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El Karim IA, Duncan HF, Cushley S, Nagendrababu V, Kirkevang LL, Kruse C, Chong BS, Shah PK, Lappin M, McLister C, Lundy FT, Clarke M. A protocol for the Development of Core Outcome Sets for Endodontic Treatment modalities (COSET): an international consensus process. Trials 2021; 22:812. [PMID: 34789318 PMCID: PMC8597272 DOI: 10.1186/s13063-021-05764-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 06/09/2021] [Accepted: 10/26/2021] [Indexed: 11/25/2022] Open
Abstract
Background The outcome of endodontic treatment is generally assessed using a range of patient and clinician-centred, non-standardised clinical and radiographic outcome measures. This makes it difficult to synthesise evidence for systematic analysis of the literature and the development of clinical guidelines. Core outcome sets (COS) represent a standardised list of outcomes that should be measured and reported in all clinical studies in a particular field. Recently, clinical researchers and guideline developers have focussed on the need for the integration of a patient-reported COS with clinician-centred measures. This study aims to develop a COS that includes both patient-reported outcomes and clinician-centred measures for various endodontic treatment modalities to be used in clinical research and practice. Methods To identify reported outcomes (including when and how they are measured), systematic reviews and their included clinical studies, which focus on the outcome of endodontic treatment and were published between 1990 and 2020 will be screened. The COSs will be defined by a consensus process involving key stakeholders using semi-structured interviews and an online Delphi methodology followed by an interactive virtual consensus meeting. A heterogeneous group of key ‘stakeholders’ including patients, general dental practitioners, endodontists, endodontic teachers, clinical researchers, students and policy-makers will be invited to participate. Patients will establish, via interactive interviews, which outcomes they value and feel should be included in a COS. In the Delphi process, other stakeholders will be asked to prioritise outcomes identified from the literature and patient interviews and will have the opportunity at the end of the first round to add outcomes that are not included, but which they consider relevant. Feedback will be provided in the second round, when participants will be asked to prioritise the list again. If consensus is reached, the remaining outcomes will be discussed at an online meeting and agreement established via defined consensus rules of outcome inclusion. If consensus is not reached after the second round, a third round will be conducted with feedback, followed by the online meeting. Following the identification of a COS, we will proceed to identify how and when these outcomes are measured. Discussion Using a rigorous methodology, the proposed consensus process aims to develop a COS for endodontic treatment that will be relevant to stakeholders. The results of the study will be shared with participants and COS users. To increase COS uptake, it will also be actively shared with clinical guideline developers, research funders and the editors of general dental and endodontology journals. Trial registration COMET 1879. 21 May 2021.
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Affiliation(s)
- I A El Karim
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland.
| | - H F Duncan
- Division of Restorative Dentistry & Periodontology, Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland
| | - S Cushley
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland
| | - V Nagendrababu
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - L L Kirkevang
- Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - C Kruse
- Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - B S Chong
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - P K Shah
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - M Lappin
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland
| | - C McLister
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland
| | - F T Lundy
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland
| | - M Clarke
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland
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Shah PK, Duncan HF, Abdullah D, Tomson PL, Murray G, Friend TM, Thomas S, Butcher S, Chong BS. Comparison of two case difficulty assessment methods on cohorts of undergraduate dental students – a multi‐centre study. Int Endod J 2020; 53:1569-1580. [DOI: 10.1111/iej.13377] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/06/2020] [Accepted: 07/28/2020] [Indexed: 11/28/2022]
Affiliation(s)
- P. K. Shah
- Institute of Dentistry Barts & The London School of Medicine & Dentistry Queen Mary University of London London UK
| | - H. F. Duncan
- School of Dental Science Trinity College Dublin The University of Dublin Dublin Ireland
| | - D. Abdullah
- Faculty of Dentistry Universiti Kebangsaan Malaysia Kuala Lumpur Malaysia
| | - P. L. Tomson
- School of Dentistry University of Birmingham Birmingham UK
| | | | - T. M. Friend
- Institute of Dentistry Barts & The London School of Medicine & Dentistry Queen Mary University of London London UK
| | | | - S. Butcher
- Institute of Dentistry Barts & The London School of Medicine & Dentistry Queen Mary University of London London UK
| | - B. S. Chong
- Institute of Dentistry Barts & The London School of Medicine & Dentistry Queen Mary University of London London UK
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Nagendrababu V, Chong BS, McCabe P, Shah PK, Priya E, Jayaraman J, Pulikkotil SJ, Dummer PMH. PRICE 2020 guidelines for reporting case reports in Endodontics: explanation and elaboration. Int Endod J 2020; 53:922-947. [PMID: 32221975 DOI: 10.1111/iej.13300] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 03/20/2020] [Indexed: 12/17/2022]
Abstract
Case reports play a key role in showcasing new, unusual or rare disease(s), and the impact of newer therapeutic approaches or interventions. The Preferred Reporting Items for Case reports in Endodontics (PRICE) 2020 guidelines are being introduced exclusively for Endodontics by adapting and integrating the CAse REport (CARE) guidelines and Clinical and Laboratory Images in Publications principles. The PRICE 2020 guidelines have been developed to help authors improve the completeness, accuracy and transparency of case reports in Endodontics and thus enhance the standard of manuscripts submitted for publication. The aim of this document is to provide a comprehensive explanation for each item in the PRICE 2020 checklist along with examples from the literature that demonstrate compliance with these guidelines. This information will highlight the importance of each item and provide practical examples to help authors understand the necessity of providing comprehensive information when preparing case reports. A link to this PRICE 2020 explanation and elaboration document is available on the Preferred Reporting Items for study Designs in Endodontology website at http://www.pride-endodonticguidelines.org.
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Affiliation(s)
- V Nagendrababu
- Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - B S Chong
- Institute of Dentistry, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - P McCabe
- Oranhill Dental Suite, Galway, Ireland
| | - P K Shah
- Institute of Dentistry, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - E Priya
- Division of Community and Children Oral Health, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - J Jayaraman
- Department of Developmental Dentistry, University of Texas Health School of Dentistry, San Antonio, TX, USA
| | - S J Pulikkotil
- Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - P M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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Nagendrababu V, Kishen A, Chong BS, Priya E, Duncan HF, Rôças IN, Jayaraman J, Figueiredo JAP, Siqueira JF, Bjørndal L, Nekoofar MH, Peters OA, McCabe P, Murray PE, Shah PK, Ordinola‐Zapata R, Pulikkotil SJ, Kvist T, Dummer PMH. Preferred Reporting Items for study Designs in Endodontology (PRIDE): guiding authors to identify and correct reporting deficiencies in their manuscripts prior to peer review. Int Endod J 2020; 53:589-590. [DOI: 10.1111/iej.13276] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- V. Nagendrababu
- Division of Clinical Dentistry School of Dentistry International Medical University Kuala Lumpur Malaysia
| | - A. Kishen
- Faculty of Dentistry University of Toronto Toronto ON Canada
| | - B. S. Chong
- Institute of Dentistry Barts & The London School of Medicine and Dentistry Queen Mary University of London London UK
| | - E. Priya
- Division of Children and Community Oral Health School of Dentistry International Medical University Kuala Lumpur Malaysia
| | - H. F. Duncan
- Division of Restorative Dentistry Dublin Dental University Hospital Trinity College Dublin Dublin Ireland
| | - I. N. Rôças
- Dental Research Department Iguaçu University Nova Iguaçu RJ Brazil
| | - J. Jayaraman
- Department of Developmental Dentistry University of Texas Health School of Dentistry San Antonio TX USA
| | | | - J. F. Siqueira
- Dental Research Department Iguaçu University Nova Iguaçu RJ Brazil
| | - L. Bjørndal
- Cariology and Endodontics Department of Odontology Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - M. H. Nekoofar
- Department of Endodontics School of Dentistry Tehran University of Medical Sciences Tehran Iran
- School of Dentistry College of Biomedical and Life Sciences Cardiff University Cardiff UK
| | - O. A. Peters
- Department of Endodontics Arthur A Dugoni School of Dentistry University of the Pacific San Francisco CA USA
- Oral Health Centre University of Queensland Herston QLD Australia
| | - P. McCabe
- Oranhill Dental Suite Galway Ireland
| | - P. E. Murray
- Department of Periodontics College of Dental Medicine Nova Southeastern University Fort Lauderdale FL USA
| | - P. K. Shah
- Institute of Dentistry Barts & The London School of Medicine and Dentistry Queen Mary University of London London UK
| | - R. Ordinola‐Zapata
- Division of Endodontics University of Minnesota School of Dentistry Minneapolis MN USA
| | - S. J. Pulikkotil
- Division of Clinical Dentistry School of Dentistry International Medical University Kuala Lumpur Malaysia
| | - T. Kvist
- Department of Endodontology Institute of Odontology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - P. M. H. Dummer
- School of Dentistry College of Biomedical and Life Sciences Cardiff University Cardiff UK
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Nagendrababu V, Chong BS, McCabe P, Shah PK, Priya E, Jayaraman J, Pulikkotil SJ, Setzer FC, Sunde PT, Dummer PMH. PRICE 2020 guidelines for reporting case reports in Endodontics: a consensus‐based development. Int Endod J 2020; 53:619-626. [DOI: 10.1111/iej.13285] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 12/12/2022]
Affiliation(s)
- V. Nagendrababu
- Division of Clinical Dentistry School of Dentistry International Medical University Kuala Lumpur Malaysia
| | - B. S. Chong
- Institute of Dentistry Barts & The London School of Medicine & Dentistry Queen Mary University of London London UK
| | - P. McCabe
- Oranhill Dental Suite Galway Ireland
| | - P. K. Shah
- Institute of Dentistry Barts & The London School of Medicine & Dentistry Queen Mary University of London London UK
| | - E. Priya
- Division of Children and Community Oral Health School of Dentistry International Medical University Kuala Lumpur Malaysia
| | - J. Jayaraman
- Department of Developmental Dentistry University of Texas Health School of Dentistry San Antonio Texas USA
| | - S. J. Pulikkotil
- Division of Clinical Dentistry School of Dentistry International Medical University Kuala Lumpur Malaysia
| | - F. C. Setzer
- Department of Endodontics School of Dental Medicine University of Pennsylvania Philadelphia Pennsylvania USA
| | - P. T. Sunde
- Department of Endodontics Institute of Clinical Dentistry Faculty of Dentistry University of Oslo Oslo Norway
| | - P. M. H. Dummer
- School of Dentistry College of Biomedical and Life Sciences Cardiff University Cardiff UK
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Sharma A, Bilong Y, Patil J, Katte JC, Ahmad Khaqan H, Kumar Gupta N, Patel A, Sundaramoorthy SK, Madhusudan RJ, Vidhya N, Lekha T, Shah PK, Saravanan VR, Dharwadkar SS, Rishi P, Franco MFE, Chelo D, Kagmeni G, Assumpta Bella L, Kuppermann BD. MIIRetCam (Make In India Retina Camera) assisted retinal imaging in paediatric patients: Useful, artefacts, learning curve. J Fr Ophtalmol 2019; 43:e35-e38. [PMID: 31837894 DOI: 10.1016/j.jfo.2019.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/30/2019] [Accepted: 09/10/2019] [Indexed: 10/25/2022]
Affiliation(s)
- A Sharma
- Department of Vitreoretina, Lotus Eye Hospital and Institute, Coimbatore, TN, India.
| | - Y Bilong
- Departments of Eye, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.
| | - J Patil
- Department of Paediatric Ophthalmology, University Hospital of Morecambe Bay NHS Foundation Trust, Kendal, UK.
| | - J-C Katte
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Cameroon.
| | - H Ahmad Khaqan
- Ameer Ud Din Medical College, Lahore General Hospital, Post Graduate Medical Institute, Lahore, Pakistan.
| | | | - A Patel
- Akash Deep Hospital, Rajkot, GJ, India.
| | - S K Sundaramoorthy
- Department of Vitreoretina, Lotus Eye Hospital and Institute, Coimbatore, TN, India.
| | - R J Madhusudan
- Department of Vitreoretina, Lotus Eye Hospital and Institute, Coimbatore, TN, India.
| | - N Vidhya
- Department of Vitreoretina, Lotus Eye Hospital and Institute, Coimbatore, TN, India.
| | - T Lekha
- Department of Ophthalmology, PSG Institute of Medical Sciences and Research, Coimbatore, TN, India.
| | - P K Shah
- Department of Paediatric Retina and Ocular Oncology, Aravind Eye Hospital, Coimbatore, TN, India.
| | - V R Saravanan
- Department of Vitreoretina, Aravind Eye Hospital, Coimbatore, TN, India.
| | | | - P Rishi
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, TN, India.
| | - M F E Franco
- Ophthalmologist Retina Specialty, Clínica Dres Estrago, Cortientes, Argentina.
| | - D Chelo
- Departments of Pediatric, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.
| | - G Kagmeni
- Departments of Eye, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.
| | - L Assumpta Bella
- Departments of Eye, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.
| | - B D Kuppermann
- Gavin Herbert Eye Institute, University of California, Irvine, Irvine, CA, USA.
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Schwartz G, Leiter LA, Ballantyne CM, Barter PJ, Black DM, Kallend D, Leitersdorf E, McMurray JJV, Nicholls SJ, Olsson AG, Preiss D, Shah PK, Tardif JC, Kittelson J. P6193Dalcetrapib reduces incident diabetes in patients with recent acute coronary syndrome. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Among patients with acute coronary syndrome (ACS) who do not have diabetes, incident diabetes is common and associated with an adverse prognosis. Some data suggest that high density lipoprotein (HDL) has favourable effects on beta cell function and that cholesteryl ester transfer protein (CETP) inhibitors reduce incident type 2 diabetes in conjunction with increased HDL cholesterol (HDL-C) concentration. Dalcetrapib is a CETP inhibitor under ongoing evaluation as a potential cardiovascular therapy.
Purpose
We compared the effect of treatment with dalcetrapib or placebo on incident diabetes in patients with recent acute coronary syndrome (ACS).
Methods
In the dal-OUTCOMES trial, 15,871 patients were randomly assigned to treatment with dalcetrapib 600 mg or placebo daily, beginning 4–12 weeks after ACS. Absence of diabetes at baseline was based upon medical history, no use of diabetes medication, haemoglobin A1c <6.5%, and plasma glucose level <7 mmol/L (if measured under fasting conditions) or <11.1 mmol/L (if measured under non-fasting conditions). Among these patients, incident diabetes after randomization was defined by any diabetes-related adverse event, use of a diabetes medication, HbA1c ≥6.5%, or two measurements of plasma glucose ≥7 mmol/L (fasting) or ≥11.1 mmol/L (non-fasting). The association of incident diabetes with baseline and on-treatment HDL-C was determined.
Results
At baseline, 10621 patients (67% of the trial cohort) did not have diabetes and formed the analysis cohort. Over median follow-up of 31 months, incident diabetes was identified in 392 of 5314 patients (7.4%) assigned to dalcetrapib and 505 of 5307 (9.5%) assigned to placebo (odds ratio [OR] 0.76; 95% confidence interval [CI] 0.66–0.87; P<0.001). This corresponds to an absolute reduction in incident diabetes of 2.1%, and a need to treat 47 patients (for 31 months) to prevent 1 case of diabetes. Kaplan-Meier estimates of the cumulative incidence of diabetes are shown in the Figure. Across both treatment groups, incident diabetes was inversely associated with baseline HDL-C (OR 0.98 for 1 mg/dL increase in baseline HDL-C; 95% CI 0.97–0.98, P<0.001). In the dalcetrapib group, there was a further inverse association of incident diabetes with the change in HDL-C on assigned treatment (OR 0.98 for 1 mg/dL increase in HDL-C from baseline; 95% CI 0.97–0.99, P=0.002). Dalcetrapib was safe and generally well-tolerated in the trial.
Conclusions
In patients with recent ACS who do not have diabetes at baseline, incident diabetes is common. Dalcetrapib treatment reduced the relative risk of incident diabetes by 24% and the absolute risk by 2.1% over a median of 31 months. The reduction in incident diabetes with dalcetrapib was associated with increased HDL-C on treatment.
Acknowledgement/Funding
The dal-OUTCOMES trial was funded by F. Hoffmann LaRoche
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Affiliation(s)
- G Schwartz
- University of Colorado School of Medicine and Rocky Mountain Regional VA Medical Center, Aurora, United States of America
| | | | - C M Ballantyne
- Baylor College of Medicine, Houston, United States of America
| | - P J Barter
- University of New South Wales, Sydney, Australia
| | - D M Black
- Dalcor Pharmaceuticals, Montreal, Canada
| | - D Kallend
- The Medicines Company, zurich, Switzerland
| | | | | | | | | | - D Preiss
- University of Oxford, Oxford, United Kingdom
| | - P K Shah
- Cedars-Sinai Medical Center, Los Angeles, United States of America
| | - J C Tardif
- Montreal Heart Institute, Montreal, Canada
| | - J Kittelson
- University of Colorado, Aurora, United States of America
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Fronza BM, Rad IY, Shah PK, Barros MD, Giannini M, Stansbury JW. Nanogel-Based Filler-Matrix Interphase for Polymerization Stress Reduction. J Dent Res 2019; 98:779-785. [PMID: 31050913 DOI: 10.1177/0022034519845843] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 11/16/2022] Open
Abstract
A novel filler-resin matrix interphase structure was developed and evaluated for dental composite restoratives. Nanogel additives were chemically attached to the filler surface to use this created interphase as a potential source of compliance to minimize stress development during polymerization. In addition, we evaluated the effects of free nanogel dispersion into the resin matrix, combined or not with nanogel-modified fillers. Nanogels with varied characteristics were synthesized (i.e., size, 5 and 11 nm; glass transition temperature, 28 °C to 65 °C). Glass fillers were treated with trimethoxyvinylsilane and further reacted with thiol-functionalized nanogels via a free radical thiol-ene reaction. γ-Methacryloxypropyltrimethoxysilane-surface treated fillers were used as a control. Composites were formulated with BisGMA/TEGDMA resin blend with 60 wt% fillers with nanogel-modified fillers and/or free nanogel additives at 15 wt% in the resin phase. Polymerization kinetics, polymerization stress, volumetric shrinkage, and rheological and mechanical properties were evaluated to provide comprehensive characterization. Nanogel-modified fillers significantly reduced the polymerization stress from 2.2 MPa to 1.7 to 1.4 MPa, resulting in 20% stress reduction. A significantly greater nanogel content was required to generate the same magnitude stress reduction when the nanogels were dispersed only in the resin phase. When the nanogel-modified filler surface treatment and resin-dispersed nanogel strategies were combined, there was a stress reduction of 50% (values of 1.2 to 1.1 MPa). Polymerization rate and volumetric shrinkage were significantly reduced for systems with nanogel additives into the resin. Notably, the flexural modulus of the materials was not compromised, although a slight reduction in flexural strength associated with the nanogel-modified interphase was observed. Overall, modest amounts of free nanogel additives in the resin phase can be effectively combined with a limited nanogel content filler-resin interphase to lower volumetric shrinkage and dramatically reduce overall polymerization stress of composites.
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Affiliation(s)
- B M Fronza
- 1 Restorative Dentistry Department, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil
| | - I Y Rad
- 2 Craniofacial Biology Department, University of Colorado, Aurora, CO, USA
| | - P K Shah
- 3 Chemical and Biological Engineering, University of Colorado, Boulder, CO, USA
| | - M D Barros
- 2 Craniofacial Biology Department, University of Colorado, Aurora, CO, USA
| | - M Giannini
- 1 Restorative Dentistry Department, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil
| | - J W Stansbury
- 2 Craniofacial Biology Department, University of Colorado, Aurora, CO, USA.,3 Chemical and Biological Engineering, University of Colorado, Boulder, CO, USA
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Naghavi M, Maron DJ, Kloner RA, Berman DS, Budoff M, Superko HR, Shah PK. Coronary artery calcium testing: A call for universal coverage. Prev Med Rep 2019; 15:100879. [PMID: 31193256 PMCID: PMC6525277 DOI: 10.1016/j.pmedr.2019.100879] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 12/14/2018] [Revised: 04/01/2019] [Accepted: 04/22/2019] [Indexed: 12/13/2022] Open
Abstract
Heart attacks kill more Americans than all cancers combined. Fatal heart attack victims have no symptoms until minutes before they die, hence early detection of high-risk asymptomatic individuals is needed. Even though heart attacks kill and cost more than cancers, as a nation we spend over 20 times more on screening for asymptomatic cancer than for asymptomatic atherosclerotic cardiovascular disease (ASCVD), the underlying cause of heart attacks. Currently, payers only cover screening for risk factors of ASCVD such as blood pressure and blood cholesterol. This approach tends to miss high-risk and over-treat low-risk individuals. Although treadmill stress testing with ECG is not indicated for ASCVD detection in asymptomatic individuals, it is done often, and frequently leads to misleading conclusions or unnecessary downstream diagnostic procedures. For example, former President Clinton had passed his treadmill stress tests for several years during his presidential annual checkup but had a heart attack shortly after his presidency. This common practice is a waste of our limited resources. Instead, a more accurate risk assessment using coronary artery calcium (CAC) testing is available; and has just been adopted by ACC/AHA guidelines, however payers do not cover it. CAC is measured non-invasively with a 5-minute CT-scan of the heart, and costs less than $200, whereas cancer screening with colonoscopy and mammography costs over $3000. There is an opportunity to save lives and dollars if CAC testing is covered for appropriately selected individuals. Texas has already passed HB1290 to mandate CAC coverage. Other states must step up and take actions.
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Affiliation(s)
- Morteza Naghavi
- Society for Heart Attack Prevention and Eradication (SHAPE), Palo Alto, CA, United States of America
| | - David J Maron
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Robert A Kloner
- Cardiovascular Research at Huntington Medical Research Institutes, Cardiovascular Division, Dept. of Medicine, Keck School of Medicine of University of Southern California, Pasadena, CA, United States of America
| | - David S Berman
- C Cedars-Sinai Heart Institute and David Geffen School of Medicine UCLA, Los Angeles, CA, United States of America
| | - Mathew Budoff
- Harbor UCLA and Los Angeles Biomedical Research Institute, Torrance, CA, United States of America
| | - H Robert Superko
- Cholesterol, Genetics, and Heart Disease Institute, Carmel, CA, United States of America
| | - P K Shah
- Oppenheimer Atherosclerosis Research Center, Cedars Sinai Medical Center, Los Angeles, CA, United States of America
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Nagendrababu V, Chong BS, McCabe P, Shah PK, Priya E, Jayaraman J, Pulikkotil SJ, Dummer PMH. Guidelines for reporting the quality of clinical case reports in Endodontics: a development protocol. Int Endod J 2019; 52:775-778. [DOI: 10.1111/iej.13067] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 12/21/2018] [Indexed: 12/16/2022]
Affiliation(s)
- V. Nagendrababu
- Division of Clinical Dentistry School of Dentistry International Medical University Kuala Lumpur Malaysia
| | - B. S. Chong
- Institute of Dentistry Barts & The London School of Medicine & Dentistry Queen Mary University of London London UK
| | - P. McCabe
- Oranhill Dental Suite Galway Ireland
| | - P. K. Shah
- Institute of Dentistry Barts & The London School of Medicine & Dentistry Queen Mary University of London London UK
| | - E. Priya
- Division of Children and Community Oral Health School of Dentistry International Medical University Kuala Lumpur Malaysia
| | - J. Jayaraman
- Division of Children and Community Oral Health School of Dentistry International Medical University Kuala Lumpur Malaysia
| | - S. J. Pulikkotil
- Division of Clinical Dentistry School of Dentistry International Medical University Kuala Lumpur Malaysia
| | - P. M. H. Dummer
- School of Dentistry College of Biomedical and Life Sciences Cardiff University Cardiff UK
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12
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Visser GHA, Ayres-de-Campos D, Barnea ER, de Bernis L, Di Renzo GC, Vidarte MFE, Lloyd I, Nassar AH, Nicholson W, Shah PK, Stones W, Sun L, Theron GB, Walani S. FIGO position paper: how to stop the caesarean section epidemic. Lancet 2018; 392:1286-1287. [PMID: 30322563 DOI: 10.1016/s0140-6736(18)32113-5] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/29/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Gerard H A Visser
- Department of Obstetrics, University Medical Center, Utrecht, Netherlands.
| | - Diogo Ayres-de-Campos
- Department of Obstetrics and Gynecology, Medical School-University of Lisbon, Santa Maria Hospital, Lisbon, Portugal
| | - Eytan R Barnea
- Society for the Investigation of Early Pregnancy, New York, NY, USA; BioIncept, LLC, New York, NY, USA
| | | | - Gian Carlo Di Renzo
- Department of Obstetrics and Gynecology, University of Perugia, Perugia, Italy
| | | | - Isabel Lloyd
- Ginecólogo Obstetra, Clinica Hospital San Fernando, Consultorio 6-8, Panama
| | - Anwar H Nassar
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Wanda Nicholson
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill School of Medicine, NC, USA
| | - P K Shah
- Department of Obstetrics and Gynecology, Seth G S Medical College and K E M Hospital, Mumbai, India
| | - William Stones
- Departments of Public Health and Obstetrics and Gynaecology, Malawi College of Medicine, Blantyre, Malawi
| | - Luming Sun
- Shanghai 1st Maternity and Infant Hospital of Tongji University, Shanghai, China
| | - Gerhard B Theron
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Salimah Walani
- Global Health Programs, March of Dimes Foundation, White Plains, NY, USA
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Medel S, Bosch P, Grabchev I, Shah PK, Liu J, Aguirre-Soto A, Stansbury JW. Simultaneous Measurement of Fluorescence, Conversion and Physical/mechanical Properties for Monitoring Bulk and Localized Photopolymerization Reactions in Heterogeneous Systems. RSC Adv 2016; 6:41275-41286. [PMID: 27213038 PMCID: PMC4871629 DOI: 10.1039/c6ra06341a] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
An FT-NIR spectrometer, rheometer and fluorescence spectrophotometer were coupled for the real-time monitoring of polymerization reactions, allowing the simultaneous tracking of polymerization kinetics, storage modulus as well as fluorescence. In this study, a methacrylate functionalized dansyl chromophore (DANSMA) was synthesized and two different nanogels were made from urethane dimethacrylate and isobornyl methacrylate. Two series of resin formulations were prepared using the DANSMA probe, ethoxylated bisphenol A dimethacrylate as the matrix monomer, Irgacure® 651 as the initiator and the dispersed, monomer-swollen nanogels to give clear UV-curable resins. Placement of the fluorescent probe either throughout the resin or linked into the nanogel before its dispersion in the matrix provides a tool to study how the nanogel structure affects local network development by means of fluorescence from the DANSMA probe. We demonstrate the potential of this new technique using a composite as the two phase system (resin and polymerizable nanogel) including a dansyl derivative as a polymerizable probe to follow the reactions that are taking places in both phases.
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Affiliation(s)
- S. Medel
- Department of Chemical and Biological Engineering, University of Colorado Boulder, 3415 Colorado Ave., Boulder, 80303, CO, USA
- Department of Macromolecular Chemistry, Institute of Polymer Science and Technology, ICJP-CSIC, Juan de la Cierva 3, E-28006, Madrid, Spain
| | - P. Bosch
- Department of Macromolecular Chemistry, Institute of Polymer Science and Technology, ICJP-CSIC, Juan de la Cierva 3, E-28006, Madrid, Spain
| | - I. Grabchev
- Sofia University “St. Kliment Ohridski”, Faculty of Medicine, 1470, Sofia, Bulgaria
| | - P. K. Shah
- Department of Chemical and Biological Engineering, University of Colorado Boulder, 3415 Colorado Ave., Boulder, 80303, CO, USA
| | - J. Liu
- Department of Chemical and Biological Engineering, University of Colorado Boulder, 3415 Colorado Ave., Boulder, 80303, CO, USA
| | - A. Aguirre-Soto
- Department of Chemical and Biological Engineering, University of Colorado Boulder, 3415 Colorado Ave., Boulder, 80303, CO, USA
| | - J. W. Stansbury
- Department of Chemical and Biological Engineering, University of Colorado Boulder, 3415 Colorado Ave., Boulder, 80303, CO, USA
- Department of Craniofacial Biology, School of Dental Medicine, University of Colorado Denver, 12800 East 19 Ave., Aurora, 80045, CO, USA
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Yadav AK, Chaudhari H, Shah PK, Madan T. Expression and localization of collectins in feto-maternal tissues of human first trimester spontaneous abortion and abortion prone mouse model. Immunobiology 2015; 221:260-8. [PMID: 26603976 DOI: 10.1016/j.imbio.2015.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 10/29/2015] [Accepted: 10/29/2015] [Indexed: 11/16/2022]
Abstract
Dysregulation of immune response at the feto-maternal interface during first trimester of pregnancy is one of the leading causes of spontaneous abortion. Previously, we reported differential expression of collectins, soluble pattern recognition molecules involved in immunoregulation, in placental and decidual tissues during spontaneous labor. In the present pilot study, the expression of collectins was analyzed in the inflamed human gestational tissues of spontaneous abortion ('SA') and in 13.5 dpc placental tissues from resorption survived embryos of murine model (CBA/J X DBA/2J). Transcripts of SP-A were significantly down-regulated and SP-D were significantly up-regulated in placental and decidual tissues of 'SA' group compared to that of 'normal' group. Immunostaining for SP-D and MBL proteins was positive in placental and decidual tissues. However, levels of SP-D and MBL proteins were not significantly altered in placental as well as in decidual tissues of 'SA' group in comparison to the 'normal' group. Placental tissues of viable embryos from the abortion prone mouse model showed significantly enhanced expression of mSP-A and mSP-D transcripts at 13.5 day post coitus (dpc) and 14.5 dpc compared to the control group (CBA/J X Balb/c). Mouse collectins were localized in placental tissues (13.5 dpc), with increased staining in murine model compared to control. Human and murine data together indicate that SP-A, SP-D and MBL are synthesised in early gestational tissues, and may contribute to regulation of immune response at the feto-maternal interface during pregnancy.
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Affiliation(s)
- A K Yadav
- National Institute for Research in Reproductive Health, Indian Council of Medical Research, Jehangir Merwanji Street, Parel, Mumbai 400012, India
| | - H Chaudhari
- Department of Obstetrics and Gynecology, Seth Gordhandas Sunderdas Medical College and King Edwards Memorial (KEM) Hospital, Parel, Mumbai 400012, India
| | - P K Shah
- Department of Obstetrics and Gynecology, Seth Gordhandas Sunderdas Medical College and King Edwards Memorial (KEM) Hospital, Parel, Mumbai 400012, India
| | - T Madan
- National Institute for Research in Reproductive Health, Indian Council of Medical Research, Jehangir Merwanji Street, Parel, Mumbai 400012, India.
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Shah PK. Response: One Good Consult Begets Another,While Providing a Learning Experience. J Am Coll Cardiol 2015; 66:201. [PMID: 26371351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Shah PK, Narendran V, Kalpana N. Safety and efficacy of simultaneous bilateral 25-gauge lens-sparing vitrectomy for vascularly active stage 4 retinopathy of prematurity. Eye (Lond) 2015; 29:1046-50. [PMID: 25998945 DOI: 10.1038/eye.2015.78] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 04/01/2015] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To report the safety and efficacy of simultaneous bilateral 25-gauge lens-sparing vitrectomy for vascularly active stage 4 retinopathy of prematurity (ROP). METHODS Retrospective, noncomparative, consecutive case series. Twenty eyes of 10 babies who presented with vascularly active stage 4 ROP in both the eyes underwent simultaneous bilateral 25-gauge lens-sparing vitrectomy. After completing surgery for one eye, the other eye was re-prepped as performed before starting any new case of a different patient and an entire new set of disposable 25-gauge instruments were used. During the post-operative period parents were advised to keep separate eye drops for each eye and to wash their hands in between switching the eyes to put the drops. RESULTS The mean follow-up was 8.7 months (range 4-17 months). None of the cases developed any signs of infection. The anatomic success rate for stage 4a was 100% (11/11 eyes) and for stage 4b was 8/9 eyes (89%). CONCLUSION These results show that simultaneous bilateral 25-gauge lens-sparing vitrectomy for stage 4 ROP is a safe and effective procedure with a good outcome provided both eyes of the baby are treated as eyes of two different patients.
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Affiliation(s)
- P K Shah
- Department of Paediatric Retina and Ocular Oncology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, India
| | - V Narendran
- Department of Paediatric Retina and Ocular Oncology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, India
| | - N Kalpana
- Department of Paediatric Retina and Ocular Oncology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, India
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Leung KY, Poon CF, Teotico AR, Hata T, Won HS, Chen M, Chittacharoen A, Malhotra J, Shah PK, Salim A. Recommendations on routine mid-trimester anomaly scan. J Obstet Gynaecol Res 2015; 41:653-61. [PMID: 25891534 DOI: 10.1111/jog.12700] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 12/16/2014] [Indexed: 11/28/2022]
Abstract
The purpose of this paper is to discuss the minimal requirements of the routine mid-trimester anomaly scan in Asian countries after taking into account various factors, including local circumstances, medical practice, guidelines, and availability of experienced sonographers and high-resolution ultrasound machines, which affect the prenatal detection rate of fetal anomalies. In general, a routine mid-trimester anomaly scan includes the assessment of the number of fetuses, fetal cardiac activity, size, anatomy, liquor and placental location. The most controversial issue is which fetal structures should at least be examined. We discussed the requirements of a basic routine scan, as well as the optional views, which can be obtained if feasible to improve the detection of fetal, placental or maternal abnormalities. Routine anomaly scan remains a clinical challenge.
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Affiliation(s)
- Kwok Yin Leung
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong, SAR
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Adhikari N, Shah PK, Acharya G, Vaidya KM. Bacteriological profile and associated risk factors of neonatal sepsis in Paropakar Maternity and Women's Hospital Thapathali, Kathmandu. Nepal Med Coll J 2014; 16:161-164. [PMID: 26930737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Neonatal Sepsis is one of the most common reasons for admission to neonatal units in developing countries. It is also a major cause of mortality in both developed and developing countries. Identification of the common bacteria and risk factors causing such infections and their susceptibility patterns will provide necessary information for timely intervention. This study was carried out to determine the bacteriological profile and associated risk factors of neonatal sepsis in Paropakar Maternity and Women's hospital. A cross-sectional prospective study was conducted among neonates suspected of neonatal sepsis. Blood culture was performed and organisms were identified and antibiotic susceptibility was carried out with standard microbiological methods. Data were analysed by using SPSS. Ver. 16 software. The positive yield of blood culture was 21%. The most common isolates were Staphylococcus epidermidis, E. coli, Staphylococcus aureus, Klebsiella pneumoniae and Pseudomonas spp. In Antibiotic susceptibility pattern Gentamycin showed the highest sensitivity to all types of isolated organisms. Vancomycin sensitivity was highest for Gram positive organism and Ciprofloxacin was most effective for Gram negative organisms isolated. Ampicillin and Amoxycillin were the least effective drug. Multiple drug resistance was observed in 77.15% of isolates. Prematurity, low birth weight and maternal pyrexia before delivery were found to be strongly associated with neonatal sepsis. Gram positive organisms were more prevalent than gram negative organisms.
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MESH Headings
- Anti-Bacterial Agents/therapeutic use
- Cross-Sectional Studies
- Drug Resistance, Multiple, Bacterial
- Female
- Fever/complications
- Hospitals, Maternity
- Humans
- Infant, Low Birth Weight
- Infant, Newborn
- Infant, Newborn, Diseases/drug therapy
- Infant, Newborn, Diseases/microbiology
- Infant, Premature
- Male
- Nepal
- Pregnancy
- Pregnancy Complications
- Prospective Studies
- Risk Factors
- Sepsis/drug therapy
- Sepsis/microbiology
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Brodov Y, Gransar H, Rozanski A, Hayes SW, Friedman JD, Thomson LEJ, Dey D, Slomka PJ, Min JK, Shaw LJ, Shah PK, Germano G, Berman DS. Extensive thoracic aortic calcification is an independent predictor of development of coronary artery calcium among individuals with coronary artery calcium score of zero. Atherosclerosis 2014; 238:4-8. [PMID: 25461732 DOI: 10.1016/j.atherosclerosis.2014.10.100] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 10/21/2014] [Accepted: 10/24/2014] [Indexed: 01/07/2023]
Abstract
OBJECTIVES The predictive value of thoracic aortic calcium (TAC) scores for coronary artery calcium (CAC) conversion (CAC>0) has not been fully evaluated. METHODS We studied 1648 asymptomatic subjects (mean age 52 ± 9 years, 54% male) with baseline CAC = 0 who underwent repeat CAC scanning 5 years later (range 3-14 years). TAC was assessed in the ascending and descending aorta. CAC and TAC were measured using Agatston scores. The cohort was categorized by baseline TAC scores: TAC = 0 (n = 1381 subjects), TAC 1-9 (n = 54), TAC 10-99 (n = 132) and TAC≥100 (n = 81). Logistic regression was used to examine the predictive value of baseline TAC scores for CAC>0 on repeat scans. RESULTS On repeat scanning, 380 subjects (23%) developed CAC>0. The frequency of CAC>0 increased progressively across baseline TAC (TAC = 0, TAC 1-9, TAC 10-99 and TAC≥100) 22%, 26%, 26% and 37%, respectively (P for trend = 0.0025). Univariate analysis showed baseline TAC ≥100 was a significant predictor of CAC>0 in repeat scans, while either TAC 1-9 or TAC 10-99 were not, OR 2.10 [CI 1.32-3.36], P = 0.002; OR 1.25 [CI 0.67-2.33], P = 0.5; OR 1.24 [CI 0.82-1.87], P = 0.3, respectively. In multivariable analysis, TAC ≥100 OR 1.90 [CI 1.08-3.33], P = 0.026, was a significant predictor of CAC>0, along with age, male gender, diabetes, hypertension, hypercholesterolemia and time between scans. CONCLUSIONS The likelihood of conversion to CAC>0 increases with increasing TAC scores. TAC ≥ 100 is an independent predictor of CAC conversion. Subjects with CAC = 0 and extensive TAC (TAC ≥ 100) may merit earlier repeat scanning than those with no TAC or lower TAC scores.
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Affiliation(s)
- Yafim Brodov
- Department of Cardiac Imaging (Division of Nuclear Medicine), The Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Cardiology, The Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Heidi Gransar
- Department of Cardiac Imaging (Division of Nuclear Medicine), The Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Cardiology, The Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alan Rozanski
- Division of Cardiology, St. Lukes Roosevelt Hospital, New York, NY, USA
| | - Sean W Hayes
- Department of Cardiac Imaging (Division of Nuclear Medicine), The Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Cardiology, The Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - John D Friedman
- Department of Cardiac Imaging (Division of Nuclear Medicine), The Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Cardiology, The Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Louise E J Thomson
- Department of Cardiac Imaging (Division of Nuclear Medicine), The Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Cardiology, The Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Damini Dey
- Department of Cardiac Imaging (Division of Nuclear Medicine), The Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Cardiology, The Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Department of Biomedical Sciences and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, CA, USA
| | - Piotr J Slomka
- Department of Cardiac Imaging (Division of Nuclear Medicine), The Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Cardiology, The Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - James K Min
- Department of Radiology and Medicine Weill Cornell Medical College, New York, NY, USA
| | - Leslee J Shaw
- Emory Clinical Cardiovascular Research Institute (ECCRI), Emory University School of Medicine, Atlanta, GA, USA
| | - P K Shah
- Department of Cardiac Imaging (Division of Nuclear Medicine), The Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Cardiology, The Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Guido Germano
- Department of Cardiac Imaging (Division of Nuclear Medicine), The Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Cardiology, The Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Daniel S Berman
- Department of Cardiac Imaging (Division of Nuclear Medicine), The Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Cardiology, The Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Pahadi PC, Shrestha UT, Adhikari N, Shah PK, Amatya R. Growing Resistance to Vancomycin among Methicillin Resistant Staphylococcus Aureus Isolates from Different Clinical Samples. JNMA J Nepal Med Assoc 2014; 52:977-981. [PMID: 26982895] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
INTRODUCTION Methicillin resistant Staphylococcus aureus (MRSA), majorly associated with nosocomial and community infections worldwide, are emerging as resistant strains to many antibiotics narrowing down the efficacy of antimicrobial therapy. In order to investigate the changing resistant pattern of MRSA to empirical drugs, the study was carried out at KIST Medical College and Hospital, Nepal. It also aims to determine the minimum inhibitory concentration (MIC) of vancomycin among MRSA. METHODS Altogether 3500 clinical samples including 1303 blood, 1489 urine and 708 body fluids were collected and processed. Isolated S. aureus were further screened for methicillin resistance by Kirby-Bauer disk diffusion technique using cefoxitin (30µg) disk. All MRSA were subjected to in vitro determination of MIC of vancomycin by agar dilution method as recommended by CLSI guidelines. RESULTS Total 287 S. aureus were isolated from the different clinical samples. Altogether 248 (86.41%) were found to be multidrug resistance (MDR) while 42 (14.63%) of the isolates were methicillin resistance with the highest prevalence in the age group of 16-30. All 42 (100%) MRSA isolates were resistant to ampicillin and penicillin followed by 41 (97.62%), 32 (76.19%), 31(73.81%), 29 (69.05%), 9 (21.43%) and seven (16.67%) to cefotaxime, gentamycin, cotrimoxazole, erythromycin, tetracycline and ciprofloxacin respectively. Although all MRSA strains were sensitive to vancomycin on disc diffusion, four isolates were intermediates in vitro determination of MIC of vancomycin. The break point for vancomycin was found to be 15mm. CONCLUSIONS The increment in vancomycin MIC among MRSA is alarming. Strict control measures to prevent MRSA spread and a routine surveillance for VRSA must be incorporated in hospitals.
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Affiliation(s)
- P C Pahadi
- Department of Microbiology, Kantipur College of Medical Science, Kathmandu, Nepal
| | - U T Shrestha
- Department of Microbiology, Kantipur College of Medical Science, Kathmandu, Nepal
| | - N Adhikari
- Department of Microbiology, Kantipur College of Medical Science, Kathmandu, Nepal
| | - P K Shah
- Department of Microbiology, Tri-Chandra Multiple Campus, Kathmandu, Nepal
| | - R Amatya
- Department of Microbiology, Nepal Medical College, Kathmandu, Nepal
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Shah PK, Hughes MR, Wang Y, Sims CE, Allbritton NL. Scalable synthesis of a biocompatible, transparent and superparamagnetic photoresist for microdevice fabrication. J Micromech Microeng 2013; 23:10.1088/0960-1317/23/10/107002. [PMID: 24273390 PMCID: PMC3835212 DOI: 10.1088/0960-1317/23/10/107002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The functionalization of photoresists with colloids has enabled the development of novel active and passive components for microfabricated devices. Incorporation of colloidal particles often results in undesirable reductions in photolithographic fidelity and device transparency. We present a novel photoresist composite incorporating poly(methyl methacrylate-co-methacrylic acid) (PMMA/MMA), the epoxy resin 1002F and colloidal maghemite nanoparticles to produce a stable, transparent and biocompatible photoresist. The composite photoresist was prepared in a scalable fashion in batches up to 1 kg with the particles remaining dispersed during room-temperature storage for at least 6 months. Following photolithography to form films, the nanoparticle size remained well below that of visible-light wavelengths as demonstrated by electron microscopy. Structures fabricated from the photoresist by conventional photolithography displayed aspect ratios greater than ten. When grown on the photoresist, the metabolic rate of HeLa cells was unchanged relative to cells grown on glass. Primary murine mesenchymal stem cells also displayed a normal morphology on the resist surface. The ability to manipulate microstructures formed from the composite was demonstrated by magnetically collecting clonal colonies of HeLa cells from a micropallet array. The transparency, biocompatibility, scalable synthesis and superparamagnetic properties of the novel composite address key limitations of existing magnetic composites.
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Affiliation(s)
- P K Shah
- Department of Biomedical Engineering, University of North Carolina, Chapel Hill, NC 27599, USA and North Carolina State University, Raleigh, NC 27695, USA
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Baniwal SK, Shah PK, Shi Y, Haduong JH, Declerck YA, Gabet Y, Frenkel B. Runx2 promotes both osteoblastogenesis and novel osteoclastogenic signals in ST2 mesenchymal progenitor cells. Osteoporos Int 2012; 23:1399-413. [PMID: 21881969 PMCID: PMC5771409 DOI: 10.1007/s00198-011-1728-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 06/28/2011] [Indexed: 12/19/2022]
Abstract
UNLABELLED We profiled the global gene expression of a bone marrow-derived mesenchymal pluripotent cell line in response to Runx2 expression. Besides osteoblast differentiation, Runx2 promoted the osteoclastogenesis of co-cultured splenocytes. This was attributable to the upregulation of many novel osteoclastogenic genes and the downregulation of anti-osteoclastogenic genes. INTRODUCTION In addition to being a master regulator for osteoblast differentiation, Runx2 controls osteoblast-driven osteoclastogenesis. Previous studies profiling gene expression during osteoblast differentiation had limited focus on Runx2 or paid little attention to its role in mediating osteoblast-driven osteoclastogenesis. METHODS ST2/Rx2(dox), a bone marrow-derived mesenchymal pluripotent cell line that expresses Runx2 in response to Doxycycline (Dox), was used to profile Runx2-induced gene expression changes. Runx2-induced osteoblast differentiation was assessed based on alkaline phosphatase staining and expression of classical marker genes. Osteoclastogenic potential was evaluated by TRAP staining of osteoclasts that differentiated from primary murine splenocytes co-cultured with the ST2/Rx2(dox) cells. The BeadChip™ platform (Illumina) was used to interrogate genome-wide expression changes in ST2/Rx2(dox) cultures after treatment with Dox or vehicle for 24 or 48 h. Expression of selected genes was also measured by RT-qPCR. RESULTS Dox-mediated Runx2 induction in ST2 cells stimulated their own differentiation along the osteoblast lineage and the differentiation of co-cultured splenocytes into osteoclasts. The latter was attributable to the stimulation of osteoclastogenic genes such as Sema7a, Ltc4s, Efnb1, Apcdd1, and Tnc as well as the inhibition of anti-osteoclastogenic genes such as Tnfrsf11b (OPG), Sema3a, Slco2b1, Ogn, Clec2d (Ocil), Il1rn, and Rspo2. CONCLUSION Direct control of osteoblast differentiation and concomitant indirect control of osteoclast differentiation, both through the activity of Runx2 in pre-osteoblasts, constitute a novel mechanism of coordination with a potential crucial role in coupling bone formation and resorption.
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Affiliation(s)
- S K Baniwal
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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Shah PK. Cholesteryl ester transfer protein inhibition and endothelial function: enough with the surrogates. Eur Heart J 2012; 33:819-21. [DOI: 10.1093/eurheartj/ehs040] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Engelbertsen D, Anand DV, Fredrikson GN, Hopkins D, Corder R, Shah PK, Lahiri A, Nilsson J, Bengtsson E. High levels of IgM against methylglyoxal-modified apolipoprotein B100 are associated with less coronary artery calcification in patients with type 2 diabetes. J Intern Med 2012; 271:82-9. [PMID: 21668821 DOI: 10.1111/j.1365-2796.2011.02411.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [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: 12/25/2022]
Abstract
OBJECTIVE Advanced glycation end products (AGE) have been implicated in diabetic vascular complications through activation of pro-inflammatory genes. AGE-modified proteins are also targeted by the immune system resulting in the generation of AGE-specific autoantibodies, but the association of these immune responses with diabetic vasculopathy remains to be fully elucidated. The aim of this study was to determine whether antibodies against apolipoprotein B100 modified by methylglyoxal (MGO-apoB100) are associated with coronary atherosclerosis in patients with type 2 diabetes. METHODS We measured antibodies against MGO-apoB100 in plasma from 497 type 2 diabetic patients without clinical signs of cardiovascular disease. Severity of coronary disease was assessed as coronary artery calcium (CAC) imaging. Immunoglobulin (Ig)M and IgG levels recognizing MGO-apoB100 were determined by enzyme-linked immunosorbent assay. RESULTS Anti-MGO-apoB100 IgM antibody levels were higher in subjects with a low to moderate CAC score (≤400 Agatston units) than in subjects with a high score (>400 Agatston units; 136.8±4.4 vs. 101.6± 7.4 arbitrary units (AU), P<0.0001) and in subjects demonstrating no progression of CAC during 30 months of follow-up (136.4±5.7 vs. 113.9 ± 6.2 AU in subjects with progression, P<0.0001). Subjects with a family history of premature myocardial infarction had lower levels of anti-MGO-apoB100 IgM. Female subjects had higher levels of anti-MGO-apoB100 antibodies and lower CAC than men. Accordingly, high levels of IgM against MGO-apoB100 are associated with less severe and a lower risk of progression of coronary disease in subjects with type 2 diabetes. CONCLUSIONS Although conclusions regarding causal relationships based on epidemiological observations need to be made with caution, our findings suggest the possibility that anti-MGO-apoB100 IgM may be protective in diabetic vasculopathy.
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Affiliation(s)
- D Engelbertsen
- Department of Clinical Sciences, Skåne University Hospital, Lund University, Malmö, Sweden.
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Shah PK, Mudaliar S, Chang AR, Aroda V, Andre M, Burke P, Henry RR. Effects of intensive insulin therapy alone and in combination with pioglitazone on body weight, composition, distribution and liver fat content in patients with type 2 diabetes. Diabetes Obes Metab 2011; 13:505-10. [PMID: 21272186 PMCID: PMC3580155 DOI: 10.1111/j.1463-1326.2011.01370.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIM To evaluate the effects of intensive insulin therapy alone and with added pioglitazone on body weight, fat distribution, lean body mass (LBM) and liver fat in type 2 diabetic patients. METHODS Twenty-five insulin-treated, obese patients with type 2 diabetes were randomized to addition of pioglitazone 45 mg (n = 12) or placebo (n = 13) and treated intensively for 12-16 weeks. Dual-energy X-ray absorptiometry/abdominal computed tomography scans were performed before/after treatment. LBM, visceral/subcutaneous adipose tissue (VAT/SAT) and liver/spleen (L/S) attenuation ratios were measured pre-/posttreatment (a ratio <1 represents fatty liver). RESULTS Intensive insulin alone and insulin + pioglitazone significantly improved glycaemic control (7.8 ± 0.3 to 7.2 ± 0.3% and 7.6 ± 0.3 to 7.1 ± 0.4%, respectively). Body weight gain was greater with insulin + pioglitazone (4.9 ± 4.5 kg) versus insulin therapy alone (1.7 ± 0.7 kg). SAT increased significantly with pioglitazone + insulin therapy (393.9 ± 48.5 to 443.2 ± 56.7 cm(2) , p < 0.01) compared to a non-significant increase with insulin therapy alone (412.9 ± 42.5 to 420.8 ± 43.8 cm(2) ). VAT decreased non-significantly in both groups (240.3 ± 41.7 to 223.8 ± 38.1 cm(2) with insulin + pioglitazone and 266.6 ± 27.4 to 250.5 ± 22.2 cm(2) with insulin therapy). LBM increased significantly by 1.92 ± 0.74 kg with insulin + pioglitazone treatment. The L/S attenuation ratio in the placebo + insulin group decreased from 1.08 ± 0.1 to 1.04 ± 0.1 (p = ns) and increased from 1.00 ± 0.1 to 1.08 ± 0.05 (p = 0.06) in the pioglitazone + insulin group. CONCLUSIONS Intensification of insulin therapy in type 2 diabetic patients causes modest weight gain and no change in body fat distribution, LBM or liver fat. In contrast, the addition of pioglitazone, at equivalent glycaemia, increases weight gain, fat mass and SAT; increases LBM and tends to decrease liver fat. These changes in fat distribution may contribute to the beneficial effects of pioglitazone, despite greater weight gain.
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Affiliation(s)
- P K Shah
- VA San Diego Healthcare System, San Diego, CA, USA
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Abstract
Current strategies for prevention of cardiovascular disease focus on risk factor intervention. Although these have been proven both safe and effective results from randomized clinical trials suggest that it is difficult to achieve relative risk reductions exceeding 40% with this approach. To further improve efficacy future therapies must aim at targeting the actual disease process in the arterial wall. Emerging evidence have identified an important role of the immune system in atherosclerosis and suggest that modulation of autoimmune responses against oxidized LDL and other antigens in the atherosclerotic plaque represent one possible new approach to disease prevention. Oxidized LDL is targeted by both antibody-mediated and cellular immune responses and as much as 10% of the T cells in atherosclerotic plaques are oxidized LDL-specific. Immune activation in the atherosclerotic plaque is primarily of the pro-inflammatory Th1-type and inhibition Th1 immunity reduces atherosclerosis in experimental animals. Atherosclerosis vaccines based on antigens derived from LDL have been developed to modulate these processes. Their mechanisms of action remain to be full characterized but may involve expression of protective antibodies that facilitate the removal of oxidized LDL and antigen-specific regulatory T cells that counteract Th1 autoimmunity against oxidized LDL. In this review we will discuss the possibilities and challenges encountering the translation of immune-modulatory therapy for atherosclerosis from the experimental stage into the clinic.
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Affiliation(s)
- J Nilsson
- Department of Clinical Sciences, Malmö University Hospital, Lund University, Malmö, Sweden.
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Fredrikson GN, Anand DV, Hopkins D, Corder R, Alm R, Bengtsson E, Shah PK, Lahiri A, Nilsson J. Associations between autoantibodies against apolipoprotein B-100 peptides and vascular complications in patients with type 2 diabetes. Diabetologia 2009; 52:1426-33. [PMID: 19448981 PMCID: PMC2688611 DOI: 10.1007/s00125-009-1377-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2008] [Accepted: 04/01/2009] [Indexed: 11/26/2022]
Abstract
AIMS/HYPOTHESIS Oxidation of LDL in the arterial extracellular matrix is a key event in the development of atherosclerosis and autoantibodies against oxidised LDL antigens reflect disease severity and the risk of developing acute cardiovascular events. Since type 2 diabetes is associated with increased oxidative stress, we tested the hypothesis that autoantibodies against oxidised LDL antigens are biomarkers for vascular complications in diabetes. METHODS We studied 497 patients with type 2 diabetes without clinical signs of coronary heart disease. Oxidised LDL autoantibodies were determined by ELISA detecting IgG and IgM specific for native and malondialdehyde (MDA)-modified apolipoprotein B-100 peptides p45 and p210. The severity of coronary disease was assessed as the coronary artery calcium score. RESULTS Patients affected by retinopathy had significantly higher levels of IgG against MDA-p45 and MDA-p210. In contrast, high levels of autoantibodies against the corresponding native peptides were associated with less coronary calcification and a lower risk of progression of coronary disease. CONCLUSIONS/INTERPRETATION Our observations suggest that LDL oxidation is involved in the pathogenesis of diabetic retinopathy and that autoantibodies against apolipoprotein B peptides may act as biomarkers for both micro- and macrovascular complications in diabetes.
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Affiliation(s)
- G. N. Fredrikson
- Department of Clinical Sciences, Malmö University Hospital, Lund University, CRC Entrance 72, 91:12, 205 02 Malmö, Sweden
- Department of Biomedical Laboratory Science and Technology, Malmö University, Malmö, Sweden
| | - D. V. Anand
- Cardiac Imaging and Research Center, Wellington Hospital, London, UK
| | - D. Hopkins
- Department of Diabetic Medicine, King’s College Hospital, London, UK
| | - R. Corder
- William Harvey Research Institute, London, UK
| | - R. Alm
- Department of Clinical Sciences, Malmö University Hospital, Lund University, CRC Entrance 72, 91:12, 205 02 Malmö, Sweden
| | - E. Bengtsson
- Department of Clinical Sciences, Malmö University Hospital, Lund University, CRC Entrance 72, 91:12, 205 02 Malmö, Sweden
| | - P. K. Shah
- Atherosclerosis Research Center and Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA USA
- David Geffen School of Medicine, UCLA School of Medicine, Los Angeles, CA USA
| | - A. Lahiri
- Cardiac Imaging and Research Center, Wellington Hospital, London, UK
| | - J. Nilsson
- Department of Clinical Sciences, Malmö University Hospital, Lund University, CRC Entrance 72, 91:12, 205 02 Malmö, Sweden
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Abstract
AIM To describe our experience in surgical management of stages 4 and 5 retinopathy of prematurity (ROP) and assess its anatomical and visual outcome. MATERIALS AND METHODS This study is a retrospective, interventional, consecutive case series. It involved 33 eyes of 29 infants. The data were retrieved retrospectively for each case from their medical records. All the eyes underwent primary vitrectomy with additional procedures like scleral buckling (two eyes), lensectomy (14 eyes), subretinal fluid drainage (two eyes), and one case of corneal transplant (open sky vitrectomy). The anatomical and visual outcome was reviewed at the final follow-up. RESULTS The mean gestational age was 29.7 weeks (range 25-34 weeks) and mean birth weight was 1332 g (range 650-2050 g). Anatomical success for stage 4A was defined as complete retinal attachment with undistorted or minimally distorted posterior pole. For stage 4B, partial residual retinal detachment and for stage 5 at least posterior pole attachment. Visual acuity was measured in anatomically successful eyes that were cooperative. The anatomical outcome was 90% (9/10 eyes) for stage 4A, 44.4% (4/9 eyes) for stage 4B, and 14.3% (2/14) for stage 5. The mean follow-up was 19.1 months. Posterior retinotomy was the commonest complication for stage 4B (66.7%). CONCLUSION Anatomical and visual success was the best for stage 4A ROP. Surgery for stage 4A can halt progression to stages 4B or 5 ROP. Aggressive peeling of posterior membranes should be avoided for stage 4B. Anatomical and visual outcome is very poor for stage 5.
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Affiliation(s)
- P K Shah
- Department of Pediatric Retina, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Coimbatore, Tamilnadu, India.
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Abstract
LDL-lowering therapies, predominantly involving statins, have been shown to significantly reduce cardiovascular events in asymptomatic subjects as well as in subjects with clinically established atherosclerotic cardiovascular disease. However, despite statin therapy, significant number of cardiovascular events continue to occur indicating the need for additional targets for atherosclerosis management. A number of pre-clinical studies have suggested that several HDL based therapies have the potential to stabilize or regress atherosclerosis consistent with epidemiologic evidence of an inverse relationship between coronary heart disease and HDL cholesterol levels. One such therapeutic approach involves direct infusion of HDL or HDL like molecules for rapid remodeling and stabilization of atherosclerosis. Pre-clinical and proof of concept type preliminary clinical studies suggest the feasibility and potential efficacy of this emerging new therapeutic paradigm.
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Affiliation(s)
- P K Shah
- Atherosclerosis Research Center, Division of Cardiology, Burns and Allen Research Institute, UCLA, Los Angeles, California, USA.
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Goodarzi MO, Taylor KD, Scheuner MT, Antoine HJ, Guo X, Shah PK, Rotter JI. Haplotypes in the lipoprotein lipase gene influence high-density lipoprotein cholesterol response to statin therapy and progression of atherosclerosis in coronary artery bypass grafts. Pharmacogenomics J 2006; 7:66-73. [PMID: 16755277 DOI: 10.1038/sj.tpj.6500402] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Lipoprotein lipase (LPL) hydrolyzes circulating triglycerides (TGs). We previously showed that 3'-end haplotypes in the LPL gene influence atherosclerosis and insulin resistance. This study asked whether these LPL haplotypes influence response to lipid-lowering therapy among 829 subjects from the Post-Coronary Artery Bypass Graft trial. Lipid profiles were obtained at baseline and 4-5 years after treatment with lovastatin. Haplotypes were based on 12 SNPs. The fourth most frequent haplotype, 12-4, was associated with a decreased increment in high-density lipoprotein-cholesterol (HDL-C) following treatment. Haplotypes 12-6, 12-7 and 12-8 were each associated with increased HDL-C response to therapy, and haplotype 12-2 with decreased TG response. The most common haplotype, 12-1, was protective against graft worsening or occlusion. Haplotype 12-4 reduced HDL-C response to lovastatin, possibly consistent with our prior observations of this haplotype as predisposing to coronary artery disease. LPL may influence atherosclerosis risk through pleiotropic effects on each aspect of the metabolic syndrome.
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Affiliation(s)
- M O Goodarzi
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Cedars-Sinai Medical Center, Los Angeles, CA 9048, USA.
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Abstract
Reduced HDL cholesterol may be a risk factor comparable in importance to increased LDL cholesterol. Interventions that raise HDL are antiatherosclerotic, presumably through acceleration of reverse cholesterol transport and by antioxidant and antiinflammatory effects. In the hypercholesterolemic rabbit, HDL levels can be increased by >50% by inhibition of cholesteryl ester transfer protein (CETP), a molecule that plays a central role in HDL metabolism. This HDL-raising effect is antiatherosclerotic in moderately severe hyperlipidemia but appears to be ineffective in the presence of severe hypertriglyceridemia. In humans, mutations resulting in CETP inhibition have been associated with both reduced and increased risk of atherosclerosis. Proposed explanations for these apparently disparate observations are that the antiatherosclerotic effect of CETP inhibition varies with either the metabolic milieu or the degree of CETP inhibition. We now have pharmacological inhibitors of CETP that are capable of increasing HDL by as much as 50% to 100% in humans. The importance of this development is that reduced HDL is a risk factor independent of LDL and that these new agents alter HDL by a magnitude comparable to that of statins on LDL. Clinical trials, now beginning, will need to identify the patient subsets in which CETP inhibition may be more or less effective.
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Affiliation(s)
- James S Forrester
- Cardiology Division, Cedars-Sinai Medical Center, Los Angeles, Calif 90048, USA.
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Meisel SR, Shechter M, Xu XP, Edgington TS, Cercek B, Shah PK. Platelet-induced expression of tissue factor procoagulant activity in freshly isolated human mononuclear cells: implications for experimental use. Clin Lab Haematol 2003; 25:321-5. [PMID: 12974724 DOI: 10.1046/j.1365-2257.2003.00544.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Monocytes express tissue factor (TF) as a result of cytokine stimulation or endothelial adherence. We evaluated monocyte-platelet interaction in vitro as another trigger for monocyte TF enhancement in human mononuclear cells isolated by density gradient centrifugation from peripheral blood. Cell TF procoagulant activity (TF-PCA) was quantitated by a one-stage recalcification clotting time assay. Platelets were counted and identified by whole blood flow cytometry as CD61 positive particles, activated platelets were characterized by P-Selectin (CD62) expression, and monocytes by surface CD14 expression. A significant correlation between normalized TF-PCA of isolated mononuclear cells and platelet count was shown (r = 0.43, P < 0.001). Percentage of activated platelets in baseline samples was 4.2 +/- 3.5 while adenosine diphosphate (ADP) increased platelet positivity to 34 +/- 17% (P < 0.001). After isolation, 52 +/- 12% of platelets within suspensions were activated (P < 0.0001). Percentage of CD62-positive monocytes (CD14+ particles) increased from baseline 5% to 13 +/- 6% in ADP-stimulated samples to 53 +/- 17% after isolation (P < 0.001). These findings suggest that density gradient centrifugation activates platelets and that an adhesive interaction between monocytes and platelets may promote TF-PCA expression in isolated mononuclear suspensions. Enhanced monocyte TF expression as a result of an activated platelet-monocyte interaction seems to be an important laboratory effect requiring consideration when utilizing this technique in an experimental setup.
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Affiliation(s)
- S R Meisel
- Department of Medicine, Division of Cardiology, Atherosclerosis Research Center, Cedar-Sinai Burns & Allen Research Institute, Israel.
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Henry TD, Annex BH, McKendall GR, Azrin MA, Lopez JJ, Giordano FJ, Shah PK, Willerson JT, Benza RL, Berman DS, Gibson CM, Bajamonde A, Rundle AC, Fine J, McCluskey ER. The VIVA trial: Vascular endothelial growth factor in Ischemia for Vascular Angiogenesis. Circulation 2003; 107:1359-65. [PMID: 12642354 DOI: 10.1161/01.cir.0000061911.47710.8a] [Citation(s) in RCA: 747] [Impact Index Per Article: 35.6] [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: 11/16/2022]
Abstract
BACKGROUND Recombinant human vascular endothelial growth factor protein (rhVEGF) stimulates angiogenesis in animal models and was well tolerated in Phase I clinical trials. VIVA (Vascular endothelial growth factor in Ischemia for Vascular Angiogenesis) is a double-blind, placebo-controlled trial designed to evaluate the safety and efficacy of intracoronary and intravenous infusions of rhVEGF. METHODS AND RESULTS A total of 178 patients with stable exertional angina, unsuitable for standard revascularization, were randomized to receive placebo, low-dose rhVEGF (17 ng x kg(-1) x min(-1)), or high-dose rhVEGF (50 ng x kg(-1) x min(-1)) by intracoronary infusion on day 0, followed by intravenous infusions on days 3, 6, and 9. Exercise treadmill tests, angina class, and quality of life assessments were performed at baseline, day 60, and day 120. Myocardial perfusion imaging was performed at baseline and day 60. At day 60, the change in exercise treadmill test (ETT) time from baseline was not different between groups (placebo, +48 seconds; low dose, +30 seconds; high dose, +30 seconds). Angina class and quality of life were significantly improved within each group, with no difference between groups. By day 120, placebo-treated patients demonstrated reduced benefit in all three measures, with no significant difference compared with low-dose rhVEGF. In contrast, high-dose rhVEGF resulted in significant improvement in angina class (P=0.05) and nonsignificant trends in ETT time (P=0.15) and angina frequency (P=0.09) as compared with placebo. CONCLUSIONS rhVEGF seems to be safe and well tolerated. rhVEGF offered no improvement beyond placebo in all measurements by day 60. By day 120, high-dose rhVEGF resulted in significant improvement in angina and favorable trends in ETT time and angina frequency.
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Affiliation(s)
- Timothy D Henry
- Division of Cardiology at Hennepin County Medical Center and University of Minnesota, Minneapolis, USA.
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Chyu KY, Shah PK. The role of inflammation in plaque disruption and thrombosis. Rev Cardiovasc Med 2003; 2:82-91. [PMID: 12439385] [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: 02/27/2023] Open
Abstract
Most of the serious clinical manifestations (such as unstable angina, acute MI, and many cases of sudden death) of coronary atherosclerosis result from thrombosis, usually occurring on a disrupted atherosclerotic plaque. Plaques prone to disruption have large lipid-rich cores with evidence of cap-thinning and active inflammation. Inflammatory cells may contribute to both plaque disruption and subsequent thrombosis. Here we review the evidence for the involvement of inflammation in plaque disruption and thrombosis and the potential clinical implications of this pathophysiologic paradigm.
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Affiliation(s)
- K Y Chyu
- Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Kar S, Shah PK. Acute coronary syndrome caused by coronary artery dissection mimicking acute plaque rupture. Rev Cardiovasc Med 2003; 2:215-9. [PMID: 12439371] [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: 02/27/2023] Open
Abstract
When a middle-aged, nonpregnant female patient with no coronary risk factors presents with chest pain, what are the red flags for unusual causes? This case report provides important diagnostic clues as well as progressive therapeutic steps to solving a potentially life-threatening problem.
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Affiliation(s)
- S Kar
- Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Shah PK. Two views of nitric oxide. Rev Cardiovasc Med 2003; 1:20-2. [PMID: 12506936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Affiliation(s)
- P K Shah
- Cedars-Sinai Medical Center, Los Angeles, California, USA
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Xu XH, Shah PK, Faure E, Equils O, Thomas L, Fishbein MC, Luthringer D, Xu XP, Rajavashisth TB, Yano J, Kaul S, Arditi M. Toll-like receptor-4 is expressed by macrophages in murine and human lipid-rich atherosclerotic plaques and upregulated by oxidized LDL. Circulation 2001; 104:3103-8. [PMID: 11748108 DOI: 10.1161/hc5001.100631] [Citation(s) in RCA: 440] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Inflammation is implicated in atherogenesis and plaque disruption. Toll-like receptor 2 (TLR-2) and TLR-4, a human homologue of drosophila Toll, play an important role in the innate and inflammatory signaling responses to microbial agents. To investigate a potential role of these receptors in atherosclerosis, we assessed the expression of TLR-2 and TLR-4 in murine and human atherosclerotic plaques. METHODS AND RESULTS Aortic root lesions of high-fat diet-fed apoE-deficient mice (n=5) and human coronary atherosclerotic plaques (n=9) obtained at autopsy were examined for TLR-4 and TLR-2 expression by immunohistochemistry. Aortic atherosclerotic lesions in all apoE-deficient mice expressed TLR-4, whereas aortic tissue obtained from control C57BL/6J mice showed no TLR-4 expression. All 5 lipid-rich human plaques expressed TRL-4, whereas the 4 fibrous plaques and 4 normal human arteries showed no or minimal expression. Serial sections and double immunostaining showed TLR-4 colocalizing with macrophages both in murine atherosclerotic lesions and at the shoulder region of human coronary artery plaques. In contrast to TLR-4, none of the plaques expressed TLR-2. Furthermore, basal TLR-4 mRNA expression by human monocyte-derived macrophages was upregulated by ox-LDL in vitro. CONCLUSIONS Our study demonstrates that TLR-4 is preferentially expressed by macrophages in murine and human lipid-rich atherosclerotic lesions, where it may play a role to enhance and sustain the innate immune and inflammatory responses. Moreover, upregulation of TLR-4 in macrophages by oxidized LDL suggests that TLR-4 may provide a potential pathophysiological link between lipids and infection/inflammation and atherosclerosis.
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Affiliation(s)
- X H Xu
- Atherosclerosis Research Center, Burns and Allen Research Institute, Division of Cardiology, Steven Spielberg Pediatric Research Center, Los Angeles, California, USA
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Abstract
Transforming growth factor (TGF-beta) protein families are cytokines that occur as a large number of homologous proteins. Three major subgroups of these proteins with marked specificities for their receptors have been found-TGF-beta, activin/inhibin, and bone morphogenic protein. Although structural information is available for some members of the TGF-beta family of ligands and receptors, very little is known about the way these growth factors interact with the extracellular domains of their cell surface receptors, especially the type II receptor. In addition, the elements that are the determinants of binding and specificity of the ligands are poorly understood. The structure of the extracellular domain of the receptor is a three-finger fold similar to some toxin structures. Amino acid exchanges between multiply aligned homologous sequences of type II receptors point to a residue at the surface, specifically finger 1, as the determinant of ligand specificity and complex formation. The "knuckle" epitope of ligands was predicted to be the surface that interacts with the type II receptor. The residues on strands beta2, beta3, beta7, beta8 and the loop region joining beta2 and beta3 and joining beta7 and beta8 of the ligands were identified as determinants of binding and specificity. These results are supported by studies on the docking of the type II receptor to the ligand dimer-type I receptor complex.
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Affiliation(s)
- P K Shah
- National Centre for Biological Sciences, UAS-GKVK Campus, Bangalore, India
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Schaefer EJ, Audelin MC, McNamara JR, Shah PK, Tayler T, Daly JA, Augustin JL, Seman LJ, Rubenstein JJ. Comparison of fasting and postprandial plasma lipoproteins in subjects with and without coronary heart disease. Am J Cardiol 2001; 88:1129-33. [PMID: 11703957 DOI: 10.1016/s0002-9149(01)02047-1] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Plasma lipoprotein levels, including remnant-like particle (RLP) cholesterol and RLP triglycerides, were assessed in fasting (12 hours) and postprandial (PP) (4 hours after a fat-rich meal) states in 88 patients with coronary heart disease (CHD) and 88 controls. All lipoproteins were assessed by direct methods. We hypothesized that patients with CHD would have greater percent increases in their triglyceride levels, RLP cholesterol, and RLP triglycerides, in response to a fat-rich meal. In the fasting state, triglycerides, RLP cholesterol, RLP triglycerides, and low-density lipoprotein (LDL) cholesterol levels were all significantly higher in cases versus controls by 51%, 35%, 39%, and 40%, respectively. These levels were 57%, 37%, 64%, and 37% higher in the PP state, respectively. Mean high-density lipoprotein (HDL) cholesterol values were 27% lower in cases in both the fasting and PP states. After eating, triglycerides, RLP cholesterol, and RLP triglycerides increased 64%, 71%, and 290% in controls, respectively, whereas in cases these levels increased by 71%, 94%, and 340%, respectively (all p <0.0001). Percent increases in the PP state were not significantly different in cases versus controls. Following the fat-rich meal, LDL and HDL cholesterol decreased by 5% and 4% in controls, and by 7% and 6% in patients, with no significant difference in percent changes between groups. Fasting values correlated very highly with PP values for all parameters (all p <0.0001). Our data indicate that although patients with CHD have higher fasting and PP levels of triglycerides, RLP cholesterol, and RLP triglycerides than controls, the response (percent increase) to a fat-rich meal is comparable in both groups. Thus, a feeding challenge is not essential for assessment of these lipoproteins. Moreover, it is not necessary to obtain a fasting sample to assess direct LDL and HDL cholesterol.
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Affiliation(s)
- E J Schaefer
- Lipid and Heart Disease Prevention Program, New England Medical Center, Boston, Massachusetts, USA.
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Shah PK, Kaul S, Nilsson J, Cercek B. Exploiting the vascular protective effects of high-density lipoprotein and its apolipoproteins: an idea whose time for testing is coming, part II. Circulation 2001; 104:2498-502. [PMID: 11705831 DOI: 10.1161/hc4501.098468] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- P K Shah
- Atherosclerosis Research Center, Division of Cardiology and Burns and Allen research Institute, Department of Medicine, Cedars Sinai Medical Center and UCLA School of Medicine, Los Angeles, California, USA.
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Shah PK, Kaul S, Nilsson J, Cercek B. Exploiting the vascular protective effects of high-density lipoprotein and its apolipoproteins: an idea whose time for testing is coming, part I. Circulation 2001; 104:2376-83. [PMID: 11696481 DOI: 10.1161/hc4401.098467] [Citation(s) in RCA: 193] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- P K Shah
- Atherosclerosis Research Center, Division of Cardiology, Burns and Allen research Institute, Los Angeles, California, USA.
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Shah PK, Sowdhamini R. Structural understanding of the transmembrane domains of inositol triphosphate receptors and ryanodine receptors towards calcium channeling. Protein Eng 2001; 14:867-74. [PMID: 11742105 DOI: 10.1093/protein/14.11.867] [Citation(s) in RCA: 22] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Inositol 1,4,5-triphosphate receptors (Insp(3)Rs) and ryanodine receptors (ryRs) act as cationic channels transporting calcium ions from the endoplasmic reticulum to cytosol by forming tetramers and are proteins localized to the endoplasmic reticulum (ER). Despite the absence of classical calcium-binding motifs, calcium channeling occurs at the transmembrane domain. We have investigated putative calcium binding motifs in these sequences. Prediction methods indicate the presence of six transmembrane helices in the C-terminal domain, one of the three domains conserved between Insp(3)R and ryR receptors. The recently identified crystal structure of the K(+) channel, which also forms tetramers, revealed that two transmembrane helices, an additional pore helix and a selectivity filter are responsible for selective K(+) ion channeling. The last three TM helices of Insp(3)R and ryR are particularly well conserved and we found analogous pore helix and selectivity filter motif in these sequences. We obtained a three-dimensional structural model for the transmembrane tetramer by extrapolating the distant structural similarity to the K(+) channels.
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Affiliation(s)
- P K Shah
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, GKVK Campus, Bangalore 560 065, India
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Shah PK, Galis ZS. Matrix metalloproteinase hypothesis of plaque rupture: players keep piling up but questions remain. Circulation 2001; 104:1878-80. [PMID: 11602486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Affiliation(s)
- S Matetzky
- Division of Cardiology, Cedars-Sinai Medical Center/UCLA School of Medicine, Los Angeles, California 90048-1865, USA
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Rukshin V, Azarbal B, Shah PK, Tsang VT, Shechter M, Finkelstein A, Cercek B, Kaul S. Intravenous magnesium in experimental stent thrombosis in swine. Arterioscler Thromb Vasc Biol 2001; 21:1544-9. [PMID: 11557686 DOI: 10.1161/hq0901.094493] [Citation(s) in RCA: 24] [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: 11/16/2022]
Abstract
We investigated the effects of magnesium on acute platelet-dependent stent thrombosis in an ex vivo porcine arteriovenous shunt model of high-shear blood flow. Control nitinol stents were expanded to 2 mm in diameter in a tubular perfusion chamber interposed in the shunt and exposed to flowing arterial blood at a shear rate of 2100 s(-1) for 20 minutes (n=156 perfusion runs in 10 swine). Animals were treated with intravenous heparin or MgSO(4) alone (2 g bolus over 20 minutes, followed by 2 g/h infusion) and combined heparin plus MgSO(4) in random fashion. Effects on thrombus weight (TW), platelet aggregation, bleeding time, activated clotting time, mean arterial blood pressure, and heart rate were quantified. Data points in the magnesium-treated animals were examined within 20 minutes after bolus (Mg-early) and >40 minutes after bolus (Mg-late). Stent TW (20+/-3 mg, pretreatment) was reduced by 42+/-21%, 47+/-19%, 48+/-16%, 67+/-12%, and 86+/-8% in the groups treated with Mg-early alone, Mg-late alone, heparin alone, heparin+Mg-early, and heparin+Mg-late, respectively (all P<0.001 versus pretreatment, P<0.001 for heparin+Mg-early and Mg-late versus heparin or magnesium alone, and P<0.05 for heparin+Mg-late versus heparin+Mg-early, ANOVA). Magnesium had no significant effect on platelet aggregation, activated clotting time, or bleeding time. There were no significant effects on heart rate or mean arterial blood pressure. The serum magnesium level was inversely correlated with TW (r=-0.70, P=0.002). In conclusion, treatment with intravenous MgSO(4) produced a time-dependent inhibition of acute stent thrombosis under high-shear flow conditions without any hemostatic or significant hemodynamic complications. Thus, magnesium may be an effective agent for preventing stent thrombosis.
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Affiliation(s)
- V Rukshin
- Thrombosis Research Laboratory of the Atherosclerosis Research Center, Burns and Allen Research Institute, Div. of Cardiology, Dept. of Medicine, Cedars-Sinai Medical Center, UCLA School of Medicine, Los Angeles, California, USA
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