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Abstract
Pediatric Budd-Chiari syndrome (BCS) is a rare cause of portal hypertension and liver disease in Europe and North America. In order to understand the long-term effect of radiological intervention on BCS we performed a single center retrospective review. Fourteen cases were identified; 6 of 14 (43%) had a congenital thrombophilia with many having multiple prothrombotic mutations. Two were managed with medical anticoagulation alone and two required super-urgent transplant for acute liver failure. The remaining 10 of 14 (71%) underwent radiological intervention: 1 of 14 thrombolysis, 5 of 14 angioplasty, and 4 of 14 transjugular intrahepatic portosystemic shunt (TIPS). Six of 14 (43%) patients required repeat radiological intervention (1 angioplasty, 5 TIPS) but none required surgical shunts or liver transplantation for chronic liver disease. The time between diagnosis and treatment did not predict the need for repeat radiological intervention. These data show that radiological intervention can be highly effective, and reduces the need for surgery, though it requires specialist multidisciplinary teams for monitoring.
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Affiliation(s)
- J P Mann
- From the Liver Unit, Birmingham Women's & Children's Hospital, Birmingham, UK
| | - F Ikram
- From the Liver Unit, Birmingham Women's & Children's Hospital, Birmingham, UK
| | - L Modin
- From the Liver Unit, Birmingham Women's & Children's Hospital, Birmingham, UK
| | - C Kelgeri
- From the Liver Unit, Birmingham Women's & Children's Hospital, Birmingham, UK
| | - K Sharif
- From the Liver Unit, Birmingham Women's & Children's Hospital, Birmingham, UK
| | - S Olliff
- Interventional Radiology Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - S McGuirk
- the Radiology Department, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - G L Gupte
- From the Liver Unit, Birmingham Women's & Children's Hospital, Birmingham, UK
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Latif Z, Umer Q, Lee C, Sharif K, Li F, Biswas S. A Machine Learning-Based Anomaly Prediction Service for Software-Defined Networks. Sensors (Basel) 2022; 22:8434. [PMID: 36366129 PMCID: PMC9658740 DOI: 10.3390/s22218434] [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] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/28/2022] [Accepted: 10/29/2022] [Indexed: 06/16/2023]
Abstract
Software-defined networking (SDN) has gained tremendous growth and can be exploited in different network scenarios, from data centers to wide-area 5G networks. It shifts control logic from the devices to a centralized entity (programmable controller) for efficient traffic monitoring and flow management. A software-based controller enforces rules and policies on the requests sent by forwarding elements; however, it cannot detect anomalous patterns in the network traffic. Due to this, the controller may install the flow rules against the anomalies, reducing the overall network performance. These anomalies may indicate threats to the network and decrease its performance and security. Machine learning (ML) approaches can identify such traffic flow patterns and predict the systems' impending threats. We propose an ML-based service to predict traffic anomalies for software-defined networks in this work. We first create a large dataset for network traffic by modeling a programmable data center with a signature-based intrusion-detection system. The feature vectors are pre-processed and are constructed against each flow request by the forwarding element. Then, we input the feature vector of each request to a machine learning classifier for training to predict anomalies. Finally, we use the holdout cross-validation technique to evaluate the proposed approach. The evaluation results specify that the proposed approach is highly accurate. In contrast to baseline approaches (random prediction and zero rule), the performance improvement of the proposed approach in average accuracy, precision, recall, and f-measure is (54.14%, 65.30%, 81.63%, and 73.70%) and (4.61%, 11.13%, 9.45%, and 10.29%), respectively.
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Affiliation(s)
- Zohaib Latif
- Department of Computer Science, Hanyang University, Seoul 04763, Korea
| | - Qasim Umer
- Department of Computer Science, COMSATS University Islamabad, Vehari Campus, Vehari 61100, Pakistan
| | - Choonhwa Lee
- Department of Computer Science, Hanyang University, Seoul 04763, Korea
| | - Kashif Sharif
- School of Computer Science and Technology, Beijing Institute of Technology, Beijing 100081, China
| | - Fan Li
- School of Computer Science and Technology, Beijing Institute of Technology, Beijing 100081, China
| | - Sujit Biswas
- Computer Science and Digital Technologies Department, University of East London, London E16 2RD, UK
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Stevens M, Hosokawa E, Hereford A, West M, Fleming R, Sharif K, Sinard R, Rohde S, Mannion K, Langerman A, Netterville J, Rosenthal E, Topf M. The Impact of Nasogastric Feeding Tube on Physiologic Swallow in Head and Neck Cancer Patients: A Multidisciplinary Clinical Trial. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2021.12.144] [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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Zhang C, Xu C, Sharif K, Zhu L. Privacy-preserving contact tracing in 5G-integrated and blockchain-based medical applications. Comput Stand Interfaces 2021; 77:103520. [PMID: 33584007 PMCID: PMC7871810 DOI: 10.1016/j.csi.2021.103520] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/20/2021] [Accepted: 02/04/2021] [Indexed: 05/14/2023]
Abstract
The current pandemic situation due to COVID-19 is seriously affecting our daily work and life. To block the propagation of infectious diseases, an effective contact tracing mechanism needs to be implemented. Unfortunately, existing schemes have severe privacy issues that jeopardize the identity-privacy and location-privacy for both users and patients. Although some privacy-preserving systems have been proposed, there remain several issues caused by centralization. To mitigate this issues, we propose a Privacy-preserving contact Tracing scheme in 5G-integrated and Blockchain-based Medical applications, named PTBM. In PTBM, the 5G-integrated network is leveraged as the underlying infrastructure where everyone can perform location checking with his mobile phones or even wearable devices connected to 5G network to find whether they have been in possible contact with a diagnosed patient without violating their privacy. A trusted medical center can effectively trace the patients and their corresponding close contacts. Thorough security and performance analysis show that the proposed PTBM scheme achieves privacy protection, traceability, reliability, and authentication, with high computation & communication efficiency and low latency.
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Affiliation(s)
- Can Zhang
- School of Computer Science & Technology, Beijing Institute of Technology, Beijing, China
| | - Chang Xu
- School of Cyberspace Science & Technology, Beijing Institute of Technology, Beijing, China
| | - Kashif Sharif
- School of Computer Science & Technology, Beijing Institute of Technology, Beijing, China
| | - Liehuang Zhu
- School of Cyberspace Science & Technology, Beijing Institute of Technology, Beijing, China
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Biswas S, Sharif K, Li F, Bairagi AK, Latif Z, Mohanty SP. GlobeChain: An Interoperable Blockchain for Global Sharing of Healthcare Data—A COVID-19 Perspective. IEEE Consumer Electronics Magazine 2021; 10:64-69. [PMCID: PMC9128831 DOI: 10.1109/mce.2021.3074688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 04/17/2021] [Indexed: 06/13/2023]
Abstract
Contagious diseases are prevalent even in the current era of advanced technology. A uniformed initiative is required to build a reliable interactive information exchange service targeting vaccination data management and other medical services. The conventional data exchange mechanism is centralized, creating many vulnerable issues such as a single point failure, data leakage, access control, etc. This article introduces a Blockchain-based medical data-sharing framework (called GlobeChain) to overcome the technical challenges to handle the outbreak records. The challenges that might arise due to the proposed Blockchain-based framework are also presented as a future direction that grabs the proposal's effectiveness.
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Affiliation(s)
| | | | - Fan Li
- Beijing Institute of TechnologyChina
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Halpert G, Halperin Sheinfeld M, Monteran L, Sharif K, Volkov A, Nadler R, Schlesinger A, Barshak I, Kalechman Y, Blank M, Shoenfeld Y, Amital H. The tellurium-based immunomodulator, AS101 ameliorates adjuvant-induced arthritis in rats. Clin Exp Immunol 2021; 203:375-384. [PMID: 33205391 PMCID: PMC7874835 DOI: 10.1111/cei.13553] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 11/29/2022] Open
Abstract
Despite undeniable improvement in the management of rheumatoid arthritis (RA), the discovery of more effective, less toxic and, ideally, less immune suppressive drugs are much needed. In the current study, we set to explore the potential anti-rheumatic activity of the non-toxic, tellurium-based immunomodulator, AS101 in an experimental animal model of RA. The effect of AS101 was assessed on adjuvant-induced arthritis (AIA) rats. Clinical signs of arthritis were assessed. Histopathological examination was used to assess inflammation, synovial changes and tissue lesions. Very late antigen-4 (VLA-4)+ cellular infiltration was detected using immunohistochemical staining. Enzyme-linked immunosorbent assay (ELISA) was used to measure circulating anti-cyclic citrullinated-peptide autoantibody (ACPA) and real-time polymerase chain reaction (PCR) was used to measure the in-vitro effect of AS101 on interleukin (IL)-6 and IL-1β expression in activated primary human fibroblasts. Prophylactic treatment with intraperitoneal AS101 reduced clinical arthritis scores in AIA rats (P < 0·01). AS101 abrogated the migration of active chronic inflammatory immune cells, particularly VLA-4+ cells, into joint cartilage and synovium, reduced the extent of joint damage and preserved joint architecture. Compared to phosphate-buffered saline (PBS)-treated AIA rats, histopathological inflammatory scores were significantly reduced (P < 0·05). Furthermore, AS101 resulted in a marked reduction of circulating ACPA in comparison to PBS-treated rats (P < 0·05). Importantly, AS101 significantly reduced mRNA levels of proinflammatory mediators such as IL-6 (P < 0·05) and IL-1β (P < 0·01) in activated primary human fibroblasts. Taken together, we report the first demonstration of the anti-rheumatic/inflammatory activity of AS101 in experimental RA model, thereby supporting an alternative early therapeutic intervention and identifying a promising agent for therapeutic intervention.
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Affiliation(s)
- G. Halpert
- Zabludowicz Center for Autoimmune DiseasesSheba Medical Center, Tel Hashomer; Affiliated to Sackler Faculty of Medicine,Tel Aviv UniversityTel AvivIsrael
| | - M. Halperin Sheinfeld
- The Safdié Institute for Cancer, AIDS and Immunology Research; Faculty of Life SciencesBar‐Ilan UniversityRamat‐GanIsrael
| | - L. Monteran
- The Safdié Institute for Cancer, AIDS and Immunology Research; Faculty of Life SciencesBar‐Ilan UniversityRamat‐GanIsrael
- Present address:
Department of Pathology, Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - K. Sharif
- Internal Medicine B and Zabludowicz Center for Autoimmune DiseasesSheba Medical Center, Tel Hashomer; Affiliated to Sackler Faculty of Medicine, Tel Aviv UniversityTel AvivIsrael
| | - A. Volkov
- Institute of PathologySheba Medical Center, Tel Hashomer; Sackler Faculty of Medicine, Tel‐Aviv UniversityTel‐AvivIsrael
| | - R. Nadler
- The Academic Center of Law and ScienceHod HasharonIsrael
| | - A. Schlesinger
- Department of GeriatricsRabin Medical Center (Beilinson Campus)Petah TikvaIsrael
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - I. Barshak
- Institute of PathologySheba Medical Center, Tel Hashomer; Sackler Faculty of Medicine, Tel‐Aviv UniversityTel‐AvivIsrael
| | - Y. Kalechman
- The Safdié Institute for Cancer, AIDS and Immunology Research; Faculty of Life SciencesBar‐Ilan UniversityRamat‐GanIsrael
| | - M. Blank
- Zabludowicz Center for Autoimmune DiseasesSheba Medical Center, Tel Hashomer; Affiliated to Sackler Faculty of Medicine,Tel Aviv UniversityTel AvivIsrael
| | - Y. Shoenfeld
- Zabludowicz Center for Autoimmune DiseasesSheba Medical Center, Tel Hashomer; Affiliated to Sackler Faculty of Medicine,Tel Aviv UniversityTel AvivIsrael
- Laboratory of the Mosaics of AutoimmunitySaint Petersburg UniversitySaint PetersburgRussian Federation
| | - H. Amital
- Internal Medicine B and Zabludowicz Center for Autoimmune DiseasesSheba Medical Center, Tel Hashomer; Affiliated to Sackler Faculty of Medicine, Tel Aviv UniversityTel AvivIsrael
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Latif Z, Sharif K, Li F, Karim MM, Biswas S, Shahzad M, Mohanty SP. DOLPHIN: Dynamically Optimized and Load Balanced Path for Inter-Domain SDN Communication. IEEE Trans Netw Serv Manage 2021. [DOI: 10.1109/tnsm.2020.3045725] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Sharif K, Bridgewood C, Russell T, Rowe H, Zhou Q, Rao AS, Khan A, Dunsmuir R, Mcgonagle D. SAT0356 THE ROLE OF IL-36 AS A POTENTIAL NOVEL THERAPEUTIC TARGET IN SPONDYLARTHROPATHY ASSOCIATED PATHOLOGY DUE TO ITS UPSTREAM INDUCTION OF IL-23/IL-17 PATHWAY CYTOKINES AND STROMAL ACTIVATION IN AN IN VITRO ENTHESITIS MODEL. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5567] [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
Background:Enthesitis, defined as inflammation of anchorage points of tendons, ligaments and joint capsules to bones, is now understood to be the cardinal pathogenic lesion in spondyloarhtopathies (SpA). Evidence from genetic studies, animal models, and therapeutic studies firmly implicates the IL-23/IL-17 axis in the pathogenesis of SpA. We have recently confirmed the presence of IL-23 myeloid cells and IL-17 producing T cells populations in the human enthesis (McGonagle, ARD 2019). The upstream drivers of these key cytokines in the enthesis is, however, not defined. Emerging evidence suggests that IL-36 may be critical in regulating the IL-23/IL-17 axis in various organs. Also IL-38 SNPs have been associated with SpA which is of interest given that IL-38 is an IL-36 antagonist. Further, IL-36α is upregulated in the joints of psoriatic arthritis patients and deficiency of the IL-36 receptor antagonist (DITRA) results in generalized pustular psoriasis with comorbid arthritis in at least third of patients. Thus, we hypothesised that IL-36 could be an upstream regulator of the IL23/17 axis at the enthesis.Objectives:To confirm the induction of IL-36 at the human enthesis and to test the effect of IL-36 on resident innate and adaptive immune cell populations and enthesis stromal cells.Methods:Entheseal spinous processes from patients undergoing elective orthopaedic surgeries was obtained and mechanically digested. Peri-entheseal bone (PEB), and entheseal soft tissue (EST) digests were stimulated with fungal and bacterial adjuvants and IL-36 measured by ELISA. Disease relevant compounds such as methotrexate and PDE4i were assessed for their ability to attenuate IL-36 secretion. IHC was used to confirm the presence of IL-36R+ cells in the enthesis. Digested PEB was stimulated with IL-36, and IL-6, IL-8, IL-23, and TNF-alpha were analysed by ELISA and Flow Cytometry. As the IL-36 cytokines require protease mediated post translational processing for full activation, these were measured in enthesis digests. Entheseal fibroblasts were isolated and stimulated with IL-36 and ICAM-1 measured by Flow Cytometry and genes by qPCR.Results:TLR ligands induced the production of IL-36 at the enthesis. Further cell sorting, revealed CD11+ myeloid cells were the predominant entheseal producer of IL-36. Induced IL-36 could be significantly attenuated by PDE4i but not by methotrexate. IHC confirmed the presence of IL-36R+ in the enthesis. Stimulation of enthesis digest with IL-36 significantly upregulated the production of IL-6, IL-8, TNF-a, and IL-23. Stimulation of enthesis fibroblasts with IL-36 upregulated surface ICAM-1 and secretion of IL-6, CCL2 and CCL20. Enthesis digests showed high basal expression of IL-36 activating protease including cathepsin S and G.Conclusion:IL-36 is inducible from enthesis myeloid cells and IL-36R+ cells are present at the enthesis. Enthesis stimulation with IL-36 results in the upregulation of several disease relevant mediators such as TNF, IL-23 and CCL20 in both immune and stromal lineage cells. This is the first demonstration of IL-36 production in human enthesis. Given its pleiotropic effect and relation to IL-23/IL-17 axis, IL-36 is a potential novel therapeutic target in SpA.Figure 1.Expression and role of IL-36 at the enthesis. (A). IL-36 is induced by stimulation with lipopolysaccharide (LPS) and Mannan. (B) IL-36 is predominantly produced by CD11c+ cells. (C) IL-36 stimulation of PEB resulted in increased TNF-alpha production by CD14+ cells, and increased production of IL-23 (D) IL-36 stimulation of stromal cells increased ICAM-1 expression, and CCL2, CCL20, IL-6 and IL8 secretionFigure 2.Gene expression by qPCR following stromal cell stimulation by IL-36Disclosure of Interests:Kassem Sharif: None declared, Charlie Bridgewood: None declared, Tobias Russell Grant/research support from: Novartis UK Investigator Initiated non-clinical research funding support, Hannah Rowe Grant/research support from: Novartis UK Investigator Initiated non-clinical research funding support, Qaio Zhou: None declared, Abhay S Rao: None declared, Almas Khan: None declared, Robert Dunsmuir: None declared, Dennis McGonagle Grant/research support from: Janssen Research & Development, LLC
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Zhou Q, Vadakekolathu J, Sharif K, Russell T, Rowe H, Millner P, Loughenbury P, Rao AS, Dunsmuir R, Bridgewood C, El-Sherbiny Y, Mcgonagle D. THU0028 AN EXPLANTION FOR HOW VIRAL INFECTION MAY TRIGGER SPONDYLOARTHROPATHY BASED ON TLR9 DRIVEN TNF RESPONSES FROM ENTHESEAL DERIVED PLASMACYTOID DENDRITIC CELLS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5262] [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
Background:It is well known that viral infections may trigger psoriatic arthritis (PsA), a disease that typically has extensive pre-clinical entheseal abnormalites. Skin resident plasmacytoid dendritic cells (pDCs) produce IFNα that contribute to T cell expansion and the development of experimental psoriasis [1, 2]. IFN pathway SNPs have been reported in both PsA and psoriasis and we previously reported the presence of pDCs at the human enthesis [3].Objectives:To investigate whether the TLR9 agonist ODN that replicates viral infection activate a wide array of of entheseal derived pDCs molecular cascades including the TNF pathway that might provide a link between viral infection and PsA.Methods:pDCs were sorted from enthesis and blood and stimulated with ODN as previously described (n=16) [3, 4]. IFNα protein pre and post stimulation were detected by ELISA. Intracellular flow cytometry (IFC) of entheseal pDCs was used to detect TNF protein. RNA was extracted post-stimulation. The mRNA were hybridised and tagged by probes then measured on the nCounter platform. Data was analysed using nSolver 4.0. Log2 |fold change| >1 and P-value <0.05 were considered statistically significant. The gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) of differentially expressed genes (DEGs) were analyzed using DAVID. Protein-protein interaction (PPI) network was drawn by STRING.Results:Stimulated entheseal pDCs showed a strong DEGs pattern pointing towards increased TNF expression. There were 11 genes significantly upregulated including TNF. RIPK3 is involved in TNF signalling pathway. TNF, RIPK3 and ZBP1 are involved in necroptosis. TNF and ITGB2 are involved in IL-4 and IL-13 signaling pathway. TNF, HLA-DOA, ITGB2/TLR7 are involved in virus infection. Together it highlights extremely activated TNF pathway genes.IFN protein was induced in sorted entheseal pDCs following stimulation (n=8). TNF protein was detected by IFC on stimulated entheseal pDCs (CD45+HLA-DR+CD123+CD303+ CD11c-) (n=3). We also compared entheseal and matched peripheral blood pDCs (n=8) following stimulation where no major differences in the TNF pathway were present between groups.The KEGG analysis was mapped in Figure 1. GO analysis showed the most significant change in biological processes was enriched in the positive regulation of DNA binding transcription factor activity. The change in molecular function was mainly enriched in p53 binding.Conclusion:Entheseal pDCs, upon viral molecule stimulation, show several markers of activation. However, TNF pathway genes were highly activiated which provides a novel mechanistic link between viral infection and PsA as reported in epidemiological studies.References:[1]Nestle, F.O., et al.,Plasmacytoid predendritic cells initiate psoriasis through interferon-alpha production.J Exp Med, 2005.202(1): p. 135-43.[2]Christophers, E., et al.,The risk of psoriatic arthritis remains constant following initial diagnosis of psoriasis among patients seen in European dermatology clinics.J Eur Acad Dermatol Venereol, 2010.24(5): p. 548-54.[3]Zhou, Q.,PLASMACYTOID DENDRITIC CELLS IN THE ENTHESIS: PHENOTYPING AND FUNCTION INVESTIGATION.Annals of the Rheumatic Diseases, 2019.78.[4]Bridgewood, C., et al.,Identification of myeloid cells in the human enthesis as the main source of local IL-23 production.Ann Rheum Dis, 2019.78(7): p. 929-933.Disclosure of Interests:Qiao Zhou: None declared, Jayakumar Vadakekolathu: None declared, Kassem Sharif: None declared, Tobias Russell Grant/research support from: Novartis UK Investigator Initiated non-clinical research funding support, Hannah Rowe Grant/research support from: Novartis UK Investigator Initiated non-clinical research funding support, Peter Millner: None declared, Peter Loughenbury: None declared, Abhay S Rao: None declared, Robert Dunsmuir: None declared, Charlie Bridgewood: None declared, Yasser El-Sherbiny: None declared, Dennis McGonagle Grant/research support from: Janssen Research & Development, LLC
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Bridgewood C, Sharif K, Rowe H, Russell T, Mcgonagle D. SAT0358 A ROLE FOR IL-4 AND IL-13 IN MODULATING THE IL-23/IL-17 AXIS IN ENTHESITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5533] [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
Background:IL-4 and IL-13 are related Th2 cytokines, with documented roles in allergic inflammation such as atopic dermatitis (AD). Psoriatic Arthritis (PsA) is typically thought to be a result of Th1/Th17 driven response, and blockage of this pathway (IL-23, IL-17 and TNF) has proven successful. Despite this, there is a strong genetic risk association for IL-13 and PsA(1), however, the precise role of IL-13 in PsA is presently unknown. The enthesis is the region where tendons or ligaments attach to bone, and inflammation of this site (enthesitis) is thought to be the cardinal lesion of PsA, whereas as Rheumatoid Arthritis inflammation is more synovial centric. Dupilumab is a monoclonal antibody that works by blocking the common receptor chain (IL-4α) shared by both IL-13 and IL-4. Recent studies have reported that AD patients receiving dupilumab have developed clinical enthesitis(2).Objectives:To investigate whether IL-4 and IL-13 could modulate IL-23production from entheseal myeloid cells and IL-17 production from enthseal T-cells.Methods:Healthy enthesis samples from patients undergoing surgery for non-inflammatory conditions such a lumbar decompression or scoliosis were obtained. Enthesis samples were digested and stimulated (Fig 1A) with LPS and anti-CD3 to induce IL-23 and IL-17 respectively. Samples were pre-treated with IL-4 and IL-13 to ascertain whether this modulated entheseal cytokine production.Results:Both IL-23 and IL-17 were readily induced from enthesis samples with IL-23 coming predominantly from entheseal myeloid resident cells (Fig 1B) and IL-17A from T-cells (Fig 1C). Pre-treatment of entheseal digested material with either IL-4 or IL-13 attenuated IL-23 secretion (Fig 1D). Neither IL-4 nor IL-13 was able to significantly attenuate IL-17 secretion from enthesis T-cells, however IL-13 trended downwards and IL-4 surprisingly trended upwards (Fig 1E).Conclusion:Our clinical and vitro data point towards a previously unknown role for IL-4 and IL-13 having a protective role in entheseal induction of IL23/17 axis cytokines. These findings point towards a novel explanation for IL-13 pathway SNPs in PsA and also a molecular explanation for why anti-IL4/13 therapy may induce entheseal pathology.References:[1]BOWES, J., S. EYRE, E. FLYNN, P. HO, S. SALAH, R.B. WARREN, H. MARZO-ORTEGA, L. COATES, R. MCMANUS, A.W. RYAN, D. KANE, E. KORENDOWYCH, N. MCHUGH, O. FITZGERALD, J. PACKHAM, A.W. MORGAN, C.E. GRIFFITHS, I.N. BRUCE, J. WORTHINGTON and A. BARTON. Evidence to support IL-13 as a risk locus for psoriatic arthritis but not psoriasis vulgaris.Ann Rheum Dis, 2011,70(6), pp.1016-9.[2]WILLSMORE, Z.N., R.T. WOOLF, C. HUGHES, B. MENON, B. KIRKHAM, C. SMITH and A. PINK. Development of inflammatory arthritis and enthesitis in patients on dupilumab: a case series.British Journal of Dermatology, 2019,181(5), pp.1068-1070.Disclosure of Interests:Charlie Bridgewood: None declared, Kassem Sharif: None declared, Hannah Rowe Grant/research support from: Novartis UK Investigator Initiated non-clinical research funding support, Tobias Russell Grant/research support from: Novartis UK Investigator Initiated non-clinical research funding support, Dennis McGonagle Grant/research support from: Janssen Research & Development, LLC
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Rowe H, Watad A, Russell T, Sharif K, Newton D, Wittmann M, Zhou Q, Khan A, Loughenbury P, Dunsmuir R, Rao AS, Millner P, Kenna T, Brown M, Bridgewood C, Mcgonagle D. SAT0361 HEALTHY HUMAN SPINAL PROCESSES PERI-ENTHESEAL T-CELLS EXHIBIT A TR1 RATHER THAN A FOXP3 REGULATORY PHENOTYPE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6689] [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
Background:We have previously reported that the normal spinal enthesis has populations of conventional T-cells including CD4+ & CD8+ T-cells that could be induced to produce IL-17A and TNF following anti-CD3/CD28 stimulation. The biology of such cells in health including their normal function and antigen reactivity is completely unknown. The purpose of this work was to define the phenotype, functionality and TCR reactivity of such T-cells in health.Objectives:To investigate whether the T-cells at the normal enthesis were regulatory in nature and to determine the type of regulatory T-cell as Tr1 or FOXP3 regulatory T-cell and to determine T-cell reactivity.Methods:Healthy interspinous ligament and spinous process with matched peripheral blood were harvested from patients undergoing elective spinal surgery (n=20). Entheseal soft tissue (EST) & peri-entheseal bone (PEB) was enzymatically digested and then sorted. Tr1 and Treg phenotypes were investigated using flow cytometry. Analysis of cytokines, growth factors and chemokines was performed by qRT-PCR, ELISA and flow cytometry. TCR sequencing was performed and a search for putative T-cell reactivity was done using TCR3 database.Results:Pro-inflammatory cytokine transcripts including IL-17A, IL-17F, IL-22, IL-23 (p19) & TNF were very low or undetectable in the Enthesis T-cells (Fig 1). Flow cytometry confirmed entheseal T-cells had a Tr1 phenotype (CD4+ LAG3+ CD49b+). Intracellular flow cytometry showed enthesis T-cells had very low FOXP3 expression, when compared to their blood counterparts. Intracellular flow cytometry and gene expression showed high basal expression of growth factors and regulatory proteins such as IL-10 & TGFβ, when compared to blood T-cells. RNA-Seq data, showed 13 potential TCR clonal sequences the most common of which are predicted to be reactive viral infection was CMV present in 8 sequences and Influenza A virus present in 2 sequences.Conclusion:The healthy human enthesis has regulatory T-cells of a Tr1 phenotype rather than a FOXP3 Treg phenotype. Many clones have antigen specificity indicating reactivity to prior infection. These findings suggest that conventional entheseal T-cells have a role in enthesis immune homeostasis.Disclosure of Interests:Hannah Rowe Grant/research support from: Novartis UK Investigator Initiated non-clinical research funding support, Abdulla Watad: None declared, Tobias Russell Grant/research support from: Novartis UK Investigator Initiated non-clinical research funding support, Kassem Sharif: None declared, Darren Newton: None declared, Miriam Wittmann: None declared, Qiao Zhou Grant/research support from: Funded by the PARTNER fellowship program, Almas Khan: None declared, Peter Loughenbury: None declared, Robert Dunsmuir: None declared, Abhay S Rao: None declared, Peter Millner: None declared, Tony Kenna: None declared, Matthew Brown: None declared, Charlie Bridgewood: None declared, Dennis McGonagle Grant/research support from: Janssen Research & Development, LLC
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Zhang C, Zhu L, Xu C, Sharif K, Zhang C, Liu X. PGAS: Privacy-preserving graph encryption for accurate constrained shortest distance queries. Inf Sci (N Y) 2020. [DOI: 10.1016/j.ins.2019.07.082] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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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13
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14
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Lwamo NM, Zhu L, Xu C, Sharif K, Liu X, Zhang C. SUAA: A Secure User Authentication Scheme with Anonymity for the Single & Multi-server Environments. Inf Sci (N Y) 2019. [DOI: 10.1016/j.ins.2018.10.037] [Citation(s) in RCA: 13] [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] [Indexed: 10/28/2022]
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15
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Liang C, Wang X, Zhang X, Zhang Y, Sharif K, Tan YA. A payload-dependent packet rearranging covert channel for mobile VoIP traffic. Inf Sci (N Y) 2018. [DOI: 10.1016/j.ins.2018.07.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [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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16
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Saleem M, Sharif K, Fahmi A. An algebraic aspect of Pareto mixture parameter estimation using censored sample: A Bayesian approach. J Integr Neurosci 2018; 17:463-477. [PMID: 29710728 DOI: 10.3233/jin-180082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Applications of Pareto distribution are common in reliability, survival and financial studies. In this paper, A Pareto mixture distribution is considered to model a heterogeneous population comprising of two subgroups. Each of two subgroups is characterized by the same functional form with unknown distinct shape and scale parameters. Bayes estimators have been derived using flat and conjugate priors using squared error loss function. Standard errors have also been derived for the Bayes estimators. An interesting feature of this study is the preparation of components of Fisher Information matrix.
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Affiliation(s)
- Muhammad Saleem
- Department of Statistics, Government Postgraduate College of Science, Faisalabad, Pakistan. E-mail:
| | - Kashif Sharif
- Department of Mathematics and Statistics, University of Agriculture, Faisalabad, Pakistan. E-mail:
| | - Aliya Fahmi
- Department of Mathematics, Hazara University, Mansehra, Pakistan. E-mail:
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17
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Sharif K, Watad A, Bragazzi NL, Asher E, Abu Much A, Horowitz Y, Lidar M, Shoenfeld Y, Amital H. Anterior ST-elevation myocardial infarction induced by rituximab infusion: A case report and review of the literature. J Clin Pharm Ther 2018; 42:356-362. [PMID: 28440561 DOI: 10.1111/jcpt.12522] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 03/05/2017] [Indexed: 12/23/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVES Rituximab is a chimeric monoclonal anti-CD20 antibody approved for the treatment of some lymphoid malignancies as well as for autoimmune diseases including rheumatoid arthritis (RA), idiopathic thrombocytopenic purpura (ITP) and vasculitis. Generally, rituximab is well tolerated; nevertheless, some patients develop adverse effects including infusion reactions. Albeit rare, these reactions may in some cases be life-threatening conditions. Rituximab cardiovascular side effects include more common effects such as hypertension, oedema and rare cases of arrhythmias and myocardial infarction. CASE SUMMARY In this article, we report a case of a 58-year-old man with a history of overlap syndrome including RA and limited scleroderma who was treated with rituximab and developed a dramatic ST-elevation myocardial infarction (STEMI) during the drug administration. WHAT IS NEW AND CONCLUSION This report underlines previous published reports emphasizing the awareness of such an association. This communication also warrants the importance of screening for ischaemic heart disease in selected cases of patients treated with rituximab.
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Affiliation(s)
- K Sharif
- Department of Medicine "B", Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel
| | - A Watad
- Department of Medicine "B", Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel.,Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
| | - N L Bragazzi
- School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - E Asher
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel.,The Leviev Heart Center, Sheba Medical Center, Tel-Hashomer, Israel
| | - A Abu Much
- Department of Medicine "B", Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel.,The Leviev Heart Center, Sheba Medical Center, Tel-Hashomer, Israel
| | - Y Horowitz
- Department of Medicine "B", Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel
| | - M Lidar
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel.,Rheumatology Unit, Sheba Medical Center, Tel-Hashomer, Israel
| | - Y Shoenfeld
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel.,Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
| | - H Amital
- Department of Medicine "B", Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel.,Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
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18
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Sharif K, Vieira Borba V, Zandman-Goddard G, Shoenfeld Y. Eppur Si Muove: ferritin is essential in modulating inflammation. Clin Exp Immunol 2017; 191:149-150. [PMID: 29023673 DOI: 10.1111/cei.13069] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2017] [Indexed: 12/23/2022] Open
Abstract
Ferritin, which was only discovered in the last century, has stirred a formidable debate. Ferritin has long been appreciated as a non-specific acute-phase reactant. Several years ago, we hypothesized the contributory role of ferritin as a pathogenic molecule rather than being a product of inflammation. The latest emerging evidence provides support to this notion. Such revelation provides a step forward towards the understanding of disease conditions associated with hyperferritinaemia, and hence provide new targets for treatment modalities.
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Affiliation(s)
- K Sharif
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - V Vieira Borba
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department A of Internal Medicine, Coimbra University Hospital Care, Coimbra, Portugal
| | - G Zandman-Goddard
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Medicine C, Wolfson Medical Center, Tel Aviv, Israel
| | - Y Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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19
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Ahmad M, Asghar R, Ashraf F, Patel N, Islim A, Sharif K. A sweet and simple solution for complex wound healing. Int J Surg 2016. [DOI: 10.1016/j.ijsu.2016.08.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Abstract
Cake rusks were prepared by using different combinations of normal and red palm oil fortified shortening to explore the possibility of red palm oil (RPO) fortified shortening to enhance the vitamin A status in human dietary intake. The replacement of normal shortening with RPO up to 50% level was the most acceptable, however, the use of RPO shortening beyond this limit showed a somewhat oily after taste. Carotenoid contents in flour, normal shortening, RPO shortening and egg were 3.57 ppm, 5.85ppm, 405.39 ppm and 5.13 ppm, respectively. Moisture content increased from 3.11% to 3.22% after 28 days of storage. During baking, loss of carotenoid contents ranged from 12.07% to 14.91%. A minimum carotenoid content of 7.19 ppm were found in the cake rusks (T1) prepared with 100% normal shortening (NS) while a maximum of 105.64 ppm was observed in (T5) 100% RPO in the freshly prepared product. The mean carotenoid content in T3 (50% RPO 50% NS) was 57.80ppm however it ranged from 6.94ppm (T1) to 102.34 ppm in (T5). A gradual decrease (7–10%) in carotenoid contents during 28 days’ storage was observed. There was significant increase (0.04–0.08 mg malonaldehyde/kg) in thiobarbituric acid number during storage. Results regarding sensory attributes reflect that T3 comprising of 50% RPO and 50% NS got the highest score. Furthermore consumer response in the acceptability study also showed that T3 treatment of cake rusk is suitable for commercialisation.
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Affiliation(s)
| | - J. Rasool
- Institute of Food Science and Technology, University of Agriculture, Faisalabad, Pakistan
| | - K. Sharif
- Institute of Food Science and Technology, University of Agriculture, Faisalabad, Pakistan; ,
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21
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Sreekantam S, Nicklaus-Wollenteit I, Orr J, Sharif K, Vijay S, McKiernan PJ, Santra S. Successful long-term outcome of liver transplantation in late-onset lysosomal acid lipase deficiency. Pediatr Transplant 2016; 20:851-4. [PMID: 27392817 DOI: 10.1111/petr.12748] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2016] [Indexed: 12/20/2022]
Abstract
Late-onset LAL deficiency, previously referred to as cholesteryl ester storage disorder, is a rare lysosomal storage disorder characterized by accumulation of cholesteryl esters. It has a heterogeneous clinical phenotype including abdominal pain, poor growth, hyperlipidemia with vascular complications and hepatosplenomegaly. End-stage liver disease may occur, but there are few reports of successful LT. There are also concerns that systemic manifestations of the disease might persist post-LT. We report a case with excellent outcome eight yr following LT. The subject was noted to have asymptomatic hepatosplenomegaly during an intercurrent illness, and LAL deficiency was confirmed with compound heterozygosity in the LIPA. Despite dietary fat restriction, he developed signs of progressive liver disease and subsequently developed hepatopulmonary syndrome. He underwent cadaveric LT at the age of nine and a half yr and recovered with prompt resolution of hepatopulmonary syndrome. Eight yr post-transplant he has normal growth, normal lipid profile, and liver and renal function tests. Liver histology showed no evidence of disease recurrence at this stage. LT in this subject resulted in an excellent functional correction of late-onset LAL deficiency.
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Affiliation(s)
- S Sreekantam
- Department of Metabolic Medicine, Birmingham Children's Hospital, Birmingham, UK
| | | | - J Orr
- Department of Hepatology and Gastroenterology, Freeman Hospital, Newcastle upon Tyne, UK
| | - K Sharif
- Department of Hepatology, Birmingham Children's Hospital, Birmingham, UK
| | - S Vijay
- Department of Metabolic Medicine, Birmingham Children's Hospital, Birmingham, UK
| | - P J McKiernan
- Department of Hepatology, Birmingham Children's Hospital, Birmingham, UK
| | - S Santra
- Department of Metabolic Medicine, Birmingham Children's Hospital, Birmingham, UK
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22
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Charbit-Henrion F, Lacaille F, McKiernan P, Girard M, de Lonlay P, Valayannopoulos V, Ottolenghi C, Chakrapani A, Preece M, Sharif K, Chardot C, Hubert P, Dupic L. Early and late complications after liver transplantation for propionic acidemia in children: a two centers study. Am J Transplant 2015; 15:786-91. [PMID: 25683683 DOI: 10.1111/ajt.13027] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [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: 05/29/2014] [Revised: 09/10/2014] [Accepted: 09/14/2014] [Indexed: 01/25/2023]
Abstract
Propionic acidemia (PA) is a severe metabolic disorder with cardiac and neurologic complications and a poor quality of life. Liver transplantation (LT) was thus proposed in PA to increase enzyme activity. We studied retrospectively LT in PA in two European centers. Twelve patients underwent 17 LTs between 1991 and 2013. They developed severe, unusual and unexpected complications, with high mortality (58%). When present, the cardiomyopathy resolved and no acute metabolic decompensation occurred allowing dietary relaxation. Renal failure was present in half of the patients before LT and worsened in all of them. We suggest that cardiac and renal functions should be assessed before LT and monitored closely afterward. A renal sparing immunosuppression should be used. We speculate that some complications may be related to accumulated toxicity of the disease and that earlier LT could prevent some of these consequences. As kidney transplantation has been performed successfully in methylmalonic acidemia, a metabolic disease in the same biochemical pathway, the choice of the organ to transplant could be further discussed.
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Affiliation(s)
- F Charbit-Henrion
- Laboratory of Intestinal Immunity, Unité INSERM UMR1163, Institut IMAGINE, Paris, France
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23
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Beath S, Lanchbury E, Alton H, Mahandru R, Toy M, van Mouirk I, McKiernan P, Hartley J, Kelly D, Sharif K, Gupte G. Selenium Homocholic Acid Taurocholate Scanning, Selenium-75-Labeled Bile Acid, a Novel Method for Testing the Function of the Terminal Ileum in Small Bowel Transplant Recipients: A Pilot Study. Transplant Proc 2014; 46:2119-21. [DOI: 10.1016/j.transproceed.2014.06.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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24
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Hartog H, Brown R, Dopazo C, Sadiq J, Ong E, Hartley J, Perera T, Muiesan P, Sharif K, Gupte G, Mirza D. Sequelae of Ischaemia-Reperfusion Injury in Intestinal Transplantation. Transplantation 2014. [DOI: 10.1097/00007890-201407151-02966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Ruth ND, Kelly D, Sharif K, Morland B, Lloyd C, McKiernan PJ. Rejection is less common in children undergoing liver transplantation for hepatoblastoma. Pediatr Transplant 2014; 18:52-7. [PMID: 24341552 DOI: 10.1111/petr.12194] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2013] [Indexed: 11/28/2022]
Abstract
To compare the incidence of acute histologically proven rejection in children who have had a liver transplant for hepatoblastoma with a control group of children transplanted for biliary atresia (EHBA). A retrospective case notes based study was performed. Twenty patients were identified with hepatoblastoma who were transplanted at a single unit between 1991 and 2008. These were matched as closely as possible for age, gender, year of transplant and type of immunosuppression used to the control group transplanted for biliary atresia (n = 60). There was a significant decrease in rate of acute rejection as assessed by the rejection activity index (RAI) in the hepatoblastoma group (75% vs. 50%, respectively, p < 0.04). Chronic rejection was rare in both groups, but twice as common in the biliary atresia group. Equal levels of immunosuppression were achieved in both groups. Renal function was noted to be reduced one yr post-transplant in both groups, as previously reported. A modified immunosuppression regimen could be considered in children with hepatoblastoma undergoing liver transplantation.
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Affiliation(s)
- N D Ruth
- Liver and Small bowel transplant Unit, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
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26
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Vidyadharan R, van Bommel ACM, Kuti K, Gupte GL, Sharif K, Richard BM. Use of tissue expansion to facilitate liver and small bowel transplant in young children with contracted abdominal cavities. Pediatr Transplant 2013; 17:646-52. [PMID: 23992350 DOI: 10.1111/petr.12138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2013] [Indexed: 11/28/2022]
Abstract
Liver and small bowel transplant is an established treatment for infants with IFALD. Despite organ reduction techniques, mortality on the waiting list remains high due to shortage of size-matched pediatric donors. Small abdominal cavity volume due to previous intestinal resection poses a significant challenge to achieve abdominal closure post-transplant. Seven children underwent tissue expansion of abdominal skin prior to multiorgan transplant. In total, 17 tissue expanders were placed subcutaneously in seven children. All seven subjects underwent re-exploration to deal with complications: hematoma, extrusion, infection, or port related. Three expanders had to be removed. Four children went on to have successful combined liver and small bowel transplant. Two children died on the waiting list of causes not related to the expander and one child died from sepsis attributed to an infected expander. Tissue expansion can generate skin to facilitate closure of abdomen post-transplant, thus allowing infants with small abdominal volumes to be considered for transplant surgery. Tissue expansion in children with end-stage liver disease and portal hypertension is associated with a very high complication rate and needs to be closely monitored during the expansion process.
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Affiliation(s)
- R Vidyadharan
- Department of Plastic Surgery, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
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27
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Platto M, Sharif K, Ong EG, Muiesan P, Gupte GL, Mirza DF. Early and Late Surgical Complication after Intestinal Transplantation in Children. Transplantation 2012. [DOI: 10.1097/00007890-201211271-00509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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28
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Taha AMI, Sharif K, Johnson T, Clarke S, Murphy MS, Gupte GL. Long-term outcomes of isolated liver transplantation for short bowel syndrome and intestinal failure-associated liver disease. J Pediatr Gastroenterol Nutr 2012; 54:547-51. [PMID: 22167020 DOI: 10.1097/mpg.0b013e31823f42e7] [Citation(s) in RCA: 17] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND AIM A select group of children with short bowel syndrome (SBS) and intestinal failure-associated liver disease (IFALD) fulfill the criteria for isolated liver transplantation (iLTx). Long-term results in this group of patients have not been reported. METHODS A retrospective study of the medical records of 8 survivors of 14 children who underwent iLTx for SBS and IFALD from 1998 to 2005, managed by a multidisciplinary intestinal rehabilitation team at our institution. RESULTS Median follow-up is 107.5 months (range 89-153 months). Five of 8 children were weaned from parenteral nutrition (PN) to enteral nutrition (EN) in a median of 10 months after iLTx (range 3-32 months). Three of 5 children were subsequently weaned from EN to full oral feeding in 13, 24, and 53 months after stopping PN, whereas the remaining 2 are still receiving EN 118 and 74 months after stopping PN. These 5 children maintain their weight median z scores with a median increase of 1.59 (range 1.24-1.79) compared with the pretransplant z score, whereas the height z scores show fluctuations through the years with a median change of 0.12 (range -0.29 to 0.36). The other 3 of 8 children developed progressive intestinal failure; 2 underwent isolated small bowel transplantation 112 and 84 months after iLTx and the third is receiving PN. CONCLUSIONS Children with SBS and IFALD who have the potential for adaptation in the residual bowel can undergo iLTx, but it is a treatment option to be exercised with extreme caution. These children need close follow-up with an experienced multidisciplinary team to monitor nutritional outcomes and may need consideration for transplant or nontransplant surgery in the long term.
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Affiliation(s)
- A M I Taha
- Liver Unit, Department of Dietetics, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, UK
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29
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Sheth J, Sharif K, Lloyd C, Gupte G, Kelly D, de Ville de Goyet J, Millar AJ, Mirza DF, Chardot C. Staged abdominal closure after small bowel or multivisceral transplantation. Pediatr Transplant 2012; 16:36-40. [PMID: 21981601 DOI: 10.1111/j.1399-3046.2011.01597.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Following paediatric SBMT, size discrepancy between the recipient's abdomen and the graft may lead to ACS, graft dysfunction, and death. We report our experience with SAC in these patients. Between 04/1993 and 03/2009, 57 children underwent 62 SBMTs. When abdominal wall tension seemed excessive for safe PAC, SAC was performed, using a Silastic® sheet and a vacuum occlusive dressing. Transplantations with SAC (23 combined liver and small bowel [CLB]) were compared with those with PAC [14 ISB and 25 CLB]. Indications for transplantation, preoperative status (after stratification for ISB/CLB transplants), age at transplantation, donor-to-recipient weight ratio, reduction in bowel and/or liver, and incidence of wound complications were not different in both groups. Post-operative intubation, stay in intensive care unit, and hospital stay were prolonged after SAC. Two deaths were related to ACS after PAC, none after SAC. Since 2000, one-yr patient survival is 73% after ISB transplantation and 57% vs. 75% after CLB transplantation with PAC vs. SAC, respectively (NS). SAC safely reduces severe ACS after paediatric SBMT and can be combined with graft reduction for transplantation of small recipients.
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Affiliation(s)
- J Sheth
- Liver Unit (including small bowel transplantation), Birmingham Children's Hospital, Birmingham, UK
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30
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Mirza D, Millar AJW, Sharif K, Vilca-Melendez H, Rela M, Heaton N. The use of TachoSil in children undergoing liver resection with or without segmental liver transplantation. Eur J Pediatr Surg 2011; 21:111-5. [PMID: 21494994 DOI: 10.1055/s-0030-1267221] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Local haemostatic agents are used for the control of surgical haemorrhage when standard techniques are inadequate, but there are few studies of these products in children. PATIENTS AND METHODS This was a prospective, open-label study in which children (aged 4 weeks to 6 years) undergoing liver resection with or without segmental liver transplantation were treated with TachoSil, a collagen patch coated with a dry layer of human fibrinogen and human thrombin, if minor (i. e., oozing) or moderate bleeding was present after primary haemostatic treatment. Time to haemostasis after TachoSil application was the primary endpoint. Safety was assessed by adverse events (AEs), including post-operative infections, symptoms of graft rejection and re-operations. RESULTS Enrolment was stopped early after 16 children had entered the study. 13 children underwent whole liver resection and transplantation and 3 patients underwent segmental resection. Satisfactory haemostasis was achieved in 13 children (81.3%; 95% CI: 61.8-100%) at 3 min and in 1 child at 8 min. Occurrence of AEs was as expected, with most being known complications of the underlying disease, surgical procedure, or use of immunosuppressive medication. No AEs were considered to be related to the use of TachoSil. CONCLUSIONS The use of TachoSil for haemostasis after primary haemostatic treatment appears to be safe and effective in children undergoing liver resection.
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Affiliation(s)
- D Mirza
- Birmingham Children's Hospital, The Liver Unit, Birmingham, United Kingdom.
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31
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Haller W, Milford DV, Goodship THJ, Sharif K, Mirza DF, McKiernan PJ. Successful isolated liver transplantation in a child with atypical hemolytic uremic syndrome and a mutation in complement factor H. Am J Transplant 2010; 10:2142-7. [PMID: 20738267 DOI: 10.1111/j.1600-6143.2010.03228.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A male infant was diagnosed with atypical hemolytic uremic syndrome (aHUS) at the age of 5.5 months. Sequencing of the gene (CFH) encoding complement factor H revealed a heterozygous mutation (c.3644G>A, p.Arg1215Gln). Despite maintenance plasmapheresis he developed recurrent episodes of aHUS and vascular access complications while maintaining stable renal function. At the age of 5 years he received an isolated split liver graft following a previously established protocol using pretransplant plasma exchange (PE) and intratransplant plasma infusion. Graft function, renal function and disease remission are preserved 2 years after transplantation. Preemptive liver transplantation prior to the development of end stage renal disease is a valuable option in the management of aHUS associated with CFH mutations.
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Affiliation(s)
- W Haller
- Liver Unit, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK.
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32
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Sheth J, Sharif K, Gupte G, Lloyd C, Hartley J, Kelly D, Buckels J, De Ville De Goyet J, Millar A, Muiesan P, Mirza D, Mayer D, Chardot C. P259 - Fermeture pariétale différée après transplantation intestinale ou multiviscérale. Arch Pediatr 2010. [DOI: 10.1016/s0929-693x(10)70657-6] [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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Abstract
Selected livers from controlled NHBD are accepted for OLT in adults. Recent evidence has shown good medium-term outcome. The purpose of this study was to report our experience of pediatric OLT with whole and partial grafts from NHBD, analyzing complications and outcome. Retrospective review of all the recipients who underwent primary OLT between December 2005 and December 2008, using livers from NHBD. Four children (one male child) mean age was 9.5 yr (0.2-17), mean weight was 26 kg (range 2.6-48), underwent OLT using NHBD. Mean donor age was 14.2 yr, and mean WIT (systolic BP<50 mmHg to cold perfusion) 12.2 min (range 10-15). Two children received reduced grafts and two full grafts. Mean cold ischemia time was 7.18 h (range 6-8). Liver function tests one wk and nine months post-OLT confirmed a good graft function. One child was treated for two episodes of acute rejection. Post-transplant complications included two cases of mild ischemic cholangiopathy treated conservatively. Graft and patient survival was 100% with a mean follow-up of 19 months (range 8.1-43.4). Short- to medium-term follow-up suggests that liver grafts from young NHBD with short warm and cold ischemia times can be safely utilized in pediatric transplantation.
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Affiliation(s)
- S Gozzini
- The Liver Unit, Birmingham Children's Hospital, Birmingham, UK
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Sakkas D, Percival G, D'Arcy Y, Lenton W, Sharif K, Afnan M. Blastocyst transfer for patients with multiple assisted reproduction treatment failures: preliminary experience. HUM FERTIL 2009; 4:104-8. [PMID: 11591265 DOI: 10.1080/1464727012000199381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This preliminary study reports the results obtained from a patient group in which blastocyst culture and transfer were performed, and discusses the advantages and disadvantages of introducing blastocyst transfer in a clinic. Twenty-six patients who had failed to achieve a pregnancy in previous in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatments were offered the choice of a fresh cycle with culture to the blastocyst stage. Of the 26 patients who elected to attempt blastocyst culture, 11 opted to have transfer on day 2 or day 3 due to low numbers of embryos. Of the 15 patients who proceeded to blastocyst culture, 46.2% of the embryos cultured reached the blastocyst stage or later and eight of the patients achieved a clinical pregnancy. More oocytes were collected in this patient group, hence the chances of obtaining blastocysts were higher. Offering blastocyst culture to patients with a reasonable chance of success who have had previous multiple assisted reproduction failures is an acceptable way of introducing blastocyst culture into practice.
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Affiliation(s)
- D Sakkas
- Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT 06520-8063, USA
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Livesey E, Cortina Borja M, Sharif K, Alizai N, McClean P, Kelly D, Hadzic N, Davenport M. Epidemiology of biliary atresia in England and Wales (1999-2006). Arch Dis Child Fetal Neonatal Ed 2009; 94:F451-5. [PMID: 19457876 DOI: 10.1136/adc.2009.159780] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To identify the epidemiological characteristics of infants with biliary atresia in England and Wales, since centralisation of its management in 1999. METHODS The care of infants with biliary atresia (BA) in England and Wales is centralised to only three centres. All infants (treated from January 1999 to December 2006) were identified from a prospective national database; demographic details were ascertained from medical records and compared between two groups based on presumed aetiology (isolated biliary atresia (IBA) and developmental biliary atresia (DBA) (for example, syndromic infants, biliary atresia splenic malformation, cystic biliary atresia)). RESULTS There were 302 (133 male (44%)) infants with BA that could be divided into IBA (n = 219, 73%) and DBA (n = 76, 25%). The overall incidence was 0.58/10 000 (1 in 17,049) live births with marked regional differences along a north-west/south-east axis varying from 0.38 (north-west England) to 0.78 (south-east England)/10,000 live births (OR 2.05 (95% CI 1.26-3.41); p = 0.002). The commonest month of birth was September with December being the least common, although there was no evidence for significant seasonal variation (p = 0.2). Infants with DBA were more likely to be female (p<0.001), of white background (p = 0.01), first-born (p = 0.04) and to be formula-fed (p = 0.07). Infants of south Asian origin came to surgery at an older age (59 (IQ 45-75) versus 52 (IQ 42-65) days; p = 0.03). CONCLUSIONS There is a remarkable variation of incidence of biliary atresia within England and Wales, some of which may have been caused by factors related to a different aetiological and racial background.
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Affiliation(s)
- E Livesey
- Paediatric Liver Centre, King's College Hospital, Denmark Hill, London SE5 9RS, UK
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Owais A, Sharif K, Rehman A, Nunn T. Asymmetric odontoid process following high-speed road traffic accident. Emerg Med J 2009; 26:218. [PMID: 19234020 DOI: 10.1136/emj.2008.059907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- A Owais
- FTSTA Surgery, Scarborough Hospital, Scarborough, Yorks, UK
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Hammadieh N, Coomarasamy A, Ola B, Papaioannou S, Afnan M, Sharif K. Reply: Ultrasound-guided hydrosalpinx aspiration during oocyte collection improves outcome in IVF. Hum Reprod 2008. [DOI: 10.1093/humrep/den449] [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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Giovanelli M, Gupte GL, Sharif K, Mayer DA, Mirza DF. Chronic rejection after combined liver and small bowel transplantation in a child with chronic intestinal pseudo-obstruction: a case report. Transplant Proc 2008; 40:1763-7. [PMID: 18589190 DOI: 10.1016/j.transproceed.2008.01.066] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2007] [Accepted: 01/16/2008] [Indexed: 12/27/2022]
Abstract
An 11-year-old boy with irreversible intestinal failure secondary to chronic intestinal pseudo-obstruction (CIPO) and intestinal failure-associated liver disease (IFALD) underwent a combined en bloc reduced liver and small bowel transplantation. He was discharged home after 9 weeks on full oral intake without requiring intravenous nutritional or fluid supplementation. The first episode of mild acute rejection, which occurred 18 months after transplantation, was successfully treated with steroids. An episode of rotavirus gastroenteritis led to severe exfoliative rejection of the bowel graft, which was resistant to steroid and Infliximab treatment but responded to OKT3. There was associated Epstein-Barr virus viremia with no evidence of posttransplant lymphoproliferative disease. Another episode of moderate to severe acute liver rejection occurred 5 months later. At the same time, multiple biliary strictures were diagnosed and treated. Persistent clinical symptoms of abdominal pain and increased stomal output as well as atrophy of the ileal mucosa on several biopsies, suggested the possibility of chronic rejection (CR). A second combined whole liver and small bowel transplant was performed. The diagnosis of CR was confirmed on histology of the explanted graft. The postoperative course was severely complicated and 71 days after the retransplantation, the boy died because of respiratory failure and multiorgan failure. In summary, intestinal transplantation can be successfully performed in children with CIPO, giving them the opportunity to be free from total parenteral nutrition. As survival following intestinal transplantation continues to improve, the problem of CR has become increasingly important and the only treatment available is retransplantation, which is associated with poor outcomes.
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Affiliation(s)
- M Giovanelli
- Department of General Surgery III, Liver and Transplant Unit, Ospedali Riuniti di Bergamo, Italy.
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Ajmal M, Butt M, Sharif K, Nasir M, Nadeem M. Preparation of Fiber and Mineral Enriched Pan Bread by Using Defatted Rice Bran. International Journal of Food Properties 2006. [DOI: 10.1080/10942910600580625] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Haghighi KS, Sharif K, Gupte G, Mirza DF, Mayer AD, Carroll D, Brown RM, Lloyd C, McKiernan PJ, Baumann U, van Mourik IDM, Kelly DA, Beath SV, Millar AJW. Is Serum Gentamicin Level a Good Predictor of Graft Injury in Intestinal Transplantation? Transplant Proc 2006; 38:1733-4. [PMID: 16908265 DOI: 10.1016/j.transproceed.2006.05.065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Following intestinal transplant (SBT), the early diagnosis and treatment of rejection is a major management aim. The diagnosis of rejection is based on histology of stomal biopsies. Oral gentamycin (2.5 mg/kg) was used for selective decontamination of the digestive system. Our hypothesis was that gentamycin might be absorbed in the presence of graft dysfunction. AIM Our goal was to assess the correlation between serum gentamycin level and the health of the intestinal graft. SUBJECTS AND METHODS Among 33 SBT performed from 1993 to 2005, serum gentamycin levels were performed once weekly or more often when there was a suspicion of rejection. All data were analyzed retrospectively. RESULTS Adequate trough levels were achieved for only 23 patients, six of whom had histologically proven rejection and only one did not have a raised gentamycin content. Five patients with raised levels but no rejection included two with severe intestinal ischemia and three with bowel obstruction/ileus. Four of the five patients required laparotomies. CONCLUSION We concluded that in our study raised serum gentamycin levels were a good predictor of rejection or significant injury to the graft.
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Affiliation(s)
- K S Haghighi
- Liver Unit, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, United Kingdom
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Rodrigues AF, van Mourik IDM, Sharif K, Barron DJ, de Giovanni JV, Bennett J, Bromley P, Protheroe S, John P, de Ville de Goyet J, Beath SV. Management of end-stage central venous access in children referred for possible small bowel transplantation. J Pediatr Gastroenterol Nutr 2006; 42:427-33. [PMID: 16641582 DOI: 10.1097/01.mpg.0000215311.71040.89] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [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] [Indexed: 02/02/2023]
Abstract
UNLABELLED The 3-year survival after small bowel transplantation (SBTx) has improved to between 73% and 88%. Impaired venous access for parenteral nutrition can be an indication for SBTx in children with chronic intestinal failure. AIM To report our experience in management of children with extreme end-stage venous access. SUBJECTS The study consisted of 6 children (all boys), median age of assessment 27 months (range, 13-52 months), diagnosed with total intestinal aganglionosis (1), protracted diarrhea (1), and short bowel syndrome (4), of which gastroschisis (2) and malrotation with midgut volvulus (2) were the causes. All had a documented history of more than 10 central venous catheter insertions previously. All had venograms, and 1 child additionally had a magnetic resonance angiogram to evaluate venous access. Five of 6 presented with thrombosis of the superior vena cava (SVC) and/or inferior vena cava. METHODS Venous access was reestablished as follows: transhepatic venous catheters (5), direct intra-atrial catheter via midline sternotomy (4), azygous venous catheters (2), dilatation of left subclavian vein after passage of a guide wire and then placing a catheter to reach the right atrium (1), radiological recanalization of the SVC and placement of a central venous catheter in situ (1), and direct puncture of SVC stump(1). Complications included serous pleural effusion after direct intra-atrial line insertion, which resolved after chest drain insertion (1), displacement of transhepatic catheter needing repositioning (2), and SVC stent narrowing requiring repeated balloon dilatation. OUTCOME Four children with permanent intestinal failure on assessment were offered SBTx, 3 of which were transplanted and were established on full enteral nutrition; the family of 1 child declined the procedure. In the remaining 2 children in whom bowel adaptation was still a possibility, attempts were made to provide adequate central venous access as feeds and drug manipulations were undertaken. One of them received liver and SBTx nearly 3 years after presenting with end-stage central venous access, because attempts to achieve independence from parenteral nutrition had failed. The other child died immediately after a transhepatic venous catheter placement, possibly from a nutritional depletion syndrome as no physical cause of death was found. Direct intra-atrial catheters in transplanted children proved to be adequate for the management of uncomplicated transplantation, although the usual infusion protocol had to be modified considerably, and the lack of access would have been critical if massive blood transfusion had been required during the transplant procedure. CONCLUSION It was possible to reestablish central venous access in all cases. However, this was time consuming and difficult to assemble a skilled team consisting of one of more: surgeon, cardiologist, interventional radiologist, and transplant anesthetist. Small bowel transplantation is easier and safer with adequate central venous access, and we advocate liaison with an SBTx center at an early stage.
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Sharif K, Ramani P, Lochbühler H, Grundy R, de Ville de Goyet J. Recurrent mesenchymal hamartoma associated with 19q translocation. A call for more radical surgical resection. Eur J Pediatr Surg 2006; 16:64-7. [PMID: 16544232 DOI: 10.1055/s-2005-873072] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [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] [Indexed: 01/06/2023]
Abstract
Hepatic mesenchymal hamartoma is a rare benign tumour in children. It is often large and centrally located in the liver at diagnosis, making surgical resection difficult; thus non-radical resection has been proposed in the past as acceptable management. However, a literature survey and a case with recurrence associated with cytogenetic anomalies suggest that radical liver surgery (resection with a margin of normal liver parenchyma, as for malignant tumour) should be recommended for mesenchymal hamartoma.
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Affiliation(s)
- K Sharif
- Liver Unit, Birmingham Children's Hospital, Birmingham, UK
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Olufowobi O, Sharif K, Papaioannou S, Mohamed H, Neelakantan D, Afnan M. Role of rescue IVF-ET treatment in the management of high response in stimulated IUI cycles. J OBSTET GYNAECOL 2005; 25:166-8. [PMID: 15814397 DOI: 10.1080/01443610500040851] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Rescue in-vitro fertilisation and embryo transfer (IVF-ET) has been used in high response gonadotrophin intrauterine insemination (IUI) cycles to minimise the risks of ovarian hyperstimulation and multiple gestation. Such unplanned IVF treatment increases the cost of treatment. But can this added cost and the risks associated with IVF be justified? We present our experience with this treatment using clinical pregnancy and live birth rates as the primary outcomes. Between 1998 to 2001, 40 women undergoing IUI cycles who over responded (>3 follicles measuring >15 mm in diameter on the planned day of hCG administration) to gonadotrophin were offered the choice of conversion to IVF-ET or cancel the cycle. 17/40 declined rescue IVF/ET and had their cycles cancelled. 23/40 converted to IVF/ET and underwent transvaginal oocyte retrieval. 21/23 had embryo transferred. The clinical pregnancy and live birth rates were 52% and 48%, respectively. Rescue IVF-ET offers excellent clinical pregnancy and live birth rates in high responders. However, affordability can be an obstacle in the utilization of this treatment option.
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Affiliation(s)
- O Olufowobi
- The Assisted Conception Unit, Birmingham Women's Hospital, Metchley Park Road, Birmingham B15 2TG, UK.
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Olufowobi O, Sharif K, Papaionnou S, Neelakantan D, Mohammed H, Afnan M. Are the anticipated benefits of myomectomy achieved in women of reproductive age? A 5-year review of the results at a UK tertiary hospital. J OBSTET GYNAECOL 2004; 24:434-40. [PMID: 15203587 DOI: 10.1080/01443610410001685600] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Fibroids are the most common benign tumours of the pelvis in women, with a prevalence estimated at 20-50%. They are more common towards the end of the reproductive years. There is a racial preponderance, being more common in black than white women. This may relate to the aetiology, which is still poorly understood. Generally, fibroids do not cause symptoms but some sufferers do complain about pressure symptoms, abnormal vaginal bleeding and infertility. For these reasons, myomectomy is often resorted to after failure of medical interventions on the premise that it brings about improvement/cure of symptoms and enhancement of fertility. However, the evidence for these indications for surgery is hazy. An analysis of the 109 medical records of symptomatic patients who had myomectomy over a 5-year period at a tertiary centre revealed the following. Single-symptom presentation in 41 (38%), menorrhagia in 20 (18%) being the most common. Only 52 (48%) patients had medical treatment of one form or another before myomectomy. Additional operative findings included pelvic adhesions, evidence of PID and endometriosis. Thirty-four (31%) had an estimated blood loss 500 ml and 23 of these patients needed blood transfusion. There were four cases of unscheduled hysterectomies due to uncontrollable bleeding. Pyrexia was the most common (38%) postoperative complication followed by superficial wound infection in 5%. We observed improvement of symptoms, assessed over a range of 2-24 months, in 34 cases (68%) in patients without fertility symptoms who accounted for 50 of these women. The symptomatic benefit was less (36%) in the 'infertility group'. Following an observation period of over 12-36 months, 17 patients in the 'infertility group' were lost to follow-up. Two (14%) of the 14 patients who attempted in vitro fertilisation (IVF) were successful. In the non-IVF group, 13 (46%) of the 28 achieved natural conception. These results suggest that symptomatic improvement and fertility enhancement may be possible in some patients with fibroids. In view of the risks and potential failure of treatment associated with myomectomy these results, yet again, support the fact that patients should be properly counselled before embarking on myomectomy and we strongly advocate local data to form the basis of the advice given during the consultation rather than what obtains in the literature.
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Affiliation(s)
- O Olufowobi
- Birmingham Women's Hospital, Birmingham, UK.
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Sharif K, English M, Ramani P, Alberti D, Otte JB, McKiernan P, Gosseye S, Jenney M, de Ville de Goyet J. Management of hepatic epithelioid haemangio-endothelioma in children: what option? Br J Cancer 2004; 90:1498-501. [PMID: 15083175 PMCID: PMC2409708 DOI: 10.1038/sj.bjc.6601720] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Hepatic epithelioid haemangio-endothelioma (HEHE) is an endothelium-derived tumour of low-to-medium grade malignancy. It is predominantly seen in adults and is unresponsive to chemotherapy. Liver transplantation is an accepted indication when the tumour is unresectable. Hepatic epithelioid haemangio-endothelioma is very rare in children and results after transplantation are not reported. The aim of this study is to review the experience of three European centres in the management of HEHE in children. A retrospective review of all paediatric patients with HEHE managed in three European centres is presented. Five children were identified. Four had unresectable tumours. The first had successful resection followed by chemotherapy and is alive, without disease 3 years after diagnosis. One child died of sepsis and one of tumour recurrence in the graft and lungs 2 and 5 months, respectively, after transplant. Two children who had progressive disease with ifosfamide-based chemotherapy have had a reduction in clinical symptoms and stabilisation of disease up to 18 and 24 months after the use of platinum-based chemotherapy. HEHE seems more aggressive in children than reported in adults and the curative role of transplantation must be questioned. Ifosfamide-based chemotherapy was not effective. Further studies are necessary to confirm if HEHE progression in children may be influenced by platinum-based chemotherapy.
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Affiliation(s)
- K Sharif
- Liver Unit and Department of Paediatric Oncology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
| | - M English
- Liver Unit and Department of Paediatric Oncology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
| | - P Ramani
- Department of Pathology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
| | - D Alberti
- Liver Transplant Centre, Ospedali Riuniti, Largo Barozzi 1, 24100 Bergamo, Italy
| | - J-B Otte
- Department of Paediatric Surgery, St Luc University Clinics Brussels, Avenue Hippocrate 10, B-1200 Brussels, Belgium
| | - P McKiernan
- Department of Pathology, St Luc University Clinics Brussels, Avenue Hippocrate 10, B-1200 Brussels, Belgium
| | - S Gosseye
- Department of Pathology, St Luc University Clinics Brussels, Avenue Hippocrate 10, B-1200 Brussels, Belgium
| | - M Jenney
- Department of Paediatric Haemato-Oncology, Llandough Hospital, Penlan Road, Llandough, Penarth, Vale of Glamorgan CF64 2XX, UK
| | - J de Ville de Goyet
- Liver Unit and Department of Paediatric Oncology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
- Liver and Paediatric Surgery, Cliniques St Luc-UCL, Av Hippocrate 10, B1200 Brussels, Belgium. E-mail:
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Abstract
BACKGROUND In the last decade, numerous studies have demonstrated concern about the presence of hydrosalpinx and its management in patients undergoing IVF. We evaluated the current management of hydrosalpinx prior to IVF treatment in the UK. METHODS A total of 117 postal survey, anonymous, sealed questionnaires were sent to all IVF centres in the UK, to determine the policy for the management of hydrosalpinx in infertile women prior to IVF treatment. RESULTS There were 88 (75%) responders, of which 80 (91%) indicated that they discussed the effect of hydrosalpinx on IVF outcome. Ten (12%) units did not recommend treatment of hydrosalpinx prior to IVF treatment, while 30 (36%), 27 (33%) and 16 (19%) recommended treatment weakly, strongly and very strongly respectively. The treatment options offered by clinicians were laparoscopic salpingectomy (75%), open salpingectomy (45%), salpingostomy (40%), proximal tubal occlusion (34%), transvaginal songraphic (TVS) aspiration during oocyte collection (23%) and TVS aspiration before oocyte collection (10%). The frequency of use varied from one option of treatment to another. Only 28% of the responders had a protocol or guidelines for the management of hydrosalpinx. CONCLUSIONS More attention should be given to patients with hydrosalpinx prior to IVF treatment and patients should be counselled about the negative effect of hydrosalpinx on IVF outcome. There is a wide variation in the management of hydrosalpinx prior to IVF treatment in the UK and many treatment options may be questionable, as they are not yet based on evidence.
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Affiliation(s)
- N Hammadieh
- Cardiff Assisted Reproduction Unit, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK.
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Abstract
Bile ducts of Luschka (also called supravesicular ducts) are small bile ducts in the gallbladder bed. Although they do not drain any liver parenchyma, they can be a source of bile leak or biliary peritonitis after cholecystectomy in both adults and children, as shown in this case report. As a reminder, variations of biliary anatomy in the gallbladder bed and cholecysto-hepatic triangle of Calot, are reviewed.
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Affiliation(s)
- K Sharif
- Liver Unit, Birmingham Children's Hospital, Birmingham, England, UK
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