Stress related disorders in family members of covid-19 patients admitted to the intensive care unit-a multi-site qualitative study [Meeting Abstract]
RATIONALE: Currently, there are over 20,000 COVID-19 positive patients requiring intensive care unit (ICU) care in the United States (US). Even prior to the pandemic, up to 30% of family members of ICU patients experience post-traumatic stress disorder and up to 50% sustain potentially prolonged anxiety and/or depression. Although family bedside engagement improves both short-and long-term outcomes for patients and their families, nationwide social distancing recommendations have curtailed hospital visitation, potentially heightening the risk of stress-related disorders in these family members. The goal of this analysis is to explore the experiences of physically distanced family members of COVID-19 ICU patients in order to inform future best practices.
Method(s): This qualitative analysis is part of a multisite, observational, mixed-methods study of 12 US hospitals. Qualitative interviews were conducted with 75 participants from five sites; 14 interviews were analyzed in this preliminary analysis. Adult family members of COVID-19 positive patients admitted to the ICU from March-June 2020 were interviewed three months post-discharge. After sequential screening by site coordinators, participants were contacted by the qualitative team until all interviews (10-15 per site) were completed. Qualitative interviews explored the illness stories, communication perceptions, and explored stressors. Thematic analysis was applied to the verbatim transcripts of the phone interviews. Four coders utilized an iteratively-developed codebook to analyze transcripts using a round-robin method with two analysts per transcript. Discrepant codes were adjudicated by a third analyst to attend to inter-rater reliability.
Result(s): Five preliminary themes and seven subthemes emerged (Table 1). Positive communication experiences were more common than negative ones. Communication themes were: 1) Participants were reassured by proactive and frequent communication, leaving them feeling informed and included in care; and 2) Mixed feelings were expressed about the value of video-conferencing technology. Themes from the emotional and stress experiences were: 3) Profound sadness and distress resulted from isolation from patients, clinicians, and supportive family; 4) Stress was amplified by external factors; and 5) Positive experiences centered upon appreciation for healthcare workers and gratitude for compassionate care.
Conclusion(s): Incorporating the voices of family members during the COVID-19 pandemic establishes a foundation to inform family-centered, best practice guidelines to support the unique needs of family members who are physically distant from their critically ill and dying loved ones
Prone Ventilation for ARDS in a Resource-Limited Setting [Meeting Abstract]
Decidual Cell Regulation of CX3CL1: Implications for the Pathogenesis of Preeclampsia. [Meeting Abstract]
Up-Regulation of Granulocyte-Colony Stimulating Factor Expression by Inflammatory Cytokines in First Trimester Decidual Cells. [Meeting Abstract]
Hilar soft tissue lesion masquerading as lymphadenopathy in a patient with pulmonary vein stenosis due to radiofrequency ablation for refractory atrial fibrillation [Meeting Abstract]
Introduction Complications of radiofrequency ablation (RFA) for atrial fibrillation (AF) include tamponade, atrio-esophageal fistulas, vagal nerve injury, and pulmonary vein stenosis (PVS). PVS may present without symptoms or with dyspnea, cough, chest pain, hemoptysis, or rarely with X-ray infiltrates.7 We present a case of man with ground-glass opacities (GGOs) and left hilar soft tissue lesion masquerading as lymphadenopathy in a patient with recurrent PVS. Case Presentation The patient is a 44-year old man with AF, refractory to pharmacologic treatment, who required left atrial RFA x 2. Two months later, he developed a cough and dyspnea. Cardiac MRI and VQ scan showed severe narrowing/sub-total occlusion of the left inferior pulmonary vein (LIPV), as well as left lung hypoperfusion but normal ventilation. He underwent balloon dilatation and stenting of the left superior pulmonary vein (LSPV). The LIPV was not amenable to stenting or dilatation due to near-total occlusion. Venous drainage of the left lower lung field was thought to occur via collateral circulation from the LSPV. Three months later, the patient's symptoms recurred. Cardiopulmonary exercise stress testing demonstrated increased pulmonary vascular resistance. Scattered GGOs and a left infrahilar soft tissue density were seen on Chest CT. PFTs revealed a restrictive defect with decreased DLCO. These findings were suggestive of sarcoidosis, hypersensitivity pneumonitis, and connective tissue-related pneumonitis. EBUS-FNA of the infrahilar lesion failed to show lymphatic tissue. Transbronchial biopsy revealed benign bronchial mucosa and mild chronic inflammation without granuloma or neoplasia. Repeat chest CT showed in-stent severe restenosis of the LSPV and no change in the soft tissue density. Discussion Symptoms of PVS include cough, chest pain, hemoptysis, and dyspnea. Patients may develop symptoms immediately, though most develop symptoms 1-3 months after RFA. Single PVS usually causes mild symptoms, which often subside due to collateral vessel formation.1 Though treatment with pulmonary vein balloon dilatation is associated with immediate symptomatic relief, restenoses recur with a 47% restenosis rate by 11 months after the intervention, likely as a result of neointimal hyperplasia and fibrosis.3 The mediastinal soft tissue densities seen on imaging may reflect extension of inflammation and fibrosis caused by thermal injury. Conclusion Pulmonary vein stenosis is a complication of RFA for AF. Long-term effects of pulmonary vein occlusion on adjacent structures in the mediastinum and lung are unknown. We recommend serial PFTs and as needed Chest CT imaging to exclude findings that may masquerade as connective tissue or neoplastic disorders
High Flow Oxygen and Low Dose Inhaled Nitric Oxide in a Case of Severe Pulmonary Hypertension and Obstructive Shock
GOLPH3 modulates mTOR signalling and rapamycin sensitivity in cancer
Genome-wide copy number analyses of human cancers identified a frequent 5p13 amplification in several solid tumour types, including lung (56%), ovarian (38%), breast (32%), prostate (37%) and melanoma (32%). Here, using integrative analysis of a genomic profile of the region, we identify a Golgi protein, GOLPH3, as a candidate targeted for amplification. Gain- and loss-of-function studies in vitro and in vivo validated GOLPH3 as a potent oncogene. Physically, GOLPH3 localizes to the trans-Golgi network and interacts with components of the retromer complex, which in yeast has been linked to target of rapamycin (TOR) signalling. Mechanistically, GOLPH3 regulates cell size, enhances growth-factor-induced mTOR (also known as FRAP1) signalling in human cancer cells, and alters the response to an mTOR inhibitor in vivo. Thus, genomic and genetic, biological, functional and biochemical data in yeast and humans establishes GOLPH3 as a new oncogene that is commonly targeted for amplification in human cancer, and is capable of modulating the response to rapamycin, a cancer drug in clinical use.
The expression of gp130 at implantation site: Implication for the pathogenesis of preeclampsia [Meeting Abstract]
Endometrial endothelial cell steroid receptor expression and steroid effects on gene expression
Controversy exists regarding the expression of specific steroid receptor proteins and mRNA in human microvascular endometrial endothelial cells (HEECs). Thus, we studied steroid receptor expression in early passaged HEEC cultures and freshly isolated HEECs. Analysis of estrogen receptor (ER) and progesterone receptor (PR) mRNA levels was carried out with real-time quantitative RT-PCR, and the repertoire of genes activated by their respective steroid ligands was assessed by mRNA microarray analyses of 18,400 genes and expressed sequence tags. We observed that cultured and freshly isolated HEECs each express ER-beta mRNA but not ER-alpha. In addition, PR mRNA was also detectable in both HEEC sources. Microarray analysis demonstrated that treatment of HEEC cultures with either estradiol or medroxyprogesterone acetate produced differential effects on a wide variety of genes, and cluster analysis demonstrated that many of the genes are involved in intracellular signaling and enzymatic pathways. Thus, quantitative RT-PCR and microarray analyses demonstrate that HEECs express ER-beta and PR mRNA and that gene expression by HEECs is differentially regulated by treatment with estrogen or progestin.