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Kenigsberg TA, Goddard K, Hanson KE, Lewis N, Klein N, Irving SA, Naleway AL, Crane B, Kauffman TL, Xu S, Daley MF, Hurley LP, Kaiser R, Jackson LA, Jazwa A, Weintraub ES. Simultaneous administration of mRNA COVID-19 bivalent booster and influenza vaccines. Vaccine 2023; 41:5678-5682. [PMID: 37599140 PMCID: PMC10661699 DOI: 10.1016/j.vaccine.2023.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/09/2023] [Accepted: 08/09/2023] [Indexed: 08/22/2023]
Abstract
The U.S. Food and Drug Administration authorized use of mRNA COVID-19 bivalent booster vaccines on August 31, 2022. Currently, CDC's clinical guidance states that COVID-19 and other vaccines may be administered simultaneously. At time of authorization and recommendations, limited data existed describing simultaneous administration of COVID-19 bivalent booster and other vaccines. We describe simultaneous influenza and mRNA COVID-19 bivalent booster vaccine administration between August 31-December 31, 2022, among persons aged ≥6 months in the Vaccine Safety Datalink (VSD) by COVID-19 bivalent booster vaccine type, influenza vaccine type, age group, sex, and race and ethnicity. Of 2,301,876 persons who received a COVID-19 bivalent booster vaccine, 737,992 (32.1%) received simultaneous influenza vaccine, majority were female (53.1%), aged ≥18 years (91.4%), and non-Hispanic White (55.7%). These findings can inform future VSD studies on simultaneous influenza and COVID-19 bivalent booster vaccine safety and coverage, which may have implications for immunization service delivery.
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Affiliation(s)
| | - Kristin Goddard
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Kayla E Hanson
- Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - Ned Lewis
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Nicola Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA, USA
| | | | | | - Bradley Crane
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Tia L Kauffman
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Stanley Xu
- Kaiser Permanente Southern California Research and Evaluation, Pasadena, CA, USA
| | - Matthew F Daley
- Institute for Health Research, Kaiser Permanente, Denver, CO, USA
| | | | | | - Lisa A Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Amelia Jazwa
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Klein N, Sander PM, Liu J, Druckenmiller P, Metz ET, Kelley NP, Scheyer TM. Comparative bone histology of two thalattosaurians (Diapsida: Thalattosauria): Askeptosaurus italicus from the Alpine Triassic (Middle Triassic) and a Thalattosauroidea indet. from the Carnian of Oregon (Late Triassic). Swiss J Palaeontol 2023; 142:15. [PMID: 37601161 PMCID: PMC10432342 DOI: 10.1186/s13358-023-00277-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/30/2023] [Indexed: 08/22/2023]
Abstract
Here, we present the first bone histological and microanatomical study of thalattosaurians, an enigmatic group among Triassic marine reptiles. Two taxa of thalattosaurians, the askeptosauroid Askeptosaurus italicus and one as yet undescribed thalattosauroid, are examined. Both taxa have a rather different microanatomy, tissue type, and growth pattern. Askeptosaurus italicus from the late Anisian middle Besano Formation of the southern Alpine Triassic shows very compact tissue in vertebrae, rib, a gastralium, and femora, and all bones are without medullary cavities. The tissue shows moderate to low vascularization, dominated by highly organized and very coarse parallel-fibred bone, resembling interwoven tissue. Vascularization is dominated by simple longitudinal vascular canals, except for the larger femur of Askeptosaurus, where simple vascular canals dominate in a radial arrangement. Growth marks stratify the cortex of femora. The vertebrae and humeri from the undescribed thalattosauroid from the late Carnian of Oregon have primary and secondary cancellous bone, resulting in an overall low bone compactness. Two dorsal vertebral centra show dominantly secondary trabeculae, whereas a caudal vertebral centrum shows much primary trabecular bone, globuli ossei, and cartilage, indicating an earlier ontogenetic stage of the specimens or paedomorphosis. The humeri of the thalattosauroid show large, simple vascular canals that are dominantly radially oriented in a scaffold of woven and loosely organized parallel-fibred tissue. Few of the simple vascular canals are thinly but only incompletely lined by parallel-fibered tissue. In the Oregon material, changes in growth rate are only indicated by changes in vascular organization but no distinct growth marks were identified. The compact bone of Askeptosaurus is best comparable to some pachypleurosaurs, whereas its combination of tissue and vascularity is similar to eosauropterygians in general, except for the coarse nature of its parallel-fibred tissue. The cancellous bone of the Oregon thalattosauroid resembles what is documented in ichthyosaurs and plesiosaurs. However, in contrast to these its tissue does not consist of fibro-lamellar bone type. Tissue types of both thalattosaurian taxa indicate rather different growth rates and growth patterns, associated with different life history strategies. The microanatomy reflects different life styles that fit to the different environments in which they had been found (intraplatform basin vs. open marine). Both thalattosaurian taxa differ from each other but in sum also from all other marine reptile taxa studied so far. Thalattosaurian bone histology documents once more that bone histology provides for certain groups (i.e., Triassic Diapsida) only a poor phylogenetic signal and is more influenced by exogenous factors. Differences in lifestyle, life history traits, and growth rate and pattern enabled all these Triassic marine reptiles to live contemporaneously in the same habitat managing to avoid substantial competition.
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Affiliation(s)
- N. Klein
- Department of Palaeontology, University of Zurich, Karl Schmid-Strasse 4, 8006 Zurich, Switzerland
- Department of Palaeontology, Institute of Geosciences, University of Bonn, Nußallee 8, 53115 Bonn, Germany
| | - P. M. Sander
- Department of Palaeontology, Institute of Geosciences, University of Bonn, Nußallee 8, 53115 Bonn, Germany
- School of Resources and Environmental Engineering, Hefei University of Technology, 193 Tunxi Road, Hefei, 230009 China
| | - J. Liu
- School of Resources and Environmental Engineering, Hefei University of Technology, 193 Tunxi Road, Hefei, 230009 China
| | - P. Druckenmiller
- University of Alaska Museum, 1962 Yukon Dr., Fairbanks, AK 99775 USA
- Department of Geosciences, University of Alaska Fairbanks, 1930 Yukon Dr., Fairbanks, AK 99775 USA
| | - E. T. Metz
- Museum of the Rockies, Montana State University, 600 W Kagy Blvd., Bozeman, MT 59717 USA
| | - N. P. Kelley
- Department of Earth and Environmental Sciences, Vanderbilt University, Nashville, TN 37240 USA
| | - T. M. Scheyer
- Department of Palaeontology, University of Zurich, Karl Schmid-Strasse 4, 8006 Zurich, Switzerland
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Zerbo O, Ray GT, Fireman B, Layefsky E, Goddard K, Lewis E, Ross P, Omer S, Greenberg M, Klein N. Maternal SARS-CoV-2 Vaccination and Infant Protection Against SARS-CoV-2 During the First 6 Months of Life. Res Sq 2022:rs.3.rs-2143552. [PMID: 36299419 PMCID: PMC9603829 DOI: 10.21203/rs.3.rs-2143552/v1] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We examined the effectiveness of maternal vaccination against SARS-CoV-2 infection in 30,288 infants born at Kaiser Permanente Northern California from December 15, 2020, to May 31, 2022. Using Cox regression, the effectiveness of maternal vaccination was 85% (95% confidence interval [CI]: 67, 93), 64% (CI: 43, 78) and 57% (CI: 36,71) during the first 2, 4 and 6 months of life, respectively, in the Delta variant period. In the Omicron variant period, the effectiveness of maternal vaccination in these three age intervals was 22% (CI: -18,48), 14% (CI: -10,32) and 12% (CI: -4,26), respectively. Over the entire study period, the incidence of hospitalization for COVID-19 was lower during the first 6 months of life among infants of vaccinated mothers compared with infants of unvaccinated mothers (21/100,000 person-years vs. 100/100,000 person-years). Maternal vaccination was protective, but protection was lower during Omicron than during Delta. Protection during both periods decreased as infants aged.
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Affiliation(s)
- Ousseny Zerbo
- Kaiser Permanente Northern California, Vaccine Study Center
| | - G Thomas Ray
- Kaiser Permanente Northern California, Vaccine Study Center
| | - Bruce Fireman
- Kaiser Permanente Northern California, Vaccine Study Center
| | - Evan Layefsky
- Kaiser Permanente Northern California, Vaccine Study Center
| | | | - Edwin Lewis
- Kaiser Permanente Northern California, Vaccine Study Center
| | - Pat Ross
- Kaiser Permanente Northern California, Vaccine Study Center
| | | | - Mara Greenberg
- Obstetrics and Gynecology, Kaiser Permanente Northern California Oakland, Regional Perinatal Service Center, Kaiser Permanente Northern California, Santa Clara
| | - Nicola Klein
- Kaiser Permanente Northern California, Vaccine Study Center
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Keidan T, Greenberg A, Mudalige B, Klein N, Oron A. The Gantzer transfer - Assessment of the feasibility of using the nerve supplying the Gantzer muscle for end-to-side supercharging of the ulnar nerve. Hand Surg Rehabil 2022; 41:477-480. [PMID: 35476954 DOI: 10.1016/j.hansur.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/16/2022] [Accepted: 03/20/2022] [Indexed: 11/27/2022]
Abstract
Our study aimed at assessing the anatomical feasibility of using the nerve supplying the Gantzer muscle (GM) to supercharge the ulnar nerve following injury. The GM nerve was dissected and measured in 36 forearms. The distance between its origin and the lateral epicondyle of humerus and between the GM nerve and the ulnar nerve was measured. The GM was present in 15 forearms (47%). The average distance between the origin of the GM nerve and the lateral epicondyle was 7.34 cm (range 3.3-9.1 cm). The average length of the GM nerve was 3.05 cm (range 1.6-4.5 cm) from origin to neuromuscular junction. The average distance from the ulnar nerve was 2.56 cm (range 1.8-13 3.4 cm). The length of the GM nerve was significantly greater (p < 0.05) than the perpendicular distance between its origin and the ulnar nerve, allowing ample margin for side-to-side or end-to-side supercharging of the ulnar nerve with minimal or no need for further translocation or dissection. The use of the GM nerve as donor following ulnar nerve injury may provide an alternative to the pronator quadratus nerve for supercharged end-to-side transfer, or as an addition, thus supercharging the ulnar nerve twice.
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Affiliation(s)
- T Keidan
- Kaplan Medical Center, Derech Pasternak 1, Rehovot, Israel.
| | - A Greenberg
- Kaplan Medical Center, Derech Pasternak 1, Rehovot, Israel
| | - B Mudalige
- Kaplan Medical Center, Derech Pasternak 1, Rehovot, Israel
| | - N Klein
- Kaplan Medical Center, Derech Pasternak 1, Rehovot, Israel
| | - A Oron
- Kaplan Medical Center, Derech Pasternak 1, Rehovot, Israel
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Mellin J, Le Prevost M, Kenny J, Sturgeon K, Thompson LC, Foster C, Kessler HH, Goswami N, Klein N, Judd A, Castro H. Arterial Stiffness in a Cohort of Young People Living With Perinatal HIV and HIV Negative Young People in England. Front Cardiovasc Med 2022; 9:821568. [PMID: 35299977 PMCID: PMC8921599 DOI: 10.3389/fcvm.2022.821568] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/07/2022] [Indexed: 12/19/2022] Open
Abstract
Background Antiretroviral therapy (ART) has increased life expectancy and consequently the risk of cardiovascular disease (CVD) in adults living with HIV. We investigated the levels and predictors of arterial stiffness in young people (YP) living with perinatal HIV (PHIV) and HIV negative YP in the Adolescents and Adults Living with Perinatal HIV (AALPHI) study. Methods AALPHI was a prospective study evaluating the impact of HIV infection and exposure to ART on YP living with PHIV (aged 13–21 years) who had known their HIV status for at least 6 months, and HIV negative YP (aged 13–23 years) who either had a sibling, friend or parent living with HIV. Participants were enrolled from HIV clinics and community services in England. Two hundred and thirteen PHIV and 65 HIV negative YP (42% siblings of PHIV) had pulse wave velocity (PWV) measurements taken (Vicorder software) from the supra-sternal notch to the middle of the thigh cuff, at their second interview in the study between 2015 and 2017. Average PWV was calculated from the three closest readings (≥3 and ≤ 12 m/s) within 0.6 m/s of each other. Linear regression examined predictors of higher (worse) PWV, including age, sex, HIV status and height as a priori, ethnicity, born outside UK/Ireland, alcohol/nicotine/drug use, weight, waist-to-hip-ratio, mean arterial pressure (MAP), caffeine 2 h before PWV and nicotine on day of PWV. A separate PHIV model included CD4, viral load, years taking ART and ART regimen. Findings One hundred and twenty eight (60%) PHIV and 45 (69%) HIV negative YP were female (p = 0.18), with median (IQR) age 18 (16, 20) and 18 (16, 21) years (p = 0.48) respectively. Most PHIV were taking a combination of three ART drugs from two classes. There was a trend toward higher (worse) mean PWV in the PHIV group than the HIV negative group [unvariable analysis 6.15 (SD 0.83) m/s vs. 5.93 (0.70) m/s, respectively, unadjusted p = 0.058], which was statistically significant in the multivariable analysis [adjusted p (ap) = 0.020]. In multivariable analysis being male (ap = 0.002), older age (ap < 0.001), higher MAP (ap < 0.001) and nicotine use on day of measurement (ap = 0.001) were also predictors of higher PWV. The predictors were the same in the PHIV model. Interpretation By late adolescence PHIV had worse PWV in comparison to HIV negative peers, and traditional risk factors for CVD (higher arterial pressure, being male and older age) were associated with higher PWV values. Regular detailed monitoring of cardiovascular risk factors should become standard of care for every young person with PHIV worldwide.
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Affiliation(s)
- J Mellin
- Gravitational Physiology and Medicine Research Unit, Division of Physiology, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - M Le Prevost
- Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
| | - J Kenny
- Guy's and St. Thomas' National Heath Service Foundation Trust, Evelina London Children's Hospital, St. Thomas' Hospital, London, United Kingdom
| | - K Sturgeon
- Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
| | - L C Thompson
- Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
| | - C Foster
- Imperial College Healthcare National Heath Service Trust, St. Mary's Hospital, London, United Kingdom
| | - H H Kessler
- Diagnostic and Research Institute of Hygiene, Microbiology, and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Nandu Goswami
- Gravitational Physiology and Medicine Research Unit, Division of Physiology, Otto Loewi Research Center, Medical University of Graz, Graz, Austria.,Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - N Klein
- Department of Infection, Immunity and Inflammation, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - A Judd
- Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
| | - H Castro
- Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
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Herbeć A, Chimhini G, Rosenberg-Pacareu J, Sithole K, Rickli F, Chimhuya S, Manyau S, Walker AS, Klein N, Lorencatto F, Fitzgerald FC. Barriers and facilitators to infection prevention and control in a neonatal unit in Zimbabwe - a theory-driven qualitative study to inform design of a behaviour change intervention. J Hosp Infect 2020; 106:804-811. [PMID: 32950588 DOI: 10.1016/j.jhin.2020.09.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/13/2020] [Accepted: 09/14/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hospital-acquired infection (HAI) is an increasing cause of neonatal morbidity/mortality in low-income settings. Hospital staff behaviours (e.g., hand hygiene) are key contributors to HAI. Understanding the drivers of these can inform interventions to improve infection prevention and control (IPC). AIM To explore barriers/facilitators to IPC in a neonatal unit in Harare, Zimbabwe. METHODS Interviews were conducted with 15 staff members of neonatal and maternity units alongside ethnographic observations. The interview guide and data analysis were informed by the COM-B (Capability, Opportunity, Motivation-Behaviour) model and explored individual, socio-cultural, and organizational barriers/facilitators to IPC. Potential interventions were identified using the Behaviour-Change Wheel. FINDINGS Enablers within Capability included awareness of IPC, and within Motivation beliefs that IPC was crucial to one's role, and concerns about consequences of poor IPC. Staff were optimistic that IPC could improve, contingent upon resource availability (Opportunity). Barriers included: limited knowledge of guidelines, no formal feedback on performance (Capability), lack of resources (Opportunity), often leading to improvization and poor habit formation. Further barriers included the unit's hierarchy, e.g., low engagement of cleaners and mothers in IPC, and staff witnessing implementation of poor practices by other team members (Opportunity). Potential interventions could include role-modelling, engaging mothers and staff across cadres, audit and feedback and flexible protocols (adaptable to water/handrub availability). CONCLUSIONS Most barriers to IPC fell within Opportunity, whilst most enablers fell under Capability and Motivation. Theory-based investigation provides the basis for systematically identifying and developing interventions to address barriers and enablers to IPC in low-income settings.
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Affiliation(s)
- A Herbeć
- Centre for Behaviour Change, Clinical, Educational and Health Psychology, UCL, London, UK.
| | - G Chimhini
- Department of Paediatrics and Child Health, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - J Rosenberg-Pacareu
- Centre for Behaviour Change, Clinical, Educational and Health Psychology, UCL, London, UK
| | - K Sithole
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - F Rickli
- University of Zurich, Switzerland
| | - S Chimhuya
- Department of Paediatrics and Child Health, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - S Manyau
- Biomedical Research and Training Institute, Harare, Zimbabwe; London School of Hygiene and Tropical Medicine, London, UK
| | - A S Walker
- MRC Clinical Trials Unit, UCL, London, UK
| | - N Klein
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - F Lorencatto
- Centre for Behaviour Change, Clinical, Educational and Health Psychology, UCL, London, UK
| | - F C Fitzgerald
- Biomedical Research and Training Institute, Harare, Zimbabwe; UCL Great Ormond Street Institute of Child Health, London, UK
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Freguja R, Bamford A, Zanchetta M, Del Bianco P, Giaquinto C, Harper L, Dalzini A, Cressey TR, Compagnucci A, Saidi Y, Riault Y, Ford D, Gibb D, Klein N, De Rossi A. Long-term clinical, virological and immunological outcomes following planned treatment interruption in HIV-infected children. HIV Med 2020; 22:172-184. [PMID: 33124144 PMCID: PMC8436743 DOI: 10.1111/hiv.12986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 08/22/2020] [Accepted: 09/23/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Planned treatment interruption (PTI) of antiretroviral therapy (ART) in adults is associated with adverse outcomes. The PENTA 11 trial randomized HIV-infected children to continuous ART (CT) vs. CD4-driven PTIs. We report 5 years' follow-up after the end of main trial. METHODS Post-trial, all children resumed ART. Clinical, immunological, virological and treatment data were collected annually. A sub-study investigated more detailed immunophenotype. CT and PTI arms were compared using intention-to-treat. Laboratory parameters were compared using linear regression, adjusting for baseline values; mixed models were used to include all data over time. RESULTS In all, 101 children (51 CT, 50 PTI) contributed a median of 7.6 years, including 5.1 years of post-trial follow-up. Post-trial, there were no deaths, one pulmonary tuberculosis and no other CDC stage B/C events. At 5 years post-trial, 90% of children in the CT vs. 82% in the PTI arm had HIV RNA < 50 copies/mL (P = 0.26). A persistent increase in CD8 cells was observed in the PTI arm. The sub-study (54 children) suggested that both naïve and memory populations contributed to higher CD8 cells following PTI. Mean CD4/CD8 ratios at 5 years post-trial were 1.22 and 1.08 in CT and PTI arms, respectively [difference (CT - PTI) = -0.15; 95% CI: -0.34-0.05), P = 0.14]. The sub-study also suggested that during the trial and at early timepoints after the end of the trial, reduction in CD4 in the PTI arm was mainly from loss of CD4 memory cells. CONCLUSIONS Children tolerated PTI with few long-term clinical, virological or immunological consequences.
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Affiliation(s)
- R Freguja
- Section of Oncology and Immunology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - A Bamford
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Trust, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK.,MRC Clinical Trials Unit, London, UK
| | - M Zanchetta
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - P Del Bianco
- Clinical Trials and Biostatistic Unit, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - C Giaquinto
- Department of Mother and Child Health, University of Padova, Padova, Italy
| | - L Harper
- MRC Clinical Trials Unit, London, UK
| | - A Dalzini
- Section of Oncology and Immunology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - T R Cressey
- PHPT/IRD 174, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand.,Department of Immunology & Infectious Diseases, Harvard T.H Chan School of Public Health, Boston, MA, USA.,Department of Molecular & Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - A Compagnucci
- INSERMSC10-US019, Essais thérapeutiques et maladies Infectieuses, Villejuif, France
| | - Y Saidi
- INSERMSC10-US019, Essais thérapeutiques et maladies Infectieuses, Villejuif, France
| | - Y Riault
- INSERMSC10-US019, Essais thérapeutiques et maladies Infectieuses, Villejuif, France
| | - D Ford
- MRC Clinical Trials Unit, London, UK
| | - D Gibb
- MRC Clinical Trials Unit, London, UK
| | - N Klein
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Trust, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK
| | - A De Rossi
- Section of Oncology and Immunology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.,Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
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Chimhini G, Chimhuya S, Madzudzo L, Heys M, Crehan C, Robertson V, Ferrand R, Sado B, Sharland M, Walker A, Klein N, Fitzgerald F. Auditing use of antibiotics in Zimbabwean neonates. Infect Prev Pract 2020; 2:100046. [PMID: 34368696 PMCID: PMC8336170 DOI: 10.1016/j.infpip.2020.100046] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/08/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Neonatal sepsis is a major cause of morbidity and mortality in low-income settings. As signs of sepsis are non-specific and deterioration precipitous, antibiotics are often used profusely in these settings where diagnostics may not be readily available. Harare Central Hospital, Zimbabwe, delivers 12000 babies per annum admitting ∼4800 to the neonatal unit. Overcrowding, understaffing and rapid staff turnover are consistent problems. Suspected sepsis is highly prevalent, and antibiotics widely used. We audited the impact of training and benchmarking intervention on rationalizing antibiotic prescription using local, World Health Organization-derived, guidelines as the standard. METHODS An initial audit of admission diagnosis and antibiotic use was performed between 8th May - 6th June 2018 as per the audit cycle. An intern training programme, focusing on antimicrobial stewardship and differentiating between babies 'at risk of' versus 'with' clinically-suspected sepsis was instituted post-primary audit. Re-audit was conducted after 5 months. RESULTS Sepsis was the most common admitting diagnosis by interns at both time points but reduced at repeat audit (81% versus 59%, P<0.0001). Re-audit after 5 months demonstrated a decrease in antibiotic prescribing at admission and discharge. Babies prescribed antibiotics at admission decreased from 449 (98%) to 96 (51%), P<0.0001. Inpatient days of therapy (DOT) reduced from 1243 to 1110/1000 patient-days. Oral amoxicillin prescription at discharge reduced from 349/354 (99%) to 1% 1/161 (P<0.0001). CONCLUSION A substantial decrease in antibiotic use was achieved by performance feedback, training and leadership, although ongoing performance review will be key to ensuring safety and sustainability.
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Affiliation(s)
- G. Chimhini
- Department of Paediatrics and Child Health University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - S. Chimhuya
- Department of Paediatrics and Child Health University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - L. Madzudzo
- Department of Paediatrics and Child Health University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - M. Heys
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Specialist Children's and Young People's Services, East London NHS Foundation Trust, London, UK
| | - C. Crehan
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - V. Robertson
- Department of Medical Microbiology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - R.A. Ferrand
- London School of Hygiene and Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - B. Sado
- Microbiology Department Harare Central Hospital, Harare, Zimbabwe
| | - M. Sharland
- St George's University of London, London, UK
| | - A.S. Walker
- Medical Research Council Clinical Trials Unit at UCL, University College London, London, UK
- Nuffield Department of Medicine, Oxford University, UK
| | - N. Klein
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - F.C. Fitzgerald
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
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Gans H, Wang W, Rosenberg-Hasson Y, Zerbo O, Modaressi S, Goddard K, Lewis N, Bok K, Klein N. 2649. Measles-Containing Vaccination Resulted in a Balanced Cytokine Profile Without Evidence of Immunosuppression in Healthy 12-Month-Old Children. Open Forum Infect Dis 2019. [PMCID: PMC6810256 DOI: 10.1093/ofid/ofz360.2327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Measles virus infection results in immune activation, viral clearance and lifelong immunity. In addition, there is an immunosuppressive state defined by type 2 skewing of CD4+ T‐cell cytokine production and induction of regulatory T cells with reduced dendritic cell (DC) activation in the recovery phase. Studies following measles immunization show conflicting immune profiles. To more robustly interrogate and define specific functional cytokine profiles, this study evaluated cytokine profiles in 12-month old infants before and after primary MMR vaccination. Methods Cytokine profiles using luminex assay (62-plex; eBioscience) were measured in 65 infants before and 42 days after MMR vaccination administered at 12 months of age as part of a randomized clinical trial. Mean cytokine percentages of children with increased or decreased concentrations of each cytokine in the post sample compared with the levels in the pre sample were evaluated using Student’s t-test. Cytokines were arranged into dominant CD4+ T-cell type, Th1, Th2, and T regulatory (Treg) and those produced by DC. Results No dominant cytokine pattern emerged following measles immunization, with a balanced profile. The mean percentage of children with increased and decreased concentrations (pg/mL) of signature CD 4+ T-cell Th1 (tumor necrosis factor alpha [TNFa], interferon gamma [IFNg]), Th2 (Interleukin [IL] IL5, IL4, IL13), Treg (IL10, transforming growth factor-β TCFb) and DC (IL12P40 and IL12P70) cytokines were equivalent when measured at 42 days after MMR vaccine compared with levels before vaccine (Table 1) (P ≥ 0.05 for all comparisons). Conclusion In contrast to data demonstrating an immune suppression profile following measles disease, measles-containing vaccine did not suppress Th1 CD4+ T-cell and DC cytokines or promote Th2 and Treg CD4+ T-cell cytokines measured 42 days after vaccination. The cytokine profile represents one of balance and homeostasis. This study supports the data that show measles vaccine does not cause immunosuppression in healthy infants. ![]()
Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Hayley Gans
- Stanford University Medical Center, Stanford, California
| | - Weiqi Wang
- Stanford University Medical Center, Stanford, California
| | | | - Ousseny Zerbo
- Kaiser Permanente Vaccine Study Center, Oakland, California
| | | | | | - Ned Lewis
- Kaiser Permanente Northern California, Oakland, California
| | - Karin Bok
- National Institute of Health, Bethesda, Maryland
| | - Nicola Klein
- Kaiser Permanente Northern California, Oakland, California
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10
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Domachowske JB, Bianco V, Ceballos A, Cousin L, D’Andrea U, Dieussaert I, Englund JA, Gandhi S, Haars G, Jose L, Klein N, Marie. Langley J, Leach A, Madhi SA, Maleux K, Lien-Anh Nguyen T, Puthanakit T, Silas P, Stoszek SK, Tangsathapornpong A, Teeratakulpisarn J, Virta M, Zaman K. 2855. Respiratory Syncytial Virus Neutralizing Antibodies in Cord Blood and Serum from Infants up to 2 Years of Age in a Multinational Prospective Study. Open Forum Infect Dis 2019. [PMCID: PMC6808773 DOI: 10.1093/ofid/ofz359.160] [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: 11/16/2022] Open
Abstract
Background Respiratory syncytial virus (RSV) is the most common cause of lower respiratory tract infections (LRTI) during infancy worldwide. High cord blood (CB) concentrations of anti-RSV neutralizing antibody (nAb) may attenuate, delay, or prevent infant infection. We report RSV A and B nAb concentrations in CB and serum from a birth cohort at different time points through 2 years of age. Methods Between 2013 and 2017, newborns from 8 countries were studied prospectively from birth to 2 years of age (NCT01995175). CB was collected at birth for the entire cohort. A subcohort of children was randomly assigned to have one blood sample collected again at either 2, 4, 6, 12, 18, or 24 months of age. Sera were analyzed for RSV A and B nAb concentrations by serum neutralization assay. Active surveillance was used to identify LRTIs during the 2-year follow-up as previously reported. Results In total, 2,401 newborns were enrolled and followed up. >99% of infants had detectable CB RSV A and B nAb. Geometric mean antibody titers (GMTs) varied by country, but were overall higher for RSV B than for RSV A (327 vs. 251; Figure 1). The lowest GMTs were seen from CB sera collected from South African newborns (197 RSV A, 255 RSV B); Canadian newborns had the highest RSV A GMT (383), while Hondurans had the highest RSV B GMT (460). 1380 infants provided follow-up serum nAb results as part of the subcohort (Figure 2). Dramatic waning of GMTs was evident, with a ~3-fold drop in GMTs at 2 months of age, and an additional ~2-fold drop between 2 and 4 months of age. At 6 and 12 months of age, 71% and 50% of infants had RSV A nAb and GMTs were at a nadir of 14. At 6, 12, and 18 months of age, RSV B nAb was detected in 98%, 69%, and 63% of infants, respectively. The RSV B nAb nadir GMT of 20 was observed at 12 months of age, while the 6- and 18-month RSV B nAb GMTs were 30 and 31, respectively. A total of 1,017 LRTIs were identified during the 2-year study period; of which, 94 (9%) were caused by RSV A and 132 (13%) by RSV B. Associations between CB nAb levels and RSV infection will be presented. Conclusion Neutralizing Ab to RSV A and B was present at birth in infants from 8 countries, and waned over time. GMTs were at a nadir at 6 to 12 months of age. Funding. GlaxoSmithKline Biologicals SA. ![]()
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Disclosures All Authors: No reported Disclosures.
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Affiliation(s)
| | | | - Ana Ceballos
- Instituto Medico Rio Cuarto, Río Cuarto, Cordoba, Argentina
| | - Luis Cousin
- Tecnologia en Investigación, San Pedro Sula, Cortes, Honduras
| | | | | | - Janet A Englund
- Seattle Children’s Hospital/University of Washington, Seattle, Washington
| | | | | | - Lisa Jose
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Nicola Klein
- Kaiser Permanente Northern California, Oakland, California
| | - Joanne Marie. Langley
- Canadian Center for Vaccinology (Dalhousie University, IWK Health Centre and Nova Scotia Health Authority), Halifax, NS, Canada
| | | | - Shabir A Madhi
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | | | | | | | | | | | | | | | - Miia Virta
- Vaccine Research Center, Tampere University, Tampere, Pirkanmaa, Finland
| | - Khalequ Zaman
- International Center for Diarrhoeal Disease Research, Dhaka, Bangladesh
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11
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Hanson KE, McLean H, Marin M, Panagiotakopoulos L, Weintraub E, Daley MF, Groom H, Jackson L, Jacobsen SJ, Klein N, Nordin JD, Belongia E. 2763. Uptake and Safety of Measles-Mumps-Rubella (MMR) Vaccine in Adolescents and Adults in the Vaccine Safety Datalink. Open Forum Infect Dis 2019. [PMCID: PMC6809901 DOI: 10.1093/ofid/ofz360.2440] [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: 11/13/2022] Open
Abstract
Abstract
Background
MMR vaccine is given routinely to young children but may be given at other ages. We described MMR use in adolescent and adult populations in the Vaccine Safety Datalink (VSD) and estimated the incidence of medically-attended outcomes after MMR to inform future studies estimating vaccine-associated risk.
Methods
The study population included adolescents (9–17 years) and adults (≥18 years) in VSD who received at least one MMR vaccine from 2010 through 2016. Outcomes were pre-specified based on previous vaccine safety studies and categorized as clinically serious (anaphylaxis, encephalitis/myelitis, GBS, meningitis, seizure) or non-serious (allergic reaction, arthropathy, fever, injection site reaction, lymphadenopathy, nonspecific reaction, parotitis, rash, syncope). Outcomes were identified by searching for ICD-9 and ICD-10 diagnosis codes in post-vaccination exposure windows. Medical records were reviewed for all serious outcomes to verify incident diagnoses. Incidence and 95% confidence intervals were calculated for validated serious and all non-serious outcomes.
Results
146,503 adolescents and adults received 162,992 MMR vaccines during the study period. The mean age at vaccination was 33.7 years, 65% were female, and 53% received at least one other vaccine simultaneously. Demographic and vaccination characteristics varied across age groups (Table 1). The analysis of post-vaccination outcomes included 162,053 MMR vaccinations. The incidence of validated serious outcomes was low, ranging from 0 to 6.8 per 100,000 vaccinations. Only one serious outcome (anaphylaxis) was noted to be vaccine-associated in the medical record. Incidence of clinically non-serious outcomes varied from 0.4 to 56.0 per 10,000 vaccinations. Injection site reactions were more common among adolescents (118.1 per 10,000 vaccinations), who also had a higher frequency of simultaneous vaccination (80%).
Conclusion
Clinically serious outcomes were rare following MMR vaccination. Rates of clinically non-serious outcomes varied but were similar to or lower than previous reports in children. This descriptive analysis did not evaluate the association between MMR and adverse events. Future analysis with an appropriate comparison group is needed for risk estimation.
Disclosures
All authors: No reported disclosures.
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Affiliation(s)
- Kayla E Hanson
- Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | - Huong McLean
- Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | - Mona Marin
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Eric Weintraub
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Holly Groom
- Kaiser Permanente Northwest, Portland, Oregon
| | - Lisa Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | | | - Nicola Klein
- Kaiser Permanente Northern California, Oakland, California
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12
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Weinmann S, Irving S, Koppolu P, Naleway A, Belongia E, Hambidge S, Jackson ML, Klein N, Lewin B, Liles E, Marin M, Smith N, Weintraub E, Chun C. 2767. Variation in Incidence of Pediatric Herpes Zoster by First- and Second-Dose Varicella Vaccine Formulations. Open Forum Infect Dis 2019. [PMCID: PMC6809746 DOI: 10.1093/ofid/ofz360.2444] [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: 11/13/2022] Open
Abstract
Abstract
Background
Varicella (VAR) and measles-mumps-rubella (MMR) vaccines are recommended for children at ages 12–15 months and 4–6 years. These are administered as separate MMR and VAR vaccines (MMR+VAR) or as combined measles-mumps-rubella-varicella (MMRV) vaccine. Herpes zoster (HZ), caused by wild-type or vaccine-strain varicella-zoster virus, can occur in children after varicella vaccination. It is unknown whether HZ incidence after varicella vaccination varies by vaccine formulation or simultaneous receipt of MMR.
Methods
Using data from six integrated health systems, we examined HZ incidence among children who turned 12 months old during 2003–2008 and received varicella and MMR vaccines according to routine recommendations. All HZ cases ≥ 21 days after first varicella vaccination were identified using ICD-9 codes from inpatient, outpatient, emergency room encounters, and claims data, through 2014. HZ incidence was examined by vaccine formulation (MMR+VAR, MMRV, or VAR without same-day MMR) and doses received and compared using incidence rate ratios (IRR).
Results
Among 199,797 children, we identified 601 HZ cases. Crude HZ incidence after first-dose MMR+VAR (18.6 [95% CI 11.1–29.2] cases/100,000 person-years) was similar to the rate after first-dose MMRV (17.9 [95% CI 10.6–28.3] cases/100,000 person-years), but approximately double the rate among those with first-dose VAR without same-day MMR (7.5 [95% CI 3.1–15.0] cases/100,000 person-years); see Table 1. The IRR for HZ after first-dose MMR+VAR or MMRV, compared with VAR, was 2.5 (95% CI 1.4–4.4; P = 0.002). When examining any first or second dose formulation, crude HZ incidence was lower after the second varicella vaccine dose (13.9 cases/100,000 person-years), than in the period before the second dose (i.e., between first and second doses or after the first dose in children with only one dose; 21.8 cases/100,000 person-years, P < 0.0001). HZ incidence was also lower after two varicella vaccine doses in each of the three first-dose formulation groups.
Conclusion
HZ incidence among children varied by first-dose varicella vaccine formulation and number of varicella vaccine doses. Regardless of the first-dose varicella vaccine formulation, children who received two vaccine doses had lower HZ incidence after the second dose.
Disclosures
All authors: No reported disclosures.
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Affiliation(s)
- Sheila Weinmann
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | | | - Padma Koppolu
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Allison Naleway
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | | | | | - Michael L Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Nicola Klein
- Kaiser Permanente Northern California, Oakland, California
| | - Bruno Lewin
- Kaiser Permanente Department of Research and Evaluation, Pasadena, California
| | - Elizabeth Liles
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Mona Marin
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ning Smith
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Eric Weintraub
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Colleen Chun
- Kaiser Permanente Center for Health Research, Portland, Oregon
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13
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Lewis N, Hsiao A, Hansen J, Yee A, Chao C, Suaya JA, Alexander-Parrish R, Isturiz RE, McLaughlin JM, Gessner BD, Klein N. 2711. Effectiveness of 13-Valent Pneumococcal Conjugate Vaccine Against Invasive Pneumococcal Disease in Older Adults. Open Forum Infect Dis 2019. [PMCID: PMC6811316 DOI: 10.1093/ofid/ofz360.2388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Routine use of 13-valent pneumococcal conjugate vaccine (PCV13) has been recommended for infants since early 2010 and for adults ≥65 years since 2014 when KPNC began routine use of PCV13 in adults. PCV13 vaccine effectiveness (VE) against vaccine-type invasive pneumococcal disease (IPD) has been demonstrated; however, recent surveillance data have been interpreted as showing limited population-level impact of PCV13 on serotype 3 IPD. We estimated PCV13 VE against IPD due to vaccine serotypes at Kaiser Permanente Northern California (KPNC). Methods The study period spanned September 2014 through September 2018. The cohort included KPNC members who were aged ≥65 years with no record of pneumococcal polysaccharide vaccine (PPV23) receipt before age 65 years. We compared IPD cases with KPNC members who were the same age on the date of the positive pneumococcal culture using conditional logistic regression, conditioned on age and date, and controlled for sex, race, KPNC service area and membership history, prior season influenza vaccine receipt, PPV23 receipt after age 65 years, risk factors for IPD, and healthcare utilization. Results From September 2014 to September 2018, PCV13 vaccine coverage among persons ≥65 years old increased from < 1% to 77%. During the same period, there was a total of 245 IPD cases. For a variety of reasons, we did not have serotype results for 57 (23%) IPD cases, which were excluded from the analysis. There were 61 (25%) PCV13-type IPD cases included in the analysis, of which 33 (14%) were serotype 3. PCV13 VE against PCV13-type serotypes was 68.0% (95% CI: 37.7%, 83.6%; P-value < 0.01), and 53.4% (95% CI: −10.0%, 80.3%; P = 0.08) against serotype 3. Conclusion During the first 4 years of PCV13 vaccination implementation in adults ≥65 years of age at KPNC, PCV13 provided significant protection against PCV13-type IPD. Further surveillance will allow for more precise estimation of PCV13 VE on overall and serotype 3 IPD over time. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Ned Lewis
- Kaiser Permanente Northern California, Oakland, California
| | - Amber Hsiao
- Kaiser Permanente Northern California, Oakland, California
| | - John Hansen
- Kaiser Permanente Northern California, Oakland, California
| | - Arnold Yee
- Kaiser Permanente Northern California, Oakland, California
| | - Charlie Chao
- Kaiser Permanente Northern California, Oakland, California
| | | | | | | | | | | | - Nicola Klein
- Kaiser Permanente Northern California, Oakland, California
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14
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Hansen J, Goddard K, Timbol J, Zhang L, Lewis N, Klein N. 2743. Safety of Recombinant Influenza Vaccine Compared with Inactivated Influenza Vaccine in Adults. Open Forum Infect Dis 2019. [PMCID: PMC6810428 DOI: 10.1093/ofid/ofz360.2420] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background In 2013, a recombinant trivalent influenza vaccine (RIV, Flublok®, Sanofi Pasteur) was licensed for use against influenza virus subtypes A and B contained in the vaccine for persons 18–49 years of age and approved for all adults ≥18 years of age in 2014. The study aim was to evaluate the safety of RIV compared with trivalent standard-dose, inactivated influenza vaccine (IIV3) in Kaiser Permanente Northern California (KPNC). Methods This was an observational, retrospective cohort study including all persons ≥18 years vaccinated in KPNC facilities with RIV or IIV3 during the 2015–2016 influenza season as part of routine clinical care. We compared the rates of pre-specified diagnoses of interest (Guillain-Barré Syndrome, pericarditis, pleural effusion, narcolepsy/cataplexy, asthma, acute hypersensitivity reactions and fever) using International Classification of Diseases codes during post-vaccination risk intervals 0–2, 0–13, 0–41, and 0–180 days, as well as all-cause hospitalization rates 0–180 days following vaccination. Comparing cohorts, we estimated odds ratios (ORs) and 95% confidence intervals (CIs) using logistic regression analyses adjusted for age, sex, race/ethnicity, month of vaccination, and concomitant receipt of other vaccinations. Results During the study period, 21,976 persons received RIV and 283,683 received IIV3. Comparing RIV with IIV3, there were no statistically significantly elevated outcomes. RIV vaccination was associated with significantly decreased fever in the 0–41 day risk interval (OR 0.38, 95% CI 0.14–0.86) and all-cause hospitalization (OR 0.66, 95% CI 0.61–0.73) in the 0–180 day risk interval. Further analyses found that the lower rates of hospitalization in RIV recipients was mostly, though not fully, related to pregnancy-related hospital events in the IIV3 cohort and to the presence of additional unmeasured confounding. There were no serious adverse events or deaths related to RIV or IIV3. Conclusion This study did not identify any safety concerns regarding the use of RIV in adults. Understanding the observed reduction in all-cause hospitalization will need additional studies. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- John Hansen
- Kaiser Permanente Northern California, Oakland, California
| | | | - Julius Timbol
- Kaiser Permanente Vaccine Study Center, Oakland, California
| | - Lea Zhang
- Kaiser Permanente Vaccine Study Center, Oakland, California
| | - Ned Lewis
- Kaiser Permanente Northern California, Oakland, California
| | - Nicola Klein
- Kaiser Permanente Northern California, Oakland, California
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15
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Espasandín‐Domínguez J, Cadarso‐Suárez C, Kneib T, Marra G, Klein N, Radice R, Lado‐Baleato O, González‐Quintela A, Gude F. Assessing the relationship between markers of glycemic control through flexible copula regression models. Stat Med 2019; 38:5161-5181. [DOI: 10.1002/sim.8358] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 07/29/2019] [Accepted: 08/06/2019] [Indexed: 01/30/2023]
Affiliation(s)
- J. Espasandín‐Domínguez
- Department of Statistics, Mathematical Analysis, and OptimizationUniversidade de Santiago de Compostela Santiago de Compostela Spain
| | - C. Cadarso‐Suárez
- Department of Statistics, Mathematical Analysis, and OptimizationUniversidade de Santiago de Compostela Santiago de Compostela Spain
| | - T. Kneib
- Chair of StatisticsGeorg‐August‐Universität Göttingen Göttingen Germany
| | - G. Marra
- Department of Statistical ScienceUniversity College London London UK
| | - N. Klein
- Humboldt‐Universitat zu Berlin Berlin Germany
| | - R. Radice
- Cass Business SchoolCity, University of London London UK
| | - O. Lado‐Baleato
- Department of Statistics, Mathematical Analysis, and OptimizationUniversidade de Santiago de Compostela Santiago de Compostela Spain
| | - A. González‐Quintela
- Department of Internal MedicineComplejo Hospitalario Universitario de Santiago de Compostela Santiago de Compostela Spain
| | - F. Gude
- Clinical Epidemiology UnitComplejo Hospitalario Universitario de Santiago de Compostela Santiago de Compostela Spain
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16
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Dobson G, Klein N, Veys P, Qasim W, Silva J, Cheng IL, Shingadia D, Tudor-Williams G, Watters SA, Lyall H, Rao A, Foster C, Bamford A. Persistence of HIV reservoir following successful haematopoietic stem cell transplant for juvenile myelomonocytic leukaemia in a child with perinatally acquired HIV. J Virus Erad 2019; 5:174-177. [PMID: 31700667 PMCID: PMC6816122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
This report describes a case of juvenile myelomonocytic leukaemia (JMML) on a background of both perinatally acquired HIV infection and congenital cytomegalovirus, and management of antiretroviral therapy during haematopoietic stem cell transplant. Peripheral blood HIV viral load remained below the lower limit of detection throughout and following transplant and is currently <20 RNA copies/mL. The child is currently in remission from JMML, but HIV DNA remains detectable despite myeloablative conditioning and sustained plasma HIV viral suppression.
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Affiliation(s)
- G Dobson
- Paediatric Infectious Diseases Department,
Great Ormond Street Hospital for Children NHS Foundation Trust,
London,
UK
| | - N Klein
- Paediatric Infectious Diseases Department,
Great Ormond Street Hospital for Children NHS Foundation Trust,
London,
UK,UCL Great Ormond Street Institute of Child Health,
London,
UK
| | - P Veys
- UCL Great Ormond Street Institute of Child Health,
London,
UK,Paediatric Bone Marrow Transplant Department,
Great Ormond Street Hospital NHS Foundation Trust,
London,
UK
| | - W Qasim
- UCL Great Ormond Street Institute of Child Health,
London,
UK,Paediatric Immunology Department,
Great Ormond Street Hospital NHS Foundation Trust,
London,
UK
| | - J Silva
- Paediatric Bone Marrow Transplant Department,
Great Ormond Street Hospital NHS Foundation Trust,
London,
UK
| | - IL Cheng
- Paediatric Pharmacy Department,
Great Ormond Street Hospital NHS Foundation Trust,
London,
UK
| | - D Shingadia
- Paediatric Infectious Diseases Department,
Great Ormond Street Hospital for Children NHS Foundation Trust,
London,
UK,UCL Great Ormond Street Institute of Child Health,
London,
UK
| | - G Tudor-Williams
- Paediatric Infectious Diseases Department,
St Mary's Hospital,
Imperial College Healthcare NHS Foundation Trust,
London,
UK,Division of Infectious Diseases,
Imperial College London,
London,
UK
| | - SA Watters
- UCL Great Ormond Street Institute of Child Health,
London,
UK
| | - H Lyall
- Paediatric Infectious Diseases Department,
St Mary's Hospital,
Imperial College Healthcare NHS Foundation Trust,
London,
UK
| | - A Rao
- Paediatric Haematology Department,
Great Ormond Street Hospital NHS Foundation Trust,
London,
UK
| | - C Foster
- Paediatric Infectious Diseases Department,
St Mary's Hospital,
Imperial College Healthcare NHS Foundation Trust,
London,
UK
| | - A Bamford
- Paediatric Infectious Diseases Department,
Great Ormond Street Hospital for Children NHS Foundation Trust,
London,
UK,UCL Great Ormond Street Institute of Child Health,
London,
UK,Corresponding author: Alasdair Bamford
Paediatric Infectious Diseases Department,
Great Ormond Street Hospital,
Great Ormond Street,
LondonWC1N 3JH,
UK
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17
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Dobson G, Klein N, Veys P, Qasim W, Silva J, Cheng I, Shingadia D, Tudor-Williams G, Watters S, Lyall H, Rao A, Foster C, Bamford A. Persistence of HIV reservoir following successful haematopoietic stem cell transplant for juvenile myelomonocytic leukaemia in a child with perinatally acquired HIV. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)30048-0] [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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18
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Greenfield I, Wu D, Anderson M, Postlethwaite D, Zerbo O, Klein N. Electronic Medical Record Intervention to Improve Adherence to Prenatal Vaccination Recommendation [12F]. Obstet Gynecol 2019. [DOI: 10.1097/01.aog.0000559043.09617.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Guenther E, Klein N, Zapf S, Weil S, Schlosser C, Rubinsky B, Stehling MK. Prostate cancer treatment with Irreversible Electroporation (IRE): Safety, efficacy and clinical experience in 471 treatments. PLoS One 2019; 14:e0215093. [PMID: 30986263 PMCID: PMC6464181 DOI: 10.1371/journal.pone.0215093] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/26/2019] [Indexed: 01/29/2023] Open
Abstract
Background Irreversible Electroporation (IRE) is a novel image-guided tissue ablation technology that induces cell death via very short but strong pulsed electric fields. IRE has been shown to have preserving properties towards vessels and nerves and the extracellular matrix. This makes IRE an ideal candidate to treat prostate cancer (PCa) where other treatment modalities frequently unselectively destroy surrounding structures inducing severe side effects like incontinence or impotence. We report the retrospective assessment of 471 IRE treatments in 429 patients of all grades and stages of PCa with 6-year maximum follow-up time. Material and findings The patient cohort consisted of low (25), intermediate (88) and high-risk cancers (312). All had multi-parametric magnetic resonance imaging, and 199 men had additional 3D-mapping biopsy for diagnostic work-up prior to IRE. Patients were treated either focally (123), sub-whole-gland (154), whole-gland (134) or for recurrent disease (63) after previous radical prostatectomy, radiation therapy, etc. Adverse effects were mild (19.7%), moderate (3.7%) and severe (1.4%), never life-threatening. Urinary continence was preserved in all cases. IRE-induced erectile dysfunction persisted in 3% of the evaluated cases 12 months post treatment. Mean transient IIEF-5-Score reduction was 33% within 12-month post IRE follow-up and 15% after 12 months. Recurrences within the follow-up period occurred in 10% of the treated men, 23 in or adjacent to the treatment field and 18 outside the treatment field (residuals). Including residuals for worst case analysis, Kaplan Maier estimation on recurrence rate at 5 years resulted in 5.6% (CI95: 1.8–16.93) for Gleason 6, 14.6% (CI95: 8.8–23.7) for Gleason 7 and 39.5% (CI95: 23.5–61.4) for Gleason 8–10. Conclusion The results indicate comparable efficacy of IRE to standard radical prostatectomy in terms of 5-year recurrence rates and better preservation of urogenital function, proving the safety and suitability of IRE for PCa treatment. The data also shows that IRE, besides focal therapy of early PCa, can also be used for whole-gland ablations, in patients with recurrent PCa, and as a problem-solver for local tumor control in T4-cancers not amenable to surgery and radiation therapy anymore.
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Affiliation(s)
- E. Guenther
- Vitus Prostate Center, Institut für Bildgebende Diagnostik, Offenbach, Germany
- * E-mail:
| | - N. Klein
- Vitus Prostate Center, Institut für Bildgebende Diagnostik, Offenbach, Germany
- Department of Information and Communication Technologies, Universitat Pompeu Fabra, C/Roc Boronat, Barcelona, Spain
| | - S. Zapf
- Vitus Prostate Center, Institut für Bildgebende Diagnostik, Offenbach, Germany
| | - S. Weil
- Vitus Prostate Center, Institut für Bildgebende Diagnostik, Offenbach, Germany
| | - C. Schlosser
- Vitus Prostate Center, Institut für Bildgebende Diagnostik, Offenbach, Germany
| | - B. Rubinsky
- Department of Mech. Engineering, University of California Berkeley, Berkeley, CA, United States of America
| | - M. K. Stehling
- Vitus Prostate Center, Institut für Bildgebende Diagnostik, Offenbach, Germany
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20
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Johnson SM, Standing JF, Klein N, Irwin AD, Shingadia D, Lonsdale DO, Gilmour KC, Flynn J, Manns C, Clapson M, Bamford A. A case for reduced frequency of CD4 count monitoring for children on combination antiretroviral therapy with consistently undetectable HIV viral load. HIV Med 2019; 20:e8-e9. [PMID: 30693658 DOI: 10.1111/hiv.12706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S M Johnson
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - J F Standing
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - N Klein
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Trust, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK
| | - A D Irwin
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Trust, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK.,University of Queensland Centre for Clinical Research, Herston, Queensland, Australia
| | - D Shingadia
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Trust, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK
| | - D O Lonsdale
- Institute of Infection and Immunity, St George's University and St George's Hospital, London, UK
| | - K C Gilmour
- UCL Great Ormond Street Institute of Child Health, London, UK.,Department of Immunology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - J Flynn
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - C Manns
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - M Clapson
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - A Bamford
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Trust, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK
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21
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Klein N, Curatola AM, Schneider RJ. Calcium-induced stabilization of AU-rich short-lived mRNAs is a common default response. Gene Expr 2018; 7:357-65. [PMID: 10440236 PMCID: PMC6174662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
The AU-rich element (AUUUA)n, found in the 3' noncoding region of many short-lived cytokine and proto-oncogene mRNAs, is sufficient to specifically target these mRNAs for rapid degradation in mammalian cells. The mechanism by which the AU-rich element promotes rapid mRNA decay is not known. Previous studies have shown that release of intracellular stored calcium by ionophore treatment of thymocytes and mast cells inhibits the rapid turnover of AU-rich interleukin mRNAs. Increased cytoplasmic half-life of interleukin mRNAs was linked to calcium-induced activation of the N-terminal c-Jun kinase. In this report we have characterized the calcium-induced stabilization of AU-rich mRNAs. We show that calcium induces stabilization of mRNAs with canonical AU-rich elements in all cell types tested. These results indicate that short-lived mRNA stabilization by calcium is not unique to immune cells nor interleukin mRNAs, but is a widespread default response that includes generic AU-rich mRNAs. Stabilization is shown to be rapid but transient, and to act without altering nuclear transcription or cytoplasmic translation rates. These data support the view that calcium release likely stabilizes short-lived mRNAs by altering trans-acting decay factors that promote AU-rich mRNA turnover.
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Affiliation(s)
- Nicola Klein
- Department of Biochemistry and Microbiology, Kaplan Cancer Center, NYU Medical School, New York, NY 10016
| | - Anna Maria Curatola
- Department of Biochemistry and Microbiology, Kaplan Cancer Center, NYU Medical School, New York, NY 10016
| | - Robert J. Schneider
- Department of Biochemistry and Microbiology, Kaplan Cancer Center, NYU Medical School, New York, NY 10016
- Address correspondence to Robert J. Schneider, Department of Biochemistry and Microbiology, Kaplan Cancer Center, NYU Medical School, 550 First Avenue, New York, NY 10016. Tel: (212) 263-6006; Fax: (212) 263-8166; E-mail:
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22
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Spinhoven P, Klein N, Kennis M, Cramer AO, Siegle G, Cuijpers P, Ormel J, Hollon SD, Bockting CL. The effects of cognitive-behavior therapy for depression on repetitive negative thinking: A meta-analysis. Behav Res Ther 2018; 106:71-85. [DOI: 10.1016/j.brat.2018.04.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 04/02/2018] [Accepted: 04/16/2018] [Indexed: 10/17/2022]
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23
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Harjunmaa U, Doyle R, Järnstedt J, Kamiza S, Jorgensen JM, Stewart CP, Shaw L, Hallamaa L, Ashorn U, Klein N, Dewey KG, Maleta K, Ashorn P. Periapical infection may affect birth outcomes via systemic inflammation. Oral Dis 2018; 24:847-855. [PMID: 29230915 DOI: 10.1111/odi.12817] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 11/26/2017] [Accepted: 12/03/2017] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Maternal dental periapical infections are associated with preterm birth and intrauterine growth restriction. This study investigates whether the association is mediated through bacterial spread from periapical lesions to placenta (direct pathway) or systemic inflammatory reaction (indirect pathway). MATERIALS AND METHODS We compared birth outcomes in Malawian mothers with and without periapical infection. As markers of a direct pathway, we identified placental bacteria using a 16S rDNA approach and assessed histological evidence of inflammation in the placenta and amniotic membranes. We measured C-reactive protein, alpha-1-acid glycoprotein, and salivary cortisol as markers of an indirect pathway. We used regression models to associate the predictor variables with duration of pregnancy and newborn size. RESULTS Of 1,024 women, 23.5% had periapical infection. There was no association of periapical infection with either bacterial DNA or histological inflammation in placenta or membranes. Periapical infection was associated with C-reactive protein, alpha-1-acid glycoprotein, and cortisol concentrations in a dose-dependent manner at 36 weeks. Addition of alpha-1-acid glycoprotein or cortisol concentration into regression models attenuated the association between periapical infection and pregnancy outcomes. CONCLUSION There was no evidence of direct spread of periapical bacteria to the placenta. Periapical infections and adverse pregnancy outcomes are in part mediated through systemic inflammation.
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Affiliation(s)
- U Harjunmaa
- Center for Child Health Research, University of Tampere Faculty of Medicine and Life Sciences and Tampere University Hospital, Tampere, Finland
| | - R Doyle
- Microbiology, Virology & Infection Control, Great Ormond Street Hospital NHS Foundation Trust, London, UK.,Institute of Child Health, University College London, London, UK
| | - J Järnstedt
- Department of Radiology, Medical Imaging Center, Tampere University Hospital, Tampere, Finland
| | - S Kamiza
- Department of Pathology, University of Malawi College of Medicine, Blantyre, Malawi
| | - J M Jorgensen
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - C P Stewart
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - L Shaw
- Institute of Child Health, University College London, London, UK
| | - L Hallamaa
- Center for Child Health Research, University of Tampere Faculty of Medicine and Life Sciences and Tampere University Hospital, Tampere, Finland
| | - U Ashorn
- Center for Child Health Research, University of Tampere Faculty of Medicine and Life Sciences and Tampere University Hospital, Tampere, Finland
| | - N Klein
- Institute of Child Health, University College London, London, UK
| | - K G Dewey
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - K Maleta
- Department of Community Health, University of Malawi College of Medicine, Blantyre, Malawi
| | - P Ashorn
- Center for Child Health Research, University of Tampere Faculty of Medicine and Life Sciences and Tampere University Hospital, Tampere, Finland
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24
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Fitzgerald F, Wing K, Naveed A, Gbessay M, Ross JCG, Checchi F, Youkee D, Jalloh MB, Baion D, Mustapha A, Jah H, Lako S, Oza S, Boufkhed S, Feury R, Bielicki J, Williamson E, Gibb DM, Klein N, Sahr F, Yeung S. Risk in the "Red Zone": Outcomes for Children Admitted to Ebola Holding Units in Sierra Leone Without Ebola Virus Disease. Clin Infect Dis 2017; 65:162-165. [PMID: 28369236 PMCID: PMC5693324 DOI: 10.1093/cid/cix223] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 03/10/2017] [Indexed: 11/13/2022] Open
Abstract
We collected data on 1054 children admitted to Ebola Holding Units in Sierra Leone and describe outcomes of 697/1054 children testing negative for Ebola virus disease (EVD) and accompanying caregivers. Case-fatality was 9%; 3/630 (0.5%) children discharged testing negative were readmitted EVD-positive. Nosocomial EVD transmission risk may be lower than feared.
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Affiliation(s)
- F Fitzgerald
- Infection, Immunity, Inflammation and Physiological Medicine, UCL Great Ormond Street Institute of Child Health, United Kingdom
- Save the Children, Sierra Leone and United Kingdom
| | - K Wing
- Save the Children, Sierra Leone and United Kingdom
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, and
| | - A Naveed
- Save the Children, Sierra Leone and United Kingdom
| | - M Gbessay
- Save the Children, Sierra Leone and United Kingdom
| | - JCG Ross
- Save the Children, Sierra Leone and United Kingdom
| | - F Checchi
- Save the Children, Sierra Leone and United Kingdom
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, and
| | - D Youkee
- Kings Sierra Leone Partnership, Kings Centre for Global Health, Kings College London, United Kingdom
| | - MB Jalloh
- 34 Military Hospital, Republic of Sierra Leone Armed Forces, Freetown
| | - D Baion
- Ola During Children’s Hospital, Sierra Leone Ministry of Health, Freetown
| | - A Mustapha
- Ola During Children’s Hospital, Sierra Leone Ministry of Health, Freetown
| | - H Jah
- Cap Anamur (German Emergency Doctors), Ola During Children’s Hospital, Freetown, and
| | - S Lako
- Welbodi Partnership, Ola During Children’s Hospital, Freetown, Sierra Leone
| | - S Oza
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, and
| | - S Boufkhed
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, United Kingdom
| | - R Feury
- Western Area Emergency Response Centre, Freetown, Sierra Leone
| | | | - E Williamson
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine
- Farr Institute of Health Informatics, London, and
| | | | - N Klein
- Infection, Immunity, Inflammation and Physiological Medicine, UCL Great Ormond Street Institute of Child Health, United Kingdom
| | - F Sahr
- 34 Military Hospital, Republic of Sierra Leone Armed Forces, Freetown
| | - S Yeung
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, United Kingdom
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25
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Hoare RL, Veys P, Klein N, Callard R, Standing JF. Predicting CD4 T-Cell Reconstitution Following Pediatric Hematopoietic Stem Cell Transplantation. Clin Pharmacol Ther 2017; 102:349-357. [PMID: 28074473 PMCID: PMC5579758 DOI: 10.1002/cpt.621] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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] [Received: 09/06/2016] [Revised: 01/03/2017] [Accepted: 01/06/2017] [Indexed: 11/10/2022]
Abstract
Hematopoietic stem cell transplantation (HSCT) is an increasingly common treatment for children with a range of hematological disorders. Conditioning with cytotoxic chemotherapy and total body irradiation leaves patients severely immunocompromised. T‐cell reconstitution can take several years due to delayed restoration of thymic output. Understanding T‐cell reconstitution in children is complicated by normal immune system maturation, heterogeneous diagnoses, and sparse uneven sampling due to the long time spans involved. We describe here a mechanistic mathematical model for CD4 T‐cell immune reconstitution following pediatric transplantation. Including relevant biology and using mixed‐effects modeling allowed the factors affecting reconstitution to be identified. Bayesian predictions for the long‐term reconstitution trajectories of individual children were then obtained using early post‐transplant data. The model was developed using data from 288 children; its predictive ability validated on data from a further 75 children, with long‐term reconstitution predicted accurately in 81% of the patients.
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Affiliation(s)
- R L Hoare
- Centre for Mathematics and Physics in the Life Sciences and Experimental Biology, University College London, London, United Kingdom.,Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - P Veys
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.,Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - N Klein
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.,Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - R Callard
- Centre for Mathematics and Physics in the Life Sciences and Experimental Biology, University College London, London, United Kingdom.,Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - J F Standing
- Centre for Mathematics and Physics in the Life Sciences and Experimental Biology, University College London, London, United Kingdom.,Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.,Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
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26
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Goniszewski S, Adabi M, Shaforost O, Hanham SM, Hao L, Klein N. Erratum: Corrigendum: Correlation of p-doping in CVD Graphene with Substrate Surface Charges. Sci Rep 2017; 7:41467. [PMID: 28198799 PMCID: PMC5304154 DOI: 10.1038/srep41467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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27
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Zwirner J, Bayer R, Hädrich C, Bollmann A, Klein N, Dreßler J, Ondruschka B. Pulmonary artery perforation and coronary air embolism-two fatal outcomes in percutaneous left atrial appendage occlusion. Int J Legal Med 2016; 131:191-197. [PMID: 27815629 DOI: 10.1007/s00414-016-1486-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 08/18/2016] [Accepted: 10/20/2016] [Indexed: 10/20/2022]
Abstract
Percutaneous left atrial appendage (LAA) closure is a routinely performed method to reduce the risk of stroke in patients suffering from atrial fibrillation, when an oral anticoagulation is no longer indicated due to relevant bleeding complications. Currently, the Amplatzer Amulet and the Watchman system are two equally used systems. While there is an acute success rate of more than 95 per cent for this intervention, several minor and major complications such as pericardial effusions, air embolism, vascular lesions in proximity to the heart or even death can occur. Here, we report two cases of very rare fatal outcomes in percutaneous LAA occlusion. Eight hours after deployment of an Amplatzer Amulet a patient died, after the pulmonary trunk was perforated by a hook of the occluder device causing pericardial tamponade. In the second case during final radiological position control of the deployed Watchman occluder air was injected accidentally. The patient immediately died due to coronary air embolism. Forensic autopsies are necessary to solve the cause and manner of death, to evaluate and develop medical devices and to rule out medical malpractice. Thus, a close collaboration of legal medicine and the various cardiologic departments is proposed.
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Affiliation(s)
- J Zwirner
- University of Leipzig, Institute of Legal Medicine, Leipzig, Germany
| | - R Bayer
- University of Leipzig, Institute of Legal Medicine, Leipzig, Germany
| | - C Hädrich
- University of Leipzig, Institute of Legal Medicine, Leipzig, Germany
| | - A Bollmann
- University of Leipzig - Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - N Klein
- Hospital St. Georg Leipzig, Clinic for Cardiology, Angiology and Intensive Care, Leipzig, Germany
| | - J Dreßler
- University of Leipzig, Institute of Legal Medicine, Leipzig, Germany
| | - B Ondruschka
- University of Leipzig, Institute of Legal Medicine, Leipzig, Germany.
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28
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Foster C, Bamford A, Turkova A, Welch S, Klein N. Paediatric European Network for Treatment of AIDS Treatment Guideline 2016 update: antiretroviral therapy recommended for all children living with HIV. HIV Med 2016; 18:133-134. [PMID: 27385585 PMCID: PMC5248631 DOI: 10.1111/hiv.12399] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- C Foster
- The Family Clinic, Imperial College NHS Trust, London, UK
| | - A Bamford
- Paediatric Infectious Diseases, Great Ormond Street Hospital, London, UK
| | - A Turkova
- MRC Clinical Trials Unit, London, UK
| | - S Welch
- Paediatrics, Birmingham Heartlands Hospital, Birmingham, UK
| | - N Klein
- Paediatric Infectious Diseases, Great Ormond Street Hospital, London, UK.,Institute of Child Health, London, UK
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29
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Omoyinmi E, Standing A, Keylock A, Rowczenio D, Melo Gomes S, Cullup T, Jenkins L, Gilmour K, Eleftheriou D, Lachmann H, Hawkins P, Klein N, Brogan P. SAT0010 A Targeted Next-Generation Sequencing Gene Panel for Autoinflammation. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3837] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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30
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Junk S, Klein N, Schreek S, Zimmermann M, Möricke A, Bleckmann K, Cario G, Kratz CP, Schrappe M, Stanulla M. TP53 single nucleotide variants (SNV) in patients developing second malignant neoplasms after treatment for childhood acute lymphoblastic leukemia. Klin Padiatr 2016. [DOI: 10.1055/s-0036-1582493] [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: 10/21/2022]
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31
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Fenton M, Simmonds J, Shah V, Brogan P, Klein N, Deanfield J, Burch M. Inflammatory Cytokines, Endothelial Function, and Chronic Allograft Vasculopathy in Children: An Investigation of the Donor and Recipient Vasculature After Heart Transplantation. Am J Transplant 2016; 16:1559-68. [PMID: 26614396 DOI: 10.1111/ajt.13643] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 11/17/2015] [Accepted: 11/22/2015] [Indexed: 01/25/2023]
Abstract
Chronic allograft vasculopathy (CAV) limits the lifespan of pediatric heart transplant recipients. We investigated blood markers of inflammation, endothelial dysfunction, and damage to both the native and transplanted vasculature in children after heart transplantation. Serum samples were taken from pediatric heart transplant recipients for markers of inflammation and endothelial activation. The systemic vasculature was investigated using brachial artery flow-mediated dilatation and carotid artery intima-medial hyperplasia. CAV was investigated using intravascular ultrasound. Mean intima-media thickness (mIMT) > 0.5 mm was used to define significant CAV. Forty-eight children (25 male) aged 8-18 years were enrolled in the study. Patients were a median (interquartile range) 4.1 (2.2-8.7) years after transplant. Patients had increased levels of circulating IL6 (3.86 [2.84-4.95] vs. 1.66 [1.22-2.63] p < 0.0001), vascular cell adhesion molecule 1 (539 [451-621] vs. 402 [342-487] p < 0.001), intracellular adhesion molecule 1 305 (247-346) vs. 256 (224-294) p = 0.002 and thrombomodulin (7.1 [5.5-8.1] vs. 3.57 [3.03-4.71] p < 0.0001) and decreased levels of tumor necrosis factor-α, E selectin, and P selectin, compared with controls. The systemic vasculature was unaffected. Patients with severe CAV had raised serum von Willebrand factor and decreased serum thrombomodulin. Posttransplant thrombomodulin levels are elevated after transplant but significantly lower in those with mIMT > 0.5 mm. This suggests that subclinical inflammation is present and that natural anticoagulant/thrombomodulin activity is important after transplant.
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Affiliation(s)
- M Fenton
- Department of Cardiothoracic Transplant, Great Ormond Street Hospital, London, UK
| | - J Simmonds
- Department of Cardiothoracic Transplant, Great Ormond Street Hospital, London, UK
| | - V Shah
- UCL Institute of Child Health, Great Ormond Street Hospital, London, UK
| | - P Brogan
- UCL Institute of Child Health, Great Ormond Street Hospital, London, UK
| | - N Klein
- UCL Institute of Child Health, Great Ormond Street Hospital, London, UK
| | - J Deanfield
- UCL Institute of Cardiovascular Sciences, London, UK
| | - M Burch
- Department of Cardiothoracic Transplant, Great Ormond Street Hospital, London, UK
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32
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Gellrich F, Klein N, Albinus J, Gellrich S. Retrospektive Analyse der individuellen Sonnenschutzberatung bei Patienten mit Aktinischen Keratosen. Akt Dermatol 2016. [DOI: 10.1055/s-0041-110609] [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: 10/22/2022]
Affiliation(s)
- F. Gellrich
- Medizinische Fakultät der Technischen Universität Dresden
| | - N. Klein
- Dermatologische Praxis, Elisabethstraße 6, 12247 Berlin
| | - J. Albinus
- Medizinische Fakultät der Technischen Universität Dresden
| | - S. Gellrich
- Dermatologische Praxis, Baumschulenstraße 74, 12437 Berlin
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33
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Gregory A, Blackburn J, Lees K, Clarke R, Hodgetts T, Hanham S, Klein N. Measurement of the permittivity and loss of high-loss materials using a Near-Field Scanning Microwave Microscope. Ultramicroscopy 2016; 161:137-145. [DOI: 10.1016/j.ultramic.2015.11.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 11/25/2015] [Accepted: 11/28/2015] [Indexed: 11/28/2022]
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34
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Gomes SM, Arostegui J, Omoyinmi E, Standing A, Klein N, Lachmann H, Hawkins P, Brogan P. Whole Exome Sequencing reveals a NLRP3 mutation in exon 5 in a patient with CINCA. Pediatr Rheumatol Online J 2015. [PMCID: PMC4597063 DOI: 10.1186/1546-0096-13-s1-p45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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35
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Rowczenio D, Gomes SM, Aróstegui J, Omoyinmi E, Gonzalez-Roca E, Standing A, Eleftheriou D, Klein N, Brogan P, Lachmann H, Hawkins P. Late onset of the cryopyrin-associated periodic syndrome (CAPS) associated with low level of somatic mosaicism in six patients. Pediatr Rheumatol Online J 2015. [PMCID: PMC4597082 DOI: 10.1186/1546-0096-13-s1-p37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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36
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Standing A, Eleftheriou D, Paisan-Ruiz C, Rowcenzio D, Hong Y, Omoyinmi E, Woo P, Hawkins P, Lachmann H, Klein N, Brogan P. 8th International Congress of Familial Mediterranean Fever and Systemic Autoinflammatory Diseases. Pediatr Rheumatol Online J 2015; 13 Suppl 1:O1-P211. [PMID: 26424586 PMCID: PMC4597419 DOI: 10.1186/1546-0096-13-s1-o1] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- A Standing
- UCL Institute of Child Health, IIIP, London, UK
| | | | | | - D Rowcenzio
- UCL Royal Free Hospital, National Amyloidosis Centre, London, UK
| | - Y Hong
- UCL Institute of Child Health, IIIP, London, UK
| | - E Omoyinmi
- UCL Institute of Child Health, IIIP, London, UK
| | - P Woo
- University College London, London, UK
| | - P Hawkins
- UCL Royal Free Hospital, National Amyloidosis Centre, London, UK
| | - H Lachmann
- UCL Royal Free Hospital, National Amyloidosis Centre, London, UK
| | - N Klein
- UCL Institute of Child Health, IIIP, London, UK
| | - P Brogan
- UCL Institute of Child Health, IIIP, London, UK
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Shah V, Christov G, Mukasa T, Brogan KS, Wade A, Eleftheriou D, Levin M, Tulloh RM, Almeida B, Dillon MJ, Marek J, Klein N, Brogan PA. Cardiovascular status after Kawasaki disease in the UK. Heart 2015; 101:1646-55. [PMID: 26316045 PMCID: PMC4621377 DOI: 10.1136/heartjnl-2015-307734] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 07/07/2015] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Kawasaki disease (KD) is an acute vasculitis that causes coronary artery aneurysms (CAA) in young children. Previous studies have emphasised poor long-term outcomes for those with severe CAA. Little is known about the fate of those without CAA or patients with regressed CAA. We aimed to study long-term cardiovascular status after KD by examining the relationship between coronary artery (CA) status, endothelial injury, systemic inflammatory markers, cardiovascular risk factors (CRF), pulse-wave velocity (PWV) and carotid intima media thickness (cIMT) after KD. METHODS Circulating endothelial cells (CECs), endothelial microparticles (EMPs), soluble cell-adhesion molecules cytokines, CRF, PWV and cIMT were compared between patients with KD and healthy controls (HC). CA status of the patients with KD was classified as CAA present (CAA+) or absent (CAA-) according to their worst-ever CA status. Data are median (range). RESULTS Ninety-two KD subjects were studied, aged 11.9 years (4.3-32.2), 8.3 years (1.0-30.7) from KD diagnosis. 54 (59%) were CAA-, and 38 (41%) were CAA+. There were 51 demographically similar HC. Patients with KD had higher CECs than HC (p=0.00003), most evident in the CAA+ group (p=0.00009), but also higher in the CAA- group than HC (p=0.0010). Patients with persistent CAA had the highest CECs, but even those with regressed CAA had higher CECs than HC (p=0.011). CD105 EMPs were also higher in the KD group versus HC (p=0.04), particularly in the CAA+ group (p=0.02), with similar findings for soluble vascular cell adhesion molecule 1 and soluble intercellular adhesion molecule 1. There was no difference in PWV, cIMT, CRF or in markers of systemic inflammation in the patients with KD (CAA+ or CAA-) compared with HC. CONCLUSIONS Markers of endothelial injury persist for years after KD, including in a subset of patients without CAA.
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Affiliation(s)
- V Shah
- Infection, Inflammation and Rheumatology Section, UCL Institute of Child Health, London, UK
| | - G Christov
- Department of Paediatric Cardiology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - T Mukasa
- Department of Paediatric Cardiology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - K S Brogan
- Infection, Inflammation and Rheumatology Section, UCL Institute of Child Health, London, UK
| | - A Wade
- Department of Clinical Epidemiology, Nutrition and Biostatistics Section, UCL Institute of Child Health, London, UK
| | - D Eleftheriou
- Infection, Inflammation and Rheumatology Section, UCL Institute of Child Health, London, UK
| | - M Levin
- Paediatric Infectious diseases group, Division of Medicine, Imperial College London, London, UK
| | - R M Tulloh
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, UK
| | - B Almeida
- Infection, Inflammation and Rheumatology Section, UCL Institute of Child Health, London, UK
| | - M J Dillon
- Infection, Inflammation and Rheumatology Section, UCL Institute of Child Health, London, UK
| | - J Marek
- Department of Paediatric Cardiology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - N Klein
- Infection, Inflammation and Rheumatology Section, UCL Institute of Child Health, London, UK
| | - P A Brogan
- Infection, Inflammation and Rheumatology Section, UCL Institute of Child Health, London, UK
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38
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Brown JR, Tang JW, Pankhurst L, Klein N, Gant V, Lai KM, McCauley J, Breuer J. Influenza virus survival in aerosols and estimates of viable virus loss resulting from aerosolization and air-sampling. J Hosp Infect 2015; 91:278-81. [PMID: 26412395 DOI: 10.1016/j.jhin.2015.08.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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: 06/08/2015] [Accepted: 08/04/2015] [Indexed: 12/17/2022]
Abstract
Using a Collison nebulizer, aerosols of influenza (A/Udorn/307/72 H3N2) were generated within a controlled experimental chamber, from known starting virus concentrations. Air samples collected after variable suspension times were tested quantitatively using both plaque and polymerase chain reaction assays, to compare the proportion of viable virus against the amount of detectable viral RNA. These experiments showed that whereas influenza RNA copies were well preserved, the number of viable viruses decreased by a factor of 10(4)-10(5). This suggests that air-sampling studies for assessing infection control risks that detect only influenza RNA may greatly overestimate the amount of viable virus available to cause infection.
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Affiliation(s)
- J R Brown
- Great Ormond Street Hospital, London, UK
| | - J W Tang
- University Hospitals Leicester, Leicester, UK.
| | - L Pankhurst
- University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - N Klein
- University College London, London, UK
| | - V Gant
- University College London Hospitals, London, UK
| | - K M Lai
- Hong Kong Baptist University, Hong Kong, China
| | - J McCauley
- The Francis Crick Institute, Mill Hill Laboratory, London, UK
| | - J Breuer
- University College London, London, UK
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39
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Palma P, Foster C, Rojo P, Zangari P, Yates A, Cotugno N, Klein N, Luzuriaga K, Pahwa S, Nastouli E, Gibb DM, Borkowsky W, Bernardi S, Calvez V, Manno E, Mora N, Compagnucci A, Wahren B, Muñoz-Fernández MÁ, De Rossi A, Ananworanich J, Pillay D, Giaquinto C, Rossi P. The EPIICAL project: an emerging global collaboration to investigate immunotherapeutic strategies in HIV-infected children. J Virus Erad 2015; 1:134-139. [PMID: 26893908 PMCID: PMC4755515] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The EPIICAL (Early-treated Perinatally HIV-infected Individuals: Improving Children's Actual Life with Novel Immunotherapeutic Strategies) project arises from the firm belief that perinatally infected children treated with suppressive antiretroviral therapy (ART) from early infancy represent the optimal population model in which to study novel immunotherapeutic strategies aimed at achieving ART-free remission. This is because HIV-infected infants treated within 2-3 months of life have a much reduced viral reservoir size, and rarely show HIV-specific immunity but preserve normal immune development. The goal of EPIICAL is the establishment of an international collaboration to develop a predictive platform using this model to select promising HIV therapeutic vaccine candidates, leading to prioritisation or deprioritisation of novel immunotherapeutic strategies. To establish this platform, the EPIICAL Consortium aims to: develop predictive models of virological and immunological dynamics associated with response to early ART and to treatment interruption using available data from existing cohorts/studies of early-treated perinatally HIV-infected children; optimise methodologies to better characterise immunological, virological and genomic correlates/profiles associated with viral control; test novel immunotherapeutic strategies using in vivo proof-of-concept (PoC) studies with the aim of inducing virological, immunological and transcriptomic correlates/profiles equivalent to those defined by the predictive model. This approach will strengthen the capacity for discovery, development and initial testing of new therapeutic vaccine strategies through the integrated efforts of leading international scientific groups, with the aim of improving the health of HIV-infected individuals.
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Affiliation(s)
- P Palma
- University Department of Pediatrics, Unit of Immune and Infectious Diseases,
Children's Hospital Bambino Gesù,
Rome,
Italy,Corresponding author: Paolo Palma,
University Department of Pediatrics Unit of Immune and Infectious Diseases,
Children's Hospital Bambino GesùPiazza Sant'Onofrio4-00165Rome,
Italy
| | - C Foster
- Imperial College Healthcare NHS Trust,
London,
UK
| | - P Rojo
- Department of Pediatrics,
Hospital 12 de Octubre,
Madrid,
Spain
| | - P Zangari
- University Department of Pediatrics, Unit of Immune and Infectious Diseases,
Children's Hospital Bambino Gesù,
Rome,
Italy,Chair of Pediatrics, Department of Systems Medicine,
University of Rome ‘Tor Vergata’,
Italy
| | - A Yates
- Institute of Infection, Immunity & Inflammation,
University of Glasgow,
Glasgow,
UK
| | - N Cotugno
- University Department of Pediatrics, Unit of Immune and Infectious Diseases,
Children's Hospital Bambino Gesù,
Rome,
Italy,Chair of Pediatrics, Department of Systems Medicine,
University of Rome ‘Tor Vergata’,
Italy
| | - N Klein
- Institute of Child Health,
University College London,
London,
UK
| | - K Luzuriaga
- Program in Molecular Medicine,
University of Massachusetts Medical School Worcester,
MA,
USA
| | - S Pahwa
- Miami Center for AIDS Research Department of Microbiology and Immunology,
University of Miami, Miller School of Medicine,
Miami,
FL,
USA
| | - E Nastouli
- Department of Virology,
University College London Hospitals,
London,
UK
| | - DM Gibb
- MRC Clinical Trials Unit,
London,
UK
| | | | - S Bernardi
- University Department of Pediatrics, Unit of Immune and Infectious Diseases,
Children's Hospital Bambino Gesù,
Rome,
Italy
| | - V Calvez
- Pierre et Marie Curie University and Pitié-Salpêtrière Hospital,
Paris,
France
| | - E Manno
- University Department of Pediatrics, Unit of Immune and Infectious Diseases,
Children's Hospital Bambino Gesù,
Rome,
Italy,Chair of Pediatrics, Department of Systems Medicine,
University of Rome ‘Tor Vergata’,
Italy
| | - Nadia Mora
- University Department of Pediatrics, Unit of Immune and Infectious Diseases,
Children's Hospital Bambino Gesù,
Rome,
Italy
| | - A Compagnucci
- INSERM SC10-US019 Clinical Trials and Infectious Diseases,
Villejuif Paris,
France
| | - B Wahren
- Department of Microbiology,
Tumor and Cell Biology, Karolinska Institutet,
Stockholm,
Sweden
| | - MÁ Muñoz-Fernández
- Department of Molecular ImmunoBiology,
Hospital General Universitario Gregorio Marañon,
Madrid,
Spain
| | - A De Rossi
- Section of Oncology and Immunology, Department of Surgery, Oncology and Gastroenterology-DiSCOG,
University of Padova & Istituto Oncologico Veneto(IOV)-IRCCS,
Padova Padova,
Italy
| | - J Ananworanich
- US Military HIV Research Program, Walter Reed Army Institute of Research and Henry M Jackson Foundation for the Advancement of Military Medicine,
Maryland,
USA
| | - D Pillay
- Africa Centre,
KwaZulu Natal,
South Africa
| | - C Giaquinto
- Department of Women's and Child's Health, Paediatric Infectious Diseases Unit,
University of Padova and PENTA Foundation,
Italy
| | - P Rossi
- University Department of Pediatrics, Unit of Immune and Infectious Diseases,
Children's Hospital Bambino Gesù,
Rome,
Italy,Chair of Pediatrics, Department of Systems Medicine,
University of Rome ‘Tor Vergata’,
Italy
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40
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Pfeiffer D, Hagendorff A, Kühne C, Reinhardt S, Klein N. [Implantable cardioverter-defibrillator at the end of life]. Herzschrittmacherther Elektrophysiol 2015; 26:134-140. [PMID: 26001358 DOI: 10.1007/s00399-015-0366-6] [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] [Received: 03/10/2015] [Accepted: 03/24/2015] [Indexed: 06/04/2023]
Abstract
Brady- and tachyarrhythmias at the end of life are common observations. Implantable cardioverter-defibrillators answer with antibrady and antitachycardia pacing, which will not be associated with any complaints of the dying patient. In contrast, defibrillation and cardioversion shocks are extremely painful. Therefore shocks should be inactivated at the end of life. Family doctors, internists, emergency physicians and paramedics are unable to inactivate shocks. Deactivation of shocks at the end of life is not comparable to euthanasia or assisted suicide, but allow the patient to die at the end of an uncurable endstage disease. Deactivation of shocks should be discussed with the patient before initial implantation of the devices. The precise moment of the inactivation at the end of life should be discussed with patients and relatives. There is no common recommendation for the time schedule of this decision; therefore it should be based on the individual situation of the patient. Emergency health care physicians need magnets and sufficient information to inactivate defibrillators. The wishes of the patient have priority in the decision process and should be written in the patient's advance directive, which must be available in the final situation. However the physician must not necessarily follow every wish of the patient. As long as the laws in the European Union are not uniform, German recommendations are needed.
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Affiliation(s)
- D Pfeiffer
- Abt. Kardiologie & Angiologie, Dept. Innere Medizin, Neurologie und Dermatologie, Universität Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland,
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41
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Patel P, Tuke P, Tettmar K, Cloutman-Green E, Hartley J, Klein N, Veys P, Tedder RS. No evidence of transfusion transmission of Adenovirus and Epstein-Barr virus infections in paediatric recipients post-bone marrow transplant. Vox Sang 2015; 109:95-7. [PMID: 25827634 DOI: 10.1111/vox.12256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 12/16/2014] [Accepted: 01/12/2015] [Indexed: 11/30/2022]
Abstract
Adenovirus and Epstein-Barr virus can cause significant morbidity and mortality in paediatric patients post-bone marrow transplant. The source of infection is thought to be either reactivation of latent viruses or primary infection. We have investigated whether transfusion of blood components from viraemic donors could provide a route of primary infection in these patients and sought the prevalence of viraemia in the blood donor population from England. In 32 linked donor/recipient samples and 300 unselected blood donors, we found no evidence to suggest that these infections in paediatric bone marrow transplant recipients had been acquired from transfused blood components.
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Affiliation(s)
- P Patel
- R & D Transfusion Microbiology, NHS Blood and Transplant, London, UK.,Blood Borne Virus Unit, Public Health England, London, UK
| | - P Tuke
- R & D Transfusion Microbiology, NHS Blood and Transplant, London, UK.,Blood Borne Virus Unit, Public Health England, London, UK
| | - K Tettmar
- R & D Transfusion Microbiology, NHS Blood and Transplant, London, UK.,Blood Borne Virus Unit, Public Health England, London, UK
| | - E Cloutman-Green
- Camelia Botnar Laboratory, Great Ormond Street Hospital, London, UK
| | - J Hartley
- Camelia Botnar Laboratory, Great Ormond Street Hospital, London, UK
| | - N Klein
- Infectious Diseases and Microbiology, Institute of Child Health, London, UK
| | - P Veys
- Bone Marrow Transplant Unit, Great Ormond Street Hospital, London, UK
| | - R S Tedder
- R & D Transfusion Microbiology, NHS Blood and Transplant, London, UK.,Blood Borne Virus Unit, Public Health England, London, UK
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42
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Klein N, de With K, Lefman M, Schönfeld N, Rüssmann H, Bauer TT. Antibiotikaverbrauch in einer pneumologischen Klinik: Punkt-Prävalenz-Analyse zur Einschätzung von ABS (Antibiotic Stewardship)-Strategien. Pneumologie 2015. [DOI: 10.1055/s-0035-1544847] [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: 10/24/2022]
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43
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Bamford A, Turkova A, Lyall H, Foster C, Klein N, Bastiaans D, Burger D, Bernadi S, Butler K, Chiappini E, Clayden P, Della Negra M, Giacomet V, Giaquinto C, Gibb D, Galli L, Hainaut M, Koros M, Marques L, Nastouli E, Niehues T, Noguera-Julian A, Rojo P, Rudin C, Scherpbier HJ, Tudor-Williams G, Welch SB. Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV-1 infection 2015: optimizing health in preparation for adult life. HIV Med 2015; 19:e1-e42. [PMID: 25649230 PMCID: PMC5724658 DOI: 10.1111/hiv.12217] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2014] [Indexed: 02/06/2023]
Abstract
The 2015 Paediatric European Network for Treatment of AIDS (PENTA) guidelines provide practical recommendations on the management of HIV‐1 infection in children in Europe and are an update to those published in 2009. Aims of treatment have progressed significantly over the last decade, moving far beyond limitation of short‐term morbidity and mortality to optimizing health status for adult life and minimizing the impact of chronic HIV infection on immune system development and health in general. Additionally, there is a greater need for increased awareness and minimization of long‐term drug toxicity. The main updates to the previous guidelines include: an increase in the number of indications for antiretroviral therapy (ART) at all ages (higher CD4 thresholds for consideration of ART initiation and additional clinical indications), revised guidance on first‐ and second‐line ART recommendations, including more recently available drug classes, expanded guidance on management of coinfections (including tuberculosis, hepatitis B and hepatitis C) and additional emphasis on the needs of adolescents as they approach transition to adult services. There is a new section on the current ART ‘pipeline’ of drug development, a comprehensive summary table of currently recommended ART with dosing recommendations. Differences between PENTA and current US and World Health Organization guidelines are highlighted and explained.
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Affiliation(s)
- A Bamford
- Department of Paediatric Infectious Diseases and Immunology, Great Ormond Street Hospital NHS Trust, London, UK
| | - A Turkova
- Medical Research Council Clinical Trials Unit, London, UK
| | - H Lyall
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, UK
| | - C Foster
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, UK
| | - N Klein
- Institute of Child Health, University College London, London, UK
| | - D Bastiaans
- Radboud University Medical Center, Nijmegan, The Netherlands
| | - D Burger
- Radboud University Medical Center, Nijmegan, The Netherlands
| | - S Bernadi
- University Department of Immunology and Infectious Disease, Bambino Gesù Children's Hospital, Rome, Italy
| | - K Butler
- Our Lady's Children's Hospital Crumlin & University College Dublin, Dublin, Ireland
| | - E Chiappini
- Meyer University Hospital, Florence University, Florence, Italy
| | | | - M Della Negra
- Emilio Ribas Institute of Infectious Diseases, Sao Paulo, Brazil
| | - V Giacomet
- Paediatric Infectious Disease Unit, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - C Giaquinto
- Department of Paediatrics, University of Padua, Padua, Italy
| | - D Gibb
- Medical Research Council Clinical Trials Unit, London, UK
| | - L Galli
- Department of Health Sciences, Pediatric Unit, University of Florence, Florence, Italy
| | - M Hainaut
- Department of Pediatrics, CHU Saint-Pierre, Free University of Brussels, Brussels, Belgium
| | - M Koros
- Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - L Marques
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Pediatric Department, Porto Central Hospital, Porto, Portugal
| | - E Nastouli
- Department of Clinical Microbiology and Virology, University College London Hospitals, London, UK
| | - T Niehues
- Centre for Pediatric and Adolescent Medicine, HELIOS Hospital Krefeld, Krefeld, Germany
| | - A Noguera-Julian
- Infectious Diseases Unit, Pediatrics Department, Sant Joan de Déu Hospital, University of Barcelona, Barcelona, Spain
| | - P Rojo
- 12th of October Hospital, Madrid, Spain
| | - C Rudin
- University Children's Hospital, Basel, Switzerland
| | - H J Scherpbier
- Department of Paediatric Immunology and Infectious Diseases, Emma Children's Hospital Academic Medical Centre, Amsterdam, The Netherlands
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44
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Andrikopoulos G, Tzeis S, Asbach S, Semmler V, Lennerz C, Solzbach U, Grebmer C, Kloppe A, Klein N, Pastromas S, Biermann J, Kolb C. A stepwise electrocardiographic algorithm for differentiation of mid-septal vs. apical right ventricular lead positioning: the SPICE ECG substudy. Europace 2015; 17:915-20. [DOI: 10.1093/europace/euu344] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 11/06/2014] [Indexed: 01/29/2023] Open
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Doyle RM, Alber DG, Jones HE, Harris K, Fitzgerald F, Peebles D, Klein N. Term and preterm labour are associated with distinct microbial community structures in placental membranes which are independent of mode of delivery. Placenta 2014; 35:1099-101. [PMID: 25458966 DOI: 10.1016/j.placenta.2014.10.007] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 10/10/2014] [Accepted: 10/13/2014] [Indexed: 10/24/2022]
Abstract
Infection is considered a possible trigger for preterm labour, supported by evidence showing the presence of bacteria in the placenta and placental membranes from preterm births. In this study, 16S rDNA pyrosequencing was used to identify bacteria in placental membranes. Caesarean sections and vaginal deliveries at term were found to harbour common genera. Mycoplasma hominis, Aerococcus christensenii, Gardnerella vaginalis and Fusobacterium nucleatum were either only present in preterm membranes or in greater abundance than at term. These data support previous studies that used either targeted qPCR or broad-range 16S rDNA PCR and cloning but not a recent microbiome analysis of placental tissue using high-throughput sequencing.
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Affiliation(s)
- R M Doyle
- Infection, Inflammation and Rheumatology Section, Institute of Child Health, London, United Kingdom.
| | - D G Alber
- Infection, Inflammation and Rheumatology Section, Institute of Child Health, London, United Kingdom.
| | - H E Jones
- Infection, Inflammation and Rheumatology Section, Institute of Child Health, London, United Kingdom.
| | - K Harris
- Microbiology Department, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, United Kingdom.
| | - F Fitzgerald
- Infection, Inflammation and Rheumatology Section, Institute of Child Health, London, United Kingdom.
| | - D Peebles
- Department of Maternal and Fetal Medicine, Institute for Womens Health, University College London, London, United Kingdom.
| | - N Klein
- Infection, Inflammation and Rheumatology Section, Institute of Child Health, London, United Kingdom.
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46
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Seel F, Klein N. Bildung von Amidophosphaten und Amidophosphorsäure aus N-Methylcarbamoylphosphaten / Formation of Amidophosphates and Amidophosphoric Acid from N-Methylcarbamoyl Phosphates. ACTA ACUST UNITED AC 2014. [DOI: 10.1515/znb-1983-0702] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
The synthesis of various amidophosphates can be readily accomplished in aqueous solutions by the reaction of amines with solutions of sodium, potassium or ammonium N-methylcarbamoyl phosphate, prepared by the reaction of methylisocyanate with the corresponding hydrogen phosphates. Procedures for the synthesis of NH4[O3PNH3] and Ca[O3PNH2CH3]2 · 4 H2O are described in detail.
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Affiliation(s)
- Fritz Seel
- Fachrichtung Anorganische Chemie der Universität des Saarlandes, Fachbereich 13, Anorganische Chemie, D-6600 Saarbrücken
| | - N. Klein
- Fachrichtung Anorganische Chemie der Universität des Saarlandes, Fachbereich 13, Anorganische Chemie, D-6600 Saarbrücken
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Nanthapisal S, Eleftheriou D, Hong Y, Klein N, Brogan PA. PReS-FINAL-2363: Behçet's disease in children: the Great Ormond Street Hospital experience. Pediatr Rheumatol Online J 2013. [PMCID: PMC4045081 DOI: 10.1186/1546-0096-11-s2-p353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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48
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Klein N, Klein M, Pfeiffer D. [Pacemaker, cardiac resynchonisation, implantable cardioverter/defibrillator, event monitoring]. Dtsch Med Wochenschr 2013; 138:2526-9. [PMID: 24281961 DOI: 10.1055/s-0033-1349644] [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: 10/26/2022]
Affiliation(s)
- N Klein
- Abteilung Kardiologie/Angiologie, Universitätsklinikum Leipzig
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Halsey NA, Griffioen M, Dreskin SC, Dekker CL, Wood R, Sharma D, Jones JF, LaRussa PS, Garner J, Berger M, Proveaux T, Vellozzi C, Broder K, Setse R, Pahud B, Hrncir D, Choi H, Sparks R, Williams SE, Engler RJ, Gidudu J, Baxter R, Klein N, Edwards K, Cano M, Kelso JM. Immediate hypersensitivity reactions following monovalent 2009 pandemic influenza A (H1N1) vaccines: reports to VAERS. Vaccine 2013; 31:6107-12. [PMID: 24120547 DOI: 10.1016/j.vaccine.2013.09.066] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 08/29/2013] [Accepted: 09/10/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Hypersensitivity disorders following vaccinations are a cause for concern. OBJECTIVE To determine the type and rate by age, gender, and vaccine received for reported hypersensitivity reactions following monovalent 2009 pandemic influenza A (H1N1) vaccines. DESIGN A systematic review of reports to the Vaccine Adverse Event Reporting System (VAERS) following monovalent 2009 pandemic influenza A (H1N1) vaccines. SETTING/PATIENTS US Civilian reports following vaccine received from October 1, 2009 through May 31, 2010. MEASUREMENTS Age, gender, vaccines received, diagnoses, clinical signs, and treatment were reviewed by nurses and physicians with expertise in vaccine adverse events. A panel of experts, including seven allergists reviewed complex illnesses and those with conflicting evidence for classification of the event. RESULTS Of 1984 reports, 1286 were consistent with immediate hypersensitivity disorders and 698 were attributed to anxiety reactions, syncope, or other illnesses. The female-to-male ratio was ≥4:1 for persons 20-to-59 years of age, but approximately equal for children under 10. One hundred eleven reports met Brighton Collaboration criteria for anaphylaxis; only one-half received epinephrine for initial therapy. The overall rate of reported hypersensitivity reactions was 10.7 per million vaccine doses distributed, with a 2-fold higher rate for live vaccine. LIMITATIONS Underreporting, especially of mild events, would result in an underestimate of the true rate of immediate hypersensitivity reactions. Selective reporting of events in adult females could have resulted in higher rates than reported for males. CONCLUSIONS Adult females may be at higher risk of hypersensitivity reactions after influenza vaccination than men. Although the risk of hypersensitivity reactions following 2009 pandemic influenza A (H1N1) vaccines was low, all clinics administering vaccines should be familiar with treatment guidelines for these adverse events, including the use of intramuscular epinephrine early in the course of serious hypersensitivity reactions.
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Affiliation(s)
- Neal A Halsey
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Shoukier M, Klein N, Auber B, Wickert J, Schröder J, Zoll B, Burfeind P, Bartels I, Alsat EA, Lingen M, Grzmil P, Schulze S, Keyser J, Weise D, Borchers M, Hobbiebrunken E, Röbl M, Gärtner J, Brockmann K, Zirn B. Array CGH in patients with developmental delay or intellectual disability: are there phenotypic clues to pathogenic copy number variants? Clin Genet 2013; 83:53-65. [DOI: 10.1111/j.1399-0004.2012.01850.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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