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Lee M, Ang C, Andreadis K, Shin J, Rameau A. An Open-Source Three-Dimensionally Printed Laryngeal Model for Injection Laryngoplasty Training. Laryngoscope 2020; 131:E890-E895. [PMID: 32750164 DOI: 10.1002/lary.28952] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/19/2020] [Accepted: 06/29/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS A limited number of three-dimensionally (3D)-printed laryngeal simulators have been described in the literature, only one of which is specifically designed for percutaneous injection laryngoplasty (PIL) training and is currently of limited availability. This study describes the development and evaluation of a high-fidelity, open-source, low-cost 3D-printed simulator for PIL training, improving on existing models. STUDY DESIGN Simulator design and survey evaluation. METHODS Computed tomography scans of the upper airways were processed with 3D Slicer to generate a computer model of the endolarynx. Blender and Fusion 360 were used to refine the mucosal model and develop casts for silicone injection molding. The casted endolaryngeal structures were inserted into a modified version of a publicly available laryngeal cartilage model. The final models were evaluated by 10 expert laryngologists using a customized version of the Michigan Standard Simulation Experience Scale. Internal consistency and interrater reliability of the survey were evaluated using Cronbach's α and intraclass correlation, respectively. RESULTS Expert laryngologists highly rated the model for measures of fidelity, educational value, and overall quality (mean = 4.8, standard deviation = 0.5; 1 = strongly disagree, 5 = strongly agree). All reviewers rated the model as ready for use as is or with slight modifications. The filament needed for one cartilage model costs $0.96, whereas the silicone needed for one soft-tissue model costs $1.89. CONCLUSIONS Using 3D-printing technology, we successfully created the first open-source, low-cost, and anatomically accurate laryngeal model for injection laryngoplasty training. Our simulator is made freely available for download on Wikifactory with step-by-step tutorials for 3D printing, silicone molding, assembly, and use. LEVEL OF EVIDENCE NA Laryngoscope, 131:E890-E895, 2021.
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Affiliation(s)
- Mark Lee
- Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, U.S.A
| | - Chelston Ang
- Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, U.S.A
| | - Katerina Andreadis
- Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, U.S.A
| | - James Shin
- Department of Radiology, Weill Cornell Medicine, New York, New York, U.S.A
| | - Anaïs Rameau
- Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, U.S.A
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Zviran A, Schulman RC, Shah M, Hill STK, Deochand S, Khamnei CC, Maloney D, Patel K, Liao W, Widman AJ, Wong P, Callahan MK, Ha G, Reed S, Rotem D, Frederick D, Sharova T, Miao B, Kim T, Gydush G, Rhoades J, Huang KY, Omans ND, Bolan PO, Lipsky AH, Ang C, Malbari M, Spinelli CF, Kazancioglu S, Runnels AM, Fennessey S, Stolte C, Gaiti F, Inghirami GG, Adalsteinsson V, Houck-Loomis B, Ishii J, Wolchok JD, Boland G, Robine N, Altorki NK, Landau DA. Genome-wide cell-free DNA mutational integration enables ultra-sensitive cancer monitoring. Nat Med 2020; 26:1114-1124. [PMID: 32483360 PMCID: PMC8108131 DOI: 10.1038/s41591-020-0915-3] [Citation(s) in RCA: 175] [Impact Index Per Article: 43.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 04/29/2020] [Indexed: 12/21/2022]
Abstract
In many areas of oncology, we lack sensitive tools to track low-burden disease. Although cell-free DNA (cfDNA) shows promise in detecting cancer mutations, we found that the combination of low tumor fraction (TF) and limited number of DNA fragments restricts low-disease-burden monitoring through the prevailing deep targeted sequencing paradigm. We reasoned that breadth may supplant depth of sequencing to overcome the barrier of cfDNA abundance. Whole-genome sequencing (WGS) of cfDNA allowed ultra-sensitive detection, capitalizing on the cumulative signal of thousands of somatic mutations observed in solid malignancies, with TF detection sensitivity as low as 10-5. The WGS approach enabled dynamic tumor burden tracking and postoperative residual disease detection, associated with adverse outcome. Thus, we present an orthogonal framework for cfDNA cancer monitoring via genome-wide mutational integration, enabling ultra-sensitive detection, overcoming the limitation of cfDNA abundance and empowering treatment optimization in low-disease-burden oncology care.
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Affiliation(s)
- Asaf Zviran
- New York Genome Center, New York, NY, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Rafael C Schulman
- New York Genome Center, New York, NY, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | | | - Steven T K Hill
- New York Genome Center, New York, NY, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Sunil Deochand
- New York Genome Center, New York, NY, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Cole C Khamnei
- New York Genome Center, New York, NY, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | | | - Kristofer Patel
- New York Genome Center, New York, NY, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Will Liao
- New York Genome Center, New York, NY, USA
| | - Adam J Widman
- New York Genome Center, New York, NY, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Phillip Wong
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Margaret K Callahan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gavin Ha
- Division of Public Health Services, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Sarah Reed
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Denisse Rotem
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Dennie Frederick
- Division of Surgical Oncology, Massachussetts General Hospital, Boston, MA, USA
| | - Tatyana Sharova
- Division of Surgical Oncology, Massachussetts General Hospital, Boston, MA, USA
| | - Benchun Miao
- Division of Surgical Oncology, Massachussetts General Hospital, Boston, MA, USA
| | - Tommy Kim
- Division of Surgical Oncology, Massachussetts General Hospital, Boston, MA, USA
| | - Greg Gydush
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | - Kevin Y Huang
- New York Genome Center, New York, NY, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Nathaniel D Omans
- New York Genome Center, New York, NY, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Patrick O Bolan
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Andrew H Lipsky
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Chelston Ang
- New York Genome Center, New York, NY, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Murtaza Malbari
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | | | | | | | | | | | - Federico Gaiti
- New York Genome Center, New York, NY, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | | | | | | | | | - Jedd D Wolchok
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Genevieve Boland
- Division of Surgical Oncology, Massachussetts General Hospital, Boston, MA, USA
| | | | | | - Dan A Landau
- New York Genome Center, New York, NY, USA.
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA.
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Izzo F, Lee SC, Poran A, Chaligne R, Gaiti F, Gross B, Murali RR, Deochand SD, Ang C, Jones PW, Nam AS, Kim KT, Kothen-Hill S, Schulman RC, Ki M, Lhoumaud P, Skok JA, Viny AD, Levine RL, Kenigsberg E, Abdel-Wahab O, Landau DA. DNA methylation disruption reshapes the hematopoietic differentiation landscape. Nat Genet 2020; 52:378-387. [PMID: 32203468 PMCID: PMC7216752 DOI: 10.1038/s41588-020-0595-4] [Citation(s) in RCA: 123] [Impact Index Per Article: 30.8] [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: 04/16/2019] [Accepted: 02/19/2020] [Indexed: 02/07/2023]
Abstract
Mutations in genes involved in DNA methylation (DNAme; for example, TET2 and DNMT3A) are frequently observed in hematological malignancies1-3 and clonal hematopoiesis4,5. Applying single-cell sequencing to murine hematopoietic stem and progenitor cells, we observed that these mutations disrupt hematopoietic differentiation, causing opposite shifts in the frequencies of erythroid versus myelomonocytic progenitors following Tet2 or Dnmt3a loss. Notably, these shifts trace back to transcriptional priming skews in uncommitted hematopoietic stem cells. To reconcile genome-wide DNAme changes with specific erythroid versus myelomonocytic skews, we provide evidence in support of differential sensitivity of transcription factors due to biases in CpG enrichment in their binding motif. Single-cell transcriptomes with targeted genotyping showed similar skews in transcriptional priming of DNMT3A-mutated human clonal hematopoiesis bone marrow progenitors. These data show that DNAme shapes the topography of hematopoietic differentiation, and support a model in which genome-wide methylation changes are transduced to differentiation skews through biases in CpG enrichment of the transcription factor binding motif.
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Affiliation(s)
- Franco Izzo
- New York Genome Center, New York, NY, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Stanley C Lee
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Asaf Poran
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Ronan Chaligne
- New York Genome Center, New York, NY, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Federico Gaiti
- New York Genome Center, New York, NY, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Baptiste Gross
- New York Genome Center, New York, NY, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Rekha R Murali
- New York Genome Center, New York, NY, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Sunil D Deochand
- New York Genome Center, New York, NY, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Chelston Ang
- New York Genome Center, New York, NY, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Philippa Wyndham Jones
- New York Genome Center, New York, NY, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Anna S Nam
- New York Genome Center, New York, NY, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Kyu-Tae Kim
- New York Genome Center, New York, NY, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Steven Kothen-Hill
- New York Genome Center, New York, NY, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Rafael C Schulman
- New York Genome Center, New York, NY, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Michelle Ki
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Jane A Skok
- New York University Langone Health, New York, NY, USA
| | - Aaron D Viny
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ross L Levine
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ephraim Kenigsberg
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Omar Abdel-Wahab
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Dan A Landau
- New York Genome Center, New York, NY, USA.
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA.
- Institute of Computational Biomedicine, Weill Cornell Medicine, New York, NY, USA.
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Dharmapuri S, Özbek U, Lin JY, Schwartz M, Branch A, Ang C. Predictive value of neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) In hepatocellular carcinoma (HCC) patients treated with nivolumab (N). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Dharmapuri S, Özbek U, Lin JY, Schwartz M, Branch A, Ang C. Outcomes of hepatocellular carcinoma (HCC) patients treated with nivolumab: The Mount Sinai Hospital experience. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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6
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Nam AS, Kim KT, Chaligne R, Izzo F, Ang C, Taylor J, Myers RM, Abu-Zeinah G, Brand R, Omans ND, Alonso A, Sheridan C, Mariani M, Dai X, Harrington E, Pastore A, Cubillos-Ruiz JR, Tam W, Hoffman R, Rabadan R, Scandura JM, Abdel-Wahab O, Smibert P, Landau DA. Somatic mutations and cell identity linked by Genotyping of Transcriptomes. Nature 2019; 571:355-360. [PMID: 31270458 PMCID: PMC6782071 DOI: 10.1038/s41586-019-1367-0] [Citation(s) in RCA: 153] [Impact Index Per Article: 30.6] [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: 10/24/2018] [Accepted: 06/05/2019] [Indexed: 02/06/2023]
Abstract
Defining the transcriptomic identity of malignant cells is challenging in the absence of surface markers that distinguish cancer clones from one another, or from admixed non-neoplastic cells. To address this challenge, here we developed Genotyping of Transcriptomes (GoT), a method to integrate genotyping with high-throughput droplet-based single-cell RNA sequencing. We apply GoT to profile 38,290 CD34+ cells from patients with CALR-mutated myeloproliferative neoplasms to study how somatic mutations corrupt the complex process of human haematopoiesis. High-resolution mapping of malignant versus normal haematopoietic progenitors revealed an increasing fitness advantage with myeloid differentiation of cells with mutated CALR. We identified the unfolded protein response as a predominant outcome of CALR mutations, with a considerable dependency on cell identity, as well as upregulation of the NF-κB pathway specifically in uncommitted stem cells. We further extended the GoT toolkit to genotype multiple targets and loci that are distant from transcript ends. Together, these findings reveal that the transcriptional output of somatic mutations in myeloproliferative neoplasms is dependent on the native cell identity.
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Affiliation(s)
- Anna S Nam
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
- New York Genome Center, New York, NY, USA
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Kyu-Tae Kim
- New York Genome Center, New York, NY, USA
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Ronan Chaligne
- New York Genome Center, New York, NY, USA
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Franco Izzo
- New York Genome Center, New York, NY, USA
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Chelston Ang
- New York Genome Center, New York, NY, USA
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Justin Taylor
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert M Myers
- New York Genome Center, New York, NY, USA
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Tri-Institutional MD-PhD Program, Weill Cornell Medicine, Rockefeller University, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ghaith Abu-Zeinah
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Richard T. Silver MD Myeloproliferative Neoplasms Center, Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Ryan Brand
- New York Genome Center, New York, NY, USA
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Nathaniel D Omans
- New York Genome Center, New York, NY, USA
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Tri-Institutional Training Program in Computational Biology and Medicine, Memorial Sloan Kettering Cancer Center, Cornell University, Weill Cornell Medicine, New York, NY, USA
| | - Alicia Alonso
- Epigenomics Core Facility, Weill Cornell Medicine, New York, NY, USA
| | - Caroline Sheridan
- Epigenomics Core Facility, Weill Cornell Medicine, New York, NY, USA
| | - Marisa Mariani
- Epigenomics Core Facility, Weill Cornell Medicine, New York, NY, USA
| | | | | | - Alessandro Pastore
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Juan R Cubillos-Ruiz
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
| | - Wayne Tam
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Ronald Hoffman
- Division of Hematology and Medical Oncology, Department of Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Raul Rabadan
- Department of Systems Biology, Columbia University Medical Center, New York, NY, USA
| | - Joseph M Scandura
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
- Richard T. Silver MD Myeloproliferative Neoplasms Center, Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Omar Abdel-Wahab
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peter Smibert
- Technology Innovation Lab, New York Genome Center, New York, NY, USA
| | - Dan A Landau
- New York Genome Center, New York, NY, USA.
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA.
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
- Institute for Computational Biomedicine, Weill Cornell Medicine, New York, NY, USA.
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Marqueen K, Ang C, Mazumdar M, Buckstein M, Ferket B. Cost-Effectiveness Analysis of Selective Internal Radiation Therapy with Yttrium-90 Resin Microspheres versus Sorafenib in Advanced Hepatocellular Carcinoma. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1185] [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: 10/28/2022]
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Rhome R, Ozbek U, Holcombe R, Buckstein M, Ang C. Differences in gastric adenocarcinoma patients at extremes of the age spectrum. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw371.45] [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: 11/14/2022] Open
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Ang C, Shields A, Xiu J, Gatalica Z, Reddy S, Salem M, Farhangfar C, Hwang J, Astsaturov I, Marshall J. Molecular characteristics of hepatocellular carcinomas (HCC) from different age groups. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw371.10] [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: 11/15/2022] Open
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Axelrad J, Itzkowitz S, Colombel J, Harpaz N, Holcombe R, Ozbek U, Ang C. 2114 Chemotherapy tolerance and oncologic outcomes in patients with inflammatory bowel disease and gastrointestinal malignancy: The Mount Sinai Hospital experience. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31036-x] [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: 12/01/2022]
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Naik R, Martin-Hirsch P, Ang C, Mukhopadhyay A, Cross P, Burnley C, Faulkner K. Histological recurrence and depth of loop treatment of the cervix in women of reproductive age: incomplete excision versus adverse pregnancy outcome. BJOG 2011. [DOI: 10.1111/j.1471-0528.2011.03126.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Martin-Hirsch P, Ang C, Mukhopadhyay A, Burnley C, Faulkner K, Cross P, Naik R. Treatment of cervical cancer precursors: influence of age, completeness of excision and cone depth on therapeutic failure, and on adverse obstetric outcomes. BJOG 2011. [DOI: 10.1111/j.1471-0528.2011.03069.x] [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: 11/29/2022]
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Abstract
Capecitabine, an oral prodrug of 5-fluorouracil (5fu), has been integrated into the management of multiple cancer types because of convenience of administration and efficacy comparable with 5fu. Cardiotoxicity induced by 5fu—in particular angina—has been well described in the literature, but reports of adverse cardiac events with capecitabine are also emerging. The mechanism underlying 5fu cardiotoxicity has long been thought to result from coronary vasospasm, but animal-model studies and patient echocardiographic findings both suggest a cardiomyopathic picture. Although 5fu cardiotoxicity is often reversible and can be managed supportively, presentations that are more severe—including arrhythmias, acute ischemic events, and cardiogenic shock—have been documented. In this report, we describe the case of a patient who ultimately required a pacemaker after developing symptomatic bradycardia and sinus arrest while receiving capecitabine for colon cancer.
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Affiliation(s)
- C Ang
- Department of Oncology, McGill University Health Centre, Montreal, QC
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Ang C, Venook AP, Choti MA, DeMatteo RP, Kelley RK, Cosgrove D, McGuire JP, Torbenson MS, Pawlik TM, Jarnagin WR, D'Angelica MI, Fong Y, Chou JF, O'Reilly EM, Klimstra DS, Griffin AC, Vallarapu GP, Capanu M, Kelsen DP, Abou-Alfa GK. Clinical/pathologic features and survival of patients with fibrolamellar-hepatocellular carcinoma (FLL-HCC): Data from the Fibrolamellar-Hepatocellular (FLL-HCC) Consortium. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ma J, Capanu M, O'Reilly EM, Kemeny NE, Ang C, Gansukh B, Kelsen DP, Saltz L, Abou-Alfa GK. Does the underlying etiology of HCC effect outcome? A single-institution analysis. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e14636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Nadarajan V, Shanmugam H, Sthaneshwar P, Jayaranee S, Sultan KS, Ang C, Arumugam S. Modification to reporting of qualitative fluorescent spot test results improves detection of glucose-6-phosphate dehydrogenase (G6PD)-deficient heterozygote female newborns. Int J Lab Hematol 2011; 33:463-70. [PMID: 21501392 DOI: 10.1111/j.1751-553x.2011.01309.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The glucose-6-phosphate dehydrogenase (G6PD) fluorescent spot test (FST) is a useful screening test for G6PD deficiency, but is unable to detect heterozygote G6PD-deficient females. We sought to identify whether reporting intermediate fluorescence in addition to absent and bright fluorescence on FST would improve identification of mildly deficient female heterozygotes. METHODS A total of 1266 cord blood samples (705 male, 561 female) were screened for G6PD deficiency using FST (in-house method) and a quantitative enzyme assay. Fluorescence intensity of the FST was graded as either absent, intermediate or normal. Samples identified as showing absent or intermediate fluorescence on FST were analysed for the presence of G6PD mutations using TaqMan@SNP genotyping assays and direct nucleotide sequencing. RESULTS Of the 1266 samples, 87 samples were found to be intermediate or deficient by FST (49 deficient, 38 intermediate). Of the 49 deficient samples, 48 had G6PD enzyme activity of ≤ 9.5 U/g Hb and one sample had normal enzyme activity. All 38 intermediate samples were from females. Of these, 21 had G6PD activity of between 20% and 60%, and 17 samples showed normal G6PD activity. Twenty-seven of the 38 samples were available for mutation analysis of which 13 had normal G6PD activity. Eleven of the 13 samples with normal G6PD activity had identifiable G6PD mutations. CONCLUSION Glucose-6-phosphate dehydrogenase heterozygote females cannot be identified by FST if fluorescence is reported as absent or present. Distinguishing samples with intermediate fluorescence from absent and bright fluorescence improves detection of heterozygote females with mild G6PD deficiency. Mutational studies confirmed that 85% of intermediate samples with normal enzyme activity had identifiable G6PD mutations.
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Affiliation(s)
- V Nadarajan
- Department of Pathology, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia Division of Laboratory Medicine, Department of Pathology, University Malaya Medical Centre, Kuala Lumpur, Malaysia
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Ang C, Mukhopadhyay A, Burnley C, Faulkner K, Cross P, Martin-Hirsch P, Naik R. Histological recurrence and depth of loop treatment of the cervix in women of reproductive age: incomplete excision versus adverse pregnancy outcome. BJOG 2011; 118:685-92. [PMID: 21429068 DOI: 10.1111/j.1471-0528.2011.02929.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Recent meta-analyses have shown that loop treatment of the cervix of > 10 mm depth may be associated with adverse outcomes in future pregnancies. The aim of this study is to assess the rate of incomplete excision and recurrent disease in relation to depth of excision in women of reproductive age undergoing loop treatment. DESIGN Observational cohort study. SETTING Colposcopy Clinic, Northern Gynaecological Oncology Centre, Gateshead, UK. POPULATION In all, 1558 women undergoing loop treatment for high-grade cervical intraepithelial neoplasia (HGCIN) between 1998 and 2003. METHODS Women were followed up until 2008. Recurrence was analysed using Kaplan-Meier plots. OUTCOME MEASURES Incomplete excision rates and recurrence rates. Recurrence was defined as post-treatment disease with high-grade histology. Any dyskaryotic cytology on follow-up was also documented. RESULTS Recurrent high-grade disease on histology was found in 57/1558 (3.7%) women. In women ≤ 35 years old, despite a greater rate of incomplete excision at the endocervical margin at loop depths < 10 mm compared with ≥ 10 mm (24.4% versus 13.3%, P < 0.01), the recurrence rate was similar between the two groups (4.3% versus 3.4%, log-rank, P = 0.52). In contrast, a loop depth < 10 mm was associated with a higher disease recurrence rate (7.5% versus 3.0%, log-rank, P = 0.05) in women > 35 years. CONCLUSION In women of reproductive age requiring treatment for HGCIN, colposcopists performing loop excision should aim for < 10 mm depth. This provides adequate treatment for HGCIN and minimises the potential risk of adverse outcomes in future pregnancies.
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Affiliation(s)
- C Ang
- Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, UK
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Bouganim N, Ang C, Kavan P, Metrakos P, Miller WH, Batist G. Perioperative bevacizumab (Bev) containing chemotherapy for colorectal liver metastases. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.15073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Agulnik JS, Cohen V, Sun S, Ang C, Kasymjanova G, Chong G, Brandao G, Pepe C, Small D, Miller WH. Epidermal growth factor receptor ( EGFR) mutations detected by denaturing high performance liquid chromatography (dHPLC) in non-small cell lung cancer (NSCLC): Correlation with disease stage and response to tyrosine kinase inhibitors (TKI) therapy. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.22118] [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: 11/20/2022] Open
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Abstract
Maternal use of marijuana, in which the exocannabinoid Delta(9)-tetrahydrocannabinol is the most active psychoactive ingredient, is known to have adverse effects on various aspects of reproduction including ovulation, spermatogenesis, implantation and pregnancy duration. Endogenous cannabinoids of which Anandamide is the prototype are widely distributed in the body especially in the reproductive tract and pregnancy tissues and act through the same receptors as the receptor as Delta(9)-tetrahydrocannabinol. Anandamide, has been reported to have pleiotropic effects on human reproduction and in experimental animal models. It appears to be the important neuro-cytokine mediator synchronizing the embryo-endometrial development for timed implantation, the development of the embryo into the blastocyst and transport of the embryo across the fallopian tubes. The mechanisms by which it exerts these effects are unclear but could be via direct actions on the various sites within the reproductive system or its differential actions on vascular tone dependent. In this review article we bring together the current knowledge on the role of endoccanabinoids in reproduction and postulate on the potential mechanisms on how these affect reproduction. In addition, we examine its role on the endothelium and vascular smooth muscle as a potential mechanism for adverse pregnancy outcome.
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Affiliation(s)
- A H Taylor
- Department of Cancer Studies and Molecular Medicine, Robert Kilpatrick Clinical Sciences Building, University of Leicester, Leicester Royal Infirmary, PO Box 65, Leicester, Leicestershire LE2 7LX, UK
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Cohen V, Agulnik JS, Ang C, Kasymjanova G, Chong G, Tejada NA, Pepe C, Batist G, Small D, Miller WH. Clinicopathologic features and prognostic implications of epidermal growth factor receptor (EGFR) gene mutations detected by denaturing high-performance liquid chromatography (dHPLC) in non-small cell lung cancer (NSCLC). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.7594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7594 Background: Somatic mutations of the EGFR gene predict sensitivity to erlotinib and gefitinib and confer a favorable prognosis in patients (pts) with NSCLC. We have recently shown that dHPLC is an efficient and more sensitive method for mutation screening compared with DNA sequencing. The goal of this study was to describe the relationship between EGFR status (mutation status and type) and clinicopathologic factors. Methods: Tumor samples were analysed for EGFR exon 19 deletions and exon 21 L858R point mutations. DNA was extracted from paraffin-embedded tumor specimens and genotyped using dHPLC. The results were correlated with gender, smoking status, pathologic subtype, disease stage, and overall survival. Results: 215 NSCLC pts were genotyped. Mutations were present in 25% of cases (54 of 215). Among pts with mutations, 70% (38 of 54) had an exon 19 mutation whereas 30% had EGFR L858R. EGFR mutations were more common in women (31% vs 14%; p=0.008), in nonsmokers than ever-smokers (54% vs 17%; p<0.001), in adenocarcinomas/BAC than with other NSCLC histologies (31% vs 11%; p=0.004) and more frequently detected in advanced-stage than in early-stage disease (36% vs 15%; p=0.001). Median survival times of pts with stage IIIB-IV disease with and without EGFR mutations were 20 and 14 months, respectively. Those with exon 19 deletion mutations had a longer median survival than pts with L858R point mutations. Data describing the impact of tyrosine kinase inhibitor therapy on survival outcomes are pending and will be presented. Conclusion: dHPLC is a reliable tool for EGFR mutation detection. Mutations were preferentially observed in women, nonsmokers, adenocarcinomas/BAC and in patients with advanced disease. Pts with mutations experienced improved survival and those harboring deletions fared better than those with point mutations. These observations warrant confirmation in large prospective trials and exploration of the biological mechanisms of the differences between mutation types. No significant financial relationships to disclose.
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Affiliation(s)
- V. Cohen
- SMBD-Jewish General Hospital, Montreal, PQ, Canada
| | | | - C. Ang
- SMBD-Jewish General Hospital, Montreal, PQ, Canada
| | | | - G. Chong
- SMBD-Jewish General Hospital, Montreal, PQ, Canada
| | - N. A. Tejada
- SMBD-Jewish General Hospital, Montreal, PQ, Canada
| | - C. Pepe
- SMBD-Jewish General Hospital, Montreal, PQ, Canada
| | - G. Batist
- SMBD-Jewish General Hospital, Montreal, PQ, Canada
| | - D. Small
- SMBD-Jewish General Hospital, Montreal, PQ, Canada
| | - W. H. Miller
- SMBD-Jewish General Hospital, Montreal, PQ, Canada
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22
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Ang C, Lumsden MA. Diabetes and the maternal resistance vasculature. Clin Sci (Lond) 2001; 101:719-29. [PMID: 11724662] [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: 02/22/2023]
Abstract
Diabetes is the most common endocrine disorder worldwide, with complications that include the development of both macro- and micro-vascular disease that contribute significantly to patient morbidity and mortality. The severity of diabetic complications is amplified during pregnancy, resulting in a higher incidence of adverse pregnancy outcomes such as pre-eclampsia, placental insufficiency and stillbirth than in non-diabetics. Vascular dysfunction is thought to underlie many of these complications, with the greatest impact occurring at the level of the resistance vasculature, where alterations in vascular reactivity can significantly affect blood flow and tissue perfusion. It is likely that problems associated with diabetic pregnancies are related, in part, to abnormal vascular function, particularly dysfunction of the vascular endothelium.
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Affiliation(s)
- C Ang
- Department of Obstetrics and Gynaecology, The Queen Mother's Hospital, University of Glasgow, Glasgow G3 8SJ, UK
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Abstract
Diabetes is associated with vascular dysfunction, which may be due in part to altered vascular responses to endogenous peptides such as endothelin-1. These altered responses may also contribute to the decreased maternal peripheral resistance in pregnancy. The aim of this study was to examine the effect of diabetes on the vasoconstrictor response to endothelin-1 in pregnant women. Small arteries were isolated from nine healthy pregnant, seven type 1 diabetic pregnant women, and five healthy nonpregnant women. Contraction curves were performed on a wire myograph for noradrenaline (1 nM to 30 microM) and endothelin-1 (1 pM to 0.3 microM). Maximum responses and sensitivity were compared by t test. No differences in maximum response to noradrenaline or potassium were seen among the three groups. The maximum response to endothelin-1 was significantly increased in pregnancy (P < 0.05), whereas endothelin-1 sensitivity was reduced in the diabetic compared with the nondiabetic pregnant women (P < 0.05). Pregnant women have an increased maximum vasoconstriction response to endothelin-1 compared with nonpregnant women, whereas diabetic pregnant women demonstrate reduced sensitivity to endothelin-1. These observations suggest that endothelin-1 may play a role in maintaining peripheral vascular tone in normal pregnancy, and the decreased sensitivity seen in pregnant women with diabetes may reflect abnormal vascular reactivity.
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Affiliation(s)
- C Ang
- Department of Obstetrics and Gynecology, University of Glasgow, Glasgow, United Kingdom G3 8SJ
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Ang C, Hillier C, MacDonald A, Cameron A, Greer I, Lumsden MA. Insulin-mediated vasorelaxation in pregnancy. BJOG 2001; 108:1088-93. [PMID: 11702842 DOI: 10.1111/j.1471-0528.2001.00257.x] [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: 11/29/2022]
Abstract
OBJECTIVE To investigate insulin-mediated vasorelaxation in pregnancy, and the role of nitric oxide in this response. DESIGN In vitro study of isolated subcutaneous resistance arteries from pregnant and non-pregnant women. METHODS Small arteries (mean vessel diameter <300 microm) were isolated from biopsies of subcutaneous fat from 14 pregnant and seven non-pregnant women. Insulin-mediated attenuation of the vasoconstriction response to noradrenaline, before and after nitric oxide synthase inhibition, was studied in isolated arteries using wire myography. Vessel responses to noradrenaline following incubation with insulin were also tested after endothelial denudation. Maximum responses were compared using one-way ANOVA and Bonferroni's post hoc test for multiple comparisons. RESULTS In pregnancy, the maximum vasoconstriction produced by noradrenaline was increased (P < 0.01). Insulin significantly reduced this response in pregnant women (P < 0.01), while inhibition of nitric oxide synthase with Nomega-nitro-L-arginine methyl ester (L-NAME) resulted in potentiation (P < 0.05). Following inhibition of nitric oxide synthase with L-NAME, addition of the insulin was still able to produce a significant attenuation in maximum vasoconstriction to noradrenaline in pregnant women (P < 0.01). Furthermore, the absence of functioning endothelium did not abolish the attenuating effect of the insulin on noradrenaline-induced vasoconstriction in pregnant women (P < 0.01). CONCLUSIONS The vasodilatory effect of insulin is not diminished in pregnancy, despite the development of insulin resistance. Furthermore, the attenuation of vasoconstrictor tone is via an endothelium-independent mechanism. This suggests that the vascular dysfunction associated with diabetes mellitus does not occur with physiological insulin resistance.
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Affiliation(s)
- C Ang
- Department of Obstetrics and Gynaecology, University of Glasgow, UK
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Abstract
Nausea and vomiting are common after adenotonsillectomy. Tropisetron is a new, long-acting serotonin antagonist that is an effective antiemetic in adults. Its effect on postoperative nausea and vomiting in children is unknown. We carried out a randomized, double-blind study of the effects of a single i.v. dose of tropisetron on vomiting after tonsillectomy with or without adenoidectomy in children. Forty-eight children undergoing tonsillectomy or adenotonsillectomy received at induction of anaesthesia either tropisetron 0.1 mg kg-1 or placebo. The incidence of vomiting was recorded for the first 24 h after surgery by nursing staff and then by parents after discharge from hospital. Children received metoclopramide 0.15 mg kg-1 as a rescue antiemetic. We found that tropisetron reduced the overall incidence of emetic episodes after surgery (29% compared with 65% in control group; P = 0.019) and the incidence of severe vomiting (0% compared with 52% in control group; P < 0.001). We conclude that tropisetron is an effective antiemetic for children undergoing tonsillectomy.
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Affiliation(s)
- C Ang
- Department of Anaesthesia, Princess Margaret Hospital for Children, Perth, Australia
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Ang C, Savige J, Dawborn J, Miach P, Heale W, Clarke B, Sinclair RS. Anti-glomerular basement membrane (GBM)-antibody-mediated disease with normal renal function. Nephrol Dial Transplant 1998; 13:935-9. [PMID: 9568853 DOI: 10.1093/ndt/13.4.935] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND This study compared the clinical and laboratory characteristics of patients with anti-glomerular basement membrane (GBM) disease and normal renal function, with those of patients with anti-GBM disease where there was renal impairment. METHODS The medical records of the 14 patients who had presented with anti-GBM disease to our hospital in the past 20 years were reviewed. RESULTS Five (36%) had a normal serum creatinine or creatinine clearance at presentation. Other features were haemoptysis (2/5, 40%), macroscopic haematuria (2/5, 40%) or systemic symptoms (1/5, 20%). All five (100%) had some degree of haematuria, four (80%) had proteinuria of at least 1 g/day, and none was hypertensive. Anaemia, a raised WCC, or elevated ESR (> 35 mm/h) occurred less often than in patients with impaired renal function (P<0.05). Two of the five (40%) with normal renal function had circulating anti-GBM antibodies, which were present at low or moderate levels; but seven of the nine with renal impairment (77%) had circulating antibodies, with high levels in five. Renal biopsies from patients with normal renal function were normal (1/5, 20%), showed mesangial proliferation (4/5, 80%) or had more than 20% glomeruli sclerosed (1/5, 20%). Complement deposition was present in 2/4 biopsies (50%). The kidneys from patients with renal impairment had crescents in more than 50% glomeruli (9/9, 100%), and four had more than 20% glomeruli sclerosed (44%). All four kidneys from patients with renal impairment that were examined had complement deposits (100%). Treatment was identical in both groups; patients with normal renal function were followed for a median of 48 months, and those with renal impairment for 180 months. There were no further episodes of haemoptysis, haematuria, or other symptoms of relapse in either group. All five patients with normal renal function are alive, and the serum creatinine is less than 0.2 mmol/l in all (100%), but haematuria persists in one (20%), and proteinuria >1 g/day in two (40%). Eight of the nine (89%) patients with impaired renal function survive, but all are currently being dialysed or have had a renal transplant. CONCLUSION Patients with anti-GBM disease with normal renal function are not uncommon, and often have a good prognosis. There is less renal damage, possibly because of lower levels of circulating anti-GBM antibodies and less glomerular complement deposition.
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Affiliation(s)
- C Ang
- Renal Unit, Austin and Repatriation Medical Centre, Heidelberg, Victoria, Australia
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Szabo E, Moody H, Hamilton T, Ang C, Kovithavongs C, Kjellstrand C. Choice of treatment improves quality of life. A study on patients undergoing dialysis. Arch Intern Med 1997; 157:1352-6. [PMID: 9201010] [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: 02/04/2023]
Abstract
BACKGROUND Quality of life (QOL) is an important measure of the success of medicine. Choice of treatment is an important variable influencing QOL. We studied QOL in patients undergoing treatment for end-stage renal failure. Until June 1993 our patients needing dialysis could freely choose continuous ambulatory peritoneal dialysis (CAPD); however, since that time most patients have been forced to undergo CAPD because the hemodialysis program is full. METHODS We compared QOL in patients accepted before or after June 1993. Forty-five patients undergoing CAPD were studied during the period of choice compared with 44 who had no choice. Quality of life was studied by Bradburn Affect Scale, Mental Health Scale, Campbell Life Satisfaction, Perceived Health, Karnofsky Scale, Activity Scale, Physical Symptoms Scale, and desire for treatment change. RESULTS The patients undergoing CAPD in the no-choice group had a lower score than the choice population in 4 of the 7 QOL scales. The Mental Health Scale mean score was 18.4 compared with 15.5, and the patients ranking highest on the Mental Health Scale decreased from 33% to 18%, while those ranking lowest increased 7-fold from 2% to 14% comparing choice with no-choice group. The Bradburn Affect Scale score was +0.7 in the choice group compared with -0.3 in the no-choice group. There were no differences in age, sex, race, or treatment that explained the difference. Influence of other time-related factors is unlikely as there were no similar lower scores with time in the QOL reported by patients in the in-center or assisted self-care hemodialysis or transplant groups. CONCLUSIONS Once the freedom of choice of treatment is gone from the patients undergoing CAPD their psychological QOL deteriorates.
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Affiliation(s)
- E Szabo
- Department of Medicine, University of Alberta, Edmonton
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Abstract
The effects of hyperthermia on potentially prothrombotic endothelial function were investigated by measuring levels of von Willebrand factor, thrombospondin, tissue plasminogen activator and plasminogen activator inhibitor-1 secreted by unstimulated human umbilical vein endothelial cells cultured at 37 degrees C, 39 degrees C, 41 degrees C and 43 degrees C for 24 h. Endothelial barrier function at 43 degrees C was compared with that at 37 degrees C by measuring permeability to radiolabelled human serum albumin and low density lipoprotein. Thrombospondin levels were unaffected by a temperature of 39 degrees C; they increased after 3 h at 41 degrees C and subsequently declined to values significantly below the 37 degrees C control. At 43 degrees C, secretion exhibited a time-dependent decrease. Secretion of von Willebrand factor was not discernibly affected by exposure to 39 degrees C or 41 degrees C. Its response to 43 degrees C resembled that of thrombospondin to 41 degrees C. In contrast, elevated temperatures markedly increased plasminogen activator inhibitor-1 while decreasing t-PA secretion, though after prolonged exposure to 43 degrees C the levels of both returned to control values. After 12-24 h at 43 degrees C, endothelial permeability to both albumin and low density lipoprotein increased markedly. Vascular endothelium may contribute to the thrombotic tendency associated with heat stroke by increasing access to the prothrombotic subendothelium and reducing fibrinolysis.
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Affiliation(s)
- C Ang
- Heart Research Institute, Camperdown, NSW, Australia
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Ang C, Clark E, Young I, Owe-Young R, Eyland A, Hunt J, Chesterman C, Krilis S. 15-hydroxyeicosatetraenoic acid synthesis from exogenous arachidonate by bronchial mucosa. J Lipid Mediat 1990; 2:263-9. [PMID: 2133271] [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: 12/30/2022]
Abstract
Arachidonate metabolism in bronchial mucosa was investigated. Bronchial biopsies from four asthmatics and three non-asthmatic controls were challenged with 300, 465, 650 and 960 mOsm/kg saline in the presence of [3H]arachidonate. Supernatants were analysed by reverse-phase high-performance liquid chromatography. The major arachidonate metabolite was identified as 15-monohydroxyeicosatetraenoic acid (15-HETE), with significantly higher production in biopsies from asthmatics than controls. Statistical analysis of the full model explained 81% of the variation (F = 14.8; df = 6, 21; P less than 0.001). Hyperosmolarity and the presence of sarcoid had no significant effect on 15-HETE synthesis, reducing R2 by only 6%.
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Affiliation(s)
- C Ang
- School of Medicine, St. George Hospital, University of New South Wales, Australia
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