1
|
Lee CT, Koleoso O, Deng M, Veltchev I, Lin T, Hallman MA, Horwitz EM, Wong JK. A dosimetric analysis of rectal hydrogel spacer use in patients with recurrent prostate cancer undergoing salvage high-dose-rate brachytherapy. Brachytherapy 2023; 22:586-592. [PMID: 37393186 PMCID: PMC10527788 DOI: 10.1016/j.brachy.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 05/18/2023] [Accepted: 06/01/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE We hypothesize rectal hydrogel spacer (RHS) improves rectal dosimetry in patients undergoing salvage high-dose-rate brachytherapy (HDR-BT) for intact, recurrent prostate cancer (PC). METHODS AND MATERIALS A prospectively collected institutional database was queried for recurrent PC patients treated with salvage HDR-BT from September 2015 to November 2021. Patients were offered RHS beginning June 2019. Dosimetric variables were compared between RHS and no-RHS groups for the average of two fractions using Wilcoxon rank-sum tests. Primary outcomes were rectal volume receiving 75% of prescription dose (V75%) and prostate volume receiving 100% of prescription dose (V100%). Generalized estimating equation (GEE) model was used to evaluate the association between other planning variables and rectal V75%. RESULTS Forty-one PC patients received salvage HDR-BT, of whom 20 had RHS. All patients received 2400cGy in 2 fractions. Median RHS volume was 6.2cm3 (Standard deviation [SD]: ± 3.5cm3). Median follow-up was 4 months and 17 months in the RHS and no-RHS groups, respectively. Median rectal V75% with and without RHS were 0.0cm3 (IQR: 0.0-0.0cm3) and 0.06cm3 (IQR: 0.0-0.14cm3), respectively (p<0.001). Median prostate V100% with and without RHS were 98.55% (IQR: 97.86-99.22%) and 97.78% (IQR: 97.50-98.18%), respectively (p = 0.007). RHS, rectum, and prostate volumes did not significantly affect rectal V75% per GEE modeling. There was 10% G1-2 and 5% G3 rectal toxicity in RHS group. There was 9.5% G1-2 and no G3+ rectal toxicities in the no-RHS group. CONCLUSIONS Absolute improvement in rectal V75% and prostate V100% was significant with RHS in PC patients undergoing salvage HDR-BT, but clinical benefit is marginal.
Collapse
Affiliation(s)
- Charles T Lee
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA.
| | - Olufela Koleoso
- Doctor of Osteopathic Medicine Program, Philadelphia College of Osteopathic Medicine, Philadelphia, PA
| | - Mengying Deng
- Department of Biostatistics and Bioinformatics, Fox Chase Cancer Center, Philadelphia, PA
| | - Iavor Veltchev
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Teh Lin
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Mark A Hallman
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Eric M Horwitz
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - J Karen Wong
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA
| |
Collapse
|
2
|
Zhang E, Ruth KJ, Buyyounouski MK, Price RA, Uzzo RG, Sobczak ML, Pollack A, Wong JK, Chen DYT, Hallman MA, Greenberg RE, Watkins-Bruner D, Al-Saleem T, Horwitz EM. Long-Term Results of a Phase 3 Randomized Prospective Trial of Erectile Tissue-Sparing Intensity-Modulated Radiation Therapy for Men With Clinically Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2023; 115:1074-1084. [PMID: 36566906 PMCID: PMC10462387 DOI: 10.1016/j.ijrobp.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/03/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE The objective of this study was to determine whether limiting the doses delivered to the penile bulb (PB) and corporal bodies with intensity modulated radiation therapy (IMRT) preserves erectile function compared with standard IMRT in men with prostate cancer. METHODS AND MATERIALS A total of 117 patients with low- to intermediate-risk, clinical T1a-T2c prostate adenocarcinoma were enrolled in a single-institution, prospective, single-blind, phase 3 randomized trial. All received definitive IMRT to 74 to 80 Gy in 37 to 40 fractions and standard IMRT (s-IMRT) or erectile tissue-sparing IMRT (ETS-IMRT), which placed additional planning constraints that limited the D90 to the penile bulb and corporal bodies to ≤15 Gy and ≤7 Gy, respectively. Erectile potency was assessed with components of the International Index of Erectile Function and phosphodiesterase type 5 inhibitor (PDE5) medication records. RESULTS Sixty-two patients received ETS-IMRT, and 54 received s-IMRT; 1 patient did not receive radiation therapy. Before treatment, all patients reported erectile potency. No patients received androgen deprivation therapy. In the intention-to-treat analysis, treatment arms did not differ in potency preservation at 24 months (37.1% ETS-IMRT vs 31.5% s-IMRT, P = .53). Of 85 evaluable patients with International Index of Erectile Function and PDE5 medication follow-up, erectile potency was seen in 47.9% of patients in the ETS-IMRT arm and 46.0% of patients in the s-IMRT arm (P = .86). PDE5 inhibitors were initiated in 41.7% of ETS-IMRT patients and 35.1% of s-IMRT patients (P = .54). Among all patients enrolled, there was no difference in freedom from biochemical failure between those treated with ETS-IMRT and s-IMRT (5-year 91.8% vs 90.7%, respectively, P = .77), with a median follow-up of 7.4 years. There were no differences in acute or late gastrointestinal or genitourinary toxicity. An unplanned per-protocol analysis demonstrated no differences in potency preservation or secondary endpoints between patients who exceeded erectile tissue-sparing constraints and those who met constraints, although power was limited by attrition and unplanned dosimetric crossover. CONCLUSIONS ETS-IMRT that strictly limits dose to the penile bulb and corporal bodies is safe and feasible. Use of this planning technique did not show an effect on potency preservation outcomes at 2 years, though power to detect a difference was limited.
Collapse
Affiliation(s)
- Eddie Zhang
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Karen J Ruth
- Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | | | - Robert A Price
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Robert G Uzzo
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Mark L Sobczak
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Alan Pollack
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida
| | - J Karen Wong
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - David Y T Chen
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Mark A Hallman
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Richard E Greenberg
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | | | - Tahseen Al-Saleem
- Department of Pathology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Eric M Horwitz
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
| |
Collapse
|
3
|
Lee CT, Ruth K, Patel S, Bleicher R, Sigurdson E, Weiss S, Hayes S, Anderson P, Wong JK. Factors Associated with Reconstruction Failure and Major Complications After Postmastectomy Radiation to a Reconstructed Breast. Pract Radiat Oncol 2023; 13:122-131. [PMID: 36332800 PMCID: PMC10684027 DOI: 10.1016/j.prro.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 09/12/2022] [Accepted: 09/22/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE Postmastectomy radiation therapy is known to increase risk of complications in the reconstruction setting. We aim to identify the variables associated with reconstruction failure and other major complications. METHODS AND MATERIALS A prospectively collected institutional database was queried for patients with up to stage IIIC breast cancer treated from 2000 to 2017, undergoing mastectomy, immediate implant or autologous tissue reconstruction, and radiation to the reconstructed breast within 1 year of surgery. Reconstruction failure was defined as complication requiring surgical revision or implant removal. Additional major complications were defined as any infection, contracture, necrosis, or fibrosis. Covariates of interest included age, body mass index, smoking status, stage, hormone receptor and HER2 status, systemic therapy timing, radiation technique, nodal irradiation, and interval between surgery and start of postmastectomy radiation therapy. Differences in complication rates were assessed with χ² or Fisher exact tests. Competing risk regression was used to estimate hazard ratios; covariates were included one at a time to avoid over adjustment. RESULTS A total of 206 reconstructed breasts in 202 patients resulted from our initial query, with 139 treated with intensity-modulated radiation therapy (IMRT) and 67 treated with conventional radiation therapy (CRT). Median follow-up was 45 months (range, 4-210 months); patient cohorts were generally similar. Eight patients were excluded from toxicity analysis for insufficient follow-up (<2 years). Overall, reconstruction failure and major complication rates were significantly lower in the IMRT group. Reconstruction failure rates were 3.0% for IMRT versus 16.4% for CRT (P = .002), and major complication rates were 6.8% for IMRT versus 24.6% for CRT (P < .001). On univariate analysis, CRT was significantly predictive of implant failure (hazard ratio, 5.54; P = .003) and increased complication rates (hazard ratio, 3.83; P = .001). Significance persisted on multivariable analysis. Survival outcomes were similar, with no difference in 2 year overall survival (P = .12) and local recurrence (P = .41). CONCLUSIONS Using IMRT may improve reconstruction outcomes over CRT, with significantly lower reconstruction failure and complication rates without compromising local control or survival.
Collapse
Affiliation(s)
- Charles T Lee
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Karen Ruth
- Department of Biostatistics and Bioinformatics, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Sameer Patel
- Department of Plastic Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Richard Bleicher
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Elin Sigurdson
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Stephanie Weiss
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Shelly Hayes
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Penny Anderson
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - J Karen Wong
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
| |
Collapse
|
4
|
Zhang E, Wang L, Shaikh T, Handorf E, Karen Wong J, Hoffman JP, Reddy S, Cooper HS, Cohen SJ, Dotan E, Meyer JE. Neoadjuvant Chemoradiation Impacts the Prognostic Effect of Surgical Margin Status in Pancreatic Adenocarcinoma. Ann Surg Oncol 2022; 29:354-363. [PMID: 34114181 PMCID: PMC8660918 DOI: 10.1245/s10434-021-10219-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 04/19/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Many studies show significantly improved survival after R0 resection compared with R1 resection in pancreatic adenocarcinoma (PAC); however, the effect of neoadjuvant chemoradiation (NACRT) on this association is unknown. OBJECTIVE The aim of this study was to evaluate the prognostic significance of positive surgical margins (SMs) after NACRT compared with upfront surgery + adjuvant therapy in PAC. METHODS All cases of surgically resected PAC at a single institution were reviewed from 1996 to 2014; patients treated with palliative intent, metastatic disease, and biliary/ampullary tumors were excluded. The primary endpoint was overall survival (OS). RESULTS Overall, 300 patients were included; 134 patients received NACRT with concurrent 5-fluorouracil or gemcitabine followed by surgery, and 166 patients received upfront surgery (+ adjuvant chemotherapy in 72% of patients and RT in 65%); 31% of both groups had a positive SM (+SM). The median OS for patients with a +SM or negative SM (-SM) was 26.6 and 31.6 months, respectively for NACRT, and 12.0 and 24.5 months, respectively, for upfront surgery. OS was significantly improved with -SM compared with +SM in both groups (p = 0.006). When resection yielded +SM, NACRT patients had improved OS compared with upfront surgery patients (p < 0.001). On multivariable analysis, +SM in the upfront surgery group (hazard ratio [HR] 2.94, 95% confidence interval [CI] 2.04-4.24; p < 0.001) and older age (HR 1.01, 95% CI 1.00-1.03, per year; p = 0.007) predicted worse OS. +SM in the NACRT group was not associated with worse OS (HR 1.09, 95% CI 0.72-1.65; p = 0.70). CONCLUSION Patients with a positive margin after NACRT and surgery had longer survival compared with patients with a positive margin after upfront surgery. NACRT should be strongly considered for patients at high risk of R1 resections.
Collapse
Affiliation(s)
- Eddie Zhang
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Lora Wang
- Department of Radiation Oncology, University of Miami, Miami, Florida
| | - Talha Shaikh
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Elizabeth Handorf
- Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - J. Karen Wong
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - John P. Hoffman
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennyslvania
| | - Sanjay Reddy
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennyslvania
| | - Harry S. Cooper
- Department of Pathology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Steven J. Cohen
- Department of Medical Oncology, Abington Hospital/Jefferson Health, Abington, Pennsylvania
| | - Efrat Dotan
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Joshua E. Meyer
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| |
Collapse
|
5
|
Pirlamarla AK, Hansen CC, Deng M, Handorf E, Paly J, Wong JK, Hallman MA, Chen DYT, Geynisman DM, Kutikov A, Horwitz EM. Early PSA kinetics for low- and intermediate-risk prostate cancer treated with definitive radiation therapy. Pract Radiat Oncol 2021; 12:60-67. [PMID: 34303033 DOI: 10.1016/j.prro.2021.07.003] [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] [Received: 04/20/2021] [Revised: 07/08/2021] [Accepted: 07/12/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE This study uses a patient-specific model to characterize and compare ideal PSA kinetics for low- and intermediate-risk prostate cancer following definitive radiation treatment with conventionally fractionated (CFRT), hypofractionated (HFRT), stereotactic body radiation therapy (SbRT), or brachytherapy, both high-dose-rate (HDR) and low-dose-rate (LDR). METHODS AND MATERIALS This retrospective analysis includes low- and intermediate-risk prostate cancer patients treated between 1998 and 2018 at an NCI-designated Comprehensive Cancer Center. Demographics and treatment characteristics were prospectively collected. Patients had at least two PSA measurements within 24-months of treatment and were free from biochemical recurrence. The incidence of, time to, and risk factors for PSA nadir (nPSA) and bounce (bPSA) were analyzed at 24-months following radiotherapy. Ideal PSA kinetics were characterized for each modality and compared. RESULTS Of 1,042 patients, 45% had low-risk cancer, 37% favorable intermediate-risk, and 19% unfavorable intermediate-risk. nPSA were higher for ablative modalities, both as absolute nPSA and relative to initial PSA (iPSA). Median time to nPSA ranged from 14.8 to 17.1 months. Over 50% treated with non-ablative therapy (CFRT, HFRT, and LDR) reached an nPSA threshold of ≤0.5 ng/mL compared to 23% of SbRT and 33% of HDR cohorts. The incidence of bPSA was 13.3% and not affected by treatment modality, Gleason Score, or prostate volume. PSA decay rate was faster for ablative therapies in the 6-24 month period. CONCLUSIONS Analysis of PSA within 24-months following radiation therapy revealed ablative therapies are associated with a latent PSA response and higher nPSA. Multivariable logistics modeling revealed younger age, iPSA above the median, presence of bPSA, and ablative therapy as predictors for not achieving nPSA ≤0.5 ng/mL. PSA decay rate appears to be faster in ablative therapies following a latent period. Understanding the different PSA kinetic profiles is necessary to assess treatment response and survey for disease recurrence.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - David Y T Chen
- Departments of Urologic Oncology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA 19111
| | - Daniel M Geynisman
- Departments of Medical Oncology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA 19111
| | - Alexander Kutikov
- Departments of Urologic Oncology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA 19111
| | | |
Collapse
|
6
|
Amin KR, Stone JP, Kerr JC, Wong JK, Fildes JE. Normothermic ex vivo perfusion of the limb allograft depletes donor leukocytes prior to transplantation. J Plast Reconstr Aesthet Surg 2021; 74:2969-2976. [PMID: 34274245 DOI: 10.1016/j.bjps.2021.03.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/02/2021] [Accepted: 03/25/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The donor immune compartment plays a central role in graft rejection of the vascularised composite allograft (VCA) by contributing to 'direct presentation'. Using our limb ex vivo normothermic machine perfusion (EVNP) protocol designed for prolonged allograft preservation, this study aimed to assess whether donor leukocytes responsible for allograft rejection are mobilised from the donor compartment. METHODS Five genetically different pig forelimbs underwent perfusion via the brachial and radial collateral artery for 6 h after 2 h of cold storage. Oxygenated haemodilute leucocyte-deplete blood was recirculated at normothermia using an extracorporeal perfusion system. Tissue perfusion was evaluated clinically and biochemically via blood perfusate. The temporal kinetics of donor leucocyte extravasation, cytokine secretion and cell-free DNA was characterised in the circulating perfusate. RESULTS Flow cytometry revealed increasing populations of viable leukocytes over time, reaching 49 billion leukocytes by 6 h. T (3.0 × 109 cells) and B cells (3.1 × 108 cells) lymphocytes, monocytes (2.7 × 109 cells), granulocytes (8.1 × 109 cells), NK (6.3 × 108) and γδ (8.1 × 108) cells were all identified. Regulatory T cells comprised a minor population (1.6 × 107 cells). There was a cumulative increase in pro-inflammatory cytokines suggesting that the donor limb has the capacity to elicit significant inflammatory responses that could contribute to leucocyte activation and diapedesis. CONCLUSION EVNP not only acts as a preservation tool, but could also be utilized to immunodeplete the VCA allograft prior to transplantation. This has clinical implications to mitigate acute rejection and prevent graft dysfunction and supports the future application of machine perfusion in graft preservation and immune modulation.
Collapse
Affiliation(s)
- K R Amin
- The Ex-Vivo Lab, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; Blond McIndoe Laboratories, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - J P Stone
- 3F66, Block 3, Alderley Park, Nether Alderley, Cheshire, SK10 4TG; The Ex-Vivo Lab, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; The Transplant Centre, Manchester University NHS Foundation Trust, Manchester M23 9LT, United Kingdom
| | - J C Kerr
- 3F66, Block 3, Alderley Park, Nether Alderley, Cheshire, SK10 4TG; The Ex-Vivo Lab, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - J K Wong
- Blond McIndoe Laboratories, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; Department of Plastic Surgery & Burns, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - J E Fildes
- 3F66, Block 3, Alderley Park, Nether Alderley, Cheshire, SK10 4TG; The Ex-Vivo Lab, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; The Transplant Centre, Manchester University NHS Foundation Trust, Manchester M23 9LT, United Kingdom.
| |
Collapse
|
7
|
Khor WS, Lazenby DJ, Campbell T, Bedford JD, Winterton RIS, Wong JK, Reid AJ. Reorganisation to a local anaesthetic trauma service improves time to treatment during the COVID-19 pandemic - experience from a UK tertiary plastic surgery centre. J Plast Reconstr Aesthet Surg 2021; 74:890-930. [PMID: 33158781 PMCID: PMC7585365 DOI: 10.1016/j.bjps.2020.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/02/2020] [Accepted: 10/10/2020] [Indexed: 11/28/2022]
Affiliation(s)
- W S Khor
- Department of Plastic Surgery & Burns, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
| | - D J Lazenby
- Department of Plastic Surgery & Burns, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - T Campbell
- Department of Plastic Surgery & Burns, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - J D Bedford
- Department of Plastic Surgery & Burns, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - R I S Winterton
- Department of Plastic Surgery & Burns, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - J K Wong
- Department of Plastic Surgery & Burns, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Blond McIndoe Laboratories, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PT, UK
| | - A J Reid
- Department of Plastic Surgery & Burns, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Blond McIndoe Laboratories, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PT, UK
| |
Collapse
|
8
|
Vapiwala N, Wong JK, Handorf E, Paly J, Grewal A, Tendulkar R, Godfrey D, Carpenter D, Mendenhall NP, Henderson RH, Stish BJ, Vargas C, Salama JK, Davis BJ, Horwitz EM. A Pooled Toxicity Analysis of Moderately Hypofractionated Proton Beam Therapy and Intensity Modulated Radiation Therapy in Early-Stage Prostate Cancer Patients. Int J Radiat Oncol Biol Phys 2021; 110:1082-1089. [PMID: 33539968 DOI: 10.1016/j.ijrobp.2021.01.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/13/2021] [Accepted: 01/23/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE Data comparing moderately hypofractionated intensity modulated radiation therapy (IMRT) and proton beam therapy (PBT) are lacking. We aim to compare late toxicity profiles of patients with early-stage prostate cancer treated with moderately hypofractionated PBT and IMRT. METHODS AND MATERIALS This multi-institutional analysis included patients with low- or intermediate-risk biopsy-proven prostate adenocarcinoma from 7 tertiary referral centers treated from 1998 to 2018. All patients were treated with moderately hypofractionated radiation, defined as 250 to 300 cGy per daily fraction given for 4 to 6 weeks, and stratified by use of IMRT or PBT. Primary outcomes were late genitourinary (GU) and gastrointestinal (GI) toxicity. Adjusted toxicity rates were calculated using inverse probability of treatment weighting, accounting for race, National Comprehensive Cancer Network risk group, age, pretreatment International Prostate Symptom Score (GU only), and anticoagulant use (GI only). RESULTS A total of 1850 patients were included: 1282 IMRT (median follow-up 80.0 months) and 568 PBT (median follow-up 43.9 months). Overall toxicity rates were low, with the majority of patients experiencing no late GU (56.6%, n = 1048) or late GI (74.4%, n = 1377) toxicity. No difference was seen in the rates of late toxicity between the groups, with late grade 3+ GU toxicity of 2.0% versus 3.9% (odds ratio [OR] 0.47; 95% confidence interval 0.17-1.28) and late grade 2+ GI toxicity of 14.6% versus 4.7% (OR 2.69; confidence interval 0.80-9.05) for the PBT and IMRT cohorts, respectively. On multivariable analysis, no factors were significantly predictive of GU toxicity, and only anticoagulant use was significantly predictive of GI toxicity (OR 1.90; P = .008). CONCLUSIONS In this large, multi-institutional analysis of 1850 patients with early-stage prostate cancer, treatment with moderately hypofractionated IMRT and PBT resulted in low rates of toxicity. No difference was seen in late GI and GU toxicity between the modalities during long-term follow-up. Both treatments are safe and well tolerated.
Collapse
Affiliation(s)
- Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - J Karen Wong
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Elizabeth Handorf
- Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Jonathan Paly
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Amardeep Grewal
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rahul Tendulkar
- Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Devon Godfrey
- Department of Radiation Oncology, Duke University, Durham, North Carolina
| | - David Carpenter
- Department of Radiation Oncology, Duke University, Durham, North Carolina
| | - Nancy P Mendenhall
- Department of Radiation Oncology, University of Florida, Gainesville, Florida
| | - Randal H Henderson
- Department of Radiation Oncology, UF Health Proton Therapy Institute, Jacksonville, Florida
| | - Bradley J Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Carlos Vargas
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Joseph K Salama
- Department of Radiation Oncology, Duke University, Durham, North Carolina
| | - Brian J Davis
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Eric M Horwitz
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
| |
Collapse
|
9
|
Khaw YC, Wong JK, Sahran Y, Nor-Azman MZ, Faisham WI. Iliac Telangiectatic Osteosarcoma - A Rare Presentation and Diagnostic Pitfall: A Case Report. Malays Orthop J 2021; 14:198-201. [PMID: 33403087 PMCID: PMC7751993 DOI: 10.5704/moj.2011.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Telangiectatic osteosarcoma is a rare variant of osteosarcoma and can be easily misdiagnosed as aneurysmal bone cyst. We report an atypical case of iliac telangiectatic osteosarcoma in a young healthy female, who presents with painful slow growing expansile lytic septate lesion in the left hemipelvis, which is initially treated as aneurysmal bone cyst. The diagnosis of aneurysmal bone cyst is made after histopathological examination of core needle biopsy. Her condition became unstable and massive bleeding is noted at the lesion site after sclerosant injection. She undergoes emergency hemipelvectomy and eventually the biopsy turns up to be telangiectatic osteosarcoma. Our case highlights that core needle biopsy is not useful in making diagnosis for iliac telangiectatic carcinoma. Hence, an open biopsy should be carried out in our case. This case also emphasises on careful evaluation for malignancy which is mandatory because bleeding from pelvis after an unsuitable treatment can be grave, to the extent that major amputation hemipelvectomy is an option. Even though telangiectatic osteosarcoma has the same prognosis and treatment with conventional osteosarcoma, the outcome of delayed treatment for telangiectatic osteosarcoma is not good due to the dilemma in establishing an early correct diagnosis.
Collapse
Affiliation(s)
- Y C Khaw
- Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - J K Wong
- Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Y Sahran
- Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - M Z Nor-Azman
- Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - W I Faisham
- Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| |
Collapse
|
10
|
Middlebrooks EH, Domingo RA, Vivas-Buitrago T, Okromelidze L, Tsuboi T, Wong JK, Eisinger RS, Almeida L, Burns MR, Horn A, Uitti RJ, Wharen RE, Holanda VM, Grewal SS. Neuroimaging Advances in Deep Brain Stimulation: Review of Indications, Anatomy, and Brain Connectomics. AJNR Am J Neuroradiol 2020; 41:1558-1568. [PMID: 32816768 DOI: 10.3174/ajnr.a6693] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/03/2020] [Indexed: 12/18/2022]
Abstract
Deep brain stimulation is an established therapy for multiple brain disorders, with rapidly expanding potential indications. Neuroimaging has advanced the field of deep brain stimulation through improvements in delineation of anatomy, and, more recently, application of brain connectomics. Older lesion-derived, localizationist theories of these conditions have evolved to newer, network-based "circuitopathies," aided by the ability to directly assess these brain circuits in vivo through the use of advanced neuroimaging techniques, such as diffusion tractography and fMRI. In this review, we use a combination of ultra-high-field MR imaging and diffusion tractography to highlight relevant anatomy for the currently approved indications for deep brain stimulation in the United States: essential tremor, Parkinson disease, drug-resistant epilepsy, dystonia, and obsessive-compulsive disorder. We also review the literature regarding the use of fMRI and diffusion tractography in understanding the role of deep brain stimulation in these disorders, as well as their potential use in both surgical targeting and device programming.
Collapse
Affiliation(s)
- E H Middlebrooks
- From the Departments of Radiology (E.H.M., L.O.) .,Neurosurgery (E.H.M., R.A.D., T.V.-B., R.E.W., S.S.G.)
| | - R A Domingo
- Neurosurgery (E.H.M., R.A.D., T.V.-B., R.E.W., S.S.G.)
| | | | | | - T Tsuboi
- and Neurology (R.J.U.), Mayo Clinic, Jacksonville, Florida.,Department of Neurology (T.T., J.K.W., R.S.E., L.A., M.R.B.), Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida
| | - J K Wong
- and Neurology (R.J.U.), Mayo Clinic, Jacksonville, Florida
| | - R S Eisinger
- and Neurology (R.J.U.), Mayo Clinic, Jacksonville, Florida
| | - L Almeida
- and Neurology (R.J.U.), Mayo Clinic, Jacksonville, Florida
| | - M R Burns
- and Neurology (R.J.U.), Mayo Clinic, Jacksonville, Florida
| | - A Horn
- Department of Neurology (T.T.), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - R J Uitti
- Department for Neurology (A.H.), Charité, University Medicine Berlin, Berlin, Germany
| | - R E Wharen
- Neurosurgery (E.H.M., R.A.D., T.V.-B., R.E.W., S.S.G.)
| | - V M Holanda
- Center of Neurology and Neurosurgery Associates (V.M.H.), BP-A Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - S S Grewal
- Neurosurgery (E.H.M., R.A.D., T.V.-B., R.E.W., S.S.G.)
| |
Collapse
|
11
|
Levin-Epstein R, Cook RR, Wong JK, Stock RG, Jeffrey Demanes D, Collins SP, Aghdam N, Suy S, Mantz C, Katz AJ, Nickols NG, Miszczyk L, Napieralska A, Namysl-Kaletka A, Prionas ND, Bagshaw H, Buyyounouski MK, Cao M, Mahal BA, Shabsovich D, Dang A, Yuan Y, Rettig MB, Chang AJ, Jackson WC, Spratt DE, Lehrer EJ, Zaorsky NG, Kupelian PA, Steinberg ML, Horwitz EM, Jiang NY, Kishan AU. Prostate-specific antigen kinetics and biochemical control following stereotactic body radiation therapy, high dose rate brachytherapy, and low dose rate brachytherapy: A multi-institutional analysis of 3502 patients. Radiother Oncol 2020; 151:26-32. [PMID: 32663537 DOI: 10.1016/j.radonc.2020.07.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/02/2020] [Accepted: 07/06/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND PURPOSE Stereotactic body radiation therapy (SBRT), low dose rate brachytherapy (LDR-BT) and high dose rate brachytherapy (HDR-BT) are ablative-intent radiotherapy options for prostate cancer (PCa). These vary considerably in dose delivery, which may impact post-treatment prostate-specific antigen (PSA) patterns and biochemical control. We compared PSA kinetics between SBRT, HDR-BT, and LDR-BT, and assessed their relationships to biochemical recurrence-free survival (BCRFS). METHODS AND MATERIALS Retrospective PSA data were analyzed for 3502 men with low-risk (n = 2223; 63.5%), favorable intermediate-risk (n = 869; 24.8%), and unfavorable intermediate-risk (n = 410; 11.7%) PCa treated with SBRT (n = 1716; 49.0%), HDR-BT (n = 512; 14.6%), or LDR-BT (n = 1274; 36.4%) without upfront androgen deprivation therapy at 10 institutions from 1990 to 2017. We compared nadir PSA (nPSA), time to nPSA, achievement of nPSA <0.2 ng/mL and <0.5 ng/mL, rates of nPSA <0.4 ng/mL at 4 years, and BCRFS. RESULTS Median follow-up was 72 months. Median nPSA and nPSA <0.2 ng/mL were stratified by risk group (interaction p ≤ 0.001). Median nPSA and time to nPSA were 0.2 ng/mL at 44 months after SBRT, 0.1-0.2 ng/mL at 37 months after HDR-BT, and 0.01-0.2 ng/mL at 51 months after LDR-BT (mean log nPSA p ≤ 0.009 for LDR-BT vs. SBRT or HDR-BT for low/favorable intermediate-risk). There were no differences in nPSA <0.4 ng/mL at 4 years (p ≥ 0.51). BCRFS was similar for all three modalities (p ≥ 0.27). Continued PSA decay beyond 4 years was predictive of durable biochemical control. CONCLUSION LDR-BT led to lower nPSAs with longer continued decay compared to SBRT and HDR-BT, but no differences in BCRFS.
Collapse
Affiliation(s)
- Rebecca Levin-Epstein
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, United States
| | - Ryan R Cook
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, United States
| | - J Karen Wong
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, United States
| | - Richard G Stock
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, United States
| | - D Jeffrey Demanes
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, United States; California Endocurietherapy Cancer Center, Oakland, United States
| | - Sean P Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, United States
| | - Nima Aghdam
- Department of Radiation Medicine, Georgetown University Hospital, Washington, United States
| | - Simeng Suy
- Department of Radiation Medicine, Georgetown University Hospital, Washington, United States
| | | | - Alan J Katz
- FROS Radiation Oncology and Cyberknife Center, Flushing, United States
| | - Nicholas G Nickols
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, United States; Department of Radiation Oncology, West Los Angeles Veterans Health Administration, Los Angeles, United States
| | - Leszek Miszczyk
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Aleksandra Napieralska
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Agnieszka Namysl-Kaletka
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Nicholas D Prionas
- Department of Radiation Oncology, Stanford University Medical Center, Stanford, United States
| | - Hilary Bagshaw
- Department of Radiation Oncology, Stanford University Medical Center, Stanford, United States
| | - Mark K Buyyounouski
- Department of Radiation Oncology, Stanford University Medical Center, Stanford, United States
| | - Minsong Cao
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, United States
| | - Brandon A Mahal
- Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, United States
| | - David Shabsovich
- David Geffen School of Medicine, University of California, Los Angeles, United States
| | - Audrey Dang
- Department of Radiation Oncology, Tulane Medical Center, New Orleans, United States
| | - Ye Yuan
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, United States
| | - Matthew B Rettig
- Department of Medical Oncology, University of California Los Angeles, Los Angeles, United States; Department of Medical Oncology, West Los Angeles Veterans Health Administration, Los Angeles, United States
| | - Albert J Chang
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, United States
| | - William C Jackson
- Department of Radiation Oncology, University of Michigan, Ann Arbor, United States
| | - Daniel E Spratt
- Department of Radiation Oncology, University of Michigan, Ann Arbor, United States
| | - Eric J Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, United States
| | - Patrick A Kupelian
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, United States
| | - Michael L Steinberg
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, United States
| | - Eric M Horwitz
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, United States
| | - Naomi Y Jiang
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, United States
| | - Amar U Kishan
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, United States.
| |
Collapse
|
12
|
Wong JK, Handorf E, Lee D, Jain R, Zhang E, Cooper HS, Farma JM, Dotan E, Meyer JE. Toxicity and outcomes in older versus younger patients treated with trimodality therapy for locally advanced rectal cancer. J Geriatr Oncol 2020; 11:1331-1334. [PMID: 32381438 DOI: 10.1016/j.jgo.2020.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/18/2020] [Accepted: 04/15/2020] [Indexed: 01/04/2023]
Affiliation(s)
- J Karen Wong
- Departments of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, United States of America
| | - Elizabeth Handorf
- Biostatistics, Fox Chase Cancer Center, Philadelphia, PA, United States of America
| | - Douglas Lee
- Departments of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, United States of America
| | - Rishi Jain
- Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, United States of America
| | - Eddie Zhang
- Departments of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, United States of America
| | - Harry S Cooper
- Pathology, Fox Chase Cancer Center, Philadelphia, PA, United States of America
| | - Jeffrey M Farma
- Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, United States of America
| | - Efrat Dotan
- Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, United States of America
| | - Joshua E Meyer
- Departments of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, United States of America.
| |
Collapse
|
13
|
Pai Panandiker AS, Wong JK, Nedelka MA, Wu S, Gajjar A, Broniscer A. Effect of time from diagnosis to start of radiotherapy on children with diffuse intrinsic pontine glioma. Pediatr Blood Cancer 2014; 61:1180-3. [PMID: 24482196 PMCID: PMC4378861 DOI: 10.1002/pbc.24971] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 01/07/2014] [Indexed: 01/16/2023]
Abstract
BACKGROUND Children with diffuse intrinsic pontine glioma (DIPG) continue to have poor outcomes, and radiotherapy (RT) is the only temporarily effective treatment. In this retrospective analysis, we studied the effect of time from diagnosis to start of RT on event-free survival (EFS) and overall survival (OS) in children with DIPG. METHODS Records of children (n = 95) with DIPG treated with RT at a single institution between April 1999 and September 2009 were analyzed. RT was delivered at doses of 54.0-55.8 Gy at 1.8 Gy per fraction, and children were followed prospectively. The effect of gender, race, interruption during treatment course, age at diagnosis, duration of symptoms prior to diagnosis, use of protocol-based chemotherapy, and time from diagnosis to initiation of RT on EFS and OS was assessed by the Cox proportional hazards model. RESULTS Time as a continuous variable from diagnosis to start of RT did not affect outcome. Time dichotomized to ≤14 days significantly affected OS (hazard ratio [HR] = 1.70, P = 0.014) and race other than white or black affected EFS (HR = 2.32, P = 0.017). The 95 patients had a 6-month EFS and OS of 60 ± 5% and 94.7 ± 2.3%, respectively, and a 12-month EFS and OS of 11.6 ± 3.1% and 49.5 ± 5%, respectively. CONCLUSIONS Time as a continuous variable did not affect OS or EFS in our cohort; however, children treated within 2 weeks of diagnosis had poor outcomes. Although rapid initiation of RT is desirable, our findings do not support intensive efforts aimed at shortening delays from diagnosis to start of RT.
Collapse
Affiliation(s)
- Atmaram S. Pai Panandiker
- Department of Radiological Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee,Corresponding author: Atmaram S. Pai Panandiker, MD, Department of Radiological Sciences, Mail Stop 220, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105-3678, Phone: 901-595-3226; Fax: 901-595-3113;
| | - J. Karen Wong
- Department of Radiological Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Michele A. Nedelka
- Department of Radiological Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Shengjie Wu
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Amar Gajjar
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Alberto Broniscer
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| |
Collapse
|
14
|
Bosworth LA, Alam N, Wong JK, Downes S. Investigation of 2D and 3D electrospun scaffolds intended for tendon repair. J Mater Sci Mater Med 2013; 24:1605-1614. [PMID: 23504088 DOI: 10.1007/s10856-013-4911-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 03/08/2013] [Indexed: 06/01/2023]
Abstract
Two-dimensional (2D) electrospun fibre mats have been investigated as fibrous sheets intended as biomaterials scaffolds for tissue repair. It is recognised that tissues are three-dimensional (3D) structures and that optimisation of the fabrication process should include both 2D and 3D scaffolds. Understanding the relative merits of the architecture of 2D and 3D scaffolds for tendon repair is required. This study investigated three different electrospun scaffolds based on poly(ε-caprolactone) fibres intended for repair of injured tendons, referred to as; 2D random sheet, 2D aligned sheet and 3D bundles. 2D aligned fibres and 3D bundles mimicked the parallel arrangement of collagen fibres in natural tendon and 3D bundles further replicated the tertiary layer of a tendon's hierarchical configuration. 3D bundles demonstrated greatest tensile properties, being significantly stronger and stiffer than 2D aligned and 2D random fibres. All scaffolds supported adhesion and proliferation of tendon fibroblasts. Furthermore, 2D aligned sheets and 3D bundles allowed guidance of the cells into a parallel, longitudinal arrangement, which is similar to tendon cells in the native tissue. With their superior physical properties and ability to better replicate tendon tissue, the 3D electrospun scaffolds warrant greater investigation as synthetic grafts in tendon repair.
Collapse
Affiliation(s)
- L A Bosworth
- School of Materials, Materials Science Centre, The University of Manchester, Grosvenor Street, Manchester M1 7HS, UK.
| | | | | | | |
Collapse
|
15
|
Devine DV, Sher GD, Reesink HW, Panzer S, Hetzel PAS, Wong JK, Horvath M, Leitner GC, Schennach H, Nussbaumer W, Genoe K, Cioffi JM, Givisiez FN, Rogerson M, Howe D, Delage G, Sarappa C, Fu Y, Sarlija D, Vuk T, Strauss Patko M, Balija M, Jukić I, Ali A, Auvinen MK, Jaakonsalo E, Cazenave JP, Waller C, Kientz D, David B, Walther-Wenke G, Heiden M, Lin CK, Tsoi WC, Lee CK, Barotine-Toth K, Sawant RB, Murphy W, Quirke B, Bowler P, Shinar E, Yahalom V, Aprili G, Piccoli P, Gandini G, Tadokaro K, Nadarajan VS, de Kort W, Jansen N, Flanagan P, Forsberg PO, Hervig T, Letowska M, Lachert E, Dudziak K, Antoniewicz-Papis J, de Olim G, Nascimento F, Hindawi S, Teo D, Reddy R, Scholtz J, Swanevelder R, Rovira LP, Sauleda S, Carasa MAV, Vaquero MP, Ania MA, Gulliksson H, Holdsworth S, Cotton S, Howell C, Baldwin C, Cusick RM, Geele GA, Paden C, McEvoy P, Gottschall JL, McLaughlin LS, Benjamin RJ, Eder A, Draper NL, AuBuchon JP, León de González G. Inventory management. Vox Sang 2010; 98:e295-363. [PMID: 20432515 DOI: 10.1111/j.1423-0410.2009.01252.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A critical aspect of blood transfusion is the timely provision of high quality blood products. This task remains a significant challenge for many blood services and blood systems reflecting the difficulty of balancing the recruitment of sufficient donors, the optimal utilization of the donor's gift, the increasing safety related restrictions on blood donation, a growing menu of specialized blood products and an ever-growing imperative to increase the efficiency of blood product provision from a cost perspective. As our industry now faces questions about our standard practices including whether or not the age of blood has a negative impact on recipients, it is timely to take a look at our collective inventory management practices. This International Forum represents an effort to get a snap shot of inventory management practices around the world, and to understand the range of different products provided for patients. In addition to sharing current inventory management practices, this Forum is intended to foster an exchange of ideas around where we see our field moving with respect to various issues including specialty products, new technologies, and reducing recipient risk from blood transfusion products.
Collapse
|
16
|
Kosakovsky Pond SL, Poon AFY, Zárate S, Smith DM, Little SJ, Pillai SK, Ellis RJ, Wong JK, Leigh Brown AJ, Richman DD, Frost SDW. Estimating selection pressures on HIV-1 using phylogenetic likelihood models. Stat Med 2008; 27:4779-89. [PMID: 18381707 PMCID: PMC2634745 DOI: 10.1002/sim.3192] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Human immunodeficiency virus (HIV-1) can rapidly evolve due to selection pressures exerted by HIV-specific immune responses, antiviral agents, and to allow the virus to establish infection in different compartments in the body. Statistical models applied to HIV-1 sequence data can help to elucidate the nature of these selection pressures through comparisons of non-synonymous (or amino acid changing) and synonymous (or amino acid preserving) substitution rates. These models also need to take into account the non-independence of sequences due to their shared evolutionary history. We review how we have developed these methods and have applied them to characterize the evolution of HIV-1 in vivo. To illustrate our methods, we present an analysis of compartment-specific evolution of HIV-1 env in blood and cerebrospinal fluid and of site-to-site variation in the gag gene of subtype C HIV-1.
Collapse
|
17
|
Strain MC, Letendre S, Pillai SK, Russell T, Ignacio CC, Günthard HF, Good B, Smith DM, Wolinsky SM, Furtado M, Marquie-Beck J, Durelle J, Grant I, Richman DD, Marcotte T, McCutchan JA, Ellis RJ, Wong JK. Genetic composition of human immunodeficiency virus type 1 in cerebrospinal fluid and blood without treatment and during failing antiretroviral therapy. J Virol 2005; 79:1772-88. [PMID: 15650202 PMCID: PMC544082 DOI: 10.1128/jvi.79.3.1772-1788.2005] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Human immunodeficiency virus (HIV) infection of the central nervous system (CNS) is a significant cause of morbidity. The requirements for HIV adaptation to the CNS for neuropathogenesis and the value of CSF virus as a surrogate for virus activity in brain parenchyma are not well established. We studied 18 HIV-infected subjects, most with advanced immunodeficiency and some neurocognitive impairment but none with evidence of opportunistic infection or malignancy of the CNS. Clonal sequences of C2-V3 env and population sequences of pol from HIV RNA in cerebrospinal fluid (CSF) and plasma were correlated with clinical and virologic variables. Most (14 of 18) subjects had partitioning of C2-V3 sequences according to compartment, and 9 of 13 subjects with drug resistance exhibited discordant resistance patterns between the two compartments. Regression analyses identified three to seven positions in C2-V3 that discriminated CSF from plasma HIV. The presence of compartmental differences at one or more of the identified positions in C2-V3 was highly associated with the presence of discordant resistance (P = 0.007), reflecting the autonomous replication of HIV and the independent evolution of drug resistance in the CNS. Discordance of resistance was associated with severity of neurocognitive deficits (P = 0.07), while low nadir CD4 counts were linked both to the severity of neurocognitive deficits and to discordant resistance patterns (P = 0.05 and 0.09, respectively). These observations support the study of CSF HIV as an accessible surrogate for HIV virions in the brain, confirm the high frequency of discordant resistance in subjects with advanced disease in the absence of opportunistic infection or malignancy of the CNS, and begin to identify genetic patterns in HIV env associated with adaptation to the CNS.
Collapse
Affiliation(s)
- M C Strain
- University of California, San Diego, La Jolla, CA, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Strain MC, Günthard HF, Havlir DV, Ignacio CC, Smith DM, Leigh-Brown AJ, Macaranas TR, Lam RY, Daly OA, Fischer M, Opravil M, Levine H, Bacheler L, Spina CA, Richman DD, Wong JK. Heterogeneous clearance rates of long-lived lymphocytes infected with HIV: intrinsic stability predicts lifelong persistence. Proc Natl Acad Sci U S A 2003; 100:4819-24. [PMID: 12684537 PMCID: PMC153639 DOI: 10.1073/pnas.0736332100] [Citation(s) in RCA: 206] [Impact Index Per Article: 9.8] [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: 10/27/2002] [Indexed: 12/11/2022] Open
Abstract
Viral replication and latently infected cellular reservoirs persist in HIV-infected patients achieving undetectable plasma virus levels with potent antiretroviral therapy. We exploited a predictable drug resistance mutation in the HIV reverse transcriptase to label and track cells infected during defined intervals of treatment and to identify cells replenished by ongoing replication. Decay rates of subsets of latently HIV-infected cells paradoxically decreased with time since establishment, reflecting heterogeneous lymphocyte activation and clearance. Residual low-level replication can replenish cellular reservoirs; however, it does not account for prolonged clearance rates in patients without detectable viremia. In patients receiving potent antiretroviral therapy, the latent pool has a heterogeneous and dynamic composition that comprises a progressively increasing proportion of stable lymphocytes. Eradication will not be achieved with complete inhibition of viral replication alone.
Collapse
Affiliation(s)
- M C Strain
- Department of Medicine and Pathology, University of California at San Diego, La Jolla, CA 90293, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Abstract
Although viral propagation is a localized process, mathematical models of viral replication kinetics have been limited to systems of ordinary differential equations describing spatially averaged behavior. In this paper, we introduce a cellular automaton model of viral propagation based on the known biophysical properties of HIV. In particular, we include the competition between viral lability and Brownian motion. The model predicts three testable effects not present in previous descriptions. First, we find a profound dependence of viral infectivity on cell concentration; virion instability decreases infectivity more than 100-fold under typical experimental conditions, resulting in misleading estimates of the number of infectious particles. Second, we find that, in a large parameter regime, infection extinguishes itself due to insufficient target cell replenishment. Finally, we find that propagation is limited by viral stability at low cell density and by geometry at high cell density. The geometry-limited regime can be modulated by downregulation of CD4. These different properties are analysed quantitatively and compared with previous experimental results.
Collapse
Affiliation(s)
- M C Strain
- Physics Department, University of California San Diego, 9500 Gilman Drive UH 220, La Jolla, CA 92093-0319, USA.
| | | | | | | |
Collapse
|
20
|
Abstract
OBJECTIVE Tunneled hemodialysis catheters are often placed by the interventional radiology service using sonographic guidance and fluoroscopy for safe and optimal placement. The aim of this study was to determine the causes of early failure (<or=7 days) of these catheters in our practice. SUBJECTS AND METHODS Data were prospectively collected for 639 radiologically placed tunneled hemodialysis catheters. The reason for catheter removal was recorded in each case. Tips of removed catheters were routinely sent for microbial culture. RESULTS Fifty-two (8.1%) of 639 catheters were removed within 7 days of insertion. Six (0.9%) of these had completed their purpose and had not failed; these were not included in the study. Of the 46 catheters having early failure, six (0.9%) were clotted and 12 (1.9%) were suspected of being infected, only three of which had a proven catheter-related infection. Twenty-eight catheters (4.4%) were removed for other reasons. In this group, the most common reasons were poor tip position (n = 9) and catheter replacement over a guidewire into a preexisting fibrin sheath (n = 8). Only two failed because of poor tip orientation. Other reasons for failure were kinked or pinched catheters (n = 4) and bleeding (n = 3), including one exsanguination, and two unknown reasons. CONCLUSION By paying careful attention to catheter tip position, searching diligently for the presence of a fibrin sheath when catheter exchanges are made over a wire, and better investigating presumed catheter infection, we could reduce the early failure rate by more than half, from 46 cases to 20 cases (nine cases of suspected infection were in fact not infected).
Collapse
Affiliation(s)
- J K Wong
- Department of Diagnostic Imaging, Foothills Medical Centre, 1403 29th St., N.W., Calgary, Alberta T2N 2T9, Canada
| | | | | | | | | | | |
Collapse
|
21
|
Wong JK, Kennedy PR, Belcher SM. Simplified serum- and steroid-free culture conditions for high-throughput viability analysis of primary cultures of cerebellar granule neurons. J Neurosci Methods 2001; 110:45-55. [PMID: 11564524 DOI: 10.1016/s0165-0270(01)00419-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A serum- and steroid-free primary culture system was developed for the maintenance and automated analysis of cerebellar granule cell viability. Conventional poly-lysine coated 96-well tissue culture plates serve as a platform for growth, experimental manipulation and subsequent automated analysis of these primary cultured neurons. Cerebellar granule neurons were seeded at densities ranging from 2 x 10(4) to 1.25 x 10(6) cells/cm(2) and maintained in serum- and steroid-free culture conditions for 7 days. Viability was subsequently determined by the reduction of [3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium (MTS), and the degree of cell death occurring over that period was determined by the release of lactate dehydrogenase (LDH). At appropriate cell densities, the results of the MTS reduction and LDH release assays were directly proportional to the initial number of cerebellar granule cells plated. Those results indicate that an initial cell density of 0.5 - 1.0 x 10(5) cells per well (0.32 cm(2)) was appropriate for simultaneous analysis with the MTS reduction and LDH release assays. Both assays were then used to demonstrate the utility of this model system for analysis of tert-butyl-hydroperoxide and hydrogen peroxide induced oxidative stress. Additionally, the MTS reduction assay was used to demonstrate that the NMDA-receptor selective antagonist MK-801 was neuroprotective against glutamate-mediated excitotoxicity. This study defines a powerful and flexible primary culture system for cerebellar neurons that is useful for high-throughput analysis of factors that influence neuronal viability.
Collapse
Affiliation(s)
- J K Wong
- Department of Pharmacology and Toxicology, University of Arkansas for Medical Sciences, Mail Slot 611, 4301 West Markham Street, Little Rock, AR 72205, USA
| | | | | |
Collapse
|
22
|
Havlir DV, Bassett R, Levitan D, Gilbert P, Tebas P, Collier AC, Hirsch MS, Ignacio C, Condra J, Günthard HF, Richman DD, Wong JK. Prevalence and predictive value of intermittent viremia with combination hiv therapy. JAMA 2001; 286:171-9. [PMID: 11448280 DOI: 10.1001/jama.286.2.171] [Citation(s) in RCA: 267] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT In HIV-infected patients having virologic suppression (plasma HIV RNA <50 copies/mL) with antiretroviral therapy, intermittent episodes of low-level viremia have been correlated with slower decay rates of latently infected cells and increased levels of viral evolution, but the clinical significance of these episodes is unknown. OBJECTIVE To determine if HIV-infected patients with intermittent viremia have a higher risk of virologic failure (confirmed HIV RNA >200 copies/mL). DESIGN AND SETTING Retrospective analysis of subjects in well-characterized cohorts, the AIDS Clinical Trials Group (ACTG) 343 trial of induction-maintenance therapy (August 1997 to November 1998) and the Merck 035 trial (ongoing since March 1995). PATIENTS Two hundred forty-one ACTG 343 patients, of whom 101 received triple-drug therapy throughout the study, and a small group of 13 patients from Merck 035 having virologic suppression after 6 months of indinavir-zidovudine-lamivudine. MAIN OUTCOME MEASURES Association of intermittent viremia (plasma HIV RNA >50 copies/mL with a subsequent measure <50 copies/mL) with virologic failure (2 consecutive plasma HIV RNA measures >200 copies/mL) in both study groups; evidence of drug resistance in 7 patients from the small (n = 13) study group with long-term follow-up. RESULTS Intermittent viremia occurred in 96 (40%) of the 241 ACTG 343 patients of whom 32 (13%) had 2 consecutive HIV RNA values >50 copies/mL during the median 84 weeks of observation (median duration of observation after first intermittent viremia episode was 46 weeks). Of the 101 individuals receiving triple-drug therapy throughout, 29% had intermittent viremia; the proportion of episodes occurring during the maintenance period was 64% for the entire cohort and 68% for the group not receiving triple-drug therapy throughout vs 55% for those who did (P =.25). Intermittent viremia did not predict virologic failure: 10 (10.4%) of 96 patients with and 20 (13.8%) of 145 patients without intermittent viremia had virologic failure (relative risk, 0.76; 95% confidence interval [CI], 0.29-1.72). In a Cox proportional hazards model, the risk for virologic failure was not significantly greater in the ACTG 343 patients with intermittent viremia (hazard ratio, 1.28; 95% CI, 0.59-2.79). Median viral load in 10 ACTG 343 patients assessed between 24 and 60 weeks of therapy using an ultrasensitive 2.5-copies/mL detection level assay was 23 copies/mL in those with intermittent viremia vs <2.5 copies/mL in those without (P =.15). Intermittent viremia occurred in 6 of 13 patients from the small study group assessed after 76 to 260 weeks of therapy (using the 2.5-copies/mL detection level assay) and was associated with a higher steady state of viral replication (P =.03), but not virologic failure over 4.5 years of observation. Viral DNA sequences from 7 patients did not show evolution of drug resistance. CONCLUSIONS Intermittent viremia occurred frequently and was associated with higher levels of replication (Merck 035), but was not associated with virologic failure in patients receiving initial combination therapy of indinavir-zidovudine-lamivudine (ACTG 343 and Merck 035). In this population, treatment changes may not be necessary to maintain long-term virologic suppression with low-level or intermittent viremia.
Collapse
Affiliation(s)
- D V Havlir
- University of California, San Diego, 150 W Washington, Suite 100, San Diego, CA 92103, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Wong JK. Adjuncts to local anesthesia: separating fact from fiction. J Can Dent Assoc 2001; 67:391-7. [PMID: 11468097] [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: 02/20/2023]
Abstract
Adjunctive local anesthetic techniques and their armamentaria, such as intraosseous injection, computer-controlled delivery systems, periodontal ligament injection and needleless jet injection, have been proposed to hold particular advantages over conventional means of achieving local anesthesia. This article describes the use of each technique and proprietary armamentarium and reviews the literature appraising their use.
Collapse
Affiliation(s)
- J K Wong
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
24
|
Gatti FG, Leigh DA, Nepogodiev SA, Slawin AM, Teat SJ, Wong JK. Stiff, and sticky in the right places: the dramatic influence of preorganizing guest binding sites on the hydrogen bond-directed assembly of rotaxanes. J Am Chem Soc 2001; 123:5983-9. [PMID: 11414832 DOI: 10.1021/ja001697r] [Citation(s) in RCA: 161] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Structural rigidity and the preorganization of thread binding sites are shown to have a major influence on template efficiency in the synthesis of hydrogen bond-assembled rotaxanes. Preorganization is so effective, in fact, that with good hydrogen bond acceptors (amides) a "world record" yield of 97% for a [2]rotaxane is obtained. The truly remarkable feature of this efficient template, however, is that it allows even poor hydrogen bond acceptors (esters) to be used to prepare hydrogen bond-assembled rotaxanes, despite the presence of competing hydrogen bonding groups (anions) which bind the key intermediates at least 10000x more strongly than single, unorganized, ester groups! The structures of the rotaxanes are established unambiguously in solution by (1)H NMR spectroscopy and in the solid state by X-ray crystallography. As a series they provide unique experimental information regarding the nature of amide-ester hydrogen bonding interactions; in particular they suggest that in CDCl(3), amide-ester NH...O=C hydrogen bonds are approximately 1 kcal mol(-)(1) weaker than the corresponding amide-amide interactions.
Collapse
Affiliation(s)
- F G Gatti
- Centre for Supramolecular and Macromolecular Chemistry, Department of Chemistry, University of Warwick, Coventry CV4 7AL, United Kingdom
| | | | | | | | | | | |
Collapse
|
25
|
Frost SD, Günthard HF, Wong JK, Havlir D, Richman DD, Leigh Brown AJ. Evidence for positive selection driving the evolution of HIV-1 env under potent antiviral therapy. Virology 2001; 284:250-8. [PMID: 11384224 DOI: 10.1006/viro.2000.0887] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In HIV-infected individuals treated with potent antiretroviral therapy, viable virus can be isolated from latently infected cells several years into therapy, due to the long life of these cells, ongoing replication replenishing this population, or both. We have analysed the V3 region of the HIV-1 env gene isolated from six patients who have undergone 2 years of potent antiretroviral therapy without frank failure of viral suppression. We show that in two (and possibly three) patients, the sequence changes between baseline virus and virus isolated from infected cells persisting 2 years into infection result from positive selection driving adaptive evolution, occurring either prior to or during therapy. Our analyses suggest low-level replication despite absence of drug resistance due to drug sanctuary sites, or to low-level ongoing replication in the presence of alterations in the selective environment during therapy, perhaps due to a decline in HIV-specific immune responsiveness or changes in target cell pools. In one patient, genetic divergence between baseline plasma and infected cells isolated during therapy may reflect the long half-life of some of these persistent cell populations and the divergence of viral subpopulations that occurred prior to therapy.
Collapse
Affiliation(s)
- S D Frost
- Centre for HIV Research, University of Edinburgh, Scotland.
| | | | | | | | | | | |
Collapse
|
26
|
Günthard HF, Havlir DV, Fiscus S, Zhang ZQ, Eron J, Mellors J, Gulick R, Frost SD, Brown AJ, Schleif W, Valentine F, Jonas L, Meibohm A, Ignacio CC, Isaacs R, Gamagami R, Emini E, Haase A, Richman DD, Wong JK. Residual human immunodeficiency virus (HIV) Type 1 RNA and DNA in lymph nodes and HIV RNA in genital secretions and in cerebrospinal fluid after suppression of viremia for 2 years. J Infect Dis 2001; 183:1318-27. [PMID: 11294662 DOI: 10.1086/319864] [Citation(s) in RCA: 115] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2000] [Revised: 01/31/2001] [Indexed: 11/03/2022] Open
Abstract
Residual viral replication persists in a significant proportion of human immunodeficiency virus (HIV)-infected patients receiving potent antiretroviral therapy. To determine the source of this virus, levels of HIV RNA and DNA from lymphoid tissues and levels of viral RNA in serum, cerebrospinal fluid (CSF), and genital secretions in 28 patients treated for < or =2.5 years with indinavir, zidovudine, and lamivudine were examined. Both HIV RNA and DNA remained detectable in all lymph nodes. In contrast, HIV RNA was not detected in 20 of 23 genital secretions or in any of 13 CSF samples after 2 years of treatment. HIV envelope sequence data from plasma and lymph nodes from 4 patients demonstrated sequence divergence, which suggests varying degrees of residual viral replication in 3 and absence in 1 patient. In patients receiving potent antiretroviral therapy, the greatest virus burden may continue to be in lymphoid tissues rather than in central nervous system or genitourinary compartments.
Collapse
Affiliation(s)
- H F Günthard
- Dept. of Medicine, Div. of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Abstract
UNLABELLED Temporomandibular joint (TMJ) disorders and rheumatoid arthritis are two conditions in which neurogenic mechanisms may play a critical role. We investigated the neurogenic contribution underlying acute TMJ inflammation by evaluating effects of local anesthetic blockade of afferent innervation on the development of mustard oil (MO)-induced edema in the rat TMJ area. Groups of eight adult male Sprague-Dawley rats were anesthetized by intraperitoneal alpha-chloralose and urethane. A saline injection into the right TMJ followed by MO (1% to 60%) 6 min later elicited dose-dependent edema development (P < 0.05, repeated measures analysis of variance). Lidocaine (5%) or bupivacaine (0.5%) followed by MO (1% or 40%) did not produce edema development different from saline controls (P > 0.05, repeated measures analysis of variance). The failure of local anesthetic blockade to prevent MO-induced edema is not consistent with MO acting through a neurogenic mechanism, as traditionally perceived. IMPLICATIONS Inflammation found in temporomandibular disorders and rheumatoid arthritis may result from mediators released by pain-sensing neurons. Local anesthesia failed to block simulated neurogenic temporomandibular inflammation in a rat model, suggesting that functional neuronal input may not be necessary for the promotion of inflammation.
Collapse
Affiliation(s)
- J K Wong
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | | | | |
Collapse
|
28
|
Kitching AR, Ritchie D, Wong JK, May A, Hatfield PJ. Chloramine-induced hemolysis associated with neurological symptoms in a home hemodialysis patient. Clin Nephrol 2001; 55:259-60. [PMID: 11316249] [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: 02/19/2023] Open
|
29
|
Schacker T, Little S, Connick E, Gebhard K, Zhang ZQ, Krieger J, Pryor J, Havlir D, Wong JK, Schooley RT, Richman D, Corey L, Haase AT. Productive infection of T cells in lymphoid tissues during primary and early human immunodeficiency virus infection. J Infect Dis 2001; 183:555-62. [PMID: 11170980 DOI: 10.1086/318524] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2000] [Revised: 10/20/2000] [Indexed: 11/03/2022] Open
Abstract
Current models suggest that during human immunodeficiency virus type 1 (HIV-1) transmission virions are selected that use the CCR5 chemokine receptor on macrophages and/or dendritic cells. A gradual evolution to CXCR4 chemokine receptor use causes a shift in the proportion of productively infected cells to the CD4 cell population. Productively infected cells during acute and early infection in lymphoid tissue were assessed, as well as the impact of productive infection on the T cell population in 21 persons who had biopsies performed on days 2-280 after symptoms of acute HIV-1 seroconversion. Even in the earliest stages of infection, most productively infected cells were T lymphocytes. There were sufficient infected cells in lymphoid tissue (LT) to account for virus production and virus load in plasma. Despite the relatively high frequency of productively infected cells in LT, the impact on the size of the T cell population in LT at this stage was minor.
Collapse
Affiliation(s)
- T Schacker
- Dept. of Medicine/Infectious Diseases, University of Minnesota, Box 250 UMHC, 516 Delaware St. SE, Minneapolis, MN 55455, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Abstract
Estrogen receptors (ER) play a significant role in the development of some regions of the mammalian brain. Recently, ER-beta (ERbeta) mRNA and protein were shown to be expressed in the rat cerebellum. In the present study, the ontogeny of ERbeta protein expression was examined in the rat cerebellum during postnatal development. Western blot analysis indicated that a single ERbeta-like immunoreactive species of approximately 55 kDa was present in protein lysates prepared from the cerebella of female and male Sprague-Dawley rat pups. Immunocytochemical analysis of cerebellar sections from the midline vermis revealed that during development, the expression of ERbeta varied with age and cell-type, but not sex. In the developing cerebellum, highest levels of ERbeta-immunoreactivity (IR) were detected in neurons during neurite growth, and in some glia during migration. Throughout the first postnatal week, ERbeta-IR was localized to differentiating granule cells in the external germinal layer and to migrating glia. Differentiating granule cells expressed detectable levels of ERbeta throughout development. In Purkinje cells, ERbeta-IR was first detected on postnatal day 6 (P6), with peak intensities of immunostaining coinciding with the initiation of axonal and dendritic growth that occurs between P7 and P8. Expression of ERbeta-IR remained high during maturation of Purkinje cell dendrites, and then decreased to a lower level maintained in the adult. From the third postnatal week, ERbeta-IR was also detected in the later developing Golgi, stellate, and basket neurons. These results suggest that ERbeta may play a role in growth-related mechanisms during differentiation of cerebellar neurons and glia.
Collapse
Affiliation(s)
- R L Jakab
- Department of Pharmacology and Toxicology, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205, USA
| | | | | |
Collapse
|
31
|
Brown AJ, Precious HM, Whitcomb JM, Wong JK, Quigg M, Huang W, Daar ES, D'Aquila RT, Keiser PH, Connick E, Hellmann NS, Petropoulos CJ, Richman DD, Little SJ. Reduced susceptibility of human immunodeficiency virus type 1 (HIV-1) from patients with primary HIV infection to nonnucleoside reverse transcriptase inhibitors is associated with variation at novel amino acid sites. J Virol 2000; 74:10269-73. [PMID: 11044070 PMCID: PMC110900 DOI: 10.1128/jvi.74.22.10269-10273.2000] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Recently, significant numbers of individuals with primary human immunodeficiency virus (HIV) infection have been found to harbor viral strains with reduced susceptibility to antiretroviral drugs. In one study, HIV from 16% of such antiretroviral-naive individuals was shown to have a susceptibility to nonnucleoside reverse transcriptase (RT) inhibitors (NNRTIs) between 2.5- and 10-fold lower than that of a wild-type control. Mutations in the RT domain that had previously been associated with antiretroviral resistance were not shared by these strains. We have analyzed by logistic regression 46 variable amino acid sites in RT for their effect on susceptibility and have identified two novel sites influencing susceptibility to NNRTIs: amino acids 135 and 283 in RT. Eight different combinations of amino acids at these sites were observed among these patients. These combinations showed a 14-fold range in mean susceptibility to both nevirapine and delavirdine. In vitro mutagenesis of the control strain combined with a phenotypic assay confirmed the significance of amino acid variation at these sites for susceptibility to NNRTIs.
Collapse
Affiliation(s)
- A J Brown
- Centre for HIV Research, Institute of Cell, Animal and Population Biology, University of Edinburgh, Edinburgh, Scotland.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Günthard HF, Wong JK, Spina CA, Ignacio C, Kwok S, Christopherson C, Hwang J, Haubrich R, Havlir D, Richman DD. Effect of influenza vaccination on viral replication and immune response in persons infected with human immunodeficiency virus receiving potent antiretroviral therapy. J Infect Dis 2000; 181:522-31. [PMID: 10669335 DOI: 10.1086/315260] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Nineteen patients infected with human immunodeficiency virus (HIV) with varying levels of viral suppression achieved with antiretroviral therapy were evaluated to determine whether trivalent influenza vaccine activated HIV replication. Humoral immune responses and CD4+ lymphocyte subsets were compared in 5 HIV-uninfected vaccinated subjects. Transient elevations of plasma HIV RNA levels (76-89 copies/mL) appeared within 2 weeks in 3 of 11 patients with <50 copies/mL at baseline. Sustained elevation in HIV plasma RNA was observed in 7 of 8 patients with baseline HIV RNA of >50 copies/mL. HIV DNA decreased in patients with <400 RNA copies/mL at baseline and showed an HIV RNA increase after vaccination (n=8) when compared with 8 patients with <50 copies/mL at baseline who lacked viral response to vaccination. Concurrent decreases in proviral DNA and memory phenotype CD4+ cells in association with increased plasma HIV RNA after vaccination in patients with <400 RNA copies/mL at baseline suggest that in vivo mobilization of the latently infected cell reservoir may occur during potent antiretroviral therapy.
Collapse
Affiliation(s)
- H F Günthard
- Department of Pathology, University of California San Diego, School of Medicine, La Jolla, California, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Precious HM, Günthard HF, Wong JK, D'Aquila RT, Johnson VA, Kuritzkes DR, Richman DD, Leigh Brown AJ. Multiple sites in HIV-1 reverse transcriptase associated with virological response to combination therapy. AIDS 2000; 14:31-6. [PMID: 10714565 DOI: 10.1097/00002030-200001070-00004] [Citation(s) in RCA: 140] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine whether analysis of sequence variation in reverse transcriptase at baseline can explain differences in response to combination antiretroviral therapy. METHODS Amino acid sequences of reverse transcriptase obtained from baseline isolates from 55 patients included in a trial of zidovudine and didanosine versus zidovudine/didanosine/nevirapine (ACTG241) were analysed. Simple and multiple linear regression were used to determine the relationship between numbers and identity of mutations at baseline and virological response after 8 and 48 weeks. RESULTS Numbers of baseline zidovudine resistance mutations were predictive of short-term response (week 8). Amino acid identity at position 215 explained > 20% of the variation in response at week 8, but less at week 48. Multiple regression identified the combinations: 215 + 44 and 41 + 202, each of which explained about 30% of the variation in week 8 response. A model incorporating amino acids 214 + 215 + 60 + 202 + baseline viral load explained > 40% of the variation in response at week 48. Unexpectedly, the mutant combination 601 + 215Y/F responded threefold better than 60V + 215Y/F over 48 weeks. CONCLUSIONS Use of clinical data to analyse virological response to combination therapy has revealed effects of baseline amino acid mutations at sites not previously identified as being important in antiretroviral resistance. Predictors of long-term responses were different from those involved in the short term and may require more complex analysis.
Collapse
Affiliation(s)
- H M Precious
- Centre for HIV Research, University of Edinburgh, Scotland
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Schacker T, Little S, Connick E, Gebhard-Mitchell K, Zhang ZQ, Krieger J, Pryor J, Havlir D, Wong JK, Richman D, Corey L, Haase AT. Rapid accumulation of human immunodeficiency virus (HIV) in lymphatic tissue reservoirs during acute and early HIV infection: implications for timing of antiretroviral therapy. J Infect Dis 2000; 181:354-7. [PMID: 10608788 DOI: 10.1086/315178] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The follicular dendritic cell network (FDC) in lymphoid tissues (LTs) is the major site of human immunodeficiency virus (HIV) storage in presymptomatic and late stages of disease. However, little is known about the rate of virus accumulation during the acute and early stages. In situ hybridization and quantitative image analysis were used to determine the amount of virus bound to the FDC network during the first year of infection. The FDC pool was already >7.0 log10 copies of HIV RNA/g LT in the first year, and 2 patients biopsied within 2-4 days of symptom onset had 7.3 and 8.2 log10 copies of HIV RNA/g LT, respectively. There was no correlation between duration of infection and accumulation of HIV into the FDC network. These data suggest that a large pool of infectious virus is established soon after infection and that initiation of antiretroviral therapy when symptoms of primary HIV infection are recognized is unlikely to prevent substantial accumulation of virus in the FDC network.
Collapse
Affiliation(s)
- T Schacker
- Department of Medicine/Infectious Diseases, University of Minnesota, 216 Delaware St., Minneapolis, MN 55455, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Njoroge FG, Vibulbhan B, Wong JK, White SK, Wong SC, Carruthers NI, Kaminski JJ, Doll RJ, Girijavallabhan V, Ganguly AK. Synthesis of C-11 methyl-substituted benzocycloheptapyridine inhibitors of farnesyl protein transferase. Org Lett 1999; 1:1371-3. [PMID: 10825985 DOI: 10.1021/ol990218u] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
[formula: see text] Synthesis of C-11 methyl-substituted benzocycloheptylpyridine tricyclic compounds has been achieved via two different methods. Methylation of C-11 has been effected by treatment of amine 4 with BuLi followed by Mel quenching. In a similar procedure, introduction of a C-11 substituent with concomitant rearrangement of the exocyclic double bond has been carried out. Potent farnesyl protein transferase inhibitors have been synthesized using the above methodologies.
Collapse
Affiliation(s)
- F G Njoroge
- Schering-Plough Research Institute, Department of Chemistry, Kenilworth, New Jersey 07033, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Günthard HF, Frost SD, Leigh-Brown AJ, Ignacio CC, Kee K, Perelson AS, Spina CA, Havlir DV, Hezareh M, Looney DJ, Richman DD, Wong JK. Evolution of envelope sequences of human immunodeficiency virus type 1 in cellular reservoirs in the setting of potent antiviral therapy. J Virol 1999; 73:9404-12. [PMID: 10516049 PMCID: PMC112975 DOI: 10.1128/jvi.73.11.9404-9412.1999] [Citation(s) in RCA: 158] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/1999] [Accepted: 07/09/1999] [Indexed: 11/20/2022] Open
Abstract
In human immunodeficiency virus (HIV)-infected patients treated with potent antiretroviral therapy, the persistence of latently infected cells may reflect the long decay half-life of this cellular reservoir or ongoing viral replication at low levels with continuous replenishment of the population or both. To address these possibilities, sequences encompassing the C2 and V3 domains of HIV-1 env were analyzed from virus present in baseline plasma and from viral isolates obtained after 2 years of suppressive therapy in six patients. The presence of sequence changes consistent with evolution was demonstrated for three subjects and correlated with less complete suppression of viral replication, as indicated by the rapidity of the initial virus load decline or the intermittent reappearance of even low levels of detectable viremia. Together, these results provide evidence for ongoing replication. In the remaining three patients, virus recovered after 2 years of therapy was either genotypically contemporary with or ancestral to virus present in plasma 2 years before, indicating that virus recovery had indeed resulted from activation of latently infected cells.
Collapse
|
37
|
Wong HC, Wong NY, Wong JK. Moxibustion for breech presentation. JAMA 1999; 282:1329; author reply 1329-30. [PMID: 10527171] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
|
38
|
Brown AJ, Günthard HF, Wong JK, D'Aquila RT, Johnson VA, Kuritzkes DR, Richman DD. Sequence clusters in human immunodeficiency virus type 1 reverse transcriptase are associated with subsequent virological response to antiretroviral therapy. J Infect Dis 1999; 180:1043-9. [PMID: 10479129 DOI: 10.1086/315017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Many amino acid (aa) sites in reverse transcriptase (RT) have been implicated in resistance to nucleoside (NRTI) and nonnucleoside antiretrovirals. Interactions between these in response to combination therapy remain poorly understood. In a trial (ACTG 241) of zidovudine/didanosine (ddI) versus zidovudine/ddI/nevirapine in nucleoside-experienced patients, baseline sequence data from the RT coding region was analyzed from 55 individuals. Sequences were clustered by use of a parsimony method and the virological responses (ratio of baseline viral load to viral load after of therapy) for each cluster were analyzed at week 8 and week 48. Both clusters and genotype at aa 215 were significantly associated with virological response at both time points, whereas viral load showed a stronger association with sequence clusters. Sequence clusters identified one group of patients who never developed high-level resistance to NRTIs despite prior nucleoside exposure and poor suppression of viral replication.
Collapse
Affiliation(s)
- A J Brown
- Centre for HIV Research, University of Edinburgh, Edinburgh EH9 3JN, Scotland.
| | | | | | | | | | | | | |
Collapse
|
39
|
Wong HC, Wong JK, Wong NY. Chinese herbal medicine for irritable bowel syndrome. JAMA 1999; 282:1036-7. [PMID: 10493198] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
|
40
|
Günthard HF, Leigh-Brown AJ, D'Aquila RT, Johnson VA, Kuritzkes DR, Richman DD, Wong JK, D'aquila RT. Higher selection pressure from antiretroviral drugs in vivo results in increased evolutionary distance in HIV-1 pol. Virology 1999; 259:154-65. [PMID: 10364500 DOI: 10.1006/viro.1999.9774] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We investigated the effect of selection pressures on evolution of HIV-1 pol in 51 patients after switching to a new antiretroviral combination reverse transcriptase (RT) inhibitor therapy. Evolution of the protease (PR) and RT reading frames were analysed separately. Pairwise evolutionary distances (ED) were calculated between sequences from baseline and week 8 and between baseline and week 48 of protocol therapy. ED were calculated for all substitutions and for synonymous and nonsynonymous substitutions separately. At week 8 when HIV RNA reduction (selection pressure) was high, significantly more divergence in pol in both synonymous and nonsynonymous substitutions was found in patients with substantial RNA reduction (strong responders). Separate analyses of PR and RT revealed significantly greater ED in the RT (under selection pressure) of strong compared with nonresponders, whereas divergence between PR genes (not under selection pressure) did not differ in those two groups. Such differential evolution indicates that PR and RT were genetically unlinked and suggests recombination. The rapid increase of ED over the first 8 weeks was followed by only a minimal further rise by week 48, suggesting that selection of preexisting quasispecies accounted for the early changes. A disproportionally high number of synonymous substitutions accounted for the observed divergence and indicated that such genetic changes may not be completely silent.
Collapse
Affiliation(s)
- H F Günthard
- Department of Pathology, University of California, San Diego, USA.
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Wong JK, Blenkinsop B, Sweet J, Wood RE. A comparison of bitemark injuries between fatal wolf and domestic dog attacks. J Forensic Odontostomatol 1999; 17:10-5. [PMID: 10709557] [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: 02/15/2023]
Abstract
Bitemark patterns in adult human victims following a fatal wolf pack attack and a domestic dog pack attack are compared. Both victims exhibited a concentration of wounds to the extremities, left and right torso, but not to the groin or internal organs. The neck and face of the domestic dog attack victim were primary sites of attack while the feral wolf pack victim was spared damage to the neck, but had facial tissue destroyed postmortem. Most punctures were found on the ventral aspect of the domestic victim and dorsal aspect of the feral victim. It is speculated that most wounds were attributable to dominant animals of both packs and in both victims and this suggests a co-ordination of activity between. Differences in bitemark patterns may well have been caused in part by differences in genetics, training, breeding, socialization and impetus of attack between wolves and dogs. Distinct differences in bitemark patterns were found in these two human victims of a wolf and domestic dog attacks.
Collapse
Affiliation(s)
- J K Wong
- Office of the Chief Coroner, Province of Ontario, Toronto, Canada
| | | | | | | |
Collapse
|
42
|
Wong JK, Tongier WK, Armbruster SC, White PF. Use of the intubating laryngeal mask airway to facilitate awake orotracheal intubation in patients with cervical spine disorders. J Clin Anesth 1999; 11:346-8. [PMID: 10470641 DOI: 10.1016/s0952-8180(99)00052-5] [Citation(s) in RCA: 28] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Airway management in patients with unstable cervical spines remains a challenge for anesthesia providers. Because neurologic evaluations may be required following tracheal intubation and positioning for the surgical procedure, an awake intubation technique is desirable in this patient population. In this report, we describe the use of an intubating laryngeal mask airway (ILMA) to facilitate awake tracheal intubation in two patients with cervical spine disorders. After topical local analgesia, the ILMA was inserted easily, and a tracheal tube was passed through the glottic opening without complications. Thus, the ILMA may be an acceptable alternative to the fiberoptic bronchoscope for awake tracheal intubation.
Collapse
Affiliation(s)
- J K Wong
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas 75235-9068, USA
| | | | | | | |
Collapse
|
43
|
Abstract
In a review of 49 carotid arteries that had been assessed by ultrasound and angiography, two Doppler criteria were compared for accuracy in grading internal carotid artery (ICA) stenosis. The Seattle criteria for Doppler spectral analysis and the internal-to-common carotid artery peak systolic velocity ratio were of similar accuracy. When used in combination, there was an increase in sensitivity compared with the use of a single criterion. The velocity ratio had a higher sensitivity for detection of high-grade stenosis, but it tended to overestimate the grade of stenosis more than the Seattle criteria. To increase the sensitivity for detection of severe stenosis, the criteria should be used together and the higher grade of stenosis should be taken if there is a mismatch in assessment.
Collapse
Affiliation(s)
- J K Wong
- University of Melbourne, Department of Radiology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | | | | |
Collapse
|
44
|
Zhang ZQ, Schuler T, Cavert W, Notermans DW, Gebhard K, Henry K, Havlir DV, Günthard HF, Wong JK, Little S, Feinberg MB, Polis MA, Schrager LK, Schacker TW, Richman DD, Corey L, Danner SA, Haase AT. Reversibility of the pathological changes in the follicular dendritic cell network with treatment of HIV-1 infection. Proc Natl Acad Sci U S A 1999; 96:5169-72. [PMID: 10220437 PMCID: PMC21835 DOI: 10.1073/pnas.96.9.5169] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Over the course of HIV-1 infection, the lymphoid follicles where the humoral immune response is generated initially increase in size and number and then progressively involute. In advanced disease, the network of the processes of follicular dendritic cells (FDCs) that serve as antigen repositories and anatomical substrate for B and T cells and antigen to interact is destroyed, contributing to the breakdown of the immune system. Because destruction of FDCs is associated with deposition of HIV-1, and much of the virus can be cleared from the network with antiretroviral therapy, we investigated the reversibility of damage. We measured the immunohistochemically stainable FDC compartment by quantitative image analysis, and we documented changes in this compartment at different stages of disease. We show that treatment, initiated even at advanced stages of HIV-1 disease, can slowly reverse pathological changes in the FDC network.
Collapse
Affiliation(s)
- Z Q Zhang
- Department of Microbiology, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Wong JK, Mustard R, Gray RR, Sadler DJ, Sanabria J, Bohnen JM, Schouten BD, Doyle G, Pugash RA. Predicting infection in localized intraabdominal fluid collections: value of pH and pO2 measurements. J Vasc Interv Radiol 1999; 10:421-7. [PMID: 10229469 DOI: 10.1016/s1051-0443(99)70059-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To evaluate the use of pH, pO2, and the subjective opinion of the radiologist compared with bacterial culture in accurate diagnoses of bacterial infection in intraabdominal fluid collections. MATERIALS AND METHODS Prospectively, 79 patients who were suspected of having an intraabdominal fluid collection underwent diagnostic fluid aspiration. The aspirate was cultured and measured for pH and pO2. A pH < or = 7.1 and a PO2 < or = 49 mm Hg were threshold values used to separate infected from sterile fluid collections. RESULTS pH alone had a 92% sensitivity and 79% specificity, whereas PO2 alone had a 51% sensitivity and 79% specificity. pH or pO2 combined yielded a 92% sensitivity and 60% specificity. The radiologist's opinion produced a 83% sensitivity and 92% specificity. pH and the radiologist's opinion combined produced a 78% sensitivity and 96% specificity. pH or the radiologist's opinion combined had a 95% sensitivity and a 63% specificity. CONCLUSION pH is the most sensitive indicator of infection and the radiologist's opinion is the most specific. We recommend proceeding to drainage if the radiologist believes the collection to be infected and performing pH analysis if not. If the pH < or = 7.04, proceed to drainage. If neither of the above criteria are met, drainage could be delayed, pending the results of culture.
Collapse
Affiliation(s)
- J K Wong
- Foothills Hospital, Calgary, Alberta, Canada
| | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Wong HC, Wong JK, Wong NY. Signs of physical abuse or evidence of moxibustion, cupping or coining? CMAJ 1999; 160:785-6. [PMID: 10189420 PMCID: PMC1230155] [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: 02/11/2023] Open
|
47
|
Abstract
Na+-glucose cotransporter (SGLT1) expression and the role of actin in epidermal growth factor (EGF)-induced alterations in glucose transport and brush-border surface area were examined in New Zealand White rabbit jejunal loops. In separate experiments, EGF or EGF concurrent with cytochalasin D, an inhibitor of actin polymerization, was administered to the experimental loop and compared with its vehicle control. SGLT1 expression was measured by Western blot in brush-border membrane vesicles (BBMV) after 5-min and 1-h exposure. Glucose kinetics were determined by a rapid filtration technique, and brush-border surface area was examined by electron microscopy after 1-h exposure. The effect of cytochalasin D alone on BBMV glucose kinetics and brush-border surface area was also assessed. EGF resulted in a significant increase in BBMV SGLT1 expression (P < 0.05), glucose maximal uptake (Vmax; P < 0.001), and absorptive brush-border surface area (P < 0.001). These effects were abolished with concurrent cytochalasin D treatment. Cytochalasin D alone had no effect on glucose transport or brush-border surface area. The findings suggest that EGF acutely upregulates jejunal brush-border surface area and the Vmax for jejunal glucose uptake via the recruitment and insertion of SGLT1 from an internal pool into the brush border by a mechanism that is dependent on actin polymerization.
Collapse
Affiliation(s)
- B M Chung
- Gastrointestinal Research Group, Health Sciences Centre, University of Calgary, Calgary, Alberta, Canada T2N 4N1
| | | | | | | |
Collapse
|
48
|
Piwinski JJ, Wong JK, Green MJ, Kaminski JJ, Colizzo F, Albanese MM, Ganguly AK, Billah MM, Anthes JC, West RE. Dual antagonists of platelet activating factor and histamine. 3. Synthesis, biological activity and conformational implications of substituted N-acyl-bis-arylcycloheptapiperazines. Bioorg Med Chem Lett 1998; 8:3469-74. [PMID: 9934454 DOI: 10.1016/s0960-894x(98)00626-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A series of N-acyl-4-(5,6-dihydro-11H-benzo[5,6]cyclohepta[1,2-b]pyridin- 11-ylidene)piperazines is described that are dual antagonists of PAF and histamine. The structural requirements for activity in this series parallel those of their previously reported piperidinylidene counterparts. Whereas their global minimum energy conformations are different for both series of compounds, computer assisted molecular modeling suggests that a common bioactive conformation is possible.
Collapse
Affiliation(s)
- J J Piwinski
- Department of Chemical Research, Schering-Plough Research Institute, Kenilworth, New Jersey 07033-0539, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Wong JK, Gray RR. Soft tissue case 24: arteriovenous fistula secondary to liver biopsy. Can J Surg 1998; 41:423, 438. [PMID: 9854528 PMCID: PMC3949795] [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: 02/09/2023] Open
Affiliation(s)
- J K Wong
- Department of Diagnostic Imaging, Foothills Hospital, University of Calgary, Alta
| | | |
Collapse
|
50
|
Wong JK, Wood RE, McLean M. Pain preceding recurrent head and neck cancer. J Orofac Pain 1998; 12:52-9. [PMID: 9656899] [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: 02/08/2023]
Abstract
Over a 7-year period, 12 patients experienced recurrence of primary head and neck cancers preceded by severe orofacial pain. Pain began within 6 months following treatment in 10 of 12 patients and was progressive in 11 of 12 patients. Six patients died from recurrence, five within 2 years following onset of pain. No clear indication of malignant disease was evident despite clinical examination, plain radiography, magnetic resonance imaging, and computed tomography. Pain was often mistaken for denture irritation. Frequently, no area of irritation was apparent.
Collapse
Affiliation(s)
- J K Wong
- Department of Dentistry, Ontario Cancer Institute, Princess Margaret Hospital, Toronto, Canada
| | | | | |
Collapse
|