1
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Seo SM, Kim SJ, Kwon O, Brilakis ES, Yoon YH, Lee KS, Kim TO, Lee PH, Kang SJ, Kim YH, Lee CW, Park SW, Lee SW. Intravascular ultrasound-guided optimization for chronic total occlusion-percutaneous coronary intervention with multiple drug-eluting stents. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2071] [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: 11/14/2022] Open
Abstract
Abstract
Background
Multiple stenting in the chronic total occlusion (CTO) lesions is frequently required, however associated with poorer clinical outcomes. It is demonstrated that intravascular ultrasound (IVUS)-guided CTO-percutaneous coronary intervention (PCI) is related to a lower risk of adverse clinical events.
Purpose
We aimed to evaluate the clinical impact of stent optimization under IVUS guidance for multiple stenting, comparing with single stenting.
Methods
A total of 916 patients receiving drug-eluting stent (DES) under IVUS guidance were classified into two groups (stent optimization and non-optimization) according to optimization criteria (an absolute expansion criteria; minimal stent area ≥4.9 mm2 and a relative expansion criteria; 80% of mean reference lumen area). Of total population, 314 patients (34.3%) were treated with single stent and 575 patients (62.7%) were treated with multiple stents, respectively. Ischemic-driven target-lesion revascularization (TLR)/reocclusion was evaluated.
Results
Under IVUS guidance, 316 patients (34.5%) met IVUS criteria for stent optimization The achieving rates were 53% in the single stent group and 24% in the multiple stents group, respectively, (p<0.001). During a median of 4.7 years, the multiple stent group showed a significantly higher TLR/reocclusion rate, compared with the single stent group (12.8% vs. 5.2%, adjusted hazard ratio [HR] 2.51, 95% confidence interval [CI] 1.20–5.25, p=0.01). (Figure 1) Meeting both the absolute and relative expansion criteria was associated with a significantly low rate of TLR/reocclusion rate (12.5% vs. 5.2%, adjusted HR 0.34, 95% CI: 0.15–0.79, p=0.01). Under IVUS-guidance, there was no significant difference between multiple stenting and single stenting in case of achieving the optimization criteria (6.5% vs. 4.2%, p=0.11), whereas non-optimization group in the patients with multiple stenting showed a significantly higher rate of TLR/reocclusion, compared with IVUS-optimization group in the patients with single stenting (14.5% vs. 4.2%, p=0.002). (Figure 2)
Conclusions
In CTO-PCI with DES, multiple stenting significantly increased the risk of TLR/reocclusion. IVUS-guided optimization for multiple stenting showed a comparable long-term risk of TLR/reocclusion to single stenting with IVUS optimization. Hence, achieving IVUS expansion criteria may help to reduce the risk of TLR/reocclusion in CTO-PCI with multiple DES overlapping.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S M Seo
- Eunpyeoung St. Mary's Hospital, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
| | - S J Kim
- Eunpyeoung St. Mary's Hospital, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
| | - O Kwon
- Eunpyeoung St. Mary's Hospital, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
| | - E S Brilakis
- Minneapolis Heart Institute Foundation , Minneapolis , United States of America
| | - Y H Yoon
- Sejong Chungnam National University Hospital , Sejong , Korea (Republic of)
| | - K S Lee
- Daejeon St. Mary's Hospital , Daejeon , Korea (Republic of)
| | - T O Kim
- Asan Medical Center , Seoul , Korea (Republic of)
| | - P H Lee
- Asan Medical Center , Seoul , Korea (Republic of)
| | - S J Kang
- Asan Medical Center , Seoul , Korea (Republic of)
| | - Y H Kim
- Asan Medical Center , Seoul , Korea (Republic of)
| | - C W Lee
- Asan Medical Center , Seoul , Korea (Republic of)
| | - S W Park
- Asan Medical Center , Seoul , Korea (Republic of)
| | - S W Lee
- Asan Medical Center , Seoul , Korea (Republic of)
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2
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Lee RLT, Leung C, Chen H, Tong WK, Lee PH. Five-step hand hygiene programme for students with mild intellectual disability: abridged secondary publication. Hong Kong Med J 2022; 28 Suppl 3:41-42. [PMID: 35701231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Affiliation(s)
- R L T Lee
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong
| | - C Leung
- Victoria University, Melbourne, Australia
| | - H Chen
- Centre for Health Protection, Department of Health, Hong Kong
| | | | - P H Lee
- Department of Health Science, University of Leicester, United Kingdom
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3
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Lee PH. Friendship and other anomalous results. Nature 2021:10.1038/d41586-021-02763-5. [PMID: 34625732 DOI: 10.1038/d41586-021-02763-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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4
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Lee PH, Peng JK, Chang HC, Huang PSB, Wu CY, Hsu SH, Weng YC, Tu CY, Lee JH, Chiu GL, Tsai JS. Strategies maintaining hospice and palliative care quality during COVID-19 pandemic in Taiwan. BMJ Support Palliat Care 2021; 12:bmjspcare-2021-003276. [PMID: 34315720 DOI: 10.1136/bmjspcare-2021-003276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/11/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Ping-Hsueh Lee
- Department of Geriatric Medicine, Kuang Tien General Hospital, Taichung, Taiwan
| | - Jen-Kuei Peng
- Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Family Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsien-Cheng Chang
- Department of Family Medicine, Lo-Hsu Medical Foundation Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Paul Sin-Bao Huang
- Department of Family Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chien-Yi Wu
- Department of Family Medicine, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung, Taiwan
| | - Su-Hsuan Hsu
- Department of Family Medicine, National Taiwan University Hospital Jinshan Branch, New Taipei, Taiwan
| | | | - Chun-Yi Tu
- Department of Family Medicine, Taipei Veterans General Hospital Taoyuan Branch, Taoyuan, Taiwan
| | - Jun-Hua Lee
- Department of Social Work, Fu Jen Catholic University, Taipei, Taiwan
| | - Ge-Lin Chiu
- Department of Nursing, National Cheng-Kung University Hospital, College of Medicine National Cheng Kung University, Tainan, Taiwan
| | - Jaw-Shiun Tsai
- Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Family Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
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5
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Liang WL, Li HG, Zhong G, Wang BS, Ma JD, Chen JL, Mao HW, Yu-Lung YL, Lee PH. [Targeted therapy of pyogenic sterile arthritis, pyoderma gangrenosum, and acne syndrome (PAPA): a case report and literature review]. Zhonghua Er Ke Za Zhi 2020; 58:977-981. [PMID: 33256319 DOI: 10.3760/cma.j.cn112140-20200430-00456] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Objective: To analyze the clinical course and targeted therapy of pyogenic sterile arthritis, pyoderma gangrenosum, and acne (PAPA) syndrome. Methods: The clinical history of a 6-year-old boy with PAPA syndrome, who was admitted to Hong Kong University Shenzhen Hospital in September 2017, was reviewed. His genetic diagnosis was confirmed by whole exome sequencing. The response to targeted therapy was evaluated by comparing the inflammatory markers (erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) and serum cytokines (interleukin (IL)-1, IL-6 and tumor necrosis factor-α (TNF-α)) before and after biological agents treatment. For literature review, "PAPA syndrome" and"PSTPIP1 gene"were used as keywords to retrieve papers published from January 1997 to December 2019 from Pubmed, Wanfang and CNKI database. Results: The patient was a 6-year-old boy, admitted to the hospital due to recurrent joint swelling and pain for more than 4 years. Before treatment, the CRP (256 mg/L), ESR (105 mm/1 h) and cytokines including serum TNF-α (7.43 ng/L), IL-1 (<5 ng/L), IL-6 (301 ng/L) were significantly elevated. Culture of the joint effusion was negative, but the IL-6 level was above 1 000 ng/L. MRI showed osteomyelitis at the lower end of the right femur. Gene detection found a heterozygous variation of PSTPIP1 gene (c.748G>A, p.E250K). Arthralgia once alleviated after the initiation of tocilizumab and infliximab, but recurred after 1 year of treatment. Thereafter, the anti-IL-1 receptor antagonist (Anakinra) was commenced, followed by a significant improvement of the arthralgia, and a complete remission during the follow-up. Besides, the level of CRP, ESR, serum TNF-α, IL-1 and IL-6 were all decreased to normal on the last followed up in December 2019. Literature review found 29 articles and 87 patients in total. The initial symptoms included those of arthritis (n=58), pyoderma gangrenosum (n=33), and acne (n=24). Among all the cases, 13 genotypes were confirmed, and 47 variations involved amino acid p.E250. Steroid and/or biological agents were used in most patients. Conclusions: PAPA syndrome should be suspected in children with recurrent pyogenic sterile arthritis, and an early diagnosis could be achieved by genetic test. Targeted treatment with biological agent may control the symptoms effectively. Biological agents can control symptoms of this disorder effectively.
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Affiliation(s)
- W L Liang
- Department of Paediatrics, Hong Kong University Shenzhen Hospital, Shenzhen 518000, China
| | - H G Li
- Department of Paediatrics, Hong Kong University Shenzhen Hospital, Shenzhen 518000, China
| | - G Zhong
- Department of Paediatrics, Hong Kong University Shenzhen Hospital, Shenzhen 518000, China
| | - B S Wang
- Department of Paediatrics, Hong Kong University Shenzhen Hospital, Shenzhen 518000, China
| | - J D Ma
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
| | - J L Chen
- Department of Paediatrics, Hong Kong University Shenzhen Hospital, Shenzhen 518000, China
| | - H W Mao
- Department of Paediatrics, Hong Kong University Shenzhen Hospital, Shenzhen 518000, China
| | - Y L Yu-Lung
- Department of Paediatrics, Hong Kong University Shenzhen Hospital, Shenzhen 518000, China
| | - P H Lee
- Department of Paediatrics, Hong Kong University Shenzhen Hospital, Shenzhen 518000, China
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6
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Jung JH, Chung SJ, Yoo HS, Lee YH, Baik K, Ye BS, Sohn YH, Lee PH. Sex-specific association of urate and levodopa-induced dyskinesia in Parkinson's disease. Eur J Neurol 2020; 27:1948-1956. [PMID: 32441832 DOI: 10.1111/ene.14337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/14/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE As a major antioxidant, uric acid (UA) is known to be associated with the clinical progression of Parkinson's disease (PD). This study investigated whether baseline UA levels are associated with the risk for levodopa-induced dyskinesia (LID) in PD in a sex-dependent manner. METHODS In all, 152 patients with de novo PD (78 males and 74 females) who were followed up for >2 years were enrolled. The effect of baseline serum UA levels on LID-free survival was assessed by Cox regression, separately for sex, whilst being adjusted for potential confounding factors. The optimal UA level cut-off value to determine the high-risk group for LID was set using Contal and O'Quigley's method. RESULTS Levodopa-induced dyskinesia developed in 23 (29.5%) male patients and 30 (40.5%) female patients. Cox regression showed a significant interaction between UA level and sex. Higher UA levels were associated with a higher risk for LID in male PD patients (hazard ratio 1.380; 95% confidence interval 1.038-1.835; P = 0.027), although this relationship was not observed in female PD patients. The optimal UA level cut-off for LID in male PD was 7.2 mg/dl, and the high UA group had a 5.7-fold higher risk of developing LID than the low UA group. CONCLUSIONS Contrary to a presumptive beneficial role of UA, the present study demonstrated that higher UA levels are associated with increased risk of LID occurrence in male patients with PD, suggesting a sex-dependent role of UA in LID.
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Affiliation(s)
- J H Jung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - S J Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
| | - H S Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Y H Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - K Baik
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - B S Ye
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Y H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - P H Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
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7
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Lee PH. Five courses on Ganymede. Nature 2020:10.1038/d41586-020-01349-x. [PMID: 32376937 DOI: 10.1038/d41586-020-01349-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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8
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Yoo HS, Chung SJ, Lee YH, Ye BS, Sohn YH, Lee PH. Cognitive anosognosia is associated with frontal dysfunction and lower depression in Parkinson's disease. Eur J Neurol 2020; 27:951-958. [PMID: 32090410 DOI: 10.1111/ene.14188] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 02/15/2020] [Accepted: 02/20/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Anosognosia refers to a deficit of self-awareness or impaired insight for cognitive and behavioral problems. Cognitive anosognosia was explored in de novo patients with Parkinson's disease (PD) and its relationship to cognitive function and neuropsychiatric symptoms was investigated. METHODS The cross-sectional study enrolled 340 drug-naïve patients with PD. According to the presence of mild cognitive impairment (MCI) and subjective cognitive complaint, patients were classified as patients with cognitive anosognosia (PD-CA, n = 74), with normal cognitive recognition (PD-NR, n = 184) or with cognitive underestimation (PD-CU, n = 82). After controlling for covariates, cognitive performance and neuropsychiatric symptoms were compared between the PD groups. RESULTS Cognitive anosognosia was found in 21.8% of patients with de novo PD. The PD-CA group showed poorer performance in all cognitive domains except for attention. Amongst PD patients with MCI, those with cognitive anosognosia showed lower composite z-scores in the Stroop color reading test than those without. The Beck Depression Inventory score in the PD-NR group was lower than that in the PD-CU group and higher than that in the PD-CA group. The Cognitive Complaints Interview score mediated the association between cognitive anosognosia and Beck Depression Inventory score. CONCLUSIONS Cognitive anosognosia in PD was associated with greater frontal dysfunction and lower depression. Since cognitive anosognosia has a harmful impact on PD patients and their caregivers due to overestimation of their abilities in everyday life, early identification of cognitive anosognosia in PD is important in management and prognosis.
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Affiliation(s)
- H S Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - S J Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Y H Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - B S Ye
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Y H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - P H Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
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9
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Ho C, Lee PH, So TC, Chiang MCS, Wong MH, Fong YH, Tsang CF, Cheng YW, Luk NH, Chui SF, Chan KC, Wong CY, Fu CL, Lee KY, Chan KT. 224 Malignancy associated pericardial effusion- do we need to drain them all? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehz872.009] [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
On Behalf
Cardiac Team, Department of Medicine, Queen Elizabeth Hospital
Background
Management of significant pericardial effusion in cancer patients is controversial. These patients have poor prognosis, and avoiding unnecessary intervention is important. Close monitoring of symptoms and echocardiogram is often a reasonable option, but inherits risk of cardiac tamponade. Whether pericardial drainage by means of percutaneous pericardiocentesis or surgical pericardiotomy could prevent future deterioration or affect survival is unknown.
Purpose
To evaluate the benefit of elective pericardial drainage in malignancy associated pericardial effusion without echocardiographic or clinical evidence of tamponade effect.
Methods
From 1st Jul 2014 to 31st Dec 2017, all patients with new onset malignancy-associated pericardial effusion with size more than 1cm were retrospectively analyzed. Patients with clinical or echocardiographic evidence of cardiac tamponade were excluded. We compared pericardial drainage versus monitoring for short-term (30-day), mid-term (90-day) and long term (1 year) survival without need for drainage.
Results
101 patients were retrospectively analyzed. 40 (39.6%) patients underwent drainage. Overall median survival free from drainage was 4 months. There were no significant difference in short-term (30-day), mid-term (90-day) and long term (1-year) survival free from drainage or mortality between treatment and monitoring group. Size of pericardial effusion did not predict mortality or future need of drainage. Chemotherapy was associated with improved 30-day mortality (RR 0.53 CI 0.32-0.87 p = 0.025) but not survival free from drainage or longer term mortality.
Conclusion
Close monitoring could be a feasible strategy in cancer patients with significant pericardial effusion without tamponade effect.
Baseline characteristics Factor Drainage (n = 40) monitoring (n = 61) p-value method of drainage pericardiocentesis alone 17 NA pericardiotomy alone 13 both 10 Male 19 (47.5%) 27 (44.3%) 0.749 mean size (cm) 1.93 2.77 <0.001 mean age 60.9 63.1 0.357 on chemotherapy 27 (67.5%) 38 (62.3%) 0.593
Abstract 224 Figure. Survival free from drainage
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Affiliation(s)
- C Ho
- Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | - P H Lee
- Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | - T C So
- Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | | | - M H Wong
- Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | - Y H Fong
- Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | - C F Tsang
- Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | - Y W Cheng
- Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | - N H Luk
- Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | - S F Chui
- Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | - K C Chan
- Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | - C Y Wong
- Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | - C L Fu
- Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | - K Y Lee
- Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | - K T Chan
- Queen Elizabeth Hospital, Hong Kong, Hong Kong
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10
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Lee PH. 502 Secondary cardiac lymphoma complicated with tamponade. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.266] [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
Introduction
A 72-year-old lady presented with one-week history of palpitation and shortness of breath. She had pyrexia of unknown origin for 4 weeks associated with weight loss. Initial clinical examination revealed sinus tachycardia of 110 beats/min and saturations of 96% on 2L/min oxygen. Neck exam revealed a 2 x 3 cm firm mass at left supraclavicular fossa. Electrocardiogram showed sinus tachycardia at 106 beats/min. There was fixed T wave inversions over anterolateral chest leads and inferior limb leads. Chest radiograph showed enlarged cardiac silhouette and evidence of pulmonary congestion
Procedure
Transthoracic echocardiogram revealed a moderate pericardial effusion with an 8 x 4 cm pericardial mass compressing at the right atrioventricular groove (Figure B & C). Respiratory variation of Doppler mitral and tricuspid inflow velocities suggested cardiac tamponade (Figure A). Inferior vena cava was engorged with impaired inspiratory collapse. Left ventricular size and function were otherwise normal. Urgent pericardiocentesis was performed which yielded 1 litre of light blood stained fluid. Her had subjective improvement of symptoms. There was also resolution of sinus tachycardia and pulmonary congestion. PET/CT scan showed multiple enlarged hypermetabolic lymph nodes in multiple regions above and below the diaphragm, worrisome for malignant lymphoma. Cytological assessment of pericardial fluid showed scattered large lymphoid cells which are immunoreactive to B cell marker CD 20 (Figure E & F). Bone marrow exam showed normal marrow.
First cycle of R-CEOP and intrathecal methotrexate was given. Follow-up echocardiogram in one week after chemotherapy showed complete resolution of pericardial effusion. Prior pericardial mass also showed marked reduction in size (Figure D). No tamponade physiology was present. She tolerated the chemotherapy well with complete resolution of palpitation and shortness of breath. She was discharged from hospital with outpatient follow up and continuation of chemotherapy course.
Discussion
Cardiac tumors are rare and secondary tumors remain the most common etiology. Most of these metastatic tumors arise from solid organs such as lung, breast, kidney, melanoma as well as lymphoma. Echocardiography is a valuable tool both in diagnosis and assessment of hemodynamic significance of cardiac masses. It also aids in diagnosis of associated condition such as pericardial effusion.
In this case, the cardiac tamponade is both contributed by mechanical compression of cardiac mass coupled with moderate pericardial effusion. Successful pericardiocentesis achieved temporary normalization of tamponade physiology and aided in early histological diagnosis of malignant lymphoma with pericardial metastasis. Timely initiation of intensive systemic chemotherapy was the key to rapid tumor size reduction, complete resolution of tamponade physiology and control of recurrent pericardial effusion.
Abstract 502 Figure. Echo & histology
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Affiliation(s)
- P H Lee
- Queen Elizabeth Hospital, Hong Kong, Hong Kong
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11
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Yoo HS, Lee EC, Chung SJ, Lee YH, Lee SG, Yun M, Lee PH, Sohn YH, Seong JK, Ye BS. Effects of Alzheimer's disease and Lewy body disease on subcortical atrophy. Eur J Neurol 2019; 27:318-326. [PMID: 31487756 DOI: 10.1111/ene.14080] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 03/28/2019] [Accepted: 08/21/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Subcortical structures are affected by neurodegeneration in Alzheimer's disease (AD) and Lewy body disease (LBD). Although the co-occurrence of AD and LBD pathologies and their possible interaction have been reported, the effect of AD and LBD on subcortical structures remains unknown. The effects of AD and LBD on subcortical atrophy and their relationship with cognitive dysfunction were investigated. METHODS The cross-sectional study recruited 42 patients with pure AD related cognitive impairment (ADCI), 30 patients with pure LBD related cognitive impairment (LBCI), 58 patients with mixed ADCI and LBCI, and 29 normal subjects. A general linear model was used to compare subcortical volume and shape amongst the groups, to investigate the independent and interaction effects of ADCI and LBCI on subcortical shape and volume, and to analyze the relationship between subcortical volume and cognitive dysfunction in each group. RESULTS Alzheimer's disease related cognitive impairment and LBCI were independently associated with subcortical atrophies in the hippocampus and amygdala and in the hippocampus and putamen respectively, but their interaction effect was not significant. Compared to the control group, the pure LBCI group exhibited additional local atrophies in the amygdala, caudate and thalamus. Subcortical atrophies correlated differently with cognitive dysfunction according to the underlying causes of cognitive dysfunction. CONCLUSIONS The patterns of subcortical atrophies and their correlation with cognitive dysfunction differ according to the underlying AD, LBD or concomitant AD and LBD.
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Affiliation(s)
- H S Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - E C Lee
- Department of Bio-convergence Engineering, Korea University, Seoul, South Korea
| | - S J Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Y H Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - S G Lee
- Department of Radiology, Yonsei University College of Medicine, Seoul, South Korea
| | - M Yun
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - P H Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Y H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - J-K Seong
- Department of Bio-convergence Engineering, Korea University, Seoul, South Korea.,School of Biomedical Engineering, Korea University, Seoul, South Korea
| | - B S Ye
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
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12
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Lee PH, Park HB, Lee JS, Lee SW, Lee CW. P4733Risk of myocardial infarction with coronary artery bypass grafting versus percutaneous coronary intervention: a systematic review and meta-analysis of fifteen randomised trials. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1109] [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
It remains controversial whether coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) is more effective in the prevention of myocardial infarction (MI). MI has been evaluated only as a secondary endpoint without a focused systematic review in multiple meta-analyses.
Purpose
To compare the risk of MI at the latest follow-up available between CABG versus PCI with stents in patients with multivessel or left main coronary artery disease in a pairwise meta-analysis of randomised controlled trials (RCT).
Methods
We searched EMBASE, Cochrane, and Pubmed databases for articles comparing CABG versus PCI for the treatment of multivessel or left main disease. We utilised random-effects model to calculate pooled risk ratio (RR) and 95% confidence interval (CI). Fifteen trials with a total of 13,592 patients treated with either CABG (n=6,596) or PCI (n=6,996) were eligible and included. A multivariable random-effects meta-regression model, including variables such as age, sex, diabetes mellitus, publication year, follow-up duration, type of stent used, and type of coronary artery disease, was used to explore the source of potential heterogeneity of the primary result.
Results
After a weighted follow-up of 4.3 years, patients treated with CABG had a significantly lower risk of MI than patients treated with PCI (RR 0.75, 95% CI 0.58–0.96, P=0.024, I2=66%). The lower risk of MI with CABG as compared to PCI was more evident during a longer duration of follow-up (≥3 years, RR 0.69, 95% CI 0.52–0.91, P=0.008; ≥5 years, RR 0.64, 95% CI 0.48–0.86, P=0.003) and in diabetic population (RR 0.55, 95% CI 0.44–0.70, P<0.001). There was a statistically meaningful trend toward fewer MIs with CABG with a similar magnitude of risk reduction across patients with left main disease (RR 0.74, 95% CI 0.47–1.15) and multivessel disease (RR 0.72, 95% CI 0.53–0.99). Moderate inter-study heterogeneity could not be explained by the clinical and trial-based variables tested in meta-regression, and is likely because of differences in definitions of MI, risk profile of enrolled patients, and procedural specifics.
Forest plots
Conclusions
In patients undergoing revascularization for multivessel or left main disease, the risk of MI was lower with CABG compared to PCI. The quality assurance for MI definition and treatment-specific procedures should be emphasized for future RCTs.
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Affiliation(s)
- P H Lee
- Asan Medical Center, Seoul, Korea (Republic of)
| | - H B Park
- Asan Medical Center, Seoul, Korea (Republic of)
| | - J S Lee
- Asan Medical Center, Seoul, Korea (Republic of)
| | - S W Lee
- Asan Medical Center, Seoul, Korea (Republic of)
| | - C W Lee
- Asan Medical Center, Seoul, Korea (Republic of)
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Chung SJ, Park YH, Yun HJ, Kwon H, Yoo HS, Sohn YH, Lee JM, Lee PH. Clinical relevance of amnestic versus non-amnestic mild cognitive impairment subtyping in Parkinson's disease. Eur J Neurol 2019; 26:766-773. [PMID: 30565368 DOI: 10.1111/ene.13886] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 12/06/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE To clarify whether subtyping of amnestic and non-amnestic mild cognitive impairment (MCI) is clinically relevant in Parkinson's disease (PD) by analyzing patterns of neuroimaging and longitudinal cognitive changes. METHODS We performed comparative analyses of cortical thickness, hippocampal volume, white matter integrity and resting-state functional connectivity between the patients with de-novo PD with amnestic MCI (PD-aMCI) (n = 50) and non-amnestic MCI (PD-naMCI) (n = 50) subtypes. Additionally, we assessed the longitudinal rate of cognitive decline in each cognitive domain over time and the rate of dementia conversion in patients with de-novo PD-aMCI (n = 125) and PD-naMCI (n = 61). RESULTS The demographic data showed that scores in memory domains were lower in the PD-aMCI group compared with the PD-naMCI group. There were no significant differences in cortical thickness, hippocampal volume and white matter integrity between the two groups, although the PD-aMCI group exhibited more cortical thinning and hippocampal atrophy relative to the control group. The PD-aMCI group exhibited increased functional connectivity in the left posterior parietal region with the salience network relative to the PD-naMCI group. The longitudinal cognitive assessment demonstrated that patients with PD-aMCI exhibited a more rapid cognitive decline in frontal/executive function than those with PD-naMCI (P = 0.022). In addition, the PD-aMCI group had a higher risk of dementia conversion than the PD-naMCI group. CONCLUSIONS This study suggests that the designation of PD-MCI subtypes based on memory function would highlight the heterogeneity of functional correlates as well as the longitudinal cognitive prognosis.
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Affiliation(s)
- S J Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul
| | - Y-H Park
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea
| | - H J Yun
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea.,Fetal Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - H Kwon
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea.,Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - H S Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul
| | - Y H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul
| | - J-M Lee
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea
| | - P H Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
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14
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Lee PH, Tse AC, Do C, Szeto GP, So BC, Lee RL. 0850 Association Between Smart Device Usage And Accelerometer-measured Sleep Efficiency Among Children And Adolescents In Hong Kong: A Cross-sectional Survey. Sleep 2018. [DOI: 10.1093/sleep/zsy061.849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- P H Lee
- Hong Kong Polytechnic University, Hong Kong, HONG KONG
| | - A C Tse
- Education University of Hong Kong, Hong Kong, HONG KONG
| | - C Do
- Hong Kong Polytechnic University, Hong Kong, HONG KONG
| | - G P Szeto
- Hong Kong Polytechnic University, Hong Kong, HONG KONG
| | - B C So
- Hong Kong Polytechnic University, Hong Kong, HONG KONG
| | - R L Lee
- Hong Kong Polytechnic University, Hong Kong, HONG KONG
- Hong Kong Polytechnic University, Hong Kong, HONG KONG
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15
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Charney AW, Ruderfer DM, Stahl EA, Moran JL, Chambert K, Belliveau RA, Forty L, Gordon-Smith K, Di Florio A, Lee PH, Bromet EJ, Buckley PF, Escamilla MA, Fanous AH, Fochtmann LJ, Lehrer DS, Malaspina D, Marder SR, Morley CP, Nicolini H, Perkins DO, Rakofsky JJ, Rapaport MH, Medeiros H, Sobell JL, Green EK, Backlund L, Bergen SE, Juréus A, Schalling M, Lichtenstein P, Roussos P, Knowles JA, Jones I, Jones LA, Hultman CM, Perlis RH, Purcell SM, McCarroll SA, Pato CN, Pato MT, Craddock N, Landén M, Smoller JW, Sklar P. Evidence for genetic heterogeneity between clinical subtypes of bipolar disorder. Transl Psychiatry 2017; 7:e993. [PMID: 28072414 PMCID: PMC5545718 DOI: 10.1038/tp.2016.242] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 09/28/2016] [Accepted: 09/28/2016] [Indexed: 01/12/2023] Open
Abstract
We performed a genome-wide association study of 6447 bipolar disorder (BD) cases and 12 639 controls from the International Cohort Collection for Bipolar Disorder (ICCBD). Meta-analysis was performed with prior results from the Psychiatric Genomics Consortium Bipolar Disorder Working Group for a combined sample of 13 902 cases and 19 279 controls. We identified eight genome-wide significant, associated regions, including a novel associated region on chromosome 10 (rs10884920; P=3.28 × 10-8) that includes the brain-enriched cytoskeleton protein adducin 3 (ADD3), a non-coding RNA, and a neuropeptide-specific aminopeptidase P (XPNPEP1). Our large sample size allowed us to test the heritability and genetic correlation of BD subtypes and investigate their genetic overlap with schizophrenia and major depressive disorder. We found a significant difference in heritability of the two most common forms of BD (BD I SNP-h2=0.35; BD II SNP-h2=0.25; P=0.02). The genetic correlation between BD I and BD II was 0.78, whereas the genetic correlation was 0.97 when BD cohorts containing both types were compared. In addition, we demonstrated a significantly greater load of polygenic risk alleles for schizophrenia and BD in patients with BD I compared with patients with BD II, and a greater load of schizophrenia risk alleles in patients with the bipolar type of schizoaffective disorder compared with patients with either BD I or BD II. These results point to a partial difference in the genetic architecture of BD subtypes as currently defined.
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Affiliation(s)
- A W Charney
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, USA
| | - D M Ruderfer
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, USA
- Institute for Genomics and Multiscale Biology, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, USA
| | - E A Stahl
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, USA
- Institute for Genomics and Multiscale Biology, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, USA
| | - J L Moran
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - K Chambert
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - R A Belliveau
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - L Forty
- MRC Centre for Psychiatric Genetics and Genomics, Cardiff Unviersity, Cardiff, UK
| | - K Gordon-Smith
- Department of Psychological Medicine, University of Worcester, Worcester, UK
| | - A Di Florio
- MRC Centre for Psychiatric Genetics and Genomics, Cardiff Unviersity, Cardiff, UK
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - P H Lee
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
| | - E J Bromet
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - P F Buckley
- Department of Psychiatry, Georgia Regents University Medical Center, Augusta, GA, USA
| | - M A Escamilla
- Center of Excellence in Neuroscience, Department of Psychiatry, Texas Tech University Health Sciences Center at El Paso, El Paso, TX, USA
| | - A H Fanous
- Department of Psychiatry, Veterans Administration Medical Center, Washington, DC, USA
- Department of Psychiatry, Georgetown University, Washington, DC, USA
| | - L J Fochtmann
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - D S Lehrer
- Department of Psychiatry, Wright State University, Dayton, OH, USA
| | - D Malaspina
- Department of Psychiatry, New York University, New York, NY, USA
| | - S R Marder
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, USA
| | - C P Morley
- Department of Psychiatry and Behavioral Science, State University of New York, Upstate Medical University, Syracuse, NY, USA
- Departments of Family Medicine, State University of New York, Upstate Medical University, Syracuse, NY, USA
- Department of Public Health and Preventive Medicine, State University of New York, Upstate Medical University, Syracuse, NY, USA
| | - H Nicolini
- Center for Genomic Sciences, Universidad Autónoma de la Ciudad de México, Mexico City, Mexico
- Department of Psychiatry, Carracci Medical Group, Mexico City, Mexico
| | - D O Perkins
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J J Rakofsky
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - M H Rapaport
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - H Medeiros
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - J L Sobell
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - E K Green
- School of Biomedical and Health Sciences, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK
| | - L Backlund
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - S E Bergen
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - A Juréus
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - M Schalling
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - P Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - P Roussos
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, USA
- Institute for Genomics and Multiscale Biology, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, USA
- Friedman Brain Institute, Department of Neuroscience, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, USA
| | - J A Knowles
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
- Zilkha Neurogenetic Institute, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - I Jones
- MRC Centre for Psychiatric Genetics and Genomics, Cardiff Unviersity, Cardiff, UK
| | - L A Jones
- Department of Psychological Medicine, University of Worcester, Worcester, UK
| | - C M Hultman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - R H Perlis
- Center for Experimental Therapeutics, Massachusetts General Hospital, Boston, MA, USA
| | - S M Purcell
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, USA
- Institute for Genomics and Multiscale Biology, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, USA
- Friedman Brain Institute, Department of Neuroscience, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, USA
| | - S A McCarroll
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Department of Genetics, Harvard Medical School, Boston, MA, USA
| | - C N Pato
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
- Zilkha Neurogenetic Institute, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - M T Pato
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
- Zilkha Neurogenetic Institute, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - N Craddock
- MRC Centre for Psychiatric Genetics and Genomics, Cardiff Unviersity, Cardiff, UK
| | - M Landén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Institute of Neuroscience and Physiology, Sahlgenska Academy at the Gothenburg University, Gothenburg, Sweden
| | - J W Smoller
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
| | - P Sklar
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, USA
- Institute for Genomics and Multiscale Biology, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, USA
- Friedman Brain Institute, Department of Neuroscience, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, USA
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Chan CW, Lee PH. Association between dietary fibre intake with cancer and all-cause mortality among 15 740 adults: the National Health and Nutrition Examination Survey III. J Hum Nutr Diet 2016; 29:633-42. [PMID: 27296222 DOI: 10.1111/jhn.12389] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Few prospective studies have examined the longitudinal associations of total dietary fibre intake and water insoluble and soluble fibres with cancer and all-cause mortality. The present study aimed to examine these associations. METHODS We studied the effects of total dietary fibre intake and water insoluble and soluble fibres on cancer and all-cause mortality, using data from 15 740 adult participants [mean (SD) age: 44.53 (19.22) years, 46.60% male] in the National Health and Nutrition Examination Survey (NHANES) III, 1988-1994, who had completed a 24-h dietary recall. Death certificate data were obtained up to 2006. Participants had been followed for 13.74 years on average. Cox regression was used to estimate the hazard ratios (HRs) of total dietary, insoluble and soluble fibres on cancer and all-cause mortality, with the first quartile as the reference group, adjusted for demographics, lifestyle and dietary factors. RESULTS Relative to those in the first quartile of total fibre intake, only the third quartile was associated with all-cause mortality, with an adjusted HR of 0.87 [95% confidence interval (CI) = 0.79, 0.97, P = 0.021], and cancer mortality, with an adjusted HR of 0.77 (95% CI = 0.61, 0.99, P = 0.05). The third quartile of insoluble fibre intake was associated with cancer mortality, with an adjusted HR of 0.76 (95% CI = 0.60, 0.96, P = 0.023), and colorectal-anal cancer mortality (in grouped data as provided for public use), with an adjusted HR of 0.42 (95% CI = 0.19, 0.91, P = 0.03). CONCLUSIONS Dietary fibre showed protective benefits in terms of mortality risk. Investigating the mechanisms and components of dietary fibres underlying the different protective benefits remains an important consideration for research on fibre-mortality risk.
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Affiliation(s)
- C W Chan
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.
| | - P H Lee
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
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17
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Ye BS, Lee WW, Ham JH, Lee JJ, Lee PH, Sohn YH. Does serum uric acid act as a modulator of cerebrospinal fluid Alzheimer's disease biomarker related cognitive decline? Eur J Neurol 2016; 23:948-57. [PMID: 26917248 DOI: 10.1111/ene.12969] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 12/22/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE The association of serum uric acid, cerebrospinal fluid (CSF) biomarkers of Alzheimer's disease (AD) and longitudinal cognitive decline was evaluated using the AD Neuroimaging Initiative database. METHODS In 271 healthy subjects, 596 mild cognitive impairment patients and 197 AD patients, serum uric acid and CSF AD biomarkers were measured at baseline, and Mini-Mental State Examination and AD Assessment Scale - Cognitive Subscale (ADAS-cog) were assessed serially (mean duration, 2.9 years). The effect of uric acid on longitudinal cognitive decline was evaluated using linear mixed effect models for Mini-Mental State Examination and ADAS-cog scores in female and male subjects separately, with possible confounders controlled (model 1). To determine the effects of uric acid independent of CSF biomarker (Aβ1-42 or tau) and to test whether the detrimental effects of CSF biomarker differ according to uric acid, CSF biomarker and its interaction with uric acid were further included in model 1 (model 2). RESULTS Higher levels of uric acid were associated with slower cognitive decline, particularly in the mild cognitive impairment and dementia subgroups, and more prominently in female subjects. Model 2 with CSF Aβ1-42 showed that higher levels of uric acid were associated with a slower cognitive decline and alleviated the detrimental effect of Aβ1-42 on cognitive decline. Model 2 with CSF tau showed that higher levels of uric acid alleviated the detrimental effect of tau on cognitive decline in female subjects but not in male subjects. CONCLUSION Higher levels of uric acid had protective effects on longitudinal cognitive decline independent of and interactively with CSF AD biomarkers.
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Affiliation(s)
- B S Ye
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - W W Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - J H Ham
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - J J Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - P H Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Y H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
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18
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Lee PH, Kok VC, Chou PL, Ku MC, Chen YC, Horng JT. Risk and clinical predictors of osteoporotic fracture in East Asian patients with chronic obstructive pulmonary disease: a population-based cohort study. PeerJ 2016; 4:e2634. [PMID: 27812429 PMCID: PMC5088616 DOI: 10.7717/peerj.2634] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 09/30/2016] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Osteoporosis is becoming an impending epidemic in the Asia-Pacific region. The association between risk of osteoporotic fracture (OTPF) and chronic obstructive pulmonary disease (COPD) in East Asian patients is yet to be fully examined. We conducted a nationwide population-based retrospective cohort study of 98,700 patients aged ≥50 years with or without COPD using a national administrative claims dataset. MATERIALS AND METHODS The patients were divided into COPD and comparison groups comprising 19,740 and 78,960 patients, respectively. The groups were 1 to 4 matched for age, gender, index date, diabetes mellitus, pre-existing osteoporosis and chronic kidney disease. Information such as the geographic area where southern part represented more sunshine exposure, smoking-related diagnoses, alcohol use disorder, whether there was regular use of inhaled corticosteroids and oral corticosteroids, vitamin D prescriptions, Charlson-Deyo comorbidity index score, and other relevant medical comorbidities were extracted for analysis. They were followed up until OTPF or the end of the year 2013. The outcome measure was an osteoporotic vertebral fracture and other long-bone fractures. A multivariate Cox model was constructed to derive adjusted hazard ratios (aHR) for OTPF with corresponding 95% confidence intervals (CI) after controlling for age, sex, insurance premium category, vitamin D prescription, osteoporosis, and coronary heart disease (CHD). Kaplan-Meier curves of the probability of OTPF-free survival for each cohort were compared using the log-rank test. Patients with OTPF during the first follow-up year were excluded from the overall risk calculation. Contributing factors to the increased risk of OTPF in COPD patients were examined in a sensitivity analysis. RESULTS After a total follow-up of 68,743 patient-years for the COPD group and 278,051 patient-years for the matched comparison group, the HR for OTPF was 1.24 (95% CI [1.02-1.51]; P = 0.0322) in COPD patients. The aHR was increased by 30% for vertebral OTPF (aHR = 1.297, 95% CI [1.020-1.649]; P = 0.0339). Differential lag time sensitivity analysis revealed a progressively elevated risk up to 8-fold increase in women (aHR = 8.0 (95% CI [1.81-35.4]; P < 0.01)) during the fifth follow-up year. COPD patients with pre-existing osteoporosis or given vitamin D prescription harbor a sustained increased risk up to the 5th (aHR, 4.1; 95% CI [1.61-10.35]) and third (aHR, 2.97; 95% CI [1.48-5.97]) follow-up year, respectively. CONCLUSIONS Our nationwide population-based cohort study demonstrates that East Asian COPD patients aged 50 and beyond do harbor a modestly increased risk for osteoporotic vertebral fractures particularly for those who are female, have pre-existing osteoporosis or require vitamin D prescription.
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Affiliation(s)
- Ping-Hsueh Lee
- Department of Geriatric Medicine, Kuang Tien General Hospital, Taichung, Taiwan
- Jen-Te Junior College of Medicine, Nursing and Management, Miaoli County, Taiwan
| | - Victor C. Kok
- KTGH Cancer Center, Kuang Tien General Hospital, Taichung, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University Taiwan, Taichung, Taiwan
- Disease Informatics Research Group, Asia University Taiwan, Taiwan
| | - Po-Liang Chou
- Department of Computer Science and Information Engineering, National Central University, Jhongli, Taoyuan, Taiwan
| | - Ming-Chang Ku
- Jen-Te Junior College of Medicine, Nursing and Management, Miaoli County, Taiwan
- Department of Diagnostic Radiology, Kuang Tien General Hospital, Taichung, Taiwan
| | - Yu-Ching Chen
- Department of Bioinformatics and Medical Engineering, Asia University Taiwan, Taichung, Taiwan
- Disease Informatics Research Group, Asia University Taiwan, Taiwan
| | - Jorng-Tzong Horng
- Department of Bioinformatics and Medical Engineering, Asia University Taiwan, Taichung, Taiwan
- Disease Informatics Research Group, Asia University Taiwan, Taiwan
- Department of Computer Science and Information Engineering, National Central University, Jhongli, Taoyuan, Taiwan
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Kok VC, Lee PH. Management of Hypoglycemia in Nondiabetic Palliative Care Patients: A Prognosis-Based Approach. Palliat Care 2016; 10:1-5. [PMID: 27920549 PMCID: PMC5123827 DOI: 10.4137/pcrt.s38956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 10/26/2016] [Accepted: 11/01/2016] [Indexed: 02/07/2023] Open
Abstract
Hypoglycemia due to underlying terminal illness in nondiabetic end-of-life patients receiving palliative care has not been fully studied. For example, we do not have adequate information on the frequency of spontaneous hypoglycemia in patients as occurs during the different stages of palliative care. Depending on the case-mix nature of the palliative care ward, at least 2% of palliative care patients may develop hypoglycemia near the end of life when the remaining life expectancy counts down in days. As many as 25%-60% of these patients will neither have autonomic response nor have neuroglycopenic symptoms during a hypoglycemic episode. Although it is not difficult to diagnose and confirm a true hypoglycemia when it is suspected clinically, an episode of hypoglycemic attack may go unnoticed in some patients in a hospice setting. Current trends in palliative care focus on providing treatments based on a prognosis-based framework, involving shared decision-making between the patient and caregivers, after considering the prognosis, professional recommendations, patient's autonomy, family expectations, and the current methods for treating the patient's physical symptoms and existential suffering. This paper provides professional care teams with both moral and literature support for providing care to nondiabetic patients presenting with hypoglycemia.
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Affiliation(s)
- Victor C. Kok
- Division of Palliative Medicine, Department of Internal Medicine, Kuang Tien General Hospital, Taichung, Taiwan
- Division of Medical Oncology, Cancer Center of Kuang Tien General Hospital, Taichung, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
- CORRESPONDENCE:
| | - Ping-Hsueh Lee
- Division of Palliative Medicine, Department of Internal Medicine, Kuang Tien General Hospital, Taichung, Taiwan
- Division of Geriatric Medicine, Department of Family Medicine, Kuang Tien General Hospital, Taichung, Taiwan
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Shin NY, Shin YS, Lee PH, Yoon U, Han S, Kim DJ, Lee SK. Different Functional and Microstructural Changes Depending on Duration of Mild Cognitive Impairment in Parkinson Disease. AJNR Am J Neuroradiol 2015; 37:897-903. [PMID: 26705323 DOI: 10.3174/ajnr.a4626] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 10/26/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The higher cortical burden of Lewy body and Alzheimer disease-type pathology has been reported to be associated with a faster onset of cognitive impairment of Parkinson disease. So far, there has been a few studies only about the changes of gray matter volume depending on duration of cognitive impairment in Parkinson disease. Therefore, our aim was to evaluate the different patterns of structural and functional changes in Parkinson disease with mild cognitive impairment according to the duration of parkinsonism before mild cognitive impairment. MATERIALS AND METHODS Fifty-nine patients with Parkinson disease with mild cognitive impairment were classified into 2 groups on the basis of shorter (<1 year, n = 16) and longer (≥1 year, n = 43) durations of parkinsonism before mild cognitive impairment. Fifteen drug-naïve patients with de novo Parkinson disease with intact cognition were included for comparison. Cortical thickness, Tract-Based Spatial Statistics, and seed-based resting-state functional connectivity analyses were performed. Age, sex, years of education, age at onset of parkinsonism, and levodopa-equivalent dose were included as covariates. RESULTS The group with shorter duration of parkinsonism before mild cognitive impairment showed decreased fractional anisotropy and increased mean and radial diffusivity values in the frontal areas compared with the group with longer duration of parkinsonism before mild cognitive impairment (corrected P < .05). The group with shorter duration of parkinsonism before mild cognitive impairment showed decreased resting-state functional connectivity in the default mode network area when the left or right posterior cingulate was used as a seed, and in the dorsolateral prefrontal areas when the left or right caudate was used as a seed (corrected P < .05). The group with longer duration of parkinsonism before mild cognitive impairment showed decreased resting-state functional connectivity mainly in the medial prefrontal cortex when the left or right posterior cingulate was used as a seed, and in the parieto-occipital areas when the left or right caudate was used as a seed (corrected P < .05). No differences in cortical thickness were found in all group contrasts. CONCLUSIONS Resting-state functional connectivity and WM alterations might be useful imaging biomarkers for identifying changes in patients with Parkinson disease with mild cognitive impairment according to the duration of parkinsonism before mild cognitive impairment. The functional and microstructural substrates may topographically differ depending on the rate of cognitive decline in these patients.
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Affiliation(s)
- N-Y Shin
- From the Department of Radiology (N.-Y.S.), Ewha Womans University School of Medicine, Seoul, Korea Radiology (N.-Y.S., D.J.K., S.-K.L.), Yonsei University College of Medicine, Seoul, Korea
| | - Y S Shin
- Department of Psychology (Y.S.S., S.H.), Yonsei University, Seoul, Korea
| | - P H Lee
- Departments of Neurology (P.H.L.)
| | - U Yoon
- Department of Biomedical Engineering (U.Y.), College of Health and Medical Science, Catholic University of Daegu, Gyeongsan-si, South Korea
| | - S Han
- Department of Psychology (Y.S.S., S.H.), Yonsei University, Seoul, Korea
| | - D J Kim
- Radiology (N.-Y.S., D.J.K., S.-K.L.), Yonsei University College of Medicine, Seoul, Korea
| | - S-K Lee
- Radiology (N.-Y.S., D.J.K., S.-K.L.), Yonsei University College of Medicine, Seoul, Korea
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Kim SW, Chung SJ, Oh YS, Yoon JH, Sunwoo MK, Hong JY, Kim JS, Lee PH. Cerebral Microbleeds in Patients with Dementia with Lewy Bodies and Parkinson Disease Dementia. AJNR Am J Neuroradiol 2015; 36:1642-7. [PMID: 26228888 DOI: 10.3174/ajnr.a4337] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 02/25/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The burden of amyloid β is greater in patients with dementia with Lewy bodies than in those with Parkinson disease dementia, and an increased amyloid β load is closely related to a higher incidence of cerebral microbleeds. Here, we investigated the prevalence and topography of cerebral microbleeds in patients with dementia with Lewy bodies and those with Parkinson disease dementia to examine whether cerebral microbleeds are more prevalent in patients with dementia with Lewy bodies than in those with Parkinson disease dementia. MATERIALS AND METHODS The study population consisted of 42 patients with dementia with Lewy bodies, 88 patients with Parkinson disease dementia, and 35 controls who underwent brain MR imaging with gradient recalled-echo. Cerebral microbleeds were classified as deep, lobar, or infratentorial. RESULTS The frequency of cerebral microbleeds was significantly greater in patients with dementia with Lewy bodies (45.2%) than in those with Parkinson disease dementia (26.1%) or in healthy controls (17.1%; P = .017). Lobar cerebral microbleeds were observed more frequently in the dementia with Lewy bodies group (40.5%) than in the Parkinson disease dementia (17%; P = .004) or healthy control (8.6%; P = .001) group, whereas the frequencies of deep and infratentorial cerebral microbleeds did not differ among the 3 groups. Logistic regression analyses revealed that, compared with the healthy control group, the dementia with Lewy bodies group was significantly associated with the presence of lobar cerebral microbleeds after adjusting for age, sex, nonlobar cerebral microbleeds, white matter hyperintensities, and other vascular risk factors (odds ratio, 4.39 [95% CI, 1.27-15.25]). However, compared with the healthy control group, the Parkinson disease dementia group was not significantly associated with lobar cerebral microbleeds. CONCLUSIONS This study showed that patients with dementia with Lewy bodies had a greater burden of cerebral microbleeds and exhibited a lobar predominance of cerebral microbleeds than did patients with Parkinson disease dementia.
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Affiliation(s)
- S W Kim
- From the Department of Neurology (S.W.K., S.J.C., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - S J Chung
- From the Department of Neurology (S.W.K., S.J.C., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - Y-S Oh
- Department of Neurology (Y.-S.O., J.-S.K.), Catholic University College of Medicine, Seoul, South Korea
| | - J H Yoon
- Department of Neurology (J.H.Y.), Ajou University College of Medicine, Suwon, South Korea
| | - M K Sunwoo
- Department of Neurology (M.K.S.), Bundang Jesaeng General Hospital, Seongnam, South Korea
| | - J Y Hong
- Department of Neurology (J.Y.H.), Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - J-S Kim
- Department of Neurology (Y.-S.O., J.-S.K.), Catholic University College of Medicine, Seoul, South Korea
| | - P H Lee
- From the Department of Neurology (S.W.K., S.J.C., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea Severance Biomedical Science Institute (P.H.L.), Seoul, South Korea.
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Chung SJ, Hong JY, Lee JE, Lee PH, Sohn YH. Dental implants-induced task-specific oromandibular dystonia. Eur J Neurol 2013; 20:e80. [PMID: 23663539 DOI: 10.1111/ene.12124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 01/30/2013] [Indexed: 11/29/2022]
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Lee PH, Perlis RH, Jung JY, Byrne EM, Rueckert E, Siburian R, Haddad S, Mayerfeld CE, Heath AC, Pergadia ML, Madden PAF, Boomsma DI, Penninx BW, Sklar P, Martin NG, Wray NR, Purcell SM, Smoller JW. Multi-locus genome-wide association analysis supports the role of glutamatergic synaptic transmission in the etiology of major depressive disorder. Transl Psychiatry 2012; 2:e184. [PMID: 23149448 PMCID: PMC3565768 DOI: 10.1038/tp.2012.95] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Major depressive disorder (MDD) is a common psychiatric illness characterized by low mood and loss of interest in pleasurable activities. Despite years of effort, recent genome-wide association studies (GWAS) have identified few susceptibility variants or genes that are robustly associated with MDD. Standard single-SNP (single nucleotide polymorphism)-based GWAS analysis typically has limited power to deal with the extensive heterogeneity and substantial polygenic contribution of individually weak genetic effects underlying the pathogenesis of MDD. Here, we report an alternative, gene-set-based association analysis of MDD in an effort to identify groups of biologically related genetic variants that are involved in the same molecular function or cellular processes and exhibit a significant level of aggregated association with MDD. In particular, we used a text-mining-based data analysis to prioritize candidate gene sets implicated in MDD and conducted a multi-locus association analysis to look for enriched signals of nominally associated MDD susceptibility loci within each of the gene sets. Our primary analysis is based on the meta-analysis of three large MDD GWAS data sets (total N=4346 cases and 4430 controls). After correction for multiple testing, we found that genes involved in glutamatergic synaptic neurotransmission were significantly associated with MDD (set-based association P=6.9 × 10(-4)). This result is consistent with previous studies that support a role of the glutamatergic system in synaptic plasticity and MDD and support the potential utility of targeting glutamatergic neurotransmission in the treatment of MDD.
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Affiliation(s)
- P H Lee
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA,Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA,Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA,Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - R H Perlis
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA,Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA,Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA,Psychiatric Genetics Program in Mood and Anxiety Disorders, Massachusetts General Hospital, Boston, MA, USA
| | - J-Y Jung
- Center for Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - E M Byrne
- Genetic Epidemiology, Queensland Institute of Medical Research, Brisbane, QLD, Australia,University of Queensland, Brisbane St Lucia, QLD, Australia
| | - E Rueckert
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA,Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - R Siburian
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
| | - S Haddad
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
| | - C E Mayerfeld
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
| | - A C Heath
- Department of Psychiatry, Washington University, St Louis, Missouri, MO, USA
| | - M L Pergadia
- Department of Psychiatry, Washington University, St Louis, Missouri, MO, USA
| | - P A F Madden
- Department of Psychiatry, Washington University, St Louis, Missouri, MO, USA
| | - D I Boomsma
- Department of Biological Psychology, VU University, Amsterdam, The Netherlands
| | - B W Penninx
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - P Sklar
- Division of Psychiatric Genomics, Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
| | - N G Martin
- Genetic Epidemiology, Queensland Institute of Medical Research, Brisbane, QLD, Australia
| | - N R Wray
- University of Queensland, Brisbane St Lucia, QLD, Australia
| | - S M Purcell
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA,Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA,Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA,Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA,Division of Psychiatric Genomics, Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
| | - J W Smoller
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA,Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA,Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA,Psychiatric Genetics Program in Mood and Anxiety Disorders, Massachusetts General Hospital, Boston, MA, USA,Center for Human Genetic Research, Massachusetts General Hospital, Simches Research Building, 185 Cambridge Street, Boston, MA 02114, USA.
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Bergen SE, O'Dushlaine CT, Ripke S, Lee PH, Ruderfer DM, Akterin S, Moran JL, Chambert KD, Handsaker RE, Backlund L, Ösby U, McCarroll S, Landen M, Scolnick EM, Magnusson PKE, Lichtenstein P, Hultman CM, Purcell SM, Sklar P, Sullivan PF. Genome-wide association study in a Swedish population yields support for greater CNV and MHC involvement in schizophrenia compared with bipolar disorder. Mol Psychiatry 2012; 17:880-6. [PMID: 22688191 PMCID: PMC3724337 DOI: 10.1038/mp.2012.73] [Citation(s) in RCA: 182] [Impact Index Per Article: 15.2] [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: 12/20/2011] [Revised: 04/02/2012] [Accepted: 04/23/2012] [Indexed: 12/21/2022]
Abstract
Schizophrenia (SCZ) and bipolar disorder (BD) are highly heritable psychiatric disorders with overlapping susceptibility loci and symptomatology. We conducted a genome-wide association study (GWAS) of these disorders in a large Swedish sample. We report a new and independent case-control analysis of 1507 SCZ cases, 836 BD cases and 2093 controls. No single-nucleotide polymorphisms (SNPs) achieved significance in these new samples; however, combining new and previously reported SCZ samples (2111 SCZ and 2535 controls) revealed a genome-wide significant association in the major histocompatibility complex (MHC) region (rs886424, P=4.54 × 10(-8)). Imputation using multiple reference panels and meta-analysis with the Psychiatric Genomics Consortium SCZ results underscored the broad, significant association in the MHC region in the full SCZ sample. We evaluated the role of copy number variants (CNVs) in these subjects. As in prior reports, deletions were enriched in SCZ, but not BD cases compared with controls. Singleton deletions were more frequent in both case groups compared with controls (SCZ: P=0.003, BD: P=0.013), whereas the largest CNVs (>500 kb) were significantly enriched only in SCZ cases (P=0.0035). Two CNVs with previously reported SCZ associations were also overrepresented in this SCZ sample: 16p11.2 duplications (P=0.0035) and 22q11 deletions (P=0.03). These results reinforce prior reports of significant MHC and CNV associations in SCZ, but not BD.
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Affiliation(s)
- S E Bergen
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA, USA.
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Lee PH, McQuillan O. P61 IM ceftriaxone for all pelvic inflammatory disease: to give or not to give? Br J Vener Dis 2012. [DOI: 10.1136/sextrans-2012-050601c.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Paroxysmal choreodystonic disorders or paroxysmal dyskinesias are a heterogeneous group of movement disorders characterized by recurrent attacks of abnormal involuntary movements. They are classified into four categories according to the precipitant, duration of attacks, and etiology: (1) paroxysmal kinesigenic dyskinesia (PKD), in which attacks are brief and induced by sudden voluntary movements; (2) paroxysmal nonkinesigenic dyskinesia (PNKD), in which attacks occur spontaneously; (3) paroxysmal exertion-induced dyskinesia (PED), in which attacks are brought on by prolonged exercise; and (4) paroxysmal hypnogenic dyskinesia (PHD), in which attacks occur during sleep. Among them, PHD is currently known to be a form of mesial frontal-lobe epilepsy, and has been given the term "autosomal-dominant nocturnal frontal lobe epilepsy" (ANDFLE) in some familiar cases with an autosomal-dominant inheritance. The clinical, etiological and pathophysiological features of PKD, PNKD, and PED are reviewed.
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Affiliation(s)
- Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.
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Lee JE, Park HJ, Song SK, Sohn YH, Lee JD, Lee PH. Neuroanatomic basis of amnestic MCI differs in patients with and without Parkinson disease. Neurology 2010; 75:2009-16. [PMID: 21115956 DOI: 10.1212/wnl.0b013e3181ff96bf] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To explore the neuroanatomic basis of amnestic mild cognitive impairment (aMCI) in patients with Parkinson disease (PD; aMCI-PD(+)) and without PD (aMCI-PD(-)). METHODS A total of 119 patients with aMCI (aMCI-PD(-), n = 78, and aMCI-PD(+), n = 41) underwent T1-weighted MRI, and the image data were analyzed using voxel-based morphometry. RESULTS No significant differences in demographic characteristics or general cognition were found between patients with aMCI-PD(-) and aMCI-PD(+). Comparisons of neuropsychological tests between groups revealed that patients with aMCI-PD(-) had lower scores in delayed verbal and visual recognition memory, whereas visuospatial dysfunction was more severe in patients with aMCI-PD(+). Gray matter (GM) density in the right temporal and posterior cingular cortices was significantly lower in the aMCI-PD(-) group compared with controls. In contrast, GM density in the aMCI-PD(+) group was significantly lower in the precuneus and left prefrontal and primary motor areas relative to controls. A direct comparison between groups showed that decreased GM density in aMCI-PD(-) relative to aMCI-PD(+) was localized in the right temporal and anterior prefrontal areas, whereas decreased GM density in aMCI-PD(+) relative to aMCI-PD(-) was involved in the bilateral precuneus, left primary motor, and right parietal areas. Memory decline was correlated with temporal area atrophy in aMCI-PD(-) and with posterior cingulate cortex atrophy in aMCI-PD(+). CONCLUSIONS Our data suggest that different neuroanatomic systems underlie memory dysfunction in patients with aMCI-PD(-) and aMCI-PD(+).
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Affiliation(s)
- J E Lee
- Department of Neurology, Yonsei University Medical College, 250 Seongsanno, Seodaemun-gu, Seoul, 120-752, South Korea
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Lin MH, Tasi MK, Lin HY, Lee CH, Chen SC, Lee PH. Analysis of the factors influencing living kidney donation: the experience in National Taiwan University Hospital. Transplant Proc 2010; 42:689-91. [PMID: 20430146 DOI: 10.1016/j.transproceed.2010.02.062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Kidney transplantation provides a choice of active treatment for patients with chronic renal failure. However, the sources of organs are limited; therefore, living kidney donation is an alternative source. The regulation of organ donation in Taiwan stipulates that living organ donation is restricted to living related recipients. We sought to investigate factors that influenced or prevented individuals from living kidney donation in our center. MATERIALS AND METHODS From January 2005 to December 2008, there were 266 potential candidates who underwent evaluation for living kidney donation in our center. RESULTS Among the potential candidates, most were spouses (n=85, 31.9%), followed by parents (n=67, 25.1%), siblings (n=62, 23.3%), and children (n=40, 15%). Eventually, 124 candidates (47%) completed organ donation, most of whom were siblings (n=39, 31.5%), then parents (n=38, 30.6%), spouses (n=26), and children (n=18). Most donors were females, including mothers and sisters. The most frequent reason to not donate was unwillingness, due to potential influences on their health, economic stress due to suspension of their job, and objection of family members. In 34 candidates (23.9%), adverse health factors of potential candidates prohibited them from donating, including age, chronic medical illness, hepatitis carrier status, severe depression, or mental retardation. Among 59 potential donor-recipient pairs with incompatible ABO blood types or highly sensitized to potential donors, 22 candidates completed living kidney donation. CONCLUSION Although laparoscopic nephrectomy for living kidney donation decreases the discomfort and hospital stay after donation, we can only promote living kidney donation if we can deal with the possible factors that prohibit candidates from living kidney donation, such as morbidity after organ donation, anxiety, or other factors. After analyzing those factors, we must also develop a protocol to closely follow the living kidney donors to ensure their health status and relieve their anxiety.
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Affiliation(s)
- M H Lin
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
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Chen PW, Hwu WL, Ho MC, Lee NC, Chien YH, Ni YH, Lee PH. Stabilization of blood methylmalonic acid level in methylmalonic acidemia after liver transplantation. Pediatr Transplant 2010; 14:337-41. [PMID: 19686300 DOI: 10.1111/j.1399-3046.2009.01227.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [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: 11/26/2022]
Abstract
Methylmalonic acidemia with complete mutase deficiency (mut(0) type) is an inborn error of metabolism with high mortality and morbidity. LT has been suggested to be a solution to this disease, but elevation of urinary and blood MMA was still observed after LT. In this study, we measured dry blood spot MMA and its precursor propionyl-carnitine (C3-carnitine) for mut(0) patients. The results revealed that when C3-carnitine rose during metabolic stress, MMA rose exponentially (up to 1000 micromol/L) in patients who did not undergo LT. In patients who underwent LT, MMA rose to 100-200 micromol/L when C3-carnitine reached 10-20 micromol/L. However, when C3-carnitine rose further to 40-50 micromol/L, MMA levels just stayed put. Therefore, LT stabilized blood MMA level, though there might be a threshold for blood MMA clearance by the donor liver. This finding should be critical to understand the long-term outcome for LT in methylmalonic acidemia.
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Affiliation(s)
- P W Chen
- Department of Medical Genetics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Tai HC, Yang PJ, Lee PH, Chung SD, Chueh SC, Yu HJ. Acute lobar nephronia in a renal allograft: a case report and literature review. Transplant Proc 2008; 40:1737-40. [PMID: 18589182 DOI: 10.1016/j.transproceed.2007.10.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2007] [Accepted: 10/17/2007] [Indexed: 01/20/2023]
Abstract
We report a diabetic renal transplant recipient who presented with fever and right lower quadrant abdominal pain. Acute appendicitis was considered initially and she underwent emergent appendectomy. However, persistent symptoms postoperatively made us perform an imaging study to identify the problems. Abdominal and pelvic computed tomography disclosed several focal wedge-shaped lesions of low attenuation in the renal allograft. Acute lobar nephronia was successfully managed with parenteral antibiotics. The patient recovered without any sequela. A renal allograft in the right iliac fossa complicates the diagnosis among acute renal infection, malignancy, acute rejection, and even acute appendicitis. Biopsy of the renal allograft is sometimes needed due to clinically ambiguous imaging results. In this report, we not only detail the clinical course of such a rare case, but also review the previous 3 cases of acute lobar nephronia in renal allografts in the literature.
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Affiliation(s)
- H C Tai
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
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Abstract
We present a unique variant of the middle turbinate that extends posteriorly through the choana to wrap around the posterior free edge of the nasal septum. The embryology and anatomy of the lateral nasal wall and the nasal septum are reviewed.
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Affiliation(s)
- P H Lee
- Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
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Lee JM, Tu CF, Tai HC, Chou NK, Weng CN, Lee YC, Lee PH. The impact of human ABO blood groups on human xenoreactive antibody-mediated cytotoxicity and the protective effect of human decay-accelerating factors exogene on swine endothelium. Transplant Proc 2008; 40:551-3. [PMID: 18374126 DOI: 10.1016/j.transproceed.2008.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
UNLABELLED Swine tissue can express antigens similar to human A/B blood types. We evaluated whether the variation in human blood type influences the human xenoreactive antibody-mediated cytotoxicity and modifies the protective effect of human decay-accelerating factor (hDAF) exogene, a complement activation regulator, on swine endothelium. METHODS Pig aortic endothelial cells were harvested form normal and hDAF transgenic pigs. Cellular viability was evaluated with an MTT assay. RESULTS As compared with that of other human blood types, human serum from blood type O donors induced more prominent cytotoxicity on swine endothelial cells both from hDAF transgenic or normal pigs (P < .05). In addition, this difference of xenoreactive antibody-induced cytotoxicity between treatment with O and other human blood type sera was more evident in hDAF transgenic swine endothelial cells than those of normal pigs (P < .05). The hDAF exogene can significantly protect the endothelial cells from human xenoreactive antibody-mediated cytotoxicty when treated with human serum from AB blood type (P < .05). Our data demonstrated that human ABO blood type significantly affected human xenoreactive antibody-induced cytotoxicity, which may modulate the protective effect of hDAF exogene expression on swine endothelial cells.
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Affiliation(s)
- J M Lee
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Bhadelia RA, Tedesco KL, Hwang S, Erbay SH, Lee PH, Shao W, Heilman C. Increased cochlear fluid-attenuated inversion recovery signal in patients with vestibular schwannoma. AJNR Am J Neuroradiol 2008; 29:720-3. [PMID: 18238842 DOI: 10.3174/ajnr.a0968] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Elevated protein levels have been reported in perilymph of patients with vestibular schwannoma. Fluid-attenuated inversion recovery (FLAIR) imaging is sensitive to high protein contents in fluids. The purpose of this study was to investigate if in patients with unilateral vestibular schwannoma, cochlear FLAIR signal intensity on the affected side is increased compared with the unaffected side and control subjects. MATERIALS AND METHODS Fifteen patients with unilateral vestibular schwannoma and 25 age-matched control subjects (without a history of hearing loss) were retrospectively evaluated. All patients and controls had routine 5-mm FLAIR and T1- and T2-weighted imaging of the brain. The signal intensity of both cochleae was evaluated by placing a small region of interest on FLAIR images. The signal intensity of the brain stem was also determined by placing a second region of interest. A ratio of cochlear signal intensity to brain stem signal intensity (CIBI ratio) was determined. A t test was used to compare the CIBI ratios. RESULTS In patients, the mean CIBI ratio of the affected side was 0.89 +/- 0.18, and that of the unaffected side was 0.57 +/- 0.12. In control subjects, it was 0.51 +/- 0.07. The CIBI ratio of the affected side was significantly higher compared with the unaffected side (P < .001) and compared with control subjects (P < .001). CONCLUSION Patients with vestibular schwannoma have increased cochlear FLAIR signal intensity on the affected side compared with the unaffected side and healthy subjects.
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Affiliation(s)
- R A Bhadelia
- Tufts-New England Medical Center and Tufts University, Boston, MA 02215, USA.
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Abstract
BACKGROUND AND PURPOSE The traditional paradigm has regarded essential tremor (ET) as a benign disorder. However, recent clinical, neuroimaging, and neuropathologic studies suggest that ET may be a progressive neurologic disorder. Based on clinicopathologic findings that cerebellum and its outflow are the key structures in ET and degeneration of gray matter in cerebellum is followed by consequent wallerian degeneration of white matter (WM) fibers, the aim of the present study was to investigate changes in anisotropy in patients with ET. MATERIALS AND METHODS Fractional anisotropy (FA) images were generated from DTI data acquired at 1.5T in 10 patients with ET compared with 8 control subjects by using statistical parametric mapping to make voxel-by-voxel comparisons. RESULTS Compared with the control subjects, the patients with ET exhibited significantly reduced FA (P(uncorrected) < .005) in the anterolateral portion of the right pons and decreased FA in the bilateral cerebellum, left retrorubral area of the midbrain, and bilateral deep WM, including the orbitofrontal, lateral frontal, parietal, and temporal WM. CONCLUSION This study demonstrates that structural changes in the WM are extensive in patients with ET, supporting the findings of previous functional neuroimaging and pathologic studies.
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Affiliation(s)
- D H Shin
- Department of Neurology, Ajou University College of Medicine, Suwon, South Korea
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Yeung SY, Huang CS, Chan CP, Lin CP, Lin HN, Lee PH, Jia HW, Huang SK, Jeng JH, Chang MC. Antioxidant and pro-oxidant properties of chlorhexidine and its interaction with calcium hydroxide solutions. Int Endod J 2007; 40:837-44. [PMID: 17877724 DOI: 10.1111/j.1365-2591.2007.01271.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
AIM To evaluate the antioxidant and pro-oxidant properties of chlorhexidine (CHX). METHODOLOGY The scavenging and generation of reactive oxygen species (ROS) by CHX in the presence or absence of saturated Ca(OH)(2) solutions was evaluated. The reaction emitted chemiluminescence in the presence of lucigenin thus was determined by a luminometer to evaluate the levels of ROS production. Changes in DNA conformation were analysed by agarose gel electrophoresis. Paired Student's t-test was used to compare the difference between groups. RESULTS Chlorhexidine (0.00002-0.02%) effectively scavenged 56-88% of the superoxide radicals generated by the xanthine/xanthine oxidase reaction. Through analysis of PUC18 DNA conformation changes, CHX was shown to be a mild scavenger of hydroxyl radicals generated by H(2)O(2) plus FeCl(2). However, CHX (>0.083%) decreased the mobility of PUC18 plasmid DNA with potential production of DNA-DNA cross-link and severe DNA breaks (presence of DNA smear) at further higher concentrations. Furthermore, CHX induced ROS production including H(2)O(2) and superoxide radicals in 0.1N NaOH (pH = 12.76) or Ca(OH)(2) (pH = 12.5) solutions. CONCLUSION Chlorhexidine exhibited both antioxidant and pro-oxidant properties under different conditions. These events are possibly involved in the killing of root canal and periodontal microorganisms when CHX and Ca(OH)(2) were used in combination or separately. Potential genotoxicity and tissue damage when extruded into the periradicular tissue and at higher concentrations should be considered during periodontal and endodontic practice.
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Affiliation(s)
- S Y Yeung
- Department of Dentistry, Chang-Gung Memorial Hospital, Taipei, Taiwan
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Yong SW, Yoon JK, An YS, Lee PH. A comparison of cerebral glucose metabolism in Parkinson's disease, Parkinson's disease dementia and dementia with Lewy bodies. Eur J Neurol 2007; 14:1357-62. [PMID: 17941855 DOI: 10.1111/j.1468-1331.2007.01977.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Parkinson's disease dementia (PDD) and dementia with Lewy bodies (DLB) share many similar aspects, and making a clinical diagnosis of one disorder over the other relies heavily on an arbitrary criterion, so-called 1-year rule. This study was designed to search for any difference of metabolic patterns in these two disorders using F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) images. We enrolled 16 patients with PD, 13 patients with PDD, and seven patients with DLB. FDG PET was performed, and images were reconstructed by iterative reconstruction using the computed tomography (CT) images, and were normalized to a standard template. Statistical comparison between groups were performed on a voxel-by-voxel basis using t-statistics (two-sample t-test). Compared with the patients with PD, both PDD and DLB patients showed similar patterns of decreased metabolism in bilateral inferior and medial frontal lobes, and right parietal lobe (P(uncorrected) < 0.001). In a direct comparison, DLB patients had significant metabolic decrease (p(uncorrected) < 0.005) in the anterior cingulate compared with those with PDD. These findings support the concept that PDD and DLB have similar underlying neurobiological characteristics, and that they can be regarded as a spectrum of Lewy body disorders.
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Affiliation(s)
- S W Yong
- Department of Neurology, Ajou University School of Medicine, Suwon, South Korea
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Lee PH, Kim JW, Bang OY, Ahn YH, Joo IS, Huh K. Autologous mesenchymal stem cell therapy delays the progression of neurological deficits in patients with multiple system atrophy. Clin Pharmacol Ther 2007; 83:723-30. [PMID: 17898702 DOI: 10.1038/sj.clpt.6100386] [Citation(s) in RCA: 181] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We evaluated the feasibility and safety of therapy with mesenchymal stem cells (MSCs) through consecutively intra-arterial and three repeated intravenous injections and compared the long-term prognosis between MSC-treated (n=11) and control multiple system atrophy (MSA) patients (n=18). The MSC-treated patients showed significantly greater improvement on the unified MSA rating scale (UMSARS) than the control patients at all visits throughout the 12-month study period. Orthostasis in UMSARS I items and cerebellar dysfunction-related items of UMSARS II items were significantly different in favor of MSC treatment compared to controls. Serial positron emission tomography scan in the MSC-treated group showed that increased fluorodeoxyglucose uptake from baseline was noted in cerebellum and frontal white matters. No serious adverse effects related to MSC therapy occurred. This study demonstrated that MSC therapy in patients with MSA was safe and delayed the progression of neurological deficits with achievement of functional improvement in the follow-up period.
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Affiliation(s)
- P H Lee
- Department of Neurology, Ajou University College of Medicine, Suwon, South Korea.
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Abstract
OBJECTIVES The purpose of this study was to investigate the attitudes and characteristics of donors for living donor liver transplantation (LDLT). METHODS This retrospective study was performed by a mailing or by telephone using a questionnaire. LDLT donors were recruited from a teaching hospitals located in a metropolitan area of northern Taiwan. The 11-item attitude questionnaire was specifically developed from the literature review with coordinator, physician, and donor feedback. Donors were asked to rate the queries on a 5-point Likert intensity scale. RESULTS The 47 LDLT donors included 28 (60%) women and 19 (40%) men. Most of the LDLT donors were aged less than 30 years old (n = 24, 51%) with (n = 12, 26%) between 31 and 40 years, and 11 (23%) more than 41 years. Self-perceived health status was poor (n = 4, 9%), not bad (n = 22, 47%), good (n = 19, 40%), or very good (n = 2, 4%). The top five LDLT donor attitudes were recognition of liver donation (n = 42, 89%), recognition of brain donation (n = 41, 88%), a hero (n = 35, 75%), honor to be a donor (n = 35, 5%), and improved relationship with recipient after donation (n = 33, 70%). The best person to suggest organ donation to a family was ranked as the doctors related to transplantation (n = 41, 88%), transplantation nurse coordinator (n = 40, 85%), social worker (n = 23, 49%), and doctor unrelated to transplantation (n = 17, 17%). CONCLUSION This study revealed positive attitudes toward donation. Some data afford insight to the decision-making procedure. Donor concerns may help professionals provide better interventions in the future.
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Affiliation(s)
- S-C Chen
- Department of Nursing, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei 100, Taiwan
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Wang SS, Chou NK, Chi NH, Hsu RB, Huang SC, Chen YS, Yu HY, Ko WJ, Chu SH, Tsai MK, Lee PH. Simultaneous Heart and Kidney Transplantation for Combined Cardiac and Renal Failure. Transplant Proc 2006; 38:2135-7. [PMID: 16980023 DOI: 10.1016/j.transproceed.2006.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Simultaneous heart and kidney transplantation (SHKT) is feasible for combined cardiac and renal failure. Herein we reviewed our 10-year experience in SHKT. Six patients underwent SHKT from June 1995 to December 2004. Their ages ranged from 13 to 63 years old with a mean of 45.5 +/- 15.8 years. They were all men except one girl, who was the youngest (aged 13) who suffered from dilated cardiomyopathy with congestive heart failure and chronic renal failure due to systemic lupus erythematosus. Because of aggravating heart failure, she changed from hemodialysis to peritoneal dialysis. Because of intractable heart failure, she underwent SHKT from a 24-year-old female donor. All received hemodialysis before SHKT. The indications for heart transplantation included dilated cardiomyopathy (n = 3), ischemic cardiomyopathy (n = 1), cardiac allograft vasculopathy (n = 1), and cardiac allograft failure (n = 1). The immunosuppressive protocol and rejection surveillance were these employed for heart transplantation. No operative mortality was noted in this study. The 1-year and 5-year survival rates were the same, 83%. The 10-year survival rate was 55%. No cardiac or renal allograft rejection was noted. No renal allograft loss was noted. There were two late mortalities: the one, who underwent redo heart transplantation for coronary artery vasculopathy died of cardiac allograft failure 1 year after SHKT. The other patient died of massive ischemic necrosis of the intestine at 6 years after SHKT. Our experience showed that SHKT had good short- and long-term results without increasing immunosuppressive doses. End-stage failure of either the heart or the kidney did not preclude heart plus kidney transplantation.
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Affiliation(s)
- S S Wang
- Department of Surgery, National Taiwan University Hospital, No. 7 Chung-shan South Road, Taipei, Taiwan.
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Abstract
Cardiac sympathetic dysfunction was investigated using 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy in 20 patients with drug induced parkinsonism (DIP). The mean heart to mediastinum ratio was significantly greater in patients with DIP than in those with Parkinson's disease (mean (SD): 2.07 (0.39) v 1.28 (0.15), p<0.001). MIBG uptake was not different between the DIP patients and controls. Two DIP patients whose MIBG uptake was significantly reduced showed persistent parkinsonism and responded dramatically to levodopa.
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Affiliation(s)
- P H Lee
- Department of Neurology, College of Medicine Ajou University, Woncheon-dong San 5, Paldal-ku, Suwon, Kyungki-do, 442-749, South Korea.
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Lee PH, Lee G, Park HJ, Bang OY, Joo IS, Huh K. The plasma alpha-synuclein levels in patients with Parkinson's disease and multiple system atrophy. J Neural Transm (Vienna) 2006; 113:1435-9. [PMID: 16465458 DOI: 10.1007/s00702-005-0427-9] [Citation(s) in RCA: 177] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2005] [Accepted: 11/27/2005] [Indexed: 12/12/2022]
Abstract
alpha-Synuclein, a synaptic protein of unknown function, is a major component of Lewy bodies and may play a role in the pathophysiological process of Parkinson's disease (PD). In this study, we measured the plasma alpha-synuclein levels in 105 patients with PD, 38 patients with multiple system atrophy (MSA), and 51 age-matched controls. The alpha-synuclein level was significantly elevated in patients with PD (79.9 +/- 4.0 pg/ml, p < 0.001) and in those with MSA (78.1 +/- 3.5 pg/ml, p = 0.019) compared with the level in controls (76.1 +/- 3.9 pg/ml). The alpha-synuclein level was higher in patients with PD than in those with MSA (79.9 +/- 4.0 vs 78.1 +/- 3.5, p = 0.016). Our study demonstrated that the alpha-synuclein level in plasma is elevated in patients with PD and MSA.
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Affiliation(s)
- P H Lee
- Department of Neurology, Ajou University School of Medicine, Suwon, South Korea.
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Abstract
BACKGROUND AND PURPOSE The pathogenesis of deep white matter medullary (WMM) artery infarcts remains controversial. To address this question, we analysed the stroke patterns of WMM infarcts using diffusion weighted magnetic resonance imaging (DWI) to detect embolic signals and investigate stroke subtypes according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classifications. METHODS We identified WMM infarcts on DWI using templates to determine the subcortical vascular territories. We classified WMM infarcts into those with small artery disease (SAD), large artery disease (LAD), cardioembolism (CE), two or more aetiologies, or undetermined aetiology. Clinical course, risk factors, and cortical spotty lesions were compared. RESULTS Of the 1420 consecutive patients, 103 (7.3%) met the criteria for WMM infarcts. The stroke subtypes were as follows: 65 (63.1%) patients with LAD, 18 (17.5%) with SAD, 12 (11.7%) with CE, four (3.9%) with two or more aetiologies, three (2.1%) with undetermined aetiology, and one (1.0%) with other determined aetiology. LAD (87.7%) or CE (83.3%) was significantly accompanied by cortical embolic signals as compared to SAD (0%, p<0.001). The LAD infarcts were larger and tended to be chain-like in shape. Ischaemic stroke recurrence was more common in strokes with cortical embolic signals than in those without embolic signals (18.9% v 0%, p = 0.009). CONCLUSIONS In present study, the most common pathogenesis of WMM infarcts was LAD. Our study indicates that WMM infarcts accompanying cortical embolic signals warrant evaluation of the underlying embolic sources in the large artery or the heart.
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Affiliation(s)
- P H Lee
- Department of Neurology, School of Medicine, Ajou University, Woncheon-dong San 5, Paldal-Ku, Suwon, Kyungki-do 442-749, South Korea
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Bang OY, Lee PH, Heo KG, Joo US, Yoon SR, Kim SY. Specific DWI lesion patterns predict prognosis after acute ischaemic stroke within the MCA territory. J Neurol Neurosurg Psychiatry 2005; 76:1222-8. [PMID: 16107355 PMCID: PMC1739781 DOI: 10.1136/jnnp.2004.059998] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Apart from diffusion-weighted imaging (DWI) lesion volume and diffusion-perfusion mismatching, there is limited information about neuroradiological predictors of early prognosis after an ischaemic stroke. This study sought to identify specific DWI lesion patterns that would help prediction of early prognosis of three different endpoints: unstable hospital course, recurrence of stroke, and poor neurological outcome at 90 days after ischaemic stroke. METHODS A total of 426 patients with acute cerebral infarcts within the middle cerebral artery territory were prospectively studied. Using the DWI data the patients were divided into six groups (territorial, other cortical, small superficial, internal border zone, small deep, and other deep infarcts), and any recurrent strokes and prognosis over the following 90 days were recorded. RESULTS DWI lesion pattern was a stronger and more consistent independent outcome predictor than DWI lesion volume. The specific DWI lesion patterns associated with each endpoint differed. An unstable hospital course was frequently observed in patients with internal border zone infarcts, whereas recurrent strokes after the index stroke were commoner in those who had small superficial infarcts (p<0.05 in both cases). Similarly, poor outcome after stroke was associated with older age, severe neurological deficits at admission, and a DWI lesion pattern showing internal border zone infarcts. CONCLUSIONS The results of the present study indicate that the DWI lesion pattern may help in recognition of the likely differences in the early prognostic endpoints after ischaemic stroke, and DWI analysis may guide targeted interventions to prevent negative outcomes.
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Affiliation(s)
- O Y Bang
- Department of Neurology, School of Medicine, Ajou University, Woncheon-dong San 5, Paldal-ku, Suwon, Kyungki-do 442-749, South Korea.
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Bang OY, Lee PH, Yoon SR, Lee MA, Joo IS, Huh K. Inflammatory markers, rather than conventional risk factors, are different between carotid and MCA atherosclerosis. J Neurol Neurosurg Psychiatry 2005; 76:1128-34. [PMID: 16024892 PMCID: PMC1739734 DOI: 10.1136/jnnp.2004.054403] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [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: 12/22/2022]
Abstract
BACKGROUND The apparent differences in risk factors for intra- and extracranial atherosclerosis are unclear and the mechanisms that underlie strokes in patients with intracranial atherosclerosis are not well known. We investigated the conventional vascular risk factors as well as other factors in stroke patients with large artery atherosclerosis. METHODS Using diffusion weighted imaging (DWI) and vascular and cardiologic studies, we selected patients with acute non-cardioembolic cerebral infarcts within the middle cerebral artery (MCA) territory. Patients were divided into two groups: those with atherosclerotic lesions on the carotid sinus (n = 112) and those with isolated lesions on the proximal MCA (n = 160). Clinical features, risk factors, and DWI patterns were compared between groups. RESULTS There were no differences in conventional risk factors, but markers for inflammation were significantly higher in patients with carotid atherosclerosis than in those with isolated MCA atherosclerosis (p < 0.01 for both). After adjustments for age/sex and the severity of stroke, an inverse correlation was observed between C-reactive protein levels and MCA atherosclerosis (odds ratio 0.57 per 1 mg/dl increase; 95% confidence interval 0.35 to 0.92; p = 0.02). Internal borderzone infarcts suggestive of haemodynamic causes were the most frequent DWI pattern in patients with MCA occlusion, whereas territorial infarcts suggesting plaque ruptures were most common in those with carotid occlusion. CONCLUSIONS Our results indicate that inflammatory markers, rather than conventional risk factors, reveal clinical and radiological differences between patients with carotid and MCA atherosclerosis. Plaques associated with MCA atherosclerosis may be more stable than those associated with carotid atherosclerosis.
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Affiliation(s)
- O Y Bang
- Department of Neurology, College of Medicine, Ajou University, Woncheon-dong San 5, Suwon, Kyungki-do, 442-749, Republic of Korea.
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Abstract
To investigate the impact of metabolic syndrome (MetSD) on the development of intracranial atherosclerotic stroke, the authors evaluated the components of the MetSD in 512 patients with stroke. The MetSD was observed most frequently in patients with intracranial atherosclerosis (p = 0.007). In multiple regression analysis, the MetSD, but not conventional risk factors, was independently associated with intracranial atherosclerosis (p = 0.005). The results suggest that treatment of metabolic abnormalities may be an important prevention strategy for intracranial atherosclerosis.
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Affiliation(s)
- O Y Bang
- Department of Neurology, School of Medicine, Ajou University, Suwon, South Korea.
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Abstract
Parkinsonism associated with dural arteriovenous fistula (DAVF) has been described rarely; however, isolated parkinsonism as the presenting symptom of DAVF has not been reported. Here, we describe a patient with DAVF showing reversible isolated parkinsonism after embolization, which was well correlated with perfusion status of basal ganglia, suggesting that a perfusion defect was responsible for the pathogenesis of the parkinsonism in our DAVF patient.
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Affiliation(s)
- P H Lee
- Department of Neurology, College of Medicine, Ajou University, Wonchon-dong, Suwon, South Korea.
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Langdon CJ, Winters C, Stürzenbaum SR, Morgan AJ, Charnock JM, Meharg AA, Piearce TG, Lee PH, Semple KT. Ligand arsenic complexation and immunoperoxidase detection of metallothionein in the earthworm Lumbricus rubellus inhabiting arsenic-rich soil. Environ Sci Technol 2005; 39:2042-8. [PMID: 15871235 DOI: 10.1021/es0490471] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Although earthworms have been found to inhabit arsenic-rich soils in the U.K., the mode of arsenic detoxification is currently unknown. Biochemical analyses and subcellular localization studies have indicated that As3+-thiol complexes may be involved; however, it is not known whether arsenic is capable of inducing the expression of metallothionein (MT) in earthworms. The specific aims of this paper were (a) to detect and gain an atomic characterization of ligand complexing by X-ray absorption spectrometry (XAS), and (b) to employ a polyclonal antibody raised against an earthworm MT isoform (w-MT2) to detect and localize the metalloprotein by immunoperoxidase histochemistry in the tissues of earthworms sampled from arsenic-rich soil. Data suggested that the proportion of arsenate to sulfur-bound species varies within specific earthworm tissues. Although some arsenic appeared to be in the form of arsenobetaine, the arsenic within the chlorogogenous tissue was predominantly coordinated with S in the form of -SH groups. This suggests the presence of an As::MT complex. Indeed, MT was detectable with a distinctly localized tissue and cellular distribution. While MT was not detectable in the surface epithelium or in the body wall musculature, immunoperoxidase histochemistry identified the presence of MT in chloragocytes around blood vessels, within the typhlosolar fold, and in the peri-intestinal region. Focal immunostaining was also detectable in a cohort of cells in the intestinal wall. The results of this study support the hypothesis that arsenic induces MT expression and is sequestered by the metalloprotein in certain target cells and tissues.
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Affiliation(s)
- C J Langdon
- Department of Environmental Management, School of Natural Resources, University of Central Lancashire, Preston, Lancashire, PR1 2HE, UK.
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