1
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Rischin D, Hughes BGM, Basset-Séguin N, Schadendorf D, Bowyer S, Trabelsi Messai S, Meier F, Eigentler TK, Casado Echarren V, Stein B, Beylot-Barry M, Dalac S, Dréno B, Migden MR, Hauschild A, Schmults CD, Lim AM, Yoo SY, Paccaly AJ, Papachristos A, Nguyen JH, Okoye E, Seebach F, Booth J, Lowy I, Fury MG, Guminski A. High response rate with extended dosing of cemiplimab in advanced cutaneous squamous cell carcinoma. J Immunother Cancer 2024; 12:e008325. [PMID: 38471711 PMCID: PMC10936461 DOI: 10.1136/jitc-2023-008325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Cemiplimab (Libtayo®), a human monoclonal immunoglobulin G4 antibody to the programmed cell death-1 receptor, is approved for the treatment of patients with advanced cutaneous squamous cell carcinoma (CSCC), who are not candidates for curative surgery or curative radiation, using an every-3-weeks (Q3W) dosing interval. Pharmacokinetic modeling indicated that Ctrough of extended intravenous dosing of 600 mg every 4 weeks (Q4W) would be comparable to the approved intravenous dosage of 350 mg Q3W. We examined the efficacy, pharmacokinetics, and safety of cemiplimab dosed Q4W. METHODS In this open-label, phase II trial (ClinicalTrials.gov identifier NCT02760498), the cohort of patients ≥18 years old with advanced CSCC received cemiplimab 600 mg intravenously Q4W for up to 48 weeks. Tumor measurements were recorded every 8 weeks. The primary endpoint was objective response rate by independent central review. RESULTS Sixty-three patients with advanced CSCC were treated with cemiplimab. The median duration of follow-up was 22.4 months (range: 1.0-39.8). An objective response was observed in 39 patients (62%; 95% CI: 48.8% to 73.9%), with 22% of patients (n=14) achieving complete response and 40% (n=25) achieving partial response. The most common treatment-emergent adverse events were diarrhea, pruritus, and fatigue. CONCLUSIONS Extended dosing of cemiplimab 600 mg intravenously Q4W exhibited substantial antitumor activity, rapid and durable responses, and an acceptable safety profile in patients with advanced CSCC. These results confirm that cemiplimab is a highly active therapy for advanced CSCC. Additional data would help ascertain the benefit-risk profile for the 600 mg intravenous dosing regimen compared with the approved regimen.
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Affiliation(s)
- Danny Rischin
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Brett G M Hughes
- Royal Brisbane and Women's Hospital and University of Queensland, Brisbane, Queensland, Australia
| | | | - Dirk Schadendorf
- University Hospital Essen and Essen and German Cancer Consortium, Essen, Germany
| | - Samantha Bowyer
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | | | - Friedegund Meier
- Skin Cancer Center at the University Cancer Centre Dresden and National Center for Tumor Diseases Dresden, Dresden, Germany
- Department of Dermatology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Thomas K Eigentler
- Department of Dermatology, Venereology and Allergology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Victoria Casado Echarren
- Department of Oncology, Oncohealth Institute, Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain
| | - Brian Stein
- ICON Cancer Centre, Adelaide, South Australia, Australia
| | - Marie Beylot-Barry
- Department of Dermatology, University Hospital of Bordeaux, Bordeaux, France
| | - Sophie Dalac
- Hospital Center University Dijon Bourgogne, Dijon, France
| | | | - Michael R Migden
- Departments of Dermatology and Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Chrysalyne D Schmults
- Dermatologic Surgery, Mohs Micrographic Surgery Center, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Annette M Lim
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Suk-Young Yoo
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Anne J Paccaly
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | | | | | - Emmanuel Okoye
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Frank Seebach
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Jocelyn Booth
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Israel Lowy
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Matthew G Fury
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Alexander Guminski
- Department of Medical Oncology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
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2
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Wang Y, Nguyen JH, de Ruiter RD, Mendell J, Srinivasan D, Davis JD, Eekhoff EMW. Garetosmab in Fibrodysplasia Ossificans Progressiva: Clinical Pharmacology Results from the Phase 2 LUMINA-1 Trial. J Clin Pharmacol 2024; 64:264-274. [PMID: 37694449 DOI: 10.1002/jcph.2344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/06/2023] [Indexed: 09/12/2023]
Abstract
Here, we report the clinical pharmacology data from LUMINA-1 (NCT03188666), a Phase 2 trial that evaluated garetosmab (a monoclonal antibody against activin A) in patients with fibrodysplasia ossificans progressiva. Forty-four patients were randomly assigned to intravenous 10 mg/kg of garetosmab or placebo every 4 weeks in a double-blind 28-week treatment period, followed by a 28-week open-label treatment period with garetosmab, and subsequent open-label extension. Serum samples were obtained to assess pharmacokinetics (PK), immunogenicity, and bone morphogenetic protein 9 (BMP9). Comparative exposure-response analyses for efficacy and safety were performed with trough concentrations (Ctrough ) of garetosmab prior to dosing. Steady-state PK was reached 12-16 weeks after the first dose of garetosmab, with mean (standard deviation) Ctrough of 105 ± 30.8 mg/L. Immunogenicity assessments showed anti-garetosmab antibody formation in 1 patient (1/43; 2.3%); titers were low, and did not affect PK or clinical efficacy. Median concentrations of BMP9 in serum were approximately 40 pg/mL at baseline. There were no meaningful differences in PK or BMP9 concentration-time profiles between patients who did and did not experience epistaxis or death. The comparative exposure-response analyses demonstrated no association between Ctrough and efficacy or safety. PK findings were consistent with prior data in healthy volunteers and were typical for a monoclonal antibody administered at doses sufficient to saturate target-mediated clearance. There were no trends that suggested patients with higher serum exposures to garetosmab were more likely to experience a reduction in heterotopic ossification or adverse events. Garetosmab is being further evaluated in the Phase 3 OPTIMA trial.
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Affiliation(s)
- Yuhuan Wang
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | | | - Ruben D de Ruiter
- Department of Endocrinology and Metabolism, Amsterdam University Medical Centers (UMC), Vrije Universiteit, Amsterdam UMC Expert Center in Rare Bone Disease, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | | | | | | | - E Marelise W Eekhoff
- Department of Endocrinology and Metabolism, Amsterdam University Medical Centers (UMC), Vrije Universiteit, Amsterdam UMC Expert Center in Rare Bone Disease, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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3
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Schill WJ, Armstrong MR, Nguyen JH, Sterbentz DM, White DA, Benedict LX, Rieben RN, Hoff A, Lorenzana HE, Belof JL, La Lone BM, Staska MD. Suppression of Richtmyer-Meshkov Instability via Special Pairs of Shocks and Phase Transitions. Phys Rev Lett 2024; 132:024001. [PMID: 38277580 DOI: 10.1103/physrevlett.132.024001] [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] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 11/13/2023] [Accepted: 11/28/2023] [Indexed: 01/28/2024]
Abstract
The classical Richtmyer-Meshkov instability (RMI) is a hydrodynamic instability characterizing the evolution of an interface following shock loading. In contrast to other hydrodynamic instabilities such as Rayleigh-Taylor, it is known for being unconditionally unstable: regardless of the direction of shock passage, any deviations from a flat interface will be amplified. In this article, we show that for negative Atwood numbers, there exist special sequences of shocks which result in a nearly perfectly suppressed instability growth. We demonstrate this principle computationally and experimentally with stepped fliers and phase transition materials. A fascinating immediate corollary is that in specific instances, a phase-transitioning material may self-suppress RMI.
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Affiliation(s)
- W J Schill
- Lawrence Livermore National Laboratory, 7000 East Avenue, Livermore, California 94550, USA
| | - M R Armstrong
- Lawrence Livermore National Laboratory, 7000 East Avenue, Livermore, California 94550, USA
| | - J H Nguyen
- Lawrence Livermore National Laboratory, 7000 East Avenue, Livermore, California 94550, USA
| | - D M Sterbentz
- Lawrence Livermore National Laboratory, 7000 East Avenue, Livermore, California 94550, USA
| | - D A White
- Lawrence Livermore National Laboratory, 7000 East Avenue, Livermore, California 94550, USA
| | - L X Benedict
- Lawrence Livermore National Laboratory, 7000 East Avenue, Livermore, California 94550, USA
| | - R N Rieben
- Lawrence Livermore National Laboratory, 7000 East Avenue, Livermore, California 94550, USA
| | - A Hoff
- Lawrence Livermore National Laboratory, 7000 East Avenue, Livermore, California 94550, USA
| | - H E Lorenzana
- Lawrence Livermore National Laboratory, 7000 East Avenue, Livermore, California 94550, USA
| | - J L Belof
- Lawrence Livermore National Laboratory, 7000 East Avenue, Livermore, California 94550, USA
| | - B M La Lone
- Special Technologies Laboratory, 5520 Ekwill Street, Suite B, Santa Barbara, California 93117, USA
| | - M D Staska
- Special Technologies Laboratory, 5520 Ekwill Street, Suite B, Santa Barbara, California 93117, USA
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4
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Mohamed M, Kang L, Zhang C, Edenfield B, Sykes J, Brown T, Johnson JL, Rehman F, Nguyen JH. Simulating Transplant Small-for-size Grafts Using Human Liver Monosegments: The Impact of Portal Perfusion Pressure. Transplant Proc 2019; 51:919-924. [PMID: 30737025 DOI: 10.1016/j.transproceed.2018.12.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 11/16/2018] [Accepted: 12/05/2018] [Indexed: 02/07/2023]
Abstract
Small-for-size-liver grafts (SFSG) in adult transplant recipients have elevated risk of graft failure, limiting its application in clinical liver transplantation. Relevant preclinical model of SFSG is lacking. Relevant to deceased-donor split liver transplant and living-donor liver transplant in adult recipients, in this study, we present our initial characterization of SFSG model using monosegments of a discarded human donor liver.
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Affiliation(s)
- M Mohamed
- Department of Transplantation, Mayo Clinic Florida, Jacksonville, Florida
| | - L Kang
- Department of Transplantation, Mayo Clinic Florida, Jacksonville, Florida
| | - C Zhang
- Department of Transplantation, Mayo Clinic Florida, Jacksonville, Florida
| | - B Edenfield
- Department of Cancer Biology, Mayo Clinic Florida, Jacksonville, Florida
| | - J Sykes
- Department of Transplantation, Mayo Clinic Florida, Jacksonville, Florida
| | - T Brown
- Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, Florida
| | - J L Johnson
- Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, Florida
| | - F Rehman
- Department of Biology, University of North Florida, Jacksonville, Florida
| | - J H Nguyen
- Department of Transplantation, Mayo Clinic Florida, Jacksonville, Florida.
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5
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Nguyen JH, Harnois DM. Allograft Portacaval Shunt in Small-for-Size Liver in Deceased Donor Liver Transplant. Transplant Proc 2018; 50:930-932. [PMID: 29661465 DOI: 10.1016/j.transproceed.2017.12.029] [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] [Received: 07/27/2017] [Revised: 11/18/2017] [Accepted: 12/12/2017] [Indexed: 11/30/2022]
Abstract
Portal hyperperfusion is detrimental to small-for-size livers (SFSLs) in liver transplantation. Surgical techniques modulating portal inflow provide the most effective approach to protect the SFSL. In this report, we describe a technique creating an allograft portacaval shunt that effectively attenuates portal inflow without a requirement of extensive surgical dissection in the recipient during the transplantation.
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Affiliation(s)
- J H Nguyen
- Divisions of Transplant Surgery and Transplant Hepatology, Department of Transplantation, Mayo Clinic Florida, Jacksonville, Florida.
| | - D M Harnois
- Divisions of Transplant Surgery and Transplant Hepatology, Department of Transplantation, Mayo Clinic Florida, Jacksonville, Florida
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6
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Nguyen JH, Harnois DM. Incidence and Outcome of Small-for-Size Liver Grafts Transplanted in Adult Recipients. Transplant Proc 2018; 50:198-201. [PMID: 29407308 DOI: 10.1016/j.transproceed.2017.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 11/08/2017] [Accepted: 12/04/2017] [Indexed: 02/04/2023]
Abstract
Small-for-size liver transplantation (SFS-LT) carries high morbidity and mortality after transplantation. SFS-LT is usually associated with living-donor or deceased-donor split LT; however its incidence and outcome are poorly defined in adult LT recipients who receive whole grafts (WLT). In this study, we retrospectively reviewed our cohort of 3,106 deceased-donor LT in adult recipients. We found that among the 31 split LTs, 11 (35.5%) were SFS. In contrast, there only 1.08% of the whole-graft transplants (31 out of 2,868) were SFS. Although less common, SFS-WLT is associated with poorer long-term outcome of both graft and patient survivals.
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Affiliation(s)
- J H Nguyen
- Divisions of Transplant Surgery and Transplant Hepatology, Department of Transplantation, Mayo Clinic Florida, Jacksonville, Florida.
| | - D M Harnois
- Divisions of Transplant Surgery and Transplant Hepatology, Department of Transplantation, Mayo Clinic Florida, Jacksonville, Florida
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7
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Croome KP, Lee DD, Nguyen JH, Keaveny AP, Taner CB. Waitlist Outcomes for Patients Relisted Following Failed Donation After Cardiac Death Liver Transplant: Implications for Awarding Model for End-Stage Liver Disease Exception Scores. Am J Transplant 2017; 17:2420-2427. [PMID: 28556380 DOI: 10.1111/ajt.14383] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 02/14/2017] [Revised: 05/04/2017] [Accepted: 05/11/2017] [Indexed: 01/25/2023]
Abstract
Understanding of outcomes for patients relisted for ischemic cholangiopathy following a donation after cardiac death (DCD) liver transplant (LT) will help standardization of a Model for End-Stage Liver Disease exception scheme for retransplantation. Early relisting (E-RL) for DCD graft failure caused by primary nonfunction (PNF) or hepatic artery thrombosis (HAT) was defined as relisting ≤14 days after DCD LT, and late relisting (L-RL) due to biliary complications was defined as relisting 14 days to 3 years after DCD LT. Of 3908 DCD LTs performed nationally between 2002 and 2016, 540 (13.8%) patients were relisted within 3 years of transplant (168 [4.3%] in the E-RL group, 372 [9.5%] in the L-RL group). The E-RL and L-RL groups had waitlist mortality rates of 15.4% and 10.5%, respectively, at 3 mo and 16.1% and 14.3%, respectively, at 1 year. Waitlist mortality in the L-RL group was higher than mortality and delisted rates for patients with exception points for both hepatocellular carcinoma (HCC) and hepatopulmonary syndrome (HPS) at 3- to 12-mo time points (p < 0.001). Waitlist outcomes differed in patients with early DCD graft failure caused by PNF or HAT compared with those with late DCD graft failure attributed to biliary complications. In L-RL, higher rates of waitlist mortality were noted compared with patients listed with exception points for HCC or HPS.
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Affiliation(s)
- K P Croome
- Department of Transplant, Mayo Clinic Florida, Jacksonville, FL
| | - D D Lee
- Department of Transplant, Mayo Clinic Florida, Jacksonville, FL
| | - J H Nguyen
- Department of Transplant, Mayo Clinic Florida, Jacksonville, FL
| | - A P Keaveny
- Department of Transplant, Mayo Clinic Florida, Jacksonville, FL
| | - C B Taner
- Department of Transplant, Mayo Clinic Florida, Jacksonville, FL
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8
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Shi J, Wang X, Nguyen JH, Bleske BE, Liang Y, Liu L, Zhu HJ. Dabigatran etexilate activation is affected by the CES1 genetic polymorphism G143E (rs71647871) and gender. Biochem Pharmacol 2016; 119:76-84. [PMID: 27614009 DOI: 10.1016/j.bcp.2016.09.003] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [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: 08/08/2016] [Accepted: 09/06/2016] [Indexed: 12/12/2022]
Abstract
The oral anticoagulant prodrug dabigatran etexilate (DABE) is sequentially metabolized by intestinal carboxylesterase 2 (CES2) and hepatic carboxylesterase 1 (CES1) to form its active metabolite dabigatran (DAB). A recent genome-wide association study reported that the CES1 single nucleotide polymorphisms (SNPs) rs2244613 and rs8192935 were associated with lower DAB plasma concentrations in the Randomized Evaluation of Long-term Anticoagulation Therapy (RE-LY) study participants. In addition, gender differences in exposure to DAB were observed in clinical studies. The aim of this study was to examine the effect of CES1 genetic polymorphisms and gender on DABE activation using several in vitro approaches. The genotypes of the CES1 SNPs rs2244613, rs8192935, and the known loss-of-function CES1 variant rs71647871 (G143E), and the activation of DABE and its intermediate metabolites M1 and M2 were determined in 104 normal human liver samples. DABE, M1, and M2 activations were found to be impaired in human livers carrying the G143E variant. However, neither rs2244613 nor rs8192935 was associated with the activation in human livers. The incubation study of DABE with supernatant fractions (S9) prepared from the G143E-transfected cells showed that the G143E is a loss-of-function variant for DABE metabolism. Moreover, hepatic CES1 activity on M2 activation was significantly higher in female liver samples than male. Our data suggest that CES1 genetic variants and gender are important contributing factors to variability in DABE activation in humans. A personalized DABE treatment approach based on patient-specific CES1 genotypes and sex may have the potential to improve the efficacy and safety of DABE pharmacotherapy.
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Affiliation(s)
- Jian Shi
- Department of Clinical Pharmacy, University of Michigan, Ann Arbor, MI, United States
| | - Xinwen Wang
- Department of Clinical Pharmacy, University of Michigan, Ann Arbor, MI, United States
| | - Jenny-Hoa Nguyen
- Department of Clinical Pharmacy, University of Michigan, Ann Arbor, MI, United States
| | - Barry E Bleske
- Department of Pharmacy Practice and Administrative Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Yan Liang
- Department of Clinical Pharmacy, University of Michigan, Ann Arbor, MI, United States; The Key Laboratory of Drug Metabolism and Pharmacokinetics, China Pharmaceutical University, Nanjing, China
| | - Li Liu
- Department of Clinical Pharmacy, University of Michigan, Ann Arbor, MI, United States; The Key Laboratory of Drug Metabolism and Pharmacokinetics, China Pharmaceutical University, Nanjing, China
| | - Hao-Jie Zhu
- Department of Clinical Pharmacy, University of Michigan, Ann Arbor, MI, United States.
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9
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Elfeki MA, Genco PV, Pungpapong S, Nakhleh RE, Nguyen JH, Harnois DM. Abatacept use in graft-versus-host disease after orthotopic liver transplantation: a case report. Transplant Proc 2015; 46:2422-5. [PMID: 25242798 DOI: 10.1016/j.transproceed.2014.06.061] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 06/30/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Graft-versus-host disease (GVHD) is a rare, serious, fatal disease that occurs after orthotopic liver transplantation (OLT). CASE REPORT We treated a 60-year-old man who underwent OLT owing to familial amyloidosis. The patient developed fever on postoperative day 16. The fever was persistent and did not respond to antibiotic therapy. Cultures and radiologic studies were done and excluded infection as a potential cause. On postoperative day 26, a skin rash appeared on his chest, accompanied by diarrhea and persistent fever. The rash spread all over the trunk, neck, and arms, but spared the palms of his hands and soles of his feet. In the meantime, his blood cell count revealed pancytopenia. Skin biopsy was done and showed interface lymphocytic infiltrate that are largely centered on the dermal-epidermal junction, is consistent with GVHD (this pattern of rash distribution is unique and different from the rash of GVHD after hematopoietic stem cell transplant, which is confined to palms of the hands and soles of the feet; Fig 1). The diagnosis was confirmed by colonoscopy and multiple forceps biopsies, which revealed extensive crypt loss. After hematology consultation, the patient was treated by withdrawal of all immunosuppressive therapy coupled with abatacept infusion. Abatacept is a chimeric protein that inhibits T-lymphocytes and is approved by the US Food and Drug Administration for the treatment of rheumatoid arthritis. Interestingly, after second dose of abatacept the patient showed marked clinical and laboratory improvement. The patient was discharged after 47 days in a stable condition. CONCLUSION Because of the lack of a consensus for treatment of these patients, we report our experience with a male patient who had post-OLT GVHD and showed a marked improvement in response to abatacept.
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Affiliation(s)
- M A Elfeki
- Department of Transplantation, Mayo Clinic Florida, Jacksonville, Florida
| | - P V Genco
- Department of Transplantation, Mayo Clinic Florida, Jacksonville, Florida
| | - S Pungpapong
- Department of Transplantation, Mayo Clinic Florida, Jacksonville, Florida
| | - R E Nakhleh
- Department of Transplantation, Mayo Clinic Florida, Jacksonville, Florida
| | - J H Nguyen
- Department of Transplantation, Mayo Clinic Florida, Jacksonville, Florida
| | - D M Harnois
- Department of Transplantation, Mayo Clinic Florida, Jacksonville, Florida.
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10
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Croome KP, Lee DD, Burns JM, Musto K, Paz D, Nguyen JH, Perry DK, Harnois DM, Taner CB. The Use of Donation After Cardiac Death Allografts Does Not Increase Recurrence of Hepatocellular Carcinoma. Am J Transplant 2015; 15:2704-11. [PMID: 25968609 DOI: 10.1111/ajt.13306] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [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: 01/02/2015] [Revised: 02/12/2015] [Accepted: 03/08/2015] [Indexed: 01/25/2023]
Abstract
Hepatocellular carcinoma (HCC) recurrence in patients undergoing liver transplantation (LT) with donation after brain death (DBD) and donation after cardiac death (DCD) allografts has not previously been investigated. Rates and patterns of HCC recurrences were investigated in patients undergoing DBD (N = 1633) and DCD (N = 243) LT between 2003 and 2012. LT for HCC was identified in 397 patients (340 DBD and 57 DCD). No difference in tumor number (p = 0.26), tumor volume (p = 0.34) and serum alphafetoprotein (AFP) (p = 0.47) was seen between the groups. HCC recurrence was identified in 41 (12.1%) patients in the DBD group and 7 (12.3%) patients in the DCD group. There was no difference in recurrence-free survival (p = 0.29) or cumulative incidence of HCC recurrence (p = 0.91) between the groups. Liver allograft was the first site of recurrence in 22 (65%) patients in the DBD group and two (37%) patients in the DCD group (p = 0.39). LT for HCC with DBD and DCD allografts demonstrate no difference in the rate of HCC recurrence. Previously published differences in survival demonstrated between recipients with HCC receiving DBD and DCD allografts despite statistical adjustment can likely be explained by practice patterns not captured by variables contained in the SRTR database.
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Affiliation(s)
- K P Croome
- Department of Transplantation, Mayo Clinic Florida, Jacksonville, FL
| | - D D Lee
- Department of Transplantation, Mayo Clinic Florida, Jacksonville, FL
| | - J M Burns
- Department of Transplantation, Mayo Clinic Florida, Jacksonville, FL
| | | | - D Paz
- Department of Transplantation, Mayo Clinic Florida, Jacksonville, FL
| | - J H Nguyen
- Department of Transplantation, Mayo Clinic Florida, Jacksonville, FL
| | - D K Perry
- Department of Transplantation, Mayo Clinic Florida, Jacksonville, FL
| | - D M Harnois
- Department of Transplantation, Mayo Clinic Florida, Jacksonville, FL
| | - C B Taner
- Department of Transplantation, Mayo Clinic Florida, Jacksonville, FL
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11
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Akin MC, Nguyen JH. Practical uncertainty reduction and quantification in shock physics measurements. Rev Sci Instrum 2015; 86:043903. [PMID: 25933867 DOI: 10.1063/1.4917555] [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] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 04/02/2015] [Indexed: 06/04/2023]
Abstract
We report the development of a simple error analysis sampling method for identifying intersections and inflection points to reduce total uncertainty in experimental data. This technique was used to reduce uncertainties in sound speed measurements by 80% over conventional methods. Here, we focused on its impact on a previously published set of Mo sound speed data and possible implications for phase transition and geophysical studies. However, this technique's application can be extended to a wide range of experimental data.
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Affiliation(s)
- M C Akin
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - J H Nguyen
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
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12
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Affiliation(s)
- L Sibulesky
- Department of Transplantation, Mayo Clinic, Jacksonville, FL
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13
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Nguyen JH. Comparison of liver transplantation outcomes from adult split liver and circulatory death donors (Br J Surg 2012; 99: 839-847). Br J Surg 2012; 99:847-8. [PMID: 22539121 DOI: 10.1002/bjs.8783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- J H Nguyen
- Division of Transplant Surgery, Department of Transplantation, Mayo Clinic Florida, Jacksonville, Florida 32224, USA.
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14
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Hellinger WC, Heckman MG, Crook JE, Taner CB, Willingham DL, Diehl NN, Zubair AC, Shalev JA, Nguyen JH. Association of surgeon with surgical site infection after liver transplantation. Am J Transplant 2011; 11:1877-84. [PMID: 21827617 DOI: 10.1111/j.1600-6143.2011.03644.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Surgical site infection (SSI) after liver transplantation has been associated with increased risk of allograft loss and death. Identification of modifiable risk factors for these infections is imperative. To our knowledge, intraoperative practices associated with transplant surgeons have not been assessed as a risk factor. A retrospective cohort study of risk factors for SSI after 1036 first liver transplantations completed by seven surgeons at a single center between 2003 and 2008 was undertaken. Cox proportional hazards models were used to evaluate the association between surgeons and SSIs. SSIs were identified in 166 of 1036 patients (16%). Single variable analysis showed strong evidence of an association between surgeon and SSI (p = 0.0007); the estimated cumulative incidence of SSI ranged from 7% to 24%. This result was consistent in multivariable analysis adjusting for potentially confounding variables (p = 0.002). The occurrence of organ-space or deep SSI varied significantly among surgeons in both single variable analysis (p = 0.005) and multivariable analysis (p = 0.006). These findings provide evidence that differences in the surgical practices of individual surgeons are associated with risk for SSI after liver transplantation. Identification of specific surgical practices associated with risk of SSI is warranted.
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Affiliation(s)
- W C Hellinger
- Division of Infectious Diseases Biostatistics Unit Division of Transplant Surgery, Mayo Clinic, Jacksonville, FL, USA.
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15
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Abstract
In this paper, we describe a velocity interferometer system based entirely on single-mode fiber optics. This paper includes a description of principles used in developing the single-mode velocity interferometry system (SMV). The SMV design is based on polarization-insensitive components. Polarization adjusters are included to eliminate the effects of residual birefringence and polarization dependent losses in the interferometers. Characterization measurements and calibration methods needed for data analysis and a method of data analysis are described. Calibration is performed directly using tunable lasers. During development, we demonstrated its operation using exploding-foil bridge-wire fliers up to 200 m/s. In a final test, we demonstrated the SMV in a gas gun experiment up to 1.2 km/sec. As a basis for comparison in the gas gun experiment, we used another velocimetry technique that is also based on single-mode fiber optics: photonic Doppler velocimetry (PDV). For the gas gun experiment, we split the light returned from a single target spot and performed a direct comparison of the homodyne (SMV) and heterodyne (PDV) techniques concurrently. The two techniques had a negligible mean difference and a 1.5% standard deviation in the one-dimensional shock zone. Within one interferometer delay time after a sudden Doppler shift, a SMV unencumbered by multimode-fiber dispersion exhibits two color beats. These beats have the same period as PDV beats-this interference occurs between the "recently" shifted and "formerly unshifted" paths within the interferometer. We believe that recognizing this identity between homodyne and heterodyne beats is novel in the shock-physics field. SMV includes the conveniences of optical fiber, while removing the time resolution limitations associated with the multimode delivery fiber.
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Affiliation(s)
- K G Krauter
- Lawrence Livermore National Laboratory, 7000 East Ave., Livermore California 94551, USA
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16
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Sibulesky L, Satyanarayana R, Menke D, Nguyen JH. Reactive nodular hyperplasia mimicking malignant lymphoma in donor liver allograft. Transplant Proc 2010; 42:1970-2. [PMID: 20620558 DOI: 10.1016/j.transproceed.2009.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Revised: 09/24/2009] [Accepted: 10/06/2009] [Indexed: 12/30/2022]
Abstract
The transmission of malignancy from donor to recipient can have devastating outcomes. Therefore, careful examination of the thoracic cavity, abdominal organs, and lymphoid tissue is important. In this report, we have described a case of a healthy 37-year-old donor with no significant past medical history who was found to have a nodule in the liver allograft during the examination at the back table. The frozen section revealed atypical lymphoid hyperplasia. Further workup revealed a rare benign lesion in the liver known as reactive lymphoid hyperplasia. Unfortunately, the liver allograft had to be discarded since low-grade lymphoma could not be excluded at the time of transplantation.
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Affiliation(s)
- L Sibulesky
- Departments of Transplantation and Pathology, Mayo Clinic, Jacksonville, Florida 32224, USA
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17
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Hori T, Egawa H, Takada Y, Oike F, Kasahara M, Ogura Y, Sakamoto S, Ogawa K, Yonekawa Y, Nguyen JH, Doi H, Ueno M, Uemoto S. Long-term outcomes after living-donor liver transplantation for Alagille syndrome: a single center 20-year experience in Japan. Am J Transplant 2010; 10:1951-2. [PMID: 20659101 DOI: 10.1111/j.1600-6143.2010.03196.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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18
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Taner B, Willingham DL, Hewitt WR, Grewal HP, Nguyen JH, Hughes CB. Polycystic liver disease and liver transplantation: single-institution experience. Transplant Proc 2010; 41:3769-71. [PMID: 19917384 DOI: 10.1016/j.transproceed.2009.05.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Accepted: 05/04/2009] [Indexed: 12/17/2022]
Abstract
Adult polycystic liver disease (PLD) can cause massive hepatomegaly leading to pain, caval obstruction, and hemorrhage. Many surgical techniques including aspiration, fenestration, and resection have been used to treat PLD. In addition to substantial morbidity and mortality, conservative surgery may have limited success, and palliation may be temporary. With improved results of liver transplantation, it has become the definitive treatment for PLD. We retrospectively reviewed our experience in patients with PLD between 1998 and 2007. Thirteen patients underwent liver only or liver-kidney transplantation. All surgical procedures were performed with preservation of the recipient inferior vena cava and without venovenous bypass (piggyback technique). Our patients experienced a high rate of perioperative morbidity. However, long-term patient and graft survival were excellent.
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Affiliation(s)
- B Taner
- Department of Transplantation Mayo Clinic Florida, Jacksonville, FL, USA.
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19
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Nguyen JH. Authors' reply: interposition graft with polytetrafluoroethylene for mesenteric and portal vein reconstruction after pancreaticoduodenectomy ( Br J Surg 2009; 96: 247–252). Br J Surg 2009. [DOI: 10.1002/bjs.6672] [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: 11/08/2022]
Affiliation(s)
- J H Nguyen
- Division of Transplant Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, Florida 32224, USA
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20
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Krishna M, Keaveny AP, Genco PV, Rosser BG, Dickson RC, Nguyen JH, Steers JL, Nakhleh RE. Clinicopathological review of 18 cases of liver allografts lost due to bile duct necrosis. Transplant Proc 2005; 37:2221-3. [PMID: 15964383 DOI: 10.1016/j.transproceed.2005.03.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2004] [Indexed: 11/27/2022]
Abstract
Clinical, radiographic, and pathological features of 18 patients with biliary necrosis in their explanted liver allografts were reviewed. Twelve patients were men and ages ranged from 27 to 72 years. Indications for initial liver transplant (LT) were viral hepatitis (n = 7), steatohepatitic cirrhosis (n = 3), cryptogenic cirrhosis (n = 3), secondary sclerosing cholangitis (n = 2), primary sclerosing cholangitis (n = 1), biliary atresia (n = 1), and nodular regenerative hyperplasia (n = 1). Donor age ranged from 16 to 75 years. Duct-to-duct biliary anastomoses were fashioned in 13 cases; warm and cold ischemia times were not significantly different from general LT population. Seventeen allograft biopsies after recirculation had no significant findings. Post-LT, clinical and radiographic evaluation indicated biliary strictures (n = 7), bile leak (n = 7), intrahepatic abscess (n = 1), and duodenal perforation (n = 1). Radiographic vascular studies suggested hepatic arterial thrombosis or stenosis in 11 cases. Biopsies prior to retransplantation were performed on 17 patients and showed acute rejection (n = 10), biliary outflow impairment (n = 4), normal histology (n = 2), and centrilobular necrosis (n = 1). Retransplantation was performed 14 to 334 days after initial LT. Pathological examination of explants revealed perihilar duct necrosis in all cases, with bacterial colonies (n = 10) and fungal organisms (n = 2). Arterial thrombi were seen in 10 cases, and two had prominent arteriosclerosis. Infarction and centrilobular necrosis were seen in 9 and 13 cases, respectively. Four explants showed features of biliary outflow impairment. Twelve patients were alive 6 to 18 months following retransplantation. We conclude that post-LT biliary necrosis is associated with ischemia, and such a complication is rarely evident in allograft biopsies. Biliary and vascular imaging studies are essential in evaluating patients for this complication.
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Affiliation(s)
- M Krishna
- Mayo Clinic, Jacksonville, Florida, USA.
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21
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Nakhleh RE, Krishna M, Keaveny AP, Dickson RC, Rosser B, Nguyen JH, Steers JL. Review of 31 Cases of Morphologic Hepatitis in Liver Transplant Patients Not Related to Disease Recurrence. Transplant Proc 2005; 37:1240-2. [PMID: 15848682 DOI: 10.1016/j.transproceed.2004.12.113] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [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: 11/19/2022]
Abstract
AIMS We examined the clinical and pathologic features of morphologic hepatitis occurring after liver transplantation (LT) that is unrelated to disease recurrence. METHODS Between February 1998 and December 2003, 704 primary LTs were performed at our center. Patients transplanted for diagnoses with low risk of disease recurrence were considered for our study (n = 282). Those with hepatitis C (HCV), hepatitis B (HBV), primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), and autoimmune hepatitis (AIH) were excluded. Those with morphologic hepatitis comprised our case series and had medical records reviewed for clinical associations, duration, and outcome. RESULTS Thirty-one cases were identified. They were transplanted for cryptogenic cirrhosis (n = 13), steatohepatitis (n = 12), alpha-1-antitrypsin deficiency (n = 3), tumor (n = 2), and acetaminophen toxicity (n = 1); 22 cases (67%) presented within the first 8 months post-LT (range, 0.5-72 months). Histological activity was mild in 19 and moderate in 12. Associated conditions were identified in 19 patients (57%) with 3 categories being identified: probable drug toxicity (n = 7), systemic infection (n = 4), and mechanical or hemodynamic abnormalities (n = 8). Of the 25 cases that underwent follow-up biopsy 2 to 32 months (mean, 15.5 months) after the index biopsy, 10 cases had resolution and 15 cases had persistence of the infiltrate. One patient had evidence of de novo HBV infection. CONCLUSIONS Morphologic hepatitis occurred in 11% of patients at low risk for disease recurrence. Associated conditions could be grouped into three categories: drug toxicity, systemic infection, and mechanical or hemodynamic factors. Most cases did not appear to progress or improved over time, with no allograft loss occurring as a result of chronic hepatitis.
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Affiliation(s)
- R E Nakhleh
- Mayo Clinic Jacksonville, Jacksonville, Florida 32256, USA.
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22
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McLaughlin SA, Schmitt TM, Huguet KL, Menke DM, Nguyen JH. Myofibrosarcoma of the adrenal gland. Am Surg 2005; 71:191-3. [PMID: 15869129] [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: 05/02/2023]
Abstract
Adrenal masses have varying presentations. Most commonly, adrenal masses are discovered incidentally on CT or MRI during an evaluation for an unrelated complaint. Although the majority of these are nonfunctional cortical adenomas, hormonally active tumors and adrenocortical carcinoma must also be considered in the differential diagnosis. Rarely, retroperitoneal tumors may mimic an adrenal mass. We report a case of a 49-year-old man with anemia and weight loss who was found to have a large retroperitoneal mass arising from the adrenal gland. Surgical treatment involved en bloc resection of the right kidney, adrenal gland, segments 7 and 8 of the liver, and a portion of the right hemidiaphragm. Final pathology revealed a low-grade myofibrosarcoma. We believe that this is the first case report of a myofibrosarcoma of the adrenal gland. Myofibrosarcomas are rare malignant tumors composed of myofibroblasts that arise from the deep soft tissues. These tumors have a predilection for the head and neck, trunk, or extremities. Myofibrosarcomas can be differentiated from other sarcomas by immunohistochemical staining and pathologic features. We will briefly discuss the workup of an adrenal mass and focus on the diagnosis of myofibrosarcoma.
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Affiliation(s)
- S A McLaughlin
- Department of General Surgery, Mayo Clinic Jacksonville, Jacksonville, Florida 32224, USA
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23
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Walter BL, Nguyen JH, Ehrenfeld E, Semler BL. Differential utilization of poly(rC) binding protein 2 in translation directed by picornavirus IRES elements. RNA 1999; 5:1570-85. [PMID: 10606268 PMCID: PMC1369879 DOI: 10.1017/s1355838299991483] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The translation of picornavirus genomic RNAs occurs by a cap-independent mechanism that requires the formation of specific ribonucleoprotein complexes involving host cell factors and highly structured regions of picornavirus 5' noncoding regions known as internal ribosome entry sites (IRES). Although a number of cellular proteins have been shown to be involved in picornavirus RNA translation, the precise role of these factors in picornavirus internal ribosome entry is not understood. In this report, we provide evidence for the existence of distinct mechanisms for the internal initiation of translation between type I and type II picornavirus IRES elements. In vitro translation reactions were conducted in HeLa cell cytoplasmic translation extracts that were depleted of the cellular protein, poly(rC) binding protein 2 (PCBP2). Upon depletion of PCBP2, these extracts possessed a significantly diminished capacity to translate reporter RNAs containing the type I IRES elements of poliovirus, coxsackievirus, or human rhinovirus linked to luciferase; however, the addition of recombinant PCBP2 could reconstitute translation. Furthermore, RNA electrophoretic mobility-shift analysis demonstrated specific interactions between PCBP2 and both type I and type II picornavirus IRES elements; however, the translation of reporter RNAs containing the type II IRES elements of encephalomyocarditis virus and foot-and-mouth disease virus was not PCBP2 dependent. These data demonstrate that PCBP2 is essential for the internal initiation of translation on picornavirus type I IRES elements but is dispensable for translation directed by the structurally distinct type II elements.
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Affiliation(s)
- B L Walter
- Department of Microbiology and Molecular Genetics, College of Medicine, University of California, Irvine 92697-4025, USA
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24
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Abstract
Intestinal failure can result from large resections of small intestine (short bowel syndrome) and from failure of normal intestinal motility. The medical management of short bowel syndrome centers around appropriate diet and use of specific medications including experimental trophic factors. Enteral tubes and prokinetic medications can be successfully used to treat patients with intestinal failure as a result of abnormal intestinal motility. Small bowel transplantation may be a treatment option in certain patients with intestinal failure. This article reviews the management of intestinal failure with a recent update on small bowel transplantation.
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Affiliation(s)
- J S Scolapio
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL 32224, USA
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25
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Benedetti LR, Nguyen JH, Caldwell WA, Liu H, Kruger M, Jeanloz R. Dissociation of CH4 at high pressures and temperatures: diamond formation in giant planet interiors? Science 1999; 286:100-2. [PMID: 10506552 DOI: 10.1126/science.286.5437.100] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Experiments using laser-heated diamond anvil cells show that methane (CH4) breaks down to form diamond at pressures between 10 and 50 gigapascals and temperatures of about 2000 to 3000 kelvin. Infrared absorption and Raman spectroscopy, along with x-ray diffraction, indicate the presence of polymeric hydrocarbons in addition to the diamond, which is in agreement with theoretical predictions. Dissociation of CH4 at high pressures and temperatures can influence the energy budgets of planets containing substantial amounts of CH4, water, and ammonia, such as Uranus and Neptune.
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Affiliation(s)
- L R Benedetti
- Department of Physics, Department of Geology and Geophysics, University of California, Berkeley, CA 94720, USA
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26
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Sarmiento JM, Munn SR, Paya CV, Velosa JA, Nguyen JH. Is cytomegalovirus infection related to mycophenolate mofetil after kidney transplantation? A case-control study. Clin Transplant 1998; 12:371-4. [PMID: 9787943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Three multicenter studies have shown that the addition of mycophenolate mofetil (MMF) to an immunosuppressive regime consisting of cyclosporin A (CSA) and prednisone (PRED) decreases the incidence of acute rejection episodes when compared with azathioprine (AZA) or placebo (1-3). In those patients receiving 3 g/d of MMF, the highest dose used in the studies, there was a trend towards an increased incidence of cytomegaloviral sepsis (CMV). We postulated therefore that MMF may represent an independent risk factor for the development of CMV infection in patients receiving renal allografts and MMF at our institution. Having altered the triple drug regime from CSA, AZA (2-2.5 mg/kg/d) and PRED to CSA, MMF (2 g/d) and PRED in July 1995, we elected to study all patients undergoing kidney transplantation for the 33-month period January 1994-September 1996, by undertaking a case control analysis to determine independent risk factors for the development of CMV infection, as defined by CMV viremia or tissue-invasive CMV. Three CMV disease-free control patients were matched to each case, these patients having been randomly selected from the entire pool of patients in the observation period. There were 31 CMV case patients and 102 control patients. Univariate analysis indicated that gender, a concomitant pancreas transplant, acute rejection and CMV seropositivity in the donor were risk factors. However, multivariate analysis indicated that only acute rejection and donor CMV seropositivity were independently linked (p < 0.05) to CMV disease in this sample. Specifically, the odds ratio (OR) for CMV disease between MMF and AZA was 1.0 (95% confidence interval (CI): 0.46-2.18). Therefore, in this case control study we find no evidence that MMF at a dose of 2 g/d is an independent risk factor for primary CMV viremia or tissue invasion in renal allograft recipients.
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Affiliation(s)
- J M Sarmiento
- Department of General Surgery, Mayo Clinic, Rochester, MN 55905 USA
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27
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Nguyen JH, Shahar Y, Tu SW, Das AK, Musen MA. A temporal database mediator for protocol-based decision support. Proc AMIA Annu Fall Symp 1997:298-302. [PMID: 9357636 PMCID: PMC2233432] [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: 02/05/2023]
Abstract
To meet the data-processing requirements for protocol-based decision support, a clinical data-management system must be capable of creating high-level summaries of time-oriented patient data, and of retrieving those summaries in a temporally meaningful fashion. We previously described a temporal-abstraction module (RESUME) and a temporal-querying module (Chronus) that can be used together to perform these tasks. These modules had to be coordinated by individual applications, however, to resolve the temporal queries of protocol planners. In this paper, we present a new module that integrates the previous two modules and that provides for their coordination automatically. The new module can be used as a standalone system for retrieving both primitive and abstracted time-oriented data, or can be embedded in a larger computational framework for protocol-based reasoning.
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Affiliation(s)
- J H Nguyen
- Section on Medical Informatics, Stanford University School of Medicine, CA 94305-5479, USA
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28
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Blair WS, Nguyen JH, Parsley TB, Semler BL. Mutations in the poliovirus 3CD proteinase S1-specificity pocket affect substrate recognition and RNA binding. Virology 1996; 218:1-13. [PMID: 8615011 DOI: 10.1006/viro.1996.0160] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [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
Sequence and structure comparisons with homologous trypsin-like serine proteases have predicted the S1-specificity pocket in picornavirus 3C proteinases. In this study, we examine the putative roles of such residues in poliovirus 3C substrate recognition. Single amino acid substitutions at 3C residues Thr-142, His-161, Gly-163, Gly-164, and Ala-172 were introduced into near full-length poliovirus cDNAs, and protein processing was examined in the context of authentic 3C cis cleavage activity. Our data are consistent with residues Thr-142, His-161, Gly-163, and Gly-164 acting as important determinants of 3C substrate specificity and support published models of 3C protein structure. An in vivo analysis of mutant viruses containing individual amino acid substitutions at 3C residues Thr-142 and Ala-172 suggests that such residues are important determinants for viral RNA replication. In addition, bacterially expressed, recombinant 3CD polypeptides containing amino acid substitutions at Thr-142 and Ala-172 show altered RNA binding properties in mobility shift assays that use a synthetic RNA corresponding to the poliovirus 5'-terminal sequences.
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Affiliation(s)
- W S Blair
- Department of Microbiology and Molecular Genetics, University of California, Irvine, 92717, USA
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29
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Wu SY, Jordan M, Nguyen JH. Compound W: a potential marker in maternal serum for assessing fetal thyroid function. Compr Ther 1995; 21:594-6. [PMID: 8565429] [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: 01/31/2023]
Affiliation(s)
- S Y Wu
- Nuclear Medicine Service, VA-UCI Medical Center, Long Beach, California 90822, USA
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30
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Wisselink W, Nguyen JH, Becker MO, Money SR, Hollier LH. Ischemia-reperfusion injury of the spinal cord: the influence of normovolemic hemodilution and gradual reperfusion. Cardiovasc Surg 1995; 3:399-404. [PMID: 7582994 DOI: 10.1016/0967-2109(95)94158-s] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Recent studies have suggested that oxygen-derived free radicals play an important role in ischemia-reperfusion injury of the spinal cord. In other organ systems, reperfusion injury has been reduced by limiting the availability of oxygen in the reperfusion phase. The purpose of this study was to test the effect of normovolemic hemodilution and gradual reperfusion on spinal cord function after aortic cross-clamping in 84 New Zealand White rabbits. All animals underwent 21 min of infrarenal aortic cross-clamping in the conscious state by means of a previously placed aortic occlusion device and were randomized to four groups. Group 1 animals were hemodiluted to a mean (s.e.m.) hematocrit of 28(2)% by extracting 25% of the effective blood volume and reinfusing the plasma component after centrifugation concurrently with a volume of normal saline three times that of the discarded red cells. Group 2 animals (controls) were bled similarly but both plasma and red cells were reinfused, resulting in a mean (s.e.m.) hematocrit of 38(2)%. In the next two groups, distal aortic flow was recorded via an implantable Doppler device. After cross-clamping, flow was returned gradually over 45 min in animals of group 3, and abruptly in group 4. Animals were observed for 5 days and neurologic function was graded by an independent observer. Paraplegia at 5 h after clamping occurred in 75% of animals in group 1 versus 32% in group 2 (P < 0.05), and in 33% of group 3 versus 28% in group 4 (not significant). Of those animals showing initial neurologic recovery, delayed-onset paraplegia was seen in 100% in group 1 versus 87% in group 4 (not significant), and in 50% of group 3 versus 92% of group 4 (P < 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- W Wisselink
- Department of Surgery, Ochsner Clinic, New Orleans, Louisiana, USA
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31
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Abstract
The replication of a picornavirus genomic RNA is a template-specific process involving the recognition of viral RNAs as target replication templates for the membrane-bound viral replication initiation complex. The virus-encoded RNA-dependent RNA polymerase, 3Dpol, is a major component of the replication complex; however, when supplied with a primed template, 3Dpol is capable of copying polyadenylated RNAs which are not of viral origin. Therefore, there must be some other molecular mechanism to direct the specific assembly of the replication initiation complex at the 3' end of viral genomic RNAs, presumably involving cis-acting binding determinants within the 3' noncoding region (3' NCR). This report describes the use of an in vitro UV cross-linking assay to identify proteins which interact with the 3' NCR of human rhinovirus 14 RNA. A cellular protein(s) was identified in cytoplasmic extracts from human rhinovirus 14-infected cells which had a marked binding preference for RNAs containing the rhinovirus 3' NCR sequence. This protein(s) showed reduced cross-linking efficiency for a 3' NCR with an engineered deletion. Virus recovered from RNA transfections with in vitro transcribed RNA containing the same 3' NCR deletion demonstrated a defective replication phenotype in vivo. Cross-linking experiments with RNAs containing the poliovirus 3' NCR and cytoplasmic extracts from poliovirus-infected cells produced an RNA-protein complex with indistinguishable electrophoretic properties, suggesting that the appearance of the cellular protein(s) may be a common phenomenon of picornavirus infection. We suggest that the observed cellular protein(s) is sequestered or modified as a result of rhinovirus or poliovirus infection and is utilized in viral RNA replication, perhaps by binding to the 3' NCR as a prerequisite for replication complex assembly at the 3' end of the viral genomic RNA.
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Affiliation(s)
- S Todd
- Department of Microbiology and Molecular Genetics, College of Medicine, University of California, Irvine 92717, USA
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32
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Wisselink W, Money SR, Crockett DE, Nguyen JH, Becker MO, Farr GH, Hollier LH. Ischemia-reperfusion injury of the spinal cord: protective effect of the hydroxyl radical scavenger dimethylthiourea. J Vasc Surg 1994; 20:444-91; discussion 449-50. [PMID: 8084038 DOI: 10.1016/0741-5214(94)90144-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE This study was undertaken to evaluate whether neurologic outcome after aortic cross-clamping in rabbits could be improved with perioperative infusion of the hydroxyl radical scavenger dimethylthiourea and, if so, to determine whether it is effective during the period of ischemia, reperfusion, or both. METHODS In 41 New Zealand White rabbits, a snare occlusion device was placed at operation around the infrarenal aorta and tunneled into a subcutaneous position. Animals were then allowed to recover and, 48 hours later, randomized into four groups. In each group, the infrarenal aorta was occluded by tightening the snare in the awake animal. In groups 1, 2, and 3, cross-clamp time was 21 minutes. Group 1 (control) animals received saline solution, whereas group 2 (preclamp 21) received dimethylthiourea 750 mg/kg intravenously just before aortic clamping. In group 3 (prerep 21), dimethylthiourea was given just before reperfusion. Group 4 received dimethylthiourea before clamping, with cross-clamp time extended to 31 minutes. A second dose of saline solution or dimethylthiourea was given 12 hours after clamping in controls and the three treatment groups, respectively. Animals were observed for 5 days, and final neurologic recovery was graded by an independent observer. Animals were then killed, and their spinal cords were removed for histologic examination. RESULTS Complete paraplegia and marked histologic spinal cord injury at 5 days were seen in 91% (10/11) of group 1 (control) animals, whereas all animals in group 2 (preclamp 21) showed neurologic recovery (p < 0.0001). In group 3 (prerep 21), the final paraplegia rate was 50% (5 of 10), in group 4 (preclamp 31), 100% (10 of 10). CONCLUSIONS Our results suggest that hydroxyl radicals play an important role in ischemia-reperfusion injury of the spinal cord and that treatment with dimethylthiourea can prevent paraplegia after 21 minutes of aortic cross-clamping in rabbits.
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Wisselink W, Becker MO, Nguyen JH, Money SR, Hollier LH. Protecting the ischemic spinal cord during aortic clamping: the influence of selective hypothermia and spinal cord perfusion pressure. J Vasc Surg 1994; 19:788-95; discussion 795-6. [PMID: 8170032 DOI: 10.1016/s0741-5214(94)70003-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [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: 01/29/2023]
Abstract
PURPOSE We verified the hypothesis that selective deep hypothermia of the spinal cord during double thoracic aortic clamping can prevent postoperative paraplegia in dogs. METHODS Normal saline solution was circulated from the cisterna magna through an extracorporeal perfusion system consisting of a reservoir, a pump, and a heat exchanger, back into the subarachnoid space at the level of the medullary cone at a rate of 25 ml/min, starting 30 minutes before clamping, and ending after removal of the clamps. The thoracic aorta was cross-clamped below the left subclavian artery and above the diaphragm for a period of 45 minutes. Cerebrospinal fluid, intracranial, and central venous pressure and aortic pressure proximal, between, and distal to the clamps were continuously recorded. In five dogs, temperature of the circulating normal saline solution at the inflow level was maintained at 2 degrees +/- 1.5 degrees C (group 1), in five controls at 37 degrees +/- 0.8 degrees C (group 2). Five dogs underwent continuous cerebrospinal fluid drainage starting before clamping until sacrifice (group 3). Dogs were observed for up to 4 days, and neurologic function was graded by an independent observer with the Tarlov scale. Animals were then killed, and their spinal cords were prepared for microscopic examination. RESULTS Hemodynamic parameters were not significantly different between groups. All dogs in groups 2 and 3 were paraplegic with histologic evidence of spinal cord infarction. All animals in group 1 were neurologically normal without microscopic evidence of infarction (p < 0.005). CONCLUSIONS Selective deep hypothermia of the spinal cord prevents paraplegia after 45 minutes of double aortic clamping in dogs. Cerebrospinal fluid drainage was not effective in preventing paraplegia in this model.
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Affiliation(s)
- W Wisselink
- Department of Surgery, Ochsner Clinic, New Orleans, Louisiana
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Nguyen JH, Kruger MB, Jeanloz R. Compression and pressure-induced amorphization of Co(OH)2 characterized by infrared vibrational spectroscopy. Phys Rev B Condens Matter 1994; 49:3734-3738. [PMID: 10011263 DOI: 10.1103/physrevb.49.3734] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Abstract
Translation initiation by internal ribosome binding is a recently discovered mechanism of eukaryotic viral and cellular protein synthesis in which ribosome subunits interact with the mRNAs at internal sites in the 5' untranslated RNA sequences and not with the 5' methylguanosine cap structure present at the extreme 5' ends of mRNA molecules. Uncapped poliovirus mRNAs harbor internal ribosome entry sites (IRES) in their long and highly structured 5' noncoding regions. Such IRES sequences are required for viral protein synthesis. In this study, a novel poliovirus was isolated whose genomic RNA contains two gross deletions removing approximately 100 nucleotides from the predicted IRES sequences within the 5' noncoding region. The deletions originated from previously in vivo-selected viral revertants displaying non-temperature-sensitive phenotypes. Each revertant had a different predicted stem-loop structure within the 5' noncoding region of their genomic RNAs deleted. The mutant poliovirus (Se1-5NC-delta DG) described in this study contains both stem-loop deletions in a single RNA genome, thereby creating a minimum IRES. Se1-5NC-delta DG exhibited slow growth and a pinpoint plaque phenotype following infection of HeLa cells, delayed onset of protein synthesis in vivo, and defective initiation during in vitro translation of the mutated poliovirus mRNAs. Interestingly, the peak levels of viral RNA synthesis in cells infected with Se1-5NC-delta DG occurred at slightly later times in infection than those achieved by wild-type poliovirus, but these mutant virus RNAs accumulated in the host cells during the late phases of virus infection. UV cross-linking assays with the 5' noncoding regions of wild-type and mutated RNAs were carried out in cytoplasmic extracts from HeLa cells and neuronal cells and in reticulocyte lysates to identify the cellular factors that interact with the putative IRES elements. The cellular proteins that were cross-linked to the minimum IRES may represent factors playing an essential role in internal translation initiation of poliovirus mRNAs.
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Affiliation(s)
- A A Haller
- Department of Microbiology and Molecular Genetics, College of Medicine, University of California, Irvine 92717
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Abstract
Th dynamics of the setting expansion of gypsum-bonded investment is complicated by many variables and not well understood. The purposes of this study were to examine the fluid mechanics of the flow of investment during setting and to determine if the presence of wax patterns influences effective setting expansion. Mesial-occlusal-distal (MOD) inlay wax patterns were invested at six different radial positions and four different axial positions in plastics casting rings. Total expansion was determined by using xeroradiography. Combined results of radial expansion data at different axial and radial locations within casting rings suggest that expansion of gypsum-bonded investment may represent a variant of the laminar flow of a viscous fluid.
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Affiliation(s)
- D R Davis
- University of California, San Francisco, Department of Restorative Dentistry 94143
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Davis DR, Nguyen JH, Grey BL. Ring volume/ring liner ratio and effective setting expansion. INT J PROSTHODONT 1992; 5:403-8. [PMID: 1290568] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Effective radial setting expansion of wax patterns in a gypsum-bonded investment is influenced by many factors, especially by the diameter of the cylindrical casting ring. The hypothesis tested was that the ratio of the volume of the casting rings to the volume of the ring liner is a primary determinant of radial setting expansion. Mesio-occlusodistal inlay wax patterns were invested individually in plastic casting rings of different lengths and diameters and imaged using xeroradiography. Effective setting expansion was determined in 34-mm-long, 28-mm-diameter rings and used as a predictor of expansion in rings of different sizes. Experimental setting expansion results did not differ significantly from the predicted values.
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Affiliation(s)
- D R Davis
- School of Dentistry, University of California, San Francisco 94143
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Davis DR, Nguyen JH, Watters JL. The relationship between the fit of MOD inlays and the storage time and conditions of investing. INT J PROSTHODONT 1991; 4:477-81. [PMID: 1811644] [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: 12/28/2022]
Abstract
It has been traditional either to cast invested wax patterns immediately after the investment has set or to store the invested patterns in a humidor for casting later. This study compared the fit of MOD inlays to parent dies after casting immediately following set of the investment, after casting 1 hour following the setting of the investment in air, storage in a humidor for 7 days, and after storage in air for 7 days. The only significant differences in fit were in the group stored in a humidor, and then only at the axiogingival junctions.
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Affiliation(s)
- D R Davis
- Department of Restorative Dentistry, University of California, San Francisco 94143-0758
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Abstract
It was previously demonstrated that flaring of MOD inlay castings was inversely proportional to the diameters of casting rings. The purpose of this study was (1) to determine if radial setting expansion of investment was primarily responsible for the inverse proportion and (2) to characterize further the fluid mechanics of setting expansion by determination of setting expansion in casting rings of different lengths and diameters. Eight sets of ten MOD inlay wax patterns with radiopaque markers at the axiogingival and axiopulpal junctions were individually invested in plastic casting rings in two groups: (A) 28 mm diameter and 30 mm, 32 mm, 34 mm, and 42 mm long; and (B) 28 mm, 40 mm, 51 mm, and 60 mm diameter and 34 mm long. All specimens were imaged (by xeroradiography) at specific intervals during the setting reaction; dimensions were measured on the images at each interval. In casting rings of different lengths, no significant differences (p greater than 0.05) were found in total effective setting expansion. Because setting expansion in the 28-mm-diameter rings was from 1.3% to 1.5% and diminished proportionately in rings of increasing diameter, setting expansion of investment appears to be the primary determinant of mold expansion. In casting rings of different diameters, significant differences (p less than 0.001) were found in total expansion in an apparent inverse proportion (p less than 0.001). Changes in dimension at intervals were strongly associated with time, and with time combined with diameter (p less than 0.001).
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Hewitt CW, Black KS, Henson LE, Achauer BM, Nguyen JH. Lymphocyte chimerism in a full allogeneic composite tissue (rat-limb) allograft model prolonged with cyclosporine. Transplant Proc 1988; 20:272-8. [PMID: 3259042] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
LEW recipients of ACI vascularized hind limb allografts were analyzed for lymphoid chimerism by a complement-dependent cytotoxicity assay using antisera produced across this strain combination. In assessing the technique, two LEW recipients of sublethal irradiation (400 rad), ACI bone-marrow allografts, and CsA exhibited mixed lymphoid chimerism 23 days posttransplant. Short-term CsA-treated CTA recipients that were assayed at various times following transplantation and underwent subacute rejection did not demonstrate any significant mixed lymphoid chimerism. Long-term CsA-treated CTA recipients that were assayed at various times prior to 100 days posttransplant also did not demonstrate any significant mixed lymphoid chimerism. However, following extensive CTA survival (greater than 100 days) significant mixed donor-host lymphocyte chimerism became evident in the peripheral blood, and in one recipient a large quantity of donor bone marrow remained viable in the ACI limb allograft at necropsy (greater than 200 days posttransplant). The development of donor-host lymphocyte chimerism and a wasting syndrome that followed long-term CTA survival was suggestive of GVHD.
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Affiliation(s)
- C W Hewitt
- Department of Surgery, University of California, Irvine 92717
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