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Kamali A, Ferguson D, Dowless H, Ortiz N, Mukhopadhyay R, Schember C, Lunsford R, Hutchinson J, Scherer M, Crandall J, Bauer H, Yu A, Kimura A. Outbreak of Invasive Serratia marcescens among Persons Incarcerated in a State Prison, California, USA, March 2020-December 2022. Emerg Infect Dis 2024; 30:S41-S48. [PMID: 38561639 PMCID: PMC10986826 DOI: 10.3201/eid3013.230801] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Serratia marcescens is an environmental gram-negative bacterium that causes invasive disease in rare cases. During 2020-2022, an outbreak of 21 invasive Serratia infections occurred in a prison in California, USA. Most (95%) patients had a history of recent injection drug use (IDU). We performed whole-genome sequencing and found isolates from 8 patients and 2 pieces of IDU equipment were closely related. We also identified social interactions among patients. We recovered S. marcescens from multiple environmental samples throughout the prison, including personal containers storing Cell Block 64 (CB64), a quaternary ammonium disinfectant solution. CB64 preparation and storage conditions were suboptimal for S. marcescens disinfection. The outbreak was likely caused by contaminated CB64 and propagated by shared IDU equipment and social connections. Ensuring appropriate preparation, storage, and availability of disinfectants and enacting interventions to counteract disease spread through IDU can reduce risks for invasive Serratia infections in California prisons.
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Grossmann NV, Milne C, Martinez MR, Relucio K, Sadeghi B, Wiley EN, Holland SN, Rutschmann S, Vugia DJ, Kimura A, Crain C, Akter F, Mukhopadhyay R, Crandall J, Shorrock M, Smith JC, Prasad N, Kahn R, Barskey AE, Lee S, Willby MJ, Kozak-Muiznieks NA, Lucas CE, Henderson KC, Hamlin JAP, Yang E, Clemmons NS, Ritter T, Henn J. Large Community Outbreak of Legionnaires Disease Potentially Associated with a Cooling Tower - Napa County, California, 2022. MMWR Morb Mortal Wkly Rep 2023; 72:1315-1320. [PMID: 38060434 PMCID: PMC10715825 DOI: 10.15585/mmwr.mm7249a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Legionnaires disease is a serious infection acquired by inhalation of water droplets from human-made building water systems that contain Legionella bacteria. On July 11 and 12, 2022, Napa County Public Health (NCPH) in California received reports of three positive urinary antigen tests for Legionella pneumophila serogroup 1 in the town of Napa. By July 21, six Legionnaires disease cases had been confirmed among Napa County residents, compared with a baseline of one or two cases per year. NCPH requested assistance from the California Department of Public Health (CDPH) and CDC to aid in the investigations. Close temporal and geospatial clustering permitted a focused environmental sampling strategy of high-risk facilities which, coupled with whole genome sequencing results from samples and investigation of water system maintenance, facilitated potential linking of the outbreak with an environmental source. NCPH, with technical support from CDC and CDPH, instructed and monitored remediation practices for all environmental locations that tested positive for Legionella. The investigation response to this community outbreak illustrates the importance of interdisciplinary collaboration by public health agencies, laboratory support, timely communication with the public, and cooperation of managers of potentially implicated water systems. Timely identification of possible sources, sampling, and remediation of any facility testing positive for Legionella is crucial to interrupting further transmission.
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Ferguson D, Ryder R, Lunsford R, Dash A, Kamali A, Kimura A, Crandall J, Mukhopadhyay R, Dowless H, Ortiz N, Jue NK. Serratia marcescens Outbreak at a Correctional Facility: Environmental Sampling, Laboratory Analyses and Genomic Characterization to Assess Sources and Persistence. Int J Environ Res Public Health 2023; 20:6709. [PMID: 37681849 PMCID: PMC10487681 DOI: 10.3390/ijerph20176709] [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] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/12/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023]
Abstract
Serratia marcescens is an environmental bacterium and clinical pathogen that can cause an array of infections. We describe an environmental sampling and comparative genomics approach used to investigate a multi-year outbreak of S. marcescens at a correctional facility. Whole genome sequencing analysis revealed a predominant cluster of clonally related S. marcescens from nine patient cases and items associated with illicit drug use. Closely related strains found among items associated with case-patient cells and diluted Cell Block 64 (CB64), a quaternary ammonium disinfectant, and Break Out (BO), a multipurpose cleaner, highlighted their role as environmental reservoirs for S. marcescens in this outbreak. Comparative genomic analysis suggested outbreak strains were both persistent (identical strains found over long periods and in multiple locations of the correctional facility) and diverse (strains clustered with multiple global samples from NCBI database). No correlation was found between antimicrobial resistance (AMR) genes of outbreak strains; NCBI strains have more AMR genes. Principal component analysis (PCA) of virulence factors associated with persistence and infectivity indicated variation based on phylogroups, including the predominant cluster; identifiable variations among environmental versus clinical strains were not observed. Identification of multiple distinct genetic groups highlights the importance of putting epidemiological genomic studies in a proper genetic context.
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Affiliation(s)
- Donna Ferguson
- Public Health Laboratory, County of Monterey Health Department, Salinas, CA 93906, USA
| | - Rahil Ryder
- Public Health Laboratory, County of Monterey Health Department, Salinas, CA 93906, USA
| | - Rawni Lunsford
- Public Health Laboratory, County of Monterey Health Department, Salinas, CA 93906, USA
| | - Arie Dash
- Public Health Laboratory, County of Monterey Health Department, Salinas, CA 93906, USA
| | - Amanda Kamali
- Public Health, Medical Services Division, California Correctional Health Care Services, Elk Grove, CA 95758, USA
| | - Akiko Kimura
- Infectious Diseases Branch, Center for Infectious Diseases, California Department of Public Health, Richmond, CA 94804, USA
| | - John Crandall
- Microbial Diseases Laboratory Branch, Center for Laboratory Sciences, California Department of Public Health, Richmond, CA 94804, USA
| | - Rituparna Mukhopadhyay
- Microbial Diseases Laboratory Branch, Center for Laboratory Sciences, California Department of Public Health, Richmond, CA 94804, USA
| | - Heather Dowless
- Public Health, Medical Services Division, California Correctional Health Care Services, Elk Grove, CA 95758, USA
| | - Nancy Ortiz
- Infectious Diseases Branch, Center for Infectious Diseases, California Department of Public Health, Richmond, CA 94804, USA
| | - Nathaniel K. Jue
- Department of Biology and Chemistry, California State University, Monterey Bay, Seaside, CA 93955, USA
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Parihar AS, Schmidt LR, Crandall J, Dehdashti F, Wahl RL. Adverse Clinical Events at the Injection Site Are Exceedingly Rare After Reported Radiopharmaceutical Extravasation in Patients Undergoing 99mTc-MDP Whole-Body Bone Scintigraphy: A 12-Year Experience. J Nucl Med 2023; 64:485-490. [PMID: 36265907 PMCID: PMC10071802 DOI: 10.2967/jnumed.122.264994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 10/12/2022] [Accepted: 10/12/2022] [Indexed: 11/16/2022] Open
Abstract
The deleterious effects of high-dose radiation on normal tissue are sometimes extrapolated to diagnostic (SPECT and PET) radiopharmaceutical extravasation (RPE). It has been hypothesized that diagnostic RPE can have gradually evolving local tissue injury and a potentially increased risk of local dermatologic or oncologic diseases over a longer period. However, data on clinical adverse events after diagnostic RPE are limited. Therefore, our primary aim was to study the occurrence of short-term and long-term clinical adverse events in patients who underwent 99mTc-methylene diphosphonate (99mTc-MDP) whole-body bone scintigraphy (WBBS) with reported RPE. Methods: The records of 99mTc-MDP WBBS performed from June 2010 to January 2022 were retrospectively examined for RPE documented in the scan reports. The clinical records of patients with a documented RPE were extensively reviewed for any related short-term adverse events (within 2 wk of the WBBS: local symptoms and care sought for local dermatologic or musculoskeletal issues) and long-term adverse events (until the last follow-up: local deleterious effects and related consults for dermatology, plastic surgery, oncology, or orthopedics). Results: Retrospective review of the records of 31,679 99mTc-MDP WBBS studies showed RPE documented in 118 (0.37%). Medical records were not retrievable for 22 patients, yielding a final cohort of 96 patients with reported RPE. The median follow-up was 18.9 mo (interquartile range, 7.8-45.7 mo). Short-term events were noted in 4 patients, of whom one was asymptomatic. Of the 3 symptomatic patients, 2 experienced mild discomfort at the injection site, and 1 had tender swelling. Three of the 4 events were in patients who had a prior intravenous contrast extravasation for contrast-enhanced CT performed earlier during the day and a 99mTc-MDP injection later at the same site, likely leading to RPE. None of the long-term local events had any plausible link with the RPE event. Conclusion: Reported RPE was rare, and 3 patients (0.009%) had short-term local symptoms, all of which were likely related to the prior higher-volume intravenous contrast extravasation. The smaller-volume diagnostic radiopharmaceutical injections for WBBS are highly unlikely to cause local symptoms on their own. No patient had any long-term adverse event with a plausible link to the RPE.
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Affiliation(s)
- Ashwin Singh Parihar
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri; and
| | - Lisa R Schmidt
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri; and
| | - John Crandall
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri; and
| | - Farrokh Dehdashti
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri; and.,Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Richard L Wahl
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri; and .,Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
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Kamau E, Adamson PC, Crandall J, Mukhopadhyay R, Yang S. Discovery of a novel sub-lineage of multi-drug resistant Shigella flexneri in Southern California. Int J Infect Dis 2023; 132:1-3. [PMID: 36990199 DOI: 10.1016/j.ijid.2023.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/24/2023] [Accepted: 03/18/2023] [Indexed: 03/30/2023] Open
Abstract
Clustered outbreaks of multi-drug resistant (MDR) Shigella are on the rise among men who have sex with men (MSM). Identification of MDR sub-lineages is critical for clinical management and public health interventions. Here, we describe a novel MDR sub-lineage of Shigella flexneri isolated from an MSM patient without travel history in Southern California. Detailed genomic characterization of this novel strain would serve as a reference to aid monitoring and future outbreak investigation of MDR Shigella among MSM.
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Parihar AS, Schmidt LR, Crandall J, Dehdashti F, Siegel BA, Wahl RL. Effect of body weight on standardized uptake values on 18F-DCFPyL (PSMA) PET/CT in patients with prostate cancer. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.52] [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: 03/15/2023] Open
Abstract
52 Background: Standardized uptake values (SUVs) on PSMA PET/CT are used as a semi-quantitative representation of in-vivo PSMA expression in prostate cancer. PSMA SUVs have been used to determine eligibility for 177Lu-PSMA therapy in previous trials, and to predict response to therapy. Higher lesion SUVmean has been shown to predict a favorable response to 177Lu-PSMA. It is known that 18F-FDG SUV is partly dependent on patient weight, and that the SUV corrected to lean-body mass (SUL) is consistent across variations in body-weight. However, the variability of PSMA SUV with body-weight is unknown. Since SUVmean on PSMA PET/CT has important diagnostic, prognostic, and therapeutic implications, we sought to assess the variability of SUVmean on 18F-DCFPyL PET/CT with body-weight in men with prostate cancer. Methods: The imaging database was searched for men with prostate cancer who underwent 18F-DCFPyL PET/CT from 2021 to 2022. We grouped the patients by age and randomly selected a maximum of 20 patients from each of the six decades of age from 40s to 90s. 18F-DCFPyL PET/CT studies were reviewed on MIM v7.1.5 workstation and semi-automatic segmentations were performed to delineate and measure the SUV of the most tracer-avid lesion. SUVs from the liver and descending thoracic aorta (blood-pool) were also measured. Additionally, the SULs were derived using the Janmahasatian formula for body mass index. A partial correlation test was performed to assess the variability of SUVmean and SULmean with body-weight. Results: A total of 85 18F-DCFPyL PET/CT studies in 85 men (mean age: 68.4±11 years; mean weight: 94.5±23.2 kg) were retrospectively analyzed. 18F-DCFPyL PET/CT was performed for evaluation of biochemical recurrence (n=56) or initial staging (n=29). At least one disease site compatible with prostate cancer was seen in 64 patients. Partial correlation tests were performed with 18F-DCFPyL dose, radiotracer uptake time and PSA value added as potential confounders for SUV. The blood-pool SUVmean (mean: 1.5±0.6; r=0.48; p<0.0001), and SUVmean of the most avid lesion (mean: 15.9±17.4; r=0.33, p=0.01) had a significant positive correlation with body weight. In contrast, liver SUVmean (mean: 5.4±1.2) was not significantly correlated with body weight (p=0.5). The SULmean of the most avid lesion (mean: 10.9±10.9; p=0.06), and blood-pool SULmean (mean: 1.0±0.3; p=0.06) did not have a significant correlation with body weight. Conclusions: Body-weight corrected SUVmean has a significant correlation with patient weight and thus is not representative of the accurate PSMA expression. As SUVmean is commonly utilized for patient selection in clinical trials and as a prognostic marker for 177Lu-PSMA therapy, these variations may lead to inaccurate outcome prediction. SULmean is a consistent representation of in-vivo PSMA expression and should be utilized for further studies of PSMA PET as a prognostic biomarker.
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Affiliation(s)
- Ashwin Singh Parihar
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO
| | - Lisa R Schmidt
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO
| | - John Crandall
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO
| | - Farrokh Dehdashti
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO
| | - Barry A. Siegel
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO
| | - Richard L. Wahl
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO
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Gebremichael Y, Crandall J, Mukhopadhyay R, Xu F. Salmonella Subpopulations Identified from Human Specimens Express Heterogenous Phenotypes That Are Relevant to Clinical Diagnosis. Microbiol Spectr 2023; 11:e0167922. [PMID: 36507668 PMCID: PMC9927314 DOI: 10.1128/spectrum.01679-22] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 11/08/2022] [Indexed: 12/15/2022] Open
Abstract
Clonal bacterial cells can give rise to functionally heterogeneous subpopulations. This diversification is considered an adaptation strategy that has been demonstrated for several bacterial species, including Salmonella enterica serovar Typhimurium. In previous studies on mouse models infected orally with pure Salmonella cultures, derived bacterial cells collected from animal tissues were found to express heterogenous phenotypes. Here, we show mixed Salmonella populations, apparently derived from the same progenitor, present in human specimens collected at a single disease time point, and in a long-term-infected patient, these Salmonella were no longer expressing surface-exposed antigen epitopes by isolates collected at earlier days of the disease. The subpopulations express different phenotypes related to cell surface antigen expression, motility, biofilm formation, biochemical metabolism, and antibiotic resistance, which can all contribute to pathogenicity. Some of the phenotypes correlate with single nucleotide polymorphisms or other sequence changes in bacterial genomes. These genetic variations can alter synthesis of cell membrane-associated molecules such as lipopolysaccharides and lipoproteins, leading to changes in bacterial surface structure and function. This study demonstrates the limitation of Salmonella diagnostic methods that are based on a single-cell population which may not represent the heterogenous bacterial community in infected humans. IMPORTANCE In animal model systems, heterogenous Salmonella phenotypes were found previously to regulate bacterial infections. We describe in this communication that different Salmonella phenotypes also exist in infected humans at a single disease time point and that their phenotypic and molecular traits are associated with different aspects of pathogenicity. Notably, variation in genes encoding antibiotic resistance and two-component systems were observed from the subpopulations of a patient suffering from persistent salmonellosis. Therefore, clinical and public health interventions of the disease that are based on diagnosis of a single-cell population may miss other subpopulations that can cause residual human infections.
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Affiliation(s)
- Yismashoa Gebremichael
- Microbial Diseases Laboratory, California Department of Public Health, Richmond, California, USA
| | - John Crandall
- Microbial Diseases Laboratory, California Department of Public Health, Richmond, California, USA
| | - Rituparna Mukhopadhyay
- Microbial Diseases Laboratory, California Department of Public Health, Richmond, California, USA
| | - Fengfeng Xu
- Microbial Diseases Laboratory, California Department of Public Health, Richmond, California, USA
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Crandall J, Fraum TJ, Wahl RL. Brown adipose tissue: a protective mechanism in "pre-prediabetes"? J Nucl Med 2022; 63:1433-1440. [PMID: 35393347 DOI: 10.2967/jnumed.121.263357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 03/21/2022] [Indexed: 11/16/2022] Open
Abstract
Brown adipose tissue (BAT) is present in a significant number of adult humans and has been postulated to exert beneficial metabolic effects. Lean, non-diabetic patients undergoing clinical positron emission tomography (PET)/computed tomography (CT) imaging are more likely to exhibit incidental BAT activation. The aim of this study was to assess metabolic changes associated with the cold-activation of BAT and to compare baseline blood metabolites in participants with varying amounts of active BAT. Methods: Serum blood samples were collected from healthy adult volunteers (body mass index 18.0-25.0 and age≤35 years) before and after 2 h cold exposure. 18F-flurodeoxyglucose (FDG) PET/CT imaging was performed immediately following cold exposure. Activated BAT was segmented and fasting glucose, insulin, lipid, and other blood metabolite levels were correlated with volume and intensity of active BAT. Using a median cutoff, subjects were classified as BATHIGH or BATLOW. Results: A higher volume of activated BAT was associated with significantly higher pre-cooling glucose and insulin levels (P<0.001 for each). Pre-cooling thyroid stimulating hormone (TSH) and triglyceride levels were significantly higher in the BATHIGH than in the BATLOW group (P = 0.002 and P<0.001, respectively). Triglyceride levels tended to increase over the cooling period in both BAT groups, but increased significantly more in the BATHIGH group (15.7±13.2 md/dl; P<0.001) than in the BATLOW group (4.5±12.2 mg/dl; P = 0.061). Conclusion: These findings may indicate that BAT is recruited to counteract incipient "pre-prediabetic" states, potentially serving as a first-line protective mechanism against very early metabolic or hormonal variations.
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Holden D, Sylvester M, Crandall J, Xu F, Schneider EC, Watson HB, Zhang P, Bacud J, Mejia R, Epson E, Berrada Z, Mitsunaga T, Mukhopadhyay R. 179. Identification and Whole Genome Sequencing Analysis of an Oxacillinase (OXA)-48-like-producing Acinetobacter baumannii Outbreak in California, January-May 2021. Open Forum Infect Dis 2021. [PMCID: PMC8644873 DOI: 10.1093/ofid/ofab466.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background In January 2021, a California acute care hospital (ACH A), a sentinel site for Acinetobacter baumannii (AB) surveillance, identified OXA-48-like-carbapenemase producing (CP) AB in a patient admitted from a ventilator-equipped skilled nursing facility (vSNF A); OXA-48-like AB had not been previously reported in the United States. Methods Our investigation included onsite infection control (IC) assessments, contact tracing, and point prevalence surveys (PPS) at vSNF A. The Antibiotic Resistance (AR) Laboratory Network performed carbapenemase testing on AB isolates (including those from ACH A) and PPS swabs. A case was defined as a patient with an OXA-48-like AB isolate, or an epidemiologically-linked patient with an OXA-48-like gene detected via screening. We performed whole genome sequencing (WGS) of OXA-48-like AB and other CP organisms on the Illumina MiSeq and Oxford Nanopore MinION for short and long read sequencing, respectively. Results Since January 2021, we have identified five OXA-48-like AB cases (including the index), six OXA-48-like cases (no organism recovered), and six patients with other CP organisms at ACH A and vSNF A. Since August 2019, vSNF A has concurrently been experiencing an OXA-109 AB outbreak. A second vSNF A patient, Patient 2, who overlapped with the index patient, had OXA-48-like Klebsiella pneumoniae (KP) (November 2019) and OXA-109 AB (May 2020) isolates. WGS of the index patient’s AB and Patient 2’s KP isolates identified a rare OXA-48-like gene located on the AB chromosome and a KP plasmid. The OXA-48-like AB was also carrying an OXA-109 gene, and hqSNP analysis indicated it varied by 9-44 single-nucleotide polymorphisms (SNPs) from 14 OXA-109 AB isolates linked to that outbreak, and 0-3 SNPs from the other OXA-48-like AB case isolates. Figure 1. Phylogenetic Tree Comparison of OXA-109 AB and OXA-48-like AB Isolates ![]()
Figure 2. Epidemic Curve of OXA-109 AB, OXA-48-like AB, and Other CP Organism Cases, 2019-2021 ![]()
Conclusion The first reported case of OXA-48-like AB in the US was identified through public health sentinel laboratory surveillance, allowing prompt response to contain spread of a novel multidrug-resistant organism (MDRO). WGS detected a rare OXA-48-like gene in AB and KP and provides evidence for possible interspecies transfer of this gene from KP to AB through plasmid transfer followed by chromosomal integration. Disclosures All Authors: No reported disclosures
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Affiliation(s)
- Diana Holden
- California Department of Public Health, Richmond, CA
| | | | - John Crandall
- California Department of Public Health, Richmond, CA
| | - Fengfeng Xu
- California Department of Public Health, Richmond, CA
| | | | | | - Peng Zhang
- California Department of Public Health, Richmond, CA
| | - Jaclyn Bacud
- California Department of Public Health, Richmond, CA
| | - Rafael Mejia
- California Department of Public Health, Richmond, CA
| | - Erin Epson
- California Department of Public Health, Richmond, CA
| | - Zenda Berrada
- California Department of Public Health, Richmond, CA
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Kim JJ, Turner NE, Holman E, Lefrak L, Youssef FA, Richardson P, Mukhopadhyay R, Crandall J, Su H, Epson E. 802. Corynebacterium striatum Outbreak Among Ventilated COVID-19 Patients in an Acute Care Hospital – California, 2021. Open Forum Infect Dis 2021. [PMCID: PMC8644052 DOI: 10.1093/ofid/ofab466.998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Corynebacterium striatum (CS), a common human commensal colonizing the skin and nasopharynx, has been associated with nosocomial infections in immunocompromised and chronically ill patients. During the winter 2020-2021 COVID-19 surge, a 420-bed California hospital reported a marked increase in CS respiratory cultures among ventilated COVID-19 patients. We conducted a public health investigation to assess and mitigate nosocomial transmission and contributing infection prevention and control (IPC) practices.
Methods
A case was defined as a patient with CS in respiratory cultures from January 1, 2020 - February 28, 2021. We reviewed clinical characteristics on a subset of cases in 2021 and IPC practices in affected hospital locations. CS respiratory isolates collected on different dates and locations were assessed for relatedness by whole genome sequencing (WGS) on MiSeq.
Results
Eighty-three cases were identified, including 75 among COVID-19 patients (Figure 1). Among 62 patients identified in 2021, all were ventilated; 58 also had COVID-19, including 4 cases identified on point prevalence survey (PPS). The median time from admission to CS culture was 19 days (range, 0-60). Patients were critically ill; often it was unclear whether CS cultures represented colonization or infection. During the COVID-19 surge, two hospital wings (7W and 7S) were converted to negative-pressure COVID-19 units. Staff donned and doffed personal protective equipment in anterooms outside the units; extended use of gowns was practiced, and lapses in glove changes and hand hygiene (HH) between patients likely occurred. In response to the CS outbreak, patients were placed in Contact precautions and cohorted. Staff were re-educated on IPC for COVID-19 patients. Gowns were changed between CS patients. Subsequent PPS were negative. Two CS clusters were identified by WGS: cluster 1 (5 cases) in unit 7W, and cluster 2 (2 cases) in unit 7S (Figure 2).
Figure 1. Corynebacterium striatum Respiratory Cultures January 2020-February 2021
Figure 2. Phylogenetic Tree Corynebacterium striatum Isolates
Conclusion
A surge in patients, extended use of gowns and lapses in core IPC practices including HH and environmental cleaning and disinfection during the winter 2020-2021 COVID-19 surge likely contributed to this CS outbreak. WGS provides supportive evidence for nosocomial CS transmission among critically ill COVID-19 patients.
Disclosures
All Authors: No reported disclosures
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Affiliation(s)
- Janice J Kim
- California Department of Public Health, Richmond, California
| | - Nancy E Turner
- Memorialcare Long Beach Medical Center, Simi Valley, California
| | - Emily Holman
- Long Beach Department of Health and Human Services, Long Beach, California
| | - Linda Lefrak
- California Department of Public Health, Richmond, California
| | - Fady A Youssef
- Long Beach Memorial Medical Center, Long Beach, California
| | | | | | - John Crandall
- California Department of Public Health, Richmond, California
| | - Henry Su
- MemorialCare Long Beach Medical Center, Long Beach, California
| | - Erin Epson
- California Department of Public Health, Richmond, California
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11
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Rosen HE, Kimura AC, Crandall J, Poe A, Nash J, Boetzer J, Tecle S, Mukhopadhyay R, Mcauley K, Kasirye O, Garza A, Shahkarami M, Chaturvedi V, Kiang D, Vidanes J, Mccoy K, Barcellos M, Derby T, Jain S, Vugia DJ. Foodborne Botulism Outbreak Associated With Commercial Nacho Cheese Sauce From a Gas Station Market. Clin Infect Dis 2021; 70:1695-1700. [PMID: 31247064 DOI: 10.1093/cid/ciz479] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 06/05/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Botulism is a rare and potentially fatal paralytic disease caused by botulinum neurotoxin (BoNT). In April 2017, 4 California residents from 2 adjacent counties were hospitalized with suspected foodborne botulism, precipitating an investigation by state and local public health departments in California. METHODS We interviewed suspected botulism patients and their families, inspected the suspect establishment, and collected suspect food. We tested patient sera, stool, and gastric aspirates using mouse bioassay for BoNT and/or culture for Clostridium botulinum. We tested suspect food and environmental samples for BoNT and confirmed presumptive positives using direct mouse bioassay and culture. We performed whole-genome sequencing on food and clinical isolates. RESULTS From April 2017 through May 2017, 10 patients in the Sacramento area were hospitalized with laboratory-confirmed botulism; 7 required mechanical ventilation, and 1 died. Of 9 patients with information, all had visited Gas Station X before illness onset, where 8 reported consuming a commercial cheese sauce. BoNT/A and/or BoNT/A-producing C. botulinum were detected from each patient and from leftover cheese sauce. Clostridium botulinum isolates from 4 patients were closely related to cheese sauce isolates by whole-genome high-quality single-nucleotide polymorphism analysis. No other botulism cases associated with this cheese sauce were reported elsewhere in the United States. CONCLUSIONS This large foodborne botulism outbreak in California was caused by consumption of commercial cheese sauce dispensed at a gas station market. The epidemiologic and laboratory evidence confirmed the cheese sauce as the outbreak source. The cheese sauce was likely locally contaminated, although the mechanism is unclear.
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Affiliation(s)
- Hilary E Rosen
- Division of Communicable Disease Control, California Department of Public Health, Los Angeles, Richmond and Sacramento
| | - Akiko C Kimura
- Division of Communicable Disease Control, California Department of Public Health, Los Angeles, Richmond and Sacramento
| | - John Crandall
- Division of Communicable Disease Control, California Department of Public Health, Los Angeles, Richmond and Sacramento
| | - Alyssa Poe
- Division of Communicable Disease Control, California Department of Public Health, Los Angeles, Richmond and Sacramento
| | - June Nash
- Sacramento County Department Public Health, Mather
| | - Jason Boetzer
- Sacramento County Environmental Management Department, Mather
| | - Selam Tecle
- Division of Communicable Disease Control, California Department of Public Health, Los Angeles, Richmond and Sacramento
| | - Rituparna Mukhopadhyay
- Division of Communicable Disease Control, California Department of Public Health, Los Angeles, Richmond and Sacramento
| | - Kate Mcauley
- Sacramento County Department Public Health, Mather
| | | | - Alvaro Garza
- San Joaquin County Department of Health Care Services, Stockton
| | - Mahtab Shahkarami
- Division of Communicable Disease Control, California Department of Public Health, Los Angeles, Richmond and Sacramento
| | - Vishnu Chaturvedi
- Division of Communicable Disease Control, California Department of Public Health, Los Angeles, Richmond and Sacramento
| | - David Kiang
- Division of Food, Drug, and Cannabis Safety, California Department of Public Health, Richmond and Sacramento
| | - Jeff Vidanes
- Division of Food, Drug, and Cannabis Safety, California Department of Public Health, Richmond and Sacramento
| | - Kelly Mccoy
- Sacramento County Environmental Management Department, Mather
| | - Mark Barcellos
- Sacramento County Environmental Management Department, Mather
| | - Tammy Derby
- Sacramento County Environmental Management Department, Mather
| | - Seema Jain
- Division of Communicable Disease Control, California Department of Public Health, Los Angeles, Richmond and Sacramento
| | - Duc J Vugia
- Division of Communicable Disease Control, California Department of Public Health, Los Angeles, Richmond and Sacramento
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12
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Keaton A, Hassan R, Luna S, Lee I, Magalhaes R, Bidlack M, Graf P, Maves R, Smith L, Freer D, Flinn K, Monk G, Trinh K, Crandall J, Noveroske D, Fortenberry G, Peak C, McDonald E, Waltz T, Patel K, Wagner D, Espiritu J, Christensen L, Gieraltowski L. 678. Outbreak of Shiga Toxin-Producing Escherichia coli Infections at Marine Corps Recruit Depot (MCRD), San Diego and Camp Pendleton, California: October–November, 2017. Open Forum Infect Dis 2018. [PMCID: PMC6255386 DOI: 10.1093/ofid/ofy210.684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Shiga toxin-producing Escherichia coli (STEC) infections are a major cause of foodborne illness and the principal cause of hemolytic-uremic syndrome (HUS). In November 2017, CDC and the US Navy responded to an outbreak of STEC illnesses in military recruits at the Marine Corps Recruit Depot in San Diego (MCRD). We investigated to determine the source of this outbreak and identify prevention and mitigation measures. Methods In October 2017, medical staff identified a high number of gastrointestinal (GI) illnesses at MCRD. Recruits with diarrhea submitted stool specimens for culture and/or culture-independent diagnostic testing (CIDT) for GI pathogens. We performed pulsed-field gel electrophoresis (PFGE) on culture isolates. Case-patients were defined as confirmed (PFGE-confirmed STEC infection matching outbreak strains), probable (diagnosis of HUS and/or CIDT evidence of STEC), or suspected (bloody diarrhea). We conducted environmental evaluations of dining facilities, training areas, and barracks. A case–control study was performed using PFGE-confirmed case-patients and platoon-matched controls. We performed product traceback for foods identified as exposure risks by interview or case–control study. Results We identified 64 confirmed, 105 probable, and 91 suspected case-patients. Thirty case-patients required hospitalization and 15 had HUS. Ages ranged from 17 to 28 years (median: 18 years). Poor hygiene practices among recruits and inconsistent cooking temperatures within dining facilities were noted. Forty-three case-patients and 135 controls were interviewed about food, hygiene, and environmental exposures. Consumption of undercooked beef was significantly associated with illness (mOR 2.40, CI 1.04–5.72, P = 0.04). We identified a single ground beef supplier for MCRD, but dining facility records did not document the dates on which specific lots of ground beef were used. Conclusion Case–control analysis and environmental observations suggested undercooked ground beef as a potential source for this outbreak. We recommended the Navy and Marine Corps retain lot information, address food handling concerns, and improve hygiene among recruits. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Amelia Keaton
- National Center for Emerging and Zoonotic Infectious Diseases, Division of Foodborne, Waterborne, and Environmental Diseases, Outbreak Response and Prevention Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rashida Hassan
- National Center for Emerging and Zoonotic Infectious Diseases, Division of Foodborne, Waterborne, and Environmental Diseases, Outbreak Response and Prevention Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sarah Luna
- National Center for Emerging and Zoonotic Infectious Diseases, Division of Foodborne, Waterborne, and Environmental Diseases, Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Isabell Lee
- Preventive Medicine, Naval Medical Center San Diego, San Diego, California
| | - Richelle Magalhaes
- Preventive Medicine, Naval Medical Center San Diego, San Diego, California
| | - Matthew Bidlack
- Branch Health Clinic, Marine Corps Recruit Depot, San Diego, California
| | - Paul Graf
- Division of Microbiology, Department of Laboratory Medicine, Naval Medical Center, San Diego, California
| | - Ryan Maves
- Infectious Diseases, Naval Medical Center San Diego, San Diego, California
| | - Linda Smith
- Naval Hospital Camp Pendleton, Oceanside, California
| | - Douglas Freer
- Branch Health Clinic, Marine Corps Recruit Depot, San Diego, California
| | - Kimberly Flinn
- Branch Health Clinic, Marine Corps Recruit Depot, San Diego, California
| | - Gregory Monk
- Branch Health Clinic, Marine Corps Recruit Depot, San Diego, California
| | - Kelly Trinh
- California Department of Public Health, Richmond, California
| | - John Crandall
- California Department of Public Health, Richmond, California
| | - Douglas Noveroske
- United States Department of Agriculture-Food Safety and Inspection Services, Washington, DC
| | - Gamola Fortenberry
- United States Department of Agriculture-Food Safety and Inspection Services, Washington, DC
| | - Corey Peak
- Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia
- County of San Diego Health and Human Services Agency, San Diego, California
| | - Eric McDonald
- Epidemiology and Immunization Services, County of San Diego Health and Human Services Agency, San Diego, California
| | - Thomas Waltz
- National Center for Emerging and Zoonotic Diseases, Division of Foodborne, Waterborne, and Environmental Diseases, Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kane Patel
- National Center for Emerging and Zoonotic Diseases, Division of Foodborne, Waterborne, and Environmental Diseases, Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Darlene Wagner
- National Center for Emerging and Zoonotic Diseases, Division of Foodborne, Waterborne, and Environmental Diseases, Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Lori Christensen
- Preventive Medicine, Naval Medical Center San Diego, San Diego, California
| | - Laura Gieraltowski
- National Center for Emerging and Zoonotic Infectious Diseases, Division of Foodborne, Waterborne, and Environmental Diseases, Outbreak Response and Prevention Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
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13
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Rosen H, Kimura A, Mukhopadhyay R, Nash J, Boetzer J, Poe A, Tecle S, McAuley K, Kasirye O, Garza A, Crandall J, Shahkarami M, Chaturvedi V, Kiang D, Vidanes J, McCoy K, Derby T, Barcellos M, Jain S, Vugia D. 1721. An Outbreak of Botulism Associated With Nacho Cheese Sauce From a Gas Station in California. Open Forum Infect Dis 2018. [PMCID: PMC6252816 DOI: 10.1093/ofid/ofy209.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Foodborne botulism is rare with 0–6 cases reported annually in California. During April 24–28, 2017, 4 hospitalized patients with suspect foodborne botulism were reported to the California Department of Public Health (CDPH) from 2 adjacent California counties. In collaboration with local public and environmental health, CDPH conducted an investigation to determine the magnitude of the outbreak, identify potential sources, and implement control measures. Methods A case was defined as clinical botulism in a visitor to or resident of Sacramento County with illness onset during April 20 to May 5, 2017. Case-patients or their proxies were interviewed. Patient specimens and suspect food items were tested for the presence of botulinum toxin and toxin-producing Clostridium botulinum; C. botulinum isolates underwent whole genome sequencing (WGS) at the CDPH laboratory. Results In April–May 2017, a total of 10 patients were hospitalized with laboratory-confirmed botulism. Median age was 34 years (range 16–57); 7 were male, and 8 were Latino. All patients required intensive care, 7 required ventilator support, and 1 died. Nine patients confirmed visiting Gas Station A in the week before illness onset; 8 reported consuming nacho cheese sauce served from a dispenser there. Inspection of Gas Station A on May 5 indicated that the cheese in the dispenser had a best by date of April 11; the dispenser was removed that day, before all patients were identified. The remaining pouch of nacho cheese sauce was laboratory confirmed to have botulinum toxin type A and toxin-producing C. botulinum. C. botulinum isolates from 3 patients clustered with the cheese isolate by WGS. Conclusion Contaminated nacho cheese sauce served at a local gas station was the source of the largest outbreak of foodborne botulism reported to date in California. No other botulism cases associated with this commercial cheese sauce were identified elsewhere in the United States; although the mechanism of contamination is unclear, the cheese was likely contaminated locally. Intensive public health investigation and intervention, before all cases were identified and C. botulinum toxin was detected in the product, likely prevented additional cases and possible deaths Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Hilary Rosen
- California Department of Public Health, Los Angeles, California
| | - Akiko Kimura
- California Department of Public Health, Los Angeles, California
| | - Rituparna Mukhopadhyay
- Microbial Diseases Laboratory, California Department of Public Health, Richmond, California
| | - June Nash
- Department of Health Services, County of Sacramento, Sacramento, California
| | - Jason Boetzer
- Environmental Management Department, Sacramento County, Mather, California
| | - Alyssa Poe
- Microbial Diseases Laboratory, California Department of Public Health, Richmond, California
| | - Selam Tecle
- California Department of Public Health, Richmond, California
| | - Katherine McAuley
- Department of Health Services, County of Sacramento, Sacramento, California
| | - Olivia Kasirye
- Department of Health Services, County of Sacramento, Sacramento, California
| | - Alvaro Garza
- San Joaquin County Health Department, Modesto, California
| | - John Crandall
- Microbial Diseases Laboratory, California Department of Public Health, Richmond, California
| | - Mahtab Shahkarami
- Microbial Diseases Laboratory, California Department of Public Health, Richmond, California
| | | | - David Kiang
- California Department of Public Health, Food and Drug Laboratory Branch (FDLB), Richmond, California
| | - Jeff Vidanes
- Food and Drug Branch, California Department of Public Health, Sacramento, California
| | - Kelly McCoy
- Environmental Management Department, Sacramento County, Mather, California
| | - Tammy Derby
- Environmental Management Department, Sacramento County, Mather, California
| | - Mark Barcellos
- Environmental Management Department, Sacramento County, Mather, California
| | - Seema Jain
- California Department of Public Health, Richmond, California
| | - D Vugia
- California Department of Public Health, Richmond, California
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14
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Tang WW, McGee P, Lachin JM, Li DY, Hoogwerf B, Hazen SL, Nathan D, Zinman B, Crofford O, Genuth S, Brown‐Friday J, Crandall J, Engel H, Engel S, Martinez H, Phillips M, Reid M, Shamoon H, Sheindlin J, Gubitosi‐Klug R, Mayer L, Pendegast S, Zegarra H, Miller D, Singerman L, Smith‐Brewer S, Novak M, Quin J, Genuth S, Palmert M, Brown E, McConnell J, Pugsley P, Crawford P, Dahms W, Gregory N, Lackaye M, Kiss S, Chan R, Orlin A, Rubin M, Brillon D, Reppucci V, Lee T, Heinemann M, Chang S, Levy B, Jovanovic L, Richardson M, Bosco B, Dwoskin A, Hanna R, Barron S, Campbell R, Bhan A, Kruger D, Jones J, Edwards P, Bhan A, Carey J, Angus E, Thomas A, Galprin A, McLellan M, Whitehouse F, Bergenstal R, Johnson M, Gunyou K, Thomas L, Laechelt J, Hollander P, Spencer M, Kendall D, Cuddihy R, Callahan P, List S, Gott J, Rude N, Olson B, Franz M, Castle G, Birk R, Nelson J, Freking D, Gill L, Mestrezat W, Etzwiler D, Morgan K, Aiello L, Golden E, Arrigg P, Asuquo V, Beaser R, Bestourous L, Cavallerano J, Cavicchi R, Ganda O, Hamdy O, Kirby R, Murtha T, Schlossman D, Shah S, Sharuk G, Silva P, Silver P, Stockman M, Sun J, Weimann E, Wolpert H, Aiello L, Jacobson A, Rand L, Rosenzwieg J, Nathan D, Larkin M, Christofi M, Folino K, Godine J, Lou P, Stevens C, Anderson E, Bode H, Brink S, Cornish C, Cros D, Delahanty L, eManbey ., Haggan C, Lynch J, McKitrick C, Norman D, Moore D, Ong M, Taylor C, Zimbler D, Crowell S, Fritz S, Hansen K, Gauthier‐Kelly C, Service F, Ziegler G, Barkmeier A, Schmidt L, French B, Woodwick R, Rizza R, Schwenk W, Haymond M, Pach J, Mortenson J, Zimmerman B, Lucas A, Colligan R, Luttrell L, Lopes‐Virella M, Caulder S, Pittman C, Patel N, Lee K, Nutaitis M, Fernandes J, Hermayer K, Kwon S, Blevins A, Parker J, Colwell J, Lee D, Soule J, Lindsey P, Bracey M, Farr A, Elsing S, Thompson T, Selby J, Lyons T, Yacoub‐Wasef S, Szpiech M, Wood D, Mayfield R, Molitch M, Adelman D, Colson S, Jampol L, Lyon A, Gill M, Strugula Z, Kaminski L, Mirza R, Simjanoski E, Ryan D, Johnson C, Wallia A, Ajroud‐Driss S, Astelford P, Leloudes N, Degillio A, Schaefer B, Mudaliar S, Lorenzi G, Goldbaum M, Jones K, Prince M, Swenson M, Grant I, Reed R, Lyon R, Kolterman O, Giotta M, Clark T, Friedenberg G, Sivitz W, Vittetoe B, Kramer J, Bayless M, Zeitler R, Schrott H, Olson N, Snetselaar L, Hoffman R, MacIndoe J, Weingeist T, Fountain C, Miller R, Johnsonbaugh S, Patronas M, Carney M, Mendley S, Salemi P, Liss R, Hebdon M, Counts D, Donner T, Gordon J, Hemady R, Kowarski A, Ostrowski D, Steidl S, Jones B, Herman W, Martin C, Pop‐Busui R, Greene D, Stevens M, Burkhart N, Sandford T, Floyd J, Bantle J, Flaherty N, Terry J, Koozekanani D, Montezuma S, Wimmergren N, Rogness B, Mech M, Strand T, Olson J, McKenzie L, Kwong C, Goetz F, Warhol R, Hainsworth D, Goldstein D, Hitt S, Giangiacomo J, Schade D, Canady J, Burge M, Das A, Avery R, Ketai L, Chapin J, Schluter M, Rich J, Johannes C, Hornbeck D, Schutta M, Bourne P, Brucker A, Braunstein S, Schwartz S, Maschak‐Carey B, Baker L, Orchard T, Cimino L, Songer T, Doft B, Olson S, Becker D, Rubinstein D, Bergren R, Fruit J, Hyre R, Palmer C, Silvers N, Lobes L, Rath PP, Conrad P, Yalamanchi S, Wesche J, Bratkowksi M, Arslanian S, Rinkoff J, Warnicki J, Curtin D, Steinberg D, Vagstad G, Harris R, Steranchak L, Arch J, Kelly K, Ostrosaka P, Guiliani M, Good M, Williams T, Olsen K, Campbell A, Shipe C, Conwit R, Finegold D, Zaucha M, Drash A, Morrison A, Malone J, Bernal M, Pavan P, Grove N, Tanaka E, McMillan D, Vaccaro‐Kish J, Babbione L, Solc H, DeClue T, Dagogo‐Jack S, Wigley C, Ricks H, Kitabchi A, Chaum E, Murphy M, Moser S, Meyer D, Iannacone A, Yoser S, Bryer‐Ash M, Schussler S, Lambeth H, Raskin P, Strowig S, Basco M, Cercone S, Zinman B, Barnie A, Devenyi R, Mandelcorn M, Brent M, Rogers S, Gordon A, Bakshi N, Perkins B, Tuason L, Perdikaris F, Ehrlich R, Daneman D, Perlman K, Ferguson S, Palmer J, Fahlstrom R, de Boer I, Kinyoun J, Van Ottingham L, Catton S, Ginsberg J, McDonald C, Harth J, Driscoll M, Sheidow T, Mahon J, Canny C, Nicolle D, Colby P, Dupre J, Hramiak I, Rodger N, Jenner M, Smith T, Brown W, May M, Lipps Hagan J, Agarwal A, Adkins T, Lorenz R, Feman S, Survant L, White N, Levandoski L, Grand G, Thomas M, Joseph D, Blinder K, Shah G, Burgess D, Boniuk I, Santiago J, Tamborlane W, Gatcomb P, Stoessel K, Ramos P, Fong K, Ossorio P, Ahern J, Gubitosi‐Klug R, Meadema‐Mayer L, Beck C, Farrell K, Genuth S, Quin J, Gaston P, Palmert M, Trail R, Dahms W, Lachin J, Backlund J, Bebu I, Braffett B, Diminick L, Gao X, Hsu W, Klumpp K, Pan H, Trapani V, Cleary P, McGee P, Sun W, Villavicencio S, Anderson K, Dews L, Younes N, Rutledge B, Chan K, Rosenberg D, Petty B, Determan A, Kenny D, Williams C, Cowie C, Siebert C, Steffes M, Arends V, Bucksa J, Nowicki M, Chavers B, O'Leary D, Polak J, Harrington A, Funk L, Crow R, Gloeb B, Thomas S, O'Donnell C, Soliman E, Zhang Z, Li Y, Campbell C, Keasler L, Hensley S, Hu J, Barr M, Taylor T, Prineas R, Feldman E, Albers J, Low P, Sommer C, Nickander K, Speigelberg T, Pfiefer M, Schumer M, Moran M, Farquhar J, Ryan C, Sandstrom D, Williams T, Geckle M, Cupelli E, Thoma F, Burzuk B, Woodfill T, Danis R, Blodi B, Lawrence D, Wabers H, Gangaputra S, Neill S, Burger M, Dingledine J, Gama V, Sussman R, Davis M, Hubbard L, Budoff M, Darabian S, Rezaeian P, Wong N, Fox M, Oudiz R, Kim L, Detrano R, Cruickshanks K, Dalton D, Bainbridge K, Lima J, Bluemke D, Turkbey E, der Geest ., Liu C, Malayeri A, Jain A, Miao C, Chahal H, Jarboe R, Nathan D, Monnier V, Sell D, Strauch C, Hazen S, Pratt A, Tang W, Brunzell J, Purnell J, Natarajan R, Miao F, Zhang L, Chen Z, Paterson A, Boright A, Bull S, Sun L, Scherer S, Lopes‐Virella M, Lyons T, Jenkins A, Klein R, Virella G, Jaffa A, Carter R, Stoner J, Garvey W, Lackland D, Brabham M, McGee D, Zheng D, Mayfield R, Maynard J, Wessells H, Sarma A, Jacobson A, Dunn R, Holt S, Hotaling J, Kim C, Clemens Q, Brown J, McVary K. Oxidative Stress and Cardiovascular Risk in Type 1 Diabetes Mellitus: Insights From the DCCT/EDIC Study. J Am Heart Assoc 2018. [PMCID: PMC6015340 DOI: 10.1161/jaha.117.008368] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Hyperglycemia leading to increased oxidative stress is implicated in the increased risk for the development of macrovascular and microvascular complications in patients with type 1 diabetes mellitus.
Methods and Results
A random subcohort of 349 participants was selected from the
DCCT
/
EDIC
(Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications) cohort. This included 320 controls and 29 cardiovascular disease cases that were augmented with 98 additional known cases to yield a case cohort of 447 participants (320 controls, 127 cases). Biosamples from
DCCT
baseline, year 1, and closeout of
DCCT
, and 1 to 2 years post‐
DCCT
(
EDIC
years 1 and 2) were measured for markers of oxidative stress, including plasma myeloperoxidase, paraoxonase activity, urinary F
2α
isoprostanes, and its metabolite, 2,3 dinor‐8
iso
prostaglandin F
2α
. Following adjustment for glycated hemoblobin and weighting the observations inversely proportional to the sampling selection probabilities, higher paraoxonase activity, reflective of antioxidant activity, and 2,3 dinor‐8
iso
prostaglandin F
2α
, an oxidative marker, were significantly associated with lower risk of cardiovascular disease (−4.5% risk for 10% higher paraoxonase,
P
<0.003; −5.3% risk for 10% higher 2,3 dinor‐8
iso
prostaglandin F
2α
,
P
=0.0092). In contrast, the oxidative markers myeloperoxidase and F
2α
isoprostanes were not significantly associated with cardiovascular disease after adjustment for glycated hemoblobin. There were no significant differences between
DCCT
intensive and conventional treatment groups in the change in all biomarkers across time segments.
Conclusions
Heightened antioxidant activity (rather than diminished oxidative stress markers) is associated with lower cardiovascular disease risk in type 1 diabetes mellitus, but these biomarkers did not change over time with intensification of glycemic control.
Clinical Trial Registration
URL
:
https://www.clinicaltrials.gov
. Unique identifiers:
NCT
00360815 and
NCT
00360893.
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Affiliation(s)
- W.H. Wilson Tang
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Paula McGee
- The Biostatistics Center, George Washington University, Rockville, MD
| | - John M. Lachin
- The Biostatistics Center, George Washington University, Rockville, MD
| | - Daniel Y. Li
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | | | - Stanley L. Hazen
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
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Jacene H, Crandall J, Kasamon YL, Ambinder RF, Piantadosi S, Serena D, Kasecamp W, Wahl RL. Initial Experience with Tositumomab and I-131-Labeled Tositumomab for Treatment of Relapsed/Refractory Hodgkin Lymphoma. Mol Imaging Biol 2018; 19:429-436. [PMID: 27798787 DOI: 10.1007/s11307-016-1019-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To determine the maximum tolerated dose (MTD) of [131I]tositumomab in patients with refractory/recurrent Hodgkin lymphoma (HL) and to preliminarily determine if [131I]tositumomab has activity against HL and if positron emission tomography (PET) with 2-deoxy-2-[18F]fluoro-D-glucose ([18F]DG) performed 6 weeks post-therapy predicted 12-week response. PROCEDURES Separate dose-finding studies were performed for patients with and without prior transplant. A single therapeutic total body radiation dose (TBD) of [131I]tositumomab was administered. TBD was escalated/de-escalated based on dose-limiting hematologic toxicity (DLT) using a modified continual reassessment method. [18F]DG-PET/CT scans were performed at baseline and 6 and 12 weeks post therapy. RESULTS Twelve patients (nine classical HL, three lymphocyte-predominant [LP] HL) completed two dosing levels (n = 3 each) in the post-transplant (55 cGy, 79 cGy) and no transplant (75 cGy, 87 cGy) groups. Hematologic toxicities were common and transient. Twelve weeks after [131I]tositumomab, 10 patients progressed and two with LPHL achieved complete response. [18F]DG-PET/CT at 6 weeks post therapy appeared more predictive than CT at 6 weeks of a response at 12 weeks. CONCLUSIONS Tositumomab and [131I]tositumomab was well-tolerated in patients with relapsed/refractory HL. Complete responses in LPHL support a therapeutic effect in this subtype. Early metabolic response assessments by [18F]DG-PET in HL after radioimmunotherapy appear to be more predictive than purely anatomic assessments.
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Affiliation(s)
- Heather Jacene
- Division of Nuclear Medicine, Department of Radiology, Johns Hopkins University, Baltimore, MD, USA. .,Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Avenue, DL203, Boston, MA, 02215, USA.
| | - John Crandall
- Division of Nuclear Medicine, Department of Radiology, Johns Hopkins University, Baltimore, MD, USA.,Mallinkrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Yvette L Kasamon
- Department of Oncology, Johns Hopkins University, Baltimore, MD, USA
| | | | - Steven Piantadosi
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai, Los Angeles, CA, USA
| | - Donna Serena
- Division of Nuclear Medicine, Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Wayne Kasecamp
- Division of Nuclear Medicine, Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Richard L Wahl
- Division of Nuclear Medicine, Department of Radiology, Johns Hopkins University, Baltimore, MD, USA.,Department of Oncology, Johns Hopkins University, Baltimore, MD, USA.,Mallinkrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
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Chamie G, Kato-Maeda M, Emperador DM, Wandera B, Mugagga O, Crandall J, Janes M, Marquez C, Kamya MR, Charlebois ED, Havlir DV. Spatial overlap links seemingly unconnected genotype-matched TB cases in rural Uganda. PLoS One 2018; 13:e0192666. [PMID: 29438413 PMCID: PMC5811029 DOI: 10.1371/journal.pone.0192666] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 01/26/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction Incomplete understanding of TB transmission dynamics in high HIV prevalence settings remains an obstacle for prevention. Understanding where transmission occurs could provide a platform for case finding and interrupting transmission. Methods From 2012–2015, we sought to recruit all adults starting TB treatment in a Ugandan community. Participants underwent household (HH) contact investigation, and provided names of social contacts, sites of work, healthcare and socializing, and two sputum samples. Mycobacterium tuberculosis culture-positive specimens underwent 24-loci MIRU-VNTR and spoligotyping. We sought to identify epidemiologic links between genotype-matched cases by analyzing social networks and mapping locations where cases reported spending ≥12 hours over the one-month pre-treatment. Sites of spatial overlap (≤100m) between genotype-matched cases were considered potential transmission sites. We analyzed social networks stratified by genotype clustering status, with cases linked by shared locations, and compared network density by location type between clustered vs. non-clustered cases. Results Of 173 adults with TB, 131 (76%) were enrolled, 108 provided sputum, and 84/131 (78%) were MTB culture-positive: 52% (66/131) tested HIV-positive. Of 118 adult HH contacts, 105 (89%) were screened and 3 (2.5%) diagnosed with active TB. Overall, 33 TB cases (39%) belonged to 15 distinct MTB genotype-matched clusters. Within each cluster, no cases shared a HH or reported shared non-HH contacts. In 6/15 (40%) clusters, potential epidemiologic links were identified by spatial overlap at specific locations: 5/6 involved health care settings. Genotype-clustered TB social networks had significantly greater network density based on shared clinics (p<0.001) and decreased density based on shared marketplaces (p<0.001), compared to non-clustered networks. Conclusions In this molecular epidemiologic study, links between MTB genotype-matched cases were only identifiable via shared locations, healthcare locations in particular, rather than named contacts. This suggests most transmission is occurring between casual contacts, and emphasizes the need for improved infection control in healthcare settings in rural Africa.
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Affiliation(s)
- Gabriel Chamie
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, California, United States of America
- * E-mail:
| | - Midori Kato-Maeda
- Curry International Tuberculosis Center, Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, United States of America
| | - Devy M. Emperador
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, California, United States of America
| | - Bonnie Wandera
- Makerere University-University of California, San Francisco (MU-UCSF) Research Collaboration, Kampala, Uganda
| | - Olive Mugagga
- Makerere University-University of California, San Francisco (MU-UCSF) Research Collaboration, Kampala, Uganda
| | - John Crandall
- California Department of Public Health, Richmond, California, United States of America
| | - Michael Janes
- Curry International Tuberculosis Center, Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, United States of America
| | - Carina Marquez
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, California, United States of America
| | - Moses R. Kamya
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Edwin D. Charlebois
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, United States of America
| | - Diane V. Havlir
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, California, United States of America
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Shake M, Crandall J, Mathews R, Snyder M, Richardson C, Nunez K, Zierten M. BINGOCIZE: AN INTERVENTION FOR OLDER ADULTS’ COGNITION, FUNCTIONAL PERFORMANCE, AND HEALTH KNOWLEDGE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M. Shake
- Psychological Sciences, Western Kentucky University, Bowling Green, Kentucky,
| | - J. Crandall
- Psychological Sciences, Western Kentucky University, Bowling Green, Kentucky,
| | - R. Mathews
- Psychological Sciences, Western Kentucky University, Bowling Green, Kentucky,
| | - M. Snyder
- Missouri Western State University, St. Joseph, Missouri
| | - C. Richardson
- Psychological Sciences, Western Kentucky University, Bowling Green, Kentucky,
| | - K. Nunez
- Psychological Sciences, Western Kentucky University, Bowling Green, Kentucky,
| | - M. Zierten
- Psychological Sciences, Western Kentucky University, Bowling Green, Kentucky,
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Affiliation(s)
- John Crandall
- Perkin-Elmer Corporation, Real-Time Systems Division, 761 Main Avenue, Norwalk, CT 068590201, USA
| | - Jerry Workman
- Perkin-Elmer Corporation, Real-Time Systems Division, 761 Main Avenue, Norwalk, CT 068590201, USA
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Kozyreva VK, Crandall J, Sabol A, Poe A, Zhang P, Concepción-Acevedo J, Schroeder MN, Wagner D, Higa J, Trees E, Chaturvedi V. Laboratory Investigation of Salmonella enterica serovar Poona Outbreak in California: Comparison of Pulsed-Field Gel Electrophoresis (PFGE) and Whole Genome Sequencing (WGS) Results. PLoS Curr 2016; 8:ecurrents.outbreaks.1bb3e36e74bd5779bc43ac3a8dae52e6. [PMID: 28018748 PMCID: PMC5145817 DOI: 10.1371/currents.outbreaks.1bb3e36e74bd5779bc43ac3a8dae52e6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Recently, Salmonella enterica serovar Poona caused a multistate outbreak, with 245 out of 907 cases occurring in California. We report a comparison of pulsed-field gel electrophoresis (PFGE) results with whole genome sequencing (WGS) for genotyping of Salmonella Poona isolates. METHODS CA Salmonella Poona isolates, collected from July to August 2015, were genotyped by PFGE using XbaI restriction enzyme. WGS was done using Nextera XT library kit with 2x300 bp or 2x250 bp sequencing chemistry on the Illumina MiSeq Sequencer. Reads were mapped to the de novo assembled serovar Poona draft genome (48 contigs, N50= 223,917) from the outbreak using CLCbio GW 8.0.2. The phylogenetic tree was generated based on hqSNPs calling. Genomes were annotated with CGE and PHAST online tools. In silico MLST was performed using the CGE online tool. RESULTS Human (14) and cucumber (2) Salmonella Poona isolates exhibited 3 possibly related PFGE patterns (JL6X01.0018 [predominant], JL6X01.0375, JL6X01.0778). All isolates that were related by PFGE also clustered together according to the WGS. One isolate with a divergent PFGE pattern (JL6X01.0776) served as an outlier in the phylogenetic analysis and substantially differed from the outbreak clade by WGS. All outbreak isolates were assigned to MLST sequence type 447. The majority of the outbreak-related isolates possessed the same set of Salmonella Pathogenicity Islands with few variations. One outbreak isolate was sequenced and analyzed independently by CDC and CDPH laboratories; there was 0 SNP difference in results. Additional two isolates were sequenced by CDC and the raw data was processed through CDPH and CDC analysis pipelines. Both data analysis pipelines also generated concordant results. Discussion: PFGE and WGS results for the recent CA Salmonella enterica serovar Poona outbreak provided concordant assignment of the isolates to the outbreak cluster. WGS allowed more robust determination of genetic relatedness, provided information regarding MLST-type, pathogenicity genes, and bacteriophage content. WGS data obtained independently at two laboratories showed complete agreement.
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Affiliation(s)
| | - John Crandall
- California Department of Public Health, Richmond, CA, USA
| | - Ashley Sabol
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alyssa Poe
- California Department of Public Health, Richmond, CA, USA
| | - Peng Zhang
- California Department of Public Health, Richmond, CA, USA
| | | | | | - Darlene Wagner
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jeffrey Higa
- California Department of Public Health, Los Angeles, CA, USA
| | - Eija Trees
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Sánchez-Molina D, Arregui-Dalmases C, Velázquez-Ameijide J, Angelini M, Kerrigan J, Crandall J. Traumatic brain injury in pedestrian-vehicle collisions: Convexity and suitability of some functionals used as injury metrics. Comput Methods Programs Biomed 2016; 136:55-64. [PMID: 27686703 DOI: 10.1016/j.cmpb.2016.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 07/19/2016] [Accepted: 08/12/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND OBJECTIVE Abrupt accelerations or decelerations can cause large strain in brain tissues and, consequently, different forms of Traumatic Brain Injury (TBI). In order to predict the effect of the accelerations on the soft tissues of the brain, many different injury metrics have been proposed (typically, an injury metric is a real valued functional of the accelerations). The objective of this article is to make a formal and empirical comparison, in order to identify general criteria for reasonable injury metrics, and propose a general guideline to avoid ill-proposed injury metrics. METHODS A medium-sized sample of vehicle-pedestrian collisions, from Post Mortem Human Subject (PMHS) tests, is analyzed. A statistical study has been conducted in order to determine the discriminant power of the usual metrics. We use Principal Component Analysis to reduce dimensionality and to check consistency among the different metrics. In addition, this article compares the mathematical properties of some of these functionals, trying to identify the desirable properties that any of those functionals needs to fulfill in order to be useful for optimization. RESULTS We have found a pair-wise consistency of all the currently used metrics (any two injury metrics are always positively related). In addition, we observed that two independent principal factors explain about 72.5% of the observed variance among all collision tests. This is remarkable because it indicates that despite high number of different injury metrics, a reduced number of variables can explain the results of all these metrics. With regard to the formal properties, we found that essentially all injury mechanisms can be accounted by means of scalable, differentiable and convex functionals (we propose to call minimization suitable injury metric any metric having these three formal properties). In addition three useful functionals, usable as injury metrics, are identified on the basis of the empirical comparisons. CONCLUSIONS The commonly used metrics are highly consistent, but also highly redundant. Formal minimal conditions of a reasonable injury metric has been identified. Future proposals of injury metrics can benefit from the results of this study.
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Subit D, Glacet A, Hamzah M, Crandall J. Orientation of the intercostal muscle fibers in the human rib cage. Comput Methods Biomech Biomed Engin 2015; 18 Suppl 1:2064-5. [DOI: 10.1080/10255842.2015.1069624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- D. Subit
- Center for Applied Biomechanics, University of Virginia, Charlottesville, VA, USA
- Arts et Metiers ParisTech, LBM/Institut de Biomecanique Humaine Georges Charpak, Paris, France
| | - A. Glacet
- Center for Applied Biomechanics, University of Virginia, Charlottesville, VA, USA
| | - M. Hamzah
- Center for Applied Biomechanics, University of Virginia, Charlottesville, VA, USA
| | - J. Crandall
- Center for Applied Biomechanics, University of Virginia, Charlottesville, VA, USA
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He J, Chaparro A, Nguyen B, Burge RJ, Crandall J, Chaparro B, Ni R, Cao S. Texting while driving: is speech-based text entry less risky than handheld text entry? Accid Anal Prev 2014; 72:287-295. [PMID: 25089769 DOI: 10.1016/j.aap.2014.07.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Revised: 07/13/2014] [Accepted: 07/13/2014] [Indexed: 06/03/2023]
Abstract
Research indicates that using a cell phone to talk or text while maneuvering a vehicle impairs driving performance. However, few published studies directly compare the distracting effects of texting using a hands-free (i.e., speech-based interface) versus handheld cell phone, which is an important issue for legislation, automotive interface design and driving safety training. This study compared the effect of speech-based versus handheld text entries on simulated driving performance by asking participants to perform a car following task while controlling the duration of a secondary text-entry task. Results showed that both speech-based and handheld text entries impaired driving performance relative to the drive-only condition by causing more variation in speed and lane position. Handheld text entry also increased the brake response time and increased variation in headway distance. Text entry using a speech-based cell phone was less detrimental to driving performance than handheld text entry. Nevertheless, the speech-based text entry task still significantly impaired driving compared to the drive-only condition. These results suggest that speech-based text entry disrupts driving, but reduces the level of performance interference compared to text entry with a handheld device. In addition, the difference in the distraction effect caused by speech-based and handheld text entry is not simply due to the difference in task duration.
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Affiliation(s)
- J He
- Department of Psychology, Wichita State University, 1845 Fairmount, Wichita, KS 67260, USA.
| | - A Chaparro
- Department of Psychology, Wichita State University, 1845 Fairmount, Wichita, KS 67260, USA
| | - B Nguyen
- Department of Psychology, Wichita State University, 1845 Fairmount, Wichita, KS 67260, USA
| | - R J Burge
- Department of Psychology, Wichita State University, 1845 Fairmount, Wichita, KS 67260, USA
| | - J Crandall
- Department of Psychology, Wichita State University, 1845 Fairmount, Wichita, KS 67260, USA
| | - B Chaparro
- Department of Psychology, Wichita State University, 1845 Fairmount, Wichita, KS 67260, USA
| | - R Ni
- Department of Psychology, Wichita State University, 1845 Fairmount, Wichita, KS 67260, USA
| | - S Cao
- Department of Systems Design Engineering, University of Waterloo, Waterloo N2L 3G1, Canada
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Riley PO, Arregui-Dalmases C, Purtserov S, Parent D, Lessley DJ, Shaw G, Crandall J, Takayama S, Ono K, Kamiji K, Yasuki T. Kinematics of the unrestrained vehicle occupants in side-impact crashes. Traffic Inj Prev 2012; 13:163-171. [PMID: 22458795 DOI: 10.1080/15389588.2011.637251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A test series involving direct right-side impact of a moving wall on unsupported, unrestrained cadavers with no arms was undertaken to better understand human kinematics and injury mechanisms during side impact at realistic speeds. The tests conducted provided a unique opportunity for a detailed analysis of the kinematics resulting from side impact. Specifically, this study evaluated the 3-dimensional (3D) kinematics of 3 unrestrained male cadavers subjected to lateral impact by a multi-element load wall carried by a pneumatically propelled rail-mounted sled reproducing a conceptual side crash impact. Three translations and 3 rotations characterize the movement of a solid body in the space, the 6 degrees of freedom (6DoF) kinematics of 15 bone segments were obtained from the 3D marker motions and computed tomography (CT)-defined relationships between the maker array mounts and the bones. The moving wall initially made contact with the lateral aspect of the pelvis, which initiated lateral motion of the spinal segments beginning with the pelvis and moving sequentially up through the lumbar spine to the thorax. Analyzing the 6DoF motions kinematics of the ribs and sternum followed right shoulder contact with the wall. Overall thoracic motion was assessed by combining the thoracic bone segments as a single rigid body. The kinematic data presented in this research provides quantified subject responses and boundary condition interactions that are currently unavailable for lateral impact.
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Affiliation(s)
- P O Riley
- University of Virginia Center for Applied Biomechanics, 4040 Lewis and Clark Drive, Charlottesville, VA 22911, USA.
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Duprey S, Kerrigan J, Kindig M, Cundary A, Zama Y, Ejima S, Kamiji K, Yasuki T, Crandall J. Biomechanical response of the clavicle under bending. Comput Methods Biomech Biomed Engin 2009. [DOI: 10.1080/10255840903077378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
AIM Iron may contribute to the pathogenesis of type 2 diabetes mellitus (DM) by inducing oxidative stress and interfering with insulin secretion. Elevated ferritin levels are associated with increased DM risk among healthy individuals. However, it is yet unknown if ferritin predicts DM incidence among high-risk individuals with impaired glucose tolerance (IGT). Furthermore, the association between soluble transferrin receptors (sTfR), a novel marker of iron status, and DM risk has not yet been prospectively investigated in these individuals. We conducted this study to evaluate the association between baseline levels of ferritin and sTfR and the risk of developing DM among overweight and obese individuals at high risk of DM. METHODS This nested case-control study (280 cases and 280 matched controls) was conducted within the placebo arm of the Diabetes Prevention Program, is a clinical trial conducted among overweight/obese individuals with IGT. Ferritin and sTfR levels were measured by immunoturbidimetric assays. Incident DM was ascertained by annual 75-g oral glucose tolerance test and semi-annual fasting glucose. RESULTS Compared with controls, cases had higher sTfR levels (3.50 +/- 0.07 vs. 3.30 +/- 0.06 mg/l; p = 0.03), but ferritin levels were not statistically different. The multivariable odds ratios (OR) and 95% confidence intervals (95% CI) for DM incidence comparing highest with the lowest quartiles of sTfR was 2.26 (1.37-4.01) (p-trend: 0.008). CONCLUSIONS Modestly elevated sTfR levels are associated with increased DM risk among overweight and obese individuals with IGT. Future studies should evaluate factors determining sTfR levels and examine if interventions that lower body iron stores reduce DM incidence.
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Affiliation(s)
- S N Rajpathak
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
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Subit D, Bose D, Ivarsson J, Untaroiu C, Crandall J. Analytical and computational methods to evaluate the effect of bone geometry in tibial loading response. J Biomech 2006. [DOI: 10.1016/s0021-9290(06)85234-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Roudsari BS, Mock CN, Kaufman R, Grossman D, Henary BY, Crandall J. Pedestrian crashes: higher injury severity and mortality rate for light truck vehicles compared with passenger vehicles. Inj Prev 2004; 10:154-8. [PMID: 15178671 PMCID: PMC1730093 DOI: 10.1136/ip.2003.003814] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.4] [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: 11/03/2022]
Abstract
INTRODUCTION During the last two decades changes in vehicle design and increase in the number of the light truck vehicles (LTVs) and vans have led to changes in pedestrian injury profile. Due to the dynamic nature of the pedestrian crashes biomechanical aspects of collisions can be better evaluated in field studies. DESIGN AND SETTING s: The Pedestrian Crash Data Study, conducted from 1994 to 1998, provided a solid database upon which details and mechanism of pedestrian crashes can be investigated. RESULTS From 552 recorded cases in this database, 542 patients had complete injury related information, making a meaningful study of pedestrian crash characteristics possible. Pedestrians struck by LTVs had a higher risk (29%) of severe injuries (abbreviated injury scale >/=4) compared with passenger vehicles (18%) (p = 0.02). After adjustment for pedestrian age and impact speed, LTVs were associated with 3.0 times higher risk of severe injuries (95% confidence interval (CI) 1.26 to 7.29, p = 0.013). Mortality rate for pedestrians struck by LTVs (25%) was two times higher than that for passenger vehicles (12%) (p<0.001). Risk of death for LTV crashes after adjustment for pedestrian age and impact speed was 3.4 times higher than that for passenger vehicles (95% CI 1.45 to 7.81, p = 0.005). CONCLUSION Vehicle type strongly influences risk of severe injury and death to pedestrian. This may be due in part to the front end design of the vehicle. Hence vehicle front end design, especially for LTVs, should be considered in future motor vehicle safety standards.
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Affiliation(s)
- B S Roudsari
- Harborview Injury Prevention and Research Center, Seattle, Washington, USA.
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Rauch U, Crandall J, Osende JI, Fallon JT, Chesebro JH, Fuster V, Badimon JJ. Increased thrombus formation relates to ambient blood glucose and leukocyte count in diabetes mellitus type 2. Am J Cardiol 2000; 86:246-9. [PMID: 10913498 DOI: 10.1016/s0002-9149(00)00871-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- U Rauch
- Cardiovascular Biology Research Laboratory, Mount Sinai School of Medicine, New York, New York, USA
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Crandall J, Kent R, Patrie J, Fertile J, Martin P. Rib fracture patterns and radiologic detection--a restraint-based comparison. Annu Proc Assoc Adv Automot Med 2000; 44:235-59. [PMID: 11558086 PMCID: PMC3217385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
This paper presents a study of the rib fracture patterns generated in simulated frontal collisions and the visibility of the rib fractures on plain film radiographs. Using 29 cadaver subjects, rib fractures were identified on oblique, lateral, and anteroposterior chest films by five radiologists independently and were compared with fractures found during a detailed necropsy. Physical, geometric, and experimental factors demonstrated an influence on the ability of a radiologist to identify rib fractures on an x-ray. Specifically, the restraint system configuration, the total number of fractures, the circumferential location of the fracture, the rib number, and the aspect (right or left) affected fracture identification. The results verify that torso belt loading produces rib fractures generally located along the path of the belt whereas superimposed airbag loading results in a more distributed and posterolateral fracture pattern. A higher proportion of rib fractures was identified on x-ray for occupants restrained by only a belt (44% of fractures) than for occupants restrained by both a belt and an airbag (24% of fractures). Overall, less than 40% of the rib fractures were detected upon an initial examination of radiographs. After being provided with the location of all fractures, detection increased to 49%. On average, occult rib fractures resulted in an average underreporting of injury severity of more than one AIS level.
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Affiliation(s)
- J Crandall
- Automobile Safety Laboratory, University of Virginia, Charlottesville, Virginia, USA
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Abstract
BACKGROUND Baseball is the leading cause of sports-related eye injuries in young persons. It is known that softer baseballs reduce the potential for brain and cardiac injury, but it has been speculated that softer baseballs may increase eye injuries by intruding more into the orbit. It also has been claimed that softer baseballs would change the "feel" of the game. OBJECTIVES To determine the orbital intrusion and eye injury potential of baseballs of varying hardness, and whether a player can feel the difference between these different baseballs. MAIN OUTCOME MEASURES Orbital force and penetration of baseballs of various hardness into an artificial orbit. Ability of subjects of varying age and baseball experience to determine the hardness of baseballs. RESULTS The peak orbital force and force onset rate from softer baseballs, at all impact velocities, were less than the force and force onset rate from baseballs that had hardness equal to, or greater than, major league baseballs. The softest (10% of major league hardness) baseballs intruded into the orbit significantly more than balls that were 15% of major league hardness or harder. Children younger than 14 years could not differentiate balls 15% of major league hardness or harder, and adults could not differentiate 20% of major league hardness or harder from each other or from major league balls. CONCLUSION The potential for injury to the unprotected eye from soft baseballs is significant, but not greater than that from a major league baseball. Baseballs that are 15% to 20% of major league ball hardness are recommended for youth baseball because these balls feel like major league balls, reduce the potential for brain injury and commotio cordis, cause less pain on impact, and do not increase the potential for eye injury to the unprotected player. Eye injuries in youth baseball could be minimized by the use of protective eyewear that conforms to the standard specifications of the American Society of Testing and Materials (Philadelphia, Pa), standards F910 (for batters and baserunners) and F803 (for fielders).
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Affiliation(s)
- P F Vinger
- Vision Performance and Safety Service, Tufts University School of Medicine, Medford, Mass, USA.
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Engel SS, Crandall J, Basch CE, Zybert P, Wylie-Rosett J. Computer-assisted diabetes nutrition education increases knowledge and self-efficacy of medical students. Diabetes Educ 1997; 23:545-9. [PMID: 9355370 DOI: 10.1177/014572179702300505] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Medical students and physicians need to improve their understanding of the role of nutrition and the multidisciplinary team in diabetes care. To assist in this learning, an interactive computer program was developed that focused on prescribing diets for patients with diabetes. Parallel 10-item knowledge tests and an 8-item self-efficacy scale were used to evaluate the efficacy of the computer program among 41 third-year medical students. Mean knowledge scores increased significantly after using the computer program. Posttest knowledge scores for the medical students approached the level achieved by general practice dietitians with no diabetes specialty training. Mean self-efficacy scores increased significantly. The mean time spent on the educational component of the program was under 30 minutes. Computer-assisted diabetes nutrition education proved to be an efficient and effective method for teaching basic nutrition competencies to medical students. This program is available on the World Wide Web (http:/(/)medicine.aecom.yu.edu/diabetes/DEC.htm ) and may be a useful means for providing basic diabetes nutrition education to primary healthcare providers from a variety of disciplines as well as for medical students.
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Affiliation(s)
- S S Engel
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York (Dr Engel)
| | - J Crandall
- The Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York (Dr Crandall)
| | - C E Basch
- The Department of I and Nutrition Education, Teachers College, Columbia University, New York, New York (Drs Basch and Zybert)
| | - P Zybert
- The Department of I and Nutrition Education, Teachers College, Columbia University, New York, New York (Drs Basch and Zybert)
| | - J Wylie-Rosett
- Epidemiology Social Medicine, Albert Einstein College of Medicine, Bronx, New York (Dr Wylie-Rosett)
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Schmidt AM, Crandall J, Hori O, Cao R, Lakatta E. Elevated plasma levels of vascular cell adhesion molecule-1 (VCAM-1) in diabetic patients with microalbuminuria: a marker of vascular dysfunction and progressive vascular disease. Br J Haematol 1996; 92:747-50. [PMID: 8616048 DOI: 10.1046/j.1365-2141.1996.379915.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Advanced glycation endproducts (AGEs), which accumulate in diabetic vasculature, result in enhanced expression of endothelial cell-associated vascular cell adhesion molecule-1 (VCAM-1) as well release of a soluble form of VCAM-1 (sVCAM-1) into culture supernatants. We hypothesized that sVCAM-1 in diabetic plasma might reflect early vascular perturbation in diabetic vasculopathy. Diabetic patients with microalbuminuria, a group with a high incidence of vascular complications, had increased plasma levels of sVCAM-1, approximately 1.5-fold greater than diabetic patients without microalbuminuria; P < 0.05. sVCAM-1 may be an indicator of ongoing cellular dysfunction in diabetes, as well as a dynamic surrogate marker for the effectiveness of therapeutic interventions.
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Affiliation(s)
- A M Schmidt
- Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, New York 10032, USA
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Clark F, Carlson M, Zemke R, Frank G, Patterson K, Ennevor BL, Rankin-Martinez A, Hobson LA, Crandall J, Mandel D, Lipson L. Life domains and adaptive strategies of a group of low-income, well older adults. Am J Occup Ther 1996; 50:99-108. [PMID: 8808413 DOI: 10.5014/ajot.50.2.99] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Older adults are at increased risk for a variety of physical and functional limitations that threaten their ability to lead independent and fulfilling lives. Consequently, they stand to benefit from personalized strategies of adaptation that enable them to achieve successful outcomes in their daily activities and desired goals. In the current investigation, a qualitative descriptive methodology was used to document the perceived life domains of importance and associated strategies of adaptation of 29 residents of Angelus Plaza, a federally subsidized apartment complex in downtown Los Angeles for low-income, well older adults. On the basis of interview data, 10 life domains were identified, and within each domain, a typology of adaptive strategies was derived. The domains were activities of daily living (ADL), adaptation to a multicultural environment, free time usage, grave illness and death-spirituality, health maintenance, mobility maintenance, personal finances, personal safety, psychological well-being and happiness, and relationships with others. Although the typology should not be generalized to a geriatric population, therapists may wish to refer to it to gain a sense of the extent to which certain adaptive strategies may be applicable to the lives of particular older adults to whom they deliver services. The teaching of these adaptive strategies could then be incorporated into an individualized treatment plan. The typology also provides a broad picture of the kinds of adaptive strategies used by the older adults as a way of coping and adapting to their setting. Although some of the domains do not differ from those typically addressed in occupational therapy textbooks on geriatric care (e.g., ADL, health maintenance), others seem uniquely tailored to the specifics of the Angelus Plaza context (e.g., personal safety). Finally, certain domains emerged that may be highly relevant to older adults in most settings but are not typically the focus of occupational therapy programs (e.g., grave illness and death-spirituality, relationships with others). The emergence of these domains from our data suggests that therapists may wish to consider them more in treatment if they are convinced that they possess local relevance.
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Affiliation(s)
- F Clark
- Department of Occupational Therapy, University of Southern California, Los Angeles 90033, USA
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Schmidt AM, Hori O, Chen JX, Li JF, Crandall J, Zhang J, Cao R, Yan SD, Brett J, Stern D. Advanced glycation endproducts interacting with their endothelial receptor induce expression of vascular cell adhesion molecule-1 (VCAM-1) in cultured human endothelial cells and in mice. A potential mechanism for the accelerated vasculopathy of diabetes. J Clin Invest 1995; 96:1395-403. [PMID: 7544803 PMCID: PMC185762 DOI: 10.1172/jci118175] [Citation(s) in RCA: 614] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Vascular cell adhesion molecule-1 (VCAM-1), an inducible cell-cell recognition protein on the endothelial cell surface (EC), has been associated with early stages of atherosclerosis. In view of the accelerated vascular disease observed in patients with diabetes, and the enhanced expression of VCAM-1 in diabetic rabbits, we examined whether irreversible advanced glycation endproducts (AGEs), could mediate VCAM-1 expression by interacting with their endothelial cell receptor (receptor for AGE, RAGE). Exposure of cultured human ECs to AGEs induced expression of VCAM-1, increased adhesivity of the monolayer for Molt-4 cells, and was associated with increased levels of VCAM-1 transcripts. The inhibitory effect of anti-RAGE IgG, a truncated form of the receptor (soluble RAGE) or N-acetylcysteine on VCAM-1 expression indicated that AGE-RAGE-induced oxidant stress was central to VCAM-1 induction. Electrophoretic mobility shift assays on nuclear extracts from AGE-treated ECs showed induction of specific DNA binding activity for NF-kB in the VCAM-1 promoter, which was blocked by anti-RAGE IgG or N-acetylcysteine. Soluble VCAM-1 antigen was elevated in human diabetic plasma. These data are consistent with the hypothesis that AGE-RAGE interaction induces expression of VCAM-1 which can prime diabetic vasculature for enhanced interaction with circulating monocytes.
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MESH Headings
- Animals
- Base Sequence
- Cell Adhesion
- Cell Adhesion Molecules/analysis
- Cell Adhesion Molecules/biosynthesis
- Cell Line
- Cell Nucleus/metabolism
- Cells, Cultured
- DNA Primers
- Diabetic Angiopathies/physiopathology
- Endothelium, Vascular/drug effects
- Endothelium, Vascular/metabolism
- Endothelium, Vascular/physiology
- Enzyme-Linked Immunosorbent Assay
- Gene Expression/drug effects
- Glycation End Products, Advanced/metabolism
- Glycation End Products, Advanced/pharmacology
- Humans
- Male
- Mice
- Models, Biological
- Molecular Sequence Data
- Oxidative Stress
- Polymerase Chain Reaction
- Receptor for Advanced Glycation End Products
- Receptors, Immunologic/metabolism
- Receptors, Immunologic/physiology
- Transcription, Genetic
- Umbilical Veins
- Vascular Cell Adhesion Molecule-1
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Affiliation(s)
- A M Schmidt
- Department of Medicine, Columbia University-College of Physicians and Surgeons, New York, New York 10032, USA
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Bowcock AM, Crandall J, Daneshvar L, Lee GM, Young B, Zunzunegui V, Craik C, Cavalli-Sforza LL, King MC. Genetic analysis of cystic fibrosis: linkage of DNA and classical markers in multiplex families. Am J Hum Genet 1986; 39:699-706. [PMID: 3026172 PMCID: PMC1684114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Linkage of cystic fibrosis (CF) to DNA and classical markers was studied in 36 families of two or three generations with at least two living affected children. Among the 79 affected children, no recombinants were detected between the disease and the markers MET and pJ3.11, previously shown to be linked to CF. No linkage between the human trypsin gene family (which appears to include at least 10 members) and CF was found, although not all genes of the trypsin family have been screened yet. In one of the CF families, recombination between MET and pJ3.11 was detected in an unaffected sib. Data from our families suggest that the gene order of markers among chromosome 7q is: (7cen;p8.33)collagen(COL1A2);DOCR1-917;paraoxonase+ ++(PON);(MET-cf-J3.11);T-cell receptor beta chain (TCRB);qter. There was no evidence for (or against) either postzygotic selection or meiotic drive to explain the high frequency of CF in Caucasian populations.
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Abstract
The research concerned relations among development at Erikson's first six stages of psychosocial development, locus of control, and several measures of time orientation. The investigation involved 68 female and 65 male high school and university students. Development at Erikson's Stages 1,3, 4, and 5 was significantly related to the I-E Scale, with positive development being associated with internal control. Locus of control was also related to sex and age. Women were found to be more externally controlled than men. Internal control was associated with increasing age over the range from 15 to 25 years. Development at each of Erikson's first five stages was significantly correlated with one or more measures of tempiral relatedness, or integration of perceived past, present, and future time zones. Other measures of time orientation failed to show consistent relations to psychosocial development.
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Crandall J, Watkins R. Correction. Thermal Transformations of Medium Ring Olefins. J Org Chem 1971. [DOI: 10.1021/jo00822a616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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