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Fischer MA, Jia L, Edelblum KL. Type I interferon induces TCR-dependent and -independent antimicrobial responses in γδ intraepithelial lymphocytes. bioRxiv 2024:2024.03.11.584444. [PMID: 38559228 PMCID: PMC10979951 DOI: 10.1101/2024.03.11.584444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Intraepithelial lymphocytes (IEL) expressing the γδ T cell receptor (TCR) survey the intestinal epithelium to limit the invasion of microbial pathogens. The production of type I interferon (IFN) is a central component of an antiviral immune response, yet how these pro-inflammatory cytokines contribute to γδ IEL effector function remains unclear. Based on the unique activation status of IELs, and their ability to bridge innate and adaptive immunity, we investigated the extent to which type I IFN signaling modulates γδ IEL function. Using an ex vivo culture model, we find that type I IFN alone is unable to drive IFNγ production, yet low level TCR activation synergizes with type I IFN to induce IFNγ production in murine γδ IELs. Further investigation into the underlying molecular mechanisms of co-stimulation revealed that TCRγδ-mediated activation of NFAT and JNK is required for type I IFN to promote IFNγ expression in a STAT4- dependent manner. Whereas type I IFN rapidly upregulates antiviral gene expression independent of a basal TCRγδ signal, neither tonic TCR triggering nor the presence of a TCR agonist was sufficient to elicit type I IFN-induced IFNγ production in vivo . However, bypassing proximal TCR signaling events synergized with IFNAR/STAT4 activation to induce γδ IEL IFNγ production. These findings indicate that γδ IELs contribute to host defense in response to type I IFN by mounting a rapid antimicrobial response independent of TCRγδ signaling, and under permissive conditions, produce IFNγ in a TCR-dependent manner.
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Williams TM, Harvey R, Fischer MA, Neelankavil J. It's Time for Effective and Affordable Therapies for Cardiac Amyloidosis: Lessons From Patisiran. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00157-5. [PMID: 38584048 DOI: 10.1053/j.jvca.2024.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/25/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Tiffany M Williams
- Department of Anesthesiology & Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Reed Harvey
- Department of Anesthesiology & Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Matthew A Fischer
- Department of Anesthesiology & Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Jacques Neelankavil
- Department of Anesthesiology & Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.
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Fischer MA, Arrieta A, Angelini M, Soehalim E, Chapski DJ, Shemin RJ, Vondriska TM, Olcese R. Decreased Left Atrial Cardiomyocyte FGF13 Expression Increases Vulnerability to Postoperative Atrial Fibrillation in Humans. bioRxiv 2024:2024.01.30.577790. [PMID: 38352455 PMCID: PMC10862764 DOI: 10.1101/2024.01.30.577790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Postoperative atrial fibrillation (POAF) is the most common complication after cardiac surgery and a significant cause of increased morbidity and mortality. The development of novel POAF therapeutics has been limited by an insufficient understanding of molecular mechanisms promoting atrial fibrillation. In this observational cohort study, we enrolled 28 patients without a history of atrial fibrillation that underwent mitral valve surgery for degenerative mitral regurgitation and obtained left atrial tissue samples along the standard atriotomy incision in proximity to the right pulmonary veins. We isolated cardiomyocytes and performed transcriptome analyses demonstrating 13 differentially expressed genes associated with new-onset POAF. Notably, decreased expression of fibroblast growth factor 13 (FGF13), a fibroblast growth factor homologous factor known to modulate voltage-gated sodium channel Na V 1.5 inactivation, had the most significant association with POAF. To assess the functional significance of decreased FGF13 expression in atrial myocytes, we performed patch clamp experiments on neonatal rat atrial myocytes after siRNA-mediated FGF13 knockdown, demonstrating action potential prolongation. These critical findings indicate that decreased FGF13 expression promotes vulnerability to POAF.
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Fischer MA, Williams TM, Harvey R, Neelankavil J. Making a Statement: The Need for a Formal Training Statement in Cardiac Anesthesiology. J Cardiothorac Vasc Anesth 2023; 37:1847-1849. [PMID: 37385881 DOI: 10.1053/j.jvca.2023.05.042] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 07/01/2023]
Affiliation(s)
- Matthew A Fischer
- Department of Anesthesiology and Perioperative Medicine; David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Tiffany M Williams
- Department of Anesthesiology and Perioperative Medicine; David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Reed Harvey
- Department of Anesthesiology and Perioperative Medicine; David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Jacques Neelankavil
- Department of Anesthesiology and Perioperative Medicine; David Geffen School of Medicine at UCLA, Los Angeles, CA.
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Schultz KM, Schneider JR, Fischer MA, Cina NP, Riegert MO, Frank DW, Klug CS. Binding and transport of LPS occurs through the coordinated combination of an array of sites across the entire E. coli LPS transport protein LptA. Protein Sci 2023:e4724. [PMID: 37417889 PMCID: PMC10360375 DOI: 10.1002/pro.4724] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/21/2023] [Accepted: 07/04/2023] [Indexed: 07/08/2023]
Abstract
The outer leaflet of the outer membrane (OM) of bacteria such as Escherichia coli, Pseudomonas aeruginosa, and other important pathogens is largely composed of lipopolysaccharide (LPS), which is essential to nearly all Gram-negative bacteria. LPS is transported to the outer leaflet of the OM through a yet unknown mechanism by seven proteins that comprise the LPS transport system. LptA, the only entirely periplasmic Lpt protein, bridges the periplasmic space between the IM LptB2 FGC and the OM LptDE complexes. LptA is postulated to protect the hydrophobic acyl chains of LPS as it crosses the hydrophilic periplasm, is essential to cell viability, and contains many conserved residues distributed across the protein. To identify which side chains are required for function of E. coli LptA in vivo, we performed a systematic, unbiased, high-throughput screen of the effect of 172 single alanine substitutions on cell viability utilizing an engineered BL21 derivative with a chromosomal knockout of the lptA gene. Remarkably, LptA is highly tolerant to amino acid substitution with alanine. Only four alanine mutants could not complement the chromosomal knockout; CD spectroscopy showed that these substitutions resulted in proteins with significantly altered secondary structure. In addition, 29 partial loss-of-function mutants were identified that led to OM permeability defects; interestingly, these sites were solely located within β-strands of the central core of the protein and each resulted in misfolding of the protein. Therefore, no single residue within LptA is responsible for LPS binding, supporting previous EPR spectroscopy data indicating that sites across the entire protein work in concert to bind and transport LPS. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Kathryn M Schultz
- Department of Biophysics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, USA
| | - John R Schneider
- Department of Biophysics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, USA
| | - Matthew A Fischer
- Department of Biophysics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, USA
| | - Nicholas P Cina
- Department of Biophysics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, USA
| | - Molly O Riegert
- Department of Microbiology & Immunology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, USA
| | - Dara W Frank
- Department of Microbiology & Immunology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, USA
| | - Candice S Klug
- Department of Biophysics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, USA
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Harvey RE, Fischer MA, Williams TM, Neelankavil J. Growing Pains: Opportunity Knocks in the 2022 Center for Disease Control Clinical Practice Guidelines for Prescribing Opioids for Pain. J Cardiothorac Vasc Anesth 2023; 37:857-859. [PMID: 36868905 DOI: 10.1053/j.jvca.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023]
Affiliation(s)
- Reed E Harvey
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.
| | - Matthew A Fischer
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Tiffany M Williams
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Jacques Neelankavil
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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Fischer MA, Chapski DJ, Soehalim E, Montoya DJ, Grogan T, Pellegrini M, Cai H, Shemin RJ, Vondriska TM. Longitudinal profiling in patients undergoing cardiac surgery reveals postoperative changes in DNA methylation. Clin Epigenetics 2022; 14:195. [PMID: 36585726 PMCID: PMC9805211 DOI: 10.1186/s13148-022-01414-4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/18/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Cardiac surgery and cardiopulmonary bypass induce a substantial immune and inflammatory response, the overactivation of which is associated with significant pulmonary, cardiovascular, and neurologic complications. Commensurate with the immune and inflammatory response are changes in the heart and vasculature itself, which together drive postoperative complications through mechanisms that are poorly understood. Longitudinal DNA methylation profiling has the potential to identify changes in gene regulatory mechanisms that are secondary to surgery and to identify molecular processes that predict and/or cause postoperative complications. In this study, we measure DNA methylation in preoperative and postoperative whole blood samples from 96 patients undergoing cardiac surgery on cardiopulmonary bypass. RESULTS While the vast majority of DNA methylation is unchanged by surgery after accounting for changes in cell-type composition, we identify several loci with statistically significant postoperative changes in methylation. Additionally, two of these loci are associated with new-onset postoperative atrial fibrillation, a significant complication after cardiac surgery. Paired statistical analysis, use of FACS data to support sufficient control of cell-type heterogeneity, and measurement of IL6 levels in a subset of patients add rigor to this analysis, allowing us to distinguish cell-type variability from actual changes in methylation. CONCLUSIONS This study identifies significant changes in DNA methylation that occur immediately after cardiac surgery and demonstrates that these acute alterations in DNA methylation have the granularity to identify processes associated with major postoperative complications. This research also establishes methods for controlling for cell-type variability in a large human cohort that may be useful to deploy in other longitudinal studies of epigenetic marks in the setting of acute and chronic disease.
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Affiliation(s)
- Matthew A. Fischer
- grid.19006.3e0000 0000 9632 6718Department of Anesthesiology & Perioperative Medicine, David Geffen School of Medicine, UCLA, CHS 37-100, 650 Charles Young Dr, Los Angeles, CA 90095 USA
| | - Douglas J. Chapski
- grid.19006.3e0000 0000 9632 6718Department of Anesthesiology & Perioperative Medicine, David Geffen School of Medicine, UCLA, CHS 37-100, 650 Charles Young Dr, Los Angeles, CA 90095 USA
| | - Elizabeth Soehalim
- grid.19006.3e0000 0000 9632 6718Department of Anesthesiology & Perioperative Medicine, David Geffen School of Medicine, UCLA, CHS 37-100, 650 Charles Young Dr, Los Angeles, CA 90095 USA
| | - Dennis J. Montoya
- grid.19006.3e0000 0000 9632 6718Department of Molecular, Cellular & Developmental Biology, David Geffen School of Medicine, UCLA, Los Angeles, USA
| | - Tristan Grogan
- grid.19006.3e0000 0000 9632 6718Department of Anesthesiology & Perioperative Medicine, David Geffen School of Medicine, UCLA, CHS 37-100, 650 Charles Young Dr, Los Angeles, CA 90095 USA
| | - Matteo Pellegrini
- grid.19006.3e0000 0000 9632 6718Department of Molecular, Cellular & Developmental Biology, David Geffen School of Medicine, UCLA, Los Angeles, USA
| | - Hua Cai
- grid.19006.3e0000 0000 9632 6718Department of Anesthesiology & Perioperative Medicine, David Geffen School of Medicine, UCLA, CHS 37-100, 650 Charles Young Dr, Los Angeles, CA 90095 USA
| | - Richard J. Shemin
- grid.19006.3e0000 0000 9632 6718Department of Surgery, David Geffen School of Medicine, UCLA, Los Angeles, USA
| | - Thomas M. Vondriska
- grid.19006.3e0000 0000 9632 6718Department of Anesthesiology & Perioperative Medicine, David Geffen School of Medicine, UCLA, CHS 37-100, 650 Charles Young Dr, Los Angeles, CA 90095 USA ,grid.19006.3e0000 0000 9632 6718Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, USA ,grid.19006.3e0000 0000 9632 6718Department of Physiology, David Geffen School of Medicine, UCLA, Los Angeles, USA
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El-Naccache DW, Chen F, Palma MJ, Lemenze A, Fischer MA, Wu W, Mishra PK, Eltzschig HK, Robson SC, Di Virgilio F, Yap GS, Edelblum KL, Haskó G, Gause WC. Adenosine metabolized from extracellular ATP promotes type 2 immunity through triggering A 2BAR signaling in intestinal epithelial cells. Cell Rep 2022; 40:111150. [PMID: 35926464 PMCID: PMC9402265 DOI: 10.1016/j.celrep.2022.111150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 06/13/2022] [Accepted: 07/12/2022] [Indexed: 11/23/2022] Open
Abstract
Intestinal nematode parasites can cross the epithelial barrier, causing tissue damage and release of danger-associated molecular patterns (DAMPs) that may promote host protective type 2 immunity. We investigate whether adenosine binding to the A2B adenosine receptor (A2BAR) on intestinal epithelial cells (IECs) plays an important role. Specific blockade of IEC A2BAR inhibits the host protective memory response to the enteric helminth, Heligmosomoides polygyrus bakeri (Hpb), including disruption of granuloma development at the host-parasite interface. Memory T cell development is blocked during the primary response, and transcriptional analyses reveal profound impairment of IEC activation. Extracellular ATP is visualized 24 h after inoculation and is shown in CD39-deficient mice to be critical for the adenosine production mediating the initiation of type 2 immunity. Our studies indicate a potent adenosine-mediated IEC pathway that, along with the tuft cell circuit, is critical for the activation of type 2 immunity.
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Affiliation(s)
- Darine W El-Naccache
- Center for Immunity and Inflammation, New Jersey Medical School, Rutgers-The State University of New Jersey, Newark, NJ 07101, USA; Department of Medicine, New Jersey Medical School, Rutgers-The State University of New Jersey, Newark, NJ 07101, USA
| | - Fei Chen
- Center for Immunity and Inflammation, New Jersey Medical School, Rutgers-The State University of New Jersey, Newark, NJ 07101, USA; Department of Medicine, New Jersey Medical School, Rutgers-The State University of New Jersey, Newark, NJ 07101, USA
| | - Mark J Palma
- Center for Immunity and Inflammation, New Jersey Medical School, Rutgers-The State University of New Jersey, Newark, NJ 07101, USA; Department of Medicine, New Jersey Medical School, Rutgers-The State University of New Jersey, Newark, NJ 07101, USA
| | - Alexander Lemenze
- Center for Immunity and Inflammation, New Jersey Medical School, Rutgers-The State University of New Jersey, Newark, NJ 07101, USA; Department of Pathology, Immunology, and Laboratory Medicine, New Jersey Medical School, Rutgers-The State University of New Jersey, Newark, NJ 07101, USA
| | - Matthew A Fischer
- Center for Immunity and Inflammation, New Jersey Medical School, Rutgers-The State University of New Jersey, Newark, NJ 07101, USA; Department of Pathology, Immunology, and Laboratory Medicine, New Jersey Medical School, Rutgers-The State University of New Jersey, Newark, NJ 07101, USA
| | - Wenhui Wu
- Center for Immunity and Inflammation, New Jersey Medical School, Rutgers-The State University of New Jersey, Newark, NJ 07101, USA; Department of Medicine, New Jersey Medical School, Rutgers-The State University of New Jersey, Newark, NJ 07101, USA
| | - Pankaj K Mishra
- Center for Immunity and Inflammation, New Jersey Medical School, Rutgers-The State University of New Jersey, Newark, NJ 07101, USA; Department of Medicine, New Jersey Medical School, Rutgers-The State University of New Jersey, Newark, NJ 07101, USA
| | - Holger K Eltzschig
- Department of Anesthesiology, University of Texas at Houston Medical School, Houston, TX 77030, USA
| | - Simon C Robson
- Center for Inflammation Research, Department of Anesthesia, Critical Care & Pain Medicine and Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | | | - George S Yap
- Center for Immunity and Inflammation, New Jersey Medical School, Rutgers-The State University of New Jersey, Newark, NJ 07101, USA; Department of Medicine, New Jersey Medical School, Rutgers-The State University of New Jersey, Newark, NJ 07101, USA
| | - Karen L Edelblum
- Center for Immunity and Inflammation, New Jersey Medical School, Rutgers-The State University of New Jersey, Newark, NJ 07101, USA; Department of Pathology, Immunology, and Laboratory Medicine, New Jersey Medical School, Rutgers-The State University of New Jersey, Newark, NJ 07101, USA
| | - György Haskó
- Department of Anesthesiology, Columbia University, New York, NY, USA.
| | - William C Gause
- Center for Immunity and Inflammation, New Jersey Medical School, Rutgers-The State University of New Jersey, Newark, NJ 07101, USA; Department of Medicine, New Jersey Medical School, Rutgers-The State University of New Jersey, Newark, NJ 07101, USA.
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Fischer MA, Mahajan A, Cabaj M, Kimball TH, Morselli M, Soehalim E, Chapski DJ, Montoya D, Farrell CP, Scovotti J, Bueno CT, Mimila NA, Shemin RJ, Elashoff D, Pellegrini M, Monte E, Vondriska TM. DNA Methylation-Based Prediction of Post-operative Atrial Fibrillation. Front Cardiovasc Med 2022; 9:837725. [PMID: 35620521 PMCID: PMC9127230 DOI: 10.3389/fcvm.2022.837725] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/17/2022] [Indexed: 12/14/2022] Open
Abstract
BackgroundAtrial fibrillation (AF) is the most common sustained cardiac arrhythmia and post-operative atrial fibrillation (POAF) is a major healthcare burden, contributing to an increased risk of stroke, kidney failure, heart attack and death. Genetic studies have identified associations with AF, but no molecular diagnostic exists to predict POAF based on pre-operative measurements. Such a tool would be of great value for perioperative planning to improve patient care and reduce healthcare costs. In this pilot study of epigenetic precision medicine in the perioperative period, we carried out bisulfite sequencing to measure DNA methylation status in blood collected from patients prior to cardiac surgery to identify biosignatures of POAF.MethodsWe enrolled 221 patients undergoing cardiac surgery in this prospective observational study. DNA methylation measurements were obtained from blood samples drawn from awake patients prior to surgery. After controlling for clinical and methylation covariates, we analyzed DNA methylation loci in the discovery cohort of 110 patients for association with POAF. We also constructed predictive models for POAF using clinical and DNA methylation data. We subsequently performed targeted analyses of a separate cohort of 101 cardiac surgical patients to measure the methylation status solely of significant methylation loci in the discovery cohort.ResultsA total of 47 patients in the discovery cohort (42.7%) and 43 patients in the validation cohort (42.6%) developed POAF. We identified 12 CpGs that were statistically significant in the discovery cohort after correcting for multiple hypothesis testing. Of these sites, 6 were amenable to targeted bisulfite sequencing and chr16:24640902 was statistically significant in the validation cohort. In addition, the methylation POAF prediction model had an AUC of 0.79 in the validation cohort.ConclusionsWe have identified DNA methylation biomarkers that can predict future occurrence of POAF associated with cardiac surgery. This research demonstrates the use of precision medicine to develop models combining epigenomic and clinical data to predict disease.
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Affiliation(s)
- Matthew A. Fischer
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
- *Correspondence: Matthew A. Fischer
| | - Aman Mahajan
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Maximilian Cabaj
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Todd H. Kimball
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Marco Morselli
- Department of Molecular, Cellular and Developmental Biology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Elizabeth Soehalim
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Douglas J. Chapski
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Dennis Montoya
- Department of Molecular, Cellular and Developmental Biology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Colin P. Farrell
- Department of Molecular, Cellular and Developmental Biology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jennifer Scovotti
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Claudia T. Bueno
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Naomi A. Mimila
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Richard J. Shemin
- Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - David Elashoff
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Biostatistics, University of California, Los Angeles, Los Angeles, CA, United States
| | - Matteo Pellegrini
- Department of Molecular, Cellular and Developmental Biology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Emma Monte
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Thomas M. Vondriska
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Physiology, University of California, Los Angeles, Los Angeles, CA, United States
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Harvey R, Williams TM, Hernandez-Morgan M, Fischer MA, Neelankavil J. Peer Review Guidance for Evaluating the Narrative Review: Lessons Applied From the Systematic Review. J Cardiothorac Vasc Anesth 2022; 36:735-738. [PMID: 34903460 DOI: 10.1053/j.jvca.2021.11.020] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Reed Harvey
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Tiffany M Williams
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Marisa Hernandez-Morgan
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Matthew A Fischer
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Jacques Neelankavil
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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Williams TM, Harvey R, Kratzert WB, Fischer MA, Neelankavil J. Ultrasound-Enhancing Agent Safety: Understanding the New Food and Drug Administration Warning on Polyethylene Glycol. J Cardiothorac Vasc Anesth 2021; 36:12-14. [PMID: 34362643 DOI: 10.1053/j.jvca.2021.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 01/22/2023]
Affiliation(s)
- Tiffany M Williams
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Reed Harvey
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Wolf B Kratzert
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Matthew A Fischer
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Jacques Neelankavil
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
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Abstract
The study of epigenomics has advanced in recent years to span the regulation of a single genetic locus to the structure and orientation of entire chromosomes within the nucleus. In this review, we focus on the challenges and opportunities of clinical epigenomics in cardiovascular disease. As an integrator of genetic and environmental inputs, and because of advances in measurement techniques that are highly reproducible and provide sequence information, the epigenome is a rich source of potential biosignatures of cardiovascular health and disease. Most of the studies to date have focused on the latter, and herein we discuss observations on epigenomic changes in human cardiovascular disease, examining the role of protein modifiers of chromatin, noncoding RNAs and DNA modification. We provide an overview of cardiovascular epigenomics, discussing the challenges of data sovereignty, data analysis, doctor-patient ethics and innovations necessary to implement precision health.
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Affiliation(s)
- Matthew A Fischer
- Department of Anesthesiology & Perioperative Medicine, David Geffen School of Medicine at UCLA, USA.
| | - Thomas M Vondriska
- Department of Anesthesiology & Perioperative Medicine, David Geffen School of Medicine at UCLA, USA
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13
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Fischer MA, Williams TM, Harvey R, Neelankavil J. TAVR Explantation: Re-Do Risk Without the Re-Do Sternotomy. J Cardiothorac Vasc Anesth 2021; 35:2256-2259. [PMID: 33888403 DOI: 10.1053/j.jvca.2021.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/14/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Matthew A Fischer
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Tiffany M Williams
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Reed Harvey
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Jacques Neelankavil
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.
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14
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Fischer MA, Golovchenko NB, Edelblum KL. γδ T cell migration: Separating trafficking from surveillance behaviors at barrier surfaces. Immunol Rev 2020; 298:165-180. [PMID: 32845516 PMCID: PMC7968450 DOI: 10.1111/imr.12915] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 12/23/2022]
Abstract
γδ T cells are found in highest numbers at barrier surfaces throughout the body, including the skin, intestine, lung, gingiva, and uterus. Under homeostatic conditions, γδ T cells provide immune surveillance of the epidermis, intestinal, and oral mucosa, whereas the presence of pathogenic microorganisms in the dermis or lungs elicits a robust γδ17 response to clear the infection. Although T cell migration is most frequently defined in the context of trafficking, analysis of specific migratory behaviors of lymphocytes within the tissue microenvironment can provide valuable insight into their function. Intravital imaging and computational analyses have been used to define "search" behavior associated with conventional αβ T cells; however, based on the known role of γδ T cells as immune sentinels at barrier surfaces and their TCR-independent functions, we put forth the need to classify distinct migratory patterns that reflect the surveillance capacity of these unconventional lymphocytes. This review will focus on how γδ T cells traffic to various barrier surfaces and how recent investigation into their migratory behavior has provided unique insight into the contribution of γδ T cells to barrier immunity.
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Affiliation(s)
- Matthew A. Fischer
- Center for Immunity and Inflammation, Department of Pathology, Immunology & Laboratory Medicine, Rutgers New Jersey Medical School, Newark, NJ
| | - Natasha B. Golovchenko
- Center for Immunity and Inflammation, Department of Pathology, Immunology & Laboratory Medicine, Rutgers New Jersey Medical School, Newark, NJ
| | - Karen L. Edelblum
- Center for Immunity and Inflammation, Department of Pathology, Immunology & Laboratory Medicine, Rutgers New Jersey Medical School, Newark, NJ
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15
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Fielding-Singh V, Willingham MD, Fischer MA, Grogan T, Benharash P, Neelankavil JP. A Population-Based Analysis of Intraoperative Cardiac Arrest in the United States. Anesth Analg 2020; 130:627-634. [DOI: 10.1213/ane.0000000000004477] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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16
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Schultz KM, Fischer MA, Noey EL, Klug CS. Disruption of the E. coli LptC dimerization interface and characterization of lipopolysaccharide and LptA binding to monomeric LptC. Protein Sci 2018; 27:1407-1417. [PMID: 29672978 PMCID: PMC6153404 DOI: 10.1002/pro.3429] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/15/2018] [Accepted: 04/17/2018] [Indexed: 11/10/2022]
Abstract
Lipopolysaccharide (LPS) is an essential element of nearly all Gram-negative bacterial outer membranes and serves to protect the cell from adverse environmental stresses. Seven members of the lipopolysaccharide transport (Lpt) protein family function together to transport LPS from the inner membrane (IM) to the outer leaflet of the outer membrane of bacteria such as Escherichia coli. Each of these proteins has a solved crystal structure, including LptC, which is a largely periplasmic protein that is associated with the IM LptB2 FG complex and anchored to the membrane by an N-terminal helix. LptC directly binds LPS and is hypothesized to be involved in the transfer of LPS to another periplasmic protein, LptA. Purified and in solution, LptC forms a dimer. Here, point mutations designed to disrupt formation of the dimer are characterized using site-directed spin labeling double electron electron resonance (DEER) spectroscopy, light scattering, circular dichroism, and computational modeling. The computational studies reveal the molecular interactions that drive dimerization of LptC and elucidate how the disruptive mutations change this interaction, while the DEER and light scattering studies identify which mutants disrupt the dimer. And, using electron paramagnetic resonance spectroscopy and comparing the results to the previous quantitative characterization of the interactions between dimeric LptC and LPS and LptA, the functional consequences of monomeric LptC were also determined. These results indicate that disruption of the dimer does not affect LPS or LptA binding and that monomeric LptC binds LPS and LptA at levels similar to dimeric LptC.
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Affiliation(s)
- Kathryn M. Schultz
- Department of BiophysicsMedical College of WisconsinMilwaukeeWisconsin53226
| | - Matthew A. Fischer
- Department of BiophysicsMedical College of WisconsinMilwaukeeWisconsin53226
| | - Elizabeth L. Noey
- Department of BiophysicsMedical College of WisconsinMilwaukeeWisconsin53226
| | - Candice S. Klug
- Department of BiophysicsMedical College of WisconsinMilwaukeeWisconsin53226
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17
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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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18
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Davies ML, Parekh NJ, Kaminsky LW, Soni C, Reider IE, Krouse TE, Fischer MA, van Rooijen N, Rahman ZSM, Norbury CC. A systemic macrophage response is required to contain a peripheral poxvirus infection. PLoS Pathog 2017; 13:e1006435. [PMID: 28614386 PMCID: PMC5484545 DOI: 10.1371/journal.ppat.1006435] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/26/2017] [Accepted: 05/26/2017] [Indexed: 02/07/2023] Open
Abstract
The goal of the innate immune system is to reduce pathogen spread prior to the initiation of an effective adaptive immune response. Following an infection at a peripheral site, virus typically drains through the lymph to the lymph node prior to entering the blood stream and being systemically disseminated. Therefore, there are three distinct spatial checkpoints at which intervention to prevent systemic spread of virus can occur, namely: 1) the site of infection, 2) the draining lymph node via filtration of lymph or 3) the systemic level via organs that filter the blood. We have previously shown that systemic depletion of phagocytic cells allows viral spread after dermal infection with Vaccinia virus (VACV), which infects naturally through the skin. Here we use multiple depletion methodologies to define both the spatial checkpoint and the identity of the cells that prevent systemic spread of VACV. Subcapsular sinus macrophages of the draining lymph node have been implicated as critical effectors in clearance of lymph borne viruses following peripheral infection. We find that monocyte populations recruited to the site of VACV infection play a critical role in control of local pathogenesis and tissue damage, but do not prevent dissemination of virus. Following infection with virulent VACV, the subcapsular sinus macrophages within the draining lymph node become infected, but are not exclusively required to prevent systemic spread. Rather, small doses of VACV enter the bloodstream and the function of systemic macrophages, but not dendritic cells, is required to prevent further spread. The results illustrate that a systemic innate response to a peripheral virus infection may be required to prevent widespread infection and pathology following infection with virulent viruses, such as poxviruses.
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Affiliation(s)
- Michael L. Davies
- Department of Microbiology and Immunology, College of Medicine, Pennsylvania State University, Hershey, PA, United States of America
| | - Nikhil J. Parekh
- Department of Microbiology and Immunology, College of Medicine, Pennsylvania State University, Hershey, PA, United States of America
| | - Lauren W. Kaminsky
- Department of Microbiology and Immunology, College of Medicine, Pennsylvania State University, Hershey, PA, United States of America
| | - Chetna Soni
- Department of Microbiology and Immunology, College of Medicine, Pennsylvania State University, Hershey, PA, United States of America
| | - Irene E. Reider
- Department of Microbiology and Immunology, College of Medicine, Pennsylvania State University, Hershey, PA, United States of America
| | - Tracy E. Krouse
- Department of Microbiology and Immunology, College of Medicine, Pennsylvania State University, Hershey, PA, United States of America
| | - Matthew A. Fischer
- Department of Microbiology and Immunology, College of Medicine, Pennsylvania State University, Hershey, PA, United States of America
| | - Nico van Rooijen
- Department of Molecular Cell Biology, Faculty of Medicine, Vrije Universiteit, BT Amsterdam, The Netherlands
| | - Ziaur S. M. Rahman
- Department of Microbiology and Immunology, College of Medicine, Pennsylvania State University, Hershey, PA, United States of America
| | - Christopher C. Norbury
- Department of Microbiology and Immunology, College of Medicine, Pennsylvania State University, Hershey, PA, United States of America
- * E-mail:
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19
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Monte E, Fischer MA, Vondriska TM. Epigenomic Disruption of Cardiovascular Care: What It Will Take. Circ Res 2017; 120:1692-1693. [PMID: 28546346 DOI: 10.1161/circresaha.117.311072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Emma Monte
- From the Department of Genetics, Stanford University, CA (E.M.); and Department of Anesthesiology and Perioperative Medicine (M.A.F., T.M.V.), Department of Medicine/Cardiology (T.M.V.), and Department of Physiology (T.M.V.), David Geffen School of Medicine, University of California, Los Angeles
| | - Matthew A Fischer
- From the Department of Genetics, Stanford University, CA (E.M.); and Department of Anesthesiology and Perioperative Medicine (M.A.F., T.M.V.), Department of Medicine/Cardiology (T.M.V.), and Department of Physiology (T.M.V.), David Geffen School of Medicine, University of California, Los Angeles
| | - Thomas M Vondriska
- From the Department of Genetics, Stanford University, CA (E.M.); and Department of Anesthesiology and Perioperative Medicine (M.A.F., T.M.V.), Department of Medicine/Cardiology (T.M.V.), and Department of Physiology (T.M.V.), David Geffen School of Medicine, University of California, Los Angeles.
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20
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Schultz KM, Lundquist TJ, Fischer MA, Klug CS. LPS Binding to LptA. Biophys J 2017. [DOI: 10.1016/j.bpj.2016.11.2390] [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: 10/20/2022] Open
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21
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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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22
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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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23
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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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24
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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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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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Fischer MA, Davies ML, Reider IE, Heipertz EL, Epler MR, Sei JJ, Ingersoll MA, Van Rooijen N, Randolph GJ, Norbury CC. CD11b⁺, Ly6G⁺ cells produce type I interferon and exhibit tissue protective properties following peripheral virus infection. PLoS Pathog 2011; 7:e1002374. [PMID: 22102816 PMCID: PMC3213107 DOI: 10.1371/journal.ppat.1002374] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 09/28/2011] [Indexed: 12/22/2022] Open
Abstract
The goal of the innate immune system is containment of a pathogen at the site of infection prior to the initiation of an effective adaptive immune response. However, effector mechanisms must be kept in check to combat the pathogen while simultaneously limiting undesirable destruction of tissue resulting from these actions. Here we demonstrate that innate immune effector cells contain a peripheral poxvirus infection, preventing systemic spread of the virus. These innate immune effector cells are comprised primarily of CD11b+Ly6C+Ly6G- monocytes that accumulate initially at the site of infection, and are then supplemented and eventually replaced by CD11b+Ly6C+Ly6G+ cells. The phenotype of the CD11b+Ly6C+Ly6G+ cells resembles neutrophils, but the infiltration of neutrophils typically occurs prior to, rather than following, accumulation of monocytes. Indeed, it appears that the CD11b+Ly6C+Ly6G+ cells that infiltrated the site of VACV infection in the ear are phenotypically distinct from the classical description of both neutrophils and monocyte/macrophages. We found that CD11b+Ly6C+Ly6G+ cells produce Type I interferons and large quantities of reactive oxygen species. We also observed that depletion of Ly6G+ cells results in a dramatic increase in tissue damage at the site of infection. Tissue damage is also increased in the absence of reactive oxygen species, although reactive oxygen species are typically thought to be damaging to tissue rather than protective. These data indicate the existence of a specialized population of CD11b+Ly6C+Ly6G+ cells that infiltrates a site of virus infection late and protects the infected tissue from immune-mediated damage via production of reactive oxygen species. Regulation of the action of this population of cells may provide an intervention to prevent innate immune-mediated tissue destruction. During a natural virus infection, small doses of infectious virus are deposited at a peripheral infection site, and then a “race” ensues, in which the replicating virus attempts to “outpace” the responding immune system of the host. In the early phases of infection, the innate immune system must contain the infection prior to the development of an effective adaptive response. Here we have characterized the cells of the innate immune system that move to a site of peripheral virus infection, and we find that a subset of these cells display atypical expression of cell surface molecules, timing of infiltration, and function. These cells protect the infected tissue from damage by producing reactive oxygen molecules, which are widely accepted to increase tissue damage. Therefore our findings indicate that during a peripheral virus infection, the typical rules governing the function of the innate immune system are altered to prevent tissue damage.
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Affiliation(s)
- Matthew A. Fischer
- Department of Microbiology and Immunology, Pennsylvania State University Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States of America
| | - Michael L. Davies
- Department of Microbiology and Immunology, Pennsylvania State University Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States of America
| | - Irene E. Reider
- Department of Microbiology and Immunology, Pennsylvania State University Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States of America
| | - Erica L. Heipertz
- Department of Microbiology and Immunology, Pennsylvania State University Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States of America
| | - Melanie R. Epler
- Department of Microbiology and Immunology, Pennsylvania State University Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States of America
| | - Janet J. Sei
- Department of Microbiology and Immunology, Pennsylvania State University Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States of America
| | - Molly A. Ingersoll
- Department of Gene and Cell Medicine, Mount Sinai School of Medicine, New York, New York, United States of America
| | - Nico Van Rooijen
- Department of Molecular Cell Biology, Faculty of Medicine, Vrije Universiteit, Amsterdam, The Netherlands
| | - Gwendalyn J. Randolph
- Department of Gene and Cell Medicine, Mount Sinai School of Medicine, New York, New York, United States of America
| | - Christopher C. Norbury
- Department of Microbiology and Immunology, Pennsylvania State University Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States of America
- * E-mail:
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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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Hong EG, Ko HJ, Cho YR, Kim HJ, Ma Z, Yu TY, Friedline RH, Kurt-Jones E, Finberg R, Fischer MA, Granger EL, Norbury CC, Hauschka SD, Philbrick WM, Lee CG, Elias JA, Kim JK. Interleukin-10 prevents diet-induced insulin resistance by attenuating macrophage and cytokine response in skeletal muscle. Diabetes 2009; 58:2525-35. [PMID: 19690064 PMCID: PMC2768157 DOI: 10.2337/db08-1261] [Citation(s) in RCA: 284] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Insulin resistance is a major characteristic of type 2 diabetes and is causally associated with obesity. Inflammation plays an important role in obesity-associated insulin resistance, but the underlying mechanism remains unclear. Interleukin (IL)-10 is an anti-inflammatory cytokine with lower circulating levels in obese subjects, and acute treatment with IL-10 prevents lipid-induced insulin resistance. We examined the role of IL-10 in glucose homeostasis using transgenic mice with muscle-specific overexpression of IL-10 (MCK-IL10). RESEARCH DESIGN AND METHODS MCK-IL10 and wild-type mice were fed a high-fat diet (HFD) for 3 weeks, and insulin sensitivity was determined using hyperinsulinemic-euglycemic clamps in conscious mice. Biochemical and molecular analyses were performed in muscle to assess glucose metabolism, insulin signaling, and inflammatory responses. RESULTS MCK-IL10 mice developed with no obvious anomaly and showed increased whole-body insulin sensitivity. After 3 weeks of HFD, MCK-IL10 mice developed comparable obesity to wild-type littermates but remained insulin sensitive in skeletal muscle. This was mostly due to significant increases in glucose metabolism, insulin receptor substrate-1, and Akt activity in muscle. HFD increased macrophage-specific CD68 and F4/80 levels in wild-type muscle that was associated with marked increases in tumor necrosis factor-alpha, IL-6, and C-C motif chemokine receptor-2 levels. In contrast, MCK-IL10 mice were protected from diet-induced inflammatory response in muscle. CONCLUSIONS These results demonstrate that IL-10 increases insulin sensitivity and protects skeletal muscle from obesity-associated macrophage infiltration, increases in inflammatory cytokines, and their deleterious effects on insulin signaling and glucose metabolism. Our findings provide novel insights into the role of anti-inflammatory cytokine in the treatment of type 2 diabetes.
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Affiliation(s)
- Eun-Gyoung Hong
- Department of Cellular and Molecular Physiology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
- Section of Endocrinology and Metabolism, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Hwi Jin Ko
- Department of Cellular and Molecular Physiology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
- Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - You-Ree Cho
- Section of Endocrinology and Metabolism, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Hyo-Jeong Kim
- Section of Endocrinology and Metabolism, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Zhexi Ma
- Department of Cellular and Molecular Physiology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Tim Y. Yu
- Section of Endocrinology and Metabolism, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Randall H. Friedline
- Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Evelyn Kurt-Jones
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Robert Finberg
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Matthew A. Fischer
- Department of Microbiology and Immunology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Erica L. Granger
- Department of Microbiology and Immunology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Christopher C. Norbury
- Department of Microbiology and Immunology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | | | - William M. Philbrick
- Section of Endocrinology and Metabolism, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Chun-Geun Lee
- Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Jack A. Elias
- Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Jason K. Kim
- Department of Cellular and Molecular Physiology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
- Section of Endocrinology and Metabolism, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
- Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
- Corresponding author: Jason K. Kim,
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Tatum AM, Mylin LM, Bender SJ, Fischer MA, Vigliotti BA, Tevethia MJ, Tevethia SS, Schell TD. CD8+ T cells targeting a single immunodominant epitope are sufficient for elimination of established SV40 T antigen-induced brain tumors. J Immunol 2008; 181:4406-17. [PMID: 18768900 DOI: 10.4049/jimmunol.181.6.4406] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Immunotherapy of established solid tumors is rarely achieved, and the mechanisms leading to success remain to be elucidated. We previously showed that extended control of advanced-stage autochthonous brain tumors is achieved following adoptive transfer of naive C57BL/6 splenocytes into sublethally irradiated line SV11 mice expressing the SV40 T Ag (T Ag) oncoprotein, and was associated with in vivo priming of CD8(+) T cells (T(CD8)) specific for the dominant epitope IV (T Ag residues 404-411). Using donor lymphocytes derived from mice that are tolerant to epitope IV or a newly characterized transgenic mouse line expressing an epitope IV-specific TCR, we show that epitope IV-specific T(CD8) are a necessary component of the donor pool and that purified naive epitope IV-specific T(CD8) are sufficient to promote complete and rapid regression of established tumors. While transfer of naive TCR-IV cells alone induced some initial tumor regression, increased survival of tumor-bearing mice required prior conditioning of the host with a sublethal dose of gamma irradiation and was associated with complete tumor eradication. Regression of established tumors was associated with rapid accumulation of TCR-IV T cells within the brain following initial priming against the endogenous T Ag in the peripheral lymphoid organs. Additionally, persistence of functional TCR-IV cells in both the brain and peripheral lymphoid organs was associated with long-term tumor-free survival. Finally, we show that production of IFN-gamma, but not perforin or TNF-alpha, by the donor lymphocytes is critical for control of autochthonous brain tumors.
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Affiliation(s)
- Angela M Tatum
- Department of Microbiology and Immunology, The Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
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Fischer MA, Tscharke DC, Donohue KB, Truckenmiller ME, Norbury CC. Reduction of vector gene expression increases foreign antigen-specific CD8+ T-cell priming. J Gen Virol 2007; 88:2378-2386. [PMID: 17698646 DOI: 10.1099/vir.0.83107-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Viral vectors have been shown to induce protective CD8(+) T-cell populations in animal models, but significant obstacles remain to their widespread use for human vaccination. One such obstacle is immunodominance, where the CD8(+) T-cell response to a vector can suppress the desired CD8(+) T-cell response to a recombinantly encoded antigen. To overcome this hurdle, we broadly reduced vector-specific gene expression. We treated a recombinant vaccinia virus, encoding antigen as a minimal peptide determinant (8-10 aa), with psoralen and short-wave UV light. The resulting virus induced 66 % fewer vector-specific immunodominant CD8(+) T cells, allowing the in vivo induction of an increased number of CD8(+) T cells specific for the recombinant antigen.
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Affiliation(s)
- Matthew A Fischer
- Department of Microbiology and Immunology, Pennsylvania State University, Milton S. Hershey College of Medicine, Hershey, PA 17033, USA
| | - David C Tscharke
- Department of Biochemistry and Molecular Biology, The Australian National University, Canberra, ACT, Australia
| | - Keri B Donohue
- Department of Microbiology and Immunology, Pennsylvania State University, Milton S. Hershey College of Medicine, Hershey, PA 17033, USA
| | - Mary E Truckenmiller
- Department of Microbiology and Immunology, Pennsylvania State University, Milton S. Hershey College of Medicine, Hershey, PA 17033, USA
| | - Christopher C Norbury
- Department of Microbiology and Immunology, Pennsylvania State University, Milton S. Hershey College of Medicine, Hershey, PA 17033, USA
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Abstract
The primary focus of our work is the initiation of an antiviral immune response. While we employ many experimental systems to address this fundamental issue, much of our work revolves around the use of vaccinia virus. Concerns over the negative effects of vaccination have prevented the return of the smallpox immunization program to the general population and underscored the importance of understanding the primary immune response to vaccinia virus. This response is comprised of a complex symphony of immune system components employing a variety of different mechanisms. In this review, we will both highlight the roles of many of these components and touch on the applications of vaccinia virus in the laboratory and the clinic.
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Affiliation(s)
- Matthew A Fischer
- Department of Microbiology and Immunology, Pennsylvania State University, Milton S. Hershey College of Medicine, Hershey, PA 17033, USA
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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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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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41
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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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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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43
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Affiliation(s)
- M A Fischer
- Department of Urology, Dalhousie University, Halifax, NS, Canada
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44
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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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45
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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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47
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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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48
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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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