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Aitken P, Stanescu I, Boddington L, Mahon C, Fogarasi A, Liao YH, Ivars M, Moreno-Artero E, Trauner D, DeRoos ST, Jancic J, Nikolic M, Balážová P, Price HN, Hadzsiev K, Riney K, Stapleton S, Tollefson MM, Bauer D, Pinková B, Atkinson H. A novel rapamycin cream formulation improves facial angiofibromas associated with tuberous sclerosis complex: a double-blind randomized placebo-controlled trial. Br J Dermatol 2023; 189:520-530. [PMID: 37463422 DOI: 10.1093/bjd/ljad243] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/03/2023] [Accepted: 07/13/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Facial angiofibromas (FAs) are a major feature of tuberous sclerosis complex (TSC). Topical rapamycin can successfully treat FAs. A new stabilized cream formulation that protects rapamycin from oxidation has been developed in 0.5% and 1% concentrations. OBJECTIVES To assess the efficacy and safety of a novel, stabilized topical rapamycin cream formulation. METHODS This multicentre double-blind randomized placebo-controlled dose-response phase II/III study with a parallel design included participants aged 6-65 years with FAs of mild or moderate severity according to the Investigator's Global Assessment (IGA) scale. Participants were randomized to one of three treatment arms: topical rapamycin 0.5%, topical rapamycin 1% or placebo. Treatment was applied once daily for 26 weeks. Safety and efficacy measures were assessed at days 14, 56, 98, 140 and 182. The primary endpoint was the percentage of participants achieving IGA scores of 'clear' or 'almost clear' after 26 weeks of treatment. Secondary measures included Facial Angiofibroma Severity Index (FASI) and participant- and clinician-reported percentage-based improvement. Safety measures included the incidence of treatment-emergent adverse events and blood rapamycin concentration changes over time. RESULTS Participants (n = 107) were randomized to receive either rapamycin 1% (n = 33), rapamycin 0.5% (n = 36) or placebo (n = 38). All treated participants were included in the final analysis. The percentage of participants with a two-grade IGA improvement was greater in the rapamycin 0.5% treatment group (11%) and rapamycin 1% group (9%) than in the placebo group (5%). However, this was not statistically significant [rapamycin 0.5%: odds ratio (OR) 1.71, 95% confidence interval (CI) 0.36-8.18 (P = 0.50); rapamycin 1%: OR 1.68, 95% CI 0.33-8.40 (P = 0.53)]. There was a statistically significant difference in the proportion of participants treated with rapamycin cream that achieved at least a one-grade improvement in IGA [rapamycin 0.5%: 56% (OR 4.73, 95% CI 1.59-14.10; P = 0.005); rapamycin 1%: 61% (OR 5.14, 95% CI 1.70-15.57; P = 0.004); placebo: 24%]. Skin adverse reactions were more common in patients following rapamycin application (64%) vs. placebo (29%). CONCLUSIONS Both rapamycin cream formulations (0.5% and 1%) were well tolerated, and either strength could lead to clinical benefit in the treatment of FA.
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Affiliation(s)
| | | | | | - Caroline Mahon
- Dermatology Department, Christchurch Hospital, Christchurch, New Zealand
| | | | - Yi-Hua Liao
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Marta Ivars
- Dermatology Department, Clínica Universidad de Navarra, Madrid, Spain
| | | | - Doris Trauner
- University of California San Diego Health Sciences, Department of Neurosciences, San Diego, CA, USA
| | | | - Jasna Jancic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic of Neurology and Psychiatry for Children and Youth, Belgrade, Serbia
| | - Milos Nikolic
- University of Belgrade School of Medicine, Department of Dermatovenereology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Patrícia Balážová
- Department of Pediatric Neurology, Faculty of Medicine, Comenius University, National Institute of Children's Diseases, Bratislava, Slovakia
| | - Harper N Price
- Division of Dermatology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Kinga Hadzsiev
- Department of Medical Genetics, Medical School, University of Pécs, Pécs, Hungary
| | - Kate Riney
- Neurosciences Unit, Queensland Children's Hospital, South Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, St Lucia, QLD, Australia
| | | | - Megha M Tollefson
- Departments of Dermatology and Pediatrics, Mayo Clinic and Mayo Clinic Children's Center, MN, USA
| | - Derek Bauer
- University of Virginia, Charlottesville, VA, USA
| | - Blanka Pinková
- Department of Paediatric Dermatology, Faculty Hospital, Brno, Czech Republic
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Jones R, Zaidi H, Hammersley D, Halliday B, Hatipoglu S, Owen R, Marvao A, Mahon C, Lota A, Mach L, Iacob A, Pennell D, Bishop M, Prasad S. In-depth phenotypic characterisation of myocardial fibrosis by cardiovascular magnetic resonance predicts sudden cardiac death in coronary heart disease: a long-term prospective outcome study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Prospective studies harnessing late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) afford the potential to non-invasively characterise the phenotypic substrate for sudden cardiac death (SCD) and simultaneously interrogate its mechanistic drivers.
Purpose
To assess the utility of infarct characterisation by CMR, including scar microstructure analysis, to predict SCD in prospectively investigated patients with coronary heart disease (CHD).
Methods
Patients with stable CHD were prospectively recruited into a registry between August 2009 and January 2016. The primary outcome for this study was SCD or aborted SCD. Patients with a secondary prevention implantable cardioverter defibrillator (ICD) indication were excluded. All patients had CMR with LGE imaging. Infarct quantification (core scar and peri-infarct zone [PIZ]) was performed by an independent level 3 CMR reader. Outcome events were adjudicated by a panel of cardiologists blinded to the CMR data. To investigate fibrosis microstructure, bespoke computational image processing algorithms were applied to the LGE images in order to extract specific morphological and texture related features.
Results
Of 437 patients (mean age 64, mean left ventricular ejection fraction [LVEF] 47%, 91% with LGE) followed for a median of 6.3 years, 49 patients (11.2%) experienced the primary outcome. Patients with higher PIZ mass had an increased risk of the primary outcome (10-year risk 0.7%, 24.0% and 37.8% for patients with PIZ mass <5.66g, 5.66–12.28g and ≥12.29g respectively, P<0.001; figure 1a). On univariable analysis, an increase in PIZ mass and core infarct mass was associated with an increased risk of the primary outcome (per gram: HR 1.12, 95% CI 1.09–1.15, P<0.001 and HR 1.05, 95% CI 1.04–1.06, P<0.001 respectively). PIZ mass and core infarct mass remained independently associated with the primary outcome after adjustment for baseline predictors (per gram: HR 1.10, 95% CI 1.06–1.14, P<0.001 and HR 1.04, 95% CI 1.02–1.06, P<0.001 respectively) and together provided incremental value compared to conventional variables in predicting the endpoint (Harrell's C-statistic 0.76 to 0.82, figure 1b-c). Bespoke analysis of imaging data identified several shape-based scar metrics that associated with the primary outcome (figure 2). These included core infarct transmurality, radiality and interface length (the latter defining the core scar-PIZ boundary length), and the number of PIZ islets.
Conclusions
In this large prospective study of patients with stable CHD, both PIZ mass and core infarct mass independently predicted long-term SCD risk after adjusting for conventional predictors including LVEF. Reassuringly, minimal or absent LGE portended a comparatively low risk of SCD. Analysis of the scar microstructure identified several shape-based features that associated with SCD. These results highlight a potential avenue towards a more personalised approach to ICD implantation decisions.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Lung and Heart Institute, Imperial College London
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Affiliation(s)
- R.E Jones
- National Heart and Lung Institute, London, United Kingdom
| | - H.A Zaidi
- King's College London, London, United Kingdom
| | - D.J Hammersley
- National Heart and Lung Institute, London, United Kingdom
| | - B.P Halliday
- National Heart and Lung Institute, London, United Kingdom
| | - S Hatipoglu
- Royal Brompton Hospital, London, United Kingdom
| | - R Owen
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - A.D Marvao
- Imperial College London, London, United Kingdom
| | - C Mahon
- Royal Brompton Hospital, London, United Kingdom
| | - A.S Lota
- Royal Brompton Hospital, London, United Kingdom
| | - L Mach
- Royal Brompton Hospital, London, United Kingdom
| | - A.O Iacob
- Royal Brompton Hospital, London, United Kingdom
| | - D.J Pennell
- Imperial College London, London, United Kingdom
| | - M.J Bishop
- King's College London, London, United Kingdom
| | - S.K Prasad
- Imperial College London, London, United Kingdom
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Rinaldi G, Creissen A, Mahon C, Syed SB. Triple pass laser therapy for recalcitrant facial port wine stains. Lasers Med Sci 2021; 37:1643-1650. [PMID: 34536181 DOI: 10.1007/s10103-021-03414-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/05/2021] [Indexed: 12/01/2022]
Abstract
Patients with recalcitrant facial port wine stains (rfPWS) can be challenging to manage, often leaving the clinician with difficult decisions for treatment options. 'Triple therapy' consists of using three different laser wavelengths at each treatment setting. The evidence on outcomes is limited as this treatment approach has not been previously reported to the best of our knowledge. Children who received triple therapy at least once for rfPWS, and for whom SIAscopy readings had been taken, were retrospectively identified. SIAscope readings were compared before the first triple therapy treatment and at final the most recent clinical follow-up. The clinical appearance was also assessed using a Visual Analogue Scale comparing clinical photographs taken before triple therapy to those taken at the most recent clinical follow-up. A total of 47 children were identified and included in our review. The SIAscope readings showed an overall significant (p < 0.001) lightening with 39 (83%) showing lightening and 8 (17%) patients showing a darkening. Scores using the VAS also showed improvement with 55% experiencing an improvement in their clinical appearance, 38% showing no visible change and 6% appearing to have worsened. Triple therapy can offer improvement of rfPWS which have failed to respond to single wavelength laser therapy. SIAscopy and VAS scores correlate well in assessing clinical response; however, the added clinical benefit of SIAscopy in vascular laser clinics remains uncertain.
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Affiliation(s)
- Giulia Rinaldi
- Department of Medicine, Guy's and St Thomas' Hospital NHS Trust, Westminster Bridge Road, London, SE1 7EH, UK.
| | | | - Caroline Mahon
- Christchurch Hospital, Christchurch, Canterbury, New Zealand
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4
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Rix-Trott K, Byrnes CA, Gilchrist CA, Matsas R, Walls T, Voss L, Mahon C, Dickson NP, Reed P, Best EJ. Surveillance of pediatric parapneumonic effusion/empyema in New Zealand. Pediatr Pulmonol 2021; 56:2949-2957. [PMID: 34232567 DOI: 10.1002/ppul.25564] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 06/07/2021] [Accepted: 07/01/2021] [Indexed: 11/07/2022]
Abstract
AIM The incidence of childhood empyema has been increasing in some developed countries despite the introduction of pneumococcal vaccination. This study aimed to document the incidence, bacterial pathogens, and morbidity/mortality of parapneumonic effusion/empyema in New Zealand. METHODS A prospective study of 102 children <15 years of age requiring hospitalization with parapneumonic effusion/empyema between May 1, 2014 and May 31, 2016 notified via the New Zealand Paediatric Surveillance Unit. Parapneumonic effusion/empyema was defined as pneumonia and pleural effusion persisting ≥7 days, and/or any pneumonia, and pleural effusion necessitating drainage. Notifying pediatricians completed standardized questionnaires. RESULTS Annual pediatric parapneumonic effusion/empyema incidence was 5.6/100,000 (95% confidence interval [CI]: 4.7-6.9). Most children (80%) required surgical intervention and 31% required intensive care. A causative organism was identified in 71/102 (70%) cases. Although Staphylococcus aureus (25%) and Streptococcus pneumoniae (25%) infection rates were equal, prolonged hospitalization and intensive care admission were more common in children with S. aureus PPE/E. Māori and Pasifika children were over-represented at 2.2 and 3.5 times, their representation in the New Zealand pediatric population. Pneumococcal vaccination was incomplete, with only 61% fully immunized and 30% unimmunized. Haemophilus influenzae type b vaccine uptake was near complete at 89/94 (95%), with influenza immunization only 3/78 (4%). CONCLUSIONS New Zealand has a high incidence of pediatric complicated parapneumonic effusion/empyema with significant morbidity. S. aureus was a significant cause of severe empyema in New Zealand, particularly for Māori and Pasifika children. Improvements in vaccine coverage are needed along with strategies to reduce S. aureus disease morbidity.
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Affiliation(s)
- Katherine Rix-Trott
- Starship Children's Health, Auckland District Health Board, Auckland, New Zealand.,KidzFirst Children's Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Catherine A Byrnes
- Starship Children's Health, Auckland District Health Board, Auckland, New Zealand.,Department of Paediatrics: Child and Youth Health, School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Catherine A Gilchrist
- Department of Paediatrics: Child and Youth Health, School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Richard Matsas
- KidzFirst Children's Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Tony Walls
- Department of Paediatrics, University of Otago, Christchurch, New Zealand.,Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Lesley Voss
- Starship Children's Health, Auckland District Health Board, Auckland, New Zealand
| | - Caroline Mahon
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Nigel P Dickson
- New Zealand Paediatric Surveillance Unit, Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Peter Reed
- Starship Children's Health, Auckland District Health Board, Auckland, New Zealand
| | - Emma J Best
- Starship Children's Health, Auckland District Health Board, Auckland, New Zealand.,Department of Paediatrics: Child and Youth Health, School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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5
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Seine AJ, Baird EA, Chan L, Davis A, Greig D, Judd LE, Mahon C, Oakley A, Rademaker M, Reiche L, Stanway AD, Cheng HS. A baseline patch test series for New Zealand. Australas J Dermatol 2021; 62:489-495. [PMID: 34293187 DOI: 10.1111/ajd.13673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/27/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patch testing is the gold standard diagnostic test for allergic contact dermatitis and needs to be relevant to the region and the population being tested. The aim of this study was to develop a specific New Zealand baseline series (NZBS). METHOD We performed a retrospective case note review of patients attending four regional patch test centres between 2008 and 2020. Demographic and diagnostic information was collected for each patient along with results of patch testing. Using the results of this review, a group of 11 dermatologists with an interest in contact dermatitis agreed on a core group of allergens for inclusion in an NZBS, based on the frequency of positive reactions and allergens of interest. The remaining potential allergens were ranked by each dermatologist using an online questionnaire, with inclusion in the final NZBS by consensus. RESULTS Results from 2402 patients (67% female, mean age 44 years) from Auckland, Wellington, Palmerston North and Christchurch were collated. The 10 most frequent positive (relevant and non-relevant) allergens were nickel sulfate (22.0%), fragrance mix I (8.6%), cobalt chloride (7.3%), Myroxylon pereirae (5.6%), colophonium (5.1%), p-phenylenediamine (4.9%), methylisothiazolinone/methylchloroisothiazolinone (4.1%), fragrance mix II (3.9%), potassium dichromate (3.5%) and methylisothiazolinone (3.4%). Based on these results, a core series of 30 allergens was developed, with an additional 30 allergens added to form the extended series (total 60 allergens). CONCLUSION The baseline series of patch test allergens for routine use in New Zealand (NZBS) is based on national patch test data and expert consensus.
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Affiliation(s)
- Adrian J Seine
- Department of Dermatology, Auckland District Health Board, Auckland, New Zealand
| | | | - Lydia Chan
- Department of Dermatology, Waikato District Health Board, Hamilton, New Zealand
| | | | - Deborah Greig
- Department of Dermatology, Auckland District Health Board, Auckland, New Zealand.,Department of Dermatology, Waitemata District Health Board, Auckland, New Zealand
| | | | - Caroline Mahon
- Department of Dermatology, Canterbury District Health Board, Christchurch, New Zealand.,University of Otago, Christchurch School of Medicine, Christchurch, New Zealand
| | - Amanda Oakley
- Department of Dermatology, Waikato District Health Board, Hamilton, New Zealand.,Waikato Clinical Campus, University of Auckland's Faculty of Medical and Health Sciences Hamilton, Hamilton, New Zealand
| | - Marius Rademaker
- Waikato Clinical Campus, University of Auckland's Faculty of Medical and Health Sciences Hamilton, Hamilton, New Zealand
| | | | | | - Harriet S Cheng
- Department of Dermatology, Auckland District Health Board, Auckland, New Zealand.,Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
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6
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Zhu J, Mahon C, Dalton SC. Mycobacterium mantenii: a rare cause of chronic ulceration in an immunocompetent female in the southern hemisphere. N Z Med J 2021; 134:78-82. [PMID: 34012142] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Julia Zhu
- Dermatology Advanced Trainee Registrar, Dermatology Department, Christchurch Public Hospital, Christchurch, New Zealand
| | - Caroline Mahon
- Clinical Lead and Consultant Dermatologist, Dermatology Department, Christchurch Public Hospital, Christchurch, New Zealand
| | - Simon C Dalton
- Consultant Infectious Diseases Physician, Infectious Diseases Department, Christchurch Public Hospital, Christchurch, New Zealand
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7
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Rahman OU, Kim J, Mahon C, Jelani M, Kang C. Two missense mutations in GPNMB cause autosomal recessive amyloidosis cutis dyschromica in the consanguineous pakistani families. Genes Genomics 2021; 43:471-478. [PMID: 33687658 DOI: 10.1007/s13258-021-01071-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/19/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Amyloidosis cutis dyschromica (ACD) is a rare variant of cutaneous amyloidosis. This disorder often clusters in families, and it has been suggested that genetic factors might be involved in its development. OBJECTIVE To identify the genetic causes of ACD, we recruited a consanguineous Pakistani family with multiple cases of ACD that display a recessive mode of inheritance. METHODS We performed whole-exome sequencing of samples from 7 members of this family, followed by bioinformatic and in silico analyses to identify the causative variant. For the replication study, we recruited a British family with Pakistani ancestry, and sequenced all exons of glycoprotein non-metastatic melanoma protein b (GPNMB) to identify mutations. We also investigated effects of the mutations on the stability of the GPNMB protein using the I-TASSER three-dimensional modeling tool. RESULTS We found a novel homozygous mutation, p.Gly363Val (c.1088 G>T), in GPNMB in all affected cases. In a replication study, another homozygous missense mutation in GPNMB, pIle174Met (c.522 C>G), was carried by the affected son. The two mutations were not observed in our in-house data set comprising 217 healthy Pakistani individuals or in The Genome Aggregation Database. Our structural modeling of GPNMB suggested that p.Gly363Val enhanced its stability, whereas p.Ile174Met caused instability. CONCLUSIONS This study reports two novel missense mutations in two Pakistani families that cause ACD. The mutations appear to influence GPNMB stability, as revealed by protein modeling.
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Affiliation(s)
- Obaid Ur Rahman
- Biochemistry Department, Swat Medical College, Swat, Pakistan
| | - Jeena Kim
- Department of Biotechnology, Sungshin Women's University, Seoul, Republic of Korea
| | - Caroline Mahon
- Department of Dermatology, Christchurch School of Medicine, Christchurch Hospital, University of Otago, Christchurch, New Zealand
| | - Musharraf Jelani
- Centre for Omic Sciences, Islamia College Peshawar, Khyber Pakhtunkhwa, Pakistan.
| | - Changsoo Kang
- Department of Biotechnology, Sungshin Women's University, Seoul, Republic of Korea.
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Mahon C, McHugh K, Alband N, Rampling D, Sebire N, Williamson E, Glover M, Kinsler VA. Routine liver ultrasound screening does not alter clinical management in a cohort study of multiple cutaneous infantile haemangioma. Br J Dermatol 2020; 184:340-341. [PMID: 32767853 PMCID: PMC8432140 DOI: 10.1111/bjd.19472] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 11/27/2022]
Affiliation(s)
- C Mahon
- Paediatric Dermatology, Great Ormond Street Hospital for Children, London, UK
| | - K McHugh
- Paediatric Radiology, Great Ormond Street Hospital for Children, London, UK
| | - N Alband
- Paediatric Dermatology, Great Ormond Street Hospital for Children, London, UK
| | - D Rampling
- Paediatric Pathology, Great Ormond Street Hospital for Children, London, UK
| | - N Sebire
- Paediatric Pathology, Great Ormond Street Hospital for Children, London, UK
| | - E Williamson
- Paediatric Dermatology, Great Ormond Street Hospital for Children, London, UK
| | - M Glover
- Paediatric Dermatology, Great Ormond Street Hospital for Children, London, UK
| | - V A Kinsler
- Paediatric Dermatology, Great Ormond Street Hospital for Children, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK.,The Francis Crick Institute, London, UK
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Mahon C, Davis A, Gambaro A, Musella F, Costam A, Nicol E, Duncan A, Mirsadraee S. Feasibility Of Quantifying Individual Aortic Leaflet Calcification And It’S Association With Paravalvular Regurgitation And Conduction Abnormalities In Transcatheter Aortic Valve Implantation. J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.175] [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: 11/16/2022]
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10
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Malone M, Radzieta M, Jensen SO, Mahon C. Wound biofilms and their role in individuals with epidermolysis bullosa. Australas J Dermatol 2020; 61:279-280. [PMID: 32201933 DOI: 10.1111/ajd.13274] [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: 11/28/2022]
Affiliation(s)
- Matthew Malone
- South Western Sydney LHD, Limb Preservation and Wound Research Academic Unit, Ingham Institute of Applied Medical Research, Liverpool, Sydney, NSW, Australia.,School of Medicine, Infectious Diseases and Microbiology, Western Sydney University, Campbelltown, Sydney, NSW, Australia
| | - Michael Radzieta
- South Western Sydney LHD, Limb Preservation and Wound Research Academic Unit, Ingham Institute of Applied Medical Research, Liverpool, Sydney, NSW, Australia.,School of Medicine, Infectious Diseases and Microbiology, Western Sydney University, Campbelltown, Sydney, NSW, Australia
| | - Slade O Jensen
- South Western Sydney LHD, Limb Preservation and Wound Research Academic Unit, Ingham Institute of Applied Medical Research, Liverpool, Sydney, NSW, Australia.,School of Medicine, Infectious Diseases and Microbiology, Western Sydney University, Campbelltown, Sydney, NSW, Australia
| | - Caroline Mahon
- Department of Dermatology, Canterbury District Health Board, Christchurch Hospital, Christchurch, New Zealand
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11
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Mahon C, Mohiaddin RH. The emerging applications of cardiovascular magnetic resonance imaging in transcatheter aortic valve implantation. Clin Radiol 2019; 76:73.e21-73.e37. [PMID: 31879023 DOI: 10.1016/j.crad.2019.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 11/13/2019] [Indexed: 12/22/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is an alternative to surgical aortic valve replacement in selected patients with severe symptomatic aortic stenosis (AS) and high surgical risk. The planning and follow-up of TAVI requires an array of imaging techniques, each has advantages and limitations. Echocardiography and multidetector computer tomography (MDCT) have established applications in patient selection and procedure guidance, but are limited in some patients. TAVI applications of cardiovascular magnetic resonance imaging (CMRI) are emerging. CMRI can provide the structural and functional imaging details required for TAVI procedure in away comparable or superior to that obtained by echocardiography and MDCT combined. In this review, we look at the continuously evolving role of CMRI as a complimentary or an alternative to more established imaging techniques and address the advantages and disadvantages of CMRI in this setting. We discuss the role of CMRI in selecting anatomically suitable patients for the TAVI procedure and in the post-TAVI follow-up with particular emphasis on its applications for assessing AS severity and haemodynamic impact, vascular imaging for TAVI access route, quantification of paravalvular leaks and LV remodelling in the post TAVI setting as well as providing imaging biomarkers tool for AS risk-stratification.
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Affiliation(s)
- C Mahon
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - R H Mohiaddin
- Royal Brompton and Harefield NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK.
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12
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Mahon C, Kiernan G, Gallagher P. Minority stress, intra-minority stress and social anxiety: Examining an extended psychological mediation framework among sexual minority men. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Compared to their heterosexual counterparts, sexual minority men (SMM) are at an increased risk of social anxiety disorder. Distal (i.e., everyday discrimination) and proximal (i.e., internalised homophobia, rejection sensitivity, concealment of sexual orientation) minority stress processes are associated with heightened social anxiety for SMM. Stressors emerging from within the sexual minority male community, termed intra-minority stress, and psychological processes that may foster resilience (i.e., a sense of coherence, connectedness to the LGBT community) are less explored in this area. This study examined potential pathways between everyday discrimination, intra-minority stress, proximal minority stressors, resilience and social anxiety.
Methods
Self-identified SMM (N = 255) residing in the Republic of Ireland completed an online survey containing measures of minority stress, intra-minority stress, resilience and social anxiety. Structural equation modelling was used to examine the model.
Results
The model yielded a good fit to the data, X2(16) = 26.61, CFI = .99, TLI = .97, RMSEA = .05, and SRMR = .03. Rejection sensitivity and a sense of coherence had a significant indirect effect in the relationships between both exogenous variables (i.e., discrimination and intra-minority stress) and social anxiety. There were no significant pathways to social anxiety involving concealment of sexual orientation, internalised homophobia or LGBT community connectedness.
Conclusions
For SMM, minority stress processes and intra-minority stress are important determinants of social anxiety. Our findings demonstrate that proximal minority stressors may operate differently in a social anxiety context for SMM in western European countries. A sense of coherence was an integral factor in the model and demonstrated the strongest association with social anxiety.
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Affiliation(s)
- C Mahon
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - G Kiernan
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - P Gallagher
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
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Webber L, Cummins M, Mann R, Shaw L, Ghinai R, Mahon C. Panniculitis in a 3-year-old child with Fanconi anemia-associated bone marrow hypoplasia heralds transformation to acute myeloid leukemia. Pediatr Dermatol 2019; 36:725-727. [PMID: 31318095 DOI: 10.1111/pde.13872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Fanconi anemia is a rare, autosomal recessive genomic instability disorder characterized by congenital limb anomalies, panmyelopathy and a high risk of malignancy, principally acute myeloid leukemia. Hematologic malignancy presenting with acute febrile neutrophilic dermatosis (Sweet syndrome), both deep and superficial forms, is well described in Fanconi anemia patients but is a rare phenomenon in otherwise healthy children. We present a case of panniculitis (presumptive subcutaneous Sweet syndrome) heralding transformation to acute myeloid leukemia in a 3-year-old boy with a severe Fanconi anemia phenotype.
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Affiliation(s)
- Lucy Webber
- Department of Paediatric Dermatology, Bristol Children's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Michelle Cummins
- Department of Paediatric Haematology & Oncology, Bristol Children's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Rebecca Mann
- Department of Paediatrics, Musgrove Park Hospital, Taunton & Somerset NHS Foundation Trust, Taunton, UK
| | - Lindsay Shaw
- Department of Paediatric Dermatology, Bristol Children's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Rosanna Ghinai
- Department of Paediatric Haematology & Oncology, Bristol Children's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Caroline Mahon
- Department of Paediatric Dermatology, Starship Child Health, Auckland, New Zealand.,Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
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14
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Mahon C, Webber L, Bisson N, Droop E, Angus J, Shaw L, Wlodek C. Aerosolised deodorant-induced bullous dermatitis artefacta: A clinicopathological correlation. Australas J Dermatol 2019; 60:331-333. [PMID: 31158918 DOI: 10.1111/ajd.13083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Caroline Mahon
- Department of Paediatric Dermatology, Starship Child Health, Auckland, New Zealand.,Department of Paediatrics and Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Lucy Webber
- Department of Paediatric Dermatology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Nicholas Bisson
- Department of Paediatric Dermatology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Elizabeth Droop
- Department of Pathology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Janet Angus
- Department of Paediatric Dermatology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Lindsay Shaw
- Department of Paediatric Dermatology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Christina Wlodek
- Department of Dermatology, Waikato Hospital, Hamilton, New Zealand
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15
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Dueva-Koganov O, Crane C, Oswald T, Skobowiat C, Bianchini R, Mahon C, Falla T. 860 Evaluation of topical dermatologics containing L-ascorbic acid and its esters on Melanoderm™. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.936] [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: 11/26/2022]
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16
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Skobowiat C, Dueva-Koganov O, Crane C, Mahon C, Bianchini R, Rodan K, Fields K, Falla T. 859 Evaluation of Kojic Acid and Hydroquinone on Melanoderm™ skin model as controls in screening architecture for skin lightening actives and formulas. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Saunderson RB, Vekic DA, Mallitt K, Mahon C, Robertson SJ, Wargon O. A retrospective cohort study evaluating the accuracy of clinical diagnosis compared with immunofluorescence and electron microscopy in children with inherited epidermolysis bullosa. Br J Dermatol 2019; 180:1258-1259. [PMID: 30657165 DOI: 10.1111/bjd.17648] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- R B Saunderson
- Department of Dermatology, Royal North Shore Hospital, Reserve Road St Leonards, Saint Leonards, NSW, 2065, Australia
| | - D A Vekic
- Department of Dermatology, Liverpool Hospital, Liverpool, NSW, 1871, Australia
| | - K Mallitt
- School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia
| | - C Mahon
- Department of Dermatology, Bristol Royal Infirmary, Bristol, BS2 8HW, U.K.,Department of Dermatology, Great Ormond Street Hospital for Children NHS Trust, London, WC1N 3JH, U.K
| | - S J Robertson
- Department of Dermatology, The Skin and Cancer Foundation, Level 1, 80 Drummond Street, Carlton, Melbourne, Victoria, 3053, Australia
| | - O Wargon
- Department of Dermatology, Sydney Children's Hospital Randwick, Randwick, NSW, Australia
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18
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Mahon C, Gallagher P, Kiernan G. Sexual orientation, gender identity and social anxiety levels in sexual minorities. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky214.069] [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: 11/13/2022] Open
Affiliation(s)
- C Mahon
- Dublin City University, Glasnevin, Ireland
| | | | - G Kiernan
- Dublin City University, Glasnevin, Ireland
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19
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Al-Olabi L, Polubothu S, Dowsett K, Andrews KA, Stadnik P, Joseph AP, Knox R, Pittman A, Clark G, Baird W, Bulstrode N, Glover M, Gordon K, Hargrave D, Huson SM, Jacques TS, James G, Kondolf H, Kangesu L, Keppler-Noreuil KM, Khan A, Lindhurst MJ, Lipson M, Mansour S, O'Hara J, Mahon C, Mosica A, Moss C, Murthy A, Ong J, Parker VE, Rivière JB, Sapp JC, Sebire NJ, Shah R, Sivakumar B, Thomas A, Virasami A, Waelchli R, Zeng Z, Biesecker LG, Barnacle A, Topf M, Semple RK, Patton EE, Kinsler VA. Mosaic RAS/MAPK variants cause sporadic vascular malformations which respond to targeted therapy. J Clin Invest 2018; 128:5185. [PMID: 30382944 PMCID: PMC6205386 DOI: 10.1172/jci124649] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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20
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Mahon C, Miller K. Tender nodular lesion on the thigh of a 15-year-old boy. Pediatr Dermatol 2018; 35:836-837. [PMID: 30397944 DOI: 10.1111/pde.13583] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Caroline Mahon
- Department of Paediatric Dermatology, Bristol Royal Infirmary, University Hospitals Bristol National Health Services Foundation Trust, Bristol, UK
| | - Keith Miller
- Department of Pathology, Southmead Hospital, North Bristol National Health Services Trust, Bristol, UK
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21
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Mahon C, Heron G, Perkins D, Drage A, Wargon O. Oral propranolol for infantile haemangioma may be associated with transient gross motor delay. Br J Dermatol 2018; 178:1443-1444. [PMID: 29330846 DOI: 10.1111/bjd.16334] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- C Mahon
- Dermatology, Bristol Royal Infirmary, Bristol, U.K.,Dermatology, Great Ormond Street Hospital for Children NHS Trust, London, U.K
| | - G Heron
- Paediatric Dermatology - Randwick, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia.,University of New South Wales - RandwickCampus, Randwick, New South Wales, Australia
| | - D Perkins
- Paediatric Dermatology - Randwick, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
| | - A Drage
- Dermatology, Bristol Royal Infirmary, Bristol, U.K
| | - O Wargon
- Paediatric Dermatology - Randwick, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia.,University of New South Wales - RandwickCampus, Randwick, New South Wales, Australia
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22
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Al-Olabi L, Polubothu S, Dowsett K, Andrews KA, Stadnik P, Joseph AP, Knox R, Pittman A, Clark G, Baird W, Bulstrode N, Glover M, Gordon K, Hargrave D, Huson SM, Jacques TS, James G, Kondolf H, Kangesu L, Keppler-Noreuil KM, Khan A, Lindhurst MJ, Lipson M, Mansour S, O'Hara J, Mahon C, Mosica A, Moss C, Murthy A, Ong J, Parker VE, Rivière JB, Sapp JC, Sebire NJ, Shah R, Sivakumar B, Thomas A, Virasami A, Waelchli R, Zeng Z, Biesecker LG, Barnacle A, Topf M, Semple RK, Patton EE, Kinsler VA. Mosaic RAS/MAPK variants cause sporadic vascular malformations which respond to targeted therapy. J Clin Invest 2018; 128:1496-1508. [PMID: 29461977 PMCID: PMC5873857 DOI: 10.1172/jci98589] [Citation(s) in RCA: 147] [Impact Index Per Article: 24.5] [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: 11/15/2017] [Accepted: 01/30/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND. Sporadic vascular malformations (VMs) are complex congenital anomalies of blood vessels that lead to stroke, life-threatening bleeds, disfigurement, overgrowth, and/or pain. Therapeutic options are severely limited, and multidisciplinary management remains challenging, particularly for high-flow arteriovenous malformations (AVM). METHODS. To investigate the pathogenesis of sporadic intracranial and extracranial VMs in 160 children in which known genetic causes had been excluded, we sequenced DNA from affected tissue and optimized analysis for detection of low mutant allele frequency. RESULTS. We discovered multiple mosaic-activating variants in 4 genes of the RAS/MAPK pathway, KRAS, NRAS, BRAF, and MAP2K1, a pathway commonly activated in cancer and responsible for the germline RAS-opathies. These variants were more frequent in high-flow than low-flow VMs. In vitro characterization and 2 transgenic zebrafish AVM models that recapitulated the human phenotype validated the pathogenesis of the mutant alleles. Importantly, treatment of AVM-BRAF mutant zebrafish with the BRAF inhibitor vemurafinib restored blood flow in AVM. CONCLUSION. Our findings uncover a major cause of sporadic VMs of different clinical types and thereby offer the potential of personalized medical treatment by repurposing existing licensed cancer therapies. FUNDING. This work was funded or supported by grants from the AVM Butterfly Charity, the Wellcome Trust (UK), the Medical Research Council (UK), the UK National Institute for Health Research, the L’Oreal-Melanoma Research Alliance, the European Research Council, and the National Human Genome Research Institute (US).
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Affiliation(s)
- Lara Al-Olabi
- Genetics and Genomic Medicine, University College London (UCL) Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Satyamaanasa Polubothu
- Genetics and Genomic Medicine, University College London (UCL) Great Ormond Street Institute of Child Health, London, United Kingdom.,Paediatric Dermatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Katherine Dowsett
- MRC Human Genetics Unit and Cancer Research UK (CRUK) Edinburgh Centre, Medical Research Council (MRC) Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, United Kingdom
| | - Katrina A Andrews
- Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom.,The National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - Paulina Stadnik
- Genetics and Genomic Medicine, University College London (UCL) Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Agnel P Joseph
- Department of Biological Sciences, Birkbeck, University of London, London, United Kingdom
| | - Rachel Knox
- Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom.,The National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - Alan Pittman
- Molecular Neuroscience, UCL Institute of Neurology, London, United Kingdom
| | - Graeme Clark
- Department of Medical Genetics, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - William Baird
- Genetics and Genomic Medicine, University College London (UCL) Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Neil Bulstrode
- Plastic Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Mary Glover
- Paediatric Dermatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Kristiana Gordon
- Dermatology and Lymphovascular Medicine, St. George's Hospital NHS Trust, London, United Kingdom
| | - Darren Hargrave
- Paediatric Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Susan M Huson
- Manchester Centre for Genomic Medicine, St. Mary's Hospital, Manchester, United Kingdom
| | - Thomas S Jacques
- Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health and Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Gregory James
- Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Hannah Kondolf
- National Human Genome Research Institute, NIH, Bethesda, Maryland, USA
| | - Loshan Kangesu
- Plastic Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | | | - Amjad Khan
- Paediatric Dermatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | | | - Mark Lipson
- Paediatrics and Clinical Genetics, Kaiser Permanente Medical Center, Sacramento, California, USA
| | - Sahar Mansour
- Clinical Genetics, St. George's Hospital NHS Trust, London, United Kingdom
| | - Justine O'Hara
- Plastic Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Caroline Mahon
- Paediatric Dermatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Anda Mosica
- Paediatric Dermatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Celia Moss
- Paediatric Dermatology, Birmingham Women's and Children's NHS Foundation Trust Birmingham and University of Birmingham, Birmingham, United Kingdom
| | - Aditi Murthy
- Paediatric Dermatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Juling Ong
- Plastic Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Victoria E Parker
- Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom.,The National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | | | - Julie C Sapp
- National Human Genome Research Institute, NIH, Bethesda, Maryland, USA
| | - Neil J Sebire
- Paediatric Pathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Rahul Shah
- Plastic Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Branavan Sivakumar
- Plastic Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Anna Thomas
- Genetics and Genomic Medicine, University College London (UCL) Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Alex Virasami
- Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health and Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Regula Waelchli
- Paediatric Dermatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Zhiqiang Zeng
- MRC Human Genetics Unit and Cancer Research UK (CRUK) Edinburgh Centre, Medical Research Council (MRC) Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, United Kingdom
| | | | - Alex Barnacle
- Interventional Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Maya Topf
- Department of Biological Sciences, Birkbeck, University of London, London, United Kingdom
| | - Robert K Semple
- Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom.,The National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, United Kingdom.,University of Edinburgh Centre for Cardiovascular Science, Queen's Medical Research Institute, Edinburgh, United Kingdom
| | - E Elizabeth Patton
- MRC Human Genetics Unit and Cancer Research UK (CRUK) Edinburgh Centre, Medical Research Council (MRC) Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, United Kingdom
| | - Veronica A Kinsler
- Genetics and Genomic Medicine, University College London (UCL) Great Ormond Street Institute of Child Health, London, United Kingdom.,Paediatric Dermatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
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Mahon C, Wargon O. Discolored Fingertip and Dysesthesia of the Fingers in a 9-year-old Girl. Pediatr Dermatol 2016; 33:667-668. [PMID: 27882664 DOI: 10.1111/pde.12977] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Caroline Mahon
- Dermatology Department, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Orli Wargon
- Sydney Children's Hospital Randwick, Randwick, NSW, Australia
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24
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Packer L, Geng X, Bonazzi V, Mahon C, Ju R, Stephenson S, Pollock P. Combination of BGJ398 with either a pan-PI3K inhibitor or a specific PIK3CA inhibitor shows synergy in FGFR2 mutant endometrial cancer cell lines. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)61523-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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25
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Mahon C, Walker W, Drage A, Best E. Incidence, aetiology and outcome of pleural empyema and parapneumonic effusion from 1998 to 2012 in a population of New Zealand children. J Paediatr Child Health 2016; 52:662-8. [PMID: 27059295 DOI: 10.1111/jpc.13172] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2016] [Indexed: 11/26/2022]
Abstract
AIM To document rising incidence rates of childhood empyema and parapneumonic effusion (PPE) in South Auckland, New Zealand between 1998 and 2012; to compare epidemiology, pathogens and outcomes of children with empyema and PPE; and to ascertain whether primary care antibiotic prescribing, delayed presentation, or bacterial epidemiology might account for the rising incident rates. METHODS Children aged 0 to14 years hospitalised with pleural empyema or PPE were retrospectively identified. Empyema was defined by ultrasound and pleural tap criteria. PPE was defined as the presence of pleural fluid on chest xray not fulfilling empyema criteria. Epidemiology, clinical features, microbiology and outcomes of empyema and PPE were compared and incidence rates analysed. RESULTS Of 184 cases identified, 104 met the criteria for empyema. Empyema incidence increased from 1 per 100 000 children aged 0 to 14 years in 1998 to 10 per 100 000 in 2012, with a peak incidence of 13 per 100 000 in 2009. Staphylococcus aureus was most frequently detected (n=38), followed by Streptococcus pneumoniae (n=31). Cases of S. aureus empyema increased 4 fold over the 15 years. Dominant S. pneumoniae serotypes were 1 and 14. Thirty-five percent of empyema and 53% of PPE cases received pre-hospital antibiotics. Children who received pre-hospital antibiotics were more than 40% less likely to require surgical intervention than those not pre-treated. CONCLUSIONS Childhood empyema incidence has increased markedly in South Auckland. Paediatric S. aureus empyema is becoming increasingly common in South Auckland. Pre-hospital antibiotic prescribing may mitigate the need for surgical intervention in our population.
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Affiliation(s)
| | - Wendy Walker
- Kidz First Hospital, South Auckland, New Zealand
| | - Alan Drage
- Kidz First Hospital, South Auckland, New Zealand
| | - Emma Best
- Department of Paediatrics, The University of Auckland, New Zealand.,Paediatric Infectious Diseases, Starship Children's Health, Auckland, New Zealand
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26
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Mahon C, Kenny C, Lim R, Earls S, Travers B, McDonald K. 24 Anaemia in heart failure unit St. Michaels hospital dun laoghaire. Heart 2015. [DOI: 10.1136/heartjnl-2015-308621.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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27
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Mahon C, Erwin J, Keane D. 16 Incidence of thromboembolism following detection by trans-oesphageal echocardiography of left atrial thrombus: Abstract 16 Table 1. Heart 2015. [DOI: 10.1136/heartjnl-2015-308621.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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28
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Mahon C, Oliver F, Purvis D, Agnew K. Amyloidosis cutis dyschromica in two siblings and review of the epidemiology, clinical features and management in 48 cases. Australas J Dermatol 2015; 57:307-311. [PMID: 25866143 DOI: 10.1111/ajd.12342] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 03/15/2015] [Indexed: 11/27/2022]
Abstract
Amyloidosis cutis dyschromica (ACD) is a rare form of primary cutaneous amyloidosis (PCA). There is a paucity of information in the dermatology literature to guide its diagnosis, investigation and treatment. We present two siblings with ACD and summarise the epidemiology, clinical features, natural history and treatments in 48 cases of ACD from the literature. Familial cases were more common (37) than sporadic cases. ACD is predominantly reported in those of East and South-East Asian ethnicity (63%). The mean age of onset was 6 years in familial cases, and 23 years in sporadic cases. The clinical features of familial and sporadic ACD do not differ substantially. Pruritus was the only symptom, and was reported in 19% of all cases. There were no reported ACD cases with systemic amyloidosis. Acitretin was reported to result in improvement in seven of 10 patients treated. Routine investigation for systemic involvement is not necessary. Acitretin may be helpful.
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Affiliation(s)
- Caroline Mahon
- Dermatology Department, Greenlane Clinical Centre, Auckland, New Zealand
| | - Fergus Oliver
- Dermatology Department, Greenlane Clinical Centre, Auckland, New Zealand
| | - Diana Purvis
- Department of Paediatric Dermatology, Starship Children's Hospital, Auckland, New Zealand
| | - Karen Agnew
- Department of Paediatric Dermatology, Starship Children's Hospital, Auckland, New Zealand
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29
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Packer L, Byron S, Mahon C, Loch D, Wortmann A, Nones K, Grimmond S, Pearson J, Waddell N, Pollock P. 94 Elucidating mechanisms of resistance to FGFR inhibitors in endometrial cancer. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70220-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Abstract
Imatinib mesylate was the first of several tyrosine kinase inhibitors approved for use in the treatment of a number of human cancers. Adverse cutaneous reactions to imatinib are common. Pseudoporphyria has been infrequently reported in adults undergoing imatinib therapy for chronic myeloid leukemia. We present two children with pseudoporphyria induced by imatinib therapy for hematologic malignancies. In view of the burgeoning use of imatinib in children, physicians should be aware that pseudoporphyria may develop as a consequence of imatinib therapy.
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Affiliation(s)
- Caroline Mahon
- Department of Paediatric Dermatology, Starship Children's Health, Auckland, New Zealand
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31
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Abstract
BACKGROUND Technological advances mean that many adults are now employed in sedentary occupations. Given evidence linking prolonged sitting to chronic disease risk, understanding sitting and physical activity in and outside the workplace may usefully inform effective interventions. AIMS To assess sitting time and physical activity during and outside working hours in full-time office workers. METHODS Participants wore a pedometer and recorded sitting times and step counts during and outside working hours for 7 days. Participants were divided into tertiles based on the proportion of time spent sitting at work. Sitting times and step counts reported outside work were compared between groups, using one-way analysis of variance. RESULTS There were 72 participants. Almost two-thirds (65%) of time at work was spent sitting. The sample accumulated 3742±2493 steps at work and 5159±2474 steps outside work on workdays. Participants in the highest tertile for workplace sitting reported sitting for longer than those in the lowest tertile during transport (64±59 versus 21±16min), after work (154±30 versus 126±51min) and at weekends (382±133 versus 288±124min, all P < 0.05). Work duration and steps reported outside work did not differ between groups. CONCLUSIONS Office workers who sit for a large proportion of their working day also report sitting for longer outside work. They do not compensate for their sedentary behaviour at work by being more active outside work. Occupational health interventions should focus on reducing workplace and leisure-time sitting in sedentary office workers.
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Affiliation(s)
- S A Clemes
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire LE11 3TU, UK
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Mahon C, Maurice P, McClean D. Congestion bleeding of the head and neck following myocardial infarction. N Z Med J 2014; 127:71-75. [PMID: 24481390] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We present an unusual case of congestion bleeding of the head and neck following myocardial infarction. A 51-year-old man presented with widespread facial petechiae and subconjunctival haemorrhages following a collapse associated with evolving electrocardiographic changes. Emergency coronary artery stent placement was undertaken. No cardiopulmonary resuscitation (CPR) was performed. We hypothesise that the presence of facial petechiae in our case following transient loss of consciousness due to a presumed ventricular arrhythmia in the setting of acute myocardial ischaemia, may have been precipitated by a Valsalva manoeuvre on regaining consciousness with sudden acute increase in venous pressure and consequent venous congestion of the head and neck, and that congestion bleeding of the face may occur in acute cardiac events without a history of CPR.
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Affiliation(s)
- Caroline Mahon
- Dermatology Department, Greenlane Clinical Centre, Private Bag 92-189, Auckland Mail Centre 1142, Auckland, New Zealand.
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O'Toole O, Mahon C, Lynch K, Brett FM. Is the contribution of alcohol to fatal traumatic brain injuries being underestimated in the acute hospital setting? Ir Med J 2009; 102:207-209. [PMID: 19771999] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Alcohol consumption in Ireland has nearly doubled during the period 1989-2001. To evaluate the relationship of alcohol to fatal head injuries in the acute hospital setting we created a data base of all fatal traumatic brain injuries in the Department of Neuropathology at Beaumont Hospital over a ten year period (1997-2006 inclusive). 498 cases were identified (351 males: 147 females). Fatalities were highest in males aged 19-25 years (N=101) and 51-70 years (N=109). Falls (N=210) and road traffic accidents (N=183) were the commonest modes of presentation. 36/210 (17%) falls had positive blood alcohol testing, 9/210 (4.3%) had documentation of alcohol in notes but no testing, 35/210 (16.7%) tested negative for alcohol and 130/210 (61.9%) were not tested. The RTA group (N=183) comprised drivers (n=79), passengers (n=47) and pedestrians (n=57). 65/79 (82.2%) of drivers were males aged 19-25 years. Blood alcohol was only available in 27/79 (34.1%) drivers and was positive in 13/27 (48.1%). 14/75 (18.7%) pedestrians were tested for alcohol, 4/14 (28.6%) were positive. Overall 142/183 (77.6%) of the RTA group were not tested. The contribution of alcohol to fatal traumatic brain injuries is probably being underestimated due to omission of blood alcohol concentration testing on admission to hospital. Absence of national guidelines on blood alcohol testing in the emergency department compounds the problem.
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Affiliation(s)
- O O'Toole
- Department of Neuropathology, Beaumont Hospital, Beaumont, Dublin
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Gatt M, MacFie J, Mahon C, Mainprize K. Risk factors for anastomotic failure after total mesorectal excision of rectal cancer (Br J Surg 2005; 92: 211-216). Br J Surg 2005; 92:896. [PMID: 15962259 DOI: 10.1002/bjs.5113] [Citation(s) in RCA: 3] [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: 11/10/2022]
Abstract
Abstract
The Editors welcome topical correspondence from readers relating to articles published in the Journal. Responses can be sent electronically via the BJS website (www.bjs.co.uk) or by post. All letters will be reviewed and, if approved, appear on the website. A selection of these will be edited and published in the Journal. Letters must be no more than 250 words in length. Letters submitted by post should be typed on A4-sized paper in double spacing and should be accompanied by a disk.
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Levadoux M, Mahon C, Beattie JH, Wallace HM, Hesketh JE. Nuclear import of metallothionein requires its mRNA to be associated with the perinuclear cytoskeleton. J Biol Chem 1999; 274:34961-6. [PMID: 10574972 DOI: 10.1074/jbc.274.49.34961] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The influence of mRNA localization on metallothionein-1 protein distribution was studied by immunocytochemistry. We used Chinese hamster ovary cells that had been transfected with either a native metallothionein-1 gene construct or metallothionein-1 5'-untranslated region and coding sequences linked to the 3'-untranslated region from glutathione peroxidase. The change in the 3'-untranslated region caused the delocalization of the mRNA with a loss of the perinuclear localization and association with the cytoskeleton. Clones were selected which expressed similar levels of metallothionein-1 protein, as assessed by radioimmunoassay. The results showed that loss of metallothionein-1 mRNA localization was associated with a loss of metallothionein-1 protein localization, most notably with a lack of metallothionein-1 protein in the nucleus of synchronized cells which were beginning to synthesize DNA. This indicates that the association of metallothionein-1 mRNA with the cytoskeleton around the nucleus is essential for efficient shuttling of the protein into the nucleus during the G(1) to S phase transition. This is the first demonstration of a physiological role for perinuclear mRNA localization and we propose that such localization may be important for a wide range of nuclear proteins, including those that shuttle between nucleus and cytoplasm in a cell cycle dependent manner.
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Affiliation(s)
- M Levadoux
- Rowett Research Institute, Greenburn Road, Bucksburn, Aberdeen AB21 9SB, United Kingdom
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Zografos GN, Scott HJ, Mahon C, Spencer J. Chylothorax complicating Ivor Lewis oesophagectomy. Eur J Surg 1996; 162:147-8. [PMID: 8639729] [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] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- G N Zografos
- Department of Surgery, Royal Postgraduate Medical School, Hammersmith Hospital, London, England
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