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Wang AA, Luessi F, Neziraj T, Pössnecker E, Zuo M, Engel S, Hanuscheck N, Florescu A, Bugbee E, Ma XI, Rana F, Lee D, Ward LA, Kuhle J, Himbert J, Schraad M, van Puijenbroek E, Klein C, Urich E, Ramaglia V, Pröbstel AK, Zipp F, Gommerman JL. B cell depletion with anti-CD20 promotes neuroprotection in a BAFF-dependent manner in mice and humans. Sci Transl Med 2024; 16:eadi0295. [PMID: 38446903 DOI: 10.1126/scitranslmed.adi0295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 02/13/2024] [Indexed: 03/08/2024]
Abstract
Anti-CD20 therapy to deplete B cells is highly efficacious in preventing new white matter lesions in patients with relapsing-remitting multiple sclerosis (RRMS), but its protective capacity against gray matter injury and axonal damage is unclear. In a passive experimental autoimmune encephalomyelitis (EAE) model whereby TH17 cells promote brain leptomeningeal immune cell aggregates, we found that anti-CD20 treatment effectively spared myelin content and prevented myeloid cell activation, oxidative damage, and mitochondrial stress in the subpial gray matter. Anti-CD20 treatment increased B cell survival factor (BAFF) in the serum, cerebrospinal fluid, and leptomeninges of mice with EAE. Although anti-CD20 prevented gray matter demyelination, axonal loss, and neuronal atrophy, co-treatment with anti-BAFF abrogated these benefits. Consistent with the murine studies, we observed that elevated BAFF concentrations after anti-CD20 treatment in patients with RRMS were associated with better clinical outcomes. Moreover, BAFF promoted survival of human neurons in vitro. Together, our data demonstrate that BAFF exerts beneficial functions in MS and EAE in the context of anti-CD20 treatment.
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Affiliation(s)
- Angela A Wang
- Department of Immunology, University of Toronto, Toronto, M5S 1A8, Canada
| | - Felix Luessi
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Tradite Neziraj
- Department of Neurology, University Hospital of Basel and University of Basel, 4031 Basel, Switzerland
- Departments of Biomedicine and Clinical Research, University Hospital of Basel and University of Basel, 4031 Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital of Basel and University of Basel, 4031 Basel, Switzerland
| | - Elisabeth Pössnecker
- Department of Neurology, University Hospital of Basel and University of Basel, 4031 Basel, Switzerland
- Departments of Biomedicine and Clinical Research, University Hospital of Basel and University of Basel, 4031 Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital of Basel and University of Basel, 4031 Basel, Switzerland
| | - Michelle Zuo
- Department of Immunology, University of Toronto, Toronto, M5S 1A8, Canada
| | - Sinah Engel
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Nicholas Hanuscheck
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Alexandra Florescu
- Department of Immunology, University of Toronto, Toronto, M5S 1A8, Canada
| | - Eryn Bugbee
- Department of Immunology, University of Toronto, Toronto, M5S 1A8, Canada
| | - Xianjie I Ma
- Department of Immunology, University of Toronto, Toronto, M5S 1A8, Canada
| | - Fatima Rana
- Department of Immunology, University of Toronto, Toronto, M5S 1A8, Canada
| | - Dennis Lee
- Department of Immunology, University of Toronto, Toronto, M5S 1A8, Canada
| | - Lesley A Ward
- Department of Immunology, University of Toronto, Toronto, M5S 1A8, Canada
| | - Jens Kuhle
- Department of Neurology, University Hospital of Basel and University of Basel, 4031 Basel, Switzerland
- Departments of Biomedicine and Clinical Research, University Hospital of Basel and University of Basel, 4031 Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital of Basel and University of Basel, 4031 Basel, Switzerland
| | - Johannes Himbert
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Muriel Schraad
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | | | - Christian Klein
- Roche Innovation Center Zurich, Roche Glycart AG, 8952 Schlieren, Switzerland
| | - Eduard Urich
- Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., 4052 Basel, Switzerland
| | - Valeria Ramaglia
- Department of Immunology, University of Toronto, Toronto, M5S 1A8, Canada
| | - Anne-Katrin Pröbstel
- Department of Neurology, University Hospital of Basel and University of Basel, 4031 Basel, Switzerland
- Departments of Biomedicine and Clinical Research, University Hospital of Basel and University of Basel, 4031 Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital of Basel and University of Basel, 4031 Basel, Switzerland
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
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Mendenhall SD, Graham EM, Memmott S, Frederiksen H, Rioux-Forker D, Wang AA, Hutchinson DT. A New Source of Mutilating Hand Injuries: The Side-by-Side Utility Terrain Vehicle. Plast Reconstr Surg 2023; 152:820-830. [PMID: 36943702 DOI: 10.1097/prs.0000000000010453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Rates of mutilating hand injuries are increasing from accidents caused by all-terrain vehicles (ATVs) and the recently popularized side-by-side utility terrain vehicles (UTVs). Increasing surgeon familiarity with upper extremity (UE) injury patterns, severity, and outcomes following ATV and UTV accidents may improve patient care and advocacy. METHODS Retrospective comparisons of UE injury patterns, severity, hospital and intensive care unit (ICU) admission lengths, and number of operations were made between ATVs and UTVs. Findings were analyzed with Fisher exact tests, multivariate analysis of variance, analyses of variance with post hoc analyses, and multiple linear regressions. RESULTS A total of 154 cases were identified for inclusion (ATV, n = 87; UTV, n = 67). Patient ages ranged from 4 to 89 years. The UTV group contained significantly more hand and finger injuries, and more of the fractures were open ( P = 0.005, P < 0.001, and P < 0.001, respectively). Riders of UTVs had nearly three times as many mutilating hand injuries and a nearly ninefold increase in amputations compared with ATV riders ( P < 0.001 and P < 0.001, respectively). On average, the UTV group spent 2.5 additional days in the hospital, 0.91 additional days in an ICU, and had 1.3 additional operations ( P = 0.001, P = 0.007, and P < 0.001, respectively). Vehicle type was the only variable significantly correlated with days in the hospital, ICU, and number of UE operations ( P = 0.002, P = 0.008, and P < 0.001, respectively). CONCLUSIONS Hand surgeons are in a unique position to serve as forerunners for increasing public awareness of off-road vehicle risks and promoting rider safety. Collaborating with manufacturers and emergency care providers and directing teaching initiatives may improve patient outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, II.
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Affiliation(s)
- Shaun D Mendenhall
- From the Division of Plastic Surgery
- Division of Plastic, Reconstructive, and Oral Surgery, Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania
| | - Emily M Graham
- School of Medicine
- Division of Plastic, Reconstructive, and Oral Surgery, Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania
| | | | | | | | - Angela A Wang
- Department of Orthopaedic Surgery, University of Utah
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Bugbee E, Wang AA, Gommerman JL. Under the influence: environmental factors as modulators of neuroinflammation through the IL-10/IL-10R axis. Front Immunol 2023; 14:1188750. [PMID: 37600781 PMCID: PMC10435745 DOI: 10.3389/fimmu.2023.1188750] [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: 03/17/2023] [Accepted: 07/12/2023] [Indexed: 08/22/2023] Open
Abstract
The IL-10/IL-10 receptor (IL-10R) axis plays an important role in attenuating neuroinflammation in animal models of Multiple Sclerosis (MS) and increased IL-10 has been associated with a positive response to MS disease modifying therapy. Because environmental factors play an important role in MS susceptibility and disease course, identification of environmental factors that impact the IL-10/IL-10R axis has therapeutic potential. In this review, we provide historical and updated perspectives of how IL-10R signaling impacts neuroinflammation, discuss environmental factors and intestinal microbes with known impacts on the IL-10/IL-10R axis, and provide a hypothetical model for how B cells, via their production of IL-10, may be important in conveying environmental "information" to the inflamed central nervous system.
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Wang AA, Rose PS. Focus on Hand Surgery-2023. J Am Acad Orthop Surg 2023; Publish Ahead of Print:00124635-990000000-00715. [PMID: 37279161 DOI: 10.5435/jaaos-d-23-00398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Indexed: 06/08/2023] Open
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Wang YH, Yu JH, Hu JH, Xu QH, Huang Q, Gan PY, Wang AA, Liao HF. [Navigation-guided nasal endoscopy for removal of the cavernous hemangioma of the orbital apex through the sphenoid approach]. Zhonghua Yan Ke Za Zhi 2021; 57:837-843. [PMID: 34743469 DOI: 10.3760/cma.j.cn112142-20210207-00081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the feasibility of navigation-guided nasal endoscopy for removal of the cavernous hemangioma of the orbital apex through the sphenoid approach. Methods: Retrospective case series study. From May 2012 to December 2019, 12 patients (12 eyes) with imaging findings of cavernous hemangioma in the orbital apex were collected at the Eye Hospital Affiliated to Nanchang University, including 3 males and 9 females aged 32 to 59 years. All patients underwent navigation-guided sinusoscopy through the sphenoid approach to remove the cavernous hemangioma of the orbital apex (video attached). Changes of visual function and complications after operation were analyzed. Results: In 3 patients without visual impairment, the postoperative visual function was still normal. Among the remaining 9 patients with preoperative visual impairment, visual function was fully recovered in 3 patients after operation, was improved in 2 patients, and had no change in 4 patients. There were no complications in 3 of the 12 patients, and 9 patients had transient, mildly limited intraocular rotation with diplopia after operation, which all returned to normal within 1 month. Conclusion: Navigation-guided sinus endoscopy through the sphenoid approach is effective and feasible in the removal of the cavernous hemangioma of the orbital apex. (Chin J Ophthalmol, 2021, 57: 837-843).
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Affiliation(s)
- Y H Wang
- Department of Orbital Diseases, Ophthalmology Hospital Affiliated to Nanchang University, Nanchang 330006, China
| | - J H Yu
- Department of Orbital Diseases, Ophthalmology Hospital Affiliated to Nanchang University, Nanchang 330006, China
| | - J H Hu
- Department of Orbital Diseases, Ophthalmology Hospital Affiliated to Nanchang University, Nanchang 330006, China
| | - Q H Xu
- Department of Orbital Diseases, Ophthalmology Hospital Affiliated to Nanchang University, Nanchang 330006, China
| | - Q Huang
- Department of Orbital Diseases, Ophthalmology Hospital Affiliated to Nanchang University, Nanchang 330006, China
| | - P Y Gan
- Department of Orbital Diseases, Ophthalmology Hospital Affiliated to Nanchang University, Nanchang 330006, China
| | - A A Wang
- Department of Orbital Diseases, Ophthalmology Hospital Affiliated to Nanchang University, Nanchang 330006, China
| | - H F Liao
- Department of Orbital Diseases, Ophthalmology Hospital Affiliated to Nanchang University, Nanchang 330006, China
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Kondo M, Kameishi S, Kim K, Metzler NF, Maak TG, Hutchinson DT, Wang AA, Maehara M, Sato M, Grainger DW, Okano T. Safety and efficacy of human juvenile chondrocyte-derived cell sheets for osteochondral defect treatment. NPJ Regen Med 2021; 6:65. [PMID: 34654830 PMCID: PMC8520001 DOI: 10.1038/s41536-021-00173-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/14/2021] [Indexed: 02/06/2023] Open
Abstract
Knee cartilage does not regenerate spontaneously after injury, and a gold standard regenerative treatment algorithm has not been established. This study demonstrates preclinical safety and efficacy of scaffold-free, human juvenile cartilage-derived-chondrocyte (JCC) sheets produced from routine surgical discards using thermo-responsive cultureware. JCCs exhibit stable and high growth potential in vitro over passage 10, supporting possibilities for scale-up to mass production for commercialization. JCC sheets contain highly viable, densely packed cells, show no anchorage-independent cell growth, express mesenchymal surface markers, and lack MHC II expression. In nude rat focal osteochondral defect models, stable neocartilage formation was observed at 4 weeks by JCC sheet transplantation without abnormal tissue growth over 24 weeks in contrast to the nontreatment group showing no spontaneous cartilage repair. Regenerated cartilage was safranin-O positive, contained type II collagen, aggrecan, and human vimentin, and lacked type I collagen, indicating that the hyaline-like neocartilage formed originates from transplanted JCC sheets rather than host-derived cells. This study demonstrates the safety of JCC sheets and stable hyaline cartilage formation with engineered JCC sheets utilizing a sustainable tissue supply. Cost-benefit and scaling issues for sheet fabrication and use support feasibility of this JCC sheet strategy in clinical cartilage repair.
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Affiliation(s)
- Makoto Kondo
- grid.223827.e0000 0001 2193 0096Cell Sheet Tissue Engineering Center (CSTEC), Department of Pharmaceutics and Pharmaceutical Chemistry, Health Sciences, University of Utah, 30 South 2000 East, Salt Lake City, UT 84112 USA
| | - Sumako Kameishi
- grid.223827.e0000 0001 2193 0096Cell Sheet Tissue Engineering Center (CSTEC), Department of Pharmaceutics and Pharmaceutical Chemistry, Health Sciences, University of Utah, 30 South 2000 East, Salt Lake City, UT 84112 USA
| | - Kyungsook Kim
- grid.223827.e0000 0001 2193 0096Cell Sheet Tissue Engineering Center (CSTEC), Department of Pharmaceutics and Pharmaceutical Chemistry, Health Sciences, University of Utah, 30 South 2000 East, Salt Lake City, UT 84112 USA
| | - Nicolas F. Metzler
- grid.223827.e0000 0001 2193 0096Cell Sheet Tissue Engineering Center (CSTEC), Department of Pharmaceutics and Pharmaceutical Chemistry, Health Sciences, University of Utah, 30 South 2000 East, Salt Lake City, UT 84112 USA ,grid.223827.e0000 0001 2193 0096Department of Biomedical Engineering, University of Utah, 36 S. Wasatch Drive SMBB 3100, Salt Lake City, UT 84112 USA
| | - Travis G. Maak
- grid.223827.e0000 0001 2193 0096Department of Orthopaedic Surgery, University of Utah Orthopaedic Center, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108 USA
| | - Douglas T. Hutchinson
- grid.223827.e0000 0001 2193 0096Department of Orthopaedic Surgery, University of Utah Orthopaedic Center, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108 USA ,grid.415178.e0000 0004 0442 6404Pediatric Orthopaedics Surgery, Primary Children’s Hospital Orthopedics, 100 North Mario Capecchi Dr. Suite 4550, Salt Lake City, UT 84113 USA
| | - Angela A. Wang
- grid.223827.e0000 0001 2193 0096Department of Orthopaedic Surgery, University of Utah Orthopaedic Center, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108 USA ,grid.415178.e0000 0004 0442 6404Pediatric Orthopaedics Surgery, Primary Children’s Hospital Orthopedics, 100 North Mario Capecchi Dr. Suite 4550, Salt Lake City, UT 84113 USA
| | - Miki Maehara
- grid.265061.60000 0001 1516 6626Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193 Japan
| | - Masato Sato
- grid.265061.60000 0001 1516 6626Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193 Japan
| | - David W. Grainger
- grid.223827.e0000 0001 2193 0096Cell Sheet Tissue Engineering Center (CSTEC), Department of Pharmaceutics and Pharmaceutical Chemistry, Health Sciences, University of Utah, 30 South 2000 East, Salt Lake City, UT 84112 USA ,grid.223827.e0000 0001 2193 0096Department of Biomedical Engineering, University of Utah, 36 S. Wasatch Drive SMBB 3100, Salt Lake City, UT 84112 USA
| | - Teruo Okano
- grid.223827.e0000 0001 2193 0096Cell Sheet Tissue Engineering Center (CSTEC), Department of Pharmaceutics and Pharmaceutical Chemistry, Health Sciences, University of Utah, 30 South 2000 East, Salt Lake City, UT 84112 USA ,grid.410818.40000 0001 0720 6587Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University, TWIns, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666 Japan
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Stephens AR, Presson AP, Jo YJ, Tyser AR, Wang AA, Hutchinson DT, Kazmers NH. Evaluating the Safety of the Hand Surgery Procedure Room: A Single-Center Cohort of 1,404 Surgical Encounters. J Hand Surg Am 2021; 46:623.e1-623.e9. [PMID: 33487491 PMCID: PMC8260433 DOI: 10.1016/j.jhsa.2020.11.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 02/14/2020] [Revised: 09/25/2020] [Accepted: 11/27/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Performing hand surgeries in the procedure room (PR) setting instead of the operating room effectively reduces surgical costs. Understanding the safety or complication rates associated with the PR is important in determining the value of its use. Our purpose was to describe the incidence of medical and surgical complications among patients undergoing minor hand surgeries in the PR. METHODS We retrospectively reviewed all adult patients who underwent an operation in the PR setting between December 2013 and May 2019 at a single tertiary academic medical center by 1 of 5 fellowship-trained orthopedic hand surgeons. Baseline patient characteristics were described. Complication rates were obtained via chart review. RESULTS For 1,404 PR surgical encounters, 1,796 procedures were performed. Mean patient age was 59 ± 15 years, 809 were female (57.6%), and average follow-up was 104 days. The most common surgeries were carpal tunnel release (39.9%), trigger finger release (35.9%), and finger mass or cyst excision (9.6%). Most surgeries were performed using a nonpneumatic wrist tourniquet (58%), whereas 42% used no tourniquet. No patient experienced a major medical complication. No procedure was aborted owing to intolerance. No patient required admission. No intraoperative surgical or medical complications occurred. Observed complications included delayed capillary refill requiring phentolamine administration after a trigger thumb release performed using epinephrine without a tourniquet (n = 1; 0.1%), complex regional pain syndrome (n = 3; 0.2%), infection requiring surgical debridement (n = 2; 0.2%), and recurrent symptoms requiring reoperation (n = 8; 0.7%). CONCLUSIONS In this cohort of patients in whom surgery was performed in a PR, there were no major intraoperative surgical or medical complications. There was a low rate of postoperative infection, development of complex regional pain syndrome, and a low need for revision surgery. These observations do not support the concern for safety as a barrier to performing minor hand surgery in the PR setting. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
| | - Angela P Presson
- Division of Public Health, University of Utah, Salt Lake City, UT
| | - Yeon J Jo
- Division of Public Health, University of Utah, Salt Lake City, UT
| | - Andrew R Tyser
- Department of Orthopaedics, University of Utah, Salt Lake City, UT
| | - Angela A Wang
- Department of Orthopaedics, University of Utah, Salt Lake City, UT
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Isho B, Florescu A, Wang AA, Gommerman JL. Fantastic IgA plasma cells and where to find them. Immunol Rev 2021; 303:119-137. [PMID: 34046908 DOI: 10.1111/imr.12980] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 12/12/2022]
Abstract
IgA is produced in large quantities at mucosal surfaces by IgA+ plasma cells (PC), protecting the host from pathogens, and restricting commensal access to the subepithelium. It is becoming increasingly appreciated that IgA+ PC are not constrained to mucosal barrier sites. Rather, IgA+ PC may leave these sites where they provide both host defense and immunoregulatory function. In this review, we will outline how IgA+ PC are generated within the mucosae and how they subsequently migrate to their "classical" effector site, the gut lamina propria. From there we provide examples of IgA+ PC displacement from the gut to other parts of the body, referencing examples during homeostasis and inflammation. Lastly, we will speculate on mechanisms of IgA+ PC displacement to other tissues. Our aim is to provide a new perspective on how IgA+ PC are truly fantastic beasts of the immune system and identify new places to find them.
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Affiliation(s)
- Baweleta Isho
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | | | - Angela A Wang
- Department of Immunology, University of Toronto, Toronto, ON, Canada
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Wang AA, Gommerman JL. A totally OSM gift to astrocytes relieves inflammation. Immunity 2021; 54:401-403. [PMID: 33691129 DOI: 10.1016/j.immuni.2021.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Dectin-1 is known for promoting anti-fungal responses through the signaling molecule Card9. In this issue of Immunity, Deerhake et al. now report that during autoimmune neuroinflammation, Dectin-1 can promote a neuroprotective feed-forward pathway through Card9-independent upregulation of Oncostatin M.
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Affiliation(s)
- Angela A Wang
- Department of Immunology, University of Toronto, Toronto, ON M5S 1A8, Canada.
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Stephens AR, Tyser AR, Presson AP, Orleans B, Wang AA, Hutchinson DT, Kazmers NH. A Comparison of Open Carpal Tunnel Release Outcomes Between Procedure Room and Operating Room Settings. J Hand Surg Glob Online 2020; 3:12-16. [PMID: 33537661 PMCID: PMC7853655 DOI: 10.1016/j.jhsg.2020.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose Carpal tunnel release (CTR) surgical costs are minimized when performed in the procedure room (PR) setting, compared with the operating room. However, it remains unclear whether outcomes differ between surgical settings. Our purpose was to compare outcomes at 1 year or greater follow-up after open CTR between patients treated in PR versus operating room settings using the Boston Carpal Tunnel Questionnaire (BCTQ). Methods A change in clinical care protocols at our institution occurred in 2014. Before this, all CTRs were performed in the operating room; thereafter, these were transitioned to the PR. Adult patients who underwent isolated unilateral or bilateral open CTR in either surgical setting were considered for inclusion, in which procedures were conducted between January 2014 and October 2018 for the PR group and January 2009 and March 2014 for the operating room group. The Functional Status Scale (FSS) and the Symptom Severity Scale (SSS) components of the BCTQ were collected for all eligible patients at a minimum of 1 year after surgery. We used univariate and multivariable linear regression to determine whether postoperative BCTQ scores were equivalent between PR and operating room groups within a threshold of one-fourth of the lowest estimates of the minimal clinically important difference. Results No differences in demographics, comorbidities, or insurance type were observed between the 104 PR and 112 operating room patients. Survey response rate was 25% and 25% for the PR and operating room patients, respectively. At a mean follow-up of 3 ± 1 years, FSS and SSS scores were equivalent between PR and operating room groups on bivariate analysis. The multivariable equivalence test also demonstrated equivalent FSS and SSS scores between PR and operating room groups within a one-fourth minimal clinically important difference threshold while controlling for age, sex, presence of diabetes or thyroid disease, unilateral versus bilateral CTR, and surgeon. Conclusions Clinical outcomes did not differ between PR and operating room settings after open CTR. Type of study/level of evidence: Therapeutic III.
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Affiliation(s)
| | - Andrew R Tyser
- Department of Orthopaedics, University of Utah, Salt Lake City, UT
| | - Angela P Presson
- Division of Public Health, University of Utah, Salt Lake City, UT
| | - Brian Orleans
- Division of Public Health, University of Utah, Salt Lake City, UT
| | - Angela A Wang
- Department of Orthopaedics, University of Utah, Salt Lake City, UT
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Wang AA, Gommerman JL, Rojas OL. Plasma Cells: From Cytokine Production to Regulation in Experimental Autoimmune Encephalomyelitis. J Mol Biol 2020; 433:166655. [PMID: 32976908 DOI: 10.1016/j.jmb.2020.09.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 01/01/2023]
Abstract
B cells are a critical arm of the adaptive immune system. After encounter with antigen, B cells are activated and differentiate into plasmablasts (PBs) and plasma cells (PCs). Although their frequency is low, PB/PCs can be found in all lymphoid organs including peripheral lymph nodes and spleen. Upon immunization, depending on the location of where B cells encounter their antigen, PB/PCs subsequently home to and accumuate in the bone marrow and the intestine where they can survive as long-lived plasma cells for years, continually producing antibody. Recent evidence has shown that, in addition to producing antibodies, PB/PCs can also produce cytokines such as IL-17, IL-10, and IL-35. In addition, PB/PCs that produce IL-10 have been shown to play a regulatory role during experimental autoimmune encephalomyelitis, an animal model of neuroinflammation. The purpose of this review is to describe the phenotype and function of regulatory PB/PCs in the context of experimental autoimmune encephalomyelitis and in patients with multiple sclerosis.
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Affiliation(s)
- Angela A Wang
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | | | - Olga L Rojas
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada.
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Abstract
Syndactyly release may be done by skin graft or graftless techniques. We prospectively examined bilateral syndactyly releases in the same patient at one operation. The grafted side was randomized and the contralateral side was done graftless. Fourteen patients had surgery at a mean age of 27 months (range 7-166). The mean follow-up was 52 months (range 6-111). The mean tourniquet time was 97 minutes (range 66-135) for graft and 84 minutes (55-120) for graftless. The mean finger abduction was 57° (32°-80°) for graft and 54° (38°-80°) for graftless. The mean web creep score was 1.2 (0-3) for graft and 2.1 (0-3) for graftless. The mean scar score was 1.9 (1-3) bilaterally. The mean parents' visual analogue scale for graft cosmesis was 7.1 (5-9) and 6.2 (4.3-8) for graftless. The surgeon's visual analogue scale for graft was 7.9 (6.4-9.5) and 6.2 (4-8.7) for graftless. The therapist's visual analogue scale was 7.9 (6.5-10) and 6.4 (4.7-8) for graftless. Although there is a longer tourniquet time with grafting, there may be advantages in appearance and web creep. Level of evidence: II.
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Affiliation(s)
- Angela A Wang
- Orthopedics, University of Utah, Salt Lake City, UT, USA
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Ge XK, Wang AA, Ying ZX, Zhang LG, Su WP, Cheng K, Feng CC, Zhou YM, Zhang LL, Wang T. Effects of diets with different energy and bile acids levels on growth performance and lipid metabolism in broilers. Poult Sci 2019; 98:887-895. [PMID: 30239873 DOI: 10.3382/ps/pey434] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [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: 03/31/2018] [Accepted: 08/26/2018] [Indexed: 01/14/2023] Open
Abstract
This experiment was conducted to evaluate the effects of bile acids (BAs) on the growth performance and lipid metabolism of broilers fed with different energy level diets. 480 one-day-old Arbor Acres broilers (45.01 ± 0.26 g) were allotted to a 2 × 2 factorial design with 2 levels of energy (basal or high-energy level) and 2 levels of BAs (with or without BAs supplementation), resulting in 4 groups of 8 replicates; the experiment lasted 42 d. High-energy diets decreased the feed/gain ratio (F/G) from 1 to 21 d (P < 0.05), and increased the liver index and abdominal fat percentage at 42 d (P < 0.05). The serum total triglyceride (TG) and high-density lipoprotein cholesterol at 42 d were increased by high-energy diets (P < 0.05), while the hepatic lipoprotein lipase (LPL) activity at 21 and 42 d was decreased (P < 0.05). BAs supplementation increased the body weight at 21 d and decreased the F/G during entire period (P < 0.05), as well as improved the carcass quality reflected by decreased abdominal fat percentage at 42 d and increased breast muscle percentage at 21 and 42 d (P < 0.05). The serum TG at 21 and 42 d were decreased by BAs (P < 0.05), and the hepatic LPL activity at 42 d was increased (P < 0.05). In addition, high-energy diets increased the expression of sterol regulatory element binding transcription factor 1, acetyl-CoA carboxylase, and fatty acid synthase (P < 0.05), while BAs diets decreased these genes expression (P < 0.05). Moreover, BAs supplementation also increased the expression of carnitine palmitoyltransferase 1 (P < 0.05), which was increased in high-energy groups (P < 0.05). In conclusion, BAs supplementation could increase growth performance, elevate carcass quality, and improve lipid metabolism in broilers.
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Affiliation(s)
- X K Ge
- College of Animal Science and Technology, Nanjing Agricultural University, Jiangsu 210095, Nanjing, P. R. China
| | - A A Wang
- College of Animal Science and Technology, Nanjing Agricultural University, Jiangsu 210095, Nanjing, P. R. China
| | - Z X Ying
- College of Animal Science and Technology, Nanjing Agricultural University, Jiangsu 210095, Nanjing, P. R. China
| | - L G Zhang
- College of Animal Science and Technology, Nanjing Agricultural University, Jiangsu 210095, Nanjing, P. R. China
| | - W P Su
- College of Animal Science and Technology, Nanjing Agricultural University, Jiangsu 210095, Nanjing, P. R. China
| | - K Cheng
- College of Animal Science and Technology, Nanjing Agricultural University, Jiangsu 210095, Nanjing, P. R. China
| | - C C Feng
- College of Animal Science and Technology, Nanjing Agricultural University, Jiangsu 210095, Nanjing, P. R. China
| | - Y M Zhou
- College of Animal Science and Technology, Nanjing Agricultural University, Jiangsu 210095, Nanjing, P. R. China
| | - L L Zhang
- College of Animal Science and Technology, Nanjing Agricultural University, Jiangsu 210095, Nanjing, P. R. China
| | - T Wang
- College of Animal Science and Technology, Nanjing Agricultural University, Jiangsu 210095, Nanjing, P. R. China
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Rojas OL, Pröbstel AK, Porfilio EA, Wang AA, Charabati M, Sun T, Lee DSW, Galicia G, Ramaglia V, Ward LA, Leung LYT, Najafi G, Khaleghi K, Garcillán B, Li A, Besla R, Naouar I, Cao EY, Chiaranunt P, Burrows K, Robinson HG, Allanach JR, Yam J, Luck H, Campbell DJ, Allman D, Brooks DG, Tomura M, Baumann R, Zamvil SS, Bar-Or A, Horwitz MS, Winer DA, Mortha A, Mackay F, Prat A, Osborne LC, Robbins C, Baranzini SE, Gommerman JL. Recirculating Intestinal IgA-Producing Cells Regulate Neuroinflammation via IL-10. Cell 2019; 176:610-624.e18. [PMID: 30612739 DOI: 10.1016/j.cell.2018.11.035] [Citation(s) in RCA: 190] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 09/28/2018] [Accepted: 11/21/2018] [Indexed: 01/29/2023]
Abstract
Plasma cells (PC) are found in the CNS of multiple sclerosis (MS) patients, yet their source and role in MS remains unclear. We find that some PC in the CNS of mice with experimental autoimmune encephalomyelitis (EAE) originate in the gut and produce immunoglobulin A (IgA). Moreover, we show that IgA+ PC are dramatically reduced in the gut during EAE, and likewise, a reduction in IgA-bound fecal bacteria is seen in MS patients during disease relapse. Removal of plasmablast (PB) plus PC resulted in exacerbated EAE that was normalized by the introduction of gut-derived IgA+ PC. Furthermore, mice with an over-abundance of IgA+ PB and/or PC were specifically resistant to the effector stage of EAE, and expression of interleukin (IL)-10 by PB plus PC was necessary and sufficient to confer resistance. Our data show that IgA+ PB and/or PC mobilized from the gut play an unexpected role in suppressing neuroinflammation.
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Affiliation(s)
- Olga L Rojas
- Department of Immunology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Anne-Katrin Pröbstel
- Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Elisa A Porfilio
- Department of Immunology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Angela A Wang
- Department of Immunology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Marc Charabati
- Neuroimmunology Unit, CRCHUM and Department of Neurosciences, Faculty of Medicine, Université de Montréal, QC H2X 0A9, Canada
| | - Tian Sun
- Department of Immunology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Dennis S W Lee
- Department of Immunology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Georgina Galicia
- Department of Immunology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Valeria Ramaglia
- Department of Immunology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Lesley A Ward
- Department of Immunology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Leslie Y T Leung
- Department of Immunology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Ghazal Najafi
- Department of Immunology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Khashayar Khaleghi
- Department of Immunology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Beatriz Garcillán
- University of Melbourne, School of Biomedical Sciences, Parkville, VIC 3010, Australia
| | - Angela Li
- Department of Immunology, University of Toronto, Toronto, ON M5S 1A8, Canada; Toronto General Research Institute, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Rickvinder Besla
- Toronto General Research Institute, University Health Network, Toronto, ON M5G 2C4, Canada; Department of Laboratory and Medicine Pathology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Ikbel Naouar
- Department of Immunology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Eric Y Cao
- Department of Immunology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Pailin Chiaranunt
- Department of Immunology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Kyle Burrows
- Department of Immunology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Hannah G Robinson
- Department of Microbiology and Immunology, Life Sciences Institute, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Jessica R Allanach
- Department of Microbiology and Immunology, Life Sciences Institute, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Jennifer Yam
- Department of Immunology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Helen Luck
- Department of Immunology, University of Toronto, Toronto, ON M5S 1A8, Canada; Toronto General Research Institute, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Daniel J Campbell
- Benaroya Research Institute and Department of Immunology University of Washington School of Medicine, Seattle, WA 98101, USA
| | - David Allman
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - David G Brooks
- Department of Immunology, University of Toronto, Toronto, ON M5S 1A8, Canada; Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G 2M9, Canada
| | - Michio Tomura
- Laboratory of Immunology, Faculty of Pharmacy, Osaka Ohtani University, Tondabayashi, Osaka Prefecture 584-8540, Japan
| | - Ryan Baumann
- Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Scott S Zamvil
- Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA; Program in Immunology, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Amit Bar-Or
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Marc S Horwitz
- Department of Laboratory and Medicine Pathology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Daniel A Winer
- Toronto General Research Institute, University Health Network, Toronto, ON M5G 2C4, Canada; Department of Laboratory and Medicine Pathology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Arthur Mortha
- Department of Immunology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Fabienne Mackay
- University of Melbourne, School of Biomedical Sciences, Parkville, VIC 3010, Australia
| | - Alexandre Prat
- Neuroimmunology Unit, CRCHUM and Department of Neurosciences, Faculty of Medicine, Université de Montréal, QC H2X 0A9, Canada
| | - Lisa C Osborne
- Department of Microbiology and Immunology, Life Sciences Institute, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Clinton Robbins
- Department of Immunology, University of Toronto, Toronto, ON M5S 1A8, Canada; Toronto General Research Institute, University Health Network, Toronto, ON M5G 2C4, Canada; Department of Laboratory and Medicine Pathology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Sergio E Baranzini
- Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA; Institute for Human Genetics, University of California, San Francisco, San Francisco, CA 94143, USA; Graduate Program in Bioinformatics, University of California, San Francisco, San Francisco, CA 94143, USA
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Zhang JF, Bai KW, Su WP, Wang AA, Zhang LL, Huang KH, Wang T. Curcumin attenuates heat-stress-induced oxidant damage by simultaneous activation of GSH-related antioxidant enzymes and Nrf2-mediated phase II detoxifying enzyme systems in broiler chickens. Poult Sci 2018; 97:1209-1219. [PMID: 29438543 DOI: 10.3382/ps/pex408] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 11/28/2017] [Indexed: 12/16/2022] Open
Abstract
The object of this study was to investigate the effect of curcumin on modulating the glutathione (GSH)-related antioxidant enzymes and antioxidant responses via NF-E2-related factor 2 (Nrf2) signaling pathway in heat-stressed broiler chickens. A total of 400 one-day-old male Arbor Acres broiler chicks was reared in an environmentally controlled room. At 21 d, broiler chicks were divided into 5 treatment groups and were fed one of 4 diets under 2 temperature conditions: 22°C + a basal diet (CON treatment); 34°C for 8 h (0900-1700) + a basal diet supplemented with 0, 50, 100, or 200 mg/kg curcumin (HS, CMN1, CMN2, and CMN3 treatments, respectively). The heat treatment lasted for 20 consecutive days. The results showed that heat stress significantly increased (P < 0.05) the weekly rectal temperature and average head and feet temperature. Compared to the HS treatment, feed conversion was significantly decreased (P < 0.05) in CMN1 and CMN2 treatments. CMN1 administration significantly improved (P < 0.05) the pH24 of muscle. The abnormal changes of serum malonaldehyde and corticosterone concentrations were prevented (P < 0.05) by curcumin. Mitochondrial GSH concentration in the liver was significantly increased (P < 0.05) in CMN1 and CMN2 treatments compared with the HS treatment. The CMN1, CMN2, and CMN3 supplementations significantly increased (P < 0.05) γ-GCL, GSH-Px, and GST activities. Curcumin significantly increased (P < 0.05) the expression of Nrf2, HO-1, and γ-GCLc in the liver as compared to the CON diet. The expression of Cu/ZnSOD and CAT were increased (P < 0.05) by feeding CMN2, respectively, as compared to the HS treatment. It was concluded that curcumin supplementation enhanced the resistance of broilers to heat stress, as evidenced by reversing the FC, increasing the GSH content and GSH-related enzyme activities, and inducing the expression of Nrf2 and Nrf2-mediated phase II detoxifying enzyme genes.
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Affiliation(s)
- J F Zhang
- College of Animal Science and Technology, No. 6, Tongwei Road, Xuanwu District, Nanjing, Jiangsu 210095, P. R. China
| | - K W Bai
- College of Animal Science and Technology, No. 6, Tongwei Road, Xuanwu District, Nanjing, Jiangsu 210095, P. R. China
| | - W P Su
- College of Animal Science and Technology, No. 6, Tongwei Road, Xuanwu District, Nanjing, Jiangsu 210095, P. R. China
| | - A A Wang
- College of Animal Science and Technology, No. 6, Tongwei Road, Xuanwu District, Nanjing, Jiangsu 210095, P. R. China
| | - L L Zhang
- College of Animal Science and Technology, No. 6, Tongwei Road, Xuanwu District, Nanjing, Jiangsu 210095, P. R. China
| | - K H Huang
- College of Veterinary Medicine, Nanjing Agricultural University, No. 6, Tongwei Road, Xuanwu District, Nanjing, Jiangsu 210095, P. R. China
| | - T Wang
- College of Animal Science and Technology, No. 6, Tongwei Road, Xuanwu District, Nanjing, Jiangsu 210095, P. R. China
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Hutchinson DT, Sueoka S, Wang AA, Tyser AR, Papi-Baker K, Kazmers NH. A Prospective, Randomized Trial of Mobilization Protocols Following Ligament Reconstruction and Tendon Interposition. J Bone Joint Surg Am 2018; 100:1275-1280. [PMID: 30063589 DOI: 10.2106/jbjs.17.01157] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the hypothesis that an increased duration of immobilization following trapeziectomy with ligament reconstruction and tendon interposition (LRTI) leads to improved patient-reported outcomes compared with an early mobilization protocol. METHODS At 2 institutions, we prospectively randomized 223 patients (238 thumbs) undergoing LRTI to receive 1 of 2 postoperative rehabilitation protocols. The immobilization protocol consisted of use of a postoperative forearm-based thumb-spica splint for 7 days followed by a forearm-based thumb-spica cast for 5 weeks and then by a custom forearm-based thermoplastic thumb-spica splint for an additional 6 weeks. An active range of motion (ROM) was started 6 weeks postoperatively. The early mobilization protocol consisted of the same postoperative splint for 7 days followed by use of a forearm-based thermoplastic thumb-spica splint for 3 weeks and then by a hand-based thumb-spica splint for 4 weeks. An active ROM was started 4 weeks postoperatively. The outcome measures included the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire; pinch and grip strength; 9-hole peg test (NHP); visual analog scale (VAS) for pain; VAS for patient satisfaction; and wrist and thumb ROM. These were measured preoperatively and at 6, 12, 26, 52, and 104 weeks postoperatively. Differences in continuous and categorical variables were assessed with use of Tukey multiple comparisons following 1-way analysis of variance and Fisher exact tests, respectively. RESULTS A minimum follow-up of 1 year (mean, 1.7 years) was achieved for 71% (169) of the 238 randomized thumbs (157 of the 223 patients): 74 patients (80 thumbs) treated with the immobilization protocol and 83 patients (89 thumbs) treated with the early mobilization protocol. DASH scores, VAS pain scores, VAS patient satisfaction scores, and strength all improved similarly with no significant differences between groups at any time point. Wrist and thumb ROM and NHP outcomes were significantly worse for the immobilization group at 6 weeks postoperatively, with no differences observed between groups at 12 weeks and beyond. CONCLUSIONS A conservative immobilization protocol does not improve functional outcomes, satisfaction, strength, or ROM following LRTI compared with an early mobilization protocol. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Stephanie Sueoka
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Angela A Wang
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Andrew R Tyser
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | | | - Nikolas H Kazmers
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
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17
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Hung M, Saltzman CL, Greene T, Voss MW, Bounsanga J, Gu Y, Wang AA, Hutchinson D, Tyser AR. The responsiveness of the PROMIS instruments and the qDASH in an upper extremity population. J Patient Rep Outcomes 2017; 1:12. [PMID: 29757302 PMCID: PMC5934915 DOI: 10.1186/s41687-017-0019-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 11/13/2017] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND This study evaluated the responsiveness of several PROMIS patient-reported outcome measures in patients with hand and upper extremity disorders and provided comparisons with the qDASH instrument. METHODS The PROMIS Upper Extremity computer adaptive test (UE CAT) v1.2, the PROMIS Physical Function (PF) CAT v1.2, the PROMIS Pain Interference (PI) CAT v1.1 and the qDASH were administered to patients presenting to an orthopaedic hand clinic during the years 2014-2016, along with anchor questions. The responsiveness of these instruments was assessed using anchor based methods. Changes in functional outcomes were evaluated by paired-sample t-test, effect size, and standardized response mean. RESULTS There were a total of 255 patients (131 females and 124 males) with an average age of 50.75 years (SD = 15.84) included in our study. Based on the change and no change scores, there were three instances (PI at 3 months, PI >3 months, and qDASH >3 months follow-ups) where scores differed between those experiencing clinically meaningful change versus no clinically meaningful change. Effect sizes for the responsiveness of all instruments were large and ranged from 0.80-1.48. All four instruments demonstrated high responsiveness, with a standardized response mean ranging from 1.05 to 1.63. CONCLUSION The PROMIS UE CAT, PF CAT, PI CAT, and qDASH are responsive to patient-reported functional change in the hand and upper extremity patient population.
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Affiliation(s)
- Man Hung
- Department of Orthopaedic Surgery Operations, University of Utah, School of Medicine, 590 Wakara Way, Salt Lake City, UT 84108 USA
- Division of Public Health, University of Utah, School of Medicine, 375 Chipeta Way Ste. A, Salt Lake City, 84108 USA
- Population Health Foundation, University of Utah, 295 Chipeta Way, Williams Building, Room 1C448, Salt Lake City, UT 84132 USA
| | - Charles L. Saltzman
- Department of Orthopaedic Surgery Operations, University of Utah, School of Medicine, 590 Wakara Way, Salt Lake City, UT 84108 USA
| | - Tom Greene
- Population Health Foundation, University of Utah, 295 Chipeta Way, Williams Building, Room 1C448, Salt Lake City, UT 84132 USA
| | - Maren W. Voss
- Department of Orthopaedic Surgery Operations, University of Utah, School of Medicine, 590 Wakara Way, Salt Lake City, UT 84108 USA
| | - Jerry Bounsanga
- Department of Orthopaedic Surgery Operations, University of Utah, School of Medicine, 590 Wakara Way, Salt Lake City, UT 84108 USA
| | - Yushan Gu
- Department of Orthopaedic Surgery Operations, University of Utah, School of Medicine, 590 Wakara Way, Salt Lake City, UT 84108 USA
| | - Angela A. Wang
- Department of Orthopaedic Surgery Operations, University of Utah, School of Medicine, 590 Wakara Way, Salt Lake City, UT 84108 USA
| | - Douglas Hutchinson
- Department of Orthopaedic Surgery Operations, University of Utah, School of Medicine, 590 Wakara Way, Salt Lake City, UT 84108 USA
| | - Andrew R. Tyser
- Department of Orthopaedic Surgery Operations, University of Utah, School of Medicine, 590 Wakara Way, Salt Lake City, UT 84108 USA
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18
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Liao HF, Wang YH, Huang Q, Gan PY, Wang AA. [Analysis of the effect of different surgical methods on the cavernous hemangioma of the deep orbit]. Zhonghua Yan Ke Za Zhi 2017; 53:288-293. [PMID: 28412802 DOI: 10.3760/cma.j.issn.0412-4081.2017.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the effect of the surgical removal of orbital deep cavernous hemangioma following the concept of minimal surgical invasion. Methods: Retrospective case series study. Sixty-three cases with surgical removal of deep orbital cavernous hemangioma were collected in the Affiliated Eye Hospital of Nanchang University from May 2012 to August 2015. There were 29 males and 34 females. The age was from 17 to 69 years with mean age (45±11) years.The surgical methods the conjunctival approach orbital surgery, lateral orbital surgery, medial skin orbital surgery, lateral orbital conjunctiva conjunctival pathway and endoscopic nasal approach were chosen for different cases. The visual acuity, visual field and electrophysiological examination were analyzed before and after operation. Result: Sixty-three patients underwent complete surgically removal of the tumor. Among them, 32 cases were conducted by conjunctival approach, 24 cases had improved visual acuity, 5 cases had no change of visual acuity, 3 cases had decreased visual acuity. Seventeen cases performed with lateral open orbital surgery had improved visual acuity in 11 cases, no change in visual acuity in 3 cases and decreased visual acuity in 3 cases postoperatively. Six cases with approach of the medial orbital surgery had improved visual acuity in 4 cases, no change of visual acuity in 1 case and decreased visual acuity in 1 case postoperatively. Six cases with approach of outside open orbital surgery combined with medial conjunctival pathway had improved visual acuity in 4 cases, no change of visual acuity in 1 case and decreased visual acuity in 1 case postoperatively. Two cases performed with endoscopic nasal approach. One of them had normal visual function and no change after surgery. Another had impaired visual function pre-operatively and it came back to normal postoperatively. Conclusions: With the concept of minimal surgical invasion, the choice of appropriate surgical approach can save patients with the greatest degree of visual function and even improve the visual function of the patients with orbital cavernous hemangioma. (Chin J Ophthalmol, 2017, 53: 288-293).
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Affiliation(s)
- H F Liao
- Affiliated eye hospital of Nanchang University, Nanchang 330000, China
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Molloy ME, Lewinska M, Liu XS, Wang AA, Yuan ZM. Abstract 3657: ZBTB7A is a tumor suppressor and novel therapeutic target in triple-negative breast cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-3657] [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: 11/16/2022]
Abstract
Abstract
Due to lack of targeted therapies triple-negative breast cancers (TNBC) are the deadliest form of breast cancer, raising a pressing need to develop new therapeutic strategies. Recent advances in tumor metabolism have created exciting therapeutic opportunities by unveiling many previously unrecognized therapeutic targets. Like other tumor types, TNBCs also feature elevated glucose and glutamine metabolism (Shen, L., et al. 2015; McCleland, M., et al. 2012). A better understanding of the underlying mechanisms may uncover novel therapeutic targets for TNBC. Our lab has recently discovered that ZBTB7A suppresses glycolysis by transcriptionally repressing key genes within the glycolytic pathway in various cancer types (Liu, X.S., et al. 2014). Currently, ZBTB7A is proposed as an oncogene in breast cancer (Zu, X., et al. 2011), however our data suggest that ZBTB7A acts as a tumor suppressor specifically in TNBC. The purpose of this study was to determine the potential therapeutic value of targeting ZBTB7A in TNBC. Using publicly available databases, we find that low ZBTB7A expression is associated with poor prognosis in patients with hormone receptor-negative breast cancers. Our studies corroborate with patient derived data by demonstrating that reduced expression of ZBTB7A in TNBC cell lines leads to increased proliferation and resistance to radiation and chemotherapy. Differential gene expression analysis across human breast cancer samples in TCGA database revealed an inverse correlation between ZBTB7A and glycolytic genes. Overexpression of ZBTB7A in TNBC cells leads to decreased MCT1, LDHB and GLUT3 expression at the transcript level, consistent with our published data. Modulation of ZBTB7A expression also leads to changes in lactate production and glucose consumption in TNBC cells. Results from this study support ZBTB7A as a novel tumor suppressor and perspective therapeutic target in TNBC.
Citation Format: Mary Ellen Molloy, Monika Lewinska, Xue-Song Liu, Angela A. Wang, Zhi-Min Yuan. ZBTB7A is a tumor suppressor and novel therapeutic target in triple-negative breast cancer. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3657.
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Langer JS, Sueoka SS, Wang AA. The importance of shoulder external rotation in activities of daily living: improving outcomes in traumatic brachial plexus palsy. J Hand Surg Am 2012; 37:1430-6. [PMID: 22652182 DOI: 10.1016/j.jhsa.2012.04.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [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] [Received: 12/02/2011] [Revised: 04/04/2012] [Accepted: 04/05/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE To define the importance of shoulder external rotation in activities of daily living in normal individuals to better understand how restoration of shoulder external rotation in traumatic brachial plexus palsy could improve patient function. METHODS Thirty-one normal individuals performed 12 common activities of daily living (ADLs) wearing a custom shoulder orthosis designed to selectively limit shoulder external rotation to 3 different settings, ranging from 0° (most restrictive) to 90° (least restrictive) of external rotation. Outcomes were measured with a visual analog scale of perceived difficulty in accomplishing the ADLs with each orthosis setting and the Disabilities of the Arm, Shoulder, and Hand questionnaire administered after each set of 12 ADLs was completed. RESULTS Subjects perceived increasing difficulty during all ADLs tested and registered higher disability scores with increasing restriction of shoulder external rotation. The ADLs requiring motions predominantly above the waist exhibited more marked and earlier changes in visual analog scale scores with increasing shoulder external rotation restriction. CONCLUSIONS Traditionally, surgeons have pursued restoration of shoulder abduction and forward elevation in secondary reconstruction of traumatic brachial plexus injuries. Recently, the concept of preferentially restoring shoulder external rotation has been proposed, without clear evidence in the literature of the role of shoulder external rotation in ADLs. CLINICAL RELEVANCE Our results support the notion that restoring shoulder external rotation in the treatment of traumatic brachial plexus palsy patients might improve outcomes by decreasing patient disability and increasing the ability to perform ADLs.
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Affiliation(s)
- Jakub S Langer
- Department of Orthopaedic Surgery and Hand Therapy, University of Utah, Salt Lake City, UT 84108, USA
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Abstract
Flail elbow is a relatively uncommon cause of elbow dysfunction. It is defined as the inability to position the arm in space for useful elbow function because of structural or neurologic inadequacies. Patient function is often severely compromised and treatment options are limited with moderate levels of success depending on etiology. This article reviews the various etiologies of dysfunctional elbow instability, their treatment options, and their expected outcomes.
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Affiliation(s)
- Robert Z Tashjian
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT 84108, USA.
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Hutchinson DT, Wang AA, Ryssman D, Brown NAT. Both-bone forearm osteotomy for supination contracture: a cadaver model. J Hand Surg Am 2006; 31:968-72. [PMID: 16843157 DOI: 10.1016/j.jhsa.2006.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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] [Received: 10/04/2004] [Revised: 01/20/2006] [Accepted: 01/20/2006] [Indexed: 02/02/2023]
Abstract
PURPOSE To quantify the magnitude of rotational correction possible when comparing a single forearm bone osteotomy and fixation with stepwise osteotomy and fixation of both bones in a cadaver model and to determine if the order in which the stepwise osteotomies are performed influences the amount of correction. METHODS Ten fresh-frozen cadaveric forearms were fixed to a frame positioned in the field of view of a motion-capture system. An experimental supination contracture was induced in full supination. Cadaver forearms were assigned randomly to group I (ulna osteotomy, rotation, plating) or group II (radius osteotomy, rotation, plating). Cadavers in group I were used later in group III (ulna + radius) by completing a radial osteotomy, rotation, and fixation in the forearms with the plated ulna. Similarly the specimens assigned to group II were used later in group IV (radius + ulna) by completing an ulna osteotomy, rotation, and fixation in the forearms with the plated radiuses. Measurements of forearm pronation were made after single-bone (groups I, II) and stepwise both-bone (groups III, IV) rotational osteotomies. RESULTS Stepwise rotational osteotomy and fixation of the ulna followed by the radius produced significantly more corrective pronation (101 degrees) than rotating the radius followed by the ulna (65 degrees). Rotating the radius gave only moderate correction (58 degrees) and minimal correction was produced by ulna osteotomy alone (15 degrees). CONCLUSIONS Rotational osteotomy of both forearm bones can create approximately 100 degrees of correction when performed at the proximal ulna followed by the distal radius. If less rotation is needed then the distal radius osteotomy alone can provide approximately 60 degrees of correction.
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Wang AA, Hutchinson DT. The effect of corticosteroid injection for trigger finger on blood glucose level in diabetic patients. J Hand Surg Am 2006; 31:979-81. [PMID: 16843159 DOI: 10.1016/j.jhsa.2006.03.022] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [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] [Received: 11/17/2005] [Revised: 03/27/2006] [Accepted: 03/28/2006] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine how corticosteroid injections for trigger finger affect the blood glucose level in diabetic patients and the clinical results of those injections. METHODS Eighteen diabetic patients receiving a methylprednisolone injection for a single trigger finger were studied. Six patients had type I (juvenile-onset) diabetes and 12 patients had type II (adult-onset) diabetes. Patients recorded their usual blood glucose measurements and then they recorded their blood glucose measurements for 5 days after injection. Clinical efficacy of the injections was measured by avoidance of surgery. RESULTS There were 3 men and 15 women with an average age of 58 years. The blood glucose level increased after corticosteroid injection for all patients. The first morning after injection showed the biggest increase in blood glucose level: 73% more than the average preinjection levels. By the fifth morning after injection the blood glucose levels still were increased by 26% more than the preinjection levels. This trend was marked particularly in type I diabetic patients, who had an average blood glucose level increase the first morning after injection of 145%, which decreased over 5 days to 22% greater than baseline levels. Sixteen patients had follow-up evaluation over a period of 1 year and of these 16 patients 7 required surgery for this condition. CONCLUSIONS A digital injection of the corticosteroid methylprednisolone acetate in diabetic patients with trigger finger causes a hyperglycemic effect that lasts for at least 5 days but can help prevent the need for surgery more than half the time. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic, Level IV.
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Affiliation(s)
- Angela A Wang
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT 84108, USA.
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Abstract
The purpose of this study was to review the Compass Universal Hinge dynamic elbow external fixator in pediatric conditions. Eight patients with diagnoses of ulnar club hand (n = 2), proximal radial synostosis with hypoplastic coronoid (n = 1), pterygium cubitale (n = 2), and elbow arthrofibrosis (n = 3) were identified. Indications for fixator placement were to maintain elbow stability during forearm lengthening (two cases), protect a coronoid reconstruction (one case), increase range of motion via the fixator (two cases), and maintain stability and increase range of motion after open release (three cases). There were five boys and three girls with an average age at surgery of 11.5 (range 3-19) years. In each case, the goal for fixator use was achieved: both forearm lengthenings were completed without elbow instability, the coronoid reconstruction healed in good position, and four of five patients obtained increased range of motion via the fixator (average improved arc of motion of 31 degrees), with all elbows remaining reduced and stable. Complications included four pin tract infections, one of which became osteomyelitis; two broken/loose pins; and two cases of decreased elbow range of motion. Average follow-up was 29 (range 3-62) months. Use of the Compass Universal Hinge dynamic external fixator can be adapted to children and has proven useful in managing certain difficult conditions.
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Affiliation(s)
- Angela A Wang
- Shriners Hospitals for Children, Intermountain Unit, Primary Children's Medical Center, University of Utah, Salt Lake City, 84108, USA.
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Wang AA, Hutchinson DT, Vanderhooft JE. Bilateral simultaneous open carpal tunnel release: a prospective study of postoperative activities of daily living and patient satisfaction. J Hand Surg Am 2003; 28:845-8. [PMID: 14507517 DOI: 10.1016/s0363-5023(03)00257-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [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: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to determine patient function and satisfaction prospectively after bilateral simultaneous open carpal tunnel release (CTR). METHODS Twenty patients (40 CTR) completed a questionnaire regarding postoperative activities of daily living (ADL), return to work, procedure satisfaction (visual analog scale), and willingness to have the surgery again. RESULTS The average patient age was 43 years (range, 23-73 y). The hardest task was opening a jar; the easiest task was using the bathroom. Other tasks on the list in descending order of difficulty included driving, household chores, carrying groceries, buttoning, bathing, cooking, writing, dressing, shopping, holding a book, eating, computer use, and holding a phone. Average return to work was 2.6 weeks (range, 3 d-6 wk). Average satisfaction with the surgery was 9.6 of 10 (range, 8-10); 20 of 20 patients (100%) would have the bilateral simultaneous surgery again. CONCLUSIONS These data are useful for patient education and decision making when considering surgery in patients with bilateral carpal tunnel syndrome, and show that bilateral simultaneous open CTR is a feasible and useful procedure.
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Affiliation(s)
- Angela A Wang
- Department of Orthopedics, University of Utah, Salt Lake City, UT 84132, USA
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Wang AA, Whitaker E, Hutchinson DT, Coleman DA. Pain levels after injection of corticosteroid to hand and elbow. Am J Orthop (Belle Mead NJ) 2003; 32:383-5. [PMID: 12943338] [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: 03/04/2023]
Abstract
The goal of this study was to examine temporal pain response after injection of corticosteroid to the upper extremity (hand and elbow). Visual analog pain questionnaires were prospectively distributed to 133 consecutive patients, and pain levels were recorded for 5 days after injection. Ninety-four patients (71%) completed the questionnaire. Forty-seven (50%) of the 94 patients did not have increased pain after injection; the other 47 patients had increased pain after injection. The increased pain in 39 (83%) of the 47 patients resolved by day 5, lasting a mean of 1.2 days, and these 39 patients eventually had mean pain improvement of 71%. At day 5, 8 (17%) of the 47 patients had increased postinjection pain levels equal to or greater than their preinjection pain. The percentage of patients who transiently experienced increased pain after corticosteroid injection is quite high (50%), but most symptoms abated by day 2. We believe that these data are important for patient education.
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Abstract
We present the case of a 39-year-old woman who applied superglue to her fingertip as a treatment for dry skin. She developed full-thickness necrosis of her thumb pad complicated by a secondary superinfection. This necrosis occurred from the degradation of the cyanoacrylate in the superglue compound to formaldehyde, causing local histotoxicity. This injury necessitated a local flap for coverage, which healed uneventfully and without lasting sequelae.
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Affiliation(s)
- Angela A Wang
- Department of Orthopedics, University of Utah, and Salt Lake Orthopaedic Clinic, Salt Lake City, UT 84132, USA
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Abstract
The purpose of this study was to define the proximal ulna anatomy with respect to olecranon osteotomy and fracture fixation. Thirty-nine cadaver elbows were dissected. The mean ulnar length (triceps insertion to ulnar styloid) was 26.0 cm (range, 27.1-29.0 cm). The mean distance from the triceps insertion to the ulna's varus angulation point was 7.6 cm (range, 6.5-9.0 cm). The distance ratio from the triceps insertion to the proximal ulnar angle to the overall ulna length was consistent, averaging 0.29 (range, 0.23-0.33). The mean diameter of the medullary canal at the ulnar angulation point could accommodate a 7.0- or 7.3-mm intramedullary screw. The mean width of the olecranon bare area (lacking articular cartilage) was 0.53 cm (range, 0.13-0.97 cm), and the mean distance from the triceps insertion to the corresponding area of the bare spot on the dorsal cortex was 2.1 cm (range, 1.4-2.5 cm).
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Affiliation(s)
- Angela A Wang
- Department of Orthopedics, University of Utah, 50 N Medical Dr, Salt Lake City, UT 84132, USA
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Abstract
The purpose of this study was to review the construction of a one-bone forearm performed to change the position of the forearm in children with fixed supination deformity due to upper extremity neurologic deficit. The one-bone forearm arthrodesis has been previously described in treating trauma, tumors, infection, and congenital deformities. It has not been described to improve forearm position in neurologically impaired upper extremities. We retrospectively evaluated 6 pediatric patients with upper extremity weakness and severe supination contracture who underwent forearm arthrodesis in neutral or slight pronation. Five patients achieved fusion, and 1 patient had an atrophic nonunion (17% nonunion rate). Average follow-up was 6 years 6 months (range 1 year 9 months to 11 years 2 months), and all patients were satisfied with their new forearm position.
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Affiliation(s)
- A A Wang
- University of Utah, Department of Orthopedics, Shriner's Hospital-Intermountain Unit, Salt Lake City, UT 84132, USA
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Abstract
The purpose of this study was to examine the behavior of ganglia of the hand and wrist in young children treated without surgery. Fourteen consecutive children, less than 10 years of age, who presented with cysts of the hand and wrist were followed up by a single surgeon. The average age of the patient at the time of diagnosis was 38 months (range, 2 months to 9 years 3 months). The masses included 7 retinacular cysts, 5 volar wrist ganglia, and 2 dorsal wrist ganglia. These cysts had been present for an average of 3.3 months (range, 1-12 months) before medical advice was sought. None of the cysts were painful. Follow-up averaged 33 months (range, 9-112 months), with 79% of all cysts spontaneously resolving, the majority within a year. We believe that a child presenting with a benign hand lesion characteristic of a ganglion cyst should initially be treated by observation.
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Affiliation(s)
- A A Wang
- University of Utah Department of Orthopedics, Primary Children's Medical Center, Shriner's Hospital-Intermountain Unit, Salt Lake City, UT 84132, USA
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Abstract
Specific adhesion of Eshcherichia coli with surface-exposed cellulose-binding domain (CBD) to cellulosic materials was investigated. Whole-cell immobilization was very specific, forming essentially a monolayer of cells onto the different supports. Cells with surface-exposed CBD bound specifically and tightly to cellulose supports at a wide range of pH. In contrast to CBD, which shows the highest binding to cellulose at 4 degrees C, highest cell loading was observed at 37 degrees C. The extent of immobilization was dependent on the amount of surface-exposed CBD. Cells binding increased with increasing amount of CBD until binding was saturated. Even induction of very low level of CBD (0.05 mM IPTG) was sufficient to provide specific and tight binding to cellulose support. Because optimal binding can be obtained under physiological conditions such as pH 7 and 37 degrees C, the results demonstrate the general utility of surface-exposed CBD as an efficient means of whole-cell immobilization.
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Affiliation(s)
- A A Wang
- Department of Chemical and Environmental Engineering, and Environmental Toxicology Program, University of California, Riverside, California 92521, USA
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Abstract
The purpose of this study was to determine the optimal position for forearm arthrodesis. We attempted to determine functional difficulties associated with different positions of simulated fusion and whether there was a difference between men and women in their preference for fusion position. The forearms of 30 subjects were immobilized in neutral, 45 degrees supination, and 45 degrees pronation. The subjects performed 2 functional tests in each splint: the Jebsen hand function test and a subjective evaluation of the difficulty of activities of daily living. Each subject was asked to choose a preferred position for forearm fusion. Overall, subjects found the supinated position the most difficult to adapt to; the majority (63.3%) preferred neutral. Based on the results of our study we recommend forearm fusion in neutral or slight pronation. A thorough preoperative activity history and functional assessment may assist in determining the desired forearm arthrodesis position in a given individual.
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Affiliation(s)
- A A Wang
- Department of Orthopaedic Surgery and Cornell Hand Rehabilitation Center, New York, NY, USA
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Abstract
Eleven fresh-frozen cadaver shoulders were dissected to define the anatomy of the teres major muscle and tendon and to determine the muscle's potential for use as a tendon transfer to the humeral head. Of the 11 specimens, 7 had Mathes type II circulation. The primary and secondary pedicles, from the circumflex scapular artery, entered the muscle 4.1 cm and 0.5 cm from the scapula, respectively. The lower subscapular nerve entered 4.1 cm from the scapula. Mean tendon and muscle lengths were 2.0 and 11.8 cm, respectively. As a unipolar transfer, the tendon reached the greater tuberosity in all but 1 specimen. The bipolar transfer offered numerous theoretical possibilities. We believe that the teres major has an appropriate vascular supply and adequate length to make it suitable for tendon transfer to the humeral head.
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Affiliation(s)
- A A Wang
- Department of Orthopaedic Surgery, New York Orthopaedic Hospital, Columbia-Presbyterian Medical Center, USA
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Abstract
A case of pseudoaneurysm of the ulnar artery occurring after distal radius and ulna fracture is presented. This case illustrates an uncommon complication following a fairly common injury.
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Affiliation(s)
- A A Wang
- Department of Orthopaedic Surgery, New York Orthopaedic Hospital, Columbia-Presbyterian Medical Center, New York, USA
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Wang AA, Patterson HS, Hemstreet MP, Tiller RE. Hemothorax in a patient with asthma. Ann Allergy 1990; 64:55-7. [PMID: 2297146] [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: 12/31/2022]
Abstract
Treatment of chronic illnesses such as asthma can often become routine. This is a case report that emphasizes the importance of a thorough history and physical examination for each exacerbation of asthma. An 11-year-old girl with a history of asthma presented to the emergency room with wheezing and dyspnea that was assumed to be an exacerbation of her chronic illness. After careful history taking and physical examination, a chest radiograph was recommended. The x-ray revealed a hemothorax and a new diagnosis was made, thoracic Ewing's sarcoma.
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Affiliation(s)
- A A Wang
- Department of Pediatrics, University of Alabama, Birmingham
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Wang AA, Gu FS. [Effect of single-dose verapamil on ventricular wall movement in hypertrophic cardiomyopathy]. Zhonghua Xin Xue Guan Bing Za Zhi 1987; 15:25-6. [PMID: 3608781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Wang AA, Ku FS. [An etiologic study of flail valve leaflet change]. Zhonghua Nei Ke Za Zhi 1984; 23:419-21, 462. [PMID: 6518870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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