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Halaweish I, Srinivas S, Farooqui Z, Sutthatarn P, Campbell D, Frischer J, Wood RJ, Langer JC. Duhamel Versus Swenson Pull-Through for Total Colonic Aganglionosis: A Multi-Institutional Study. J Pediatr Surg 2024; 59:216-219. [PMID: 37973423 DOI: 10.1016/j.jpedsurg.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 10/11/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Total colonic aganglionosis (TCA) is a rare variant of Hirschsprung disease (HD) where the colon and portion of distal ileum lack ganglion cells. Most pediatric use either a straight ileoanal (Swenson or Yancey-Soave) or a short Duhamel pull-through for TCA. There are no large studies comparing these techniques. We aimed to compare short-and medium-term outcomes between these approaches. METHOD A retrospective review was performed among children with TCA from 2001 to 2019 undergoing a primary Duhamel or Swenson pull-through across three large children's hospitals. Patients undergoing redo and patients with greater than 30 % small bowel aganglionosis were excluded. We gathered data on demographics, operative approach, and outcomes at one, two, and three years. Continuous variables were analyzed with t-tests and categorical variables with Chi square or Fisher's tests. RESULTS There were 54 patients, with 26 (48 %) undergoing Duhamel and 28 (52 %) undergoing Swenson pull-through. There were no differences in sex, age, medical comorbidities, or operative details, including age at pull-through, laparoscopic vs open, length of involved small bowel, and operative time. Length of stay and post-operative complications were not different. Three years after pull-through, patients undergoing Duhamel had fewer stools per day (1-3 stools 69.6 % vs 14.3 %, p = 0.003) and were less likely to be prescribed fiber supplementation (4.2 % vs 43.8 %, p = 0.003). There were no differences in irrigations, botulinum toxin administration, loperamide, or HD admissions. CONCLUSION Both Duhamel and straight pull-throughs are safe for treatment of TCA, with acceptable short- and medium-term outcomes. Further studies on patient-reported outcomes are necessary to examine long-term differences. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ihab Halaweish
- Department of Surgery, Nationwide Children's Hospital, Columbus, OH, USA.
| | - Shruthi Srinivas
- Department of Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Zishaan Farooqui
- Department of Surgery, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Pattamon Sutthatarn
- Department of Surgery, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Drayson Campbell
- Department of Surgery, Nationwide Children's Hospital, Columbus, OH, USA; College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Jason Frischer
- Department of Surgery, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Richard J Wood
- Department of Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jacob C Langer
- Department of Surgery, Hospital for Sick Children and University of Toronto, Toronto, Canada
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Reza HA, Farooqui Z, Reza AA, Conroy C, Iwasawa K, Ogura Y, Okita K, Osafune K, Takebe T. Synthetic augmentation of bilirubin metabolism in human pluripotent stem cell-derived liver organoids. Stem Cell Reports 2023; 18:2071-2083. [PMID: 37832542 PMCID: PMC10679658 DOI: 10.1016/j.stemcr.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 10/15/2023] Open
Abstract
UGT1A1 (UDP glucuronosyltransferase family 1 member A1) is the primary enzyme required for bilirubin conjugation, which is essential for preventing hyperbilirubinemia. Animal models lack key human organic anion transporting polypeptides with distinct epigenetic control over bilirubin metabolism, necessitating a human model to interrogate the regulatory mechanism behind UGT1A1 function. Here, we use induced pluripotent stem cells to develop human liver organoids that can emulate conjugation failure phenotype. Bilirubin conjugation assays, chromatin immunoprecipitation, and transcriptome analysis elucidated the role of glucocorticoid antagonism in UGT1A1 activation. This antagonism prevents the binding of transcriptional repressor MECP2 at the expense of NRF2 with associated off-target effects. Therefore, we introduced functional GULO (L-gulonolactone oxidase) in human organoids to augment intracellular ascorbate for NRF2 reactivation. This engineered organoid conjugated more bilirubin and protected against hyperbilirubinemia when transplanted in immunosuppressed Crigler-Najjar syndrome rat model. Collectively, we demonstrate that our organoid system serves as a manipulatable model for interrogating hyperbilirubinemia and potential therapeutic development.
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Affiliation(s)
- Hasan Al Reza
- Division of Developmental Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Center for Stem Cell and Organoid Medicine (CuSTOM), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Zishaan Farooqui
- Division of Gastroenterology, Hepatology & Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Abid Al Reza
- Division of Developmental Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Callen Conroy
- College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Kentaro Iwasawa
- Division of Gastroenterology, Hepatology & Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Yasuhiro Ogura
- Department of Transplantation Surgery, Nagoya University Hospital, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Keisuke Okita
- Center for iPS Cell Research and Application (CiRA), Kyoto University, Kyoto, Japan
| | - Kenji Osafune
- Center for iPS Cell Research and Application (CiRA), Kyoto University, Kyoto, Japan
| | - Takanori Takebe
- Division of Developmental Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Center for Stem Cell and Organoid Medicine (CuSTOM), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Division of Gastroenterology, Hepatology & Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Institute of Research, Tokyo Medical and Dental University, Tokyo, Japan; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Premium Research Institute for Human Metaverse Medicine (WPI-PRIMe), and Division of Stem Cell and Organoid Medicine, Osaka University, Suita, Osaka 565-0871, Japan.
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Farooqui Z, Johnston M, Schepers E, Brewer N, Hartman S, Jenkins T, Bondoc A, Pai A, Geller J, Tiao GM. Quality of Life Outcomes for Patients Who Underwent Conventional Resection and Liver Transplantation for Locally Advanced Hepatoblastoma. Children (Basel) 2023; 10:children10050890. [PMID: 37238438 DOI: 10.3390/children10050890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/04/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023]
Abstract
Hepatoblastoma is the most common malignant liver tumor of childhood, with liver transplant and extended resection used as surgical treatments for locally advanced tumors. Although each approach has well-described post-operative complications, quality-of-life outcomes have not been described following the two interventions. Long-term pediatric survivors of hepatoblastoma who underwent conventional liver resection or liver transplantation at a single institution from January 2000-December 2013 were recruited to complete quality-of-life surveys. Survey responses for the Pediatric Quality of Life Generic Core 4.0 (PedsQL, n = 30 patient and n = 31 parent surveys) and Pediatric Quality of Life Cancer Module 3.0 (PedsQL-Cancer, n = 29 patient and n = 31 parent surveys) were collected from patients and parents. The mean total patient-reported PedsQL score was 73.7, and the parent-reported score was 73.9. There were no significant differences in scores on the PedsQL between patients who underwent resection compared to those who underwent transplantation (p > 0.05 for all comparisons). On the PedsQL-Cancer module, procedural anxiety scores were significantly lower for patients who underwent resection as compared to transplant (M = 33.47 points less, CI [-60.41, -6.53], p-value 0.017). This cross-sectional study demonstrates that quality of life outcomes are overall similar among patients receiving transplants and resections. Patients who received a resection reported worse procedural anxiety.
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Affiliation(s)
- Zishaan Farooqui
- Department of Surgery, University of Cincinnati College of Medicine, CARE/Crawley Building, Suite E-870 Eden Avenue, Cincinnati, OH 45267, USA
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Michael Johnston
- Department of Surgery, University of Cincinnati College of Medicine, CARE/Crawley Building, Suite E-870 Eden Avenue, Cincinnati, OH 45267, USA
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Emily Schepers
- Department of Surgery, University of Cincinnati College of Medicine, CARE/Crawley Building, Suite E-870 Eden Avenue, Cincinnati, OH 45267, USA
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Nathalie Brewer
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Stephen Hartman
- Department of Surgery, University of Cincinnati College of Medicine, CARE/Crawley Building, Suite E-870 Eden Avenue, Cincinnati, OH 45267, USA
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Todd Jenkins
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Alexander Bondoc
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Ahna Pai
- Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - James Geller
- Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Gregory M Tiao
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
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Casar Berazaluce AM, Moody S, Jenkins T, Farooqui Z, Shebesta K, Kotagal M, Falcone RA. Catching the red eye: A retrospective review of factors associated with retinal hemorrhage in child physical abuse. J Pediatr Surg 2021; 56:1009-1012. [PMID: 32888720 DOI: 10.1016/j.jpedsurg.2020.07.031] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/22/2020] [Accepted: 07/18/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND/PURPOSE Accurate identification of child physical abuse is crucial during the evaluation of injured children. Retinal hemorrhages (RH) are used for diagnosis, but clear criteria for screening with direct fundoscopic exam are lacking. We sought to identify key factors associated with RH to guide evaluations. METHODS Electronic medical records for patients <1 year of age presenting to a Level I Pediatric Trauma Center with unwitnessed head injury from January 2015 to December 2018 were retrospectively reviewed. Multivariable logistic regression was used to identify factors associated with RH. RESULTS Two hundred and seventy-six patients were included; 63% underwent direct fundoscopic examination, of which 23% were positive and 77% were negative for RH. Unscreened patients tended to be older and have isolated skull fractures. Multivariable regression analysis revealed that abnormal GCS and subdural hemorrhage were positively associated with a diagnosis of retinal hemorrhage, while isolated skull fracture was negatively associated. CONCLUSIONS Children under 1 year of age with subdural hemorrhage have a greater risk of associated RH and should undergo routine screening with direct fundoscopic examination. Conversely, those with isolated skull fractures may not require an ophthalmology consultation. Standardized screening protocols may help reduce the risk of missing child physical abuse. LEVEL OF EVIDENCE III (Diagnostic Test).
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Affiliation(s)
- Alejandra M Casar Berazaluce
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Suzanne Moody
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Todd Jenkins
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Zishaan Farooqui
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Kaaren Shebesta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Meeta Kotagal
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Richard A Falcone
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
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Shahid F, Farooqui Z, Alam T, Abidi S, Parwez I, Khan F. Thymoquinone supplementation ameliorates cisplatin-induced hepatic pathophysiology. Hum Exp Toxicol 2021; 40:1673-1684. [PMID: 33832332 DOI: 10.1177/09603271211003645] [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: 12/15/2022]
Abstract
Hepatotoxicity is a major dose-limiting side effect of CP chemotherapy besides nephrotoxicity and gastrointestinal dysfunction. TQ, a principal Nigella sativa seed oil constituent, has been shown to improve hepatic functions in various in vivo models of acute hepatic injury. In view of this, the present study aimed to evaluate the effect of TQ against CP-induced hepatotoxicity. Rats were divided into four experimental groups; control, CP, CP+TQ and TQ. Animals in CP+TQ and TQ groups were administered TQ (1.5 mg/kg bwt, orally), with or without a single hepatotoxic dose of CP (6 mg/kg bwt, i.p.) respectively, for 14 days before and four days following the CP treatment. CP induced an upsurge in serum ALT and AST activities, indicating liver injury, as also confirmed by the histopathological findings. CP caused significant alterations in the activities of membrane marker enzymes, carbohydrate metabolic enzymes, and the enzymatic and nonenzymatic components of the antioxidant defense system. TQ supplementation ameliorated all these adverse biochemical and histological changes in CP-treated rats. Thus, TQ may have excellent scope for clinical applications in combating CP-induced hepatic pathophysiology.
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Affiliation(s)
- F Shahid
- Department of Biochemistry, Faculty of Life Sciences, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Z Farooqui
- Department of Biochemistry, Faculty of Life Sciences, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - T Alam
- Department of Biochemistry, Faculty of Life Sciences, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - S Abidi
- Department of Zoology, Faculty of Life Sciences, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - I Parwez
- Department of Zoology, Faculty of Life Sciences, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - F Khan
- Department of Biochemistry, Faculty of Life Sciences, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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Lautz TB, Farooqui Z, Jenkins T, Heaton TE, Doski JJ, Cooke-Barber J, Murphy AJ, Davidoff AM, Mansfield SA, Kim ES, Zuber S, Goodhue C, Vasudevan SA, LaQuaglia MP, Piche N, Le-Nguyen A, Aldrink JH, Malek MM, Siow VS, Glick RD, Rich BS, Meyers RL, Short SS, Butter A, Baertschiger RM, Fialkowski EA, Dasgupta R. Thoracoscopy vs thoracotomy for the management of metastatic osteosarcoma: A Pediatric Surgical Oncology Research Collaborative Study. Int J Cancer 2020; 148:1164-1171. [PMID: 32818304 DOI: 10.1002/ijc.33264] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/27/2020] [Accepted: 08/04/2020] [Indexed: 01/01/2023]
Abstract
Complete surgical resection of pulmonary metastatic disease in patients with osteosarcoma is crucial to long-term survival. Open thoracotomy allows palpation of nodules not identified on imaging but the impact on survival is unknown. The objective of this study was to compare overall survival (OS) and pulmonary disease-free survival (DFS) in children who underwent thoracotomy vs thoracoscopic surgery for pulmonary metastasectomy. A multi-institutional collaborative group retrospectively reviewed 202 pediatric patients with osteosarcoma who underwent pulmonary metastasectomy by thoracotomy (n = 154) or thoracoscopy (n = 48). Results were analyzed by Kaplan-Meier survival estimates and multivariate Cox proportional hazard regression models. With median follow-up of 45 months, 135 (67.5%) patients had a pulmonary relapse and 95 (47%) patients were deceased. Kaplan-Meier analysis showed no significant difference in 5-year pulmonary DFS (25% vs 38%; P = .18) or OS (49% vs 42%, P = .37) between the surgical approaches of thoracotomy and thoracoscopy. In Cox regression analysis controlling for other factors impacting outcome, there was a significantly increased risk of mortality (HR 2.11; P = .027; 95% CI 1.09-4.09) but not pulmonary recurrence (HR 0.96; P = .90; 95% CI 0.52-1.79) with a thoracoscopic approach. However, in the subset analysis limited to patients with oligometastatic disease, thoracoscopy had no increased risk of mortality (HR 1.16; P = .62; 0.64-2.11). In conclusion, patients with metastatic osteosarcoma and limited pulmonary disease burden demonstrate comparable outcomes after thoracotomy and thoracoscopy for metastasectomy. While significant selection bias in these surgical cohorts limits the generalizability of the conclusions, clinical equipoise for a randomized clinical trial in patients with oligometastatic disease is supported.
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Affiliation(s)
- Timothy B Lautz
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois, USA
| | - Zishaan Farooqui
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Todd Jenkins
- Departments of Pediatrics and Surgery, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Todd E Heaton
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - John J Doski
- Division of Pediatric Surgery, UT San Antonio, San Antonio, Texas, USA
| | - Jo Cooke-Barber
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Andrew J Murphy
- Department of Surgery, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Andrew M Davidoff
- Department of Surgery, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Sara A Mansfield
- Department of Surgery, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Eugene S Kim
- Division of Pediatric Surgery, Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Samuel Zuber
- Division of Pediatric Surgery, Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Catherine Goodhue
- Division of Pediatric Surgery, Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Sanjeev A Vasudevan
- Division of Pediatric Surgery, Texas Children's Hospital, Houston, Texas, USA
| | - Michael P LaQuaglia
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nelson Piche
- Division of Pediatric Surgery, CHU Ste-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Annie Le-Nguyen
- Division of Pediatric Surgery, CHU Ste-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Marcus M Malek
- Division of Pediatric General and Thoracic Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Vei Shaun Siow
- Division of Pediatric General and Thoracic Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Richard D Glick
- Division of Pediatric Surgery, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell, East Garden City, New York, USA
| | - Barrie S Rich
- Division of Pediatric Surgery, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell, East Garden City, New York, USA
| | - Rebecka L Meyers
- Division of Pediatric Surgery, Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Scott S Short
- Division of Pediatric Surgery, Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Andreana Butter
- Division of Pediatric Surgery, Children's Hospital of Western Ontario, London, Ontario, Canada
| | - Reto M Baertschiger
- Division of Pediatric Surgery, Department of Surgery, NH, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Division of Thoracic and General Surgery, The Hospital of Sick Children, Toronto, Ontario, Canada
| | - Elizabeth A Fialkowski
- Division of Pediatric Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
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Wagner ML, Farooqui Z, Elson NC, Makley AT, Pritts TA, Goodman MD. Characterizing Early Inpatient Death After Trauma. J Surg Res 2020; 255:405-410. [PMID: 32619854 DOI: 10.1016/j.jss.2020.05.083] [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: 04/23/2020] [Revised: 05/23/2020] [Accepted: 05/27/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is a paucity of data to predict early death or futility after trauma. The objective of this study was to characterize the laboratory values, blood product administration, and hospital disposition for patients with trauma who died within 72 h of admission. METHODS All deaths within 72 h of admission over a 5-y period at a level I trauma center were reviewed. Blood transfusion within the first 4 h of arrival and patient disposition from the emergency department to the operating room (OR), surgical intensive care unit, or the neuroscience intensive care unit (NSICU) were analyzed. Kaplan-Meier curves were generated to determine time to death. RESULTS A total of 622 subjects were identified; 39.5% died in the emergency department, 10.6% went directly to the OR, 13.6% were admitted to the surgical intensive care unit, and 29.7% admitted to the NSICU. Of these subjects, 201 (32.2%) patients received blood within the first 4 h. By 24 h, early blood transfusion was associated with more rapid death for patients who were admitted to the NSICU (80% versus 60% mortality, P = 0.01) but not for patients taken directly to the OR (80% versus 70% mortality, P = 0.2). Admission coagulopathy by international normalized ratio (P < 0.01), but not anemia (P = 0.64) or acidosis (P = 0.45), correlated with a shorter time to death. In contrast, laboratory values obtained at 4 h after admission did not correlate with time to death. CONCLUSIONS Our data demonstrate that admission coagulation derangement and need for early blood product transfusion are the two factors most associated with early death after injury, particularly in those patients with traumatic brain injury. These data will help construct future models for futility of continued care in patients with trauma.
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Affiliation(s)
- Monica L Wagner
- Division of Trauma, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Zishaan Farooqui
- Division of Trauma, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Nora C Elson
- Division of Trauma, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Amy T Makley
- Division of Trauma, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Timothy A Pritts
- Division of Trauma, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Michael D Goodman
- Division of Trauma, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio.
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Farooqui Z, Wagner M, Elson N, Makley A, Pritts T, Goodman M. Why We Die: Variables Predicting Early Death after Trauma. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.685] [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: 11/28/2022]
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Dou JF, Farooqui Z, Faulk CD, Barks AK, Jones T, Dolinoy DC, Bakulski KM. Perinatal Lead (Pb) Exposure and Cortical Neuron-Specific DNA Methylation in Male Mice. Genes (Basel) 2019; 10:genes10040274. [PMID: 30987383 PMCID: PMC6523909 DOI: 10.3390/genes10040274] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/25/2019] [Accepted: 03/29/2019] [Indexed: 12/14/2022] Open
Abstract
: Lead (Pb) exposure is associated with a wide range of neurological deficits. Environmental exposures may impact epigenetic changes, such as DNA methylation, and can affect neurodevelopmental outcomes over the life-course. Mating mice were obtained from a genetically invariant C57BL/6J background agouti viable yellow Avy strain. Virgin dams (a/a) were randomly assigned 0 ppm (control), 2.1 ppm (low), or 32 ppm (high) Pb-acetate water two weeks prior to mating with male mice (Avy/a), and this continued through weaning. At age 10 months, cortex neuronal nuclei were separated with NeuN⁺ antibodies in male mice to investigate neuron-specific genome-wide promoter DNA methylation using the Roche NimbleGen Mouse 3x720K CpG Island Promoter Array in nine pooled samples (three per dose). Several probes reached p-value < 10-5 , all of which were hypomethylated: 12 for high Pb (minimum false discovery rate (FDR) = 0.16, largest intensity ratio difference = -2.1) and 7 for low Pb (minimum FDR = 0.56, largest intensity ratio difference = -2.2). Consistent with previous results in bulk tissue, we observed a weak association between early-life exposure to Pb and DNA hypomethylation, with some affected genes related to neurodevelopment or cognitive function. Although these analyses were limited to males, data indicate that non-dividing cells such as neurons can be carriers of long-term epigenetic changes induced in development.
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Affiliation(s)
- John F Dou
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Zishaan Farooqui
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Christopher D Faulk
- Department of Animal Science, College of Food, Agricultural, and Natural Resource Sciences, University of Minnesota, St. Paul, MN 55108, USA.
| | - Amanda K Barks
- Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN 55454, USA.
| | - Tamara Jones
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Dana C Dolinoy
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA.
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Kelly M Bakulski
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA.
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Joseph JR, Farooqui Z, Smith BW, Kahn EN, Liu X, La Marca F, Park P. Does clinical improvement of symptomatic degenerative lumbar disease impact obesity? J Neurosurg Spine 2017; 26:705-708. [DOI: 10.3171/2016.11.spine16973] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEObesity and low-back pain associated with degenerative spondylosis or spondylolisthesis are common comorbid conditions. Many patients report that the pain and disability associated with degenerative lumbar disease are key factors in their inability to lose weight. The aim of this retrospective study was to determine if there is an association between improved functional status and weight loss following a successful transforaminal lumbar interbody fusion (TLIF) procedure.METHODSA retrospective cohort study of patients who underwent single-level TLIF was performed. Inclusion criteria were preoperative body mass index (BMI) greater than 30 kg/m2, achievement of minimum clinically important difference in the Oswestry Disability Index (ODI, defined as improvement of 15 points), and minimum 1-year postoperative followup BMI. Preoperative and postoperative BMI, ODI, and visual analog scale (VAS) scores were compared. A subgroup analysis of patients who achieved substantial clinical benefit (SCB, defined as a net improvement of 18.8 points on the ODI) was also performed.RESULTSA total of 56 patients met the inclusion criteria. The mean age of the study population was 55.6 ± 13.7 years. The mean preoperative BMI was 34.8 ± 4.6 kg/m2, the mean preoperative ODI was 66.2 ± 10.1, and the mean preoperative VAS score was 7.1 ± 1.7. The mean change in ODI was −33.1 ± 13.5 (p < 0.01) and the mean change in the VAS score was −4.1 ± 2.1 (p < 0.01). The mean change in BMI was +0.15 ± 2.1 kg/m2 (range −4.2 to +6.5 kg/m2; p = 0.6). SCB was achieved in 46 patients on the ODI. The mean preoperative BMI for patients with SCB was 34.8 ± 4.8 kg/m2, and the mean postoperative BMI was 34.7 ± 5.0 kg/m2. The mean change in BMI was −0.03 ± 1.9 kg/m2 (p = 0.9).CONCLUSIONSDespite successful surgical intervention via TLIF with achievement of improved function and pain, obese patients did not have significant change in weight postoperatively.
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Farooqui Z, Bakulski KM, Power MC, Weisskopf MG, Sparrow D, Spiro A, Vokonas PS, Nie LH, Hu H, Park SK. Associations of cumulative Pb exposure and longitudinal changes in Mini-Mental Status Exam scores, global cognition and domains of cognition: The VA Normative Aging Study. Environ Res 2017; 152:102-108. [PMID: 27770710 PMCID: PMC5135609 DOI: 10.1016/j.envres.2016.10.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 05/17/2016] [Revised: 09/23/2016] [Accepted: 10/11/2016] [Indexed: 05/16/2023]
Abstract
BACKGROUND Lead (Pb) exposure has been associated with poorer cognitive function cross-sectionally in aging adults, however the association between cumulative Pb exposure and longitudinal changes in cognition is little characterized. METHODS In a 1993-2007 subcohort of the VA Normative Aging Study (Mini-mental status exam (MMSE) n=741; global cognition summary score n=715), we used linear mixed effects models to test associations between cumulative Pb exposure (patella or tibia bone Pb) and repeated measures of cognition (MMSE, individual cognitive tests, and global cognition summary). Cox proportional hazard modeling assessed the risk of an MMSE score falling below 25. RESULTS Among men 51-98 at baseline, higher patella Pb concentration (IQR: 21μg/g) was associated with -0.13 lower baseline MMSE (95% CI: -0.25, -0.004) and faster longitudinal MMSE decline (-0.016 units/year, 95% CI: -0.032, -0.0004) over 15 years. Each IQR increase in patella Pb was associated with increased risk of a MMSE score below 25 (HR=1.21, 95% CI: 0.99, 1.49; p=0.07). There were no significant associations between Pb and global cognition (both baseline and longitudinal change). Patella Pb was associated with faster longitudinal decline in Word List Total Recall in the language domain (0.014 units/year, 95% CI: -0.026, -0.001) and Word List Delayed Recall in the memory domain (0.014 units/year, 95% CI: -0.027, -0.002). We found weaker associations with tibia Pb. CONCLUSIONS Cumulative Pb exposure is associated with faster declines in MMSE and Word List Total and Delayed Recall tests. These findings support the hypothesis that Pb exposure accelerates cognitive aging.
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Affiliation(s)
- Zishaan Farooqui
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Kelly M Bakulski
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Melinda C Power
- Department of Epidemiology and Biostatistics, George Washington University Milken Institute of Public Health, Washington, DC, USA
| | - Marc G Weisskopf
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - David Sparrow
- VA Normative Aging Study, Veterans Affairs Boston Health Care System, Boston, MA, USA; Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Avron Spiro
- VA Normative Aging Study, Veterans Affairs Boston Health Care System, Boston, MA, USA; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Pantel S Vokonas
- VA Normative Aging Study, Veterans Affairs Boston Health Care System, Boston, MA, USA; Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Linda H Nie
- School of Health Sciences, Purdue University, West Lafayette, IN, USA
| | - Howard Hu
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sung Kyun Park
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
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Lin Y, Zhao T, Jian X, Farooqui Z, Qu X, He C, Dinner AR, Scherer NF. Using the bias from flow to elucidate single DNA repair protein sliding and interactions with DNA. Biophys J 2009; 96:1911-7. [PMID: 19254550 DOI: 10.1016/j.bpj.2008.11.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Accepted: 11/05/2008] [Indexed: 11/28/2022] Open
Abstract
We perform single-molecule spatial tracking measurements of a DNA repair protein, the C-terminal domain of Ada (C-Ada) from Escherichia coli, moving on DNA extended by flow. The trajectories of single proteins labeled with a fluorophore are constructed. We analyze single-protein dwell times on DNA for different flow rates and conclude that sliding (with essentially no hopping) is the mechanism of C-Ada motion along stretched DNA. We also analyze the trajectory results with a drift-diffusion Langevin equation approach to elucidate the influence of flow on the protein motion; systematic variation of the flow enables one to estimate the microscopic friction. We integrate the step-size probability distribution to obtain a version of the fluctuation theorem that articulates the relation between the entropy production and consumption under the adjustable drag (i.e., bias) from the flow. This expression allows validation of the Langevin equation description of the motion. Comparison of the rate of sliding with recent computer simulations of DNA repair suggests that C-Ada could conduct its repair function while moving at near the one-dimensional diffusion limit.
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Affiliation(s)
- Yihan Lin
- Department of Chemistry, The University of Chicago, Chicago, Illinois 60637, USA
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