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Xiao J, Poblete RA, Lerner A, Nguyen PL, Song JW, Sanossian N, Wilcox AG, Song SS, Lyden PD, Saver JL, Wasserman BA, Fan Z. MRI in the Evaluation of Cryptogenic Stroke and Embolic Stroke of Undetermined Source. Radiology 2024; 311:e231934. [PMID: 38652031 DOI: 10.1148/radiol.231934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Cryptogenic stroke refers to a stroke of undetermined etiology. It accounts for approximately one-fifth of ischemic strokes and has a higher prevalence in younger patients. Embolic stroke of undetermined source (ESUS) refers to a subgroup of patients with nonlacunar cryptogenic strokes in whom embolism is the suspected stroke mechanism. Under the classifications of cryptogenic stroke or ESUS, there is wide heterogeneity in possible stroke mechanisms. In the absence of a confirmed stroke etiology, there is no established treatment for secondary prevention of stroke in patients experiencing cryptogenic stroke or ESUS, despite several clinical trials, leaving physicians with a clinical dilemma. Both conventional and advanced MRI techniques are available in clinical practice to identify differentiating features and stroke patterns and to determine or infer the underlying etiologic cause, such as atherosclerotic plaques and cardiogenic or paradoxical embolism due to occult pelvic venous thrombi. The aim of this review is to highlight the diagnostic utility of various MRI techniques in patients with cryptogenic stroke or ESUS. Future trends in technological advancement for promoting the adoption of MRI in such a special clinical application are also discussed.
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Affiliation(s)
- Jiayu Xiao
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.), Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.), Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland-Baltimore, Baltimore, Md (B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Md (B.A.W.)
| | - Roy A Poblete
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.), Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.), Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland-Baltimore, Baltimore, Md (B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Md (B.A.W.)
| | - Alexander Lerner
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.), Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.), Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland-Baltimore, Baltimore, Md (B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Md (B.A.W.)
| | - Peggy L Nguyen
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.), Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.), Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland-Baltimore, Baltimore, Md (B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Md (B.A.W.)
| | - Jae W Song
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.), Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.), Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland-Baltimore, Baltimore, Md (B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Md (B.A.W.)
| | - Nerses Sanossian
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.), Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.), Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland-Baltimore, Baltimore, Md (B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Md (B.A.W.)
| | - Alison G Wilcox
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.), Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.), Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland-Baltimore, Baltimore, Md (B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Md (B.A.W.)
| | - Shlee S Song
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.), Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.), Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland-Baltimore, Baltimore, Md (B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Md (B.A.W.)
| | - Patrick D Lyden
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.), Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.), Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland-Baltimore, Baltimore, Md (B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Md (B.A.W.)
| | - Jeffrey L Saver
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.), Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.), Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland-Baltimore, Baltimore, Md (B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Md (B.A.W.)
| | - Bruce A Wasserman
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.), Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.), Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland-Baltimore, Baltimore, Md (B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Md (B.A.W.)
| | - Zhaoyang Fan
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.), Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.), Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland-Baltimore, Baltimore, Md (B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Md (B.A.W.)
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Lerner A, Lee AJX, Yan H, Van Griethuysen J, Bartlett AD, Veli M, Jiang Y, Luong M, Naban N, Kane C, Conibear J, Papadatos-Pastos D, Ahmad T, Chao D, Anand G, Asghar US. A Multicentric, Retrospective, Real-world Study on Immune-related Adverse Events in Patients with Advanced Non-small Cell Lung Cancers Treated with Pembrolizumab Monotherapy. Clin Oncol (R Coll Radiol) 2024; 36:193-199. [PMID: 38246850 DOI: 10.1016/j.clon.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 12/05/2023] [Accepted: 01/12/2024] [Indexed: 01/23/2024]
Abstract
AIMS We present 7 years of clinical experience with single-agent pembrolizumab immune checkpoint inhibitor immunotherapy in non-small cell lung cancers (NSCLC) from four UK cancer centres. MATERIALS AND METHODS This multi-institutional retrospective cohort study included 226 metastatic NSCLC patients. Outcomes were number and severity of immune-related adverse events (irAEs), median progression-free survival (mPFS) and median overall survival (mOS). RESULTS Within our cohort, 119/226 (53%) patients developed irAEs. Of these, 54/119 (45%) experienced irAEs affecting two or more organ systems. The most common irAEs were diarrhoea and rash. The development of an irAE was associated with better mOS (20.7 versus 8.0 months; P < 0.001) and mPFS (12.0 versus 3.9 months; P < 0.001). The development of grade 3/4 toxicities was associated with worse outcomes compared with the development of grade 1/2 toxicities (mOS 6.1 months versus 25.2 months, P < 0.01; mPFS 5.6 months versus 19.3 months, P = 0.01, respectively). Females had a higher proportion of reported grade 3/4 toxicities (13/44 [29.5%] versus 10/74 [13.5%], P = 0.03). Using a multiple Cox regression model, the presence of irAEs was associated with a better overall survival (hazard ratio = 0.42, 95% confidence interval 0.29-0.61; P < 0.01) and better PFS (hazard ratio 0.38, 95% confidence interval 0.27-0.53; P < 0.001). CONCLUSION In this multicentre retrospective cohort study, the development of at least one irAE was associated with significantly longer mPFS and mOS; however, more severe grade 3 and 4 irAEs were associated with worse outcomes. Delayed-onset irAEs, after the 3-month timepoint, were associated with better clinical outcomes.
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Affiliation(s)
- A Lerner
- North Middlesex University Hospital, London, UK
| | - A J X Lee
- UCL Cancer Institute, University College London, London, UK; University College London Hospitals NHS Foundation Trust, London, UK
| | - H Yan
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | - M Veli
- University College London Hospitals NHS Foundation Trust, London, UK; Princess Alexandra Hospital, Harlow, UK
| | - Y Jiang
- University College London Hospitals NHS Foundation Trust, London, UK
| | - M Luong
- University College London Hospitals NHS Foundation Trust, London, UK
| | - N Naban
- North Middlesex University Hospital, London, UK
| | - C Kane
- Mount Vernon Cancer Centre, Northwood, UK
| | | | - D Papadatos-Pastos
- University College London Hospitals NHS Foundation Trust, London, UK; Princess Alexandra Hospital, Harlow, UK
| | - T Ahmad
- University College London Hospitals NHS Foundation Trust, London, UK
| | - D Chao
- Royal Free London Hospital, London, UK
| | - G Anand
- North Middlesex University Hospital, London, UK
| | - U S Asghar
- The Royal Marsden NHS Foundation Trust, Sutton, UK; Concr LTD, Cambridge, UK; Croydon University Hospital, Thornton Heath, UK.
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3
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Yoo KG, Abella-Ayala F, Lerner A, Kwok A, Chang JR. P-ANCA Vasculitis Presenting with Orbital Infiltration. Ophthalmic Plast Reconstr Surg 2024:00002341-990000000-00321. [PMID: 38231652 DOI: 10.1097/iop.0000000000002593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) may affect the eye or orbit, and ophthalmic manifestations of AAV are associated with higher mortality than other inflammatory eye diseases. Perinuclear ANCA (p-ANCA) vasculitis is an uncommon cause of orbital inflammation. A 70-year-old woman with chronic kidney disease presented with a 1-year history of orbital mass and edema around her OD. Fundoscopy revealed 360° optic disc elevation OD. MRI orbits showed an infiltrative, intra- and extraconal lesion extending through the right orbital apex to the cavernous sinus. Labwork and orbital biopsy were consistent with p-ANCA vasculitis, and the patient's ocular symptoms improved after methylprednisolone. Diagnosis of AAV is complicated by a wide diversity of symptoms, and this case highlights an unusual presentation of p-ANCA vasculitis in the orbit. Ophthalmologists have an important role in diagnosing systemic conditions such as AAV by initiating the proper inflammatory workup.
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Affiliation(s)
- Kristy G Yoo
- Keck School of Medicine at the University of Southern California, Los Angeles, California, U.S.A
| | - Frank Abella-Ayala
- Keck School of Medicine at the University of Southern California, Los Angeles, California, U.S.A
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine at the University of Southern California, Los Angeles, California, U.S.A
| | - Alexander Lerner
- Keck School of Medicine at the University of Southern California, Los Angeles, California, U.S.A
- Department of Radiology, Keck School of Medicine at the University of Southern California, Los Angeles, California, U.S.A
| | - Alyssa Kwok
- Keck School of Medicine at the University of Southern California, Los Angeles, California, U.S.A
- Department of Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, California, U.S.A
| | - Jessica R Chang
- Keck School of Medicine at the University of Southern California, Los Angeles, California, U.S.A
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine at the University of Southern California, Los Angeles, California, U.S.A
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Pinto SN, Lerner A, Phung D, Barisano G, Chou B, Xu W, Sheikh-Bahaei N. Arterial Spin Labeling in Migraine: A Review of Migraine Categories and Mimics. J Cent Nerv Syst Dis 2023. [DOI: 10.1177/11795735231160032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Migraine is a complex headache characterized by changes in functional connectivity and cerebral perfusion. The perfusion changes represent a valuable domain for targeted drug therapy. Arterial spin labeling is a noncontrast imaging technique of quantifying cerebral perfusion changes in the migraine setting. In this narrative review, we will discuss the pathophysiology of the different categories of migraine, as defined by the International Classification of Headache Disorders-3 and describe a category-based approach to delineating perfusion changes in migraine on arterial spin labeling images. We will also discuss the use of arterial spin labeling to differentiate migraine from stroke and/or seizures in the adult and pediatric populations. Our systematic approach will help improve the understanding of the complicated vascular changes that occur during migraines and identify potential areas of future research.
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Affiliation(s)
- Soniya N Pinto
- Department of Diagnostic Imaging, St Jude Children’s Research Hospital, Memphis, TN, USA
| | - Alexander Lerner
- University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Daniel Phung
- University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Giuseppe Barisano
- University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Brendon Chou
- University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Wilson Xu
- University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Nasim Sheikh-Bahaei
- University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
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Chou BC, Lerner A, Barisano G, Phung D, Xu W, Pinto SN, Sheikh-Bahaei N. Functional MRI and Diffusion Tensor Imaging in Migraine: A Review of Migraine Functional and White Matter Microstructural Changes. J Cent Nerv Syst Dis 2023; 15:11795735231205413. [PMID: 37900908 PMCID: PMC10612465 DOI: 10.1177/11795735231205413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 09/14/2023] [Indexed: 10/31/2023] Open
Abstract
Migraine is a complex and heterogenous disorder whose disease mechanisms remain disputed. This narrative review summarizes functional MRI (fMRI) and diffusion tensor imaging (DTI) findings and interprets their association with migraine symptoms and subtype to support and expand our current understanding of migraine pathophysiology. Our PubMed search evaluated and included fMRI and DTI studies involving comparisons between migraineurs vs healthy controls, migraineurs with vs without aura, and episodic vs chronic migraineurs. Migraineurs demonstrate changes in functional connectivity (FC) and regional activation in numerous pain-related networks depending on migraine phase, presence of aura, and chronicity. Changes to diffusion indices are observed in major cortical white matter tracts extending to the brainstem and cerebellum, more prominent in chronic migraine and associated with FC changes. Reported changes in FC and regional activation likely relate to pain processing and sensory hypersensitivities. Diffuse white matter microstructural changes in dysfunctional cortical pain and sensory pathways complement these functional differences. Interpretations of reported fMRI and DTI measure trends have not achieved a clear consensus due to inconsistencies in the migraine neuroimaging literature. Future fMRI and DTI studies should establish and implement a uniform methodology that reproduces existing results and directly compares migraineurs with different subtypes. Combined fMRI and DTI imaging may provide better pathophysiological explanations for nonspecific FC and white matter microstructural differences.
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Affiliation(s)
- Brendon C. Chou
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Alexander Lerner
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Daniel Phung
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Wilson Xu
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Soniya N. Pinto
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Nasim Sheikh-Bahaei
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Wonders K, Schmitz K, Harness JK, Lerner A, Hale ER. The Impact of Supervised, Individualized Exercise on Fatigue and Quality of Life during Adjuvant Radiotherapy for Breast Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e267. [PMID: 37785014 DOI: 10.1016/j.ijrobp.2023.06.1229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Adjuvant radiation therapy in treatment for breast cancer has been shown to improve patient outcomes and reduce mortality rates. However, many patients experience debilitating fatigue as a result. Currently, there are limited treatment options for fatigue in cancer survivors. Options include pharmaceutical agents, psychological interventions, or nutrition strategies, all of which have limited efficacy. Exercise is recommended in survivorship care plans, but it not widely implemented beyond the use of generalized statements or resource guides given to patients. Therefore, the purpose of this study was the examine the impact of an individualized exercise program on fatigue, quality of life, and physical functioning during radiation therapy for breast cancer. MATERIALS/METHODS This multi-institutional prospective trial evaluated the effects of supervised, individualized exercise therapy in 422 patients undergoing adjuvant radiotherapy for breast cancer. Following a comprehensive fitness assessment and the completion of the Brief Fatigue Instrument (BFI) questionnaire, each participant participated in a 12-week individualized exercise program offered through Maple Tree Cancer Alliance. At its conclusion, the patients repeated the assessment and questionnaire. RESULTS Individualized exercise had a positive impact on fitness parameters and severity of fatigue. Specifically, cardiovascular endurance, muscular strength, muscular endurance, and flexibility all significantly improved following the exercise intervention (p<0.05). On average, patients fatigue levels decreased by 31.1% (P<0.01). CONCLUSION These results signify that fatigue levels are positively impacted by exercise among patients with breast cancer.
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Affiliation(s)
- K Wonders
- Maple Tree Cancer Alliance, Dayton, OH; Wright State University, Dayton, OH
| | - K Schmitz
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - A Lerner
- Maple Tree Cancer Alliance, Dayton, OH
| | - E R Hale
- Kettering Health Cancer Center, Kettering, OH
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7
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Shiroishi MS, Weinert D, Cen SY, Varghese B, Dondlinger T, Prah M, Mendoza J, Nazemi S, Ameli N, Amini N, Shohas S, Chen S, Bigjahan B, Zada G, Chen T, Neman-Ebrahim J, Chang EL, Chow FE, Fan Z, Yang W, Attenello FJ, Ye J, Kim PE, Patel VN, Lerner A, Acharya J, Hu LS, Quarles CC, Boxerman JL, Wu O, Schmainda KM. A cross-sectional study to test equivalence of low- versus intermediate-flip angle dynamic susceptibility contrast MRI measures of relative cerebral blood volume in patients with high-grade gliomas at 1.5 Tesla field strength. Front Oncol 2023; 13:1156843. [PMID: 37799462 PMCID: PMC10548232 DOI: 10.3389/fonc.2023.1156843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/21/2023] [Indexed: 10/07/2023] Open
Abstract
Introduction 1.5 Tesla (1.5T) remain a significant field strength for brain imaging worldwide. Recent computer simulations and clinical studies at 3T MRI have suggested that dynamic susceptibility contrast (DSC) MRI using a 30° flip angle ("low-FA") with model-based leakage correction and no gadolinium-based contrast agent (GBCA) preload provides equivalent relative cerebral blood volume (rCBV) measurements to the reference-standard acquisition using a single-dose GBCA preload with a 60° flip angle ("intermediate-FA") and model-based leakage correction. However, it remains unclear whether this holds true at 1.5T. The purpose of this study was to test this at 1.5T in human high-grade glioma (HGG) patients. Methods This was a single-institution cross-sectional study of patients who had undergone 1.5T MRI for HGG. DSC-MRI consisted of gradient-echo echo-planar imaging (GRE-EPI) with a low-FA without preload (30°/P-); this then subsequently served as a preload for the standard intermediate-FA acquisition (60°/P+). Both normalized (nrCBV) and standardized relative cerebral blood volumes (srCBV) were calculated using model-based leakage correction (C+) with IBNeuro™ software. Whole-enhancing lesion mean and median nrCBV and srCBV from the low- and intermediate-FA methods were compared using the Pearson's, Spearman's and intraclass correlation coefficients (ICC). Results Twenty-three HGG patients composing a total of 31 scans were analyzed. The Pearson and Spearman correlations and ICCs between the 30°/P-/C+ and 60°/P+/C+ acquisitions demonstrated high correlations for both mean and median nrCBV and srCBV. Conclusion Our study provides preliminary evidence that for HGG patients at 1.5T MRI, a low FA, no preload DSC-MRI acquisition can be an appealing alternative to the reference standard higher FA acquisition that utilizes a preload.
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Affiliation(s)
- Mark S. Shiroishi
- Department of Radiology, Keck School of Medicine of the University of Southern California (USC), Los Angeles, CA, United States
- Imaging Genetics Center, USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Marina del Rey, CA, United States
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Dane Weinert
- Department of Radiology, Keck School of Medicine of the University of Southern California (USC), Los Angeles, CA, United States
| | - Steven Y. Cen
- Department of Radiology, Keck School of Medicine of the University of Southern California (USC), Los Angeles, CA, United States
| | - Bino Varghese
- Department of Radiology, Keck School of Medicine of the University of Southern California (USC), Los Angeles, CA, United States
| | | | - Melissa Prah
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jesse Mendoza
- Department of Radiology, Keck School of Medicine of the University of Southern California (USC), Los Angeles, CA, United States
| | - Sina Nazemi
- Department of Radiology, Keck School of Medicine of the University of Southern California (USC), Los Angeles, CA, United States
| | - Nima Ameli
- Department of Radiology, Keck School of Medicine of the University of Southern California (USC), Los Angeles, CA, United States
| | - Negin Amini
- Department of Radiology, Keck School of Medicine of the University of Southern California (USC), Los Angeles, CA, United States
| | - Salman Shohas
- Department of Radiology, Keck School of Medicine of the University of Southern California (USC), Los Angeles, CA, United States
| | - Shannon Chen
- Department of Radiology, Keck School of Medicine of the University of Southern California (USC), Los Angeles, CA, United States
| | - Bavrina Bigjahan
- Department of Radiology, Keck School of Medicine of the University of Southern California (USC), Los Angeles, CA, United States
| | - Gabriel Zada
- Department of Neurological Surgery, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Thomas Chen
- Department of Neurological Surgery, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Josh Neman-Ebrahim
- Department of Neurological Surgery, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Eric L. Chang
- Department of Radiation Oncology, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Frances E. Chow
- Department of Neurological Surgery, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Zhaoyang Fan
- Department of Radiology, Keck School of Medicine of the University of Southern California (USC), Los Angeles, CA, United States
- Department of Radiation Oncology, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Wensha Yang
- Department of Radiation Oncology, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Frank J. Attenello
- Department of Neurological Surgery, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Jason Ye
- Department of Radiation Oncology, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Paul E. Kim
- Department of Radiology, Keck School of Medicine of the University of Southern California (USC), Los Angeles, CA, United States
| | - Vishal N. Patel
- Department of Radiology, Mayo Clinic, Jacksonville, FL, United States
| | - Alexander Lerner
- Department of Radiology, Keck School of Medicine of the University of Southern California (USC), Los Angeles, CA, United States
| | - Jay Acharya
- Department of Radiology, Keck School of Medicine of the University of Southern California (USC), Los Angeles, CA, United States
| | - Leland S. Hu
- Department of Radiology, Mayo Clinic, Phoenix, AZ, United States
| | - C. Chad Quarles
- Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jerrold L. Boxerman
- Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Ona Wu
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Kathleen M. Schmainda
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, WI, United States
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8
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Lerner A, Jakusonoka R, Jumtins A, Rothem D. Treatment of Bifocal Periprosthetic Fractures above and below a Knee after Tumor using Spanning Ilizarov Device: A Case Report. J Orthop Case Rep 2023; 13:33-37. [PMID: 37753117 PMCID: PMC10519321 DOI: 10.13107/jocr.2023.v13.i09.3866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/11/2023] [Indexed: 09/28/2023] Open
Abstract
Introduction Multiple treatment options and internal and external devices have been recommended for periprosthetic fractures management around total knee arthroplasty. Case Report We present the case of the high-energy bifocal periprosthetic fractures of the femur and the tibia after total knee prosthesis following excision of a tumor. One of the fractures was an open tibial fracture Gustilo Type IIIB and the other - comminuted subtrochanteric fracture of the femur with extrusion of periprosthetic cement pieces out from the bone defect. The Ilizarov circular external fixator was used for the skeletal stabilization and early functional treatment in this compound case. Conclusion The use of Ilizarov external fixator for patients with complex periprosthetic fractures, who present severe technical difficulties in bone stabilization, especially by concomitant severe soft-tissue damage after high-energy injuries, is a good surgical alternative.
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Affiliation(s)
- Alexander Lerner
- Department of Orthopaedics, Riga Stradins University, Latvia
- Department of Orthopaedic Surgery, Ziv Medical Center, Zefat, Israel
- Department of Orthopaedics, Azrieli Faculty of Medicine, Bar-Ilan University, Zefat, Israel
| | - Ruta Jakusonoka
- Department of Orthopaedics, Riga Stradins University, Latvia
| | - Andris Jumtins
- Department of Orthopaedics, Riga Stradins University, Latvia
| | - David Rothem
- Department of Orthopaedic Surgery, Ziv Medical Center, Zefat, Israel
- Department of Orthopaedics, Azrieli Faculty of Medicine, Bar-Ilan University, Zefat, Israel
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9
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Donington J, Hu X, Zhang S, Song Y, Gao C, Arunachalam A, Chirovsky D, Lerner A, Jiang A, Signorovitch J, Samkari A. 95P Neoadjuvant treatment pattern and association between real-world event-free survival (rwEFS) and overall survival (OS) in patients (pts) with resected early-stage non-small cell lung cancer (eNSCLC). J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00350-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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10
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Zhou H, Xiao J, Ganesh S, Lerner A, Ruan D, Fan Z. VWI-APP: Vessel wall imaging-dedicated automated processing pipeline for intracranial atherosclerotic plaque quantification. Med Phys 2023; 50:1496-1506. [PMID: 36345580 PMCID: PMC10033308 DOI: 10.1002/mp.16074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/16/2022] [Accepted: 10/30/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Quantitative plaque assessment based on 3D magnetic resonance (MR) vessel wall imaging (VWI) has been shown to provide valuable numerical markers of the burden and risk of intracranial atherosclerotic disease (ICAD). However, plaque quantification is currently time-consuming and observer-dependent due to the demand for heavy manual effort. A VWI-dedicated automated processing pipeline (VWI-APP) is desirable. PURPOSE To develop and evaluate a VWI-APP for end-to-end quantitative analysis of intracranial atherosclerotic plaque. METHODS We retrospectively enrolled 91 subjects with ICAD (80 for pipeline development, 10 for an end-to-end pipeline evaluation, and 1 for demonstrating longitudinal plaque assessment) who had undergone VWI and MR angiography. In an end-to-end evaluation, diameter stenosis (DS), normalized wall index (NWI), remodeling ratio (RR), plaque wall contrast ratio (CR), and total plaque volume (TPV) were quantified at each culprit lesion using the developed VWI-APP and a computer-aided manual approach by a neuroradiologist, respectively. The time consumed in each quantification approach was recorded. Two-sided paired t-tests and intraclass correlation coefficient (ICC) were used to determine the difference and agreement in each plaque metric between VWI-APP and manual quantification approaches. RESULTS There was no significant difference between VWI-APP and manual quantification in each plaque metric. The ICC was 0.890, 0.813, 0.827, 0.891, and 0.991 for DS, NWI, RR, CR, and TPV, respectively, suggesting good to excellent accuracy of the pipeline method in plaque quantification. Quantitative analysis of each culprit lesion on average took 675.7 s using the manual approach but shortened to 238.3 s with the aid of VWI-APP. CONCLUSIONS VWI-APP is an accurate and efficient approach to intracranial atherosclerotic plaque quantification. Further clinical assessment of this automated tool is warranted to establish its utility in the risk assessment of ICAD lesions.
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Affiliation(s)
- Hanyue Zhou
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Jiayu Xiao
- Department of Radiology, University of Southern California, Los Angeles, CA 90033, USA
| | - Siddarth Ganesh
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA 90089, USA
| | - Alexander Lerner
- Department of Radiology, University of Southern California, Los Angeles, CA 90033, USA
| | - Dan Ruan
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA 90095, USA
- Department of Radiation Oncology, University of California, Los Angeles, CA 90095, USA
| | - Zhaoyang Fan
- Department of Radiology, University of Southern California, Los Angeles, CA 90033, USA
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA 90089, USA
- Department of Radiation Oncology, University of Southern California, Los Angeles, CA 90033, USA
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11
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Lerner A, Jakusonoka R, Jumtins A, Rothem D. Temporary bridging trans-hip external fixation in damage control orthopaedics treatment after severe combat trauma: A clinical case series. Injury 2023; 54:991-995. [PMID: 36621359 DOI: 10.1016/j.injury.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/13/2022] [Accepted: 01/02/2023] [Indexed: 01/05/2023]
Abstract
The role of external fixation in Damage Control Orthopaedics has been well described. Temporary external fixation has been recommended to provide relative bone stability while the soft tissue heals, prior to formal open reduction and internal fixation. Temporary bridging external fixation, that spans the joint, is recommended as primary skeletal stabilization in complex intra-articular and peri-articular fractures, in extensive peri-articular soft-tissue damage around the knee, ankle, elbow and wrist joints. Works devoted to temporary trans-hip external fixation in treatment of complex high-energy injuries are relatively rare. The purpose of this article is to present our experience in using temporary hip spanning external fixation during primary treatment of six patients suffered from complex open intra-articular and peri-articular fractures of the proximal femoral bone with extensive soft tissue damage due to war blast or high-velocity gunshot trauma. Primary management was based on the concept of Advanced Trauma Life Support and Damage Control Orthopaedics. Conversion to definitive bone reconstruction was performed on the next stage of the treatment after general and local stabilization.
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Affiliation(s)
- Alexander Lerner
- Department of Orthopaedics, Riga Stradins University, 22 Duntes Str., Riga, LV-1005, Latvia; Department of Orthopaedic Surgery, Ziv Medical Center, P.o.b. 1008, Zefat, Israel; Orthopaedic Department, Azrieli Faculty of Medicine, Bar-Ilan University, Henrietta Szold 8, Zefat, Israel.
| | - Ruta Jakusonoka
- Department of Orthopaedics, Riga Stradins University, 22 Duntes Str., Riga, LV-1005, Latvia.
| | - Andris Jumtins
- Department of Orthopaedics, Riga Stradins University, 22 Duntes Str., Riga, LV-1005, Latvia.
| | - David Rothem
- Department of Orthopaedic Surgery, Ziv Medical Center, P.o.b. 1008, Zefat, Israel; Orthopaedic Department, Azrieli Faculty of Medicine, Bar-Ilan University, Henrietta Szold 8, Zefat, Israel.
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12
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Li J, Li S, Park KE, Wen J, Lee J, Ayala FA, Lerner A, Gokoffski KK, Zhang-Nunes S, Patel V, Chang JR. Re: "Correlation of Automated Computed Tomography Volumetric Analysis Metrics With Motility Disturbances in Thyroid Eye Disease". Ophthalmic Plast Reconstr Surg 2023; 39:194. [PMID: 36867765 DOI: 10.1097/iop.0000000000002353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
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13
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Xu WJ, Barisano G, Phung D, Chou B, Pinto SN, Lerner A, Sheikh-Bahaei N. Structural MRI in Migraine: A Review of Migraine Vascular and Structural Changes in Brain Parenchyma. J Cent Nerv Syst Dis 2023; 15:11795735231167868. [PMID: 37077432 PMCID: PMC10108417 DOI: 10.1177/11795735231167868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 03/15/2023] [Indexed: 04/21/2023] Open
Abstract
Migraine is a complex and common disorder that affects patients around the world. Despite recent advances in this field, the exact pathophysiology of migraine is still not completely understood. Structural MRI sequences have revealed a variety of changes to brain parenchyma associated with migraine, including white matter lesions, volume changes, and iron deposition. This Review highlights different structural imaging findings in various types of migraine and their relationship to migraine characteristics and subtypes in order to improve our understanding of migraine, its pathophysiologic mechanisms, and how to better diagnose and treat it.
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Affiliation(s)
- Wilson J Xu
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Daniel Phung
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Brendon Chou
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Alexander Lerner
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Nasim Sheikh-Bahaei
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Nasim Sheikh-Bahaei, Keck School of Medicine, University of Southern California, 1520 San Pablo St, Lower Level Imaging L1451, Los Angeles, CA 90033, USA.
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14
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Lerner A, Grant EG, Acharya J, Chambers TN, Maceri DR, Cen SY, Tchelepi H. Utility of Contrast-Enhanced Ultrasound and 4-Dimensional Computed Tomography for Preoperative Detection and Localization of Parathyroid Adenomas Compared With Surgical Results. J Ultrasound Med 2022; 41:2295-2306. [PMID: 34918364 DOI: 10.1002/jum.15916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/25/2021] [Accepted: 12/01/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To investigate the accuracy, sensitivity, and specificity of contrast-enhanced ultrasound (CEUS) for detection of parathyroid adenomas and compare it to those of 4-dimensional computed tomography (4DCT), which has been established as a reliable, effective tool for preoperative localization of parathyroid adenomas. METHODS About 27 patients with suspected parathyroid pathology underwent imaging evaluations with 4DCT and CEUS and 22 patients subsequently underwent surgical resection of parathyroid lesions. 4DCT and CEUS were performed and interpreted by consensus of two expert radiologists with extensive experience in each modality. Assessment for the side, z-axis (craniocaudal axis), and quadrant of the pathologically proven lesion was performed based on the surgical report. RESULTS For single-gland disease, the accuracy for CEUS localization to the correct quadrant and side were 81.0 and 90.1% respectively. For single-gland disease, the accuracy for 4DCT localization to the correct quadrant and side were 81.0 and 90.5% respectively. 4DCT localization sensitivity and specificity were comparable to those for CEUS. 4DCT allowed for accurate diagnosis in multigland disease in contradistinction to CEUS. CONCLUSIONS CEUS is a noninvasive, real-time imaging technique that has relatively high diagnostic confidence and accuracy of localization which are comparable to the accuracy of 4DCT for preoperative parathyroid adenoma detection, characterization, and localization. This technique should be considered for primary preoperative diagnosis, especially in younger patients.
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Affiliation(s)
- Alexander Lerner
- Department of Radiology, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Edward G Grant
- Department of Radiology, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jay Acharya
- Department of Radiology, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tamara N Chambers
- Department of Otolaryngology, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Dennis R Maceri
- Department of Otolaryngology, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Steven Yong Cen
- Department of Neurology, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Hisham Tchelepi
- Department of Radiology, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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15
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Lerner A, Sheikh-Bahaei N, Go JL. Utility of Neuroimaging in the Management of Chronic and Acute Headache. Otolaryngol Clin North Am 2022; 55:559-577. [PMID: 35490044 DOI: 10.1016/j.otc.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Imaging plays an important role in identifying the cause of the much less common secondary headaches. Such headaches may be caused by a variety of pathologic conditions which can be categorized as intracranial and extracranial. Idiopathic intracranial hypertension imaging findings include "empty sella," orbital changes, and dural venous sinus narrowing. Intracranial hypotension (ICH) is frequently caused by CSF leaks. Imaging findings include loss of the CSF spaces, downward displacement of the brain, as well as dural thickening and enhancement. Severe cases of ICH may result in subdural hematomas. A variety of intracranial and skull base tumors may cause headaches due to dural involvement. Extracranial tumors and lesions that frequently present with headaches include a variety of sinonasal tumors as well as mucoceles. Neurovascular compression disorders causing headaches include trigeminal and glossopharyngeal neuralgia. Imaging findings include displacement and atrophy of the cranial nerve caused by an adjacent arterial or venous structure.
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Affiliation(s)
- Alexander Lerner
- Keck Medical Center of USCD, Department of Radiology, 1500 San Pablo Street, 2nd Floor, Imaging, Los Angeles, CA 90033, USA.
| | - Nasim Sheikh-Bahaei
- Keck Medical Center of USCD, Department of Radiology, 1500 San Pablo Street, 2nd Floor, Imaging, Los Angeles, CA 90033, USA
| | - John L Go
- Keck Medical Center of USCD, Department of Radiology, 1500 San Pablo Street, 2nd Floor, Imaging, Los Angeles, CA 90033, USA
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16
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Lerner A, Keshwani K, Okines A, Sanderson B, Board R, Flynn M, Sharkey E, Konstantis A, Roylance R, Hanna D, King J, Murphy R, Rehman F, Guppy A, Westbury C, Takeuchi E, Spurrell E, Jayaweera H, Raja F. A Multicentre Retrospective Study of Fulvestrant Use and Efficacy in Advanced/Metastatic Breast Cancer. Clin Oncol (R Coll Radiol) 2022; 34:261-266. [DOI: 10.1016/j.clon.2021.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 11/17/2021] [Accepted: 12/16/2021] [Indexed: 11/26/2022]
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17
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Patel V, Li CH, Rye V, Liu CSJ, Lerner A, Acharya J, Rajamohan AG. A Comparison of WebRTC and Conventional Videoconferencing for Synchronized Remote Medical Image Presentation. J Digit Imaging 2021; 35:68-76. [PMID: 34935095 PMCID: PMC8691158 DOI: 10.1007/s10278-021-00544-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 10/18/2021] [Accepted: 11/11/2021] [Indexed: 10/26/2022] Open
Abstract
DICOM viewers must fulfill roles beyond primary diagnostic interpretation, including serving as presentation tools in teaching and multidisciplinary conferences, thereby enabling multiple individuals to review images collaboratively in real time. When in-person gathering is not possible, a variety of solutions have been deployed to maintain the ability for spatially separated users to view medical images simultaneously. These approaches differ in their backend architectures, utilization of application-specific optimizations, and ultimately in their end user satisfaction. In this work, we systematically compare the performance of conventional screensharing using a videoconferencing application with that of a custom, synchronized DICOM viewer linked using Web Real Time Communications (WebRTC) technology. We find superior performance for the WebRTC method with regard to image quality and latency across a range of simulated adverse network conditions, and we show how increasing the number of conference participants differentially affects the bandwidth requirements of the two viewing solutions. In addition, we compare these two approaches in a real-world teaching scenario and gather the feedback of trainee and faculty radiologists, who we found to favor the WebRTC method for its decreased latency, improved image quality, ease of setup, and overall experience. Ultimately, our results demonstrate the value of application-specific solutions for the remote synchronized viewing of medical imaging, which, given the recent increase in reliance on remote collaboration, may constitute a significant consideration for future enterprise viewer procurement decisions.
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Affiliation(s)
- Vishal Patel
- Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, 2025 Zonal Ave, Los Angeles, CA, 90033, USA.
| | - Charles H Li
- Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, 2nd Floor, Los Angeles, CA, 90033, USA
| | - Van Rye
- Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, 2nd Floor, Los Angeles, CA, 90033, USA
| | - Chia-Shang J Liu
- Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, 2nd Floor, Los Angeles, CA, 90033, USA
| | - Alexander Lerner
- Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, 2nd Floor, Los Angeles, CA, 90033, USA
| | - Jay Acharya
- Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, 2nd Floor, Los Angeles, CA, 90033, USA
| | - Anandh G Rajamohan
- Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, 2nd Floor, Los Angeles, CA, 90033, USA
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18
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Dvornikova KA, Bystrova EY, Churilov LP, Lerner A. Pathogenesis of the inflammatory bowel disease in context of SARS-COV-2 infection. Mol Biol Rep 2021; 48:5745-5758. [PMID: 34296352 PMCID: PMC8297608 DOI: 10.1007/s11033-021-06565-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 07/13/2021] [Indexed: 02/07/2023]
Abstract
To date, the latest research results suggest that the novel severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) can enter host cells directly via the gastrointestinal tract by binding to the enterocyte-expressed ACE2 receptor, or indirectly as a result of infection of type II alveolar epithelial cells. At the same time, entry of SARS-CoV-2 through the gastrointestinal tract initiates the activation of innate and adaptive immune responses, the formation of an excessive inflammatory reaction and critical increase in the expression of proinflammatory cytokines, which, subsequently, can presumably increase inflammation and induce intestinal damage in patients suffering from inflammatory bowel disease (IBD). The aims of the present review were to reveal and analyze possible molecular pathways and consequences of the induction of an innate and adaptive immune response during infection with SARS-CoV-2 in patients with IBD. A thorough literature search was carried out by using the keywords: IBD, SARS-CoV-2, COVID-19. Based on the screening, a number of intracellular and extracellular pathways were considered and discussed, which can impact the immune response during SARS-CoV-2 infection in IBD patients. Additionally, the possible consequences of the infection for such patients were estimated. We further hypothesize that any virus, including the new SARS-CoV-2, infecting intestinal tissues and/or entering the host's body through receptors located on intestinal enterocytes may be a trigger for the onset of IBD in individuals with a genetic predisposition and/or the risk of developing IBD associated with other factors.
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Affiliation(s)
- K. A. Dvornikova
- Pavlov Institute of Physiology, Russian Academy of Sciences, Saint Petersburg, Russian Federation
| | - E. Yu. Bystrova
- Pavlov Institute of Physiology, Russian Academy of Sciences, Saint Petersburg, Russian Federation
| | - L. P. Churilov
- Saint Petersburg State University, Saint Petersburg, Russian Federation
| | - A. Lerner
- Chaim Sheba Medical Center, The Zabludowicz Research Center for Autoimmune Diseases, Tel Hashomer, Israel
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19
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Jumtins A, Jakusonoka R, Vikmanis A, Grigorjevs D, Ciems M, Krupenko I, Lerner A. COVID-19 Crisis Effect: Experience at Two Orthopedic Trauma Units. Isr Med Assoc J 2021; 23:71-75. [PMID: 33595209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND The coronavirus disease-2019 (COVID-19) crisis has affected how hospitals work and has had an effect on orthopedic surgery. OBJECTIVES To compare patient management and low-energy and high-energy trauma treatment at two orthopedic trauma units during the COVID-19 crisis and to clarify resource demands and preparedness in orthopedic clinics during the state of emergency caused by the COVID-19 pandemic. METHODS This retrospective study was conducted at two orthopedic trauma units from 14 March 2019 to 14 April 2019 and from 14 March 2020 to 14 April 2020. RESULTS The proportion of patients admitted in the multi-trauma orthopedic unit decreased by one-third, the mean time interval from admission to surgery significantly decreased, and the number of surgeries and mean length of stay in hospital decreased in 2020 compared to the same test period in 2019. In the orthopedic trauma unit, the number of patients and surgeries also decreased. CONCLUSIONS Our study highlights changes in orthopedic injury characteristics in two orthopedic units during the COVID-19 crisis in Latvia and compares these changes to data from the same time period one year earlier.
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Affiliation(s)
- Andris Jumtins
- Department of Orthopaedics, Riga Stradins University, Riga, Latvia
- Hospital of Traumatology and Orthopaedics, Riga, Latvia
| | - Ruta Jakusonoka
- Department of Orthopaedics, Riga Stradins University, Riga, Latvia
| | - Andris Vikmanis
- Department of Orthopaedics, Riga Stradins University, Riga, Latvia
- Hospital of Traumatology and Orthopaedics, Riga, Latvia
| | - Dmitrijs Grigorjevs
- Department of Residency, Riga Stradins University, Riga, Latvia
- Hospital of Traumatology and Orthopaedics, Riga, Latvia
| | - Modris Ciems
- Hospital of Traumatology and Orthopaedics, Riga, Latvia
| | - Ivans Krupenko
- Department of Traumatology and Orthopaedics, Clinical Centre "Gailezers", Riga Eastern Clinical University Hospital, Riga, Latvia
| | - Alexander Lerner
- Department of Orthopedics, Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
- Department of Orthopedic Surgery, Ziv Medical Center, Safed, Israel
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20
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Wang N, Shen X, Zhang G, Gao B, Lerner A. Cerebrovascular disease in pregnancy and puerperium: perspectives from neuroradiologists. Quant Imaging Med Surg 2021; 11:838-851. [PMID: 33532282 DOI: 10.21037/qims-20-830] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Pregnancy-related cerebrovascular disease is a serious complication of pregnancy and puerperium. The etiology and pathological mechanisms of cerebrovascular disease are complex, involving changes in the cardiovascular, endocrine, and immune systems. Vascular risk factors during pregnancy and puerperium may cause vasospasm and endothelial cell damage leading to cerebral ischemia, hemorrhage, posterior reversible encephalopathy syndrome (PRES), and reversible cerebral vasoconstriction syndrome. Arterial or venous obstruction may damage the blood-brain barrier (BBB) and impede venous return, resulting in cerebral edema, hemorrhage, and intracranial hypertension. Pregnancy with hypercoagulability may threaten the lives of both the mother and the developing fetus. With improvements in stroke treatment during pregnancy and puerperium, neuroradiologists have gained new insights into this problem. This article reviews the pathogenesis, imaging findings, and risk factors of stroke during pregnancy and puerperium, focusing on imaging diagnosis and prognostic assessment.
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Affiliation(s)
- Naiwu Wang
- Department of Radiology, Jinan City People's Hospital, Laiwu, China
| | - Xudong Shen
- Department of Radiology, Enshi Center Hospital, Enshi, China
| | - Gang Zhang
- Department of Radiology, Yantai Yuhuangding Hospital, Yantai, China
| | - Bo Gao
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Key Laboratory of Brain Imaging, Guizhou Medical University, Guiyang, China
| | - Alexander Lerner
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Alifrangis C, Lee A, Fernando S, Cakir O, Koliou P, Lerner A, Forgenie J, Akers C, Harland S, Freeman A, Walkden M, Hadway P, Alnajjar H, Muneer A, Mitra A. 784P Perioperative multimodality treatment in high-risk node-positive penile cancer: A single institution study of patients treated in a supraregional centre. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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22
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Lerner A, Keshwani K, Sanderson B, Board R, Flynn M, Sharkey E, Okines A, Konstantis A, Roylance R, Hanna D, King J, Murphy R, Rehman F, Guppy A, Westbury C, Takeuchi E, Spurrell E, Raja F. Is Universal Patient Access to Fulvestrant in Hormone Receptor-positive Advanced Breast Cancer Justified? A UK Retrospective Multicentre Study. Clin Oncol (R Coll Radiol) 2020. [DOI: 10.1016/j.clon.2020.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Legriel S, Lerner A, Wintermark M, Rykken JB, Gao B. Editorial: Posterior Reversible Encephalopathy Syndrome and Associated Diseases. Front Neurol 2020; 11:667. [PMID: 32849174 PMCID: PMC7396664 DOI: 10.3389/fneur.2020.00667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/03/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stephane Legriel
- Medico-Surgical Intensive Care Department, Centre Hospitalier de Versailles, Le Chesnay, France
- University Paris-Saclay, UVSQ, INSERM, CESP, Team “PsyDev”, Villejuif, France
| | - Alexander Lerner
- Division of Neuroradiology, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Max Wintermark
- Neuroradiology Section, Department of Radiology, Stanford University School of Medicine, Stanford, CA, United States
| | - Jeffrey Bruce Rykken
- Department of Radiology, University of Minnesota, School of Medicine, Minneapolis, MN, United States
| | - Bo Gao
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
- *Correspondence: Bo Gao
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24
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Anderson RC, Patel V, Sheikh-Bahaei N, Liu CSJ, Rajamohan AG, Shiroishi MS, Kim PE, Go JL, Lerner A, Acharya J. Posterior Reversible Encephalopathy Syndrome (PRES): Pathophysiology and Neuro-Imaging. Front Neurol 2020; 11:463. [PMID: 32612567 PMCID: PMC7308488 DOI: 10.3389/fneur.2020.00463] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 04/29/2020] [Indexed: 12/18/2022] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) represents a unique clinical entity with non-specific clinical symptoms and unique neuroradiological findings. This syndrome may present with a broad range of clinical symptoms from headache and visual disturbances to seizure and altered mentation. Typical imaging findings include posterior-circulation predominant vasogenic edema. Although there are many well-documented diseases associated with PRES, the exact pathophysiologic mechanism has yet to be fully elucidated. Generally accepted theories revolve around disruption of the blood-brain barrier secondary to elevated intracranial pressures or endothelial injury. In this article, we will review the clinical, typical, and atypical radiological features of PRES, as well as the most common theories behind the pathophysiology of PRES. Additionally, we will discuss some of the treatment strategies for PRES related to the underlying disease state.
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Affiliation(s)
- Redmond-Craig Anderson
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Vishal Patel
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Nasim Sheikh-Bahaei
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Chia Shang J Liu
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Anandh G Rajamohan
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Mark S Shiroishi
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Paul E Kim
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - John L Go
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Alexander Lerner
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Jay Acharya
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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Agardh D, Matthias T, Wusterhausen P, Neidhöfer S, Heller A, Lerner A. Antibodies against neo-epitope of microbial and human transglutaminase complexes as biomarkers of childhood celiac disease. Clin Exp Immunol 2020; 199:294-302. [PMID: 31663117 PMCID: PMC7008223 DOI: 10.1111/cei.13394] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2019] [Indexed: 12/19/2022] Open
Abstract
Tissue transglutaminase (tTG) and microbial transglutaminase (mTG) cross-link gliadins to form complexes that expose immunogenic neo-epitopes to produce tTG and mTG-neo-epitope antibodies. The aim of this study was to test the diagnostic performance of antibodies against non-complexed and complexed forms of transglutaminases, to correlate their activities to the intestinal damage and to explore age group dependency in celiac disease (CD). A total of 296 children with untreated CD and 215 non-celiac disease controls were checked by in-house enzyme-linked immunosorbent assays detecting immunoglobulin (Ig)A, IgG or combined detection of IgA and IgG (check) against tTG, AESKULISA® tTG New Generation (tTG-neo) and mTG-neo (RUO), IgA and IgG antibodies against deamidated gliadin peptide (DGP) and human IgA anti-endomysium antibodies (EMA) using AESKUSLIDES® EMA. Intestinal pathology was graded according the revised Marsh criteria, and age dependencies of the antibody activities were analysed. Using cut-offs estimated from receiver operating characteristic (ROC) curves, the highest area under curve (AUC) of the TG assays was 0·963 for tTG-neo check, followed by tTG check (0·962) when the diagnosis was based on enteric mucosal histology. tTG-neo check was the most effective to reflect the intestinal abnormalities in CD (r = 0·795, P < 0·0001). High levels of anti-mTG-neo IgG and anti-tTG-neo IgG appeared in the earlier age groups, as compared to anti-tTG IgG (P < 0·001). Considering antibody diagnostic performance based on AUC, enteric damage reflection and predictability at an early age, the anti-neo tTG check was the most effective diagnostic biomarker for pediatric CD. The mTG neo check might represent a new marker for CD screening, diagnosis and predictability.
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Affiliation(s)
- D. Agardh
- Diabetes and Celiac Disease UnitDepartment of Clinical SciencesLund UniversityMalmöSweden
- Department of PediatricsSkåne University HospitalMalmöSweden
| | | | | | | | - A. Heller
- AESKU.KIPP InstituteWendelsheimGermany
| | - A. Lerner
- AESKU.KIPP InstituteWendelsheimGermany
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26
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Makrinou E, Drong AW, Christopoulos G, Lerner A, Chapa-Chorda I, Karaderi T, Lavery S, Hardy K, Lindgren CM, Franks S. Genome-wide methylation profiling in granulosa lutein cells of women with polycystic ovary syndrome (PCOS). Mol Cell Endocrinol 2020; 500:110611. [PMID: 31600550 PMCID: PMC7116598 DOI: 10.1016/j.mce.2019.110611] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 08/20/2019] [Accepted: 10/04/2019] [Indexed: 02/08/2023]
Abstract
Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder amongst women of reproductive age, whose aetiology remains unclear. To improve our understanding of the molecular mechanisms underlying the disease, we conducted a genome-wide DNA methylation profiling in granulosa lutein cells collected from 16 women suffering from PCOS, in comparison to 16 healthy controls. Samples were collected by follicular aspiration during routine egg collection for IVF treatment. Study groups were matched for age and BMI, did not suffer from other disease and were not taking confounding medication. Comparing women with polycystic versus normal ovarian morphology, after correcting for multiple comparisons, we identified 106 differentially methylated CpG sites with p-values <5.8 × 10-8 that were associated with 88 genes, several of which are known to relate either to PCOS or to ovarian function. Replication and validation of the experiment was done using pyrosequencing to analyse six of the identified differentially methylated sites. Pathway analysis indicated potential disruption in canonical pathways and gene networks that are, amongst other, associated with cancer, cardiogenesis, Hedgehog signalling and immune response. In conclusion, these novel findings indicate that women with PCOS display epigenetic changes in ovarian granulosa cells that may be associated with the heterogeneity of the disorder.
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Affiliation(s)
- E Makrinou
- Imperial College London, Faculty of Medicine, Institute of Reproductive and Developmental Biology, London, W12 0NN, UK.
| | - A W Drong
- Big Data Institute at the Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, OX3 7LF, UK
| | - G Christopoulos
- IVF Unit, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, W12 0NN, UK
| | - A Lerner
- Imperial College London, Faculty of Medicine, Institute of Reproductive and Developmental Biology, London, W12 0NN, UK
| | - I Chapa-Chorda
- Imperial College London, Faculty of Medicine, Institute of Reproductive and Developmental Biology, London, W12 0NN, UK
| | - T Karaderi
- Wellcome Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK; Department of Biological Sciences, Faculty of Arts and Sciences, Eastern Mediterranean University, Famagusta, Cyprus
| | - S Lavery
- IVF Unit, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, W12 0NN, UK
| | - K Hardy
- Imperial College London, Faculty of Medicine, Institute of Reproductive and Developmental Biology, London, W12 0NN, UK
| | - C M Lindgren
- Big Data Institute at the Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, OX3 7LF, UK; Wellcome Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
| | - S Franks
- Imperial College London, Faculty of Medicine, Institute of Reproductive and Developmental Biology, London, W12 0NN, UK
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Wang Q, Huang B, Shen G, Zeng Y, Chen Z, Lu C, Lerner A, Gao B. Blood-Brain Barrier Disruption as a Potential Target for Therapy in Posterior Reversible Encephalopathy Syndrome: Evidence From Multimodal MRI in Rats. Front Neurol 2019; 10:1211. [PMID: 31849806 PMCID: PMC6901929 DOI: 10.3389/fneur.2019.01211] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 10/30/2019] [Indexed: 12/16/2022] Open
Abstract
Background: To explore blood-brain barrier disruption in hypertensive posterior reversible encephalopathy syndrome. Methods: The hypertension rat models were successfully established and scanned on 7T micro-MRI. MRI parameter maps including apparent diffusion coefficient, T1 value, and perfusion metrics such as cerebral blood volume, cerebral blood flow, mean transit time and time to peak maps, were calculated. Results: The ADC values of the experimental group were higher than those of the control group both in cortical (P < 0.01) and subcortical (P < 0.05) regions. Voxel-wise analysis of ADC maps localized vasogenic edema primarily to the posterior portion of the brain. The increase in cerebral blood volume and cerebral blood flow values were found in the cortical and subcortical regions of rats with acute hypertension. No correlation was found between perfusion metrics and mean arterial pressure. The Evans blue dye content was higher in the posterior brain region than the anterior one (P < 0.05). Conclusions: Cerebral vasogenic edema resulting from acute hypertension supports the hypothesis of posterior reversible encephalopathy syndrome as the result of blood-brain barrier disruption, which maybe the potential therapeutic target for intervention.
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Affiliation(s)
- Quanlai Wang
- Department of Imaging, Zhoukou Central Hospital, Zhoukou, China.,Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Bin Huang
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Guiquan Shen
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Yu Zeng
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Zheng Chen
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Chunqiang Lu
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Southeast University, Nanjing, China
| | - Alexander Lerner
- Division of Neuroradiology, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Bo Gao
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
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28
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Song L, Lyu C, Shen G, Guo T, Wang J, Wang W, Qiu X, Lerner A, Wintermark M, Gao B. Application of FLAIR Vascular Hyperintensity-DWI Mismatch in Ischemic Stroke Depending on Semi-Quantitative DWI-Alberta Stroke Program Early CT Score. Front Neurol 2019; 10:994. [PMID: 31611838 PMCID: PMC6776088 DOI: 10.3389/fneur.2019.00994] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 09/02/2019] [Indexed: 02/06/2023] Open
Abstract
Objective: Diffusion-weighted imaging (DWI)-Alberta Stroke Program Early CT Score (ASPECTS) is a simple, widely used method to estimate the size of the infarct. Our aim is to determine whether there is a relationship between DWI-ASPECTS and fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH)-DWI mismatch and to better quantify FVH-DWI mismatch to assess the prognosis of cerebral infarction. Materials and Methods: A retrospective analysis of 109 patients with MCA stenosis or occlusion with cerebral infarction was performed by dividing this cohort into FVH-DWI match group and FVH-DWI mismatch group based on FVH and DWI results. The clinical and imaging data of these two groups of patients were reviewed and analyzed to identify associations between FVH-DWI mismatch and prognosis of patients for preservation of neurological function. Correlation between DWI-ASPECTS and FVH-DWI mismatch was also performed. Results: FVH-DWI mismatch was present in 66/109 (60.55%) patients, and FVH-DWI match was present in 43/109 (39.45%). Patients with FVH-DWI mismatch had higher DWI-ASPECTS (7.0 vs. 4.0, P < 0.001) and lower mRS at 3 months (3.0 vs. 4.0, P < 0.001) than patients without FVH-DWI mismatch. Multiple regression analysis suggested that DWI-ASPECTS (OR = 4.7, 95% CI = 2.5–9.2, P < 0.001) remained significantly associated with FVH-DWI mismatch. Two threshold points for DWI-ASPECTS of 3 and 8 can be used to distinguish whether there is a mismatch in FVH-DWI by smooth curve fitting. Conclusions: The DWI-ASPECTS score was an independent predictor of FVH-DWI mismatch. At DWI-ASPECTS ≤ 3, the FVH-DWI mismatch offers no prognostic value; whereas, at DWI-ASPECTS ≥ 8, the FVH-DWI mismatch had the highest prognostic value. DWI-ASPECTS can roughly determine whether there is a FVH-DWI mismatch in order to select optimal clinical treatment and accurately assess prognosis.
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Affiliation(s)
- Lei Song
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Department of Radiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Cui Lyu
- Healthcare Examination Center, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Guiquan Shen
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Tingting Guo
- Department of Radiology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Jiangtao Wang
- Department of Radiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Wanbi Wang
- Department of Radiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Xiaoming Qiu
- Department of Radiology, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Huangshi, China
| | - Alexander Lerner
- Division of Neuroradiology, Department of Radiology, Keck School of Medicine University of Southern California, Los Angeles, CA, United States
| | - Max Wintermark
- Neuroradiology Section, Department of Radiology, Stanford University School of Medicine, Stanford, CA, United States
| | - Bo Gao
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
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Barisano G, Bigjahan B, Metting S, Cen S, Amezcua L, Lerner A, Toga AW, Law M. Signal Hyperintensity on Unenhanced T1-Weighted Brain and Cervical Spinal Cord MR Images after Multiple Doses of Linear Gadolinium-Based Contrast Agent. AJNR Am J Neuroradiol 2019; 40:1274-1281. [PMID: 31345942 DOI: 10.3174/ajnr.a6148] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 06/06/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The clinical implications of gadolinium deposition in the CNS are not fully understood, and it is still not known whether gadolinium tends to be retained more in the brain compared with the spinal cord. In this study, we assessed the effects of linear gadolinium-based contrast agents on the T1 signal intensity of 3 cerebral areas (dentate nucleus, globus pallidus, and the less studied substantia nigra) and the cervical spinal cord in a population of patients with MS. MATERIALS AND METHODS A single-center population of 100 patients with MS was analyzed. Patients underwent 2-16 contrast-enhanced MRIs. Fifty patients received ≤5 linear gadolinium injections, and 50 patients had ≥6 injections: Fifty-two patients had both Gd-DTPA and gadobenate dimeglumine injections, and 48 patients received only gadobenate dimeglumine. A quantitative analysis of signal intensity changes was independently performed by 2 readers on the first and last MR imaging scan. The globus pallidus-to-thalamus, substantia nigra-to-midbrain, dentate nucleus-to-middle cerebellar peduncle, and the cervical spinal cord-to-pons signal intensity ratios were calculated. RESULTS An increase of globus pallidus-to-thalamus (mean, +0.0251 ± 0.0432; P < .001), dentate nucleus-to-middle cerebellar peduncle (mean, +0.0266 ± 0.0841; P = .002), and substantia nigra-to-midbrain (mean, +0.0262 ± 0.0673; P < .001) signal intensity ratios after multiple administrations of linear gadolinium-based contrast agents was observed. These changes were significantly higher in patients who received ≥6 injections (P < .001) and positively correlated with the number of injections and the accumulated dose of contrast. No significant changes were detected in the spinal cord (mean, +0.0008 ± 0.0089; P = .400). CONCLUSIONS Patients with MS receiving ≥6 linear gadolinium-based contrast agent injections showed a significant increase in the signal intensity of the globus pallidus, dentate nucleus, and substantia nigra; no detectable changes were observed in the cervical spinal cord.
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Affiliation(s)
- G Barisano
- From the Department of Radiology (G.B., B.B., S.M., S.C., A.L., M.L.) .,Stevens Neuroimaging and Informatics Institute (G.B., B.B., A.W.T., M.L.)
| | - B Bigjahan
- From the Department of Radiology (G.B., B.B., S.M., S.C., A.L., M.L.).,Stevens Neuroimaging and Informatics Institute (G.B., B.B., A.W.T., M.L.)
| | - S Metting
- From the Department of Radiology (G.B., B.B., S.M., S.C., A.L., M.L.)
| | - S Cen
- From the Department of Radiology (G.B., B.B., S.M., S.C., A.L., M.L.)
| | - L Amezcua
- Department of Neurology (L.A.), Keck School of Medicine, University of Southern California, Los Angeles, California
| | - A Lerner
- From the Department of Radiology (G.B., B.B., S.M., S.C., A.L., M.L.)
| | - A W Toga
- Stevens Neuroimaging and Informatics Institute (G.B., B.B., A.W.T., M.L.)
| | - M Law
- From the Department of Radiology (G.B., B.B., S.M., S.C., A.L., M.L.).,Stevens Neuroimaging and Informatics Institute (G.B., B.B., A.W.T., M.L.)
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31
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Lerner A, Owens LA, Coates M, Simpson C, Poole G, Velupillai J, Liyanage M, Christopoulos G, Lavery S, Hardy K, Franks S. Expression of genes controlling steroid metabolism and action in granulosa-lutein cells of women with polycystic ovaries. Mol Cell Endocrinol 2019; 486:47-54. [PMID: 30802529 DOI: 10.1016/j.mce.2019.02.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/15/2019] [Accepted: 02/18/2019] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Aberrant function of granulosa cells has been implicated in the pathophysiology of PCOS. MATERIALS & METHODS Granulosa lutein (GL) cells were collected during oocyte retrieval for IVF/ICSI. RT-qPCR was used to compare gene expression between 12 control women, 12 with ovulatory PCO and 12 with anovulatory PCOS. To examine which genes are directly regulated by androgens, GL cells from an additional 12 control women were treated in-vitro with 10 nM dihydrotestosterone (DHT). RESULTS GL cells from women with PCOS showed reduced expression of CYP11A1 3-fold (p = 0.005), HSD17B1 1.8-fold (p = 0.02) and increased expression of SULT1E1 7-fold (p = 0.0003). Similar results were seen in ovulatory women with PCO. GL cells treated with 10 nM DHT showed a 4-fold (p = 0.03) increase in expression of SULT1E1 and a 5-fold reduction in SRD5A1 (p = 0.03). CONCLUSIONS These findings support the notion that aberrant regulation of steroid metabolism or action play a part in ovarian dysfunction in PCOS.
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Affiliation(s)
- A Lerner
- Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Hospital, London, UK
| | - L A Owens
- Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Hospital, London, UK.
| | - M Coates
- Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Hospital, London, UK
| | - C Simpson
- Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Hospital, London, UK
| | - G Poole
- Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Hospital, London, UK
| | - J Velupillai
- Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Hospital, London, UK
| | - M Liyanage
- Wolfson Fertility Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - G Christopoulos
- Wolfson Fertility Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - S Lavery
- Wolfson Fertility Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - K Hardy
- Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Hospital, London, UK
| | - S Franks
- Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Hospital, London, UK
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Lerner A, Akers C, Forgenie J, Muneer A, Alifrangis C, Mitra A. Adjuvant Radiotherapy in the Management of High Risk Penile Cancer – Outcomes from a Single Institution. Clin Oncol (R Coll Radiol) 2019. [DOI: 10.1016/j.clon.2018.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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33
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Owens LA, Abbara A, Lerner A, O'floinn S, Christopoulos G, Khanjani S, Islam R, Hardy K, Hanyaloglu AC, Lavery SA, Dhillo WS, Franks S. The direct and indirect effects of kisspeptin-54 on granulosa lutein cell function. Hum Reprod 2019; 33:292-302. [PMID: 29206944 DOI: 10.1093/humrep/dex357] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 11/13/2017] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION What are the in vivo and in vitro actions of kisspeptin-54 on the expression of genes involved in ovarian reproductive function, steroidogenesis and ovarian hyperstimulation syndrome (OHSS) in granulosa lutein (GL) cells when compared with traditional triggers of oocyte maturation? SUMMARY ANSWER The use of kisspeptin-54 as an oocyte maturation trigger augmented expression of genes involved in ovarian steroidogenesis in human GL cells including, FSH receptor (FSHR), LH/hCG receptor (LHCGR), steroid acute regulatory protein (STAR), aromatase, estrogen receptors alpha and beta (ESR1, ESR2), 3-beta-hydroxysteroid dehydrogenase type 2 (3BHSD2) and inhibin A (INHBA), when compared to traditional maturation triggers, but did not alter markers of OHSS. WHAT IS KNOWN ALREADY hCG is the most widely used trigger of oocyte maturation, but is associated with an increased risk of OHSS. The use of GnRH agonists to trigger oocyte maturation is a safer alternative to hCG. More recently, kisspeptin-54 has emerged as a novel therapeutic option that safely triggers oocyte maturation even in women at high risk of OHSS. Kisspeptin indirectly stimulates gonadotropin secretion by acting on hypothalamic GnRH neurons. Kisspeptin and its receptor are also expressed in the human ovary, but there is limited data on the direct action of kisspeptin on the ovary. STUDY DESIGN SIZE, DURATION Forty-eight women undergoing IVF treatment for infertility consented to kisspeptin-54 triggering and/or granulosa cell collection and were included in the study. Twelve women received hCG, 12 received GnRH agonist and 24 received kisspeptin-54 to trigger oocyte maturation. In the kisspeptin-54 group, 12 received one injection of kisseptin-54 (9.6 nmol/kg) and 12 received two injections of kisspeptin-54 at a 10 h interval (9.6 nmol/kg × 2). PARTICIPANTS/MATERIALS, SETTING, METHODS Follicular fluid was aspirated and pooled from follicles during the retrieval of oocytes for IVF/ICSI. GL cells were isolated and either RNA extracted immediately or cultured in vitro ± kisspeptin or hCG. MAIN RESULTS AND THE ROLE OF CHANCE GL cells from women who had received kisspeptin-54 had a 14-fold and 8-fold higher gene expression of FSHR and a 2-fold (ns) and 2.5-fold (P < 0.05) higher expression of LHCGR than GL cells from women who had received hCG or GnRH agonist, respectively. CYP19A1 expression was 3.6-fold (P < 0.05) and 4.5-fold (P < 0.05) higher, STAR expression was 3.4-fold (P < 0.01) and 1.8-fold (P < 0.05) higher, HSD3B2 expression was 7.5- (P < 0.01) and 2.5-fold higher (P < 0.05), INHBA was 2.5-fold (P < 0.01) and 2.5-fold (P < 0.01) higher in GL cells from women who had received kisspeptin-54 than hCG or GnRHa, respectively. ESR1 (P < 0.05) and ESR2 (P < 0.05) both showed 3-fold higher expression in cells from kisspeptin treated than GnRHa treated women. Markers of vascular permeability and oocyte growth factors were unchanged (VEGFA, SERPINF1, CDH5, amphiregulin, epiregulin). Gene expression of kisspeptin receptor was unchanged. Whereas treating GL cells in vitro with hCG induced steroidogenic gene expression, kisspeptin-54 had no significant direct effects on either OHSS genes or steroidogenic genes. LIMITATIONS REASONS FOR CAUTION Most women in the study had PCOS, which may limit applicability to other patient groups. For the analysis of the in vitro effects of kisspeptin-54, it is important to note that GL cells had already been exposed in vivo to an alternate maturation trigger. WIDER IMPLICATIONS OF THE FINDINGS The profile of serum gonadotropins seen with kisspeptin administration compared to other triggers more closely resemble that of the natural cycle as compared with hCG. Thus, kisspeptin could potentially permit an ovarian environment augmented for steroidogenesis, in particular progesterone synthesis, which is required for embryo implantation. STUDY FUNDING/COMPETING INTEREST(S) Dr Owens is supported by an Imperial College London PhD Scholarship. Dr Abbara is supported by an National Institute of Health Research Academic Clinical Lectureship. The authors do not have any conflict of interest to declare. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT01667406.
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Affiliation(s)
- L A Owens
- Institute of Reproductive and Developmental Biology, Hammersmith Hospital, Imperial College, Du Cane Road, London W12 0NN, UK
| | - A Abbara
- Department of Investigative Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK
| | - A Lerner
- Institute of Reproductive and Developmental Biology, Hammersmith Hospital, Imperial College, Du Cane Road, London W12 0NN, UK
| | - S O'floinn
- Institute of Reproductive and Developmental Biology, Hammersmith Hospital, Imperial College, Du Cane Road, London W12 0NN, UK
| | - G Christopoulos
- Department of Reproductive Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, UK
| | - S Khanjani
- Department of Reproductive Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, UK
| | - R Islam
- Department of Reproductive Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, UK
| | - K Hardy
- Institute of Reproductive and Developmental Biology, Hammersmith Hospital, Imperial College, Du Cane Road, London W12 0NN, UK
| | - A C Hanyaloglu
- Institute of Reproductive and Developmental Biology, Hammersmith Hospital, Imperial College, Du Cane Road, London W12 0NN, UK
| | - S A Lavery
- Department of Reproductive Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, UK
| | - W S Dhillo
- Department of Investigative Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK
| | - S Franks
- Institute of Reproductive and Developmental Biology, Hammersmith Hospital, Imperial College, Du Cane Road, London W12 0NN, UK
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Perrotta F, Nankivell M, Adizie J, Elshafi M, Jafri S, Maqsood U, Munavvar M, Woolhouse I, Lerner A, Evison M, Booton R, Baldwin D, Janes S, Yarmus L, Bianco A, Navani N. Performance of endobronchial ultrasound-guided transbronchial needle aspiration in PD-L1 testing in patients with NSCLC. Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30095-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Cerebrovascular complications may occur in infectious diseases in the setting of infective endocarditis, central nervous system (CNS) infections, systemic bacteremia and sepsis. Cerebrovascular complications of infections include vasculitis, mycotic aneurysms, and thrombophlebitis. Infectious vasculitis of the CNS may cause cerebral hemorrhage, infarction or ischemia. Ruptured aneurysms may endanger the patient's life. Infectious thrombophlebitis may cause intracranial pressure to increase and lead to cerebral hemorrhage. These cerebrovascular complications are associated with a poor prognosis and often cause irreversible neurological deficits. Cerebrovascular events secondary to infection are not easily distinguishable from the more common cerebral infarct and non-infectious vasculitis. In addition, the clinical manifestations of cerebrovascular complications of infections are non-specific and highly variable. Therefore, early imaging, antibiotics, and anticoagulation may be lifesaving the patient's life and prevent disability. The main focus of this article is to review imaging analysis of the cerebrovascular complications of infections and imaging features that help differentiate them from non-infectious vascular diseases.
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Affiliation(s)
- Guiquan Shen
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Xudong Shen
- Department of Radiology, Enshi Central Hospital, Enshi 445000, China
| | - Wei Pu
- Department of Radiology, Guizhou Provincial People's Hospital, Guiyang 550002, China
| | - Gang Zhang
- Department of Radiology, Yantai Yuhuangding Hospital, Yantai 264000, China
| | - Alexander Lerner
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Bo Gao
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China.,Department of Radiology, Yantai Yuhuangding Hospital, Yantai 264000, China
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Chen Z, Zhang G, Lerner A, Wang AH, Gao B, Liu J. Risk factors for poor outcome in posterior reversible encephalopathy syndrome: systematic review and meta-analysis. Quant Imaging Med Surg 2018; 8:421-432. [PMID: 29928607 DOI: 10.21037/qims.2018.05.07] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The roles of clinical etiology and symptoms, imaging findings and biochemical parameters in predicting the prognosis of posterior reversible encephalopathy syndrome (PRES) have not been well-characterized. We perform a meta-analysis of all published studies to assess the value of various risk factors in predicting the prognosis of PRES. Methods Searches of the PubMed, EMBASE, Cochrane Library, and Web of Science databases were performed to identify the eligible studies. The odds ratios (ORs) with their corresponding 95% confidence interval (CI) for related risk factors were used to calculate the pooled estimates of the outcomes. Results Six studies with 448 cases were included in the meta-analysis. Hemorrhage was associated with high risk for poor outcome in patients with PRES. Toxemia of pregnancy (pre-eclampsia/eclampsia) was associated with improved outcome in PRES patients. Cytotoxic edema was noted to be related to poor outcome, but did not show statistical significance. The pooled OR for hemorrhage, pre-eclampsia/eclampsia, cytotoxic edema was 4.93 (95% CI: 3.94-6.17; P<0.00001), 0.24 (95% CI: 0.15-0.40; P<0.00001) and 2.59 (95% CI: 0.84-7.99; P=0.10), respectively. Conclusions PRES patients with hemorrhage or cytotoxic edema are likely to have poor outcomes. Pre-eclampsia/eclampsia is associated with reduced risk of poor outcome in patients with PRES.
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Affiliation(s)
- Zheng Chen
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China.,Department of Radiology, Yantai Yuhuangding Hospital, Yantai 264000, China
| | - Gang Zhang
- Department of Radiology, Yantai Yuhuangding Hospital, Yantai 264000, China
| | - Alexander Lerner
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - An-Hui Wang
- Department of Epidemiology, School of Public Health, The Fourth Military Medical University, Xi'an 710032, China
| | - Bo Gao
- Department of Radiology, Yantai Yuhuangding Hospital, Yantai 264000, China
| | - Jie Liu
- Department of Neurosurgery, Yantai Yuhuangding Hospital, Yantai 264000, China
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Abstract
In 2016, World Health Organization announced Zika virus infection and its neurological sequalae are a public health emergency of global scope. Preliminary studies have confirmed a relationship between Zika virus infection and certain neurological disorders, including microcephaly and Guillain–Barre syndrome (GBS). The neuroimaging features of microcephaly secondary to Zika virus infection include calcifications at the junction of gray–white matter and subcortical white matter with associated cortical abnormalities, diminution of white matter, large ventricles with or without hydrocephalus, cortical malformations, hypoplasia of cerebellum and brainstem, and enlargement of cerebellomedullary cistern. Contrast enhancement of the cauda equine nerve roots is the typical neuroimaging finding of GBS associated with Zika virus. This review describes the nervous system disorders and associated imaging findings seen in Zika virus infection, with the aim to improve the understanding of this disease. Imaging plays a key role on accurate diagnosis and prognostic evaluation of this disease.
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Affiliation(s)
- Shanshan Wu
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Department of Radiology, Yantai Yuhuangding Hospital, Yantai, China
| | - Yu Zeng
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Alexander Lerner
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Bo Gao
- Department of Radiology, Yantai Yuhuangding Hospital, Yantai, China
| | - Meng Law
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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Gao B, Lyu C, Lerner A, McKinney AM. Controversy of posterior reversible encephalopathy syndrome: what have we learnt in the last 20 years? J Neurol Neurosurg Psychiatry 2018; 89:14-20. [PMID: 28794149 DOI: 10.1136/jnnp-2017-316225] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 07/03/2017] [Accepted: 07/03/2017] [Indexed: 11/03/2022]
Abstract
Over two decades have passed since posterior reversible encephalopathy syndrome (PRES) was first described in 1996. It has becoming increasingly recognised because of improved and more readily available imaging modality. The exact pathophysiological mechanism is not completely understood and remains controversial at present. Precise diagnosis is essential to guide prompt, proper management. Our ability of differentiating it from other acute neurological disorders is likely to improve as we learnt more about the spectrum of this entity in the last 20 years. We emphasise the importance of recognising its diagnostic criteria and biomarker, which would be of great relevance to either outcome evaluation or study design. PRES has a favourable prognosis generally, but neurological sequelae and even fatalities can occur, especially in severe forms that might cause substantial morbidity and even mortality, particularly when the syndrome is complicated by intracranial haemorrhage or brain infarction. In this review, the pathophysiology, approach to diagnosis, some controversies as to the prognosis, as well as the future research direction of PRES are described.
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Affiliation(s)
- Bo Gao
- Department of Radiology, Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Cui Lyu
- Department of Neurology, Yantaishan Hospital of Yantai City, Yantai, Shandong, China
| | - Alexander Lerner
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Shiroishi MS, Gupta V, Bigjahan B, Cen SY, Rashid F, Hwang DH, Lerner A, Boyko OB, Liu CSJ, Law M, Thompson PM, Jahanshad N. Brain cortical structural differences between non-central nervous system cancer patients treated with and without chemotherapy compared to non-cancer controls: a cross-sectional pilot MRI study using clinically-indicated scans. Proc SPIE Int Soc Opt Eng 2017; 10572. [PMID: 30034079 DOI: 10.1117/12.2285971] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background Cognitive deficit associated with cancer and its treatment is called cancer-related cognitive impairment (CRCI). Increases in cancer survival have made understanding the basis of CRCI more important. CRCI neuroimaging studies have traditionally used dedicated research brain MRIs in breast cancer survivors after chemotherapy with small sample sizes; little is known about other non-central nervous system (CNS) cancers after chemotherapy as well as those not exposed to chemotherapy. However, there may be a wealth of unused data from clinically-indicated MRIs that could be used to study CRCI. Objective Evaluate brain cortical structural differences in those with various non-CNS cancers using clinically-indicated MRIs. Design Cross-sectional. Patients Adult non-CNS cancer and non-cancer control (C) patients who underwent clinically-indicated MRIs. Methods Brain cortical surface area and thickness were measured using 3D T1-weighted images. An age-adjusted linear regression model was used and the Benjamini and Hochberg false discovery rate (FDR) corrected for multiple comparisons. Group comparisons were: cancer cases with chemotherapy (Ch+), cancer cases without chemotherapy (Ch-) and subgroup of lung cancer cases with and without chemotherapy vs C. Results Sixty-four subjects were analyzed: 22 Ch+, 23 Ch- and 19 C patients. Subgroup analysis of 16 lung cancer (LCa) patients was also performed. Statistically significant decreases in either cortical surface area or thickness were found in multiple regions of interest (ROIs) primarily within the frontal and temporal lobes for all comparisons. Effect sizes were variable with the greatest seen in the left middle temporal surface area ROI (Cohen's d -0.690) in the Ch- vs C group comparison. Limitations Several limitations were apparent including a small sample size that precluded adjustment for other covariates. Conclusions Our preliminary results suggest that, in addition to breast cancer, other types of non-CNS cancers treated with chemotherapy may result in brain structural abnormalities. Similar findings also appear to occur in those not exposed to chemotherapy. These results also suggest that there is potentially a wealth of untapped clinical MRIs that could be used for future CRCI studies.
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Affiliation(s)
- Mark S Shiroishi
- Imaging Genetics Center, USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, Marina del Rey, CA, USA.,Department of Radiology, Keck School of Medicine of USC, Los Angeles, CA, USA.,Southern California Clinical & Translational Science Institute, Los Angeles, CA, USA
| | - Vikash Gupta
- Imaging Genetics Center, USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, Marina del Rey, CA, USA
| | - Bavrina Bigjahan
- Department of Radiology, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Steven Y Cen
- Department of Radiology, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Faisal Rashid
- Imaging Genetics Center, USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, Marina del Rey, CA, USA
| | - Darryl H Hwang
- Department of Radiology, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Alexander Lerner
- Department of Radiology, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Orest B Boyko
- Department of Radiology, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Chia-Shang Jason Liu
- Imaging Genetics Center, USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, Marina del Rey, CA, USA
| | - Meng Law
- Department of Radiology, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Paul M Thompson
- Imaging Genetics Center, USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, Marina del Rey, CA, USA
| | - Neda Jahanshad
- Imaging Genetics Center, USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, Marina del Rey, CA, USA
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Batash R, Rubin G, Lerner A, Shehade H, Rozen N, Rothem DE. Computed navigated total knee arthroplasty compared to computed tomography scans. Knee 2017; 24:622-626. [PMID: 28400204 DOI: 10.1016/j.knee.2017.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 01/27/2017] [Accepted: 03/16/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Successful total knee arthroplasty (TKA) includes accurate alignment. Controversy remains as to whether computer-navigated TKA improves the overall result and clinical outcome. Our aim is to compare the limb alignment and prosthesis positioning according to the pre- and postoperative computed tomography (CT) scans with the data collected from the navigation system. METHODS We compared the pre- and postoperative limb alignments and prosthesis alignment provided by the Orthopilot navigation system, Aesculap®, with CT scans measured by the Traumacad® software of 70 TKAs. RESULTS A positive correlation with statistical significance (P=0.00001, r=0.874) between the navigation system data and the CT images was found. Mean femoral cut was five degrees (valgus), and mean tibial cut was one degree (varus). Our study revealed that the navigation system assisted the surgeon to implant the prosthesis at a good acceptable alignment. CONCLUSION We found that the navigation system is accurate and correlates to the pre- and postoperative CT scans. Furthermore, the navigation system can assist the surgeon to achieve good limb alignment and cutting planes of the prosthesis.
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Affiliation(s)
- Ron Batash
- Faculty of Medicine, Bar-Ilan, Zeffat, Israel
| | - Guy Rubin
- Orthopedic Department, Emek Medical Center, Afula, Israel; Faculty of Medicine, Technion, Haifa, Israel
| | - Alexander Lerner
- Faculty of Medicine, Bar-Ilan, Zeffat, Israel; Orthopedic Department, Ziv Medical Center, Zefat, Israel
| | | | - Nimrod Rozen
- Orthopedic Department, Emek Medical Center, Afula, Israel; Faculty of Medicine, Technion, Haifa, Israel
| | - David E Rothem
- Faculty of Medicine, Bar-Ilan, Zeffat, Israel; Orthopedic Department, Ziv Medical Center, Zefat, Israel.
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Grace K, Lerner A, Mikal J, Sangli G. A qualitative investigation of childbearing and seasonal hunger in peri-urban Ouagadougou, Burkina Faso. Popul Environ 2017; 38:369-380. [PMID: 29937612 PMCID: PMC6009842 DOI: 10.1007/s11111-016-0268-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Poor women who live in peri-urban communities are often faced with food insecurity due to seasonal variations in food availability and accessibility. Additionally, in these communities, fertility levels are often elevated despite geographic proximity to urban areas with low cost contraception. We conducted five focus group interviews to investigate the lived experiences of childbearing in peri-urban Ouagadougou, Burkina Faso to understand the behavioral and biological determinants of fertility outcomes. In the analysis of the interviews we pay particular attention to seasonal food insecurity experiences and the biological and behavioral determinants of childbearing. Our results suggest that there are less optimal times of year for childbearing and that poor, peri-urban women adjust their behavior accordingly. The results also suggest that there remain important barriers to contraceptive use even in cases where individuals associate pregnancy and childbearing with physical and psychological risk. This paper provides greater depth in understanding the determinants of fertility in resource-poor, peri-urban communities and points to some barriers for lowering fertility in similar areas.
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Affiliation(s)
- Kathryn Grace
- Please address all correspondence and requests for materials to corresponding author, Kathryn Grace. , 558 Social Sciences Building, 267-19 Avenue South, Minneapolis, MN 55455
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Nutman A, Lerner A, Schwartz D, Carmeli Y. Evaluation of carriage and environmental contamination by carbapenem-resistant Acinetobacter baumannii. Clin Microbiol Infect 2016; 22:949.e5-949.e7. [DOI: 10.1016/j.cmi.2016.08.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/14/2016] [Accepted: 08/15/2016] [Indexed: 10/21/2022]
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Nayyar M, Mayo MC, Shiroishi M, Commins D, Liu CY, Go JL, Kim PE, Zee CS, Law M, Lerner A. Atypical central neurocytoma with metastatic craniospinal dissemination: a case report. Clin Imaging 2016; 40:1108-1111. [DOI: 10.1016/j.clinimag.2016.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 06/09/2016] [Indexed: 11/27/2022]
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Matthias T, Jeremias P, Neidhöfer S, Lerner A. The industrial food additive, microbial transglutaminase, mimics tissue transglutaminase and is immunogenic in celiac disease patients. Autoimmun Rev 2016; 15:1111-1119. [PMID: 27640315 DOI: 10.1016/j.autrev.2016.09.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 08/03/2016] [Indexed: 12/12/2022]
Abstract
Microbial transglutaminase (mTg) is capable of cross-linking numerous molecules. It is a family member of human tissue transglutaminase (tTg), and is involved in CD. Despite declarations of the safety of mTg for industrial use, direct evidence for immunogenicity of the enzyme is lacking. The serological activity of mTg, tTg, gliadin complexed mTg (mTg neo-epitope) and gliadin complexed tTg (tTg neo-epitope) were studied in 95 pediatric celiac patients (CD), 99 normal children (NC), 79 normal adults (NA) and 45 children with nonspecific abdominal pain (AP). Sera were tested by ELISAs, detecting IgA, IgG or both IgA and IgG (check): AESKULISA® tTg (tTg), AESKULISA® tTg New Generation (tTg neo-epitope (tTg-neo)), microbial transglutaminase (mTg) and mTg neo-epitope (mTg-neo). Marsh criteria were used for the degree of intestinal injury. Parallel, mTg and tTg neo-epitopes were purified by asymmetric field flow fractionation, confirmed by multi-light-scattering and SDS-PAGE, and analyzed in adult CD and control groups by competition ELISAs. No sequence homology but active site similarity were detected on alignment of the 2 Tgs. Comparing pediatric CD patients with the 2 normal groups: mTg-neo IgA, IgG and IgA+IgG antibody activities exceed the comparable mTg ones (p<0.0001). All mTg-neo and tTg-neo levels were higher (p<0.001). tTg IgA and IgG+IgA were higher than mTg IgA and IgA+IgG (p<0.0001). The levels of tTg-neo IgA/IgG were higher than tTg IgA/IgG (p<0.0001). The sequential antibody activities best reflecting the increased intestinal damage were tTg-neo check>tTg-neo IgA≥mTg-neo IgG>tTg-neo IgG>mTg-neo check>mTg-neo IgA. Taken together, tTg-neo check, tTg-neo IgA and mTg-neo IgG correlated best with intestinal pathology (r2=0.6454, r2=0.6165, r2=0.5633; p<0.0001, p<0.0001, p<0.0001, respectively). Purified mTg-neo IgG and IgA showed an increased immunoreactivity compared to single mTg and gliadin (p<0.001) but similar immunoreactivity to the tTg-neo IgG and IgA ELISA. Using competition ELISA, the mTg neo-epitopes and tTg neo-epitopes have identical outcomes in CD sera both showing a decrease in optical density of 55±6% (p<0.0002). mTg is immunogenic in children with CD and, by complexing to gliadin, its immunogenicity is enhanced. Anti-mTg-neo-epitope IgG antibodies correlate with intestinal damage to a comparable degree as anti-tTg-neo IgA. mTg and tTg display a comparable immunopotent epitope. mTg-neo IgG is a new marker for CD. Further studies are needed to explore the pathogenic potential of anti-mTg antibodies in CD.
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Affiliation(s)
- T Matthias
- AESKU.KIPP Institute, Wendelsheim, Germany
| | - P Jeremias
- AESKU.KIPP Institute, Wendelsheim, Germany
| | | | - A Lerner
- AESKU.KIPP Institute, Wendelsheim, Germany; B. Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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Stewart T, Caffrey DG, Gilman RH, Mathai SC, Lerner A, Hernandez A, Pinto ME, Huaylinos Y, Cabrera L, Wise RA, Miranda JJ, Checkley W. Can a simple test of functional capacity add to the clinical assessment of diabetes? Diabet Med 2016; 33:1133-9. [PMID: 26599981 PMCID: PMC4955604 DOI: 10.1111/dme.13032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2015] [Indexed: 01/06/2023]
Abstract
AIM To identify impairment in functional capacity associated with complicated and non-complicated diabetes using the 6-min walk distance test. METHODS We enrolled 111 adults, aged ≥40 years, with Type 2 diabetes from a hospital facility and 150 healthy control subjects of similar age and sex from a community site in Lima, Peru. All participants completed a 6-min walk test. RESULTS The mean age of the 261 participants was 58.3 years, and 43.3% were male. Among those with diabetes, 67 (60%) had non-complicated diabetes and 44 (40%) had complications such as peripheral neuropathy, retinopathy or nephropathy. The mean unadjusted 6-min walk distances were 376 m and 394 m in adults with and without diabetes complications, respectively, vs 469 m in control subjects (P<0.001). In multivariable regression, the subjects with diabetes complications walked 84 m less far (95% CI -104 to -63 m) and those without complications walked 60 m less far (-77 to -42 m) than did control subjects. When using HbA1c level as a covariate in multivariable regression, participants walked 13 m less far (-16.9 to -9.9 m) for each % increase in HbA1c . CONCLUSIONS The subjects with diabetes had lower functional capacity compared with healthy control subjects with similar characteristics. Differences in 6-min walk distance were even apparent in the subjects without diabetes complications. Potential mechanisms that could explain this finding are early cardiovascular disease or deconditioning.
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Affiliation(s)
- T Stewart
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - D G Caffrey
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - R H Gilman
- Program in Disease Control and Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- A.B. PRISMA, Lima, Peru
| | - S C Mathai
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - A Lerner
- Program in Disease Control and Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - A Hernandez
- Division of Endocrinology, Department of Medicine, Hospital Nacional Cayetano Heredia, Lima, Peru
| | - M E Pinto
- Division of Endocrinology, Department of Medicine, Hospital Nacional Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Y Huaylinos
- Division of Endocrinology, Department of Medicine, Hospital Nacional Cayetano Heredia, Lima, Peru
| | | | - R A Wise
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - J J Miranda
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - W Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Program in Disease Control and Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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46
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Affiliation(s)
- A. Lerner
- ACETO Chemical Company 126-02 Northern Blvd. Flushing, NY 11368
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47
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Affiliation(s)
- B Gao
- Department of Radiology Yantai Yuhuangding Hospital Qingdao University Yantai, Shandong, China Department of Radiology Keck School of Medicine University of Southern California Los Angeles, California
| | - A Lerner
- Department of Radiology Keck School of Medicine University of Southern California Los Angeles, California
| | - M Law
- Department of Radiology Keck School of Medicine University of Southern California Los Angeles, California
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Abstract
The clinical decision-making process for patients with severe trauma of the extremities for primary amputation or to initiate extensive reconstructive measures for limb salvage in the best interests of the patient can be complex and difficult. The many factors influencing the decision-making process, such as local anatomical, pathomechanical, physiological, psychosocial and general factors are demonstrated and discussed. In the past, the role of scores supporting the decision-making process for amputation or limb salvage has been overestimated. In the LEAP study it could clearly be demonstrated that none of the sometimes highly complex scores could fulfill the expectations to predict successful limb salvage or the need for amputation. In this article it is shown that initiators and authors of scores achieved much higher sensitivity and specificity in the inaugural studies compared to the standardized and controlled conditions used in the LEAP study. For a long time, a lack of feeling in the feet was considered a safe and reliable criterion for amputation but the LEAP study has made a substantial contribution to demythologizing this as a lead symptom. Patients with severe trauma of the ankle or foot requiring a free flap or ankle arthrodesis have a significantly worse outcome compared to patients with a below knee amputation. Taking all these influencing factors into consideration, a comprehensive algorithm is presented that facilitates, strengthens and standardizes decision-making for amputation or limb salvage. This algorithm consists of four modules: 1) decision-making, 2) emergency treatment, 3) definitive treatment and 4) fine tuning. In the decision-making module not only local and general injury severity are addressed but the expected result, the general condition, comorbidities, compliance and the will of the patient are also included.
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Affiliation(s)
- C Krettek
- Unfallchirurgische Klinik, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - A Lerner
- Department of Orthopedic Surgery, Ziv Medical Center, Rambam st. Zefat, 13100, Zefat, Israel
| | - P Giannoudis
- Department of Trauma & Orthopaedic Surgery, School of Medicine, University of Leeds, Leeds, UK
| | - C Willy
- Abteilung Unfallchirurgie und Orthopädie, Septisch-Rekonstruktive Chirurgie, Bundeswehrkrankenhaus Berlin, Scharnhorststr. 13, 10115, Berlin, Deutschland
| | - C W Müller
- Unfallchirurgische Klinik, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
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Basu T, Bao P, Lerner A, Anderson L, Page K, Stanczyk F, Mishell D, Segall-Gutierrez P. The Effect of Depo Medroxyprogesterone Acetate (DMPA) on Cerebral Food Motivation Centers: A Pilot Study using Functional Magnetic Resonance Imaging. Contraception 2016; 94:321-7. [PMID: 27129935 DOI: 10.1016/j.contraception.2016.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 04/12/2016] [Accepted: 04/15/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The primary objective is to examine activation of food motivation centers in the brain before and 8 weeks after depo medroxyprogesterone acetate (DMPA) administration. STUDY DESIGN This prospective experimental pilot study examined the effects of DMPA on food motivation centers utilizing functional magnetic resonance imaging (fMRI) in eight nonobese, ovulatory subjects. fMRI blood oxygen level dependent (BOLD) signal was measured using a 3-Tesla Scanner while participants viewed images of high-calorie foods, low-calorie foods and nonfood objects. fMRI scans were performed at baseline and 8 weeks after participants received one intramuscular dose of DMPA 150 mg. fMRI data were analyzed using the FMRIB Software Library. Changes in adiposity and circulating leptin and ghrelin levels were also measured. RESULTS There was a greater BOLD signal response to food cues in brain regions associated with food motivation (anterior cingulate gyrus, orbitofrontal cortex) 8 weeks after DMPA administration compared to baseline (z>2.3, p<.05 whole-brain analysis clustered corrected). No statistically significant change was detected in circulating leptin or ghrelin levels or fat mass 8 weeks after DMPA administration. CONCLUSION Analysis of differences in food motivation may guide the development of interventions to prevent weight gain in DMPA users. IMPLICATIONS These data support a neural origin as one of the mechanisms underlying weight gain in DMPA users and may guide future research examining weight gain and contraception.
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Affiliation(s)
- Tania Basu
- Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine
| | - Pinglei Bao
- Department of Neuroscience, University of Southern California
| | - Alexander Lerner
- Department of Radiology, University of Southern California Keck School of Medicine
| | - Lindsey Anderson
- Divison of Biokinesiology and Physical Therapy, University of Southern California
| | - Kathleen Page
- Department of Internal Medicine, University of Southern California Keck School of Medicine
| | - Frank Stanczyk
- Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine
| | - Daniel Mishell
- Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine
| | - Penina Segall-Gutierrez
- Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine
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Shiroishi MS, Cen SY, Tamrazi B, D'Amore F, Lerner A, King KS, Kim PE, Law M, Hwang DH, Boyko OB, Liu CSJ. Predicting Meningioma Consistency on Preoperative Neuroimaging Studies. Neurosurg Clin N Am 2016; 27:145-54. [PMID: 27012379 DOI: 10.1016/j.nec.2015.11.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This article provides an overview of the neuroimaging literature focused on preoperative prediction of meningioma consistency. A validated, noninvasive neuroimaging method to predict tumor consistency can provide valuable information regarding neurosurgical planning and patient counseling. Most of the neuroimaging literature indicates conventional MRI using T2-weighted imaging may be helpful to predict meningioma consistency; however, further rigorous validation is necessary. Much less is known about advanced MRI techniques, such as diffusion MRI, MR elastography (MRE), and MR spectroscopy. Of these methods, MRE and diffusion tensor imaging appear particularly promising.
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Affiliation(s)
- Mark S Shiroishi
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
| | - Steven Y Cen
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Benita Tamrazi
- Pediatric Neuroradiology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA
| | - Francesco D'Amore
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Alexander Lerner
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Kevin S King
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Paul E Kim
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Meng Law
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Darryl H Hwang
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Orest B Boyko
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Chia-Shang J Liu
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
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