Interstitial cystitis: a phenotype and rare variant exome sequencing study.

Metabolic factors have been proposed to be related to the bladder pain syndrome/interstitial cystitis (BPS/IC) pathogenesis. Herein, we investigated the association between metabolic factors, especially blood lipids, and BPS/IC. The present study adopted a case‒control design, comparing several metabolic indicators in 106 women with BPS/IC versus 164 women without BPS/IC, all of whom were diagnosed at the Hospital between January 2013 and December 2022. The case-control odds ratio (OR) and 95% confidence interval (CI) for metabolic indicators were estimated using logistic regression. The associations between indicators and BPS/IC classifications were assessed using ordinal multinominal logistic regression. The propensity score-matching method was used to eliminate bias from age and body mass index (BMI), and the BPS/IC group had a greater hypercholesterolemia prevalence than the control group (16.3% vs 7.1%, p = 0.046), with an OR > 2.4 (p < 0.05). Ordinal multinomial logistic regression between indicators and BPS/IC classifications showed that age and triglycerides correlated with the BPS/IC lesion grade. However, when the data were corrected for age and BMI, triglycerides still correlated with lesion grade. The BPS/IC group had a greater hypercholesterolemia prevalence than the control group. Hypercholesterolemia may be a risk factor. Cystoscopic lesion grade correlated with age and triglyceride level. These results indicate a potential association between hyperlipidemia and the BPS/IC pathogenesis.

Study Type - Prognosis (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Interstitial cystitis/painful bladder syndrome (IC/PBS) comprises pain perceived to be from the bladder, urinary urgency and frequency, and nocturia. As diagnosed at present, it is primarily identified in adult women. It is a chronic disease yet its natural history has not been well studied. In a prospective study of 304 incident female IC/PBS cases followed for a median of 33 months after onset, women with baseline chronic fatigue syndrome had a worse prognosis for IC/PBS. Mild IC/PBS at baseline was the only variable that was directly associated with a good prognosis. To identify baseline variables that predict the prognosis of interstitial cystitis/painful bladder syndrome (IC/PBS) in women seeking medical care for recent onset of this syndrome. In a prospective study of women with incident IC/PBS (≤12 months of symptoms), we contacted patients at intervals and asked standardized questions about IC/PBS symptoms in the previous week. Logistic regression analyses assessed baseline variables as predictors of mild vs more severe IC/PBS at the last follow-up. Median length of follow-up was 33 months after onset of IC/PBS; 304 (97%) patients had at least one follow-up assessment. Mild IC/PBS at baseline was the only variable that was directly associated with a mild IC/PBS endpoint. Conversely, a history of chronic fatigue syndrome (CFS) was inversely associated with a mild endpoint of IC/PBS (i.e. individuals with CFS had a worse prognosis for their IC/PBS symptoms). At a median of nearly 3 years after onset, baseline mild IC/PBS was directly associated with a milder disease severity. Baseline co-morbid CFS was associated with more severe disease. Whether CFS was uniquely associated or represented several co-morbid non-bladder syndromes (NBSs) could not be determined.

To investigate the characteristics of videourodynamic study (VUDS) in females with interstitial cystitis/bladder pain syndrome (IC/BPS) focusing on the etiologies of bladder outlet dysfunction (BOD) and their associations with clinical and urodynamic parameters. IC/BPS females with complete data on symptom assessment, VUDS, the potassium sensitivity test, and cystoscopic hydrodistention were reviewed retrospectively. Diagnoses of bladder dysfunction (hypersensitive bladder, HSB) and BOD including dysfunctional voiding (DV), poor relaxation of the external urethral sphincter (PRES), and bladder neck dysfunction (BND) were made by VUDS. The clinical and urodynamic parameters between patients with normal and abnormal VUDS diagnoses were analyzed. A total of 348 IC/BPS female patients (mean age 48.8 ± 13.5) were enrolled. HSB was found in 307 (88.2%) patients and BOD in 209 (60.1%). The causes of BOD included DV in 40 (11.5%), PRES in 168 (48.3%), and BND in 1 (0.3%). Patients with DV and BND had higher, and those with PRES had lower detrusor pressures at maximum flow rate (Qmax ) than those with normal tracings. For all BOD patients, univariate logistic regression revealed a significant positive correlation of disease duration and negative correlations of urodynamic volume parameters with BOD in IC/BPS patients. Multivariate logistic regression found a cut-off value of Qmax ≦ 11 mL/s predicted BOD in IC/BPS with a receiver operating characteristic area of 0.81 (sensitivity = 82.0%, specificity = 68.5%). HSB and BOD are common findings on VUDS in IC/BPS females. BOD is associated with duration and hypersensitive bladder. A Qmax ≦ 11 mL/s predicts BOD in IC/BPS.

Pediatric Blood & CancerVolume 50, Issue 4 p. 737-738 Commentary Can less really be more? Using lessons from leukemia and cancer stem cells to make sense of oral maintenance for metastatic sarcoma Timothy P. Cripe MD, PhD, Corresponding Author Timothy P. Cripe MD, PhD timothy.cripe@cchmc.org Division of Hematology/Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave., Cincinnati, Ohio 45229Division of Hematology/Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave., Cincinnati, OH 45229.===Search for more papers by this author Timothy P. Cripe MD, PhD, Corresponding Author Timothy P. Cripe MD, PhD timothy.cripe@cchmc.org Division of Hematology/Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave., Cincinnati, Ohio 45229Division of Hematology/Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave., Cincinnati, OH 45229.===Search for more papers by this author First published: 16 October 2007 https://doi.org/10.1002/pbc.21364Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume50, Issue4April 2008Pages 737-738 RelatedInformation

Ultrasound in Obstetrics & GynecologyAccepted Articles Letter to the Editor Surgical management of first-trimester heterotopic dichorionic diamniotic Cesarean scar pregnancy E. Krispin, E. Krispin orcid.org/0000-0001-5859-9528 Baylor College of Medicine, Department of Obstetrics and Gynecology and Texas Children's Hospital Pavilion for Women, Houston, TX, USASearch for more papers by this authorM. A. Belfort, M. A. Belfort orcid.org/0000-0001-7887-5737 Baylor College of Medicine, Department of Obstetrics and Gynecology and Texas Children's Hospital Pavilion for Women, Houston, TX, USASearch for more papers by this authorA. A. Shamshirsaz, Corresponding Author A. A. Shamshirsaz shamshir@bcm.edu alirezashamshirsaz@yahoo.com Baylor College of Medicine, Department of Obstetrics and Gynecology and Texas Children's Hospital Pavilion for Women, Houston, TX, USACorrespondence address: Department of Obstetrics and Gynecology/Division of Fetal Therapy and Surgery, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, Suite F1040, Houston, Texas, shamshir@bcm.edu, alirezashamshirsaz@yahoo.comSearch for more papers by this author E. Krispin, E. Krispin orcid.org/0000-0001-5859-9528 Baylor College of Medicine, Department of Obstetrics and Gynecology and Texas Children's Hospital Pavilion for Women, Houston, TX, USASearch for more papers by this authorM. A. Belfort, M. A. Belfort orcid.org/0000-0001-7887-5737 Baylor College of Medicine, Department of Obstetrics and Gynecology and Texas Children's Hospital Pavilion for Women, Houston, TX, USASearch for more papers by this authorA. A. Shamshirsaz, Corresponding Author A. A. Shamshirsaz shamshir@bcm.edu alirezashamshirsaz@yahoo.com Baylor College of Medicine, Department of Obstetrics and Gynecology and Texas Children's Hospital Pavilion for Women, Houston, TX, USACorrespondence address: Department of Obstetrics and Gynecology/Division of Fetal Therapy and Surgery, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, Suite F1040, Houston, Texas, shamshir@bcm.edu, alirezashamshirsaz@yahoo.comSearch for more papers by this author First published: 07 December 2021 https://doi.org/10.1002/uog.24830 This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/uog.24830. AboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Accepted ArticlesAccepted, unedited articles published online and citable. The final edited and typeset version of record will appear in the future. RelatedInformation

OPEN ACCESSOctober 27, 2015Management of Postoperative Pediatric Patients Karen Jerardi, MD, MEd, Katie Meier, MD, Erin Shaughnessy, MD Karen Jerardi, MD, MEd Cincinnati Children's Hospital Medical Center Google Scholar More articles by this author , Katie Meier, MD Cincinnati Children's Hospital Medical Center Google Scholar More articles by this author , Erin Shaughnessy, MD Cincinnati Children's Hospital Medical Center Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.10241 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail Abstract Introduction: According to a 2013 study of career intents, 12% of graduating pediatric residents pursue careers in pediatric hospital medicine, often without additional fellowship training. Increasingly, pediatric hospitalists are asked to help comanage postoperative patients. There is a lack of evidence-based curricula in the management of the postoperative pediatric patient. Recently, the American Academy of Pediatrics Section on Hospital Medicine Surgical Care Subcommittee has identified the need for such curricula as a priority. As a result, the education co-leads for the subcommittee have teamed together with the director of fellowship, resident elective, and advanced practice nurse practitioner education for the Division of Hospital Medicine at Cincinnati Children's to develop this curriculum. Content for this curriculum was chosen based on a needs assessment of recent pediatric residency graduates and practicing pediatric hospitalists, who selected high-yield topics. Methods: The resource was developed by pediatric hospital medicine faculty who focus on the care of the postoperative pediatric patient and includes 11 narrated PowerPoint presentations. Each module contains learning objectives and questions for review. The modules together provide a background of the most common issues that arise in the care of the pediatric postoperative population. The modules can be used as a stand-alone resource or to augment a clinical rotation. Results: The resource has been used for a variety of providers, including pediatric residents, pediatric hospital medicine fellows, faculty, and nurse practitioners. Evaluations from each learner have been collected, and appropriate changes have been made to enhance the curriculum. Outcomes were measured using time spent reviewing the modules, as measured by the learning platform used to store the modules, and self-assessments from the learners. Average time spent accessing the modules was 5.5 hours, with a range of 2-16.5 hours. Learners completed an anonymous evaluation rating the modules and their overall response to the curriculum. Overall, 100% stated that the presentations did “inform your care” of patients, 90% felt the presentations increased their comfort level for caring for surgical patients, and 100% would recommend the curriculum to a colleague. Discussion: There are currently no published curricula addressing topics commonly encountered during the care and co-management of postoperative pediatric patients. This resource was developed by pediatric hospital medicine faculty in response to this vacancy. Educational Objectives At the conclusion of the activity, the participant will: Recognize a typical postoperative course and anticipate complications for pediatric surgical patients.Report increased knowledge and comfort in caring for pediatric surgical patients. ReferencesBaker RC, Klein M, Samaan Z, Lewis K. Effectiveness of an online pediatric primary care curriculum, Acad Pediatr.2010;10(2):131–137. http://dx.doi.org/10.1016/j.acap.2009.12.004Medline, Google ScholarCox ED, Koscik RI, Olson CA, et al. Caring for the underserved: blending service learning and a web-based curriculum, Am J Prev Med.2006;31(4):342–349. http://dx.doi.org/10.1016/j.amepre.2006.06.024Medline, Google ScholarFall LH, Berman NB, Smith S, White CB, Woodhead JC, Olson AL. Multi-institutional development and utilization of a computer-assisted learning program for the pediatric clerkship: the CLIPP project, Acad Med.2005;80(9):847–855. http://dx.doi.org/10.1097/00001888-200509000-00012Medline, Google ScholarFrintner MP, Mulvey HJ, Pletcher BA, Olson LM. Pediatric resident debt and career intentions, Pediatrics.2013;131(2):312–318. http://dx.doi.org/10.1542/peds.2012-0411Medline, Google ScholarRappaport DI, Rosenberg RE, Shaughnessy EE, et al. Pediatric hospitalist comanagement of surgical patients: structural, quality, and financial considerations, J Hosp Med.2014;9(11):737–742. http://dx.doi.org/10.1002/jhm.2266Medline, Google ScholarRauch DA, Percelay JM, Quinonez R, Alverson B, Fisher ES. Pediatric hospital medicine worklife: findings from the American Academy of Pediatrics 2012-13 survey. Presented at: the Annual Meeting of the Society of Hospital Medicine; March 24-27, 2014; Las Vegas, NV.Google ScholarSimon TD, Eilert R, Dickinson LM, Kempe A, Benefield E, Berman D. Pediatric hospitalist comanagement of spinal fusion surgery patients, J Hosp Med.2007;2(1):23–30. http://dx.doi.org/10.1002/jhm.144Medline, Google Scholar Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Postoperative Pediatric Patients Instructor's Guide.docx Venous Thromboembolism.pptx Shunt Malfunction.pptx Posterior Spinal Fusion.pptx Postoperative Anemia.pptx Postoperative Ileus.pptx Postoperative Tachycardia.pptx Postoperative Fever.pptx Syndrome of Inappropriate Anti-Diuretic Hormone Secretion.pptx Postoperative Nutrition.pptx Postoperative Pain.pptx To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. CitationJerardi K, Meier K, Shaughnessy E. Management of Postoperative Pediatric Patients. MedEdPORTAL. 2015;11:10241. https://doi.org/10.15766/mep_2374-8265.10241 Copyright & Permissions© 2015 Jerardi et al. This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial-Share Alike license.KeywordsPediatricsSurgical ComanagmentHospital Medicine Disclosures None to report. Funding/Support None to report. tabs.loading

Genetic counseling in direct-to-consumer exome sequencing: a case report.

Before the onset of interstitial cystitis/bladder pain syndrome, the presence of multiple non-bladder syndromes is strongly associated with a history of multiple surgeries

Genome-wide associations studies (GWAS) have been very successful in identifying common genetic variation associated to numerous complex diseases [1]. However, most of the identified common genetic variants appear to confer modest risk and few causal alleles have been identified [2]. Furthermore, these associations account for a small portion of the total heritability of inherited disease variation [1]. This has led to the reexamination of the contribution of environment, gene-gene and gene-environment interactions, and rare genetic variants in complex diseases [1, 3, 4]. There is strong evidence that rare variants play an important role in complex disease etiology and may have larger genetic effects than common variants [2]. Currently, much of what we know regarding the contribution of rare genetic variants to disease risk is based on a limited number of phenotypes and candidate genes. However, rapid advancement of second generation sequencing technologies will invariably lead to widespread association studies comparing whole exome and eventually whole genome sequencing of cases and controls. A tremendous challenge for enabling these "next generation" medical genomic studies is developing statistical approaches for correlating rare genetic variants with disease outcome. The analysis of rare variants is challenging since methods used for common variants are woefully underpowered. Therefore, methods that can deal with genetic heterogeneity at the trait-associated locus have been developed to analyze rare variants. These methods instead analyzing individual variants analyze variants within a region/gene as a group and usually rely on collapsing. They can be applied to both in cases vs. controls and quantitative trait studies are needed. The paper of Bansal et al. in this volume describes the application of a number of statistical methods for testing associations between rare variants in two genes to obesity. The authors considered the relative merits of the different methods as well as important implementation details, such as the leveraging of genomic annotations and determining p-values. Knowledge of haplotypes can increase the power of GWAS studies and also highlight associations that are impossible to detect without haplotype phase (e.g. loss of heterozygosity). Even more complicated phase-dependent interactions of variants in linkage equilibrium have also been suggested as possible causes of missing heritability. In their work, Hallsorsson et al. formulate algorithmic strategies for haplotype phasing by multi-assembly of shared haplotypes from next-generation sequencing data. These methods would allow testing haplotypes harboring rare variants for association and potentially increase their explanatory power. Since single SNP tests are often underpowered in rare variant association analysis, Zeggini and Asimit propose a locus-based method that has high power in the presence of rare variants and that incorporate base quality scores available for sequencing data. Their results suggest that this multi-marker approach may be best suited for smaller regions, or after some filtering to reduce the number of SNPs that are jointly tested to reduce loss of power due to multiple-testing adjustments. Finally, the paper of Zhou et al., presents a penalized regression framework for association testing on sequence data, in the presence of both common and rare variants. This method also introduces the use of weights to incorporate available biological information on the variants. Although these tactics improve both false positive and false negative rates, they represent an incremental development and there is still significant room for improvement. With the development of sequencing technologies and methods to detect complex trait rare variant associations many new and exciting discovery are imminent. The analysis of rare variants is still in its infancy and the next few years promises to produce many new methods to meet the special demands of analyzing this type of data. Note from Publisher: This article contains the abstract and references.

Event Abstract Back to Event Clinical Application of MEG Source Localization Algorithms in Presurgical Epilepsy Evaluation: Strengths and Limitations Douglas Rose1*, Hisako Fujiwara1, Nat Hemasilpin1, Ki Lee1 and Francesco Mangano1 1 University of Cincinnati, Cincinnati Children's Hospital Medical Center, United States MEG source localization algorithms perform well in simulation studies with low noise; little is known regarding relative strengths and limitations of algorithms for real clinical data. We compared algorithms with a common presurgical evaluation clinical dataset. We recorded MEG interictal discharges for 209 patients (ages 1 mo–26 years) with medically intractable epilepsy. We analyzed all recordings with equivalent current dipole models (ECD) and a beamformer, synthetic aperture magnetometry (SAM). We additionally analyzed recordings in 50 patients with dipole scan (DS), (multiple signal classification -MUSIC) and distributed dipole models (DD) (minimum norm estimate - MNE, standardized low resolution brain electromagnetic tomography - sLORETA). We compared each to presurgical scalp interictal/ictal EEG findings. We compared MEG to ECoG localization for 59 patients who had ECD and SAM only and for 17 patients studied with all 5 algorithms. For ECD and DD we had to carefully choose representative samples with low background noise. Use of segmented cortical mantle improved localization for ECD, DS, and DD, but also introduced potential errors. DD tended to localize a single contiguous source region for each patient. SAM tended to identify multiple locations and gave reasonable localizations in the presence of VNS artifact (24 patients) but failed to localize spikes under several conditions. Use of several methodologies limited errors from each; when multiple algorithms indicated a similar region, the localization more often agreed with ictal onset by ECoG. MEG source localization algorithms highlight different aspects of the irritative zone associated with interictal discharges based on different a priori assumptions and different approaches to the inverse problem. Use of several different MEG source localization methodologies may improve localization non-invasively of the irritative zone prior to placement of intracranial electrodes and prior to epilepsy surgery. Conference: Biomag 2010 - 17th International Conference on Biomagnetism , Dubrovnik, Croatia, 28 Mar - 1 Apr, 2010. Presentation Type: Poster Presentation Topic: Epilepsy Citation: Rose D, Fujiwara H, Hemasilpin N, Lee K and Mangano F (2010). Clinical Application of MEG Source Localization Algorithms in Presurgical Epilepsy Evaluation: Strengths and Limitations. Front. Neurosci. Conference Abstract: Biomag 2010 - 17th International Conference on Biomagnetism . doi: 10.3389/conf.fnins.2010.06.00377 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 08 Apr 2010; Published Online: 08 Apr 2010. * Correspondence: Douglas Rose, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, United States, douglas.rose@cchmc.org Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Douglas Rose Hisako Fujiwara Nat Hemasilpin Ki Lee Francesco Mangano Google Douglas Rose Hisako Fujiwara Nat Hemasilpin Ki Lee Francesco Mangano Google Scholar Douglas Rose Hisako Fujiwara Nat Hemasilpin Ki Lee Francesco Mangano PubMed Douglas Rose Hisako Fujiwara Nat Hemasilpin Ki Lee Francesco Mangano Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

The purpose of this manuscript is to describe the regulatory, technological, and training considerations for audiologists investigating telehealth and to offer some examples of audiology services provided through telehealth. The authors presented the regulatory components, the technology required for audiology staff and patients, and staff training for the audiology telehealth program at Cincinnati Children's Hospital Medical Center. Four case studies highlighting the successful use of telehealth in providing auditory device services to patients were also presented. The described regulatory, technological, and training hierarchy provides a framework for audiologists interested in starting a telehealth program. The cases presented illustrate that telehealth can be used to provide some auditory device services, such as troubleshooting, mapping, and parent consulting.

Pediatric DiabetesVolume 21, Issue 1 p. 143-143 CORRECTIONFree Access Obesity and type 2 diabetes are associated with elevated PCSK9 levels in young women This article corrects the following: Obesity and type 2 diabetes are associated with elevated PCSK9 levels in young women Amy E. Levenson, Amy S. Shah, Philip R. Khoury, Thomas R. Kimball, Elaine M. Urbina, Sarah D. de Ferranti, David M. Maahs, Lawrence M. Dolan, R. Paul Wadwa, Sudha B. Biddinger, Volume 18Issue 8Pediatric Diabetes pages: 755-760 First Published online: January 17, 2017 First published: 14 November 2019 https://doi.org/10.1111/pedi.12941AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat In Levenson et al. (2017) page 756, under section 2.1 Participants, the description of the cohort from which the lean and obese controls came from for this study was inaccurate. The published version states: Briefly, youth ages 11 to 26 years with type 2 diabetes, and obese and lean controls without diabetes, were recruited as part of the Type 2 Cardiovascular Disease Study conducted at Cincinnati Children's Hospital Medical Center between 2005 and 2010. It should have read: Youth with T2D between ages of 11 and 26 years previously recruited as part of the Type 2 Cardiovascular Disease Study conducted at Cincinnati Children's Hospital Medical Center from 2005 until 2010 were included. Lean and obese control subjects were included from a longitudinal study of the natural history of obesity and insulin resistance in an urban school district in Cincinnati (Urbina J Am Soc HTN 2007;1[3]:200-207) which used the same methods for assessment of CV risk factors. This inaccuracy in description does not change the datasets used for the analyses, nor does it affect the results or outcomes of the manuscript. The authors sincerely apologize for this discrepancy. REFERENCE 1Levenson AE, Shah AS, Khoury PR, Kimball TR, Urbina EM, de Ferranti SD, Maahs DM, Dolan LM, Wadwa RP, Biddinger SB. Obesity and type 2 diabetes are associated with elevated PCSK9 levels in young women. Pediatr Diabetes, 2017. doi: 10.1111/pedi.12490 Volume21, Issue1February 2020Pages 143-143 ReferencesRelatedInformation

identify robust and strain-, sex-, and strain*sex-dependent responses to the diet. Global analysis of the expression data by ANOVA revealed extensive impact of both strain and sex on dietary responses in liver. The main effect of diet was apparent in the differential expression of almost 57% of genes on the arrays. Among the top co-regulated of these, the authors showed using Gene Ontology (GO) enrichment analyses that the expected effects of diet-mediated suppression of cholesterol biosynthesis occurred in all strains and that other specific biological systems functional involvements were also strongly implicated. Valuable data emerge from the ability to identify sets of genes that are reflective of strain-, sex-, and strain*sexdependent effects of diet, attributable in part from the statistical power of the study design in which the underlying genetic variations imparted systematic effects at the level of biological pathways and processes. When strain is taken into account, the majority of significantly enriched GO categories reflected a powerful correlation between effects of diet on immune function, such as antigen processing and presentation. The authors suggest that these changes may be related to diet-induced liver damage, which was indicated by changes expression of damage-related genes and by an increase in circulating levels of glutamate dehydrogenase. However, these changes may also broadly reflect genetic correlation between pathways that mediate immune responses and the development of diet-induced atherogenic plaques, the formation and propagation of which are driven by immune responses. Integrating the expression data with information about the incidence, severity, and phenotypic details of atherosclerotic lesions in this same set of strains should shed additional light on this possibility. Other important follow-on studies may also determine if strainspecific patterns of immune gene expression in liver are paralleled by qualitatively similar effects on lymphocyte populations, atherogenic lesions, and insulin pathway-associated tissues. Importantly, the authors have also provided a publicly accessible database that can be mined in a number of ways. For example, this resource could be used to select strains with divergent responses to diet (e.g., sensitive and resistant to liver damage) or to identify coexpression networks centered around a gene(s) of specific interest. It could also be used to extract supportive evidence for genes implicated in processes related

Successful Integration of Advanced Practice Providers Into a Pediatric Academic Community Intensive Care Unit

Improving Patient Outcomes by Standardizing Care