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Hurley C, McArthur J, Gossett JM, Hall EA, Barker PJ, Hijano DR, Hines MR, Kang G, Rains J, Srinivasan S, Suliman A, Qudeimat A, Ghafoor S. Intrapulmonary administration of recombinant activated factor VII in pediatric, adolescent, and young adult oncology and hematopoietic cell transplant patients with pulmonary hemorrhage. Front Oncol 2024; 14:1375697. [PMID: 38680864 PMCID: PMC11055461 DOI: 10.3389/fonc.2024.1375697] [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: 01/24/2024] [Accepted: 03/26/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction Diffuse alveolar hemorrhage (DAH) is a devastating disease process with 50-100% mortality in oncology and hematopoietic cell transplant (HCT) recipients. High concentrations of tissue factors have been demonstrated in the alveolar wall in acute respiratory distress syndrome and DAH, along with elevated levels of tissue factor pathway inhibitors. Activated recombinant factor VII (rFVIIa) activates the tissue factor pathway, successfully overcoming the tissue factor pathway inhibitor (TFPI) inhibition of activation of Factor X. Intrapulmonary administration (IP) of rFVIIa in DAH is described in small case series with successful hemostasis and minimal complications. Methods We completed a single center retrospective descriptive study of treatment with rFVIIa and outcomes in pediatric oncology and HCT patients with pulmonary hemorrhage at a quaternary hematology/oncology hospital between 2011 and 2019. We aimed to assess the safety and survival of patients with pulmonary hemorrhage who received of IP rFVIIa. Results We identified 31 patients with pulmonary hemorrhage requiring ICU care. Thirteen patients received intrapulmonary rFVIIa, while eighteen patients did not. Overall, 13 of 31 patients (41.9%) survived ICU discharge. ICU survival (n=6) amongst those in the IP rFVIIa group was 46.2% compared to 38.9% (n=7) in those who did not receive IP therapy (p=0.69). Hospital survival was 46.2% in the IP group and 27.8% in the non-IP group (p=0.45). There were no adverse events noted from use of IP FVIIa. Conclusions Intrapulmonary rFVIIa can be safely administered in pediatric oncology patients with pulmonary hemorrhage and should be considered a viable treatment option for these patients.
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Affiliation(s)
- Caitlin Hurley
- Department of Pediatrics, Division of Critical Care Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
- Department of Bone Marrow Transplant and Cellular Therapy, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Jennifer McArthur
- Department of Pediatrics, Division of Critical Care Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Jeffrey M. Gossett
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Elizabeth A. Hall
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Patricia J. Barker
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Diego R. Hijano
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, TN, United States
- Department of Pediatrics, University of Tennessee Health and Science Center, Memphis, TN, United States
| | - Melissa R. Hines
- Department of Pediatrics, Division of Critical Care Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Guolian Kang
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Jason Rains
- Department of Pediatrics, Division of Critical Care Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Saumini Srinivasan
- Department of Pediatrics, Division of Pulmonary Medicine, University of Tennessee Health and Science Center, Memphis, TN, United States
| | - Ali Suliman
- Department of Bone Marrow Transplant and Cellular Therapy, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Amr Qudeimat
- Department of Bone Marrow Transplant and Cellular Therapy, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Saad Ghafoor
- Department of Pediatrics, Division of Critical Care Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
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Canavera K, Ghafoor S, Fan K, Cheng C, Jeha S, Pui CH, Elliott A, Morrison RR, Jacola LM. Post-PICU Cognitive and Psychological Outcomes in Children Receiving Treatments for Acute Lymphoblastic Leukemia. Pediatr Crit Care Med 2023; 24:e584-e591. [PMID: 38055007 DOI: 10.1097/pcc.0000000000003340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
OBJECTIVES To examine neurocognitive and psychological outcomes associated with post-PICU admissions in children treated for childhood acute lymphoblastic leukemia (ALL). DESIGN Observational study from October 2007 to March 2017. SETTING Pediatric onco-critical care unit. PATIENTS All patients in this study (n = 296; ages 3-21) were treated for ALL on the St. Jude Total Therapy 16 clinical trial (NCT00549848) from 2007 to 2017. Of these, 104 patients were admitted to the PICU during protocol-directed therapy. All patients completed protocol-directed neurocognitive monitoring prospectively, at the end of cancer-directed therapy. Data on PICU stays were abstracted retrospectively from the medical record. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Demographic and critical illness variables were abstracted from institutional databases and medical records. Neurocognitive and psychosocial outcomes were prospectively obtained at the end of treatment. Children who had a PICU admission experienced significantly lower functioning compared to normative samples in several areas of cognitive functioning (working memory, processing speed, executive functions, inattention, math achievement, fine motor dexterity, and speed), daily living skills, and internalizing problems (all ps < 0.05). Compared with those without PICU admissions, patients with PICU admissions had worse performance on a measure of sustained attention (p = 0.017). The frequency of patients at risk for problems with learning and memory was significantly higher in the PICU group compared with the non-PICU group (25% vs 12%, p = 0.006). Critical illness symptom severity was not associated with neurocognitive or psychological outcomes. CONCLUSIONS Children with ALL, with or without a PICU admission, experienced lower cognitive and psychological outcomes following treatment. Future research is needed to continue identifying risk factors for post-intensive care syndrome (PICS-p) and post-PICU cognitive and psychological impairments in pediatric patients.
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Affiliation(s)
- Kristin Canavera
- Department of Pediatrics, Ochsner Hospital for Children, New Orleans, LA
| | - Saad Ghafoor
- Division of Critical Care Medicine, St. Jude Children's Research Hospital, Memphis, TN
| | - Kimberly Fan
- Division of Critical Care Medicine, St. Jude Children's Research Hospital, Memphis, TN
| | - Cheng Cheng
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Sima Jeha
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Andrew Elliott
- Department of Pediatrics, St. Jude Children's Research Hospital, Memphis, TN
| | - R Ray Morrison
- Division of Critical Care Medicine, St. Jude Children's Research Hospital, Memphis, TN
| | - Lisa M Jacola
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN
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Ghafoor S, Tognella A, Stocker D, Hötker AM, Kaniewska M, Sartoretti T, Euler A, Vonlanthen R, Bueter M, Alkadhi H. Diagnostic performance of CT with Valsalva maneuver for the diagnosis and characterization of inguinal hernias. Hernia 2023; 27:1253-1261. [PMID: 37410196 PMCID: PMC10533612 DOI: 10.1007/s10029-023-02830-y] [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: 04/10/2023] [Accepted: 06/25/2023] [Indexed: 07/07/2023]
Abstract
PURPOSE Inguinal hernias are mainly diagnosed clinically, but imaging can aid in equivocal cases or for treatment planning. The purpose of this study was to evaluate the diagnostic performance of CT with Valsalva maneuver for the diagnosis and characterization of inguinal hernias. METHODS This single-center retrospective study reviewed all consecutive Valsalva-CT studies between 2018 and 2019. A composite clinical reference standard including surgery was used. Three blinded, independent readers (readers 1-3) reviewed the CT images and scored the presence and type of inguinal hernia. A fourth reader measured hernia size. Interreader agreement was quantified with Krippendorff's α coefficients. Sensitivity, specificity, and accuracy of Valsalva-CT for the detection of inguinal hernias was computed for each reader. RESULTS The final study population included 351 patients (99 women) with median age 52.2 years (interquartile range (IQR), 47.2, 68.9). A total of 381 inguinal hernias were present in 221 patients. Sensitivity, specificity, and accuracy were 85.8%, 98.1%, and 91.5% for reader 1, 72.7%, 92.5%, and 81.8% for reader 2, and 68.2%, 96.3%, and 81.1% for reader 3. Hernia neck size was significantly larger in cases correctly detected by all three readers (19.0 mm, IQR 13, 25), compared to those missed by all readers (7.0 mm, IQR, 5, 9; p < 0.001). Interreader agreement was substantial (α = 0.723) for the diagnosis of hernia and moderate (α = 0.522) for the type of hernia. CONCLUSION Valsalva-CT shows very high specificity and high accuracy for the diagnosis of inguinal hernia. Sensitivity is only moderate which is associated with missed smaller hernias.
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Affiliation(s)
- S Ghafoor
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - A Tognella
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - D Stocker
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - A M Hötker
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - M Kaniewska
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - T Sartoretti
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - A Euler
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - R Vonlanthen
- Department of Visceral and Transplantation Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - M Bueter
- Department of Visceral and Transplantation Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - H Alkadhi
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Flerlage T, Fan K, Qin Y, Agulnik A, Arias AV, Cheng C, Elbahlawan L, Ghafoor S, Hurley C, McArthur J, Morrison RR, Zhou Y, Park HJ, Carcillo JA, Hines MR. Mortality Risk Factors in Pediatric Onco-Critical Care Patients and Machine Learning Derived Early Onco-Critical Care Phenotypes in a Retrospective Cohort. Crit Care Explor 2023; 5:e0976. [PMID: 37780176 PMCID: PMC10538916 DOI: 10.1097/cce.0000000000000976] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Abstract
OBJECTIVES To use supervised and unsupervised statistical methodology to determine risk factors associated with mortality in critically ill pediatric oncology patients to identify patient phenotypes of interest for future prospective study. DESIGN This retrospective cohort study included nonsurgical pediatric critical care admissions from January 2017 to December 2018. We determined the prevalence of multiple organ failure (MOF), ICU mortality, and associated factors. Consensus k-means clustering analysis was performed using 35 bedside admission variables for early, onco-critical care phenotype development. SETTING Single critical care unit in a subspeciality pediatric hospital. INTERVENTION None. PATIENTS There were 364 critical care admissions in 324 patients with underlying malignancy, hematopoietic cell transplant, or immunodeficiency reviewed. MEASUREMENTS Prevalence of multiple organ failure, ICU mortality, determination of early onco-critical care phenotypes. MAIN RESULTS ICU mortality was 5.2% and was increased in those with MOF (18.4% MOF, 1.7% single organ failure [SOF], 0.6% no organ failure; p ≤ 0.0001). Prevalence of MOF was 23.9%. Significantly increased ICU mortality risk was associated with day 1 MOF (hazards ratio [HR] 2.27; 95% CI, 1.10-6.82; p = 0.03), MOF during ICU admission (HR 4.16; 95% CI, 1.09-15.86; p = 0.037), and with invasive mechanical ventilation requirement (IMV; HR 5.12; 95% CI, 1.31-19.94; p = 0.018). Four phenotypes were derived (PedOnc1-4). PedOnc1 and 2 represented patient groups with low mortality and SOF. PedOnc3 was enriched in patients with sepsis and MOF with mortality associated with liver and renal dysfunction. PedOnc4 had the highest frequency of ICU mortality and MOF characterized by acute respiratory failure requiring invasive mechanical ventilation at admission with neurologic dysfunction and/or severe sepsis. Notably, most of the mortality in PedOnc4 was early (i.e., within 72 hr of ICU admission). CONCLUSIONS Mortality was lower than previously reported in critically ill pediatric oncology patients and was associated with MOF and IMV. These findings were further validated and expanded by the four derived nonsynonymous computable phenotypes. Of particular interest for future prospective validation and correlative biological study was the PedOnc4 phenotype, which was composed of patients with hypoxic respiratory failure requiring IMV with sepsis and/or neurologic dysfunction at ICU admission.
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Affiliation(s)
- Tim Flerlage
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN
| | - Kimberly Fan
- Division of Critical Care, Department of Pediatrics, MD Anderson Cancer Center, Houston, TX
| | - Yidi Qin
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Asya Agulnik
- Department of Global Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Anita V Arias
- Division of Critical Care, Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Cheng Cheng
- Division of Critical Care, Department Biostatistics, St Jude Children's Research Hospital, Memphis, TN
| | - Lama Elbahlawan
- Division of Critical Care, Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Saad Ghafoor
- Division of Critical Care, Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Caitlin Hurley
- Division of Critical Care, Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Jennifer McArthur
- Division of Critical Care, Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - R Ray Morrison
- Division of Critical Care, Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Yinmei Zhou
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN
| | - H J Park
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Joseph A Carcillo
- Division of Pediatric Critical Care, Department of Critical Care Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Melissa R Hines
- Division of Critical Care, Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
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Ghafoor S, Alkadhi H. Comment to: Diagnostic performance of CT with Valsalva maneuver for the diagnosis and characterization of inguinal hernias. Author's reply. Hernia 2023; 27:1335-1336. [PMID: 37642772 DOI: 10.1007/s10029-023-02867-z] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 08/20/2023] [Indexed: 08/31/2023]
Affiliation(s)
- S Ghafoor
- Diagnostic and Interventional Radiology, University Hospital Zurich, University Zurich, Zurich, Switzerland.
| | - H Alkadhi
- Diagnostic and Interventional Radiology, University Hospital Zurich, University Zurich, Zurich, Switzerland
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Jonas JP, Rössler F, Ghafoor S, Kobe A, Pfammatter T, Schlag C, Gutschow CA, Petrowsky H, Müller PC, Oberkofler CE. Surgical therapy of celiac axis and superior mesenteric artery syndrome. Langenbecks Arch Surg 2023; 408:59. [PMID: 36690823 PMCID: PMC9870837 DOI: 10.1007/s00423-023-02803-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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/20/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Compression syndromes of the celiac artery (CAS) or superior mesenteric artery (SMAS) are rare conditions that are difficult to diagnose; optimal treatment remains complex, and symptoms often persist after surgery. We aim to review the literature on surgical treatment and postoperative outcome in CAS and SMAS syndrome. METHODS A systematic literature review of medical literature databases on the surgical treatment of CAS and SMAS syndrome was performed from 2000 to 2022. Articles were included according to PROSPERO guidelines. The primary endpoint was the failure-to-treat rate, defined as persistence of symptoms at first follow-up. RESULTS Twenty-three studies on CAS (n = 548) and 11 on SMAS (n = 168) undergoing surgery were included. Failure-to-treat rate was 28% for CAS and 21% for SMAS. Intraoperative blood loss was 95 ml (0-217) and 31 ml (21-50), respectively, and conversion rate was 4% in CAS patients and 0% for SMAS. Major postoperative morbidity was 2% for each group, and mortality was described in 0% of CAS and 0.4% of SMAS patients. Median length of stay was 3 days (1-12) for CAS and 5 days (1-10) for SMAS patients. Consequently, 47% of CAS and 5% of SMAS patients underwent subsequent interventions for persisting symptoms. CONCLUSION Failure of surgical treatment was observed in up to every forth patient with a high rate of subsequent interventions. A thorough preoperative work-up with a careful patient selection is of paramount importance. Nevertheless, the surgical procedure was associated with a beneficial risk profile and can be performed minimally invasive.
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Affiliation(s)
- J P Jonas
- Department of Surgery and Transplantation, Swiss HPB & Transplant Center Zurich, University Hospital Zurich, Zurich, Switzerland
| | - F Rössler
- Department of Surgery and Transplantation, Swiss HPB & Transplant Center Zurich, University Hospital Zurich, Zurich, Switzerland
| | - S Ghafoor
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - A Kobe
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - T Pfammatter
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - C Schlag
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - C A Gutschow
- Department of Surgery and Transplantation, Swiss HPB & Transplant Center Zurich, University Hospital Zurich, Zurich, Switzerland
| | - H Petrowsky
- Department of Surgery and Transplantation, Swiss HPB & Transplant Center Zurich, University Hospital Zurich, Zurich, Switzerland
| | - P C Müller
- Department of Surgery and Transplantation, Swiss HPB & Transplant Center Zurich, University Hospital Zurich, Zurich, Switzerland
| | - C E Oberkofler
- Department of Surgery and Transplantation, Swiss HPB & Transplant Center Zurich, University Hospital Zurich, Zurich, Switzerland.
- Vivévis AG-Visceral, Tumor, Robotic Surgery, Clinic Hirslanden, Zurich, Switzerland.
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Aurora T, Joseph N, Bhoopalan SV, Caniza MA, Flerlage T, Ghafoor S, Hankins J, Hijano DR, Jesudas R, Kirkham J, Martinez H, Alfaro GM, Sharma A, Hines M. The successful use of eculizumab for treatment of thrombotic microangiopathy in pediatric acute SARSCoV2 infection and multisystem inflammatory syndrome in children. Haematologica 2022. [PMID: 35615927 PMCID: PMC9521228 DOI: 10.3324/haematol.2021.280603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Tarun Aurora
- Department of Clinical Education, St Jude Children’s Research Hospital
| | - Noel Joseph
- Department of Pediatrics, Clinical Education, University of Tennessee Health Science Center
| | | | - Miguela A Caniza
- Department of Infectious Diseases, St Jude Children’s Research Hospital,Department of Global Pediatric Medicine, St Jude Children’s Research Hospital
| | - Tim Flerlage
- Department of Infectious Diseases, St Jude Children’s Research Hospital
| | - Saad Ghafoor
- Department of Pediatric Medicine, Division of Critical Care, St Jude Children’s Research Hospital
| | - Jane Hankins
- Department of Hematology, St Jude Children’s Research Hospital
| | - Diego R Hijano
- Department of Infectious Diseases, St Jude Children’s Research Hospital
| | - Rohith Jesudas
- Department of Hematology, St Jude Children’s Research Hospital
| | - Justin Kirkham
- Department of Clinical Education, St Jude Children’s Research Hospital
| | - Hugo Martinez
- Department of Pediatrics, Division of Cardiology, University of Tennessee Health Science Center and
| | | | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St Jude Children’s Research Hospital, Memphis, TN, USA
| | - Melissa Hines
- Department of Pediatric Medicine, Division of Critical Care, St Jude Children’s Research Hospital,M. HINES -
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Aurora T, Joseph N, Bhoopalan SV, Caniza MA, Flerlage T, Ghafoor S, Hankins J, Hijano DR, Jesudas R, Kirkham J, Martinez H, Alfaro GM, Sharma A, Hines M. The successful use of eculizumab for treatment of thrombotic microangiopathy in pediatric acute SARS-CoV2 infection and multisystem inflammatory syndrome in children. Haematologica 2022; 107:2517-2522. [PMID: 35615927 DOI: 10.3324/haematol.2022.280603] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Indexed: 11/09/2022] Open
Abstract
Not available.
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Affiliation(s)
- Tarun Aurora
- Department of Clinical Education, St Jude Children's Research Hospital, Memphis, TN
| | - Noel Joseph
- Department of Pediatrics, Clinical Education, University of Tennessee Health Science Center, Memphis, TN
| | | | - Miguela A Caniza
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN; Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Tim Flerlage
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN
| | - Saad Ghafoor
- Department of Pediatric Medicine, Division of Critical Care, St Jude Children's Research Hospital, Memphis, TN
| | - Jane Hankins
- Department of Hematology, St Jude Children's Research Hospital, Memphis, TN
| | - Diego R Hijano
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN
| | - Rohith Jesudas
- Department of Hematology, St Jude Children's Research Hospital, Memphis, TN
| | - Justin Kirkham
- Department of Clinical Education, St Jude Children's Research Hospital, Memphis, TN
| | - Hugo Martinez
- Department of Pediatrics, Division of Cardiology, University of Tennessee Health Science Center, Memphis, TN
| | - Gabriela Maron Alfaro
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN
| | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St Jude Children's Research Hospital, Memphis, TN
| | - Melissa Hines
- Department of Pediatric Medicine, Division of Critical Care, St Jude Children's Research Hospital, Memphis, TN.
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Di Nardo M, Ahmad AH, Merli P, Zinter MS, Lehman LE, Rowan CM, Steiner ME, Hingorani S, Angelo JR, Abdel-Azim H, Khazal SJ, Shoberu B, McArthur J, Bajwa R, Ghafoor S, Shah SH, Sandhu H, Moody K, Brown BD, Mireles ME, Steppan D, Olson T, Raman L, Bridges B, Duncan CN, Choi SW, Swinford R, Paden M, Fortenberry JD, Peek G, Tissieres P, De Luca D, Locatelli F, Corbacioglu S, Kneyber M, Franceschini A, Nadel S, Kumpf M, Loreti A, Wösten-Van Asperen R, Gawronski O, Brierley J, MacLaren G, Mahadeo KM. Extracorporeal membrane oxygenation in children receiving haematopoietic cell transplantation and immune effector cell therapy: an international and multidisciplinary consensus statement. Lancet Child Adolesc Health 2022; 6:116-128. [PMID: 34895512 PMCID: PMC9372796 DOI: 10.1016/s2352-4642(21)00336-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/12/2021] [Accepted: 10/19/2021] [Indexed: 01/03/2023]
Abstract
Use of extracorporeal membrane oxygenation (ECMO) in children receiving haematopoietic cell transplantation (HCT) and immune effector cell therapy is controversial and evidence-based guidelines have not been established. Remarkable advancements in HCT and immune effector cell therapies have changed expectations around reversibility of organ dysfunction and survival for affected patients. Herein, members of the Extracorporeal Life Support Organization (ELSO), Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network (HCT and cancer immunotherapy subgroup), the Pediatric Diseases Working Party of the European Society for Blood and Marrow Transplantation (EBMT), the supportive care committee of the Pediatric Transplantation and Cellular Therapy Consortium (PTCTC), and the Pediatric Intensive Care Oncology Kids in Europe Research (POKER) group of the European Society of Pediatric and Neonatal Intensive Care (ESPNIC) provide consensus recommendations on the use of ECMO in children receiving HCT and immune effector cell therapy. These are the first international, multidisciplinary consensus-based recommendations on the use of ECMO in this patient population. This Review provides a clinical decision support tool for paediatric haematologists, oncologists, and critical care physicians during the difficult decision-making process of ECMO candidacy and management. These recommendations can represent a base for future research studies focused on ECMO selection criteria and bedside management.
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Affiliation(s)
- Matteo Di Nardo
- Pediatric Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Ali H Ahmad
- Department of Pediatrics, Pediatric Critical Care, Houston, TX, USA
| | - Pietro Merli
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Matthew S Zinter
- Department of Pediatrics, Divisions of Critical Care and Bone Marrow Transplantation, University of California, San Francisco, CA, USA
| | - Leslie E Lehman
- Pediatric Hematology-Oncology, Dana-Farber Cancer Institute, Harvard University, Boston, MA, USA
| | - Courtney M Rowan
- Department of Pediatrics, Division of Critical Care, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN, USA
| | - Marie E Steiner
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Sangeeta Hingorani
- Department of Pediatrics, Division of Nephrology, University of Washington School of Medicine, and the Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Joseph R Angelo
- Renal Section, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Hisham Abdel-Azim
- Department of Pediatrics, Transplantation and Cell Therapy Program, Keck School of Medicine, University of Southern California, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Sajad J Khazal
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapy, Houston, TX, USA; The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Basirat Shoberu
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapy, Houston, TX, USA; The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jennifer McArthur
- Division of Critical Care Medicine, Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Rajinder Bajwa
- Department of Pediatrics, Division of Blood and Marrow Transplantation, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Saad Ghafoor
- Division of Critical Care Medicine, Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Samir H Shah
- Division of Pediatric Critical Care Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Hitesh Sandhu
- Division of Pediatric Critical Care Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Karen Moody
- CARTOX Program, and Department of Pediatrics, Supportive Care, Houston, TX, USA
| | - Brandon D Brown
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapy, Houston, TX, USA; The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Diana Steppan
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Taylor Olson
- Division of Critical Care Medicine, Children's National Hospital, Washington, DC, USA
| | - Lakshmi Raman
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Brian Bridges
- Division of Pediatric Critical Care, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Christine N Duncan
- Pediatric Hematology-Oncology, Dana-Farber Cancer Institute, Harvard University, Boston, MA, USA
| | - Sung Won Choi
- University of Michigan, Rogel Cancer Center, Ann Arbor, MI, USA; Department of Pediatrics, Ann Arbor, MI, USA
| | - Rita Swinford
- Department of Pediatrics, Division of Pediatric Nephrology, McGovern Medical School, The University of Texas Health Science Center, Houston, TX, USA
| | - Matt Paden
- Pediatric Critical Care, Children's Healthcare of Atlanta, and Emory University School of Medicine, Atlanta, GA, USA
| | - James D Fortenberry
- Pediatric Critical Care, Children's Healthcare of Atlanta, and Emory University School of Medicine, Atlanta, GA, USA
| | - Giles Peek
- Congenital Heart Center, University of Florida, Gainesville, FL, USA
| | - Pierre Tissieres
- Division of Pediatric Intensive Care and Neonatal Medicine, Paris South University Hospital, Le Kremlin-Bicetre, France; Institute of Integrative Biology of the Cell, CNRS, CEA, Univ. Paris Sud, Paris Saclay University, Paris, France
| | - Daniele De Luca
- Division of Pediatrics, Transportation and Neonatal Critical Care Medicine, APHP, Paris Saclay University Hospital, "A.Beclere" Medical Center and Physiopathology and Therapeutic Innovation Unit-INSERM-U999, Paris Saclay University, Paris, France
| | - Franco Locatelli
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Selim Corbacioglu
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University of Regensburg, Regensburg, Germany
| | - Martin Kneyber
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Beatrix Children's Hospital Groningen, Groningen, Netherlands; Critical Care, Anesthesiology, Peri-Operative and Emergency Medicine (CAPE), University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Alessio Franceschini
- Department of Cardiosurgery, Cardiology, Heart and Lung Transplant, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Simon Nadel
- Pediatric Intensive Care Unit, Imperial College Healthcare NHS Trust, London, UK
| | - Matthias Kumpf
- Interdisciplinary Pediatric Intensive Care Unit, Universitäetsklinikum Tuebingen, Tuebingen, Germany
| | - Alessandra Loreti
- Medical Library, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Roelie Wösten-Van Asperen
- Department of Pediatric Intensive Care, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, Netherlands
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Joe Brierley
- Department of Pediatric Intensive Care, Great Ormond Street Hospital for Children, London, UK
| | - Graeme MacLaren
- Director of Cardiothoracic ICU, National University Health System, Singapore, Singapore; Pediatric Intensive Care Unit, The Royal Children's Hospital, Melbourne, Australia
| | - Kris M Mahadeo
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapy, Houston, TX, USA; The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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10
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Ghafoor S, Fan K, Di Nardo M, Talleur AC, Saini A, Potera RM, Lehmann L, Annich G, Wang F, McArthur J, Sandhu H. Extracorporeal Membrane Oxygenation Candidacy in Pediatric Patients Treated With Hematopoietic Stem Cell Transplant and Chimeric Antigen Receptor T-Cell Therapy: An International Survey. Front Oncol 2022; 11:798236. [PMID: 35004323 PMCID: PMC8727600 DOI: 10.3389/fonc.2021.798236] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/06/2021] [Indexed: 01/03/2023] Open
Abstract
Introduction Pediatric patients who undergo hematopoietic cell transplant (HCT) or chimeric antigen receptor T-cell (CAR-T) therapy are at high risk for complications leading to organ failure and the need for critical care resources. Extracorporeal membrane oxygenation (ECMO) is a supportive modality that is used for cardiac and respiratory failure refractory to conventional therapies. While the use of ECMO is increasing for patients who receive HCT, candidacy for these patients remains controversial. We therefore surveyed pediatric critical care and HCT providers across North America and Europe to evaluate current provider opinions and decision-making and institutional practices regarding ECMO use for patients treated with HCT or CAR-T. Methods An electronic twenty-eight question survey was distributed to pediatric critical care and HCT providers practicing in North America (United States and Canada) and Europe through the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network and individual emails. Responses to the survey were recorded in a REDCap® database. Results Two-hundred and ten participants completed the survey. Of these, 159 (76%) identified themselves as pediatric critical care physicians and 47 (22%) as pediatric HCT physicians or oncologists. The majority (99.5%) of survey respondents stated that they would consider patients treated with HCT or CAR-T therapy as candidates for ECMO support. However, pediatric critical care physicians identified more absolute and relative contraindications for ECMO than non-pediatric critical care physicians. While only 0.5% of respondents reported that they consider HCT as an absolute contraindication for ECMO, 6% of respondents stated that ECMO is contraindicated in HCT patients within their institution and only 23% have an institutional protocol or policy to guide the evaluation for ECMO candidacy of these patients. Almost half (49.1%) of respondents would accept a survival to hospital discharge of 20-30% for pediatric HCT patients requiring ECMO as adequate. Conclusions ECMO use for pediatric patients treated with HCT and CAR-T therapy is generally acceptable amongst physicians. However, there are differences in the evaluation and decision-making regarding ECMO candidacy amongst providers across medical specialties and institutions. Therefore, multidisciplinary collaboration is an essential component in establishing practice guidelines and advancing ECMO outcomes for these patients.
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Affiliation(s)
- Saad Ghafoor
- Department of Pediatric Medicine, Division of Critical Care, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Kimberly Fan
- Department of Pediatric Medicine, Division of Critical Care, St. Jude Children's Research Hospital, Memphis, TN, United States.,Division of Pediatric Critical Care, University of Tennessee (IT) Health Science Center, Memphis, TN, United States
| | - Matteo Di Nardo
- Pediatric Intensive Care Unit, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Aimee C Talleur
- Department of Bone Marrow Transplant and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Arun Saini
- Division of Pediatric Critical Care, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, United States
| | - Renee M Potera
- Division of Pediatric Critical Care, University of Tennessee (UT) Southwestern Medical Center, Dallas, TX, United States
| | - Leslie Lehmann
- Pediatric Hematology-Oncology, Dana Farber Boston Children's Cancer and Blood Disorder Center, Boston, MA, United States
| | - Gail Annich
- Department of Critical Care Medicine, University of Toronto/The Hospital for Sick Children, Toronto, ON, Canada
| | - Fang Wang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Jennifer McArthur
- Department of Pediatric Medicine, Division of Critical Care, St. Jude Children's Research Hospital, Memphis, TN, United States.,Division of Pediatric Critical Care, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Hitesh Sandhu
- Division of Pediatric Critical Care, University of Tennessee (IT) Health Science Center, Memphis, TN, United States
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11
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Malik S, Rashid M, Javid A, Hussain A, Bukhari SM, Suleman S, Noor R, Husaain S, Ismat N, Hussain M, Ghafoor S, Mustafa G, Ali W. Genetic variations and phylogenetic relationship of genus Uromastyx from Punjab Pakistan. BRAZ J BIOL 2021; 84:e254253. [PMID: 34816973 DOI: 10.1590/1519-6984.254253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/24/2021] [Indexed: 11/22/2022] Open
Abstract
During the present study, specimens were collected from selected sites of Cholistan desert and Kalabagh Game Reserve, Punjab province, Pakistan. Each captured specimen was tagged with voucher number and morphometric measurements were taken. The average snout to vent length was 172.559±1.40 mm and average weight was 92.1±1.30 g. The DNA of Uromastyx hardwickii was amplified and sequenced using 16S rRNA primer set. The obtained DNA sequence has shown reliable and clear species identification. After trimming ambiguous bases, the obtained 16S rRNA fragment was 520 bp while 16S rRNA fragments aligned with closely matched sequence from NCBI comprised of 510 bp. Closely matched sequences of genus Uromastyx were retrieved from NCBI in blast searches. Neighbour-joining tree of genus Uromastyx was constructed based on p-distance using MEGA X. The mean intraspecific variation was 0.095±0.01 while intraspecific variation was ranging from 0-1%. Similarly, interspecific variation of Uromastyx hardwikii with Saara asmussi, Uromastyx alfredschmidti, Uromastyx geyri, Uromastyx thomasi, Uromastyx alfredschmidti was 0-12%, 0-19%, 0-19%, 0-20%, 12-19% respectively. The newly produced DNA was submitted to NCBI and accession number was obtained (MW052563.1). Results of current study provided information about the molecular and morphological identification of Genus Uromastyx. In our recommendation, comprehensive molecular based identification of Pakistan's reptiles is required to report any new or subspecies from country.
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Affiliation(s)
- S Malik
- University of Veterinary and Animal Sciences, Department of Wildlife and Ecology, Lahore, Pakistan
| | - M Rashid
- University of Veterinary and Animal Sciences, Faculty of Fisheries and Wildlife, Lahore, Pakistan
| | - A Javid
- University of Veterinary and Animal Sciences, Department of Wildlife and Ecology, Lahore, Pakistan
| | - A Hussain
- University of Veterinary and Animal Sciences, Department of Wildlife and Ecology, Lahore, Pakistan
| | - S M Bukhari
- University of Veterinary and Animal Sciences, Department of Wildlife and Ecology, Lahore, Pakistan
| | - S Suleman
- University of Veterinary and Animal Sciences, Department of Wildlife and Ecology, Lahore, Pakistan
| | - R Noor
- University of Veterinary and Animal Sciences, Department of Wildlife and Ecology, Lahore, Pakistan
| | - S Husaain
- University of Veterinary and Animal Sciences, Department of Wildlife and Ecology, Lahore, Pakistan
| | - N Ismat
- The University of Lahore, Institue of Molecular Biology and Biotechnology - IMBB, Pakistan
| | - M Hussain
- University of Veterinary and Animal Sciences, Department of Wildlife and Ecology, Lahore, Pakistan
| | - S Ghafoor
- University of Veterinary and Animal Sciences, Department of Wildlife and Ecology, Lahore, Pakistan
| | - G Mustafa
- University of Veterinary and Animal Sciences, Department of Wildlife and Ecology, Lahore, Pakistan
| | - W Ali
- University of Veterinary and Animal Sciences, Department of Wildlife and Ecology, Lahore, Pakistan
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12
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Emery MV, Bolhofner K, Ghafoor S, Winingear S, Buikstra JE, Fulginiti LC, Stone AC. Whole mitochondrial genomes assembled from thermally altered forensic bones and teeth. Forensic Sci Int Genet 2021; 56:102610. [PMID: 34735939 DOI: 10.1016/j.fsigen.2021.102610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/29/2021] [Accepted: 10/18/2021] [Indexed: 12/17/2022]
Abstract
The recovery and analysis of genetic material obtained from thermally altered human bones and teeth are increasingly important to forensic investigations, especially in cases where soft-tissue identification is no longer possible. Although little is known about how these fire-related processes affect DNA degradation over time, next-generation sequencing technology in combination with traditional osteobiographical applications may provide us clues to these questions. In this study, we compare whole mitochondrial genome data generated using two different DNA extraction methods from 27 thermally altered samples obtained from fire victims (Maricopa County, Arizona) . DNA extracts were converted to double-stranded DNA libraries and enriched for whole mitochondrial DNA (mtDNA) using synthetic biotinylated RNA baits, then sequenced on an Illumina MiSeq. We processed the mitochondrial data using an in-house computational pipeline (MitoPipe1.0) composed of ancient DNA and modern genomics applications, then compared the resulting information across the two extraction types and five burn categories. Our analysis shows that DNA fragmentation increases with temperature, but that the acute insult from fire combined with the lack of water is insufficient to produce 5' and 3' terminal deamination characteristic of ancient DNA. Our data also suggest an acute and significant point of DNA degradation between 350 °C and 550 °C, and that the likelihood of generating high quality mtDNA haplogroup calls decreases significantly at temperatures > 550 °C. This research is part of a concerted effort to understand how fire affects our ability to generate genetic profiles suitable for forensic identification purposes.
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Affiliation(s)
- M V Emery
- School of Human Evolution and Social Change, Arizona State University, United States; Center for Evolution and Medicine, Arizona State University, United States.
| | - K Bolhofner
- School of Human Evolution and Social Change, Arizona State University, United States; Center for Bioarchaeology, Arizona State University, United States; Maricopa County Office of the Medical Examiner, Phoenix, AZ, United States; School of Life Sciences, Arizona State University, United States; School of Mathematical and Natural Sciences, Arizona State University, United States
| | - S Ghafoor
- Center for Evolution and Medicine, Arizona State University, United States; School of Life Sciences, Arizona State University, United States
| | - S Winingear
- School of Human Evolution and Social Change, Arizona State University, United States; Center for Evolution and Medicine, Arizona State University, United States; School of Life Sciences, Arizona State University, United States
| | - J E Buikstra
- School of Human Evolution and Social Change, Arizona State University, United States; Center for Evolution and Medicine, Arizona State University, United States; Center for Bioarchaeology, Arizona State University, United States; School of Life Sciences, Arizona State University, United States
| | - L C Fulginiti
- School of Human Evolution and Social Change, Arizona State University, United States; Maricopa County Office of the Medical Examiner, Phoenix, AZ, United States; School of Life Sciences, Arizona State University, United States
| | - A C Stone
- School of Human Evolution and Social Change, Arizona State University, United States; Center for Evolution and Medicine, Arizona State University, United States; Center for Bioarchaeology, Arizona State University, United States.
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13
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Ghafoor S, Fan K, Williams S, Brown A, Bowman S, Pettit KL, Gorantla S, Quillivan R, Schwartzberg S, Curry A, Parkhurst L, James M, Smith J, Canavera K, Elliott A, Frett M, Trone D, Butrum-Sullivan J, Barger C, Lorino M, Mazur J, Dodson M, Melancon M, Hall LA, Rains J, Avent Y, Burlison J, Wang F, Pan H, Lenk MA, Morrison RR, Kudchadkar SR. Beginning Restorative Activities Very Early: Implementation of an Early Mobility Initiative in a Pediatric Onco-Critical Care Unit. Front Oncol 2021; 11:645716. [PMID: 33763377 PMCID: PMC7982584 DOI: 10.3389/fonc.2021.645716] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 12/23/2020] [Accepted: 02/01/2021] [Indexed: 12/23/2022] Open
Abstract
Introduction Children with underlying oncologic and hematologic diseases who require critical care services have unique risk factors for developing functional impairments from pediatric post-intensive care syndrome (PICS-p). Early mobilization and rehabilitation programs offer a promising approach for mitigating the effects of PICS-p in oncology patients but have not yet been studied in this high-risk population. Methods We describe the development and feasibility of implementing an early mobility quality improvement initiative in a dedicated pediatric onco-critical care unit. Our primary outcomes include the percentage of patients with consults for rehabilitation services within 72 h of admission, the percentage of patients who are mobilized within 72 h of admission, and the percentage of patients with a positive delirium screen after 48 h of admission. Results Between January 2019 and June 2020, we significantly increased the proportion of patients with consults ordered for rehabilitation services within 72 h of admission from 25 to 56% (p<0.001), increased the percentage of patients who were mobilized within 72 h of admission to the intensive care unit from 21 to 30% (p=0.02), and observed a decrease in patients with positive delirium screens from 43 to 37% (p=0.46). The early mobility initiative was not associated with an increase in unplanned extubations, unintentional removal of central venous catheters, or injury to patient or staff. Conclusions Our experience supports the safety and feasibility of early mobility initiatives in pediatric onco-critical care. Additional evaluation is needed to determine the effects of early mobilization on patient outcomes.
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Affiliation(s)
- Saad Ghafoor
- Division of Critical Care Medicine, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Kimberly Fan
- Department of Pediatric Critical Care, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Sarah Williams
- Division of Critical Care Medicine, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Amanda Brown
- Division of Critical Care Medicine, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Sarah Bowman
- Division of Critical Care Medicine, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Kenneth L Pettit
- Office of Quality and Patient Care, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Shilpa Gorantla
- Office of Quality and Patient Care, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Rebecca Quillivan
- Office of Quality and Patient Care, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Sarah Schwartzberg
- Department of Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Amanda Curry
- Department of Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Lucy Parkhurst
- Department of Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Marshay James
- Division of Critical Care Medicine, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Jennifer Smith
- Department of Child Life, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Kristin Canavera
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Andrew Elliott
- Division of Psychiatry, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Michael Frett
- Division of Anesthesiology, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Deni Trone
- Department of Pharmaceutical Services, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Jacqueline Butrum-Sullivan
- Department Critical Care/Pulmonary Medicine-Respiratory Therapy, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Cynthia Barger
- Department of Inpatient Units-Nursing, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Mary Lorino
- Department of Inpatient Units-Nursing, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Jennifer Mazur
- Department of Nursing Administration- Nursing Education, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Mandi Dodson
- Department of Nursing Administration- Nursing Education, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Morgan Melancon
- Department of Nursing Administration- Nursing Education, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Leigh Anne Hall
- Department of Inpatient Units-Nursing, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Jason Rains
- Department Critical Care/Pulmonary Medicine-Respiratory Therapy, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Yvonne Avent
- Division of Critical Care Medicine, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Jonathan Burlison
- Department of Pharmaceutical Sciences- Patient Safety, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Fang Wang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Haitao Pan
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Mary Anne Lenk
- Department of Quality Improvement Education and Training, Cincinnati Children's Hospital- James M. Anderson Center for Health Systems Excellence, Cincinnati, OH, United States
| | - R Ray Morrison
- Division of Critical Care Medicine, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Sapna R Kudchadkar
- Departments of Anesthesiology and Critical Care Medicine, Pediatrics and Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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14
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Ghafoor S, Grigg NP, Mathrani S, Mann R. A bibliometric and thematic review of business excellence journal papers from 1990 to 2020. Total Quality Management & Business Excellence 2020. [DOI: 10.1080/14783363.2020.1847638] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Saad Ghafoor
- Department of Operations and Engineering Innovation, Massey University, Palmerston North, New Zealand
- Centre for Organisational Excellence Research, Massey University, Palmerston North, New Zealand
| | - Nigel P. Grigg
- Department of Operations and Engineering Innovation, Massey University, Palmerston North, New Zealand
| | - Sanjay Mathrani
- Department of Operations and Engineering Innovation, Massey University, Palmerston North, New Zealand
| | - Robin Mann
- Department of Operations and Engineering Innovation, Massey University, Palmerston North, New Zealand
- Centre for Organisational Excellence Research, Massey University, Palmerston North, New Zealand
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15
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Dallas RH, Rains JK, Wilder K, Humphrey W, Cross SJ, Ghafoor S, Brazelton de Cardenas JN, Hayden RT, Hijano DR. The Aerogen ® Solo Is an Alternative to the Small Particle Aerosol Generator (SPAG-2) for Administration of Inhaled Ribavirin. Pharmaceutics 2020; 12:pharmaceutics12121163. [PMID: 33260359 PMCID: PMC7760766 DOI: 10.3390/pharmaceutics12121163] [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: 11/05/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 11/16/2022] Open
Abstract
Respiratory syncytial virus (RSV) is associated with adverse outcomes among immunocompromised patients. Inhaled ribavirin has been shown to improve mortality rates. The Small-Particle Aerosol Generator delivery system (SPAG-2) is the only FDA-cleared device to deliver inhaled ribavirin. However, it is difficult to set up and maintain. We developed a method for delivery of this medication using the vibrating mesh nebulizer (Aerogen®). We did not observe any adverse events with this method.
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Affiliation(s)
- Ronald H. Dallas
- Department of Infectious Diseases, St. Jude Children Research Hospital, Memphis, TN 38105, USA;
| | - Jason K. Rains
- Department of Critical Care and Pulmonary Medicine, St. Jude Children Research Hospital, Memphis, TN 38105, USA; (J.K.R.); (K.W.); (S.G.)
| | - Keith Wilder
- Department of Critical Care and Pulmonary Medicine, St. Jude Children Research Hospital, Memphis, TN 38105, USA; (J.K.R.); (K.W.); (S.G.)
| | - William Humphrey
- Department of Pharmaceutical Sciences, St. Jude Children Research Hospital, Memphis, TN 38105, USA; (W.H.); (S.J.C.)
| | - Shane J. Cross
- Department of Pharmaceutical Sciences, St. Jude Children Research Hospital, Memphis, TN 38105, USA; (W.H.); (S.J.C.)
| | - Saad Ghafoor
- Department of Critical Care and Pulmonary Medicine, St. Jude Children Research Hospital, Memphis, TN 38105, USA; (J.K.R.); (K.W.); (S.G.)
| | | | - Randall T. Hayden
- Department of Pathology, St. Jude Children Research Hospital, Memphis, TN 38105, USA; (J.N.B.d.C.); (R.T.H.)
| | - Diego R. Hijano
- Department of Infectious Diseases, St. Jude Children Research Hospital, Memphis, TN 38105, USA;
- Correspondence: ; Tel.: +1-901-595-0448
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16
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Kim S, Wu M, Stylianou A, Ghafoor S, Lakhman Y, Park K, Leitao M, Sonoda Y, Gardner G, Broach V, Jewell E, Cohen S, Tew W, Zivanovic O, Roche KL, Mueller J, Zamarin D, Abu-Rustum N, Aghajanian C, Cadoo K, Weigelt B. Circulating cell-free DNA in patients with newly diagnosed and recurrent cervical cancer. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.06.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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17
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Fan K, McArthur J, Morrison RR, Ghafoor S. Diffuse Alveolar Hemorrhage After Pediatric Hematopoietic Stem Cell Transplantation. Front Oncol 2020; 10:1757. [PMID: 33014865 PMCID: PMC7509147 DOI: 10.3389/fonc.2020.01757] [Citation(s) in RCA: 12] [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: 06/06/2020] [Accepted: 08/05/2020] [Indexed: 12/21/2022] Open
Abstract
Pulmonary complications are common following hematopoietic cell transplantation (HCT) and contribute significantly to its morbidity and mortality. Diffuse alveolar hemorrhage is a devastating non-infectious complication that occurs in up to 5% of patients post-HCT. Historically, it carries a high mortality burden of 60–100%. The etiology remains ill-defined but is thought to be due to lung injury from conditioning regimens, total body irradiation, occult infections, and other comorbidities such as graft vs. host disease, thrombotic microangiopathy, and subsequent cytokine release and inflammation. Clinically, patients present with hypoxemia, dyspnea, and diffuse opacities consistent with an alveolar disease process on chest radiography. Diagnosis is most commonly confirmed with bronchoscopy findings of progressively bloodier bronchoalveolar lavage or the presence of hemosiderin-laden macrophages on microscopy. Treatment with glucocorticoids is common though dosing and duration of therapy remains variable. Other agents, such as aminocaproic acid, tranexamic acid, and activated recombinant factor VIIa have also been tried with mixed results. We present a review of diffuse alveolar hemorrhage with a focus on its pathogenesis and treatment options.
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Affiliation(s)
- Kimberly Fan
- Division of Pediatric Critical Care, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Jennifer McArthur
- Division of Critical Care, St. Jude Children's Research Center, Memphis, TN, United States
| | - R Ray Morrison
- Division of Critical Care, St. Jude Children's Research Center, Memphis, TN, United States
| | - Saad Ghafoor
- Division of Critical Care, St. Jude Children's Research Center, Memphis, TN, United States
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18
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Ghafoor S, Akhtar T, Khawar MB, Sheikh N. Alterations in hepatic trace elements and ferritin expression in high energy diet fed rat model. J BIOL REG HOMEOS AG 2020; 34:1229-1233. [PMID: 32643354 DOI: 10.23812/18-360-l-70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S Ghafoor
- Cell & Molecular Biology Laboratory, Department of Zoology, University of the Punjab, Lahore, Pakistan
| | - T Akhtar
- Cell & Molecular Biology Laboratory, Department of Zoology, University of the Punjab, Lahore, Pakistan
| | - M B Khawar
- Cell & Molecular Biology Laboratory, Department of Zoology, University of the Punjab, Lahore, Pakistan.,State Key Laboratory of Stem Cells and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, P.R. China.,University Chinese Academy of Sciences, Beijing, P.R. China
| | - N Sheikh
- Cell & Molecular Biology Laboratory, Department of Zoology, University of the Punjab, Lahore, Pakistan
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Fan K, Hurley C, McNeil MJ, Agulnik A, Federico S, Qudeimat A, Saini A, McArthur J, Morrison RR, Sandhu H, Shah S, Ghafoor S. Case Report: Management Approach and Use of Extracorporeal Membrane Oxygenation for Diffuse Alveolar Hemorrhage After Pediatric Hematopoietic Cell Transplant. Front Pediatr 2020; 8:587601. [PMID: 33520888 PMCID: PMC7838496 DOI: 10.3389/fped.2020.587601] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 08/07/2020] [Accepted: 12/14/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Diffuse alveolar hemorrhage (DAH) is an early pulmonary complication of hematopoietic cell transplantation (HCT) associated with severe hypoxemic respiratory failure and mortality. Extracorporeal membrane oxygenation (ECMO) support is often used for respiratory failure refractory to conventional interventions; however, its use has been limited in HCT patients with DAH due to potential for worsening alveolar hemorrhage and reported high mortality. Case Presentation: We report two cases of DAH following HCT who developed refractory hypoxemic respiratory failure despite cessation of bleeding and were successfully supported with ECMO. Conclusion: DAH after HCT should not automatically preclude ECMO support; rather, these patients must be evaluated individually for ECMO within the context of their overall clinical picture.
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Affiliation(s)
- Kimberly Fan
- Division of Pediatric Critical Care, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Caitlin Hurley
- Division of Critical Care, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Michael J McNeil
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Asya Agulnik
- Division of Critical Care, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Sara Federico
- Division of Solid Tumor, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Amr Qudeimat
- Department of Bone Marrow Transplant, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Arun Saini
- Division of Pediatric Critical Care, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, United States
| | - Jennifer McArthur
- Division of Critical Care, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Ronald Ray Morrison
- Division of Critical Care, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Hitesh Sandhu
- Division of Pediatric Critical Care, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Samir Shah
- Division of Pediatric Critical Care, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Saad Ghafoor
- Division of Critical Care, St. Jude Children's Research Hospital, Memphis, TN, United States
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20
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Nasim H, Ghafoor S, Shah A, Khan A. Synthesis of phosphate based bioactive glasses. Dent Mater 2017. [DOI: 10.1016/j.dental.2017.08.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Ud-Din A, Rauf M, Ghafoor S, Khattak MNK, Hameed MW, Shah H, Jan S, Muhammad K, Rehman A, Inamullah. Efficient use of artificial micro-RNA to downregulate the expression of genes at the post-transcriptional level in Arabidopsis thaliana. Genet Mol Res 2016; 15:gmr7439. [PMID: 27173203 DOI: 10.4238/gmr.15027439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Micro-RNAs are cellular components regulating gene expression at the post-transcription level. In the present study, artificial micro-RNAs were used to decrease the transcript level of two genes, AtExpA8 (encoding an expansin) and AHL25 (encoding an AT-hook motif nuclear localized protein) in Arabidopsis thaliana. The backbone of the Arabidopsis endogenous MIR319a micro-RNA was used in a site-directed mutagenesis approach for the generation of artificial micro-RNAs targeting two genes. The recombinant cassettes were expressed under the control of the CaMV 35S promoter in individual A. thaliana plants. Transgenic lines of the third generation were tested by isolating total RNA and by subsequent cDNA synthesis using oligo-dT18 primers and mRNAs as templates. The expression of the two target genes was checked through quantitative real-time polymerase chain reaction to confirm reduced transcript levels for AtExpA8 and AHL25. Downregulation of AtExpA8 resulted in the formation of short hypocotyls compared with those of the wild-type control in response to low pH and high salt concentration. This technology could be used to prevent the expression of exogenous and invading genes posing a threat to the normal cellular physiology of the host plant.
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Affiliation(s)
- A Ud-Din
- Department of Genetics, Garden Campus, Hazara University, Mansehra, Pakistan.,Institute of Biochemistry and Biology, University of Potsdam, Potsdam, Germany
| | - M Rauf
- Institute of Biochemistry and Biology, University of Potsdam, Potsdam, Germany
| | - S Ghafoor
- Department of Genetics, Garden Campus, Hazara University, Mansehra, Pakistan
| | - M N K Khattak
- Department of Zoology, Garden Campus, Hazara University, Mansehra, Pakistan
| | - M W Hameed
- Dr. Panjwani Center for Molecular Medicine and Drug Research, University of Karachi, Karachi, Pakistan
| | - H Shah
- National Agricultural Research Centre, Islamabad, Pakistan
| | - S Jan
- Department of Genetics, Garden Campus, Hazara University, Mansehra, Pakistan
| | - K Muhammad
- Department of Genetics, Garden Campus, Hazara University, Mansehra, Pakistan
| | - A Rehman
- Department of Zoology, Garden Campus, Hazara University, Mansehra, Pakistan
| | - Inamullah
- Department of Genetics, Garden Campus, Hazara University, Mansehra, Pakistan
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22
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Blackburn J, Kawasaki K, Porntaveetus T, Kawasaki M, Otsuka-Tanaka Y, Miake Y, Ota MS, Watanabe M, Hishinuma M, Nomoto T, Oommen S, Ghafoor S, Harada F, Nozawa-Inoue K, Maeda T, Peterková R, Lesot H, Inoue J, Akiyama T, Schmidt-Ullrich R, Liu B, Hu Y, Page A, Ramírez Á, Sharpe PT, Ohazama A. Excess NF-κB induces ectopic odontogenesis in embryonic incisor epithelium. J Dent Res 2014; 94:121-8. [PMID: 25376721 DOI: 10.1177/0022034514556707] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Nuclear factor kappa B (NF-κB) signaling plays critical roles in many physiological and pathological processes, including regulating organogenesis. Down-regulation of NF-κB signaling during development results in hypohidrotic ectodermal dysplasia. The roles of NF-κB signaling in tooth development, however, are not fully understood. We examined mice overexpressing IKKβ, an essential component of the NF-κB pathway, under keratin 5 promoter (K5-Ikkβ). K5-Ikkβ mice showed supernumerary incisors whose formation was accompanied by up-regulation of canonical Wnt signaling. Apoptosis that is normally observed in wild-type incisor epithelium was reduced in K5-Ikkβ mice. The supernumerary incisors in K5-Ikkβ mice were found to phenocopy extra incisors in mice with mutations of Wnt inhibitor, Wise. Excess NF-κB activity thus induces an ectopic odontogenesis program that is usually suppressed under physiological conditions.
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Affiliation(s)
- J Blackburn
- Craniofacial Development and Stem Cell Biology and Biomedical Research Centre, Kings College London, London, UK
| | - K Kawasaki
- Craniofacial Development and Stem Cell Biology and Biomedical Research Centre, Kings College London, London, UK Department of Pediatric Dentistry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - T Porntaveetus
- Craniofacial Development and Stem Cell Biology and Biomedical Research Centre, Kings College London, London, UK Department of Physiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - M Kawasaki
- Craniofacial Development and Stem Cell Biology and Biomedical Research Centre, Kings College London, London, UK Division of Bio-Prosthodontics, Department of Oral Health Science, Course for Oral Life Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Y Otsuka-Tanaka
- Craniofacial Development and Stem Cell Biology and Biomedical Research Centre, Kings College London, London, UK Department of Special Needs Dentistry, Nihon University School of Dentistry at Matsudo, Matsudo, Japan
| | - Y Miake
- Department of Ultrastructural Science, Tokyo Dental College, Chiyoda-ku, Tokyo, Japan
| | - M S Ota
- Laboratory of Food Biological Science, Department of Food and Nutrition, Japan Women's University, Bunkyō, Japan
| | - M Watanabe
- Division of Oral Anatomy, Department of Oral Biological Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - M Hishinuma
- Department of Special Needs Dentistry, Nihon University School of Dentistry at Matsudo, Matsudo, Japan
| | - T Nomoto
- Department of Special Needs Dentistry, Nihon University School of Dentistry at Matsudo, Matsudo, Japan
| | - S Oommen
- Craniofacial Development and Stem Cell Biology and Biomedical Research Centre, Kings College London, London, UK
| | - S Ghafoor
- Craniofacial Development and Stem Cell Biology and Biomedical Research Centre, Kings College London, London, UK
| | - F Harada
- Craniofacial Development and Stem Cell Biology and Biomedical Research Centre, Kings College London, London, UK
| | - K Nozawa-Inoue
- Craniofacial Development and Stem Cell Biology and Biomedical Research Centre, Kings College London, London, UK
| | - T Maeda
- Division of Oral Anatomy, Department of Oral Biological Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - R Peterková
- Department of Teratology, Institute of Experimental Medicine, Academy of Sciences CR, Prague, Czech Republic
| | - H Lesot
- INSERM UMR_S1109, Team "Osteoarticular and Dental Regenerative NanoMedicine," FMTS, Faculté de Médecine, Faculté de Chirurgie Dentaire, Université de Strasbourg, Strasbourg, France
| | - J Inoue
- Division of Cellular and Molecular Biology, Institute of Medical Science, University of Tokyo, Minato-ku, Tokyo, Japan
| | - T Akiyama
- Division of Cellular and Molecular Biology, Institute of Medical Science, University of Tokyo, Minato-ku, Tokyo, Japan
| | - R Schmidt-Ullrich
- Department of Signal Transduction in Tumor Cells, Max-Delbrück-Center for Molecular Medicine, Berlin, Germany
| | - B Liu
- Department of Molecular Carcinogenesis, University of Texas MD Anderson Cancer Center, Smithville, TX, USA
| | - Y Hu
- Laboratory of Experimental Immunology, Inflammation and Tumorigenesis Section, National. Cancer Institute-Frederick, Frederick, MD, USA
| | - A Page
- Department of Epithelial Biomedicine, Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), Madrid, Spain
| | - Á Ramírez
- Department of Epithelial Biomedicine, Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), Madrid, Spain
| | - P T Sharpe
- Craniofacial Development and Stem Cell Biology and Biomedical Research Centre, Kings College London, London, UK
| | - A Ohazama
- Craniofacial Development and Stem Cell Biology and Biomedical Research Centre, Kings College London, London, UK Division of Oral Anatomy, Department of Oral Biological Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Venkata C, Ghafoor S, Venkateshiah SB. A 35-year-old man with recurrent pneumonias, eczema, coarse facial features, and cystic lung lesions. Chest 2008; 133:1026-9. [PMID: 18398125 DOI: 10.1378/chest.07-2148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Chakradhar Venkata
- Department of Internal Medicine, Creighton University Medical Center, Omaha, NE 68131, USA.
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Ghafoor S, Shah MM, Ahmad H, Swati ZA, Shah SH, Pervez A, Farooq U. Molecular characterization of Ephedra species found in Pakistan. Genet Mol Res 2007; 6:1123-1130. [PMID: 18273806] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Ephedra, also known as "ma huang", is a dioecious, drought- and frost-resistant, perennial, evergreen shrub with compelling medicinal value. The genus is represented by 42 species around the world, 9 of which were provisionally reported from Pakistan. Species of the genus have a controversial taxonomy due to their overlapping morphological features. Conventional tools alone are not sufficient for characterizing the species. The objective of present study was to assess the genetic variability present in different biotypes of Ephedra growing in Pakistan using molecular markers. A total of six genotypes collected from diverse geographic zones of Pakistan were used. The DNA of all genotypes was amplified using nine randomly amplified polymorphic DNA (RAPD) primers to study genetic variability at the molecular level. The dissimilarity coefficient matrix based on the data of 9 RAPD primers was used to construct a dendrogram which was then used to group the genotypes in clusters. Based on the dendrogram and dissimilarity coefficient matrix, the RAPD markers used here revealed a moderate to high level of genetic polymorphism (6 to 49%) among the genotypes. It was found that the collection of genotype accessions from Swat Valley in northwestern Pakistan was most distantly related to the other five collections. More molecular markers including functional genes and ribosomal spacer regions are suggested to find a better estimate of the genetic diversity present in Ephedra growing in Pakistan. The information provided here is useful for identifying valuable Ephedra variants which will be used for medicinal purposes and earning foreign currency.
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Affiliation(s)
- S Ghafoor
- Department of Genetics, Hazara University, Dhodial Mansehra, Pakistan
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Shah SM, Karira KA, Soomro MS, Ghafoor S. Serum lipoprotein (a) in offspring of patients with premature myocardial infarction. J PAK MED ASSOC 2001; 51:180-3. [PMID: 11467239] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
OBJECTIVES To compare serum Lp(a), lipids: TC, TG and lipoproteins: HDL-C and LDL-C levels of offspring with history of paternal myocardial infarction with the serum levels in offspring without paternal history of myocardial infarction. SETTING Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi. METHODS Thirty offspring between the ages of 8-25 years with the history of paternal myocardial infarction were randomly selected from population and were matched with offspring having no history of parental myocardial infarction. RESULTS Offspring of fathers who had a myocardial infarction tended to have a significantly raised level of Lp(a) (p < 0.001) compared with those without parental history. None of the other lipoprotein variables we examined exhibited a significant difference between the two groups of subjects. CONCLUSION The offspring of fathers with early myocardial infarction have higher mean values of Lp(a) than control subjects suggesting that this lipid variable may strongly predispose to CAD.
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Affiliation(s)
- S M Shah
- Department of Biochemistry, Kyber Medical College, Peshawar
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