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Dimaano KL, Dib VA, Parnall T, Covington A, Kaji AH, Choi P, Chen KT. The Utility of ACR TI-RADS in Predicting False-Negative Fine Needle Aspiration for Thyroid Cancer. Am Surg 2024; 90:1156-1160. [PMID: 38212274 DOI: 10.1177/00031348241227184] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
BACKGROUND Thyroid nodule fine needle aspiration (FNA) biopsies are associated with a low false-negative rate. There is limited data regarding the predictive value of American College of Radiology Thyroid Imaging Reporting and Data System for false-negative FNA. METHODS This single-center retrospective study evaluated 119 patients who underwent thyroidectomy. The association of TR category, along with other clinical variables, with false-negative FNA was evaluated. RESULTS The overall false-negative rate of FNA was 10.8% (n = 9). False-negative FNAs were associated with younger age (mean 42 years vs 50.6 years, P = .04), larger nodule size (mean 4.4 cm vs 3.2 cm, P = .03), and a lower TR category (median 3 v 4, P = .01). DISCUSSION Lower TR category, younger age, and larger nodule size were associated with false-negative FNA of thyroid nodules. These findings should be taken into context when counseling patients with thyroid nodules who have a benign FNA.
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Affiliation(s)
- Katrina L Dimaano
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Valerie A Dib
- Department of Radiology, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Taylor Parnall
- Department of Radiology, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Audrey Covington
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Amy H Kaji
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Patrick Choi
- Department of Radiology, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Kathryn T Chen
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
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Schwed AC, Chen KT, de Virgilio CM. Preserving and Enhancing Resident Autonomy-Strategies for Surgical Educators. JAMA Surg 2024; 159:9-10. [PMID: 37851454 DOI: 10.1001/jamasurg.2023.3819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
This Viewpoint suggests measures to improve surgical resident autonomy and thereby produce capable and resilient surgeons.
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Affiliation(s)
| | - Kathryn T Chen
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, California
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3
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Chen KT, Tesfay R, Koran MEI, Ouyang J, Shams S, Young CB, Davidzon G, Liang T, Khalighi M, Mormino E, Zaharchuk G. Generative Adversarial Network-Enhanced Ultra-Low-Dose [ 18F]-PI-2620 τ PET/MRI in Aging and Neurodegenerative Populations. AJNR Am J Neuroradiol 2023; 44:1012-1019. [PMID: 37591771 PMCID: PMC10494955 DOI: 10.3174/ajnr.a7961] [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: 11/03/2022] [Accepted: 07/11/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND AND PURPOSE With the utility of hybrid τ PET/MR imaging in the screening, diagnosis, and follow-up of individuals with neurodegenerative diseases, we investigated whether deep learning techniques can be used in enhancing ultra-low-dose [18F]-PI-2620 τ PET/MR images to produce diagnostic-quality images. MATERIALS AND METHODS Forty-four healthy aging participants and patients with neurodegenerative diseases were recruited for this study, and [18F]-PI-2620 τ PET/MR data were simultaneously acquired. A generative adversarial network was trained to enhance ultra-low-dose τ images, which were reconstructed from a random sampling of 1/20 (approximately 5% of original count level) of the original full-dose data. MR images were also used as additional input channels. Region-based analyses as well as a reader study were conducted to assess the image quality of the enhanced images compared with their full-dose counterparts. RESULTS The enhanced ultra-low-dose τ images showed apparent noise reduction compared with the ultra-low-dose images. The regional standard uptake value ratios showed that while, in general, there is an underestimation for both image types, especially in regions with higher uptake, when focusing on the healthy-but-amyloid-positive population (with relatively lower τ uptake), this bias was reduced in the enhanced ultra-low-dose images. The radiotracer uptake patterns in the enhanced images were read accurately compared with their full-dose counterparts. CONCLUSIONS The clinical readings of deep learning-enhanced ultra-low-dose τ PET images were consistent with those performed with full-dose imaging, suggesting the possibility of reducing the dose and enabling more frequent examinations for dementia monitoring.
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Affiliation(s)
- K T Chen
- From the Department of Biomedical Engineering (K.T.C.), National Taiwan University, Taipei, Taiwan
- Department of Radiology (K.T.C., M.E.I.K., J.O., S.S., G.D., T.L., M.K., G.Z.), Stanford University, Stanford, California
| | - R Tesfay
- Meharry Medical College (R.T.), Nashville, Tennessee
| | - M E I Koran
- Department of Radiology (K.T.C., M.E.I.K., J.O., S.S., G.D., T.L., M.K., G.Z.), Stanford University, Stanford, California
| | - J Ouyang
- Department of Radiology (K.T.C., M.E.I.K., J.O., S.S., G.D., T.L., M.K., G.Z.), Stanford University, Stanford, California
| | - S Shams
- Department of Radiology (K.T.C., M.E.I.K., J.O., S.S., G.D., T.L., M.K., G.Z.), Stanford University, Stanford, California
| | - C B Young
- Department of Neurology and Neurological Sciences (C.B.Y., E.M.), Stanford University, Stanford, California
| | - G Davidzon
- Department of Radiology (K.T.C., M.E.I.K., J.O., S.S., G.D., T.L., M.K., G.Z.), Stanford University, Stanford, California
| | - T Liang
- Department of Radiology (K.T.C., M.E.I.K., J.O., S.S., G.D., T.L., M.K., G.Z.), Stanford University, Stanford, California
| | - M Khalighi
- Department of Radiology (K.T.C., M.E.I.K., J.O., S.S., G.D., T.L., M.K., G.Z.), Stanford University, Stanford, California
| | - E Mormino
- Department of Neurology and Neurological Sciences (C.B.Y., E.M.), Stanford University, Stanford, California
| | - G Zaharchuk
- Department of Radiology (K.T.C., M.E.I.K., J.O., S.S., G.D., T.L., M.K., G.Z.), Stanford University, Stanford, California
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Chen KT, Dissanaike S, de Virgilio C. Creating an Optimal Learning Environment in the Operating Room: Lessons From the Soccer Field. J Surg Educ 2023; 80:1053-1055. [PMID: 37271597 DOI: 10.1016/j.jsurg.2023.05.002] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/10/2023] [Accepted: 05/08/2023] [Indexed: 06/06/2023]
Abstract
For trainees, the operating room (OR) often represents an educational sanctuary, where for a few hours they can focus on their craft, rather than on phone calls, pages, and the never-ending task of electronic health record documentation. The OR provides a unique opportunity for unfettered one-on-one time with an attending surgeon at their side, where they can learn the art of surgery without interruption. It is vitally important to maximize learning in the OR, yet evidence suggests that it is not always an ideal educational environment. Considering the recent excitement over the World Cup soccer tournament (full disclosure: the senior author is an Argentine immigrant and soccer fan), in this article, we provide evidence-based ideas and suggestions on how to optimize learning in the OR using some analogies from the soccer field.
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Affiliation(s)
- Kathryn T Chen
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, California.
| | - Sharmila Dissanaike
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas
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Liu JK, Porras PA, Hari DM, Chen KT. Routine pre-operative Covid testing in elective surgeries: Is it worth it? Am J Surg 2022; 224:1380-1384. [PMID: 36424202 PMCID: PMC9639377 DOI: 10.1016/j.amjsurg.2022.10.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 08/12/2022] [Accepted: 10/13/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Pre-procedural COVID-19 testing in patients scheduled for elective cases have become routine to reduce the risk of COVID-19 exposure and pulmonary complications related to perioperative COVID-19 infection, and to reduce the use of specific hospital resources among other reasons. This study evaluates the efficacy of universal COVID-19 testing for elective procedures. METHODS Single institution retrospective observational study from July 2020 through August 2021. RESULTS There were a total of 499 unique patients who were scheduled for 581 surgeries or procedures. A total of 569 anterior nares reverse transcriptase polymerase chain reaction (RT-PCR) tests were completed before scheduled procedure. There were 2 (0.35%) positive COVID tests, both of whom were asymptomatic and unvaccinated at time of testing, and 13 (2.2%) cancelled cases overall. The total cost for labor and materials during this period was $19,738, with each RT-PCR test costing $34.69 and each true positive test costing $9,869. CONCLUSIONS Given the low COVID-19 positivity in the elective procedural patient population, testing protocols for elective procedures should be re-evaluated as the pandemic evolves.
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Affiliation(s)
| | | | | | - Kathryn T. Chen
- Corresponding author. Department of Surgery Harbor-UCLA Medical Center, 1000 W. Carson Street, Bldg 1 E Torrance, CA, 90502, United States
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Braschi C, Tung C, Chen KT. The impact of waste reduction in general surgery operating rooms. Am J Surg 2022; 224:1370-1373. [PMID: 36273939 DOI: 10.1016/j.amjsurg.2022.10.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 09/23/2022] [Accepted: 10/13/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Operating rooms are responsible for a significant burden of waste and negative environmental impact. This study aimed to reduce OR waste and improve both environmental impact and hospital cost savings. METHODS The unused items in two standard single-use surgical packs were tracked for general surgery cases. A new pack was created excluding the most frequently unused items. The feasibility of the new pack was then tested, and a projected cost savings analysis was performed. RESULTS A total of 35 general surgery operations were tracked using two standard packs ($89.51 or $93.68 per case, each 23.2 lbs). The new pack ($46.88 per case, 20.8 lbs) was then successfully used in nine cases. The projected cost-savings of substituting the new pack was $45,719 annually with a 2437 pounds annual waste reduction. CONCLUSIONS Simple and feasible adjustments to standard single-use surgical packs can have a significant impact on waste reduction and cost-savings.
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Affiliation(s)
- Caitlyn Braschi
- Division of Surgical Oncology, Department of Surgery, Harbor-UCLA Medical Center, USA.
| | - Christine Tung
- Division of Surgical Oncology, Department of Surgery, Harbor-UCLA Medical Center, USA
| | - Kathryn T Chen
- Division of Surgical Oncology, Department of Surgery, Harbor-UCLA Medical Center, USA
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Chen KT, Ozao-Choy J, de Virgilio C. Disparities in Physician Compensation-A Call to Action. JAMA Surg 2022; 157:1023. [PMID: 36169972 DOI: 10.1001/jamasurg.2022.4302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Kathryn T Chen
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, California
| | - Junko Ozao-Choy
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, California
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Balan N, Petrie BA, Chen KT. Racial Disparities in Colorectal Cancer Care for Black Patients: Barriers and Solutions. Am Surg 2022; 88:2823-2830. [PMID: 35757937 DOI: 10.1177/00031348221111513] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Racial disparities in colorectal cancer for Black patients have led to a significant mortality difference when compared to White patients, a gap which has remained to this day. These differences have been linked to poorer quality insurance and socioeconomic status in addition to lower access to high-quality health care resources, which are emblematic of systemic racial inequities. Disparities impact nearly every point along the colorectal cancer care continuum and include barriers to screening, surgical care, oncologic care, and surveillance. These critical faults are the driving forces behind the mortality difference Black patients face. Health care systems should strive to correct these disparities through both cultural competency at the provider level and public policy change at the national level.
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Affiliation(s)
- Naveen Balan
- Department of Surgery, 21640Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Beverley A Petrie
- Department of Surgery, 21640Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Kathryn T Chen
- Department of Surgery, 21640Harbor-UCLA Medical Center, Torrance, CA, USA
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Balan N, Braschi C, Kirkland P, Kaji AH, Chen KT. The Impact of Primary Care Physicians on the Surgical Presentation and Outcomes of Colorectal Cancer in Vulnerable Populations. Am Surg 2022; 88:2596-2601. [PMID: 35703089 DOI: 10.1177/00031348221109474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Multiple socioeconomic and clinical factors have been implicated in the health disparities that exist amongst vulnerable populations with colorectal cancer. Efforts have been directed toward addressing these factors to improve outcomes. We evaluate the impact of primary care physicians (PCP) on the surgical presentation and outcomes of colorectal cancer at a safety-net hospital. METHODS A retrospective chart review of 331 patients diagnosed with colorectal adenocarcinoma between 2014 and 2020 at a single-institution urban county medical center. RESULTS The cohort was predominantly male (59%) and Hispanic (52.1%). Thirty-two percent of patients had a PCP at time of diagnosis. Patients with PCPs compared to those without PCPs had significantly lower rates of acute presentation (perforation or obstruction) (17.0 vs 38.1%, P < .001), higher rates of surgical resection (83.0 vs 70.7%, P = .016), and were less likely to have metastatic disease at presentation (20.4 vs 33.5%, P = .02). Overall, having a PCP also improved probability of survival (HR 1.36, P < .04). CONCLUSION Having a PCP at the time of colorectal cancer diagnosis is associated with improved outcomes in a safety-net population, with significant differences in surgical presentation and resection.
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Affiliation(s)
- Naveen Balan
- Department of Surgery, 21640Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Caitlyn Braschi
- Department of Surgery, 21640Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Patrick Kirkland
- Department of Surgery, 21640Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Amy H Kaji
- Department of Emergency Medicine, 21640Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Kathryn T Chen
- Department of Surgery, 21640Harbor-UCLA Medical Center, Torrance, CA, USA
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Sirody J, Kaji AH, Hari DM, Chen KT. Patterns of gastric cancer metastasis in the United States. Am J Surg 2022; 224:445-448. [DOI: 10.1016/j.amjsurg.2022.01.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 12/19/2021] [Accepted: 01/19/2022] [Indexed: 12/22/2022]
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Liu JK, Kaji AH, Roth KG, Hari DM, Yeh JJ, Dauphine C, Ozao-Choy J, Chen KT. Determinants of Psychosocial Distress in Breast Cancer Patients at a Safety Net Hospital. Clin Breast Cancer 2021; 22:43-48. [PMID: 34474985 DOI: 10.1016/j.clbc.2021.06.011] [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: 02/27/2021] [Revised: 05/27/2021] [Accepted: 06/25/2021] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Psychosocial distress screening of cancer patients is an American College of Surgeons Commission on Cancer mandate for accredited cancer programs. We evaluated psychosocial distress in breast cancer patients to characterize risk factors for high distress scores at a safety net hospital. MATERIALS AND METHODS The psychosocial distress screening form includes a list of potential issues and a distress score scaled from 1 through 10. Psychosocial distress screening results were retrospectively analyzed, along with patient demographics and clinical data. Cochran-Mantel-Haenszel test was applied to identify predictors for high distress scores, which were defined as a score of 5 and greater. RESULTS 775 distress screens were completed by 171 breast cancer patients. High distress scores were reported in 21.3%. Patients who had no evidence of disease at time of screening were less likely to report a high distress score compared to those who were newly diagnosed or in active treatment (odds ratio 0.51, 95% CI, 0.38-0.68, P< .0001). Patients with high distress scores were more likely to report concerns with insurance (29.1% vs. 7.6%, P< .0001), transportation (16.4% vs. 4.6%, P< .0001), housing (15.2% vs 2.1%, P< .0001), sadness/depression (63.6% vs. 14.1, P< .0001), and physical issues (89.1% vs. 52.8%, P< .0001). CONCLUSION Status of cancer at time of screening, particularly newly diagnosed cancer and active treatment of cancer were associated with high distress scores in this patient group. While there should be an emphasis to ensure patients with these risk factors receive psychosocial distress screening, routine periodic screening for all patients should continue to be implemented to ensure quality cancer care.
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Affiliation(s)
- Jessica K Liu
- Division of Surgical Oncology, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA
| | - Amy H Kaji
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA
| | - Katherine G Roth
- Division of Medical Oncology, Department of Internal Medicine, Harbor-UCLA Medical Center, Torrance, CA
| | - Danielle M Hari
- Division of Surgical Oncology, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA
| | - James J Yeh
- Division of Medical Oncology, Department of Internal Medicine, Harbor-UCLA Medical Center, Torrance, CA
| | - Christine Dauphine
- Division of Surgical Oncology, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA
| | - Junko Ozao-Choy
- Division of Surgical Oncology, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA
| | - Kathryn T Chen
- Division of Surgical Oncology, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA.
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Kapadia S, Kaji AH, Hari DM, Ozao-Choy J, Chen KT. Helicobacter pylori and Gallstone Disease: Incidence and Outcomes in a Los Angeles County Population. J Gastrointest Surg 2021; 25:887-889. [PMID: 33620634 DOI: 10.1007/s11605-021-04918-1] [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: 07/01/2020] [Accepted: 01/12/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Sonam Kapadia
- Department of Surgery, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, 1000 West Carson Street, Box 25, Torrance, CA, 90502, USA.
| | - Amy H Kaji
- Department of Surgery, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, 1000 West Carson Street, Box 25, Torrance, CA, 90502, USA
| | - Danielle M Hari
- Department of Surgery, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, 1000 West Carson Street, Box 25, Torrance, CA, 90502, USA
| | - Junko Ozao-Choy
- Department of Surgery, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, 1000 West Carson Street, Box 25, Torrance, CA, 90502, USA
| | - Kathryn T Chen
- Department of Surgery, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, 1000 West Carson Street, Box 25, Torrance, CA, 90502, USA
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Kapadia SG, Kaji AH, Hari DM, Ozao-Choy J, Chen KT. Surgical referral for cholecystectomy in patients with atypical symptoms. Am J Surg 2020; 220:1451-1455. [PMID: 33289652 DOI: 10.1016/j.amjsurg.2020.10.016] [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] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/26/2020] [Accepted: 10/10/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cholelithiasis referrals often present with concomitant or isolated atypical symptoms such as reflux, bloating, or epigastric pain. We sought to identify the impact of preoperative symptomatology of atypical or dyspepsia-type biliary colic on operative and non-operative clinical outcomes. METHODS A retrospective review of patients referred for gallstone disease from 2014 to 2018 at a single institution in Los Angeles County was performed. RESULTS Of 746 patients evaluated for gallstone disease, 87.4% (n = 652) underwent cholecystectomy - 90.8% (n = 592) had symptom resolution postoperatively whereas 9.2% (n = 60) did not. Over half presented with concomitant atypical and/or dyspepsia symptoms (n = 411). Heartburn/reflux was significantly associated with unresolved symptoms postoperatively (OR 2.1,1.0-4.4, p = 0.04). Overall, 11.1% (n = 83) of all 746 patients and 20.2% of patients with atypical and/or dyspepsia symptoms improved with medical management of gastritis or Helicobacter pylori triple therapy pre/post-operatively. CONCLUSION Atypical biliary colic and/or dyspepsia is associated with unresolved symptoms following cholecystectomy. Such patients may benefit from H. pylori testing or PPI trial prior to cholecystectomy.
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Affiliation(s)
- Sonam G Kapadia
- Department of Surgery, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, 1000 West Carson Street, Torrance, CA, 90502, United States
| | - Amy H Kaji
- Department of Surgery, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, 1000 West Carson Street, Torrance, CA, 90502, United States
| | - Danielle M Hari
- Department of Surgery, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, 1000 West Carson Street, Torrance, CA, 90502, United States
| | - Junko Ozao-Choy
- Department of Surgery, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, 1000 West Carson Street, Torrance, CA, 90502, United States
| | - Kathryn T Chen
- Department of Surgery, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, 1000 West Carson Street, Torrance, CA, 90502, United States.
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Mejia I, Bodapati S, Chen KT, Díaz B. Pancreatic Adenocarcinoma Invasiveness and the Tumor Microenvironment: From Biology to Clinical Trials. Biomedicines 2020; 8:E401. [PMID: 33050151 PMCID: PMC7601142 DOI: 10.3390/biomedicines8100401] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/28/2020] [Accepted: 10/03/2020] [Indexed: 12/18/2022] Open
Abstract
Pancreatic adenocarcinoma (PDAC) originates in the glandular compartment of the exocrine pancreas. Histologically, PDAC tumors are characterized by a parenchyma that is embedded in a particularly prominent stromal component or desmoplastic stroma. The unique characteristics of the desmoplastic stroma shape the microenvironment of PDAC and modulate the reciprocal interactions between cancer and stromal cells in ways that have profound effects in the pathophysiology and treatment of this disease. Here, we review some of the most recent findings regarding the regulation of PDAC cell invasion by the unique microenvironment of this tumor, and how new knowledge is being translated into novel therapeutic approaches.
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Affiliation(s)
- Isabel Mejia
- Department of Medicine, Division of Medical Hematology Oncology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA 90502, USA;
| | - Sandhya Bodapati
- College of Osteopathic Medicine, Pacific Western University of Health Sciences, Pomona, CA 91766, USA;
| | - Kathryn T. Chen
- Department of Surgery, Division of Surgical Oncology, Harbor-UCLA Medical Center, Torrance, CA 90502, USA;
| | - Begoña Díaz
- Department of Medicine, Division of Medical Hematology Oncology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA 90502, USA;
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA
- Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, CA 90095, USA
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Wu X, Liu M, Zhuang HW, Chen KT, Yang ZY, Xiong GX. [Cochleo-vestibular lesions and prognosis in patients with profound sudden sensorineural hearing loss: a comparative analysis]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2020; 55:472-478. [PMID: 32842361 DOI: 10.3760/cma.j.cn115330-20190726-00462] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the characteristics of cochleo-vestibular dysfunction in patients with profound sudden deafness, and the prognosis of inner ear hemorrhage. Methods: From January 2017 to December 2018, 92 inpatients with profound sudden sensorineural hearing loss were enrolled in the Department of Otorhinolaryngology, First Affiliated Hospital of Sun Yat-sen University. Our studied patients included 47 males and 45 females, aged 20-78 (39.3±6.1) years. According to the results of inner ear magnetic resonance imaging (MRI), the patients were divided into two groups: inner ear hemorrhage group and non-inner ear hemorrhage group. The clinical features, vestibular tests and audiological examination results during follow up were compared between the two groups. SPSS 22.0 software was used for statistical analysis. Results: The inner ear hemorrhage group consisted of 32 cases (34.8%, 32/92), all of whom complained of vertigo (100%, 32/32). Simultaneous vertigo attack and hearing loss occurred in 78.1% of this group (24/32). Neither semicircular canals function, nor cervical vestibular evoked myogenic potential (c-VEMP), nor ocular vestibular evoked myogenic potential (o-VEMP) in the affected side was normal (100%, 32/32). The rates of benign paroxysmal positional vertigo (BPPV) and disequilibrium were 37.5% (12/32) and 25.0% (8/32) respectively. Hearing improved in 28.1% (9/32) two weeks after treatment, and became stable at one month's follow up. In 60 cases without inner ear hemorrhage, 58.3% of them (35/60) experienced vertigo, which occurred simultaneously with hearing loss in 21 patients (60%, 21/35). The abnormal rates of semicircular canals function, c-VEMP and o-VEMP were 71.6% (43/60), 78.3% (47/60) and 66.7% (40/60), respectively. The incidence of BPPV was 16.7% (10/60) and 8.3% (5/60) in cases with disequilibrium. Hearing improved in 58.3% (35/60) two week after treatment, and became stable at three months' follow up. Significant difference was found in either vertigo rate, or simultaneous vertigo/hearing loss rate, or abnormal c-VEMP/o-VEMP rates, or accompanying BPPV, or disequilibrium rates between the two groups (P<0.05 each). Moreover, we observed better hearing recovery in non-inner ear hemorrhage group in the two weeks, one month, three months and six months' follow up, when compared with those in inner ear hemorrhage groups (P<0.05 each). Conclusions: Inner ear hemorrhage is associated with more severe cochlea-vestibular lesion and poorer prognosis, in comparison to the non-inner ear hemorrhage,in patients with profound sudden sensorineural hearing loss.
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Affiliation(s)
- X Wu
- Department of Otorhinolaryngology, the First Affiliated Hospital, Sun Yat-sen University and Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou 510080, China
| | - M Liu
- Department of Otorhinolaryngology, the First Affiliated Hospital, Sun Yat-sen University and Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou 510080, China
| | - H W Zhuang
- Department of Otorhinolaryngology, the First Affiliated Hospital, Sun Yat-sen University and Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou 510080, China
| | - K T Chen
- Department of Otorhinolaryngology, the First Affiliated Hospital, Sun Yat-sen University and Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou 510080, China
| | - Z Y Yang
- Department of Radiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - G X Xiong
- Department of Otorhinolaryngology, the First Affiliated Hospital, Sun Yat-sen University and Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou 510080, China
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McClintock NC, Satyananda V, Dauphine C, Hari DM, Chen KT, Ozao-Choy JJ. Lipomatous Soft Tissue Masses: Challenging the Paradigm of Routine Preoperative Biopsy. J Surg Res 2019; 247:103-107. [PMID: 31767281 DOI: 10.1016/j.jss.2019.10.037] [Citation(s) in RCA: 5] [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: 04/19/2019] [Revised: 09/26/2019] [Accepted: 10/20/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lipomatous masses are the most common soft tissue tumors. While the majority are benign lipomas, it is important to identify those masses that are malignant prior to excision. Current guidelines recommend core needle biopsy (CNB) for all lipomatous masses larger than 3-5 cm. The objective of this study was to determine if routine preoperative CNB based on mass size is necessary, or if radiographic features can guide the need for CNB. MATERIALS AND METHODS Patients who underwent excision of extremity or truncal lipomatous masses at a single institution from October 2014 to July 2017 were retrospectively reviewed. By protocol, preoperative imaging was routinely obtained for all masses larger than 5 cm. High-risk radiographic features (intramuscular location, septations, nonfat nodules, heterogeneity, and ill-defined margins) and surgical pathology were evaluated to determine patients most likely to benefit from preoperative CNB. RESULTS Of 178 patients, 2 (1.1%) had malignant tumors on surgical pathology. All masses smaller than 5 cm were benign and, if imaging was obtained, had two or fewer high-risk radiographic features. Both of the patients with malignant tumors had masses larger than 5 cm, preoperative imaging that showed at least four high-risk radiographic features, and underwent CNB prior to excision. CONCLUSIONS The overall rate of malignancy is very low. The results of this study suggest that lipomatous masses smaller than 5 cm without concerning clinical characteristics do not require preoperative imaging or CNB. Conversely, lipomatous masses larger than 5 cm should undergo routine MRI with subsequent CNB if multiple high-risk radiographic features are present.
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Affiliation(s)
- Natalie C McClintock
- Division of Surgical Oncology, Department of Surgery, Harbor-UCLA Medical Center, Torrance, California
| | - Vikas Satyananda
- Division of Surgical Oncology, Department of Surgery, Harbor-UCLA Medical Center, Torrance, California
| | - Christine Dauphine
- Division of Surgical Oncology, Department of Surgery, Harbor-UCLA Medical Center, Torrance, California
| | - Danielle M Hari
- Division of Surgical Oncology, Department of Surgery, Harbor-UCLA Medical Center, Torrance, California
| | - Kathryn T Chen
- Division of Surgical Oncology, Department of Surgery, Harbor-UCLA Medical Center, Torrance, California
| | - Junko J Ozao-Choy
- Division of Surgical Oncology, Department of Surgery, Harbor-UCLA Medical Center, Torrance, California.
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McClintock NC, Chen KT, Behare S, Diaz B. N-Myristoyltransferase Inhibition Decreases Tumor Growth in a Syngeneic Mouse Model of Lung Cancer. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.1289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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19
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Lalchandani P, Korn A, Lu JG, French SW, Hou L, Chen KT. Traumatic bile duct neuroma presenting with acute cholangitis: A case report and review of literature. Ann Hepatobiliary Pancreat Surg 2019; 23:282-285. [PMID: 31501819 PMCID: PMC6728252 DOI: 10.14701/ahbps.2019.23.3.282] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 02/11/2019] [Accepted: 02/21/2019] [Indexed: 12/20/2022] Open
Abstract
Traumatic neuroma of the biliary tree has been previously reported as isolated case reports. In literature, these typically present following prior liver transplant or cholecystectomy, wherein the bile ducts have been disrupted in some form. Here we report the case of a 41-year old male who initially presented with acute cholangitis ten years after an open cholecystectomy complicated by a bile leak. Endoscopic retrograde cholangiography revealed a stricture within the mid distal common hepatic duct. The patient temporarily resolved his initial episode with stent placement, and he was eventually taken to the operating room for bile duct resection and hepaticojejunostomy given a persistent stricture and concern for underlying malignancy. Final pathology demonstrated a traumatic bile duct neuroma. This unusual entity should be considered in patients with benign appearing strictures presenting years after surgery, and awareness may aid in preoperative counseling as well.
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Affiliation(s)
- Priti Lalchandani
- Department of General Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Abraham Korn
- Department of General Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Jiajie G Lu
- Department of Pathology, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Samuel W French
- Department of Pathology, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Linda Hou
- Department of Internal Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Kathryn T Chen
- Department of General Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
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Wu X, Liu M, Chen KT, Zhuang HW, Yang ZY, Xiong GX. [Clinical characteristics and etiological analysis of sudden deafness patients with vertigo]. Zhonghua Yi Xue Za Zhi 2019; 99:2197-2202. [PMID: 31434392 DOI: 10.3760/cma.j.issn.0376-2491.2019.28.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the possible causes and mechanisms of sudden deafness with vertigo. Methods: Between August 2016 and December 2017, 74 patients with sudden deafness and vertigo were hospitalized in the Department of Otolaryngology, First Affiliated Hospital of Sun Yat-sen University. Among them, 36 were male and 38 were female, aged 18-75 (40.5±6.5) years. According to the results of magnetic resonance imaging (MRI), the patients were divided into two groups: internal ear hemorrhage (IEH) and non-IEH (NIEH). The characteristics of deafness, vertigo, laboratory examination and follow-up results were compared between the two groups. Results: In IEH group, deafness and vertigo occurred simultaneously in 22 cases (84.6%), abnormalities of semicircular canal function, cervical vestibular evoked myogenic potential (C-VEMP), ocular vestibular evoked myogenic potential (O-VEMP) in 26 cases (100%) and benign paroxysmal positional vertigo (BPPV) in 10 cases (38.5%). The total effective rate was 19.2% (5/26) after 14 days of treatment, and 11 cases (42.3%) appeared disturbance after 180 days of treatment. The abnormal rate of lateral vestibular function, C-VEMP and O-VEMP was 69.2% (18/26), 53.8% (14/26) and 57.7% (15/26) respectively. The improvement of hearing threshold was (28.6±9.7) dB. In NIEH group, deafness and vertigo occurred simultaneously in 25 cases (52.1%). The abnormalities of semicircular canal function, C-VEMP and O-VEMP happened in 37 cases (77.1%), 34 cases (70.8%), 26 cases (54.2%), respectively, and 6 cases (12.5%) were of BPPV. The total effective rate was 52.1% (25/48) after 14 days of treatment. After 180 days of treatment, 8 cases (16.7%) were out of balance, and the abnormal rate of lateral vestibular function, C-VEMP and O-VEMP were 31.2% (15/48), 25.0% (12/48) and 20.8% (10/48) respectively. The improvement of hearing threshold was (42.5±10.3) dB. The incidence of stimulantous deafness and vertigo, vestibular dysfunction rate, BPPV incidence rate and the total effective rate after 14 days of treatment were significantly different between the two groups (all P<0.05). The vestibular and cochlear dysfunction in IEH group was more serious than that in NIEH group. After 180 days of treatment, the vestibular dysfunction rate, imbalance rate and improvement of hearing threshold in NIEH group were significantly higher than that in IEH group (all P<0.05). The recovery of vestibular and cochlear function in NIEH group was better than that in IEH group. Conclusions: Sudden deafness with vertigo can cause vestibular and cochlear dysfunction. Different etiologies may lead to different clinical features and prognosis. The vestibular and cochlear function damage caused by inner ear hemorrhage was more serious and the recovery effect was poor.
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Affiliation(s)
- X Wu
- Department of Otolaryngology, First Affiliated Hospital of Sun Yat-sen University, Institute of Otolaryngology, Sun Yat-sen University, Guangzhou 510080, China
| | - M Liu
- Department of Otolaryngology, First Affiliated Hospital of Sun Yat-sen University, Institute of Otolaryngology, Sun Yat-sen University, Guangzhou 510080, China
| | - K T Chen
- Department of Otolaryngology, First Affiliated Hospital of Sun Yat-sen University, Institute of Otolaryngology, Sun Yat-sen University, Guangzhou 510080, China
| | - H W Zhuang
- Department of Otolaryngology, First Affiliated Hospital of Sun Yat-sen University, Institute of Otolaryngology, Sun Yat-sen University, Guangzhou 510080, China
| | - Z Y Yang
- Department of Radiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - G X Xiong
- Department of Otolaryngology, First Affiliated Hospital of Sun Yat-sen University, Institute of Otolaryngology, Sun Yat-sen University, Guangzhou 510080, China
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Chen KT, Zhuang HW, Wu X, Liu M, Xiong GX. [Clinical study of inner ear hemorrhage-associated sudden deafness and vertigo]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2019; 54:495-500. [PMID: 31315355 DOI: 10.3760/cma.j.issn.1673-0860.2019.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Objective: To analyze the clinical features and possible pathogenesis of sudden deafenss and vertigo induced by inner ear hemorrhage. Methods: Clinical data of 30 patients with inner ear hemorrhage, from the first affiliated hospital of Sun Yat-sen university during Jan 2016 to May 2017, were retrospectively analyzed. Results: Vergito and profound deafness were seen in all patients. The duration of vertigo ranged from 24 hours to three days in 11 cases, three to 14 days in the remaining 19 cases. Simultaneous occurrence of vergito and deafenss were seen in 24 patients. Semicircular canal hypofunction and abnormal cervical vestibular evoked myogenic potentials(C-VEMP)/ocular vestibular evoked myogenic potentials(O-VEMP) were detected in all cases. Ten patients had benign paroxysmal positional vertigo(BPPV) simultaneously. Hearing recovered in 20% of the cohort posttreatment. Dizziness and balance disturbance disappeared 1 to 2 months after therapy in 16 cases. Long term (6 months) follow up revealed poor hearing outcome and vestibular rehabilitation. Conclusion: Vestibular vertigo and profound sensorineural hearing loss, with unsatisfactory clinical prognosis, constituted the characters of inner ear hemorrhage-associated sudden deafness.
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Affiliation(s)
- K T Chen
- Department of Otorhinolaryngology, the First Affiliated Hospital, Sun Yat-sen University and Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou 510080, China
| | - H W Zhuang
- Department of Otorhinolaryngology, the First Affiliated Hospital, Sun Yat-sen University and Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou 510080, China
| | - X Wu
- Department of Otorhinolaryngology, the First Affiliated Hospital, Sun Yat-sen University and Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou 510080, China
| | - M Liu
- Department of Otorhinolaryngology, the First Affiliated Hospital, Sun Yat-sen University and Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou 510080, China
| | - G X Xiong
- Department of Otorhinolaryngology, the First Affiliated Hospital, Sun Yat-sen University and Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou 510080, China
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Baik M, French B, Chen YC, Byers JT, Chen KT, French SW, Díaz B. Identification of invadopodia by TKS5 staining in human cancer lines and patient tumor samples. MethodsX 2019; 6:718-726. [PMID: 31011543 PMCID: PMC6461573 DOI: 10.1016/j.mex.2019.03.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 03/18/2019] [Indexed: 11/19/2022] Open
Abstract
Invadopodia, cancer cell protrusive structures with associated proteolytic activity, provide cancer cells with the ability to remodel the extracellular matrix. Invadopodia facilitate invasive migration and their formation correlates with cancer cell invasiveness and metastatic potential. The unambiguous identification of invadopodia is an important step to undergo studies on invadopodia regulatory inputs, functional outputs, as well as the prevalence and significance of invadopodia for cancer cells and human tumors. The adaptor protein TKS5 is a known invadopodia regulatory protein, which is necessary for invadopodia formation and activity. TKS5 is highly enriched at invadopodia and, unlike other commonly used invadopodia markers, it does not accumulate significantly in other types of cellular protrusions. However, the use of TKS5 as a marker of invadopodia has not been generalized, in part due to the availability of suitable antibodies against the human protein. We have evaluated two commercial antibodies raised against human TKS5. Here, we detail protocols for the detection of invadopodia-associated TKS5 in human cells in culture and in paraffin-embedded archived tumor surgical specimens using commercial antibodies. These methods should facilitate the identification and study of human invadopodia. TKS5 staining identifies invadopodia in human cancer cell lines and archived surgical tumor specimens.
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Affiliation(s)
- Matthew Baik
- Division of Medical Hematology Oncology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Barbara French
- Department of Pathology, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Yu-Chuan Chen
- Division of Medical Hematology Oncology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Joshua T. Byers
- Department of Pathology, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Kathryn T. Chen
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Samuel W. French
- Department of Pathology, Harbor-UCLA Medical Center, Torrance, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Begoña Díaz
- Division of Medical Hematology Oncology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA, USA
- Corresponding author at: Division of Medical Hematology Oncology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1024 W. Carson St., Torrance, CA, 90502, USA.
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Satyananda V, Gupta R, Hari DM, Yeh J, Chen KT. Advances in Translational Research and Clinical Care in Pancreatic Cancer: Where Are We Headed? Gastroenterol Res Pract 2019; 2019:7690528. [PMID: 30863442 PMCID: PMC6378762 DOI: 10.1155/2019/7690528] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 01/08/2019] [Indexed: 02/06/2023] Open
Abstract
While significant advances have been made in the treatment of many different solid tumors, pancreatic cancer remains a glaring exception. Overall 5-year survival rates for pancreatic cancer remain in the single digits. While newer chemotherapy regimens such as FOLFIRINOX and nab-paclitaxel/gemcitabine have demonstrated modest improvement in survival benefit for metastatic disease and have improved the resectability rates of previously borderline or locally advanced tumors, clinically significant improvements from immunotherapy and targeted therapy remain to be demonstrated. Regardless, a wealth of basic science research in pancreatic cancer has been directed at understanding its aggressive biology and its resistance to therapy. We present a brief summary of key areas of laboratory research and its translation to clinical care.
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Affiliation(s)
- Vikas Satyananda
- Division of Surgical Oncology, Department of Surgery, Harbor-UCLA Medical Center, USA
| | - Rohan Gupta
- Division of Medical Oncology, Department of Medicine, Harbor-UCLA Medical Center, USA
| | - Danielle M. Hari
- Division of Surgical Oncology, Department of Surgery, Harbor-UCLA Medical Center, USA
| | - James Yeh
- Division of Medical Oncology, Department of Medicine, Harbor-UCLA Medical Center, USA
| | - Kathryn T. Chen
- Division of Surgical Oncology, Department of Surgery, Harbor-UCLA Medical Center, USA
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Satyananda V, Ozao-Choy J, Dauphine C, Chen KT. Effect of the Affordable Care Act on breast cancer presentation at a safety net hospital. Am J Surg 2019; 217:764-766. [PMID: 30683317 DOI: 10.1016/j.amjsurg.2019.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/06/2018] [Accepted: 01/12/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The Affordable Care Act (ACA) mandated the expansion of Medicaid in order to increase access to health care services. We examined the effect of the ACA on breast cancer screening and diagnosis at a Los Angeles safety net hospital. METHODS We performed a retrospective review of breast cancer patients treated at our institution. We compared two cohorts: patients diagnosed with breast cancer in the years 2011-2012 (pre-ACA) vs. 2015-2016 (post-ACA). RESULTS There were no differences in number of screening mammograms performed, age at diagnosis, mammography-detected cancers, or clinical stage at diagnosis. There was a significant decrease in the number of patients who reported as self-pay (34% vs. 6%, p < 0.0001). CONCLUSION In the 2-year period following ACA implementation, there was limited impact on breast cancer presentation at a safety-net hospital. Long-term follow-up across different healthcare systems is necessary to fully evaluate the global impact of the ACA on breast cancer care.
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Affiliation(s)
- Vikas Satyananda
- Division of Surgical Oncology, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, 90502, USA
| | - Junko Ozao-Choy
- Division of Surgical Oncology, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, 90502, USA
| | - Christine Dauphine
- Division of Surgical Oncology, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, 90502, USA
| | - Kathryn T Chen
- Division of Surgical Oncology, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, 90502, USA.
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Chen YC, Baik M, Byers JT, Chen KT, French SW, Díaz B. Experimental supporting data on TKS5 and Cortactin expression and localization in human pancreatic cancer cells and tumors. Data Brief 2018; 22:132-136. [PMID: 30581916 PMCID: PMC6297239 DOI: 10.1016/j.dib.2018.11.138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 11/12/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 11/27/2022] Open
Abstract
In this article, using human pancreatic cancer cell lines and tumor specimens, we analyze the expression and localization of the invadopodia-related proteins TKS5 and Cortactin. Specifically, we present data on: a) TKS5 expression and localization by immunofluorescence in human pancreatic tumors, b) Cortactin expression by western blotting in various human pancreatic adenocarcinoma cell lines, c) TKS5 and Cortactin localization at invadopodia in BxPC-3 pancreatic adenocarcinoma cells, and d) TKS5 and Cortactin localization by co-immunofluorescence in human pancreatic cancer specimens. Data presented here is related to and supportive of the research article by Chen et al., "TKS5-positive invadopodia-like structures in human tumor surgical specimens" (Chen et al., 2019), where interpretation of the research data presented here is available.
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Affiliation(s)
- Yu-Chuan Chen
- Division of Medical Hematology Oncology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California USA
| | - Matthew Baik
- Division of Medical Hematology Oncology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California USA
| | - Joshua T Byers
- Department of Pathology. Harbor-UCLA Medical Center, Torrance, California USA
| | - Kathryn T Chen
- Department of Surgery. Harbor-UCLA Medical Center, Torrance, California USA.,David Geffen School of Medicine at UCLA, Los Angeles, California USA
| | - Samuel W French
- Department of Pathology. Harbor-UCLA Medical Center, Torrance, California USA.,David Geffen School of Medicine at UCLA, Los Angeles, California USA
| | - Begoña Díaz
- Division of Medical Hematology Oncology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California USA.,David Geffen School of Medicine at UCLA, Los Angeles, California USA.,Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, California USA
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Chen YC, Baik M, Byers JT, Chen KT, French SW, Díaz B. TKS5-positive invadopodia-like structures in human tumor surgical specimens. Exp Mol Pathol 2018; 106:17-26. [PMID: 30439350 DOI: 10.1016/j.yexmp.2018.11.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 10/15/2018] [Revised: 11/02/2018] [Accepted: 11/09/2018] [Indexed: 12/15/2022]
Abstract
Invadopodia, cancer cell protrusions with proteolytic activity, are functionally associated with active remodeling of the extracellular matrix. Here, we show that the invadopodia-related protein TKS5 is expressed in human pancreatic adenocarcinoma lines, and demonstrate that pancreatic cancer cells depend on TKS5 for invadopodia formation and function. Immunofluorescence staining of human pancreatic cancer cells reveals that TKS5 is a marker of mature and immature invadopodia. We also analyze the co-staining patterns of TKS5 and the commonly used invadopodia marker Cortactin, and find only partial co-localization of these two proteins at invadopodia, with a large fraction of TKS5-positive invadopodia lacking detectable levels of Cortactin. Whereas compelling evidence exist on the role of invadopodia as mediators of invasive migration in cultured cells and in animal models of cancer, these structures have never been detected inside human tumors. Here, using antibodies against TKS5 and Cortactin, we describe for the first time structures strongly resembling invadopodia in various paraffin-embedded human tumor surgical specimens from pancreas and other organs. Our results strongly suggest that invadopodia are present inside human tumors, and warrants further investigation on their regulation and occurrence in surgical specimens, and on the value of TKS5 antibodies as pathological research and diagnostic tools.
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Affiliation(s)
- Yu-Chuan Chen
- Division on Medical Oncology Hematology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Matthew Baik
- Division on Medical Oncology Hematology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Joshua T Byers
- Department of Pathology, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Kathryn T Chen
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Samuel W French
- Department of Pathology, Harbor-UCLA Medical Center, Torrance, CA, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Begoña Díaz
- Division on Medical Oncology Hematology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA, USA.
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Yoo T, Hou LA, Reicher S, Chen KT, Eysselein VE. Successful repair of duodenal perforation with endoscopic vacuum therapy. Gastrointest Endosc 2018; 87:1363-1364. [PMID: 29170083 DOI: 10.1016/j.gie.2017.11.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 11/15/2017] [Indexed: 02/08/2023]
Affiliation(s)
- Timothy Yoo
- Department of Internal Medicine, Division of Gastroenterology, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Linda A Hou
- Department of Internal Medicine, Division of Gastroenterology, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Sonya Reicher
- Department of Internal Medicine, Division of Gastroenterology, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Kathryn T Chen
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Viktor E Eysselein
- Department of Internal Medicine, Division of Gastroenterology, Harbor-UCLA Medical Center, Torrance, California, USA
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Chang CH, Lin HJ, Liao YY, Chu FY, Chen KT. Elevated Aminotransferases are Predictors of Hepatic Injury in Blunt Abdominal Trauma Patients. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791302000602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objective Computed tomography (CT) scan is currently the most commonly used tool for evaluating solid-organ injuries in trauma management. However, liberal use of CT scanning increases the risk of excess radiation exposure and toxicity from contrast material. Animal studies and clinical research on the paediatric population indicated that liver enzymes elevations were related to hepatic injury. The present study was undertaken to determine whether elevated liver enzymes were associated with the occurrence of hepatic injury in adult patients with blunt abdominal trauma. Methods This is a cross-sectional study from August 2003 to October 2006. All adult patients with blunt injury to abdomino-pelvic organs documented by CT or surgery who were admitted to Chi-Mei Medical Centre in the captioned period were included. The study population sorted to hepatic injury (HI) and no hepatic injury (NHI) groups according to the presence or absence of hepatic injury. Variables including liver enzymes were compared between the groups. Results Totally 419 patients were included, including 150 patients in the HI group and 269 patients in the NHI group. The HI group was younger and had a lower rate of laparotomy (36.3 years old vs 41.4 years old; 26% vs 42%, respectively). The mean levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in the HI group were significantly higher than levels in the NHI group (439.6 IU/L vs 104.7 IU/L; 353.5 IU/L vs 76.6 IU/L, p<0.01). We define AST >200 IU/L or ALT level >125 IU/L as abnormal according to previous studies. The diagnostic characteristics of hepatic injury were 87.3% sensitivity, 80.3% specificity, 71.2% positive predictive value, and 91.9% negative predictive value. Conclusion In adults who have experienced blunt abdominal trauma, AST >200 U/L or of ALT >125 U/L are practical predictors of hepatic injury. Screening serum aminotransferases will have a role in detecting occult hepatic injury and may reduce the hazards of excessive CT scanning. (Hong Kong j.emerg.med. 2013;20:337-342)
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Affiliation(s)
| | - HJ Lin
- Sourthern Tainan University of Technology, Department of Biotechnology, Tainan, Taiwan
| | - YY Liao
- Chi-Mei Medical Centre, Emergency Department, Liouying, Taiwan
| | - FY Chu
- Chi-Mei Medical Centre, Emergency Department, Chiali, Taiwan
| | - KT Chen
- Taipei Medical University, Department of Emergency Medicine, Taipei, Taiwan
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Chen TJ, Lin HJ, Chen KT. Severe Hyperemesis Gravidarum Masking the Presentations of Hyperthyroidism. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791302000301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Hyperemesis gravidarum may present with weight loss and tachycardia secondary to dehydration. Its severity correlates with the level of the serum chorionic gonadotropin which can interfere with the assay of the thyroid stimulating hormone. Therefore, hyperemesis gravidarum are at times difficult to be distinguished from hyperthyroidism. Missing hyperthyroidism during pregnancy results not only in inappropriate maternal care, but adverse neonatal outcomes including low birth weight. The authors report a case of hyperemesis gravidarum complicated by the concurrence of hyperthyroidism. Goiter and refractory tachycardia are the useful clues to detect occult hyperthyroidism in patients with hyperemesis gravidarum.
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Affiliation(s)
| | - HJ Lin
- Taipei Medical University, Department of Emergency Medicine, Taipei, Taiwan
| | - KT Chen
- Southern Tainan University of Technology, Department of Biotechnology, Taiwan
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Tsai JC, Wang CT, Chen KT. X-Ray Quiz: A 32-Year-Old Female with Abdominal Pain. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791702400211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | - KT Chen
- Taipei Medical University, Department of Emergency Medicine, Taipei, Taiwan
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Chen KT, Devarajan K, Hoffman JP. Morbidity among long-term survivors after pancreatoduodenectomy for pancreatic adenocarcinoma. Ann Surg Oncol 2014; 22:1185-9. [PMID: 25384699 DOI: 10.1245/s10434-014-3969-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND Because pancreatoduodenectomy for pancreatic adenocarcinoma is focused on disease-free and overall survival, morbidity among long-term survivors is not well described. This study sought to evaluate outcomes for long-term survivors of pancreatic cancer after pancreatoduodenectomy. METHODS The authors identified 29 patients from their prospectively collected database of patients with pancreatic adenocarcinoma who had undergone pancreatoduodenectomy and were without evidence of disease during at least 3 years of follow-up evaluation. Demographics, treatment, and pathologic characteristics were collected for review. Data with regard to long-term sequelae also were collected, focusing on those complications requiring additional procedures and on the development of metachronous cancers. RESULTS The median follow-up period was 83 months, with 62 % of patients still alive. All patients received an R0 resection, and 34 % of the patients had N1 disease. For 42 % of the patients, no significant subsequent sequelae occurred. In the four remaining patients (14 %), ascites developed, requiring repeated paracentesis or Denver shunt, with a median time to development (MTD) of 63 months. Six patients (21 %) experienced a biliary stricture requiring stent placement (MTD, 56 months). One patient experienced portal venous thrombosis requiring a venous stent (MTD, 52 months), and four patients (14 %) experienced clinically significant ulcers (MTD, 52 months). With regard to metachronous cancers, two patients experienced subsequent lymphomas (MTD, 92 months). CONCLUSIONS Long-term survivors among patients who undergo pancreatoduodenectomy for pancreatic adenocarcinoma can experience significant late sequelae, which often manifest more than 3 years after surgery. As such, continued follow-up evaluation and counseling are warranted.
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Affiliation(s)
- Kathryn T Chen
- Department of Surgery, St. Luke's Hospital, Southcoast Health System, New Bedford, MA, USA,
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Chen KT, Devarajan K, Milestone BN, Cooper HS, Denlinger C, Cohen SJ, Meyer JE, Hoffman JP. Neoadjuvant chemoradiation and duration of chemotherapy before surgical resection for pancreatic cancer: does time interval between radiotherapy and surgery matter? Ann Surg Oncol 2013; 21:662-9. [PMID: 24276638 DOI: 10.1245/s10434-013-3396-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Indexed: 01/09/2023]
Abstract
BACKGROUND Neoadjuvant chemoradiation and chemotherapy provided for borderline or locally advanced, potentially resectable pancreatic adenocarcinoma improves resectability rates. Response to therapy is also an important prognostic factor. There are no data in the literature regarding optimal time interval or duration of chemotherapy after chemoradiation before surgery, and pathologic response rates. Using our database, we evaluated these relationships and the effect on overall and progression-free survival. METHODS We retrospectively analyzed the records of 83 patients who underwent neoadjuvant chemoradiation for locally advanced, potentially resectable, and borderline resectable pancreatic cancers before definitive resection. We divided patients into three groups according to time interval between completion of chemoradiation and resection: group A (0-10 weeks), group B (11-20 weeks), and group C (>20 weeks). After chemoradiation, patients underwent ongoing chemotherapy before resection. Pathologic response was defined as major (>95% fibrosis), partial (50-94% fibrosis), or minor (<50% fibrosis). RESULTS There were 56 patients in group A, 17 patients in group B, and 10 patients in group C. Patients in groups B and C were significantly more likely to experience a major response than group A (p < 0.013). Patients in group C had significantly increased median progression-free and overall survival (p < 0.05). Multivariable classification and regression tree analysis demonstrated pathologic response to be the only significant factor in overall survival. CONCLUSIONS Patients who underwent a prolonged time interval after neoadjuvant chemoradiation with ongoing chemotherapy were more likely to have an improved pathologic response at time of surgical resection, which was associated with improved median overall survival.
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Affiliation(s)
- Kathryn T Chen
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA,
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Chen SC, Tsai YT, Hu SC, Lin CL, Chen KL, Chen KH, Chen KT. Factors affecting the use of anti-amoebiasis protective measures among Taiwan immigrants returning to amoebiasis-endemic regions. Public Health 2013; 127:1126-32. [PMID: 24169441 DOI: 10.1016/j.puhe.2013.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 04/09/2013] [Accepted: 09/13/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the predictors of use of anti-amoebiasis protective measures (AAPMs) among Taiwan immigrants returning to their country of origin, using the Health Belief Model (HBM) to guide the investigation. DESIGN Cross-sectional study. METHODS Between March and May 2011, all permanent immigrants originating from amoebiasis-endemic countries who received services at the immigrant service centres in Taipei or Tainan and who reported that they had returned to their country of origin within the past five years were enrolled in the study. A structured questionnaire containing questions on sociodemographic characteristics and items related to the constructs of the HBM was used as the data collection instrument. RESULTS Complete information was collected from 384 immigrants, with a response rate of 80% (384/480). The mean age of the subjects was 38.4 years (standard deviation 10.6 years). The majority (70%) of participants did not receive travel information through a pretravel consultation, and more than 17% reported that they did not use measures to prevent amoebiasis. Multiple regression analyses revealed that Chinese proficiency, pretravel consultation and lower barriers to using protective measures were significantly associated with the use of AAPMs during return trips to country of origin (R(2) = 0.45; F = 77.5; P < 0.001). CONCLUSION The HBM significantly predicted the use of AAPMs in this study. A high proportion of immigrants did not use appropriate AAPMs when they returned to their country of origin. Educational approaches should be targeted at immigrants originating from amoebiasis-endemic regions who return to their country of origin.
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Affiliation(s)
- S C Chen
- Department of Family Medicine, Da-Chien General Hospital, Miaoli, Taiwan; General Education Centre, Ta Tung University, Taipei, Taiwan
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Chen KT, Papavasiliou P, Edwards K, Zhu F, Perlis C, Wu H, Turaka A, Berger A, Farma JM. A better prognosis for Merkel cell carcinoma of unknown primary origin. Am J Surg 2013; 206:752-7. [PMID: 23835211 DOI: 10.1016/j.amjsurg.2013.02.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Revised: 12/03/2012] [Accepted: 02/28/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND There is limited evidence that Merkel cell carcinoma (MCC) arising from a nodal basin without evidence of a primary cutaneous (PC) site has better prognosis. We present our experience at 2 tertiary care referral centers with stage III MCC with and without a PC site. METHODS Fifty stage III MCC patients were identified between 1996 and 2011. Clinical data were analyzed, with primary endpoints being disease-free survival and overall survival. RESULTS Of stage III patients, 34 patients presented with a PC site and 16 patients with an unknown primary (UP) site. Treatment strategies varied; of patients with UP vs. PC sites, 25% vs. 44% underwent combined regional lymphadenectomy and radiation, with an additional 25% vs. 15% receiving chemotherapy. The median disease-free survival for a UP site was not reached vs. 15 months for a PC site (hazards ratio = .48, P = .18). The median overall survival for a UP site was not reached vs 21 months for a PC site (hazards ratio = .34, P = .03). Multivariate analysis showed that UP status was a significant factor in overall survival (P = .002). CONCLUSIONS Stage III MCC with a UP site portends a better prognosis than MCC with a PC site.
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Affiliation(s)
- Kathryn T Chen
- Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA.
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35
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Lu JH, Chu FY, Chen KT. Conjunctival Inclusion Cyst. HONG KONG J EMERG ME 2013. [DOI: 10.1177/102490791302000311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Conjunctival inclusion cysts are the most common cystic lesions of the conjunctiva and are either congenital or acquired; the latter are more prevalent. Some of the major factors that provoke the development of an acquired cyst are surgery, trauma, and chronic inflammation. Here, we report on a conjunctival inclusion cyst that developed following a case of untreated chronic conjunctivitis. To temporarily relieve the patient's symptoms a needle aspiration of the cyst was performed, and the patient was referred to an ophthalmologist for surgical excision of the cyst.
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Chung MH, Kuo EY, Wu CM, Chen KT, Lin HJ. Cerebral “eThrombosis”: Cerebral Venous Sinus Thrombosis Associated with Prolonged Sitting in Front of a Computer. HONG KONG J EMERG ME 2013. [DOI: 10.1177/102490791302000207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Venous thromboembolism caused by prolonged sitting during air travel has been recognised as economy-class syndrome for more than 30 years. Since 2003, the term “eThrombosis” has been proposed to describe the 21st Century variant of venous thromboembolism associated with immobilisation. We reported a case of cerebral venous sinus thrombosis presenting with severe headache after a prolonged period of sitting for over 12 hours in front of a computer for recreational purpose. We described this case as cerebral “eThrombosis”. Considering the widespread use of computers for many purposes including working, recreation and communications in the present digital era, we would like to put forward that prolonged immobilisation associated with computer use is a possible provoking risk factor of cerebral venous sinus thrombosis.
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Affiliation(s)
| | | | | | - KT Chen
- Taipei Medical University, Department of Emergency Medicine, Taipei, Taiwan
| | - HJ Lin
- Southern Tainan University of Technology, Department of Biotechnology, Tainan, Taiwan
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37
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Chen TJ, Lin HJ, Chen KT. Severe Hyperemesis Gravidarum Masking the Presentations of Hyperthyroidism. HONG KONG J EMERG ME 2013. [DOI: 10.1177/102490791302000210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Hyperemesis gravidarum may present with weight loss and tachycardia secondary to dehydration. Its severity correlates with the level of the serum chorionic gonadotropin which can interfere with the assay of the thyroid stimulating hormone. Therefore, hyperemesis gravidarum are at times difficult to be distinguished from hyperthyroidism. Missing hyperthyroidism during pregnancy results not only in inappropriate maternal care, but adverse neonatal outcomes including low birth weight. The authors report a case of hyperemesis gravidarum complicated by the concurrence of hyperthyroidism. Goiter and refractory tachycardia are the useful clues to detect occult hyperthyroidism in patients with hyperemesis gravidarum.
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Affiliation(s)
| | - HJ Lin
- Southern Tainan University of Technology, Department of Biotechnology, Taiwan
| | - KT Chen
- Taipei Medical University, Department of Emergency Medicine, Taipei, Taiwan
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38
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Lin CC, Lin CC, Lin HJ, Chen KT. Capnography: An Accurate Method to Assess the Position of the Feeding Tube in a Porcine Model. HONG KONG J EMERG ME 2013. [DOI: 10.1177/102490791302000202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To test the accuracy of capnography in the differential placement of feeding tubes into the trachea versus the oesophagus. Method Nineteen pigs were anesthetised, and feeding tubes were placed into their tracheas and oesophagi. A naïve examiner attached a capnography to the tube and evaluated the presence or absence of flow waveforms on the capnography. In the next step experiment, we gave 20 intentional oesophageal ventilations to the animals to create a distended stomach. The feeding tubes were reinserted, and examined by a naïve examiner by capnography. Results Capnography demonstrated continuous flow waveforms for the feeding tubes placed in the tracheas, but no waveforms were observed for those placed in the oesophagi. In the next step experiment, we found the same results. Conclusion Capnography can be used to accurately determine the placement of tracheal versus oesophageal feeding tubes based on the presence or absence of flow waveforms.
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Affiliation(s)
- CC Lin
- Chi-Mei Hospital, Department of Nursing, Chiali, Tainan, Taiwan
| | - CC Lin
- Chi-Mei Medical Center, Department of Medical Research, Tainan, Taiwan
| | - HJ Lin
- Southern Tainan University of Technology, Department of Biotechnology, Tainan, Taiwan
| | - KT Chen
- Taipei Medical University, Department of Emergency Medicine, Taipei, Taiwan
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Chen KT, Olszanski A, Farma JM. Donor transmission of melanoma following renal transplant. Case Rep Transplant 2012; 2012:764019. [PMID: 23259141 PMCID: PMC3504199 DOI: 10.1155/2012/764019] [Citation(s) in RCA: 5] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 10/10/2012] [Indexed: 11/22/2022] Open
Abstract
Donor transmission of melanoma is one of the more common and lethal of recipient malignancies, often presenting with systemic disease. Although some patients may receive durable remission of melanoma following explantation of the allograft and withdrawal of immunosuppression, donor transmission of melanoma is fatal in most patients. Here we present a case of a 44-year-old male who developed metastatic melanoma following renal transplant.
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Affiliation(s)
- Kathryn T. Chen
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA 19147, USA
| | - Anthony Olszanski
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA 19147, USA
| | - Jeffrey M. Farma
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA 19147, USA
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Affiliation(s)
- Kathryn T Chen
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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41
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Chen KT, Stephens DJ, Anderson E, Acton R, Saltzman D, Hess DJ. Clostridium difficile infection in the pediatric surgery population. J Pediatr Surg 2012; 47:1385-9. [PMID: 22813801 DOI: 10.1016/j.jpedsurg.2011.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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: 05/15/2011] [Revised: 12/01/2011] [Accepted: 12/02/2011] [Indexed: 12/14/2022]
Abstract
PURPOSE The incidence of Clostridium difficile-associated disease (CDAD) in the adult population doubled in the past decade, with increasing morbidity and mortality; however, little research has been performed in the pediatric population. We characterized C difficile infection in the pediatric population, with emphasis on the surgical population. METHODS At a university-based children's hospital, we reviewed 231 patient (birth to 18 years of age) records containing a diagnosis of CDAD between January 1, 2002, and December 31, 2008. RESULTS Clostridium difficile-associated disease incidence increased from 250 per 100,000 hospitalizations in 2002 to 580 per 100,000 hospitalizations in 2008. No fatalities or surgical interventions were attributable to CDAD. Eighty-seven percent of patients received antibiotics within 2 months of diagnosis. Fifty-two percent of patients underwent operative intervention within 2 months of diagnosis; of these, 89% percent received previous antibiotic therapy and 57% were immunosuppressed. The most common antecedent procedures were bone marrow biopsy and line placement for myelodysplastic diseases (40%), followed by renal transplant (11%). CONCLUSIONS Pediatric CDAD incidence doubled during the study period but was not associated with death or operative intervention. A substantial number of CDAD cases were associated with previous operative procedures, particularly in immunosuppressed patients and those who received prior antibiotics.
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Affiliation(s)
- Kathryn T Chen
- Department of Surgery, University of Minnesota, Amplatz Children's Hospital, Minneapolis, MN 55455, USA.
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Papavasiliou P, Piposar JR, Arrangoiz R, Chen KT, Zhu F, Chun YS, Hoffman JP. Margin status and neoadjuvant chemoradiation in patients with borderline resectable pancreatic cancer. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.4_suppl.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
304 Background: The objective of this study was to examine the effect of margin status and neoadjuvant therapy in determining outcomes for borderline resectable (BLR) pancreatic cancer and how neoadjuvant chemoradiation impacts margin of resection. Methods: A retrospective chart review was conducted to identify patients who underwent resection for BLR pancreatic cancer based on the AHPBA/SSO/SSAT consensus definition. Outcomes including overall survival (OS) and disease free survival (DFS) were determined based on margin status, location of positive margin (artery, vein, or pancreas), and receipt of neoadjuvant chemoradiation. Results: One hundred and three patients who met the definition of BLR pancreatic cancer and underwent resection between April 1993 and July 2010 were reviewed. Mean age at diagnosis was 65 with a median follow up time of 19.7 months. Neoadjuvant chemoradiation was administered in 49.5% of patients. Twenty-five percent of patients underwent portal and/or superior mesenteric vein resection, and 7% hepatic artery resection. Microscopic positive margin rate was 54%. Median OS was 17.2 months for patients with positive margins versus 24.9 months for patients with negative margins (p=0.003). Median DFS was 13.1 months for patients with positive margins versus 18.6 months for patients with negative margins (p=0.001). There was no difference in OS or DFS for patients with positive margins based on location or number of positive margins. Of the patients who received neoadjuvant chemoradiation, 61.7% had a negative margin of resection versus a 38.3% negative margin of resection rate for patients who did not receive neoadjuvant chemoradiation (p=0.02). Among patients with a positive margin, there was no difference in OS or DFS with or without neoadjuvant chemoradiation. Conclusions: A positive margin of resection, irrespective of location or number, is associated with worse outcome in patients with BLR pancreatic cancer. The use of neoadjuvant chemoradiation is associated with higher rates of margin free resection.
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Affiliation(s)
- Pavlos Papavasiliou
- Fox Chase Cancer Center, Philadelphia, PA; Temple University Health System, Philadelphia, PA
| | - Jonathan R Piposar
- Fox Chase Cancer Center, Philadelphia, PA; Temple University Health System, Philadelphia, PA
| | - Rodrigo Arrangoiz
- Fox Chase Cancer Center, Philadelphia, PA; Temple University Health System, Philadelphia, PA
| | - Kathryn T Chen
- Fox Chase Cancer Center, Philadelphia, PA; Temple University Health System, Philadelphia, PA
| | - Fang Zhu
- Fox Chase Cancer Center, Philadelphia, PA; Temple University Health System, Philadelphia, PA
| | - Yun Shin Chun
- Fox Chase Cancer Center, Philadelphia, PA; Temple University Health System, Philadelphia, PA
| | - John Parker Hoffman
- Fox Chase Cancer Center, Philadelphia, PA; Temple University Health System, Philadelphia, PA
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Chen KT, Singla S, Papavasiliou P, Devarajan K, Hoffman JP. Revisiting the prognostic significance of positive peritoneal cytology in pancreatic cancer. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.4_suppl.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
177 Background: Positive peritoneal cytology (PPC) in the setting of pancreatic cancer predicts a poor prognosis, such that it is considered metastatic disease in the American Joint Commission on Cancer staging guidelines. We re-evaluate the role of PPC, with particular attention to outcomes following neoadjuvant therapy. Methods: We retrospectively identified 185 patients from January 1, 2000 to present with the diagnosis of pancreatic adenocarcinoma who had undergone peritoneal washings with cytology at the time of planned resection. Data regarding demographics, tumor stage, intraoperative cytology, surgical and chemoradiation therapeutics, and clinicopathological outcomes were analyzed, with the primary endpoints being disease-free and overall survival (DFS and OS). Results: 20 patients (11%) had PPC at the time of planned resection; of these, 11 patients (55%) received neoadjuvant therapy prior to surgery. 165 patients (89%) had negative peritoneal cytology (NPC) at the time of planned resection; of these, 75 (45%) received neoadjuvant therapy prior to surgery. All patients proceeded with resection in the absence of visible metastatic disease. 42% of NPC reached 2-year survival compared to just 20% of patients with PPC. Overall, patients with PPC vs. NPC had significantly poorer DFS (p<0.0064) and OS (p<0.0135). When stratifying by neoadjuvant therapy, in those patients with stage II disease or higher who did not receive neoadjuvant therapy, multivariable CART analysis revealed that PPC predicted poorer DFS compared with NPC (p<0.004). However, among stage II or higher disease receiving neoadjuvant therapy, it failed to show a significant difference in DFS or OS between PPC and NPC. Conclusions: Overall, patients with positive peritoneal cytology are shown to have worse DFS and OS compared to patients with negative peritoneal cytology in pancreatic adenocarcinoma. However, after multivariable analysis, the prognostic significance of positive peritoneal cytology disappears in those patients with stage II and higher disease receiving neoadjuvant therapy.
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Affiliation(s)
- Kathryn T. Chen
- Fox Chase Cancer Center, Philadelphia, PA; Temple University Hospital, Philadelphia, PA
| | - Smit Singla
- Fox Chase Cancer Center, Philadelphia, PA; Temple University Hospital, Philadelphia, PA
| | - Pavlos Papavasiliou
- Fox Chase Cancer Center, Philadelphia, PA; Temple University Hospital, Philadelphia, PA
| | - Karthik Devarajan
- Fox Chase Cancer Center, Philadelphia, PA; Temple University Hospital, Philadelphia, PA
| | - John Parker Hoffman
- Fox Chase Cancer Center, Philadelphia, PA; Temple University Hospital, Philadelphia, PA
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Chen KT, Malo MS, Beasley-Topliffe LK, Poelstra K, Millan JL, Mostafa G, Alam SN, Ramasamy S, Warren HS, Hohmann EL, Hodin RA. A role for intestinal alkaline phosphatase in the maintenance of local gut immunity. Dig Dis Sci 2011; 56:1020-7. [PMID: 20844955 PMCID: PMC3931260 DOI: 10.1007/s10620-010-1396-x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Accepted: 08/12/2010] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Intestinal alkaline phosphatase (IAP) is a gut mucosal defense factor known to dephosphorylate lipopolysaccharide (LPS); however, the role of IAP in the gut response to luminal bacteria remains poorly defined. We investigated immune responses of wild-type (WT) and IAP-knockout (IAP-KO) mice to LPS and Salmonella typhimurium challenges. METHODS Cryostat sectioning and standard indirect immunohistochemical staining for major histocompatibility complex (MHC) class II molecules were performed on liver tissue from WT and IAP-KO mice. WT and IAP-KO mice were orally gavaged with S. typhimurium; bacterial translocation to mesenteric nodes, liver, and spleen was determined by tissue homogenization and plating. In other experiments, WT and IAP-KO mice received intraperitoneal injections of LPS, with subsequent quantification of complete blood counts and serum interleukin (IL)-6 by enzyme-linked immunosorbent assay (ELISA). WT and IAP-KO whole blood were plated and stimulated with LPS and Pam-3-Cys, followed by cytokine assays. RESULTS Immunohistologic liver examinations showed increased expression of MHC class II molecules in IAP-KO mice. Following S. typhimurium challenge, WT mice appeared moribund compared with IAP-KO mice, with increased bacterial translocation. WT mice had >50% decrease (P<.005) in platelets and 1.8-fold (P<.05) increased serum IL-6 compared with IAP-KO mice in response to LPS injections. IAP-KO whole-blood stimulation with LPS and Pam-3-Cys resulted in increased IL-6 and tumor necrosis factor (TNF)-alpha secretion compared with WT. CONCLUSIONS IAP-KO mice exhibit characteristics consistent with local LPS tolerance. Whole-blood response of IAP-KO mice did not reflect systemic tolerance. These data suggest that IAP is a local immunomodulating factor, perhaps regulating LPS-toll-like receptor 4 (TLR4) interaction between commensal microflora and intestinal epithelium.
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Affiliation(s)
- Kathryn T. Chen
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Department of Surgery, University of Minnesota, 420 Delaware Street SE, Mayo Mail Code 195, Minneapolis, MN 55455, USA
| | - Madhu S. Malo
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | | | - Klaas Poelstra
- Department of Pharmacokinetics, Toxicology and Targeting, University of Groningen, Groningen, The Netherlands
| | - Jose Luis Millan
- Sanford Children’s Health Research Center, Burnham Institute for Medical Research, La Jolla, CA 92037, USA
| | - Golam Mostafa
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Sayeda N. Alam
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Sundaram Ramasamy
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - H. Shaw Warren
- Division of Infectious Disease, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Elizabeth L. Hohmann
- Division of Infectious Disease, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Richard A. Hodin
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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Ramasamy S, Nguyen DD, Eston M, Alam SN, Moss AK, Ebrahimi F, Biswas B, Mostafa G, Chen KT, Kaliannan K, Yammine H, Narisawa S, Millán JL, Warren HS, Hohmann EL, Mizoguchi E, Reinecker HC, Bhan AK, Snapper SB, Malo MS, Hodin RA. Intestinal alkaline phosphatase has beneficial effects in mouse models of chronic colitis. Inflamm Bowel Dis 2011; 17:532-42. [PMID: 20645323 PMCID: PMC3154118 DOI: 10.1002/ibd.21377] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The brush border enzyme intestinal alkaline phosphatase (IAP) functions as a gut mucosal defense factor and is protective against dextran sulfate sodium (DSS)-induced acute injury in rats. The present study evaluated the potential therapeutic role for orally administered calf IAP (cIAP) in two independent mouse models of chronic colitis: 1) DSS-induced chronic colitis, and 2) chronic spontaneous colitis in Wiskott-Aldrich Syndrome protein (WASP)-deficient (knockout) mice that is accelerated by irradiation. METHODS The wildtype (WT) and IAP knockout (IAP-KO) mice received four cycles of 2% DSS ad libitum for 7 days. Each cycle was followed by a 7-day DSS-free interval during which mice received either cIAP or vehicle in the drinking water. The WASP-KO mice received either vehicle or cIAP for 6 weeks beginning on the day of irradiation. RESULTS Microscopic colitis scores of DSS-treated IAP-KO mice were higher than DSS-treated WT mice (52±3.8 versus 28.8±6.6, respectively, P<0.0001). cIAP treatment attenuated the disease in both groups (KO=30.7±6.01, WT=18.7±5.0, P<0.05). In irradiated WASP-KO mice cIAP also attenuated colitis compared to control groups (3.3±0.52 versus 6.2±0.34, respectively, P<0.001). Tissue myeloperoxidase activity and proinflammatory cytokines were significantly decreased by cIAP treatment. CONCLUSIONS Endogenous IAP appears to play a role in protecting the host against chronic colitis. Orally administered cIAP exerts a protective effect in two independent mouse models of chronic colitis and may represent a novel therapy for human IBD.
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Affiliation(s)
- Sundaram Ramasamy
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Deanna D. Nguyen
- Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114,Center for the Study of Inflammatory Bowel Disease, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Michelle Eston
- Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Sayeda Nasrin Alam
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Angela K. Moss
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Farzad Ebrahimi
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Brishti Biswas
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Golam Mostafa
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Kathryn T. Chen
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Kanakaraju Kaliannan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Halim Yammine
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Sonoko Narisawa
- Sanford Children’s Health Research Center, Sanford-Burnham Medical Research Institute, La Jolla, CA 92037
| | - José Luis Millán
- Sanford Children’s Health Research Center, Sanford-Burnham Medical Research Institute, La Jolla, CA 92037
| | - H. Shaw Warren
- Infectious Disease Unit, Departments of Pediatrics and Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Elizabeth L. Hohmann
- Infectious Disease Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Emiko Mizoguchi
- Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114,Center for the Study of Inflammatory Bowel Disease, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Hans-Christian Reinecker
- Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114,Center for the Study of Inflammatory Bowel Disease, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Atul K. Bhan
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114,Center for the Study of Inflammatory Bowel Disease, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Scott B. Snapper
- Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114,Center for the Study of Inflammatory Bowel Disease, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Madhu S. Malo
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114,Corresponding Author: Madhu S. Malo, M.D., Ph.D., Department of Surgery, Massachusetts General Hospital, Jackson 812, 55 fruit Street, Boston, MA 02114, Telephone: (617) 726 1956, Fax: (617) 726 3114,
| | - Richard A. Hodin
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
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Malo MS, Alam SN, Mostafa G, Zeller SJ, Johnson PV, Mohammad N, Chen KT, Moss AK, Ramasamy S, Faruqui A, Hodin S, Malo PS, Ebrahimi F, Biswas B, Narisawa S, Millán JL, Warren HS, Kaplan JB, Kitts CL, Hohmann EL, Hodin RA. Intestinal alkaline phosphatase preserves the normal homeostasis of gut microbiota. Gut 2010; 59:1476-84. [PMID: 20947883 DOI: 10.1136/gut.2010.211706] [Citation(s) in RCA: 149] [Impact Index Per Article: 10.6] [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: 12/12/2022]
Abstract
BACKGROUND AND AIMS The intestinal microbiota plays a critical role in maintaining human health; however, the mechanisms governing the normal homeostatic number and composition of these microbes are largely unknown. Previously it was shown that intestinal alkaline phosphatase (IAP), a small intestinal brush border enzyme, functions as a gut mucosal defence factor limiting the translocation of gut bacteria to mesenteric lymph nodes. In this study the role of IAP in the preservation of the normal homeostasis of the gut microbiota was investigated. METHODS Bacterial culture was performed in aerobic and anaerobic conditions to quantify the number of bacteria in the stools of wild-type (WT) and IAP knockout (IAP-KO) C57BL/6 mice. Terminal restriction fragment length polymorphism, phylogenetic analyses and quantitative real-time PCR of subphylum-specific bacterial 16S rRNA genes were used to determine the compositional profiles of microbiotas. Oral supplementation of calf IAP (cIAP) was used to determine its effects on the recovery of commensal gut microbiota after antibiotic treatment and also on the colonisation of pathogenic bacteria. RESULTS IAP-KO mice had dramatically fewer and also different types of aerobic and anaerobic microbes in their stools compared with WT mice. Oral supplementation of IAP favoured the growth of commensal bacteria, enhanced restoration of gut microbiota lost due to antibiotic treatment and inhibited the growth of a pathogenic bacterium (Salmonella typhimurium). CONCLUSIONS IAP is involved in the maintenance of normal gut microbial homeostasis and may have therapeutic potential against dysbiosis and pathogenic infections.
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Affiliation(s)
- M S Malo
- Department of Surgery, Massachusetts General Hospital, Boston, MA 02114, USA.
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Chen KT, Malo MS, Moss AK, Zeller S, Johnson P, Ebrahimi F, Mostafa G, Alam SN, Ramasamy S, Warren HS, Hohmann EL, Hodin RA. Identification of specific targets for the gut mucosal defense factor intestinal alkaline phosphatase. Am J Physiol Gastrointest Liver Physiol 2010; 299:G467-75. [PMID: 20489044 PMCID: PMC2928538 DOI: 10.1152/ajpgi.00364.2009] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Intestinal alkaline phosphatase (IAP) is a small intestinal brush border enzyme that has been shown to function as a gut mucosal defense factor, but its precise mechanism of action remains unclear. We investigated the effects of IAP on specific bacteria and bacterial components to determine its molecular targets. Purulent fluid from a cecal ligation and puncture model, specific live and heat-killed bacteria (Escherichia coli, Salmonella typhimurium, and Listeria monocytogenes), and a variety of proinflammatory ligands (LPS, CpG DNA, Pam-3-Cys, flagellin, and TNF) were incubated with or without calf IAP (cIAP). Phosphate release was determined by using a malachite green assay. The various fluids were applied to target cells (THP-1, parent HT-29, and IAP-expressing HT-29 cells) and IL-8 secretion measured by ELISA. cIAP inhibited IL-8 induction by purulent fluid in THP-1 cells by >35% (P < 0.005). HT29-IAP cells had a reduced IL-8 response specifically to gram-negative bacteria; >90% reduction compared with parent cells (P < 0.005). cIAP had no effect on live bacteria but attenuated IL-8 induction by heat-killed bacteria by >40% (P < 0.005). cIAP exposure to LPS and CpG DNA caused phosphate release and reduced IL-8 in cell culture by >50% (P < 0.005). Flagellin exposure to cIAP also resulted in reduced IL-8 secretion by >40% (P < 0.005). In contrast, cIAP had no effect on TNF or Pam-3-Cys. The mechanism of IAP action appears to be through dephosphorylation of specific bacterial components, including LPS, CpG DNA, and flagellin, and not on live bacteria themselves. IAP likely targets these bacterially derived molecules in its role as a gut mucosal defense factor.
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Affiliation(s)
- Kathryn T. Chen
- 1Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston; ,2Department of Surgery, University of Minnesota, Minneapolis, Minnesota; and
| | - Madhu S. Malo
- 1Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston;
| | - Angela K. Moss
- 1Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston;
| | - Skye Zeller
- 3Division of Infectious Disease, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Paul Johnson
- 3Division of Infectious Disease, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Farzad Ebrahimi
- 1Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston;
| | - Golam Mostafa
- 1Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston;
| | - Sayeda N. Alam
- 1Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston;
| | - Sundaram Ramasamy
- 1Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston;
| | - H. Shaw Warren
- 3Division of Infectious Disease, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Elizabeth L. Hohmann
- 3Division of Infectious Disease, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Richard A. Hodin
- 1Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston;
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Chen KT, Lu CS, Chang TH, Lai YY, Chang TH, Wu CW, Chen CC. Comparison of photodegradative efficiencies and mechanisms of Victoria Blue R assisted by Nafion-coated and fluorinated TiO2 photocatalysts. J Hazard Mater 2010; 174:598-609. [PMID: 19815344 DOI: 10.1016/j.jhazmat.2009.09.094] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Revised: 08/26/2009] [Accepted: 09/17/2009] [Indexed: 05/28/2023]
Abstract
The purposes of this research were to study the effects of two modified photocatalysts, Nafion-coated TiO(2) and fluorinated TiO(2), and photocatalytic degradation of Victoria Blue R in aqueous solution. Photocatalytic degradation of Victoria Blue R was accelerated by the modified photocatalysts. Bulk and surface characterizations of the resulting powders were carried out. Attachment of the anions to the TiO(2) surface using the Nafion-coated-TiO(2) possibly results in increased adsorption of the cationic dye, and the degradation rate is larger for the cationic dye. It was found that Victoria Blue R on the two illuminated TiO(2) surfaces underwent very different changes. To obtain a better understanding on the mechanistic details of this modified-TiO(2)-assisted photodegradation of the Victoria Blue R dye with UV irradiation, a large number of intermediates of the process were separated, identified, and characterized by a high-performance liquid chromatography-mass spectrometry technique. Several probable photodegradation pathways were proposed and discussed.
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Affiliation(s)
- K T Chen
- Department of General Education, Ming Hsing University of Science and Technology, 304 Taiwan, ROC
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Handelsman E, Cheng I, Thompson B, Hershow R, Mofenson LM, Hollinger FB, Chen KT, Burchett SK, Klinzman D, Stapleton JT. Impact of GB virus type C infection on mother-to-child HIV transmission in the Women and Infants Transmission Study Cohort. HIV Med 2008; 8:561-7. [PMID: 17944690 DOI: 10.1111/j.1468-1293.2007.00510.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND GB virus type C (GBV-C) viraemia is associated with a beneficial outcome in HIV-infected individuals in several though not all studies. GBV-C viraemia was examined in a matched case-control study of 133 HIV-infected pregnant women who transmitted HIV to their infants ('cases') and 266 non-transmitting controls. METHODS HIV-infected children and controls were pair-matched for high-risk delivery, race and year of delivery. GBV-C status was determined in maternal plasma samples obtained at or within 3 months of delivery. RESULTS Pregnant women with GBV-C viraemia (11% of those studied) had lower HIV RNA levels (P=0.01) and higher CD4 percentages (P=0.0006) [corrected] than women without GBV-C. A trend towards decreased mother-to-child transmission in the multivariate analysis was observed among GBV-C viraemic women delivering after highly active antiretroviral therapy (HAART) became available [odds ratio (OR) 0.30, 95% confidence interval (CI) 0.08-1.05; P=0.06], but not in women delivering prior to the widespread use of HAART. CONCLUSIONS GBV-C viraemia was associated with a beneficial effect on CD4 percentage and HIV RNA level in these pregnant women, and was also associated with a trend towards reduced risk of mother-to-child HIV transmission among women after HAART became available. Further studies with larger or multiple cohorts are necessary to assess possible benefits in this population.
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Abstract
BACKGROUND The cuff pressures may be different in oesophageal and tracheal intubations. We conducted a study to evaluate if cuff pressures of endotracheal tubes (ETTs) could provide information to distinguish tracheal or oesophageal intubations in a pig trachea-oesophagus model. METHODS In each preparation of pig trachea-oesophagus model, the trachea and the oesophagus were intubated separately with a cuffed ETT, and the cuff pressures were measured after each 1 ml increment of air (1-10 ml) during inflation. The cuff pressures and the pressure-volume relationships in both intubations were compared. RESULTS The cuff pressures of oesophageal intubations were significantly higher than those of tracheal intubations in all comparisons from 1 to 10 ml of cuff volumes (P < 0.05). The cuff pressure-volume curve was steeper in the oesophageal intubation group, and the difference between the two curves was the largest when the cuff volume was 4-5 ml. CONCLUSIONS We conclude that the cuff pressures may be useful in detecting oesophageal intubations. This method is faster than other confirmation measures as it can detect inadvertent oesophageal intubations at the time of inflating the cuffs.
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Affiliation(s)
- H J Lin
- Department of Emergency Medicine, Chi-Mei Medical Center, 901 Chung-Hwa Road, Yung-Kung City, Tainan 710, Taiwan
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