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In the News: AHA Award, Human Cell Atlas, Bihormonal Bionic Pancreas, Autism in School

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September 17, 2021
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In the News

The Research Institute's work highlighted In the News this week ranges from research-based guidelines for cardiac resuscitation to novel devices to improve treatment for children with congenital hyperinsulinism and diabetes who struggle to maintain stable glucose levels. Also, a Center for Autism Research study is the largest to date to look at "real world" school conditions and how autistic children control their thoughts and emotions.

CHOP Awarded Gold Resuscitation Quality Achievement Award

The America Heart Association (AHA) awarded Children's Hospital of Philadelphia the Gold Level Get With The Guidelines®- Resuscitation Quality Achievement Award. This award is given to hospitals with a commitment to treating in-hospital cardiac arrest, ultimately helping to improve patient survival rates. CHOP was specifically chosen for our work with pediatric and infant patients.

"Our Critical Care team is honored to be recognized by the AHA for our dedication to helping our patients have the best possible chance of survival after a cardiac arrest," said Robert Sutton, MD, MSCE, director of Clinical Resuscitation Science at CHOP Research Institute's Resuscitation Science Center. "Get With The Guidelines-Resuscitation makes it easier for our teams to put proven knowledge and guidelines to work on a daily basis."

More than 200,000 adults and children have an in-hospital cardiac arrest each year, according to the AHA. Survival from cardiac arrest is largely dependent on timely medical emergency team response and effective CPR.

The Get With The Guidelines-Resuscitation program was developed to help save lives of patients who experience in-hospital cardiac arrests by consistently following the most up-to-date research-based guidelines for treatment. Guidelines include following protocols for patient safety, medical emergency team response, effective and timely resuscitation (CPR) and post-resuscitation care.

Human Developmental Cell Atlas: Opportunity to Study Human Development at Cellular Level

An international group of researchers, including author Deanne Taylor, PhD, director of Bioinformatics at CHOP, published a perspective paper in Nature outlining the implications of the Human Developmental Cell Atlas (HDCA). Similar to the Pediatric Cell Atlas, this project seeks to provide a comprehensive reference map of cells, but this time during development — from fertilized oocyte to birth.

"Knowing which genes are turned on in a particular tissue during a specific stage of development will help us better understand any effects of perturbations and hence the root of many birth defects and childhood cancers," said first co-author Dr. Taylor, one of the coordinators for the HDCA project.

A new generation of single cell genomic and imaging technologies affords researchers this unprecedented opportunity to study the course of human development. All research of these tissues will be done in Europe, but the data will be available to researchers worldwide.

CHOP is providing a consulting role on the pediatric ramifications of the project, so that researchers involved can provide information that is crucial to the understanding of pediatric disease and, ultimately, better interventions.

To learn more see this Human Cell Atlas press release.

Pilot Study Shows Novel Device Helps HI Patients With Diabetes Maintain Stable Glucose Levels

Congenital hyperinsulinism (HI) is a genetic disorder in which the insulin cells of the pancreas, called beta cells, secrete too much insulin. About half of children with the condition require surgery for a partial or near total removal of their pancreas, which leads to post-pancreatectomy diabetes (PPD) and dysregulated production of glucagon, a hormone formed in the pancreas which promotes the breakdown of glycogen to glucose in the liver.

"Managing glucose levels in patients with HI and post-pancreatectomy diabetes is extremely challenging because they have residual insulin that is highly dysregulated, so they often fluctuate between low blood sugar and high blood sugar," said Diva D. De León-Crutchlow, MD, Chief of the Division of Endocrinology and Diabetes and Director of the Congenital Hyperinsulinism Center at Children's Hospital of Philadelphia.

Researchers from CHOP, Massachusetts General Hospital, and Boston University are studying a novel device, known as the bihormonal bionic pancreas (BHBP), developed by researchers at Boston University to help HI patients with diabetes maintain stable glucose levels. The BHBP works by autonomously administering insulin and glucagon based on plasma glucose levels detected by a continuous glucose monitor; an algorithm calculates the exact dosage based on the CGM measurements.

"Our study shows that the bihormonal bionic pancreas offers glycemic control to these patients without the risk of human error in calculating doses," Dr. De León-Crutchlow said.

The researchers enrolled 10 patients with HI and PPD. The patients spent two periods of three nights each using two methods of blood glucose control: one period using their own insulin pump, and one using the BHBP. Although the differences between the two periods were not large due to small sample size, the results showed a trend towards an overall improvement of blood sugar control in the BHBP period relative to the period in which patients used their own insulin pumps. The study team reported results in Diabetes Care.

"Given the promising results of this pilot study, larger and longer studies using the newer BHBP device in this population to establish the long-term benefit and risks of the BHBP should be pursued," Dr. De León-Crutchlow said.

Read more in CHOP News.

CHOP Researchers Study Executive Functioning Challenges for Autistic Children in School

While caregivers have identified significant executive function challenges in the home setting for children on the autism spectrum, there are no large studies where school personnel rated executive function skills for children on the autism spectrum. Benjamin Yerys, PhD, a psychologist in the Department of Child and Adolescent Psychiatry and Behavioral Sciences and the Center for Autism Research at CHOP, conducted a study to provide further insight into how to support school-age autistic children's success.

"School can be a very different place than home and is arguably one of the most demanding environments on a child's executive function skills — children have to manage multiple demands from teachers, peers, and themselves for six hours with little downtime," said Dr. Yerys, senior author of the study that published in Autism.

The study enrolled a total of 337 participants, including 241 patients with an autism spectrum disorder diagnosis and 96 typically developing patients, between the ages of 6 and 18 over a period of six years. In establishing a baseline, the researchers found that all executive function ratings in both the school and home settings differed between the autistic and typically developing groups. In the autism group, shifting attention or deviating from routines was identified as a key impairment in both the home and school settings.

However, the older the children were, the wider the gap in executive functioning skills was between the autism and typically developing groups in the school setting, but not in the home setting. This finding suggests that executive functioning impairment, particularly as it relates to being in school, is a critical target for early intervention efforts.

"The more we know about executive functioning challenges that exist for autistic children across different settings, the more we can develop targeted intervention strategies that take the individual home and the school settings into account," Dr. Yerys said.

Read more in CHOP News.

ICYMI

Catch up on our headlines from our Sept. 3 In the News:

  • CHOP Researchers Find New Genetic Markers for Rarer Form of Type 1 Diabetes
  • CHOP/Penn Researchers Receive Grant from Chan Zuckerberg Initiative
  • CHOP Welcomes New Director of Cystic Fibrosis Center
  • Stephen R. Master, MD, PhD, Begins Term as President of American Association for Clinical Chemistry
  • New Tools to Measure Skeletal Muscle Function in Patients with Mitochondrial Disease

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