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Higgins JP. Erratum to 'Ten Traits of Great Physicians! And Tips to Help You Improve' [The American Journal of Medicine (2023) Volume 136, Issue 4, Pages 355-359]. Am J Med 2023; 136:608. [PMID: 37055282 DOI: 10.1016/j.amjmed.2023.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Affiliation(s)
- John P Higgins
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Tex.
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Higgins JP. Ten Traits of Great Physicians! And Tips to Help You Improve. Am J Med 2023; 136:355-359. [PMID: 36566894 DOI: 10.1016/j.amjmed.2022.12.011] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
Abstract
There are certain traits that differentiate great doctors from good doctors. This article will discuss some of these traits along with tips you can incorporate to go from good to great. By applying these tips, I hope you will enhance your ability to practice medicine and improve your patients' experience.
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Affiliation(s)
- John P Higgins
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Tex.
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Lascano D, Hsieh K, Kedia B, Higgins JP, Chung BI. Robotic‐assisted laparoscopic removal of dermoid cyst mimicking an enlarged cystic mass in the seminal vesicle. IJU Case Rep 2022; 5:346-349. [PMID: 36090941 PMCID: PMC9436656 DOI: 10.1002/iju5.12477] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/11/2022] [Indexed: 11/09/2022] Open
Abstract
Introduction Isolated seminal vesicle cysts not associated with Zinner syndrome is a rare disorder that can present initially with urinary obstructive symptoms or nonspecific groin pain. Case description We present the uncommon case of a dermoid cyst mimicking a seminal vesicle cyst treated with robotic‐assisted laparoscopic seminal vesiculectomy. Conclusion For dermoid cysts, surgical excision is the gold standard of treatment with a high cure rate and little risk of regrowth if spillage is avoided and full resection is completed. Robotic‐assisted laparoscopic surgery is a viable management option with good visualization of the anatomy.
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Affiliation(s)
- Danny Lascano
- Department of Surgery Westchester Medical Center Valhalla New York USA
| | - Kelly Hsieh
- Department of Urology Stanford University School of Medicine Stanford California USA
| | - Bhuvi Kedia
- Department of Urology Stanford University School of Medicine Stanford California USA
| | - John P Higgins
- Department of Pathology Stanford University School of Medicine Stanford California USA
| | - Benjamin I Chung
- Department of Urology Stanford University School of Medicine Stanford California USA
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Narayan RR, Abadilla N, Yang L, Chen SB, Klinkachorn M, Eddington HS, Trickey AW, Higgins JP, Melcher ML. Artificial intelligence for prediction of donor liver allograft steatosis and early post-transplantation graft failure. HPB (Oxford) 2022; 24:764-771. [PMID: 34815187 DOI: 10.1016/j.hpb.2021.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/29/2021] [Accepted: 10/06/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Donor livers undergo subjective pathologist review of steatosis before transplantation to mitigate the risk for early allograft dysfunction (EAD). We developed an objective, computer vision artificial intelligence (CVAI) platform to score donor liver steatosis and compared its capability for predicting EAD against pathologist steatosis scores. METHODS Two pathologists scored digitized donor liver biopsy slides from 2014 to 2019. We trained four CVAI platforms with 1:99 training:prediction split. Mean intersection-over-union (IU) characterized CVAI model accuracy. We defined EAD using liver function tests within 1 week of transplantation. We calculated separate EAD logistic regression models with CVAI and pathologist steatosis and compared the models' discrimination and internal calibration. RESULTS From 90 liver biopsies, 25,494 images trained CVAI models yielding peak mean IU = 0.80. CVAI steatosis scores were lower than pathologist scores (median 3% vs 20%, P < 0.001). Among 41 transplanted grafts, 46% developed EAD. The median CVAI steatosis score was higher for those with EAD (2.9% vs 1.9%, P = 0.02). CVAI steatosis was independently associated with EAD after adjusting for donor age, donor diabetes, and MELD score (aOR = 1.34, 95%CI = 1.03-1.75, P = 0.03). CONCLUSION The CVAI steatosis EAD model demonstrated slightly better calibration than pathologist steatosis, meriting further investigation into which modality most accurately and reliably predicts post-transplantation outcomes.
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Affiliation(s)
- Raja R Narayan
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Natasha Abadilla
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Linfeng Yang
- Department of Bioengineering, Stanford University School of Engineering, Stanford, CA, USA
| | - Simon B Chen
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Mac Klinkachorn
- Department of Bioengineering, Stanford University School of Engineering, Stanford, CA, USA
| | - Hyrum S Eddington
- Stanford-Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Amber W Trickey
- Stanford-Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - John P Higgins
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Marc L Melcher
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
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Miller P, Xiao AY, Kung VL, Sibley RK, Higgins JP, Kambham N, Charu V, Lenihan C, Uber AM, Talley EM, Arora N, Walavalkar V, Laszik ZG, Nast CC, Troxell ML. Progression of proliferative glomerulonephritis with monoclonal IgG deposits in pediatric patients. Pediatr Nephrol 2021; 36:927-937. [PMID: 33044675 DOI: 10.1007/s00467-020-04763-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/24/2020] [Accepted: 09/07/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) is a glomerular disease defined by non-organized glomerular deposits of heavy and light chain-restricted immunoglobulin and is rarely reported in children. METHODS We characterized a series of nine pediatric patients from two academic centers with biopsy-proven PGNMID and additionally describe two patients with monotypic IgG in the setting of IgM deposition. RESULTS Each patient presented with hematuria and/or proteinuria; however, only five had elevated serum creatinine. Prodromal or concurrent infection was identified in six patients, low C3 in five, and alternate complement pathway gene variants in two. No monoclonal serum proteins were identified in five tested patients. Seven patients had monotypic deposits composed of IgG3-λ, two showed IgG3-κ, and one each IgG1 and IgG3 with lambda dominance in the setting of IgM deposition. The glomerular pattern was predominantly mesangial proliferative or membranoproliferative glomerulonephritis (MPGN). Treatment and outcomes were variable; four patients have recent PGNMID diagnoses and therefore minimal follow up, one had relatively stable kidney function for over a decade, and six experienced kidney failure, with four receiving transplants. Recurrent deposits of the same isotype were identified in five of six transplanted kidneys, corresponding to three of four transplanted patients. One of these patients developed PGNMID recurrences in three separate kidney allografts over a 20-year disease course. CONCLUSIONS Our study emphasizes the need for upfront IgG subclass investigation in pediatric mesangial or MPGN with IgG deposition and monotypic or biased light-chain staining. Furthermore, this pediatric experience suggests expanded pathogenic considerations in PGNMID. Graphical abstract.
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Affiliation(s)
- Paul Miller
- Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, L235, Stanford, CA, 94305, USA
| | - Andrew Y Xiao
- Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, L235, Stanford, CA, 94305, USA.,Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Vanderlene L Kung
- Department of Pathology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Richard K Sibley
- Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, L235, Stanford, CA, 94305, USA
| | - John P Higgins
- Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, L235, Stanford, CA, 94305, USA
| | - Neeraja Kambham
- Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, L235, Stanford, CA, 94305, USA
| | - Vivek Charu
- Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, L235, Stanford, CA, 94305, USA
| | - Colin Lenihan
- Stanford Adult Kidney Transplant Program, Stanford, CA, USA
| | - Amanda M Uber
- Department of Pediatrics (Nephrology), Stanford University School of Medicine, Stanford, CA, USA
| | - Elizabeth M Talley
- Department of Pediatrics (Nephrology), Stanford University School of Medicine, Stanford, CA, USA
| | - Neiha Arora
- Department of Nephrology, The Permanente Medical Group Northern California, Oakland, CA, USA
| | - Vighnesh Walavalkar
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Zoltan G Laszik
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Cynthia C Nast
- Department of Pathology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Megan L Troxell
- Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, L235, Stanford, CA, 94305, USA.
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Higgins JP, Liras GN, Liras IN, Jacob R, Husain F, Pabba KC, Schultea M. Energy Drink Effects on Hemodynamics and Endothelial Function in Young Adults. Cardiology 2020; 146:258-262. [PMID: 33341807 DOI: 10.1159/000512433] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 06/01/2020] [Accepted: 10/20/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Cardiovascular side effects associated with energy drink consumption may be related to effects on vascular endothelial function, heart rate, blood pressure, and electrocardiogram parameters. We sought to measure them following energy drink consumption. METHODS Forty-four healthy non-smoking young volunteer medical students, at an average age of 24.7 years (range 23-27 years, 34 males), with an average BMI of 23.4, received electrocardiograms and had their heart rates and blood pressures taken. Subjects then underwent baseline testing of endothelial function using the technique of endothelium-dependent flow-mediated dilatation (FMD) with high-resolution ultrasound. The subjects then drank an energy drink (24 oz Monster Energy Drink®). Hemodynamic measurements were repeated 15 and 90 min later. FMD and the electrocardiogram were repeated 90 min later. The FMD was calculated as the ratio of the post-cuff release and the baseline diameter. RESULTS Energy drink consumption resulted in a significantly attenuated peak FMD response (mean ± SD): baseline 5.1 ± 4.1% versus post-energy drink (2.8 ± 3.8%; p = 0.004). In addition, systolic and diastolic blood pressures and heart rate increased after 15 min. Diastolic blood pressure and heart rate remained increased 90 min following energy drink consumption. There were no significant changes in electrocardiogram parameters. CONCLUSION Energy drink consumption was associated with an acute significant impairment in endothelial function in young healthy adults as well as with significant hemodynamic changes. As energy drinks are becoming more popular, it is important to study their effects to better determine safe consumption patterns.
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Affiliation(s)
- John P Higgins
- McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth) Houston, TX & Baylor University, Waco, Texas, USA,
| | - George N Liras
- McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth) Houston, TX & Baylor University, Waco, Texas, USA
| | - Ioannis N Liras
- McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth) Houston, TX & Baylor University, Waco, Texas, USA
| | - Robin Jacob
- McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth) Houston, TX & Baylor University, Waco, Texas, USA
| | - Farzan Husain
- McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth) Houston, TX & Baylor University, Waco, Texas, USA
| | - Krishna C Pabba
- McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth) Houston, TX & Baylor University, Waco, Texas, USA
| | - Mikayla Schultea
- McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth) Houston, TX & Baylor University, Waco, Texas, USA
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Vaikunth SS, Higgins JP, Concepcion W, Haeffele C, Wright GE, Chen S, Lui GK, Daugherty T. Does liver biopsy accurately measure fibrosis in Fontan-associated liver disease? A comparison of liver biopsy pre-combined heart and liver transplant and liver explant post-transplant. Clin Transplant 2020; 34:e14120. [PMID: 33053213 DOI: 10.1111/ctr.14120] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 07/24/2020] [Revised: 09/13/2020] [Accepted: 09/30/2020] [Indexed: 01/12/2023]
Abstract
The accuracy of liver biopsy to stage fibrosis due to Fontan-associated liver disease (FALD) remains unclear. We compared the results of biopsy pre-combined heart and liver transplantation (CHLT) to the results of whole liver explant. Liver biopsy and explants from 15 Fontan patients (ages 16-49, median 28 years) were retrospectively reviewed. Staging was as follows: stage 0: no fibrosis, stage 1: pericellular fibrosis, stage 2: bridging fibrosis, and stage 3: regenerative nodules. There is no stage 4. Clinical characteristics including Model of End-stage Liver Disease eXcluding INR and Varices, Ascites, Splenomegaly, and Thrombocytopenia (VAST) scores were collected, and descriptive statistics and Mann-Whitney U tests were used to analyze the data. All patients had biopsies with at least bridging fibrosis, and all had nodularity on explant; transjugular biopsy never overestimated fibrosis. Explant showed higher-grade fibrosis (stage 3) than pre-CHLT biopsy (stage 2) in 6 of 15 patients and equal grade of fibrosis (stage 3) in 9 of 15 patients. Though clinical characteristics varied significantly, VAST score was ≥2 in all but two patients. Transjugular liver biopsy does not overestimate and can underestimate fibrosis in Fontan patients undergoing CHLT, likely due to the patchy nature of fibrosis in FALD.
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Affiliation(s)
- Sumeet S Vaikunth
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - John P Higgins
- Department of Pathology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Waldo Concepcion
- Division of Abdominal Transplantation, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Christiane Haeffele
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Gail E Wright
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Sharon Chen
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - George K Lui
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Tami Daugherty
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
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Sangoi AR, Cox RM, Higgins JP, Quick CM, McKenney JK. Non-invasive papillary urothelial carcinoma with 'micropapillary' architecture: clinicopathological study of 18 patients emphasising clinical outcomes. Histopathology 2020; 77:728-733. [PMID: 32443178 DOI: 10.1111/his.14161] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/17/2020] [Indexed: 11/30/2022]
Abstract
AIMS Invasive micropapillary carcinoma is a recognised aggressive urothelial carcinoma variant. One prior study focusing on non-invasive (pTa) high-grade papillary urothelial carcinoma with micropapillary architecture has been reported. METHODS AND RESULTS We collected bladder transurethral resection specimens showing non-invasive high-grade papillary urothelial carcinoma with non-hierarchical secondary papillae lacking fibrovascular cores (i.e. micropapillary architecture). Cases with any invasive component or any prior history of invasive urothelial carcinoma were excluded. Twenty cases were identified from 16 male and two female patients (aged 55-86 years). Micropapillary architecture comprised from 10 to 95% (mean = 31%), but non-invasive cribriform (15 cases, comprising 5-60%, mean = 19%) and villoglandular patterns (nine cases, comprising 5-60%, mean = 24%) were commonly admixed. Treatment data were available for 16 patients: surveillance (n = 13), cystoprostatectomy (n = 1), BCG plus mitomycin (n = 1) and BCG (n = 1). Follow-up data were available from 16 patients (range = 1-128 months, mean = 50 months): 13 patients had no new occurrences to date (81%), two had stage progression to pT1 papillary urothelial carcinoma (13%) with one dying of other causes, and one died of other causes with no evidence of disease (6%). CONCLUSION Non-invasive urothelial carcinomas with micropapillary architecture are often admixed with non-invasive cribriform and villoglandular patterns. Stage progression to lamina propria invasion in only two of 16 patients (13%) is not higher than expected for otherwise typical pTa high-grade urothelial carcinomas and no progression to invasive micropapillary carcinoma was identified, adding further support to the current World Health Organisation recommendation excluding use of the term 'micropapillary' for pTa urothelial carcinoma.
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Affiliation(s)
| | - Roni M Cox
- Pathology, Cleveland Clinic, Cleveland, OH, USA
| | | | - Charles M Quick
- Pathology, University for Arkansas Medical Sciences, Little Rock, AR, USA
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Abstract
BACKGROUND AND PURPOSE Whiplash-associated disorders frequently develop following motor vehicle collisions and often involve a range of cognitive and affective symptoms, though the neural correlates of the disorder are largely unknown. In this study, a sample of participants with chronic whiplash injuries were scanned by using resting-state fMRI to assess brain network changes associated with long-term outcome metrics. MATERIALS AND METHODS Resting-state fMRI was collected for 23 participants and used to calculate network modularity, a quantitative measure of the functional segregation of brain region communities. This was analyzed for associations with whiplash-associated disorder outcome metrics, including scales of neck disability, traumatic distress, depression, and pain. In addition to these clinical scales, cervical muscle fat infiltration was quantified by using Dixon fat-water imaging, which has shown promise as a biomarker for assessing disorder severity and predicting recovery in chronic whiplash. RESULTS An association was found between brain network structure and muscle fat infiltration, wherein lower network modularity was associated with larger amounts of cervical muscle fat infiltration after controlling for age, sex, body mass index, and scan motion (t = -4.02, partial R 2 = 0.49, P < .001). CONCLUSIONS This work contributes to the existing whiplash literature by examining a sample of participants with whiplash-associated disorder by using resting-state fMRI. Less modular brain networks were found to be associated with greater amounts of cervical muscle fat infiltration suggesting a connection between disorder severity and neurologic changes, and a potential role for neuroimaging in understanding the pathophysiology of chronic whiplash-associated disorders.
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Affiliation(s)
- J P Higgins
- From the Departments of Radiology (J.P.H., T.B.P.)
| | - J M Elliott
- Physical Therapy and Human Movement Sciences (J.M.E.), Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Discipline of Physiotherapy, Faculty of Health Sciences (J.M.E.), The University of Sydney and the Northern Sydney Local Health District; and The Kolling Research Institute, St. Leonards, NSW, Australia
| | - T B Parrish
- From the Departments of Radiology (J.P.H., T.B.P.)
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Chan E, Stohr BA, Croom NA, Cho SJ, Garg K, Troxell ML, Higgins JP, Bean GR. Molecular characterisation of metanephric adenomas beyond BRAF: genetic evidence for potential malignant evolution. Histopathology 2020; 76:1084-1090. [PMID: 32064677 DOI: 10.1111/his.14094] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 01/14/2020] [Revised: 02/07/2020] [Accepted: 02/13/2020] [Indexed: 12/11/2022]
Abstract
AIMS Metanephric adenomas (MAs) are conventionally regarded as rare renal tumours with indolent behaviour; limited case reports have described MAs with aggressive features. Conventional MAs harbour hotspot BRAF V600E mutations. A BRAF V600E senescence pathway, mediated by cyclin-dependent kinase inhibitor 2A (CDKN2A)/p16, has been proposed to confer MA benignity. Aside from BRAF, the molecular landscape in both conventional MAs and those with aggressive features has not been fully characterised. The aim of this study was to molecularly profile a series of MAs to investigate the correlation between genomic findings and clinical outcome. METHODS AND RESULTS We retrospectively examined the histomorphology and patient outcomes of 11 conventional MAs and one MA with aggressive features. Each was subjected to capture-based next-generation DNA sequencing of 479 cancer-related genes and immunohistochemical profiling. All tumours were positive for WT1 immunostaining and BRAF V600E mutation. One conventional MA contained an additional somatic BRCA2 pathogenic mutation. The MA with aggressive features had a biphasic appearance: one component was epithelial, with areas morphologically consistent with conventional MA; the second component was sarcomatous, with areas of solid and angiosarcomatous growth. Differential profiling of the two populations revealed identical BRAF, EIF1AX and TERT promoter hotspot mutations in the epithelial and sarcomatous components. Deep deletion of CDKN2A and MYC amplification were identified only in the sarcomatous component. CONCLUSIONS Although the vast majority of MAs show indolent behaviour, rare pathogenic alterations can occur in conventional MAs in addition to BRAF. Molecular profiling of a case with aggressive clinical and pathological features shows genetic evidence for malignant evolution in MAs.
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Affiliation(s)
- Emily Chan
- Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Bradley A Stohr
- Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Nicole A Croom
- Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Soo-Jin Cho
- Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Karuna Garg
- Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Megan L Troxell
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - John P Higgins
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Gregory R Bean
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
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11
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Narayan R, Abadilla N, Yang L, Chuan Hsu C, Jensen C, Chen SB, Higgins JP, Melcher ML. Quantification of Donor Liver Steatosis Using an Unsupervised Artificial Intelligence Platform. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.1141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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13
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Higgins JP, Yang B, Herrin NE, Yarlagadda S, Le GT, Ortiz BL, Ali A, Infanger SC. Consumption of energy beverage is associated with attenuation of arterial endothelial flow-mediated dilatation. World J Cardiol 2017; 9:162-166. [PMID: 28289530 PMCID: PMC5329743 DOI: 10.4330/wjc.v9.i2.162] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 11/09/2016] [Accepted: 12/09/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate whether consumption of an energy drink will acutely impair endothelial function in young healthy adults.
METHODS Energy drinks are being consumed more and more worldwide, and have been associated with some deaths in adolescents and young adults, especially when consumed while exercising. After fasting and not smoking for at least 8 h prior, eleven medical students (9 males) received an electrocardiogram, blood pressure and pulse check, and underwent baseline testing (BL) of endothelial function using the technique of endothelium-dependent flow mediated dilatation (FMD) with high-resolution ultrasound (according to recommended guidelines of the University of Wisconsin Atherosclerosis Imaging Research Program Core Laboratory). The subjects then drank an energy beverage (EB), a 24-oz can of Monster Energy, and the above was repeated at 90 min after consumption. The relative FMD (%) was calculated as the ratio between the average post-cuff release and the baseline diameter. Each image was checked for quality control, and each artery diameter was measured from the media to media points by two experts, 3 measurements at the QRS complex, repeated on 3 separate beats, and then all were averaged.
RESULTS Subjects characteristics averages (given with standard deviations) include: Age 24.5 ± 1.5 years, sex 9 male and 2 female, weight 71.0 ± 9.1 kg, height 176.4 ± 6.0 cm, BMI 22.8 ± 2.7 kg/m2. The hemodynamics were as follows, BL vs EB group respectively (mean ± SD): Heart rate 65.2 ± 11.3 vs 68.2 ± 11.8 beats per minute, systolic blood pressure 114.0 ± 10.4 mmHg vs 114.1 ± 10.4 mmHg, diastolic blood pressure 68.8 ± 9.3 mmHg vs 70.6 ± 7.1 mmHg; all were not significantly different. However after drinking the EB, a significantly attenuated peak FMD response was measured (mean ± SD): BL group 5.9% ± 4.6% vs EB group 1.9% ± 2.1%; P = 0.03). Given the increased consumption of energy beverages associated with exercise in young adults, more research is needed.
CONCLUSION Energy beverage consumption has a negative impact on arterial endothelial function in young healthy adults.
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Higgins JP. The Reply. Am J Med 2016; 129:e147. [PMID: 27453385 DOI: 10.1016/j.amjmed.2016.01.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 01/26/2016] [Accepted: 01/27/2016] [Indexed: 11/15/2022]
Affiliation(s)
- John P Higgins
- Division of Cardiology, Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
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Abstract
Colon biopsies are often used to determine the presence and severity of acute gastrointestinal graft-versus-host disease following bone marrow transplant.Context.—
To establish a threshold consensus within our institution on the number of crypt apoptotic bodies (CAB) indicative of grade 1 acute colorectal graft-versus-host disease, we retrospectively reviewed colon biopsies from posttransplant patients and incorporated clinical and endoscopic findings to validate recently proposed minimum criteria for grade 1 graft-versus-host disease as 7 or more CAB per 10 contiguous crypts.Objective.—
Eighty-one biopsies performed for suspected graft-versus-host disease from 74 individual patients were initially stratified based on their prior (prestudy) diagnoses: no significant abnormality, grade 1 graft-versus-host disease, and descriptive diagnoses mentioning increased apoptosis. A chart review was performed to assess the clinical and endoscopic impression at the time of biopsy and to determine the subsequent management and outcome.Design.—
Twenty-six biopsies with an average of 3 CAB were considered true-negative cases, and 32 biopsies with an average of 9.75 CAB were considered true-positive cases (t = 3.95999, P < .001). True-negative cases had an average density of 1.36 CAB per crypt, and true-positive cases had an average density of 2.97 CAB per crypt (t = 3.950178, P < .001).Results.—
A threshold of 7 or more CAB per 10 contiguous crypts promotes appropriate treatment of grade 1 acute graft-versus-host disease after other diagnostic entities are excluded. Although this threshold is 100% specific to grade 1 acute colorectal graft-versus-host disease after other histologic mimics are excluded, this threshold has a low sensitivity (59.4%) as patients with less than 7 CAB per 10 contiguous crypts constitute a heterogeneous group.Conclusions.—
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Affiliation(s)
- Adam J. Gomez
- From the Division of Blood & Marrow Transplantation in the Department of Medicine (Dr Arai) and the Department of Pathology (Drs Gomez, Higgins, and Kambham), Stanford University, Stanford, California
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16
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Perumpail RB, Ahmed A, Higgins JP, So SK, Cochran JL, Drobeniuc J, Mixson-Hayden TR, Teo CG. Fatal Accelerated Cirrhosis after Imported HEV Genotype 4 Infection. Emerg Infect Dis 2016; 21:1679-81. [PMID: 26291424 PMCID: PMC4550159 DOI: 10.3201/eid2109.150300] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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17
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Abstract
Exercise, in conjunction with diet, is critical to losing weight and maintaining health in obese patients. While it can be challenging for an obese person to transition to a healthy lifestyle, the physical and emotional benefits of a regular exercise program make it worth the effort.
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Affiliation(s)
- John P Higgins
- Memorial Hermann Sports Medicine Institute, University of Texas Medical School at Houston, Houston, TX, USA.,LBJ General Hospital, Houston, TX, USA. E-mail:
| | - Christopher L Higgins
- School of Human Movement Studies, University of Queensland, St. Lucia, Queensland, Australia
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18
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Perumpail RB, Wong RJ, Pham EA, Higgins JP, Daugherty TJ, Ahmed A. A New Standard of Care? Standard Dose Sofosbuvir in an HCV-Infected Liver Transplant Recipient Undergoing Hemodialysis. Dig Dis Sci 2016; 61:39-41. [PMID: 26082077 DOI: 10.1007/s10620-015-3756-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 06/09/2015] [Indexed: 01/30/2023]
Affiliation(s)
- Ryan B Perumpail
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 750 Welch Road, Suite # 210, Stanford, CA, 94304, USA
| | - Robert J Wong
- Division of Gastroenterology and Hepatology, Alameda Health System, Highland Hospital Campus, Oakland, CA, USA
| | - Edward A Pham
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 750 Welch Road, Suite # 210, Stanford, CA, 94304, USA
| | - John P Higgins
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Tami J Daugherty
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 750 Welch Road, Suite # 210, Stanford, CA, 94304, USA
| | - Aijaz Ahmed
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 750 Welch Road, Suite # 210, Stanford, CA, 94304, USA.
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19
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O’Brown ZK, Van Nostrand EL, Higgins JP, Kim SK. The Inflammatory Transcription Factors NFκB, STAT1 and STAT3 Drive Age-Associated Transcriptional Changes in the Human Kidney. PLoS Genet 2015; 11:e1005734. [PMID: 26678048 PMCID: PMC4682820 DOI: 10.1371/journal.pgen.1005734] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 11/19/2015] [Indexed: 01/17/2023] Open
Abstract
Human kidney function declines with age, accompanied by stereotyped changes in gene expression and histopathology, but the mechanisms underlying these changes are largely unknown. To identify potential regulators of kidney aging, we compared age-associated transcriptional changes in the human kidney with genome-wide maps of transcription factor occupancy from ChIP-seq datasets in human cells. The strongest candidates were the inflammation-associated transcription factors NFκB, STAT1 and STAT3, the activities of which increase with age in epithelial compartments of the renal cortex. Stimulation of renal tubular epithelial cells with the inflammatory cytokines IL-6 (a STAT3 activator), IFNγ (a STAT1 activator), or TNFα (an NFκB activator) recapitulated age-associated gene expression changes. We show that common DNA variants in RELA and NFKB1, the two genes encoding subunits of the NFκB transcription factor, associate with kidney function and chronic kidney disease in gene association studies, providing the first evidence that genetic variation in NFκB contributes to renal aging phenotypes. Our results suggest that NFκB, STAT1 and STAT3 underlie transcriptional changes and chronic inflammation in the aging human kidney. The structure and function of human kidneys deteriorate steadily with age, yet little is known about the underlying causes of kidney aging. In this work, we first used a genomics approach to identify candidate regulators of gene expression changes in the aging human kidney and identified inflammation-related transcription factors NFκB, STAT1 and STAT3 as the top candidate regulators. We found that kidney aging is associated with activation of NFκB, STAT1 and STAT3 in the renal parenchyma, and that the gene expression signatures evoked by activation of these transcription factors in human renal epithelial cells mimics age-associated gene expression changes in the kidney. Furthermore, we identified specific genetic variants in the NFκB transcription factor genes RELA and NFKB1 that associate with renal function and chronic kidney disease in humans, implicating NFκB as a potential contributor to the pathogenesis of chronic kidney disease and renal dysfunction in old age. Our findings suggest that activation of the inflammatory transcription factors STAT1, STAT3 and NFκB underlie transcriptional changes and reduced renal function in the elderly.
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Affiliation(s)
- Zach K. O’Brown
- Department of Developmental Biology, Stanford University, Stanford, California, United States of America
- Department of Genetics, Stanford University, Stanford, California, United States of America
- Cancer Biology Program, Stanford University, Stanford, California, United States of America
- * E-mail:
| | - Eric L. Van Nostrand
- Department of Cellular and Molecular Medicine, University of California, San Diego, La Jolla, California, United States of America
| | - John P. Higgins
- Department of Pathology, Stanford University Medical Center, Stanford, California, United States of America
| | - Stuart K. Kim
- Department of Developmental Biology, Stanford University, Stanford, California, United States of America
- Department of Genetics, Stanford University, Stanford, California, United States of America
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20
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Bordawekar S, Chanda A, Daly AM, Garrett AW, Higgins JP, LaPack MA, Maloney TD, Morgado J, Mukherjee S, Orr JD, Reid GL, Yang BS, Ward HW. Industry Perspectives on Process Analytical Technology: Tools and Applications in API Manufacturing. Org Process Res Dev 2015. [DOI: 10.1021/acs.oprd.5b00088] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Shailendra Bordawekar
- Process
Research and Development, AbbVie Inc., 1 North Waukegan Road, North Chicago, Illinois 60064, United States
| | - Arani Chanda
- Analytical Research Laboratories-US, Pharmaceutical Science & Technology, Eisai Inc., 4 Corporate Drive, Andover, Massachusetts 01810, United States
| | - Adrian M. Daly
- Process
Analytical Sciences Group, Global Technology Services, Pfizer Global Supply, Ringaskiddy, Co. Cork, Ireland
| | - Aaron W. Garrett
- Global
Quality Laboratories, Eli Lilly and Company, Indianapolis, Indiana 46285, United States
| | - John P. Higgins
- Process
Analytical Technology, Merck and Co., Inc., 2000 Galloping Hill Rd, Kenilworth, New Jersey 07033, United States
| | - Mark A. LaPack
- Small Molecule Design & Development, Eli Lilly and Company, Indianapolis, Indiana 46285, United States
| | - Todd D. Maloney
- Small Molecule Design & Development, Eli Lilly and Company, Indianapolis, Indiana 46285, United States
| | - James Morgado
- Analytical
Research and Development, Pfizer Inc., Worldwide Research and Development, 445 Eastern Point Road, Groton, Connecticut 06340, United States
| | - Samrat Mukherjee
- Process
Research and Development, AbbVie Inc., 1 North Waukegan Road, North Chicago, Illinois 60064, United States
| | - John D. Orr
- Analytical Research Laboratories-US, Pharmaceutical Science & Technology, Eisai Inc., 4 Corporate Drive, Andover, Massachusetts 01810, United States
| | - George L. Reid
- Cardinal Health
Specialty Solutions, Regulatory Sciences, 7400 W. 110th St., Suite 300, Overland Park, Kansas 66210, United States
| | - Bing-Shiou Yang
- Chemical
Development/Material and Analytical Sciences, Boehringer-Ingelheim Pharmaceuticals, Inc., 900 Ridgebury Rd, Ridgefield, Connecticut 06877, United States
| | - Howard W. Ward
- Analytical
Research and Development, Pfizer Inc., Worldwide Research and Development, 445 Eastern Point Road, Groton, Connecticut 06340, United States
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21
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Chou C, Wong RJ, Higgins JP, Perumpail RB, Ahmed A. Acute Liver Failure: A Potential Complication of Antithyroid Medication Use. Dig Dis Sci 2015; 60:1924-7. [PMID: 25366145 DOI: 10.1007/s10620-014-3389-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 10/07/2014] [Indexed: 12/09/2022]
Affiliation(s)
- Christina Chou
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA,
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22
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Davogustto G, Higgins JP. Response to: Regarding sudden cardiac death in soccer players. PHYSICIAN SPORTSMED 2015; 43:116-8. [PMID: 25797373 DOI: 10.1080/00913847.2015.1027640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Giovanni Davogustto
- Department of Internal Medicine, University of Texas Health Science Center at Houston , Houston, TX , USA
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23
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Perumpail RB, Wong RJ, Ha LD, Pham EA, Wang U, Luong H, Kumari R, Daugherty TJ, Higgins JP, Younossi ZM, Kim WR, Glenn JS, Ahmed A. Sofosbuvir and simeprevir combination therapy in the setting of liver transplantation and hemodialysis. Transpl Infect Dis 2015; 17:275-8. [PMID: 25641426 DOI: 10.1111/tid.12348] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 12/06/2014] [Accepted: 12/10/2014] [Indexed: 12/28/2022]
Abstract
We report safety, tolerability, and 12-week sustained virologic response with half-standard dose sofosbuvir and standard-dose simeprevir combination therapy in a hepatitis C virus genotype 1a-infected liver transplant recipient on hemodialysis - uncharted territory for sofosbuvir-based therapy. The patient was a non-responder to prior treatment with pegylated interferon plus ribavirin. Sofosbuvir efficacy was maintained despite pill-splitting and administration of half-standard dose, 200 mg per day. No drug-drug interactions were noted with tacrolimus-based immunosuppression. Laboratory tests remained stable or improved during therapy. Our observation, if reproduced in a larger study, may lead to significant improvement in clinical outcomes and cost savings in this patient population.
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Affiliation(s)
- R B Perumpail
- Division of Gastroenterology and Hepatology, Liver Transplant Program, Stanford University School of Medicine, Stanford, California, USA
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24
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Higgins JP, Del Giovane C, Chaimani A, Caldwell DM, Salanti G. Evaluating the Quality of Evidence from a Network Meta-Analysis. Value Health 2014; 17:A324. [PMID: 27200533 DOI: 10.1016/j.jval.2014.08.572] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - C Del Giovane
- University of Modena and Reggio Emilia, Modena, Italy
| | - A Chaimani
- University of Ioannina School of Medicine, Ioannina, Greece
| | | | - G Salanti
- University of Ioannina School of Medicine, Ioannina, Greece
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25
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26
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Affiliation(s)
- E L Lum
- Department of Medicine, Division of Nephrology, Kidney Transplantation, UCLA David Geffen School of Medicine, Los Angeles, CA
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27
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Abstract
Caffeine consumption has been receiving increased interest from both the medical and lay press, especially given the increased amounts now available in energy products. Acute ingestion of caffeine usually increases cardiac work; however, caffeine impairs the expected proportional increase in myocardial blood flow to match this increased work of the heart, most notably during exercise. This appears to be mainly due to caffeine's effect on blocking adenosine-induced vasodilatation in the coronary arteries in normal healthy subjects. This review summarizes the available medical literature specifically relating to pure caffeine tablet ingestion and reduced exercise coronary blood flow, and suggests possible mechanisms. Further studies are needed to evaluate this effect for other common caffeine-delivery systems, including coffee, energy beverages, and energy gels, which are often used for exercise performance enhancement, especially in teenagers and young athletes.
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Affiliation(s)
- John P Higgins
- Memorial Hermann Ironman Sports Medicine Institute, The University of Texas Medical School at Houston, Houston, TX 77030-1501, USA.
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28
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Lam WL, Lin WN, Bell D, Higgins JP, Lin YT, Wei FC. The physiology, microcirculation and clinical application of the shunt-restricted arterialized venous flaps for the reconstruction of digital defects. J Hand Surg Eur Vol 2013. [PMID: 23186864 DOI: 10.1177/1753193412468632] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Reconstruction of digital defects using the venous flap offer several advantages but remained unpopular owing to levels of venous congestion rates. We performed animal studies to test the hypothesis that an arterio-venous shunt increases pressure for peripheral flap perfusion and decreases venous congestion. Using an abdominal adipofascial flap model in six male Sprague-Dawley rats, microcirculation was modified as follows: type I - arterial flap; type II - flow-through arterio-venous flap (AVF); and type III - shunt-restricted AVF. In type I flaps, blood flow was observed to be unidirectional in both arterioles and venules. In type I flaps, blood flow was observed to be unidirectional in both arterioles and venules. In type II flaps, blood flow oscillated without a dominant direction and came to a standstill. In type III flaps, blood flowed proximally in a reverse direction whereas distally, flow was similar to type I flaps. In a clinical series, 21 patients received a total of 22 shunt-restricted AVFs. All 22 clinical flaps survived; four flaps suffered epidermolysis but recovered without full thickness loss.
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Affiliation(s)
- W L Lam
- Department of Plastic and Hand Surgery, Royal Hospital for Sick Children, Edinburgh, UK
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29
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Ghebremariam YT, Yamada K, Lee JC, Johnson CLC, Atzler D, Anderssohn M, Agrawal R, Higgins JP, Patterson AJ, Böger RH, Cooke JP. FXR agonist INT-747 upregulates DDAH expression and enhances insulin sensitivity in high-salt fed Dahl rats. PLoS One 2013; 8:e60653. [PMID: 23593273 PMCID: PMC3617194 DOI: 10.1371/journal.pone.0060653] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 03/01/2013] [Indexed: 12/18/2022] Open
Abstract
Aims Genetic and pharmacological studies have shown that impairment of the nitric oxide (NO) synthase (NOS) pathway is associated with hypertension and insulin-resistance (IR). In addition, inhibition of NOS by the endogenous inhibitor, asymmetric dimethylarginine (ADMA), may also result in hypertension and IR. On the other hand, overexpression of dimethylarginine dimethylaminohydrolase (DDAH), an enzyme that metabolizes ADMA, in mice is associated with lower ADMA, increased NO and enhanced insulin sensitivity. Since DDAH carries a farnesoid X receptor (FXR)-responsive element, we aimed to upregulate its expression by an FXR-agonist, INT-747, and evaluate its effect on blood pressure and insulin sensitivity. Methods and Results In this study, we evaluated the in vivo effect of INT-747 on tissue DDAH expression and insulin sensitivity in the Dahl rat model of salt-sensitive hypertension and IR (Dahl-SS). Our data indicates that high salt (HS) diet significantly increased systemic blood pressure. In addition, HS diet downregulated tissue DDAH expression while INT-747 protected the loss in DDAH expression and enhanced insulin sensitivity compared to vehicle controls. Conclusion Our study may provide the basis for a new therapeutic approach for IR by modulating DDAH expression and/or activity using small molecules.
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Affiliation(s)
- Yohannes T Ghebremariam
- Division of Cardiovascular Medicine, Stanford University, Stanford, California, United States of America
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30
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Higgins JP, Andino A. Soccer and Sudden Cardiac Death in Young Competitive Athletes: A Review. J Sports Med (Hindawi Publ Corp) 2013; 2013:967183. [PMID: 26464886 PMCID: PMC4590894 DOI: 10.1155/2013/967183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 01/08/2013] [Indexed: 01/02/2023]
Abstract
Sudden cardiac death (SCD) in young competitive athletes (<35 years old) is a tragic event that has been brought to public attention in the past few decades. The incidence of SCD is reported to be 1-2/100,000 per year, with athletes at a 2.5 times higher risk. Soccer is the most popular sport in the world, played by people of all ages. However, unfortunately it is cardiovascular diseases such as hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy that have subtly missed screening and claimed the lives of soccer stars such as Marc Vivien Foe and Antonio Puerta during live action on the field and on an internationally televised stage. This paper covers the physiological demands of soccer and the relationship between soccer and SCD. It also reviews the most common causes of SCD in young athletes, discusses the current guidelines in place by The Fédération Internationale de Football Association (FIFA) for screening among professional soccer players, and the precautions that have been put in place to prevent SCD on the field in professional soccer.
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Affiliation(s)
- John P. Higgins
- Exercise Physiology, Memorial Hermann-Texas Medical Institute, The University of Texas Health Science Center at Houston, 6431 Fannin, Houston, TX 77030, USA
- Lyndon B. Johnson General Hospital, The University of Texas Medical School at Houston, UT Annex-Room 104, 5656 Kelley Street Houston, TX 77026, USA
| | - Aldo Andino
- The University of Texas Medical School at Houston, 6431 Fannin, Houston, TX 77030, USA
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31
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Higgins JP, Ananaba IE, Higgins CL. Sudden cardiac death in young athletes: preparticipation screening for underlying cardiovascular abnormalities and approaches to prevention. PHYSICIAN SPORTSMED 2013; 41:81-93. [PMID: 23445863 DOI: 10.3810/psm.2013.02.2002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The study of sudden cardiac death (SCD) in athletes has received more interest in the medical and lay press over the past few years. Professional athletes represent ideals of fitness and health, and the sudden death of prominent athletes can come as a shock. Underlying occult cardiovascular disorders are the most common cause of SCD in athletes. Unfortunately, because these disorders rarely present clinically, their initial manifestation is often a fatal event. Due to this, much attention has turned to both primary and secondary prevention. Primary prevention includes preparticipation screening and secondary prevention includes having automatic external defibrillators available at sporting events. This article summarizes the most common causes of athletic-related cardiac arrest and evaluates the screening methods used to screen for these conditions. The general sentiment is that we need to more effectively identify athletes who are at risk for SCD, but how to do so using an efficient screening system and in a cost-effective manner have not been determined.
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Affiliation(s)
- John P Higgins
- The University of Texas Medical School, Houston, TX, USA.
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32
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Fernando RR, Yilmaz M, Higgins JP. The changing electrocardiogram in Brugada syndrome. Int J Cardiol 2013; 163:e36-7. [DOI: 10.1016/j.ijcard.2012.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 08/31/2012] [Indexed: 11/16/2022]
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33
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Nadamuni M, Piras R, Mazbar S, Higgins JP, Kambham N. Fibronectin Glomerulopathy: An Unusual Cause of Adult-Onset Nephrotic Syndrome. Am J Kidney Dis 2012; 60:839-42. [DOI: 10.1053/j.ajkd.2012.04.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 04/19/2012] [Indexed: 01/17/2023]
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34
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Sangoi AR, McKenney JK, Brooks JD, Higgins JP. Evaluation of SF-1 Expression in Testicular Germ Cell Tumors: A Tissue Microarray Study of 100 Cases. Am J Clin Pathol 2012. [DOI: 10.1093/ajcp/138.suppl1.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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35
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Chernikova SB, Razorenova OV, Higgins JP, Sishc BJ, Nicolau M, Dorth JA, Chernikova DA, Kwok S, Brooks JD, Bailey SM, Game JC, Brown JM. Deficiency in mammalian histone H2B ubiquitin ligase Bre1 (Rnf20/Rnf40) leads to replication stress and chromosomal instability. Cancer Res 2012; 72:2111-9. [PMID: 22354749 DOI: 10.1158/0008-5472.can-11-2209] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Mammalian Bre1 complexes (BRE1A/B (RNF20/40) in humans and Bre1a/b (Rnf20/40) in mice) function similarly to their yeast homolog Bre1 as ubiquitin ligases in monoubiquitination of histone H2B. This ubiquitination facilitates methylation of histone H3 at K4 and K79, and accounts for the roles of Bre1 and its homologs in transcriptional regulation. Recent studies by others suggested that Bre1 acts as a tumor suppressor, augmenting expression of select tumor suppressor genes and suppressing select oncogenes. In this study, we present an additional mechanism of tumor suppression by Bre1 through maintenance of genomic stability. We track the evolution of genomic instability in Bre1-deficient cells from replication-associated double-strand breaks (DSB) to specific genomic rearrangements that explain a rapid increase in DNA content and trigger breakage-fusion-bridge cycles. We show that aberrant RNA-DNA structures (R-loops) constitute a significant source of DSBs in Bre1-deficient cells. Combined with a previously reported defect in homologous recombination, generation of R-loops is a likely initiator of replication stress and genomic instability in Bre1-deficient cells. We propose that genomic instability triggered by Bre1 deficiency may be an important early step that precedes acquisition of an invasive phenotype, as we find decreased levels of BRE1A/B and dimethylated H3K79 in testicular seminoma and in the premalignant lesion in situ carcinoma.
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Affiliation(s)
- Sophia B Chernikova
- Department of Radiation Oncology, Stanford University, Stanford, California 94305, USA
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36
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Higgins JP, Laing ST, Chen Z. Media Reporting Bias Affects Reported Sudden Death Rates. J Am Coll Cardiol 2011; 58:990-1; author reply 991-2. [DOI: 10.1016/j.jacc.2011.03.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 03/28/2011] [Indexed: 11/28/2022]
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37
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Malhotra S, Lapointe J, Salari K, Higgins JP, Ferrari M, Montgomery K, van de Rijn M, Brooks JD, Pollack JR. A tri-marker proliferation index predicts biochemical recurrence after surgery for prostate cancer. PLoS One 2011; 6:e20293. [PMID: 21629784 PMCID: PMC3100337 DOI: 10.1371/journal.pone.0020293] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 04/28/2011] [Indexed: 12/20/2022] Open
Abstract
Prostate cancer exhibits tremendous variability in clinical behavior, ranging
from indolent to lethal disease. Better prognostic markers are needed to
stratify patients for appropriately aggressive therapy. By expression profiling,
we can identify a proliferation signature variably expressed in prostate
cancers. Here, we asked whether one or more tissue biomarkers might capture that
information, and provide prognostic utility. We assayed three proliferation
signature genes: MKI67 (Ki-67; also a classic proliferation
biomarker), TOP2A (DNA topoisomerase II, alpha), and
E2F1 (E2F transcription factor 1). Immunohistochemical
staining was evaluable on 139 radical prostatectomy cases (in tissue microarray
format), with a median clinical follow-up of eight years. Each of the three
proliferation markers was by itself prognostic. Notably, combining the three
markers together as a “proliferation index” (0 or 1,
vs. 2 or 3 positive markers) provided superior prognostic
performance (hazard ratio = 2.6 (95% CI:
1.4–4.9); P = 0.001). In a
multivariate analysis that included preoperative serum prostate specific antigen
(PSA) levels, Gleason grade and pathologic tumor stage, the composite
proliferation index remained a significant predictor
(P = 0.005). Analysis of
receiver-operating characteristic (ROC) curves confirmed the improved
prognostication afforded by incorporating the proliferation index (compared to
the clinicopathologic data alone). Our findings highlight the potential value of
a multi-gene signature-based diagnostic, and define a tri-marker proliferation
index with possible utility for improved prognostication and treatment
stratification in prostate cancer.
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Affiliation(s)
- Sameer Malhotra
- Department of Urology, Stanford University, Stanford, California, United
States of America
| | - Jacques Lapointe
- Department of Surgery, Urology Division, McGill University, Montreal,
Quebec, Canada
| | - Keyan Salari
- Department of Pathology, Stanford University, Stanford, California,
United States of America
- Department of Genetics, Stanford University, Stanford, California, United
States of America
| | - John P. Higgins
- Department of Pathology, Stanford University, Stanford, California,
United States of America
| | - Michelle Ferrari
- Department of Urology, Stanford University, Stanford, California, United
States of America
| | - Kelli Montgomery
- Department of Pathology, Stanford University, Stanford, California,
United States of America
| | - Matt van de Rijn
- Department of Pathology, Stanford University, Stanford, California,
United States of America
| | - James D. Brooks
- Department of Urology, Stanford University, Stanford, California, United
States of America
- * E-mail: (JDB); (JRP)
| | - Jonathan R. Pollack
- Department of Pathology, Stanford University, Stanford, California,
United States of America
- * E-mail: (JDB); (JRP)
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Sangoi AR, Karamchandani J, Lane B, Higgins JP, Rouse RV, Brooks JD, McKenney JK. Specificity of brachyury in the distinction of chordoma from clear cell renal cell carcinoma and germ cell tumors: a study of 305 cases. Mod Pathol 2011; 24:425-9. [PMID: 21102418 DOI: 10.1038/modpathol.2010.196] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Brachyury is recognized as a specific marker for notochord-derived tissues and neoplasms, and has become a defining immunohistochemical feature of chordoma. The main differential diagnostic consideration for chordoma is chondrosarcoma, which is known to lack brachyury expression. However, within the spectrum of genitourinary neoplasia, metastatic germ cell tumors and clear cell renal cell carcinoma may also be close morphological mimics of chordoma, particularly given the increasing prevalence of small tissue samples from image-guided biopsies. Although immunoreactivity for brachyury has been reported in a few germ cell tumors, a thorough characterization of staining by specific subtype has not been performed in a large series. Additionally, brachyury expression in clear cell renal cell carcinoma has not been well studied. In this study, immunohistochemical expression with the brachyury antibody was evaluated in 111 germ cell tumors, 30 non-neoplastic and neoplastic (non-germ cell) testicular tissues, and 184 metastatic clear cell renal cell carcinomas using tissue microarray technology. In addition, immunoreactivity for PAX-8 and SALL-4 was evaluated in 12 chordomas on whole section. No nuclear brachyury expression was identified in any of the 101 germ cell tumors within the tissue microarray (including choriocarcinoma (1), embryonal carcinoma (20), intratubular germ cell neoplasia unclassified (2), seminoma (64), spermatocytic seminoma (1), teratoma (5) and yolk sac tumor (8)), in any of the 30 non-neoplastic and neoplastic (non-germ cell) testicular tissues, or in any of the 10 whole-section seminomas. All 184 metastatic clear cell renal cell carcinomas were also non-reactive for brachyury. All 12 chordomas showed strong nuclear immunoreactivity for brachyury, but no expression of SALL-4. In all, 1 of 12 chordoma cases showed patchy, 1+ nuclear immunoreactivity for PAX-8. This study confirms the specificity of brachyury for chordoma in the differential diagnostic distinction from the potential genitourinary mimics, germ cell tumors and metastatic clear cell renal cell carcinoma.
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Affiliation(s)
- Ankur R Sangoi
- Department of Pathology, Stanford University, Stanford, CA, USA.
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Harshman LC, Bepler G, Zheng Z, Higgins JP, Allen GI, Srinivas S. Ribonucleotide reductase subunit M1 expression in resectable, muscle-invasive urothelial cancer correlates with survival in younger patients. BJU Int 2011; 106:1805-11. [PMID: 20438561 DOI: 10.1111/j.1464-410x.2010.09327.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess whether high ribonucleotide reductase subunit M1 (RRM1) expression in patients with resected, muscle-invasive (T2-4NxM0) urothelial carcinoma (UC) correlated with longer overall survival (OS). RRM1 is the primary cellular target of gemcitabine and previous studies in resected early-stage lung cancer have shown a survival benefit for patients with high expression. PATIENTS AND METHODS In all, 84 radical cystectomy specimens with muscle-invasive UC were identified from existing tissue microarrays. The patients' medical records were retrospectively reviewed to confirm pathology and stage. Specimens were analysed for RRM1 expression using automated quantitative analysis. The median value of RRM1 was established a priori as the threshold for high and low expression. RESULTS The median age of the patients was 69 years. Stages were nearly equally distributed: 30%, 38%, and 32% for stage II, III, and IV, respectively. Most were high grade (99%) with no nodal involvement (69%). The median (range) OS was 2.0 (0-13.1) years. Tumoral RRM1 levels did not correlate with OS for the entire cohort, but when adjusted for age, high tumoral RRM1 expression in younger patients (aged <70 years) correlated with increased survival. Younger patients with high RRM1 expression had a median OS of 10.6 years compared with 1.6 years in older patients (P= 0.001). There was no difference in OS among low RRM1 expressors: 2.3 vs 1.6 years in younger and older patients, respectively (P= 0.22). CONCLUSIONS Our results suggest that high RRM1 expression may be prognostic for improved survival in patients with muscle-invasive UC aged <70 years.
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Affiliation(s)
- Lauren C Harshman
- Division of Oncology and Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA.
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Abstract
Exercise is making a resurgence in many countries, given its benefits for fitness as well as prevention of obesity. This trend has spawned many supplements that purport to aid performance, muscle growth, and recovery. Initially, sports drinks were developed to provide electrolyte and carbohydrate replacement. Subsequently, energy beverages (EBs) containing stimulants and additives have appeared in most gyms and grocery stores and are being used increasingly by "weekend warriors" and those seeking an edge in an endurance event. Long-term exposure to the various components of EBs may result in significant alterations in the cardiovascular system, and the safety of EBs has not been fully established. For this review, we searched the MEDLINE and EMBASE databases from 1976 through May 2010, using the following keywords: energy beverage, energy drink, power drink, exercise, caffeine, red bull, bitter orange, glucose, ginseng, guarana, and taurine. Evidence regarding the effects of EBs is summarized, and practical recommendations are made to help in answering the patient who asks, "Is it safe for me to drink an energy beverage when I exercise?"
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Affiliation(s)
- John P Higgins
- Division of Cardiology, Lyndon B. Johnson General Hospital, and Memorial Hermann Sports Medicine Institute, The University of Texas Medical School at Houston, Houston, TX 77026-1967, USA.
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Graham KL, Lee LY, Higgins JP, Steinman L, Utz PJ, Ho PP. Treatment with a toll-like receptor inhibitory GpG oligonucleotide delays and attenuates lupus nephritis in NZB/W mice. Autoimmunity 2010; 43:140-55. [PMID: 19845477 DOI: 10.3109/08916930903229239] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Activation of the innate immune system by DNA containing hypomethylated CpG motifs has been implicated in the pathogenesis of systemic lupus erythematosus (SLE). Here, we examined the consequences of immunostimulatory CpG-oligodeoxynucleotide (ODN) and inhibitory GpG-ODN treatment in the NZB x NZW F1 (NZB/W) murine model of SLE. Beginning at 5 months of age, we administered CpG-ODN or GpG-ODN at regular intervals to female NZB/W animals. We also determined the effects of ODN administration on NZB/W mouse lymphocyte function, and the specificity of ODN binding to Toll-like receptors (TLRs) other than TLR-9. While CpG-ODN treatment did not appear to have a major impact on disease severity, GpG-ODN treatment significantly delayed the onset of proteinuria in NZB/W mice. Interestingly, short-term GpG-ODN treatment promoted Th2-type T and B cell responses, and inhibited B lymphocyte proliferation in vitro. On the other hand, extended GpG-ODN treatment did not result in sustained Th2 responses or significantly reduced renal disease. Moreover, the binding of CpG-ODN and GpG-ODN was not restricted to TLR-9 as both ODNs also interacted with TLR-3, TLR-7, and TLR-8. Taken together, the data indicate that the protective mechanism of GpG-ODN treatment in the NZB/W model of lupus nephritis involves modulating T cell cytokine profiles and B lymphocyte activation through the inhibition of several TLRs, including TLR-7 and TLR-9.
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Affiliation(s)
- Kareem L Graham
- Department of Medicine, Stanford University School of Medicine, CA 94305, USA
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Arriagada R, Auperin A, Burdett S, Higgins JP, Johnson DH, Le Chevalier T, Le Pechoux C, Parmar MKB, Pignon JP, Souhami RL, Stephens RJ, Stewart LA, Tierney JF, Tribodet H, van Meerbeeck J. Adjuvant chemotherapy, with or without postoperative radiotherapy, in operable non-small-cell lung cancer: two meta-analyses of individual patient data. Lancet 2010; 375:1267-77. [PMID: 20338627 PMCID: PMC2853682 DOI: 10.1016/s0140-6736(10)60059-1] [Citation(s) in RCA: 460] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Many randomised controlled trials have investigated the effect of adjuvant chemotherapy in operable non-small-cell lung cancer. We undertook two comprehensive systematic reviews and meta-analyses to establish the effects of adding adjuvant chemotherapy to surgery, or to surgery plus radiotherapy. METHODS We included randomised trials, not confounded by additional therapeutic differences between the two groups and that started randomisation on or after Jan 1, 1965, which compared surgery plus adjuvant chemotherapy versus surgery alone, or surgery plus adjuvant radiotherapy and chemotherapy versus surgery plus adjuvant radiotherapy. Updated individual patient data were collected, checked, and included in meta-analyses stratified by trial. The primary endpoint was overall survival, defined as time from randomisation until death by any cause. All analyses were by intention to treat. FINDINGS The first meta-analysis of surgery plus chemotherapy versus surgery alone was based on 34 trial comparisons and 8447 patients (3323 deaths). We recorded a benefit of adding chemotherapy after surgery (hazard ratio [HR] 0.86, 95% CI 0.81-0.92, p<0.0001), with an absolute increase in survival of 4% (95% CI 3-6) at 5 years (from 60% to 64%). The second meta-analysis of surgery plus radiotherapy and chemotherapy versus surgery plus radiotherapy was based on 13 trial comparisons and 2660 patients (1909 deaths). We recorded a benefit of adding chemotherapy to surgery plus radiotherapy (HR 0.88, 95% CI 0.81-0.97, p=0.009), representing an absolute improvement in survival of 4% (95% CI 1-8) at 5 years (from 29% to 33%). In both meta-analyses we noted little variation in effect according to the type of chemotherapy, other trial characteristics, or patient subgroup. INTERPRETATION The addition of adjuvant chemotherapy after surgery for patients with operable non-small-cell lung cancer improves survival, irrespective of whether chemotherapy was adjuvant to surgery alone or adjuvant to surgery plus radiotherapy. FUNDING UK Medical Research Council, Institut Gustave-Roussy, Programme Hospitalier de Recherche Clinique (AOM 05 209), Ligue Nationale Contre le Cancer, and Sanofi-Aventis.
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Higgins JP, Higgins SE, Wolfenden AD, Henderson SN, Torres-Rodriguez A, Vicente JL, Hargis BM, Tellez G. Effect of lactic acid bacteria probiotic culture treatment timing on Salmonella Enteritidis in neonatal broilers. Poult Sci 2010; 89:243-7. [PMID: 20075275 DOI: 10.3382/ps.2009-00436] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In the present study, a series of experiments were conducted to evaluate the ability of a combination of 3 ATCC lactobacilli (LAB3) or a commercially available probiotic culture (PROB) to reduce Salmonella enterica serovar Enteritidis (Salmonella Enteritidis) in broiler chicks. Additionally, we varied the timing of PROB administration in relationship to Salmonella challenge and determined the influence on recovery of enteric Salmonella. In experiments 1 to 3, chicks were randomly assigned to treatment groups and were then challenged via oral gavage with Salmonella Enteritidis. Chicks were treated 1 h after Salmonella Enteritidis challenge with LAB3 or PROB. Twenty-four hours posttreatment, cecal tonsils were collected for recovery of enteric Salmonella. In experiments 4 to 7, day-of-hatch chicks were randomly assigned to treatment groups and were then treated with PROB via oral gavage and placed into pens. Chicks were challenged with Salmonella Enteritidis 24 h after treatment via oral gavage. At 24 h after Salmonella Enteritidis challenge, cecal tonsils were collected and recovery of enteric Salmonella was determined. In experiments 8 to 10, 1-d-old chicks were randomly assigned to treatment groups and were then challenged via oral gavage with Salmonella Enteritidis and placed into pens. Chicks were treated 24 h after challenge with PROB via oral gavage. Twenty-four hours post PROB treatment, cecal tonsils were collected and enriched as described above. It was found that PROB significantly reduced cecal Salmonella Enteritidis recovery 24 h after treatment as compared with controls or LAB3-treated chicks in experiments 1 to 3 (P<0.05). Administration of PROB 24 h before Salmonella Enteritidis challenge significantly reduced recovery of Salmonella Enteritidis in 2 out of 4 experiments and no reduction in cecal Salmonella Enteritidis was observed when chicks were challenged with Salmonella Enteritidis and treated 24 h later with PROB. These data demonstrate that PROB more effectively reduced Salmonella Enteritidis than LAB3, and the timing of PROB treatment affects Salmonella Enteritidis-associated reductions.
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Affiliation(s)
- J P Higgins
- Laboratory of Tumor Immunology and Biology, National Cancer Institute/National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
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Higgins JP, Tuttle T, Higgins JA. Altitude and the heart: is going high safe for your cardiac patient? Am Heart J 2010; 159:25-32. [PMID: 20102863 DOI: 10.1016/j.ahj.2009.10.028] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Accepted: 10/21/2009] [Indexed: 11/24/2022]
Abstract
Our aging population combined with the ease of travel and the interest in high altitude recreation pursuits exposes more patients to the acute physiologic effects of high altitude and lower oxygen availability. Acute exposure to high altitude is associated with significant alterations to the cardiovascular system. These may be important in patients with underlying cardiovascular disease who are not able to compensate to such physiologic changes. Exacerbating factors pertinent to patients with cardiovascular disease include acute hypoxia, increased myocardial work, increased epinephrine release, and increased pulmonary artery pressures. This review summarizes the physiology and clinical evidence regarding acute altitude exposure on the cardiopulmonary system with practical recommendations to address the question: "Is it safe for me to ski in the Rockies or climb Mt. Kilimanjaro?"
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Abstract
Current therapies for rheumatoid arthritis (RA) and other autoimmune diseases non-specifically suppress immune function, and there is great need for fundamental approaches such as antigen-specific tolerizing therapy. In this paper we describe development of antigen-specific tolerizing DNA vaccines to treat collagen-induced arthritis (CIA) in mice, and use of protein microarrays to monitor response to therapy and to identify potential additional autoimmune targets for next generation vaccines. We demonstrate that tolerizing DNA vaccines encoding type II collagen (CII) reduced the incidence and severity of CIA. Atorvastatin, a statin drug found to reduce the severity of autoimmunity, potentiated the effect of DNA vaccines encoding CII. Analysis of cytokines produced by collagen-reactive T cells derived from mice receiving tolerizing DNA encoding CII, as compared to control vaccines, revealed reduced production of the pro-inflammatory cytokines IFN-gamma and TNF-alpha. Arthritis microarray analysis demonstrated reduced spreading of autoantibody responses in mice treated with DNA encoding CII. The development of tolerizing DNA vaccines, and the use of antibody profiling to guide design of and to monitor therapeutic responses to such vaccines, represents a promising approach for the treatment of RA and other autoimmune diseases.
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Affiliation(s)
- Peggy P Ho
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
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Damani RH, Ananaba I, West JJ, Higgins JP. Prevalence Of LVH In Athletes Classified By Race And Gender. Med Sci Sports Exerc 2009. [DOI: 10.1249/01.mss.0000356049.17277.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Sangoi AR, Higgins JP, Rouse RV, Schneider AG, McKenney JK. Immunohistochemical comparison of MUC1, CA125, and Her2Neu in invasive micropapillary carcinoma of the urinary tract and typical invasive urothelial carcinoma with retraction artifact. Mod Pathol 2009; 22:660-7. [PMID: 19270645 DOI: 10.1038/modpathol.2009.16] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
On the basis of recent clinical studies, some urologic oncologists do not offer bladder-sparing therapy for patients diagnosed with micropapillary carcinoma of the urinary bladder, even in the setting superficially invasive disease. Unfortunately, the distinction of invasive micropapillary carcinoma from typical invasive urothelial carcinoma with prominent retraction artifact may be difficult in some cases. In this study, we compared the immunophenotype of invasive micropapillary carcinoma to invasive urothelial carcinoma with retraction artifact using antibodies previously reported as specific for micropapillary carcinoma. Immunohistochemical staining was performed on 24 invasive micropapillary carcinomas of the urinary tract and 24 case controls of invasive urothelial carcinoma with retraction artifact using monoclonal antibodies MUC1, CA125, and Her2Neu. The staining extent and intensity for MUC1 and CA125 were scored on one representative section per case. Immunostaining for Her2Neu was scored based on the 2007 CAP/ASCO guidelines for breast carcinoma. Basal ('reverse-apical') MUC1 staining was identified in 23 of the 24 (96%) invasive micropapillary carcinomas and in 15 of the 24 (63%) invasive urothelial carcinomas with retraction artifact (P=0.0102). Membranous reactivity with CA125 was seen in 8 of the 24 (33%) invasive micropapillary carcinomas and in 3 of the 24 (13%) invasive urothelial carcinomas with retraction artifact (P=0.1681). Positive (3+) membranous Her2Neu staining was present in 6 of 24 (25%) invasive micropapillary carcinomas and in 2 of the 24 (8%) invasive urothelial carcinomas with retraction artifact (P=0.2448). The specificity for invasive micropapillary carcinoma vs invasive urothelial carcinoma with retraction artifact using antibodies MUC1, CA125, and Her2Neu was 37, 87, and 92%, respectively. Invasive micropapillary carcinoma more commonly showed immunoreactivity for MUC1, CA125, and Her2Neu compared to invasive urothelial carcinoma with retraction artifact, but only MUC1 reached statistical significance. The lack of specificity of these evaluated markers for invasive micropapillary carcinoma limits their utility in the distinction from invasive urothelial carcinoma with retraction artifact, especially given the potentially significant therapeutic implications.
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Affiliation(s)
- Ankur R Sangoi
- Department of Pathology, Stanford University, Stanford, CA 94305, USA.
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Ananaba IE, Damani RH, West JJ, Higgins JP. Diagnosis Of Left Ventricular Hypertrophy By Lead Criteria In The Analysis Of ECGs Over Time In Young Athletes. Med Sci Sports Exerc 2009. [DOI: 10.1249/01.mss.0000356058.93512.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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West JJ, Higgins JP. Temporal Electrocardiographic Changes In Athletes Undergoing Pre-participation Screening. Med Sci Sports Exerc 2009. [DOI: 10.1249/01.mss.0000353530.90405.de] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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West JJ, Higgins JP. Aborted Sudden Cardiac Death During Sport Participation Resulting From Non-obstructive Hypertrophic Cardiomyopathy. Med Sci Sports Exerc 2009. [DOI: 10.1249/01.mss.0000353914.18106.e7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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