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Pathak SJ, Attard T, Hall M, Arain M, Heyman MB, Perito ER. Availability and utilization of endoscopic retrograde cholangiopancreatography at children's hospitals. J Pediatr Gastroenterol Nutr 2024. [PMID: 38506111 DOI: 10.1002/jpn3.12183] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 01/18/2024] [Accepted: 02/20/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVES No study has explored whether availability of endoscopic retrograde cholangiopancreatography (ERCP) is adequate and equitable across US children's hospitals. We hypothesized that ERCP availability and utilization differs by geography and patient factors. METHODS Healthcare encounter data from 2009 to 2019 on children with pancreatic and biliary diseases from the Pediatric Health Information System were analyzed. ERCP availability was defined as treatment at a hospital that performed pediatric ERCP during the year of service. RESULTS From 2009 to 2019, 37,946 children (88,420 encounters) had a potential pancreatic or biliary indication for ERCP; 7066 ERCPs were performed. The commonest pancreatic diagnoses leading to ERCP were chronic (47.2%) and acute pancreatitis (43.2%); biliary diagnoses were calculus (68.3%) and obstruction (14.8%). No ERCP was available for 25.0% of pancreatic encounters and 8.1% of biliary encounters. In multivariable analysis, children with public insurance, rural residence, or of Black race were less likely to have pancreatic ERCP availability; those with rural residence or Asian race were less likely to have biliary ERCP availability. Black children or those with public insurance were less likely to undergo pancreatic ERCP where available. Among encounters for calculus or obstruction, those of Black race or admitted to hospitals in the West were less likely to undergo ERCP when available. CONCLUSIONS One-in-four children with pancreatic disorders and one-in-12 with biliary disorders may have limited access to ERCP. We identified racial and geographic disparities in availability and utilization of ERCP. Further studies are needed to understand these differences to ensure equitable care.
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Affiliation(s)
- Sagar J Pathak
- Department of Pediatrics, UCSF Benioff Children's Hospital San Francisco and University of California, San Francisco, California, USA
| | - Thomas Attard
- Division of Gastroenterology, Hepatology and Nutrition, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Matthew Hall
- Children's Hospital Association, Overland Park, Kansas, USA
| | - Mustafa Arain
- Department of Gastroenterology, AdventHealth Medical Group Interventional Endoscopy, Orlando, Florida, USA
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Melvin B Heyman
- Department of Pediatrics, UCSF Benioff Children's Hospital San Francisco and University of California, San Francisco, California, USA
| | - Emily R Perito
- Department of Pediatrics, UCSF Benioff Children's Hospital San Francisco and University of California, San Francisco, California, USA
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2
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Low Kapalu CM, Uraizee O, Lerner DG, Thomson M, Attard T. Endoscopist experience with pediatric recurrent and intentional foreign body ingestion (RIFBI): Management considerations and future directions. J Pediatr Gastroenterol Nutr 2024; 78:711-719. [PMID: 38284750 DOI: 10.1002/jpn3.12114] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 11/30/2023] [Accepted: 12/11/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVES AND STUDY Accidental foreign body ingestion (FBI) is a common pediatric referral concern. In contrast, recurrent and intentional FBI (RIFBI) is infrequent and associated with greater endoscopic and surgical intervention in adults. Although pediatric guidelines exist for FBI, the risk and therapeutic implications of RIFBI are not addressed. An anonymous international survey on pediatric gastroenterologist experience with RIFBI was distributed. METHODS A 33-item REDCap© survey was distributed via email to pediatric gastroenterologists identified through mailing and email lists obtained from pediatric gastroenterology professional organizations. RESULTS During 9-12/2021 we accrued 202 completed surveys. Respondents were from 27 countries and across the career span. Eighty percent reported experience with RIFBI; 74% reported seeing ≤ 3 patients with RIFBI within the past 24 months and 4% reported seeing ≥ 6. Of those who treated RIFBI, 38% reported an average number of annual ingestions per patient was ≥5. Frequent morbidity but not mortality was reported. Half reported adherence to FBI guidelines. Later-career endoscopists treated RIFBI more aggressively than accidental ingestion. Ninety-six percent noted that patients with RIFBI had psychiatric comorbidities. Providers at academic medical centers reported referring to behavioral health more than those in other settings. CONCLUSION Most gastroenterologists surveyed reported encountering RFBI several times a year and in patients with psychiatric comorbidities. Greater likelihood of adverse outcomes associated with endoscopy was reported. Most reported referral to behavioral health and few had RIFBI management protocols. A broader spectrum of psychologic comorbidities in the pediatric population with RIFBI, notably depression and autism spectrum disorder, were reported.
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Affiliation(s)
- Christina M Low Kapalu
- Pediatric Psychology and Gastroenterology, Oregon Health & Science University, Portland, Oregon, USA
- Gastroenterology, Hepatology and Nutrition, Children's Mercy Kansas City, Kansas City, Missouri, USA
- Department of Pediatrics, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Omar Uraizee
- College of Osteopathic Medicine, Kansas City University, Kansas City, Missouri, USA
| | - Diana G Lerner
- Section of Gastroenterology, Hepatology, and Nutrition, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Mike Thomson
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Thomas Attard
- Gastroenterology, Hepatology and Nutrition, Children's Mercy Kansas City, Kansas City, Missouri, USA
- Department of Pediatrics, University of Missouri Kansas City, Kansas City, Missouri, USA
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3
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Cohen S, Hyer W, Attard T. Endoscopy in pediatric polyposis syndromes: why, when and how. Eur J Gastroenterol Hepatol 2024; 36:255-263. [PMID: 38251433 DOI: 10.1097/meg.0000000000002702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Single or multiple polyps are frequently encountered during colonoscopy among children and adolescents and may be indicative of hereditary polyposis syndrome (HPS). The management of children with single or multiple polyps is guided by the number of polyps, their distribution and the histological findings. Children with HPS carry a high risk of complications, including intestinal and extra-intestinal malignancies. The goals of surveillance in pediatric HPS are to treat symptoms, monitor the burden of polyps and prevent short- and long-term complications. Therefore, the management of children with HPS is based on therapeutic endoscopy. The strategy of therapeutic endoscopy is a careful assessment and characterization of the polyps and performing polypectomies using advanced endoscopic techniques. A multidisciplinary approach, comprising clinical, interventional endoscopy, cancer surveillance and support of familial and emotional aspects is essential in the management of children with HPS.
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Affiliation(s)
- Shlomi Cohen
- Pediatric Gastroenterology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Warren Hyer
- St Mark's Hospital Polyposis Registry, Harrow, UK
| | - Thomas Attard
- Division of Gastroenterology, Hepatology and Nutrition, The University of Missouri in Kansas Division of Gastroenterology, Hepatology and Nutrition, City School of Medicine, Children's Mercy Hospital Kansas City, Missouri, USA
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Sami AS, Sylvester FA, Attard T, Mir S. Fundic Gland Polyps: Strategizing a Surveillance Framework for Children and Adolescents. J Pediatr Gastroenterol Nutr 2023; 77:439-441. [PMID: 37440343 DOI: 10.1097/mpg.0000000000003891] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Affiliation(s)
- Ahmad Salah Sami
- From the Division of Pediatric Gastroenterology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Francisco A Sylvester
- From the Division of Pediatric Gastroenterology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Thomas Attard
- the Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Missouri School of Medicine, Children's Mercy Kansas City, Kansas City, MO
| | - Sabina Mir
- From the Division of Pediatric Gastroenterology, University of North Carolina at Chapel Hill, Chapel Hill, NC
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5
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Alatorre-Jimenez M, Attard T. Incidental Finding of an Inverted Appendix. J Pediatr Gastroenterol Nutr 2023; 77:e61. [PMID: 37195888 DOI: 10.1097/mpg.0000000000003832] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
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6
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Chevalier R, Attard T, Van Driest SL, Shakhnovich V. A fresh look at proton pump inhibitor (PPI)-associated adverse events through a CYP2C19 pharmacogenetic lens. Expert Opin Drug Metab Toxicol 2023; 19:53-56. [PMID: 36919492 DOI: 10.1080/17425255.2023.2190883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Affiliation(s)
- Rachel Chevalier
- University of Missouri School of Medicine, Kansas, MO, USA
- Children's Mercy Kansas City, Division of Gastroenterology, Hepatology and Nutrition, Kansas City, MO, USA
| | - Thomas Attard
- University of Missouri School of Medicine, Kansas, MO, USA
- Children's Mercy Kansas City, Division of Gastroenterology, Hepatology and Nutrition, Kansas City, MO, USA
| | - Sara L Van Driest
- Department of Pediatrics, Center for Pediatric Precision Medicine, Nashville, TN, USA
| | - Valentina Shakhnovich
- University of Missouri School of Medicine, Kansas, MO, USA
- Children's Mercy Kansas City, Division of Gastroenterology, Hepatology and Nutrition, Kansas City, MO, USA
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Stoecklein N, Ahmed AA, Lawson CE, Attard T. PTEN Hamartoma Syndrome in a Child Presenting With Malrotation, Panintestinal Polyps, Severe Anemia, and Protein-Losing Enteropathy. JPGN Rep 2021; 2:e092. [PMID: 37205954 PMCID: PMC10191558 DOI: 10.1097/pg9.0000000000000092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 03/21/2021] [Indexed: 05/21/2023]
Abstract
PTEN hamartoma syndrome (PTEN-HS) is a rare syndrome including neurologic, neurodevelopmental, integumentary, endocrine, and gastrointestinal manifestations. Eosinophilic disorders of the gastrointestinal system are diverse group of disorders reported to be more common in PTEN-HS. Our patient had malrotation and obstruction in infancy and subsequently developed macrocephaly and a lipoma. She presented at 4 years of age with both iron deficiency anemia and hypoalbuminemia from protein-losing enteropathy. She went on to endoscopy, colonoscopy, and video capsule endoscopy showing gastric, small intestinal, and colonic polyps but with histology including both a mixed histologic characterization of the polyps as expected with PTEN-HS, along with eosinophilic esophagitis, gastric, duodenal, colonic and polyp eosinophilia. She improved with enteral nutritional support and budesonide. Intestinal malrotation is a previously unrecognized feature of PTEN-HS, in our patient protein-losing enteropathy may have resulted from polyposis or eosinophilic gastrointestinal disorder. Albeit rare, PTEN-HS represents an elusive differential diagnosis with a broad spectrum including gastrointestinal symptomatology. Our case report illustrates the overlap of clinical, endoscopic, and histologic findings that can complicate PTEN-HS.
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Affiliation(s)
- Nicole Stoecklein
- From the Pediatric Gastroenterology, Children’s Mercy Hospital Kansas City, Kansas City, MO
| | - Atif A. Ahmed
- Anatomic Pathology, Children’s Mercy Hospital Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | | | - Thomas Attard
- Pediatric Gastroenterology, Children’s Mercy Hospital Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO
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Halma J, Attard T. Small Bowel Hemolymphangioma Treated by Polypectomy in a Pediatric Patient with Cystic Fibrosis. JPGN Rep 2021; 2:e060. [PMID: 37207072 PMCID: PMC10191469 DOI: 10.1097/pg9.0000000000000060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/20/2021] [Indexed: 05/21/2023]
Affiliation(s)
- Jennifer Halma
- From the Department of Gastroenterology, Children’s Mercy Hospital, Kansas City, MO
| | - Thomas Attard
- From the Department of Gastroenterology, Children’s Mercy Hospital, Kansas City, MO
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9
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Martin I, Hawkins J, Hyer W, Attard T, Cohen S, Spigelman A, Clark SK, Latchford A. Upper GI in patients with FAP-the need for formal research. Gastrointest Endosc 2020; 91:206-207. [PMID: 31865993 DOI: 10.1016/j.gie.2019.07.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 07/27/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Isabel Martin
- St Mark's Hospital Polyposis Registry, London, UK; Imperial College, London, UK
| | | | - Warren Hyer
- St Mark's Hospital Polyposis Registry, London, UK; Imperial College, London, UK
| | | | | | | | - Susan K Clark
- St Mark's Hospital Polyposis Registry, London, UK; Imperial College, London, UK
| | - Andrew Latchford
- St Mark's Hospital Polyposis Registry, London, UK; Imperial College, London, UK
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10
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James AD, Richardson DA, Oh IW, Sritangos P, Attard T, Barrett L, Bruce JIE. Cutting off the fuel supply to calcium pumps in pancreatic cancer cells: role of pyruvate kinase-M2 (PKM2). Br J Cancer 2020; 122:266-278. [PMID: 31819190 PMCID: PMC7052184 DOI: 10.1038/s41416-019-0675-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [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: 05/28/2019] [Revised: 11/13/2019] [Accepted: 11/15/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Pancreatic ductal adenocarcinoma (PDAC) has poor survival and treatment options. PDAC cells shift their metabolism towards glycolysis, which fuels the plasma membrane calcium pump (PMCA), thereby preventing Ca2+-dependent cell death. The ATP-generating pyruvate kinase-M2 (PKM2) is oncogenic and overexpressed in PDAC. This study investigated the PKM2-derived ATP supply to the PMCA as a potential therapeutic locus. METHODS PDAC cell growth, migration and death were assessed by using sulforhodamine-B/tetrazolium-based assays, gap closure assay and poly-ADP ribose polymerase (PARP1) cleavage, respectively. Cellular ATP and metabolism were assessed using luciferase/fluorescent-based assays and the Seahorse XFe96 analyzer, respectively. Cell surface biotinylation identified membrane-associated proteins. Fura-2 imaging was used to assess cytosolic Ca2+ overload and in situ Ca2+ clearance. PKM2 knockdown was achieved using siRNA. RESULTS The PKM2 inhibitor (shikonin) reduced PDAC cell proliferation, cell migration and induced cell death. This was due to inhibition of glycolysis, ATP depletion, inhibition of PMCA and cytotoxic Ca2+ overload. PKM2 associates with plasma membrane proteins providing a privileged ATP supply to the PMCA. PKM2 knockdown reduced PMCA activity and reduced the sensitivity of shikonin-induced cell death. CONCLUSIONS Cutting off the PKM2-derived ATP supply to the PMCA represents a novel therapeutic strategy for the treatment of PDAC.
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Affiliation(s)
- Andrew D James
- Division of Cancer Sciences, Faculty of Biology, Medicine & Health Sciences, The University of Manchester, Michael Smith Building, Manchester, M13 9PT, UK
- Division of Cancer Sciences, Department of Biology, University of York, Heslington, York, YO10 5DD, UK
| | - Daniel A Richardson
- Division of Cancer Sciences, Faculty of Biology, Medicine & Health Sciences, The University of Manchester, Michael Smith Building, Manchester, M13 9PT, UK
| | - In-Whan Oh
- Division of Cancer Sciences, Faculty of Biology, Medicine & Health Sciences, The University of Manchester, Michael Smith Building, Manchester, M13 9PT, UK
| | - Pishyaporn Sritangos
- Division of Cancer Sciences, Faculty of Biology, Medicine & Health Sciences, The University of Manchester, Michael Smith Building, Manchester, M13 9PT, UK
| | - Thomas Attard
- Division of Cancer Sciences, Faculty of Biology, Medicine & Health Sciences, The University of Manchester, Michael Smith Building, Manchester, M13 9PT, UK
| | - Lisa Barrett
- Division of Cancer Sciences, Faculty of Biology, Medicine & Health Sciences, The University of Manchester, Michael Smith Building, Manchester, M13 9PT, UK
| | - Jason I E Bruce
- Division of Cancer Sciences, Faculty of Biology, Medicine & Health Sciences, The University of Manchester, Michael Smith Building, Manchester, M13 9PT, UK.
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Abstract
Mental health disorders in adolescents present some of the most challenging of all ethical dilemmas. This is particularly true when they lead to self-injurious behavior that can only be prevented by either limiting the freedom of the adolescent or forcing treatments on them that they do not want. Intentional and repeated foreign-body ingestion (FBI) in youth is a poorly understood self-injurious behavior that can be life-threatening. It poses unique clinical and ethical challenges. Ingestion of sharp or magnetic objects increases the need for endoscopic retrieval or surgical intervention with associated risks, including perforation and anesthesia-related adverse events. When behavior modification efforts fail to prevent recurrent FBI, the cumulative risk of medical intervention mounts. Sometimes, as a last resort, doctors consider surgical procedures that limit jaw movement and may physically prevent recurrent FBI. In this Ethics Rounds article, we present a case in which doctors consider whether it is in the best interest of a teenager with this behavior to undergo orthodontic jaw wiring as a next step in treatment of repeated FBI. Doctor commentary on the ethical decision-making process is provided.
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Affiliation(s)
- Christina Low Kapalu
- Children's Mercy Kansas City, Kansas City, Missouri; .,School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri; and
| | - John Lantos
- Children's Mercy Kansas City, Kansas City, Missouri.,School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri; and
| | - Adam Booser
- Children's Mercy Kansas City, Kansas City, Missouri.,School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri; and
| | - Mike Thomson
- Department of Gastroenterology, Sheffield Children's Hospital, Western Bank, Sheffield, United Kingdom
| | - Thomas Attard
- Children's Mercy Kansas City, Kansas City, Missouri.,School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri; and
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Krishnamachary B, Subramaniam D, Dandawate P, Ponnurangam S, Srinivasan P, Ramamoorthy P, Umar S, Thomas SM, Dhar A, Septer S, Weir SJ, Attard T, Anant S. Targeting transcription factor TCF4 by γ-Mangostin, a natural xanthone. Oncotarget 2019; 10:5576-5591. [PMID: 31608135 PMCID: PMC6771460 DOI: 10.18632/oncotarget.27159] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 04/10/2019] [Accepted: 07/17/2019] [Indexed: 01/29/2023] Open
Abstract
Given that colon cancer is the third most common cancer in incidence and cause of death in the United States, and current treatment modalities are insufficient, there is a need to develop novel agents. Towards this, here we focus on γ-Mangostin, a bioactive compound present in the Mangosteen (Garcinia mangostana) fruit. γ-Mangostin suppressed proliferation and colony formation, and induced cell cycle arrest and apoptosis of colon cancer cell lines. Further, γ-Mangostin inhibited colonosphere formation. Molecular docking and CETSA (Cellular thermal shift assay) binding assays demonstrated that γ-Mangostin interacts with transcription factor TCF4 (T-Cell Factor 4) at the β-catenin binding domain with the binding energy of -5.5 Kcal/mol. Moreover, γ-Mangostin treatment decreased TCF4 expression and reduced TCF reporter activity. The compound also suppressed the expression of Wnt signaling target proteins cyclin D1 and c-Myc, and stem cell markers such as LGR5, DCLK1 and CD44. To determine the effect of γ-Mangostin on tumor growth in vivo, we administered nude mice harboring HCT116 tumor xenografts with 5 mg/Kg of γ-Mangostin intraperitoneally for 21 days. γ-Mangostin treatment significantly suppressed tumor growth, with notably lowered tumor volume and weight. In addition, western blot analysis revealed a significant decrease in the expression of TCF4 and its downstream targets such as cyclin D1 and c-Myc. Together, these data suggest that γ-Mangostin inhibits colon cancer growth through targeting TCF4. γ-Mangostin may be a potential therapeutic agent for colon cancer.
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Affiliation(s)
- Balaji Krishnamachary
- Department of Cancer Biology, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Prasad Dandawate
- Department of Cancer Biology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Sivapriya Ponnurangam
- Department of Cancer Biology, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Prabhu Ramamoorthy
- Department of Cancer Biology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Shahid Umar
- Department of General Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Sufi Mary Thomas
- Department of Otolaryngology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Animesh Dhar
- Department of Cancer Biology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Seth Septer
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, University of Colorado, Aurora, CO, USA
| | - Scott J Weir
- Department of Cancer Biology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Thomas Attard
- Department of Pediatrics, Division of Gastroenterology, Children's Mercy Hospital, Kansas City, KS, USA
| | - Shrikant Anant
- Department of Cancer Biology, University of Kansas Medical Center, Kansas City, KS, USA
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Attard T, He L. Linking Nanoscale Chemical Changes to Bulk Material Properties in IEPM Polymer Composites Subject to Impact Dynamics. ACS Appl Mater Interfaces 2019; 11:20404-20416. [PMID: 31070883 DOI: 10.1021/acsami.9b04741] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A synthesizable interfacial epoxy-polyurea-hybridized matrix (IEPM), composed of chemical bonded nanostructures across an interface width ranging between 2 and 50 μm, is a candidate for dialing-in molecular vibrational properties and providing high-impact dynamics resistance to conventional fiber(x)-reinforced epoxy (F/E), engendering an x-hybrid polymeric matrix composite system (x-IEPM- tc). Atomic force microscopy and scanning electron microscopy elucidate the interfacial nanoscale morphology and chemical structure via reaction kinetics of curing epoxy (as a function of time, tc) and fast-reacting (prepolymerized) polyurea. Nano-infrared spectroscopy (nano-IR) spectra, per non-negative matrix factorization analysis, reveal that simultaneous presence of characteristic epoxy and polyurea vibrational modes, within a nanoscale region, along with unique IEPM characteristics and properties following thermomechanical analysis and dynamic mechanical analysis (DMA), indicate chemical bonding, enabling IEPM reaction kinetics, as a function of tc, to control natural bond vibrations and type/distribution of interfacial chemical bonds and physical mixtures, likely due to the bond mechanism between -NCO in polyurea and epoxide and -NH2 in epoxy hardener (corresponding to characteristic absorption peaks in nano-IR results), leading to enhanced IEPM quality (fewer defects/voids). Test results of ballistic-resistant panels, integrated with thin intermediate layers of x-IEPM-b- tc, confirm that lower tc significantly enhances loss modulus (∝ material damping and per DMA) in impact dynamics environments.
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Affiliation(s)
- Thomas Attard
- Department of Civil, Construction, and Environmental Engineering , University of Alabama at Birmingham , Birmingham , Alabama 35294 , United States
| | - Li He
- Department of Civil, Construction, and Environmental Engineering , University of Alabama at Birmingham , Birmingham , Alabama 35294 , United States
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Krishnamachary B, Subramaniam D, Attard T, Septer S, Anant S. Abstract 5175: γ-Mangostin, a natural xanthone derivative targets Wnt signaling pathway in colon cancer cells. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-5175] [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: 11/16/2022]
Abstract
Abstract
Background: Colorectal cancer is the third most common cancer in incidence and cause of death in the United States. The current treatment modalities include chemotherapy, radiation, and surgery. Many people are genetically predisposed for colon cancer through mutations in genes such as adenomatous polyposis coli (APC). While the absence of APC causes aberrant Wnt/Beta catenin signaling, the APC mutations are found in more than 80% of colorectal tumors. γ-Mangostin is a major bioactive compound present in Mangosteen (Garcinia mangostana) which possess significant anti-cancer activity. Herein, we investigated the effects of γ -Mangostin on colon cancer growth and elucidated its mechanistic action through Wnt signaling pathway.
Methods: HCT116, SW480 and RKO cell lines were used in the study. The effects of γ-Mangostin on cell proliferation were assessed by hexosaminidase and clonogenicity assays. Effects of γ-Mangostin on apoptosis were evaluated by cell cycle and western blot analysis. Moreover the effect of γ-Mangostin on colonosphere formation was also evaluated. Furthermore, the effect of γ-Mangostin on Wnt signaling proteins was evaluated by western blot analysis. The in vivo anti-cancer effect of γ -Mangostin was investigated on the HCT116 subcutaneous tumor xenograft model implanted in five-week-old male athymic nude mice. Further, the effect of γ -Mangostin was assessed by the specific marker expression in tissue samples by western blot analysis and immunohistochemistry.
Results: γ-Mangostin treatment resulted in a dose and time dependent inhibition of proliferation and colony formation in all the three cell lines. Treatment also induced colon cancer cells to undergo G0/G1 and S-phase arrest. Apoptosis was confirmed by increased levels of Bax/Bcl2 ratio, coupled with a reduction in cyclin D1. γ -Mangostin significantly reduced the number and size of colonospheres. Moreover, γ-Mangostin treatment decreased the expression of Wnt signaling proteins, which suggest that γ-Mangostin inhibits the colon cancer growth through Wnt signaling pathway. To determine the effect of γ-Mangostin on tumor growth in vivo, nude mice harboring HCT116 tumor xenografts in their flanks were administered with 5mg/Kg γ-Mangostin intraperitoneally for 21 days. γ-Mangostin treatment significantly reduced the tumor growth, with notably lower tumor volume and weight. Western blot and immunohistochemistry analyses revealed significant decrease in the expression of Wnt signaling proteins.
Conclusion: Together, these data suggest that γ-Mangostin inhibits colon cancer growth through Wnt signaling pathway. γ-Mangostin may be a potential therapeutic agent for colon cancer.
Citation Format: Balaji Krishnamachary, Dharmalingam Subramaniam, Thomas Attard, Seth Septer, Shrikant Anant. γ-Mangostin, a natural xanthone derivative targets Wnt signaling pathway in colon cancer cells [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5175. doi:10.1158/1538-7445.AM2017-5175
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Smarrazzo A, Misak Z, Costa S, Mičetić-Turk D, Abu-Zekry M, Kansu A, Abkari A, Bouziane-Nedjadi K, Ben Hariz M, Roma E, Velmishi V, Legarda Tamara M, Attard T, Djurisic V, Greco L, Magazzù G. Diagnosis of celiac disease and applicability of ESPGHAN guidelines in Mediterranean countries: a real life prospective study. BMC Gastroenterol 2017; 17:17. [PMID: 28109250 PMCID: PMC5251284 DOI: 10.1186/s12876-017-0577-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 01/18/2017] [Indexed: 12/14/2022] Open
Abstract
Background We assessed how the diagnosis of Celiac Disease (CD) is made and how the new ESPGHAN guidelines can be applied in children from countries with different resources. Methods A real life prospective study was performed in 14 centres of 13 different Mediterranean countries. Participants were asked to apply the usual diagnostic work-up for CD according to their diagnostic facilities. Results There were 1974 patients enrolled in the study, mean age 4 years, 10 months; 865 male, 1109 female. CD was confirmed in 511 (25.9%) and was unconfirmed in 1391 (70.5%) patients; 14 patients were diagnosed as having CD according to the new ESPGHAN guidelines, 43 patients were classified as having potential CD. In all participating countries the diagnosis of CD relied on histology of duodenal biopsy; in 5 countries, HLA, and in one country endomysial antibodies (EMA) were not available. Symptoms did not add a significant increase to the pre-test probability of serological tests. The positive predictive value of tissue transglutaminase type 2 (tTG) antibodies performed with different kits but all corresponding to those recommended by ESPGHAN was 96.1% (95% CI 94–97.9%) in presence of tTG > 10xULN. In 135 patients with tTG >10xULN, HLA genotyping was performed and in all it was compatible with CD. Conclusions The results of our study show that CD diagnosis still relies on intestinal biopsy in the Mediterranean area. New ESPGHAN criteria are not applicable in 5 countries due to lack of resources needed to perform HLA genotyping and, in one country, EMA assay. Further simplification of the new ESPGHAN guidelines might be made according to what preliminarily the present results suggest if confirmed by new prospective studies.
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Affiliation(s)
- Andrea Smarrazzo
- Department of Translational Medical Sciences, School of Medicine, University "Federico II", Naples, Italy.,European Laboratory for Food Induced Diseases, Naples, Italy
| | | | - Stefano Costa
- Celiac Regional Centre, Pediatric Gastroenterology and Cystic Fibrosis Unit, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | | | | | - Aydan Kansu
- Department of Pediatric Gastroenterology, School of Medicine, Ankara University, Ankara, Turkey
| | - Abdelhak Abkari
- Centre Hospitalier Universitaire Ibnou Rochd, Casablanca, Morocco
| | | | - Mongi Ben Hariz
- Pediatric Unit, Mongi SLIM's Hospital of Tunis, Marsa, Tunisia
| | - Eleftheria Roma
- First Department of Pediatrics, University of Athens, Athens, Greece
| | - Virtut Velmishi
- Service of Pediatric Gastroenterology "Mother Teresa" Hospital, Tirana, Albania
| | | | | | | | - Luigi Greco
- Department of Translational Medical Sciences, School of Medicine, University "Federico II", Naples, Italy.,European Laboratory for Food Induced Diseases, Naples, Italy
| | - Giuseppe Magazzù
- Celiac Regional Centre, Pediatric Gastroenterology and Cystic Fibrosis Unit, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy.
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Slowik V, Attard T, Dai H, Shah R, Septer S. Desmoid tumors complicating Familial Adenomatous Polyposis: a meta-analysis mutation spectrum of affected individuals. BMC Gastroenterol 2015; 15:84. [PMID: 26179480 PMCID: PMC4504176 DOI: 10.1186/s12876-015-0306-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 06/23/2015] [Indexed: 01/09/2023] Open
Abstract
Background Desmoid tumors are a group of benign, invasive, solid tumors that are relatively rare in the general population, but can occur in up to 21 % of patients with Familial Adenomatous Polyposis (FAP). They can be difficult to treat and have high rates of recurrence even after resection. Our goal with this study was to identify the genetic mutations that put certain patients with FAP at high risk for desmoid tumors and could be future targets for research. Methods We performed a search in Pubmed, Ovid Medline and Embase to identify subjects with desmoid tumors and FAP. As a reference group for APC mutations in the unselected FAP population, we used the UMD-APC database referenced in the Orphanet portal which includes APC mutation data on 2040 individuals with FAP. Results Mutations were able to be broken down into 7 regions based on previously published data. Mutations in the APC gene from codons 1310 to 2011 were the most common region encompassing 48 % of published desmoid cases and 40 % of the reference population. It had a slightly elevated odds ratio of 1.4 that was statistically significant along with codon region 543-713 that had an odds ratio of 2.0. Using a combination of p-value and CI, the remaining 5 regions did not meet statistical significance as either the p >0.05 or the CI included 1.0. The most common point mutation found was codon 1309 (13.1 %), but it was also the most commonly found mutation in our reference population (12.9 %) and had an odds ratio of 1.0. Conclusions There is an increased risk for desmoid tumors in individuals with APC mutations between codons 543-713 and 1310-2011 when compared to a reference population. These patients may benefit from further study to develop surveillance protocols that could improve outcomes. Electronic supplementary material The online version of this article (doi:10.1186/s12876-015-0306-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Voytek Slowik
- Section of Pediatric Gastroenterology, Children's Mercy Hospital, Kansas City, MO, USA.
| | - Thomas Attard
- Section of Pediatric Gastroenterology, Children's Mercy Hospital, Kansas City, MO, USA.
| | - Hongying Dai
- Department of Medical Research, Children's Mercy Hospital, Kansas City, MO, USA.
| | - Raj Shah
- University of Missouri Kansas City - School of Medicine, Kansas City, MO, USA.
| | - Seth Septer
- Section of Pediatric Gastroenterology, Children's Mercy Hospital, Kansas City, MO, USA.
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17
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Tucci F, Astarita L, Abkari A, Abu-Zekry M, Attard T, Ben Hariz M, Bilbao JR, Boudraa G, Boukthir S, Costa S, Djurisic V, Hugot JP, Irastorza I, Kansu A, Kolaček S, Magazzù G, Mičetić-Turk D, Misak Z, Roma E, Rossi P, Terzic S, Velmishi V, Arcidiaco C, Auricchio R, Greco L. Celiac disease in the Mediterranean area. BMC Gastroenterol 2014; 14:24. [PMID: 24517104 PMCID: PMC3922979 DOI: 10.1186/1471-230x-14-24] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 01/30/2014] [Indexed: 01/17/2023] Open
Abstract
Background The World Gastroenterology Organization recommends developing national guidelines for the diagnosis of Celiac Disease (CD): hence a profile of the diagnosis of CD in each country is required. We aim to describe a cross-sectional picture of the clinical features and diagnostic facilities in 16 countries of the Mediterranean basin. Since a new ESPGHAN diagnostic protocol was recently published, our secondary aim is to estimate how many cases in the same area could be identified without a small intestinal biopsy. Methods By a stratified cross-sectional retrospective study design, we examined clinical, histological and laboratory data from 749 consecutive unselected CD children diagnosed by national referral centers. Results The vast majority of cases were diagnosed before the age of 10 (median: 5 years), affected by diarrhea, weight loss and food refusal, as expected. Only 59 cases (7.8%) did not suffer of major complaints. Tissue transglutaminase (tTG) assay was available, but one-third of centers reported financial constraints in the regular purchase of the assay kits. 252 cases (33.6%) showed tTG values over 10 times the local normal limit. Endomysial antibodies and HLA typing were routinely available in only half of the centers. CD was mainly diagnosed from small intestinal biopsy, available in all centers. Based on these data, only 154/749 cases (20.5%) would have qualified for a diagnosis of CD without a small intestinal biopsy, according to the new ESPGHAN protocol. Conclusions This cross-sectional study of CD in the Mediterranean referral centers offers a puzzling picture of the capacities to deal with the emerging epidemic of CD in the area, giving a substantive support to the World Gastroenterology Organization guidelines.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Luigi Greco
- European Laboratory for Food Induced Diseases, University of Naples Federico II, Naples 80131, Italy.
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18
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Septer S, Slowik V, Morgan R, Dai H, Attard T. Thyroid cancer complicating familial adenomatous polyposis: mutation spectrum of at-risk individuals. Hered Cancer Clin Pract 2013; 11:13. [PMID: 24093640 PMCID: PMC3854022 DOI: 10.1186/1897-4287-11-13] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 09/30/2013] [Indexed: 12/30/2022] Open
Abstract
Background Lifetime risk of thyroid cancer associated with FAP has been reported as 1-2%. The mean age at diagnosis of thyroid carcinoma in FAP has been reported at 28 years. The aims of this paper are to better understand gene mutations associated with thyroid cancer and refine surveillance recommendations for patients with FAP. Methods We performed a search in Pubmed, Ovid Medline and Embase with the terms ("Thyroid Gland"[Mesh] OR "Thyroid Neoplasms"[Mesh]) AND "Adenomatous Polyposis Coli"[Meshdenomatous Polyposis Coli"[Mesh] to identify subjects with thyroid cancer and FAP. As a reference group for APC mutations in the unselected FAP population, we used the UMD-APC database referenced in the Orphanet portal, which includes APC mutation data on 2040 individuals with FAP. Results There were 115 reported cases of thyroid cancer in patients with FAP (95 female: 11 male) with an average age of 29.2 years. Gene mutation testing results were reported in 48 patients. On comparing the prevalence of APC mutation in the population of FAP patients with thyroid cancer and the prevalence of the same mutation in the reference population an increased odds ratio was evident in individuals harboring an APC mutation at codon 1061 (OR: CI 4.1: 1.7-8.9). Analysis of the prevalence of thyroid cancer in individuals with FAP segregated by the region of the gene affected shows an increased risk of thyroid cancer in individuals harboring mutations proximal to codon 512 (OR 2.6, p 0.0099). Conclusions There is increased risk for thyroid cancer in individuals with APC mutations at the 5' end (proximal to codon 528) along with the established high risk group harboring mutation at codon 1061. It is suggested that these patients might benefit from directed surveillance by annual ultrasound from age 18 years onwards.
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Affiliation(s)
- Seth Septer
- Section of Pediatric Gastroenterology, Children's Mercy Hospital, Kansas City, MO, USA.
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Septer S, Zhang L, Lawson CE, Cocjin J, Attard T, Ardinger HH. Aggressive juvenile polyposis in children with chromosome 10q23 deletion. World J Gastroenterol 2013; 19:2286-2292. [PMID: 23599658 PMCID: PMC3627896 DOI: 10.3748/wjg.v19.i14.2286] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 02/07/2013] [Indexed: 02/06/2023] Open
Abstract
Juvenile polyps are relatively common findings in children, while juvenile polyposis syndrome (JPS) is a rare hereditary syndrome entailing an increased risk of colorectal cancer. Mutations in BMPR1A or SMAD4 are found in roughly half of patients diagnosed with JPS. Mutations in PTEN gene are also found in patients with juvenile polyps and in Bannayan-Riley-Ruvalcaba syndrome and Cowden syndrome. Several previous reports have described microdeletions in chromosome 10q23 encompassing both PTEN and BMPR1A causing aggressive polyposis and malignancy in childhood. These reports have also described extra-intestinal findings in most cases including cardiac anomalies, developmental delay and macrocephaly. In this report we describe a boy with a 5.75 Mb deletion of chromosome 10q23 and a 1.03 Mb deletion within chromosome band 1p31.3 who displayed aggressive juvenile polyposis and multiple extra-intestinal anomalies including macrocephaly, developmental delay, short stature, hypothyroidism, atrial septal defect, ventricular septal defect and hypospadias. He required colectomy at six years of age, and early colectomy was a common outcome in other children with similar deletions. Due to the aggressive polyposis and reports of dysplasia and even malignancy at a young age, we propose aggressive gastrointestinal surveillance in children with 10q23 microdeletions encompassing the BMPR1A and PTEN genes to include both the upper and lower gastrointestinal tracts, and also include a flowchart for an effective genetic testing strategy in children with juvenile polyposis.
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Greco L, Timpone L, Abkari A, Abu-Zekry M, Attard T, Bouguerrà F, Cullufi P, Kansu A, Micetic-Turk D, Mišak Z, Roma E, Shamir R, Terzic S. Burden of celiac disease in the Mediterranean area. World J Gastroenterol 2011; 17:4971-8. [PMID: 22174546 PMCID: PMC3236588 DOI: 10.3748/wjg.v17.i45.4971] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2011] [Revised: 06/15/2011] [Accepted: 06/22/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To estimate the burden of undiagnosed celiac disease (CD) in the Mediterranean area in terms of morbidity, mortality and health cost.
METHODS: For statistics regarding the population of each country in the Mediterranean area, we accessed authoritative international sources (World Bank, World Health Organization and United Nations). The prevalence of CD was obtained for most countries from published reports. An overall prevalence rate of 1% cases/total population was finally estimated to represent the frequency of the disease in the area, since none of the available confidence intervals of the reported rates significantly excluded this rate. The distribution of symptoms and complications was obtained from reliable reports in the same cohort. A standardized mortality rate of 1.8 was obtained from recent reports. Crude health cost was estimated for the years between symptoms and diagnosis for adults and children, and was standardized for purchasing power parity to account for the different economic profiles amongst Mediterranean countries.
RESULTS: In the next 10 years, the Mediterranean area will have about half a billion inhabitants, of which 120 million will be children. The projected number of CD diagnoses in 2020 is 5 million cases (1 million celiac children), with a relative increase of 11% compared to 2010. Based on the 2010 rate, there will be about 550 000 symptomatic adults and about 240 000 sick children: 85% of the symptomatic patients will suffer from gastrointestinal complaints, 40% are likely to have anemia, 30% will likely have osteopenia, 20% of children will have short stature, and 10% will have abnormal liver enzymes. The estimated standardized medical costs for symptomatic celiac patients during the delay between symptom onset and diagnosis (mean 6 years for adults, 2 years for children) will be about €4 billion (€387 million for children) over the next 10 years. A delay in diagnosis is expected to increase mortality: about 600 000 celiac patients will die in the next 10 years, with an excess of 44.4% vs age- and sex-matched controls.
CONCLUSION: In the near future, the burden of CD will increase tremendously. Few Mediterranean countries are able to face this expanding epidemic alone.
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Azzopardi N, Ellul P, Attard T, Attard J, DeGaetano J, Vassallo M, Piscopo T. A difficult case of Crohn's disease? Case Reports 2011; 2011:2011/mar05_1/bcr1220103612. [DOI: 10.1136/bcr.12.2010.3612] [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] Open
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Lynch HT, Lynch JF, Lynch PM, Attard T. Hereditary colorectal cancer syndromes: molecular genetics, genetic counseling, diagnosis and management. Fam Cancer 2007; 7:27-39. [PMID: 17999161 DOI: 10.1007/s10689-007-9165-5] [Citation(s) in RCA: 144] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Accepted: 10/04/2007] [Indexed: 12/18/2022]
Abstract
Hereditary forms of colorectal cancer, as is the case with virtually all forms of hereditary cancer, show extensive phenotypic and genotypic heterogeneity, a phenomenon discussed throughout this special issue of Familial Cancer. Clearly, the family physician, oncology specialist, genetic counselor, and cancer geneticist must know fully the complexity of hereditary cancer syndromes, their differential diagnosis, in order to establish a diagnosis, direct highly-targeted surveillance and management, and then be able to communicate effectively with the molecular geneticist so that an at-risk patient's DNA can be tested in accord with the syndrome of concern. Thus, a family with features of the Lynch syndrome will merit microsatellite instability testing, consideration for immunohistochemistry evaluation, and mismatch repair gene testing, while, in contrast, a patient with FAP will require APC testing. However, other germline mutations, yet to be identified, may be important should testing for these mutations prove to be absent and, therein, unrewarding to the patient. Nevertheless, our position is that if the patient's family history is consistent with one of these syndromes, but a mutation is not found in the family, we still recommend the same surveillance and management strategies for patients from families with an established cancer-causing germline mutation. Our purpose in this paper is to provide a concise coverage of the major hereditary colorectal cancer syndromes, to discuss genetic counseling, molecular genetic evaluation, highly targeted surveillance and management, so that cancer control can be maximized for these high hereditary cancer risk patients.
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Affiliation(s)
- Henry T Lynch
- Department of Preventive Medicine and Public Health, Creighton University School of Medicine, Omaha, Nebraska 68178, USA.
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Touzé E, Saillour-Glenisson F, Durieux P, Verdier A, Leyshon S, Bendavid S, Attard T, Scheimann A, Mas JL, Coste J. Lack of validity of a French adaptation of a scale measuring attitudes towards clinical practice guidelines. Int J Qual Health Care 2006; 18:195-202. [PMID: 16484314 DOI: 10.1093/intqhc/mzi104] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Valid instruments to measure practitioners' attitudes towards clinical practice guidelines need to be developed. However, few of the available instruments have been thoroughly validated. OBJECTIVE To adapt into French and to test the reliability and validity of a scale for measurement of attitudes towards guidelines developed by Elovainio et al. METHODS A 27-item scale (divided into six dimensions) measuring attitudes towards guidelines was translated into French by two English native translators, reviewed and finalized by expert committee and administered to 314 practitioners who agreed to participate. Main practitioners' characteristics were collected. Item and dimension reproducibility were assessed for 62 practitioners by calculation of intraclass correlation coefficients. Internal construct validity was assessed by principal components analyses. Convergent and discriminant validity were analysed. RESULTS Item response rates ranged from 82 to 100%. In the test-retest procedure, intraclass correlation coefficients for separate items ranged from 0.1 to 0.7 and those for dimensions were 0.7 [95% confidence interval (CI): 0.5-0.8] for usefulness, 0.5 (0.3-0.6) for reliability, 0.4 (0.2-0.5) for individual competence, 0.5 (0.3-0.6) for organizational competence, 0.7 (0.5-0.8) for impracticality and 0.4 (0.3-0.6) for availability. The factorial structure after Varimax rotation showed that none of the different solutions obtained had a strictly comparable structure to that of the original scale. External construct validity was satisfactory. CONCLUSION This scale does not have satisfactory psychometric properties and therefore cannot confidently be used in future research assessing whether attitudes towards guidelines are a determining factor in physicians' compliance with guidelines. More research is needed to develop valid scales in a more rigorous procedure, involving qualitative and quantitative steps.
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Affiliation(s)
- E Touzé
- Medexact Company, Boulogne-Billancourt, France.
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