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1.
Transfusion ; 63(4): 684-689, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36762622

RESUMO

BACKGROUND: Late complications of chemotherapy include treatment-related secondary leukemias. We describe an unusual case of a new treatment-related acute lymphoblastic leukemia (t-ALL) that was unmasked and mobilized by G-CSF during autologous hematopoietic progenitor cell collection (HPCC) in a young man with testicular cancer. METHODS: Electronic chart review of the patient medical history and pertinent laboratory findings. Patient CD34 and blast results were compared to 4249 autologous and 437 allogeneic HPCC performed between 2004 and 2022. In autologous donors, the %blast and %CD34 were compared by linear regression and paired t-test using commercial software. RESULTS: The patient was a 21-year-old male with relapsed testicular cancer referred for G-CSF cytokine-only mobilization and autologous HPCC. His pre-mobilization WBC count and differential were normal. On the day of HPCC, his WBC = 37.9 K/mcL with 12% blasts and 9.75% circulating CD34+ cells. The patient was admitted 9 days after HPCC with a normal WBC count and 15% blasts. He was diagnosed with a pro-B t-ALL bearing an t(4:11)(q21:q23) translocation and KMT2A-AF4 rearrangement. Upon review, this patient had the highest %CD34 among 4686 HPCC and was the only donor with %CD34 > 1% after a cytokine-only mobilization. CONCLUSION: We report a case of t-ALL that mimicked CD34+ HPC and was mobilized by high-dose G-CSF. Up to 70% of secondary leukemias bear 11q23/KMT2A rearrangements, which occur at the multipotent stem cell stage and can result in myeloid and lymphoid leukemias. Donors who have received past chemotherapy, especially with topoisomerase II inhibitors, are at increased risk for 11q23/KMT2A leukemias.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Leucemia-Linfoma Linfoblástico de Células Precursoras , Leucemia-Linfoma Linfoblástico de Células T Precursoras , Neoplasias Testiculares , Humanos , Masculino , Adulto Jovem , Antígenos CD34 , Fator Estimulador de Colônias de Granulócitos/efeitos adversos , Mobilização de Células-Tronco Hematopoéticas/métodos , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Células-Tronco Hematopoéticas , Leucaférese/métodos , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Leucemia-Linfoma Linfoblástico de Células T Precursoras/induzido quimicamente , Neoplasias Testiculares/terapia , Neoplasias Testiculares/induzido quimicamente
2.
Clin Infect Dis ; 75(5): 857-866, 2022 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-34950950

RESUMO

BACKGROUND: Sepsis causes a major health burden in the United States. To better understand the role of sepsis as a driver of the burden and cost of foodborne illness in the United States, we estimated the frequency and treatment cost of sepsis among US patients hospitalized with 31 pathogens commonly transmitted through food or with unspecified acute gastrointestinal illness (AGI). METHODS: Using data from the National Inpatient Sample from 2012 to 2015, we identified sepsis hospitalizations using 2 approaches-explicit ICD-9-CM codes for sepsis and a coding scheme developed by Angus that identifies sepsis using specific ICD-9-CM diagnosis codes indicating an infection plus organ failure. We examined differences in the frequency and the per-case cost of sepsis across pathogens and AGI and estimated total hospitalization costs using prior estimates of foodborne hospitalizations. RESULTS: Using Explicit Sepsis Codes, sepsis hospitalizations accounted for 4.6% of hospitalizations with a pathogen commonly transmitted through food or unspecified AGI listed as a diagnosis; this was 33.2% using Angus Sepsis Codes. The average per-case cost was $35 891 and $20 018, respectively. Applying the proportions of hospitalizations with sepsis from this study to prior estimates of the number foodborne hospitalizations, the total annual cost was $248 million annually using Explicit Sepsis Codes and $889 million using Angus Sepsis Codes. CONCLUSIONS: Sepsis is a serious complication among patients hospitalized with a foodborne pathogen infection or AGI resulting in a large burden of illness. Hospitalizations that are diagnosed using explicit sepsis codes are more severe and costly, but likely underestimate the burden of foodborne sepsis.


Assuntos
Doenças Transmitidas por Alimentos , Sepse , Efeitos Psicossociais da Doença , Doenças Transmitidas por Alimentos/epidemiologia , Hospitalização , Humanos , Incidência , Classificação Internacional de Doenças , Sepse/diagnóstico , Sepse/epidemiologia , Estados Unidos/epidemiologia
3.
Emerg Infect Dis ; 28(6): 1254-1256, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35608817

RESUMO

Quantifying the effect of public health actions on population health is essential when justifying sustained public health investment. Using modeling, we conservatively estimated that rapid response to a multistate foodborne outbreak of Salmonella Typhimurium in the United States in 2018 potentially averted 94 reported cases and $633,181 in medical costs and productivity losses.


Assuntos
Saúde Pública , Saladas , Intoxicação Alimentar por Salmonella/epidemiologia , Salmonella typhimurium , Animais , Galinhas , Surtos de Doenças , Humanos , Saúde Pública/métodos , Saladas/efeitos adversos , Saladas/microbiologia , Intoxicação Alimentar por Salmonella/economia , Intoxicação Alimentar por Salmonella/etiologia , Salmonella typhimurium/isolamento & purificação , Salmonella typhimurium/patogenicidade , Estados Unidos/epidemiologia
4.
Foodborne Pathog Dis ; 19(8): 558-568, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35960532

RESUMO

Foodborne illness is common in the United States with most, but not all, foodborne pathogens causing symptoms of acute gastroenteritis (AGI). Outpatient care is the most frequent type of medical care sought; however, more accurate estimates of outpatient costs are needed to inform food safety policy decision. Using the U.S. MarketScan Commercial Claims and Encounters database, we quantified the per-visit cost of outpatient visits with any AGI-related diagnosis (including pathogen-specific and nonspecific or symptom-based diagnoses) and for those with a pathogen-specific diagnosis for 1 of 29 pathogens commonly transmitted through food (including pathogens that cause AGI and some that do not). Our estimates included the per-case cost of office visits and associated laboratory tests and procedures as well as the conservative estimates of prescription cost. Most AGI outpatient visits were coded using nonspecific codes (e.g., infectious gastroenteritis), rather than pathogen-specific codes (e.g., Salmonella). From 2012 to 2015, we identified more than 3.4 million initial outpatient visits with any AGI diagnosis and 45,077 with a foodborne pathogen-specific diagnosis. As is typical of treatment cost data, severe cases of illness drove mean costs above median. The mean cost of an outpatient visit with any AGI was $696 compared with the median of $162. The mean costs of visits with pathogen-specific diagnoses ranged from $254 (median $131; interquartile range [IQR]: $98-184) for Streptococcus spp. Group A (n = 22,059) to $1761 (median $161; IQR: $104-$1101) for Clostridium perfringens (n = 30). Visits with two of the most common causes of foodborne illness, nontyphoidal Salmonella and norovirus, listed as a diagnosis, had mean costs of $841 and $509, respectively. Overall, the median per-case costs of outpatient visits increased with age, with some variation by pathogen. More empirically based estimates of outpatient costs for AGI and specific pathogens can enhance estimates of the economic cost of foodborne illness used to guide food policy and focus prevention efforts.


Assuntos
Doenças Transmitidas por Alimentos , Gastroenterite , Efeitos Psicossociais da Doença , Doenças Transmitidas por Alimentos/epidemiologia , Gastroenterite/epidemiologia , Custos de Cuidados de Saúde , Humanos , Pacientes Ambulatoriais , Salmonella , Estados Unidos/epidemiologia
5.
Foodborne Pathog Dis ; 18(11): 812-821, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34591654

RESUMO

Foodborne illness is a continuing public health problem in the United States. Seven pathogens-Campylobacter, Clostridium perfringens, Shiga toxin-producing Escherichia coli O157, Listeria monocytogenes, nontyphoidal Salmonella, norovirus, and Toxoplasma gondii-are estimated to cause >90% of the foodborne illnesses, hospitalizations, and deaths attributed to 31 known pathogens. The purpose of this article was to inform estimates of the cost of hospitalizations associated with these pathogens using National Inpatient Survey data from January 2012 through September 2015. The article explored two methodological issues. First, is it more appropriate to use hospitalizations identified using principal or all diagnosis codes when estimating cost? Second, should pathogen-specific or overall mean cost estimates be used? After excluding C. perfringens because of low sample size, the remaining six pathogens included in the analysis were associated with 17,102 hospital discharge records. Of these 55% have the pathogen listed as a principal diagnosis (FBP-PD), ranging from 6% for T. gondii to 68% for nontyphoidal Salmonella. The mean per-case cost of records with the pathogen listed as a secondary diagnosis (FBP-SD) was 2.7 times higher than FBP-PD. FBP-SD were also more severe than FBP-PD with longer lengths of stay, increasing loss of function, and increasing risk of mortality. Severity was the main driver of cost. We also found severity of illness and cost of hospitalizations vary by pathogen. Based on identifying cases with a pathogen in either FBP-PD or FBP-SD, we found mean per-case hospitalization cost across the six pathogens included in this study was $17,515, ranging from $11,552 for Campylobacter to $34,206 for norovirus. In summary, if only FBP-PD cases were used to estimate cost, estimates would likely underestimate hospitalization costs among those cases with a pathogen-specific diagnosis. Because these foodborne pathogens varied in severity of illness, the mean cost of hospitalizations also varied significantly by pathogen.


Assuntos
Microbiologia de Alimentos , Doenças Transmitidas por Alimentos , Doenças Transmitidas por Alimentos/epidemiologia , Hospitalização , Humanos , Classificação Internacional de Doenças , Vigilância da População , Estados Unidos/epidemiologia
6.
Foodborne Pathog Dis ; 17(3): 172-177, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31593489

RESUMO

Cost of foodborne illness (CoFI) estimates provide estimates of the overall impact of foodborne illnesses, including hospitalizations, long-term complications, and deaths. CoFI estimates are needed in countries that require cost-benefit analysis as part of the process of adopting new regulations, as is the case in the United States. Monetary estimates of the impact of disease also provide a meaningful way of communicating with the public about the impact of foodborne disease. In 2014, researchers at the U.S. Department of Agriculture, Economic Research Service (ERS), published CoFI estimates for 15 pathogens that account for roughly 95% of illnesses and deaths from the 31 major foodborne pathogens included in the Centers for Disease Control and Prevention (CDC) foodborne disease incidence estimates. ERS is currently updating their estimates to include all 31 known pathogens and unspecific agents included in CDC incidence estimates. CoFI estimates are based on quantitative models of the health outcomes people experience as a result of these illnesses and an assessment of the costs associated with these health outcomes. Research on the incidence of foodborne disease provides a starting point for this disease modeling, but it usually must be supplemented by other additional synthesis of research on acute complications and long-term health outcomes of different foodborne diseases. As part of its current work revising CoFI estimates, ERS convened a workshop attended by leading foodborne disease public health scientists to discuss how changes in scientific research on the incidence and outcomes of foodborne illnesses should inform the next revision of ERS's CoFI estimates. This article presents a summary, based on discussion at this workshop, of the state of scientific research available to inform updated economic modeling of the CoFI in the United States.


Assuntos
Doenças Transmitidas por Alimentos/economia , Doenças Transmitidas por Alimentos/epidemiologia , Centers for Disease Control and Prevention, U.S. , Efeitos Psicossociais da Doença , Análise Custo-Benefício , Surtos de Doenças/economia , Contaminação de Alimentos , Microbiologia de Alimentos , Custos de Cuidados de Saúde , Hospitalização/economia , Humanos , Incidência , Estados Unidos/epidemiologia
7.
Artigo em Inglês | MEDLINE | ID: mdl-30930202

RESUMO

The aim of the present study was to characterize ß-adrenergic receptors in the snake heart and lung of corn and Boa constrictor snakes. The ß-adrenergic receptor binding sites were studied in purified heart and lung membranes using the specific ß-adrenergic receptor antagonist [125J]-iodocyanopindolol (ICYP) and subtypes using selective ß1-adrenergic receptor antagonist CGP-20712A and selective ß2-adrenergic receptor antagonist ICI-118.551. A saturable and specific ß-adrenergic receptor binding site was detected in cardiac membranes with maximal receptor density (Bmax) of 43.99 ±â€¯3.86 fmol/mg protein (corn snake) and 58.07 ±â€¯2.88 fmol/mg protein (Boa constrictor) as well as KD of 24.21 ±â€¯7.38 pM (corn snake) and 21.48 ±â€¯3.85 pM (Boa constrictor) and in lung membranes (Bmax fmol/mg protein: 55.95 ±â€¯16.28 (corn snake) and 107.00 ±â€¯14.21 (Boa constrictor); KD pM: 71.25 ±â€¯21.92 (corn snake) and 55.04 ±â€¯18.68 (Boa constrictor)). Competition-binding studies showed ß-adrenergic receptors with low affinities to the ß2-selective adrenergic receptor antagonist and high affinity binding to ß1-selective adrenergic receptor antagonist in both heart and lung tissues of both snake species, suggesting the presence of high population of the post-synaptic ß1-adrenergic receptor subtype. It seems that the presence of the predominant ß1-subtype also in lung tissues may indicate the importance of the vascular system in the snake lung.


Assuntos
Boidae/fisiologia , Coração/efeitos dos fármacos , Pulmão/efeitos dos fármacos , Receptores Adrenérgicos beta/genética , Antagonistas de Receptores Adrenérgicos beta 2/farmacologia , Animais , Sítios de Ligação/efeitos dos fármacos , Boidae/metabolismo , Coração/fisiologia , Imidazóis/farmacologia , Pulmão/fisiologia , Propanolaminas/farmacologia , Ligação Proteica/efeitos dos fármacos , Transdução de Sinais/efeitos dos fármacos
9.
Transfusion ; 57(6): 1543-1554, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28370131

RESUMO

BACKGROUND: AABB Standards requires that laboratories participate in a proficiency test (PT) program for critical analytes. Institutions can purchase commercial PT materials; however, PT can also be performed through interlaboratory exchange. We investigated the utility of allogeneic hematopoietic progenitor cell apheresis (HPC-A) products as an interlaboratory PT challenge for total nucleated cell count (TNC) and CD34 assessment. STUDY DESIGN AND METHODS: Three-year retrospective and comparative review of unrelated allogeneic HPC-A products received by the University of Michigan between January 2011 and December 2013. Internal TNC and CD34 count were compared to the external collecting facility by paired t test and linear regression. The absolute and percent difference between external and internal counts and 95% limits of agreeability (95% LA) were determined. Results were analyzed relative to donor center location (international, domestic), time zone (domestic), and calendar year. RESULTS: There was a strong correlation between internal and external TNC, regardless of donor center location or year. For CD34, there was a good correlation between centers (R = 0.88-0.91; slope = 0.95-0.98x) with a median difference of -1% (95% LA, -50%, +47%). This was considerably better than commercial PT challenges, which showed a persistent negative bias for absolute CD34 and CD3 counts. CONCLUSION: Allogeneic HPC-A products represent an interlaboratory PT exchange for all critical analytes, including TNC and CD34 count, cell viability, and sterility. Allogeneic HPC-A products, which are fresh and transported under validated conditions, are less subject to preanalytical variables that may impact commercial PT samples such as aliquoting and sample homogeneity, commercial additives, and sample stability during manufacturing and transport.


Assuntos
Remoção de Componentes Sanguíneos , Células-Tronco/citologia , Adulto , Aloenxertos , Antígenos CD34/imunologia , Sobrevivência Celular/fisiologia , Eritroblastos/metabolismo , Feminino , Células-Tronco Hematopoéticas/citologia , Células-Tronco Hematopoéticas/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Células-Tronco/metabolismo
12.
J Clin Apher ; 32(6): 501-516, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28485045

RESUMO

INTRODUCTION: Autologous peripheral blood hematopoietic progenitor cell collection (A-HPCC) in children typically requires placement of a central venous catheter (CVC) for venous access. There is scant published data regarding the performance and safety of femoral CVCs in pediatric A-HPCC. METHODS: Seven-year, retrospective study of A-HPCC in pediatric patients collected between 2009 and January 2017. Inclusion criteria were an age ≤ 21 years and A-HPCC using a femoral CVC for venous access. Femoral CVC performance was examined by CD34 collection rate, inlet rate, collection efficiency (MNC-FE, CD34-FE), bleeding, flow-related adverse events (AE), CVC removal, and product sterility testing. Statistical analysis and graphing were performed with commercial software. RESULTS: A total of 75/119 (63%) pediatric patients (median age 3 years) met study criteria. Only 16% of children required a CVC for ≥ 3 days. The CD34 collect rate and CD34-FE was stable over time whereas MNC-FE decreased after day 4 in 80% of patients. CD34-FE and MNC-FE showed inter- and intra-patient variability over time and appeared sensitive to plerixafor administration. Femoral CVC showed fewer flow-related AE compared to thoracic CVC, especially in pediatric patients (6.7% vs. 37%, P = 0.0005; OR = 0.12 (95%CI: 0.03-0.45). CVC removal was uneventful in 73/75 (97%) patients with hemostasis achieved after 20-30 min of pressure. In a 10-year period, there were no instances of product contamination associated with femoral CVC colonization. CONCLUSION: Femoral CVC are safe and effective for A-HPCC in young pediatric patients. Femoral CVC performance was maintained over several days with few flow-related alarms when compared to thoracic CVCs.


Assuntos
Cateteres Venosos Centrais/normas , Veia Femoral , Células-Tronco de Sangue Periférico/citologia , Adolescente , Antígenos CD34/análise , Cateteres Venosos Centrais/efeitos adversos , Criança , Pré-Escolar , Hemorragia/etiologia , Humanos , Lactente , Estudos Retrospectivos , Transplante Autólogo
13.
J Clin Apher ; 32(1): 35-48, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27092461

RESUMO

INTRODUCTION: Autologous peripheral blood hematopoietic progenitor cell collection (A-HPCC) in pediatric patients is considered relatively safe although technically challenging. Very little is known regarding the incidence, risk factors and impact of procedure-related adverse events (AE) on pediatric A-HPCC outcomes. METHODS: Prospective 4.5-year review of AE associated with pediatric A-HPCC. AE were graded by severity and type. Potential demographic and procedural risk factors, and the impact on product quality, were compared by t-test, chi-square, and linear regression. RESULTS: Sixty-two children underwent 110 A-HPCC, including 36 (58%) under 20 kg. Fifty-five AE were documented in 25.4% A-HPCCs and 39% of children (citrate 25%, access 19%, technical 11%, cardiovascular 0%, allergic 1.8%). No AE were noted in children < 10 kg anticoagulated with heparin. Access and technical AE accounted for 73% of severe AE, with line-related problems underlying most technical AE (87.5%, P = 0.006). AE were more likely in older (P = 0.012), heavier patients (P = 0.02), who frequently required more than one A-HPCC (P = 0.012). In contrast, young children were more likely to experience citrate AE with gastrointestinal symptoms (median age, 6 years; P = 0.076). AE had no impact on CD34 collection rates; however, mean CD34 yields (4.2 vs. 20.4 million/kg; P = 0.0035) were decreased in patients with technical AE due to lower peripheral CD34 counts and a high number of aborted procedures (37%). CONCLUSION: Venous access and flow-related issues are a major factor associated with moderate and severe AE, effecting ∼10% of patients. AE are more frequent with increasing patient age, weight, and number of procedures. J. Clin. Apheresis 32:35-48, 2017. © 2016 Wiley Periodicals, Inc.


Assuntos
Separação Celular/normas , Transplante de Células-Tronco de Sangue Periférico/efeitos adversos , Células-Tronco de Sangue Periférico/citologia , Adolescente , Fatores Etários , Antígenos CD34/análise , Antígenos CD34/sangue , Peso Corporal , Criança , Pré-Escolar , Humanos , Transplante de Células-Tronco de Sangue Periférico/métodos , Transplante Autólogo
14.
Biol Blood Marrow Transplant ; 22(5): 862-8, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26551636

RESUMO

Reduced-intensity conditioning (RIC) regimens minimize early toxicity after allogeneic hematopoietic cell transplantation (HCT) by placing greater reliance on establishing a graft-versus-leukemia effect (GVL). Because graft-versus-host disease (GVHD) and GVL are tightly linked, inhibition of T cell populations that cause GVHD may lead to an unintended increased risk of relapse in the RIC setting. Although not completely understood, etanercept and extracorporeal photopheresis (ECP) are thought to ameliorate GVHD without direct T cell inhibition. We hypothesized that adding these 2 agents to a standard GVHD prophylaxis regimen of tacrolimus and mycophenolate mofetil (MMF) would improve survival by reducing GVHD-related mortality without increasing relapse rates. Therefore, we conducted a prospective phase II clinical trial that incorporated tacrolimus, MMF, etanercept, and ECP as GVHD prophylaxis in 48 patients undergoing RIC unrelated donor transplantation. The preferred RIC was fludarabine 160 mg/m(2) + busulfan 6.4 mg/kg to 12.8 mg/kg ± total body irradiation 200 cGy. Etanercept .4 mg/kg (maximum dose, 25 mg) was given subcutaneously twice weekly for 8 weeks after HCT and ECP was given for 12 treatments, starting weekly on day 28 weekly and tapering off by day 180. The median age of the study patients was 60 (range, 18 to 71) years. Donors were 7/8 (n = 14, 29%) or 8/8 (n = 34, 71%) HLA matched. All patients engrafted neutrophils at a median of 12 days. The cumulative incidence of grades II to IV acute GVHD at day 100 was 46%, but it was typically sensitive to initial steroid treatment (84% day 56 complete response/partial response rate). Overall survival at 1 year in this older, frequently mismatched unrelated donor setting was excellent (73%) because of low rates of nonrelapse mortality (21%) and relapse (19%). However, this strategy was not effective at preventing a high incidence of chronic GVHD and late deaths led to a drop in 2-year survival, declining to 56%, reflecting a high incidence of chronic GVHD.


Assuntos
Etanercepte/administração & dosagem , Doença Enxerto-Hospedeiro/prevenção & controle , Transplante de Células-Tronco Hematopoéticas , Fotoferese/métodos , Condicionamento Pré-Transplante , Adolescente , Adulto , Idoso , Aloenxertos , Intervalo Livre de Doença , Feminino , Doença Enxerto-Hospedeiro/sangue , Doença Enxerto-Hospedeiro/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Taxa de Sobrevida
15.
Basic Res Cardiol ; 111(3): 36, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-27138930

RESUMO

Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia with a strong genetic component. Molecular pathways involving the homeodomain transcription factor Shox2 control the development and function of the cardiac conduction system in mouse and zebrafish. Here we report the analysis of human SHOX2 as a potential susceptibility gene for early-onset AF. To identify causal variants and define the underlying mechanisms, results from 378 patients with early-onset AF before the age of 60 years were analyzed and compared to 1870 controls or reference datasets. We identified two missense mutations (p.G81E, p.H283Q), that were predicted as damaging. Transactivation studies using SHOX2 targets and phenotypic rescue experiments in zebrafish demonstrated that the p.H283Q mutation severely affects SHOX2 pacemaker function. We also demonstrate an association between a 3'UTR variant c.*28T>C of SHOX2 and AF (p = 0.00515). Patients carrying this variant present significantly longer PR intervals. Mechanistically, this variant creates a functional binding site for hsa-miR-92b-5p. Circulating hsa-miR-92b-5p plasma levels were significantly altered in AF patients carrying the 3'UTR variant (p = 0.0095). Finally, we demonstrate significantly reduced SHOX2 expression levels in right atrial appendages of AF patients compared to patients with sinus rhythm. Together, these results suggest a genetic contribution of SHOX2 in early-onset AF.


Assuntos
Fibrilação Atrial/genética , Predisposição Genética para Doença/genética , Proteínas de Homeodomínio/genética , Adolescente , Animais , Estudos de Coortes , Análise Mutacional de DNA , Feminino , Humanos , Masculino , Camundongos , Pessoa de Meia-Idade , Mutação de Sentido Incorreto , Reação em Cadeia da Polimerase , Transfecção , Adulto Jovem , Peixe-Zebra
16.
Dev Dyn ; 243(5): 629-39, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24347445

RESUMO

BACKGROUND: The short stature homeodomain transcription factors SHOX and SHOX2 play key roles in limb formation. To gain more insight into genes regulated by Shox2 during limb development, we analyzed expression profiles of WT and Shox2-/- mouse embryonic limbs and identified the T-Box transcription factor Tbx4 as a potential downstream target. Tbx4 is known to exert essential functions in skeletal and muscular hindlimb development. In humans, haploinsufficiency of TBX4 causes small patella syndrome, a skeletal dysplasia characterized by anomalies of the knee, pelvis, and foot. RESULTS: Here, we demonstrate an inhibitory regulatory effect of Shox2 on Tbx4 specifically in the forelimbs. We also show that Tbx4 activates Shox2 expression in fore- and hindlimbs, suggesting Shox2 as a feedback modulator of Tbx4. Using EMSA studies, we find that Tbx4/TBX4 is able to bind to distinct T-box binding sites within the mouse and human Shox2/SHOX2 promoter. CONCLUSIONS: Our data identifies Tbx4 as a novel transcriptional activator of Shox2 during murine fore- and hindlimb development. Tbx4 is also regulated by Shox2 specifically in the forelimb bud possibly via a feedback mechanism. These data extend our understanding of the role and regulation of Tbx4 and Shox2 in limb development and limb associated diseases.


Assuntos
Embrião de Mamíferos/embriologia , Membro Posterior/embriologia , Proteínas de Homeodomínio/metabolismo , Organogênese/fisiologia , Proteínas com Domínio T/metabolismo , Animais , Proteínas de Homeodomínio/genética , Humanos , Camundongos , Camundongos Knockout , Proteínas com Domínio T/genética
17.
Transfusion ; 54(8): 2004-14, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24527786

RESUMO

BACKGROUND: Central nervous system (CNS) malignancies represent 20% of all childhood cancers. To improve outcomes in infants and children with high-risk disease, treatment can include adjuvant chemotherapy and early autologous peripheral blood human progenitor cell collection (AHPCC), followed by high-dose chemotherapy and stem cell rescue. In many protocols, postoperative chemotherapy includes the administration of weekly vincristine (VCR) between induction chemotherapy cycles, regardless of scheduled AHPCC. We observed anecdotal AHPCC failures in children receiving midcycle VCR (MC-VCR). STUDY DESIGN AND METHODS: The study was an 8-year retrospective chart review of all children with a CNS malignancy and who underwent AHPCC. Information included patient demographic and clinical data, mobilization regimen, VCR administration, product yields, infusion toxicity, and patient charges. Data were analyzed relative to MC-VCR administration. Graphics and statistical analysis (t-test, chi-square, linear regression) were performed with commercial software. RESULTS: Twenty-four patients and 47 AHPCCs were available for analysis. Nine patients (37%) received MC-VCR within 7 days of scheduled AHPCC. MC-VCR was associated with delayed marrow recovery (17.9 days vs. 14.9 days, p=0.0012), decreased median peripheral CD34 counts (75 × 10(6) CD34/L vs. 352 × 10(6) CD34/L, p=0.03), decreased median CD34 yields (2.4 × 10(6) CD34/L vs. 17.8 × 10(6) CD34/kg, p=0.08), more AHPCCs per mobilization (2.9 vs. 1.1, p=0.01), and an increased rate of remobilization (33% vs. 6%). Mean patient charges were 2.5× higher in patients receiving MC-VCR than controls (p=0.01). CONCLUSION: MC-VCR should be withheld before scheduled AHPCC to optimize CD34 collection.


Assuntos
Medula Óssea/efeitos dos fármacos , Neoplasias do Sistema Nervoso Central/sangue , Mobilização de Células-Tronco Hematopoéticas , Vincristina/efeitos adversos , Adolescente , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Contagem de Células Sanguíneas , Neoplasias do Sistema Nervoso Central/terapia , Quimioterapia Adjuvante , Criança , Pré-Escolar , Ensaios Clínicos como Assunto , Terapia Combinada , Irradiação Craniana , Esquema de Medicação , Feminino , Humanos , Lactente , Leucaférese , Masculino , Estudos Multicêntricos como Assunto , Transplante de Células-Tronco de Sangue Periférico/efeitos adversos , Transplante de Células-Tronco de Sangue Periférico/métodos , Estudos Retrospectivos , Transplante Autólogo , Vincristina/administração & dosagem , Vincristina/farmacologia , Adulto Jovem
18.
Foodborne Pathog Dis ; 11(5): 395-402, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24588853

RESUMO

Measures of disease burden such as quality-adjusted life years (QALYs) are increasingly important to risk-based food safety policy. They provide a means of comparing relative risk from diverse health outcomes. We present detailed disease-outcome trees and EQ-5D scoring for 14 major foodborne pathogens representing over 95% of foodborne illnesses, hospitalizations, and deaths due to specified agents in the United States (Campylobacter spp., Clostridium perfringens, Cryptosporidium parvum, Cyclospora cayetanensis, Escherichia coli O157:H7, Shiga toxin-producing E. coli non-O157, Listeria monocytogenes, nontyphoidal Salmonella enterica, Shigella, Toxoplasma gondii, Vibrio vulnificus, Vibrio parahaemolyticus and other noncholera Vibrio, and Yersinia enterocolitica). We estimate over 5800 QALYs lost per 1000 cases of L. monocytogenes and V. vulnificus, compared to 125 QALYs lost per 1000 cases of T. gondii, 26 for E. coli O157:H7, 16 for Salmonella and Campylobacter, and 14 for Y. enterocolitica. The remaining 7 pathogens are estimated to cause less than 5 QALYs lost per 1000 cases. In total, these 14 pathogens cause over 61,000 in QALY loss annually, with more than 90% due solely to acute infection being responsible for 65% of total QALY loss, with premature mortality and morbidity due to chronic and congenital illness responsible for another 28%. These estimates of the burden of chronic sequelae are likely conservative; additional epidemiological research is needed to support more accurate burden estimates. This study shows the value of using integrated metrics for comparing disease burden, and the need to consider chronic and congenital illness when prioritizing foodborne pathogens.


Assuntos
Doenças Transmitidas por Alimentos/diagnóstico , Anos de Vida Ajustados por Qualidade de Vida , Campylobacter/isolamento & purificação , Clostridium perfringens/isolamento & purificação , Cryptosporidium parvum/isolamento & purificação , Cyclospora/isolamento & purificação , Escherichia coli O157/isolamento & purificação , Contaminação de Alimentos/análise , Microbiologia de Alimentos , Inocuidade dos Alimentos , Doenças Transmitidas por Alimentos/prevenção & controle , Humanos , Listeria monocytogenes/isolamento & purificação , Vigilância da População , Salmonella enterica/isolamento & purificação , Escherichia coli Shiga Toxigênica/isolamento & purificação , Shigella/isolamento & purificação , Toxoplasma/isolamento & purificação , Estados Unidos , Vibrio parahaemolyticus/isolamento & purificação , Yersinia enterocolitica/isolamento & purificação
19.
J Agric Food Chem ; 72(9): 4888-4896, 2024 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-38394621

RESUMO

Grapevine (Vitis vinifera) is one of the most important perennial fruit plants. The variety Riesling stands out by developing a characteristic petrol-like odor note during aging, elicited by the aroma compound 1,1,6-trimethyl-1,2-dihydronaphthalene (TDN). The UV-dependent TDN contents differ largely among Rieslings grown in the northern versus the southern hemisphere. Highest TDN concentrations were found in Australian Rieslings, where TDN is a scoring ingredient. In contrast, in Rieslings from Europe, for example, TDN may be a tending cause of rejection. A human receptor for TDN has been unknown. Here, we report on the identification of OR8H1 as a TDN-selective odorant receptor, out of a library of 766 odorant receptor variants. OR8H1 is selectively tuned to six carbon ring structures, identified by screening a collection of 180 key food odorants, using a HEK-293 cell-based cAMP luminescence assay equipped with the GloSensor technology.


Assuntos
Naftalenos , Receptores Odorantes , Vitis , Vinho , Humanos , Vinho/análise , Receptores Odorantes/genética , Células HEK293 , Austrália , Vitis/química , Odorantes/análise , Frutas/química
20.
J Agric Food Chem ; 72(28): 15865-15874, 2024 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-38955350

RESUMO

Geosmin, a ubiquitous volatile sesquiterpenoid of microbiological origin, is causative for deteriorating the quality of many foods, beverages, and drinking water, by eliciting an undesirable "earthy/musty" off-flavor. Moreover, and across species from worm to human, geosmin is a volatile, chemosensory trigger of both avoidance and attraction behaviors, suggesting its role as semiochemical. Volatiles typically are detected by chemosensory receptors of the nose, which have evolved to best detect ecologically relevant food-related odorants and semiochemicals. An insect receptor for geosmin was recently identified in flies. A human geosmin-selective receptor, however, has been elusive. Here, we report on the identification and characterization of a human odorant receptor for geosmin, with its function being conserved in orthologs across six mammalian species. Notably, the receptor from the desert-dwelling kangaroo rat showed a more than 100-fold higher sensitivity compared to its human ortholog and detected geosmin at low nmol/L concentrations in extracts from geosmin-producing actinomycetes.


Assuntos
Naftóis , Receptores Odorantes , Sesquiterpenos , Animais , Humanos , Naftóis/metabolismo , Naftóis/química , Naftóis/análise , Sesquiterpenos/metabolismo , Sesquiterpenos/análise , Sesquiterpenos/química , Receptores Odorantes/metabolismo , Receptores Odorantes/genética , Receptores Odorantes/química , Ratos , Feromônios/metabolismo , Feromônios/química , Feromônios/análise , Odorantes/análise
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