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McKee AC, Mez J, Abdolmohammadi B, Butler M, Huber BR, Uretsky M, Babcock K, Cherry JD, Alvarez VE, Martin B, Tripodis Y, Palmisano JN, Cormier KA, Kubilus CA, Nicks R, Kirsch D, Mahar I, McHale L, Nowinski C, Cantu RC, Stern RA, Daneshvar D, Goldstein LE, Katz DI, Kowall NW, Dwyer B, Stein TD, Alosco ML. Neuropathologic and Clinical Findings in Young Contact Sport Athletes Exposed to Repetitive Head Impacts. JAMA Neurol 2023; 80:1037-1050. [PMID: 37639244 PMCID: PMC10463175 DOI: 10.1001/jamaneurol.2023.2907] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/06/2023] [Indexed: 08/29/2023]
Abstract
Importance Young contact sport athletes may be at risk for long-term neuropathologic disorders, including chronic traumatic encephalopathy (CTE). Objective To characterize the neuropathologic and clinical symptoms of young brain donors who were contact sport athletes. Design, Setting, and Participants This case series analyzes findings from 152 of 156 brain donors younger than 30 years identified through the Understanding Neurologic Injury and Traumatic Encephalopathy (UNITE) Brain Bank who donated their brains from February 1, 2008, to September 31, 2022. Neuropathologic evaluations, retrospective telephone clinical assessments, and online questionnaires with informants were performed blinded. Data analysis was conducted between August 2021 and June 2023. Exposures Repetitive head impacts from contact sports. Main Outcomes and Measures Gross and microscopic neuropathologic assessment, including diagnosis of CTE, based on defined diagnostic criteria; and informant-reported athletic history and informant-completed scales that assess cognitive symptoms, mood disturbances, and neurobehavioral dysregulation. Results Among the 152 deceased contact sports participants (mean [SD] age, 22.97 [4.31] years; 141 [92.8%] male) included in the study, CTE was diagnosed in 63 (41.4%; median [IQR] age, 26 [24-27] years). Of the 63 brain donors diagnosed with CTE, 60 (95.2%) were diagnosed with mild CTE (stages I or II). Brain donors who had CTE were more likely to be older (mean difference, 3.92 years; 95% CI, 2.74-5.10 years) Of the 63 athletes with CTE, 45 (71.4%) were men who played amateur sports, including American football, ice hockey, soccer, rugby, and wrestling; 1 woman with CTE played collegiate soccer. For those who played football, duration of playing career was significantly longer in those with vs without CTE (mean difference, 2.81 years; 95% CI, 1.15-4.48 years). Athletes with CTE had more ventricular dilatation, cavum septum pellucidum, thalamic notching, and perivascular pigment-laden macrophages in the frontal white matter than those without CTE. Cognitive and neurobehavioral symptoms were frequent among all brain donors. Suicide was the most common cause of death, followed by unintentional overdose; there were no differences in cause of death or clinical symptoms based on CTE status. Conclusions and Relevance This case series found that young brain donors exposed to repetitive head impacts were highly symptomatic regardless of CTE status, and the causes of symptoms in this sample are likely multifactorial. Future studies that include young brain donors unexposed to repetitive head impacts are needed to clarify the association among exposure, white matter and microvascular pathologic findings, CTE, and clinical symptoms.
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Affiliation(s)
- Ann C. McKee
- Veterans Affairs (VA) Boston Healthcare System, US Department of Veteran Affairs, Boston, Massachusetts
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Neurology, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Pathology and Laboratory Medicine, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- VA Bedford Healthcare System, US Department of Veteran Affairs, Bedford, Massachusetts
- National Center for PTSD, VA Boston Healthcare, Boston, Massachusetts
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Jesse Mez
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Neurology, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
| | - Bobak Abdolmohammadi
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
| | - Morgane Butler
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Anatomy and Neurobiology, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
| | - Bertrand Russell Huber
- Veterans Affairs (VA) Boston Healthcare System, US Department of Veteran Affairs, Boston, Massachusetts
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Neurology, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- VA Bedford Healthcare System, US Department of Veteran Affairs, Bedford, Massachusetts
- National Center for PTSD, VA Boston Healthcare, Boston, Massachusetts
| | - Madeline Uretsky
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
| | - Katharine Babcock
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Anatomy and Neurobiology, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
| | - Jonathan D. Cherry
- Veterans Affairs (VA) Boston Healthcare System, US Department of Veteran Affairs, Boston, Massachusetts
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Pathology and Laboratory Medicine, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
| | - Victor E. Alvarez
- Veterans Affairs (VA) Boston Healthcare System, US Department of Veteran Affairs, Boston, Massachusetts
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Neurology, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- VA Bedford Healthcare System, US Department of Veteran Affairs, Bedford, Massachusetts
| | - Brett Martin
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Yorghos Tripodis
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Joseph N. Palmisano
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Kerry A. Cormier
- Veterans Affairs (VA) Boston Healthcare System, US Department of Veteran Affairs, Boston, Massachusetts
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- VA Bedford Healthcare System, US Department of Veteran Affairs, Bedford, Massachusetts
| | - Caroline A. Kubilus
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- VA Bedford Healthcare System, US Department of Veteran Affairs, Bedford, Massachusetts
| | - Raymond Nicks
- Veterans Affairs (VA) Boston Healthcare System, US Department of Veteran Affairs, Boston, Massachusetts
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Neurology, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- VA Bedford Healthcare System, US Department of Veteran Affairs, Bedford, Massachusetts
| | - Daniel Kirsch
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Pathology and Laboratory Medicine, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
| | - Ian Mahar
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
| | - Lisa McHale
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Concussion Legacy Foundation, Boston, Massachusetts
| | - Christopher Nowinski
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Concussion Legacy Foundation, Boston, Massachusetts
| | - Robert C. Cantu
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Concussion Legacy Foundation, Boston, Massachusetts
- Department of Neurosurgery, Emerson Hospital, Concord, Massachusetts
- Department of Neurosurgery, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
| | - Robert A. Stern
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Neurology, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Neurosurgery, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
| | - Daniel Daneshvar
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Rehabilitation Medicine, Harvard Medical School, Boston, Massachusetts
| | - Lee E. Goldstein
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Psychiatry, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Biomedical, Electrical, and Computer Engineering, Boston University College of Engineering, Boston, Massachusetts
| | - Douglas I. Katz
- Department of Neurology, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Braintree Rehabilitation Hospital, Braintree, Massachusetts
| | - Neil W. Kowall
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Neurology, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
| | - Brigid Dwyer
- Department of Neurology, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Braintree Rehabilitation Hospital, Braintree, Massachusetts
| | - Thor D. Stein
- Veterans Affairs (VA) Boston Healthcare System, US Department of Veteran Affairs, Boston, Massachusetts
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Pathology and Laboratory Medicine, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- VA Bedford Healthcare System, US Department of Veteran Affairs, Bedford, Massachusetts
| | - Michael L. Alosco
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Neurology, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
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Rosen G, Kirsch D, Horowitz S, Cherry JD, Nicks R, Kelley H, Uretsky M, Dell'Aquila K, Mathias R, Cormier KA, Kubilus CA, Mez J, Tripodis Y, Stein TD, Alvarez VE, Alosco ML, McKee AC, Huber BR. Three dimensional evaluation of cerebrovascular density and branching in chronic traumatic encephalopathy. Acta Neuropathol Commun 2023; 11:123. [PMID: 37491342 PMCID: PMC10369801 DOI: 10.1186/s40478-023-01612-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/27/2023] Open
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with exposure to repetitive head impacts (RHI) and characterized by perivascular accumulations of hyperphosphorylated tau protein (p-tau) at the depths of the cortical sulci. Studies of living athletes exposed to RHI, including concussive and nonconcussive impacts, have shown increased blood-brain barrier permeability, reduced cerebral blood flow, and alterations in vasoreactivity. Blood-brain barrier abnormalities have also been reported in individuals neuropathologically diagnosed with CTE. To further investigate the three-dimensional microvascular changes in individuals diagnosed with CTE and controls, we used SHIELD tissue processing and passive delipidation to optically clear and label blocks of postmortem human dorsolateral frontal cortex. We used fluorescent confocal microscopy to quantitate vascular branch density and fraction volume. We compared the findings in 41 male brain donors, age at death 31-89 years, mean age 64 years, including 12 donors with low CTE (McKee stage I-II), 13 with high CTE (McKee stage III-IV) to 16 age- and sex-matched non-CTE controls (7 with RHI exposure and 9 with no RHI exposure). The density of vessel branches in the gray matter sulcus was significantly greater in CTE cases than in controls. The ratios of sulcus versus gyrus vessel branch density and fraction volume were also greater in CTE than in controls and significantly above one for the CTE group. Hyperphosphorylated tau pathology density correlated with gray matter sulcus fraction volume. These findings point towards increased vascular coverage and branching in the dorsolateral frontal cortex (DLF) sulci in CTE, that correlates with p-tau pathology.
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Affiliation(s)
- Grace Rosen
- VA Boston Healthcare System, US Department of Veterans Affairs, 150 S Huntington Avenue, Boston, MA, 02130, USA
- National Center for PTSD, US Department of Veterans Affairs, Boston, MA, USA
| | - Daniel Kirsch
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
| | - Sarah Horowitz
- VA Boston Healthcare System, US Department of Veterans Affairs, 150 S Huntington Avenue, Boston, MA, 02130, USA
- National Center for PTSD, US Department of Veterans Affairs, Boston, MA, USA
| | - Jonathan D Cherry
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA
| | - Raymond Nicks
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA
| | - Hunter Kelley
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA
| | - Madeline Uretsky
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA
| | - Kevin Dell'Aquila
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA
| | - Rebecca Mathias
- VA Boston Healthcare System, US Department of Veterans Affairs, 150 S Huntington Avenue, Boston, MA, 02130, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
| | - Kerry A Cormier
- VA Boston Healthcare System, US Department of Veterans Affairs, 150 S Huntington Avenue, Boston, MA, 02130, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA
- VA Bedford Healthcare System, US Department of Veterans Affairs, Bedford, MA, USA
| | - Caroline A Kubilus
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA
- VA Bedford Healthcare System, US Department of Veterans Affairs, Bedford, MA, USA
| | - Jesse Mez
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA
| | - Yorghos Tripodis
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, USA
| | - Thor D Stein
- VA Boston Healthcare System, US Department of Veterans Affairs, 150 S Huntington Avenue, Boston, MA, 02130, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA
| | - Victor E Alvarez
- VA Boston Healthcare System, US Department of Veterans Affairs, 150 S Huntington Avenue, Boston, MA, 02130, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA
| | - Michael L Alosco
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA
| | - Ann C McKee
- VA Boston Healthcare System, US Department of Veterans Affairs, 150 S Huntington Avenue, Boston, MA, 02130, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA
- VA Bedford Healthcare System, US Department of Veterans Affairs, Bedford, MA, USA
| | - Bertrand R Huber
- VA Boston Healthcare System, US Department of Veterans Affairs, 150 S Huntington Avenue, Boston, MA, 02130, USA.
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, USA.
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA.
- National Center for PTSD, US Department of Veterans Affairs, Boston, MA, USA.
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3
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Kirsch D, Shah A, Dixon E, Kelley H, Cherry JD, Xia W, Daley S, Aytan N, Cormier K, Kubilus C, Mathias R, Alvarez VE, Huber BR, McKee AC, Stein TD. Vascular injury is associated with repetitive head impacts and tau pathology in chronic traumatic encephalopathy. J Neuropathol Exp Neurol 2023; 82:127-139. [PMID: 36617181 PMCID: PMC9852946 DOI: 10.1093/jnen/nlac122] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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] [Indexed: 01/09/2023] Open
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease linked to repetitive head impacts (RHI) and characterized by perivascular hyperphosphorylated tau (p-tau) deposits. The role of vascular injury, blood-brain barrier leakage, and neuroinflammation in CTE pathogenesis is not well understood. We performed quantitative immunoassays for intercellular adhesion molecule 1 (ICAM1), vascular cellular adhesion molecule 1 (VCAM1), and C-reactive protein (CRP) within the postmortem dorsolateral frontal cortex of participants with and without a history of RHI and CTE (n = 156), and tested for associations with RHI, microgliosis, and tau pathology measures. Levels of vascular injury-associated markers ICAM1, VCAM1, and CRP were increased in CTE compared to RHI-exposed and -naïve controls. ICAM1 and CRP increased with RHI exposure duration (p < 0.01) and were associated with increased microglial density (p < 0.001) and tau pathology (AT8, p-tau396, p-tau202; p < 0.05). Histologically, there was significantly increased ICAM1 staining of the microvasculature, extracellular space, and astrocytes at the sulcal depths in high stage CTE compared to both low stage CTE and controls. Multifocal perivascular immunoreactivity for serum albumin was present in all RHI-exposed individuals. These findings demonstrate that vascular injury markers are associated with RHI exposure, duration, and microgliosis, are elevated in CTE, and increase with disease severity.
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Affiliation(s)
- Daniel Kirsch
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Arsal Shah
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Erin Dixon
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Hunter Kelley
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Jonathan D Cherry
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Weiming Xia
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Sarah Daley
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Nurgul Aytan
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Kerry Cormier
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Carol Kubilus
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Rebecca Mathias
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Victor E Alvarez
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Bertrand R Huber
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Ann C McKee
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Thor D Stein
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Bedford Healthcare System, Bedford, Massachusetts, USA
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4
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Cherry JD, Baucom ZH, Eppich KG, Kirsch D, Dixon ER, Tripodis Y, Bieniek KF, Farrell K, Whitney K, Uretsky M, Crary JF, Dickson D, McKee AC. Neuroimmune proteins can differentiate between tauopathies. J Neuroinflammation 2022; 19:278. [PMID: 36403052 PMCID: PMC9675129 DOI: 10.1186/s12974-022-02640-6] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/09/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Tauopathies are a group of neurodegenerative diseases where there is pathologic accumulation of hyperphosphorylated tau protein (ptau). The most common tauopathy is Alzheimer's disease (AD), but chronic traumatic encephalopathy (CTE), progressive supranuclear palsy (PSP), corticobasal degeneration (CBD), and argyrophilic grain disease (AGD) are significant health risks as well. Currently, it is unclear what specific molecular factors might drive each distinct disease and represent therapeutic targets. Additionally, there is a lack of biomarkers that can differentiate each disease in life. Recent work has suggested that neuroinflammatory changes might be specific among distinct diseases and offers a novel resource for mechanistic targets and biomarker candidates. METHODS To better examine each tauopathy, a 71 immune-related protein multiplex ELISA panel was utilized to analyze anterior cingulate grey matter from 127 individuals neuropathologically diagnosed with AD, CTE, PSP, CBD, and AGD. A partial least square regression analysis was carried out to perform unbiased clustering and identify proteins that are distinctly correlated with each tauopathy correcting for age and gender. Receiver operator characteristic and binary logistic regression analyses were then used to examine the ability of each candidate protein to distinguish diseases. Validation in postmortem cerebrospinal fluid (CSF) from 15 AD and 14 CTE cases was performed to determine if candidate proteins could act as possible novel biomarkers. RESULTS Five clusters of immune proteins were identified and compared to each tauopathy to determine if clusters were specific to distinct disease. Each cluster was found to correlate with either CTE, AD, PSP, CBD, or AGD. When examining which proteins were the strongest driver of each cluster, it was observed the most distinctive protein for CTE was CCL21, AD was FLT3L, and PSP was IL13. Individual proteins that were specific to CBD and AGD were not observed. CCL21 was observed to be elevated in CTE CSF compared to AD cases (p = 0.02), further validating the use as possible biomarkers. Sub-analyses for male only cases confirmed the results were not skewed by gender differences. CONCLUSIONS Overall, these results highlight that different neuroinflammatory responses might underlie unique mechanisms in related neurodegenerative pathologies. Additionally, the use of distinct neuroinflammatory signatures could help differentiate between tauopathies and act as novel biomarker candidate to increase specificity for in-life diagnoses.
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Affiliation(s)
- Jonathan D Cherry
- VA Boston Healthcare System, 150 S. Huntington Ave., Boston, MA, 02130, USA.
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA , USA.
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, USA.
| | - Zach H Baucom
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Kaleb G Eppich
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Daniel Kirsch
- VA Boston Healthcare System, 150 S. Huntington Ave., Boston, MA, 02130, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA , USA
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, USA
| | - Erin R Dixon
- VA Boston Healthcare System, 150 S. Huntington Ave., Boston, MA, 02130, USA
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, USA
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Kevin F Bieniek
- Department of Pathology, UT Health San Antonio, San Antonio, TX, USA
- Gleen Biggs Institute for Alzheimer's and Neurodegenerative Diseases, UT Health San Antonio, San Antonio, TX, USA
| | - Kurt Farrell
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Artificial Intelligence, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Neuropathology Brain Bank and Research CoRE, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Ronald M. Loeb Center for Alzheimer's Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kristen Whitney
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Artificial Intelligence, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Neuropathology Brain Bank and Research CoRE, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Ronald M. Loeb Center for Alzheimer's Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Madeline Uretsky
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, USA
| | - John F Crary
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Artificial Intelligence, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Neuropathology Brain Bank and Research CoRE, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Ronald M. Loeb Center for Alzheimer's Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dennis Dickson
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Ann C McKee
- VA Boston Healthcare System, 150 S. Huntington Ave., Boston, MA, 02130, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA , USA
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
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Kirsch D, Scordi-Bello I. Fatal Microscopic Pulmonary Tumor Thromboemboli: Unusual Presentation of Occult Cervical Carcinoma. Two Case Reports and Review of the Literature. Acad Forensic Pathol 2019; 9:81-92. [PMID: 34394793 DOI: 10.1177/1925362119851131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 02/05/2019] [Indexed: 11/15/2022]
Abstract
Cor pulmonale (right heart failure) due to microscopic pulmonary tumor emboli (MPTE) can arise from a variety of malignancies including breast, lung, and liver and carries significant morbidity and mortality. Tumor cell aggregates spread hematogenously to the lungs and occlude small pulmonary vessels leading to pulmonary hypertension through either a mechanical process or inducing vascular remodeling as a downstream result of interactions between the embolus and the vessel wall. Its presentation includes unexplained dyspnea, hypoxemia, tachycardia, pulmonary hypertension, right heart failure, and in some cases sudden death. The symptoms may suggest the more common entity of pulmonary thromboembolism, particularly in the setting of previously known metastatic cancer; however, computed tomography scans may appear normal and ventilation-perfusion scans which are the preferable diagnostic modality are not always ordered. In most cases of MPTE, the presentation reflects metastasis of an already known and advanced tumor, but, in rare cases, it may be the primary manifestation of an occult malignancy. We present here 2 unique cases of MPTE in women with occult cervical cancer. In both cases, the malignancy was discovered and diagnosed at autopsy. Microscopic pulmonary tumor emboli can be easily overlooked, and therefore, forensic pathologists and other death investigators should be aware of it and trained to at least consider the possibility in appropriate situations. Thorough microscopic examination of apparently normal tissues may be necessary, particularly in cases of unexplained right heart failure and sudden death, even if the decedent has few or no identifiable risk factors for cancer.
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Vaickus M, Hsieh T, Kintsurashvili E, Kim J, Kirsch D, Kasotakis G, Remick DG. Mild Traumatic Brain Injury in Mice Beneficially Alters Lung NK1R and Structural Protein Expression to Enhance Survival after Pseudomonas aeruginosa Infection. Am J Pathol 2018; 189:295-307. [PMID: 30472211 DOI: 10.1016/j.ajpath.2018.10.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/04/2018] [Accepted: 10/23/2018] [Indexed: 12/11/2022]
Abstract
Mild traumatic brain injury (mTBI) in a murine model increases survival to a bacterial pulmonary challenge compared with blunt tail trauma (TT). We hypothesize substance P and its receptor, the neurokinin 1 receptor (NK1R; official name TACR1), play a role in the increased survival of mTBI mice. Mice were subjected to mTBI or TT, and 48 hours after trauma, the levels of NK1R mRNA and protein were significantly up-regulated in mTBI lungs. Examination of the lung 48 hours after injury by microarray showed significant differences in the expression of 433 gene sets between groups, most notably genes related to intercellular proteins. Despite down-regulated gene expression of connective proteins, the presence of an intact pulmonary vasculature was supported by normal histology and bronchoalveolar lavage protein levels. To determine whether these mTBI-induced lung changes benefited in vivo responses, two chemotactic stimuli (a CXCL1 chemokine and a live Pseudomonas aeruginosa infection) were administered 48 hours after trauma. For both stimuli, mTBI mice recruited more neutrophils to the lung 4 hours after instillation (CXCL1: mTBI = 6.3 ± 1.3 versus TT = 3.3 ± 0.7 neutrophils/mL; Pseudomonas aeruginosa: mTBI = 9.4 ± 1.4 versus TT = 5.3 ± 1.1 neutrophils/mL). This study demonstrates that the downstream consequences of mTBI on lung NK1R levels and connective protein expression enhance neutrophil recruitment to a stimulus that may contribute to increased survival.
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Affiliation(s)
- Max Vaickus
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Terry Hsieh
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Ekaterina Kintsurashvili
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Jiyoun Kim
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Daniel Kirsch
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - George Kasotakis
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Daniel G Remick
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts.
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Sandow T, Thevenot P, Gimenez J, Arndt S, Nunez K, DeVun D, Gulotta P, Ramalingam V, Gilbert P, Kirsch D, Bohorquez H, Kay D, Cohen A. 3:18 PM Abstract No. 35 ■ DISTINGUISHED ABSTRACT Lymphopenia selects poor DEB-TACE response in transplant waitlist patients: prospective, single-center, observational study. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.043] [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: 11/29/2022] Open
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Goldman D, Sandow T, Gimenez J, Arndt S, Thevenot P, Nunez K, DeVun D, Gulotta P, Ramalingam V, Gilbert P, Kirsch D, Bohorquez H, Galliano G, Cohen A, Kay D. 3:00 PM Abstract No. 33 Pre-TACE immune status correlates with treatment response and necrosis rates in HCC as a bridge to liver transplant. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.041] [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: 12/01/2022] Open
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Arndt S, Sandow T, Kay D, DeVun D, Gulotta P, Kirsch D, Ramalingam V, Nunez K, Bohorquez H, Cohen A, Thevenot P, Gimenez J. 3:27 PM Abstract No. 274 A prospective study of lung shunt fraction as a determinant of DEB-TACE response and metastasis and determinants of lung shunt fraction. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.306] [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: 11/30/2022] Open
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Sandow T, Albar A, Gulotta P, Bennett G, Galliano G, DeVun D, Kirsch D, Gimenez J, Malkerneker D, Gilbert P, Bohorquez H, Kay D. Tumor grade and primary treatment response following DEB-TACE for hepatocellular carcinoma based on liver explant. J Vasc Interv Radiol 2017. [DOI: 10.1016/j.jvir.2016.12.901] [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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Sandow T, Albar A, Gulotta P, Bennett G, Galliano G, DeVun D, Kirsch D, Gimenez J, Malkerneker D, Gilbert P, Bohorquez H, Kay D. Primary treatment response based on tumor explant morphology in HCC following DEB-TACE. J Vasc Interv Radiol 2017. [DOI: 10.1016/j.jvir.2016.12.778] [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: 11/28/2022] Open
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Bittrich HJ, Kirsch D. Kurze Mitteilungen. Die Konzentrationsabhängigkeit der Methyldublettaufspaltung von N,N-Dimethylformamid: Assoziation oder nichtspezifische Wechselwirkung? ACTA ACUST UNITED AC 2017. [DOI: 10.1515/zpch-1976-25744] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Landi G, Gualtieri G, Bello IS, Kirsch D. A case of fatal Clostridium perfringens bacteremia and sepsis following CT-guided liver biopsy of a rare neuroendocrine hepatic tumor. Forensic Sci Med Pathol 2017; 13:78-81. [PMID: 28093692 DOI: 10.1007/s12024-016-9823-8] [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] [Accepted: 11/05/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Gianluca Landi
- Section of Legal Medicine, University of Siena, Siena, Italy.
| | | | | | - Daniel Kirsch
- The Office of Chief Medical Examiner, New York City, NY, USA
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Scordi-Bello I, Kirsch D, Hammers J. Fatal Pulmonary Thromboembolism in Patients with Diabetic Ketoacidosis: A Seven-Case Series and Review of the Literature. Acad Forensic Pathol 2016; 6:198-205. [PMID: 31239892 DOI: 10.23907/2016.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/01/2016] [Accepted: 04/25/2016] [Indexed: 12/16/2022]
Abstract
Diabetes mellitus is a well-recognized risk factor for arterial thrombosis, however its relationship to venous thromboembolism (VTE) in adults is still debated. We report here seven cases of fatal pulmonary thromboembolism in adults with diabetic ketoacidosis as the underlying cause. In four of seven cases, there was no prior diagnosis of diabetes mellitus and patients were newly diagnosed either upon presenting to the hospital in diabetic ketoacidosis (DKA) or at the time of autopsy by the vitreous glucose concentration. None of the patients had family history, recent surgery, recent trauma, long distance travel, or other strong risk factors for VTE. Only two patients had a body mass index greater than 35 kg/m2 and the same two cases had hospital stays that ranged from three to five days. We believe that DKA is a frequently unrecognized and sometimes overlooked risk factor for VTE, particularly in the forensic setting where routine toxicology and vitreous glucose analysis may not be standard practices. We encourage forensic pathologists, medical examiners, and coroners to consider the possibility of diabetic ketoacidosis as a risk factor, and in some cases, the underlying etiology for pulmonary thromboembolism. Additionally, we recommend vitreous glucose testing be performed if there are any signs of DKA or diabetes present, such as acetone in the blood.
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Kirsch D. SP-0099: The role of ATM and p53 in normal tissue radiation response. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31348-2] [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: 11/27/2022]
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Riba M, Kirsch D, Martel A, Goldsmith M. Preparing and Training the College Mental Health Workforce. Acad Psychiatry 2015; 39:498-502. [PMID: 26307363 DOI: 10.1007/s40596-015-0406-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 07/27/2015] [Indexed: 06/04/2023]
Affiliation(s)
| | - Daniel Kirsch
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Adele Martel
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Aaberg-Jessen C, Fogh L, Halle B, Jensen V, Brunner N, Kristensen BW, Abe T, Momii Y, Watanabe J, Morisaki I, Natsume A, Wakabayashi T, Fujiki M, Aldaz B, Fabius AWM, Silber J, Harinath G, Chan TA, Huse JT, Anai S, Hide T, Nakamura H, Makino K, Yano S, Kuratsu JI, Balyasnikova IV, Prasol MS, Kanoija DK, Aboody KS, Lesniak MS, Barone T, Burkhart C, Purmal A, Gudkov A, Gurova K, Plunkett R, Barton K, Misuraca K, Cordero F, Dobrikova E, Min H, Gromeier M, Kirsch D, Becher O, Pont LB, Kloezeman J, van den Bent M, Kanaar R, Kremer A, Swagemakers S, French P, Dirven C, Lamfers M, Leenstra S, Pont LB, Balvers R, Kloezeman J, Kleijn A, Lawler S, Leenstra S, Dirven C, Lamfers M, Gong X, Andres A, Hanson J, Delashaw J, Bota D, Chen CC, Yao NW, Chuang WJ, Chang C, Chen PY, Huang CY, Wei KC, Cheng Y, Dai Q, Morshed R, Han Y, Auffinger B, Wainwright D, Zhang L, Tobias A, Rincon E, Thaci B, Ahmed A, He C, Lesniak M, Choi YA, Pandya H, Gibo DM, Fokt I, Priebe W, Debinski W, Chornenkyy Y, Agnihotri S, Buczkowicz P, Rakopoulos P, Morrison A, Barszczyk M, Becher O, Hawkins C, Chung S, Decollogne S, Luk P, Shen H, Ha W, Day B, Stringer B, Hogg P, Dilda P, McDonald K, Moore S, Hayden-Gephart M, Bergen J, Su Y, Rayburn H, Edwards M, Scott M, Cochran J, Das A, Varma AK, Wallace GC, Dixon-Mah YN, Vandergrift WA, Giglio P, Ray SK, Patel SJ, Banik NL, Dasgupta T, Olow A, Yang X, Mueller S, Prados M, James CD, Haas-Kogan D, Dave ND, Desai PB, Gudelsky GA, Chow LML, LaSance K, Qi X, Driscoll J, Driscoll J, Ebsworth K, Walters MJ, Ertl LS, Wang Y, Berahovic RD, McMahon J, Powers JP, Jaen JC, Schall TJ, Eroglu Z, Portnow J, Sacramento A, Garcia E, Raubitschek A, Synold T, Esaki S, Rabkin S, Martuza R, Wakimoto H, Ferluga S, Tome CL, Debinski W, Forde HE, Netland IA, Sleire L, Skeie B, Enger PO, Goplen D, Giladi M, Tichon A, Schneiderman R, Porat Y, Munster M, Dishon M, Weinberg U, Kirson E, Wasserman Y, Palti Y, Giladi M, Porat Y, Schneiderman R, Munster M, Weinberg U, Kirson E, Palti Y, Gramatzki D, Staudinger M, Frei K, Peipp M, Weller M, Grasso C, Liu L, Becher O, Berlow N, Davis L, Fouladi M, Gajjar A, Hawkins C, Huang E, Hulleman E, Hutt M, Keller C, Li XN, Meltzer P, Quezado M, Quist M, Raabe E, Spellman P, Truffaux N, van Vurden D, Wang N, Warren K, Pal R, Grill J, Monje M, Green AL, Ramkissoon S, McCauley D, Jones K, Perry JA, Ramkissoon L, Maire C, Shacham S, Ligon KL, Kung AL, Zielinska-Chomej K, Grozman V, Tu J, Viktorsson K, Lewensohn R, Gupta S, Mladek A, Bakken K, Carlson B, Boakye-Agyeman F, Kizilbash S, Schroeder M, Reid J, Sarkaria J, Hadaczek P, Ozawa T, Soroceanu L, Yoshida Y, Matlaf L, Singer E, Fiallos E, James CD, Cobbs CS, Hashizume R, Tom M, Ihara Y, Ozawa T, Santos R, Torre JDL, Lepe E, Waldman T, Prados M, James D, Hashizume R, Ihara Y, Huang X, Yu-Jen L, Tom M, Mueller S, Gupta N, Solomon D, Waldman T, Zhang Z, James D, Hayashi T, Adachi K, Nagahisa S, Hasegawa M, Hirose Y, Gephart MH, Moore S, Bergen J, Su YS, Rayburn H, Scott M, Cochran J, Hingtgen S, Kasmieh R, Nesterenko I, Figueiredo JL, Dash R, Sarkar D, Fisher P, Shah K, Horne E, Diaz P, Stella N, Huang C, Yang H, Wei K, Huang T, Hlavaty J, Ostertag D, Espinoza FL, Martin B, Petznek H, Rodriguez-Aguirre M, Ibanez C, Kasahara N, Gunzburg W, Gruber H, Pertschuk D, Jolly D, Robbins J, Hurwitz B, Yoo JY, Bolyard C, Yu JG, Wojton J, Zhang J, Bailey Z, Eaves D, Cripe T, Old M, Kaur B, Serwer L, Yoshida Y, Le Moan N, Santos R, Ng S, Butowski N, Krtolica A, Ozawa T, Cary SPL, James CD, Johns T, Greenall S, Donoghue J, Adams T, Karpel-Massler G, Westhoff MA, Kast RE, Dwucet A, Wirtz CR, Debatin KM, Halatsch ME, Karpel-Massler G, Kast RE, Westhoff MA, Merkur N, Dwucet A, Wirtz CR, Debatin KM, Halatsch ME, Kievit F, Stephen Z, Wang K, Kolstoe D, Silber J, Ellenbogen R, Zhang M, Kitange G, Schroeder M, Sarkaria J, Kleijn A, Haefner E, Leenstra S, Dirven C, Lamfers M, Knubel K, Pernu BM, Sufit A, Pierce AM, Nelson SK, Keating AK, Jensen SS, Kristensen BW, Lachowicz J, Demeule M, Regina A, Tripathy S, Curry JC, Nguyen T, Castaigne JP, Le Moan N, Serwer L, Yoshida Y, Ng S, Davis T, Santos R, Davis A, Tanaka K, Keating T, Getz J, Kapp GT, Romero JM, Ozawa T, James CD, Krtolica A, Cary SPL, Lee S, Ramisetti S, Slagle-Webb B, Sharma A, Connor J, Lee WS, Maire C, Kluk M, Aster JC, Ligon K, Sun S, Lee D, Ho ASW, Pu JKS, Zhang ZQ, Lee NP, Day PJR, Leung GKK, Liu Z, Liu X, Madhankumar AB, Miller P, Webb B, Connor JR, Yang QX, Lobo M, Green S, Schabel M, Gillespie Y, Woltjer R, Pike M, Lu YJ, Torre JDL, Waldman T, Prados M, Ozawa T, James D, Luchman HA, Stechishin O, Nguyen S, Cairncross JG, Weiss S, Lun X, Wells JC, Hao X, Zhang J, Grinshtein N, Kaplan D, Luchman A, Weiss S, Cairncross JG, Senger D, Robbins S, Madhankumar A, Slagle-Webb B, Rizk E, Payne R, Park A, Pang M, Harbaugh K, Connor J, Wilisch-Neumann A, Pachow D, Kirches E, Mawrin C, McDonell S, Liang J, Piao Y, Nguyen N, Yung A, Verhaak R, Sulman E, Stephan C, Lang F, de Groot J, Mizobuchi Y, Okazaki T, Kageji T, Kuwayama K, Kitazato KT, Mure H, Hara K, Morigaki R, Matsuzaki K, Nakajima K, Nagahiro S, Kumala S, Heravi M, Devic S, Muanza T, Nelson SK, Knubel KH, Pernu BM, Pierce AM, Keating AK, Neuwelt A, Nguyen T, Wu YJ, Donson A, Vibhakar R, Venkatamaran S, Amani V, Neuwelt E, Rapkin L, Foreman N, Ibrahim F, New P, Cui K, Zhao H, Chow D, Stephen W, Nozue-Okada K, Nagane M, McDonald KL, Ogawa D, Chiocca E, Godlewski J, Ozawa T, Yoshida Y, Santos R, James D, Pang M, Liu X, Madhankumar AB, Slagle-Webb B, Patel A, Miller P, Connor J, Pasupuleti N, Gorin F, Valenzuela A, Leon L, Carraway K, Ramachandran C, Nair S, Quirrin KW, Khatib Z, Escalon E, Melnick S, Phillips A, Boghaert E, Vaidya K, Ansell P, Shalinsky D, Zhang Y, Voorbach M, Mudd S, Holen K, Humerickhouse R, Reilly E, Huang T, Parab S, Diago O, Espinoza FL, Martin B, Ibanez C, Kasahara N, Gruber H, Pertschuk D, Jolly D, Robbins J, Ryken T, Agarwal S, Al-Keilani M, Alqudah M, Sibenaller Z, Assemolt M, Sai K, Li WY, Li WP, Chen ZP, Saito R, Sonoda Y, Kanamori M, Yamashita Y, Kumabe T, Tominaga T, Sarkar G, Curran G, Jenkins R, Scharnweber R, Kato Y, Lin J, Everson R, Soto H, Kruse C, Kasahara N, Liau L, Prins R, Semenkow S, Chu Q, Eberhart C, Sengupta R, Marassa J, Piwnica-Worms D, Rubin J, Serwer L, Kapp GT, Le Moan N, Yoshida Y, Romero JM, Ng S, Davis A, Ozawa T, Krtolica A, James CD, Cary SPL, Shai R, Pismenyuk T, Moshe I, Fisher T, Freedman S, Simon A, Amariglio N, Rechavi G, Toren A, Yalon M, Shen H, Decollogne S, Dilda P, Chung S, Luk P, Hogg P, McDonald K, Shimazu Y, Kurozumi K, Ichikawa T, Fujii K, Onishi M, Ishida J, Oka T, Watanabe M, Nasu Y, Kumon H, Date I, Sirianni RW, McCall RL, Spoor J, van der Kaaij M, Kloezeman J, Geurtjens M, Dirven C, Lamfers M, Leenstra S, Stephen Z, Veiseh O, Kievit F, Fang C, Leung M, Ellenbogen R, Silber J, Zhang M, Strohbehn G, Atsina KK, Patel T, Piepmeier J, Zhou J, Saltzman WM, Takahashi M, Valdes G, Inagaki A, Kamijima S, Hiraoka K, Micewicz E, McBride WH, Iwamoto KS, Gruber HE, Robbins JM, Jolly DJ, Kasahara N, Warren K, McCully C, Bacher J, Thomas T, Murphy R, Steffen-Smith E, McAllister R, Pastakia D, Widemann B, Wei K, Yang H, Huang C, Chen P, Hua M, Liu H, Woolf EC, Abdelwahab MG, Fenton KE, Liu Q, Turner G, Preul MC, Scheck AC, Yoshida Y, Ozawa T, Butowski N, Shen W, Brown D, Pedersen H, James D, Zhang J, Hariono S, Yao TW, Sidhu A, Hashizume R, James CD, Weiss WA, Nicolaides TP, Olusanya T. EXPERIMENTAL THERAPEUTICS AND PHARMACOLOGY. Neuro Oncol 2013; 15:iii37-iii61. [PMCID: PMC3823891 DOI: 10.1093/neuonc/not176] [Citation(s) in RCA: 2] [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: 09/21/2023] Open
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Wang D, Zhang Q, Eisenberg B, Kane J, Li X, Lucas D, Freeman C, Trotti A, Hitchcock Y, Kirsch D. Significant Reduction of Radiation Related Morbidities in the Extremity Sarcoma Patients Treated With Image Guided Radiation Therapy to Reduced Target Volume: Results of RTOG 0630. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.164] [Citation(s) in RCA: 2] [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: 10/26/2022]
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Oldham M, Newton J, Rankine L, Adamovics J, Kirsch D, Das S. How accurate is image guided radiation therapy (IGRT) delivered with a micro-irradiator? J Phys : Conf Ser 2013; 444:12070. [PMID: 24454521 PMCID: PMC3894105 DOI: 10.1088/1742-6596/444/1/012070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is significant interest in delivering precisely targeted small-volume radiation treatments, in the pre-clinical setting, to study dose-volume relationships with tumor control and normal tissue damage. In this work we investigate the IGRT targeting accuracy of the XRad225Cx system from Precision x-Ray using high resolution 3D dosimetry techniques. Initial results revealed a significant targeting error of about 2.4mm. This error was reduced to within 0.5mm after the IGRT hardware and software had been recalibrated. The facility for 3D dosimetry was essential to gain a comprehensive understanding of the targeting error in 3D.
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Newton J, Li Y, Adamovics J, Kirsch D, Das S, Oldham M. TU-C-BRB-02: Identification of a Targeting Error in a Small Field Biological Irradiator Using 3D Dosimetry Techniques. Med Phys 2012. [DOI: 10.1118/1.4735914] [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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Rodrigues A, Nguyen G, Li Y, Roy Choudhury K, Kirsch D, Das S, Yoshizumi T. SU-E-T-275: Dose Verification in a Small Animal Image-Guided Radiation Therapy X-Ray Machine: A Dose Comparison between TG-61 Based Look-Up Table and MOSFET Method for Various Collimator Sizes. Med Phys 2012; 39:3766. [DOI: 10.1118/1.4735343] [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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Doan P, Russell J, Meadows S, Himburg H, Daher P, Chao N, Kirsch D, Chute J. Tie2+Bone Marrow Endothelial Cells Regulate Hematopoietic Reconstitution in vivo. Biol Blood Marrow Transplant 2010. [DOI: 10.1016/j.bbmt.2009.12.064] [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]
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Wasif N, Garreau J, Terando A, Kirsch D, Mund DF, Giuliano AE. MRI versus ultrasonography and mammography for preoperative assessment of breast cancer. Am Surg 2009; 75:970-975. [PMID: 19886147] [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: 05/28/2023]
Abstract
Mammography and ultrasonography are traditional for preoperative estimation of breast cancer size; magnetic resonance imaging (MRI) is more recent but not as well studied. We compared ultrasonography, mammography, and MRI for preoperative imaging of primary breast cancer presenting as a mass in patients treated at our center over a 2-year period. Of the 61 breast cancers with all three imaging modalities performed, 52 were infiltrating ductal cancer, 5 were infiltrating lobular cancer, 2 were ductal carcinoma in situ, and 2 were other histologic types. When pathologic size was used to determine the accuracy of imaging assessments, the Pearson correlation coefficient was better for MRI (r = 0.80) than ultrasonography (r = 0.57) or mammography (r = 0.26). Mean tumor size was 2.1 cm by mammography, 1.73 cm by ultrasonography, 2.65 cm by MRI, and 2.76 cm by pathology. MRI-based tumor size was within 1 cm of pathologic size in 44 (72%) tumors, > 1 cm above pathologic size in 6 (10%) tumors, and > 1 cm below pathologic size in 11 (18%) tumors. We conclude that MRI is more accurate than either ultrasonography or mammography for assessment of the size of primary breast cancer presenting as a mass.
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Affiliation(s)
- Nabil Wasif
- John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California 90404, USA
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Abstract
Mammography and ultrasonography are traditional for preoperative estimation of breast cancer size; magnetic resonance imaging (MRI) is more recent but not as well studied. We compared ultrasonography, mammography, and MRI for preoperative imaging of primary breast cancer presenting as a mass in patients treated at our center over a 2-year period. Of the 61 breast cancers with all three imaging modalities performed, 52 were infiltrating ductal cancer, 5 were infiltrating lobular cancer, 2 were ductal carcinoma in situ, and 2 were other histologic types. When pathologic size was used to determine the accuracy of imaging assessments, the Pearson correlation coefficient was better for MRI (r = 0.80) than ultrasonography (r = 0.57) or mammography (r = 0.26). Mean tumor size was 2.1 cm by mammography, 1.73 cm by ultrasonography, 2.65 cm by MRI, and 2.76 cm by pathology. MRI-based tumor size was within 1 cm of pathologic size in 44 (72%) tumors, > 1 cm above pathologic size in 6 (10%) tumors, and > 1 cm below pathologic size in 11 (18%) tumors. We conclude that MRI is more accurate than either ultrasonography or mammography for assessment of the size of primary breast cancer presenting as a mass.
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Affiliation(s)
- Nabil Wasif
- From the John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California
| | - Jennifer Garreau
- From the John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California
| | - Alicia Terando
- From the John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California
| | - Daniel Kirsch
- From the John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California
| | - Debra F. Mund
- From the John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California
| | - Armando E. Giuliano
- From the John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California
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Haglund K, Goldberg S, Rosenberg A, Harmon D, Kirsch D, Hornicek F, Springfield D, Raskin K, Choy E, DeLaney T. Percent Necrosis in Extremity Soft Tissue Sarcoma After Preoperative Radiation Alone Versus Preoperative Radiation and Chemotherapy. Int J Radiat Oncol Biol Phys 2007. [DOI: 10.1016/j.ijrobp.2007.07.174] [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: 10/22/2022]
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Kirsch D. CLINICIAN'S GUIDE TO SLEEP DISORDERS. Neurology 2007. [DOI: 10.1212/01.wnl.0000266598.06817.83] [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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28
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Lu H, Safai S, Schneider R, Adams J, Chen Y, Sharp G, Brett R, Kirsch D, Hong T, Delaney T. 2734. Int J Radiat Oncol Biol Phys 2006. [DOI: 10.1016/j.ijrobp.2006.07.1150] [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: 11/26/2022]
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29
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Agarwal A, Goldberg S, DeLaney T, Kirsch D, Suit H. 210. Int J Radiat Oncol Biol Phys 2006. [DOI: 10.1016/j.ijrobp.2006.07.243] [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: 11/28/2022]
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30
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Grimm J, Kirsch D, Windsor S, Ntziachristos V, Weissleder R. Multimodale molekulare Bildgebung zur Charakterisierung von Lungentumoren. ROFO-FORTSCHR RONTG 2005. [DOI: 10.1055/s-2005-867774] [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: 10/19/2022]
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Abstract
We report our experience with excision of hooked-wire bracketed breast carcinomas in a community hospital setting. The mammographic and pathology reports from 36 nonpalpable or minimally palpable breast cancers were retrieved from a single surgical oncologist's office records and a number of factors that might influence a successful initial surgical excision were examined. The median lesion size was 1 cm. The radiographic abnormalities were microcalcifications only in 14 cases (39%), combined mass/density and microcalcifications in 9 cases (25%), and mass/density without microcalcifications in 13 cases (36%). The median number of bracketing wires placed was two. A prior fine-needle aspiration (FNA) or core biopsy was performed in 29 of the 36 cases (81%). Of these, 27 were positive for malignancy. The tumor was considered to be inadequately excised if it was present within 5 mm of any surgical margin; this outcome occurred in 21 of the 36 cases (58%). Fifteen cases (42%) had tumor involving either the margin or extending to within 1 mm of the margin. Inadequately excised lesions were more commonly seen with increasing tumor size, a radiographic appearance of microcalcifications without an associated mass, and a pathologic diagnosis of ductal carcinoma in situ (DCIS). An intraoperative consult led to taking additional marginal tissue in 23 cases and was successful in achieving final clear histologic margins in 8 of these (35%). Our experience suggests that there are at least two ways to optimize the adequacy of conservative excision of nonpalpable or difficult-to-palpate breast cancers using standard modalities presently available in most community hospitals. These are (a) having the pathologist and radiologist available for intraoperative consultation and (b) obtaining a tissue diagnosis of malignancy preoperatively. The use of bracketing wires to better delineate the margins of tissue to be excised may also be helpful, but this needs to be further evaluated in a randomized study.
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MESH Headings
- Adult
- Aged
- Biopsy
- Biopsy, Fine-Needle
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/epidemiology
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- California/epidemiology
- Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging
- Carcinoma, Intraductal, Noninfiltrating/epidemiology
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Female
- Hospitals, Community
- Humans
- Mastectomy, Segmental/instrumentation
- Mastectomy, Segmental/methods
- Mastectomy, Segmental/statistics & numerical data
- Middle Aged
- Outcome Assessment, Health Care
- Radiography
- Retrospective Studies
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Affiliation(s)
- Barbara D Florentine
- Department of Pathology, Henry Mayo Newhall Memorial Hospital, Valencia, CA 91355, USA.
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Neufang A, Dorweiler B, Espinola-Klein C, Reinstadler J, Kirsch D, Schmiedt W, Oelert H. External reinforcement of varicose veins with PTFE prosthesis in infrainguinal bypass surgery -- clinical results. Thorac Cardiovasc Surg 2003; 51:62-6. [PMID: 12730812 DOI: 10.1055/s-2003-38985] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Segmental varicose degeneration of the autogenous greater saphenous vein may limit its use in infrainguinal bypass surgery. Wrapping a PTFE prosthesis around dilated veins has emerged as an option to create externally reinforced vein bypasses. Results regarding graft patency and limb salvage were analyzed. METHODS Between September 1995 and January 2001, 35 infrainguinal bypass operations in 33 patients were performed with greater saphenous veins exhibiting segmental varicose dilatation. Grafts were followed by duplex scan and retrospective analysis of graft patency and limb salvage was performed. RESULTS One bypass prompted successful revision for early occlusion. Four bypasses required additional reintervention during follow-up. 48 months primary, primary assisted and secondary patency rates were 66%, 82% and 82%, respectively, with a limb salvage rate of 97%. Duplex scan failed to demonstrate stenosis of the reinforced vein segments or aneurysmal degeneration of the residual vein. CONCLUSION External reinforcement with a PTFE prosthesis allows the use of autogenous greater saphenous veins with varicose dilatation and enables the construction of all autogenous bypasses with promising graft patency and limb salvage.
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Affiliation(s)
- A Neufang
- Department of Cardiothoracic and Vascular Surgery, Johannes Gutenberg-University School of Medicine, Mainz, Germany.
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Shih H, Jiang S, Doppke K, Brown A, Lawenda B, Willers H, Kirsch D, Chen G, Choi N. Surrogate planning target volume (PTV) accounting for respiratory movement determined with fused ct images of fast and four second simulation CT scan in 3D CRT planning for lung cancer. Int J Radiat Oncol Biol Phys 2002. [DOI: 10.1016/s0360-3016(02)03402-8] [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: 11/27/2022]
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Böttger T, Kirsch D, Hengstler JG, Bauer A, Wolf HK, Junginger T. [Hereditary pancreatitis - a clinically relevant cause of pancreatic adenocarcinoma?]. Zentralbl Chir 2001; 126:897-900. [PMID: 11753800 DOI: 10.1055/s-2001-19145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
UNLABELLED Hereditary pancreatitis is an autosomal dominant disease. Recently, the genetic defect has been mapped to chromosome 7q35 and consists mainly of a point mutation in exon 3 of the cationic trypsinogen gene which causes an Arg(CGC)-His(CAC) substitution at residue 117. In patients with hereditary pancreatitis the estimated cumulative risk for pancreatic carcinoma to age 70 approaches 40 %. Thus, the role of hereditary pancreatitis in the pathogenesis of pancreatic carcinoma is of interest. PATIENTS AND METHODS DNA was extracted from peripheral blood (n = 16), fresh tumor tissue (n = 29) and formalin fixed and paraffin embedded tumor tissue (n = 5) of 50 patients with ductal adenocarcinoma of the pancreas. We specifically amplified exon 3 and the intronic flanking sequences of the cationic trypsinogen gene by nested PCR and performed restriction fragment length polymorphism analysis using the restriction enzyme Afl III. In patients with hereditary pancreatitis the G : A point mutation creates a recognition site for Afl III which is not present in unaffected individuals. RESULTS None of the 50 patients with ductal adenocarcinoma of the pancreas revealed the G : A point mutation in exon 3 of the cationic trypsinogen gene which is characteristic of hereditary pancreatitis. In addition sequencing of exon 3 did not reveal any other mutations in the DNA of patients with pancreatic adenocarcinoma. CONCLUSION Although hereditary pancreatitis markedly increases the risk for pancreatic cancer, it is rare and probably of little significance with respect to the pathogenesis of the majority of pancreatic adenocarcinomas.
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Affiliation(s)
- T Böttger
- Klinik und Poliklinik für Allgemein- und Abdominalchirurgie, Johannes Gutenberg Universität Mainz, Germany
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Wahl W, Wern T, Kirsch D, Junginger T. [Status of discontinuity resection in septic diverticular complications. History or a still current procedure?]. Zentralbl Chir 2001; 126:357-63. [PMID: 11396243 DOI: 10.1055/s-2001-14750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Primary anastomosis is becoming increasingly favoured because of the shorter hospital stay even in emergency operations on the colon and rectum. This appears entirely justified when an objective of cost-effective medicine has been set. At our hospital between September 1985 and February 1999, 365 patients were operated on because of diverticular disease. The data from 346 of these patients were evaluated. 202 of these cases were elective; 144 were carried out on an emergency or urgent basis. In 223 cases, a primary anastomosis (Stage I and II according to Hinchey) and in 56 patients a double-barreled colostomy with a distal mucus fistula were performed. 57 patients had a too short rectum-sigma stump and were operated in two stages, according to Hartmann. Of 223 patients with a primary anastomosis, 6 (2.7%) developed an insufficiency of the anastomosis, whereby 3 (1.3%) of these patients subsequently died. Of the patients with Hartmann operation, 11 (19.3%) died due to the sequelae of peritonitis and only 2 patients died following insufficiency of the Hartmann's stump. Of the patients with a mucus fistula, 10 patients (17.9%) died as a result of complications of peritonitis. Of the 113 patients (21 died) with a discontinuity resection, 66 (71%) had their colostomy closed. There were no cases of anastomosis insufficiency and no patient died as a result of the colostomy closure. In the interest of the patients in septic diverticulitis the safest surgical procedure, the discontinuity resection, should be chosen.
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Affiliation(s)
- W Wahl
- Klinik und Poliklinik für Allgemein- und Abdominalchirurgie, Johannes Gutenberg-Universität, Mainz
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Kirsch D, Dienes HP, Küchle R, Duschner H, Wahl W, Böttger T, Junginger T. Changes in the extracellular matrix of the vein wall--the cause of primary varicosis? VASA 2000; 29:173-7. [PMID: 11037714 DOI: 10.1024/0301-1526.29.3.173] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Conflicting theories on the development of primary varicosis have led to the molecular biological investigation of the vein wall or, more accurately, of the extracellular matrix. It was the aim of this study to quantify matrix expression and to compare pathological changes in the vein wall with valve-orientated staging of varicosis, in order to determine indicators of the primary cause of varicosis. MATERIALS AND METHODS Three hundred seventy-two tissue specimens of greater saphenous veins were obtained from 17 patients with varicosities and categorised according to Hach stage and procurement site. The specimens were compared with 36 specimens collected from six patients without varicosities, incubated with fluorescence-stained antibodies for collagen 4, laminin, fibronectin and tenascin prior to being assessed with confocal laser scan microscopy. In addition, 22 vein specimens (16 varicose, 6 normal veins) serving as negative controls were investigated. RESULTS Image analysis and statistical evaluation showed that compared with normal veins, varicose veins are associated with a significant increase in matrix protein expression for collagen 4, laminin and tenascin. A trend towards an increase in matrix expression was further observed for fibronectin. There was, however, no difference between varicose veins and clinically healthy vein segments inferior to a varicose segment. CONCLUSION If the findings of the present investigation can be confirmed by other studies, alterations in the vein wall may be regarded as the primary cause of varicosis and valvular insufficiency as the result of these changes.
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Affiliation(s)
- D Kirsch
- Department of General and Abdominal Surgery, Johannes Gutenberg-University Hospital, Mainz, Germany.
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37
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Kirsch D. Developing outpatient mental health services for managed care. Psychiatr Clin North Am 2000; 23:403-13. [PMID: 10909116 DOI: 10.1016/s0193-953x(05)70167-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
One of the characteristics of the best outpatient treaters is their capacity to manage their own anxieties so as not to interfere with their patients' progress. This does not mean "sitting on," shutting out, or otherwise ignoring those signals to prevent their intruding into the therapeutic space. On the contrary, this requires that a clinician be acutely aware of his or her internal dialogue and be able to listen to use it to facilitate the treatment. This has meant simultaneously listening to oneself while paying complete attention to one's patient. This paradox is part of the nature of this work and remains one of its important features. Today, those who choose to treat psychiatric patients in this setting are presented with many more such paradoxes, including the necessity of being aware of (1) populations needing to be served while providing the best care for individual patients; (2) limited resources; and (3) balancing ethical, fiscal, legal, and clinical concerns. This article demonstrates that the successful development of outpatient services in a managed care environment requires attention to these same tensions on a larger scale. It also shows that understanding the evolution of managed care and the myriad competing interests involved are necessary to be able to care successfully for psychiatric patients.
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Affiliation(s)
- D Kirsch
- Department of Psychiatry, University of Massachusetts School of Medicine, Worcester, USA
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38
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Affiliation(s)
- S Benjamin
- Department of Psychiatry, University of Massachusetts Medical School, Worcester 01655, USA.
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39
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Abstract
The aetiology of varicosis is still unclear. Investigation of changes in normal veins which result in the formation of varicosis led to examination of elastic properties and histomorphological alterations in the region of the extracellular matrix in the vessel wall of the long saphenous vein in normal and varicose veins. The rigidity of varicose veins was higher than that of normal veins; there was no difference between the varicose vein above a competent valve and the "normal" vein below this competent valve. The matrix proteins demonstrated an increase in total fibres, whereas the elastic fibres were reduced and fragmented, explained the rigidity of varices. These results suggest that the role of the venous valves in the development of varicose veins is secondary to changes of the vein wall.
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Affiliation(s)
- D Kirsch
- Klinik und Poliklinik für Allgemein- und Abdominalchirurgie, Johannes Gutenberg-Universität Mainz.
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Kirsch D, Böttger T, Junginger T. [Amputation due to chronic peripheral vascular disease. Risks and prognosis]. Zentralbl Chir 1999; 124:508-13. [PMID: 10436508] [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: 02/13/2023]
Abstract
A series of 181 amputations in 156 patients treated between 1985 and 1996 because of chronic peripheral vascular disease was reviewed. 107 major amputations (above- and below-knee) and 74 minor amputations (foot and forefoot) were performed. 81% of the patient population had previous vascular operations. Complications, revisions and mortality of all patients were retrospectively analyzed. The operative mortality rate of major amputations was 20% and the operative mortality rate of minor amputations was 9%. By a vessel-reconstruction before amputation the complication- (wound healing) and revision-rate could be reduced. By examination of the family-doctors, the survival times of the patients and the rehabilitation status of 69 living patients were recorded. Minor amputations, below-knee amputations and knee-disarticulations had the best results of rehabilitation.
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Affiliation(s)
- D Kirsch
- Klinik und Poliklinik für Allegmein- und Abdominalchirurgie, Johannes-Gutenberg-Universität Mainz
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41
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Wingerath T, Kirsch D, Spengler B, Stahl W. Analysis of cyclic and acyclic analogs of retinol, retinoic acid, and retinal by laser desorption ionization-, matrix-assisted laser desorption ionization-mass spectrometry, and UV/Vis spectroscopy. Anal Biochem 1999; 272:232-42. [PMID: 10415093 DOI: 10.1006/abio.1999.4194] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [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: 11/22/2022]
Abstract
Laser desorption ionization (LDI)- and matrix-assisted laser desorption ionization (MALDI)-mass spectrometry (LDI-MS, MALDI-MS) at 337-nm laser wavelength were used to analyze retinol (vitamin A), retinoic acid, and retinal and their analogs 3-hydroxyretinol, 3-hydroxyretinoic acid, 3-hydroxyretinal, 4-oxoretinol, 4-oxoretinoic acid, 4-oxoretinal, 3,4-didehydroretinol (vitamin A(2)), 3,4-didehydroretinoic acid, 3,4-didehydroretinal, acycloretinol, acycloretinoic acid, and acycloretinal. The compounds exhibit sufficient ionizability which allows to obtain mass spectra by LDI which are similar in quality to those obtained by MALDI. Mass spectra were recorded with a linear time-of-flight (TOF) instrument or a reflectron-type (RETOF) instrument in positive-ion mode. Under the conditions of LDI-MS the compounds form abundant radical molecular ions (M+*), whereas in the MALDI mass spectra abundant protonated molecular ions ([M + H]+) are observed. Characteristic fragment ions provide additional structural information. High-performance liquid chromatography (HPLC) coupled with UV/Vis photodiode detection was used to assist in retinoid characterization. Synthesis of 3-hydroxyretinal, 4-oxoretinal, and acycloretinal was performed by oxidative cleavage of the all-trans-carotenoids of zeaxanthin, canthaxanthin, and lycopene.
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Affiliation(s)
- T Wingerath
- Institut für Physiologische Chemie I, Heinrich-Heine-Universität Düsseldorf, Germany
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42
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Abstract
BACKGROUND Investigation of changes in normal veins which result in the formation of varicosis led to examination of the histological organisation of the vessel wall and to histomorphological alterations in the region of the extracellular matrix. PATIENTS AND METHODS The expression pattern of the matrix proteins collagen IV, fibronectin, laminin, tenascin, and undulin as well as the structure and orientation of elastic fibres were determined by means of immunohistochemical staining. RESULTS All varices exhibited an increased expression pattern in comparison to healthy veins. The venous vessel wall was often non-homogeneously enlarged. The intima was always more involved than the media and showed enhanced accumulation, whereas, the adventitia was not influenced by the pathological process. Collagen IV exhibited an early accumulation, especially in the subendothelial region. The other matrix proteins demonstrated an increase in fibre propagation parallel to the enlargement of the vessel wall. Essentially, an augmented de novo synthesis of fibres with an irregular arrangement and the formation of local plaques was found. Elastic fibres were enhanced by slight involvement of the vessel wall and were reduced and fragmented during increased involvement of the venous wall which explained the rigidity of varices in contrast to normal veins.
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Affiliation(s)
- D Kirsch
- Department of General and Abdominal Surgery, Johannes Gutenberg University Hospital, Germany
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Post K, Pitschke M, Schäfer O, Wille H, Appel TR, Kirsch D, Mehlhorn I, Serban H, Prusiner SB, Riesner D. Rapid acquisition of beta-sheet structure in the prion protein prior to multimer formation. Biol Chem 1998; 379:1307-17. [PMID: 9865603 DOI: 10.1515/bchm.1998.379.11.1307] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.9] [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: 11/15/2022]
Abstract
The N-terminally truncated form of the prion protein, PrP 27-30, and the corresponding recombinant protein, rPrP, were solubilized in 0.2% SDS, and the transitions induced by changing the conditions from 0.2% SDS to physiological conditions, i.e. removing SDS, were characterized with respect to solubility, resistance to proteolysis, secondary structure and multimerization. Circular dichroism, electron microscopy and fluorescence correlation spectroscopy were used to study the structural transitions of PrP. Within one minute the alpha-helical structure of PrP was transformed into one that was enriched in beta-sheets and consisted mainly of dimers. Larger oligomers were found after 20 minutes and larger multimers exhibiting resistance to proteolysis were found after several hours. It was concluded that the monomeric alpha-helical conformation was stable in SDS or when attached to the membrane; however, the state of lowest free energy in aqueous solution at neutral pH seems to be the multimeric, beta-sheet enriched conformation.
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Affiliation(s)
- K Post
- Institut für Physikalische Biologie, Biologisch-Medizinisches Forschungszentrum, Heinrich-Heine-Universität Düsseldorf, Germany
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Klein TR, Kirsch D, Kaufmann R, Riesner D. Prion rods contain small amounts of two host sphingolipids as revealed by thin-layer chromatography and mass spectrometry. Biol Chem 1998; 379:655-66. [PMID: 9687014 DOI: 10.1515/bchm.1998.379.6.655] [Citation(s) in RCA: 109] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sphingolipids were detected in prions, the agents of transmissible spongiform encephalopathies. The analysis was carried out on highly purified, infectious prion rods, which are composed mainly of insoluble aggregates of the N-terminally truncated prion protein, so-called PrP 27-30. Lipid classes were quantified by high performance thin-layer chromatography with a detection limit of 25-50 ng per lipid class. Matrix-assisted laser desorption/ionization mass spectrometry was applied for the first time to lipid analysis in complex biological samples. A newly developed preparation technique improved the sensitivity to 1-20 pg per molecular species. Only the sphingolipids, galactosylceramide and sphingomyelin, were consistently observed in chloroform/methanol (2:1 v/v) extracts of prion rods. The molar ratio of PrP to the sphingolipids was between 2:1 and 40:1, depending on the purity of the prion preparation. The same lipids were also present in the low density fraction of a gradient centrifugation of prion-rods after sonication in 0.2% SDS. From the two alternatives, that the sphingolipids are either required for prion function or are relics from the cellular location of PrP in caveolae, the second alternative appears more plausible since the preparation of highest specific infectivity contained the lowest amount of sphingolipids.
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Affiliation(s)
- T R Klein
- Institut für Physikalische Biologie, Heinrich-Heine-Universität Düsseldorf, Germany
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Abstract
BACKGROUND On January 1, 1994, in response to escalating Medicaid costs, the State of Tennessee implemented TennCare, a statewide managed health care system for three population groups: Medicaid eligibles, uninsurable individuals, and people who lacked access to insurance through their place of employment. METHODS Under the TennCare program, the State contracts with ten managed care organizations to provide a comprehensive benefit package to each enrollee. Preventive services are exempt from copayment or deductible requirements. Each patient is assigned to a primary care provider who is responsible for assuring that the enrollee receives preventive services. RESULTS More than 400,000 previously uninsured and uninsurable persons now receive health care coverage through the TennCare program. An extensive quality assurance program monitors managed care organization service delivery, with particular emphasis on prevention and access. Effective case management, combined with an enrollment cap, have enabled the program to grow at a predictable rate, without exceeding the annual rate of growth of state revenues. CONCLUSIONS The TennCare program has been successful in using the savings experienced during the shift from a fee-for-service to a managed care Medicaid program to expand coverage to previously uninsured populations.
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Affiliation(s)
- W J Long
- Tennessee Department of Health, Bureau of TennCare, Nashville 37247, USA
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Küchle R, Kirsch D, Junginger T. [Evaluation and internal quality assurance in general and abdominal surgery]. Langenbecks Arch Chir Suppl Kongressbd 1998; 114:834-6. [PMID: 9574284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The measuring of perioperative risk, the finding of intraoperative influences and the objective rating of quality of treatment were achieved by our program of quality assurance. With our system it is possible to measure differences between several surgeons and also differences in comparison to national and international results. Through optimised therapy the program can lead to an improvement of quality.
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Affiliation(s)
- R Küchle
- Klinik für Allgemein- und Abdominalchirurgie, Universität Mainz
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Immler D, Gremm D, Kirsch D, Spengler B, Presek P, Meyer HE. Identification of phosphorylated proteins from thrombin-activated human platelets isolated by two-dimensional gel electrophoresis by electrospray ionization-tandem mass spectrometry (ESI-MS/MS) and liquid chromatography-electrospray ionization-mass spectrometry (LC-ESI-MS). Electrophoresis 1998; 19:1015-23. [PMID: 9638948 DOI: 10.1002/elps.1150190617] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.3] [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: 11/09/2022]
Abstract
Two-dimensional polyacrylamide gel electrophoresis (2-D PAGE) is a powerful tool to separate complex protein mixtures including whole cell lysates. In combination with immunoblotting techniques or radioactive labeling techniques it is a fast and convenient way to demonstrate the presence of certain proteins or protein modifications. With the development of extremely sensitive analytical techniques such as matrix-assisted laser desorption/ionization-mass spectrometry (MALDI-MS) or electrospray ionization (ESI)-MS, it has become possible to use 2-D gels not only as an analytical but also as a preparative tool. Starting with a number of spots excised from 2-D gels, a protein can be identified using different strategies involving enzymatic cleavage of the protein in the gel matrix, elution of the resulting peptides and analysis of these peptides by mass spectrometry. The obtained peptide mass fingerprint or fragment ion spectra from peptides can be used to screen protein or nucleic acid databases in order to identify the protein. We have used the techniques described above to identify proteins from human platelets which change their phosphorylation state following activation of platelets by thrombin. Platelets were radioactively labeled with [32P]orthophosphate and stimulated. Several protein spots in the observed range of 10-80 kDa and an isoelectric point of 3-10 showed a significant increase or decrease in phosphorylation. We present the results from the investigation of a spot group representing different isoforms and phosphorylation states of myosin light chain.
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Affiliation(s)
- D Immler
- Proteinstrukturlabor, Institut für Physiologische Chemie I, Ruhr-Universität Bochum, Germany
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48
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Collin-Osdoby P, Li L, Rothe L, Anderson F, Kirsch D, Oursler MJ, Osdoby P. Inhibition of avian osteoclast bone resorption by monoclonal antibody 121F: a mechanism involving the osteoclast free radical system. J Bone Miner Res 1998; 13:67-78. [PMID: 9443792 DOI: 10.1359/jbmr.1998.13.1.67] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Osteoclasts generate high levels of superoxide anions during bone resorption that contribute to the degradative process, although excessive levels of this free radical may be damaging. One mechanism for their removal is via superoxide dismutase (SOD), a protective superoxide scavenging enzyme. We have previously described a novel developmentally regulated 150 kDa plasma membrane glycoprotein of avian osteoclasts which is reactive with the osteoclast-specific monoclonal antibody (Mab) 121F and is related immunologically, biochemically, and in protein sequence to mitochondrial Mn2+/Fe2+ SOD. We hypothesized that this unusual osteoclast surface component may be involved in protection against superoxides generated during active bone resorption. Increasing concentrations of monovalent Fab fragments prepared from Mab 121F, but not those from another antiosteoclast Mab designated 29C, markedly inhibited both bone particle and bone pit resorption by avian osteoclasts, while reducing tartrate-resistant acid phosphatase activity and causing the morphological contraction of osteoclasts on bone. Thus, the SOD-related membrane antigen may be essential for osteoclast bone resorption. Osteoclast superoxide production, monitored kinetically by cytochrome c reduction and histochemically by nitroblue tetrazolium reduction staining, was significantly greater in the presence of 121F, but not 29C, Fab treatment. Furthermore, the release of another free radical known as nitric oxide, which is produced by osteoclasts, can scavenge superoxides, and acts to potently inhibit osteoclast bone resorption, was dose-dependently increased by 121F Fab in resorbing osteoclast cultures. Therefore, Mab 121F binding may block the potential protective function of the osteoclast plasma membrane SOD-related glycoprotein, leading to a rapid elevation of superoxide levels and a subsequent rise in osteoclast nitric oxide release, feedback messages which may be sensed by the osteoclast as signals to cease active bone resorption.
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Affiliation(s)
- P Collin-Osdoby
- Department of Biology, Washington University, St. Louis, Missouri 63130, USA
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Wingerath T, Kirsch D, Spengler B, Kaufmann R, Stahl W. High-performance liquid chromatography and laser desorption/ionization mass spectrometry of retinyl esters. Anal Chem 1997; 69:3855-60. [PMID: 9322426 DOI: 10.1021/ac970463w] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [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: 02/05/2023]
Abstract
Laser desorption/ionization mass spectrometry (LDI-MS) at 337 nm laser wavelength was used to analyze retinol and several long-chain fatty acid esters of retinol. Employing this ionization technique helped to overcome the inherent problems resulting from thermal instability of retinyl esters which render this group of compounds rather difficult for standard ionization techniques. Mass spectra were recorded with a linear time-of-flight instrument in positive ion mode. Under these conditions, retinyl esters formed radical molecular ions (M.+) and in addition fragmented by elimination of the fatty acyl chain to uniformly form a peak at m/z = 269 u. The elimination of carbon dioxide was also observed in the spectra. The method is suitable to identify specific retinyl esters in complex mixtures of these compounds. A gradient reversed-phase high-performance liquid chromatography (HPLC) is described for the separation of retinol and 15 related fatty acid esters within 28 min. HPLC was applied to separate retinyl esters from rat liver extracts. The LDI mass spectrum of the collected HPLC fraction of rat liver extract showed the molecular parent ions of retinyl myristate, pentadecanoate, palmitoleate, palmitate, heptadecanoate, linoleate, oleate, stearate, and 3,4-didehydroretinyl palmitate. LDI-MS was found to be more appropriate than matrix-assisted laser desorption/ionization for the described analytical task.
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Affiliation(s)
- T Wingerath
- Institut für Physiologische Chemie I, Heinrich-Heine-Universität, Düsseldorf, Germany
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Sunyer T, Rothe L, Kirsch D, Jiang X, Anderson F, Osdoby P, Collin-Osdoby P. Ca2+ or phorbol ester but not inflammatory stimuli elevate inducible nitric oxide synthase messenger ribonucleic acid and nitric oxide (NO) release in avian osteoclasts: autocrine NO mediates Ca2+-inhibited bone resorption. Endocrinology 1997; 138:2148-62. [PMID: 9112415 DOI: 10.1210/endo.138.5.5144] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Osteoclast bone resorption is essential for normal calcium homeostasis and is therefore tightly controlled by calciotropic hormones and local modulatory cytokines and factors. Among these is nitric oxide (NO), a multifunctional free radical that potently inhibits osteoclast bone resorption in vitro and in vivo. Previous findings led us to propose that NO might serve as an autocrine, as well as paracrine, regulator of osteoclast function. This premise was investigated using isolated bone-resorptive avian osteoclasts and focusing on the inducible isoform of NO synthase (iNOS) responsible for inflammatory stimulated high-level NO synthesis in other cells. Avian osteoclasts expressed both iNOS messenger RNA (mRNA) and protein. However, inflammatory cytokines that induce iNOS mRNA, protein, and NO in other cells did not do so in avian osteoclasts, consistent with the known role of inflammatory stimuli in promoting osteoclast resorption and localized bone loss. In searching for potential modulators of osteoclast iNOS, protein kinase C activation [by phorbol 12-myristate 13-acetate (PMA)] and intracellular Ca2+ rises (A23187) were each found to elevate osteoclast iNOS mRNA and protein levels, while increasing NO release and reducing osteoclast bone resorption. The iNOS selective inhibitor aminoguanidine suppressed stimulated osteoclast NO production elicited by either signal, but reversed only the resorption inhibition due to raised Ca2+. Thus, whereas additional inhibitory signals are presumably coproduced in osteoclasts treated with PMA, osteoclast iNOS-derived NO may act as an autocrine signal to mediate Ca2+-inhibited bone resorption. These findings document for the first time an iNOS whose mRNA levels are regulated by Ca2+ or PMA, but not inflammatory stimuli, and the autocrine production of NO as a Ca2+ sensing signal to suppress osteoclast bone resorption. The unusual regulation of osteoclast iNOS makes it a potentially attractive target for designing novel therapeutic agents to alleviate excessive bone loss.
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Affiliation(s)
- T Sunyer
- Department of Biology, Washington University, St. Louis, Missouri 63130, USA
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