1
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Yang K, Shah K, Patsalides A, Knobel D, Dehdashti AR. Resection of Aggressive Recurrent Cavernous Sinus Meningioma-Stage 1, IMAX-RAG-MCA Bypass: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 24:e110. [PMID: 36637314 DOI: 10.1227/ons.0000000000000470] [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: 04/25/2022] [Accepted: 09/02/2022] [Indexed: 01/14/2023] Open
Affiliation(s)
- Kaiyun Yang
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Kevin Shah
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Athos Patsalides
- Department of Interventional Neuroradiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Denis Knobel
- Department of Plastic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Amir R Dehdashti
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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Chiluwal AK, Nouri M, Knobel D, Dehdashti AR. Surgical Trapping of a Large Complex Middle Cerebral Artery Aneurysm With Double-Barrel Bypass: 3-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 20:E444-E445. [PMID: 33554252 DOI: 10.1093/ons/opab028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 07/07/2020] [Accepted: 12/22/2020] [Indexed: 11/14/2022] Open
Abstract
Large middle cerebral artery (MCA) bifurcation aneurysms are known vascular lesions that are usually symptomatic but often difficult to treat (whether with open or endovascular techniques), especially when the M2 branches originate from the aneurysm dome.1-7 The challenge lies in securing the aneurysm while fully maintaining the flow in the vessels arising from the dome. Standard microsurgical clipping or endovascular techniques are not feasible in perfectly treating these aneurysms. Revascularization of the MCA branches with bypass and trapping of the aneurysm is often necessary. Here, we present a case of a large complex partially thrombosed right MCA bifurcation aneurysm with both the superior and the inferior divisions arising from the dome. The patient initially presented with a right MCA stroke and left hemiparesis. Using radial artery as an interposition graft, 2 bypasses-internal maxillary artery to the inferior division and superficial temporal artery to the superior division-were performed. The aneurysm was trapped and decompressed by placing clips at the M1 terminus and the M2 origins. Intraoperative angiography and postoperative NOVA (VasSol Inc.) magnetic resonance angiography (MRA) confirmed patency and excellent flow in the bypass grafts. The patient's postoperative course was uncomplicated, and at 2-mo follow-up, had significant improvement of her hemiparesis. The patient provided informed consent for the procedure.
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Affiliation(s)
- Amrit K Chiluwal
- Department of Neurosurgery, North Shore University Hospital, Manhasset, New York, USA.,Department of Neurosurgery, Richmond Hills, New York, USA
| | - Mohsen Nouri
- Department of Neurosurgery, North Shore University Hospital, Manhasset, New York, USA.,Department of Neurosurgery, Richmond Hills, New York, USA
| | - Denis Knobel
- Department of Plastic Surgery, North Shore University Hospital, Manhasset, New York, USA
| | - Amir R Dehdashti
- Department of Neurosurgery, North Shore University Hospital, Manhasset, New York, USA
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Karanetz I, Stanley S, Knobel D, Smith BD, Bastidas N, Beg M, Kasabian AK, Tanna N. Melanoma Extirpation with Immediate Reconstruction: The Oncologic Safety and Cost Savings of Single-Stage Treatment. Plast Reconstr Surg 2016; 138:256-261. [PMID: 27351470 DOI: 10.1097/prs.0000000000002241] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 11/26/2022]
Abstract
BACKGROUND The timing of reconstruction following melanoma extirpation remains controversial, with some advocating definitive reconstruction only when the results of permanent pathologic evaluation are available. The authors evaluated oncologic safety and cost benefit of single-stage neoplasm extirpation with immediate reconstruction. METHODS The authors reviewed all patients treated with biopsy-proven melanoma followed by immediate reconstruction during a 3-year period (January of 2011 to December of 2013). Patient demographic data, preoperative biopsies, operative details, and postoperative pathology reports were evaluated. Cost analysis was performed using hospital charges for single-stage surgery versus theoretical two-stage surgery. RESULTS During the study period, 534 consecutive patients were treated with wide excision and immediate reconstruction, including primary closure in 285 patients (55 percent), local tissue rearrangement in 155 patients (30 percent), and skin grafting in 78 patients (15 percent). The mean patient age was 67 years (range, 19 to 98 years), and the median follow-up time was 1.2 years. Shave biopsy was the most common diagnostic modality, resulting in tumor depth underestimation in 30 patients (6.0 percent). Nine patients (2.7 percent) had positive margins on permanent pathologic evaluation. The only variables associated with positive margins were desmoplastic melanoma (p = 0.004) and tumor location on the cheek (p = 0.0001). The mean hospital charge for immediate reconstruction was $22,528 compared with the theoretical mean charge of $35,641 for delayed reconstruction, leading to mean savings of 38.5 percent (SD, 7.9 percent). CONCLUSION This large series demonstrates that immediate reconstruction can be safely performed in melanoma patients with an acceptable rate of residual tumor requiring reoperation and significant health care cost savings. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Irena Karanetz
- New York, N.Y
- From the Divisions of Plastic and Reconstructive Surgery and Surgical Oncology, Northwell Health, Hofstra Northwell School of Medicine
| | - Sharon Stanley
- New York, N.Y
- From the Divisions of Plastic and Reconstructive Surgery and Surgical Oncology, Northwell Health, Hofstra Northwell School of Medicine
| | - Denis Knobel
- New York, N.Y
- From the Divisions of Plastic and Reconstructive Surgery and Surgical Oncology, Northwell Health, Hofstra Northwell School of Medicine
| | - Benjamin D Smith
- New York, N.Y
- From the Divisions of Plastic and Reconstructive Surgery and Surgical Oncology, Northwell Health, Hofstra Northwell School of Medicine
| | - Nicholas Bastidas
- New York, N.Y
- From the Divisions of Plastic and Reconstructive Surgery and Surgical Oncology, Northwell Health, Hofstra Northwell School of Medicine
| | - Mansoor Beg
- New York, N.Y
- From the Divisions of Plastic and Reconstructive Surgery and Surgical Oncology, Northwell Health, Hofstra Northwell School of Medicine
| | - Armen K Kasabian
- New York, N.Y
- From the Divisions of Plastic and Reconstructive Surgery and Surgical Oncology, Northwell Health, Hofstra Northwell School of Medicine
| | - Neil Tanna
- New York, N.Y
- From the Divisions of Plastic and Reconstructive Surgery and Surgical Oncology, Northwell Health, Hofstra Northwell School of Medicine
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Byaruhanga C, Collins NE, Knobel D, Kabasa W, Oosthuizen MC. Endemic status of tick-borne infections and tick species diversity among transhumant zebu cattle in Karamoja Region, Uganda: Support for control approaches. Vet Parasitol Reg Stud Reports 2016; 1-2:21-30. [PMID: 31018404 DOI: 10.1016/j.vprsr.2015.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 11/13/2015] [Accepted: 11/30/2015] [Indexed: 10/22/2022]
Abstract
We conducted a study to investigate tick species diversity, seroprevalence of antibodies to Anaplasma marginale and Theileria parva, and the risk factors for these infections among cattle under a transhumant production system in Karamoja Region, Uganda, from November 2013 through January 2014. Twenty herds were randomly selected from 20 purposively-selected superherds. Semi-structured interviews and piling for annual proportion of tick-borne disease (TBD) cases in different age groups, with pastoralist groups, clinical examinations and field observations were employed to obtain information related to the epidemiology of TBDs. Ticks were collected and identified from whole body inspections of at least seven systematically selected cattle in each herd. Concurrently, serum was collected from 397 cattle. Antibodies to A. marginale were detected by MSP-5 competitive inhibition enzyme-linked immunosorbent assay, and to T. parva by indirect fluorescent antibody test. Clinical examinations and informant interviews showed that TBDs affected all age groups of cattle. Tick species that have not been reported in recent studies from other parts of Uganda were collected, namely Amblyomma lepidum, Hyalomma truncatum, Amblyomma gemma, and Rhipicephalus pulchellus. Out of the 10,923 ticks collected, Rhipicephalus appendiculatus (54.4%) was the most abundant species followed by Rhipicephalus (Boophilus) decoloratus (17.7%), Amblyomma variegatum (12%) and A. lepidum (11.6%). Two-thirds of the sampled cattle had moderate (37.3%, 11-50 ticks) to abundant (28.6%, >50 ticks) numbers of ticks. Seroprevalence of A. marginale was high (86.6%, 95% confidence interval [CI] 80.8%-91.8%), while that of T. parva was low (14.6%, 95% CI 7.1%-22.4%). Cattle of 5-12months (18.3%, Odds ratio [OR]=4.1) and 13-24months (30.3%, OR=8.0) were more likely to be seropositive for T. parva than those >24months. For A. marginale, cattle of 13-24months (92.4%, OR=2.7) and >24months (89.7%, OR=2.0) were more likely to be seropositive than those 5-12months. There was a significant difference (p<0.001, OR=6.5) in the proportion of T. parva seropositive animals between Moroto (24.5%) and Kotido districts (4.8%), but not for A. marginale. In conclusion, the low seroprevalence for T. parva, possibly due to limited exposure in calves, may suggest a high likelihood of ECF in cattle. High seroprevalence for A. marginale suggests that a high proportion of cattle were exposed to infection. The findings provide knowledge of epidemiology of TBDs in Karamoja cattle and support for strategic control and improvement of cattle productivity.
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Affiliation(s)
- C Byaruhanga
- Department of Veterinary Tropical Diseases, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa; National Agricultural Research Organisation, P.O. Box 259, Entebbe, Uganda.
| | - N E Collins
- Department of Veterinary Tropical Diseases, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa
| | - D Knobel
- Department of Veterinary Tropical Diseases, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa
| | - W Kabasa
- College of Veterinary Medicine, Animal Resources and Bio-security, Makerere University, P.O. Box 7062, Kampala, Uganda
| | - M C Oosthuizen
- Department of Veterinary Tropical Diseases, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa
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5
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Byaruhanga C, Oosthuizen M, Collins N, Knobel D. Using participatory epidemiology to investigate management options and relative importance of tick-borne diseases amongst transhumant zebu cattle in Karamoja Region, Uganda. Prev Vet Med 2015; 122:287-97. [DOI: 10.1016/j.prevetmed.2015.10.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 10/18/2015] [Accepted: 10/19/2015] [Indexed: 10/22/2022]
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6
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Quan V, Frean J, Simpson G, Knobel D, Meiring S, Weyer J, Rossouw J, Blumberg L. Zoonotic infections in adults in the Bushbuckridge District of Mpumalanga Province. Int J Infect Dis 2014. [DOI: 10.1016/j.ijid.2014.03.808] [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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7
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Hacker RI, Ritter G, Nelson C, Knobel D, Gupta R, Hopkins K, Marini CP, Barrera R. Subcutaneous heparin does not increase postoperative complications in neurosurgical patients: An institutional experience. J Crit Care 2012; 27:250-4. [DOI: 10.1016/j.jcrc.2011.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 08/10/2011] [Accepted: 09/23/2011] [Indexed: 10/14/2022]
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8
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Deutsch GB, Kandel AR, Knobel D, Gupta R, Ritter G, Marini CP, Barrera R. Bleeding risk secondary to deep vein thrombosis prophylaxis in patients with lower gastrointestinal bleeding. J Intensive Care Med 2011; 27:379-83. [PMID: 22056532 DOI: 10.1177/0885066611420339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Deep vein thrombosis (DVT) and pulmonary embolism (PE) continue to pose a major burden on the health care system in the United States. The precise timing of anticoagulation initiation in critically ill patients with recent or active lower gastrointestinal bleeding (LGIB) is not well defined. We set out to study the safety and efficacy of early heparin administration for DVT prophylaxis in these patients. METHODS A review of all patients admitted to the ICU with a diagnosis of LGIB over a 13-year period was performed. A total of 60 patients received subcutaneous heparin along with mechanical prophylaxis, whereas 59 patients had intermittent pneumatic compression devices alone. RESULTS There was no difference in morbidity or mortality between the groups who received heparin and the nonheparin cohort. Neither of the groups developed a DVT or PE during the study period. Patients who received heparin had a median ICU LOS of 3 days, when compared with 2 days for patients who did not receive heparin (P < .0118). There was a significant association between units of blood received during the first 24 hours in the ICU and heparin usage (P < .0229). Those administered heparin received more units (median 3) than those who did not receive heparin (median 2). CONCLUSIONS Administration of subcutaneous heparin increases the transfusion requirements and LOS in ICU patients with LGIB. After 24 hours, however, the blood transfusion requirements are equivalent. DVT prophylaxis in patients with a diagnosis of LGIB should be initiated after 24 hours of ICU admission.
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Affiliation(s)
- Gary B Deutsch
- Department of Surgery and Critical Care, Long Island Jewish Medical Center, New Hyde Park, NY 11040, USA.
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9
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Khader A, Deutsch G, Knobel D, Ritter G, Marini C, Barrera R. Surgical Geriatric Patient Outcome in Critical Care Patients: Age as an Independent Factor. Chest 2011. [DOI: 10.1378/chest.1116796] [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: 11/01/2022] Open
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10
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Sultan SM, Barr JS, Butala P, Davidson EH, Weinstein AL, Knobel D, Saadeh PB, Warren SM, Coleman SR, Hazen A. Fat grafting accelerates revascularisation and decreases fibrosis following thermal injury. J Plast Reconstr Aesthet Surg 2011; 65:219-27. [PMID: 21962530 DOI: 10.1016/j.bjps.2011.08.046] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 07/04/2011] [Accepted: 08/24/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Fat grafting has been shown clinically to improve the quality of burn scars. To date, no study has explored the mechanism of this effect. We aimed to do so by combining our murine model of fat grafting with a previously described murine model of thermal injury. METHODS Wild-type FVB mice (n=20) were anaesthetised, shaved and depilitated. Brass rods were heated to 100°C in a hot water bath before being applied to the dorsum of the mice for 10s, yielding a full-thickness injury. Following a 2-week recovery period, the mice underwent Doppler scanning before being fat/sham grafted with 1.5cc of human fat/saline. Half were sacrificed 4 weeks following grafting, and half were sacrificed 8 weeks following grafting. Both groups underwent repeat Doppler scanning immediately prior to sacrifice. Burn scar samples were taken following sacrifice at both time points for protein quantification, CD31 staining and Picrosirius red staining. RESULTS Doppler scanning demonstrated significantly greater flux in fat-grafted animals than saline-grafted animals at 4 weeks (fat=305±15.77mV, saline=242±15.83mV; p=0.026). Enzyme-linked immunosorbent assay (ELISA) analysis in fat-grafted animals demonstrated significant increase in vasculogenic proteins at 4 weeks (vascular endothelial growth factor (VEGF): fat=74.3±4.39ngml(-1), saline=34.3±5.23ngml(-1); p=0.004) (stromal cell-derived factor-1 (SDF-1): fat=51.8±1.23ngml(-1), saline grafted=10.2±3.22ngml(-1); p<0.001) and significant decreases in fibrotic markers at 8 weeks (transforming growth factor-ß1(TGF-ß): saline=9.30±0.93, fat=4.63±0.38ngml(-1); p=0.002) (matrix metallopeptidase 9 (MMP9): saline=13.05±1.21ngml(-1), fat=6.83±1.39ngml(-1); p=0.010). CD31 staining demonstrated significantly up-regulated vascularity at 4 weeks in fat-grafted animals (fat=30.8±3.39 vessels per high power field (hpf), saline=20.0±0.91 vessels per high power field (hpf); p=0.029). Sirius red staining demonstrated significantly reduced scar index in fat-grafted animals at 8 weeks (fat=0.69±0.10, saline=2.03±0.53; p=0.046). CONCLUSIONS Fat grafting resulted in more rapid revascularisation at the burn site as measured by laser Doppler flow, CD31 staining and chemical markers of angiogenesis. In turn, this resulted in decreased fibrosis as measured by Sirius red staining and chemical markers.
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Affiliation(s)
- Steven M Sultan
- Institute of Reconstructive Plastic Surgery, New York University Medical Center, 560 First Avenue, TCH-169, New York, NY 10017, USA
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11
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Khader A, Ritter G, Gupta R, Knobel D, Deutsch G, Marini C, Barrera R. Body Mass Index Is Not a Risk Factor for Mortality in the Surgical Intensive Care Unit. Chest 2011. [DOI: 10.1378/chest.1118889] [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: 11/01/2022] Open
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12
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Khader A, Deutsch G, Knobel D, Ritter G, Marini C, Barrera R. Emergency Surgery Is an Independent Factor for Outcome in Surgical Critical Care Patients. Chest 2011. [DOI: 10.1378/chest.1118881] [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: 11/01/2022] Open
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13
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Gupta R, Knobel D, Gunabushanam V, Agaba E, Ritter G, Marini C, Barrera R. The Effect of Low Body Mass Index on Outcome in Critically Ill Surgical Patients. Nutr Clin Pract 2011; 26:593-7. [DOI: 10.1177/0884533611419666] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Rajeev Gupta
- North Shore Long Island Jewish Health System, Glen Oaks, New York
| | - Denis Knobel
- North Shore Long Island Jewish Health System, Glen Oaks, New York
| | | | - Emanuel Agaba
- North Shore Long Island Jewish Health System, Glen Oaks, New York
| | - Gary Ritter
- North Shore Long Island Jewish Health System, Glen Oaks, New York
| | - Corrado Marini
- North Shore Long Island Jewish Health System, Glen Oaks, New York
| | - Rafael Barrera
- North Shore Long Island Jewish Health System, Glen Oaks, New York
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Wetterau M, George F, Weinstein A, Nguyen PD, Tutela JP, Knobel D, Cohen O, Warren SM, Saadeh PB. Topical prolyl hydroxylase domain-2 silencing improves diabetic murine wound closure. Wound Repair Regen 2011; 19:481-6. [PMID: 21627711 PMCID: PMC3200292 DOI: 10.1111/j.1524-475x.2011.00697.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Prolyl hydroxylase domain 2 (PHD2) has been implicated in several pathways of cell signaling, most notably in its regulation of hypoxia-inducible factor (HIF)-1α stability. In normoxia, PHD2 hydroxylates proline residues on HIF-1α, rendering it inactive. However, in hypoxia, PHD2 is inactive, HIF-1α is stabilized and downstream effectors such as vascular endothelial growth factor and fibroblast growth factor-2 are produced to promote angiogenesis. In the present study we utilize RNA interference to PHD2 to promote therapeutic angiogenesis in a diabetic wound model, presumably by the stabilization of HIF-1α. Stented wounds were created on the dorsum of diabetic Lepr db/db mice. Mice were treated with PHD2 small interfering RNA (siRNA) or nonsense siRNA. Wounds were measured photometrically on days 0-28. Wounds were harvested for histology, protein, and RNA analysis. Diabetic wounds treated with siRNA closed within 21±1.2 days; sham-treated closed in 28±1.5 days. By day 7, Western blot revealed near complete suppression of PHD protein and corresponding increased HIF-1α. Angiogenic mediators vascular endothelial growth factor and fibroblast growth factor-2 were elevated, corresponding to increased CD31 staining in the treated groups. siRNA-mediated silencing of PHD2 increases HIF-1α and several mediators of angiogenesis. This corresponded to improved time to closure in diabetic wounds compared with sham-treated wounds. These findings suggest that impaired wound healing in diabetes can be ameliorated with therapeutic angiogenesis.
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Affiliation(s)
| | | | - Andrew Weinstein
- Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY
| | - Phuong D. Nguyen
- Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY
| | - John Paul Tutela
- Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY
| | - Denis Knobel
- Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY
| | - Oriana Cohen
- Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY
| | - Stephen M. Warren
- Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY
| | - Pierre B. Saadeh
- Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY
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Kennedy LJ, Randall DA, Knobel D, Brown JJ, Fooks AR, Argaw K, Shiferaw F, Ollier WER, Sillero-Zubiri C, Macdonald DW, Laurenson MK. Major histocompatibility complex diversity in the endangered Ethiopian wolf (Canis simensis). ACTA ACUST UNITED AC 2011; 77:118-25. [PMID: 21214524 DOI: 10.1111/j.1399-0039.2010.01591.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The major histocompatibility complex (MHC) influences immune response to infection and vaccination. In most species, MHC genes are highly polymorphic, but few wild canid populations have been investigated. In Ethiopian wolves, we identified four DLA (dog leucocyte antigen)-DRB1, two DLA-DQA1 and five DQB1 alleles. Ethiopian wolves, the world's rarest canids with fewer than 500 animals worldwide, are further endangered and threatened by rabies. Major rabies outbreaks in the Bale Mountains of southern Ethiopia (where over half of the Ethiopian wolf population is located) have killed over 75% of wolves in the affected sub-populations. In 2004, following a rabies outbreak, 77 wolves were vaccinated, and 19 were subsequently recaptured to monitor the effectiveness of the intervention. Pre- and post-vaccination rabies antibody titres were available for 18 animals, and all of the animals sero-converted after vaccination. We compared the haplotype frequencies of this group of 18 with the post-vaccination antibody titre, and showed that one haplotype was associated with a lower response (uncorrected P < 0.03). In general, Ethiopian wolves probably have an adequate amount of MHC variation to ensure the survival of the species. However, we sampled only the largest Ethiopian wolf population in Bale, and did not take the smaller populations further north into consideration.
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Affiliation(s)
- L J Kennedy
- Centre for Integrated Genomic Medical Research, University of Manchester, Manchester, UK.
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16
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Sultan SM, Butala P, Barr JS, Davidson EH, Weinstein AL, Knobel D, Saadeh PB, Warren SM, Coleman SR, Hazen A. 143: FAT GRAFTING ACCELERATES NEOVASCULARIZATION AND DECREASES FIBROSIS FOLLOWING THERMAL INJURY. Plast Reconstr Surg 2011. [DOI: 10.1097/01.prs.0000396830.21880.7e] [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: 11/25/2022]
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17
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Shah K, Ritter G, Gupta R, Knobel D, Kohn N, Marini C, Barrera R. Comparison Of APACHE I, APACHE III, SAPS And MODS Scores In Predicting Mortality In The Surgical Intensive Care Unit. J Surg Res 2011. [DOI: 10.1016/j.jss.2010.11.497] [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: 10/18/2022]
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18
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Nguyen PD, Tutela JP, Thanik VD, Knobel D, Allen RJ, Chang CC, Levine JP, Warren SM, Saadeh PB. Improved diabetic wound healing through topical silencing of p53 is associated with augmented vasculogenic mediators. Wound Repair Regen 2010; 18:553-9. [PMID: 20955346 DOI: 10.1111/j.1524-475x.2010.00638.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Diabetes is characterized by several poorly understood phenomena including dysfunctional wound healing and impaired vasculogenesis. p53, a master cell cycle regulator, is upregulated in diabetic wounds and has recently been shown to play a regulatory roles in vasculogenic pathways. We have previously described a novel method to topically silence target genes in a wound bed with small interfering (si)RNA. We hypothesized that silencing p53 results in improved diabetic wound healing and augmentation of vasculogenic mediators. Paired 4-mm stented wounds were created on diabetic db/db mice. Topically applied p53 siRNA, evenly distributed in an agarose matrix, was applied to wounds at postwound day 1 and 7 (matrix alone and nonsense siRNA served as controls). Animals were sacrificed at postwound days 10 and 24. Wound time to closure was photometrically assessed, and wounds were harvested for histology, immunohistochemistry, and immunofluorescence. Vasculogenic cytokine expression was evaluated via Western blot, reverse transcription-polymerase chain reaction, and enzyme-linked immunosorbent assay. The ANOVA/t-test was used to determine significance (p≤ 0.05). Local p53 silencing resulted in faster wound healing with wound closure at 18±1.3 d in the treated group vs. 28±1.0 d in controls. The treated group demonstrated improved wound architecture at each time point while demonstrating near-complete local p53 knockdown. Moreover, treated wounds showed a 1.92-fold increase in CD31 endothelial cell staining over controls. Western blot analysis confirmed near-complete p53 knockdown in treated wounds. At day 10, VEGF secretion (enzyme-linked immunosorbent assay) was significantly increased in treated wounds (109.3±13.9 pg/mL) vs. controls (33.0±3.8 pg/mL) while reverse transcription-polymerase chain reaction demonstrated a 1.86-fold increase in SDF-1 expression in treated wounds vs. controls. This profile was reversed after the treated wounds healed and before closure of controls (day 24). Augmented vasculogenic cytokine profile and endothelial cell markers are associated with improved diabetic wound healing in topical gene therapy with p53 siRNA.
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Affiliation(s)
- Phuong D Nguyen
- Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, New York 10016, USA
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Butala P, Sultan SM, Davidson EH, Crawford JL, Szpalski C, Knobel D, Marchac A, Saadeh PB, Warren SM, Coleman S, Hazen A. Progenitor Cell Mobilization Augments Fat Graft Survival. Plast Reconstr Surg 2010. [DOI: 10.1097/01.prs.0000388778.99220.39] [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: 11/25/2022]
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20
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Kandel AR, Deutsch G, Pokharel N, Knobel D, Marini C, Ritter G, Barrera R. Bleeding Risk Secondary to DVT Prophylaxis in Patients With Lower GI Bleeding. Chest 2010. [DOI: 10.1378/chest.9893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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21
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Butala P, Sultan SM, Davidson EH, Crawford JL, Szpalski C, Knobel D, Saadeh PB, Warren SM, Coleman S, Hazen A. Improved fat graft survival with mobilization of progenitor cells. J Am Coll Surg 2010. [DOI: 10.1016/j.jamcollsurg.2010.06.250] [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: 10/19/2022]
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22
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Davidson EH, Sultan SM, Butala P, Knobel D, Tutela JP, Canizares O, Wagner JI, Witek L, Hu B, Warren SM. Is lacunocanalicular flow the transducer of mechanical tension stress to osteogenesis in distraction? J Am Coll Surg 2010. [DOI: 10.1016/j.jamcollsurg.2010.06.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Butala P, Szpalski C, Knobel D, Crawford JL, Marchac A, Davidson EH, Sultan SM, Wetterau M, Saadeh PB, Warren SM. Modeling senescent wound healing with the Zmpste24 transgenic mouse. J Am Coll Surg 2010. [DOI: 10.1016/j.jamcollsurg.2010.06.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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24
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Canizares O, Allen RJ, Davidson EH, Knobel D, Butala P, Wagner IJ, Tutela JP, Saadeh PB, Warren SM, Hazen A. 112B: CHEWING THE FAT: THE IMPORTANCE OF PROCESSING TECHNIQUES ON FAT GRAFT SURVIVAL. Plast Reconstr Surg 2010. [DOI: 10.1097/01.prs.0000371847.20611.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Knobel D, Crawford J, Nguyen P, Tutela J, Thanik V, Klein J, Eydlin O, Cohen O, Davidson E, Levine J, Warren S, Saadeh P. Novel Mechanisms for Augmenting Diabetic Wound Healing. J Surg Res 2010. [DOI: 10.1016/j.jss.2009.11.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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26
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Besson J, Bonsack C, Gothuey I, Sanchez-Mazas P, Knobel D, Zullino DF. [Addiction]. Rev Med Suisse 2007; 3:122, 124-7. [PMID: 17354536] [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: 05/14/2023]
Abstract
This year review emphasizes three aspects coming from addiction psychiatry: 1. Psychosis and cannabis: a motivational approach. 2. Connection between addiction services and psychiatric wards. 3. Use of antiepileptic agents in addiction medicine.
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Affiliation(s)
- J Besson
- Service de psychiatrie communautaire, Département de psychiatrie-DP-CHUV, Lausanne.
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27
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Ozsahin M, Tsang R, Poortmans P, Belkacemi Y, Bolla M, Oner F, Landmann C, Castelain B, Buijsen J, Knobel D. 709 Outcome and patterns of failure in solitary plasmacytoma: a multicenter rare cancer network study on 258 patients. EJC Suppl 2003. [DOI: 10.1016/s1359-6349(03)90740-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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28
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Abstract
A 7-year-old boy with hepatic hydatid cysts developed fatal hypernatraemia after surgery for cyst removal where 20% hypertonic saline (HS) was used as a scolicidal agent. Symptoms of generalised seizures, tachycardia, and hypotension developed within 6 h of surgery. Serum electrolytes confirmed hypernatraemia (170 mmol/l) and hyperchloraemia (141 mmol/l). Despite attempts at resuscitation, he died 20 h later. The literature is reviewed, emphasising the potential dangers of the use of HS and the clinical presentation and appropriate management of hypernatraemia.
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Affiliation(s)
- J E J Krige
- Department of Surgery, University of Cape Town, Medical School, Observatory 7925, Cape Town, South Africa
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