Day 2 :
Keynote Forum
Mingyi Chen
UT Southwestern Medical Center, USA
Keynote: Lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) is a therapeutic target of sickle cell disease vasculopathy
Biography:
Mingyi Chen is currently an Associate Professor at UTSW Medical center since 2016. Formerly, He was an Associate Professor at the UC Davis Health System in California (since 2010). He is a board certified in Hematology and Pathology (Anatomic and Clinical Pathology). He areas of clinical interest include: hematopathology - lymphoma, leukemia, flow cytometry, bone marrow transplant, diagnostic molecular pathology by NGS muatational analysis, pulmonary pathology and GI-liver pathology. My research interests include atherosclerosis, thrombosis, vascular biology, lipid metabolism, GVHD, molecular pathogenesis of lymphoma and leukemia, tumor immunology, viral infections and cancergenesis. His current research focuses on the genetic and epigenetic alterations of endothelial cells and hematopoietic cells. The primary diseases against which advancements in his laboratory are targeted are malignant lymphoma, leukemia and other hematological problems. He received MD from Peking University Health Science Center and PhD in Pharmacology from Kyoto University. He has completed residency training at UCSD and Loma Linda University Medical Center and Fellowship in Hematopathology at City of Hope National Medical Center. He published over 90 peer reviewed papers and 120 abstracts, 11 book chapters, and delivered many speeches and education courses in scientific meeting in ASH, USCAP, CSP, ASCP, ISH etc.
Abstract:
Sickle cell disease (SCD) is a recessively inherited disorder that affects hemoglobin structure, function and stability. Although the principal manifestation of SCD is anemia, the significant morbidity and mortality of SCD is due to vaso-occlusive complications. Strokes in children and adults with SCD continue to be a major cause of morbidity and mortality, ∼50% of the children with SCD will have either an overt or silent cerebral infarct before their 18th birthday. Lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) has been identified as a major receptor for oxidized low-density lipoprotein (ox-LDL) as well as phosphatidylserine of aged RBC cells in endothelial cells. We have recently reported increased expression of LOX-1 in human vascular endothelial cells exposed to sickle erythrocytes, as well as in the vessels of SCD patients with vaso-occlusive damage, suggesting a possible causative link between the increased expression of LOX-1 and SCD vasculopathy. The sickle erythrocyte/LOX-1 axis plays a key role in initiating the vicious cycle of SCD that results in vaso-occlusion. The mechanism involves LOX-1 serving as a tether that attaches sickle red blood cells to vascular endothelial cells. This in turn causes signaling amplification that involves upregulation of LOX-1 expression, oxidative stress, and the release of thromboxane A2 that results in further platelet activation/aggregation and vasoconstriction, ultimately leading to vaso-occlusive events and the clinical manifestations of SCD. We anticipate the findings could also lead to the identification of useful therapeutic strategies for the effective clinical management of this debilitating inherited disease.
- Pediatric Neuro-Oncology| Pediatric Oncology Nursing | Pediatric Leukemia | Pediatric Medicine
Location: Tahiti
Chair
Mingyi Chen
UT Southwestern Medical Center, USA
Co-Chair
Sanjay Mishra
King George’s Medical University, India
Session Introduction
Nancy E Cisneros
Excelsior College, USA
Title: Improving pediatric case management in home health
Biography:
Nancy E Cisneros began her career as a broker and processor of almonds and pistachios in 1990 in California’s Central Valley. While growing her business, she married her life partner whom took the reins of the company to allow Nancy to follow her dreams of delivering compassionate health care to children with cancer. Nancy completed her undergraduate nursing education in 1999 and quickly found herself in the role of bedside Oncology RN. With her sights set on pediatric oncology in the public health sector, she took a position as pediatric oncology case manager in home health with Sutter Care at Home in 2002. Developing effective forms of communication, documentation, and care delivery used in Sutter, she declared to complete her graduate school education in slow steady pace. This year, Nancy completed her MSN with emphasis in nursing education and as a clinical nurse specialist. The graduate school capstone project she created was geared towards pediatric oncology and has been adopted by several home health agencies as a working case management paradigm. Still excited to grow, learn, and give; Nancy started a community health education company with her husband along with a non-profit for children and young adults suffering cancer and other life-threatening diseases with her siblings.
Abstract:
Problem
This project author recognized a deficiency in home-based care regarding a lack of a standardized pediatric case management model. Due to this deficiency, and through evidence-based research, many post-bone marrow pediatric patients treated at hospitals are often not discharged home for aftercare and are kept in the hospital causing a great financial burden to the stakeholders along with added stress to patient and family.
Purpose
The purpose of this capstone project is to provide through evidence-based practice that Registered Nurse (RN) case managers quarterback patient-and family-centered care through coordination, teamwork and collaboration within a vast interdisciplinary team; meeting positive outcomes/ goals, while decreasing re-hospitalizations that can offload the financial health costs.
Goal
This capstone project seeks to position the pediatric cancer patient and family/caregivers as the core team member(s) and the drivers of a collaborative patient-centered care model in the home-based setting. The proposed model will evidence the unique aspect of teamwork and collaboration with the inter-disciplinary care team in the home health setting and the inter-disciplinary oncology treatment team based in the hospitals responsible for delivery of in-patient and follow-up medical care.
Objectives
This author will demonstrate through education and leadership, the best practices to employ home-based patient-and family-centered care directly to the pediatric patient with the assistance of the larger interprofessional team. The RN case manager’s knowledge will be gained and competencies met through observing YouTube video simulation of central line access with lab draw, and effectively communicating through coordination with the home health and hospital teams.
Outcomes and Results
With the utilization of this proposed project, the pediatric post-bone marrow transplant cancer patient has enhanced home-based care outcomes and decreased risk of re-hospitalization, which has significantly impacted more than forty patients during 2016. Additionally, the patient can be treated safely in their home setting which significantly decreasing the cost of care to the insurance companies, the hospitals, families, along with the security for the pediatric patient to be treated in their own loving homes.
Alysa Fairchild
University of Alberta, Canada
Title: Does quality of radiotherapy predict outcomes of pediatric multicenter cooperative group trials? A systematic review
Biography:
Alysa Fairchild is committed to highest standard of excellence at Department of Radiation Oncology, University of Alberta in Canada.
Abstract:
Introduction & Aim: Radiotherapy (RT) and quality assurance (QA) programs aim to standardize RT delivered on multicenter clinical trials to minimize variables that may confound the validity of results. Our objective was to review available evidence for correlation of RT quality with clinical outcomes within pediatric multicenter clinical trials.
Methods: A Medline, Embase and Cochrane Central Register of Controlled Trials literature search was performed restricted to English but with no date limits. Candidate studies accrued children with age <21 years or median age <15, were led by any cooperative group, published in full and described central subjective ± objective assessment of RT protocol compliance (quality). Data abstracted included assignment of violations in relation to clinical outcomes (locoregional and/or distant failure, progression-free survival [PFS], overall survival [OS]).
Results: 27 multicenter studies described in 26 articles met inclusion criteria. Disease sites were medulloblastoma (M; 9 trials), rhabdomyosarcoma (RMS; 7), Hodgkin’s (H; 4) Supratentorial Primitive Neuroectodermal tumor (SPNET; 3), Ewing’s (E; 3) and Acute Lymphocytic Leukemia (ALL; 1). Deviations were found in 0-77% of RT plans reviewed. 10/27 reported that dose and/or field deviations significantly affected clinical outcomes in the form of inferior overall survival (N=1), PFS (4), local PFS (1), local control (3) and any recurrence (1). One study suggested improved PFS with local field RT deviations versus without. Studies reporting a significant relationship between RT quality and clinical outcomes were: 4 M, 3 SPNET, 2 H, 1 E and 1 RMS.
Conclusions: Overall, the weight of the evidence suggests that suboptimal RT negatively impacts clinical outcomes in pediatric multicenter and cooperative group trials.
Hypothesis: The hypothesis is that radiotherapy not delivered in accordance with study protocol specifications leads to worse clinical outcomes.
Maria de Spengler
Panama Children’s Hospital, Panama
Title: Lessons learned in a third-level hospital on the treatment of retinoblastoma
Biography:
Maria de Spengler is currently working as an eminent Faculty member at Instituto Nacional de Estadística, Panama. She has published numerous research papers and articles in reputed journals and has various other achievements in the related studies. She has extended his valuable service towards the scientific community with her extensive research work.
Abstract:
Introduction & Purpose: Everyday this tumor typical of early infancy has better results in terms of long-term survival. For the authors, treating retinoblastoma is an open book. Retinoblastoma is a pathology that requires a multidisciplinary approach. We still have a lot to learn. We want to share with the primary care pediatrician some important facts about retinoblastoma.
Material & Methods: This is a descriptive, retrospective, transversal and single institution study that includes all retinoblastoma patients, diagnosed between the first of January 1996 and December 31, 2016. All the participants must have finished treatment at the moment of data collection (January 2017) and must be active in the follow-up clinic. Those patients that were missing from the follow-up for more than a year were excluded.
Result: The age range at diagnosis is between 3 and 70 months. The average age at diagnosis is 21.3 months. One patient in our series had Wolf-Hirschhorn Syndrome. 68.4% of our cases received chemotherapy and 41% received chemo and radiation therapy. An attempt was made to preserve the eye in 26.3% of cases. What gave the indication to proceed with enucleation was retinal detachment in 66.6% of the cases, progression of the disease in the remaining 33.3%. In the series there is a percentage of 80.6% of patients who are alive and free of disease. Of the 25 patients who were alive at their last appointment, 42.1% had 10 or more years of survival. Of the survivors, 85.7% have completed their education.
Conclusion: Today we have a great challenge to contribute to the quality of life of the survivors of childhood cancer. As a society we must create the best conditions for inclusion.