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Jensen S, Sanderfer VC, Porter K, Rieker MG, Maniscalco BR, Lloyd J, Gallagher R, Wang H, Ross S, Lauer C, Cunningham K, Thomas B. Surgical stabilization of rib fractures in the geriatric trauma population is associated with equivalent outcomes to a younger cohort: A propensity matched analysis. Injury 2024; 55:111593. [PMID: 38762943 DOI: 10.1016/j.injury.2024.111593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Surgical stabilization of rib fractures (SSRF) improves outcomes in chest wall trauma. Geriatric patients are particularly vulnerable to poor outcomes; yet, this population is often excluded from SSRF studies. Further delineating patient outcomes by age is necessary to optimize care for the aging trauma population. METHODS A retrospective cohort study was conducted examining outcomes among patients aged 40+ for whom an SSRF consult was placed between 2017 and 2022 at a level 1 trauma center. Patients were categorized into geriatric (65+) and adult (40-64), as well as 80 years and older (80+) and 79 and younger (40-79). Patient outcomes were assessed comparing non-operative and operative management of chest wall trauma. Propensity matched analysis was performed to evaluate mortality differences between adult and geriatric patients who did and did not undergo SSRF. RESULTS A total of 543 patients had an SSRF consult. Of these, 227 were 65+, and 73 were 80+. A total of 129 patients underwent SSRF (24 %). The percentage of patients undergoing SSRF did not vary between 40 and 64 and 65+ (23.7 % and 23.6 %, respectively, p = 0.97) or 40-79 and 80+ (24.0 vs 21.9, p = 0.69). Patients undergoing SSRF had higher chest injury burden and were more likely to require mechanical ventilation and ICU level care on admission. Overall, in-hospital mortality rate was 4.6 %. Among patients who underwent SSRF, mortality rate did not significantly differ between 65+ and 40-64 (7.8% vs 2.7 %, p = 0.18) or 80+ and 40-79 (6.3% vs 4.6 %, p = 0.77). This remained true in propensity matched analysis. CONCLUSION Geriatric and octogenarian patients with rib fractures underwent SSRF at similar rates and achieved equivalent outcomes to their younger counterparts. SSRF did not differentially affect mortality outcomes based on age group in propensity matched analysis. SSRF is safe for geriatric patients including octogenarians.
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Affiliation(s)
- Stephanie Jensen
- Carolinas Medical Center, Department of Surgery, 1000 Blythe Blvd, Charlotte, NC 28203, United States of America.
| | - Van Christian Sanderfer
- Carolinas Medical Center, Department of Surgery, 1000 Blythe Blvd, Charlotte, NC 28203, United States of America.
| | - Kierstin Porter
- Des Moines University Medical School, 3200 Grand Ave, Des Moines, IA 50312, United States of America.
| | - Madeline G Rieker
- Wake Forest School of Medicine, 475 Vine St, Winston-Salem, NC 27101, United States of America.
| | - Brianna R Maniscalco
- Wake Forest School of Medicine, 475 Vine St, Winston-Salem, NC 27101, United States of America.
| | - Jenna Lloyd
- Carolinas Medical Center, Department of Surgery, 1000 Blythe Blvd, Charlotte, NC 28203, United States of America.
| | - Robert Gallagher
- Des Moines University Medical School, 3200 Grand Ave, Des Moines, IA 50312, United States of America.
| | - Huaping Wang
- Carolinas Medical Center, Department of Surgery, 1000 Blythe Blvd, Charlotte, NC 28203, United States of America.
| | - Sam Ross
- Carolinas Medical Center, Department of Surgery, 1000 Blythe Blvd, Charlotte, NC 28203, United States of America.
| | - Cynthia Lauer
- Carolinas Medical Center, Department of Surgery, 1000 Blythe Blvd, Charlotte, NC 28203, United States of America.
| | - Kyle Cunningham
- Carolinas Medical Center, Department of Surgery, 1000 Blythe Blvd, Charlotte, NC 28203, United States of America.
| | - Bradley Thomas
- Carolinas Medical Center, Department of Surgery, 1000 Blythe Blvd, Charlotte, NC 28203, United States of America.
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Appelbaum RD, Butler D, Stirparo JJ, Coleman J, Hartwell JL, Cunningham K. Eastern Association for the Surgery of Trauma (EAST) System Wellness White Paper: An Evaluation of Wellness from a Systems Perspective. J Trauma Acute Care Surg 2024:01586154-990000000-00647. [PMID: 38439151 DOI: 10.1097/ta.0000000000004311] [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] [Indexed: 03/06/2024]
Abstract
ABSTRACT Providers are charged with responsibility to maintain their own health and wellness [1,2]. Wellness or wellbeing is multifactorial and complex, but the construct lacks clarity [3]. Wellness can impact patient safety and it has significant financial implications. Both financial and healthcare industries have recognized this multifactorial issue, and have applied research and resources to the issue of employee wellness and wellbeing [4]. Thus, solutions to sustainable change must be multi-tiered and intentional [1,5].We reviewed the wellness literature with a focus on systems to provide a framework for consensus-building for a quality Acute Care Surgery system. Within this review we highlight several categories for consideration: 1) provider wellness 2) culture of safety, 3)learning health systems, and 4) organizational perspectives, Figure 1. Finally, we provide specific system recommendations for the Acute Care Surgery practice. We aim to support personal safety, longevity, and preserve our workforce by creating a system that works for its providers.
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3
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Jensen S, Dabagian HO, Porter K, Thomas B, Dieffenbaugher S, Cunningham K, Green J, Ross SW, Sachdev G. Extracorporeal Membrane Oxygenation During Surgical Stabilization of Rib Fractures in Successful Management of Severe Blunt Chest Trauma. Am Surg 2024; 90:303-305. [PMID: 38124319 DOI: 10.1177/00031348231212590] [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] [Indexed: 12/23/2023]
Abstract
Early surgical stabilization of rib fracture (SSRF) improves outcomes in patients with flail physiology and severely displaced fractures. We present two cases of patients with severe chest injury and large flail segment who underwent SSRF while on veno-venous extracorporeal membrane oxygenation (VV-ECMO). The patients developed respiratory failure within 24 hours of admission requiring VV-ECMO. The extent of their chest wall injury limited pulmonary mechanics prohibiting transition off VV-ECMO. Therefore, SSRF was performed on hospital days 2 and 3 and while on VV-ECMO support. Stabilizing the chest wall allowed for improved ventilation and successful decannulation from VV-ECMO on postoperative days 3 and 4. Ultimately, both achieved a functional recovery and were discharged home. These cases demonstrate a unique thoracic damage control strategy wherein SSRF is performed while on VV-ECMO. Improving chest stability and pulmonary mechanics with SSRF allowed for safe transition off VV-ECMO and achieved a favorable long-term outcome.
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Affiliation(s)
- Stephanie Jensen
- Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | | | | | - Bradley Thomas
- Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | | | - Kyle Cunningham
- Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - John Green
- Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Samuel W Ross
- Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Gaurav Sachdev
- Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
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McCartt J, Cleveland E, Duet M, Paton L, Thompson K, Matthews B, Cunningham K, Ross SW, Reinke CE. Implementation of a Gastrografin Order Set for Small Bowel Obstruction Across a Health System: A Cohort Study. Am Surg 2023; 89:5850-5857. [PMID: 37191904 DOI: 10.1177/00031348231175135] [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] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND The use of Gastrografin (GG) in the management of adhesive small bowel obstruction (SBO) has been shown to decrease the length of stay and operative intervention. METHODS This retrospective cohort study examined patients with an SBO diagnosis prior to implementation (PRE, January 2017-January 2019) and following implementation (POST, January 2019-May 2021) of a GG challenge order set made available across 9 hospitals within a health care system. Primary outcomes were utilization of the order set across facilities and over time. Secondary outcomes included time to surgery for operative patients, rate of surgery, nonoperative length of stay, and 30-day readmission. Standard descriptive, univariate, and multivariable regression analyses were performed. RESULTS PRE cohort had 1746 patients and POST had 1889. The utilization of GG increased from 14% to 49.5% following implementation. Significant variability existed within the hospital system with utilization at each individual hospital from 11.5% to 60%. There was an increase in surgical intervention (13.9% vs 16.4%, P = .04) and decrease in nonoperative LOS (65.6 vs 59.9 hours, P < .001) following implementation. For POST patients, multivariable linear regression showed significant reduction in nonoperative length of stay (-23.1 hours, P < .001) but no significant difference in time to surgery (-19.6 hours, P = .08). DISCUSSION The availability of a standardized order set for SBO can result in increased Gastrografin administration across hospital settings. The implementation of a Gastrografin order set was associated with decreased length of stay in nonoperative patients.
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Affiliation(s)
- Jason McCartt
- Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Elaine Cleveland
- Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Mary Duet
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Lauren Paton
- Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Kyle Thompson
- Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Brent Matthews
- Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Kyle Cunningham
- Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Samuel W Ross
- Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
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Papaiakovou M, Maclean K, Zwanenburg L, Ajakaye OG, Chakraborty S, Costain A, Souza COS, Cunningham K, Cobb SA, Moescheid MF, Mora J, Amaral MS. Hydra at 21, key to the door for helminth researchers. Trends Parasitol 2023; 39:973-981. [PMID: 37833165 DOI: 10.1016/j.pt.2023.09.013] [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] [Received: 09/23/2023] [Accepted: 09/23/2023] [Indexed: 10/15/2023]
Affiliation(s)
- Marina Papaiakovou
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK.
| | - Kate Maclean
- Malaghan Institute of Medical Research, Wellington, New Zealand.
| | | | | | | | - Alice Costain
- Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, UK.
| | - Camila Oliveira Silva Souza
- Type 2 Immunity Section, Laboratory of Parasitic Disease, National Institute of Allergy and Infectious Diseases (NIAID), National Institute of Health, Bethesda, MD, USA.
| | | | - Sarah A Cobb
- University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Max F Moescheid
- Institute of Parasitology, Biomedical Research Center Seltersberg (BFS), Justus Liebig University Giessen, Giessen, Germany.
| | - Javier Mora
- Centro de Investigación de Enfermedades Tropicales, Centro de Investigación en Cirugía y Cáncer, and Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica.
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Singh SP, Smyth DJ, Cunningham K, Mukundan A, Byeon CH, Hinck CS, White MPJ, Ciancia C, Wosowska N, Sanders A, Jin R, Lilla S, Zanivan S, Schoenherr C, Inman G, van Dinther M, ten Dijke P, Hinck AP, Maizels RM. The helminth TGF-β mimic TGM4 is a modular ligand that binds CD44, CD49d and TGF-β receptors to preferentially target myeloid cells. bioRxiv 2023:2023.11.13.566701. [PMID: 38014296 PMCID: PMC10680678 DOI: 10.1101/2023.11.13.566701] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
The murine helminth parasite Heligmosomoides polygyrus expresses a family of modular proteins which, replicating the functional activity of the immunomodulatory cytokine TGF-β, have been named TGM (TGF-β Μimic). Multiple domains bind to different receptors, including TGF-β receptors TβRI (ALK5) and TβRII through domains 1-3, and prototypic family member TGM1 binds the cell surface co-receptor CD44 through domains 4-5. This allows TGM1 to induce T lymphocyte Foxp3 expression, characteristic of regulatory (Treg) cells, and to activate a range of TGF-β-responsive cell types. In contrast, a related protein, TGM4, targets a much more restricted cell repertoire, primarily acting on myeloid cells, with less potent effects on T cells and lacking activity on other TGF-β-responsive cell types. TGM4 binds avidly to myeloid cells by flow cytometry, and can outcompete TGM1 for cell binding. Analysis of receptor binding in comparison to TGM1 reveals a 10-fold higher affinity than TGM1 for TGFβR-I (TβRI), but a 100-fold lower affinity for TβRII through Domain 3. Consequently, TGM4 is more dependent on co-receptor binding; in addition to CD44, TGM4 also engages CD49d (Itga4) through Domains 1-3, as well as CD206 and Neuropilin-1 through Domains 4 and 5. TGM4 was found to effectively modulate macrophage populations, inhibiting lipopolysaccharide-driven inflammatory cytokine production and boosting interleukin (IL)-4-stimulated responses such as Arginase-1 in vitro and in vivo. These results reveal that the modular nature of TGMs has allowed the fine tuning of the binding affinities of the TβR- and co-receptor binding domains to establish cell specificity for TGF-β signalling in a manner that cannot be attained by the mammalian cytokine.
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Affiliation(s)
- Shashi P. Singh
- Wellcome Centre of Integrative Parasitology, School of Infection and Immunity, University of Glasgow, G12 8TA, UK
| | - Danielle J. Smyth
- Wellcome Centre of Integrative Parasitology, School of Infection and Immunity, University of Glasgow, G12 8TA, UK
| | - Kyle Cunningham
- Wellcome Centre of Integrative Parasitology, School of Infection and Immunity, University of Glasgow, G12 8TA, UK
| | - Ananya Mukundan
- Department of Structural Biology, University of Pittsburgh, USA
| | | | | | - Madeleine P. J. White
- Wellcome Centre of Integrative Parasitology, School of Infection and Immunity, University of Glasgow, G12 8TA, UK
| | - Claire Ciancia
- Wellcome Centre of Integrative Parasitology, School of Infection and Immunity, University of Glasgow, G12 8TA, UK
| | - Nątalia Wosowska
- Wellcome Centre of Integrative Parasitology, School of Infection and Immunity, University of Glasgow, G12 8TA, UK
| | - Anna Sanders
- Wellcome Centre of Integrative Parasitology, School of Infection and Immunity, University of Glasgow, G12 8TA, UK
| | - Regina Jin
- Wellcome Centre of Integrative Parasitology, School of Infection and Immunity, University of Glasgow, G12 8TA, UK
| | - Sergio Lilla
- Cancer Research UK Scotland Institute, Glasgow, G61 1BD, UK
| | - Sara Zanivan
- Cancer Research UK Scotland Institute, Glasgow, G61 1BD, UK
| | | | - Gareth Inman
- Cancer Research UK Scotland Institute, Glasgow, G61 1BD, UK
| | - Maarten van Dinther
- Oncode Institute and Department of Cell and Chemical Biology, University of Leiden, The Netherlands
| | - Peter ten Dijke
- Oncode Institute and Department of Cell and Chemical Biology, University of Leiden, The Netherlands
| | - Andrew P. Hinck
- Department of Structural Biology, University of Pittsburgh, USA
| | - Rick M. Maizels
- Wellcome Centre of Integrative Parasitology, School of Infection and Immunity, University of Glasgow, G12 8TA, UK
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Ghneim M, Kufera J, Zhang A, Penaloza-Villalobos L, Swentek L, Watras J, Smith A, Hahn A, Rodriguez Mederos D, Dickhudt TJ, Laverick P, Cunningham K, Norwood S, Fernandez L, Jacobson LE, Williams JM, Lottenberg L, Azar F, Shillinglaw W, Slivinski A, Nahmias J, Donnelly M, Bala M, Egodage T, Zhu C, Udekwu PO, Norton H, Dunn JA, Baer R, McBride K, Santos AP, Shrestha K, Metzner CJ, Murphy JM, Schroeppel TJ, Stillman Z, O'Connor R, Johnson D, Berry C, Ratner M, Reynolds JK, Humphrey M, Scott M, Hickman ZL, Twelker K, Legister C, Glass NE, Siebenburgen C, Palmer B, Semon GR, Lieser M, McDonald H, Bugaev N, LeClair MJ, Stein D. Does lower extremity fracture fixation technique influence neurologic outcomes in patients with traumatic brain injury? The EAST Brain vs. Bone multicenter trial. J Trauma Acute Care Surg 2023; 95:516-523. [PMID: 37335182 DOI: 10.1097/ta.0000000000004095] [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: 06/21/2023]
Abstract
OBJECTIVE This study aimed to determine whether lower extremity fracture fixation technique and timing (≤24 vs. >24 hours) impact neurologic outcomes in TBI patients. METHODS A prospective observational study was conducted across 30 trauma centers. Inclusion criteria were age 18 years and older, head Abbreviated Injury Scale (AIS) score of >2, and a diaphyseal femur or tibia fracture requiring external fixation (Ex-Fix), intramedullary nailing (IMN), or open reduction and internal fixation (ORIF). The analysis was conducted using analysis of variamce, Kruskal-Wallis, and multivariable regression models. Neurologic outcomes were measured by discharge Ranchos Los Amigos Revised Scale (RLAS-R). RESULTS Of the 520 patients enrolled, 358 underwent Ex-Fix, IMN, or ORIF as definitive management. Head AIS was similar among cohorts. The Ex-Fix group experienced more severe lower extremity injuries (AIS score, 4-5) compared with the IMN group (16% vs. 3%, p = 0.01) but not the ORIF group (16% vs. 6%, p = 0.1). Time to operative intervention varied between the cohorts with the longest time to intervention for the IMN group (median hours: Ex-Fix, 15 [8-24] vs. ORIF, 26 [12-85] vs. IMN, 31 [12-70]; p < 0.001). The discharge RLAS-R score distribution was similar across the groups. After adjusting for confounders, neither method nor timing of lower extremity fixation influenced the discharge RLAS-R. Instead, increasing age and head AIS score were associated with a lower discharge RLAS-R score (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.002-1.03 and OR, 2.37; 95% CI, 1.75-3.22), and a higher Glasgow Coma Scale motor score on admission (OR, 0.84; 95% CI, 0.73-0.97) was associated with higher RLAS-R score at discharge. CONCLUSION Neurologic outcomes in TBI are impacted by severity of the head injury and not the fracture fixation technique or timing. Therefore, the strategy of definitive fixation of lower extremity fractures should be dictated by patient physiology and the anatomy of the injured extremity and not by the concern for worsening neurologic outcomes in TBI patients. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level III.
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Affiliation(s)
- Mira Ghneim
- From the R Adams Cowley Shock Trauma Center (M.G., D.S.), Program in Trauma, Department of Surgery, University of Maryland School of Medicine; National Study Center for Trauma and Emergency Medical Systems, Program in Trauma, Center for Shock, Trauma and Anesthesiology Research (J.K.), University of Maryland School of Medicine; University of Maryland School of Medicine (A.Z.); Department of Surgery (L.P.-V., L.S.), Loma Linda University Medical Center; Inova Fairfax Hospital (J.W.); LSUHCS (A.S.); Ochsner Medical Center (A.H.); Broward Health Medical Center (D.R.M., T.J.D.); Atrium Health Carolinas Medical Center (P.L., K.C.); University of Texas Health Science Center (S.N., L.F.); Ascension St. Vincent Hospital (L.E.J., J.M.W.); St. Mary's Medical Center (L.L., F.A.), Florida Atlantic University, Schmidt College of Medicine; Mission Hospital (W.S., A.S.); University of California, Irvine (J.N., M.D.); Hadassah Medical Center and Faculty of Medicine (M.B.), Hebrew University of Jerusalem; Cooper University Health Care (T.E.); Cooper University Health Care (C.Z.); WakeMed Health and Hospitals (P.O.U., H.N.); Medical Center of the Rockies (J.A.D.), University of Colorado Health North; Orthopedic Center of the Rockies (R.B.); Memorial University Medical Center (K.M.); Texas Tech University Health Sciences Center (A.P.S., K.S.); Spartanburg Regional Medical Center (C.J.M., J.M.M.); Memorial Hospital Central (T.J.S., Z.S.); Yale School of Medicine (R.O., D.J.); NYU Grossman School of Medicine (C.B., M.R.,); University of Kentucky (J.K.R., M.H.); St. Mary's Medical Center (M.S.), Essentia Health; NYC Health + Hospitals/Elmhurst (Z.L.H., K.T.), Icahn School of Medicine at Mount Sinai; Rutgers New Jersey Medical School (C.L., N.E.G.); Kettering Health Main Campus (C.S., B.P.); Wright State University Boonshoft School of Medicine (G.R.S.); Research Medical Center (M.L., H.M.); Tufts Medical Center (N.B.), Tuft University School of Medicine; and Tufts Medical Center (M.J.L.)
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Horwitz D, Dumas RP, Cunningham K, Palacio CH, Margulies DR, Eme C, Bukur M. How do we PI? Results of an EAST quality, patient safety, and outcomes survey. Trauma Surg Acute Care Open 2023; 8:e001059. [PMID: 37560073 PMCID: PMC10407366 DOI: 10.1136/tsaco-2022-001059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 06/16/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Quality improvement is a cornerstone for any verified trauma center. Conducting effective quality and performance improvement, however, remains a challenge. In this study, we sought to better explore the landscape and challenges facing the members of the Eastern Association for the Surgery of Trauma (EAST) through a survey. METHODS A survey was designed by the EAST Quality Patient Safety and Outcomes Committee. It was reviewed by the EAST Research and Scholarship Committee and then distributed to 2511 EAST members. The questions were designed to understand the frequency, content, and perceptions surrounding quality improvement processes. RESULTS There were 151 respondents of the 2511 surveys sent (6.0%). The majority were trauma faculty (55%) or trauma medical directors (TMDs) (37%) at American College of Surgeons level I (62%) or II (17%) trauma centers. We found a wide variety of resources being used across hospitals with the majority of cases being identified by a TMD or attending (81%) for a multidisciplinary peer review (70.2%). There was a statistically significant difference in the perception of the effectiveness of the quality improvement process with TMDs being more likely to describe their process as moderately or very effective compared with their peers (77.5% vs. 57.7%, p=0.026). The 'Just Culture' model appeared to have a positive effect on the process improvement environment, with providers less likely to report a non-conducive environment (10.9% vs. 27.6%, p=0.012) and less feelings of assigning blame (3.1% vs. 13.8%, p=0.026). CONCLUSION Case review remains an essential but challenging process. Our survey reveals a need to continue to advocate for appropriate time and resources to conduct strong quality improvement processes. LEVEL OF EVIDENCE Epidemiological study, level III.
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Affiliation(s)
- Daniel Horwitz
- Department of Surgery, NYU Langone Health, New York, New York, USA
- Division of Trauma and Acute Care Surgery, Bellevue Hospital Center, New York City, New York, USA
| | - Ryan Peter Dumas
- Department of Surgery, UT Southwestern Medical, Dallas, Texas, USA
| | - Kyle Cunningham
- Department of Surgery, Atrium Health, Charlotte, North Carolina, USA
| | | | - Daniel R Margulies
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Christine Eme
- Eastern Association for the Surgery of Trauma, Chicago, Illinois, USA
| | - Marko Bukur
- Department of Surgery, NYU Langone Health, New York, New York, USA
- Division of Trauma and Acute Care Surgery, Bellevue Hospital Center, New York City, New York, USA
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Sorah AB, Cunningham K, Wang H, Karvetski C, Ekaney M, Brintzenhoff R, Evans S. Effects of Guideline-Based Correction of Platelet Inhibition on Outcomes in Moderate to Severe Isolated Blunt Traumatic Brain Injury. Neurotrauma Rep 2022; 3:388-397. [PMID: 36204390 PMCID: PMC9531883 DOI: 10.1089/neur.2022.0003] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Platelet dysfunction has been demonstrated after traumatic brain injury (TBI) regardless of the use of platelet inhibitors. The purpose of this study was to determine the efficacy of a platelet-mapping thromboelastography (PM-TEG) in predicting TBI patients who would benefit from platelet transfusion. We hypothesized that adenosine diphosphate (ADP) and arachadonic acid (AA) inhibition in patients with TBI is associated with increased mortality and can be corrected with platelet transfusion. This is a retrospective review of patients admitted to a level 1 trauma center from January 2016 through September 2017 with moderate to severe blunt TBI (msTBI), defined by an initial Glasgow Coma Scale (GCS) ≤12 with intracranial hemorrhage. Patients received PM-TEG. Those with platelet dysfunction (ADP or AA inhibition ≥60%) received one unit of platelets followed by repeat PM-TEG, until inhibition <60% or three units of platelets. Cohorts were defined as patients initially without (NPI) and with (PI) inhibition and subdivided into those whose inhibition corrected (PI-C) versus those whose did not correct (PI-NC). From 69 patients with isolated blunt TBI, 40 (58%) presented with NPI, 29 (42%) with PI. Of those with PI, 16 (55%) were with PI-C and 13 (45%) with PI-NC. Platelet inhibition in msTBI patients undergoing guideline-based transfusion is associated with age and GCS and an increase in mortality. Platelet inhibition seems to have a more adverse effect on patients >55 years of age or with GCS <8. Correction of platelet inhibition normalized mortality to that of NPI.
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Affiliation(s)
- Andrew B. Sorah
- F.H. Sammy Ross Trauma Center, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Kyle Cunningham
- F.H. Sammy Ross Trauma Center, Carolinas Medical Center, Charlotte, North Carolina, USA
| | | | - Colleen Karvetski
- Information and Analytic Services, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Michael Ekaney
- F.H. Sammy Ross Trauma Center, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Rita Brintzenhoff
- F.H. Sammy Ross Trauma Center, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Susan Evans
- F.H. Sammy Ross Trauma Center, Carolinas Medical Center, Charlotte, North Carolina, USA
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Mukundan A, Byeon CH, Hinck CS, Cunningham K, Campion T, Smyth DJ, Maizels RM, Hinck AP. Convergent evolution of a parasite-encoded complement control protein-scaffold to mimic binding of mammalian TGF-β to its receptors, TβRI and TβRII. J Biol Chem 2022; 298:101994. [PMID: 35500648 PMCID: PMC9163516 DOI: 10.1016/j.jbc.2022.101994] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 04/22/2022] [Accepted: 04/23/2022] [Indexed: 11/02/2022] Open
Abstract
The mouse intestinal helminth Heligmosomoides polygyrus modulates host immune responses by secreting a transforming growth factor (TGF)-β mimic (TGM), to expand the population of Foxp3+ Tregs. TGM comprises five complement control protein (CCP)-like domains, designated D1-D5. Though lacking homology to TGF-β, TGM binds directly to the TGF-β receptors TβRI and TβRII and stimulates the differentiation of naïve T-cells into Tregs. However, the molecular determinants of binding are unclear. Here, we used surface plasmon resonance, isothermal calorimetry, NMR spectroscopy, and mutagenesis to investigate how TGM binds the TGF-β receptors. We demonstrate that binding is modular, with D1-D2 binding to TβRI and D3 binding to TβRII. D1-D2 and D3 were further shown to compete with TGF-β(TβRII)2 and TGF-β for binding to TβRI and TβRII, respectively. The solution structure of TGM-D3 revealed that TGM adopts a CCP-like fold but is also modified to allow the C-terminal strand to diverge, leading to an expansion of the domain and opening potential interaction surfaces. TGM-D3 also incorporates a long structurally ordered hypervariable loop, adding further potential interaction sites. Through NMR shift perturbations and binding studies of TGM-D3 and TβRII variants, TGM-D3 was shown to occupy the same site of TβRII as bound by TGF-β using both a novel interaction surface and the hypervariable loop. These results, together with the identification of other secreted CCP-like proteins with immunomodulatory activity in H. polygyrus, suggest that TGM is part of a larger family of evolutionarily plastic parasite effector molecules that mediate novel interactions with their host.
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Affiliation(s)
- Ananya Mukundan
- Department of Structural Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania USA
| | - Chang-Hyeock Byeon
- Department of Structural Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania USA
| | - Cynthia S Hinck
- Department of Structural Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania USA
| | - Kyle Cunningham
- Wellcome Centre for Integrative Parasitology, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Tiffany Campion
- Wellcome Centre for Integrative Parasitology, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Danielle J Smyth
- Wellcome Centre for Integrative Parasitology, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Rick M Maizels
- Wellcome Centre for Integrative Parasitology, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Andrew P Hinck
- Department of Structural Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania USA.
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11
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McCartt J, Loszko A, Backes K, Cunningham K, Evans S, Draughon M, Sachdev G. Improving Enteral Nutrition Delivery in the Critically Ill Trauma and Surgical Population. JPEN J Parenter Enteral Nutr 2022; 46:1191-1197. [DOI: 10.1002/jpen.2353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/09/2022] [Accepted: 02/14/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Jason McCartt
- Department of Surgery Carolinas Medical Center, Atrium Health Charlotte North Carolina
| | - Abigail Loszko
- University of North Carolina School of Medicine Chapel Hill North Carolina
| | - Kehaulani Backes
- Clinical Nutrition, Carolinas Medical Center, Atrium Health Charlotte North Carolina
| | - Kyle Cunningham
- Department of Surgery Carolinas Medical Center, Atrium Health Charlotte North Carolina
| | - Susan Evans
- Department of Surgery Carolinas Medical Center, Atrium Health Charlotte North Carolina
| | | | - Gaurav Sachdev
- Department of Surgery Carolinas Medical Center, Atrium Health Charlotte North Carolina
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12
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Loszko A, Watson M, Khan A, Cunningham K, Thomas B, Ross S, Lauer C, Sing R, Sachdev G. Acute Care Surgeons Spend More Time than General Surgeons on the Electronic Health Record (EHR). Am Surg 2021:31348211061102. [PMID: 34933572 DOI: 10.1177/00031348211061102] [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: 11/16/2022]
Abstract
BACKGROUND The paradigm of Acute Care Surgery (ACS) emerged in response to decreasing operative opportunities for trauma surgeons and increasing need for surgical coverage in disciplines to which the expertise of trauma surgeons naturally extends. While the continued evolution of this specialty remains largely beneficial, unintended consequences may have arisen along the way. One aspect of ACS that remains to be thoroughly investigated is the impact of the electronic health record (EHR). The purpose of this study is to objectively quantify EHR usage for ACS and compare it to other general surgery specialties. METHODS EHR user data were collected for fifteen ACS attendings and thirty-seven general surgery attendings from October 2014 to September 2019. Comparative analysis was conducted using two-tailed t-tests. Subgroup analysis was conducted for subspecialties included in the general surgery group. RESULTS ACS attendings opened almost 3 times as many charts as general surgery attendings per month (180 vs 64 charts/month, P < .0001), and ultimately spent more time on the EHR as a result (10 vs 6.4 hours/month, P < .0001). Documentation was the most time consuming EHR task for both groups. Although ACS attendings spent less overall time per patient chart, the proportion of time spent on certain EHR tasks was similar to that of general surgery colleagues. DISCUSSION The EHR imposes a disproportionate burden on ACS attendings compared to their general surgery counterparts, and additional study is warranted to improve usage. EHR usage burden has workforce implications for trainees considering a career in ACS.
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Affiliation(s)
- Abigail Loszko
- 6797University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Michael Watson
- Department of Surgery, 22442Carolinas Medical Center, Charlotte, NC, USA
| | - Ahsan Khan
- 1374Morehouse School of Medicine, Atlanta, GA, USA
| | - Kyle Cunningham
- Department of Surgery, 22442Carolinas Medical Center, Charlotte, NC, USA
| | - Bradley Thomas
- Department of Surgery, 22442Carolinas Medical Center, Charlotte, NC, USA
| | - Samuel Ross
- Department of Surgery, 22442Carolinas Medical Center, Charlotte, NC, USA
| | - Cynthia Lauer
- Department of Surgery, 22442Carolinas Medical Center, Charlotte, NC, USA
| | - Ronald Sing
- Department of Surgery, 22442Carolinas Medical Center, Charlotte, NC, USA
| | - Gaurav Sachdev
- Department of Surgery, 22442Carolinas Medical Center, Charlotte, NC, USA
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13
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Abstract
Patient: Female, 30-year-old Final Diagnosis: Papillary thyroid carcinoma Symptoms: Hyperthyroidism • thyroid mass Medication: — Clinical Procedure: Thyroidectomy Specialty: Surgery
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Affiliation(s)
- Kyle Cunningham
- OMS-IV, Alabama College of Osteopathic Medicine, Dothan, AL, USA
| | | | - Barton Wood
- Department of Surgery, Brookwood Baptist Health, Birmingham, AL, USA
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14
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Zamora J, Stafford S, Mifflin R, Gilbertson S, Cunningham K, Anastasio N. Pharmacological profiles of 5‐HT
2A
Receptor (5‐HT
2A
R):5‐HT
2C
R Interactions
In Vitro. FASEB J 2021. [DOI: 10.1096/fasebj.2021.35.s1.03788] [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)
- J. Zamora
- Center for Addiction ResearchUniversity of Texas Medical BranchGalvestonTX
- Pharmacology and ToxicologyUniversity of Texas Medical BranchGalvestonTX
| | - S. Stafford
- Center for Addiction ResearchUniversity of Texas Medical BranchGalvestonTX
- Pharmacology and ToxicologyUniversity of Texas Medical BranchGalvestonTX
| | - R. Mifflin
- Center for Addiction ResearchUniversity of Texas Medical BranchGalvestonTX
- Pharmacology and ToxicologyUniversity of Texas Medical BranchGalvestonTX
| | | | - K. Cunningham
- Center for Addiction ResearchUniversity of Texas Medical BranchGalvestonTX
- Pharmacology and ToxicologyUniversity of Texas Medical BranchGalvestonTX
| | - N. Anastasio
- Center for Addiction ResearchUniversity of Texas Medical BranchGalvestonTX
- Pharmacology and ToxicologyUniversity of Texas Medical BranchGalvestonTX
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15
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Eaton BC, Vesselinov R, Ahmeti M, Stansbury JJ, Regner J, Sadler C, Nevarez S, Lissauer M, Stout L, Harmon L, Glassett B, Hampton DA, Castro HJ, Cunningham K, Mulkey S, O'Meara L, Dia JJ, Bruns BR. Surgical Faculty Perception of Service-Based Advanced Practice Provider Impact: A Southwestern Surgical Congress Multicenter Survey. Am Surg 2020; 87:971-978. [PMID: 33295188 DOI: 10.1177/0003134820956929] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND A previous single-center survey of trauma and general surgery faculty demonstrated perceived positive impact of trauma and surgical subspecialty service-based advanced practice providers (SB APPs). The aim of this multicenter survey was to further validate these findings. METHODS Faculty surgeons on teams that employ SB APPs at 8 academic centers completed an electronic survey querying perception about advanced practice provider (APP) competency and impact. RESULTS Respondents agreed that SB APPs decrease workload (88%), length of stay (72%), contribute to continuity (92%), facilitate care coordination (87%), enhance patient satisfaction (88%), and contribute to best practice/safe patient care (83%). Fewer agreed that APPs contribute to resident education (50%) and quality improvement (QI)/research (36%). Although 93% acknowledged variability in the APP level of function, 91% reported trusting their clinical judgment. CONCLUSION This study supports the perception that SB APPs have a positive impact on patient care and quality indicators. Areas for potential improvement include APP contribution to resident education and research/QI initiatives.
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Affiliation(s)
- Barbara C Eaton
- 137889R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, MD, USA
| | - Roumen Vesselinov
- Department of Epidemiology and Public Health, Department of Anesthesiology, 12264University of Maryland, Baltimore, MD, USA
| | - Mentor Ahmeti
- 23506Sanford Medical Center Fargo, ND, USA.,School of Medicine and Health Sciences, 12281University of North Dakota, ND, USA
| | | | | | - Craig Sadler
- 6040Eastern Virginia Medical School, VA, USA.,Norfolk General Hospital, VA, USA
| | | | | | | | | | | | - David A Hampton
- Department of Surgery, Section of Trauma and Acute Care Surgery, University of Chicago Medicine and Biological Sciences, IL, USA
| | - Helen J Castro
- Department of Surgery, Section of Trauma and Acute Care Surgery, University of Chicago Medicine and Biological Sciences, IL, USA
| | | | | | - Lindsay O'Meara
- 137889R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, MD, USA
| | - Jose J Dia
- 137889R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, MD, USA
| | - Brandon R Bruns
- 137889R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, MD, USA
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16
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Ann Sealey L, Raddatz J, Shah NR, Cunningham K, Morey J, Laverick P, Thiet Huynh T. Alignment in Surrogate Decision Maker Research Opinions: Adult vs Pediatric Intensive Care Patients. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.08.468] [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: 10/23/2022]
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17
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Watson MD, Elhage SA, Scully C, Peterson S, Gulledge M, Cunningham K, Sachdev G. Electronic health record usage among nurse practitioners, physician assistants, and junior residents. J Am Assoc Nurse Pract 2020; 33:200-204. [PMID: 32740334 DOI: 10.1097/jxx.0000000000000466] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/08/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Studies demonstrate significant electronic health record (EHR) use by junior residents; however, few studies have investigated this for nurse practitioners and physician assistants (NPs/PAs). PURPOSE The aim of this study was to quantify the time spent on the EHR by NPs/PAs and junior residents. METHODS Electronic health record usage data were collected from April 2015 through April 2016. Monthly EHR usage was compared between NPs/PAs and postgraduate second and third year residents. Further subgroup analysis of NPs/PAs and residents from surgical or nonsurgical fields was conducted. RESULTS Data for 22 NPs/PAs (16 surgical and six nonsurgical) and 125 residents (31 surgical and 94 nonsurgical) were analyzed. Nurse practitioners/physician assistants opened fewer charts per day (4.9 ± 1.5 vs. 5.4 ± 3.1), placed more orders per month, and spent more daily time on the EHR (176.5 ± 51.7 minutes vs. 152.3 ± 71.9 minutes; p < .0001). Compared with residents, NPs/PAs spent more time per patient in all categories (chart review, documentation, order entry) and in total time per patient chart (all p < .05). Comparing surgical NPs/PAs to surgical residents, findings were similar with fewer charts per day, more total daily EHR time, and more EHR time per patient in every tracked category (all p < .05). IMPLICATIONS FOR PRACTICE This is the first study to quantify time on the EHR for NPs/PAs. Nurse practitioners/physician assistants spent more time on the EHR than residents, and this is accentuated with surgical NPs/PAs. Electronic health record utilization appears more burdensome for NPs/PAs; however, the reason for this is unclear and highlights the need for targeted interventions.
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Affiliation(s)
- Michael D Watson
- Department of Surgery, Atrium Health, Carolinas Medical Center, Charlotte, North Carolina
| | - Sharbel A Elhage
- Department of Surgery, Atrium Health, Carolinas Medical Center, Charlotte, North Carolina
| | - Casey Scully
- Department of Surgery, Atrium Health, Carolinas Medical Center, Charlotte, North Carolina
| | - Sabrina Peterson
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Marialice Gulledge
- Department of Surgery, Atrium Health, Carolinas Medical Center, Charlotte, North Carolina
| | - Kyle Cunningham
- Department of Surgery, Atrium Health, Carolinas Medical Center, Charlotte, North Carolina
| | - Gaurav Sachdev
- Department of Surgery, Atrium Health, Carolinas Medical Center, Charlotte, North Carolina
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18
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Osakwe E, Meighan V, Cunningham K, Morrissey B. Point of Care Ultrasound in the Diagnosis and Management of Severe Ovarian Hyperstimulation Syndrome. Ir Med J 2020; 113:11. [PMID: 32298563] [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: 06/11/2023]
Abstract
Presentation A 32year old woman, presented with a 5-day history of non-productive cough, chest pain, shortness of breath andabdominal bloating. She had undergone Embryo Transfer Treatment 6 days previously. Diagnosis A point of care ultrasound (POCUS) exam was performed as part of her initial investigations which showed right pleuraleffusion, ascites and cystic ovaries. Treatment She received Oxygen, IV Fluids and Antibiotics and was referred to the Obstetricians. Discussion Point of care ultrasound (POCUS) aided the prompt diagnosis of ovarian hyperstimulation syndrome (OHSS) in thispatient, making it possible for her to receive appropriate resuscitation and referral and an excellent outcome despitethis being a case of severe ovarian hyperstimulation syndrome.
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Affiliation(s)
- E Osakwe
- Emergency Department, Sligo University Hospital, The Mall, Sligo, Ireland
| | - V Meighan
- Emergency Department, Sligo University Hospital, The Mall, Sligo, Ireland
| | - K Cunningham
- Emergency Department, Sligo University Hospital, The Mall, Sligo, Ireland
| | - B Morrissey
- Emergency Department, Sligo University Hospital, The Mall, Sligo, Ireland
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19
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Quinn SM, Cunningham K, Raverdeau M, Walsh RJ, Curham L, Malara A, Mills KHG. Anti-inflammatory Trained Immunity Mediated by Helminth Products Attenuates the Induction of T Cell-Mediated Autoimmune Disease. Front Immunol 2019; 10:1109. [PMID: 31178861 PMCID: PMC6537856 DOI: 10.3389/fimmu.2019.01109] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/01/2019] [Indexed: 12/26/2022] Open
Abstract
Recent studies have suggested that the innate immune system can display characteristics of immunological memory and this has been called “innate immune memory” or “trained immunity.” Certain fungal products have been shown to induce epigenetic imprinting on monocytes/macrophages that results in heightened inflammatory responses to subsequent stimuli. Here we report that innate immune cells can be trained to be more anti-inflammatory following exposure to products of a helminth pathogen. Macrophages trained in vitro with Fasciola hepatica total extract (FHTE) had enhanced IL-10 and IL-1RA, but reduced TNF production upon re-stimulation with FHTE or TLR ligands and this was reversed by inhibitors of DNA methylation. In contrast, macrophages trained with β-glucan or Bacillus Calmette–Guérin had enhanced TNF production upon re-stimulation with Pam3cys or LPS. Furthermore, FHTE-trained macrophages had enhanced expression of markers of alternative activated macrophages (AAM). Macrophages from mice treated with FHTE expressed markers of AAM and had heightened IL-10 and IL-1RA production in response to FHTE or TLR ligands and had suppressed TNF and IL-12p40 production. Macrophages from mice treated with FHTE had reduced APC function and inhibited IL-17 production and the encephalitogenic activity of T cells in the experimental autoimmune encephalomyelitis (EAE) model. In addition, mice pre-treated with FHTE were resistant to induction of EAE and this was associated with a significant reduction in IL-17-producing γδ and CD4 T cells infiltrating the CNS. Our findings reveal that cells of the innate immune system can be trained in vitro or in vivo to be more anti-inflammatory by exposure to helminth products and this protects mice against the induction of a T cell-mediated autoimmune disease.
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Affiliation(s)
- Shauna M Quinn
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Kyle Cunningham
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Mathilde Raverdeau
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Robert J Walsh
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Lucy Curham
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Anna Malara
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Kingston H G Mills
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
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20
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Sorah AB, Cunningham K, Morgan J, Rinaldi M, Christmas AB, Sing R. STROKE RISK VERSUS FALL RISK: A GROWING CONUNDRUM IN THE ANTICOAGULATION OF GERIATRIC PATIENTS WITH ATRIAL FIBRILLATION. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32474-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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21
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Smith S, Wu PW, Seo JJ, Fernando T, Jin M, Contreras J, Montano EN, Gabhann JN, Cunningham K, Widaa A, McCarthy EM, Molloy ES, Kearns G, Murphy CC, Kong W, Björkbacka H, Kornfeld H, Forbess L, Venuturupalli S, Ishimori M, Wallace D, Weisman MH, Jefferies CA. IL-16/miR-125a axis controls neutrophil recruitment in pristane-induced lung inflammation. JCI Insight 2018; 3:120798. [PMID: 30089723 DOI: 10.1172/jci.insight.120798] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/26/2018] [Indexed: 12/20/2022] Open
Abstract
Severe lung inflammation and alveolar hemorrhage can be life-threatening in systemic lupus erythematosus (SLE) patients if not treated early and aggressively. Neutrophil influx is the driver key of this pathology, but little is known regarding the molecular events regulating this recruitment. Here, we uncover a role for IL-16/mir-125a in this pathology and show not only that IL-16 is a target for miR-125a but that reduced miR-125a expression in SLE patients associates with lung involvement. Furthermore, in the pristane model of acute "SLE-like" lung inflammation and alveolar hemorrhage, we observed reduced pulmonary miR-125a and enhanced IL-16 expression. Neutrophil infiltration was markedly reduced in the peritoneal lavage of pristane-treated IL-16-deficient mice and elevated following i.n. delivery of IL-16. Moreover, a miR-125a mimic reduced pristane-induced IL-16 expression and neutrophil recruitment and rescued lung pathology. Mechanistically, IL-16 acts directly on the pulmonary epithelium and markedly enhances neutrophil chemoattractant expression both in vitro and in vivo, while the miR-125a mimic can prevent this. Our results reveal a role for miR-125a/IL-16 in regulating lung inflammation and suggest this axis may be a therapeutic target for management of acute lung injury in SLE.
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Affiliation(s)
- Siobhan Smith
- Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Pei Wen Wu
- Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jane J Seo
- Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Thilini Fernando
- Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Mengyao Jin
- Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jorge Contreras
- Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Erica N Montano
- Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Joan Ní Gabhann
- Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kyle Cunningham
- Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Amro Widaa
- Department of Anatomy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Eamonn S Molloy
- Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland
| | - Grainne Kearns
- Department of Rheumatology, Beaumont Hospital, Dublin, Ireland
| | - Conor C Murphy
- Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Weiping Kong
- China-Japan Friendship Hospital, Chaoyang District, Beijing, China
| | - Harry Björkbacka
- Experimental Cardiovascular Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Hardy Kornfeld
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Lindsy Forbess
- Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Swamy Venuturupalli
- Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Mariko Ishimori
- Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Daniel Wallace
- Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Michael H Weisman
- Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Caroline A Jefferies
- Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
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22
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MacKenzie K, Cunningham K, Thomas S, Mondal T, el Helou S, Shah P, Mukerji A. INCIDENCE, RISK FACTORS AND OUTCOMES OF PULMONARY HYPERTENSION IN PRETERM INFANTS WITH BRONCHOPULMONARY DYSPLASIA: A SINGLE CENTRE EXPERIENCE. Paediatr Child Health 2017. [DOI: 10.1093/pch/pxx086.057] [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: 11/15/2022] Open
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23
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Lauerman MH, Dubose J, Cunningham K, Bruns B, Bradley M, Diaz J, Scalea T, Stein D. Delayed interventions and mortality in trauma damage control laparotomy. Surgery 2016; 160:1568-1575. [PMID: 27499147 DOI: 10.1016/j.surg.2016.05.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 03/16/2016] [Revised: 05/08/2016] [Accepted: 05/27/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND In damage control laparotomy, operative principles include hemorrhage and contamination control. However, required components of initial damage control laparotomy are unknown, and nonemergency injury repair is sometimes delayed for resuscitation, angiography, or nonabdominal operations. The frequency and effects of delayed interventions are unknown. METHODS A retrospective review of patients undergoing damage control laparotomy at a single, urban trauma center was performed. Interventions initially performed at the second laparotomy were considered delayed interventions. RESULTS In the study, 330 damage control laparotomy patients survived to reoperation. Of all interventions, 13.9% were first performed at the second laparotomy, including 11.9% of visceral interventions and 27.2% of vascular interventions. Overall, 29.7% of patients underwent an unplanned re-exploration, and 21.8% of patients underwent re-exploration for hemorrhage control. There was no significant increase in mortality (33.3% vs 23.9%, P = .09), intra-abdominal infection (37.9% vs 28.0%; P = .10), anastomotic leak (8.0% vs 5.8%, P = .45), or enterocutaneous fistula formation (9.2% vs 9.1%, P = 1.00) with delayed interventions overall. However, mortality was increased in patients undergoing delayed vascular interventions (59.1% vs 22.8%, P = .003), unplanned re-exploration (45.9% vs 18.1%, P < .001) and re-exploration for hemorrhage control (50.0% vs 19.8%, P < .001). CONCLUSION Delayed interventions are common in damage control laparotomy, with abdominal interventions often spread over multiple explorations. Mortality is increased in patients undergoing emergent re-exploration and with delayed repair of major vascular injuries. Ideal treatment of damage control laparotomy patients may include addressing injuries more completely at the first laparotomy instead of deferring care for other priorities.
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Affiliation(s)
- Margaret H Lauerman
- Division of Trauma and Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD.
| | - Joseph Dubose
- Division of Trauma, Acute Care Surgery and Critical Care, University of California Davis, Sacramento, CA
| | - Kyle Cunningham
- Division of Trauma and Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD
| | - Brandon Bruns
- Division of Trauma and Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD
| | - Matthew Bradley
- Division of Trauma and Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD
| | - Jose Diaz
- Division of Trauma and Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD
| | - Thomas Scalea
- Division of Trauma and Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD
| | - Deborah Stein
- Division of Trauma and Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD
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Stark J, Weller P, Leanage R, Cunningham K, De Leval M, Macartney F, Taylor JF. Late results of surgical treatment of transposition of the great arteries. Adv Cardiol 2015; 27:254-65. [PMID: 7004128 DOI: 10.1159/000383992] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
In summary, many of these patients have achieved a normal working capacity, but as a group there is a statistically significant reduction when compared to healthy children (p < 0.01). There was no significant difference between the group of patients who had their Mustard operation in infancy and later. As yet, there is no suggestion that the older patients, or those with the longest time interval between the operation and the exercise test, have a progressive reduction in working capacity. The decreased working capacity and moderate increase in ventilation suggests restricted cardiac output on exercise. This could be related to the abnormal heart rate response rather than indicating poor ventricular function. Equally, a restricted cardiac output on exercise may be due to inefficiency of atrial transport, tricuspid regurgitation or unmasked pulmonary vascular obstructive disease. Further studies may clarify these points. This study demonstrated that the exercise performance of asymptomatic patients 6-13 years after Mustard's operation was somewhat diminished, compared with a group of normal children. Nevertheless, these patients did lead and enjoy a normal life. Only longitudinal studies may bring the final answer to the important question: How many patients will be alive with normal or near normal exercise tolerance 40-50 years after Mustard's operation? Until such an answer is available, we believe that the Mustard operation should be used in the treatment of TGA, while the alternative techniques are carefully explored.
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van Oosten E, Boag A, Cunningham K, Veinot J, Hamilton A, Petsikas D, Payne D, Redfearn D, Zhang S, Baranchuk A. HISTOLOGICAL CHANGES IN RIGHT HUMAN ATRIAL TISSUE CAUSED BY OBSTRUCTIVE SLEEP APNEA: A PILOT STUDY. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.225] [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: 11/26/2022] Open
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26
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Cunningham K, Scanlan B, Coghlan D, Quinn S. Infants with FPIES to solid food proteins--chicken, rice and oats. Ir Med J 2014; 107:151. [PMID: 24908862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We present two cases of Food Protein Induced Enterocolitis Syndrome (FPIES), a non-IgE mediated food hypersensitivity. FPIES induces severe vomiting 1.5-to-3 hours post ingestion of the offending food, and may be associated with diarrhoea, hypovolemic shock and acidosis. Avoidance of that food will lead to resolution of symptoms and prevents further episodes.
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Smith T, Benard S, Jacob J, Tsao D, Cunningham K, DeSilva T, Lin L, Carter L, Shaw G, Kriz R, Schaub R, Kelleher K. IDENTIFICATION OF POTENT CYCLIC PEPTIDES THAT BIND TO PLATELET GLYCOPROTEIN IB ALPHA AND SELECTIVELY INHIBIT VON WILLEBRAND FACTOR DEPENDENT HIGH-SHEAR PLATELET AGGREGATION. J Thromb Haemost 2014. [DOI: 10.1111/j.1538-7836.2007.tb02824.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hafner LM, Cunningham K, Beagley KW. Ovarian steroid hormones: effects on immune responses and Chlamydia trachomatis infections of the female genital tract. Mucosal Immunol 2013; 6:859-75. [PMID: 23860476 DOI: 10.1038/mi.2013.46] [Citation(s) in RCA: 28] [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: 06/05/2011] [Accepted: 06/04/2013] [Indexed: 02/04/2023]
Abstract
Female sex hormones are known to regulate the adaptive and innate immune functions of the female reproductive tract. This review aims to update our current knowledge of the effects of the sex hormones estradiol and progesterone in the female reproductive tract on innate immunity, antigen presentation, specific immune responses, antibody secretion, genital tract infections caused by Chlamydia trachomatis, and vaccine-induced immunity.
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Affiliation(s)
- L M Hafner
- Infectious Diseases Program, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), Kelvin Grove, Queensland, Australia.
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Ryan A, Hunter K, Cunningham K, Williams J, O'Shea H, Rooney P, Hickey F. STEPS: lean thinking, theory of constraints and identifying bottlenecks in an emergency department. Ir Med J 2013; 106:105-107. [PMID: 23691842] [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: 06/02/2023]
Abstract
This study aimed to identify the bottlenecks in patients' journeys through an emergency department (ED). For each stage of the patient journey, the average times were compared between two groups divided according to the four hour time frame and disproportionate delays were identified using a significance test These bottlenecks were evaluated with reference to a lean thinking value-stream map and the five focusing steps of the theory of constraints. A total of 434 (72.5%) ED patients were tracked over one week. Logistic regression showed that patients who had radiological tests, blood tests or who were admitted were 4.4, 4.1 and 7.7 times more likely, respectively, to stay over four hours in the ED than those who didn't The stages that were significantly delayed were the time spent waiting for radiology (p = 0.001), waiting for the in-patient team (p = 0.004), waiting for a bed (p < 0.001) and ED doctor turnaround time (p < 0.001).
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Affiliation(s)
- A Ryan
- Department of Public Health Medicine, Iona House, Ballyshannon, Sligo.
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Brown J, Reddy S, Cunningham K, Dong H, Ibram F, Clatworthy P, Wiggins J. TEST YOUR MEMORY (TYM) TESTING IN NON-ALZHEIMER DEMENTIAS. J Neurol Neurosurg Psychiatry 2012. [DOI: 10.1136/jnnp-2012-304200a.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Breslin T, Cunningham K. Trauma care. Ir Med J 2011; 104:57. [PMID: 21465881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Johnson NM, Qian G, Xu L, Tietze D, Marroquin-Cardona A, Robinson A, Rodriguez M, Kaufman L, Cunningham K, Wittmer J, Guerra F, Donnelly KC, Williams JH, Wang JS, Phillips TD. Aflatoxin and PAH exposure biomarkers in a U.S. population with a high incidence of hepatocellular carcinoma. Sci Total Environ 2010; 408:6027-31. [PMID: 20870273 PMCID: PMC2993492 DOI: 10.1016/j.scitotenv.2010.09.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 08/26/2010] [Accepted: 09/03/2010] [Indexed: 05/23/2023]
Abstract
The incidence of hepatocellular carcinoma (HCC) is significantly elevated in a Hispanic community in Bexar County, Texas. Chronic exposure to dietary aflatoxins (AFs) is a major risk factor for HCC; increased risk has been linked to polycyclic aromatic hydrocarbon (PAH) co-exposure and hepatitis virus infection. The aims of this study were to assess AF and PAH exposures, investigate dietary factors that may contribute to increased AF exposure, and determine the prevalence of hepatitis virus infection in Bexar Co. Blood and urine samples were collected from 184 volunteers for biomarker analyses and hepatitis screening. Serum AFB(1)-lysine adduct, urinary AFM(1) and 1-hydroxypyrene (1-OHP) levels were measured using high-performance liquid chromatography. The average AFB(1)-lysine adduct level detected in 20.6% of serums was 3.84 ± 3.11 pg/mg albumin (range 1.01-16.57 pg/mg). AFM(1) was detected in 11.7% of urines, averaging 223.85 ± 250.56 pg/mg creatinine (range 1.89-935.49 pg/mg). AFM(1) detection was associated with increased consumption of corn tortillas (p=0.009), nuts (p=0.033) and rice (p=0.037). A significant difference was observed between mean 1-OHP values of non-smokers (0.07 ± 0.13) and smokers (0.80 ± 0.68) μmol/mol creatinine (p<0.01). A high hepatitis C virus positivity rate (7.1%) was observed. Findings suggest that the incidence and level of AF and PAH exposure were less than those observed in a high-risk population; however, participants consuming higher amounts of foods prone to AF contamination may be more vulnerable to exposure and interactions with other environmental/biological factors (i.e., HCV).
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Affiliation(s)
- Natalie M Johnson
- Department of Veterinary Integrative Biosciences, College of Veterinary Medicine, Texas A&M University, 4458 TAMU, College Station, TX 77843, USA
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Nazha A, Cook R, Vogl DT, Mangan PA, Gardler M, Hummel K, Cunningham K, Luger SM, Porter DL, Schuster S, O'Doherty U, Siegel D, Stadtmauer EA. Stem cell collection in patients with multiple myeloma: impact of induction therapy and mobilization regimen. Bone Marrow Transplant 2010; 46:59-63. [DOI: 10.1038/bmt.2010.63] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Delzenne N, Blundell J, Brouns F, Cunningham K, De Graaf K, Erkner A, Lluch A, Mars M, Peters HPF, Westerterp-Plantenga M. Gastrointestinal targets of appetite regulation in humans. Obes Rev 2010; 11:234-50. [PMID: 20433660 DOI: 10.1111/j.1467-789x.2009.00707.x] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [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: 12/13/2022]
Abstract
The aim of this paper is to describe and discuss relevant aspects of the assessment of physiological functions - and related biomarkers - implicated in the regulation of appetite in humans. A short introduction provides the background and the present state of biomarker research as related to satiety and appetite. The main focus of the paper is on the gastrointestinal tract and its functions and biomarkers related to appetite for which sufficient data are available in human studies. The first section describes how gastric emptying, stomach distension and gut motility influence appetite; the second part describes how selected gastrointestinal peptides are involved in the control of satiety and appetite (ghrelin, cholecystokinin, glucagon-like peptide, peptide tyrosin-tyrosin) and can be used as potential biomarkers. For both sections, methodological aspects (adequacy, accuracy and limitation of the methods) are described. The last section focuses on new developments in techniques and methods for the assessment of physiological targets involved in appetite regulation (including brain imaging, interesting new experimental approaches, targets and markers). The conclusion estimates the relevance of selected biomarkers as representative markers of appetite regulation, in view of the current state of the art.
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Affiliation(s)
- N Delzenne
- Louvain Drug Research Institute, Unit PMNT 7369, Université Catholique de Louvain, Brussels, Belgium
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Wilkes R, Zhao Y, Cunningham K, Kieswetter K, Haridas B. 3D strain measurement in soft tissue: Demonstration of a novel inverse finite element model algorithm on MicroCT images of a tissue phantom exposed to negative pressure wound therapy. J Mech Behav Biomed Mater 2009; 2:272-87. [DOI: 10.1016/j.jmbbm.2008.10.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Revised: 09/08/2008] [Accepted: 10/06/2008] [Indexed: 12/18/2022]
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Cook RJ, Vogl D, Mangan PA, Cunningham K, Luger S, Porter DL, Tsai DE, Raguza-Lopez M, Wiley K, Masters K, Stadtmauer EA. Lenalidomide and stem cell collection in patients with multiple myeloma. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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37
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Adegbola O, Andreadis C, Schuster SJ, Chong EA, Nasta SD, Porter DL, Luger SM, Tsai DE, Cunningham K, Stadtmauer EA. Effect of rituximab (R) on clinical outcomes after autologous stem cell transplantation (ASCT) in pts with relapsed or refractory diffuse large B-cell lymphoma (DLBCL). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.8122] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8122 Background: First-line chemotherapy cures ∼50% of pts with DLBCL, while salvage therapy followed by ASCT can cure another ∼30%. R significantly improves response rates to 1st line therapy. This retrospective study was designed to test the hypotheses that: 1) ASCT is effective in pts relapsed after R-chemotherapy and 2) addition of R to salvage improves outcomes after ASCT. Methods: We identified 84 pts with relapsed/refractory DLBCL who underwent ASCT at our institution between 1990 and 2006. In all, 32% received a R-chemo 1st line regimen and 27% received R with salvage. The median age at ASCT was 49 yrs and the median time from diagnosis to ASCT was 16 mos. High-dose regimens included BCV (48%), BEAM (8%) and alkylator/TBI (20%). Results: Overall response rate (ORR) after ASCT was 52%, with 37% of pts in CR by day 100. Among those in CR, 16% had a CR pre-ASCT, 72% had a lesser response, and 9% were chemo-resistant. The addition of R to salvage (23/84 pts) was favorably associated with ORR after ASCT (OR: 5.2, 95% CI: 1.1 - 25, p=0.029), even in pts who had failed a prior R regimen (p=0.013). Other factors favorably associated with ORR were response to salvage (p=0.046) and time to ASCT >12 mos (p=0.017). At last f/u (med: 22 mos, iqr: 7 - 55 mos), event-free (EFS) and overall survival (OS) were both 35%. The only factor associated with EFS and OS in univariate and multivariate analyses was ORR after ASCT (HR: 0.16, 95% CI: 0.07 - 0.37, p<0.001 and HR: 0.12, 95% CI: 0.05 - 0.28, p<0.001 respectively). Age at ASCT, time to ASCT, year of ASCT, mobilization/conditioning regimen, and failure of a R-chemo regimen were not associated with EFS or OS. Conclusions: Pts with DLBCL who have failed a R-chemo first-line regimen derive an equal benefit from ASCT as pts who are R-naïve, with significant long-term EFS and OS. Additionally, inclusion of R in salvage therapy prior to ASCT provides superior response rates, even after a failed prior R-chemo regimen. These results confirm the benefit of ASCT for pts with DLBCL in the rituximab era and argue for the incorporation of R and related agents in studies of high-dose therapy and ASCT. No significant financial relationships to disclose.
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Affiliation(s)
| | | | | | | | | | | | | | - D. E. Tsai
- Abramson Cancer Center, Philadelphia, PA
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Barone J, Cunningham K, Slogoff M, Yao K, Harford F, Shoup M. Is colonoscopy underutilized in high risk patients? J Surg Res 2006. [DOI: 10.1016/j.jss.2005.11.424] [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: 10/25/2022]
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39
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Olin R, Luger S, Porter D, Schuster S, Tsai D, Nasta S, Perl A, Loren A, Goldstein S, Mangan P, Sherry V, Cunningham K, Sachs B, Hummel K, Stadtmauer E. Pegfilgrastim versus filgrastim to accelerate hematopoietic recovery after high-dose melphalan and autologous hematopoietic stem cell transplantation (ASCT) for multiple myeloma. Biol Blood Marrow Transplant 2005. [DOI: 10.1016/j.bbmt.2004.12.257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lin TS, Dalton JT, Wu D, Fischer B, Moran M, Lucas D, Cunningham K, Colevas AD, Grever MR, Byrd JC. Flavopiridol given as a 30-min intravenous (IV) bolus followed by 4-hr continuous IV infusion (CIVI) results in clinical activity and tumor lysis in refractory chronic lymphocytic leukemia (CLL). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6564] [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: 11/20/2022] Open
Affiliation(s)
- T. S. Lin
- The Ohio State University, Columbus, OH; National Cancer Institute, Bethesda, MD
| | - J. T. Dalton
- The Ohio State University, Columbus, OH; National Cancer Institute, Bethesda, MD
| | - D. Wu
- The Ohio State University, Columbus, OH; National Cancer Institute, Bethesda, MD
| | - B. Fischer
- The Ohio State University, Columbus, OH; National Cancer Institute, Bethesda, MD
| | - M. Moran
- The Ohio State University, Columbus, OH; National Cancer Institute, Bethesda, MD
| | - D. Lucas
- The Ohio State University, Columbus, OH; National Cancer Institute, Bethesda, MD
| | - K. Cunningham
- The Ohio State University, Columbus, OH; National Cancer Institute, Bethesda, MD
| | - A. D. Colevas
- The Ohio State University, Columbus, OH; National Cancer Institute, Bethesda, MD
| | - M. R. Grever
- The Ohio State University, Columbus, OH; National Cancer Institute, Bethesda, MD
| | - J. C. Byrd
- The Ohio State University, Columbus, OH; National Cancer Institute, Bethesda, MD
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Abstract
The antiarrhythmic drug amiodarone was recently demonstrated to have novel broad range fungicidal activity. We provide evidence that amiodarone toxicity is mediated by disruption of Ca2+ homeostasis in Saccharomyces cerevisiae. In mutants lacking calcineurin and various Ca2+ transporters, including pumps (Pmr1 and Pmc1), channels (Cch1/Mid1 and Yvc1), and exchangers (Vcx1), amiodarone sensitivity correlates with cytoplasmic calcium overload. Measurements of cytosolic Ca2+ by aequorin luminescence demonstrate a biphasic response to amiodarone. An immediate and extensive calcium influx was observed that was dose-dependent and correlated with drug sensitivity. The second phase consisted of a sustained release of calcium from the vacuole via the calcium channel Yvc1 and was independent of extracellular Ca2+ entry. To uncover additional cellular pathways involved in amiodarone sensitivity, we conducted a genome-wide screen of nearly 5000 single-gene yeast deletion mutants. 36 yeast strains with amiodarone hypersensitivity were identified, including mutants in transporters (pmr1, pdr5, and vacuolar H+-ATPase), ergosterol biosynthesis (erg3, erg6, and erg24), intracellular trafficking (vps45 and rcy1), and signaling (ypk1 and ptc1). Of three mutants examined (vps45, vma3, and rcy1), all were found to have defective calcium homeostasis, supporting a correlation with amiodarone hypersensitivity. We show that low doses of amiodarone and an azole (miconazole, fluconazole) are strongly synergistic and exhibit potent fungicidal effects in combination. Our findings point to the potentially effective application of amiodarone as a novel antimycotic, particularly in combination with conventional antifungals.
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Affiliation(s)
- Soma Sen Gupta
- Department of Physiology, The Johns Hopkins University, Baltimore, Maryland 21205, USA
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Deck LB, Post ES, Smith E, Wiener M, Cunningham K, Richmond H. Estimates of the health risk reductions associated with attainment of alternative particulate matter standards in two U.S. cities. Risk Anal 2001; 21:821-836. [PMID: 11798119 DOI: 10.1111/0272-4332.215154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
As part of its periodic re-evaluation of particulate matter (PM) standards, the U.S. Environmental Protection Agency estimated the health risk reductions associated with attainment of alternative PM standards in two locations in the United States with relatively complete air quality data: Philadelphia and Los Angeles. PM standards at the time of the analysis were defined for particles of aerodynamic diameter less than or equal to 10 microm, denoted as PM-10. The risk analyses estimated the risk reductions that would be associated with changing from attainment of the PM-10 standards then in place to attainment of alternative standards using an indicator measuring fine particles, defined as those particles of aerodynamic diameter less than or equal to 2.5 microm and denoted as PM-2.5. Annual average PM-2.5 standards of 12.5, 15, and 20 microg/m3 were considered in various combinations with daily PM-2.5 standards of 50 and 65 microg/m3. Attainment of a standard or set of standards was simulated by a proportional rollback of "as is" daily PM concentrations to daily PM concentrations that would just meet the standard(s). The predicted reductions in the incidence of health effects varied from zero, for those alternative standards already being met, to substantial reductions of over 88% of all PM-associated incidence (e.g., in mortality associated with long-term exposures in Los Angeles, under attainment of an annual standard of 12.5 microg/m3). Sensitivity analyses and integrated uncertainty analyses assessed the multiple-source uncertainty surrounding estimates of risk reduction.
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Affiliation(s)
- L B Deck
- Abt Associates Inc., Bethesda, MD 20814, USA
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Saxe G, Stoddard F, Courtney D, Cunningham K, Chawla N, Sheridan R, King D, King L. Relationship between acute morphine and the course of PTSD in children with burns. J Am Acad Child Adolesc Psychiatry 2001; 40:915-21. [PMID: 11501691 DOI: 10.1097/00004583-200108000-00013] [Citation(s) in RCA: 219] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the relationship between the dose of morphine administered during a child's hospitalization for an acute burn and the course of posttraumatic stress disorder (PTSD) symptoms over the 6-month period following discharge from the hospital. METHOD Twenty-four children admitted to the hospital for an acute burn were assessed twice with the Child PTSD Reaction Index: while in the hospital and 6 months after discharge. The Colored Analogue Pain Scale was also administered during the hospitalization. All patients received morphine while in the hospital. The mean dose of morphine (mg/kg/day) was calculated for each subject through chart review. RESULTS The Pearson product moment correlation revealed a significant association between the dose of morphine received while in the hospital and a 6-month reduction in PTSD symptoms. Children receiving higher doses of morphine had a greater reduction in PTSD symptoms over 6 months. CONCLUSIONS This study suggests the possibility that acute treatment with morphine can secondarily prevent PTSD. This result is discussed in terms of the possible effect of morphine on fear conditioning and the consolidation of traumatic memory.
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Affiliation(s)
- G Saxe
- Department of Child and Adolescent Psychiatry, Boston Medical Center Boston University School of Medicine, MA 02118, USA
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Privalova LI, Wilcock KE, Katsnelson BA, Keane SE, Cunningham K, Kuzmin SV, Voronin SA, Nikonov BI, Gurvich VB. Some considerations concerning multimedia-multipollutant risk assessment methodology: use of epidemiologic data for non-cancer risk assessment in Russia. Environ Health Perspect 2001; 109:7-13. [PMID: 11171518 PMCID: PMC1242044 DOI: 10.1289/ehp.011097] [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] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The highly industrialized small town of Verkhnyaya Pyshma (in the Urals region of Russia) was chosen as the site of a multimedia-multipollutant risk assessment using the U.S. Environmental Protection Agency methodology. The assessment was based on routine environmental pollution monitoring data for ambient air, soils, drinking water, and food, and the international environmental epidemiology literature. Using an a priori set of the preliminary health-based criteria, we selected nine pollutants for risk assessment: total suspended particles (TSP), sulfur dioxide, nitrogen dioxide, benzo(a)pyrene (BaP), ammonia arsenic, copper, cadmium, and lead. We used dose-response functions derived from epidemiologic studies to assess individual and population risks for TSP, SO2, NO2, As, Cd, and Pb. We assessed both cancer (for BaP, As, and Cd) and non-cancer (for all the chosen pollutants but BaP) responses, but in this paper we discuss only the assessments of noncarcinogenic risks due to TSP, SO2, NO2, Pb, and Cd as examples of how the quantitative estimates of health effects can be produced by using a risk function approach. We also schematically present a modified conceptual model of multimedia-multipollutant risk assessment taking into account the experience gained with this study.
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Affiliation(s)
- L I Privalova
- Department of Environmental Epidemiology, the Urals Branch of the Center for Preparation and Implementation of International Projects on Technical Assistance, Yekaterinburg, Russia.
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Adams K, Ackerly H, Cunningham K, Dunnick W. A DNase I hypersensitive site near the murine gamma1 switch region contributes to insertion site independence of transgenes and modulates the amount of transcripts induced by CD40 ligation. Int Immunol 2000; 12:1705-13. [PMID: 11099310 DOI: 10.1093/intimm/12.12.1705] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Several cis-acting elements regulate the expression of germline transcripts of heavy chain constant region genes and their subsequent switch recombination. To study such elements in the murine gamma1 gene, we have utilized a transgenic approach. In this study we focused on a DNase I hypersensitive site (termed 'Site II') that lies about 2 kb 3' of the gamma1 promoter region and I exon, just 5' to the gamma1 switch region. We have reported that gamma1 transgenes with Site II display the characteristics of a locus control region (LCR) in that they are insertion site independent and copy number dependent. For the present study we prepared six lines of transgenic mice that have the promoter region and I exon, but lack Site II. Expression of RNA from gamma1 transgenes that lack Site II is not correlated with transgene copy number; expression is insertion site dependent. This result indicates that DNase hypersensitive Site II is an important part of the LCR-like elements in the murine gamma1 gene. RNA expression from the gamma1 transgenes that lack Site II is inducible by IL-4 and by CD40 ligation. However, the induction of transgenic RNA expression by CD40 ligation is greater than expected, suggesting that elements within Site II participate in negative regulation of the amount of germline transcripts after CD40 ligation.
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Affiliation(s)
- K Adams
- Department of Microbiology and Immunology, University of Michigan Medical School, Room 6746, Medical Science Building II, 1301 East Catherine, Ann Arbor, MI 48109-0620, USA
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Leonardi A, Chariot A, Claudio E, Cunningham K, Siebenlist U. CIKS, a connection to Ikappa B kinase and stress-activated protein kinase. Proc Natl Acad Sci U S A 2000; 97:10494-9. [PMID: 10962033 PMCID: PMC27052 DOI: 10.1073/pnas.190245697] [Citation(s) in RCA: 136] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Pathogens, inflammatory signals, and stress cause acute transcriptional responses in cells. The induced expression of genes in response to these signals invariably involves transcription factors of the NF-kappaB and AP-1/ATF families. Activation of NF-kappaB factors is thought to be mediated primarily via IkappaB kinases (IKK), whereas that of AP-1/ATF can be mediated by stress-activated protein kinases (SAPKs; also named Jun kinases or JNKs). IKKalpha and IKKbeta are two catalytic subunits of a core IKK complex that also contains the regulatory subunit NEMO (NF-kappaB essential modulator)/IKKgamma. The latter protein is essential for activation of the IKKs, but its mechanism of action is not known. Here we describe the molecular cloning of CIKS (connection to IKK and SAPK/JNK), a previously unknown protein that directly interacts with NEMO/IKKgamma in cells. When ectopically expressed, CIKS stimulates IKK and SAPK/JNK kinases and it transactivates an NF-kappaB-dependent reporter. Activation of NF-kappaB is prevented in the presence of kinase-deficient, interfering mutants of the IKKs. CIKS may help to connect upstream signaling events to IKK and SAPK/JNK modules. CIKS could coordinate the activation of two stress-induced signaling pathways, functions reminiscent of those noted for tumor necrosis factor receptor-associated factor adaptor proteins.
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Affiliation(s)
- A Leonardi
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892-1876, USA
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Cunningham K, Wolbert R, Brockmeier MB. Moving beyond the illness: factors contributing to gaining and maintaining employment. Am J Community Psychol 2000; 28:481-94. [PMID: 10965387 DOI: 10.1023/a:1005136531079] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The work presented here, exploratory in nature, uses a comparative and qualitative approach to understand the factors associated with the ability of individuals with severe and persistent mental illness to successfully gain and maintain employment. Based on open-ended interviews with individuals in an Assertive Community Treatment (ACT) program, we compare the experiences of those who have been successful gaining and maintaining employment, with those who have been successful gaining but not maintaining work, and those who have been unsuccessful gaining employment. The three groups seemed to differ in three significant ways: (1) in the ways the individuals talked about their illness, (2) in the ways the individuals talked about work, and (3) in the strategies they described for coping with bad days. In each of these areas individuals' awareness of and attitude toward their illness was significant. The findings have clear implications for agencies working to help people with severe and persistent mental illness obtain and maintain employment.
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Affiliation(s)
- K Cunningham
- Department of Anthropology, Kalamazoo College, Michigan 49006, USA.
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Cunningham K, Brown TD, Gradwell E, Nee PA. Airbag associated fatal head injury: case report and review of the literature on airbag injuries. J Accid Emerg Med 2000; 17:139-42. [PMID: 10718243 PMCID: PMC1725331 DOI: 10.1136/emj.17.2.139] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [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: 11/03/2022]
Abstract
Airbags have been shown to significantly reduce mortality and morbidity in motor vehicle crashes. However, the airbag, like the seat belt, produces its own range of injuries. With the increasing use of airbags in the UK, airbag associated injuries will be seen more often. These are usually minor, but in certain circumstances severe and fatal injuries result. Such injuries have been described before in the medical literature, but hitherto most reports have been from North America. This is the first case report from the UK of serious injury due to airbag deployment and describes the case of a driver who was fatally injured when her airbag deployed in a moderate impact frontal collision where such severe injury would not normally have been anticipated. The range of airbag associated injuries is described and predisposing factors such as lack of seat belt usage, short stature, and proximity to airbag housing are discussed. The particular dangers airbags pose to children are also discussed.
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Affiliation(s)
- K Cunningham
- Department of Accident and Emergency Medicine, Whiston Hospital, Prescot, Merseyside.
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Poljak L, Carlson L, Cunningham K, Kosco-Vilbois MH, Siebenlist U. Distinct activities of p52/NF-kappa B required for proper secondary lymphoid organ microarchitecture: functions enhanced by Bcl-3. J Immunol 1999; 163:6581-8. [PMID: 10586052] [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: 02/14/2023]
Abstract
Mice rendered deficient in p52, a subunit of NF-kappa B, or in Bcl-3, an I kappa B-related regulator that associates with p52 homodimers, share defects in the microarchitecture of secondary lymphoid organs. The mutant mice are impaired in formation of B cell follicles and are unable to form proper follicular dendritic cell (FDC) networks upon antigenic challenge. The defects in formation of B cell follicles may be attributed, at least in part, to impaired production of the B lymphocyte chemoattractant (BLC) chemokine, possibly a result of defective FDCs. The p52- and Bcl-3-deficient mice exhibit additional defects within the splenic marginal zone, including reduced numbers of metallophilic macrophages, reduced deposition of the laminin-beta 2 chain and impaired expression of a mucosal addressin marker on sinus-lining cells. Whereas p52-deficient mice are severely defective in all of these aspects, Bcl-3-deficient mice are only partially defective. We determined that FDCs or other non-hemopoietic cells that underlie FDCs are intrinsically impaired in p52-deficient mice. Adoptive transfers of wild-type bone marrow into p52-deficient mice failed to restore FDC networks or follicles. The transfers did restore metallophilic macrophages to the marginal zone, however. Together, the results suggest that p52 carries out functions essential for a proper splenic microarchitecture in both hemopoietic and non-hemopoietic cells and that Bcl-3 is important in enhancing these essential activities of p52.
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Affiliation(s)
- L Poljak
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, Bethesda, MD 20892, USA
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Cunningham K, Ackerly H, Claflin L, Collins J, Wu P, Ford C, Lansford R, Alt F, Dunnick WA. Germline transcription and recombination of a murine VDJmudeltagamma1 transgene. Int Immunol 1998; 10:1027-37. [PMID: 9723688 DOI: 10.1093/intimm/10.8.1027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
To investigate the regulation of Ig switch recombination, we have constructed mice with a 56 kb VDJmudeltagamma1 transgene. This transgene included an anti-nitrophenyl VDJ segment, Smu, Cmu, Cdelta, Igamma1, Sgamma1, Cgamma1 and the Cgamma1 membrane exons from the murine Igh(a) haplotype. Two founder lines were produced, with very similar characteristics. Transgenic B cells expressed normal amounts of Cmu (which is >95% transgenic), Cdelta and other cell surface markers, and normal amounts of VDJ and Cmu RNA. Gamma1 germline transcription of the transgenes is properly regulated since stable transcripts were not expressed in B cells treated with lipopolysaccharide (LPS) alone, nor in thymus or non-lymphoid tissues, but were expressed after treatment of B cells with LPS + IL-4 or CD40L + IL-4. B cells from both lines of transgenic mice expressed transgenic gamma1a after in vitro culture with CD40L + IL-4, but not after culture with CD40L alone. However, the CD40L + IL-4 induced IgG1 precursor frequency is much lower for VDJmudeltagamma1 transgenic B cells (1:240-760) than for non-transgenic B cells (1:9). Analysis of DNA from transgenic hybridomas indicated that switch recombination can take place in switch (S) regions, but can also take place outside S regions. These results indicate that targeting of switch recombinase to S regions must include regulation beyond the S regions themselves and correct germline transcription. This additional regulation might include cis-acting elements or appropriate spacing or arrangement of the recombining elements.
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Affiliation(s)
- K Cunningham
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor 48109-0620, USA
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