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Kudrimoti S, Machin J, Arojojoye AS, Awuah SG, Eisenberg R, Fenger C, Maylin G, Lehner AF, Tobin T. Synthesis and characterization of d 5 -barbarin for use in barbarin-related research. Drug Test Anal 2023; 15:42-46. [PMID: 35975356 PMCID: PMC10087961 DOI: 10.1002/dta.3357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/12/2022] [Accepted: 08/12/2022] [Indexed: 01/26/2023]
Abstract
Based on structural similarities and equine administration experiments, Barbarin, 5-phenyl-2-oxazolidinethione from Brassicaceae plants, is a possible source of equine urinary identifications of aminorex, (R,S)-5-phenyl-4,5-dihydro-1,3-oxazol-2-amine, an amphetamine-related US Drug Enforcement Administration (DEA) controlled substance considered illegal in sport horses. We now report the synthesis and certification of d5 -barbarin to facilitate research on the relationship between plant barbarin and such aminorex identifications. D5 -barbarin synthesis commenced with production of d5 -2-oxo-2-phenylacetaldehyde oxime (d5 -oxime) from d5 -acetophenone via butylnitrite in an ethoxide/ethanol solution. This d5 -oxime was then reduced with lithium aluminum hydride (LiAlH4 ) to produce the corresponding d5 -2-amino-1-phenylethan-1-ol (d5 -phenylethanolamine). Final ring closure of the d5 -phenylethanolamine was performed by the addition of carbon disulfide (CS2 ) with pyridine. The reaction product was purified by recrystallization and presented as a stable white crystalline powder. Proton NMR spectroscopy revealed a triplet at 5.88 ppm for one proton, a double doublet at 3.71 ppm for one proton, and double doublet at 4.11 ppm for one proton, confirming d5 -barbarin as the product. Further characterization by high resolution mass spectrometry supports the successful synthesis of d5 -barbarin. Purity of the recrystallized product was ascertained by High Performance Liquid Chromatography (HPLC) to be greater than 98%. Together, we have developed the synthesis and full characterization of d5 -barbarin for use as an internal standard in barbarin-related and equine forensic research.
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Affiliation(s)
- Sucheta Kudrimoti
- The Department of Veterinary Science and the Maxwell H. Gluck Equine Research Center and the Department of Toxicology and Cancer Biology, University of Kentucky, Lexington, Kentucky, USA
| | - Jacob Machin
- The Department of Veterinary Science and the Maxwell H. Gluck Equine Research Center and the Department of Toxicology and Cancer Biology, University of Kentucky, Lexington, Kentucky, USA
| | | | - Samuel G Awuah
- Department of Chemistry, University of Kentucky, Lexington, Kentucky, USA.,Center for Pharmaceutical Research and Innovation, College of Pharmacy and Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA
| | | | - Clara Fenger
- Equine Integrated Medicine, Georgetown, Kentucky, USA
| | - George Maylin
- New York Drug Testing and Research Program, Ithaca, New York, USA
| | - Andreas F Lehner
- Veterinary Diagnostic Lab Section of Toxicology, Michigan State University, Lansing, Michigan, USA
| | - Thomas Tobin
- The Department of Veterinary Science and the Maxwell H. Gluck Equine Research Center and the Department of Toxicology and Cancer Biology, University of Kentucky, Lexington, Kentucky, USA
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Valberg SJ, Velez-Irizarry D, Williams ZJ, Henry ML, Iglewski H, Herrick K, Fenger C. Enriched Pathways of Calcium Regulation, Cellular/Oxidative Stress, Inflammation, and Cell Proliferation Characterize Gluteal Muscle of Standardbred Horses between Episodes of Recurrent Exertional Rhabdomyolysis. Genes (Basel) 2022; 13:1853. [PMID: 36292738 PMCID: PMC9601720 DOI: 10.3390/genes13101853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 11/04/2022] Open
Abstract
Certain Standardbred racehorses develop recurrent exertional rhabdomyolysis (RER-STD) for unknown reasons. We compared gluteal muscle histopathology and gene/protein expression between Standardbreds with a history of, but not currently experiencing rhabdomyolysis (N = 9), and race-trained controls (N = 7). Eight RER-STD had a few mature fibers with small internalized myonuclei, one out of nine had histologic evidence of regeneration and zero out of nine degeneration. However, RER-STD versus controls had 791/13,531 differentially expressed genes (DEG). The top three gene ontology (GO) enriched pathways for upregulated DEG (N = 433) were inflammation/immune response (62 GO terms), cell proliferation (31 GO terms), and hypoxia/oxidative stress (31 GO terms). Calcium ion regulation (39 GO terms), purine nucleotide metabolism (32 GO terms), and electron transport (29 GO terms) were the top three enriched GO pathways for down-regulated DEG (N = 305). DEG regulated RYR1 and sarcoplasmic reticulum calcium stores. Differentially expressed proteins (DEP ↑N = 50, ↓N = 12) involved the sarcomere (24% of DEP), electron transport (23%), metabolism (20%), inflammation (6%), cell/oxidative stress (7%), and other (17%). DEP included ↑superoxide dismutase, ↑catalase, and DEP/DEG included several cysteine-based antioxidants. In conclusion, gluteal muscle of RER-susceptible Standardbreds is characterized by perturbation of pathways for calcium regulation, cellular/oxidative stress, inflammation, and cellular regeneration weeks after an episode of rhabdomyolysis that could represent therapeutic targets.
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Affiliation(s)
- Stephanie J. Valberg
- Mary Anne McPhail Equine Performance Center, Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - Deborah Velez-Irizarry
- Mary Anne McPhail Equine Performance Center, Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - Zoë J. Williams
- Mary Anne McPhail Equine Performance Center, Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - Marisa L. Henry
- Mary Anne McPhail Equine Performance Center, Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - Hailey Iglewski
- Mary Anne McPhail Equine Performance Center, Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - Keely Herrick
- Mary Anne McPhail Equine Performance Center, Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - Clara Fenger
- Equine Integrated Medicine, PLC, Lexington, KY 40324, USA
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Brewer K, Machin J, Maylin G, Fenger C, Morales-Briceño A, Tobin T. Gabapentin, a human therapeutic medication and an environmental substance transferring at trace levels to horses: a case report. Ir Vet J 2022; 75:19. [PMID: 36192810 PMCID: PMC9531455 DOI: 10.1186/s13620-022-00226-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/08/2022] [Indexed: 11/10/2022] Open
Abstract
Gabapentin, 1-(Aminomethyl)cyclohexaneacetic acid, MW 171.240, is a frequently prescribed high dose human medication that is also used recreationally. Gabapentin is orally absorbed; the dose can be 3,000 mg/day and it is excreted essentially unchanged in urine. Gabapentin is stable in the environment and routinely detected in urban wastewater. Gabapentin randomly transfers from humans to racing horses and is at times detected at pharmacologically ineffective / trace level concentrations in equine plasma and urine. In Ohio racing between January 2019 and July 2020,18 Gabapentin identifications, all less than 2 ng/ml in plasma, were reported. These identifications were ongoing because the horsemen involved were unable to pin down and therefore avoid the source of these identifications. Given that 44 ng/ml or less is an Irrelevant Plasma Concentration (IPC) of Gabapentin in horses, we proposed a 5 ng/ml plasma interim Screening Limit of Detection for Gabapentin identifications in Ohio racing, and an essentially similar 8 ng/ml plasma Screening Limit of Detection was suggested by a scientific advisor to the Ohio Horse Racing Commission. As such, an analytical Screening Limit of 8 ng /ml in plasma is an appropriate and pharmacologically conservative analytical "cut-off" or Screening Limit of Detection (SLOD) for Gabapentin in equine competitive events to avoid the calling of "positive" identifications on random unavoidable trace level identifications of this widely prescribed human therapeutic medication in equine forensic samples.
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Affiliation(s)
| | - Jacob Machin
- The Maxwell H. Gluck Equine Research Center and Department of Toxicology and Cancer Biology, University of Kentucky, Lexington, Kentucky, 40546, USA
| | - George Maylin
- New York Drug Testing and Research Program, 777 Warren Rd, Ithaca, NY, 14853, USA
| | - Clara Fenger
- Equine Integrated Medicine, 4904 Ironworks Rd., Georgetown, KY, 40324, USA
| | | | - Thomas Tobin
- The Maxwell H. Gluck Equine Research Center and Department of Toxicology and Cancer Biology, University of Kentucky, Lexington, Kentucky, 40546, USA.
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Machin J, Brewer K, Morales-Briceno A, Fenger C, Maylin G, Tobin T. Sporadic worldwide "clusters" of feed driven Zilpaterol identifications in racing horses: a review and analysis. Ir Vet J 2022; 75:11. [PMID: 35568924 PMCID: PMC9107120 DOI: 10.1186/s13620-022-00215-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/31/2022] [Indexed: 11/10/2022] Open
Abstract
Zilpaterol is a β2-adrenergic agonist medication approved in certain countries as a cattle feed additive to improve carcass quality. Trace amounts of Zilpaterol can transfer to horse feed, yielding equine urinary "identifications" of Zilpaterol. These "identifications" occur because Zilpaterol is highly bioavailable in horses, resistant to biotransformation and excreted as unchanged Zilpaterol in urine, where it has a 5 day or so terminal half-life.In horses, urinary steady-state concentrations are reached 25 days (5 half-lives) after exposure to contaminated feed. Zilpaterol readily presents in horse urine, yielding clusters of feed related Zilpaterol identifications in racehorses. The first cluster, April 2013, involved 48 racehorses in California; the second cluster, July 2013, involved 15 to 80 racehorses in Hong Kong. The third cluster, March 2019, involved 24 racehorses in Mauritius; this cluster traced to South African feedstuffs, triggering an alert concerning possible Zilpaterol feed contamination in South African racing. The fourth cluster, September/October 2020 involved 18 or so identifications in French racing, reported by the French Laboratories des Courses Hippiques, (LCH), and in July 2021, a fifth cluster of 10 Zilpaterol identifications in South Africa.The regulatory approach to these identifications has been to alert horsemen and feed companies and penalties against horsemen are generally not implemented. Additionally, given their minimal exposure to Zilpaterol, there is little likelihood of Zilpaterol effects on racing performance or adverse health effects for exposed horses.The driving factor in these events is that Zilpaterol is dissolved in molasses for incorporation into cattle feed. Inadvertent incorporation of Zilpaterol containing molasses into horse feed was the source of the California and Hong Kong Zilpaterol identifications. A second factor in the 2019 Mauritius and 2020 French identifications was the sensitivity of testing for Zilpaterol in Mauritius and France, with the French laboratory reportedly testing at a "more sensitive level for Zilpaterol". As of January 1st, 2021, the new FEI Atypical Finding (ATF) policy specifies Zilpaterol as a substance to be treated as an Atypical Finding (ATF), allowing consideration of inadvertent feed contamination in the regulatory evaluation of Zilpaterol identifications.
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Affiliation(s)
- Jacob Machin
- Department of Toxicology and Cancer Biology and the Maxwell H. Gluck Equine Research Center, Dept. of Veterinary Science, University of Kentucky, Lexington, KY, 40546, USA
| | - Kimberly Brewer
- , 15775 Cypress Creek Lane, Wellington, FL, 33414, New Zealand
| | | | - Clara Fenger
- Equine Integrated Medicine, 4904 Ironworks Rd, Georgetown, KY, 40324, USA
| | - George Maylin
- New York Drug Testing and Research Program, 777 Warren Rd Ithaca, New York, NY, 14853, USA
| | - Thomas Tobin
- Department of Toxicology and Cancer Biology and the Maxwell H. Gluck Equine Research Center, Dept. of Veterinary Science, University of Kentucky, Lexington, KY, 40546, USA.
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Brewer K, Machin JJ, Maylin G, Fenger C, Morales-Briceño A, Neidhart MM, Tobin T. Case report: Synephrine, a plant substance yielding classic environmental clusters of hay related identifications in equine urine. Drug Test Anal 2022; 14:774-780. [PMID: 35088566 DOI: 10.1002/dta.3212] [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] [Received: 11/26/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 11/12/2022]
Affiliation(s)
| | - Jacob Joseph Machin
- The Maxwell H. Gluck Equine Research Center and Department of Toxicology and Cancer Biology, University of Kentucky, Lexington, Kentucky, USA
| | - George Maylin
- Director, New York Drug Testing and Research Program, Ithaca, New York, USA
| | - Clara Fenger
- Equine Integrated Medicine, PLC, Georgetown, Kentucky, USA
| | | | | | - Thomas Tobin
- The Maxwell H. Gluck Equine Research Center and Department of Toxicology and Cancer Biology, University of Kentucky, Lexington, Kentucky, USA
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Iglewski H, Henry M, Fenger C, Pagan J, McKenzie E, Valberg S. 145 Comparison of skeletal muscle citrate synthase activity across equine breeds. J Equine Vet Sci 2021. [DOI: 10.1016/j.jevs.2021.103608] [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: 10/21/2022]
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McClure S, Fenger C, Kersh K, Brown B, Maylin G, Duer W, Dirikolu L, Brewer K, Machin J, Tobin T. Dexamethasone serum concentrations after intravenous administration in horses during race training. Comparative Exercise Physiology 2021. [DOI: 10.3920/cep200015] [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: 11/19/2022]
Abstract
Dexamethasone (DXM) sodium phosphate is a widely used corticosteroid for inflammatory conditions in horses, regulated in racing jurisdictions in the USA by a 0.005 ng/ml serum/plasma threshold. This study seeks to describe serum concentrations of DXM at 48 and 72 h after intravenous administration of 20 mg DXM sodium phosphate over 1 to 5 days, and to identify a possible source of DXM overages. 74 horses (39 Thoroughbreds, 13 Standardbreds, 22 Quarter Horses) in active race training received 20 mg DXM sodium phosphate. Serum was collected before injection, at 48 and 72 h post last injection, and analysed by LC/MS-MS (limit of quantification (LOQ) = 2.5 pg/ml). No differences were identified by ANOVA (P≤0.05) for racing breeds, age, gender or the number of days of DXM sodium phosphate administration, so data were pooled for each time point. The DXM serum concentration at 48 h (mean ± standard deviation, range) was 2.18±1.56 pg/ml (<2.5 to 40 pg/ml). Summary statistics could not be derived for 72 h DXM serum concentration data owing to censored data, but ranged from <2.5 to 95.8 pg/ml. There was one extreme outlier (Tukey) at 48 h, and two extreme outliers at 72 h. A separate study was conducted using sedentary experimental horses to determine the likelihood that positive DXM samples could result from environmental transfer. Urine was collected from a mare 2 to 3 h post administration of 20 mg DXM. Hay with 100 ml of the DXM (17 ng/ml) containing urine was offered to each of six experimental horses and blood was collected at 0, 4, 8, 12, 16, 20 and 24 h. All six horses had plasma DXM concentration above the limit of detection and five of six had plasma DXM concentrations above the LOQ for at least one sample time.
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Affiliation(s)
- S. McClure
- Midwest Equine Surgery and Sports Medicine, 2615 Eastgate Drive, Boone, IA 50036, USA
- Department of Veterinary Clinical Sciences College of Veterinary Medicine, Iowa State University, 1800 Christensen Drive, Ames, IA 50011-1134, USA
| | - C. Fenger
- Equine Integrated Medicine, PLC, 4904 Ironworks Rd., Georgetown, KY 40324, USA
| | - K. Kersh
- Department of Veterinary Clinical Sciences College of Veterinary Medicine, Iowa State University, 1800 Christensen Drive, Ames, IA 50011-1134, USA
| | - B. Brown
- Bradley Brown, private practice, 425 Sacree Rd., Shelbyville, KY 40065, USA
| | - G. Maylin
- New York Drug Testing and Research Program, Morrisville State College, 777 Warren Rd, Ithaca, NY 14853, USA
| | - W. Duer
- Duer Forensic Toxicology LLC., 1621 Gulf Blvd #102, Clearwater, FL 33767-2928, USA
| | - L Dirikolu
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, Skip Bertman Drive, Baton Rouge, LA 70803, USA
| | - K. Brewer
- Kimberly Brewer, private practice, 15775 Cypress Creek Lane, Wellington, FL 33414, USA
| | - J. Machin
- The Maxwell H. Gluck Equine Research Center, University of Kentucky, 1400 Nicholasville Rd, Lexington, KY 40503, USA
| | - T. Tobin
- The Maxwell H. Gluck Equine Research Center, University of Kentucky, 1400 Nicholasville Rd, Lexington, KY 40503, USA
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Machin J, Childers T, Kudrimoti S, Eisenberg R, Fenger C, Hartmann P, Maylin G, Shults T, Tobin T. Synthesis and characterization of barbarin, a possible source of unexplained aminorex identifications in forensic science. Drug Test Anal 2020; 12:1477-1482. [PMID: 32567235 DOI: 10.1002/dta.2883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/29/2020] [Accepted: 06/18/2020] [Indexed: 11/07/2022]
Abstract
Aminorex is a US DEA Schedule 1 controlled substance occasionally detected in racing horses. A number of aminorex identifications in sport horses were thought to have been caused by exposure to plant sources of aminorex. Glucobarbarin, found in plants of the Brassicaceae family, has been suggested as a potential proximate chemical source by being metabolized in the plant or the horse to aminorex. In Brassicaceae, glucobarbarin is hydrolyzed by myrosinase to yield barbarin, which serves as an insect repellant and/or attractant and is structurally related to aminorex. The synthesis, purification, and characterization of barbarin is now reported for use as a reference standard in aminorex related research concerning equine urinary identifications of aminorex and also for possible use in equine administration experiments. Synthesis of barbarin was performed via ring closure between phenylethanolamine and carbon disulfide in tetrahydrofuran with the catalyst pyridine under reflux. The reaction yielded a white crystalline substance that was purified and chemically characterized as barbarin for use as a Certified Reference Standard or for studies related to equine aminorex identification.
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Affiliation(s)
- Jacob Machin
- Department of Toxicology and Cancer Biology and the Maxwell H. Gluck Equine Research Center, Department of Veterinary Science, University of Kentucky, Lexington, Kentucky, USA
| | - Taylor Childers
- Department of Toxicology and Cancer Biology and the Maxwell H. Gluck Equine Research Center, Department of Veterinary Science, University of Kentucky, Lexington, Kentucky, USA
| | - Sucheta Kudrimoti
- Department of Toxicology and Cancer Biology and the Maxwell H. Gluck Equine Research Center, Department of Veterinary Science, University of Kentucky, Lexington, Kentucky, USA
| | | | - Clara Fenger
- Equine Integrated Medicine, Georgetown, Kentucky, USA
| | | | - George Maylin
- New York Drug Testing and Research Program, Ithaca, NY, USA
| | - Theodore Shults
- American Association of Medical Review Officers, Durham, NC, USA
| | - Thomas Tobin
- Department of Toxicology and Cancer Biology and the Maxwell H. Gluck Equine Research Center, Department of Veterinary Science, University of Kentucky, Lexington, Kentucky, USA
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Machin J, Brewer K, Catignani M, Shults T, Fenger C, Maylin G, Tobin T. An interim screening limit of detection for naproxen in equine plasma: a review and analysis. Comparative Exercise Physiology 2020. [DOI: 10.3920/cep190044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Starting in August 2015 Thoroughbred racing in Charles Town, West Virginia experienced a sequence of intermittent low concentration Naproxen identifications from 6.3 to 161 ng/ml of plasma (27.3 to 699 nM). These identifications were ongoing, indicating the horsemen were unaware of their origins. Naproxen is administered orally to horses at substantial doses and is chemically stable in the environment. These identifications are therefore most likely associated with exposure of these horses to environmental traces of Naproxen. Given the low concentrations of these identifications, we were asked to identify a Screening Limit of Detection (SLOD) below which these trace level Naproxen identifications would not be reported. Review of the data set suggested an SLOD of 200 ng/ml, while outlier analysis suggested an ‘extreme’ outlier level at 247 ng/ml, which figure was rounded up to 250 ng/ml Naproxen or 1.09 uM. This proposed SLOD is in good agreement with other US regulatory thresholds for therapeutic medications and this Interim Screening Limit of Detection was presented for review.
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Affiliation(s)
- J. Machin
- Department of Toxicology and Cancer Biology and The Maxwell H. Gluck Equine Research Center, University of Kentucky, 1400 Nicholasville Road, Lexington, KY 40546, USA
| | - K. Brewer
- 1711 Lakefield North Court, Wellington, FL 33414, USA
| | - M. Catignani
- Charles Town HBPA, 835 E. Washington Street 106, Charles Town, WV 25414, USA
| | - T.F. Shults
- American Association of Medical Review Officers, 17 Running Brook Ct. Durham, NC 27713, USA
| | - C. Fenger
- Equine Integrated Medicine, PLC, 4904 Ironworks Rd., Georgetown, KY 40324, USA
| | - G.A. Maylin
- New York Drug Testing and Research Program, 777 Warren Rd, Ithaca, NY 14853, USA
| | - T. Tobin
- Department of Toxicology and Cancer Biology and The Maxwell H. Gluck Equine Research Center, University of Kentucky, 1400 Nicholasville Road, Lexington, KY 40546, USA
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Maylin G, Fenger C, Machin J, Kudrimoti S, Eisenberg R, Green J, Tobin T. Aminorex identified in horse urine following consumption of Barbarea vulgaris; a preliminary report. Ir Vet J 2019; 72:15. [PMID: 31890155 PMCID: PMC6929286 DOI: 10.1186/s13620-019-0153-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 11/22/2019] [Indexed: 11/27/2022] Open
Abstract
Background Aminorex, (RS)-5- Phenyl-4,5-dihydro-1,3-oxazol-2-amine, is an amphetamine-like anorectic and in the United States a Drug Enforcement Administration [DEA] Schedule 1 controlled substance. Aminorex in horse urine is usually present as a metabolite of Levamisole, an equine anthelmintic and immune stimulant. Recently, Aminorex identifications have been reported in horse urine with no history or evidence of Levamisole administration. Analysis of the urine samples suggested a botanical source, directing attention to the Brassicaceae plant family, with their contained GlucoBarbarin and Barbarin as possible sources of Aminorex. Since horsepersons face up to a 1 year suspension and a $10,000.00 fine for an Aminorex identification, the existence of natural sources of Aminorex precursors in equine feedstuffs is of importance to both individual horsepersons and the industry worldwide. Results Testing the hypothesis that Brassicaceae plants could give rise to Aminorex identifications in equine urine we botanically identified and harvested flowering Kentucky Barbarea vulgaris, (“Yellow Rocket”) in May 2018 in Kentucky and administered the plant orally to two horses. Analysis of post-administration urine samples yielded Aminorex, showing that consumption of Kentucky Barbarea vulgaris can give rise to Aminorex identifications in equine urine. Conclusions Aminorex has been identified in post administration urine samples from horses fed freshly harvested flowering Kentucky Barbarea vulgaris, colloquially “Yellow Rocket”. These identifications are consistent with occasional low concentration identifications of Aminorex in equine samples submitted for drug testing. The source of these Aminorex identifications is believed to be the chemically related Barbarin, found as its precursor GlucoBarbarin in Kentucky Barbarea vulgaris and related Brassicaceae plants worldwide.
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Affiliation(s)
- George Maylin
- New York Drug Testing and Research Program, 777 Warren Rd, Ithaca, NY 14853 USA
| | - Clara Fenger
- Equine Integrated Medicine, 4904 Ironworks Rd, Georgetown, KY 40324 USA
| | - Jacob Machin
- 3The Maxwell H. Gluck Equine Research Center and Department of Toxicology and Cancer Biology, University of Kentucky, Lexington, KY 40546 USA
| | - Sucheta Kudrimoti
- 3The Maxwell H. Gluck Equine Research Center and Department of Toxicology and Cancer Biology, University of Kentucky, Lexington, KY 40546 USA
| | | | - Jonathan Green
- 5Department of Plant and Soil Sciences, University of Kentucky, Lexington, KY 40546 USA
| | - Thomas Tobin
- 3The Maxwell H. Gluck Equine Research Center and Department of Toxicology and Cancer Biology, University of Kentucky, Lexington, KY 40546 USA
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Valberg SJ, Soave K, Williams ZJ, Perumbakkam S, Schott M, Finno CJ, Petersen JL, Fenger C, Autry JM, Thomas DD. Coding sequences of sarcoplasmic reticulum calcium ATPase regulatory peptides and expression of calcium regulatory genes in recurrent exertional rhabdomyolysis. J Vet Intern Med 2019; 33:933-941. [PMID: 30720217 PMCID: PMC6430904 DOI: 10.1111/jvim.15425] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 01/11/2019] [Indexed: 12/12/2022] Open
Abstract
Background Sarcolipin (SLN), myoregulin (MRLN), and dwarf open reading frame (DWORF) are transmembrane regulators of the sarcoplasmic reticulum calcium transporting ATPase (SERCA) that we hypothesized played a role in recurrent exertional rhabdomyolysis (RER). Objectives Compare coding sequences of SLN, MRLN, DWORF across species and between RER and control horses. Compare expression of muscle Ca2+ regulatory genes between RER and control horses. Animals Twenty Thoroughbreds (TB), 5 Standardbreds (STD), 6 Quarter Horses (QH) with RER and 39 breed‐matched controls. Methods Sanger sequencing of SERCA regulatory genes with comparison of amino acid (AA) sequences among control, RER horses, human, mouse, and rabbit reference genomes. In RER and control gluteal muscle, quantitative real‐time polymerase chain reaction of SERCA regulatory peptides, the calcium release channel (RYR1), and its accessory proteins calsequestrin (CASQ1), and calstabin (FKBP1A). Results The SLN gene was the highest expressed horse SERCA regulatory gene with a uniquely truncated AA sequence (29 versus 31) versus other species. Coding sequences of SLN, MRLN, and DWORF were identical in RER and control horses. A sex‐by‐phenotype effect occurred with lower CASQ1 expression in RER males versus control males (P < .001) and RER females (P = .05) and higher FKBP1A (P = .01) expression in RER males versus control males. Conclusions and Clinical Importance The SLN gene encodes a uniquely truncated peptide in the horse versus other species. Variants in the coding sequence of SLN, MLRN, or DWORF were not associated with RER. Males with RER have differential gene expression that could reflect adaptations to stabilize RYR1.
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Affiliation(s)
- Stephanie J Valberg
- McPhail Equine Performance Center, Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, Michigan
| | - Kaitlin Soave
- McPhail Equine Performance Center, Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, Michigan
| | - Zoë J Williams
- McPhail Equine Performance Center, Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, Michigan
| | - Sudeep Perumbakkam
- McPhail Equine Performance Center, Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, Michigan
| | - Melissa Schott
- McPhail Equine Performance Center, Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, Michigan
| | - Carrie J Finno
- Department of Population Health and Reproduction, University of California-Davis, Davis, California
| | - Jessica L Petersen
- Department of Animal Science, University of Nebraska-Lincoln, Lincoln, Nebraska
| | - Clara Fenger
- Equine Integrated Medicine, PLC, Lexington, Kentucky
| | - Joseph M Autry
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota Medical School, Minneapolis, Minnesota
| | - David D Thomas
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota Medical School, Minneapolis, Minnesota
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12
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Machin J, Duer W, Maylin G, Fenger C, Wilson D, Ivey M, Berthold B, Allison S, Tobin T. Variability in plasma concentrations of methylprednisolone 6 days after intrasynovial injection of methylprednisolone acetate in racing horses: A field study. Equine Vet J 2018; 51:343-348. [DOI: 10.1111/evj.13003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 07/29/2018] [Indexed: 11/30/2022]
Affiliation(s)
- J. Machin
- The Maxwell H. Gluck Equine Research Center and Department of Toxicology and Cancer Biology University of Kentucky Lexington Kentucky USA
| | - W. Duer
- Duer Forensic Toxicology, Inc. Isle of Sand Key Clearwater Florida USA
| | - G. Maylin
- New York Drug Testing and Research Program Ithaca New York USA
| | - C. Fenger
- Equine Integrated Medicine PLC Georgetown Kentucky USA
| | - D. Wilson
- Cleveland Equine Clinic LLC Ravenna Ohio USA
| | - M. Ivey
- Equine Sports Medicine and Surgery Weatherford Texas USA
| | - B. Berthold
- Cleveland Equine Clinic LLC Ravenna Ohio USA
| | - S. Allison
- Cleveland Equine Clinic LLC Ravenna Ohio USA
| | - T. Tobin
- The Maxwell H. Gluck Equine Research Center and Department of Toxicology and Cancer Biology University of Kentucky Lexington Kentucky USA
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13
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Abstract
Staging of rectal carcinoma before surgical treatment was performed in a prospective blind study, comparing digital rectal exploration and transrectal linear ultrasonography (TRUS) with the resulting pathological examination. TRUS underestimated depth of penetration in 3 of 33 patients and overestimation resulted in 9 of 74. The figures for digital examination were 5 of 18 and 20 of 76, respectively. Penetration of the rectal wall was correctly identified in 56 of 61 patients by digital examination and in 59 of 61 by TRUS. Specimens without penetration of the rectal wall were identified in 26 of 33 patients by TRUS, but in not more than 13 of 33 by digital examination. Regional lymph node metastases were present in 19 patients; none were diagnosed by digital examination, but TRUS identified 11 of the 19. It is concluded that TRUS will result in more patients having the possibility of local surgery for cure.
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Brewer K, Shults TF, Machin J, Kudrimoti S, Eisenberg RL, Hartman P, Wang C, Fenger C, Beaumier P, Tobin T. A cluster of trace-concentration methamphetamine identifications in racehorses associated with a methamphetamine-contaminated horse trailer: A report and analysis. Can Vet J 2016; 57:860-864. [PMID: 27493286 PMCID: PMC4944564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Three low concentration methamphetamine "positive" tests were linked to use of a methamphetamine-contaminated trailer to transport the affected horses. This incident establishes methamphetamine as a human-use substance that can inadvertently enter the environment of racing horses, resulting in urinary methamphetamine "positives;" an interim regulatory cut-off of 15 ng/mL for methamphetamine in post-race urine is proposed.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Thomas Tobin
- Address all correspondence to Dr. Thomas Tobin; e-mail:
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15
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Fenger C, Tobin T, Casey P, Langemeier J, Haines D. Bovine Colostrum Supplementation Does Not Influence Serum Insulin-like Growth Factor-1 in Horses in Race Training. J Equine Vet Sci 2014. [DOI: 10.1016/j.jevs.2014.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lambertsen KL, Clausen BH, Fenger C, Wulf H, Owens T, Dagnaes-Hansen F, Meldgaard M, Finsen B. Microglia and macrophages express tumor necrosis factor receptor p75 following middle cerebral artery occlusion in mice. Neuroscience 2007; 144:934-49. [PMID: 17161916 DOI: 10.1016/j.neuroscience.2006.10.046] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2006] [Revised: 10/24/2006] [Accepted: 10/26/2006] [Indexed: 01/01/2023]
Abstract
The proinflammatory and potential neurotoxic cytokine tumor necrosis factor (TNF) is produced by activated CNS resident microglia and infiltrating blood-borne macrophages in infarct and peri-infarct areas following induction of focal cerebral ischemia. Here, we investigated the expression of the TNF receptors, TNF-p55R and TNF-p75R, from 1 to 10 days following permanent occlusion of the middle cerebral artery in mice. Using quantitative polymerase chain reaction (PCR), we observed that the relative level of TNF-p55R mRNA was significantly increased at 1-2 days and TNF-p75R mRNA was significantly increased at 1-10 days following arterial occlusion, reaching peak values at 5 days, when microglial-macrophage CD11b mRNA expression was also increased. In comparison, the relative level of TNF mRNA was significantly increased from 1 to 5 days, with peak levels 1 day after arterial occlusion. In situ hybridization revealed mRNA expression of both receptors in predominantly microglial- and macrophage-like cells in the peri-infarct and subsequently in the infarct, and being most marked from 1 to 5 days. Using green fluorescent protein-bone marrow chimeric mice, we confirmed that TNF-p75R was expressed in resident microglia and blood-borne macrophages located in the peri-infarct and infarct 1 and 5 days after arterial occlusion, which was supported by Western blotting. The data show that increased expression of the TNF-p75 receptor following induction of focal cerebral ischemia in mice can be attributed to expression in activated microglial cells and blood-borne macrophages.
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Affiliation(s)
- K L Lambertsen
- Medical Biotechnology Center, Winsloewparken 25, University of Southern Denmark, Odense, DK-5000, Denmark.
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19
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Nielsen RG, Fenger C, Bindslev-Jensen C, Husby S. Eosinophilia in the upper gastrointestinal tract is not a characteristic feature in cow's milk sensitive gastro-oesophageal reflux disease. Measurement by two methodologies. J Clin Pathol 2006; 59:89-94. [PMID: 16394287 PMCID: PMC1860270 DOI: 10.1136/jcp.2004.024513] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND An association between cow's milk hypersensitivity (CMH) and gastro-oesophageal reflux disease (GERD) in childhood has been reported in the past decade. AIM To assess whether biopsies from the upper gastrointestinal tract of children with cow's milk sensitive GERD have a specific allergic inflammatory pattern, and to compare two different techniques for measuring inflammatory cells in gastrointestinal biopsies. METHODS GERD was diagnosed by means of endoscopy and oesophageal pH monitoring. Hypersensitivity to cow's milk was determined by an elimination diet and cow's milk challenge. Allergic inflammatory cells in upper gastrointestinal biopsies were identified by immunohistochemistry and their numbers were assessed by two different methods-counting the number of cells/high power field and using the computerised Cast-Grid system. RESULTS Cow's milk sensitive GERD was identified in 10 of 17 children with severe GERD (median age, 7.8 years). Biopsies from children with endoscopic oesophagitis had significantly increased numbers of mast cells and T cells. No differences in the number of eosinophils, mast cells, or T cells were found between children with CMH and those with primary GERD. Several differences were found between the two different histological quantification methods. CONCLUSIONS CMH was found not only in infants but also in school age children with GERD. Histology did not identify the cow's milk sensitive GERD subgroup. The computerised histological method provides a more complete evaluation based upon total biopsy area, and helped to limit the bias of uneven biopsy size.
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Affiliation(s)
- R G Nielsen
- Department of Paediatrics, Odense University Hospital, Sdr. Boulevard 29, Dk-5000 Odense C, Denmark.
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Kronborg O, Jørgensen OD, Fenger C, Rasmussen M. Randomized study of biennial screening with a faecal occult blood test: results after nine screening rounds. Scand J Gastroenterol 2004; 39:846-51. [PMID: 15513382 DOI: 10.1080/00365520410003182] [Citation(s) in RCA: 174] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Two large true population studies in Europe have shown a significant reduction in mortality from colorectal cancer (CRC) by screening with a faecal occult blood test. In one trial conducted in Funen County, 61,933 individuals (aged 45-75 years) were randomly allocated either to a control group or to receive a biennial Hemoccult-II test. METHODS These individuals were followed from 1985 to 2002 and 9 screening rounds were performed. RESULTS First screening was accepted by 67% (20,672). Positivity rates varied between 0.8% and 3.8%, and the cumulative proportion of the test group having colonoscopy was 5.3%. Screen-detected CRC was early (Dukes' A) in 36% compared to 11% among controls. Incidence of CRC was unchanged, but mortality was reduced by 11%. This figure increased to 43% in persons participating in all 9 rounds. No more than 8,558 were screened at the 9th round. Patients with CRC detected between screenings had better survival than controls. Death rates from causes other than CRC among participants never became higher than among controls. CONCLUSION The lesser reduction in mortality from CRC of 11% compared to 18% after 5 screening rounds may be explained by the decrease in the number screened. Efficacy in those screened supports the introduction of countrywide screening in Denmark, but it must be ascertained that acceptability, proportion of early CRC and logistics all reach the same standard as in the randomized trial.
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Affiliation(s)
- O Kronborg
- Department of Surgery A, Odense University Hospital, Linde Alle 32, DK-5230 Odense, Denmark.
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Abstract
PURPOSE The identification of groups with a high risk of colorectal adenoma recurrence remains a controversial issue for clinicians. This study was designed to assess the predictive value of initial patient and adenoma characteristics of the three-year recurrence. METHODS The study population was composed of 552 patients with resected colorectal adenomas who completed the European Fiber-Calcium Intervention trial. At both baseline and three-year examinations, the characteristics of adenomas were recorded according to a standardized protocol. The main outcomes measured were the three-year overall recurrence, recurrence of multiple adenomas, recurrence of advanced adenomas (size > or = 1 cm or tubulovillous/villous architecture or moderate/severe dysplasia), and proximal and distal recurrence. RESULTS A three-year recurrence was observed in 122 patients (22.1 percent), and more than one-half of them had recurrent adenomas on the proximal colon. After adjustment for patient characteristics and treatment allocation, the number of adenomas and their proximal location at baseline were the main predictors of recurrence. In comparison with patients who had one or two adenomas on the distal colon, patients with three or more adenomas with at least one of them located on the proximal colon had a much higher risk of overall recurrence (5.3; 95 percent confidence interval, 2.7-10.3), proximal recurrence (8.5; 95 percent confidence interval, 4.1-18), and advanced adenoma recurrence (5.5; 95 percent confidence interval, 2.4-12.6). CONCLUSIONS Follow-up colonoscopies in patients with adenomas should include careful examination of the proximal colon. The time interval between follow-up examinations could probably be extended beyond three years in patients who have only one or two distal adenomas.
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Affiliation(s)
- C Bonithon-Kopp
- Registre Bourguignon des Tumeurs Digestives, INSERM EPI 01-06, Faculté de Médecine de Dijon, Dijon, France.
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Abstract
BACKGROUND Mesorectal excision for rectal cancer has resulted in local recurrence rates of 3-11 per cent compared with up to 38 per cent after conventional methods. The results of a prospective Danish study with a historical control group are presented. METHODS Three hundred and eleven patients with a mobile rectal cancer had mesorectal excision with curative intent performed by certified surgeons and were followed for 3 years. Demographic, perioperative and follow-up data were recorded prospectively. A series of patients who had conventional operations for rectal cancer served as a control group. RESULTS The cumulative 3-year local recurrence rate was 11 per cent after mesorectal excision compared with 30 per cent after conventional surgery (hazard ratio (HR) 0.33 (95 per cent confidence interval (c.i.) 0.21 to 0.52); P < 0.001). Multivariate regression analysis showed that only advanced age (HR 0.97 (95 per cent c.i. 0.94 to 1.00); P = 0.048) and tumour in the lower third of the rectum (HR 0.21 (95 per cent c.i. 0.04 to 1.97); P = 0.075) were marginal independent predictors of local recurrence after mesorectal excision. The cumulative crude 3-year survival rate was 77 per cent after mesorectal excision and 62 per cent after conventional surgery (HR 0.58 (95 per cent c.i. 0.43 to 0.77); P < 0.001). Age was the only independent predictor of death after mesorectal excision (HR 1.04 (95 per cent c.i. 1.02 to 1.07); P = 0.001). CONCLUSION Mesorectal excision is associated with a considerably lower risk of local recurrence and a better survival rate than conventional surgery, and is the optimum method for rectal cancer resection.
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Affiliation(s)
- S Bülow
- Department of Surgical Gastroenterology, H:S-Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.
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23
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Rehbein S, Holste JE, Doucet MY, Fenger C, Paul AJ, Reinemeyer CR, Smith LL, Yoon S, Marley SE. Field efficacy of ivermectin plus praziquantel oral paste against naturally acquired gastrointestinal nematodes and cestodes of horses in North America and Europe. Vet Ther 2003; 4:220-7. [PMID: 15136982] [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: 04/29/2023]
Abstract
The efficacy of an oral formulation of ivermectin plus praziquantel in the reduction of nematode and cestode egg counts in horses was assessed in 273 horses under field conditions at 15 sites in North America (n = 6) and Europe (n = 9). Horses were confirmed by fecal examination to have natural infections of strongyles (100%) and tapeworms (76%). Replicates of four horses were formed at each site, and in each replicate three animals received ivermectin (0.2 mg/kg body weight) plus praziquantel (1 mg/kg body weight) oral paste and one animal remained untreated or received vehicle paste. Fecal samples were collected for fecal nematode and cestode egg counting before and 7, 8, 9, 14, 15, and 16 days after treatment. Horses treated with ivermectin plus praziquantel oral paste had significantly (P <.01) lower posttreatment strongylid and cestode egg counts (reductions of 98% or more) than controls. Combined site analyses revealed that 95% or 96% of the horses positive for cestode eggs before treatment that were treated with ivermectin plus praziquantel were negative for cestode eggs at each posttreatment fecal examination. No adverse reactions attributable to ivermectin plus praziquantel oral paste treatments were observed. The results of the studies demonstrated that ivermectin plus praziquantel paste was highly effective in reducing egg shedding by gastrointestinal nematodes and cestodes, and no adverse reactions were observed in horses treated under field conditions.
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Affiliation(s)
- Steffen Rehbein
- Merial GmbH, Kathrinenhof Research Center, Walchenseestr 8-12, D-83101 Rohrdorf, Germany
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Rasmussen M, Fenger C, Kronborg O. Diagnostic yield in a biennial Hemoccult-II screening program compared to a once-only screening with flexible sigmoidoscopy and Hemoccult-II. Scand J Gastroenterol 2003; 38:114-8. [PMID: 12608473] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND Flexible sigmoidoscopy (FS) has a higher degree of sensitivity for detecting colorectal neoplasia in the left side of the colon than Hemoccult (H-II). However, no randomized controlled trial has compared a single FS screening with a H-II screening program (annual or biennial) despite the well-documented mortality reduction from colorectal cancer (CRC) in the latter. The aim was to compare the diagnostic yield of colorectal neoplasia in two aged-matched groups from two different randomized screening trials; one group screened by a single FS+H-II, the other with biennial H-II over the course of 16 years. METHODS 24,465 persons invited to participate in the Funen biennial H-II screening program were compared with 4,460 similar persons invited to another Funen trial using a single FS+H-II. RESULTS Compliance in the biennial H-II program was 65.5% during the first screening round compared to 39.8% for FS+H-II. The cumulative number of persons with positive tests was 8.2% (positive H-II) in the biennial H-II program during 16 years and 20.3% (polyps > 3 mm in diameter seen at FS or positive H-II) for once-only FS+H-II. The diagnostic yield of CRC per 1,000 screened was 9.9 in the biennial H-II program and 6.6 after FS+H-II (6.5 and 2.7 per 1,000 invited). The yield of advanced adenomas (> or = 10 mm and/or villous structure and/or severe dysplasia) was 2.3% in the H-II program and 3.3% after FS+H-II among the screened persons, but this difference disappeared when persons invited, but not necessarily screened, were compared (1.5% versus 1.3%). CONCLUSION Screening with H-II in a biennial screening program during 16 years detected more CRCs than a single screening with FS+H-II and a similar number of advanced adenomas.
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Affiliation(s)
- M Rasmussen
- Dept. of Surgery A, Odense University Hospital, Odense, Denmark.
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25
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Kang W, Nielsen O, Fenger C, Madsen J, Hansen S, Tornoe I, Eggleton P, Reid KBM, Holmskov U. The scavenger receptor, cysteine-rich domain-containing molecule gp-340 is differentially regulated in epithelial cell lines by phorbol ester. Clin Exp Immunol 2002; 130:449-58. [PMID: 12452835 PMCID: PMC1906537 DOI: 10.1046/j.1365-2249.2002.01992.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Gp-340 is a glycoprotein belonging to the scavenger receptor cysteine rich (SRCR) group B family. It binds to host immune components such as lung surfactant protein D (SP-D). Recent studies found that gp-340 interacts directly with pathogenic microorganisms and induces their aggregation, suggesting its involvement in innate immunity. In order to investigate further its potential immune functions in the appropriate cell lines, the expression of gp-340 in four conventional immune cell lines (U937, HL60, Jurkat, Raji), and two innate immune-related epithelial cell lines (A549 derived from lung and AGS from stomach), was examined by RT-PCR and immunohistochemistry. The resting immune cell lines showed weak or no gp-340 mRNA expression; while the two epithelial cell lines expressed gp-340 at much higher level, which was differentially regulated by phorbol myristate acetate (PMA) treatment. In the A549 cells, gp-340 was up-regulated along with the PMA-induced proinflammatory expression of both IL-6 and IL-8. In AGS cells, PMA down-regulation of gp-340 was seen in parallel with an up-regulation of the two mature gastric epithelial specific proteins TFF1 (trefoil factor 1) and TFF2, which are implicated as markers of terminal differentiation. Analysis of the distribution of gp-340, together with the TFFs and SP-D in normal lung and gastric mucosa, supported further our in vitro data. We conclude that the differential regulation of gp-340 in the two epithelial cell lines by PMA indicates that gp-340 s involvement in mucosal defence and growth of epithelial cells may vary at different body locations and during different stages of epithelial differentiation.
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Affiliation(s)
- W Kang
- MRC Immunochemistry Unit, Department of Biochemistry, Oxford University, Oxford, UK
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Zbar AP, Fenger C, Efron J, Beer-Gabel M, Wexner SD. The pathology and molecular biology of anal intraepithelial neoplasia: comparisons with cervical and vulvar intraepithelial carcinoma. Int J Colorectal Dis 2002; 17:203-15. [PMID: 12073068 DOI: 10.1007/s00384-001-0369-0] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2001] [Indexed: 02/04/2023]
Abstract
BACKGROUND Anal intraepithelial neoplasia (AIN) is a well-described pathological precursor of invasive squamous cell carcinoma which has recently been detected with increasing frequency in immunocompromised patients, particularly those with seropositivity for human immunodeficiency virus (HIV). The epidemiology and natural history of this entity is somewhat unclear, since the overall prevalence in the HIV seronegative population is unknown. DISCUSSION There is a clear etiological association between AIN and high-risk human papillomavirus (HPV) subtype infection although there is great variability in HPV DNA detection of cytological and histological material in these patients. It appears that there is an antigen-specific hyporesponsiveness by cytotoxic lymphocytes against HPV peptide sequences or recombinant proteins encoded by oncogenic HPV subtypes in these patients, which is dependent upon the stage of their HIV-associated disease. Although the molecular biology of AIN and cervical or vulvar intraepithelial neoplasia are comparable, in AIN there is less significance of tumor suppressor gene mutations, proto-oncogenic growth factor activation, and genomic instability. CONCLUSION Current concepts in the epidemiology and etiology of AIN are discussed, as well as its immunological response in the HIV-positive population, drawing parallels where possible between other HPV-related preinvasive disorders, and concluding with a suggested management protocol
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Affiliation(s)
- A P Zbar
- Department of Colorectal Surgery, Kaplan Medical Center, Rehovot, Israel.
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Jørgensen OD, Kronborg O, Fenger C. A randomised study of screening for colorectal cancer using faecal occult blood testing: results after 13 years and seven biennial screening rounds. Gut 2002; 50:29-32. [PMID: 11772963 PMCID: PMC1773083 DOI: 10.1136/gut.50.1.29] [Citation(s) in RCA: 236] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Three randomised trials have demonstrated reduction in mortality from colorectal cancer (CRC) by repeated screening with faecal occult blood tests, including the trial presented here, which is the only one still in progress. AIMS To evaluate reduction in mortality after seven screening rounds and the possible influence of compliance on mortality from CRC. METHODS At Funen in Denmark, random allocation to biennial screening with Hemoccult-II in 30 967 subjects aged 45-75 years and 30,966 controls was performed in 1985 from a population of 137,485 of the same age. Only participants who completed the first screening round were invited for further screening. Colonoscopy was offered if the test was positive. The primary end point was death from CRC, and the 10 year results were published in 1996. RESULTS From the beginning of the first screening to the seventh round, mean age increased from 59.8 to 70.0 years in the screening and control groups, and the male/female ratio decreased from 0.92 to 0.81. Those who accepted screening were younger than non-responders. Positivity rates varied from 0.8% to 3.8%, the cumulative ratio of a positive test was 5.1% after seven rounds, and 4.8% of patients had at least one colonoscopy. Mortality from CRC was significantly less in the screening group (relative risk (RR) 0.82 (0.69-0.97)), and the reduction in mortality was most pronounced above the sigmoid colon. After seven rounds, RR was reduced to less than 0.70 compared with controls. Mortality rates from causes other than CRC did not differ. Non-responders had a significantly increased risk of death from CRC compared with those who accepted the full programme. Subjects who accepted the first screening, but not subsequent ones, demonstrated a tendency towards increased risk. CONCLUSIONS The persistent reduction in mortality from CRC in a biennial screening program with Hemoccult-II, and a reduction in RR to less than 0.70 in those adhering to the programme, support attempts to introduce larger scale population screening programmes. The smaller effect on mortality from CRC in the rectum and sigmoid colon suggests evaluation by additional flexible sigmoidoscopy with longer intervals.
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Affiliation(s)
- O D Jørgensen
- Department of Surgical Gastroenterology, Odense University Hospital, Denmark
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Bomme L, Lothe RA, Bardi G, Fenger C, Kronborg O, Heim S. Assessments of clonal composition of colorectal adenomas by FISH analysis of chromosomes 1, 7, 13 and 20. Int J Cancer 2001; 92:816-23. [PMID: 11351301 DOI: 10.1002/ijc.1275] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [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: 11/11/2022]
Abstract
Chromosome banding analysis has shown that numerical aberrations, in particular gains of chromosomes 7, 13 and 20, are common in colorectal adenomas but cannot provide reliable information on the size of the abnormal clones in vivo. We examined interphase nuclei from 70 colorectal adenomas, of which 64 had been previously karyotyped, using fluorescence in situ hybridization (FISH) with probes for the pericentromeric regions of chromosomes 1, 7, 13 and 20. Gain of chromosome 7 was seen in 34% of the analyzed adenomas, +13 was seen in 44% and trisomy 20 was found in 32% of the adenomas, verifying that the trisomies are in vivo phenomena. The median proportion of cells with trisomy was larger than 50%. A comparison with the G-banding analysis showed a good correlation between the results yielded by the 2 methods. Based on the clonal size and karyotypic findings, a likely order of events during clonal evolution could be ascribed to each case. More than 1 numerical aberration was detected by FISH analysis in 16 adenomas. In 6 adenomas, a clone with only trisomy 7 was present alongside a clone with additional gain(s) of chromosomes 13 and/or 20. Seven cases had gain of chromosome 13 and/or gain of chromosome 20 in the largest clone, suggesting that a clone with either of these changes was present before the changes in chromosome 7 copy number took place. On the basis of the results of this combined meta- and interphase cytogenetic study, we conclude that gains of chromosomes 7, 13 and 20 are common in colorectal adenomas and that the trisomies usually are present in a large proportion of the cells. They seem to be primary chromosome aberrations in some adenomas, whereas in others they arise secondarily as part of the clonal evolution. Although the first gain usually is of chromosome 7, it is evident that it is the end result of the chromosomal aberrations, not the exact sequence in which they occur, that determines the pathogenetic consequences.
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MESH Headings
- Adenoma/genetics
- Adult
- Aged
- Aged, 80 and over
- Chromosome Aberrations
- Chromosome Banding
- Chromosomes, Human, Pair 1
- Chromosomes, Human, Pair 13
- Chromosomes, Human, Pair 20
- Chromosomes, Human, Pair 7
- Colorectal Neoplasms/genetics
- Humans
- In Situ Hybridization, Fluorescence
- Karyotyping
- Middle Aged
- Models, Genetic
- Trisomy
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Affiliation(s)
- L Bomme
- Department of Medical Genetics, Odense University, University of Southern Denmark, Odense, Denmark.
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Nielsen RG, Fenger C, Pedersen SA, Qvist N, Sørensen J, Husby S. [Diagnostic benefit of gastrointestinal endoscopy in infants under one year of age--a two-year survey]. Ugeskr Laeger 2001; 163:1074-8. [PMID: 11242665] [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: 02/19/2023]
Abstract
INTRODUCTION Gastrointestinal endoscopy in children is a well-established procedure. We reviewed our experience of endoscopy in infants below one year of age to evaluate indications, endoscopic findings, histology, and complications. MATERIAL AND METHODS Twenty-eight infants were studied over a two-year period. Of these, 18 underwent upper endoscopy, six recto/sigmoidoscopy or colonoscopy, and four both procedures. RESULTS The most common indication (10/22) for upper endoscopy was vomiting and suspicion of gastrooesophageal reflux disease. In these infants, 24-hour continuous monitoring of the oesophageal pH followed the procedure. Indications for lower endoscopy were rectal bleeding (n = 6) and intractable diarrhoea (n = 4). There were no complications to anaesthesia, endoscopy, or biopsy. Overall, there were endoscopic abnormalities in 82% and histological abnormalities in 75% of the infants. The diagnostic findings included rare disorders, such as eosinophilic gastroenteritis, microvillous inclusion disease, and chylomicron retention disease. Diagnosis of these diseases requires gastrointestinal biopsy. DISCUSSION Gastrointestinal endoscopy is a safe procedure, which is a valuable part of the diagnostic work-up in a selected group of infants with long-lasting or severe gastrointestinal symptoms.
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Affiliation(s)
- R G Nielsen
- Odense Universitetshospital, børneafdeling H, Patologisk Institut, kirurgisk afdeling og anaestesiologisk-intensiv afdeling V
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30
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Fenger C. [Autopsy in the year of 2000]. Ugeskr Laeger 2000; 162:5755-7. [PMID: 11082670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- C Fenger
- Odense Universitetshospital, Patologisk Institut
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31
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Lindebjerg J, Fenger C. [Celiac disease with subepithelial deposition of collagen]. Ugeskr Laeger 2000; 162:3615-6. [PMID: 11016288] [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: 02/17/2023]
Abstract
In 1970 a case of malabsorption with flat small intestinal mucosa with subepithelial collagen deposition was described. There was no response to a gluten-free diet, and the condition was termed collagenous sprue. We report a case of coeliac disease with subepithelial deposition of collagen in duodenal biopsy, which responded to a gluten-free diet.
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Affiliation(s)
- J Lindebjerg
- Odense Universitetshospital, Patologisk institut
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32
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Abstract
For histological subtyping of anal squamous carcinomas the WHO advocates a six-way subdivision, but it has been suspected that the six types cannot be reliably discriminated in practice. We conducted a blinded study involving slides from 103 consecutive cases, each slide being examined by three experts (from Denmark, Australia and UK) on two occasions at least 8 months apart. Agreement on subtypes was low: 72% between rounds within pathologist, 61% between pathologists. Even for the commonest, and most stably diagnosed, type, viz. large-cell keratinising squamous carcinoma, the intra- and interpathologist frequencies of confirmation were only 81% and 71%, respectively. The pathologist marked the picture as typical and his subtype diagnosis as certain 41% of times: even then confirmation frequencies were only 88% and 74%, respectively. Calculations, including kappa analyses, suggest that 26% of the typing variation was noise. The WHO scheme must be even more unreliable in everyday practice. We finally mention a recently demonstrated link between human papilloma virus (HPV) and certain types of anal cancer, which may well provide an additional argument for revising existing subtyping schemes.
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Affiliation(s)
- C Fenger
- Department of Pathology, Odense University Hospital, Denmark.
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33
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Kobaek-Larsen M, Thorup I, Diederichsen A, Fenger C, Hoitinga MR. Review of colorectal cancer and its metastases in rodent models: comparative aspects with those in humans. Comp Med 2000; 50:16-26. [PMID: 10987662] [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: 02/17/2023]
Abstract
BACKGROUND AND PURPOSE Colorectal cancer (CRC) remains one of the most common cancer forms developing in industrialized countries, and its incidence appears to be rising. Studies of human population groups provide insufficient information about carcinogenesis, pathogenesis, and treatment of CRC. To study these phenomena in detail, a number of animal models of human CRC have been developed. The hypothetical ideal animal model should mimic the human disease in terms of morphology, biochemical alterations, and biological behavior. No existing model replicates the disease as an entity, but available models approximate many of the characteristics of human colonic carcinogenesis and metastasis. So far few comparative evaluations of the various animal models of CRC have been made. CONCLUSION Animal studies cannot replace human clinical trials, but they can be used as a pre-screening tool, so that human trials become more directed, with greater chances of success. The orthotopic transplantation of colon cancer cells into the cecum of syngeneic animals or intraportal inoculation appears to resemble the human metastatic disease most closely, providing a model for study of the treatment of metastases. Which model(s) to choose depends on the goal(s) of the experiment(s). The review published here can provide help in selecting the most optimal CRC model(s) for a certain purpose and in preventing unnecessary duplication of animal experimentation.
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Affiliation(s)
- M Kobaek-Larsen
- Biomedical Laboratory, Faculty of Health Sciences, University of Southern Denmark, Odense University
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34
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Kronborg O, Fenger C. Clinical evidence for the adenoma-carcinoma sequence. Eur J Cancer Prev 1999; 8 Suppl 1:S73-86. [PMID: 10772421] [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: 02/16/2023]
Abstract
A review is given on evidence supporting or rejecting the hypothesis of a colorectal adenoma-carcinoma sequence. The majority of studies discuss adenomas from a clinical point of view, but pathology has also been considered in detail, and molecular biology has been touched on. It is concluded the adenoma stage is, most probably, a phase on the way to carcinoma. But it remains to be shown what effect the removal of adenomas will have in the long run on the incidence of colorectal carcinoma.
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Affiliation(s)
- O Kronborg
- Odense University Hospital, Department of Surgery, Denmark
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35
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Cawkwell L, Gray S, Murgatroyd H, Sutherland F, Haine L, Longfellow M, O'Loughlin S, Cross D, Kronborg O, Fenger C, Mapstone N, Dixon M, Quirke P. Choice of management strategy for colorectal cancer based on a diagnostic immunohistochemical test for defective mismatch repair. Gut 1999; 45:409-15. [PMID: 10446111 PMCID: PMC1727633 DOI: 10.1136/gut.45.3.409] [Citation(s) in RCA: 143] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Despite intensive research into the molecular abnormalities associated with colorectal cancer (CRC), no diagnostic tests have emerged which usefully complement standard histopathological assessments. AIMS To assess the feasibility of using immunohistochemistry to detect replication error (RER) positive CRCs and determine the incidence of RER positivity within distinct patient subgroups. METHODS 502 CRCs were analysed for RER positivity (at least two markers affected) and/or expression of hMSH2 and hMLH1. RESULTS There were 15/30 (50%) patients with metachronous CRCs, 16/51 (31%) with synchronous CRCs, 14/45 (31%) with a proximal colon carcinoma, and 4/23 (17%) who developed a CRC under the age of 50 showed RER positivity. However, 0/54 patients who developed a solitary carcinoma of the rectum/left colon over the age of 50 showed RER positivity. Immunohistochemical analysis revealed that 66/66 (100%) RER positive carcinomas were associated with complete lack of expression of either hMSH2 or hMLH1. This correlation was confirmed using a further 101 proximal colon carcinomas. Patients with a mismatch repair defective carcinoma showed improved survival but a 5.54 times relative risk of developing a metachronous CRC. A prospective immunohistochemical study revealed 13/117 (11%) patients had a mismatch repair defective carcinoma. A fivefold excess of hMLH1 defective cases was noted. CONCLUSIONS All RER positive carcinomas were identified by the immunohistochemical test. This is the first simple laboratory test which can be performed routinely on all CRCs. It will provide a method for selecting patients who should be investigated for HNPCC, offered long term follow up, and who may not respond to standard chemotherapy regimens.
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Affiliation(s)
- L Cawkwell
- Molecular Oncology, Algernon Firth Institute of Pathology, School of Medicine, University of Leeds, Leeds, UK
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36
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Holck S, Engel UH, Federspiel BH, Fenger C, Svanholm H. [Quality assurance and quality development of the patho-anatomical specimens of resected colorectal carcinoma]. Ugeskr Laeger 1999; 161:4406-9. [PMID: 10487106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Affiliation(s)
- S Holck
- Hillerød Sygehus, patologisk institut
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37
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Hansen TP, Fenger C, Kronborg O. The expression of p53, Ki-67 and urokinase plasminogen activator receptor in colorectal adenomas with true invasion and pseudoinvasion. APMIS 1999; 107:689-94. [PMID: 10440067 DOI: 10.1111/j.1699-0463.1999.tb01461.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [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: 11/30/2022]
Abstract
The recognition of pseudoinvasion is important in the differential diagnosis of adenocarcinoma in patients with adenomas. This distinction might occasionally be difficult, particularly when the dysplasia is pronounced. The present study was undertaken in order to investigate whether the immunohistochemical expression of p53, Ki-67 and the urokinase plasminogen activator receptor (uPAR) was different in adenomas with true invasion and pseudoinvasion. We studied 26 formalin-fixed, paraffin-embedded tumor samples, consisting of 10 cases of adenomas with pseudoinvasion and 16 cases of adenocarcinomas in adenomas. In this series of selected histologically typical cases a constant moderate or strong reaction for uPAR was present at the invasive front in all of the 16 adenomas with adenocarcinoma, but only focally in one of 10 adenomas with pseudoinvasion. The reactions for p53 and Ki-67 showed only minor differences. In conclusion, the immunohistochemical reaction for uPAR seems to be a useful supplement in cases without typical histology or with severe dysplasia.
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Affiliation(s)
- T P Hansen
- Department of Pathology, Odense University Hospital, Denmark
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38
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Frisch M, Fenger C, van den Brule AJ, Sørensen P, Meijer CJ, Walboomers JM, Adami HO, Melbye M, Glimelius B. Variants of squamous cell carcinoma of the anal canal and perianal skin and their relation to human papillomaviruses. Cancer Res 1999; 59:753-7. [PMID: 9973228] [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: 02/10/2023]
Abstract
High-risk types of human papillomaviruses (hrHPVs) may be a necessary cause in cervical cancer and in some subtype of anal, vulvar, and penile cancers. Large studies aimed at characterizing hrHPV-associated and non-hrHPV-associated subtypes of anal carcinomas are, however, lacking. We searched for human papillomavirus type 16 and 13 other hrHPVs in tumor tissue by PCR and performed a systematic histological evaluation of specimens from 386 patients with anal cancer (86% invasive; 302 women and 84 men). Cancers in women and homosexual men were more often hrHPV positive (P < 0.01) and located in the anal canal (P < or = 0.01) than were cancers in heterosexual men. In both women and men, anal canal cancers contained hrHPV clearly more often than did perianal skin cancers, and increasing hrHPV positivity was seen with higher localization in the anal canal. Indeed, 95 and 83% of cancers involving the anal canal in women and men, respectively, were hrHPV positive versus 80 and 28% of perianal skin cancers (P-trend < 0.001). Basaloid feature, adjacent anal intraepithelial neoplasia, poor or absent keratinization, and a predominance of small or medium neoplastic cells were all strongly positively associated with hrHPV status. Like cancer of the uterine cervix, the development of cancer of the anal canal may require infection with hrHPV, whereas a dual etiology of perianal skin cancers bears parallels to vulvar and penile cancers.
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Affiliation(s)
- M Frisch
- Department of Epidemiology Research, Danish Epidemiology Science Center, Statens Serum Institut, Copenhagen S
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39
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Rasmussen M, Kronborg O, Fenger C, Jørgensen OD. Possible advantages and drawbacks of adding flexible sigmoidoscopy to hemoccult-II in screening for colorectal cancer. A randomized study. Scand J Gastroenterol 1999; 34:73-8. [PMID: 10048736 DOI: 10.1080/00365529950172862] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Flexible sigmoidoscopy (FS) has been recommended as a screening method to reduce mortality from colorectal cancer (CRC). The present study evaluates the effect of adding FS to the fecal occult blood test Hemoccult-II (H-II) on diagnostic yield of colorectal neoplasia. METHODS A total of 10,978 normal persons aged 50-75 years were invited to participate, 5495 persons being allocated at random to H-II and FS and 5483 to H-II alone. RESULTS In spite of a lower compliance (40% versus 56%) for the combined procedure, the diagnostic yield of colorectal neoplasia was higher than for H-II alone (12 CRC versus 4 CRC, and 72 large adenomas versus 14). Within 24-62 months after screening there were fewer CRCs detected after H-II + FS than after H-II alone. The stage distribution was less favorable than in screen-detected cases. CONCLUSION One FS may not be an optimal way of screening, but FS deserves to be evaluated in randomized population studies including repeated H-II tests in the control arm.
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Affiliation(s)
- M Rasmussen
- Dept. of Surgery A, Odense University Hospital, Denmark
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40
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Bomme L, Bardi G, Pandis N, Fenger C, Kronborg O, Heim S. Cytogenetic analysis of colorectal adenomas: karyotypic comparisons of synchronous tumors. Cancer Genet Cytogenet 1998; 106:66-71. [PMID: 9772912 DOI: 10.1016/s0165-4608(98)00047-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The phenotypic progression of colorectal tumors is driven by their step-by-step acquisition of genomic alterations. These pathogenetically important mutations are at the same time markers of tumor clonality. The aim of this study was to describe the clonal relation among synchronous colorectal adenomas. Twenty-four colorectal adenomas from 11 patients were subjected to chromosome banding analysis. Clonal chromosome abnormalities were found in 20 tumors. Recurrent structural rearrangements involved chromosomes 1, 13, 17, and 18. The most common numerical changes were gain of chromosomes 7, 13, 20, and 3 and loss of chromosome 18. Eight adenomas had subclones as evidence of clonal evolution. Similar clones in separate polyps were seen in tumors from 6 patients; these adenomas were always located in the same part of the large bowel. In 2 patients, both with one rectal adenoma and one adenoma in the colon, no karyotypic similarity between the lesions was found. Our findings indicate that whereas close, but macroscopically distinct, synchronous colorectal adenomas usually have a common pathway of progression, perhaps even the same clonal origin, large bowel adenomas at a considerable distance from one another exhibit karyotypic differences, indicating that they arise independently.
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Affiliation(s)
- L Bomme
- Department of Medical Genetics, Odense University, Denmark
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41
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Diederichsen AC, Stenholm AC, Kronborg O, Fenger C, Jensenius JC, Zeuthen J, Kristensen T, Christensen PB. Immunisation of colorectal cancer patients with autologous tumour cells. Oncol Rep 1998; 5:823-6. [PMID: 9625825 DOI: 10.3892/or.5.4.823] [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: 11/05/2022] Open
Abstract
Patients with colorectal cancer were entered into a clinical phase I trial of immunotherapy with an autologous tumour cell/bacillus Calmette-Guerin (BCG) vaccine. We attempted to describe the possible effects and side effects of the immunisation, and further to investigate whether expression of immune-response-related surface molecules on the tumour cells in the vaccine correlated with survival. The first and second vaccine comprised of 107 irradiated tumour cells mixed with BCG, the third of irradiated tumour cells only. Thirty-nine patients were considered, but only 6 patients fulfilled the criteria for inclusion. No serious side effects were observed. With three years of observation time, two patients are healthy, while the rest have had recurrence, and two of them have died. In all vaccines, all tumour cells expressed HLA class I, some expressed HLA class II and none expressed CD80. There was an inverse relation between survival and HLA class II expression. This highlights an essential problem, in the absence of CD80 expression the expression of HLA class II may induce anergy. In future attempts to develop improved vaccines this problem should be addressed.
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Affiliation(s)
- A C Diederichsen
- Department of Clinical Immunology, Odense University Hospital, DK-5000 Odense C, Denmark
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42
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Diederichsen AC, Stenholm AC, Kronborg O, Fenger C, Jensenius JC, Zeuthen J, Christensen PB, Kristensen T, Ostenhom AC. Flow cytometric investigation of immune-response-related surface molecules on human colorectal cancers. Int J Cancer 1998; 79:283-7. [PMID: 9645352 DOI: 10.1002/(sici)1097-0215(19980619)79:3<283::aid-ijc13>3.0.co;2-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [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: 12/30/2022]
Abstract
Our purpose was to clarify whether human colorectal cancer cells are equipped to present tumour-associated-antigens to the immune system, and whether this ability correlates with lymphoid infiltration, the Dukes' stage and Jass classification. Enzymatically dissociated tumour cells from 70 different colorectal cancers were monitored by multiparameter flow cytometry. Gating on EP4+ cells, the expression of the surface molecules HLA class I, HLA class II, CD80 (B7-1), CD54 (ICAM-I) and CD58 (LFA-3) was evaluated. In 60 of 70 tumours, all tumour cells expressed HLA class I, in 10 tumours 15-96% of the tumour cells expressed HLA class I. In 1 tumour, all tumour cells expressed HLA class II, in 67 tumours some expressed HLA class II, in 2 tumours none expressed HLA class II. Expression of CD58 was heterogeneous, and there was no or only sparse expression of CD80 and CD54. Expression of the HLA class I molecules, but not the class II, was correlated with lymphoid infiltration and the Jass classification. Expression of these surface molecules was not correlated with the Dukes' stage. The tumour cells were generally equipped to present antigens to the effector arm of the immune system since HLA class I is expressed, but the tumour cells were not optimal in stimulating an immune response, since HLA class II and CD58 were only marginally expressed and CD80 and CD54 were absent.
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Affiliation(s)
- A C Diederichsen
- Department of Clinical Immunology, Odense University Hospital, Denmark.
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43
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Diederichsen AC, Hansen TP, Nielsen O, Fenger C, Jensenius JC, Christensen PB, Kristensen T, Zeuthen J. A comparison of flow cytometry and immunohistochemistry in human colorectal cancers. APMIS 1998; 106:562-70. [PMID: 9674894 DOI: 10.1111/j.1699-0463.1998.tb01385.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [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: 11/28/2022]
Abstract
In human colorectal cancer it has been reported that some tumours lack the HLA-ABC antigens. This has been interpreted as reflecting tumour escape from the immune system. Earlier data have been obtained by immunohistochemistry. In this study, we compared the expression of HLA-ABC, HLA-DR, CD80 (B7-1) and CD54 (ICAM-1) in 20 tumours using both a conventional immunohistochemistry two-layer technique and multiparameter flow cytometry, gating on an epithelial cell marker. Colorectal cancer tissue used in flow cytometry was dissociated with collagenase, deoxyribonuclease and hyaluronidase. The intensity of expression of HLA-ABC, HLA-DR and CD80 was unaffected by the enzymes, but CD54 was decreased by 30%. The reproducibility of flow cytometry was good. Microscopy of sections revealed that about 5% of each tumour sample consisted of normal epithelium, but even after correction for this, flow cytometry was superior to immunohistochemistry in 33 out of 80 cases, and showed that tumours described as HLA-ABC negative by immunohistochemistry were in fact weakly positive for HLA-ABC. We conclude that flow cytometry and immunohistochemistry are complementary, and that flow cytometry is superior to immunohistochemistry for detecting antigens/epitopes present in low amounts.
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Affiliation(s)
- A C Diederichsen
- Department of Clinical Immunology, Odense University Hospital, Denmark
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44
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Bomme L, Heim S, Bardi G, Fenger C, Kronborg O, Brøgger A, Lothe RA. Allelic imbalance and cytogenetic deletion of 1p in colorectal adenomas: a target region identified between DIS199 and DIS234. Genes Chromosomes Cancer 1998; 21:185-94. [PMID: 9523193 DOI: 10.1002/(sici)1098-2264(199803)21:3<185::aid-gcc2>3.0.co;2-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [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: 11/06/2022] Open
Abstract
Both cytogenetic and molecular genetic analyses have shown that many colorectal adenomas carry an acquired deletion distally in the short arm of one chromosome 1, but the two methods have never been brought to bear on the same tumors. The major part of this study was the analysis of 53 previously short-term cultured and karyotyped colorectal adenomas for allelic imbalance at eight microsatellite loci in 1p. Allelic imbalances were detected in seven of the 12 adenomas that had cytogenetically visible abnormalities of chromosome 1, as well as in four adenomas that either had a normal karyotype (one case) or had clonal chromosome abnormalities that did not seem to involve chromosome 1 (three cases); i.e., 30% of the adenomas had abnormalities involving 1p by the combined approach. A minimal region of overlap seemed to map to between DIS199 and DIS234, suggesting that this is a relevant target region. This genomic area contains the human homologue of the tumor modifier gene Mom1 (1p35-36.1), which, in mice, modifies the number of intestinal tumors in multiple intestinal neoplasia (Min)-mutated animals. To evaluate whether the imbalances corresponded to interstitial deletions of 1p material, we performed fluorescence in situ hybridization with a pericentromeric probe (15 adenomas) and a telomeric probe (6 adenomas) on uncultured cells from the 16 adenomas with chromosome 1 abnormalities. Except for three adenomas that had already been shown by banding analysis to have a trisomic pattern, two centromere 1 signals were invariably found. In the cases hybridized with the 1p-telomeric probe, we found the same frequencies of telomeric and centromeric signals, in agreement with the interpretation that the deletions were interstitial. One of the 53 adenomas had genomic instability, seen as new alleles at five of eight microsatellite loci. A comparison of the genetic findings with clinicopathologic data indicated that adenomas in the rectum have 1p abnormalities more often than do adenomas of the sigmoid colon, and that adenomas with 1p changes are larger than adenomas without abnormalities of chromosome 1.
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Affiliation(s)
- L Bomme
- Department of Medical Genetics, Odense University, Denmark
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45
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Kjeldsen BJ, Kronborg O, Fenger C, Jørgensen OD. The pattern of recurrent colorectal cancer in a prospective randomised study and the characteristics of diagnostic tests. Int J Colorectal Dis 1998; 12:329-34. [PMID: 9457525 DOI: 10.1007/s003840050118] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In a prospective randomised study, 597 patients subjected to curative surgery for colorectal cancer were allocated to either a group with frequent follow-up or a control group with follow-up every 5 years. The pattern of recurrence is reviewed. An equal number of recurrences was detected in the two groups, but the recurrence was diagnosed 9 months earlier in patients followed frequently, and the diagnostic characteristics of various tests dependent upon how often they were used. It is unlikely that frequent follow-up after curative surgery for colorectal cancer has a large positive influence upon survival, but a small benefit from an intensive follow-up program cannot be ruled out. The present results indicate that clinical examination, digital rectal examination, proctoscopy, colonoscopy and chest x-ray should be included in such a programme, whereas others (blood haemoglobin, faecal occult blood test, double contrast braium enema, serum alanine aminotransferase, and serum bilirubin) should be avoided, having a low sensitivity for detecting recurrent colorectal cancer.
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Affiliation(s)
- B J Kjeldsen
- Department of Surgery A, Odense University Hospital, Denmark
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46
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Abstract
Eighteen tumor samples from 11 patients with metastatic colorectal cancer were cytogenetically analyzed after short-term culturing. Of the 13 metastases examined, 11 were from lymph nodes, 1 from the peritoneum and 1 from the lung. In 5 of the 11 patients, matched samples from the primary tumor and lymph node metastases were analyzed. Cytogenetic similarities between the primary and secondary lesions were found in all 5 cases, indicating that many of the chromosomal aberrations presumably occurred before disease spreading took place. Compared with the primaries, the metastases appeared to exhibit decreased clonal heterogeneity but, concurrently, an increase in the karyotypic complexity of individual clones. Among the aberrations recurrently found in metastatic lesions were del(1)(p34), i(17)(q10), -18, -Y, -21, +7 and +20, all of which have been seen repeatedly in previous series of primary colorectal carcinomas, and del(10)(q22) and add(16)(p13), which so far have not been associated with primary tumors and which may play a particular pathogenetic role in the metastatic process.
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Affiliation(s)
- G Bardi
- Department of Clinical Genetics, University Hospital, Lund, Sweden.
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47
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Kronborg O, Fenger C, Olsen J, Jørgensen OD, Søndergaard O. [Randomized population study of screening for intestinal cancer with Hemoccult-II]. Ugeskr Laeger 1997; 159:4977-81. [PMID: 9281212] [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: 02/05/2023]
Abstract
The aim of the randomised study was to compare mortality rates from colorectal cancer (CRC) in persons screened with faecal occult-blood tests every two years during a 10-year period with those of unscreened similar controls. Thirty thousand nine hundred and sixty-seven persons aged 45-75 years in 1985 were allocated to screening and another 30,966 to a control group. Only participants who completed the first round with Hemoccult-II were invited for further screening. Participants with positive tests were offered colonoscopy. The primary endpoint was death from CRC. Sixty-seven percent completed the first screening round, and of these more than 90% accepted repeated screenings. During the 10 year study, 481 persons in the screening group had a diagnosis of CRC, compared with 483 unscreened controls. CRC mortality was significantly lower in the screening group (205 deaths) than in controls (249 deaths) (mortality ratio 0.82 [95% conf. lim. 0.68-0.99], p = 0.03). Our findings indicate that biennial screening by faecal occult-blood tests can reduce CRC mortality.
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Affiliation(s)
- O Kronborg
- Odense Universitetshospital, kirurgisk afdeling A
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48
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Abstract
Eighteen tumor samples from 11 patients with metastatic colorectal cancer were cytogenetically analyzed after short-term culturing. Of the 13 metastases examined, 11 were from lymph nodes, 1 from the peritoneum and 1 from the lung. In 5 of the 11 patients, matched samples from the primary tumor and lymph node metastases were analyzed. Cytogenetic similarities between the primary and secondary lesions were found in all 5 cases, indicating that many of the chromosomal aberrations presumably occurred before disease spreading took place. Compared with the primaries, the metastases appeared to exhibit decreased clonal heterogeneity but, concurrently, an increase in the karyotypic complexity of individual clones. Among the aberrations recurrently found in metastatic lesions were del(1)(p34), i(17)(q10), -18, -Y, -21, +7 and +20, all of which have been seen repeatedly in previous series of primary colorectal carcinomas, and del(10)(q22) and add(16)(p13), which so far have not been associated with primary tumors and which may play a particular pathogenetic role in the metastatic process.
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Affiliation(s)
- G Bardi
- Department of Clinical Genetics, University Hospital, Lund, Sweden.
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49
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Abstract
BACKGROUND The possible benefit for patients from follow-up examinations after curative surgery for colorectal cancer is unproven. The purpose of this study was to determine whether survival is improved by frequent follow-up examinations. METHODS A total of 597 patients less than 76 years old treated with radical surgery for colorectal cancer were included in the study from 1983 to 1994. Patients were randomized to frequent follow-up (group 1) or virtually no follow-up (group 2) with examinations at 5 and 10 years. RESULTS Group 1 comprised 290 patients, group 2 contained 307. Recurrence was equally frequent (26 per cent), but the time of diagnosis was 9 months earlier in group 1; also, more recurrences were asymptomatic in group 1 and more patients had new surgery with curative intent (P = 0.02). However, no improvement in overall survival or in cancer-related survival resulted. CONCLUSION Patients subjected to intensive follow-up have recurrence diagnosed earlier, and have more operations for recurrence, but the survival results suggest that any major improvement by intensive follow-up is unlikely.
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Affiliation(s)
- B J Kjeldsen
- Department of Surgery A, Odense University Hospital, Denmark
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50
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Abstract
BACKGROUND The possible benefit for patients from follow-up examinations after curative surgery for colorectal cancer is unproven. The purpose of this study was to determine whether survival is improved by frequent follow-up examinations. METHODS A total of 597 patients less than 76 years old treated with radical surgery for colorectal cancer were included in the study from 1983 to 1994. Patients were randomized to frequent follow-up (group 1) or virtually no follow-up (group 2) with examinations at 5 and 10 years. RESULTS Group 1 comprised 290 patients, group 2 contained 307. Recurrence was equally frequent (26 per cent), but the time of diagnosis was 9 months earlier in group 1; also, more recurrences were asymptomatic in group 1 and more patients had new surgery with curative intent (P = 0.02). However, no improvement in overall survival or in cancer-related survival resulted. CONCLUSION Patients subjected to intensive follow-up have recurrence diagnosed earlier, and have more operations for recurrence, but the survival results suggest that any major improvement by intensive follow-up is unlikely.
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Affiliation(s)
- B J Kjeldsen
- Department of Surgery A, Odense University Hospital, Denmark
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