1
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Lan L, Daly H, Sung R, Tuna F, Skillen N, Robertson PKJ, Hardacre C, Fan X. Mechanistic Study of Glucose Photoreforming over TiO 2-Based Catalysts for H 2 Production. ACS Catal 2023; 13:8574-8587. [PMID: 37441233 PMCID: PMC10334428 DOI: 10.1021/acscatal.3c00858] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/11/2023] [Indexed: 07/15/2023]
Abstract
Glucose is a key intermediate in cellulose photoreforming for H2 production. This work presents a mechanistic investigation of glucose photoreforming over TiO2 and Pt/m-TiO2 catalysts. Analysis of the intermediates formed in the process confirmed the α-scission mechanism of glucose oxidation forming arabinose (Cn-1 sugar) and formic acid in the initial oxidation step. The selectivity to sugar products and formic acid differed over Pt/TiO2 and TiO2, with Pt/TiO2 showing the lower selectivity to formic acid due to enhanced adsorption/conversion of formic acid over Pt/TiO2. In situ ATR-IR spectroscopy of glucose photoreforming showed the presence of molecular formic acid and formate on the surface of both catalysts at low glucose conversions, suggesting that formic acid oxidation could dominate surface reactions in glucose photoreforming. Further in situ ATR-IR of formic acid photoreforming showed Pt-TiO2 interfacial sites to be key for formic acid oxidation as TiO2 was unable to convert adsorbed formic acid/formate. Isotopic studies of the photoreforming of formic acid in D2O (with different concentrations) showed that the source of the protons (to form H2 at Pt sites) was determined by the relative surface coverage of adsorbed water and formic acid.
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Affiliation(s)
- Lan Lan
- Department
of Chemical Engineering, School of Engineering, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - Helen Daly
- Department
of Chemical Engineering, School of Engineering, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - Rehana Sung
- Manchester
Institute of Biotechnology, The University
of Manchester, Manchester M13 9PL, United
Kingdom
| | - Floriana Tuna
- Department
of Chemistry, University of Manchester, Manchester, M13 9PL, United Kingdom
- Photon
Science Institute, University of Manchester, Manchester, M13 9PL, United Kingdom
| | - Nathan Skillen
- School
of Chemistry and Chemical Engineering, Queen’s
University Belfast, Belfast BT9 5AG, United
Kingdom
| | - Peter K. J. Robertson
- School
of Chemistry and Chemical Engineering, Queen’s
University Belfast, Belfast BT9 5AG, United
Kingdom
| | - Christopher Hardacre
- Department
of Chemical Engineering, School of Engineering, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - Xiaolei Fan
- Department
of Chemical Engineering, School of Engineering, The University of Manchester, Manchester M13 9PL, United Kingdom
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2
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Herbert AJ, Shepherd SA, Cronin VA, Bennett MR, Sung R, Micklefield J. Engineering Orthogonal Methyltransferases to Create Alternative Bioalkylation Pathways. Angew Chem Int Ed Engl 2020; 59:14950-14956. [PMID: 32402113 PMCID: PMC7496830 DOI: 10.1002/anie.202004963] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/05/2020] [Indexed: 11/10/2022]
Abstract
S-adenosyl-l-methionine (SAM)-dependent methyltransferases (MTs) catalyse the methylation of a vast array of small metabolites and biomacromolecules. Recently, rare carboxymethylation pathways have been discovered, including carboxymethyltransferase enzymes that utilise a carboxy-SAM (cxSAM) cofactor generated from SAM by a cxSAM synthase (CmoA). We show how MT enzymes can utilise cxSAM to catalyse carboxymethylation of tetrahydroisoquinoline (THIQ) and catechol substrates. Site-directed mutagenesis was used to create orthogonal MTs possessing improved catalytic activity and selectivity for cxSAM, with subsequent coupling to CmoA resulting in more efficient and selective carboxymethylation. An enzymatic approach was also developed to generate a previously undescribed co-factor, carboxy-S-adenosyl-l-ethionine (cxSAE), thereby enabling the stereoselective transfer of a chiral 1-carboxyethyl group to the substrate.
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Affiliation(s)
- Abigail J. Herbert
- Department of Chemistry and Manchester Institute of BiotechnologyThe University of Manchester131 Princess StreetManchesterM1 7DNUK
| | - Sarah A. Shepherd
- Department of Chemistry and Manchester Institute of BiotechnologyThe University of Manchester131 Princess StreetManchesterM1 7DNUK
| | - Victoria A. Cronin
- Department of Chemistry and Manchester Institute of BiotechnologyThe University of Manchester131 Princess StreetManchesterM1 7DNUK
| | - Matthew R. Bennett
- Department of Chemistry and Manchester Institute of BiotechnologyThe University of Manchester131 Princess StreetManchesterM1 7DNUK
| | - Rehana Sung
- Department of Chemistry and Manchester Institute of BiotechnologyThe University of Manchester131 Princess StreetManchesterM1 7DNUK
| | - Jason Micklefield
- Department of Chemistry and Manchester Institute of BiotechnologyThe University of Manchester131 Princess StreetManchesterM1 7DNUK
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3
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Herbert AJ, Shepherd SA, Cronin VA, Bennett MR, Sung R, Micklefield J. Engineering Orthogonal Methyltransferases to Create Alternative Bioalkylation Pathways. Angew Chem Int Ed Engl 2020. [DOI: 10.1002/ange.202004963] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Abigail J. Herbert
- Department of Chemistry and Manchester Institute of Biotechnology The University of Manchester 131 Princess Street Manchester M1 7DN UK
| | - Sarah A. Shepherd
- Department of Chemistry and Manchester Institute of Biotechnology The University of Manchester 131 Princess Street Manchester M1 7DN UK
| | - Victoria A. Cronin
- Department of Chemistry and Manchester Institute of Biotechnology The University of Manchester 131 Princess Street Manchester M1 7DN UK
| | - Matthew R. Bennett
- Department of Chemistry and Manchester Institute of Biotechnology The University of Manchester 131 Princess Street Manchester M1 7DN UK
| | - Rehana Sung
- Department of Chemistry and Manchester Institute of Biotechnology The University of Manchester 131 Princess Street Manchester M1 7DN UK
| | - Jason Micklefield
- Department of Chemistry and Manchester Institute of Biotechnology The University of Manchester 131 Princess Street Manchester M1 7DN UK
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4
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Jervis AJ, Carbonell P, Taylor S, Sung R, Dunstan MS, Robinson CJ, Breitling R, Takano E, Scrutton NS. SelProm: A Queryable and Predictive Expression Vector Selection Tool for Escherichia coli. ACS Synth Biol 2019; 8:1478-1483. [PMID: 30870592 DOI: 10.1021/acssynbio.8b00399] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The rapid prototyping and optimization of plasmid-based recombinant gene expression is one of the key steps in the development of bioengineered bacterial systems. Often, multiple genes or gene modules need to be coexpressed, and for this purpose compatible, inducible plasmid systems have been developed. However, inducible expression systems are not favored in industrial processes, due to their prohibitive cost, and consequently the conversion to constitutive expression systems is often desired. Here we present a set of constitutive-expression plasmids for this purpose, which were benchmarked using fluorescent reporter genes. To further facilitate the conversion between inducible and constitutive expression systems, we developed SelProm, a design tool that serves as a parts repository of plasmid expression strength and predicts portability rules between constitutive and inducible plasmids through model comparison and machine learning. The SelProm tool is freely available at http://selprom.synbiochem.co.uk .
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Affiliation(s)
- Adrian J. Jervis
- Manchester Synthetic Biology Research Centre for Fine and Speciality Chemicals (SYNBIOCHEM), Manchester Institute of Biotechnology and School of Chemistry, University of Manchester, Manchester M1 7DN, U.K
| | - Pablo Carbonell
- Manchester Synthetic Biology Research Centre for Fine and Speciality Chemicals (SYNBIOCHEM), Manchester Institute of Biotechnology and School of Chemistry, University of Manchester, Manchester M1 7DN, U.K
| | - Sandra Taylor
- Manchester Synthetic Biology Research Centre for Fine and Speciality Chemicals (SYNBIOCHEM), Manchester Institute of Biotechnology and School of Chemistry, University of Manchester, Manchester M1 7DN, U.K
| | - Rehana Sung
- Manchester Synthetic Biology Research Centre for Fine and Speciality Chemicals (SYNBIOCHEM), Manchester Institute of Biotechnology and School of Chemistry, University of Manchester, Manchester M1 7DN, U.K
| | - Mark S. Dunstan
- Manchester Synthetic Biology Research Centre for Fine and Speciality Chemicals (SYNBIOCHEM), Manchester Institute of Biotechnology and School of Chemistry, University of Manchester, Manchester M1 7DN, U.K
| | - Christopher J. Robinson
- Manchester Synthetic Biology Research Centre for Fine and Speciality Chemicals (SYNBIOCHEM), Manchester Institute of Biotechnology and School of Chemistry, University of Manchester, Manchester M1 7DN, U.K
| | - Rainer Breitling
- Manchester Synthetic Biology Research Centre for Fine and Speciality Chemicals (SYNBIOCHEM), Manchester Institute of Biotechnology and School of Chemistry, University of Manchester, Manchester M1 7DN, U.K
| | - Eriko Takano
- Manchester Synthetic Biology Research Centre for Fine and Speciality Chemicals (SYNBIOCHEM), Manchester Institute of Biotechnology and School of Chemistry, University of Manchester, Manchester M1 7DN, U.K
| | - Nigel S. Scrutton
- Manchester Synthetic Biology Research Centre for Fine and Speciality Chemicals (SYNBIOCHEM), Manchester Institute of Biotechnology and School of Chemistry, University of Manchester, Manchester M1 7DN, U.K
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5
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Jervis AJ, Carbonell P, Vinaixa M, Dunstan MS, Hollywood KA, Robinson CJ, Rattray NJW, Yan C, Swainston N, Currin A, Sung R, Toogood H, Taylor S, Faulon JL, Breitling R, Takano E, Scrutton NS. Machine Learning of Designed Translational Control Allows Predictive Pathway Optimization in Escherichia coli. ACS Synth Biol 2019; 8:127-136. [PMID: 30563328 DOI: 10.1021/acssynbio.8b00398] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The field of synthetic biology aims to make the design of biological systems predictable, shrinking the huge design space to practical numbers for testing. When designing microbial cell factories, most optimization efforts have focused on enzyme and strain selection/engineering, pathway regulation, and process development. In silico tools for the predictive design of bacterial ribosome binding sites (RBSs) and RBS libraries now allow translational tuning of biochemical pathways; however, methods for predicting optimal RBS combinations in multigene pathways are desirable. Here we present the implementation of machine learning algorithms to model the RBS sequence-phenotype relationship from representative subsets of large combinatorial RBS libraries allowing the accurate prediction of optimal high-producers. Applied to a recombinant monoterpenoid production pathway in Escherichia coli, our approach was able to boost production titers by over 60% when screening under 3% of a library. To facilitate library screening, a multiwell plate fermentation procedure was developed, allowing increased screening throughput with sufficient resolution to discriminate between high and low producers. High producers from one library did not translate during scale-up, but the reduced screening requirements allowed rapid rescreening at the larger scale. This methodology is potentially compatible with any biochemical pathway and provides a powerful tool toward predictive design of bacterial production chassis.
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Affiliation(s)
- Adrian J. Jervis
- Manchester Synthetic Biology Research Centre for Fine and Speciality Chemicals (SYNBIOCHEM), Manchester Institute of Biotechnology and School of Chemistry, University of Manchester, Manchester M1 7DN, United Kingdom
| | - Pablo Carbonell
- Manchester Synthetic Biology Research Centre for Fine and Speciality Chemicals (SYNBIOCHEM), Manchester Institute of Biotechnology and School of Chemistry, University of Manchester, Manchester M1 7DN, United Kingdom
| | - Maria Vinaixa
- Manchester Synthetic Biology Research Centre for Fine and Speciality Chemicals (SYNBIOCHEM), Manchester Institute of Biotechnology and School of Chemistry, University of Manchester, Manchester M1 7DN, United Kingdom
| | - Mark S. Dunstan
- Manchester Synthetic Biology Research Centre for Fine and Speciality Chemicals (SYNBIOCHEM), Manchester Institute of Biotechnology and School of Chemistry, University of Manchester, Manchester M1 7DN, United Kingdom
| | - Katherine A. Hollywood
- Manchester Synthetic Biology Research Centre for Fine and Speciality Chemicals (SYNBIOCHEM), Manchester Institute of Biotechnology and School of Chemistry, University of Manchester, Manchester M1 7DN, United Kingdom
| | - Christopher J. Robinson
- Manchester Synthetic Biology Research Centre for Fine and Speciality Chemicals (SYNBIOCHEM), Manchester Institute of Biotechnology and School of Chemistry, University of Manchester, Manchester M1 7DN, United Kingdom
| | - Nicholas J. W. Rattray
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, 161 Cathedral Street, Glasgow G4 0RE, United Kingdom
| | - Cunyu Yan
- Manchester Synthetic Biology Research Centre for Fine and Speciality Chemicals (SYNBIOCHEM), Manchester Institute of Biotechnology and School of Chemistry, University of Manchester, Manchester M1 7DN, United Kingdom
| | - Neil Swainston
- Manchester Synthetic Biology Research Centre for Fine and Speciality Chemicals (SYNBIOCHEM), Manchester Institute of Biotechnology and School of Chemistry, University of Manchester, Manchester M1 7DN, United Kingdom
| | - Andrew Currin
- Manchester Synthetic Biology Research Centre for Fine and Speciality Chemicals (SYNBIOCHEM), Manchester Institute of Biotechnology and School of Chemistry, University of Manchester, Manchester M1 7DN, United Kingdom
| | - Rehana Sung
- Manchester Synthetic Biology Research Centre for Fine and Speciality Chemicals (SYNBIOCHEM), Manchester Institute of Biotechnology and School of Chemistry, University of Manchester, Manchester M1 7DN, United Kingdom
| | - Helen Toogood
- Manchester Synthetic Biology Research Centre for Fine and Speciality Chemicals (SYNBIOCHEM), Manchester Institute of Biotechnology and School of Chemistry, University of Manchester, Manchester M1 7DN, United Kingdom
| | - Sandra Taylor
- Manchester Synthetic Biology Research Centre for Fine and Speciality Chemicals (SYNBIOCHEM), Manchester Institute of Biotechnology and School of Chemistry, University of Manchester, Manchester M1 7DN, United Kingdom
| | - Jean-Loup Faulon
- Manchester Synthetic Biology Research Centre for Fine and Speciality Chemicals (SYNBIOCHEM), Manchester Institute of Biotechnology and School of Chemistry, University of Manchester, Manchester M1 7DN, United Kingdom
- MICALIS, INRA-AgroParisTech, Domaine de Vilvert, 78352 Jouy en Josas Cedex, France
| | - Rainer Breitling
- Manchester Synthetic Biology Research Centre for Fine and Speciality Chemicals (SYNBIOCHEM), Manchester Institute of Biotechnology and School of Chemistry, University of Manchester, Manchester M1 7DN, United Kingdom
| | - Eriko Takano
- Manchester Synthetic Biology Research Centre for Fine and Speciality Chemicals (SYNBIOCHEM), Manchester Institute of Biotechnology and School of Chemistry, University of Manchester, Manchester M1 7DN, United Kingdom
| | - Nigel S. Scrutton
- Manchester Synthetic Biology Research Centre for Fine and Speciality Chemicals (SYNBIOCHEM), Manchester Institute of Biotechnology and School of Chemistry, University of Manchester, Manchester M1 7DN, United Kingdom
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6
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Alejos A, Schaubel D, Magee J, Colvin M, Sung R. Understanding Perceived Racial and Gender Differences in LVAD Use on the Transplant Waitlist. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.1094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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7
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Alshali RZ, Salim NA, Sung R, Satterthwaite JD, Silikas N. Analysis of long-term monomer elution from bulk-fill and conventional resin-composites using high performance liquid chromatography. Dent Mater 2015; 31:1587-98. [DOI: 10.1016/j.dental.2015.10.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 09/02/2015] [Accepted: 10/16/2015] [Indexed: 01/16/2023]
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8
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Alshali RZ, Salim NA, Sung R, Satterthwaite JD, Silikas N. Qualitative and quantitative characterization of monomers of uncured bulk-fill and conventional resin-composites using liquid chromatography/mass spectrometry. Dent Mater 2015; 31:711-20. [DOI: 10.1016/j.dental.2015.03.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/02/2015] [Accepted: 03/24/2015] [Indexed: 11/25/2022]
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9
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Flechner SM, Mulgoankar S, Melton LB, Waid TH, Agarwal A, Miller SD, Fokta F, Getts MT, Frederick TJ, Herrman JJ, Puisis JP, O’Toole L, Sung R, Shihab F, Wiseman AC, Getts DR. First-in-human study of the safety and efficacy of TOL101 induction to prevent kidney transplant rejection. Am J Transplant 2014; 14:1346-55. [PMID: 24751150 PMCID: PMC4404309 DOI: 10.1111/ajt.12698] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 01/31/2014] [Accepted: 01/31/2014] [Indexed: 02/06/2023]
Abstract
TOL101 is a murine IgM mAb targeting the αβ TCR. Unlike other T cell targets, the αβ TCR has no known intracellular signaling domains and may provide a nonmitogenic target for T cell inactivation. We report the 6-month Phase 2 trial data testing TOL101 in kidney transplantation. The study was designed to identify a dose that resulted in significant CD3 T cell modulation (<25 T cell/mm(3) ), to examine the safety and tolerability of TOL101 and to obtain preliminary efficacy information. Thirty-six patients were enrolled and given 5-10 daily doses of TOL101; 33 patients completed dosing, while three discontinued after two doses due to a self-limiting urticarial rash. Infusion adjustments, antihistamines, steroids and dose escalation of TOL101 reduced the incidence of the rash. Doses of TOL101 above 28 mg resulted in prolonged CD3 modulation, with rapid recovery observed 7 days after therapy cessation. There were no cases of patient or graft loss. Few significant adverse events were reported, with one nosocomial pneumonia. There were five biopsy-confirmed acute cellular rejections (13.9%); however, no donor-specific antibodies were detected. Overall TOL101 was well-tolerated, supporting continued clinical development using the dose escalating 21-28-42-42-42 mg regimen.
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Affiliation(s)
- S. M. Flechner
- Glickman Urology and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH,Corresponding author: Stuart M. Flechner,
| | - S. Mulgoankar
- Department of Nephrology, St. Barnabus Medical Center, Livingston, NJ
| | - L. B. Melton
- Department of Nephrology, Baylor University Medical Center, Dallas, TX
| | - T. H. Waid
- Department of Nephrology, University of Kentucky, Lexington, KY
| | - A. Agarwal
- Department of Surgery, University of Virginia, Charlottesville, VA
| | - S. D. Miller
- Department of Microbiology and Immunology, Northwestern University, Chicago, IL
| | - F. Fokta
- Tolera Therapeutics, Inc., Kalamazoo, MI
| | | | | | | | | | - L. O’Toole
- Tolera Therapeutics, Inc., Kalamazoo, MI
| | - R. Sung
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - F. Shihab
- Department of Nephrology, University of Utah, Salt Lake City, UT
| | - A. C. Wiseman
- Department of Nephrology, University of Colorado, Denver, CO
| | - D. R. Getts
- Department of Microbiology and Immunology, Northwestern University, Chicago, IL,Tolera Therapeutics, Inc., Kalamazoo, MI
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10
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Fuller J, Kim D, Arnhold E, Sung R, Borden A, Ortega L, Johnson R, Albornoz‐Williams H, Gummin C, Martinez A, Boldt N, Ogunkunle O, Ahn P, Kasten B, Furumo Q, Yorke N, McBride J, Mullooly I, Tripi M, Hutt D, Klestinski K, Kaiser C, Jackson W. The Silent Assassin (LB93). FASEB J 2014. [DOI: 10.1096/fasebj.28.1_supplement.lb93] [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: 11/11/2022]
Affiliation(s)
- J. Fuller
- Marquette University High SchoolMIlwaukeeWIUnited States
| | - D. Kim
- Marquette University High SchoolMIlwaukeeWIUnited States
| | - E. Arnhold
- Marquette University High SchoolMIlwaukeeWIUnited States
| | - R. Sung
- Marquette University High SchoolMIlwaukeeWIUnited States
| | - A. Borden
- Marquette University High SchoolMIlwaukeeWIUnited States
| | - L. Ortega
- Marquette University High SchoolMIlwaukeeWIUnited States
| | - R. Johnson
- Marquette University High SchoolMIlwaukeeWIUnited States
| | | | - C. Gummin
- Marquette University High SchoolMIlwaukeeWIUnited States
| | - A. Martinez
- Marquette University High SchoolMIlwaukeeWIUnited States
| | - N. Boldt
- Marquette University High SchoolMIlwaukeeWIUnited States
| | - O. Ogunkunle
- Marquette University High SchoolMIlwaukeeWIUnited States
| | - P. Ahn
- Marquette University High SchoolMIlwaukeeWIUnited States
| | - B. Kasten
- Marquette University High SchoolMIlwaukeeWIUnited States
| | - Q. Furumo
- Marquette University High SchoolMIlwaukeeWIUnited States
| | - N. Yorke
- Marquette University High SchoolMIlwaukeeWIUnited States
| | - J. McBride
- Marquette University High SchoolMIlwaukeeWIUnited States
| | - I. Mullooly
- Marquette University High SchoolMIlwaukeeWIUnited States
| | - M. Tripi
- Marquette University High SchoolMIlwaukeeWIUnited States
| | - D. Hutt
- Marquette University High SchoolMIlwaukeeWIUnited States
| | - K. Klestinski
- Marquette University High SchoolMIlwaukeeWIUnited States
| | - C. Kaiser
- Marquette University High SchoolMIlwaukeeWIUnited States
| | - William Jackson
- Microbiology and Molecular Genetics Medical College of WisconsinMIlwaukeeWIUnited States
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11
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Arnold E, Bell N, Boesen T, Boldt N, Borden A, Bro J, Douglas M, Fuller J, Furumo Q, Gummin C, Keuler A, Kim D, Martinez A, Moldenhauer D, Mullooly I, Nelsen‐Freund R, Ogunkunle D, Ortega L, Palmersheim S, Sabatino T, Schwabe B, Sung R, Trzcinski K, Ulschmid C, Klestinski K, Kaiser C, Vogt D, Cunningham CW. One Indole Ring to Rule Them All: How Modeling of Naltrindole Bound to the Delta Opioid Receptor Can Aid the Development of Novel Analgesics. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.lb171] [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: 11/11/2022]
Affiliation(s)
- E. Arnold
- Marquette University High SchoolMilwaukeeWI
| | - N. Bell
- Marquette University High SchoolMilwaukeeWI
| | - T. Boesen
- Marquette University High SchoolMilwaukeeWI
| | - N. Boldt
- Marquette University High SchoolMilwaukeeWI
| | - A. Borden
- Marquette University High SchoolMilwaukeeWI
| | - J. Bro
- Marquette University High SchoolMilwaukeeWI
| | - M. Douglas
- Marquette University High SchoolMilwaukeeWI
| | - J. Fuller
- Marquette University High SchoolMilwaukeeWI
| | - Q. Furumo
- Marquette University High SchoolMilwaukeeWI
| | - C. Gummin
- Marquette University High SchoolMilwaukeeWI
| | - A. Keuler
- Marquette University High SchoolMilwaukeeWI
| | - D. Kim
- Marquette University High SchoolMilwaukeeWI
| | | | | | | | | | | | - L. Ortega
- Marquette University High SchoolMilwaukeeWI
| | | | | | - B. Schwabe
- Marquette University High SchoolMilwaukeeWI
| | - R. Sung
- Marquette University High SchoolMilwaukeeWI
| | | | | | | | - C. Kaiser
- Marquette University High SchoolMilwaukeeWI
| | - D. Vogt
- Marquette University High SchoolMilwaukeeWI
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12
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Abstract
Consensus recommendations have been published to help better define those patients who would benefit from simultaneous liver-kidney transplantation (SLK). We conducted a survey of transplant centers that perform SLK (n = 88, 65% response rate) to determine practice patterns in the United States. The majority of centers (73%) stated that they use dialysis duration whereas only 30% of centers use acute kidney injury duration as a criterion for determining need for SLK. Dialysis duration >4 weeks was used by 32% of centers, >6 weeks by 37% and >8 weeks by 32% of centers. Glomerular filtration rate (GFR) was estimated using the modified diet in renal disease (MDRD)-4 equation in roughly half of centers whereas the MDRD-6 equation was used by only 6%. In patients with chronic kidney disease, GFR < 40 mL/min was used by 24% of centers as a criterion for SLK transplants instead of the recommended threshold of < 30 mL/min. Regional differences in practices were also observed. This survey demonstrates significant variation in the criteria used for SLK among transplant centers, with few centers following the current published recommendations, and emphasizes the need for evidence-based guidelines and uniformity in studying renal dysfunction in liver transplant candidates.
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Affiliation(s)
- M K Nadim
- Division of Nephrology, Department of Medicine, University of Southern California, Los Angeles, CA, USA.
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13
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Borden A, Fuller J, Kim D, Martinez A, Puchner J, Bell N, Bro J, Broadnax S, Gebhard J, Griffin N, Cummins C, Keuler A, Moldenhauer D, Sabatino T, Spaulding R, Sung R, Ulschmid C, Klestinski K, Vogt D, Czarnecki K, Mak P, Kincaid J. Cytochrome P450: The Metabolizer. FASEB J 2012. [DOI: 10.1096/fasebj.26.1_supplement.lb257] [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: 11/11/2022]
Affiliation(s)
- A. Borden
- Marquette University HIgh SchoolMilwaukeeWI
| | - J. Fuller
- Marquette University HIgh SchoolMilwaukeeWI
| | - D. Kim
- Marquette University HIgh SchoolMilwaukeeWI
| | | | - J. Puchner
- Marquette University HIgh SchoolMilwaukeeWI
| | - N. Bell
- Marquette University HIgh SchoolMilwaukeeWI
| | - J. Bro
- Marquette University HIgh SchoolMilwaukeeWI
| | | | - J. Gebhard
- Marquette University HIgh SchoolMilwaukeeWI
| | - N. Griffin
- Marquette University HIgh SchoolMilwaukeeWI
| | - C. Cummins
- Marquette University HIgh SchoolMilwaukeeWI
| | - A. Keuler
- Marquette University HIgh SchoolMilwaukeeWI
| | | | | | | | - R. Sung
- Marquette University HIgh SchoolMilwaukeeWI
| | | | | | - D. Vogt
- Marquette University HIgh SchoolMilwaukeeWI
| | - K. Czarnecki
- Department of ChemistryMarquette UniversityMilwaukeeWI
| | - P. Mak
- Department of ChemistryMarquette UniversityMilwaukeeWI
| | - J. Kincaid
- Department of ChemistryMarquette UniversityMilwaukeeWI
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14
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Fryer J, DaRosa DA, Wang E, Han L, Axelrod D, Ishitani M, Baker T, Knight R, Sung R, Magee J, Pomfret EA. What defines a transplant surgeon? A needs assessment for curricular development in transplant surgery fellowship training. Am J Transplant 2010; 10:664-74. [PMID: 20055807 DOI: 10.1111/j.1600-6143.2009.02956.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This study compares the perceptions of transplant surgery program directors (PDs) and recent fellowship graduates (RFs) regarding the adequacy of training and relevancy to practice of specific curricular content items in fellowship training. Surveys were sent to all American Society of Transplant Surgery approved fellowship PDs and all RFs in practice <5 years. For operative procedures, the RFs considered the overall training to be less adequate than the PDs (p = 0.0117), while both groups considered the procedures listed to be relevant to practice (p = 0.8281). Regarding nonoperative patient care items, although RFs tended to rank many individual items lower, both groups generally agreed that the training was both adequate and relevant. For nonpatient care related items (i.e. transplant-related ethics, economics, research, etc.), both groups scored them low regarding their adequacy of training although RFs scored them significantly lower than PDs (p = 0.0006). Regarding their relevance to practice, while both groups considered these items relevant, RFs generally considered them more relevant than PDs. Therefore, although there is consensus on many items, significant differences exist between PDs and RFs regarding their perceptions of the adequacy of training and the relevance to practice of specific curriculum items in transplant surgery fellowship training.
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Affiliation(s)
- J Fryer
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Davis CL, Feng S, Sung R, Wong F, Goodrich NP, Melton LB, Reddy KR, Guidinger MK, Wilkinson A, Lake J. Simultaneous liver-kidney transplantation: evaluation to decision making. Am J Transplant 2007; 7:1702-9. [PMID: 17532752 DOI: 10.1111/j.1600-6143.2007.01856.x] [Citation(s) in RCA: 172] [Impact Index Per Article: 10.1] [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: 01/25/2023]
Abstract
Questions about appropriate allocation of simultaneous liver and kidney transplants (SLK) are being asked because kidney dysfunction in the context of liver failure enhances access to deceased donor organs. There is specific concern that some patients who undergo combined liver and kidney transplantation may have reversible renal failure. There is also concern that liver transplants are placed prematurely in those with end-stage renal disease. Thus to assure allocation of transplants only to those truly in need, the transplant community met in March 2006 to review post-MELD (model for end-stage liver disease) data on the impact of renal function on liver waitlist and transplant outcomes and the results of SLK.
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Affiliation(s)
- C L Davis
- Department of Medicine, University of Washington, Seattle, WA, USA.
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Wong J, Sin NC, Sung R, Lee PSF, Lee KF, Lai PBS. Budd-Chiari-induced protein-losing enteropathy after liver transplantation. Transplant Proc 2007; 39:1554-7. [PMID: 17580187 DOI: 10.1016/j.transproceed.2007.02.095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2006] [Accepted: 02/05/2007] [Indexed: 10/23/2022]
Abstract
Budd-Chiari syndrome (BCS) is one of the uncommon complications of hepatic venous reconstruction in liver transplantation. Protein-losing enteropathy (PLE) secondary to this event has rarely been described. A 14-year-old girl suffering from acute hepatic failure underwent an emergency living-related liver transplantation and developed BCS 1 year later. Her condition has been managed with several sessions of hepatic venoplasty. On one occasion, she suffered septicemia and severe diarrhea, passing large amount of fibrinoid material. The diagnosis of PLE was made clinically, which resolved immediately after reestablishment of hepatic venous patency by balloon venoplasty. This observation suggested that BCS was responsible for PLE in this patient. Prompt diagnosis and early intervention for this life-threatening condition is essential.
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Affiliation(s)
- J Wong
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
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Saleh L, Gauvreau G, Duong M, Howie K, Cordova A, Sung R, Rerecich T, O'Byrne P. Regulation Of IL-5Rα On Bone Marrow Eosinophils and CD34+ Progenitors. J Allergy Clin Immunol 2006. [DOI: 10.1016/j.jaci.2005.12.997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
The aim of this study was to assess the reliability and validity of the 6-min walk test (6MWT) in healthy children. Chinese secondary school students were randomly recruited. They attended the current authors' unit on two occasions, separated by 2 weeks. Physical examination and standardised maximum incremental exercise testing on a treadmill were performed on the first visit. Spirometry and 6MWT were carried out on the second visit. A randomly selected subgroup was invited to return for repeat 6MWT at an interval of 2-4 weeks. Seventy-eight subjects were recruited; however, four failed to achieve maximal effort on exercise test. The final group included 43 young females and the mean+/-sd age of the subjects was 14.2+/-1.2 yrs. Physical examination was unremarkable in all cases. The mean+/-sd per cent predicted forced expiratory volume in one second was 91.4+/-10.2%. Concurrent validity was demonstrated by good correlation between the 6-min walking distance and maximum oxygen uptake determined on the exercise treadmill. Test-retest reliability was undertaken in 52 subjects, and the intraclass correlation coefficient (95% confidence interval) was calculated as 0.94 (0.89-0.96). In addition, Bland and Altman plots demonstrated a high degree of repeatability. In healthy children, the 6-min walk test is a reliable and valid functional test for assessing exercise tolerance and endurance.
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Affiliation(s)
- A M Li
- Dept. of Paediatrics, 6th Floor, Clinical Sciences Building, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong.
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Chen D, Murphy B, Sung R, Bromberg JS. Adaptive and innate immune responses to gene transfer vectors: role of cytokines and chemokines in vector function. Gene Ther 2003; 10:991-8. [PMID: 12756420 DOI: 10.1038/sj.gt.3302031] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- D Chen
- Carl C Ichan Center for Gene Therapy and Molecular Medicine, New York, NY 10029-6574, USA
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21
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Abstract
Gene transfer and gene therapy represent a relatively new field that has grown and expanded enormously in the last 5-10 years. The application of gene transfer and gene medicines to transplantation is currently in its infancy. Consideration for gene medicines in transplantation requires delivery of vectors, either to the graft or to the immune system. Delivery of vectors to the graft provides a choice of potential immunologic targets including: costimulatory signals; inhibitory cytokines; adhesion molecules; and molecules relating to apoptosis. In addition, non-immunologic targets, that increase graft protective mechanisms by reducing ischemic and immunologic damage, represent significant targets for gene transfer. Delivery of vectors to the immune system includes potential targets to modify the immune system, and results in tolerance. Other considerations for gene therapy include the development of additional technologies, such as gene conversion or transgenesis coupled with xenotransplantation, which may provide genetically modified organs. Another important aspect of gene transfer relates to regulation of the transgene expression. A variety of issues concerning innate immunity, adaptive immunity, response to vector components, response to transgene products, and entry of vectors into the antigen presentation and processing pathway require further investigation and refinement of approaches. Lastly, regulatable promoters and the understanding of their interaction with individual cells, tissues and organs, and their interaction with innate and adaptive immunity, are of paramount importance to improving the efficacy and utility of gene transfer. There is no doubt that there is much exciting basic and translational science to be accomplished in the next decade in order to solve these potential barriers and advance gene medicines into the clinical realm in transplantation.
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Affiliation(s)
- D Chen
- Carl C. Icahn Institute for Gene Therapy and Molecular Medicine and the Recanati/Miller Transplantation Institute, Mount Sinai School of Medicine, New York, NY 10029-6574, USA
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Affiliation(s)
- J S Bromberg
- Institute for Gene Therapy and Molecular Medicine, Mount Sinai School of Medicine, New York, New York 10029, USA
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Epstein JA, Sung R, Wang JC. Re: correlation between a positive Hoffmann's reflex and cervical pathology in asymptomatic individuals. Spine (Phila Pa 1976) 2001; 26:1639-40. [PMID: 11464162 DOI: 10.1097/00007632-200107150-00031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Ko GT, Tang J, Chan JC, Sung R, Wu MM, Wai HP, Chen R. Lower BMI cut-off value to define obesity in Hong Kong Chinese: an analysis based on body fat assessment by bioelectrical impedance. Br J Nutr 2001; 85:239-42. [PMID: 11242492 DOI: 10.1079/bjn2000251] [Citation(s) in RCA: 140] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
There is increasing evidence suggesting that the cut-off values for defining obesity used in the Western countries cannot be readily applied to Asians, who often have smaller body frames than Caucasians. We examined the BMI and body fat (BF) as measured by bioelectrical impedance in 5153 Hong Kong Chinese subjects. We aimed to assess the optimal BMI reflecting obesity as defined by abnormal BF in Hong Kong Chinese. Receiver operating characteristic curve (ROC) analysis was used to assess the optimal BMI predicting BF at different levels. The mean age and SD of the 5153 subjects (3734 women and 1419 men) was 51.5 (SD 16.3) years (range: 18.0-89.5 years, median: 50.7 years). Age-adjusted partial correlation (r) between BMI and BF in women and men were 0.899 (P < 0.001) and 0.818 (P < 0.001) respectively. Using ROC analysis, the BMI corresponding to the conventional upper limit of normal BF was 22.5-23.1 kg/m(2), and the BMI corresponding to the 90 percentiles of BF was 25.4-26.1 kg/m(2). Despite similar body fat contents, the BMI cut-off value used to define obesity in Hong Kong Chinese should be lower as compared to Caucasians. We suggest a BMI of 23 kg/m(2) and 26 kg/m(2) as the cut-off values to define overweight and obesity respectively in Hong Kong Chinese.
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Affiliation(s)
- G T Ko
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, 11, Chuen On Road, Tai Po, Hong Kong.
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25
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Shen P, Wang F, Underhill PA, Franco C, Yang WH, Roxas A, Sung R, Lin AA, Hyman RW, Vollrath D, Davis RW, Cavalli-Sforza LL, Oefner PJ. Population genetic implications from sequence variation in four Y chromosome genes. Proc Natl Acad Sci U S A 2000; 97:7354-9. [PMID: 10861003 PMCID: PMC16549 DOI: 10.1073/pnas.97.13.7354] [Citation(s) in RCA: 149] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Some insight into human evolution has been gained from the sequencing of four Y chromosome genes. Primary genomic sequencing determined gene SMCY to be composed of 27 exons that comprise 4,620 bp of coding sequence. The unfinished sequencing of the 5' portion of gene UTY1 was completed by primer walking, and a total of 20 exons were found. By using denaturing HPLC, these two genes, as well as DBY and DFFRY, were screened for polymorphic sites in 53-72 representatives of the five continents. A total of 98 variants were found, yielding nucleotide diversity estimates of 2.45 x 10(-5), 5. 07 x 10(-5), and 8.54 x 10(-5) for the coding regions of SMCY, DFFRY, and UTY1, respectively, with no variant having been observed in DBY. In agreement with most autosomal genes, diversity estimates for the noncoding regions were about 2- to 3-fold higher and ranged from 9. 16 x 10(-5) to 14.2 x 10(-5) for the four genes. Analysis of the frequencies of derived alleles for all four genes showed that they more closely fit the expectation of a Luria-Delbrück distribution than a distribution expected under a constant population size model, providing evidence for exponential population growth. Pairwise nucleotide mismatch distributions date the occurrence of population expansion to approximately 28,000 years ago. This estimate is in accord with the spread of Aurignacian technology and the disappearance of the Neanderthals.
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Affiliation(s)
- P Shen
- Stanford DNA Sequencing and Technology Center, 855 California Avenue, Palo Alto, CA 94304, USA.
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Abstract
OBJECTIVE The route of transmission of Helicobacter pylori (H. pylori) is unclear. Gastro-oral transmission via contaminated vomitus has been proposed as an important mode of transmitting H. pylori, especially in children. This pilot study attempted to isolate H. pylori from the vomitus of children. METHODS Children presenting for evaluation with gastroenteritis-associated vomiting were studied. Fresh vomitus samples were collected for detection of H. pylori by bacteriological culture and polymerase chain reaction, (PCR). A rapid, whole blood test was used to determine the H. pylori status of patients. RESULTS A total of 18 children with mean age of 6 yr were studied; four had a positive serology test. Among these four children, H. pylori was isolated from vomitus by culture in one child and by PCR in two. An 18-month-old girl with negative serology had H. pylori detected in vomitus by PCR. Six months later, she had seroconversion confirmed, suggesting that she had an acute H. pylori infection on initial presentation. CONCLUSIONS This is the first study reporting successful isolation of H. pylori from naturally produced vomitus. The result implies that transmission of H. pylori infection by vomitus, especially in children, is possible.
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Affiliation(s)
- W K Leung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin
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Larson MS, McDonald K, Young C, Sung R, Hlatky MA. Quality of life before and after radiofrequency catheter ablation in patients with drug refractory atrioventricular nodal reentrant tachycardia. Am J Cardiol 1999; 84:471-3, A9. [PMID: 10468092 DOI: 10.1016/s0002-9149(99)00338-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In a retrospective survey of 161 highly symptomatic patients, we found significant improvements in symptoms, patient utility, and use of medical care services after radiofrequency ablation for atrioventricular nodal reentrant tachycardia.
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Affiliation(s)
- M S Larson
- Department of Health Research and Policy, Stanford University School of Medicine, California 94305-5405, USA
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Abstract
OBJECTIVE Comparison of the healing process in open osteotomy and closed fracture models that were used to study fracture healing. DESIGN Randomized, prospective study in experimental animals, with a recovery duration of two and four weeks. SETTING Unrestricted cage activity with weight bearing as tolerated. ANIMALS Thirty-four skeletally mature, female New Zealand White rabbits. INTERVENTIONS Closed fractures and open osteotomies of the tibial diaphysis were reduced and immobilized with four-pin, double-bar external fixators. MAIN OUTCOME MEASUREMENTS Callus circumference was measured with a tape measure, bridging callus was assessed on biplane radiographs and evaluated histologically, and torsional stiffness and maximum torque were measured. RESULTS Periosteum damage was more severe and hematoma formation was smaller in the osteotomy model, resulting in a delay in biological healing and restoration of the biomechanical properties. CONCLUSIONS Investigators should consider the difference between the closed fracture and open osteotomy models when selecting an animal model to investigate fracture healing.
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Affiliation(s)
- S H Park
- The J. Vernon Luck, Sr., M.D., Orthopaedic Research Center, Los Angeles Orthopaedic Hospital, California 90007, USA
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Abstract
A 5-year territory-wide retrospective survey of invasive Haemophilus influenzae type b (Hib) diseases in Hong Kong established that the annual incidence for children <5 years old was 2.7 per 100000 [95% confidence interval (CI), 2.0 to 3.5]. However, the corresponding annual incidence in Vietnamese refugees in Hong Kong was 42.7 per 100000 (95% CI 17.2 to 87.9), giving a relative risk of 18.5 (95% CI 8.3 to 41.0). The nasopharyngeal carriage rate of Hib was zero in 621 healthy Chinese children and 1.3% (95% CI 0.04 to 2.63%) in 300 healthy Vietnamese refugees 2 months to 5 years old in Hong Kong. The corresponding carriage rate of nontypable H. influenzae was 5.8% (95% CI 1.4 to 7.6%) in Chinese and 65.4% (95% CI 58.9 to 69.8) in Vietnamese. In a larger study of 1812 healthy Chinese children between 6 months and 5 years of age investigated by throat swabs, again no Hib was isolated but 141 children (7.8%) were found to be carriers of nontype b H. influenzae. In a study of 596 healthy Chinese children and adults, 25% had the protective level of anti-Hib antibody of >0.15 microg/ml by 1 year and 90% had reached >0.15 microg/ml by 6 years of age. There was some evidence that these "natural" antibodies against Hib in Hong Kong Chinese were cross-reacting antibodies against antigens on other encapsulated bacteria.
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Affiliation(s)
- Y L Lau
- Department of Pediatrics, Queen Mary Hospital, The University of Hong Kong, Hong Kong
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Yuen KY, Chan PK, Peiris M, Tsang DN, Que TL, Shortridge KF, Cheung PT, To WK, Ho ET, Sung R, Cheng AF. Clinical features and rapid viral diagnosis of human disease associated with avian influenza A H5N1 virus. Lancet 1998; 351:467-71. [PMID: 9482437 DOI: 10.1016/s0140-6736(98)01182-9] [Citation(s) in RCA: 739] [Impact Index Per Article: 28.4] [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: 02/06/2023]
Abstract
BACKGROUND Human infection with an avian influenza A virus (subtype H5N1) was reported recently in Hong Kong. We describe the clinical presentation of the first 12 patients and options for rapid viral diagnosis. METHODS Case notes of 12 patients with virus-culture-confirmed influenza A H5N1 infection were analysed. The clinical presentation and risk factors associated with severe disease were defined and the results of methods for rapid virus diagnosis were compared. FINDINGS Patients ranged from 1 to 60 years of age. Clinical presentation was that of an influenza-like illness with evidence of pneumonia in seven patients. All seven patients older than 13 years had severe disease (four deaths), whereas children 5 years or younger had mild symptoms with the exception of one who died with Reye's syndrome associated with intake of aspirin. Gastrointestinal manifestations, raised liver enzymes, renal failure unrelated to rhabdomyolysis, and pancytopenia were unusually prominent. Factors associated with severe disease included older age, delay in hospitalisation, lower-respiratory-tract involvement, and a low total peripheral white blood cell count or lymphopenia at admission. An H5-specific reverse-transcription PCR assay (RT-PCR) was useful for rapid detection of virus directly in respiratory specimens. A commercially available enzyme immunoassay was more sensitive than direct immunofluorescence for rapid viral diagnosis. Direct immunofluorescence with an H5-specific monoclonal antibody pool was useful for rapid exclusion of H5-subtype infection. INTERPRETATION Avian Influenza A H5N1 virus causes human influenza-like illness with a high rate of complications in adults admitted to hospital. Rapid H5-subtype-specific laboratory diagnosis can be made by RT-PCR applied directly to clinical specimens.
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Affiliation(s)
- K Y Yuen
- Department of Microbiology, University of Hong Kong, China
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Sung R. Clinical and Electrophysiological Significance of Induction of Morphologically Different Ventricular Fibrillation During Ventricular Vulnerable Period in Humans. J Am Coll Cardiol 1998. [DOI: 10.1016/s0735-1097(97)85167-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
This report presents a case of calcifying fibrous pseudotumor arising in the posterior mediastinum of a 54-year-old woman. The histopathologic features of this case were identical to that of calcifying fibrous pseudotumor first designated in 1993. It is a distinctive benign fibrous lesion characterized by the presence of characteristics psammomatous or dystrophic calcification, abundant hyalinized collagen and lymphoplasmacytic cell infiltrate. Immunohistochemically most of the scattered fibroblasts were positive for vimentin, but not for CD-34 and cytokeratins, distinguishing it from solitary fibrous tumor of pleura and desmoplastic mesothelioma. The unusual site of the posterior mediastinum and the old age characterize this case.
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Affiliation(s)
- H S Jeong
- Department of Pathology and Thoracic Surgery, College of Medicine, Chungbuk National University, Cheongiu, Korea
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Lieberman JR, Sung R, Dorey F, Thomas BJ, Kilgus DJ, Finerman GA. Low-dose warfarin prophylaxis to prevent symptomatic pulmonary embolism after total knee arthroplasty. J Arthroplasty 1997; 12:180-4. [PMID: 9139100 DOI: 10.1016/s0883-5403(97)90064-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [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: 02/04/2023] Open
Abstract
Pulmonary embolism poses a risk to patients undergoing total knee arthroplasty. The selection of an appropriate prophylaxis agent and its implementation have been influenced by decreased duration of hospital stay and the pressures of cost containment. The purpose of this study was to determine the inpatient and outpatient pulmonary embolism rates, the number of days required to attain the target level of anticoagulation, and complications associated with the use of a low-dose warfarin prophylaxis protocol after primary and revision total knee arthroplasty. Between 1984 and 1993, there were 815 primary and revision total knee arthroplasties that received low-dose warfarin prophylaxis at our institution. The average time to attainment of the target level of anticoagulation was 3 days. The average duration of warfarin prophylaxis was 12 days. Overall, there were a total of three symptomatic pulmonary embolisms (0.3%; 95% confidence interval, 0.08%-1.1%). There were eight (1%) symptomatic deep vein thromboses (all distal). There were two deaths (0.3%), but neither one was secondary to a pulmonary embolism. Seventeen knees (2.5%) developed a hematoma after surgery, and two of these patients required drainage of the knee. Low-dose warfarin prophylaxis is safe and effective in preventing symptomatic pulmonary embolism after total knee arthroplasty.
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Affiliation(s)
- J R Lieberman
- Department of Orthopaedic Surgery, UCLA Medical Center 90095, USA
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Botvinick E, Frais M, O'Connell W, Faulkner D, Scheinman M, Morady F, Sung R, Shosa D, Dae M. Phase image evaluation of patients with ventricular pre-excitation syndromes. J Am Coll Cardiol 1984; 3:799-814. [PMID: 6693651 DOI: 10.1016/s0735-1097(84)80257-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
To localize bypass pathways, left and right ventricular regions were analyzed at rest by phase image analysis in 18 patients with ventricular pre-excitation syndromes. These were compared with image findings in 18 normal subjects. In each of 17 patients with pre-excitation, the site localized on electrophysiologic study correlated closely with the region of earliest ventricular phase angle. This site could be objectively separated from that in normal subjects in each of eight patients with an active left-sided pathway and in both patients with a right-sided pathway. Those with a septal pathway revealed earliest septal phase angle, but could not be separated from normal subjects. In the eight patients with an active left bypass tract, the onset, upstroke and peak of the left ventricular phase histogram preceded those of the right ventricular histogram. Those with a left-sided pathway demonstrated a mean left ventricular phase angle, a difference between mean left and mean right ventricular phase angle and a difference between earliest left and right ventricular phase angles which was significantly less than that in normal subjects (p less than 0.05). These variables presented characteristic converse changes in those with a right-sided pathway. Sequential phase changes in 10 studies suggested "fusion" of normal septal with lateral bypass fronts. Electrocardiographic and electrophysiologic localization of the bypass pathway agreed in only 8 of 14 patients with a recognized delta wave. The phase image represents a new, noninvasive method of evaluating ventricular pre-excitation. The method may provide useful information complementary to that of electrocardiographic and electrophysiologic analysis.
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Sung R, Stephens M, Blayney L, Henderson A. Cardiac hypertrophy and its regression in rat: comparison of morphological changes in response to aortic constriction, iron deficiency anaemia and isoprenaline. J Mol Cell Cardiol 1982; 14:501-12. [PMID: 6217348 DOI: 10.1016/0022-2828(82)90211-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Botvinick E, Frais M, Shosa D, O'Connell W, Pacheco J, Morady F, Sheinman M, Sung R. Interpretation of the phase image in WPW — Its advantages as a clinical and research tool. Am J Cardiol 1982. [DOI: 10.1016/0002-9149(82)92387-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Richter S, Aranda JM, Embi A, Sung R, El-Sherif N, Befeler B. Functional significance of electrocardiographic changes after left ventricular aneurysmectomy. J Electrocardiol 1978; 11:247-52. [PMID: 308526 DOI: 10.1016/s0022-0736(78)80124-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Electrocardiographic (ECG) changes after left ventricular aneurysmectomy were analyzed in 20 patients, thirteen of whom had additional aorto coronary saphenous vein bypass surgery. ECG changes were correlated with postoperative clinical and hemodynamic results. Out of 14 patients (Group I) who showed hemodynamic and/or clinical improvement, eight had decrease of chronic ST segment elevation that was associated in five with loss of pathologic Q waves. In the remaining six patients (Group II) who showed no hemodynamic or clinical improvement as well as in six patients in Group I, chronic ST segment elevation persisted or increased and in some, new pathologic Q waves developed after surgery. The study suggests that loss of pathologic Q waves and/or decrease of chronic ST segment elevation in patients who undergo a left ventricular aneurysmectomy with aorto coronary saphenous vein bypass surgery may reflect postoperative clinical, hemodynamic and angiographic improvement. On the other hand, failure of these ECG changes to occur or, conversely, increased ST segment elevation and/or appearance of new Q waves may have no predictive value. The mechanisms for these ECG changes are discussed.
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