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  1. Article ; Online: Cardiopulmonary arrest from metformin-induced lactic acidosis.

    Pell, Robert / Littell, Jonathan / Hernandez, Michelle / Mirajkar, Amber / Ganti, Latha

    Resuscitation plus

    2022  Volume 9, Page(s) 100217

    Language English
    Publishing date 2022-03-09
    Publishing country Netherlands
    Document type Journal Article
    ISSN 2666-5204
    ISSN (online) 2666-5204
    DOI 10.1016/j.resplu.2022.100217
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  2. Article: A Non-Classical Presentation of Erythema Migrans in a 51-Year-Old Woman With Early Manifestation of Lyme Neuroborreliosis (Bannwarth Syndrome).

    Lorquet, Jovans R / Pell, Robert / Adams, Jeffrey / Tak, Mihir / Ganti, Latha

    Cureus

    2023  Volume 15, Issue 6, Page(s) e39931

    Abstract: The authors present a case of a 51-year-old female who presented to the emergency department with general malaise, headache, neck stiffness, and an expanding rash consistent with Lyme neuroborreliosis. In this case report, the clinical presentation, ... ...

    Abstract The authors present a case of a 51-year-old female who presented to the emergency department with general malaise, headache, neck stiffness, and an expanding rash consistent with Lyme neuroborreliosis. In this case report, the clinical presentation, diagnosis, and management of Lyme neuroborreliosis and different presentations of erythema migrans are discussed.
    Language English
    Publishing date 2023-06-04
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.39931
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  3. Article ; Online: Cardiopulmonary arrest from metformin-induced lactic acidosis

    Robert Pell / Jonathan Littell / Michelle Hernandez / Amber Mirajkar / Latha Ganti

    Resuscitation Plus, Vol 9, Iss , Pp 100217- (2022)

    2022  

    Keywords Specialties of internal medicine ; RC581-951
    Language English
    Publishing date 2022-03-01T00:00:00Z
    Publisher Elsevier
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Assessment of remote ischemic conditioning delivery with optical sensor in acute ischemic stroke: Randomised clinical trial protocol.

    Nair, Radhika / Sarmiento, Robert / Sheriff, Asif / Shuaib, Ashfaq / Buck, Brian / Gauthier, Michel / Mushahwar, Vivian / Ferguson-Pell, Martin / Kate, Mahesh

    PloS one

    2023  Volume 18, Issue 5, Page(s) e0284879

    Abstract: Background: Remote ischemic conditioning (RIC) is delivered by a blood pressure cuff over the limb, raising pressure 50 mmHg above the systolic blood pressure, to a maximum of 200 mmHg. The cuff is inflated for five minutes and then deflated for five ... ...

    Abstract Background: Remote ischemic conditioning (RIC) is delivered by a blood pressure cuff over the limb, raising pressure 50 mmHg above the systolic blood pressure, to a maximum of 200 mmHg. The cuff is inflated for five minutes and then deflated for five minutes in a sequential ischemia-reperfusion cycle 4-5 times per session. Elevated pressure in the limb may be associated with discomfort and consequently reduced compliance. Continuous assessment of relative blood concentration and oxygenation with a tissue reflectance spectroscopy (a type of optical sensor device) placed over the forearm during the RIC sessions of the arm will allow us to observe the effect of inflation and deflation of the pressure cuff. We hypothesize, in patients with acute ischemic stroke (AIS) and small vessel disease, RIC delivered together with a tissue reflectance sensor will be feasible.
    Methods: The study is a prospective, single-center, randomized control trial testing the feasibility of the device. Patients with AIS within 7 days from symptoms onset; who also have small vessel disease will be randomized 2:1 to intervention or sham control arms. All patients randomized to the intervention arm will receive 5 cycles of ischemia/reperfusion in the non-paralyzed upper limb with a tissue reflectance sensor and patients in the sham control arm will receive pressure by keeping the cuff pressure at 30 mmHg for 5 minutes. A total of 51 patients will be randomized, 17 in the sham control arm and 34 in the intervention arm. The primary outcome measure will be the feasibility of RIC delivered for 7 days or at the time of discharge. The secondary device-related outcome measures are fidelity of RIC delivery and the completion rate of intervention. The secondary clinical outcome includes a modified Rankin scale, recurrent stroke and cognitive assessment at 90 days.
    Discussion: RIC delivery together with a tissue reflectance sensor will allow insight into the blood concentration and blood oxygenation changes in the skin. This will allow individualized delivery of the RIC and improve compliance.
    Clinical trial registration: ClinicalTrials.gov Identifier: NCT05408130, June 7, 2022.
    MeSH term(s) Humans ; Ischemic Stroke ; Prospective Studies ; Treatment Outcome ; Ischemia ; Stroke/therapy ; Randomized Controlled Trials as Topic
    Language English
    Publishing date 2023-05-04
    Publishing country United States
    Document type Clinical Trial Protocol ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2267670-3
    ISSN 1932-6203 ; 1932-6203
    ISSN (online) 1932-6203
    ISSN 1932-6203
    DOI 10.1371/journal.pone.0284879
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  5. Book ; Online: Multi-Stage Threat Modelling and Security Monitoring in 5GCN

    Pell, Robert / Moschoyiannis, Sotiris / Panaousis, Emmanouil

    2021  

    Abstract: The fifth generation of mobile networks (5G) promises a range of new capabilities including higher data rates and more connected users. To support the new capabilities and use cases the 5G Core Network (5GCN) will be dynamic and reconfigurable in nature ... ...

    Abstract The fifth generation of mobile networks (5G) promises a range of new capabilities including higher data rates and more connected users. To support the new capabilities and use cases the 5G Core Network (5GCN) will be dynamic and reconfigurable in nature to deal with demand. It is these improvements which also introduce issues for traditional security monitoring methods and techniques which need to adapt to the new network architecture. The increased data volumes and dynamic network architecture mean an approach is required to focus security monitoring resources where it is most needed and react to network changes in real time. When considering multi-stage threat scenarios a coordinated, centralised approach to security monitoring is required for the early detection of attacks which may affect different parts of the network. In this chapter we identify potential solutions for overcoming these challenges which begins by identifying the threats to the 5G networks to determine suitable security monitoring placement in the 5GCN.
    Keywords Computer Science - Cryptography and Security
    Subject code 303
    Publishing date 2021-08-25
    Publishing country us
    Document type Book ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  6. Book ; Online: Towards Dynamic Threat Modelling in 5G Core Networks Based on MITRE ATT&CK

    Pell, Robert / Moschoyiannis, Sotiris / Panaousis, Emmanouil / Heartfield, Ryan

    2021  

    Abstract: This article discusses how the gap between early 5G network threat assessments and an adversarial Tactics, Techniques, Procedures (TTPs) knowledge base for future use in the MITRE ATT&CK threat modelling framework can be bridged. We identify knowledge ... ...

    Abstract This article discusses how the gap between early 5G network threat assessments and an adversarial Tactics, Techniques, Procedures (TTPs) knowledge base for future use in the MITRE ATT&CK threat modelling framework can be bridged. We identify knowledge gaps in the existing framework for key 5G technology enablers such as SDN, NFV, and 5G specific signalling protocols of the core network. We adopt a pre-emptive approach to identifying adversarial techniques which can be used to launch attacks on the 5G core network (5GCN) and map these to its components. Using relevant 5G threat assessments along with industry reports, we study how the domain specific techniques can be employed by APTs in multi-stage attack scenarios based on historic telecommunication network attacks and motivation of APT groups. We emulate this mapping in a pre-emptive fashion to facilitate a rigorous cyber risk assessment, support intrusion detection, and design defences based on common APT TTPs in a 5GCN.
    Keywords Computer Science - Cryptography and Security
    Publishing date 2021-08-25
    Publishing country us
    Document type Book ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  7. Article: Acute Myopericarditis in the Post COVID-19 Recovery Phase.

    Rivera-Morales, Mark D / Pell, Robert / Rubero, Jose / Ganti, Latha

    Cureus

    2020  Volume 12, Issue 10, Page(s) e11247

    Abstract: The COVID-19 viral infection, caused by the novel coronavirus severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is a currently ongoing global pandemic that, as of mid-October, 2020, has resulted in more than 38.7 million confirmed cases ... ...

    Abstract The COVID-19 viral infection, caused by the novel coronavirus severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is a currently ongoing global pandemic that, as of mid-October, 2020, has resulted in more than 38.7 million confirmed cases globally and has caused more than 1.1 million fatalities. COVID-19 infection is associated with severe life threatening respiratory and cardiac complications such as acute respiratory distress syndrome (ARDS), pneumonia, shock, cardiac arrhythmias, myocardial infarction and heart failure, particularly in the acute infectious stage. Acute myopericarditis is another reported cardiac complication of COVID-19. Case reports have been limited in reporting the effects of COVID-19 in the post-symptomatic period. In this article, we present a case of acute myopericarditis resulting 6 to 8 weeks after testing positive for COVID-19. Here we will breakdown the initial emergency department (ED) presentation, with particular attention to the electrocardiogram (ECG) findings of acute myopericarditis. This case, to the our best knowledge and after an extensive literature review, depicts the first case of myopericarditis in the post COVID-19 infection recovery phase.
    Language English
    Publishing date 2020-10-29
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.11247
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  8. Article ; Online: Factors Predicting Long-term Outcome and the Need for Surgery in Graves Orbitopathy: Extended Follow-up From the CIRTED Trial.

    Taylor, Peter / Rajendram, Rathie / Hanna, Stephanie / Wilson, Victoria / Pell, Julie / Li, Chunhei / Cook, Anne / Gattamaneni, Rao / Plowman, Nicholas / Jackson, Sue / Hills, Robert / French, Robert / Uddin, Jimmy M / Lee, Richard W J / Dayan, Colin M

    The Journal of clinical endocrinology and metabolism

    2023  Volume 108, Issue 10, Page(s) 2615–2625

    Abstract: Graves orbitopathy is both disabling and disfiguring. Medical therapies to reduce inflammation are widely used, but there is limited trial data beyond 18 months of follow-up.: Methods: Three-year follow-up of a subset of the CIRTED trial (N = 68), ... ...

    Abstract Graves orbitopathy is both disabling and disfiguring. Medical therapies to reduce inflammation are widely used, but there is limited trial data beyond 18 months of follow-up.
    Methods: Three-year follow-up of a subset of the CIRTED trial (N = 68), which randomized patients to receive high-dose oral steroid with azathioprine/placebo and radiotherapy/sham radiotherapy.
    Results: Data were available at 3 years from 68 of 126 randomized subjects (54%). No additional benefit was seen at 3 years for patients randomized to azathioprine or radiotherapy with regard to a binary clinical composite outcome measure (BCCOM), modified European Group on Graves' Orbitopathy score, or Ophthalmopathy Index.Clinical Activity Score (CAS), Ophthalmopathy Index, and Total Eye Score improved over 3 years (P < .001). However, quality of life at 3 years remained poor. Of 64 individuals with available surgical outcome data, 24 of 64 (37.5%) required surgical intervention. Disease duration of greater than 6 months before treatment was associated with increased need for surgery [odds ratio (OR) 16.8; 95% CI 2.95, 95.0; P = .001]. Higher baseline levels of CAS, Ophthalmopathy Index, and Total Eye Score but not early improvement in CAS were associated with increased requirement for surgery.
    Conclusion: In this long-term follow-up from a clinical trial, 3-year outcomes remained suboptimal with ongoing poor quality of life and high numbers requiring surgery. Importantly, reduction in CAS in the first year, a commonly used surrogate outcome measure, was not associated with improved long-term outcomes.
    MeSH term(s) Humans ; Graves Ophthalmopathy/drug therapy ; Graves Ophthalmopathy/surgery ; Azathioprine/therapeutic use ; Follow-Up Studies ; Quality of Life ; Inflammation/drug therapy ; Treatment Outcome
    Chemical Substances Azathioprine (MRK240IY2L)
    Language English
    Publishing date 2023-03-27
    Publishing country United States
    Document type Randomized Controlled Trial ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 3029-6
    ISSN 1945-7197 ; 0021-972X
    ISSN (online) 1945-7197
    ISSN 0021-972X
    DOI 10.1210/clinem/dgad084
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  9. Article: At-Line Reversed Phase Liquid Chromatography for In-Process Monitoring of Inclusion Body Solubilization.

    Ebner, Julian / Humer, Diana / Klausser, Robert / Rubus, Viktor / Pell, Reinhard / Spadiut, Oliver / Kopp, Julian

    Bioengineering (Basel, Switzerland)

    2021  Volume 8, Issue 6

    Abstract: Refolding is known as the bottleneck in inclusion body (IB) downstream processing in the pharmaceutical industry: high dilutions leading to large operating volumes, slow refolding kinetics and low refolding yields are only a few of the problems that ... ...

    Abstract Refolding is known as the bottleneck in inclusion body (IB) downstream processing in the pharmaceutical industry: high dilutions leading to large operating volumes, slow refolding kinetics and low refolding yields are only a few of the problems that impede industrial application. Solubilization prior to refolding is often carried out empirically and the effects of the solubilizate on the subsequent refolding step are rarely investigated. The results obtained in this study, however, indicate that the quality of the IB solubilizate has a severe effect on subsequent refolding. As the solubilizate contains chaotropic reagents in high molarities, it is commonly analyzed with sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). SDS-PAGE, however, suffers from a long analysis time, making at-line analytical implementation difficult. In this study, we established an at-line reversed phase liquid chromatography method to investigate the time-dependent quality of the solubilizate. To verify the necessity of at-line solubilization monitoring, we varied the essential solubilization conditions for horseradish peroxidase IBs. The solubilization time was found to have a major influence on subsequent refolding, underlining the high need for an at-line analysis of solubilization. Furthermore, we used the developed reversed phase liquid chromatography method for an in-process control (IPC). In conclusion, the presented reversed phase liquid chromatography method allows a proper control of IB solubilization applicable for tailored refolding.
    Language English
    Publishing date 2021-06-07
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2746191-9
    ISSN 2306-5354
    ISSN 2306-5354
    DOI 10.3390/bioengineering8060078
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  10. Article ; Online: Severe acute myositis and myocarditis on initiation of 6-weekly pembrolizumab post-COVID-19 mRNA vaccination.

    Watson, Robert A / Ye, Weiyu / Taylor, Chelsea A / Jungkurth, Elsita / Cooper, Rosalin / Tong, Orion / James, Tim / Shine, Brian / Hofer, Monika / Jenkins, Damian / Pell, Robert / Ieremia, Eleni / Jones, Stephanie / Maldonado-Perez, David / Roberts, Ian S D / Coupe, Nicholas / Middleton, Mark R / Payne, Miranda J / Fairfax, Benjamin P

    Journal for immunotherapy of cancer

    2024  Volume 12, Issue 4

    Abstract: We describe three cases of critical acute myositis with myocarditis occurring within 22 days of each other at a single institution, all within 1 month of receiving the initial cycle of the anti-PD-1 drug pembrolizumab. Analysis of T cell receptor ... ...

    Abstract We describe three cases of critical acute myositis with myocarditis occurring within 22 days of each other at a single institution, all within 1 month of receiving the initial cycle of the anti-PD-1 drug pembrolizumab. Analysis of T cell receptor repertoires from peripheral blood and tissues revealed a high degree of clonal expansion and public clones between cases, with several T cell clones expanded within the skeletal muscle putatively recognizing viral epitopes. All patients had recently received a COVID-19 mRNA booster vaccine prior to treatment and were positive for SARS-CoV2 Spike antibody. In conclusion, we report a series of unusually severe myositis and myocarditis following PD-1 blockade and the COVID-19 mRNA vaccination.
    MeSH term(s) Humans ; Myocarditis/chemically induced ; Antibodies, Monoclonal, Humanized/adverse effects ; Antibodies, Monoclonal, Humanized/therapeutic use ; Myositis/chemically induced ; COVID-19/prevention & control ; COVID-19/immunology ; Male ; SARS-CoV-2/immunology ; Female ; Middle Aged ; Aged ; COVID-19 Vaccines/adverse effects ; Immune Checkpoint Inhibitors/adverse effects ; Immune Checkpoint Inhibitors/therapeutic use ; Vaccination/adverse effects
    Chemical Substances Antibodies, Monoclonal, Humanized ; pembrolizumab (DPT0O3T46P) ; COVID-19 Vaccines ; Immune Checkpoint Inhibitors
    Language English
    Publishing date 2024-04-24
    Publishing country England
    Document type Journal Article ; Case Reports ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
    ZDB-ID 2719863-7
    ISSN 2051-1426 ; 2051-1426
    ISSN (online) 2051-1426
    ISSN 2051-1426
    DOI 10.1136/jitc-2023-008151
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