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Brito E, Sherman N, Mahoney AP. A 23-Year Analysis of the Litigation in Orthopaedic Elbow Surgery. J Shoulder Elbow Surg 2024:S1058-2746(24)00259-3. [PMID: 38631456 DOI: 10.1016/j.jse.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/16/2024] [Accepted: 03/03/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND The reasons for malpractice litigation in elbow surgery are not well understood. The aim of this study is to report the most frequently litigated surgeries of the elbow and analyze the reasons for litigation and case outcomes. METHODS A retrospective review of the Westlaw legal database was performed, and all federal and state jurisdiction litigation cases involving the elbow from 2000-2023 were queried. Cases were excluded if they did not involve an orthopedic surgeon, nor primary elbow injury or procedure. Cases were reviewed for demographic information, surgical procedure based on reference CPT codes, complications, symptoms, and reasons for litigation. Quantitative information, including settlement and indemnity cost to the defendant orthopedic surgeon, was analyzed. Cases were sub-divided based on United States Census Bureau regions and states to assess regional frequency of litigation with ANOVA tests. RESULTS There were 59 cases meeting inclusion criteria from 2000-2023.The most litigated cases involved were ulnar nerve transposition/release and open reduction and internal fixation of the proximal radius and/or ulna at the elbow. The most litigated complication was claimed nerve damage (46%) and permanent disability (27%). Of the total cases, the most frequently litigated symptoms were nerve damage (46%) and loss of function (37%), while the least frequent was postoperative stiffness (2%). The Pacific region demonstrated the highest litigation rate (20%), while the East South Central, Mountain, and New England regions had the lowest litigation rate (3% each). A favorable verdict was given to the defendant orthopedic surgeon in 59% of the cases. The average loss incurred through settlement was $245,590, while the average indemnity paid through verdict was $523,334. CONCLUSION Operative fixation of the proximal ulna/radius and ulnar nerve release/transposition are the most litigated procedures of the elbow. Litigation is most associated with nerve injury. Across Census Bureau regions, there is no significant difference in monetary cost incurred through settlements and verdict losses. Although a majority of litigated cases are won by the defending orthopedic surgeon, thorough informed consent and perioperative expectation management may mitigate litigation risk.
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Affiliation(s)
- Emmanuel Brito
- University of California Riverside, School of Medicine, Riverside, CA, USA.
| | - Nathan Sherman
- Department of Orthopaedic Surgery, University of Arizona, Tucson, AZ, USA
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Chirshev E, Hojo N, Bertucci A, Sanderman L, Nguyen A, Wang H, Suzuki T, Brito E, Martinez SR, Castañón C, Mirshahidi S, Vazquez ME, Wat P, Oberg KC, Ioffe YJ, Unternaehrer JJ. Epithelial/mesenchymal heterogeneity of high-grade serous ovarian carcinoma samples correlates with miRNA let-7 levels and predicts tumor growth and metastasis. Mol Oncol 2020; 14:2796-2813. [PMID: 32652647 PMCID: PMC7607177 DOI: 10.1002/1878-0261.12762] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/16/2020] [Accepted: 07/07/2020] [Indexed: 12/18/2022] Open
Abstract
Patient‐derived samples present an advantage over current cell line models of high‐grade serous ovarian cancer (HGSOC) that are not always reliable and phenotypically faithful models of in vivo HGSOC. To improve upon cell line models of HGSOC, we set out to characterize a panel of patient‐derived cells and determine their epithelial and mesenchymal characteristics. We analyzed RNA and protein expression levels in patient‐derived xenograft (PDX) models of HGSOC, and functionally characterized these models using flow cytometry, wound healing assays, invasion assays, and spheroid cultures. Besides in vitro work, we also evaluated the growth characteristics of PDX in vivo (orthotopic PDX). We found that all samples had hybrid characteristics, covering a spectrum from an epithelial‐to‐mesenchymal state. Samples with a stronger epithelial phenotype were more active in self‐renewal assays and more tumorigenic in orthotopic xenograft models as compared to samples with a stronger mesenchymal phenotype, which were more migratory and invasive. Additionally, we observed an inverse association between microRNA let‐7 (lethal‐7) expression and stemness, consistent with the loss of let‐7 being an important component of the cancer stem cell phenotype. We observed that lower let‐7 levels were associated with the epithelial state and a lower epithelial mesenchymal transition (EMT) score, more efficient spheroid and tumor formation, and increased sensitivity to platinum‐based chemotherapy. Surprisingly, in these HGSOC cells, stemness could be dissociated from invasiveness: Cells with lower let‐7 levels were more tumorigenic, but less migratory, and with a lower EMT score, than those with higher let‐7 levels. We conclude that let‐7 expression and epithelial/mesenchymal state are valuable predictors of HGSOC proliferation, in vitro self‐renewal, and tumor burden in vivo.
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Affiliation(s)
- Evgeny Chirshev
- Division of Biochemistry, Department of Basic Sciences, Loma Linda University, Loma Linda, CA, USA.,Department of Pathology and Human Anatomy, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Nozomi Hojo
- Division of Biochemistry, Department of Basic Sciences, Loma Linda University, Loma Linda, CA, USA
| | - Antonella Bertucci
- Division of Biochemistry, Department of Basic Sciences, Loma Linda University, Loma Linda, CA, USA
| | - Linda Sanderman
- Division of Biochemistry, Department of Basic Sciences, Loma Linda University, Loma Linda, CA, USA.,Biology Department, California State University San Bernardino, San Bernardino, CA, USA
| | - Anthony Nguyen
- Division of Biochemistry, Department of Basic Sciences, Loma Linda University, Loma Linda, CA, USA
| | - Hanmin Wang
- Division of Biochemistry, Department of Basic Sciences, Loma Linda University, Loma Linda, CA, USA
| | - Tise Suzuki
- Division of Biochemistry, Department of Basic Sciences, Loma Linda University, Loma Linda, CA, USA
| | - Emmanuel Brito
- Division of Biochemistry, Department of Basic Sciences, Loma Linda University, Loma Linda, CA, USA.,Biology Department, California State University San Bernardino, San Bernardino, CA, USA
| | - Shannalee R Martinez
- Center for Health Disparities and Molecular Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Christine Castañón
- Division of Biochemistry, Department of Basic Sciences, Loma Linda University, Loma Linda, CA, USA.,Center for Health Disparities and Molecular Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Saied Mirshahidi
- Biospecimen Laboratory, Division of Microbiology & Molecular Genetics, Department of Basic Sciences, Loma Linda University Cancer Center, Loma Linda University, Loma Linda, CA, USA
| | - Marcelo E Vazquez
- Department of Radiation Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Pamela Wat
- Department of Pathology and Human Anatomy, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Kerby C Oberg
- Department of Pathology and Human Anatomy, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Yevgeniya J Ioffe
- Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Juli J Unternaehrer
- Division of Biochemistry, Department of Basic Sciences, Loma Linda University, Loma Linda, CA, USA.,Center for Health Disparities and Molecular Medicine, Loma Linda University, Loma Linda, CA, USA.,Department of Gynecology and Obstetrics, Loma Linda University, Loma Linda, CA, USA
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Unternaehrer J, Chirshev E, Hojo N, Bertucci A, Sanderman L, Nguyen A, Wang H, Suzuki T, Brito E, Martine S, Castañón C, Mirshahidi S, Vazquez M, Oberg KC, Ioffe YJ. Abstract 1682: Epithelial-mesenchymal heterogeneity of high-grade serous ovarian carcinoma samples correlates with let-7 levels and predicts tumor growth and metastasis. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-1682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Objective: Patient-derived samples present an advantage over current cell line models of high grade serous ovarian cancer (HGSOC), which are flawed in terms of being reliable and phenotypically faithful models of in vivo HGSOC. To improve upon cell line models of HGSOC, we characterized a panel of patient-derived cells to determine their epithelial and mesenchymal characteristics, invasiveness, proliferation, stemness, and in vivo growth.
Experimental procedures: Patient-derived xenograft (PDX) models of HGSOC were analyzed in vitro for phenotypic (RNA, let-7 miRNA, and protein expression, flow cytometry) and functional aspects including growth in spheroids, wound healing assays, invasion assays and in vivo (orthotopic PDX) growth characteristics.
Results: Samples fell along the spectrum from epithelial to mesenchymal, and all had hybrid characteristics. Those toward the more epithelial end of the spectrum were most active in self-renewal assays, and grew most robustly in orthotopic xenograft models. Chemoresistance correlated both with the mesenchymal state and with BRCA2 wild type status. Loss of microRNA let-7 (lethal-7) is an important component of the cancer stem cell phenotype, and we observed an inverse association between let-7 expression and the epithelial state. We observed lower levels of let-7, more efficient spheroid and tumor formation, and increased sensitivity to platinum-based chemotherapy in cells with the most epithelial phenotype.
Conclusions: Surprisingly, in these HGSOC cells, stemness could be dissociated from invasiveness: epithelial cells (those with least let-7 expression) were less migratory, but more tumorigenic, than the mesenchymal cells with higher let-7 expression. We conclude that epithelial/mesenchymal state and let-7 expression are valuable predictors of HGSOC proliferation, in vitro self-renewal, and tumor burden in vivo.
Citation Format: Juli Unternaehrer, Evgeny Chirshev, Nozomi Hojo, Antonella Bertucci, Linda Sanderman, Anthony Nguyen, Hanmin Wang, Tise Suzuki, Emmanuel Brito, Shannalee Martine, Christine Castañón, Saied Mirshahidi, Marcelo Vazquez, Kerby C. Oberg, Yevgeniya J. Ioffe. Epithelial-mesenchymal heterogeneity of high-grade serous ovarian carcinoma samples correlates with let-7 levels and predicts tumor growth and metastasis [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 1682.
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Affiliation(s)
| | | | - Nozomi Hojo
- 2Laboratory for Prediction of Cell Systems Dynamics, RIKEN, Osaka, Osaka, Japan
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Rosa ACP, Cruz C, Santana WS, Brito E, Moret MA. Non-Arrhenius behavior and fragile-to-strong transition of glass-forming liquids. Phys Rev E 2020; 101:042131. [PMID: 32422727 DOI: 10.1103/physreve.101.042131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 04/03/2020] [Indexed: 11/07/2022]
Abstract
Characterization of the non-Arrhenius behavior of glass-forming liquids is a broad avenue for research toward the understanding of the formation mechanisms of noncrystalline materials. In this context, this paper explores the main properties of the viscosity of glass-forming systems, considering super-Arrhenius diffusive processes. We establish the viscous activation energy as a function of the temperature, measure the degree of fragility of the system, and characterize the fragile-to-strong transition through the standard Angell's plot. Our results show that the non-Arrhenius behavior observed in fragile liquids can be understood through the non-Markovian dynamics that characterize the diffusive processes of these systems. Moreover, the fragile-to-strong transition corresponds to a change in the spatiotemporal range of correlations during the glass transition process.
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Affiliation(s)
- A C P Rosa
- Grupo de Informação Quântica e Física Estatística, Centro de Ciências Exatas e das Tecnologias, Universidade Federal do Oeste da Bahia, Rua Bertioga, 892, Morada Nobre I, 47810-059 Barreiras, Bahia, Brazil
| | - C Cruz
- Grupo de Informação Quântica e Física Estatística, Centro de Ciências Exatas e das Tecnologias, Universidade Federal do Oeste da Bahia, Rua Bertioga, 892, Morada Nobre I, 47810-059 Barreiras, Bahia, Brazil
| | - W S Santana
- Grupo de Informação Quântica e Física Estatística, Centro de Ciências Exatas e das Tecnologias, Universidade Federal do Oeste da Bahia, Rua Bertioga, 892, Morada Nobre I, 47810-059 Barreiras, Bahia, Brazil
| | - E Brito
- Grupo de Informação Quântica e Física Estatística, Centro de Ciências Exatas e das Tecnologias, Universidade Federal do Oeste da Bahia, Rua Bertioga, 892, Morada Nobre I, 47810-059 Barreiras, Bahia, Brazil
| | - M A Moret
- Programa de Modelagem Computacional-SENAI-CIMATEC, 41650-010 Salvador, Bahia, Brazil.,Universidade do Estado da Bahia (UNEB), 41150-000 Salvador, Bahia, Brazil
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Affiliation(s)
- E. Brito
- Departamento de Estatística, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - G. M. Cordeiro
- Departamento de Estatística, Universidade Federal de Pernambuco, Recife, Brazil
| | - H. M. Yousof
- Department of Statistics, Mathematics and Insurance, Benha University, Benha, Egypt
| | - M. Alizadeh
- Department of Statistics, Persian Gulf University, Bushehr, Iran
| | - G. O. Silva
- Departamento de Estatística, Universidade Federal da Bahia, Salvador, Bahia, Brazil
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Eychenne N, Brito E, De Terline D, Profizi E, Roudot M, Hue B, Fernandez C, Ederhy S, Cohen A, Antignac M. DI-091 Assessment of an education program for patients treated with oral anticoagulants in a cardiology department: a pilot study. Eur J Hosp Pharm 2015. [DOI: 10.1136/ejhpharm-2015-000639.265] [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: 11/04/2022] Open
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Maldonado Romero L, Sifuentes Giraldo W, Velázquez Arce C, Barbolla Díaz I, Bachiller Corral J, Brito E, Zea Mendoza A. AB0338 Large Granular Lymphocyte Syndromes Associated with Rheumatoid Arthritis: Report of 6 Cases. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Almodόvar R, Zarco P, Brito E, Rosas J, Muñoz-Fernández S, Navarro-Compán V. FRI0130 Clinical and Imaging Differences between Patients with Familial Early Axial Spondiloarthritis and Sporadic Forms: Results from Esperanza Cohort. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2054] [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: 11/04/2022]
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Naredo E, Möller I, Acebes C, Batlle-Gualda E, Brito E, de Agustín JJ, de Miguel E, Martínez A, Mayordomo L, Moragues C, Rejón E, Rodríguez A, Uson J, Garrido J. Three-dimensional volumetric ultrasonography. Does it improve reliabililty of musculoskeletal ultrasound? Clin Exp Rheumatol 2010; 28:79-82. [PMID: 20346243] [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: 05/29/2023]
Abstract
OBJECTIVE To compare the interobserver reliability of three-dimensional (3D) volumetric ultrasonography (US) and 2D real-time US in detecting inflammatory and destructive changes in rheumatoid arthritis (RA) wrist and hand. METHODS Two RA patients were selected by a rheumatologist who performed independently a grey-scale and power Doppler (PD) volumetric acquisition at three anatomic sites in their more symptomatic wrist/hand using two identical scanners equipped with 3D volumetric probe. Twelve rheumatologists expert in MSUS were randomly assigned to a US scanner and a patient. In the first part of the study, each group of experts blindly, independently, and consecutively performed a 2D real-time grey-scale and PD US investigation of inflammatory changes and/or bone erosions at the three anatomic sites. In the second part of the study, each group of investigators blindly evaluated the same pathologic changes in the 6 volumes from the patient not scanned by them. RESULTS The kappa values were higher for 3D volumetric US than for 2D US in the detection of synovitis/tenosyno-vitis (0.41 vs. 0.37) and PD signal (0.82 vs 0.45) and in the PD signal grading (0.81 vs. 0.55). CONCLUSION 3D volumetric US may improve the interobserver reliability in RA multicentre studies.
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Affiliation(s)
- E Naredo
- Ultrasound School of the Spanish Society of Rheumatology, Department of Rheumatology, Hospital Severo Ochoa, Madrid, Spain.
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Collantes E, Zarco P, Muñoz E, Juanola X, Mulero J, Fernández-Sueiro JL, Torre-Alonso JC, Gratacós J, González C, Batlle E, Fernández P, Linares LF, Brito E, Carmona L. Disease pattern of spondyloarthropathies in Spain: description of the first national registry (REGISPONSER) extended report. Rheumatology (Oxford) 2007; 46:1309-15. [PMID: 17526930 DOI: 10.1093/rheumatology/kem084] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.9] [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: 11/14/2022] Open
Abstract
OBJECTIVE The national registry of spondyloarthropathies (REGISPONSER) is launched to classify patients with this group of diseases treated in Spanish rheumatology clinics. This manuscript describes the methodological and organizational background as well as characteristics of patients finally included, and provides a comparative analysis between characteristics of both ankylosing spondylitis and undifferentiated spondyloarthropathy groups of patients. PATIENTS AND METHODS Twelve members of the GRESSER group have participated in the registry, for a one-year recruitment period. All consecutively registered adult patients treated in their clinics met the classification criteria of the European Spondyloarthropathies Study Group (ESSG). Data collected reflect the socio-demographic characteristics, as well as disease activity and functional status, clinical form at onset, treatment used and quality of life; all measured by standard instruments. RESULTS Throughout 1 yr, 1385 patients have been included in the registry: 939 males (68%) and 440 females (32%), with an average age of 47 +/- 13 years (mean +/- s.d.), and an average disease duration of 12 +/- 9 years. Diagnoses of the included patients were: AS (n = 842, 61%), PsA (n = 290, 21%), u-SpA (n = 205, 15%), reactive arthritis (n = 16, 1.2%), inflammatory bowel disease arthritis (n = 13, 0.9%) and JCA-spondyloathropathy (n = 13, 0.9%). Regarding clinical form, 54% had axial disease, 20% peripheral disease, 24% mixed disease and 0.6% isolated enthesitic form. Low-back pain was the first symptom reported in 53% of the patients, and most common extra-articular disease manifestations were psoriasis (25%), anterior uveitis (16%) and intestinal inflammatory disease (4%). Some kind of work disability was reported by 353 patients (25.5%). CONCLUSIONS Such databases are very useful to obtain information about characteristics of SpA patients treated in a certain location or following a specific treatment practice, and provide a tool for assessing the impact of the disease. Data collected in this registry provide an appropriate clinical and demographic profile of patients suffering from SpA in Spain.
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Affiliation(s)
- E Collantes
- Department of Rheumatology, Hospital Reina Sofia and University of Córdoba, Córdoba, Spain.
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López-Cepero J, Piedra Buena A, Díez-Rojo MA, Regalado R, Brito E, Hernández Z, Figueredo M, Almendros G, Bello A. Evaluation of soil biodesinfestation with crop and garden residues in the control of root-knot nematodes populations. Commun Agric Appl Biol Sci 2007; 72:703-711. [PMID: 18399508] [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: 05/26/2023]
Abstract
Fresh crop and garden residues were applied both under laboratory conditions and in commercial greenhouse in order to asses their effect on soil nematodes populations and soil fertility. In the laboratory experiments, dosages of 5 to 20 g of cabbage residues, chicken manure, cabbage residues+chicken manure, grass+chicken manure, as well as leaves and stems of orange tree, pine tree, oleander, olive tree, palm tree and boxwood were mixed with 500 g soil having root-knot nematodes (Meloidogyne incognita) and soil moisture was adjusted at field capacity. A control treatment without residues was also included. The mixtures were kept into plastic bags, with four replications, and the bags were incubated for four weeks at 30 degrees C, when nematological and soil fertility analyses were carried out. In general, all these materials significantly (P < 0.05) reduced M. incognita populations and increased saprophagous nematodes, with slight effects on soil fertility except for the K increase with residues application. Tomato plants susceptible to M. incognita were planted in pots with 300 cm3 of the treated soils and kept for five weeks in a growth chamber (24 +/- 1 degrees C, 14 hours light), when root galling indices were evaluated. Most materials applied reduced root galling indices as regards to the control. In the greenhouse experiment, cabbage residues, cabbage residues+chicken manure, grass+chicken manure and grass+cabbage residues were applied to the soil and covered with a polyethylene sheet for 5 weeks. A cabbage residues:chicken manure treatment and a control (not-amended) treatment, without polyethylene, were also included. At the end of the experiment, the nematological analysis showed that all materials successfully controlled M. incognita populations, reaching 86-100% mortality with organic amendments vs. 6% for the control. After the greenhouse biodesinfestation experiment, a tomato crop was grown for one month, when root galling indices were determined. All materials significantly reduced this value from 4.75 in the control to 1.0-2.25 with the organic amendments, except for the cabbage residues+chicken manure treatment without polyethylene (index = 4.0). Our results show that fresh crop and garden residues successfully reduced M. incognita populations and root galling indices when applied with polyethylene covers, having good potential to be considered in integrated management programs.
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Affiliation(s)
- J López-Cepero
- ETSIA-Universidad de La Laguna, Ctra de Geneto no 2, ES-38071 La Laguna, Tenerife, Spain
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Lopes AA, Port FK, James SA, Silveira MA, Martinelli R, Brito E, Rocha H. Race and glomerulonephritis in patients with and without hepatosplenic Schistosomiasis mansoni. Clin Nephrol 2002; 58:333-6. [PMID: 12425482 DOI: 10.5414/cnp58333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 11/18/2022] Open
Abstract
BACKGROUND/AIMS United States investigators have shown evidence of higher susceptibility to focal segmental glomerulosclerosis (FSGS) in blacks than in whites. This association between race and FSGS has not been assessed outside the US. The present study assesses the association between race and type of glomerulonephritis in a sample of Brazilian patients, taking into account the presence of the hepatosplenic form of Schistosomiasis mansoni (HSM). METHODS Eighty patients with focal segmental glomerulosclerosis (FSGS) were compared to 50 with membranoproliferative glomerulonephritis (MPGN). The association between race (i.e. black versus white) and type of glomerulonephritis was adjusted for age, gender and HSM by logistic regression. RESULTS Blacks were more likely than whites to have FSGS (as compared to MPGN), both among patients with HSM (odds ratio (OR) = 2.67; 95% confidence interval (CI) = 0.81 - 8.81) and without HSM (OR = 2.19; 95% CI = 0.79 - 6.05). After adjustment for age, gender and HSM, the odds of FSGS remained significantly greater for blacks (OR = 2.49; 95% CI = 1.05 - 5.95). CONCLUSION The increased likelihood of FSGS in Brazilian blacks is consistent with findings from US patients. The association between race and type of glomerulonephritis was similar between patients with and without HSM. Future investigations should focus on the mediators factors that might explain these findings.
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Affiliation(s)
- A A Lopes
- Nephrology and Epidemiology, Federal University of Bahia, Brazil.
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Garmendia E, Brito E, Martínez-Martin B, Prieto A, Zea A, Alvarez-Mon M. Apoptosis induced by polyclonal mitogenic stimulation in PBMC from reactive arthritis patients. Immunol Lett 1997. [DOI: 10.1016/s0165-2478(97)86282-7] [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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Martinelli R, Pereira LJ, Brito E, Rocha H. Clinical course of focal segmental glomerulosclerosis associated with hepatosplenic schistosomiasis mansoni. Nephron Clin Pract 1995; 69:131-4. [PMID: 7723893 DOI: 10.1159/000188427] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
To analyze the clinical course and response to therapy 15 patients (9 male and 6 female) with the hepatosplenic form of schistosomiasis mansoni and focal segmental glomerulosclerosis (FSGS) were prospectively studied (mean follow-up = 115.8 +/- 93.2 months). Nephrotic syndrome was the most frequent clinical presentation, followed by abnormalities of urinalysis. The clinical course was progressive: at final evaluation 9 patients (60%) had developed renal failure. Hypertension or/and renal insufficiency at initial evaluation and persistence of the nephrotic syndrome were associated with progression toward advanced renal failure. Response to immunosuppressive therapy was recorded in 30% of the patients; all responsive patients still had normal renal function at final evaluation. The treatment of the Schistosoma mansoni infection did not influence the clinical course of the renal disease. It is concluded that FSGS in patients with hepatosplenic schistosomiasis mansoni is a disease progressing to advanced stage independently of the presence of the parasite.
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Affiliation(s)
- R Martinelli
- Department of Medicine and Pathology, Medical School, Federal University of Bahia, Brazil
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Martinelli R, Pereira LJ, Brito E, Rocha H. Renal involvement in prolonged Salmonella bacteremia: the role of schistosomal glomerulopathy. Rev Inst Med Trop Sao Paulo 1992; 34:193-8. [PMID: 1342069 DOI: 10.1590/s0036-46651992000300002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [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: 12/26/2022] Open
Abstract
Renal involvement has been well documented in patients with hepatosplenic schistosomiasis and in patients with prolonged Salmonella bacteremia (PSB). Whether there is a specific renal lesion related to PSB or the chronic bacterial infection aggravates a pre-existing schistosomal glomerulopathy has been a matter of controversy. To analyze the clinical manifestations and histopathological findings of the renal involvement, 8 patients with hepatosplenic schistosomiasis and PSB (group I) were compared with 8 patients with schistosomal glomerulopathy (group II) matched by sex and glomerular disease. The mean age in group I was 17.7 years. All patients presented with hematuria, in 4 cases associated with non-nephrotic proteinuria. In group II the mean age was 23 years; nephrotic syndrome was the clinical presentation in 7 of the 8 patients in the group. All patients in group I experienced remission of the clinical and laboratory abnormalities as the salmonella infection was cured; in group II the patients had persistent, steroid-resistant, nephrotic syndrome. On histological examination, no difference was noted between the two groups, except for pronounced glomerular hypercellularity and interstitial mononuclear cell infiltration in group I. These observations strongly suggest that PSB exacerbates a pre-existing sub-clinical schistosomal glomerulopathy by the addition of active lesions directly related to the prolonged bacteremia.
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Affiliation(s)
- R Martinelli
- Departamento de Medicina, Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brasil
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Valdazo JP, Romero B, Orte J, Brito E. [Guillain-Barré syndrome secondary to chrysotherapy]. Med Clin (Barc) 1990; 95:556. [PMID: 2128101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Abstract
Schistosomiasis mansoni has been well documented as one of the causes of infectious glomerulopathy, with mesangiocapillary glomerulonephritis being the most frequent lesion observed in this condition. Twenty-one patients with hepatosplenic schistosomiasis mansoni and biopsy-documented mesangiocapillary glomerulonephritis (MCGN) were studied and compared with 19 patients with the idiopathic form of MCGN. Nephrotic syndrome was the most frequent clinical presentation in both groups. At the time of diagnosis nine patients with hepatosplenomegaly (4 with associated arterial hypertension) and 12 (8 with arterial hypertension) among the patients with idiopathic MCGN had renal insufficiency. At the end of the follow-up period 16 patients with hepatosplenic schistosomiasis and MCGN (75.2 months) and 15 with the idiopathic form (52.1 months) had renal failure. Also, when compared at 48 months of follow-up, no difference in renal function could be detected in both groups. No benefits related to anti-parasitic treatment in the schistosomiasis group and immunosuppression therapy in either group could be documented. The progression of the renal disease, as assessed by the reciprocal of serum creatinine versus time, and the survival curve, were not different between the two groups. It is concluded that MCGN in patients with the hepatosplenic form of schistosomiasis mansoni is a progressive disease not influenced by anti-parasitic or immunosuppressive therapy, and presents a clinical course similar to that of the idiopathic form.
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Affiliation(s)
- R Martinelli
- Department of Medicine and Pathology, Federal University of Bahia, Salvador, Brazil
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Santos WL, Ramos EA, Pereira LJ, Martinelli R, Brito E, Andrade ZA, Rocha H. Schistosomal glomerulonephritis: is it more prevalent in hepatosplenic patients when cor pulmonale is present? Rev Soc Bras Med Trop 1989; 22:51-2. [PMID: 2517804 DOI: 10.1590/s0037-86821989000100009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Cueto García L, Brito E, Barrera Guerrero J, Gutiérrez Avila MC. [Prevention of coronary atherosclerosis. (III). Prevalence of risk factors among civil servants of Mexico City, Federal District]. Arch Inst Cardiol Mex 1989; 59:19-27. [PMID: 2486731] [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: 01/01/2023]
Abstract
The prevalence of risk factors in civil servants living in Mexico City was investigated prospectively in 1942 individuals. Risk factors tended to increase with age and in some cases were related to sex. Hypertension was found to be as high as fifteen percent in the older age groups despite the fact that the critical limit was 160/95 in all decades. Hypercholesterolemia was found to be close to the rates reported in the so-called developed countries. Diabetes mellitus varied between 1 and 14%. Obesity and hypertrygliceridemia were also common findings and related. Smoking was independent of sex. Prevalence of the association between the major risk factors are presented. These data, are in agreement with the death causes among civil servants and indicate that preventive programs for ischemic heart disease are needed in civil servants in Mexico City.
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Pérez O, Lecha L, Lastre M, González R, Pérez R, Brito E. [Epidemic human fascioliasis, Cuba, 1983. I. Climatic characterization]. Rev Cubana Med Trop 1988; 40:68-81. [PMID: 3072616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Moya JL, Sanchez M, Morales MD, Brito E. Mitral valve prolapse (MVP) in psoriatic arthritis (PA). Arch Intern Med 1987; 147:992. [PMID: 3579451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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González R, Pérez R, Pérez O, Glez de la Torre R, Lastre M, Brito E, Díaz J. [Epidemic human fascioliasis, Cuba 1983. II. Epidemiologic study]. G E N 1987; 41:53-7. [PMID: 3147208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Brito E, Olazábal E, Pérez O, Lastre M, González R, Pérez R, González J. [Epidemic human fascioliasis, Cuba 1983. III. Trematode indices]. G E N 1987; 41:58-61. [PMID: 3147209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Abstract
In a prospective study of 50 patients with visceral leishmaniasis, laboratory abnormalities suggestive of renal involvement were not infrequent. Proteinuria and/or microscopic hematuria or pyuria were observed in 51% of such cases. Twenty-four hour urinary protein excretion was elevated in 57% of patients in all cases below 1g/24 hours. An abnormal acid-load test was demonstrated in 12 of 18 patients studied before therapy of the parasitic infection with N-methyl-glucamine. Of interest was the demonstration of tubulo-interstitial involvement in the renal histology of all seven patients studied; also, in five of seven patients there was a proliferative glomerulonephritis, usually mild, on histologic examination. In general, there was a tendency to subsidence of abnormal laboratory findings within one month after specific therapy. Renal involvement in visceral leishmaniasis was mild and seemed to revert with the cure of the leishmanial infection.
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Bittencourt AL, Brito E, Sadigursky M, Dias NF. [Systemic lupus erythematosus with bullous manifestations. Association with bullous pemphigoid and a rare presentation of systemic lupus erythematosus]. ACTA MEDICA PORT 1984; 5:119-25. [PMID: 6380218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Martinelli R, Brito E, Rocha H. Value of beta 1C/1A globulin serum levels as an early index of glomerular involvement in Schistosoma mansoni infection. Am J Trop Med Hyg 1980; 29:882-5. [PMID: 6159796 DOI: 10.4269/ajtmh.1980.29.882] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
In attempting the early detection of glomerular abnormalities in patients with the hepatosplenic form of Schistosoma mansoni infection, the serum concentration of beta 1C/1A globulin was determined in 17 patients without clinical evidence of nephropathy. Renal biopsies were obtained during splenectomy in all of them. The serum levels of beta 1C/1A globulin were below the normal limit in eight patients; of these, two had histological evidence of focal proliferative glomerulonephritis, two others had membranoproliferative glomerulonephritis, and one showed focal sclerosing glomerulonephritis. Of nine patients with normal serum levels of beta 1C/1A globulin, eight had no glomerular abnormalities demonstrated by light microscopy. Determination of the serum concentration of beta 1C/1A globulin proved to be a valuable index for the detection of early glomerulopathy in patients with hepatosplenic schistosomiasis, since a low level correlated well with the histologic demonstration of glomerular involvement by light microscopy.
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Brito E, Santoro F, Rocha H, Dutra M, Capron A. Immune complexes in schistosomiasis. VI--Circulating IC levels in patients with and without nephropathy. Rev Inst Med Trop Sao Paulo 1979; 21:119-24. [PMID: 388591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Dutra M, de Carvalho Filho EM, Gusmão EA, Queiroz FP, Brito E, Rocha H. [Treatment of glomerulopathy in schistosomiasis mansoni. Effect of corticosteroids, cyclophosphamide and schistosomicides]. Rev Inst Med Trop Sao Paulo 1979; 21:99-105. [PMID: 482773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Abstract
Elution of complexed immunoglobulins was carried out in renal tissue obtained at autopsy from schistosomiasis mansoni and control cases. Substantial amounts of IgG were found in acid eluates of 2 of 5 schistosomiasis cases and 2 of 3 controls. The IgG from schistosomiasis cases produced specific indirect immunofluorescence reactions in gut and tegument of sections of adult Schistosoma mansoni; no reactivity was present against egg granulomas, cercariae, or mouse liver tissue. Control case eluates produced no fluorescence with S. mansoni antigens.
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Abstract
In a prospective study of renal involvement in 100 consecutively hospitalized patients with hepatosplenic schistosomiasis mansoni, 15 exhibited persistent proteinuria of varying degree, which in 6 instances was accompanied by hypertension. Nine patients had the nephrotic syndrome. The most common glomerular lesion in this group was membrano-proliferative glomerulonephritis. Surgical biospy obtained during splenectomy in 15 patients without clinical evidence of renal involvement showed glomerular lesions in 6 instances. Focal proliferative glomerulonephritis was the most common lesion in this group. The detection of silent glomerular lesions in patients with Schistosoma mansoni infection suggests that the glomerular alterations may precede clinical manifestations of renal disease.
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Queiroz FP, Brito E, Martinelli R. Influence of regional factors in the distribution of the histologic patterns of glomerulopathies in the nephrotic syndrome. Nephron Clin Pract 1975; 14:466-70. [PMID: 1153046 DOI: 10.1159/000180481] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Analysis of 47 renal biopsies performed on adult patients with nephrotic syndrome in Bahia, Brazil, shows a peculiar distribution of the histologic types with a preponderance of membranoproliferative glomerulonephritis. The possibility of a regional influence is discussed, particularly with regard to Schistosoma mansoni infection which is endemic in this area and probably an important cause of glomerulopathy.
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Brito E, Tafur F. [Urethroplasty with fascia lata. Preliminary report]. Acta Urol Belg 1974; 42:50-1. [PMID: 4857453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Rocha H, Da Silva Teles E, Brito E. Studies on experimental bacteremia and pyelonephritis in the marmoset (Callithrix jacchus). Proc Soc Exp Biol Med 1968; 129:506-9. [PMID: 4972244 DOI: 10.3181/00379727-129-33356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Páramo PG, Brito E, Nacarino L, Silmi A. [Testicular tumors. Prognosis and treatment]. Rev Clin Esp 1967; 105:406-11. [PMID: 5609897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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