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Bredel D, Tihic E, Mouraud S, Danlos FX, Susini S, Aglave M, Alfaro A, Mohamed-Djalim C, Rouanne M, Halse H, Bigorgne A, Tselikas L, Dalle S, Hartl DM, Baudin E, Guettier C, Vibert E, Rosmorduc O, Robert C, Ferlicot S, Parier B, Albiges L, de Montpreville VT, Besse B, Mercier O, Even C, Breuskin I, Classe M, Radulescu C, Lebret T, Pautier P, Gouy S, Scoazec JY, Zitvogel L, Marabelle A, Bonvalet M. Immune checkpoints are predominantly co-expressed by clonally expanded CD4 +FoxP3 + intratumoral T-cells in primary human cancers. J Exp Clin Cancer Res 2023; 42:333. [PMID: 38057799 DOI: 10.1186/s13046-023-02897-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/11/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND In addition to anti-PD(L)1, anti-CTLA-4 and anti-LAG-3, novel immune checkpoint proteins (ICP)-targeted antibodies have recently failed to demonstrate significant efficacy in clinical trials. In these trials, patients were enrolled without screening for drug target expression. Although these novel ICP-targeted antibodies were expected to stimulate anti-tumor CD8 + T-cells, the rationale for their target expression in human tumors relied on pre-clinical IHC stainings and transcriptomic data, which are poorly sensitive and specific techniques for assessing membrane protein expression on immune cell subsets. Our aim was to describe ICP expression on intratumoral T-cells from primary solid tumors to better design upcoming neoadjuvant cancer immunotherapy trials. METHODS We prospectively performed multiparameter flow cytometry and single-cell RNA sequencing (scRNA-Seq) paired with TCR sequencing on freshly resected human primary tumors of various histological types to precisely determine ICP expression levels within T-cell subsets. RESULTS Within a given tumor type, we found high inter-individual variability for tumor infiltrating CD45 + cells and for T-cells subsets. The proportions of CD8+ T-cells (~ 40%), CD4+ FoxP3- T-cells (~ 40%) and CD4+ FoxP3+ T-cells (~ 10%) were consistent across patients and indications. Intriguingly, both stimulatory (CD25, CD28, 4-1BB, ICOS, OX40) and inhibitory (PD-1, CTLA-4, PD-L1, CD39 and TIGIT) checkpoint proteins were predominantly co-expressed by intratumoral CD4+FoxP3+ T-cells. ScRNA-Seq paired with TCR sequencing revealed that T-cells with high clonality and high ICP expressions comprised over 80% of FoxP3+ cells among CD4+ T-cells. Unsupervised clustering of flow cytometry and scRNAseq data identified subsets of CD8+ T-cells and of CD4+ FoxP3- T-cells expressing certain checkpoints, though these expressions were generally lower than in CD4+ FoxP3+ T-cell subsets, both in terms of proportions among total T-cells and ICP expression levels. CONCLUSIONS Tumor histology alone does not reveal the complete picture of the tumor immune contexture. In clinical trials, assumptions regarding target expression should rely on more sensitive and specific techniques than conventional IHC or transcriptomics. Flow cytometry and scRNAseq accurately characterize ICP expression within immune cell subsets. Much like in hematology, flow cytometry can better describe the immune contexture of solid tumors, offering the opportunity to guide patient treatment according to drug target expression rather than tumor histological type.
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Affiliation(s)
- Delphine Bredel
- Gustave Roussy, 114 Rue Édouard Vaillant, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1015, Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), 94805, Villejuif, France
| | - Edi Tihic
- Gustave Roussy, 114 Rue Édouard Vaillant, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1015, Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) CIC1428, Centre d'Investigation Clinique BIOTHERIS, 94805, Villejuif, France
| | - Séverine Mouraud
- Gustave Roussy, 114 Rue Édouard Vaillant, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1015, Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) CIC1428, Centre d'Investigation Clinique BIOTHERIS, 94805, Villejuif, France
| | - François-Xavier Danlos
- Gustave Roussy, 114 Rue Édouard Vaillant, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1015, Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) CIC1428, Centre d'Investigation Clinique BIOTHERIS, 94805, Villejuif, France
- Université Paris-Saclay, Faculté de Médecine, 94270, Le Kremlin-Bicêtre, France
- Gustave Roussy, Département d'Innovation Thérapeutique Et d'Essais Précoces (DITEP), 94805, Villejuif, France
| | - Sandrine Susini
- Gustave Roussy, 114 Rue Édouard Vaillant, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1015, Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) CIC1428, Centre d'Investigation Clinique BIOTHERIS, 94805, Villejuif, France
| | - Marine Aglave
- Gustave Roussy, Plateforme de bioinformatique, F-94805, Villejuif, France
| | - Alexia Alfaro
- Gustave Roussy, Université Paris-Saclay, UMS 23/3655, Plateforme Imagerie Et Cytométrie, Villejuif, France
| | - Chifaou Mohamed-Djalim
- Gustave Roussy, 114 Rue Édouard Vaillant, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) CIC1428, Centre d'Investigation Clinique BIOTHERIS, 94805, Villejuif, France
| | - Mathieu Rouanne
- Gustave Roussy, 114 Rue Édouard Vaillant, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1015, Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) CIC1428, Centre d'Investigation Clinique BIOTHERIS, 94805, Villejuif, France
- Department of Microbiology and Immunology, Vagelos College of Physicians and Surgeons, Columbia University, New York, USA
| | - Héloise Halse
- Gustave Roussy, 114 Rue Édouard Vaillant, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1015, Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) CIC1428, Centre d'Investigation Clinique BIOTHERIS, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1163, Institut Imagine, Université Paris Descartes, 75015, Paris, France
| | - Amélie Bigorgne
- Gustave Roussy, 114 Rue Édouard Vaillant, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1015, Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) CIC1428, Centre d'Investigation Clinique BIOTHERIS, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1163, Institut Imagine, Université Paris Descartes, 75015, Paris, France
| | - Lambros Tselikas
- Gustave Roussy, 114 Rue Édouard Vaillant, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1015, Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) CIC1428, Centre d'Investigation Clinique BIOTHERIS, 94805, Villejuif, France
- Université Paris-Saclay, Faculté de Médecine, 94270, Le Kremlin-Bicêtre, France
- Gustave Roussy, Université Paris Saclay, Département d'Anesthésie, Chirurgie et Imagerie Interventionnelle, F-94805, Villejuif, France
| | - Stéphane Dalle
- Department of Dermatology, HCL Cancer Institute, Lyon Cancer Research Center, 69495, Lyon, France
| | - Dana M Hartl
- Gustave Roussy, Université Paris Saclay, Département d'Anesthésie, Chirurgie et Imagerie Interventionnelle, F-94805, Villejuif, France
| | - Eric Baudin
- Gustave Roussy, Département d'Oncologie Médicale, F-94805, Villejuif, France
| | - Catherine Guettier
- Université Paris-Saclay, Faculté de Médecine, 94270, Le Kremlin-Bicêtre, France
- Service d'Anatomie Pathologique, Hôpital Bicêtre, AP-HP, 94270, Le Kremlin-Bicêtre, France
- UMR-S 1193, Hôpital Paul Brousse Université Paris Saclay, 94800, Villejuif, France
| | - Eric Vibert
- UMR-S 1193, Hôpital Paul Brousse Université Paris Saclay, 94800, Villejuif, France
- Centre Hépato-Biliaire, Hôpital Paul Brousse, AP-HP, 94800, Villejuif, France
| | - Olivier Rosmorduc
- Centre Hépato-Biliaire, Hôpital Paul Brousse, AP-HP, 94800, Villejuif, France
| | - Caroline Robert
- Université Paris-Saclay, Faculté de Médecine, 94270, Le Kremlin-Bicêtre, France
- Gustave Roussy, Département d'Oncologie Médicale, F-94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U981, Gustave Roussy, 94805, Villejuif, France
| | - Sophie Ferlicot
- Université Paris-Saclay, Faculté de Médecine, 94270, Le Kremlin-Bicêtre, France
- Service d'Anatomie Pathologique, Hôpital Bicêtre, AP-HP, 94270, Le Kremlin-Bicêtre, France
- Centre National de Recherche Scientifique (CNRS), Gustave Roussy, Université Paris-Saclay, UMR 9019, 94805, Villejuif, France
| | - Bastien Parier
- Service de Chirurgie Urologique, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - Laurence Albiges
- Université Paris-Saclay, Faculté de Médecine, 94270, Le Kremlin-Bicêtre, France
- Gustave Roussy, Département d'Oncologie Médicale, F-94805, Villejuif, France
| | | | - Benjamin Besse
- Université Paris-Saclay, Faculté de Médecine, 94270, Le Kremlin-Bicêtre, France
- Gustave Roussy, Département d'Oncologie Médicale, F-94805, Villejuif, France
| | - Olaf Mercier
- Université Paris-Saclay, Faculté de Médecine, 94270, Le Kremlin-Bicêtre, France
- Service de Chirurgie Thoracique Et Transplantation Cardio-Pulmonaire, Hôpital Marie-Lannelongue, UMR_S 999 INSERM, Université Paris-Saclay, GHPSJ, 92350, Le Plessis-Robinson, France
| | - Caroline Even
- Gustave Roussy, Département d'Oncologie Médicale, F-94805, Villejuif, France
| | - Ingrid Breuskin
- Gustave Roussy, Université Paris Saclay, Département d'Anesthésie, Chirurgie et Imagerie Interventionnelle, F-94805, Villejuif, France
| | - Marion Classe
- Gustave Roussy, Département de Biopathologie, F-94805, Villejuif, France
| | - Camélia Radulescu
- Département de Pathologie, Hôpital Foch, UVSQ, Université Paris-Saclay, 92150, Suresnes, France
| | - Thierry Lebret
- Département d'Urologie, Hôpital Foch, UVSQ-Université Paris-Saclay, 92150, Suresnes, France
| | - Patricia Pautier
- Gustave Roussy, Département d'Oncologie Médicale, F-94805, Villejuif, France
| | - Sébastien Gouy
- Gustave Roussy, Université Paris Saclay, Département d'Anesthésie, Chirurgie et Imagerie Interventionnelle, F-94805, Villejuif, France
| | - Jean-Yves Scoazec
- Gustave Roussy, Département de Biopathologie, F-94805, Villejuif, France
| | - Laurence Zitvogel
- Gustave Roussy, 114 Rue Édouard Vaillant, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1015, Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) CIC1428, Centre d'Investigation Clinique BIOTHERIS, 94805, Villejuif, France
- Université Paris-Saclay, Faculté de Médecine, 94270, Le Kremlin-Bicêtre, France
| | - Aurélien Marabelle
- Gustave Roussy, 114 Rue Édouard Vaillant, 94805, Villejuif, France.
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1015, Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), 94805, Villejuif, France.
- Institut National de La Santé Et de La Recherche Médicale (INSERM) CIC1428, Centre d'Investigation Clinique BIOTHERIS, 94805, Villejuif, France.
- Université Paris-Saclay, Faculté de Médecine, 94270, Le Kremlin-Bicêtre, France.
- Gustave Roussy, Département d'Innovation Thérapeutique Et d'Essais Précoces (DITEP), 94805, Villejuif, France.
| | - Mélodie Bonvalet
- Gustave Roussy, 114 Rue Édouard Vaillant, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1015, Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) CIC1428, Centre d'Investigation Clinique BIOTHERIS, 94805, Villejuif, France
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2
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Mosele F, Deluche E, Lusque A, Le Bescond L, Filleron T, Pradat Y, Ducoulombier A, Pistilli B, Bachelot T, Viret F, Levy C, Signolle N, Alfaro A, Tran DTN, Garberis IJ, Talbot H, Christodoulidis S, Vakalopoulou M, Droin N, Stourm A, Kobayashi M, Kakegawa T, Lacroix L, Saulnier P, Job B, Deloger M, Jimenez M, Mahier C, Baris V, Laplante P, Kannouche P, Marty V, Lacroix-Triki M, Diéras V, André F. Trastuzumab deruxtecan in metastatic breast cancer with variable HER2 expression: the phase 2 DAISY trial. Nat Med 2023; 29:2110-2120. [PMID: 37488289 PMCID: PMC10427426 DOI: 10.1038/s41591-023-02478-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 06/28/2023] [Indexed: 07/26/2023]
Abstract
The mechanisms of action of and resistance to trastuzumab deruxtecan (T-DXd), an anti-HER2-drug conjugate for breast cancer treatment, remain unclear. The phase 2 DAISY trial evaluated the efficacy of T-DXd in patients with HER2-overexpressing (n = 72, cohort 1), HER2-low (n = 74, cohort 2) and HER2 non-expressing (n = 40, cohort 3) metastatic breast cancer. In the full analysis set population (n = 177), the confirmed objective response rate (primary endpoint) was 70.6% (95% confidence interval (CI) 58.3-81) in cohort 1, 37.5% (95% CI 26.4-49.7) in cohort 2 and 29.7% (95% CI 15.9-47) in cohort 3. The primary endpoint was met in cohorts 1 and 2. Secondary endpoints included safety. No new safety signals were observed. During treatment, HER2-expressing tumors (n = 4) presented strong T-DXd staining. Conversely, HER2 immunohistochemistry 0 samples (n = 3) presented no or very few T-DXd staining (Pearson correlation coefficient r = 0.75, P = 0.053). Among patients with HER2 immunohistochemistry 0 metastatic breast cancer, 5 of 14 (35.7%, 95% CI 12.8-64.9) with ERBB2 expression below the median presented a confirmed objective response as compared to 3 of 10 (30%, 95% CI 6.7-65.2) with ERBB2 expression above the median. Although HER2 expression is a determinant of T-DXd efficacy, our study suggests that additional mechanisms may also be involved. (ClinicalTrials.gov identifier NCT04132960 .).
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Affiliation(s)
- Fernanda Mosele
- INSERM U981, Gustave Roussy, Villejuif, France
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Elise Deluche
- Department of Medical Oncology, CHU Dupuytren, Limoges, France
| | - Amelie Lusque
- Department of Biostatistics, Institut Claudius-Regaud, IUCT Oncopole, Toulouse, France
| | - Loïc Le Bescond
- INSERM U981, Gustave Roussy, Villejuif, France
- CVN Lab, CentraleSupélec,Université Paris-Saclay, Gif-Sur-Yvette, France
- OPIS, Inria, CentraleSupélec, Université Paris-Saclay, Gif-Sur-Yvette, France
| | - Thomas Filleron
- Department of Biostatistics, Institut Claudius-Regaud, IUCT Oncopole, Toulouse, France
| | - Yoann Pradat
- MICS Lab, CentraleSupélec, Université Paris-Saclay, Gif-Sur-Yvette, France
| | | | - Barbara Pistilli
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Thomas Bachelot
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Frederic Viret
- Department of Medical Oncology, Centre Paoli Calmettes, Marseille, France
| | - Christelle Levy
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | - Nicolas Signolle
- AMMICa Platform, INSERM US23, CNRS UAR 3655, AMMICa, Villejuif, France
| | - Alexia Alfaro
- Imaging and Cytometry Platform, Gustave Roussy, UAR 23/3655, Université Paris-Saclay, Villejuif, France
| | | | | | - Hugues Talbot
- CVN Lab, CentraleSupélec,Université Paris-Saclay, Gif-Sur-Yvette, France
- OPIS, Inria, CentraleSupélec, Université Paris-Saclay, Gif-Sur-Yvette, France
| | | | - Maria Vakalopoulou
- OPIS, Inria, CentraleSupélec, Université Paris-Saclay, Gif-Sur-Yvette, France
- MICS Lab, CentraleSupélec, Université Paris-Saclay, Gif-Sur-Yvette, France
| | - Nathalie Droin
- AMMICa Platform, INSERM US23, CNRS UAR 3655, AMMICa, Villejuif, France
| | - Aurelie Stourm
- AMMICa Platform, INSERM US23, CNRS UAR 3655, AMMICa, Villejuif, France
| | - Maki Kobayashi
- Translational Research Department, Daiichi Sankyo RD Novare, Tokyo, Japan
| | - Tomoya Kakegawa
- Translational Research Department, Daiichi Sankyo RD Novare, Tokyo, Japan
| | - Ludovic Lacroix
- AMMICa Platform, INSERM US23, CNRS UAR 3655, AMMICa, Villejuif, France
- Department of Medical Biology and Pathology, Gustave Roussy, Villejuif, France
| | - Patrick Saulnier
- AMMICa Platform, INSERM US23, CNRS UAR 3655, AMMICa, Villejuif, France
- Department of Medical Biology and Pathology, Gustave Roussy, Villejuif, France
| | - Bastien Job
- AMMICa Platform, INSERM US23, CNRS UAR 3655, AMMICa, Villejuif, France
| | - Marc Deloger
- AMMICa Platform, INSERM US23, CNRS UAR 3655, AMMICa, Villejuif, France
| | | | | | - Vianney Baris
- UMR9019, CNRS, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Pierre Laplante
- UMR9019, CNRS, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Patricia Kannouche
- UMR9019, CNRS, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Virginie Marty
- AMMICa Platform, INSERM US23, CNRS UAR 3655, AMMICa, Villejuif, France
| | | | - Veronique Diéras
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - Fabrice André
- INSERM U981, Gustave Roussy, Villejuif, France.
- Department of Medical Oncology, Gustave Roussy, Villejuif, France.
- Faculty of Medicine, Université Paris-Saclay, Kremlin Bicêtre, France.
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3
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Willekens C, Laplane L, Dagher T, Benlabiod C, Papadopoulos N, Lacout C, Rameau P, Catelain C, Alfaro A, Edmond V, Signolle N, Marchand V, Droin N, Hoogenboezem R, Schneider RK, Penson A, Abdel-Wahab O, Giraudier S, Pasquier F, Marty C, Plo I, Villeval JL, Constantinescu SN, Porteu F, Vainchenker W, Solary E. SRSF2-P95H decreases JAK/STAT signaling in hematopoietic cells and delays myelofibrosis development in mice. Leukemia 2023:10.1038/s41375-023-01878-0. [PMID: 37100881 DOI: 10.1038/s41375-023-01878-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/10/2023] [Accepted: 03/15/2023] [Indexed: 04/28/2023]
Abstract
Heterozygous mutation targeting proline 95 in Serine/Arginine-rich Splicing Factor 2 (SRSF2) is associated with V617F mutation in Janus Activated Kinase 2 (JAK2) in some myeloproliferative neoplasms (MPNs), most commonly primary myelofibrosis. To explore the interaction of Srsf2P95H with Jak2V617F, we generated Cre-inducible knock-in mice expressing these mutants under control of the stem cell leukemia (Scl) gene promoter. In transplantation experiments, Srsf2P95H unexpectedly delayed myelofibrosis induced by Jak2V617F and decreased TGFβ1 serum level. Srsf2P95H reduced the competitiveness of transplanted Jak2V617F hematopoietic stem cells while preventing their exhaustion. RNA sequencing of sorted megakaryocytes identified an increased number of splicing events when the two mutations were combined. Focusing on JAK/STAT pathway, Jak2 exon 14 skipping was promoted by Srsf2P95H, an event detected in patients with JAK2V617F and SRSF2P95 co-mutation. The skipping event generates a truncated inactive JAK2 protein. Accordingly, Srsf2P95H delays myelofibrosis induced by the thrombopoietin receptor agonist Romiplostim in Jak2 wild-type animals. These results unveil JAK2 exon 14 skipping promotion as a strategy to reduce JAK/STAT signaling in pathological conditions.
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Affiliation(s)
- Christophe Willekens
- INSERM U1287, Gustave Roussy Cancer Campus, Villejuif, France
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Département d'hématologie, Gustave Roussy Cancer Campus, Villejuif, France
| | - Lucie Laplane
- INSERM U1287, Gustave Roussy Cancer Campus, Villejuif, France
- Institut d'Histoire et Philosophie des Sciences et des Techniques, Université Paris I Panthéon-Sorbonne, Paris, France
| | - Tracy Dagher
- INSERM U1287, Gustave Roussy Cancer Campus, Villejuif, France
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Camelia Benlabiod
- INSERM U1287, Gustave Roussy Cancer Campus, Villejuif, France
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Institut d'Histoire et Philosophie des Sciences et des Techniques, Université Paris I Panthéon-Sorbonne, Paris, France
| | - Nicolas Papadopoulos
- Ludwig Institute for Cancer Research Brussels, Brussels, Belgium
- Université catholique de Louvain and de Duve Institute, Brussels, Belgium
| | | | | | | | | | - Valérie Edmond
- INSERM U1287, Gustave Roussy Cancer Campus, Villejuif, France
| | | | - Valentine Marchand
- INSERM U1287, Gustave Roussy Cancer Campus, Villejuif, France
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Nathalie Droin
- INSERM U1287, Gustave Roussy Cancer Campus, Villejuif, France
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Gustave Roussy Cancer Campus, Villejuif, France
| | - Remco Hoogenboezem
- Department of Hematology, Erasmus University, Rotterdam, The Netherlands
| | - Rebekka K Schneider
- Department of Hematology, Erasmus University, Rotterdam, The Netherlands
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, RWTH Aachen University, Aachen, Germany
| | - Alex Penson
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Omar Abdel-Wahab
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Florence Pasquier
- INSERM U1287, Gustave Roussy Cancer Campus, Villejuif, France
- Département d'hématologie, Gustave Roussy Cancer Campus, Villejuif, France
| | - Caroline Marty
- INSERM U1287, Gustave Roussy Cancer Campus, Villejuif, France
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Isabelle Plo
- INSERM U1287, Gustave Roussy Cancer Campus, Villejuif, France
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Jean-Luc Villeval
- INSERM U1287, Gustave Roussy Cancer Campus, Villejuif, France
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Stefan N Constantinescu
- Ludwig Institute for Cancer Research Brussels, Brussels, Belgium
- Université catholique de Louvain and de Duve Institute, Brussels, Belgium
- WELBIO department, WEL Research Institute, Wavre, Belgium
- Ludwig Institute for Cancer Research, Nuffield Department of Medicine, Oxford University, Oxford, UK
| | - Françoise Porteu
- INSERM U1287, Gustave Roussy Cancer Campus, Villejuif, France
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - William Vainchenker
- INSERM U1287, Gustave Roussy Cancer Campus, Villejuif, France
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Eric Solary
- INSERM U1287, Gustave Roussy Cancer Campus, Villejuif, France.
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France.
- Département d'hématologie, Gustave Roussy Cancer Campus, Villejuif, France.
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4
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Tirelli L, Alfaro A, Citera G, Echeverría C. Nonscarring Alopecia Secondary to Secukinumab. Actas Dermo-Sifiliográficas 2022; 113:T1011-T1013. [DOI: 10.1016/j.ad.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/08/2022] [Indexed: 11/06/2022] Open
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5
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Tirelli L, Alfaro A, Citera G, Echeverría C. Nonscarring Alopecia Secondary to Secukinumab. Actas Dermo-Sifiliográficas 2022; 113:1011-1013. [DOI: 10.1016/j.ad.2022.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 10/23/2021] [Accepted: 01/08/2022] [Indexed: 11/26/2022] Open
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6
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Danlos FX, Goubet AG, Aglave M, Alfaro A, Job B, Francillette M, Hanna A, Pradere P, Dolidon S, Lecluse Y, Droin N, Deloger M, Besse B, Robert C, Michot JM, Soria JC, Barlesi F, Zitvogel L, Marabelle A, Le Pavec J. 1773P Anti-PD1-induced acute interstitial pneumonitis is characterized by alveolar infiltration of PD-1+CD38+TIGIT+ cytotoxic effector CD8+ T cells and CD206+ inflammatory macrophages. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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7
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Meziani L, Robert C, Classe M, Da Costa B, Mondini M, Clémenson C, Alfaro A, Mordant P, Ammari S, Le Goffic R, Deutsch E. Low Doses of Radiation Increase the Immunosuppressive Profile of Lung Macrophages During Viral Infection and Pneumonia. Int J Radiat Oncol Biol Phys 2021; 110:1283-1294. [PMID: 33722770 PMCID: PMC7954779 DOI: 10.1016/j.ijrobp.2021.03.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 12/02/2022]
Abstract
Purpose Severe pneumonia and acute respiratory distress syndrome (ARDS) have been described in patients with severe coronavirus disease 2019 (COVID-19). Recently, early clinical data reported the feasibility of low doses of radiation therapy (RT) in the treatment of ARDS in patients with severe COVID-19. However, the involved mechanisms remained unknown. Methods and Materials Here, we used airways-instilled lipopolysaccharide (LPS) and influenza virus (H1N1) as murine models of pneumonia, and toll-like receptor (TLR)-3 stimulation in human lung macrophages. Results Low doses of RT (0.5-1 Gray) decreased LPS-induced pneumonia, and increased the percentage of nerve- and airway-associated macrophages producing interleukin (IL) 10. During H1N1 viral infection, we observed decreased lung tissue damage and immune cell infiltration in irradiated animals. Low doses of RT increased IL-10 production by infiltrating immune cells into the lung. Irradiation of TLR-3 ligand-stimulated human lung macrophages ex vivo increased IL-10 secretion and decreased interferon γ production in the culture supernatant. The percentage of human lung macrophages producing IL-6 was also decreased. Conclusions Our data highlight a mechanism by which low doses of RT regulate lung inflammation and skew lung macrophages toward an anti-inflammatory profile. These data provide a preclinical mechanistic support to clinical trials evaluating low doses of RT, such as COVID-19-induced ARDS.
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Affiliation(s)
- Lydia Meziani
- INSERM U1030, Molecular Radiation Therapy and Therapeutic Innovation, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France; Labex LERMIT, DHU TORINO, SIRIC SOCRATE, Villejuif, France.
| | - Charlotte Robert
- INSERM U1030, Molecular Radiation Therapy and Therapeutic Innovation, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France; Labex LERMIT, DHU TORINO, SIRIC SOCRATE, Villejuif, France; Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Marion Classe
- INSERM U1030, Molecular Radiation Therapy and Therapeutic Innovation, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France; Department of Pathology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Bruno Da Costa
- Université Paris-Saclay, INRAE, UVSQ, VIM, Jouy-en-Josas, France
| | - Michele Mondini
- INSERM U1030, Molecular Radiation Therapy and Therapeutic Innovation, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France; Labex LERMIT, DHU TORINO, SIRIC SOCRATE, Villejuif, France
| | - Céline Clémenson
- INSERM U1030, Molecular Radiation Therapy and Therapeutic Innovation, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France; Labex LERMIT, DHU TORINO, SIRIC SOCRATE, Villejuif, France
| | - Alexia Alfaro
- Gustave Roussy, Plateforme Imagerie et Cytométrie, UMS 23/3655, Université Paris-Saclay, Villejuif, France
| | - Pierre Mordant
- Department of Vascular Surgery, Thoracic Surgery, and Lung Transplantation, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, INSERM U1152, Université de Paris, Paris, France
| | - Samy Ammari
- Department of Radiology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France; BioMaps (UMR1281), Université Paris-Saclay, CNRS, INSERM, CEA, Orsay, 91471, France
| | - Ronan Le Goffic
- Université Paris-Saclay, INRAE, UVSQ, VIM, Jouy-en-Josas, France
| | - Eric Deutsch
- INSERM U1030, Molecular Radiation Therapy and Therapeutic Innovation, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France; Labex LERMIT, DHU TORINO, SIRIC SOCRATE, Villejuif, France; Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France.
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8
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Silvin A, Chapuis N, Dunsmore G, Goubet AG, Dubuisson A, Derosa L, Almire C, Hénon C, Kosmider O, Droin N, Rameau P, Catelain C, Alfaro A, Dussiau C, Friedrich C, Sourdeau E, Marin N, Szwebel TA, Cantin D, Mouthon L, Borderie D, Deloger M, Bredel D, Mouraud S, Drubay D, Andrieu M, Lhonneur AS, Saada V, Stoclin A, Willekens C, Pommeret F, Griscelli F, Ng LG, Zhang Z, Bost P, Amit I, Barlesi F, Marabelle A, Pène F, Gachot B, André F, Zitvogel L, Ginhoux F, Fontenay M, Solary E. Elevated Calprotectin and Abnormal Myeloid Cell Subsets Discriminate Severe from Mild COVID-19. Cell 2020; 182:1401-1418.e18. [PMID: 32810439 PMCID: PMC7405878 DOI: 10.1016/j.cell.2020.08.002] [Citation(s) in RCA: 552] [Impact Index Per Article: 138.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/12/2020] [Accepted: 07/31/2020] [Indexed: 12/18/2022]
Abstract
Blood myeloid cells are known to be dysregulated in coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2. It is unknown whether the innate myeloid response differs with disease severity and whether markers of innate immunity discriminate high-risk patients. Thus, we performed high-dimensional flow cytometry and single-cell RNA sequencing of COVID-19 patient peripheral blood cells and detected disappearance of non-classical CD14LowCD16High monocytes, accumulation of HLA-DRLow classical monocytes (Human Leukocyte Antigen - DR isotype), and release of massive amounts of calprotectin (S100A8/S100A9) in severe cases. Immature CD10LowCD101−CXCR4+/− neutrophils with an immunosuppressive profile accumulated in the blood and lungs, suggesting emergency myelopoiesis. Finally, we show that calprotectin plasma level and a routine flow cytometry assay detecting decreased frequencies of non-classical monocytes could discriminate patients who develop a severe form of COVID-19, suggesting a predictive value that deserves prospective evaluation.
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Affiliation(s)
- Aymeric Silvin
- INSERM U1015, Gustave Roussy Cancer Campus, Villejuif 94800, France
| | - Nicolas Chapuis
- Université de Paris, Institut Cochin, CNRS UMR8104, INSERM U1016, Paris 75006, France; Service d'Hématologie Biologique, AP-HP, Hôpital Cochin, Paris 75014, France
| | - Garett Dunsmore
- INSERM U1015, Gustave Roussy Cancer Campus, Villejuif 94800, France
| | | | - Agathe Dubuisson
- INSERM U1015, Gustave Roussy Cancer Campus, Villejuif 94800, France
| | - Lisa Derosa
- INSERM U1015, Gustave Roussy Cancer Campus, Villejuif 94800, France; Département d'Oncologie Médicale, Gustave Roussy Cancer Campus, Villejuif 94800, France
| | - Carole Almire
- Service d'Hématologie Biologique, AP-HP, Hôpital Cochin, Paris 75014, France
| | - Clémence Hénon
- INSERM U981, Gustave Roussy Cancer Campus, Villejuif 94800, France
| | - Olivier Kosmider
- Université de Paris, Institut Cochin, CNRS UMR8104, INSERM U1016, Paris 75006, France; Service d'Hématologie Biologique, AP-HP, Hôpital Cochin, Paris 75014, France
| | - Nathalie Droin
- INSERM U1287, Gustave Roussy Cancer Campus, Villejuif 94800, France; INSERM US23, CNRS UMS 3655, Gustave Roussy Cancer Campus, Villejuif 94800, France
| | - Philippe Rameau
- INSERM US23, CNRS UMS 3655, Gustave Roussy Cancer Campus, Villejuif 94800, France
| | - Cyril Catelain
- INSERM US23, CNRS UMS 3655, Gustave Roussy Cancer Campus, Villejuif 94800, France
| | - Alexia Alfaro
- INSERM US23, CNRS UMS 3655, Gustave Roussy Cancer Campus, Villejuif 94800, France
| | - Charles Dussiau
- Université de Paris, Institut Cochin, CNRS UMR8104, INSERM U1016, Paris 75006, France; Service d'Hématologie Biologique, AP-HP, Hôpital Cochin, Paris 75014, France
| | - Chloé Friedrich
- Université de Paris, Institut Cochin, CNRS UMR8104, INSERM U1016, Paris 75006, France; Service d'Hématologie Biologique, AP-HP, Hôpital Cochin, Paris 75014, France
| | - Elise Sourdeau
- Service des Urgences, AP-HP, Hôpital Hôtel-Dieu, Paris 75014, France
| | - Nathalie Marin
- Service de Médecine Intensive et Réanimation, AP-HP, Hôpital Cochin, Paris 75014, France
| | - Tali-Anne Szwebel
- Service de Médecine Interne, AP-HP, Hôpital Cochin, Paris 75014, France
| | - Delphine Cantin
- Service des Urgences, AP-HP, Hôpital Hôtel-Dieu, Paris 75014, France
| | - Luc Mouthon
- Université de Paris, Institut Cochin, CNRS UMR8104, INSERM U1016, Paris 75006, France; Service de Médecine Interne, AP-HP, Hôpital Cochin, Paris 75014, France
| | - Didier Borderie
- Service de Diagnostic Biologique Automatisé, AP-HP, Hôpital Cochin, Paris 75014, France
| | - Marc Deloger
- INSERM US23, CNRS UMS 3655, Gustave Roussy Cancer Campus, Villejuif 94800, France
| | - Delphine Bredel
- INSERM U1015, Gustave Roussy Cancer Campus, Villejuif 94800, France
| | - Severine Mouraud
- INSERM U1015, Gustave Roussy Cancer Campus, Villejuif 94800, France
| | - Damien Drubay
- INSERM U1018, Gustave Roussy Cancer Campus, Villejuif 94800, France
| | - Muriel Andrieu
- Université de Paris, Institut Cochin, CNRS UMR8104, INSERM U1016, Paris 75006, France
| | | | - Véronique Saada
- Département de Biologie et Pathologie, Gustave Roussy Cancer Campus, Villejuif 94800, France
| | - Annabelle Stoclin
- Service de Réanimation Médicale, Gustave Roussy Cancer Campus, Villejuif 94800, France
| | - Christophe Willekens
- INSERM U1287, Gustave Roussy Cancer Campus, Villejuif 94800, France; Département d'Hématologie, Gustave Roussy Cancer Campus, Villejuif 94800, France
| | - Fanny Pommeret
- Département d'Oncologie Médicale, Gustave Roussy Cancer Campus, Villejuif 94800, France
| | - Frank Griscelli
- Département d'Oncologie Médicale, Gustave Roussy Cancer Campus, Villejuif 94800, France; Département de Biologie et Pathologie, Gustave Roussy Cancer Campus, Villejuif 94800, France
| | - Lai Guan Ng
- Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A(∗)STAR), 8A Biomedical Grove, Immunos Building #3-4, Biopolis, Singapore 138648, Singapore
| | - Zheng Zhang
- Institute for Hepatology, National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital, School of Medicine, Southern University of Science and Technology, Shenzhen 518112, Guangdong Province, China
| | - Pierre Bost
- Systems Biology Group, Department of Computational Biology and USR 3756, Institut Pasteur and CNRS, Paris 75015, France; Department of Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Ido Amit
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Fabrice Barlesi
- Département d'Oncologie Médicale, Gustave Roussy Cancer Campus, Villejuif 94800, France
| | - Aurélien Marabelle
- INSERM U1015, Gustave Roussy Cancer Campus, Villejuif 94800, France; Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy Cancer Campus, Villejuif 94800, France
| | - Frédéric Pène
- Université de Paris, Institut Cochin, CNRS UMR8104, INSERM U1016, Paris 75006, France; Service de Médecine Intensive et Réanimation, AP-HP, Hôpital Cochin, Paris 75014, France
| | - Bertrand Gachot
- Service de Réanimation Médicale, Gustave Roussy Cancer Campus, Villejuif 94800, France
| | - Fabrice André
- Département d'Oncologie Médicale, Gustave Roussy Cancer Campus, Villejuif 94800, France; INSERM U981, Gustave Roussy Cancer Campus, Villejuif 94800, France; Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre 94270, France
| | - Laurence Zitvogel
- INSERM U1015, Gustave Roussy Cancer Campus, Villejuif 94800, France; Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre 94270, France; Centre d'Investigation Clinique - Biothérapie, INSERM CICBT1428, Villejuif 94800, France
| | - Florent Ginhoux
- Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A(∗)STAR), 8A Biomedical Grove, Immunos Building #3-4, Biopolis, Singapore 138648, Singapore; Shanghai Institute of Immunology, Shanghai JiaoTong University School of Medicine, 280 South Chongqing Road, Shanghai 200025, China; Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore 169856, Singapore.
| | - Michaela Fontenay
- Université de Paris, Institut Cochin, CNRS UMR8104, INSERM U1016, Paris 75006, France; Service d'Hématologie Biologique, AP-HP, Hôpital Cochin, Paris 75014, France.
| | - Eric Solary
- INSERM U1287, Gustave Roussy Cancer Campus, Villejuif 94800, France; Service de Réanimation Médicale, Gustave Roussy Cancer Campus, Villejuif 94800, France; Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre 94270, France.
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Merchán D, Sanz L, Alfaro A, Pérez I, Goñi M, Solsona F, Hernández-García I, Pérez C, Casalí J. Irrigation implementation promotes increases in salinity and nitrate concentration in the lower reaches of the Cidacos River (Navarre, Spain). Sci Total Environ 2020; 706:135701. [PMID: 31940725 DOI: 10.1016/j.scitotenv.2019.135701] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/14/2019] [Accepted: 11/21/2019] [Indexed: 06/10/2023]
Abstract
The shift from rainfed to irrigated agriculture is associated with a change in the fertilization rates due to increases in expected production and the fact of growing more N demanding crops. In addition, the circulation of irrigation return flows (IRF) mobilizes soluble salts stored in soils or geological materials. As a consequence, it implies severe modifications in the dynamics and total amount of soluble salts and nitrogen exported, especially in semi-arid watersheds. In this study, long-term data collected by the regional authorities was used to assess the effects of irrigation implementation on salinity (using electrical conductivity, EC, as a proxy) and nitrate concentration (NO3-) after the transformation of ca. 77 km2 from rainfed to irrigated agriculture in the Cidacos River (CR) watershed. The results indicate that water quality in the lower reaches of the CR was significantly modified after the diffuse incorporation of IRF. In contrast, neither EC nor NO3- were different in those monitoring stations whose contributing watersheds did not include transformed area. In addition, the temporal dynamics in the analysed variables shifted from a rainfed land signal typical in the region to an irrigated land signal, and the hydrochemical type of the CR shifted from mixed-to-Na+-mixed-to-HCO3- to mostly Na+-mixed type, typical of waters affected by IRF in the region. Groundwater EC and NO3- also increased in those wells located within the irrigated area. Although there are great uncertainties in the actual amount of salt and N reaching the CR via IRF, the expected contribution of waste water spilled into the CR is minor in comparison to other sources, mostly agricultural sources in the case of N. The observed changes have promoted the designation of the lower reaches of the CR as "affected" by NO3- pollution, and the whole CR watershed as a Nitrate Vulnerable Zone, with the emergent question about whether irrigation implementation as carried out currently in Spain is against the environmental objectives of the Water Framework Directive.
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Affiliation(s)
- D Merchán
- Public University of Navarre, Campus de Arrosadía, 31006 Pamplona, Navarra, Spain.
| | - L Sanz
- Environmental Management of Navarre, C/ Padre Adoain, 219 Bajo, 31015 Pamplona, Navarra, Spain
| | - A Alfaro
- Navarre Institute of Agricultural and Food Technologies and Infrastructures, Avda. Serapio Huici 22, 31610 Villava, Navarra, Spain
| | - I Pérez
- Environmental Management of Navarre, C/ Padre Adoain, 219 Bajo, 31015 Pamplona, Navarra, Spain
| | - M Goñi
- Public University of Navarre, Campus de Arrosadía, 31006 Pamplona, Navarra, Spain
| | - F Solsona
- Department of Rural Development, Environment and Local Administration, Government of Navarre, C/ González Tablas 9, 31003 Pamplona, Navarra, Spain
| | - I Hernández-García
- Public University of Navarre, Campus de Arrosadía, 31006 Pamplona, Navarra, Spain
| | - C Pérez
- Department of Rural Development, Environment and Local Administration, Government of Navarre, C/ González Tablas 9, 31003 Pamplona, Navarra, Spain
| | - J Casalí
- Public University of Navarre, Campus de Arrosadía, 31006 Pamplona, Navarra, Spain
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10
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De Leeuw F, Abbaci M, Casiraghi O, Ben Lakhdar A, Alfaro A, Breuskin I, Laplace-Builhé C. Value of Full-Field Optical Coherence Tomography Imaging for the Histological Assessment of Head and Neck Cancer. Lasers Surg Med 2020; 52:768-778. [PMID: 32072655 DOI: 10.1002/lsm.23223] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND OBJECTIVES In head and neck surgery, intraoperative and postoperative evaluation of tumor margins is achieved by histopathological assessment, which is a multistep process. Intraoperative analysis of tumor margins to obtain a preliminary diagnosis is usually carried out on frozen sections. Analysis of frozen sections is challenging due to technical difficulties in processing. Full-field optical coherence tomography (FFOCT) provides ex vivo images of fresh tissue samples at a microscopic scale without tissue processing. The objectives of our study were to define the diagnostic criteria required to interpret head and neck FFOCT images and to evaluate the reliability of a histological diagnosis made on an "optical biopsy" produced by head and neck FFOCT imaging compared with conventional histology. STUDY DESIGN/MATERIALS AND METHODS First, we established an atlas of comparative images (FFOCT/standard histology) and defined the diagnostic criteria based on FFOCT images. Two pathologists subsequently performed a blinded review on 57 FFOCT images (32 patients). Specificity and sensitivity were measured by comparison with the standard histological diagnosis. The primary endpoint was major concordance, defined as two classifications leading to the same therapeutic decision (treatment/no treatment). RESULTS Pathologists identified four main criteria for tissue diagnosis on FFOCT images: heterogeneous cell distribution, stromal reaction, coiling, and keratinization abnormalities. The correlation study showed good results, with sensitivity from 88% to 90% and specificity from 81% to 87%, regardless of whether the FFOCT image review was performed by a pathologist with or without previous experience in optical imaging. CONCLUSIONS Our results demonstrate that FFOCT images can be used by pathologists for differential diagnosis, and that high-resolution FFOCT imaging can provide an assessment of microscopic architecture in head and neck tissues without tissue processing requirements. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.
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Affiliation(s)
- Frederic De Leeuw
- Gustave Roussy, Plate-forme Imagerie et Cytométrie, Université Paris-Saclay, UMS 23/3655, Villejuif, F-94805, France
| | - Muriel Abbaci
- Gustave Roussy, Plate-forme Imagerie et Cytométrie, Université Paris-Saclay, UMS 23/3655, Villejuif, F-94805, France.,UMR CNRS 8081-IR4M, Univ Paris-Sud, Université Paris-Saclay, Orsay, F-91401, France
| | - Odile Casiraghi
- Département de pathologie, Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Aïcha Ben Lakhdar
- Département de pathologie, Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Alexia Alfaro
- Gustave Roussy, Plate-forme Imagerie et Cytométrie, Université Paris-Saclay, UMS 23/3655, Villejuif, F-94805, France
| | - Ingrid Breuskin
- Département de chirurgie, Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Corinne Laplace-Builhé
- Gustave Roussy, Plate-forme Imagerie et Cytométrie, Université Paris-Saclay, UMS 23/3655, Villejuif, F-94805, France.,UMR CNRS 8081-IR4M, Univ Paris-Sud, Université Paris-Saclay, Orsay, F-91401, France
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Morales J, Alfaro A, Kipar A, Hepojoki J, Hetzel U. Boid Inclusion Body Disease (BIBD) in Indigenous Snakes in Costa Rica. J Comp Pathol 2020. [DOI: 10.1016/j.jcpa.2019.10.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Alfaro A, Asensio M, García-Escrivá A, Medrano V, Salom J, Tortosa D, Palao S, Lezcano M, Berenguer L, Navarro M, Cerdán M, Buendía J, Giner J. LAM study: Effects of lacosamide on behaviour and quality of life in patients with epilepsy. Neurología (English Edition) 2019. [DOI: 10.1016/j.nrleng.2018.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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13
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Bolaños L, Espinoza A, Alfaro A, Barron E, Juárez E, Berumen Campos J. Glycolytic enzymes lactate dehydrogenase A (LDHA) and phosphofructokinase P (PFKP) are good biomarkers of survival and potential therapeutic targets in cervical cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy314.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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14
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Alfaro A, Asensio M, García-Escrivá A, Medrano V, Salom JM, Tortosa D, Palao S, Lezcano M, Berenguer L, Navarro M, Cerdán M, Buendía JF, Giner JC. LAM study: Effects of lacosamide on behaviour and quality of life in patients with epilepsy. Neurologia 2016; 34:1-6. [PMID: 27993420 DOI: 10.1016/j.nrl.2016.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 10/06/2016] [Accepted: 10/11/2016] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Psychiatric comorbidities are common in epileptic patients, and evaluating the impact of antiepileptic drugs on patients' moods is therefore essential. The aim of this study is to assess the effects of lacosamide on behaviour and quality of life in people with epilepsy. METHODS We conducted a multicentre prospective observational study of poorly-controlled epileptic patients who received lacosamide as an adjuvant treatment. Patients were evaluated on 4 occasions during a 12-month period. The impact of lacosamide on patients' mood and quality of life was assessed with the Quality of Life in Epilepsy Inventory-10 (QOLIE-10), the Hospital Anxiety and Depression Scale (HADS), and the Barratt Impulsiveness Scale (BIS-11). As a secondary objective, we evaluated the effectiveness and safety of lacosamide. RESULTS We included 55 patients with a mean age of 47.1±18.4 years. At baseline, 34.5% of the patients had psychiatric comorbidities; the mean number of crises in the previous month was 3.6±4.3. The QOLIE-10 and HADS scales revealed statistically significant improvements in patients with a poor baseline condition (anxiety, depression, and/or poor quality of life). The BIS-11 scale detected no impulsive behaviour during follow-up. After 12 months of treatment, 51.9% of the patients were seizure-free and 77.8% experienced a reduction of at least 50% in seizure frequency. Adverse effects were mild in most cases; lacosamide was discontinued in 10 patients (18.2%). CONCLUSIONS Lacosamide is a safe and effective treatment option for patients with epilepsy and psychiatric comorbidities.
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Affiliation(s)
- A Alfaro
- CIBER-BBN Grupo de Neuroingeniería Biomédica, Universidad Miguel Hernández, Elche, Alicante, España; Sección de Neurología, Hospital Vega Baja de Orihuela, Alicante, España.
| | - M Asensio
- Servicio de Neurología, Hospital General Universitario de Alicante, Alicante, España
| | - A García-Escrivá
- Sección de Neurología, Hospital IMED-Levante, Benidorm, Alicante, España
| | - V Medrano
- Sección de Neurología, Hospital Virgen de la Salud, Elda, Alicante, España
| | - J M Salom
- Sección de Neurología. Hospital Clínico Universitario de Valencia, Valencia, España
| | - D Tortosa
- Servicio de Neurología, Hospital General Universitario Virgen de la Arrixaca, Murcia, España
| | - S Palao
- Servicio de Neurología, Hospital General Universitario de Alicante, Alicante, España
| | - M Lezcano
- Servicio de Neurología, Regionshospitalet Holstebro, Holstebro, Dinamarca
| | - L Berenguer
- Sección de Neurología, Hospital de la Marina Baja, Villajoyosa, Alicante, España
| | - M Navarro
- Sección de Neurología, Hospital Los Arcos del Mar Menor, Murcia, España
| | - M Cerdán
- Servicio de Neurología, Hospital General Universitario Virgen de la Arrixaca, Murcia, España
| | - J F Buendía
- Sección de Neurología, Hospital Comarcal del Noroeste, Caravaca de la Cruz, Murcia, España
| | - J C Giner
- Servicio de Neurología, Hospital General Universitario de Elche, Alicante, España
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Jiménez C, Romero M, Piche M, Baldi M, Alfaro A, Chaves A, Morales J, León B, Hutter S, Corrales-Aguilar E. Arboviral encephalitis in Costa Rican horses: 2009-2016. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.11.375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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16
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Cavero-Carbonell C, Gimeno-Martos S, Gras-Colomer E, Páramo-Rodríguez L, Alfaro A, Zurriaga O. Stevens Johnson Syndrome: identification of the risk factors in a rare disease. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw174.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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17
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Panno S, Biondo C, Piazza V, Graci S, Alfaro A, Font M, Marchione S, Davino M, Bella P, Davino S. First outbreak of
Pepper vein yellows virus
infecting sweet pepper in Italy. ACTA ACUST UNITED AC 2016. [DOI: 10.5197/j.2044-0588.2016.034.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- S. Panno
- Department of Agriculture and Forest ScienceUniversity of PalermoViale delle Scienze Ed. 590128PalermoItaly
| | - C. Biondo
- Department of Agriculture and Forest ScienceUniversity of PalermoViale delle Scienze Ed. 590128PalermoItaly
| | - V. Piazza
- Department of Agriculture and Forest ScienceUniversity of PalermoViale delle Scienze Ed. 590128PalermoItaly
| | - S. Graci
- Department of Agriculture and Forest ScienceUniversity of PalermoViale delle Scienze Ed. 590128PalermoItaly
- Grupo de VirologíaInstituto Agroforestal MediterráneoUniversitat Politènica de ValènciaCamino de Vera s/n46022ValenciaSpain
| | - A. Alfaro
- Grupo de VirologíaInstituto Agroforestal MediterráneoUniversitat Politènica de ValènciaCamino de Vera s/n46022ValenciaSpain
| | - M.I. Font
- Grupo de VirologíaInstituto Agroforestal MediterráneoUniversitat Politènica de ValènciaCamino de Vera s/n46022ValenciaSpain
| | - S. Marchione
- Osservatorio per le Malattie delle PianteVia Uditore 1590145PalermoItaly
| | - M. Davino
- Department Di3A ‐ University of CataniaVia S. Sofia 10095100CataniaItaly
| | - P. Bella
- Department of Agriculture and Forest ScienceUniversity of PalermoViale delle Scienze Ed. 590128PalermoItaly
| | - S. Davino
- Department of Agriculture and Forest ScienceUniversity of PalermoViale delle Scienze Ed. 590128PalermoItaly
- Institute for Sustainable Plant Protection ‐ National Research Council (IPSP‐CNR)Strada delle Cacce 7310135TorinoItaly
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18
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Jiménez C, Romero M, Baldi M, Piche M, Alfaro A, Chaves A, Morales J, León B, Hutter S, Corrales E. Arboviral Infections (Eastern Equine Encephalitis, Western Equine Encephalitis, Venezuelan Equine Encephalitis and West Nile Encephalitis) in horses of Costa Rica. J Equine Vet Sci 2016. [DOI: 10.1016/j.jevs.2016.02.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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19
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Requena C, Alfaro A, Traves V, Nagore E, Llombart B, Serra C, Martorell A, Guillén C, Sanmartín O. Paraneoplastic dermatomyositis: a study of 12 cases. Actas Dermosifiliogr 2014; 105:675-82. [PMID: 24484630 DOI: 10.1016/j.ad.2013.11.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 11/19/2013] [Accepted: 11/24/2013] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Adult dermatomyositis presents as a paraneoplastic syndrome in up to 25% of cases, but no clinical, histologic, or laboratory markers completely specific for paraneoplastic disease in dermatomyositis have been identified to date. Furthermore, studies on adult dermatomyositis do not usually report the frequency of cutaneous features of dermatomyositis in patients with associated cancer. Our aim was to review the characteristics of paraneoplastic dermatomyositis in patients seen at our hospital. MATERIAL AND METHODS We studied 12 cases of paraneoplastic dermatomyositis and recorded patient age and sex, associated cancer, time between onset of dermatomyositis and cancer, emergent cutaneous manifestations, muscle involvement, dysphagia, lung disease, and levels of creatine phosphokinase and circulating autoantibodies. RESULTS The mean age of the patients was 61 years and the 2 most common malignancies were ovarian cancer and bladder cancer. The mean time between the diagnosis of cancer and dermatomyositis was 7 months and in most cases, the cancer was diagnosed first. Seven patients had amyopathic dermatomyositis. The most common cutaneous signs were a violaceous photodistributed rash sparing the interscapular area and a heliotrope rash, followed by Gottron papules and cuticle involvement. Superficial cutaneous necrosis was observed in 3 cases. Myositis-specific autoantibodies were not detected in any of the 6 patients who underwent this test. CONCLUSIONS Paraneoplastic dermatomyositis is often amyopathic. There are no specific cutaneous markers for malignancy in dermatomyositis. Myositis-specific antibodies are not associated with paraneoplastic dermatomyositis.
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Affiliation(s)
- C Requena
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España.
| | - A Alfaro
- Servicio de Dermatología, Hospital de Manises, Valencia, España
| | - V Traves
- Servicio de Anatomía Patológica, Instituto Valenciano de Oncología, Valencia, España
| | - E Nagore
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - B Llombart
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - C Serra
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - A Martorell
- Servicio de Dermatología, Hospital de Manises, Valencia, España
| | - C Guillén
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - O Sanmartín
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España; Departamento de Patología Médico-Quirúrgica, Universidad Católica de Valencia, San Vicente Mártir, Valencia, España
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20
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Martínez S, Izquierdo A, Merchante M, Sánchez-Rubio L, Zorzano A, Carrillo L, Berisa S, Alfaro A, Hurtado MF, Aibar P. GRP-135 Pharmaceutical Intervention in Outpatient Safety: Prevention of Medication Errors in an Intravenous Mixing Unit. Eur J Hosp Pharm 2013. [DOI: 10.1136/ejhpharm-2013-000276.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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21
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Izquierdo A, Martínez S, Alfaro A, Merchante M, Sanchez-Rubio L, Zorzano A, Hurtado MF. DGI-074 Treatment and Prognosis in Patients with Waldenstrom’s Macorglobulinemia. Eur J Hosp Pharm 2013. [DOI: 10.1136/ejhpharm-2013-000276.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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22
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Izquierdo A, Martínez S, Alfaro A, Merchante M, Sanchez-Rubio L, Zorzano A, Aibar MP, Serrano A, Carrillo L, Hurtado MF. GRP-140 Pharmacist Involvement in Cytostatic Doses: in an Obese Population. Eur J Hosp Pharm 2013. [DOI: 10.1136/ejhpharm-2013-000276.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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23
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Alfaro A. 136. Hematomas after lidocaine femoral nerve blocks to assess a stiff knee gait. Clin Neurophysiol 2012. [DOI: 10.1016/j.clinph.2011.11.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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24
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Merchante M, Alfaro A, Zorzano A, Esteban M, Martinez S, de Rozas CS, Aibar P. Zoledronic dose adjustment in cancer patients: GRP055 Table 1. Eur J Hosp Pharm 2012. [DOI: 10.1136/ejhpharm-2012-000074.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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25
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Ong A, Orozco F, Sheikh ES, Anmuth C, Alfaro A, Kathrins R, Grove GL, Zerweck C, Madden AM, Raspa R, Weis MT. An RCT on the effects of topical CGP on surgical wound appearance and residual scarring in bilateral total-knee arthroplasty patients. J Wound Care 2012; 20:592-8. [PMID: 22240886 DOI: 10.12968/jowc.2011.20.12.592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To test the hypothesis that topically applied calcium glycerophosphate (CGP) would improve the appearance of the wound following bilateral knee replacement. METHOD Healthy patients, aged 45-75 years, scheduled for bilateral total-knee replacement surgery were recruited into the study. One knee was randomly assigned to the treatment group, while the contralateral knee was designated the control (standard care). Subjects were instructed to apply a preparation of 10% CGP in an aqueous lotion to the treated knee once daily for 42 days, starting at the third postoperative day. Functional sealing and cosmetic appearance of the incision were evaluated by two surgeons by direct examination of the patient and then by two experienced assessors from photographs. The investigators qualitatively scored the intensity and extent of erythema along the incision and over the entire knee, the appearance of visible oedema along the incision and over the knee, and the overall clinical impression of wound healing. All four assessors were blinded to the subjects' allocation and the latter two assessors to the initial investigators' assessments. Subjects were also followed up for an additional 46 weeks, giving a total study duration of 12 months. RESULTS Twenty patients completed the study. Statistical analysis showed that both the area and intensity of erythema along the incision were significantly reduced in the treated vs untreated knee over the entire study period. The analysis further showed that treatment significantly reduced oedema, both along the incision and across the entire knee. The differences were most marked at the seventh postoperative day and diminished with time. No adverse effects were observed for any patient, in either treated or untreated knees. CONCLUSION These data demonstrate that postoperative application of 10% CGP could improve the appearance of the wound following total knee arthroplasty.
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Affiliation(s)
- A Ong
- Rothman Institute, Philadelphia, USA
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26
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Alfaro A, López F, Pérez A, García JC, Rodríguez A. Integral valorization of tagasaste (Chamaecytisus proliferus) under hydrothermal and pulp processing. Bioresour Technol 2010; 101:7635-7640. [PMID: 20493685 DOI: 10.1016/j.biortech.2010.04.059] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Revised: 04/20/2010] [Accepted: 04/24/2010] [Indexed: 05/26/2023]
Abstract
Tagasaste wood (Chamaecytisus proliferus L.F. ssp palmensis) was characterized, chemical and energy terms, and assessed its potential as a lignocellulosic raw material, and its integral fractionation by autohydrolysis and delignification with ethanol. The hydrothermal treatment of the raw material at 175-185 degrees C provided a liquor containing a substantially increased amount of oligomers (between 16.6% and 47.4% as percentages with respect to the content of the raw material in each polymer fraction). A cellulose pulp with autohydrolysis treatment increased yields (53-60%), reduced Kappa number (28.8-34.6) but also viscosity (755-857 mL/g), and decreased paper strength (2.97-5.22 kN m/kg). However, beating ethanol cellulose from tagasaste was found to improve its strength-related properties more markedly than in soda pulp from the same material (tensile index of 44 kN m/kg).
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Affiliation(s)
- A Alfaro
- Forest Engineering Department, Faculty of Experimental Sciences, Huelva University, Huelva, Spain
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27
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Alfaro A, Qian Y. SU-FF-J-43: Significance of Patient Rotation for Dosimetry in IGRT. Med Phys 2009. [DOI: 10.1118/1.3181335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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28
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Basak G, Yasukawa S, Alfaro A, Miniev B, Carrier E. Human Embryonic Stem Cells-Derived Hemangioblast Express HLA-Antigens. Biol Blood Marrow Transplant 2009. [DOI: 10.1016/j.bbmt.2008.12.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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29
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Alfaro A, Rivera A, Pérez A, Yáñez R, García JC, López F. Integral valorization of two legumes by autohydrolysis and organosolv delignification. Bioresour Technol 2009; 100:440-445. [PMID: 18694639 DOI: 10.1016/j.biortech.2008.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Revised: 04/30/2008] [Accepted: 05/01/2008] [Indexed: 05/26/2023]
Abstract
Two woody legumes species (Chamaecytisus proliferus L.F. ssp. palmensis and Leucaena diversifolia) were evaluated for integrally exploitation. The raw material was subjected to autohydrolysis under variable operating conditions which provided a liquid phase rich in hemicellulose oligomers and a solid phase that was used to obtain cellulose pulp and paper sheets by using organosolv procedures. The chemical properties of both C. proliferus and L. diversifolia allow their integral exploitation by using a hydrothermal treatment prior to their organosolv pulping with ethanol. The pulp yields obtained are quite high (40.3% for L. diversifolia and 58.2% for C. proliferus), and so are the sugar concentrations in the liquors from the thermal pretreatment (viz. 16.1 and 20.0 g oligomers/l in C. proliferus and L. diversifolia, respectively, and 1.5 and 1.1g xylose/l, respectively, in the two raw materials). The strength-related properties of the paper sheets obtained are acceptable (tensile index 7.76 and 10.77 kN m/kg for C. proliferus and L. diversifolia, respectively and kappa index 31 and 12.5 for C. proliferus and L. diversifolia, respectively), but somewhat worse than those provided by other raw materials such as eucalyptus; however, they can be improved by mechanical refining of the pulp.
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Affiliation(s)
- A Alfaro
- Agroforestry Science Department, Universidad de Huelva, Ctra Huelva-Palos de la Frontera s/n, Palos de la Frontera, Huelva, Spain
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García MM, López F, Alfaro A, Ariza J, Tapias R. The use of Tagasaste (Chamaecytisus proliferus) from different origins for biomass and paper production. Bioresour Technol 2008; 99:3451-7. [PMID: 17881228 DOI: 10.1016/j.biortech.2007.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2007] [Revised: 07/31/2007] [Accepted: 08/03/2007] [Indexed: 05/17/2023]
Abstract
In order to identify faster-growing non-woody species usable for biomass and paper production, four Tagasastes (Chamaecytisus proliferus) from different origins are tested. All the Tagasaste species (T. Huelva, T. Australia, T. New Zealand and T. La Palma island) show a good soil and climatic adaptation to Southwest Spain. The studied Tagasaste provenances shows biomass productivity ranges from 1.0 t ha(-1)yr(-1) to 3.4 th a(-1)yr(-1) (o.d.b.) and 25.3 t ha(-1)yr(-1) to 49.4 t ha(-1)yr(-1) under Mediterranean conditions for first and second year sprouts, respectively. The quantity of solubles and extractives shows similar values when compared with wood materials. A relatively lower lignin content in Tagasaste (from 13.7% to 17.1%) species has been found with respect to other vegetal species. The alpha-celullose contents (43.6-45.3%) were in the range of the normal values expected for the other non-wood raw materials. The study confirms the feasibility of the organocell yield pulping process to Tagasaste provenances. Organocell processes provide an efficient delignification (kappa index from 7.2 to 10.9 and pulp yield from 43.6% to 54.1%). The best results are obtained for the physical properties of paper sheets for Tagasaste from Australia in the second year, with values of tensile index of 16.0 kNm/kg, burst index of 1.12 MPa m2/kg and tear index of 0.55 Nm2/kg.
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Affiliation(s)
- M M García
- Chemical Engineering Department, Huelva University, Avda. Fuerzas Armadas s/n, 21071 Huelva, Spain
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31
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Hernández I, Sanmartín O, Cardá C, Góme S, Alfaro A. [B-cell pseudolymphoma caused by aluminium hydroxide following hyposensitization therapy]. Actas Dermosifiliogr 2008; 99:213-216. [PMID: 18358197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Aluminium hydroxide is used as an adjuvant in vaccines. We describe the case of a patient who presented a persistent adverse local reaction to aluminium hydroxide due to hyposensitization therapy to dust mites. Multiple painful and pruriginous subcutaneous nodules were observed in both arms, along with hypertrichosis at the injection site. Histology revealed a pseudolymphomatous B cell reaction predominantly involving cells that were CD20 positive, did not express bcl-2, and did not display the t(14-18) translocation. The cells also exhibited polyclonal rearrangement of the immunoglobulin heavy chains. X-ray spectral microanalysis revealed deposits of inorganic aluminium in the granular histiocytes among the germinal centers. The patient was diagnosed with cutaneous B-cell pseudolymphoma due to aluminium hydroxide as a result of immunotherapy.
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Affiliation(s)
- I Hernández
- Servicio de Dermatología. Hospital General Básico de la Defensa de Valencia. España
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32
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Llombart B, Sanmartin O, Requena C, Monteagudo C, Botella-Estrada R, Nagore E, Serra C, Alfaro A, Pellín A, Llombart-Bosch A, Guillén C, López-Guerrero JA. Atrophic dermatofibrosarcoma protuberans with the fusion gene COL1A1-PDGFB. J Eur Acad Dermatol Venereol 2008; 22:371-4. [DOI: 10.1111/j.1468-3083.2007.02327.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hernández I, Sanmartín O, Cardá C, Gómez S, Alfaro A. B-Cell Pseudolymphoma Caused by Aluminium Hydroxide Following Hyposensitization Therapy. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s1578-2190(08)70234-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Esmer D, Alvarez-Tostado J, Alfaro A, Carmona R, Salas M. Thoracoscopic and laparoscopic repair of complicated Bochdalek hernia in adult. Hernia 2007; 12:307-9. [PMID: 17990045 DOI: 10.1007/s10029-007-0293-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Accepted: 10/12/2007] [Indexed: 10/22/2022]
Abstract
Bochdalek's hernia is a congenital defect of the diaphragm that occurs predominantly in children. Perforation or necrosis of the involved organ is a feared complication and surgical repair constitutes the gold standard of treatment. We present a case of a 42-year-old female patient who presented with a 3-month history of left-upper-quadrant abdominal pain, nausea, tachycardia, and early postprandial vomit. Physical exploration was remarkable for audible peristalsis in the left hemithorax. Total white blood count was elevated and chest X-rays showed images of intestines in the left hemithorax. Tomography with double contrast reported left colon herniated to thorax. Left thoracoscopy was practised, finding a Bochdalek's hernia with presence of herniated descendent colon with a necrotic area, which was perforated and sealed. The herniated content was returned back in place, the diaphragmatic defect was corrected, and colostomy by laparoscopy was simultaneously performed. Her postoperative recovery was uneventful and she was discharged from the hospital. Combined thoracoscopy and laparoscopic surgery is effective in complicated cases of Bochdalek's hernia in adults, lessening surgical trauma and postsurgical morbidity.
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Affiliation(s)
- D Esmer
- Hospital Central Ignacio Morones Prieto, San Luís Potosí, SLP, México.
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35
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Alfaro A, Torrelo A, Hernández A, Zambrano A, Happle R. [Becker nevus syndrome]. Actas Dermosifiliogr 2007; 98:624-626. [PMID: 17961453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Becker nevus is a hyperpigmented hamartoma with an irregular outline and often hairy. It is normally found on the shoulders and chest, although it can appear in other areas. Becker nevus is sometimes associated with other muscular, skeletal, or cutaneous abnormalities such as ipsilateral breast hypoplasia or scoliosis. This characteristic phenotype of Becker nevus associated with unilateral breast hypoplasia or other abnormalities is referred to as Becker nevus syndrome. Although the lesions usually become apparent during adolescence, they are present from birth and represent part of the spectrum of so-called epidermal nevus syndromes. We present 4 cases of Becker nevus syndrome in which Becker nevus was associated with ipsilateral breast hypoplasia and, less consistently, other abnormalities.
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Affiliation(s)
- A Alfaro
- Servicio de Dermatología. Hospital del Niño Jesús. Madrid. España
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Serra-Guillén C, Requena C, Alfaro A, Hueso L, Sanmartín O, Llombart B, Nagore E, Botella-Estrada R, Martorell-Calatayud A, Guillén C. [Oral involvement in lymphomatoid papulosis]. Actas Dermosifiliogr 2007; 98:265-7. [PMID: 17506958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
Lymphomatoid papulosis is a cutaneous lymphoma with an indolent clinical behaviour characterized by chronic development of recurrent, self-limited lesions appearing as necrotic papules and with a pathology compatible with T cell lymphoma. Mucosal involvement by lymphomatoid papulosis is very rare but has been reported in the literature. It usually appears as ulcers in patients previously diagnosed of lymphomatoid papulosis. From a histological perspective it is characterized by an infiltrate of CD 30 positive atypical lymphocytes together with a mixed inflammatory infiltrate of eosinophils, neutrophils, histiocytes and plasma cells. We report the case of a man previously diagnosed of lymphomatoid papulosis that developed two ulcerated lesions in the tongue whose biopsy confirmed the diagnosis of oral involvement by lymphomatoid papulosis.
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Affiliation(s)
- C Serra-Guillén
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España.
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Serra-Guillén C, Requena C, Alfaro A, Hueso L, Sanmartín O, Llombart B, Nagore E, Botella-Estrada R, Martorell-Calatayud A, Guillén C. Afectación de la mucosa oral por papulosis linfomatoide. Actas Dermo-Sifiliográficas 2007. [DOI: 10.1016/s0001-7310(07)70060-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Serra-Guillén C, Requena C, Alfaro A, Hueso L, Sanmartín O, Llombart B, Nagore E, Botella-Estrada R, Martorell-Calatayud A, Guillén C. Oral Involvement in Lymphomatoid Papulosis. Actas Dermo-Sifiliográficas (English Edition) 2007. [DOI: 10.1016/s1578-2190(07)70440-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Alfaro A, Tórrelo A, Hernández Á, Zambrano A, Happle R. Becker Nevus Syndrome. Actas Dermo-Sifiliográficas (English Edition) 2007. [DOI: 10.1016/s1578-2190(07)70529-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Requena C, Requena L, Sánchez-Yus E, Nagore E, Alfaro A, Llombart B, Botella R, Sanmartín O, Guillén C. Pigmented epithelioid Spitz naevus: report of two cases. Histopathology 2006; 49:549-51. [PMID: 17064308 DOI: 10.1111/j.1365-2559.2006.02485.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Botella-Estrada R, Nagore E, Sopena J, Cremades A, Alfaro A, Sanmartín O, Requena C, Serra-Guillén C, Guillén C. Clinical, dermoscopy and histological correlation study of melanotic pigmentations in excision scars of melanocytic tumours. Br J Dermatol 2006; 154:478-84. [PMID: 16445779 DOI: 10.1111/j.1365-2133.2005.07105.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Melanotic pigmentations in scars consecutive to the excision of melanocytic tumours can be secondary to a reactive phenomenon related to the scar tissue or to a recurrence of the melanocytic lesion excised in the first case. Recurrent naevi may sometimes adopt unusual features that make them difficult to differentiate from a melanoma. OBJECTIVES To describe the clinical, dermoscopic and histological features of melanotic pigmentations in scars consecutive to the excision of melanocytic tumours, and to correlate the histological diagnosis with the dermoscopic features. METHODS This was a prospective cohort study using macrophotography, dermoscopy and histopathological study. Ninety-five melanotic pigmentations (77 patients) in scars secondary to the excision of melanocytic tumours were prospectively collected in the Department of Dermatology at the Instituto Valenciano de Oncología in Valencia, Spain. Histopathological study was performed in 57 scars. RESULTS Thirteen dermoscopic structures were identified. Four criteria allowed a differentiation between reactive and specific melanocytic pigmentations. Presence of globules and presence of heterogeneous pigmentation were features associated with specific melanocytic pigmentations (P < 0.0001). Presence of a regular network and presence of streaks were more frequently found in reactive pigmentations (P = 0.023 and 0.026, respectively). CONCLUSIONS Dermoscopic examination of melanotic pigmentations in excision scars of melanocytic tumours provides useful information about the origin of that pigmentation. Based on such information, recurrent naevi can be differentiated from reactive pigmentations in most cases. Excision and histopathological diagnosis continue to be imperative in some cases of recurrent naevi with atypical clinical features.
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Affiliation(s)
- R Botella-Estrada
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain.
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Alfaro A, Doan M, Finke J, Galdes M, Zohdy M. Application of Divide and Conquer Extended Genetic Algorithm to tertiary protein structure of chymotrypsin inhibitor-2. Appl Bionics Biomech 2006. [DOI: 10.1533/abbi.2006.0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Fernández E, Pelayo F, Romero S, Bongard M, Marin C, Alfaro A, Merabet L. Development of a cortical visual neuroprosthesis for the blind: the relevance of neuroplasticity. J Neural Eng 2005; 2:R1-12. [PMID: 16317227 DOI: 10.1088/1741-2560/2/4/r01] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Clinical applications such as artificial vision require extraordinary, diverse, lengthy and intimate collaborations among basic scientists, engineers and clinicians. In this review, we present the state of research on a visual neuroprosthesis designed to interface with the occipital visual cortex as a means through which a limited, but useful, visual sense could be restored in profoundly blind individuals. We review the most important physiological principles regarding this neuroprosthetic approach and emphasize the role of neural plasticity in order to achieve desired behavioral outcomes. While full restoration of fine detailed vision with current technology is unlikely in the immediate near future, the discrimination of shapes and the localization of objects should be possible allowing blind subjects to navigate in a unfamiliar environment and perhaps even to read enlarged text. Continued research and development in neuroprosthesis technology will likely result in a substantial improvement in the quality of life of blind and visually impaired individuals.
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Affiliation(s)
- E Fernández
- Instituto de Bioingeniería, Universidad Miguel Hernández, Elche, Spain.
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López F, Alfaro A, García M, Díaz M, Calero A, Ariza J. Pulp and Paper from Tagasaste (Chamaecytisus Proliferus L.F. SSP. Palmensis). Chem Eng Res Des 2004. [DOI: 10.1205/0263876041580730] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Díaz MJ, Alfaro A, García MM, Eugenio ME, Ariza J, López F. Ethanol Pulping from Tagasaste (Chamaecytisus proliferus L.F. ssp palmensis). A New Promising Source for Cellulose Pulp. Ind Eng Chem Res 2004. [DOI: 10.1021/ie030611a] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M. J. Díaz
- Chemical Engineering Department Facultad de Ciencias Experimentales Campus del Carmen, Universidad de Huelva, Avda, de las Fuerzas Armadas S/N, 21007 Huelva Spain, Forestry Science Department, Universidad de Huelva, Ctra, Huelva-Palos de la Frontera s/n, 21819 La Rábida, Palos de la Frontera, Huelva, Spain, and Environmental Science Department, Universidad Pablo de Olavide, Ctra, Utrera Km. 5, Sevilla, Spain
| | - A. Alfaro
- Chemical Engineering Department Facultad de Ciencias Experimentales Campus del Carmen, Universidad de Huelva, Avda, de las Fuerzas Armadas S/N, 21007 Huelva Spain, Forestry Science Department, Universidad de Huelva, Ctra, Huelva-Palos de la Frontera s/n, 21819 La Rábida, Palos de la Frontera, Huelva, Spain, and Environmental Science Department, Universidad Pablo de Olavide, Ctra, Utrera Km. 5, Sevilla, Spain
| | - M. M. García
- Chemical Engineering Department Facultad de Ciencias Experimentales Campus del Carmen, Universidad de Huelva, Avda, de las Fuerzas Armadas S/N, 21007 Huelva Spain, Forestry Science Department, Universidad de Huelva, Ctra, Huelva-Palos de la Frontera s/n, 21819 La Rábida, Palos de la Frontera, Huelva, Spain, and Environmental Science Department, Universidad Pablo de Olavide, Ctra, Utrera Km. 5, Sevilla, Spain
| | - M. E. Eugenio
- Chemical Engineering Department Facultad de Ciencias Experimentales Campus del Carmen, Universidad de Huelva, Avda, de las Fuerzas Armadas S/N, 21007 Huelva Spain, Forestry Science Department, Universidad de Huelva, Ctra, Huelva-Palos de la Frontera s/n, 21819 La Rábida, Palos de la Frontera, Huelva, Spain, and Environmental Science Department, Universidad Pablo de Olavide, Ctra, Utrera Km. 5, Sevilla, Spain
| | - J. Ariza
- Chemical Engineering Department Facultad de Ciencias Experimentales Campus del Carmen, Universidad de Huelva, Avda, de las Fuerzas Armadas S/N, 21007 Huelva Spain, Forestry Science Department, Universidad de Huelva, Ctra, Huelva-Palos de la Frontera s/n, 21819 La Rábida, Palos de la Frontera, Huelva, Spain, and Environmental Science Department, Universidad Pablo de Olavide, Ctra, Utrera Km. 5, Sevilla, Spain
| | - F. López
- Chemical Engineering Department Facultad de Ciencias Experimentales Campus del Carmen, Universidad de Huelva, Avda, de las Fuerzas Armadas S/N, 21007 Huelva Spain, Forestry Science Department, Universidad de Huelva, Ctra, Huelva-Palos de la Frontera s/n, 21819 La Rábida, Palos de la Frontera, Huelva, Spain, and Environmental Science Department, Universidad Pablo de Olavide, Ctra, Utrera Km. 5, Sevilla, Spain
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Ayala-Guerrero F, Alfaro A, Martínez C, Campos-Sepúlveda E, Vargas L, Mexicano G. Effect of kainic acid-induced seizures on sleep patterns. Proc West Pharmacol Soc 2003; 45:178-80. [PMID: 12434574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Affiliation(s)
- F Ayala-Guerrero
- Facultad de Psicología, Universidad Nacional Autónoma de México.
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Fernandez E, Alfaro A, Tormos JM, Climent R, Martínez M, Vilanova H, Walsh V, Pascual-Leone A. Mapping of the human visual cortex using image-guided transcranial magnetic stimulation. Brain Res Brain Res Protoc 2002; 10:115-24. [PMID: 12431711 DOI: 10.1016/s1385-299x(02)00189-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We describe a protocol using transcranial magnetic stimulation (TMS) to systematically map the visual sensations induced by focal and non-invasive stimulation of the human occipital cortex. TMS is applied with a figure of eight coil to 28 positions arranged in a 2x2-cm grid over the occipital area. A digitizing tablet connected to a PC computer running customized software, and audio and video recording are used for detailed and accurate data collection and analysis of evoked phosphenes. A frameless image-guided neuronavigational device is used to describe the position of the actual sites of the stimulation coils relative to the cortical surface. Our results show that TMS is able to elicit phosphenes in almost all sighted subjects and in a proportion of blind subjects. Evoked phosphenes are topographically organized. Despite minor inter-individual variations, the mapping results are reproducible and show good congruence among different subjects. This procedure has potential to improve our understanding of physiologic organization and plastic changes in the human visual system and to establish the degree of remaining functional visual cortex in blind subjects. Such a non-invasive method is critical for selection of suitable subjects for a cortical visual prosthesis.
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Affiliation(s)
- E Fernandez
- Institute of Bioengineering, Faculty of Medicine, Universidad Miguel Hernández, San Juan 03550, Spain.
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Affiliation(s)
- M Peñarrocha
- School of Dentistry, University of Valencia, Spain
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Alfaro A. [Don Juan Jose Barcia Goyanes and the development of neurology in Valencia]. Rev Neurol 1997; 25:219-20. [PMID: 9147740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Alfaro A, Hauw JJ. [Progressive dementia in a 76-year-old man]. Med Clin (Barc) 1996; 106:227-36. [PMID: 8667666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- A Alfaro
- Servicio de Neurología, Hospital Universitario La Fe, Valencia
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