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Sain A, Metry A, Manzoor N, Wattage K, Elkilany A, Halasa M, Chia J, Arif S, Hussain F, Aisabokhale O, Sohail Z. THE ROLE OF DISTAL LOCKING IN INTRAMEDULLARY NAILS FOR HIP FRACTURE FIXATION: A REVIEW OF CURRENT LITERATURE. Georgian Med News 2024:149-150. [PMID: 38609132] [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: 04/14/2024]
Abstract
Traditionally, it was believed that both proximal and distal locking are essential for achieving stability during intra-medullary fixation for extra-capsular hip fractures. However, recent literature has presented varying perspectives on the necessity of distal locking. Distal locking plays a significant role in managing hip fractures with uncertainties regarding longitudinal and rotational stability. This includes cases of comminuted intertrochanteric fractures with subtrochanteric extension, reverse oblique and high oblique fractures, broad medullary canals, comminution of the lateral wall, diaphyseal fractures, and large posteromedial fragments extending below the level of the lesser trochanter. In stable pertrochanteric fractures, with the lag screw passing through the lateral cortex of the distal fragment, may not require a distal locking screw. Distal locking has been associated with potential complications, including irritation of the fascia lata, prolonged operation time, increased radiation exposure, greater blood loss, implant loosening, secondary femoral stress fractures, and damage to the femoral artery. Thus, although distal locking is of doubtful significance in stable pertrochanteric fractures it is essential in unstable fracture patterns.
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Affiliation(s)
- A Sain
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - A Metry
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - N Manzoor
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - K Wattage
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - A Elkilany
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - M Halasa
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - J Chia
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - S Arif
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - F Hussain
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - O Aisabokhale
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - Z Sohail
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
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2
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Sain A, Arif S, Manyar H, Manzoor N, Wattage K, Halasa M, Metry A, Chia J, Prendergast E, Elkilany A, Aisabokhale O, Hussain F, Sohail Z. CURRENT CONCEPTS IN THE MANAGEMENT OF BOXER'S FRACTURE. Georgian Med News 2024:122-124. [PMID: 38609127] [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: 04/14/2024]
Abstract
Fractures of the metacarpal particularly the 5th metacarpal is quite common among all hand fractures and has a high incidence in male adult population. Proper management of these fractures plays a key role in rehabilitation and early return to work thus reducing the economic burden. Treatment of these injuries depends on the type of injury: whether it is a closed/open fracture, degree of angulation at the fracture site and also mal-rotation and shortening of the finger. Non-operative management is suitable for fractures which are closed, non-displaced and without angulation or rotation. Open fractures, fractures with angulation and/or mal-rotation and fractures with neuro-vascular injury are more suitable for operative management. The acceptable angulation for conservative management for most studies is 70 degrees. Buddy strapping with a Futura splint provides good functional results. In fractures requiring operative intervention, K-wire fixation is a minimally invasive method of fixation, which in most cases has good functional results. Plate and screw fixation, however, is preferred for cases with significant comminution or multiple metacarpal fractures.
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Affiliation(s)
- A Sain
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - S Arif
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - H Manyar
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - N Manzoor
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - K Wattage
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - M Halasa
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - A Metry
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - J Chia
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - E Prendergast
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - A Elkilany
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - O Aisabokhale
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - F Hussain
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - Z Sohail
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
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3
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Lim YL, Mond H, Michael R, Liew TS, Chu E, Health P, Visagathilagar T, Basioni N, Chia J, Bharatula S. Seven-day holter monitoring detects more significant arrhythmias than 24-hour and 3-day monitoring. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background/Introduction
24-hour Holter monitors have been used widely to assess patients with suspected and known arrhythmias. Recent studies have shown increased yield of arrhythmia detection with longer durations of Holter monitoring.
Purpose
The aim of the study was to evaluate the incremental yield in significant arrhythmias detected using a 7-day continuous Holter monitor, as compared to what can be achieved within a 24-hour and 48 to 72 hours study.
Methods
A retrospective study of patients from 72 sites in two geographical locations, A and B, who completed a continuous 7-days patch monitor study was performed. 801 of these studies detected significant arrhythmias; pauses 3 seconds or more (PA), ventricular tachycardia of 6 beats or more (VT), and paroxysmal atrial fibrillation (PAF). The day of the first occurrence of a significant arrhythmia was noted and tallied to determine the incremental yield of a multiday Holter monitoring.
Results
Of 801 total cases detected with significant arrhythmia, only 278 (35%) were detected in the first 24hours, while 523 (65%) cases were detected after Day 1. 331 (41%) had first significant arrhythmia detected after the 3rd day of monitoring, with 68 (44%) being PA, 125 (40%) PAF, and 138 (41%) VT. Notably, in Group A, 31 (72%) of total VT detected and 35 (72%) of total PAF detected were first picked up after Day 1, 21 (49%) of total VT were first detected only after the 3rd day of monitoring.
Conclusions
1-day (24-hour) monitoring period fails to detect a significant number of potentially serious cardiac arrhythmias. Extended continuous Holter monitoring increases the yield of detection, with a substantial fraction (40-49%) detected after the 3rd day of monitoring. No difference in results obtained between two geographical locations demonstrates strong evidence that findings are consistent across different sites. Review of current practice and guidelines is necessary to further expand usage of multiday Holter monitoring, thus increasing benefits to patients.
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Affiliation(s)
- Y L Lim
- Cardioscan Asia , Singapore , Singapore
| | - H Mond
- Cardioscan Asia , Singapore , Singapore
| | - R Michael
- Cardioscan Asia , Singapore , Singapore
| | - T S Liew
- Cardioscan Asia , Singapore , Singapore
| | - E Chu
- Cardioscan Asia , Singapore , Singapore
| | - P Health
- Cardioscan Asia , Singapore , Singapore
| | | | - N Basioni
- Cardioscan Asia , Singapore , Singapore
| | - J Chia
- Cardioscan Asia , Singapore , Singapore
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4
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Chan D, Chin T, Chia J, Li Y, Tsang JH, Poh J, Wong C, Tan MH. 260MO Liquid biopsy NGS test identifies actionable DNA mutations from CSF specimens of lung cancer patients. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.288] [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: 12/07/2022] Open
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5
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Osman M, Hardin J, Street L, Chia J. Transitioning to pegylated interferon for the treatment of cutaneous T-cell lymphoma: meeting the challenge of therapy discontinuation and a proposed algorithm. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)00648-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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6
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Chia J, Shimwell L, Bano C, Neal D, Howlett D. Diagnostic Yield of Endoscopy after Upper Gastrointestinal Tract Abnormality Found on Computed Tomography. Hong Kong Journal of Radiology 2019. [DOI: 10.12809/hkjr1916907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- J Chia
- Radiology Department, Eastbourne District General Hospital, Eastbourne, United Kingdom
| | - L Shimwell
- Imaging Department, Eastbourne District General Hospital, Eastbourne, United Kingdom
| | - C Bano
- Imaging Department, Eastbourne District General Hospital, Eastbourne, United Kingdom
| | - D Neal
- Gastroenterology Department, Eastbourne District General Hospital, Eastbourne, United Kingdom
| | - D Howlett
- Imaging Department, Eastbourne District General Hospital, Eastbourne, United Kingdom
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7
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Tan T, Ong W, Chan S, Chan J, Chay W, Lim E, Lim S, Soh L, Tan D, Chia J. Interim Analysis of A Single-Arm Phase 2 Clinical Trial of Regorafenib in Patients with Epithelial Ovarian Cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx663.013] [Citation(s) in RCA: 3] [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] [Indexed: 11/12/2022] Open
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Roberts V, Lu B, Chia J, Cowan PJ, Dwyer KM. CD39 overexpression does not attenuate renal fibrosis in the unilateral ureteric obstructive model of chronic kidney disease. Purinergic Signal 2016; 12:653-660. [PMID: 27565966 DOI: 10.1007/s11302-016-9528-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 08/03/2016] [Indexed: 12/19/2022] Open
Abstract
Chronic kidney disease has multiple etiologies, but its single, hallmark lesion is renal fibrosis. CD39 is a key purinergic enzyme in the hydrolysis of ATP and increased CD39 activity on regulatory T cells (Treg) is protective in adriamycin-induced renal fibrosis. We examined the effect of overexpression of human CD39 on the development of renal fibrosis in the unilateral ureteric obstructive (UUO) model, a model widely used to study the molecular and cellular factors involved in renal fibrosis. Mice overexpressing human CD39 (CD39Tg) and their wild-type (WT) littermates were subjected to UUO; renal histology and messenger RNA (mRNA) levels of adenosine receptors and markers of renal fibrosis were examined up to 14 days after UUO. There were no differences between CD39Tg mice and WT mice in the development of renal fibrosis at days 3, 7, and 14 of UUO. Relative mRNA expression of the adenosine A2A receptor and endothelin-1 were higher in CD39Tg than WT mice at day 7 post UUO, but there were no differences in markers of fibrosis. We conclude that human CD39 overexpression does not attenuate the development of renal fibrosis in the UUO model. The lack of protection by CD39 overexpression in the UUO model is multifactorial due to the different effects of adenosinergic receptors on the development of renal fibrosis.
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Affiliation(s)
- Veena Roberts
- Immunology Research Centre, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia. .,University of Melbourne, Victoria, Australia.
| | - B Lu
- Immunology Research Centre, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia
| | - J Chia
- Immunology Research Centre, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia
| | - P J Cowan
- Immunology Research Centre, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia.,University of Melbourne, Victoria, Australia
| | - K M Dwyer
- Immunology Research Centre, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia.,University of Melbourne, Victoria, Australia.,School of Medicine, Faculty of Health, Deakin University, Victoria, Australia
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Hepp Z, Dodick D, Varon S, Gillard P, Mathew N, Chia J, Hansen R, Devine EB. EHMTI-0032. Persistence and switching characteristics among chronic migraine patient population: a retrospective claims analysis. J Headache Pain 2014. [PMCID: PMC4182227 DOI: 10.1186/1129-2377-15-s1-g8] [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: 11/30/2022] Open
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10
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Bloudek L, Hepp Z, Chia J, Varon S. Claims-Based Analysis of the Impact of Adherence to Oral Migraine Prophylaxis in a Newly Diagnosed Chronic Migraine Population (P04.238). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p04.238] [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: 11/15/2022] Open
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11
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Affiliation(s)
- J Chia
- Schulich School of Medicine, University of Western Ontario, London, Ontario, Canada.
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12
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Carruthers BM, van de Sande MI, De Meirleir KL, Klimas NG, Broderick G, Mitchell T, Staines D, Powles ACP, Speight N, Vallings R, Bateman L, Baumgarten-Austrheim B, Bell DS, Carlo-Stella N, Chia J, Darragh A, Jo D, Lewis D, Light AR, Marshall-Gradisnik S, Mena I, Mikovits JA, Miwa K, Murovska M, Pall ML, Stevens S. Myalgic encephalomyelitis: International Consensus Criteria. J Intern Med 2011; 270:327-38. [PMID: 21777306 PMCID: PMC3427890 DOI: 10.1111/j.1365-2796.2011.02428.x] [Citation(s) in RCA: 695] [Impact Index Per Article: 53.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The label 'chronic fatigue syndrome' (CFS) has persisted for many years because of the lack of knowledge of the aetiological agents and the disease process. In view of more recent research and clinical experience that strongly point to widespread inflammation and multisystemic neuropathology, it is more appropriate and correct to use the term 'myalgic encephalomyelitis' (ME) because it indicates an underlying pathophysiology. It is also consistent with the neurological classification of ME in the World Health Organization's International Classification of Diseases (ICD G93.3). Consequently, an International Consensus Panel consisting of clinicians, researchers, teaching faculty and an independent patient advocate was formed with the purpose of developing criteria based on current knowledge. Thirteen countries and a wide range of specialties were represented. Collectively, members have approximately 400 years of both clinical and teaching experience, authored hundreds of peer-reviewed publications, diagnosed or treated approximately 50 000 patients with ME, and several members coauthored previous criteria. The expertise and experience of the panel members as well as PubMed and other medical sources were utilized in a progression of suggestions/drafts/reviews/revisions. The authors, free of any sponsoring organization, achieved 100% consensus through a Delphi-type process. The scope of this paper is limited to criteria of ME and their application. Accordingly, the criteria reflect the complex symptomatology. Operational notes enhance clarity and specificity by providing guidance in the expression and interpretation of symptoms. Clinical and research application guidelines promote optimal recognition of ME by primary physicians and other healthcare providers, improve the consistency of diagnoses in adult and paediatric patients internationally and facilitate clearer identification of patients for research studies.
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Affiliation(s)
- B M Carruthers
- Department of Physiology and Medicine, Vrije University of Brussels, Himmunitas Foundation, Brussels, Belgium.
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13
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Chia J, Chia A, Voeller M, Lee T, Chang R. Acute enterovirus infection followed by myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and viral persistence. J Clin Pathol 2009; 63:165-8. [PMID: 19828908 DOI: 10.1136/jcp.2009.070466] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS Enteroviruses are well-known causes of acute respiratory and/or gastrointestinal infections and non-specific flu-like illness. Although enterovirus protein, RNA and non-cytopathic viruses have been demonstrated in the stomach biopsies of patients with myalgia encephalomyelitis/chronic fatigue syndrome (ME/CFS), causality for chronic diseases is difficult to establish without having well-documented cases of acute enterovirus infections. The aim of this study was to link acute enteroviral infection to viral persistence in patients with ME/CFS. METHOD Patients admitted to the hospital with acute febrile illnesses were screened for enteroviral infections. Acutely infected patients were followed longitudinally, and those who developed symptoms of ME/CFS underwent oesophagogastroduodenoscopy and biopsies of the antrum to document viral persistence by immunoperoxidase staining for viral protein and viral RNA assay. RESULTS Three representative patients with different manifestations of acute enterovirus infections progressed to have chronic symptoms of ME/CFS. Persistent viral infection was demonstrated in the antrum years later. CONCLUSION After acute infections, enteroviruses can persist in patients resulting in manifestation of ME/CFS. Chronic enterovirus infection in an immunocompetent host may be an example of a stalemate between attenuated, intracellular viruses and an ineffective immune response.
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Affiliation(s)
- J Chia
- EV Med Research, Torrance, California, USA.
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14
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Wilde EA, McCauley SR, Hunter JV, Bigler ED, Chu Z, Wang ZJ, Hanten GR, Troyanskaya M, Yallampalli R, Li X, Chia J, Levin HS. Diffusion tensor imaging of acute mild traumatic brain injury in adolescents. Neurology 2008; 70:948-55. [PMID: 18347317 DOI: 10.1212/01.wnl.0000305961.68029.54] [Citation(s) in RCA: 410] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Despite normal CT imaging and neurologic functioning, many individuals report postconcussion symptoms following mild traumatic brain injury (MTBI). This dissociation has been enigmatic for clinicians and investigators. METHODS Diffusion tensor imaging tractography of the corpus callosum was performed in 10 adolescents (14 to 19 years of age) with MTBI 1 to 6 days postinjury with Glasgow Coma Scale score of 15 and negative CT, and 10 age- and gender-equivalent uninjured controls. Subjects were administered the Rivermead Post Concussion Symptoms Questionnaire and the Brief Symptom Inventory to assess self-reported cognitive, affective, and somatic symptoms. RESULTS The MTBI group demonstrated increased fractional anisotropy and decreased apparent diffusion coefficient and radial diffusivity, and more intense postconcussion symptoms and emotional distress compared to the control group. Increased fractional anisotropy and decreased radial diffusivity were correlated with severity of postconcussion symptoms in the MTBI group, but not in the control group. CONCLUSIONS In adolescents with mild traumatic brain injury (MTBI) with Glasgow Coma Scale score of 15 and negative CT, diffusion tensor imaging (DTI) performed within 6 days postinjury showed increased fractional anisotropy and decreased diffusivity suggestive of cytotoxic edema. Advanced MRI-based DTI methods may enhance our understanding of the neuropathology of TBI, including MTBI. Additionally, DTI may prove more sensitive than conventional imaging methods in detecting subtle, but clinically meaningful, changes following MTBI and may be critical in refining MTBI diagnosis, prognosis, and management.
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Affiliation(s)
- E A Wilde
- Physical Medicine and Rehabilitation Alliance of Baylor College of Medicine, Houston, TX 77025, USA.
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15
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Abstract
Circumferential defects of digit are uncommon but present a challenging problem to the clinician. The use of simple skin grafts tends to cause tendon adhesions and can limit digital range of motion. The use of local skin flaps, such as a cross-finger flap, is limited by the considerable skin loss in a defect that is circumferential in nature. Other options have included the use of reversed forearm flap or some free tissue transfer. We report a case in which the circumferential defect of an index finger, measuring 6 cm around the digit and 3 cm long, is resurfaced by the use of a free arterialized venous flap raised from the volar forearm skin.
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Affiliation(s)
- J Chia
- Department of Hand and Reconstructive Microsurgery, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Republic of Singapore.
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16
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Setser RM, Sayre K, Flacke S, Chia J, Lunn K, Lorenz CH. Assessment of ventricular contractility during cardiac magnetic resonance imaging examinations using normalized maximal ventricular power. Ann Biomed Eng 2001; 29:974-82. [PMID: 11791680 DOI: 10.1114/1.1415530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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: 11/24/2022]
Abstract
Normalized maximal ventricular power (nPWRmax) is an index of cardiac function which measures the innate blood pumping ability, or contractility, of the left ventricle (LV), and its noninvasive assessment could prove useful in a variety of patients. nPWRmax is defined as the maximum instantaneous product of LV pressure and the rate of change of LV volume, divided by the end diastolic volume squared. We have quantified nPWRmax noninvasively in humans by pairing magnetic resonance imaging (MRI) LV volume measurements with aortic pressure estimated using radial artery tonometry and a frequency domain transfer function. In healthy volunteers undergoing cardiac MRI we have tested the sensitivity of nPWRmax to LV contractility with dobutamine and to cardiac loading with methoxamine, a vasoconstrictor. We have found that aortic pressures can be reliably estimated using a transfer function, which we generated and validated in a group of patients undergoing cardiac catheterization. Furthermore, we found that nPWRmax was unchanged by methoxamine, yet sensitive to contractility, with a 325% increase at dobutamine levels half that given during routine clinical cardiac stress tests for ischemia. In conclusion, we have shown that ventricular contractility can be assessed independent of cardiac loading in patients during routine noninvasive cardiac imaging examinations.
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Affiliation(s)
- R M Setser
- Cardiovascular Division, Barnes-Jewish Hospital at Washington University Medical Center, St Louis, MO, USA.
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17
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Lim YW, Chia J, Looi KP. A case report of mycobacterium marinum infection of the hand. Singapore Med J 2000; 41:221-3. [PMID: 11063172] [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: 02/18/2023]
Abstract
We report a case of Mycobacterium marinum infection of the hand presenting initially as triggering of the digits. We like to highlight the unusual source of the infection and difficulty of diagnosis in this case as well as the various treatment modalities.
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Affiliation(s)
- Y W Lim
- Department of Hand & Reconstructive Microsurgery, National University Hospital, Singapore
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18
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Kuehnert MJ, Clark E, Lockhart SR, Soll DR, Chia J, Jarvis WR. Candida albicans endocarditis associated with a contaminated aortic valve allograft: implications for regulation of allograft processing. Clin Infect Dis 1998; 27:688-91. [PMID: 9798016 DOI: 10.1086/514944] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.7] [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: 11/03/2022] Open
Abstract
A patient developed Candida albicans endocarditis and fungemia after undergoing aortic valve replacement with an allograft. The allograft had been found during tissue bank processing to be contaminated with C. albicans, but it was culture-negative for C. albicans after routine disinfection with an antifungal-containing antimicrobial solution. Comparison of the preimplantation and postimplantation C. albicans isolates revealed remarkable genetic similarity, but antifungal susceptibility testing showed that the postimplantation isolate was more resistant to fluconazole and amphotericin B than the preimplantation isolate, suggesting emergence of resistance after disinfection. Implantation of a contaminated heart valve allograft can occur despite disinfection during processing and can result in endocarditis in the recipient. Antimicrobial disinfection protocols that include antifungal drugs may be ineffective. Current U.S. Food and Drug Administration regulations do not require companies to specify details concerning allograft processing. Additional measures may be required to prevent tissue bank release of allografts contaminated with C. albicans or other pathogens.
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Affiliation(s)
- M J Kuehnert
- Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
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19
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Abstract
Fixation of small bones in the adult and the child's hands remains a challenge. The authors present a technique of bone fixation using customized staples made intraoperatively from K-wires (0.9-1.6 mm in diameter). Their specific purpose was to provide axial alignment and rotational stability for carpal bone fixation and for epiphysiodesis in phalanges. This technique was used in 14 cases (11 adult and three paediatric). No bone shattering, implant breakage, implant loosening or infection occurred. As K-wires are quite malleable, custom sized and shaped staples which follow the bone contours could be made to give a more exact fixation. All cases had satisfactory outcomes, achieving the preoperative objectives of bony fixation. This method is safe, precise and technically easy. It is also relatively cheap and only requires simple, standard instruments.
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Affiliation(s)
- K P Looi
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore
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20
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Abstract
A rare case of an epitheloid haemangioendothelioma presenting as an aggressive soft tissue mass in the wrist of an infant is presented. The management of the lesion presents particular difficulties because of its diffuse involvement of surrounding muscles, tendons and neurovascular bundle and the importance of preserving hand function. The epitheloid haemangioendothelioma rarely occurs extravascularly with less than 15 such cases reported in the literature.
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Affiliation(s)
- J Chia
- Department of Hand and Reconstructive Microsurgery, National University of Singapore, Singapore
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21
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Abstract
We report triggering of the thumb in a 2-year-old female child caused by intratendinous granulation tissue after trauma to the thumb.
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Affiliation(s)
- J Chia
- Department of Orthopaedic Surgery, National University of Singapore
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22
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Chia J, Soh CR, Wong HP, Low YP. Complications following metal removal: a follow-up of surgically treated forearm fractures. Singapore Med J 1996; 37:268-9. [PMID: 8942225] [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: 02/03/2023]
Abstract
We undertook a retrospective study of 82 patients with 128 diaphyseal fractures of the forearm who had been operated at our institution for their initial injury and subsequently had implant removal when the fractures had healed. The majority of the patients (97.5%) had no major complications after the removal of implants but 2 patients sustained a re-fracture of the same bone within 6 months after plate removal. Both patients had suffered from open fracture at the initial injury and sustained re-fracture in the original fracture site after implant removal. These fractures were both treated conservatively in a cast and united without further problems. Another 20 patients (24.4%) had minor complications ranging from mild superficial wound infection to nerve injury.
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Affiliation(s)
- J Chia
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
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23
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Liew YM, Chia J, Low YP. Delayed abscess formation in the wrist due to an unusual retained foreign body--a case report. Ann Acad Med Singap 1995; 24:867-8. [PMID: 8838998] [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: 02/02/2023]
Abstract
It is well documented that retained foreign bodies can be associated with delayed abscess formation in the body. We report an unusual case of a large bomb shrapnel in the wrist of a 64-year-old Chinese woman which was retained for 52 years, causing gross wrist destruction and delayed abscess formation. An open drainage of the wrist abscess was done and the shrapnel was removed. A secondary closure was subsequently done but the patient refused another procedure for a formal wrist arthrodesis.
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Affiliation(s)
- Y M Liew
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
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24
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Kour AK, Phone MH, Chia J, Pho RW. A preliminary report of tissue preservation with University of Wisconsin cold storage solution in major limb replantation. Ann Acad Med Singap 1995; 24:37-41. [PMID: 8572524] [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: 01/31/2023]
Abstract
We report our results using University of Wisconsin (UW) cold storage solution in two cases of major replantation of the upper extremity. We employed a technique of a complete vascular washout with 1000 ml UW solution at 4 degrees Celsius at 120 cm hydrostatic pressure into the artery via a size 18 cannula. The ischaemic time of the amputated limbs were 7 hours and 11 1/4 hours respectively. No fasciotomy was performed upon revascularisation and minimal swelling was observed postoperatively. No post-ischaemic syndrome was encountered following the replantation surgery. With a follow-up of 10 and 16 months respectively, muscle and nerve viability were observed with sensory recovery and motor reinnervation. There was absence of muscle contracture and at subsequent surgical procedures, healthy musculature was present in the replanted limbs. These two clinical cases suggest that the UW solution has a role in extending the duration of tissue preservation and improving the quality of the tissues preserved.
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Affiliation(s)
- A K Kour
- Department of Orthopaedic Surgery, National University of Singapore, Singapore
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25
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Kour AK, Phone MH, Chia J, Pho RW. Digital replantations under local anaesthesia. Ann Acad Med Singap 1995; 24:68-72. [PMID: 8572530] [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: 01/31/2023]
Abstract
We performed 10 digital replantations under local anaesthesia. Nine were single digit replantations and one case had a digital replantation together with another digit revascularisation. Criteria for patient selection for the local anaesthetic procedure included healthy young individuals, solitary hand injury, ability to understand the procedure and a stable emotional makeup. A combination of 10 ml of lidocaine 1% and 10 ml of bupivacaine 0.5% was used for volar metacarpal block and a dorsal ring block to the base of the digit. The patient was simultaneously sedated with 10 mg diazepam intramuscularly. Standard intraoperative monitoring of blood pressure, continuous electrocardiogram and pulse oximeter were carried out. The average duration of surgery was 3 hours. There was complete pain relief intraoperatively and good postoperative sensory block for an additional 7 to 15 hours. The technical execution of microsurgery was not compromised. All replantations were successful with no complication encountered from the use of local anaesthesia.
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Affiliation(s)
- A K Kour
- Department of Orthopaedic Surgery, National University of Singapore, Singapore
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26
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Ogura K, Terasaki PI, Koyama H, Chia J, Imagawa DK, Busuttil RW. High one-month liver graft failure rates in flow cytometry crossmatch-positive recipients. Clin Transplant 1994; 8:111-5. [PMID: 8019019] [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: 01/28/2023]
Abstract
In a retrospective study of 84 primary cadaver donor orthotopic liver transplants (OLTs), we investigated the damaging effect of preformed donor-specific antibodies by a standard T-cell warm crossmatch test (TWXM) and a more sensitive flow cytometry crossmatch test (FCXM). The incidence of a positive crossmatch was 12% (10/84) by TWXM and 24% (20/84) by FCXM, respectively. The incidence of 1-month graft failure was 30% (3/10) for patients with a positive TWXM, compared with 23% (17/74) for a negative TWXM. The deleterious effect was more pronounced when the patients were examined by FCXM. Nine of 20 (45%) FCXM-positive recipients lost their grafts within 1 month (p = 0.01) and 8 of those 9 failures occurred within 2 weeks posttransplant. A comparison of graft survival rates at 6 months demonstrated that FCXM-positive patients had a 25% lower survival rate (p = 0.01) than those with a negative FCXM. The positive rate of FCXM was 4 times higher in sensitized patients (PRA 11-100). However, 9 patients in the non-sensitized group (PRA 0-10) had a positive FCXM, and 5 of 9 patients had graft failure within 1 month, suggesting that even a low level of antibodies or non-complement fixing antibodies may have a very damaging effect. This study shows that preformed donor-specific antibodies do have a deleterious effect on allografts. Although the effect is not necessarily expressed as hyperacute rejection, the antibody response is capable of damaging the allografted organs within 1 month. Consideration should be given to crossmatching OLT patients in order to avoid transplantation over a positive crossmatch.
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Affiliation(s)
- K Ogura
- UCLA Tissue Typing Laboratory, Department of Surgery, UCLA School of Medicine 90024
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27
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Abstract
The unusually high 88% one-year cadaver kidney graft survival rate in patients with IgA nephropathy (IgAN) prompted us to investigate the influence of IgA anti-HLA class I antibodies on subsequent graft survival. We found that patients with various original diseases with IgA antibodies to the HLA molecule had high 91% one-year graft survival compared with 58% one-year survival for those who did not have preformed IgA antibodies against the HLA molecule prior to transplantation (P < 0.0005). The IgA antibodies were detected by reaction with class I HLA molecules isolated by capture with monoclonal antibody and detected with an enzyme-linked immunosorbent assay. In contrast, IgG antibodies to the HLA molecule resulted in a lower one-year graft survival rate (74%) than in those patients without IgG antibodies (87%) (p = 0.08). IgA antibodies to the HLA molecule, when present, tended to react at a high frequency on a random lymphocyte panel. These findings suggest that sensitization resulting in IgA anti-HLA antibodies may counteract the deleterious effect of an IgG antibody response in clinical kidney transplantation.
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Affiliation(s)
- P Koka
- Department of Surgery, UCLA School of Medicine 90024
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28
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Chia J, Poh WT, Tan SK. Malignant granular cell tumour of the lower limb--a case report and review of the literature. Ann Acad Med Singap 1993; 22:384-6. [PMID: 8373125] [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: 01/30/2023]
Abstract
Granular cell tumour is a rare tumour of undetermined origin. Fewer than 1000 cases have been reported and less than 40 cases of malignant forms of this tumour have been described in the literature. We report a single case of the malignant form of granular cell tumour in the lower limb and review the literature regarding the possible origin of this tumour. Presently, wide surgical excision is the only modality of treatment for this lesion.
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Affiliation(s)
- J Chia
- Department of Orthopaedic Surgery O Unit, Singapore General Hospital
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29
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Ogura K, Koyama H, Takemoto S, Chia J, Johnson C, Terasaki PI. Flow cytometry crossmatching for kidney transplantation. Transplant Proc 1993; 25:245-6. [PMID: 8438287] [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: 01/30/2023]
Affiliation(s)
- K Ogura
- University of California, Los Angeles Tissue Typing Laboratory, Department of Surgery 90024
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30
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Abstract
The infrequent occurrence of right colon diverticulitis in the developed West has led to a controversy in the management of this disease. In Singapore, we continued to avoid colectomy whenever possible because this disease is usually nonprogressive. We reviewed 68 patients treated by conservative surgery to evaluate the effectiveness of this treatment policy. Almost 70 percent of our patients were below 40 years of age, and the clinical presentation was indistinguishable from acute appendicitis. Diverticulectomy was done only for inflamed and perforated diverticula (25 cases), while the nonperforated diverticulum was left alone (40 cases). The inflammation invariably responded to antibiotic therapy. Only three patients had colonic resection since a malignant neoplasm could not be excluded. There were no adverse sequelae over a mean follow-up period of three and one-half years, except for one patient who had recurrent attacks of right colon diverticulitis necessitating colectomy. With this policy of management we encountered no mortality, and morbidity was acceptable.
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Affiliation(s)
- S S Ngoi
- Department of Surgery, National University Hospital, Singapore
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31
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Abstract
Figure 9 summarizes the morphogenetic process of feather and hair. Hair of feathers are formed from a layer of homogeneously distributed mesenchymal cells. The mesenchymal cells start to condense to form foci in response to some unidentified induction signal (Fig. 9B). Several adhesion molecules, including L-CAM, N-CAM, integrin, tenascin, as well as proteoglycan, are involved. These adhesion molecules appear to have different roles in this process, because perturbation with specific antibodies leads to different aborted patterns. Hair or feather follicles then form following cell proliferation and epithelial invagination (Fig. 9C). The dermal papilla is enriched with N-CAM and tenascin, whereas the feather collar (equivalent of hair matrix) is enriched with L-CAM and PDGF receptor. Epithelial cells in the feather collar receive a signal from the dermal papilla and are able to continue to divide. Several growth factors, such as PDGF and EGF, may be involved. As epithelial cells are pushed upwards, they differentiate and keratinize in a cylindrical structure into hair. In feather, another morphogenetic event takes place to form the branched structure. The epithelial cylinder of the feather shaft invaginates to form rows of cells that die to become space and create the secondary branch or barbs (Fig. 9D). N-CAM is enriched in the cells destined to die and appears to form the border of cell groups within which the "death signal" is transmitted. In some, but not all, feathers the same process is repeated, in a way analogous to fractal formation, to form the tertiary branches or the barbules (Fig. 9E). Thus, in each step of the morphogenesis of feather and hair, different adhesion molecules are expressed and are involved in different functions: induction, mesenchymal condensation, epithelial folding, and cell death, depending on different scenarios. We have just begun to elucidate these molecular events.
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Affiliation(s)
- C M Chuong
- Department of Pathology, School of Medicine, University of Southern California, Los Angeles 90033
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32
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Pollack M, Oishi K, Chia J, Evans M, Guelde G, Koles N. Specificity and function of monoclonal antibodies reactive with discrete structural elements of bacterial lipopolysaccharide. Adv Exp Med Biol 1990; 256:331-40. [PMID: 1691578 DOI: 10.1007/978-1-4757-5140-6_28] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We examined the binding and functional activities of monoclonal antibodies (mAbs) reactive with different structural elements of Escherichia coli and Salmonella minnesota LPS. O-side chain-reactive mAbs were highly specific for homologous, smooth LPS, bound avidly to intact bacteria, mediated complement-dependent bactericidal and/or opsonic activity, and protected against live, homologous IP challenges in mice. Core- and lipid A-specific mAbs, on the other hand, were more cross-reactive, although this cross-reactivity was severely restricted by the relative inaccessibility of epitopes in the core/lipid A region. This was reflected in the general inability of these mAbs to react with isolated smooth LPS or wild type bacteria, or to mediate bactericidal or opsonic functions. No LPS-reactive mAbs, regardless of molecular specificity, was able to block LPS- or lipid A-induced TNF production by RAW 264.7 macrophages, thus raising doubts concerning the putative endotoxin-neutralizing properties of mAbs reactive with the core/lipid A complex. Bacterial lipopolysaccharides (LPS) exhibit a complex identity. They represent an essential structural element of the outer membrane of all Gramnegative bacteria (7); they are toxins (5); they mediate a variety of immunomodulatory activities; and they are important bacterial surface antigens (2). In general, LPS macromolecules consist of three genetically, biochemically, and antigenetically distinct regions or domains: the O-side chain, core oligosaccharide, and lipid A moiety (15). Of these three regions, the O-side chain is the most phylogenetically diverse. It also represents the most antigenetically exposed element on isolated or cell-associated, native LPS. The core and lipid A structures, in contrast, are relatively conserved among different bacteria and are less accessible to antibody attack by virtue of overlying sugars contained in the O-side chain or outer core (8). In this study, we investigated selected functional activities of monoclonal antibodies (mAbs) specific for different epitopes within the three major structural domains of Escherichia coli and Salmonella minnesota LPS. The possible endotoxin-neutralizing and antibacterial properties of these mAbs were our particular focus.
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Affiliation(s)
- M Pollack
- Department of Medicine, Uniformed Services University, F. Edward Hébert School of Medicine, Bethesda, Maryland
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Affiliation(s)
- K Satku
- Department of Orthopaedic Surgery, National University Hospital, Republic of Singapore
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34
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Abstract
A cytotoxic mouse monoclonal antibody (CALL2) was produced against a cultured T acute lymphocytic leukaemia (T ALL) cell line 8402. Ascites fluid containing the antibody was cytotoxic to a titre of up to 1:100 000 against 4 of 6 cultured T ALL cell lines and against leukaemia cells from 7 of 8 T ALL patients and 1 of 5 T chronic lymphatic leukaemia patients. The antibody did not react with normal peripheral-blood T and B lymphocytes, monocytes, granulocytes, spleen cells, thymocytes, platelets, and other acute and chronic leukaemia cells. The CALL2 antibody did not react with bone marrow stem cells of the myeloid series (CFU-C). This antibody may be useful for passive immunotherapy trials since it does not react with normal cells and is highly cytotoxic to T ALL cells.
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Chao TC, Pakiam JE, Chia J. A study of lightning deaths in Singapore. Singapore Med J 1981; 22:150-7. [PMID: 7302622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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36
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Moore RM, Williams JD, Chia J. Factors affecting concentrations of dimethylated indolealkylamines in Phalaris tuberosa L. Aust J Biol Sci 1967; 20:1131-40. [PMID: 5583048 DOI: 10.1071/bi9671131] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
In an experiment conducted in controlled� environment rooms, factors (temperature, light intensity, and nitrate supply) that influenced nitrate nitrogen concentrations in Phalaris tuberosa also affected concentrations of tryptamine alkaloids.
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