1
|
Mian MUM, Kennedy CE, Coss-Bu JA, Javaid R, Naeem B, Lam FW, Fogarty T, Arikan AA, Nguyen TC, Bashir D, Virk M, Harpavat S, Galvan NTN, Rana AA, Goss JA, Leung DH, Desai MS. Estimating risk of prolonged mechanical ventilation after liver transplantation in children: PROVE-ALT score. Pediatr Transplant 2024; 28:e14623. [PMID: 37837221 DOI: 10.1111/petr.14623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 07/11/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Children at high risk for prolonged mechanical ventilation (PMV) after liver transplantation (LT) need to be identified early to optimize pulmonary support, allocate resources, and improve surgical outcomes. We aimed to develop and validate a metric that can estimate risk for Prolonged Ventilation After LT (PROVE-ALT). METHODS We identified preoperative risk factors for PMV by univariable analysis in a retrospective cohort of pediatric LT recipients between 2011 and 2017 (n = 205; derivation cohort). We created the PROVE-ALT score by mapping multivariable logistic regression coefficients as integers, with cutoff values using the Youden Index. We validated the score by C-statistic in a retrospectively collected separate cohort of pediatric LT recipients between 2018 and 2021 (n = 133, validation cohort). RESULTS Among total 338 patients, 21% (n = 72) were infants; 49% (n = 167) had cirrhosis; 8% (n = 27) required continuous renal replacement therapy (CRRT); and 32% (n = 111) required management in hospital (MIH) before LT. Incidence of PMV post-LT was 20% (n = 69) and 3% (n = 12) required tracheostomy. Independent risk factors (OR [95% CI]) for PMV were cirrhosis (3.8 [1-14], p = .04); age <1-year (8.2 [2-30], p = .001); need for preoperative CRRT (6.3 [1.2-32], p = .02); and MIH before LT (12.4 [2.1-71], p = .004). PROVE-ALT score ≥8 [Range = 0-21] accurately predicted PMV in the validation cohort with 73% sensitivity and 80% specificity (AUC: 0.81; 95% CI: 0.71-0.91). CONCLUSION PROVE-ALT can predict PMV after pediatric LT with a high degree of sensitivity and specificity. Once externally validated in other centers, PROVE-ALT will empower clinicians to plan patient-specific ventilation strategies, provide parental anticipatory guidance, and optimize hospital resources.
Collapse
Affiliation(s)
- Muhammad Umair M Mian
- Division of Child Health, University of Missouri School of Medicine, Springfield Clinical Campus, Columbia, Missouri, USA
| | - Curtis E Kennedy
- Department of Pediatrics, Division of Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Jorge A Coss-Bu
- Department of Pediatrics, Division of Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Ramsha Javaid
- Division of Child Health, University of Missouri School of Medicine, Springfield Clinical Campus, Columbia, Missouri, USA
| | - Buria Naeem
- Department of Pediatrics, Division of Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Fong Wilson Lam
- Department of Pediatrics, Division of Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Thomas Fogarty
- Department of Pediatrics, Division of Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Ayse A Arikan
- Department of Pediatrics, Division of Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USA
- Department of Pediatrics, Division of Nephrology, Baylor College of Medicine, Houston, Texas, USA
| | - Trung C Nguyen
- Department of Pediatrics, Division of Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Dalia Bashir
- Department of Pediatrics, Division of Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Manpreet Virk
- Department of Pediatrics, Division of Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Sanjiv Harpavat
- Department of Pediatrics, Division of Gastroenterology, Baylor College of Medicine, Houston, Texas, USA
| | - Nhu Thao Nguyen Galvan
- Department of Surgery, Division of Abdominal Transplantation and Hepatobiliary Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Abbas A Rana
- Department of Surgery, Division of Abdominal Transplantation and Hepatobiliary Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - John A Goss
- Department of Surgery, Division of Abdominal Transplantation and Hepatobiliary Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Daniel H Leung
- Department of Pediatrics, Division of Gastroenterology, Baylor College of Medicine, Houston, Texas, USA
| | - Moreshwar S Desai
- Department of Pediatrics, Division of Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
2
|
Thungathurthi K, Antoniou E, Arachchi A, Tay Y, Nguyen TC, Lim J, Chouhan H, Narasimhan V, Teoh W. Surgical management of splenic flexure cancer: is there an optimal technique? A bi-national registry analysis. ANZ J Surg 2023; 93:1854-1860. [PMID: 37158233 DOI: 10.1111/ans.18469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 03/29/2023] [Accepted: 04/09/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Splenic flexure tumours (SFC) are uncommon and present at more advanced disease stages. The optimal surgical technique for SFC remains controversial. We sought to compare the short-term outcomes of a left hemicolectomy (LHC) versus an extended resection (subtotal colectomy, STC) for SFCs. METHODS A retrospective analysis using the Binational Colorectal Cancer Audit (BCCA) registry was performed. All patients with SFC who underwent elective or emergency surgery for a SFC between 2010 and 2021 were included. Primary outcomes included short-term inpatient complications. Secondary outcomes included survival outcomes. RESULTS Six hundred and ninety-nine patients underwent resections for SFCs. A LHC was more common, performed in 64.1%. Patients having a LHC were significantly older, with proportionally more LHCs done laparoscopically. Overall grade III/IV complications were similar between both operations. Prolonged ileus and return to theatre were significantly higher in patients undergoing a STC. On multivariate analysis, anastomotic leak and overall grade III/IV complications were not independently associated with the type of operation. There was no difference in medial survival based on type of operation. Higher tumour stage (Stage III/IV) were independently associated with worse survival. CONCLUSION Segmental and extended resections are both oncologically sound procedures for SFCs. Segmental resections are associated with lower rates of prolonged ileus.
Collapse
Affiliation(s)
| | - Ellathios Antoniou
- Department of Colorectal Surgery, Monash Health, Melbourne, Victoria, Australia
| | - Asiri Arachchi
- Department of Colorectal Surgery, Monash Health, Melbourne, Victoria, Australia
| | - Yeng Tay
- Department of Colorectal Surgery, Monash Health, Melbourne, Victoria, Australia
| | - T C Nguyen
- Department of Colorectal Surgery, Monash Health, Melbourne, Victoria, Australia
| | - James Lim
- Department of Colorectal Surgery, Monash Health, Melbourne, Victoria, Australia
| | - Hanumant Chouhan
- Department of Colorectal Surgery, Monash Health, Melbourne, Victoria, Australia
| | - Vignesh Narasimhan
- Department of Colorectal Surgery, Monash Health, Melbourne, Victoria, Australia
| | - William Teoh
- Department of Colorectal Surgery, Monash Health, Melbourne, Victoria, Australia
| |
Collapse
|
3
|
Nguyen TC, Marini JC, Guillory B, Valladolid-Brown C, Martinez-Vargas M, Subramanyam D, Cohen D, Cirlos SC, Lam F, Stoll B, Didelija IC, Vonderohe C, Orellana R, Saini A, Pradhan S, Bashir D, Desai MS, Flores S, Virk M, Tcharmtchi H, Navaei A, Kaplan S, Lamberth L, Hulten KG, Scull BP, Allen CE, Akcan-Arikan A, Vijayan KV, Cruz MA. Pediatric Swine Model of Methicillin-Resistant Staphylococcus aureus Sepsis-Induced Coagulopathy, Disseminated Microvascular Thrombosis, and Organ Injuries. Crit Care Explor 2023; 5:e0916. [PMID: 37255626 PMCID: PMC10226618 DOI: 10.1097/cce.0000000000000916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Sepsis-induced coagulopathy leading to disseminated microvascular thrombosis is associated with high mortality and has no existing therapy. Despite the high prevalence of Gram-positive bacterial sepsis, especially methicillin-resistant Staphylococcus aureus (MRSA), there is a paucity of published Gram-positive pediatric sepsis models. Large animal models replicating sepsis-induced coagulopathy are needed to test new therapeutics before human clinical trials. HYPOTHESIS Our objective is to develop a pediatric sepsis-induced coagulopathy swine model that last 70 hours. METHODS AND MODELS Ten 3 weeks old piglets, implanted with telemetry devices for continuous hemodynamic monitoring, were IV injected with MRSA (n = 6) (USA300, Texas Children's Hospital 1516 strain) at 1 × 109 colony forming units/kg or saline (n = 4). Fluid resuscitation was given for heart rate greater than 50% or mean arterial blood pressure less than 30% from baseline. Acetaminophen and dextrose were provided as indicated. Point-of-care complete blood count, prothrombin time (PT), activated thromboplastin time, d-dimer, fibrinogen, and specialized coagulation assays were performed at pre- and post-injection, at 0, 24, 48, 60, and 70 hours. Piglets were euthanized and necropsies performed. RESULTS Compared with the saline treated piglets (control), the septic piglets within 24 hours had significantly lower neurologic and respiratory scores. Over time, PT, d-dimer, and fibrinogen increased, while platelet counts and activities of factors V, VII, protein C, antithrombin, and a disintegrin and metalloproteinase with thrombospondin-1 motifs (13th member of the family) (ADAMTS-13) decreased significantly in septic piglets compared with control. Histopathologic examination showed minor focal organ injuries including microvascular thrombi and necrosis in the kidney and liver of septic piglets. INTERPRETATIONS AND CONCLUSIONS We established a 70-hour swine model of MRSA sepsis-induced coagulopathy with signs of consumptive coagulopathy, disseminated microvascular thrombosis, and early organ injuries with histological minor focal organ injuries. This model is clinically relevant to pediatric sepsis and can be used to study dysregulated host immune response and coagulopathy to infection, identify potential early biomarkers, and to test new therapeutics.
Collapse
Affiliation(s)
- Trung C Nguyen
- Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, TX
- Center for Translational Research on Inflammatory Diseases at the Michael E. DeBakey Veteran Administration Medical Center, Houston, TX
- Baylor College of Medicine, Division of Thrombosis Research, Department of Medicine, Houston, TX
| | - Juan C Marini
- Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, TX
- USDA/Agricultural Research Service, Children's Nutrition Research Center, Houston, TX
| | - Bobby Guillory
- Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, TX
| | - Christian Valladolid-Brown
- Center for Translational Research on Inflammatory Diseases at the Michael E. DeBakey Veteran Administration Medical Center, Houston, TX
- Baylor College of Medicine, Division of Thrombosis Research, Department of Medicine, Houston, TX
| | - Marina Martinez-Vargas
- Center for Translational Research on Inflammatory Diseases at the Michael E. DeBakey Veteran Administration Medical Center, Houston, TX
- Baylor College of Medicine, Division of Thrombosis Research, Department of Medicine, Houston, TX
| | - Deepika Subramanyam
- Center for Translational Research on Inflammatory Diseases at the Michael E. DeBakey Veteran Administration Medical Center, Houston, TX
- Baylor College of Medicine, Division of Thrombosis Research, Department of Medicine, Houston, TX
| | - Daniel Cohen
- Center for Translational Research on Inflammatory Diseases at the Michael E. DeBakey Veteran Administration Medical Center, Houston, TX
- Baylor College of Medicine, Department of Pathology, Houston, TX
| | - Sonya C Cirlos
- Center for Translational Research on Inflammatory Diseases at the Michael E. DeBakey Veteran Administration Medical Center, Houston, TX
- Baylor College of Medicine, Division of Thrombosis Research, Department of Medicine, Houston, TX
| | - Fong Lam
- Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, TX
- Center for Translational Research on Inflammatory Diseases at the Michael E. DeBakey Veteran Administration Medical Center, Houston, TX
| | - Barbara Stoll
- USDA/Agricultural Research Service, Children's Nutrition Research Center, Houston, TX
| | - Inka C Didelija
- USDA/Agricultural Research Service, Children's Nutrition Research Center, Houston, TX
| | - Caitlin Vonderohe
- USDA/Agricultural Research Service, Children's Nutrition Research Center, Houston, TX
| | - Renan Orellana
- Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, TX
| | - Arun Saini
- Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, TX
- Center for Translational Research on Inflammatory Diseases at the Michael E. DeBakey Veteran Administration Medical Center, Houston, TX
| | - Subhashree Pradhan
- Center for Translational Research on Inflammatory Diseases at the Michael E. DeBakey Veteran Administration Medical Center, Houston, TX
- Baylor College of Medicine, Division of Thrombosis Research, Department of Medicine, Houston, TX
| | - Dalia Bashir
- Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, TX
| | - Moreshwar S Desai
- Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, TX
| | - Saul Flores
- Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, TX
| | - Manpreet Virk
- Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, TX
| | - Hossein Tcharmtchi
- Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, TX
| | - Amir Navaei
- Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, TX
| | - Sheldon Kaplan
- Division of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, TX
| | - Linda Lamberth
- Division of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, TX
| | - Kristina G Hulten
- Division of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, TX
| | - Brooks P Scull
- Division of Hematology and Oncology, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, TX
| | - Carl E Allen
- Division of Hematology and Oncology, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, TX
| | - Ayse Akcan-Arikan
- Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, TX
- Division of Critical Care & Nephrology, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, TX
| | - K Vinod Vijayan
- Center for Translational Research on Inflammatory Diseases at the Michael E. DeBakey Veteran Administration Medical Center, Houston, TX
- Baylor College of Medicine, Division of Thrombosis Research, Department of Medicine, Houston, TX
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Miguel A Cruz
- Center for Translational Research on Inflammatory Diseases at the Michael E. DeBakey Veteran Administration Medical Center, Houston, TX
- Baylor College of Medicine, Division of Thrombosis Research, Department of Medicine, Houston, TX
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| |
Collapse
|
4
|
Chaturvedi V, Marsh RA, Zoref-Lorenz A, Owsley E, Chaturvedi V, Nguyen TC, Goldman JR, Henry MM, Greenberg JN, Ladisch S, Hermiston ML, Jeng M, Naqvi A, Allen CE, Wong HR, Jordan MB. T-cell activation profiles distinguish hemophagocytic lymphohistiocytosis and early sepsis. Blood 2021; 137:2337-2346. [PMID: 33512385 PMCID: PMC8085480 DOI: 10.1182/blood.2020009499] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/25/2020] [Indexed: 12/18/2022] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a fatal disorder of immune hyperactivation that has been described as a cytokine storm. Sepsis due to known or suspected infection has also been viewed as a cytokine storm. Although clinical similarities between these syndromes suggest similar immunopathology and may create diagnostic uncertainty, distinguishing them is critical as treatments are widely divergent. We examined T-cell profiles from children with either HLH or sepsis and found that HLH is characterized by acute T-cell activation, in clear contrast to sepsis. Activated T cells in patients with HLH were characterized as CD38high/HLA-DR+ effector cells, with activation of CD8+ T cells being most pronounced. Activated T cells were type 1 polarized, proliferative, and displayed evidence of recent and persistent activation. Circulating activated T cells appeared to be broadly characteristic of HLH, as they were seen in children with and without genetic lesions or identifiable infections and resolved with conventional treatment of HLH. Furthermore, we observed even greater activation and type 1 polarization in tissue-infiltrating T cells, described here for the first time in a series of patients with HLH. Finally, we observed that a threshold of >7% CD38high/HLA-DR+ cells among CD8+ T cells had strong positive and negative predictive value for distinguishing HLH from early sepsis or healthy controls. We conclude that the cytokine storm of HLH is marked by distinctive T-cell activation whereas early sepsis is not, and that these 2 syndromes can be readily distinguished by T-cell phenotypes.
Collapse
Affiliation(s)
- Vandana Chaturvedi
- Division of Immunobiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH
| | - Rebecca A Marsh
- Division of Bone Marrow Transplantation and Immune Deficiency, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Adi Zoref-Lorenz
- Division of Immunobiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Erika Owsley
- Division of Bone Marrow Transplantation and Immune Deficiency, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Vijaya Chaturvedi
- Division of Bone Marrow Transplantation and Immune Deficiency, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Trung C Nguyen
- Section of Critical Care, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Jordana R Goldman
- Center for Translational Research on Inflammatory Diseases, Michael E. DeBakey VA Medical Center, Houston, TX
| | - Michael M Henry
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, AZ
| | - Jay N Greenberg
- Division of Hematology, Department of Pediatrics, Children's National Hospital, Washington, DC
| | - Stephan Ladisch
- Division of Hematology, Department of Pediatrics, Children's National Hospital, Washington, DC
| | - Michelle L Hermiston
- Division of Hematology Oncology, Department of Pediatrics, UCSF School of Medicine, San Francisco, CA
| | - Michael Jeng
- Hematology and Oncology, Department of Pediatrics, Stanford Medical School, Stanford, CA
| | - Ahmed Naqvi
- Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Carl E Allen
- Section of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX; and
| | - Hector R Wong
- Division of Critical Care, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Michael B Jordan
- Division of Immunobiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH
- Division of Bone Marrow Transplantation and Immune Deficiency, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| |
Collapse
|
5
|
Mohammad MA, Didelija IC, Stoll B, Nguyen TC, Marini JC. Pegylated arginine deiminase depletes plasma arginine but maintains tissue arginine availability in young pigs. Am J Physiol Endocrinol Metab 2021; 320:E641-E652. [PMID: 33427052 PMCID: PMC7988784 DOI: 10.1152/ajpendo.00472.2020] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Pegylated arginine deiminase (ADI-PEG20) results in the depletion of arginine with the production of isomolar amounts of citrulline. This citrulline has the potential to be utilized by the citrulline recycling pathway regenerating arginine and sustaining tissue arginine availability. The goal of this research was to test the hypothesis that ADI-PEG20 depletes circulating arginine in pigs but maintains tissue arginine concentration and function, and to characterize the kinetics of citrulline and arginine. Two multitracer approaches (bolus dose and primed-continuous infusion) were used to investigate the metabolism of arginine and citrulline in Control (n = 7) and ADI-PEG20 treated (n = 8) pigs during the postprandial period. In addition, blood pressure was monitored by telemetry, and multiple tissues were collected to determine arginine concentration. Plasma arginine was depleted immediately after ADI-PEG20 administration, with an increase in plasma citrulline concentration (P < 0.01). The depletion of arginine did not affect (P > 0.10) blood pressure, whole body protein synthesis, or urea production. Despite the lack of circulating arginine in ADI-PEG20-treated pigs, most tissues were able to maintain concentrations similar (P > 0.10) to those in Control animals. The kinetics of citrulline and arginine indicated the high citrulline turnover and regeneration of arginine through the citrulline recycling pathway. ADI-PEG20 administration resulted in an absolute and almost instantaneous depletion of circulating arginine, thus reducing global availability without affecting cardiovascular parameters and protein metabolism. The citrulline produced from the deimination of arginine was in turn utilized by the citrulline recycling pathway restoring local tissue arginine availability.NEW & NOTEWORTHY Pegylated arginine deiminase depletes circulating arginine, but the citrulline generated is utilized by multiple tissues to regenerate arginine and sustain local arginine availability. Preempting the arginine depletion that occurs as result of sepsis and trauma with arginine deiminase offers the possibility of maintaining tissue arginine availability despite negligible plasma arginine concentrations.
Collapse
Affiliation(s)
- Mahmoud A Mohammad
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas
- Food Science and Nutrition Department, National Research Centre, Giza, Egypt
| | - Inka C Didelija
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas
| | - Barbara Stoll
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas
| | - Trung C Nguyen
- Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Juan C Marini
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas
- Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
6
|
Bashir DA, Da Q, Pradhan S, Sekhar N, Valladolid C, Lam F, Guffey D, Goldman J, Desai MS, Cruz MA, Allen C, Nguyen TC, Vijayan KV. Secretion of von Willebrand Factor and Suppression of ADAMTS-13 Activity by Markedly High Concentration of Ferritin. Clin Appl Thromb Hemost 2021; 27:1076029621992128. [PMID: 33539188 PMCID: PMC7868463 DOI: 10.1177/1076029621992128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Hyperferritinemia is associated with poor outcomes in critically ill patients with sepsis, hemophagocytic lymphohistiocytosis (HLH), macrophage activation syndromes (MAS) and coronavirus disease 19 (COVID-19). Autopsies of hyperferritinemic patients that succumbed to either sepsis, HLH, MAS or COVID-19 have revealed disseminated microvascular thromboses with von Willebrand factor (VWF)-, platelets-, and/or fibrin-rich microthrombi. It is unknown whether high plasma ferritin concentration actively promotes microvascular thrombosis, or merely serves as a prognostic biomarker in these patients. Here, we show that secretion of VWF from human umbilical vein endothelial cells (HUVEC) is significantly enhanced by 100,000 ng/ml of recombinant ferritin heavy chain protein (FHC). Ferritin fraction that was isolated by size exclusion chromatography from the plasma of critically ill HLH patients promoted VWF secretion from HUVEC, compared to similar fraction from non-critically ill control plasma. Furthermore, recombinant FHC moderately suppressed the activity of VWF cleaving metalloprotease ADAMTS-13. These observations suggest that a state of marked hyperferritinemia could promote thrombosis and organ injury by inducing endothelial VWF secretion and reducing the ADAMTS-13 activity.
Collapse
Affiliation(s)
- Dalia A Bashir
- Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.,Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), Houston, TX, USA
| | - Qi Da
- Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Subhashree Pradhan
- Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Nitin Sekhar
- Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Christian Valladolid
- Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Fong Lam
- Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.,Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), Houston, TX, USA
| | - Danielle Guffey
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
| | - Jordana Goldman
- Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - Moreshwar S Desai
- Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - Miguel A Cruz
- Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.,Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Carl Allen
- Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - Trung C Nguyen
- Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.,Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), Houston, TX, USA
| | - K Vinod Vijayan
- Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.,Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
7
|
Abstract
Thrombocytopenia-associated multiple organ failure is a clinical phenotype encompassing a spectrum of syndromes associated with disseminated microvascular thromboses. Autopsies performed in patients that died with thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, or disseminated intravascular coagulation reveal specific findings that can differentiate these 3 entities. Significant advancements have been made in our understanding of the pathologic mechanisms of these syndromes. Von Willebrand factor and ADAMTS-13 play a central role in thrombotic thrombocytopenic purpura. Shiga toxins and the complement pathway drive the hemolytic uremic syndrome pathology. Tissue factor activity is vital in the development of disseminated intravascular coagulation.
Collapse
Affiliation(s)
- Trung C Nguyen
- Department of Pediatrics, Critical Care Medicine Section, Texas Children's Hospital/Baylor College of Medicine, 6651 Main Street, MC: E 1420, Houston, TX 77030, USA; The Center for Translational Research on Inflammatory Diseases (CTRID), The Michael E. DeBakey Veteran Administration Medical Center, Houston, TX 77030, USA.
| |
Collapse
|
8
|
Weiss SL, Peters MJ, Alhazzani W, Agus MSD, Flori HR, Inwald DP, Nadel S, Schlapbach LJ, Tasker RC, Argent AC, Brierley J, Carcillo J, Carrol ED, Carroll CL, Cheifetz IM, Choong K, Cies JJ, Cruz AT, De Luca D, Deep A, Faust SN, De Oliveira CF, Hall MW, Ishimine P, Javouhey E, Joosten KFM, Joshi P, Karam O, Kneyber MCJ, Lemson J, MacLaren G, Mehta NM, Møller MH, Newth CJL, Nguyen TC, Nishisaki A, Nunnally ME, Parker MM, Paul RM, Randolph AG, Ranjit S, Romer LH, Scott HF, Tume LN, Verger JT, Williams EA, Wolf J, Wong HR, Zimmerman JJ, Kissoon N, Tissieres P. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med 2020; 46:10-67. [PMID: 32030529 PMCID: PMC7095013 DOI: 10.1007/s00134-019-05878-6] [Citation(s) in RCA: 266] [Impact Index Per Article: 66.5] [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: 12/16/2022]
Abstract
Objectives To develop evidence-based recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with septic shock and other sepsis-associated organ dysfunction. Design A panel of 49 international experts, representing 12 international organizations, as well as three methodologists and three public members was convened. Panel members assembled at key international meetings (for those panel members attending the conference), and a stand-alone meeting was held for all panel members in November 2018. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. Teleconferences and electronic-based discussion among the chairs, co-chairs, methodologists, and group heads, as well as within subgroups, served as an integral part of the guideline development process. Methods The panel consisted of six subgroups: recognition and management of infection, hemodynamics and resuscitation, ventilation, endocrine and metabolic therapies, adjunctive therapies, and research priorities. We conducted a systematic review for each Population, Intervention, Control, and Outcomes question to identify the best available evidence, statistically summarized the evidence, and then assessed the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. We used the evidence-to-decision framework to formulate recommendations as strong or weak, or as a best practice statement. In addition, “in our practice” statements were included when evidence was inconclusive to issue a recommendation, but the panel felt that some guidance based on practice patterns may be appropriate. Results The panel provided 77 statements on the management and resuscitation of children with septic shock and other sepsis-associated organ dysfunction. Overall, six were strong recommendations, 49 were weak recommendations, and nine were best-practice statements. For 13 questions, no recommendations could be made; but, for 10 of these, “in our practice” statements were provided. In addition, 52 research priorities were identified. Conclusions A large cohort of international experts was able to achieve consensus regarding many recommendations for the best care of children with sepsis, acknowledging that most aspects of care had relatively low quality of evidence resulting in the frequent issuance of weak recommendations. Despite this challenge, these recommendations regarding the management of children with septic shock and other sepsis-associated organ dysfunction provide a foundation for consistent care to improve outcomes and inform future research.
Collapse
Affiliation(s)
- Scott L Weiss
- Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Mark J Peters
- Great Ormond Street Hospital for Children, London, UK
| | - Waleed Alhazzani
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods and Impact, McMaster University, Hamilton, ON, Canada
| | - Michael S D Agus
- Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | | | - Luregn J Schlapbach
- Paediatric Critical Care Research Group, The University of Queensland and Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Robert C Tasker
- Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrew C Argent
- Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa
| | - Joe Brierley
- Great Ormond Street Hospital for Children, London, UK
| | | | | | | | | | - Karen Choong
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods and Impact, McMaster University, Hamilton, ON, Canada
| | - Jeffry J Cies
- St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | | | - Daniele De Luca
- Paris South University Hospitals-Assistance Publique Hopitaux de Paris, Paris, France.,Physiopathology and Therapeutic Innovation Unit-INSERM U999, South Paris-Saclay University, Paris, France
| | | | - Saul N Faust
- University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
| | | | - Mark W Hall
- Nationwide Children's Hospital, Columbus, OH, USA
| | | | | | | | - Poonam Joshi
- All India Institute of Medical Sciences, New Delhi, India
| | - Oliver Karam
- Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | | | - Joris Lemson
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Graeme MacLaren
- National University Health System, Singapore, Singapore.,Royal Children's Hospital, Melbourne, VIC, Australia
| | - Nilesh M Mehta
- Department of Anesthesiology, Critical Care and Pain, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | | | - Akira Nishisaki
- Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Mark E Nunnally
- New York University Langone Medical Center, New York, NY, USA
| | | | - Raina M Paul
- Advocate Children's Hospital, Park Ridge, IL, USA
| | - Adrienne G Randolph
- Department of Anesthesiology, Critical Care and Pain, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | | | | | - Judy T Verger
- Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,College of Nursing, University of Iowa, Iowa City, IA, USA
| | | | - Joshua Wolf
- St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | | | | | - Pierre Tissieres
- Paris South University Hospitals-Assistance Publique Hopitaux de Paris, Paris, France.,Institute of Integrative Biology of the Cell-CNRS, CEA, Univ Paris Sud, Gif-Sur-Yvette, France
| |
Collapse
|
9
|
Weiss SL, Peters MJ, Alhazzani W, Agus MSD, Flori HR, Inwald DP, Nadel S, Schlapbach LJ, Tasker RC, Argent AC, Brierley J, Carcillo J, Carrol ED, Carroll CL, Cheifetz IM, Choong K, Cies JJ, Cruz AT, De Luca D, Deep A, Faust SN, De Oliveira CF, Hall MW, Ishimine P, Javouhey E, Joosten KFM, Joshi P, Karam O, Kneyber MCJ, Lemson J, MacLaren G, Mehta NM, Møller MH, Newth CJL, Nguyen TC, Nishisaki A, Nunnally ME, Parker MM, Paul RM, Randolph AG, Ranjit S, Romer LH, Scott HF, Tume LN, Verger JT, Williams EA, Wolf J, Wong HR, Zimmerman JJ, Kissoon N, Tissieres P. Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children. Pediatr Crit Care Med 2020; 21:e52-e106. [PMID: 32032273 DOI: 10.1097/pcc.0000000000002198] [Citation(s) in RCA: 458] [Impact Index Per Article: 114.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To develop evidence-based recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with septic shock and other sepsis-associated organ dysfunction. DESIGN A panel of 49 international experts, representing 12 international organizations, as well as three methodologists and three public members was convened. Panel members assembled at key international meetings (for those panel members attending the conference), and a stand-alone meeting was held for all panel members in November 2018. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. Teleconferences and electronic-based discussion among the chairs, co-chairs, methodologists, and group heads, as well as within subgroups, served as an integral part of the guideline development process. METHODS The panel consisted of six subgroups: recognition and management of infection, hemodynamics and resuscitation, ventilation, endocrine and metabolic therapies, adjunctive therapies, and research priorities. We conducted a systematic review for each Population, Intervention, Control, and Outcomes question to identify the best available evidence, statistically summarized the evidence, and then assessed the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. We used the evidence-to-decision framework to formulate recommendations as strong or weak, or as a best practice statement. In addition, "in our practice" statements were included when evidence was inconclusive to issue a recommendation, but the panel felt that some guidance based on practice patterns may be appropriate. RESULTS The panel provided 77 statements on the management and resuscitation of children with septic shock and other sepsis-associated organ dysfunction. Overall, six were strong recommendations, 52 were weak recommendations, and nine were best-practice statements. For 13 questions, no recommendations could be made; but, for 10 of these, "in our practice" statements were provided. In addition, 49 research priorities were identified. CONCLUSIONS A large cohort of international experts was able to achieve consensus regarding many recommendations for the best care of children with sepsis, acknowledging that most aspects of care had relatively low quality of evidence resulting in the frequent issuance of weak recommendations. Despite this challenge, these recommendations regarding the management of children with septic shock and other sepsis-associated organ dysfunction provide a foundation for consistent care to improve outcomes and inform future research.
Collapse
Affiliation(s)
- Scott L Weiss
- Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Mark J Peters
- Great Ormond Street Hospital for Children, London, United Kingdom
| | - Waleed Alhazzani
- Department of Medicine, Division of Critical Care, and Department of Health Research Methods and Impact, McMaster University, Hamilton, ON, Canada
| | - Michael S D Agus
- Department of Pediatrics (to Dr. Agus), Department of Anesthesiology, Critical Care and Pain (to Drs. Mehta and Randolph), Boston Children's Hospital and Harvard Medical School, Boston, MA
| | | | | | | | - Luregn J Schlapbach
- Paediatric Critical Care Research Group, The University of Queensland and Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Robert C Tasker
- Department of Pediatrics (to Dr. Agus), Department of Anesthesiology, Critical Care and Pain (to Drs. Mehta and Randolph), Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Andrew C Argent
- Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa
| | - Joe Brierley
- Great Ormond Street Hospital for Children, London, United Kingdom
| | | | | | | | | | - Karen Choong
- Department of Medicine, Division of Critical Care, and Department of Health Research Methods and Impact, McMaster University, Hamilton, ON, Canada
| | - Jeffry J Cies
- St. Christopher's Hospital for Children, Philadelphia, PA
| | | | - Daniele De Luca
- Paris South University Hospitals-Assistance Publique Hopitaux de Paris, Paris, France.,Physiopathology and Therapeutic Innovation Unit-INSERM U999, South Paris-Saclay University, Paris, France
| | - Akash Deep
- King's College Hospital, London, United Kingdom
| | - Saul N Faust
- University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, United Kingdom
| | | | - Mark W Hall
- Nationwide Children's Hospital, Columbus, OH
| | | | | | | | - Poonam Joshi
- All India Institute of Medical Sciences, New Delhi, India
| | - Oliver Karam
- Children's Hospital of Richmond at VCU, Richmond, VA
| | | | - Joris Lemson
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Graeme MacLaren
- National University Health System, Singapore, and Royal Children's Hospital, Melbourne, VIC, Australia
| | - Nilesh M Mehta
- Department of Pediatrics (to Dr. Agus), Department of Anesthesiology, Critical Care and Pain (to Drs. Mehta and Randolph), Boston Children's Hospital and Harvard Medical School, Boston, MA
| | | | | | | | - Akira Nishisaki
- Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | | | | | | | - Adrienne G Randolph
- Department of Pediatrics (to Dr. Agus), Department of Anesthesiology, Critical Care and Pain (to Drs. Mehta and Randolph), Boston Children's Hospital and Harvard Medical School, Boston, MA
| | | | | | | | - Lyvonne N Tume
- University of the West of England, Bristol, United Kingdom
| | - Judy T Verger
- Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.,College of Nursing, University of Iowa, Iowa City, IA
| | | | - Joshua Wolf
- St. Jude Children's Research Hospital, Memphis, TN
| | | | | | - Niranjan Kissoon
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Pierre Tissieres
- Paris South University Hospitals-Assistance Publique Hopitaux de Paris, Paris, France.,Institute of Integrative Biology of the Cell-CNRS, CEA, Univ Paris Sud, Gif-sur-Yvette, France
| |
Collapse
|
10
|
Steen EH, Lasa JJ, Nguyen TC, Keswani SG, Checchia PA, Anders MM. Central Venous Catheter-Related Deep Vein Thrombosis in the Pediatric Cardiac Intensive Care Unit. J Surg Res 2019; 241:149-159. [PMID: 31026793 DOI: 10.1016/j.jss.2019.03.052] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/08/2019] [Accepted: 03/22/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Central venous catheter (CVC) use is common in the management of critically ill children, especially those with congenital heart disease. CVCs are known to augment the risk of deep vein thrombosis (DVT), but data on CVC-associated DVTs in the pediatric cardiac intensive care unit (CICU) are limited. In this study, we aim to identify the incidence of and risk factors for CVC-related DVT in this high-risk population, as its complications are highly morbid. MATERIALS AND METHODS The PC4 database and a radiologic imaging database were retrospectively reviewed for the demographics and outcomes of patients admitted to the Texas Children's Hospital CICU requiring CVC placement, as well as the incidence of DVT and its complications. RESULTS Between January 2017 and December 2017, 1215 central lines were placed over 851 admissions. DVT was diagnosed in 8% of admissions with a CVC, 29% of which demonstrated thrombus in the inferior vena cava. The risk factors significantly associated with DVT included the presence of >1 line, higher total line hours, longer intubation times, and extended CICU stay. A diagnosis of low cardiac output syndrome, sepsis, central line-associated bloodstream infection, and cardiac catheterization were also significant risk factors. Interestingly, cardiac surgery with cardiopulmonary bypass appeared to be protective of clot development. DVT was a highly significant risk factor for mortality in these patients. CONCLUSIONS CVC-related DVTs in critically ill children with congenital heart disease are associated with higher risks of morbidity and mortality, highlighting the need for well-designed studies to determine the best preventative and treatment strategies and to establish guidelines for appropriate monitoring and follow-up of these patients.
Collapse
Affiliation(s)
- Emily H Steen
- Department of Surgery, Baylor College of Medicine, Houston, Texas; Laboratory for Regenerative Tissue Repair, Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Javier J Lasa
- Section of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Trung C Nguyen
- Section of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Sundeep G Keswani
- Laboratory for Regenerative Tissue Repair, Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas; Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Paul A Checchia
- Section of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Marc M Anders
- Section of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
| |
Collapse
|
11
|
Suhardja TS, Buxey K, Teoh WMK, Nguyen TC, Chouhan H. Utilisation of a modified Roeder's knot in the era of minimal invasive surgery. Tech Coloproctol 2019; 23:1101-1104. [PMID: 30976928 DOI: 10.1007/s10151-019-01986-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 04/05/2019] [Indexed: 10/27/2022]
Affiliation(s)
- T S Suhardja
- Colorectal Surgery Unit, Monash Health, Dandenong Hospital, 135 David Street, Dandenong, VIC, 3175, Australia. .,Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia.
| | - K Buxey
- Colorectal Surgery Unit, Monash Health, Dandenong Hospital, 135 David Street, Dandenong, VIC, 3175, Australia
| | - W M K Teoh
- Colorectal Surgery Unit, Monash Health, Dandenong Hospital, 135 David Street, Dandenong, VIC, 3175, Australia.,Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia
| | - T C Nguyen
- Colorectal Surgery Unit, Monash Health, Dandenong Hospital, 135 David Street, Dandenong, VIC, 3175, Australia
| | - H Chouhan
- Colorectal Surgery Unit, Monash Health, Dandenong Hospital, 135 David Street, Dandenong, VIC, 3175, Australia
| |
Collapse
|
12
|
Alcamo AM, Pang D, Bashir DA, Carcillo JA, Nguyen TC, Aneja RK. Role of Damage-Associated Molecular Patterns and Uncontrolled Inflammation in Pediatric Sepsis-Induced Multiple Organ Dysfunction Syndrome. J Pediatr Intensive Care 2018; 8:25-31. [PMID: 31073505 DOI: 10.1055/s-0038-1675639] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 03/19/2018] [Indexed: 01/20/2023] Open
Abstract
The incidence of multiple organ dysfunction syndrome (MODS) in sepsis varies from 17 to 73% and furthermore, increases the risk of death by 60% when controlled for the number of dysfunctional organs. Several MODS phenotypes exist, each unique in presentation and pathophysiology. Common to the phenotypes is the stimulation of the immune response by pathogen-associated molecular patterns (PAMPs), or danger-associated molecular patterns (DAMPs) causing an unremitting inflammation. Two of the MODS phenotypes are discussed in detail, thrombocytopenia-associated multiple organ failure (TAMOF) and the hyperinflammatory phenotype-macrophage activating syndrome (MAS) and hemophagocytic lymphohistiocytosis (HLH). In the end, we will briefly review the role of mitochondrial dysfunction as a significant contributor to the pathogenesis of MODS.
Collapse
Affiliation(s)
- Alicia M Alcamo
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States.,Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Diana Pang
- Department of Critical Care Medicine, Children's Hospital of the King's Daughters, Norfolk, Virginia, United States
| | - Dalia A Bashir
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, United States.,Michael E. DeBakey Veteran Affairs Medical Center, Center for Translational Research on Inflammatory Diseases, Houston, Texas, United States
| | - Joseph A Carcillo
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States.,Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Trung C Nguyen
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, United States.,Michael E. DeBakey Veteran Affairs Medical Center, Center for Translational Research on Inflammatory Diseases, Houston, Texas, United States
| | - Rajesh K Aneja
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States.,Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| |
Collapse
|
13
|
Chinn IK, Eckstein OS, Peckham-Gregory EC, Goldberg BR, Forbes LR, Nicholas SK, Mace EM, Vogel TP, Abhyankar HA, Diaz MI, Heslop HE, Krance RA, Martinez CA, Nguyen TC, Bashir DA, Goldman JR, Stray-Pedersen A, Pedroza LA, Poli MC, Aldave-Becerra JC, McGhee SA, Al-Herz W, Chamdin A, Coban-Akdemir ZH, Jhangiani SN, Muzny DM, Cao TN, Hong DN, Gibbs RA, Lupski JR, Orange JS, McClain KL, Allen CE. Genetic and mechanistic diversity in pediatric hemophagocytic lymphohistiocytosis. Blood 2018; 132:89-100. [PMID: 29632024 PMCID: PMC6034641 DOI: 10.1182/blood-2017-11-814244] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 04/03/2018] [Indexed: 11/20/2022] Open
Abstract
The HLH-2004 criteria are used to diagnose hemophagocytic lymphohistiocytosis (HLH), yet concern exists for their misapplication, resulting in suboptimal treatment of some patients. We sought to define the genomic spectrum and associated outcomes of a diverse cohort of children who met the HLH-2004 criteria. Genetic testing was performed clinically or through research-based whole-exome sequencing. Clinical metrics were analyzed with respect to genomic results. Of 122 subjects enrolled over the course of 17 years, 101 subjects received genetic testing. Biallelic familial HLH (fHLH) gene defects were identified in only 19 (19%) and correlated with presentation at younger than 1 year of age (P < .0001). Digenic fHLH variants were observed but lacked statistical support for disease association. In 28 (58%) of 48 subjects, research whole-exome sequencing analyses successfully identified likely molecular explanations, including underlying primary immunodeficiency diseases, dysregulated immune activation and proliferation disorders, and potentially novel genetic conditions. Two-thirds of patients identified by the HLH-2004 criteria had underlying etiologies for HLH, including genetic defects, autoimmunity, and malignancy. Overall survival was 45%, and increased mortality correlated with HLH triggered by infection or malignancy (P < .05). Differences in survival did not correlate with genetic profile or extent of therapy. HLH should be conceptualized as a phenotype of critical illness characterized by toxic activation of immune cells from different underlying mechanisms. In most patients with HLH, targeted sequencing of fHLH genes remains insufficient for identifying pathogenic mechanisms. Whole-exome sequencing, however, may identify specific therapeutic opportunities and affect hematopoietic stem cell transplantation options for these patients.
Collapse
Affiliation(s)
- Ivan K Chinn
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Department of Pediatrics, Texas Children's Hospital, Houston, TX
- Division of Pediatric Immunology/Allergy/Rheumatology and
| | - Olive S Eckstein
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Department of Pediatrics, Texas Children's Hospital, Houston, TX
- Division of Pediatric Hematology/Oncology, Texas Children's Hospital Cancer Center, Houston, TX
| | - Erin C Peckham-Gregory
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Division of Pediatric Hematology/Oncology, Texas Children's Hospital Cancer Center, Houston, TX
| | - Baruch R Goldberg
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Department of Pediatrics, Texas Children's Hospital, Houston, TX
- Division of Pediatric Immunology/Allergy/Rheumatology and
| | - Lisa R Forbes
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Department of Pediatrics, Texas Children's Hospital, Houston, TX
- Division of Pediatric Immunology/Allergy/Rheumatology and
| | - Sarah K Nicholas
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Department of Pediatrics, Texas Children's Hospital, Houston, TX
- Division of Pediatric Immunology/Allergy/Rheumatology and
| | - Emily M Mace
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Department of Pediatrics, Texas Children's Hospital, Houston, TX
- Division of Pediatric Immunology/Allergy/Rheumatology and
| | - Tiphanie P Vogel
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Department of Pediatrics, Texas Children's Hospital, Houston, TX
- Division of Pediatric Immunology/Allergy/Rheumatology and
| | - Harshal A Abhyankar
- Department of Pediatrics, Texas Children's Hospital, Houston, TX
- Division of Pediatric Hematology/Oncology, Texas Children's Hospital Cancer Center, Houston, TX
| | - Maria I Diaz
- Department of Pediatrics, Texas Children's Hospital, Houston, TX
- Division of Pediatric Hematology/Oncology, Texas Children's Hospital Cancer Center, Houston, TX
| | - Helen E Heslop
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Department of Pediatrics, Texas Children's Hospital, Houston, TX
- Division of Pediatric Hematology/Oncology, Texas Children's Hospital Cancer Center, Houston, TX
- Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX
| | - Robert A Krance
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Department of Pediatrics, Texas Children's Hospital, Houston, TX
- Division of Pediatric Hematology/Oncology, Texas Children's Hospital Cancer Center, Houston, TX
- Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX
| | - Caridad A Martinez
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Department of Pediatrics, Texas Children's Hospital, Houston, TX
- Division of Pediatric Hematology/Oncology, Texas Children's Hospital Cancer Center, Houston, TX
- Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX
| | - Trung C Nguyen
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Department of Pediatrics, Texas Children's Hospital, Houston, TX
- Division of Critical Care Medicine, Texas Children's Hospital, Houston, TX
- Center for Translational Research on Inflammatory Diseases, Michael E. DeBakey Veteran Affairs Medical Center, Houston, TX
| | - Dalia A Bashir
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Department of Pediatrics, Texas Children's Hospital, Houston, TX
- Division of Critical Care Medicine, Texas Children's Hospital, Houston, TX
- Center for Translational Research on Inflammatory Diseases, Michael E. DeBakey Veteran Affairs Medical Center, Houston, TX
| | - Jordana R Goldman
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Department of Pediatrics, Texas Children's Hospital, Houston, TX
- Division of Critical Care Medicine, Texas Children's Hospital, Houston, TX
| | - Asbjørg Stray-Pedersen
- Norwegian National Unit for Newborn Screening, Department of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Baylor-Hopkins Center for Mendelian Genomics, Houston, TX
| | - Luis A Pedroza
- Universidad San Francisco de Quito, Colegio de Ciencias de la Salud-Hospital de los Valles, Quito, Ecuador
| | - M Cecilia Poli
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Department of Pediatrics, Texas Children's Hospital, Houston, TX
- Universidad del Desarrollo, Clinica Alemana de Santiago, Santiago, Chile
| | - Juan C Aldave-Becerra
- Division of Allergy and Immunology, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - Sean A McGhee
- Division of Immunology and Allergy, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - Waleed Al-Herz
- Department of Pediatrics, Kuwait University, Kuwait City, Kuwait
| | - Aghiad Chamdin
- Department of Pediatrics and Human Development, Michigan State University, Lansing, MI; and
| | - Zeynep H Coban-Akdemir
- Baylor-Hopkins Center for Mendelian Genomics, Houston, TX
- Department of Molecular and Human Genetics and
| | - Shalini N Jhangiani
- Department of Molecular and Human Genetics and
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX
| | - Donna M Muzny
- Department of Molecular and Human Genetics and
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX
| | - Tram N Cao
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Department of Pediatrics, Texas Children's Hospital, Houston, TX
- Division of Pediatric Immunology/Allergy/Rheumatology and
| | - Diana N Hong
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Department of Pediatrics, Texas Children's Hospital, Houston, TX
- Division of Pediatric Immunology/Allergy/Rheumatology and
| | - Richard A Gibbs
- Baylor-Hopkins Center for Mendelian Genomics, Houston, TX
- Department of Molecular and Human Genetics and
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX
| | - James R Lupski
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Department of Pediatrics, Texas Children's Hospital, Houston, TX
- Baylor-Hopkins Center for Mendelian Genomics, Houston, TX
- Department of Molecular and Human Genetics and
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX
| | - Jordan S Orange
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Department of Pediatrics, Texas Children's Hospital, Houston, TX
- Division of Pediatric Immunology/Allergy/Rheumatology and
| | - Kenneth L McClain
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Department of Pediatrics, Texas Children's Hospital, Houston, TX
- Division of Pediatric Hematology/Oncology, Texas Children's Hospital Cancer Center, Houston, TX
| | - Carl E Allen
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Department of Pediatrics, Texas Children's Hospital, Houston, TX
- Division of Pediatric Hematology/Oncology, Texas Children's Hospital Cancer Center, Houston, TX
| |
Collapse
|
14
|
Chinn IK, Eckstein OS, Peckham-Gregory EC, Goldberg BR, Forbes LR, Nicholas SK, Mace EM, Vogel TP, Abhyankar HA, Diaz MI, Heslop HE, Krance RA, Martinez CA, Nguyen TC, Bashir DA, Goldman JR, Stray-Pedersen A, Pedroza LA, Poli MC, Aldave Becerra JC, McGhee SA, Coban-Akdemir ZH, Jhangiani SN, Muzny DM, Cao TN, Hong DN, Gibbs RA, Lupski JR, Orange JS, McClain KL, Allen CE. Genetic and Mechanistic Diversity in Hemophagocytic Lymphohistiocytosis. J Allergy Clin Immunol 2018. [DOI: 10.1016/j.jaci.2017.12.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
15
|
Abstract
Background Plasma therapies are being applied to thombotic syndromes, but there are limited controlled studies. Objective To review the evidence and the current practices for plasma therapies in thrombotic syndromes. Methods Expert-enhanced evidence-based analysis. Evidence obtained as of Dec 31, 2002 using Pub Med electronic reference library and expert-obtained library for a total of > 3,000 references obtained using the terms plasma therapy or plasma exchange or plasmapheresis or plasmafiltration or sorbents each combined with the words thrombotic syndrome or sepsis or septic shock. The authors screened the abstracts, reviewed the agreed set of papers, and compiled the recommendations. Results Plasma therapies, which alter the plasma components in patients, have been applied in thrombotic syndromes worldwide. In these patients, there is a biologic plausibility for plasma therapies since they have molecules that are prothrombotic and/or antifibrinolytic which would put them at risk for microvascular thrombosis and end-organ damage. There are respectively one randomized controlled trial (RCT) in primary thrombotic syndrome, and secondary thrombotic syndrome, which showed an improvement in mortality in applying plasma therapies (plasma exchange by centrifugation). However, there are numerous non-randomized and case series. Plasma exchange is accepted as the standard therapy for primary thrombotic syndrome as in thrombotic thrombocytopenic purpura (TTP). However, no consensus has been reached for plasma exchange in secondary thrombotic syndromes such as in sepsis, hemolytic uremic syndrome (HUS), thrombocytopenia associated multiple organ failure, TTP/HUS, s/p bone marrow or solid organ transplant, HELLP syndrome, immunologic disorders, drug exposure, or pancreatitis. Conclusions As we understand more about the pathophysiology of thrombotic syndromes, specific plasma therapies can be applied for the specific need of a particular patient population. There are sufficient preliminary data to recommend a definitive RCT to evaluate the efficacy of the different types of plasma therapies in secondary thrombotic syndromes.
Collapse
Affiliation(s)
- T C Nguyen
- Section of Critical Care, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | | | | | | | | |
Collapse
|
16
|
Peng ZY, Kiss JE, Cortese-Hasset A, Carcillo JA, Nguyen TC, Kellum JA. Plasma Filtration on Mediators of Thrombotic Microangiopathy: An in Vitro Study. Int J Artif Organs 2018; 30:401-6. [PMID: 17551903 DOI: 10.1177/039139880703000507] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives. Sepsis-induced thrombotic microangiopathy is successfully treated by plasma exchange therapy However, certain putative mediators of thrombotic microangiopathy may not be removed by plasma filtration. Methods. We conducted an in vitro study to determine whether plasma filtration can remove ultra-large von Willebrand factor (ULvWF) multimers and other mediators. In separate experiments, human umbilical venous endothelial cell (HUVEC) supernatant enriched with ULvWF or human whole blood was passed through a therapeutic plasma exchange (TPE 2000, PRISMA) filter and samples were taken for measurement of ULvWF, vWF ristocetin cofactor, vWF antigen and PAI-1. Results. The sieving coefficients for vWF and PAI-1 were above 0.9. The ULvWF was gradually eliminated, and nearly disappeared after four circulations. Conclusion. The TPE 2000 filter can directly remove potential mediators of sepsis-induced thrombotic microangiopathy.
Collapse
Affiliation(s)
- Z Y Peng
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261, USA
| | | | | | | | | | | |
Collapse
|
17
|
Lakosi L, Zsigrai J, Kocsonya A, Nguyen TC, Ramebäck H, Parsons-Moss T, Gharibyan N, Moody K. Gamma spectrometry in the ITWG CMX-4 exercise. J Radioanal Nucl Chem 2018; 315:409-416. [PMID: 29497227 PMCID: PMC5820385 DOI: 10.1007/s10967-017-5667-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Indexed: 11/09/2022]
Abstract
Low enriched uranium samples of unknown origin were analyzed by 16 laboratories in the context of a Collaborative Materials Exercise (CMX), organized by the Nuclear Forensics International Technical Working Group (ITWG). The purpose was to compare and prioritize nuclear forensic methods and techniques, and to evaluate attribution capabilities among participants. This paper gives a snapshot of the gamma spectrometric capabilities of the participating laboratories and summarizes the results achieved by gamma spectrometry.
Collapse
Affiliation(s)
- L Lakosi
- 1Nuclear Security Department, Hungarian Academy of Sciences, Centre for Energy Research, 29-33 Konkoly-Thege M., Budapest, 1121 Hungary
| | - J Zsigrai
- 2European Commission, Joint Research Centre, Directorate for Nuclear Safety and Security, P.O.Box 2340, 76125 Karlsruhe, Germany
| | - A Kocsonya
- 1Nuclear Security Department, Hungarian Academy of Sciences, Centre for Energy Research, 29-33 Konkoly-Thege M., Budapest, 1121 Hungary
| | - T C Nguyen
- 1Nuclear Security Department, Hungarian Academy of Sciences, Centre for Energy Research, 29-33 Konkoly-Thege M., Budapest, 1121 Hungary
| | - H Ramebäck
- 3Swedish Defence Research Agency, CBRN Defence and Security, Cementvägen 20, SE-901 82 Umeå, Sweden.,4Department of Chemistry and Chemical Engineering, Chalmers University of Technology, Kemivägen 4, SE-412 58 Göteborg, Sweden
| | - T Parsons-Moss
- 5Lawrence Livermore National Laboratory, P.O. Box 808, L-186, Livermore, CA 94551 USA
| | - N Gharibyan
- 5Lawrence Livermore National Laboratory, P.O. Box 808, L-186, Livermore, CA 94551 USA
| | - K Moody
- 5Lawrence Livermore National Laboratory, P.O. Box 808, L-186, Livermore, CA 94551 USA
| |
Collapse
|
18
|
Sims CR, Singh SP, Mu S, Gokden N, Zakaria D, Nguyen TC, Mayeux PR. Rolipram Improves Outcome in a Rat Model of Infant Sepsis-Induced Cardiorenal Syndrome. Front Pharmacol 2017; 8:237. [PMID: 28515693 PMCID: PMC5413568 DOI: 10.3389/fphar.2017.00237] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 03/14/2017] [Accepted: 04/18/2017] [Indexed: 02/06/2023] Open
Abstract
While the mortality rate associated with sepsis in children has fallen over the years, it still remains unacceptably high. The development of both acute cardiac dysfunction and acute kidney injury during severe sepsis is categorized as type 5 cardiorenal syndrome (CRS) and is poorly understood in infants. To address this lack of understanding and the need for an appropriate animal model in which to conduct relevant preclinical studies, we developed a model of infant sepsis-induced CRS in rat pups then evaluated the therapeutic potential of the phosphodiesterase (PDE) 4 inhibitor, rolipram. Rat pups at 17-18-days old were subjected to cecal ligation and puncture (CLP) to induce fecal polymicrobial sepsis. Uptake of Evans Blue dye was used to assess renal microvascular leakage. Intravital videomicroscopy was used to assess renal microvascular perfusion and oxidant generation. Glomerular filtration rate (GFR) was used to assess renal function. Left ventricular (LV) catheterization and echocardiography were used to assess cardiac function. Impairment of both cardiac and renal function developed rapidly following CLP, indicating type 5 CRS. Most notable were the rapid decline in LV diastolic function, the decline in cardiac output, renal microvascular failure, and the decline in GFR. A dose-response study with rolipram determined 0.1 mg/kg, ip as the lowest most efficacious dose to protect the renal microcirculation. Rolipram was then evaluated using a clinically relevant delayed dosing paradigm (a single dose at 6 h post-CLP). With delayed dosing, rolipram restored the renal microcirculation and reduced microvascular leakage but did not reduce oxidant generation in the kidney nor restore GFR. In contrast, delayed dosing with rolipram restored cardiac function. Rolipram also improved 4-days survival. In summary, CLP in the rat pup produces a clinically relevant pediatric model of sepsis-induced CRS. The PDE4 inhibitor rolipram was effective in improving renal microvascular function and cardiac function, which improved mortality. These findings suggest that rolipram should be evaluated further as adjunctive therapy for the septic infant with CRS.
Collapse
Affiliation(s)
- Clark R. Sims
- Department of Pharmacology and Toxicology, University of Arkansas for Medical Sciences, Little RockAR, USA
| | - Sharda P. Singh
- Department of Pharmacology and Toxicology, University of Arkansas for Medical Sciences, Little RockAR, USA
| | - Shengyu Mu
- Department of Pharmacology and Toxicology, University of Arkansas for Medical Sciences, Little RockAR, USA
| | - Neriman Gokden
- Department of Pathology, University of Arkansas for Medical Sciences, Little RockAR, USA
| | - Dala Zakaria
- Department of Pediatrics, Division of Pediatric Cardiology, University of Arkansas for Medical Sciences and Arkansas Children’s Hospital, Little RockAR, USA
| | - Trung C. Nguyen
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine and Center for Translational Research on Inflammatory Diseases, Michael E. DeBakey Veterans Affairs Medical Center, HoustonTX, USA
| | - Philip R. Mayeux
- Department of Pharmacology and Toxicology, University of Arkansas for Medical Sciences, Little RockAR, USA
| |
Collapse
|
19
|
Barmayehvar B, Nguyen TC, Sullivan A, Kalkat M. P271 Rates of resectable bronchiectasis and introduction of a referral framework for surgical management of bronchiectasis. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.414] [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: 11/03/2022]
|
20
|
Huynh DH, Nguyen TC, Nguyen PD, Abeyrathne CD, Hossain MS, Evans R, Skafidas E. Environmentally friendly power generator based on moving liquid dielectric and double layer effect. Sci Rep 2016; 6:26708. [PMID: 27255577 PMCID: PMC4891717 DOI: 10.1038/srep26708] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 05/03/2016] [Indexed: 11/24/2022] Open
Abstract
An electrostatic power generator converts mechanical energy to electrical energy by utilising the principle of variable capacitance. This change in capacitance is usually achieved by varying the gap or overlap between two parallel metallic plates. This paper proposes a novel electrostatic micro power generator where the change in capacitance is achieved by the movement of an aqueous solution of NaCl. A significant change in capacitance is achieved due to the higher than air dielectric constant of water and the Helmholtz double layer capacitor formed by ion separation at the electrode interfaces. The proposed device has significant advantages over traditional electrostatic devices which include low bias voltage and low mechanical frequency of operation. This is critical if the proposed device is to have utility in harvesting power from the environment. A figure of merit exceeding 10000(108μW)/(mm2HzV2) which is two orders of magnitude greater than previous devices, is demonstrated for a prototype operating at a bias voltage of 1.2 V and a droplet frequency of 6 Hz. Concepts are presented for large scale power harvesting.
Collapse
Affiliation(s)
- D H Huynh
- Centre for Neural Engineering, Bld 261, 203 Bouverie St, The University of Melbourne, Parkville, VIC 3010, Australia.,Department of Electrical and Electronic Engineering, Bld 193, Wilson Avenue, The University of Melbourne, Parkville, VIC 3010, Australia.,NICTA Victoria Research Laboratory, 115 Batman Street, West Melbourne VIC 3003, Australia
| | - T C Nguyen
- Centre for Neural Engineering, Bld 261, 203 Bouverie St, The University of Melbourne, Parkville, VIC 3010, Australia.,Department of Electrical and Electronic Engineering, Bld 193, Wilson Avenue, The University of Melbourne, Parkville, VIC 3010, Australia
| | - P D Nguyen
- Centre for Neural Engineering, Bld 261, 203 Bouverie St, The University of Melbourne, Parkville, VIC 3010, Australia.,Department of Electrical and Electronic Engineering, Bld 193, Wilson Avenue, The University of Melbourne, Parkville, VIC 3010, Australia.,NICTA Victoria Research Laboratory, 115 Batman Street, West Melbourne VIC 3003, Australia
| | - C D Abeyrathne
- Centre for Neural Engineering, Bld 261, 203 Bouverie St, The University of Melbourne, Parkville, VIC 3010, Australia.,Department of Electrical and Electronic Engineering, Bld 193, Wilson Avenue, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Md S Hossain
- Centre for Neural Engineering, Bld 261, 203 Bouverie St, The University of Melbourne, Parkville, VIC 3010, Australia.,Department of Electrical and Electronic Engineering, Bld 193, Wilson Avenue, The University of Melbourne, Parkville, VIC 3010, Australia.,NICTA Victoria Research Laboratory, 115 Batman Street, West Melbourne VIC 3003, Australia
| | - R Evans
- Centre for Neural Engineering, Bld 261, 203 Bouverie St, The University of Melbourne, Parkville, VIC 3010, Australia
| | - E Skafidas
- Centre for Neural Engineering, Bld 261, 203 Bouverie St, The University of Melbourne, Parkville, VIC 3010, Australia.,Department of Electrical and Electronic Engineering, Bld 193, Wilson Avenue, The University of Melbourne, Parkville, VIC 3010, Australia
| |
Collapse
|
21
|
Sims CR, Nguyen TC, Mayeux PR. Could Biomarkers Direct Therapy for the Septic Patient? J Pharmacol Exp Ther 2016; 357:228-39. [PMID: 26857961 DOI: 10.1124/jpet.115.230797] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 02/05/2016] [Indexed: 01/25/2023] Open
Abstract
Sepsis is a serious medical condition caused by a severe systemic inflammatory response to a bacterial, fungal, or viral infection that most commonly affects neonates and the elderly. Advances in understanding the pathophysiology of sepsis have resulted in guidelines for care that have helped reduce the risk of dying from sepsis for both children and older adults. Still, over the past three decades, a large number of clinical trials have been undertaken to evaluate pharmacological agents for sepsis. Unfortunately, all of these trials have failed, with the use of some agents even shown to be harmful. One key issue in these trials was the heterogeneity of the patient population that participated. What has emerged is the need to target therapeutic interventions to the specific patient's underlying pathophysiological processes, rather than looking for a universal therapy that would be effective in a "typical" septic patient, who does not exist. This review supports the concept that identification of the right biomarkers that can direct therapy and provide timely feedback on its effectiveness will enable critical care physicians to decrease mortality of patients with sepsis and improve the quality of life of survivors.
Collapse
Affiliation(s)
- Clark R Sims
- Department of Pharmacology and Toxicology, University of Arkansas for Medical Sciences, Little Rock, Arkansas (C.R.S., P.R.M.); and Department of Pediatrics, Section of Critical Care Medicine, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas (T.C.N.)
| | - Trung C Nguyen
- Department of Pharmacology and Toxicology, University of Arkansas for Medical Sciences, Little Rock, Arkansas (C.R.S., P.R.M.); and Department of Pediatrics, Section of Critical Care Medicine, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas (T.C.N.)
| | - Philip R Mayeux
- Department of Pharmacology and Toxicology, University of Arkansas for Medical Sciences, Little Rock, Arkansas (C.R.S., P.R.M.); and Department of Pediatrics, Section of Critical Care Medicine, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas (T.C.N.)
| |
Collapse
|
22
|
Janko N, Nguyen TC, Lubel J. Looking beyond the scope: recurrent rectal bleeding in a young woman. Gut 2015; 64:1119, 1157. [PMID: 25550181 DOI: 10.1136/gutjnl-2014-308740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 12/06/2014] [Indexed: 12/08/2022]
Affiliation(s)
- Natasha Janko
- Department of Gastroenterology and Hepatology, Eastern Health, Melbourne, Victoria, Australia
| | - T C Nguyen
- Department of Colorectal Surgery, Eastern Health, Melbourne, Victoria, Australia Department of Colorectal Surgery, Monash Health, Melbourne, Victoria, Australia
| | - John Lubel
- Department of Gastroenterology and Hepatology, Eastern Health, Melbourne, Victoria, Australia Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
23
|
Nguyen TC, Gushiken F, Correa JI, Dong JF, Dasgupta SK, Thiagarajan P, Cruz MA. A recombinant fragment of von Willebrand factor reduces fibrin-rich microthrombi formation in mice with endotoxemia. Thromb Res 2015; 135:1025-30. [PMID: 25769494 DOI: 10.1016/j.thromres.2015.02.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 02/24/2015] [Accepted: 02/25/2015] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Disseminated fibrin deposition in the microvasculature such as in disseminated intravascular coagulation (DIC) arises from uninhibited activated coagulation secondary to sustained systemic inflammation. Currently there is no treatment for DIC. Treating the underlying trigger and supportive care are the current recommendations to manage DIC. This study aims at using recombinant von Willebrand factor (VWF) A2 domain polypeptide to inhibit VWF-mediated platelet adhesion to fibrin and prevent DIC. MATERIALS AND METHODS We use flow chamber assay to test the capacity of purified A2 protein to inhibit platelet adhesion to immobilized fibrin(ogen) and platelet-fibrin clot formation. We use a murine model of lipopolysaccharide-induced DIC to examine the effect of A2 protein on DIC. RESULTS The A2 protein blocked flow-dependent platelet adhesion to fibrin, delayed fibrin polymerization, and inhibited platelet-fibrin clot formation in vitro. The infusion of the purified A2 protein to the endotoxin-treated mice prevented fibrin-rich microthrombi formation in brain, lung, kidney, and liver. It also attenuated levels of inflammatory mediators, and markedly reduced mortality rates at 96hours. CONCLUSIONS The A2 protein inhibited platelet interaction with fibrin(ogen). Furthermore, A2 prevented disseminated fibrin-rich microthrombi and decrease mortality in a lipopolysaccharide-induced DIC murine model. A2 could provide a novel therapeutic approach in critically ill patients with uninhibited activated coagulation and disseminated fibrin deposition such as DIC.
Collapse
Affiliation(s)
- Trung C Nguyen
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, TX 77030; Cardiovascular Research Section, Department of Medicine, Baylor College of Medicine, Houston, TX 77030; Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX 77030, United States
| | - Francisca Gushiken
- Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX 77030, United States
| | - Juliana I Correa
- Cardiovascular Research Section, Department of Medicine, Baylor College of Medicine, Houston, TX 77030
| | - Jing-Fei Dong
- Cardiovascular Research Section, Department of Medicine, Baylor College of Medicine, Houston, TX 77030
| | - Swapan K Dasgupta
- Department of Pathology, Michael E. DeBakey VA Medical Center, Houston, TX 77030, United States; Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX 77030, United States
| | - Perumal Thiagarajan
- Department of Pathology, Michael E. DeBakey VA Medical Center, Houston, TX 77030, United States; Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX 77030, United States
| | - Miguel A Cruz
- Cardiovascular Research Section, Department of Medicine, Baylor College of Medicine, Houston, TX 77030; Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX 77030, United States.
| |
Collapse
|
24
|
Soundar EP, Jariwala P, Nguyen TC, Eldin KW, Teruya J. Evaluation of the International Society on Thrombosis and Haemostasis and institutional diagnostic criteria of disseminated intravascular coagulation in pediatric patients. Am J Clin Pathol 2013; 139:812-6. [PMID: 23690126 DOI: 10.1309/ajcpo64iwnlycvvb] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Globally, adult intensive care units routinely use the International Society on Thrombosis and Haemostasis (ISTH) scoring system for identifying overt disseminated intravascular coagulation (DIC). However, in our pediatric intensive care unit, a modified diagnostic criterion (Texas Children's Hospital [TCH] criteria) that requires serial monitoring of the coagulation variables is employed. A retrospective analysis of 2,136 DIC panels from 130 patients who had at least 4 DIC panels during 1 admission to a pediatric intensive care unit was done to compare the diagnostic utility of the TCH criteria with the ISTH scoring method in children. Both scoring systems were evaluated against the gold standard diagnostic method of autopsy confirmation of DIC in the subset of children who died. Receiver operating characteristic analysis indicates that TCH diagnostic criteria are comparable to the ISTH scoring method (area under the curve of 0.878 for TCH and 0.950 for ISTH). On the contrary, TCH diagnostic criteria perform better, with a sensitivity significantly higher than the ISTH scoring method when tested against the gold standard (P < .05). Fibrinogen is not a significant predictor of overt DIC in both models. Sequential testing of coagulation parameters is recommended for improved sensitivity when applying ISTH criteria to pediatric populations.
Collapse
|
25
|
Desai MS, Koo SJ, Eblimit Z, Suryawan A, Coss‐Bu JA, Nguyen TC, Davis T, Orellana RA. Cholanemia induces skeletal muscle wasting despite stimulation of translation initiation, decreased autophagy, activation of Yes Associated Protein (YAP) and proteosomal signal activation in mice. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.631.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Sue Jie Koo
- Pediatrics ‐ Critical CareBaylor College of MedicineHoustonTX
- USDA/ARS Children's Nutrition Research CenterBaylor College of MedicineHoustonTX
| | - Zeena Eblimit
- Pediatrics ‐ Critical CareBaylor College of MedicineHoustonTX
| | - Agus Suryawan
- USDA/ARS Children's Nutrition Research CenterBaylor College of MedicineHoustonTX
| | - Jorge A Coss‐Bu
- Pediatrics ‐ Critical CareBaylor College of MedicineHoustonTX
| | - Trung C Nguyen
- Pediatrics ‐ Critical CareBaylor College of MedicineHoustonTX
| | - Teresa Davis
- USDA/ARS Children's Nutrition Research CenterBaylor College of MedicineHoustonTX
| | - Renan A Orellana
- Pediatrics ‐ Critical CareBaylor College of MedicineHoustonTX
- USDA/ARS Children's Nutrition Research CenterBaylor College of MedicineHoustonTX
| |
Collapse
|
26
|
|
27
|
Abstract
Thrombotic microangiopathies (TMAs) are syndromes associated with thrombocytopenia and multiple organ failure. Plasma exchange is a proven therapy for primary TMA such as thrombotic thrombocytopenic purpura (TTP). There is growing evidence that plasma exchange therapy might also facilitate resolution of organ dysfunction and improve outcomes for secondary TMAs such as disseminated intravascular coagulation (DIC) and systemic inflammation-induced TTP. In this review, we survey the current available evidence and practice of plasma exchange therapy for TMAs.
Collapse
Affiliation(s)
- Trung C Nguyen
- Section of Critical Care, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
| | | |
Collapse
|
28
|
Kindberg K, Carlhäll C, Karlsson M, Nguyen TC, Cheng A, Langer F, Rodriguez F, Daughters GT, Miller DC, Ingels NB. Transmural strains in the ovine left ventricular lateral wall during diastolic filling. J Biomech Eng 2009; 131:061004. [PMID: 19449958 DOI: 10.1115/1.3118774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Rapid early diastolic left ventricular (LV) filling requires a highly compliant chamber immediately after systole, allowing inflow at low driving pressures. The transmural LV deformations associated with such filling are not completely understood. We sought to characterize regional transmural LV strains during diastole, with focus on early filling, in ovine hearts at 1 week and 8 weeks after myocardial marker implantation. In seven normal sheep hearts, 13 radiopaque markers were inserted to silhouette the LV chamber and a transmural beadset was implanted into the lateral equatorial LV wall to measure transmural strains. Four-dimensional marker dynamics were obtained 1 week and 8 weeks thereafter with biplane videofluoroscopy in closed-chest, anesthetized animals. LV transmural strains in both cardiac and fiber-sheet coordinates were studied from filling onset to the end of early filling (EOEF, 100 ms after filling onset) and at end diastole. At the 8 week study, subepicardial circumferential strain (ECC) had reached its final value already at EOEF, while longitudinal and radial strains were nearly zero at this time. Subepicardial ECC and fiber relengthening (Eff) at EOEF were reduced to 1 compared with 8 weeks after surgery (ECC:0.02+/-0.01 to 0.08+/-0.02 and Eff:0.00+/-0.01 to 0.03+/-0.01, respectively, both P<0.05). Subepicardial ECC during early LV filling was associated primarily with fiber-normal and sheet-normal shears at the 1 week study, but to all three fiber-sheet shears and fiber relengthening at the 8 week study. These changes in LV subepicardial mechanics provide a possible mechanistic basis for regional myocardial lusitropic function, and may add to our understanding of LV myocardial diastolic dysfunction.
Collapse
Affiliation(s)
- K Kindberg
- Department of Management and Engineering, Linköping University, Linköping SE-581 83, Sweden
| | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Cullen PR, Millot P, Nguyen TC. Sheep histocompatibility antigens: a population level comparison between lymphocyte antigens previously defined in France, England and Scotland, and sheep red cell groups. Anim Blood Groups Biochem Genet 2009; 16:19-34. [PMID: 4003855 DOI: 10.1111/j.1365-2052.1985.tb01448.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A comparison test was performed to look for correlations between the three nomenclature systems for sheep histocompatibility antigens which have been previously described in France, England and Scotland. 187 French sheep from a wide variety of breeds were typed for lymphocyte antigens with antisera which detect the OLA, P and ED series of antigens; they were also tested against 387 uncharacterized French antisera. Six clusters of sera were found which showed correspondence between antigens of at least two of the three nomenclatures; five of these clusters gave high r values of 0.78-0.94. New antisera from French sheep were found which contributed to the above clusters but few additional clusters were noted. No correlation was found between any of the lymphocyte groups of antisera tested and the sheep red cell antigens which were also tested.
Collapse
|
30
|
Abstract
Genetic linkage between the Booroola locus (Fec) and 11 sheep blood polymorphic loci (i.e. Tf, Hb, CA, OLA, and A, B, C, D, M, R, F41 red cell blood groups) was investigated in six large sire families (163 informative female offspring). The six sires tested were heterozygous for the Booroola allele (FecB) and for several genetic markers. No evidence in favour of linkage was found. Moreover, depending on the marker locus considered, linkage closer than or as close as the recombination frequency of 10-30% was excluded.
Collapse
Affiliation(s)
- T C Nguyen
- INRA-CRJ, Laboratoire des Groupes sanguins, Jouy-en-Josas, France
| | | | | |
Collapse
|
31
|
Abstract
Rambouillet sheep originating from Spanish Merino have been maintained in France as a small and closed flock since their importation. After 190 years of independent evolution, the flock has markedly differentiated from its Spanish parental population. The observed differences between them were characterized by the fixation in Rambouillet of the Mb and F30 alleles, which occurred in Spanish Merino with frequencies of 0.90 and 0.80 respectively (at two distinct blood group loci M and F30) and by the absence in Rambouillet of other alleles or phenogroups (at the Tf and the A, B, C blood group loci) which were observed in Spanish Merino with frequencies ranging from 0.10 to 0.28. On the basis of their phenotypic distributions at 11 blood polymorphic loci, the two populations differed significantly from each other (total chi 2 values = 352.62, 23 df, P less than 0.001). By comparing the observed magnitude of gene frequency differences between Rambouillet and Spanish Merino with the estimate of inbreeding coefficient for Rambouillet obtained from pedigrees, it appeared that the observed genetic differences could be attributed to the evolutionary change due to random drift in the small and closed flock of Rambouillet.
Collapse
Affiliation(s)
- T C Nguyen
- Département de Génétique animale, INRA-CRJ, Jouy-en-Josas, France
| | | | | | | |
Collapse
|
32
|
Abstract
Linkage between the C and I blood group loci in sheep was demonstrated by lod score analysis of data from double backcross matings. The recombination frequency between the I locus and the gene coding for the Cb red cell antigen was estimated to be 0.09 with a standard error of 0.04.
Collapse
|
33
|
Brown CP, Nguyen TC, Moody HR, Crawford RW, Oloyede A. Assessment of common hyperelastic constitutive equations for describing normal and osteoarthritic articular cartilage. Proc Inst Mech Eng H 2009; 223:643-52. [DOI: 10.1243/09544119jeim546] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
With the aim of providing information for modelling joint and limb systems, widely available constitutive hyperelastic laws are evaluated in this paper for their ability to predict the mechanical responses of normal and osteoarthritic articular cartilage. Load—displacement data from mechanical indentation were obtained for normal and osteoarthritic cartilage at 0.1 s−1 and 0.025 s−1 and converted to the stress—stretch ratio. The data were then fitted to the ArrudA—Boyce, Mooney—Rivlin, neo-Hookean, Ogden, polynomial, and Yeoh hyperelastic laws in the MATLAB environment. Although each of the hyperelastic laws performed satisfactorily at the higher rate of loading, their ability to fit experimental data at the lower loading rate varied considerably. For the preferred models, coefficients were provided for stiff, soft, and average tissues to represent normal and degraded tissue at high and low loading rates. The present authors recommend the use of the Mooney—Rivlin or the Yeoh models for describing both normal and degraded articular cartilage, with the Mooney—Rivlin model providing the best compromise between accuracy and required computational power.
Collapse
Affiliation(s)
- C P Brown
- School of Engineering Systems, Queensland University of Technology, Brisbane, Australia
| | - T C Nguyen
- School of Engineering Systems, Queensland University of Technology, Brisbane, Australia
| | - H R Moody
- School of Engineering Systems, Queensland University of Technology, Brisbane, Australia
| | - R W Crawford
- School of Engineering Systems, Queensland University of Technology, Brisbane, Australia
| | - A Oloyede
- School of Engineering Systems, Queensland University of Technology, Brisbane, Australia
| |
Collapse
|
34
|
Abstract
AIMS To determine the incidence of retinopathy of prematurity (ROP) based upon a national database and to identify baseline characteristics, demographic information, comorbidities, and surgical interventions. METHODS The National Inpatient Sample, a representative sample of all US hospital discharges from 1997 to 2002, was queried for all newborn infants with and without ROP. Primary outcome variables included demographics, comorbidities, hospital length of stay (LOS), and hospital charges. Multivariate logistic regression was used to predict risk factors for ROP. RESULTS 4.67 million live births were recorded during the study period. The total incidence of ROP was 0.12% overall and 7.35% for premature infants with LOS greater than 14 days. Newborns with ROP were more likely to be born at a teaching hospital and to have higher LOS and hospitalisation charges. The odds ratios for the development of ROP were greatest in infants weighing less than 1250 grams. The multivariate regression model revealed that only respiratory distress and intraventricular haemorrhage were predictive of the development of ROP and Hispanic infants were 33% more likely to develop ROP. CONCLUSION This study represents the largest cohort of newborns analysed for ROP. The multivariate analysis emphasised the role of birth weight in extended-stay infants, as well as Hispanic race, respiratory distress syndrome, and intraventricular haemorrhage.
Collapse
Affiliation(s)
- E M Lad
- Department of Ophthalmology, Stanford University School of Medicine, 1225 Crane Street, Menlo Park, CA 94025, USA
| | | | | | | |
Collapse
|
35
|
Nguyen TC, Carcillo JA. Bench-to-bedside review: thrombocytopenia-associated multiple organ failure--a newly appreciated syndrome in the critically ill. Crit Care 2007; 10:235. [PMID: 17096864 PMCID: PMC1794442 DOI: 10.1186/cc5064] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
New onset thrombocytopenia and multiple organ failure (TAMOF) presages poor outcome in critical illness. Patients who resolve thrombocytopenia by day 14 are more likely to survive than those who do not. Patients with TAMOF have a spectrum of microangiopathic disorders that includes thrombotic thrombocytopenic purpura (TTP), disseminated intravascular coagulation (DIC) and secondary thrombotic microanigiopathy (TMA). Activated protein C is effective in resolving fibrin-mediated thrombosis (DIC); however, daily plasma exchange is the therapy of choice for removing ADAMTS 13 inhibitors and replenishing ADAMTS 13 activity which in turn resolves platelet: von Willebrand Factor mediated thrombosis (TTP/secondary TMA).
Collapse
Affiliation(s)
- Trung C Nguyen
- Texas Children's Hospital, 6621 Fannin St MC2-3450, Houston, TX 770330, USA
| | - Joseph A Carcillo
- Division CCM, 6th Floor, Children's Hospital of Pittsburgh, 3705 5th Avenue, Pittsburgh PA 15213, USA
| |
Collapse
|
36
|
Nguyen TC, Carcillo JA. Understanding the role of von Willebrand factor and its cleaving protease ADAM TS13 in the pathophysiology of critical illness. Pediatr Crit Care Med 2007; 8:187-9. [PMID: 17353760 DOI: 10.1097/01.ccm.0000257468.75474.d4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
37
|
Nguyen TC, Liu A, Liu L, Ball C, Choi H, May WS, Aboulfatova K, Bergeron AL, Dong JF. Acquired ADAMTS-13 deficiency in pediatric patients with severe sepsis. Haematologica 2007; 92:121-4. [PMID: 17229645 DOI: 10.3324/haematol.10262] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We studied the state of ultra-large von Willebrand factor (ULVWF) proteolysis in 21 pediatric patients with severe sepsis and found that the overall group of patients had moderately reduced ADAMTS-13 activity, but 31% had severe enzymatic deficiency. The severe deficiency correlated with greater adhesion activity of von Willebrand factor, severity of thrombocytopenia and plasma levels of interleukin-6. It also correlated clinically with severity of illness and organ dysfunction. These results suggest that ULVWF proteolysis is insufficient in septic patients and severely deficient in a subgroup of patients. The deficiency may contribute to the development of thrombocytopenia and ischemic organ failure associated with sepsis.
Collapse
Affiliation(s)
- Trung C Nguyen
- Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Han YY, Carcillo JA, Venkataraman ST, Clark RSB, Watson RS, Nguyen TC, Bayir H, Orr RA. Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system. Pediatrics 2005; 116:1506-12. [PMID: 16322178 DOI: 10.1542/peds.2005-1287] [Citation(s) in RCA: 768] [Impact Index Per Article: 40.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE In response to the landmark 1999 report by the Institute of Medicine and safety initiatives promoted by the Leapfrog Group, our institution implemented a commercially sold computerized physician order entry (CPOE) system in an effort to reduce medical errors and mortality. We sought to test the hypothesis that CPOE implementation results in reduced mortality among children who are transported for specialized care. METHODS Demographic, clinical, and mortality data were collected of all children who were admitted via interfacility transport to our regional, academic, tertiary-care level children's hospital during an 18-month period. A commercially sold CPOE program that operated within the framework of a general, medical-surgical clinical application platform was rapidly implemented hospital-wide over 6 days during this period. Retrospective analyses of pre-CPOE and post-CPOE implementation time periods (13 months before and 5 months after CPOE implementation) were subsequently performed. RESULTS Among 1942 children who were referred and admitted for specialized care during the study period, 75 died, accounting for an overall mortality rate of 3.86%. Univariate analysis revealed that mortality rate significantly increased from 2.80% (39 of 1394) before CPOE implementation to 6.57% (36 of 548) after CPOE implementation. Multivariate analysis revealed that CPOE remained independently associated with increased odds of mortality (odds ratio: 3.28; 95% confidence interval: 1.94-5.55) after adjustment for other mortality covariables. CONCLUSIONS We have observed an unexpected increase in mortality coincident with CPOE implementation. Although CPOE technology holds great promise as a tool to reduce human error during health care delivery, our unanticipated finding suggests that when implementing CPOE systems, institutions should continue to evaluate mortality effects, in addition to medication error rates, for children who are dependent on time-sensitive therapies.
Collapse
Affiliation(s)
- Yong Y Han
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Lejeune A, Espern A, Phung DC, Nguyen TC, Miegeville M. Mise en évidence du premier cas de microsporidiose intestinale à Enterocytozoon bieneusi chez un patient VIH positif à Hanoï, Vietnam. Med Mal Infect 2005; 35:425-6. [PMID: 16139460 DOI: 10.1016/j.medmal.2005.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2005] [Accepted: 06/22/2005] [Indexed: 11/23/2022]
|
40
|
Pirpiris M, Wilkinson AJ, Rodda J, Nguyen TC, Baker RJ, Nattrass GR, Graham HK. Walking speed in children and young adults with neuromuscular disease: comparison between two assessment methods. J Pediatr Orthop 2003; 23:302-7. [PMID: 12724591] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Self-selected walking speed is being increasingly used as a primary outcome measure in the management of neuromuscular disease. It would be useful if the speed recorded in the gait laboratory represented the child's walking speed in the community. This study investigated the difference in self-selected walking speeds between a 10-meter walk, as measured during instrumented gait analysis, and a 10-minute walk. The authors found that self-selected walking speed during the 10-minute walk was slower than the self-selected walking speed recorded during the 10-meter walk. The former may be more representative of walking speed in the community setting. Walking speed measured during walks of 10 minutes or more should become an integral part of gait laboratory evaluation.
Collapse
Affiliation(s)
- M Pirpiris
- Hugh Williamson Gait Analysis Laboratory, Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia
| | | | | | | | | | | | | |
Collapse
|
41
|
Berg M, Tran HC, Nguyen TC, Pham HV, Schertenleib R, Giger W. Arsenic contamination of groundwater and drinking water in Vietnam: a human health threat. Environ Sci Technol 2001; 35:2621-6. [PMID: 11452583 DOI: 10.1021/es010027y] [Citation(s) in RCA: 448] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This is the first publication on arsenic contamination of the Red River alluvial tract in the city of Hanoi and in the surrounding rural districts. Due to naturally occurring organic matter in the sediments, the groundwaters are anoxic and rich in iron. With an average arsenic concentration of 159 micrograms/L, the contamination levels varied from 1 to 3050 micrograms/L in rural groundwater samples from private small-scale tubewells. In a highly affected rural area, the groundwater used directly as drinking water had an average concentration of 430 micrograms/L. Analysis of raw groundwater pumped from the lower aquifer for the Hanoi water supply yielded arsenic levels of 240-320 micrograms/L in three of eight treatment plants and 37-82 micrograms/L in another five plants. Aeration and sand filtration that are applied in the treatment plants for iron removal lowered the arsenic concentrations to levels of 25-91 micrograms/L, but 50% remained above the Vietnamese Standard of 50 micrograms/L. Extracts of sediment samples from five bore cores showed a correlation of arsenic and iron contents (r2 = 0.700, n = 64). The arsenic in the sediments may be associated with iron oxyhydroxides and released to the groundwater by reductive dissolution of iron. Oxidation of sulfide phases could also release arsenic to the groundwater, but sulfur concentrations in sediments were below 1 mg/g. The high arsenic concentrations found in the tubewells (48% above 50 micrograms/L and 20% above 150 micrograms/L) indicate that several million people consuming untreated groundwater might be at a considerable risk of chronic arsenic poisoning.
Collapse
Affiliation(s)
- M Berg
- Swiss Federal Institute for Environmental Science and Technology (EAWAG), CH-8600 Dübendorf, Switzerland.
| | | | | | | | | | | |
Collapse
|
42
|
Abstract
This paper reports the blood groups and blood protein distribution in West African sheep breeds. About 100 animals of the Djallonke, Fulani and Touabire breeds were sampled for blood polymorphism analysis. Their blood groups were typed by haemolytic and agglutination reactions, and their blood proteins by starch gel electrophoresis. Almost all the loci analysed showed variability in the three breeds, with the Touabire and Fulani being closer to each other than to the Djallonke.
Collapse
Affiliation(s)
- A Missohou
- Service de Zootechnie-Alimentation, Ecole Inter-Etats des Sciences et Médecine Vétérinaires (EISMV), Dakar, Sénégal
| | | | | | | |
Collapse
|
43
|
Missohou A, Nguyen TC, Dorchies P, Gueye A, Sow RS. Note on transferrin, hemoglobin types, and packed cell volume in Senegalese trypanotolerant Djallonke sheep. Ann N Y Acad Sci 1998; 849:209-12. [PMID: 9668466 DOI: 10.1111/j.1749-6632.1998.tb11050.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In this study we examined transferrin (Tf) and hemoglobin (Hb) types and frequencies and their relationship with Packed Cell Volume (PCV), which is considered as a selection criterion for the trypanotolerance trait. Blood samples were collected from 96 sheep and were typed for Tf and Hb. The frequencies of the alleles TfA, TfB, TfC and TfD were respectively 0.276, 0.005, 0.109, and 0.609. At the locus Hb, all animals were monomorphic B. The lowest PCV value was observed in animals homozygous for TfC, while the highest value was found in heterozygous (CD) animals; however, the difference was not significant.
Collapse
Affiliation(s)
- A Missohou
- Service de Zootechnie-Alimentation, Ecole Inter-Etats des Sciences et Médecine Vétérinaires (EISMV), Dakar, Sénégal
| | | | | | | | | |
Collapse
|
44
|
Nguyen AL, Nguyen TC, Van TL, Hoang MH, Nguyen S, Jonai H, Villanueva MB, Matsuda S, Sotoyama M, Sudo A. Noise levels and hearing ability of female workers in a textile factory in Vietnam. Ind Health 1998; 36:61-65. [PMID: 9473860 DOI: 10.2486/indhealth.36.61] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Noise and hearing ability profiles were determined in a textile factory in Vietnam. Noise mapping done in the weaving section showed that the noise levels exceeded the Vietnamese standard of 90 dBA by as much as 9 dBA in some areas. Audiometric tests performed on 69 female workers from the weaving section revealed that workers with more than 10 years of noise exposure had the worst hearing threshold levels at 1,000 and 4,000 Hz. Similar findings were observed for workers greater than 35 years old. The 4,000 Hz notch, suggestive of exposure to intense noise, was noted in the audiograms of 26 subjects.
Collapse
Affiliation(s)
- A L Nguyen
- National Institute of Labour Protection, Vietnam, Hanoi, Vietnam
| | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Nguyen TC, Solomon T, Mai XT, Nguyen TL, Nguyen TT, Wain J, To SD, Smith MD, Day NP, Le TP, Parry C, White NJ. Short courses of ofloxacin for the treatment of enteric fever. Trans R Soc Trop Med Hyg 1997; 91:347-9. [PMID: 9231214 DOI: 10.1016/s0035-9203(97)90102-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Typhoid fever continues to be a major public health problem in tropical countries, exacerbated in recent years by the spread of multi-drug resistant strains of Salmonella typhi. Short treatment courses of fluoroquinolones are effective, and have the advantage of reduced cost and increased compliance, but the optimal length of treatment is unknown. In an open, randomized comparison, 107 adults with uncomplicated enteric fever (95 of whom had positive blood cultures for S. typhi and 5 for S. paratyphi) were treated with oral ofloxacin, 15 mg/kg/d for 2 d or 10 mg/kg/d for 3 d. Mean fever clearance times were the same in the 2 treatment groups (97 h). There were 7 treatment failures, one in the 2 d group and 6 in the 3 d group (P = 0.07). Three of the 5 patients infected with nalidixic acid resistant strains of S. typhi had treatment failures, compared with 4 of 90 with nalidixic acid sensitive isolates (P < 0.0001; relative risk 13.5, 95% confidence interval 4.1-43%). Treatment with ofloxacin for 2 or 3 d is equally effective in adults with uncomplicated enteric fever caused by nalidixic acid sensitive strains of S. typhi. The epidemiology and management of nalidixic acid resistent typhoid needs further investigation.
Collapse
Affiliation(s)
- T C Nguyen
- Centre for Tropical Diseases, Cho Quan Hospital, Ho Chi Minh City, Viet Nam
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Matsuda S, Nguyen AL, Jonai H, Nguyen VH, Dinh HT, Le VT, Nguyen TC, Hoang MT, Phung HD, Dang DT. Occupational exposure and chronic respiratory symptoms--a population based study in Vietnam. Ind Health 1997; 35:271-277. [PMID: 9127561 DOI: 10.2486/indhealth.35.271] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
In order to investigate the relationship between occupational exposure to dust/chemicals (toxic gases/fumes) and chronic respiratory symptoms in Vietnam, the questionnaire standardized by the American Thoracic Society was applied to 368 subjects living in Ha Thai district of Vietnam. According to the results of multiple logistic regression analyses, the odds ratios of chronic respiratory symptoms by occupational exposure are over unity, except for the relationship between chronic cough and occupational exposure to chemicals. Especially for chronic breathlessness, significantly higher odds ratios are observed among people with a history of occupational exposure to dust or chemicals: 2.925 (95% CI: 1.130-7.574) for dust, and 3.721 (95% CI: 1.412-9.803) for chemicals. As for the interaction between occupational exposure to dust and cigarette smoking, it is considered that occupational exposure leads to an increase in chronic respiratory symptoms independent of the effects of cigarette smoking.
Collapse
Affiliation(s)
- S Matsuda
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Kitakyushu, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Cook KR, Murphy TD, Nguyen TC, Karpen GH. Identification of trans-acting genes necessary for centromere function in Drosophila melanogaster using centromere-defective minichromosomes. Genetics 1997; 145:737-47. [PMID: 9055083 PMCID: PMC1207858 DOI: 10.1093/genetics/145.3.737] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Deletions in the Drosophila minichromosome Dp1187 were used to investigate the genetic interactions of trans-acting genes with the centromere. Mutations in several genes known to have a role in chromosome inheritance were shown to have dominant effects on the stability of minichromosomes with partially defective centromeres. Heterozygous mutations in the ncd and klp3A kinesin-like protein genes strongly reduced the transmission of minichromosomes missing portions of the genetically defined centromere but had little effect on the transmission of minichromosomes with intact centromeres. Using this approach, ncd and klp3A were shown to require only the centromeric region of the chromosome for their roles in chromosome segregation. Increased gene dosage also affected minichromosome transmission and was used to demonstrate that the nod kinesin-like protein gene interacts genetically with the centro mere, in addition to interacting with extracentromeric regions as demonstrated previously. The results presented in this study strongly suggest that dominant genetic interactions between mutations and centromere-defective minichromosomes could be used effectively to identify novel genes necessary for centromere function.
Collapse
Affiliation(s)
- K R Cook
- Molecular Biology and Virology Laboratory, Salk Institute for Biological Studies, La Jolla, California 92037, USA
| | | | | | | |
Collapse
|
48
|
Sudo A, Nguyen AL, Jonai H, Matsuda S, Villanueva MB, Sotoyama M, Nguyen TC, Le VT, Hoang MH, Nguyen DT, Nguyen S. Effects of earplugs on catecholamine and cortisol excretion in noise-exposed textile workers. Ind Health 1996; 34:279-86. [PMID: 8768672 DOI: 10.2486/indhealth.34.279] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
To investigate physiological and psychological effects of industrial noise, a survey was performed on 50 female workers exposed to machinery noise [93-100 dB(A)] (noise group) and 25 female workers in less-noisy environments [71-75 dB(A)] (control group) in a textile factory in Vietnam. Urine was collected for analysis of catecholamines and cortisol. The subjects were also asked to fill out a questionnaire. Each subject was examined over 2 working days. The workers in the noise group were asked to put earplugs in their ears during the working hours of the 2nd day. On the 1st day without earplugs, urinary excretion of catecholamines in the noise group were greater than those in the control group. Cortisol in urine showed a similar tendency. Differences in catecholamine excretion between the noise group and the control group decreased on the 2nd day when the earplugs were used for attenuation of noise level in the noise group. Frequency of subjective fatigue symptoms was lower on the 2nd day than that on the 1st day in noise group, while the control group showed almost no day-difference. The results indicate that the catecholamine response to noise in workers was reduced through the use of earplugs.
Collapse
Affiliation(s)
- A Sudo
- National Institute of Industrial Health, Kawasaki, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Wang DS, Liang YX, Nguyen TC, Le DD, Tanaka T, Ueno Y. Natural co-occurrence of Fusarium toxins and aflatoxin B1 in corn for feed in north Vietnam. Nat Toxins 1995; 3:445-9. [PMID: 8612007 DOI: 10.1002/nt.2620030607] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Natural occurrence of Fusarium mycotoxins (trichothecenes and fumonisins) and aflatoxin B1 (AFB1) were surveyed in 32 corn samples, harvested in 1993 and randomly sampled in 1994 in several districts of Hanoi, Vietnam. Corn samples were first milled into fine powder, extracted with methanol-water (3:1) and the crude extracts obtained from the same samples were used for the simultaneous analysis of the trichothecenes such as nivalenol (NIV), deoxynivalenol (DON), and T-2 toxin (T-2) by gas chromatography/mass spectrometry (GC/NS); fumonisins B1 (FB1), B2 (FB2), and B3 (FB3) by high-performance liquid chromatography (HPLC) with a flourescence detector; and AFB1 by and ELISA kit based on a monoclonal antibody. The data revealed that 14, 8, 4, 3, and 2 out of 15 corn kernel samples were positive for AFB1, FB1, FB2, FB3, and NIV with the average levels being 28, 1, 101, 276, 232, and 858 ppb, respectively, and neither DON nor T-2 were detected. As for the other 17 samples of corn powder, 13, 15, 12, 10, 4 and 2 were positive for AFB1, FB1, FB2, FB3, DON, and NIV with the average being 30, 780, 289, 176, 3, 170, and 1,365 ppb, respectively, and T-2 was not detected. Although their positive rates and levels fell in the ranges reported elsewhere, it was found for the first time that the Fusarium toxins (NIV, DON, and fumonisins) and an Aspergillus toxin (AFB1) were naturally co-contaminated in selected samples of corn produced in north Vietnam.
Collapse
Affiliation(s)
- D S Wang
- Research Institute for Biosciences, Science University of Tokyo, Japan
| | | | | | | | | | | |
Collapse
|
50
|
Abstract
Data on allele frequencies at six red cell blood group systems and three blood protein polymorphic loci in five goat breeds are reported. Two blood proteins, albumin and carbonic anhydrase, were not found to be polymorphic. The B blood group system of goats, like its homologue in cattle and sheep, is highly complex. At least 44 B phenogroups (haplotypes) have been distinguished in this study. Based on the variation in allele frequencies between breeds, genetic distances were calculated. The distances estimated by four different methods were in close agreement with data from the history and geographic origins of the breeds examined.
Collapse
Affiliation(s)
- L Pépin
- Laboratoire des Groupes Sanguins, INRA CRJ, Jouy en Josas, France
| | | |
Collapse
|