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Bottorff EC, Gupta P, Ippolito GM, Moore MB, Rodriguez GM, Bruns TM. Short-term Dorsal Genital Nerve Stimulation Increases Subjective Arousal in Women With and Without Spinal Cord Injury: A Preliminary Investigation. Neuromodulation 2024:S1094-7159(24)00059-X. [PMID: 38573280 DOI: 10.1016/j.neurom.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 12/23/2023] [Accepted: 02/13/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVES Female sexual dysfunction (FSD) affects an estimated 40% of women. Unfortunately, FSD is understudied, leading to limited treatment options for FSD. Neuromodulation has shown some success in alleviating FSD symptoms. We developed a pilot study to investigate the short-term effect of electrical stimulation of the dorsal genital nerve and tibial nerve on sexual arousal in healthy women, women with FSD, and women with spinal cord injury (SCI) and FSD. MATERIALS AND METHODS This study comprises a randomized crossover design in three groups: women with SCI, women with non-neurogenic FSD, and women without FSD or SCI. The primary outcome measure was change in vaginal pulse amplitude (VPA) from baseline. Secondary outcome measures were changes in subjective arousal, heart rate, and mean arterial pressure from baseline. Participants attended one or two study sessions where they received either transcutaneous dorsal genital nerve stimulation (DGNS) or tibial nerve stimulation (TNS). At each session, a vaginal photoplethysmography sensor was used to measure VPA. Participants also rated their level of subjective arousal and were asked to report any pelvic sensations. RESULTS We found that subjective arousal increased significantly from before to after stimulation in DGNS study sessions across all women. TNS had no effect on subjective arousal. There were significant differences in VPA between baseline and stimulation, baseline and recovery, and stimulation and recovery periods among participants, but there were no trends across groups or stimulation type. Two participants with complete SCIs experienced genital sensations. CONCLUSIONS To our knowledge, this is the first study to measure sexual arousal in response to short-term neuromodulation in women. This study indicates that short-term DGNS but not TNS can increase subjective arousal, but the effect of stimulation on genital arousal is inconclusive. This study provides further support for DGNS as a treatment for FSD.
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Affiliation(s)
- Elizabeth C Bottorff
- Biomedical Engineering Department, University of Michigan, Ann Arbor, MI, USA; Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA
| | - Priyanka Gupta
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | | | - Mackenzie B Moore
- Biomedical Engineering Department, University of Michigan, Ann Arbor, MI, USA; Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA
| | - Gianna M Rodriguez
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Tim M Bruns
- Biomedical Engineering Department, University of Michigan, Ann Arbor, MI, USA; Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA.
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Bottorff EC, Gupta P, Ippolito GM, Moore MB, Rodriguez GM, Bruns TM. Acute dorsal genital nerve stimulation increases subjective arousal in women with and without spinal cord injury: a preliminary investigation. medRxiv 2023:2023.04.24.23288935. [PMID: 37163021 PMCID: PMC10168483 DOI: 10.1101/2023.04.24.23288935] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Introduction Female sexual dysfunction (FSD) impacts an estimated 40% of women. Unfortunately, female sexual function is understudied, leading to limited treatment options for FSD. Neuromodulation has demonstrated some success in improving FSD symptoms. We developed a pilot study to investigate the short-term effect of electrical stimulation of the dorsal genital nerve and tibial nerve on sexual arousal in healthy women, women with FSD, and women with spinal cord injury (SCI) and FSD. Methods This study consists of a randomized crossover design in three groups: women with SCI, women with non-neurogenic FSD, and women without FSD or SCI. The primary outcome measure was change in vaginal pulse amplitude (VPA) from baseline. Secondary outcome measures were changes in subjective arousal, heart rate, and mean arterial pressure from baseline. Participants attended one or two study sessions where they received either transcutaneous dorsal genital nerve stimulation (DGNS) or tibial nerve stimulation (TNS). At each session, a vaginal photoplethysmography sensor was used to measure VPA. Participants also rated their level of subjective arousal and were asked to report any pelvic sensations. Results We found that subjective arousal increased significantly from before to after stimulation in DGNS study sessions across all women. TNS had no effect on subjective arousal. There were significant differences in VPA between baseline and stimulation, baseline and recovery, and stimulation and recovery periods among participants, but there were no trends across groups or stimulation type. Two participants with complete SCIs experienced genital sensations. Discussion This is the first study to measure sexual arousal in response to acute neuromodulation in women. This study demonstrates that acute DGNS, but not TNS, can increase subjective arousal, but the effect of stimulation on genital arousal is inconclusive. This study provides further support for DGNS as a treatment for female sexual dysfunction.
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Affiliation(s)
- Elizabeth C. Bottorff
- University of Michigan, Biomedical Engineering Department, Ann Arbor, MI, USA
- University of Michigan, Biointerfaces Institute, Ann Arbor, MI, USA
| | - Priyanka Gupta
- University of Michigan, Department of Urology, Ann Arbor, MI, USA
| | | | - Mackenzie B. Moore
- University of Michigan, Biomedical Engineering Department, Ann Arbor, MI, USA
| | - Gianna M. Rodriguez
- University of Michigan, Department of Physical Medicine and Rehabilitation, Ann Arbor, MI, USA
| | - Tim M. Bruns
- University of Michigan, Biomedical Engineering Department, Ann Arbor, MI, USA
- University of Michigan, Biointerfaces Institute, Ann Arbor, MI, USA
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Tate DG, Rohn EJ, Forchheimer M, Walsh S, DiPonio L, Rodriguez GM, Cameron AP. Factors influencing decisions about neurogenic bladder and bowel surgeries among veterans and civilians with spinal cord injury. J Spinal Cord Med 2023; 46:215-230. [PMID: 34726578 PMCID: PMC9987721 DOI: 10.1080/10790268.2021.1970897] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE This study investigated factors influencing surgical decision-making (DM) to treat neurogenic bladder and bowel (NBB) dysfunction for veterans and civilians with spinal cord injury (SCI) in the United States (US). DESIGN Semi-structured interviews complemented by survey measures. SETTING Community-dwelling participants who received treatment at a major Midwestern US medical system, a nearby Veterans Affairs (VA) facility, and other VA sites around the US. PARTICIPANTS Eighteen participants with SCI who underwent surgeries; completed semi-structured interviews and survey measures. INTERVENTIONS Not applicable. OUTCOMES MEASURES Semi-structured interviews were coded to reflect factors, DM enactment, and outcomes, including surgery satisfaction and quality of life (QOL). Quantitative measures included COMRADE, Ways of Coping Questionnaire, Bladder and Bowel Treatment Inventory, PROMIS Global Health and Cognitive Abilities scales, and SCI-QOL Bladder and Bowel short form. RESULTS Themes identified about factors influencing DM included: recurrent symptoms and complications; balancing dissatisfaction with NBB management against surgery risks; achieving independence and life style adjustments; participant's driven solutions; support and guidance and trust in doctors; and access and barriers to DM. DM enactment varied across surgeries and individuals, revealing no clear patterns. Most participants were satisfied with the surgery outcomes. Some differences in demographics were observed between veterans and civilians. CONCLUSIONS We have attempted to illustrate the process of NBB DM as individuals move from factors to enactment to outcomes. Attending to the complexity of the DM process through careful listening and clear communication will allow clinicians to better assist patients in making surgical decisions about NBB management.
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Affiliation(s)
- Denise G Tate
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Edward J Rohn
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA.,Department of Interdisciplinary Health Sciences, Oakland University, Rochester, Michigan, USA
| | - Martin Forchheimer
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Suzanne Walsh
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Lisa DiPonio
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA.,Veterans Administration Ann Arbor Health Care System, Ann Arbor, Michigan, USA
| | - Gianna M Rodriguez
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Anne P Cameron
- Department of Urology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Rodriguez GM, Gater DR. Neurogenic Bowel and Management after Spinal Cord Injury: A Narrative Review. J Pers Med 2022; 12:jpm12071141. [PMID: 35887638 PMCID: PMC9324073 DOI: 10.3390/jpm12071141] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/02/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022] Open
Abstract
People with spinal cord injury (SCI) suffer from the sequela of neurogenic bowel and its disabling complications primarily constipation, fecal incontinence, and gastrointestinal (GI) symptoms. Neurogenic bowel is a functional bowel disorder with a spectrum of defecatory disorders as well as colonic and gastrointestinal motility dysfunction. This manuscript will review the anatomy and physiology of gastrointestinal innervation, as well as the pathophysiology associated with SCI. It will provide essential information on the recent guidelines for neurogenic bowel assessment and medical management. This will allow medical providers to partner with their patients to develop an individualized bowel plan utilizing a combination of various pharmacological, mechanical and surgical interventions that prevent complications and ensure successful management and compliance. For people with SCI and neurogenic bowel dysfunction, the fundamental goal is to maintain health and well-being, promote a good quality of life and support active, fulfilled lives in their homes and communities.
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Affiliation(s)
- Gianna M. Rodriguez
- Department of Physical Medicine and Rehabilitation, University of Michigan College of Medicine, Ann Arbor, MI 48108, USA
- Correspondence:
| | - David R. Gater
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL 33136, USA;
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL 33136, USA
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Wecht JM, Krassioukov AV, Alexander M, Handrakis JP, McKenna SL, Kennelly M, Trbovich M, Biering-Sorensen F, Burns S, Elliott SL, Graves D, Hamer J, Krogh K, Linsenmeyer TA, Liu N, Hagen EM, Phillips AA, Previnaire JG, Rodriguez GM, Slocum C, Wilson JR. International Standards to document Autonomic Function following SCI (ISAFSCI): Second Edition. Top Spinal Cord Inj Rehabil 2021; 27:23-49. [PMID: 34108833 DOI: 10.46292/sci2702-23] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Jill M Wecht
- James J Peters VA Medical Center, Bronx, NY.,Bronx Veterans Medical Research Foundation, Bronx, NY.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Andrei V Krassioukov
- International Collaboration on Repair Discoveries (ICORD) and Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia.,Spinal Cord Program, GF Strong Rehabilitation Centre, University of British Columbia, Vancouver, Canada.,GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada.,President, American Spinal Injury Association (ASIA)
| | - Maralee Alexander
- Sustain Our Abilities, Birmingham, AL.,University of Alabama at Birmingham School of Medicine, Birmingham, AL.,Spaulding Rehabilitation Hospital, Charlestown, MA
| | - John P Handrakis
- James J Peters VA Medical Center, Bronx, NY.,Bronx Veterans Medical Research Foundation, Bronx, NY.,New York Institute of Technology, Department of Physical Therapy, School of Health Professions, Old Westbury, NY
| | - Stephen L McKenna
- Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, CA.,Department of Neurosurgery, Stanford University, Stanford, CA
| | - Michael Kennelly
- James J Peters VA Medical Center, Bronx, NY.,Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY.,International Collaboration on Repair Discoveries (ICORD) and Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia
| | - Michele Trbovich
- South Texas Veterans Health Care System, San Antonio, TX.,Department of Rehabilitation Medicine, University of Texas Health San Antonio
| | - Fin Biering-Sorensen
- Department for Spinal Cord Injuries, Copenhagen University Hospital, Rigshospitalet, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Stephen Burns
- Spinal Cord Injury Service, VA Puget Sound Health Care System, Seattle, WA.,Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA
| | - Stacy L Elliott
- International Collaboration on Repair Discoveries (ICORD) and Division of Sexual Medicine, Departments of Psychiatry and Urologic Sciences, Faculty of Medicine, University of British Columbia
| | - Daniel Graves
- College of Rehabilitation Sciences, Department of Rehabilitation Medicine, Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, PA
| | | | - Klaus Krogh
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Todd A Linsenmeyer
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.,Department of Surgery ( Division of Urology), Rutgers New Jersey Medical School, Newark, NJ.,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ
| | - Nan Liu
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China
| | - Ellen Merete Hagen
- National Hospital for Neurology and Neurosurgery, Queens Square, UCLH, London, UK.,Institute of Neurology, University College London, London, UK
| | - Aaron A Phillips
- Departments of Physiology and Pharmacology, Clinical Neurosciences, Cardiac Sciences, Hotchkiss Brain Institute, University of Calgary.,Cardiovascular Institute, Cumming School of Medicine, University of Calgary
| | | | - Gianna M Rodriguez
- Physical Medicine and Rehabilitation Department, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Chloe Slocum
- Spaulding Rehabilitation Hospital, Charlestown, MA.,Harvard Medical School Department of Physical Medicine and Rehabilitation, Boston, MA
| | - James R Wilson
- Department of Physical Medicine and Rehabilitation, MetroHealth Rehabilitation Institute, Cleveland, OH.,Department of Physical Medicine and Rehabilitation, Case Western Reserve University-SOM, Cleveland, OH
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Rupp R, Biering-Sørensen F, Burns SP, Graves DE, Guest J, Jones L, Read MS, Rodriguez GM, Schuld C, Tansey-Md KE, Walden K, Kirshblum S. International Standards for Neurological Classification of Spinal Cord Injury: Revised 2019. Top Spinal Cord Inj Rehabil 2021; 27:1-22. [PMID: 34108832 DOI: 10.46292/sci2702-1] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Johns J, Krogh K, Rodriguez GM, Eng J, Haller E, Heinen M, Laredo R, Longo W, Montero-Colon W, Korsten M. Management of Neurogenic Bowel Dysfunction in Adults after Spinal Cord Injury Suggested citation: Jeffery Johns, Klaus Krogh, Gianna M. Rodriguez, Janice Eng, Emily Haller, Malorie Heinen, Rafferty Laredo, Walter Longo, Wilda Montero-Colon, Mark Korsten. Management of Neurogenic Bowel Dysfunction in Adults after Spinal Cord Injury: Clinical Practice Guideline for Healthcare Providers. Journal of Spinal Cord Med. 2021. Doi:10.1080/10790268.2021.1883385. J Spinal Cord Med 2021; 44:442-510. [PMID: 33905316 PMCID: PMC8115581 DOI: 10.1080/10790268.2021.1883385] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Jeffery Johns
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Klaus Krogh
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Gianna M Rodriguez
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Janice Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emily Haller
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Malorie Heinen
- University of Kansas Health Care System, Kansas City, Kansas, USA
| | | | - Walter Longo
- Department of Surgery, Division of Gastrointestinal Surgery, Yale University, New Haven, Connecticut, USA
| | | | - Mark Korsten
- Icahn School of Medicine at Mount Sinai, Department of Internal Medicine, Division of Gastroenterology, New York, New York, USA
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Johns J, Krogh K, Rodriguez GM, Eng J, Haller E, Heinen M, Laredo R, Longo W, Montero-Colon W, Wilson C, Korsten M. Management of Neurogenic Bowel Dysfunction in Adults after Spinal Cord Injury: Clinical Practice Guideline for Health Care Providers. Top Spinal Cord Inj Rehabil 2021; 27:75-151. [PMID: 34108835 PMCID: PMC8152174 DOI: 10.46292/sci2702-75] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Jeffery Johns
- Vanderbilt University Medical Center, Nashville, Tennessee USA
| | | | | | - Janice Eng
- University of British Columbia, Vancouver Canada
| | | | - Malorie Heinen
- University of Kansas Health Care System, Kansas City, Kansas USA
| | | | | | | | - Catherine Wilson
- Diplomate, American Board of Professional Psychology (RP) Private Practice, Denver, Colorado
| | - Mark Korsten
- Icahn School of Medicine @ Mt Sinai, New York, New York USA
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Tate DG, Wheeler T, Lane GI, Forchheimer M, Anderson KD, Biering-Sorensen F, Cameron AP, Santacruz BG, Jakeman LB, Kennelly MJ, Kirshblum S, Krassioukov A, Krogh K, Mulcahey MJ, Noonan VK, Rodriguez GM, Spungen AM, Tulsky D, Post MW. Recommendations for evaluation of neurogenic bladder and bowel dysfunction after spinal cord injury and/or disease. J Spinal Cord Med 2020; 43:141-164. [PMID: 32105586 PMCID: PMC7054930 DOI: 10.1080/10790268.2019.1706033] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Objective: To provide an overview of clinical assessments and diagnostic tools, self-report measures (SRMs) and data sets used in neurogenic bladder and bowel (NBB) dysfunction and recommendations for their use with persons with spinal cord injury /disease (SCI/D).Methods: Experts in SCI/D conducted literature reviews, compiled a list of NBB related assessments and measures, reviewed their psychometric properties, discussed their use in SCI/D and issued recommendations for the National Institutes of Health (NIH), National Institute of Neurological Disorders and Stroke (NINDS) Common Data Elements (CDEs) guidelines.Results: Clinical assessments included 15 objective tests and diagnostic tools for neurogenic bladder and 12 for neurogenic bowel. Following a two-phase evaluation, eight SRMs were selected for final review with the Qualiveen and Short-Form (SF) Qualiveen and the Neurogenic Bowel Dysfunction Score (NBDS) being recommended as supplemental, highly-recommended due to their strong psychometrics and extensive use in SCI/D. Two datasets and other SRM measures were recommended as supplemental.Conclusion: There is no one single measure that can be used to assess NBB dysfunction across all clinical research studies. Clinical and diagnostic tools are here recommended based on specific medical needs of the person with SCI/D. Following the CDE for SCI studies guidelines, we recommend both the SF-Qualiveen for bladder and the NBDS for bowel as relatively short measures with strong psychometrics. Other measures are also recommended. A combination of assessment tools (objective and subjective) to be used jointly across the spectrum of care seems critical to best capture changes related to NBB and develop better treatments.
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Affiliation(s)
- Denise G. Tate
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Giulia I. Lane
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Martin Forchheimer
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Kim D. Anderson
- Department of Physical Medicine and Rehabilitation, Metro Health Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Fin Biering-Sorensen
- Clinic for Spinal Cord Injuries, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anne P. Cameron
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Lyn B. Jakeman
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Michael J. Kennelly
- Department of Urology, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Steve Kirshblum
- Rutgers New Jersey Medical School, Kessler Foundation, Kessler Institution for Rehabilitation, West Orange, New Jersey, USA
| | - Andrei Krassioukov
- International collaboration On Repair Discoveries (ICORD), Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Klaus Krogh
- Department of Clinical Medicine, Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - M. J. Mulcahey
- Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Vanessa K. Noonan
- The Praxis Spinal Institute, The Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - Gianna M. Rodriguez
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Ann M. Spungen
- VA RR&D National Center of Excellence for the Medical Consequences of Spinal Cord Injury, James J Peters VA Medical Center, Bronx, New York, USA
| | - David Tulsky
- Department of Physical Therapy and Psychological & Brain Sciences, University of Delaware, Newark, Delaware, USA
| | - Marcel W. Post
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Center of Excellence for Rehabilitation Medicine, UMC Brain Center, University Medical Center Utrecht, University of Utrecht and De Hoogstraat, Utrecht, the Netherlands
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Tompkins BA, Rieger AC, Florea V, Banerjee MN, Natsumeda M, Nigh ED, Landin AM, Rodriguez GM, Hatzistergos KE, Schulman IH, Hare JM. Comparison of Mesenchymal Stem Cell Efficacy in Ischemic Versus Nonischemic Dilated Cardiomyopathy. J Am Heart Assoc 2018; 7:JAHA.117.008460. [PMID: 30005555 PMCID: PMC6064862 DOI: 10.1161/jaha.117.008460] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Ischemic cardiomyopathy (ICM) and dilated cardiomyopathy (DCM) differ in histopathology and prognosis. Although transendocardial delivery of mesenchymal stem cells is safe and provides cardiovascular benefits in both, a comparison of mesenchymal stem cell efficacy in ICM versus DCM has not been done. Methods and Results We conducted a subanalysis of 3 single‐center, randomized, and blinded clinical trials: (1) TAC‐HFT (Transendocardial Autologous Mesenchymal Stem Cells and Mononuclear Bone Marrow Cells in Ischemic Heart Failure Trial); (2) POSEIDON (A Phase I/II, Randomized Pilot Study of the Comparative Safety and Efficacy of Transendocardial Injection of Autologous Mesenchymal Stem Cells Versus Allogeneic Mesenchymal Stem Cells in Patients With Chronic Ischemic Left Ventricular Dysfunction Secondary to Myocardial Infarction); and (3) POSEIDON‐DCM (Percutaneous Stem Cell Injection Delivery Effects on Neomyogenesis in Dilated Cardiomyopathy). Baseline and 1‐year cardiac structure and function and quality‐of‐life data were compared in a post hoc pooled analysis including ICM (n=46) and DCM (n=33) patients who received autologous or allogeneic mesenchymal stem cells. Ejection fraction improved in DCM by 7% (within‐group, P=0.002) compared to ICM (1.5%; within‐group, P=0.14; between‐group, P=0.003). Similarly, stroke volume increased in DCM by 10.59 mL (P=0.046) versus ICM (−0.2 mL; P=0.73; between‐group, P=0.02). End‐diastolic volume improved only in ICM (10.6 mL; P=0.04) and end‐systolic volume improved only in DCM (17.8 mL; P=0.049). The sphericity index decreased only in ICM (−0.04; P=0.0002). End‐diastolic mass increased in ICM (23.1 g; P<0.0001) versus DCM (−4.1 g; P=0.34; between‐group, P=0.007). The 6‐minute walk test improved in DCM (31.1 m; P=0.009) and ICM (36.3 m; P=0.006) with no between‐group difference (P=0.79). The New York Heart Association class improved in DCM (P=0.005) and ICM (P=0.02; between‐group P=0.20). The Minnesota Living with Heart Failure Questionnaire improved in DCM (−19.5; P=0.002) and ICM (−6.4; P=0.03; δ between‐group difference P=0.042) patients. Conclusions Mesenchymal stem cell therapy is beneficial in DCM and ICM patients, despite variable effects on cardiac phenotypic outcomes. Whereas cardiac function improved preferentially in DCM patients, ICM patients experienced reverse remodeling. Mesenchymal stem cell therapy enhanced quality of life and functional capacity in both etiologies. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifiers: TAC‐HFT: NCT00768066, POSEIDON: NCT01087996, POSEIDON‐DCM: NCT01392625.
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Affiliation(s)
- Bryon A Tompkins
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL.,Department of Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - Angela C Rieger
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Victoria Florea
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Monisha N Banerjee
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL.,Department of Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - Makoto Natsumeda
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Evan D Nigh
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Ana Marie Landin
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Gianna M Rodriguez
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL
| | | | - Ivonne Hernandez Schulman
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL.,Katz Family Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, FL
| | - Joshua M Hare
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL .,Cardiovascular Division, University of Miami Miller School of Medicine, Miami, FL
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11
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Brown JP, Bauman KA, Kurili A, Rodriguez GM, Chiodo AE, Sitrin RG, Schotland HM. Positive airway pressure therapy for sleep-disordered breathing confers short-term benefits to patients with spinal cord injury despite widely ranging patterns of use. Spinal Cord 2018. [PMID: 29515212 DOI: 10.1038/s41393-018-0077-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
STUDY DESIGN Prospective, cohort study. OBJECTIVES To evaluate the effectiveness of bi-level positive airway pressure (PAP) therapy and the patterns of use for sleep-disordered breathing (SDB) in individuals with spinal cord injury (SCI). SETTING Academic tertiary care center, USA. METHODS Overall, 91 adults with C1-T6 SCI for ≥3 months were recruited and 74 remained in the study to be evaluated for SDB and follow-up. Individuals with SDB but no nocturnal hypercapnia (NH) were prescribed auto-titrating PAP. Those with NH were prescribed PAP with volume-assured pressure support. Device downloads and overnight transcutaneous capnography were performed at 3, 6, and 12 months to quantify PAP use and effectiveness. Participants kept daily event logs, and quality of life (QOL) questionnaires were performed after 3, 6, and 12 months. RESULTS Overall, 45% of 91 participants completed the study. There was great diversity among SCI patients in PAP utilization; after 3 months, 37.8% of participants used PAP for ≥70% nights and ≥240 min per night, whereas 42.2% seldom used PAP and 20% used PAP sporadically or for short periods. PAP therapy was effective in improving OSA in 89% and nocturnal hypercapnia in 77%. Higher PAP pressures predicted higher levels of device use. There were marked reductions in symptoms of autonomic dysreflexia (AD) and orthostatic hypotension as well as some improved indices of QOL. CONCLUSIONS Despite widely diverse patterns of use, PAP therapy may have short-term benefits with regard to QOL and reducing episodes of dizziness and autonomic dysreflexia.
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Affiliation(s)
- Jeanette P Brown
- Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, 48109, USA.
| | - Kristy A Bauman
- Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, 48109, USA
| | - Armando Kurili
- Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, 48109, USA
| | - Gianna M Rodriguez
- Department of Physical Medicine and Rehabilitation, University of Michigan Health System, Ann Arbor, MI, 48109, USA
| | - Anthony E Chiodo
- Department of Physical Medicine and Rehabilitation, University of Michigan Health System, Ann Arbor, MI, 48109, USA
| | - Robert G Sitrin
- Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, 48109, USA
| | - Helena M Schotland
- Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, 48109, USA.,Department of Neurology, Sleep Disorders Center, University of Michigan Health System, Ann Arbor, MI, 48109, USA
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Bauman KA, Kurili A, Schotland HM, Rodriguez GM, Chiodo AE, Sitrin RG. The Authors Respond. Arch Phys Med Rehabil 2016; 97:177-8. [PMID: 26710862 DOI: 10.1016/j.apmr.2015.10.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 10/16/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Kristy A Bauman
- Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, Ann Arbor, MI
| | - Armando Kurili
- Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, Ann Arbor, MI
| | - Helena M Schotland
- Pulmonary and Critical Care Medicine Division, Department of Internal Medicine and Department of Neurology, Sleep Disorders Center, Ann Arbor, MI
| | - Gianna M Rodriguez
- Department of Physical Medicine and Rehabilitation, University of Michigan Health System, Ann Arbor, MI
| | - Anthony E Chiodo
- Department of Physical Medicine and Rehabilitation, University of Michigan Health System, Ann Arbor, MI
| | - Robert G Sitrin
- Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, Ann Arbor, MI
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Cameron AP, Rodriguez GM, Gursky A, He C, Clemens JQ, Stoffel JT. The Severity of Bowel Dysfunction in Patients with Neurogenic Bladder. J Urol 2015; 194:1336-41. [DOI: 10.1016/j.juro.2015.04.100] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2015] [Indexed: 01/19/2023]
Affiliation(s)
- Anne P. Cameron
- Departments of Urology, and Physical Medicine and Rehabilitation (GMR), University of Michigan, Ann Arbor, Michigan
| | - Gianna M. Rodriguez
- Departments of Urology, and Physical Medicine and Rehabilitation (GMR), University of Michigan, Ann Arbor, Michigan
| | - Amy Gursky
- Departments of Urology, and Physical Medicine and Rehabilitation (GMR), University of Michigan, Ann Arbor, Michigan
| | - Chang He
- Departments of Urology, and Physical Medicine and Rehabilitation (GMR), University of Michigan, Ann Arbor, Michigan
| | - J. Quentin Clemens
- Departments of Urology, and Physical Medicine and Rehabilitation (GMR), University of Michigan, Ann Arbor, Michigan
| | - John T. Stoffel
- Departments of Urology, and Physical Medicine and Rehabilitation (GMR), University of Michigan, Ann Arbor, Michigan
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Bauman KA, Kurili A, Schotland HM, Rodriguez GM, Chiodo AE, Sitrin RG. Simplified Approach to Diagnosing Sleep-Disordered Breathing and Nocturnal Hypercapnia in Individuals With Spinal Cord Injury. Arch Phys Med Rehabil 2015; 97:363-71. [PMID: 26297810 DOI: 10.1016/j.apmr.2015.07.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 07/28/2015] [Accepted: 07/30/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate a strategy of home-based testing to diagnose sleep-disordered breathing and nocturnal hypercapnia in individuals with spinal cord injury (SCI). DESIGN Case series. SETTING Referral center. PARTICIPANTS Adults with C1-T6 SCI (N=81). Individuals were eligible if ≥ 18 years old, with SCI of ≥ 3 months' duration, living within 100 miles of the study site, and not meeting exclusion criteria. Of the 161 individuals recruited from the SCI Model System database who were not enrolled, reasons were not interested in participating, change of location, prior positive pressure ventilation use, or medical contraindication. Ten individuals did not complete the study. INTERVENTIONS Performance of an unsupervised home sleep apnea test combined with transcutaneous partial pressure of carbon dioxide/oxygen saturation by pulse oximetry monitoring. MAIN OUTCOME MEASURES Prevalence of sleep-disordered breathing and nocturnal hypercapnia. Clinical and physiological variables were examined to determine which, if any, correlate with the severity of sleep-disordered breathing. RESULTS Obstructive sleep apnea (OSA) was found in 81.3% of individuals, central sleep apnea (CSA) was found in 23.8%, and nonspecific hypopnea events, where respiratory effort was too uncertain to classify, were present in 35%. Nonspecific hypopnea events correlated strongly with CSA but weakly with OSA, suggesting that conventional sleep apnea test scoring may underestimate central/neuromuscular hypopneas. Nocturnal hypercapnia was present in 28% and oxygen desaturation in 18.3%. Neck circumference was the primary predictor for OSA, whereas baclofen use and obstructive apnea/hypopnea index weakly predicted CSA. Awake transcutaneous partial pressure of carbon dioxide and CSA were only marginally associated with nocturnal hypercapnia. CONCLUSIONS Unsupervised home sleep apnea testing with transcutaneous capnography effectively identifies sleep-disordered breathing and nocturnal hypercapnia in individuals with SCI.
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Affiliation(s)
- Kristy A Bauman
- Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI.
| | - Armando Kurili
- Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI
| | - Helena M Schotland
- Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI; Department of Neurology, Sleep Disorders Center, University of Michigan Health System, Ann Arbor, MI
| | - Gianna M Rodriguez
- Department of Physical Medicine and Rehabilitation, University of Michigan Health System, Ann Arbor, MI
| | - Anthony E Chiodo
- Department of Physical Medicine and Rehabilitation, University of Michigan Health System, Ann Arbor, MI
| | - Robert G Sitrin
- Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI
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Cameron AP, Rodriguez GM, Gursky A, He C, Clemens JQ, Stoffel JT. PD10-07 THE SEVERITY OF BOWEL DYSFUNCTION IN PATIENTS WITH NEUROGENIC BLADDER. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kirshblum SC, Biering-Sørensen F, Betz R, Burns S, Donovan W, Graves DE, Johansen M, Jones L, Mulcahey MJ, Rodriguez GM, Schmidt-Read M, Steeves JD, Tansey K, Waring W. International standards for neurological classification of spinal cord injury: cases with classification challenges. Top Spinal Cord Inj Rehabil 2014; 20:81-9. [PMID: 25477729 DOI: 10.1310/sci2002-81] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI) is routinely used to determine levels of injury and to classify the severity of the injury. Questions are often posed to the International Standards Committee of the American Spinal Injury Association (ASIA) regarding the classification. The committee felt that disseminating some of the challenging questions posed, as well as the responses, would be of benefit for professionals utilizing the ISNCSCI. Case scenarios that were submitted to the committee are presented with the responses as well as the thought processes considered by the committee members. The importance of this documentation is to clarify some points as well as update the SCI community regarding possible revisions that will be needed in the future based upon some rules that require clarification.
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Affiliation(s)
- S C Kirshblum
- Kessler Institute for Rehabilitation, West Orange, New Jersey, and Rutgers New Jersey Medical School , Newark, New Jersey
| | - F Biering-Sørensen
- Clinic for Spinal Cord Injuries, Glostrup University Hospital, and Faculty of Health Sciences, University of Copenhagen , Denmark
| | - R Betz
- Shriners Hospitals for Children-Philadelphia , Philadelphia, Pennsylvania
| | - S Burns
- University of Washington School of Medicine , Seattle, Washington
| | - W Donovan
- The Institute for Rehabilitation & Research , Houston, Texas
| | - D E Graves
- University of Louisville , Louisville, Kentucky
| | | | - L Jones
- Craig H. Neilsen Foundation , Encino, California
| | - M J Mulcahey
- Jefferson School of Health Professions, Thomas Jefferson University , Philadelphia, Pennsylvania
| | - G M Rodriguez
- University of Michigan Hospital and Health Systems , Ann Arbor, Michigan
| | - M Schmidt-Read
- Magee Rehabilitation Hospital , Philadelphia, Pennsylvania
| | - J D Steeves
- International Collaboration On Repair Discoveries, University of British Columbia , Vancouver, British Columbia, Canada
| | - K Tansey
- Departments of Neurology and Physiology, Emory University School of Medicine, and Veterans Administration Medical Center , Atlanta, Georgia
| | - W Waring
- Medical College of Wisconsin , Milwaukee, Wisconsin
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Chen XL, Bobbala D, Rodriguez GM, Mayhue M, Chen YG, Ilangumaran S, Ramanathan S. Induction of autoimmune diabetes in non-obese diabetic mice requires interleukin-21-dependent activation of autoreactive CD8⁺ T cells. Clin Exp Immunol 2013; 173:184-94. [PMID: 23607664 DOI: 10.1111/cei.12108] [Citation(s) in RCA: 10] [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] [Accepted: 03/19/2013] [Indexed: 12/28/2022] Open
Abstract
Non-obese diabetic (NOD) mice lacking interleukin (IL)-21 or IL-21 receptor do not develop autoimmune type 1 diabetes (T1D). We have shown recently that IL-21 may promote activation of autoreactive CD8(+) T cells by increasing their antigen responsiveness. To investigate the role of IL-21 in activating diabetogenic CD8(+) T cells in the NOD mouse, we generated IL-21-deficient NOD mice expressing the highly pathogenic major histocompatibility complex (MHC) class-I-restricted 8.3 transgenic T cell receptor (TCR). IL-21 deficiency protected 8.3-NOD mice completely from T1D. CD8(+) T cells from the 8.3-NOD.Il21(-/-) mice showed decreased antigen-induced proliferation but displayed robust antigen-specific cytolytic activity and production of effector cytokines. IL-21-deficient 8.3 T cells underwent efficient homeostatic proliferation, and previous antigen stimulation enabled these cells to cause diabetes in NOD.Scid recipients. The 8.3 T cells that developed in an IL-21-deficient environment showed impaired antigen-specific proliferation in vivo even in IL-21-sufficient mice. These cells also showed impaired IL-2 production and Il2 gene transcription following antigen stimulation. However, IL-2 addition failed to reverse their impaired proliferation completely. These findings indicate that IL-21 is required for efficient initial activation of autoreactive CD8(+) T cells but is dispensable for the activated cells to develop effector functions and cause disease. Hence, therapeutic targeting of IL-21 in T1D may inhibit activation of naive autoreactive CD8(+) T cells, but may have to be combined with other strategies to inhibit already activated cells.
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Affiliation(s)
- X-L Chen
- Department of Pediatrics, Immunology Division, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
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Abstract
PURPOSE There is no consensus on the appropriate urological followup of individuals after spinal cord injury but it is well known that they are at risk for renal deterioration, bladder cancer and stones. We systematically reviewed the literature to evaluate evidence of urological screening in this population. MATERIALS AND METHODS We reviewed 385 abstracts, of which 50 met study inclusion criteria. We rated evidence using American Academy of Neurology 2004 guidelines. RESULTS A total of 12 articles evaluated urinary tract infection screening. Patient reported symptoms used to predict urinary tract infection yielded mixed results and urine dipstick testing had the same accuracy as microscopy. Routine urine culture was unnecessary in healthy, asymptomatic individuals with normal urinalysis. Urodynamics probably must be done periodically (6 articles) but there was no information on frequency. In 11 articles ultrasound was recommended as a useful, noninvasive and possibly cost-effective screening method. Renal scan was a good method for further testing, especially if ultrasound was positive (11 articles). Evidence was sufficient (11 articles) to recommend ultrasound of the urinary tract to detect urinary tract stones with good sensitivity but not plain x-ray of the kidneys, ureters and bladder (2 articles). There was insufficient evidence to recommend urine markers or cytology for bladder cancer screening (9 articles). CONCLUSIONS Based on this review no definitive recommendations for screening can be made except routine renal ultrasound. Urodynamics are an important part of screening but the frequency is unclear. The optimum bladder cancer screening method has not been defined.
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Affiliation(s)
- Anne P Cameron
- Department of Urology, University of Michigan, Ann Arbor, MI, USA.
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Cameron AP, Wallner LP, Tate DG, Sarma AV, Rodriguez GM, Clemens JQ. Bladder management after spinal cord injury in the United States 1972 to 2005. J Urol 2010; 184:213-7. [PMID: 20478597 DOI: 10.1016/j.juro.2010.03.008] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2009] [Indexed: 11/15/2022]
Abstract
PURPOSE Studies have shown that bladder management with an indwelling catheter for patients with spinal cord injury is associated with more urological complications such as stones, urinary infection, urethral strictures and bladder cancer. However, little is known about actual bladder management for these patients in clinical practice. MATERIALS AND METHODS Using the National Spinal Cord Injury Database the bladder management method was determined at discharge from rehabilitation and at each 5-year followup period for 30 years. RESULTS At discharge from rehabilitation (24,762 patients) the selection of bladder management with a condom catheter decreased steadily from a peak of 34.6% in 1972 to a low of 1.50% in 2001. The use of clean intermittent catheterization increased from 12.6% in 1972 to a peak of 56.2% in 1991. Indwelling catheter use initially decreased from 33.1% in 1972 to 16.5% in 1991 but increased to 23.1% in 2001. Of 12,984 individuals with followup data those originally using an indwelling catheter for bladder management were unlikely to switch to another method, with 71.1% continuing to use an indwelling catheter at 30 years. Individuals using clean intermittent catheterization and condom catheterization at discharge home did not continue to use these methods with only 20% and 34.6% remaining on the same management, respectively. CONCLUSIONS With time bladder management with clean intermittent catheterization has increased in popularity. However, only 20% of patients initially on clean intermittent catheterization remained on this form of bladder management. More research on the safety of each of these methods needs to be performed to provide better guidance to aid with this decision.
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Affiliation(s)
- Anne P Cameron
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA.
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Kalpakjian CZ, Quint EH, Bushnik T, Rodriguez GM, Terrill MS. Menopause characteristics and subjective symptoms in women with and without spinal cord injury. Arch Phys Med Rehabil 2010; 91:562-9. [PMID: 20382288 DOI: 10.1016/j.apmr.2009.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Revised: 11/25/2009] [Accepted: 12/02/2009] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine menopause transition characteristics and symptom bother in women with spinal cord injury (SCI). DESIGN Prospective cohort (4 data collection periods across 4 years). SETTING Community. PARTICIPANTS Women (n=62) with SCI (injury levels C6-T12, nonambulatory, >36mo postinjury; 86.1% retention) and women without SCI (n=66; 92.9% retention) with intact ovaries, not using hormone therapy, and between the ages of 45 and 60 years volunteered. A total of 505 observations were collected and analyzed. INTERVENTIONS None. MAIN OUTCOME MEASURES Age at final menstrual period (FMP), transitions through menopause status classifications, and menopause symptom bother (vasomotor, somatic, psychologic symptoms). RESULTS The number of women transitioning through a menopause status classification over the course of the study did not significantly vary by group (P=.263), nor did age at FMP (P=.643). Women with SCI experienced greater bother of somatic symptoms (a subscale, P<.001), bladder infections (P<.001), and diminished sexual arousal (P=.012). Women without SCI had significantly greater bother of vasomotor symptoms (P=.020). There were no significant group by menopause status interactions; main effects for menopause status were significant only for vasomotor symptoms and vaginal dryness. CONCLUSIONS Results suggested that women with SCI experience greater symptom bother in certain areas, but that patterns of symptom bother across menopause, transition through menopause, and age at FMP are similar to those of their peers. Larger studies are needed to examine menopause outcomes with respect to level of injury and completeness of injury. These findings provide a framework that women with SCI and their health care providers can use to address the menopause transition and highlight the importance of multidisciplinary involvement to maximize health and well being during this transition.
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Affiliation(s)
- Claire Z Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI 48108-5744, USA.
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Cameron AP, Wallner LP, Sarma AV, Tate DG, Rodriguez GM, Clemens JQ. 263 BLADDER MANAGEMENT METHODS AFTER TRAUMATIC SPINAL CORD INJURY IN THE UNITED STATES. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Gorgey AS, Chiodo AE, Zemper ED, Hornyak JE, Rodriguez GM, Gater DR. Relationship of spasticity to soft tissue body composition and the metabolic profile in persons with chronic motor complete spinal cord injury. J Spinal Cord Med 2010; 33:6-15. [PMID: 20397439 PMCID: PMC2853330 DOI: 10.1080/10790268.2010.11689669] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Accepted: 06/29/2009] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND/OBJECTIVE To determine the effects of spasticity on anthropometrics, body composition (fat mass [FM] and fat-free mass [FFM]), and metabolic profile (energy expenditure, plasma glucose, insulin concentration, and lipid panel) in individuals with motor complete spinal cord injury (SCI). METHODS Ten individuals with chronic motor complete SCI (age, 33 +/- 7 years; BMI, 24 +/- 4 kg/m2; level of injury, C6-T11; American Spinal Injury Association A and B) underwent waist and abdominal circumferences to measure trunk adiposity. After the first visit, the participants were admitted to the general clinical research center for body composition (FFM and FM) assessment using dual energy x-ray absorptiometry. After overnight fasting, resting metabolic rate (RMR) and metabolic profile (plasma glucose, insulin, and lipid profile) were measured. Spasticity of the hip, knee, and ankle flexors and extensors was measured at 6 time points over 24 hours using the Modified Ashworth Scale. RESULTS Knee extensor spasticity was negatively correlated to abdominal circumferences (r = -0.66, P = 0.038). After accounting for leg or total FFM, spasticity was negatively related to abdominal circumference (r = -0.67, P = 0.03). Knee extensor spasticity was associated with greater total %FFM (r = 0.64; P = 0.048), lower % FM (r = -0.66; P = 0.03), and lower FM to FFM ratio. Increased FFM (kg) was associated with higher RMR (r = 0.89; P = 0.0001). Finally, spasticity may indirectly influence glucose homeostasis and lipid profile by maintaining FFM (r = -0.5 to -0.8, P < 0.001). CONCLUSION Significant relationships were noted between spasticity and variables of body composition and metabolic profile in persons with chronic motor complete SCI, suggesting that spasticity may play a role in the defense against deterioration in these variables years after injury. The exact mechanism is yet to be determined.
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Affiliation(s)
- Ashraf S Gorgey
- Spinal Cord Injury and Disorders Service, Hunter Holmes McGuire VA Medical Center, 1201 Broad Rock Boulevard, Richmond, VA 23249, USA.
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Gorgey AS, Chiodo AE, Rodriguez GM, Gater DR. Visceral & Abdominal Subcutaneous Fat And Body Composition In Motor Complete Spinal Cord Injury. Med Sci Sports Exerc 2009. [DOI: 10.1249/01.mss.0000355773.70712.7c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
The matrix of stroke rehabilitation is evolving as we look outside the box of traditional therapy type, timing, and intensity of rehabilitation techniques. For inpatient wards, the goal of medical stability and prompt resolution of complications to maximize participation in therapy remains paramount. In the current medical model, we focus on teaching compensatory strategies and rarely on restorative approaches because of time and financial limitations. Researchers aim to identify new technologic and molecular approaches to improve functional outcomes and more accurately predict disability. This article examines different concepts surrounding the comprehensive rehabilitation paradigm of stroke survivors.
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Affiliation(s)
- Brian M Kelly
- Department of Physical Medicine and Rehabilitation, University of Michigan Health System, 325 Eisenhower, Suite 200, Ann Arbor, MI 48108, USA.
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Abstract
OBJECTIVE To determine the effect of shoe wedges and lifts on symmetry of stance and weight bearing in hemiparetic individuals. DESIGN Weight bearing on the paretic side was measured in patients with hemiparesis during quiet standing and in conditions of compelled weight shift. SETTING Free-standing acute inpatient rehabilitation hospital. PARTICIPANTS Nine individuals with hemiparesis as a result of unilateral stroke who were able to stand for 3 to 5 minutes without assistance or rest, and satisfied other inclusion criteria. INTERVENTIONS Compelled shift of the body weight was induced with different shoe wedges (5 degrees, 7.5 degrees, 12.5 degrees) or shoe lifts (0.6, 0.9, 1.2cm), which extended under the entire shoe of the unaffected limb. Weight-bearing symmetry scores were used to characterize the symmetry of stance. MAIN OUTCOME MEASURES Weight-bearing symmetry scores. RESULTS Without a shoe wedge or a shoe lift, weight-bearing symmetry was characterized by underloading of the paretic limb (39.90% +/-.80% of body weight). Weight shift induced by shoe wedges or shoe lifts applied to the unaffected limb promoted improved symmetry of weight bearing and stance. A shoe wedge of 5 degrees provided the most symmetrical weight distribution (51.44% +/- 1.88% of body weight). CONCLUSION Shoe wedges and shoe lifts under the unaffected limb induced compelled weight shift toward the paretic limb, resulting in improved symmetry of stance of individuals with mild hemiparesis. We suggest that improved symmetry of bipedal standing obtained with a shoe wedge or a shoe lift applied to the unaffected limb can help overcome the learned disuse of the affected limb. We further suggest that weight distribution induced by shoe wedges or shoe lifts may help in the treatment of ambulatory hemiparetic individuals with asymmetrical stance caused by unilateral stroke.
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Affiliation(s)
- Gianna M Rodriguez
- Department of Physical Medicine and Rehabilitation, Rush-Presbyterian St. Luke's Medical Center, Chicago, IL 60612, USA
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Gold B, Rodriguez GM, Marras SA, Pentecost M, Smith I. The Mycobacterium tuberculosis IdeR is a dual functional regulator that controls transcription of genes involved in iron acquisition, iron storage and survival in macrophages. Mol Microbiol 2001; 42:851-65. [PMID: 11722747 DOI: 10.1046/j.1365-2958.2001.02684.x] [Citation(s) in RCA: 203] [Impact Index Per Article: 8.8] [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] [Indexed: 11/20/2022]
Abstract
In this work, we characterize genes in Mycobacterium tuberculosis that are regulated by IdeR (iron-dependent regulator), an iron-responsive DNA-binding protein of the DtxR family that has been shown to regulate iron acquisition in Mycobacterium smegmatis. To identify some of the genes that constitute the IdeR regulon, we searched the M. tuberculosis genome for promoter regions containing the consensus IdeR/DxR binding sequence. Genes preceded by IdeR boxes included a set encoding proteins necessary for iron acquisition, such as the biosynthesis of siderophores (mbtA, mbtB, mbtI), aromatic amino acids (pheA, hisE, hisB-like) and others annotated to be involved in the synthesis of iron-storage proteins (bfrA, bfrB). Some putative IdeR-regulated genes identified in this search encoded proteins predicted to be engaged in the biosynthesis of lipopolysaccharide (LPS)-like molecules (rv3402c), lipids (acpP) and peptidoglycan (murB). We analysed four promoter regions containing putative IdeR boxes, mbtA-mbtB, mbI, rv3402c and bfrA-bfd, for interaction with IdeR and for iron-dependent expression. Gel retardation experiments and DNase footprinting analyses with purified IdeR showed that IdeR binds to these IdeR boxes in vitro. Analysis of the promoters by primer extension indicated that the IdeR boxes are located near the -10 position of each promoter, suggesting that IdeR acts as a transcriptional repressor by blocking RNA polymerase binding. Using quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) coupled to molecular beacons, we showed that mRNA levels of mbtA, mbtB, mbtI, rv3402c and bfd are induced 14- to 49-fold in cultures of M. tuberculosis starved for iron, whereas mRNA levels of bfrA decreased about threefold. We present evidence that IdeR not only acts as a transcriptional repressor but also functions as an activator of bfrA. Three of the IdeR- and iron-repressed genes, mbtB, mbtI and rv3402c, were induced during M. tuberculosis infection of human THP-1 macrophages.
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Affiliation(s)
- B Gold
- Department of Microbiology, New York University Medical Center, New York, NY 10016, USA
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Paul SM, Rodriguez GM. World AIDS Day: men make a difference. N J Med 2000; 97:33-4. [PMID: 11103600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- S M Paul
- Division of AIDS Prevention and Control, New Jersey Department of Health and Senior Services, Trenton, USA
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Rodriguez GM, Gold B, Gomez M, Dussurget O, Smith I. Identification and characterization of two divergently transcribed iron regulated genes in Mycobacterium tuberculosis. Tuber Lung Dis 2000; 79:287-98. [PMID: 10707257 DOI: 10.1054/tuld.1999.0219] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
SETTING Low iron availability in the host induces the expression of iron acquisition systems and virulence genes in many pathogens. IdeR is a mycobacterial iron dependent regulator that controls the iron starvation and oxidative stress responses in Mycobacterium smegmatis. It is important to determine the role of IdeR and its regulon in M. tuberculosis, as identification of iron regulated genes can aid in the design of new drugs and generation of attenuated strains. OBJECTIVE A potential IdeR binding site was found in the M. tuberculosis genome flanked by two divergently oriented open reading frames, irg1 and irg2. The aim of this study was to determine whether irg1 and irg2 were iron and IdeR regulated genes. DESIGN Interaction of IdeR with the putative binding sequence was examined by gel shift and footprinting assays. Transcriptional fusions of irg1 and irg2 to IacZ were used to study the effect of iron levels on the expression of these genes. RESULTS IdeR binds to the predicted binding site, which overlaps with the irg1 promoter. irg1 and irg2 expression was decreased by iron in M. tuberculosis and in wild type M. smegmatis, but not in a M. smegmatis ideR mutant. CONCLUSION Two M. tuberculosis iron/IdeR regulated genes were identified. irg1 is predicted to be the M. tuberculosis hisE gene, which is involved in histidine biosynthesis. It is directly upstream of the M. tuberculosis hisG. irg2 encodes a putative membrane protein that is a member of the PPE family.
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Affiliation(s)
- G M Rodriguez
- TB Center, Public Health Research Institute, New York, New York 10016, USA
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Smith I, Dussurget O, Rodriguez GM, Timm J, Gomez M, Dubnau J, Gold B, Manganelli R. Extra and intracellular expression of Mycobacterium tuberculosis genes. Tuber Lung Dis 2000; 79:91-7. [PMID: 10645446 DOI: 10.1054/tuld.1998.0010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To understand how Mycobacterium tuberculosis survives and grows in an infected host, we are studying the mycobacterial transcriptional machinery and its response to stresses encountered in vitro and in vivo. Much has been learned about sigma factors and other transcriptional regulators concerning their roles in controlling mycobacterial gene expression. It has recently been shown that sigma A is the essential housekeeping sigma factor and the alternative sigma factor sigma B, not essential for growth in a laboratory setting, is required for a robust protective response to various environmental stresses. We are also studying the mechanism by which the R522H mutation in sigma A prevents the transcription of certain genes, including some that are believed necessary for virulence. Also under investigation is the mycobacterial iron acquisition apparatus and its regulation, as metabolism of this essential element plays a key role in microbial pathogenesis. We have identified and characterized the major mycobacterial iron regulator IdeR that blocks the synthesis of the iron uptake machinery and have identified target genes in M. smegmatis and M. tuberculosis that are directly repressed by IdeR. Recent studies have examined the control of M. tuberculosis gene expression in vivo. Among these new approaches are an in vivo expression technology system to identify M. tuberculosis genes that are induced in macrophages and mice and a novel RT-PCR method that allows an accurate comparison between the levels of specific mRNAs in M. tuberculosis grown in vitro with those found in bacteria growing in human macrophages.
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Affiliation(s)
- I Smith
- Public Health Research Institute, New York, NY 10016, USA.
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Freeman RC, Rodriguez GM, French JF. Compliance with AZT treatment regimen of HIV-seropositive injection drug users: a neglected issue. AIDS Educ Prev 1996; 8:58-71. [PMID: 8703641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Although treatment with zidovudine (AZT) is now recommended for asymptomatic and symptomatic HIV-infected persons with CD4+ cell counts of 0.20 to 0.50 x 10(9)/L and under, data gathered from a small convenience sample of current and former injection drug users with AIDS in the New York City metropolitan region suggest that noncompliance with HIV/AIDS-related therapeutic regimen may be common in this population. This paper enumerates the reasons for noncompliance offered by these informants, reviews the general literature on treatment compliance to identify additional potential reasons for non-adherence to AZT treatment regimen, and outlines some suggestions for future research into this important issue that may prompt changes in the antiviral delivery system.
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Affiliation(s)
- R C Freeman
- Division of Alcoholism, Drug Abuse, and Addiction Services, New Jersey State Department of Health, USA
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Freeman RC, Rodriguez GM, French JF. Seroprevalence and risk factors associated with HTLV-I/II infection in injection drug users in northern New Jersey. J Addict Dis 1995; 14:51-66. [PMID: 8555279 DOI: 10.1300/j069v14n03_04] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [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] [Indexed: 01/31/2023]
Abstract
Data from an AIDS Demonstration Research project in Paterson, NJ, that enrolled out-of-treatment injection drug users (IDUs) were analyzed to detect demographic patterns and risk factors associated with infection with human immunodeficiency virus (HIV) and human T-lymphotropic virus types I or II (HTLV-I/II). Of 410 IDUs screened, 44.2% were HIV-positive and 19.3% were HTLV-I/II-positive. African-Americans were significantly more likely than other racial groups to be HTLV-I/II-seropositive and to be HIV-seropositive. Over one-fifth of African-Americans--but no Latinos or whites--were doubly infected with HIV and HTLV-I/II. In logistic regression analysis, African-American race, long-term injection drug use, and age were significant predictors of HTLV-I/II-seropositivity. While the associations between recent needle practices and HTLV-I/II-seropositivity fell short of significance, the trends in the data were consistent with a hypothesis that HTLV-I/II is transmitted through the sharing of injection equipment. Public health implications of the data are discussed.
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Affiliation(s)
- R C Freeman
- New Jersey State Department of Health, Division of Alcoholism, Drug Abuse, and Addiction Services, Newark, USA
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Abstract
Most native antigens require digestion by acidic proteases in order to be recognized in the context of major histocompatibility complex class II by T helper cells (Th). We have studied the roles of three different acidic proteases, cathepsin D, cathepsin B and cathepsin L, in the processing of ovalbumin (OVA) for presentation in the context of I-Ad. We report that digestion of OVA in vitro with the aspartyl protease cathepsin D generates the epitope OVA322-336, which is recognized by I-Ad-restricted OVA-specific Th in the presence of paraformaldehyde-fixed antigen-presenting cells (APC). In contrast, digestion of OVA with the cysteine proteases cathepsin B and L not only failed to generate an epitope, but also destroyed OVA322-336. In the presence of fixed APC expressing I-Ad. OVA322-336 was protected from destructive proteolysis by cathepsin L. These results illustrate the dependence of epitope selection on the intracellular proteolytic environment in APC, and suggest that mechanisms must exist for protection of epitopes from destructive proteolysis in the processing compartments.
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Affiliation(s)
- G M Rodriguez
- Michael Heidelberger Division of Immunology, Department of Pathology, New York University Medical Center, New York 10016, USA
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Abstract
Melanosomes, the subcellular site of melanin synthesis and deposition, may be related to the endolysosomal lineage of organelles. To determine if melanosomes contain lysosomal hydrolases, we examined the subcellular distribution of five of these enzymes in melanocytes cultured from C57BL/6J mice. Analyses of Percoll gradient density centrifugations demonstrated that beta-hexosaminidase, beta-galactosidase, beta-glucuronidase, and cathepsins B and L all co-sedimented with tyrosinase-rich densely sedimenting melanosomes. The melanosomal distribution of these enzymes was confirmed in studies of melanocytes cultured from albino mice and of melanocytes rendered amelanotic by transfection with the v-rasHa oncogene (which lack dense, melanized melanosomes). In these cells, only a less dense peak of activity for each hydrolase was present. The level of each hydrolase was elevated in black cells when compared with albino cells. Metabolic labeling studies confirmed that the increase in beta-glucuronidase in black versus albino cells resulted mainly from increased synthesis of this enzyme. The data suggest that melanosomes represent specialized lysosomes present within melanocytes, that they contain a broad array of lysosomal hydrolases, and that the levels of these hydrolases are elevated in cells actively engaged in pigment production.
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Affiliation(s)
- S Diment
- Department of Pathology, New York University School of Medicine, New York 10016
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Freeman RC, Rodriguez GM, French JF. A comparison of male and female intravenous drug users' risk behaviors for HIV infection. Am J Drug Alcohol Abuse 1994; 20:129-57. [PMID: 8042600 DOI: 10.3109/00952999409106779] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Despite the central role played by female intravenous drug users (IVDUs) in the worsening AIDS statistics of states in the northeastern United States, the relative paucity of research into the HIV risk behaviors--particularly risky needle practices--of female drug injections has left significant gaps in researchers' understanding of how and to what extent such women may differ in their risks from their better-studied male counterparts. This study, derived from a sample of 769 out-of-treatment IVDUs residing in an area (Paterson, New Jersey) characterized by high levels of AIDS and HIV infection among drug users, attempts to address this lacuna in the research literature by comparing the drug usage, AIDS knowledge, and needle and sexual behaviors of male and female IVDUs that place them at risk for HIV infection. In this sample, gender was found to be unrelated to HIV serostatus, injection frequency and injected drug of choice, and to most dimensions of knowledge about AIDS and the means of HIV transmission. Overall, it appears that the average Paterson female IVDU may be at greater risk for HIV infection as a result of involvement with a drug-using sex partner than because of especially risky needle practices, for females in this sample were significantly more likely than males to report injecting with a sex partner in the previous 6 months, and female IVDUs with one sex partner were more than twice as likely as males with one partner to report that this individual was an IVDU. Condom use was relatively rare, particularly among those with one partner. Moreover, female IVDUs were significantly more likely than males to be daily users of crack cocaine, and significantly more likely to report poorer health. However, current needle and sexual practices were found to be unrelated to HIV seropositivity among both males and females. In logistic regression analysis, only length of IV drug involvement was found to be independently associated with HIV seropositivity for both sexes. Implications of the data for future prevention efforts aimed at female IVDUs are discussed.
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Affiliation(s)
- R C Freeman
- Data Analysis and Epidemiology Unit, Division of Alcoholism, Drug Abuse, and Addiction Services, New Jersey State Department of Health, Newark
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Abstract
Abstract
Modification of protein Ag by proteolysis is one of the principal steps in the presentation of Ag to Th cells. However, little is known about the enzymes participating in these events, their specificity or the characteristics of the natural fragments that they produce. Cathepsin D (CD) is an aspartyl protease identified in endosomes of APC. In this report, the role of CD in the processing of OVA has been investigated. OVA digested in vitro with purified CD was able to stimulate IL-2 secretion by three different OVA-specific I-Ad restricted Th cell hybridomas when it was presented by fixed APC. The digest of OVA was recognized in the context of I-Ad, but not by I-Ak-restricted OVA-specific Th cells. No difference was observed in the ability of OVA digested with CD to stimulate Th cells in the absence of FCS or in the presence of protease inhibitors indicating that extracellular proteases were not likely to contribute to processing of OVA. Taken together, these results suggest that CD is necessary and sufficient for the generation of an antigenic epitope from OVA. A fragment containing the epitope was isolated from the OVA digest by reverse phase HPLC. This fragment, which migrates in SDS-PAGE as a 10-kDa polypeptide, is a potent epitope. Its capacity to activate Th cells is compared to that of the tryptic peptide OVA323-339.
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Affiliation(s)
- G M Rodriguez
- Michael Heidelberger Division of Immunology, Department of Pathology, New York University Medical Center, NY 10016
| | - S Diment
- Michael Heidelberger Division of Immunology, Department of Pathology, New York University Medical Center, NY 10016
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Rodriguez GM, Diment S. Role of cathepsin D in antigen presentation of ovalbumin. J Immunol 1992; 149:2894-8. [PMID: 1328388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Modification of protein Ag by proteolysis is one of the principal steps in the presentation of Ag to Th cells. However, little is known about the enzymes participating in these events, their specificity or the characteristics of the natural fragments that they produce. Cathepsin D (CD) is an aspartyl protease identified in endosomes of APC. In this report, the role of CD in the processing of OVA has been investigated. OVA digested in vitro with purified CD was able to stimulate IL-2 secretion by three different OVA-specific I-Ad restricted Th cell hybridomas when it was presented by fixed APC. The digest of OVA was recognized in the context of I-Ad, but not by I-Ak-restricted OVA-specific Th cells. No difference was observed in the ability of OVA digested with CD to stimulate Th cells in the absence of FCS or in the presence of protease inhibitors indicating that extracellular proteases were not likely to contribute to processing of OVA. Taken together, these results suggest that CD is necessary and sufficient for the generation of an antigenic epitope from OVA. A fragment containing the epitope was isolated from the OVA digest by reverse phase HPLC. This fragment, which migrates in SDS-PAGE as a 10-kDa polypeptide, is a potent epitope. Its capacity to activate Th cells is compared to that of the tryptic peptide OVA323-339.
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Affiliation(s)
- G M Rodriguez
- Michael Heidelberger Division of Immunology, Department of Pathology, New York University Medical Center, NY 10016
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Abstract
The clinical course, changes in liver function tests and the behaviour of viral markers over the course of time have been examined in 45 patients with acute hepatitis B and 14 patients with acute hepatitis caused by B and D viruses coinfection. There were no significant differences either in the clinical course or in the liver function tests, in the two groups. The changes in serum viral markers were as follows: HBV-DNA was the first marker to disappear; this was closely followed by HBeAg, and HBsAg was the last marker to become negative, during convalescence. This pattern was not altered by Delta coinfection. When we quantified serum HBV-DNA in both groups of patients, we found that Delta virus infection led to parital inhibition of HBV replication, so that serum HBV-DNA levels were significantly lower in those patients with acute hepatitis B who were simultaneously infected with Delta virus.
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Affiliation(s)
- A L Morante
- Gastrointestinal Unit, Hospital Valdecilla, Faculty of Medicine, University of Cantabria, Spain
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Rodriguez GM, González A, Garcia-Villalba A, De La Fuente P, Ezcurdia MA. [Diagnosis of fetal maturity by studying the amniotic fluid]. Rev Clin Inst Matern Lisb 1967; 18:29-32. [PMID: 5632490] [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: 01/16/2023]
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