Esophageal squamous cell carcinoma (ESCC) is prevalent in some geographical regions of the world.... more Esophageal squamous cell carcinoma (ESCC) is prevalent in some geographical regions of the world. ESCC development presents a multistep pathogenic process from inflammation to invasive cancer; however, what is critical in these processes and how they evolve is largely unknown, obstructing early diagnosis and effective treatment. Here, we create a mouse model mimicking human ESCC development and construct a single-cell ESCC developmental atlas. We identify a set of key transitional signatures associated with oncogenic evolution of epithelial cells and depict the landmark dynamic tumorigenic trajectories. An early downregulation of CD8+ response against the initial tissue damage accompanied by the transition of immune response from type 1 to type 3 results in accumulation and activation of macrophages and neutrophils, which may create a chronic inflammatory environment that promotes carcinogen-transformed epithelial cell survival and proliferation. These findings shed light on how ESC...
Supplemental material, Appendix_1_-_Cannabis for Use of oral cannabis extracts in the pediatric p... more Supplemental material, Appendix_1_-_Cannabis for Use of oral cannabis extracts in the pediatric palliative care setting: A retrospective chart review by Megan Doherty, Liam Power, Monica Attala and Christina Vadeboncoeur in Palliative Medicine
Pacific Symposium on Biocomputing. Pacific Symposium on Biocomputing, 2020
Dynamic processes are inherently important in disease, and identifying disease-related disruption... more Dynamic processes are inherently important in disease, and identifying disease-related disruptions of normal dynamic processes can provide information about individual patients. We have previously characterized individuals’ disease states via pathway-based anomalies in expression data, and we have identified disease-correlated disruption of predictable dynamic patterns by modeling a virtual time series in static data. Here we combine the two approaches, using an anomaly detection model and virtual time series to identify anomalous temporal processes in specific disease states. We demonstrate that this approach can informatively characterize individual patients, suggesting personalized therapeutic approaches.
PURPOSE We performed a systematic review and meta-analysis of the literature to evaluate the effi... more PURPOSE We performed a systematic review and meta-analysis of the literature to evaluate the efficacy of the routine use of tranexamic acid during percutaneous nephrolithotomy. METHODS This systematic review was conducted following best practices from Cochrane and the Institute of Medicine [Cochrane Handbook and IOM citations]. We followed the updated reporting guidelines from PRISMA 2020. RESULTS In total 275 titles and abstracts were reviewed, of which 20 were screened to be eligible for full text review. Of these 20 articles, 11 were selected for inclusion after full article evaluations. Seven of these 11 studies were seen as having a low risk of bias with a Jadad score of ≥3. These studies were included for data extraction. Once data was extracted, 964 patients were included. The primary outcome, blood transfusion rate, showed significant reduction with a ratio for transfusion rate of 0.34 [ 95% CI (0.19 to 0.61), z= 3.61, p=0.0003]. Mean Hemoglobin (Hgb) drop, and operative time were both shown to be reduced with the use of TXA. The mean difference for Hgb drop was -0.86 [ 95% CI (-1.26 to -0.46), z= 4.23, p< 0.0001]. Reduction in operative time showed a mean difference of -8.45 min [ 95% CI (-15.04 to -1.86), z= 2.51, p= 0.01]. Stone clearance was not shown to differ significantly between experimental and control groups, with a risk ratio of 1.28 [ 95% CI (0.89 to 1.84), z= 1.31, p= 0.19]. CONCLUSIONS This meta-analysis revealed that the routine use of TXA at time of PCNL reduces the rates of blood transfusion, mean Hgb drop, and operative time. With the low cost of TXA and strong safety profile, stronger consideration should be given to the routine use of TXA during PCNL by endoscopic surgeons.
Background Power wheelchairs can empower children with physical limitations to gain independence ... more Background Power wheelchairs can empower children with physical limitations to gain independence in their everyday lives; however, traditional methods of power wheelchair training are often limited by poor accessibility and safety concerns. Immersive virtual reality technology (IVRT) uses advanced display technology to place users in a fully immersive web-based environment that can support real-time skills training, often requiring less resources and fewer safety concerns than real-world methods. IVRT interventions have shown to be a feasible training option among adult power wheelchair users; however, there is still a need to understand the technical and clinical feasibility of developing an IVRT power wheelchair training tool for the pediatric population. Objective This proposed study aims to use expert feedback and an iterative design process to develop an IVRT training intervention for pediatric power wheelchair skill development. Methods This 3-phase feasibility study will be c...
PURPOSE The majority of pediatric cancer deaths occur in low- and middle-income countries (LMICs)... more PURPOSE The majority of pediatric cancer deaths occur in low- and middle-income countries (LMICs). Pediatric palliative care (PPC) focuses on relieving physical, psychosocial, and spiritual suffering throughout the continuum of cancer care and is considered integral to cancer care for children in all settings. There is limited evidence from LMICs about the characteristics, symptoms, and outcomes of children with cancer who receive PPC, which is needed to define the global need and guide the development of these services. METHODS This retrospective review of clinical records of children who received PPC was conducted during a pilot project (January 2014-August 2015) that implemented a PPC team at a tertiary hospital in Dhaka, Bangladesh. Clinical data on diagnosis, symptoms, treatment status, deaths, and key palliative care interventions were collected and analyzed using descriptive statistics. RESULTS There were 200 children who received PPC during the pilot project. The most common...
Background Perinatal palliative care is a relatively new component of paediatric palliative care ... more Background Perinatal palliative care is a relatively new component of paediatric palliative care which supports families who are expecting the birth of a child with a life-limiting condition. This study seeks to understand the characteristics of the infants and families referred for perinatal palliative care and the context for referrals in terms of diagnoses, referral characteristics, interventions, and outcomes. Methods A retrospective chart review of infants with prenatally diagnosed life-limiting conditions that were referred for perinatal palliative care. Results Eighty-five referrals were made for perinatal palliative care during the 10-year period, of which, 84 chose to continue with the service. Average gestational age at diagnosis was 23 weeks, and the mean time between diagnosis and referral to palliative care was 7 weeks. Stillbirths were common, occurring in 29% cases. Of livebirths, 59% of the infants survived for 2 days, and 80% died within 30 days. The most commonly r...
... M. SALAH IBRAHIM, MRCPEd., Lecturer in Medicine, Ein-Shams University, Cairo ... IDENTIFICATI... more ... M. SALAH IBRAHIM, MRCPEd., Lecturer in Medicine, Ein-Shams University, Cairo ... IDENTIFICATION OF MYOGLOBIN The identification of the urine pigment is usually made spectroscopically, although Whisnant, Owings, Cantrell, and Cooper (1959) used the ...
Esophageal squamous cell carcinoma (ESCC) is prevalent in some geographical regions of the world.... more Esophageal squamous cell carcinoma (ESCC) is prevalent in some geographical regions of the world. ESCC development presents a multistep pathogenic process from inflammation to invasive cancer; however, what is critical in these processes and how they evolve is largely unknown, obstructing early diagnosis and effective treatment. Here, we create a mouse model mimicking human ESCC development and construct a single-cell ESCC developmental atlas. We identify a set of key transitional signatures associated with oncogenic evolution of epithelial cells and depict the landmark dynamic tumorigenic trajectories. An early downregulation of CD8+ response against the initial tissue damage accompanied by the transition of immune response from type 1 to type 3 results in accumulation and activation of macrophages and neutrophils, which may create a chronic inflammatory environment that promotes carcinogen-transformed epithelial cell survival and proliferation. These findings shed light on how ESC...
Supplemental material, Appendix_1_-_Cannabis for Use of oral cannabis extracts in the pediatric p... more Supplemental material, Appendix_1_-_Cannabis for Use of oral cannabis extracts in the pediatric palliative care setting: A retrospective chart review by Megan Doherty, Liam Power, Monica Attala and Christina Vadeboncoeur in Palliative Medicine
Pacific Symposium on Biocomputing. Pacific Symposium on Biocomputing, 2020
Dynamic processes are inherently important in disease, and identifying disease-related disruption... more Dynamic processes are inherently important in disease, and identifying disease-related disruptions of normal dynamic processes can provide information about individual patients. We have previously characterized individuals’ disease states via pathway-based anomalies in expression data, and we have identified disease-correlated disruption of predictable dynamic patterns by modeling a virtual time series in static data. Here we combine the two approaches, using an anomaly detection model and virtual time series to identify anomalous temporal processes in specific disease states. We demonstrate that this approach can informatively characterize individual patients, suggesting personalized therapeutic approaches.
PURPOSE We performed a systematic review and meta-analysis of the literature to evaluate the effi... more PURPOSE We performed a systematic review and meta-analysis of the literature to evaluate the efficacy of the routine use of tranexamic acid during percutaneous nephrolithotomy. METHODS This systematic review was conducted following best practices from Cochrane and the Institute of Medicine [Cochrane Handbook and IOM citations]. We followed the updated reporting guidelines from PRISMA 2020. RESULTS In total 275 titles and abstracts were reviewed, of which 20 were screened to be eligible for full text review. Of these 20 articles, 11 were selected for inclusion after full article evaluations. Seven of these 11 studies were seen as having a low risk of bias with a Jadad score of ≥3. These studies were included for data extraction. Once data was extracted, 964 patients were included. The primary outcome, blood transfusion rate, showed significant reduction with a ratio for transfusion rate of 0.34 [ 95% CI (0.19 to 0.61), z= 3.61, p=0.0003]. Mean Hemoglobin (Hgb) drop, and operative time were both shown to be reduced with the use of TXA. The mean difference for Hgb drop was -0.86 [ 95% CI (-1.26 to -0.46), z= 4.23, p< 0.0001]. Reduction in operative time showed a mean difference of -8.45 min [ 95% CI (-15.04 to -1.86), z= 2.51, p= 0.01]. Stone clearance was not shown to differ significantly between experimental and control groups, with a risk ratio of 1.28 [ 95% CI (0.89 to 1.84), z= 1.31, p= 0.19]. CONCLUSIONS This meta-analysis revealed that the routine use of TXA at time of PCNL reduces the rates of blood transfusion, mean Hgb drop, and operative time. With the low cost of TXA and strong safety profile, stronger consideration should be given to the routine use of TXA during PCNL by endoscopic surgeons.
Background Power wheelchairs can empower children with physical limitations to gain independence ... more Background Power wheelchairs can empower children with physical limitations to gain independence in their everyday lives; however, traditional methods of power wheelchair training are often limited by poor accessibility and safety concerns. Immersive virtual reality technology (IVRT) uses advanced display technology to place users in a fully immersive web-based environment that can support real-time skills training, often requiring less resources and fewer safety concerns than real-world methods. IVRT interventions have shown to be a feasible training option among adult power wheelchair users; however, there is still a need to understand the technical and clinical feasibility of developing an IVRT power wheelchair training tool for the pediatric population. Objective This proposed study aims to use expert feedback and an iterative design process to develop an IVRT training intervention for pediatric power wheelchair skill development. Methods This 3-phase feasibility study will be c...
PURPOSE The majority of pediatric cancer deaths occur in low- and middle-income countries (LMICs)... more PURPOSE The majority of pediatric cancer deaths occur in low- and middle-income countries (LMICs). Pediatric palliative care (PPC) focuses on relieving physical, psychosocial, and spiritual suffering throughout the continuum of cancer care and is considered integral to cancer care for children in all settings. There is limited evidence from LMICs about the characteristics, symptoms, and outcomes of children with cancer who receive PPC, which is needed to define the global need and guide the development of these services. METHODS This retrospective review of clinical records of children who received PPC was conducted during a pilot project (January 2014-August 2015) that implemented a PPC team at a tertiary hospital in Dhaka, Bangladesh. Clinical data on diagnosis, symptoms, treatment status, deaths, and key palliative care interventions were collected and analyzed using descriptive statistics. RESULTS There were 200 children who received PPC during the pilot project. The most common...
Background Perinatal palliative care is a relatively new component of paediatric palliative care ... more Background Perinatal palliative care is a relatively new component of paediatric palliative care which supports families who are expecting the birth of a child with a life-limiting condition. This study seeks to understand the characteristics of the infants and families referred for perinatal palliative care and the context for referrals in terms of diagnoses, referral characteristics, interventions, and outcomes. Methods A retrospective chart review of infants with prenatally diagnosed life-limiting conditions that were referred for perinatal palliative care. Results Eighty-five referrals were made for perinatal palliative care during the 10-year period, of which, 84 chose to continue with the service. Average gestational age at diagnosis was 23 weeks, and the mean time between diagnosis and referral to palliative care was 7 weeks. Stillbirths were common, occurring in 29% cases. Of livebirths, 59% of the infants survived for 2 days, and 80% died within 30 days. The most commonly r...
... M. SALAH IBRAHIM, MRCPEd., Lecturer in Medicine, Ein-Shams University, Cairo ... IDENTIFICATI... more ... M. SALAH IBRAHIM, MRCPEd., Lecturer in Medicine, Ein-Shams University, Cairo ... IDENTIFICATION OF MYOGLOBIN The identification of the urine pigment is usually made spectroscopically, although Whisnant, Owings, Cantrell, and Cooper (1959) used the ...
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