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Norwich-Cavanaugh A, Kim S, Panse G, Saberski E, Hsia HC, Narayan D. Prelamination of Vascularized Tensor Fascia Lata for Complex Abdominal Wall Reconstruction. Ann Plast Surg 2021; 86:S332-S335. [PMID: 33443881 DOI: 10.1097/sap.0000000000002690] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT There are 2 to 5 million laparotomies performed in the United States annually. Of these, 250,000 to 350,000 will undergo a ventral hernia repair. Repairs are often complicated by recurrence and infection. These risks are significantly increased in previously infected repairs, with reported recurrence rates varying from 17% to 28% after repair of infected ventral hernias, double the rates reported for first-time uninfected repairs. We describe here a novel treatment strategy involving the creation then use of bilateral prelaminated permanent mesh-reinforced tensor fascia latae flaps for abdominal wall reconstruction in patients who have recurrent ventral hernias and had undergone previous repairs complicated by infection. Previous repairs included anterior components separation, thereby making subsequent fascial release techniques and achievement of a reinforced repair extremely unlikely. Three patients were treated by a single surgeon using this 2-stage technique. There have been no incidences of recurrence and no infections after 2 to 10 years. In these patients, the only conventional option would have been a bridged repair with absorbable mesh. Combining the advantages of permanent mesh and well-vascularized autologous tissue optimizes the repair's tensile strength while mitigating the chance of recurrent infection associated with the use of permanent mesh. We propose that this strategy may be an appropriate treatment option for patients with recurrent ventral hernias that have not responded to other conventional modalities of treatment.
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Affiliation(s)
| | - Samuel Kim
- From the Division of Plastic Surgery, Department of Surgery
| | - Gauri Panse
- Department of Dermatology, Yale School of Medicine, New Haven, CT
| | - Ean Saberski
- From the Division of Plastic Surgery, Department of Surgery
| | - Henry C Hsia
- From the Division of Plastic Surgery, Department of Surgery
| | - Deepak Narayan
- From the Division of Plastic Surgery, Department of Surgery
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2
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Nouws J, Fitch M, Mata M, Santoro N, Galuppo B, Kursawe R, Narayan D, Vash-Margita A, Pierpont B, Shulman GI, Hellerstein M, Caprio S. Altered In Vivo Lipid Fluxes and Cell Dynamics in Subcutaneous Adipose Tissues Are Associated With the Unfavorable Pattern of Fat Distribution in Obese Adolescent Girls. Diabetes 2019; 68:1168-1177. [PMID: 30936147 PMCID: PMC6610014 DOI: 10.2337/db18-1162] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 03/24/2019] [Indexed: 12/20/2022]
Abstract
Patterns of abdominal fat distribution (for example, a high vs. low visceral adipose tissue [VAT]/[VAT + subcutaneous adipose tissue (SAT)] ratio), independent of obesity, during adolescence carry a high risk for insulin resistance and type 2 diabetes. Longitudinal follow-up of a cohort of obese adolescents has recently revealed that a high ratio (high VAT/[VAT + SAT]) is a major determinant of fatty liver and metabolic impairment over time, with these effects being more pronounced in girls than in boys. To unravel the underlying metabolic alterations associated with the unfavorable VAT/(VAT + SAT) phenotype, we used the 2H2O labeling method to measure the turnover of adipose lipids and cells in the subcutaneous abdominal and gluteal/femoral adipose tissue (SAT) of weight-stable obese adolescent girls with a similar level of obesity but discordant VAT/(VAT + SAT) ratios. Girls with the unfavorable (high VAT/[VAT + SAT]) phenotype exhibited higher in vivo rates of triglyceride (TG) turnover (representing both lipolysis and synthesis at steady state), without significant differences in de novo lipogenesis in both abdominal and gluteal depots, compared with obese girls with the favorable phenotype. Moreover, mature adipocytes had higher turnover, with no difference in stromal vascular cell proliferation in both depots in the metabolically unfavorable phenotype. The higher TG turnover rates were significantly correlated with higher intrahepatic fat stores. These findings are contrary to the hypothesis that impaired capacity to deposit TGs or proliferation of new mature adipocytes are potential mechanisms for ectopic fat distribution in this setting. In summary, these results suggest that increased turnover of TGs (lipolysis) and of mature adipocytes in both abdominal and gluteal SAT may contribute to metabolic impairment and the development of fatty liver, even at this very early stage of disease.
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Affiliation(s)
- Jessica Nouws
- Division of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Mark Fitch
- Department of Nutritional Sciences and Toxicology, University of California at Berkeley, Berkeley, CA
| | - Mariana Mata
- Division of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Nicola Santoro
- Division of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Brittany Galuppo
- Division of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Romy Kursawe
- Diabetes and Obesity, The Jackson Laboratory, Farmington, CT
| | - Deepak Narayan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Alla Vash-Margita
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Bridget Pierpont
- Division of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Gerald I Shulman
- Howard Hughes Medical Institute, Yale University School of Medicine, New Haven, CT
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
- Department of Cellular and Molecular Physiology, Yale University, New Haven, CT
| | - Marc Hellerstein
- Department of Nutritional Sciences and Toxicology, University of California at Berkeley, Berkeley, CA
| | - Sonia Caprio
- Division of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT
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3
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Schultz B, Spock C, Tom L, Kong Y, Canadas K, Kim S, Waner M, O. T, Antaya R, Narayan D. MicroRNA Microarray Profiling in Infantile Hemangiomas. Eplasty 2019; 19:e13. [PMID: 31068993 PMCID: PMC6482871] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective: MicroRNAs are short, noncoding RNA molecules that negatively regulate the stability and translational efficiency of target mRNAs. They are critical regulators of growth and development. Our aim was to identify microRNAs involved in the growth and regulation of infantile hemangiomas. In addition, we searched for the presence of Piwi-interacting RNAs in hemangioma tissue as another regulator of infantile hemangiomas. Methods: RNA was extracted from hemangioma specimens from 3 clinical, age-based categories: proliferative (N = 16), quiescent (N = 8), and involuting (N = 9). RNAs from human dermal microvascular endothelial cells were used as controls. MicroRNA microarray was performed, and the expression profiles of the hemangiomas and endothelial cells were compared using the t test. 5' End-labeling of RNA of our hemangioma specimens was performed for Piwi-interacting RNA detection. Results: Analysis confirmed statistically significant downregulated (N = 18) and upregulated (N = 15) microRNAs. Piwi-interacting RNA analysis did not detect Piwi-interacting RNA transcripts in the hemangioma specimens. Conclusions: The differential expression of microRNAs found in our hemangioma specimens provides insight into the regulation of hemangioma formation and proliferation, quiescence, and fibrofatty involution. Piwi-interacting RNA transcripts were not detected in the hemangioma specimens. These novel findings will help in establishing new therapeutic and diagnostic initiatives for these tumors.
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Affiliation(s)
| | | | | | - Yong Kong
- bYale School of Public Health: Biostatistics, New Haven, Conn
| | | | - Samuel Kim
- dSection of Plastic and Reconstructive Surgery
| | | | - Teresa O.
- fVascular Birthmark Institute, New York, NY
| | - Richard Antaya
- eDepartments of Dermatology and Pediatrics, Yale School of Medicine, New Haven, Conn
| | - Deepak Narayan
- dSection of Plastic and Reconstructive Surgery,Correspondence:
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4
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Halaban R, Bacchiocchi A, Straub R, Cao J, Sznol M, Narayan D, Allam A, Krauthammer M, Mansour TS. A novel anti-melanoma SRC-family kinase inhibitor. Oncotarget 2019; 10:2237-2251. [PMID: 31040916 PMCID: PMC6481345 DOI: 10.18632/oncotarget.26787] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 03/04/2019] [Indexed: 12/29/2022] Open
Abstract
The major drawback of melanoma therapy with BRAF and MAPK inhibitors is the innate and acquired drug resistance. We therefore explored alternative targets and developed a new compound, SAB298, that is a SRC-family kinase (SFK) inhibitor. The drug is cytotoxic to patient-derived melanoma cells regardless of oncogene expression and inhibits tumor growth in vivo. As expected, it inhibited SRC and PI3K activity, and had the additional property of ERBB2 inhibition, that lead to inactivation of the two ERK phosphatases PP2A and SHP2. In 57% of the melanoma cell lines tested, the consequent increase in ERK activity lead to proteolytic degradation of its substrate, the lineage specific transcription factor MITF, likely contributing to growth arrest. Treatment with a combination of SAB298 and AZD6244 (selumetinib), induced a synergistic growth inhibition, suggesting that the new compound could be used in the clinic as a substitute for, or in combination with MAPK inhibitors.
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Affiliation(s)
- Ruth Halaban
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Antonella Bacchiocchi
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Robert Straub
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jian Cao
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Mario Sznol
- Comprehensive Cancer Center Section of Medical Oncology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Deepak Narayan
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Ahmed Allam
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
| | - Michael Krauthammer
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
- Program in Computational Biology and Bioinformatics, Yale University School of Medicine, New Haven, Connecticut, USA
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5
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Chan BK, Turner PE, Kim S, Mojibian HR, Elefteriades JA, Narayan D. Publisher's Note: Phage treatment of an aortic graft infected with Pseudomonas aeruginosa. Evol Med Public Health 2019; 2019:35. [PMID: 30847220 PMCID: PMC6398325 DOI: 10.1093/emph/eoz006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Benjamin K Chan
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, CT, USA
| | - Paul E Turner
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, CT, USA.,Program in Microbiology, Yale School of Medicine, New Haven, CT, USA
| | - Samuel Kim
- Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Hamid R Mojibian
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - John A Elefteriades
- Section of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Deepak Narayan
- Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
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6
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Perez MC, Sun J, Farley C, Han D, Sun AH, Narayan D, Lowe M, Delman KA, Messina JL, Gonzalez RJ, Sondak VK, Khushalani NI, Zager JS. Management of intussusception in patients with melanoma. J Surg Oncol 2019; 119:897-902. [PMID: 30734297 DOI: 10.1002/jso.25393] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 01/08/2019] [Accepted: 01/19/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Increased cross-sectional imaging for surveillance of metastatic melanoma has led to more diagnoses of asymptomatic intussusception. METHODS We performed a multi-institutional retrospective review of patient records with a history of metastatic melanoma and a diagnosis of intussusception. Patients were divided into three groups: 1) asymptomatic patients without current evidence of melanoma (no evidence of disease [NED]); 2) asymptomatic intussusception and known active metastatic melanoma; 3) symptomatic intussusception and known active metastatic melanoma; the number of patients requiring surgery and intraoperative findings were recorded. RESULTS We reviewed 73 patients diagnosed with intussusception from 2004 to 2017. Among asymptomatic patients with NED (n = 16), 14 spontaneously resolved and 2 underwent pre-emptive surgery without abnormal intraoperative findings. Of asymptomatic patients with active metastatic disease (n = 32), 25 were initially observed and 7 underwent pre-emptive surgery and 9 of the 25 initially observed patients required surgery for development of symptoms. In this group, all 16 patients undergoing surgery (50% of the group) had intraoperative findings of intussusception and/or metastatic intestinal melanoma.. All symptomatic patients with metastatic melanoma (n = 25) underwent surgery; all had intraoperative findings of intussusception and/or metastatic melanoma except 1 (Meckel's diverticulum). CONCLUSION Asymptomatic patients with NED do not require surgery and intussusception will likely resolve spontaneously. Asymptomatic patients with known metastatic melanoma may be initially observed, but a low threshold for surgery should be maintained. Symptomatic patients with known metastases should undergo surgery.
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Affiliation(s)
- Matthew C Perez
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida.,Division of Surgical Oncology, Emory University, Atlanta, Georgia
| | - James Sun
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Clara Farley
- Division of Surgical Oncology, Emory University, Atlanta, Georgia
| | - Dale Han
- Division of Surgical Oncology, Department of Surgery, Oregon Health and Science University, Portland, Oregon
| | - Alexander H Sun
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Deepak Narayan
- Division of Plastic Surgery, Department of Surgery, Yale University, New Haven, Connecticut
| | - Michael Lowe
- Division of Surgical Oncology, Emory University, Atlanta, Georgia
| | - Keith A Delman
- Division of Surgical Oncology, Emory University, Atlanta, Georgia
| | - Jane L Messina
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida
| | | | - Vernon K Sondak
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida
| | | | - Jonathan S Zager
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida
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8
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Pavri SN, Gary C, Martinez RS, Kim S, Han D, Ariyan S, Narayan D. Nonvisualization of Sentinel Lymph Nodes by Lymphoscintigraphy in Primary Cutaneous Melanoma: Incidence, Risk Factors, and a Review of Management Options. Plast Reconstr Surg 2018; 142:527e-534e. [PMID: 30020233 DOI: 10.1097/prs.0000000000004771] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Lymphoscintigraphy is often performed before sentinel lymph node biopsy, especially in areas likely to have multiple or aberrant drainage patterns. This study aims to determine the incidence and characteristics of melanoma patients with negative lymphoscintigraphic findings and to review the management options and surgical recommendations. METHODS This is a retrospective study of patients with primary cutaneous melanoma who underwent sentinel lymph node biopsy between 2005 and 2016. Patients with nonvisualized lymph nodes on preoperative lymphoscintigraphy were compared in a 1:4 ratio with a randomly selected unmatched cohort drawn from all melanoma patients who underwent preoperative lymphoscintigraphy within the period of the study. Demographic, clinical, and outcome data were compared between these groups. RESULTS A negative lymphoscintigraphic scan was seen in 2.3 percent of all cases (25 of 1073). In both univariate and multivariate analyses, predictive patient- and tumor-specific factors for negative lymphoscintigraphy included older age and head and neck location. Patients with a nonvisualized sentinel lymph node had significantly worse overall survival compared with patients who had a visualized sentinel lymph node, but there was no difference in melanoma-specific survival. In 16 of the 25 cases (64 percent), at least one sentinel lymph node was found intraoperatively despite the negative lymphoscintigraphic findings. CONCLUSIONS Older patients with head and neck melanomas are more likely to experience nodal nonvisualization on lymphoscintigraphy. In patients who have nodal nonvisualization, the surgeon should attempt sentinel lymph node biopsy at the time of excision of the primary lesion because a sentinel lymph node can still be found in a majority of cases, and it offers prognostic information. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, II.
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Affiliation(s)
- Sabrina Nicole Pavri
- From the Department of Surgery, Sections of Plastic and Reconstructive Surgery and Surgical Oncology, Yale University School of Medicine
| | - Cyril Gary
- From the Department of Surgery, Sections of Plastic and Reconstructive Surgery and Surgical Oncology, Yale University School of Medicine
| | - Rajendra Sawh Martinez
- From the Department of Surgery, Sections of Plastic and Reconstructive Surgery and Surgical Oncology, Yale University School of Medicine
| | - Samuel Kim
- From the Department of Surgery, Sections of Plastic and Reconstructive Surgery and Surgical Oncology, Yale University School of Medicine
| | - Dale Han
- From the Department of Surgery, Sections of Plastic and Reconstructive Surgery and Surgical Oncology, Yale University School of Medicine
| | - Stephan Ariyan
- From the Department of Surgery, Sections of Plastic and Reconstructive Surgery and Surgical Oncology, Yale University School of Medicine
| | - Deepak Narayan
- From the Department of Surgery, Sections of Plastic and Reconstructive Surgery and Surgical Oncology, Yale University School of Medicine
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9
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Balkin DM, Nelson-Williams C, Sumpio BJ, Scott DA, Pabic PL, Schilling TF, Lifton RP, Narayan D. Abstract QS43. Plast Reconstr Surg Glob Open 2018. [PMCID: PMC5959671 DOI: 10.1097/01.gox.0000534051.38103.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Chan BK, Turner PE, Kim S, Mojibian HR, Elefteriades JA, Narayan D. Phage treatment of an aortic graft infected with Pseudomonas aeruginosa. Evol Med Public Health 2018; 2018:60-66. [PMID: 29588855 PMCID: PMC5842392 DOI: 10.1093/emph/eoy005] [Citation(s) in RCA: 281] [Impact Index Per Article: 46.8] [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: 09/29/2017] [Accepted: 01/28/2018] [Indexed: 12/11/2022]
Abstract
Management of prosthetic vascular graft infections caused by Pseudomonas aeruginosa can be a significant challenge to clinicians. These infections often do not resolve with antibiotic therapy alone due to antibiotic resistance/tolerance by bacteria, poor ability of antibiotics to permeate/reduce biofilms and/or other factors. Bacteriophage OMKO1 binding to efflux pump proteins in P. aeruginosa was consistent with an evolutionary trade-off: wildtype bacteria were killed by phage whereas evolution of phage-resistance led to increased antibiotic sensitivity. However, phage clinical-use has not been demonstrated. Here, we present a case report detailing therapeutic application of phage OMKO1 to treat a chronic P. aeruginosa infection of an aortic Dacron graft with associated aorto-cutaneous fistula. Following a single application of phage OMKO1 and ceftazidime, the infection appeared to resolve with no signs of recurrence.
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Affiliation(s)
- Benjamin K Chan
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, CT, USA
| | - Paul E Turner
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, CT, USA.,Program in Microbiology, Yale School of Medicine, New Haven, CT, USA
| | - Samuel Kim
- Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Hamid R Mojibian
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - John A Elefteriades
- Section of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Deepak Narayan
- Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
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11
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Broer PN, Aung T, Heidekrueger PI, Prantl L, Narayan D. Divisive influence of interleukin-1 receptor antagonist polymorphisms in melanoma patients. Clin Hemorheol Microcirc 2017; 67:319-326. [DOI: 10.3233/ch-179212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- P. Niclas Broer
- Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
- Department of Plastic, Reconstructive, Hand, and Burn Surgery, StKM Klinikum Bogenhausen, Academic Teaching Hospital Technical University Munich, Germany
| | - Thiha Aung
- Department of Plastic and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Paul I. Heidekrueger
- Department of Plastic, Reconstructive, Hand, and Burn Surgery, StKM Klinikum Bogenhausen, Academic Teaching Hospital Technical University Munich, Germany
- Department of Plastic and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - L. Prantl
- Department of Plastic and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Deepak Narayan
- Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
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12
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Dhodapkar KM, Boddupalli CS, Bar N, Kadaveru K, Krauthammer M, Pornputtapong N, Mai Z, Ariyan S, Narayan D, Kluger HM, Deng Y, Verma R, Das R, Bacchiocchi A, Halaban R, Sznol M, Dhodapkar MV. Distinct dominant T-cell receptors with a tissue resident memory phenotype in individual melanoma metastases. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.7_suppl.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3 Background: Expression of inhibitory immune checkpoints (ICPs) within tumors has emerged as an important barrier for effective anti-tumor immunity. Antibody-mediated blockade of ICPs can lead to durable responses in patients. Interestingly, only a small subset of tumor infiltrating lymphocytes (TILs) express these checkpoints and there is a need to better understand the characteristics of this subset. We undertook this study to understand characteristics of TILs within melanoma. Methods: We used single cell mass cytometry, gene expression profiling of purified T cell subsets, T cell receptor (TCR) sequencing as well as functional studies to understand the characteristics of TILs in melanoma patients (n=50). We also performed exome sequencing of tumor cells in some patients. Results: We find that TILs are functionally and phenotypically distinct from circulating T cells. They express higher levels of inhibitory ICPs (PD-1, TIM-3) and secrete less IL2, IFNg and TNFa than T cells in circulation. Expression of vascular endothelial growth factor within tumors correlated with reduced T cell infiltration. Expression of ICPs (PD-1, TIM-3, PD-L1) were enriched in T cells with a phenotype and expression profile of tissue resident memory T (TRM) cells with most cells expressing multiple checkpoints. Within the myeloid compartment, ICPs were predominantly expressed on CD14+CD16+ subset. TCR sequencing revealed that individual melanoma metastases revealed that the top clones within each of the lesions have distinct TCRs. Concurrent TCR and tumor exome sequencing of individual metastases in the same patient revealed that inter-lesional diversity of TCRs exceeded differences in mutation/neoantigen load in tumor cells. Conclusions: Our findings suggest that TRM cells and CD16+ myeloid cells may be the major target of ICP blockade within tumors. The ability to activate, and retain TRM cells may be an important determinant of the T cell content of the tumor microenvironment and should be a goal for future vaccines. Importantly, our study illustrates inter-lesional diversity of TCRs within individual metastases which may differentially impact the outcome of immune therapy at each site.
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Affiliation(s)
| | | | - Noffar Bar
- Yale-New Haven Smilow Cancer Hosp, New Haven, CT
| | | | | | | | | | | | | | | | - Yanhong Deng
- Yale Center for Analytical Sciences, New Haven, CT
| | | | | | | | - Ruth Halaban
- Yale University School of Medicine, New Haven, CT
| | - Mario Sznol
- Yale University School of Medicine, New Haven, CT
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13
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Boddupalli CS, Bar N, Kadaveru K, Krauthammer M, Pornputtapong N, Mai Z, Ariyan S, Narayan D, Kluger H, Deng Y, Verma R, Das R, Bacchiocchi A, Halaban R, Sznol M, Dhodapkar MV, Dhodapkar KM. Interlesional diversity of T cell receptors in melanoma with immune checkpoints enriched in tissue-resident memory T cells. JCI Insight 2016; 1:e88955. [PMID: 28018970 DOI: 10.1172/jci.insight.88955] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Heterogeneity of tumor cells and their microenvironment can affect outcome in cancer. Blockade of immune checkpoints (ICPs) expressed only on a subset of immune cells leads to durable responses in advanced melanoma. Tissue-resident memory T (TRM) cells have recently emerged as a distinct subset of memory T cells in nonlymphoid tissues. Here, we show that functional properties and expression of ICPs within tumor-infiltrating lymphocytes (TILs) differ from those of blood T cells. TILs secrete less IL-2, IFN-γ, and TNF-α compared with circulating counterparts, and expression of VEGF correlated with reduced TIL infiltration. Within tumors, ICPs are particularly enriched within T cells with phenotype and genomic features of TRM cells and the CD16+ subset of myeloid cells. Concurrent T cell receptor (TCR) and tumor exome sequencing of individual metastases in the same patient revealed that interlesional diversity of TCRs exceeded differences in mutation/neoantigen load in tumor cells. These findings suggest that the TRM subset of TILs may be the major target of ICP blockade and illustrate interlesional diversity of tissue-resident TCRs within individual metastases, which did not equilibrate between metastases and may differentially affect the outcome of immune therapy at each site.
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Affiliation(s)
| | | | | | - Michael Krauthammer
- Program for Computational Biology and Bioinformatics.,Department of Pathology
| | | | | | | | | | | | | | | | | | | | | | | | - Madhav V Dhodapkar
- Department of Medicine.,Yale Cancer Center.,Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut, USA
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14
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Rubinstein JC, Han G, Jackson L, Bulloch K, Ariyan S, Narayan D, Rothberg BG, Han D. Regression in thin melanoma is associated with nodal recurrence after a negative sentinel node biopsy. Cancer Med 2016; 5:2832-2840. [PMID: 27671840 PMCID: PMC5083736 DOI: 10.1002/cam4.922] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/21/2016] [Accepted: 08/23/2016] [Indexed: 02/06/2023] Open
Abstract
Prognostic markers for nodal metastasis in thin melanoma patients are debated. We present a single institution study looking at factors predictive of nodal disease in thin melanoma patients. Retrospective review from 1997 to 2012 identified 252 patients with thin melanoma (≤1 mm) who underwent a sentinel lymph node biopsy (SLNB). Node‐positive patients included positive SLNB patients and negative SLNB patients who developed a nodal recurrence (false‐negative SLNB). Clinicopathologic characteristics were correlated with nodal status and outcome. Median follow‐up was 45.5 months. Twelve of 252 patients (4.8%) were node‐positive including six positive SLNB (2.4%) and six false‐negative SLNB (2.4%) patients. No clinicopathologic factors were significantly correlated with nodal disease. For the six false‐negative SLNB patients, median time to nodal recurrence was 37.5 months. Regression was seen in only 16% of cases, but the rate increased to 60% for false‐negative SLNB cases. Both age (odds ratio [OR]: 1.09, 95% CI: 1.01–1.17; P = 0.02) and regression (OR: 8.33, 95% CI: 1.34–52.63; P = 0.02) were significantly associated with nodal recurrence after a negative SLNB on univariable analysis. Nodal disease in thin melanoma patients was seen in 4.8% of cases. Although regression was not correlated with nodal metastasis, it was correlated with a false‐negative SLNB. Patients with thin melanoma and regression may need more intensive surveillance after a negative SLNB. Further study is needed to determine if the same immune mechanisms that result in regression in primary tumors also lead to regression in lymph nodes, which may decrease detection of melanoma nodal metastases.
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Affiliation(s)
- Jill C Rubinstein
- Section of Surgical Oncology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, 06520
| | - Gang Han
- Department of Epidemiology & Biostatistics, Texas A&M, College Station, Texas, 77843
| | - Laura Jackson
- Medical Oncology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, 06520
| | - Kaleigh Bulloch
- Medical Oncology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, 06520
| | - Stephan Ariyan
- Section of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, 06520
| | - Deepak Narayan
- Section of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, 06520
| | - Bonnie G Rothberg
- Medical Oncology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, 06520
| | - Dale Han
- Section of Surgical Oncology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, 06520.
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Boddupalli CS, Nair S, Gray SM, Nowyhed HN, Verma R, Gibson JA, Abraham C, Narayan D, Vasquez J, Hedrick CC, Flavell RA, Dhodapkar KM, Kaech SM, Dhodapkar MV. ABC transporters and NR4A1 identify a quiescent subset of tissue-resident memory T cells. J Clin Invest 2016; 126:3905-3916. [PMID: 27617863 DOI: 10.1172/jci85329] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 08/04/2016] [Indexed: 12/16/2022] Open
Abstract
Immune surveillance in tissues is mediated by a long-lived subset of tissue-resident memory T cells (Trm cells). A putative subset of tissue-resident long-lived stem cells is characterized by the ability to efflux Hoechst dyes and is referred to as side population (SP) cells. Here, we have characterized a subset of SP T cells (Tsp cells) that exhibit a quiescent (G0) phenotype in humans and mice. Human Trm cells in the gut and BM were enriched in Tsp cells that were predominantly in the G0 stage of the cell cycle. Moreover, in histone 2B-GFP mice, the 2B-GFP label was retained in Tsp cells, indicative of a slow-cycling phenotype. Human Tsp cells displayed a distinct gene-expression profile that was enriched for genes overexpressed in Trm cells. In mice, proteins encoded by Tsp signature genes, including nuclear receptor subfamily 4 group A member 1 (NR4A1) and ATP-binding cassette (ABC) transporters, influenced the function and differentiation of Trm cells. Responses to adoptive transfer of human Tsp cells into immune-deficient mice and plerixafor therapy suggested that human Tsp cell mobilization could be manipulated as a potential cellular therapy. These data identify a distinct subset of human T cells with a quiescent/slow-cycling phenotype, propensity for tissue enrichment, and potential to mobilize into circulation, which may be harnessed for adoptive cellular therapy.
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MESH Headings
- ATP-Binding Cassette Transporters/genetics
- ATP-Binding Cassette Transporters/metabolism
- Adoptive Transfer
- Animals
- Cells, Cultured
- Humans
- Immunologic Memory
- Mice, Inbred C57BL
- Mice, Inbred NOD
- Mice, Knockout
- Mice, SCID
- Nuclear Receptor Subfamily 4, Group A, Member 1/genetics
- Nuclear Receptor Subfamily 4, Group A, Member 1/metabolism
- Organ Specificity
- Resting Phase, Cell Cycle
- T-Lymphocytes/metabolism
- Transcriptome
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16
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Bello DM, Han G, Jackson L, Bulloch K, Ariyan S, Narayan D, Rothberg BG, Han D. The Prognostic Significance of Sentinel Lymph Node Status for Patients with Thick Melanoma. Ann Surg Oncol 2016; 23:938-945. [DOI: 10.1245/s10434-016-5502-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Indexed: 11/18/2022]
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17
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Lim YH, Bacchiocchi A, Qiu J, Straub R, Bruckner A, Bercovitch L, Narayan D, McNiff J, Ko C, Robinson-Bostom L, Antaya R, Halaban R, Choate KA. GNA14 Somatic Mutation Causes Congenital and Sporadic Vascular Tumors by MAPK Activation. Am J Hum Genet 2016; 99:443-50. [PMID: 27476652 PMCID: PMC4974082 DOI: 10.1016/j.ajhg.2016.06.010] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [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: 05/23/2016] [Accepted: 06/13/2016] [Indexed: 12/20/2022] Open
Abstract
Vascular tumors are among the most common neoplasms in infants and children; 5%-10% of newborns present with or develop lesions within the first 3 months of life. Most are benign infantile hemangiomas that typically regress by 5 years of age; other vascular tumors include congenital tufted angiomas (TAs), kaposiform hemangioendotheliomas (KHEs), and childhood lobular capillary hemangiomas (LCHs). Some of these lesions can become locally invasive and unresponsive to pharmacologic intervention, leading to significant complications. Recent investigation has revealed that activating mutations in HRAS, KRAS, NRAS, GNAQ, and GNA11 can cause certain types of rare childhood vascular tumors, and we have now identified causal recurrent somatic activating mutations in GNA14 by whole-exome and targeted sequencing. We found somatic activating GNA14 c.614A>T (p.Gln205Leu) mutations in one KHE, one TA, and one LCH and a GNA11 c.547C>T (p.Arg183Cys) mutation in two LCH lesions. We examined mutation pathobiology via expression of mutant GNA14 or GNA11 in primary human endothelial cells and melanocytes. GNA14 and GNA11 mutations induced changes in cellular morphology and rendered cells growth-factor independent by upregulating the MAPK pathway. Our findings identify GNA14 mutations as a cause of childhood vascular tumors, offer insight into mechanisms of oncogenic transformation by mutations affecting Gaq family members, and identify potential targets for therapeutic intervention.
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Affiliation(s)
- Young H Lim
- Department of Dermatology, School of Medicine, Yale University, New Haven, CT 06510, USA; Department of Pathology, School of Medicine, Yale University, New Haven, CT 06510, USA; Department of Genetics, School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Antonella Bacchiocchi
- Department of Dermatology, School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Jingyao Qiu
- Department of Genetics, School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Robert Straub
- Department of Dermatology, School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Anna Bruckner
- Departments of Dermatology and Pediatrics, School of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Lionel Bercovitch
- Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, RI 02903, USA
| | - Deepak Narayan
- Section of Plastic Surgery, Department of Surgery, School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Jennifer McNiff
- Department of Dermatology, School of Medicine, Yale University, New Haven, CT 06510, USA; Department of Pathology, School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Christine Ko
- Department of Dermatology, School of Medicine, Yale University, New Haven, CT 06510, USA; Department of Pathology, School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Leslie Robinson-Bostom
- Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, RI 02903, USA
| | - Richard Antaya
- Department of Dermatology, School of Medicine, Yale University, New Haven, CT 06510, USA; Department of Pediatrics, School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Ruth Halaban
- Department of Dermatology, School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Keith A Choate
- Department of Dermatology, School of Medicine, Yale University, New Haven, CT 06510, USA; Department of Pathology, School of Medicine, Yale University, New Haven, CT 06510, USA; Department of Genetics, School of Medicine, Yale University, New Haven, CT 06510, USA.
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18
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Abstract
LEARNING OBJECTIVES After reading this article, the participant should be able to: 1. Discuss the initial management of cutaneous malignant melanoma with regard to diagnostic biopsy and currently accepted resection margins. 2. Be familiar with the management options for melanoma in specific situations such as subungual melanoma, auricular melanoma, and melanoma in the pregnant patient. 3. Discuss the differentiating characteristics of desmoplastic melanoma and its treatment options. 4. List the indications for sentinel lymph node biopsy and be aware of the ongoing trials and current literature. 5. Discuss the medical therapies available to patients with metastatic melanoma. SUMMARY Management of the melanoma patient is a complex and evolving subject. Plastic surgeons should be aware of the recent changes in the field. Excisional biopsy remains the gold standard for diagnosis, although there is no evidence that use of other biopsy types alters survival or recurrence. Wide local excisions should be carried out with margins as recommended by National Comprehensive Cancer Network guidelines according to lesion Breslow depth, with sentinel lymph node biopsy being offered to all medically suitable candidates with intermediate thickness melanomas (1.0 to 4.0 mm), and with sentinel lymph node biopsy being considered for high-risk lesions (ulceration and/or high mitotic figures) with melanomas of 0.75 to 1.0 mm. Melanomas diagnosed during pregnancy can be treated with preoperative lymphoscintigraphy and wide local excision under local anesthesia, with sentinel lymph node biopsy under general anesthesia delayed until after delivery. Management of desmoplastic melanoma is currently controversial with regard to the indications for sentinel lymph node biopsy and the efficacy of postoperative radiation therapy. Subungual and auricular melanoma have evolved from being treated by amputation of the involved appendage to less radical procedures-ear reconstruction is now attempted in the absence of gross invasion into the perichondrium, and subungual melanomas may be treated with wide local excision down to and including the periosteum, with immediate full-thickness skin grafting over bone. Although surgical treatment remains the current gold standard, recent advances in immunotherapy and targeted molecular therapy for metastatic melanoma show great promise for the development of medical therapies for melanoma.
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Affiliation(s)
- Sabrina N Pavri
- New Haven, Conn
- From the Section of Plastic and Reconstructive Surgery, Yale University School of Medicine
| | - James Clune
- New Haven, Conn
- From the Section of Plastic and Reconstructive Surgery, Yale University School of Medicine
| | - Stephan Ariyan
- New Haven, Conn
- From the Section of Plastic and Reconstructive Surgery, Yale University School of Medicine
| | - Deepak Narayan
- New Haven, Conn
- From the Section of Plastic and Reconstructive Surgery, Yale University School of Medicine
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Srisuttiyakorn C, Bulloch K, Rodic N, Bosenberg M, Ariyan S, Narayan D, Gould Rothberg BE, Galan A. Intratumoral multinucleated giant cells are not a prognostic pathologic feature in cutaneous melanoma. J Cutan Pathol 2016; 43:821-9. [DOI: 10.1111/cup.12750] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/30/2016] [Accepted: 05/30/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Chutika Srisuttiyakorn
- Department of Medicine, Division of DermatologyPhramongkutklao Hospital Bangkok Thailand
- Department of DermatologyYale School of Medicine New Haven CT USA
| | - Kaleigh Bulloch
- Department of Internal Medicine, Medical Oncology DivisionYale School of Medicine New Haven CT USA
| | - Nemanja Rodic
- Department of DermatologyYale School of Medicine New Haven CT USA
| | - Marcus Bosenberg
- Department of DermatologyYale School of Medicine New Haven CT USA
- Department of PathologyYale School of Medicine New Haven CT USA
| | - Stephen Ariyan
- Department of Surgery, Section of Plastic and Reconstructive SurgeryYale School of Medicine New Haven CT USA
| | - Deepak Narayan
- Department of Surgery, Section of Plastic and Reconstructive SurgeryYale School of Medicine New Haven CT USA
| | - Bonnie E. Gould Rothberg
- Department of Internal Medicine, Medical Oncology DivisionYale School of Medicine New Haven CT USA
- Department of PathologyYale School of Medicine New Haven CT USA
- Department of EpidemiologyYale School of Medicine New Haven CT USA
| | - Anjela Galan
- Department of DermatologyYale School of Medicine New Haven CT USA
- Department of PathologyYale School of Medicine New Haven CT USA
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20
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Chan BK, Sistrom M, Wertz JE, Kortright KE, Narayan D, Turner PE. Phage selection restores antibiotic sensitivity in MDR Pseudomonas aeruginosa. Sci Rep 2016; 6:26717. [PMID: 27225966 PMCID: PMC4880932 DOI: 10.1038/srep26717] [Citation(s) in RCA: 370] [Impact Index Per Article: 46.3] [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: 03/07/2016] [Accepted: 05/05/2016] [Indexed: 02/08/2023] Open
Abstract
Increasing prevalence and severity of multi-drug-resistant (MDR) bacterial infections has necessitated novel antibacterial strategies. Ideally, new approaches would target bacterial pathogens while exerting selection for reduced pathogenesis when these bacteria inevitably evolve resistance to therapeutic intervention. As an example of such a management strategy, we isolated a lytic bacteriophage, OMKO1, (family Myoviridae) of Pseudomonas aeruginosa that utilizes the outer membrane porin M (OprM) of the multidrug efflux systems MexAB and MexXY as a receptor-binding site. Results show that phage selection produces an evolutionary trade-off in MDR P. aeruginosa, whereby the evolution of bacterial resistance to phage attack changes the efflux pump mechanism, causing increased sensitivity to drugs from several antibiotic classes. Although modern phage therapy is still in its infancy, we conclude that phages, such as OMKO1, represent a new approach to phage therapy where bacteriophages exert selection for MDR bacteria to become increasingly sensitive to traditional antibiotics. This approach, using phages as targeted antibacterials, could extend the lifetime of our current antibiotics and potentially reduce the incidence of antibiotic resistant infections.
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Affiliation(s)
- Benjamin K Chan
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, CT 06520, USA
| | - Mark Sistrom
- School of Natural Sciences, University of California Merced, Merced, CA, 95343, USA
| | - John E Wertz
- E. coli Genetic Stock Center, Department of Molecular, Cellular and Developmental Biology, Yale University, New Haven, CT 06520, USA
| | - Kaitlyn E Kortright
- Department of Microbial Pathogenesis, Yale School of Medicine, New Haven, CT 06520, USA
| | - Deepak Narayan
- Department of Surgery, Yale School of Medicine, New Haven, CT 06520, USA
| | - Paul E Turner
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, CT 06520, USA.,Program in Microbiology, Yale School of Medicine, New Haven, CT 06520, USA
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21
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Geiger EJ, Basques BA, Chang CC, Son Y, Sasaki CT, McGregor A, Ariyan S, Narayan D. Pedicle versus free flap reconstruction in patients receiving intraoperative brachytherapy. J Plast Surg Hand Surg 2016; 50:227-32. [DOI: 10.3109/2000656x.2016.1152974] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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22
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Abstract
A 6-month-old girl presented with an irregular nodule on the right lateral neck. The lesion, which superficially resembled a lymphangioma or mastocytoma, had been present since birth but had recently been growing. The patient was referred for surgical resection. Microscopic findings were compatible with a recently described rare hamartoma termed "panfollicular nevus," which is a well-circumscribed lesion containing aberrantly differentiated, clustered hair follicles in high density.
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Affiliation(s)
- Linna Duan
- School of Medicine, Yale University, New Haven, CT, USA
| | - Richard J Antaya
- Department of Dermatology, Yale University, New Haven, CT, USA.,Department of Pediatrics, Yale University, New Haven, CT, USA
| | - Christine J Ko
- Department of Dermatology, Yale University, New Haven, CT, USA
| | - Deepak Narayan
- Department of Plastic Surgery, Yale University, New Haven, CT, USA
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23
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Kursawe R, Dixit VD, Scherer PE, Santoro N, Narayan D, Gordillo R, Giannini C, Lopez X, Pierpont B, Nouws J, Shulman GI, Caprio S. A Role of the Inflammasome in the Low Storage Capacity of the Abdominal Subcutaneous Adipose Tissue in Obese Adolescents. Diabetes 2016; 65:610-8. [PMID: 26718495 PMCID: PMC4764142 DOI: 10.2337/db15-1478] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 12/17/2015] [Indexed: 12/26/2022]
Abstract
The innate immune cell sensor leucine-rich-containing family, pyrin domain containing 3 (NLRP3) inflammasome controls the activation of caspase-1, and the release of proinflammatory cytokines interleukin (IL)-1β and IL-18. The NLRP3 inflammasome is implicated in adipose tissue inflammation and the pathogenesis of insulin resistance. Herein, we tested the hypothesis that adipose tissue inflammation and NLRP3 inflammasome are linked to the downregulation of subcutaneous adipose tissue (SAT) adipogenesis/lipogenesis in obese adolescents with altered abdominal fat partitioning. We performed abdominal SAT biopsies on 58 obese adolescents and grouped them by MRI-derived visceral fat to visceral adipose tissue (VAT) plus SAT (VAT/VAT+SAT) ratio (cutoff 0.11). Adolescents with a high VAT/VAT+SAT ratio showed higher SAT macrophage infiltration and higher expression of the NLRP3 inflammasome-related genes (i.e., TLR4, NLRP3, IL1B, and CASP1). The increase in inflammation markers was paralleled by a decrease in genes related to insulin sensitivity (ADIPOQ, GLUT4, PPARG2, and SIRT1) and lipogenesis (SREBP1c, ACC, LPL, and FASN). Furthermore, SAT ceramide concentrations correlated with the expression of CASP1 and IL1B. Infiltration of macrophages and upregulation of the NLRP3 inflammasome together with the associated high ceramide content in the plasma and SAT of obese adolescents with a high VAT/VAT+SAT may contribute to the limited expansion of the subcutaneous abdominal adipose depot and the development of insulin resistance.
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Affiliation(s)
- Romy Kursawe
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Vishwa D Dixit
- Section of Comparative Medicine, Yale Program in Integrative Cell Signaling and Neurobiology of Metabolism, and Department of Immunobiology, Yale University School of Medicine, New Haven, CT
| | - Philipp E Scherer
- Internal Medicine, Touchstone Diabetes Center, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Nicola Santoro
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Deepak Narayan
- Department of Plastic Surgery, Yale University School of Medicine, New Haven, CT
| | - Ruth Gordillo
- Internal Medicine, Touchstone Diabetes Center, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Cosimo Giannini
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Ximena Lopez
- Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Bridget Pierpont
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Jessica Nouws
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Gerald I Shulman
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT Department of Cellular and Molecular Physiology, Yale University School of Medicine, New Haven, CT Howard Hughes Medical Institute, Chevy Chase, MD
| | - Sonia Caprio
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
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Jackson LK, Bulloch KJ, Narayan D, Ariyan S, Gould Rothberg BE. Correlation of body mass index with female survival benefit among a single-institution cohort of cutaneous melanomas >1 mm thick following wide-local excision and sentinel lymph node biopsy. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.3_suppl.172] [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: 11/20/2022] Open
Abstract
172 Background: As the 10-year mortality for localized cutaneous melanomas (CMMs) > 1.00 mm is 40%, non-therapeutic interventions to supplement active surveillance following resection may be beneficial. Data describing the impact of lifestyle choices on survival in this population are limited. Methods: 837 consecutive patients who underwent wide local excision and sentinel lymph node biopsy (WLE + SLNB) at Yale during 1997-2012 for CMMs > 1.00 mm thick were enrolled. Smoking, alcohol use and caffeine consumption were assessed by questionnaire at diagnosis and were each categorized according to quantity used with never-users as the reference. Body mass index (BMI) was calculated from height and weight measured at surgery. Crude and multivariable marginal relationships between lifestyle factors and disease free survival (DFS), the latter adjusted for age, sex, thickness (mm), ulceration, mitotic count, and SLN status, were assessed using Cox proportional hazards. Interactions with clinicopathologic factors were conducted. Results: A female survival benefit (HRFEMALE= 0.69; 95% CI: 0.49-0.97; p = 0.04) was observed on multivariable analysis. While BMI was not independently associated with DFS (p = 0.31), we noted a significant interaction between sex and BMI (p = 0.01). Compared with referent normal weight (BMI < 25) men, normal weight women had similar survival (HRBMI < 25= 0.91; 95% CI: 0.52-1.57, p = 0.74) but a progressive survival advantage was observed among women with increasing BMI (HROVERWT= 0.62; 95% CI: 0.33-1.14, HROBESE= 0.23; 95% CI: 0.07-0.58, ptrend= 0.01). A similar relationship was not observed among men (ptrend= 0.51). Neither the marginal effects nor those modified by sex for each of alcohol, tobacco or caffeine were associated with DFS (p > 0.15). Conclusions: Following WLE+SLNB, increasing BMI may improve survival among women but not among men. Research to identify contributory molecular mechanisms in the context of the female survival benefit is warranted.
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25
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Duan L, Mukherjee EM, Narayan D. Tailoring the Treatment of Melanoma: Implications for Personalized Medicine. Yale J Biol Med 2015; 88:389-95. [PMID: 26604863 PMCID: PMC4654188] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Oncology has been revolutionized by the ability to selectively inhibit the growth of cancerous cells while ostensibly avoiding the disruption of proteins and pathways necessary for normal cellular function. This paradigm has triggered an explosion of targeted therapies for cancer, creating a burgeoning billion-dollar industry of small molecules and monoclonal antibodies [1]. Largely due to these new treatments, spending on cancer pharmaceuticals has surpassed $100 billion worldwide [2]. In particular, the treatment of melanoma, a deadly and fast-spreading form of skin cancer, has been transformed by these new targeted therapies. In this mini-review, we summarize the progress made in the field of personalized treatment of melanoma, with an emphasis on targeted therapies. We then outline future directions for treatment, including novel cell-mediated therapies and new potential targets.
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Affiliation(s)
- Linna Duan
- Yale School of Medicine, New Haven, Connecticut
| | - Eric M. Mukherjee
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Deepak Narayan
- Department of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, Connecticut
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Schultz B, Yao X, Deng Y, Waner M, Spock C, Tom L, Persing J, Narayan D. A Common Polymorphism within the IGF2 Imprinting Control Region Is Associated with Parent of Origin Specific Effects in Infantile Hemangiomas. PLoS One 2015; 10:e0113168. [PMID: 26496499 PMCID: PMC4619854 DOI: 10.1371/journal.pone.0113168] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Accepted: 10/24/2014] [Indexed: 11/30/2022] Open
Abstract
Infantile hemangioma (IH) is the most common tumor of the pediatric age group, affecting up to 4% of newborns ranging from inconsequential blemishes, to highly aggressive tumors. Following well defined growth phases (proliferative, plateau involutional) IH usually regress into a fibro-fatty residuum. Despite the high prevalence of IH, little is known regarding the pathogenesis of disease. A reported six fold decrease in IGF2 expression (correlating with transformation of proliferative to involuted lesions) prompted us to study the IGF-2 axis further. We demonstrate that IGF2 expression in IH is strongly related to the expression of a cancer testes and suspected oncogene BORIS (paralog of CTCF), placing IH in the unique category of being the first known benign BORIS positive tumor. IGF2 expression was strongly and positively related to BORIS transcript expression. Furthermore, a stronger association was made when comparing BORIS levels against the expression of CTCF via either a percentage or difference between the two. A common C/T polymorphism at CTCF BS6 appeared to modify the correlation between CTCF/BORIS and IGF2 expression in a parent of origin specific manner. Moreover, these effects may have phenotypic consequences as tumor growth also correlates with the genotype at CTCF BS6. This may provide a framework for explaining the clinical variability seen in IH and suggests new insights regarding CTCF and BORIS related functionality in both normal and malignant states.
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Affiliation(s)
- Brent Schultz
- University of Washington, Division of Plastic Surgery, Seattle, WA, United States of America
| | - Xiaopan Yao
- Yale Center for Analytic Sciences at YSPH, New Haven, CT, United States of America
| | - Yanhong Deng
- Yale Center for Analytic Sciences at YSPH, New Haven, CT, United States of America
| | - Milton Waner
- Vascular Birthmark Institute, New York, NY, United States of America
| | | | - Laura Tom
- Division of Plastic Surgery, University of Washington, Seattle, WA, United States of America
| | - John Persing
- Yale Plastic and Reconstructive Surgery, New Haven, United States of America
| | - Deepak Narayan
- Yale Plastic and Reconstructive Surgery, New Haven, United States of America
- * E-mail:
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Alcon A, Geiger EJ, Pandit A, McGregor A, Narayan D. Cranial Nerve Palsies: A Rare, Long-Term Complication of Radiotherapy for Nasopharyngeal Carcinoma. Conn Med 2015; 79:543-546. [PMID: 26630706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
UNLABELLED Cranial nerves (CN) are believed to be relatively resistant to radiotherapy (RT); however, there have been case reports of cranial nerve palsy (CNP) following RT. We present a case of a gentleman with cranial nerve palsy of CN V and VII after RT for nasopharyngeal carcinoma (NPC). CASE PRESENTATION A 54-year-old male presented to our clinic with masticatory difficulty, facial hypoesthesia, and dysphagia. In 1998, he was treated with external beam RT for NPC. He underwent sural nerve grafting, anastomosing his functioning hypoglossal nerve to the buccal branch of the facial nerve in an end-to-side fashion, and direct implantation of a nerve graft from the spinal accessory to the masseter muscle. He unfortunately was unable to regain masticatory function postoperatively. CONCLUSION Cranial nerve palsies are severely debilitating to patients and difficult to treat. Radiation-induced CNP is important to consider in the differential diagnosis in patients previously treated for NPC.
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Abstract
IMPORTANCE Timely delivery of surgery for cancer affects health care quality and outcomes. However, population-based studies characterizing the delay of surgery for melanoma in the United States have not been performed. OBJECTIVE To assess the delay of surgery for melanoma by tumor-, patient-, and physician-level characteristics. DESIGN, SETTING, AND PARTICIPANTS We performed a retrospective cohort study of Medicare beneficiaries diagnosed as having melanoma from January 1, 2000, through December 31, 2009, using the Surveillance, Epidemiology, and End Results-Medicare database. We included all patients undergoing surgical excision of melanoma diagnosed by means of results of skin biopsy. EXPOSURES Anatomic location and stage of the tumor, patient sociodemographic characteristics, prior melanoma, Elixhauser comorbidities, and the specialties of the physicians who performed the biopsy and surgery. MAIN OUTCOMES AND MEASURES Surgical delay, measured as the time from the biopsy to surgical excision. We estimated risk-adjusted odds ratios (ORs) and marginal probabilities of delay with 95% CIs for each covariate using mixed-effects logistic regression. RESULTS Our cohort consisted of 32 501 cases of melanoma. Most of the patients were white (95.4%), male (63.1%), married (47.9%), and 75 years or older (60.8%) and did not have a prior melanoma (93.7%). Melanomas were most frequently located on the head and neck (40.5%) and staged as in situ disease (48.2%). More than three-quarters of cases (25 269 [77.7%]) underwent excision within 1.5 months of biopsy. Among those treated after 1.5 months (7232 [22.3%]), 2620 (8.1% of all cases) experienced a delay of longer than 3 months. The incidence of a risk-adjusted surgical delay longer than 1.5 months was significantly increased among patients 85 years or older compared with those younger than 65 years (odds ratio [OR], 1.28 [95% CI, 1.05-1.55]; P = .02), those with a prior melanoma (OR, 1.20 [95% CI, 1.08-1.34]; P = .001), and those with an increased comorbidity burden (OR, 1.18 [95% CI, 1.09-1.27]; P < .001). Melanomas that underwent biopsy and excision by dermatologists had the lowest likelihood of delay (probability, 16% [95% CI, 14%-18%]). The highest likelihood of delay (probability, 31% [95% CI, 24%-37%]) occurred when the biopsy was performed by a nondermatologist and excised by a primary care physician. Similar findings were observed for a delay longer than 3 months. CONCLUSIONS AND RELEVANCE Approximately 1 in 5 Medicare beneficiaries experience a delay of surgery for melanoma that is longer than 1.5 months. Those patients undergoing biopsy and surgery by dermatologists have the lowest risk for delay, highlighting potential opportunities for improved access to and coordination of dermatologic care.
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Affiliation(s)
- Jason P Lott
- Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut2Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut3Section of Dermatology, Veterans Affairs Conne
| | - Deepak Narayan
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Pamela R Soulos
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut5Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University School of Medicine, New Haven, Connecticut
| | - Jenerius Aminawung
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut5Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University School of Medicine, New Haven, Connecticut
| | - Cary P Gross
- Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut2Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut5Cancer Outcomes, Public Policy, and Effectiven
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Krauthammer M, Kong Y, Bacchiocchi A, Evans P, Pornputtapong N, Wu C, McCusker JP, Ma S, Cheng E, Straub R, Serin M, Bosenberg M, Ariyan S, Narayan D, Sznol M, Kluger HM, Mane S, Schlessinger J, Lifton RP, Halaban R. Exome sequencing identifies recurrent mutations in NF1 and RASopathy genes in sun-exposed melanomas. Nat Genet 2015. [PMID: 26214590 DOI: 10.1038/ng.3361] [Citation(s) in RCA: 278] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We report on whole-exome sequencing (WES) of 213 melanomas. Our analysis established NF1, encoding a negative regulator of RAS, as the third most frequently mutated gene in melanoma, after BRAF and NRAS. Inactivating NF1 mutations were present in 46% of melanomas expressing wild-type BRAF and RAS, occurred in older patients and showed a distinct pattern of co-mutation with other RASopathy genes, particularly RASA2. Functional studies showed that NF1 suppression led to increased RAS activation in most, but not all, melanoma cases. In addition, loss of NF1 did not predict sensitivity to MEK or ERK inhibitors. The rebound pathway, as seen by the induction of phosphorylated MEK, occurred in cells both sensitive and resistant to the studied drugs. We conclude that NF1 is a key tumor suppressor lost in melanomas, and that concurrent RASopathy gene mutations may enhance its role in melanomagenesis.
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Affiliation(s)
- Michael Krauthammer
- Program in Computational Biology and Bioinformatics, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Yong Kong
- Molecular Biophysics and Biochemistry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Antonella Bacchiocchi
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Perry Evans
- Program in Computational Biology and Bioinformatics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Natapol Pornputtapong
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Cen Wu
- School of Public Health, Yale University School of Medicine, New Haven, Connecticut, USA
| | - James P McCusker
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Shuangge Ma
- School of Public Health, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Elaine Cheng
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Robert Straub
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Merdan Serin
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Marcus Bosenberg
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Stephan Ariyan
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Deepak Narayan
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Mario Sznol
- Comprehensive Cancer Center Section of Medical Oncology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Harriet M Kluger
- Comprehensive Cancer Center Section of Medical Oncology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Shrikant Mane
- Yale Center for Genome Analysis, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Genetics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Joseph Schlessinger
- Department of Pharmacology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Richard P Lifton
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut, USA.,Howard Hughes Medical Institute, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Ruth Halaban
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA
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Lim YH, Douglas SR, Ko CJ, Antaya RJ, McNiff JM, Zhou J, Choate KA, Narayan D. Somatic Activating RAS Mutations Cause Vascular Tumors Including Pyogenic Granuloma. J Invest Dermatol 2015; 135:1698-1700. [PMID: 25695684 PMCID: PMC4430357 DOI: 10.1038/jid.2015.55] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Young H Lim
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA; Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA; Department of Genetics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Stephanie R Douglas
- Section of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Christine J Ko
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA; Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Richard J Antaya
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA; Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jennifer M McNiff
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA; Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jing Zhou
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA; Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA; Department of Genetics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Keith A Choate
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA; Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA; Department of Genetics, Yale University School of Medicine, New Haven, Connecticut, USA.
| | - Deepak Narayan
- Section of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
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Pandit AS, Geiger EJ, Ariyan S, Narayan D, Choi JN. Using topical imiquimod for the management of positive in situ margins after melanoma resection. Cancer Med 2015; 4:507-12. [PMID: 25620351 PMCID: PMC4402064 DOI: 10.1002/cam4.402] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 11/25/2014] [Accepted: 11/28/2014] [Indexed: 11/26/2022] Open
Abstract
The treatment of melanoma in situ (MIS) is controversial with current standard of care being surgical excision with clear margins. Alternative topical therapy with imiquimod has been proposed in recent studies as a possible treatment for MIS. This study aimed to evaluate the use of topical 5% imiquimod as an alternative approach for the treatment of residual melanoma in situ after surgical resection of the primary lesion. A retrospective chart review of all patients treated with topical 5% imiquimod for residual MIS following standard resection with 5–10 mm margins at Yale-New Haven Hospital from 2008 through 2013 was performed. The pre- and posttreatment results were confirmed by diagnostic tissue biopsy. Twenty-two patients were included in the study. One of these 22 patients was lost to follow up. Twenty patients (95%) had complete resolution of their residual MIS and 1 patient did not respond to imiquimod (5%). No reports of recurrences were noted at the treatment sites. For patients with residual melanoma in situ after the initial excision, topical 5% imiquimod appears to be a reasonable alternative treatment with good clinical and histopathologic success rates.
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Affiliation(s)
- Amrita S Pandit
- Department of General Surgery, Western Connecticut Health Network, Danbury, Connecticut, 06810
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Teng E, Sue GR, Sawh-Martinez R, Nishikawa S, Ariyan S, Natarajan A, Narayan D. Scalp Melanoma and In-transit Metastases: A Retrospective Case-controlled Study. Am Surg 2014. [DOI: 10.1177/000313481408001233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Edward Teng
- Section of Plastic and Reconstructive Surgery Department of Surgery Yale University School of Medicine New Haven, Connecticut
| | - Gloria R. Sue
- Section of Plastic and Reconstructive Surgery Department of Surgery Yale University School of Medicine New Haven, Connecticut
| | - Rajendra Sawh-Martinez
- Section of Plastic and Reconstructive Surgery Department of Surgery Yale University School of Medicine New Haven, Connecticut
| | | | - Stephan Ariyan
- Section of Plastic and Reconstructive Surgery Department of Surgery Yale University School of Medicine New Haven, Connecticut
| | - Ashwini Natarajan
- Section of Plastic and Reconstructive Surgery Department of Surgery Yale University School of Medicine New Haven, Connecticut
| | - Deepak Narayan
- Section of Plastic and Reconstructive Surgery Department of Surgery Yale University School of Medicine New Haven, Connecticut
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Teng E, Sue GR, Sawh-Martinez R, Nishikawa S, Ariyan S, Natarajan A, Narayan D. Scalp melanoma and in-transit metastases: a retrospective case-controlled study. Am Surg 2014; 80:1272-1274. [PMID: 25513930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Edward Teng
- Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
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Abstract
Pleomorphic liposarcomas are rare entities with less than 40 cases diagnosed each year, of which a small proportion arise from the chest wall. Optimal management involves wide local resection with negative margins. We describe the case of a 69-year-old gentleman with a chronically growing chest wall mass. After computed tomography and positron-emission tomography, the mass was resected. Chest wall reconstruction was performed with mesh and a transverse rectus abdominis myocutaneous flap. The patient did well postoperatively, with no evidence of recurrence at 10 months.
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Affiliation(s)
- Mark W Maxfield
- Section of Thoracic Surgery, Yale School of Medicine, New Haven, CT, USA
| | | | - Deepak Narayan
- Section of Plastic Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Anthony W Kim
- Section of Thoracic Surgery, Yale School of Medicine, New Haven, CT, USA
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35
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Lott JP, Wititsuwannakul J, Lee JJ, Ariyan S, Narayan D, Kluger HH, Lazova R. Clinical characteristics associated with Spitz nevi and Spitzoid malignant melanomas: the Yale University Spitzoid Neoplasm Repository experience, 1991 to 2008. J Am Acad Dermatol 2014; 71:1077-82. [PMID: 25308882 DOI: 10.1016/j.jaad.2014.08.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 08/13/2014] [Accepted: 08/18/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Spitz nevi and Spitzoid malignant melanomas are uncommon and may be difficult to distinguish histopathologically. Identification of clinical features associated with these lesions may aid in diagnosis. OBJECTIVE We sought to identify clinical characteristics associated with Spitz nevi and Spitzoid malignant melanomas. METHODS We conducted a retrospective cohort study of Spitz nevi and Spitzoid malignant melanomas from the Yale University Spitzoid Neoplasm Repository diagnosed from years 1991 through 2008. Descriptive statistics and multivariate logistic regression were used to compare select patient- and tumor-level factors associated with each lesion. RESULTS Our cohort included 484 Spitz nevi and 54 Spitzoid malignant melanomas. Spitz nevi were more common (P = .03) in females (65%; n = 316) compared with Spitzoid malignant melanomas (50%; n = 27), occurred more frequently in younger patients (mean age at diagnosis 22 vs 55 years; P < .001), and more likely presented as smaller lesions (diameter 7.6 vs 10.5 mm; P < .001). Increasing age (odds ratio 1.16, 95% CI [1.09, 1.14]; P< .001) and male gender (odds ratio 2.77, 95% CI [1.17, 6.55]; P< .02) predicted Spitzoid malignant melanoma diagnosis. LIMITATIONS Small sample size, unmeasured confounding, and restriction to a single institution may limit the accuracy and generalizability of our findings. CONCLUSIONS Age and gender help predict diagnosis of Spitz nevi and Spitzoid malignant melanomas.
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Affiliation(s)
- Jason P Lott
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; Section of Dermatology, Veterans Administration Connecticut Healthcare System, West Haven, Connecticut
| | - Jade Wititsuwannakul
- Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Julie J Lee
- University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Stephan Ariyan
- Yale Cancer Center, New Haven, Connecticut; Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Deepak Narayan
- Yale Cancer Center, New Haven, Connecticut; Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Harriet H Kluger
- Yale Cancer Center, New Haven, Connecticut; Section of Medical Oncology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Rossitza Lazova
- Yale Cancer Center, New Haven, Connecticut; Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut.
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Abstract
Recent reports suggest that topical imiquimod cream is an effective treatment option for certain types of melanomas. No reports exist on the efficacy of using imiquimod cream to treat melanoma located on the plantar surface of the foot. We present two patients with a melanoma of the foot who had residual melanoma following surgical excision with acceptable margins. The patients were then treated with topical imiquimod for 8 weeks after which a repeat biopsy of the affected region showed no evidence of residual melanoma in situ. The use of topical imiquimod cream should be considered in the management of residual melanoma in situ of the plantar surface of the foot.
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Affiliation(s)
- Gloria R Sue
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Allison Hanlon
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Rossitza Lazova
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Deepak Narayan
- Section of Plastic Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
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Abstract
Deep sternal wound infection (DSWI) is a life-threatening complication that develops in 5% of patients undergoing median sternotomy. One feared complication is major bleeding, associated with up to 50% mortality. We characterized a series of patients who experienced major bleeding following DSWI. We included eight patients with DSWI who experienced major bleeding at our institution from 1990 to 2012. The median age was 70.9 (range, 47-81) and the cohort consisted of seven male patients and one female patient. All eight patients required emergent surgical repair for the bleeding and all survived past 30 days postoperatively from the repair.
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Affiliation(s)
- Gloria Sue
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Gary Price
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Richard Stahl
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Edward Teng
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Deepak Narayan
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, United States
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Abstract
Abdominal wall defects resulting from recurrent hernias, trauma, and radiation necrosis are difficult and challenging to repair given the high rates of recurrence and surgical morbidity. Complex abdominal wall defects often require the transposition of autologous material to bridge the fascial gap. We present a review of niche reconstructive techniques that have been used in complex abdominal wall repair. The specific techniques reviewed include use of delayed and tunneled pedicled tensor fascia lata myofascial flap, de-epithelialized flap closure, free latissimus dorsi myocutaneous flap with or without innervation, and abdominal wall transplant. These niche surgical techniques have great potential to reduce recurrence rates when used in the proper setting for complex abdominal wall reconstruction. More studies are needed to evaluate the relative use of these techniques with the more widely established surgical methods of reconstruction.
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Affiliation(s)
- Gloria R. Sue
- From the Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Deepak Narayan
- From the Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
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Sue GR, Narayan D. Niche reconstructive techniques for complex abdominal wall reconstruction: a review. Am Surg 2014; 80:327-334. [PMID: 24887661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Abdominal wall defects resulting from recurrent hernias, trauma, and radiation necrosis are difficult and challenging to repair given the high rates of recurrence and surgical morbidity. Complex abdominal wall defects often require the transposition of autologous material to bridge the fascial gap. We present a review of niche reconstructive techniques that have been used in complex abdominal wall repair. The specific techniques reviewed include use of delayed and tunneled pedicled tensor fascia lata myofascial flap, de-epithelialized flap closure, free latissimus dorsi myocutaneous flap with or without innervation, and abdominal wall transplant. These niche surgical techniques have great potential to reduce recurrence rates when used in the proper setting for complex abdominal wall reconstruction. More studies are needed to evaluate the relative use of these techniques with the more widely established surgical methods of reconstruction.
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Affiliation(s)
- Gloria R Sue
- Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
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40
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Hoang D, Broer N, Roman SA, Yao X, Abitbol N, Li F, Sosa JA, Sue GR, DeWan AT, Wong ML, Licinio J, Simpson C, Li AY, Pizzoferrato N, Narayan D. Leptin signaling and hyperparathyroidism: clinical and genetic associations. J Am Coll Surg 2013; 218:1239-1250.e4. [PMID: 24468228 DOI: 10.1016/j.jamcollsurg.2013.11.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 11/09/2013] [Accepted: 11/18/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND The role of leptin in mediating calcium-related metabolic processes is not well understood. STUDY DESIGN We enrolled patients with hyperparathyroidism undergoing parathyroidectomy in a prospective study to assess postoperative changes to serum leptin and parathyroid hormone levels and to determine the presence of LEPR (leptin receptor) polymorphisms. Patients undergoing hemithyroidectomy under identical surgical conditions were enrolled as controls. Wilcoxon signed-rank test was used to analyze changes in leptin. Pearson correlations and Bland-Altman methods were used to examine the between-subject and within-subject correlations in changes in leptin and parathyroid hormone levels. Five single-nucleotide polymorphisms in the LEPR gene were genotyped, and linear regression analysis was performed for each polymorphism. RESULTS Among the 71 patients included in the clinical study, after-surgery leptin levels decreased significantly in the parathyroid adenoma (p < 0.001) and parathyroid hyperplasia subgroups (p = 0.002) and increased in the control group (p = 0.007). On multivariate analysis, parathyroid disease subtype, baseline leptin levels, age, body mass index, and calcium at diagnosis was associated with changes in leptin. Among the 132 patients included in the genotyping analysis, under a recessive model of inheritance, single-nucleotide polymorphism rs1137101 had a significant association with the largest parathyroid gland and total mass of parathyroid tissue removed (p = 0.045 and p = 0.040, respectively). When analyzing obese patients only, rs1137100 and rs1137101 were significantly associated with total parathyroid size (p = 0.0343 and p = 0.0259, respectively). CONCLUSIONS Our results suggest a role for the parathyroid gland in regulating leptin production. Genetic contributions from the leptin pathway might predispose to hyperparathyroidism.
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Affiliation(s)
- Don Hoang
- Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Niclas Broer
- Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Sanziana A Roman
- Section of Endocrine Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC
| | - Xiaopan Yao
- Yale Center of Analytical Science, Yale University School of Public Health, New Haven, CT
| | - Nathalie Abitbol
- Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Fangyong Li
- Yale Center of Analytical Science, Yale University School of Public Health, New Haven, CT
| | - Julie A Sosa
- Section of Endocrine Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC
| | - Gloria R Sue
- Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Andrew T DeWan
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, CT
| | - Ma-Li Wong
- Mind and Brain Theme, South Australian Health and Medical Research Institute and Department of Psychiatry, School of Medicine, Flinders University, Adelaide, South Australia
| | - Julio Licinio
- Mind and Brain Theme, South Australian Health and Medical Research Institute and Department of Psychiatry, School of Medicine, Flinders University, Adelaide, South Australia
| | - Christine Simpson
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Alexander Y Li
- Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Nicole Pizzoferrato
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, CT
| | - Deepak Narayan
- Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT.
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Abstract
Perineal hernia is an uncommon complication of abdominoperineal resection of the rectum. Gracilis muscle flaps can be used to reconstruct the pelvic floor. The traditional repair utilises gracilis muscle alone, without overlying tissues and skin. We present the case of a 69-year-old white man who presented with a perineal hernia subsequent to abdominoperineal resection for advanced rectal cancer who was successfully treated with a modified de-epithelised gracilis myocutaneous flap with no evidence of recurrence at 18 months postsurgery. Surgical repair of postoperative perineal hernia using a gracilis flap spares the morbidity of abdominal-based reconstruction and provides a good option for patients in whom the abdomen is unavailable. Use of a myocutaneous flap adds strength to the repair when compared to reconstruction with the gracilis muscle alone, owing to the strength imparted by the dermis.
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Kursawe R, Caprio S, Giannini C, Narayan D, Lin A, D’Adamo E, Shaw M, Pierpont B, Cushman SW, Shulman GI. Decreased transcription of ChREBP-α/β isoforms in abdominal subcutaneous adipose tissue of obese adolescents with prediabetes or early type 2 diabetes: associations with insulin resistance and hyperglycemia. Diabetes 2013; 62:837-44. [PMID: 23209190 PMCID: PMC3581226 DOI: 10.2337/db12-0889] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Insulin resistance associated with altered fat partitioning in liver and adipose tissues is a prediabetic condition in obese adolescents. We investigated interactions between glucose tolerance, insulin sensitivity, and the expression of lipogenic genes in abdominal subcutaneous adipose and liver tissue in 53 obese adolescents. Based on their 2-h glucose tests they were stratified in the following groups: group 1, 2-h glucose level <120 mg/dL; group 2, 2-h glucose level between 120 and 140 mg/dL; and group 3, 2-h glucose level >140 mg/dL. Liver and adipose tissue insulin sensitivity were greater in group 1 than in group 2 and group 3, and muscle insulin sensitivity progressively decreased from group 1 to group 3. The expression of the carbohydrate-responsive element-binding protein (ChREBP) was decreased in adipose tissue but increased in the liver (eight subjects) in adolescents with impaired glucose tolerance or type 2 diabetes. The expression of adipose ChREBPα and ChREBPβ was inversely related to 2-h glucose level and positively correlated to insulin sensitivity. Improvement of glucose tolerance in four subjects was associated with an increase of ChREBP/GLUT4 expression in the adipose tissue. In conclusion, early in the development of prediabetes/type 2 diabetes in youth, ChREBPβ expression in adipose tissue predicts insulin resistance and, therefore, might play a role in the regulation of glucose tolerance.
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Affiliation(s)
- Romy Kursawe
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut; the
| | - Sonia Caprio
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut; the
- Corresponding author: Sonia Caprio,
| | - Cosimo Giannini
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut; the
| | - Deepak Narayan
- Department of Plastic Surgery, Yale University School of Medicine, New Haven, Connecticut; the
| | - Aiping Lin
- W.M. Keck Foundation Biostatistics Resource, Yale University School of Medicine, New Haven, Connecticut; the
| | - Ebe D’Adamo
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut; the
| | - Melissa Shaw
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut; the
| | - Bridget Pierpont
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut; the
| | - Samuel W. Cushman
- Diabetes Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland; the
| | - Gerald I. Shulman
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; the
- Department of Cellular and Molecular Physiology, Yale University School of Medicine, New Haven, Connecticut; and the
- Howard Hughes Medical Institute, Yale University School of Medicine, New Haven, Connecticut
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Hoang D, Sue GR, Xu F, Li P, Narayan D. Absence of aneuploidy and gastrointestinal tumours in a man with a chromosomal 2q13 deletion and BUB1 monoallelic deficiency. BMJ Case Rep 2013; 2013:bcr-2013-008684. [PMID: 23440991 DOI: 10.1136/bcr-2013-008684] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Chromosomal instability is a potentially critical step in the development of colorectal cancer. The budding uninhibited by benzimidazole 1 (BUB1) gene is a highly conserved protein that plays a critical role at the spindle assembly checkpoint during cell division. BUB1 mutations function in a dominant-negative fashion and have been implicated in causing dysfunctional kinetochore attachments, premature chromatid separation, accelerated mis-segregation of whole chromosomes and aneuploidy. BUB1 mutations have been observed in patients with colorectal cancers. We report a remarkable case of BUB1 haploinsufficiency owing to a 1.7 Mb deletion of chromosome 2q13 in a 54-year-old man with no prior history of carcinoma. These mutant alleles were observed in both tissue from the hand and peripheral blood. Aneuploidy was not observed on cytogenetic analysis. These findings highlight the insufficiency of BUB1 haploinsufficiency to directly stimulate tumourigenesis, and suggest that other factors may be more critical to this process.
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Affiliation(s)
- Don Hoang
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
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Sue G, Hoang D, Li A, Pizzoforato N, Sosa J, Roman S, Dewan A, Narayan D. Functional Variants of the Lepr Gene in Patients With Hyperparathyroidism. J Surg Res 2013. [DOI: 10.1016/j.jss.2012.10.463] [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: 11/24/2022]
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Abstract
Objective Auricular melanomas are now considered less aggressive than originally thought, but those located on the conchal bowl and posterior ear can create particular challenges for reconstruction. Given the paucity of cases, no standardized recommendations exist for tumor resection. In this study, we provide a pathologic basis in support of conservative tumor resection along the perichondrial plane. Study Design Case series with review of pathology and medical records. Setting Academic tertiary referral center. Subjects and Methods We retrospectively reviewed all ear melanomas from the archives of Yale Dermatopathology and Surgical Pathology laboratories between 1987 and 2009. Cases of melanoma in situ or malignant melanoma of the earlobe were excluded. Results Fifty-one cases were included in the study. Patients’ age ranged from 26 to 94 years, with a mean (SD) of 58.9 (17.5) years. The male to female ratio was of 5.4:1. Melanomas were distributed similarly between right and left ears, at 52% and 48%, respectively. The most common location was the helix (74.5%). The Breslow depth ranged from 0.19 to 11 mm, with a mean (SD) of 1.64 (1.6) mm. The lesion-perichondrium distance ranged from 0 to 8.12 mm, with a mean (SD) of 1.11 (1.1) mm. Notably, the perichondrium was not invaded in any of the cases. Conclusion Based on the histopathologic characteristics of our cases, the perichondrium can be considered an effective barrier and therefore a biological plane for wide local resection in some cases of auricular melanomas, allowing surgeons to achieve negative margins without necessarily sacrificing underlying cartilage.
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Affiliation(s)
- E. Stirling Craig
- Department of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Esther S. Lee
- Department of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Rossitza Lazova
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jordan Terner
- Department of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Deepak Narayan
- Department of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, Connecticut, USA
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Levinsohn JL, Tian LC, Boyden LM, McNiff JM, Narayan D, Loring ES, Yun D, Sugarman JL, Overton JD, Mane SM, Lifton RP, Paller AS, Wagner AM, Antaya RJ, Choate KA. Whole-exome sequencing reveals somatic mutations in HRAS and KRAS, which cause nevus sebaceus. J Invest Dermatol 2012; 133:827-830. [PMID: 23096712 PMCID: PMC3556376 DOI: 10.1038/jid.2012.379] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Jonathan L Levinsohn
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Li C Tian
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Lynn M Boyden
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jennifer M McNiff
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Deepak Narayan
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Erin S Loring
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Duri Yun
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jeffrey L Sugarman
- Departments of Dermatology and Family Medicine, University of California, San Francisco, San Francisco, California, USA
| | - John D Overton
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut, USA; Yale Center for Mendelian Genomics, New Haven, Connecticut, USA
| | - Shrikant M Mane
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut, USA; Yale Center for Mendelian Genomics, New Haven, Connecticut, USA
| | - Richard P Lifton
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut, USA; Yale Center for Mendelian Genomics, New Haven, Connecticut, USA; Howard Hughes Medical Institute, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Amy S Paller
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Annette M Wagner
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Richard J Antaya
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA; Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Keith A Choate
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA.
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Walker M, Broer P, Mody P, Patel A, Lazova R, Narayan D, Ariyan S. 492. Skin Flap Closure in Desmoplastic Melanoma - a 12-year Experience. European Journal of Surgical Oncology 2012. [DOI: 10.1016/j.ejso.2012.06.437] [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: 10/27/2022]
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Hoang D, Roberts KE, Teng E, Narayan D. Laparoscopic iliac and iliofemoral lymph node resection for melanoma. Surg Endosc 2012; 26:3686-7. [DOI: 10.1007/s00464-012-2376-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2011] [Accepted: 04/24/2012] [Indexed: 11/29/2022]
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Spock CR, Smith DA, Narayan D. Minimally invasive groin dissection. Conn Med 2012; 76:273-277. [PMID: 22685982] [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: 06/01/2023]
Abstract
INTRODUCTION Melanoma of the lower extremity with a positive sentinel lymph node biopsy (SLNB) mandates a groin dissection. This procedure has been associated with numerous complications; therefore we devised a modified approach. METHODS All patients presenting with lower extremity melanomas that met criteria for SLNB had this procedure performed through an incision in the inguino-femoral region. In the event of a positive SLND, this same incision was used for the minimally invasive groin dissection (MIGD). A lighted retractor was used to improve visualization and a Ligasure (Valley-lab) was used to prevent seroma formation. RESULTS Twenty patients met criteria for this investigation and five underwent MIGD. All patients tolerated the procedure well. There was no incidence of flap necrosis nor wound dehiscence. There was one case of seroma and cellulitis, one seroma, and one patient with lymphedema. All patients preferred the MIGD incision over traditional incisions. CONCLUSIONS This new algorithm utilizing MIGD is well tolerated in patients. Complications appear to be minimal and patient satisfaction superior to traditional groin dissection.
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Smith DA, Hoang D, Broer N, Narayan D. Acellularized cadaver dermis for reconstruction of complex scalp defects. J Plast Reconstr Aesthet Surg 2012; 65:406-7. [DOI: 10.1016/j.bjps.2011.06.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 04/15/2011] [Accepted: 06/10/2011] [Indexed: 10/17/2022]
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