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1.
Circulation ; 147(9): 718-727, 2023 02 28.
Artículo en Inglés | MEDLINE | ID: mdl-36335467

RESUMEN

BACKGROUND: Hypertrophic cardiomyopathy (HCM) can be associated with an abnormal exercise response. In adults with HCM, abnormal results on exercise stress testing are predictive of heart failure outcomes. Our goal was to determine whether an abnormal exercise response is associated with adverse outcomes in pediatric patients with HCM. METHODS: In an international cohort study including 20 centers, phenotype-positive patients with primary HCM who were <18 years of age at diagnosis were included. Abnormal exercise response was defined as a blunted blood pressure response and new or worsened ST- or T-wave segment changes or complex ventricular ectopy. Sudden cardiac death (SCD) events were defined as a composite of SCD and aborted sudden cardiac arrest. Using Kaplan-Meier survival, competing outcomes, and Cox regression analyses, we analyzed the association of abnormal exercise test results with transplant and SCD event-free survival. RESULTS: Of 724 eligible patients, 630 underwent at least 1 exercise test. There were no major differences in clinical characteristics between those with or without an exercise test. The median age at exercise testing was 13.8 years (interquartile range, 4.7 years); 78% were male and 39% were receiving beta-blockers. A total of 175 (28%) had abnormal test results. Patients with abnormal test results had more severe septal hypertrophy, higher left atrial diameter z scores, higher resting left ventricular outflow tract gradient, and higher frequency of myectomy compared with participants with normal test results (P<0.05). Compared with normal test results, abnormal test results were independently associated with lower 5-year transplant-free survival (97% versus 88%, respectively; P=0.005). Patients with exercise-induced ischemia were most likely to experience all-cause death or transplant (hazard ratio, 4.86 [95% CI, 1.69-13.99]), followed by those with an abnormal blood pressure response (hazard ratio, 3.19 [95% CI, 1.32-7.71]). Exercise-induced ischemia was also independently associated with lower SCD event-free survival (hazard ratio, 3.32 [95% CI, 1.27-8.70]). Exercise-induced ectopy was not associated with survival. CONCLUSIONS: Exercise abnormalities are common in childhood HCM. An abnormal exercise test result was independently associated with lower transplant-free survival, especially in those with an ischemic or abnormal blood pressure response with exercise. Exercise-induced ischemia was also independently associated with SCD events. These findings argue for routine exercise testing in childhood HCM as part of ongoing risk assessment.


Asunto(s)
Cardiomiopatía Hipertrófica , Prueba de Esfuerzo , Masculino , Femenino , Humanos , Estudios de Cohortes , Prevalencia , Muerte Súbita Cardíaca/epidemiología , Muerte Súbita Cardíaca/etiología , Cardiomiopatía Hipertrófica/complicaciones , Cardiomiopatía Hipertrófica/diagnóstico , Cardiomiopatía Hipertrófica/cirugía , Arritmias Cardíacas/etiología , Factores de Riesgo
2.
Pediatr Transplant ; 28(7): e14854, 2024 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-39279200

RESUMEN

BACKGROUND: Life with end-stage organ failure is accompanied by an accumulation of traumatic medical or surgical experiences. Despite recovery after solid organ transplantation (SOT), many children and adolescents develop post-traumatic stress symptoms (PTSS). PTSS remain underappreciated as a major comorbidity in SOT programs, despite their association with decreased quality of life. METHODS: We conducted a retrospective, cross-sectional study of 86 pediatric SOT recipients (17 heart, 44 kidney, and 25 liver) to evaluate potential determinants of PTSS. Trauma symptoms were measured by the Child Trauma Screening Questionnaire (CTSQ). Demographic, baseline, and contemporaneous factors were tested for independent association with CTSQ scores. RESULTS: The median post-transplant CTSQ score was 2 (IQR 1-4), and 22% were identified as high risk (score ≥5) for PTSD. Higher CTSQ scores were independently associated with the number of ICU days within the previous 12 months, the number of medications (complexity), and involvement with foster care in the primary model (R2 [adj.] = 0.26). The addition of the Family Impact Module improved the overall model (R2 [adj.] = 0.33), wherein higher family functioning was independently associated with lower CTSQ scores. An exploratory analysis of pre-transplant patients (n = 34) found a median pre-transplant CTSQ of 2 (IQR 1-6), suggesting that PTSS are onset before transplant and persist afterward. CONCLUSIONS: PTSS are highly prevalent in the SOT population. Risk factors include recent adverse medical experiences and complexity, whereas family stability may be protective. Additional research is needed to improve early ascertainment and support for patients at high risk of developing PTSS throughout their transplant journey.


Asunto(s)
Trasplante de Órganos , Trastornos por Estrés Postraumático , Receptores de Trasplantes , Humanos , Femenino , Masculino , Trastornos por Estrés Postraumático/etiología , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/psicología , Estudios Retrospectivos , Niño , Estudios Transversales , Factores de Riesgo , Adolescente , Trasplante de Órganos/psicología , Receptores de Trasplantes/psicología , Preescolar , Calidad de Vida , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/psicología , Complicaciones Posoperatorias/etiología , Encuestas y Cuestionarios
3.
Pediatr Exerc Sci ; 36(3): 135-145, 2024 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-38096811

RESUMEN

PURPOSE: Musculoskeletal strength can be impaired in pediatric solid organ transplant recipients. Exercise training programs can be beneficial but in-person delivery can be challenging; virtual exercise programs can alleviate some of these challenges. This feasibility study aimed to deliver an 8-week virtual exercise program in pediatric solid organ transplant recipients. METHOD: Program delivery occurred 3 times per week for 30 minutes. An exercise stress test was completed prior to program start. The Bruininks-Oseretsky Test of Motor Proficiency strength subtest and self-report surveys were used to assess musculoskeletal strength, quality of life, fatigue, and physical activity. Contact was maintained through a text messaging platform. Z scores were calculated using standardized normative data. Medians (interquartile range) are reported for all other data. RESULTS: Eleven participants completed the program (2 liver, 5 kidney, 4 heart; 58% females; median age = 11.5 [10.3-13.8] y). Six participants attended ≥60% of classes, 5 participants attended <50% of classes. After 8 weeks, strength scores improved (Z score, Pre: -1.0 [-1.65 to -0.60] to Post: -0.2 [-1.30 to 0.40]; P = .007) with no change in other outcome measures. CONCLUSION: The virtual exercise program was delivered without technical issues and received positive participant feedback. Engagement and costs need to be considered.


Asunto(s)
Terapia por Ejercicio , Estudios de Factibilidad , Trasplante de Órganos , Calidad de Vida , Humanos , Femenino , Masculino , Niño , Adolescente , Terapia por Ejercicio/métodos , Fuerza Muscular , Receptores de Trasplantes , Fatiga/prevención & control , Ejercicio Físico/fisiología
4.
Pediatr Res ; 2023 Dec 04.
Artículo en Inglés | MEDLINE | ID: mdl-38044334

RESUMEN

The highest incidence of sepsis across all age groups occurs in neonates leading to substantial mortality and morbidity. Cardiovascular dysfunction frequently complicates neonatal sepsis including biventricular systolic and/or diastolic dysfunction, vasoregulatory failure, and pulmonary arterial hypertension. The haemodynamic response in neonatal sepsis can be hyperdynamic or hypodynamic and the underlying pathophysiological mechanisms are heterogeneous. The diagnosis and definition of both neonatal sepsis and cardiovascular dysfunction complicating neonatal sepsis are challenging and not consensus-based. Future developments in neonatal sepsis management will be facilitated by common definitions and datasets especially in neonatal cardiovascular optimisation. IMPACT: Cardiovascular dysfunction is common in neonatal sepsis but there is no consensus-based definition, making calculating the incidence and designing clinical trials challenging. Neonatal cardiovascular dysfunction is related to the inflammatory response, which can directly target myocyte function and systemic haemodynamics.

5.
Pediatr Transplant ; 26(3): e14219, 2022 05.
Artículo en Inglés | MEDLINE | ID: mdl-35142005

RESUMEN

BACKGROUND: Facilitating communication between adolescents and HCP outside of appointments may enhance patient experience and outcomes. The purpose of this study was to determine whether SMS enhances the healthcare experience, QoL, and medication adherence in adolescent SOT patients. METHODS: This was a prospective observational study of an SMS platform (WelTel Inc) for SOT patients aged 12-19 years. QoL was assessed before and after using the PedsQL™ Transplant Module. Medication adherence was assessed with the frequency of therapeutic tacrolimus levels and variation based on control chart analysis. Patient experience and engagement was evaluated with surveys, response rate to messages, and number of clinical conversations (>2 messages). RESULTS: Twenty-three patients were included (median age 15.7 years (IQR 13.6-17.1)). Median intervention duration was 13.5 months (range 4.0-16.7 months). There was a 68% response rate (742/1095) with 375 clinical conversations. The majority of patients reported the intervention provided a positive outlook on their health (17/23), was useful (18/23), and improved their connection to HCPs (17/23). Following the intervention, there was no significant difference in the median scaled QoL scores (pre-intervention: 81 (IQR 76.5-93.3), post-intervention: 78 (IQR 76-93); p = .37), mean percentage of therapeutic tacrolimus levels (pre-intervention: 52 ± 25%, post-intervention: 65 ± 17%; p = .07), or variation on control chart analysis of tacrolimus levels. CONCLUSIONS: The WelTel messaging platform provided supplemental clinical care for a group of adolescent SOT patients that enhanced their healthcare experience. Patient QoL and adherence were unchanged following the intervention and remained at a high level.


Asunto(s)
Trasplante de Órganos , Envío de Mensajes de Texto , Adolescente , Humanos , Cumplimiento de la Medicación , Calidad de Vida , Tacrolimus/uso terapéutico
6.
J Cardiovasc Electrophysiol ; 32(2): 500-506, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33382510

RESUMEN

BACKGROUND: Long QT syndrome (LQTS) is a dangerous arrhythmia disorder that often presents in childhood and adolescence. The exercise stress test (EST) and QT-stand test may unmask QT interval prolongation at key heart rate transition points in LQTS, but their utility in children is debated. OBJECTIVE: To determine if the QT-stand test or EST can differentiate children with a low probability of LQTS from those with confirmed LQTS. METHODS: This retrospective study compares the corrected QT intervals (QTc) of children (<19 years) during the QT-stand test and EST. Patients were divided into three groups for comparison: confirmed LQTS (n = 14), low probability of LQTS (n = 14), and a control population (n = 9). RESULTS: Using the Bazett formula, confirmed LQTS patients had longer QTc intervals than controls when supine, standing, and at 3-4 min of recovery (p ≤ .01). Patients with a low probability of LQTS had longer QTc duration upon standing (p = .018) and at 1 min of recovery (p = .016) versus controls. There were no significant QTc differences at any transition point between low probability and confirmed LQTS. Using the Fridericia formula, differences in QTc between low probability and confirmed LQTS were also absent at the transition points examined, except at 1 min into exercise, where low probability patients had shorter QTc intervals (437 vs. 460 ms, p = .029). CONCLUSION: The diagnostic utility of the QT stand test and EST remains unclear in pediatric LQTS. The formula used for heart rate correction may influence accuracy, and dynamic T-U wave morphology changes may confound interpretation in low probability situations.


Asunto(s)
Electrocardiografía , Síndrome de QT Prolongado , Adolescente , Niño , Prueba de Esfuerzo , Frecuencia Cardíaca , Humanos , Síndrome de QT Prolongado/diagnóstico , Síndrome de QT Prolongado/epidemiología , Uso Excesivo de los Servicios de Salud , Probabilidad , Estudios Retrospectivos
7.
Pediatr Transplant ; 25(4): e14005, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33769652

RESUMEN

Living with end-stage organ failure is associated with an accumulation of traumatic medical events, and despite recovery after solid-organ transplantation (SOT), many children continue to exhibit lower quality of life (QOL). Few studies have examined the relationship between post-traumatic stress disorder (PTSD) and QOL among pediatric SOT recipients. We conducted a retrospective, cross-sectional review of 61 pediatric SOT recipients (12 heart, 30 kidney, and 19 liver) to evaluate the association of PTSD with self-reported QOL. PTSD was measured by the Child Trauma Screening Questionnaire (CTSQ), and QOL was measured using the PedsQL and PedsQL Transplant Module (PedsQL-TM) surveys. Demographics, baseline, and contemporaneous factors were tested for independent association. SOT recipients were 15.2 (12.1-17.6) years old at survey completion. Median CTSQ score was 2 (1-3), highest in kidney recipients, and 13% were identified as high risk for PTSD. Median PedsQL score was 83 (70-91) and significantly associated with the CTSQ score (r = -.68, p < .001). Median PedsQL Transplant Module score was 89 (83-95) and similarly associated with the CTSQ score (r = -.64, p < .001). Age at time of surveys and presence of any disability were also independently associated with PedsQL and PedsQL-TM, respectively. When adjusted for Emotional Functioning, CTSQ remained associated with PedsQL subscores (r = -.65, p < .001). Trauma symptoms are a major modifiable risk factor for lower self-perceived QOL and represent a potentially important target for post-transplant rehabilitation. Additional research is needed to understand the root contributors to PTSD and potential treatments in this population.


Asunto(s)
Trasplante de Órganos/psicología , Complicaciones Posoperatorias/psicología , Calidad de Vida/psicología , Trastornos por Estrés Postraumático/etiología , Adolescente , Niño , Preescolar , Estudios Transversales , Femenino , Indicadores de Salud , Humanos , Lactante , Masculino , Trasplante de Órganos/efectos adversos , Complicaciones Posoperatorias/diagnóstico , Pruebas Psicológicas , Estudios Retrospectivos , Autoinforme , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/psicología , Adulto Joven
8.
Pediatr Transplant ; 25(8): e14093, 2021 12.
Artículo en Inglés | MEDLINE | ID: mdl-34296505

RESUMEN

BACKGROUND: Physical activity (PA) has been shown to have benefits, including improving health-related quality of life (HRQOL). However, there are few and conflicting studies assessing PA and its relationship with HRQOL in a pediatric solid-organ transplant (SOT) population. The aim of this study was to assess whether overall HRQOL was associated with PA and to determine whether that association was independent of other baseline and contemporaneous clinical and demographic indicators. METHODS: A retrospective cross-sectional review was performed on 55 pediatric transplant patients (13 heart, 27 kidney, and 15 liver transplant). PA was measured by PAQ-C/PAQ-A, and HRQOL was measured using PedsQL. Demographics, baseline, and contemporaneous data were collected. RESULTS: There were no significant differences in baseline and contemporaneous characteristics between heart, kidney, and liver transplant recipients. SOT recipients were 15.0 (11.0-18.0) years old at completion of surveys. Median PAQ score was 2.3 (1.6-3.2), PedsQL total score was 77 (65-91), and PedsQL physical functioning score was 88 (72-97). The PedsQL total score was not significantly associated with PAQ score. The PAQ score was significantly associated with physical functioning subscore of the PedsQL (r = 0.37, p < 0.01). Higher physical functioning score was associated with time since transplant (r = 0.29, p = 0.031). CONCLUSION: Our SOT cohort has a HRQOL similar to other chronic conditions and higher than previous reported HRQOL in pediatric SOT populations. Higher levels of PA and longer time since transplant are associated with higher physical functioning scores.


Asunto(s)
Ejercicio Físico , Trasplante de Órganos , Calidad de Vida , Receptores de Trasplantes , Adolescente , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Lactante , Masculino , Estudios Retrospectivos , Autoinforme , Encuestas y Cuestionarios
9.
Pediatr Transplant ; 24(5): e13745, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32525279

RESUMEN

PA has been shown to have benefits in SOT patients. Studies assessing physical activity levels and its correlates in a pediatric solid-organ transplant population are limited. The aim of this study was to assess PA levels and identify baseline and contemporaneous factors that contribute to PA in a pediatric SOT population. A retrospective cross-sectional review was performed on 58 pediatric transplant patients (16 heart, 29 kidney, and 13 liver transplant). PA was measured by PAQ-C or PAQ-A. Demographics, baseline, and contemporaneous factors were collected. There were no significant differences in baseline and contemporaneous characteristics between heart, kidney, and liver transplant recipients. SOT recipients were 15.2 [12.3-17.3] years old at time of completing the PAQ. Median PAQ score was 2.2 [1.7-2.9]. There were no significant differences in PAQ scores between organ transplant type or between genders. Lower PAQ score was associated with sensory disability (9 vs 49 without disability; P = <.01) and age at time of completing the PAQ (r = -.50, P = <.01). These results suggest that older age at time of completing the PAQ and presence of sensory disability may influence PA levels in the pediatric SOT population.


Asunto(s)
Ejercicio Físico , Conductas Relacionadas con la Salud , Trasplante de Órganos , Adolescente , Factores de Edad , Niño , Estudios Transversales , Ejercicio Físico/fisiología , Ejercicio Físico/psicología , Femenino , Conductas Relacionadas con la Salud/fisiología , Humanos , Masculino , Trasplante de Órganos/psicología , Estudios Retrospectivos , Autoinforme
10.
Pediatr Nephrol ; 31(1): 153-6, 2016 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-26386589

RESUMEN

BACKGROUND: Dialysate leakage into the pericardium is a rare but potentially life-threatening complication of peritoneal dialysis (PD). There has been one reported pediatric case of spontaneous peritoneo-pericardial fistula in a 2-year-old boy with tissue fragility due to malnutrition and two reported adult cases in PD patients with a history of previous cardiac surgery and/or pericardiocentesis. CASE-DIAGNOSIS/TREATMENT: We describe a 15-year-old girl with end-stage renal disease secondary to granulomatosis with polyangiitis, with recurrent pericardial effusions secondary to a peritoneo-pericardial fistula while on continuous cycling peritoneal dialysis (CCPD). She had previously presented with chylous pericardial effusion that required pericardiocentesis and subsequently developed recurrent pericardial effusions when she was commenced on CCPD 9 months later. Pericardial fluid chemistry revealed a sterile, serous fluid containing 15.1 mmol/L of glucose and <0.11 mmol/L of triglycerides. Peritoneal scintigraphy with Tc-99m labeled sulfur colloid injected intra-peritoneally confirmed the presence of a peritoneo-pericardial fistula. The pericardial effusions resolved upon switching the patient to hemodialysis (HD). CONCLUSIONS: Our case of recurrent pericardial effusions in a child on PD secondary to a peritoneo-pericardial fistula highlights the need for close follow-up in patients with a history of previous pericardiocentesis who are commenced on PD.


Asunto(s)
Líquido Ascítico , Soluciones para Diálisis/efectos adversos , Fístula/etiología , Granulomatosis con Poliangitis/complicaciones , Cardiopatías/etiología , Fallo Renal Crónico/terapia , Derrame Pericárdico/etiología , Diálisis Peritoneal/efectos adversos , Enfermedades Peritoneales/etiología , Adolescente , Femenino , Fístula/diagnóstico , Fístula/terapia , Granulomatosis con Poliangitis/diagnóstico , Cardiopatías/diagnóstico , Cardiopatías/terapia , Humanos , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/etiología , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/terapia , Pericardiocentesis , Enfermedades Peritoneales/diagnóstico , Enfermedades Peritoneales/terapia , Recurrencia , Diálisis Renal , Factores de Tiempo , Tomografía Computarizada de Emisión de Fotón Único , Resultado del Tratamiento
12.
J Am Heart Assoc ; 13(12): e033968, 2024 Jun 18.
Artículo en Inglés | MEDLINE | ID: mdl-38879453

RESUMEN

BACKGROUND: Hypertrophic cardiomyopathy is a burdensome condition that inflicts both physical and psychological impairment on those with the disease, negatively impacting health-related quality of life (HRQoL). Given the abundance of evidence suggesting a role of physical activity (PA) in modulating HRQoL in healthy populations of children, we sought to determine the relationship between HRQoL and PA in children diagnosed with hypertrophic cardiomyopathy. METHODS AND RESULTS: A multicenter prospective observational cohort study was conducted, with patients with hypertrophic cardiomyopathy aged 10 to 19 years being provided a wrist-worn activity tracker (Fitbit Charge HR) to wear for 14 days. Patients self-reported on Pediatric Quality of Life 4.0 quality of life inventory items, which were associated with PA metrics following covariate adjustment using linear regression. A total of 56 participants were recruited to the study. The median age at enrollment was 15.5 years (interquartile range, 13.8-16.8), and 16 out of 56 (29%) of the cohort were girls. The cohort reported decreased metrics of physical, psychosocial, and total summary scores compared with health reference populations, with scores comparable with that of published populations with chronic disease. Increased physical HRQoL scores were significantly associated with increased daily steps taken, distance traveled, and flights of stairs climbed. CONCLUSIONS: These results show that impaired PA correlates with reduced HRQoL in children with hypertrophic cardiomyopathy, suggesting PA may partially mediate HRQoL in this population.


Asunto(s)
Cardiomiopatía Hipertrófica , Ejercicio Físico , Calidad de Vida , Humanos , Femenino , Adolescente , Cardiomiopatía Hipertrófica/fisiopatología , Cardiomiopatía Hipertrófica/psicología , Masculino , Estudios Prospectivos , Niño , Adulto Joven , Monitores de Ejercicio , Estado de Salud
13.
J Am Coll Cardiol ; 81(11): 1035-1045, 2023 03 21.
Artículo en Inglés | MEDLINE | ID: mdl-36922089

RESUMEN

BACKGROUND: Genetic defects in the RAS/mitogen-activated protein kinase pathway are an important cause of hypertrophic cardiomyopathy (RAS-HCM). Unlike primary HCM (P-HCM), the risk of sudden cardiac death (SCD) and long-term survival in RAS-HCM are poorly understood. OBJECTIVES: The study's objective was to compare transplant-free survival, incidence of SCD, and implantable cardioverter-defibrillator (ICD) use between RAS-HCM and P-HCM patients. METHODS: In an international, 21-center cohort study, we analyzed phenotype-positive pediatric RAS-HCM (n = 188) and P-HCM (n = 567) patients. The between-group differences in cumulative incidence of all outcomes from first evaluation were compared using Gray's tests, and age-related hazard of all-cause mortality was determined. RESULTS: RAS-HCM patients had a lower median age at diagnosis compared to P-HCM (0.9 years [IQR: 0.2-5.0 years] vs 9.8 years [IQR: 2.0-13.9 years], respectively) (P < 0.001). The 10-year cumulative incidence of SCD from first evaluation was not different between RAS-HCM and P-HCM (4.7% vs 4.2%, respectively; P = 0.59). The 10-year cumulative incidence of nonarrhythmic deaths or transplant was higher in RAS-HCM compared with P-HCM (11.0% vs 5.4%, respectively; P = 0.011). The 10-year cumulative incidence of ICD insertions, however, was 5-fold lower in RAS-HCM compared with P-HCM (6.9% vs 36.6%; P < 0.001). Nonarrhythmic deaths occurred primarily in infancy and SCD primarily in adolescence. CONCLUSIONS: RAS-HCM was associated with a higher incidence of nonarrhythmic death or transplant but similar incidence of SCD as P-HCM. However, ICDs were used less frequently in RAS-HCM compared to P-HCM. In addition to monitoring for heart failure and timely consideration of advanced heart failure therapies, better risk stratification is needed to guide ICD practices in RAS-HCM.


Asunto(s)
Cardiomiopatía Hipertrófica , Desfibriladores Implantables , Insuficiencia Cardíaca , Humanos , Estudios de Cohortes , Muerte Súbita Cardíaca/epidemiología , Muerte Súbita Cardíaca/etiología , Desfibriladores Implantables/efectos adversos , Cardiomiopatía Hipertrófica/complicaciones , Cardiomiopatía Hipertrófica/genética , Cardiomiopatía Hipertrófica/diagnóstico , Insuficiencia Cardíaca/complicaciones , Factores de Riesgo , Medición de Riesgo
14.
Psychol Serv ; 2022 Aug 11.
Artículo en Inglés | MEDLINE | ID: mdl-35951393

RESUMEN

This article samples the career of Dr. Guy O. Seymour, whose undergraduate studies were completed at La Universidad Interamericana in Puerto Rico. He earned his MA and PhD in clinical, counseling, and community psychology at Boston University. The first bilingual person of color appointed to the professional staff of the city of Boston's general hospital, he founded the nation's first multicultural internship program and rose to be the chief psychologist of the Boston Department of Health and Hospitals. His career path led him to develop psychological services in nontraditional workspaces, including medical, police, fire, and correction departments and for the International Olympic Games. At the end of his career, a family member's encounter with marijuana laws led to an interest in advocacy for criminal justice reform. Since retirement from practice, he has continued to volunteer with efforts to decriminalize marijuana possession and to abolish cash bail for pretrial and misdemeanor offenses. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

15.
Appl Neuropsychol Child ; 11(3): 260-269, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-32758025

RESUMEN

Agreement between parent and adolescent ratings of executive function (EF) is not known in adolescents with solid organ transplant (SOT), even though pressing concerns about EF deficits are being raised in this population. The current study investigated EF in adolescents with SOT using parent and self report. Twenty-five adolescents (M = 15.51 years) with SOT and their parent completed a behavior rating scale assessing EF within everyday context using the Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2). Parents and their adolescents demonstrated moderate to excellent agreement across the BRIEF2 clinical and index scores, higher than previous research with a typical sample. Adolescent males had higher agreement with their parents than female adolescents. Both parents and adolescents reported significantly higher mean T scores on various BRIEF2 indices and domains, in addition to higher rates of clinically elevated executive dysfunction than their peers. Assessment of EF and targeting specific EF domains for intervention may be useful in this population.


Asunto(s)
Función Ejecutiva , Trasplante de Órganos , Adolescente , Femenino , Humanos , Masculino , Pruebas Neuropsicológicas , Relaciones Padres-Hijo , Padres , Autoinforme
16.
Can J Cardiol ; 38(7): 1086-1099, 2022 07.
Artículo en Inglés | MEDLINE | ID: mdl-35314336

RESUMEN

Ventricular assist devices (VADs) are being increasingly used to support patients with congenital heart disease and single-ventricle physiology. Because of their unique anatomy and physiology, special consideration must be used to provide effective mechanical circulatory support for each individual patient. This can include alternative cannulation techniques, strategies to balance cardiac output to the systemic and pulmonary circulations from a single ventricle, or the use of continuous vs pulsatile VADs for better ventricular offloading. In this article we review the etiology of single-ventricle failure, VAD options for support, cannulation strategies, post-VAD management considerations, and outcomes at each of the 3 stages of palliation.


Asunto(s)
Cardiopatías Congénitas , Insuficiencia Cardíaca , Corazón Auxiliar , Enfermedades Vasculares , Gasto Cardíaco , Cardiopatías Congénitas/cirugía , Insuficiencia Cardíaca/terapia , Ventrículos Cardíacos , Humanos , Circulación Pulmonar , Resultado del Tratamiento
17.
Biochem J ; 423(3): 353-61, 2009 Oct 12.
Artículo en Inglés | MEDLINE | ID: mdl-19698083

RESUMEN

TCR (T-cell receptor) recognition of antigenic peptides bound and presented by MHC (major histocompatibility complex) molecules forms the basis of the cellular immune response to pathogens and cancer. TCRs bind peptide-MHC complexes weakly and with fast kinetics, features which have hindered detailed biophysical studies of these interactions. Modified peptides resulting in enhanced TCR binding could help overcome these challenges. Furthermore, there is considerable interest in using modified peptides with enhanced TCR binding as the basis for clinical vaccines. In the present study, we examined how fluorine substitutions in an antigenic peptide can selectively impact TCR recognition. Using a structure-guided design approach, we found that fluorination of the Tax peptide [HTLV (human T-cell lymphotropic virus)-1 Tax(11-19)] enhanced binding by the Tax-specific TCR A6, yet weakened binding by the Tax-specific TCR B7. The changes in affinity were consistent with crystallographic structures and fluorine chemistry, and with the A6 TCR independent of other substitutions in the interface. Peptide fluorination thus provides a means to selectively modulate TCR binding affinity without significantly perturbing peptide composition or structure. Lastly, we probed the mechanism of fluorine's effect on TCR binding and we conclude that our results were most consistent with a 'polar hydrophobicity' mechanism, rather than a purely hydrophobic- or electrostatic-based mechanism. This finding should have an impact on other attempts to alter molecular recognition with fluorine.


Asunto(s)
Flúor/metabolismo , Productos del Gen tax/metabolismo , Antígenos HLA/metabolismo , Péptidos/metabolismo , Receptores de Antígenos de Linfocitos T/metabolismo , Flúor/química , Flúor/inmunología , Productos del Gen tax/química , Productos del Gen tax/inmunología , Antígenos HLA/química , Antígenos HLA/inmunología , Humanos , Interacciones Hidrofóbicas e Hidrofílicas , Péptidos/química , Péptidos/inmunología , Unión Proteica/inmunología , Receptores de Antígenos de Linfocitos T/química , Receptores de Antígenos de Linfocitos T/inmunología , Vacunas Virales/química , Vacunas Virales/inmunología , Vacunas Virales/metabolismo
18.
Acta Psychol (Amst) ; 210: 103136, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32768610

RESUMEN

Converging evidence demonstrates increased levels of sensitivity to infant faces in mothers. This may be reflective of a series of psychological and neurobiological changes that occur in the transition to, and during early, parenthood for the purpose of appropriate caregiving; however, this enhanced infant facial recognition is in contrast with the general adult literature regarding facial processing. In the current study, we aimed to replicate a prior study of emotion facial recognition in pregnant women in a sample of mothers with children under a year old, utilizing a paradigm in which adult and infant faces gradually changed from neutral expressions to either happy or sad expressions. Mothers were faster at the recognition of adult faces in comparison to infant faces, and were also faster at happy faces in comparison to sad faces. Results are discussed in context of the current processing literature regarding the perinatal period, and implications for the persistence of the own-age bias and happy face advantage are considered.


Asunto(s)
Desarrollo Infantil , Reconocimiento Facial , Adulto , Atención , Sesgo , Niño , Emociones , Expresión Facial , Femenino , Felicidad , Humanos , Lactante , Relaciones Madre-Hijo , Embarazo
19.
Biochem J ; 415(2): 183-96, 2008 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-18800968

RESUMEN

A necessary feature of the immune system, TCR (T-cell receptor) cross-reactivity has been implicated in numerous autoimmune pathologies and is an underlying cause of transplant rejection. Early studies of the interactions of alphabeta TCRs (T-cell receptors) with their peptide-MHC ligands suggested that conformational plasticity in the TCR CDR (complementarity determining region) loops is a dominant contributor to T-cell cross-reactivity. Since these initial studies, the database of TCRs whose structures have been solved both bound and free is now large enough to permit general conclusions to be drawn about the extent of TCR plasticity and the types and locations of motion that occur. In the present paper, we review the conformational differences between free and bound TCRs, quantifying the structural changes that occur and discussing their possible roles in specificity and cross-reactivity. We show that, rather than undergoing major structural alterations or 'folding' upon binding, the majority of TCR CDR loops shift by relatively small amounts. The structural changes that do occur are dominated by hinge-bending motions, with loop remodelling usually occurring near loop apexes. As predicted from previous studies, the largest changes are in the hypervariable CDR3alpha and CDR3beta loops, although in some cases the germline-encoded CDR1alpha and CDR2alpha loops shift in magnitudes that approximate those of the CDR3 loops. Intriguingly, the smallest shifts are in the germline-encoded loops of the beta-chain, consistent with recent suggestions that the TCR beta domain may drive ligand recognition.


Asunto(s)
Regiones Determinantes de Complementariedad/inmunología , Complejo Mayor de Histocompatibilidad/inmunología , Receptores de Antígenos de Linfocitos T/inmunología , Animales , Regiones Determinantes de Complementariedad/química , Regiones Determinantes de Complementariedad/metabolismo , Humanos , Unión Proteica , Conformación Proteica , Receptores de Antígenos de Linfocitos T/química , Receptores de Antígenos de Linfocitos T/metabolismo
20.
Front Neurosci ; 13: 1197, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31798399

RESUMEN

Puberty is initiated by hormonal changes in the adolescent body that trigger physical and behavioral changes to reach adult maturation. As these changes occur, some adolescents experience concerning pubertal symptoms that are associated with dysfunction of the autonomic nervous system (ANS). Vasovagal syncope (VVS) and Postural Orthostatic Tachycardia Syndrome (POTS) are common disorders of the ANS associated with puberty that are related to orthostatic intolerance and share similar symptoms. Compared to young males, young females have decreased orthostatic tolerance and a higher incidence of VVS and POTS. As puberty is linked to changes in specific sex and non-sex hormones, and hormonal therapy sometimes improves orthostatic symptoms in female VVS patients, it is possible that pubertal hormones play a role in the increased susceptibility of young females to autonomic dysfunction. The purpose of this paper is to review the key hormonal changes associated with female puberty, their effects on the ANS, and their potential role in predisposing some adolescent females to cardiovascular autonomic dysfunctions such as VVS and POTS. Increases in pubertal hormones such as estrogen, thyroid hormones, growth hormone, insulin, and insulin-like growth factor-1 promote vasodilatation and decrease blood volume. This may be exacerbated by higher levels of progesterone, which suppresses catecholamine secretion and sympathetic outflow. Abnormal heart rate increases in POTS patients may be exacerbated by pubertal increases in leptin, insulin, and thyroid hormones acting to increase sympathetic nervous system activity and/or catecholamine levels. Given the coincidental timing of female pubertal hormone surges and adolescent onset of VVS and POTS in young women, coupled with the known roles of these hormones in modulating cardiovascular homeostasis, it is likely that female pubertal hormones play a role in predisposing females to VVS and POTS during puberty. Further research is necessary to confirm the effects of female pubertal hormones on autonomic function, and their role in pubertal autonomic disorders such as VVS and POTS, in order to inform the treatment and management of these debilitating disorders.

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