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Radel LJ, Branstetter J, Jones TL, Briceno-Medina M, Tadphale SD, Onder AM, Rayburn MS. Use of Aminophylline to Reverse Acute Kidney Injury in Pediatric Critical Care Patients. J Pediatr Pharmacol Ther 2022; 27:739-745. [DOI: 10.5863/1551-6776-27.8.739] [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: 11/02/2021] [Accepted: 03/01/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE
Acute kidney injury (AKI) is a complication encountered in 18% to 51% of pediatric critical care patients admitted for treatment of other primary diagnoses and is an independent risk factor for increased morbidity and mortality. Aminophylline has shown promise as a medication to treat AKI, but published studies have shown conflicting results. Our study seeks to assess the reversal of AKI following the administration of aminophylline in critically ill pediatric patients.
METHODS
We performed a single-institution retrospective chart review of pediatric inpatients who were diagnosed with AKI and subsequently treated with non-continuous dose aminophylline between January 2016 and December 2018. Data were collected beginning 2 days prior to the initial dose of aminophylline through completion of the 5-day aminophylline course.
RESULTS
Nineteen therapies among 17 patients were included in analysis. Twelve of the therapies resulted in resolution of AKI during the study period. We observed urine output increase of 19% (p = 0.0063) on the day following initiation of aminophylline therapy in the subset of patients whose AKI resolved. Trends toward decreased serum creatinine and lower inotropic support were also noted.
CONCLUSIONS
Based on these findings, aminophylline could be considered a potentially effective medication for use as rescue therapy in critically ill children with AKI. Limitations include small study population and retrospective nature. Further research in this area with a larger study population and a randomized control trial would allow for better characterization of the efficacy of aminophylline in reversal of AKI.
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Affiliation(s)
- Laura J. Radel
- Department of Pediatric Cardiology (LJR, MBM, SDT), Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, TN
| | - Joshua Branstetter
- Department of Pharmacy (MSR), Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, TN
| | - Tamekia L. Jones
- Department of Pediatrics and Preventive Medicine (TLJ), University of Tennessee Health Science Center and Children's Foundation Research Institute, Memphis, TN
| | - Mario Briceno-Medina
- Department of Pediatric Cardiology (LJR, MBM, SDT), Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, TN
| | - Sachin D. Tadphale
- Department of Pediatric Cardiology (LJR, MBM, SDT), Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, TN
| | - Ali Mirza Onder
- Department of Nephrology (AMO), Children's of Mississippi and University of Mississippi Medical Campus, Jackson, MS
| | - Mark S. Rayburn
- Department of Pharmacy (MSR), Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, TN
- Department of Clinical Pharmacy and Translational Science (MSR), University of Tennessee Health Science Center and Children's Foundation Research Institute, Memphis, TN
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Kumari R, Irudayam MJ, Al Abdallah Q, Jones TL, Mims TS, Puchowicz MA, Pierre JF, Brown CW. SMAD2 and SMAD3 differentially regulate adiposity and the growth of subcutaneous white adipose tissue. FASEB J 2021; 35:e22018. [PMID: 34731499 DOI: 10.1096/fj.202101244r] [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: 08/03/2021] [Revised: 09/28/2021] [Accepted: 10/13/2021] [Indexed: 11/11/2022]
Abstract
Adipose tissue is the primary site of energy storage, playing important roles in health. While adipose research largely focuses on obesity, fat also has other critical functions, producing adipocytokines and contributing to normal nutrient metabolism, which in turn play important roles in satiety and total energy homeostasis. SMAD2/3 proteins are downstream mediators of activin signaling, which regulate critical preadipocyte and mature adipocyte functions. Smad2 global knockout mice exhibit embryonic lethality, whereas global loss of Smad3 protects mice against diet-induced obesity. The direct contributions of Smad2 and Smad3 in adipose tissues, however, are unknown. Here, we sought to determine the primary effects of adipocyte-selective reduction of Smad2 or Smad3 on diet-induced adiposity using Smad2 or Smad3 "floxed" mice intercrossed with Adiponectin-Cre mice. Additionally, we examined visceral and subcutaneous preadipocyte differentiation efficiency in vitro. Almost all wild type subcutaneous preadipocytes differentiated into mature adipocytes. In contrast, visceral preadipocytes differentiated poorly. Exogenous activin A suppressed differentiation of preadipocytes from both depots. Smad2 conditional knockout (Smad2cKO) mice did not exhibit significant effects on weight gain, irrespective of diet, whereas Smad3 conditional knockout (Smad3cKO) male mice displayed a trend of reduced body weight on high-fat diet. On both diets, Smad3cKO mice displayed an adipose depot-selective phenotype, with a significant reduction in subcutaneous fat mass but not visceral fat mass. Our data suggest that Smad3 is an important contributor to the maintenance of subcutaneous white adipose tissue in a sex-selective fashion. These findings have implications for understanding SMAD-mediated, depot selective regulation of adipocyte growth and differentiation.
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Affiliation(s)
- Roshan Kumari
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Department of Genetics, Genomics and Informatics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Maria Johnson Irudayam
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Qusai Al Abdallah
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Tamekia L Jones
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Children's Foundation Research Institute, Memphis, Tennessee, USA
| | - Tahliyah S Mims
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Michelle A Puchowicz
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Joseph F Pierre
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Chester W Brown
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Department of Genetics, Genomics and Informatics, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Le Bonheur Children's Hospital, Memphis, Tennessee, USA
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3
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Smith WA, Gray E, Jones TL, Han JC, Burton ET. Waitlist management in a pediatric weight management clinic: implementing an orientation session. BMC Pediatr 2021; 21:416. [PMID: 34551757 PMCID: PMC8456555 DOI: 10.1186/s12887-021-02868-w] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/30/2021] [Indexed: 11/16/2022] Open
Abstract
Background This study evaluates implementation of an orientation session to address a waitlist of more than 2000 referrals to a pediatric weight management clinic in the Mid-South United States. Methods An hour-long group-based orientation to the pediatric weight management clinic was implemented to provide information about the structure and expectations of the clinic as well as education on healthy lifestyle recommendations. Families were contacted from the waitlist by telephone and invited to attend an orientation session prior to scheduling a clinic appointment. Results Of 2251 patients contacted from the waitlist, 768 scheduled an orientation session, of which 264 (34 %) attended. Of the 264 orientation participants, 246 (93 %) scheduled a clinic appointment. Of those, 193 (79 %) completed a clinic visit. Waitlist times decreased from 297.8 ± 219.4 days prior to implementation of orientation sessions to 104.1 ± 219.4 days after. Conclusions Orientation has been an effective and efficient way to triage patient referrals while maximizing attendance in limited clinic slots for patients and families demonstrating interest and motivation. Elements of this approach are likely generalizable to other pediatric clinical settings that must strategically manage a large volume of patient referrals.
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Affiliation(s)
- Webb A Smith
- Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, 50 North Dunlap Street, Room 453R, TN, 38103, Memphis, USA. .,Children's Foundation Research Institute, Le Bonheur Children's Hospital, 50 North Dunlap Street, Room 453R, TN, 38103, Memphis, USA.
| | - Emily Gray
- Department of Health Promotion and Disease Prevention, College of Nursing, University of Tennessee Health Science Center, TN, Memphis, USA
| | - Tamekia L Jones
- Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, 50 North Dunlap Street, Room 453R, TN, 38103, Memphis, USA.,Children's Foundation Research Institute, Le Bonheur Children's Hospital, 50 North Dunlap Street, Room 453R, TN, 38103, Memphis, USA.,Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, TN, Memphis, USA
| | - Joan C Han
- Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, 50 North Dunlap Street, Room 453R, TN, 38103, Memphis, USA.,Children's Foundation Research Institute, Le Bonheur Children's Hospital, 50 North Dunlap Street, Room 453R, TN, 38103, Memphis, USA.,Department of Physiology, College of Medicine, University of Tennessee Health Science Center, TN, Memphis, USA
| | - E Thomaseo Burton
- Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, 50 North Dunlap Street, Room 453R, TN, 38103, Memphis, USA.,Children's Foundation Research Institute, Le Bonheur Children's Hospital, 50 North Dunlap Street, Room 453R, TN, 38103, Memphis, USA
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4
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Oyana TJ, Minso J, Jones TL, McCullers JA, Arnold SR, Cormier SA. Particulate matter exposure predicts residence in high-risk areas for community acquired pneumonia among hospitalized children. Exp Biol Med (Maywood) 2021; 246:1907-1916. [PMID: 34053235 DOI: 10.1177/15353702211014456] [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] [Indexed: 11/17/2022] Open
Abstract
Particulate matter exposure is a risk factor for lower respiratory tract infection in children. Here, we investigated the geospatial patterns of community-acquired pneumonia and the impact of PM2.5 (particulate matter with an aerodynamic diameter ≤2.5 µm) on geospatial variability of pneumonia in children. We performed a retrospective analysis of prospectively collected population-based surveillance study data of community-acquired pneumonia hospitalizations among children <18 years residing in the Memphis metropolitan area, who were enrolled in the Centers for Disease Control and Prevention sponsored Etiology of Pneumonia in the Community (EPIC) study from January 2010 to June 2012. The outcome measure, residence in high- and low-risk areas for community-acquired pneumonia, was determined by calculating pneumonia incidence rates and performing cluster analysis to identify areas with higher/lower than expected rates of community-acquired pneumonia for the population at risk. High PM2.5 was defined as exposure to PM2.5 concentrations greater than the mean value (>10.75 μg/m3), and low PM2.5 is defined as exposure to PM2.5 concentrations less than or equal to the mean value (≤10.75 μg/m3). We also assessed the effects of age, sex, race/ethnicity, history of wheezing, insurance type, tobacco smoke exposure, bacterial etiology, and viral etiology of infection. Of 810 (96.1%) subjects with radiographic community-acquired pneumonia, who resided in the Memphis metropolitan area and had addresses which were successfully geocoded (Supplementary Figure F2), 220 (27.2%) patients were identified to be from high- (n = 126) or low-risk (n = 94) community-acquired pneumonia areas. Community-acquired pneumonia in Memphis metropolitan area had a non-homogenous geospatial pattern. PM2.5 was associated with residence in high-risk areas for community-acquired pneumonia. In addition, children with private insurance and bacterial, as opposed to viral, etiology of infection had a decreased risk of residence in a high-risk area for community-acquired pneumonia. The results from this paper suggest that environmental exposures as well as social risk factors are associated with childhood pneumonia.
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Affiliation(s)
- Tonny J Oyana
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Jagila Minso
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38103, USA
| | - Tamekia L Jones
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38103, USA.,Children's Foundation Research Institute, Memphis, TN 38105, USA
| | - Jonathan A McCullers
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38103, USA.,Children's Foundation Research Institute, Memphis, TN 38105, USA.,Le Bonheur Children's Hospital, Memphis, TN 38103, USA
| | - Sandra R Arnold
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38103, USA.,Children's Foundation Research Institute, Memphis, TN 38105, USA.,Le Bonheur Children's Hospital, Memphis, TN 38103, USA
| | - Stephania A Cormier
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38103, USA.,Children's Foundation Research Institute, Memphis, TN 38105, USA.,Le Bonheur Children's Hospital, Memphis, TN 38103, USA.,Department of Biological Sciences, Louisiana State University and Pennington Biomedical Research Center, Baton Rouge, LA 70803, USA
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5
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Jones TL, Calbay R, da Cunha AF, Hofmeister EH. Descriptive assessment of adverse events associated with midazolam-etomidate versus saline-etomidate in healthy hydromorphone premedicated dogs. J Small Anim Pract 2021; 62:437-441. [PMID: 33565094 DOI: 10.1111/jsap.13304] [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: 10/05/2020] [Revised: 11/17/2020] [Accepted: 12/29/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the frequency, severity and duration of adverse events including myoclonus, pain on injection, hypersalivation, regurgitation and apnoea after administration of midazolam or saline followed by etomidate in hydromorphone premedicated dogs. MATERIALS AND METHODS Dogs undergoing elective dental prophylaxis or soft tissue surgeries were enrolled in this randomised trial. Dogs were premedicated with hydromorphone 0.1 mg/kg IV. Sixty seconds later, midazolam 0.3 mg/kg or saline at an equivalent volume was administered IV. Sixty seconds after that, etomidate 1.5 mg/kg IV was administered over 60 seconds. Additional doses of 0.5 mg/kg etomidate were administered until endotracheal intubation was successful. Observers were blinded to the treatment. Frequency, duration and a severity score of 0 to 3 were recorded for myoclonus, pain on injection, hypersalivation and regurgitation. Duration of apnoea and frequency of any additional complications was recorded. RESULTS Forty variable breed healthy dogs were enrolled in the study. Myoclonus, pain on injection, regurgitation, hypersalivation, gagging, tachypnoea and pigmenturia occurred, respectively, in 10%, 40%, 0%, 15%, 35%, 25% and 5% of dogs in the saline group and 0%, 65%, 0%, 10%, 45%, 15% and 5% of dogs in the midazolam group. Apnoea occurred for 115 seconds (range 0 to 660 seconds) and 160 seconds (range 0 to 600 seconds) in the saline and midazolam groups, respectively. Two dogs developed pigmenturia. The trial was stopped early due to the occurrence of pigmenturia. CLINICAL SIGNIFICANCE Due to early stopping of the trial, the predefined sample size was not reached. Further investigation is needed to determine if midazolam reduced the incidence of adverse events or improved the induction quality when combined with hydromorphone and etomidate.
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Affiliation(s)
- T L Jones
- Department of Specialty Medicine, College of Veterinary Medicine, Midwestern University, 19555 N 59th Avenue, Glendale, AZ, 85308, USA
| | - R Calbay
- Department of Specialty Medicine, College of Veterinary Medicine, Midwestern University, 19555 N 59th Avenue, Glendale, AZ, 85308, USA
| | - A F da Cunha
- Department of Specialty Medicine, College of Veterinary Medicine, Midwestern University, 19555 N 59th Avenue, Glendale, AZ, 85308, USA
| | - E H Hofmeister
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL, USA
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6
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Lee RP, Ajmera S, Thomas F, Dave P, Lillard JC, Wallace D, Broussard A, Motiwala M, Norrdahl SP, Venable GT, Khan NR, Harrell C, Jones TL, Vaughn BN, Gooldy T, Hersh DS, Klimo P. Shunt Failure-The First 30 Days. Neurosurgery 2020; 87:123-129. [PMID: 31557298 DOI: 10.1093/neuros/nyz379] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 06/06/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Incontrovertible predictors of shunt malfunction remain elusive. OBJECTIVE To determine predictors of shunt failure within 30 d of index surgery. METHODS This was a single-center retrospective cohort study from January 2010 through November 2016. Using a ventricular shunt surgery research database, clinical and procedural variables were procured. An "index surgery" was defined as implantation of a new shunt or revision or augmentation of an existing shunt system. The primary outcome was shunt failure of any kind within the first 30 days of index surgery. Bivariate models were created, followed by a final multivariable logistic regression model using a backward-forward selection procedure. RESULTS Our dataset contained 655 unique patients with a total of 1206 operations. The median age for the cohort at the time of first shunt surgery was 4.6 yr (range, 0-28; first and third quartile, .37 and 11.8, respectively). The 30-day failure rates were 12.4% when analyzing the first-index operation only (81/655), and 15.7% when analyzing all-index operations (189/1206). Small or slit ventricles at the time of index surgery and prior ventricular shunt operations were found to be significant covariates in both the "first-index" (P < .01 and P = .05, respectively) and "all-index" (P = .02 and P < .01, respectively) multivariable models. Intraventricular hemorrhage at the time of index surgery was an additional predictor in the all-index model (P = .01). CONCLUSION This study demonstrates that only 3 variables are predictive of 30-day shunt failure when following established variable selection procedures, 2 of which are potentially under direct control of the surgeon.
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Affiliation(s)
- Ryan P Lee
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sonia Ajmera
- College of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Fridtjof Thomas
- Division of Biostatistics, Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee
| | | | - Jock C Lillard
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - David Wallace
- College of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Austin Broussard
- College of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Mustafa Motiwala
- College of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Sebastian P Norrdahl
- College of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Garrett T Venable
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Nickalus R Khan
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Camden Harrell
- Department of Pediatrics, The University of Tennessee Health Science Center, Children's Foundation Research Institute, Memphis, Tennessee.,Department of Preventive Medicine, The University of Tennessee Health Science Center, Children's Foundation Research Institute, Memphis, Tennessee
| | - Tamekia L Jones
- Department of Pediatrics, The University of Tennessee Health Science Center, Children's Foundation Research Institute, Memphis, Tennessee.,Department of Preventive Medicine, The University of Tennessee Health Science Center, Children's Foundation Research Institute, Memphis, Tennessee
| | | | - Tim Gooldy
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - David S Hersh
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Paul Klimo
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee.,Le Bonheur Children's Hospital, Memphis, Tennessee.,Semmes Murphey, Memphis, Tennessee
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7
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Siefker DT, Vu L, You D, McBride A, Taylor R, Jones TL, DeVincenzo J, Cormier SA. Respiratory Syncytial Virus Disease Severity Is Associated with Distinct CD8 + T-Cell Profiles. Am J Respir Crit Care Med 2020; 201:325-334. [PMID: 31644878 DOI: 10.1164/rccm.201903-0588oc] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Rationale: Respiratory syncytial virus (RSV) causes significant morbidity and mortality in infants worldwide. Although T-helper type 2 (Th2) cell pathology is implicated in severe disease, the mechanisms underlying the development of immunopathology are incompletely understood.Objectives: We aimed to identify local immune responses associated with severe RSV in infants. Our hypothesis was that disease severity would correlate with enhanced Th2 cellular responses.Methods: Nasal aspirates were collected from infants hospitalized with severe (admitted to the pediatric ICU) or moderate (maintained in the general ward) RSV disease at 5 to 9 days after enrollment. The immune response was investigated by evaluating T-lymphocyte cellularity, cytokine concentration, and viral load.Measurements and Main Results: Patients with severe disease had increased proportions of CD8 (cluster of differentiation 8)-positive T cells expressing IL-4 (Tc2) and reduced proportions of CD8+ T cells expressing IFNγ (Tc1). Nasal aspirates from patients with severe disease had reduced concentrations of IL-17. Patients with greater frequencies of Tc1, CD8+ T cells expressing IL-17 (Tc17), and CD4+ T cells expressing IL-17 (Th17) had shorter durations of hospitalization.Conclusions: Severe RSV disease was associated with distinct T-cell profiles. Tc1, Tc17, and Th17 were associated with shorter hospital stay and may play a protective role, whereas Tc2 cells may play a previously underappreciated role in pathology.
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Affiliation(s)
- David T Siefker
- Department of Biological Sciences, College of Science, and Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana
| | - Luan Vu
- Department of Biological Sciences, College of Science, and Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana
| | - Dahui You
- Department of Pediatrics, and.,Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, Tennessee
| | | | | | - Tamekia L Jones
- Department of Pediatrics, and.,Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee; and.,Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - John DeVincenzo
- Department of Pediatrics, and.,Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Stephania A Cormier
- Department of Biological Sciences, College of Science, and Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana
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8
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Vu LD, Siefker D, Jones TL, You D, Taylor R, DeVincenzo J, Cormier SA. Elevated Levels of Type 2 Respiratory Innate Lymphoid Cells in Human Infants with Severe Respiratory Syncytial Virus Bronchiolitis. Am J Respir Crit Care Med 2020; 200:1414-1423. [PMID: 31237777 DOI: 10.1164/rccm.201812-2366oc] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Rationale: Studies of the immune responses at the site of respiratory syncytial virus (RSV) infection are sparse despite nearly five decades of research into understanding RSV disease.Objectives: To investigate the role of mucosal innate immune responses to RSV and respiratory viral load in infants hospitalized with the natural disease.Methods: Cytokines, viral load, and type 2 innate lymphoid cell (ILC2) levels in nasal aspirates, collected within 24 hours of enrollment, from infants hospitalized with RSV infection were quantified.Measurements and Main Results: RSV severity in infants was categorized based on admission to the general ward (moderate) or the pediatric ICU (severe). Evaluable subjects included 30 patients with severe and 63 patients with moderate disease (median age, 74 d; range, 9-297 d). ILC2s were found in the nasal aspirates of patients with severe disease (0.051% of total respiratory CD45+ cells) to a significantly greater extent than in patients with moderate disease (0.018%, P = 0.004). Levels of IL-4, IL-13, IL-33, and IL-1β were significantly higher in nasal aspirates of patients with severe disease compared with those of patients with moderate disease. Factors associated with disease severity were gestational age (odds ratio, 0.49; 95% confidence interval, 0.29-0.82; P = 0.007) and IL-4 (odds ratio, 9.67; 95% confidence interval, 2.45-38.15; P = 0.001).Conclusions: This study shows, for the first time, that elevated levels of ILC2s is associated with infant RSV severity. The findings highlight the dominance of type-2 responses to RSV infection in infants and suggest an important role of ILC2 in shaping the immune response early during RSV infection.
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Affiliation(s)
- Luan D Vu
- Department of Biological Sciences, Louisiana State University, Baton Rouge, Louisiana.,Department of Comparative Biomedical Sciences, Louisiana State University School of Veterinary Medicine, Baton Rouge, Louisiana
| | - David Siefker
- Department of Biological Sciences, Louisiana State University, Baton Rouge, Louisiana.,Department of Comparative Biomedical Sciences, Louisiana State University School of Veterinary Medicine, Baton Rouge, Louisiana
| | - Tamekia L Jones
- Department of Pediatrics.,Department of Preventive Medicine, and.,Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, Tennessee
| | | | | | - John DeVincenzo
- Department of Pediatrics.,Department of Microbiology, Immunology, and Biochemistry, University of Tennessee Health Science Center, Memphis, Tennessee; and.,Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Stephania A Cormier
- Department of Biological Sciences, Louisiana State University, Baton Rouge, Louisiana.,Department of Comparative Biomedical Sciences, Louisiana State University School of Veterinary Medicine, Baton Rouge, Louisiana
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9
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Abstract
Youth with obesity are more likely than normal-weight peers to experience psychosocial problems. Empirically-based recommendations for addressing pediatric obesity include intensive interdisciplinary weight management comprising medical, behavioral health, nutrition, and exercise components. The present study examined changes in psychosocial functioning associated with frequency of participation in an interdisciplinary pediatric weight management program. Participants were 86 patients (55.8% females; median age = 11.5 years; 67.4% Non-Hispanic Black; median BMI percentile = 99.5) enrolled in an interdisciplinary pediatric weight management program for at least one year. Psychosocial functioning was measured with the Pediatric Symptom Checklist (PSC-17), a caregiver-completed mental health screen that assesses internalizing, externalizing, and attention difficulties as well as global functioning. The PSC-17 was completed at the initial clinic visit (baseline) and repeated one-year later (annual). The Wilcoxon Signed Rank test indicated that annual PSC-17 scores were significantly lower than baseline scores across all domains. Spearman correlation coefficients revealed no significant association between total number of clinic visits and PSC-17 global or subscale scores. However, the number of visits for exercise-only sessions was significantly correlated with caregiver-reported improvement in internalizing behaviors. Findings suggest that participation in interdisciplinary pediatric weight management may improve psychosocial functioning in youth with obesity and that attending supervised exercise sessions may be especially beneficial for improving internalizing behavior symptoms.
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Affiliation(s)
- E Thomaseo Burton
- Le Bonheur Children's Hospital, Children's Foundation Research Institute.,Department of Pediatrics, University of Tennessee Health Science Center
| | - Tamekia L Jones
- Le Bonheur Children's Hospital, Children's Foundation Research Institute.,Department of Pediatrics, University of Tennessee Health Science Center.,Department of Preventive Medicine, University of Tennessee Health Science Center
| | - Webb A Smith
- Le Bonheur Children's Hospital, Children's Foundation Research Institute.,Department of Pediatrics, University of Tennessee Health Science Center
| | - Joan C Han
- Le Bonheur Children's Hospital, Children's Foundation Research Institute.,Department of Pediatrics, University of Tennessee Health Science Center.,Department of Physiology, University of Tennessee Health Science Center
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10
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Norrdahl SP, Jones TL, Dave P, Hersh DS, Vaughn B, Klimo P. A hospital-based analysis of pseudomeningoceles after elective craniotomy in children: what predicts need for intervention? J Neurosurg Pediatr 2020; 25:1-8. [PMID: 32005010 DOI: 10.3171/2019.11.peds19227] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 11/06/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In pediatric patients, the development of a postoperative pseudomeningocele after an elective craniotomy is not unusual. Most will resolve with time, but some may require intervention. In this study, the authors analyzed patients who required intervention for a postoperative pseudomeningocele following an elective craniotomy or craniectomy and identified factors associated with the need for intervention. METHODS An institutional operative database of elective craniotomies and craniectomies was queried to identify all surgeries associated with development of a postoperative pseudomeningocele from January 1, 2010, to December 31, 2017. Demographic and surgical data were collected, as were details regarding postoperative events and interventions during either the initial admission or upon readmission. A bivariate analysis was performed to compare patients who underwent observation with those who required intervention. RESULTS Following 1648 elective craniotomies or craniectomies, 84 (5.1%) clinically significant pseudomeningoceles were identified in 82 unique patients. Of these, 58 (69%) of the pseudomeningoceles were diagnosed during the index admission (8 of which persisted and resulted in readmission), and 26 (31%) were diagnosed upon readmission. Forty-nine patients (59.8% of those with a pseudomeningocele) required one or more interventions, such as lumbar puncture(s), lumbar drain placement, wound exploration, or shunt placement or revision. Only race (p < 0.01) and duraplasty (p = 0.03, OR 3.0) were associated with the need for pseudomeningocele treatment. CONCLUSIONS Clinically relevant pseudomeningoceles developed in 5% of patients undergoing an elective craniotomy, with 60% of these pseudomeningoceles needing some form of intervention. The need for intervention was associated with race and whether a duraplasty was performed.
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Affiliation(s)
| | - Tamekia L Jones
- Departments of2Pediatrics and
- 3Preventive Medicine, University of Tennessee Health Science Center, Memphis
- 4Children's Foundation Research Institute, Memphis
| | | | - David S Hersh
- 6Department of Neurosurgery, University of Tennessee Health Science Center, Memphis
- 7Le Bonheur Children's Hospital, Memphis; and
| | | | - Paul Klimo
- 6Department of Neurosurgery, University of Tennessee Health Science Center, Memphis
- 7Le Bonheur Children's Hospital, Memphis; and
- 8Semmes Murphey, Memphis, Tennessee
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11
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Hersh DS, Smith LGF, Jones TL, Fraser BD, Kumar R, Vaughn B, Klimo P. Predictors of an Extended Length of Stay following an Elective Craniotomy in Children and Young Adults. Pediatr Neurosurg 2020; 55:259-267. [PMID: 33099552 DOI: 10.1159/000511090] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/24/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Length of stay (LOS) is now a generally accepted clinical metric within the USA. An extended LOS following an elective craniotomy can significantly impact overall costs. Few studies have evaluated predictors of an extended LOS in pediatric neurosurgical patients. OBJECTIVE The aim of the study was to determine predictors of an extended hospital LOS following an elective craniotomy in children and young adults. METHODS All pediatric patients and young adults undergoing an elective craniotomy between January 1, 2010, and April 1, 2019, were retrospectively identified using a prospectively maintained database. Demographic, clinical, radiological, and surgical data were collected. The primary outcome was extended LOS, defined as a postsurgical stay greater than 7 days. Bivariate and multivariable analyses were performed. RESULTS A total of 1,498 patients underwent 1,720 elective craniotomies during the study period over the course of 1,698 hospitalizations with a median LOS of 4 days (interquartile range 3-6 days). Of these encounters, 218 (12.8%) had a prolonged LOS. Multivariable analysis demonstrated that non-Caucasian race (OR = 1.9 [African American]; OR = 1.6 [other]), the presence of an existing shunt (OR = 1.8), the type of craniotomy (OR = 0.3 [vascular relative to Chiari]), and the presence of a postoperative complication (OR = 14.7) were associated with an extended LOS. CONCLUSIONS Inherent and modifiable factors predict a hospital stay of more than a week in children and young adults undergoing an elective craniotomy.
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Affiliation(s)
- David S Hersh
- Division of Neurosurgery, Connecticut Children's, Hartford, Connecticut, USA, .,Department of Surgery, UConn School of Medicine, Farmington, Connecticut, USA,
| | - Luke G F Smith
- Department of Neurosurgery, The Ohio State University, Columbus, Ohio, USA
| | - Tamekia L Jones
- Departments of Pediatrics and Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, Tennessee, USA
| | - Brittany D Fraser
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Rahul Kumar
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Brandy Vaughn
- Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee, USA
| | - Paul Klimo
- Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee, USA.,Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Semmes Murphey, Memphis, Tennessee, USA
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12
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Dave P, Venable GT, Jones TL, Khan NR, Albert GW, Chern JJ, Wheelus JL, Governale LS, Huntoon KM, Maher CO, Bruzek AK, Mangano FT, Mehta V, Beaudoin W, Naftel RP, Basem J, Whitney A, Shimony N, Rodriguez LF, Vaughn BN, Klimo P. The Preventable Shunt Revision Rate: A Multicenter Evaluation. Neurosurgery 2020; 84:788-798. [PMID: 29982642 DOI: 10.1093/neuros/nyy263] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 01/18/2018] [Accepted: 05/17/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Preventable Shunt Revision Rate (PSRR) was recently introduced as a novel quality metric. OBJECTIVE To evaluate the PSRR across multiple centers and determine associated variables. METHODS Nine participating centers in North America provided at least 2 years of consecutive shunt operations. Index surgery was defined as new shunt implantation, or revision of an existing shunt. For any index surgery that resulted in a reoperation within 90-days, index surgery information (demographic, clinical, and procedural) was collected and a decision made whether the failure was potentially preventable. The 90-day shunt failure rate and PSRR were calculated per institution and combined. Bivariate analyses were performed to evaluate individual effects of each independent variable on preventable shunt failure followed by a final multivariable model using a backward model selection approach. RESULTS A total of 5092 shunt operations were performed; 861 failed within 90 days of index operation, resulting in a 16.9% combined 90-day shunt failure rate and 17.6% median failure rate (range, 8.7%-26.9%). Of the failures, 307 were potentially preventable (overall and median 90-day PSRR, 35.7% and 33.9%, respectively; range, 16.1%-55.4%). The most common etiologies of avoidable failure were infection (n = 134, 44%) and proximal catheter malposition (n = 83, 27%). Independent predictors of preventable failure (P < .05) were lack of endoscopy (odds ratio [OR] = 2.26), recent shunt infection (OR = 3.65), shunt type (OR = 2.06) and center. CONCLUSION PSRR is variable across institutions, but can be 50% or higher. While the PSRR may never reach zero, this study demonstrates that overall about a third of early failures are potentially preventable.
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Affiliation(s)
| | - Garrett T Venable
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Tamekia L Jones
- Departments of Pediatrics and Preventive Medicine, University of Tennessee Health Science Center, Children's Foundation Research Institute, Memphis, Tennessee
| | - Nickalus R Khan
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Gregory W Albert
- Division of Neurosurgery, Arkansas Children's Hospital, Little Rock, Arkansas.,Department of Neurosurgery, University of Arkansas, Little Rock, Arkansas
| | - Joshua J Chern
- Pediatric Neurosurgical Associates, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Jennifer L Wheelus
- Pediatric Neurosurgical Associates, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Lance S Governale
- Division of Pediatric Neurosurgery, University of Florida, Gainesville, Florida
| | | | - Cormac O Maher
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Amy K Bruzek
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Francesco T Mangano
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Vivek Mehta
- Stollery Children's Hospital, Edmonton, Alberta, Canada
| | | | - Robert P Naftel
- Division of Pediatric Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jade Basem
- Surgical Outcomes Center for Kids, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Anna Whitney
- Surgical Outcomes Center for Kids, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nir Shimony
- Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.,Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Luis F Rodriguez
- Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.,Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | | | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.,Le Bonheur Children's Hospital, Memphis, Tennessee.,Semmes Murphey, Memphis, Tennessee
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13
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Schuman SS, Regen RB, Stuart LH, Harrell C, Jones TL, Stewart BM, Berg AM, Longjohn M, Kink RJ. Reducing Time to Pain Medication Administration for Pediatric Patients with Long Bone Fractures in the Emergency Department. Pediatr Qual Saf 2019; 3:e120. [PMID: 31334452 PMCID: PMC6581474 DOI: 10.1097/pq9.0000000000000120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 09/28/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction Pain management is a critical aspect of effective long bone fracture treatment. Pediatric patients frequently report suboptimal pain management, which is an area of growing public concern. The purpose of this quality improvement project was to develop a protocol with the goal to administer pain medication to children presenting with suspected long bone fractures ≤47 minutes of emergency department arrival. Methods A multidisciplinary team developed a standardized protocol for pain management of patients presenting with musculoskeletal pain utilizing acetaminophen as the first-line agent under a nurse-initiated order. Following education and implementation, weekly reports generated using the International Classification of Diseases codes of fractures were reviewed to assess compliance with the protocol. This study evaluates the frequency of a second pain medication administration and reduction in vital signs and pain scores. Results Implementation of a pain management protocol reduced median time to pain medication administration to 26 minutes. Overall, 63% (n = 638) of patients required a second pain medication. Of these, 66.5% (348/523) who initially received acetaminophen and 59.7% (286/479) who initially received an opioid required a second pain medication. No significant changes in pre and posttreatment vital signs were found between groups. Patients who initially received opioids experienced a greater reduction in posttreatment pain scores. Conclusions Using a standardized pain management protocol in combination with comprehensive education effectively reduces median time to pain medication administration in pediatric patients with long bone fractures. Acetaminophen is a rapid and effective first-line agent for managing pain in this population.
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Affiliation(s)
- Sarah S Schuman
- Department of Pharmacy, Le Bonheur Children's Hospital, Department of Clinical Pharmacy and Translational Science, The University of Tennessee Health Science Center
| | - Rebecca B Regen
- Department of Pharmacy, Le Bonheur Children's Hospital, Department of Clinical Pharmacy and Translational Science, The University of Tennessee Health Science Center
| | - Lindsay H Stuart
- Department of Pharmacy, Le Bonheur Children's Hospital, Department of Clinical Pharmacy and Translational Science, The University of Tennessee Health Science Center
| | - Camden Harrell
- Children's Foundation Research Institute, Le Bonheur Children's Hospital
| | - Tamekia L Jones
- Children's Foundation Research Institute, Le Bonheur Children's Hospital, Department of Pediatrics, Department of Preventative Medicine, The University of Tennessee Health Science Center
| | | | - Allyson M Berg
- Department of Pharmacy, Le Bonheur Children's Hospital, Department of Clinical Pharmacy and Translational Science, The University of Tennessee Health Science Center
| | - Mindy Longjohn
- Division of Pediatric Emergency Medicine, Department of Pediatric Medicine, Le Bonheur Children's Hospital, The University of Tennessee Health Science Center
| | - Rudy J Kink
- Division of Pediatric Emergency Medicine, Department of Pediatric Medicine, Le Bonheur Children's Hospital, The University of Tennessee Health Science Center
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14
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Siefker D, Vu L, You D, McBride A, Taylor R, Jones TL, DeVincenzo JP, Cormier S. Respiratory syncytial virus disease severity is associated with distinct CD8+ T cell profiles. The Journal of Immunology 2019. [DOI: 10.4049/jimmunol.202.supp.198.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
Most infants are infected with RSV by their second birthday. Despite known risk factors such as prematurity or congenital heart disease, most hospitalized infants are previously healthy. The mechanisms underlying the immunopathology of severe disease is incompletely understood. Our objective was to compare T cell profiles in nasal aspirates between infants with moderate and severe RSV disease hospitalized without immune deficiencies or congenital heart disease, during 2014–2017. Infants requiring intensive care were categorized as having severe disease, while infants maintained in the general ward were categorized as having moderate disease. The T cell profile in nasal aspirates collected 7 days after hospitalization (median 11 days after first symptom onset) was determined by flow cytometry. Nasal aspirates from patients with severe disease were characterized by a higher proportion of CD8+ T cells expressing IL-4 (Tc2) (P=0.024) and a lower proportion of CD8+ T cells expressing IFNγ (Tc1) (P=0.019) compared to patients with moderate disease. Patients with reduced frequencies of Tc1, Tc17, or Th17 cells had shorter durations of hospitalization (P=0.0023, P=0.0188, P=0.0437, respectively). Additionally, patients with severe disease had lower concentrations of IL-17 in nasal aspirates compared to patients with moderate disease (P=0.0133). These results suggest that RSV disease severity is associated with a specific T cell profile, and that Tc2 cells may play an underappreciated role in the development of RSV immunopathology.
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Affiliation(s)
| | | | - Dahui You
- 2The University of Tennessee Health Science Center
| | | | | | | | - John P. DeVincenzo
- 3Children’s Foundation Research Institute, Le Bonheur Children’s Hospital
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15
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Oravec CS, Motiwala M, Reed K, Jones TL, Klimo P. Big Data Research in Pediatric Neurosurgery: Content, Statistical Output, and Bibliometric Analysis. Pediatr Neurosurg 2019; 54:85-97. [PMID: 30799390 DOI: 10.1159/000495790] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 11/23/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS We sought to describe pediatric "big data" publications since 2000, their statistical output, and clinical implications. METHODS We searched 4 major North American neurosurgical journals for articles utilizing non-neurosurgery-specific databases for clinical pediatric neurosurgery research. Articles were analyzed for descriptive and statistical information. We analyzed effect sizes (ESs), confidence intervals (CIs), and p values for clinical relevance. A bibliometric analysis was performed using several key citation metrics. RESULTS We identified 74 articles, which constituted 1.7% of all pediatric articles (n = 4,436) published, with an exponential increase after 2013 (53/74, 72%). The Healthcare Cost and Utilization Project (HCUP) databases were most frequently utilized (n = 33); hydrocephalus (n = 19) was the most common study topic. The statistical output (n = 49 studies with 464 ESs, 456 CIs, and 389 p values) demonstrated that the majority of the ESs (253/464, 55%) were categorized as small; half or more of the CI spread (CIS) values and p values were high (274/456, 60%) and very strong (195/389, 50%), respectively. Associations with a combination of medium-to-large ESs (i.e., magnitude of difference), medium-to-high CISs (i.e., precision), and strong-to-very strong p values comprised only 20% (75/381) of the reported ESs. The total number of citations for the 74 articles was 1,115 (range per article, 0-129), with the median number of citations per article being 8.5. Four studies had > 50 citations, and 2 of them had > 100 citations. The calculated h-index was 16, h-core citations were 718, the e-index was 21.5, and the Google i10-index was 34. CONCLUSIONS There has been a dramatic increase in the use of "big data" in the pediatric neurosurgical literature. Reported associations that may, as a group, be of greatest interest to practitioners represented only 20% of the total output from these publications. Citations were weighted towards a few highly cited publications.
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Affiliation(s)
- Chesney S Oravec
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Mustafa Motiwala
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kevin Reed
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Tamekia L Jones
- Departments of Pediatrics and Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, Tennessee, USA
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA, .,Semmes Murphey, Memphis, Tennessee, USA, .,Le Bonheur Children's Hospital, Memphis, Tennessee, USA,
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16
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Saini A, West AN, Harrell C, Jones TL, Nellis ME, Joshi AD, Cowan KM, Gatewood CW, Ryder AB, Reiss UM. Platelet Transfusions in the PICU: Does Disease Severity Matter? Pediatr Crit Care Med 2018; 19:e472-e478. [PMID: 29927877 DOI: 10.1097/pcc.0000000000001653] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 12/28/2022]
Abstract
OBJECTIVES Pediatric intensivists frequently prescribe platelet transfusions to critically ill children, but there are limited data on platelet transfusion practice and platelet transfusion-related outcomes in the PICU. In this study, we evaluated the current platelet transfusion practice and platelet transfusion-related outcomes in the PICU. DESIGN Institutional review board-approved, retrospective cohort study from January 2010 to March 2016. SETTING Tertiary-level PICU. PATIENTS Children less than 19 years old who received platelet transfusions in the PICU. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Thirty-six percent (1,547/4,339) of platelet transfusions in the institution were given to 2.4% of PICU patients (232/9,659). The patients who received a platelet transfusion (platelet transfusions, n = 232) compared with those who did not receive platelets (no platelet transfusions, n = 9,427) were younger, had similar gender distribution, had a higher median Pediatric Risk of Mortality-3 score, and stayed longer in the PICU. Fifty percent of platelet transfusions were prescribed prophylactically for thrombocytopenia to patients without extracorporeal membrane oxygenation support. The mortality was higher for platelet transfusions group (30% vs 2.3%) with an 18 times increased unadjusted odds of mortality when compared with no platelet transfusion group (odds ratio, 18.2; 95% CI, 13.3-24.8; p < 0.0001). In a multiple logistic regression analysis, the predicted probability of dying for platelet transfusion group compared with no platelet transfusion group depended on the median Pediatric Risk of Mortality-3 score. Patients who received platelet transfusion versus no platelet transfusion have increased odds of dying at lower median Pediatric Risk of Mortality-3 scores, but decreased odds of dying at higher median Pediatric Risk of Mortality-3 scores. CONCLUSIONS This PICU cohort demonstrates that the odds or predicted probability of dying change in patients who received platelet transfusions based on underlying disease severity measured by Pediatric Risk of Mortality-3 score compared with patients who did not receive platelet transfusions. A large, prospective trial is required to confirm this association and determine whether to consider underlying disease severity in estimating risks and benefits of prophylactic platelet transfusions in critically ill children.
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Affiliation(s)
- Arun Saini
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, The University Of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TN
| | - Alina N West
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, The University Of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TN
| | - Camden Harrell
- Department of Biostatistics, Children's Research Foundation Institute, Le Bonheur Children's Hospital, Memphis, TN
| | - Tamekia L Jones
- Department of Biostatistics, Children's Research Foundation Institute, Le Bonheur Children's Hospital, Memphis, TN.,Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TN
| | - Marianne E Nellis
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medical College, New York, NY
| | - Ashwini D Joshi
- School of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Krista M Cowan
- School of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Connor W Gatewood
- School of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Alex B Ryder
- Department of Pathology and Pediatrics, University of Tennessee Health Science Center, Memphis, TN
| | - Ulrike M Reiss
- Division of Clinical Hematology, Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN
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17
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Palmer FB, Graff JC, Jones TL, Murphy LE, Keisling BL, Whitaker TM, Wang L, Tylavsky FA. Socio-demographic, maternal, and child indicators of socioemotional problems in 2-year-old children: A cohort study. Medicine (Baltimore) 2018; 97:e11468. [PMID: 29995806 PMCID: PMC6076199 DOI: 10.1097/md.0000000000011468] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Throughout infancy and early childhood, stable and secure relationships with caregivers are needed to promote optimal socioemotional (SE) and cognitive development.The objective is to examine socio-demographic, maternal, and child indicators of SE problems in 2-year-olds living in an urban-suburban community in the southern United States.Mother-infant pairs enrolled in a prospective pregnancy cohort study.Shelby County (Memphis), Tennessee.One thousand five hundred three women were recruited during their second trimester and followed with their children through the child's age of 2 years.Child SE development was measured by the Brief Infant-Toddler Social Emotional Assessment at 2 years of age. Mothers reported their own behavioral and mental health, temperament, parenting stress, and potential for child abuse during gestation and/or when their child was 1 year of age. Examiners measured maternal IQ during data collection at the child's age of 1 year. Child communication, cognitive development, and risk for autism spectrum disorder were assessed at 1 and 2 years of age. Multivariable regression models were developed to predict mother-reported SE problems.In bivariate analyses, multiple maternal behavioral and mental health indicators and child cognitive skills were associated with reported child SE problems at 2 years of age. Regression analyses, controlling for socio-demographic, maternal, and child variables, showed the following factors were independently associated with mother-reported child SE problems: maternal education of high school or less, lower maternal IQ, higher maternal cyclothymic temperament score, greater parenting stress, greater maternal psychological distress, lower child expressive communication score, and child risk for autism spectrum disorder. Socio-demographic variables accounted for the variance often attributed to race.Since mothers in the study were medically low-risk, generalizing these findings to medically high-risk mothers is unwarranted. In addition, these SE outcomes in 2-year-old children do not reflect the trajectory of SE development throughout early childhood.Attention to independent indicators of future SE problems in children may help identify individual children and families needing intervention and target public prevention/treatment programs in communities.
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Affiliation(s)
- Frederick B. Palmer
- Department of Pediatrics
- Boling Center for Developmental Disabilities, College of Medicine
| | - Joyce C. Graff
- Boling Center for Developmental Disabilities, College of Medicine
- College of Nursing
| | - Tamekia L. Jones
- Department of Pediatrics
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center
- Children's Foundation Research Institute, Le Bonheur Children's Hospital
| | - Laura E. Murphy
- Boling Center for Developmental Disabilities, College of Medicine
- Department of Psychiatry, College of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Bruce L. Keisling
- Department of Pediatrics
- Boling Center for Developmental Disabilities, College of Medicine
| | - Toni M. Whitaker
- Department of Pediatrics
- Boling Center for Developmental Disabilities, College of Medicine
| | - Lei Wang
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center
| | - Frances A. Tylavsky
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center
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18
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Akbilgic O, Langham MR, Walter AI, Jones TL, Huang EY, Davis RL. A novel risk classification system for 30-day mortality in children undergoing surgery. PLoS One 2018; 13:e0191176. [PMID: 29351327 PMCID: PMC5774754 DOI: 10.1371/journal.pone.0191176] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 12/03/2017] [Indexed: 12/21/2022] Open
Abstract
A simple, objective and accurate way of grouping children undergoing surgery into clinically relevant risk groups is needed. The purpose of this study, is to develop and validate a preoperative risk classification system for postsurgical 30-day mortality for children undergoing a wide variety of operations. The National Surgical Quality Improvement Project-Pediatric participant use file data for calendar years 2012–2014 was analyzed to determine preoperative variables most associated with death within 30 days of operation (D30). Risk groups were created using classification tree analysis based on these preoperative variables. The resulting risk groups were validated using 2015 data, and applied to neonates and higher risk CPT codes to determine validity in high-risk subpopulations. A five-level risk classification was found to be most accurate. The preoperative need for ventilation, oxygen support, inotropic support, sepsis, the need for emergent surgery and a do not resuscitate order defined non-overlapping groups with observed rates of D30 that vary from 0.075% (Very Low Risk) to 38.6% (Very High Risk). When CPT codes where death was never observed are eliminated or when the system is applied to neonates, the groupings remained predictive of death in an ordinal manner.
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Affiliation(s)
- Oguz Akbilgic
- University of Tennessee Health Science Center-Oak Ridge National Laboratory Center for Biomedical Informatics, Memphis, Tennessee, United States of America
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
| | - Max R. Langham
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
- * E-mail:
| | - Arianne I. Walter
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
| | - Tamekia L. Jones
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
- Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, Tennessee, United States of America
| | - Eunice Y. Huang
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
| | - Robert L. Davis
- University of Tennessee Health Science Center-Oak Ridge National Laboratory Center for Biomedical Informatics, Memphis, Tennessee, United States of America
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19
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Nakano N, Lisenda L, Jones TL, Loveday DT, Khanduja V. Complications following arthroscopic surgery of the hip: a systematic review of 36 761 cases. Bone Joint J 2017; 99-B:1577-1583. [PMID: 29212679 DOI: 10.1302/0301-620x.99b12.bjj-2017-0043.r2] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [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: 01/10/2017] [Accepted: 08/01/2017] [Indexed: 11/05/2022]
Abstract
AIMS The number of patients undergoing arthroscopic surgery of the hip has increased significantly during the past decade. It has now become an established technique for the treatment of many intra- and extra-articular conditions affecting the hip. However, it has a steep learning curve and is not without the risk of complications. The purpose of this systematic review was to determine the prevalence of complications during and following this procedure. MATERIALS AND METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used in designing this study. Two reviewers systematically searched the literature for complications related to arthroscopy of the hip. The research question and eligibility criteria were established a priori. Pertinent data were abstracted and analysed. RESULTS We found 276 relevant studies with a total of 36 761 arthroscopies that met the inclusion criteria. The mean age of the patients was 36.7 years (1.7 to 70) and the mean body mass index was 25.7 kg/m2 (20.2 to 29.2). Femoroacetabular impingement and labral tears were the most common indications for the procedure. The total number of complications was 1222 (3.3%). Nerve injury (0.9%), mainly involving the pudendal and lateral femoral cutaneous nerves, and iatrogenic chondral and labral injury (0.7%), were the two most common complications. There were 58 major complications (0.2%), the most common being intra-abdominal extravasation of fluid, which was found in 13 cases (0.04%). There were three deaths (0.008%). CONCLUSION Arthroscopic surgery of the hip is a procedure with a relatively low rate of complications, although some may be significant in this young cohort of patients. This study relied on the reported complications only and the results should be interpreted with caution. Cite this article: Bone Joint J 2017;99-B:1577-83.
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Affiliation(s)
- N Nakano
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK
| | - L Lisenda
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK
| | - T L Jones
- Portsmouth Hospitals NHS Trust, Southwick Hill Rd, Portsmouth, PO6 3LY, UK
| | - D T Loveday
- Norfolk and Norwich University Hospital NHS Foundation Trust, Colney Lane, Norwich NR4 7UY, UK
| | - V Khanduja
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK
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20
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Gateño J, Jones TL, Shen SGF, Chen KC, Jajoo A, Kuang T, English JD, Nicol M, Teichgraeber JF, Xia JJ. Fluctuating asymmetry of the normal facial skeleton. Int J Oral Maxillofac Surg 2017; 47:534-540. [PMID: 29103833 DOI: 10.1016/j.ijom.2017.10.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 06/20/2017] [Revised: 09/06/2017] [Accepted: 10/24/2017] [Indexed: 10/18/2022]
Abstract
The purpose of this study was to produce reliable estimations of fluctuating facial asymmetry in a normal population. Fifty-four computed tomography (CT) facial models of average-looking and symmetrical Chinese subjects with a class I occlusion were used in this study. Eleven midline landmarks and 12 pairs of bilateral landmarks were digitized. The repeatability of the landmark digitization was first evaluated. A Procrustes analysis was then used to measure the fluctuating asymmetry of each CT model, after all of the models had been scaled to the average face size of the study sample. A principal component analysis was finally used to establish the direction of the fluctuating asymmetries. The results showed that there was excellent absolute agreement among the three repeated measurements. The mean fluctuating asymmetry of the average-size face varied at each anthropometric landmark site, ranging from 1.0mm to 2.8mm. At the 95% upper limit, the asymmetries ranged from 2.2mm to 5.7mm. Most of the asymmetry of the midline structures was mediolateral, while the asymmetry of the bilateral landmarks was more equally distributed. These values are for the average face. People with larger faces will have higher values, while subjects with smaller faces will have lower values.
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Affiliation(s)
- J Gateño
- Department of Oral and Maxillofacial Surgery, Houston Methodist Hospital, Houston, Texas, USA; Oral and Maxillofacial Surgery, Weill Medical College, Cornell University, New York, USA
| | - T L Jones
- Department of Orthodontics, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, Texas, USA; Private Practice, Plano, Texas, USA
| | - S G F Shen
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University College of Medicine, Shanghai, China
| | - K-C Chen
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, Texas, USA; Oral and Maxillofacial Surgery, National Cheng-Kung University Medical College and Hospital, Tainan, Taiwan
| | - A Jajoo
- Department of Mathematics, University of Houston, Houston, Texas, USA
| | - T Kuang
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, Texas, USA
| | - J D English
- Department of Orthodontics, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - M Nicol
- Department of Mathematics, University of Houston, Houston, Texas, USA
| | - J F Teichgraeber
- Division of Pediatric Plastic Surgery, Department of Pediatric Surgery, The University of Texas Houston Health Science Center, Houston, Texas, USA
| | - J J Xia
- Department of Oral and Maxillofacial Surgery, Houston Methodist Hospital, Houston, Texas, USA; Oral and Maxillofacial Surgery, Weill Medical College, Cornell University, New York, USA; Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University College of Medicine, Shanghai, China; Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, Texas, USA.
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21
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Aldoss O, Fonseca BM, Truong UT, Bracken J, Darst JR, Guo R, Jones TL, Fagan TE. Diagnostic Utility of Three-Dimensional Rotational Angiography in Congenital Cardiac Catheterization. Pediatr Cardiol 2016; 37:1211-21. [PMID: 27278632 DOI: 10.1007/s00246-016-1418-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 05/20/2016] [Indexed: 12/19/2022]
Abstract
We evaluated the diagnostic utility of the three modalities of three-dimensional rotational angiography (3DRA): rotational angiography (RA), multiplanar reformat (MPR) and three-dimensional angiographic reconstruction (3D-R) in pediatric cardiac catheterization. The 3DRA studies were classified by anatomy of interest based on our injection protocol: pulmonary arteries (PA), aorta, cavopulmonary connection (CPC), and others. Retrospective review of 3DRA images by two reviewers for each modality was conducted with grading as inferior, similar, or superior in comparison with the diagnostic quality of fixed-plane angiography (FPA). The percentages of grades for each modality were averaged. Weighted kappa statistic was used to evaluate inter-rater reliability. In total, 114 3DRA studies were performed on 87 patients between August 2010 and March 2012. Median age was 2.7 years (1 day-48.4 years) and median weight 12.1 kg (3.6-106.5 kg). For RA: 79.4 % of the studies were of diagnostic quality and 52.2 % were superior; 3D-R: 82 % were of diagnostic quality and 65.8 % were superior; and MPR: 83.5 % were of diagnostic quality and 63 % were superior. Overall 3DRA technologies (RA, 3D-R, MPR) were of diagnostic quality or better in 111/114 (97.4 %) studies and 103/114 (90.4 %) were judged superior. Most common reasons for inferior grading were limited opacification and metallic artifact. In pediatric cardiac catheterization, 3DRA imaging was of diagnostic quality and frequently provided additional clinically relevant data when compared to FPA.
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Affiliation(s)
- Osamah Aldoss
- Division of Cardiology, Department of Pediatrics, University of Iowa and Children's Hospital of Iowa, Iowa City, IA, 52242, USA
| | - Brian M Fonseca
- Division of Cardiology, Department of Pediatrics, University of Colorado and Children's Hospital Colorado, Aurora, CO, 80045, USA
| | - Uyen T Truong
- Division of Cardiology, Department of Pediatrics, University of Colorado and Children's Hospital Colorado, Aurora, CO, 80045, USA
| | - John Bracken
- Philips Research North America, Briarcliff Manor, NY, 10510, USA
- Division of Cardiology, Department of Internal Medicine, University of Colorado and University of Colorado Hospital, Aurora, CO, 80045, USA
| | - Jeffrey R Darst
- Division of Cardiology, Department of Pediatrics, University of Colorado and Children's Hospital Colorado, Aurora, CO, 80045, USA
| | - Ruixin Guo
- Department of Biostatistics and Informatics, University of Colorado, Aurora, CO, 80045, USA
| | - Tamekia L Jones
- Department of Pediatrics, Children's Foundation Research Institute, University of Tennessee Health Science Center and Le Bonheur Children's Hospital, Memphis, TN, 38103, USA
| | - Thomas E Fagan
- Division of Cardiology, Department of Pediatrics, University of Tennessee Health Science Center and Le Bonheur Children's Hospital, 49 N. Dunlap Street, Floor 3, Memphis, TN, 38103, USA.
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Savoie KB, Bachier-Rodriguez M, Jones TL, Jeffreys K, Papraniku D, Sevilla WMA, Tillman E, Huang EY. Standardization of Feeding Advancement After Neonatal Gastrointestinal Surgery. Nutr Clin Pract 2016; 31:810-818. [DOI: 10.1177/0884533616658766] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Kate B. Savoie
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis, Tennessee, USA
| | - Marielena Bachier-Rodriguez
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis, Tennessee, USA
| | - Tamekia L. Jones
- Children’s Foundation Research Institute, Departments of Pediatrics & Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kristen Jeffreys
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis, Tennessee, USA
| | - Dita Papraniku
- Dietetics and Nutrition, Le Bonheur Children’s Hospital, Memphis, Tennessee, USA
| | - Wednesday Marie A. Sevilla
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis, Tennessee, USA
| | - Emma Tillman
- Department of Clinical Pharmacy, Indiana University Health, Riley Hospital for Children, Indianapolis, Indiana, USA
| | - Eunice Y. Huang
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis, Tennessee, USA
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23
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Shah SD, Dereddy N, Jones TL, Dhanireddy R, Talati AJ. Early versus Delayed Human Milk Fortification in Very Low Birth Weight Infants-A Randomized Controlled Trial. J Pediatr 2016; 174:126-131.e1. [PMID: 27112041 DOI: 10.1016/j.jpeds.2016.03.056] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [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: 12/09/2015] [Revised: 02/15/2016] [Accepted: 03/22/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To compare the effect of initiating human milk fortification at 2 different feeding volumes on feeding intolerance and the time to reach full feeding volume. STUDY DESIGN Very low birth weight infants (n = 100) were prospectively randomized to early fortification (EF) (beginning at a feeding volume of 20 mL/kg/d) or delayed fortification (at a feeding volume of 100 mL/kg/d). We employed a standardized feeding protocol and parenteral nutrition guidelines for the nutritional management of all study infants. RESULTS The median days to reach full feeding volumes were equivalent in the 2 groups (20 vs 20, P = .45). No significant difference was observed in the total number of episodes of feeding intolerance (58 vs 57). Two cases of necrotizing enterocolitis (Bell stage ≥2) and deaths occurred in each group. Median daily protein intake (g/kg/d) was higher in EF group in week 1 (3.3 [3.2, 3.5] vs 3.1 [2.9, 3.3], P < .001), week 2 (3.6 [3.5, 3.8] vs 3.2 [2.9, 3.4], P < .001), and week 3 (3.7 [3.4, 3.9] vs 3.5 [2.8, 3.8], P = .006). Cumulative protein intake (g/kg) in the first 4 weeks of life was higher in EF group (98.6 [93.8, 104] vs 89.6 [84.2, 96.4], P < .001). CONCLUSIONS Very early human milk fortification may improve early protein intake in very low birth weight infants without increasing frequencies of adverse events. TRIAL REGISTRATION ClinicalTrials.gov: NCT01988792.
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Affiliation(s)
- Sanket D Shah
- Department of Pediatrics, University of Florida, Jacksonville, FL.
| | - Narendra Dereddy
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
| | - Tamekia L Jones
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN; Children's Foundation Research Institute at Le Bonheur Children's Hospital, Memphis, TN
| | - Ramasubbareddy Dhanireddy
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN; Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN
| | - Ajay J Talati
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN; Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN
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24
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Murphy RF, Moisan A, Kelly DM, Warner WC, Jones TL, Sawyer JR. Use of Vertical Expandable Prosthetic Titanium Rib (VEPTR) in the Treatment of Congenital Scoliosis Without Fused Ribs. J Pediatr Orthop 2016; 36:329-35. [PMID: 25887832 DOI: 10.1097/bpo.0000000000000460] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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: 02/07/2023]
Abstract
BACKGROUND Although the vertical expandable prosthetic titanium rib (VEPTR) has been shown to be useful in treating congenital scoliosis (CS) with fused ribs, no studies to date have specifically evaluated the efficacy of VEPTR in the treatment of CS without fused ribs. The purpose of this study was to determine the effectiveness of VEPTR in sagittal/coronal curve correction and spine growth and compare its complication rate to the use of VEPTR in other conditions and to other treatment methods used for CS. METHODS A multicenter database was queried for patients with CS without fused ribs treated with VEPTR. Anteroposterior (AP) and lateral radiographs were used to measure parameters at 3 timepoints (preoperative, immediate postoperative, and latest follow-up): coronal Cobb angle, sagittal kyphosis, and thoracic and lumbar spine heights. Clinical data included age, time to follow-up, and complications. RESULTS Twenty-five patients (13 females, 12 males) were identified. The average age at implantation was 5.7 years, with an average follow-up of 50 months. Several parameters improved from preoperative to latest follow-up: coronal Cobb angle (69 to 54 degrees, P<0.0001), thoracic spine height (T1-T12) in the AP (13.3 to 15.9 cm, P<0.0001) and lateral (14.8 to 17.4 cm, P=0.0024) planes, and lumbar spine height (L1-S1) in the AP (8.8 to 11.4 cm, P<0.0001) and lateral (9.9 to 11.9 cm, P=0.0002) planes. Kyphosis increased over the study period (36 to 41 degrees, P=0.6). Fifteen patients (60%) had 41 complications (average 2.75; range, 1 to 12). Twenty-eight complications (68%) were device-related, and 13 (32%) were disease-related. The most common complications were infection, wound dehiscence, and device migration. Six complications (15%) altered the course of treatment. Thoracic spine height increased 79% of expected growth. CONCLUSION VEPTR is an effective treatment for patients with CS without fused ribs, as evidenced by improved radiographic parameters and increased spinal height, with a complication rate which is high but similar to other methods of treatment. LEVEL OF EVIDENCE Level IV-case series.
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Affiliation(s)
- Robert F Murphy
- *Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic †Le Bonheur Children's Hospital ‡Departments of Pediatrics and Preventive Medicine, University of Tennessee, Memphis, TN
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25
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Rossi NB, Khan NR, Jones TL, Lepard J, McAbee JH, Klimo P. Predicting shunt failure in children: should the global shunt revision rate be a quality measure? J Neurosurg Pediatr 2016; 17:249-59. [PMID: 26544083 DOI: 10.3171/2015.5.peds15118] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Ventricular shunts for pediatric hydrocephalus continue to be plagued with high failure rates. Reported risk factors for shunt failure are inconsistent and controversial. The raw or global shunt revision rate has been the foundation of several proposed quality metrics. The authors undertook this study to determine risk factors for shunt revision within their own patient population. METHODS In this single-center retrospective cohort study, a database was created of all ventricular shunt operations performed at the authors' institution from January 1, 2010, through December 2013. For each index shunt surgery, demographic, clinical, and procedural variables were assembled. An "index surgery" was defined as implantation of a new shunt or the revision or augmentation of an existing shunt system. Bivariate analyses were first performed to evaluate individual effects of each independent variable on shunt failure at 90 days and at 180 days. A final multivariate model was chosen for each outcome by using a backward model selection approach. RESULTS There were 466 patients in the study accounting for 739 unique ("index") operations, for an average of 1.59 procedures per patient. The median age for the cohort at the time of the first shunt surgery was 5 years (range 0-35.7 years), with 53.9% males. The 90- and 180-day shunt failure rates were 24.1% and 29.9%, respectively. The authors found no variable-demographic, clinical, or procedural-that predicted shunt failure within 90 or 180 days. CONCLUSIONS In this study, none of the risk factors that were examined were statistically significant in determining shunt failure within 90 or 180 days. Given the negative findings and the fact that all other risk factors for shunt failure that have been proposed in the literature thus far are beyond the control of the surgeon (i.e., nonmodifiable), the use of an institution's or individual's global shunt revision rate remains questionable and needs further evaluation before being accepted as a quality metric.
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Affiliation(s)
- Nicholas B Rossi
- Department of Neurosurgery, University of Tennessee Health Science Center
| | - Nickalus R Khan
- Department of Neurosurgery, University of Tennessee Health Science Center
| | - Tamekia L Jones
- Departments of Pediatrics and Preventive Medicine, University of Tennessee Health Science Center, Children's Foundation Research Institute
| | - Jacob Lepard
- Department of Neurosurgery, University of Alabama, Birmingham, Alabama; and
| | - Joseph H McAbee
- School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center;,Semmes-Murphey Neurologic & Spine Institute; and.,Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee
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Klimo P, Rossi NB, Khan NR, Jones TL. Response. J Neurosurg Pediatr 2016; 17:248. [PMID: 27358967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
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27
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Langham MR, Walter A, Boswell TC, Beck R, Jones TL. Identifying children at risk of death within 30 days of surgery at an NSQIP pediatric hospital. Surgery 2015; 158:1481-91. [DOI: 10.1016/j.surg.2015.04.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 04/11/2015] [Accepted: 04/22/2015] [Indexed: 10/23/2022]
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Saravia J, You D, Shrestha B, Jaligama S, Siefker D, Lee GI, Harding JN, Jones TL, Rovnaghi C, Bagga B, DeVincenzo JP, Cormier SA. Respiratory Syncytial Virus Disease Is Mediated by Age-Variable IL-33. PLoS Pathog 2015; 11:e1005217. [PMID: 26473724 PMCID: PMC4608776 DOI: 10.1371/journal.ppat.1005217] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 09/21/2015] [Indexed: 12/31/2022] Open
Abstract
Respiratory syncytial virus (RSV) is the most common cause of infant hospitalizations and severe RSV infections are a significant risk factor for childhood asthma. The pathogenic mechanisms responsible for RSV induced immunopathophysiology remain elusive. Using an age-appropriate mouse model of RSV, we show that IL-33 plays a critical role in the immunopathogenesis of severe RSV, which is associated with higher group 2 innate lymphoid cells (ILC2s) specifically in neonates. Infection with RSV induced rapid IL-33 expression and an increase in ILC2 numbers in the lungs of neonatal mice; this was not observed in adult mice. Blocking IL-33 with antibodies or using an IL-33 receptor knockout mouse during infection was sufficient to inhibit RSV immunopathogenesis (i.e., airway hyperresponsiveness, Th2 inflammation, eosinophilia, and mucus hyperproduction); whereas administration of IL-33 to adult mice during RSV infection was sufficient to induce RSV disease. Additionally, elevated IL-33 and IL-13 were observed in nasal aspirates from infants hospitalized with RSV; these cytokines declined during convalescence. In summary, IL-33 is necessary, either directly or indirectly, to induce ILC2s and the Th2 biased immunopathophysiology observed following neonatal RSV infection. This study provides a mechanism involving IL-33 and ILC2s in RSV mediated human asthma.
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Affiliation(s)
- Jordy Saravia
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
- Children’s Foundation Research Institute at Le Bonheur Children’s Hospital, Memphis, Tennessee, United States of America
| | - Dahui You
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
- Children’s Foundation Research Institute at Le Bonheur Children’s Hospital, Memphis, Tennessee, United States of America
| | - Bishwas Shrestha
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
- Children’s Foundation Research Institute at Le Bonheur Children’s Hospital, Memphis, Tennessee, United States of America
| | - Sridhar Jaligama
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
- Children’s Foundation Research Institute at Le Bonheur Children’s Hospital, Memphis, Tennessee, United States of America
| | - David Siefker
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
- Children’s Foundation Research Institute at Le Bonheur Children’s Hospital, Memphis, Tennessee, United States of America
| | - Greg I. Lee
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
- Children’s Foundation Research Institute at Le Bonheur Children’s Hospital, Memphis, Tennessee, United States of America
| | - Jeffrey N. Harding
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
- Children’s Foundation Research Institute at Le Bonheur Children’s Hospital, Memphis, Tennessee, United States of America
| | - Tamekia L. Jones
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
- Children’s Foundation Research Institute at Le Bonheur Children’s Hospital, Memphis, Tennessee, United States of America
| | - Cynthia Rovnaghi
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
| | - Bindiya Bagga
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
- Children’s Foundation Research Institute at Le Bonheur Children’s Hospital, Memphis, Tennessee, United States of America
| | - John P. DeVincenzo
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
- Children’s Foundation Research Institute at Le Bonheur Children’s Hospital, Memphis, Tennessee, United States of America
- Department of Microbiology, Immunology, and Biochemistry, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
| | - Stephania A. Cormier
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
- Children’s Foundation Research Institute at Le Bonheur Children’s Hospital, Memphis, Tennessee, United States of America
- Department of Microbiology, Immunology, and Biochemistry, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
- * E-mail:
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Ko RH, Jones TL, Radvinsky D, Robison N, Gaynon PS, Panosyan EH, Avramis IA, Avramis VI, Rubin J, Ettinger LJ, Seibel NL, Dhall G. Allergic reactions and antiasparaginase antibodies in children with high-risk acute lymphoblastic leukemia: A children's oncology group report. Cancer 2015; 121:4205-11. [PMID: 26308766 DOI: 10.1002/cncr.29641] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 07/17/2015] [Accepted: 07/21/2015] [Indexed: 11/05/2022]
Abstract
BACKGROUND The objectives of this study were to assess the incidence of clinical allergy and end-induction antiasparaginase (anti-ASNase) antibodies in children with high-risk acute lymphoblastic leukemia treated with pegylated (PEG) Escherichia coli ASNase and to determine whether they carry any prognostic significance. METHODS Of 2057 eligible patients, 1155 were allocated to augmented arms in which PEG ASNase replaced native ASNase postinduction. Erwinia chrysanthemi (Erwinia) ASNase could be used to replace native ASNase after allergy, if available. Allergy and survival data were complete for 990 patients. End-induction antibody titers were available for 600 patients. RESULTS During the consolidation phase, 289 of 990 patients (29.2%) had an allergic reaction. There were fewer allergic reactions to Erwinia ASNase than to native ASNase (odds ratio, 4.33; P < .0001) or PEG ASNase (odds ratio, 3.08; P < .0001) only during phase 1 of interim maintenance. There was no significant difference in 5-year event-free survival (EFS) between patients who received PEG ASNase throughout the entire study postinduction versus those who developed an allergic reaction to PEG ASNase during consolidation phase and subsequently received Erwinia ASNase (80.8% ± 2.8% and 81.6% ± 3.8%, respectively; P = .66). Patients who had positive antibody titers postinduction were more likely to have an allergic reaction to PEG ASNase (odds ratio, 2.4; P < .001). The 5-year EFS rate between patients who had negative versus positive antibody titers (80% ± 2.6% and 77.7% ± 4.3%, respectively; P = .68) and between patients who did not receive any ASNase postconsolidation and those who received PEG ASNase throughout the study (P = .22) were significantly different. CONCLUSIONS The current results demonstrate differences in the incidence rates of toxicity between ASNase preparations but not in EFS. The presence of anti-ASNase antibodies did not affect EFS.
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Affiliation(s)
- Richard H Ko
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, California.,Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Tamekia L Jones
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - David Radvinsky
- State University of New York of New York Downstate Medical Center, Brooklyn New York
| | - Nathan Robison
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, California.,Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Paul S Gaynon
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, California.,Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Eduard H Panosyan
- Division of Pediatric Hematology and Oncology, Harbor-University of California Los Angeles Medical Center, Torrance, California
| | - Ioannis A Avramis
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, California
| | - Vassilios I Avramis
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, California.,Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Joan Rubin
- Department of Pediatrics, St. Peter's University Hospital, New Brunswick, New Jersey
| | | | - Nita L Seibel
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland
| | - Girish Dhall
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, California.,Keck School of Medicine, University of Southern California, Los Angeles, California
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Johnson AK, Ford MA, Jones TL, Nahar VK, Hallam JS. Predictors of bone mineral density in african-american and caucasian college-aged women. Health Promot Perspect 2015; 5:14-23. [PMID: 26000242 DOI: 10.15171/hpp.2015.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 02/12/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Research regarding risk factors and prevalence of low bone mineral density (BMD) among African-American and Caucasian college-aged women are limited. The objective of this cross-sectional study was to determine if selected predictors of BMD in African-American and Caucasian college-aged women differ by race. METHODS A total of 101 local African-American (n=50) and Caucasian (n=51) females, ages 18 to 30 years, were in this study. All data were collected in the Bone Density and Body Composition Laboratory. BMD was measured using DXA technology. Race, family history of osteoporosis, BMI, current physical activity, osteoporosis knowledge, length of time on oral contraceptives, age at menarche and calcium intake were included in the multiple regression analyses with spinal and femoral BMD as dependent variables. RESULTS Overall, 38.6% had low spinal BMD and 7.9% had low femoral BMD. BMI (β=0.073, R(2) = .148, P = .001, 95% CI [0.030, 0.116]) and current physical activity (β=0.071, R(2) = .148, P = .017, 95% CI [0.013, 0.129]) were the only variables that were statistically significant in predicting spinal BMD. BMI (β=0.056, R(2) = .13, P = .010, 95% CI [0.014, 0.098]) and current physical activ-ity (β=0.078, R(2) = .13, P = .007, 95% CI [0.022, 0.134]) were also the only varia-bles that were statistically significant in predicting femoral BMD. Race was not a significant predictor of spinal or femoral BMD. CONCLUSION It is imperative for both African-American and Caucasian women to engage in osteoporosis-preventive behaviors.
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Affiliation(s)
- Andrea K Johnson
- Department of Health and Human Performance, University of Tennessee at Martin, Martin, TN, 38238, USA
| | - M Allison Ford
- Department of Health, Exercise Science & Recreation Management, University of Mississippi, University, MS, 38677, USA
| | - Tamekia L Jones
- Department of Pediatrics and Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, USA
| | - Vinayak K Nahar
- Department of Health, Exercise Science & Recreation Management, University of Mississippi, University, MS, 38677, USA
| | - Jeffrey S Hallam
- College of Public Health, Department of Social and Behavioral Sciences, Kent State University, Kent, USA
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Dreyer ZE, Hilden JM, Jones TL, Devidas M, Winick NJ, Willman CL, Harvey RC, Chen IM, Behm FG, Pullen J, Wood BL, Carroll AJ, Heerema NA, Felix CA, Robinson B, Reaman GH, Salzer WL, Hunger SP, Carroll WL, Camitta BM. Intensified chemotherapy without SCT in infant ALL: results from COG P9407 (Cohort 3). Pediatr Blood Cancer 2015; 62:419-26. [PMID: 25399948 PMCID: PMC5145261 DOI: 10.1002/pbc.25322] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 09/23/2014] [Indexed: 11/12/2022]
Abstract
BACKGROUND Infants with acute lymphoblastic leukemia (ALL) present with aggressive disease and a poor prognosis. Early relapse within 6-9 months of diagnosis is common. Approximately 75% of infants have MLL-rearranged (MLL-R) ALL with event free survival (EFS) ranging from 20% to 30%. Children's Oncology Group (COG) P9407 used shortened (46 weeks), intensified therapy to address early relapse and poor EFS. PROCEDURE P9407 therapy was modified three times for induction toxicity resulting in three cohorts of therapy. One hundred forty-seven infants were enrolled in the third cohort. RESULTS We report an overall 5-year EFS and OS of 42.3 ± 6% and 52.9 ± 6.5% respectively. Poor prognostic factors included age ≤90 days at diagnosis, MLL-R ALL and white cell count ≥50,000/μl. For infants ≤90 days of age, the 5-year EFS was 15.5 ± 10.1% and 48.5 ± 6.7% for those >90 days (P < 0.0001). Among infants >90 days of age, 5-year EFS rates were 43.8 ± 8% for MLL-R versus 69.1 ± 13.6% for MLL-germline ALL (P < 0.0001). CONCLUSIONS Age ≤90 days at diagnosis was the most important prognostic factor. Despite shortened therapy with early intensification, EFS remained less than 50% overall in MLL-R ALL.
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Affiliation(s)
- ZoAnn E. Dreyer
- Texas Children’s Cancer Center, Baylor College of Medicine, Houston, TX
| | - Joanne M. Hilden
- University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO
| | - Tamekia L. Jones
- Department of Biostatistics, Colleges of Medicine and Public Health & Health Professions, University of Florida, Gainesville, FL
| | - Meenakshi Devidas
- Department of Biostatistics, Colleges of Medicine and Public Health & Health Professions, University of Florida, Gainesville, FL
| | - Naomi J. Winick
- Pediatric Hematology-Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Cheryl L. Willman
- Department of Pathology and UMN Cancer Center, University of New Mexico Health Services, Albuquerque, NM
| | - Richard C. Harvey
- Department of Pathology and UMN Cancer Center, University of New Mexico Health Services, Albuquerque, NM
| | - I-Ming Chen
- Department of Pathology and UMN Cancer Center, University of New Mexico Health Services, Albuquerque, NM
| | | | - Jeanette Pullen
- Pediatric Hematology/Oncology, University of Mississippi Medical Center, Jackson, MS
| | - Brent L. Wood
- Laboratory Medicine, Seattle Children’s Hospital, Seattle, WA
| | - Andrew J. Carroll
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL
| | - Nyla A. Heerema
- Department of Pathology, The Ohio State University, Columbus, OH
| | - Carolyn A. Felix
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Blaine Robinson
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Gregory H. Reaman
- Hematology-Oncology, Children’s National Medical Center, Washington, DC
| | - Wanda L. Salzer
- Mark O Hatfield-Warren Grant Magnuson Clinical Canter, Pediatric Oncology, Silver Spring, MD
| | - Stephen P. Hunger
- University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO
| | - William L. Carroll
- NYU Cancer Institute, New York University Langone Medical Center, New York, NY
| | - Bruce M. Camitta
- Midwest Center for Cancer and Blood Disorders, Medical College of Wisconsin, Milwaukee, WI
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32
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Salzer WL, Jones TL, Devidas M, Dreyer ZE, Gore L, Winick NJ, Sung L, Raetz E, Loh ML, Wang CY, De Lorenzo P, Valsecchi MG, Pieters R, Carroll WL, Hunger SP, Hilden JM, Brown P. Decreased induction morbidity and mortality following modification to induction therapy in infants with acute lymphoblastic leukemia enrolled on AALL0631: a report from the Children's Oncology Group. Pediatr Blood Cancer 2015; 62:414-8. [PMID: 25407157 PMCID: PMC4480675 DOI: 10.1002/pbc.25311] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [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: 06/04/2014] [Accepted: 09/22/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND Infants with acute lymphoblastic leukemia (ALL) have a poor prognosis. Intensification of therapy has resulted in fewer relapses but increased early deaths, resulting in failure to improve survival. PROCEDURE AALL0631 is a Phase 3 study for infants (<366 days of age) with newly diagnosed ALL. Induction initially (Cohort 1) consisted of 3 weeks of therapy based on COG P9407. Due to excessive early mortality, induction was amended to a less intensive 5 weeks of therapy based on Interfant-99. Additionally, enhanced supportive care guidelines were incorporated with hospitalization during induction until evidence of marrow recovery and recommendations for prevention/treatment of infections (Cohort 2). RESULTS Induction mortality was significantly lower for patients in Cohort 2 (2/123, 1.6%) versus Cohort 1 (4/26, 15.4%; P = 0.009). All induction deaths were infection related except one due to progressive disease (Cohort 2). Sterile site infections were lower for patients in Cohort 2 (24/123, 19.5%) versus Cohort 1 (15/26, 57.7%; P = 0.0002), with a significantly lower rate of Gram positive infections during induction for patients in Cohort 2, P = 0.0002. No clinically significant differences in grades 3-5 non-infectious toxicities were observed between the two cohorts. Higher complete response rates were observed at end induction intensification for Cohort 2 (week 9, 94/100, 94%) versus Cohort 1 (week 7, 17/25, 68%; P = 0.0.0012). CONCLUSION De-intensification of induction therapy and enhanced supportive care guidelines significantly decreased induction mortality and sterile site infections, without decreasing complete remission rates.
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Affiliation(s)
- Wanda L. Salzer
- U.S. Army Medical Research and Materiel Command, Fort Detrick, MD
| | - Tamekia L. Jones
- Department of Biostatistics, Colleges of Medicine and Public Health & Health Professions, University of Florida, Gainesville, FL
| | - Meenakshi Devidas
- Department of Biostatistics, Colleges of Medicine and Public Health & Health Professions, University of Florida, Gainesville, FL
| | - ZoAnn E. Dreyer
- Texas Children’s Cancer Center, Baylor College of Medicine, Houston, TX
| | - Lia Gore
- Childrens Hospital Colorado and the University of Colorado School of Medicine, Aurora, CO
| | - Naomi J. Winick
- Division of Pediatric Hematology/Oncology, University of Texas Southwestern School of Medicine, Dallas, TX
| | - Lillian Sung
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elizabeth Raetz
- Department of Pediatrics and Huntsman Cancer Institute, University of Utah
| | - Mignon L. Loh
- Department of Pediatrics, University of California at San Francisco, CA
| | - Cindy Y. Wang
- Children’s Oncology Group Statistics and Data Center University of Florida, Gainesville, FL
| | - Paola De Lorenzo
- Interfant Trial Data Center, Pediatric Clinic, University of Milano-Bicocca, Monza, Italy,Department of Health Sciences, University of Milano Bicocca, Monza, Italy
| | | | - Rob Pieters
- Princess Maxima Center for Pediatric Oncology, Utrecht, Pediatric Oncology, Erasmus MC - Sophia Children’s Hospital, Rotterdam, Netherlands
| | | | - Stephen P Hunger
- Childrens Hospital Colorado and the University of Colorado School of Medicine, Aurora, CO
| | - Joanne M. Hilden
- Childrens Hospital Colorado and the University of Colorado School of Medicine, Aurora, CO
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Raschke F, Jones TL, Barrick TR, Howe FA. Delineation of gliomas using radial metabolite indexing. NMR Biomed 2014; 27:1053-1062. [PMID: 25042619 DOI: 10.1002/nbm.3154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 11/28/2013] [Revised: 05/18/2014] [Accepted: 05/20/2014] [Indexed: 06/03/2023]
Abstract
(1) H MRSI has demonstrated the ability to characterise and delineate brain tumours, but robust data analysis methods are still needed. In this study, we present an objective analysis method for MRSI data to delineate tumour abnormality regions. The presented method is a development of the choline-to-N-acetylaspartate index (CNI), which uses perpendicular distances in a choline versus N-acetylaspartate plot as a measure of abnormality. We propose a radial CNI (rCNI) method that uses the choline to N-acetylaspartate ratio directly as an abnormality measure. To avoid problems with small or zero denominators, we perform an arctangent transformation. CNI abnormality contours were evaluated using a z-score threshold of 2 (CNI2) and 2.5 (CNI2.5) and compared with rCNI2. Simulations modelling low-grade (LGG) and high-grade (HGG) gliomas with different tissue compartments and partial volume effects suggest improved specificity of rCNI2 (LGG 92%/HGG 91%) over CNI2 (LGG 69%/HGG 69%) and CNI2.5 (LGG 74%/HGG 75%), whilst retaining a similar sensitivity to both CNI2 and CNI2.5. Our simulation results also confirm a previously reported increase in specificity of CNI2.5 over CNI2 with little penalty in sensitivity. The analysis of MRSI data acquired from 10 patients with low-grade glioma at 3 T suggests a more robust delineation of the lesions using rCNI with respect to conventional imaging compared with standard CNI. Further analysis of 29 glioma datasets acquired at 1.5 T, together with previously published estimated tumour proportions, suggests that rCNI has higher sensitivity and specificity for the identification of abnormal MRSI voxels.
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Affiliation(s)
- F Raschke
- Neurosciences Research Centre, Cardiovascular and Cell Sciences Institute, St George's, University of London, London, UK
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35
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Johnson AK, Ford MA, Hallam JS, Jones TL. Osteoporosis Knowledge Among African-American and Caucasian College-Age Women. Med Sci Sports Exerc 2014. [DOI: 10.1249/01.mss.0000493296.76663.ad] [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: 11/21/2022]
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36
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Affiliation(s)
- A Misro
- Ealing Hospital NHS Trust, UK.
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Huang CJ, Beasley KN, Acevedo EO, Franco RL, Jones TL, Mari DC, Shibata Y. Chitin enhances obese inflammation ex vivo. Hum Immunol 2013; 75:41-6. [PMID: 24055693 DOI: 10.1016/j.humimm.2013.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 08/31/2013] [Accepted: 09/11/2013] [Indexed: 10/26/2022]
Abstract
Infection has been implicated as a co-risk factor for obesity, but the mechanism remains uncertain. Elevated levels of plasma chitinase 3-like 1 (CHI3L1) are found in obese individuals. Since CHI3L1 is produced by activated immune cells including macrophages and recognizes microbial N-acetylglucosamine polymer (chitin), we asked whether the plasma CHI3L1 protein change in obese individuals might alter their innate immune response to chitin. Thirty-six subjects (15 obese and 21 non-obese), ages 18-30 years, were recruited. Peripheral blood mononuclear cells (PBMCs) were cultured with chitin microparticles (CMP; 1-10 μm) for 24h; tumor necrosis factor α (TNF-α), interleukin 6 (IL-6), and CHI3L1 in the culture supernatants were measured. We chose CMP, since neither large chitin beads (40-100 μm), chitosan microparticles (1-10 μm), nor soluble chitin induced the cytokine/CHI3L1 production by PBMCs isolated from non-obese PBMCs ex vivo. We found that the quantity of IL-6, but not TNF-α or CHI3L1, induced by CMP was significantly correlated with plasma IL-6, BMI, waist/hip circumferences, fasting plasma insulin, and insulin resistance. These findings suggest that chitin, a substrate of CHI3L1, further promotes obese inflammation in a size- and chemical composition- dependent manner.
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Affiliation(s)
- Chun-Jung Huang
- Department of Exercise Science and Health Promotion, Florida Atlantic University, Boca Raton, FL, United States.
| | - Kathleen N Beasley
- School of Pharmacy, University of Southern California, Los Angeles, CA, United States
| | - Edmund O Acevedo
- Department of Health and Human Performance, Virginia Commonwealth University, Richmond, VA, United States
| | - Robert L Franco
- Department of Health and Human Performance, Virginia Commonwealth University, Richmond, VA, United States
| | - Tamekia L Jones
- Children's Foundation Research Institute, Departments of Pediatrics and Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - David C Mari
- Department of Exercise Science and Health Promotion, Florida Atlantic University, Boca Raton, FL, United States
| | - Yoshimi Shibata
- Department of Biomedical Science, College of Medicine, Florida Atlantic University, Boca Raton, FL, United States
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Abstract
Burkholderia pseudomallei is the cause of melioidosis in humans and other animals. Disease occurs predominately in Asia and Australia. It is rare in North America, and affected people and animals typically have a history of travel to (in human cases) or importation from (in animal cases) endemic areas. We describe the gross and histopathologic features and the microbiologic, molecular, and immunohistochemical diagnoses of a case of acute meningoencephalomyelitis and focal pneumonia caused by B. pseudomallei infection in a pigtail macaque that was imported from Indonesia to the United States for research purposes. This bacterium has been classified as a Tier 1 overlap select agent and toxin; therefore, recognition of pathologic features, along with accurate and timely confirmatory diagnostic testing, in naturally infected research animals is imperative to protect animals and personnel in the laboratory animal setting.
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Affiliation(s)
- J M Ritter
- Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop G 32, Atlanta, GA 30333, USA.
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Raju S, Kirk OK, Jones TL. Endovenous management of venous leg ulcers. J Vasc Surg Venous Lymphat Disord 2013; 1:165-72. [PMID: 26992338 DOI: 10.1016/j.jvsv.2012.09.006] [Citation(s) in RCA: 27] [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: 07/11/2012] [Revised: 09/12/2012] [Accepted: 09/16/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Compression is the current "standard" in the treatment of venous leg ulcers, and corrective surgery is ancillary. The emergence of safe and effective minimally invasive corrective techniques prompts a reappraisal of this paradigm. METHODS Among 192 consecutive limbs with venous leg ulcers, 189 were treated by (1) endovenous laser ablation (n = 30), (2) iliac vein stent placement (n = 89), or (3) both (n = 69). Residual deep reflux was not treated. No specialized wound care was used, and 38% of patients did not use stockings. Outcome measures were time to heal the ulcer and cumulative long-term healing. RESULTS Sixty percent of the limbs were post-thrombotic. The median reflux segment score was 3 (range, 0-7). Thirty-seven percent had deep axial reflux. Median intravascular ultrasound-detected stenosis was 70% (range, 0%-100%) in stented patients. Sensitivity of venography to iliac vein obstruction was 52%. Postprocedural mortality was 0%, and 2% had deep venous thrombosis (<30 days). By 14 weeks, 81% of the small ulcers approximately ≤1 inch in diameter had healed. Larger ulcers were slower in healing (P < .001). Post-thrombotic etiology, presence of uncorrected deep reflux, demographic factors, or stocking use had no bearing on healing time. Long-term cumulative healing at 5 years overall was 75%. Healing was better in nonthrombotic limbs compared with post-thrombotic limbs (87% vs 66% at 5 years; P < .02) but was similar among the various demographic subsets, procedures, and whether or not patients used compression. Quality-of-life measures improved significantly. Cumulative long-term healing was unaffected by residual axial reflux and was unrelated to hemodynamic severity (air plethysmography, ambulatory venous pressure). However, long-term ulcer healing was inferior in limbs with reflux segment score of ≥3 (P < .03). Post-thrombotic limbs with a reflux score of ≥3 had the lowest cumulative healing among cohorts, but even in this category, 60% of limbs had durable healing with very few recurrences. CONCLUSIONS Most venous leg ulcers in this consecutive series achieved long-term healing with the described minimally invasive algorithm. Uncorrected residual reflux was not an impediment to ulcer healing. Ulcers sized ≤1 inch required no specialized or prolonged wound care. Compression was not necessary to achieve or maintain healing after interventional correction.
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Affiliation(s)
| | | | - Tamekia L Jones
- Department of Biostatistics, University of Florida, Gainesville, Fla
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Abstract
Questionnaires are a very useful survey tool that allow large populations to be assessed with relative ease. Despite a widespread perception that surveys are easy to conduct, in order to yield meaningful results, a survey needs extensive planning, time and effort. In this article, we aim to cover the main aspects of designing, implementing and analysing a survey as well as focusing on techniques that would improve response rates.
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Affiliation(s)
| | | | - V Khanduja
- Cambridge University Hospitals NHS Foundation Trust,UK
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Salzer WL, Jones TL, Devidas M, Hilden JM, Winick N, Hunger S, Carroll WL, Camitta B, Dreyer ZE. Modifications to induction therapy decrease risk of early death in infants with acute lymphoblastic leukemia treated on Children's Oncology Group P9407. Pediatr Blood Cancer 2012; 59:834-9. [PMID: 22488662 PMCID: PMC4008315 DOI: 10.1002/pbc.24132] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 02/14/2012] [Indexed: 12/28/2022]
Abstract
BACKGROUND Infants (<366 days of age) with acute lymphoblastic leukemia (ALL) have a poor prognosis. Most treatment failures occur within 6-9 months of diagnosis, primarily from relapse. PROCEDURE The Children's Oncology Group P9407 study was designed to test if early intensified treatment would improve outcome for infants with ALL. Due to a significant number of early deaths (< 90 days from enrollment), Induction therapy was amended three times. Cohorts 1 + 2 (n = 68), received identical Induction therapy except for reduced daunorubicin dose in Cohort 2. Cohort 3 (n = 141) received prednisone (40 mg/m(2)/day) instead of dexamethasone (10 mg/m(2)/day) and short infusion daunorubicin (30 minutes) instead of continuous infusion (48 hours), as well as additional supportive care measures throughout therapy. RESULTS Early deaths occurred in 17/68 (25%) infants in Cohorts 1 + 2 and 8/141 (5.7%) infants in Cohort 3 (P < 0.0001). Among infants ≤90 days of age at diagnosis, early death occurred in 10/17 (58.8%) in Cohorts 1 + 2 and 4/27 (14.8%) in Cohort 3 (P = 0.006). Among infants >90 days of age at diagnosis, early death occurred in 7/51 (13.7%) in Cohorts 1 + 2 and 4/114 (3.5%) in Cohort 3 (P = 0.036). Bacterial, viral, and fungal infections were more common in Cohorts 1 + 2 versus Cohort 3. CONCLUSIONS Early morbidity and mortality for infants with ALL were reduced by substitution of prednisone (40 mg/m(2)/day) for dexamethasone (10 mg/m(2)/day), the delivery of daunorubicin over 30 minutes instead of a continuous infusion for 48 hours, and the provision of more specific supportive care measures.
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Affiliation(s)
- Wanda L. Salzer
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland,Correspondence to: Wanda L. Salzer, MD, 1335 East West Hwy, 9th Floor, Silver Spring, MD 20910.
| | - Tamekia L. Jones
- Department of Biostatistics, Colleges of Medicine and Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Meenakshi Devidas
- Department of Biostatistics, Colleges of Medicine and Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Joanne M. Hilden
- Department of Pediatrics, The Children’s Hospital, University of Colorado, Aurora, Colorado
| | - Naomi Winick
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Stephen Hunger
- Department of Pediatrics, The Children’s Hospital, University of Colorado, Aurora, Colorado
| | | | - Bruce Camitta
- Midwest Center for Cancer and Blood Disorders, Medical College of Wisconsin and Children’s Hospital, Milwaukee, Wisconsin
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Affiliation(s)
- H A Tran
- Hunter Area Pathology Service, John Hunter Hospital, Locked Bag Number 1, Hunter Mail Region Centre, Newcastle, New South Wales 2310, Australia.
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Martin SE, Wu ZH, Gehlhaus K, Jones TL, Zhang YW, Guha R, Miyamoto S, Pommier Y, Caplen NJ. RNAi screening identifies TAK1 as a potential target for the enhanced efficacy of topoisomerase inhibitors. Curr Cancer Drug Targets 2012; 11:976-86. [PMID: 21834757 DOI: 10.2174/156800911797264734] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 06/16/2011] [Accepted: 07/27/2011] [Indexed: 01/21/2023]
Abstract
In an effort to develop strategies that improve the efficacy of existing anticancer agents, we have conducted a siRNA-based RNAi screen to identify genes that, when targeted by siRNA, improve the activity of the topoisomerase I (Top1) poison camptothecin (CPT). Screening was conducted using a set of siRNAs corresponding to over 400 apoptosisrelated genes in MDA-MB-231 breast cancer cells. During the course of these studies, we identified the silencing of MAP3K7 as a significant enhancer of CPT activity. Follow-up analysis of caspase activity and caspase-dependent phosphorylation of histone H2AX demonstrated that the silencing of MAP3K7 enhanced CPT-associated apoptosis. Silencing MAP3K7 also sensitized cells to additional compounds, including CPT clinical analogs. This activity was not restricted to MDA-MB-231 cells, as the silencing of MAP3K7 also sensitized the breast cancer cell line MDA-MB-468 and HCT-116 colon cancer cells. However, MAP3K7 silencing did not affect compound activity in the comparatively normal mammary epithelial cell line MCF10A, as well as some additional tumorigenic lines. MAP3K7 encodes the TAK1 kinase, an enzyme that is central to the regulation of many processes associated with the growth of cancer cells (e.g. NF- κB, JNK, and p38 signaling). An analysis of TAK1 signaling pathway members revealed that the silencing of TAB2 also sensitizes MDA-MB-231 and HCT-116 cells towards CPT. These findings may offer avenues towards lowering the effective doses of Top1 inhibitors in cancer cells and, in doing so, broaden their application.
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Affiliation(s)
- S E Martin
- Gene Silencing Section, Genetics Branch, CCR, NCI, NIH, Bethesda, MD 20892, USA
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Johnson A, Ford-Wade A, Hallam JS, Jones TL. Determinants Of Bone Mineral Density In African-american And Caucasian College-aged Women. Med Sci Sports Exerc 2011. [DOI: 10.1249/01.mss.0000400686.92337.37] [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: 11/21/2022]
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Tran HA, Reeves GEM, Jones TL. The natural history of interferon-alpha2b-induced thyroiditis and its exclusivity in a cohort of patients with chronic hepatitis C infection. QJM 2009; 102:117-22. [PMID: 19033352 DOI: 10.1093/qjmed/hcn150] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Interferon-alpha2b (IFN-alpha2b) is well known to cause both hyper- and hypo-thyroidism. In the former, the commonest aetiology is thyroiditis. As there is no previous data to fully characterize the entity of IFN-related thyroiditis, the aim of this study is to document in detail its evolution in a cohort of hepatitis C patients treated with pegylated IFN-alpha2b and Ribavirin (RBV). METHODS A prospective observational study was conducted in patients who developed thyroid diseases whilst receiving combination of pegylated IFN-alpha2b and RBV for hepatitis C. The patients were followed with monthly thyrotropin (TSH). Where TSH was undetectable, free tetra- (fT4) and tri-iodothyronine (fT3) were added. Anti-thyroperoxidase (TPO), anti-thyroglobulin (Tg) and thyroid stimulating immunoglobulin (TSI) levels were also performed at diagnosis, during and at the end of IFN therapy. All patients were assessed and followed up closely with monthly TSH, fT4 and fT3 levels until the completion, after 6 and 12 months of treatment. RESULTS There were seven females and four males over a 30-month period. All patients were found to have thyroiditis. On average, the time to the development of thyroid disease was 10 weeks and duration of disease 9 weeks. All patients eventually recovered normal biochemical thyroid function although two required short-term supplementation. CONCLUSION Thyroiditis was found exclusively in our patients. Both the hyper- and hypo-thyroid phase can be short lived, extreme and transient in nature which warrants strict monthly TSH monitoring. Careful follow-up of all patients is mandatory as complete recovery is expected.
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Affiliation(s)
- H A Tran
- Hunter Area Pathology Service, Newcastle University, Newcastle, New South Wales 2310, Australia.
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Shikany JM, Lewis CE, Freedman BI, Arnett DK, Leiendecker-Foster C, Jones TL, Redden DT, Oberman A. Plasma adiponectin concentrations and correlates in African Americans in the Hypertension Genetic Epidemiology Network (HyperGEN) study. Metabolism 2007; 56:1011-6. [PMID: 17618943 DOI: 10.1016/j.metabol.2007.03.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Accepted: 02/22/2007] [Indexed: 11/17/2022]
Abstract
Adiponectin has demonstrated insulin-sensitizing, antiatherogenic, and anti-inflammatory properties, and may be an important risk factor for coronary heart disease and diabetes. Relatively few previous studies of plasma adiponectin have included sizable numbers of African Americans. The objective of the study was to investigate plasma concentrations of adiponectin and correlates of these concentrations in African Americans. This was a cross-sectional analysis that took place within the Hypertension Genetic Epidemiology Network. This study included 211 normotensive offspring (aged 22-37 years) of hypertensive siblings recruited by the Hypertension Genetic Epidemiology Network Birmingham, AL, field center. In addition to measuring plasma adiponectin, demographic and lifestyle data were collected, and anthropometric, clinical, and laboratory measurements were obtained. Mean plasma adiponectin concentration was 5.5+/-3.8 microg/mL. Adiponectin was 55% higher in women than in men: 6.5+/-4.4 vs 4.2+/-2.5 microg/mL, respectively (P<.0001). In a multivariable analysis, high-density lipoprotein cholesterol concentration was positively associated and male sex and insulin concentration were negatively associated with plasma adiponectin concentration. Plasma adiponectin concentrations in these African Americans were lower than those reported in other racial/ethnic groups, including Japanese, whites, and Pima Indians. The directions of the associations of plasma adiponectin with other factors were in agreement with results in other racial/ethnic groups.
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Affiliation(s)
- James M Shikany
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
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Shikany J, Lewis CE, Freedman BI, Leiendecker‐Foster C, Jones TL, Oberman A. Plasma adiponectin concentrations and correlates in African Americans in the HyperGEN Network Birmingham field center. FASEB J 2006. [DOI: 10.1096/fasebj.20.4.a148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- James Shikany
- Univ. of Alabama at Birmingham1530 3rd Ave. S.BirminghamAL35294
| | - Cora E. Lewis
- Univ. of Alabama at Birmingham1530 3rd Ave. S.BirminghamAL35294
| | | | | | | | - Albert Oberman
- Univ. of Alabama at Birmingham1530 3rd Ave. S.BirminghamAL35294
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Ridgway PF, Ziprin P, Jones TL, Paraskeva PA, Peck DH, Darzl AW. Laparoscopic staging of pancreatic tumors induces increased invasive capacity in vitro. Surg Endosc 2003; 17:306-10. [PMID: 12399839 DOI: 10.1007/s00464-002-8904-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2002] [Accepted: 07/31/2002] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Laparoscopy and laparoscopic ultrasound have a well-defined role in staging patients with pancreatic malignancy. The effect of the hypoxic pneumoperitoneum induction on tumor biology is unknown. The authors investigated whether an in vitro pneumoperitoneum augments the invasive capacity of pancreatic tumors and elucidate a mechanism by which this may occur. METHODS A pancreatic (PSN-1) adenocarcinoma cell line was exposed to an in vitro pneumoperitoneum (carbon dioxide (CO2) or helium) for a maximum of 2 h or left in normal growth conditions (control). Cells were nonenzymatically harvested and placed in invasion assays. These were performed over 72 h using Matrigel coated 8-mm Transwell filters and analyzed using MTS colorimetric assay. Gelatin zymography was employed to assess the level of matrix metalloproteases (MMP) 2 and 9 (gelatinase A and B) secretion. Expression of tissue inhibitor of metalloproteases 1 (TIMP-1) was assessed using ELISA (Biotrak). Inhibition of invasion assays was performed using a specific gelatinase inhibitor (MMPI; Calbiochem). RESULTS The invasive capacity of pancreatic tumour cells is augmented versus control in both helium (p <0.05) and CO2 (p <0.001) groups. Concomitant significant upregulation of the gelatinase activity was demonstrated with both insufflants (p <0.05; 0.001, respectively). Enhanced invasion was attenuated by the addition of a specific gelatinase inhibitor (p <0.05). CONCLUSIONS These results indicate the invasive capacity of pancreatic tumor cells is augmented by laparoscopic staging in vitro. This is in part mediated by increased gelatinase activity and may be attenuated by the addition of specific inhibitors.
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Affiliation(s)
- P F Ridgway
- Department of Surgical Oncology and Technology, Imperial College School of Medicine, St. Mary's Hospital, London, UK.
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Ridgway PF, Smith A, Ziprin P, Jones TL, Paraskeva PA, Peck DH, Darzi AW. Pneumoperitoneum augmented tumor invasiveness is abolished by matrix metalloproteinase blockade. Surg Endosc 2002; 16:533-6. [PMID: 11928043 DOI: 10.1007/s00464-001-8311-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2001] [Accepted: 09/25/2001] [Indexed: 10/28/2022]
Abstract
BACKGROUND Certain surgical strategies, including Helium (He) and carbon dioxide (CO2) insufflation in laparoscopy, have been shown to induce a hypoxic environment. This may have a significant effect on the invasive capacity of tumor cells and may be a factor in the incidence of port-site metastases seen in patients following laparoscopic resection for malignancy. METHODS A colon adenocarcinoma cell line (SW1222) was exposed to an in vitro pneumoperitoneum of CO2 or He at 3 mmHg or left in normal growth conditions (control). After a 4-hour exposure to an in vitro pneumoperitoneum, the ability of the cells to invade through 8.0-microm Transwell filters coated with Matrigel was analyzed by colorimetric MTS assay and by direct staining of the filters. The effect of the addition of a known blocker of matrix metalloproteinases (MMPs), 1,10-phenanthroline (1,10-P), was investigated. RESULTS Cells exposed to an in vitro pneumoperitoneum demonstrate significantly increased invasive capacity compared to the control set, without loss of viability (He vs control, p <0.001; CO2 vs control, p <0.001). This augmented capacity is abolished by the addition of 1,10-P (p <0.01). CONCLUSION Exposure of a colonic adenocarcinoma cell line to either a CO2 or He pneumoperitoneum causes an increase in tumor cell invasiveness, which is abolished by the presence of a known inhibitor of MMPs. This suggests that MMPs have an important role in the metastatic potential of tumors exposed to a hypoxic operative environment.
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Affiliation(s)
- P F Ridgway
- Department of Surgical Oncology and Technology, Imperial College School of Medicine, St. Mary's Hospital, 10th Floor QEQM Wing, Praed Street, London W2 1NY, United Kingdom.
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Abstract
Membrane microdomains enriched in cholesterol and sphingolipids modulate a number of signal transduction pathways and provide a residence for heterotrimeric G proteins, their receptors, and their effectors. We investigated whether signaling through G(s) was dependent on these membrane domains, characterized by their resistance to detergents, by depleting cells of cholesterol and sphingolipids. For cholesterol depletion, rat salivary epithelial A5 cells were cultured under low-cholesterol conditions, and then treated with the cholesterol chelator methyl-beta-cyclodextrin. For sphingolipid depletion, LY-B cells, a mutant CHO cell line that is unable to synthesize sphingolipids, were incubated under low-sphingolipid conditions. Depletion of cholesterol or sphingolipid led to a loss or decrease, respectively, in the amount of Galpha(s) from the detergent-resistant membranes without any change in the cellular or membrane-bound amounts of Galpha(s). The cAMP accumulation in response to a receptor agonist was intact and the level slightly increased in cells depleted of cholesterol or sphingolipids compared to that in control cells. These results indicate that localization of Galpha(s) to detergent-resistant membranes was not required for G(s) signaling. Analysis of the role of lipid rafts on the kinetics of protein associations in the membrane suggests that compartmentalization in lipid rafts may be more effective in inhibiting protein interactions and, depending on the pathway, ultimately inhibit or promote signaling.
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Affiliation(s)
- Y Miura
- Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA
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