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Geist Hauserman J, Laverty CG, Donkervoort S, Hu Y, Silverstein S, Neuhaus SB, Saade D, Vaughn G, Malicki D, Kaur R, Li Y, Luo Y, Liu P, Burr P, Foley AR, Mohassel P, Bönnemann CG. Clinical, immunohistochemical, and genetic characterization of splice-altering biallelic DES variants: Therapeutic implications. HGG Adv 2024; 5:100274. [PMID: 38358893 PMCID: PMC10876619 DOI: 10.1016/j.xhgg.2024.100274] [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: 11/09/2023] [Revised: 01/24/2024] [Accepted: 01/24/2024] [Indexed: 02/17/2024] Open
Abstract
Pathogenic variants in the DES gene clinically manifest as progressive skeletal muscle weakness, cardiomyopathy with associated severe arrhythmias, and respiratory insufficiency, and are collectively known as desminopathies. While most DES pathogenic variants act via a dominant mechanism, recessively acting variants have also been reported. Currently, there are no effective therapeutic interventions for desminopathies of any type. Here, we report an affected individual with rapidly progressive dilated cardiomyopathy, requiring heart transplantation at age 13 years, in the setting of childhood-onset skeletal muscle weakness. We identified biallelic DES variants (c.640-13 T>A and c.1288+1 G>A) and show aberrant DES gene splicing in the affected individual's muscle. Through the generation of an inducible lentiviral system, we transdifferentiated fibroblast cultures derived from the affected individual into myoblasts and validated this system using RNA sequencing. We tested rationally designed, custom antisense oligonucleotides to screen for splice correction in these transdifferentiated cells and a functional minigene splicing assay. However, rather than correctly redirecting splicing, we found them to induce undesired exon skipping. Our results indicate that, while an individual precision-based molecular therapeutic approach to splice-altering pathogenic variants is promising, careful preclinical testing is imperative for each novel variant to test the feasibility of this type of approach for translation.
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Affiliation(s)
- Janelle Geist Hauserman
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA.
| | | | - Sandra Donkervoort
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA
| | - Ying Hu
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA
| | - Sarah Silverstein
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA
| | - Sarah B Neuhaus
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA
| | - Dimah Saade
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA
| | | | | | - Rupleen Kaur
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA
| | - Yuesheng Li
- DNA Sequencing and Genomics Core, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD, USA
| | - Yan Luo
- DNA Sequencing and Genomics Core, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD, USA
| | - Poching Liu
- DNA Sequencing and Genomics Core, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD, USA
| | - Patrick Burr
- DNA Sequencing and Genomics Core, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD, USA
| | - A Reghan Foley
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA
| | - Payam Mohassel
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA
| | - Carsten G Bönnemann
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA.
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Ybarra AM, Kamsheh AM, O'Connor MJ, Hollander SA, Bano M, Ploutz M, Vaughn G, Lambert A, Wallendorf M, Kirklin J, Canter CE. Survival does not differ by annual center transplant volume-A Pediatric Heart Transplant Society Registry study. Pediatr Transplant 2024; 28:e14720. [PMID: 38433570 DOI: 10.1111/petr.14720] [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: 12/20/2023] [Accepted: 02/08/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND There are conflicting data regarding the relationship between center volume and outcomes in pediatric heart transplantation. Previous studies have not fully accounted for differences in case mix, particularly in high-risk congenital heart disease (CHD) groups. We aimed to evaluate the relationship between center volume and outcomes using the Pediatric Heart Transplant Society (PHTS) Registry and explore how case mix may affect outcomes. METHODS A retrospective cohort study of all pediatric patients in the PHTS Registry who received a heart transplant from 2009 to 2018 was performed. Centers were divided into 5 groups based on average yearly transplant volume. The primary outcome was time to death or graft loss and outcomes were compared using Kaplan-Meier analysis. RESULTS There were 4583 cases among 55 centers included. There was no difference in time to death or graft loss by center volume in the entire cohort (p = .75), in patients with CHD (p = .79) or in patients with cardiomyopathy (p = .23). There was also no difference in time to death or graft loss by center size in patients undergoing transplant after Norwood, Glenn or Fontan (log rank p = .17, p = .31, and p = .10 respectively). There was a statistically significant difference in outcomes by center size in the positive crossmatch group (p < .0001), though no discernible pattern related to high or low center volume. CONCLUSIONS Outcomes are similar among transplant centers of all sizes, including for high-risk patient groups with CHD. Future work is needed to understand how patient-specific risk factors may vary among centers of various sizes and whether this influences patient outcomes.
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Affiliation(s)
- A Marion Ybarra
- Department of Pediatrics, Division of Pediatric Cardiology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Alicia M Kamsheh
- Department of Pediatrics, Division of Pediatric Cardiology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Matthew J O'Connor
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Seth A Hollander
- Department of Pediatrics, Stanford University, Palo Alto, California, USA
| | - Maria Bano
- Department of Pediatrics, UT Southwestern, Dallas, Texas, USA
| | - Michelle Ploutz
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Gabrielle Vaughn
- Department of Pediatrics, University of California San Diego, San Diego, California, USA
| | - Andrea Lambert
- University of Louisville and Norton Children's Hospital, Louisville, Kentucky, USA
| | - Michael Wallendorf
- Department of Biostatistics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - James Kirklin
- Division of Surgery, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Charles E Canter
- Department of Pediatrics, Division of Pediatric Cardiology, Washington University in St. Louis, St. Louis, Missouri, USA
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El-Sabrout H, Ganta S, Guyon P, Ratnayaka K, Vaughn G, Perry J, Kimball A, Ryan J, Thornburg CD, Tucker S, Mo J, Hegde S, Nigro J, El-Said H. Neonatal Myocardial Infarction: A Proposed Algorithm for Coronary Arterial Thrombus Management. Circ Cardiovasc Interv 2022; 15:e011664. [PMID: 35485231 DOI: 10.1161/circinterventions.121.011664] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Neonatal myocardial infarction is rare and is associated with a high mortality of 40% to 50%. We report our experience with neonatal myocardial infarction, including presentation, management, outcomes, and our current patient management algorithm. METHODS We reviewed all infants admitted with a diagnosis of coronary artery thrombosis, coronary ischemia, or myocardial infarction between January 2015 and May 2021. RESULTS We identified 21 patients (median age, 1 [interquartile range (IQR), 0.25-9.00] day; weight, 3.2 [IQR, 2.9-3.7] kg). Presentation included respiratory distress (16), shock (3), and murmur (2). Regional wall motion abnormalities by echocardiogram were a key criterion for diagnosis and were present in all 21 with varying degrees of depressed left ventricular function (severe [8], moderate [6], mild [2], and low normal [5]). Ejection fraction ranged from 20% to 54% (median, 43% [IQR, 34%-51%]). Mitral regurgitation was present in 19 (90%), left atrial dilation in 15 (71%), and pulmonary hypertension in 18 (86%). ECG was abnormal in 19 (90%). Median troponin I was 0.18 (IQR, 0.12-0.56) ng/mL. Median BNP (B-type natriuretic peptide) was 2100 (IQR, 924-2325) pg/mL. Seventeen had documented coronary thrombosis by cardiac catheterization. Seventeen (81%) were treated with intracoronary tPA (tissue-type plasminogen activator) followed by systemic heparin, AT (antithrombin), and intravenous nitroglycerin, and 4 (19%) were treated with systemic heparin, AT, and intravenous nitroglycerin alone. Nineteen of 21 recovered. One died (also had infradiaphragmatic total anomalous pulmonary venous return). One patient required a ventricular assist device and later underwent heart transplant; this patient was diagnosed late at 5 weeks of age and did not respond to tPA. Nineteen of 21 (90%) regained normal left ventricular function (ejection fraction, 60%-74%; mean, 65% [IQR, 61%-67%]) at latest follow-up (median, 6.8 [IQR, 3.58-14.72] months). Two of 21 (10%) had residual trivial mitral regurgitation. After analysis of these results, we present our current algorithm, which developed and matured over time, to manage neonatal myocardial infarction. CONCLUSIONS We experienced a lower mortality rate for infants with neonatal infarction than that reported in the literature. We propose a post hoc algorithm that may lead to improvement in patient outcomes following coronary artery thrombus.
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Affiliation(s)
- Hannah El-Sabrout
- Division of Pediatric Cardiology (H. El-Sabrout, P.G., K.R., G.V., J.P., S.H., H. El-Said), Rady Children's Hospital/University of California, San Diego
| | - Srujan Ganta
- Division of Pediatric Cardiac Surgery (S.G., J.N.), Rady Children's Hospital/University of California, San Diego
| | - Peter Guyon
- Division of Pediatric Cardiology (H. El-Sabrout, P.G., K.R., G.V., J.P., S.H., H. El-Said), Rady Children's Hospital/University of California, San Diego
| | - Kanishka Ratnayaka
- Division of Pediatric Cardiology (H. El-Sabrout, P.G., K.R., G.V., J.P., S.H., H. El-Said), Rady Children's Hospital/University of California, San Diego
| | - Gabrielle Vaughn
- Division of Pediatric Cardiology (H. El-Sabrout, P.G., K.R., G.V., J.P., S.H., H. El-Said), Rady Children's Hospital/University of California, San Diego
| | - James Perry
- Division of Pediatric Cardiology (H. El-Sabrout, P.G., K.R., G.V., J.P., S.H., H. El-Said), Rady Children's Hospital/University of California, San Diego
| | - Amy Kimball
- Division of Neonatology (A.K.), Rady Children's Hospital/University of California, San Diego
| | - Justin Ryan
- 3D Innovation Lab (J.R.), Rady Children's Hospital/University of California, San Diego
| | - Courtney D Thornburg
- Division of Hematology (C.D.T.), Rady Children's Hospital/University of California, San Diego
| | - Suzanne Tucker
- Division of Pathology (S.T., J.M.), Rady Children's Hospital/University of California, San Diego
| | - Jun Mo
- Division of Pathology (S.T., J.M.), Rady Children's Hospital/University of California, San Diego
| | - Sanjeet Hegde
- Division of Pediatric Cardiology (H. El-Sabrout, P.G., K.R., G.V., J.P., S.H., H. El-Said), Rady Children's Hospital/University of California, San Diego
| | - John Nigro
- Division of Pediatric Cardiac Surgery (S.G., J.N.), Rady Children's Hospital/University of California, San Diego
| | - Howaida El-Said
- Division of Pediatric Cardiology (H. El-Sabrout, P.G., K.R., G.V., J.P., S.H., H. El-Said), Rady Children's Hospital/University of California, San Diego
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Vaughn G, Chau P, Artrip J, Ganta S, Abcede E, Haldeman S, Sekeres J, Nigro J, Bock M. Heart Transplantation in Infants with Congenital Heart Disease: Outcomes Stratified by Prior Surgery. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1280] [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: 11/29/2022] Open
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5
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Silva‐Sepulveda JA, Fonseca Y, Vodkin I, Vaughn G, Newbury R, Vavinskaya V, Dwek J, Perry JC, Reshamwala P, Baehling C, Lyon J, Davis C, Lee JW, El‐Sabrout H, Shahbah D, Alshawabkeh L, Moore JW, El‐Said H. Evaluation of Fontan liver disease: Correlation of transjugular liver biopsy with magnetic resonance and hemodynamics. CONGENIT HEART DIS 2019; 14:600-608. [DOI: 10.1111/chd.12770] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/17/2019] [Accepted: 03/17/2019] [Indexed: 12/28/2022]
Affiliation(s)
- Jose A. Silva‐Sepulveda
- Division of Pediatric Cardiology University of California San Diego and Rady Children's Hospital USA
| | - Yudy Fonseca
- Division of Pediatric ICU University of California San Diego and Rady Children's HospitalUSA
| | - Irine Vodkin
- Division of Gastroenterology University of California San DiegoUSA
| | - Gabrielle Vaughn
- Division of Pediatric Cardiology University of California San Diego and Rady Children's Hospital USA
| | - Robert Newbury
- Division of Pediatric Pathology University of California San Diego and Rady Children's HospitalUSA
| | | | - Jerry Dwek
- Department of Radiology Rady Children's HospitalUSA
| | - James C. Perry
- Division of Pediatric Cardiology University of California San Diego and Rady Children's Hospital USA
| | - Preeti Reshamwala
- Department of medicine Division of digestive diseases & transplant, University of EmoryUSA
| | | | - James Lyon
- Department of Interventional Radiology Sharp Memorial hospitalUSA
| | - Christopher Davis
- Division of Pediatric Cardiology University of California San Diego and Rady Children's Hospital USA
| | - Jesse W. Lee
- Division of Pediatric Cardiology University of California San Diego and Rady Children's Hospital USA
| | | | | | | | - John W Moore
- Division of Pediatric Cardiology University of California San Diego and Rady Children's Hospital USA
| | - Howaida El‐Said
- Division of Pediatric Cardiology University of California San Diego and Rady Children's Hospital USA
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Aurigemma D, Moore JW, Vaughn G, Moiduddin N, El-Said HG. Perforation and right ventricular outflow tract stenting: Alternative palliation for infants with pulmonary atresia/ventricular septal defect. CONGENIT HEART DIS 2017; 13:226-231. [PMID: 29181862 DOI: 10.1111/chd.12552] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 10/24/2017] [Accepted: 10/28/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Right ventricular outflow tract (RVOT) stents have been used as palliation in patients with severe tetralogy of Fallot (TOF). Radiofrequency perforation of the RVOT has also been described in patients with pulmonary atresia (PA)/ventricular septal defect (VSD). However, RVOT stenting in conjunction with radiofrequency perforation as a means for establishing reliable pulmonary blood flow in patients with PA/VSD has not previously been reported. OBJECTIVES Our aim is to report our experience with using perforation of plate-like pulmonary valve atresia combined with stenting of RVOT as an alternative and equally efficacious intervention for infants with PA/VSD, as compared to a surgical pulmonary artery shunt (SPS). METHODS A retrospective review of patients with PA/VSD at our institution from Jan 2006 to October 2015 was performed. RESULTS Twenty-seven patients received palliation for PA/VSD. Five (median 2.5 kg, 2.1-4.1 kg) underwent RVOT stenting and 22 (3.5 kg, 2.1-4.6 kg) underwent surgical SPS. Of the patients who received an RVOT stent, 3 underwent guidewire perforation and balloon dilation of the plate-like pulmonary valve, and 2 underwent radiofrequency perforation of the pulmonary plate, followed by balloon dilation. Postprocedure saturations averaged 93% in the stent group and 89% in the shunt group. One of the patients who underwent RVOT stenting required additional stenting of the PDA for isolation of the LPA, but none required re-intervention. Four patients in the SPS cohort required re-intervention (18%). Two required stenting of the shunt, and 2 required surgical revision of the shunt. There was one death in the stent group, however this was secondary to withdrawal of support given an underlying genetic diagnosis (trisomy 13). There was one fatality in the SPS cohort prior to hospital discharge. CONCLUSIONS Perforation followed by RVOT stenting may be a safe and effective alternative to surgical SPS in infants with PA/VSD.
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Affiliation(s)
- David Aurigemma
- Rady Children's Hospital, San Diego, University of California, San Diego, California, USA
| | - John W Moore
- Rady Children's Hospital, San Diego, University of California, San Diego, California, USA
| | - Gabrielle Vaughn
- Rady Children's Hospital, San Diego, University of California, San Diego, California, USA
| | - Nasser Moiduddin
- Rady Children's Hospital, San Diego, University of California, San Diego, California, USA
| | - Howaida G El-Said
- Rady Children's Hospital, San Diego, University of California, San Diego, California, USA
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7
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Clarke NS, Karamlou T, Vaughn G, Lamberti J, Murthy R. Mixed Total Anomalous Pulmonary Venous Return With Ascending and Descending Vertical Veins. World J Pediatr Congenit Heart Surg 2017; 8:633-634. [PMID: 28901227 DOI: 10.1177/2150135117717267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Nicholas S Clarke
- 1 Division of Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tara Karamlou
- 2 Division of Pediatric Cardiothoracic Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Gabrielle Vaughn
- 3 Division of Pediatric Cardiology, Rady Children's Hospital, University of California, San Diego, CA, USA
| | - John Lamberti
- 4 Division of Pediatric Cardiothoracic Surgery, Rady Children's Hospital, University of California, San Diego, CA, USA
| | - Raghav Murthy
- 4 Division of Pediatric Cardiothoracic Surgery, Rady Children's Hospital, University of California, San Diego, CA, USA
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8
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Vaughn G, Moore J, Lamberti J, Canter C. Management of the failing Fontan: Medical, interventional and surgical treatment. Progress in Pediatric Cardiology 2016. [DOI: 10.1016/j.ppedcard.2016.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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9
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Mallula K, Vaughn G, El-Said H, Lamberti JJ, Moore JW. Comparison of ductal stenting versus surgical shunts for palliation of patients with pulmonary atresia and intact ventricular septum. Catheter Cardiovasc Interv 2015; 85:1196-202. [DOI: 10.1002/ccd.25870] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 01/25/2015] [Indexed: 12/17/2022]
Affiliation(s)
- Kiran Mallula
- Division of Cardiology; Rady Children's Hospital; University of California San Diego School of Medicine; San Diego California
| | - Gabrielle Vaughn
- Division of Cardiology; Rady Children's Hospital; University of California San Diego School of Medicine; San Diego California
| | - Howaida El-Said
- Division of Cardiology; Rady Children's Hospital; University of California San Diego School of Medicine; San Diego California
| | - John J. Lamberti
- Division of Cardiovascular Surgery; Rady Children's Hospital; University of California San Diego School of Medicine; San Diego California
| | - John W. Moore
- Division of Cardiology; Rady Children's Hospital; University of California San Diego School of Medicine; San Diego California
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10
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Mehta P, Wallace G, Davies S, Vaughn G, Kim M, Lawrence J, Bleesing J, Jodele S, Marsh R, Jordan M, Grimley M, Myers K, Kumar A, Joshi S, Perez A, Filipovich A. High-Dose Weekly Ambisome Antifungal Prophylaxis in High Risk Pediatric Patients Undergoing Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2011. [DOI: 10.1016/j.bbmt.2010.12.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Since protease inhibitors (PIs) were first introduced in 1995, research has shown that use of PIs greatly improves rates of survival, while slowing HIV disease progression. However, there are concerns that use of PIs may be associated with an increased risk of cardiovascular disease (CVD). To examine the relationship between PI use and CVD among HIV-infected patients, a large retrospective/prospective observational study was conducted. The study population was a clinic-based population seeking HIV treatment services between 1990 and 2000 at several sites in Los Angeles County. CVD was defined as ischemic heart disease/coronary artery disease (ICD-9 codes 410-414, 428, and 429.7) and cerebrovascular disease/stroke (ICD-9 codes 430-438). Multiple imputation was performed on missing data, and survival analysis was performed on the imputed datasets using an extended Cox Proportional Hazards Model. The 5,667 HIV-infected individuals contributed 15,550 person-years of follow-up. Eighty incident cases of CVD were identified. Use of PIs (hazard ratio (HR)=6.22 [95% CI: 3.13-12.39], p-value <0.001) and time-dependent non-PI use (HR 3.18 [1.99-5.09], p<0.001) were associated with CVD. Clinicians should monitor treatment of HIV-infected patients for adverse CVD events, and consider alternate forms of drug therapy and CVD-preventing drugs, particularly for those with a personal or family history of CVD.
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Affiliation(s)
- G Vaughn
- UCLA School of Public Health, Epidemiology, Los Angeles, USA.
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12
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Sukchawalit R, Vattanaviboon P, Utamapongchai S, Vaughn G, Mongkolsuk S. Characterization of Xanthomonas oryzae pv. oryzae recX, a gene that is required for high-level expression of recA. FEMS Microbiol Lett 2001; 205:83-9. [PMID: 11728720 DOI: 10.1111/j.1574-6968.2001.tb10929.x] [Citation(s) in RCA: 23] [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] [Indexed: 11/28/2022] Open
Abstract
Analysis of the nucleotide sequence downstream from the Xanthomonas oryzae pv. oryzae recA gene reveals two orfs designated orfX and recX. The former has the potential to code for a 5.6 kDa protein of unknown function while the latter encodes for a putative 14.6 kDa protein with homology to RecX from various bacteria. Northern blot analysis and RT-PCR results show that recA-orfX-recX are co-regulated and arranged in an operon. A recX mutant was constructed. The mutant has no obvious growth defects or stress response defects, except that it cannot support high-level expression of recA from an expression vector. Introduction of the plasmid containing recA into the recX mutant resulted in reduced transformation efficiency and all transformants tested had mutations with reduced RecA levels. Moreover, the recX mutant has reduced basal levels of RecA. This has not been observed in other bacteria. When inactivated recX was complemented in trans, both changes were reversed. recX mutation has no effect on the regulation of the recA promoter, suggesting that its effect on the RecA level could be post-transcriptional.
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Affiliation(s)
- R Sukchawalit
- Laboratory of Biotechnology, Chulabhorn Research Institute, Lak Si, Bangkok 10210, Thailand
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13
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Abstract
Parent surveys typically ask about aspects of care nurses think are important. The Parent Satisfaction Survey at a 250-bed children's hospital was revised based on what parents thought was most important for a nurse to do for themselves and their children. This report is based on a retrospective review of 1,405 self-reported parent surveys collected as a performance improvement activity over a 12-month time period. Surveys were distributed to parents of hospitalized children and were returned anonymously to mailboxes on the units. Using content analysis, a group of pediatric nurses reviewed the parents' comments to determine major themes. The themes were caring, communication, safety, environment, and appreciation. The parent survey was revised to include the themes parents identified as important.
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Affiliation(s)
- P Schaffer
- Division of Patient Services, Children's Hospital Medical Center, University of Cincinnati, College of Nursing, Cincinnati, OH, USA
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Winokur TS, McClellan S, Siegal GP, Redden D, Gore P, Lazenby A, Reddy V, Listinsky CM, Conner DA, Goldman J, Grimes G, Vaughn G, McDonald JM. A prospective trial of telepathology for intraoperative consultation (frozen sections). Hum Pathol 2000; 31:781-5. [PMID: 10923912 DOI: 10.1053/hupa.2000.8452] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [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: 11/11/2022]
Abstract
Telepathology is a maturing technology that, for a variety of reasons, has not been widely deployed. In addition, clinical validation is relatively modest compared with accepted telemedicine applications such as teleradiology. A prototype telepathology system (Tele-Path(sm)) featuring high-resolution images selected from a remote microscope site has been developed at the University of Alabama at Birmingham (UAB). To validate the diagnostic efficacy of the system, a prospective study was undertaken of parallel diagnoses by conventional microscopy and telepathology with a remotely operated microscope. Slides from 99 intraoperative consultations from 29 tissue/ organ sites in the University of Alabama Hospitals by 9 academic pathologists were used in the study. Each microscopic and telepathology diagnosis was compared with the final diagnosis rendered by a referee pathologist. Diagnoses were classified as correct, false positive, or false negative or classification error. Of the 99 frozen sections evaluated, 3 cases were deferred. Of the remaining 96 cases, 2 received incorrect diagnoses in both the microscopic and telepathology arms of the study. Three errors occurred only in the telepathology arm. There was 1 false-positive diagnosis, 1 false-negative diagnosis, and 1 classification error. Statistical analysis indicated no significant difference between telepathology and conventional microscopy. Qualitative data indicated that the pathologists were generally satisfied with the performance of the system. Telepathology using this system paradigm is sufficiently accurate for real time utilization in a complex surgical environment. Telepathology therefore may be an effective model to support the surgical services of hospitals lacking full-time pathology coverage, resulting in full-time access to anatomic pathology services.
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Affiliation(s)
- T S Winokur
- Department of Pathology, UAB Cancer Center, University of Alabama at Birmingham 35233, USA
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Abstract
OBJECTIVE To study advance directives (code status) among subgroups of Asian nursing home residents. DESIGN Cross-sectional design. PARTICIPANTS AND SETTING A total of 423 residents of Asian descent (aged >55) from two ethnic nursing homes in Seattle, Washington. METHODS Chart review was conducted on 423 residents (199 discharged between 1995 and 1998 and 244 current residents) to ascertain code status, age, gender, ethnicity, comorbidity (using the Charlson Index), and religion. RESULTS Seventy percent of the residents were women, median age was 83 +/- 9, 43% were Chinese, 40% Japanese, and 17% other Asian (Korean, Filipino, Southeast Asian). The majority of the patients in any subgroup (72% overall) were 'no code'. In bivariate analysis, ethnicity, increased age, and comorbidity were correlated with no code status. In multivariable logistic regression, Japanese residents were more likely to be no code (OR 4.1 (95% CI, 3.1- 5.4)) controlling for age, comorbidity, gender, and religion. Chinese were more likely to be full code (OR 3.3 (95% CI, 2.6-4.2)). CONCLUSIONS Code status differs significantly among Asian subgroups in these ethnic nursing homes. Whereas the majority of residents are no code, Japanese residents are more likely than Chinese or others to be no code. Higher age and comorbidity are also correlated with no code status.
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Affiliation(s)
- G Vaughn
- University of Washington Harborview Medical Center, Division of Geriatrics, Seattle 98104, USA
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16
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Abstract
A Xoo recA insertion inactivation mutant was constructed. The mutant, lacking RecA, showed increased sensitivity towards mutagen killing. This phenotype could be complemented by a cloned, functional recA. Unlike other bacteria, both the recA mutant and the parental strain had similar level of resistance to H2O2 killing and peroxide-induced mutagenesis.
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Affiliation(s)
- S Mongkolsuk
- Laboratory of Biotechnology, Chulabhorn Research Institute, Bangkok, Thailand.
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17
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Winokur TS, McClellan S, Siegal GP, Reddy V, Listinsky CM, Conner D, Goldman J, Grimes G, Vaughn G, McDonald JM. An initial trial of a prototype telepathology system featuring static imaging with discrete control of the remote microscope. Am J Clin Pathol 1998; 110:43-9. [PMID: 9661922 DOI: 10.1093/ajcp/110.1.43] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Routine diagnosis of pathology images transmitted over telecommunications lines remains an elusive goal. Part of the resistance stems from the difficulty of enabling image selection by the remote pathologist. To address this problem, a telepathology microscope system (TelePath, TeleMedicine Solutions, Birmingham, Ala) that has features associated with static and dynamic imaging systems was constructed. Features of the system include near real time image transmission, provision of a tiled overview image, free choice of any fields at any desired optical magnification, and automated tracking of the pathologist's image selection. All commands and images are discrete, avoiding many inherent problems of full motion video and continuous remote control. A set of 64 slides was reviewed by 3 pathologists in a simulated frozen section environment. Each pathologist provided diagnoses for all 64 slides, as well as qualitative information about the system. Thirty-one of 192 diagnoses disagreed with the reference diagnosis that had been reached before the trial began. Qf the 31, 13 were deferrals and 12 were diagnoses of cases that had a deferral as the reference diagnosis. In 6 cases, the diagnosis disagreed with the reference diagnosis yielding an overall accuracy of 96.9%. Confidence levels in the diagnoses were high. This trial suggests that this system provides high-quality anatomic pathology services, including intraoperative diagnoses, over telecommunications lines.
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Affiliation(s)
- T S Winokur
- Department of Pathology, University of Alabama at Birmingham, 35233, USA
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Plewa MC, Otto R, Verbrugge J, Buderer NM, Vaughn G, Mattevi P. Intrasound vibration testing in acute ankle injuries. Acad Emerg Med 1996; 3:849-52. [PMID: 8870756 DOI: 10.1111/j.1553-2712.1996.tb03529.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine the accuracy of intrasound vibration testing (IVT) in comparison with plain radiography in the diagnosis of acute ankle fractures. METHODS A group-sequential, nonrandomized, double-blind, observational study design was used. A convenience sample of patients were studied, aged > or = 10 years, with acute ankle injuries, undergoing ankle radiography, evaluated at a community teaching hospital ED. Excluded were cases involving injuries of > 24 hours' duration, inadequate documentation, protocol violation, or positive IVT on the uninjured ankle. IVT was performed with the intrasound apparatus placed on the anterior and posterior aspects of the medial and lateral malleoli of the uninjured and injured ankles; positive IVT was defined as patient withdrawal secondary to pain. RESULTS Of 105 patients enrolled, 8 were excluded; 1 for inadequate documentation, 5 for protocol violation, and 2 for positive IVT of the uninjured ankle. Of the 97 patients analyzed, 13 had fractures identified by radiography, including 9 lateral malleolar, 1 medial malleolar, 1 bimalleolar, and 2 talar fractures. Only 5 of the 13 fractures were detected with IVT (sensitivity = 39%; 95% CI: 14-68%). Seventy of 84 nonfractured ankles had negative IVT (specificity = 83%; 95% CI: 74-91%). Of the 19 with positive IVT, 5 had fractures (positive predictive value of 26%; 95% CI: 9-51%). Of the 78 with negative IVT, 70 had no fracture (negative predictive value of 90%; 95% CI: 81-96%). Overall, 75 of 97 IVTs were correct (77%), most of which were among patients without fractures.
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Affiliation(s)
- M C Plewa
- Vincent Medical Center, Toledo, OH 43608, USA.
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Craig PL, Swinburn BA, Matenga-Smith T, Matangi H, Vaughn G. Do Polynesians still believe that big is beautiful? Comparison of body size perceptions and preferences of Cook Islands, Maori and Australians. N Z Med J 1996; 109:200-3. [PMID: 8668297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
AIMS To examine body size perceptions in a group of Polynesians from the Cook Islands and compare these with perceptions of Australians of European decent. METHODS Residents of Tutakimoa village on the island of Rarotonga, Cook Islands completed a questionnaire on body size perception (83 females, 49 males, 80% response rate). The responses were compared with the same number of Australian subjects who were matched for sex, age and body mass index (BMI). Culturally appropriate, graded sets of photographs (one female and one male for each ethnic group) were used as the stimuli for questions on body perception. RESULTS Cook Islands women were the most accurate in their perception of their current size; other groups overestimated. All groups preferred to be smaller, particularly women, with similar preferences (BMI 23-24) in women of both ethnic groups. Cook Islands subjects chose larger ideal sizes than Australians for both females (BMI 24.4 vs 22.5) and males (BMI 27 vs 24.2). CONCLUSIONS The traditional Polynesian concepts of very large body sizes being considered healthy and attractive are not evident in the modern day Cook Islanders. The excessive pursuit of western fashions for small female body size may have longer term detrimental effects in Polynesian women.
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Affiliation(s)
- P L Craig
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia
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20
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Affiliation(s)
- G Vaughn
- Reforming Feelings Counseling and Consulting, Liberty, Mo
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Galbraith LK, Bailey D, Kelly L, Rehn K, Spear S, Steinle C, Vaughn G, Wehage S. Treatment for alteration in oral mucosa related to chemotherapy. Pediatr Nurs 1991; 17:233-6. [PMID: 2062581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Possibly one of the most painful and difficult side effects of chemoradiotherapy is stomatitis. Early intervention to limit its severity and aggressive treatment to prevent related complications such as infection and hemorrhage are essential.
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