1
|
Deitz RL, Thorngren CK, Seese LM, Ryan JP, Ramanan R, Sanchez PG, Murray H. Evolution of extracorporeal membrane oxygenation trigger criteria in COVID-19 acute respiratory distress syndrome. J Thorac Cardiovasc Surg 2024; 167:1333-1343. [PMID: 36481061 PMCID: PMC9625843 DOI: 10.1016/j.jtcvs.2022.09.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 09/08/2022] [Accepted: 09/25/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To understand the implications of a tiered extracorporeal membrane oxygenation (ECMO) criteria framework and the outcomes of patients with COVID-19 acute respiratory distress syndrome who we were consulted on for ECMO but ultimately declined. METHODS All patients declined for ECMO support by a large regional health care system between March 2020 and July 2021 were included. Restrictive selection criteria were enacted midway through the study stratifying the cohort into 2 groups. Primary outcomes included 30-day mortality. Secondary outcomes included reasons for declining ECMO and survival stratified by phase. RESULTS One hundred ninety-three patients with COVID-19 acute respiratory distress syndrome were declined for ECMO within the study period out of 260 ECMO consults. At the time of consult, 71.0% (n = 137) were mechanically ventilated and 38% (n = 74) were proned and chemically paralyzed. Thirty-day mortality was 66% (n = 117), which increased from 53% to 73% (P = .010) when restrictive criteria were enacted. Patients with multisystem organ failure, prolonged ventilator time, and advanced age had respectively an 11-fold (odds ratio, 10.6; 95% CI, 1.7-65.2), 4-fold (odds ratio, 3.5; 95% CI, 1.1-12.0), and 4-fold (odds ratio, 4.4; 95% CI, 1.9-10.2) increase in the odds of mortality. CONCLUSIONS Patients with COVID-19 acute respiratory distress syndrome declined for ECMO represent a critically ill cohort. We observed an increase in the severity of disease and 30-day mortality in consults in the latter phase of our study period. These findings may reflect our use of tiered selection criteria coupled with ongoing education and communication with referring centers, sparing both patients likely to respond to medical therapy and those who were unsalvageable by ECMO.
Collapse
Affiliation(s)
- Rachel L Deitz
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
| | - Christina K Thorngren
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Laura M Seese
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - John P Ryan
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Raj Ramanan
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Pablo G Sanchez
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa; Division of Lung Transplant and Lung Failure, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Holt Murray
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pa
| |
Collapse
|
2
|
Deitz RL, Clifford S, Ryan JP, Chan EG, Coster JN, Furukawa M, Hage CA, Sanchez PG. Performance status at the time of lung retransplant predicts long-term function. Clin Transplant 2024; 38:e15310. [PMID: 38591128 DOI: 10.1111/ctr.15310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/05/2024] [Accepted: 03/22/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Lung retransplantation is offered to select patients with chronic allograft dysfunction. Given the increased risk of morbidity and mortality conferred by retransplantation, post-transplant function should be considered in the decision of who and when to list. The aim of this study is to identify predictors of post-operative disability in patients undergoing lung retransplantation. METHODS Data were collected from the UNOS national dataset and included all patients who underwent lung retransplant from May 2005-March 2023. Pre- and post-operative function was reported by the Karnofsky Performance Status (KPS) and patients were stratified based on their needs. Cumulative link mixed effects models identified associations between pre-transplant variables and post-transplant function. RESULTS A total of 1275 lung retransplant patients were included. After adjusting for between-group differences, pre-operative functional status was predictive of post-transplant function; patients requiring Total Assistance ( n = 740) were 74% more likely than No/Some Assistance patients (n = 535) to require more assistance in follow-up (OR 1.74, 95% CI 1.13-2.68, p = .012). Estimated one year survival of Total Assistance patients is lower than No/Some Assistance Recipients (72% vs. 82%, CI 69%-75%; 79%-86%) but similar to overall re-transplant survival (76%, CI 74%-79%). CONCLUSION Both survival and regain of function in patients requiring Total Assistance prior to retransplant may be higher than previously reported. Pre-operative functional status is predictive of post-operative function and should weigh in the selection, timing and post-operative care of patients considered for lung retransplantation.
Collapse
Affiliation(s)
- Rachel L Deitz
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Sarah Clifford
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - John P Ryan
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA
- Department of Cardiothoracic Surgery, Division of Lung Transplant and Lung Failure, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Ernest G Chan
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Jenalee N Coster
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA
- Department of Cardiothoracic Surgery, Division of Lung Transplant and Lung Failure, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Masashi Furukawa
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA
- Department of Cardiothoracic Surgery, Division of Lung Transplant and Lung Failure, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Chadi A Hage
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Pablo G Sanchez
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA
- Department of Cardiothoracic Surgery, Division of Lung Transplant and Lung Failure, University of Pittsburgh Medical Center, Pittsburgh, USA
| |
Collapse
|
3
|
Donohue JK, Chan EG, Clifford S, Ryan JP, Furukawa M, Haidar G, Bertani A, Hage CA, Sanchez PG. Lung transplantation in HIV seropositive recipients: An analysis of the UNOS registry. Clin Transplant 2024; 38:e15246. [PMID: 38289885 DOI: 10.1111/ctr.15246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/29/2023] [Accepted: 01/12/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Experience with lung transplantation (LT) in patients with human immunodeficiency virus (HIV) is limited. Many studies have demonstrated the success of kidney and liver transplantation in HIV-seropositive (HIV+) patients. Our objective was to conduct a national registry analysis comparing LT outcomes in HIV+ to HIV-seronegative (HIV-) recipients. METHODS The United Network for Organ Sharing database was queried to identify LTs performed in adult HIV+ patients between 2016 and 2023. Patients with unknown HIV status, multiorgan transplants, and redo transplants were excluded. The primary endpoints were mortality and graft rejection. Survival time was analyzed using Kaplan-Meier analysis. RESULTS The study included 17 487 patients, 67 of whom were HIV+. HIV+ recipients were younger (59 vs. 62 years, p = .02), had higher pulmonary arterial pressure (28 vs. 25 mm Hg, p = .04), and higher lung allocation scores (47 vs. 41, p = .01) relative to HIV- recipients. There were no differences in graft/recipient survival time between groups. HIV+ recipients had higher rates of post-transplant dialysis (18% vs. 8.4%, p = .01), but otherwise had similar post-transplant outcomes to HIV-recipients. CONCLUSIONS This national registry analysis suggests LT outcomes in HIV+ patients are not inferior to outcomes in HIV- patients and that well-selected HIV+ recipients can achieve comparable patient and graft survival rates relative to HIV- recipients.
Collapse
Affiliation(s)
- Jack K Donohue
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ernest G Chan
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sarah Clifford
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - John P Ryan
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Masashi Furukawa
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ghady Haidar
- Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alessandro Bertani
- Division of Thoracic Surgery and Lung Transplantation, Thoracic Center, IRCCS ISMETT - UPMC, Palermo, Italy
| | - Chadi A Hage
- Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Pablo G Sanchez
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
4
|
Hyzny EJ, Chan EG, Malik SM, Morrell M, Furukawa M, Ryan JP, Sanchez PG. Risk Factors and Outcomes of Postoperative Hepatic Dysfunction After Lung Transplantation. Ann Thorac Surg 2023; 116:1277-1284. [PMID: 37000464 DOI: 10.1016/j.athoracsur.2022.08.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 07/18/2022] [Accepted: 08/27/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hepatic dysfunction is a morbid complication of lung transplantation. Little is known about risk factors for postoperative hepatic dysfunction or its impact on survival after lung transplantation. METHODS This retrospective analysis of 1406 adult lung transplant recipients was performed at the University of Pittsburgh Medical Center in Pittsburgh, Pennsylvania between January 1, 2007 and December 1, 2019. Patients were excluded for redo lung transplantation, concomitant cardiac surgery, or concurrent solid organ transplantation. Postoperative liver dysfunction was classified as either ischemic liver injury or nonischemic dysfunction (transaminitis, hyperbilirubinemia). RESULTS Among the 1155 primary lung transplant recipients included, postoperative hepatic dysfunction developed in 96 (8.3%) after lung transplantation. A history of liver disease was the greatest predictor of postoperative hepatic dysfunction (odds ratio, 6.19; CI, 2.13-17.4; P < .001). Patients with postoperative hepatic dysfunction had a greater need for intraoperative blood products (ischemic, 12 U [range, 6-21 U]; nonischemic, 10 U [range, 4-28 U]; vs none, 4 U [range, 1-12 U]; P < .001) and an increased need for postoperative circulatory support (ischemic, 16 [76%]; nonischemic, 25 [33%]; none, 117 [11%]; P < .001). Both ischemic liver injury and nonischemic dysfunction were associated with diminished 1-, 3-, and 5-year term survival (ischemic, 27.5%, 16.5%, and 0%, respectively; nonischemic, 60%, 49.6%, and 46.9%, respectively; none, 87.3%, 72.3%, and 59.5%, respectively; P < .001). CONCLUSIONS Hepatic dysfunction after lung transplantation is associated with significant morbidity and mortality. A history of liver disease was the best positive predictor for postoperative dysfunction. Additional studies are necessary to identify the best treatment algorithm to avoid hepatic dysfunction more effectively in the postoperative setting after lung transplantation.
Collapse
Affiliation(s)
- Eric J Hyzny
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ernest G Chan
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Shahid M Malik
- Division of Gastroenterology Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Matthew Morrell
- Division of Pulmonary and Critical Care, Department of Medicine, University of Utah, Salt Lake City, Utah
| | - Masashi Furukawa
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - John P Ryan
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Pablo G Sanchez
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| |
Collapse
|
5
|
Brunson JK, Thukral M, Ryan JP, Anderson CR, Kolody BC, James C, Chavez FP, Leaw CP, Rabines AJ, Venepally P, Zheng H, Kudela RM, Smith GJ, Moore BS, Allen AE. Molecular Forecasting of Domoic Acid during a Pervasive Toxic Diatom Bloom. bioRxiv 2023:2023.11.02.565333. [PMID: 37961417 PMCID: PMC10635071 DOI: 10.1101/2023.11.02.565333] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
In 2015, the largest recorded harmful algal bloom (HAB) occurred in the Northeast Pacific, causing nearly 100 million dollars in damages to fisheries and killing many protected marine mammals. Dominated by the toxic diatom Pseudo-nitzschia australis , this bloom produced high levels of the neurotoxin domoic acid (DA). Through molecular and transcriptional characterization of 52 near-weekly phytoplankton net-tow samples collected at a bloom hotspot in Monterey Bay, California, we identified active transcription of known DA biosynthesis ( dab ) genes from the three identified toxigenic species, including P. australis as the primary origin of toxicity. Elevated expression of silicon transporters ( sit1 ) during the bloom supports the previously hypothesized role of dissolved silica (Si) exhaustion in contributing to bloom physiology and toxicity. We find that co-expression of the dabA and sit1 genes serves as a robust predictor of DA one week in advance, potentially enabling the forecasting of DA-producing HABs. We additionally present evidence that low levels of iron could have co-limited the diatom population along with low Si. Iron limitation represents a previously unrecognized driver of both toxin production and ecological success of the low iron adapted Pseudo-nitzschia genus during the 2015 bloom, and increasing pervasiveness of iron limitation may fuel the escalating magnitude and frequency of toxic Pseudo-nitzschia blooms globally. Our results advance understanding of bloom physiology underlying toxin production, bloom prediction, and the impact of global change on toxic blooms. Significance Pseudo-nitzschia diatoms form oceanic harmful algal blooms that threaten human health through production of the neurotoxin domoic acid (DA). DA biosynthetic gene expression is hypothesized to control DA production in the environment, yet what regulates expression of these genes is yet to be discovered. In this study, we uncovered expression of DA biosynthesis genes by multiple toxigenic Pseudo-nitzschia species during an economically impactful bloom along the North American West Coast, and identified genes that predict DA in advance of its production. We discovered that iron and silica co-limitation restrained the bloom and likely promoted toxin production. This work suggests that increasing iron limitation due to global change may play a previously unrecognized role in driving bloom frequency and toxicity.
Collapse
|
6
|
Chan EG, Pan G, Clifford S, Hyzny EJ, Furukawa M, Coster JN, Ryan JP, Gomez H, Sanchez PG. Postoperative Acute Kidney Injury and Long-Term Outcomes After Lung Transplantation. Ann Thorac Surg 2023; 116:1056-1062. [PMID: 37414386 DOI: 10.1016/j.athoracsur.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/17/2023] [Accepted: 06/19/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND This study sought to characterize perioperative risk factors of acute kidney injury (AKI) and report outcomes associated with its development in the immediate postoperative setting after lung transplantation. METHODS Study investigator performed a retrospective analysis of all adult patients undergoing primary lung transplantation at a single institution from January 1, 2011 to December 31, 2021 AKI was defined using Kidney Disease: Improving Global Outcomes (KDIGO) criteria after lung transplantation and was stratified on the basis of whether patients required renal replacement therapy (RRT; AKI-no RRT vs AKI-RRT). RESULTS Of the 754 patients included, 369 (48.9%) any AKI developed in the postoperative period (252 AKI-no RRT vs 117 AKI-RRT). Risk factors for postoperative AKI included higher preoperative creatinine levels (odds ratio [OR], 5.15; P < .001), lower preoperative estimated glomerular filtration rate (OR, 0.99; P < 0.018), delayed chest closure (OR, 2.72; P < .001), and higher volumes of postoperative blood products (OR, 1.09; P < .001) in the multivariable analysis. On univariate analysis, both AKI groups were also associated with higher rates of pneumonia (P < .001), reintubation (P < .001), mortality on index admission (P < 0.001), longer ventilator duration (P < .001), longer intensive care unit length of stay (P < .001), and longer hospital length of stay (P < .001), with the highest rates in the AKI-RRT group. In a multivariable survival analysis, postoperative AKI-no RRT (hazard ratio [HR], 1.50; P = .006) and AKI-RRT (HR, 2.70; P < .001) were associated with significantly worse survival independent of severe grade 3 primary graft dysfunction at 72 hours (HR, 1.45; P = .038). CONCLUSIONS The development of postoperative AKI was associated with numerous preoperative and intraoperative factors. Postoperative AKI remained significantly associated with poorer posttransplantation survival. Severe cases of AKI necessitating RRT portended the worst survival after lung transplantation.
Collapse
Affiliation(s)
- Ernest G Chan
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Gilbert Pan
- Boston University School of Medicine, Boston, Massachusetts
| | - Sarah Clifford
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Eric J Hyzny
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Masashi Furukawa
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jenalee N Coster
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - John P Ryan
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Hernando Gomez
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Pablo G Sanchez
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
| |
Collapse
|
7
|
Furukawa M, Chan EG, Ryan JP, Coster JN, Sanchez PG. Impact of gastro-jejunostomy tube in lung transplant patients: a propensity-matched analysis. Interdiscip Cardiovasc Thorac Surg 2023; 37:ivad149. [PMID: 37656927 PMCID: PMC10918761 DOI: 10.1093/icvts/ivad149] [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] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/21/2023] [Accepted: 08/31/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVES During the postoperative phase of lung transplantation, the surgical creation of a gastro-jejunostomy (GJ) may be deemed necessary for patients with severe oesophageal dysmotility, prolonged oral intake difficulties stemming from use of a ventilator or marked malnutrition. We explored the effects of postoperative GJ tube on survival and bronchiolitis obliterans syndrome in lung transplant recipients. METHODS We retrospectively reviewed all lung transplants performed at our institution between 2011 and 2022. Propensity score matching was performed to match patients who required a GJ tube with control patients on a 1:1 ratio. The preoperative, operative and postoperative outcomes of the patients were evaluated. RESULTS After propensity score matching, 193 patients with GJ were compared to 193 patients without GJ. Patients with GJ had significantly higher rates of delayed chest closure (P = 0.007), and postoperative dialysis (P = 0.016), longer intensive care unit stays (P < 0.001), longer ventilator duration (P < 0.001), higher rates of pneumonia (P = 0.035) and higher rates of being treated for acute cellular rejection within 1 year of transplant (P = 0.008). Overall survival and freedom from bronchiolitis obliterans syndrome were not found to be significantly different between the matched groups (P = 0.09 and P = 0.3). CONCLUSIONS GJ tube placement during the postoperative phase of lung transplantation did not compromise patient survival or freedom from bronchiolitis obliterans syndrome although the results reflect more difficult and complicated cases. This study indicates that the GJ tube may be a useful option for enteral feeding.
Collapse
Affiliation(s)
- Masashi Furukawa
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ernest G Chan
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - John P Ryan
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jenalee N Coster
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Pablo G Sanchez
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| |
Collapse
|
8
|
Iyanna N, Chan EG, Ryan JP, Furukawa M, Coster JN, Hage CA, Sanchez PG. Lung Transplantation Outcomes in Recipients Aged 70 Years or Older and the Impact of Center Volume. J Clin Med 2023; 12:5372. [PMID: 37629414 PMCID: PMC10455483 DOI: 10.3390/jcm12165372] [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: 07/05/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
OBJECTIVE To evaluate trends and outcomes of lung transplants (LTx) in recipients ≥ 70 years. METHODS We performed a retrospective analysis of the UNOS database identifying all patients undergoing LTx (May 2005-December 2022). Baseline characteristics and postoperative outcomes were compared by age (<70 years, ≥70 years) and center volume. Kaplan-Meier analyses were performed with pairwise comparisons between subgroups. RESULTS 34,957 patients underwent LTx, of which 3236 (9.3%) were ≥70 years. The rate of LTx in recipients ≥ 70 has increased over time, particularly in low-volume centers (LVCs); consequently, high-volume centers (HVCs) and LVCs perform similar rates of LTx for recipients ≥ 70. Recipients ≥ 70 had higher rates of receiving from donor after circulatory death lungs and of extended donor criteria. Recipients ≥ 70 were more likely to die of cardiovascular diseases or malignancy, while recipients < 70 of chronic primary graft failure. Survival time was shorter for recipients ≥ 70 compared to recipients < 70 old (hazard ratio (HR): 1.36, 95% confidence interval (CI): 1.28-1.44, p < 0.001). HVCs were associated with a survival advantage in recipients < 70 (HR: 0.91, 95% CI: 0.88-0.94, p < 0.001); however, in recipients ≥ 70, survival was similar between HVCs and LVCs (HR: 1.11, 95% CI: 0.99-1.25, p < 0.08). HVCs were more likely to perform a bilateral LTx (BLT) for obstructive lung diseases compared to LVCs, but there was no difference in BLT and single LTx likelihood for restrictive lung diseases. CONCLUSIONS Careful consideration is needed for recipient ≥ 70 selection, donor assessment, and post-transplant care to improve outcomes. Further research should explore strategies that advance perioperative care in centers with low long-term survival for recipients ≥ 70.
Collapse
Affiliation(s)
- Nidhi Iyanna
- University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA;
| | - Ernest G. Chan
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; (E.G.C.); (J.P.R.); (M.F.); (J.N.C.)
| | - John P. Ryan
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; (E.G.C.); (J.P.R.); (M.F.); (J.N.C.)
| | - Masashi Furukawa
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; (E.G.C.); (J.P.R.); (M.F.); (J.N.C.)
| | - Jenalee N. Coster
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; (E.G.C.); (J.P.R.); (M.F.); (J.N.C.)
| | - Chadi A. Hage
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA;
| | - Pablo G. Sanchez
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; (E.G.C.); (J.P.R.); (M.F.); (J.N.C.)
| |
Collapse
|
9
|
Deitz RL, Emerel L, Chan EG, Ryan JP, Hyzny E, Furukawa M, Sanchez PG. Waitlist Mortality and Extracorporeal Membrane Oxygenation Bridge to Lung Transplant. Ann Thorac Surg 2023; 116:156-162. [PMID: 37004804 PMCID: PMC10587849 DOI: 10.1016/j.athoracsur.2023.02.062] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 01/13/2023] [Accepted: 02/28/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Use of extracorporeal membrane oxygenation (ECMO) as bridge to lung transplant has increased. However, little is known about patients placed on ECMO who die while on the waiting list. Using a national lung transplant data set, we investigated variables associated with waitlist mortality of patients bridged to lung transplant. METHODS All patients supported on ECMO at time of listing were identified using the United Network for Organ Sharing database. Univariable analyses were performed using bias-reduced logistic regression. Cause-specific hazard models were used to determine the effect of variables of interest on hazard of outcomes. RESULTS From April 2016 to December 2021, 634 patients met inclusion criteria. Of these, 445 (70%) were successfully bridged to transplant, 148 (23%) died on the waitlist, and 41 (6.5%) were removed for other reasons. Univariable analysis found associations between waitlist mortality and blood group, age, body mass index, serum creatinine, lung allocation score, days on waitlist, United Network for Organ Sharing region, and being listed at a lower-volume center. Cause-specific hazard models demonstrated that patients at high-volume centers were 24% more likely to survive to transplant and 44% less likely to die on the waitlist. Among patients who were successfully bridged to transplant, there was no difference in survival between low- and high-volume centers. CONCLUSIONS ECMO is an appropriate strategy to bridge selected high-risk patients to lung transplant. Of those placed on ECMO with intent to transplant, about one quarter may not survive to transplantation. High-risk patients requiring advanced support strategies may be more likely to survive to transplant when bridged at a high-volume center.
Collapse
Affiliation(s)
- Rachel L Deitz
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| | - Leonid Emerel
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ernest G Chan
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - John P Ryan
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Division of Lung Transplantation and Lung Failure, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Eric Hyzny
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Masashi Furukawa
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Division of Lung Transplantation and Lung Failure, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Pablo G Sanchez
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Division of Lung Transplantation and Lung Failure, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| |
Collapse
|
10
|
Melnyk V, Xu W, Ryan JP, Karim HT, Chan EG, Mahajan A, Subramaniam K. Utilization of machine learning to model the effect of blood product transfusion on short-term lung transplant outcomes. Clin Transplant 2023:e14961. [PMID: 36912861 DOI: 10.1111/ctr.14961] [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: 03/06/2022] [Revised: 11/29/2022] [Accepted: 03/01/2023] [Indexed: 03/14/2023]
Abstract
The objective of this study was to identify the relationship between blood product transfusion and short-term morbidity and mortality following lung transplantation utilizing machine learning. Preoperative recipient characterstics, procedural variables, perioperative blood product transfusions, and donor charactersitics were included in the model. The primary composite outcome was occurrence on any of the following six endpoints: mortality during index hospitalization; primary graft dysfunction at 72 h post-transplant or the need for postoperative circulatory support; neurological complications (seizure, stroke, or major encephalopathy); perioperative acute coronary syndrome or cardiac arrest; and renal dysfunction requiring renal replacement therapy. The cohort included 369 patients, with the composite outcome occurring in 125 cases (33.9%). Elastic net regression analysis identified 11 significant predictors of composite morbidity: higher packed red blood cell, platelet, cryoprecipitate and plasma volume from the critical period, preoperative functional dependence, any preoperative blood transfusion, VV ECMO bridge to transplant, and antifibrinolytic therapy were associated with higher risk of morbidity. Preoperative steroids, taller height, and primary chest closure were protective against composite morbidity.
Collapse
Affiliation(s)
- Vladyslav Melnyk
- Department of Anesthesiology, University of Alberta - Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Wen Xu
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - John P Ryan
- Division of Lung Transplantation, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Helmet T Karim
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ernest G Chan
- Division of Lung Transplantation, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Aman Mahajan
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Kathirvel Subramaniam
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
11
|
Chan EG, Hyzny EJ, Furukawa M, Ryan JP, Subramaniam K, Morrell MR, Pilewski J, Luketich JD, Sanchez PG. Intraoperative Support for Primary Bilateral Lung Transplantation: A Propensity-Matched Analysis. Ann Thorac Surg 2023; 115:743-749. [PMID: 35780817 DOI: 10.1016/j.athoracsur.2022.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 04/19/2022] [Accepted: 06/06/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Single-center studies support benefits of venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a method of intraoperative support. Propensity-matched data from a large cohort, however, are currently lacking. Therefore, our goal was to compare outcomes of intraoperative VA-ECMO and cardiopulmonary bypass (CPB) during bilateral lung transplantation (LTx) with a propensity analysis. METHODS We performed a retrospective analysis of 795 consecutive primary adult LTx patients (June 1, 2011-December 26, 2020) using no intraoperative support (n = 210), VA-ECMO (n = 150), or CPB (n = 197). Exclusion criteria included LTx on venovenous-ECMO, single/redo LTx, ex vivo lung perfusion, and concomitant solid-organ transplantation or cardiac procedure. Propensity analysis was performed comparing patients who underwent intraoperative CPB or VA-ECMO. RESULTS The propensity CPB group required more blood products at 72 hours (P = .02) and longer intensive care unit length of stay (P < .001) and ventilator dependence days (P < .001). There were no differences in cerebrovascular accident (P = 1), reintubation (P = .4), dialysis (P = .068), in-hospital mortality (P = .33), and 1-year (P = .67) and 3-year (P = .32) survival. The CPB group had a higher incidence of grade 3 primary graft dysfunction at 72 hours (P < .001). Neither support strategy was a predictor of 1- and 3-year mortality in our multivariable model (VA-ECMO, P = .72 and P = .57; CPB, P = .45 and P = .91, respectively). CONCLUSIONS Intraoperative VA-ECMO during lung transplantation was associated with fewer postoperative blood transfusions, shorter length of mechanical ventilation, and lower incidence of a grade 3 primary graft dysfunction at 72 hours. Although there were some differences in the postoperative course between the VA-ECMO and CPB groups, support type was not associated with differences in survival.
Collapse
Affiliation(s)
- Ernest G Chan
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Eric J Hyzny
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Masashi Furukawa
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - John P Ryan
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Kathirvel Subramaniam
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Matthew R Morrell
- Division of Pulmonary and Critical Care, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Joseph Pilewski
- Department of Medicine, Pulmonary, Allergy, and Critical Care Medicine Division, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - James D Luketich
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Pablo G Sanchez
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| |
Collapse
|
12
|
Furukawa M, Noda K, Chan EG, Ryan JP, Coster JN, Sanchez PG. Lung transplantation from donation after circulatory death, evolution, and current status in the United States. Clin Transplant 2023; 37:e14884. [PMID: 36542414 DOI: 10.1111/ctr.14884] [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: 10/11/2022] [Revised: 12/05/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The number of lung transplants from donors after circulatory death has increased over the last decade. This study aimed to describe the evolution and outcomes following lung transplantation donation after circulatory death (DCD) and report the practices and outcomes of ex vivo lung perfusion (EVLP) in this donor population. METHODS This was a retrospective study using a prospectively collected national registry. The United Network for Organ Sharing (UNOS) database was queried to identify adult patients who underwent lung transplantation between May 1, 2005, and December 31, 2021. Kaplan-Meier analysis and Weibull regression were used to compare survival in four cohorts (donation after brain death [DBD] with or without EVLP, and DCD with or without EVLP). The primary outcome of interest was patient survival. RESULTS Of the 21 356 recipients who underwent lung transplantation, 20 380 (95.4%) were from brain death donors and 976 (4.6%) from donors after circulatory death. Kaplan-Meier analysis showed no difference in the survival time between the two groups. In a multivariable analysis that controlled for baseline differences in donor and recipient characteristics, recipients who received lungs from cardiac death donors after EVLP had 28% shorter survival time relative to donor lungs after brain death without EVLP (hazard ratio [HR] 1.53, 95% confidence interval [CI] 1.10-2.15, p = .01). CONCLUSIONS The early survival differences observed after lung transplants from donors after circulatory death in lungs evaluated with EVLP deserves further investigation.
Collapse
Affiliation(s)
- Masashi Furukawa
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kentaro Noda
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ernest G Chan
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - John P Ryan
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jenalee N Coster
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Pablo G Sanchez
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
13
|
Noda K, Chan EG, Furukawa M, Ryan JP, Clifford S, Luketich JD, Sanchez PG. Single-center experience of ex vivo lung perfusion and subsequent lung transplantation. Clin Transplant 2023; 37:e14901. [PMID: 36588340 DOI: 10.1111/ctr.14901] [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: 09/30/2022] [Revised: 12/21/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND The safety of lung transplantation using ex vivo lung perfusion (EVLP) has been confirmed in multiple clinical studies; however, limited evidence is currently available regarding the potential effects of EVLP on posttransplant graft complications and survival with mid- to long-term follow-up. In this study, we reviewed our institutional data to better understand the impact of EVLP. METHODS Lungs placed on EVLP from 2014 through 2020 and transplant outcomes were retrospectively analyzed. Data were compared between lungs transplanted and declined after EVLP, between patients with severe primary graft dysfunction (PGD3) and no PGD3 after EVLP, and between matched patients with lungs transplanted with and without EVLP. RESULTS In total, 98 EVLP cases were performed. Changes in metabolic indicators during EVLP were correlated with graft quality and transplantability, but not changes in physiological parameters. Among 58 transplanted lungs after EVLP, PGD3 at 72 h occurred in 36.9% and was associated with preservation time, mechanical support prior to transplant, and intraoperative transfusion volume. Compared with patients without EVLP, patients who received lungs screened with EVLP had a higher incidence of PGD3 and longer ICU and hospital stays. Lung grafts placed on EVLP exhibited a significantly higher chance of developing airway anastomotic ischemic injury by 30 days posttransplant. Acute and chronic graft rejection, pulmonary function, and posttransplant survival were not different between patients with lungs screened on EVLP versus lungs with no EVLP. CONCLUSION EVLP use is associated with an increase of early posttransplant adverse events, but graft functional outcomes and patient survival are preserved.
Collapse
Affiliation(s)
- Kentaro Noda
- Division of Lung Transplant and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ernest G Chan
- Division of Lung Transplant and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Masashi Furukawa
- Division of Lung Transplant and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - John P Ryan
- Division of Lung Transplant and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sarah Clifford
- Division of Lung Transplant and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James D Luketich
- Division of Lung Transplant and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Pablo G Sanchez
- Division of Lung Transplant and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | |
Collapse
|
14
|
Coster JN, Noda K, Ryan JP, Chan EG, Furukawa M, Luketich JD, Sanchez PG. Effects of Intraoperative Support Strategies on Endothelial Injury and Clinical Lung Transplant Outcomes. Semin Thorac Cardiovasc Surg 2023:S1043-0679(23)00001-1. [PMID: 36716942 DOI: 10.1053/j.semtcvs.2022.09.016] [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: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 01/29/2023]
Abstract
In lung transplantation, postoperative outcomes favor intraoperative use of extracorporeal membrane oxygenation (ECMO) over cardiopulmonary bypass (CBP). We investigated the effect of intraoperative support strategies on endothelial injury biomarkers and short-term posttransplant outcomes. Adults undergoing bilateral lung transplantation with No-Support, venoarterial (V-A) ECMO, or CPB were included. Plasma samples pre- and post-transplant were collected for Luminex assay to measure endothelial injury biomarkers including syndecan-1 (SYN-1), intercellular adhesion molecule-1 (ICAM-1), and matrix metalloprotease-9. Fifty five patients were included for analysis. The plasma level of SYN-1 at arrival in the intensive care unit was significantly higher with CPB compared to V-A ECMO and No-Support (P < 0.01). The rate of primary graft dysfunction grade 3 (PGD3) at 72 hours was 60.0% in CPB, 40.1% in V-A ECMO, and 15% in No-Support (P = 0.01). Postoperative plasma levels of SYN-1 and ICAM-1 were significantly higher in recipients who developed PGD3 at 72 hours. SYN-1 levels were also significantly higher in patients who developed acute kidney injury and hepatic dysfunction after transplant. Postoperative, SYN-1 upon intensive care arrival was found to be a significant predictive biomarker of PGD3, acute kidney injury, and hepatic dysfunction following lung transplantation. CPB is associated with higher plasma concentrations of SYN-1, a marker of endothelial glycocalyx degradation, upon arrival to the intensive care unit. Higher levels of SYN-1 are predictive of end-organ dysfunction following lung transplantation. Our data suggests that intraoperative strategies aimed at modulating endothelial injury will help improve lung transplantation outcomes.
Collapse
Affiliation(s)
- Jenalee N Coster
- Division of Lung Transplant and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Kentaro Noda
- Division of Lung Transplant and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - John P Ryan
- Division of Lung Transplant and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ernest G Chan
- Division of Lung Transplant and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Masashi Furukawa
- Division of Lung Transplant and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - James D Luketich
- Division of Lung Transplant and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Pablo G Sanchez
- Division of Lung Transplant and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
| |
Collapse
|
15
|
Ryan JP, Benoit‐Bird KJ, Oestreich WK, Leary P, Smith KB, Waluk CM, Cade DE, Fahlbusch JA, Southall BL, Joseph JE, Margolina T, Calambokidis J, DeVogelaere A, Goldbogen JA. Oceanic giants dance to atmospheric rhythms: Ephemeral wind-driven resource tracking by blue whales. Ecol Lett 2022; 25:2435-2447. [PMID: 36197736 PMCID: PMC9827854 DOI: 10.1111/ele.14116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/04/2022] [Accepted: 08/14/2022] [Indexed: 01/12/2023]
Abstract
Trophic transfer of energy through marine food webs is strongly influenced by prey aggregation and its exploitation by predators. Rapid aggregation of some marine fish and crustacean forage species during wind-driven coastal upwelling has recently been discovered, motivating the hypothesis that predators of these forage species track the upwelling circulation in which prey aggregation occurs. We examine this hypothesis in the central California Current Ecosystem using integrative observations of upwelling dynamics, forage species' aggregation, and blue whale movement. Directional origins of blue whale calls repeatedly tracked upwelling plume circulation when wind-driven upwelling intensified and aggregation of forage species was heightened. Our findings illustrate a resource tracking strategy by which blue whales may maximize energy gain amid ephemeral foraging opportunities. These findings have implications for the ecology and conservation of diverse predators that are sustained by forage populations whose behaviour is responsive to episodic environmental dynamics.
Collapse
Affiliation(s)
- John P. Ryan
- Monterey Bay Aquarium Research InstituteMoss LandingCaliforniaUSA
| | | | - William K. Oestreich
- Monterey Bay Aquarium Research InstituteMoss LandingCaliforniaUSA,Hopkins Marine StationStanford UniversityStanfordCaliforniaUSA
| | - Paul Leary
- Naval Postgraduate SchoolMontereyCaliforniaUSA
| | | | - Chad M. Waluk
- Monterey Bay Aquarium Research InstituteMoss LandingCaliforniaUSA
| | - David E. Cade
- Hopkins Marine StationStanford UniversityStanfordCaliforniaUSA
| | - James A. Fahlbusch
- Hopkins Marine StationStanford UniversityStanfordCaliforniaUSA,Cascadia Research CollectiveOlympiaWashingtonUSA
| | - Brandon L. Southall
- Southall Environmental Associates, Inc.AptosCaliforniaUSA,University of CaliforniaSanta CruzCaliforniaUSA
| | | | | | | | | | | |
Collapse
|
16
|
Furukawa M, Chan EG, Ryan JP, Hyzny EJ, Sacha LM, Coster JN, Pilewski JM, Lendermon EA, Kilaru SD, McDyer JF, Sanchez PG. Induction Strategies in Lung Transplantation: Alemtuzumab vs. Basiliximab a Single-Center Experience. Front Immunol 2022; 13:864545. [PMID: 35720296 PMCID: PMC9199390 DOI: 10.3389/fimmu.2022.864545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
Background Induction therapy is used in about 80% of lung transplant centers and is increasing globally. Currently, there are no standards or guidelines for the use of induction therapy. At our institution, we have two induction strategies, basiliximab, and alemtuzumab. The goal of this manuscript is to share our experience and practice since this is an area of controversy. Methods We retrospectively reviewed 807 lung transplants performed at our institution between 2011 and 2020. Indications for the use of the basiliximab protocol were as follows: patients over the age of 70 years, history of cancer, hepatitis C virus or human immunodeficiency virus infection history, and cytomegalovirus or Epstein-Barr virus (donor positive/ recipient negative). In the absence of these clinical factors, the alemtuzumab protocol was used. Results 453 patients underwent alemtuzumab induction and 354 patients underwent basiliximab. There were significant differences in delayed chest closure (24.7% alemtuzumab vs 31.4% basiliximab, p = 0.037), grade 3 primary graft dysfunction observed within 72 hours (19.9% alemtuzumab vs 29.9% basiliximab, p = 0.002), postoperative hepatic dysfunction (8.8% alemtuzumab vs 14.7% basiliximab, p = 0.009), acute cellular rejection in first year (39.1% alemtuzumab vs 53.4% basiliximab, p < 0.001). The overall survival rate of the patients with alemtuzumab induction was significantly higher than those of the patients with basiliximab induction (5 years survival rate: 64.1% alemtuzumab vs 52.3%, basiliximab, p < 0.001). Multivariate Cox regression analysis confirmed lower 5-year survival for basiliximab induction (HR = 1.41, p = 0.02), recipient cytomegalovirus positive (HR = 1.49, p = 0.01), postoperative hepatic dysfunction (HR = 2.20, p < 0.001), and acute kidney injury requiring renal replacement therapy (HR = 2.27, p < 0.001). Conclusions In this single center retrospective review, there was a significant difference in survival rates between induction strategies. This outcome may be attributable to differences in recipient characteristics between the groups. However, the Alemtuzumab group experienced less episodes of acute cellular rejection within the first year.
Collapse
Affiliation(s)
- Masashi Furukawa
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Ernest G Chan
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - John P Ryan
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Eric J Hyzny
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Lauren M Sacha
- Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Jenalee N Coster
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Joseph M Pilewski
- Department of Pulmonology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Elizabeth A Lendermon
- Department of Pulmonology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Silpa D Kilaru
- Department of Pulmonology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - John F McDyer
- Department of Pulmonology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Pablo G Sanchez
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| |
Collapse
|
17
|
Zhang Y, McGill PR, Ryan JP. Optimized design of windowed-sinc anti-aliasing filters for phase-preserving decimation of hydrophone data. J Acoust Soc Am 2022; 151:2077. [PMID: 35364936 DOI: 10.1121/10.0009823] [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] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/27/2022] [Indexed: 06/14/2023]
Abstract
Passive acoustic monitoring generates large data sets for which decimation is beneficial to analysis and portability for data sharing. Among the goals for effective decimation are avoidance of aliasing in the passband, accurate and complete control of the attenuation profile, phase preservation, and high efficiency in processing. We present an approach to decimator design that addresses each of these goals, and we demonstrate its application to ocean audio recordings. Anti-aliasing is achieved by windowed-sinc filters that also preserve phase. Control of the passband attenuation profile is based on the specification of the maximum allowed attenuation at a certain percentage of the final output Nyquist frequency. The window type is selected to meet the stopband attenuation requirement. Efficiency is achieved through optimization of the anti-aliasing filters applied in each decimation stage, and through parallelization of processing. The best combination of the sinc function's cutoff frequency and the mainlobe bandwidth of the window function generates the shortest qualifying filter, optimizing the trade-off between filter performance and computational load. Parallelization is enabled by applying the overlap-add method to contiguous segments of audio data, consistent with the commonly used storage of contiguous audio data in files of limited duration. Beyond addressing common goals for effective decimation of audio data, the approach presented is deployable in open-source environments.
Collapse
Affiliation(s)
- Yanwu Zhang
- Monterey Bay Aquarium Research Institute, Moss Landing, California 95039, USA
| | - Paul R McGill
- Monterey Bay Aquarium Research Institute, Moss Landing, California 95039, USA
| | - John P Ryan
- Monterey Bay Aquarium Research Institute, Moss Landing, California 95039, USA
| |
Collapse
|
18
|
Furukawa M, Chan EG, Morrell MR, Ryan JP, Rivosecchi RM, Iasella CJ, Lendermon EA, Pilewski JM, Sanchez PG. Risk factors of bronchial dehiscence after primary lung transplantation. J Card Surg 2022; 37:950-957. [PMID: 35133655 DOI: 10.1111/jocs.16291] [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: 09/07/2021] [Revised: 10/15/2021] [Accepted: 11/03/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although the incidence of bronchial dehiscence following lung transplantation has decreased significantly due to improvements in perioperative managements and surgical techniques, it remains a devastating postoperative complication associated with high morbidity and mortality. METHODS We retrospectively reviewed 811 lung transplantation performed at our institution between January 2011 and December 2020. Bronchial dehiscence was confirmed with flexible bronchoscopy, computed tomography (CT) scan, or clinical findings grade using International Society for Heart and Lung Transplantation recommendations. RESULTS Bronchial dehiscence was diagnosed in 38 patients (4.7%). The overall survival rates of the patients with bronchial dehiscence were significantly worse than those of the patients without bronchial dehiscence (p = .003). Multivariate analysis identified use of our basiliximab induction protocol (odds ratio = 3.03, p = .008) as an independent predictive factor of postoperative airway dehiscence in our multivariable model, along with total ventilator duration (odds ratio = 1.02, p = .002). CONCLUSIONS Based on our analysis, patients that underwent our basiliximab induction protocol for lung transplantation experienced a higher rate of postoperative bronchial dehiscence when compared with patients who receive alemtuzumab induction. We believe this may be associated with a higher steroid exposure in this population. Additional studies are necessary to further characterize the relationship between different induction protocols and bronchial dehiscence following transplantation.
Collapse
Affiliation(s)
- Masashi Furukawa
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ernest G Chan
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Matthew R Morrell
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Utah
| | - John P Ryan
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ryan M Rivosecchi
- Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Carlo J Iasella
- Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Elizabeth A Lendermon
- Department of Pulmonology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Joseph M Pilewski
- Department of Pulmonology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Pablo G Sanchez
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
19
|
Oestreich WK, Abrahms B, McKenna MF, Goldbogen JA, Crowder LB, Ryan JP. Acoustic signature reveals blue whales tune life history transitions to oceanographic conditions. Funct Ecol 2022. [DOI: 10.1111/1365-2435.14013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- William K. Oestreich
- Hopkins Marine Station Department of Biology Stanford University Pacific Grove CA USA
| | - Briana Abrahms
- Center for Ecosystem Sentinels Department of Biology University of Washington Seattle WA USA
| | - Megan F. McKenna
- Hopkins Marine Station Department of Biology Stanford University Pacific Grove CA USA
| | - Jeremy A. Goldbogen
- Hopkins Marine Station Department of Biology Stanford University Pacific Grove CA USA
| | - Larry B. Crowder
- Hopkins Marine Station Department of Biology Stanford University Pacific Grove CA USA
| | - John P. Ryan
- Monterey Bay Aquarium Research Institute Moss Landing CA USA
| |
Collapse
|
20
|
Chan EG, Hyzny EJ, Ryan JP, Morrell MR, Pilewski J, Sanchez PG. Outcomes following lung re-transplantation in patients with cystic fibrosis. J Cyst Fibros 2021; 21:482-488. [PMID: 34949557 DOI: 10.1016/j.jcf.2021.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 11/10/2021] [Accepted: 12/05/2021] [Indexed: 01/09/2023]
Abstract
PURPOSE We examined cystic fibrosis (CF) patients and compared their clinical status at the time of primary versus double lung re-transplantation (re-DLTx) in order to better understand lung retransplant practice patterns. METHODS We performed a retrospective analysis of the UNOS Database identifying CF patients ≥18 years old undergoing re-DLTx (5/4/2005 and 12/4/2020). Baseline and clinical variables at the primary and re-DLTx were compared utilizing the paired student t-test. Graft survival was defined as time from surgery to retransplant and analyzed using Kaplan-Meier estimates. RESULTS 277 CF patients who underwent re-DLTx experienced a significantly worse 5-year survival when compared to the primary DLTx cohort (47.9% vs 58.8%, p = 0.00012). The following differences were observed comparing CF re-DLTx group to their primary DLTx: higher LAS score at the time of listing (50.66 vs 42.15, p < 0.001) and transplant (62.19 vs 48.20, p < 0.001), and increase LAS from the time of listing to transplant (+12.22 vs +7.23, p = 0.002). While serum albumin and total bilirubin were similar, CF patients had a higher creatinine (1.05 vs 0.74, p < 0.001), dialysis (4.4% vs 0.6%, p < 0.001), ECMO bridge to transplant rates (7.6% vs 4.0%, p < 0.001), and higher oxygen requirements (5.95 vs 3.93, p < 0.001) at the time of listing for a re-DLTx. CONCLUSION Compared to their initial transplant, CF patients experience significant clinical decline in renal, cardiac, and pulmonary function at the time of lung retransplantation. This may indicate that an earlier evaluation and rehabilitation process may be necessary to identify patients earlier for lung retransplantation prior significant clinical decline.
Collapse
Affiliation(s)
- Ernest G Chan
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Eric J Hyzny
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - John P Ryan
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Matthew R Morrell
- Department of Medicine, Pulmonary, Allergy, and Critical Care Medicine Division, University of Pittsburgh, Pittsburgh, PA, United States
| | - Joseph Pilewski
- Department of Medicine, Pulmonary, Allergy, and Critical Care Medicine Division, University of Pittsburgh, Pittsburgh, PA, United States
| | - Pablo G Sanchez
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
| |
Collapse
|
21
|
Joubert KD, Okusanya OT, Mazur S, Ryan JP, Ekeke CN, Schuchert MJ, Soloff AC, Dhupar R. Prognostic Difference of Pleural versus Distant Metastasis after Surgery for Lung Cancer. J Clin Med 2021; 10:jcm10214846. [PMID: 34768370 PMCID: PMC8584474 DOI: 10.3390/jcm10214846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Pleural metastasis in lung cancer found at diagnosis has a poor prognosis, with 5–11 months’ survival. We hypothesized that prognosis might be different for patients who have had curative-intent surgery and subsequent pleural recurrence and that survival might differ based on the location of the first metastasis (distant versus pleural). This may clarify if pleural recurrence is a local event or due to systemic disease. Methods: A database of 5089 patients who underwent curative-intent surgery for lung cancer was queried, and 85 patients were found who had biopsy-proven pleural metastasis during surveillance. We examined survival based on pattern of metastasis (pleural first versus distant first/simultaneously). Results: Median survival was 34 months (range: 1–171) from the time of surgery and 13 months (range: 0–153) from the time of recurrence. The shortest median survival after recurrence was in patients with adenocarcinoma and pleural metastasis as the first site (6 months). For patients with pleural metastasis as the first site, those with adenocarcinoma had a significantly shorter post-recurrence survival when compared with squamous cell carcinoma (6 vs. 12 months; HR = 0.34) and a significantly shorter survival from the time of surgery when compared with distant metastases first/simultaneously (25 vs. 52 months; HR = 0.49). Conclusions: Patients who undergo curative-intent surgery for lung adenocarcinoma that have pleural recurrence as the first site have poor survival. This may indicate that pleural recurrence after lung surgery is not likely due to a localized event but rather indicates systemic disease; however, this would require further study.
Collapse
Affiliation(s)
- Kyla D. Joubert
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA 15213, USA; (K.D.J.); (O.T.O.); (S.M.); (J.P.R.); (C.N.E.); (M.J.S.); (A.C.S.)
| | - Olugbenga T. Okusanya
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA 15213, USA; (K.D.J.); (O.T.O.); (S.M.); (J.P.R.); (C.N.E.); (M.J.S.); (A.C.S.)
| | - Summer Mazur
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA 15213, USA; (K.D.J.); (O.T.O.); (S.M.); (J.P.R.); (C.N.E.); (M.J.S.); (A.C.S.)
| | - John P. Ryan
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA 15213, USA; (K.D.J.); (O.T.O.); (S.M.); (J.P.R.); (C.N.E.); (M.J.S.); (A.C.S.)
| | - Chigozirim N. Ekeke
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA 15213, USA; (K.D.J.); (O.T.O.); (S.M.); (J.P.R.); (C.N.E.); (M.J.S.); (A.C.S.)
| | - Matthew J. Schuchert
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA 15213, USA; (K.D.J.); (O.T.O.); (S.M.); (J.P.R.); (C.N.E.); (M.J.S.); (A.C.S.)
| | - Adam C. Soloff
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA 15213, USA; (K.D.J.); (O.T.O.); (S.M.); (J.P.R.); (C.N.E.); (M.J.S.); (A.C.S.)
| | - Rajeev Dhupar
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA 15213, USA; (K.D.J.); (O.T.O.); (S.M.); (J.P.R.); (C.N.E.); (M.J.S.); (A.C.S.)
- Surgical Services Division, Veteran’s Affairs Pittsburgh Healthcare System, University Drive C, Pittsburgh, PA 15219, USA
- Correspondence: or ; Tel.: +1-(412)-623-2025
| |
Collapse
|
22
|
Powers AA, Jones KE, Eisenberg SH, Rigatti LH, Ryan JP, Luketich JD, Lotze MT, LaRue AC, Dhupar R, Soloff AC. Experimental respiratory exposure to putative Gulf War toxins promotes persistent alveolar macrophage recruitment and pulmonary inflammation. Life Sci 2021; 282:119839. [PMID: 34293400 DOI: 10.1016/j.lfs.2021.119839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 07/06/2021] [Accepted: 07/14/2021] [Indexed: 02/04/2023]
Abstract
AIMS Respiratory disorders are a prominent component of Gulf War Illness. Although much of the underlying mechanisms of Gulf War Illness remain undefined, chronic immune dysfunction is a consistent feature of this multi-symptomatic, multi-organ disorder. Alveolar macrophages represent the predominant mononuclear phagocytes of the pulmonary mucosa, orchestrating the host response to pathogens and environmental stimuli. Herein, we sought to characterize the innate immune response of the pulmonary mucosa, with a focus on macrophages, to experimental respiratory exposure to two putative Gulf War Toxins (GWTs). MATERIALS AND METHODS Utilizing commercially available instrumentation, we evaluated the effect of aerosolized exposure to the pesticide malathion and diesel exhaust particulate (DEP) on the immune composition and inflammatory response of the lung in FVB/N mice using multiparametric spectral cytometry, cytokine analysis, and histology. KEY FINDINGS Aerosolized GWTs induced gross pulmonary pathology with transient recruitment of neutrophils and sustained accumulation of alveolar macrophages to the lung for up to two weeks after exposure cessation. High-dimensional cytometry and unbiased computational analysis identified novel myeloid subsets recruited to the lung post-exposure driven by an influx of peripheral monocyte-derived progenitors. DEP and malathion, either alone or in combination, induced soluble mediators in bronchoalveolar lavage indicative of oxidative stress (PGF2α), inflammation (LTB4, TNFα, IL-12), and immunosuppression (IL-10), that were sustained or increased two weeks after exposures concluded. SIGNIFICANCE These findings indicate that macrophage accumulation and pulmonary inflammation induced by GWTs continue in the absence of toxin exposure and may contribute to the immunopathology of respiratory Gulf War Illness.
Collapse
Affiliation(s)
- Amy A Powers
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Katherine E Jones
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Seth H Eisenberg
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lora H Rigatti
- Division of Laboratory Animal Resources, University of Pittsburgh, Pittsburgh, PA, USA; UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - John P Ryan
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - James D Luketich
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael T Lotze
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA; Department of Surgery, Division of Surgical Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Amanda C LaRue
- Research Services, Ralph H. Johnson VA Medical Center, Charleston, SC, USA; Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Rajeev Dhupar
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA; Surgical Services Division, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Adam C Soloff
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA.
| |
Collapse
|
23
|
Zhang Y, Ryan JP, Hobson BW, Kieft B, Romano A, Barone B, Preston CM, Roman B, Raanan BY, Pargett D, Dugenne M, White AE, Freitas FH, Poulos S, Wilson ST, DeLong EF, Karl DM, Birch JM, Bellingham JG, Scholin CA. A system of coordinated autonomous robots for Lagrangian studies of microbes in the oceanic deep chlorophyll maximum. Sci Robot 2021; 6:6/50/eabb9138. [PMID: 34043577 DOI: 10.1126/scirobotics.abb9138] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 12/14/2020] [Indexed: 12/31/2022]
Abstract
The deep chlorophyll maximum (DCM) layer is an ecologically important feature of the open ocean. The DCM cannot be observed using aerial or satellite remote sensing; thus, in situ observations are essential. Further, understanding the responses of microbes to the environmental processes driving their metabolism and interactions requires observing in a reference frame that moves with a plankton population drifting in ocean currents, i.e., Lagrangian. Here, we report the development and application of a system of coordinated robots for studying planktonic biological communities drifting within the ocean. The presented Lagrangian system uses three coordinated autonomous robotic platforms. The focal platform consists of an autonomous underwater vehicle (AUV) fitted with a robotic water sampler. This platform localizes and drifts within a DCM community, periodically acquiring samples while continuously monitoring the local environment. The second platform is an AUV equipped with environmental sensing and acoustic tracking capabilities. This platform characterizes environmental conditions by tracking the focal platform and vertically profiling in its vicinity. The third platform is an autonomous surface vehicle equipped with satellite communications and subsea acoustic tracking capabilities. While also acoustically tracking the focal platform, this vehicle serves as a communication relay that connects the subsea robot to human operators, thereby providing situational awareness and enabling intervention if needed. Deployed in the North Pacific Ocean within the core of a cyclonic eddy, this coordinated system autonomously captured fundamental characteristics of the in situ DCM microbial community in a manner not possible previously.
Collapse
Affiliation(s)
- Yanwu Zhang
- Monterey Bay Aquarium Research Institute, Moss Landing, CA, USA.
| | - John P Ryan
- Monterey Bay Aquarium Research Institute, Moss Landing, CA, USA
| | - Brett W Hobson
- Monterey Bay Aquarium Research Institute, Moss Landing, CA, USA
| | - Brian Kieft
- Monterey Bay Aquarium Research Institute, Moss Landing, CA, USA
| | - Anna Romano
- University of Hawai'i at Mānoa, Honolulu, HI, USA
| | | | | | - Brent Roman
- Monterey Bay Aquarium Research Institute, Moss Landing, CA, USA
| | - Ben-Yair Raanan
- Monterey Bay Aquarium Research Institute, Moss Landing, CA, USA
| | - Douglas Pargett
- Monterey Bay Aquarium Research Institute, Moss Landing, CA, USA
| | | | | | | | - Steve Poulos
- University of Hawai'i at Mānoa, Honolulu, HI, USA
| | | | | | - David M Karl
- University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - James M Birch
- Monterey Bay Aquarium Research Institute, Moss Landing, CA, USA
| | | | | |
Collapse
|
24
|
Chan EG, Chan PG, Harano T, Ryan JP, Morrell MR, Sanchez PG. Trends in Lung Transplantation Practices Across the United States During the COVID-19 Pandemic. Transplantation 2021; 105:187-192. [PMID: 33141810 DOI: 10.1097/tp.0000000000003522] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 12/11/2022]
Abstract
BACKGROUND The purpose of this study is to examine the effects of the coronavirus disease 2019 (COVID-19) pandemic on adult lung transplants and report practice changes in the United States. METHODS A retrospective analysis of a public dataset from the United Network for Organ Sharing was performed regarding adult lung transplantation (January 19, 2020-June 30, 2020). Data were stratified into 3 periods: pre-COVID-19 (January 19, 2020-March 14, 2020), first COVID-19 era (March 15, 2020-May 8, 2020), and second COVID-19 era (May 9, 2020-June 30, 2020). Weekly changes in waitlist inactivations (COVID-19 precautions or not), waitlist additions, transplant volume, and donor recovery were examined across eras and changes across era were correlated. RESULTS During the first COVID-19 era, 301 patients were added to the waitlist, representing a 40% decrease when compared to the prior 8-week period. This was followed by a significant increase in listing during the second COVID-19 era (t = 2.16, P = 0.032). Waitlist inactivations decreased in the second COVID-19 era from the first COVID-19 era (t = 3.60, P < 0.001). There was no difference in waitlist inactivations between the pre-COVID era and the second COVID-19 era (P = 0.10). Weekly volume was not associated with trends in COVID-19 cases across any era, but was negatively associated with waitlist inactivations due to COVID-19 precautions entering the first COVID-19 era (r = -0.73, P = 0.04) and second COVID-19 era (r = -0.89, P = 0.003). CONCLUSIONS Due to the COVID-19 pandemic, the United States experienced a decrease in lung transplant volume. While overall volume has returned to normal, additional studies are needed to identify areas of improvement to better prepare for future pandemics.
Collapse
Affiliation(s)
- Ernest G Chan
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Patrick G Chan
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Takashi Harano
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - John P Ryan
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Matthew R Morrell
- Department of Pulmonology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Pablo G Sanchez
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| |
Collapse
|
25
|
Harano T, Ryan JP, Chan EG, Noda K, Morrell MR, Luketich JD, Sanchez PG. Lung transplantation for the treatment of irreversible acute respiratory distress syndrome. Clin Transplant 2020; 35:e14182. [PMID: 33280169 PMCID: PMC7883278 DOI: 10.1111/ctr.14182] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/21/2020] [Accepted: 11/30/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite advances in critical care for acute respiratory distress syndrome (ARDS), some survivors in the acute phase are unable to wean from extracorporeal membrane oxygenation (ECMO) or mechanical ventilation. To date, little is known regarding whether lung transplantation confers a survival benefit for irreversible ARDS. METHODS This retrospective study was conducted using the United Network for Organ Sharing database (May 2005-December 2018). Patients with restrictive lung disease were divided into two groups: patients with and without ARDS. Propensity score matching identified recipients without ARDS for the control group. RESULTS A total of 63 patients with ARDS were waitlisted for lung transplantation, while 39 received a lung transplant after a median waitlist duration of 8 days. Seventy-eight patients were matched as controls. In the ARDS group, the median age was 30 years, and the median lung allocation score was 88.4. Among the 39 recipients, 30 (76.9%) received ECMO support prior to transplantation. Lung transplantation for ARDS and restrictive lung disease showed similar 90-day (87.2% vs. 88.5%, p = .80), 1-year (82.1% vs. 85.9%, p = .52), and 3-year (69.2% vs. 65.4%, p = .94) survival rates. CONCLUSIONS Lung transplantation provides acceptable outcomes in selected patients with irreversible ARDS.
Collapse
Affiliation(s)
- Takashi Harano
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - John P Ryan
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ernest G Chan
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kentaro Noda
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Matthew R Morrell
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - James D Luketich
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Pablo G Sanchez
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| |
Collapse
|
26
|
Oestreich WK, Fahlbusch JA, Cade DE, Calambokidis J, Margolina T, Joseph J, Friedlaender AS, McKenna MF, Stimpert AK, Southall BL, Goldbogen JA, Ryan JP. Animal-Borne Metrics Enable Acoustic Detection of Blue Whale Migration. Curr Biol 2020; 30:4773-4779.e3. [DOI: 10.1016/j.cub.2020.08.105] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/31/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
|
27
|
Philips BJ, Kumar A, Burki S, Ryan JP, Noda K, D'Cunha J. Triptolide-induced apoptosis in non-small cell lung cancer via a novel miR204-5p/Caveolin-1/Akt-mediated pathway. Oncotarget 2020; 11:2793-2806. [PMID: 32733649 PMCID: PMC7367654 DOI: 10.18632/oncotarget.27672] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 04/14/2020] [Indexed: 12/12/2022] Open
Abstract
Lung cancer is one of the most prevalent malignancies world-wide with non-small cell lung cancer (NSCLC) comprising nearly 80% of all cases. Unfortunately, many lung cancer patients are diagnosed at advanced stages of the disease with an associated poor prognosis. Recently, the Chinese herb root extract Triptolide/Minnelide (TL) has shown significant promise as a therapeutic agent for NSCLC treatment both in vitro and in vivo. The aim of this study was to investigate the underlying mechanism(s) of action regarding TL-induced cytotoxicity in NSCLC. We demonstrate that triptolide treatment of A549 and H460 NSCLC cells decreases Caveolin-1 (CAV-1) mRNA/protein expression, resulting in activation of the Akt/Bcl-2-mediated mitochondrial apoptosis pathway. CAV-1 down-regulation was triggered by Micro-RNA 204-5p (miR204-5p) up-regulation and could be significantly blocked by pre-treatment with both Sirt-1/Sirt-3 specific siRNA and SIRT-1/SIRT-3 enzyme inhibitors, EX-527 and nicotinamide. Overall, our results provide evidence for a novel mechanism by which TL exerts its cytotoxic effects on NSCLC via CAV-1 down-regulation. Furthermore, these findings demonstrate a pivotal role for TL induction of the Akt/Bax pathway in apoptosis of human lung cancer.
Collapse
Affiliation(s)
- Brian J Philips
- Division of Lung Transplantation and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ajay Kumar
- Division of Lung Transplantation and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sarah Burki
- Division of Lung Transplantation and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - John P Ryan
- Division of Lung Transplantation and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kentaro Noda
- Division of Lung Transplantation and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jonathan D'Cunha
- Department of Cardiothoracic Surgery, Mayo Clinic, Phoenix, AZ, USA
| |
Collapse
|
28
|
Christie IG, Chan EG, Ryan JP, Harano T, Morrell M, Luketich JD, Sanchez PG. National Trends in Extended Criteria Donor Utilization and Outcomes for Lung Transplantation. Ann Thorac Surg 2020; 111:421-426. [PMID: 32663473 DOI: 10.1016/j.athoracsur.2020.05.087] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/15/2020] [Accepted: 05/11/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Extended criteria donor (ECD) for lung transplantation (LTx) have been implemented due to the donor organ shortage. The impact on recipient survival is under investigation. We report trends in the use of extended criteria lungs in the modern era and its association with survival outcomes using a large national database. METHODS We performed a retrospective analysis of all adult LTx from May 2005 to December 2018 using the United Network for Organ Sharing database. ECD were defined by 2 or more variances from standard criteria: age ≥ 55 years, pO2 ≤ 300, pack years ≥ 20, diabetes, purulent bronchoscopy, blood infection, or abnormal chest radiographs. Transplant centers were dichotomized based on volume. Recipient survival was analyzed using lung allocation score as a covariate. RESULTS Of 24,888 LTx, 80% had extended criteria; 42% had 2 or more extensions and were deemed ECD in this analysis. Both LTx volume (2005: 1352; 2018: 2495) and use of ECD (2005: 27% ECD, 2018: 50% ECD) have increased over the study period. Survival of LTx recipients has steadily increased (2005: 82% 1-year survival in 2005; 2017: 90% 1-year survival). High-volume centers (>47 annual LTx) utilized ECD in 46% of transplants compared with 40% ECD among other centers. Recipients of ECD and standard criteria organs had no difference in 1-year survival. CONCLUSIONS Donor supply limits the number of LTx performed. Extension of donor criteria has occurred alongside increased overall LTx volume. Use of ECD did not compromise 30-day, 90-day, nor 1-year survival. Further studies are warranted to define long-term outcomes.
Collapse
Affiliation(s)
- Ian G Christie
- Division of Lung Transplant and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center; Pittsburgh, Pennsylvania
| | - Ernest G Chan
- Division of Lung Transplant and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center; Pittsburgh, Pennsylvania
| | - John P Ryan
- Division of Lung Transplant and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center; Pittsburgh, Pennsylvania
| | - Takashi Harano
- Division of Lung Transplant and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center; Pittsburgh, Pennsylvania
| | - Matthew Morrell
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center; Pittsburgh, Pennsylvania
| | - James D Luketich
- Division of Lung Transplant and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center; Pittsburgh, Pennsylvania
| | - Pablo G Sanchez
- Division of Lung Transplant and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center; Pittsburgh, Pennsylvania.
| |
Collapse
|
29
|
Ryan JP, Cline DE, Joseph JE, Margolina T, Santora JA, Kudela RM, Chavez FP, Pennington JT, Wahl C, Michisaki R, Benoit-Bird K, Forney KA, Stimpert AK, DeVogelaere A, Black N, Fischer M. Humpback whale song occurrence reflects ecosystem variability in feeding and migratory habitat of the northeast Pacific. PLoS One 2019; 14:e0222456. [PMID: 31525231 PMCID: PMC6746543 DOI: 10.1371/journal.pone.0222456] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 08/30/2019] [Indexed: 11/20/2022] Open
Abstract
This study examines the occurrence of humpback whale (Megaptera novaeangliae) song in the northeast Pacific from three years of continuous recordings off central California (36.713°N, 122.186°W). Song is prevalent in this feeding and migratory habitat, spanning nine months of the year (September-May), peaking in winter (November-January), and reaching a maximum of 86% temporal coverage (during November 2017). From the rise of song in fall through the end of peak occurrence in winter, song length increases significantly from month to month. The seasonal peak in song coincides with the seasonal trough in day length and sighting-based evidence of whales leaving Monterey Bay, consistent with seasonal migration. During the seasonal song peak, diel variation shows maximum occurrence at night (69% of the time), decreasing during dawn and dusk (52%), and further decreasing with increasing solar elevation during the day, reaching a minimum near solar noon (30%). Song occurrence increased 44% and 55% between successive years. Sighting data within the acoustic detection range of the hydrophone indicate that variation in local population density was an unlikely cause of this large interannual variation. Hydrographic data and modeling of acoustic transmission indicate that changes in neither habitat occupancy nor acoustic transmission were probable causes. Conversely, the positive interannual trend in song paralleled major ecosystem variations, including similarly large positive trends in wind-driven upwelling, primary productivity, and krill abundance. Further, the lowest song occurrence during the first year coincided with anomalously warm ocean temperatures and an extremely toxic harmful algal bloom that affected whales and other marine mammals in the region. These major ecosystem variations may have influenced the health and behavior of humpback whales during the study period.
Collapse
Affiliation(s)
- John P. Ryan
- Monterey Bay Aquarium Research Institute, Moss Landing, California, United States of America
| | - Danelle E. Cline
- Monterey Bay Aquarium Research Institute, Moss Landing, California, United States of America
| | - John E. Joseph
- Department of Oceanography, Naval Postgraduate School, Monterey, California, United States of America
| | - Tetyana Margolina
- Department of Oceanography, Naval Postgraduate School, Monterey, California, United States of America
| | - Jarrod A. Santora
- Department of Applied Mathematics, University of California Santa Cruz, Santa Cruz, California, United States of America
| | - Raphael M. Kudela
- Ocean Sciences Department, University of California Santa Cruz, Santa Cruz, California, United States of America
| | - Francisco P. Chavez
- Monterey Bay Aquarium Research Institute, Moss Landing, California, United States of America
| | - J. Timothy Pennington
- Monterey Bay Aquarium Research Institute, Moss Landing, California, United States of America
| | - Christopher Wahl
- Monterey Bay Aquarium Research Institute, Moss Landing, California, United States of America
| | - Reiko Michisaki
- Monterey Bay Aquarium Research Institute, Moss Landing, California, United States of America
| | - Kelly Benoit-Bird
- Monterey Bay Aquarium Research Institute, Moss Landing, California, United States of America
| | - Karin A. Forney
- Marine Mammal & Turtle Division, Southwest Fisheries Science Center, National Marine Fisheries Service, NOAA, Moss Landing, California, United States of America
- Moss Landing Marine Laboratories, San Jose State University, Moss Landing, California, United States of America
| | - Alison K. Stimpert
- Bioacoustics/Vertebrate Ecology, San Jose State University, Moss Landing Marine Laboratories, Moss Landing, California, United States of America
| | - Andrew DeVogelaere
- Monterey Bay National Marine Sanctuary, National Ocean Service, National Oceanic and Atmospheric Administration, Monterey, California, United States of America
| | - Nancy Black
- Monterey Bay Whale Watch, Monterey, California, United States of America
| | - Mark Fischer
- Aguasonic Acoustics, Santa Clara, California, United States of America
| |
Collapse
|
30
|
Ryan JP, Aizenstein HJ, Orchard TJ, Nunley KA, Karim H, Rosano C. Basal ganglia cerebral blood flow associates with psychomotor speed in adults with type 1 diabetes. Brain Imaging Behav 2019; 12:1271-1278. [PMID: 29164504 DOI: 10.1007/s11682-017-9783-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Type 1 diabetes is associated with slower psychomotor speed, but the neural basis of this relationship is not yet understood. The basal ganglia are a set of structures that are vulnerable to small vessel disease, particularly in individuals with type 1 diabetes. Thus, we examined the relationship between psychomotor speed and resting state resting cerebral blood flow in a sample of adults with diabetes onset during childhood (≤ 17 years of age). The sample included 77 patients (39 M, 38 F) with a mean age of 47.43 ± 5.72 years, age of onset at 8.50 ± 4.26 years, and duration of disease of 38.92 ± 4.18 years. Resting cerebral blood flow was quantified using arterial spin labeling. After covarying for sex, years of education and normalized gray matter volume, slower psychomotor speed was associated with lower cerebral blood flow in bilateral caudate nucleus-thalamus and a region in the superior frontal gyrus. These results suggest that the basal ganglia and frontal cortex may underlie slower psychomotor speed in individuals with type 1 diabetes.
Collapse
Affiliation(s)
- John P Ryan
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA, 15213, USA.
| | - Howard J Aizenstein
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA, 15213, USA
| | - Trevor J Orchard
- Department of Epidemiology, Diabetes and Lipid Research Building, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Karen A Nunley
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Helmet Karim
- Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA, USA
| | - Caterina Rosano
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| |
Collapse
|
31
|
Zhang Y, Rueda C, Kieft B, Ryan JP, Wahl C, O’Reilly TC, Maughan T, Chavez FP. Autonomous tracking of an oceanic thermal front by a Wave Glider. J FIELD ROBOT 2019. [DOI: 10.1002/rob.21862] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yanwu Zhang
- Engineering Division, Monterey Bay Aquarium Research Institute Moss Landing California
| | - Carlos Rueda
- Engineering Division, Monterey Bay Aquarium Research Institute Moss Landing California
| | - Brian Kieft
- Engineering Division, Monterey Bay Aquarium Research Institute Moss Landing California
| | - John P. Ryan
- Engineering Division, Monterey Bay Aquarium Research Institute Moss Landing California
| | - Christopher Wahl
- Engineering Division, Monterey Bay Aquarium Research Institute Moss Landing California
| | - Thomas C. O’Reilly
- Engineering Division, Monterey Bay Aquarium Research Institute Moss Landing California
| | - Thom Maughan
- Engineering Division, Monterey Bay Aquarium Research Institute Moss Landing California
| | - Francisco P. Chavez
- Engineering Division, Monterey Bay Aquarium Research Institute Moss Landing California
| |
Collapse
|
32
|
Bowers HA, Ryan JP, Hayashi K, Woods AL, Marin R, Smith GJ, Hubbard KA, Doucette GJ, Mikulski CM, Gellene AG, Zhang Y, Kudela RM, Caron DA, Birch JM, Scholin CA. Diversity and toxicity of Pseudo-nitzschia species in Monterey Bay: Perspectives from targeted and adaptive sampling. Harmful Algae 2018; 78:129-141. [PMID: 30196920 DOI: 10.1016/j.hal.2018.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 08/14/2018] [Accepted: 08/17/2018] [Indexed: 05/20/2023]
Abstract
Monterey Bay, California experiences near-annual blooms of Pseudo-nitzschia that can affect marine animal health and the economy, including impacts to tourism and commercial/recreational fisheries. One species in particular, P. australis, has been implicated in the most toxic of events, however other species within the genus can contribute to widespread variability in community structure and associated toxicity across years. Current monitoring methods are limited in their spatial coverage as well as their ability to capture the full suite of species present, thereby hindering understanding of HAB events and limiting predictive accuracy. An integrated deployment of multiple in situ platforms, some with autonomous adaptive sampling capabilities, occurred during two divergent bloom years in the bay, and uncovered detailed aspects of population and toxicity dynamics. A bloom in 2013 was characterized by spatial differences in Pseudo-nitzschia populations, with the low-toxin producer P. fraudulenta dominating the inshore community and toxic P. australis dominating the offshore community. An exceptionally toxic bloom in 2015 developed as a diverse Pseudo-nitzschia community abruptly transitioned into a bloom of highly toxic P. australis within the time frame of a week. Increases in cell density and proliferation coincided with strong upwelling of nutrients. High toxicity was driven by silicate limitation of the dense bloom. This temporal shift in species composition mirrored the shift observed further north in the California Current System off Oregon and Washington. The broad scope of sampling and unique platform capabilities employed during these studies revealed important patterns in bloom formation and persistence for Pseudo-nitzschia. Results underscore the benefit of expanded biological observing capabilities and targeted sampling methods to capture more comprehensive spatial and temporal scales for studying and predicting future events.
Collapse
Affiliation(s)
- Holly A Bowers
- Monterey Bay Aquarium Research Institute, 7700 Sandholdt Road, Moss Landing, CA 95039, USA; Moss Landing Marine Laboratories, 8272 Moss Landing Road, Moss Landing, CA 95039, USA.
| | - John P Ryan
- Monterey Bay Aquarium Research Institute, 7700 Sandholdt Road, Moss Landing, CA 95039, USA
| | - Kendra Hayashi
- Ocean Sciences Department, University of California, 1156 High Street, Santa Cruz, CA 95064, USA
| | - April L Woods
- Moss Landing Marine Laboratories, 8272 Moss Landing Road, Moss Landing, CA 95039, USA
| | - Roman Marin
- Monterey Bay Aquarium Research Institute, 7700 Sandholdt Road, Moss Landing, CA 95039, USA
| | - G Jason Smith
- Moss Landing Marine Laboratories, 8272 Moss Landing Road, Moss Landing, CA 95039, USA
| | - Katherine A Hubbard
- Fish and Wildlife Research Institute, Florida Fish and Wildlife Conservation Commission, 100 8th Ave. SE, Saint Petersburg, FL 33701, USA; Woods Hole Oceanographic Institute, Woods Hole, MA, 02543, USA
| | - Gregory J Doucette
- National Centers for Coastal Ocean Science, NOAA/National Ocean Service, 219 Fort Johnson Road, Charleston, SC 29412, USA
| | - Christina M Mikulski
- National Centers for Coastal Ocean Science, NOAA/National Ocean Service, 219 Fort Johnson Road, Charleston, SC 29412, USA
| | - Alyssa G Gellene
- Department of Biological Sciences, University of Southern California, 3616 Trousdale Parkway, Los Angeles, CA 90089, USA
| | - Yanwu Zhang
- Monterey Bay Aquarium Research Institute, 7700 Sandholdt Road, Moss Landing, CA 95039, USA
| | - Raphael M Kudela
- Ocean Sciences Department, University of California, 1156 High Street, Santa Cruz, CA 95064, USA
| | - David A Caron
- Department of Biological Sciences, University of Southern California, 3616 Trousdale Parkway, Los Angeles, CA 90089, USA
| | - James M Birch
- Monterey Bay Aquarium Research Institute, 7700 Sandholdt Road, Moss Landing, CA 95039, USA
| | - Christopher A Scholin
- Monterey Bay Aquarium Research Institute, 7700 Sandholdt Road, Moss Landing, CA 95039, USA
| |
Collapse
|
33
|
Pontré JC, Ryan JP, Tan A, Hart RJ. The interval transfer of a frozen-thawed embryo is more successful than a fresh embryo transfer for women undergoing IVF with recurrent implantation failure after cleavage stage embryo biopsy. Aust N Z J Obstet Gynaecol 2018; 59:134-139. [PMID: 29551013 DOI: 10.1111/ajo.12798] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 02/11/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Recurrent implantation failure (RIF) is repeated unsuccessful embryo transfers (ETs). AIMS To identify predictive embryonic markers of implantation in RIF, following pre-implantation genetic screening (PGS) of cleavage stage embryos, after accounting for male and female factors. MATERIALS AND METHODS Retrospective analysis of RIF patients undergoing PGS after correction of modifiable causes. RESULTS Eighty-four patients underwent 140 in vitro ferilisation cycles. Forty-one cycles were excluded: 12 (no embryo for transfer), four (double ETs) and 25 (no biopsy). Sixty-three patients underwent 99 single euploid ETs (48 fresh, 51 frozen) resulting in 11 biochemical pregnancies, 36 clinical pregnancies (CP), and six miscarriages and 30 live births (LB). Frozen ET was more successful than fresh; respective live birth rate (LBR) and clinical pregnancy rate (CPR), 39.2% versus 20.8%, (P = 0.02), 45.1% versus 27.1% (P = 0.04). LBR and CPR were lower when 5-6 blastomeres were present at embryo biopsy, compared to embryos with ≥7 blastomeres: 15.4% versus 32.6% (P = 0.185) and 15.4% versus 39.5% (P = 0.074) respectively. Serum β human chorionic gonadotropin (βhCG) concentration was greater when a more developed embryo was biopsied (r = 0.448, P = 0.017 and r = 0.476, P = 0.118, fresh and frozen transfers, respectively). Embryo morphokinetic analysis demonstrated faster development to blastocyst stage when more cells were present at biopsy: mean 103.3, 102.2 and 96.0 h for biopsy at the 5-6, 7-8 or ≥9 cell stage respectively (P = 0.040 for difference between 7-8 cells vs ≥9). CONCLUSIONS After cleavage stage biopsy, frozen ET was more successful than fresh ET. Chance of conception and serum βhCG concentration correlated with number of cells present at time of biopsy.
Collapse
Affiliation(s)
- Jennifer C Pontré
- Fertility Specialists of Western Australia, Bethesda Hospital, Perth, Western Australia, Australia.,Division of Obstetrics and Gynaecology, King Edward Memorial Hospital, University of Western Australia, Perth, Western Australia, Australia
| | - John P Ryan
- Fertility Specialists of Western Australia, Bethesda Hospital, Perth, Western Australia, Australia.,Division of Obstetrics and Gynaecology, King Edward Memorial Hospital, University of Western Australia, Perth, Western Australia, Australia
| | - Andy Tan
- Fertility Specialists of Western Australia, Bethesda Hospital, Perth, Western Australia, Australia
| | - Roger J Hart
- Fertility Specialists of Western Australia, Bethesda Hospital, Perth, Western Australia, Australia.,Division of Obstetrics and Gynaecology, King Edward Memorial Hospital, University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
34
|
Ryan JP, Karim HT, Aizenstein HJ, Helbling NL, Toledo FGS. Insulin sensitivity predicts brain network connectivity following a meal. Neuroimage 2018; 171:268-276. [PMID: 29339315 DOI: 10.1016/j.neuroimage.2018.01.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 01/09/2018] [Accepted: 01/11/2018] [Indexed: 11/19/2022] Open
Abstract
There is converging evidence that insulin plays a role in food-reward signaling in the brain and has effects on enhancing cognition. Little is known about how these effects are altered in individuals with insulin resistance. The present study was designed to identify the relationships between insulin resistance and functional brain connectivity following a meal. Eighteen healthy adults (7 male, 11 female, age: 41-57 years-old) completed a frequently-sampled intravenous glucose tolerance test to quantify insulin resistance. On separate days at least one week apart, a resting state functional magnetic resonance imaging scan was performed: once after a mixed-meal and once after a 12-h fast. Seed-based resting state connectivity of the caudate nucleus and eigenvector centrality were used to identify relationships between insulin resistance and functional brain connectivity. Individuals with greater insulin resistance displayed stronger connectivity within reward networks following a meal suggesting insulin was less able to suppress reward. Insulin resistance was negatively associated with eigenvector centrality in the dorsal anterior cingulate cortex following a meal. These data suggest that individuals with less sensitivity to insulin may fail to shift brain networks away from reward and toward cognitive control following a meal. This altered feedback loop could promote overeating and obesity.
Collapse
Affiliation(s)
- John P Ryan
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA; Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Helmet T Karim
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Nicole L Helbling
- Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Frederico G S Toledo
- Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
35
|
Ryan JP, Green JR, Espinoza E, Hearn AR. Association of whale sharks (Rhincodon typus) with thermo-biological frontal systems of the eastern tropical Pacific. PLoS One 2017; 12:e0182599. [PMID: 28854201 PMCID: PMC5576648 DOI: 10.1371/journal.pone.0182599] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 04/04/2017] [Accepted: 07/23/2017] [Indexed: 11/30/2022] Open
Abstract
Satellite tracking of 27 whale sharks in the eastern tropical Pacific, examined in relation to environmental data, indicates preferential occupancy of thermo-biological frontal systems. In these systems, thermal gradients are caused by wind-forced circulation and mixing, and biological gradients are caused by associated nutrient enrichment and enhanced primary productivity. Two of the frontal systems result from upwelling, driven by divergence in the current systems along the equator and the west coast of South America; the third results from wind jet dynamics off Central America. All whale sharks were tagged near Darwin Island, Galápagos, within the equatorial Pacific upwelling system. Occupancy of frontal habitat is pronounced in synoptic patterns of shark locations in relation to serpentine, temporally varying thermal fronts across a zonal expanse > 4000 km. 80% of shark positions in northern equatorial upwelling habitat and 100% of positions in eastern boundary upwelling habitat were located within the upwelling front. Analysis of equatorial shark locations relative to thermal gradients reveals occupancy of a transition point in environmental stability. Equatorial subsurface tag data show residence in shallow, warm (>22°C) water 94% of the time. Surface zonal current speeds for all equatorial tracking explain only 16% of the variance in shark zonal movement speeds, indicating that passive drifting is not a primary determinant of movement patterns. Movement from equatorial to eastern boundary frontal zones occurred during boreal winter, when equatorial upwelling weakens seasonally. Off Peru sharks tracked upwelling frontal positions within ~100–350 km from the coast. Off Central America, the largest tagged shark (12.8 m TL) occupied an oceanic front along the periphery of the Panama wind jet. Seasonal movement from waning equatorial upwelling to productive eastern boundary habitat is consistent with underlying trophic dynamics. Persistent shallow residence in thermo-biological frontal zones suggests the role of physical-biological interactions that concentrate food resources.
Collapse
Affiliation(s)
- John P. Ryan
- Monterey Bay Aquarium Research Institute, Moss Landing, California, United States of America
- * E-mail:
| | | | - Eduardo Espinoza
- Galápagos National Park Directorate, Puerto Ayora, Galápagos Islands, Ecuador
| | - Alex R. Hearn
- Universidad San Francisco de Quito / Galápagos Science Center, Quito, Ecuador
| |
Collapse
|
36
|
Walls ML, Hart R, Keelan JA, Ryan JP. Structural and morphologic differences in human oocytes after in vitro maturation compared with standard in vitro fertilization. Fertil Steril 2016; 106:1392-1398.e5. [PMID: 27565256 DOI: 10.1016/j.fertnstert.2016.08.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 03/09/2016] [Revised: 08/04/2016] [Accepted: 08/04/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To study whether the size and texture of oocytes/zygotes differ between in vitro maturation (IVM) and traditional IVF and to determine whether these affect the rate of fertilization and blastocyst development. DESIGN Prospective case-control study. SETTING Fertility clinic. PATIENT(S) The study involved 83 participants/cycles of IVF with intracytoplasmic sperm injection (ICSI) or IVM treatment. INTERVENTION(S) Participants were allocated to the following groups: patients with and without polycystic ovary syndrome (PCOS) undergoing ICSI (PCOS-ICSI and Control-ICSI), and patients with PCOS undergoing IVM (PCOS-IVM). All oocytes were cultured in an Embryoscope incubator. MAIN OUTCOME MEASURE(S) Oocyte/zygote sizes were recorded and texture parameters of the ooplasm were analyzed using ImageJ and maZda software. Measurements were recorded at five developmental stages: sperm injection, second polar body extrusion, the first pronuclei appearance, pronuclei disappearance, and immediately before cytokinesis. RESULT(S) Normally fertilized PCOS-IVM oocytes were significantly larger at the sperm injection and second polar body extrusion stages, compared with both the PCOS-ICSI and Control-ICSI groups. The PCOS-IVM oocytes were significantly larger at the pronuclei disappearance stage compared with the Control-ICSI group. Oocyte texture parameters were significantly different from both other treatment groups in the early developmental stages, although these were predominantly seen when compared with the Control-ICSI group. There were no significant differences in size or texture by the final stage of immediately before cytokinesis between any of the treatment groups. CONCLUSION(S) This study suggests that oocyte size and texture differ in the early stages of the first cell cycle.
Collapse
Affiliation(s)
- Melanie L Walls
- Fertility Specialists of Western Australia, Bethesda Hospital, Perth, Western Australia, Australia; School of Women's and Infant's Health, University of Western Australia, King Edward Memorial Hospital, Perth, Western Australia, Australia.
| | - Roger Hart
- Fertility Specialists of Western Australia, Bethesda Hospital, Perth, Western Australia, Australia; School of Women's and Infant's Health, University of Western Australia, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Jeffrey A Keelan
- School of Women's and Infant's Health, University of Western Australia, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - John P Ryan
- Fertility Specialists of Western Australia, Bethesda Hospital, Perth, Western Australia, Australia; School of Women's and Infant's Health, University of Western Australia, King Edward Memorial Hospital, Perth, Western Australia, Australia
| |
Collapse
|
37
|
Walls ML, Douglas K, Ryan JP, Tan J, Hart R. In-vitro maturation and cryopreservation of oocytes at the time of oophorectomy. Gynecol Oncol Rep 2015; 13:79-81. [PMID: 26425730 PMCID: PMC4563796 DOI: 10.1016/j.gore.2015.07.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 07/30/2015] [Indexed: 11/17/2022] Open
Abstract
A 27 year old female presented for fertility preservation prior to undergoing pelvic radiotherapy. She had previously undergone a radical laparoscopic hysterectomy for cervical carcinoma seven months earlier. A trans-vaginal oocyte aspiration was not advisable due to a vaginal recurrence of the disease. Due to a polycystic ovarian morphology (PCO), follicle stimulating hormone (FSH) priming with no human chorionic gonadotrophin (hCG) trigger was performed prior to oophorectomy followed by ex-vivo oocyte aspiration and in vitro maturation (IVM). All visualized follicles were punctured and follicular fluid aspirated. There were 22 immature oocytes identified and placed into maturation culture for 24 h. After this time, 15 oocytes were deemed to be mature and suitable for vitrification. Following an additional 24 h in maturation culture of the remaining 7 oocytes, three more were suitable for cryopreservation. The patient recovered well and progressed to radiotherapy three days later. This report demonstrates the use of IVM treatment to store oocytes for oncology patients in time-limited circumstances. A patient sought fertility preservation treatment prior to cancer therapy. The patient had polycystic ovarian morphology. We performed in vitro maturation on oocytes collected at the time of oophorectomy. Twenty-two immature oocytes were collected. A total of 18 oocytes were suitable for vitrification and were cryopreserved.
Collapse
Affiliation(s)
- Melanie L. Walls
- Fertility Specialists of Western Australia, Perth, Australia
- University of Western Australia, Perth, Australia
- Corresponding author at: University of Western Australia, Perth, Australia.University of Western AustraliaPerthAustralia
| | - Kirsty Douglas
- Fertility Specialists of Western Australia, Perth, Australia
| | - John P. Ryan
- Fertility Specialists of Western Australia, Perth, Australia
- University of Western Australia, Perth, Australia
| | - Jason Tan
- Dr Jason Tan Gynecologic Oncology, Perth, Australia
| | - Roger Hart
- Fertility Specialists of Western Australia, Perth, Australia
- University of Western Australia, Perth, Australia
| |
Collapse
|
38
|
Das J, Py F, Harvey JB, Ryan JP, Gellene A, Graham R, Caron DA, Rajan K, Sukhatme GS. Data-driven robotic sampling for marine ecosystem monitoring. Int J Rob Res 2015. [DOI: 10.1177/0278364915587723] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Robotic sampling is attractive in many field robotics applications that require persistent collection of physical samples for ex-situ analysis. Examples abound in the earth sciences in studies involving the collection of rock, soil, and water samples for laboratory analysis. In our test domain, marine ecosystem monitoring, detailed understanding of plankton ecology requires laboratory analysis of water samples, but predictions using physical and chemical properties measured in real-time by sensors aboard an autonomous underwater vehicle (AUV) can guide sample collection decisions. In this paper, we present a data-driven and opportunistic sampling strategy to minimize cumulative regret for batches of plankton samples acquired by an AUV over multiple surveys. Samples are labeled at the end of each survey, and used to update a probabilistic model that guides sampling during subsequent surveys. During a survey, the AUV makes irrevocable sample collection decisions online for a sequential stream of candidates, with no knowledge of the quality of future samples. In addition to extensive simulations using historical field data, we present results from a one-day field trial where beginning with a prior model learned from data collected and labeled in an earlier campaign, the AUV collected water samples with a high abundance of a pre-specified planktonic target. This is the first time such a field experiment has been carried out in its entirety in a data-driven fashion, in effect “closing the loop” on a significant and relevant ecosystem monitoring problem while allowing domain experts (marine ecologists) to specify the mission at a relatively high level.
Collapse
Affiliation(s)
- Jnaneshwar Das
- Department of Computer Science, University of Southern California, USA
| | - Frédéric Py
- Monterey Bay Aquarium Research Institute, Moss Landing, USA
| | | | - John P. Ryan
- Monterey Bay Aquarium Research Institute, Moss Landing, USA
| | - Alyssa Gellene
- Department of Biological Sciences, University of Southern California, USA
| | - Rishi Graham
- Monterey Bay Aquarium Research Institute, Moss Landing, USA
| | - David A. Caron
- Department of Biological Sciences, University of Southern California, USA
| | - Kanna Rajan
- Monterey Bay Aquarium Research Institute, Moss Landing, USA
| | | |
Collapse
|
39
|
Dubovsky EV, Russell CD, Yester MV, Thorstad BL, Ryan JP. Will 99mTc-MAG3 replace 131I-OIH and 99mTc-DTPA in the follow-up of renal transplants? Contrib Nephrol 2015; 79:118-22. [PMID: 2146081 DOI: 10.1159/000418162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
40
|
Henderson CY, Ryan JP. Predicting mortality following hip fracture: an analysis of comorbidities and complications. Ir J Med Sci 2015; 184:667-71. [PMID: 25715773 DOI: 10.1007/s11845-015-1271-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 02/07/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hip fracture is common in the geriatric population. These patients have multiple comorbidities that complicate treatment and recovery such that poor functional outcomes often result. Since functional outcomes are associated with comorbidities and complications it is important to define the contributing factors. AIMS To describe comorbidities common to geriatric hip fracture patients and determine predictability of complications and mortality based on comorbidities. METHODS Data in this study were sourced from information prospectively collected for evaluation of a new orthogeriatric service established at a University Teaching Hospital over the period of 1 year. RESULTS The median age was 82 years (range 54-100) and 73 % were female (N = 206). Common comorbidities included hypertension (51 %), dementia (28 %), osteoporosis (19 %), ischaemic heart disease (IHD) (15 %) and chronic obstructive pulmonary disease (15 %). In predicting 1-year mortality based on comorbidities, the final model included age, IHD, delay to surgery and explained 26 % of the variability in mortality. Predicting 1-year mortality based on complications, the final model included age and respiratory complications and explained 26 % of the variability in mortality. There was a significant association between having respiratory complications and chronic obstructive pulmonary disease (p < 0.001) with 63 % of those with respiratory complications having chronic obstructive pulmonary disease. CONCLUSIONS This study highlights specific patient comorbidities and medical complications that could be used to guide clinical assessment, management and targeted interventions that improve outcomes in this patient group.
Collapse
Affiliation(s)
- C Y Henderson
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland,
| | | |
Collapse
|
41
|
Clarnette RM, Ryan JP, O'Herlihy E, Svendrovski A, Cornally N, O'Caoimh R, Leahy-Warren P, Paul C, Molloy DW. The Community Assessment of Risk Instrument: Investigation of Inter-Rater Reliability of an Instrument Measuring Risk of Adverse Outcomes. J Frailty Aging 2015; 4:80-9. [PMID: 27032049 DOI: 10.14283/jfa.2015.40] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Frailty is increasingly common in community dwelling older adults and increases their risk of adverse outcomes. Risk assessment is implicit in the Aged Care Assessment Teams process, but few studies have considered the factors that influence the assessor's decision making or explored the factors that may contribute to their interpretation of risk. OBJECTIVE to examine the inter-rater reliability of the Community Assessment of Risk Instrument (CARI), which is a new risk assessment instrument. DESIGN A cohort study was used. SETTING AND PARTICIPANTS A sample of 50 community dwelling older adults underwent comprehensive geriatric assessment by two raters: a geriatrician and a registered nurse. Procedure and measurements: Each participant was scored for risk by the two raters using the CARI. This instrument ranks risk of three adverse outcomes, namely i) institutionalisation, ii) hospitalisation and iii) death within the next year from a score of 1, which is minimal risk to 5, which is extreme risk. Inter-rater reliability was assessed with Gamma, Spearman correlation and Kappa statistics. Internal consistency was assessed with Cronbach's alpha. RESULTS There were 30 female (mean age 82.23 years) and 20 male (mean age 81.75 years) participants. Items within domains showed good-excellent agreement. The gamma statistic was >0.77 on 6/7 Mental State items, 14/15 items in the Activities of Daily Living domain. In the Medical domain, 6/9 items had Gamma scores >0.80. The global domain scores correlated well, 0.88, 0.72 and 0.87. Caregiver network scores were 0.71, 0.73 and 0.51 for the three domains. Inter-rater reliability scores for global risk scales were 0.86 (institutionalisation) and 0.78 (death). The gamma statistic for hospitalisation was 0.29, indicative of lower inter-rater reliability. Cronbach's alpha was 0.86 and 0.83 for the Activities of Daily Living domain, 0.51 and 0.42 for the Mental state domain and 0.23 and 0.10 for the Medical state domain. CONCLUSIONS Overall, the instrument shows good inter-rater reliability. Poor correlations on some items relate to poor communication of clinical data and variable interpretation based on professional background. Lack of internal consistency in the medical condition domain confirms the discrete nature of these variables.
Collapse
Affiliation(s)
- R M Clarnette
- Dr Patricia Leahy-Warren, , Telephone: +353214901461
| | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Fischer AM, Ryan JP, Levesque C, Welschmeyer N. Characterizing estuarine plume discharge into the coastal ocean using fatty acid biomarkers and pigment analysis. Mar Environ Res 2014; 99:106-116. [PMID: 24838080 DOI: 10.1016/j.marenvres.2014.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 08/14/2013] [Revised: 04/04/2014] [Accepted: 04/13/2014] [Indexed: 06/03/2023]
Abstract
The transformation of estuaries by human activities continues to alter the biogeochemical balance of the coastal ocean. The disruption of this balance can negatively impact the provision of goods and services, including fisheries, commerce and transportation, recreation and esthetic enjoyment. Here we examine a link, between the Elkhorn Slough and the coastal ocean in Monterey Bay, California (USA) using a novel application of fatty acid and pigment analysis. Fatty acid analysis of filtered water samples showed biologically distinct water types between the Elkhorn Slough plume and the receiving waters of the coastal ocean. A remarkable feature of the biological content of the plume entering the coastal ocean was the abundance of bacteria-specific fatty acids, which correlated well with concentrations of colored dissolved organic matter (CDOM). Pigment analysis showed that plume waters contained higher concentrations of diatoms and cryptophytes, while the coastal ocean waters showed higher relative concentrations of dinoflagellates. Bacteria and cryptophytes can provide a source of labile, energy-rich organic matter that may be locally important as a source of food for pelagic and benthic communities. Surface and depth surveys of the plume show that the biogeochemical constituents of the slough waters are injected into the coastal waters and become entrained in the northward flowing, nearshore current of Monterey Bay. Transport of these materials to the northern portion of the bay can fuel a bloom incubator, which exists in this region. This study shows that fatty acid markers can reveal the biogeochemical interactions between estuaries and the coastal ocean and highlights how man-made changes have the potential to influence coastal ecological change.
Collapse
Affiliation(s)
- Andrew M Fischer
- Monterey Bay Aquarium Research Institute, 7700 Sandholdt Road, Moss Landing, CA 95039, USA; National Centre for Marine Conservation and Resource Sustainability, University of Tasmania, Australian Maritime College, Launceston, TAS 7250, Australia.
| | - John P Ryan
- Monterey Bay Aquarium Research Institute, 7700 Sandholdt Road, Moss Landing, CA 95039, USA.
| | - Christian Levesque
- Monterey Bay Aquarium Research Institute, 7700 Sandholdt Road, Moss Landing, CA 95039, USA; John Abbot College, 21 275 Lakeshore Road, Sainte-Anne-de-Bellevue, Québec H9X 3L9, Canada.
| | - Nicholas Welschmeyer
- Moss Landing Marine Laboratories, 8272 Moss Landing Road, Moss Landing, CA 95039, USA.
| |
Collapse
|
43
|
Abstract
Type 2 diabetes mellitus (T2D) and Alzheimer disease (AD) are major public health burdens associated with aging. As the age of the population rapidly increases, a sheer increase in the incidence of these diseases is expected. Research has identified T2D as a risk factor for cognitive impairment and potentially AD, but the neurobiological pathways that are affected are only beginning to be understood. The rapid advances in neuroimaging in the past decade have added significant understanding to how T2D affects brain structure and function and possibly lead to AD. This article provides a review of studies that have utilized structural and functional neuroimaging to identify neural pathways that link T2D to impaired cognitive performance and potentially AD. A primary focus of this article is the potential for neuroimaging to assist in understanding the mechanistic pathways that may provide translational opportunities for clinical intervention.
Collapse
Affiliation(s)
- John P. Ryan
- University of Pittsburgh, Department of Psychiatry
- Address correspondence to: John Ryan, Department of Psychiatry, 3811 O’Hara St., Pittsburgh, PA 15213., , Phone: 412-246-5692, Fax: 412-586-9111
| | - David F. Fine
- Geriatric Psychiatry Neuroimaging Lab, University of Pittsburgh
| | | |
Collapse
|
44
|
Robidart JC, Church MJ, Ryan JP, Ascani F, Wilson ST, Bombar D, Marin R, Richards KJ, Karl DM, Scholin CA, Zehr JP. Ecogenomic sensor reveals controls on N2-fixing microorganisms in the North Pacific Ocean. ISME J 2014; 8:1175-85. [PMID: 24477197 DOI: 10.1038/ismej.2013.244] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 11/28/2013] [Accepted: 12/02/2013] [Indexed: 11/09/2022]
Abstract
Nitrogen-fixing microorganisms (diazotrophs) are keystone species that reduce atmospheric dinitrogen (N2) gas to fixed nitrogen (N), thereby accounting for much of N-based new production annually in the oligotrophic North Pacific. However, current approaches to study N2 fixation provide relatively limited spatiotemporal sampling resolution; hence, little is known about the ecological controls on these microorganisms or the scales over which they change. In the present study, we used a drifting robotic gene sensor to obtain high-resolution data on the distributions and abundances of N2-fixing populations over small spatiotemporal scales. The resulting measurements demonstrate that concentrations of N2 fixers can be highly variable, changing in abundance by nearly three orders of magnitude in less than 2 days and 30 km. Concurrent shipboard measurements and long-term time-series sampling uncovered a striking and previously unrecognized correlation between phosphate, which is undergoing long-term change in the region, and N2-fixing cyanobacterial abundances. These results underscore the value of high-resolution sampling and its applications for modeling the effects of global change.
Collapse
Affiliation(s)
- Julie C Robidart
- 1] Department of Ocean Sciences, University of California Santa Cruz, Santa Cruz, CA, USA [2] Monterey Bay Aquarium Research Institute, Moss Landing, CA, USA [3] Center for Microbial Oceanography: Research and Education, University of Hawaii, Honolulu, HI, USA
| | - Matthew J Church
- 1] Center for Microbial Oceanography: Research and Education, University of Hawaii, Honolulu, HI, USA [2] Department of Oceanography, University of Hawaii, Honolulu, HI, USA
| | - John P Ryan
- Monterey Bay Aquarium Research Institute, Moss Landing, CA, USA
| | - François Ascani
- 1] Center for Microbial Oceanography: Research and Education, University of Hawaii, Honolulu, HI, USA [2] Department of Oceanography, University of Hawaii, Honolulu, HI, USA
| | - Samuel T Wilson
- 1] Center for Microbial Oceanography: Research and Education, University of Hawaii, Honolulu, HI, USA [2] Department of Oceanography, University of Hawaii, Honolulu, HI, USA
| | - Deniz Bombar
- 1] Department of Ocean Sciences, University of California Santa Cruz, Santa Cruz, CA, USA [2] Center for Microbial Oceanography: Research and Education, University of Hawaii, Honolulu, HI, USA
| | - Roman Marin
- Monterey Bay Aquarium Research Institute, Moss Landing, CA, USA
| | - Kelvin J Richards
- 1] Center for Microbial Oceanography: Research and Education, University of Hawaii, Honolulu, HI, USA [2] Department of Oceanography, University of Hawaii, Honolulu, HI, USA
| | - David M Karl
- 1] Center for Microbial Oceanography: Research and Education, University of Hawaii, Honolulu, HI, USA [2] Department of Oceanography, University of Hawaii, Honolulu, HI, USA
| | - Christopher A Scholin
- 1] Monterey Bay Aquarium Research Institute, Moss Landing, CA, USA [2] Center for Microbial Oceanography: Research and Education, University of Hawaii, Honolulu, HI, USA
| | - Jonathan P Zehr
- 1] Department of Ocean Sciences, University of California Santa Cruz, Santa Cruz, CA, USA [2] Center for Microbial Oceanography: Research and Education, University of Hawaii, Honolulu, HI, USA
| |
Collapse
|
45
|
Ryan JP, Sheu LK, Verstynen TD, Onyewuenyi IC, Gianaros PJ. Cerebral blood flow links insulin resistance and baroreflex sensitivity. PLoS One 2013; 8:e83288. [PMID: 24358272 PMCID: PMC3865223 DOI: 10.1371/journal.pone.0083288] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [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: 08/01/2013] [Accepted: 11/12/2013] [Indexed: 12/02/2022] Open
Abstract
Insulin resistance confers risk for diabetes mellitus and associates with a reduced capacity of the arterial baroreflex to regulate blood pressure. Importantly, several brain regions that comprise the central autonomic network, which controls the baroreflex, are also sensitive to the neuromodulatory effects of insulin. However, it is unknown whether peripheral insulin resistance relates to activity within central autonomic network regions, which may in turn relate to reduced baroreflex regulation. Accordingly, we tested whether resting cerebral blood flow within central autonomic regions statistically mediated the relationship between insulin resistance and an indirect indicator of baroreflex regulation; namely, baroreflex sensitivity. Subjects were 92 community-dwelling adults free of confounding medical illnesses (48 men, 30-50 years old) who completed protocols to assess fasting insulin and glucose levels, resting baroreflex sensitivity, and resting cerebral blood flow. Baroreflex sensitivity was quantified by measuring the magnitude of spontaneous and sequential associations between beat-by-beat systolic blood pressure and heart rate changes. Individuals with greater insulin resistance, as measured by the homeostatic model assessment, exhibited reduced baroreflex sensitivity (b = -0.16, p < .05). Moreover, the relationship between insulin resistance and baroreflex sensitivity was statistically mediated by cerebral blood flow in central autonomic regions, including the insula and cingulate cortex (mediation coefficients < -0.06, p-values < .01). Activity within the central autonomic network may link insulin resistance to reduced baroreflex sensitivity. Our observations may help to characterize the neural pathways by which insulin resistance, and possibly diabetes mellitus, relates to adverse cardiovascular outcomes.
Collapse
Affiliation(s)
- John P. Ryan
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Lei K. Sheu
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Timothy D. Verstynen
- Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States of America
| | - Ikechukwu C. Onyewuenyi
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Peter J. Gianaros
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| |
Collapse
|
46
|
J. Vanman E, P. Ryan J, C. Pedersen W, A. Ito T. Probing prejudice with startle eyeblink modification: a marker of attention, emotion, or both? Int J Psychol Res (Medellin) 2013; 6:30-41. [DOI: 10.21500/20112084.717] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
In social neuroscience research, startle eyeblink modification can serve as a marker of emotion, but it is less clear whether it can also serve as a marker of prejudice. In Experiment 1, 30 White students viewed photographs of White and Black targets while the startle eyeblink reflex and facial EMG from the brow and cheek regions were recorded. Prejudice was related to facial EMG activity, but not to startle modification, which instead appeared to index attention to race. To test further whether racial categorizations are associated with differential attention, a dual-task paradigm was used in Experiment 2. Fifty-four White and fifty-five Black participants responded more slowly to a tone presented when viewing a racial outgroup member or a negative stimulus, indicating that both draw more attention than ingroup members or positive stimuli. We conclude that startle modification is useful to index differential attention to groups when intergroup threat is low.
Collapse
|
47
|
Ryan JP. Immunostaining Kits: How much experience is necessary? J Histotechnol 2013. [DOI: 10.1179/his.1986.9.3.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
48
|
Ryan JP. The Continuing Evolution of Histotechnology. J Histotechnol 2013. [DOI: 10.1179/his.1988.11.4.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
49
|
Mackey KRM, Mioni CE, Ryan JP, Paytan A. Phosphorus cycling in the red tide incubator region of monterey bay in response to upwelling. Front Microbiol 2012; 3:33. [PMID: 22347222 PMCID: PMC3273705 DOI: 10.3389/fmicb.2012.00033] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 01/18/2012] [Indexed: 11/13/2022] Open
Abstract
This study explores the cycling of phosphorus (P) in the euphotic zone following upwelling in northeastern Monterey Bay (the Red Tide Incubator region) of coastal California, with particular emphasis on how bacteria and phytoplankton that form harmful algal blooms mediate and respond to changes in P availability. In situ measurements of nutrient concentrations, phytoplankton community composition, and cell-specific alkaline phosphatase (AP) activity (determined via enzyme-labeled fluorescence assay) were measured during three cruises. Upwelling led to a 10-fold increase in dissolved inorganic (DIP) in surface waters, reaching ∼0.5 μmol L−1. This DIP was drawn down rapidly as upwelling relaxed over a period of 1 week. Ratios of nitrate to DIP drawdown (∼5:1, calculated as the change in nitrate divided by the change in DIP) were lower than the Redfield ratio of 16:1, suggesting that luxury P uptake was occurring as phytoplankton bloomed. Dissolved organic (DOP) remained relatively constant (∼0.3 μmol L−1) before and immediately following upwelling, but doubled as upwelling relaxed, likely due to phytoplankton excretion and release during grazing. This transition from a relatively high DIP:DOP ratio to lower DIP:DOP ratio was accompanied by a decline in the abundance of diatoms, which had low AP activity, toward localized, spatially heterogeneous blooms of dinoflagellates in the genera Prorocentrum, Ceratium, Dinophysis, Alexandrium, and Scrippsiella that showed high AP activity regardless of ambient DIP levels. A nutrient addition incubation experiment showed that phytoplankton growth was primarily limited by nitrate, followed by DIP and DOP, suggesting that P regulates phytoplankton physiology and competition, but is not a limiting nutrient in this region. AP activity was observed in bacteria associated with lysed cell debris and aggregates of particulate organic material, where it may serve to facilitate P regeneration, as well as affixed to the surfaces of intact phytoplankton cells, possibly indicative of close, beneficial phytoplankton–bacteria interactions.
Collapse
Affiliation(s)
- Katherine R M Mackey
- Marine Chemistry and Geochemistry, Woods Hole Oceanographic Institution Woods Hole, MA, USA
| | | | | | | |
Collapse
|
50
|
Preston CM, Harris A, Ryan JP, Roman B, Marin R, Jensen S, Everlove C, Birch J, Dzenitis JM, Pargett D, Adachi M, Turk K, Zehr JP, Scholin CA. Underwater application of quantitative PCR on an ocean mooring. PLoS One 2011; 6:e22522. [PMID: 21829630 PMCID: PMC3148215 DOI: 10.1371/journal.pone.0022522] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 06/22/2011] [Indexed: 11/21/2022] Open
Abstract
The Environmental Sample Processor (ESP) is a device that allows for the underwater, autonomous application of DNA and protein probe array technologies as a means to remotely identify and quantify, in situ, marine microorganisms and substances they produce. Here, we added functionality to the ESP through the development and incorporation of a module capable of solid-phase nucleic acid extraction and quantitative PCR (qPCR). Samples collected by the instrument were homogenized in a chaotropic buffer compatible with direct detection of ribosomal RNA (rRNA) and nucleic acid purification. From a single sample, both an rRNA community profile and select gene abundances were ascertained. To illustrate this functionality, we focused on bacterioplankton commonly found along the central coast of California and that are known to vary in accordance with different oceanic conditions. DNA probe arrays targeting rRNA revealed the presence of 16S rRNA indicative of marine crenarchaea, SAR11 and marine cyanobacteria; in parallel, qPCR was used to detect 16S rRNA genes from the former two groups and the large subunit RuBisCo gene (rbcL) from Synecchococcus. The PCR-enabled ESP was deployed on a coastal mooring in Monterey Bay for 28 days during the spring-summer upwelling season. The distributions of the targeted bacterioplankon groups were as expected, with the exception of an increase in abundance of marine crenarchaea in anomalous nitrate-rich, low-salinity waters. The unexpected co-occurrence demonstrated the utility of the ESP in detecting novel events relative to previously described distributions of particular bacterioplankton groups. The ESP can easily be configured to detect and enumerate genes and gene products from a wide range of organisms. This study demonstrated for the first time that gene abundances could be assessed autonomously, underwater in near real-time and referenced against prevailing chemical, physical and bulk biological conditions.
Collapse
Affiliation(s)
- Christina M Preston
- Monterey Bay Aquarium Research Institute, Moss Landing, California, United States of America.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|