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Fischer MA, Mustafa AHM, Hausmann K, Ashry R, Kansy AG, Liebl MC, Brachetti C, Piée-Staffa A, Zessin M, Ibrahim HS, Hofmann TG, Schutkowski M, Sippl W, Krämer OH. Novel hydroxamic acid derivative induces apoptosis and constrains autophagy in leukemic cells. J Adv Res 2023:S2090-1232(23)00197-2. [PMID: 37467961 DOI: 10.1016/j.jare.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/18/2023] [Accepted: 07/09/2023] [Indexed: 07/21/2023] Open
Abstract
INTRODUCTION Posttranslational modification of proteins by reversible acetylation regulates key biological processes. Histone deacetylases (HDACs) catalyze protein deacetylation and are frequently dysregulated in tumors. This has spurred the development of HDAC inhibitors (HDACi). Such epigenetic drugs modulate protein acetylation, eliminate tumor cells, and are approved for the treatment of blood cancers. OBJECTIVES We aimed to identify novel, nanomolar HDACi with increased potency over existing agents and selectivity for the cancer-relevant class I HDACs (HDAC1,-2,-3,-8). Moreover, we wanted to define how such drugs control the apoptosis-autophagy interplay. As test systems, we used human leukemic cells and embryonic kidney-derived cells. METHODS We synthesized novel pyrimidine-hydroxamic acid HDACi (KH9/KH16/KH29) and performed in vitro activity assays and molecular modeling of their direct binding to HDACs. We analyzed how these HDACi affect leukemic cell fate, acetylation, and protein expression with flow cytometry and immunoblot. The publicly available DepMap database of CRISPR-Cas9 screenings was used to determine sensitivity factors across human leukemic cells. RESULTS Novel HDACi show nanomolar activity against class I HDACs. These agents are superior to the clinically used hydroxamic acid HDACi SAHA (vorinostat). Within the KH-series of compounds, KH16 (yanostat) is the most effective inhibitor of HDAC3 (IC50 = 6 nM) and the most potent inducer of apoptosis (IC50 = 110 nM; p<0.0001) in leukemic cells. KH16 though spares embryonic kidney-derived cells. Global data analyses of knockout screenings verify that HDAC3 is a dependency factor in 115 human blood cancer cells of different lineages, independent of mutations in the tumor suppressor p53. KH16 alters pro- and anti-apoptotic protein expression, stalls cell cycle progression, and induces caspase-dependent processing of the autophagy proteins ULK1 and p62. CONCLUSION These data reveal that HDACs are required to stabilize autophagy proteins through suppression of apoptosis in leukemic cells. HDAC3 appears as a valid anti-cancer target for pharmacological intervention.
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Affiliation(s)
- Marten A Fischer
- Department of Toxicology, University Medical Center, 55131 Mainz, Germany.
| | - Al-Hassan M Mustafa
- Department of Toxicology, University Medical Center, 55131 Mainz, Germany; Department of Zoology, Faculty of Science, Aswan University, Aswan, Egypt.
| | - Kristin Hausmann
- Department of Medicinal Chemistry, Institute of Pharmacy, Martin-Luther-University of Halle-Wittenberg, Halle (Saale), Germany.
| | - Ramy Ashry
- Department of Toxicology, University Medical Center, 55131 Mainz, Germany; Department of Oral Pathology, Faculty of Dentistry, Mansoura University, Egypt.
| | - Anita G Kansy
- Department of Toxicology, University Medical Center, 55131 Mainz, Germany.
| | - Magdalena C Liebl
- Department of Toxicology, University Medical Center, 55131 Mainz, Germany.
| | | | - Andrea Piée-Staffa
- Department of Toxicology, University Medical Center, 55131 Mainz, Germany.
| | - Matthes Zessin
- Department of Enzymology, Institute of Biochemistry, Martin-Luther-University of Halle-Wittenberg, Halle (Saale), Germany.
| | - Hany S Ibrahim
- Department of Medicinal Chemistry, Institute of Pharmacy, Martin-Luther-University of Halle-Wittenberg, Halle (Saale), Germany; Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Egyptian Russian University, Badr City, Cairo, Egypt.
| | - Thomas G Hofmann
- Department of Toxicology, University Medical Center, 55131 Mainz, Germany.
| | - Mike Schutkowski
- Department of Enzymology, Institute of Biochemistry, Martin-Luther-University of Halle-Wittenberg, Halle (Saale), Germany.
| | - Wolfgang Sippl
- Department of Medicinal Chemistry, Institute of Pharmacy, Martin-Luther-University of Halle-Wittenberg, Halle (Saale), Germany.
| | - Oliver H Krämer
- Department of Toxicology, University Medical Center, 55131 Mainz, Germany.
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Ibrahim HS, Abdelsalam M, Zeyn Y, Zessin M, Mustafa AHM, Fischer MA, Zeyen P, Sun P, Bülbül EF, Vecchio A, Erdmann F, Schmidt M, Robaa D, Barinka C, Romier C, Schutkowski M, Krämer OH, Sippl W. Synthesis, Molecular Docking and Biological Characterization of Pyrazine Linked 2-Aminobenzamides as New Class I Selective Histone Deacetylase (HDAC) Inhibitors with Anti-Leukemic Activity. Int J Mol Sci 2021; 23:ijms23010369. [PMID: 35008795 PMCID: PMC8745332 DOI: 10.3390/ijms23010369] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 12/23/2021] [Accepted: 12/27/2021] [Indexed: 12/19/2022] Open
Abstract
Class I histone deacetylases (HDACs) are key regulators of cell proliferation and they are frequently dysregulated in cancer cells. We report here the synthesis of a novel series of class-I selective HDAC inhibitors (HDACi) containing a 2-aminobenzamide moiety as a zinc-binding group connected with a central (piperazin-1-yl)pyrazine or (piperazin-1-yl)pyrimidine moiety. Some of the compounds were additionally substituted with an aromatic capping group. Compounds were tested in vitro against human HDAC1, 2, 3, and 8 enzymes and compared to reference class I HDACi (Entinostat (MS-275), Mocetinostat, CI994 and RGFP-966). The most promising compounds were found to be highly selective against HDAC1, 2 and 3 over the remaining HDAC subtypes from other classes. Molecular docking studies and MD simulations were performed to rationalize the in vitro data and to deduce a complete structure activity relationship (SAR) analysis of this novel series of class-I HDACi. The most potent compounds, including 19f, which blocks HDAC1, HDAC2, and HDAC3, as well as the selective HDAC1/HDAC2 inhibitors 21a and 29b, were selected for further cellular testing against human acute myeloid leukemia (AML) and erythroleukemic cancer (HEL) cells, taking into consideration their low toxicity against human embryonic HEK293 cells. We found that 19f is superior to the clinically tested class-I HDACi Entinostat (MS-275). Thus, 19f is a new and specific HDACi with the potential to eliminate blood cancer cells of various origins.
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Affiliation(s)
- Hany S. Ibrahim
- Department of Medicinal Chemistry, Institute of Pharmacy, Martin-Luther-University of Halle-Wittenberg, 06120 Halle (Saale), Germany; (H.S.I.); (M.A.); (M.Z.); (P.Z.); (P.S.); (E.F.B.); (A.V.); (F.E.); (M.S.); (D.R.)
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Egyptian Russian University, Badr City, Cairo 11829, Egypt
| | - Mohamed Abdelsalam
- Department of Medicinal Chemistry, Institute of Pharmacy, Martin-Luther-University of Halle-Wittenberg, 06120 Halle (Saale), Germany; (H.S.I.); (M.A.); (M.Z.); (P.Z.); (P.S.); (E.F.B.); (A.V.); (F.E.); (M.S.); (D.R.)
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Alexandria University, Alexandria 21521, Egypt
| | - Yanira Zeyn
- Department of Toxicology, University Medical Center, 55131 Mainz, Germany; (Y.Z.); (A.-H.M.M.); (M.A.F.)
| | - Matthes Zessin
- Department of Medicinal Chemistry, Institute of Pharmacy, Martin-Luther-University of Halle-Wittenberg, 06120 Halle (Saale), Germany; (H.S.I.); (M.A.); (M.Z.); (P.Z.); (P.S.); (E.F.B.); (A.V.); (F.E.); (M.S.); (D.R.)
- Department of Enzymology, Institute of Biochemistry, Martin-Luther-University of Halle-Wittenberg, 06120 Halle (Saale), Germany;
| | - Al-Hassan M. Mustafa
- Department of Toxicology, University Medical Center, 55131 Mainz, Germany; (Y.Z.); (A.-H.M.M.); (M.A.F.)
- Department of Zoology, Faculty of Science, Aswan University, Aswan 81528, Egypt
| | - Marten A. Fischer
- Department of Toxicology, University Medical Center, 55131 Mainz, Germany; (Y.Z.); (A.-H.M.M.); (M.A.F.)
| | - Patrik Zeyen
- Department of Medicinal Chemistry, Institute of Pharmacy, Martin-Luther-University of Halle-Wittenberg, 06120 Halle (Saale), Germany; (H.S.I.); (M.A.); (M.Z.); (P.Z.); (P.S.); (E.F.B.); (A.V.); (F.E.); (M.S.); (D.R.)
| | - Ping Sun
- Department of Medicinal Chemistry, Institute of Pharmacy, Martin-Luther-University of Halle-Wittenberg, 06120 Halle (Saale), Germany; (H.S.I.); (M.A.); (M.Z.); (P.Z.); (P.S.); (E.F.B.); (A.V.); (F.E.); (M.S.); (D.R.)
| | - Emre F. Bülbül
- Department of Medicinal Chemistry, Institute of Pharmacy, Martin-Luther-University of Halle-Wittenberg, 06120 Halle (Saale), Germany; (H.S.I.); (M.A.); (M.Z.); (P.Z.); (P.S.); (E.F.B.); (A.V.); (F.E.); (M.S.); (D.R.)
| | - Anita Vecchio
- Department of Medicinal Chemistry, Institute of Pharmacy, Martin-Luther-University of Halle-Wittenberg, 06120 Halle (Saale), Germany; (H.S.I.); (M.A.); (M.Z.); (P.Z.); (P.S.); (E.F.B.); (A.V.); (F.E.); (M.S.); (D.R.)
| | - Frank Erdmann
- Department of Medicinal Chemistry, Institute of Pharmacy, Martin-Luther-University of Halle-Wittenberg, 06120 Halle (Saale), Germany; (H.S.I.); (M.A.); (M.Z.); (P.Z.); (P.S.); (E.F.B.); (A.V.); (F.E.); (M.S.); (D.R.)
| | - Matthias Schmidt
- Department of Medicinal Chemistry, Institute of Pharmacy, Martin-Luther-University of Halle-Wittenberg, 06120 Halle (Saale), Germany; (H.S.I.); (M.A.); (M.Z.); (P.Z.); (P.S.); (E.F.B.); (A.V.); (F.E.); (M.S.); (D.R.)
| | - Dina Robaa
- Department of Medicinal Chemistry, Institute of Pharmacy, Martin-Luther-University of Halle-Wittenberg, 06120 Halle (Saale), Germany; (H.S.I.); (M.A.); (M.Z.); (P.Z.); (P.S.); (E.F.B.); (A.V.); (F.E.); (M.S.); (D.R.)
| | - Cyril Barinka
- Institute of Biotechnology of the Czech Academy of Sciences, BIOCEV, Prumyslova 595, 25250 Vestec, Czech Republic;
| | - Christophe Romier
- Département de Biologie Structurale Intégrative, Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), CNRS, INSERM, Université de Strasbourg, CEDEX, 67404 Illkirch, France;
| | - Mike Schutkowski
- Department of Enzymology, Institute of Biochemistry, Martin-Luther-University of Halle-Wittenberg, 06120 Halle (Saale), Germany;
| | - Oliver H. Krämer
- Department of Toxicology, University Medical Center, 55131 Mainz, Germany; (Y.Z.); (A.-H.M.M.); (M.A.F.)
- Correspondence: (O.H.K.); (W.S.)
| | - Wolfgang Sippl
- Department of Medicinal Chemistry, Institute of Pharmacy, Martin-Luther-University of Halle-Wittenberg, 06120 Halle (Saale), Germany; (H.S.I.); (M.A.); (M.Z.); (P.Z.); (P.S.); (E.F.B.); (A.V.); (F.E.); (M.S.); (D.R.)
- Correspondence: (O.H.K.); (W.S.)
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Kim SC, Choudhry N, Franklin JM, Bykov K, Eikermann M, Lii J, Fischer MA, Bateman BT. Patterns and predictors of persistent opioid use following hip or knee arthroplasty. Osteoarthritis Cartilage 2017; 25:1399-1406. [PMID: 28433815 PMCID: PMC5565694 DOI: 10.1016/j.joca.2017.04.002] [Citation(s) in RCA: 128] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 04/06/2017] [Accepted: 04/11/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The relationship between arthroplasty and long-term opioid use in patients with knee or hip osteoarthritis is not well studied. We examined the prevalence, patterns and predictors of persistent opioid use after hip or knee arthroplasty. METHOD Using claims data (2004-2013) from a US commercial health plan, we identified adults who underwent hip or knee arthroplasty and filled ≥1 opioid prescription within 30 days after the surgery. We defined persistent opioid users as patients who filled ≥1 opioid prescription every month during the 1-year postoperative period based on group-based trajectory models. Multivariable logistic regression was used to determine preoperative predictors of persistent opioid use after surgery. RESULTS We identified 57,545 patients who underwent hip or knee arthroplasty. The mean ± SD age was 61.5 ± 7.8 years and 87.1% had any opioid use preoperatively. Overall, 7.6% persistently used opioids after the surgery. Among patients who used opioids in 80% of the time for ≥4 months preoperatively (n = 3023), 72.1% became persistent users. In multivariable analysis, knee arthroplasty vs hip, a longer hospitalization stay, discharge to a rehabilitation facility, preoperative opioid use (e.g., a longer duration and greater dosage and frequency), a higher comorbidity score, back pain, rheumatoid arthritis, fibromyalgia, migraine and smoking, and benzodiazepine use at baseline were strong predictors for persistent opioid use (C-statistic = 0.917). CONCLUSION Over 7% of patients persistently used opioids in the year after hip or knee arthroplasty. Given the adverse health effects of persistent opioid use, strategies need to be developed to prevent persistent opioid use after this common surgery.
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Affiliation(s)
- S C Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - N Choudhry
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - J M Franklin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - K Bykov
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - M Eikermann
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - J Lii
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - M A Fischer
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - B T Bateman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Abstract
Chronic sports injuries of the knee joint are common and mainly caused by repetitive (micro) trauma and exertion. Chronic insertion tendinopathies and avulsion fractures and symptoms related to entrapment, friction and impingement can be pathophysiologically distinguished in athletes. In this review, we depict the characteristic magnetic resonance imaging (MRI) findings of the most commonly occurring pathologies.
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Affiliation(s)
- M Mannil
- Institut für Radiologie und Nuklearmedizin, Stadtspital Triemli, Birmensdorferstrasse 497, 8063, Zürich, Schweiz.
| | - G Andreisek
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsspital Zürich, Universität Zürich, Zürich, Schweiz
| | - D Weishaupt
- Institut für Radiologie und Nuklearmedizin, Stadtspital Triemli, Birmensdorferstrasse 497, 8063, Zürich, Schweiz
| | - M A Fischer
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsspital Zürich, Universität Zürich, Zürich, Schweiz.,Abteilung für Radiologie, Universitätsklinik Balgrist, Universität Zürich, Zürich, Schweiz
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Crawford RJ, Filli L, Elliott JM, Nanz D, Fischer MA, Marcon M, Ulbrich EJ. Age- and Level-Dependence of Fatty Infiltration in Lumbar Paravertebral Muscles of Healthy Volunteers. AJNR Am J Neuroradiol 2016; 37:742-8. [PMID: 26635285 DOI: 10.3174/ajnr.a4596] [Citation(s) in RCA: 158] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 09/11/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Normative age-related decline in paravertebral muscle quality is important for reference to disease and risk identification in patients. We aimed to establish age- and vertebral level-dependence of paravertebral (multifidus and erector spinae) muscle volume and fat content in healthy adult volunteers. MATERIALS AND METHODS In this prospective study multifidus and erector spinae fat signal fraction and volume at lumbar levels L1-L5 were measured in 80 healthy volunteers (10 women and men per decade, 20-62 years of age) by 2-point Dixon 3T MR imaging. ANOVA with post hoc Bonferroni correction compared fat signal fraction and volume among subgroups. Pearson and Spearman analysis were used for correlations (P < .05). RESULTS Fat signal fraction was higher in women (17.8% ± 10.7%) than men (14.7% ± 7.8%; P < .001) and increased with age. Multifidus and erector spinae volume was lower in women (565.4 ± 83.8 cm(3)) than in men (811.6 ± 98.9 cm(3); P < .001) and was age-independent. No differences in fat signal fraction were shown between the right and left paravertebral muscles or among the L1, L2, and L3 lumbar levels. The fat signal fraction was highest at L5 (women, 31.9% ± 9.3%; men, 25.7% ± 8.0%; P < .001). The fat signal fraction at L4 correlated best with total lumbar fat signal fraction (women, r = 0.95; men, r = 0.92, P < .001). Total fat signal fraction was higher in the multifidus compared with erector spinae muscles at L1-L4 for both sexes (P < .001). CONCLUSIONS Lumbar paravertebral muscle fat content increases with aging, independent of volume, in healthy volunteers 20-62 years of age. Women, low lumbar levels, and the multifidus muscle are most affected. Further study examining younger and older subjects and the functional impact of fatty infiltrated paravertebral muscles are warranted.
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Affiliation(s)
- R J Crawford
- From the Centre for Health Sciences (R.J.C., J.M.E.), Zurich University of Applied Sciences, Winterthur, Switzerland Faculty of Health Professions (R.J.C.), Curtin University, Perth, Australia
| | - L Filli
- Institute of Diagnostic and Interventional Radiology (L.F., D.N., M.A.F., M.M., E.J.U.), University Hospital and University of Zurich, Zurich, Switzerland
| | - J M Elliott
- From the Centre for Health Sciences (R.J.C., J.M.E.), Zurich University of Applied Sciences, Winterthur, Switzerland Feinberg School of Medicine (J.M.E.), Northwestern University, Chicago, Illinois School of Health and Rehabilitation Sciences (J.M.E.), University of Queensland, Brisbane, Australia
| | - D Nanz
- Institute of Diagnostic and Interventional Radiology (L.F., D.N., M.A.F., M.M., E.J.U.), University Hospital and University of Zurich, Zurich, Switzerland
| | - M A Fischer
- Institute of Diagnostic and Interventional Radiology (L.F., D.N., M.A.F., M.M., E.J.U.), University Hospital and University of Zurich, Zurich, Switzerland
| | - M Marcon
- Institute of Diagnostic and Interventional Radiology (L.F., D.N., M.A.F., M.M., E.J.U.), University Hospital and University of Zurich, Zurich, Switzerland Institute of Diagnostic Radiology (M.M.), University Hospital Santa Maria della Misericordia, Udine, Italy
| | - E J Ulbrich
- Institute of Diagnostic and Interventional Radiology (L.F., D.N., M.A.F., M.M., E.J.U.), University Hospital and University of Zurich, Zurich, Switzerland
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Loizou L, Albiin N, Leidner B, Axelsson E, Fischer MA, Grigoriadis A, Del Chiaro M, Segersvärd R, Verbeke C, Sundin A, Kartalis N. Multidetector CT of pancreatic ductal adenocarcinoma: Effect of tube voltage and iodine load on tumour conspicuity and image quality. Eur Radiol 2016; 26:4021-4029. [PMID: 26965503 DOI: 10.1007/s00330-016-4273-y] [Citation(s) in RCA: 10] [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: 04/02/2015] [Revised: 02/03/2016] [Accepted: 02/04/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To compare a low-tube-voltage with or without high-iodine-load multidetector CT (MDCT) protocol with a normal-tube-voltage, normal-iodine-load (standard) protocol in patients with pancreatic ductal adenocarcinoma (PDAC) with respect to tumour conspicuity and image quality. METHODS Thirty consecutive patients (mean age: 66 years, men/women: 14/16) preoperatively underwent triple-phase 64-channel MDCT examinations twice according to: (i) 120-kV standard protocol (PS; 0.75 g iodine (I)/kg body weight, n = 30) and (ii) 80-kV protocol A (PA; 0.75 g I/kg, n = 14) or protocol B (PB; 1 g I/kg, n = 16). Two independent readers evaluated tumour delineation and image quality blindly for all protocols. A third reader estimated the pancreas-to-tumour contrast-to-noise ratio (CNR). Statistical analysis was performed with the Chi-square test. RESULTS Tumour delineation was significantly better in PB and PA compared with PS (P = 0.02). The evaluation of image quality was similar for the three protocols (all, P > 0.05). The highest CNR was observed with PB and was significantly better compared to PA (P = 0.02) and PS (P = 0.0002). CONCLUSION In patients with PDAC, a low-tube-voltage, high-iodine-load protocol improves tumour delineation and CNR leading to higher tumour conspicuity compared to standard protocol MDCT. KEY POINTS • Low-tube-voltage high-iodine-load MDCT improves pancreatic cancer conspicuity compared to a standard protocol. • The pancreas-to-tumour attenuation difference increases significantly by reducing the tube voltage. • The radiation exposure dose decreases by reducing the tube voltage.
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Affiliation(s)
- L Loizou
- Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 14186, Stockholm, Sweden. .,Department of Radiology, C1-46 Karolinska University Hospital Huddinge, 14186, Stockholm, Sweden.
| | - N Albiin
- Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 14186, Stockholm, Sweden.,Department of Radiology, Ersta Hospital, 11691, Stockholm, Sweden
| | - B Leidner
- Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 14186, Stockholm, Sweden.,Department of Radiology, C1-46 Karolinska University Hospital Huddinge, 14186, Stockholm, Sweden
| | - E Axelsson
- Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 14186, Stockholm, Sweden.,Department of Radiology, C1-46 Karolinska University Hospital Huddinge, 14186, Stockholm, Sweden
| | - M A Fischer
- Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 14186, Stockholm, Sweden.,Department of Radiology, C1-46 Karolinska University Hospital Huddinge, 14186, Stockholm, Sweden
| | - A Grigoriadis
- Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 14186, Stockholm, Sweden.,Department of Radiology, C1-46 Karolinska University Hospital Huddinge, 14186, Stockholm, Sweden
| | - M Del Chiaro
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Center for Digestive Diseases, Karolinska University Hospital Huddinge, 14186, Stockholm, Sweden
| | - R Segersvärd
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Center for Digestive Diseases, Karolinska University Hospital Huddinge, 14186, Stockholm, Sweden
| | - C Verbeke
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet and Karolinska University Hospital Huddinge, 14186, Stockholm, Sweden
| | - A Sundin
- Department of Surgical Sciences, Division of Radiology, Uppsala University and Department of Radiology, Uppsala University Hospital, 751 85, Uppsala, Sweden
| | - N Kartalis
- Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 14186, Stockholm, Sweden.,Department of Radiology, C1-46 Karolinska University Hospital Huddinge, 14186, Stockholm, Sweden
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Fischer MA, Raptis DA, Donati OF, Hunziker R, Schade E, Sotiropoulos GC, McCall J, Bartlett A, Bachellier P, Frilling A, Breitenstein S, Clavien PA, Alkadhi H, Patak MA. MR imaging features for improved diagnosis of hepatocellular carcinoma in the non-cirrhotic liver: Multi-center evaluation. Eur J Radiol 2015; 84:1879-87. [PMID: 26194029 DOI: 10.1016/j.ejrad.2015.06.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 06/26/2015] [Accepted: 06/28/2015] [Indexed: 01/10/2023]
Abstract
PURPOSE To determine MR-imaging features for the differentiation between hepatocellular carcinoma (HCC) and benign hepatocellular tumors in the non-cirrhotic liver. MATERIAL AND METHODS 107 consecutive patients without liver cirrhosis (46 male; 45 ± 14 years) who underwent liver resection due to suspicion of HCC were included in this multi-center study. The following imaging features were assessed: lesion diameter and demarcation, satellite-lesions, central-scar, capsule, fat-content, hemorrhage, vein-infiltration and signal-intensity (SI) on native T1-, T2- and dynamic-enhanced T1-weighted images (center versus periphery). In addition, contrast-media (CM) uptake in the liver specific phase was analyzed in a sub-group of 42 patients. RESULTS Significant differences between HCC (n=55) and benign lesions (n=52) were shown for native T1-, T2- and dynamic-enhanced T1-SI, fat-content, and satellite-lesions (all, P<.05). Independent predictors for HCC were T1-hypointensity (odds-ratio, 4.81), T2-hypo-/hyperintensity (5.07), lack of central tumor-enhancement (3.36), and satellite-lesions (5.78; all P<0.05). Sensitivity and specificity of HCC was 91% and 75% respectively for two out-of four independent predictors, whereas specificity reached 98% for all four predictors. Sub-analysis, showed significant differences in liver specific CM uptake between HCC (n=18) and benign lesions (n=24; P<0.001) and revealed lack of liver specific CM uptake (odds-ratio, 2.7) as additional independent feature for diagnosis of HCC. CONCLUSION Independent MRI features indicating HCC are T1-hypointensity, T2-hypo- or hyperintensity, lack of central tumor-enhancement, presence of satellite-lesions and lack of liver specific CM-uptake. These features may have the potential to improve the diagnosis of HCC in the non-cirrhotic liver.
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Affiliation(s)
- M A Fischer
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
| | - D A Raptis
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
| | - O F Donati
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - R Hunziker
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - E Schade
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
| | - G C Sotiropoulos
- Department of Visceral and Transplant Surgery, University Hospital Essen, Essen, Germany
| | - J McCall
- Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand
| | - A Bartlett
- Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand
| | - Ph Bachellier
- Department of Visceral and Transplant Surgery, University Hospital Strasbourg, Strasbourg, France
| | - A Frilling
- Department of Surgery and Cancer, Hammersmith Hospital, Imperial College, London, UK
| | - S Breitenstein
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
| | - P-A Clavien
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
| | - H Alkadhi
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - M A Patak
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
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Polinski JM, Kesselheim AS, Frolkis JP, Wescott P, Allen-Coleman C, Fischer MA. A matter of trust: patient barriers to primary medication adherence. Health Educ Res 2014; 29:755-763. [PMID: 24838119 DOI: 10.1093/her/cyu023] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Primary medication adherence occurs when a patient properly fills the first prescription for a new medication. Primary adherence only occurs about three-quarters of the time for antihypertensive medications. We assessed patients' barriers to primary adherence and attributes of patient-provider discussions that might improve primary adherence for antihypertensives. In total, 26 patients with incomplete primary adherence for an antihypertensive, identified using their retail pharmacy claims, participated in four focus groups. Following a moderators' guide developed a priori, moderators led patients in a discussion of patients' attitudes and experiences with hypertension and receiving an antihypertensive medication, barriers to primary adherence, and their preferences for shared decision making and communication with providers. Three authors analysed and organized data into salient themes, including patients' anger about and suspicion of their hypertension diagnosis, the need for medication and providers' credibility. A trusting patient-provider relationship, shared decision-making support, full disclosure of side effects and cost sensitivity were attributes that might enhance primary adherence. Developing decision support interventions that strengthen the patient-provider relationship by enhancing provider credibility and patient trust prior to prescribing may provide more effective approaches for improving primary adherence.
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Affiliation(s)
- J M Polinski
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA 02120, USA, Harvard Medical School, Boston, MA 02115, USA, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA 02120, USA and Informed Medical Decisions Foundation, Boston, MA 02108, USA Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA 02120, USA, Harvard Medical School, Boston, MA 02115, USA, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA 02120, USA and Informed Medical Decisions Foundation, Boston, MA 02108, USA
| | - A S Kesselheim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA 02120, USA, Harvard Medical School, Boston, MA 02115, USA, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA 02120, USA and Informed Medical Decisions Foundation, Boston, MA 02108, USA Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA 02120, USA, Harvard Medical School, Boston, MA 02115, USA, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA 02120, USA and Informed Medical Decisions Foundation, Boston, MA 02108, USA
| | - J P Frolkis
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA 02120, USA, Harvard Medical School, Boston, MA 02115, USA, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA 02120, USA and Informed Medical Decisions Foundation, Boston, MA 02108, USA Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA 02120, USA, Harvard Medical School, Boston, MA 02115, USA, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA 02120, USA and Informed Medical Decisions Foundation, Boston, MA 02108, USA
| | - P Wescott
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA 02120, USA, Harvard Medical School, Boston, MA 02115, USA, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA 02120, USA and Informed Medical Decisions Foundation, Boston, MA 02108, USA
| | - C Allen-Coleman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA 02120, USA, Harvard Medical School, Boston, MA 02115, USA, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA 02120, USA and Informed Medical Decisions Foundation, Boston, MA 02108, USA
| | - M A Fischer
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA 02120, USA, Harvard Medical School, Boston, MA 02115, USA, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA 02120, USA and Informed Medical Decisions Foundation, Boston, MA 02108, USA Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA 02120, USA, Harvard Medical School, Boston, MA 02115, USA, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA 02120, USA and Informed Medical Decisions Foundation, Boston, MA 02108, USA
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Bateman BT, Hernandez-Diaz S, Huybrechts KF, Palmsten K, Mogun H, Ecker JL, Seely EW, Fischer MA. Outpatient calcium-channel blockers and the risk of postpartum haemorrhage: a cohort study. BJOG 2013; 120:1668-76; dicussion 1676-7. [PMID: 24020971 DOI: 10.1111/1471-0528.12428] [Citation(s) in RCA: 14] [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] [Accepted: 06/19/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine whether outpatient exposure to calcium-channel blockers (CCBs) at the time of delivery is associated with an increased risk for postpartum haemorrhage (PPH). DESIGN Cohort study. SETTING United States of America. POPULATION OR SAMPLE Medicaid beneficiaries. METHODS We identified a cohort of 9750 patients with outpatient prescriptions for CCBs, methyldopa, or labetalol for pre-existing or gestational hypertension whose days of supply overlapped with delivery; 1226 were exposed to CCBs. The risk of PPH was compared in those exposed to CCBs to those exposed to methyldopa or labetalol. Propensity score matching and stratification were used to address potential confounding. MAIN OUTCOME MEASURES The occurrence of PPH during the delivery hospitalisation. RESULTS There were 27 patients exposed to CCBs (2.2%) and 232 patients exposed to methyldopa or labetalol (2.7%) who experienced PPH. After accounting for confounders, there was no meaningful association between CCB exposure and PPH in the propensity score matched (odds ratio 0.77, 95% CI 0.50-1.18) or stratified (odds ratio 0.79, 95% CI 0.53-1.19) analyses. Similar results were obtained across multiple sensitivity analyses. CONCLUSIONS The outpatient use of CCBs in late pregnancy for the treatment of hypertension does not increase the risk of PPH.
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Affiliation(s)
- B T Bateman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Feldman CH, Hiraki LT, Lui J, Alarcón GS, Fischer MA, Yazdany J, Costenbader KH. Area-level socioeconomic status and variation in medication use among Medicaid enrollees with incident systemic lupus erythematosus, 2000 to 2004. Arthritis Res Ther 2012. [PMCID: PMC3467484 DOI: 10.1186/ar3941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Hiraki LT, Feldman CH, Liu J, Alarcón GS, Fischer MA, Winkelmayer WC, Costenbader KH. Variation in renal biopsy and medication prescribing practices among pediatric Medicaid patients with lupus nephritis prior to end-stage renal disease in the US, 2000 to 2004. Arthritis Res Ther 2012. [PMCID: PMC3467535 DOI: 10.1186/ar3992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Yazdany J, Feldman C, Liu J, Ward MM, Fischer MA, Costenbader KH. Usual source of care and geographic region are largest predictors of healthcare quality for incident lupus nephritis in US Medicaid recipients. Arthritis Res Ther 2012. [PMCID: PMC3467494 DOI: 10.1186/ar3951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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13
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Pazahr S, Fischer MA, Luechinger R, Schick F, Nanz D, Boss A. Assessment of segment specific flip angle distribution in Multi-Transmit 3.0T liver imaging: effects on contrast weighting in standard imaging. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1295504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Scheffel H, Fischer MA, Pfammatter T, Alkadhi H. [Acute gastrointestinal bleeding - diagnosis with computed tomography]. Praxis (Bern 1994) 2011; 100:707-713. [PMID: 21656498 DOI: 10.1024/1661-8157/a000563] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Computed tomography represents a fast, non-invasive and accurate imaging modality for the diagnosis of acute gastrointestinal bleeding by providing information about localization and source of bleeding. Owing to its robustness and wide availability, it has the potential to be the first line imaging test in patients with acute life-threatening bleeding, for helping in the planning of interventional or surgical procedures.
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Affiliation(s)
- H Scheffel
- Institut f. Diagnostische und Interventionelle Radiologie, Unispitätsspital Zürich.
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15
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Abstract
OBJECTIVES To evaluate the amount, motility, and viability of sperm in fluid aspirated from naturally occurring spermatoceles and to investigate the effect of cryopreservation of sperm retrieved from spermatoceles. Assisted reproductive technologies have led to successful pregnancies and deliveries using sperm harvested from the epididymis and/or testis of infertile men. METHODS Aspiration of spermatocele fluid and analysis of the fluid obtained was performed on 20 patients before elective spermatocelectomy. Randomly selected samples (n = 5) were washed using a 70% Percoll gradient, and repeated semen analysis was performed. The washed specimens were cryopreserved in liquid nitrogen, and repeated semen analysis was performed on the thawed specimens. RESULTS All spermatoceles (n = 20) had viable sperm present (count range 54 x 10(4) to 326 x 10(6)) and 16 (80%) of 20 contained motile sperm. The average percentage of motile sperm was 5%. The average sperm motility and average percent viability of sperm recovered after Percoll gradient improved compared with sperm in the initial spermatocele aspirates (motility 5%, range 0% to 25% and viability 36%, range 2% to 91% before Percoll vs. motility 13%, range 2% to 38% and viability 39%, range 10% to 92% after Percoll). Sperm retrieved after cryopreservation demonstrated reduced motility and viability; however, motile and viable sperm were recovered from all washed and cryopreserved samples. CONCLUSIONS Our results suggest that spermatocele fluid may contain sufficient numbers of sperm for use with assisted reproductive technologies. Motile and viable sperm can be recovered after cryopreservation and storage of sperm obtained from a spermatocele. Spermatocele fluid may be an additional source of sperm for assisted reproductive technologies.
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Affiliation(s)
- M A Fischer
- Division of Urology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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16
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Zini A, Fischer MA, Mak V, Phang D, Jarvi K. Catalase-like and superoxide dismutase-like activities in human seminal plasma. Urol Res 2002; 30:321-3. [PMID: 12389121 DOI: 10.1007/s00240-002-0283-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2002] [Accepted: 08/14/2002] [Indexed: 10/27/2022]
Abstract
Human spermatozoa are highly susceptible to oxidative injury but are naturally protected from such injury by the antioxidant properties of seminal plasma. We measured catalase-like and superoxide dismutase (SOD)-like activities in the seminal plasma of fertile and vasectomized men in order to gain insight into the potential source(s) and function(s) of these antioxidants in semen. Semen samples were obtained from fertile men ( n=11) and men post-vasectomy ( n=16). Catalase-like activity was measured by the decrease in hydrogen peroxide concentration after incubation with seminal plasma. SOD-like activity was measured as the inhibition of nitroblue tetrazolium reduction due to superoxide anion generation by xanthine plus xanthine oxidase. Mean seminal catalase-like activity (+/-1SD) in the fertile group was not significantly different from that of the post-vasectomy group (389+/-163 and 325+/-119 U/ml, respectively). Similarly, mean seminal SOD-like activity in the fertile group was not significantly different from that of the post-vasectomy group (37+/-10 and 36+/-10 U/ml, respectively). Our data suggest that the testis and epididymis are not an important source of catalase-like and SOD-like activities in semen. These findings indicate that antioxidants in semen are primarily of post-testicular origin and probably serve to protect ejaculated spermatozoa from oxidative stress such as that which occurs in the female reproductive tract.
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Affiliation(s)
- A Zini
- Department of Surgery, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Suite 1525, Toronto, Ontario, Canada M5G 1X5.
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Abstract
Renal 11beta-hydroxysteroid dehydrogenases (11beta-HSDs) are subject to modulation by various endogenous factors. 11beta-HSDs convert glucocorticoids into inactive 11-ketones and thereby determine tissue levels of active glucocorticoids and thus the extent of glucocorticoid receptor (GR) and mineralocorticoid receptor (MR) activation. As such, modulation of the activity of renal 11beta-HSDs may contribute to the cascade of regulatory events involved in renal electrolyte water handling. We investigated whether renal 11beta-HSDs are modulated by elevated circulating angiotensin II. In rats infused for 2 wk with angiotensin II (250 ng/[kg x min] subcutaneously), plasma angiotensin II, aldosterone, and corticosterone were raised 5.1-, 10.7-, and 2.3-fold, respectively, compared with control rats. Angiotensin II infusion raised corticosterone 11beta-oxidation 1.46- and 1.35-fold in renal cortical proximal and distal tubules (enriched by Percoll centrifugation), respectively, but had no effect on 11beta-HSD1 and 11beta-HSD2 mRNA levels (semiquantitative reverse transcriptase polymerase chain reaction), except for distal tubular 11beta-HSD1 mRNA, which was decreased to 50%. In vitro treatment of freshly isolated tubules with angiotensin II for 45 min prior to assessment of 11beta-HSD activity showed no direct acute effects of angiotensin II on tubular corticosterone 11beta-oxidation. The enhanced renal tubular corticosterone 11beta-oxidation in vivo may partly protect renal GR and MR from elevated plasma corticosterone on angiotensin II infusion.
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Abstract
OBJECTIVE To compare the outcome of a modified one-layer and two-layer vasovasotomy (VV) in two groups of similar men undergoing vasectomy reversal. PATIENTS AND METHODS The charts and surgical records of all surgical procedures performed on men undergoing a modified one- or two-layer VV between June 1992 and July 1994 were retrospectively reviewed. A successful outcome (patency) was defined as sperm present at follow-up (mean follow-up 8 weeks). A modified one-layer VV was used in 17 men (group 1) and a two-layer VV in 23 (group 2). RESULTS Sperm were present in both groups if surgery was undertaken after vasal obstruction lasting < 36 months. The modified one- and two-layer VV had equal patency (88% and 90%, respectively) when undertaken after an obstructed interval of 36-96 months; outcomes were poorer if surgery was performed after > 96 months. The mean operative duration was 96 min for a modified one-layer VV and 167 min for the two-layer VV. CONCLUSIONS The simpler and faster modified one-layer VV provides sufficient accuracy for successful vasectomy reversal in most cases. For most patients, both procedures have equivalent patency.
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Affiliation(s)
- M A Fischer
- Department of Urology, Dalhousie University, Queen Elizabeth II Health Sciences Center, Halifax NS, Canada
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McLellan RA, Fischer MA, Belitsky P. Perinephric abscess presenting as chronic diarrhea. Can J Urol 2000; 7:983-5. [PMID: 11119443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Perinephric abscess is an uncommon diagnosis with a variable presentation and high mortality. We report an unusual case of a patient with a perinephric abscess who presented with chronic diarrhea and weight loss.
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Affiliation(s)
- R A McLellan
- School of Medicine, Dalhousie University, Halifax, Nova Scotia
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20
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Hermans JJ, Fischer MA, Schiffers PM, Struijker-Boudier HA. High dietary potassium chloride intake augments rat renal mineralocorticoid receptor selectivity via 11beta-hydroxysteroid dehydrogenase. Biochim Biophys Acta 1999; 1472:537-49. [PMID: 10564768 DOI: 10.1016/s0304-4165(99)00160-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Glucocorticoid access to renal corticosteroid receptors is regulated by 11beta-hydroxysteroid dehydrogenases (11beta-HSDs), converting 11beta-hydroxyglucocorticoids into inactive 11-ketones. This mechanism plays a key role in maintaining normal salt-water homeostasis and blood pressure. To study whether renal cortical proximal and distal tubular 11beta-HSDs are modulated, upon shifting the electrolyte status (and may thereby contribute to adjusting the salt-water homeostasis), rats were treated for 14 days with diets with low (0.058 w/w%), normal (0.58%, which is the KCl content of standard European laboratory rat food) or high (5.8%) potassium chloride content. In proximal tubules, dietary KCl had no effect regarding corticosterone 11beta-oxidation in intact cells as well as 11beta-HSD1 and 11beta-HSD2 protein (Western blotting) and mRNA levels (semi-quantitative RT-PCR). In distal tubules, the low KCl diet also had no effect. However, distal tubules of rats fed the high KCl diet showed increased corticosterone 11beta-oxidation rates (1.6-fold, P<0.01) and 11beta-HSD2 protein (4-fold, P<0.01), whereas 11beta-HSD1 protein was decreased (no longer detected, P<0.05). Distal tubular 11beta-HSD mRNA levels were not changed upon dietary treatment. Our results suggest that upon dietary KCl loading distal tubular mineralocorticoid receptor selectivity for aldosterone is increased because of enhanced corticosterone 11beta-oxidation. This may contribute to the fine-tuning of salt-water homeostasis by the kidney.
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Affiliation(s)
- J J Hermans
- Department of Pharmacology and Toxicology, Cardiovascular Research Institute Maastricht, University of Maastricht, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
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Affiliation(s)
- M A Fischer
- Department of Urology, Dalhousie University, Halifax, NS, Canada
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Fischer MA, Norman RW, Gupta R. Renal cell carcinoma metastatic to the contralateral ureter. Can J Urol 1998; 5:595-596. [PMID: 11305959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
The ureter is an uncommon location for cancer metastases, the majority of which are due to nonurologic cancers such as stomach and breast.(1) Renal cell carcinoma (RCC) metastatic to the ureter has been reported infrequently. We report a case of metachronous metastatic RCC to the contralateral ureter.
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Affiliation(s)
- M A Fischer
- Department of Urology, Dalhousie University, Halifax, Nova Scotia
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Robers M, Van der Hulst FF, Fischer MA, Roos W, Salud CE, Eisenwiener HG, Glatz JF. Development of a rapid microparticle-enhanced turbidimetric immunoassay for plasma fatty acid-binding protein, an early marker of acute myocardial infarction. Clin Chem 1998; 44:1564-7. [PMID: 9665443] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- M Robers
- Department of Physiology, Cardiovascular Research Institute, Maastricht, Maastricht University, The Netherlands
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Vivès L, Fayas S, Fischer MA, Vanche J, Cabréra J, Goyeau E, Biel P, Stambach Y, Farny M, Duffour M, Durand M, Didier A, Duchange M, Neukirch F, Charlet JP. [Fatal asthma. Description and study of risk factors, in the heart of an asthmatic population followed by the College of Pneumonology of the Southwest]. Rev Mal Respir 1997; 14:473-80. [PMID: 9496606] [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: 02/06/2023]
Abstract
OBJECTIVES To describe asthma deaths and to identify the principal short term risk factors in a population followed by twelve thoracic physicians in the South West of France between 1989 and 1995. METHODS A multicentre clinical study in 312 pure asthmatics recruited freely and reviewed on average 37.4 months later by the same specialist. The attribution of deaths due to asthma was discussed case by case. Predicted risk factors for survival have been researched from variables on the identify card (T0) and analyses using Cox's model. RESULTS Twenty one subjects died, 16 were due to asthma. This was an annual mortality due to asthma of 1.6%. Seven deaths occurred at home (an acute crisis was the most common) and nine in hospital (respiratory prolonged distress). The principal variables linked to poor survival were: advanced years, asthma with continuous dyspnoea, previous stay in intensive care unit, taking inhaled beta 2 mimetics continuously after inclusion, decreasing FEV1 (P < 0.001). Other variables had a weaker link: duration of asthma, exacerbation of asthma at T0 (P = 0.01), social and psychological problems (P = 0.05), severity of disease at T0 (1992 consensus) were linked to asthma mortality: 75% of the deaths concerned severe asthmatics but 25% occurred in an unforeseen fashion in moderate asthmatics. The presence of personal allergy and of rhinitis was linked to better survival independent of age and severity of asthma. CONCLUSION This study has shown that it was possible to determine predicted risk factors for asthma deaths in the short term at the time of consultation with an asthmatic and so, to identify the most threatened subjects. The institution of assistance programs could be beneficial as a result of the knowledge of these risk factors.
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Affiliation(s)
- L Vivès
- Collège de Pneumologie du Sud-Ouest, Saint-Gaudens
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Thijssen HH, Drittij-Reijnders MJ, Fischer MA. Phylloquinone and menaquinone-4 distribution in rats: synthesis rather than uptake determines menaquinone-4 organ concentrations. J Nutr 1996; 126:537-43. [PMID: 8632229 DOI: 10.1093/jn/126.2.537] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.0] [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: 02/01/2023] Open
Abstract
To clarify the origin of organ menaquinone-4 (MK-4), the distributions of phylloquinone and MK-4 were investigated in rats fed diets containing phylloquinone, MK-4 or menadione (1.1, 2.2 and 31 mumol/kg diet, respectively, 6 rats per group). Warfarin (2 x 1 mg/kg subcutaneously) was given (3 rats per group) to study the effect of vitamin K cycle blockage. In rats fed phylloquinone the vitamin accumulated mainly in liver and heart. Additionally, the diet resulted in significantly higher organ MK-4 concentrations compared with the vitamin K-deficient controls. The epoxide of MK-4 also was significantly higher in some organs. The MK-4 diet increased MK-4 concentration primarily in the heart, liver and lung. Rats fed menadione had significantly higher MK-4 and MK-4 epoxide concentrations in all organs examined. The greatest accumulations were in nonhepatic organs, particularly the pancreas, salivary gland and brain. Generally, liver and plasma had low MK-4 concentrations. Warfarin treatment lowered significantly the MK-4 concentrations, whereas MK-4 epoxide accumulated. The study shows the following: 1) dietary phylloquinone is accumulated mainly in the heart and liver, 2) the MK-4 accumulation in nonhepatic organs is due to synthesis rather than uptake and 3) MK-4 rather than phylloquinone may be the functional vitamin in nonhepatic organs.
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Affiliation(s)
- H H Thijssen
- Department of Pharmacology, University of Limburg, Maastricht, The Netherlands
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Fischer MA, Feinstein AR. The etymology and pathogenesis of "wonk". J Clin Epidemiol 1995; 48:1089-90. [PMID: 7775997 DOI: 10.1016/0895-4356(95)00001-k] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- M A Fischer
- Yale University School of Medicine, New Haven, CT 06520-8025, USA
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Abstract
Admissions records were reviewed for six acute care Veterans Affairs Medical Centers (VAMC's) in New England to determine appropriateness of short-stay admissions (two days or less) in fiscal years 1986 and 1987 for certain medical and surgical procedures. Results indicated that such admissions accounted for 18,588 (22%) of a total of 84,266 admissions for the six hospitals; of these admissions, 4,362 were for procedures commonly performed on an outpatient basis. Criteria developed by a peer review board of physicians was applied to a sample of 728 (16.7%) of the 4,362 short-stay admissions for these procedures; 190 (26.1%) admissions from this sample were found to be inappropriate. Inappropriateness rates (9.1% to 46.1%), as well as the number and type of procedures, varied among the six VAMCs. Some VAMCs may be able to improve efficiency by performing more procedures on an outpatient basis.
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Affiliation(s)
- R N Winickoff
- Brockton/West Roxbury Veterans Affairs Medical Center, MA
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Fischer MA, Black HS. Modification of membrane composition, eicosanoid metabolism, and immunoresponsiveness by dietary omega-3 and omega-6 fatty acid sources, modulators of ultraviolet-carcinogenesis. Photochem Photobiol 1991; 54:381-7. [PMID: 1784638 DOI: 10.1111/j.1751-1097.1991.tb02031.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Dietary sources of lipids containing predominantly n-3 or n-6 fatty acids (FA) have been examined for effect upon several potential pathophysiologic parameters. Epidermal, plasma, and red blood cell (RBC) membrane FA composition exhibited marked differences between animals fed the respective dietary lipid sources. Reduced levels of 18:1, 20:3 and 20:4 occurred in the n-3 FA fed animals which exhibited significantly higher levels of 20:5 and 22:6. Approximately equal levels of 18:2 were present in animals fed either diet. Despite marked differences in RBC membrane FA composition, only marginal effect upon osmotic fragility occurred. Lower levels of 20:3 and 20:4 found in n-3 fed animals could result from a deficit of elongase and/or delta 5-desaturase activity. Whether lower 20:4 levels in n-3 fed animals could rate-limit eicosanoid metabolism is unknown, but epidermal capacity to metabolise arachidonic acid in these animals was found to be closely related to n-6 FA intake. Animals fed n-3 FA exhibited markedly lower levels of plasma PGE2, even when the diet was supplemented with n-6 FA. In addition, UV-radiated animals receiving the n-3 FA source demonstrated a reduced (approximately 30%) response to inflammatory stimulus and a greater (4.5-fold) delayed hypersensitivity (DH) to dinitrochlorobenzene than animals fed the n-6 FA source. These data demonstrate that dietary lipid strongly influences tissue FA composition, eicosanoid metabolism, and, in the case of DH, at least one type of T-cell mediated immune response in UV-irradiated animals.
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Affiliation(s)
- M A Fischer
- Photobiology Laboratory, Veterans Affairs Medical Center, Houston, TX
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Abstract
The social-communicative transactions between 5 preverbal children with Down syndrome and their mothers were compared with those of 5 developmentally matched nonretarded child-mother dyads. Although overall similarities were evidenced, between-group differences were observed in the percentage of child-initiated social-communicative signals used and in the levels of contingent maternal responsiveness.
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Fischer MA, Leophonte P, Delaude A. [Epidemiology of Legionnaires' disease]. Rev Pneumol Clin 1984; 40:167-171. [PMID: 6379825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The authors discuss the epidemiological problems of legionnaire's disease. Although Legionella is known to proliferate in watery environments, the origin and extension of sporadic cases and the factors responsible for bacterial spread remain unclear. The problem of prevention has also to be resolved.
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