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Article ; Online: Acute Respiratory Failure From Early Pandemic COVID-19: Noninvasive Respiratory Support vs Mechanical Ventilation.

Fisher, Julia M / Subbian, Vignesh / Essay, Patrick / Pungitore, Sarah / Bedrick, Edward J / Mosier, Jarrod M

CHEST critical care

2023 Volume 2, Issue 1

Abstract: Background: The optimal strategy for initial respiratory support in patients with respiratory failure associated with COVID-19 is unclear, and the initial strategy may affect outcomes.: Research question: Which initial respiratory support strategy is ...

Abstract	Background: The optimal strategy for initial respiratory support in patients with respiratory failure associated with COVID-19 is unclear, and the initial strategy may affect outcomes. Research question: Which initial respiratory support strategy is associated with improved outcomes in patients with COVID-19 with acute respiratory failure? Study design and methods: All patients with COVID-19 requiring respiratory support and admitted to a large health care network were eligible for inclusion. We compared patients treated initially with noninvasive respiratory support (NIRS; noninvasive positive pressure ventilation by facemask or high-flow nasal oxygen) with patients treated initially with invasive mechanical ventilation (IMV). The primary outcome was time to in-hospital death analyzed using an inverse probability of treatment weighted Cox model adjusted for potential confounders. Secondary outcomes included unweighted and weighted assessments of mortality, lengths of stay (ICU and hospital), and time to intubation. Results: Nearly one-half of the 2,354 patients (47%) who met inclusion criteria received IMV first, and 53% received initial NIRS. Overall, in-hospital mortality was 38% (37% for IMV and 39% for NIRS). Initial NIRS was associated with an increased hazard of death compared with initial IMV (hazard ratio, 1.42; 95% CI, 1.03-1.94), but also an increased hazard of leaving the hospital sooner that waned with time (noninvasive support by time interaction: hazard ratio, 0.97; 95% CI, 0.95-0.98). Interpretation: Patients with COVID-19 with acute hypoxemic respiratory failure initially treated with NIRS showed an increased hazard of in-hospital death.
Language	English
Publishing date	2023-11-24
Publishing country	United States
Document type	Journal Article
ISSN	2949-7884
ISSN (online)	2949-7884
DOI	10.1016/j.chstcc.2023.100030
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Fate and State of Vascular Smooth Muscle Cells in Atherosclerosis.

Miano, Joseph M / Fisher, Edward A / Majesky, Mark W

Circulation

2021 Volume 143, Issue 21, Page(s) 2110–2116

Abstract: Vascular smooth muscle cells (VSMCs) have long been associated with phenotypic modulation/plasticity or dedifferentiation. Innovative technologies in cell lineage tracing, single-cell RNA sequencing, and human genomics have been integrated to gain ... ...

Abstract	Vascular smooth muscle cells (VSMCs) have long been associated with phenotypic modulation/plasticity or dedifferentiation. Innovative technologies in cell lineage tracing, single-cell RNA sequencing, and human genomics have been integrated to gain unprecedented insights into the molecular reprogramming of VSMCs to other cell phenotypes in experimental and clinical atherosclerosis. The current thinking is that an apparently small subset of contractile VSMCs undergoes a fate switch to transitional, multipotential cells that can adopt plaque-destabilizing (inflammation, ossification) or plaque-stabilizing (collagen matrix deposition) cell states. Several candidate mediators of such VSMC fate and state changes are coming to light with intriguing implications for understanding coronary artery disease risk and the development of new treatment modalities. Here, we briefly summarize some technical and conceptual advancements derived from 2 publications in
MeSH term(s)	Atherosclerosis/physiopathology ; Cell Proliferation ; Humans ; Muscle, Smooth, Vascular/metabolism
Language	English
Publishing date	2021-05-24
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	80099-5
ISSN	1524-4539 ; 0009-7322 ; 0069-4193 ; 0065-8499
ISSN (online)	1524-4539
ISSN	0009-7322 ; 0069-4193 ; 0065-8499
DOI	10.1161/CIRCULATIONAHA.120.049922
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Article: A Review of Decontamination Methods for Filtering Facepiece Respirators.

Bergman, Mike / Fisher, Edward M / Heimbuch, Brian K

Journal of the International Society for Respiratory Protection

2020 Volume 37, Issue 2, Page(s) 71–86

Abstract: During the current COVID-19 infectious disease pandemic, the demand for NIOSH-approved filtering facepiece respirators (FFR) has exceeded supplies and decontamination and reuse of FFRs has been implemented by various user groups. FFR decontamination and ... ...

Abstract	During the current COVID-19 infectious disease pandemic, the demand for NIOSH-approved filtering facepiece respirators (FFR) has exceeded supplies and decontamination and reuse of FFRs has been implemented by various user groups. FFR decontamination and reuse is only intended to be implemented as a crisis capacity strategy. This paper provides a review of decontamination procedures in the published literature and calls attention to their benefits and limitations. In most cases, the data are limited to a few FFR models and a limited number of decontamination cycles. Institutions planning to implement a decontamination method must understand its limitations in terms of the degree of inactivation of the intended microorganisms and the treatment's effects on the fit and filtration of the device.
Language	English
Publishing date	2020-10-09
Publishing country	United States
Document type	Journal Article
ISSN	0892-6298
ISSN	0892-6298
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Article ; Online: Smallest Clinically Meaningful Improvement in Amputation-Related Pain and Brief Pain Inventory Scores as Defined by Patient Reports of Global Improvement After Cryoneurolysis: a Retrospective Analysis of a Randomized, Controlled Clinical Trial.

Ilfeld, Brian M / Smith, Cameron R / Turan, Alparslan / Mariano, Edward R / Miller, Matthew E / Fisher, Rick L / Trescot, Andrea M / Cohen, Steven P / Eisenach, James C / Sessler, Daniel I / Prologo, J David / Mascha, Edward J / Liu, Liu / Gabriel, Rodney A

Anesthesia and analgesia

2024

Abstract: Background: The smallest meaningful improvement in pain scores (minimal clinically important difference [MCID]) after an analgesic intervention is essential information when both interpreting published data and designing a clinical trial. However, ... ...

Abstract	Background: The smallest meaningful improvement in pain scores (minimal clinically important difference [MCID]) after an analgesic intervention is essential information when both interpreting published data and designing a clinical trial. However, limited information is available for patients with chronic pain conditions, and what is published is derived from studies involving pharmacologic and psychological interventions. We here calculate these values based on data collected from 144 participants of a previously published multicenter clinical trial investigating the effects of a single treatment with percutaneous cryoneurolysis. Methods: In the original trial, we enrolled patients with a lower-limb amputation and established phantom pain. Each received a single-injection femoral and sciatic nerve block with lidocaine and was subsequently randomized to receive either ultrasound-guided percutaneous cryoneurolysis or sham treatment at these same locations. Investigators, participants, and clinical staff were masked to treatment group assignment with the exception of the treating physician performing the cryoneurolysis, who had no subsequent participant interaction. At both baseline and 4 months (primary end point), participants rated their phantom limb pain based on a numeric rating scale (NRS) and their interference of pain on physical and emotional functioning as measured with the Brief Pain Inventory's interference subscale. They subsequently qualitatively defined the change using the 7-point ordinal Patient Global Impression of Change (PGIC). The smallest clinically meaningful improvements in phantom limb pain and Brief Pain Inventory scores were calculated using an anchor-based method based on the PGIC. Results: The median (interquartile range [IQR]) phantom pain NRS (0-10) improvements at 4 months considered small, medium, and large were 1 [1-1], 3 [3-4], and 4 [3-6], respectively. The median improvements in the Brief Pain Inventory interference subscale (0-70) associated with a small, medium, and large analgesic changes were 16 [6-18], 24 [22-31], and 34 [22-46]. The proportions of patients that experienced PGIC ≥5 were 33% and 36% in the active and placebo groups, respectively. The relative risk of a patient experiencing PGIC ≥5 in the active group compared to the sham group with 95% confidence interval was 0.9 (0.6-1.4), P = .667. Conclusions: Amputees with phantom limb pain treated with percutaneous cryoneurolysis rate analgesic improvements as clinically meaningful similar to pharmacologic treatments, although their MCID for the Brief Pain Inventory was somewhat larger than previously published values. This information on patient-defined clinically meaningful improvements will facilitate interpretation of available studies and guide future trial design.
Language	English
Publishing date	2024-03-14
Publishing country	United States
Document type	Journal Article
ZDB-ID	80032-6
ISSN	1526-7598 ; 0003-2999
ISSN (online)	1526-7598
ISSN	0003-2999
DOI	10.1213/ANE.0000000000006833
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Article ; Online: Acetylcholine synergizes with netrin-1 to drive persistent firing in the entorhinal cortex.

Glasgow, Stephen D / Fisher, Teddy A J / Wong, Edwin W / Lançon, Kevin / Feighan, Kira M / Beamish, Ian V / Gibon, Julien / Séguéla, Philippe / Ruthazer, Edward S / Kennedy, Timothy E

Cell reports

2024 Volume 43, Issue 2, Page(s) 113812

Abstract: The ability of the mammalian brain to maintain spatial representations of external or internal information for short periods of time has been associated with sustained neuronal spiking and reverberatory neural network activity in the medial entorhinal ... ...

Abstract	The ability of the mammalian brain to maintain spatial representations of external or internal information for short periods of time has been associated with sustained neuronal spiking and reverberatory neural network activity in the medial entorhinal cortex. Here, we show that conditional genetic deletion of netrin-1 or the netrin receptor deleted-in-colorectal cancer (DCC) from forebrain excitatory neurons leads to deficits in short-term spatial memory. We then demonstrate that conditional deletion of either netrin-1 or DCC inhibits cholinergic persistent firing and show that cholinergic activation of muscarinic receptors expressed by entorhinal cortical neurons promotes persistent firing by recruiting DCC to the plasma membrane. Together, these findings indicate that normal short-term spatial memory function requires the synergistic actions of acetylcholine and netrin-1.
MeSH term(s)	Animals ; Acetylcholine/pharmacology ; Netrin-1 ; Entorhinal Cortex ; Prosencephalon ; Cholinergic Agents ; Mammals
Chemical Substances	Acetylcholine (N9YNS0M02X) ; Netrin-1 (158651-98-0) ; Cholinergic Agents
Language	English
Publishing date	2024-02-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	2649101-1
ISSN	2211-1247 ; 2211-1247
ISSN (online)	2211-1247
ISSN	2211-1247
DOI	10.1016/j.celrep.2024.113812
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Article ; Online: A Systems Approach to Biomechanics, Mechanobiology, and Biotransport.

Peirce-Cottler, Shayn M / Sander, Edward A / Fisher, Matthew B / Deymier, Alix C / LaDisa, John F / O'Connell, Grace / Corr, David T / Han, Bumsoo / Singh, Anita / Wilson, Sara E / Lai, Victor K / Clyne, Alisa Morss

Journal of biomechanical engineering

2024 Volume 146, Issue 4

Abstract: The human body represents a collection of interacting systems that range in scale from nanometers to meters. Investigations from a systems perspective focus on how the parts work together to enact changes across spatial scales, and further our ... ...

Abstract	The human body represents a collection of interacting systems that range in scale from nanometers to meters. Investigations from a systems perspective focus on how the parts work together to enact changes across spatial scales, and further our understanding of how systems function and fail. Here, we highlight systems approaches presented at the 2022 Summer Biomechanics, Bio-engineering, and Biotransport Conference in the areas of solid mechanics; fluid mechanics; tissue and cellular engineering; biotransport; and design, dynamics, and rehabilitation; and biomechanics education. Systems approaches are yielding new insights into human biology by leveraging state-of-the-art tools, which could ultimately lead to more informed design of therapies and medical devices for preventing and treating disease as well as rehabilitating patients using strategies that are uniquely optimized for each patient. Educational approaches can also be designed to foster a foundation of systems-level thinking.
MeSH term(s)	Humans ; Biomechanical Phenomena ; Bioengineering ; Biophysics ; Systems Analysis
Language	English
Publishing date	2024-01-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	243094-0
ISSN	1528-8951 ; 0148-0731
ISSN (online)	1528-8951
ISSN	0148-0731
DOI	10.1115/1.4064547
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Article: Outcomes in Patients with Acute Hypoxemic Respiratory Failure Secondary to COVID-19 Treated with Noninvasive Respiratory Support versus Invasive Mechanical Ventilation.

Fisher, Julia M / Subbian, Vignesh / Essay, Patrick / Pungitore, Sarah / Bedrick, Edward J / Mosier, Jarrod M

medRxiv : the preprint server for health sciences

2022

Abstract: Purpose: The goal of this study was to compare noninvasive respiratory support to invasive mechanical ventilation as the initial respiratory support in COVID-19 patients with acute hypoxemic respiratory failure.: Methods: All patients admitted to a ... ...

Abstract	Purpose: The goal of this study was to compare noninvasive respiratory support to invasive mechanical ventilation as the initial respiratory support in COVID-19 patients with acute hypoxemic respiratory failure. Methods: All patients admitted to a large healthcare network with acute hypoxemic respiratory failure associated with COVID-19 and requiring respiratory support were eligible for inclusion. We compared patients treated initially with noninvasive respiratory support (noninvasive positive pressure ventilation by facemask or high flow nasal oxygen) with patients treated initially with invasive mechanical ventilation. The primary outcome was time-to-in-hospital death analyzed using an inverse probability of treatment weighted Cox model adjusted for potential confounders. Secondary outcomes included unweighted and weighted assessments of mortality, lengths-of-stay (intensive care unit and hospital) and time-to-intubation. Results: Over the study period, 2354 patients met inclusion criteria. Nearly half (47%) received invasive mechanical ventilation first and 53% received initial noninvasive respiratory support. There was an overall 38% in-hospital mortality (37% for invasive mechanical ventilation and 39% for noninvasive respiratory support). Initial noninvasive respiratory support was associated with an increased hazard of death compared to initial invasive mechanical ventilation (HR: 1.61, p < 0.0001, 95% CI: 1.33 - 1.94). However, patients on initial noninvasive respiratory support also experienced an increased hazard of leaving the hospital sooner, but the hazard ratio waned with time (HR: 0.97, p < 0.0001, 95% CI: 0.96 - 0.98). Conclusion: These data show that the COVID-19 patients with acute hypoxemic respiratory failure initially treated with noninvasive respiratory support had an increased hazard of in-hospital death.
Language	English
Publishing date	2022-12-20
Publishing country	United States
Document type	Preprint
DOI	10.1101/2022.12.19.22283704
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Article ; Online: Total outward leakage of half-mask respirators and surgical masks used for source control.

Myers, Warren R / Yang, Weihua / Ryan, Kenneth J / Bergman, Michael S / M Fisher, Edward / Soo, Jhy-Charm / Zhuang, Ziqing

Journal of occupational and environmental hygiene

2023 Volume 20, Issue 12, Page(s) 610–620

Abstract: Both respirators and surgical masks (SM) are used as source control devices. During the COVID-19 pandemic, there was much interest in understanding the extent of particle total outward leakage (TOL) from these devices. The objective of this study was to ... ...

Abstract	Both respirators and surgical masks (SM) are used as source control devices. During the COVID-19 pandemic, there was much interest in understanding the extent of particle total outward leakage (TOL) from these devices. The objective of this study was to quantify the TOL for five categories of devices: SMs, National Institute for Occupational Safety and Health (NIOSH) Approved N95 filtering facepiece respirators (FFRs) without exhalation valves, NIOSH Approved N95 FFRs with exhalation valves (N95 FFRV), NIOSH Approved elastomeric half-mask respirators (EHMRs) with exhalation valves, and NIOSH Approved EHMRs with an SM covering the exhalation valve (EHMRSM). A benchtop test system was designed to test two models of each device category. Each device was mounted on a headform at three faceseal levels (0% faceseal, 50% faceseal, and 100% faceseal). At each faceseal level, the TOL was assessed at three flow rates of minute ventilations of 17, 28, and 39 L/min. The experimental design was a split-split-plot configuration. Device type, faceseal level, flow rate, and the interaction of device type and faceseal level were found to have a significant effect (
MeSH term(s)	United States ; Humans ; Occupational Exposure/prevention & control ; Masks ; Pandemics ; Respiratory Protective Devices ; Ventilators, Mechanical ; Filtration
Language	English
Publishing date	2023-09-08
Publishing country	England
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	2131820-7
ISSN	1545-9632 ; 1545-9624
ISSN (online)	1545-9632
ISSN	1545-9624
DOI	10.1080/15459624.2023.2257254
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Article ; Online: Fentanyl and carfentanil permeation through commercial disposable gloves.

Greenawald, Lee Ann / Hofacre, Kent C / Fisher, Edward M

Journal of occupational and environmental hygiene

2020 Volume 17, Issue 9, Page(s) 398–407

Abstract: In 2018, the Centers for Disease Control and Prevention reported that opioid overdose deaths (including fentanyl and carfentanil) comprised 46,802 (69%) of the 67,367 total drug overdose deaths. The opioid overdose epidemic affects Americans not only at ... ...

Abstract	In 2018, the Centers for Disease Control and Prevention reported that opioid overdose deaths (including fentanyl and carfentanil) comprised 46,802 (69%) of the 67,367 total drug overdose deaths. The opioid overdose epidemic affects Americans not only at home but also in the workplace. First responders may be at risk of opioid exposure during incidents such as vehicle searches and responses to overdose calls. To reduce direct exposure to opioids and other hazardous drugs, first responders rely in part on personal protective equipment (PPE) as their last line of defense. First responders seek guidance from the National Institute for Occupational Safety and Health (NIOSH) regarding appropriate PPE selection for potential opioid exposure. There is limited empirical glove performance data for illicit drugs. Empirical data are needed to validate NIOSH's current recommendations regarding gloves to help prevent exposure to illicit drugs (i.e., powder-free nitrile gloves with a minimum thickness of 5 ± 2 mil [0.127 ± 0.051 millimeters]); however, no industry standard or test method currently exists for specifically evaluating PPE performance against fentanyl and its analogs. To understand the permeation qualities of gloves when challenged against fentanyl and carfentanil solutions, the ASTM International (formerly American Society for Testing and Materials) ASTM D6978-19 standard for chemotherapy drug glove permeation was adapted to test fentanyl and carfentanil hydrochloride solution permeation through twelve disposable glove models, including five models in which the manufacturers claim fentanyl protection. No nitrile glove models showed fentanyl or carfentanil permeation rates above the chemotherapy drug threshold criterion of 0.01 µg/cm
MeSH term(s)	Fentanyl/analogs & derivatives ; Fentanyl/chemistry ; Gloves, Protective/standards ; Materials Testing/methods ; Occupational Exposure/prevention & control ; Permeability
Chemical Substances	carfentanil (LA9DTA2L8F) ; Fentanyl (UF599785JZ)
Language	English
Publishing date	2020-07-13
Publishing country	England
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	2131820-7
ISSN	1545-9632 ; 1545-9624
ISSN (online)	1545-9632
ISSN	1545-9624
DOI	10.1080/15459624.2020.1784426
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Article: Noninvasive vs Invasive Respiratory Support for Patients with Acute Hypoxemic Respiratory Failure.

Mosier, Jarrod M / Subbian, Vignesh / Pungitore, Sarah / Prabhudesai, Devashri / Essay, Patrick / Bedrick, Edward J / Stocking, Jacqueline C / Fisher, Julia M

medRxiv : the preprint server for health sciences

2023

Abstract: Rationale: Noninvasive respiratory support modalities are common alternatives to mechanical ventilation for patients with early acute hypoxemic respiratory failure. These modalities include noninvasive positive pressure ventilation, using either ... ...

Abstract	Rationale: Noninvasive respiratory support modalities are common alternatives to mechanical ventilation for patients with early acute hypoxemic respiratory failure. These modalities include noninvasive positive pressure ventilation, using either continuous or bilevel positive airway pressure, and nasal high flow using a high flow nasal cannula system. However, outcomes data historically compare noninvasive respiratory support to conventional oxygen rather than to mechanical ventilation. Objectives: The goal of this study was to compare the outcomes of in-hospital death and alive discharge in patients with acute hypoxemic respiratory failure when treated initially with noninvasive respiratory support compared to patients treated initially with invasive mechanical ventilation. Methods: We used a validated phenotyping algorithm to classify all patients with eligible International Classification of Diseases codes at a large healthcare network between January 1, 2018 and December 31, 2019 into noninvasive respiratory support and invasive mechanical ventilation cohorts. The primary outcome was time-to-in-hospital death analyzed using an inverse probability of treatment weighted Cox model adjusted for potential confounders, with estimated cumulative incidence curves. Secondary outcomes included time-to-hospital discharge alive. A secondary analysis was conducted to examine potential differences between noninvasive positive pressure ventilation and nasal high flow. Results: During the study period, 3177 patients met inclusion criteria (40% invasive mechanical ventilation, 60% noninvasive respiratory support). Initial noninvasive respiratory support was not associated with a decreased hazard of in-hospital death (HR: 0.65, 95% CI: 0.35 - 1.2), but was associated with an increased hazard of discharge alive (HR: 2.26, 95% CI: 1.92 - 2.67). In-hospital death varied between the nasal high flow (HR 3.27, 95% CI: 1.43 - 7.45) and noninvasive positive pressure ventilation (HR 0.52, 95% CI 0.25 - 1.07), but both were associated with increased likelihood of discharge alive (nasal high flow HR 2.12, 95 CI: 1.25 - 3.57; noninvasive positive pressure ventilation HR 2.29, 95% CI: 1.92 - 2.74). Conclusion: These observational data from a large healthcare network show that noninvasive respiratory support is not associated with reduced hazards of in-hospital death but is associated with hospital discharge alive. There are also potential differences between the noninvasive respiratory support modalities.
Language	English
Publishing date	2023-12-28
Publishing country	United States
Document type	Preprint
DOI	10.1101/2023.12.23.23300368
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