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Blew KH, Chua A, Foreman J, Gbadegesin R, Jackson A, Nagaraj S, Sadun R, Wigfall D, Kirk AD, Chambers ET. Tailored use of belatacept in adolescent kidney transplantation. Am J Transplant 2020; 20:884-888. [PMID: 31550421 DOI: 10.1111/ajt.15611] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/08/2019] [Accepted: 09/03/2019] [Indexed: 01/25/2023]
Abstract
Adolescent transplant recipients are at risk for nonadherence, development of de novo donor-specific antibody (dnDSA), and allograft loss. Belatacept, a selective T cell costimulatory blocker, is associated with reduced dnDSA, improved renal function, and prolonged allograft survival when compared to calcineurin inhibitor-based regimens in adults; however, its use in children is scant. Three adolescents were initiated on belatacept between August 2017 and September 2018 at the time of kidney transplantation. Selection criteria included age ≥ 14 and EBV IgG + serostatus. Intraoperative alemtuzumab and methylprednisolone were given as induction therapy. Tailored maintenance therapy included steroid-free belatacept and sirolimus for two patients. One patient was initially maintained steroid-free on belatacept and belimumab, an inhibitor of B cell activating factor to treat concurrent systemic lupus erythematous; steroids were added subsequently. Renal function, biopsy-proven rejection, dnDSA, allograft survival, infection, nonadherence, and proteinuria were monitored. Renal function was 86, 73, 52 mL/min/1.73 m2 at 20, 20, and 8 months, respectively. There was 100% adherence to therapy and no development of dnDSA. All patients had treatable infections. One developed steroid-responsive acute cellular rejection. Belatacept-based regimens can be tailored for adolescent recipients with good short-term clinical outcomes.
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Affiliation(s)
- Kathryn H Blew
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Annabelle Chua
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - John Foreman
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Rasheed Gbadegesin
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Annette Jackson
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Shashi Nagaraj
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Rebecca Sadun
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina.,Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Del Wigfall
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Allan D Kirk
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina.,Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Eileen T Chambers
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
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Flores JB, Caraang C, Siddiqui Y, Foreman J, Tinklenberg L, Somerville-Reeser J, Barbarash S. The Impact of a Dedicated Heart Failure (HF) Clinic on Hospitalization Rates, Hospitalization Costs, and Left Ventricular Ejection Fraction (LVEF) in Systolic Heart Failure Patients. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.543] [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]
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Keel S, Foreman J, Xie J, Taylor HR, Dirani M. Prevalence and associations of presenting near-vision impairment in the Australian National Eye Health Survey. Eye (Lond) 2018; 32:506-514. [PMID: 29473920 DOI: 10.1038/eye.2017.317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 11/03/2017] [Indexed: 11/09/2022] Open
Abstract
PurposeTo describe the prevalence and associations of presenting near vision impairment (NVI) in Indigenous and non-Indigenous Australians.MethodsA sample of 3098 non-Indigenous Australians (aged 50-98 years) and 1738 Indigenous Australians (aged 40-92 years) living in 30 randomly selected Australian sites were examined as part of the population-based National Eye Health Survey (NEHS). Binocular presenting NVI was defined as near vision worse than N8 (20/50).ResultsIn total, 4817 participants (99.6% of the total sample, comprising 3084 non-Indigenous Australians and 1733 Indigenous Australians) had complete data on near visual acuity. The overall weighted prevalence of presenting NVI was 21.6% (95% CI: 19.6, 23.8) in non-Indigenous Australians and 34.7% (95% CI: 29.2, 40.8) among Indigenous Australians. In the non-Indigenous population, higher odds of presenting NVI were associated with older age (OR=1.68 per 10 years, P<0.001), fewer years of education (OR=0.95 per year, P<0.001) and residing in Remote geographical areas (OR=1.71, P=0.003) after multivariate adjustments. Among Indigenous Australians, older age (OR=1.69 per 10 years, P<0.001), fewer years of education (OR=0.91 per year, P=0.003) and residing in Inner Regional (OR=2.01, P=0.008), Outer Regional (OR=2.17, P=<0.001) and Remote geographical areas (OR=1.72, P=0.03) were associated with greater odds of presenting NVI.ConclusionsNVI represents a notable public health concern in Australia, affecting approximately 20% of non-Indigenous Australian and one-third of Indigenous Australian adults.
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Affiliation(s)
- S Keel
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, Melbourne, VIC, Australia
| | - J Foreman
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, Melbourne, VIC, Australia.,Ophthalmology, University of Melbourne, Department of Surgery, Melbourne, VIC, Australia
| | - J Xie
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, Melbourne, VIC, Australia
| | - H R Taylor
- Indigenous Eye Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - M Dirani
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, Melbourne, VIC, Australia.,Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
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Pelletier JH, Nagaraj S, Gbadegesin R, Wigfall D, McGann KA, Foreman J. Neutropenic enterocolitis (typhlitis) in a pediatric renal transplant patient. A case report and review of the literature. Pediatr Transplant 2017; 21. [PMID: 28664544 DOI: 10.1111/petr.13022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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] [Accepted: 06/08/2017] [Indexed: 12/15/2022]
Abstract
NE (typhlitis) is a potentially life-threatening disease process characterized by bowel wall edema, ulceration, and hemorrhage in an immunosuppressed patient. We report a 15-year-old boy status post deceased donor renal transplantation who presented with fever, abdominal pain, and diarrhea. Laboratory studies revealed neutropenia 5 days prior to admission, and abdominal computed tomography revealed bowel wall thickening in the cecum consistent with NE. He was treated with piperacillin-tazobactam and gentamicin and recovered. To our knowledge, this is the first report of a case of NE in a pediatric kidney transplant recipient.
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Affiliation(s)
| | - Shashi Nagaraj
- Division of Pediatric Nephrology, Department of Pediatrics, Duke University Health System, Durham, NC, USA
| | - Rasheed Gbadegesin
- Division of Pediatric Nephrology, Department of Pediatrics, Duke University Health System, Durham, NC, USA
| | - Delbert Wigfall
- Division of Pediatric Nephrology, Department of Pediatrics, Duke University Health System, Durham, NC, USA
| | - Kathleen A McGann
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Duke University Health System, Durham, NC, USA
| | - John Foreman
- Division of Pediatric Nephrology, Department of Pediatrics, Duke University Health System, Durham, NC, USA
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Elahi S, Homstad A, Vaidya H, Stout J, Hall G, Wu G, Conlon P, Routh JC, Wiener JS, Ross SS, Nagaraj S, Wigfall D, Foreman J, Adeyemo A, Gupta IR, Brophy PD, Rabinovich CE, Gbadegesin RA. Rare variants in tenascin genes in a cohort of children with primary vesicoureteric reflux. Pediatr Nephrol 2016; 31:247-53. [PMID: 26408188 PMCID: PMC4747108 DOI: 10.1007/s00467-015-3203-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 05/24/2015] [Revised: 08/10/2015] [Accepted: 08/26/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Primary vesicoureteral reflux (PVUR) is the most common malformation of the kidney and urinary tract, and reflux nephropathy is a major cause of chronic kidney disease in children. Recently, we reported mutations in the tenascin XB gene (TNXB) as a cause of PVUR with joint hypermobility. METHODS To define the role of rare variants in tenascin genes in the etiology of PVUR, we screened a cohort of patients with familial PVUR (FPVUR) and non-familial PVUR (NFPVUR) for rare missense variants inTNXB and the tenascin C gene (TNC) after excluding mutations in ROBO2 and SOX17. RESULTS The screening procedure identified 134 individuals from 112 families with PVUR; two families with mutations in ROBO2 were excluded from further analysis. Rare missense variants in TNXB were found in the remaining 110 families, of which 5/55 (9%) families had FPVUR and 2/55 (4%) had NFPVUR. There were no differences in high-grade reflux or renal parenchymal scarring between patients with and without TNXB variants. All patients with TNXB rare variants who were tested exhibited joint hypermobility. Overall we were able to identify causes of FPVUR in 7/57 (12%) families (9% in TNXB and 3% in ROBO2). CONCLUSIONS In conclusion, the identification of a rare missense variant in TNXB in combination with a positive family history of VUR and joint hypermobility may represent a non-invasive method to diagnose PVUR and warrants further evaluation in other cohorts.
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Affiliation(s)
- Shan Elahi
- Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Alison Homstad
- Department of Pediatrics, Duke University Medical Center, Durham, NC
,Duke Molecular Physiology Institute, Durham, NC
| | - Himani Vaidya
- Department of Pediatrics, Duke University Medical Center, Durham, NC
,Duke Molecular Physiology Institute, Durham, NC
| | - Jennifer Stout
- Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Gentzon Hall
- Duke Molecular Physiology Institute, Durham, NC
,Department of Medicine, Duke University Medical Center, Durham, NC
| | - Guanghong Wu
- Duke Molecular Physiology Institute, Durham, NC
,Department of Medicine, Duke University Medical Center, Durham, NC
| | - Peter Conlon
- Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Jonathan C. Routh
- Department of Pediatrics, Duke University Medical Center, Durham, NC
,Department of Surgery, Division of Urology, Duke University Medical Center, Durham NC
| | - John S. Wiener
- Department of Pediatrics, Duke University Medical Center, Durham, NC
,Department of Surgery, Division of Urology, Duke University Medical Center, Durham NC
| | - Sherry S. Ross
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham NC
,Department of Urology, Pediatric Urology, University of North Carolina Chapel Hill School of Medicine, Chapel Hill, NC
| | - Shashi Nagaraj
- Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Delbert Wigfall
- Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - John Foreman
- Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Adebowale Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892-5635, USA
| | - Indra R. Gupta
- Department of Pediatrics and Human Genetics, McGill University, Montreal, Quebec, Canada
| | | | | | - Rasheed A. Gbadegesin
- Department of Pediatrics, Duke University Medical Center, Durham, NC
,Duke Molecular Physiology Institute, Durham, NC
,To whom correspondence should be addressed:
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Phelan PJ, Hall G, Wigfall D, Foreman J, Nagaraj S, Malone AF, Winn MP, Howell DN, Gbadegesin R. Variability in phenotype induced by the podocin variant R229Q plus a single pathogenic mutation. Clin Kidney J 2015; 8:538-42. [PMID: 26413278 PMCID: PMC4581382 DOI: 10.1093/ckj/sfv063] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 03/26/2015] [Accepted: 06/29/2015] [Indexed: 01/23/2023] Open
Abstract
Background Mutations in podocin (NPHS2) are the most common cause of childhood onset autosomal recessive steroid-resistant nephrotic syndrome (SRNS). The disease is characterized by early-onset proteinuria, resistance to immunosuppressive therapy and rapid progression to end-stage renal disease. Compound heterozygous changes involving the podocin variant R229Q combined with another pathogenic mutation have been associated with a mild phenotype with disease onset often in adulthood. Methods We screened 19 families with early-onset SRNS for mutations in NPHS2 and WT1 and identified four disease-causing mutations (three in NPHS2 and one in WT1) prior to planned whole-exome sequencing. Results We describe two families with three individuals presenting in childhood who are compound heterozygous for R229Q and one other pathogenic NPHS2 mutation, either L327F or A297V. One child presented at age 4 years (A297V plus R229Q) and the other two at age 13 (L327F plus R229Q), one with steadily deteriorating renal function. Conclusions These cases highlight the phenotypic variability associated with the NPHS2 R229Q variant plus pathogenic mutation. Individuals may present with early aggressive disease.
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Affiliation(s)
- Paul J Phelan
- Duke Molecular Physiology Institute , Duke University , Durham, NC , USA ; Division of Nephrology, Department of Medicine , Duke University Medical Center , Durham, NC , USA ; Department of Nephrology , Royal Infirmary of Edinburgh, NHS Lothian , Edinburgh , UK
| | - Gentzon Hall
- Duke Molecular Physiology Institute , Duke University , Durham, NC , USA ; Division of Nephrology, Department of Medicine , Duke University Medical Center , Durham, NC , USA
| | - Delbert Wigfall
- Department of Nephrology , Royal Infirmary of Edinburgh, NHS Lothian , Edinburgh , UK
| | - John Foreman
- Department of Nephrology , Royal Infirmary of Edinburgh, NHS Lothian , Edinburgh , UK
| | - Shashi Nagaraj
- Department of Nephrology , Royal Infirmary of Edinburgh, NHS Lothian , Edinburgh , UK
| | - Andrew F Malone
- Duke Molecular Physiology Institute , Duke University , Durham, NC , USA ; Division of Nephrology, Department of Medicine , Duke University Medical Center , Durham, NC , USA
| | - Michelle P Winn
- Duke Molecular Physiology Institute , Duke University , Durham, NC , USA ; Division of Nephrology, Department of Medicine , Duke University Medical Center , Durham, NC , USA
| | - David N Howell
- Department of Pathology , Duke University Medical Center , Durham, NC , USA
| | - Rasheed Gbadegesin
- Duke Molecular Physiology Institute , Duke University , Durham, NC , USA ; Department of Pediatrics , Duke University Medical Center , Durham, NC , USA
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7
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Gbadegesin RA, Adeyemo A, Webb NJA, Greenbaum LA, Abeyagunawardena A, Thalgahagoda S, Kale A, Gipson D, Srivastava T, Lin JJ, Chand D, Hunley TE, Brophy PD, Bagga A, Sinha A, Rheault MN, Ghali J, Nicholls K, Abraham E, Janjua HS, Omoloja A, Barletta GM, Cai Y, Milford DD, O'Brien C, Awan A, Belostotsky V, Smoyer WE, Homstad A, Hall G, Wu G, Nagaraj S, Wigfall D, Foreman J, Winn MP. HLA-DQA1 and PLCG2 Are Candidate Risk Loci for Childhood-Onset Steroid-Sensitive Nephrotic Syndrome. J Am Soc Nephrol 2014; 26:1701-10. [PMID: 25349203 DOI: 10.1681/asn.2014030247] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 09/09/2014] [Indexed: 12/11/2022] Open
Abstract
Steroid-sensitive nephrotic syndrome (SSNS) accounts for >80% of cases of nephrotic syndrome in childhood. However, the etiology and pathogenesis of SSNS remain obscure. Hypothesizing that coding variation may underlie SSNS risk, we conducted an exome array association study of SSNS. We enrolled a discovery set of 363 persons (214 South Asian children with SSNS and 149 controls) and genotyped them using the Illumina HumanExome Beadchip. Four common single nucleotide polymorphisms (SNPs) in HLA-DQA1 and HLA-DQB1 (rs1129740, rs9273349, rs1071630, and rs1140343) were significantly associated with SSNS at or near the Bonferroni-adjusted P value for the number of single variants that were tested (odds ratio, 2.11; 95% confidence interval, 1.56 to 2.86; P=1.68×10(-6) (Fisher exact test). Two of these SNPs-the missense variants C34Y (rs1129740) and F41S (rs1071630) in HLA-DQA1-were replicated in an independent cohort of children of white European ancestry with SSNS (100 cases and ≤589 controls; P=1.42×10(-17)). In the rare variant gene set-based analysis, the best signal was found in PLCG2 (P=7.825×10(-5)). In conclusion, this exome array study identified HLA-DQA1 and PLCG2 missense coding variants as candidate loci for SSNS. The finding of a MHC class II locus underlying SSNS risk suggests a major role for immune response in the pathogenesis of SSNS.
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Affiliation(s)
- Rasheed A Gbadegesin
- Department of Pediatrics, Division of Nephrology and Center for Human Genetics, Duke University Medical Center, Durham, North Carolina
| | - Adebowale Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland;
| | - Nicholas J A Webb
- Department of Pediatric Nephrology and NIHR/Wellcome Trust Children's Clinical Research Facility, The University of Manchester, Manchester Academic Health Science Centre, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Larry A Greenbaum
- Division of Pediatric Nephrology, Emory University School of Medicine and Children's Healthcare of Atlanta, Georgia
| | | | | | - Arundhati Kale
- Division of Nephrology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Debbie Gipson
- Department of Pediatrics, Division of Nephrology, University of Michigan, Ann Arbor, Michigan
| | - Tarak Srivastava
- Division of Nephrology, Children's Mercy Hospital, Kansas City, Missouri
| | - Jen-Jar Lin
- Department of Pediatrics, Division of Nephrology, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | - Deepa Chand
- Department of Pediatrics, Division of Nephrology, Rush University, Chicago, Illinois
| | - Tracy E Hunley
- Department of Pediatrics, Division of Nephrology, Vanderbilt University, Nashville, Tennessee
| | - Patrick D Brophy
- Department of Pediatrics, Division of Nephrology, University of Iowa, Iowa City, Iowa
| | - Arvind Bagga
- Department of Pediatrics, Division of Nephrology, All India Institute of Medical Science, Ansari Nagar, New Delhi, India
| | - Aditi Sinha
- Department of Pediatrics, Division of Nephrology, All India Institute of Medical Science, Ansari Nagar, New Delhi, India
| | - Michelle N Rheault
- Department of Pediatrics, Division of Nephrology, University of Minnesota Amplatz Children's Hospital, Minneapolis, Minnesota
| | - Joanna Ghali
- Department of Nephrology, Royal Melbourne Hospital, Parkville, Australia
| | - Kathy Nicholls
- Department of Nephrology, Royal Melbourne Hospital, Parkville, Australia
| | - Elizabeth Abraham
- Department of Pediatrics, Division of Nephrology, St. Louis University, St. Louis, Missouri
| | - Halima S Janjua
- Pediatric Institute, Center for Pediatric Nephrology, Cleveland Clinic, Cleveland, Ohio
| | - Abiodun Omoloja
- Division of Nephrology, Dayton Children's Hospital, Dayton, Ohio
| | | | - Yi Cai
- Division of Nephrology, Helen Devos Children's Hospital, Grand Rapids, Michigan
| | | | | | - Atif Awan
- Division of Nephrology, The Children's University Hospital, Dublin, Ireland
| | - Vladimir Belostotsky
- Department of Pediatrics, Division of Nephrology, Leeds Teaching Hospital, Leeds, United Kingdom
| | - William E Smoyer
- Center for Clinical and Translational Research, Research Institute at Nationwide Children's Hospital, Columbus, Ohio; and
| | - Alison Homstad
- Department of Pediatrics, Division of Nephrology and Center for Human Genetics, Duke University Medical Center, Durham, North Carolina
| | - Gentzon Hall
- Department of Medicine, Division of Nephrology and Center for Human Genetics, Duke University Medical Center, Durham, North Carolina
| | - Guanghong Wu
- Department of Medicine, Division of Nephrology and Center for Human Genetics, Duke University Medical Center, Durham, North Carolina
| | - Shashi Nagaraj
- Department of Pediatrics, Division of Nephrology and Center for Human Genetics, Duke University Medical Center, Durham, North Carolina
| | - Delbert Wigfall
- Department of Pediatrics, Division of Nephrology and Center for Human Genetics, Duke University Medical Center, Durham, North Carolina
| | - John Foreman
- Department of Pediatrics, Division of Nephrology and Center for Human Genetics, Duke University Medical Center, Durham, North Carolina
| | - Michelle P Winn
- Department of Medicine, Division of Nephrology and Center for Human Genetics, Duke University Medical Center, Durham, North Carolina
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Affiliation(s)
- B Bergstrom
- University of Illinois; Urbana Illinois United States
| | - J Foreman
- University of Illinois; Urbana Illinois United States
| | - C Foreman
- University of Illinois; Urbana Illinois United States
| | - A Barger
- University of Illinois; Urbana Illinois United States
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9
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Foreman J, Foreman C. “Positive” Plasma tCO2Tests in Racehorses in New York, Maine, and California Result from Day-to-Day Instrument Variability. Equine Vet J 2014. [DOI: 10.1111/evj.12267_52] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- J Foreman
- University of Illinois; Urbana Illinois United States
| | - C Foreman
- University of Illinois; Urbana Illinois United States
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10
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Affiliation(s)
- J Foreman
- University of Illinois; Urbana Illinois United States
| | - C Foreman
- University of Illinois; Urbana Illinois United States
| | - B Bergstrom
- University of Illinois; Urbana Illinois United States
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11
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Foreman C, Foreman J, Bergstrom B. Efficacy of Intravenous Dexamethasone Versus Placebo in Experimental Foot Lameness in Horses. Equine Vet J 2014. [DOI: 10.1111/evj.12267_7] [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] [Indexed: 11/28/2022]
Affiliation(s)
- C Foreman
- University of Illinois; Urbana Illinois United States
| | - J Foreman
- University of Illinois; Urbana Illinois United States
| | - B Bergstrom
- University of Illinois; Urbana Illinois United States
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12
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Rajan S, Foreman J, Wallis MG, Caldas C, Britton P. Multidisciplinary decisions in breast cancer: does the patient receive what the team has recommended? Br J Cancer 2013; 108:2442-7. [PMID: 23736032 PMCID: PMC3694248 DOI: 10.1038/bjc.2013.267] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 05/08/2013] [Accepted: 05/12/2013] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND A multidisciplinary team (MDT) approach to breast cancer management is the gold standard. The aim is to evaluate MDT decision making in a modern breast unit. METHODS All referrals to the breast MDT where breast cancer was diagnosed from 1 July 2009 to 30 June 2011 were included. Multidisciplinary team decisions were compared with subsequent patient management and classified as concordant or discordant. RESULTS Over the study period, there were 3230 MDT decisions relating to 705 patients. Overall, 91.5% (2956 out of 3230) of decisions were concordant, 4.5% (146 out of 3230), were discordant and 4% (128 out of 3230) had no MDT decision. Of 146 discordant decisions, 26 (17.8%) were considered 'unjustifiable' as there was no additional information available after the MDT to account for the change in management. The remaining 120 discordant MDT decisions were considered 'justifiable', as management was altered due to patient choice (n=61), additional information available after MDT (n=54) or MDT error (n=5). CONCLUSION The vast majority of MDT decisions are implemented. Management alteration was most often due to patient choice or additional information available after the MDT. A minority of management alterations were 'unjustifiable' and the authors recommend that any patient whose treatment is subsequently changed should have MDT rediscussion prior to treatment.
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Affiliation(s)
- S Rajan
- Cambridge Breast Unit, Box 97, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK.
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Gbadegesin RA, Brophy PD, Adeyemo A, Hall G, Gupta IR, Hains D, Bartkowiak B, Rabinovich CE, Chandrasekharappa S, Homstad A, Westreich K, Wu G, Liu Y, Holanda D, Clarke J, Lavin P, Selim A, Miller S, Wiener JS, Ross SS, Foreman J, Rotimi C, Winn MP. TNXB mutations can cause vesicoureteral reflux. J Am Soc Nephrol 2013; 24:1313-22. [PMID: 23620400 DOI: 10.1681/asn.2012121148] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Primary vesicoureteral reflux (VUR) is the most common congenital anomaly of the kidney and the urinary tract, and it is a major risk factor for pyelonephritic scarring and CKD in children. Although twin studies support the heritability of VUR, specific genetic causes remain elusive. We performed a sequential genome-wide linkage study and whole-exome sequencing in a family with hereditary VUR. We obtained a significant multipoint parametric logarithm of odds score of 3.3 on chromosome 6p, and whole-exome sequencing identified a deleterious heterozygous mutation (T3257I) in the gene encoding tenascin XB (TNXB in 6p21.3). This mutation segregated with disease in the affected family as well as with a pathogenic G1331R change in another family. Fibroblast cell lines carrying the T3257I mutation exhibited a reduction in both cell motility and phosphorylated focal adhesion kinase expression, suggesting a defect in the focal adhesions that link the cell cytoplasm to the extracellular matrix. Immunohistochemical studies revealed that the human uroepithelial lining of the ureterovesical junction expresses TNXB, suggesting that TNXB may be important for generating tensile forces that close the ureterovesical junction during voiding. Taken together, these results suggest that mutations in TNXB can cause hereditary VUR.
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Gbadegesin R, Lavin P, Foreman J, Winn M. Pathogenesis and therapy of focal segmental glomerulosclerosis: an update. Pediatr Nephrol 2011; 26:1001-15. [PMID: 21110043 PMCID: PMC3624015 DOI: 10.1007/s00467-010-1692-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 09/28/2010] [Accepted: 10/04/2010] [Indexed: 02/07/2023]
Abstract
Focal and segmental glomerulosclerosis (FSGS) is an important cause of steroid-resistant nephrotic syndrome in adults and children. It is responsible for 5-20% of all cases of end-stage kidney disease (ESKD) in the United States. The pathogenesis of FSGS has not been fully elucidated; however, data from molecular studies of familial cases in the last two decades suggest that FSGS is a defect of the podocyte. The therapeutic agents available for treatment of FSGS are not very effective and only a small percentage of affected individuals will achieve complete remission. Recent data from molecular biology and molecular genetics has provided insight into the mechanisms of action of old agents and also identification of other novel therapeutic targets. This review focuses on recent advances in the molecular pathogenesis of FSGS and currently available therapeutic agents as well as potential novel therapies.
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Affiliation(s)
- Rasheed Gbadegesin
- Department of Pediatrics, Duke University Medical Center, Durham, NC 27710, USA.
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15
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Abstract
The nasal actions of histamine were originally attributed to vascular and neuronal H(1) receptor activation. Recent studies have identified a H(3) receptor that contributes to histamine-induced inflammation via the inhibition of sympathetic activity. There is also evidence that pollen-induced nasal blockage can be treated by H(1) antagonists. However, although desloratadine might offer relief, this is unlikely to be through inhibition of nasal H(1) receptors. Despite evidence of an active H(2) receptor on nasal vasculature, this receptor subtype appears to play only a minor role in nasal inflammation. The activation of H(1) receptors cannot account for all of the acute actions of histamine in the nasal airway.
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Affiliation(s)
- Thomas Taylor-Clark
- Department of Pharmacology, University College London, Gower Street, London WC1E 6BT, UK
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16
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Abstract
1. The aim of this study was to investigate the mechanisms by which histamine causes nasal blockage. Histamine, 40-800 microg, intranasally into each nostril, induced significant blockage of the nasal airway in normal human subjects, as measured by acoustic rhinometry. 2. Oral pretreatment with cetirizine, 5-30 mg, the H1 antagonist, failed to reverse completely the nasal blockage induced by histamine, 400 microg. 3. Dimaprit, 50-200 microg, the H2 agonist, intranasally, caused nasal blockage, which was reversed by oral pretreatment with ranitidine, 75 mg, the H2 antagonist. 4. A combination of cetirizine, 20 mg, and ranitidine, 75 mg, caused greater inhibition of the nasal blockage caused by histamine, 400 microg, than cetirizine alone. In the presence of both antagonists, there was residual histamine-induced nasal blockage. 5. R-alpha-methylhistamine (R-alpha-MeH), 100-600 microg, the H3 agonist, intranasally, caused nasal blockage, which was not inhibited by either cetirizine or ranitidine. 6. Thioperamide, 700 microg, the H3 antagonist, intranasally, reversed the R-alpha-MeH-induced nasal blockage. Thioperamide alone had no significant action on the nasal blockage induced by histamine, 400 and 1000 microg, but, in the presence of cetirizine, 20 mg, thioperamide further reduced the histamine-induced nasal blockage. 7. Corynanthine, 2 mg, the alpha1-adrenoceptor antagonist, administered intranasally, caused nasal blockage. 8. Corynanthine produced a greater increase in nasal blockage when in combination with bradykinin compared to its combination with R-alpha-MeH. 9. There appears to be a contribution of H1, H2 and H3 receptors to histamine-induced nasal blockage in normal human subjects. The sympathetic nervous system actively maintains nasal patency and we suggest that activation of nasal H3 receptors may downregulate sympathetic activity.
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Affiliation(s)
- Thomas Taylor-Clark
- Department of Pharmacology, University College London, Gower Street, London WC1E 6BT
| | - Reena Sodha
- Department of Pharmacology, University College London, Gower Street, London WC1E 6BT
| | - Ben Warner
- Department of Pharmacology, University College London, Gower Street, London WC1E 6BT
| | - John Foreman
- Department of Pharmacology, University College London, Gower Street, London WC1E 6BT
- Author for correspondence:
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Andreoli SP, Brewer ED, Watkins S, Fivush B, Powe N, Shevchek J, Foreman J. American Society of Pediatric Nephrology Position Paper on Linking Reimbursement to Quality of Care: Table 1. J Am Soc Nephrol 2005; 16:2263-9. [PMID: 15987749 DOI: 10.1681/asn.2005020186] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Sharon P Andreoli
- James Whitcomb Riley Hospital for Children, Riley Research Room 234B, 699 West Drive, Indianapolis, IN 46202, USA.
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Bunyard P, Handley M, Pollara G, Rutault K, Wood I, Chaudry M, Alderman C, Foreman J, Katz DR, Chain BM. Ribotoxic stress activates p38 and JNK kinases and modulates the antigen-presenting activity of dendritic cells. Mol Immunol 2003; 39:815-27. [PMID: 12617997 DOI: 10.1016/s0161-5890(02)00262-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [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: 11/24/2022]
Abstract
Initiation of adaptive immunity requires activation of dendritic cells (DC) by "danger" signals. This study examines the functional consequences of activating a cellular stress response in human DC. Anisomycin, a potent inducer of this "stress" response, selectively activates p38 kinase in DC at low concentrations, and both p38 kinases and JNKs at higher concentrations. Activation of p38, was accompanied by an increase in the potency of dendritic cells to activate T cells. In contrast to LPS, anisomycin had no effect on the expression of several DC activation markers. Anisomycin synergised with LPS in driving release of IL-12 and TNF-alpha. Anisomycin also enhanced the formation of clusters between DC and T cells. Enhanced cytokine release and clustering were both inhibited by the selective p38 alpha and p38 beta inhibitor SB203580. This study demonstrates that the cellular stress response, mediated via p38 kinases, plays an important role in the regulation of several aspects of DC function.
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Affiliation(s)
- Peter Bunyard
- Department of Immunology and Molecular Biology, Windeyer Institute for Medical Sciences, University College London, 46 Cleveland Street, London W1T 4JF, UK
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19
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Abstract
Cardiac transplantation for sarcomas has met with little success and the surgical treatment remains controversial. We describe the case of a 56-year-old woman who was referred for transplantation after two procedures in which undifferentiated atrial sarcoma was locally excised successfully. The patient underwent atrial homograft transplantation, the first reported to date. Advantages of the procedure include wide atrial resection and no need for immune suppression.
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Affiliation(s)
- S C Stoica
- Department of Cardiothoracic Surgery and Transplantation, Papworth Hospital, Cambridge, UK
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Alford P, Geller S, Richrdson B, Slater M, Honnas C, Foreman J, Robinson J, Messer M, Roberts M, Goble D, Hood D, Chaffin M. A multicenter, matched case-control study of risk factors for equine laminitis. Prev Vet Med 2001; 49:209-22. [PMID: 11311954 DOI: 10.1016/s0167-5877(01)00188-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.7] [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: 10/18/2022]
Abstract
Risk factors for equine laminitis were examined in a prospective case-control study of the 258 cases seen at six collaborating veterinary teaching hospitals over a 32-month period. Case-control pairs were matched on institution, clinician, and season of diagnosis. The 90% of case-control pairs (78 acute, 155 chronic) that had complete data for age, gender, and breed were used in separate conditional logistic-regression models for acute and chronic laminitis. There was an increase in risk for horses with acute laminitis from 5 to 7 years of age (OR 4.7, 95% CI 1.3-16) and from 13 to 31 years of age (OR 3.9, 95% CI 1.3-12) (both compared to <5 years); risk was increased for chronic laminitis from 10 to 14 years (OR 3, 95% CI 1.4-6.8) and from 15 to 38 years (OR 2.9, 95% CI 1.4-6.1) (both compared to <6 years). Mares - but not stallions - were more likely than geldings to develop acute laminitis (OR 2.6, 95% CI 1.1-6.2) and chronic laminitis (OR 2.0, 95% CI 1.1-3.6). In the small acute-laminitis data set, the breed variable was collapsed into three categories: Thoroughbred (THB, reference), the Quarter Horse (QH), and other (non-QH-THB). The non-QH-THB group was at increased risk of acute laminitis (OR 3.8, 95% CI 1.2-11.8). For the seven breed-group categories used in the chronic-laminitis model, however, all non-THB breed groups appeared significantly at risk as compared to the THB, with odds ratios ranging from 3.3 (95% CI 1.3-8.30) for the QH to 9.1 (95% CI 2.1-39.3) for ponies.
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Affiliation(s)
- P Alford
- Department of Veterinary Anatomy and Public Health, College of Veterinary Medicine, Texas A&M University, Mail Stop 4458, College Station, TX 77843-4458, USA
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21
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Favery B, Ryan E, Foreman J, Linstead P, Boudonck K, Steer M, Shaw P, Dolan L. KOJAK encodes a cellulose synthase-like protein required for root hair cell morphogenesis in Arabidopsis. Genes Dev 2001; 15:79-89. [PMID: 11156607 PMCID: PMC312599 DOI: 10.1101/gad.188801] [Citation(s) in RCA: 192] [Impact Index Per Article: 8.3] [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: 11/25/2022]
Abstract
The cell wall is an important determinant of plant cell form. Here we define a class of Arabidopsis root hair mutants with defective cell walls. Plants homozygous for kojak (kjk) mutations initiate root hairs that rupture at their tip soon after initiation. The KJK gene was isolated by positional cloning, and its identity was confirmed by the molecular complementation of the Kjk(-) phenotype and the sequence of three kjk mutant alleles. KOJAK encodes a cellulose synthase-like protein, AtCSLD3. KOJAK/AtCSLD3 is the first member of this subfamily of proteins to be shown to have a function in cell growth. Subcellular localization of the KOJAK/AtCSLD3 protein using a GFP fusion shows that KOJAK/AtCSLD3 is located on the endoplasmic reticulum, indicating that KOJAK/AtCSLD3 is required for the synthesis of a noncellulosic wall polysaccharide. Consistent with the cell specific defect in the roots of kjk mutants, KOJAK/AtCSDL3 is preferentially expressed in hair cells of the epidermis. The Kjk(-) phenotype and the pattern of KOJAK/AtCSLD3 expression suggest that this gene acts early in the process of root hair outgrowth. These results suggest that KOJAK/AtCSLD3 is involved in the biosynthesis of beta-glucan-containing polysaccharides that are required during root hair elongation.
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Affiliation(s)
- B Favery
- Department of Cell Biology, John Innes Centre, Norwich, NR4 7UH, UK
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22
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Abstract
In the first two years of operation of a tissue bank, bone was processed on 63 occasions from 22 cadaveric donors and on 37 occasions from 185 living donors. A standardized protocol for microbiological sampling, culturing and interpretation of the results was developed. Semi-quantitative culture of washings of bone was performed on receipt by the tissue bank, and broth enrichment cultures of bone samples were performed at the end of processing, and again after irradiation. One bone donation was rejected because of heavy contamination with Klebsiella sp. on receipt, and contamination of six donations with Burkholderia cepacia was shown to have come from a water deionizer. Contamination of bone on receipt by the tissue bank decreased during the study period, probably related to increasing experience of staff harvesting bone. Microbiological surveillance of bone grafts protect recipients from infection, and is useful as a quality control of the process of bone banking.
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Affiliation(s)
- M Farrington
- Clinical Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Cambridge, UK
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Abstract
Commodification of low-cost diagnostic technologies (LCDTs) carries the risk of an unintended and potentially worrisome shift in how we conceive of health assessment. Optimizing practice requires a balanced understanding of both the beneficial and harmful impact of the use of LCDTs and the development of system incentives for appropriate use.
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Colquhoun D, Foreman J. Complementary medicine in the medical curriculum. J R Soc Med 1997; 90:178. [PMID: 9135625 PMCID: PMC1296197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Abstract
Allogeneic bone grafts are frequently sterilized by means of ionizing radiation. We investigated the effects of ionizing radiation on both quasistatic and impact mechanical properties of human bone. Specimens from four paired femora of four donors received doses of 29.5 kGy ("standard," frequently used by tissue banks), 94.7 kGy ("high"), or 17 kGy ("low") of ionizing radiation. Young's modulus was unchanged by any level of radiation. Radiation significantly reduced bending strength, work to fracture, and impact energy absorption; in each case, the severity of the effect increased from low to standard to high doses of radiation. Work to fracture was particularly severely degraded; specimens irradiated with the high dose absorbed only 5% of the energy of the controls. Radiation, even at relatively low doses, makes the bone more brittle and thereby reduces its energy-absorbing capacity. We suggest that because the level of radiation required to produce an acceptable level of viral inactivation (90 kGy) produces an unacceptable reduction in the mechanical integrity of the bone, low levels of radiation, sufficient to produce bacterial safety, should be used in conjunction with biological tests to ensure viral safety.
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Affiliation(s)
- J D Currey
- Department of Biology, University of York, England, U.K.
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26
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Farrington M, Matthews I, Jestice HK, Scott MA, Marcus RE, Hunt C, Foreman J. Bacterial contamination of autologous bone marrow during processing. J Hosp Infect 1996; 34:230-3. [PMID: 8923280 DOI: 10.1016/s0195-6701(96)90072-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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27
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Jestice HK, Farrington M, Hunt C, Matthews I, Scott MA, Foreman J, Marcus RE. Bacterial contamination of peripheral blood progenitor cells for transplantation. Transfus Med 1996; 6:103-10. [PMID: 8809956 DOI: 10.1046/j.1365-3148.1996.d01-57.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Peripheral blood progenitor cells (PBPC) were obtained from 128 apheresis harvests on 64 patients and were tested in duplicate for microbiological contamination (1) after collection and (2) after thawing, following processing and cryopreservation. In this study we have attempted to improve the monitoring of contamination in peripheral blood progenitor cell collections by identifying exogenous contamination that probably originated from the testing laboratory and is therefore not clinically significant. We found no contamination in 82% of harvests, 1.6% of harvests to be significantly contaminated and organisms were isolated from 16.4% that were assessed as clinically nonsignificant. Our experience indicates that the choice of microbiological methods will influence the results and their clinical relevance. No samples were positive by direct culture. We recommend that sampling should be performed at more than one stage during the procedure and that initially only the post-thaw samples be analysed. Testing should be performed by enrichment culture in duplicate only and if positive to aid interpretation the post-collection sample should then be cultured. No patient given nonsignificantly contaminated graft without antibiotic cover suffered infection from the identified organism. The incidence of significant contamination was low and we recommend that in these cases PBPC grafts can be infused safely provided prophylactic antibiotic cover is given.
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Affiliation(s)
- H K Jestice
- Department of Clinical Haematology, Addenbrooke's NHS Trust, Cambridge, U.K
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28
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Goldsmith P, Bunker C, Leslie T, Foreman J, Dowd PM. The effect of topical steroid on the actions of vasoconstrictor and vasodilator peptides in human skin. Skin Pharmacol 1996; 9:289-97. [PMID: 8990503 DOI: 10.1159/000211427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The effect of topical application of clobetasol propionate ointment (0.05% w/v) on the vascular changes induced by intradermal injections of histamine, calcitonin gene-related peptide, substance P, endothelin-1 and compound 48/80 was studied. Clobetasol propionate ointment was applied topically under occlusion to the forearm skin of healthy volunteers and vehicle base was applied to the contralateral forearm. The intradermal injections were made 4 h or, in a separate study, 72 h after topical steroid application. Responses were measured by planimetry and laser Doppler flowmetry. Four hours application of steroid did not significantly alter the responses to any of the vasoactive substances. After 72 hours application, clobetasol propionate significantly increased the size of the endothelin-1-induced area of vasoconstriction (p < 0.02) and significantly reduced the size of the flares induced by endothelin-1 (p < 0.02), substance P (p < 0.009) and compound 48/80 (p < 0.05). We conclude that the most likely explanation of our data is an inhibition by the steroid of cutaneous mast cell function.
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Affiliation(s)
- P Goldsmith
- Department of Dermatology, University College London Medical School, UK
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Abstract
An organism resembling Burkholderia (formerly Pseudomonas) cepacia was isolated from cultures taken during processing of six bone grafts. The source of the contamination was traced to a water de-ionizer; the problem had begun when procedures had been changed, so that water from the de-ionizer had been used without sterilization. Cultures of bone for grafting not only protect recipients from infection, but act also as useful controls for processes involved in bone banking.
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Affiliation(s)
- M Farrington
- Clinical Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Cambridge, UK
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Kohn CW, Hinchcliff KW, McCutcheon LJ, Geor R, Foreman J, Allen AK, White SL, Maykuth PL, Williamson LH. Physiological responses of horses competing at a modified 1 star 3-day-event. Equine Vet J 1995:97-104. [PMID: 8933091 DOI: 10.1111/j.2042-3306.1995.tb05014.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 02/03/2023]
Abstract
The impending 1996 summer Olympic 3-day-event in Atlanta has focused attention on the need to determine what modifications to the demanding Endurance Test will be required to ensure safety of the horses competing. Three groups of horses participated in a Field Trial held in August of 1994 in northern Georgia to determine the safety and feasibility of conducting a modified 3-day-event in hot, humid weather. One group (TD) completed a modified 1 Star 3-day-event test, a control group (HT) completed a Horse Trial identical to the modified 1 Star test except for the omission of Phases B and C and the third group (E), comprised of European horses, completed the modified 1 Star test with a longer, faster Phase C than was used for TD. During the Endurance Test, the ambient temperature and relative humidity ranged from 24.3 degrees C and 98.9% in the morning to 30.2 degrees C and 51.6% in the afternoon. No horse failed to complete the Trial because of heat stress or fatigue. There were no significant (P < 0.05) differences detected in heart rate, rectal temperature, respiratory rate or net weight loss between HT and TD horses at any observation time. The highest rectal temperature recorded at the end of Phase C was 39.6 degrees C. These findings suggest that the modified 1 Star Endurance Test was as well tolerated by American horses as the control Horse Trial test. Rectal temperature was significantly higher for E than for TD or HT at the finish of Phase C. European horses had significantly greater decreases in weight than HT and TD at the end of Phases C and D and the next day. These findings probably reflect the faster and longer work effort of E horses during Phase C. Modification of Phase C and the rest-pause to ensure that recovery and heat dissipation occurred before the start of Phase D resulted in a 3-day-event that was safe for horses. The Field Trial provides a model for designing a modified Olympic Endurance Test. If the 1996 Olympic 3-day-event is held in hotter and more humid weather than the Field Trial, additional modifications to the Endurance Test (decreased distances, speeds and numbers of jumping efforts) will probably be required to ensure safety of competing horses.
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Affiliation(s)
- C W Kohn
- Department of Veterinary Clinical Sciences, Ohio State University, Columbus 43210, USA
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Hinchcliff KW, Kohn CW, Geor R, McCutcheon LJ, Foreman J, Andrews FM, Allen AK, White SL, Williamson LH, Maykuth PL. Acid:base and serum biochemistry changes in horses competing at a modified 1 Star 3-day-event. Equine Vet J 1995:105-10. [PMID: 8933092 DOI: 10.1111/j.2042-3306.1995.tb05015.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 02/03/2023]
Abstract
We examined the effects of participation in each of 3 modifications of Day 2 of a 3-day-event on blood and serum variables indicative of hydration, acid:base status and electrolyte homeostasis of horses. Three groups of horses - 8 European (E) horses and 2 groups each of 9 North American horses performed identical Days 1 (dressage) and 3 (stadium jumping) of a 3-day-event. E horses and one group of the North American horses (TD) performed modifications of Day 2 of a 1 Star 3-day-event and the other group of North American horses (HT) performed a Horse Trial on Day 2. Jugular venous blood was collected from each horse on the morning of Day 2 before any warm-up activity, between 4 min 55 s and 5 min 15 s after Phase D and the following morning. Eight E horses, 5 TD horses and 8 HT horses completed the trials. There were few significant differences in acid:base or serum biochemistry variables detected among horses performing either 2 variations of the Speed and Endurance day of a 1 Star 3-day-event, or a conventional Horse Trial. Failure to detect differences among groups may have been related to the low statistical power associated with the small number of horses, especially in the TD group, variation in quality of horses among groups and the different times of the day at which the E horses competed. Differences detected among time points were usually common to all groups and demonstrated metabolic acidosis with a compensatory respiratory alkalosis, a reduction in total body water and cation content, and hypocalcaemia. Importantly, horses of all groups did not replenish cation, chloride, and calcium deficits after 14-18 h of recovery.
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Affiliation(s)
- K W Hinchcliff
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Ohio State University, Columbus 43210-1089, USA
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Abstract
STUDY OBJECTIVE To determine indications for thoracolumbar radiography. DESIGN Case series with prospective data collection. SETTING Level I trauma center. PARTICIPANTS Blunt-trauma victims more than 12 years old who underwent routine thoracic and lumbar radiography according to institutional protocol. Patients were classified as group 1, not able to be evaluated clinically (Glasgow Coma Scale score of less than 13, intoxication, intubation, or cervical neurologic deficit); and group 2, able to be evaluated clinically. RESULTS Twenty-four of 319 patients sustained 25 thoracic or lumbar fractures. Seven of 136 group 1 patients and 17 of 183 group 2 patients had fractures. Eight of 17 patients with pain and 9 of 17 with tenderness had fractures (P = .001). No group 2 patients without pain, tenderness, thoracic or lumbar neuro-deficit, or major distracting injury, including cervical fracture, had fractures. The negative predictive value of pain and tenderness was 95%. Five of 46 patients with spinal fractures at any level had multiple fractures. CONCLUSION Blunt-trauma victims who cannot be evaluated clinically should undergo thoracolumbar radiography. Routine radiography may be unnecessary in asymptomatic patients who can be evaluated clinically and who do not have neurologic deficits or distracting injuries. Spinal fracture at any level mandates complete spinal radiography.
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Affiliation(s)
- C A Terregino
- Department of Emergency Medicine, Cooper Hospital/University Medical Center, Camden, New Jersey, USA
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Raney B, Ensign LG, Foreman J, Khan F, Newton W, Ortega J, Ragab A, Wharam M, Wiener E, Maurer H. Renal toxicity of ifosfamide in pilot regimens of the intergroup rhabdomyosarcoma study for patients with gross residual tumor. Am J Pediatr Hematol Oncol 1994; 16:286-95. [PMID: 7978043] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE The purpose of this review is to characterize the nephrotoxicity noted in newly diagnosed patients under 21 years of age after treatment with ifosfamide-containing chemotherapy regimens and local irradiation for localized gross residual rhabdomyosarcoma or undifferentiated sarcoma. PATIENTS AND METHODS From 1987 to 1991, 194 previously untreated patients received vincristine and ifosfamide plus dactinomycin or etoposide for 1-2 years. Ifosfamide was given at 1.8 g/m2/day for 5 days with sodium mercaptoethane sulfonate, or 9 g/m2 of ifosfamide per course. The three-drug regimen was repeated every 3-4 weeks. RESULTS Twenty-eight patients (14%) developed renal toxicity: 19 had renal tubular dysfunction (RTD) characterized by low serum phosphate (< or = 3 mg/dl) or bicarbonate (< 20 or = mEq/L) levels, five had decreased glomerular function (DGF), and four had both RTD and DGF. When nine or more courses of ifosfamide (> 72 g/m2) were given, children < 3 years of age had a higher incidence of RTD than did children > or = 3 years of age (34% versus 6%; p < 0.001). A similar age difference was observed even when eight or fewer courses (< or = 72 g/m2) were given (p = 0.03). A matched case-control comparison showed that renal abnormalities at diagnosis, chiefly hydronephrosis, also increased the risk of renal tubular injury by ifosfamide by a factor of 13 (p < 0.001). Patients with DGF tended to be older than those with RTD, and all but one received > 72 g/m2 of ifosfamide. CONCLUSIONS Patients who are < 3 years of age who receive more than eight courses (> 72 g/m2) of ifosfamide and who have a preexisting renal abnormality have an increased risk of RTD and DGF. The renal function of patients being considered for ifosfamide treatment must be carefully monitored. Ifosfamide should be avoided in patients with renal abnormalities at diagnosis unless the potential benefit clearly exceeds the risk of further renal impairment.
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Affiliation(s)
- B Raney
- Rhabdomyosarcoma Study Committee of the Childrens Cancer Group, Duke University Medical Center
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Foreman J, Moriya H, Taylor M. Effect of cooling rate and its interaction with pre-freeze and post-thaw tissue culture on the in vitro and in vivo function of cryopreserved pancreatic islets. Transpl Int 1993. [DOI: 10.1111/j.1432-2277.1993.tb00646.x] [Citation(s) in RCA: 13] [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: 01/19/2023]
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Foreman J, Moriya H, Taylor MJ. Effect of cooling rate and its interaction with pre-freeze and post-thaw tissue culture on the in vitro and in vivo function of cryopreserved pancreatic islets. Transpl Int 1993; 6:191-200. [PMID: 8347264 DOI: 10.1007/bf00337098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [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: 01/30/2023]
Abstract
Rapid cooling destroys passenger lymphoid cells during cryopreservation. We now describe improved in vivo survival of rat islets after rapid cooling by adding pre-freeze tissue culture. Islets were equilibrated with 2M dimethylsulphoxide, cooled at 0.3 degrees, 20 degrees, or 70 degrees C/min, and stored at -196 degrees C. The culture was kept at 37 degrees C for 2 or 72 h before and/or after preservation. When cooled at 0.3 degrees C/min, keeping the culture for 72 h gave the highest proportion of dye-excluding cells, but more than 50% were viable under all culture conditions. Islets cooled at 20 degrees or 70 degrees C/min (rapidly) required 72 h of culture for a survival rate of more than 50%. When islets were cultured for 72 h before cryopreservation, their in vitro insulin secretory ability was similar to that of slowly cooled islets and they were able to sustain normoglycaemia in diabetic animals, although more islets were needed. Extended tissue culture before freezing improves the survival of rapidly cooled islets and is therefore important for combined immunomodulation and cryopreservation.
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Affiliation(s)
- J Foreman
- MRC Medical Cryobiology Group, University Department of Surgery, Cambridge, UK
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Foreman J. Physicians not entirely responsible for rising health care costs. Arch Ophthalmol 1993; 111:741. [PMID: 8512472 DOI: 10.1001/archopht.1993.01090060027014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Foreman J. Clinton's proposal cuts federal payments to physicians. Arch Ophthalmol 1993; 111:445. [PMID: 8470971 DOI: 10.1001/archopht.1993.01090040037021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Foreman J. How many Americans are uninsured? Arch Ophthalmol 1993; 111:309. [PMID: 8447734 DOI: 10.1001/archopht.1993.01090030027016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Foreman J. Medicare trust funds on shaky ground. Arch Ophthalmol 1993; 111:173. [PMID: 8431152 DOI: 10.1001/archopht.1993.01090020027014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Foreman J. National health care spending. Where do the dollars go? Arch Ophthalmol 1993; 111:34. [PMID: 8424722 DOI: 10.1001/archopht.1993.01090010038021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Foreman J. Health Access America revisited and revised. Arch Ophthalmol 1992; 110:1690. [PMID: 1463407 DOI: 10.1001/archopht.1992.01080240028020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Taylor MJ, Foreman J, Biwata Y, Tsukikawa S. Prolongation of islet allograft survival is facilitated by storage conditions using cryopreservation involving fast cooling and/or tissue culture. Transplant Proc 1992; 24:2860-2. [PMID: 1465975] [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: 12/27/2022]
Affiliation(s)
- M J Taylor
- University Department of Surgery, Cambridge University, England
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Foreman J. Physicians provide $6.8 billion in charity care. Arch Ophthalmol 1992; 110:1211. [PMID: 1520104 DOI: 10.1001/archopht.1992.01080210029012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Foreman J. AMA OKs physician self-referral with stipulations. Arch Ophthalmol 1992; 110:1058. [PMID: 1497516 DOI: 10.1001/archopht.1992.01080200038016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Foreman J. Recommendations for better Medicare performance. Arch Ophthalmol 1992; 110:923. [PMID: 1637276 DOI: 10.1001/archopht.1992.01080190029013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Foreman J. Proposed legislation to protect Medicare beneficiaries. Arch Ophthalmol 1992; 110:758. [PMID: 1596220 DOI: 10.1001/archopht.1992.01080180028012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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