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Lenders NF, Chui J, Low J, Inder WJ, Earls PE, McCormack AI. Development of a cost-effective diagnostic algorithm incorporating transcription factor immunohistochemistry in the evaluation of pituitary tumours. Pituitary 2022; 25:997-1003. [PMID: 36271964 PMCID: PMC9675696 DOI: 10.1007/s11102-022-01284-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine the utility of the 2022 WHO Classification of pituitary tumours in routine clinical practice and to develop an optimal diagnostic algorithm for evaluation of tumour type in a real-world setting. METHODS Retrospective evaluation of pituitary tumour immunohistochemistry (IHC), operatively managed at St Vincent's Hospital Sydney, between 2019 and 2021. Routine IHC comprised evaluation of transcription factors [steroidogenic factor 1 (SF1), T-box transcription factor 19 (TPIT) and pituitary-specific positive transcription factor (PIT1)] and anterior pituitary hormones. Three tiered algorithms were tested, in which hormone IHC was performed selectively based on the initial transcription factor results. These were applied retrospectively and compared with current practice 'gold standard' comprising all transcription factor and hormone IHC. Diagnostic accuracy and cost were evaluated for each. RESULTS There were 113 tumours included in the analysis. All three algorithms resulted in 100% concordance with the 'gold standard' in the characterisation of tumour lineage. While all three were associated with relative cost reduction, Algorithm #3, which omitted hormone IHC in the setting of positive SF1 or TPIT and performed IHC for growth hormone, prolactin and thyroid stimulating hormone only in the setting of PIT1 positivity, was the most cost-efficient. Additionally, there were 12/113 tumours with no distinct cell lineage. CONCLUSION A diagnostic algorithm omitting hormone IHC except in cases of PIT1 positivity is an accurate and cost-effective approach to diagnose the type of pituitary tumour. A significant subgroup of pituitary tumours with no distinct cell lineage, frequently plurihormonal, remains difficult to classify with the new WHO criteria and requires further evaluation.
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Affiliation(s)
- N F Lenders
- Department of Endocrinology, St Vincent's Hospital, Sydney, NSW, Australia.
- Garvan Institute of Medical Research, Sydney, NSW, Australia.
- St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia.
| | - J Chui
- Department of Anatomical Pathology and Cytopathology, St Vincent's Pathology, Sydney, NSW, Australia
| | - J Low
- Department of Anatomical Pathology and Cytopathology, St Vincent's Pathology, Sydney, NSW, Australia
| | - W J Inder
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - P E Earls
- Department of Anatomical Pathology and Cytopathology, St Vincent's Pathology, Sydney, NSW, Australia
| | - A I McCormack
- Department of Endocrinology, St Vincent's Hospital, Sydney, NSW, Australia
- Garvan Institute of Medical Research, Sydney, NSW, Australia
- St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
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Kenny G, McCann K, O’Brien C, Savinelli S, Tinago W, Yousif O, Lambert JS, O’Broin C, Feeney ER, De Barra E, Doran P, Mallon PWG, Cotter A, Muldoon E, Sheehan G, McGinty T, Lambert JS, Green S, Leamy K, Kenny G, McCann K, McCann R, O’Broin C, Waqas S, Savinelli S, Feeney E, Mallon PWG, Garcia Leon A, Miles S, Alalwan D, Negi R, de Barra E, McConkey S, Hurley K, Sulaiman I, Horgan M, Sadlier C, Eustace J, Kelly C, Bracken T, Whelan B, Low J, Yousif O, McNicholas B, Courtney G, Gavin P. Identification of Distinct Long COVID Clinical Phenotypes Through Cluster Analysis of Self-Reported Symptoms. Open Forum Infect Dis 2022; 9:ofac060. [PMID: 35265728 PMCID: PMC8900926 DOI: 10.1093/ofid/ofac060] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/01/2022] [Indexed: 12/14/2022] Open
Abstract
Background We aimed to describe the clinical presentation of individuals presenting with prolonged recovery from coronavirus disease 2019 (COVID-19), known as long COVID. Methods This was an analysis within a multicenter, prospective cohort study of individuals with a confirmed diagnosis of COVID-19 and persistent symptoms >4 weeks from onset of acute symptoms. We performed a multiple correspondence analysis (MCA) on the most common self-reported symptoms and hierarchical clustering on the results of the MCA to identify symptom clusters. Results Two hundred thirty-three individuals were included in the analysis; the median age of the cohort was 43 (interquartile range [IQR], 36–54) years, 74% were women, and 77.3% reported a mild initial illness. MCA and hierarchical clustering revealed 3 clusters. Cluster 1 had predominantly pain symptoms with a higher proportion of joint pain, myalgia, and headache; cluster 2 had a preponderance of cardiovascular symptoms with prominent chest pain, shortness of breath, and palpitations; and cluster 3 had significantly fewer symptoms than the other clusters (2 [IQR, 2–3] symptoms per individual in cluster 3 vs 6 [IQR, 5–7] and 4 [IQR, 3–5] in clusters 1 and 2, respectively; P < .001). Clusters 1 and 2 had greater functional impairment, demonstrated by significantly longer work absence, higher dyspnea scores, and lower scores in SF-36 domains of general health, physical functioning, and role limitation due to physical functioning and social functioning. Conclusions Clusters of symptoms are evident in long COVID patients that are associated with functional impairments and may point to distinct underlying pathophysiologic mechanisms of disease.
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Affiliation(s)
- Grace Kenny
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Kathleen McCann
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Conor O’Brien
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
| | - Stefano Savinelli
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Willard Tinago
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
| | - Obada Yousif
- Endocrinology Department, Wexford General Hospital, Carricklawn, Wexford, Ireland
| | - John S Lambert
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Cathal O’Broin
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Eoin R Feeney
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Eoghan De Barra
- Department of Infectious Diseases, Beaumont Hospital, Beaumont, Dublin, Ireland
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Peter Doran
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
| | - Patrick W G Mallon
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
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Yu CC, Koh EJ, Low JA, Ong ML, Sim AGH, Hong DYQ, Chong R, Low J, Ng R. Correction to: A multi-site study on the impact of an advance care planning workshop on attitudes, beliefs and behavioural intentions over a 6-month period. BMC Med Educ 2021; 21:372. [PMID: 34238268 PMCID: PMC8264986 DOI: 10.1186/s12909-021-02816-3] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- C C Yu
- Geriatric Education and Research Institute, 2 Yishun Central 2, Singapore, 768024, Singapore.
| | - E J Koh
- Geriatric Education and Research Institute, 2 Yishun Central 2, Singapore, 768024, Singapore
| | - J A Low
- Geriatric Education and Research Institute, 2 Yishun Central 2, Singapore, 768024, Singapore
- Khoo Teck Puat Hospital, Singapore, Singapore
| | - M L Ong
- Khoo Teck Puat Hospital, Singapore, Singapore
| | - A G H Sim
- Singapore General Hospital, Singapore, Singapore
| | - D Y Q Hong
- Singapore General Hospital, Singapore, Singapore
| | - R Chong
- Tan Tock Seng Hospital, Singapore, Singapore
| | - J Low
- Tan Tock Seng Hospital, Singapore, Singapore
| | - R Ng
- Geriatric Education and Research Institute, 2 Yishun Central 2, Singapore, 768024, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
- Woodlands Health Campus, Singapore, Singapore
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Yu CC, Koh EJ, Low JA, Ong ML, Sim AGH, Hong DYQ, Chong R, Low J, Ng R. A multi-site study on the impact of an advance care planning workshop on attitudes, beliefs and behavioural intentions over a 6-month period. BMC Med Educ 2021; 21:298. [PMID: 34034725 PMCID: PMC8146668 DOI: 10.1186/s12909-021-02735-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/13/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND This study evaluated the impact of the adapted version of the Respecting Choices® The Living Matters Advance Care Planning (ACP) facilitator training programme on trainees' attitudes on facilitation 6 months post-training. SETTING AND PARTICIPANTS Two hundred and twenty-one healthcare professionals consisting of doctors, nurses, medical social workers from different training venues in Singapore participated in the first phase of the study (pre- and post) of which 107 participated in the second phase 6 months later (follow-up). METHODS Participants self-rated their attitudes, beliefs and behavioural intentions through surveys at three time points in an evaluation design that utilised repeated measures one-way ANOVA (pre-, post-, follow-up). Between-group differences were also examined using independent t-test. RESULTS At follow-up, mean scores increased significantly in understanding, confidence, and competence. Changes in effect sizes were large. Although trainees continued to think that ACP is emotionally draining for facilitators, more than before, facilitation experience was considered pleasant for themselves with the positive change significant and moderate in effect size. Those who had experience completing/initiating ACP significantly held more positive views than those who did not. CONCLUSIONS The ACP facilitator training programme had lasting effects on enhancing the understanding, competence, and confidence of trainees. Importantly, findings showed that experience in actual facilitation within 6 months after training was important and giving trainees opportunities to facilitate is recommended.
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Affiliation(s)
- C C Yu
- Geriatric Education and Research Institute, 2 Yishun Central 2, Singapore, 768024, Singapore.
| | - E J Koh
- Geriatric Education and Research Institute, 2 Yishun Central 2, Singapore, 768024, Singapore
| | - J A Low
- Geriatric Education and Research Institute, 2 Yishun Central 2, Singapore, 768024, Singapore
- Khoo Teck Puat Hospital, Singapore, Singapore
| | - M L Ong
- Khoo Teck Puat Hospital, Singapore, Singapore
| | - A G H Sim
- Singapore General Hospital, Singapore, Singapore
| | - D Y Q Hong
- Singapore General Hospital, Singapore, Singapore
| | - R Chong
- Tan Tock Seng Hospital, Singapore, Singapore
| | - J Low
- Tan Tock Seng Hospital, Singapore, Singapore
| | - R Ng
- Geriatric Education and Research Institute, 2 Yishun Central 2, Singapore, 768024, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
- Woodlands Health Campus, Singapore, Singapore
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Adekambi SA, Okello JJ, Rajendran S, Acheremu K, Carey EE, Low J, Abidin PE. Effect of varietal attributes on the adoption of an orange-fleshed sweetpotato variety in Upper East and Northern Ghana. Outlook Agric 2020; 49:311-320. [PMID: 33239831 PMCID: PMC7649934 DOI: 10.1177/0030727020950324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Despite sustained economic growth and reduction in some of forms of malnutrition, Ghana still faces a national prevalence rate of 20.8% vitamin A deficiency (VAD) among for children 6-59 months old. Orange-fleshed sweetpotato (Ipomoea batatas L.) (OFSP) can significantly improve vitamin A intake and contribute toward reducing VAD, especially in Northern Ghana where VAD is 31% among young children. Several poverty and nutrition projects in Ghana have promoted the use of OFSP for its health benefits. This study assesses the effect of three varietial attributes on adoption of the first released OFSP variety in Northern Ghana namely, Apomuden. The study concluded that sweetness, taste and dry matter have joint significant effects on adoption of an OFSP variety. The positive and negative traits highlighted will inform the on-going breeding effort.
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Affiliation(s)
- SA Adekambi
- University Institute of Technology, University of Parakou, Parakou, Benin
| | - JJ Okello
- Social and Nutrition Sciences Division, CIP, Kampala, Uganda
| | - S Rajendran
- International Potato Center (CIP), Nairobi, Kenya
| | - K Acheremu
- CSIR Savanna Agricultural Research Institute, Tamale, Ghana
| | - EE Carey
- International Potato Center (CIP), Kumasi, Ghana
| | - J Low
- International Potato Center (CIP), Nairobi, Kenya
| | - PE Abidin
- International Potato Center (CIP), Kumasi, Ghana
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Yeo M, Wong S, Low J. Inflammatory myofibroblastic tumour of the breast – A case report. Pathology 2020. [DOI: 10.1016/j.pathol.2020.01.328] [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: 10/25/2022]
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Ngoi N, Heong V, Kumarakulasinghe N, Phyu P, Peh E, Lim S, Lim Y, Tang J, Choo B, Koh V, Ilancheran A, Low J, Ng J, Thian Y, Tan D. Phase I study of low dose whole abdominal radiation therapy (LDWART) in combination with weekly paclitaxel (wP) for platinum resistant ovarian cancer (PROC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz250.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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8
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Low J, Maratos E, Kumar A, King A, Al-Sarraj S, Barazi S. P43 Parasellar capillary haemangioma with intrasellar extension. J Neurol Psychiatry 2019. [DOI: 10.1136/jnnp-2019-abn.113] [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: 11/03/2022]
Abstract
ObjectivesCapillary haemangioma is a benign vascular tumour that typically arises from skin and mucosal surfaces at birth and in infants. Central nervous system (CNS) capillary haemangioma in adults is extremely rare. We describe a case of capillary haemangioma located within the parasellar region extending into the sella.DesignCase report.ResultsWe report a 64-year-old patient who presented with a short history of ptosis and left sided headaches. CT showed a 3 cm by 2.5 cm para-sellar lesion extending into the sella. MRI showed a homogenously hyperintense lesion on T2-weighted MRI and FLAIR, which was isointense with adjacent brain parenchyma on T1-weighted MRI. This lesion also demonstrated contrast enhancement. The patient underwent an initial endoscopic transsphenoidal biopsy, which was inconclusive, followed by a craniotomy and debulking. Histological examination revealed fibrous tissue containing numerous thin walled and irregular vascular channels of varying sizes. There was a mild associated inflammatory infiltrate, mainly formed of small mononuclear chronic inflammatory cells, and occasional histiocytes. The histological appearances were in keeping capillary haemangioma.ConclusionsThe present case describes a capillary haemangioma located in the sella. The rarity of this vascular entity and the absence of any pathognomonic imaging features make it difficult to diagnose based on radiological appearances alone. Although rare, CH should be a differential when considering a sella or parasellar lesion.
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Heong V, Lim Y, Lee S, Ow S, Lim S, Ong P, Low J, Ng J, Ilancheran A, Tong P, Lim D, Tan D. Efficacy and tolerability of olaparib in Asian patients with recurrent ovarian, primary peritoneal or fallopian tube carcinoma: The National University Cancer Institute, Singapore experience. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy436.022] [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: 11/13/2022] Open
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Abstract
SummaryComparative plasma heparin levels were measured in normal subjects injected subcutaneously with 5,000 units of the sodium and calcium salts of heparin. Plasma heparin levels were measured up to 7 hr post-injection by an anti-factor Xa assay (Denson and Bonnar 1973). Preliminary studies indicated that heparin levels were reproducible in subjects who received two injections of the same heparin. Peak plasma concentrations (Cmax) and the time at which peak concentration was reached (Tmax) varied greatly from subject to subject. In one group of subjects (15) two commonly used heparins, a sodium heparin (Evans) and a calcium heparin (Choay) were compared. Peak heparin concentrations were not significantly different. However the Tmax for the sodium heparin (1.5 hr) was significantly earlier than the Tmax for the calcium heparin (3 hr) and this was not due to a difference in the volume of the two heparin injections. No significant difference could be detected in the plasma clearance rate and the molecular weight distribution of the two heparins.In two other groups of subjects, sodium and calcium preparations from two manufacturers were compared. In general, the sodium salts gave rise to significantly higher plasma concentrations, which could be interpreted as a greater bioavailability of sodium salts. These results indicate that the salt of the heparin can influence the plasma concentration achieved after subcutaneous injection.
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Affiliation(s)
- Joyce Low
- The Haematology Department, St. Vincent’s Hospital, Darlinghurst, Sydney N. S. W. 2010, Australia
| | - J C Biggs
- The Haematology Department, St. Vincent’s Hospital, Darlinghurst, Sydney N. S. W. 2010, Australia
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Hong E, Low J, Toner E, Chaudhurry M, Lazenby D, Gawne S. Improving confidence and competence of junior doctors in a surgical environment. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.509] [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: 11/30/2022]
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12
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Tang J, Koh V, Ng J, Low J. Feasibility study and dosimetric evaluation of real time CT-guided intracavitary plus interstitial cervical implantation in an outpatient setting for locally advanced cervical cancer patients. Gynecol Oncol 2018. [DOI: 10.1016/j.ygyno.2018.04.369] [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: 10/28/2022]
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13
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Mai A, Mathew M, Niekamp A, Low J, Zvavanjanja R. Abstract No. 497 Renal tumor cryoablation with cauterization capable probes: 3-year patient safety experience at a single institution. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.542] [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] Open
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14
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Low J, Joseph J, Kotlyar E, George P, Brennan S, Sheen C. Fibrinogen Darlinghurst: Hypofibrinogenaemia caused by a W253G mutation in the gamma chain in a patient with both bleeding and thrombotic complications. Thromb Haemost 2017. [DOI: 10.1160/th06-08-0425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Favaloro EJ, Bonar R, Duncan E, Earl G, Low J, Aboud M, Just S, Sioufi J, Street A, Marsden K. Identification of factor inhibitors by diagnostic haemostasis laboratories. Thromb Haemost 2017; 96:73-8. [PMID: 16807654 DOI: 10.1160/th06-01-0004] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummaryWe have assessed the proficiency of diagnostic haemostasis facilities to correctly identify coagulation factor abnormalities and inhibitors. Forty-two laboratories participating in the external Quality Assurance Program (QAP) conducted by the RCPA agreed to participate and were each sent a set of eight sample (each 3x1ml) for evaluation. They were asked to blind test these samples for the presence or absence of inhibitors, and wher identified, to perform further analysis (including specific inhibitor analysis). In order to make the exercise more challenging, in addition to true factor inhibitors, samples were provided that reflected potential pre-analytical variables that might arise and complicate inhibitor detection or lead to false inhibitor identification. In brief, the sample set comprised a true high level factor (F)V inhibitor, a true moderate level FVIII inhibitor (but sample was defibrinogenated),a true lupus anticoagulant (LA),a normal (but slightly aged) plasma sample, a normal serum sample, a normal EDTA sample, an oral anticoagulant/vitamin K deficiency sample, and a gross heparin (∼10U/ml) contaminated sample. Sixty-three percent of participants correctly identified the true FV inhibitor as such, although the reported range varied greatly [10 to >250 Bethesda units (BU/ml)] and 46% correctly identi fied the true FVIII inhibitor, despite the complication of the sample presentation, although the reported range also varied (7 to 64 BU/ml). Some laboratories either failed to identify the inhibitor present, or misidentified the inhibitor type. The LA, the oral anticoagulant/vitamin K deficiency, the normal serum sample, and the normal (aged) sample were also correctly identified by most laboratories, as was the absence of specific factor inhibitors in these samples. However, a small subset of laboratories incorrectly identified the presence of specific factor inhibitors in some of these samples. The heparin sample was also correctly identified by most (68%) laboratories. In contrast, the normal EDTA sample was misidentified as a FV and/or FVIII inhibitor by most (68%) laboratories, and only one laboratory correctly identified this as an EDTA sample. Thus, we conclude that although laboratories are able, in most cases, to identify the presence of true factor inhibitors, there is a large variation in identified inhibitor levels and there are also some significant errors in identification (i.e. false negatives and misidentifications). In addition, there is a significant false positive error rate where some laboratories will identify the presence of specific factor inhibitors where no such inhibitor exists (i.e. false positives).
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Affiliation(s)
- Emmanuel J Favaloro
- Department of Haematology and RCPA Quality Assurance Program (QAP), Institute of Clinical Pathology and Medical Research (ICPMR),Westmead Hospital, Westmead, New South Wales, Australia.
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Low J, Koh J, Leong H, Lau D, Zhang X, Kwang X, Chan J, Rikka S, Tan DSW, Periyasamy G, Iyer N, Dasgupta R. A chemical genetics approach to identify therapeutic vulnerabilities in Gefitinib resistant, EGFR T790M. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx511.014] [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: 11/14/2022] Open
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Choo B, Koh V, Tang J, Low J, Stephenson M, Cheong DH, Laurens E, Totman J, Ng JY, Roy S. 324P Radiation response assessment by hybrid positron emission tomography/magnetic resonance imaging for cervical cancer treatment. Ann Oncol 2016. [DOI: 10.1016/s0923-7534(21)00482-8] [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: 10/22/2022] Open
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Choo B, Lee Z, Zhao W, Wang X, Ng J, Low J, Deng L. 326P Biomarker discovery for early prediction of therapy resistance in cervical cancers. Ann Oncol 2016. [DOI: 10.1016/s0923-7534(21)00484-1] [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: 10/22/2022] Open
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19
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Huang RJ, Antony J, Tan T, Low J, Choolani M, Thiery J. 297O Stratifying ovarian cancer based on AXL signaling for therapeutic targeting. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw585.001] [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: 11/13/2022] Open
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20
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Choo B, Lee Z, Zhao W, Wang X, Ng J, Low J, Deng L. 326P Biomarker discovery for early prediction of therapy resistance in cervical cancers. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw585.030] [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: 11/15/2022] Open
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21
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Choo B, Koh V, Tang J, Low J, Stephenson M, Cheong DH, Laurens E, Totman J, Ng JY, Roy S. 324P Radiation response assessment by hybrid positron emission tomography/magnetic resonance imaging for cervical cancer treatment. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw585.028] [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: 11/14/2022] Open
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22
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Connor DE, Ly K, Aslam A, Boland J, Low J, Jarvis S, Muller DW, Joseph JE. Effects of antiplatelet therapy on platelet extracellular vesicle release and procoagulant activity in health and in cardiovascular disease. Platelets 2016; 27:805-811. [PMID: 27310292 DOI: 10.1080/09537104.2016.1190008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Dual antiplatelet therapy with aspirin and clopidogrel is commonly used to prevent recurrent ischemic events in patients with cardiovascular disease. Whilst their effects on platelet reactivity are well documented, it is unclear, however, whether antiplatelet therapy inhibits platelet extracellular vesicle (EV) release. The aim of this study was to investigate the effects of antiplatelet therapy on platelet EV formation and procoagulant activity. Blood samples from 10 healthy controls not receiving antiplatelet therapy were incubated in vitro with aspirin or a P2Y12 inhibitor (MeSAMP). Blood samples from 50 patients receiving long-term dual antiplatelet therapy and undergoing coronary angiography were also studied. Platelet reactivity was assessed by Multiplate™ impedance aggregometry. Platelet EV formation and procoagulant activity of pretreated and untreated blood samples in response to arachidonic acid (AA), adenosine diphosphate (ADP), ADP+PGE1, and thrombin receptor-activating peptide (TRAP) stimulation were assessed by flow cytometry and Procoag-PL assays, respectively. Incubation of normal platelets with aspirin significantly inhibited AA-induced platelet reactivity, EV formation, and procoagulant activity, whilst MeSAMP significantly inhibited platelet reactivity and EV formation in response to AA, ADP, and TRAP, but had minimal effect on procoagulant activity. Most patients receiving dual antiplatelet therapy showed an appropriate reduction in platelet reactivity in response to their treatment; however there was not complete inhibition of increased platelet and EV procoagulant activity in response to ADP, AA, or TRAP. In addition, we could not find any correlation between platelet reactivity and procoagulant activity in patients receiving dual antiplatelet therapy.
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Affiliation(s)
- David E Connor
- a Blood, Stem Cell and Cancer Research Unit , St Vincent's Centre for Applied Medical Research , Darlinghurst , NSW , Australia.,b St Vincent's Clinical School, Faculty of Medicine , University of New South Wales , Randwick , NSW , Australia
| | - Ken Ly
- a Blood, Stem Cell and Cancer Research Unit , St Vincent's Centre for Applied Medical Research , Darlinghurst , NSW , Australia
| | - Anoosha Aslam
- a Blood, Stem Cell and Cancer Research Unit , St Vincent's Centre for Applied Medical Research , Darlinghurst , NSW , Australia.,b St Vincent's Clinical School, Faculty of Medicine , University of New South Wales , Randwick , NSW , Australia
| | - John Boland
- c Department of Cardiology , St Vincent's Hospital , Darlinghurst , NSW , Australia
| | - Joyce Low
- d Haemostasis Laboratory, SydPath , St Vincent's Hospital , Darlinghurst , NSW , Australia
| | - Susan Jarvis
- d Haemostasis Laboratory, SydPath , St Vincent's Hospital , Darlinghurst , NSW , Australia
| | - David W Muller
- b St Vincent's Clinical School, Faculty of Medicine , University of New South Wales , Randwick , NSW , Australia.,c Department of Cardiology , St Vincent's Hospital , Darlinghurst , NSW , Australia
| | - Joanne E Joseph
- a Blood, Stem Cell and Cancer Research Unit , St Vincent's Centre for Applied Medical Research , Darlinghurst , NSW , Australia.,b St Vincent's Clinical School, Faculty of Medicine , University of New South Wales , Randwick , NSW , Australia.,d Haemostasis Laboratory, SydPath , St Vincent's Hospital , Darlinghurst , NSW , Australia
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Muthiah K, Connor D, Ly K, Gardiner EE, Andrews RK, Qiao J, Rutgers D, Robson D, Low J, Jarvis S, Macdonald P, Dhital K, Jansz P, Joseph J, Hayward CS. Longitudinal changes in hemostatic parameters and reduced pulsatility contribute to non-surgical bleeding in patients with centrifugal continuous-flow left ventricular assist devices. J Heart Lung Transplant 2016; 35:743-51. [DOI: 10.1016/j.healun.2015.12.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 11/09/2015] [Accepted: 12/15/2015] [Indexed: 01/14/2023] Open
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Lim L, Tong P, Lee S, Low J. 278P Characteristics of endometrial and ovarian cancers in Lynch syndrome and hereditary breast ovarian cancer syndrome. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv525.12] [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: 11/13/2022] Open
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Hofstra LM, Sauvageot N, Albert J, Alexiev I, Garcia F, Struck D, Van de Vijver DAMC, Åsjö B, Beshkov D, Coughlan S, Descamps D, Griskevicius A, Hamouda O, Horban A, Van Kasteren M, Kolupajeva T, Kostrikis LG, Liitsola K, Linka M, Mor O, Nielsen C, Otelea D, Paraskevis D, Paredes R, Poljak M, Puchhammer-Stöckl E, Sönnerborg A, Staneková D, Stanojevic M, Van Laethem K, Zazzi M, Zidovec Lepej S, Boucher CAB, Schmit JC, Wensing AMJ, Puchhammer-Stockl E, Sarcletti M, Schmied B, Geit M, Balluch G, Vandamme AM, Vercauteren J, Derdelinckx I, Sasse A, Bogaert M, Ceunen H, De Roo A, De Wit S, Echahidi F, Fransen K, Goffard JC, Goubau P, Goudeseune E, Yombi JC, Lacor P, Liesnard C, Moutschen M, Pierard D, Rens R, Schrooten Y, Vaira D, Vandekerckhove LPR, Van den Heuvel A, Van Der Gucht B, Van Ranst M, Van Wijngaerden E, Vandercam B, Vekemans M, Verhofstede C, Clumeck N, Van Laethem K, Beshkov D, Alexiev I, Lepej SZ, Begovac J, Kostrikis L, Demetriades I, Kousiappa I, Demetriou V, Hezka J, Linka M, Maly M, Machala L, Nielsen C, Jørgensen LB, Gerstoft J, Mathiesen L, Pedersen C, Nielsen H, Laursen A, Kvinesdal B, Liitsola K, Ristola M, Suni J, Sutinen J, Descamps D, Assoumou L, Castor G, Grude M, Flandre P, Storto A, Hamouda O, Kücherer C, Berg T, Braun P, Poggensee G, Däumer M, Eberle J, Heiken H, Kaiser R, Knechten H, Korn K, Müller H, Neifer S, Schmidt B, Walter H, Gunsenheimer-Bartmeyer B, Harrer T, Paraskevis D, Hatzakis A, Zavitsanou A, Vassilakis A, Lazanas M, Chini M, Lioni A, Sakka V, Kourkounti S, Paparizos V, Antoniadou A, Papadopoulos A, Poulakou G, Katsarolis I, Protopapas K, Chryssos G, Drimis S, Gargalianos P, Xylomenos G, Lourida G, Psichogiou M, Daikos GL, Sipsas NV, Kontos A, Gamaletsou MN, Koratzanis G, Sambatakou H, Mariolis H, Skoutelis A, Papastamopoulos V, Georgiou O, Panagopoulos P, Maltezos E, Coughlan S, De Gascun C, Byrne C, Duffy M, Bergin C, Reidy D, Farrell G, Lambert J, O'Connor E, Rochford A, Low J, Coakely P, O'Dea S, Hall W, Mor O, Levi I, Chemtob D, Grossman Z, Zazzi M, de Luca A, Balotta C, Riva C, Mussini C, Caramma I, Capetti A, Colombo MC, Rossi C, Prati F, Tramuto F, Vitale F, Ciccozzi M, Angarano G, Rezza G, Kolupajeva T, Vasins O, Griskevicius A, Lipnickiene V, Schmit JC, Struck D, Sauvageot N, Hemmer R, Arendt V, Michaux C, Staub T, Sequin-Devaux C, Wensing AMJ, Boucher CAB, van de Vijver DAMC, van Kessel A, van Bentum PHM, Brinkman K, Connell BJ, van der Ende ME, Hoepelman IM, van Kasteren M, Kuipers M, Langebeek N, Richter C, Santegoets RMWJ, Schrijnders-Gudde L, Schuurman R, van de Ven BJM, Åsjö B, Kran AMB, Ormaasen V, Aavitsland P, Horban A, Stanczak JJ, Stanczak GP, Firlag-Burkacka E, Wiercinska-Drapalo A, Jablonowska E, Maolepsza E, Leszczyszyn-Pynka M, Szata W, Camacho R, Palma C, Borges F, Paixão T, Duque V, Araújo F, Otelea D, Paraschiv S, Tudor AM, Cernat R, Chiriac C, Dumitrescu F, Prisecariu LJ, Stanojevic M, Jevtovic D, Salemovic D, Stanekova D, Habekova M, Chabadová Z, Drobkova T, Bukovinova P, Shunnar A, Truska P, Poljak M, Lunar M, Babic D, Tomazic J, Vidmar L, Vovko T, Karner P, Garcia F, Paredes R, Monge S, Moreno S, Del Amo J, Asensi V, Sirvent JL, de Mendoza C, Delgado R, Gutiérrez F, Berenguer J, Garcia-Bujalance S, Stella N, de Los Santos I, Blanco JR, Dalmau D, Rivero M, Segura F, Elías MJP, Alvarez M, Chueca N, Rodríguez-Martín C, Vidal C, Palomares JC, Viciana I, Viciana P, Cordoba J, Aguilera A, Domingo P, Galindo MJ, Miralles C, Del Pozo MA, Ribera E, Iribarren JA, Ruiz L, de la Torre J, Vidal F, Clotet B, Albert J, Heidarian A, Aperia-Peipke K, Axelsson M, Mild M, Karlsson A, Sönnerborg A, Thalme A, Navér L, Bratt G, Karlsson A, Blaxhult A, Gisslén M, Svennerholm B, Bergbrant I, Björkman P, Säll C, Mellgren Å, Lindholm A, Kuylenstierna N, Montelius R, Azimi F, Johansson B, Carlsson M, Johansson E, Ljungberg B, Ekvall H, Strand A, Mäkitalo S, Öberg S, Holmblad P, Höfer M, Holmberg H, Josefson P, Ryding U. Transmission of HIV Drug Resistance and the Predicted Effect on Current First-line Regimens in Europe. Clin Infect Dis 2015; 62:655-663. [PMID: 26620652 PMCID: PMC4741360 DOI: 10.1093/cid/civ963] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [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: 06/08/2015] [Accepted: 11/06/2015] [Indexed: 11/13/2022] Open
Abstract
Transmitted human immunodeficiency virus drug resistance in Europe is stable at around 8%. The impact of baseline mutation patterns on susceptibility to antiretroviral drugs should be addressed using clinical guidelines. The impact on baseline susceptibility is largest for nonnucleoside reverse transcriptase inhibitors. Background. Numerous studies have shown that baseline drug resistance patterns may influence the outcome of antiretroviral therapy. Therefore, guidelines recommend drug resistance testing to guide the choice of initial regimen. In addition to optimizing individual patient management, these baseline resistance data enable transmitted drug resistance (TDR) to be surveyed for public health purposes. The SPREAD program systematically collects data to gain insight into TDR occurring in Europe since 2001. Methods. Demographic, clinical, and virological data from 4140 antiretroviral-naive human immunodeficiency virus (HIV)–infected individuals from 26 countries who were newly diagnosed between 2008 and 2010 were analyzed. Evidence of TDR was defined using the WHO list for surveillance of drug resistance mutations. Prevalence of TDR was assessed over time by comparing the results to SPREAD data from 2002 to 2007. Baseline susceptibility to antiretroviral drugs was predicted using the Stanford HIVdb program version 7.0. Results. The overall prevalence of TDR did not change significantly over time and was 8.3% (95% confidence interval, 7.2%–9.5%) in 2008–2010. The most frequent indicators of TDR were nucleoside reverse transcriptase inhibitor (NRTI) mutations (4.5%), followed by nonnucleoside reverse transcriptase inhibitor (NNRTI) mutations (2.9%) and protease inhibitor mutations (2.0%). Baseline mutations were most predictive of reduced susceptibility to initial NNRTI-based regimens: 4.5% and 6.5% of patient isolates were predicted to have resistance to regimens containing efavirenz or rilpivirine, respectively, independent of current NRTI backbones. Conclusions. Although TDR was highest for NRTIs, the impact of baseline drug resistance patterns on susceptibility was largest for NNRTIs. The prevalence of TDR assessed by epidemiological surveys does not clearly indicate to what degree susceptibility to different drug classes is affected.
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Affiliation(s)
- L Marije Hofstra
- Luxembourg Institute of Health, Luxembourg.,Department of Virology, University Medical Center Utrecht, The Netherlands
| | | | - Jan Albert
- Karolinska Institute, Solna.,Karolinska University Hospital, Stockholm, Sweden
| | - Ivailo Alexiev
- National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Federico Garcia
- Complejo Hospitalario Universitario de Granada, Instituto de Investigación IBS Granada; on behalf of Cohorte de Adultos de la Red de Investigación en SIDA, Spain
| | | | | | | | - Danail Beshkov
- National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | | | - Diane Descamps
- AP-HP Groupe hospitalier Bichat-Claude Bernard, IAME INSERM UMR 1137, Université Paris Diderot Sorbonne Paris Cité, Paris, France
| | | | | | | | | | | | | | - Kirsi Liitsola
- Department of Infectious Diseases, National Institute for Health and Welfare, Helsinki, Finland
| | - Marek Linka
- National Reference Laboratory for HIV/AIDS, National Institute of Public Health, Prague, Czech Republic
| | - Orna Mor
- National HIV Reference Laboratory, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | | | - Dan Otelea
- National Institute for Infectious Diseases "Prof. dr. Matei Bals", Bucharest, Romania
| | | | | | - Mario Poljak
- Faculty of Medicine, Slovenian HIV/AIDS Reference Centre, University of Ljubljana, Slovenia
| | | | - Anders Sönnerborg
- Karolinska Institute, Solna.,Karolinska University Hospital, Stockholm, Sweden
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Low J, Nicholson H. 2516 Identification of downstream players after the loss of polymerase-1 and transcript release factor (PTRF) in prostate cancer. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(15)30048-4] [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: 10/23/2022]
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Rodriguez DA, Weinlich R, Brown S, Guy C, Fitzgerald P, Dillon CP, Oberst A, Quarato G, Low J, Cripps JG, Chen T, Green DR. Characterization of RIPK3-mediated phosphorylation of the activation loop of MLKL during necroptosis. Cell Death Differ 2015; 23:76-88. [PMID: 26024392 DOI: 10.1038/cdd.2015.70] [Citation(s) in RCA: 270] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 04/28/2015] [Accepted: 04/28/2015] [Indexed: 12/14/2022] Open
Abstract
Mixed lineage kinase domain-like pseudokinase (MLKL) mediates necroptosis by translocating to the plasma membrane and inducing its rupture. The activation of MLKL occurs in a multimolecular complex (the 'necrosome'), which is comprised of MLKL, receptor-interacting serine/threonine kinase (RIPK)-3 (RIPK3) and, in some cases, RIPK1. Within this complex, RIPK3 phosphorylates the activation loop of MLKL, promoting conformational changes and allowing the formation of MLKL oligomers, which migrate to the plasma membrane. Previous studies suggested that RIPK3 could phosphorylate the murine MLKL activation loop at Ser345, Ser347 and Thr349. Moreover, substitution of the Ser345 for an aspartic acid creates a constitutively active MLKL, independent of RIPK3 function. Here we examine the role of each of these residues and found that the phosphorylation of Ser345 is critical for RIPK3-mediated necroptosis, Ser347 has a minor accessory role and Thr349 seems to be irrelevant. We generated a specific monoclonal antibody to detect phospho-Ser345 in murine cells. Using this antibody, a series of MLKL mutants and a novel RIPK3 inhibitor, we demonstrate that the phosphorylation of Ser345 is not required for the interaction between RIPK3 and MLKL in the necrosome, but is essential for MLKL translocation, accumulation in the plasma membrane, and consequent necroptosis.
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Affiliation(s)
- D A Rodriguez
- Department of Immunology, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - R Weinlich
- Department of Immunology, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - S Brown
- Department of Immunology, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - C Guy
- Department of Immunology, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - P Fitzgerald
- Department of Immunology, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - C P Dillon
- Department of Immunology, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - A Oberst
- Department of Immunology, University of Washington, Seattle, WA 98109, USA
| | - G Quarato
- Department of Immunology, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - J Low
- Department Chemical Biology & Therapeutics, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - J G Cripps
- Institute for Cellular Therapeutics, University of Louisville, Louisville, KY 40202, USA
| | - T Chen
- Department Chemical Biology & Therapeutics, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - D R Green
- Department of Immunology, St Jude Children's Research Hospital, Memphis, TN 38105, USA
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Gola A, Davis S, Greenslade L, Hopkins K, Low J, Marshall A, Thorburn D, Vickerstaff V, Jones L. ECONOMIC ANALYSIS OF COSTS FOR PATIENTS WITH END STAGE LIVER DISEASE OVER THE LAST YEAR OF LIFE. BMJ Support Palliat Care 2015. [DOI: 10.1136/bmjspcare-2014-000838.23] [Citation(s) in RCA: 7] [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: 11/04/2022]
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Asad M, Wong MK, Tan TZ, Choolani M, Low J, Mori S, Virshup D, Thiery JP, Huang RYJ. FZD7 drives in vitro aggressiveness in Stem-A subtype of ovarian cancer via regulation of non-canonical Wnt/PCP pathway. Cell Death Dis 2014; 5:e1346. [PMID: 25032869 PMCID: PMC4123093 DOI: 10.1038/cddis.2014.302] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 05/27/2014] [Accepted: 06/09/2014] [Indexed: 01/02/2023]
Abstract
Ovarian cancer (OC) can be classified into five biologically distinct molecular subgroups: epithelial-A (Epi-A), Epi-B, mesenchymal (Mes), Stem-A and Stem-B. Among them, Stem-A expresses genes relating to stemness and is correlated with poor clinical prognosis. In this study, we show that frizzled family receptor 7 (FZD7), a receptor for Wnt signalling, is overexpressed in the Stem-A subgroup. To elucidate the functional roles of FZD7, we used an RNA interference gene knockdown approach in three Stem-A cell lines: CH1, PA1 and OV-17R. Si-FZD7 OC cells showed reduced cell proliferation with an increase in the G0/G1 sub-population, with no effect on apoptosis. The cells also displayed a distinctive morphologic change by colony compaction to become more epithelial-like and polarised with smaller internuclear distances and increased z-axis height. Immunofluorescence (IF) staining patterns of pan-cadherin and β-catenin suggested an increase in cadherin-based cell–cell adhesion in si-FZD7 cells. We also observed a significant rearrangement in the actin cytoskeleton and an increase in tensile contractility in si-FZD7 OC cells, as evident by the loss of stress fibres and the redistribution of phospho-myosin light chain (pMLC) from the sites of cell–cell contacts to the periphery of cell colonies. Furthermore, there was reciprocal regulation of RhoA (Ras homolog family member A) and Rac1 (Ras-related C3 botulinum toxin substrate 1 (Rho family, small GTP-binding protein Rac1)) activities upon FZD7 knockdown, with a significant reduction in RhoA activity and a concomitant upregulation in Rac1 activity. These changes in pMLC and RhoA, as well as the increased TopFlash reporter activities in si-FZD7 cells, suggested involvement of the non-canonical Wnt/planar cell polarity (PCP) pathway. Selected PCP pathway genes (cadherin EGF LAG seven-pass G-type receptor 3 (CELSR3), prickle homolog 4 (Drosophila) (PRICKLE4), dishevelled-associated activator of morphogenesis 1 (DAAM1), profilin 2 (PFN2), protocadherin 9 (PCDH9), protocadherin α1 (PCDHA1), protocadherin β17 pseudogene (PCDHB17), protocadherin β3 (PCDHB3), sprouty homolog 1 (SPRY1) and protein tyrosine kinase 7 (PTK7)) were found to be more highly expressed in Stem-A than non Stem-A subgroup of OC. Taken together, our results suggest that FZD7 might drive aggressiveness in Stem-A OC by regulating cell proliferation, cell cycle progression, maintenance of the Mes phenotype and cell migration via casein kinase 1ɛ-mediated non-canonical Wnt/PCP pathway.
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Affiliation(s)
- M Asad
- Cancer Science Institute of Singapore, Centre for Translational Medicine NUS Yong Loo Lin School of Medicine, Singapore, Singapore
| | - M K Wong
- Cancer Science Institute of Singapore, Centre for Translational Medicine NUS Yong Loo Lin School of Medicine, Singapore, Singapore
| | - T Z Tan
- Cancer Science Institute of Singapore, Centre for Translational Medicine NUS Yong Loo Lin School of Medicine, Singapore, Singapore
| | - M Choolani
- Department of Obstetrics and Gynaecology, National University Hospital of Singapore, Singapore, Singapore
| | - J Low
- 1] Department of Obstetrics and Gynaecology, National University Hospital of Singapore, Singapore, Singapore [2] National University Cancer Institute of Singapore, Singapore, Singapore
| | - S Mori
- Division of Cancer Genomics, Cancer Institute of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-Ku, Tokyo, Japan
| | - D Virshup
- Duke NUS Graduate Medical School, Singapore, Singapore
| | - J P Thiery
- 1] Cancer Science Institute of Singapore, Centre for Translational Medicine NUS Yong Loo Lin School of Medicine, Singapore, Singapore [2] National University Cancer Institute of Singapore, Singapore, Singapore [3] Department of Biochemistry, National University of Singapore, Singapore, Singapore [4] Institute of Molecular and Cell Biology, A*STAR, Singapore, Singapore
| | - R Y-J Huang
- 1] Cancer Science Institute of Singapore, Centre for Translational Medicine NUS Yong Loo Lin School of Medicine, Singapore, Singapore [2] Department of Obstetrics and Gynaecology, National University Hospital of Singapore, Singapore, Singapore [3] National University Cancer Institute of Singapore, Singapore, Singapore
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Panosyan E, Gotesman M, Kallay T, Martinez S, Bolaris M, Lasky J, Fouyssac F, Gentet JC, Frappaz D, Piguet C, Gorde-Grosjean S, Grill J, Schmitt E, Pall-Kondolff S, Chastagner P, Dudley R, Torok M, Gallegos D, Liu A, Handler M, Hankinson T, Dudley R, Torok M, Gallegos D, Liu A, Handler M, Hankinson T, Fukuoka K, Yanagisawa T, Suzuki T, Shirahata M, Adachi JI, Mishima K, Fujimaki T, Matsutani M, Sasaki A, Wada S, Nishikawa R, Suzuki M, Kondo A, Miyajima M, Arai H, Morin S, Uro-Coste E, Munzer C, Gambart M, Puget S, Miquel C, Maurage CA, Dufour C, Leblond P, Andre N, Kanold J, Icher C, Bertozzi AAI, Diez B, Muggeri A, Cerrato S, Calabrese B, Arakaki N, Marron A, Sevlever G, Fisher MJ, Widemann BC, Dombi E, Wolters P, Cantor A, Vinks A, Parentesis J, Ullrich N, Gutmann D, Viskochil D, Tonsgard J, Korf B, Packer R, Weiss B, Fisher MJ, Marcus L, Weiss B, Kim A, Dombi E, Baldwin A, Whitcomb P, Martin S, Gillespie A, Doyle A, Widemann BC, Bulwer C, Gan HW, Ederies A, Korbonits M, Powell M, Jeelani O, Jacques T, Stern E, Spoudeas H, Kimpo M, Tang J, Tan CL, Yeo TT, Chong QT, Ruland V, Hartung S, Kordes U, Wolff JE, Paulus W, Hasselblatt M, Patil S, Zaky W, Khatua S, Lassen-Ramshad Y, Christensen L, Clausen N, Bendel A, Dobyns W, Bennett J, Reyes-Mugica M, Petronio J, Nikiforova M, Mueller H, Kirches E, Korshunov A, Pfister S, Mawrin C, Hemenway M, Foreman N, Kumar A, Kalra S, Acharya R, Radhakrishnan N, Sachdeva A, Nimmervoll B, Hadjadj D, Tong Y, Shelat AA, Low J, Miller G, Stewart CF, Guy RK, Gilbertson RJ, Miwa T, Nonaka Y, Oi S, Sasaki H, Yoshida K, Northup R, Klesse L, McNall-Knapp R, Blagia M, Romeo F, Toscano S, D'Agostino A, Lafay-Cousin L, Lindzon G, Bouffet E, Taylor M, Hader W, Nordal R, Hawkins C, Laperriere N, Laughlin S, Shash H, McDonald P, Wrogemann J, Ahsanuddin A, Matsuda K, Soni R, Vanan MI, Cohen K, Taylor I, Rodriguez F, Burger P, Yeh J, Rao S, Iskandar B, Kienitz BA, Bruce R, Keller L, Salamat S, Puccetti D, Patel N, Hana A, Gunness VRN, Berthold C, Hana A, Bofferding L, Neuhaeuser C, Scalais E, Kieffer I, Feiden W, Graf N, Boecher-Schwarz H, Hertel F, Cruz O, Morales A, de Torres C, Vicente A, Gonzalez MA, Sunol M, Mora J, Garcia G, Guillen A, Muchart J, Yankelevich M, Sood S, Diver J, Savasan S, Poulik J, Bhambhani K, Hochart A, Gaillard V, Bonne NX, Baroncini M, Andre N, Vannier JP, Dubrulle F, Lejeune JP, Vincent C, Leblond P, Japp A, Gessi M, Muehlen AZ, Klein-Hitpass L, Pietsch T, Sharma M, Yadav R, Malgulwar PB, Pathak P, Sigamani E, Suri V, Sarkar C, Jagdevan A, Singh M, Sharma BS, Garg A, Bakhshi S, Faruq M, Doromal D, Villafuerte CJ, Tezcanli E, Yilmaz M, Sengoz M, Peker S, Dhall G, Robison N, Margol A, Evans A, Krieger M, Finlay J, Rosser T, Khakoo Y, Pratilas C, Marghoob A, Berger M, Hollmann T, Rosenblum M, Mrugala M, Giglio P, Keene C, Ferreira M, Garcia D, Weil A, Khatib Z, Diaz A, Niazi T, Bhatia S, Ragheb J, Robison N, Rangan K, Margol A, Rosser T, Finlay J, Dhall G, Gilles F, Morris C, Chen Y, Shetty V, Elbabaa S, Guzman M, Abdel-Baki MS, Abdel-Baki MS, Waguespack S, Jones J, Stapleton S, Baskin D, M, Okcu F. RARE TUMOURS. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou081] [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: 11/15/2022] Open
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Hauber M, Samaš P, Anderson M, Rutila J, Low J, Cassey P, Grim T. Life-history theory predicts host behavioural responses to experimental brood parasitism. ETHOL ECOL EVOL 2013. [DOI: 10.1080/03949370.2013.851121] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [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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Parsi K, Connor DE, Pilotelle A, Low J, Ma DD, Joseph JE. Low Concentration Detergent Sclerosants Induce Platelet Activation but Inhibit Aggregation due to Suppression of GPIIb/IIIa Activation in vitro. Thromb Res 2012; 130:472-8. [DOI: 10.1016/j.thromres.2012.03.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 03/16/2012] [Accepted: 03/26/2012] [Indexed: 10/28/2022]
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France R, Sampson L, Bravery R, Low J, Candy B. Volunteer activity in end–of-life care: a national survey of current practice. BMJ Support Palliat Care 2012. [DOI: 10.1136/bmjspcare-2012-000264.25] [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: 11/04/2022]
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Heng S, Low J, Kandaiya S. EP-1479 THE INFLUENCE OF BOWEL AND BLADDER PREPARATION PROTOCOLS FOR RADIOTHERAPY OF PROSTATE CANCER. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71812-1] [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: 10/28/2022]
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Parsi K, Exner T, Low J, Fung Ma D, Joseph J. In Vitro Effects of Detergent Sclerosants on Clot Formation and Fibrinolysis. Eur J Vasc Endovasc Surg 2011; 41:267-77. [DOI: 10.1016/j.ejvs.2010.10.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Accepted: 10/06/2010] [Indexed: 10/18/2022]
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Qiu MR, Jiang L, Matthaei KI, Schoenwaelder SM, Kuffner T, Mangin P, Joseph JE, Low J, Connor D, Valenzuela SM, Curmi PMG, Brown LJ, Mahaut-Smith M, Jackson SP, Breit SN. Generation and characterization of mice with null mutation of the chloride intracellular channel 1 gene. Genesis 2010; 48:127-36. [PMID: 20049953 DOI: 10.1002/dvg.20590] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
CLIC1 belongs to a family of highly conserved and widely expressed intracellular chloride ion channel proteins existing in both soluble and membrane integrated forms. To study the physiological and biological role of CLIC1 in vivo, we undertook conditional gene targeting to engineer Clic1 gene knock-out mice. This represents creation of the first gene knock-out of a vertebrate CLIC protein family member. We first generated a Clic1 Knock-in (Clic1(FN)) allele, followed by Clic1 knock-out (Clic1(-/-)) mice by crossing Clic1(FN) allele with TNAP-cre mice, resulting in germline gene deletion through Cre-mediated recombination. Mice heterozygous or homozygous for these alleles are viable and fertile and appear normal. However, Clic1(-) (/-) mice show a mild platelet dysfunction characterized by prolonged bleeding times and decreased platelet activation in response to adenosine diphosphate stimulation linked to P2Y(12) receptor signaling.
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Affiliation(s)
- Min Ru Qiu
- St. Vincent's Centre for Applied Medical Research, St. Vincent's Hospital and University of New South Wales, Sydney, New South Wales, Australia
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Lee HP, Chew CT, Consigliere DT, Heng D, Huang DT, Khoo J, Khoo KS, Low J, Lui S, Ooi LL, Puvanendran R, Siow A, Tan A, Yeoh KG. Ministry of health clinical practice guidelines: cancer screening. Singapore Med J 2010; 51:170-175. [PMID: 20358158] [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: 05/29/2023]
Abstract
The Ministry of Health publishes national clinical practice guidelines to provide doctors and patients in Singapore with evidence-based guidance on managing important medical conditions. This article reproduces the introduction and executive summary (with key recommendations from the guidelines) from the Ministry of Health clinical practice guidelines on cancer screening, for the information of readers of the Singapore Medical Journal. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website (http://www.moh.gov. sg/mohcorp/publications.aspx?id=24018). The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.
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Affiliation(s)
- H P Lee
- Epidemiology and Disease Control Division, Ministry of Health, Singapore
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Qiu MR, Jiang L, Matthaei KI, Schoenwaelder SM, Kuffner T, Mangin P, Joseph JE, Low J, Connor D, Valenzuela SM, Curmi PM, Brown LJ, Mahaut-Smith M, Jackson SP, Breit SN. Generation and characterization of mice with null mutation of the chloride intracellular channel 1 gene. Genesis 2010. [DOI: 10.1002/dvg.20616] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Fong RKC, Low J, Koh TH, Kurup A. Clinical features and treatment outcomes of vancomycin-intermediate Staphylococcus aureus (VISA) and heteroresistant vancomycin-intermediate Staphylococcus aureus (hVISA) in a tertiary care institution in Singapore. Eur J Clin Microbiol Infect Dis 2009; 28:983-7. [DOI: 10.1007/s10096-009-0741-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Accepted: 03/24/2009] [Indexed: 10/20/2022]
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Budowle B, Ge J, Low J, Lai C, Yee WH, Law G, Tan WF, Chang YM, Perumal R, Keat PY, Mizuno N, Kasai K, Sekiguchi K, Chakraborty R. The effects of Asian population substructure on Y STR forensic analyses. Leg Med (Tokyo) 2009; 11:64-9. [DOI: 10.1016/j.legalmed.2008.08.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Revised: 08/11/2008] [Accepted: 08/26/2008] [Indexed: 10/21/2022]
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Bryant A, Low J, Austin S, Joseph JE. Timely diagnosis and management of heparin-induced thrombocytopenia in a frequent request, low incidence single centre using clinical 4T's score and particle gel immunoassay. Br J Haematol 2009; 143:721-6. [PMID: 19036016 DOI: 10.1111/j.1365-2141.2008.07401.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Clinicians must promptly decide which patients suspected of having heparin-induced thrombocytopenia (HIT) warrant a change in anticoagulation. This single-centre series of 246 HIT testing referrals assessed the combination of clinical score (thrombocytopenia, timing, thrombosis, other causes of thrombocytopenia not evident; 4T's), Diamed ID-Heparin-PF4 immunoassay (PaGIA) and 14C Serotonin Release Assay (SRA) to develop a practical and safe diagnostic strategy for HIT. A total of 142/256 (58%) referrals were in patients with a low 4T's score, with 12/246 (5%) in the high scoring group. PaGIA was positive in 24/246 (9.7%) patients, whilst SRA was positive in 9/246 (3.6%). The overall positive predictive value of a positive PaGIA test alone was 37.5%, however this reached 80% for the high scoring group. Both negative PaGIA and low clinical score independently had negative predictive values of 100%. We subsequently developed an algorithm that, when applied to this cohort, would have resulted in 18/246 patients (7%) definitely requiring alternative anticoagulation, whilst a further 7/246 (2.8%) patients would have been considered on an individual basis. Ultimately (based on SRA) this would have resulted in 16/246 (6.5%) patients unnecessarily having a change in their anticoagulation, with 9/246 (3.6%) patients being 'correctly treated'. The combination of 4T's scoring and PaGIA permitted a practical and safe approach to rapid HIT diagnosis and management.
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Affiliation(s)
- Adam Bryant
- Department of Haematology, St Vincent's Hospital, Sydney, NSW, Australia
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Liu N, Kaplan AT, Low J, Nguyen L, Liu GY, Equils O, Hewison M. Vitamin D induces innate antibacterial responses in human trophoblasts via an intracrine pathway. Biol Reprod 2008; 80:398-406. [PMID: 19005165 DOI: 10.1095/biolreprod.108.073577] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The active form of vitamin D, 1,25-dihydroxyvitamin D (1,25(OH)(2)D), is a potent inducer of the antimicrobial protein cathelicidin, CAMP (LL37). In macrophages this response is dependent on intracrine synthesis of 1,25(OH)(2)D from precursor 25-hydroxyvitamin D (25OHD), catalyzed by the enzyme 25-hydroxyvitamin D-1alpha-hydroxylase (CYP27B1). In view of the fact that trophoblastic cells also express abundant CYP27B1, we postulated a similar intracrine pathway for induction of CAMP in the placenta. Analysis of placenta explants, primary cultures of human trophoblast, and the 3A trophoblastic cell line treated with 1,25(OH)(2)D (1-100 nM) revealed dose-dependent induction of CAMP similar to that observed with primary cultures of human macrophages. Also consistent with macrophages, induction of trophoblastic CAMP was enhanced via intracrine conversion of 25OHD to 1,25(OH)(2)D. However, in contrast to macrophages, induction of CAMP by vitamin D in trophoblasts was not enhanced by costimulation with Toll-like receptor ligands, such as lipopolysaccharide. Despite this, exposure to vitamin D metabolites significantly enhanced antibacterial responses in trophoblastic cells: 3A cells infected with Escherichia coli showed decreased numbers of bacterial colony-forming units compared with vehicle-treated controls when treated with 25OHD (49.6% +/- 10.9%) or 1,25(OH)(2)D (45.4% +/- 9.2%), both P < 0.001. Treatment with 25OHD (1-100 nM) or 1,25(OH)(2)D (0.1-10 nM) also protected 3A cells against cell death following infection with E. coli (13.6%-26.9% and 22.3%-40.2% protection, respectively). These observations indicate that 1,25(OH)(2)D can function as an intracrine regulator of CAMP in trophoblasts, and may thus provide a novel mechanism for activation of innate immune responses in the placenta.
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Affiliation(s)
- N Liu
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California, Los Angeles, California 90095, USA
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Gessler S, Low J, Daniells E, Williams R, Brough V, Tookman A, Jones L. Screening for distress in cancer patients: is the distress thermometer a valid measure in the UK and does it measure change over time? A prospective validation study. Psychooncology 2008; 17:538-47. [PMID: 17973237 DOI: 10.1002/pon.1273] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A prospective validation study was conducted in 171 consenting patients from oncology and palliative care outpatient clinics to validate the Distress Thermometer (DT) against the Hospital Anxiety and Depression Scale (HADS), General Health Questionnaire-12 (GHQ-12) and Brief Symptom Inventory-18 (BSI-18) at baseline, four weeks and eight weeks. Receiver Operating Characteristic analysis was used to examine the sensitivity and specificity of the DT scores against the clinically significant cut-off scores of the criterion measures reporting 95% confidence intervals. Standardised response means were used to compare DT scores with criterion measures over time. For a cut-off of 4 vs 5, sensitivity against HADS was 79%, specificity 81%; against GHQ-12, sensitivity was 63%, specificity 83%; and against BSI-18, sensitivity was 88%, specificity 74%. At both four and eight weeks, DT scores tended to change significantly in the same direction as the criterion measures. Ninety-five percent of patients found completing the DT acceptable. The DT is valid and acceptable for use as a rapid screening instrument for patients in the UK with cancer. Our results indicate that it can be used to monitor change in psychological distress over time, but further work is needed to confirm this.
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Affiliation(s)
- S Gessler
- UCL Hospitals Gynaecological Oncology Centre, Elizabeth Garrett Anderson Hospital, London, UK.
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Wilkinson S, Farrelly S, Low J, Chakraborty A, Williams R, Wilkinson S. The use of complementary therapy by men with prostate cancer in the UK. Eur J Cancer Care (Engl) 2008; 17:492-9. [PMID: 18637112 DOI: 10.1111/j.1365-2354.2007.00904.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The study aims were to determine the use of complementary therapies (CT) by men with prostate cancer, and to explore factors influencing CT use and attitudes toward CT use. A cross-sectional survey design was used in which a postal questionnaire was mailed to an eligible sample of 405 patients with prostate cancer receiving outpatient treatment in a London teaching hospital. The primary outcomes were the prevalence of CT use and the relationship between CT use and mental health status. Two hundred and ninety-four patients (73%) responded, of whom 25% were using CT. The most frequently used CTs were vitamins, low-fat diets, lycopene and green tea. Multivariate analyses revealed no differences in mental health scores between CT users and non-users. CT users were younger (OR 0.93, 95% CI 0.89-0.97) and were more likely to be receiving conservative management in the form of 'active surveillance' (OR 5.23, 95% CI 1.78-15.41) compared with non-users. Over half of the participants (55%) wanted to learn more about CT. Forty-three per cent of CT users had not informed any doctor about their CT use. Clinicians need to be aware of the prevalence of CT use amongst patients with prostate cancer, considering the potential harm that could be caused by interactions with conventional treatments.
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Affiliation(s)
- S Wilkinson
- Department of Mental Health Sciences, Royal Free and University College Medical School, The Hampstead Campus, London, UK.
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Abstract
The correct identification of the cause, and ideally the individual acid, responsible for metabolic acidosis in the critically ill ensures rational management. In Part 2 of this review, we examine the elevated (corrected) anion gap acidoses (lactic, ketones, uraemic and toxin ingestion) and contrast them with nonelevated conditions (bicarbonate wasting, renal tubular acidoses and iatrogenic hyperchloraemia) using readily available base excess and anion gap techniques. The potentially erroneous interpretation of elevated lactate signifying cell ischaemia is highlighted. We provide diagnostic and therapeutic guidance when faced with a high anion gap acidosis, for example pyroglutamate, in the common clinical scenario 'I can't identify the acid--but I know it's there'. The evidence that metabolic acidosis affects outcomes and thus warrants correction is considered and we provide management guidance including extracorporeal removal and fomepizole therapy.
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Affiliation(s)
- C G Morris
- Intensive Care Medicine and Anaesthesia, Derby Hospitals Foundation Trust, Derby Royal Infirmary, London Road, Derby DE1 2QY, UK.
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