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Halaris A, Hain D, Law R, Brown L, Lewis D, Filip M. Single nucleotide polymorphisms in C-reactive protein (CRP) predict response to adjunctive celecoxib treatment of resistant bipolar depression. Brain Behav Immun Health 2023; 30:100625. [PMID: 37181328 PMCID: PMC10172701 DOI: 10.1016/j.bbih.2023.100625] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 05/16/2023] Open
Abstract
Background Affective illness has been associated with a proinflammatory state, and it is generally accepted that the immune system plays a key role in the pathophysiology of mood disorders. Since inflammatory biomarkers are elevated in bipolar disorder, anti-inflammatory combination therapies may enhance response and reverse treatment resistance. Purpose In the present study we investigated the possible impact of single nucleotide polymorphisms (SNPs) within the CRP gene on CRP blood levels, treatment response and level-of-stress perception in our cohort of treatment-resistant bipolar-depressed patients receiving escitalopram and celecoxib, or escitalopram and placebo, as previously reported (Halaris et al., 2020). Methods Study design, clinical findings, and CRP blood levels have been reported previously (Halaris et al., 2020; Edberg et al., 2018). In this follow-up study we extracted DNA from blood cells collected at baseline. Genome-wide genotyping was performed for all subjects using the Infinium Multi-Ethnic Global-8 v1.0 Kit. Based on reports in the literature indicating possible associations with psychiatric conditions, ten previously reported CRP gene polymorphisms were evaluated in a preliminary analysis. We focused on rs3093059 and rs3093077 were in complete LD. Carriers were defined as those possessing at least one C allele for rs3093059, or at least one G allele for rs3093077. Additionally, we determined blood levels of the medications administered. Results Non-carriers of rs3093059 and rs3093077 had significantly lower baseline CRP blood levels than carriers (p = 0.03). Increased rates of HAM-D17 response (p = 0.21) and remission (p = 0.13) and lower PSS-14 scores (p = 0.13) were observed in non-carriers among subjects receiving celecoxib but they did not reach statistical significance. When examining all subjects, nominally significant associations between carrier-status and remission (p = 0.04) and PSS-14 scores (p = 0.04) were observed after correcting for treatment arm. Non-carriers receiving celecoxib had the highest rates of response and remission, and the lowest stress scores. Conclusions Carriers of the CRP SNPs may have higher baseline CRP levels, although non-carriers appear to benefit more from celecoxib co-therapy. Determination of the carrier status in conjunction with pretreatment blood CRP level measurement may contribute to personalized psychiatric practice, but replication of the present findings is needed.
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Affiliation(s)
- Angelos Halaris
- Loyola University School of Medicine and Loyola University Medical Center, 2160 South First Ave., Maywood, IL, 60153, USA
- Corresponding author.
| | - Daniel Hain
- Myriad Neuroscience, 6960 Cintas Blvd, Mason, OH, 45040, USA
| | - Rebecca Law
- Myriad Neuroscience, 6960 Cintas Blvd, Mason, OH, 45040, USA
| | - Lisa Brown
- Myriad Neuroscience, 6960 Cintas Blvd, Mason, OH, 45040, USA
| | - David Lewis
- Myriad Neuroscience, 6960 Cintas Blvd, Mason, OH, 45040, USA
| | - Maria Filip
- Department of Adult Psychiatry Medical University of Lodz, Aleksandrowska 159, 91-229, Lodz, Poland
- The Polish National Agency for Academic Exchange, Polna 40, 00-635, Warsaw, Poland
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Ghosh P, Martinez J, Shah N, Kenan W, Fowler A, Limdi N, Burns L, Cogan ES, Gardiner A, Hain D, Johnson H, Lewis D, Shelton R, Liebelt E. Pharmacogenomic Profiling of Pediatric Patients on Psychotropic Medications in an Emergency Department. Pediatr Emerg Care 2023; 39:6-12. [PMID: 36413430 PMCID: PMC9815804 DOI: 10.1097/pec.0000000000002871] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the ability of a combinatorial pharmacogenomic test to predict medication blood levels and relative clinical improvements in a selected pediatric population. METHODS This study enrolled patients between ages 3 to 18 years who presented to a pediatric emergency department with acute psychiatric, behavioral, or mental health crisis and/or concerns, and had previously been prescribed psychotropic medications. Patients received combinatorial pharmacogenomic testing with medications categorized according to gene-drug interactions (GDIs); medications with a GDI were considered "incongruent," and medications without a GDI were considered "congruent." Blood levels for escitalopram, fluoxetine, aripiprazole, and clonidine were evaluated according to level of GDI. Relative clinical improvements in response to the prescribed psychotropic medications were measured using a parent-rated Clinical Global Impression of Improvement (CGI-I) assessment, where lower scores corresponded with greater improvement. RESULTS Of the 100 patients enrolled, 73% reported taking ≥1 incongruent medication. There was no significant difference in CGI-I scores between patients prescribed congruent versus incongruent medications (3.37 vs 3.68, P = 0.343). Among patients who presented for depression or suicidal ideation, those prescribed congruent medications had significantly lower CGI-I scores compared with those taking incongruent medications ( P = 0.036 for depression, P = 0.018 for suicidal ideation). There was a significant association between medication GDI and blood levels for aripiprazole (n = 15, P = 0.01) and escitalopram (n = 10, P = 0.01). CONCLUSIONS Our preliminary findings suggest that combinatorial pharmacogenomic testing can predict medication blood levels and relative outcomes based on medication congruency in children presenting to an emergency department with acute psychiatric/behavioral crises. Additional studies will be needed to confirm these findings.
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Affiliation(s)
- Pallavi Ghosh
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics, The University of Alabama at Birmingham Heersink School of Medicine
| | - Jesse Martinez
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Neurobiology, The University of Alabama at Birmingham Heersink School of Medicine
| | - Nipam Shah
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics, The University of Alabama at Birmingham Heersink School of Medicine
| | - Will Kenan
- Department of Biomedical and Health Sciences, The University of Alabama at Birmingham, School of Health Processions, Birmingham, AL
| | - Andrew Fowler
- Pediatric Residency Program at Arkansas Children's Hospital, University of Arkansas for Medical Sciences, College of Medicine, Little Rock, AR
| | - Nita Limdi
- Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL
| | | | | | | | | | | | | | - Richard Shelton
- Department of Psychiatry, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL
| | - Erica Liebelt
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics, The University of Alabama at Birmingham Heersink School of Medicine
- Department of Pediatrics, Section of Pediatric Emergency Medicine and Pharmacology and Medical Toxicology, University of Arkansas for Medical Sciences, Little Rock, AR
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Law R, Lewis D, Hain D, Daut R, DelBello MP, Frazier JA, Newcorn JH, Nurmi E, Cogan ES, Wagner S, Johnson H, Lanchbury J. Characterisation of seven medications approved for attention-deficit/hyperactivity disorder using in vitro models of hepatic metabolism. Xenobiotica 2022; 52:676-686. [PMID: 36317558 DOI: 10.1080/00498254.2022.2141151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The metabolism of most medications approved for the treatment of attention deficit/hyperactivity disorder (ADHD) is not fully understood.In vitro studies using cryopreserved, plated human hepatocytes (cPHHs) and pooled human liver microsomes (HLMs) were performed to more thoroughly characterise the metabolism of several ADHD medications.The use of enzyme-specific chemical inhibitors indicated a role for CYP2D6 in atomoxetine (ATX) metabolism, and roles for CYP3A4/5 in guanfacine (GUA) metabolism.The 4-hydroxy-atomoxetine and N-desmethyl-atomoxetine pathways represented 98.4% and 1.5% of ATX metabolism in cPHHs, respectively. The 3-OH-guanfacine pathway represented at least 2.6% of GUA metabolism in cPHHs, and 71% in HLMs.The major metabolising enzyme for methylphenidate (MPH) and dexmethylphenidate (dMPH) could not be identified using these methods because these compounds were too unstable. Hydrolysis of these medications was spontaneous and did not require the presence of protein to occur.Clonidine (CLD), amphetamine (AMPH), and dextroamphetamine (dAMPH) did not deplete substantially in cPHHs nor HLMs, suggesting that these compounds may not undergo considerable hepatic metabolism. The major circulating metabolites of AMPH and dAMPH (benzoic acid and hippuric acid) were not observed in either system, and therefore could not be characterised. Additionally, inhibition experiments suggested a very minimal role for CYP2D6 in CLD and AMPH metabolism.
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Affiliation(s)
| | | | | | | | - Melissa P DelBello
- Department of Psychiatry and Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Jean A Frazier
- Eunice Kennedy Shriver Center, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | | | - Erika Nurmi
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA, USA
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Islam F, Hain D, Lewis D, Law R, Brown LC, Tanner JA, Müller DJ. Pharmacogenomics of Clozapine-induced agranulocytosis: a systematic review and meta-analysis. Pharmacogenomics J 2022; 22:230-240. [PMID: 35710824 PMCID: PMC9363274 DOI: 10.1038/s41397-022-00281-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 05/03/2022] [Accepted: 05/30/2022] [Indexed: 11/16/2022]
Abstract
Although clozapine is the most effective pharmacotherapy for treatment-resistant schizophrenia, it is under-utilized, and initiation is often delayed. One reason is the occurrence of a potentially fatal adverse reaction, clozapine-induced agranulocytosis (CIA). Identifying genetic variations contributing to CIA would help predict patient risk of developing CIA and personalize treatment. Here, we (1) review existing pharmacogenomic studies of CIA, and (2) conduct meta-analyses to identify targets for clinical implementation. A systematic literature search identified studies that included individuals receiving clozapine who developed CIA and controls who did not. Results showed that individuals carrying the HLA-DRB1*04:02 allele had nearly sixfold (95% CI 2.20–15.80, pcorrected = 0.03) higher odds of CIA with a negative predictive value of 99.3%. Previously unreplicated alleles, TNFb5, HLA-B*59:01, TNFb4, and TNFd3 showed significant associations with CIA after multiple-testing corrections. Our findings suggest that a predictive HLA-DRB1*04:02-based pharmacogenomic test may be promising for clinical implementation but requires further investigation.
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Rothschild AJ, Parikh SV, Hain D, Law R, Thase ME, Dunlop BW, DeBattista C, Conway CR, Forester BP, Shelton RC, Macaluso M, Brown K, Lewis D, Gutin A, Jablonski MR, Greden JF. Clinical validation of combinatorial pharmacogenomic testing and single-gene guidelines in predicting psychotropic medication blood levels and clinical outcomes in patients with depression. Psychiatry Res 2021; 296:113649. [PMID: 33360967 DOI: 10.1016/j.psychres.2020.113649] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/12/2020] [Indexed: 12/13/2022]
Abstract
We evaluated the clinical validity of a combinatorial pharmacogenomic test and single-gene Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines against patient outcomes and medication blood levels to assess their ability to inform prescribing in major depressive disorder (MDD). This is a secondary analysis of the Genomics Used to Improve DEpression Decisions (GUIDED) randomized-controlled trial, which included patients with a diagnosis of MDD, and ≥1 prior medication failure. The ability to predict increased/decreased medication metabolism was validated against blood levels at screening (adjusted for age, sex, smoking status). The ability of predicted gene-drug interactions (pharmacogenomic test) or therapeutic recommendations (single-gene guidelines) to predict patient outcomes was validated against week 8 outcomes (17-item Hamilton Depression Rating Scale; symptom improvement, response, remission). Analyses were performed for patients taking any eligible medication (outcomes N=1,022, blood levels N=1,034) and the subset taking medications with single-gene guidelines (outcomes N=584, blood levels N=372). The combinatorial pharmacogenomic test was the only significant predictor of patient outcomes. Both the combinatorial pharmacogenomic test and single-gene guidelines were significant predictors of blood levels for all medications when evaluated separately; however, only the combinatorial pharmacogenomic test remained significant when both were included in the multivariate model. There were no substantial differences when all medications were evaluated or for the subset with single-gene guidelines. Overall, this evaluation of clinical validity demonstrates that the combinatorial pharmacogenomic test was a superior predictor of patient outcomes and medication blood levels when compared with guidelines based on individual genes.
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Affiliation(s)
- Anthony J Rothschild
- University of Massachusetts Medical School and UMass Memorial Healthcare, Worcester, MA 01655, United States.
| | - Sagar V Parikh
- University of Michigan Comprehensive Depression Center and Department of Psychiatry, and National Network of Depression Centers, Ann Arbor, MI 48109, United States
| | - Daniel Hain
- Myriad Neuroscience, Mason, OH 45040, United States
| | - Rebecca Law
- Myriad Neuroscience, Mason, OH 45040, United States
| | - Michael E Thase
- Perelman School of Medicine of the University of Pennsylvania and the Corporal Michael Crescenz VAMC, Philadelphia, PA 19104, United States
| | - Boadie W Dunlop
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30329, United States
| | - Charles DeBattista
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Charles R Conway
- Department of Psychiatry, Washington University School of Medicine, and the John Cochran Veteran's Administration Hospital, St. Louis, MO 63110, United States
| | - Brent P Forester
- McLean Hospital, Division of Geriatric Psychiatry, Belmont, MA 02478, United States; Harvard Medical School, Boston, MA, United States
| | - Richard C Shelton
- Department of Psychiatry and Behavioral Neurobiology and School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Matthew Macaluso
- Department of Psychiatry and Behavioral Neurobiology and School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Krystal Brown
- Myriad Genetics, Inc., Salt Lake City, UT 84108, United States
| | - David Lewis
- Myriad Neuroscience, Mason, OH 45040, United States
| | - Alexander Gutin
- Myriad Genetics, Inc., Salt Lake City, UT 84108, United States
| | | | - John F Greden
- University of Michigan Comprehensive Depression Center and Department of Psychiatry, and National Network of Depression Centers, Ann Arbor, MI 48109, United States
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Germani F, Hain D, Sternlicht D, Moreno E, Basler K. The Toll pathway inhibits tissue growth and regulates cell fitness in an infection-dependent manner. eLife 2018; 7:39939. [PMID: 30451683 PMCID: PMC6279345 DOI: 10.7554/elife.39939] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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: 07/09/2018] [Accepted: 11/16/2018] [Indexed: 01/31/2023] Open
Abstract
The Toll pathway regulates the cellular response to infection via the transcriptional upregulation of antimicrobial peptides. In Drosophila, apart from its role in innate immunity, this pathway has also been reported to be important for the elimination of loser cells in a process referred to as cell competition, which can be locally triggered by secreted factors released from winner cells. In this work, we provide evidence that the inhibition of Toll signaling not only increases the fitness of loser cells, but also bestows a clonal growth advantage on wild-type cells. We further demonstrate that this growth advantage depends on basal infection levels since it is no longer present under axenic conditions but exacerbated upon intense pathogen exposure. Thus, the Toll pathway functions as a fine-tuned pro-apoptotic and anti-proliferative regulator, underlining the existence of a trade-off between innate immunity and growth during development.
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Affiliation(s)
- Federico Germani
- Institute of Molecular Life Sciences, University of Zurich, Zurich, Switzerland
| | - Daniel Hain
- Institute of Cell Biology, University of Bern, Bern, Switzerland
| | - Denise Sternlicht
- Institute of Molecular Life Sciences, University of Zurich, Zurich, Switzerland
| | - Eduardo Moreno
- Institute of Cell Biology, University of Bern, Bern, Switzerland.,Champalimaud Research Center Lisbon, Lisboa, Portugal
| | - Konrad Basler
- Institute of Molecular Life Sciences, University of Zurich, Zurich, Switzerland
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Hain D, Langlands A, Sonnenberg HC, Bailey C, Bullock SL, Müller HAJ. The Drosophila MAST kinase Drop out is required to initiate membrane compartmentalisation during cellularisation and regulates dynein-based transport. Development 2014; 141:2119-30. [PMID: 24803657 PMCID: PMC4011086 DOI: 10.1242/dev.104711] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Cellularisation of the Drosophila syncytial blastoderm embryo into the polarised blastoderm epithelium provides an excellent model with which to determine how cortical plasma membrane asymmetry is generated during development. Many components of the molecular machinery driving cellularisation have been identified, but cell signalling events acting at the onset of membrane asymmetry are poorly understood. Here we show that mutations in drop out (dop) disturb the segregation of membrane cortical compartments and the clustering of E-cadherin into basal adherens junctions in early cellularisation. dop is required for normal furrow formation and controls the tight localisation of furrow canal proteins and the formation of F-actin foci at the incipient furrows. We show that dop encodes the single Drosophila homologue of microtubule-associated Ser/Thr (MAST) kinases. dop interacts genetically with components of the dynein/dynactin complex and promotes dynein-dependent transport in the embryo. Loss of dop function reduces phosphorylation of Dynein intermediate chain, suggesting that dop is involved in regulating cytoplasmic dynein activity through direct or indirect mechanisms. These data suggest that Dop impinges upon the initiation of furrow formation through developmental regulation of cytoplasmic dynein.
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Affiliation(s)
- Daniel Hain
- Division of Cell and Developmental Biology, College of Life Sciences, University of Dundee, Dundee DD1 5EH, UK
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Hain D, Langlands A, Sonnenberg H, Bailey C, Bullock SL, Müller HAJ. The Drosophila MAST kinase Drop out is required to initiate membrane compartmentalisation during cellularisation and regulates dynein-based transport. J Cell Sci 2014. [DOI: 10.1242/jcs.156208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Vazquez-Pianzola P, Adam J, Haldemann D, Hain D, Urlaub H, Suter B. Clathrin heavy chain plays multiple roles in polarizing the Drosophila oocyte downstream of Bic-D. Development 2014; 141:1915-26. [PMID: 24718986 DOI: 10.1242/dev.099432] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Bicaudal-D (Bic-D), Egalitarian (Egl), microtubules and their motors form a transport machinery that localizes a remarkable diversity of mRNAs to specific cellular regions during oogenesis and embryogenesis. Bic-D family proteins also promote dynein-dependent transport of Golgi vesicles, lipid droplets, synaptic vesicles and nuclei. However, the transport of these different cargoes is still poorly understood. We searched for novel proteins that either mediate Bic-D-dependent transport processes or are transported by them. Clathrin heavy chain (Chc) co-immunopurifies with Bic-D in embryos and ovaries, and a fraction of Chc colocalizes with Bic-D. Both proteins control posterior patterning of the Drosophila oocyte and endocytosis. Although the role of Chc in endocytosis is well established, our results show that Bic-D is also needed for the elevated endocytic activity at the posterior of the oocyte. Apart from affecting endocytosis indirectly by its role in osk mRNA localization, Bic-D is also required to transport Chc mRNA into the oocyte and for transport and proper localization of Chc protein to the oocyte cortex, pointing to an additional, more direct role of Bic-D in the endocytic pathway. Furthermore, similar to Bic-D, Chc also contributes to proper localization of osk mRNA and to oocyte growth. However, in contrast to other endocytic components and factors of the endocytic recycling pathway, such as Rabenosyn-5 (Rbsn-5) and Rab11, Chc is needed during early stages of oogenesis (from stage 6 onwards) to localize osk mRNA correctly. Moreover, we also uncovered a novel, presumably endocytosis-independent, role of Chc in the establishment of microtubule polarity in stage 6 oocytes.
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Hain D, Bettencourt BR, Okamura K, Csorba T, Meyer W, Jin Z, Biggerstaff J, Siomi H, Hutvagner G, Lai EC, Welte M, Müller HAJ. Natural variation of the amino-terminal glutamine-rich domain in Drosophila argonaute2 is not associated with developmental defects. PLoS One 2010; 5:e15264. [PMID: 21253006 PMCID: PMC3002974 DOI: 10.1371/journal.pone.0015264] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 11/08/2010] [Indexed: 11/20/2022] Open
Abstract
The Drosophila argonaute2 (ago2) gene plays a
major role in siRNA mediated RNA silencing pathways. Unlike mammalian Argonaute
proteins, the Drosophila protein has an unusual amino-terminal
domain made up largely of multiple copies of glutamine-rich repeats (GRRs). We
report here that the ago2 locus produces an alternative
transcript that encodes a putative short isoform without this amino-terminal
domain. Several ago2 mutations previously reported to be null
alleles only abolish expression of the long, GRR-containing isoform. Analysis of
drop out (dop) mutations had previously
suggested that variations in GRR copy number result in defects in RNAi and
embryonic development. However, we find that dop mutations
genetically complement transcript-null alleles of ago2 and that
ago2 alleles with variant GRR copy numbers support normal
development. In addition, we show that the assembly of the central RNAi
machinery, the RISC (RNA induced silencing complex), is unimpaired in embryos
when GRR copy number is altered. In fact, we find that GRR copy number is highly
variable in natural D. melanogaster populations as well as in
laboratory strains. Finally, while many other insects share an extensive,
glutamine-rich Ago2 amino-terminal domain, its primary sequence varies
drastically between species. Our data indicate that GRR variation does not
modulate an essential function of Ago2 and that the amino-terminal domain of
Ago2 is subject to rapid evolution.
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Affiliation(s)
- Daniel Hain
- Division of Cell and Developmental Biology, College of Life Sciences,
University of Dundee, Dundee, United Kingdom
| | | | - Katsutomo Okamura
- Sloan-Kettering Institute, Department of Developmental Biology, New York,
New York, United States of America
| | - Tibor Csorba
- Wellcome Trust Centre for Gene Regulation and Expression, College of Life
Sciences, University of Dundee, Dundee, United Kingdom
| | - Wibke Meyer
- Institut für Genetik, Heinrich Heine Universität,
Düsseldorf, Germany
| | - Zhigang Jin
- Sloan-Kettering Institute, Department of Developmental Biology, New York,
New York, United States of America
| | | | - Haruhiko Siomi
- Department of Molecular Biology, Keio University School of Medicine,
Tokyo, Japan
| | - Gyorgy Hutvagner
- Wellcome Trust Centre for Gene Regulation and Expression, College of Life
Sciences, University of Dundee, Dundee, United Kingdom
| | - Eric C. Lai
- Sloan-Kettering Institute, Department of Developmental Biology, New York,
New York, United States of America
| | - Michael Welte
- Department of Biology, University of Rochester, Rochester, New York,
United States of America
| | - H.-Arno J. Müller
- Division of Cell and Developmental Biology, College of Life Sciences,
University of Dundee, Dundee, United Kingdom
- * E-mail:
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Lawrence YR, Pokroy R, Berlowitz D, Aharoni D, Hain D, Breuer GS. Splenic infarction: an update on William Osler's observations. Isr Med Assoc J 2010; 12:362-365. [PMID: 20928991] [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: 05/30/2023]
Abstract
BACKGROUND Osler taught that splenic infarction presents with left upper abdominal quadrant pain, tenderness and swelling accompanied by a peritoneal friction rub. Splenic infarction is classically associated with bacterial endocarditis and sickle cell disease. OBJECTIVES To describe the contemporary experience of splenic infarction. METHODS We conducted a chart review of inpatients diagnosed with splenic infarction in a Jerusalem hospital between 1990 and 2003. RESULTS We identified 26 cases with a mean age of 52 years. Common causes were hematologic malignancy (six cases) and intracardiac thrombus (five cases). Only three cases were associated with bacterial endocarditis. In 21 cases the splenic infarction brought a previously undiagnosed underlying disease to attention. Only half the subjects complained of localized left-sided abdominal pain, 36% had left-sided abdominal tenderness; 31% had no signs or symptoms localized to the splenic area, 36% had fever, 56% had leukocytosis and 71% had elevated lactate dehydrogenase levels. One splenectomy was performed and all patients survived to discharge. A post hoc analysis demonstrated that single infarcts were more likely to be associated with fever (20% vs. 63%, p < 0.05) and leukocytosis (75% vs. 33%, P = 0.06) CONCLUSIONS The clinical presentation of splenic infarction in the modern era differs greatly from the classical teaching, regarding etiology, signs and symptoms. In patients with unexplained splenic infarction, investigation frequently uncovers a new underlying diagnosis.
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Affiliation(s)
- Yaacov R Lawrence
- Department of Radiation Oncology, Bodine Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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Chertin B, Pollack A, Koulikov D, Rabinowitz R, Shen O, Hain D, Hadas-Halpren I, Farkas A. Does Renal Function Remain Stable After Puberty in Children With Prenatal Hydronephrosis and Improved Renal Function After Pyeloplasty? J Urol 2009; 182:1845-8. [DOI: 10.1016/j.juro.2009.03.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Indexed: 11/27/2022]
Affiliation(s)
- Boris Chertin
- Department of Urology, Shaare Zedek Medical Center, Jerusalem, Faculty of Medical Science, Hebrew University, Jerusalem, Israel
- Department of Urology (Division of Pediatric Urology), Shaare Zedek Medical Center, Jerusalem, Faculty of Medical Science, Hebrew University, Jerusalem, Israel
| | - Avner Pollack
- Department of Urology, Shaare Zedek Medical Center, Jerusalem, Faculty of Medical Science, Hebrew University, Jerusalem, Israel
- Department of Urology (Division of Pediatric Urology), Shaare Zedek Medical Center, Jerusalem, Faculty of Medical Science, Hebrew University, Jerusalem, Israel
| | - Dmitry Koulikov
- Department of Urology, Shaare Zedek Medical Center, Jerusalem, Faculty of Medical Science, Hebrew University, Jerusalem, Israel
| | - Ron Rabinowitz
- Obstetric Ultrasound Unit, Shaare Zedek Medical Center, Jerusalem, Faculty of Medical Science, Hebrew University, Jerusalem, Israel
| | - Ori Shen
- Obstetric Ultrasound Unit, Shaare Zedek Medical Center, Jerusalem, Faculty of Medical Science, Hebrew University, Jerusalem, Israel
| | - Daniel Hain
- Department of Nuclear Medicine, Shaare Zedek Medical Center, Jerusalem, Faculty of Medical Science, Hebrew University, Jerusalem, Israel
| | - Irit Hadas-Halpren
- Department of Diagnostic Radiology, Shaare Zedek Medical Center, Jerusalem, Faculty of Medical Science, Hebrew University, Jerusalem, Israel
| | - Amicur Farkas
- Department of Urology, Shaare Zedek Medical Center, Jerusalem, Faculty of Medical Science, Hebrew University, Jerusalem, Israel
- Department of Urology (Division of Pediatric Urology), Shaare Zedek Medical Center, Jerusalem, Faculty of Medical Science, Hebrew University, Jerusalem, Israel
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Chertin B, Pollack A, Koulikov D, Rabinowitz R, Shen O, Hain D, Hadas-Halpren I, Shenfeld OZ, Farkas A. Long-term follow up of antenatally diagnosed megaureters. J Pediatr Urol 2008; 4:188-91. [PMID: 18631923 DOI: 10.1016/j.jpurol.2007.11.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2007] [Accepted: 11/29/2007] [Indexed: 10/22/2022]
Abstract
AIM We have retrospectively evaluated our 17 years of experience with antenatal diagnosis of hydronephrosis that led to postnatal diagnosis of megaureter, and tried to determine criteria for surgery. PATIENTS AND METHODS Seventy-nine children (64 boys and 15 girls) with antenatal diagnosis of hydronephrosis that led to postnatal diagnosis of megaureter were followed conservatively over a period of 18 years (1988-2006). Right ureterohydronephrosis was seen in 23 children, left in 30 and 26 had bilateral ureterohydronephrosis comprising a total of 105 renal units (RU). According to SFU (Society for Fetal Urology) classification, 8 RU were grade 1, 57 grade 2, 29 grade 3 and 11 grade 4 postnatal hydronephrosis. Mean ureteral diameter was 1.2 cm. Relative renal function was in 82 RU more than 40%, in 18 RU 30-40% and in 5 RU less than 30%. Functional deterioration of the hydronephrotic kidney of more than 5%, worsening of hydronephrosis (SFU upgrade) and a persistent obstructive curve on radionuclide scans were the main indications for surgery. RESULTS Twenty-five (31%) children required surgical correction. Mean age at surgery was 14.3 months (range 3-60). Univariate analysis revealed that gender and side of obstruction are not significant predictive factors for surgery SFU grade 3-4 of postnatal hydronephrosis, Relative renal function less than 30% and ureteral diameter more than 1.33 cm were significant independent risk factors leading to reimplantation. CONCLUSIONS Only 30% of children with antenatal diagnosis of megaureter required surgical correction. Renal function less than 30%, grades 3 and 4 hydronephrosis, and ureteric diameter more than 1.33 cm are statistically significant and independent predictive factors for surgery.
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Affiliation(s)
- Boris Chertin
- Department of Urology, Shaare Zedek Medical Center, Faculty of Medical Science, Hebrew University, Jerusalem, Israel.
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Carmon M, Hain D, Shapira J, Golomb E. Preoperative lymphatic mapping does not predict the number of axillary sentinel lymph nodes identified during surgery in breast cancer patients. Breast J 2008; 12:424-7. [PMID: 16958959 DOI: 10.1111/j.1075-122x.2006.00296.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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
Sentinel lymph node biopsy (SLNB) has become the standard of care in most centers for axillary staging in patients with early breast cancer. Multiple radioactive nodes are often identified at surgery. The finding of multiple sentinel lymph nodes (SLNs) has been shown to be associated with lower rates of false-negative results in the SLNB procedure, hence the importance of removing and examining all SLNs. Often preoperative lymphatic mapping (PLM) is performed prior to surgery. In this study we examined whether the exact number of SLNs identified during surgery can be accurately predicted by PLM. During the years 2001-2004, 155 patients underwent both PLM and a SLNB in our breast unit. During surgery, an attempt was made to remove all radioactive nodes. The number of axillary radioactive foci found on PLM was compared with the number of radioactive nodes identified during surgery. The average number of sentinel nodes harvested was 2.3 (range 1-9). The average number of radioactive foci identified on PLM was 1.8 (range 0-5). Of the 155 patients, the number of sentinel nodes retrieved in surgery was greater than that found in preoperative mapping in 65 patients (41.9%), equal to that found in preoperative mapping in 60 patients (38.7%), and less than that found in preoperative mapping in 30 patients (19.4%). Thus in most patients, the number of SLNs found on PLM did not reflect the number of SLNs found intraoperatively. Therefore, even when the number of nodes identified on PLM has been reached in surgery, a meticulous search for additional nodes should still be carried out. The number of hot spots in preoperative mapping should serve as a rough indicator of the smallest number of nodes the surgeon should attempt to resect, but not the exact number of nodes expected to be found.
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Affiliation(s)
- Moshe Carmon
- Breast Health Center, Shaare Zedek Medical Center, Jerusalem, Israel.
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Chertin B, Pollack A, Koulikov D, Rabinowitz R, Hain D, Hadas-Halpren I, Farkas A. Conservative Treatment of Ureteropelvic Junction Obstruction in Children with Antenatal Diagnosis of Hydronephrosis: Lessons Learned after 16 Years of Follow-Up. Eur Urol 2006; 49:734-8. [PMID: 16504374 DOI: 10.1016/j.eururo.2006.01.046] [Citation(s) in RCA: 148] [Impact Index Per Article: 8.2] [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: 10/22/2005] [Accepted: 01/30/2006] [Indexed: 11/23/2022]
Abstract
OBJECTIVES We attempted to define predictive factors for surgery in children with antenatal diagnosis of hydronephrosis that led to postnatal diagnosis of ureteropelvic junction (UPJ) obstruction. METHODS We retrospectively evaluated our 16-yr experience (1988-2003) with 343 children (260 male and 83 female) with antenatal diagnosis of hydronephrosis that led to postnatal diagnosis of UPJ obstruction and who were followed conservatively. Right-sided hydronephrosis was present in 110 and left-sided in 233 children. According to the Society for Fetal Urology (SFU) classification none had grade 0 of postnatal hydronephrosis, 20 had grade 1, 118 grade 2, 147 grade 3, and the remaining 58 children grade 4 postnatal hydronephrosis. Relative renal function (RRF) on radionuclide scans revealed 235 children with RRF>40%, 68 with RRF between 30% and 40%, and 40 patients with RRF<30%. Renal function deterioration >5% was the main indication for surgery. Commercially available software GraphPad Prism 4.0 (GraphPad prism, Prism 4 for Windows, version 4) using the Fisher exact test was used for statistical evaluation. RESULTS Surgical correction was needed in 179 children (52.2%) during the course of conservative management. The average age at surgery was 10.6 mo (range, 1 mo to 7 yr). Of those, 50% underwent surgery during the first 2 yr of life and the majority of the remaining patients underwent surgery between the 2 and 4 yr of age; only two patients required surgery later on. Univariate analysis revealed that child sex, side of hydronephrosis, and SFU grade of prenatal hydronephrosis were not significant predictive factors for surgery. However, SFU grade 3-4 of postnatal hydronephrosis (p<0.0001; odds ratio, 0.06281) and RRF<40% (p<0.0001; odds ratio, 0.1022) were significant independent risk factors for surgery. CONCLUSION In contrast with previous publications by others and by us these data show that >50% of children with antenatal diagnosis of UPJ obstruction in this series required surgical correction while on conservative protocol. SFU grade 3-4 of postnatal hydronephrosis and RRF<40% are significant independent predictive factors for surgery.
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Affiliation(s)
- Boris Chertin
- Department of Urology, Shaare Zedek Medical Center, Jerusalem, Faculty for the Health Sciences, Ben-Gurion University of the Negev, Israel.
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Abstract
Extra-axillary sentinel lymph nodes can only be detected if radioactive tracer is used and pre-operative scans are carried out. The presence of metastatic sentinel lymph nodes in most extra-axillary sites will upstage patients if the ipsilateral axillary sentinel lymph node is normal. Paradoxically, the presence of metastatic sentinel lymph nodes in the contralateral axilla has the potential to prevent upstaging to stage IV, but only if detected as a sentinel node at the initial surgery rather than as a systemic recurrence at some later time. We describe a case of bilateral axillary sentinel lymph nodes detected by pre-operative lymphoscintigraphy in a patient with a medial quadrant breast cancer and discuss the possible implications of such a finding.
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Affiliation(s)
- Moshe Carmon
- Department of Surgery (Breast Health Center), Shaare Zedek Medical Center (affiliated with the Faculty of Health Sciences, Ben-Gurion University of the Negev), PO Box 3235, Jerusalem 91031, Israel
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Abstract
The aim of this study is to assess the role of PET/CT in differentiating between mesenteric panniculitis (MP) and co-existing MP and mesenteric tumoural involvement. A total of 33 PET/CT examinations, of 19 oncologic patients (16 men and three women with ages ranging from 48 years to 83 years) with findings of MP on the CT part of the study were retrospectively reviewed. The FDG uptake in mesenteric nodules was recorded. The final diagnosis of malignant mesenteric involvement was based on clinical and imaging follow-up. Based on the FDG uptake in mesenteric nodules, patients were categorized as group A: increased mesenteric uptake (n=8) and group B: no mesenteric uptake (n=11). In seven of the eight patients in group A, a co-existing MP and mesenteric tumour involvement was found: one patient had a recurrent cervical carcinoma and the other six patients had lymphoma. In four of these six patients, the positive PET findings disappeared on follow-up PET/CT with complete remission while the CT findings of the MP remained unchanged. In the other two, the PET findings progressed along with clinical deterioration. In the last patient of group A, with rectal carcinoma without evidence of recurrence, the mesenteric FDG uptake was a false positive uptake. In all 11 patients with CT findings of MP and negative PET, no malignant involvement of the mesentery was diagnosed. To conclude, a negative PET has a high diagnostic accuracy in excluding tumoural mesenteric involvement while increased uptake suggests the co-existing of mesenteric deposits, particularly in patients with lymphoma.
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Affiliation(s)
- R Zissin
- Department of Nuclear Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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Carmon M, Olsha O, Levy-Lahad E, Hain D, Spira R, Abu-Dalo R, Odenheimer D, Gabizon A. Sentinel lymph node biopsy in prophylactic mastectomy for risk reduction in breast cancer patients. EJC Suppl 2004. [DOI: 10.1016/s1359-6349(04)90706-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Lebel E, Elstein D, Hain D, Hadas-Halpern I, Zimran A, Itzchaki M. Osteonecrosis in a patient with Gaucher's disease treated with enzyme replacement. Isr Med Assoc J 2003; 5:595-6. [PMID: 12929302] [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] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Affiliation(s)
- Ehud Lebel
- Department of Orthopedic Surgery, Shaare Zedek Medical Center, Jerusalem, Israel
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Chertin B, Fridmans A, Knizhnik M, Hadas-Halperin I, Hain D, Farkas A. Does early detection of ureteropelvic junction obstruction improve surgical outcome in terms of renal function? J Urol 1999; 162:1037-40. [PMID: 10458427 DOI: 10.1097/00005392-199909000-00020] [Citation(s) in RCA: 10] [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: 10/26/2022]
Abstract
PURPOSE Prenatal ultrasound leads to the early detection of hydronephrosis. When followed by the early diagnosis of ureteropelvic junction obstruction surgical treatment, if indicated, is associated with minimal morbidity. We attempt to prove the benefits of this therapeutical approach from the point of view of renal function. MATERIALS AND METHODS From 1979 to 1997, 452 patients with ureteropelvic junction obstruction underwent dismembered pyeloplasty. Of these patients 113 with comparable data were retrospectively evaluated. Patients were divided into group 1-50 who presented with prenatal hydronephrosis and group 2-63 with neonatal hydronephrosis who were lost to followup and who then presented with symptoms leading to the diagnosis of ureteropelvic junction obstruction. In each group the diagnostic criteria and indications for surgery were identical based on symptomatology, ultrasound and renal scan. Patients with bilateral disease, solitary kidney or vesicoureteral reflux were excluded from study. In groups 1 and 2 median patient age at surgery was 11 months and 5 years, and average postoperative followup was 4.2 and 3.2 years, respectively. RESULTS In 41 of the 50 group 1 and 60 of the 63 group 2 patients hydronephrosis was severe and the renal pelvis was more than 3 cm. wide. Poor relative renal function (less than 30%) was significantly more pronounced in group 2 than in group 1 (56 of 63 patients or 89% versus 6 of 50 or 12%, p <0.05). In all 113 patients postoperative followup ultrasound and renal scan revealed significant improvement in hydronephrosis and washout curve pattern. There was a significant difference in the 2 groups in regard to renal function improvement postoperatively (66% of group 1 versus 16% of group 2 patients, p <0.05). CONCLUSIONS We believe that patients who undergo prenatal imaging and are diagnosed early with ureteropelvic junction obstruction should be carefully and meticulously followed. Special efforts should be made to ensure that patients are not lost to followup. After any sign of deterioration develops early surgery is indicated. According to our data operative treatment results in improved renal function.
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Affiliation(s)
- B Chertin
- Department of Urology, Diagnostic Radiology and Nuclear Medicine, Shaare Zedek Medical Center, Jerusalem, Israel
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Weiss DB, Lupa S, Tamir E, Shem-Tov E, Shemesh D, Hain D. [Quantitative analysis of testicular varicocele by scintigraphy]. Harefuah 1996; 130:801-6, 880. [PMID: 8885500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Testicular varcocele is the most common factor affecting male fertility. The determental effects of the varicocele on semen quality and fertility are codonsidered to be related to its severity. The aim of this study was to establish a quantitative radioisotopic method for the diagnosis and evaluation of testicular varicocele. 31 men attending our infertility clinic underwent scintigraphy with a gamma camera scanner (Apex 415) equipped with a pinhole low energy collimator (zoom factor 2). The evaluation was performed in the supine position and the collimator at 8.5 cm above the testicular area. The patients' red blood cells were labeled in-vivo by injection of SN-pyrophosphate before i.v. administration of To-99. An image of the scrotal area was obtained and the computer processing consisted of a drawing of the region of interest over the area of the varicocele, with background subtraction. The following indices were calculated: testes total count, varicocele area (in pixels) and average count per pixel (ACPP). The patients also underwent high resolution duplex sonography (HRDS) using a Multigon duplex scanner with a 7.5 Mhz transducer. Spermatic vein diameter, and reflux when present, were determined. HRDS was performed to compare and to validate the results obtained by scintigraphy. In men without varicocele mean ACPP was 2.80, in those with mild varicocele 3.76, in those with moderate varicocele 5.40 and in those with severe varicocele 7.48. A significant positive correlation was found between ACPP values and severity of the varicocele, as determined either by the diameter of the spermatic veins or by reflux of blood in the veins. We conclude that the ACPP index obtained by this new technique enables objective diagnosis and quantitative grading of testicular varicocele.
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Affiliation(s)
- D B Weiss
- Male Inferctility Unit, Shaare Zedek Medical Center, Jersualem
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Krausz Y, Horne T, Hain D, Chisin R, Atlan H. Scintigraphic techniques in pre-operative localization of parathyroid adenoma. Isr J Med Sci 1992; 28:217-20. [PMID: 1592591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Solitary parathyroid adenoma is the most common cause of primary hyperparathyroidism. It can be removed surgically with a 92-96% success rate without any pre-operative imaging procedures. However, imaging procedures may be of help in localization, thereby reducing operative morbidity, and in the detection of ectopic adenomas. The decision to undertake surgical exploration should not be based on these procedures because of their low sensitivity and limited specificity when used alone, but rather on an established biochemical diagnosis of hyperparathyroidism.
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Affiliation(s)
- Y Krausz
- Department of Nuclear Medicine, Hadassah University Hospital, Jerusalem, Israel
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Hain D, Leversha M, Campbell N, Daniel A, Barr PA, Rogers JG. The ascertainment and implications of an unbalanced translocation in the neonate. Familial 1:15 translocation. Aust Paediatr J 1980; 16:196-200. [PMID: 7224998 DOI: 10.1111/j.1440-1754.1980.tb01296.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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