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Nyawo G, Naidoo C, Wu BG, Kwok B, Clemente JC, Li Y, Minnies S, Reeve B, Moodley S, John TJ, Karamchand S, Singh S, Pecararo A, Doubell A, Kyriakakis C, Warren R, Segal LN, Theron G. Bad company? The pericardium microbiome in people investigated for tuberculosis pericarditis in an HIV-prevalent setting. medRxiv 2024:2024.04.26.24306431. [PMID: 38712063 PMCID: PMC11071582 DOI: 10.1101/2024.04.26.24306431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Background The microbiome likely plays a role in tuberculosis (TB) pathogenesis. We evaluated the site-of-disease microbiome and predicted metagenome in people with presumptive tuberculous pericarditis, a major cause of mortality, and explored for the first time, the interaction between its association with C-reactive protein (CRP), a potential diagnostic biomarker and the site-of-disease microbiome in extrapulmonary TB. Methods People with effusions requiring diagnostic pericardiocentesis (n=139) provided background sampling controls and pericardial fluid (PF) for 16S rRNA gene sequencing analysed using QIIME2 and PICRUSt2. Blood was collected to measure CRP. Results PF from people with definite (dTB, n=91), probable (pTB, n=25), and non- (nTB, n=23) tuberculous pericarditis differed in β-diversity. dTBs were, vs. nTBs, Mycobacterium-, Lacticigenium-, and Kocuria- enriched. Within dTBs, HIV-positives were Mycobacterium-, Bifidobacterium- , Methylobacterium- , and Leptothrix -enriched vs. HIV-negatives and HIV-positive dTBs on ART were Mycobacterium - and Bifidobacterium -depleted vs. those not on ART. Compared to nTBs, dTBs exhibited short-chain fatty acid (SCFA) and mycobacterial metabolism microbial pathway enrichment. People with additional non-pericardial involvement had differentially PF taxa (e.g., Mycobacterium -enrichment and Streptococcus -depletion associated with pulmonary infiltrates). Mycobacterium reads were in 34% (31/91), 8% (2/25) and 17% (4/23) of dTBs, pTBs, and nTBs, respectively. β-diversity differed between patients with CRP above vs. below the median value ( Pseudomonas -depleted). There was no correlation between enriched taxa in dTBs and CRP. Conclusions PF is compositionally distinct based on TB status, HIV (and ART) status and dTBs are enriched in SCFA-associated taxa. The clinical significance of these findings, including mycobacterial reads in nTBs and pTBs, requires evaluation.
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Sulaiman I, Wu BG, Chung M, Isaacs B, Tsay JCJ, Holub M, Barnett CR, Kwok B, Kugler MC, Natalini JG, Singh S, Li Y, Schluger R, Carpenito J, Collazo D, Perez L, Kyeremateng Y, Chang M, Campbell CD, Hansbro PM, Oppenheimer BW, Berger KI, Goldring RM, Koralov SB, Weiden MD, Xiao R, D’Armiento J, Clemente JC, Ghedin E, Segal LN. Lower Airway Dysbiosis Augments Lung Inflammatory Injury in Mild-to-Moderate Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2023; 208:1101-1114. [PMID: 37677136 PMCID: PMC10867925 DOI: 10.1164/rccm.202210-1865oc] [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: 10/18/2022] [Accepted: 09/07/2023] [Indexed: 09/09/2023] Open
Abstract
Rationale: Chronic obstructive pulmonary disease (COPD) is associated with high morbidity, mortality, and healthcare costs. Cigarette smoke is a causative factor; however, not all heavy smokers develop COPD. Microbial colonization and infections are contributing factors to disease progression in advanced stages. Objectives: We investigated whether lower airway dysbiosis occurs in mild-to-moderate COPD and analyzed possible mechanistic contributions to COPD pathogenesis. Methods: We recruited 57 patients with a >10 pack-year smoking history: 26 had physiological evidence of COPD, and 31 had normal lung function (smoker control subjects). Bronchoscopy sampled the upper airways, lower airways, and environmental background. Samples were analyzed by 16S rRNA gene sequencing, whole genome, RNA metatranscriptome, and host RNA transcriptome. A preclinical mouse model was used to evaluate the contributions of cigarette smoke and dysbiosis on lower airway inflammatory injury. Measurements and Main Results: Compared with smoker control subjects, microbiome analyses showed that the lower airways of subjects with COPD were enriched with common oral commensals. The lower airway host transcriptomics demonstrated differences in markers of inflammation and tumorigenesis, such as upregulation of IL-17, IL-6, ERK/MAPK, PI3K, MUC1, and MUC4 in mild-to-moderate COPD. Finally, in a preclinical murine model exposed to cigarette smoke, lower airway dysbiosis with common oral commensals augments the inflammatory injury, revealing transcriptomic signatures similar to those observed in human subjects with COPD. Conclusions: Lower airway dysbiosis in the setting of smoke exposure contributes to inflammatory injury early in COPD. Targeting the lower airway microbiome in combination with smoking cessation may be of potential therapeutic relevance.
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Affiliation(s)
- Imran Sulaiman
- Division of Pulmonary and Critical Care Medicine
- Department of Medicine
- Department of Respiratory Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - Benjamin G. Wu
- Division of Pulmonary and Critical Care Medicine
- Department of Medicine
- Division of Pulmonary and Critical Care Medicine, Veterans Affairs (VA) New York Harbor Healthcare System, New York, New York
| | - Matthew Chung
- Systems Genomics Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Bradley Isaacs
- Division of Pulmonary and Critical Care Medicine
- Department of Medicine
| | - Jun-Chieh J. Tsay
- Division of Pulmonary and Critical Care Medicine
- Department of Medicine
- Division of Pulmonary and Critical Care Medicine, Veterans Affairs (VA) New York Harbor Healthcare System, New York, New York
| | - Meredith Holub
- Division of Pulmonary and Critical Care Medicine
- Department of Medicine
- Division of Pulmonary and Critical Care Medicine, Hartford Health Care, Hartford, Connecticut
| | - Clea R. Barnett
- Division of Pulmonary and Critical Care Medicine
- Department of Medicine
| | - Benjamin Kwok
- Division of Pulmonary and Critical Care Medicine
- Department of Medicine
| | | | - Jake G. Natalini
- Division of Pulmonary and Critical Care Medicine
- Department of Medicine
| | - Shivani Singh
- Division of Pulmonary and Critical Care Medicine
- Department of Medicine
| | - Yonghua Li
- Division of Pulmonary and Critical Care Medicine
- Department of Medicine
| | - Rosemary Schluger
- Division of Pulmonary and Critical Care Medicine
- Department of Medicine
| | - Joseph Carpenito
- Division of Pulmonary and Critical Care Medicine
- Department of Medicine
| | - Destiny Collazo
- Division of Pulmonary and Critical Care Medicine
- Department of Medicine
| | - Luisanny Perez
- Division of Pulmonary and Critical Care Medicine
- Department of Medicine
| | - Yaa Kyeremateng
- Division of Pulmonary and Critical Care Medicine
- Department of Medicine
| | - Miao Chang
- Division of Pulmonary and Critical Care Medicine
- Department of Medicine
| | - Christina D. Campbell
- Department of Respiratory Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - Philip M. Hansbro
- Centre for Inflammation, Centenary Institute and University of Technology Sydney, School of Life Sciences, Sydney, New South Wales, Australia
| | | | - Kenneth I. Berger
- Division of Pulmonary and Critical Care Medicine
- Department of Medicine
| | | | | | - Michael D. Weiden
- Division of Pulmonary and Critical Care Medicine
- Department of Medicine
| | - Rui Xiao
- Department of Physiology and Cellular Biophysics, Columbia University School of Medicine, New York, New York; and
| | - Jeanine D’Armiento
- Department of Physiology and Cellular Biophysics, Columbia University School of Medicine, New York, New York; and
| | - Jose C. Clemente
- Department of Genetics and Genomic Sciences and Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Elodie Ghedin
- Systems Genomics Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Leopoldo N. Segal
- Division of Pulmonary and Critical Care Medicine
- Department of Medicine
- Laura and Isaac Perlmutter Cancer Center, New York University Grossman School of Medicine, New York University (NYU) Langone Health, New York, New York
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Sharpe AL, Reibman J, Oppenheimer BW, Goldring RM, Liu M, Shao Y, Bohart I, Kwok B, Weinstein T, Addrizzo-Harris D, Sterman DH, Berger KI. Role of small airway dysfunction in unexplained exertional dyspnoea. ERJ Open Res 2023; 9:00603-2022. [PMID: 37284422 PMCID: PMC10240305 DOI: 10.1183/23120541.00603-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/01/2023] [Indexed: 06/08/2023] Open
Abstract
Background Isolated small airway abnormalities may be demonstrable at rest in patients with normal spirometry; however, the relationship of these abnormalities to exertional symptoms remains uncertain. This study uses an augmented cardiopulmonary exercise test (CPET) to include evaluation of small airway function during and following exercise to unmask abnormalities not evident with standard testing in individuals with dyspnoea and normal spirometry. Methods Three groups of subjects were studied: 1) World Trade Center (WTC) dust exposure (n=20); 2) Clinical Referral (n=15); and Control (n=13). Baseline evaluation included respiratory oscillometry. Airway function during an incremental workload CPET was assessed by: 1) tidal flow versus volume curves during exercise to assess for dynamic hyperinflation and expiratory flow limitation; and 2) post-exercise spirometry and oscillometry to evaluate for airway hyperreactivity. Results All subjects demonstrated normal baseline forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC). Dyspnoea was reproduced during CPET in WTC and Clinical Referral groups versus Control without abnormality in respiratory pattern and minute ventilation. Tidal flow-volume curves uncovered expiratory flow limitation and/or dynamic hyperinflation with increased prevalence in WTC and Clinical Referral versus Control (55%, 87% versus 15%; p<0.001). Post-exercise oscillometry uncovered small airway hyperreactivity with increased prevalence in WTC and Clinical Referral versus Control (40%, 47% versus 0%, p<0.05). Conclusions We uncovered mechanisms for exertional dyspnoea in subject with normal spirometry that was attributable to either small airway dysfunction during exercise and/or small airway hyperreactivity following exercise. The similarity of findings in WTC environmentally exposed and clinically referred cohorts suggests broad relevance for these evaluations.
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Affiliation(s)
- Alexis L. Sharpe
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, NYU Grossman School of Medicine, New York, NY, USA
- André Cournand Pulmonary Physiology Laboratory, Bellevue Hospital, New York, NY, USA
| | - Joan Reibman
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Department of Environmental Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Beno W. Oppenheimer
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, NYU Grossman School of Medicine, New York, NY, USA
- André Cournand Pulmonary Physiology Laboratory, Bellevue Hospital, New York, NY, USA
| | - Roberta M. Goldring
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, NYU Grossman School of Medicine, New York, NY, USA
- André Cournand Pulmonary Physiology Laboratory, Bellevue Hospital, New York, NY, USA
| | - Mengling Liu
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Yongzhao Shao
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Isaac Bohart
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, NYU Grossman School of Medicine, New York, NY, USA
- André Cournand Pulmonary Physiology Laboratory, Bellevue Hospital, New York, NY, USA
| | - Benjamin Kwok
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, NYU Grossman School of Medicine, New York, NY, USA
- André Cournand Pulmonary Physiology Laboratory, Bellevue Hospital, New York, NY, USA
| | - Tatiana Weinstein
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, NYU Grossman School of Medicine, New York, NY, USA
- André Cournand Pulmonary Physiology Laboratory, Bellevue Hospital, New York, NY, USA
| | - Doreen Addrizzo-Harris
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Daniel H. Sterman
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Kenneth I. Berger
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, NYU Grossman School of Medicine, New York, NY, USA
- André Cournand Pulmonary Physiology Laboratory, Bellevue Hospital, New York, NY, USA
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Kwok B, Wu BG, Kocak IF, Sulaiman I, Schluger R, Li Y, Anwer R, Goparaju C, Ryan DJ, Sagatelian M, Dreier MS, Murthy V, Rafeq S, Michaud GC, Sterman DH, Bessich JL, Pass HI, Segal LN, Tsay JCJ. Pleural fluid microbiota as a biomarker for malignancy and prognosis. Sci Rep 2023; 13:2229. [PMID: 36755121 PMCID: PMC9908925 DOI: 10.1038/s41598-023-29001-4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 01/27/2023] [Indexed: 02/10/2023] Open
Abstract
Malignant pleural effusions (MPE) complicate malignancies and portend worse outcomes. MPE is comprised of various components, including immune cells, cancer cells, and cell-free DNA/RNA. There have been investigations into using these components to diagnose and prognosticate MPE. We hypothesize that the microbiome of MPE is unique and may be associated with diagnosis and prognosis. We compared the microbiota of MPE against microbiota of pleural effusions from non-malignant and paramalignant states. We collected a total of 165 pleural fluid samples from 165 subjects; Benign (n = 16), Paramalignant (n = 21), MPE-Lung (n = 57), MPE-Other (n = 22), and Mesothelioma (n = 49). We performed high throughput 16S rRNA gene sequencing on pleural fluid samples and controls. We showed that there are compositional differences among pleural effusions related to non-malignant, paramalignant, and malignant disease. Furthermore, we showed differential enrichment of bacterial taxa within MPE depending on the site of primary malignancy. Pleural fluid of MPE-Lung and Mesothelioma were associated with enrichment with oral and gut bacteria that are commonly thought to be commensals, including Rickettsiella, Ruminococcus, Enterococcus, and Lactobacillales. Mortality in MPE-Lung is associated with enrichment in Methylobacterium, Blattabacterium, and Deinococcus. These observations lay the groundwork for future studies that explore host-microbiome interactions and their influence on carcinogenesis.
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Affiliation(s)
- Benjamin Kwok
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University Grossman School of Medicine, 462 First Avenue 7N21, New York, NY, 10016, USA
| | - Benjamin G Wu
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University Grossman School of Medicine, 462 First Avenue 7N21, New York, NY, 10016, USA
- Division of Pulmonary and Critical Care Medicine, Veterans Affairs New York Harbor Healthcare System, New York, NY, USA
| | - Ibrahim F Kocak
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University Grossman School of Medicine, 462 First Avenue 7N21, New York, NY, 10016, USA
| | - Imran Sulaiman
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University Grossman School of Medicine, 462 First Avenue 7N21, New York, NY, 10016, USA
- Department of Respiratory Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - Rosemary Schluger
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University Grossman School of Medicine, 462 First Avenue 7N21, New York, NY, 10016, USA
| | - Yonghua Li
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University Grossman School of Medicine, 462 First Avenue 7N21, New York, NY, 10016, USA
| | - Raheel Anwer
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University Grossman School of Medicine, 462 First Avenue 7N21, New York, NY, 10016, USA
| | - Chandra Goparaju
- Department of Cardiothoracic Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Daniel J Ryan
- Department of Respiratory Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - Marla Sagatelian
- School of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Matthew S Dreier
- New York University Grossman School of Medicine, New York, NY, USA
| | - Vivek Murthy
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University Grossman School of Medicine, 462 First Avenue 7N21, New York, NY, 10016, USA
- Department of Cardiothoracic Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Samaan Rafeq
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University Grossman School of Medicine, 462 First Avenue 7N21, New York, NY, 10016, USA
- Department of Cardiothoracic Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Gaetane C Michaud
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of South Florida Health, Tampa, FL, USA
| | - Daniel H Sterman
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University Grossman School of Medicine, 462 First Avenue 7N21, New York, NY, 10016, USA
- Department of Cardiothoracic Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Jamie L Bessich
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University Grossman School of Medicine, 462 First Avenue 7N21, New York, NY, 10016, USA
- Department of Cardiothoracic Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Harvey I Pass
- Department of Cardiothoracic Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Leopoldo N Segal
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University Grossman School of Medicine, 462 First Avenue 7N21, New York, NY, 10016, USA
| | - Jun-Chieh J Tsay
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University Grossman School of Medicine, 462 First Avenue 7N21, New York, NY, 10016, USA.
- Division of Pulmonary and Critical Care Medicine, Veterans Affairs New York Harbor Healthcare System, New York, NY, USA.
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5
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Flaifel A, Kwok B, Ko J, Chang S, Smith D, Zhou F, Chiriboga LA, Zeck B, Theise N, Rudym D, Lesko M, Angel L, Moreira A, Narula N. Pulmonary Pathology of End-Stage COVID-19 Disease in Explanted Lungs and Outcomes After Lung Transplantation. Am J Clin Pathol 2022; 157:908-926. [PMID: 34999755 PMCID: PMC8755396 DOI: 10.1093/ajcp/aqab208] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 11/15/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may develop end-stage lung disease requiring lung transplantation. We report the clinical course, pulmonary pathology with radiographic correlation, and outcomes after lung transplantation in three patients who developed chronic respiratory failure due to postacute sequelae of SARS-CoV-2 infection. METHODS A retrospective histologic evaluation of explanted lungs due to coronavirus disease 2019 was performed. RESULTS None of the patients had known prior pulmonary disease. The major pathologic findings in the lung explants were proliferative and fibrotic phases of diffuse alveolar damage, interstitial capillary neoangiogenesis, and mononuclear inflammation, specifically macrophages, with varying numbers of T and B lymphocytes. The fibrosis varied from early collagen deposition to more pronounced interstitial collagen deposition; however, pulmonary remodeling with honeycomb change was not present. Other findings included peribronchiolar metaplasia, microvascular thrombosis, recanalized thrombi in muscular arteries, and pleural adhesions. No patients had either recurrence of SARS-CoV-2 infection or allograft rejection following transplant at this time. CONCLUSIONS The major pathologic findings in the lung explants of patients with SARS-CoV-2 infection suggest ongoing fibrosis, prominent macrophage infiltration, neoangiogenesis, and microvascular thrombosis. Characterization of pathologic findings could help develop novel management strategies.
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Affiliation(s)
- Abdallah Flaifel
- Departments of Pathology, NYU Langone Medical Center, New York University School of Medicine, New York, NY, USA
| | - Benjamin Kwok
- Medicine, NYU Langone Medical Center, New York University School of Medicine, New York, NY, USA
| | - Jane Ko
- Radiology, NYU Langone Medical Center, New York University School of Medicine, New York, NY, USA
| | - Stephanie Chang
- Cardiothoracic Surgery, NYU Langone Medical Center, New York University School of Medicine, New York, NY, USA
| | - Deane Smith
- Cardiothoracic Surgery, NYU Langone Medical Center, New York University School of Medicine, New York, NY, USA
| | - Fang Zhou
- Departments of Pathology, NYU Langone Medical Center, New York University School of Medicine, New York, NY, USA
| | - Luis A Chiriboga
- Departments of Pathology, NYU Langone Medical Center, New York University School of Medicine, New York, NY, USA
| | - Briana Zeck
- Departments of Pathology, NYU Langone Medical Center, New York University School of Medicine, New York, NY, USA
| | - Neil Theise
- Departments of Pathology, NYU Langone Medical Center, New York University School of Medicine, New York, NY, USA
| | - Darya Rudym
- Medicine, NYU Langone Medical Center, New York University School of Medicine, New York, NY, USA
| | - Melissa Lesko
- Medicine, NYU Langone Medical Center, New York University School of Medicine, New York, NY, USA
| | - Luis Angel
- Medicine, NYU Langone Medical Center, New York University School of Medicine, New York, NY, USA
| | - Andre Moreira
- Departments of Pathology, NYU Langone Medical Center, New York University School of Medicine, New York, NY, USA
| | - Navneet Narula
- Departments of Pathology, NYU Langone Medical Center, New York University School of Medicine, New York, NY, USA
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6
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Kwok B, Brosnahan SB, Amoroso NE, Goldenberg RM, Heyman B, Horowitz JM, Jamin C, Sista AK, Smith DE, Yuriditsky E, Maldonado TS. Pulmonary Embolism Response Team activation during the COVID-19 pandemic in a New York City Academic Hospital: a retrospective cohort analysis. J Thromb Thrombolysis 2021; 51:330-338. [PMID: 32910409 PMCID: PMC7482370 DOI: 10.1007/s11239-020-02264-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is associated with increased rates of deep vein thrombosis (DVT) and pulmonary embolism (PE). Pulmonary Embolism Response Teams (PERT) have previously been associated with improved outcomes. We aimed to investigate whether PERT utilization, recommendations, and outcomes for patients diagnosed with acute PE changed during the COVID-19 pandemic. This is a retrospective cohort study of all adult patients with acute PE who received care at an academic hospital system in New York City between March 1st and April 30th, 2020. These patients were compared against historic controls between March 1st and April 30th, 2019. PE severity, PERT utilization, initial management, PERT recommendations, and outcomes were compared. There were more cases of PE during the pandemic (82 vs. 59), but less PERT activations (26.8% vs. 64.4%, p < 0.001) despite similar markers of PE severity. PERT recommendations were similar before and during the pandemic; anticoagulation was most recommended (89.5% vs. 86.4%, p = 0.70). During the pandemic, those with PERT activations were more likely to be female (63.6% vs. 31.7%, p = 0.01), have a history of DVT/PE (22.7% vs. 1.7%, p = 0.01), and to be SARS-CoV-2 PCR negative (68.2% vs. 38.3% p = 0.02). PERT activation during the pandemic is associated with decreased length of stay (7.7 ± 7.7 vs. 13.2 ± 12.7 days, p = 0.02). PERT utilization decreased during the COVID-19 pandemic and its activation was associated with different biases. PERT recommendations and outcomes were similar before and during the pandemic, and led to decreased length of stay during the pandemic.
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Affiliation(s)
- Benjamin Kwok
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Langone Health, New York, NY, USA.
| | - Shari B Brosnahan
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Langone Health, New York, NY, USA
| | - Nancy E Amoroso
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Langone Health, New York, NY, USA
| | - Ronald M Goldenberg
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Langone Health, New York, NY, USA
| | - Brooke Heyman
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Langone Health, New York, NY, USA
| | - James M Horowitz
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Catherine Jamin
- Ronald O. Perelman Department of Emergency Medicine, New York University Langone Health, New York, NY, USA
| | - Akhilesh K Sista
- Division of Vascular and Interventional Radiology, New York University Langone Health, New York, NY, USA
| | - Deane E Smith
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, USA
| | - Eugene Yuriditsky
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Thomas S Maldonado
- Division of Vascular and Endovascular Surgery, New York University Langone Health, New York, NY, USA
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7
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Horowitz JM, Yuriditsky E, Henderson IJ, Stachel MW, Kwok B, Saric M. Clot in Transit on Transesophageal Echocardiography in a Prone Patient with COVID-19 Acute Respiratory Distress Syndrome. CASE (Phila) 2020; 4:200-203. [PMID: 32426575 PMCID: PMC7229961 DOI: 10.1016/j.case.2020.05.007] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
•The risk for thromboembolic events in COVID-19 is substantial. •PE should be considered in cases of clinical deterioration. •Management of CIT is controversial.
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Affiliation(s)
- James M Horowitz
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Eugene Yuriditsky
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Ian J Henderson
- Department of Medicine, New York University Langone Health, New York, New York
| | - Maxine Wallis Stachel
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Benjamin Kwok
- Department of Medicine, New York University Langone Health, New York, New York
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
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Durnin L, Kwok B, Kukadia P, McAvera R, Corrigan RD, Ward SM, Zhang Y, Chen Q, Koh SD, Sanders KM, Mutafova-Yambolieva VN. An ex vivo bladder model with detrusor smooth muscle removed to analyse biologically active mediators released from the suburothelium. J Physiol 2018; 597:1467-1485. [PMID: 30289177 DOI: 10.1113/jp276924] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 10/02/2018] [Indexed: 12/15/2022] Open
Abstract
KEY POINTS Studies of urothelial cells, bladder sheets or lumens of filled bladders have suggested that mediators released from urothelium into suburothelium (SubU)/lamina propria (LP) activate mechanisms controlling detrusor excitability. None of these approaches, however, has enabled direct assessment of availability of mediators at SubU/LP during filling. We developed an ex vivo mouse bladder preparation with intact urothelium and SubU/LP but no detrusor, which allows direct access to the SubU/LP surface of urothelium during filling. Pressure-volume measurements during filling demonstrated that bladder compliance is governed primarily by the urothelium. Measurements of purine mediators in this preparation demonstrated asymmetrical availability of purines in lumen and SubU/LP, suggesting that interpretations based solely on intraluminal measurements of mediators may be inaccurate. The preparations are suitable for assessments of release, degradation and transport of mediators in SubU/LP during bladder filling, and are superior to experimental approaches previously used for urothelium research. ABSTRACT The purpose of this study was to develop a decentralized (ex vivo) detrusor smooth muscle (DSM)-denuded mouse bladder preparation, a novel model that enables studies on availability of urothelium-derived mediators at the luminal and anti-luminal aspects of the urothelium during filling. Urinary bladders were excised from C57BL6/J mice and the DSM was removed by fine-scissor dissection without touching the mucosa. Morphology and cell composition of the preparation wall, pressure-volume relationships during filling, and fluorescent dye permeability of control, protamine sulfate- and lipopolysaccharide-treated denuded bladders were characterized. The preparation wall contained intact urothelium and suburothelium (SubU)/lamina propria (LP) and lacked the DSM and the serosa. The utility of the model for physiological research was validated by measuring release, metabolism and transport of purine mediators at SubU/LP and in bladder lumen during filling. We determined asymmetrical availability of purines (e.g. ATP, ADP, AMP and adenosine) in lumen and at SubU/LP during filling, suggesting differential mechanisms of release, degradation and bilateral transurothelial transport of purines during filling. Some observations were validated in DSM-denuded bladder of the cynomolgus monkey (Macaca fascicularis). The novel model was superior to current models utilized to study properties of the urothelium (e.g. cultured urothelial cells, bladder mucosa sheets mounted in Ussing chambers or isolated bladder strips in organ baths) in that it enabled direct access to the vicinity of SubU/LP during authentic bladder filling. The model is particularly suitable for understanding local mechanisms of urothelium-DSM connectivity and for broad understanding of the role of urothelium in regulating continence and voiding.
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Affiliation(s)
- Leonie Durnin
- Department of Physiology and Cell Biology, University of Nevada Reno School of Medicine, Reno, NV, 89557-0575, USA
| | - Benjamin Kwok
- Department of Physiology and Cell Biology, University of Nevada Reno School of Medicine, Reno, NV, 89557-0575, USA
| | - Priya Kukadia
- Department of Physiology and Cell Biology, University of Nevada Reno School of Medicine, Reno, NV, 89557-0575, USA
| | - Roisin McAvera
- Department of Physiology and Cell Biology, University of Nevada Reno School of Medicine, Reno, NV, 89557-0575, USA
| | - Robert D Corrigan
- Department of Physiology and Cell Biology, University of Nevada Reno School of Medicine, Reno, NV, 89557-0575, USA
| | - Sean M Ward
- Department of Physiology and Cell Biology, University of Nevada Reno School of Medicine, Reno, NV, 89557-0575, USA
| | - Ying Zhang
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, 100101, China
| | - Qi Chen
- Department of Physiology and Cell Biology, University of Nevada Reno School of Medicine, Reno, NV, 89557-0575, USA
| | - Sang Don Koh
- Department of Physiology and Cell Biology, University of Nevada Reno School of Medicine, Reno, NV, 89557-0575, USA
| | - Kenton M Sanders
- Department of Physiology and Cell Biology, University of Nevada Reno School of Medicine, Reno, NV, 89557-0575, USA
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Kwok B, Crisman R, Malik R, Šlapeta J. Presumptive vertical transmission of Neospora caninum in related Bernese Mountain dogs. Vet Parasitol Reg Stud Reports 2018; 14:7-10. [PMID: 31014740 DOI: 10.1016/j.vprsr.2018.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/31/2018] [Accepted: 07/31/2018] [Indexed: 10/28/2022]
Abstract
Neospora caninum is a tissue cyst-forming coccidium capable of causing spinal cord or skeletal muscle disease in dogs. Infected bitches can transmit the parasite to their pups in utero. Seroprevalence of N. caninum was studied in naturally-infected, privately owned Bernese Mountain dogs, using antibody detection via an indirect fluorescent antibody test (IFAT) to identify infected individuals. A retrospective study was undertaken on available dogs from 14 litters. Five of eight dams tested seropositive. The index case was a bitch with a titre of 1:3200 by IFAT. Only one offspring from her first litter was seropositive. The frequency of putative congenital transmission in the breeding kennel was variable. Our results reiterate the importance of serological testing of all dams and littermates in a breeding kennel when clinical neosporosis is suspected in neonatal puppies.
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Affiliation(s)
- Benjamin Kwok
- Sydney School of Veterinary Science, Faculty of Science, The University of Sydney, Sydney, New South Wales 2006, Australia
| | - Robin Crisman
- Somersby Veterinary Hospital, Somersby, New South Wales 2250, Australia
| | - Richard Malik
- Centre for Veterinary Education, Sydney School of Veterinary Science, The University of Sydney, New South Wales 2006, Australia
| | - Jan Šlapeta
- Sydney School of Veterinary Science, Faculty of Science, The University of Sydney, Sydney, New South Wales 2006, Australia.
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10
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Kwok B, McLean C, Wong A, Aktar S, Yoong W. Re: Intimate partner violence during pregnancy and the risk for adverse infant outcomes: a systematic review and meta-analysis. BJOG 2016; 123:1565-6. [PMID: 27440606 DOI: 10.1111/1471-0528.14125] [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] [Accepted: 04/06/2016] [Indexed: 11/26/2022]
Affiliation(s)
- B Kwok
- University College London Medical School, London, UK
| | - C McLean
- University College London Medical School, London, UK
| | - A Wong
- University College London Medical School, London, UK
| | - S Aktar
- University College London Medical School, London, UK
| | - W Yoong
- Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, UK
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11
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Kumar K, Chow CR, Ebine K, Arslan AD, Kwok B, Bentrem DJ, Eckerdt FD, Platanias LC, Munshi HG. Differential Regulation of ZEB1 and EMT by MAPK-Interacting Protein Kinases (MNK) and eIF4E in Pancreatic Cancer. Mol Cancer Res 2015; 14:216-27. [PMID: 26609108 DOI: 10.1158/1541-7786.mcr-15-0285] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 11/15/2015] [Indexed: 02/07/2023]
Abstract
UNLABELLED Human pancreatic ductal adenocarcinoma (PDAC) tumors are associated with dysregulation of mRNA translation. In this report, it is demonstrated that PDAC cells grown in collagen exhibit increased activation of the MAPK-interacting protein kinases (MNK) that mediate eIF4E phosphorylation. Pharmacologic and genetic targeting of MNKs reverse epithelial-mesenchymal transition (EMT), decrease cell migration, and reduce protein expression of the EMT-regulator ZEB1 without affecting ZEB1 mRNA levels. Paradoxically, targeting eIF4E, the best-characterized effector of MNKs, increases ZEB1 mRNA expression through repression of ZEB1-targeting miRNAs, miR-200c and miR-141. In contrast, targeting the MNK effector hnRNPA1, which can function as a translational repressor, increases ZEB1 protein without increasing ZEB1 mRNA levels. Importantly, treatment with MNK inhibitors blocks growth of chemoresistant PDAC cells in collagen and decreases the number of aldehyde dehydrogenase activity-positive (Aldefluor+) cells. Significantly, MNK inhibitors increase E-cadherin mRNA levels and decrease vimentin mRNA levels in human PDAC organoids without affecting ZEB1 mRNA levels. Importantly, MNK inhibitors also decrease growth of human PDAC organoids. IMPLICATIONS These results demonstrate differential regulation of ZEB1 and EMT by MNKs and eIF4E, and identify MNKs as potential targets in pancreatic cancer.
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Affiliation(s)
- Krishan Kumar
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Jesse Brown VA Medical Center, Chicago, Illinois
| | - Christina R Chow
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. The Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois
| | - Kazumi Ebine
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Jesse Brown VA Medical Center, Chicago, Illinois
| | - Ahmet D Arslan
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. The Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois
| | - Benjamin Kwok
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - David J Bentrem
- Jesse Brown VA Medical Center, Chicago, Illinois. The Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois. Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Frank D Eckerdt
- The Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois
| | - Leonidas C Platanias
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Jesse Brown VA Medical Center, Chicago, Illinois. The Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois
| | - Hidayatullah G Munshi
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Jesse Brown VA Medical Center, Chicago, Illinois. The Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois.
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Strauss S, Mistry P, Mendoza A, Robson M, Holme H, Nandabhiwat P, Kwok B, Qadir M, Pedley R, Whelan J, Sorensen P. 245 Chk1 is a potential novel therapeutic target that regulates cell survival and potentiates chemotherapy in osteosarcoma (OS) models. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70371-5] [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: 11/28/2022]
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Engel JB, Meyer S, Dietl J, Kwok B, Ortmann O, Hönig A, Hahne J. Specific inhbitor of ERK 1/2 AEZS-131: anticancer activity in models of human cancers with and without overactivation of ERK 1/2. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388478] [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: 10/24/2022] Open
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Engel JB, Treeck O, Ortmann O, Buchholz S, Seitz S, Kwok B. AEZS-125 induces inhibition of cell growth of triple negative breast cancer via binding to GnRH receptor. Geburtshilfe Frauenheilkd 2013. [DOI: 10.1055/s-0033-1347877] [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: 10/26/2022] Open
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Dahal GR, Rawson J, Gassaway B, Kwok B, Tong Y, Ptácek LJ, Bates E. An inwardly rectifying K+ channel is required for patterning. Development 2012; 139:3653-64. [PMID: 22949619 DOI: 10.1242/dev.078592] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Mutations that disrupt function of the human inwardly rectifying potassium channel KIR2.1 are associated with the craniofacial and digital defects of Andersen-Tawil Syndrome, but the contribution of Kir channels to development is undefined. Deletion of mouse Kir2.1 also causes cleft palate and digital defects. These defects are strikingly similar to phenotypes that result from disrupted TGFβ/BMP signaling. We use Drosophila melanogaster to show that a Kir2.1 homolog, Irk2, affects development by disrupting BMP signaling. Phenotypes of irk2 deficient lines, a mutant irk2 allele, irk2 siRNA and expression of a dominant-negative Irk2 subunit (Irk2DN) all demonstrate that Irk2 function is necessary for development of the adult wing. Compromised Irk2 function causes wing-patterning defects similar to those found when signaling through a Drosophila BMP homolog, Decapentaplegic (Dpp), is disrupted. To determine whether Irk2 plays a role in the Dpp pathway, we generated flies in which both Irk2 and Dpp functions are reduced. Irk2DN phenotypes are enhanced by decreased Dpp signaling. In wild-type flies, Dpp signaling can be detected in stripes along the anterior/posterior boundary of the larval imaginal wing disc. Reducing function of Irk2 with siRNA, an irk2 deletion, or expression of Irk2DN reduces the Dpp signal in the wing disc. As Irk channels contribute to Dpp signaling in flies, a similar role for Kir2.1 in BMP signaling may explain the morphological defects of Andersen-Tawil Syndrome and the Kir2.1 knockout mouse.
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Affiliation(s)
- Giri Raj Dahal
- Department of Chemistry and Biochemistry, Brigham Young University, Provo, UT 84602, USA
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Marriott AJ, Hwang NC, Lai FO, Tan CK, Tan YM, Lim CH, Boey SK, Tay SM, Cheow PC, Lim YP, Chan T, Loh K, Kwok B, Chung A, Sivathasan C. Combined heart-liver transplantation with extended cardiopulmonary bypass. Singapore Med J 2011; 52:e48-e51. [PMID: 21451915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We report a case of combined heart and liver transplantation for familial amyloid polyneuropathy. This is the first such combined transplant performed in Asia, and differs from previously described cases, in that cardiopulmonary bypass was continued at partial flow during liver transplantation in our case. This was done in order to provide haemodynamic support to the cardiac graft and to protect it from the impending reperfusion insult that frequently accompanies liver transplantation. The utility of this management course is discussed, along with its actual and potential complications. We also describe the impact of a lung-protective ventilation strategy employed during cardiac transplantation.
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Affiliation(s)
- A J Marriott
- Department of Anaesthesiology, Singapore General Hospital, Outram Road, Singapore 169608
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Kamath V, Sugo E, Ziegler D, Kwok B, Lukeis R. Atypical teratoid/rhaboid tumour arising in association with a pleomorphic xanthoastrocytoma: a case report. Pathology 2011. [DOI: 10.1016/s0031-3025(16)33261-5] [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: 10/22/2022]
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18
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Kwok B, Varol C. Priapism and Penile Gangrene Due to Thrombotic Thrombocytopenic Purpura. Urology 2010; 75:71-2. [DOI: 10.1016/j.urology.2009.04.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2009] [Revised: 03/14/2009] [Accepted: 04/05/2009] [Indexed: 11/27/2022]
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Abstract
Central neurocytomas are characterized by their intraventricular locations, usually arising from the lateral ventricles and their benign clinical course. Variations in location, histology and clinical behaviour have been reported in recent years. The authors present two cases of central neurocytomas arising in the third and fourth ventricles with aqueductal involvement. The atypical features in their location and behaviour are discussed. The cases represent the extended spectrum of central neurocytomas.
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Affiliation(s)
- J Wong
- Department of Neurosurgery, Prince of Wales Hospital, Sydney, New South Wales, Australia.
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20
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Qadir MA, Kwok B, Dragowska WH, To KH, Le D, Bally MB, Gorski SM. Macroautophagy inhibition sensitizes tamoxifen-resistant breast cancer cells and enhances mitochondrial depolarization. Breast Cancer Res Treat 2008; 112:389-403. [PMID: 18172760 DOI: 10.1007/s10549-007-9873-4] [Citation(s) in RCA: 184] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Accepted: 12/17/2007] [Indexed: 12/19/2022]
Abstract
Macroautophagy (autophagy), a process for lysosomal degradation of organelles and long-lived proteins, has been linked to various pathologies including cancer and to the cellular response to anticancer therapies. In the human estrogen receptor positive MCF7 breast adenocarcinoma cell line, treatment with the endocrine therapeutic tamoxifen was shown previously to induce cell cycle arrest, cell death, and autophagy. To investigate specifically the role of autophagy in tamoxifen treated breast cancer cell lines, we used a siRNA approach, targeting three different autophagy genes, Atg5, Beclin-1, and Atg7. We found that knockdown of autophagy, in combination with tamoxifen in MCF7 cells, results in decreased cell viability concomitant with increased mitochondrial-mediated apoptosis. The combination of autophagy knockdown and tamoxifen treatment similarly resulted in reduced cell viability in the breast cancer cell lines, estrogen receptor positive T-47D and tamoxifen-resistant MCF7-HER2. Together, these results indicate that autophagy has a primary pro-survival role following tamoxifen treatment, and suggest that autophagy knockdown may be useful in a combination therapy setting to sensitize breast cancer cells, including tamoxifen-resistant breast cancer cells, to tamoxifen therapy.
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Affiliation(s)
- M A Qadir
- Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC, Canada
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21
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Abstract
PURPOSE Parameters derived from uroflowmetry are frequently used in the evaluation and reassessment of children presenting with lower urinary tract dysfunction. Since current nomograms have been constructed from 1 to 2 voids per child, variability of flow parameters is unknown. We evaluate intraindividual variability of flow parameters in children free of lower urinary tract symptoms. MATERIALS AND METHODS Children between 4 and 16 years old (mean age 9.8) who were hospitalized but not suffering from urinary tract infection, pyelonephritis or neurological disturbance, and who had neither structural abnormality of the urinary tract nor acute pain or disorientation voided spontaneously over a flowmeter on 4 to 6 occasions. Post-void urine was estimated by ultrasound within 5 minutes of micturition to confirm complete emptying. RESULTS A total of 98 subjects provided a mean of 4.4 traces each. Neither maximum nor average flow rate showed great intraindividual variability (maximum flow rate r >0.8, average flow rate r >0.74). Flow rates significantly correlated with flow duration, volume voided and patient age. Initial flow curves were bell-shaped in 63% of cases, staccato in 30% and intermittent in 6%. These proportions did not change with subsequent voids. There was no significant difference between genders with respect to staccato voiding, although boys demonstrated 70% of intermittent voids and were significantly older than girls. CONCLUSIONS In normal children there is minimal variability in flow rates and the phenomenon of staccato voiding is seen approximately 30% of the time, despite no significant levels of post-void residual urine.
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Affiliation(s)
- W F Bower
- Department of Surgery, The Chinese University of Hong Kong Prince of Wales Hospital, Shatin, Hong Kong, SAR China.
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Abstract
BACKGROUND Combined anterior craniofacial resection (CFR) has been in use for more than 25 years. The advent of the free revascularized tissue transfer flap in l980 permitted safe resection of tumors that had spread beyond the confines of the paranasal sinuses with immediate reconstruction of the sino-orbital cranial defect. The purpose of this study was to examine the outcomes and morbidity of a management policy of primary CFR and postoperative radiotherapy for paranasal sinus cancers infiltrating the skull base over a 21-year period. METHODS Seventy-three patients with paranasal sinus cancers were treated at the Prince of Wales Hospital between l975 and l996. All were newly diagnosed with the exception of one patient who had received radiotherapy elsewhere 5 years earlier. Only 22% were early lesions and 31% were advanced (more than six sites involved). There were 59 men and 14 women. The mean age was 57 years. All but two patients had a performance status of either 0 or 1. Orbital exenteration was performed in 31 patients. Since l980, all major defects were reconstructed with free tissue transfer flaps. RESULTS The 5-year cancer-specific survival (CSS) for the 73 patients was 69%, which was unchanged at 10 years. Twenty two patients died from or with their index cancer. An additional 11 patients died from unrelated causes. The actuarial overall survival (OS) at 5 and 10 years was 61% and 48%, respectively. The 5-year recurrence-free rate was 59%. The CSS for the three dominant pathologic conditions were adenocarcinoma 70%, squamous cancer 51%, and olfactory neuroblastoma 84%. The difference was not significant; however, there was a significant difference in OS, with olfactory neuroblastoma having the best prognosis. Orbital involvement, radiologic evidence of skull base erosion, and involvement of the infratemporal fossa were not poor prognostic indicators. Patients with a performance status of 0 had improved OS. There was no operative mortality. CONCLUSIONS An aggressive policy of combined CFR and postoperative radiotherapy with free-flap reconstruction for large defects gave survival results that were comparable to less-advanced lesions and superior to many other treatment alternatives. There was a high exenteration rate (42%). Squamous cancers were associated with the greatest morbidity and poorest OS.
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Affiliation(s)
- G P Bridger
- Department of Otolaryngology, Prince of Wales Hospital, Randwick 2031, New South Wales, Australia
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23
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Stening WA, Berry G, Dan NG, Kwok B, Mandryk JA, Ring I, Sewell M, Simpson DA. Experience with acute subdural haematomas in New South Wales. Aust N Z J Surg 1986; 56:549-56. [PMID: 3461777 DOI: 10.1111/j.1445-2197.1986.tb07098.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A retrospective survey of head injuries in NSW in 1977 and 1978 was conducted by the Trauma Subcommittee of the Neurosurgical Society of Australasia. Two hundred and ninety patients, who were found to have acute or subacute subdural haematomas, were considered. The mortality rate was 76%, with 19% making a satisfactory recovery. Several factors were found to produce significant improvement in outcome. The availability of neurosurgical facilities at the time of admission made a significant difference. Those patients who had decompressive operations also fared better. No patient survived without operation. Shock, defined as a systolic blood pressure lower than 90 mmHg for more than 60 min was associated with significantly increased mortality. The chance of developing a significant hypotensive episode was greater if two or more other parts of the body were injured. If three other areas were injured, the mortality was 100%. A case control study suggested that some 35 (16%) of all deaths could have resulted from preventable causes, notably delay in instituting definitive treatment and/or inadequate treatment of shock.
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Ring IT, Berry G, Dan NG, Kwok B, Mandryk JA, North JB, Selecki BR, Sewell MF, Simpson DA, Stening WA. Epidemiology and clinical outcomes of neurotrauma in New South Wales. Aust N Z J Surg 1986; 56:557-66. [PMID: 3090991 DOI: 10.1111/j.1445-2197.1986.tb07099.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This study of 1161 neurotrauma patients in New South Wales hospitals was designed to examine the role of preventable causes of death and disability in cases of spinal injury, extradural, subdural and multiple intracranial haematomas in order to make recommendations for improvements in accident, emergency, ambulance and hospital services. Methods have been developed for standardizing diagnosis in different classes of hospital for the assessment of severity in terms of the patient's age, sex, physical signs, head and spine injuries and other injuries. Estimates have been made of the number of preventable deaths by a case control study of each category of neurotrauma under study.
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Abstract
A retrospective study of 126 patients with extradural haematomas was made to determine whether their outcome could be modified by alteration of their management. Poor outcome occurred in those over 65 years of age, in motor smash victims, in those with fixed pupils, in those with major associated injuries or those comatose on hospital admission. The detection of skull fracture or of a lucid interval was not prognostically useful. A graduation in mortality according to the type of hospital was present but did not reach statistical significance. Failure to correct shock and delay in instituting definitive treatment were the major preventable factors which could be modified to improve outcome.
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Selecki BR, Berry G, Kwok B, Mandryk JA, Ring IT, Sewell MF, Simpson DA, Vanderfield GK. Experience with spinal injuries in New South Wales. Aust N Z J Surg 1986; 56:567-76. [PMID: 3461778 DOI: 10.1111/j.1445-2197.1986.tb07100.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Two hundred and two patients with acute and severe spinal injuries were treated in various hospitals in New South Wales during 1977 and 1978. Of these, 132 (65%) were cervical, 60 (30%) thoracic, eight (4%) lumbar and two were inadequately recorded. A major concurrent injury to the head was present in every third patient, to the chest in every fourth patient, and to the limbs in every fifth patient. The outcomes of patients reported in this series make it one of the worst in the literature. Sixty-nine (34%) patients died in hospital; of the 133 survivors, only 22 (11%) have resumed work, the remainder being partially or totally disabled. It is estimated that another 302 patients died before arrival in hospital. In country areas, the time lags between accident and ambulance notification, and between notification and arrival at hospital, were uncertain in many cases, but periods in excess of 2 hours were recorded in 28 (14%). One-man ambulances or private vehicles were used in at least 43 cases (21%). After admission, 139 patients were transferred to other hospitals for definitive treatment, arriving after an average time of 22 h (median time 9 h); for such patients, the original hospital presumably served as a first aid station. A case control study suggests that preventable delay in transport, inappropriate treatment, and failure to correct shock may have been causative factors in 16 deaths in this series. Reduction of the time lag between accident and institution of definitive treatment will save lives, and may avoid some crippling neurological deficits.(ABSTRACT TRUNCATED AT 250 WORDS)
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Vanderfield GK, Berry G, Dan NG, Kwok B, Mandryk JA, Ring IT, Sewell MF, Simpson D. Experience with chronic subdural haematomas in New South Wales. Aust N Z J Surg 1986; 56:577-83. [PMID: 3461779 DOI: 10.1111/j.1445-2197.1986.tb07101.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
This study considered 135 cases of chronic subdural haematoma following head injury in 1977 and 1978. The majority were in the older age group and more often males. Falls were the commonest cause. Among intracranial haematomas they carry a much better prognosis. However, there was a mortality rate of 9% and delay in diagnosis was the most likely preventable factor contributing to this. Accordingly the possibility of this complication after head injury should be known to those concerned in the later hospital treatment and follow-up management especially of older patients and alcoholics. When the diagnosis has been made, the preferred surgical method of treatment is drainage through burrholes. Follow-up CT scanning should be arranged usually about 8 weeks afterwards unless there are clinical indications for an earlier examination.
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Abstract
The logistics of early management have been studied in a series of 1161 patients with head and/or spinal injuries, who were admitted to hospital in NSW in 1977-78. Special attention has been given to three subgroups: 336 head injuries with records of impaired consciousness before first hospital admission, 355 head injuries later transferred because of deterioration, and 202 serious spinal injuries. It was found that in at least 18% of unconscious head injuries, and a similar percentage of spinal injuries, first aid and transport to hospital were provided by ambulances recorded to have only one trained staff member. In country areas, 41% of unconscious head injuries reached hospital after periods of time exceeding 1 h. For administrative as well as geographic reasons, more than 80% of initially unconscious head injuries and spinal injuries were first admitted to hospitals without neurosurgical and/or spinal services; the majority of cases in both groups, therefore, had to be transferred to other hospitals, often within 6 h of first admission. In the subgroup of cases transferred because of deterioration, mortality increased with distance from a neurosurgical unit. These findings are related to the concept of an integrated regional trauma service.
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Selecki BR, Berry G, Dan NG, Kwok B, Mandryk JA, North JB, Ring IT, Sewell MF, Simpson DA, Stening WA. Preventable causes of death and disability from neurotrauma. Aust N Z J Surg 1986; 56:529-34. [PMID: 2943259 DOI: 10.1111/j.1445-2197.1986.tb07095.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Preventable causes of death and disability have been studied retrospectively in a series of 1161 cases of neurotrauma occurring in New South Wales in 1977-78, and prospectively in 153 cases of neurotrauma occurring in country districts in South Australia in 1981-82. In the first study, it was found that at least 80 deaths could be attributed to preventable causes; chiefly, transfer to an inappropriate hospital and/or delay in instituting treatment. Apparent failures in initial management of shock and airway obstruction were evident in this study and also in the South Australian study, which identified major deficiencies in cardiorespiratory management in 7% of cases transferred from country areas. These studies confirm that there is a need for better training, at all levels, in the management of neurotrauma. They also provide powerful arguments for the concept of an integrated regional trauma service.
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Stening WA, Berry G, Dan NG, Kwok B, Mandryk JA, Ring IT, Sewell MF, Simpson DA. Experience with multiple intracranial haematomas in New South Wales. Aust N Z J Surg 1986; 56:543-8. [PMID: 3461776 DOI: 10.1111/j.1445-2197.1986.tb07097.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A retrospective survey of head injuries in NSW in 1977 and 1978 was conducted by the Trauma Subcommittee of the Neurosurgical Society of Australasia. This paper describes the findings for 129 patients who had more than one significant intracranial haematoma. Overall, the case fatality rate for these patients was 85%. The presence of low or fluctuating blood pressure was associated with a significantly higher mortality than in the rest of the group. Bilateral reacting pupils or an improvement in level of consciousness following decompressive surgery carried a more favourable prognosis. There was 100% fatality if surgery was not carried out or if the bleeding was not found at operation. A subset of patients who died was selected on the basis of a calculated prognostic variable, and compared with a similar subset of survivors. A higher proportion of patients who died had a delay in the provision of definitive treatment and failure to correct shock. This comparison was made on two criteria. Using the first accepted optimal treatment in 1984, nearly all cases were treated suboptimally, as might be expected. Using the second, acceptable treatment in 1977-78, it was calculated that between nine and 12 patients died with MIH in NSW in the 2 years of the survey, whose deaths might have been prevented.
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MESH Headings
- Accidents, Traffic
- Adolescent
- Adult
- Aged
- Blood Pressure
- Child
- Child, Preschool
- Coma/etiology
- Female
- Fixation, Ocular
- Hematoma, Epidural, Cranial/etiology
- Hematoma, Epidural, Cranial/mortality
- Hematoma, Epidural, Cranial/surgery
- Hematoma, Subdural/etiology
- Hematoma, Subdural/mortality
- Hematoma, Subdural/surgery
- Humans
- Infant
- Infant, Newborn
- Male
- Middle Aged
- Prognosis
- Retrospective Studies
- Skull Fractures/etiology
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