Publications by authors named "Megan Vu"

8 Publications

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Granulocyte-colony stimulating factor GCSF mobilizes hematopoietic stem cells in Kasai patients with biliary atresia in a phase 1 study and improves short term outcome.

J Pediatr Surg 2021 Apr 9. Epub 2021 Apr 9.

Vietnam National Children Hospital, Hanoi, Vietnam.

Aims: In RCT of adults with decompensated cirrhosis, GCSF mobilizes hematopoietic stem cells HSC and improves short-term outcome. An FDA-IND for sequential Kasai-GCSF treatment in biliary atresia BA was approved. This phase 1 study examines GCSF safety in Kasai subjects. Preliminary short-term outcome was evaluated.

Methods: GCSF (Neupogen) at 5 or 10 μg/kg (n = 3/group) was given in 3 daily doses starting on day 3 of Kasai surgery (NCT03395028). Serum CD34+ HSC cell counts, and 1-month of GCSF-related adverse events were monitored. The 6-months Phase 1 clinical outcome was compared against 10 subsequent post Phase 1 Kasai patients who did not receive GCSF.

Results: With GCSF, WBC and platelet count transiently increased, LFT and serum creatinine remained stable. Reversible splenic enlargement (by 8.5-20%) occurred in 5/6 subjects. HSC count increased 12-fold and 17.5-fold for the 5 μg/kg and10 ug/kg dose respectively; with respective median total bilirubin levels for GCSF vs no-GCSF groups of 55 vs 91 μM at 1 month, p = 0.05; 15 vs 37 μM at 3 months, p = 0.24); and the 6-months cholangitis frequency of 40% vs 90%, p = 0.077.

Conclusions: GCSF safely mobilizes HSC in Kasai infants and may improve short-term biliary drainage and cholangitis. Phase 2 efficacy outcome of GCSF adjunct therapy for sequential Kasai and GCSF is pending.
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http://dx.doi.org/10.1016/j.jpedsurg.2021.03.038DOI Listing
April 2021

Perspectives on progress in global surgery.

ANZ J Surg 2020 10;90(10):1836-1837

Emergency and Essential Surgical Care Programme, World Health Organization, Geneva, Switzerland.

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http://dx.doi.org/10.1111/ans.15490DOI Listing
October 2020

Personalized Graduate Medical Education and the Global Surgeon: Training for Resource-Limited Settings.

Acad Med 2021 03;96(3):384-389

T.K. Rosengart is professor and chair, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.

Problem: The World Health Organization and the World Bank have identified improvement in access to surgical care as an urgent global health challenge and a cost-effective investment in public health. However, trainees in standard U.S. general surgery programs do not have adequate exposure to the procedures, technical skills, and foundational knowledge essential for providing surgical care in resource-limited settings.

Approach: The Michael E. DeBakey Department of Surgery at Baylor College of Medicine (BCM) created a 7-year global surgery track within its general surgery residency in 2014. Individualized rotations equip residents with the necessary skills, knowledge, and experience to operate in regions with low surgeon density and develop sustainable surgical infrastructures. BCM provides a formal, integrated global surgery curriculum-including 2 years dedicated to global surgery-with surgical specialty rotations in domestic and international settings. Residents tailor their individual experience to the needs of their future clinical practice, region of interest, and surgical specialty.

Outcomes: There have been 4 major outcomes of the BCM global surgery track: (1) increased exposure for trainees to a broad range of surgeries critical in resource-limited settings, (2) meaningful international partnerships, (3) contributions to global surgery scholarship, and (4) establishment of sustainable global surgery activities.

Next Steps: To better facilitate access to safe, timely, and affordable surgical care worldwide, global surgeons should pursue expertise in topics not currently included in U.S. general surgical curricula, such as setting-specific technical skills, capacity building, and organizational collaboration. Future evaluations of the BCM global surgery track will assess the effect of individualized education on trainees' professional identities, clinical practices, academic pursuits, global surgery leadership preparedness, and comfort with technical skills not encompassed in general surgery programs. Increasing availability of quality global surgery training programs would provide a critical next step toward contributing to the delivery of safe surgical care worldwide.
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http://dx.doi.org/10.1097/ACM.0000000000003898DOI Listing
March 2021

Obliterative Portal Venopathy Without Cirrhosis Is Prevalent in Pediatric Cystic Fibrosis Liver Disease With Portal Hypertension.

Clin Gastroenterol Hepatol 2019 09 4;17(10):2134-2136. Epub 2018 Nov 4.

Section of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.

Cystic fibrosis liver disease (CFLD) has long been postulated to be secondary to dysfunctional cystic fibrosis transmembrane conductance regulator in the apical biliary epithelium, leading to bile stasis and eventually cirrhosis with portal hypertension. However, pathologic changes in the cystic fibrosis (CF) liver are distinct from the pancreas and lungs in that fibrocystic changes are absent. Furthermore, the lack of clinically evident biliary obstruction and liver dysfunction suggest there may be alternative mechanisms that contribute to CFLD. Two recent studies in young adults described obliterative portal venopathy (OPV) and noncirrhotic portal hypertension (NCPH) as the predominant pathophysiology in young adults (median, 22 y) with CFLD. It is unknown if OPV develops early in childhood. Herein, we report the clinical features and liver pathology in 17 explants from children and adolescents with CF, representing 13.6% (17 of 125) of the CF liver transplant population in the United States according to the United Network for Organ Sharing and Organ Procurement and Transplantation Network.
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http://dx.doi.org/10.1016/j.cgh.2018.10.046DOI Listing
September 2019

Multiple Schwannomas in a Patient with Gynecomastia.

Breast J 2017 05 18;23(3):360-362. Epub 2016 Dec 18.

School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

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http://dx.doi.org/10.1111/tbj.12741DOI Listing
May 2017

Sustained impact of short-term international medical mission trips: resident perspectives.

Med Teach 2014 Dec 29;36(12):1057-63. Epub 2014 Jul 29.

University of Central Florida College of Medicine , USA.

Purpose: To assess perspectives of residents: (1) who participated in short-term international medical mission trips (STIMMTs) as medical students regarding impact of the experiences on their professional development; and (2) who did not participate in STIMMTs regarding barriers to participation.

Methods: Three hundred seventy-nine residents from 16 programs at two Florida institutions completed surveys requesting Participant and Trip Details and Impact of Participation (including items rating learning, cultural competency, and social responsibility).

Results: One hundred thirty-one residents participated in at least one STIMMT. They identified improved adaptability to new healthcare settings, communication with patients and professionals from different backgrounds, and appreciation for the impact of culture on health as positive outcomes. Leading barriers to STIMMT participation included cost, timing, and lack of availability.

Conclusions: Years after participation in STIMMTs, residents perceived sustained benefits in cultural competency, communication skills, adaptability, and desire for service. Institutions may consider facilitating STIMMTs as one way to address standards specified by accrediting authorities to provide training in cultural competency, social responsibility, altruism, and understanding the importance of caring for underserved populations. Barriers to STIMMT participation may be reduced through availability of institution-sponsored scholarships, identification of external grant and scholarship opportunities, and coordination of fund-raising activities.
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http://dx.doi.org/10.3109/0142159X.2014.920491DOI Listing
December 2014

Clinical and structural effects of traditional Chinese medicine and the herbal preparation, Iberogast, in a rat model of ulcerative colitis.

J Evid Based Complementary Altern Med 2014 Jan 7;19(1):10-9. Epub 2013 Oct 7.

The University of Adelaide, Adelaide, South Australia, Australia.

Plant-sourced formulations such as Iberogast and the traditional Chinese medicine formulation, Cmed, purportedly possess anti-inflammatory and radical scavenging properties. We investigated Iberogast and Cmed, independently, for their potential to decrease the severity of the large bowel inflammatory disorder, ulcerative colitis. Sprague Dawley rats (n = 8/group) received daily 1 mL gavages (days 0-13) of water, Iberogast (100 μL/200 μL), or Cmed (10 mg/20 mg). Rats ingested 2% dextran sulfate sodium or water ad libitum for 7 days commencing on day 5. Dextran sulfate sodium administration increased disease activity index scores from days 6 to 12, compared with water controls (P < .05). On day 10, 200 μL Iberogast decreased disease activity index scores in colitic rats compared with colitic controls (P < .05). Neither Iberogast nor Cmed achieved statistical significance for daily metabolic parameters or colonic crypt depth. The therapeutic effects of Iberogast and Cmed were minimal in the colitis setting. Further studies of plant extracts are required investigating greater concentrations and alternative delivery systems.
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http://dx.doi.org/10.1177/2156587213503660DOI Listing
January 2014

Prostaglandin ethanolamides attenuate damage in a human explant colitis model.

Prostaglandins Other Lipid Mediat 2013 Jan 1;100-101:22-9. Epub 2013 Feb 1.

Discipline of Pharmacology, School of Medical Sciences, Faculty of Health Sciences, The University of Adelaide, South Australia, Australia.

Endocannabinoids are protective in animal colitis models. As endocannabinoids also form novel prostaglandin ethanolamides (prostamides) via COX-2, we investigated the effects of prostamides and other COX-2 mediators on tissue damage in an ex vivo human mucosal explant colitis model. Healthy human colonic mucosae were incubated with pro-inflammatory cytokines TNF-α and IL-1β to elicit colitis-like tissue damage. The PGF-ethanolamide analogue, bimatoprost decreased colitis scores which were reversed by a prostamide-specific antagonist AGN 211334, but not the FP receptor antagonist AL-8810. PGF-ethanolamide and PGE-ethanolamide also reduced cytokine-evoked epithelial damage. Anandamide was protective in the explant colitis model; however COX-2 inhibition did not alter its effects, associated with a lack of COX-2 induction in explant mucosal tissue. These findings support an anti-inflammatory role for prostamides and endocannabinoids in the human colon.
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http://dx.doi.org/10.1016/j.prostaglandins.2013.01.003DOI Listing
January 2013