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Paulino M, Espinosa-Bustos C, Bertrand J, Cabezas D, Mella J, Dávila B, Cerecetto H, Ballesteros-Casallas A, Salas CO. Development of 3D-QSAR and pharmacophoric models to design new anti- Trypanosoma cruzi agents based on 2-aryloxynaphthoquinone scaffold. SAR QSAR Environ Res 2022; 33:701-728. [PMID: 36106834 DOI: 10.1080/1062936x.2022.2120069] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 08/28/2022] [Indexed: 06/15/2023]
Abstract
In this work we have collected a set of 30 trypanosomicidal naphthoquinones and developed pharmacophoric and 3D-QSAR models as tools for the design of new potential anti-Chagasic compounds. Firstly, qualitative information was obtained from SAR and pharmacophoric models identifying some fragments around the 2-aryloxynaphthoquinone scaffold important for the antiparasitic activity. Then, 3D-QSAR CoMFA and CoMSIA models were developed. The models showed adequate statistical parameters where the steric, electrostatic, and hydrophobic features explain the trypanosomicidal effect. Therefore, to validate our models, we carried out the design, synthesis, and biological evaluation on T. cruzi epimastigotes of five new compounds (33a-e). According to CoMFA model, three out of five compounds showed pIC50 values within one logarithmic unit of deviation. The two compounds that did not fit the predictions were those with high lipophilicity, which agreed with the SAR and pharmacophore models. Docking and molecular dynamic studies were performed on T. cruzi trypanothione reductase, in a proposed binding site for this type of naphthoquinone. Interestingly, 33a-e showed the same interaction pattern as a naphthoquinone inhibitor (2). Finally, predicted drug-likeness properties indicated that 33a-e have optimal oral bioavailability. Thus, this study provides new in silico models for obtaining novel trypanosomicidal compounds.
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Affiliation(s)
- M Paulino
- Área Bioinformática, Departamento de Experimentación y Teoría de la Materia y sus Aplicaciones, Facultad de Química, Universidad de la República, Montevideo, Uruguay
| | - C Espinosa-Bustos
- Departamento de Farmacia, Facultad de Química y de Farmacia, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - J Bertrand
- Departamento de Química Orgánica, Facultad de Química y de Farmacia, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - D Cabezas
- Instituto de Química y Bioquímica, Facultad de Ciencias, Universidad de Valparaíso, Valparaíso, Chile
| | - J Mella
- Instituto de Química y Bioquímica, Facultad de Ciencias, Universidad de Valparaíso, Valparaíso, Chile
- Centro de Investigación Farmacopea Chilena, Escuela de Química y Farmacia, Facultad de Farmacia, Universidad de Valparaíso, Valparaíso, Chile
| | - B Dávila
- Grupo de Química Orgánica Medicinal, Facultad de Ciencias, Universidad de la República, Montevideo, Uruguay
| | - H Cerecetto
- Grupo de Química Orgánica Medicinal, Facultad de Ciencias, Universidad de la República, Montevideo, Uruguay
- Área de Radiofarmacia, Centro de Investigaciones Nucleares, Facultad de Ciencias, Universidad de la República, Montevideo, Uruguay
| | - A Ballesteros-Casallas
- Área Bioinformática, Departamento de Experimentación y Teoría de la Materia y sus Aplicaciones, Facultad de Química, Universidad de la República, Montevideo, Uruguay
| | - C O Salas
- Departamento de Química Orgánica, Facultad de Química y de Farmacia, Pontificia Universidad Católica de Chile, Santiago, Chile
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Balakrishnan B, Siddiqi A, Mella J, Lupo A, Li E, Hollien J, Johnson J, Lai K. Salubrinal enhances eIF2α phosphorylation and improves fertility in a mouse model of Classic Galactosemia. Biochim Biophys Acta Mol Basis Dis 2019; 1865:165516. [PMID: 31362041 DOI: 10.1016/j.bbadis.2019.07.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 02/20/2019] [Revised: 07/15/2019] [Accepted: 07/23/2019] [Indexed: 12/12/2022]
Abstract
Loss of galactose-1 phosphate uridylyltransferase (GALT) activity in humans results in Classic Galactosemia, and the GalT-deficient (GalT-/-) mouse mimics the patient condition. GalT-/- ovaries display elevated endoplasmic reticulum (ER) stress marker, BiP, and downregulated canonical phosphatidylinositol 3-kinase (Pi3k)/protein kinase B (Akt) growth/pro-survival signaling. Numbers of primordial follicles are reduced in the mutants, recapitulating the accelerated ovarian aging seen in human patients. We previously found that oral administration of the compound Salubrinal (an eIF2α phosphatase inhibitor), resulted in reduction of ovarian BiP expression, rescued Pi3k/Akt signaling, and a doubling of primordial follicles in GalT-/- adults. Here, we further characterized galactosemic stress in GalT-/- mice versus wild-type (WT) controls, and examined whether Salubrinal treatment improved broader reproductive parameters. We assessed the expression levels of factors of the unfolded protein response (UPR), and found that BiP, phospho-Perk, and phospho-eIF2α were all elevated in GalT-/- ovaries. However, neither IKK activation (NFκB pathway) nor alternative Xbp1 splicing downstream of ER membrane protein Ire1α activation was induced, suggesting an Xbp1-independent UPR in galactosemic stress. Moreover, Salubrinal treatment significantly increased the number of ovulated eggs in mutant animals after gonadotrophic superovulation. Salubrinal treatment also normalized estrus cycle stage lengths and resulted in significantly larger litter sizes than vehicle-treated mutants. Overall, we show that Salubrinal protects against galactosemia-induced primordial follicle loss in a fashion that includes suppressing the de-phosphorylation of eIF2α, and that intervention in this way significantly improves and extends ovarian function, fertility, and fecundity.
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Affiliation(s)
- B Balakrishnan
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, United States
| | - A Siddiqi
- Department of Pathology and Laboratory Medicine, University of Florida College of Medicine, United States
| | - J Mella
- School of Biological Sciences, University of Utah College of Science, United States
| | - A Lupo
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, United States
| | - E Li
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, United States
| | - J Hollien
- School of Biological Sciences, University of Utah College of Science, United States
| | - J Johnson
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Colorado, United States.
| | - K Lai
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, United States.
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Abstract
We propose a generalization of the Su-Schrieffer-Heeger (SSH) model of the bipartite lattice, consisting of a periodic array of domain walls. The low-energy description is governed by the superposition of localized states at each domain wall, forming an effective mono-atomic chain at a larger scale. When the domain walls are dimerized, topologically protected edge states can appear, just like in the original SSH model. These new edge states are formed exclusively by soliton-like states and therefore, the new topological states are qualitatively different from the regular SSH edge states. They posses a much longer localization length and are more resistant to on-site disorder, in marked contrast to the standard SSH case.
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Affiliation(s)
- F Munoz
- Departamento de Física, Facultad de Ciencias, Universidad de Chile, Santiago, Chile. .,Center for the Development of Nanoscience and Nanotechnology (CEDENNA), Santiago, Chile.
| | - Fernanda Pinilla
- Departamento de Física, Facultad de Ciencias, Universidad de Chile, Santiago, Chile
| | - J Mella
- Departamento de Física, Facultad de Ciencias, Universidad de Chile, Santiago, Chile.,Center for the Development of Nanoscience and Nanotechnology (CEDENNA), Santiago, Chile
| | - Mario I Molina
- Departamento de Física, Facultad de Ciencias, Universidad de Chile, Santiago, Chile.,MSI-Nucleus on Advanced Optics, Facultad de Ciencias, Universidad de Chile, Santiago, Chile
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Orozco F, Anders M, Mella J, Antinucci F, Pagano P, Esteban P, Cartier M, Romero G, Francini B, Mastai R. [Adrenal insufficiency in cirrhotic patients]. Medicina (B Aires) 2016; 76:208-212. [PMID: 27576278] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Relative adrenal insufficiency (RAI) is a common finding in cirrhotic patients with severe sepsis, and increased mortality. Its significance is unknown in stable conditions. The aim of this study was to evaluate the prevalence of RAI in stable cirrhotic patients at different stages of the disease. Also, the impact of RAI on the survival was evaluated and basal cortisol levels between plasma and saliva was correlated in control subjects and cirrhotic patients. Forty seven ambulatory patients and 16 control subjects were studied. RAI was defined as a serum cortisol increase of less than 9 υg/dl from baseline after the stimulation with 250 mg of synthetic ACTH. Twenty two had Child-Pugh = 8 and 25 = 9. The prevalence of RAI in patients with stable cirrhosis was 22%. A higher incidence of RAI was observed in patients with a Child-Pugh = 9 (8/32) than in those with = 8 (3/13, p < 0.05). A correlation between salivary cortisol and basal plasma cortisol (r = 0.6, p < 0.0004) was observed. Finally, survival at 1 year (97%) and 3 years (91%) was significantly higher without RAI than those who developed this complication (79% and 51%, p < 0.05, respectively). In summary, the prevalence of RAI is frequent in patients with stable cirrhosis and that it is related to the severity of liver diseaseand increased mortality.
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Affiliation(s)
- Federico Orozco
- Servicio de Hepatología y Unidad de Trasplante, Hospital Alemán, Argentina.E-mail:
| | - María Anders
- Servicio de Hepatología y Unidad de Trasplante, Hospital Alemán, Argentina
| | - José Mella
- Servicio de Hepatología y Unidad de Trasplante, Hospital Alemán, Argentina
| | | | | | | | - Mariano Cartier
- Unidad de Hepatología, Hospital Bonorino Udaondo, Buenos Aires, Argentina
| | - Gustavo Romero
- Unidad de Hepatología, Hospital Bonorino Udaondo, Buenos Aires, Argentina
| | - Bettina Francini
- Servicio de Hepatología y Unidad de Trasplante, Hospital Alemán, Argentina
| | - Ricardo Mastai
- Servicio de Hepatología y Unidad de Trasplante, Hospital Alemán, Argentina
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Andrades J, Campanini J, Vásquez D, Silvestri C, Morales C, Romero J, Mella J. A combined CoMFA and CoMSIA 3D-QSAR study of benzamide type antibacterial inhibitors of the FtsZ protein in drug-resistant Staphylococcus aureus. SAR QSAR Environ Res 2015; 26:925-942. [PMID: 26505124 DOI: 10.1080/1062936x.2015.1095798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A major problem today is bacterial resistance to antibiotics and the small number of new therapeutic agents approved in recent years. The development of new antibiotics capable of acting on new targets is urgently required. The filamenting temperature-sensitive Z (FtsZ) bacterial protein is a key biomolecule for bacterial division and survival. This makes FtsZ an attractive new pharmacological target for the development of antibacterial agents. There have been several attempts to develop ligands able to inhibit FtsZ. Despite the large number of synthesized compounds that inhibit the FtsZ protein, there are no quantitative structure-activity relationships (QSAR) that allow for the rational design and synthesis of promising new molecules. We present the first 3D-QSAR study of a large and diverse set of molecules that are able to inhibit the FtsZ bacterial protein. We summarize a set of chemical changes that can be made in the steric, electrostatic, hydrophobic and donor/acceptor hydrogen-bonding properties of the pharmacophore, to generate new bioactive molecules against FtsZ. These results provide a rational guide for the design and synthesis of promising new antibacterial agents, supported by the strong statistical parameters obtained from CoMFA (r(2)(pred) = 0.974) and CoMSIA (r(2)(pred) = 0.980) analyses.
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Affiliation(s)
- J Andrades
- a Departamento de Química Farmacológica y Toxicológica , Universidad de Chile , Santiago , Chile
| | - J Campanini
- a Departamento de Química Farmacológica y Toxicológica , Universidad de Chile , Santiago , Chile
| | - D Vásquez
- a Departamento de Química Farmacológica y Toxicológica , Universidad de Chile , Santiago , Chile
| | - C Silvestri
- b Department of Bioengineering , Imperial College London , London , England
| | - C Morales
- c Departamento de Ciencias Químicas y Biológicas , Universidad Bernardo O Higgins , Santiago , Chile
| | - J Romero
- d Department of Pharmacy , Pontificia Universidad Católica de Chile , Santiago , Chile
| | - J Mella
- e Instituto de Química y Bioquímica, Universidad de Valparaíso , Valparaíso , Chile
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Antinucci F, Anders M, Orozco F, Mella J, Cobos M, McCormack L, Mastai R. [De novo malignant tumors following liver transplantation. A single-center experience in Argentina]. Medicina (B Aires) 2015; 75:18-22. [PMID: 25637895] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
The aim of the present study was to evaluate the incidence and clinical features of de novo tumors in patients undergoing liver transplantation in our center as well as to assess survival. We retrospectively analyzed 168 liver transplantations (159 patients) performed from May 2006 to May 2014. The incidence of de novo tumors was 7.5% (n = 12). The mean age at diagnosis was 63 ± 7 years. The most frequent neoplasms were non melanoma skin tumors and adenocarcinomas. Fifty percent of the tumors developed in the second and third year after transplantation. Type of immunosuppression did not influence tumoral type, although most patients receive tacrolimus in combination with mycofenolate and/or corticoids. The mean duration of follow-up after diagnosis of the tumor was 25 ± 29 months (range 0-76) and the mortality was 41%. The actuarial probability of survival at 1 and 5 years was 83 and 55%, respectively. De novo tumors are frequent after liver transplantation and their clinical course differs from that in the general population. Because their clinical course is more aggressive, regular follow up of these patients is essential for early diagnosis.
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Affiliation(s)
- Florencia Antinucci
- Programa Trasplante Hepático, Unidad de Trasplante, Hospital Alemán, Buenos Aires, Argentina
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Boerr E, Anders M, Mella J, Quiñonez E, Goldaracena N, Orozco F, McCormack L, Mastai R. [Cost analysis of liver transplantation in a community hospital: association with the Model for End-stage Liver Disease, a prognostic index to prioritize the most severe patients]. Gastroenterol Hepatol 2012; 36:1-6. [PMID: 23123035 DOI: 10.1016/j.gastrohep.2012.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2012] [Revised: 08/23/2012] [Accepted: 08/28/2012] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The aim of the present study was to investigate the impact of the Model for End-stage Liver Disease (MELD) on transplantation costs. MATERIAL AND METHODS We included all patients who received a liver transplant for end-stage liver disease between 2006 and 2010. The study period encompassed the day of transplantation until hospital discharge. The patients were classified into two groups: those with a MELD score of 6-19 and those with a score of 20-40. RESULTS The mean MELD score at transplantation was 19.2±7.0 (mean±SD). The mean cost per procedure in the study period was USD 33,461 per patient (range 21,795-104,629). The cost of transplantation was USD 30,493±8,825 in patients with a MELD score of 6-19 and was USD 36,506±15,833 in those with a score of 20-40; this difference was statistically significant (P=.04). In a stepwise logistic regression analysis, the only independent predictor of high cost was having a MELD score of 20 (OR 11.8; CI 1.6-87). In the linear regression model, the most important predictor of cost was the length of hospital stay (r(2)=43%). DISCUSSION Our results demonstrate that the MELD score directly affects transplantation costs. We suggest that reimbursement systems compensate the distinct financing bodies according to the severity of the underlying disease, evaluated with the MELD.
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Affiliation(s)
- Elisabeth Boerr
- Programa de Trasplante Hepático, Hospital Alemán, Buenos Aires, Argentina
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Alvarez D, Anders M, Mella J, Amante M, Orozco F, Mastai R. [Usefulness of transient elastography (Fibroscan®) in the assessment of fibrosis in patients with chronic liver disease]. Medicina (B Aires) 2012; 72:10-14. [PMID: 22257449] [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: 05/31/2023] Open
Abstract
The prognosis and management of chronic liver disease largely depends on the extent and progression of liver fibrosis. Unfortunately, liver biopsy, an invasive and painful technique with several limitations, continues to be the gold standard for the staging and grading of fibrosis. Therefore, accurate noninvasive tests for liver injury are urgently needed. During the last years, transient elastography (Fibroscan®) has been proposed for the assessment of hepatic fibrosis in patients with chronic liver disease, by measuring liver stiffness. The aim of this study was to evaluate the effectiveness, objectivity and safety of this technique. We included 68 patients who underwent a liver biopsy in the last 18 months with a wide spectrum of chronic liver diseases. All procedures as well as the liver biopsies according to the METAVIR scoring system were analyzed by the same sonographer and the same specialist in pathology, respectively. Median value of stiffness with none or mild fibrosis (F0 and FI), and severe fibrosis or cirrhosis (F3 and F4) was 6.8 ± 3.0 kPa and 21.0 ± 15.1 kPa, respectively, with a significant difference between them (p < 0.01). The areas under the receiver operating characteristic curves showed the optimal liver stiffness cut-off values for each group. We found also a positive correlation between liver stiffness found by transient elastography and fibrosis stage on biopsy in all patients, independently of the liver disease etiology. Fibroscan® is an easy, quick to perform and safe non-invasive method, reliable for assessing liver fibrosis.
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López-Alarcón C, Lissi E, Hoffmann P, Mella J, Pessoa-Mahana C, Speisky H, Möller M, Ferrer-Sueta G, Denicola A. Interaction of 5-aminosalicylic acid with nitrous acid: formation of the diazonium derivative and nitric oxide release. CAN J CHEM 2011. [DOI: 10.1139/v11-056] [Citation(s) in RCA: 2] [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] [Indexed: 12/20/2022]
Abstract
The reaction of 5-aminosalicylic acid (5-ASA) with nitrous acid has been studied at low pH under conditions that simulate a gastric environment. The course of the reaction was followed by UV–visible and fluorescence spectroscopy and the products were analyzed by high performance liquid chromatography (HPLC) with UV–visible and mass spectroscopic detectors. In addition, the formation of nitric oxide (NO) was estimated electrochemically. 5-ASA was readily consumed in a process catalyzed by chloride and thiocyanate, whose rate is first order in 5-ASA and second order in nitrous acid. 2-Hydroxy-5-diazonium benzoic acid (diazonium derivative) and NO were detected as products of the reaction. From the NO formation profiles, it is concluded that NO is produced as a minor product in a process parallel to the path that leads to generation of the diazonium derivative. While the formation of NO could be beneficial for the protection of the stomach, the generation of the diazonium derivative could be considered a potentially toxic process.
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Affiliation(s)
- C. López-Alarcón
- Departamento de Farmacia, Facultad de Química, Pontificia Universidad Católica de Chile, C.P. 782 0436, Santiago, Chile
| | - E. Lissi
- Facultad de Química y Biología, Universidad de Santiago de Chile, Santiago, Chile
| | - P. Hoffmann
- UMR/CNRS 5068, Université Paul Sabatier, Toulouse, France
| | - J. Mella
- Departamento de Farmacia, Facultad de Química, Pontificia Universidad Católica de Chile, C.P. 782 0436, Santiago, Chile
| | - C.D. Pessoa-Mahana
- Departamento de Farmacia, Facultad de Química, Pontificia Universidad Católica de Chile, C.P. 782 0436, Santiago, Chile
| | - H. Speisky
- Instituto de Nutrición y Tecnología de los Alimentos, Universidad de Chile, Santiago, Chile
| | - M. Möller
- Laboratorio de Fisicoquímica Biológica, Facultad de Ciencias, and Center for Free Radical and Biomedical Research, Universidad de la República, Montevideo 11400, Uruguay
| | - G. Ferrer-Sueta
- Laboratorio de Fisicoquímica Biológica, Facultad de Ciencias, and Center for Free Radical and Biomedical Research, Universidad de la República, Montevideo 11400, Uruguay
| | - A. Denicola
- Laboratorio de Fisicoquímica Biológica, Facultad de Ciencias, and Center for Free Radical and Biomedical Research, Universidad de la República, Montevideo 11400, Uruguay
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Vega A, Garciga M, Rodriguez A, Prat L, Mella J. BLUEBERRIES MYCORRHIZAL SYMBIOSIS OUTSIDE OF THE BOUNDARIES OF NATURAL DISPERSION FOR ERICACEOUS PLANTS IN CHILE. ACTA ACUST UNITED AC 2009. [DOI: 10.17660/actahortic.2009.810.88] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Toblli JE, Muñoz MC, Cao G, Mella J, Pereyra L, Mastai R. ACE inhibition and AT1 receptor blockade prevent fatty liver and fibrosis in obese Zucker rats. Obesity (Silver Spring) 2008; 16:770-6. [PMID: 18239590 DOI: 10.1038/oby.2007.114] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Non-alcoholic steatohepatitis (NASH), which is a common liver disease in industrialized countries, is associated with obesity, hypertension, and type-2 diabetes (metabolic syndrome). Since angiotensin II (ANG II) has been suggested to play an important role in liver inflammation and fibrosis, the purpose of this study was to investigate whether therapy against renin-angiotensin system (RAS) may provide some beneficial effect in liver of an animal model of metabolic syndrome. METHODS AND PROCEDURES For 6 months, obese Zucker rats (OZRs) were treated as follows: OZR-group, OZR + Perindopril (P) group, OZR + Irbesartan (IRB) group, OZR + Amlodipine (AML) group, and lean Zucker rats (LZRs) group as a control. Livers were evaluated by immunohistochemistry techniques using corresponding antibodies. RESULTS All treated groups showed a similar reduction in blood pressure compared to untreated OZR. Therapy either with IRB or P improves insulin sensitivity and reduces hepatic enzyme level with respect to untreated OZR. Conversely, AML failed to modify both parameters. Untreated OZR displayed higher hepatic ANG II levels and steatosis together with a marked increase in tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6) and transforming growth factor-beta1 (TGF-beta1) level compared to LZR. Following RAS inhibition either by P or IRB, a significant reduction (P < 0.01) in the immunostaining of TNF-alpha, IL-6 and TGF-beta1 compared to untreated OZR was observed. DISCUSSION These results indicate that ANG II expression is increased in the liver of these animals with steatohepatitis. Furthermore, RAS control by either angiotensin-converting enzyme inhibition or AT1 receptor blockade seems to provide a beneficial modulation concerning the inflammatory response to liver injury in this model. Consequently, blockade of RAS could be a new approach to prevent or to treat patients with NASH.
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Affiliation(s)
- Jorge E Toblli
- Laboratory of Experimental Medicine, Hospital Alemán, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina.
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12
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Mella J, Biffin A, Radcliffe AG, Stamatakis JD, Steele RJ. Population-based audit of colorectal cancer management in two UK health regions. Colorectal Cancer Working Group, Royal College of Surgeons of England Clinical Epidemiology and Audit Unit. Br J Surg 1998. [PMID: 9448628 DOI: 10.1002/bjs.1800841224] [Citation(s) in RCA: 150] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND To obtain information on the contemporary management of colorectal cancer in the UK to assist in the development of management guidelines, an independent, 1-year population audit was carried out in Trent Region and Wales. METHODS Data were collected on all patients admitted to hospital with a new diagnosis of colorectal cancer in a 1-year period. RESULTS Of 3520 patients, 3221 (91.5 per cent) had surgery. Emergency/urgent operations were carried out as the first procedure in 552 (17.1 per cent). Resection of the primary disease was achieved in 2859 (81.2 per cent) and this was deemed curative in 2070 (58.8 per cent). Twenty-one per cent of all patients had metastatic disease at presentation. Overall, 30-day operative mortality was 7.6 per cent (21.7 per cent for emergency/urgent and 5.5 per cent for scheduled/elective procedures). Anastomotic dehiscence occurred in 105 patients (4.9 per cent); this was 3.9 per cent after colonic resections and 7.9 per cent after anterior rectal resections. Elective rectal excision resulted in a permanent stoma in 486 of 1054 patients (46 per cent). CONCLUSION This initial report from a comprehensive, independent audit of colorectal cancer management shows improvement in some aspects of treatment as evidenced by improved anastomotic dehiscence and stoma rates when compared with previous studies. However, there has been little improvement in the proportion of patients presenting with advanced disease, and curative resection rates remain low.
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Affiliation(s)
- J Mella
- University of Nottingham, UK
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13
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Mella J, Biffin A, Radcliffe AG, Stamatakis JD, Steele RJ. Population-based audit of colorectal cancer management in two UK health regions. Colorectal Cancer Working Group, Royal College of Surgeons of England Clinical Epidemiology and Audit Unit. Br J Surg 1998. [PMID: 9448628 DOI: 10.1046/j.1365-2168.1997.02869.x] [Citation(s) in RCA: 29] [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] [Indexed: 12/19/2022]
Abstract
BACKGROUND To obtain information on the contemporary management of colorectal cancer in the UK to assist in the development of management guidelines, an independent, 1-year population audit was carried out in Trent Region and Wales. METHODS Data were collected on all patients admitted to hospital with a new diagnosis of colorectal cancer in a 1-year period. RESULTS Of 3520 patients, 3221 (91.5 per cent) had surgery. Emergency/urgent operations were carried out as the first procedure in 552 (17.1 per cent). Resection of the primary disease was achieved in 2859 (81.2 per cent) and this was deemed curative in 2070 (58.8 per cent). Twenty-one per cent of all patients had metastatic disease at presentation. Overall, 30-day operative mortality was 7.6 per cent (21.7 per cent for emergency/urgent and 5.5 per cent for scheduled/elective procedures). Anastomotic dehiscence occurred in 105 patients (4.9 per cent); this was 3.9 per cent after colonic resections and 7.9 per cent after anterior rectal resections. Elective rectal excision resulted in a permanent stoma in 486 of 1054 patients (46 per cent). CONCLUSION This initial report from a comprehensive, independent audit of colorectal cancer management shows improvement in some aspects of treatment as evidenced by improved anastomotic dehiscence and stoma rates when compared with previous studies. However, there has been little improvement in the proportion of patients presenting with advanced disease, and curative resection rates remain low.
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Affiliation(s)
- J Mella
- University of Nottingham, UK
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Mella J, Datta SN, Biffin A, Radcliffe AG, Steele RJ, Stamatakis JD. Surgeons' follow-up practice after resection of colorectal cancer. Ann R Coll Surg Engl 1997; 79:206-9. [PMID: 9196343 PMCID: PMC2502904] [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: 02/04/2023] Open
Abstract
Consultant surgeons in two United Kingdom Health Regions were invited to complete a questionnaire on details of their personal management of patients with colon and rectal cancer, with particular emphasis on follow-up. Replies from 140 (94%) were analysed by the surgeon's subspecialty of colorectal and gastrointestinal surgery (group 1) and all others (group 2). There was a wide variation in the duration of followup, but no difference between the two groups. More group 1 surgeons carried out investigations as a routine after colonic (P < 0.01) and rectal (P < 0.01) resection. Colonoscopy was used more frequently by group 1 (P < 0.0001) and barium enema by group 2 surgeons (P < 0.05). Investigations to detect asymptomatic metastases were used as a routine by 33.3% of surgeons, in whom there was no concordance over the choice or combination of tests and no difference between the two groups of surgeons. There is no consensus among surgeons as to the ideal duration, intensity and method of follow-up after resection for colorectal cancer and little difference between the practice of colorectal and gastrointestinal surgeons and that of other specialists, except in the use of colonoscopy and barium enema. These results reflect the continuing lack of evidence on which to base the follow-up of patients after surgery for colorectal cancer.
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Affiliation(s)
- J Mella
- Audit and Epidemiology Unit, Royal College of Surgeons of England, London
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Abstract
AIMS To audit the information content of pathology reports of colorectal cancer specimens in one National Health Service region. METHODS All reports of colorectal cancer resection specimens from the 17 NHS histopathology laboratories in Wales during 1993 were evaluated against: (a) standards previously agreed as desirable by pathologists in Wales; and (b) standards considered to be the minimum required for informed patient management. RESULTS 1242 reports were audited. There was notable variation in the performance of different laboratories and in the completeness of reporting of individual items of information. While many items were generally well reported, only 51.5% (640/ 1242) of rectal cancer reports contained a statement on the completeness of excision at the circumferential resection margin and only 30% (373/1242) of all reports stated the number of involved lymph nodes. All of the previously agreed items were contained in only 11.3% (140/1242) of reports on colonic tumours and 4.0% (40/1242) of reports on rectal tumours. Seventy eight per cent (969/1242) of colonic carcinoma reports and 46.6% (579/ 1242) of rectal carcinoma reports met the minimum standards. CONCLUSIONS The informational content of many routine pathology reports on colorectal cancer resection specimens is inadequate for quality patient management, for ensuring a clinically effective cancer service through audit, and for cancer registration. Template proforma reporting using nationally agreed standards is recommended as a remedy for this, along with improved education, review of laboratory practices in the light of current knowledge, and further motivation of pathologists through their involvement in multidisciplinary cancer management teams.
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Affiliation(s)
- A D Bull
- Department of Pathology, University of Wales College of Medicine, Cardiff
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Moreno M, Mella J, Arredondo I. [Preoperative cobaltotherapy in endometrial carcinoma]. Rev Chil Obstet Ginecol 1964; 29:339-42. [PMID: 5866909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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