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Lancaster JJ, Grijalva A, Fink J, Ref J, Daugherty S, Whitman S, Fox K, Gorman G, Lancaster LD, Avery R, Acharya T, McArthur A, Strom J, Pierce MK, Moukabary T, Borgstrom M, Benson D, Mangiola M, Pandey AC, Zile MR, Bradshaw A, Koevary JW, Goldman S. Biologically derived epicardial patch induces macrophage mediated pathophysiologic repair in chronically infarcted swine hearts. Commun Biol 2023; 6:1203. [PMID: 38007534 PMCID: PMC10676365 DOI: 10.1038/s42003-023-05564-w] [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: 02/07/2023] [Accepted: 11/09/2023] [Indexed: 11/27/2023] Open
Abstract
There are nearly 65 million people with chronic heart failure (CHF) globally, with no treatment directed at the pathologic cause of the disease, the loss of functioning cardiomyocytes. We have an allogeneic cardiac patch comprised of cardiomyocytes and human fibroblasts on a bioresorbable matrix. This patch increases blood flow to the damaged heart and improves left ventricular (LV) function in an immune competent rat model of ischemic CHF. After 6 months of treatment in an immune competent Yucatan mini swine ischemic CHF model, this patch restores LV contractility without constrictive physiology, partially reversing maladaptive LV and right ventricular remodeling, increases exercise tolerance, without inducing any cardiac arrhythmias or a change in myocardial oxygen consumption. Digital spatial profiling in mice with patch placement 3 weeks after a myocardial infarction shows that the patch induces a CD45pos immune cell response that results in an infiltration of dendritic cells and macrophages with high expression of macrophages polarization to the anti-inflammatory reparative M2 phenotype. Leveraging the host native immune system allows for the potential use of immunomodulatory therapies for treatment of chronic inflammatory diseases not limited to ischemic CHF.
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Affiliation(s)
- J J Lancaster
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - A Grijalva
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - J Fink
- Division of Blood & Marrow Transplant & Cellular Therapy, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, 55455, USA
| | - J Ref
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - S Daugherty
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - S Whitman
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - K Fox
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
- Division of Cardiothoracic Surgery, Department of Surgery, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - G Gorman
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - L D Lancaster
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - R Avery
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - T Acharya
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - A McArthur
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - J Strom
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - M K Pierce
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - T Moukabary
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - M Borgstrom
- Research & Discovery Tech, Research Computing Specialist, Principal, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - D Benson
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - M Mangiola
- Department of Pathology, NYU Grossman School of Medicine, New York City, NY, 11016, USA
| | - A C Pandey
- Section of Cardiology, Tulane University Heart and Vascular Institute, John W. Deming Department of Medicine, Section of Cardiology, Department of Medicine, Southeast Louisiana Veterans Healthcare System, Tulane University School of Medicine, New Orleans, LA, 70122, USA
| | - M R Zile
- Ralph H. Johnson VA Medical Center, Division of Cardiology, Medical University of South Carolina, Thurmond/Gazes Building, 30 Courtenay Drive, Charleston, SC, 29425, USA
| | - A Bradshaw
- Ralph H. Johnson VA Medical Center, Division of Cardiology, Medical University of South Carolina, Thurmond/Gazes Building, 30 Courtenay Drive, Charleston, SC, 29425, USA
| | - J W Koevary
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
- Biomedical Engineering, College of Engineering, University of Arizona, 1127 E. James E. Rogers Way, Tucson, AZ, 85721, USA
| | - S Goldman
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA.
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Morris CC, Ref J, Acharya S, Johnson KJ, Squire S, Acharya T, Dennis T, Daugherty S, McArthur A, Chinyere IR, Koevary JW, Hare JM, Lancaster JJ, Goldman S, Avery R. Free-breathing gradient recalled echo-based CMR in a swine heart failure model. Sci Rep 2022; 12:3698. [PMID: 35260607 PMCID: PMC8904633 DOI: 10.1038/s41598-022-07611-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 02/10/2022] [Indexed: 11/09/2022] Open
Abstract
In swine models, there are well-established protocols for creating a closed-chest myocardial infarction (MI) as well as protocols for characterization of cardiac function with cardiac magnetic resonance (CMR). This methods manuscript outlines a novel technique in CMR data acquisition utilizing smart-signal gradient recalled echo (GRE)-based array sequences in a free-breathing swine heart failure model allowing for both high spatial and temporal resolution imaging. Nine male Yucatan mini swine weighing 48.7 ± 1.6 kg at 58.2 ± 3.1 weeks old underwent the outlined imaging protocol before and 1-month after undergoing closed chest left anterior descending coronary artery (LAD) occlusion/reperfusion. The left ventricular ejection fraction (LVEF) at baseline was 59.3 ± 2.4% and decreased to 48.1 ± 3.7% 1-month post MI (P = 0.029). The average end-diastolic volume (EDV) at baseline was 55.2 ± 1.7 ml and increased to 74.2 ± 4.2 ml at 1-month post MI (P = 0.001). The resulting images from this novel technique and post-imaging analysis are presented and discussed. In a Yucatan swine model of heart failure via closed chest left anterior descending coronary artery (LAD) occlusion/reperfusion, we found that CMR with GRE-based array sequences produced clinical-grade images with high spatial and temporal resolution in the free-breathing setting.
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Affiliation(s)
- Craig C Morris
- Department of Medicine, Oregon Health and Sciences University, Portland, OR, USA
| | - Jacob Ref
- MD Program, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Satya Acharya
- Department of Chemistry and Biochemistry, University of Arizona, Tucson, AZ, USA
| | - Kevin J Johnson
- Magnetic Resonance Research Facility, University of Arizona, Tucson, AZ, USA
| | - Scott Squire
- Magnetic Resonance Research Facility, University of Arizona, Tucson, AZ, USA
| | | | - Tyler Dennis
- Department of Chemistry and Biochemistry, University of Arizona, Tucson, AZ, USA
| | | | - Alice McArthur
- Sarver Heart Center, University of Arizona, Tucson, AZ, USA
| | - Ikeotunye Royal Chinyere
- Sarver Heart Center, University of Arizona, Tucson, AZ, USA.,MD-PhD Program, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Jen Watson Koevary
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, USA
| | - Joshua M Hare
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Steven Goldman
- Sarver Heart Center, University of Arizona, Tucson, AZ, USA
| | - Ryan Avery
- Department of Radiology, Northwestern University, 676 N Saint Clair, Suite 800, Chicago, IL, 60611, USA.
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Lancaster JJ, Koevary J, Avery R, Daugherty SL, Fox K, Gorman G, LANCASTER L, McArthur A, Ref J, Grijalva A, Goldman S. Abstract MP205: Human Induced Pluripotent Stem Cell Derived Cardiomyocyte And Fibroblast Patch To Treat Heart Failure. Circ Res 2021. [DOI: 10.1161/res.129.suppl_1.mp205] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
We tested a tissue engineered (TE) patch composed of a biodegradable mesh embedded with human neonatal fibroblasts and seeded with human induced pluripotent stem cell derived cardiomyocytes (hiPSC-CMs) to treat heart failure in Yucatan mini swine receiving no immune suppression.
Methods:
Swine (N=12) underwent a 90-minute balloon occlusion/reperfusion of the left anterior descending coronary artery to create a myocardial infarction (MI). Following a 4-week recovery, the TE patch was implanted via a mini median sternotomy. The following were obtained: Cardiac Magnetic Resonance (CMR) imaging, cardiac catheterization, activity monitoring with FitBark collars, treadmill testing, 24/7 ECGs with implanted loop recorders.
Results:
At 4 weeks after MI, swine had increased left ventricular (LV) volumes, decreased end-systolic elastance (Ees), a shift of the diastolic pressure/volume (P/V) to the right of baseline and an increase in the LV mass/volume. After 6 months of treatment, the TE treated swine (N=7) compared to inert tissue treated swine (N=5): End-systolic volume (2% decrease vs 18% increase); End-diastolic volume (7% decrease vs 26% increase): Ees (1.0±0.2 vs 1.9±0.2 mmHg/mL, P=0.006); the diastolic P/V loops shifted back toward baseline with no change in slope, and LV mass decreased. There was no mortality related to treatment; the TE patch was well tolerated as assessed by CMR and histology. The loop recorders showed TE treated animals remained in sinus rhythm throughout with no ventricular arrhythmias, no change in heart rate and a 20% increase in daily activity levels and a 20% increase in exercise tolerance.
Conclusions:
This TE patch with human neonatal fibroblasts and hiPSC-CMs improves LV function, partially reverses LV remodeling and improves exercise in non-immune suppressed swine with heart failure after 6 months of treatment.
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Munn Z, McArthur A, Mander GTW, Steffensen CJ, Jordan Z. The only constant in radiography is change: A discussion and primer on change in medical imaging to achieve evidence-based practice. Radiography (Lond) 2020; 26 Suppl 2:S3-S7. [PMID: 32713823 DOI: 10.1016/j.radi.2020.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 04/17/2020] [Revised: 06/02/2020] [Accepted: 07/02/2020] [Indexed: 11/27/2022]
Abstract
Medical imaging is an ever changing field with significant advancements in techniques and technologies over the years. Despite being constantly challenged by change, it can be difficult to introduce changes into healthcare settings. In this article we introduce the principles of change management to achieve an evidence-based practice in radiography.
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Affiliation(s)
- Z Munn
- JBI, University of Adelaide, Australia.
| | | | - G T W Mander
- Dept Medical Imaging, Toowoomba Hospital, Darling Downs Health, QLD Health, Australia
| | | | - Z Jordan
- JBI, University of Adelaide, Australia
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Munn Z, McArthur A, Mander GTW, Steffensen CJ, Jordan Z. Evidence-based healthcare, knowledge translation, implementation science and radiography: What does it all mean? Radiography (Lond) 2020; 26 Suppl 2:S8-S13. [PMID: 32620353 DOI: 10.1016/j.radi.2020.05.008] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 12/30/2022]
Abstract
Evidence-based healthcare is an approach to practice whereby decision making and service delivery considers the best available evidence, patient choice, local resources and clinical expertise. Although sound in theory, compliance with evidence-based practice is often far from optimal. To address this, related fields such as knowledge translation and implementation science have emerged, which largely focus on methods and techniques to facilitate the transfer of evidence into practice. This introductory article explains the key concepts of evidence-based healthcare by using the JBI Model as a framework to highlight the lifecycle of evidence-based information. Throughout the article we refer to exemplars from medical radiation to highlight these concepts.
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Affiliation(s)
- Z Munn
- JBI, University of Adelaide, Australia.
| | | | - G T W Mander
- Dept Medical Imaging, Toowoomba Hospital, Darling Downs Health, QLD Health, Australia
| | | | - Z Jordan
- JBI, University of Adelaide, Australia
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Duggins A, Bergeron M, Tiemeyer K, Mullen L, Crisalli J, McArthur A, Ishman S. Shared-decision making tool for obstructive sleep apnea. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.240] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Soeung S, Grundy J, Kamara L, McArthur A, Samnang C. Developments in immunization planning in Cambodia--rethinking the culture and organization of national program planning. Rural Remote Health 2007; 7:630. [PMID: 17508838] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
INTRODUCTION As part of its health system reconstruction following decades of civil war, Cambodia undertook a program of health sector reform in 1996 to expand coverage of essential health services to the population of 14 million, 80% of whom are resident in over 13 000 rural villages. During this reform period, one of the major national health programs, the National Immunization Program (NIP), adapted its planning system to accommodate changes in social and health sector structure. AIMS The aims of this article are to review changes made in the approach to national immunization planning and to illustrate how these adaptations can help identify future challenges and opportunities for further improving immunization coverage in Cambodia. Sources of information for the study include immunization plans and data from international and national sources, as well as data from the national health information system. Findings of review: Management and service delivery reforms undertaken by the NIP include (1) strengthening links between immunization, health sector and international health planning; (2) development of immunization program multiyear and financial sustainability plans; (3) strengthening of national program decision making structures and processes; (4) widening of decentralized stakeholder participation in health planning; and (5) implementation of service level micro-planning. OUTCOMES These management reforms have been associated with significant improvement in public health program performance and outcomes during this period (2003-2006). There has been an increase in vaccination coverage for children under the age of one year, over a five-year period (increase of 29% for fully immunized child at one year of age), with no significant differences in vaccination rates between urban and rural areas, and a sharp decrease in the incidence of vaccine preventable diseases. CONCLUSION The NIP is now well positioned to take on additional challenges in coming years associated with expanding international partnerships, the continued development of civil society, further health system decentralization, and the requirement to further improve coverage in support of global and regional disease elimination goals. However, as costs continue to rise, planners in the future will need to emphasize the economic and public health benefits of immunization programs in order to sustain increasing levels of national and international investment.
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Affiliation(s)
- S Soeung
- National Immunization Program, Ministry of Health, Phnom Penh, Cambodia
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Matute AJ, Hak E, Schurink CAM, McArthur A, Alonso E, Paniagua M, Van Asbeck E, Roskott AM, Froeling F, Rozenberg-Arska M, Hoepelman IM. Resistance of uropathogens in symptomatic urinary tract infections in León, Nicaragua. Int J Antimicrob Agents 2004; 23:506-9. [PMID: 15120732 DOI: 10.1016/j.ijantimicag.2003.10.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2003] [Accepted: 10/31/2003] [Indexed: 11/22/2022]
Abstract
Management of urinary tract infections (UTI) in Central America and especially Nicaragua, is complicated by the lack of knowledge about the antibiotic resistance of uropathogens. We conducted a prevalence study to gain more insight into the aetiology, bacterial resistance and risk factors for symptomatic UTI in the region of León, Nicaragua. In 2002, all consecutive patients with UTI symptoms and pyuria >/=10 WBC/hpf were admitted to the study. Positive cultures from midstream urine specimens were defined as >/=10(5) cfu/ml of a single uropathogen. Susceptibility tests were performed with disc diffusion tests using the Kirby-Bauer method and broth microdilution using National Committee for Clinical Laboratory Standards criteria both in León and a reference laboratory in Utrecht. A positive culture was present in 62 of 208 study subjects (30%). Escherichia coli (56%), Klebsiella spp. (18%) and Enterobacter spp. (11%) were the most frequent pathogens isolated. Presence of cystocele, incontinence and increasing age were risk factors for bacterial UTI. E. coli was least resistant to ceftriaxone, amikacin and nitrofurantoin (>90% susceptible). We observed high resistance rates in E. coli to amoxicillin (82%, MIC(90) 128 mg/l), trimethoprim-sulphamethoxazole (TMP-SMX) (64%, MIC(90) 32 mg/l), cephalothin (58%, MIC(90), 32 mg/l), ciprofloxacin (30%; MIC(90), 32 mg/l), amoxicillin/clavulanate (21%, MIC(90) 8 mg/l) and gentamicin (12%, MIC(90) 2 mg/l). Our results suggests that community acquired uropathogens in Nicaragua are highly resistant to many antimicrobial agents. The use of amoxicillin, trimethoprim-sulphamethoxazole and cephalothin against uropathogens needs to be reconsidered. High quinolone resistance rates among E. coli in Nicaragua gives cause for great concern.
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Affiliation(s)
- A J Matute
- Department of Medicine, University Hospital, UNAN, León (L), Nicaragua
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Streckfus C, Bigler L, Dellinger T, Dai X, Cox WJ, McArthur A, Kingman A, Thigpen JT. Reliability assessment of soluble c-erbB-2 concentrations in the saliva of healthy women and men. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001; 91:174-9. [PMID: 11174594 DOI: 10.1067/moe.2001.111758] [Citation(s) in RCA: 20] [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] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The protein c-erb B-2, also known as Her2/neu, is a prognostic breast cancer marker assayed in tissue biopsy specimens from women diagnosed with malignant tumors. Current studies suggest that soluble fragments of the c-erb B-2 oncogene may be released from the cell surface and become detectable in patients with a carcinoma of the breast. Consequently, the purpose of this study is to assay soluble c-erb B-2 protein in the saliva of healthy men and women to determine the reliability of the assay. METHODS To determine the diagnostic utility of this oncogene, we assayed the soluble form of the c-erb B-2 protein in the saliva with an enzyme-linked immunosorbent assay. The study population consisted of 10 healthy women and 9 healthy men who were serially sampled for saliva 3 times a day for a 5-day period. Saliva was collected from each subject at 9 AM, 4 PM, and 9 PM during the 5-day period. RESULTS We found the presence of c-erb B-2 protein in the saliva of both groups of subjects. The salivary levels of c-erb B-2 were not significantly different when compared for gender differences. Likewise, the results suggest that sampling during various times of the day for salivary c-erb B-2 levels has no effect on marker concentration. Reliability analyses showed that supervised salivary collections were more reliable than unsupervised collections. CONCLUSIONS The results of this pilot study suggest that the assay for salivary c-erb B-2 protein is reliable and might have potential use in the initial detection and follow-up screening for the recurrence of breast cancer in both men and women.
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Affiliation(s)
- C Streckfus
- School of Dentistry, Department of Research, University of Mississippi Medical Center, Jackson 39216-4505, USA
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Sidebottom C, Buckley S, Pudney P, Twigg S, Jarman C, Holt C, Telford J, McArthur A, Worrall D, Hubbard R, Lillford P. Heat-stable antifreeze protein from grass. Nature 2000; 406:256. [PMID: 10917518 DOI: 10.1038/35018639] [Citation(s) in RCA: 198] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kamath MV, Halton J, Harvey A, Turner-Gomes S, McArthur A, Barr RD. Cardiac autonomic dysfunction in survivors of acute lymphoblastic leukemia in childhood. Int J Oncol 1998; 12:635-40. [PMID: 9472104 DOI: 10.3892/ijo.12.3.635] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [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: 02/06/2023] Open
Abstract
The purpose of this study was to investigate autonomic regulation of neurocardiac function in survivors of acute lymphoblastic leukemia (ALL) in childhood, through power spectral and time domain analyses of the heart rate variability signal. Studies were conducted on 34 unselected patients and 34 age matched controls. Patients were in remission, off therapy for at least 20 months and from high risk (HR, n=21) and standard risk (SR, n=13) groups as described by Dana-Farber Cancer Institute protocols 87-01 and 91-01. Twenty-nine patients had received cranial irradiation, 7 on a hyperfractionated schedule. Power spectral analysis of the heart rate (PS/HRV) was performed on 30 min heart rate time series and time domain statistics were computed from 24 h Holter recordings. Left ventricular function was assessed by measuring ejection and shortening fractions on echocardiography. All such measures were normal. Analysis of PS/HRV revealed that the supine low frequency: high frequency (LF:HF) area ratio was elevated in patients compared to controls. Changes in the LF and HF power on standing were attenuated in the patients compared to controls. Circadian analysis revealed a depressed diurnal rhythm of heart rate in the patients. Those from the SR group showed greater reduction of the LF power response to orthostatic stress and a reduced circadian rhythm of the heart rate compared to those with HR ALL. Patients from the HR group showed reductions in both HF and LF power responses to orthostasis compared to controls. Elevated supine LF power and depressed circadian variation in the HF power band were evident only in female subjects. Patients who received standard cranial irradiation had higher LF:HF area ratio and diminished LF and HF power responses to orthostatic stress than did subjects in the hyperfractionated group. These findings suggest that the autonomic nervous regulation of the heart is compromised in patients treated for ALL in childhood even when resting echocardiographic measures provide no evidence of cardiac decompensation. The extent of neurocardiac dysfunction is influenced by risk status, gender and schedule of cranial irradiation.
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Affiliation(s)
- M V Kamath
- Health Sciences Centre, Room 3E25, McMaster University, 1200 Main Street West, Hamilton, Ontario, L8N 3Z5, Canada
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Jull BA, Merryman JI, Thomas WB, McArthur A. Necrotizing encephalitis in a Yorkshire terrier. J Am Vet Med Assoc 1997; 211:1005-7. [PMID: 9343544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- B A Jull
- Department of Pathology, College of Veterinary Medicine, University of Tennessee, Knoxville 37901-1071, USA
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Dunton RF, Donovan TJ, Drezner AD, Sigman R, Bucknam CA, McArthur A, Donaldson M. Early experience with in situ saphenous vein grafts for severe ischemia of the lower extremity. Surg Gynecol Obstet 1984; 158:472-4. [PMID: 6710316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Based upon this group of 35 patients with a variety of vascular lesions, it would appear that the in situ saphenous vein technique is certainly, at least, a viable alternative to standard bypass techniques. It has been applied with equally encouraging results by several surgeons in a variety of clinical settings, all using the procedure for the first time in a learning phase. This technique may become the procedure of choice for the treatment of occlusive disease of the lower extremity in this difficult and challenging group of patients.
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