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  1. AU="Klouda, Timothy"
  2. AU="Olsson-Brown, Anna C."
  3. AU="Schmauß, Max"
  4. AU="Raza, Syed Tasleem"
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  1. Article: Inflammation in Pulmonary Arterial Hypertension.

    Klouda, Timothy / Yuan, Ke

    Advances in experimental medicine and biology

    2021  Volume 1303, Page(s) 351–372

    Abstract: Pulmonary artery hypertension (PAH) is a devastating cardiopulmonary disease characterized by vascular remodeling and obliteration of the precapillary pulmonary arterioles. Alterations in the structure and function of pulmonary vessels result in the ... ...

    Abstract Pulmonary artery hypertension (PAH) is a devastating cardiopulmonary disease characterized by vascular remodeling and obliteration of the precapillary pulmonary arterioles. Alterations in the structure and function of pulmonary vessels result in the resistance of blood flow and can progress to right-sided heart failure, causing significant morbidity and mortality. There are several types of PAH, and the disease can be familial or secondary to an underlying medical condition such as a connective tissue disorder or infection. Regardless of the cause, the exact pathophysiology and cellular interactions responsible for disease development and progression are largely unknown.There is significant evidence to suggest altered immune and vascular cells directly participate in disease progression. Inflammation has long been hypothesized to play a vital role in the development of PAH, as an altered or skewed immune response favoring a proinflammatory environment that can lead to the infiltration of cells such as lymphocytes, macrophages, and neutrophils. Current treatment strategies focus on the dilation of partially occluded vessels; however, such techniques have not resulted in an effective strategy to reverse or prevent vascular remodeling. Therefore, current studies in human and animal models have attempted to understand the underlying pathophysiology of pulmonary hypertension (PH), specifically focusing on the inflammatory cascade predisposing patients to disease so that better therapeutic targets can be developed to potentially reverse or prevent disease progression.The purpose of this chapter is to provide a comprehensive review of the expanding literature on the inflammatory process that participates in PH development while highlighting important and current studies in both animal and human models. While our primary focus will be on cells found in the adaptive and innate immune system, we will review all potential causes of PAH, including cells of the endothelium, pulmonary lymphatics, and genetic mutations predisposing patients. In addition, we will discuss current therapeutic options while highlighting potential future treatments and the questions that still remain unanswered.
    MeSH term(s) Animals ; Familial Primary Pulmonary Hypertension ; Humans ; Hypertension, Pulmonary ; Inflammation ; Pulmonary Arterial Hypertension ; Pulmonary Artery ; Vascular Remodeling
    Language English
    Publishing date 2021-03-31
    Publishing country United States
    Document type Journal Article ; Review
    ISSN 2214-8019 ; 0065-2598
    ISSN (online) 2214-8019
    ISSN 0065-2598
    DOI 10.1007/978-3-030-63046-1_19
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Identification of Irpex and Rhodotorula on surveillance bronchoscopy in a pediatric lung transplant recipient: A case report and review of literature of these atypical fungal organisms.

    Atwood, Daniel T / Köhler, Julia R / Vargas, Sara O / Wong, Wai / Klouda, Timothy

    Pediatric transplantation

    2024  Volume 28, Issue 3, Page(s) e14759

    Abstract: Background: Invasive fungal disease (IFD) is a frequent complication in pediatric lung transplant recipients, occurring in up to 12% of patients in the first year. Risk factors for infection include impaired lung defenses and intense immunosuppressive ... ...

    Abstract Background: Invasive fungal disease (IFD) is a frequent complication in pediatric lung transplant recipients, occurring in up to 12% of patients in the first year. Risk factors for infection include impaired lung defenses and intense immunosuppressive regimens. While most IFD occurs from Aspergillus, other fungal conidia are continuously inhaled, and infections with fungi on a spectrum of human pathogenicity can occur.
    Case report: We report a case of a 17-year-old lung transplant recipient in whom Irpex lacteus and Rhodotorula species were identified during surveillance bronchoscopy. She was asymptomatic and deemed to be colonized by Irpex lacteus and Rhodotorula species following transplant. 2 years after transplantation, she developed a fever, respiratory symptoms, abnormal lung imaging, and histological evidence of acute and chronic bronchitis on transbronchial biopsy. After developing symptoms concerning for a pulmonary infection and graft dysfunction, she was treated for a presumed IFD. Unfortunately, further diagnostic testing could not be performed at this time given her tenuous clinical status. Despite the initiation of antifungal therapy, her graft function continued to decline resulting in a second lung transplantation.
    Conclusions: This case raises the concern for IFD in lung transplant recipients from Irpex species. Further investigation is needed to understand the pathogenicity of this organism, reduce the incidence and mortality of IFD in lung transplant recipients, and refine the approach to diagnosis and manage the colonization and isolation of rare, atypical fungal pathogens in immunocompromised hosts.
    MeSH term(s) Adolescent ; Female ; Humans ; Antifungal Agents/therapeutic use ; Bronchoscopy ; Invasive Fungal Infections ; Lung ; Lung Transplantation/adverse effects ; Polyporales ; Rhodotorula ; Transplant Recipients
    Chemical Substances Antifungal Agents
    Language English
    Publishing date 2024-04-24
    Publishing country Denmark
    Document type Review ; Case Reports
    ZDB-ID 1390284-2
    ISSN 1399-3046 ; 1397-3142
    ISSN (online) 1399-3046
    ISSN 1397-3142
    DOI 10.1111/petr.14759
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Epidemiology of complications among hospitalized children with hereditary hemorrhagic telangiectasia: A kids' inpatient database study.

    Tsou, Po-Yang / Ruiz-Gutierrez, Melisa / Alomari, Ahmad / Kuo, Pei-Lun / Klouda, Timothy

    Pediatric pulmonology

    2024  Volume 59, Issue 5, Page(s) 1507–1510

    MeSH term(s) Humans ; Telangiectasia, Hereditary Hemorrhagic/complications ; Telangiectasia, Hereditary Hemorrhagic/epidemiology ; Child ; Male ; Female ; Adolescent ; Child, Preschool ; Databases, Factual ; Hospitalization/statistics & numerical data ; Infant ; United States/epidemiology ; Retrospective Studies ; Inpatients/statistics & numerical data
    Language English
    Publishing date 2024-02-21
    Publishing country United States
    Document type Letter
    ZDB-ID 632784-9
    ISSN 1099-0496 ; 8755-6863
    ISSN (online) 1099-0496
    ISSN 8755-6863
    DOI 10.1002/ppul.26922
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Polymicrobial brain abscess as the initial presentation of hereditary hemorrhagic telangiectasia in a teenage girl.

    Tsou, Po-Yang / Klouda, Timothy / Quinn, Brian / Casey, Alicia

    Pediatric pulmonology

    2022  Volume 57, Issue 11, Page(s) 2877–2879

    MeSH term(s) Adolescent ; Brain Abscess/diagnostic imaging ; Brain Abscess/etiology ; Female ; Humans ; Telangiectasia, Hereditary Hemorrhagic/diagnosis ; Telangiectasia, Hereditary Hemorrhagic/diagnostic imaging
    Language English
    Publishing date 2022-09-06
    Publishing country United States
    Document type Letter
    ZDB-ID 632784-9
    ISSN 1099-0496 ; 8755-6863
    ISSN (online) 1099-0496
    ISSN 8755-6863
    DOI 10.1002/ppul.26095
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Gastrointestinal complications in pediatric lung transplant recipients: Incidence, risk factors, and effects on patient outcomes.

    Klouda, Timothy / Ryan E, Morgan / Leonard, Jessica Brie / Freiberger, Dawn / Midyat, Levent / Dahlberg, Suzanne / Rosen, Rachel / Visner, Gary

    Pediatric transplantation

    2024  Volume 28, Issue 1, Page(s) e14665

    Abstract: Background: Gastrointestinal (GI) complications in lung transplant recipients can occur any time during the post-operative period, leading to prolonged morbidity and mortality. Despite the negative association between GI complications and patient ... ...

    Abstract Background: Gastrointestinal (GI) complications in lung transplant recipients can occur any time during the post-operative period, leading to prolonged morbidity and mortality. Despite the negative association between GI complications and patient outcomes, little is known about their incidence and risk factors for their development in pediatric lung transplant recipients.
    Methods: We performed a retrospective chart review at one pediatric tertiary center to describe the frequency of GI complications in lung transplant recipients. We identified potential risk factors for the diagnosis of gastroparesis, gastroesophageal reflux disease (GERD) and aspiration in the post-transplant period. Lastly, we investigated the association of these complications with mortality and graft survival.
    Results: 84.3% of lung transplant recipients experienced at least one GI complication in the post-transplant period. Gastroparesis (52.9%), GERD (41.2%), and oropharyngeal dysphagia/laryngeal penetration (33.3%) were the most common complications diagnosed. Post-operative opioid exposure was a risk factor for gastroparesis, with the odds increasing 3.0% each day a patient was prescribed opioids (p = .021). The risk of death or retransplant in individuals who experienced gastroparesis was 2.7 times higher than those not diagnosed with gastroparesis (p = .027).
    Conclusion: Exposure to opioids in the post-operative period is a risk factor for gastroparesis and a prolonged hospitalization placed patients at risk for aspiration. Gastroparesis was associated with increased patient mortality and graft failure, while aspiration and GERD had no effect on long term outcomes. Future prospective studies investigating the relationship between opioid use and the development of a gastroparesis are necessary to improve patient outcomes.
    MeSH term(s) Humans ; Child ; Gastroparesis/etiology ; Gastroparesis/complications ; Retrospective Studies ; Incidence ; Prospective Studies ; Analgesics, Opioid ; Transplant Recipients ; Gastrointestinal Diseases/epidemiology ; Gastrointestinal Diseases/etiology ; Gastroesophageal Reflux/complications ; Gastroesophageal Reflux/epidemiology ; Risk Factors ; Lung Transplantation/adverse effects ; Lung
    Chemical Substances Analgesics, Opioid
    Language English
    Publishing date 2024-02-05
    Publishing country Denmark
    Document type Journal Article
    ZDB-ID 1390284-2
    ISSN 1399-3046 ; 1397-3142
    ISSN (online) 1399-3046
    ISSN 1397-3142
    DOI 10.1111/petr.14665
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Restrictive allograft syndrome after lung transplantation.

    Klouda, Timothy / Vargas, Sara O / Midyat, Levent

    Pediatric transplantation

    2021  Volume 25, Issue 3, Page(s) e14000

    Abstract: Despite recent advances over the past decade in lung transplantation including improved surgical technique and immunotherapy, the diagnosis and treatment of chronic lung allograft dysfunction remains a significant barrier to recipient survival. Aside ... ...

    Abstract Despite recent advances over the past decade in lung transplantation including improved surgical technique and immunotherapy, the diagnosis and treatment of chronic lung allograft dysfunction remains a significant barrier to recipient survival. Aside from bronchiolitis obliterans syndrome, a restrictive phenotype called restrictive allograft syndrome has recently been recognized and affects up to 35% of all patients with CLAD. The main characteristics of RAS include a persistent and unexplained decline in lung function compared to baseline and persistent parenchymal infiltrates on imaging. The median survival after diagnosis of RAS is 6 to 18 months, significantly shorter than other forms of CLAD. Treatment options are limited, as therapies used for BOS are typically ineffective at halting disease progression. Specific medications such as fibrinolytics are lacking large, multicenter prospective studies. In this manuscript, we discuss the definition, mechanism, and characteristics of RAS while highlighting the similarities and differences between other forms of CLAD. We also review the diagnoses along with current and potential treatment options that are available for patients. Finally, we discuss the existing knowledge gaps and areas for future research to improve patient outcomes and understanding of RAS.
    MeSH term(s) Allografts ; Child ; Humans ; Lung Diseases/diagnosis ; Lung Diseases/etiology ; Lung Diseases/therapy ; Lung Transplantation/adverse effects ; Postoperative Complications/diagnosis ; Postoperative Complications/etiology ; Postoperative Complications/therapy ; Syndrome
    Language English
    Publishing date 2021-03-17
    Publishing country Denmark
    Document type Journal Article ; Review
    ZDB-ID 1390284-2
    ISSN 1399-3046 ; 1397-3142
    ISSN (online) 1399-3046
    ISSN 1397-3142
    DOI 10.1111/petr.14000
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Association of Cough Status With Bacterial Infections in Febrile Infants.

    Klouda, Timothy M / Wang, Hongyue / Yaeger, Jeffrey P

    Hospital pediatrics

    2020  Volume 10, Issue 2, Page(s) 185–189

    Abstract: Objectives: To examine the association between cough status and bacterial infections (BIs) to more accurately stratify risk and predict BIs in febrile infants.: Methods: A retrospective cohort study was performed by identifying all infants ≤60 days ... ...

    Abstract Objectives: To examine the association between cough status and bacterial infections (BIs) to more accurately stratify risk and predict BIs in febrile infants.
    Methods: A retrospective cohort study was performed by identifying all infants ≤60 days old with temperature ≥38°C at an urban pediatric emergency department from 2014 to 2016. The Rochester Risk model was used to stratify risk. Cough status (with or without) was the main covariate of interest. The primary outcome was a BI, including urinary tract infection, bacteremia, or meningitis. Analyses consisted of descriptive statistics, simple and multiple regression to compare the odds of BI on the basis of cough status, as well as χ
    Results: Of 508 febrile infants ≤60 days old, 46 (9.1%) had a BI, 13 of which were either bacteremia or meningitis. There were no BIs among low-risk infants with a cough. The odds of BI increased progressively, peaking at 14.6 (95% confidence interval: 4.3-49.7) for high-risk infants without a cough. The adjusted odds of BI among infants with cough was 0.47 (95% confidence interval: 0.22-0.99).
    Conclusions: In our findings, an inverse relationship is demonstrated between presence of cough and odds of BI, suggesting that cough status may be a useful marker of viral infections in febrile infants. Considering that detecting cough status is noninvasive, inexpensive, and immediately available, it represents an attractive value-based risk factor to enhance current BI prediction models.
    MeSH term(s) Bacteremia ; Bacterial Infections/complications ; Cough/etiology ; Fever ; Humans ; Infant ; Meningitis, Bacterial ; Retrospective Studies ; Urinary Tract Infections
    Language English
    Publishing date 2020-01-08
    Publishing country United States
    Document type Journal Article
    ISSN 2154-1671
    ISSN (online) 2154-1671
    DOI 10.1542/hpeds.2019-0227
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Pediatric Lung Transplant: Influences of Viral and Fungal Infections on Outcomes and Viral Markers as a Predictor of Outcome.

    Klouda, Timothy / Chiel, Laura / Davis, Jaclyn / Boyer, Debra

    American journal of respiratory and critical care medicine

    2020  Volume 201, Issue 9, Page(s) 1146–1148

    MeSH term(s) Biomarkers ; Child ; Humans ; Lung Diseases, Fungal ; Lung Transplantation ; Mycoses
    Chemical Substances Biomarkers
    Language English
    Publishing date 2020-07-31
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 1180953-x
    ISSN 1535-4970 ; 0003-0805 ; 1073-449X
    ISSN (online) 1535-4970
    ISSN 0003-0805 ; 1073-449X
    DOI 10.1164/rccm.201910-2037RR
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article: Changes in Blood Profile from Steady State in Patients with Sickle Cell Anemia Admitted for Vaso-occlusive Crisis and Acute Chest Syndrome.

    Klouda, Timothy / Raybagkar, Deepti / Bernstein, Bruce / Apollonsky, Nataly

    Advances in hematology

    2020  Volume 2020, Page(s) 3656717

    Abstract: Close to half of all patients with sickle cell disease (SCD) will have at least one episode of acute chest syndrome (ACS) during their lifetime. Multiple cells and molecules involved with the inflammatory cascade play a role in the development of ACS. We ...

    Abstract Close to half of all patients with sickle cell disease (SCD) will have at least one episode of acute chest syndrome (ACS) during their lifetime. Multiple cells and molecules involved with the inflammatory cascade play a role in the development of ACS. We found that patients with SCD who developed ACS as a complication of a vaso-occlusive crisis (VOC) had a significant increase in leukocytes and decrease in platelets from their steady state when compared with a separate admission for VOC without ACS development. No significant change from steady state hemoglobin or reticulocyte count was noted between the two admissions. These results indicate that trending laboratory markers may be useful to predict patients at risk for ACS development.
    Language English
    Publishing date 2020-08-25
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2494501-8
    ISSN 1687-9112 ; 1687-9104
    ISSN (online) 1687-9112
    ISSN 1687-9104
    DOI 10.1155/2020/3656717
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Precision Cut Lung Slices as an Efficient Tool for Ex vivo Pulmonary Vessel Structure and Contractility Studies.

    Klouda, Timothy / Kim, Hyunbum / Kim, Jiwon / Visner, Gary / Yuan, Ke

    Journal of visualized experiments : JoVE

    2021  , Issue 171

    Abstract: The visualization of murine lung tissue provides valuable structural and cellular information regarding the underlying airway and vasculature. However, the preservation of pulmonary vessels that truly represents physiological conditions still presents ... ...

    Abstract The visualization of murine lung tissue provides valuable structural and cellular information regarding the underlying airway and vasculature. However, the preservation of pulmonary vessels that truly represents physiological conditions still presents challenges. In addition, the delicate configuration of murine lungs result in technical challenges preparing samples for high-quality images that preserve both cellular composition and architecture. Similarly, cellular contractility assays can be performed to study the potential of cells to respond to vasoconstrictors in vitro, but these assays do not reproduce the complex environment of the intact lung. In contrast to these technical issues, the precision-cut lung slice (PCLS) method can be applied as an efficient alternative to visualize lung tissue in three dimensions without regional bias and serve as a live surrogate contractility model for up to 10 days. Tissue prepared using PCLS has preserved structure and spatial orientation, making it ideal to study disease processes ex vivo. The location of endogenous tdTomato-labeled cells in PCLS harvested from an inducible tdTomato reporter murine model can be successfully visualized by confocal microscopy. After exposure to vasoconstrictors, PCLS demonstrates the preservation of both vessel contractility and lung structure, which can be captured by a time-lapse module. In combination with the other procedures, such as western blot and RNA analysis, PCLS can contribute to the comprehensive understanding of signaling cascades that underlie a wide variety of disorders and lead to a better understanding of the pathophysiology in pulmonary vascular diseases.
    MeSH term(s) Animals ; Lung ; Lung Diseases ; Mice ; Muscle Contraction ; Signal Transduction ; Specimen Handling
    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 ; Video-Audio Media
    ZDB-ID 2259946-0
    ISSN 1940-087X ; 1940-087X
    ISSN (online) 1940-087X
    ISSN 1940-087X
    DOI 10.3791/62392
    Database MEDical Literature Analysis and Retrieval System OnLINE

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