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Item CALIPSO: A Randomized Controlled Trial of Calfactant for Acute Lung Injury in Pediatric Stem Cell and Oncology Patients(Elsevier, 2018) Thomas, Neal J.; Spear, Debbie; Wasserman, Emily; Pon, Steven; Markovitz, Barry; Singh, Aalok R.; Li, Simon; Gertz, Shira J.; Rowan, Courtney M.; Kunselman, Allen; Tamburro, Robert F.; Pediatrics, School of MedicineTo assess if calfactant reduces mortality among children with leukemia/lymphoma or after hematopoietic cell transplantation (HCT) with pediatric acute respiratory distress syndrome (PARDS), we conducted a multicenter, randomized, placebo-controlled, double-blinded trial in 17 pediatric intensive care units (PICUs) of tertiary care children's hospitals. Patients ages 18 months to 25 years with leukemia/lymphoma or having undergone HCT who required invasive mechanical ventilation for bilateral lung disease with an oxygenation index (OI) > 10 and <37 were studied. Interventions used were intratracheal instillation of either calfactant or air placebo (1 or 2 doses). Forty-three subjects were enrolled between November 2010 and June 2015: 26 assigned to calfactant and 17 to placebo. There were no significant differences in the primary outcome, which was survival to PICU discharge (adjusted hazard ratio of mortality for calfactant versus placebo, 1.78; 95% confidence interval, .53 to 6.05; P = .35), OI, functional outcomes, or ventilator-free days, adjusting for risk strata and Pediatric Risk of Mortality (PRISM) score. Despite the risk-stratified randomization, more allogeneic HCT patients received calfactant (76% and 39%, respectively) due to low recruitment at various sites. This imbalance is important because independent of treatment arm and while adjusting for PRISM score, those with allogeneic HCT had a nonsignificant higher likelihood of death at PICU discharge (adjusted odds ratio, 3.02; 95% confidence interval, .76 to 12.06; P = .12). Overall, 86% of the patients who survived to PICU discharge also were successfully discharged from the hospital. These data do not support the use of calfactant among this high mortality group of pediatric leukemia/lymphoma and/or HCT patients with PARDS to increase survival. In spite of poor enrollment, allogeneic HCT patients with PARDS appeared to be characterized by higher mortality than even other high-risk immunosuppressed groups. Conducting research among these children is challenging but necessary, because survival to PICU discharge usually results in successful discharge to home.Item The Effects of Surfactants on Colloidal, Nanoparticulate, and Dissolved Sulfur(Office of the Vice Chancellor for Research, 2016-04-08) Kurek, Martin; Druschel, Greg; Gilhooly, William P., IIIElemental sulfur is generally insoluble in water unless in the presence of a surfactant. This phenomenon was investigated by Steudel and Holdt in 1988 by filtering mixtures of sulfur, water, and surfactants through a 0.45 micron filter; however, since then sulfur nanoparticles smaller than 0.45 microns have been detected. The smaller than expected particle size suggests that the distribution of elemental sulfur in water with surfactants may be partitioned into colloidal, nanoparticulate, and truly dissolved components. Experiments have been conducted measuring the sulfur solubility in water with several chemical surfactants and varying filter sizes smaller than 0.45 microns. These experiments were conducted under equilibrium conditions with the solubility being measured using HPLC and square wave voltammetry. Kinetic studies detailing the solubility of sulfur with the surfactants over time have also been investigated. Data regarding the size and occurrence of sulfur nanoparticles present in water and the surfactants has been collected as well to give a complete description of the system under examination. Sulfur isotope fractionation of the dissolved sulfur species is also an interesting component of the system that is currently being investigated using stable isotope ratio mass spectrometry of 34S.