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Vazquez T, Patel J, Kodali N, Diaz D, Bashir MM, Chin F, Keyes E, Sharma M, Sprow G, Grinnell M, Dan J, Werth VP. Plasmacytoid Dendritic Cells Are Not Major Producers of Type 1 IFN in Cutaneous Lupus: An In-Depth Immunoprofile of Subacute and Discoid Lupus. J Invest Dermatol 2023:S0022-202X(23)03126-3. [PMID: 38086428 DOI: 10.1016/j.jid.2023.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 10/16/2023] [Accepted: 10/25/2023] [Indexed: 03/12/2024]
Abstract
The immunologic drivers of cutaneous lupus erythematosus (CLE) and its clinical subtypes remain poorly understood. We sought to characterize the immune landscape of discoid lupus erythematosus and subacute CLE using multiplexed immunophenotyping. We found no significant differences in immune cell percentages between discoid lupus erythematosus and subacute CLE (P > .05) with the exception of an increase in TBK1 in discoid lupus erythematosus (P < .05). Unbiased clustering grouped subjects into 2 major clusters without respect to clinical subtype. Subjects with a history of smoking had increased percentages of neutrophils, disease activity, and endothelial granzyme B compared with nonsmokers. Despite previous assumptions, plasmacytoid dendritic cells (pDCs) did not stain for IFN-1. Skin-eluted and circulating pDCs from subjects with CLE expressed significantly less IFNα than healthy control pDCs upon toll-like receptor 7 stimulation ex vivo (P < .0001). These data suggest that discoid lupus erythematosus and subacute CLE have similar immune microenvironments in a multiplexed investigation. Our aggregated analysis of CLE revealed that smoking may modulate disease activity in CLE through neutrophils and endothelial granzyme B. Notably, our data suggest that pDCs are not the major producers of IFN-1 in CLE. Future in vitro studies to investigate the role of pDCs in CLE are needed.
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Affiliation(s)
- Thomas Vazquez
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA; Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jay Patel
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA; Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nilesh Kodali
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA; Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - DeAnna Diaz
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA; Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Muhammad M Bashir
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA; Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Felix Chin
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA; Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Emily Keyes
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA; Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Meena Sharma
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA; Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Grant Sprow
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA; Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Madison Grinnell
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA; Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Joshua Dan
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA; Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Victoria P Werth
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA; Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
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Pandya R, Dan J, Kleitsch J, White B, Werth VP. Validation of Cutaneous Dermatomyositis Disease Area and Severity Index Activity Score and Other Efficacy Outcomes as Measures of Skin Disease in Dermatomyositis in the Lenabasum Phase 3 Trial. J Invest Dermatol 2023; 143:2378-2385.e7. [PMID: 37331616 DOI: 10.1016/j.jid.2023.05.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 06/20/2023]
Abstract
In the past decade, there have been six industry-sponsored phase 3 trials in adult patients with dermatomyositis (DM), primarily focusing on improving muscle weakness. However, skin disease is a cardinal manifestation of DM. This study evaluated the sensitivity of Cutaneous Dermatomyositis Disease Area and Severity Index Activity score, Cutaneous Dermatomyositis Activity Investigator Global Assessment, Total Improvement Score, and other outcome measures used in DM clinical trials to detect improvement in DM skin disease activity. Data analyzed from the lenabasum phase 3 trial in DM showed that improvement in Cutaneous Dermatomyositis Disease Area and Severity Index Activity score increased proportionately with the degree of patient- or physician-reported improvement in skin disease, consistently measuring improvement when clinically meaningful improvement was reported at weeks 16-52. In contrast, Cutaneous Dermatomyositis Activity Investigator Global Assessment measured little change from baseline with reported no improvement in skin disease but also a similar change from baseline with slight improvement. No Skindex-29+3 subscale performed well at reflecting increasing degrees of improvement in skin disease. Extramuscular Global Assessment and Total Improvement Score generally showed increasing levels of improvement as the degree of patient- and physician-reported improvement in skin disease increased, but these are composite measures and are not specific to improvement in DM skin disease. To measure clinically meaningful improvement in skin disease in a DM trial, Cutaneous Dermatomyositis Disease Area and Severity Index Activity score is the more sensitive outcome measure across time points.
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Affiliation(s)
- Rachita Pandya
- Corporal Micheal J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA; Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joshua Dan
- Corporal Micheal J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA; Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Julianne Kleitsch
- Corporal Micheal J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA; Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Victoria P Werth
- Corporal Micheal J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA; Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Dan J, Sprow G, Diaz D, Kodali N, Patel J, Vazquez T, Werth VP. Bullous pemphigoid: Comparing the prevalence and severity of itch and pain. J Am Acad Dermatol 2023; 89:159-160. [PMID: 36842504 DOI: 10.1016/j.jaad.2023.02.025] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 02/28/2023]
Affiliation(s)
- Joshua Dan
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Corporal Michael J. Crescenz Veteran Affairs Medical Center, Philadelphia, Pennsylvania
| | - Grant Sprow
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Corporal Michael J. Crescenz Veteran Affairs Medical Center, Philadelphia, Pennsylvania
| | - DeAnna Diaz
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Corporal Michael J. Crescenz Veteran Affairs Medical Center, Philadelphia, Pennsylvania
| | - Nilesh Kodali
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Corporal Michael J. Crescenz Veteran Affairs Medical Center, Philadelphia, Pennsylvania
| | - Jay Patel
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Corporal Michael J. Crescenz Veteran Affairs Medical Center, Philadelphia, Pennsylvania
| | - Thomas Vazquez
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Corporal Michael J. Crescenz Veteran Affairs Medical Center, Philadelphia, Pennsylvania
| | - Victoria P Werth
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Corporal Michael J. Crescenz Veteran Affairs Medical Center, Philadelphia, Pennsylvania.
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Dan J, Sprow G, Concha J, Patel J, Kodali N, Diaz D, Vazquez T, Werth VP. A comparison of the efficacy of Skindex-16 and Skindex-29 in dermatomyositis. Br J Dermatol 2023:7153252. [PMID: 37146088 DOI: 10.1093/bjd/ljad133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 03/15/2023] [Accepted: 04/25/2023] [Indexed: 05/07/2023]
Abstract
Recently, more emphasis has been placed on patient-reported outcomes in clinical trials, which has inadvertently led to an increase in respondent burden. In this investigation, we found that the Skindex-16 form captures patient-reported quality of life in dermatomyositis as well as the Skindex-29 form, but with fewer questions. Additional questions regarding photosensitivity, body image, and cosmetic use did not correlate with skin activity in dermatomyositis.
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Affiliation(s)
- Joshua Dan
- Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Corporal Micheal J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Grant Sprow
- Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Corporal Micheal J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Josef Concha
- Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Corporal Micheal J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Jay Patel
- Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Corporal Micheal J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Nilesh Kodali
- Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Corporal Micheal J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - DeAnna Diaz
- Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Corporal Micheal J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Thomas Vazquez
- Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Corporal Micheal J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Victoria P Werth
- Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Corporal Micheal J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
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Manta AI, Jackson NJ, Dan J, Tran A, Rootman DB. Effect of external eyelid weighting on eyelid and eyebrow position in normal and ptosis patients. Graefes Arch Clin Exp Ophthalmol 2023; 261:849-855. [PMID: 36112219 DOI: 10.1007/s00417-022-05825-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 07/21/2022] [Accepted: 09/02/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE This study aims to characterize the physiologic response of both eyelid and eyebrow position to increasing downward forces simulated by external weights. METHODS In this prospective observational study, both normal individuals and patients affected by ptosis were tested. External eyelid weights were placed on one upper eyelid with incrementally increasing weight from 0.2 to 2.4 g. The eyelid carrying the weight was randomly selected for normal subjects and patients with bilateral ptosis, whereas for unilateral ptosis, the ptotic eyelid was utilized. Photographs were obtained at baseline and with increasing weight until MRD1 reached 0 on the weighted side or, until 2.4 g was reached. Eyelid and brow position on the weighted and unweighted sides were digitally measured in millimeter. Primary outcome measures were change in the margin to reflex distance (MRD1) and pupil to brow distance (PTB) with weight on the weighted and unweighted sides for normal and ptosis subjects. RESULTS The weighted eyelid MRD1 decreased linearly with increasing weight. This was true for normal and ptosis subjects. The unweighted eyelid MRD1 increased linearly with increasing weight. This was also the case for both normal and ptosis subjects. With increasing weight, PTB increased linearly on the weighted side. No significant intergroup differences were noted. CONCLUSIONS In normal and ptosis subjects, when external weight on the eyelid is incrementally increased, the weighted eyelid MRD1 decreases, the unweighted eyelid MRD1 increases, and both brows elevate in a linear fashion.
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Affiliation(s)
- Alexandra I Manta
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, 300 Stein Plaza UCLA, Los Angeles, CA, 9009, USA.
| | - Nicholas J Jackson
- David Geffen School of Medicine, Department of Medicine Statistics Core, University of California, Los Angeles, Los Angeles, USA
| | - Joshua Dan
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, 300 Stein Plaza UCLA, Los Angeles, CA, 9009, USA
| | - Annie Tran
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, 300 Stein Plaza UCLA, Los Angeles, CA, 9009, USA
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, 300 Stein Plaza UCLA, Los Angeles, CA, 9009, USA.,Division of Orbital and Ophthalmic Plastic Surgery, Doheny Eye Center, University of California, Los Angeles, CA, USA
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Dan J, Afarideh M, Sprow G, Keyes E, Diaz D, Vazquez T, Kodali N, Werth VP. Preliminary definition of cutaneous flare in dermatomyositis: A retrospective review. J Am Acad Dermatol 2023; 88:190-191. [PMID: 35381299 PMCID: PMC9526755 DOI: 10.1016/j.jaad.2022.03.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/21/2022] [Accepted: 03/28/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Joshua Dan
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz Veteran Affairs Medical Center, Philadelphia, Pennsylvania
| | - Mohsen Afarideh
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz Veteran Affairs Medical Center, Philadelphia, Pennsylvania
| | - Grant Sprow
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz Veteran Affairs Medical Center, Philadelphia, Pennsylvania
| | - Emily Keyes
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz Veteran Affairs Medical Center, Philadelphia, Pennsylvania
| | - DeAnna Diaz
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz Veteran Affairs Medical Center, Philadelphia, Pennsylvania
| | - Thomas Vazquez
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz Veteran Affairs Medical Center, Philadelphia, Pennsylvania
| | - Nilesh Kodali
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz Veteran Affairs Medical Center, Philadelphia, Pennsylvania
| | - Victoria P Werth
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz Veteran Affairs Medical Center, Philadelphia, Pennsylvania.
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Sprow G, Dan J, Feng R, Werth VP. Comparing dermatologic patient-reported outcome measures in cutaneous lupus erythematosus. Lupus Sci Med 2022; 9:9/1/e000827. [PMID: 36521938 PMCID: PMC9756276 DOI: 10.1136/lupus-2022-000827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Grant Sprow
- Dermatology, Corporal Michael J Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA,Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Joshua Dan
- Dermatology, Corporal Michael J Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA,Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Rui Feng
- Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Victoria P Werth
- Dermatology, Corporal Michael J Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA,Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Vazquez T, Diaz D, Kodali N, Patel J, Keyes E, Sprow G, Sharma M, Ogawa-Momohara M, Grinnell M, Dan J, Werth V. 066 Plasmacytoid dendritic cells are not major producers of type 1 interferons in cutaneous lupus. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.120] [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: 10/17/2022]
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Dan J, Sprow G, Afarideh M, Concha J, Kodali N, Vazquez T, Diaz D, Werth V. 223 Evaluation of nailfold capillaries in dermatomyositis using a dermatoscope. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.230] [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: 10/17/2022]
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Ogawa-Momohara M, Li Y, Kodali N, Dan J, Vazquez T, Diaz D, Sprow G, Werth V. 041 Specific extracellular vesicles correlate with skin activity in dermatomyositis. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.095] [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: 11/27/2022]
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Dan J, Concha J, Sprow G, Feng R, Afarideh M, Kodali N, Vazquez T, Diaz D, White B, Werth V. 238 Cutaneous dermatomyositis area and severity index activity score (CDASI-A) and associated patient-reported outcomes in a phase 2 clinical trial in dermatomyositis. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.245] [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: 11/16/2022]
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Dan J, Afarideh M, Sprow G, Concha J, Kodali N, Vazquez T, Diaz D, Werth V. 239 Incidence and severity of itch and pain in bullous pemphigoid. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Vazquez T, Sharma M, Feng R, Diaz D, Kodali N, Dan J, Grinnell M, Keyes E, Sprow G, White B, Werth V. 068 Lenabasum reduces IFNγ and pIRF3 in dermatomyositis skin: Biomarker results from a double-blind phase 3 international randomized controlled trial. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Diaz D, Vazquez T, Kodali N, Grinnell M, Keyes E, Dan J, Sprow G, Li Y, Bashir M, Sharma M, Momohara M, Werth V. 023 Lenabasum, a cannabinoid type 2 receptor agonist, exerts anti-inflammatory effects in dermatomyositis in Th1 cells. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.077] [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: 10/17/2022]
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Sprow G, Afarideh M, Dan J, Hedberg ML, Werth VP. Bullous systemic lupus erythematosus in females. Int J Womens Dermatol 2022; 8:e034. [PMID: 35923586 PMCID: PMC9324630 DOI: 10.1097/jw9.0000000000000034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/06/2022] [Indexed: 11/30/2022] Open
Abstract
Bullous systemic lupus erythematosus (BSLE) is a rare blistering presentation of systemic lupus erythematosus, typically affecting women with the highest incidence in those of African descent. The key pathogenic insult includes the formation of autoantibodies against type VII collagen, which weaken the basement membrane zone and lead to the formation of subepidermal blisters. The acute vesiculobullous eruptions in BSLE generally tend to affect photo-distributed areas, although they can arise unrelated to sun exposure (eg, mucous membranes, axillae). The bullae can arise from erythematous macules, inflammatory plaques, or previously normal skin. Their appearance can range from small, grouped vesicles reminiscent of lesions in dermatitis herpetiformis to large, tense blisters, similar to bullous pemphigoid. Internal organ involvement occurs in up to 90% of those affected. This mostly includes lupus nephritis (classes III–V, lifetime prevalence of up to 90%), arthralgias/arthritis, and cytopenias, while serositis and neuropsychiatric involvement are rare. First-line management with dapsone should be considered in mild disease with stable underlying systemic lupus erythematosus. As discussed in this review, the off-label use of rituximab (an anti-CD20 B-cell depleting agent) has been shown to be safe and effective in several refractory cases of BSLE unresponsive to dapsone, glucocorticoids, or steroid-sparing immunosuppressants.
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Sprow G, Dan J, Merola JF, Werth VP. Emerging Therapies in Cutaneous Lupus Erythematosus. Front Med (Lausanne) 2022; 9:968323. [PMID: 35899214 PMCID: PMC9313535 DOI: 10.3389/fmed.2022.968323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
Cutaneous lupus erythematosus (CLE) is an autoimmune disease that can occur with or without underlying systemic lupus erythematosus (SLE) and often has a profoundly negative impact on patient quality of life. There is substantial need for new and more effective therapies to treat CLE. CLE has a multifactorial pathogenesis that involves several key immune cells and pathways, including abnormalities in innate (e.g., type 1 interferon pathways) and adaptive immune responses (e.g., B and T cell autoreactivity), presenting multiple opportunities for more targeted therapies that do not require immunosuppression. Here we review several emerging therapies and their efficacy in CLE. Anifrolumab and belimumab have both been approved for the treatment of SLE in recent years, and clinical trial evidence suggests some forms of CLE may improve with these agents. Therapies currently in development that are being evaluated with CLE-specific outcome measures include BIIB059 and VIB7734, which target plasmacytoid dendritic cells (pDCs), and iberdomide, a cereblon modulator. These novel therapies all have previously demonstrated clinical benefit in some forms of CLE. Other therapies which target molecules believed to play a role in CLE pathogenesis, such as Janus kinases (JAKs), spleen tyrosine kinase (SYK), interferon γ (IFNγ), IL-12, and IL-23, have been evaluated in lupus clinical trials with skin-specific outcomes but failed to meet their primary endpoints.
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Affiliation(s)
- Grant Sprow
- Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Dermatology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States
| | - Joshua Dan
- Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Dermatology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States
| | - Joseph F. Merola
- Department of Dermatology, Department of Medicine, Division of Rheumatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Victoria P. Werth
- Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Dermatology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States
- *Correspondence: Victoria P. Werth
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Ujiie H, Rosmarin D, Schön MP, Ständer S, Boch K, Metz M, Maurer M, Thaci D, Schmidt E, Cole C, Amber KT, Didona D, Hertl M, Recke A, Graßhoff H, Hackel A, Schumann A, Riemekasten G, Bieber K, Sprow G, Dan J, Zillikens D, Sezin T, Christiano AM, Wolk K, Sabat R, Kridin K, Werth VP, Ludwig RJ. Unmet Medical Needs in Chronic, Non-communicable Inflammatory Skin Diseases. Front Med (Lausanne) 2022; 9:875492. [PMID: 35755063 PMCID: PMC9218547 DOI: 10.3389/fmed.2022.875492] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [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: 02/14/2022] [Accepted: 05/09/2022] [Indexed: 12/15/2022] Open
Abstract
An estimated 20-25% of the population is affected by chronic, non-communicable inflammatory skin diseases. Chronic skin inflammation has many causes. Among the most frequent chronic inflammatory skin diseases are atopic dermatitis, psoriasis, urticaria, lichen planus, and hidradenitis suppurativa, driven by a complex interplay of genetics and environmental factors. Autoimmunity is another important cause of chronic skin inflammation. The autoimmune response may be mainly T cell driven, such as in alopecia areata or vitiligo, or B cell driven in chronic spontaneous urticaria, pemphigus and pemphigoid diseases. Rare causes of chronic skin inflammation are autoinflammatory diseases, or rheumatic diseases, such as cutaneous lupus erythematosus or dermatomyositis. Whilst we have seen a significant improvement in diagnosis and treatment, several challenges remain. Especially for rarer causes of chronic skin inflammation, early diagnosis is often missed because of low awareness and lack of diagnostics. Systemic immunosuppression is the treatment of choice for almost all of these diseases. Adverse events due to immunosuppression, insufficient therapeutic responses and relapses remain a challenge. For atopic dermatitis and psoriasis, a broad spectrum of innovative treatments has been developed. However, treatment responses cannot be predicted so far. Hence, development of (bio)markers allowing selection of specific medications for individual patients is needed. Given the encouraging developments during the past years, we envision that many of these challenges in the diagnosis and treatment of chronic inflammatory skin diseases will be thoroughly addressed in the future.
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Affiliation(s)
- Hideyuki Ujiie
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - David Rosmarin
- Department of Dermatology, Tufts Medical Center, Boston, MA, United States
| | - Michael P Schön
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany.,Lower Saxony Institute of Occupational Dermatology, University Medical Center Göttingen, Göttingen, Germany
| | - Sonja Ständer
- Center for Chronic Pruritus, Department of Dermatology, University Hospital Muenster, Muenster, Germany
| | - Katharina Boch
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Martin Metz
- Institute for Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Marcus Maurer
- Institute for Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Diamant Thaci
- Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | - Enno Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany.,Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Connor Cole
- Division of Dermatology, Rush University Medical Center, Chicago, IL, United States.,Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Kyle T Amber
- Division of Dermatology, Rush University Medical Center, Chicago, IL, United States.,Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Dario Didona
- Department of Dermatology and Allergology, Philipps-Universität, Marburg, Germany
| | - Michael Hertl
- Department of Dermatology and Allergology, Philipps-Universität, Marburg, Germany
| | - Andreas Recke
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Hanna Graßhoff
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Alexander Hackel
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Anja Schumann
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Gabriela Riemekasten
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Katja Bieber
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Gant Sprow
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States
| | - Joshua Dan
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States
| | - Detlef Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Tanya Sezin
- Department of Dermatology, Columbia University Medical Center, New York, NY, United States
| | - Angela M Christiano
- Department of Dermatology, Columbia University Medical Center, New York, NY, United States
| | - Kerstin Wolk
- Psoriasis Research and Treatment Centre, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Interdisciplinary Group Molecular Immunopathology, Dermatology/Medical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Robert Sabat
- Psoriasis Research and Treatment Centre, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Interdisciplinary Group Molecular Immunopathology, Dermatology/Medical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Khalaf Kridin
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Victoria P Werth
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States
| | - Ralf J Ludwig
- Department of Dermatology, University of Lübeck, Lübeck, Germany.,Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
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Dan J, Patel J, Sprow G, Concha J, Feng R, Kodali N, Vazquez T, Diaz D, White B, Werth V. AB1485 PATIENT-REPORTED OUTCOMES AND BIOMARKERS ASSOCIATED WITH THE CUTANEOUS DERMATOMYOSITIS AREA AND SEVERITY ACTIVITY (CDASI-A) SCORE IN A PHASE 2 CLINICAL TRIAL IN DERMATOMYOSITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundRetrospective reviews of clinical databases from two sites have identified strong relationships between patient-reported outcomes and skin activity in dermatomyositis (DM), as measured by CDASI-A.1,2 No studies validate these associations in a controlled setting. Additionally, the relationship between the PROMIS-29 Short Form and skin activity in DM has not been assessed. Previous investigations have demonstrated a correlation between IL-31 and itch in DM.3 IFN-β and IFN-γ are known type I and II interferons, which are critical drivers of DM pathogenesis.4ObjectivesTo assess correlations between CDASI-A, quality of life (QoL), and biomarkers of disease activity in a double-blind, randomized, placebo-controlled clinical trial.MethodsData were retrospectively collected from five visits of a Phase 2 trial evaluating Lenabasum, a cannabinoid receptor type 2 agonist. Quality of life assessments extracted from the trial included Patient Global Assessment (PtGA) scores, PROMIS domains, and Skindex domains. Skindex question 10, regarding itch, was included in the analysis as a separate domain. Physician Global Assessment scores were also evaluated. Additionally, biomarkers derived from skin samples via IHC/PCR collected at visits 1 and 6 were assessed for predictors of CDASI-A response and association with disease activity. Analysis used linear mixed effect models to account for within subject-variability and repeated measures, where applicable. Analysis was performed without regard to treatment arm, as our goal was to correlate CDASI, QoL, and biomarkers among all subjects.ResultsData from 22 subjects with DM and a combined total of 110 visits were included. Biopsies were collected from 12 subjects. Improvement in CDASI-A significantly correlated with Skindex-S, Skindex-E, Skindex-F, Skindex-Itch, PtGA global skin, PtGA global skin, PtGA global skin, and PtGA global skin, with p < 0.001. Improvement in PROMIS social role (p = 0.046) correlated with improvement in CDASI-A. Worsening of PROMIS fatigue (p = 0.019) and pain (p < 0.001) correlated with improvement in CDASI-A. Decreases in PGA overall disease, PGA skin activity, and PGA global skin all correlated with improvement of CDASI-A (p < 0.001). Change in IL-31 protein area positively correlated with change in disease activity (p = 0.047). A positive relationship between changes in IFN-β and IFN-γ protein area and disease activity trended towards significance.ConclusionIn accordance with previous investigations from our group, well-established measures of QoL correlated significantly with CDASI-A. These findings support that CDASI-A reflects both clinical and patient-reported aspects of skin disease and is an appropriate outcome in DM clinical trials. Additionally, Skindex and PtGA scores may better relate to skin activity as measured by the CDASI compared to PROMIS domains. IL-31, a cytokine previously associated with itch in DM,3 correlated significantly with CDASI-A in our study. Trends for IFN-β and IFN-γ reduction with disease improvement support their role in the pathogenesis of DM. This study helps define patient-reported outcomes and biomarkers that may be informative in DM trials.References[1]Goreshi R, et al. J Am Acad Dermatol. 2011;65(6):1107-1116[2]Robinson ES, et al. Br J Dermatol. 2015;172(1):169-174.[3]Patel J, et al. J Invest Dermatol. 2021;141(9):2151-2160.[4]Wong D, et al. PLoS One. 2012;7(1):e29161Disclosure of InterestsJoshua Dan: None declared, Jay Patel: None declared, Grant Sprow: None declared, Josef Concha: None declared, Rui Feng: None declared, Nilesh Kodali: None declared, Thomas Vazquez: None declared, DeAnna Diaz: None declared, Barbara White Shareholder of: Corbus Pharmaceuticals, Victoria Werth Speakers bureau: University of Pennsylvania, which owns the copyright for the CDASI, Grant/research support from: Corbus Pharmaceuticals
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Sprow G, Afarideh M, Dan J, Feng R, Keyes E, Grinnell M, Concha J, Werth VP. Autoimmune Skin Disease Exacerbations Following COVID-19 Vaccination. Front Immunol 2022; 13:899526. [PMID: 35693768 PMCID: PMC9186119 DOI: 10.3389/fimmu.2022.899526] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/20/2022] [Indexed: 11/17/2022] Open
Abstract
Background Vaccination against COVID-19 reduces the risk of severe COVID-19 disease and death. However, few studies have examined the safety of the COVID-19 vaccine in patients with autoimmune skin disease. Objectives We sought to determine the incidence of disease exacerbation in this population following COVID-19 vaccination as well as the associated factors. Methods We performed a chart review of all patients seen in the autoimmune skin disease clinic of the principal investigator during the study period. All patients included for analysis were systematically and prospectively asked about COVID-19 vaccination status, manufacturers, vaccine dates, autoimmune symptoms after the vaccine, and timing of symptom onset using a standardized template as part of their visit. Demographics and autoimmune disease diagnosis were also collected. Analysis used Chi-square and Fisher's exact tests. Results 402 subjects were included for analysis. 85.6% of patients were fully vaccinated, with 12.9% unvaccinated and 1.5% partially vaccinated. 14.8% of fully vaccinated patients reported worsening autoimmune signs and symptoms after the vaccine. Fully vaccinated dermatomyositis patients were more likely to report worsening autoimmune signs and symptoms after the vaccine (22.7%) than fully vaccinated lupus erythematosus patients (8.6%) (p=0.009). Patients fully vaccinated with the Moderna vaccine trended towards an increased likelihood of reporting worsening autoimmune signs and symptoms after the vaccine (19.1%) than those with the Pfizer-BioNTech vaccine (12.0%) (p=0.076). Of the patients who had autoimmune symptoms after vaccination, 20% had symptoms after the 1st dose, 82% after the 2nd dose, and 4% after the 3rd dose with median onset (95% confidence interval) of 7 (2,14), 14 (14,21), and 18 (7,28) days later, respectively. Conclusions More fully vaccinated dermatomyositis patients had exacerbation of autoimmune signs and symptoms after the vaccine than fully vaccinated lupus erythematosus patients. However, given the risks of COVID-19, clinicians should still promote vaccination in most patients with autoimmune skin disease.
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Affiliation(s)
- Grant Sprow
- Dermatology, Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, PA, United States
- Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Mohsen Afarideh
- Dermatology, Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, PA, United States
- Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Joshua Dan
- Dermatology, Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, PA, United States
- Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Rui Feng
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, United States
| | - Emily Keyes
- Dermatology, Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, PA, United States
- Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Madison Grinnell
- Dermatology, Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, PA, United States
- Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Josef Concha
- Dermatology, Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, PA, United States
- Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Victoria P. Werth
- Dermatology, Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, PA, United States
- Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Affiliation(s)
- Grant Sprow
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joshua Dan
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - James Abbott
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Angela Jiang
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - DeAnna Diaz
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thomas Vazquez
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nilesh Kodali
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Victoria P. Werth
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Correspondence to: Victoria P. Werth, MD, Department of Dermatology, Perelman Center for Advanced Medicine, University of Pennsylvania, Suite 1-330A, 3400 Civic Center Boulevard, Philadelphia, PA 19104.
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Maron SZ, Dan J, Gal JS, Neifert SN, Martini ML, Lamb CD, Genadry L, Rothrock RJ, Steinberger J, Rasouli JJ, Caridi JM. Surgical Start Time Is Not Predictive of Microdiscectomy Outcomes. Clin Spine Surg 2021; 34:E107-E111. [PMID: 33633067 DOI: 10.1097/bsd.0000000000001063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 07/24/2020] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Retrospective analysis of clinical data from a single institution. OBJECTIVE The objective of this study was to assess the time of surgery as a possible predictor for outcomes, length of stay, and cost following microdiscectomy. SUMMARY OF BACKGROUND DATA The volume of microdiscectomy procedures has increased year over year, heightening interest in surgical outcomes. Previous investigations have demonstrated an association between time of procedures and clinical outcomes in various surgeries, however, no study has evaluated its influence on microdiscectomy. METHODS Demographic and outcome variables were collected from all patients that underwent a nonemergent microdiscectomy between 2008 and 2016. Patients were divided into 2 cohorts: those receiving surgery before 2 pm were assigned to the early group and those with procedures beginning after 2 pm were assigned to the late group. Outcomes and patient-level characteristics were compared using bivariate, multivariable logistic, and linear regression models. Adjusted length of stay and cost were coprimary outcomes. Secondary outcomes included operative complications, nonhome discharge, postoperative emergency department visits, or readmission rates. RESULTS Of the 1261 consecutive patients who met the inclusion criteria, 792 were assigned to the late group and 469 were assigned to the early group. There were no significant differences in demographics or baseline characteristics between the 2 cohorts. In the unadjusted analysis, mean length of stay was 1.80 (SD=1.82) days for the early group and 2.00 (SD=1.70) days for the late group (P=0.054). Mean direct cost for the early cohort was $5088 (SD=$4212) and $4986 (SD=$2988) for the late cohort (P=0.65). There was no difference in adjusted length of stay or direct cost. No statistically significant differences were found in operative complications, nonhome discharge, postoperative emergency department visits, or readmission rates between the 2 cohorts. CONCLUSION The study findings suggest that early compared with late surgery is not significantly predictive of surgical outcomes following microdiscectomy.
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Affiliation(s)
| | | | - Jonathan S Gal
- Anesthesia, Perioperative and Pain Medicine, Mount Sinai Hospital, New York, NY
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Pavel AB, Zhou L, Diaz A, Ungar B, Dan J, He H, Estrada YD, Xu H, Fernandes M, Renert-Yuval Y, Krueger JG, Guttman-Yassky E. The proteomic skin profile of moderate-to-severe atopic dermatitis patients shows an inflammatory signature. J Am Acad Dermatol 2020; 82:690-699. [DOI: 10.1016/j.jaad.2019.10.039] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/16/2019] [Accepted: 10/22/2019] [Indexed: 01/08/2023]
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Dan J, Zhou QJ, Xie LX. [The research progress of relationship between advanced glycation end products and diabetic keratopathy]. Zhonghua Yan Ke Za Zhi 2018; 54:475-480. [PMID: 29895121 DOI: 10.3760/cma.j.issn.0412-4081.2018.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Diabetic keratopathy is a common ocular complication of patients with a long-term history of diabetes and it will have a negative effect on the visual quality and function. A study reported that the incidence of diabetic keratopathy in diabetic patients ranged from 47% to 64%, but the precise underlying pathogenesis remains unclear. There is evidence that advanced glycation end products contribute substantially to the onset and progress of various diabetic complications and it is a key factor for the mechanism of the hyperglycemic memory. This review focuses primarily on the present research state and prospect of advanced glycation end products and their role in the pathological changes of the cornea. (Chin J Ophthalmol, 2018, 54: 475-480).
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Affiliation(s)
- J Dan
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan 430060, China
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Aslam S, Yung G, Dan J, Reed S, LeFebvre M, Logan C, Taplitz R, Law N, Golts E, Afshar K, Lehman S, Morales S, Furr C, Rosas F, Gaidamaka A, Bilinsky I, Grint P, Biswas B, Duplessis C, Hamilton T, Schooley R. Bacteriophage Treatment in a Lung Transplant Recipient. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.376] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Xie W, Xie H, Liu F, Li W, Dan J, Mei Y, Dan L, Xiao X, Li J, Chen X. Propranolol induces apoptosis of human umbilical vein endothelial cells through downregulation of CD147. Br J Dermatol 2013; 168:739-48. [PMID: 23528058 DOI: 10.1111/bjd.12193] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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
BACKGROUND Infantile haemangiomas (IHs) are benign tumours in infancy. Most patients suffering from IHs do not require treatment. However, if there is a dramatic aesthetic or functional impairment, treatment is needed. Currently the most promising therapy for complicated IHs is the oral administration of propranolol, but its mechanism is unclear. OBJECTIVES To investigate the role of CD147 in propranolol-induced apoptosis in human umbilical vein endothelial cells (HUVECs). METHODS Human umbilical vein endothelial cells were treated with propranolol, and the treatment effects were investigated through the following methodology. (i) Cell proliferation and apoptosis were detected using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay and flow cytometric analysis. (ii) The expression level of CD147 was measured by reverse-transcription polymerase chain reaction and Western blotting. (iii) HUVECs were transfected with lentivirus encoding CD147 short hairpin (sh)RNA or CD147 cDNA. Ensuing changes in cell proliferation and apoptosis after transfection were measured using the MTT assay and flow cytometry. (iv) The level of phosphorylation of Bcl-2-associated death promoter (BAD) at Ser112 in HUVECs after propranolol treatment and/or CD147 shRNA transfection was detected by Western blotting. RESULTS Propranolol inhibited cell proliferation and induced apoptosis in HUVECs. It decreased CD147 protein expression in a concentration-dependent manner. Knocking down CD147 not only induced apoptosis but also exacerbated the apoptosis triggered by propranolol in HUVECs. Overexpression of CD147 can protect HUVECs from apoptosis and propranolol-induced apoptosis. Furthermore, knockdown of both propranolol and CD147 can downregulate Ser112 phosphorylation of BAD, indicating that propranolol and CD147 induce apoptosis in HUVECs through the same signalling transduction pathway. CONCLUSIONS Our studies demonstrate that propranolol-induced apoptosis may be mediated through the downregulation of CD147 in HUVECs. This study highlights a novel step in propranolol action and suggests a potential new target for the treatment of IHs.
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Affiliation(s)
- W Xie
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, 410008, China
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Xie W, Xie H, Liu F, Li W, Dan J, Liu L, Dan L, Xiao X, Li J, Chen X. Propranolol induces apoptosis of human umbilical vein endothelial cells through down-regulation of CD147. Br J Dermatol 2012. [DOI: 10.1111/bjd.12127] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wong CM, Vichit-Vadakan N, Vajanapoom N, Ostro B, Thach TQ, Chau PYK, Chan EKP, Chung RYN, Ou CQ, Yang L, Peiris JSM, Thomas GN, Lam TH, Wong TW, Hedley AJ, Kan H, Chen B, Zhao N, London SJ, Song G, Chen G, Zhang Y, Jiang L, Qian Z, He Q, Lin HM, Kong L, Zhou D, Liang S, Zhu Z, Liao D, Liu W, Bentley CM, Dan J, Wang B, Yang N, Xu S, Gong J, Wei H, Sun H, Qin Z. Part 5. Public health and air pollution in Asia (PAPA): a combined analysis of four studies of air pollution and mortality. Res Rep Health Eff Inst 2010:377-418. [PMID: 21446215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND In recent years, Asia has experienced rapid economic growth and a deteriorating environment caused by the increasing use of fossil fuels. Although the deleterious effects of air pollution from fossil-fuel combustion have been demonstrated in many Western nations, few comparable studies have been conducted in Asia. Time-series studies of daily mortality in Asian cities can contribute important new information to the existing body of knowledge about air pollution and health. Not only can these studies verify important health effects of air pollution in local regions in Asia, they can also help determine the relevance of existing air pollution studies to mortality and morbidity for policymaking and environmental controls. In addition, the studies can help identify factors that might modify associations between air pollution and health effects in various populations and environmental conditions. Collaborative multicity studies in Asia-especially when designed, conducted, and analyzed using a common protocol-will provide more robust air pollution effect estimates for the region as well as relevant, supportable estimates of local adverse health effects needed by environmental and public-health policymakers. SPECIFIC OBJECTIVES The Public Health and Air Pollution in Asia (PAPA*) project, sponsored by the Health Effects Institute, consisted of four studies designed to assess the effects of air pollution on mortality in four large Asian cities, namely Bangkok, in Thailand, and Hong Kong, Shanghai, and Wuhan, in China. In the PAPA project, a Common Protocol was developed based on methods developed and tested in NMMAPS, APHEA, and time-series studies in the literature to help ensure that the four studies could be compared with each other and with previous studies by following an established protocol. The Common Protocol (found at the end of this volume) is a set of prescriptive instructions developed for the studies and used by the investigators in each city. It is flexible enough to allow for adjustments in methods to optimize the fit of health-effects models to each city's data set. It provides the basis for generating reproducible results in each city and for meta-estimates from combined data. By establishing a common methodology, factors that might influence the differences in results from previous studies can more easily be explored. Administrative support was provided to ensure that the highest quality data were used in the analysis. It is anticipated that the PAPA results will contribute to the international scientific discussion of how to conduct and interpret time-series studies of air pollution and will stimulate the development of high-quality routine systems for recording daily deaths and hospital admissions for time-series analysis. METHODS Mortality data were retrieved from routine databases with underlying causes of death coded using the World Health Organization (WHO) International Classification of Diseases, 9th revision or 10th revision (ICD-9, ICD-10). Air quality measurements included nitrogen dioxide (NO2), sulfur dioxide (SO2), particulate matter with aerodynamic diameter < or = 10 microm (PM10), and ozone (O3) and were obtained from several fixed-site air monitoring stations that were located throughout the metropolitan areas of the four cities and that met the standards of procedures for quality assurance and quality control carried out by local government units in each city. Using the Common Protocol, an optimized core model was established for each city to assess the effects of each of the four air pollutants on daily mortality using generalized linear modeling with adjustments for time trend, seasonality, and other time-varying covariates by means of a natural-spline smoothing function. The models were adjusted to suit local situations by correcting for influenza activity, autocorrelation, and special weather conditions. Researchers in Hong Kong, for example, used influenza activity based on frequency of respiratory mortality; researchers in Hong Kong and Shanghai used autoregressive terms for daily outcomes at lag days; and researchers in Wuhan used additional smoothing for periods with extreme weather conditions. RESULTS AND DISCUSSION For mortality due to all natural (nonaccidental) causes at all ages, the effects of air pollutants per 10-microg/m3 increase in concentration was found to be higher in Bangkok than in the three Chinese cities, with the exception of the effect of NO2 in Wuhan. The magnitude of the effects for cardiovascular and respiratory mortality were generally higher than for all natural mortality at all ages. In addition, the effects associated with PM10 and O3 in all natural, cardiovascular; and respiratory mortality were found to be higher in Bangkok than in the three Chinese cities. The explanation for these three findings might be related to consistently higher daily mean temperatures in Bangkok, variations in average time spent outdoors by the susceptible populations, and the fact that less air conditioning is available and used in Bangkok than in the other cities. However, when pollutant concentrations were incorporated into the excess risk estimates through the use of interquartile range (IQR), the excess risk was more comparable across the four cities. We found that the increases in effects among older age groups were greater in Bangkok than in the other three cities. After excluding data on extremely high concentrations of PM10 in Bangkok, the effect estimate associated with PM10 concentrations decreased in Bangkok (suggesting a convex relationship between risk and PM10, where risk levels off at high concentrations) instead of increasing, as it did in the other cities. This leveling off of effect estimates at high concentrations might be related to differences in vulnerability and exposure of the population to air pollution as well as to the sources of the air pollutant. IMPLICATIONS OF THE STUDY: The PAPA project is the first coordinated Asian multicity air pollution study ever published; this signifies the beginning of an era of cooperation and collaboration in Asia, with the development of a common protocol for coordination, data management, and analysis. The results of the study demonstrated that air pollution in Asia is a significant public health burden, especially given the high concentrations of pollutants and high-density populations in major cities. When compared with the effect estimates reported in the research literature of North America and Western Europe, the study's effect estimates for PM10 were generally similar and the effect estimates for gaseous pollutants were relatively higher. In Bangkok, however, a tropical city where total exposures to outdoor pollution might be higher than in most other cities, the observed effects were greater than those reported in the previous (i.e., Western) studies. In general, the results suggested that, even though social and environmental conditions across Asia might vary, it is still generally appropriate to apply to Asia the effect estimates for other health outcomes from previous studies in the West. The results also strongly support the adoption of the global air quality guidelines recently announced by WHO.
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Affiliation(s)
- C M Wong
- Department of Community Medicine, The University of Hong Kong, 5/F William MW Mong Block, Li Ka Shing Faculty of Medicine Building, 21 Sassoon Road, Hong Kong
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Liy Y, Yaling L, Dan J, Tao H, Xuedong Z. Regulation of urease expression of Actinomyces naeslundii in biofilms in response to pH and carbohydrate. ACTA ACUST UNITED AC 2008; 23:315-9. [PMID: 18582331 DOI: 10.1111/j.1399-302x.2008.00430.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The hydrolysis of urea by the urease enzymes of oral bacteria is believed to have a major impact on oral microbial ecology and to be intimately involved in oral health and diseases. Actinomyces naeslundii is a ureolytic bacterium that is adapted to tolerate the rapid and dramatic fluctuations in nutrient availability, carbohydrate source, and pH in dental biofilms. Our research objectives were to better understand the regulation of the expression of urease under environmental conditions that closely mimic those in dental biofilms. METHODS A. naeslundii ATCC12104 were grown in a chemostat biofilm reactor with carbohydrate-limited medium for 3 days followed by a carbohydrate pulse, at pH 7.0 and at pH 5.5. Urease activities and ureC gene messenger RNA levels of cells in the biofilm were measured before and after the carbohydrate pulse. RESULTS We found that the neutral pH environments and excess carbohydrate availability could both result in enhancement of urease activity in biofilm cells. The ureC messenger RNA level of A. naeslundii biofilm cells cultivated at pH 7.0 was approximately 10-fold higher than that of cells grown at pH 5.5, but no changes in ureC gene expression were detected after the carbohydrate pulse. CONCLUSIONS Neutral pH environments and excess carbohydrate availability could promote urease expression of A. naeslundii in biofilms, but only neutral pH environments could up-regulate the ureC gene expression and the pH regulates ureC gene expression at a transcriptional level.
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Affiliation(s)
- Y Liy
- Department of Oral Biology, College of Dentistry, University of Florida, Gainesville, FL, USA.
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Jiang F, Xie J, Dan J, Liu J, Wang H. [Selection of optimal ultrasonic extraction process of Elaeagnus angustifolia L. by uniform design]. Zhong Yao Cai 2001; 24:891-2. [PMID: 11917851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
The influences of ultrasonic frequency, ultrasonic time and solvent content on the extraction rate of fat oil in Elaeagnus angustifolia L. were studied. The optimum extraction condition was obtained. The results showed that the ultrasonic extraction method of fat oil in Elaeagnus angustifolia L. could save time, improve extraction rate and need not be hot compared with traditional extraction method.
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Affiliation(s)
- F Jiang
- Shihezi University, Shihezi 832002
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Liu H, Dan J, Tang S, Wu S. Involving of the cytoplasmic region of leukemia inhibitory factor receptor alpha subunit, IL-6 related signal transducer-gp130 or fas death domain for MAPK p42/44 activation in HL-60 cell with LIF or anti-Fas IgG. Mol Cell Biochem 2001; 217:113-20. [PMID: 11269654 DOI: 10.1023/a:1007220627845] [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: 11/12/2022]
Abstract
The chimeric receptors were prepared by exchanging the cytoplasmic region between leukemia inhibitory factor (LIF) receptor alpha subunit (gp190) and the other subunit-gp130 (190/130,130/190) and separately transduced into leukemia line HL-60 (to have the wild type subunit). The purpose is to investigate which subunit for activating MAPK p42/44 in leukemia cell while the cytoplasmic region homodimerization (190cyt-190cyt, 130cyt-130cyt) was induced by LIF. The results showed that MAPK p42/44 expression level after LIF stimulation 5 h was lower in the transformants with pED 130/190 (190cyt- 190cyt) (p < 0.01) and higher in the transformants with pED 190/130 (130cyt- 130cyt) (p < 0.05) than those in the parent cells. Meanwhile, MAPK p42/44 phosphorylation (Thr202/Tyr204) was ascended and the highest at 10 min in the 190/130 and descended in the 130/190. It suggests that gp130 activate MAPK p42/44 and gp190 indirectly regulate its expression and function. In order to analyses the relation of the subunit oligomerization and MAPK p42/44 we also prepared the recombination of the extracellular and transmembrane region of Fas and the cytoplasmic region of each LIFR subunit (Fas/190, Fas/130). After transduction into HL-60 with lipofection and induction by anti-Fas IgG, we found that MAPK p42/44 expression levels were lower in the Fas/190 than in the Fas/130 and parent cells (p < 0.01) and no difference between the Fas/130 and the wild type receptor. However, phospho-MAPK p42/44 were increased in the Fas/130 than the parent cells. It suggests that the oligomerization of the cytoplasmic regions of gp130 be potential to normally initiate MAPK p42/44 for the signal of HL-60 proliferation. We also determine that the separated oligomerization FasDD (no dimerization) can initiate the corresponding signal molecules, then regulate MAPK p42/44 expression and phosphorylation in leukemia cells.
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Affiliation(s)
- H Liu
- Department of Histology and Embryology, Second Military Medical University, Shanghai, China
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31
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Sandberg MA, Pawlyk BS, Dan J, Arnaud B, Dryja TP, Berson EL. Rod and cone function in the Nougaret form of stationary night blindness. Arch Ophthalmol 1998; 116:867-72. [PMID: 9682699 DOI: 10.1001/archopht.116.7.867] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Recently, a mutation (Gly38Asp) was identified in the alpha subunit of rod transducin in members of the Nougaret pedigree affected with dominantly inherited stationary night blindness. OBJECTIVE To evaluate retinal function in patients with the Gly38Asp gene defect. DESIGN Ocular examinations, including specialized measures of rod and cone function. SETTING A clinical research facility in Boston, Mass. PATIENTS A father (aged 48 years) and son (aged 25 years) with the Gly38Asp mutation. MAIN OUTCOME MEASURES Psychophysical thresholds to white and narrowband lights and full-field electroretinographic (ERG) responses. RESULTS Both patients showed dark-adapted thresholds to white light that were elevated approximately 2 log-units across the retina. Spectral sensitivity testing revealed thresholds that seemed to be governed mostly by rods. Although both patients' dark-adapted ERG responses to a dim blue flash were nondetectable, their dark-adapted ERGs to a white flash showed an a-wave with cone and rod components and a b-wave amplitude larger than what could have been generated by cone function alone. Rod ERGs to bright blue flashes had subnormal, but detectable, amplitudes that seemed to result from a profound reduction in sensitivity. The patients also showed loss of a cone subcomponent in the dark-adapted response to a red flash. The abnormal dark-adapted ERG responses of the patients could be simulated in the ERG responses of normal subjects tested with blue, white, and red flashes presented in the presence of a mesopic background. CONCLUSIONS Although the Nougaret form of stationary night blindness has been cited as a prototype of absent rod function with normal cone function, our findings, based on the genealogically and genotypically documented descendants of Jean Nougaret, show that rod function is present, although subnormal, and that there is slight impairment of cone function. The data also suggest that these abnormalities can be simulated by light-adapting the normal retina, compatible with the proposal that the rod transducin encoded by the mutant gene is constitutively active and that the night blindness results from partial desensitization of rods caused by the constitutive activity.
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Affiliation(s)
- M A Sandberg
- Berman-Gund Laboratory for the Study of Retinal Degenerations, Harvard Medical School, Boston, Mass., USA.
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Zhao Q, Dan J, Xu Y. [Pharmacognostic identification on crude drug of Dendrobium denneanum]. Zhong Yao Cai 1998; 21:282-4. [PMID: 12567520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
This paper reported the morphological and histological characteristics of Diequiao Shihu(the crude drug of Dendrobium denneanum Kerr), with linedrawings, and compared the TLC diagram with Jichai Shihu (the crude drug of Dendrobium nobile Lindl.).
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Affiliation(s)
- Q Zhao
- Leshan Institute for Drug Control, Leshan 614000
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Zheng T, Boyle P, Willett WC, Hu H, Dan J, Evstifeeva TV, Niu S, MacMahon B. A case-control study of oral cancer in Beijing, People's Republic of China. Associations with nutrient intakes, foods and food groups. Eur J Cancer B Oral Oncol 1993; 29B:45-55. [PMID: 8180577 DOI: 10.1016/0964-1955(93)90010-c] [Citation(s) in RCA: 83] [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] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A case-control study of oral cancer was conducted in Beijing, People's Republic of China to examine the association between dietary nutrient intake and risk of oral cancer, both in terms of estimated intake of nutrients and micro-nutrients, and in terms of specific foods and food groups. The study was hospital-based and controls were hospital in-patients matched for age and sex with the cases. The response rate for cases and controls was 100% and 404 case/control pairs were interviewed. The results suggest that increased protein and fat intake are related to a decreased risk of oral cancer. Carbohydrate intake, however, showed a moderate increased risk for oral cancer. Total carotene intake and carotene intake from fruits and vegetables are inversely associated with risk of oral cancer. A similar pattern was observed for dietary vitamin C intake. Dietary fibre derived from fruits and vegetables showed a strong negative association with oral cancer risk, but fibre derived from other sources did not exhibit any protective effect. At the level of foods and food groups, increased consumption of fresh meat, chicken and liver was significantly associated with a reduction in oral cancer risk: the tests for trend were all statistically significant at the P < 0.01 level. Consumption of common carp, hairtail, shrimp and lobster were also associated with decreased risk. Risk was found to increase with increasing consumption of millet and corn bread (P < 0.01) but to decrease with increasing consumption of rice (P < 0.01). Increased consumption of grapes, bananas, oranges, tangerines, peaches and pears were associated with reduced risk.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- T Zheng
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
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Vaislic C, Clerc P, Cloitre G, Dan J, de Tilly I, Escalard JM, Gosselin J, Hamel Desnos C, Quelier Moulis M, Legagneux A. [Return to work after surgical treatment of varicosities of the lower limb]. Phlebologie 1992; 45:159-65; discussion 166. [PMID: 1528968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Factors which the duration of time off work after surgical treatment of venous insufficiency of the legs were studied in 3000 patients undergoing surgery in our institution between 1985 and 1990. Three variables significantly influenced return to work at 2 weeks (RW2w). The first was socio-professional group. All patients in the first was socio-professional group. All patients in the professions and 95 per cent of tradesmen or freelance workers had returned to work after 2 weeks, while 40 per cent of civil servants and 35 per cent of employees in private organisations were still off work. Time spent of work was 23 +/- 10 days in civil servants, 4 +/- 3 days in the professions and 5 +/- 2 days in tradesmen of freelance workers. The second was the type of anesthesia with or without hospitalisation, local or general. The final variable was the physical effort involved in work, the RW2w was 72 par cent in patients in whom such effort was mild or moderate, and 56 per cent in effort was considerable. The second was the type of anesthesia with or without hospitalisation, local or general. The final variable was the physical effort involved in work. The RW2w was 72 percent in patients in whom such effort was mild or moderate, and 56 per cent in effort was considerable. It is concluded that the rapidity of return to work was not as good as could legitimately be expected following an operation with nil mortality and extremely limited morbidity.(ABSTRACT TRUNCATED AT 250 WORDS)
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Dan J, Seth S, Chakraborty S. Structure of tris{2'-[α-(2-pyridyl)benzylidene]salicylohydrazido}samarium(III), [Sm(C19H14N3O2)3]. Acta Crystallogr C 1989. [DOI: 10.1107/s010827018900017x] [Citation(s) in RCA: 5] [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: 11/11/2022] Open
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Matsuki Y, Dan J, Fukuhara K, Ito T, Nambara T. Isolation and characterization of human urinary metabolites of meclomen. Chem Pharm Bull (Tokyo) 1988; 36:1431-6. [PMID: 3416363 DOI: 10.1248/cpb.36.1431] [Citation(s) in RCA: 6] [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: 01/05/2023]
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Dan J. [Role of the family physician in interdisciplinary complex dispensary patient care]. Z Alternsforsch 1986; 41:285-7. [PMID: 3788215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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39
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Dan J. [First aid in geriatrics from the viewpoint of the specialist in general medicine]. Z Alternsforsch 1985; 40:119-24. [PMID: 3993080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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40
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Dan J. [The retired person in a socialist society]. Z Alternsforsch 1984; 39:111-4. [PMID: 6730527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
There are not possibilities to stop aging. Therefore we should add to years life. To it necessary making the problems of aging to a task for the complete society. In our socialist country pensioners guaranteed on foundation of the constitution, the employment-low-book and the votes of party and government all chances to life carefree and with activities.
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Dan J. [The rural physician and the complex care of the elderly citizen]. Z Alternsforsch 1983; 38:75-8. [PMID: 6845749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The specialist for general medicine is a key figure in the comprehensive care for the elderly citizen. On him revolves all the extensive basic medical care, and the coordination of all the more far-reaching measures in both the medical and the social fields. He is best able to fulfill these tasks by spending his entire professional life at the same place and actively participating in the social life of the community concerned.
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Dan J. [The need for nursing care of retired persons in the country]. Z Alternsforsch 1982; 37:373-7. [PMID: 7157853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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43
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Dan J. [Various aspects of the use of drugs and pleasure-producing substances by retired persons]. Z Alternsforsch 1982; 37:379-82. [PMID: 7157854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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44
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Dan J. [Contentment with life in retirement]. Z Alternsforsch 1982; 37:365-71. [PMID: 7157852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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45
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Dan J. [Patient compliance as a function of type of management and age]. Z Alternsforsch 1982; 37:273-6. [PMID: 7136020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
For the medical monitoring of selected groups of patients to be successful, it is necessary that the patients concerned cooperate in every respect. Our studies have showen that compliance was best (82 per cent) in the case of those locked after in their homes. Groups of specially selected patients came next with just under 80 per cent. Cooperation was least satisfactory (33 per cent) among those who were not given a definite appointment.
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Dan J. [Dying patients and medical problems from the family doctors point of view (author's transl)]. Z Alternsforsch 1982; 37:35-40. [PMID: 7064488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Problems appearing to the confrontation with dying patients concern the family doctor as well as the clinician. To our computation 55,3% all man did not die in the hospital. Near 38% all at home dying man have had a more or less long sick bed and did care by the family doctor. In opposite to the hospital the general practitioner may cooperate only with medical laymans. The community nurse can many help but she has a lot of other tasks. According to our view, the enlightenment hopelessly ill patients is a very difficult problem solving of which we can on consideration of all conditions only. We should keep the straight talk not too early, otherwise we take the patients hope and paralyse all kinds of activities. There are some cases with complications in which we don't avoid hospitalisation in spite of very good home cars. All our troubles we may terminate not till after definite death.
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Dan J. [Acrosomal reaction]. Tanpakushitsu Kakusan Koso 1967; 12:1148-55. [PMID: 4876850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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