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Zimmerer JM, Han JL, Peterson CM, Zeng Q, Ringwald BA, Cassol C, Chaudhari S, Hart M, Hemminger J, Satoskar A, Abdel-Rasoul M, Wang JJ, Warren RT, Zhang ZJ, Breuer CK, Bumgardner GL. Antibody-suppressor CXCR5 + CD8 + T cellular therapy ameliorates antibody-mediated rejection following kidney transplant in CCR5 KO mice. Am J Transplant 2022; 22:1550-1563. [PMID: 35114045 PMCID: PMC9177711 DOI: 10.1111/ajt.16988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 07/01/2021] [Revised: 01/10/2022] [Accepted: 01/29/2022] [Indexed: 01/25/2023]
Abstract
CCR5 KO kidney transplant (KTx) recipients are extraordinarily high alloantibody producers and develop pathology that mimics human antibody-mediated rejection (AMR). C57BL/6 and CCR5 KO mice (H-2b ) were transplanted with A/J kidneys (H-2a ); select cohorts received adoptive cell therapy (ACT) with alloprimed CXCR5+ CD8+ T cells (or control cells) on day 5 after KTx. ACT efficacy was evaluated by measuring posttransplant alloantibody, pathology, and allograft survival. Recipients were assessed for the quantity of CXCR5+ CD8+ T cells and CD8-mediated cytotoxicity to alloprimed IgG+ B cells. Alloantibody titer in CCR5 KO recipients was four-fold higher than in C57BL/6 recipients. The proportion of alloprimed CXCR5+ CD8+ T cells 7 days after KTx in peripheral blood, lymph node, and spleen was substantially lower in CCR5 KO compared to C57BL/6 recipients. In vivo cytotoxicity towards alloprimed IgG+ B cells was also reduced six-fold in CCR5 KO recipients. ACT with alloprimed CXCR5+ CD8+ T cells (but not alloprimed CXCR5- CD8+ or third-party primed CXCR5+ CD8+ T cells) substantially reduced alloantibody titer, ameliorated AMR pathology, and prolonged allograft survival. These results indicate that a deficiency in quantity and function of alloprimed CXCR5+ CD8+ T cells contributes to high alloantibody and AMR in CCR5 KO recipient mice, which can be rescued with ACT.
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Affiliation(s)
- Jason M. Zimmerer
- Department of Surgery, Comprehensive Transplant Center, The Ohio State University, Columbus, OH
| | - Jing L. Han
- Department of Surgery, Comprehensive Transplant Center, The Ohio State University, Columbus, OH,Biomedical Sciences Graduate Program, The Ohio State University College of Medicine, Columbus, OH
| | - Chelsea M. Peterson
- Department of Surgery, Comprehensive Transplant Center, The Ohio State University, Columbus, OH
| | - Qiang Zeng
- Center for Regenerative Medicine, The Research Institute at Nationwide Children’s Hospital, Columbus, OH
| | - Bryce A. Ringwald
- Medical Student Research Program, The Ohio State University College of Medicine, Columbus, OH
| | - Clarissa Cassol
- Department of Pathology, The Ohio State University, Columbus, OH
| | - Sachi Chaudhari
- Department of Surgery, Comprehensive Transplant Center, The Ohio State University, Columbus, OH
| | - Madison Hart
- Department of Surgery, Comprehensive Transplant Center, The Ohio State University, Columbus, OH
| | | | - Anjali Satoskar
- Department of Pathology, The Ohio State University, Columbus, OH
| | | | - Jiao-Jing Wang
- Department of Surgery, Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Robert T. Warren
- Department of Surgery, Comprehensive Transplant Center, The Ohio State University, Columbus, OH
| | - Zheng J. Zhang
- Department of Surgery, Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Christopher K. Breuer
- Center for Regenerative Medicine, The Research Institute at Nationwide Children’s Hospital, Columbus, OH
| | - Ginny L. Bumgardner
- Department of Surgery, Comprehensive Transplant Center, The Ohio State University, Columbus, OH
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Hemminger J, AbuAlsheikh N, Kahwash S. Identification and reporting of common hemoglobin disorders: A review. Ibnosina Journal of Medicine and Biomedical Sciences 2022. [DOI: 10.4103/1947-489x.210759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Hemoglobinopathies and thalassemias constitute a major cause of anemia worldwide. Some of these disorders may necessitate chronic red blood cell transfusion therapy, which frequently results in a host of serious clinical sequelae, including iron overload. The following review attempts to offer a simplified approach to the identification of the most commonly encountered hemoglobin disorders. In addition, practical comments on reporting the results of hemoglobin studies and the expected clinical impact of the various findings are discussed.
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Affiliation(s)
- Jessica Hemminger
- Department of Pathology, The Ohio State University, Columbus, Ohio, USA
| | - Nazih AbuAlsheikh
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Samir Kahwash
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
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Ware K, Yildiz V, Xiao M, Medipally A, Hemminger J, Scarl R, Satoskar AA, Hebert L, Ivanov I, Biederman L, Brodsky SV. Hypertension and the Kidney: Reduced Kidney Mass Is Bad for Both Normotensive and Hypertensive Rats. Am J Hypertens 2021; 34:1196-1202. [PMID: 34181718 PMCID: PMC9526805 DOI: 10.1093/ajh/hpab103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/17/2020] [Revised: 04/21/2021] [Accepted: 06/25/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Hypertension is a leading cause of chronic kidney disease worldwide. Early studies demonstrated the short-term effects of hypertension on kidney function and morphology in ablative nephropathy. The aim of this study was to investigate the long-term consequences of hypertension in 5/6 nephrectomy (5/6NE) model. METHODS Reduction of the kidney mass by 5/6NE was created in spontaneous hypertensive rats (SHR) and genetically similar normotensive Wistar Kyoto (WKY) rats. Blood pressure, serum creatinine (SCr), hematuria, and proteinuria were monitored weekly for 23 weeks. Kidney morphology was assessed at the end of the study. Sham-operated rats from both strains were used as controls. RESULTS Rats with 5/6NE had increased SCr, blood pressure, hematuria, and proteinuria in both SHR and WKY. Even though the SCr levels and blood pressure were greater in 5/6NE SHR as compared with 5/6NE WKY rats, absolute changes from sham-operated rats were not statistically significant between these 2 groups. 5/6NE SHR had earlier onset and higher proteinuria than 5/6NE WKY rats. Hematuria was similar in 5/6NE SHR and 5/6NE WKY rats. However, 5/6NE SHR had enlarged glomeruli, increased interstitial fibrosis, and prominent intimal thickening in the small arteries/arterioles as compared with 5/6NE WKY rats. CONCLUSIONS The long-term severity of kidney injury correlated with higher blood pressure. Reduction of the kidney mass increases SCr, hematuria, proteinuria, and blood pressure in both normotensive and hypertensive rats. Histological assessment provides better information about underlying chronic kidney injury than actual changes in SCr and urinalysis.
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Affiliation(s)
- Kyle Ware
- Department of Pathology, The Ohio State University, Columbus, Ohio, USA
| | - Vedat Yildiz
- Center for Biostatistics, College of Medicine, Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA
| | - Min Xiao
- Department of Pathology, The Ohio State University, Columbus, Ohio, USA
| | - Ajay Medipally
- Department of Pathology, The Ohio State University, Columbus, Ohio, USA
| | | | - Rachel Scarl
- Department of Pathology, The Ohio State University, Columbus, Ohio, USA
| | - Anjali A Satoskar
- Department of Pathology, The Ohio State University, Columbus, Ohio, USA
| | - Lee Hebert
- Department of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Iouri Ivanov
- Department of Pathology, The Ohio State University, Columbus, Ohio, USA
| | - Laura Biederman
- Department of Pathology, The Ohio State University, Columbus, Ohio, USA
| | - Sergey V Brodsky
- Department of Pathology, The Ohio State University, Columbus, Ohio, USA,Correspondence: Sergey V. Brodsky ()
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Pearlman R, Hemminger J, Hampel H, Frankel WL. "Histology of colorectal adenocarcinoma with double somatic mismatch-repair mutations is indistinguishable from those caused by Lynch syndrome"-reply. Hum Pathol 2019; 89:116-117. [PMID: 31075301 DOI: 10.1016/j.humpath.2019.04.017] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 04/18/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Rachel Pearlman
- Department of Internal Medicine, Division of Human Genetics, The Ohio State University Wexner Medical Center, Columbus, OH.; Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Jessica Hemminger
- Department of Internal Medicine, Division of Human Genetics, The Ohio State University Wexner Medical Center, Columbus, OH.; Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Heather Hampel
- Department of Internal Medicine, Division of Human Genetics, The Ohio State University Wexner Medical Center, Columbus, OH.; Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Wendy L Frankel
- Department of Internal Medicine, Division of Human Genetics, The Ohio State University Wexner Medical Center, Columbus, OH.; Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH..
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Brodsky SV, Satoskar A, Hemminger J, Rovin B, Hebert L, Ryan MS, Nadasdy T. Anticoagulant-Related Nephropathy in Kidney Biopsy: A Single-Center Report of 41 Cases. Kidney Med 2019; 1:51-56. [PMID: 32715287 PMCID: PMC7380361 DOI: 10.1016/j.xkme.2019.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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] [Indexed: 10/27/2022] Open
Abstract
Rationale & Objective In 2009, the first case of acute kidney injury and occlusive red blood cell (RBC) tubular casts associated with a high international normalized ratio in a patient receiving warfarin was identified. This entity, named warfarin-related nephropathy, was later renamed anticoagulant-related nephropathy (ARN) after similar cases with other anticoagulants were described. We provide our 10-year experience with ARN based on a single-center kidney biopsy laboratory. Study Design The kidney pathology database at the Ohio State University Wexner Medical Center (OSUWMC) was searched for native kidney biopsy cases consistent with ARN. Clinical data were obtained from patient medical records. Setting & Participants Native kidney biopsies evaluated between January 1, 2009, and December 31, 2017 at OSUWMC. Results Among 8,636 native kidney biopsies reviewed at the OSUWMC, there were 41 (0.5%) patients for whom deterioration in kidney function could not be explained by kidney biopsy findings alone if anticoagulation was not considered. There were 63% men and 95% were white; average age was 62 ± 14 years. Most were on warfarin therapy (N = 28), although cases were also attributed to direct-acting anticoagulants (N = 2), antiplatelet medications (N = 1), heparin or enoxaparin (N = 4), and disseminated intravascular coagulopathy (N = 6). Morphologically, there was acute tubular necrosis and RBC casts. The majority of biopsies had an underlying glomerular disease and many patients had positive serologic test results. In all these cases, the severity of kidney failure, RBC tubular casts, and hematuria were disproportionate to glomerular morphologic changes. Limitations Selection bias in the decision to perform a kidney biopsy. Conclusions ARN is an uncommon diagnosis in kidney pathology practice, but it should be considered when the number of RBC tubular casts is disproportionate to the severity of glomerular changes in a kidney biopsy in patients either receiving anticoagulation therapy or who presented with acute coagulopathy. Our data suggest that anticoagulation aggravates underlying glomerular diseases rather than directly affecting the glomerular filtration barrier.
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Affiliation(s)
- Sergey V Brodsky
- Departments of Pathology (SVB, AS, JH, TN) and Medicine (BR, LH), Ohio State University, Columbus, OH; and Department of Pathology, Mayo Clinic, Scottsdale, AZ (MSR)
| | - Anjali Satoskar
- Departments of Pathology (SVB, AS, JH, TN) and Medicine (BR, LH), Ohio State University, Columbus, OH; and Department of Pathology, Mayo Clinic, Scottsdale, AZ (MSR)
| | - Jessica Hemminger
- Departments of Pathology (SVB, AS, JH, TN) and Medicine (BR, LH), Ohio State University, Columbus, OH; and Department of Pathology, Mayo Clinic, Scottsdale, AZ (MSR)
| | - Brad Rovin
- Departments of Pathology (SVB, AS, JH, TN) and Medicine (BR, LH), Ohio State University, Columbus, OH; and Department of Pathology, Mayo Clinic, Scottsdale, AZ (MSR)
| | - Lee Hebert
- Departments of Pathology (SVB, AS, JH, TN) and Medicine (BR, LH), Ohio State University, Columbus, OH; and Department of Pathology, Mayo Clinic, Scottsdale, AZ (MSR)
| | - Margaret S Ryan
- Departments of Pathology (SVB, AS, JH, TN) and Medicine (BR, LH), Ohio State University, Columbus, OH; and Department of Pathology, Mayo Clinic, Scottsdale, AZ (MSR)
| | - Tibor Nadasdy
- Departments of Pathology (SVB, AS, JH, TN) and Medicine (BR, LH), Ohio State University, Columbus, OH; and Department of Pathology, Mayo Clinic, Scottsdale, AZ (MSR)
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Hemminger J, Arole V, Ayoub I, Brodsky SV, Nadasdy T, Satoskar AA. Acute glomerulonephritis with large confluent IgA-dominant deposits associated with liver cirrhosis. PLoS One 2018; 13:e0193274. [PMID: 29634718 PMCID: PMC5892865 DOI: 10.1371/journal.pone.0193274] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 02/07/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Small glomerular IgA deposits have been reported in patients with liver cirrhosis, mainly as an incidental finding in autopsy studies. We recently encountered nine cirrhotic patients who presented with acute proliferative glomerulonephritis with unusually large, exuberant glomerular immune complex deposits, in the absence of systemic lupus erythematosus (SLE) or monoclonal gammopathy-related kidney disease. Deposits were typically IgA dominant/codominant. Our aim was to further elucidate the etiology, diagnostic pitfalls, and clinical outcomes. METHODS We present clinical features and kidney biopsy findings of nine cirrhotic patients with an unusual acute immune complex glomerulonephritis. We also identified native kidney biopsies from all patients with liver cirrhosis at our institution over a 13-year period (January 2004 to December 2016) to evaluate presence of glomerular IgA deposits in them (n = 118). RESULTS Six of nine cirrhotic patients with the large immune deposits had a recent/concurrent acute bacterial infection, prompting a diagnosis of infection-associated glomerulonephritis and treatment with antibiotics. In the remaining three patients, no infection was identified and corticosteroids were initiated. Three of nine patients recovered kidney function (one recovered kidney function after liver transplant); three patients developed chronic kidney disease but remained off dialysis; two patients became dialysis-dependent and one patient developed sepsis and expired shortly after biopsy. Within the total cohort of 118 patients with cirrhosis, 67 others also showed IgA deposits, albeit small; and 42 patients had no IgA deposits. CONCLUSIONS These cases provide support to the theory that liver dysfunction may compromise clearance of circulating immune complexes, enabling deposition in the kidney. At least in a subset of cirrhotic patients, a superimposed bacterial infection may serve as a "second-hit" and lead to acute glomerulonephritis with exuberant immune complex deposits. Therefore, a trial of antibiotics is recommended and caution is advised before immunosuppressive treatment is offered. Unfortunately, most of these patients have advanced liver failure; therefore both diagnosis and management remain a challenge.
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Affiliation(s)
- Jessica Hemminger
- Department of Pathology, Division of Renal and Transplant Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
| | - Vidya Arole
- Department of Pathology, Division of Renal and Transplant Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
| | - Isabelle Ayoub
- Department of Internal Medicine, Division of Nephrology, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
| | - Sergey V. Brodsky
- Department of Pathology, Division of Renal and Transplant Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
| | - Tibor Nadasdy
- Department of Pathology, Division of Renal and Transplant Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
| | - Anjali A. Satoskar
- Department of Pathology, Division of Renal and Transplant Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
- * E-mail:
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Brodsky SV, Mhaskar NS, Thiruveedi S, Dhingra R, Reuben SC, Calomeni E, Ivanov I, Satoskar A, Hemminger J, Nadasdy G, Hebert L, Rovin B, Nadasdy T. Acute kidney injury aggravated by treatment initiation with apixaban: Another twist of anticoagulant-related nephropathy. Kidney Res Clin Pract 2017; 36:387-392. [PMID: 29285431 PMCID: PMC5743048 DOI: 10.23876/j.krcp.2017.36.4.387] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 08/29/2017] [Accepted: 09/15/2017] [Indexed: 12/02/2022] Open
Abstract
Anticoagulant-related nephropathy (ARN) was initially described in patients on warfarin (as warfarin-related nephropathy) and recently in those using dabigatran. Herein, we report clinical history and kidney biopsy findings in a patient on apixaban (Eliquis). Initiation of treatment with apixaban resulted in aggravation of preexisting mild acute kidney injury (AKI). A few days after apixaban therapy, the patient became oligoanuric, and kidney biopsy showed severe acute tubular necrosis with numerous occlusive red blood cell casts. Only one out of 68 glomeruli with open capillary loops had small segmental cellular crescent. Therefore, there was major discrepancy between the degree of glomerular injury and the glomerular hematuria. Considering that the onset of this AKI was associated with apixaban treatment initiation, we propose that this patient had ARN associated with factor Xa inhibitor (apixaban), which has not previously been described. Monitoring of kidney function is recommended after initiation of anticoagulant therapy.
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Affiliation(s)
- Sergey V Brodsky
- Department of Pathology, The Ohio State University, Columbus, OH, USA
| | - Nilesh S Mhaskar
- Department of Medicine, Wright State University, Dayton, OH, USA
| | | | - Rajnish Dhingra
- Department of Medicine, Wright State University, Dayton, OH, USA
| | - Sharon C Reuben
- Department of Medicine, Wright State University, Dayton, OH, USA.,Department of Internal Medicine, Kettering Hospital, Kettering, OH, USA
| | - Edward Calomeni
- Department of Pathology, The Ohio State University, Columbus, OH, USA
| | - Iouri Ivanov
- Department of Pathology, The Ohio State University, Columbus, OH, USA
| | - Anjali Satoskar
- Department of Pathology, The Ohio State University, Columbus, OH, USA
| | - Jessica Hemminger
- Department of Pathology, The Ohio State University, Columbus, OH, USA
| | - Gyongyi Nadasdy
- Department of Pathology, The Ohio State University, Columbus, OH, USA
| | - Lee Hebert
- Department of Medicine, The Ohio State University, Columbus, OH, USA
| | - Brad Rovin
- Department of Medicine, The Ohio State University, Columbus, OH, USA
| | - Tibor Nadasdy
- Department of Pathology, The Ohio State University, Columbus, OH, USA
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Maly JJ, Wei L, Hemminger J, Christian B, Maddocks KJ, Jones JA, Wright C, Blum KA. Association of FDG PET-CT (PET) avid skeletal lesions (SL) with progression-free survival (PFS) in patients (pts) with previously untreated follicular lymphoma (FL). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e19026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19026 Background: PET scan is frequently utilized in FL. Reduced EFS has been observed in DLBCL pts with SL treated with RCHOP (Held, JCO 31:4115, 2013). Methods: We performed a retrospective single center study to assess outcomes of FL pts with PET avid SL between January 2005 and November 2015. 131 pts with newly diagnosed FL and PET performed within 1 month of diagnosis were included. Results: 32 of these pts had SL (median 4, range 1-11) on initial PET. Median age was 57 (range 43-79), 15 (47%) were female, 30 (94%) had stage IV disease, LDH was elevated in 6 (19%), 6 (19%) had bulky disease > 6 cm, and FLIPI-1 score was low in 5, intermediate in 11, and high 16 pts. 27 pts had grade (gr) 1-2 FL, 2 had gr 3a, and 3 had gr 3 (not classified). All but 1 patient received rituximab (R)-containing therapy (9 received BR, 7 received RCHOP, 5 RCVP, 9 other). 8 pts received maintenance R, and none received radiation. There were no statistically significant differences in median age, tumor gr, LDH, or use of anthracycline containing therapy (28% in SL group vs 16% in non-SL group, p = 0.13) in pts with SL compared to those without SL (n = 99). Pts with SL had higher incidence of bone marrow involvement (27% vs 9%, p = 0.013). With a median follow-up of 35 months, SL pts had 44% rate of transformation to DLBCL compared 12% in non-SL pts (p = 0.004). Median PFS was 45.8 months in SL pts not-reached in non-SL pts (p = 0.003). Median OS was 105.9 months in SL pts and not reached in non-SL pts (p = 0.08). In the multi-variate analysis, SL (p = 0.037), male gender (p = 0.048), higher FLIPI-1 score (p = 0.009), and absence of anthracycline containing therapy (p = 0.005) were significantly associated with decreased PFS using backward selection. Conclusions: The presence of PET identified SL in previously untreated FL is associated with an increased risk of transformation and reduced PFS in this single center retrospective analysis. Larger studies of uniformly treated pts are needed to validate these data. The identification of high-risk PET avid SL in FL pts in future prospective therapeutic trials could be used to select pts for specific induction regimens, maintenance rituximab, or consolidative radiation.
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Affiliation(s)
- Joseph J. Maly
- The Ohio State University James Cancer Hospital, Columbus, OH
| | - Lai Wei
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Beth Christian
- The Ohio State Univeristy Wexner Medical Center, Columbus, OH
| | - Kami J. Maddocks
- Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Chad Wright
- Ohio State University Wexner Medical Center, Columbus, OH
| | - Kristie A. Blum
- Department of Internal Medicine, Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
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Eulitt P, Fabian D, Kelly C, Hemminger J, William BM. Waldenström's macroglobulinemia masquerading as ovarian cancer with peritoneal carcinomatosis, ascites, and elevated CA-125. Hematol Oncol Stem Cell Ther 2017; 12:54-59. [PMID: 28390215 DOI: 10.1016/j.hemonc.2017.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 08/14/2016] [Revised: 01/24/2017] [Accepted: 02/17/2017] [Indexed: 12/26/2022] Open
Abstract
Waldenström's macroglobulinemia is a rare hematology malignancy which often presents with "B symptoms," anemia, and thrombocytopenia. A 46-year-old woman presented with 2 months of abdominal distension accompanied by an unintentional 20-lb weight loss. Her abdominal CT scan demonstrated diffuse carcinomatosis with bilateral ovarian lesions and screening labs revealed a markedly elevated CA-125, suggesting a diagnosis of ovarian cancer. Upon admission for workup, patient was found to have a significant protein gap, later attributed to a markedly elevated IgM. Omental and bone marrow biopsy confirmed the diagnosis of Waldenström's macroglobulinemia, with elevation in CA-125 thought to be secondary to peritoneal irritation. This patient has since been successfully treated with six cycles of bendamusine and rituximab with no evidence of disease on staging scans and normalization of both CA-125 and IgM. To our knowledge, this is the first documented case of Waldenström's macroglobulinemia presenting with symptoms classically associated with ovarian cancer and demonstrates the importance of maintaining a broad differential when evaluating patients with abdominal carcinomatosis.
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Affiliation(s)
- Patrick Eulitt
- Ohio State University, Wexner Medical Center, 460 West 10th Avenue, Columbus, OH 43210, USA.
| | - Denise Fabian
- Ohio State University, Wexner Medical Center, 460 West 10th Avenue, Columbus, OH 43210, USA
| | - Crystal Kelly
- Ohio State University, Wexner Medical Center, 460 West 10th Avenue, Columbus, OH 43210, USA
| | - Jessica Hemminger
- Ohio State University, Wexner Medical Center, 460 West 10th Avenue, Columbus, OH 43210, USA
| | - Basem M William
- Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, A352 Starling Loving Hall, 320 W. 10th Avenue, Columbus, OH 43210, USA
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10
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Satoskar AA, Suleiman S, Ayoub I, Hemminger J, Parikh S, Brodsky SV, Bott C, Calomeni E, Nadasdy GM, Rovin B, Hebert L, Nadasdy T. Staphylococcus Infection-Associated GN - Spectrum of IgA Staining and Prevalence of ANCA in a Single-Center Cohort. Clin J Am Soc Nephrol 2017; 12:39-49. [PMID: 27821389 PMCID: PMC5220658 DOI: 10.2215/cjn.05070516] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [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: 05/09/2016] [Accepted: 09/15/2016] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND OBJECTIVES Staphylococcus infection-associated GN (SAGN) is a well recognized disease entity, particularly because of the frequent IgA-dominant glomerular immunoglobulin staining on kidney biopsy. Biopsy features can resemble two other disease entities - primary IgA nephropathy and Henoch-Schönlein purpura nephritis - posing a diagnostic pitfall. This is clinically relevant because of the crucial difference in the therapeutic approach. The diagnosis of SAGN is further complicated by the variability in the degree of glomerular IgA (and C3) staining, the extent of electron dense immune-type deposits, and positive ANCA serology in some patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We performed a thorough histopathologic review of our single-center cohort of 78 culture-proven SAGN biopsies to assess the spectrum of IgA staining, prevalence of ANCA serology, prevalence of subepithelial "humps," and other histologic features to distinguish from primary IgA nephropathy. RESULTS Among the 78 SAGN biopsies, IgA staining was trace in 25%, mild in 19%, moderate in 44%, and strong in 12% of the cases. C3 was frequently moderate-to-strong but was trace in 14% of the biopsies. Concomitantly trace IgA, IgG, and C3 (pauci-immune pattern) was seen in 13%. Crescents were present in 35% of the SAGN biopsies. Out of 41 patients tested for ANCA, nine (22%) were positive, including patients with endocarditis and other infections. Subepithelial humps were identified in only 31% of the SAGN biopsies. CONCLUSIONS SAGN biopsies show marked variability in IgA immunofluorescence staining and low frequency of subepithelial humps compared with poststreptococcal GN. Occasional ANCA positivity is present in cases of SAGN, even in infections other than endocarditis. Therefore, biopsy diagnosis can be difficult particularly when clinical symptoms of infection are subtle. Both the pathologist and the nephrologist should be aware of these diagnostic pitfalls.
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Affiliation(s)
| | | | - Isabelle Ayoub
- Department of Internal Medicine, Division of Nephrology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - Samir Parikh
- Department of Internal Medicine, Division of Nephrology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | | | | | | | - Brad Rovin
- Department of Internal Medicine, Division of Nephrology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Lee Hebert
- Department of Internal Medicine, Division of Nephrology, Ohio State University Wexner Medical Center, Columbus, Ohio
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Owen D, Alexander AJ, Wei L, Hemminger J, Shah MH. Abstract 3116: MGMT immunohistochemistry (IHC) as a biomarker for response to combination therapy with capecitabine and temozolomide (C/T) in patients (pts) with advanced neuroendocrine carcinomas (aNEC). Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-3116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Tumor O6-methylguanine-methyltransferase (MGMT) reverses temozolomide-induced DNA injury, and low MGMT tumor expression has been shown as a predictor of response to temozolomide in glioblastoma. C/T therapy induces partial responses in up to 70% of pts with grade 1-2 pancreatic NEC but the role of MGMT expression as a predictor is unclear. We evaluated MGMT expression by IHC as a prognostic and predictive biomarker for pts with aNEC of all grades and primary sites treated with C/T.
Methods: A retrospective review was carried out at Ohio State University of 29 pts with aNEC who received C/T therapy from 2009 to 2013 and who were evaluable for RECIST response. MGMT expression was assessed when available by IHC on pre-treatment tumor samples to test the hypothesis that low MGMT expression (<10%) predicts response to C/T therapy vs high levels (≥10%).
Results: Of 29 pts, primary NEC site was pancreas in 18 pts, and non-pancreas in 11 pts. Objective response, progression-free survival (PFS) and overall survival (OS) data are outlined in the Table. Partial response (PR) rate was 50% in pts with pancreas primary vs 18% for non-pancreas primary. High PRs were observed in pts with grade 3 NEC (57%). Median PFS in the MGMT-low group was 16.6 months vs 9.5 months in the MGMT-high group (p = 0.19). Median OS in the MGMT low group was 42.9 months vs 18.1 months in the MGMT-high group (p = 0.16). There was a trend toward higher rate of PR (63%) in pts whose tumors had low levels of MGMT expression compared to those with high levels (17%) (p = 0.18).
Conclusion: We observed a trend towards increased PR, median PFS, and median OS in aNEC pts whose tumors had low MGMT protein expression by IHC. The small sample size likely limited the statistical significance of the data. Results of this trial serve as strong rationale for future prospective trials to clarify role of MGMT expression in choosing C/T therapy for pts with NEC. Objective response rate, progression free survival (PFS) and overall survival (OS)N%PR%SD%PDMedian PFSp-valueMedian OSp-valueAll patients2938521013.029.3Low MGMT by IHC (<10%)126238016.60.1942.90.16High MGMT by IHC (≥10%)81767179.518.1Well-differentiated tumor grade (Ki-67 <3%)74357020.00.34NR0.027Moderately differentiated tumor grade (Ki-67 3-20%)13316189.525.9Poorly-differentiated tumor grade (Ki-67 >20%)75714298.413.1
Citation Format: Dwight Owen, Andrew J. Alexander, Lai Wei, Jessica Hemminger, Manisha H. Shah. MGMT immunohistochemistry (IHC) as a biomarker for response to combination therapy with capecitabine and temozolomide (C/T) in patients (pts) with advanced neuroendocrine carcinomas (aNEC). [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3116.
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Affiliation(s)
| | | | - Lai Wei
- Ohio State University, Columbus, OH
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Fauzi MFA, Pennell M, Sahiner B, Chen W, Shana'ah A, Hemminger J, Gru A, Kurt H, Losos M, Joehlin-Price A, Kavran C, Smith SM, Nowacki N, Mansor S, Lozanski G, Gurcan MN. Classification of follicular lymphoma: the effect of computer aid on pathologists grading. BMC Med Inform Decis Mak 2015; 15:115. [PMID: 26715518 PMCID: PMC4696238 DOI: 10.1186/s12911-015-0235-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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: 08/31/2015] [Accepted: 12/15/2015] [Indexed: 11/28/2022] Open
Abstract
Background Follicular lymphoma (FL) is one of the most common lymphoid malignancies in the western world. FL cases are stratified into three histological grades based on the average centroblast count per high power field (HPF). The centroblast count is performed manually by the pathologist using an optical microscope and hematoxylin and eosin (H&E) stained tissue section. Although this is the current clinical practice, it suffers from high inter- and intra-observer variability and is vulnerable to sampling bias. Methods In this paper, we present a system, called Follicular Lymphoma Grading System (FLAGS), to assist the pathologist in grading FL cases. We also assess the effect of FLAGS on accuracy of expert and inexperienced readers. FLAGS automatically identifies possible HPFs for examination by analyzing H&E and CD20 stains, before classifying them into low or high risk categories. The pathologist is first asked to review the slides according to the current routine clinical practice, before being presented with FLAGS classification via color-coded map. The accuracy of the readers with and without FLAGS assistance is measured. Results FLAGS was used by four experts (board-certified hematopathologists) and seven pathology residents on 20 FL slides. Access to FLAGS improved overall reader accuracy with the biggest improvement seen among residents. An average AUC value of 0.75 was observed which generally indicates “acceptable” diagnostic performance. Conclusions The results of this study show that FLAGS can be useful in increasing the pathologists’ accuracy in grading the tissue. To the best of our knowledge, this study measure, for the first time, the effect of computerized image analysis on pathologists’ grading of follicular lymphoma. When fully developed, such systems have the potential to reduce sampling bias by examining an increased proportion of HPFs within follicle regions, as well as to reduce inter- and intra-reader variability. Electronic supplementary material The online version of this article (doi:10.1186/s12911-015-0235-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Michael Pennell
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Berkman Sahiner
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, USA
| | - Weijie Chen
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, USA
| | - Arwa Shana'ah
- Department of Pathology, The Ohio State University, Columbus, OH, USA
| | - Jessica Hemminger
- Department of Pathology, The Ohio State University, Columbus, OH, USA
| | - Alejandro Gru
- Department of Pathology, The Ohio State University, Columbus, OH, USA
| | - Habibe Kurt
- Department of Pathology, The Ohio State University, Columbus, OH, USA
| | - Michael Losos
- Department of Pathology, The Ohio State University, Columbus, OH, USA
| | - Amy Joehlin-Price
- Department of Pathology, The Ohio State University, Columbus, OH, USA
| | - Christina Kavran
- Department of Pathology, The Ohio State University, Columbus, OH, USA
| | - Stephen M Smith
- Department of Pathology, The Ohio State University, Columbus, OH, USA
| | - Nicholas Nowacki
- Department of Pathology, The Ohio State University, Columbus, OH, USA
| | - Sharmeen Mansor
- Department of Pathology, The Ohio State University, Columbus, OH, USA
| | - Gerard Lozanski
- Department of Pathology, The Ohio State University, Columbus, OH, USA
| | - Metin N Gurcan
- Department of Biomedical Informatics, The Ohio State University, 250 Lincoln Tower, 1800 Cannon Drive, Columbus, OH, 43210, USA.
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Hemminger J, Kandarpa M, Tsai A, Nadasdy T. Proliferative Glomerulonephritis With Monoclonal IgG1κ Deposits in a Hepatitis C Virus-Positive Patient. Am J Kidney Dis 2015; 67:703-8. [PMID: 26612277 DOI: 10.1053/j.ajkd.2015.08.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 08/15/2015] [Accepted: 10/08/2015] [Indexed: 02/07/2023]
Abstract
Hepatitis C virus infection is associated with several glomerular diseases, most commonly cryoglobulinemic glomerulonephritis, which is typically secondary to type II mixed cryoglobulinemia. We present a patient with hepatitis C virus infection and cryoglobulinemic glomerulonephritis secondary to type I (monoclonal) cryoglobulinemia that is likely related to a concurrent hepatitis C virus infection-associated lymphoproliferative disorder. We list the differential diagnosis of cryoglobulinemic glomerulonephritis. Additionally, the case draws attention to the possibility that, rarely, even clinically undetectable "occult" B-cell lymphoproliferative disorders may result in significant kidney disease.
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Affiliation(s)
| | | | | | - Tibor Nadasdy
- Department of Pathology, The Ohio State University, Columbus, OH.
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Evens AM, Kanakry JA, Sehn LH, Kritharis A, Feldman T, Kroll A, Gascoyne RD, Abramson JS, Petrich AM, Hernandez-Ilizaliturri FJ, Al-Mansour Z, Adeimy C, Hemminger J, Bartlett NL, Mato A, Caimi PF, Advani RH, Klein AK, Nabhan C, Smith SM, Fabregas JC, Lossos IS, Press OW, Fenske TS, Friedberg JW, Vose JM, Blum KA. Gray zone lymphoma with features intermediate between classical Hodgkin lymphoma and diffuse large B-cell lymphoma: characteristics, outcomes, and prognostication among a large multicenter cohort. Am J Hematol 2015; 90:778-83. [PMID: 26044261 DOI: 10.1002/ajh.24082] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 05/29/2015] [Accepted: 06/01/2015] [Indexed: 12/21/2022]
Abstract
Gray zone lymphoma (GZL) with features between classical Hodgkin lymphoma and diffuse large B-cell lymphoma (DLBCL) is a recently recognized entity reported to present primarily with mediastinal disease (MGZL). We examined detailed clinical features, outcomes, and prognostic factors among 112 GZL patients recently treated across 19 North American centers. Forty-three percent of patients presented with MGZL, whereas 57% had non-MGZL (NMGZL). NMGZL patients were older (50 versus 37 years, P = 0.0001); more often had bone marrow involvement (19% versus 0%, P = 0.001); >1 extranodal site (27% versus 8%, P = 0.014); and advanced stage disease (81% versus 13%, P = 0.0001); but they had less bulk (8% versus 44%, P = 0.0001), compared with MGZL patients. Common frontline treatments were cyclophosphamide-doxorubicin-vincristine-prednisone +/- rituximab (CHOP+/-R) 46%, doxorubicin-bleomycin-vinblastine-dacarbazine +/- rituximab (ABVD+/-R) 30%, and dose-adjusted etoposide-doxorubicin-cyclophosphamide-vincristine-prednisone-rituximab (DA-EPOCH-R) 10%. Overall and complete response rates for all patients were 71% and 59%, respectively; 33% had primary refractory disease. At 31-month median follow-up, 2-year progression-free survival (PFS) and overall survival rates were 40% and 88%, respectively. Interestingly, outcomes in MGZL patients seemed similar compared with that of NMGZL patients. On multivariable analyses, performance status and stage were highly prognostic for survival for all patients. Additionally, patients treated with ABVD+/-R had markedly inferior 2-year PFS (22% versus 52%, P = 0.03) compared with DLBCL-directed therapy (CHOP+/-R and DA-EPOCH-R), which persisted on Cox regression (hazard ratio, 1.88; 95% confidence interval, 1.03-3.83; P = 0.04). Furthermore, rituximab was associated with improved PFS on multivariable analyses (hazard ratio, 0.35; 95% confidence interval, 0.18-0.69; P = 0.002). Collectively, GZL is a heterogeneous and likely more common entity and often with nonmediastinal presentation, whereas outcomes seem superior when treated with a rituximab-based, DLBCL-specific regimen.
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Affiliation(s)
| | | | - Laurie H. Sehn
- Centre for Lymphoid Cancer, British Columbia Cancer Agency; Vancouver BC Canada
| | | | | | - Aimee Kroll
- Quantitative Health Sciences, The University of Massachusetts (UMASS); Worcester Massachusetts
| | - Randy D. Gascoyne
- Centre for Lymphoid Cancer, British Columbia Cancer Agency; Vancouver BC Canada
| | | | - Adam M. Petrich
- Northwestern University Feinberg School of Medicine; Chicago Illinois
| | | | | | | | | | | | - Anthony Mato
- Hackensack University Medical Center; Hackensack New Jersey
| | | | | | | | | | | | | | | | | | | | | | - Julie M. Vose
- University of Nebraska Medical Center; Omaha Nebraska
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Haverkos BM, Hemminger J, Geyer SM, Bingman A, Van Deusen K, Lustberg M, Wong H, Gru A, Ambinder R, Baiocchi RA, Porcu P. Prognostic implications, predictive value, and latency analysis of Epstein-Barr virus (EBV) DNA in advanced stage cutaneous T-cell lymphoma (AS-CTCL). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e19518] [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: 11/20/2022] Open
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Patel S, Hemminger J, Kahwash S. A nine month old boy with hemolytic anemia. Ibnosina Journal of Medicine and Biomedical Sciences 2013. [DOI: 10.4103/1947-489x.210549] [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: 11/04/2022]
Affiliation(s)
- Shweta Patel
- Department of Pathology and Laboratory Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Jessica Hemminger
- Department of Pathology and Laboratory Medicine, Wexner Medical Center at the Ohio State University, Columbus, Ohio, USA
| | - Samir Kahwash
- Department of Pathology, Nationwide Children's Hospital, 700 Children's Drive, Columbus OH 43205, Ohio, USA
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Hemminger J, Iwenofu OH. Discovered on gastrointestinal stromal tumours 1 (DOG1) expression in non-gastrointestinal stromal tumour (GIST) neoplasms. Histopathology 2012; 61:170-7. [DOI: 10.1111/j.1365-2559.2011.04150.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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