: PMC10097486 DOI: 10.1097/mpg.0000000000003734] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 12/12/2022] [Indexed: 02/23/2023]
Abstract
BACKGROUND Biologic medications are recommended for treatment of moderately-to-severely active Crohn disease (CD) or ulcerative colitis (UC) in children. However, many patients require sequential biologic treatment because of nonresponse or loss of response to the initial biologic. METHODS We analyzed pediatric inflammatory bowel disease (IBD) data from the ImproveCareNow Network registry between May 2006 and September 2016, including time to biologic initiation, choice of first subsequent biologics, biologic durability, and reasons for discontinuation. RESULTS Of 17,649 patients with IBD [CD: 12,410 (70%); UC: 5239 (30%)], 7585 (43%) were treated with a biologic agent before age 18 (CD: 50%; UC: 25%). Biologic treatment was more likely for CD than UC (odds ratio, 3.0; 95% CI: 2.8-3.2; P < 0.0001). First biologic agents for all patients were anti-tumor necrosis factor agents (88% infliximab, 12% adalimumab). Probability of remaining on the first biologic was significantly higher in CD than UC ( P < 0.0001). First biologics were discontinued because of loss of response (39%), intolerance (23%), and nonresponse (19%). In univariate analysis, factors associated with discontinuation of first and/or second biologics in CD include colonic-only disease, corticosteroid use, upper gastrointestinal tract involvement, and clinical and biochemical markers of severe disease. Biologic durability improved with later induction date. CONCLUSIONS Treatment with biologic medications is common in pediatric IBD. Patients with CD are more likely to receive biologics, receive biologics earlier in disease course, and remain on the first biologic longer than patients with UC. Multiple factors may predict biologic durability in children with IBD.
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Affiliation(s)
- Jess L. Kaplan
- From the Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA
| | - Chunyan Liu
- Cincinnati Children’s Hospital, Cincinnati, OH
| | - Eileen C. King
- Cincinnati Children’s Hospital, Cincinnati, OH
- University of Cincinnati College of Medicine, Cincinnati, OH
| | | | | | - Jeanne Tung
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Shiran Chen
- Cincinnati Children’s Hospital, Cincinnati, OH
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Kappelman MD, Wohl DA, Herfarth HH, Firestine AM, Adler J, Ammoury RF, Aronow JE, Bass DM, Bass JA, Benkov K, Berenblum Tobi C, Boccieri ME, Boyle BM, Brinkman WB, Cabera JM, Chun K, Colletti RB, Dodds CM, Dorsey JM, Ebach DR, Entrena E, Forrest CB, Galanko JA, Grunow JE, Gulati AS, Ivanova A, Jester TW, Kaplan JL, Kugathasan S, Kusek ME, Leibowitz IH, Linville TM, Lipstein EA, Margolis PA, Minar P, Molle Rios Z, Moses J, Olano KK, Osaba L, Palomo PJ, Pappa H, Park KT, Pashankar DS, Pitch L, Robinson M, Samson CM, Sandberg KC, Schuchard JR, Seid M, Shelly KA, Steiner SJ, Strople JA, Sullivan JS, Tung J, Wali P, Zikry M, Weinberger M, Saeed SA, Bousvaros A. Comparative Effectiveness of Anti-TNF in Combination with Low Dose Methotrexate vs Anti-TNF Monotherapy in Pediatric Crohn's Disease: a Pragmatic Randomized Trial. Gastroenterology 2023:S0016-5085(23)00538-3. [PMID: 37004887 DOI: 10.1053/j.gastro.2023.03.224] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/02/2023] [Accepted: 03/10/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND AND AIMS Tumor Necrosis Factor inhibitors (TNFi), including infliximab and adalimumab, are a mainstay of pediatric Crohn's disease (PCD) therapy; however, non-response and loss of response is common. As combination therapy with methotrexate may improve response, we performed a multi-center, randomized, double-blind, placebo-controlled pragmatic trial to compare TNFi with oral methotrexate to TNFi monotherapy. METHODS PCD patients initiating infliximab or adalimumab were randomized in 1:1 allocation to methotrexate or placebo and followed for 12-36 months. The primary outcome was a composite indicator of treatment failure. Secondary outcomes included anti-drug antibodies (ADA) and patient reported outcomes (PROs) of pain interference and fatigue. Adverse events (AEs) and Serious AEs (SAEs) were collected. RESULTS Of 297 participants (mean age 13.9 years, 35% female), 156 were assigned to methotrexate (110 infliximab initiators and 46 adalimumab initiators) and 141 to placebo (102 infliximab initiators and 39 adalimumab initiators). In the overall population, time to treatment failure did not differ by study arm (HR 0.69, 95% CI 0.45-1.05). Among infliximab initiators, there were no differences between combination and monotherapy (HR 0.93, 95% CI 0.55-1.56). Among adalimumab initiators, combination therapy was associated with longer time to treatment failure (HR 0.40, 95% CI 0.19-0.81). A trend towards lower ADA development in the combination therapy arm was not significant. [(infliximab OR 0.72 (0.49-1.07); adalimumab OR 0.71 (0.24-2.07)]. No differences in PROs were observed. Combination therapy resulted in more AEs but fewer SAEs. CONCLUSIONS Among adalimumab but not infliximab initiators, PCD patients treated with methotrexate combination therapy experienced a 2-fold reduction in treatment failure with a tolerable safety profile.
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Affiliation(s)
- Michael D Kappelman
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - David A Wohl
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Hans H Herfarth
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC
| | - Ann M Firestine
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jeremy Adler
- Susan B. Meister Child Health Evaluation and Research Center and Division of Pediatric Gastroenterology, University of Michigan, Ann Arbor, MI
| | - Rana F Ammoury
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of The King's Daughters, Norfolk, VA
| | | | - Dorsey M Bass
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children's Hospital, Palo Alto, CA
| | - Julie A Bass
- Department of Pediatrics, School of Medicine, University of Missouri Kansas City, Kansas City, MO, Division of Gastroenterology, Children's Mercy Kansas City, Kansas City, MO
| | - Keith Benkov
- Division of Pediatric Gastroenterology, Icahn School of Medicine at Mt Sinai, New York City, NY
| | | | - Margie E Boccieri
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Brendan M Boyle
- Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, OH
| | - William B Brinkman
- Department of Pediatrics, University of Cincinnati College of Medicine; Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jose M Cabera
- Division of Pediatric Gastroenterology, Department of Pediatrics, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI
| | - Kelly Chun
- Esoterix Specialty Laboratory, Labcorp, Calabasas, CA
| | - Richard B Colletti
- Division of Gastroenterology, Department of Pediatrics, University of Vermont, Burlington, VT
| | - Cassandra M Dodds
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jill M Dorsey
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nemours Children's Health, Jacksonville, FL
| | - Dawn R Ebach
- Division of Pediatric Gastroenterology, Hepatology, Pancreatology, and Nutrition, University of Iowa, Iowa City, IA
| | - Edurne Entrena
- Progenika Biopharma, a Grifols Company, Derio, Bizkaia Spain
| | | | - Joseph A Galanko
- Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - John E Grunow
- University of Oklahoma Children's Physicians, Pediatric Gastroenterology, Oklahoma City, OK
| | - Ajay S Gulati
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Anastasia Ivanova
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Traci W Jester
- Department of Pediatrics, Division of Gastroenterology, University of Alabama at Birmingham, AL
| | - Jess L Kaplan
- Division of Pediatric Gastroenterology, Mass General for Children and Harvard Medical School, Boston, MA
| | | | - Mark E Kusek
- Division of Gastroenterology, University of Nebraska Medical Center, Omaha, NE
| | - Ian H Leibowitz
- Division of Gastroenterology, Hepatology and Nutrition, Children's National Medical Center, Department of Pediatrics, George Washington University, Washington, DC
| | - Tiffany M Linville
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Levine Children's Hospital, Charlotte, NC
| | - Ellen A Lipstein
- Department of Pediatrics, University of Cincinnati College of Medicine, James M. Anderson Center for Health Systems Excellence, and Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Peter A Margolis
- Department of Pediatrics, University of Cincinnati College of Medicine, James M. Anderson Center for Health Systems Excellence, and Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Phillip Minar
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Zarela Molle Rios
- Division of Pediatric Gastroenterology, Nemours Children's Hospital, Wilmington, DE
| | - Jonathan Moses
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, UH Rainbow Babies and Children's Hospital, Cleveland, OH
| | - Kelly K Olano
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Lourdes Osaba
- Progenika Biopharma, a Grifols Company, Derio, Bizkaia Spain
| | - Pablo J Palomo
- Division of Pediatric Gastroenterology, Nemours Children's Hospital, Orlando, FL
| | - Helen Pappa
- Division of Pediatric Gastroenterology, Cardinal Glennon Children's Hospital, Saint Louis University School of Medicine, Saint Louis, MO
| | - K T Park
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children's Hospital, Palo Alto, CA
| | - Dinesh S Pashankar
- Section of Pediatric Gastroenterology & Hepatology, Department of Pediatrics, Yale School of Medicine, Yale University, New Haven, CT
| | | | - Michelle Robinson
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Charles M Samson
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - Kelly C Sandberg
- Department of Gastroenterology, Dayton Children's Hospital, Boonshoft School of Medicine, Wright State University, Dayton, OH
| | - Julia R Schuchard
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Michael Seid
- Department of Pediatrics, University of Cincinnati College of Medicine; Division Pulmonary Medicine and the James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Kimberly A Shelly
- Division of Pediatric Gastroenterology/Hepatology/Nutrition, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
| | - Steven J Steiner
- Division of Pediatric Gastroenterology/Hepatology/Nutrition, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
| | - Jennifer A Strople
- Division of Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern Feinberg School of Medicine, Chicago, IL
| | - Jillian S Sullivan
- The University of Vermont Children's Hospital and Department of Pediatrics, Larner College of Medicine, The University of Vermont, Burlington, VT
| | - Jeanne Tung
- University of Oklahoma Children's Physicians, Pediatric Gastroenterology, Oklahoma City, OK
| | - Prateek Wali
- Division of Gastroenterology, Hepatology, and Nutrition, State University of New York Upstate Medical University, Syracuse, NY
| | - Michael Zikry
- Esoterix Specialty Laboratory, Labcorp, Calabasas, CA
| | - Morris Weinberger
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Shehzad A Saeed
- Boonshoft School of Medicine, Wright State University, Associate Chief Medical Officer, Physician Lead, Patient and Family Experience, Dayton Children's Hospital, Dayton OH
| | - Athos Bousvaros
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA
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Lee S, Lim B, Chan T, Neo S, Low A, Tung J, Sundaram P, Cheng C, Lee L, Lim Y. Rezūm water vapour therapy (Rezūm): Is it safe to continue antiplatelet or anticoagulation medication? Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00284-1] [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: 02/12/2023]
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7
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Gamwell KL, Roberts CM, Kraft JD, Edwards CS, Baudino MN, Grunow JE, Jacobs NJ, Tung J, Mullins LL, Chaney JM. Factor analysis of the stigma scale-child in pediatric inflammatory bowel disease. J Psychosom Res 2023; 164:111095. [PMID: 36495755 DOI: 10.1016/j.jpsychores.2022.111095] [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: 08/23/2022] [Revised: 11/12/2022] [Accepted: 11/13/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Illness stigma, or perceived stigma related to a chronic health condition, is pervasive among youth with inflammatory bowel disease (IBD). However, no studies exist examining the psychometric properties of illness stigma measures in this population. Using a modified version of the Child Stigma Scale originally developed for youth with epilepsy, the current study investigated the factor structure and validity of this adapted measure (i.e., Stigma Scale - Child; SS-C) in youth with IBD. METHODS Factor analyses were conducted to determine the most parsimonious factor structure for the adapted 8-item Stigma Scale - Child in a sample of 180 youth with IBD. Correlations were conducted to assess convergent validity, and a multiple regression was conducted to further evaluate the measure's predictive validity of child depressive symptoms. RESULTS The most parsimonious model for the SS-C is a one-factor solution with an error covariance between the two items assessing concealment/disclosure of IBD diagnosis. CONCLUSIONS The SS-C is a psychometrically sound illness stigma measure in pediatric IBD that demonstrates strong convergent validity with psychosocial adjustment factors such as thwarted belongingness, illness uncertainty, and illness intrusiveness, as well as strong predictive validity with youth depressive symptoms. The SS-C is a viable option for use as a brief screener in youth with IBD across clinical and research settings.
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Affiliation(s)
- Kaitlyn L Gamwell
- University of South Carolina School of Medicine, Department of Pediatrics, Greenville, SC, United States of America; Prisma Health Children's Hospital, Department of Pediatric Pain Medicine, Greenville, SC, United States of America.
| | - Caroline M Roberts
- Baylor College of Medicine, Texas Children's Hospital, Division of Psychology, United States of America
| | - Jacob D Kraft
- University of Michigan, Department of Psychiatry, United States of America
| | - Clayton S Edwards
- Oklahoma State University, Department of Psychology, United States of America
| | - Marissa N Baudino
- Baylor College of Medicine, Texas Children's Hospital, Division of Psychology, United States of America
| | - John E Grunow
- University of Oklahoma Children's Physicians, Pediatric Gastroenterology, United States of America
| | - Noel J Jacobs
- University of Oklahoma Children's Physicians, General and Community Pediatrics, United States of America
| | - Jeanne Tung
- University of Oklahoma Children's Physicians, Pediatric Gastroenterology, United States of America
| | - Larry L Mullins
- Oklahoma State University, Department of Psychology, United States of America
| | - John M Chaney
- Oklahoma State University, Department of Psychology, United States of America
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8
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Baudino MN, Roberts CM, Edwards CS, Gamwell KL, Tung J, Jacobs NJ, Grunow JE, Chaney JM. The impact of illness intrusiveness and overparenting on depressive symptoms in parents of youth with inflammatory bowel disease. J SPEC PEDIATR NURS 2022; 27:e12362. [PMID: 34811881 DOI: 10.1111/jspn.12362] [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: 05/21/2021] [Revised: 10/11/2021] [Accepted: 10/28/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Inflammatory bowel disease (IBD) management creates significant caregiver demands that can interfere with parents' ability to engage in a number of role functions (i.e., illness intrusiveness) well into their child's adolescence, potentially resulting in excessive or misdirected parenting (i.e., overparenting). Disruptions and limited access to routine and valued activities (e.g., family, work, and leisure) due to IBD and excessive parenting may result in parents neglecting their own personal and emotional self-care needs, increasing their risk for depressive symptoms. To explore these associations, the present study examined parents' experience of illness intrusiveness and subsequent overparenting as serial mediators in the association between disease severity and parent depressive symptoms. DESIGN AND METHODS Participants were 146 caregivers of adolescents with IBD from an outpatient pediatric gastroenterology clinic. During a scheduled outpatient visit, parents completed measures of illness intrusiveness, overparenting, and depressive symptoms. Pediatric gastroenterologists provided ratings of disease severity. RESULTS Several direct and indirect associations were observed among the modeled variables. Notably, mediation analysis revealed a significant disease severity → illness intrusiveness → overparenting → depressive symptoms serial indirect effect. CONCLUSIONS Parents' experience of greater IBD-induced lifestyle disruptions is associated with increased overparenting and a heightened risk for depressive symptoms. PRACTICE IMPLICATIONS Parents should be encouraged to establish and maintain a healthy balance between parenting and self-care/role function activities, especially during adolescence when greater youth autonomy and independence are crucial. These types of clinical efforts may reduce the likelihood of parents experiencing depressive symptoms, and have the added benefit of improving adolescent IBD self-management.
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Affiliation(s)
- Marissa N Baudino
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Caroline M Roberts
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Clayton S Edwards
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Kaitlyn L Gamwell
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jeanne Tung
- Pediatric Gastroenterology, University of Oklahoma Children's Physicians, Oklahoma City, Oklahoma, USA
| | - Noel J Jacobs
- General and Community Pediatrics, University of Oklahoma Children's Physicians, Oklahoma City, Oklahoma, USA
| | - John E Grunow
- Pediatric Gastroenterology, University of Oklahoma Children's Physicians, Oklahoma City, Oklahoma, USA
| | - John M Chaney
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
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9
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Roberts CM, Addante SM, Baudino MN, Edwards CS, Gamwell KL, Jacobs NJ, Tung J, Grunow JE, Mullins LL, Chaney JM. Stigma Moderates the Relation Between Peer Victimization, Thwarted Belongingness, and Depressive Symptoms in Youth with Inflammatory Bowel Disease. J Pediatr Nurs 2021; 59:137-142. [PMID: 33878539 DOI: 10.1016/j.pedn.2021.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/09/2021] [Accepted: 04/10/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The stigmatizing nature of IBD symptoms may place youth at risk for being targets of peer victimization, potentially resulting in a decreased sense of social belongingness and poorer emotional adjustment. The present study tested a series of mediation and moderated mediation models examining the associations among peer victimization, thwarted social belongingness, and depressive symptoms, as well as the moderating role of IBD stigma in these associations. We hypothesized peer victimization would have an indirect effect on youth depressive symptoms through thwarted belongingness, and this effect would be amplified for youth endorsing greater IBD stigma. DESIGN AND METHODS Seventy-five youth (10-18 yrs.) diagnosed with IBD were recruited from a pediatric gastroenterology clinic. Participants completed self-report measures of IBD stigma, peer victimization, thwarted belongingness, and depressive symptoms. RESULTS As anticipated, mediation analyses revealed a significant peer victimization → thwarted belongingness → depressive symptoms indirect path. Moderated mediation analyses indicated that this indirect effect was moderated by IBD stigma and was significantly greater among youth reporting higher IBD stigma. CONCLUSIONS Youth who experience higher levels of IBD-related stigma are at increased risk for depressive symptoms as a function of the socially isolating effects of peer victimization. PRACTICE IMPLICATIONS Our findings highlight the need for routine screening and identification of the socioemotional challenges faced by youth with IBD. Clinical interventions that incorporate coping strategies aimed at minimizing youths' stigmatizing self-perceptions and improving overall social skills and social engagement may lessen the negative impact of peer victimization on youths' social and emotional adjustment.
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Affiliation(s)
- Caroline M Roberts
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University, USA.
| | - Samantha M Addante
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University, USA
| | - Marissa N Baudino
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University, USA
| | - Clayton S Edwards
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University, USA
| | | | - Noel J Jacobs
- University of Oklahoma Children's Physicians, General and Community Pediatrics, USA
| | - Jeanne Tung
- University of Oklahoma Children's Physicians, Pediatric Gastroenterology, USA
| | - John E Grunow
- University of Oklahoma Children's Physicians, Pediatric Gastroenterology, USA
| | - Larry L Mullins
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University, USA
| | - John M Chaney
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University, USA
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10
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Baudino MN, Perez MN, Roberts CM, Edwards CS, Gamwell KL, Keirns NG, Tung J, Jacobs NJ, Grunow JE, Mullins LL, Chaney JM. Stigma by Association: Parent Stigma and Youth Adjustment in Inflammatory Bowel Disease. J Pediatr Psychol 2021; 46:27-35. [PMID: 33120420 DOI: 10.1093/jpepsy/jsaa083] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 04/17/2020] [Revised: 08/19/2020] [Accepted: 08/21/2020] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE Examine the indirect association between parents' experience of stigma (i.e., associative stigma) and youth depressive symptoms through the serial effects of associative stigma on parent and youth illness intrusiveness in pediatric inflammatory bowel disease (IBD). METHODS During routine clinic visits, 150 youth with well-controlled IBD (ages 10-18 years) completed measures of perceived illness intrusiveness and depressive symptoms. Parents completed measures of associative stigma and illness intrusiveness. Pediatric gastroenterologists provided ratings of IBD disease severity. RESULTS Structural equation modeling revealed significant direct associations for associative stigma → parent illness intrusiveness, parent illness intrusiveness → youth illness intrusiveness, and youth illness intrusiveness → youth depressive symptoms. Results also revealed a significant associative stigma → parent illness intrusiveness → youth illness intrusiveness→ youth depressive symptoms serial mediation path, indicating that parents' experience of associative stigma indirectly influenced youth depressive symptoms through its sequential effects on parent and youth perceived illness intrusiveness. CONCLUSIONS Parents who face stigma related to their child's IBD (i.e., associative stigma) are more likely to experience IBD-induced lifestyle intrusions (i.e., illness intrusiveness), which in turn is associated with youths' illness intrusiveness and ultimately youth depressive symptoms. These findings provide further evidence for the important role of illness-related stigma in pediatric IBD, particularly the transactional relation between parents' associative stigma and youths' illness appraisals and emotional functioning. The clinical implications of our results for addressing adjustment difficulties in youth with IBD are also discussed.
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Affiliation(s)
| | - Megan N Perez
- Center for Pediatric Psychology, Oklahoma State University
| | | | | | | | | | - Jeanne Tung
- University of Oklahoma Children's Physicians Pediatric Gastroenterology
| | - Noel J Jacobs
- University of Oklahoma Children's Physicians General and Community Pediatrics
| | - John E Grunow
- University of Oklahoma Children's Physicians Pediatric Gastroenterology
| | | | - John M Chaney
- Center for Pediatric Psychology, Oklahoma State University
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11
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Roberts CM, Gamwell KL, Baudino MN, Grunow JE, Jacobs NJ, Tung J, Gillaspy SR, Hommel KA, Mullins LL, Chaney JM. The Contributions of Illness Stigma, Health Communication Difficulties, and Thwarted Belongingness to Depressive Symptoms in Youth with Inflammatory Bowel Disease. J Pediatr Psychol 2020; 45:81-90. [PMID: 31633787 DOI: 10.1093/jpepsy/jsz084] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 05/25/2019] [Revised: 09/21/2019] [Accepted: 09/22/2019] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE Youth with inflammatory bowel disease (IBD) often experience difficulties communicating about their disease. It is suspected that the stigmatizing nature of IBD symptoms contributes to youths' health communication difficulties, leaving youth feeling disconnected from their social environment and potentially resulting in decreased social belongingness and poorer emotional functioning. In this study, we tested an illness stigma → health communication difficulties → thwarted belongingness → depressive symptoms serial mediation model. It was anticipated that youth illness stigma would confer a serial indirect effect on youth depressive symptoms through the sequential effects of stigma on health communication difficulties and thwarted social belongingness. METHODS Seventy-five youth with IBD between the ages of 10 and 18 completed measures of perceived illness stigma, health communication difficulties, thwarted belongingness, and depressive symptoms. RESULTS Results indicated a significant illness stigma → thwarted belongingness → depressive symptoms simple mediation path. Importantly, findings also revealed a significant serial mediation path for illness stigma → health communication difficulties → thwarted belongingness → depressive symptoms. CONCLUSIONS Youth who perceive greater IBD stigma appear to experience increased difficulty communicating about their IBD with others, which in turn is associated with feelings of thwarted social belongingness and ultimately elevated depressive symptoms. These findings suggest that difficulty communicating about IBD is one potential route by which illness stigma has a negative impact on youth adjustment outcomes. Results could also inform clinical interventions to address IBD stigma and health communication difficulties associated with the social and emotional challenges in youth with IBD.
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Affiliation(s)
- Caroline M Roberts
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University
| | - Kaitlyn L Gamwell
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University
| | - Marissa N Baudino
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University
| | | | | | - Jeanne Tung
- University of Oklahoma Health Sciences Center
| | | | | | - Larry L Mullins
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University
| | - John M Chaney
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University
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12
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Gupta N, Liu C, King E, Sylvester F, Lee D, Boyle B, Trauernicht A, Chen S, Colletti R, Ali SA, Al-Nimr A, Ayers TD, Baron HI, Beasley GL, Benkov KJ, Cabrera JM, Cho-Dorado ME, Dancel LD, Di Palma JS, Dorsey JM, Gulati AS, Hellmann JA, Higuchi LM, Hoffenberg E, Israel EJ, Jester TW, Kiparissi F, Konikoff MR, Leibowitz I, Maheshwari A, Moulton DE, Moses J, Ogunmola NA, Palmadottir JG, Pandey A, Pappa HM, Pashankar DS, Pasternak BA, Patel AS, Quiros JA, Rountree CB, Samson CM, Sandberg KC, Schoen B, Steiner SJ, Stephens MC, Sudel B, Sullivan JS, Suskind DL, Tomer G, Tung J, Verstraete SG. Continued Statural Growth in Older Adolescents and Young Adults With Crohn's Disease and Ulcerative Colitis Beyond the Time of Expected Growth Plate Closure. Inflamm Bowel Dis 2020; 26:1880-1889. [PMID: 31968095 DOI: 10.1093/ibd/izz334] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cessation of statural growth occurs with radiographic closure of the growth plates, radiographically defined as bone age (BA) 15 years in females and 17 in males. METHODS We determined the frequency of continued growth and compared the total height gain beyond the time of expected growth plate closure and the chronological age at achievement of final adult height in Crohn's disease (CD) vs ulcerative colitis (UC) and described height velocity curves in inflammatory bowel disease (IBD) compared with children in the National Health and Nutrition Examination Survey (NHANES). We identified all females older than chronological age (CA) 15 years and males older than CA 17 years with CD or UC in the ImproveCareNow registry who had height documented at ≥3 visits ≥6 months apart. RESULTS Three thousand seven patients (48% female; 76% CD) qualified. Of these patients, 80% manifested continued growth, more commonly in CD (81%) than UC (75%; P = 0.0002) and in females with CD (83%) than males with CD (79%; P = 0.012). Median height gain was greater in males with CD (1.6 cm) than in males with UC (1.3 cm; P = 0.0004), and in females with CD (1.8 cm) than in females with UC (1.5 cm; P = 0.025). Height velocity curves were shifted to the right in patients with IBD vs NHANES. CONCLUSIONS Pediatric patients with IBD frequently continue to grow beyond the time of expected growth plate closure. Unexpectedly, a high proportion of patients with UC exhibited continued growth, indicating delayed BA is also common in UC. Growth, a dynamic marker of disease status, requires continued monitoring even after patients transition from pediatric to adult care.
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Affiliation(s)
- Neera Gupta
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA
| | - Chunyan Liu
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Eileen King
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Francisco Sylvester
- Division of Pediatric Gastroenterology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dale Lee
- Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA
| | - Brendan Boyle
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Anna Trauernicht
- Division of Pediatric Gastroenterology, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Shiran Chen
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Richard Colletti
- Department of Pediatrics, University of Vermont College of Medicine, Burlington, VT, USA
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13
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Tung J, Rogers A, Ravi N, Bhatia N, Shah R, Purewal S, Baykaner T, Rappel W, Viswanathan M, Brodt C, Wang P, Clifford G, Tereshchenko L, Narayan S. Comparing machine learning approaches to identify myocardial scar from the ECG. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Detection of myocardial infarction (MI) traditionally requires ECG Q waves, which have poor sensitivity, or imaging, which is time consuming. We hypothesized that machine learning (ML) of the ECG could identify prior MI, but its accuracy may depend highly upon the architecture and parameters chosen.
Purpose
To compare ML architectures that predict prior MI from the ECG.
Methods
We curated ECGs in 608 patients seen in cardiology clinics at 2 centers. We transformed 12-lead ECGs to median beats in Frank (X, Y, Z) planes (fig. A). We tested 3 architectures: a 1D deep neural network (DNN), a 3D neural network, and a support vector machine (SVM). The 1D DNN used only temporal convolutions (fig B) while the 3D DNN uses a spatial convolution (fig C) prior to the fully-connected layer (fig. C). Predictive accuracy for history of MI was compared for all architectures (fig. D).
Results
Patients (61.4±14.5 years, 31.2% female) had a 28.7% (175/608) prevalence of prior MI. Optimized SVM of 6 features provided accuracy of 66.1% for identifying prior MI, similar to ECG Q wave analysis. 1D DDN had accuracy of 63.6% with an area under curve (AUC) of 0.625. 3D DNN outperformed 1D DNN and SVM, providing an accuracy of 71±5% (using k=5-fold cross validation), with an AUC of 0.730.
Conclusion
ECG machine learning can identify prior MI better than Q wave analysis, but is sensitive to technical parameters and specific computational architecture. It is important to develop a framework to enable robust comparisons of different ML studies and future refinements.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Institutes of Health - United States
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Affiliation(s)
- J Tung
- Stanford University Medical Center, Stanford, United States of America
| | - A.J Rogers
- Stanford University Medical Center, Stanford, United States of America
| | - N Ravi
- Yale University, New Haven, United States of America
| | - N.K Bhatia
- Emory University, Atlanta, United States of America
| | - R.L Shah
- Stanford University Medical Center, Stanford, United States of America
| | - S.K Purewal
- Stanford University Medical Center, Stanford, United States of America
| | - T Baykaner
- Stanford University Medical Center, Stanford, United States of America
| | - W.J Rappel
- University of California, San Diego, San Diego, United States of America
| | - M.N Viswanathan
- Stanford University Medical Center, Stanford, United States of America
| | - C.R Brodt
- Stanford University Medical Center, Stanford, United States of America
| | - P.J Wang
- Stanford University Medical Center, Stanford, United States of America
| | - G Clifford
- Emory University, Atlanta, United States of America
| | - L Tereshchenko
- Oregon Health and Science University, Portland, United States of America
| | - S.M Narayan
- Stanford University Medical Center, Stanford, United States of America
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14
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Micheletti SJ, Bryc K, Ancona Esselmann SG, Freyman WA, Moreno ME, Poznik GD, Shastri AJ, Beleza S, Mountain JL, Agee M, Aslibekyan S, Auton A, Bell R, Clark S, Das S, Elson S, Fletez-Brant K, Fontanillas P, Gandhi P, Heilbron K, Hicks B, Hinds D, Huber K, Jewett E, Jiang Y, Kleinman A, Lin K, Litterman N, McCreight J, McIntyre M, McManus K, Mozaffari S, Nandakumar P, Noblin L, Northover C, O’Connell J, Petrakovitz A, Pitts S, Shelton J, Shringarpure S, Tian C, Tung J, Tunney R, Vacic V, Wang X, Zare A. Genetic Consequences of the Transatlantic Slave Trade in the Americas. Am J Hum Genet 2020; 107:265-277. [PMID: 32707084 PMCID: PMC7413858 DOI: 10.1016/j.ajhg.2020.06.012] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/15/2020] [Indexed: 01/07/2023] Open
Abstract
According to historical records of transatlantic slavery, traders forcibly deported an estimated 12.5 million people from ports along the Atlantic coastline of Africa between the 16th and 19th centuries, with global impacts reaching to the present day, more than a century and a half after slavery's abolition. Such records have fueled a broad understanding of the forced migration from Africa to the Americas yet remain underexplored in concert with genetic data. Here, we analyzed genotype array data from 50,281 research participants, which-combined with historical shipping documents-illustrate that the current genetic landscape of the Americas is largely concordant with expectations derived from documentation of slave voyages. For instance, genetic connections between people in slave trading regions of Africa and disembarkation regions of the Americas generally mirror the proportion of individuals forcibly moved between those regions. While some discordances can be explained by additional records of deportations within the Americas, other discordances yield insights into variable survival rates and timing of arrival of enslaved people from specific regions of Africa. Furthermore, the greater contribution of African women to the gene pool compared to African men varies across the Americas, consistent with literature documenting regional differences in slavery practices. This investigation of the transatlantic slave trade, which is broad in scope in terms of both datasets and analyses, establishes genetic links between individuals in the Americas and populations across Atlantic Africa, yielding a more comprehensive understanding of the African roots of peoples of the Americas.
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15
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Hoe LS, Wells M, Bouquet M, Hyslop K, Passmore M, Bartnikowski N, Obonyo N, Reid J, O'Neill H, Shuker T, McDonald C, Engkilde-Pedersen S, Wildi K, Ainola C, Skeggs K, Jung J, Colombo S, Sato K, James L, He P, Wood E, Heinser S, Wang X, Abbate G, Livingstone S, Haymet A, Walweel K, Mullins D, Marasco S, Diab S, Tung J, Molenaar P, Bassi GL, Suen J, McGiffin D, Fraser J. Metabolic and Mitochondrial Alterations Following Brain Death and Heart Transplantation. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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16
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Park SH, Al-Bawardy B, Aniwan S, Kane SV, Coelho-Prabhu N, Papadakis KA, Kisiel JB, Bruining DH, Faubion WA, Raffals LE, Pardi DS, Tremaine WJ, Stephens MC, Tung J, Khanna S, Willrich MAV, Loftus EV. Distinct Cutoff Values of Adalimumab Trough Levels Are Associated With Different Therapeutic Outcomes in Patients With Inflammatory Bowel Disease. Crohn's & Colitis 360 2019. [DOI: 10.1093/crocol/otz047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Abstract
Background and Aims
We aimed to evaluate the relationship of serum adalimumab trough levels (ATL) with disease activity of inflammatory bowel disease (IBD) patients in a large, well-characterized referral center-based cohort.
Methods
We compared serum ATL between those with clinical, biochemical, or endoscopic/radiologic disease activity and those without.
Results
A total of 236 patients with IBD were included. Higher cutoff levels were associated with endoscopic and/or radiologic responses (cutoff value: 5.3 mcg/mL, P = 0.003) compared with improvement in C-reactive protein (cutoff value: 4.3 mcg/mL, P = 0.031).
Conclusions
Higher cutoff ATL was associated with endoscopic and/or radiologic response.
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Affiliation(s)
- Sang Hyoung Park
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Badr Al-Bawardy
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
- Yale School of Medicine, Section of Digestive Diseases, New Haven, CT
| | - Satimai Aniwan
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
- Division of Gastroenterology, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Sunanda V Kane
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | | | | | - John B Kisiel
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - David H Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - William A Faubion
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Laura E Raffals
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Darrell S Pardi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | | | | | - Jeanne Tung
- Department of Pediatrics, Oklahoma University Health Sciences Center, Oklahoma City. OK
| | - Sahil Khanna
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | | | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
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17
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Tung J, Chadder J, Dudgeon D, Louzado C, Niu J, Rahal R, Sinnarajah A. Palliative care for cancer patients near end of life in acute-care hospitals across Canada: a look at the inpatient palliative care code. ACTA ACUST UNITED AC 2019; 26:43-47. [PMID: 30853797 DOI: 10.3747/co.26.4563] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/15/2022]
Abstract
Hospitals play an important role in the care of patients with advanced cancer: nearly half of all cancer deaths occur in acute-care settings. The need for increasing access to palliative care and related support services for patients with cancer in acute-care hospitals is therefore growing. Here, we examine how often and how early in their illness patients with cancer might be receiving palliative care services in the 2 years before their death in an acute-care hospital in Canada. The palliative care code from inpatient administrative databases was used as a proxy for receiving, or being referred for, palliative care. Currently, the palliative care code is the only data element routinely collected from patient charts that allows for the tracking of palliative care activity at a pan-Canadian level. Our findings suggest that most patients with cancer who die in an acute-care hospital receive a palliative designation; however, many of those patients are identified as palliative only in their final admission before death. Of the patients who received a palliative designation before their final admission, nearly half were identified as palliative less than 2 months before death. Findings signal that delivery of services within and between jurisdictions is not consistent, that the palliative care needs of some patients are being missed by physicians, and that palliative care is still largely seen as end-of-life care and is not recognized as an integral component of cancer care. Measuring the provision of system-wide palliative care remains a challenge because comprehensive national data about palliative care are not currently reported from all sectors. To advance measurement and reporting of palliative care in Canada, attention should be focused on collecting comparable data from regional and provincial palliative care programs that individually capture data about palliative care delivery in all health care sectors.
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Affiliation(s)
- J Tung
- Canadian Partnership Against Cancer, Toronto, ON
| | - J Chadder
- Canadian Partnership Against Cancer, Toronto, ON
| | - D Dudgeon
- Canadian Partnership Against Cancer, Toronto, ON
| | - C Louzado
- Canadian Partnership Against Cancer, Toronto, ON
| | - J Niu
- Canadian Partnership Against Cancer, Toronto, ON
| | - R Rahal
- Canadian Partnership Against Cancer, Toronto, ON
| | - A Sinnarajah
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB
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18
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Tung J, Decaria K, Dudgeon D, Green E, Moxam RS, Niu J, Rahal R. Acute-Care Hospital Use Patterns Near End-of-Life for Cancer Patients Who Die in Hospital in Canada. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.13800] [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: 11/20/2022] Open
Abstract
Background: Acute-care hospitals have a role in managing the needs of people with cancer when they are at the end-of-life; however, overutilization of hospital care at the end-of-life results in poorer quality of life and can worsen the patient's experience. Early integration of comprehensive palliative care can greatly reduce unplanned visits to the emergency department, reduce avoidable admissions to hospital, shorten hospital stays, and increase the number of home deaths as well as improve the quality of life of patients with advanced cancer. Aim: To describe the current landscape of acute-care hospital utilization near the end-of-life across Canada and indirectly examine access to palliative care in cancer patients who die in hospital. Methods: Data were obtained from the Canadian Institute for Health Information. The analysis was restricted to adults aged 18+ who died in an acute care hospital in 2014/15 and 2015/16 for nine provinces and three territories. The Discharge Abstract Database was used to extract acute-care cancer death abstracts. Data on intensive care unit (ICU) admissions includes only facilities that report ICU data. Results: Acute care utilization at end-of-life remains commonplace. In Canada (excluding Québec), 43% (48,987) of deaths from cancer occurred in acute-care hospitals, with 70% admitted through the emergency department (ED). In the last six months of life, cancer patients dying in hospital had a median cumulative length of stay ranging from 17 to 25 days, depending on the province. Between 18.1% and 32.8% of patients experienced two or more admissions to the hospital in the last month of life. The proportion of cancer patients admitted to the ICU in the last 14 days of life ranged from 6.4% to 15.1%. Patient demographics (age, sex, place of residence) and clinical factors (cancer type) were often predictors of hospital utilization at end-of-life and likely point to inequities in access to palliative and end-of-life care. Conclusion: Despite previous patient surveys indicating that patients would prefer to receive care and spend their finals days at home or in a hospice, there appears to be overuse of and overreliance on acute care hospital services near the end-of-life in Canada. The high rates of hospital deaths and admissions through the ED at the end-of-life for cancer patients may signal a lack of planning for impeding death and inadequate availability of or access to community- and home-based palliative and end-of-life care services. Acute care hospitals may have a role in managing the health care needs of people affected by cancer; however, end-of-life care should be an option in other settings that align with patient preferences. Standards or practice guidelines to identify, assess and refer patients to palliative care services earlier in their cancer journey should be developed and implemented to ensure optimal quality of life.
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Affiliation(s)
- J. Tung
- Canadian Partnership Against Cancer, System Performance, Toronto, Canada
| | - K. Decaria
- Canadian Partnership Against Cancer, System Performance, Toronto, Canada
| | - D. Dudgeon
- Canadian Partnership Against Cancer, System Performance, Toronto, Canada
| | - E. Green
- Canadian Partnership Against Cancer, System Performance, Toronto, Canada
| | - R. Shaw Moxam
- Canadian Partnership Against Cancer, System Performance, Toronto, Canada
| | - J. Niu
- Canadian Partnership Against Cancer, System Performance, Toronto, Canada
| | - R. Rahal
- Canadian Partnership Against Cancer, System Performance, Toronto, Canada
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Tung J, Politis C, Chadder J, Han J, Niu J, Fung S, Rahal R, Earle C. Geographic Variation in Colorectal Cancer Incidence and the Disparities in the Prevalence of Modifiable Risk Factors Across Canada. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.36600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Colorectal cancer is the third most common cancer worldwide. There is wide geographic variation in incidence with rates varying ten-fold between high- and low-income countries. This heavy burden can be mitigated given previous research has estimated that nearly half of all colorectal cancer cases could have been prevented through healthier diets and physically active lifestyles. In Canada, there is considerable geographic variation in age-adjusted incidence rates for colorectal cancer between jurisdictions, greater than that seen for many other cancers. These wide variations likely reflect differences in the prevalence of risk factors across provinces and territories. Aim: To describe the extent of the variation in colorectal cancer incidence rates across Canada and the disparities in the prevalence of modifiable risk factors across jurisdictions known to contribute to this burden. Methods: Colorectal cancer incident cases were obtained from the Canadian Cancer Registry; 2014 was used for provinces (except Quebec where 2010 was the most recent year available) and years 2012 to 2014 were combined to achieve more stable rates for the territories, which are much smaller in population. Data on four known modifiable risk factors for colorectal cancer (excess weight, physical inactivity, alcohol intake and low fruit and vegetable consumption) were obtained from the 2015-16 combined Canadian Community Health Survey. Results: Findings suggest that there is a north-south and east-west gradient in colorectal cancer modifiable risk factors in Canada. For instance, the percentage of adults with excess body weight ranged from 56.8% in British Columbia (west) to 73.1% in New Brunswick (east) and the percentage of adults not meeting physical activity guidelines ranged from 31.8% in Yukon (north) to 50.3% in New Brunswick (east). Generally, this pattern also reflects colorectal cancer incidence rates. The highest prevalence of modifiable risk factors and rates of colorectal cancer are typically in the northern (territories) and eastern provinces of Canada. Conclusion: The global burden of colorectal cancer is expected to increase by nearly 60% by 2030; therefore, targeted interventions are needed to ensure there is not a widening gap in colorectal cancer burden worldwide. Based on current knowledge, the most effective approaches to reduce the burden of colorectal cancer include: 1) adopting public policies that make healthy choices easier and create healthier environments where people live, work and play, and 2) continuing emphasis on screening and early detection. Strategic approaches to addressing modifiable risk factors, as well as mechanisms for detecting colorectal cancer before it develops, have the potential to translate into positive effects on population health and less people developing and dying from cancer.
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Affiliation(s)
- J. Tung
- Canadian Partnership Against Cancer, System Performance, Toronto, Canada:
| | - C. Politis
- Canadian Partnership Against Cancer, Prevention, Toronto, Canada
| | - J. Chadder
- Canadian Partnership Against Cancer, System Performance, Toronto, Canada:
| | - J. Han
- Canadian Partnership Against Cancer, Analytics, Toronto, Canada
| | - J. Niu
- Canadian Partnership Against Cancer, Analytics, Toronto, Canada
| | - S. Fung
- Canadian Partnership Against Cancer, Analytics, Toronto, Canada
| | - R. Rahal
- Canadian Partnership Against Cancer, Cancer Control, Toronto, Canada
| | - C. Earle
- Canadian Partnership Against Cancer, Cancer Control, Toronto, Canada
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Tung J, Politis CE, Chadder J, Han J, Niu J, Fung S, Rahal R, Earle CC. The north-south and east-west gradient in colorectal cancer risk: a look at the distribution of modifiable risk factors and incidence across Canada. ACTA ACUST UNITED AC 2018; 25:231-235. [PMID: 29962842 DOI: 10.3747/co.25.4071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Colorectal cancer (crc) is the 2nd most common cancer in Canada and the 2nd leading cause of cancer death. That heavy burden can be mitigated given the preventability of crc through lifestyle changes and screening. Here, we describe the extent of the variation in crc incidence rates across Canada and the disparities, by jurisdiction, in the prevalence of modifiable risk factors known to contribute to the crc burden. Findings suggest that there is a north-south and east-west gradient in crc modifiable risk factors, including excess weight, physical inactivity, excessive alcohol consumption, and low fruit and vegetable consumption, with the highest prevalence of risk factors typically found in the territories and Atlantic provinces. In general, that pattern reflects the crc incidence rates seen across Canada. Given the substantial interjurisdictional variation, more work is needed to increase prevention efforts, including promoting a healthier diet and lifestyle, especially in jurisdictions facing disproportionately higher burdens of crc. Based on current knowledge, the most effective approaches to reduce the burden of crc include adopting public policies that create healthier environments in which people live, work, learn, and play; making healthy choices easier; and continuing to emphasize screening and early detection. Strategic approaches to modifiable risk factors and mechanisms for early cancer detection have the potential to translate into positive effects for population health and fewer Canadians developing and dying from cancer.
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Affiliation(s)
- J Tung
- Canadian Partnership Against Cancer, Toronto, ON
| | - C E Politis
- Canadian Partnership Against Cancer, Toronto, ON
| | - J Chadder
- Canadian Partnership Against Cancer, Toronto, ON
| | - J Han
- Canadian Partnership Against Cancer, Toronto, ON
| | - J Niu
- Canadian Partnership Against Cancer, Toronto, ON
| | - S Fung
- Canadian Partnership Against Cancer, Toronto, ON
| | - R Rahal
- Canadian Partnership Against Cancer, Toronto, ON
| | - C C Earle
- Canadian Partnership Against Cancer, Toronto, ON
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21
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Boon A, See Hoe L, Pederson S, Obonyo N, Wells M, Bartnikowski N, Passmore M, Marshall L, James L, Tung J, Suen J, Macdonald P, McGiffin D, Fraser J. Inflammatory Cytokine Profiles in 24-Hour Brain Stem Death Model. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.506] [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: 10/17/2022] Open
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Lee PT, Sng G, Loh J, Tung J, Yeo KK. Authors’ reply: Comment on: Empathy and burnout: a study on residents from a Singapore institution. Singapore Med J 2018; 59:168. [DOI: 10.11622/smedj.2018034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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See Hoe L, Obonyo N, Byrne L, Shiino K, Diab S, Dunster K, Passmore M, Boon C, Engkilde-Pedersen S, Esguerra A, Fauzi M, Pretti Pimenta L, Simonova G, Van Haren F, Shekar K, Anstey C, Tung J, Cullen L, Platts D, Chan J, Maitland K, Fraser J. Fluid Resuscitation with 0.9% Saline Impairs Myocardial Contractility in an Ovine Model of Endotoxaemic Shock. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.129] [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: 10/28/2022]
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24
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Tung J, Ching JY, Ng YM, Tew LS, Khung YL. Grafting of Ring-Opened Cyclopropylamine Thin Films on Silicon (100) Hydride via UV Photoionization. ACS Appl Mater Interfaces 2017; 9:31083-31094. [PMID: 28832115 DOI: 10.1021/acsami.7b08343] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The grafting of cyclopropylamine onto a silicon (100) hydride (Si-H) surface via a ring-opening mechanism using UV photoionization is described here. In brief, radicals generated from the Si-H surface upon UV irradiation were found to behave in classical hydrogen abstraction theory manner by which the distal amine group was first hydrogen abstracted and the radical propagated down to the cyclopropane moiety. This subsequently liberated the strained bonds of the cyclopropane group and initiated the surface grafting process, producing a thin film approximately 10-15 nm in height. Contact angle measurements also showed that such photoionization irradiation had yielded an extremely hydrophilic surface (∼21.3°) and X-ray photoelectron spectroscopy also confirmed the coupling was through the Si-C linkage. However, when the surface underwent high-temperature hydrosilylation (>160 °C), the reaction proceeded predominantly through the nucleophilic NH2 group to form a Si-N linkage to the surface. This rendered the surface hydrophobic and hence suggested that the Si-H homolysis model may not be the main process. To the best of our knowledge, this was the first attempt reported in the literature to use photoionization to directly graft cyclopropylamine onto a silicon surface and in due course generate a highly rich NH-terminated surface that was found to be highly bioactive in promoting cell viability on the basis of 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide studies.
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Affiliation(s)
- J Tung
- College of Arts and Sciences, University of North Carolina (UNC) at Chapel Hill , Chapel Hill, North Carolina 27514, United States
| | - J Y Ching
- Institute of New Drug Development, China Medical University , No. 91 Hsueh-Shih Road, Taichung 40402, Taiwan, Republic of China
| | - Y M Ng
- Advanced Medical and Dental Institute (AMDI), Universiti Sains Malaysia , 13200 Kepala Batas, Pulau Pinang, Malaysia
| | - L S Tew
- Advanced Medical and Dental Institute (AMDI), Universiti Sains Malaysia , 13200 Kepala Batas, Pulau Pinang, Malaysia
| | - Y L Khung
- Institute of New Drug Development, China Medical University , No. 91 Hsueh-Shih Road, Taichung 40402, Taiwan, Republic of China
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Eickstaedt JB, Killpack L, Tung J, Davis D, Hand JL, Tollefson MM. Psoriasis and Psoriasiform Eruptions in Pediatric Patients with Inflammatory Bowel Disease Treated with Anti-Tumor Necrosis Factor Alpha Agents. Pediatr Dermatol 2017; 34:253-260. [PMID: 28211161 DOI: 10.1111/pde.13081] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [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: 01/06/2023]
Abstract
BACKGROUND Anti-tumor necrosis factor alpha (TNF-α) agents are used to treat a variety of autoimmune and inflammatory conditions, including psoriasis. Paradoxically, numerous reports have documented new-onset or exacerbation of psoriasis or psoriasiform skin lesions (PSO) in patients treated with these agents for conditions other than PSO-particularly in adults with inflammatory bowel disease (IBD). Not much is known regarding similar cases in children. METHODS A retrospective chart review was performed on children younger than 19 years of age with IBD seen at the Mayo Clinic between 2003 and 2015 who developed new-onset or recurrent PSO while undergoing anti-TNF-α therapy. RESULTS Fourteen children developed PSO while undergoing anti-TNF-α therapy for IBD. All three anti-TNF-α agents (infliximab, adalimumab, certolizumab) used to treat IBD in this series led to induction or recurrence of PSO lesions. The median time to development of PSO was 11 months (range 0-48 mos), the median age was 15 years (range 12.5-17.5 yrs), and 57% of patients were male. IBD activity was quiescent in 93% of cases at PSO onset. Seven patients (50%) discontinued their initial anti-TNF-α therapy because of their skin disease. Ultimately, four patients (29%) had to discontinue all anti-TNF-α therapy to induce PSO resolution. CONCLUSION TNF-α antagonist-induced PSO in children with IBD is a rarely reported adverse reaction. PSO onset has a variable latency, but usually occurs during IBD remission, with a slight male bias. Nearly half of patients required a change in their initial anti-TNF-α agent despite conventional skin-directed therapies, and one-third of patients discontinued all anti-TNF-α therapy because of PSO.
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Affiliation(s)
| | | | - Jeanne Tung
- Division of Pediatric Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Dawn Davis
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Jennifer L Hand
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota.,Department of Clinical Genomics, Mayo Clinic, Rochester, Minnesota.,Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
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Abstract
IntroductionJoint hypermobility syndrome/Ehlers Danlos III (JHS/EDS III) is a common, connective tissue condition. This group is over-represented in panic/anxiety disorders and exhibits autonomic abnormalities and heightened interoceptive sensibility. Previous neuroimaging in healthy volunteers with hypermobility has observed differences in key emotional brain regions, notably amygdala and insula.Aims and objective To explore, in a clinical population, the structural brain correlates underpinning the association between JHS/EDS III and anxiety.MethodSeventy participants were divided into four experimental groups: (2 × 2 factor design: presence/absence of hypermobility; presence/absence of anxiety). Hypermobility was assessed using Brighton Criteria. All participants underwent brief tests of autonomic function and interoception. Structural images were obtained using a 1.5 T MRI scanner. Results are reported at whole brain uncorrected significance threshold of P < 0.001.ResultsComparison of grey matter volume revealed increased insular volume in anxious patients with JHS/EDS-III compared to anxious patients without (Fig. 1A, B), correlating with initial peak heart rate on standing. Additionally, amygdala volume correlated with hypermobility score in anxious patients, but not in non-anxious individuals (Fig. 1C, D). Amygdala volume correlated with interoceptive accuracy.ConclusionsThis data implicates amygdala and insula as likely neural substrates mediating clinical relationships between hypermobility syndrome and anxiety, demonstrating the relevance of autonomic and interoceptive influences on this relationship. Further work hopes to explore functional and structural connectivity between these regions in JHS/EDS-III.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Polites SF, Potter DD, Moir CR, Zarroug AE, Stephens MC, Tung J, Pavey ES, Harmsen WS, Pemberton JH. Long-term outcomes of ileal pouch-anal anastomosis for pediatric chronic ulcerative colitis. J Pediatr Surg 2015; 50:1625-9. [PMID: 25863545 DOI: 10.1016/j.jpedsurg.2015.03.044] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 12/02/2014] [Revised: 03/02/2015] [Accepted: 03/08/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Ileal pouch-anal anastomosis (IPAA) is the surgical treatment of choice for patients with chronic ulcerative colitis (CUC). In the pediatric population, short-term outcomes of IPAA are excellent but long-term data limited. The purpose of this study is to report long-term functional and quality of life outcomes of IPAA in pediatric patients. METHODS Functional outcomes and quality of life (QoL) following IPAA in patients ≤ 18 years of age were prospectively assessed by survey over a 30 year period. Preoperative information, chronic pouchitis and pouch loss were retrospectively reviewed. RESULTS Over 30 years, 202 children with CUC underwent IPAA. Questionnaires were returned by 87% and median (range) survey follow-up was 181.5 (7.8-378.5) months. Postoperative day and night-time stool frequency did not increase over time though incontinence increased slightly. Quality of life (QoL) was generally excellent and stable over time. Crohn's disease (CD) was diagnosed in 33 (16%) patients during the follow-up period. Chronic pouchitis occurred in 22 patients and pouch failure in 13 patients. Kaplan Meier estimates of pouch survival at 20 years were 61% for patients with CD and 92% for CUC. CONCLUSIONS Ileal pouch-anal anastomosis has long-term durability as a cure for pediatric chronic ulcerative colitis, with most patients reporting stable bowel function and QoL. Chronic pouchitis and pouch failure affect a minority of patients and require further study.
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Affiliation(s)
| | - Donald D Potter
- Division of Pediatric Surgery, University of Iowa Children's Hospital, University of Iowa, Iowa City, IA.
| | | | | | - Michael C Stephens
- Division of Pediatric Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Jeanne Tung
- Division of Pediatric Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Emily S Pavey
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - W Scott Harmsen
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
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28
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Forrest CB, Crandall WV, Bailey LC, Zhang P, Joffe MM, Colletti RB, Adler J, Baron HI, Berman J, del Rosario F, Grossman AB, Hoffenberg EJ, Israel EJ, Kim SC, Lightdale JR, Margolis PA, Marsolo K, Mehta DI, Milov DE, Patel AS, Tung J, Kappelman MD. Effectiveness of anti-TNFα for Crohn disease: research in a pediatric learning health system. Pediatrics 2014; 134:37-44. [PMID: 24935993 PMCID: PMC4531278 DOI: 10.1542/peds.2013-4103] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [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] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES ImproveCareNow (ICN) is the largest pediatric learning health system in the nation and started as a quality improvement collaborative. To test the feasibility and validity of using ICN data for clinical research, we evaluated the effectiveness of anti-tumor necrosis factor-α (anti-TNFα) agents in the management of pediatric Crohn disease (CD). METHODS Data were collected in 35 pediatric gastroenterology practices (April 2007 to March 2012) and analyzed as a sequence of nonrandomized trials. Patients who had moderate to severe CD were classified as initiators or non-initiators of anti-TNFα therapy. Among 4130 patients who had pediatric CD, 603 were new users and 1211 were receiving anti-TNFα therapy on entry into ICN. RESULTS During a 26-week follow-up period, rate ratios obtained from Cox proportional hazards models, adjusting for patient and disease characteristics and concurrent medications, were 1.53 (95% confidence interval [CI], 1.20-1.96) for clinical remission and 1.74 (95% CI, 1.33-2.29) for corticosteroid-free remission. The rate ratio for corticosteroid-free remission was comparable to the estimate produced by the adult SONIC study, which was a randomized controlled trial on the efficacy of anti-TNFα therapy. The number needed to treat was 5.2 (95% CI, 3.4-11.1) for clinical remission and 5.0 (95% CI, 3.4-10.0) for corticosteroid-free remission. CONCLUSIONS In routine pediatric gastroenterology practice settings, anti-TNFα therapy was effective at achieving clinical and corticosteroid-free remission for patients who had Crohn disease. Using data from the ICN learning health system for the purpose of observational research is feasible and produces valuable new knowledge.
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Affiliation(s)
| | - Wallace V. Crandall
- Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children’s Hospital, Columbus, Ohio
| | - L. Charles Bailey
- Department of Pediatrics, and,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Marshall M. Joffe
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Richard B. Colletti
- Department of Pediatrics, The University of Vermont College of Medicine, Burlington, Vermont
| | - Jeremy Adler
- Department of Pediatrics and Communicable Diseases, Division of Pediatric Gastroenterology, University of Michigan, Ann Arbor, Michigan
| | - Howard I. Baron
- Department of Pediatrics, University of Nevada School of Medicine, Pediatric Gastroenterology and Nutrition Associates, Las Vegas, Nevada
| | - James Berman
- Advocate Children's Hospital, UIC College of Medicine, Loyola University School of Medicine, Chicago, Illinois
| | - Fernando del Rosario
- Department of Pediatrics, Division of Pediatric Gastroenterology Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Andrew B. Grossman
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Edward J. Hoffenberg
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado
| | - Esther J. Israel
- Department of Pediatrics, Massachusetts General Hospital for Children, Harvard Medical School, Boston, Massachusetts
| | - Sandra C. Kim
- Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children’s Hospital, Columbus, Ohio
| | | | - Peter A. Margolis
- Department of Pediatrics, James M. Anderson Center for Health Systems Excellence, and
| | - Keith Marsolo
- Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Devendra I. Mehta
- Department of Pediatrics, Arnold Palmer Hospital for Children, Florida State University, Orlando, Florida
| | - David E. Milov
- Department of Pediatrics, Nemour’s Children’s Hospital, Orlando, Florida
| | - Ashish S. Patel
- Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, Texas;,Department of Pediatrics, Children’s Medical Center, Dallas, Texas
| | - Jeanne Tung
- Department of Pediatric and Adolescent Medicine, Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota; and
| | - Michael D. Kappelman
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Joyce DD, Antiel RM, Oderich G, Gloviczki P, Tung J, Grothe R, Absah I, Zarroug AE. Pediatric Median Arcuate Ligament Syndrome: Surgical Outcomes and Quality of Life. J Laparoendosc Adv Surg Tech A 2014; 24:104-10. [DOI: 10.1089/lap.2013.0438] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Ryan M. Antiel
- Divisions of General Surgery, Mayo Clinic, Rochester, Minnesota
| | - Gustavo Oderich
- Divisions of Vascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Peter Gloviczki
- Divisions of Vascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jeanne Tung
- Divisions of Pediatric Gastroenterology, Mayo Clinic, Rochester, Minnesota
| | - Rayna Grothe
- Divisions of Pediatric Gastroenterology, Mayo Clinic, Rochester, Minnesota
| | - Imad Absah
- Divisions of Pediatric Gastroenterology, Mayo Clinic, Rochester, Minnesota
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Abstract
OBJECTIVE Microscopic colitis (MC) is prevalent in adults investigated for chronic watery diarrhea, yet characterization of pediatric MC is limited. METHODS Our pathology database was searched from 1995 to 2011 for pediatric cases of lymphocytic colitis (LC) or collagenous colitis (CC). Those with diarrhea persisting for >2 weeks and visually normal colonoscopy were accepted as cases. Demographics, laboratory results, medication use within 3 months of presentation, medical and family history of autoimmune disease, and response to treatment were abstracted. RESULTS A total of 27 cases were histologically consistent with MC on biopsy; 5 with concomitant enteric infection or isolated abdominal pain were excluded. Twenty-two cases of MC (female patients, 59%; median age at diagnosis, 15.3 years) were included (19 LC and 3 CC). Two had type 1 diabetes mellitus, 2 were anti-nuclear antibody positive, and 2 had common variable immunodeficiency. Of 20 patients who underwent an esophagogastroduodenoscopy, 1 had collagenous sprue and 4 had celiac disease. One presented after the clearance of recurrent Clostridium difficile infection. Previous drug exposures included nonsteroidal anti-inflammatory drugs (n = 7), proton pump inhibitors (n = 6), and selective serotonin reuptake inhibitors (n = 3). Common symptoms in addition to diarrhea included abdominal pain (77.3%) and weight loss (27.3%). Of 17 patients with follow-up, all of the 8 treated with steroids had some response: 57.1% (4/7) responded to mesalamine and 42.9% (3/7) responded to bismuth subsalicylate. CONCLUSIONS In this cohort of pediatric patients, LC was much more common than CC. As described in adults, we observed associations with celiac disease, type 1 diabetes mellitus, and medications; we additionally saw an association with immunodeficiency. Our patients showed greater response to steroids than mesalamine or bismuth.
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MESH Headings
- Abdominal Pain/etiology
- Abdominal Pain/prevention & control
- Adolescent
- Anti-Inflammatory Agents/therapeutic use
- Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
- Antidiarrheals/therapeutic use
- Child
- Child, Preschool
- Cohort Studies
- Colitis, Collagenous/drug therapy
- Colitis, Collagenous/immunology
- Colitis, Collagenous/pathology
- Colitis, Collagenous/physiopathology
- Colitis, Lymphocytic/drug therapy
- Colitis, Lymphocytic/immunology
- Colitis, Lymphocytic/pathology
- Colitis, Lymphocytic/physiopathology
- Colon/drug effects
- Colon/immunology
- Colon/pathology
- Diarrhea/etiology
- Diarrhea/prevention & control
- Drug Resistance
- Female
- Follow-Up Studies
- Humans
- Lost to Follow-Up
- Male
- Proton Pump Inhibitors/therapeutic use
- Retrospective Studies
- Selective Serotonin Reuptake Inhibitors/therapeutic use
- Weight Loss/drug effects
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Affiliation(s)
- Nirmala P Narla
- *Mayo Medical School †Department of Anatomic Pathology and Laboratory Medicine ‡Division of Gastroenterology and Hepatology §Division of Pediatric Gastroenterology and Hepatology Mayo Clinic, Rochester, MN
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32
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Abstract
Amphibian species around the world are currently becoming endangered or lost at a rate that outstrips other vertebrates—victims of a combination of habitat loss, climate change and susceptibility to emerging infectious disease (Stuart et al. 2004). One of the most devastating such diseases is caused by the chytrid fungus Batrachochytrium dendrobatidis (Bd), which infects hundreds of amphibian species on multiple continents. While Bd itself has been characterized for some time, we still know little about the mechanisms that make it so deadly. In this issue of Molecular Ecology, Rosenblum et al. describe a genomic approach to this question, reporting the results of a genome-wide analysis of the transcriptional response to Bd in the liver, skin and spleen of mountain yellow-legged frogs (Rana mucosa and R. sierrae: Fig. 1) (Rosenblum et al. 2012). Their results indicate that the skin is not only the first, but likely the most important, line of defence in these animals. Strikingly, they describe a surprisingly modest immune response to infection in Rana, a result that may help explain variable Bd susceptibility across populations and species.
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Affiliation(s)
- L B Barreiro
- Sainte-Justine Hospital Research Centre, Department ofPediatrics, University of Montreal, 3175 Chemin de la CoteSainte-Catherine, Montreal, Quebec H3T 1C5, Canada
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Tung F, Tung J, Fischl M. A dose-escalation clinical trial to evaluate the safety and immunogenicity of a replication-defective HIV-1 vaccine-HIVAX. Retrovirology 2012. [PMCID: PMC3441395 DOI: 10.1186/1742-4690-9-s2-p127] [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: 11/29/2022] Open
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Kennedy R, Potter DD, Moir C, Zarroug AE, Faubion W, Tung J. Pediatric chronic ulcerative colitis: does infliximab increase post-ileal pouch anal anastomosis complications? J Pediatr Surg 2012; 47:199-203. [PMID: 22244417 DOI: 10.1016/j.jpedsurg.2011.10.042] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [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: 10/01/2011] [Accepted: 10/08/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Total proctocolectomy with ileal pouch anal anastomosis (IPAA) is a common surgical approach to chronic ulcerative colitis (CUC). Preoperative use of Infliximab (IFX) has raised concern of increased postoperative complications. We sought to compare outcomes of pediatric patients (≤ 18 years) who were treated with IFX before IPAA to those who did not. METHODS Patients (≤ 18 years of age) who underwent IPAA from 2003 to 2008 for CUC were included, and their records were retrospectively reviewed for preoperative medications, operative technique, and 1-year postoperative complications (leak, wound infection, small bowel obstruction, pouchitis). Subjects were divided into 2 groups--those who received IFX preoperatively and those who did not. RESULTS Eleven patients received IFX preoperatively, and 27 children did not. All complications following IPAA were more frequent in the IFX group compared to controls (55% vs 26%). Small bowel obstruction was significantly higher in the IFX group (55% vs 7%). Long-term complications occurred in 64% of the IFX group and 61% of the controls. CONCLUSION Children that were treated with IFX prior to IPAA suffered twice as many postoperative complications. Long-term outcomes are similar. Currently, we recommend colectomy with end ileostomy for patients that receive IFX within 8 weeks of colectomy for CUC.
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Affiliation(s)
- Raelene Kennedy
- Division of Pediatric Surgery, Mayo Clinic, Rochester, MN 55905, USA
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Potter DD, Tung J, Faubion WA, Moir C. Single-incision laparoscopic colon and rectal surgery for pediatric inflammatory bowel disease and polyposis syndromes. J Laparoendosc Adv Surg Tech A 2011; 22:203-7. [PMID: 22047143 DOI: 10.1089/lap.2011.0117] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Minimally invasive procedures for inflammatory bowel disease have been shown to improve recovery in children. We report our initial experience with single-incision laparoscopic operations for pediatric intestinal disease. METHODS We retrospectively reviewed 12 procedures in 11 patients (4 women) from March 2010 to January 2011. Procedures were conducted by using standard laparoscopic instruments. RESULTS Mean age was 15 years (9-17 years). Procedures included three total abdominal colectomies, four two-stage ileal-pouch anal anastomosis (IPAA), two single-stage IPAA, two three-stage IPAA, and one ileocectomy. An accessory umbilical port was used in 6 cases. Mean operating time was 287 minutes. Mean length of stay was 4.1 days (3-9 days). Postoperative complications have occurred in 5 patients (42%). Anastomotic leak occurred in 2 patients with IPAA without protective ileostomy, 1 operative small bowel obstruction, 1 pelvic abscess and portal vein thrombosis, and 1 readmission for dehydration. Both patients who had leaked have recovered well and had their stomas reversed. Mean follow-up is 190 days. Average number of daily bowel movements is 4.5. Pouchitis has occurred in 50% (4/8) of patients. CONCLUSIONS Single-incision laparoscopic surgery for pediatric intestinal disease is safe and feasible by using standard laparoscopic instruments. We do not advocate IPAA without a stoma due to the high rate of anastomotic leak. Continued experience will shorten operative times and reduce complications.
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Affiliation(s)
- Donald Dean Potter
- Division of Pediatric Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
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Charpentier MJE, Fontaine MC, Cherel E, Renoult JP, Jenkins T, Benoit L, Barthès N, Alberts SC, Tung J. Genetic structure in a dynamic baboon hybrid zone corroborates behavioural observations in a hybrid population. Mol Ecol 2011; 21:715-31. [PMID: 21988698 DOI: 10.1111/j.1365-294x.2011.05302.x] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Behaviour and genetic structure are intimately related: mating patterns and patterns of movement between groups or populations influence the movement of genetic variation across the landscape and from one generation to the next. In hybrid zones, the behaviour of the hybridizing taxa can also impact the incidence and outcome of hybridization events. Hybridization between yellow baboons and anubis baboons has been well documented in the Amboseli basin of Kenya, where more anubis-like individuals tend to experience maturational and reproductive advantages. However, it is unknown whether these advantages are reflected in the genetic structure of populations surrounding this area. Here, we used microsatellite genotype data to evaluate the structure and composition of baboon populations in southern Kenya. Our results indicate that, unlike for mitochondrial DNA, microsatellite-based measures of genetic structure concord with phenotypically based taxonomic distinctions and that the currently active hybrid zone is relatively narrow. Isolation with migration analysis revealed asymmetric gene flow in this region from anubis populations into yellow populations, in support of the anubis-biased phenotypic advantages observed in Amboseli. Populations that are primarily yellow but that receive anubis gene flow exhibit higher levels of genetic diversity than yellow populations far from the introgression front. Our results support previous work that indicates a long history of hybridization and introgression among East African baboons. Specifically, it suggests that anubis baboons are in the process of gradual range expansion into the range of yellow baboons, a pattern potentially explained by behavioural and life history advantages that correlate with anubis ancestry.
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Abstract
Natural populations hold enormous potential for evolutionary genetic studies, especially when phenotypic, genetic and environmental data are all available on the same individuals. However, untangling the genotype-phenotype relationship in natural populations remains a major challenge. Here, we describe results of an investigation of one class of phenotype, allele-specific gene expression (ASGE), in the well-studied natural population of baboons of the Amboseli basin, Kenya. ASGE measurements identify cases in which one allele of a gene is overexpressed relative to the alternative allele of the same gene, within individuals, thus providing a control for background genetic and environmental effects. Here, we characterize the incidence of ASGE in the Amboseli baboon population, focusing on the genetic and environmental contributions to ASGE in a set of eleven genes involved in immunity and defence. Within this set, we identify evidence for common ASGE in four genes. We also present examples of two relationships between cis-regulatory genetic variants and the ASGE phenotype. Finally, we identify one case in which this relationship is influenced by a novel gene-environment interaction. Specifically, the dominance rank of an individual's mother during its early life (an aspect of that individual's social environment) influences the expression of the gene CCL5 via an interaction with cis-regulatory genetic variation. These results illustrate how environmental and ecological data can be integrated into evolutionary genetic studies of functional variation in natural populations. They also highlight the potential importance of early life environmental variation in shaping the genetic architecture of complex traits in wild mammals.
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Affiliation(s)
- J Tung
- Department of Biology, Duke University, PO Box 90338, Durham, NC 27708, USA Institute for Genome Sciences & Policy, Durham, NC 27708, USA.
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Rahman MK, Midtling EH, Svingen PA, Xiong Y, Bell MP, Tung J, Smyrk T, Egan LJ, Faubion WA. The pathogen recognition receptor NOD2 regulates human FOXP3+ T cell survival. J Immunol 2010; 184:7247-56. [PMID: 20483763 DOI: 10.4049/jimmunol.0901479] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The expression of pathogen recognition receptors in human FOXP3+ T regulatory cells is established, yet the function of these receptors is currently obscure. In the process of studying the function of both peripheral and lamina propria FOXP3+ lymphocytes in patients with the human inflammatory bowel disease Crohn's disease, we observed a clear deficiency in the quantity of FOXP3+ lymphocytes in patients with disease-associated polymorphisms in the pathogen recognition receptor gene NOD2. Subsequently, we determined that the NOD2 ligand, muramyl dipeptide (MDP), activates NF-kappaB in primary human FOXP3+ T cells. This activation is functionally relevant, as MDP-stimulated human FOXP3+ T cells are protected from death receptor Fas-mediated apoptosis. Importantly, apoptosis protection was not evident in MDP-stimulated FOXP3+ T cells isolated from a patient with the disease-associated polymorphism. Thus, we propose that one function of pathogen recognition receptors in human T regulatory cells is the protection against death receptor-mediated apoptosis in a Fas ligand-rich environment, such as that of the inflamed intestinal subepithelial space.
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Affiliation(s)
- Meher K Rahman
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Tung F, Ansari A, Tung J. P19-38. Safety and protective immunity in Rhesus monkeys immunized with replication-defective HIV/SIV vaccine. Retrovirology 2009. [PMCID: PMC2767868 DOI: 10.1186/1742-4690-6-s3-p358] [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: 11/22/2022] Open
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Leonhardt S, Tung J, Camden J, Leal M, Drea C. Seeing red: behavioral evidence of trichromatic color vision in strepsirrhine primates. Behav Ecol 2008. [DOI: 10.1093/beheco/arn106] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [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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Tung J, Charpentier MJE, Garfield DA, Altmann J, Alberts SC. Genetic evidence reveals temporal change in hybridization patterns in a wild baboon population. Mol Ecol 2008; 17:1998-2011. [PMID: 18363664 DOI: 10.1111/j.1365-294x.2008.03723.x] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The process and consequences of hybridization are of interest to evolutionary biologists because of the importance of hybridization in understanding reproductive isolation, speciation, and the influence of introgression on population genetic structure. Recent studies of hybridization have been enhanced by the advent of sensitive, genetic marker-based techniques for inferring the degree of admixture occurring within individuals. Here we present a genetic marker-based analysis of hybridization in a large-bodied, long-lived mammal over multiple generations. We analysed patterns of hybridization between yellow baboons (Papio cynocephalus) and anubis baboons (Papio anubis) in a well-studied natural population in Amboseli National Park, Kenya, using genetic samples from 450 individuals born over the last 36 years. We assigned genetic hybrid scores based on genotypes at 14 microsatellite loci using the clustering algorithm implemented in STRUCTURE 2.0, and assessed the robustness of these scores by comparison to pedigree information and through simulation. The genetic hybrid scores showed generally good agreement with previous morphological assessments of hybridity, but suggest that genetic methods may be more sensitive for identification of low levels of hybridity. The results of our analysis indicate that the proportion of hybrids in the Amboseli population has grown over time, but that the average proportion of anubis ancestry within hybrids is gradually decreasing. We argue that these patterns are probably a result of both selective and nonselective processes, including differences in the timing of life-history events for hybrid males relative to yellow baboon males, and stochasticity in long-distance dispersal from the source anubis population into Amboseli.
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Affiliation(s)
- J Tung
- Department of Biology, Duke University, PO Box 90338, Durham, NC 27708, USA.
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Abstract
The timing of early life-history events, such as sexual maturation and first reproduction, can greatly influence variation in individual fitness. In this study, we analysed possible sources of variation underlying different measures of age at social and physical maturation in wild baboons in the Amboseli basin, Kenya. The Amboseli baboons are a natural population primarily comprised of yellow baboons (Papio cynocephalus) that occasionally hybridize with anubis baboons (Papio anubis) from outside the basin. We found that males and females differed in the extent to which various factors influenced their maturation. Surprisingly, we found that male maturation was most strongly related to the proportion of anubis ancestry revealed by their microsatellite genotypes: hybrid males matured earlier than yellow males. In contrast, although hybrid females reached menarche slightly earlier than yellow females, maternal rank and the presence of maternal relatives had the largest effects on female maturation, followed by more modest effects of group size and rainfall. Our results indicate that a complex combination of demographic, genetic, environmental, and maternal effects contribute to variation in the timing of these life-history milestones.
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Affiliation(s)
- M J E Charpentier
- Department of Biology, Duke University, PO Box 90338, Durham, NC 27708, USA.
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Tung J, Loftus EV, Freese DK, El-Youssef M, Zinsmeister AR, Melton LJ, Harmsen WS, Sandborn WJ, Faubion WA. A population-based study of the frequency of corticosteroid resistance and dependence in pediatric patients with Crohn's disease and ulcerative colitis. Inflamm Bowel Dis 2006; 12:1093-100. [PMID: 17119382 DOI: 10.1097/01.mib.0000235835.32176.85] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The goal of this study was to examine the 1-year outcome after the first course of systemic corticosteroids in an inception cohort of pediatric patients with inflammatory bowel disease. METHODS All Olmsted County (Minnesota) residents diagnosed with Crohn's disease (n = 50) or ulcerative colitis (n = 36) before 19 years of age from 1940 to 2001 were identified. Outcomes at 30 days and 1 year after the initial course of corticosteroids were recorded. RESULTS Twenty-six patients with Crohn's disease (65%) and 14 with ulcerative colitis (44%) were treated with corticosteroids before age 19. Thirty-day outcomes for corticosteroid-treated Crohn's disease were complete remission in 16 (62%), partial remission in 7 (27%), and no response in 3 (12%), with 2 of these patients requiring surgery. Thirty-day outcomes for treated ulcerative colitis were complete remission in 7 (50%), partial remission in 4 (29%), and no response in 3 (21%). One-year outcomes for Crohn's disease were prolonged response in 11 (42%) and corticosteroid dependence in 8 (31%), whereas 7 (27%) were postsurgical. One-year outcomes for ulcerative colitis were prolonged response in 8 (57%) and corticosteroid dependence in 2 (14%), whereas 4 (29%) were postsurgical. CONCLUSIONS Most pediatric patients with inflammatory bowel disease initially responded to corticosteroids. However, after 1 year, 58% of pediatric patients with Crohn's disease and 43% of pediatric patients with ulcerative colitis either were steroid dependent or required surgery. This finding emphasizes the need for early steroid-sparing medications in pediatric inflammatory bowel disease.
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Affiliation(s)
- Jeanne Tung
- Division of Pediatric Gastroenterology and Hepatology, Department of Pediatrics, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
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Affiliation(s)
- J H Taylor
- DEPARTMENT OF BOTANY, COLUMBIA UNIVERSITY
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McGregor RS, Tung J. Concurrent meningitis/serious bacterial infection in an infant hospitalized with respiratory syncytial virus. Arch Pediatr Adolesc Med 2002; 156:1055; author reply 1056-7. [PMID: 12361455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Affiliation(s)
- Robert S McGregor
- St Christopher's Hospital for Children, Erie Avenue at Front Street, Philadelphia, PA 19134-1095, USA
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Abstract
BACKGROUND Aplastic anemia is a rare but well-recognized complication of acute hepatitis and acute liver failure. The cause is unknown, and the condition is fatal without bone marrow recovery. Treatment includes immunosuppression regimens or bone marrow transplantation. The purpose of this study was to investigate the incidence, cause, treatment, and outcomes of this disorder in children. METHODS Retrospective chart review of 75 patients with acute liver failure in a major pediatric liver center. RESULTS Eight patients had evidence of bone marrow failure. Of those, six had aplastic anemia, and two had transient bone marrow suppression. There were five boys, median age 57 months (range, 36-132 months). Two had parvovirus B19, six had non-A, non-B, non-C hepatitis. Five underwent liver transplantation: auxiliary in one, orthotopic in four. The interval between initial symptoms and development of aplastic anemia and/or bone marrow suppression was 21 to 99 days (median, 39 days). Four patients with aplastic anemia received intravenous antithymocyte globulin (ATG) or antilymphocyte globulin (ALG). Median recovery period of granulopoiesis was 62 days (range, 27-115 days). Two made a full recovery, one had myelodysplasia, and one with unresponsive disease died of septic complications. Four did not receive ATG/ALG, two had aplastic anemia, and two had bone marrow suppression. Three underwent liver transplantation, and all four resumed granulopoiesis. One child who underwent liver transplantation died of sepsis with chronic rejection. Median recovery of granulopoiesis was 99 days (range, 20-153 days). CONCLUSIONS Bone marrow failure occurs in 10.7% of children with acute liver failure. It sometimes occurs in association with non-A, non-B, non-C hepatitis and parvovirus B19 infection. Treatment with ATG/ALG is successful and is well tolerated in most cases.
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Affiliation(s)
- J Tung
- Department of Child Health, King's College Hospital, United Kingdom
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Francavilla R, Castellaneta SP, Hadzic N, Chambers SM, Portmann B, Tung J, Cheeseman P, Rela M, Heaton ND, Mieli-Vergani G. Prognosis of alpha-1-antitrypsin deficiency-related liver disease in the era of paediatric liver transplantation. J Hepatol 2000; 32:986-92. [PMID: 10898319 DOI: 10.1016/s0168-8278(00)80103-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND/AIM Alpha-1-antitrypsin deficiency (alpha1ATD) is the commonest metabolic disease leading to liver transplantation (LT) in children. Approximately 10-15% of the PiZZ population develops liver disease. Five percent of them will require LT within the first 4 years of life. This study aimed to investigate the prognosis of the liver disease associated with PiZZ alpha1ATD in the era of liver transplantation and to determine predictors of outcome. METHODS We reviewed retrospectively the clinical notes of 97 consecutive patients referred from January 1989, when LT became routinely available in our Unit, to July 1998. RESULTS Of 26 (27%) patients who developed end-stage liver disease, 24 have been transplanted and two are waiting for LT. Twenty-one (81%) of these patients presented with neonatal hepatitis at a median age of 2.1 months. Of 71 (73%) children who have not required LT, 61 (86%) presented with neonatal hepatitis at a median age of 1.6 months. Among infants with neonatal hepatitis who required LT, 18 out of 21 (86%) had jaundice for more than 6 weeks compared with 34 of 61 (56%) who survived without LT (p<0.01). Children requiring LT had higher aspartate aminotransferase (AST) at presentation (p<0.0001) and both higher AST and gamma-glutamyl transferase (GGT) at 6 months (p<0.001), 1-year (p<0.0003) and 5-year (p<0.01) follow up when compared to those who are well without LT. Furthermore, children who developed end-stage liver disease more frequently had severe bile duct reduplication (p<0.01), severe fibrosis (p<0.03) with bridging septa (p<0.02) and established cirrhosis (p<0.04) in the initial liver biopsy. Ninety-five of the 97 children (98%) are currently alive; two died after LT. CONCLUSIONS The advent of liver transplantation has significantly improved the prognosis of liver disease associated with PiZZ alpha1ATD. Duration of jaundice, severity of histological features and biochemical abnormalities predict outcome at an early stage of the disease.
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Affiliation(s)
- R Francavilla
- Department of Child Health, King's College Hospital, London, UK
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Abstract
Since anti-CD1 TCR transgenic T cells can activate syngeneic B cells via CD1 to secrete IgM and IgG and induce lupus in BALB/c mice, we studied the role of CD1 in the pathogenesis of lupus in NZB/NZW mice. Approximately 20% of B cells from the spleens of NZB/NZW mice expressed high levels of CD1 (CD1high B cells). The latter subset spontaneously produced large amounts of IgM anti-dsDNA Abs in vitro that was up to 25-fold higher than that of residual CD1int/low B cells. T cells in the NZB/NZW spleen proliferated vigorously to the CD1-transfected A20 B cell line, but not to the parent line. Treatment of NZB/NZW mice with anti-CD1 mAbs ameliorated the development of lupus. These results suggest that the CD1high B cells and their progeny are a major source of autoantibody production, and activation of B cells via CD1 may play an important role in the pathogenesis of lupus.
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Affiliation(s)
- D Zeng
- Department of Medicine, Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, CA 94306, USA
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Sinha S, Anderson JP, Barbour R, Basi GS, Caccavello R, Davis D, Doan M, Dovey HF, Frigon N, Hong J, Jacobson-Croak K, Jewett N, Keim P, Knops J, Lieberburg I, Power M, Tan H, Tatsuno G, Tung J, Schenk D, Seubert P, Suomensaari SM, Wang S, Walker D, Zhao J, McConlogue L, John V. Purification and cloning of amyloid precursor protein beta-secretase from human brain. Nature 1999; 402:537-40. [PMID: 10591214 DOI: 10.1038/990114] [Citation(s) in RCA: 1226] [Impact Index Per Article: 49.0] [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: 11/09/2022]
Abstract
Proteolytic processing of the amyloid precursor protein (APP) generates amyloid beta (Abeta) peptide, which is thought to be causal for the pathology and subsequent cognitive decline in Alzheimer's disease. Cleavage by beta-secretase at the amino terminus of the Abeta peptide sequence, between residues 671 and 672 of APP, leads to the generation and extracellular release of beta-cleaved soluble APP, and a corresponding cell-associated carboxy-terminal fragment. Cleavage of the C-terminal fragment by gamma-secretase(s) leads to the formation of Abeta. The pathogenic mutation K670M671-->N670L671 at the beta-secretase cleavage site in APP, which was discovered in a Swedish family with familial Alzheimer's disease, leads to increased beta-secretase cleavage of the mutant substrate. Here we describe a membrane-bound enzyme activity that cleaves full-length APP at the beta-secretase cleavage site, and find it to be the predominant beta-cleavage activity in human brain. We have purified this enzyme activity to homogeneity from human brain using a new substrate analogue inhibitor of the enzyme activity, and show that the purified enzyme has all the properties predicted for beta-secretase. Cloning and expression of the enzyme reveals that human brain beta-secretase is a new membrane-bound aspartic proteinase.
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Affiliation(s)
- S Sinha
- Elan Pharmaceuticals, South San Francisco, California 94080, USA.
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