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Schmidt ML, McCrady E, Lee A, Bowerbank T, Miller MR, Watson M, Dhandapani A, Woolfson JP, Zizzo AN, Bax K, Crowley E. Home-based fecal calprotectin utilization in a general pediatric gastroenterology clinic. J Pediatr Gastroenterol Nutr 2024; 78:790-799. [PMID: 38318970 DOI: 10.1002/jpn3.12150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 12/20/2023] [Accepted: 01/14/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE Remote investigation and monitoring have gained importance in ambulatory practice. A home-based fecal calprotectin (FC) test has been developed where the sample is processed and analyzed at home through a smartphone application. We aimed to assess the use of standard ELISA (sFC) versus home-based (hFC) FC testing in a general pediatric gastroenterology clinic. METHODS Ambulatory pediatric patients with hFC or sFC performed between August 2019 and November 2020 were included. Data regarding demographics, clinical characteristics, medication use, investigations, and final diagnosis, categorized as inflammatory bowel disease (IBD), functional gastrointestinal (GI) disorders, organic non-IBD (ONI) GI disorders, non-GI disorders, and undetermined after 6 months of investigation, were recorded. RESULTS A total of 453 FC tests from 453 unique patients were included. Of those, 249 (55%) were hFC. FC levels (median) were higher in children with IBD compared to non-IBD diagnosis (sFC 795 vs. 57 μg/g, hFC 595 vs. 47 μg/g, p < 0.001), and in ONI compared to functional GI disorders (sFC 85 vs. 54 μg/g, p = 0.003, hFC 57 vs. 40 μg/g, p < 0.001). No significant difference was observed between different ONI GI disorders or subtypes of functional disorders. Age did not significantly influence levels. CONCLUSIONS Overall, hFC and sFC provide similar results in the general pediatric GI ambulatory setting. FC is a sensitive but not disease-specific marker to identify patients with IBD. Values appear to be higher in ONI GI disorders over functional disorders, although cut-off values have yet to be determined.
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Affiliation(s)
- Melanie L Schmidt
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Pediatrics, Division of Pediatric Gastroenterology & Hepatology, Children's Hospital of Western Ontario, London Health Sciences Center, London, Ontario, Canada
- Children's Health Research Institute, London, Ontario, Canada
| | - Emma McCrady
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Angus Lee
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | | | - Michael R Miller
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Pediatrics, Division of Pediatric Gastroenterology & Hepatology, Children's Hospital of Western Ontario, London Health Sciences Center, London, Ontario, Canada
- Children's Health Research Institute, London, Ontario, Canada
| | - Melanie Watson
- Department of Pediatrics, Division of Pediatric Gastroenterology & Hepatology, Children's Hospital of Western Ontario, London Health Sciences Center, London, Ontario, Canada
| | - Ashok Dhandapani
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Pediatrics, Division of Pediatric Gastroenterology & Hepatology, Children's Hospital of Western Ontario, London Health Sciences Center, London, Ontario, Canada
- Children's Health Research Institute, London, Ontario, Canada
| | - Jessica P Woolfson
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Pediatrics, Division of Pediatric Gastroenterology & Hepatology, Children's Hospital of Western Ontario, London Health Sciences Center, London, Ontario, Canada
- Children's Health Research Institute, London, Ontario, Canada
| | - Andréanne N Zizzo
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Pediatrics, Division of Pediatric Gastroenterology & Hepatology, Children's Hospital of Western Ontario, London Health Sciences Center, London, Ontario, Canada
- Children's Health Research Institute, London, Ontario, Canada
| | - Kevin Bax
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Pediatrics, Division of Pediatric Gastroenterology & Hepatology, Children's Hospital of Western Ontario, London Health Sciences Center, London, Ontario, Canada
- Children's Health Research Institute, London, Ontario, Canada
| | - Eileen Crowley
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Pediatrics, Division of Pediatric Gastroenterology & Hepatology, Children's Hospital of Western Ontario, London Health Sciences Center, London, Ontario, Canada
- Children's Health Research Institute, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
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Lamb FS, Choi H, Miller MR, Stark RJ. Vascular Inflammation and Smooth Muscle Contractility: The Role of Nox1-Derived Superoxide and LRRC8 Anion Channels. Hypertension 2024; 81:752-763. [PMID: 38174563 PMCID: PMC10954410 DOI: 10.1161/hypertensionaha.123.19434] [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] [Indexed: 01/05/2024]
Abstract
Vascular inflammation underlies the development of hypertension, and the mechanisms by which it increases blood pressure remain the topic of intense investigation. Proinflammatory factors including glucose, salt, vasoconstrictors, cytokines, wall stress, and growth factors enhance contractility and impair relaxation of vascular smooth muscle cells. These pathways share a dependence upon redox signaling, and excessive activation promotes oxidative stress that promotes vascular aging. Vascular smooth muscle cell phenotypic switching and migration into the intima contribute to atherosclerosis, while hypercontractility increases systemic vascular resistance and vasospasm that can trigger ischemia. Here, we review factors that drive the initiation and progression of this vasculopathy in vascular smooth muscle cells. Emphasis is placed on the contribution of reactive oxygen species generated by the Nox1 NADPH oxidase which produces extracellular superoxide (O2•-). The mechanisms of O2•- signaling remain poorly defined, but recent evidence demonstrates physical association of Nox1 with leucine-rich repeat containing 8 family volume-sensitive anion channels. These may provide a pathway for influx of O2•- to the cytoplasm, creating an oxidized cytoplasmic nanodomain where redox-based signals can affect both cytoskeletal structure and vasomotor function. Understanding the mechanistic links between inflammation, O2•- and vascular smooth muscle cell contractility may facilitate targeting of anti-inflammatory therapy in hypertension.
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Affiliation(s)
- Fred S Lamb
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Hyehun Choi
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Michael R Miller
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Ryan J Stark
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
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Pourquoi A, Miller MR, Koch SR, Boyle K, Surratt V, Nguyen H, Panja S, Cartailler JP, Shrestha S, Stark RJ. DIFFERENTIAL SIGNALING EFFECTS OF ESCHERICHIA COLI AND STAPHYLOCOCCUS AUREUS IN HUMAN WHOLE BLOOD INDICATE DISTINCT REGULATION OF THE NRF2 PATHWAY. Shock 2024; 61:557-563. [PMID: 38604133 PMCID: PMC11018340 DOI: 10.1097/shk.0000000000002305] [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] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
ABSTRACT Escherichia coli and Staphylococcus aureus are two of the most common bacterial species responsible for sepsis. While it is observed that they have disparate clinical phenotypes, the signaling differences elicited by each bacteria that drive this variance remain unclear. Therefore, we used human whole blood exposed to heat-killed E. coli or S. aureus and measured the transcriptomic signatures. Relative to unstimulated control blood, heat-killed bacteria exposure led to significant dysregulation (upregulated and downregulated) of >5,000 genes for each experimental condition, with a slight increase in gene alterations by S. aureus. While there was significant overlap regarding proinflammatory pathways, Gene Ontology overrepresentation analysis of the most altered genes suggested biological processes like macrophage differentiation and ubiquinone biosynthesis were more unique to heat-killed S. aureus, compared with heat-killed E. coli exposure. Using Ingenuity Pathway Analysis, it was demonstrated that nuclear factor erythroid 2-related factor 2 signaling, a main transcription factor in antioxidant responses, was predominately upregulated in S. aureus exposed blood relative to E. coli. Furthermore, the use of pharmacologics that preferentially targeted the nuclear factor erythroid 2-related factor 2 pathway led to differential cytokine profiles depending on the type of bacterial exposure. These findings reveal significant inflammatory dysregulation between E. coli and S. aureus and provide insight into the targeting of unique pathways to curb bacteria-specific responses.
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Affiliation(s)
| | | | - Stephen R Koch
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - Hong Nguyen
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sourav Panja
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Shristi Shrestha
- Vanderbilt University, Creative Data Solutions, Nashville, Tennessee
| | - Ryan J Stark
- Vanderbilt University Medical Center, Nashville, Tennessee
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Leonard S, Guertin H, Odoardi N, Miller MR, Patel MA, Daley M, Cepinskas G, Fraser DD. Pediatric sepsis inflammatory blood biomarkers that correlate with clinical variables and severity of illness scores. J Inflamm (Lond) 2024; 21:7. [PMID: 38454423 PMCID: PMC10921642 DOI: 10.1186/s12950-024-00379-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 02/19/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Sepsis is a dysregulated systemic inflammatory response triggered by infection, resulting in organ dysfunction. A major challenge in clinical pediatrics is to identify sepsis early and then quickly intervene to reduce morbidity and mortality. As blood biomarkers hold promise as early sepsis diagnostic tools, we aimed to measure a large number of blood inflammatory biomarkers from pediatric sepsis patients to determine their predictive ability, as well as their correlations with clinical variables and illness severity scores. METHODS Pediatric patients that met sepsis criteria were enrolled, and clinical data and blood samples were collected. Fifty-eight inflammatory plasma biomarker concentrations were determined using immunoassays. The data were analyzed with both conventional statistics and machine learning. RESULTS Twenty sepsis patients were enrolled (median age 13 years), with infectious pathogens identified in 75%. Vasopressors were administered to 85% of patients, while 55% received invasive ventilation and 20% were ventilated non-invasively. A total of 24 inflammatory biomarkers were significantly different between sepsis patients and age/sex-matched healthy controls. Nine biomarkers (IL-6, IL-8, MCP-1, M-CSF, IL-1RA, hyaluronan, HSP70, MMP3, and MMP10) yielded AUC parameters > 0.9 (95% CIs: 0.837-1.000; p < 0.001). Boruta feature reduction yielded 6 critical biomarkers with their relative importance: IL-8 (12.2%), MCP-1 (11.6%), HSP70 (11.6%), hyaluronan (11.5%), M-CSF (11.5%), and IL-6 (11.5%); combinations of 2 biomarkers yielded AUC values of 1.00 (95% CI: 1.00-1.00; p < 0.001). Specific biomarkers strongly correlated with illness severity scoring, as well as other clinical variables. IL-3 specifically distinguished bacterial versus viral infection (p < 0.005). CONCLUSIONS Specific inflammatory biomarkers were identified as markers of pediatric sepsis and strongly correlated to both clinical variables and sepsis severity.
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Affiliation(s)
- Sean Leonard
- Pediatrics, Western University, London, ON, Canada
| | | | - Natalya Odoardi
- Emergency Medicine, Lakeridge Health, Ajax/Oshawa, ON, Canada
| | | | - Maitray A Patel
- Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Mark Daley
- Epidemiology and Biostatistics, Western University, London, ON, Canada
- Computer Science, Western University, London, ON, Canada
| | - Gediminas Cepinskas
- Medical Biophysics, Western University, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Douglas D Fraser
- Pediatrics, Western University, London, ON, Canada.
- Lawson Health Research Institute, London, ON, Canada.
- Clinical Neurological Sciences, Western University, London, ON, Canada.
- Physiology & Pharmacology, Western University, London, ON, Canada.
- Room C2-C82, London Health Sciences Centre, 800 Commissioners Road East, London, ON, N6A 5W9, Canada.
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Sarpal A, Miller MR, Martin CM, Sibbald RW, Speechley KN. Perceived potentially inappropriate treatment in the PICU: frequency, contributing factors and the distress it triggers. Front Pediatr 2024; 12:1272648. [PMID: 38304746 PMCID: PMC10830678 DOI: 10.3389/fped.2024.1272648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 01/03/2024] [Indexed: 02/03/2024] Open
Abstract
Background Potentially inappropriate treatment in critically ill adults is associated with healthcare provider distress and burnout. Knowledge regarding perceived potentially inappropriate treatment amongst pediatric healthcare providers is limited. Objectives Determine the frequency and factors associated with potentially inappropriate treatment in critically ill children as perceived by providers, and describe the factors that providers report contribute to the distress they experience when providing treatment perceived as potentially inappropriate. Methods Prospective observational mixed-methods study in a single tertiary level PICU conducted between March 2 and September 14, 2018. Patients 0-17 years inclusive with: (1) ≥1 organ system dysfunction (2) moderate to severe mental and physical disabilities, or (3) baseline dependence on medical technology were enrolled if they remained admitted to the PICU for ≥48 h, and were not medically fit for transfer/discharge. The frequency of perceived potentially inappropriate treatment was stratified into three groups based on degree of consensus (1, 2 or 3 providers) regarding the appropriateness of ongoing active treatment per enrolled patient. Distress was self-reported using a 100-point scale. Results Of 374 patients admitted during the study, 133 satisfied the inclusion-exclusion criteria. Eighteen patients (unanimous - 3 patients, 2 providers - 7 patients; single provider - 8 patients) were perceived as receiving potentially inappropriate treatment; unanimous consensus was associated with 100% mortality on 3-month follow up post PICU discharge. Fifty-three percent of providers experienced distress secondary to providing treatment perceived as potentially inappropriate. Qualitative thematic analysis revealed five themes regarding factors associated with provider distress: (1) suffering including a sense of causing harm, (2) conflict, (3) quality of life, (4) resource utilization, and (5) uncertainty. Conclusions While treatment perceived as potentially inappropriate was infrequent, provider distress was commonly observed. By identifying specific factor(s) contributing to perceived potentially inappropriate treatment and any associated provider distress, organizations can design, implement and assess targeted interventions.
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Affiliation(s)
- Amrita Sarpal
- Department of Paediatrics, Children's Hospital – London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Children's Health Research Institute, London, ON, Canada
| | - Michael R. Miller
- Department of Paediatrics, Children's Hospital – London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Children's Health Research Institute, London, ON, Canada
| | - Claudio M. Martin
- Lawson Health Research Institute, London, ON, Canada
- Division of Critical Care, Department of Medicine, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Robert W. Sibbald
- Department of Ethics, London Health Sciences Centre, London, ON, Canada
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Kathy N. Speechley
- Department of Paediatrics, Children's Hospital – London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Children's Health Research Institute, London, ON, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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Van Nynatten LR, Miller MR, Patel MA, Daley M, Filler G, Badrnya S, Miholits M, Webb B, McIntyre CW, Fraser DD. A novel multiplex biomarker panel for profiling human acute and chronic kidney disease. Sci Rep 2023; 13:21210. [PMID: 38040779 PMCID: PMC10692319 DOI: 10.1038/s41598-023-47418-9] [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: 06/14/2023] [Accepted: 11/13/2023] [Indexed: 12/03/2023] Open
Abstract
Acute and chronic kidney disease continues to confer significant morbidity and mortality in the clinical setting. Despite high prevalence of these conditions, few validated biomarkers exist to predict kidney dysfunction. In this study, we utilized a novel kidney multiplex panel to measure 21 proteins in plasma and urine to characterize the spectrum of biomarker profiles in kidney disease. Blood and urine samples were obtained from age-/sex-matched healthy control subjects (HC), critically-ill COVID-19 patients with acute kidney injury (AKI), and patients with chronic or end-stage kidney disease (CKD/ESKD). Biomarkers were measured with a kidney multiplex panel, and results analyzed with conventional statistics and machine learning. Correlations were examined between biomarkers and patient clinical and laboratory variables. Median AKI subject age was 65.5 (IQR 58.5-73.0) and median CKD/ESKD age was 65.0 (IQR 50.0-71.5). Of the CKD/ESKD patients, 76.1% were on hemodialysis, 14.3% of patients had kidney transplant, and 9.5% had CKD without kidney replacement therapy. In plasma, 19 proteins were significantly different in titer between the HC versus AKI versus CKD/ESKD groups, while NAG and RBP4 were unchanged. TIMP-1 (PPV 1.0, NPV 1.0), best distinguished AKI from HC, and TFF3 (PPV 0.99, NPV 0.89) best distinguished CKD/ESKD from HC. In urine, 18 proteins were significantly different between groups except Calbindin, Osteopontin and TIMP-1. Osteoactivin (PPV 0.95, NPV 0.95) best distinguished AKI from HC, and β2-microglobulin (PPV 0.96, NPV 0.78) best distinguished CKD/ESKD from HC. A variety of correlations were noted between patient variables and either plasma or urine biomarkers. Using a novel kidney multiplex biomarker panel, together with conventional statistics and machine learning, we identified unique biomarker profiles in the plasma and urine of patients with AKI and CKD/ESKD. We demonstrated correlations between biomarker profiles and patient clinical variables. Our exploratory study provides biomarker data for future hypothesis driven research on kidney disease.
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Affiliation(s)
| | | | - Maitray A Patel
- Epidemiology and Biostatistics, Western University, London, ON, N6A 3K7, Canada
| | - Mark Daley
- Epidemiology and Biostatistics, Western University, London, ON, N6A 3K7, Canada
- Computer Science, Western University, London, ON, N6A 3K7, Canada
- The Vector Institute for Artificial Intelligence, Toronto, ON, M5G 1M1, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Guido Filler
- Medicine, Western University, London, ON, Canada
- Pediatrics, Western University, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | | | | | - Brian Webb
- Thermo Fisher Scientific, Rockford, IL, USA
| | - Christopher W McIntyre
- Medicine, Western University, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Douglas D Fraser
- Pediatrics, Western University, London, ON, Canada.
- Lawson Health Research Institute, London, ON, Canada.
- Clinical Neurological Sciences, Western University, London, ON, Canada.
- Physiology and Pharmacology, Western University, London, ON, Canada.
- London Health Sciences Centre, Room C2-C82, 800 Commissioners Road East, London, ON, N6A 5W9, Canada.
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Choi H, Miller MR, Nguyen HN, Surratt VE, Koch SR, Stark RJ, Lamb FS. Extracellular SOD modulates canonical TNFα signaling and α5β1 integrin transactivation in vascular smooth muscle cells. Free Radic Biol Med 2023; 209:152-164. [PMID: 37852546 PMCID: PMC10841345 DOI: 10.1016/j.freeradbiomed.2023.10.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/03/2023] [Accepted: 10/15/2023] [Indexed: 10/20/2023]
Abstract
TNFα activates NADPH oxidase 1 (Nox1) in vascular smooth muscle cells (VSMCs). The extracellular superoxide anion (O2•-) produced is essential for the pro-inflammatory effects of the cytokine but the specific contributions of O2•- to signal transduction remain obscure. Extracellular superoxide dismutase (ecSOD, SOD3 gene) is a secreted protein that binds to cell surface heparin sulfate proteoglycans or to Fibulin-5 (Fib-5, FBLN5 gene), an extracellular matrix protein that also associates with elastin and integrins. ecSOD converts O2•- to hydrogen peroxide (H2O2) which prevents NO• inactivation, limits generation of hydroxyl radical (OH•), and creates high local concentrations of H2O2. We hypothesized that ecSOD modifies TNFα signaling in VSMCs. Knockdown of ecSOD (siSOD3) suppressed downstream TNFα signals including MAPK (JNK and ERK phosphorylation) and NF-κB activation (luciferase reporter and IκB phosphorylation), interleukin-6 (IL-6) secretion, iNOS and VCAM expression, and proliferation (Sulforhodamine B assay, PCNA western blot). These effects were associated with significant reductions in the expression of both Type1 and 2 TNFα receptors. Reduced Fib-5 expression (siFBLN5) similarly impaired NF-κB activation by TNFα, but potentiated FAK phosphorylation at Y925. siSOD3 also increased both resting and TNFα-induced phosphorylation of FAK and of glycogen synthase kinase-3β (GSK3β), a downstream target of integrin linked kinase (ILK). These effects were dependent upon α5β1 integrins and siSOD3 increased resting sulfenylation (oxidation) of both integrin subunits, while preventing TNFα-induced increases in sulfenylation. To determine how ecSOD modified TNFα-induced inflammation in intact blood vessels, mesenteric arteries from VSMC-specific ecSOD knockout (KO) mice were exposed to TNFα (10 ng/ml) in culture for 48 h. Relaxation to acetylcholine and sodium nitroprusside was impaired in WT but not ecSOD KO vessels. Thus, ecSOD association with Fib-5 supports pro-inflammatory TNFα signaling while tonically inhibiting α5β1 integrin activation.
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Affiliation(s)
- Hyehun Choi
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, 37232, USA.
| | - Michael R Miller
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Hong-Ngan Nguyen
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Victoria E Surratt
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Stephen R Koch
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Ryan J Stark
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Fred S Lamb
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
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Hnaini M, Downs M, Miller MR, Campbell C, St-Laurent A. Duchenne muscular dystrophy respiratory profiles from real world registry data. Pediatr Pulmonol 2023; 58:2725-2732. [PMID: 37539841 DOI: 10.1002/ppul.26554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 05/16/2023] [Accepted: 06/03/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION Understanding real-world profiles from neuromuscular databases is helpful for optimizing clinical care and planning research studies. The Canadian Neuromuscular Disease Registry (CNDR) has respiratory data from a population of boys with Duchenne Muscular Dystrophy (DMD). OBJECTIVES To describe cross-sectional respiratory profiles from a national DMD real-world dataset. To explore the relationship between forced vital capacity percent predicted (FVC%) and disease severity parameters: scoliosis, ambulation and ventilation status. METHODS Descriptive statistics summarized the respiratory profiles. The CNDR registry enrolls and collects DMD clinic data from 36 Canadian centers. RESULTS There were 414 participants enrolled. The age ranged from 2 to 36 years old. Pulmonary function test data were available for 323 participants. The use of ventilatory support was seen in a significant proportion (19.5%) of subjects by age 14-16 years and was used by the majority (69.2%) by age 20-22 years. FVC% declined at a rate of 3.19% per year with every 1-year increase in age. FVC% declined annually by 2.47% in nonambulatory participants versus by 0.96% in ambulatory participants. FVC% did not significantly change over age with the presence of scoliosis or use of ventilatory technology. CONCLUSIONS The data from this large cohort are valuable for understanding real-world patterns of clinical care and disease progression. There is a significant association between the loss of ambulation and the rate of FVC% decline. Further longitudinal studies are needed to better understand the impact of disease parameters on pulmonary function decline and the need for ventilatory support.
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Affiliation(s)
- Mona Hnaini
- Department of Pediatrics, Schulich School of Medicine & Dentistry Western University, London, Ontario, Canada
| | - Matt Downs
- Department of Pediatrics, Children's Hospital London Health Sciences Centre, London, Ontario, Canada
| | - Michael R Miller
- Division of Children's Health & Therapeutics, Department of Pediatrics, Children's Health Research Institute, Western University, London, Ontario, Canada
| | - Craig Campbell
- Department of Pediatrics, Schulich School of Medicine & Dentistry Western University, London, Ontario, Canada
- Department of Pediatrics, Children's Hospital London Health Sciences Centre, London, Ontario, Canada
- Division of Children's Health & Therapeutics, Department of Pediatrics, Children's Health Research Institute, Western University, London, Ontario, Canada
| | - Aaron St-Laurent
- Department of Pediatrics, Schulich School of Medicine & Dentistry Western University, London, Ontario, Canada
- Department of Pediatrics, Children's Hospital London Health Sciences Centre, London, Ontario, Canada
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Amos KA, Ogilvie JD, Ponti M, Miller MR, Yang F, Ens AR. Paediatricians' awareness of Canadian screen time guidelines, perception of screen time use, and counselling during the COVID-19 pandemic. Paediatr Child Health 2023; 28:357-361. [PMID: 37744755 PMCID: PMC10517250 DOI: 10.1093/pch/pxad022] [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: 01/17/2023] [Accepted: 04/17/2023] [Indexed: 09/26/2023] Open
Abstract
Objectives Paediatricians are essential in guiding families on screen time use as digital media becomes increasingly prevalent. While this has been highlighted through the COVID-19 pandemic there is no literature on paediatricians' awareness of Canadian screen time guidelines, or perception of these guidelines during this time. The aim of this study was to assess pediatricians' knowledge, attitudes, and comfort with the Canadian Paediatric Society's (CPS) screen time guidelines, specifically during the COVID-19 pandemic. Methods Our survey was developed by a paediatric resident and paediatric endocrinologist, reviewed by local experts, and sent electronically to members of the CPS Community and Developmental Paediatrics sections. Results All 53 respondents were aware of current CPS screen time guidelines, and the majority self-reported fair to excellent knowledge of guidelines for both age groups (<5 years and school-aged children/adolescents). Over 80% noticed increased screen use during the pandemic, and 98% were somewhat or very concerned about screen use and their patients' health and well-being. Pediatricians reported concerns about associations between increased screen time with worsening behaviour, mental health concerns, obesity, and sedentary lifestyle. The greatest barrier to reducing screen time was perceived insufficient motivation or support from caregivers/families. Conclusions Responding Canadian paediatricians are knowledgeable and comfortable with current screen time guidelines in Canada. Despite this, there is increasing concern with health outcomes associated with screen use. These results highlight paediatricians' important role in counselling patients and may encourage further local advocacy and public education around screen use and associated health risks in children.
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Affiliation(s)
- Kiersten A Amos
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Paediatrics, Children’s Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - Jacqueline D Ogilvie
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Paediatrics, Children’s Hospital, London Health Sciences Centre, London, Ontario, Canada
- Division of Developmental Pediatrics, Children’s Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - Michelle Ponti
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Paediatrics, Children’s Hospital, London Health Sciences Centre, London, Ontario, Canada
- Division of Developmental Pediatrics, Children’s Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - Michael R Miller
- Department of Paediatrics, Children’s Hospital, London Health Sciences Centre, London, Ontario, Canada
- Children’s Health Research Institute, London, Ontario, Canada
| | - Fanyu Yang
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Andrea R Ens
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Paediatrics, Children’s Hospital, London Health Sciences Centre, London, Ontario, Canada
- Division of Endocrinology, Department of Pediatrics, Children’s Hospital, London Health Sciences Centre, London, Ontario, Canada
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Poonai N, Freedman SB, Newton AS, Sawyer S, Gaucher N, Ali S, Wright B, Miller MR, Mater A, Fitzpatrick E, Jabbour M, Zemek R, Eltorki M, Doan Q. Emergency department visits and hospital admissions for suicidal ideation, self-poisoning and self-harm among adolescents in Canada during the COVID-19 pandemic. CMAJ 2023; 195:E1221-E1230. [PMID: 37722746 PMCID: PMC10506508 DOI: 10.1503/cmaj.220507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic had profound effects on the mental wellbeing of adolescents. We sought to evaluate pandemic-related changes in health care use for suicidal ideation, self-poisoning and self-harm. METHODS We obtained data from the Canadian Institute for Health Information on emergency department visits and hospital admissions from April 2015 to March 2022 among adolescents aged 10-18 years in Canada. We calculated the quarterly percentage of emergency department visits and hospital admissions for a composite outcome comprising suicidal ideation, self-poisoning and self-harm relative to all-cause emergency department visits and hospital admissions. We used interrupted time-series methods to compare changes in levels and trends of these outcomes between the prepandemic (Apr. 1, 2015-Mar. 1, 2020) and pandemic (Apr. 1, 2020-Mar. 31, 2022) periods. RESULTS The average quarterly percentage of emergency department visits for suicidal ideation, self-poisoning and self-harm relative to all-cause emergency department visits was 2.30% during the prepandemic period and 3.52% during the pandemic period. The level (0.08%, 95% confidence interval [CI] -0.79% to 0.95%) or trend (0.07% per quarter, 95% CI -0.14% to 0.28%) of this percentage did not change significantly between periods. The average quarterly percentage of hospital admissions for the composite outcome relative to all-cause admissions was 7.18% during the prepandemic period and 8.96% during the pandemic period. This percentage showed no significant change in level (-0.70%, 95% CI -1.90% to 0.50%), but did show a significantly increasing trend (0.36% per quarter; 95% 0.07% to 0.65%) during the pandemic versus prepandemic periods, specifically among females aged 10-14 years (0.76% per quarter, 95% CI 0.22% to 1.30%) and females aged 15-18 years (0.56% per quarter, 95% CI 0.31% to 0.81%). INTERPRETATION The quarterly change in the percentage of hospital admissions for suicidal ideation, self-poisoning and self-harm increased among adolescent females in Canada during the first 2 years of the COVID-19 pandemic. This underscores the need to promote public health policies that mitigate the impact of the pandemic on adolescent mental health.
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Affiliation(s)
- Naveen Poonai
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
| | - Stephen B Freedman
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
| | - Amanda S Newton
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
| | - Scott Sawyer
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
| | - Nathalie Gaucher
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
| | - Samina Ali
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
| | - Bruce Wright
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
| | - Michael R Miller
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
| | - Ahmed Mater
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
| | - Eleanor Fitzpatrick
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
| | - Mona Jabbour
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
| | - Roger Zemek
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
| | - Mohamed Eltorki
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
| | - Quynh Doan
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
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Homedi A, De La Hoz A, Miller MR, Lalitha R, McClean M, Bhattacharya S. Impact of Targeted Neonatal Echocardiography on Patent Ductus Arteriosus Management in a Canadian Tertiary Care Neonatal Unit: A Retrospective Cohort Study. Am J Perinatol 2023. [PMID: 37714181 DOI: 10.1055/s-0043-1774313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
OBJECTIVE Comprehensive assessment of hemodynamic significance of a patent ductus arteriosus (PDA) is a common indication to perform targeted neonatal echocardiography (TNE). Impact of implementation of such an assessment on PDA management decisions remains to be reported. The objective of this study is to compare PDA-related hemodynamic information and PDA treatment decisions before and after introduction of TNE service. STUDY DESIGN This was a retrospective cohort study at a tertiary level neonatal intensive care unit in Southwestern Ontario. We investigated two time periods: Epoch-1 (non-TNE 2013-2016) versus Epoch-2 (TNE 2018-2021). We included neonates < 32 weeks with PDA. Data on baseline clinical characteristics, PDA-related echocardiographic parameters, PDA treatment details, and relevant long-term outcomes were collected. Primary outcome was defined as PDA treatment rates and need for multiple courses. Secondary outcomes included availability of PDA hemodynamic data and neonatal mortality/morbidity (PDA-related) RESULTS: A total of 275 neonates were included. A total of 162 were assessed by conventional echocardiography in Epoch-1, whereas 113 were assessed by TNE in Epoch-2. Baseline clinical characteristics were similar. Epoch-2 had more echocardiographic assessments per patient of 2.7 (±1.8) versus 1.9 (± 1.3), p < 0.001 in Epoch1. The mean postnatal age at first echocardiographic assessment was higher in Epoch-2 (12.7 days [ ± 14.6]) than in Epoch-1 (7.9 days [ ± 10.4]), p < 0.001. Comprehensive hemodynamic assessment of PDA-related echocardiographic parameters such as PDA size, shunt pattern, effect on systemic circulation, and pulmonary circulation were higher in Epoch-2. Overall, PDA treatment rates were comparable in the two time periods. The use of multiple courses of treatment was higher in Epoch-1 than in Epoch-2 (47.8 vs. 31.7%, p = 0.047). In Epoch-1, neonates received PDA treatment earlier than in Epoch-2. CONCLUSION With the implementation of the TNE service, increased echocardiographic evaluations per patient were completed with availability of more comprehensive hemodynamic information about PDA. PDA treatment rates were similar in the two epochs, but need for multiple courses were less in TNE era. KEY POINTS · TNE allows comprehensive hemodynamic assessment of PDA.. · Implementation of dedicated TNE service led to increased use of echocardiography to assess PDA.. · Standardized hemodynamic assessment of PDA may allow improved individualization of treatment need..
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Affiliation(s)
- Abdulaziz Homedi
- Department of Pediatrics, Western University, London, Ontario, Canada
| | - Andrea De La Hoz
- Department of Lawson Research - Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Michael R Miller
- Department of Pediatrics, Western University, London, Ontario, Canada
- Department of Lawson Research - Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Renjini Lalitha
- Department of Pediatrics, Western University, London, Ontario, Canada
| | - Marisha McClean
- Department of Pediatrics, Western University, London, Ontario, Canada
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Gupte D, Assaf M, Miller MR, McKenzie K, Loosley J, Tijssen JA. Evaluation of hospital management of paediatric out-of-hospital cardiac arrest. Resusc Plus 2023; 15:100433. [PMID: 37555196 PMCID: PMC10405089 DOI: 10.1016/j.resplu.2023.100433] [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: 04/04/2023] [Revised: 06/22/2023] [Accepted: 07/11/2023] [Indexed: 08/10/2023] Open
Abstract
INTRODUCTION Pediatric out of hospital cardiac arrest (POHCA) is rare, with high mortality and neurological morbidity. Adherence to Pediatric Advanced Life Support guidelines standardizes in-hospital care and improves outcomes. We hypothesized that in-hospital care of POHCA patients was variable and deviations from guidelines were associated with higher mortality. METHODS POHCA patients in the London-Middlesex region between January 2012 and June 2020 were included. The care of children with ongoing arrest (intra-arrest) and post-arrest outcomes were reviewed using the Children's Hospital, London Health Sciences Centre (LHSC) patient database and the Adverse Event Management System. RESULTS 50 POHCA patients arrived to hospital, with 15 (30%) patients admitted and 2 (4.0%) surviving to discharge, both with poor neurological outcomes and no improvement at 90 days. Deviations occurred at every event with intra-arrest care deviations occurring mostly in medication delivery and defibrillation (98%). Post-arrest deviations occurred mostly in temperature monitoring (60%). Data missingness was 15.9% in the intra-arrest and 1.7% in the post-arrest group. DISCUSSION Deviations commonly occurred in both in-hospital arrest and post-arrest care. The study was under-powered to identify associations between DEVs and outcomes. Future work includes addressing specific deviations in intra-arrest and post-arrest care of POHCA patients and standardizing electronic documentation.
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Affiliation(s)
- Dhruv Gupte
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1, Canada
| | - Maysaa Assaf
- Department of Paediatrics, London Health Sciences Centre, 800 Commissioners Rd. E., London, ON N6A 5W9, Canada
| | - Michael R. Miller
- Department of Paediatrics, London Health Sciences Centre, 800 Commissioners Rd. E., London, ON N6A 5W9, Canada
- Children’s Health Research Institute, 800 Commissioners Rd. E., London, ON N6C 2V5, Canada
| | - Kate McKenzie
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1, Canada
| | - Jay Loosley
- Middlesex-London Paramedic Service, 1035 Adelaide St. S., London, ON N6E 1R4, Canada
| | - Janice A. Tijssen
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1, Canada
- Department of Paediatrics, London Health Sciences Centre, 800 Commissioners Rd. E., London, ON N6A 5W9, Canada
- Children’s Health Research Institute, 800 Commissioners Rd. E., London, ON N6C 2V5, Canada
- Lawson Health Research Institute, 750 Base Line Rd. E., London, ON N6C 2R5, Canada
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Choi H, Miller MR, Nguyen HN, Rohrbough JC, Koch SR, Boatwright N, Yarboro MT, Sah R, McDonald WH, Reese JJ, Stark RJ, Lamb FS. LRRC8A anion channels modulate vascular reactivity via association with myosin phosphatase rho interacting protein. FASEB J 2023; 37:e23028. [PMID: 37310356 PMCID: PMC10591482 DOI: 10.1096/fj.202300561r] [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: 03/23/2023] [Revised: 05/23/2023] [Accepted: 06/01/2023] [Indexed: 06/14/2023]
Abstract
Leucine-rich repeat containing 8A (LRRC8A) volume regulated anion channels (VRACs) are activated by inflammatory and pro-contractile stimuli including tumor necrosis factor alpha (TNFα), angiotensin II and stretch. LRRC8A associates with NADPH oxidase 1 (Nox1) and supports extracellular superoxide production. We tested the hypothesis that VRACs modulate TNFα signaling and vasomotor function in mice lacking LRRC8A exclusively in vascular smooth muscle cells (VSMCs, Sm22α-Cre, Knockout). Knockout (KO) mesenteric vessels contracted normally but relaxation to acetylcholine (ACh) and sodium nitroprusside (SNP) was enhanced compared to wild type (WT). Forty-eight hours of ex vivo exposure to TNFα (10 ng/mL) enhanced contraction to norepinephrine (NE) and markedly impaired dilation to ACh and SNP in WT but not KO vessels. VRAC blockade (carbenoxolone, CBX, 100 μM, 20 min) enhanced dilation of control rings and restored impaired dilation following TNFα exposure. Myogenic tone was absent in KO rings. LRRC8A immunoprecipitation followed by mass spectroscopy identified 33 proteins that interacted with LRRC8A. Among them, the myosin phosphatase rho-interacting protein (MPRIP) links RhoA, MYPT1 and actin. LRRC8A-MPRIP co-localization was confirmed by confocal imaging of tagged proteins, Proximity Ligation Assays, and IP/western blots. siLRRC8A or CBX treatment decreased RhoA activity in VSMCs, and MYPT1 phosphorylation was reduced in KO mesenteries suggesting that reduced ROCK activity contributes to enhanced relaxation. MPRIP was a target of redox modification, becoming oxidized (sulfenylated) after TNFα exposure. Interaction of LRRC8A with MPRIP may allow redox regulation of the cytoskeleton by linking Nox1 activation to impaired vasodilation. This identifies VRACs as potential targets for treatment or prevention of vascular disease.
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Affiliation(s)
- Hyehun Choi
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael R Miller
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Hong-Ngan Nguyen
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeffrey C Rohrbough
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephen R Koch
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Naoko Boatwright
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael T Yarboro
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rajan Sah
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - W Hayes McDonald
- Department of Biochemistry, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - J Jeffrey Reese
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ryan J Stark
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Fred S Lamb
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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14
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Al Harthy T, Miller MR, daSilva O, Bhattacharya S. Purpose Built Catheters for Minimally Invasive Surfactant Therapy: Experience from a Canadian Tertiary Level Neonatal Intensive Care Unit. Can J Respir Ther 2023; 59:137-144. [PMID: 37781350 PMCID: PMC10540161 DOI: 10.29390/001c.77606] [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] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/31/2023] [Indexed: 10/03/2023]
Abstract
Background Minimally invasive surfactant therapy (MIST), a method of surfactant delivery via a thin catheter during spontaneous breathing, is an increasingly popular alternative to intubation and surfactant administration. Recently, purpose-built catheters for MIST received regulatory approval in Canada and became available for use. However, procedural success and user experience with such catheters have not been described. Methods This retrospective cohort study included neonates who received MIST using purpose-built catheters between January 1, 2021, and March 31, 2022. Two types of purpose-built catheters were used in this period - SurfCath™ and BLEScath™. Procedural success, number of attempts, and adverse events in neonates receiving MIST via the two catheters were compared using chi-square or Fisher's tests. User experience was described using an ease-of-use scale. Results Thirty-seven neonates met eligibility criteria; 22 received MIST via SurfCath™, whereas 15 received MIST via BLEScath™. Success rates were 91% in SurfCath™ and 93% in BLEScath™ (P> 0.994). Failed attempts were lower in SurfCath™ (23%) in comparison to BLEScath™ (33%), but the difference was not statistically significant (P=0.708). Among operators, 90% found SurfCath™ very easy/relatively easy to use compared to 43% of users reflecting the same degree of use with BLEScath™ (P=.021). There was no difference in adverse events. Conclusion This is the first study in Canada to report MIST with purpose-built catheters. Overall, the success rate was equally high with both catheters. Users subjectively reported higher ease of use with SurfCath™. Commercially available purpose-built catheters should facilitate universal adaptation of the MIST method.
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Affiliation(s)
- Talib Al Harthy
- Schulich School of Medicine, Western University
- Department of Pediatrics London Health Sciences Centre
| | - Michael R Miller
- Department of Pediatrics Western University
- Children's Health Research Institute
| | | | - Soume Bhattacharya
- Department of Pediatrics Western University
- London Health Sciences Centre
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15
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Pitch N, Verma R, Davidson L, Robertson T, Anagnostopoulos G, Sunkonkit K, Qazi A, Ambreen M, Mekhuri S, Miller MR, Orkin J, Amin R. Screening for psychosocial risk in caregivers of children with medical complexity during the COVID-19 pandemic: a cross-sectional study. BMJ Open 2023; 13:e068867. [PMID: 37185638 PMCID: PMC10151246 DOI: 10.1136/bmjopen-2022-068867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVE The primary objective was to quantify psychosocial risk in family caregivers (FCs) of children with medical complexity (CMC) during the COVID-19 pandemic using the Psychosocial Assessment Tool (PAT). The secondary objectives were to compare this finding with the average PAT score of this population before the COVID-19 pandemic and to examine potential clinical predictors of psychosocial risk in FCs of CMC. DESIGN Cross-sectional study. PARTICIPANTS FCs of CMC were recruited from the Long-Term Ventilation Clinic at The Hospital for Sick Children, Toronto, Ontario, Canada. A total of 91 completed the demographic and PAT questionnaires online from 10 June 2021 through 13 December 2021. MAIN OUTCOME MEASURES Mean PAT scores in FCs were categorised as 'Universal' low risk, 'Targeted' intermediate risk or 'Clinical' high risk. The effect of sociodemographic and clinical variables on overall PAT scores was assessed using multiple linear regression analysis. Comparisons with a previous study were made using Mann-Whitney tests and χ2 analysis. RESULTS Mean (SD) PAT score was 1.34 (0.69). Thirty-one (34%) caregivers were classified as Universal, 43 (47%) as Targeted and 17 (19%) as Clinical. The mean PAT score (1.34) was significantly higher compared with the mean PAT score (1.17) found prior to the COVID-19 pandemic. Multiple linear regression analysis demonstrated an overall significant model, with the number of hospital admissions since the onset of COVID-19 being the only variable associated with the overall PAT score. CONCLUSION FCs of CMC are experiencing significant psychosocial stress during the COVID-19 pandemic. Timely and effective interventions are warranted to ensure these individuals receive the appropriate support.
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Affiliation(s)
- Natalie Pitch
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rahul Verma
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Laura Davidson
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Taylor Robertson
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Kanokkarn Sunkonkit
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Pulmonary and Critical Care, Department of Pediatrics, Chiang Mai University Faculty of Medicine, Chiang Mai, Thailand
| | - Adam Qazi
- Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Munazzah Ambreen
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Samantha Mekhuri
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael R Miller
- Children's Health Research Institute, London, Ontario, Canada
- Department of Paediatrics, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Julia Orkin
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences SickKids Research Institute, Toronto, Ontario, Canada
| | - Reshma Amin
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences SickKids Research Institute, Toronto, Ontario, Canada
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16
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Choi H, Miller MR, Nguyen HN, Rohrbough JC, Koch SR, Boatwright N, Yarboro MT, Sah R, McDonald WH, Reese JJ, Stark RJ, Lamb FS. LRRC8A anion channels modulate vasodilation via association with Myosin Phosphatase Rho Interacting Protein (MPRIP). bioRxiv 2023:2023.03.08.531807. [PMID: 36945623 PMCID: PMC10028897 DOI: 10.1101/2023.03.08.531807] [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: 06/18/2023]
Abstract
BACKGROUND In vascular smooth muscle cells (VSMCs), LRRC8A volume regulated anion channels (VRACs) are activated by inflammatory and pro-contractile stimuli including tumor necrosis factor alpha (TNFα), angiotensin II and stretch. LRRC8A physically associates with NADPH oxidase 1 (Nox1) and supports its production of extracellular superoxide (O 2 -• ). METHODS AND RESULTS Mice lacking LRRC8A exclusively in VSMCs (Sm22α-Cre, KO) were used to assess the role of VRACs in TNFα signaling and vasomotor function. KO mesenteric vessels contracted normally to KCl and phenylephrine, but relaxation to acetylcholine (ACh) and sodium nitroprusside (SNP) was enhanced compared to wild type (WT). 48 hours of ex vivo exposure to TNFα (10ng/ml) markedly impaired dilation to ACh and SNP in WT but not KO vessels. VRAC blockade (carbenoxolone, CBX, 100 μM, 20 min) enhanced dilation of control rings and restored impaired dilation following TNFα exposure. Myogenic tone was absent in KO rings. LRRC8A immunoprecipitation followed by mass spectroscopy identified 35 proteins that interacted with LRRC8A. Pathway analysis revealed actin cytoskeletal regulation as the most closely associated function of these proteins. Among these proteins, the Myosin Phosphatase Rho-Interacting protein (MPRIP) links RhoA, MYPT1 and actin. LRRC8A-MPRIP co-localization was confirmed by confocal imaging of tagged proteins, Proximity Ligation Assays, and IP/western blots which revealed LRRC8A binding at the second Pleckstrin Homology domain of MPRIP. siLRRC8A or CBX treatment decreased RhoA activity in cultured VSMCs, and MYPT1 phosphorylation at T853 was reduced in KO mesenteries suggesting that reduced ROCK activity contributes to enhanced relaxation. MPRIP was a target of redox modification, becoming oxidized (sulfenylated) after TNFα exposure. CONCLUSIONS Interaction of Nox1/LRRC8A with MPRIP/RhoA/MYPT1/actin may allow redox regulation of the cytoskeleton and link Nox1 activation to both inflammation and vascular contractility.
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17
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Norozi K, Müller MJ, Xing C, Miller MR, Bock J, Paul T, Geyer S, Dellas C. Predictors of Developing Heart Failure in Adults with Congenital Heart Defects. Rev Cardiovasc Med 2023. [DOI: 10.31083/j.rcm2403085] [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: 03/12/2023] Open
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18
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Saker A, Surak A, Kimani S S, De La Hoz A, Miller MR, Lalitha R, Bhattacharya S. Combination therapy for patent ductus arteriosus in preterm infants: Echocardiographic changes and clinical use. Progress in Pediatric Cardiology 2023. [DOI: 10.1016/j.ppedcard.2022.101611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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19
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Fraser DD, Patel MA, Van Nynatten LR, Martin C, Seney SL, Miller MR, Daley M, Slessarev M, Cepinskas G, Juneja GK, Sabourin V, Fox-Robichaud A, Yeh CH, Kim PY, Badrnya S, Oehler S, Miholits M, Webb B. Cross-immunity against SARS-COV-2 variants of concern in naturally infected critically ill COVID-19 patients. Heliyon 2023; 9:e12704. [PMID: 36594041 PMCID: PMC9797417 DOI: 10.1016/j.heliyon.2022.e12704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 12/31/2022] Open
Abstract
Critically ill patients infected with SARS-CoV-2 display adaptive immunity, but it is unknown if they develop cross-reactivity to variants of concern (VOCs). We profiled cross-immunity against SARS-CoV-2 VOCs in naturally infected, non-vaccinated, critically ill COVID-19 patients. Wave-1 patients (wild-type infection) were similar in demographics to Wave-3 patients (wild-type/alpha infection), but Wave-3 patients had higher illness severity. Wave-1 patients developed increasing neutralizing antibodies to all variants, as did patients during Wave-3. Wave-3 patients, when compared to Wave-1, developed more robust antibody responses, particularly for wild-type, alpha, beta and delta variants. Within Wave-3, neutralizing antibodies were significantly less to beta and gamma VOCs, as compared to wild-type, alpha and delta. Patients previously diagnosed with cancer or chronic obstructive pulmonary disease had significantly fewer neutralizing antibodies. Naturally infected ICU patients developed adaptive responses to all VOCs, with greater responses in those patients more likely to be infected with the alpha variant, versus wild-type.
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Key Words
- ACE2, angiotensin-converting enzyme
- AUC, area-under-the-curve
- Adaptive immunity
- Antibodies
- COPD, chronic obstructive pulmonary disease
- COVID-19
- COVID-19, coronavirus disease 2019
- ICU, intensive care unit
- IQR, interquartile range
- Intensive care units
- MFI, median fluorescence intensity
- MODS, multi-organ dysfunction score
- Neutralizing
- P/F, arterial partial pressure to inspired oxygen
- RBD, receptor binding domain
- REB, research ethics board
- ROC, receiver operating characteristic
- SARS-CoV-2
- SARS-CoV-2 alpha variant
- SARS-CoV-2 beta variant
- SARS-CoV-2 delta variant
- SARS-CoV-2 gamma variant
- SOFA, sequential organ failure assessment
- VOC, variants of concern
- VTE, venous thromboembolism
- WT, wild-type
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Affiliation(s)
- Douglas D. Fraser
- Lawson Health Research Institute, London, ON, N6C 2R5, Canada,Pediatrics, Western University, London, ON, N6A 3K7, Canada,Clinical Neurological Sciences, Western University, London, ON, N6A 3K7, Canada,Physiology & Pharmacology, Western University, London, ON, N6A 3K7, Canada,Corresponding author. Lawson Health Research Institute, London, ON, N6C 2R5, Canada
| | | | | | - Claudio Martin
- Lawson Health Research Institute, London, ON, N6C 2R5, Canada,Medicine, Western University, London, ON, N6A 3K7, Canada
| | | | - Michael R. Miller
- Lawson Health Research Institute, London, ON, N6C 2R5, Canada,Pediatrics, Western University, London, ON, N6A 3K7, Canada
| | - Mark Daley
- Epidemiology, Western University, London, ON, N6A 3K7, Canada
| | - Marat Slessarev
- Lawson Health Research Institute, London, ON, N6C 2R5, Canada,Medicine, Western University, London, ON, N6A 3K7, Canada
| | - Gediminas Cepinskas
- Lawson Health Research Institute, London, ON, N6C 2R5, Canada,Medical Biophysics, Western University, London, ON, N6A 3K7, Canada
| | - Ganeem K. Juneja
- Medicine, McMaster University, Hamilton, ON, L8S 4L8, Canada,Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, L8L 2X2, Canada
| | - Vanessa Sabourin
- Medicine, McMaster University, Hamilton, ON, L8S 4L8, Canada,Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, L8L 2X2, Canada
| | - Alison Fox-Robichaud
- Medicine, McMaster University, Hamilton, ON, L8S 4L8, Canada,Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, L8L 2X2, Canada
| | - Calvin H. Yeh
- Medicine, McMaster University, Hamilton, ON, L8S 4L8, Canada,Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, L8L 2X2, Canada
| | - Paul Y. Kim
- Medicine, McMaster University, Hamilton, ON, L8S 4L8, Canada,Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, L8L 2X2, Canada
| | | | | | | | - Brian Webb
- Thermo Fisher Scientific, Rockford, IL, USA
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20
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Van Nynatten LR, Slessarev M, Martin CM, Leligdowicz A, Miller MR, Patel MA, Daley M, Patterson EK, Cepinskas G, Fraser DD. Novel plasma protein biomarkers from critically ill sepsis patients. Clin Proteomics 2022; 19:50. [PMID: 36572854 PMCID: PMC9792322 DOI: 10.1186/s12014-022-09389-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/09/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Despite the high morbidity and mortality associated with sepsis, the relationship between the plasma proteome and clinical outcome is poorly understood. In this study, we used targeted plasma proteomics to identify novel biomarkers of sepsis in critically ill patients. METHODS Blood was obtained from 15 critically ill patients with suspected/confirmed sepsis (Sepsis-3.0 criteria) on intensive care unit (ICU) Day-1 and Day-3, as well as age- and sex-matched 15 healthy control subjects. A total of 1161 plasma proteins were measured with proximal extension assays. Promising sepsis biomarkers were narrowed with machine learning and then correlated with relevant clinical and laboratory variables. RESULTS The median age for critically ill sepsis patients was 56 (IQR 51-61) years. The median MODS and SOFA values were 7 (IQR 5.0-8.0) and 7 (IQR 5.0-9.0) on ICU Day-1, and 4 (IQR 3.5-7.0) and 6 (IQR 3.5-7.0) on ICU Day-3, respectively. Targeted proteomics, together with feature selection, identified the leading proteins that distinguished sepsis patients from healthy control subjects with ≥ 90% classification accuracy; 25 proteins on ICU Day-1 and 26 proteins on ICU Day-3 (6 proteins overlapped both ICU days; PRTN3, UPAR, GDF8, NTRK3, WFDC2 and CXCL13). Only 7 of the leading proteins changed significantly between ICU Day-1 and Day-3 (IL10, CCL23, TGFα1, ST2, VSIG4, CNTN5, and ITGAV; P < 0.01). Significant correlations were observed between a variety of patient clinical/laboratory variables and the expression of 15 proteins on ICU Day-1 and 14 proteins on ICU Day-3 (P < 0.05). CONCLUSIONS Targeted proteomics with feature selection identified proteins altered in critically ill sepsis patients relative to healthy control subjects. Correlations between protein expression and clinical/laboratory variables were identified, each providing pathophysiological insight. Our exploratory data provide a rationale for further hypothesis-driven sepsis research.
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Affiliation(s)
| | - Marat Slessarev
- grid.39381.300000 0004 1936 8884Medicine, Western University, London, ON Canada ,grid.415847.b0000 0001 0556 2414Lawson Health Research Institute, London, ON Canada
| | - Claudio M. Martin
- grid.39381.300000 0004 1936 8884Medicine, Western University, London, ON Canada ,grid.415847.b0000 0001 0556 2414Lawson Health Research Institute, London, ON Canada
| | - Aleks Leligdowicz
- grid.39381.300000 0004 1936 8884Medicine, Western University, London, ON Canada ,grid.415847.b0000 0001 0556 2414Lawson Health Research Institute, London, ON Canada
| | - Michael R. Miller
- grid.415847.b0000 0001 0556 2414Lawson Health Research Institute, London, ON Canada ,grid.39381.300000 0004 1936 8884Pediatrics, Western University, London, ON Canada
| | - Maitray A. Patel
- grid.39381.300000 0004 1936 8884Computer Science, Western University, London, ON N6A 3K7 Canada
| | - Mark Daley
- grid.415847.b0000 0001 0556 2414Lawson Health Research Institute, London, ON Canada ,grid.39381.300000 0004 1936 8884Computer Science, Western University, London, ON N6A 3K7 Canada ,grid.494618.6The Vector Institute for Artificial Intelligence, Toronto, ON M5G 1M1 Canada
| | - Eric K. Patterson
- grid.415847.b0000 0001 0556 2414Lawson Health Research Institute, London, ON Canada
| | - Gediminas Cepinskas
- grid.415847.b0000 0001 0556 2414Lawson Health Research Institute, London, ON Canada ,grid.39381.300000 0004 1936 8884Medical Biophysics, Western University, London, ON N6A 3K7 Canada
| | - Douglas D. Fraser
- grid.415847.b0000 0001 0556 2414Lawson Health Research Institute, London, ON Canada ,grid.39381.300000 0004 1936 8884Pediatrics, Western University, London, ON Canada ,grid.39381.300000 0004 1936 8884Clinical Neurological Sciences, Western University, London, ON Canada ,grid.39381.300000 0004 1936 8884Physiology and Pharmacology, Western University, London, ON Canada ,grid.412745.10000 0000 9132 1600London Health Sciences Centre, Room C2-C82, 800 Commissioners Road East, London, ON N6A 5W9 Canada
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21
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Brown BE, Huisman E, Miller MR, Ulrich C, Reid G, da Silva O. Enteral supplementation with probiotics in preterm infants: A retrospective cohort study and 6-year follow-up. Front Nutr 2022; 9:1063121. [PMID: 36643974 PMCID: PMC9835551 DOI: 10.3389/fnut.2022.1063121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
The objective of this retrospective cohort study was to assess the impact of an enteral probiotics supplementation protocol on the incidence of necrotizing enterocolitis (NEC) in infants born <33 weeks gestational age (GA) or birth weight (BW) <1,500 g. In addition, a 6-year follow-up is presented after instigation of probiotic use. In October 2014, our NICU introduced an enteral probiotics supplementation protocol for infants born <33 weeks GA or BW <1,500 g. Infants received 0.5 g of Bifidobacterium breve HA-129, Lacticaseibacillus rhamnosus HA-111, Bifidobacterium bifidum HA-132, Bifidobacterium longum subsp. infantis HA-116, and Bifidobacterium longum subsp. longum HA-135 (FloraBABYⓇ) daily until discharge or transfer from hospital. The incidence of NEC was compared among infants for 2 years pre- and post implementation of the protocol then 6-years following continuous implementation of the probiotic use. In total, 370 infants not treated with probiotics between 2012 and 2014 were included with an incidence of NEC at 4.9%. In comparison, the 367 infants who received had a 67% reduction (4.9-1.6%, p = 0.01) in our Neonatal Intensive Care Unit (NICU). The results remained significant (aOR = 0.26; 95% CI: 0.09, 0.72; p < 0.01) after adjusting for GA, small for gestational age, and antenatal corticosteroid use. Data from the Canadian Neonatal Network not only showed a consistently high rate of NEC in October 2014, but also identified exceedingly high rates (8.7-15.6%) in some hospitals up to 2021, while our rates have been consistently low with using the probiotic as standard therapy for low BW premature babies, with no serious side effects reported. In conclusion, the introduction of a five-strain probiotic natural health product has coincided with a reduced incidence and complications of NEC in our NICU setting.
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Affiliation(s)
- Beth Ellen Brown
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Western Ontario, London, ON, Canada
| | - Esther Huisman
- Department of Pediatrics, Division of Neonatology, McMaster University, Hamilton, ON, Canada
| | - Michael R. Miller
- Department of Pediatrics, The Children's Health Research Institute, University of Western Ontario, London, ON, Canada
| | - Cindy Ulrich
- Neonatal Intensive Care Unit, Children's Hospital, London Health Sciences Centre, London, ON, Canada
| | - Gregor Reid
- Departments of Microbiology and Immunology, and Surgery, University of Western Ontario, London, ON, Canada,Canadian Centre for Microbiome and Probiotics, Lawson Health Research Institute, London, ON, Canada,*Correspondence: Gregor Reid
| | - Orlando da Silva
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Western Ontario, London, ON, Canada
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22
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Al Ali RA, Gautam B, Miller MR, Coulson S, Yuen D. Laryngeal Mask Airway for Surfactant Administration Versus Standard Treatment Methods in Preterm Neonates with Respiratory Distress Syndrome: A Systematic Review and Meta-analysis. Am J Perinatol 2022; 39:1433-1440. [PMID: 33517565 DOI: 10.1055/s-0041-1722953] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Laryngeal mask airway (LMA) has emerged as an alternative surfactant delivery method. The effectiveness of this method for the delivery of surfactant is uncertain. A meta-analysis of randomized control trials (RCTs) comparing LMA with standard methods of surfactant delivery for the outcomes of surfactant dose repetition, oxygen requirement, mechanical ventilation, intubation, mortality, bronchopulmonary dysplasia (BPD), and pneumothorax. STUDY DESIGN Systematic review and meta-analysis of RCTs. Homogeneity between studies was analyzed by using I2 statistics. Risk ratio or mean difference of outcomes was assessed from random effects models. Subgroup analyses were conducted when necessary. Data sources are as follows: Ovid Medline, Embase, and the Cochrane Central Register of Controlled trials from inception till December 2018, bibliographies of identified reviews and trial registries for ongoing studies. RCTs comparing short-term respiratory outcomes in neonates with respiratory distress syndrome who were administered surfactant through an LMA versus standard method of care. RESULTS Six RCTs were identified, enrolling a total of 357 infants. Administering surfactant via LMA was associated with decreased FiO2 requirement (mean difference = 1.82 (95% confidence interval [CI]: -6.01-9.66), decreased intubation (risk ratio [RR] = 0.17; 95% CI: 0.05-0.57), and decreased mechanical ventilation (RR = 0.44; 95% CI: 0.31-0.61). There were no significant differences between groups for death, BPD, or pneumothorax. CONCLUSION LMA might be an effective alternative method of surfactant delivery; however, further high-quality RCTs with larger sample size and including extreme preterm infants are needed to establish LMA as an alternative technique for surfactant delivery. KEY POINTS · Pulmonary surfactants reduce mortality and pulmonary air leaks in newborns with respiratory distress syndrome.. · Preterm lungs are at risk of volutrauma by mechanical ventilation; laryngoscopy is still traumatic.. · Surfactant administration via LMA to avoid mechanical ventilation and intubation might be feasible..
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Affiliation(s)
- Roqaia Ayesh Al Ali
- Neonatal Division, Maternity and Children Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia.,Neonatal Division, Department of Pediatrics, Western University, London, Canada
| | - Bishal Gautam
- Neonatal Division, Department of Pediatrics, Western University, London, Canada.,Neonatal Division, Royal Alexandria Hospital, Edmonton, Canada
| | - Michael R Miller
- Neonatal Division, Department of Pediatrics, Western University, London, Canada.,Children's Health Research Institute, Western University, London, Canada
| | - Sherry Coulson
- Children's Health Research Institute, Western University, London, Canada
| | - Doris Yuen
- Neonatal Division, Department of Pediatrics, Western University, London, Canada
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23
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Stark RJ, Koch SR, Stothers CL, Pourquoi A, Lamb CK, Miller MR, Choi H. Loss of Sirtuin 1 (SIRT1) potentiates endothelial dysfunction via impaired glycolysis during infectious challenge. Clin Transl Med 2022; 12:e1054. [PMID: 36103428 PMCID: PMC9473483 DOI: 10.1002/ctm2.1054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/04/2022] [Accepted: 08/25/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Ryan J. Stark
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennessee
| | - Stephen R. Koch
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennessee
| | - Cody L. Stothers
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennessee
| | - Allison Pourquoi
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennessee
| | - Celia K. Lamb
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennessee
| | - Michael R. Miller
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennessee
| | - Hyehun Choi
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennessee
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24
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Liu A, Love A, Katz S, Patrick A, Parra D, Halasa N, Miller MR. Multisystem inflammatory syndrome in a fully vaccinated 18-year-old without known SARS-CoV-2 infection. Pediatr Rheumatol Online J 2022; 20:74. [PMID: 36050690 PMCID: PMC9434514 DOI: 10.1186/s12969-022-00730-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/10/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C) is a febrile syndrome that is observed in the pediatric population following severe acute respiratory syndrome 2 (SARS-CoV-2) infection. Vaccines have prevented or lessened the severity of the initial acute respiratory infection, while their effectiveness against severe MIS-C is just beginning to be reported. CASE PRESENTATION Here we report a fully vaccinated teenage female with no known history of SARS-CoV-2 infection who presented with shock and heart failure. Her presentation was initially thought secondary to a retropharyngeal abscess but was later identified as MIS-C after confirmed nucleocapsid antibody. CONCLUSIONS Given the recent Omicron waves, the ongoing international outbreaks with evolving variants and the continued evolution of the COVID-19 pandemic, this case emphasizes the need to include MIS-C in the differential diagnosis, even in a fully vaccinated, previously healthy child.
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Affiliation(s)
- Andy Liu
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA. .,Division of Critical Care, Vanderbilt University Medical Center, Nashville, TN, USA. .,Monroe Carell Jr Children's Hospital at Vanderbilt, 5121 DOT, 2200 Children's Way, Nashville, TN, 37232, USA.
| | - Alexa Love
- grid.412807.80000 0004 1936 9916Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN USA
| | - Sophie Katz
- grid.412807.80000 0004 1936 9916Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN USA
| | - Anna Patrick
- grid.412807.80000 0004 1936 9916Division of Rheumatology, Vanderbilt University Medical Center, Nashville, TN USA
| | - David Parra
- grid.412807.80000 0004 1936 9916Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN USA
| | - Natasha Halasa
- grid.412807.80000 0004 1936 9916Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN USA
| | - Michael R. Miller
- grid.412807.80000 0004 1936 9916Division of Critical Care, Vanderbilt University Medical Center, Nashville, TN USA
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25
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Abdulsatar F, Miller MR, Taheri S. Use of Unsafe Teething Remedies: A Survey. J Can Dent Assoc 2022; 88:m7. [PMID: 36322634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Various teething remedies have been widely marketed to caregivers. Unsafe remedies, including teething necklaces and topical anesthetics, have been implicated in adverse events, such as suffocation injuries and death. However, little is known about the extent of their use. Our primary objective was to assess the prevalence of teething remedy use among caregivers. A secondary objective was to determine whether the use of unsafe teething remedies is related to socioeconomic status (SES) or maternal education. METHODS Children aged 12-18 months visiting primary care providers for routine checkups were included. Children outside that age group and those with chronic medical conditions were excluded. Caregivers completed a questionnaire about their children's teething symptoms and remedies used to relieve them. Unsafe remedies were defined on the basis of American Academy of Pediatrics and Canadian Paediatric Society recommendations and included topical anesthetics, teething necklaces and liquid-filled teething rings. RESULTS Of the 130 questionnaires, 123 were complete and included in statistical analysis: 98% of families used teething remedies and 67% were unsafe. Of these families, 27% used amber teething necklaces; 28% used more than 1 unsafe remedy. Apart from topical anesthetic use, no significant correlations were found between overall unsafe remedy use and SES or maternal education. CONCLUSION Unsafe teething remedies are commonly used despite recommendations against them. Use of unsafe teething remedies transcends SES and education level.
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26
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Hemstrom WB, Freedman MG, Zalucki MP, Ramírez SR, Miller MR. Population genetics of a recent range expansion and subsequent loss of migration in monarch butterflies. Mol Ecol 2022; 31:4544-4557. [PMID: 35779004 PMCID: PMC9546011 DOI: 10.1111/mec.16592] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 08/30/2021] [Revised: 06/15/2022] [Accepted: 06/22/2022] [Indexed: 11/29/2022]
Abstract
Range expansions—whether permanent or transient—strongly influence the distribution of genetic variation in space. Monarch butterflies are best known for long‐distance seasonal migration within North America but are also established as nonmigratory populations around the world, including on Pacific Islands. Previous research has highlighted stepwise expansion across the Pacific, though questions remain about expansion timing and the population genetic consequences of migration loss. Here, we present reduced‐representation sequencing data for 275 monarchs from North America (n = 85), 12 Pacific Islands (n = 136) and three locations in Australia (n = 54), with the goal of understanding (i) how the monarch's Pacific expansion has shaped patterns of population genetic variation and (ii) how loss of migration has influenced spatial patterns of differentiation. We find support for previously described stepwise dispersal across the Pacific and document an additional expansion from Hawaii into the Mariana Islands. Nonmigratory monarchs within the Mariana Islands show strong patterns of differentiation, despite their proximity; by contrast, migratory North American samples form a single genetically panmictic population across the continent. Estimates of Pacific establishment timing are highly uncertain (~100–1,000,000 years ago) but overlap with historical records that indicate a recent expansion. Our data support (i) a recent expansion across the Pacific whose timing overlaps with available historical records of establishment and (ii) a strong role for seasonal migration in determining patterns of spatial genetic variation. Our results are noteworthy because they demonstrate how the evolution of partial migration can drive population differentiation over contemporary timescales.
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Affiliation(s)
| | - Micah G Freedman
- Department of Evolution and Ecology, University of California, Davis.,Center for Population Biology, University of California, Davis
| | - Myron P Zalucki
- School of Biological Sciences, The University of Queensland, 4072, Australia
| | - Santiago R Ramírez
- Department of Evolution and Ecology, University of California, Davis.,Center for Population Biology, University of California, Davis
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27
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Fraser DD, Miller MR, Martin CM, Slessarev M, Hahn P, Higgins I, Melo C, Pest MA, Rothery N, Wang X, Zeidler J, Cruz-Aguado JA. Cohort-Specific Serological Recognition of SARS-CoV-2 Variant RBD Antigens. Ann Clin Lab Sci 2022; 52:651-662. [PMID: 36197765] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Estimating the response of different population cohorts to new SARS-CoV-2 variants is important to customize measures of control. Our goal was to evaluate how antibodies from sera of infected and vaccinated people recognize antigens expressed by different SARS-CoV-2 variants. METHODS We compared sera from vaccinated donors and four patient/donor cohorts: Sera from critically ill patients collected 2-7 days and more than 10 days after admission to an intensive care unit, a NIBSC/WHO reference panel of SARS-CoV-2 positive individuals, and ambulatory or hospitalized (but not critically ill) positive donors. Samples were tested with an anti-SARS-CoV-2 ELISA kit coated with SARS-CoV-2 RBD recombinant antigens including mutations present in eleven of the most widespread variants. RESULTS Sera from vaccinated individuals exhibited higher antibody binding (P<0.001) than sera from infected (but not critically ill) individuals when tested against the wild type (WT) and each of 11 variants' receptor binding domain (RBD). Antibodies' binding to the SARS-CoV-2 antigens of at least 6 variants, including Variants of Concern (VOCs), was reduced in comparison to the WT in vaccinated and non-critically ill convalescence individuals. CONCLUSION Understanding differences between population cohorts in the antibody titers against WT vs variant RBD antigens can help design variant-specific immunoassays for surveillance and evaluation of the epidemiology of new variants.
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Affiliation(s)
- Douglas D Fraser
- Lawson Health Research Institute, Department of Pediatrics, Western University, Department of Clinical Neurological Sciences, Western University, Department of Physiology & Pharmacology, Western University, London, Ontario, Canada
| | - Michael R Miller
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Pediatrics, Western University, London, Ontario, Canada
| | - Claudio M Martin
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Pediatrics, Western University, London, Ontario, Canada
| | - Marat Slessarev
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Pediatrics, Western University, London, Ontario, Canada
| | - Paul Hahn
- Diagnostics Biochem Canada Inc, London, Ontario, Canada
| | - Ian Higgins
- Diagnostics Biochem Canada Inc, London, Ontario, Canada
| | | | | | - Nate Rothery
- Diagnostics Biochem Canada Inc, London, Ontario, Canada
| | - Xiaoqin Wang
- Diagnostics Biochem Canada Inc, London, Ontario, Canada
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28
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Alkhachroum A, Ganesan SL, Koren JP, Kromm J, Massad N, Reyes RA, Miller MR, Roh D, Agarwal S, Park S, Claassen J. Quantitative EEG-Based Seizure Estimation in Super-Refractory Status Epilepticus. Neurocrit Care 2022; 36:897-904. [PMID: 34791594 PMCID: PMC9987776 DOI: 10.1007/s12028-021-01395-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/04/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The objective of this study was to evaluate the accuracy of seizure burden in patients with super-refractory status epilepticus (SRSE) by using quantitative electroencephalography (qEEG). METHODS EEG recordings from 69 patients with SRSE (2009-2019) were reviewed and annotated for seizures by three groups of reviewers: two board-certified neurophysiologists using only raw EEG (gold standard), two neurocritical care providers with substantial experience in qEEG analysis (qEEG experts), and two inexperienced qEEG readers (qEEG novices) using only a qEEG trend panel. RESULTS Raw EEG experts identified 35 (51%) patients with seizures, accounting for 2950 seizures (3,126 min). qEEG experts had a sensitivity of 93%, a specificity of 61%, a false positive rate of 6.5 per day, and good agreement (κ = 0.64) between both qEEG experts. qEEG novices had a sensitivity of 98.5%, a specificity of 13%, a false positive rate of 15 per day, and fair agreement (κ = 0.4) between both qEEG novices. Seizure burden was not different between the qEEG experts and the gold standard (3,257 vs. 3,126 min), whereas qEEG novices reported higher burden (6066 vs. 3126 min). CONCLUSIONS Both qEEG experts and novices had a high sensitivity but a low specificity for seizure detection in patients with SRSE. qEEG could be a useful tool for qEEG experts to estimate seizure burden in patients with SRSE.
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Affiliation(s)
- Ayham Alkhachroum
- Department of Neurology, Columbia University and NewYork Presbyterian Hospital, New York, NY, USA
- Department of Neurology, University of Miami, Miami, FL, USA
- Department of Neurology, Jackson Memorial Hospital, Miami, FL, USA
| | - Saptharishi Lalgudi Ganesan
- Children's Hospital of Western Ontario, London Health Sciences Centre, London, ON, Canada
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | | | - Julie Kromm
- Departments of Critical Care Medicine and Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Nina Massad
- Department of Neurology, Columbia University and NewYork Presbyterian Hospital, New York, NY, USA
| | - Renz A Reyes
- Department of Neurology, Columbia University and NewYork Presbyterian Hospital, New York, NY, USA
| | - Michael R Miller
- Children's Hospital of Western Ontario, London Health Sciences Centre, London, ON, Canada
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - David Roh
- Department of Neurology, Columbia University and NewYork Presbyterian Hospital, New York, NY, USA
| | - Sachin Agarwal
- Department of Neurology, Columbia University and NewYork Presbyterian Hospital, New York, NY, USA
| | - Soojin Park
- Department of Neurology, Columbia University and NewYork Presbyterian Hospital, New York, NY, USA
| | - Jan Claassen
- Department of Neurology, Columbia University and NewYork Presbyterian Hospital, New York, NY, USA.
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29
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Waples RS, Ford MJ, Nichols K, Kardos M, Myers J, Thompson TQ, Anderson EC, Koch IJ, McKinney G, Miller MR, Naish K, Narum SR, O'Malley KG, Pearse DE, Pess GR, Quinn TP, Seamons TR, Spidle A, Warheit KI, Willis SC. Implications of Large-Effect Loci for Conservation: A Review and Case Study with Pacific Salmon. J Hered 2022; 113:121-144. [PMID: 35575083 DOI: 10.1093/jhered/esab069] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 11/07/2021] [Indexed: 11/13/2022] Open
Abstract
The increasing feasibility of assembling large genomic datasets for non-model species presents both opportunities and challenges for applied conservation and management. A popular theme in recent studies is the search for large-effect loci that explain substantial portions of phenotypic variance for a key trait(s). If such loci can be linked to adaptations, 2 important questions arise: 1) Should information from these loci be used to reconfigure conservation units (CUs), even if this conflicts with overall patterns of genetic differentiation? 2) How should this information be used in viability assessments of populations and larger CUs? In this review, we address these questions in the context of recent studies of Chinook salmon and steelhead (anadromous form of rainbow trout) that show strong associations between adult migration timing and specific alleles in one small genomic region. Based on the polygenic paradigm (most traits are controlled by many genes of small effect) and genetic data available at the time showing that early-migrating populations are most closely related to nearby late-migrating populations, adult migration differences in Pacific salmon and steelhead were considered to reflect diversity within CUs rather than separate CUs. Recent data, however, suggest that specific alleles are required for early migration, and that these alleles are lost in populations where conditions do not support early-migrating phenotypes. Contrasting determinations under the US Endangered Species Act and the State of California's equivalent legislation illustrate the complexities of incorporating genomics data into CU configuration decisions. Regardless how CUs are defined, viability assessments should consider that 1) early-migrating phenotypes experience disproportionate risks across large geographic areas, so it becomes important to identify early-migrating populations that can serve as reliable sources for these valuable genetic resources; and 2) genetic architecture, especially the existence of large-effect loci, can affect evolutionary potential and adaptability.
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Affiliation(s)
- Robin S Waples
- Northwest Fisheries Science Center, National Marine Fisheries Service, 2725 Montlake Blvd. East, Seattle, WA, USA
| | - Michael J Ford
- Northwest Fisheries Science Center, National Marine Fisheries Service, 2725 Montlake Blvd. East, Seattle, WA, USA
| | - Krista Nichols
- Northwest Fisheries Science Center, National Marine Fisheries Service, 2725 Montlake Blvd. East, Seattle, WA, USA
| | | | - Jim Myers
- Northwest Fisheries Science Center, National Marine Fisheries Service, 2725 Montlake Blvd. East, Seattle, WA, USA
| | | | - Eric C Anderson
- Southwest Fisheries Science Center, National Marine Fisheries Service, Santa Cruz, CA, USA
| | - Ilana J Koch
- Columbia River Inter-Tribal Fish Commission, Hagerman, ID, USA
| | - Garrett McKinney
- Northwest Fisheries Science Center, National Marine Fisheries Service, 2725 Montlake Blvd. East, Seattle, WA, USA
- Washington Department of Fish and Wildlife, Olympia, WA, USA
| | | | - Kerry Naish
- School of Aquatic and Fishery Sciences, University of Washington, Seattle, WAUSA
| | - Shawn R Narum
- Columbia River Inter-Tribal Fish Commission, Hagerman, ID, USA
| | | | - Devon E Pearse
- Southwest Fisheries Science Center, National Marine Fisheries Service, Santa Cruz, CA, USA
| | - George R Pess
- Northwest Fisheries Science Center, National Marine Fisheries Service, 2725 Montlake Blvd. East, Seattle, WA, USA
| | - Thomas P Quinn
- School of Aquatic and Fishery Sciences, University of Washington, Seattle, WAUSA
| | - Todd R Seamons
- Washington Department of Fish and Wildlife, Olympia, WA, USA
| | - Adrian Spidle
- Northwest Indian Fisheries Commission, Olympia, WA, USA
| | | | - Stuart C Willis
- Columbia River Inter-Tribal Fish Commission, Hagerman, ID, USA
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30
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Abstract
OBJECTIVES In Canada, critically ill pediatric patients require transfer to a tertiary care center for definitive medical and surgical management. Some studies suggest that family accompaniment could compromise care; currently, limited research has examined patient safety and outcomes during pediatric critical care transport with family presence, and no Canada-specific data currently exists. The primary objective of this study was to compare the rate of adverse events during the transport of pediatric patients by a specialized pediatric critical care transport team with parental accompaniment to those without parental accompaniment. Secondary objectives included whether geographic or patient-specific factors affected rates of parental accompaniment and if parental presence during transport was related to patient outcomes. METHODS Retrospective cohort study in a pediatric critical care unit convenience sample at an academic children's hospital. Inclusion criteria constituted all patients younger than 18 years who were admitted to the pediatric critical care unit after interfacility transport by the London Health Sciences Center Neonatal Pediatric Transport Team between April 1, 2018, and April 30, 2020, inclusive. Adverse event rates, patient characteristics, and clinical outcomes were compared. RESULTS There were 357 transports eligible for analysis. Of these, there were 180 transports with, and 177 without, parental accompaniment. The primary outcome was adverse event occurrence using the composite definition of adverse events, previously defined by a Canadian consensus process, which included patient-, transport provider-, laboratory-, and system/vehicle-related safety factors. The occurrence of adverse events was not significantly different between transports with and without parental accompaniment, 49.4% and 54.8%, respectively (odds ratio, 0.80; P = 0.311). CONCLUSIONS This is the first study to compare the effect on adverse event rate and clinically relevant outcomes between transports with and without parental presence during interfacility pediatric critical care transport. Our study found no significant difference in the adverse event rate between transports with and without parental presence.
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Affiliation(s)
- Aaisham Ali
- From the Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University
| | | | - Saoirse Cameron
- From the Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University
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31
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Miller MR, DiBattista A, Patel MA, Daley M, Tenn C, Nakashima A, Rhind SG, Vartanian O, Shiu MY, Caddy N, Garrett M, Saunders D, Smith I, Jetly R, Fraser DD. A Distinct Metabolite Signature in Military Personnel Exposed to Repetitive Low-Level Blasts. Front Neurol 2022; 13:831792. [PMID: 35463119 PMCID: PMC9021419 DOI: 10.3389/fneur.2022.831792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/10/2022] [Indexed: 11/30/2022] Open
Abstract
Military Breachers and Range Staff (MBRS) are subjected to repeated sub-concussive blasts, and they often report symptoms that are consistent with a mild traumatic brain injury (mTBI). Biomarkers of blast injury would potentially aid blast injury diagnosis, surveillance and avoidance. Our objective was to identify plasma metabolite biomarkers in military personnel that were exposed to repeated low-level or sub-concussive blast overpressure. A total of 37 military members were enrolled (18 MBRS and 19 controls), with MBRS having participated in 8–20 breaching courses per year, with a maximum exposure of 6 blasts per day. The two cohorts were similar except that the number of blast exposures were significantly higher in the MBRS, and the MBRS cohort suffered significantly more post-concussive symptoms and poorer health on assessment. Metabolomics profiling demonstrated significant differences between groups with 74% MBRS classification accuracy (CA). Feature reduction identified 6 metabolites that resulted in a MBRS CA of 98%, and included acetic acid (23.7%), formate (22.6%), creatine (14.8%), acetone (14.2%), methanol (12,7%), and glutamic acid (12.0%). All 6 metabolites were examined with individual receiver operating characteristic (ROC) curve analyses and demonstrated areas-under-the-curve (AUCs) of 0.82–0.91 (P ≤ 0.001) for MBRS status. Several parsimonious combinations of three metabolites increased accuracy of ROC curve analyses to AUCs of 1.00 (P < 0.001), while a combination of volatile organic compounds (VOCs; acetic acid, acetone and methanol) yielded an AUC of 0.98 (P < 0.001). Candidate biomarkers for chronic blast exposure were identified, and if validated in a larger cohort, may aid surveillance and care of military personnel. Future point-of-care screening could be developed that measures VOCs from breath, with definitive diagnoses confirmed with plasma metabolomics profiling.
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Affiliation(s)
- Michael R. Miller
- Lawson Health Research Institute, London, ON, Canada
- Department of Pediatrics, Western University, London, ON, Canada
| | - Alicia DiBattista
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Neurolytix Inc., Toronto, ON, Canada
| | - Maitray A. Patel
- Department of Computer Science, Western University, London, ON, Canada
| | - Mark Daley
- Department of Computer Science, Western University, London, ON, Canada
- The Vector Institute for Artificial Intelligence, Toronto, ON, Canada
| | - Catherine Tenn
- Defence Research and Development Canada, Suffield Research Centre, Medicine Hat, AB, Canada
| | - Ann Nakashima
- Defence Research and Development Canada, Toronto Research Centre, Toronto, ON, Canada
| | - Shawn G. Rhind
- Defence Research and Development Canada, Toronto Research Centre, Toronto, ON, Canada
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, ON, Canada
| | - Oshin Vartanian
- Defence Research and Development Canada, Toronto Research Centre, Toronto, ON, Canada
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Maria Y. Shiu
- Defence Research and Development Canada, Toronto Research Centre, Toronto, ON, Canada
| | - Norleen Caddy
- Defence Research and Development Canada, Suffield Research Centre, Medicine Hat, AB, Canada
| | - Michelle Garrett
- Defence Research and Development Canada, Suffield Research Centre, Medicine Hat, AB, Canada
| | - Doug Saunders
- Defence Research and Development Canada, Toronto Research Centre, Toronto, ON, Canada
| | - Ingrid Smith
- Defence Research and Development Canada, Toronto Research Centre, Toronto, ON, Canada
| | - Rakesh Jetly
- Canadian Forces Health Services, National Defence Headquarters, Ottawa, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Douglas D. Fraser
- Lawson Health Research Institute, London, ON, Canada
- Department of Pediatrics, Western University, London, ON, Canada
- Neurolytix Inc., Toronto, ON, Canada
- Clinical Neurological Sciences, Western University, London, ON, Canada
- Physiology and Pharmacology, Western University, London, ON, Canada
- *Correspondence: Douglas D. Fraser
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32
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Daley M, Cameron S, Ganesan SL, Patel MA, Stewart TC, Miller MR, Alharfi I, Fraser DD. Pediatric severe traumatic brain injury mortality prediction determined with machine learning-based modeling. Injury 2022; 53:992-998. [PMID: 35034778 DOI: 10.1016/j.injury.2022.01.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 01/02/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Severe traumatic brain injury (sTBI) is a leading cause of mortality in children. As clinical prognostication is important in guiding optimal care and decision making, our goal was to create a highly discriminative sTBI outcome prediction model for mortality. METHODS Machine learning and advanced analytics were applied to the patient admission variables obtained from a comprehensive pediatric sTBI database. Demographic and clinical data, head CT imaging abnormalities and blood biochemical data from 196 children and adolescents admitted to a tertiary pediatric intensive care unit (PICU) with sTBI were integrated using feature ranking by way of a forest of randomized decision trees, and a model was generated from a reduced number of admission variables with maximal ability to discriminate outcome. RESULTS In total, 36 admission variables were analyzed using feature ranking with variable weighting to determine their predictive importance for mortality following sTBI. Reduction analysis utilizing Borata feature selection resulted in a parsimonious six-variable model with a mortality classification accuracy of 82%. The final admission variables that predicted mortality were: partial thromboplastin time (22%); motor Glasgow Coma Scale (21%); serum glucose (16%); fixed pupil(s) (16%); platelet count (13%) and creatinine (12%). Using only these six admission variables, a t-distributed stochastic nearest neighbor embedding algorithm plot demonstrated visual separation of sTBI patients that lived or died, with high mortality predictive ability of this model on the validation dataset (AUC = 0.90) which was confirmed with a conventional area-under-the-curve statistical approach on the total dataset (AUC = 0.91; P < 0.001). CONCLUSIONS Machine learning-based modeling identified the most clinically important prognostic factors resulting in a pragmatic, high performing prognostic tool for pediatric sTBI with excellent discriminative ability to predict mortality risk with 82% classification accuracy (AUC = 0.90). After external multicenter validation, our prognostic model might help to guide treatment decisions, aggressiveness of therapy and prepare family members and caregivers for timely end-of-life discussions and decision making. LEVEL OF EVIDENCE III; Prognostic.
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Affiliation(s)
- Mark Daley
- Computer Science, Western University, London, ON N6A 3K7, Canada; The Vector Institute for Artificial Intelligence, Toronto, ON M5G 1M1, Canada.
| | - Saoirse Cameron
- Pediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6A 3K7, Canada.
| | - Saptharishi Lalgudi Ganesan
- Pediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6A 3K7, Canada.
| | - Maitray A Patel
- Computer Science, Western University, London, ON N6A 3K7, Canada.
| | - Tanya Charyk Stewart
- Pediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6A 3K7, Canada; Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, Canada.
| | - Michael R Miller
- Pediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6A 3K7, Canada.
| | - Ibrahim Alharfi
- Pediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6A 3K7, Canada
| | - Douglas D Fraser
- Pediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6A 3K7, Canada; Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, Canada; Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, Canada; NeuroLytix Inc., Toronto, ON M5E 1J8, Canada.
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McKenzie K, Cameron S, Odoardi N, Gray K, Miller MR, Tijssen JA. Evaluation of Local Pediatric Out-of-Hospital Cardiac Arrest and Emergency Services Response. Front Pediatr 2022; 10:826294. [PMID: 35273929 PMCID: PMC8901601 DOI: 10.3389/fped.2022.826294] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/24/2022] [Indexed: 11/30/2022] Open
Abstract
Background Survival after pediatric out-of-hospital cardiac arrest is poor. Paramedic services provide critical interventions that impact survival outcomes. We aimed to describe local pediatric out-of-hospital cardiac arrest (POHCA) events and evaluate the impact of the paramedic service response to POHCA. Methods The Canadian Resuscitation Outcomes Consortium and corresponding ambulance call records were used to evaluate deviations from best practice by paramedics for patients aged 1 day to <18 years who had an atraumatic out-of-hospital cardiac arrest between 2012 and 2020 in Middlesex-London County. Deviations were any departure from protocol as defined by Middlesex-London Paramedic Services. Results Fifty-one patients were included in this study. All POHCA events had at least one deviation, with a total of 188 deviations for the study cohort. Return of spontaneous circulation (ROSC) was achieved in 35.3% of patients and 5.8% survived to hospital discharge. All survivors developed a new, severe neurological impairment. Medication deviations were most common (n = 40, 21.3%) followed by process timing (n = 38, 20.2%), vascular access (n = 27, 14.4%), and airway (n = 27, 14.4%). A delay in vascular access was the most common deviation (n = 25, 49.0%). The median (IQR) time to epinephrine administration was 8.6 (5.90-10.95) min from paramedic arrival. Cardiac arrests occurring in public settings had more deviations than private settings (p = 0.04). ROSC was higher in events with a deviation in any circulation category (p = 0.03). Conclusion Patient and arrest characteristics were similar to other POHCA studies. This cohort exhibited high rates of ROSC and bystander cardiopulmonary resuscitation but low survival to hospital discharge. The study was underpowered for its primary outcome of survival. The total deviations scored was low relative to the total number of tasks in a resuscitation. Epinephrine was frequently administered outside of the recommended timeframe, highlighting an important quality improvement opportunity.
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Affiliation(s)
- Kate McKenzie
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Saoirse Cameron
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Natalya Odoardi
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Katelyn Gray
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Michael R. Miller
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Children's Health Research Institute, Lawson Health Research Institute, London, ON, Canada
| | - Janice A. Tijssen
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Children's Health Research Institute, Lawson Health Research Institute, London, ON, Canada
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Babalola FT, Miller MR, Ens AR, Stein RI, Gallego PH, Clarson CL. Frequency of diabetes team contacts in children and adolescents using insulin pumps. Clinical Diabetology 2022. [DOI: 10.5603/dk.a2022.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Miller MR, Robinson M, Fischer L, DiBattista A, Patel MA, Daley M, Bartha R, Dekaban GA, Menon RS, Shoemaker JK, Diamandis EP, Prassas I, Fraser DD. Putative Concussion Biomarkers Identified in Adolescent Male Athletes Using Targeted Plasma Proteomics. Front Neurol 2022; 12:787480. [PMID: 34987469 PMCID: PMC8721148 DOI: 10.3389/fneur.2021.787480] [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: 09/30/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022] Open
Abstract
Sport concussions can be difficult to diagnose and if missed, they can expose athletes to greater injury risk and long-lasting neurological disabilities. Discovery of objective biomarkers to aid concussion diagnosis is critical to protecting athlete brain health. To this end, we performed targeted proteomics on plasma obtained from adolescent athletes suffering a sports concussion. A total of 11 concussed male athletes were enrolled at our academic Sport Medicine Concussion Clinic, as well as 24 sex-, age- and activity-matched healthy control subjects. Clinical evaluation was performed and blood was drawn within 72 h of injury. Proximity extension assays were performed for 1,472 plasma proteins; a total of six proteins were considered significantly different between cohorts (P < 0.01; five proteins decreased and one protein increased). Receiver operating characteristic curves on the six individual protein biomarkers identified had areas-under-the-curves (AUCs) for concussion diagnosis ≥0.78; antioxidant 1 copper chaperone (ATOX1; AUC 0.81, P = 0.003), secreted protein acidic and rich in cysteine (SPARC; AUC 0.81, P = 0.004), cluster of differentiation 34 (CD34; AUC 0.79, P = 0.006), polyglutamine binding protein 1 (PQBP1; AUC 0.78, P = 0.008), insulin-like growth factor-binding protein-like 1 (IGFBPL1; AUC 0.78, P = 0.008) and cytosolic 5'-nucleotidase 3A (NT5C3A; AUC 0.78, P = 0.009). Combining three of the protein biomarkers (ATOX1, SPARC and NT5C3A), produced an AUC of 0.98 for concussion diagnoses (P < 0.001; 95% CI: 0.95, 1.00). Despite a paucity of studies on these three identified proteins, the available evidence points to their roles in modulating tissue inflammation and regulating integrity of the cerebral microvasculature. Taken together, our exploratory data suggest that three or less novel proteins, which are amenable to a point-of-care immunoassay, may be future candidate biomarkers for screening adolescent sport concussion. Validation with protein assays is required in larger cohorts.
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Affiliation(s)
- Michael R Miller
- Department of Pediatrics, Western University, London, ON, Canada.,Children's Health Research Institute, London, ON, Canada
| | - Michael Robinson
- School of Health Studies, Western University, London, ON, Canada.,School of Kinesiology, Western University, London, ON, Canada.,Department of Family Medicine, Western University, London, ON, Canada
| | - Lisa Fischer
- Department of Family Medicine, Western University, London, ON, Canada
| | - Alicia DiBattista
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Neurolytixs Inc., Toronto, ON, Canada
| | - Maitray A Patel
- Department of Epidemiology, Western University, London, ON, Canada
| | - Mark Daley
- Department of Epidemiology, Western University, London, ON, Canada.,Department of Computer Science, Western University, London, ON, Canada
| | - Robert Bartha
- Department of Medical Biophysics, Western University, London, ON, Canada.,Robarts Research Institute, London, ON, Canada
| | - Gregory A Dekaban
- Robarts Research Institute, London, ON, Canada.,Department of Microbiology and Immunology, Western University, London, ON, Canada
| | - Ravi S Menon
- Department of Medical Biophysics, Western University, London, ON, Canada.,Robarts Research Institute, London, ON, Canada
| | | | | | - Ioannis Prassas
- Department of Pathology and Laboratory Medicine, University of Toronto, Toronto, ON, Canada
| | - Douglas D Fraser
- Department of Pediatrics, Western University, London, ON, Canada.,Children's Health Research Institute, London, ON, Canada.,Neurolytixs Inc., Toronto, ON, Canada.,Department of Physiology and Pharmacology, Western University, London, ON, Canada.,Depatment of Clinical Neurological Sciences, Western University, London, ON, Canada
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Miller MR, Koch SR, Choi H, Lamb FS, Stark RJ. Apoptosis signal-regulating kinase 1 (ASK1) inhibition reduces endothelial cytokine production without improving permeability after toll-like receptor 4 (TLR4) challenge. Transl Res 2021; 235:115-128. [PMID: 33857660 PMCID: PMC8328918 DOI: 10.1016/j.trsl.2021.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 04/05/2021] [Accepted: 04/08/2021] [Indexed: 12/12/2022]
Abstract
Sepsis represents a life-threatening event often mediated by the host's response to pathogens such as gram-negative organisms, which release the proinflammatory lipopolysaccharide (LPS). Within the endothelium, the mitogen-activated protein kinase (MAPK) pathway is an important driver of endothelial injury during sepsis, of which oxidant-sensitive apoptosis signal-regulating kinase 1 (ASK1) is postulated to be a critical upstream regulator. We hypothesized that ASK1 would play a key role in endothelial inflammation during bacterial challenge. Utilizing RNA sequencing data from patients and cultured human microvascular endothelial cells (HMVECs), ASK1 expression was increased in sepsis and after LPS challenge. Two ASK1 inhibitors, GS444217 and MSC2023964A, reduced cytokine production in HMVECs following LPS stimulation, but had no effect on permeability as measured by transendothelial electrical resistance and intercellular space. MAPKs are known to interact with endothelial nitric oxide synthase (eNOS) and ASK1 expression levels correlated with eNOS expression in patients with septic shock. In addition, eNOS physically interacted with ASK1, though this interaction was not altered by ASK1 inhibition, nor did inhibition alter MAPK p38 activity. Instead, among MAPKs, ASK1 inhibition only impaired LPS-induced JNK phosphorylation. The reduction in JNK activation caused by ASK1 inhibition impaired JNK-mediated cytokine production without affecting permeability. Thus, LPS triggers JNK-dependent cytokine production that requires ASK1 activation, but both its effects on permeability and activation of p38 are ASK1-independent. These data demonstrate how distinct MAPK signaling pathways regulate endothelial inflammatory outputs during acute infectious challenge.
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Affiliation(s)
- Michael R Miller
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Stephen R Koch
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hyehun Choi
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Fred S Lamb
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ryan J Stark
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
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Verma R, Mocanu C, Shi J, Miller MR, Chiang J, Wolter NE, Propst EJ, St-Laurent A, Amin R. Decannulation following tracheostomy in children: A systematic review of decannulation protocols. Pediatr Pulmonol 2021; 56:2426-2443. [PMID: 34231976 DOI: 10.1002/ppul.25503] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 04/18/2021] [Accepted: 04/30/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To provide a systematic review of the existing pediatric decannulation protocols, including the role of polysomnography, and their clinical outcomes. METHODS Five online databases were searched from database inception to May 29, 2020. Study inclusion was limited to publications that evaluated tracheostomy decannulation in children 18 years of age and younger. Data extracted included patient demographics and primary indication for tracheostomy. Methods used to assess readiness for decannulation were noted including the use of bronchoscopy, tracheostomy tube modifications, and gas exchange measurements. After decannulation, details regarding mode of ventilation, location, and length of observation period, and clinical outcomes were also collected. Descriptive statistical analyses were performed. RESULTS A total of 24 studies including 1395 children were reviewed. Tracheostomy indications included upper airway obstruction at a well-defined anatomic site (35%), upper airway obstruction not at a well-defined site (12%) and need for long-term ventilation and pulmonary care (53%). Bronchoscopy was routinely used in 23 of 24 (96%) protocols. Tracheostomy tube modifications in the protocols included capping (n = 20, 83%), downsizing (n = 14, 58%), and fenestrations (n = 2, 8%). Measurements of gas exchange included polysomnography (n = 13/18, 72%), oximetry (n = 10/18, 56%), blood gases (n = 3,17%), and capnography (n = 3, 17%). After decannulation, children in 92% of protocols were transitioned to room air. Observation period of 48 h or less was used in 76% of children. CONCLUSIONS There exists large variability in pediatric decannulation protocols. Polysomnography plays an integral role in assessing most children for tracheostomy removal. Evidence-based guidelines to standardize pediatric tracheostomy care remain an urgent priority.
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Affiliation(s)
- Rahul Verma
- Department of Pediatrics, Children's Hospital, Western University, London, Ontario, Canada
| | - Cora Mocanu
- Faculty of Health, York University, Toronto, Ontario, Canada
| | - Jenny Shi
- Division of Respiratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Michael R Miller
- Department of Pediatrics, Children's Hospital, Western University, London, Ontario, Canada
- Children's Health Research Institute, London, Ontario, Canada
| | - Jackie Chiang
- Division of Respiratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Nikolaus E Wolter
- Department of Otolaryngology-Head & Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Evan J Propst
- Department of Otolaryngology-Head & Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Aaron St-Laurent
- Division of Respiratory Medicine, Children's Hospital, Western University, London, Ontario, Canada
| | - Reshma Amin
- Division of Respiratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences (CHES) SickKids Research Institute, Toronto, Ontario, Canada
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38
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Fraser DD, Chen M, Ren A, Miller MR, Martin C, Daley M, Diamandis EP, Prassas I. Novel severe traumatic brain injury blood outcome biomarkers identified with proximity extension assay. Clin Chem Lab Med 2021; 59:1662-1669. [PMID: 34144643 DOI: 10.1515/cclm-2021-0103] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/28/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Severe traumatic brain injury (sTBI) patients suffer high mortality. Accurate prognostic biomarkers have not been identified. In this exploratory study, we performed targeted proteomics on plasma obtained from sTBI patients to identify potential outcome biomarkers. METHODS Blood sample was collected from patients admitted to the ICU suffering a sTBI, using standardized clinical and computerized tomography (CT) imaging criteria. Age- and sex-matched healthy control subjects and sTBI patients were enrolled. Targeted proteomics was performed on plasma with proximity extension assays (1,161 proteins). RESULTS Cohorts were well-balanced for age and sex. The majority of sTBI patients were injured in motor vehicle collisions and the most frequent head CT finding was subarachnoid hemorrhage. Mortality rate for sTBI patients was 40%. Feature selection identified the top performing 15 proteins for identifying sTBI patients from healthy control subjects with a classification accuracy of 100%. The sTBI proteome was dominated by markers of vascular pathology, immunity/inflammation, cell survival and macrophage/microglia activation. Receiver operating characteristic (ROC) curve analyses demonstrated areas-under-the-curves (AUC) for identifying sTBI that ranged from 0.870-1.000 (p≤0.005). When mortality was used as outcome, ROC curve analyses identified the top 3 proteins as Willebrand factor (vWF), Wnt inhibitory factor-1 (WIF-1), and colony stimulating factor-1 (CSF-1). Combining vWF with either WIF-1 or CSF-1 resulted in excellent mortality prediction with AUC of 1.000 for both combinations (p=0.011). CONCLUSIONS Targeted proteomics with feature classification and selection distinguished sTBI patients from matched healthy control subjects. Two protein combinations were identified that accurately predicted sTBI patient mortality. Our exploratory findings require confirmation in larger sTBI patient populations.
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Affiliation(s)
- Douglas D Fraser
- Lawson Health Research Institute, London, ON, Canada.,Pediatrics, Western University, London, ON, Canada.,Clinical Neurological Sciences, Western University, London, ON, Canada.,Physiology and Pharmacology, Western University, London, ON, Canada.,NeuroLytixs Inc., Toronto, ON, Canada
| | - Michelle Chen
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Annie Ren
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Michael R Miller
- Lawson Health Research Institute, London, ON, Canada.,Pediatrics, Western University, London, ON, Canada
| | | | - Mark Daley
- Lawson Health Research Institute, London, ON, Canada
| | - Eleftherios P Diamandis
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada.,Clinical Biochemistry, University Health Network, Toronto, ON, Canada.,Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
| | - Ioannis Prassas
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada.,Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
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Giza SA, Koreman TL, Sethi S, Miller MR, Penava DA, Eastabrook GD, McKenzie CA, de Vrijer B. Water-fat magnetic resonance imaging of adipose tissue compartments in the normal third trimester fetus. Pediatr Radiol 2021; 51:1214-1222. [PMID: 33512538 DOI: 10.1007/s00247-020-04955-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/21/2020] [Accepted: 12/20/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Assessment of fetal adipose tissue gives information about the future metabolic health of an individual, with evidence that the development of this tissue has regional heterogeneity. OBJECTIVE To assess differences in the proton density fat fraction (PDFF) between fetal adipose tissue compartments in the third trimester using water-fat magnetic resonance imaging (MRI). MATERIALS AND METHODS Water-fat MRI was performed in a 1.5-T scanner. Fetal adipose tissue was segmented into cheeks, thorax, abdomen, upper arms, forearms, thighs and lower legs. PDFF and R2* values were measured in each compartment. RESULTS Twenty-eight women with singleton pregnancies were imaged between 28 and 38 weeks of gestation. At 30 weeks' gestation (n=22), the PDFF was statistically different between the compartments (P<0.0001), with the highest PDFF in cheeks, followed by upper arms, thorax, thighs, forearms, lower legs and abdomen. There were no statistical differences in the rate of PDFF change with gestational age between the white adipose tissue compartments (P=0.97). Perirenal brown adipose tissue had a different PDFF and R2* compared to white adipose tissue, while the rate of R2* change did not significantly change with gestational age between white adipose tissue compartments (P=0.96). CONCLUSION Fetal adipose tissue accumulates lipids at a similar rate in all white adipose tissue compartments. PDFF variances between the compartments suggest that accumulation begins at different gestational ages, starting with cheeks, followed by extremities, trunk and abdomen. Additionally, MRI was able to detect differences in the PDFF between fetal brown adipose tissue and white adipose tissue.
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Affiliation(s)
- Stephanie A Giza
- Department of Medical Biophysics, Western University, London, ON, Canada
| | - Tianna L Koreman
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Simran Sethi
- Department of Medical Biophysics, Western University, London, ON, Canada
| | - Michael R Miller
- Division of Maternal, Fetal and Newborn Health, Children's Health Research Institute, London Health Sciences Centre, Victoria Hospital, 800 Commissioner's Road E, Room B2-412, London, ON, N6A 3B4, Canada.,Department of Paediatrics, Western University, London, ON, Canada
| | - Debbie A Penava
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Division of Maternal, Fetal and Newborn Health, Children's Health Research Institute, London Health Sciences Centre, Victoria Hospital, 800 Commissioner's Road E, Room B2-412, London, ON, N6A 3B4, Canada.,Department of Obstetrics and Gynaecology, Western University, London, ON, Canada
| | - Genevieve D Eastabrook
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Division of Maternal, Fetal and Newborn Health, Children's Health Research Institute, London Health Sciences Centre, Victoria Hospital, 800 Commissioner's Road E, Room B2-412, London, ON, N6A 3B4, Canada.,Department of Obstetrics and Gynaecology, Western University, London, ON, Canada
| | - Charles A McKenzie
- Department of Medical Biophysics, Western University, London, ON, Canada.,Division of Maternal, Fetal and Newborn Health, Children's Health Research Institute, London Health Sciences Centre, Victoria Hospital, 800 Commissioner's Road E, Room B2-412, London, ON, N6A 3B4, Canada
| | - Barbra de Vrijer
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. .,Division of Maternal, Fetal and Newborn Health, Children's Health Research Institute, London Health Sciences Centre, Victoria Hospital, 800 Commissioner's Road E, Room B2-412, London, ON, N6A 3B4, Canada. .,Department of Obstetrics and Gynaecology, Western University, London, ON, Canada.
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Affiliation(s)
- Ryan A. Peek
- Center for Watershed Sciences University of California Davis California95616USA
| | - Sean M. O'Rourke
- Department of Animal Science University of California Davis California95616USA
| | - Michael R. Miller
- Department of Animal Science University of California Davis California95616USA
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Fraser DD, Cepinskas G, Slessarev M, Martin CM, Daley M, Patel MA, Miller MR, Patterson EK, O'Gorman DB, Gill SE, Oehler S, Miholits M, Webb B. Detection and Profiling of Human Coronavirus Immunoglobulins in Critically Ill Coronavirus Disease 2019 Patients. Crit Care Explor 2021; 3:e0369. [PMID: 33786445 PMCID: PMC7994038 DOI: 10.1097/cce.0000000000000369] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Coronavirus disease 2019 continues to spread worldwide with high levels of morbidity and mortality. We performed anticoronavirus immunoglobulin G profiling of critically ill coronavirus disease 2019 patients to better define their underlying humoral response. DESIGN Blood was collected at predetermined ICU days to measure immunoglobulin G with a research multiplex assay against four severe acute respiratory syndrome coronavirus 2 proteins/subunits and against all six additionally known human coronaviruses. SETTING Tertiary care ICU and academic laboratory. SUBJECTS ICU patients suspected of being infected with severe acute respiratory syndrome coronavirus 2 had blood collected until either polymerase chain reaction testing was confirmed negative on ICU day 3 (coronavirus disease 2019 negative) or until death or discharge if the patient tested polymerase chain reaction positive (coronavirus disease 2019 positive). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Age- and sex-matched healthy controls and ICU patients who were either coronavirus disease 2019 positive or coronavirus disease 2019 negative were enrolled. Cohorts were well-balanced with the exception that coronavirus disease 2019 positive patients had greater body mass indexes, presented with bilateral pneumonias more frequently, and suffered lower Pao2:Fio2 ratios, when compared with coronavirus disease 2019 negative patients (p < 0.05). Mortality rate for coronavirus disease 2019 positive patients was 50%. On ICU days 1-3, anti-severe acute respiratory syndrome coronavirus 2 immunoglobulin G was significantly elevated in coronavirus disease 2019 positive patients, as compared to both healthy control subjects and coronavirus disease 2019 negative patients (p < 0.001). Weak severe acute respiratory syndrome coronavirus immunoglobulin G serologic responses were also detected, but not other coronavirus subtypes. The four anti-severe acute respiratory syndrome coronavirus 2 immunoglobulin G were maximal by ICU day 3, with all four anti-severe acute respiratory syndrome coronavirus 2 immunoglobulin G providing excellent diagnostic potential (severe acute respiratory syndrome coronavirus 2 Spike 1 protein immunoglobulin G, area under the curve 1.0, p < 0.0005; severe acute respiratory syndrome coronavirus receptor binding domain immunoglobulin G, area under the curve, 0.93-1.0; p ≤ 0.0001; severe acute respiratory syndrome coronavirus 2 Spike proteins immunoglobulin G, area under the curve, 1.0; p < 0.0001; severe acute respiratory syndrome coronavirus 2 Nucleocapsid protein immunoglobulin G area under the curve, 0.90-0.95; p ≤ 0.0003). Anti-severe acute respiratory syndrome coronavirus 2 immunoglobulin G increased and/or plateaued over 10 ICU days. CONCLUSIONS Critically ill coronavirus disease 2019 patients exhibited anti-severe acute respiratory syndrome coronavirus 2 immunoglobulin G, whereas serologic responses to non-severe acute respiratory syndrome coronavirus 2 antigens were weak or absent. Detection of human coronavirus immunoglobulin G against the different immunogenic structural proteins/subunits with multiplex assays may be useful for pathogen identification, patient cohorting, and guiding convalescent plasma therapy.
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Affiliation(s)
- Douglas D Fraser
- Lawson Health Research Institute, London, ON, Canada
- Pediatrics, Western University, London, ON, Canada
- Clinical Neurological Sciences, Western University, London, ON, Canada
- Physiology & Pharmacology, Western University, London, ON, Canada
| | - Gediminas Cepinskas
- Lawson Health Research Institute, London, ON, Canada
- Medical Biophysics, Western University, London, ON, Canada
| | - Marat Slessarev
- Lawson Health Research Institute, London, ON, Canada
- Medicine, Western University, London, ON, Canada
| | - Claudio M Martin
- Lawson Health Research Institute, London, ON, Canada
- Medicine, Western University, London, ON, Canada
| | - Mark Daley
- Lawson Health Research Institute, London, ON, Canada
- Computer Science, Western University, London, ON, Canada
- The Vector Institute for Artificial Intelligence, Toronto, ON, Canada
| | | | - Michael R Miller
- Lawson Health Research Institute, London, ON, Canada
- Pediatrics, Western University, London, ON, Canada
| | | | - David B O'Gorman
- Lawson Health Research Institute, London, ON, Canada
- Surgery, Western University, London, ON, Canada
- Biochemistry, Western University, London, ON, Canada
| | - Sean E Gill
- Lawson Health Research Institute, London, ON, Canada
- Physiology & Pharmacology, Western University, London, ON, Canada
- Medicine, Western University, London, ON, Canada
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Abeytunge K, Miller MR, Cameron S, Stewart TC, Alharfi I, Fraser DD, Tijssen JA. Development of a Mortality Prediction Tool in Pediatric Severe Traumatic Brain Injury. Neurotrauma Rep 2021; 2:115-122. [PMID: 34223549 PMCID: PMC8240826 DOI: 10.1089/neur.2020.0039] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Severe traumatic brain injury (sTBI) is a leading cause of pediatric death, yet outcomes remain difficult to predict. The goal of this study was to develop a predictive mortality tool in pediatric sTBI. We retrospectively analyzed 196 patients with sTBI (pre-sedation Glasgow Coma Scale [GCS] score <8 and head Maximum Abbreviated Injury Scale (MAIS) score >4) admitted to a pediatric intensive care unit (PICU). Overall, 56 patients with sTBI (29%) died during PICU stay. Of the survivors, 88 (63%) were discharged home, and 52 (37%) went to an acute care or rehabilitation facility. Receiver operating characteristic (ROC) curve analyses of admission variables showed that pre-sedation GCS score, Rotterdam computed tomography (CT) score, and partial thromboplastin time (PTT) were fair predictors of PICU mortality (area under the curve [AUC] = 0.79, 0.76, and 0.75, respectively; p < 0.001). Cutoff values best associated with PICU mortality were pre-sedation GCS score <5 (sensitivity = 0.91, specificity = 0.54), Rotterdam CT score >3 (sensitivity = 0.84, specificity = 0.53), and PTT >34.5 sec (sensitivity = 0.69 specificity = 0.67). Combining pre-sedation GCS score, Rotterdam CT score, and PTT in ROC curve analysis yielded an excellent predictor of PICU mortality (AUC = 0.91). In summary, pre-sedation GCS score (<5), Rotterdam CT score (>3), and PTT (>34.5 sec) obtained on hospital admission were fair predictors of PICU mortality, ranked highest to lowest. Combining these three admission variables resulted in an excellent pediatric sTBI mortality prediction tool for further prospective validation.
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Affiliation(s)
- Kawmadi Abeytunge
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Michael R Miller
- Department of Paediatrics, Western University, London, Ontario, Canada.,Children's Health Research Institute, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - Saoirse Cameron
- Department of Paediatrics, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | | | - Ibrahim Alharfi
- Department of Pediatric Critical Care, Children's Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Douglas D Fraser
- Department of Paediatrics, Western University, London, Ontario, Canada.,Children's Health Research Institute, London, Ontario, Canada.,Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
| | - Janice A Tijssen
- Department of Paediatrics, Western University, London, Ontario, Canada.,Children's Health Research Institute, London, Ontario, Canada
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Cowley E, Miller MR, Yin C, Kelly L. Correlation between Medication Administration–Related Errors in Patients with Parkinson Disease and Timing of Pharmacy-Led Best Possible Medication Histories. Can J Hosp Pharm 2021. [DOI: 10.4212/cjhp.v74i1.3036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background: Poor prescribing and incomplete medication administration have been linked to increased lengths of hospitalization for patients with Parkinson disease. The Institute for Safe Medication Practices (ISMP) has recommended that patients with Parkinson disease receive a pharmacy consultation within 2 h of admission to hospital.
Objectives: To examine whether the time for a pharmacy team member to obtain a best possible medication history (BPMH) was associated with administration-related medication errors. The primary outcome was the proportion of doses with a medication error during a patient’s admission in relation to the time to completion of the initial BPMH by a registered pharmacist (RPh) or registered pharmacy technician (RPhT). The secondary objective was to compare the proportion of doses with a medication error in relation to whether the BPMH was completed by an RPh or an RPhT.
Methods: This retrospective chart review involved patients with Parkinson disease who were admitted to the medicine services at London Health Sciences Centre from September 30, 2014, to September 30, 2018. Patients were included if they had Parkinson disease and a medication regimen that included levodopa-carbidopa. For all patients, an RPhT or RPh conducted the initial BPMH or updated the BPMH. Pearson correlation analysis was used to determine whether a correlation existed between administration-related errors and completion of the BPMH by a pharmacy staff member.
Results: A total of 84 patients with 104 admissions were included. There was no significant correlation between the time to completion of the initial BPMH by a pharmacy team member and the proportion of doses with medication errors (p = 0.32). Although RPhTs completed the BPMHs more quickly than RPhs (p < 0.001), there was no significant difference between pharmacy team members in terms of the proportion of doses with medication errors (p = 0.86).
Conclusions: Completing a BPMH within 2 h of a patient’s admission, as per the ISMP recommendation, is unlikely to affect administration-related medication errors, given that no correlation was identified. Expediting BPMH without addressing other factors is insufficient, and initiatives are required to improve the medication administration process.
RÉSUMÉ
Contexte : La mauvaise prescription et l’administration incomplète de médicaments ont été liées à une augmentation de la durée du séjour à l’hôpital des patients atteints de la maladie de Parkinson. L’Institute for Safe Medication Practices (ISMP) a recommandé que les patients atteints de la maladie de Parkinson obtiennent une consultation en pharmacie dans les 2 heures après leur admission à l’hôpital.
Objectifs : Vérifier si le temps d’attente pour l’obtention, par un membre de l’équipe de la pharmacie, du meilleur schéma thérapeutique possible (MSTP) était associé ou non à des erreurs de médication liées à l’administration. Le résultat principal portait sur la proportion des doses comportant une erreur de médication lors de l’admission d’un patient par rapport au temps nécessaire à un pharmacien ou à un technicien en pharmacie autorisés pour réaliser le MSTP initial. L’objectif secondaire visait à comparer la proportion des doses comportant une erreur de médication entre un MSTP réalisé par un pharmacien autorisé et un MSTP réalisé par un technicien en pharmacie autorisé.
Méthodes : Cet examen rétrospectif des dossiers impliquait des patients atteints de la maladie de Parkinson ayant été admis aux services de médecine au London Health Sciences Centre entre le 30 septembre 2014 et le 30 septembre 2018. Les patients pouvaient participer à l’étude s’ils avaient la maladie de Parkinson et qu’ils suivaient un traitement médicamenteux comprenant du lévodopa-carbidopa. Un pharmacien autorisé ou un technicien en pharmacie autorisé réalisait ou actualisait le MSTP initial de tous les patients. La corrélation de Pearson a servi à déterminer s’il existait une corrélation entre les erreurs liées à l’administration et la réalisation du MSTP par un membre du personnel de la pharmacie.
Résultats : Au total, 84 patients correspondant à 104 admissions ont été inclus dans l’étude. Il n’y avait aucune corrélation importante entre le moment de la réalisation du MSTP initial par un membre du personnel de la pharmacie et la proportion des doses comportant des erreurs de médication (p = 0,32). Bien que les techniciens en pharmacie autorisés aient terminé plus rapidement leur MSTP que les pharmaciens autorisés (p < 0,001), aucune différence importante n’a été notée entre les membres du personnel de la pharmacie en termes de proportion des doses et d’erreur de médication (p = 0,86).
Conclusions : Il est peu probable que la réalisation d’un MSTP dans les 2 heures après l’admission d’un patient, conformément à la recommandation de l’ISMP, ait une influence sur les erreurs de médication liées à l’administration, vu qu’aucune corrélation n’a été décelée. Précipiter la réalisation du MSTP sans aborder les autres facteurs ne suffit pas et des actions sont nécessaires pour améliorer le processus d’administration des médicaments.
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Miller MR, Robinson M, Bartha R, Charyk Stewart T, Fischer L, Dekaban GA, Menon RS, Shoemaker JK, Fraser DD. Concussion Acutely Decreases Plasma Glycerophospholipids in Adolescent Male Athletes. J Neurotrauma 2021; 38:1608-1614. [PMID: 33176582 DOI: 10.1089/neu.2020.7125] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Concussions are frequent in sports and can contribute to significant and long-lasting neurological disability. Adolescents are particularly susceptible to concussions, with accurate determination of the injury challenging. Our previous study demonstrated that concussion diagnoses could be aided by metabolomics profiling and machine learning, with particular weighting on changes in plasma glycerophospholipids (PCs). Here, our aim was to report directional change of PCs after concussion and develop a diagnostic concussion panel utilizing a minimum number of plasma PCs. To this end, we enrolled 12 concussed male athletes at our academic Sport Medicine Concussion Clinic, as well as 17 sex-, age-, and activity-matched healthy controls. Blood was drawn and 71 plasma PCs were measured for statistically significant changes within 72 h of injury, and individual PCs were further analyzed with receiver operating characteristic (ROC) curves. Our data demonstrated that 26 of 71 PCs measured were significantly decreased after sports-related concussion (p < 0.01). None of the PCs increased in plasma after concussion. ROC curve analyses identified the top four PCs with areas under the curve (AUCs) ≥0.86 for concussion diagnosis: PCaeC36:0 (0.92; p < 0.001); PCaaC42:6 (0.90; p < 0.001); PCaeC36:2 (0.86; p = 0.001), and PCaaC32:0 (0.86; p = 0.001). Cut-off values in μM were ≤0.31, 0.22, 5.07, and 4.63, respectively. Importantly, combining these four PCs produced an AUC of 0.96 for concussion diagnoses (p < 0.001; 95% confidence interval, 0.89, 1.00). Our data suggest that as few as four circulating PCs may provide excellent diagnostic potential for adolescent concussion. External validation is required in larger cohorts.
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Affiliation(s)
- Michael R Miller
- Pediatrics, Western University, London, Ontario, Canada.,Children's Health Research Institute, London, Ontario, Canada
| | | | - Robert Bartha
- Medical Biophysics, Western University, London, Ontario, Canada.,Robarts Research Institute, London, Ontario, Canada
| | | | - Lisa Fischer
- Family Medicine, Western University, London, Ontario, Canada
| | - Gregory A Dekaban
- Microbiology and Immunology, Western University, London, Ontario, Canada.,Robarts Research Institute, London, Ontario, Canada
| | - Ravi S Menon
- Medical Biophysics, Western University, London, Ontario, Canada.,Robarts Research Institute, London, Ontario, Canada
| | | | - Douglas D Fraser
- Pediatrics, Western University, London, Ontario, Canada.,Physiology and Pharmacology, Western University, London, Ontario, Canada.,Clinical Neurological Sciences, Western University, London, Ontario, Canada.,Children's Health Research Institute, London, Ontario, Canada.,Neurolytixs, Inc., Toronto, Ontario, Canada
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Cowley E, Miller MR, Yin C, Kelly L. Correlation between Medication Administration-Related Errors in Patients with Parkinson Disease and Timing of Pharmacy-Led Best Possible Medication Histories. Can J Hosp Pharm 2021; 74:15-20. [PMID: 33487650 PMCID: PMC7801329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Poor prescribing and incomplete medication administration have been linked to increased lengths of hospitalization for patients with Parkinson disease. The Institute for Safe Medication Practices (ISMP) has recommended that patients with Parkinson disease receive a pharmacy consultation within 2 h of admission to hospital. OBJECTIVES To examine whether the time for a pharmacy team member to obtain a best possible medication history (BPMH) was associated with administration-related medication errors. The primary outcome was the proportion of doses with a medication error during a patient's admission in relation to the time to completion of the initial BPMH by a registered pharmacist (RPh) or registered pharmacy technician (RPhT). The secondary objective was to compare the proportion of doses with a medication error in relation to whether the BPMH was completed by an RPh or an RPhT. METHODS This retrospective chart review involved patients with Parkinson disease who were admitted to the medicine services at London Health Sciences Centre from September 30, 2014, to September 30, 2018. Patients were included if they had Parkinson disease and a medication regimen that included levodopa-carbidopa. For all patients, an RPhT or RPh conducted the initial BPMH or updated the BPMH. Pearson correlation analysis was used to determine whether a correlation existed between administration-related errors and completion of the BPMH by a pharmacy staff member. RESULTS A total of 84 patients with 104 admissions were included. There was no significant correlation between the time to completion of the initial BPMH by a pharmacy team member and the proportion of doses with medication errors (p = 0.32). Although RPhTs completed the BPMHs more quickly than RPhs (p < 0.001), there was no significant difference between pharmacy team members in terms of the proportion of doses with medication errors (p = 0.86). CONCLUSIONS Completing a BPMH within 2 h of a patient's admission, as per the ISMP recommendation, is unlikely to affect administration-related medication errors, given that no correlation was identified. Expediting BPMH without addressing other factors is insufficient, and initiatives are required to improve the medication administration process.
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Affiliation(s)
- Emily Cowley
- , PharmD, ACPR, was, at the time of this study, a Year I Pharmacy Resident at London Health Sciences Centre, London, Ontario. She is now a Pharmacist with Alberta Health Services, Edmonton, Alberta
| | - Michael R Miller
- , PhD, is a Statistician with the Department of Paediatrics and the Children's Health Research Institute, Western University, London, Ontario
| | - Charles Yin
- , PhD, is an MD/PhD candidate with the Schulich School of Medicine and Dentistry, Western University, London, Ontario
| | - Lynne Kelly
- , BScPharm, ACPR, is a Pharmacist with the Victoria Hospital, London Health Sciences Centre, London, Ontario
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Baird TD, Miller MR, Cameron S, Fraser DD, Tijssen JA. Clinical and Physiologic Factors Associated With Mode of Death in Pediatric Severe TBI. Front Pediatr 2021; 9:793008. [PMID: 34966706 PMCID: PMC8710712 DOI: 10.3389/fped.2021.793008] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Aims and Objectives: Severe traumatic brain injury (sTBI) is the leading cause of death in children. Our aim was to determine the mode of death for children who died with sTBI in a Pediatric Critical Care Unit (PCCU) and evaluate factors associated with mortality. Methods: We performed a retrospective cohort study of all severely injured trauma patients (Injury Severity Score ≥ 12) with sTBI (Glasgow Coma Scale [GCS] ≤ 8 and Maximum Abbreviated Injury Scale ≥ 4) admitted to a Canadian PCCU (2000-2016). We analyzed mode of death, clinical factors, interventions, lab values within 24 h of admission (early) and pre-death (48 h prior to death), and reviewed meeting notes in patients who died in the PCCU. Results: Of 195 included patients with sTBI, 55 (28%) died in the PCCU. Of these, 31 (56%) had a physiologic death (neurologic determination of death or cardiac arrest), while 24 (44%) had withdrawal of life-sustaining therapies (WLST). Median (IQR) times to death were 35.2 (11.8, 86.4) hours in the physiologic group and 79.5 (17.6, 231.3) hours in the WLST group (p = 0.08). The physiologic group had higher partial thromboplastin time (PTT) within 24 h of admission (p = 0.04) and lower albumin prior to death (p = 0.04). Conclusions: Almost half of sTBI deaths in the PCCU were by WLST. There was a trend toward a longer time to death in these patients. We found few early and late (pre-death) factors associated with mode of death, namely higher PTT and lower albumin.
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Affiliation(s)
- Talia D Baird
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Michael R Miller
- Department of Paediatrics, Western University, London, ON, Canada.,Children's Health Research Institute, London, ON, Canada
| | - Saoirse Cameron
- Department of Paediatrics, Western University, London, ON, Canada.,Children's Health Research Institute, London, ON, Canada
| | - Douglas D Fraser
- Department of Paediatrics, Western University, London, ON, Canada.,Children's Health Research Institute, London, ON, Canada.,Department of Clinical Neurological Sciences, Western University, London, ON, Canada
| | - Janice A Tijssen
- Department of Paediatrics, Western University, London, ON, Canada.,Children's Health Research Institute, London, ON, Canada.,Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
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Haakman O, Liang T, Murray K, Vilos A, Vilos G, Bates C, Watson AJ, Miller MR, Abu-Rafea B. In vitro fertilization cycles stimulated with follitropin delta result in similar embryo development and quality when compared with cycles stimulated with follitropin alfa or follitropin beta. F S Rep 2020; 2:30-35. [PMID: 34223270 PMCID: PMC8244387 DOI: 10.1016/j.xfre.2020.12.002] [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: 08/06/2020] [Revised: 12/02/2020] [Accepted: 12/10/2020] [Indexed: 11/19/2022] Open
Abstract
Objective To study the impact of follitropin delta for ovarian stimulation on embryo development and quality compared with that of follitropin alfa or beta in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles. Design Retrospective cohort study Setting University-affiliated, hospital-based fertility clinic Patient(s) A total of 403 IVF/ICSI cycles were conducted from September 1, 2018 to December 31, 2019. Cycles were grouped on the basis of stimulation with follitropin delta vs. follitropin alfa or beta. Intervention(s) None. Main Outcome Measure(s) Embryo parameters and clinical pregnancy and implantation rates. Result(s) Ovarian stimulation using follitropin delta resulted in no statistically significant difference in day 3 embryo quality between the control group and follitropin delta group (median 0.50 vs. 0.54 for good quality embryos and median 0.25 vs. 0.20 for intermediate quality embryos). Although on initial analysis there was a lower proportion of good quality blastocysts in the follitropin delta group than in the control group (0.11 vs. 0.22), this difference was no longer present when day 3 after fertilization vitrification and transfer cycles were excluded (0.26 vs. 0.33 follitropin delta vs. control). The clinical pregnancy rates and clinical implantation rates were similar in both groups in fresh transfer cycles. Conclusion(s) Stimulation with follitropin delta in IVF/ICSI cycles resulted in similar embryo development and pregnancy rates compared with those of stimulation with follitropin alfa or beta.
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Affiliation(s)
- Olga Haakman
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Tina Liang
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Kristen Murray
- Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Angelos Vilos
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - George Vilos
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Carlee Bates
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Andrew J. Watson
- Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Michael R. Miller
- Department of Pediatrics, Children’s Health Research Institute, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Basim Abu-Rafea
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, Ontario, Canada
- Reprint requests: Basim Abu-Rafea, M.D., The Fertility Clinic, Victoria Hospital, London Health Sciences Centre, London, Ontario, N6A 5W9.
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Gill SE, Dos Santos CC, O'Gorman DB, Carter DE, Patterson EK, Slessarev M, Martin C, Daley M, Miller MR, Cepinskas G, Fraser DD. Transcriptional profiling of leukocytes in critically ill COVID19 patients: implications for interferon response and coagulation. Intensive Care Med Exp 2020; 8:75. [PMID: 33306162 PMCID: PMC7729690 DOI: 10.1186/s40635-020-00361-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [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: 08/20/2020] [Accepted: 11/19/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND COVID19 is caused by the SARS-CoV-2 virus and has been associated with severe inflammation leading to organ dysfunction and mortality. Our aim was to profile the transcriptome in leukocytes from critically ill patients positive for COVID19 compared to those negative for COVID19 to better understand the COVID19-associated host response. For these studies, all patients admitted to our tertiary care intensive care unit (ICU) suspected of being infected with SARS-CoV-2, using standardized hospital screening methodologies, had blood samples collected at the time of admission to the ICU. Transcriptome profiling of leukocytes via ribonucleic acid sequencing (RNAseq) was then performed and differentially expressed genes as well as significantly enriched gene sets were identified. RESULTS We enrolled seven COVID19 + (PCR positive, 2 SARS-CoV-2 genes) and seven age- and sex-matched COVID19- (PCR negative) control ICU patients. Cohorts were well-balanced with the exception that COVID19- patients had significantly higher total white blood cell counts and circulating neutrophils and COVID19 + patients were more likely to suffer bilateral pneumonia. The mortality rate for this cohort of COVID19 + ICU patients was 29%. As indicated by both single-gene based and gene set (GSEA) approaches, the major disease-specific transcriptional responses of leukocytes in critically ill COVID19 + ICU patients were: (i) a robust overrepresentation of interferon-related gene expression; (ii) a marked decrease in the transcriptional level of genes contributing to general protein synthesis and bioenergy metabolism; and (iii) the dysregulated expression of genes associated with coagulation, platelet function, complement activation, and tumour necrosis factor/interleukin 6 signalling. CONCLUSIONS Our findings demonstrate that critically ill COVID19 + patients on day 1 of admission to the ICU display a unique leukocyte transcriptional profile that distinguishes them from COVID19- patients, providing guidance for future targeted studies exploring novel prognostic and therapeutic aspects of COVID19.
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Affiliation(s)
- Sean E Gill
- Lawson Health Research Institute, London, ON, Canada. .,Physiology and Pharmacology, Western University, London, ON, Canada. .,Medicine, Western University, London, ON, Canada. .,Victoria Research Labs, Room A6-134, 800 Commissioners Road East, London, ON, N6A 5W9, Canada.
| | - Claudia C Dos Santos
- Interdepartmental Division of Critical Care Medicine and Keenan Center for Biomedical Research of St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - David B O'Gorman
- Lawson Health Research Institute, London, ON, Canada.,Biochemistry, Western University, London, ON, Canada
| | - David E Carter
- London Regional Genomics Centre, Western University, London, ON, Canada
| | | | - Marat Slessarev
- Lawson Health Research Institute, London, ON, Canada.,Medicine, Western University, London, ON, Canada
| | - Claudio Martin
- Lawson Health Research Institute, London, ON, Canada.,Medicine, Western University, London, ON, Canada
| | - Mark Daley
- Lawson Health Research Institute, London, ON, Canada.,Computer Science, Western University, London, ON, Canada
| | - Michael R Miller
- Lawson Health Research Institute, London, ON, Canada.,Pediatrics, Western University, London, ON, Canada
| | - Gediminas Cepinskas
- Lawson Health Research Institute, London, ON, Canada.,Medical Biophysics, Western University, London, ON, Canada
| | - Douglas D Fraser
- Lawson Health Research Institute, London, ON, Canada. .,Physiology and Pharmacology, Western University, London, ON, Canada. .,Pediatrics, Western University, London, ON, Canada. .,London Health Sciences Centre, Room C2-C82, 800 Commissioners Road East, London, ON, N6A 5W9, Canada.
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Yeung F, Miller MR, Ojha R, McKelvie B, Poonai N, Bock DE, Cameron S, Taheri S. Saline-Lock Versus Continuous Infusion: Maintaining Peripheral Intravenous Catheter Access in Children. Hosp Pediatr 2020; 10:1038-1043. [PMID: 33172866 DOI: 10.1542/hpeds.2020-0137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES In children, peripheral intravenous catheters (PIVs) are maintained by either a continuous infusion of fluid "to keep vein open" (TKO) or a saline lock (SL). There is a widespread perception that TKO prolongs PIV patency, but there is a lack of evidence for this. We hypothesized that there would be no significant difference in duration of PIV patency between TKO and SL. PATIENTS AND METHODS This prospective, time-allocated study included patients from newborn to 17 years of age admitted to our pediatric ward. Patients enrolled in the first 3 months were assigned to TKO, and patients in the latter 3 months were assigned to SL. Primary outcome was duration of functional patency of the first PIV during the time of TKO or SL. Secondary outcomes included PIV-related complications and patient and caregiver satisfaction. RESULTS Complete PIV data were available on 172 (n = 85 TKO, n = 87 SL) of 194 enrolled patients. The mean (SD) duration of PIV patency was 41.68 (41.71) hours in the TKO group and 44.05 (41.46) hours in the SL group, which was not significantly different (P = .71). There were no significant differences in complication rates or overall patient and caregiver satisfaction. One patient in the TKO group had their PIV removed because of risk of strangulation from tubing. CONCLUSION There were no significant differences between TKO and SL in the duration of PIV patency, complication rates, and overall patient and caregiver satisfaction in our pediatric population. Overall, SL is a safe and reasonable alternative to TKO in maintaining PIV patency in children.
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Affiliation(s)
- Frances Yeung
- Department of Pediatrics, Children's Hospital, London Health Sciences Centre, London, Ontario.,Division of General Academic Pediatrics, Department of Pediatrics, Western University, London, Ontario; and
| | - Michael R Miller
- Department of Pediatrics, Children's Hospital, London Health Sciences Centre, London, Ontario.,Children's Health Research Institute, London, Ontario.,Lawson Health Research Institute, London, Ontario.,Division of General Academic Pediatrics, Department of Pediatrics, Western University, London, Ontario; and
| | - Rahul Ojha
- Department of Pediatrics, Children's Hospital, London Health Sciences Centre, London, Ontario.,Children's Health Research Institute, London, Ontario
| | - Brianna McKelvie
- Department of Pediatrics, Children's Hospital, London Health Sciences Centre, London, Ontario.,Children's Health Research Institute, London, Ontario
| | - Naveen Poonai
- Department of Pediatrics, Children's Hospital, London Health Sciences Centre, London, Ontario.,Children's Health Research Institute, London, Ontario.,Lawson Health Research Institute, London, Ontario.,Division of General Academic Pediatrics, Department of Pediatrics, Western University, London, Ontario; and.,Department of Pediatrics, Children's Hospital, London Health Sciences Centre, London, Ontario.,Internal Medicine, and.,Epidemiology and Biostatistics, London Health Sciences Centre, London, Ontario
| | - Dirk E Bock
- Department of Pediatrics, Children's Hospital, London Health Sciences Centre, London, Ontario.,Children's Health Research Institute, London, Ontario.,Division of General Academic Pediatrics, Department of Pediatrics, Western University, London, Ontario; and
| | - Saoirse Cameron
- Department of Pediatrics, Children's Hospital, London Health Sciences Centre, London, Ontario
| | - Sepideh Taheri
- Department of Pediatrics, Children's Hospital, London Health Sciences Centre, London, Ontario; .,Children's Health Research Institute, London, Ontario.,Lawson Health Research Institute, London, Ontario.,Division of General Academic Pediatrics, Department of Pediatrics, Western University, London, Ontario; and
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Pepping MY, O’Rourke SM, Huang C, Katz JVE, Jeffres C, Miller MR. Rapture facilitates inexpensive and high-throughput parent-based tagging in salmonids. PLoS One 2020; 15:e0239221. [PMID: 33175847 PMCID: PMC7657533 DOI: 10.1371/journal.pone.0239221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 03/26/2020] [Accepted: 09/01/2020] [Indexed: 11/30/2022] Open
Abstract
Accurate methods for tracking individuals are crucial to the success of fisheries and aquaculture management. Management of migratory salmonid populations, which are important for the health of many economies, ecosystems, and indigenous cultures, is particularly dependent on data gathered from tagged fish. However, the physical tagging methods currently used have many challenges including cost, variable marker retention, and information limited to tagged individuals. Genetic tracking methods combat many of the problems associated with physical tags, but have their own challenges including high cost, potentially difficult marker design, and incompatibility of markers across species. Here we show the feasibility of a new genotyping method for parent-based tagging (PBT), where individuals are tracked through the inherent genetic relationships with their parents. We found that Rapture sequencing, a combination of restriction-site associated DNA and capture sequencing, provides sufficient data for parentage assignment. Additionally, the same capture bait set, which targets specific restriction-site associated DNA loci, can be used for both Rainbow Trout Oncorhynchus mykiss and Chinook Salmon Oncorhynchus tshawytscha. We input 248 single nucleotide polymorphisms from 1,121 samples to parentage assignment software and compared parent-offspring relationships of the spawning pairs recorded in a hatchery. Interestingly, our results suggest sperm contamination during hatchery spawning occurred in the production of 14% of offspring, further confirming the need for genetic tagging in accurately tracking individuals. PBT with Rapture successfully assigned progeny to parents with a 98.86% accuracy with sufficient genetic data. Cost for this pilot study was approximately $3 USD per sample. As costs vary based on the number of markers used and individuals sequenced, we expect that when implemented at a large-scale, per sample costs could be further decreased. We conclude that Rapture PBT provides a cost-effective and accurate alternative to the physical coded wire tags, and other genetic-based methods.
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Affiliation(s)
- Michelle Y. Pepping
- Department of Animal Science, University of California, Davis, California, United States of America
- Center for Watershed Sciences, University of California, Davis, California, United States of America
| | - Sean M. O’Rourke
- Department of Animal Science, University of California, Davis, California, United States of America
| | - Connie Huang
- Department of Animal Science, University of California, Davis, California, United States of America
| | - Jacob V. E. Katz
- California Trout, San Francisco, California, United States of America
| | - Carson Jeffres
- Center for Watershed Sciences, University of California, Davis, California, United States of America
| | - Michael R. Miller
- Department of Animal Science, University of California, Davis, California, United States of America
- Center for Watershed Sciences, University of California, Davis, California, United States of America
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