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Jin W, Shen S, Xu X, Xie X, Zhou X, Su X, Wu L, Wang S, Zhang L, Chen B, Yang F. All-in-one hydrogel patches with sprayed bFGF-loaded GelMA microspheres for infected wound healing studies. Int J Pharm 2024; 658:124205. [PMID: 38734278 DOI: 10.1016/j.ijpharm.2024.124205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 04/30/2024] [Accepted: 05/03/2024] [Indexed: 05/13/2024]
Abstract
The current wound healing process faces numerous challenges such as bacterial infection, inflammation and oxidative stress. However, wound dressings used to promote wound healing, are not well suited to meet the clinical needs. Hyaluronic acid (HA) not only has excellent water absorption and good biocompatibility but facilitates cell function and tissue regeneration. Dopamine, on the other hand, increases the overall viscosity of the hydrogel and possesses antioxidant property. Furthermore, chitosan exhibits outstanding performance in antimicrobial, anti-inflammatory and antioxidant activities. Basic fibroblast growth factor (bFGF) is conducive to cell proliferation and migration, vascular regeneration and wound healing. Hence, we designed an all-in-one hydrogel patch containing dopamine and chitosan framed by hyaluronic acid (HDC) with sprayed gelatin methacryloyl (GelMA) microspheres loaded with bFGF (HDC-bFGF). The hydrogel patch exhibits excellent adhesive, anti-inflammatory, antioxidant and antibacterial properties. In vitro experiments, the HDC-bFGF hydrogel patch not only showed significant inhibitory effect on RAW cell inflammation and Staphylococcus aureus (S. aureus) growth but also effectively scavenged free radicals, in addition to promoting the migration of 3 T3 cells. In the mice acute infected wound model, the HDC-bFGF hydrogel patch adhered to the wound surface greatly accelerated the healing process via its anti-inflammatory and antioxidant activities, bacterial inhibition and pro-vascularization effects. Therefore, the multifunctional HDC-bFGF hydrogel patch holds great promise for clinical application.
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Affiliation(s)
- Wenzhang Jin
- Department of Vascular Surgery, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang Province Wenzhou 325000, PR China; Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, PR China; Department of Colorectal Surgery, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310000, PR China
| | - Shuqi Shen
- Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, PR China
| | - Xiaoniuyue Xu
- Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, PR China; Department of Hand Surgery, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang Province Wenzhou 325000, PR China
| | - Xueting Xie
- Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, PR China
| | - Xingjian Zhou
- Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, PR China
| | - Xiang Su
- Department of Vascular Surgery, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang Province Wenzhou 325000, PR China; Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, PR China
| | - Lina Wu
- Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, PR China
| | - Shunfu Wang
- Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, PR China
| | - Lijiang Zhang
- Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, PR China
| | - Bicheng Chen
- Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, PR China.
| | - Fajing Yang
- Department of Vascular Surgery, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang Province Wenzhou 325000, PR China; Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, PR China.
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Palui R, Sridharan K, Sahoo J, Suryadevara V, Kamalanathan S, Naik D, Halanaik D, Durgia H, Raj H. Role of bisphosphonates in hypertrophic osteoarthropathy: a systematic review. Endocrine 2024:10.1007/s12020-024-03804-5. [PMID: 38564085 DOI: 10.1007/s12020-024-03804-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/25/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND The role of bisphosphonates (BP) in hypertrophic osteoarthropathy (HPOA) is unclear. We presented a case of primary HPOA and performed a systematic review of literature on the effect of BP on treatment response in primary and secondary HPOA. METHODS The study was prospectively registered in PROSPERO (CRD42022343786). We performed a PubMed literature search that restricted to the English language. We included patients diagnosed with primary or secondary HPOA who received BP. The primary endpoint assessed was the effectiveness of BP on response to pain or arthritis. Secondary outcomes included timing, degree, and duration of response, comparison to other HPOA therapies, impact of BP on radiology, bone scan, bone turnover markers, and adverse effects of BP. RESULTS Literature search retrieved only case reports. Forty-five patients (21 primary, 24 secondary HPOA) had received BP. Majority(88.3%) experienced improvement in pain or arthritis. Response was gradual for primary HPOA and within a median of 3 to 7 days for secondary HPOA after treatment with BP. Most patients had reduced bone scan uptake after BP. When other HPOA therapies were tried, half responded to BP after not having previously responded to other therapies, while a third received the treatments concurrently, making it difficult to attribute treatment response to a drug. Reporting of other secondary outcomes was very heterogenous and qualitative to draw conclusions. No major adverse effects have been reported for BP in HPOA. CONCLUSION Bisphosphonates provide an effective and safe treatment option for primary and secondary HPOA. However, there is a lack of randomized controlled trials.
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Affiliation(s)
- Rajan Palui
- Consultant Endocrinologist, The Mission Hospital, Durgapur, West Bengal, India
| | - Kalyani Sridharan
- Department of Endocrinology, All India Institute of Medical Sciences (AIIMS), Rishikesh, India.
| | - Jayaprakash Sahoo
- Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Varun Suryadevara
- Associate Consultant Endocrinologist, Apollo Hospitals, Bangalore, Karnataka, India
| | - Sadishkumar Kamalanathan
- Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Dukhabandhu Naik
- Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Dhanapathi Halanaik
- Department of Nuclear Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Harsh Durgia
- Consultant Endocrinologist, Dr Harsh's Endocrine and Diabetes Center, Rajkot, Gujarat, India
| | - Henith Raj
- Consultant Endocrinologist, Dr Jayaharan Memorial Hospital, Nagercoil, Tamilnadu, India
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Jubashi T, Horai Y, Tomokawa T, Hara K, Kawakami A. Takayasu's arteritis after a prolonged course of hypertrophic osteoarthropathy. Mod Rheumatol Case Rep 2023; 8:107-111. [PMID: 37494419 DOI: 10.1093/mrcr/rxad042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/09/2023] [Accepted: 07/10/2023] [Indexed: 07/28/2023]
Abstract
A 71-year-old male with hypertrophic osteoarthropathy was referred to our hospital because of a nocturnal fever and tenderness stretching from the left parotid region to the left front neck, in which antibacterials were ineffective. He was diagnosed with Takayasu's arteritis following findings of contrast-enhanced computed tomography and neck ultrasound. This is the first report to describe the development of Takayasu's arteritis after a prolonged course of typical hypertrophic osteoarthropathy, and the proposed hypertrophic osteoarthropathy and Takayasu's arteritis have common underlying pathophysiological factors.
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Affiliation(s)
- Takashi Jubashi
- Department of Rheumatology, Sasebo City General Hospital, Sasebo, Nagasaki, Japan
| | - Yoshiro Horai
- Department of Rheumatology, Sasebo City General Hospital, Sasebo, Nagasaki, Japan
| | - Takuya Tomokawa
- Department of Rheumatology, Sasebo City General Hospital, Sasebo, Nagasaki, Japan
| | - Kazusato Hara
- Department of Rheumatology, Sasebo City General Hospital, Sasebo, Nagasaki, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Koliakos E, Chappalley D, Kalogiannis E, Sgardello S, Christodoulou M. Pierre-Marie Bamberger Syndrome Leading to the Diagnosis and Surgical Treatment of a Localized Lung Cancer. Cureus 2023; 15:e48991. [PMID: 38111395 PMCID: PMC10726300 DOI: 10.7759/cureus.48991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2023] [Indexed: 12/20/2023] Open
Abstract
Hypertrophic osteoarthropathy (HOA), manifested with digital clubbing, tubular bone periostosis, and large joint synovial effusions, exists in two forms: primary, which is the rarest form, and secondary. The latter is frequently associated with lung diseases and, in some cases, with non-small cell lung cancer (NSCLC) and is thus expressed in the form of a paraneoplastic syndrome. We report the case of a male smoker who was presented with secondary hypertrophic osteoarthropathy and was subsequently diagnosed with primary adenocarcinoma of the lung. A 63-year-old male with a history of ischemic heart disease and heavy tobacco consumption (60 pack-years) presented with painful osteoarthritis of all four extremities. A chest computed tomography (CT), a positron emission tomography (PET) scan, and a bronchoscopy revealed a 9 cm mass within the right lower lobe without mediastinal adenopathy. Bilateral lower limb X-rays revealed osteoarthropathy of the tibia. A right lower lobectomy and mediastinal lymph node dissection were performed. Final histopathology analysis reported an advanced mixed pulmonary adenocarcinoma. The postoperative course was uneventful and the patient was discharged on postoperative day 6. This report has highlighted the importance of clinical awareness of the association between HOA and carcinoma of the lung.
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Affiliation(s)
| | - Dimitri Chappalley
- Department of Visceral Surgery, CHUV (Centre Hospitalier Universitaire Vaudois) - Lausanne University Hospital, Lausanne, CHE
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Lu Q, Xu Y, Zhang Z, Li S, Zhang Z. Primary hypertrophic osteoarthropathy: genetics, clinical features and management. Front Endocrinol (Lausanne) 2023; 14:1235040. [PMID: 37705574 PMCID: PMC10497106 DOI: 10.3389/fendo.2023.1235040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/31/2023] [Indexed: 09/15/2023] Open
Abstract
Primary hypertrophic osteoarthropathy (PHO) is a genetic disorder mainly characterized by clubbing fingers, pachydermia and periostosis. Mutations in the HPGD or SLCO2A1 gene lead to impaired prostaglandin E2 (PGE2) degradation, thus elevating PGE2 levels. The identification of the causative genes has provided a better understanding of the underlying mechanisms. PHO can be divided into three subtypes according to its pathogenic gene and inheritance patterns. The onset age, sex ratio and clinical features differ among subtypes. The synthesis and signaling pathways of PGE2 are outlined in this review. Cyclooxygenase-2 (COX-2) is the key enzyme that acts as the rate-limiting step for prostaglandin production, thus COX-2 inhibitors have been used to treat this disease. Although this treatment showed effective results, it has side effects that restrain its use. Here, we reviewed the genetics, clinical features, differential diagnosis and current treatment options of PHO according to our many years of clinical research on the disease. We also discussed probable treatment that may be an option in the future.
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Affiliation(s)
- Qi Lu
- Shanghai Clinical Research Center of Bone Disease, Department of Osteoporosis and Bone Diseases, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Yang Xu
- Shanghai Clinical Research Center of Bone Disease, Department of Osteoporosis and Bone Diseases, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Zeng Zhang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Shanshan Li
- Shanghai Clinical Research Center of Bone Disease, Department of Osteoporosis and Bone Diseases, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Zhenlin Zhang
- Shanghai Clinical Research Center of Bone Disease, Department of Osteoporosis and Bone Diseases, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
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Tagawa R, Soda H, Dotsu Y, Senju H, Irifune S, Yoshida M, Nakashima S, Umemura A, Iwasaki K, Taniguchi H, Takemoto S, Fukuda Y, Mukae H. Hypertrophic osteoarthropathy associated with lung cancer: Possible links among hypoxia‐inducible factor‐1α, vascular endothelial growth factor, and hypervascularization. Thorac Cancer 2023; 14:1320-1324. [PMID: 36967655 PMCID: PMC10175026 DOI: 10.1111/1759-7714.14869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Abstract
Hypertrophic osteoarthropathy (HOA) is a paraneoplastic syndrome, the exact pathogenesis of which remains to be elucidated. The case of a 69-year-old man who developed intractably painful HOA secondary to lung cancer is presented. Contrast-enhanced computed tomography of the chest showed an 80-mm solid nodule with a large low-density area. The patient was diagnosed as having stage IIIA undifferentiated non-small cell lung cancer. The combination of carboplatin and paclitaxel with bevacizumab reduced tumor size and plasma vascular endothelial growth factor (VEGF) levels, relieving his leg pain. On immunohistochemical examination, lung cancer cells were positive for VEGF. A hypoxic tumor microenvironment may have caused some lung cancer cells to express hypoxia-inducible factor-1α, which contributed, at least in part, to the production of VEGF. The deep dermis vessels showed proliferation in the shin, with their thickened walls positive for VEGF. These findings may encourage investigators to explore novel management strategies for painful HOA.
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Alhaskawi A, Zhou H, Dong Y, Lai J, Wang Z, Hasan Abdullah Ezzi S, Goutham Kota V, Hasan Abdulla Hasan Abdulla M, Sun Z, Lu H. The first case report of an intraosseous epidermoid cyst in the distal phalanx of the index finger with infection resulting in single clubbing finger: A case report and review of the literature. Front Surg 2023; 9:1008358. [PMID: 36733677 PMCID: PMC9887288 DOI: 10.3389/fsurg.2022.1008358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 12/27/2022] [Indexed: 01/18/2023] Open
Abstract
An intraosseous epidermoid cyst at the distal phalanx of the index finger is extremely rare. These cysts are asymptomatic unless ruptured, severely infected, or transformed into malignant squamous cell carcinoma. We present a case of a single clubbing finger in an adult diagnosed with an intraosseous epidermoid cyst in the distal phalanx of the left index finger with no history of pulmonary or cardiovascular diseases. Preoperative MRI showed an expansile lytic lesion with a sclerotic margin. Histopathological examination indicates that there is keratinous cell debris in the cyst with a wall of stratified squamous epithelium, which was the key to the correct diagnosis of an intraosseous epidermoid cyst. Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
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Affiliation(s)
- Ahmad Alhaskawi
- Department of Orthopedics, the First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Haiying Zhou
- Department of Orthopedics, the First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Yanzhao Dong
- Department of Orthopedics, the First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Jingtian Lai
- Department of Orthopedic, Zhejiang University School of Medicine, Hangzhou, China
| | - Zewei Wang
- Department of Orthopedic, Zhejiang University School of Medicine, Hangzhou, China
| | | | - Vishnu Goutham Kota
- Department of Orthopedic, Zhejiang University School of Medicine, Hangzhou, China
| | | | - Zhenyu Sun
- Department of Orthopedics, the First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Hui Lu
- Department of Orthopedics, the First Affiliated Hospital, Zhejiang University, Hangzhou, China,Correspondence: Hui Lu
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8
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Impact of highly effective CFTR modulator therapy on digital clubbing in patients with cystic fibrosis. J Cyst Fibros 2022; 21:861-865. [DOI: 10.1016/j.jcf.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 05/21/2022] [Accepted: 07/10/2022] [Indexed: 11/22/2022]
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Foreman M, Belmudes A, Villiers E, Scarpante E. Case Report: Diffuse Lumbar Hyperostosis Causing Vertebral Canal Stenosis in a Dog With Concurrent Multicentric T-Cell Lymphoma. Front Vet Sci 2022; 9:825525. [PMID: 35812849 PMCID: PMC9258736 DOI: 10.3389/fvets.2022.825525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
A 4-year-old female spayed Bullmastiff-cross presented with a 24-h history of progressive paraparesis. Neurological examination was consistent with L4–S3 myelopathy. On magnetic resonance imaging (MRI), all vertebrae showed homogenously increased short tau inversion recovery (STIR) signal with strong contrast enhancement. The vertebral canal was concentrically narrowed along the length of the L5 vertebra secondary to bony proliferation of the vertebral pedicles, dorsal lamina, and vertebral body. Cytological analysis of the peripheral lymph nodes and subsequent flow cytometry was consistent with T-cell lymphoma. The dog was euthanised due to poor prognosis. Necropsy confirmed the presence of stage V multicentric T-cell lymphoma, as well as diffuse hyperostosis of the vertebral bodies. This is the first report of presumed paraneoplastic lumbar skeletal hyperostosis.
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Affiliation(s)
- Max Foreman
- Neurology and Neurosurgery Service, Dick White Referrals, Part of Linnaeus Veterinary Limited, Cambridgeshire, United Kingdom
- *Correspondence: Max Foreman
| | - Audrey Belmudes
- Diagnostic Imaging Service, Dick White Referrals, Part of Linnaeus Veterinary Limited, Cambridgeshire, United Kingdom
| | - Elizabeth Villiers
- Clinical Pathology Service, Dick White Referrals, Part of Linnaeus Veterinary Limited, Cambridgeshire, United Kingdom
| | - Elena Scarpante
- Neurology and Neurosurgery Service, Dick White Referrals, Part of Linnaeus Veterinary Limited, Cambridgeshire, United Kingdom
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Zhou Y, Wang W, Zhong L, Wang L, Ma M, Tang X, Li Z, Wang C, Gou L, Zhang T, Song H. Clinical and genetic spectrum of 14 cases of NLRP3-associated autoinflammatory disease (NLRP3-AID) in China and a review of the literature. Orphanet J Rare Dis 2022; 17:214. [PMID: 35668534 PMCID: PMC9169254 DOI: 10.1186/s13023-022-02364-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 05/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND NLRP3-associated autoinflammatory disease (NLRP3-AID), caused by mutations of NLRP3, is one of the autoinflammatory diseases affecting inflammasomes. Since there are little cases of Chinese NLRP3-AID, we reported 14 Chinese NLRP3-AID patients in our center and summarized the clinical features of all Chinese patients by reviewing the literature. RESULTS Fourteen patients had been diagnosed as NLRP3-AID in our center. 12 different NLRP3 variants were identified, among which one is novel: p.Leu361Trp. Rash, recurrent fever, arthritis/arthralgia, uveitis, sensorineural deafness, symptoms of central neural systems (CNS), and increased inflammatory markers (including CRP, ESR, except Ferritin) were the common findings in Chinese patients. The frequencies of fever, neurological symptoms, musculoskeletal manifestations and ocular manifestations in Chinese patients might differ from that of patients from other regions. Besides, we also found clubbing fingers and optic neuritis in some NLRP3-AID patients, which were not commonly mentioned in previous reports. CONCLUSION In our study, we expanded the clinical spectrum as well as the genetic pathogenic variants of NLRP3-AID. We also found that there were some differences between Chinese patients and patients from other regions, and that Chinese patients were more likely to develop severe symptoms.
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Affiliation(s)
- Yu Zhou
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Wei Wang
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China. .,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China.
| | - Linqing Zhong
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Lin Wang
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Mingsheng Ma
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Xiaoyan Tang
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Zhuo Li
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Changyan Wang
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Lijuan Gou
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Tiannan Zhang
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Hongmei Song
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China. .,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China.
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Cutaneous manifestations of monoclonal gammopathy. Blood Cancer J 2022; 12:58. [PMID: 35411042 PMCID: PMC9001632 DOI: 10.1038/s41408-022-00661-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/17/2022] [Accepted: 02/23/2022] [Indexed: 12/29/2022] Open
Abstract
Monoclonal gammopathy associated with dermatological manifestations are a well-recognized complication. These skin disorders can be associated with infiltration and proliferation of a malignant plasma cells or by a deposition of the monoclonal immunoglobulin in a nonmalignant monoclonal gammopathy. These disorders include POEMS syndrome, light chain amyloidosis, Schnitzler syndrome, scleromyxedema and TEMPI syndrome. This article provides a review of clinical manifestations, diagnostics criteria, natural evolution, pathogenesis, and treatment of these cutaneous manifestations.
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Parperis K, Constantinidou A, Panos G. Paraneoplastic Arthritides: Insights to Pathogenesis, Diagnostic Approach, and Treatment. J Clin Rheumatol 2021; 27:e505-e509. [PMID: 31743270 DOI: 10.1097/rhu.0000000000001202] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Paraneoplastic arthritides are a group of inflammatory rheumatic syndromes induced by an occult and manifest malignancy, characterized by a wide range of musculoskeletal signs and symptoms that masquerade other rheumatic diseases such as rheumatoid arthritis. Although the pathogenesis of paraneoplastic arthritides is unknown, immune-mediated mechanisms can induce a paraneoplastic syndrome, with a dominant feature the polyarthritis. Common entities of paraneoplastic arthritides include paraneoplastic polyarthritis, hypertrophic osteoarthropathy, remitting seronegative symmetrical synovitis with pitting edema, palmar fasciitis and polyarthritis, and polyarthritis and panniculitis associated with pancreatic carcinoma. The electronic databases PubMed and Scopus were scrutinized using the following terms: paraneoplastic arthritis, paraneoplastic polyarthritis, or paraneoplastic rheumatic diseases. Abstracts, full articles, and selected references were reviewed. The aim of the present narrative review article was to describe the clinical characteristics, diagnostic evaluation, and management of paraneoplastic arthritides, and highlight the challenges that health care providers may encounter, distinguishing those conditions from other autoimmune rheumatic disorders. Future studies are needed to give insight into the mechanisms associated with paraneoplastic arthritides, leading to the development of novel diagnostic biomarkers.
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Affiliation(s)
- Konstantinos Parperis
- From the Division of Rheumatology, Department of Internal Medicine, University of Arizona College of Medicine/Maricopa Integrated Health System, Phoenix, AZ; and University of Cyprus Medical School
| | | | - George Panos
- Department of Internal Medicine, University of Cyprus Medical School, Nicosia, Cyprus
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Prajapati BB, Filippi A, Sears EH. Chronic Joint Pain in a Young Adult With Cystic Fibrosis. Cureus 2021; 13:e17229. [PMID: 34540456 PMCID: PMC8442824 DOI: 10.7759/cureus.17229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2021] [Indexed: 12/03/2022] Open
Abstract
A 25-year-old male with end-stage cystic fibrosis (CF) with genotype F508del/F508del presented to the clinic complaining of bilateral knee and ankle pain. He had severe lung disease (forced expiratory volume 1 {FEV1} 19% of predicted), chronic colonization with achromobacter, malnutrition, and CF-related diabetes. On physical examination, he was found to have bilateral knee swelling as well as pain on flexion and extension of the wrists and ankles without erythema or warmth. He was empirically started on prednisone and tramadol; however, at a three-month follow-up visit, he remained symptomatic. He was sent for a whole-body bone scan, which was consistent with hypertrophic pulmonary osteoarthropathy (HPOA). He was started on highly effective modulator therapy with elexacaftor/tezacaftor/ivacaftor and symptoms spontaneously resolved without further intervention.
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Affiliation(s)
| | - Alexandra Filippi
- Pulmonary and Critical Care Medicine, Maine Medical Center, Portland, USA
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Pathological Role of Phosphoglycerate Kinase 1 in Balloon Angioplasty-Induced Neointima Formation. Int J Mol Sci 2021; 22:ijms22168822. [PMID: 34445528 PMCID: PMC8396187 DOI: 10.3390/ijms22168822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/15/2021] [Accepted: 08/16/2021] [Indexed: 02/07/2023] Open
Abstract
Restenosis is a common vascular complication after balloon angioplasty. Catheter balloon inflation-induced transient ischemia (hypoxia) of local arterial tissues plays a pathological role in neointima formation. Phosphoglycerate kinase 1 (PGK1), an adenosine triphosphate (ATP)-generating glycolytic enzyme, has been reported to associate with cell survival and can be triggered under hypoxia. The purposes of this study were to investigate the possible role and regulation of PGK1 in vascular smooth muscle cells (VSMCs) and balloon-injured arteries under hypoxia. Neointimal hyperplasia was induced by a rat carotid artery injury model. The cellular functions and regulatory mechanisms of PGK1 in VSMCs were investigated using small interfering RNAs (siRNAs), chemical inhibitors, or anaerobic cultivation. Our data indicated that protein expression of PGK1 can be rapidly induced at a very early stage after balloon angioplasty, and the silencing PGK1-induced low cellular energy circumstance resulted in the suppressions of VSMC proliferation and migration. Moreover, the experimental results demonstrated that blockage of PDGF receptor-β (PDGFRB) or its downstream pathway, the phosphoinositide 3-kinase (PI3K)-AKT-mammalian target of rapamycin (mTOR) axis, effectively reduced hypoxia-induced factor-1 (HIF-1α) and PGK1 expressions in VSMCs. In vivo study evidenced that PGK1 knockdown significantly reduced neointima hyperplasia. PGK1 was expressed at the early stage of neointimal formation, and suppressing PGK1 has a potential beneficial effect for preventing restenosis.
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Martin-Broto J, Mondaza-Hernandez JL, Moura DS, Hindi N. A Comprehensive Review on Solitary Fibrous Tumor: New Insights for New Horizons. Cancers (Basel) 2021; 13:cancers13122913. [PMID: 34200924 PMCID: PMC8230482 DOI: 10.3390/cancers13122913] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/01/2021] [Accepted: 06/04/2021] [Indexed: 12/16/2022] Open
Abstract
Simple Summary Solitary fibrous tumor (SFT) is a malignant condition that exhibits different clinical behaviors ranging from low to high aggressive SFT, with dedifferentiated SFT (DD-SFT) being the fastest-growing subtype. Even when surgery alone provides curation rates above 60%, recurrences do occur in a fraction of patients where surgery is unable to provide disease control. Among the systemic therapeutic options, antiangiogenic compounds have shown higher efficacy than chemotherapy by indirect comparisons. Furthermore, rotating different antiangiogenics, at the progression time, has been shown to be effective. The exception is DD-SFT since it is resistant to antiangiogenics but can respond to chemotherapy. This comprehensive review also analyzes the underlying molecular components that play a key role in SFT origin and aggressiveness. The discovery in 2013 of anomalous fusion genes between NAB2 and STAT6 was determinant to increase the knowledge on the molecular drivers in SFT that could be potential targets for future therapies. Abstract Solitary fibrous tumor (SFT) is a rare mesenchymal, ubiquitous tumor, with an incidence of 1 new case/million people/year. In the 2020 WHO classification, risk stratification models were recommended as a better tool to determine prognosis in SFT, to the detriment of “typical” or “malignant” classic terms. The risk for metastasis is up to 35–45%, or even greater, in series with a longer follow-up. Over the last few decades, advances in immunohistochemistry and molecular diagnostics identified STAT6 nuclear protein expression and the NAB2–STAT6 fusion gene as more precise tools for SFT diagnosis. Recent evidence taken from retrospective series and from two prospective phase II clinical trials showed that antiangiogenics are active and their sequential use from first line should be considered, except for dedifferentiated SFT for which chemotherapy is the best option. Since the fusion transcript driver’s first description in 2013, new insights have been brought on key molecular events in SFT. This comprehensive review mainly focuses on the superior efficacy of antiangiogenics over chemotherapeutic agents in SFT, provides the current knowledge of key molecules that could co-drive the SFT behavior, and suggests new target candidates that deserve to be explored in preclinical and clinical research in SFT.
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Affiliation(s)
- Javier Martin-Broto
- Fundacion Jimenez Díaz University Hospital, 28040 Madrid, Spain;
- General de Villalba University Hospital, Collado Villalba, 28400 Madrid, Spain
- Fundación Jiménez Díaz Institute for Medical Research (IIS/FJD), 28040 Madrid, Spain
- Correspondence:
| | - Jose L. Mondaza-Hernandez
- Institute of Biomedicine of Seville (IBiS, CSIC, US and HUVR), 41013 Sevilla, Spain; (J.L.M.-H.); (D.S.M.)
| | - David S. Moura
- Institute of Biomedicine of Seville (IBiS, CSIC, US and HUVR), 41013 Sevilla, Spain; (J.L.M.-H.); (D.S.M.)
| | - Nadia Hindi
- Fundacion Jimenez Díaz University Hospital, 28040 Madrid, Spain;
- General de Villalba University Hospital, Collado Villalba, 28400 Madrid, Spain
- Fundación Jiménez Díaz Institute for Medical Research (IIS/FJD), 28040 Madrid, Spain
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Finger clubbing in inflammatory bowel disease: association with upper small bowel lesions and need of surgery in Crohn's disease. Eur J Gastroenterol Hepatol 2021; 33:844-851. [PMID: 33136723 DOI: 10.1097/meg.0000000000001966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE Finger clubbing has been associated with inflammatory bowel disease (IBD). AIMS In a prospective single-center study, we aimed to assess the frequency of finger clubbing in a cohort of IBD patients. Whether finger clubbing is associated with clinical characteristics of IBD was also investigated. METHODS IBD patients with a detailed clinical history were enrolled. Finger clubbing was assessed by visual inspection. Data were expressed as median (range), chi-square, t-test. Multivariate logistic regression analysis was used to assess risk factors for finger clubbing, when considering demographic and clinical characteristics, smoking habits and chronic pulmonary diseases (CPD). RESULTS Finger clubbing was searched in 470 IBD patients: 267 Crohn's disease and 203 ulcerative colitis. Finger clubbing was more frequent in Crohn's disease than in ulcerative colitis: 45/267 (16.8%) vs. 15/203 (7.3%) [odds ratio (OR), 2.54 (1.37-4.70); P = 0.003]. Crohn's disease involved the ileum (59.9%), colon (4.5%), ileum-colon (25.8%) and upper gastrointestinal (GI) (9.8%). Ulcerative colitis extent included proctitis (E1) (13.4%), left-sided (E2) (43.3%) and pancolitis (E3) (43.3%). Upper GI lesions, but not other Crohn's disease localizations, were more frequent in patients with finger clubbing [9/45 (20%) vs. 17/222 (7.7%); P = 0.032]. Crohn's disease-related surgery was more frequent in patients with finger clubbing [36/45 (80%) vs. 107/222 (48.1%); P < 0.001]. In Crohn's disease, the only risk factors for finger clubbing were upper GI lesions and Crohn's disease-related surgery [OR, 2.58 (1.03-6.46), P = 0.04; OR, 4.07 (1.86-8.91), P = 0.006]. Ulcerative colitis extent was not associated with finger clubbing [E1: OR, 0.27 (0.02-3.44), P = 0.33; E2: OR, 0.93 (0.24-3.60), P = 0.92; E3:OR, 0.64 (0.22-1.86), P = 0.59]. In ulcerative colitis, but not in Crohn's disease, finger clubbing was more frequent in smokers [13/15 (86.6%) vs. 99/188 (52.6%); P = 0.01] and in patients with CPD [5/15 (33.3%) vs. 16/188 (8.5%); P = 0.002]. Smoking and CPD were the only risk factors for finger clubbing in ulcerative colitis [OR, 7.18 (1.44-35.78), P = 0.01; OR, 10.93 (2.51-47.45), P = 0.001]. CONCLUSION In the tested IBD population, finger clubbing was more frequent in Crohn's disease than in ulcerative colitis. In Crohn's disease, upper GI lesions and history of Crohn's disease-related surgery were risk factors for finger clubbing, suggesting the possible role of finger clubbing as a subclinical marker of Crohn's disease severity.
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Labrada S, Salman-Monte TC, Carrión-Barberà I, Monfort J. "Black nails" as a sign of hypertrophic osteoarthropathy. Rheumatology (Oxford) 2021; 61:874-875. [PMID: 33895813 DOI: 10.1093/rheumatology/keab382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/01/2021] [Accepted: 04/21/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Selene Labrada
- Department of Rheumatology, Hospital del Mar, Barcelona, Spain
| | | | | | - Jordi Monfort
- Department of Rheumatology, Hospital del Mar, Barcelona, Spain
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Matralis D, Panopoulos I, Papadogiannaki I, Van der Lugt J, Papadogiannakis E. Hypertrophic osteopathy associated with lepidic pulmonary adenocarcinoma in a cat. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
Digital clubbing has been regarded as an important sign in medicine. A 33-year-old woman with no history of hepatic, pulmonary, or malignant disease was referred to our hospital. She had been taking lubiprostone every day for three years for constipation. Clubbing in her upper and lower limb digits began gradually about two years ago. The results of laboratory investigations were almost normal. We suspected the clubbed digits were a side effect of lubiprostone and confirmed that the levels of urinary prostaglandin E2 (PGE2), which can cause clubbed digits, were elevated. Thus, we instructed the woman to stop taking lubiprostone and monitored this lab value. However, the value continued to rise over 2 months to 41.9 μg/g Cr. During that time, she had been taking sennoside A B calcium instead of lubiprostone for constipation. Since sennoside A B calcium also has the effect of increasing PGE2, we ordered the discontinuation. Her urinary PGE2 to creatinine level normalized, and the clubbing improved after the discontinuation of these two medications.
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Affiliation(s)
- Ryuichi Kawamoto
- Department of Community Medicine, Ehime University Graduate School of Medicine, Japan
| | - Asuka Kikuchi
- Department of Community Medicine, Ehime University Graduate School of Medicine, Japan
| | - Daisuke Ninomiya
- Department of Community Medicine, Ehime University Graduate School of Medicine, Japan
| | - Teru Kumagi
- Department of Community Medicine, Ehime University Graduate School of Medicine, Japan
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Gunasekera SN, Madurapperuma C, Weerasooriya N, Karunathilake H, Jayanaga A. A rare presentation of Takayasu’s arteritis- unilateral finger clubbing – case report. BMC Rheumatol 2020; 4:66. [PMID: 33298181 PMCID: PMC7727161 DOI: 10.1186/s41927-020-00166-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/11/2020] [Indexed: 12/02/2022] Open
Abstract
Background Takayasu’s arteritis (TA) is a granulomatous, large vessel vasculitis with a preponderance for young women. The inflammation results in disruption of the arterial endothelium causing stenosis, endoluminal thrombosis and aneurismal dilatation. Early disease presentation is with nonspecific general symptoms, and in such instances, the diagnosis can be missed. Unilateral clubbing is a manifestation of myriad of diseases, but is not a common sign of TA. In medical literature, only three such cases have been reported. Case presentation We present a 24-year-old female who presented with multiple constitutional symptoms such as arthralgia, malaise, poor appetite and two episodes of syncope over 3 months’ duration. On examination, unilateral finger clubbing was observed in the right hand, with very low volume radial, ulnar and brachial artery pulses on the ipsilateral side. Her blood pressure measured on the unaffected arm, was normal. Inflammatory markers were elevated and magnetic resonance angiogram (MRA) confirmed TA. Conclusion Although rare, unilateral clubbing may be a manifestation of TA. Therefore, detection of unilateral clubbing should raise a strong clinical suspicion of TA and prompt early diagnosis and initiation of treatment.
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Elhamiani Khatat S, Vallefuoco R, El Mrini M, Canonne-Guibert M, Rosenberg D. Renal adenocarcinoma associated with hypertrophic osteopathy in a cat. JFMS Open Rep 2020; 6:2055116920962433. [PMID: 33282332 PMCID: PMC7686623 DOI: 10.1177/2055116920962433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Case summary A 10-year-old neutered male domestic shorthair cat was diagnosed
with renal adenocarcinoma associated with hypertrophic
osteopathy. The cat was referred for chronic ambulation
difficulties. The physical examination showed a painful
thickening of all four limbs, a right cranial abdominal mass and
a conjunctival hyperaemia. Radiographic findings were consistent
with extensive periosteal new bone formation involving not only
the diaphyses of the fore- and hindlimbs, but also of the
pelvis, tarsus and carpus. Abdominal ultrasonography and CT
revealed a mass within the right kidney and a primary neoplasm
was suspected. A ureteronephrectomy of the right kidney was
performed and histopathology confirmed the diagnosis of renal
adenocarcinoma. Although clinical improvement of the lameness
occurred after surgery, no radiographic changes of hypertrophic
osteopathy lesions were observed at the 9-month follow-up. Relevance and novel information Feline cases of hypertrophic osteopathy are rarely reported in the
literature and only a few of them were associated with abdominal
neoplastic diseases. To our knowledge, this is the first case of
renal adenocarcinoma associated with hypertrophic osteopathy in
a cat.
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Affiliation(s)
- Sarah Elhamiani Khatat
- Department of Medicine, Surgery and Reproduction, Hassan II Institute of Agronomy and Veterinary Medicine, Rabat, Morocco
| | | | - Meryem El Mrini
- Department of Animal Production, National Office of Sanitary Safety of Food Products, Rabat, Morocco
| | - Morgane Canonne-Guibert
- Department of Small Animal Internal Medicine, University Hospital Center, National Veterinary Schooll of Maisons-Alfort, University of Paris-Est Créteil, Val-de-Marne, France
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Abstract
Hypertrophic osteoarthropathy (HOA) is an orphan syndrome characterized by abnormal proliferation of the skin and osseous tissues at the distal parts of the extremities. The main clinical features are: a peculiar bulbous deformity of the tips of the digits conventionally described as "clubbing," periosteal proliferation of the tubular bones, and synovial effusions. In most instances, HOA develops a reaction to a severe internal illness, such as lung cancer, cyanotic heart disease, or liver cirrhosis. There is a subgroup of patients who do not have underlying pathology. Such cases are classified as having primary HOA. Digital clubbing is easy to recognize. Any patient with newly developed digital clubbing should undergo careful search for an underlying illness with special attention to intra-thoracic pathologies. Painful HOA is treated with non-steroidal anti-inflammatory medications. Vascular endothelial growth factor and prostaglandin E2 have been proposed as key bone proliferating mediators.
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Affiliation(s)
- Manuel Martínez-Lavín
- Chief Rheumatology Department. National Institute of Cardiology, Juan Badiano 1, 14080, Mexico City, Mexico.
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23
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Rheumatologic Manifestations of CF. Respir Med 2020. [DOI: 10.1007/978-3-030-42382-7_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Kumari P, Yeung P, Medani A, Kiani AN. Hypertrophic pulmonary osteoarthropathy: an unusual presentation. Rheumatol Adv Pract 2018; 2:rky009. [PMID: 31431958 PMCID: PMC6649912 DOI: 10.1093/rap/rky009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 03/05/2018] [Indexed: 12/02/2022] Open
Abstract
Objectives Hypertrophic pulmonary osteoarthropathy (HPOA) is a syndrome characterized by the triad of periostitis, digital clubbing and painful arthropathy of the large joints, especially involving the lower limbs. HPOA without clubbing of the digits is considered an incomplete form of HPOA and has been rarely reported. We are presenting here a case of HPOA without clubbing in a patient with lung cancer. Methods A 52-year-old female active smoker presented with a complaint of multiple joint pains with associated morning stiffness, swelling and weight loss for 3 months. On examination, the patient had tenderness to palpation over the anterior shin, but no obvious clubbing was noted. X-rays of the lower extremities revealed periosteal thickening compatible with HPOA. Results A bone scan showed increased uptake along the periosteum and cortex of the long bones. In view of her smoking history and weight loss, a chest X-ray was done that revealed an upper lung mass. A diagnosis of lung carcinoma was made on biopsy. Conclusion Our case demonstrates that the unusual finding of HPOA in the absence of clubbing is a rare entity and can often be missed. Once diagnosed, a prompt search of other associated conditions should be conducted.
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Affiliation(s)
- Pooja Kumari
- Marshfield Clinic/St. Joseph Hospital Marshfield, Marshfield, WI, USA
| | - Paul Yeung
- Marshfield Clinic/St. Joseph Hospital Marshfield, Marshfield, WI, USA
| | - Abuzaid Medani
- Marshfield Clinic/St. Joseph Hospital Marshfield, Marshfield, WI, USA
| | - Adnan N Kiani
- Marshfield Clinic/St. Joseph Hospital Marshfield, Marshfield, WI, USA
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Atiase Y, Yorke E, Akpalu J, Opoku-Asare B, Adjei P, Amissah-Arthur MB, Akpalu A. Pachydermoperiostosis in a patient with chronic hepatitis B virus infection referred as acromegaly: a case report. J Med Case Rep 2018. [PMID: 29514715 PMCID: PMC5842528 DOI: 10.1186/s13256-018-1578-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary hypertrophic osteoarthropathy also known as pachydermoperiostosis is a rare genetic disorder that has often been confused with acromegaly because of similar clinical features. Vascular endothelial growth factors which have been implicated in the clinical features of pachydermoperiostosis, have also been shown to be present in chronic hepatitis and implicated in the malignant transformation of hepatitis B infection to hepatocellular carcinoma. To the best of our knowledge there is one reported case of pachydermoperiostosis with chronic hepatitis B infection. We do not imply a causal relationship between pachydermoperiostosis and hepatitis B infection because pachydermoperiostosis is a genetic disorder; however, the question is raised whether hypertrophic osteoarthropathy is one of the many extrahepatic manifestations of chronic hepatitis B infection. CASE PRESENTATION A 21-year-old African (Ghanaian) man with chronic hepatitis B infection was referred to our Endocrine unit as having acromegaly with changing facial features, enlarging hands and feet, and large knee joint effusions which affected activities of daily living. He was finally diagnosed as having pachydermoperiostosis when acromegaly, rheumatological disorders, as well as cardiopulmonary disorders were ruled out. He improved with arthrocentesis, a tapering regime of steroids, non-steroidal anti-inflammatory drugs, and proton pump inhibitors. CONCLUSIONS The possible role of hepatitis B in hypertrophic osteoarthropathy, that is, secondary hypertrophic osteoarthropathy, needs to be explored; however, with digital clubbing in his father our patient is likely to have pachydermoperiostosis.
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Affiliation(s)
- Yacoba Atiase
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Legon, Accra, Ghana.
| | - Ernest Yorke
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Josephine Akpalu
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Bismark Opoku-Asare
- Department of Medicine and Therapeutics, Korle Bu Teaching Hospital, Accra, Ghana
| | - Patrick Adjei
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Maame Boatemma Amissah-Arthur
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Albert Akpalu
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
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Hypertrophic Osteopathy Associated with Mycotic Pneumonia in a Roe Deer ( Capreolus capreolus). J Wildl Dis 2018; 54:631-634. [PMID: 29498897 DOI: 10.7589/2017-07-171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Aspergillus fumigatus is one of the most common Aspergillus species causing disease in individual animals but it rarely affects deer species. We report a case of A. fumigatus infection causing mycotic pneumonia and hypertrophic osteopathy in a roe deer ( Capreolus capreolus).
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Brouwers A, Dingjan PG, Dujardin B, van Zoelen EJ, Lips P, Gooren LJ. Hypertrophic osteoarthropathy: estrogens, prostaglandinE 2, prostaglandin A 2, and the inflammatory reflex. Clin Rheumatol 2018; 38:211-222. [PMID: 29480386 DOI: 10.1007/s10067-018-4044-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/09/2018] [Accepted: 02/15/2018] [Indexed: 01/22/2023]
Abstract
It has been claimed that hyperestrogenism occurs in hypertrophic osteoarthropathy (HOA), but not in simple clubbing. However, one of our patients had simple clubbing and hyperestrogenism. We therefore measured estrogens, androgens, sex hormone-binding globulin (SHBG), and gonadotropins in five patients with HOA and in 18 patients with simple clubbing. Of the patients with HOA, 80% had a high urinary estriol concentration. In their serum, 80% had high estrone, 0% high estradiol, and 40% high SHBG. Of the patients with simple clubbing, 89% had a high urinary estriol concentration. In their serum, 76% had high estrone, 6% high estradiol, and 31% high SHBG. In all patients, urinary estriol concentration correlated positively with the degree of clubbing. Serum concentration of androstenedione, testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) was mostly normal, but androstenedione concentration correlated positively with the degree of clubbing. Spider angiomas were present in 74%, palmar erythema in 39%, and gynecomastia in 9%. Urinary creatinine concentration was low in 48% and correlated positively with the degree of clubbing. We reject the claim that hyperestrogenism occurs in HOA, but not in simple clubbing. Hyperestrogenism occurs both in HOA and in simple clubbing. Our results also support earlier reports that clubbing and HOA are associated with spider angiomas, palmar erythema, gynecomastia, adrenal cortical hyperfunction, muscle atrophy, and water retention. These results led to a new hypothesis on the pathogenesis of HOA, involving estrogens, prostaglandin E2, prostaglandin A2, and the inflammatory reflex.
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Affiliation(s)
- Ad Brouwers
- Department of Internal Medicine, Gelderse Vallei Hospital, Ede, The Netherlands. .,, Wageningen, The Netherlands.
| | - Pieter G Dingjan
- Department of Clinical Chemistry, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Ben Dujardin
- Department of Clinical Chemistry, Gelderse Vallei Hospital, Ede, The Netherlands.,, Ede, The Netherlands
| | - Everardus J van Zoelen
- Department of Cell and Applied Biology Nijmegen, Centre for Molecular Life Sciences, Radboud University, Nijmegen, The Netherlands.,, Oosterbeek, The Netherlands
| | - Paul Lips
- Endocrine Section, Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.,, Amsterdam, The Netherlands
| | - Louis J Gooren
- Endocrine Section, Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.,, Chiang Mai, Thailand
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Rheumatic paraneoplastic syndromes – A clinical link between malignancy and autoimmunity. Clin Immunol 2018; 186:67-70. [DOI: 10.1016/j.clim.2017.07.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 07/19/2017] [Indexed: 12/31/2022]
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Pachydermoperiostosis in a Patient with Crohn's Disease: Treatment and Literature Review. IRANIAN JOURNAL OF MEDICAL SCIENCES 2018; 43:81-85. [PMID: 29398756 PMCID: PMC5775998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Pachydermoperiostosis (PDP) is a rare disorder characterized by pachydermia, digital clubbing, periostitis, and an excess of affected males. It is the primary form of hypertrophic osteoarthropathy (HOA) and there are some rare associations of PDP with other disorders. Here we describe a patient with Crohn's disease associated with PDP. A 26-year-old man, who was a known case of Crohn's disease, referred with diffuse swelling in the upper and lower limbs and cutis verticis gyrata since 7 years ago. PDP was suspected and endocrinological and radiological studies were conducted for the evaluation of underlying disease. He was prescribed celecoxib, low-dose prednisolone, and pamidronate to control the swelling, periostitis, azathiopurine, and mesalazine according to gastrointestinal involvement. In conclusion, it is important to identify this condition since a misdiagnosis might subject the patient to unnecessary investigations.
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van Manen M, Vermeer L, Moor C, Vrijenhoeff R, Grutters J, Veltkamp M, Wijsenbeek M. Clubbing in patients with fibrotic interstitial lung diseases. Respir Med 2017; 132:226-231. [DOI: 10.1016/j.rmed.2017.10.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 10/24/2017] [Accepted: 10/25/2017] [Indexed: 11/16/2022]
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Abdullah NRA, Jason WLC, Nasruddin AB. Pachydermoperiostosis: a rare mimicker of acromegaly. Endocrinol Diabetes Metab Case Rep 2017; 2017:EDM170029. [PMID: 28567291 PMCID: PMC5445428 DOI: 10.1530/edm-17-0029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 04/11/2017] [Indexed: 11/23/2022] Open
Abstract
Pachydermoperiostosis is a very rare osteoarthrodermopathic disorder whose clinical and radiographic presentations may mimic those of acromegaly. In the evaluation of patients with acromegaloid appearances, pachydermoperiostosis should be considered as a differential diagnosis. In this article, we report a 17-year-old boy who presented with 2-year history of acral enlargement and facial appearance changes associated with joint pain and excessive sweating. He had been investigated extensively for acromegaly, and the final diagnosis was pachydermoperiostosis.
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Affiliation(s)
| | - Wong Lok Chin Jason
- Department of Medicine, National University of Malaysia Medical Centre, Kuala LumpurMalaysia
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Mishra R, Patel R, Khaja M. Cannabis-induced bullous lung disease leading to pneumothorax: Case report and literature review. Medicine (Baltimore) 2017; 96:e6917. [PMID: 28489809 PMCID: PMC5428643 DOI: 10.1097/md.0000000000006917] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Marijuana use has been increasing in the United States among college students and young adults. Marijuana use has been associated with bullous lung disease which can lead to pneumothorax. There are other recreational drugs like methylphenidate, cocaine and heroin which have been associated with pneumothorax. PATIENT CONCERNS We present a case of a 30-year-old man with spontaneous pneumothorax associated with marijuana use. The patient had no medical conditions and presented to the emergency room with chest pain. The physical examination revealed decreased breath sound on the right side of the chest. DIAGNOSES Bed side ultrasound of chest showed stratosphere sign, absent lung sliding; consistent with right-sided pneumothorax. INTERVENTIONS AND OUTCOMES The patient underwent placement of a chest tube. Computed tomography chest scans performed on day two also showed bullous lung disease in the right lung. Serial x-rays of the chest showed re-expansion of the lung. LESSONS Despite the beneficial effects of Marijuana there are deleterious effects which are emphasized here. This case highlights the need for further studies to establish the relationship between marijuana use and lung diseases in the absence of nicotine use.
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Affiliation(s)
| | - Ravi Patel
- Department of Medicine, Bronx Lebanon Hospital Center, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY
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Ohlmeier M, Karras P, Suero EM, Grasmücke D, Aach M, Meindl R, Schildhauer TA, Citak M. Ankylosing spondylitis does not increase the risk of neurogenic heterotopic ossification in patients with a spinal cord injury: a retrospective cohort study. Spinal Cord 2016; 55:213-215. [PMID: 27752058 DOI: 10.1038/sc.2016.143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 09/03/2016] [Accepted: 09/10/2016] [Indexed: 12/12/2022]
Abstract
STUDY DESIGN Retrospective chart review. OBJECTIVES The present study was performed to analyze the impact of ankylosing spondylitis (AS) in developing heterotopic ossification (HO) in patients following spinal cord injury. SETTING Department of Spinal Cord Injury and Department of General and Trauma Surgery, BG-University Hospital Bergmannsheil Bochum, Ruhr-University Bochum, Germany. MATERIALS AND METHODS Between January 2003 and December 2015, 67 patients with AS and SCI were included in the study. The control group consisted of 141 patients with SCI and without AS. The definitive diagnosis of HO was made via magnetic resonance imaging or computed tomography. Primary outcome measure was to analyze the impact of AS on the development of HO. RESULTS Fifteen out of 67 AS patients (22.4%) had a diagnosed HO. In the control group, 28 of 141 patients (19.9%) suffered from HO. Patients with AS had no significant higher risk for HO development compared with patients without AS (RR=1.16; 95% CI=0.65-2.09). However, patients with a complete neurological deficit had a twofold higher risk for HO development (RR=2.55; 95% CI=1.26-5.16). CONCLUSIONS AS does not increase the risk for HO development in patients with spinal cord injury.
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Affiliation(s)
- M Ohlmeier
- Department of General and Trauma Surgery, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - P Karras
- Department of General and Trauma Surgery, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - E M Suero
- Department of General and Trauma Surgery, Medical School Hannover, Hannover, Germany
| | - D Grasmücke
- Department of Spinal Cord Injury, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - M Aach
- Department of Spinal Cord Injury, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - R Meindl
- Department of Spinal Cord Injury, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - T A Schildhauer
- Department of General and Trauma Surgery, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - M Citak
- Department of Spinal Cord Injury, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
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Galuppi E, Bortoluzzi A, Govoni M, Trotta F. Hypertrophic osteoarthropathy: classification, diagnostic features, and treatment options. Expert Opin Orphan Drugs 2016. [DOI: 10.1080/21678707.2016.1205481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Fuji S, Matsushita S, Hyodo K, Osaka M, Sakamoto H, Tanioka K, Miyakawa K, Kubota M, Hiramatsu Y, Tokunaga C. Association between endothelial function and micro-vascular remodeling measured by synchrotron radiation pulmonary micro-angiography in pulmonary arterial hypertension. Gen Thorac Cardiovasc Surg 2016; 64:597-603. [PMID: 27393332 DOI: 10.1007/s11748-016-0684-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 07/01/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Pulmonary arterial hypertension (PAH) is a progressive disease which causes increased vascular resistance. In this study, our purpose was to quantify the micro-vascular remodeling in monocrotaline-induced PAH rats using synchrotron radiation pulmonary micro-angiography (SRPA), a method we have previously established in an in vivo rat model. To determine the relationship between endothelial function and vascular remodeling, the local expression of endothelin-1 (ET-1), endothelial nitric oxide synthase (eNOS) and vascular endothelial growth factor (VEGF) was evaluated using immunohistochemical staining. METHODS Monocrotaline-induced PAH rats were created by subcutaneous injection of monocrotaline. After 2 weeks, SRPA was performed at the Photon Factory of the High Energy Accelerator Research Organization. The internal diameters of pulmonary arterioles were measured using SRPA images. Semi-quantified analyses of ET-1, eNOS and VEGF expression in pulmonary arterioles were performed by immunohistochemical staining. RESULTS Micro-vascular density and the internal diameters of pulmonary arterioles were significantly decreased in PAH. ET-1 expression was significantly increased in PAH compared with the control (1.53 ± 0.45 vs. 0.80 ± 0.14) and eNOS expression was significantly decreased in PAH compared with the control (1.12 ± 0.59 vs. 1.91 ± 0.66), although VEGF expression did not differ between the groups. CONCLUSIONS SRPA can be effectively used for visualizing the decreased pulmonary micro-vasculature associated with PAH. Increased ET-1 expression and decreased eNOS expression may contribute to the proliferation and vasospasm of pulmonary arterioles induced by endothelial dysfunction due to PAH. This SRPA technology may help to identify a correlation between endothelial function and micro-vasculature remodeling in PAH.
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Affiliation(s)
- Satoko Fuji
- School of Medicine, University of Tsukuba, Tsukuba, Japan
| | | | - Kazuyuki Hyodo
- Photon Factory, High Energy Accelerator Research Organization, Tsukuba, Japan
| | - Motoo Osaka
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8577, Japan
| | - Hiroaki Sakamoto
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8577, Japan
| | | | | | - Misao Kubota
- NHK Science and Technology Research Laboratories, Tsukuba, Japan
| | - Yuji Hiramatsu
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8577, Japan
| | - Chiho Tokunaga
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8577, Japan.
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Dubrey S, Pal S, Singh S, Karagiannis G. Digital clubbing: forms, associations and pathophysiology. Br J Hosp Med (Lond) 2016; 77:403-8. [DOI: 10.12968/hmed.2016.77.7.403] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Simon Dubrey
- Consultant Cardiologist in the Department of Cardiology, Hillingdon and Mount Vernon Hospitals NHS Foundation Trust, Middlesex UB8 3NN
| | - Shrestha Pal
- FY1 in General Internal Medicine in the Department of Cardiology, Hillingdon and Mount Vernon Hospitals NHS Foundation Trust, Middlesex
| | - Sarneet Singh
- CT2 in Cardiology in the Department of Cardiology, Hillingdon and Mount Vernon Hospitals NHS Foundation Trust, Middlesex
| | - Georgios Karagiannis
- Consultant Cardiologist in the Department of Cardiology, Hillingdon and Mount Vernon Hospitals NHS Foundation Trust, Middlesex
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Trinh NT, Yamashita T, Ohneda K, Kimura K, Salazar GT, Sato F, Ohneda O. Increased Expression of EGR-1 in Diabetic Human Adipose Tissue-Derived Mesenchymal Stem Cells Reduces Their Wound Healing Capacity. Stem Cells Dev 2016; 25:760-73. [PMID: 26988763 DOI: 10.1089/scd.2015.0335] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The prevalence of type 2 diabetes mellitus (T2DM), which leads to diabetic complications, has been increasing worldwide. The possible applications of T2DM-derived stem cells in cell therapy are limited because their characteristics are still not fully understood. In this study, we characterized adipose tissue-derived mesenchymal stem cells (AT-MSCs) from diabetic patients (dAT-MSCs) and found that insulin receptor substrate-1 (IRS-1) was highly phosphorylated at serine 636/639 in dAT-MSCs. Moreover, we found that early growth response factor-1 (EGR-1) and its target genes of PTEN and GGPS1 were highly expressed in dAT-MSCs in comparison to healthy donor-derived AT-MSCs (nAT-MSCs). We observed impaired wound healing after the injection of dAT-MSCs in the ischemic flap mouse model. The expressions of EGR-1 and its target genes were diminished by small hairpin RNA-targeted EGR-1 (shEGR-1) and treatment with a mitogen-activated protein kinase/extracellular signal-regulated kinase (MAPK/ERK) inhibitor (PD98059). Importantly, dAT-MSCs with shEGR-1 were able to restore the wound healing ability in the mouse model. Interestingly, under hypoxic conditions, hypoxia-inducible factor-1α (HIF-1α) can bind to the EGR-1 promoter in dAT-MSCs, but not in nAT-MSCs. Together, these results demonstrate that the expression of EGR-1 was upregulated in dAT-MSCs through two pathways: the main regulatory pathway is the MAPK/ERK pathway, the other is mediated by HIF-1α through direct transcriptional activation at the promoter region of the EGR1 gene. Our study suggests that dAT-MSCs may contribute to microvascular damage and delay wound healing through the overexpression of EGR-1. Interrupting the expression of EGR-1 in dAT-MSCs may be a useful treatment for chronic wounds in diabetic patients.
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Affiliation(s)
- Nhu-Thuy Trinh
- 1 Graduate School of Comprehensive Human Science, Laboratory of Regenerative Medicine and Stem Cell Biology, University of Tsukuba , Tsukuba, Japan
| | - Toshiharu Yamashita
- 1 Graduate School of Comprehensive Human Science, Laboratory of Regenerative Medicine and Stem Cell Biology, University of Tsukuba , Tsukuba, Japan
| | - Kinuko Ohneda
- 2 Laboratory of Molecular Pathophysiology, Faculty of Pharmacy, Takasaki University of Health and Welfare , Takasaki, Japan
| | - Kenichi Kimura
- 1 Graduate School of Comprehensive Human Science, Laboratory of Regenerative Medicine and Stem Cell Biology, University of Tsukuba , Tsukuba, Japan
| | - Georgina To'a Salazar
- 1 Graduate School of Comprehensive Human Science, Laboratory of Regenerative Medicine and Stem Cell Biology, University of Tsukuba , Tsukuba, Japan
| | - Fujio Sato
- 3 Department of Cardiovascular Surgery, University of Tsukuba , Tsukuba, Japan
| | - Osamu Ohneda
- 1 Graduate School of Comprehensive Human Science, Laboratory of Regenerative Medicine and Stem Cell Biology, University of Tsukuba , Tsukuba, Japan
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Tavarelli M, Sarfati J, De Gennes C, Haroche J, Buffet C, Ghander C, Simon JM, Ménégaux F, Leenhardt L. Hypertrophic Osteoarthropathy and Follicular Thyroid Cancer: A Rare Paraneoplastic Syndrome. Eur Thyroid J 2015; 4:266-70. [PMID: 26835431 PMCID: PMC4716416 DOI: 10.1159/000437052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 06/16/2015] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Hypertrophic osteoarthropathy (HOA) is a rare condition characterized by bone and joint pain and digital clubbing usually associated with bronchopulmonary diseases. Primary HOA is rare and the pathogenesis remains unclear. OBJECTIVES Cases of HOA as a paraneoplastic syndrome associated with thyroid carcinoma are very rare - only 2 cases have been described in the literature. RESULTS We present the first case of a 40-year-old patient affected by HOA associated with invasive differentiated follicular thyroid carcinoma operated in 2 stages. Both operations were followed by radioiodine ablation, and then a rapid unresectable local recurrence developed requiring cervical radiotherapy (70 Gy). A second treatment with 100 mCi of (131)I confirmed it was a refractory thyroid cancer. Further surgery confirmed a poorly differentiated follicular cancer and 12 cycles of chemotherapy by gemcitabine and oxaliplatin followed. During the 8 years of follow-up, cervical recurrence was stable, but severe episodes of hemoptysis occurred requiring iterative embolization of the bronchial and tracheal arteries. Other lung diseases were excluded. Digital clubbing appeared, which was associated with arthritis, bone pain and inflammatory syndrome. X-rays and magnetic resonance imaging found periosteal apposition in the long bones; bone scintigraphy confirmed the HOA diagnosis. Other causes of arthritis were eliminated. She was treated with colchicine, corticosteroids and nonsteroidal anti-inflammatory drugs, but only the combination of methotrexate and hydroxychloroquine reduced the morphine requirements. CONCLUSION HOA is exceptionally associated with thyroid cancer and we raised the hypothesis of the secretion of a circulating factor in a patient with invasive and recurrent follicular thyroid cancer, refractory to radioiodine.
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Affiliation(s)
- Martina Tavarelli
- Unité Thyroïde Tumeurs Endocrines, Groupe Hospitalier et Faculté de Médecine Pitié-Salpêtrière, Institut du Cancer, Université Pierre et Marie Curie, Paris, France
| | - Julie Sarfati
- Unité Thyroïde Tumeurs Endocrines, Groupe Hospitalier et Faculté de Médecine Pitié-Salpêtrière, Institut du Cancer, Université Pierre et Marie Curie, Paris, France
| | - Christian De Gennes
- Service de Médecine Interne Immuno-clinique, Groupe Hospitalier et Faculté de Médecine Pitié-Salpêtrière, Institut du Cancer, Université Pierre et Marie Curie, Paris, France
| | - Julien Haroche
- Service de Médecine Interne 2, Groupe Hospitalier et Faculté de Médecine Pitié-Salpêtrière, Institut du Cancer, Université Pierre et Marie Curie, Paris, France
| | - Camille Buffet
- Unité Thyroïde Tumeurs Endocrines, Groupe Hospitalier et Faculté de Médecine Pitié-Salpêtrière, Institut du Cancer, Université Pierre et Marie Curie, Paris, France
| | - Cécile Ghander
- Unité Thyroïde Tumeurs Endocrines, Groupe Hospitalier et Faculté de Médecine Pitié-Salpêtrière, Institut du Cancer, Université Pierre et Marie Curie, Paris, France
| | - Jean Marc Simon
- Service de Radiothérapie, Groupe Hospitalier et Faculté de Médecine Pitié-Salpêtrière, Institut du Cancer, Université Pierre et Marie Curie, Paris, France
| | - Fabrice Ménégaux
- Service de Chirurgie Générale et Digestive, Groupe Hospitalier et Faculté de Médecine Pitié-Salpêtrière, Institut du Cancer, Université Pierre et Marie Curie, Paris, France
| | - Laurence Leenhardt
- Unité Thyroïde Tumeurs Endocrines, Groupe Hospitalier et Faculté de Médecine Pitié-Salpêtrière, Institut du Cancer, Université Pierre et Marie Curie, Paris, France
- *Prof. Laurence Leenhardt, Unité Thyroïde Tumeurs Endocrines, Groupe Hospitalier Pitié-Salpêtrière, 83 Bd de l'Hôpital, FR-75651 Paris Cedex 13 (France), E-Mail
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González-Reimers E, Trujillo-Mederos A, Machado-Calvo M, Castañeyra-Ruiz M, Ordóñez AC, Arnay-de-la-Rosa M. A skeletal case of hypertrophic osteoarthropathy from the Canary Islands dating from 1000 BP. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2015; 11:1-6. [PMID: 28802962 DOI: 10.1016/j.ijpp.2015.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 07/10/2015] [Accepted: 07/15/2015] [Indexed: 06/07/2023]
Abstract
A left tibia, the distal right tibia, and the proximal four fifths of the right ulna and radius, probably belonging to an adult prehispanic man (antiquity of ≈1000 years BP) were found among commingled bone remains in a collective burial cave of the island of El Hierro, in the Canary Archipelago. All four bones show an intense periosteal bone formation, encrusting the preserved cortical bone of the diaphyses. Differential diagnosis include melorheostosis, syphilis, and leprosy, although the most likely diagnosis is hypertrophic osteoarthropathy, which is usually associated with lung neoplasm or non-malignant diseases leading to chronic hypoxemia. The marked bone proliferation, possibly due to a chronic condition, suggests that possibly the underlying illness was a non-malignant one.
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Affiliation(s)
- Emilio González-Reimers
- Departamento de Medicina Interna, Hospital Universitario de Canarias, 38320, Universidad de La Laguna, La Laguna, Tenerife, Canary Islands, Spain.
| | - Aioze Trujillo-Mederos
- Departamento de Geografía e Historia, Universidad de La Laguna, Tenerife, Canary Islands, Spain
| | - Manuel Machado-Calvo
- Departamento de Radiología, Hospital Universitario de Canarias, 38320, Universidad de La Laguna, La Laguna, Tenerife, Canary Islands, Spain
| | - María Castañeyra-Ruiz
- Departamento de Anatomía y Anatomía Patológica, Universidad de La Laguna, Tenerife, Canary Islands, Spain
| | - Alejandra C Ordóñez
- Departamento de Geografía e Historia, Universidad de La Laguna, Tenerife, Canary Islands, Spain
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Horacio MC, María VG, Alonso GL. Hypertrophic osteoarthropathy as a complication of pulmonary tuberculosis. ACTA ACUST UNITED AC 2015; 11:255-7. [DOI: 10.1016/j.reuma.2014.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 10/15/2014] [Accepted: 10/16/2014] [Indexed: 10/24/2022]
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Abstract
For patients that present with musculoskeletal symptoms, diagnostic procedures carried out by physicians and rheumatologists are primarily aimed at confirming or excluding the occurrence of primary rheumatic diseases. Another important trigger for musculoskeletal disease, however, is the presence of a tumour. Careful clinical investigation and knowledge of the gestalt of musculoskeletal syndromes related to respective tumour entities is of utmost importance for the diagnosis of paraneoplastic rheumatic diseases such as hypertrophic osteoarthropathy, paraneoplastic polyarthritis, RS3PE syndrome, palmar fasciitis and polyarthritis, cancer-associated myositis and tumour-induced osteomalacia. This places great responsibility on rheumatologists in diagnosing malignancies and referring the patient for effective treatment. The selective influence of tumours on musculoskeletal tissue is surprising and indicates that tumours alter tissues such as the periosteum, synovial membrane, subcutaneous connective tissue, fascia, muscles and bones by specific molecular processes. Some of the underlying mechanisms have been unravelled, providing valuable information on the physiologic and pathophysiologic roles of mediators such as vascular endothelial growth factor and fibroblast growth factor 23.
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Affiliation(s)
- Bernhard Manger
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Ulmenweg 18, D-91054 Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Ulmenweg 18, D-91054 Erlangen, Germany
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Kanaji N, Watanabe N, Kita N, Bandoh S, Tadokoro A, Ishii T, Dobashi H, Matsunaga T. Paraneoplastic syndromes associated with lung cancer. World J Clin Oncol 2014; 5:197-223. [PMID: 25114839 PMCID: PMC4127595 DOI: 10.5306/wjco.v5.i3.197] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 04/12/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
Paraneoplastic syndromes are signs or symptoms that occur as a result of organ or tissue damage at locations remote from the site of the primary tumor or metastases. Paraneoplastic syndromes associated with lung cancer can impair various organ functions and include neurologic, endocrine, dermatologic, rheumatologic, hematologic, and ophthalmological syndromes, as well as glomerulopathy and coagulopathy (Trousseau’s syndrome). The histological type of lung cancer is generally dependent on the associated syndrome, the two most common of which are humoral hypercalcemia of malignancy in squamous cell carcinoma and the syndrome of inappropriate antidiuretic hormone secretion in small cell lung cancer. The symptoms often precede the diagnosis of the associated lung cancer, especially when the symptoms are neurologic or dermatologic. The proposed mechanisms of paraneoplastic processes include the aberrant release of humoral mediators, such as hormones and hormone-like peptides, cytokines, and antibodies. Treating the underlying cancer is generally the most effective therapy for paraneoplastic syndromes, and treatment soon after symptom onset appears to offer the best potential for symptom improvement. In this article, we review the diagnosis, potential mechanisms, and treatments of a wide variety of paraneoplastic syndromes associated with lung cancer.
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Rhee SM, Park KJ, Ha YC. Hypertrophic osteoarthropathy in patient with Crohn's disease: a case report. J Bone Metab 2014; 21:151-4. [PMID: 25025001 PMCID: PMC4075269 DOI: 10.11005/jbm.2014.21.2.151] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 04/04/2014] [Accepted: 04/07/2014] [Indexed: 11/26/2022] Open
Abstract
Numerous causes of hypertrophic osteoarthropathy (HOA) have been reported. Commonly, secondary osteoarthropathy accompanies pulmonary diseases such as carcinoma of the lung, pleural tumors, lung abscesses, and bronchiectasis. However, HOA in inflammatory bowel disease is a rare complication. There are only a few reports of secondary HOA with Crohn's disease. Our purpose was to report another case of HOA in Crohn's disease. We describe a case of a 27-year-old man with underlying Crohn's disease presenting with 2 years of pain in multiple joints. Radiographic findings suggested HOA in extremities. We performed a conservative treatment including medication and rehabilitations. The patient's symptoms were much improved at the latest follow-up. Although numerous studies on HOA have been published, the pathogenesis of HOA is still unclear. Various treatment modalities were recommended but further studies to uncover the pathogenesis of HOA with Crohn's disease and to establish a treatment modality are needed.
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Affiliation(s)
- Sung-Min Rhee
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Ki Jeong Park
- Department of Radiology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
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LI X, TAN H, LI YL, WU ZY, SHEN GL, YU RQ. Aptamer-based Liquid Crystal Biosensor for Detection of Platelet-derived Growth Factor BB. CHINESE JOURNAL OF ANALYTICAL CHEMISTRY 2014. [DOI: 10.1016/s1872-2040(13)60729-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Jaipersad AS, Lip GYH, Silverman S, Shantsila E. The role of monocytes in angiogenesis and atherosclerosis. J Am Coll Cardiol 2013; 63:1-11. [PMID: 24140662 DOI: 10.1016/j.jacc.2013.09.019] [Citation(s) in RCA: 278] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 09/13/2013] [Accepted: 09/16/2013] [Indexed: 02/06/2023]
Abstract
New vessel formation inside the arterial wall and atherosclerotic plaques plays a critical role in pathogenesis of heart attacks and strokes. The 2 known mechanisms resulting in the formation of new vessels within the plaque are local ischemia and inflammation. Blood monocytes play an important role in both processes. First, they express receptors for vascular endothelial growth factor and some of them may serve as circulating ancestors of endothelial cells. Second, monocytes are associated with inflammation by synthesis of inflammatory molecules following their activation (e.g., after stimulation of Toll-like receptors). Neovascularization is a reparative response to ischemia, and includes 3 processes: angiogenesis, arteriogenesis, and vasculogenesis. Angiogenesis, the formation of new capillary vessels is known to occur in response to a hypoxic environment. The interaction between leukocytes and vascular wall via overexpression of various molecules facilitates the migration of inflammatory cells into the plaque microenvironment. Monocytes are intimately involved in tissue damage and repair and an imbalance of these processes may have detrimental consequences for plaque development and stability. Importantly, monocytes are comprised of distinct subsets with different cell surface markers and functional characteristics and this heterogeneity may be relevant to angiogenic processes in atherosclerosis. The aim of this review article is to present an overview of the available evidence supporting a role for monocytes in angiogenesis and atherosclerosis.
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Affiliation(s)
- Anthony S Jaipersad
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom
| | - Gregory Y H Lip
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom
| | - Stanley Silverman
- Department of Vascular Surgery, City Hospital, Birmingham, United Kingdom
| | - Eduard Shantsila
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom.
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Abstract
We present a florid case of remitting seronegative symmetrical synovitis with pitting edema that was actually a paraneoplastic syndrome of an asymptomatic undiagnosed adenosquamous lung cell carcinoma. The arthritis led to a screening for lung cancer and an early enough diagnosis for a curative intervention.
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Affiliation(s)
- Cláudia Ferrao
- Department of Medicine, Hospital Santo António, Porto, Portugal
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Affiliation(s)
- John D Rutherford
- Division of Cardiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8831, USA.
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