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Stretton B, Koovor JG, Hains L, Kleinig O, Tan S, Gupta AK, Ittimani M, Dwyer A, McNeil K, Chan W, Cusack M, O'Callaghan PG, Maddison J, Bacchi S. How will the artificial intelligence algorithm work within the constraints of this healthcare system? Intern Med J 2024; 54:190-191. [PMID: 38267379 DOI: 10.1111/imj.16308] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 11/30/2023] [Indexed: 01/26/2024]
Affiliation(s)
- Brandon Stretton
- SA Health, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Joshua G Koovor
- SA Health, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Lewis Hains
- University of Adelaide, Adelaide, South Australia, Australia
| | - Oliver Kleinig
- University of Adelaide, Adelaide, South Australia, Australia
| | - Sheryn Tan
- University of Adelaide, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- University of Adelaide, Adelaide, South Australia, Australia
| | - Mana Ittimani
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Andrew Dwyer
- SA Health, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Keith McNeil
- Commission on Excellence and Innovation in Health, Adelaide, South Australia, Australia
| | - WengOnn Chan
- SA Health, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | | | - Patrick G O'Callaghan
- SA Health, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - John Maddison
- SA Health, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- SA Health, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Flinders University, Adelaide, South Australia, Australia
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Islam KT, Zhong S, Zakavi P, Chen Z, Kavnoudias H, Farquharson S, Durbridge G, Barth M, McMahon KL, Parizel PM, Dwyer A, Egan GF, Law M, Chen Z. Improving portable low-field MRI image quality through image-to-image translation using paired low- and high-field images. Sci Rep 2023; 13:21183. [PMID: 38040835 PMCID: PMC10692211 DOI: 10.1038/s41598-023-48438-1] [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: 08/22/2023] [Accepted: 11/27/2023] [Indexed: 12/03/2023] Open
Abstract
Low-field portable magnetic resonance imaging (MRI) scanners are more accessible, cost-effective, sustainable with lower carbon emissions than superconducting high-field MRI scanners. However, the images produced have relatively poor image quality, lower signal-to-noise ratio, and limited spatial resolution. This study develops and investigates an image-to-image translation deep learning model, LoHiResGAN, to enhance the quality of low-field (64mT) MRI scans and generate synthetic high-field (3T) MRI scans. We employed a paired dataset comprising T1- and T2-weighted MRI sequences from the 64mT and 3T and compared the performance of the LoHiResGAN model with other state-of-the-art models, including GANs, CycleGAN, U-Net, and cGAN. Our proposed method demonstrates superior performance in terms of image quality metrics, such as normalized root-mean-squared error, structural similarity index measure, peak signal-to-noise ratio, and perception-based image quality evaluator. Additionally, we evaluated the accuracy of brain morphometry measurements for 33 brain regions across the original 3T, 64mT, and synthetic 3T images. The results indicate that the synthetic 3T images created using our proposed LoHiResGAN model significantly improve the image quality of low-field MRI data compared to other methods (GANs, CycleGAN, U-Net, cGAN) and provide more consistent brain morphometry measurements across various brain regions in reference to 3T. Synthetic images generated by our method demonstrated high quality both quantitatively and qualitatively. However, additional research, involving diverse datasets and clinical validation, is necessary to fully understand its applicability for clinical diagnostics, especially in settings where high-field MRI scanners are less accessible.
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Affiliation(s)
- Kh Tohidul Islam
- Monash Biomedical Imaging, Monash University, Melbourne, VIC, Australia.
| | - Shenjun Zhong
- Monash Biomedical Imaging, Monash University, Melbourne, VIC, Australia
- Australian National Imaging Facility, Brisbane, QLD, Australia
| | - Parisa Zakavi
- Monash Biomedical Imaging, Monash University, Melbourne, VIC, Australia
| | - Zhifeng Chen
- Monash Biomedical Imaging, Monash University, Melbourne, VIC, Australia
- Department of Data Science and AI, Faculty of Information Technology, Monash University, Melbourne, VIC, Australia
| | - Helen Kavnoudias
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of Radiology, Alfred Hospital, Melbourne, VIC, Australia
| | | | - Gail Durbridge
- Herston Imaging Research Facility, University of Queensland, Brisbane, QLD, Australia
| | - Markus Barth
- School of Information Technology and Electrical Engineering and Centre for Advanced Imaging, University of Queensland, Brisbane, QLD, Australia
| | - Katie L McMahon
- School of Clinical Science, Herston Imaging Research Facility, Queensland University of Technology, Brisbane, QLD, Australia
| | - Paul M Parizel
- David Hartley Chair of Radiology, Department of Radiology, Royal Perth Hospital, Perth, WA, Australia
- Medical School, University of Western Australia, Perth, WA, Australia
| | - Andrew Dwyer
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Gary F Egan
- Monash Biomedical Imaging, Monash University, Melbourne, VIC, Australia
| | - Meng Law
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of Radiology, Alfred Hospital, Melbourne, VIC, Australia
| | - Zhaolin Chen
- Monash Biomedical Imaging, Monash University, Melbourne, VIC, Australia
- Department of Data Science and AI, Faculty of Information Technology, Monash University, Melbourne, VIC, Australia
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Chau MT, Agzarian M, Wilcox RA, Dwyer A, Bezak E, Todd G. Simple quantitative planimetric measurement of nigrosome-1 for clinical settings. J Neurol Sci 2023; 454:120857. [PMID: 37939625 DOI: 10.1016/j.jns.2023.120857] [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: 07/25/2023] [Revised: 10/22/2023] [Accepted: 10/26/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Loss of MRI hyperintense signal in nigrosome-1 (assessed with susceptibility-weighted imaging) is a biomarker for Parkinson's disease (PD). Current clinical practice involves subjectively rating the appearance of nigrosome-1 which is challenging. The study aimed to test and compare a simple method for quantifying nigrosome-1 with the current subjective rating method. METHODS Two experienced neuroradiologists measured area of hyperintense signal in nigrosome-1 (quantitative method) and rated nigrosome-1 appearance (as normal, attenuated, or absent; subjective method) in 42 patients encompassing the full spectrum of nigrosome-1 integrity (21 patients aged 55.5 ± 20.9 years with Essential tremor (ET) and a subset of 21 patients aged 69.6 ± 8.6 years with PD). Neuroradiologists were blinded to each other's measurements, clinical notes, and patient group. RESULTS Both methods yielded a significant difference between the groups (PD vs ET; p < 0.001). Pooled (across sides) area of nigrosome-1 hyperintense signal was significantly smaller in the PD group (median = 2.1 mm2, range = 0-15.8 mm2) than ET group (median = 8.3 mm2, range = 0-15.7 mm2; p < 0.001). Inter-rater reliability was high to very high for both methods (subjective: weighted kappa = 0.640, p < 0.001; quantitative: W = 0.733, p = 0.004). Our primary hypothesis that area of nigrosome-1 hyperintense signal exhibits higher inter-rater reliability than subjective rating of nigrosome-1 appearance was not supported. CONCLUSION The simple quantitative method, used with subjectively rated nigrosome-1 appearance, may improve confidence in longitudinal clinical reporting, when nigrosome-1 is attenuated. However, further work on the incremental diagnostic value of planimetry and bias, repeatability and reproducibility are needed before it can be recommended in clinical practice.
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Affiliation(s)
- Minh T Chau
- UniSA Allied Health & Human Performance and Alliance for Research in Exercise, Nutrition and Activity (ARENA), City East Campus, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia; South Australia Medical Imaging, Flinders Medical Centre, 1 Flinders Drive, Bedford Park, SA 5042, Australia
| | - Marc Agzarian
- South Australia Medical Imaging, Flinders Medical Centre, 1 Flinders Drive, Bedford Park, SA 5042, Australia; College of Medicine and Public Health, Flinders University, 1 Flinders Drive, Bedford Park, SA 5042, Australia
| | - Robert A Wilcox
- College of Medicine and Public Health, Flinders University, 1 Flinders Drive, Bedford Park, SA 5042, Australia; Neurology Department, Flinders Medical Centre, 1 Flinders Drive, Bedford Park, SA 5042, Australia; UniSA Clinical & Health Sciences and Alliance for Research in Exercise, Nutrition and Activity (ARENA), City East Campus, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia
| | - Andrew Dwyer
- South Australia Medical Imaging, Flinders Medical Centre, 1 Flinders Drive, Bedford Park, SA 5042, Australia; College of Medicine and Public Health, Flinders University, 1 Flinders Drive, Bedford Park, SA 5042, Australia; Clinical and Research Imaging Centre, South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, SA 5000, Australia
| | - Eva Bezak
- UniSA Allied Health & Human Performance and Alliance for Research in Exercise, Nutrition and Activity (ARENA), City East Campus, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia
| | - Gabrielle Todd
- UniSA Clinical & Health Sciences and Alliance for Research in Exercise, Nutrition and Activity (ARENA), City East Campus, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia.
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Dwyer A, Korlaet M, Callary SA, Robertson T, Smitham P, Solomon LB. Impact of computed tomography metal artifact reduction protocol on periprosthetic tissue characterization after total hip arthroplasty: A cadaveric study. J Orthop Res 2023; 41:657-662. [PMID: 35652835 DOI: 10.1002/jor.25391] [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: 01/20/2022] [Revised: 04/19/2022] [Accepted: 05/14/2022] [Indexed: 02/04/2023]
Abstract
Metal artifact reduction (MAR) has improved computed tomography (CT) imaging of total hip arthroplasty (THA) but the assessment of osteolysis and implant to bone contact relies on the accurate depiction of bone defects, cancellous bone, and cement. This study evaluates the impact of available single and dual-energy protocols on periprosthetic tissue characterization in a cadaveric phantom. Bilateral THA was performed on a fresh frozen cadaveric pelvis with simulated osteolytic cavities. CT acquisitions with projection-based MAR and noise equivalence were performed using single energy 140 kVp, single energy 150 kVp with 0.6 mm tin filtration, and dual-energy at 100/150 kVp with 0.6 mm tin filtration, from which simulated energies were extracted. Image subtraction, segmentation, region of interest histograms, and line profiles were used to characterize tissue density and separation. Tissue densities were heavily dependent on the energy profile of the protocol. Cancellous bone ranged from 182 to 45 HU and cement from 1012 to 131 HU using 140 kVp compared to dual-energy with weighted high energy tube, respectively. Spectral separation between cancellous bone, osteolytic defect, and cement was reduced for all protocols compared with 140 kVp. Spectral overlap was most severe using dual-energy with heavily weighted high-energy tubes. Dual-energy algorithms reduced trabecular contrast within the cancellous bone and cortical edge response. Although the dual-energy acquisition has been proposed as an additive to projection-based MAR techniques in THA, reduced density and contrast in clinically relevant periprosthetic tissue compared to 140 kVp single energy may limit its use in characterizing periprosthetic tissues.
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Affiliation(s)
- Andrew Dwyer
- Clinical & Research Imaging Centre, South Australian Health & Medical Research Institute, Adelaide, South Australia, Australia
| | - Mishelle Korlaet
- Clinical & Research Imaging Centre, South Australian Health & Medical Research Institute, Adelaide, South Australia, Australia
| | - Stuart A Callary
- Department of Orthopedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Centre for Orthopedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Thomas Robertson
- Department of Orthopedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Centre for Orthopedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Peter Smitham
- Department of Orthopedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Centre for Orthopedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Lucian B Solomon
- Department of Orthopedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Centre for Orthopedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
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Terry M, Powell J, Gilmore WS, Way DP, Dwyer A, Bhanji F, Panchal AR. Deriving National Continued Competency Priorities for Emergency Medical Services Clinicians. PREHOSP EMERG CARE 2022; 27:439-448. [PMID: 36066437 DOI: 10.1080/10903127.2022.2120934] [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: 10/17/2022]
Abstract
Objective: Continued competency is poorly defined in emergency medical services (EMS), with no established method for verifying continued competency at a national level. The objective of this project was to refine understanding of continued competency for EMS clinicians in the U.S. and establish priorities for developing competency assessments.Methods: A panel of EMS managers, educators, medical directors, and experts in competency assessment, simulation, and certification used a modified Delphi technique to address two questions: "What is the content for continued competency in EMS that should be assessed or verified?" (content) and "How should continued competency of EMS clinicians be demonstrated?" (process) The Delphi process was conducted through electronic conferencing and survey software over a 6-month period. In round one, panelists responded to open-ended prompts and their contributions were analyzed and categorized into themes by independent reviewers. In round two, the panel rated theme importance using five-point Likert-type scales. In round three, the panel ranked their top 10 themes, and in round four, the panel selected the most important themes for each of the two questions through consensus-building discussions. Descriptive statistics and thematic analyses were performed with Excel and STATA 16.Results: Fourteen invited experts participated in all Delphi activities. The panel contributed 70 content and 35 process items from the original prompts. Following thematic analysis, these contributions were reduced to 21 and 14 unique themes, respectively. The final top five prioritized themes for content important for continued competency included 1) airway, respiration, and ventilation, 2) patient assessment, 3) pharmacology, 4) pediatrics, and 5) management of time critical disease progressions. The final top five prioritized themes for the processes for continued competency assessment included 1) assessments of evidence-based practice, 2) performance-based assessments, 3) combined knowledge and skill assessments, 4) performance improvement over time, and 5) frequent, short knowledge assessments.Conclusion: This modified Delphi process identified priorities for content and assessment, laying the groundwork for EMS continued competency at a national level. These findings can be leveraged by national task forces to develop transparent and consistent guidelines for systems that verify continued competency related to certification, licensure, and local credentialing.
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Affiliation(s)
- Mark Terry
- National Registry of Emergency Medical Technicians, Columbus, OH, U.S.A
| | - Jonathan Powell
- National Registry of Emergency Medical Technicians, Columbus, OH, U.S.A.,Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH
| | - W Scott Gilmore
- National Registry of Emergency Medical Technicians, Columbus, OH, U.S.A.,St. Louis Fire Department, St. Louis, MO, U.S.A.,Mercy Clinic East Communities, St. Louis, MO, U.S.A
| | - David P Way
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, OH, U.S.A
| | - Andrew Dwyer
- The American Board of Pediatrics, Chapel Hill, NC, U.S.A
| | - Farhan Bhanji
- Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada.,Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Ashish R Panchal
- National Registry of Emergency Medical Technicians, Columbus, OH, U.S.A.,Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH.,Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, OH, U.S.A
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Hubbard DK, Wambach JA, LaTuga MS, Dwyer A, Aurora S, Lorch SA, Akinbi HT. Identifying the essential knowledge and skills for Neonatal-Perinatal Medicine: a systematic analysis of practice. J Perinatol 2022; 42:1266-1270. [PMID: 35732728 DOI: 10.1038/s41372-022-01429-y] [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] [Received: 02/19/2022] [Revised: 05/27/2022] [Accepted: 06/08/2022] [Indexed: 12/14/2022]
Abstract
The knowledge and skills expected for board certification in Neonatal-Perinatal Medicine (NPM) should reflect the clinical practice of neonatology. First, a 14-member panel of practicing neonatologists, convened by the American Board of Pediatrics (ABP), drafted a practice analysis document which identified the practice domains, tasks, knowledge, and skills deemed essential for clinical practice. NPM fellowship program directors provided feedback via online survey resulting in revisions to the document. During the second phase of the project, the panel organized testable knowledge areas into content domains and subdomains to update the existing ABP NPM content outline. All ABP board-certified neonatologists were asked to review via online survey, and results were used to guide final revisions to the content outline. The NPM practice analysis document and the updated NPM content outline should serve as helpful resources for educators, trainees, and practicing neonatologists.
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Affiliation(s)
- D K Hubbard
- Children's Mercy-Kansas City and University of Missouri-Kansas City, Kansas City, MO, USA
| | - J A Wambach
- Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO, USA
| | - M S LaTuga
- Children's Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, NY, USA
| | - A Dwyer
- The American Board of Pediatrics, Chapel Hill, NC, USA
| | - S Aurora
- Massachusetts General Hospital, Boston and UMass Chan Medical School, Worcester, MA, USA
| | - S A Lorch
- University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - H T Akinbi
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, USA.
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Seah RB, Mak WK, Bryant K, Korlaet M, Dwyer A, Bain GI. Four-dimensional computed tomography scan for dynamic elbow disorders: recommendations for clinical utility. JSES Int 2021; 6:182-186. [PMID: 35141694 PMCID: PMC8811401 DOI: 10.1016/j.jseint.2021.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 11/19/2022] Open
Abstract
Background Four-dimensional computed tomography (4D CT) is rapidly emerging as a diagnostic tool for the investigation of dynamic upper limb disorders. Dynamic elbow pathologies are challenging to diagnose, and at present, limitations exist in current imaging modalities Objective We aimed to assess the clinical utility of 4D CT in detecting potential dynamic elbow disorders. Methods Twenty-eight elbow joints from 26 patients with symptoms of dynamic elbow pathology were included in this study. They were first assessed by a senior orthopedic surgeon with subsequent qualitative data obtained via a Siemens Force Dual Source CT scanner (Erlangen, Germany), producing two- and three-dimensional “static” images and 4D dynamic “movie” images for assessment in each clinical scenario. Clinical assessment before and after scan was compared. Results Use of 4D CT scan resulted in a change of diagnosis in 16 cases (57.14%). This included a change in primary diagnosis in 2 cases (7.14%) and secondary diagnosis in 14 cases (50%). In 25 cases (89.29%), the 4D CT scan allowed us to understand the pathological anatomy in greater detail which led to a change in the management plan of 15 cases (53.57%). Conclusion 4D CT is a promising diagnostic tool in the management of dynamic elbow disorders and may be considered in clinical practice. Future studies need to compare it with other diagnostic modalities such as three-dimensional CT.
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Affiliation(s)
| | - Wai-Keong Mak
- Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore
- Corresponding author: Wai-Keong Mak, MRCS, MBBS, 110 Sengkang E Way, Singapore 544886.
| | - Kimberley Bryant
- Clinical and Research Imaging Centre, SAHMRI, Adelaide, SA, Australia
| | - Mishelle Korlaet
- Department of Orthopaedic Surgery and Trauma, Flinders University, Bedford Park, SA, Australia
| | - Andrew Dwyer
- Department of Orthopaedic Surgery and Trauma, Flinders University, Bedford Park, SA, Australia
| | - Gregory I. Bain
- Department of Orthopaedic Surgery and Trauma, Flinders University, Bedford Park, SA, Australia
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Escagedo PD, Deal CL, Dwyer A, Hauschild M. Insulin Growth Factor 1 Predicts Central Precocious Puberty in Girls 6 to 8 Years-Old: A Retrospective Study. J Endocr Soc 2021. [PMCID: PMC8090603 DOI: 10.1210/jendso/bvab048.1347] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background: Central precocious puberty (CPP) in females is characterized by thelarche before 8 years of age. Evidence of reproductive axis activation confirms the diagnosis (basal serum LH ≥ 0.3 IU/L or luteinizing hormone-releasing hormone (LHRH)-stimulated LH ≥ 5 IU/L. Stimulation testing is the diagnostic gold standard but is time-consuming and costly. Serum levels of insulin-like growth factor-1 (IGF-1) and insulin-like growth factor-binding protein 3 (IGFBP-3) are increased in girls with CPP. Objective: To assess the utility of serum IGF-1 and IGFBP-3 in identifying CPP in girls aged 6 to 8 years old. Methods: The study was a single-center retrospective study. Girls with confirmed CPP (n=44) and isolated premature adrenarche/thelarche (PA/PT, n=16) had baseline biochemical profiling and LHRH stimulation testing. Serum IGF-1 and IGFBP-3 results were converted to standard deviation scores (SDS). Correlations were calculated and receiver operating characteristic curves were plotted. Results: Girls with CPP had higher basal and peak LH, IGF-1 SDS, and growth velocity (p<0.05). IGF-1 SDS correlated positively with basal and peak LH (p<0.05). IGF-1 SDS (1.75-2.15) differentiated CPP and PA/PT with 89% sensitivity and 56% specificity (basal LH) and 94% specificity and 55% sensitivity (peak LH). IGFBP-3 SDS did not differ between groups or by CPP parameters. Conclusions: In clinical practice, IGF-1 SDS may be an additional tool for identifying CPP in girls aged 6 to 8 years-old when baseline clinical and laboratory diagnostic criteria are inconclusive, possibly avoiding more invasive procedures.
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Affiliation(s)
- Patricia Diaz Escagedo
- CHU Sainte Justine University Hospital Center/Université de Montréal, Montreal, QC, Canada
| | - Cheri L Deal
- Université de Montréal/Research Center CHU Sainte-Justine, Montreal, QC, Canada
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Mouron-Hryciuk J, Stoppa-Vaucher S, Busiah K, Bouthors T, Antoniou MC, Jacot E, Brusgaard K, Christesen HT, Hussain K, Dwyer A, Roth-Kleiner M, Hauschild M. Congenital hyperinsulinism: 2 case reports with different rare variants in ABCC8. Ann Pediatr Endocrinol Metab 2021; 26:60-65. [PMID: 32871644 PMCID: PMC8026340 DOI: 10.6065/apem.2040042.021] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/19/2020] [Indexed: 11/20/2022] Open
Abstract
Congenital hyperinsulinism (CHI) is a rare glucose metabolism disorder characterized by unregulated secretion of insulin that leads to hyperinsulinemic hypoglycemia (HH). Most cases are caused by mutations in the KATP-channel genes ABCC8 and KCNJ11. We report 2 patients that experienced severe HH from the first day of life. Patient 1 developed midgut volvulus after initiating diazoxide and required intestinal resection. He was subsequently managed with a high-dose octreotide and glucose-enriched diet. Consistent with diffuse type CHI by 18F-dihydroxyphenylalanine positron emission tomography-computed tomography, genetic testing revealed a homozygous ABCC8 variant, c.1801G>A, p.(Val601Ile). The rare variant was previously reported to be diazoxide-responsive, and the patient responded well to diazoxide monotherapy, with clinical remission at 2 years of age. Patient 2 responded to diazoxide with spontaneous clinical remission at 15 months of age. However, an oral glucose tolerance test at 7 years of age revealed hyperinsulinism. Genetic testing revealed that the proband and several seemingly healthy family members harbored a novel, heterozygous ABCC8 variant, c.1780T>C, p.(Ser594Pro). Genetic findings identified previously unrecognized HH in the proband's mother. The proband's uncle had been diagnosed with monogenic ABCC8-diabetes and was successfully transitioned from insulin to glibenclamide therapy. We report findings of intestinal malrotation and volvulus occurring 2 days after initiation of diazoxide treatment. We also report a novel, heterozygous ABCC8 variant in a family that exhibited cases of CHI in infancy and HH and monogenic diabetes in adult members. The cases demonstrate the importance and clinical utility of genetic analyses for informing and guiding treatment and care.
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Affiliation(s)
- Julie Mouron-Hryciuk
- Pediatric Endocrinology and Diabetology Unit, Ser vice of Pediatrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Sophie Stoppa-Vaucher
- Pediatric Endocrinology and Diabetology Unit, Ser vice of Pediatrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland,Department of Pediatrics, Hôpitaux Neuchâtelois, Neuchâtel, Switzerland
| | - Kanetee Busiah
- Pediatric Endocrinology and Diabetology Unit, Ser vice of Pediatrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Thérèse Bouthors
- Pediatric Endocrinology and Diabetology Unit, Ser vice of Pediatrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Maria Christina Antoniou
- Pediatric Endocrinology and Diabetology Unit, Ser vice of Pediatrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Klaus Brusgaard
- Departement of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | | | - Khalid Hussain
- D e velopmental Endocr inology Research Group, Clinical and Molecular Genetics Unit, Institute of Child Health, University College London, London, UK
| | - Andrew Dwyer
- Boston College, William F. Connell School of Nursing, Chestnut Hill, MA, USA
| | - Matthias Roth-Kleiner
- Service of Neonatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Michael Hauschild
- Pediatric Endocrinology and Diabetology Unit, Ser vice of Pediatrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland,Address for correspondence: Michael Hauschild Pediatric Endocrinology and Diabetology Unit, Service of Pediatrics, Lausanne University Hospital and University of Lausanne, Chemin de Montétan 16 1004 Lausanne, Switzerland
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Arshad U, Pertinez H, Box H, Tatham L, Rajoli RK, Neary M, Sharp J, Valentijn A, Hobson J, Unsworth C, Dwyer A, Savage A, Mcdonald TO, Rannard SP, Curley P, Owen A. Optimisation and validation of a sensitive bioanalytical method for niclosamide. bioRxiv 2021:2021.01.13.426426. [PMID: 33469585 PMCID: PMC7814822 DOI: 10.1101/2021.01.13.426426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The SARS-CoV-2 pandemic has spread at an unprecedented rate, and repurposing opportunities have been intensively studied with only limited success to date. If successful, repurposing will allow interventions to become more rapidly available than development of new chemical entities. Niclosamide has been proposed as a candidate for repurposing for SARS-CoV-2 based upon the observation that it is amongst the most potent antiviral molecules evaluated in vitro . To investigate the pharmacokinetics of niclosamide, reliable, reproducible and sensitive bioanalytical assays are required. Here, a liquid chromatography tandem mass spectrometry assay is presented which was linear from 31.25-2000 ng/mL (high dynamic range) and 0.78-100 ng/mL (low dynamic range). Accuracy and precision ranged between 97.2% and 112.5%, 100.4% and 110.0%, respectively. The presented assay should have utility in preclinical evaluation of the exposure-response relationship and may be adapted for later evaluation of niclosamide in clinical trials.
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Affiliation(s)
- A. Dwyer
- Genesee Valley Equine Clinic Scottsville New YorkUSA
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12
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Messina A, Pulli K, Santini S, Acierno J, Känsäkoski J, Cassatella D, Xu C, Casoni F, Malone SA, Ternier G, Conte D, Sidis Y, Tommiska J, Vaaralahti K, Dwyer A, Gothilf Y, Merlo GR, Santoni F, Niederländer NJ, Giacobini P, Raivio T, Pitteloud N. Neuron-Derived Neurotrophic Factor Is Mutated in Congenital Hypogonadotropic Hypogonadism. Am J Hum Genet 2020; 106:58-70. [PMID: 31883645 DOI: 10.1016/j.ajhg.2019.12.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [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: 07/22/2019] [Accepted: 11/22/2019] [Indexed: 12/20/2022] Open
Abstract
Congenital hypogonadotropic hypogonadism (CHH) is a rare genetic disorder characterized by infertility and the absence of puberty. Defects in GnRH neuron migration or altered GnRH secretion and/or action lead to a severe gonadotropin-releasing hormone (GnRH) deficiency. Given the close developmental association of GnRH neurons with the olfactory primary axons, CHH is often associated with anosmia or hyposmia, in which case it is defined as Kallmann syndrome (KS). The genetics of CHH are heterogeneous, and >40 genes are involved either alone or in combination. Several CHH-related genes controlling GnRH ontogeny encode proteins containing fibronectin-3 (FN3) domains, which are important for brain and neural development. Therefore, we hypothesized that defects in other FN3-superfamily genes would underlie CHH. Next-generation sequencing was performed for 240 CHH unrelated probands and filtered for rare, protein-truncating variants (PTVs) in FN3-superfamily genes. Compared to gnomAD controls the CHH cohort was statistically enriched for PTVs in neuron-derived neurotrophic factor (NDNF) (p = 1.40 × 10-6). Three heterozygous PTVs (p.Lys62∗, p.Tyr128Thrfs∗55, and p.Trp469∗, all absent from the gnomAD database) and an additional heterozygous missense mutation (p.Thr201Ser) were found in four KS probands. Notably, NDNF is expressed along the GnRH neuron migratory route in both mouse embryos and human fetuses and enhances GnRH neuron migration. Further, knock down of the zebrafish ortholog of NDNF resulted in altered GnRH migration. Finally, mice lacking Ndnf showed delayed GnRH neuron migration and altered olfactory axonal projections to the olfactory bulb; both results are consistent with a role of NDNF in GnRH neuron development. Altogether, our results highlight NDNF as a gene involved in the GnRH neuron migration implicated in KS.
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Affiliation(s)
- Andrea Messina
- Service of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Kristiina Pulli
- Stem Cells and Metabolism Research Program, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
| | - Sara Santini
- Service of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - James Acierno
- Service of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital, 1011 Lausanne, Switzerland; Università Vita-Salute San Raffaele, Via Olgettina 58, 20132, Milan, Italy
| | - Johanna Känsäkoski
- Department of Physiology, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
| | - Daniele Cassatella
- Service of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital, 1011 Lausanne, Switzerland; Università Vita-Salute San Raffaele, Via Olgettina 58, 20132, Milan, Italy
| | - Cheng Xu
- Service of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Filippo Casoni
- Inserm, Jean-Pierre Aubert Research Center, Development and Plasticity of the Neuroendocrine Brain, Unité 1172 Lille, 59045 Lille, France; Division of Neuroscience, San Raffaele Scientific Institute, Milan 20132, Italy, Milan 20132, Italy; Università Vita-Salute San Raffaele, Via Olgettina 58, 20132, Milan, Italy
| | - Samuel A Malone
- Inserm, Jean-Pierre Aubert Research Center, Development and Plasticity of the Neuroendocrine Brain, Unité 1172 Lille, 59045 Lille, France
| | - Gaetan Ternier
- Inserm, Jean-Pierre Aubert Research Center, Development and Plasticity of the Neuroendocrine Brain, Unité 1172 Lille, 59045 Lille, France
| | - Daniele Conte
- Department of Molecular Biotechnology and Health Science, University of Torino, 10126 Torino, Italy
| | - Yisrael Sidis
- Service of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Johanna Tommiska
- Department of Physiology, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
| | - Kirsi Vaaralahti
- Stem Cells and Metabolism Research Program, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
| | - Andrew Dwyer
- Service of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Yoav Gothilf
- Department of Neurobiology, George S. Wise Faculty of Life Sciences and Sagol School of Neurosciences, University of Tel Aviv, Tel Aviv 69978, Israel
| | - Giorgio R Merlo
- Department of Molecular Biotechnology and Health Science, University of Torino, 10126 Torino, Italy
| | - Federico Santoni
- Service of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Nicolas J Niederländer
- Service of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Paolo Giacobini
- Inserm, Jean-Pierre Aubert Research Center, Development and Plasticity of the Neuroendocrine Brain, Unité 1172 Lille, 59045 Lille, France
| | - Taneli Raivio
- Stem Cells and Metabolism Research Program, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland; Pediatric Research Center, New Children's Hospital, Helsinki University Hospital, 00290 Helsinki, Finland
| | - Nelly Pitteloud
- Service of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital, 1011 Lausanne, Switzerland; Faculty of Biology and Medicine, University of Lausanne, Lausanne 1005, Switzerland.
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Rockwell H, Mack M, Famula T, Sandmeyer L, Bauer B, Dwyer A, Lassaline M, Beeson S, Archer S, McCue M, Bellone RR. Genetic investigation of equine recurrent uveitis in Appaloosa horses. Anim Genet 2019; 51:111-116. [PMID: 31793009 DOI: 10.1111/age.12883] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2019] [Indexed: 01/05/2023]
Abstract
Equine recurrent uveitis (ERU) is characterized by intraocular inflammation that often leads to blindness in horses. Appaloosas are more likely than any other breed to develop insidious ERU, distinguished by low-grade chronic intraocular inflammation, suggesting a genetic predisposition. Appaloosas are known for their white coat spotting patterns caused by the leopard complex spotting allele (LP) and the modifier PATN1. A marker linked to LP on ECA1 and markers near MHC on ECA20 were previously associated with increased ERU risk. This study aims to further investigate these loci and identify additional genetic risk factors. A GWAS was performed using the Illumina Equine SNP70 BeadChip in 91 horses. Additive mixed model approaches were used to correct for relatedness. Although they do not reach a strict Bonferroni genome-wide significance threshold, two SNPs on ECA1 and one SNP each on ECA12 and ECA29 were among the highest ranking SNPs and thus warranted further analysis (P = 1.20 × 10-5 , P = 5.91 × 10-6 , P = 4.91 × 10-5 , P = 6.46 × 10-5 ). In a second cohort (n = 98), only an association with the LP allele on ECA1 was replicated (P = 5.33 × 10-5 ). Modeling disease risk with LP, age and additional depigmentation factors (PATN1 genotype and extent of roaning) supports an additive role for LP and suggests an additive role for PATN1. Genotyping for LP and PATN1 may help predict ERU risk (AUC = 0.83). The functional role of LP and PATN1 in ERU development requires further investigation. Testing samples across breeds with leopard complex spotting patterns and a denser set of markers is warranted to further refine the genetic components of ERU.
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Affiliation(s)
- H Rockwell
- Veterinary Genetics Laboratory, Department of Population Health and Reproduction, School of Veterinary Medicine, University of California - Davis, Davis, 95616, CA, USA
| | - M Mack
- Veterinary Genetics Laboratory, Department of Population Health and Reproduction, School of Veterinary Medicine, University of California - Davis, Davis, 95616, CA, USA
| | - T Famula
- Appaloosa Project, Davis, 95616, CA, USA
| | - L Sandmeyer
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, S7N 5B4, Canada
| | - B Bauer
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, S7N 5B4, Canada
| | - A Dwyer
- Genesee Valley Equine Clinic, LLC, Scottsville, NY, 14546, USA
| | - M Lassaline
- Department of Radiological and Surgical Sciences, School of Veterinary Medicine, University of California - Davis, Davis, CA, 95616, USA
| | - S Beeson
- Veterinary Population Medicine Department, College of Veterinary Medicine, University of Minnesota, St Paul, MN, 55108, USA
| | - S Archer
- Appaloosa Project, Sayward, V0P 1R0, BC, Canada
| | - M McCue
- Veterinary Population Medicine Department, College of Veterinary Medicine, University of Minnesota, St Paul, MN, 55108, USA
| | - R R Bellone
- Veterinary Genetics Laboratory, Department of Population Health and Reproduction, School of Veterinary Medicine, University of California - Davis, Davis, 95616, CA, USA
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Shehata M, Shalaby A, Ghazal M, Abou El-Ghar M, Badawy MA, Beache G, Dwyer A, El-Melegy M, Giridharan G, Keynton R, El-Baz A. EARLY ASSESSMENT OF RENAL TRANSPLANTS USING BOLD-MRI: PROMISING RESULTS. Proc Int Conf Image Proc 2019; 2019:1395-1399. [PMID: 34690556 DOI: 10.1109/icip.2019.8803042] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Non-invasive evaluation of renal transplant function is essential to minimize and manage renal rejection. A computer-assisted diagnostic (CAD) system was developed to evaluate kidney function post-transplantation. The developed CAD system utilizes the amount of blood-oxygenation extracted from 3D (2D + time) blood oxygen level-dependent magnetic resonance imaging (BOLD-MRI) to estimate renal function. BOLD-MRI scans were acquired at five different echo-times (2, 7, 12, 17, and 22) ms from 15 transplant patients. The developed CAD system first segments kidneys using the level-sets method followed by estimation of the amount of deoxyhemoglobin, also known as apparent relaxation rate (R2*). These R2* estimates were used as discriminatory features (global features (mean R2*) and local features (pixel-wise R2*)) to train and test state-of-the-art machine learning classifiers to differentiate between non-rejection (NR) and acute renal rejection. Using a leave-one-out cross-validation approach along with an artificial neural network (ANN) classifier, the CAD system demonstrated 93.3% accuracy, 100% sensitivity, and 90% specificity in distinguishing AR from non-rejection . These preliminary results demonstrate the efficacy of the CAD system to detect renal allograft status non-invasively.
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Affiliation(s)
- M Shehata
- Bioengineering Department, University of Louisville, Louisville, KY, USA
| | - A Shalaby
- Bioengineering Department, University of Louisville, Louisville, KY, USA
| | - M Ghazal
- Electrical and Computer Engineering Department, Abu Dhabi University, Abu Dhabi, UAE.,Bioengineering Department, University of Louisville, Louisville, KY, USA
| | - M Abou El-Ghar
- Radiology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - M A Badawy
- Radiology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - G Beache
- Radiology Department, University of Louisville, Louisville, KY, USA
| | - A Dwyer
- Kidney Disease Program, University of Louisville, Louisville, KY, USA
| | - M El-Melegy
- Department of Electrical Engineering, Assiut University, Assiut, Egypt
| | - G Giridharan
- Bioengineering Department, University of Louisville, Louisville, KY, USA
| | - R Keynton
- Bioengineering Department, University of Louisville, Louisville, KY, USA
| | - A El-Baz
- Bioengineering Department, University of Louisville, Louisville, KY, USA
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15
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Tatham LM, Savage AC, Dwyer A, Siccardi M, Scott T, Vourvahis M, Clark A, Rannard SP, Owen A. Towards a Maraviroc long-acting injectable nanoformulation. Eur J Pharm Biopharm 2019; 138:92-98. [DOI: 10.1016/j.ejpb.2018.04.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/09/2018] [Accepted: 04/12/2018] [Indexed: 10/17/2022]
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16
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Delaney A, Volochayev R, Meader B, Lee J, Almpani N, Noukelak G, Brooks B, Henkind J, Chalmers L, Law J, Williamson K, Jacobsen C, Buitrago TP, Silva OP, Chie-Hee C, Kaindl A, Anita R, steindl K, Garcia-Ortiz J, Bart L, Russell B, Prasad R, Mondal U, Reigstad HM, Clements S, Salnikov K, DiOrio N, Balasubramanian R, Dwyer A, Seminara S, Crowley W, Plummer L, Hall J, Graham J, Lin A, Shaw N. SUN-219 Human Congenital Arhinia Is Associated with GnRH Deficiency and Primary Testicular Defects. J Endocr Soc 2019. [PMCID: PMC6552745 DOI: 10.1210/js.2019-sun-219] [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: 11/22/2022] Open
Abstract
Congenital arhinia (absent external nose) is an extremely rare mendelian disorder (<100 case reports in the past century) caused by heterozygous missense mutations in the gene SMCHD1. Arhinia is frequently accompanied by ocular and reproductive defects, a clinical triad which defines the Bosma arhinia microphthalmia syndrome (BAMS). The etiology and spectrum of reproductive defects in BAMS is unknown. We studied eleven subjects with arhinia or nasal hypoplasia (aged 18-53 yrs; 5 males) to assess endogenous luteinizing hormone (LH) secretion (n=11), a validated marker of GnRH, responsiveness to pulsatile GnRH (n=2), and non-reproductive phenotypes (n=11). Clinical data abstracted from questionnaires were analyzed in 33 additional international patients. Nearly every male demonstrated clinical and biochemical signs of severe congenital GnRH deficiency (CGD) including a history of microphallus and/or cryptorchidism, testicular volumes < 3 ml, hypogonadotropic hypogonadism (HH), low inhibin B levels, and apulsatile LH profiles; two young boys (studied from afar) had normal genitals but an absent mini-puberty of infancy was confirmed biochemically in one case. Pulsatile GnRH administered to one adult male and hCG to two others also revealed testicular resistance. Several females reported spontaneous breast bud development, but all had primary amenorrhea, small ovaries on pelvic ultrasound, HH, and apulsatile LH profiles. Pulsatile GnRH administered to one female induced ovulation on treatment day 21. Two females (studied from afar) reported normal thelarche and menstrual cycles. The 11 subjects studied in detail were completely anosmic with absent internal olfactory structures on brain MRI but normal hypothalamic-pituitary anatomy. Subjects with arhinia demonstrated some, but not all, non-reproductive phenotypes characteristic of Kallmann syndrome (KS) and/or CHARGE syndrome including dental agenesis (56%) and congenital mirror movements (CMMs; 50%); none had renal agenesis, severe congenital heart defects, or deafness. This study demonstrates for the first time that the hypogonadotropism observed in BAMS is indeed secondary to GnRH deficiency. In contrast to the male predominance (3-5:1) in KS, there is no sex bias in the incidence of BAMS. However, females may demonstrate partial or complete pubertal development whereas males are severely affected with some showing both hypothalamic and testicular defects. The combination of defects in the nasal skeleton, olfactory structures, and GnRH ontogeny point to aberrant development of the nasal placode in BAMS, yet the high prevalence of CMMs, a sign of misrouted commissural axons, suggests insults may occur even earlier in neurogenesis, at the neural plate border.
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Affiliation(s)
- Angela Delaney
- Dept. of Child Health and Human Dev., National Institutes of Health, Bethesda, MD, United States
| | | | | | | | | | | | | | | | | | - Jennifer Law
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | - Christina Jacobsen
- Dept of Endo, Boston Children's Hosp/Harvard Medical School, Boston, MA, United States
| | | | | | - Cho Chie-Hee
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University Hospital of Bern, Bern, , Switzerland
| | - Angela Kaindl
- Biology and Neurobiology, Charité-University Medicine Berlin and Berlin Institute of Health, Berlin, , Germany
| | - Rauch Anita
- Insitute of Medical Genetics University of Zürich, Zürich, , Switzerland
| | - Katharina steindl
- Institute of Medical Genetics and Radiz-Rare Disease Initiative Zurich, Zurich, , Switzerland
| | - Jose Garcia-Ortiz
- División de Genética, Centro de Investigación Biomédica de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, , Mexico
| | - Loeys Bart
- Center for Medical Genetics, University of Antwerp and Antwerp University Hospital, Antwerp, , Belgium
| | | | - Rameshwar Prasad
- Department of Neonatology, IPGME&R and SSKM Hospital, Kolkata, 700020, Kolkata, , India
| | - Uttam Mondal
- Department of Neonatology, IPGME&R and SSKM Hospital, Kolkata, 700020, Kolkata, , India
| | - Hallvard Martin Reigstad
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, , Norway
| | - Scott Clements
- Pediatric Endocrinology, University of Utah; Primary Children's Hospital, Salt Lake City, UT, United States
| | | | - Nicole DiOrio
- Massachusetts General Hospital, Boston, MA, United States
| | | | | | | | - William Crowley
- Harvard Reproductive Endocrine Sciences Center, Massachusetts General Hospital, Boston, MA, United States
| | - Lacey Plummer
- Massachusetts General Hospital, Boston, MA, United States
| | - Janet Hall
- NIH-NIEHS, National Institute of Environmental Health Sciences, Research Triangle Park, NC, United States
| | - John Graham
- Cedars Sinai, Los Angeles, CA, United States
| | - Angela Lin
- MASS GENERAL HOSP, Boston, MA, United States
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Antoniou MC, Bouthors T, Xu C, Phan-Hug F, Elowe-Gruau E, Stoppa-Vaucher S, van der Sloot A, Acierno J, Cassatella D, Richard C, Dwyer A, Pitteloud N, Hauschild M. A novel CHD7 mutation in an adolescent presenting with growth and pubertal delay. Ann Pediatr Endocrinol Metab 2019; 24:49-54. [PMID: 30943680 PMCID: PMC6449621 DOI: 10.6065/apem.2019.24.1.49] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 07/31/2018] [Indexed: 11/22/2022] Open
Abstract
Mutations in the CHD7 gene, encoding for the chromodomain helicase DNA-binding protein 7, are found in approximately 60% of individuals with CHARGE syndrome (coloboma, heart defects, choanal atresia, retarded growth and development, genital hypoplasia, ear abnormalities and/or hearing loss). Herein, we present a clinical case of a 14-year-old male presenting for evaluation of poor growth and pubertal delay highlighting the diagnostic challenges of CHARGE syndrome. The patient was born full term and underwent surgery at 5 days of life for bilateral choanal atresia. Developmental milestones were normally achieved. At age 14 his height and weight were -2.04 and -1.74 standard deviation score respectively. He had anosmia as well as prepubertal testes and micropenis (4 cm×1 cm). The biological profile showed low basal serum testosterone and gonadotropins (testosterone, 0.2 nmol/L; luteinizing hormone, 0.5 U/L; follicle-stimulating hormone, 1.3 U/L), and otherwise normal pituitary function and normal imaging of the hypothalamic-pituitary area. The constellation of choanal atresia, anosmia, mild dysmorphic features, micropenis and delayed puberty were suggestive of CHARGE syndrome. Targeted genetic testing of CHD7 was performed revealing a de novo heterozygous CHD7 mutation (c.4234T>G [p.Tyr1412Asp]). Further paraclinical investigations confirmed CHARGE syndrome. Despite the presence of suggestive features, CHARGE syndrome remained undiagnosed in this patient until adolescence. Genetic testing helps clarify the phenotypic and genotypic spectrum to facilitate diagnosis, thus promoting optimal follow-up, treatment, and appropriate genetic counselling.
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Affiliation(s)
- Maria-Christina Antoniou
- Department of Pediatric Endocrinology and Diabetology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Thérèse Bouthors
- Department of Pediatric Endocrinology and Diabetology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Cheng Xu
- Service of Endocrinology, Diabetes and Metabolism, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Franziska Phan-Hug
- Department of Pediatric Endocrinology and Diabetology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Eglantine Elowe-Gruau
- Department of Pediatric Endocrinology and Diabetology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Sophie Stoppa-Vaucher
- Department of Pediatric Endocrinology and Diabetology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Almer van der Sloot
- Institute for Research in Immunology and Cancer (IRIC), University of Montreal, Montreal, Canada
| | - James Acierno
- Service of Endocrinology, Diabetes and Metabolism, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Daniele Cassatella
- Service of Endocrinology, Diabetes and Metabolism, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Celine Richard
- Otorhinolaryngology Service, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Andrew Dwyer
- Service of Endocrinology, Diabetes and Metabolism, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Nelly Pitteloud
- Department of Pediatric Endocrinology and Diabetology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland,Service of Endocrinology, Diabetes and Metabolism, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Michael Hauschild
- Department of Pediatric Endocrinology and Diabetology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland,Address for correspondence: Michael Hauschild, MD Department of Pediatric Endocrinology and Diabetology, Centre Hospitalier Universitaire Vaudois (CHUV), Chemin de Montétan 16, 1000 Lausanne 7, Switzerland Tel: +41-21-314-8773 Fax: +41-21-314-9496 E-mail:
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18
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Leslie LK, Olmsted MG, Turner A, Carraccio C, Dwyer A, Althouse L. MOCA-Peds: Development of a New Assessment of Medical Knowledge for Continuing Certification. Pediatrics 2018; 142:peds.2018-1428. [PMID: 30510031 DOI: 10.1542/peds.2018-1428] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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] [Accepted: 09/11/2018] [Indexed: 11/24/2022] Open
Abstract
The American Board of Pediatrics (ABP) certifies that general and subspecialty pediatricians meet standards of excellence established by their peers. Certification helps demonstrate that a general pediatrician or pediatric subspecialist has successfully completed accredited training and fulfills continuous certification requirements (Maintenance of Certification [MOC]). One current component of the MOC program is a closed-book examination administered at a secure testing center (ie, the MOC Part 3 examination). In this article, we describe the development of an alternative to this examination termed the "Maintenance of Certification Assessment for Pediatrics" (MOCA-Peds) during 2015-2016. MOCA-Peds was conceptualized as an online, summative (ie, pass/fail), continuous assessment of a pediatrician's knowledge that would also promote learning. The system would consist of a set number of multiple-choice questions delivered each quarter, with immediate feedback on questions, rationales clarifying correct and incorrect answers, references for further learning, and peer benchmarking. Questions would be delivered quarterly and taken at any time within the quarter in a setting with Internet connectivity and on any device. As part of the development process in 2015-2016, the ABP actively recruited pediatricians to serve as members of a yearlong user panel or single-session focus groups. Refinements to MOCA-Peds were made on the basis of their feedback. MOCA-Peds is being actively piloted with pediatricians in 2017-2018. The ABP anticipates an expected launch in January 2019 of MOCA-Peds for General Pediatrics, Pediatric Gastroenterology, Child Abuse, and Pediatric Infectious Diseases with launch dates for the remaining pediatric subspecialties between 2020 and 2022.
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Affiliation(s)
- Laurel K Leslie
- The American Board of Pediatrics, Chapel Hill, North Carolina; .,School of Medicine, Tufts University, Boston, Massachusetts; and
| | | | - Adam Turner
- The American Board of Pediatrics, Chapel Hill, North Carolina
| | - Carol Carraccio
- The American Board of Pediatrics, Chapel Hill, North Carolina
| | - Andrew Dwyer
- The American Board of Pediatrics, Chapel Hill, North Carolina
| | - Linda Althouse
- The American Board of Pediatrics, Chapel Hill, North Carolina
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19
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Peterse E, Meester R, Siegel R, Chen J, Dwyer A, Ahnen D, Smith R, Zauber A, Lansdorp-Vogelaar I. The Impact of the Rising Colorectal Cancer Incidence in Young Adults on the Optimal Age to Start Screening in the US: A Microsimulation Analysis. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.34900] [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: 11/20/2022] Open
Abstract
Background: In 2016, the MISCAN-Colon model was used to inform the US Preventive Services Task Force (USPSTF) colorectal cancer (CRC) screening guidelines, which recommend screening from ages 50 to 75 years for average risk individuals. However, these models did not take into account the increase in CRC incidence below the age of 50 years. Aim: In this study, we reevaluated the optimal age to start screening, age to end screening and screening interval in light of the increase in CRC incidence observed in young adults. Methods: We adjusted the simulated lifetime CRC incidence in the MISCAN-Colon model to reflect the observed increase in young onset incidence. In line with the strong birth cohort effect, the current generation of 40-year-olds was assumed to carry forward escalated disease risk as they age. Life-years gained (benefit), the number of colonoscopies (burden) and the ratios of incremental burden to benefit (efficiency ratio) were projected for different screening strategies. Strategies differed with respect to test modality, ages to start screening (40, 45, 50), ages to stop screening (75, 80, 85), and screening intervals (depending on screening modality). We then determined the model-recommended strategies in a similar way as we did for the USPSTF, using similar efficiency ratio thresholds to the previously accepted efficiency ratio of 39 incremental colonoscopies per life-year gained. Results: The life-years gained and the number of colonoscopies for each colonoscopy strategy are plotted in Fig 1. Because of the higher CRC incidence, model-predicted life-years gained from screening increased compared with our previous analyses for the USPSTF. Consequently, the balance of burden to benefit of screening improved, with colonoscopy screening every 10 years starting at age 45 years resulting in an efficiency ratio of 32 incremental colonoscopies per life-year gained. Conclusion: This decision-analytic modeling approach suggests that based on the increase in young-onset CRC incidence, screening initiation at age 45 years has a favorable balance between screening benefits and burden. Screening until age 75 years with colonoscopy every 10 years, fecal immunochemical testing annually, flexible sigmoidoscopy every 5 years, and computed tomographic colonography every 5 years was recommended by the model as these strategies provided similar life-years gained at an acceptable screening burden.[Figure: see text]
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Affiliation(s)
| | | | - R.L. Siegel
- Erasmus Medical Center, Rotterdam, The Netherlands
| | - J.C. Chen
- Erasmus Medical Center, Rotterdam, The Netherlands
| | - A. Dwyer
- Erasmus Medical Center, Rotterdam, The Netherlands
| | - D.J. Ahnen
- Erasmus Medical Center, Rotterdam, The Netherlands
| | - R.A. Smith
- Erasmus Medical Center, Rotterdam, The Netherlands
| | - A.G. Zauber
- Erasmus Medical Center, Rotterdam, The Netherlands
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Helou N, Dwyer A, Shaha M, Zanchi A. Erratum to: Multidisciplinary management of diabetic kidney disease: a systematic review and meta-analysis. JBI Database System Rev Implement Rep 2018; 16:1902. [PMID: 30204674 DOI: 10.11124/jbisrir-2017-003886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Nancy Helou
- Bureau d'change des savoirs pour des pratiques exemplaires de soins (BEST), The University of Health Sciences (HESAV), Lausanne, University of Applied Sciences of Western Switzerland: a Joanna Briggs Institute Affiliate Center
- University of Lausanne-Faculty of Biology and Medicine, Institut Universitaire de Formation et de Recherche en Soins IUFRS, Lausanne, Switzerland
| | - Andrew Dwyer
- Service of Endocrinology, Diabetes and Metabolism, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Maya Shaha
- University of Lausanne-Faculty of Biology and Medicine, Institut Universitaire de Formation et de Recherche en Soins IUFRS, Lausanne, Switzerland
- Inselspital, University Hospital Berne, Directorate of Nursingand Allied Health Professions, Department of Nursing Development, Switzerland
| | - Anne Zanchi
- Service of Endocrinology, Diabetes and Metabolism, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
- Service of Nephrology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
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Singer-Berk M, Knickelbein KE, Vig S, Liu J, Bentley E, Nunnery C, Reilly C, Dwyer A, Drögemüller C, Unger L, Gerber V, Lassaline M, Bellone RR. Genetic risk for squamous cell carcinoma of the nictitating membrane parallels that of the limbus in Haflinger horses. Anim Genet 2018; 49:457-460. [PMID: 29999543 DOI: 10.1111/age.12695] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2018] [Indexed: 11/29/2022]
Abstract
Squamous cell carcinoma (SCC) is the most common cancer affecting the equine eye, with a higher incidence documented in Haflinger horses. Recently, a missense variant in the gene damage specific DNA binding protein 2 (DDB2, p.Thr338Met) on ECA12 was identified as a risk factor for the development of limbal SCC in Haflinger horses. SCC also occurs on the nictitating membrane; therefore, investigating the role of this missense variant in nictitating membrane SCC is warranted. In this study, a common ancestor was identified among Haflinger horses affected with limbal SCC or with nictitating membrane SCC, thus supporting a recessive risk factor for the development of cancer at both ocular locations. Analysis of genotype data from Haflinger horses with and without nictitating membrane SCC revealed that the same region on ECA12 associated with limbal SCC was also associated with nictitating membrane SCC (P < 2.04 × 10-5 ). Fine mapping of this locus using 25 cases and 49 controls supported the hypothesis that DDB2:c.1013C>T, p.Thr338Met, is a risk factor for nictitating membrane SCC, as 88% of our cases were homozygous for this variant and no other polymorphism was more strongly associated (P = 4.13 × 10-14 ). These data indicate that the genetic risk is the same for the development of both limbal and nictitating membrane SCC in Haflinger horses and validates utilization of genetic testing of the DDB2 variant for both clinical management and the guidance of mating decisions.
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Affiliation(s)
- M Singer-Berk
- Veterinary Genetics Laboratory, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616, USA
| | - K E Knickelbein
- Veterinary Genetics Laboratory, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616, USA.,Veterinary Medical Teaching Hospital, University of California-Davis, Davis, CA, 95616, USA
| | - S Vig
- Veterinary Genetics Laboratory, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616, USA
| | - J Liu
- Veterinary Genetics Laboratory, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616, USA
| | - E Bentley
- Department of Surgical Services, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - C Nunnery
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - C Reilly
- Insight Veterinary Specialty Pathology, 6902A Bennett Ave., Austin, TX, 78752, USA
| | - A Dwyer
- Genesee Valley Equine Clinic, LLC, Scottsville, NY, 14546, USA
| | - C Drögemüller
- Institute of Genetics, Vetsuisse Faculty, University of Bern, Hochschulstrasse 6, Bern, Switzerland
| | - L Unger
- Department of Clinical Veterinary Medicine, Swiss Institute of Equine Medicine, Vetsuisse Faculty, University of Bern and Agroscope, Hochschulstrasse 6, Bern, Switzerland
| | - V Gerber
- Department of Clinical Veterinary Medicine, Swiss Institute of Equine Medicine, Vetsuisse Faculty, University of Bern and Agroscope, Hochschulstrasse 6, Bern, Switzerland
| | - M Lassaline
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616, USA
| | - R R Bellone
- Veterinary Genetics Laboratory, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616, USA.,Department of Population Health and Reproduction, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616, USA
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Sposato LA, Lam Y, Karapetis C, Vatandoust S, Roy A, Hakendorf P, Dwyer A, de Fontgalland D, Hollington P, Wattchow D. Observation of "complete clinical response" in rectal cancer after neoadjuvant chemoradiation: The Flinders experience. Asia Pac J Clin Oncol 2018; 14:439-445. [PMID: 29932278 DOI: 10.1111/ajco.12993] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 04/29/2018] [Indexed: 01/17/2023]
Abstract
AIM Observation with close follow-up ("watch and wait") is a recognized treatment option in patients who achieve a complete clinical response to long course chemoradiotherapy. This review of a prospective database aims to evaluate the clinical outcomes among patients with a complete clinical response managed with observation. METHODS A prospective study of 32 patients who achieved a complete clinical response was undertaken. The primary outcomes measured were overall and recurrence-free survival, and rate of organ preservation in patients who deferred immediate surgery. RESULTS Seven patients developed local regrowth over a median follow-up period of 38 months (range, 9-91 months). Median time to detection was 12 months. All seven underwent salvage surgery with complete surgical clearance. One patient developed combined local and systemic recurrence following a low anterior resection. Organ preservation was possible in 25 (78%) patients who sustained a complete clinical response with no evidence of local regrowth or disease recurrence. Among the patients who sustained a complete response, two developed isolated systemic disease. Overall and recurrence-free survival was 95.7% and 87.0%, respectively. CONCLUSION The majority of patients with rectal cancer who achieved a complete clinical response after chemoradiotherapy and managed with a "watch and wait" approach preserved their rectum and did not develop cancer relapse. Salvage surgery was achieved in all patients who developed local regrowth. The study supports a period of observation in rectal cancer patients who achieve a complete clinical response.
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Affiliation(s)
- Luigi A Sposato
- Department of Surgery, Flinders Medical Centre, Flinders University, Bedford Park, South Australia, Australia
| | - Yick Lam
- Department of Surgery, Flinders Medical Centre, Flinders University, Bedford Park, South Australia, Australia
| | - Chris Karapetis
- Department of Medical Oncology, Flinders Medical Centre, Flinders University, Bedford Park, South Australia, Australia
| | - Sina Vatandoust
- Department of Medical Oncology, Flinders Medical Centre, Flinders University, Bedford Park, South Australia, Australia
| | - Amitesh Roy
- Department of Medical Oncology, Flinders Medical Centre, Flinders University, Bedford Park, South Australia, Australia
| | - Paul Hakendorf
- Department of Epidemiology, Flinders Medical Centre, Flinders University, Bedford Park, South Australia, Australia
| | - Andrew Dwyer
- Department of Radiology, Flinders Medical Centre, Flinders University, Bedford Park, South Australia, Australia
| | - Dayan de Fontgalland
- Department of Surgery, Flinders Medical Centre, Flinders University, Bedford Park, South Australia, Australia
| | - Paul Hollington
- Department of Surgery, Flinders Medical Centre, Flinders University, Bedford Park, South Australia, Australia
| | - David Wattchow
- Department of Surgery, Flinders Medical Centre, Flinders University, Bedford Park, South Australia, Australia
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Hodgetts T, Grenyer R, Greenhough B, McLeod C, Dwyer A, Lorimer J. The microbiome and its publics: A participatory approach for engaging publics with the microbiome and its implications for health and hygiene. EMBO Rep 2018; 19:embr.201845786. [PMID: 29777052 DOI: 10.15252/embr.201845786] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Timothy Hodgetts
- School of Geography and the Environment, University of Oxford, Oxford, UK
| | - Richard Grenyer
- School of Geography and the Environment, University of Oxford, Oxford, UK
| | - Beth Greenhough
- School of Geography and the Environment, University of Oxford, Oxford, UK
| | - Carmen McLeod
- School of Geography and the Environment, University of Oxford, Oxford, UK
| | - Andrew Dwyer
- School of Geography and the Environment, University of Oxford, Oxford, UK
| | - Jamie Lorimer
- School of Geography and the Environment, University of Oxford, Oxford, UK
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Abstract
BACKGROUND The increasing prevalence of diabetes poses significant challenges to healthcare systems around the world. Diabetes is the leading cause of end-stage renal disease. Diabetic kidney disease (DKD) is becoming a global health concern because it is a progressive disease associated with major health complications and increased health costs. The treatment goals for DKD are to slow the progression of the renal disease and prevent cardiovascular events. Accordingly, patients are expected to adhere to prescribed treatments and manage a wide range of daily self-care activities. Multidisciplinary management of chronic diseases, like diabetes and kidney disease, has been suggested as a means to improve patients' adherence to treatment and enhance health-related outcomes. This systematic review of multidisciplinary management of DKD is an important step in evaluating if such a management approach is effective in delaying disease progression. OBJECTIVES The goal of this systematic review was to identify the best available evidence regarding multidisciplinary management of DKD and to determine if a multidisciplinary management of DKD can improve patient outcomes. Specifically the review question was: What is the impact of multidisciplinary management of DKD on patient outcomes? INCLUSION CRITERIA TYPES OF PARTICIPANTS The current review considered adults aged 18 years and older who had been diagnosed with type 1 or type 2 diabetes and chronic kidney disease. TYPES OF INTERVENTION(S)/PHENOMENA OF INTEREST The current review examined studies that compared multidisciplinary interventions with usual standard care in ambulatory settings for patients with DKD. OUTCOMES The current review considered studies with the following primary outcomes: kidney function, incidence of kidney failure, generic or specific health-related quality of life, patient self-care abilities, adherence to treatment recommendations or goals; and the following secondary clinical outcomes: mortality rates secondary to DKD, glycemic control, blood pressure (BP) control, lipid profile, incidence of cardiovascular disease/events, patient knowledge on diabetes or DKD, patient empowerment or self-efficacy, generic or specific patient satisfaction with care and patient healthcare utilization. TYPES OF STUDIES The current review will consider randomized and quasi-experimental trials but included only randomized controlled trials (RCTs). SEARCH STRATEGY A three-step search strategy was utilized starting with a search of MEDLINE and CINAHL for the identification of keywords, followed by a search using keywords and index terms across MEDLINE, CINAHL and Embase databases and clinical trials registry platforms, and finally a search of the reference list of all identified papers. Studies published from the time of the respective database inception to November 2014 in English, German and French were considered. METHODOLOGICAL QUALITY Two independent reviewers assessed the methodological validity of the papers prior to inclusion in the review using the standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). DATA EXTRACTION Data were extracted from papers included in the review using the standardized data extraction tool from JBI-MAStARI. DATA SYNTHESIS Quantitative data were pooled using the RevMan 5 software for kidney function using estimated Glomerular Filtration Rate (eGFR), glycated hemoglobin, BP and total cholesterol (TC). Results were considered significant for P < 0.05. RESULTS Three RCTs were included in this review. Meta-analysis showed that multidisciplinary management was associated with a statistically significant improvement of glycated hemoglobin as compared with standard usual care (Relative Risk [RR] -0.49, at 95% confidence interval [CI] -0.83, -0.16, P < 0.01). The meta-analysis for eGFR showed a tendency to favor standard care; however, this finding cannot be conclusive because the CI was too wide (RR -3.30, at 95% CI -6.55, -0.05, P = 0.05). Meta-analysis results for BP and TC failed to show a difference between the multidisciplinary management of DKD and the usual standard care. Only one study measured patient-oriented primary and secondary outcomes and showed an improvement in health-related quality of life, patient self-care abilities, patient level of knowledge on diabetes and exercise self-efficacy. CONCLUSION Multidisciplinary management of DKD has the potential for improving glycemic control and thus preventing complications. Its effect on other clinical and patient-oriented outcomes, especially on delaying the progression of the disease through preserving and preventing the decline in kidney function, has yet to be determined. There is not enough evidence to recommend multidisciplinary management for preserving kidney function. Further studies are needed.
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Affiliation(s)
- Nancy Helou
- 1Bureau d'Echange des Savoirs pour des praTiques exemplaires de soins (BEST), The University of Health Sciences (HESAV), Lausanne, University of Applied Sciences of Western Switzerland: an Affiliate Center of the Joanna Briggs Institute 2University of Lausanne-Faculty of Biology and Medicine, Institut Universitaire de Formation et de Recherche en Soins IUFRS, Lausanne, Vaud, Switzerland 3Service of Endocrinology, Diabetes and Metabolism, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Vaud, Switzerland 4Service of Nephrology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Vaud, Switzerland 5Inselspital, University Hospital Berne, Directorate of Nursing and Allied Health Professions, Department of Nursing Development, Switzerland
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Affiliation(s)
- Sally S Cohen
- New York University Rory Meyers College of Nursing, New York, NY, USA.
| | - Andrew Dwyer
- Connell School of Nursing, Boston College, Chestnut Hill, MA, USA
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Mabire C, Dwyer A, Garnier A, Pellet J. Effectiveness of nursing discharge planning interventions on health-related outcomes in discharged elderly inpatients: a systematic review. ACTA ACUST UNITED AC 2018; 14:217-260. [PMID: 27755325 DOI: 10.11124/jbisrir-2016-003085] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Inadequate discharge planning for the growing elderly population poses significant challenges for health services. Effective discharge planning interventions have been examined in several studies, but little information is available on nursing's role or the specific components of these interventions. Despite the research published on the importance of discharge planning, the impact on patient's health outcomes still needs to be proven in practice. OBJECTIVES To determine the best available evidence on the effectiveness of discharge planning interventions involving at least one nurse on health-related outcomes for elderly inpatients discharged home and to assess the relative impact of individual components of discharge planning interventions. INCLUSION CRITERIA TYPES OF PARTICIPANTS Elderly inpatients aged 65 years or older, discharged from acute care and post-acute care rehabilitation hospitals to home. TYPES OF INTERVENTIONS The review focused on the six keys components of Naylor's Transitional Care Model: early geriatric assessment, discharge preparation, patient or caregiver's participation, continuity of care, day of discharge assessment and post-discharge follow-up. TYPES OF STUDIES This review considered randomized and non-randomized controlled trials, quasi-experimental studies, before and after studies, prospective and retrospective cohort studies, case-control studies and analytical cross-sectional studies. OUTCOMES The outcomes for this review were functional ability, symptoms management, adverse outcomes, unmet needs after discharge, coping with disease, health-related quality of life (QoL), satisfaction with care, readmission rate and healthcare utilization. SEARCH STRATEGY A systematic search was undertaken across 13 databases to retrieve published and unpublished studies in English between 2000 and 2015. METHODOLOGICAL QUALITY Critical appraisal was undertaken by two independent reviewers using standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). DATA EXTRACTION Quantitative data were extracted from included studies independently by the two reviewers using the standardized data extraction tool from JBI-MAStARI. DATA SYNTHESIS Due to the wide range of outcome measures, a comprehensive meta-analysis for all studies was not possible. However, meta-analysis was conducted for specific outcome measures, such as readmission, length of stay and QoL. RESULTS Thirteen studies met the inclusion criteria and were included in the review. Two out of the 13 studies were pilot studies and one had a pre-post design. Included studies involved a total of 3964 participants with a median age of 77 years. Nurse discharge planning did not significantly reduce hospital readmission rate (odds ratio [OR] = 0.73, 95% confidence intervals [CIs] = 0.53-1.01, P = 0.06). The overall effect score for length of stay was significant (weighted mean difference = 0.29, P < 0.01), suggesting that discharge planning increased the length of hospitalization. The effectiveness of discharge planning did not significantly impact QoL (mental OR = 0.37, P = 0.19 and physical OR = 0.47, P = 0.15). CONCLUSION Findings of this review suggest that nursing discharge planning for elderly inpatients discharged home increases length of stay, yet neither reduces readmission rates nor improves QoL.
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Affiliation(s)
- Cedric Mabire
- 1University of Applied Sciences and Arts Western Switzerland (HES-SO), School of Health Sciences (HESAV), Lausanne, Vaud, Switzerland 2Bureau d'Echange des Savoirs pour des praTique exemplaires de soins (BEST): a Joanna Briggs Institute Centre of Excellence 3Institute of Higher Education and Research in Healthcare (IUFRS), Lausanne University and CHUV, Vaud, Switzerland 4Lausanne University Hospital - CHUV, Lausanne, Vaud, Switzerland
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Davis A, Baldwin A, Hingorani M, Dwyer A, Flanagan D. Response to: ‘Comment on A review of 145 234 ophthalmic patient episodes lost to follow-up’. Eye (Lond) 2018; 32:475. [DOI: 10.1038/eye.2017.188] [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: 11/09/2022] Open
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Mabire C, Dwyer A, Garnier A, Pellet J. Meta-analysis of the effectiveness of nursing discharge planning interventions for older inpatients discharged home. J Adv Nurs 2017; 74:788-799. [DOI: 10.1111/jan.13475] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2017] [Indexed: 01/05/2023]
Affiliation(s)
- Cédric Mabire
- Institute of Higher Education and Research in Healthcare (IUFRS); Lausanne University and Lausanne University Hospital; Lausanne Switzerland
- Bureau d'Echange des Savoirs pour des praTique exemplaires de soins: an Affiliate Center of the Joanna Briggs Institute; Lausanne Switzerland
- Lausanne University Hospital (CHUV); Lausanne Switzerland
| | - Andrew Dwyer
- Institute of Higher Education and Research in Healthcare (IUFRS); Lausanne University and Lausanne University Hospital; Lausanne Switzerland
- Lausanne University Hospital (CHUV); Lausanne Switzerland
- Boston College William F. Connell School of Nursing; Chestnut Hill MA USA
| | | | - Joanie Pellet
- Institute of Higher Education and Research in Healthcare (IUFRS); Lausanne University and Lausanne University Hospital; Lausanne Switzerland
- Bureau d'Echange des Savoirs pour des praTique exemplaires de soins: an Affiliate Center of the Joanna Briggs Institute; Lausanne Switzerland
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Hussain A, Valsamis E, Butt F, Dwyer A. Plain Radiographic Findings of Rotator Cuff Tears. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.398] [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: 10/18/2022]
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Somm E, Henry H, Bruce SJ, Aeby S, Rosikiewicz M, Sykiotis GP, Asrih M, Jornayvaz FR, Denechaud PD, Albrecht U, Mohammadi M, Dwyer A, Acierno JS, Schoonjans K, Fajas L, Greub G, Pitteloud N. β-Klotho deficiency protects against obesity through a crosstalk between liver, microbiota, and brown adipose tissue. JCI Insight 2017; 2:91809. [PMID: 28422755 DOI: 10.1172/jci.insight.91809] [Citation(s) in RCA: 37] [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] [Received: 11/28/2016] [Accepted: 03/07/2017] [Indexed: 12/21/2022] Open
Abstract
β-Klotho (encoded by Klb) is the obligate coreceptor mediating FGF21 and FGF15/19 signaling. Klb-/- mice are refractory to beneficial action of pharmacological FGF21 treatment including stimulation of glucose utilization and thermogenesis. Here, we investigated the energy homeostasis in Klb-/- mice on high-fat diet in order to better understand the consequences of abrogating both endogenous FGF15/19 and FGF21 signaling during caloric overload. Surprisingly, Klb-/- mice are resistant to diet-induced obesity (DIO) owing to enhanced energy expenditure and BAT activity. Klb-/- mice exhibited not only an increase but also a shift in bile acid (BA) composition featured by activation of the classical (neutral) BA synthesis pathway at the expense of the alternative (acidic) pathway. High hepatic production of cholic acid (CA) results in a large excess of microbiota-derived deoxycholic acid (DCA). DCA is specifically responsible for activating the TGR5 receptor that stimulates BAT thermogenic activity. In fact, combined gene deletion of Klb and Tgr5 or antibiotic treatment abrogating bacterial conversion of CA into DCA both abolish DIO resistance in Klb-/- mice. These results suggested that DIO resistance in Klb-/- mice is caused by high levels of DCA, signaling through the TGR5 receptor. These data also demonstrated that gut microbiota can regulate host thermogenesis via conversion of primary into secondary BA. Pharmacologic or nutritional approaches to selectively modulate BA composition may be a promising target for treating metabolic disorders.
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Affiliation(s)
- Emmanuel Somm
- Service of Endocrinology, Diabetology and Metabolism, Lausanne University Hospital; Department of Physiology, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Hugues Henry
- Clinical Chemistry Laboratory, Lausanne University Hospital, Lausanne, Switzerland
| | - Stephen J Bruce
- Clinical Chemistry Laboratory, Lausanne University Hospital, Lausanne, Switzerland
| | - Sébastien Aeby
- Institute of Microbiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Marta Rosikiewicz
- Institute of Microbiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Gerasimos P Sykiotis
- Service of Endocrinology, Diabetology and Metabolism, Lausanne University Hospital; Department of Physiology, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Mohammed Asrih
- Service of Endocrinology, Diabetology and Metabolism, Lausanne University Hospital; Department of Physiology, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - François R Jornayvaz
- Service of Endocrinology, Diabetology and Metabolism, Lausanne University Hospital; Department of Physiology, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Pierre Damien Denechaud
- Department of Physiology, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Urs Albrecht
- Department of Biology, Unit of Biochemistry, University of Fribourg, Fribourg, Switzerland
| | - Moosa Mohammadi
- Department of Biochemistry and Molecular Pharmacology, New York University School of Medicine, New York, New York, USA
| | - Andrew Dwyer
- Service of Endocrinology, Diabetology and Metabolism, Lausanne University Hospital; Department of Physiology, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - James S Acierno
- Service of Endocrinology, Diabetology and Metabolism, Lausanne University Hospital; Department of Physiology, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Kristina Schoonjans
- Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Lluis Fajas
- Department of Physiology, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Gilbert Greub
- Institute of Microbiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Nelly Pitteloud
- Service of Endocrinology, Diabetology and Metabolism, Lausanne University Hospital; Department of Physiology, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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Serena A, Dwyer A, Peters S, Eicher M. Feasibility of advanced practice nurse in lung cancer consultations during early treatment: a phase II study. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30594-4] [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: 10/20/2022]
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Serena A, Dwyer A, Eicher M. OA14.01 Acceptability of an Advanced Practice Nurse in Lung Cancer by Health Professionals and Patients: A Qualitative Exploration. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.306] [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: 10/20/2022]
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Phan-Hug F, Kraus C, Paoloni-Giacobino A, Fellmann F, Typaldou SA, Ansermet F, Alamo L, Eggert N, Pelet O, Vial Y, Muehlethaler V, Birraux J, Ramseyer P, Renteria SC, Dwyer A, Pitteloud N, Meyrat BJ. [Patients with variations of sex development : an example of interdisciplinary care]. Rev Med Suisse 2016; 12:1923-1929. [PMID: 28696598] [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: 06/07/2023]
Abstract
The medical, psychological and social aspects of disorders of sex development (DSD) represent a challenge for the management of these patients. However, advances in our understanding of the etiology and genetics of this condition, novel surgical approaches and the growing influence of patient groups as well as wider recognition of ethical issues have helped improve the care of patients with a DSD. Importantly, a multidisciplinary approach involving specialists is crucial for understanding and treating such rare and complex cases. According to the recommendations of the Swiss National Ethical Commission, we shall use the term « Variation of Sex Development » rather than « Disorder of Sex Development » in this publication. This article addresses the care of DSD patients throughout development from the point of view of specialists in complementary fields.
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Affiliation(s)
| | - Cynthia Kraus
- Institut des sciences sociales, Faculté des sciences sociales et politiques, 1015 Lausanne
| | | | | | - Sophia-Anna Typaldou
- Service de psychiatrie de l'enfant et de l'adolescent, Département de psychiatrie, CHUV, 1011 Lausanne
| | | | - Leonor Alamo
- Unité de radiologie pédiatrique, Service de radiologie diagnostique et interventionnelle, CHUV, 1011 Lausanne
| | - Nadja Eggert
- Plateforme interdisciplinaire d'éthique Ethos, Université de Lausanne, 1015 Lausanne
| | - Odile Pelet
- Docteur en droit-Avocate au Barreau, Spécialiste FSA en responsabilité civile et droit des assurances, Petit-Chêne 12, 1002 Lausanne
| | - Yvan Vial
- Service d'obstétrique, Département de gynécologie-obstétrique et génétique médicale, CHUV, 1011 Lausanne
| | - Vincent Muehlethaler
- Service de néonatologie, Département médico-chirurgical de pédiatrie, CHUV, 1011 Lausanne
| | - Jacques Birraux
- Service de chirurgie pédiatrique, Département de pédiatrie, HUG, 1211 Genève 14
| | - Pascal Ramseyer
- Service de chirurgie pédiatrique, Département de pédiatrie, Hôpital cantonal du Valais, 1950 Sion
| | - Saira-Christine Renteria
- Service d'obstétrique, Département de gynécologie-obstétrique et génétique médicale, CHUV, 1011 Lausanne
| | - Andrew Dwyer
- Département d'endocrinologie, diabétologie et métabolisme, CHUV, 1011 Lausanne
| | - Nelly Pitteloud
- Unité d'endocrinologie pédiatrique, CHUV, 1011 Lausanne
- Département d'endocrinologie, diabétologie et métabolisme, CHUV, 1011 Lausanne
| | - Blaise J Meyrat
- Service de chirurgie pédiatrique, Département médico-chirurgical de pédiatrie, CHUV, 1011 Lausanne
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Lovell J, Dwyer A, Jones E, Shah N, Gautam R, Asokan I, Metwalli A, Srinivasan R, Linehan WM, Malayeri A. PD14-04 SPECTRUM OF RADIOLOGICAL FINDINGS OF HEREDITARY LEIOMYOMATOSIS AND RENAL CELL CANCER (HLRCC). J Urol 2016. [DOI: 10.1016/j.juro.2016.02.1001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Deillon E, Hauschild M, Faouzi M, Stoppa-Vaucher S, Elowe-Gruau E, Dwyer A, Theintz GE, Dubuis JM, Mullis PE, Pitteloud N, Phan-Hug F. Natural history of growth hormone deficiency in a pediatric cohort. Horm Res Paediatr 2016; 83:252-61. [PMID: 25676059 DOI: 10.1159/000369392] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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] [Received: 04/14/2014] [Accepted: 10/27/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Controversies still exist regarding the evaluation of growth hormone deficiency (GHD) in childhood at the end of growth. The aim of this study was to describe the natural history of GHD in a pediatric cohort. METHODS This is a retrospective study of a cohort of pediatric patients with GHD. Cases of acquired GHD were excluded. Univariate logistic regression was used to identify predictors of GHD persisting into adulthood. RESULTS Among 63 identified patients, 47 (75%) had partial GHD at diagnosis, while 16 (25%) had complete GHD, including 5 with multiple pituitary hormone deficiencies. At final height, 50 patients underwent repeat stimulation testing; 28 (56%) recovered and 22 (44%) remained growth hormone (GH) deficient. Predictors of persisting GHD were: complete GHD at diagnosis (OR 10.1, 95% CI 2.4-42.1), pituitary stalk defect or ectopic pituitary gland on magnetic resonance imaging (OR 6.5, 95% CI 1.1-37.1), greater height gain during GH treatment (OR 1.8, 95% CI 1.0-3.3), and IGF-1 level <-2 standard deviation scores (SDS) following treatment cessation (OR 19.3, 95% CI 3.6-103.1). In the multivariate analysis, only IGF-1 level <-2 SDS (OR 13.3, 95% CI 2.3-77.3) and complete GHD (OR 6.3, 95% CI 1.2-32.8) were associated with the outcome. CONCLUSION At final height, 56% of adolescents with GHD had recovered. Complete GHD at diagnosis, low IGF-1 levels following retesting, and pituitary malformation were strong predictors of persistence of GHD.
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Affiliation(s)
- Eva Deillon
- Division of Endocrinology, Diabetology and Obesity, University Hospital Lausanne, Lausanne, Switzerland
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Dwyer A, Raivio T. Comment on reversal of hypogonadotropic hypogonadism in a Chinese cohort. Asian J Androl 2015; 17:508. [PMID: 25814161 PMCID: PMC4430960 DOI: 10.4103/1008-682x.151399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Taneli Raivio
- University of Helsinki, Department of Physiology and the Children's Hospital of Helsinki University Central Hospital, Helsinki, 00014, Finland
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Hauschild M, Elowe-Gruau E, Dwyer A, Aquarone MP, Unal S, Jornayvaz FR, Perrenoud L, Gastaldi G, Castellsague M, Dirlewanger M, Schwitzgebel VM. [Transition in diabetology]. Rev Med Suisse 2015; 11:450-455. [PMID: 25915986] [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: 06/04/2023]
Abstract
For patients with type I diabetes, transition from pediatric to adult care is a challenge due to complex treatment requirements and the physical, psychological and social changes of adolescence. Members of the care team must recognize that while these emerging adults need to develop self-management skills, this may conflict at times with the developmentally appropriate desire for increasing autonomy. The role of nursing in coordinating a successful transition is critical for maintaining continuity of patient-centered care that responds to the specific needs of these young adults.
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Risendal B, Dwyer A, Seidel R, Lorig K, Katzenmeyer C, Coombs L, Kellar-Guenther Y, Warren L, Franco A, Ory M. Adaptation of the chronic disease self-management program for cancer survivors: feasibility, acceptability, and lessons for implementation. J Cancer Educ 2014; 29:762-771. [PMID: 24903138 DOI: 10.1007/s13187-014-0652-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Self-management in chronic disease has been shown to improve patient-reported and health care-related outcomes. However, relatively little information about its utility in cancer survivorship is known. We evaluated the feasibility and acceptability of the delivery of an adaptation of the evidence-based Chronic Disease Self-management Program (Stanford) called Cancer Thriving and Surviving (CTS). Triangulated mixed methods were used to capture baseline characteristics and post-program experiences using a combination of closed- and open-ended survey items; emergent coding and simple descriptive statistics were used to summarize the data. Twenty-seven workshops were delivered by 22 CTS leaders to 244 participants between August 2011 and January 2013 in a variety of settings (48 % community, 30 % health care, 22 % regional/community cancer center). Representing a variety of cancer types, about half the participants were 1-3 years post-diagnosis and 45 % were 4 or more years from diagnosis. Program attendance was high with 84 % of participants attending four or more of the six sessions in the workshop. Overall, 95 % of the participants were satisfied with the program content and leaders, and would recommend the program to friends and family. These results confirm the feasibility and acceptability of delivery of a high-fidelity, peer-led model for self-management support for cancer survivors. Expansion of the CTS represents a powerful tool toward improving health-related outcomes in this at-risk population.
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Affiliation(s)
- B Risendal
- Community and Behavioral Health, Colorado School of Public Health, University of Colorado Cancer Center, 13001 E. 17th Street, MS F538, Aurora, CO, 80045, USA,
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Helou N, Dwyer A, Burnier M, Shaha M, Zanchi A. Multidisciplinary management of diabetic kidney disease: a systematic review protocol. ACTA ACUST UNITED AC 2014. [DOI: 10.11124/jbisrir-2014-1543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Broskey NT, Greggio C, Boss A, Boutant M, Dwyer A, Schlueter L, Hans D, Gremion G, Kreis R, Boesch C, Canto C, Amati F. Skeletal muscle mitochondria in the elderly: effects of physical fitness and exercise training. J Clin Endocrinol Metab 2014; 99:1852-61. [PMID: 24438376 DOI: 10.1210/jc.2013-3983] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Sarcopenia is thought to be associated with mitochondrial (Mito) loss. It is unclear whether the decrease in Mito content is consequent to aging per se or to decreased physical activity. OBJECTIVES The objective of the study was to examine the influence of fitness on Mito content and function and to assess whether exercise could improve Mito function in older adults. DESIGN AND SUBJECTS Three distinct studies were conducted: 1) a cross-sectional observation comparing Mito content and fitness in a large heterogeneous cohort of older adults; 2) a case-control study comparing chronically endurance-trained older adults and sedentary (S) subjects matched for age and gender; and 3) a 4-month exercise intervention in S. SETTING The study was conducted at a university-based clinical research center. OUTCOMES Mito volume density (MitoVd) was assessed by electron microscopy from vastus lateralis biopsies, electron transport chain proteins by Western blotting, mRNAs for transcription factors involved in M biogenesis by quantitative RT-PCR, and in vivo oxidative capacity (ATPmax) by (31)P-magnetice resonance spectroscopy. Peak oxygen uptake was measured by graded exercise test. RESULTS Peak oxygen uptake was strongly correlated with MitoVd in 80 60- to 80-year-old adults. Comparison of chronically endurance-trained older adults vs S revealed differences in MitoVd, ATPmax, and some electron transport chain protein complexes. Finally, exercise intervention confirmed that S subjects are able to recover MitoVd, ATPmax, and specific transcription factors. CONCLUSIONS These data suggest the following: 1) aging per se is not the primary culprit leading to Mito dysfunction; 2) an aerobic exercise program, even at an older age, can ameliorate the loss in skeletal muscle Mito content and may prevent aging muscle comorbidities; and 3) the improvement of Mito function is all about content.
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Affiliation(s)
- Nicholas T Broskey
- Department of Physiology (N.T.B., C.G., F.A.), School of Biology and Medicine, University of Lausanne, Lausanne CH-1005, Switzerland; Department of Clinical Research, Magnetic Resonance Spectroscopy, and Methodology (A.B., R.K., C.B.), University of Bern, CH-3010 Bern, Switzerland; Nestle Institute of Health Sciences (M.B., C.C.), Lausanne CH-1015, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (A.D., F.A.), Service of Cardiology (L.S.), Center for Bone Disease (D.H.), and Sports Medicine Unit (G.G.), University Hospital, CH-1011 Lausanne, Switzerland; and Endocrinology and Metabolism Research Center (F.A.), School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15213
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Dwyer A. Science-in-brief: clinical highlights from the American Association of Equine Practitioners 59th Annual Convention and Equine Veterinary Journal Supplement 45. Equine Vet J 2014; 46:259-61. [PMID: 24716704 PMCID: PMC7163692 DOI: 10.1111/evj.12239] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A Dwyer
- Genesee Valley Equine Clinic, Scottsville, New York, USA
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Pitteloud N, Dwyer A. Hormonal control of spermatogenesis in men: Therapeutic aspects in hypogonadotropic hypogonadism. Annales d'Endocrinologie 2014; 75:98-100. [DOI: 10.1016/j.ando.2014.04.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kim H, Montealegre Sanchez GA, Chapelle DC, Plass N, Dwyer A, Goldbach-Mansky R, Hill S. A80: Skeletal Features of Neonatal-Onset Multisystem Inflammatory Disease (NOMID) on Anakinra Treatment: Long-Term Follow-up. Arthritis Rheumatol 2014. [DOI: 10.1002/art.38496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Hanna Kim
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH; Bethesda MD
| | | | - Dawn C. Chapelle
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH; Bethesda MD
| | - Nicole Plass
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH; Bethesda MD
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Sidhoum VF, Chan YM, Lippincott MF, Balasubramanian R, Quinton R, Plummer L, Dwyer A, Pitteloud N, Hayes FJ, Hall JE, Martin KA, Boepple PA, Seminara SB. Reversal and relapse of hypogonadotropic hypogonadism: resilience and fragility of the reproductive neuroendocrine system. J Clin Endocrinol Metab 2014; 99:861-70. [PMID: 24423288 PMCID: PMC3942233 DOI: 10.1210/jc.2013-2809] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [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] [Indexed: 12/27/2022]
Abstract
CONTEXT A subset of patients diagnosed with idiopathic hypogonadotropic hypogonadism (IHH) later achieves activation of their hypothalamic-pituitary-gonadal axis with normalization of steroidogenesis and/or gametogenesis, a phenomenon termed reversal. OBJECTIVE The objective of this study was to determine the natural history of reversal and to identify associated phenotypes and genotypes. DESIGN, SETTING, AND SUBJECTS This was a retrospective review of clinical, biochemical, and genetic features of patients with IHH evaluated at an academic medical center. MAIN OUTCOME MEASURES History of spontaneous fertility, regular menses, testicular growth, or normalization of serum sex steroids, LH secretory profiles, brain imaging findings, and sequences of 14 genes associated with IHH were reviewed. RESULTS Of 308 patients with IHH, 44 underwent reversal. Time-to-event analysis estimated a lifetime incidence of reversal of 22%. There were no differences in the rates of cryptorchidism, micropenis, or partial pubertal development in patients with reversal vs IHH patients without reversal. Fifteen patients with reversal (30%) had Kallmann syndrome (IHH and anosmia); one had undetectable olfactory bulbs on a brain magnetic resonance imaging scan. Subjects with reversal were enriched for mutations affecting neurokinin B signaling compared with a cohort of IHH patients without reversal (10% vs 3%, P = .044), had comparable frequencies of mutations in FGFR1, PROKR2, and GNRHR, and had no mutations in KAL1. Five men did not sustain their reversal and again developed hypogonadotropism. CONCLUSIONS Reversal of IHH may be more widespread than previously appreciated and occurs across a broad range of genotypes and phenotypes. Enrichment for mutations that disrupt neurokinin B signaling in patients who reversed indicates that, despite the importance of this signaling pathway for normal pubertal timing, its function is dispensable later in life. The occurrence of reversal in a patient with no olfactory bulbs demonstrates that these structures are not essential for normal reproductive function. Patients with IHH require lifelong monitoring for reversal and, if reversal occurs, subsequent relapse also may occur.
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Affiliation(s)
- Valerie F Sidhoum
- Harvard Center for Reproductive Endocrine Sciences and Reproductive Endocrine Unit (V.F.S., Y.-M.C., M.F.L., R.B., L.P., A.D., N.P., F.J.H., J.E.H., K.A.M., P.A.B., S.B.S.), Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114; Division of Endocrinology (Y.-M.C.), Department of Medicine, Boston Children's Hospital, Boston, Massachusetts 02115; and Department of Endocrinology (R.Q.), Institute for Human Genetics, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne NE1 3BZ, United Kingdom
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Mabire C, Monod S, Dwyer A, Pellet J. Effectiveness of nursing discharge planning interventions on health-related outcomes in elderly inpatients discharged home: a systematic review protocol. ACTA ACUST UNITED AC 2013. [DOI: 10.11124/jbisrir-2013-937] [Citation(s) in RCA: 4] [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] [Indexed: 10/31/2022]
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Wiehle R, Cunningham GR, Pitteloud N, Wike J, Hsu K, Fontenot GK, Rosner M, Dwyer A, Podolski J. Testosterone Restoration by Enclomiphene Citrate in Men with Secondary Hypogonadism: Pharmacodynamics and Pharmacokinetics. BJU Int 2013; 112:1188-1200. [PMID: 23875626 PMCID: PMC4155868 DOI: 10.1111/bju.12363] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [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] [Accepted: 06/23/2013] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To determine the pharmacodynamic (PD) profile of serum total testosterone levels (TT) and luteinizing hormone (LH) in men with secondary hypogonadism following initial and chronic daily oral doses of enclomiphene citrate in comparison to transdermal testosterone. To determine the effects of daily oral doses of enclomiphene citrate (Androxal®) in comparison to transdermal testosterone on other hormones and markers in men with secondary hypogonadism. PATIENTS AND METHODS This was a randomized, single blind, two-center phase II study to evaluate three different doses of enclomiphene citrate (6.25mg, 12.5mg and 25 mg Androxal®), versus AndroGel®, a transdermal testosterone, on 24-hour LH and TT in otherwise normal healthy men with secondary hypogonadism. Forty-eight men were enrolled in the trial (ITT Population), but 4 men had T levels >350 ng/dL at baseline. Forty-four men completed the study per protocol (PP population). All subjects enrolled in this trial had serum TT in the low range (<350 ng/dL) and had low to normal LH (<12 IU/L) on at least two occasions. TT and LH levels were assessed each hour for 24 hours to examine the effects at each of three treatment doses of enclomiphene versus a standard dose (5 grams) of transdermal testosterone (AndroGel). In the initial profile TT and LH were determined in a naïve population following a single initial oral or transdermal treatment (Day 1). This was contrasted to that seen after six weeks of continuous daily oral or transdermal treatment (Day 42). The pharmacokinetics of enclomiphene was performed in a select subpopulation. Serum samples were obtained over the course of the study to determine levels of various hormones and lipids. RESULTS After six weeks of continuous use, the mean ± SD concentration of TT at Day 42 C0hrTT, was 604 ± 160 ng/dL for men taking the highest of dose of enclomiphene citrate (enclomiphene, 25 mg daily) and 500 ± 278 ng in those men treated with transdermal testosterone. These values were higher than Day 1 values but not different from each other (p = 0.23, T-test). All three doses of enclomiphene increased C0hrTT, CavgTT, CmaxTT, CminTT and CrangeTT. Transdermal testosterone also raised TT, albeit with more variability, and with suppressed LH levels. The patterns of TT over 24 hour period following six weeks of dosing could be fit to a non-linear function with morning elevations, mid-day troughs, and rising night-time levels. Enclomiphene and transdermal testosterone increased levels of TT within two weeks, but they had opposite effects on FSH and LH Treatment with enclomiphene did not significantly affect levels of TSH, ACTH, cortisol, lipids, or bone markers. Both transdermal testosterone and enclomiphene citrate decreased IGF-1 levels (p<0.05) but suppression was greater in the enclomiphene citrate groups. CONCLUSIONS Enclomiphene citrate increased serum LH and TT; however, there was not a temporal association between the peak drug levels and the Cmax levels LH or TT. Enclomiphene citrate consistently increased serum TT into the normal range and increased LH and FSH above the normal range. The effects on LH and TT persisted for at least one week after stopping treatment.
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Chong WH, Andreopoulou P, Chen CC, Reynolds J, Guthrie L, Kelly M, Gafni RI, Bhattacharyya N, Boyce AM, El-Maouche D, Crespo DO, Sherry R, Chang R, Wodajo FM, Kletter GB, Dwyer A, Collins MT. Tumor localization and biochemical response to cure in tumor-induced osteomalacia. J Bone Miner Res 2013; 28:1386-98. [PMID: 23362135 PMCID: PMC3900247 DOI: 10.1002/jbmr.1881] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [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: 09/13/2012] [Revised: 01/10/2013] [Accepted: 01/17/2013] [Indexed: 01/17/2023]
Abstract
Tumor-induced osteomalacia (TIO) is a rare disorder of phosphate wasting due to fibroblast growth factor-23 (FGF23)-secreting tumors that are often difficult to locate. We present a systematic approach to tumor localization and postoperative biochemical changes in 31 subjects with TIO. All had failed either initial localization, or relocalization (in case of recurrence or metastases) at outside institutions. Functional imaging with ¹¹¹Indium-octreotide with single photon emission computed tomography (octreo-SPECT or SPECT/CT), and ¹⁸fluorodeoxyglucose positron emission tomography/CT (FDG-PET/CT) were performed, followed by anatomic imaging (CT, MRI). Selective venous sampling (VS) was performed when multiple suspicious lesions were identified or high surgical risk was a concern. Tumors were localized in 20 of 31 subjects (64.5%). Nineteen of 20 subjects underwent octreo-SPECT imaging, and 16 of 20 FDG-PET/CT imaging. Eighteen of 19 (95%) were positive on octreo-SPECT, and 14 of 16 (88%) on FDG-PET/CT. Twelve of 20 subjects underwent VS; 10 of 12 (83%) were positive. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were as follows: sensitivity = 0.95, specificity = 0.64, PPV = 0.82, and NPV = 0.88 for octreo-SPECT; sensitivity = 0.88, specificity = 0.36, PPV = 0.62, and NPV = 0.50 for FDG-PET/CT. Fifteen subjects had their tumor resected at our institution, and were disease-free at last follow-up. Serum phosphorus returned to normal in all subjects within 1 to 5 days. In 10 subjects who were followed for at least 7 days postoperatively, intact FGF23 (iFGF23) decreased to near undetectable within hours and returned to the normal range within 5 days. C-terminal FGF23 (cFGF23) decreased immediately but remained elevated, yielding a markedly elevated cFGF23/iFGF23 ratio. Serum 1,25-dihydroxyvitamin D₃ (1,25D) rose and exceeded the normal range. In this systematic approach to tumor localization in TIO, octreo-SPECT was more sensitive and specific, but in many cases FDG-PET/CT was complementary. VS can discriminate between multiple suspicious lesions and increase certainty prior to surgery. Sustained elevations in cFGF23 and 1,25D were observed, suggesting novel regulation of FGF23 processing and 1,25D generation.
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Affiliation(s)
- William H Chong
- Skeletal Clinical Studies Unit, Craniofacial and Skeletal Disease Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
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Margolin DH, Kousi M, Chan YM, Lim ET, Schmahmann JD, Hadjivassiliou M, Hall JE, Adam I, Dwyer A, Plummer L, Aldrin SV, O'Rourke J, Kirby A, Lage K, Milunsky A, Milunsky JM, Chan J, Hedley-Whyte ET, Daly MJ, Katsanis N, Seminara SB. Ataxia, dementia, and hypogonadotropism caused by disordered ubiquitination. N Engl J Med 2013; 368:1992-2003. [PMID: 23656588 PMCID: PMC3738065 DOI: 10.1056/nejmoa1215993] [Citation(s) in RCA: 156] [Impact Index Per Article: 14.2] [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] [Indexed: 12/14/2022]
Abstract
BACKGROUND The combination of ataxia and hypogonadism was first described more than a century ago, but its genetic basis has remained elusive. METHODS We performed whole-exome sequencing in a patient with ataxia and hypogonadotropic hypogonadism, followed by targeted sequencing of candidate genes in similarly affected patients. Neurologic and reproductive endocrine phenotypes were characterized in detail. The effects of sequence variants and the presence of an epistatic interaction were tested in a zebrafish model. RESULTS Digenic homozygous mutations in RNF216 and OTUD4, which encode a ubiquitin E3 ligase and a deubiquitinase, respectively, were found in three affected siblings in a consanguineous family. Additional screening identified compound heterozygous truncating mutations in RNF216 in an unrelated patient and single heterozygous deleterious mutations in four other patients. Knockdown of rnf216 or otud4 in zebrafish embryos induced defects in the eye, optic tectum, and cerebellum; combinatorial suppression of both genes exacerbated these phenotypes, which were rescued by nonmutant, but not mutant, human RNF216 or OTUD4 messenger RNA. All patients had progressive ataxia and dementia. Neuronal loss was observed in cerebellar pathways and the hippocampus; surviving hippocampal neurons contained ubiquitin-immunoreactive intranuclear inclusions. Defects were detected at the hypothalamic and pituitary levels of the reproductive endocrine axis. CONCLUSIONS The syndrome of hypogonadotropic hypogonadism, ataxia, and dementia can be caused by inactivating mutations in RNF216 or by the combination of mutations in RNF216 and OTUD4. These findings link disordered ubiquitination to neurodegeneration and reproductive dysfunction and highlight the power of whole-exome sequencing in combination with functional studies to unveil genetic interactions that cause disease. (Funded by the National Institutes of Health and others.).
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Affiliation(s)
- David H Margolin
- Department of Neurology, Massachusetts General Hospital, Boston 02115, USA
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Affiliation(s)
- A. Dwyer
- Genesee Valley Equine Clinic; PLLC; New York USA
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Phan-Hug F, Hauschild M, Dwyer A, Pitteloud N. [Caring for patients with pediatric endocrinopathies and diabetes into adulthood: challenges of an often difficult transition]. Rev Med Suisse 2012; 8:2170-2174. [PMID: 23240318] [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: 06/01/2023]
Abstract
The success of therapies for a number of pediatric disorders has posed new challenges for the long-term follow-up of adolescents with chronic endocrinopathies. Unfortunately, too many patients are lost during the transfer from pediatric to adult clinics. The transition process should be well-organized and include the young person and family. Recognizing the special needs of these adolescents is an important step in developing patient-centered approaches to care that enable patients to develop autonomy and self care skills. Key elements in this process include structured policies and guidelines, communication and close collaboration between pediatric and adult clinics, and integrating nurse clinicians in the transition process to help close the gaps in care.
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Affiliation(s)
- F Phan-Hug
- Division d'endocrinologie pédiatrique, Département de pédiatrie, CHUV, 1011 Lausanne
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