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Chakraborty R, Kommineni S, Hayward M, Nelson T, Kristich CJ, Salzman NH. Role of the innate immune system in systemic enterococcus dissemination and clearance. THE JOURNAL OF IMMUNOLOGY 2016. [DOI: 10.4049/jimmunol.196.supp.65.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Abstract
Enterococci are gram-positive commensals of the mammalian intestinal tract and intrinsically resistant to broad-spectrum cephalosporin antibiotics. They proliferate in the gut and disseminate systemically causing infections in immunocompromised individuals and hospitalized patients undergoing cephalosporin therapy. Using a unique mouse model with stable intestinal colonization with a lab strain of Enterococcus faecalis (EF), we investigated the role of the immune system in EF dissemination and clearance from mice treated with cephalosporins. Ceftriaxone mediated depletion of indigenous microbiota was associated with expansion of EF throughout the gut, reduced levels of gut mucosal barrier components and eventually EF dissemination to peripheral organs. We observed that EF was not associated with the FACS sorted populations of lamina propria mononuclear phagocytes suggesting that these immune cells did not actively translocate EF across the intestinal mucosa. Mice cleared EF systemically by 2 weeks post-antibiotic treatment without evidence of adaptive immune response. Studies in Rag1−/− mice suggested that adaptive immune system was not essential in EF clearance or containment. Our observations support that intestinal containment and systemic clearance of EF are mediated by innate immune mechanisms. We predict that this reflects general mechanisms for host containment and management of the intestinal commensal microbiota.
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Panagiotopoulos N, Patrini D, Cabanyes SD, Hayward M, Lawrence D. 103P: Lobectomy for non-small cell lung cancer in octogenarians: A 7-year single center experience. J Thorac Oncol 2016. [DOI: 10.1016/s1556-0864(16)30216-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Grilley-Olsen J, Keith KC, Hayward M, Dees EC, Deal A, Ivanova A, Benbow JM, Parker J, Patel NM, Eberhard D, Mieczkowski P, Weck KE, Hayes DN, Muss H, Jolly T, Reeder-Hayes K, Earp HS, Sharpless N, Carey L, Anders CK. Abstract PD6-07: Genomic sequencing in metastatic breast cancer patients to inform clinical practice at the University of North Carolina at Chapel Hill. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-pd6-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: An increasing number of molecularly-targeted therapies for metastatic breast cancer (MBC) are clinically-available (approved and investigational). These anti-cancer agents target specific molecular abnormalities such as mutated, amplified, deleted, or rearranged genes. Reporting of unique tumor genetic alterations is not included in routine clinical/diagnostic panels. In MBC, knowledge of mutational status may foster efficient transitions in clinical care and trial enrollment at disease progression. We describe the development and implementation of a clinically-integrated genomic sequencing program and report how information regarding targetable genomic aberrations in MBC patients (pts) is used to improve clinical practice in an academic setting.
Methods: Genomic sequencing of investigative biomarkers was prospectively offered to pts with MBC. DNA libraries were prepared separately from a retrieved archival FFPE tumor sample and a matched normal sample from each pt. Relevant targets were enriched by custom Agilent SureSelect hybrid capture baits using standard protocols. Samples were sequenced on Illumina HiSeq 2000/2500 platforms. Mutational findings were reviewed by a molecular tumor board (MTB); variants identified to be potentially actionable underwent confirmatory testing in a CLIA-approved laboratory. Confirmed findings were inserted into the pt's EMR accessible by both the pt and the treating oncologist.
Results: Of the 725 MBC pts seen at UNC since 1/1/2012, 194 (27%) contributed samples for genomic sequencing. Of those whose tumors were sequenced, average age at MBC diagnosis was 54 (25 - 91); 73% were Caucasian, 16% African American. De novo MBC accounted for 39 (20%) sequenced pts. Of sequenced patients, sites of metastatic disease included bone only (7%), visceral only (46%), and both bone and visceral (47%). Approximately 1/3 of pts were consented for sequencing at time of initial MBC diagnosis, 1/4 after 1st line therapy for MBC, and the remaining at or beyond their 2nd line. In total, 131 (68%) pts have sequencing results available of which 43% of pts had reportable mutations deemed actionable by the MTB. Specific mutations and observed frequency by subtype are shown below. Pts (19%) whose tumors were sequenced were more commonly enrolled in a therapeutic clinical trial for MBC, a higher rate than seen in the non-sequenced group (7%) (p<0.001). To date, 27% of pts' tumors harbored an alteration that is an eligibility requirement for a molecularly-targeted therapeutic trial accruing pts at UNC.
Observed Mutation by Clinical Subype Genes Total # (56 pts)HR+/HER2- (25 pts)HER2+ (13 pts)TNBC (18pts)PIK3CA15933TP5315456CCND19531NF-14103FGFR13300PTEN3012KRAS2011MDM22110PIK3R12002ROS12011TSC12011Other*14518TOTAL73281728*Mutations observed only once
Conclusion: Preemptive genomic sequencing can be integrated into the clinical and operational practice of a comprehensive cancer center. Currently this research tool and program provides valuable information that has the potential to foster both clinical trial eligibility and/or enrollment. With longer follow-up, we hope such an approach ultimately will improve patient outcomes.
Citation Format: Grilley-Olsen J, Keith KC, Hayward M, Dees EC, Deal A, Ivanova A, Benbow JM, Parker J, Patel NM, Eberhard D, Mieczkowski P, Weck KE, Hayes DN, Muss H, Jolly T, Reeder-Hayes K, Earp HS, Sharpless N, Carey L, Anders CK. Genomic sequencing in metastatic breast cancer patients to inform clinical practice at the University of North Carolina at Chapel Hill. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr PD6-07.
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Le Page PA, Furtado R, Hayward M, Law S, Tan A, Vivian SJ, Van der Wall H, Falk GL. Durability of giant hiatus hernia repair in 455 patients over 20 years. Ann R Coll Surg Engl 2015; 97:188-93. [PMID: 26263802 DOI: 10.1308/003588414x14055925060839] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The surgical management of symptomatic giant hiatus hernia (GHH) aims to improve quality of life (QoL) and reduce the risk of life threatening complications. Previous reports are predominantly those with small sample sizes and short follow-up periods. The present study sought to assess a large cohort of patients for recurrence and QoL over a longer time period. METHODS This was a follow-up study of a prospectively collected database of 455 consecutive patients. Primary repair of GHH was evaluated by endoscopy/barium meal for recurrence and a standardised symptom questionnaire for QoL. Recurrence was assessed for size, elapsed time, oesophagitis and symptoms. RESULTS Objective and subjective review was achieved in 91.9% and 68.6% of patients. The median age was 69 years (range: 15-93 years) and 64% were female. Laparoscopic repair was completed in 95% (mesh in 6% and Collis gastroplasty in 7%). The 30-day mortality rate was 0.9%. The proportion of patients alive at five and ten years were 90% and 75% respectively. Postoperative QoL scores improved from a mean of 95 to 111 (p<0.01) and were stable over time (112 at 10 years). The overall recurrence rate was 35.6% (149/418) at 42 months; this was 11.5% (48/418) for hernias >2cm and 24.2% (101/418) for <2cm. The rate of new recurrence at 0-1 years was 13.7% (>2cm = 3.4%, <2cm = 10.3%), at 1-5 years it was 30.8% (>2cm = 9.5%, <2cm = 21.3%), at 5-10 years it was 40.1% (>2cm = 13.8%, <2cm = 26.3%) and at over 10 years it was 50.0% (>2cm = 25.0%, <2cm = 25.0%). Recurrence was associated with oesophagitis but not decreased QoL. Revision surgery was required in 4.8% of cases (14.8% with recurrence). There were no interval major GHH complications. CONCLUSIONS Surgery has provided sustained QoL improvements irrespective of recurrence. Recurrence occurred progressively over ten years and may predispose to oesophagitis.
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Cunningham S, Hall A, Jackson A, Jarrett-Smith L, Rees P, Brennan C, Saeed Y, Ng F, Kirkwood G, Orini M, Lambiase P, Srinivasan N, Walker N, Wright G, Goodwin J, Reilly J, Connelly D, Mudd P, Wilson C, Rice A, Iglesias A, Taggart S, James S, Thornley A, Turley A, Linker N, Rashid-Fadel T, Bond R, Rosengarten J, Thomas G, Butcher C, Lysitsas D, Wong T, Markides V, Jones D, Hussain W, Gilmore M, Barry J, Srinivasan N, Patel K, Lowe M, Segal O, Temple I, Borbas Z, Atkinson A, Yanni J, Yanni J, Boyett M, Garratt C, Dobrzynski H, Roney C, Debney M, Eichhorn C, Nachiappan A, Qureshi N, Chowdhury R, Kanagaratnam P, Lyon A, Peters N, Lawless M, Pearman C, Radcliffe E, Caldwell J, Trafford A, Taggart P, Hanson B, Hayward M, Lambiase PD, Yanni J, Orini M, Hanson B, Hayward M, Smith A, Zhang H, Dobrzynski H, Boyett M, Taggart P, Orini M, Simon R, Providencia R, Babu G, Vyas S, Khan F, Chow T, Segal O, Lowe M, Lambiase P. Allied Professionals. Europace 2015; 17:v3-v5. [PMCID: PMC4892104 DOI: 10.1093/europace/euv325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
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Rees PSC, Babu GG, Boston-Griffiths EA, Bognolo G, Hayward M, Kolvekar S, Lawrence D, Yap J, Hausenloy DJ, Yellon DM. 014 Atorvastatin protects human myocardium from lethal ischaemia-reperfusion injury by activating the risk pathway. Heart 2015. [DOI: 10.1136/hrt.2010.195941.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Mangini L, Dong Y, Hayward M, Forman M. Household Food Insecurity and Asthma in the 3rd Grade of the Early Childhood Longitudinal Study‐Kindergarten Cohort. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.261.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Succony L, Gowers K, Hynds R, Hayward M, Lawrence D, Giangreco A, Janes S. S111 Methods To Isolate Basal Cells From The Respiratory Epithelium. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hayward M. Animal law in Australasia, 2nd edition by P Sankoff, S White and C Black. The Federation Press, Australia, 2013. 416 pages. Price: A$84.95. ISBN 9781862879300. Aust Vet J 2014. [DOI: 10.1111/avj.12201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Candilio L, Malik A, Ariti C, Barnard M, Wright S, Smith A, Giannaris S, Ashley E, Martin B, Hamilton-Davies C, Cordery R, Hurley R, Bertoja E, Burt C, Di Salvo C, Lawrence D, Hayward M, Yap J, Roberts N, McGregor C, Sheikh A, Kolvekar S, Hausenloy DJ, Yellon DM. 123 THE EFFECTS OF MULTI-LIMB REMOTE ISCHAEMIC PRECONDITIONING IN PATIENTS UNDERGOING CARDIAC BYPASS SURGERY. BRITISH HEART JOURNAL 2013. [DOI: 10.1136/heartjnl-2013-304019.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Spillane J, Hayward M, Hirsch NP, Taylor C, Kullmann DM, Howard RS. Thymectomy: role in the treatment of myasthenia gravis. J Neurol 2013; 260:1798-801. [PMID: 23508539 DOI: 10.1007/s00415-013-6880-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 02/14/2013] [Accepted: 02/16/2013] [Indexed: 11/26/2022]
Abstract
Thymectomy is a frequently used treatment for myasthenia gravis (MG) and is virtually always indicated in MG patients who have a thymoma. However, the evidence for thymectomy in non-thymomatous MG remains less certain-no randomised controlled trials have been published to date, although one is currently underway. We reviewed the management and clinical outcome of patients with MG who underwent thymectomy over a 12 year period. Eighty-nine patients who underwent transsternal thymectomy were identified. A thymoma was identified on histology in 24 %, whereas 48, 9 and 19 % had hyperplastic, atrophic and normal thymic histology, respectively. One patient developed post operative myasthenic crisis but generally the procedure was well tolerated. Outcome was favourable for the majority of patients, with 34 % achieving complete stable remission (CSR) and an additional 33 % achieving pharmacological remission. Moreover, steroid requirements fell progressively during follow-up. Patients with a hyperplastic gland had a significantly greater chance of achieving CSR compared to other histological subtypes and the incidence of CSR increased with a longer duration of follow-up. Thymectomy for MG is generally safe and well tolerated and is associated with a sustained improvement of symptoms in the majority of patients.
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Hodges LA, Connolly SM, Winter J, Schmidt T, Stevens HNE, Hayward M, Wilson CG. Modulation of gastric pH by a buffered soluble effervescent formulation: A possible means of improving gastric tolerability of alendronate. Int J Pharm 2012; 432:57-62. [PMID: 22564778 DOI: 10.1016/j.ijpharm.2012.04.073] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 04/25/2012] [Accepted: 04/26/2012] [Indexed: 11/27/2022]
Abstract
Gastrointestinal side-effects of alendronate (ALN) are believed to be associated with oesophageal lodging of tablets and perhaps reflux of gastric contents with alendronate under strongly acidic pH conditions. This leads to unfavourable posture restrictions when dosing. This clinical study evaluated gastric emptying and gastric pH after administration of Fosamax(®) tablets and a novel effervescent ALN formulation with a high buffering capacity. This novel formulation, EX101, was developed to potentially improve gastric tolerance. Gastric pH was monitored by nasogastric probes. Gastric emptying was determined simultaneously by scintigraphic imaging of (99m)Tc-DTPA labelled formulations. Both formulations tested rapidly cleared the oesophagus and there were no statistically significant or physiologically relevant differences in gastric emptying times. Mean pH at time to 50% gastric emptying of the radiolabel was significantly higher in EX101-treated subjects compared to those treated with Fosamax(®). At time to 90% gastric emptying of the radiolabel, mean pH values were comparable. Mucosal exposure to ALN at pH less than 3 is irritating to gastro-oesophageal tissue. Ingestion of Fosamax(®) resulted in ALN being present in the stomach at a pH below 3 within minutes. EX101 minimised the possibility of exposing the oesophagus (in case of reflux) to acidified ALN.
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Diaz A, Di Salvo C, Lawrence D, Hayward M. Left atrial and right ventricular myxoma: an uncommon presentation of a rare tumour. Interact Cardiovasc Thorac Surg 2011; 12:622-3. [DOI: 10.1510/icvts.2010.255661] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Naqvi J, Navani N, Saeed S, Shastry M, Groves A, Shaw P, Lawrence D, Kolvekar S, Hayward M, Janes S. P222 A retrospective study of disease recurrence post thoracotomy for non-small cell lung cancer. Thorax 2010. [DOI: 10.1136/thx.2010.151068.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hayward M. Animal law in Australasia. Aust Vet J 2010. [DOI: 10.1111/j.1751-0813.2010.00606.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Berry C, Gerry L, Hayward M, Chandler R. Expectations and illusions: a position paper on the relationship between mental health practitioners and social exclusion. J Psychiatr Ment Health Nurs 2010; 17:411-21. [PMID: 20584238 DOI: 10.1111/j.1365-2850.2009.01538.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Over the last 10 years, the social inclusion agenda has been gaining momentum as a policy driver in mental health services. Prior to the seminal Social Exclusion Unit (SEU) report, Mental Health and Social Exclusion, there was a lack of awareness concerning the pervasive links between social exclusion and mental health problems. In the report, the SEU suggested that mental health practitioners themselves may actually be contributing to this social exclusion. This finding has been given limited coverage in both social inclusion literature and research. The current paper is a positioned commentary further exploring the relationship between practitioners and the social exclusion of mental health service users. A literature review was conducted in order to identify themes among factors which appear to moderate and contribute to this relationship. These factors are presented and implications for inclusive practice are explored.
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Ang M, Zhao N, Hayward M, Patel M, Yin X, Wilkerson MD, Funkhouser WK, Fritchie K, Olshan A, Hayes DN. Expression and prognostic significance of X-ray crosscomplementation group 1 (XRCC1) in head and neck squamous cell carcinoma patients undergoing concurrent chemoradiation. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.5541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Salzman NH, Hung K, Haribhai D, Chu H, Karlsson-Sjöberg J, Amir E, Teggatz P, Barman M, Hayward M, Eastwood D, Stoel M, Zhou Y, Sodergren E, Weinstock GM, Bevins CL, Williams CB, Bos NA. Enteric defensins are essential regulators of intestinal microbial ecology. Nat Immunol 2009; 11:76-83. [PMID: 19855381 PMCID: PMC2795796 DOI: 10.1038/ni.1825] [Citation(s) in RCA: 880] [Impact Index Per Article: 58.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Accepted: 10/16/2009] [Indexed: 12/12/2022]
Abstract
Antimicrobial peptides are important effectors of innate immunity throughout the plant and animal kingdoms. In the mammalian small intestine, Paneth cell alpha-defensins are antimicrobial peptides that contribute to host defense against enteric pathogens. To determine if alpha-defensins also govern intestinal microbial ecology, we analyzed the intestinal microbiota of mice expressing a human alpha-defensin gene (DEFA5) and in mice lacking an enzyme required for the processing of mouse alpha-defensins. In these complementary models, we detected significant alpha-defensin-dependent changes in microbiota composition, but not in total bacterial numbers. Furthermore, DEFA5-expressing mice had striking losses of segmented filamentous bacteria and fewer interleukin 17 (IL-17)-producing lamina propria T cells. Our data ascribe a new homeostatic role to alpha-defensins in regulating the makeup of the commensal microbiota.
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Carter KN, Cronin M, Blakely T, Hayward M, Richardson K. Cohort Profile: Survey of Families, Income and Employment (SoFIE) and Health Extension (SoFIE-health). Int J Epidemiol 2009; 39:653-9. [PMID: 19478042 DOI: 10.1093/ije/dyp215] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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ten Tusscher KHWJ, Mourad A, Nash MP, Clayton RH, Bradley CP, Paterson DJ, Hren R, Hayward M, Panfilov AV, Taggart P. Organization of ventricular fibrillation in the human heart: experiments and models. Exp Physiol 2009; 94:553-62. [PMID: 19168541 DOI: 10.1113/expphysiol.2008.044065] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Sudden cardiac death is a major health problem in the industrialized world. The lethal event is typically ventricular fibrillation (VF), during which the co-ordinated regular contraction of the heart is overthrown by a state of mechanical and electrical anarchy. Understanding the excitation patterns that sustain VF is important in order to identify potential therapeutic targets. In this paper, we studied the organization of human VF by combining clinical recordings of electrical excitation patterns on the epicardial surface during in vivo human VF with simulations of VF in an anatomically and electrophysiologically detailed computational model of the human ventricles. We find both in the computational studies and in the clinical recordings that epicardial surface excitation patterns during VF contain around six rotors. Based on results from the simulated three-dimensional excitation patterns during VF, which show that the total number of electrical sources is 1.4 +/- 0.12 times greater than the number of epicardial rotors, we estimate that the total number of sources present during clinically recorded VF is 9.0 +/- 2.6. This number is approximately fivefold fewer compared with that observed during VF in dog and pig hearts, which are of comparable size to human hearts. We explain this difference by considering differences in action potential duration dynamics across these species. The simpler spatial organization of human VF has important implications for treatment and prevention of this dangerous arrhythmia. Moreover, our findings underline the need for integrated research, in which human-based clinical and computational studies complement animal research.
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Grilley-Olson JE, Hayes DN, Miller RD, Socinski MA, Stinchcombe TE, Hayward M, Qaqish BF, Moore DT, Funkhouser WK. Inter-observer reliability for the diagnosis of lung cancer in a clinical cohort using the WHO classification system, version. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.22020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Hayes DN, Lee CB, Hayward M, Socinski MA, Stinchcombe TE, Roberts P, Thorne L, Bernard PS, Yin X, Parsons A, Funkhouser WK. Molecular markers distinguish patients at differential risk of brain metastases in lung cancer by immunohistochemistry. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ffolkes LV, Brull D, Krywawych S, Hayward M, Hughes SE. Aortic stenosis in cardiovascular ochronosis. J Clin Pathol 2007; 60:92-3. [PMID: 17213354 PMCID: PMC1860586 DOI: 10.1136/jcp.2005.032417] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Alkaptonuria (endogenous ochronosis) is a rare metabolic disorder caused by a deficiency of homogentisic acid oxidase, an enzyme responsible for the metabolic degradation of tyrosine. Patients with alkaptonuria commonly present with joint pain owing to degenerative arthritis. Other affected patients may present with pigmentation of the ear cartilage and sclera. This article reports a case of aortic stenosis associated with ochronosis in a 48-year-old man who presented with severe cardiac failure. He had no previous diagnosis of alkaptonuria, which was confirmed by mass spectrometry analysis of urine. The pathogenesis of cardiovascular ochronosis is unclear, but is probably related to the extensive extracellular deposits of ochronotic pigment in the cardiac tissue.
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Merkin SS, Karlarnangla A, Crimmins E, Hayward M, Seeman T. Education Differentials by Race in the Diagnosis. Am J Epidemiol 2006. [DOI: 10.1093/aje/163.suppl_11.s1-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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