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Roth CL, Scimia C, Shoemaker AH, Gottschalk M, Miller J, Yuan G, Malhotra S, Abuzzahab MJ. Setmelanotide for the treatment of acquired hypothalamic obesity: a phase 2, open-label, multicentre trial. Lancet Diabetes Endocrinol 2024:S2213-8587(24)00087-1. [PMID: 38697184 DOI: 10.1016/s2213-8587(24)00087-1] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/08/2024] [Accepted: 03/10/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND Hypothalamic obesity resulting from hypothalamic damage might affect melanocortin signalling. We investigated the melanocortin-4 receptor agonist setmelanotide for treatment of hypothalamic obesity. METHODS This phase 2, open-label, multicentre trial was done in five centres in the USA. Eligible patients were aged between 6 and 40 years with obesity and history of hypothalamic injury or diagnosis of a non-malignant tumour affecting the hypothalamus that was treated with surgery, chemotherapy, or radiation. Setmelanotide was titrated up to a dose of 3·0 mg and administered subcutaneously once a day for a total duration of 16 weeks. The primary endpoint was the proportion of patients with a reduction in BMI of at least 5% from baseline after 16 weeks, compared with a historic control rate of less than 5% in this population. The primary endpoint was analysed using the full analysis set, which includes all patients with baseline data who received at least one dose of setmelanotide. Safety was assessed in all patients who received at least one dose of study drug. This trial is registered with ClinicalTrials.gov (NCT04725240) and is complete. FINDINGS Between June 6, 2021, and Jan 13, 2022, 19 patients were screened for inclusion. One patient was excluded, and 18 were enrolled and received at least one dose of setmelanotide. Patients were primarily White (n=14 [78%]) and male (n=11 [61%]). Enrolled patients had a mean age of 15·0 years (SD 5·3) and a mean BMI of 38·0 kg/m2 (SD 6·5). Of 18 patients enrolled, 16 (89%) of 18 patients completed the study and met the primary endpoint of reduction in BMI of at least 5% from baseline after 16 weeks (p<0·0001). The mean reduction in BMI across all patients was 15% (SD 10). A composite proportion of patients had a clinically meaningful change (89%, 90% CI 69-98%; p<0·0001), comprising a reduction in BMI Z score of at least 0·2 points for patients younger than 18 years (92%, 68-100%; p<0·0001) and reduction in bodyweight of at least 5% for patients aged 18 years or older (80%, 34-99%; p<0·0001). Patients aged 12 years or older had a mean reduction in hunger score of 45%. Frequent adverse events included nausea (61%), vomiting (33%), skin hyperpigmentation (33%), and diarrhoea (22%). Of 14 patients who continued treatment in a long-term extension study (NCT03651765), 12 completed at least 12 months of treatment at the time of publication and had a mean change in BMI of -26% (SD 12) from index trial baseline. INTERPRETATION These findings support setmelanotide as a novel effective treatment of hypothalamic obesity. FUNDING Rhythm Pharmaceuticals.
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Affiliation(s)
- Christian L Roth
- Seattle Children's Research Institute, Seattle, WA, USA; Division of Endocrinology, Department of Pediatrics, University of Washington, Seattle, WA, USA.
| | | | - Ashley H Shoemaker
- Ian Burr Division of Endocrinology and Diabetes, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael Gottschalk
- Pediatric Endocrinology, University of California San Diego/Rady Children's Hospital, San Diego, CA, USA
| | - Jennifer Miller
- Pediatric Endocrinology, Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL, USA
| | | | - Sonali Malhotra
- Rhythm Pharmaceuticals, Boston, MA, USA; Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Arkelius K, Wendt TS, Andersson H, Arnou A, Gottschalk M, Gonzales RJ, Ansar S. LOX-1 and MMP-9 Inhibition Attenuates the Detrimental Effects of Delayed rt-PA Therapy and Improves Outcomes After Acute Ischemic Stroke. Circ Res 2024; 134:954-969. [PMID: 38501247 DOI: 10.1161/circresaha.123.323371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 03/06/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Acute ischemic stroke triggers endothelial activation that disrupts vascular integrity and increases hemorrhagic transformation leading to worsened stroke outcomes. rt-PA (recombinant tissue-type plasminogen activator) is an effective treatment; however, its use is limited due to a restricted time window and hemorrhagic transformation risk, which in part may involve activation of MMPs (matrix metalloproteinases) mediated through LOX-1 (lectin-like oxLDL [oxidized low-density lipoprotein] receptor 1). This study's overall aim was to evaluate the therapeutic potential of novel MMP-9 (matrix metalloproteinase 9) ± LOX-1 inhibitors in combination with rt-PA to improve stroke outcomes. METHODS A rat thromboembolic stroke model was utilized to investigate the impact of rt-PA delivered 4 hours poststroke onset as well as selective MMP-9 (JNJ0966) ±LOX-1 (BI-0115) inhibitors given before rt-PA administration. Infarct size, perfusion, and hemorrhagic transformation were evaluated by 9.4-T magnetic resonance imaging, vascular and parenchymal MMP-9 activity via zymography, and neurological function was assessed using sensorimotor function testing. Human brain microvascular endothelial cells were exposed to hypoxia plus glucose deprivation/reperfusion (hypoxia plus glucose deprivation 3 hours/R 24 hours) and treated with ±tPA and ±MMP-9 ±LOX-1 inhibitors. Barrier function was assessed via transendothelial electrical resistance, MMP-9 activity was determined with zymography, and LOX-1 and barrier gene expression/levels were measured using qRT-PCR (quantitative reverse transcription PCR) and Western blot. RESULTS Stroke and subsequent rt-PA treatment increased edema, hemorrhage, MMP-9 activity, LOX-1 expression, and worsened neurological outcomes. LOX-1 inhibition improved neurological function, reduced edema, and improved endothelial barrier integrity. Elevated MMP-9 activity correlated with increased edema, infarct volume, and decreased neurological function. MMP-9 inhibition reduced MMP-9 activity and LOX-1 expression. In human brain microvascular endothelial cells, LOX-1/MMP-9 inhibition differentially attenuated MMP-9 levels, inflammation, and activation following hypoxia plus glucose deprivation/R. CONCLUSIONS Our findings indicate that LOX-1 inhibition and ± MMP-9 inhibition attenuate negative aspects of ischemic stroke with rt-PA therapy, thus resulting in improved neurological function. While no synergistic effect was observed with simultaneous LOX-1 and MMP-9 inhibition, a distinct interaction is evident.
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Affiliation(s)
- Kajsa Arkelius
- Applied Neurovascular Research, Neurosurgery, Department of Clinical Sciences, Lund University, Sweden (K.A., H.A., A.A., S.A.)
| | - Trevor S Wendt
- Department of Basic Medical Sciences, University of Arizona College of Medicine, Phoenix, AZ (T.S.W., R.J.G.)
| | - Henrik Andersson
- Applied Neurovascular Research, Neurosurgery, Department of Clinical Sciences, Lund University, Sweden (K.A., H.A., A.A., S.A.)
| | - Anaële Arnou
- Applied Neurovascular Research, Neurosurgery, Department of Clinical Sciences, Lund University, Sweden (K.A., H.A., A.A., S.A.)
| | | | - Rayna J Gonzales
- Department of Basic Medical Sciences, University of Arizona College of Medicine, Phoenix, AZ (T.S.W., R.J.G.)
| | - Saema Ansar
- Applied Neurovascular Research, Neurosurgery, Department of Clinical Sciences, Lund University, Sweden (K.A., H.A., A.A., S.A.)
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3
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Costanzo A, Clarke D, Holt M, Sharma S, Nagy K, Tan X, Kain L, Abe B, Luce S, Boitard C, Wyseure T, Mosnier LO, Su AI, Grimes C, Finn MG, Savage PB, Gottschalk M, Pettus J, Teyton L. Repositioning the Early Pathology of Type 1 Diabetes to the Extraislet Vasculature. J Immunol 2024; 212:1094-1104. [PMID: 38426888 PMCID: PMC10944819 DOI: 10.4049/jimmunol.2300769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024]
Abstract
Type 1 diabetes (T1D) is a prototypic T cell-mediated autoimmune disease. Because the islets of Langerhans are insulated from blood vessels by a double basement membrane and lack detectable lymphatic drainage, interactions between endocrine and circulating T cells are not permitted. Thus, we hypothesized that initiation and progression of anti-islet immunity required islet neolymphangiogenesis to allow T cell access to the islet. Combining microscopy and single cell approaches, the timing of this phenomenon in mice was situated between 5 and 8 wk of age when activated anti-insulin CD4 T cells became detectable in peripheral blood while peri-islet pathology developed. This "peri-insulitis," dominated by CD4 T cells, respected the islet basement membrane and was limited on the outside by lymphatic endothelial cells that gave it the attributes of a tertiary lymphoid structure. As in most tissues, lymphangiogenesis seemed to be secondary to local segmental endothelial inflammation at the collecting postcapillary venule. In addition to classic markers of inflammation such as CD29, V-CAM, and NOS, MHC class II molecules were expressed by nonhematopoietic cells in the same location both in mouse and human islets. This CD45- MHC class II+ cell population was capable of spontaneously presenting islet Ags to CD4 T cells. Altogether, these observations favor an alternative model for the initiation of T1D, outside of the islet, in which a vascular-associated cell appears to be an important MHC class II-expressing and -presenting cell.
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Affiliation(s)
- Anne Costanzo
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA
| | - Don Clarke
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA
| | - Marie Holt
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA
| | - Siddhartha Sharma
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA
| | - Kenna Nagy
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA
| | - Xuqian Tan
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA
| | - Lisa Kain
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA
| | - Brian Abe
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA
| | | | | | - Tine Wyseure
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA
| | - Laurent O. Mosnier
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA
| | - Andrew I. Su
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA
| | - Catherine Grimes
- Department of Chemistry and Biochemistry, University of Delaware, Newark, DE
| | - M. G. Finn
- School of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, GA
| | - Paul B. Savage
- Department of Chemistry and Biochemistry, Brigham Young University, Provo, UT
| | - Michael Gottschalk
- Rady Children’s Hospital, University of California San Diego, San Diego, CA
| | - Jeremy Pettus
- UC San Diego School of Medicine, University of California San Diego, San Diego, CA
| | - Luc Teyton
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA
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4
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Fine S, Gottschalk M, Marc-Aurele K. Neonatal Graves disease with persistent hypoglycemia: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241237433. [PMID: 38463451 PMCID: PMC10924547 DOI: 10.1177/2050313x241237433] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/19/2024] [Indexed: 03/12/2024] Open
Abstract
Neonatal Graves disease is the most common cause of hyperthyroidism during the newborn period. Maternal Graves disease increases the risk of intrauterine growth restriction, small for gestational age, and neonatal Graves disease. Intrauterine growth restriction and small for gestational age are associated with hypoglycemia and transient neonatal hyperinsulinism. Neonatal Graves disease with severe persistent hypoglycemia has not been well described. We present the case of a female patient born at 34 weeks and 3 days with a birth weight of 1.6 kg (fifth percentile) to a mother with recent treatment for Graves disease. Prenatal ultrasounds were significant for intrauterine growth restriction and small for gestational age. The mother did not begin hyperthyroidism medical therapy until 23 weeks and 2 days of gestation. After the infant was born, the infant not only had symptoms of hyperthyroidism such as tachycardia and abnormal thyroid values but also had persistent hypoglycemia, which could be due to maternal propranolol usage, prematurity, IUGR, increased metabolism due to neonatal Graves, and transient stress-induced hyperinsulinism. The infant was started on methimazole for hyperthyroidism and propranolol for tachycardia. She was also started on diazoxide for persistent hypoglycemia. By 6 months of age, the hyperthyroidism and hypoglycemia had resolved. This is an interesting case of neonatal Graves disease with severe persistent hypoglycemia which we suspect is due to transient neonatal hyperinsulinism induced by multiple stress responses.
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Affiliation(s)
- Samantha Fine
- Rady Children’s Hospital, San Diego, CA, USA
- Department of Pediatrics, University of California San Diego Jacobs Medical Center, San Diego, CA, USA
| | - Michael Gottschalk
- Rady Children’s Hospital, San Diego, CA, USA
- Department of Pediatrics, University of California San Diego Jacobs Medical Center, San Diego, CA, USA
| | - Krishelle Marc-Aurele
- Rady Children’s Hospital, San Diego, CA, USA
- Department of Pediatrics, University of California San Diego Jacobs Medical Center, San Diego, CA, USA
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Mautner K, Gottschalk M, Boden SD, Akard A, Bae WC, Black L, Boggess B, Chatterjee P, Chung CB, Easley KA, Gibson G, Hackel J, Jensen K, Kippner L, Kurtenbach C, Kurtzberg J, Mason RA, Noonan B, Roy K, Valentine V, Yeago C, Drissi H. Author Correction: Cell-based versus corticosteroid injections for knee pain in osteoarthritis: a randomized phase 3 trial. Nat Med 2024; 30:905. [PMID: 38135824 PMCID: PMC10957470 DOI: 10.1038/s41591-023-02776-9] [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] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Affiliation(s)
- Ken Mautner
- Department of Orthopaedics, Emory University, Atlanta, GA, USA.
| | | | - Scott D Boden
- Department of Orthopaedics, Emory University, Atlanta, GA, USA
| | - Alison Akard
- Department of Orthopaedics, Emory University, Atlanta, GA, USA
| | - Won C Bae
- Department of Radiology, University of California, Davis, La Jolla, CA, USA
| | | | | | - Paramita Chatterjee
- Marcus Center for Therapeutic Cell Characterization and Manufacturing, Georgia Institute of Technology, Atlanta, GA, USA
| | - Christine B Chung
- Department of Radiology, University of California, Davis, La Jolla, CA, USA
| | - Kirk A Easley
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Greg Gibson
- Center for Integrative Genomics, Georgia Institute of Technology, Atlanta, GA, USA
| | | | | | - Linda Kippner
- Marcus Center for Therapeutic Cell Characterization and Manufacturing, Georgia Institute of Technology, Atlanta, GA, USA
| | | | - Joanne Kurtzberg
- Marcus Center for Therapeutic Cures, Duke University, Durham, NC, USA
| | - R Amadeus Mason
- Department of Orthopaedics, Emory University, Atlanta, GA, USA
| | | | - Krishnendu Roy
- Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | | | - Carolyn Yeago
- Marcus Center for Therapeutic Cell Characterization and Manufacturing, Georgia Institute of Technology, Atlanta, GA, USA
| | - Hicham Drissi
- Department of Orthopaedics, Emory University, Atlanta, GA, USA.
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6
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Mautner K, Gottschalk M, Boden SD, Akard A, Bae WC, Black L, Boggess B, Chatterjee P, Chung CB, Easley KA, Gibson G, Hackel J, Jensen K, Kippner L, Kurtenbach C, Kurtzberg J, Mason RA, Noonan B, Roy K, Valentine V, Yeago C, Drissi H. Cell-based versus corticosteroid injections for knee pain in osteoarthritis: a randomized phase 3 trial. Nat Med 2023; 29:3120-3126. [PMID: 37919438 PMCID: PMC10719084 DOI: 10.1038/s41591-023-02632-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 04/13/2023] [Accepted: 10/05/2023] [Indexed: 11/04/2023]
Abstract
Various types of cellular injection have become a popular and costly treatment option for patients with knee osteoarthritis despite a paucity of literature establishing relative efficacy to each other or corticosteroid injections. Here we aimed to identify the safety and efficacy of cell injections from autologous bone marrow aspirate concentrate, autologous adipose stromal vascular fraction and allogeneic human umbilical cord tissue-derived mesenchymal stromal cells, in comparison to corticosteroid injection (CSI). The study was a phase 2/3, four-arm parallel, multicenter, single-blind, randomized, controlled clinical trial with 480 patients with a diagnosis of knee osteoarthritis (Kellgren-Lawrence II-IV). Participants were randomized to the three different arms with a 3:1 distribution. Arm 1: autologous bone marrow aspirate concentrate (n = 120), CSI (n = 40); arm 2: umbilical cord tissue-derived mesenchymal stromal cells (n = 120), CSI (n = 40); arm 3: stromal vascular fraction (n = 120), CSI (n = 40). The co-primary endpoints were the visual analog scale pain score and Knee injury and Osteoarthritis Outcome Score pain score at 12 months versus baseline. Analyses of our primary endpoints, with 440 patients, revealed that at 1 year post injection, none of the three orthobiologic injections was superior to another, or to the CSI control. In addition, none of the four groups showed a significant change in magnetic resonance imaging osteoarthritis score compared to baseline. No procedure-related serious adverse events were reported during the study period. In summary, this study shows that at 1 year post injection, there was no superior orthobiologic as compared to CSI for knee osteoarthritis. ClinicalTrials.gov Identifier: NCT03818737.
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Affiliation(s)
- Ken Mautner
- Department of Orthopaedics, Emory University, Atlanta, GA, USA.
| | | | - Scott D Boden
- Department of Orthopaedics, Emory University, Atlanta, GA, USA
| | - Alison Akard
- Department of Orthopaedics, Emory University, Atlanta, GA, USA
| | - Won C Bae
- Department of Radiology, University of California, Davis, La Jolla, CA, USA
| | | | | | - Paramita Chatterjee
- Marcus Center for Therapeutic Cell Characterization and Manufacturing, Georgia Institute of Technology, Atlanta, GA, USA
| | - Christine B Chung
- Department of Radiology, University of California, Davis, La Jolla, CA, USA
| | - Kirk A Easley
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Greg Gibson
- Center for Integrative Genomics, Georgia Institute of Technology, Atlanta, GA, USA
| | | | | | - Linda Kippner
- Marcus Center for Therapeutic Cell Characterization and Manufacturing, Georgia Institute of Technology, Atlanta, GA, USA
| | | | - Joanne Kurtzberg
- Marcus Center for Therapeutic Cures, Duke University, Durham, NC, USA
| | - R Amadeus Mason
- Department of Orthopaedics, Emory University, Atlanta, GA, USA
| | | | - Krishnendu Roy
- Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | | | - Carolyn Yeago
- Marcus Center for Therapeutic Cell Characterization and Manufacturing, Georgia Institute of Technology, Atlanta, GA, USA
| | - Hicham Drissi
- Department of Orthopaedics, Emory University, Atlanta, GA, USA.
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7
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Sharma S, Tan X, Boyer J, Clarke D, Costanzo A, Abe B, Kain L, Holt M, Armstrong A, Rihanek M, Su A, Speake C, Gottlieb P, Gottschalk M, Pettus J, Teyton L. Measuring anti-islet autoimmunity in mouse and human by profiling peripheral blood antigen-specific CD4 T cells. Sci Transl Med 2023; 15:eade3614. [PMID: 37406136 PMCID: PMC10495123 DOI: 10.1126/scitranslmed.ade3614] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Received: 08/10/2022] [Accepted: 06/16/2023] [Indexed: 07/07/2023]
Abstract
The endocrine pancreas is one of the most inaccessible organs of the human body. Its autoimmune attack leads to type 1 diabetes (T1D) in a genetically susceptible population and a lifelong need for exogenous insulin replacement. Monitoring disease progression by sampling peripheral blood would provide key insights into T1D immune-mediated mechanisms and potentially change preclinical diagnosis and the evaluation of therapeutic interventions. This effort has been limited to the measurement of circulating anti-islet antibodies, which despite a recognized diagnostic value, remain poorly predictive at the individual level for a fundamentally CD4 T cell-dependent disease. Here, peptide-major histocompatibility complex tetramers were used to profile blood anti-insulin CD4 T cells in mice and humans. While percentages of these were not directly informative, the state of activation of anti-insulin T cells measured by RNA and protein profiling was able to distinguish the absence of autoimmunity versus disease progression. Activated anti-insulin CD4 T cell were detected not only at time of diagnosis but also in patients with established disease and in some at-risk individuals. These results support the concept that antigen-specific CD4 T cells might be used to monitor autoimmunity in real time. This advance can inform our approach to T1D diagnosis and therapeutic interventions in the preclinical phase of anti-islet autoimmunity.
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Affiliation(s)
- Siddhartha Sharma
- Department of Immunology and Microbial Science, Scripps Research Institute, La Jolla, CA 92037, USA
| | - Xuqian Tan
- Department of Integrative Structural and Computational Biology, Scripps Research Institute, La Jolla, CA 92037, USA
- School of Biological Science, University of California San Diego, La Jolla, CA 92093, USA
| | - Josh Boyer
- Department of Immunology and Microbial Science, Scripps Research Institute, La Jolla, CA 92037, USA
| | - Don Clarke
- Department of Immunology and Microbial Science, Scripps Research Institute, La Jolla, CA 92037, USA
| | - Anne Costanzo
- Department of Immunology and Microbial Science, Scripps Research Institute, La Jolla, CA 92037, USA
| | - Brian Abe
- Department of Immunology and Microbial Science, Scripps Research Institute, La Jolla, CA 92037, USA
| | - Lisa Kain
- Department of Immunology and Microbial Science, Scripps Research Institute, La Jolla, CA 92037, USA
| | - Marie Holt
- Department of Immunology and Microbial Science, Scripps Research Institute, La Jolla, CA 92037, USA
| | - Adrienne Armstrong
- Division of Endocrinology, University of California San Diego, San Diego, CA 92123, USA
| | - Marynette Rihanek
- Barbara Davis Center, University of Colorado, Boulder, CO 80045, USA
| | - Andrew Su
- Department of Integrative Structural and Computational Biology, Scripps Research Institute, La Jolla, CA 92037, USA
| | - Cate Speake
- Diabetes Clinical Research Program, Benaroya Research Institute at Virginia Mason, Seattle, WA,98101, USA
- Center for Interventional Immunology, Diabetes Clinical Research Program, Benaroya Research Institute at Virginia Mason, Seattle, WA 98101, USA
| | - Peter Gottlieb
- Barbara Davis Center, University of Colorado, Boulder, CO 80045, USA
| | - Michael Gottschalk
- Division of Pediatric Endocrinology, University of California San Diego, School of Medicine, Rady Children's Hospital, San Diego, CA 92123, USA
| | - Jeremy Pettus
- Division of Endocrinology, University of California San Diego, San Diego, CA 92123, USA
| | - Luc Teyton
- Department of Immunology and Microbial Science, Scripps Research Institute, La Jolla, CA 92037, USA
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8
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Graf AR, Ahmed AS, Thompson D, Wagner E, Gottschalk M, Suh N, Seiler JG. Intramedullary Metacarpal Fracture Fixation: A Biomechanical Study of Screw Diameter and Comparison With Intramedullary Wire Stabilization. J Hand Surg Am 2023:S0363-5023(23)00067-9. [PMID: 36914453 DOI: 10.1016/j.jhsa.2023.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 01/02/2023] [Accepted: 01/25/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE Interest in intramedullary metacarpal fracture fixation (IMFF) with screws is increasing. However, the optimal screw diameter for fracture fixation is not yet established. In theory, larger screws should be more stable, but there is concern about long-term sequelae of larger metacarpal head defects and extensor mechanism injury created during insertion as well as implant cost. Therefore, the purpose of this study was to compare different diameter screws for IMFF to a popular and more cost-effective alternative of intramedullary wiring. METHODS Thirty-two cadaveric metacarpals were used in a transverse metacarpal shaft fracture model. Treatment groups consisted of IMFF with 3.0 × 60 mm, 3.5 x 60 mm, and 4.5 x 60 mm screws as well as 4 1.1-mm intramedullary wires. Cyclic cantilever bending was performed with the metacarpals mounted at 45° to simulate physiologic loading. Cyclical loading at 10, 20, and 30 N was performed to determine fracture displacement, stiffness, and ultimate force. RESULTS At 10, 20, and 30 N of cyclical loading, all screw diameters tested provided similar stability as measured by fracture displacement and were superior to the wire group. However, ultimate force under load to failure testing was similar between the 3.5- and 4.5-mm screws and superior to 3.0-mm screws and wires. CONCLUSIONS For IMFF, 3.0, 3.5, and 4.5-mm diameter screws provide adequate stability for early active motion and are superior to wires. When comparing the different screw diameters, 3.5- and 4.5-mm diameter screws offer similar construct stability and strength superior to the 3.0-mm diameter screw. Therefore, to minimize metacarpal head morbidity, smaller screw diameters may be preferable. CLINICAL RELEVANCE This study suggests that IMFF with screws is biomechanically superior to wires in cantilever bending strength in the transverse fracture model. However, smaller screws may be sufficient to permit early active motion while minimizing metacarpal head morbidity.
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Affiliation(s)
- Alexander R Graf
- Emory University, Department of Orthopedic Surgery, Atlanta, GA.
| | - Adil S Ahmed
- Emory University, Department of Orthopedic Surgery, Atlanta, GA
| | - Dan Thompson
- Emory University, Department of Orthopedic Surgery, Atlanta, GA
| | - Eric Wagner
- Emory University, Department of Orthopedic Surgery, Atlanta, GA
| | | | - Nina Suh
- Emory University, Department of Orthopedic Surgery, Atlanta, GA
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Meissner A, Garcia-Serrano AM, Vanherle L, Rafiee Z, Don-Doncow N, Skoug C, Larsson S, Gottschalk M, Magnusson M, Duarte JMN. Alterations to Cerebral Perfusion, Metabolite Profiles, and Neuronal Morphology in the Hippocampus and Cortex of Male and Female Mice during Chronic Exposure to a High-Salt Diet. Int J Mol Sci 2022; 24:ijms24010300. [PMID: 36613742 PMCID: PMC9820346 DOI: 10.3390/ijms24010300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/17/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Excess dietary salt reduces resting cerebral blood flow (CBF) and vascular reactivity, which can limit the fueling of neuronal metabolism. It is hitherto unknown whether metabolic derangements induced by high-salt-diet (HSD) exposure during adulthood are reversed by reducing salt intake. In this study, male and female mice were fed an HSD from 9 to 16 months of age, followed by a normal-salt diet (ND) thereafter until 23 months of age. Controls were continuously fed either ND or HSD. CBF and metabolite profiles were determined longitudinally by arterial spin labeling magnetic resonance imaging and magnetic resonance spectroscopy, respectively. HSD reduced cortical and hippocampal CBF, which recovered after dietary salt normalization, and affected hippocampal but not cortical metabolite profiles. Compared to ND, HSD increased hippocampal glutamine and phosphocreatine levels and decreased creatine and choline levels. Dietary reversal only allowed recovery of glutamine levels. Histology analyses revealed that HSD reduced the dendritic arborization and spine density of cortical and hippocampal neurons, which were not recovered after dietary salt normalization. We conclude that sustained HSD exposure throughout adulthood causes permanent structural and metabolic alterations to the mouse brain that are not fully normalized by lowering dietary salt during aging.
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Affiliation(s)
- Anja Meissner
- Department of Experimental Medical Science, Faculty of Medicine, Lund University, 22184 Lund, Sweden
- Wallenberg Centre for Molecular Medicine, Lund University, 22184 Lund, Sweden
- Department of Physiology, Institute of Theoretical Medicine, Medical Faculty, University of Augsburg, 86159 Augsburg, Germany
| | - Alba M. Garcia-Serrano
- Department of Experimental Medical Science, Faculty of Medicine, Lund University, 22184 Lund, Sweden
- Wallenberg Centre for Molecular Medicine, Lund University, 22184 Lund, Sweden
| | - Lotte Vanherle
- Department of Experimental Medical Science, Faculty of Medicine, Lund University, 22184 Lund, Sweden
- Wallenberg Centre for Molecular Medicine, Lund University, 22184 Lund, Sweden
| | - Zeinab Rafiee
- Department of Experimental Medical Science, Faculty of Medicine, Lund University, 22184 Lund, Sweden
- Wallenberg Centre for Molecular Medicine, Lund University, 22184 Lund, Sweden
| | - Nicholas Don-Doncow
- Department of Experimental Medical Science, Faculty of Medicine, Lund University, 22184 Lund, Sweden
- Wallenberg Centre for Molecular Medicine, Lund University, 22184 Lund, Sweden
| | - Cecilia Skoug
- Department of Experimental Medical Science, Faculty of Medicine, Lund University, 22184 Lund, Sweden
- Wallenberg Centre for Molecular Medicine, Lund University, 22184 Lund, Sweden
| | - Sara Larsson
- Department of Experimental Medical Science, Faculty of Medicine, Lund University, 22184 Lund, Sweden
- Wallenberg Centre for Molecular Medicine, Lund University, 22184 Lund, Sweden
| | | | - Martin Magnusson
- Wallenberg Centre for Molecular Medicine, Lund University, 22184 Lund, Sweden
- Department of Clinical Sciences, Lund University, 20502 Malmö, Sweden
- Department of Cardiology, Skåne University Hospital, 20502 Malmö, Sweden
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom 2520, South Africa
| | - João M. N. Duarte
- Department of Experimental Medical Science, Faculty of Medicine, Lund University, 22184 Lund, Sweden
- Wallenberg Centre for Molecular Medicine, Lund University, 22184 Lund, Sweden
- Correspondence:
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10
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Hurt J, Graf A, Dawes A, Toston R, Gottschalk M, Wagner E. Winter sport musculoskeletal injuries: epidemiology and factors predicting hospital admission. Eur J Orthop Surg Traumatol 2022:10.1007/s00590-022-03322-y. [PMID: 35943590 DOI: 10.1007/s00590-022-03322-y] [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] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/15/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Participation in winter sports such as skiing, snowboarding and snowmobiling is associated with risk of musculoskeletal injury. The purpose of our study was to describe and quantify emergency department encounters associated with these sports. METHODS The National Electronic Injury Surveillance System (NEISS) was queried for skiing-, snowboarding- and snowmobiling-related injuries from 2009 to 2018. Patient demographics and disposition data were collected from emergency department encounters. Descriptive statistics were utilized to describe the trends in injuries from each sport and factors associated with the sports-specific injuries. RESULTS From 2009 to 2018, there were an estimated 156,353 injuries related to snowboarding, skiing, or snowmobiling. Estimated injury incidence per 100,000 people decreased over time for skiing (3.24-1.23), snowboarding (3.98-1.22,) and snowmobiling (0.71-0.22,). The most common injury location by sport was shoulder for skiing (29.6%), wrist for snowboarding (32.5%) and shoulder for snowmobiling (21.9%), with fractures being the most common diagnosis. Only 4.5% required admission to the hospital. Fracture or dislocation was associated with highest likelihood of hospital admission (OR 42.34; 95% CI 22.59-79.37). Snowmobiling injuries (OR 1.63; 95% CI 1.20-2.22) and white race (OR 1.42; 95% CI 1.17-1.72) were also both associated with increased risk of hospital admission. CONCLUSIONS Upper extremity injuries, particularly those involving fractures, were more common than lower extremity injuries for all three sports, with the shoulder being the most common location of injury for skiing and snowmobiling. This study can serve as the foundation for future research in sports safety and health policy to continue the declining trend of musculoskeletal injuries in the future. LEVEL OF EVIDENCE III.
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Affiliation(s)
- John Hurt
- Division of Upper Extremity Surgery, Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Alexander Graf
- Division of Upper Extremity Surgery, Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Alex Dawes
- Division of Upper Extremity Surgery, Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Roy Toston
- Division of Upper Extremity Surgery, Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael Gottschalk
- Division of Upper Extremity Surgery, Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Eric Wagner
- Division of Upper Extremity Surgery, Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA.
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11
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Hörold M, Gottschalk M, Debbeler CM, Heytens H, Wissel A, Ehrentreich S, Braun-Dullaeus R, Apfelbacher C. Patients' perspectives on the challenges of chronic heart
disease care in rural areas: A qualitative study. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- M Hörold
- Otto-von-Guericke-Universität Magdeburg, Insitut für
Sozialmedizin und Gesundheitssystemforschung, Magdeburg,
Deutschland
| | - M Gottschalk
- Universitätsklinikum Magdeburg, Universitätsklinik
für Kardiologie und Angiologie, Magdeburg, Deutschland
| | - CM Debbeler
- Otto-von-Guericke-Universität Magdeburg, Insitut für
Sozialmedizin und Gesundheitssystemforschung, Magdeburg,
Deutschland
| | - H Heytens
- Otto-von-Guericke-Universität Magdeburg, Insitut für
Sozialmedizin und Gesundheitssystemforschung, Magdeburg,
Deutschland
| | - A Wissel
- Otto-von-Guericke-Universität Magdeburg, Insitut für
Sozialmedizin und Gesundheitssystemforschung, Magdeburg,
Deutschland
| | - S Ehrentreich
- Otto-von-Guericke-Universität Magdeburg, Insitut für
Sozialmedizin und Gesundheitssystemforschung, Magdeburg,
Deutschland
- Universitätskinikum Magdeburg, Universitätsklinik
für Unfallchirurgie, Magdeburg, Deutschland
| | - R Braun-Dullaeus
- Universitätsklinikum Magdeburg, Universitätsklinik
für Kardiologie und Angiologie, Magdeburg, Deutschland
| | - C Apfelbacher
- Otto-von-Guericke-Universität Magdeburg, Insitut für
Sozialmedizin und Gesundheitssystemforschung, Magdeburg,
Deutschland
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12
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Vigna L, Gottschalk M, Cacocciola N, Verna A, Marasso S, Seeger S, Pirri C, Cocuzza M. Flexible and reusable parylene C mask technology for applications in cascade impactor air quality monitoring systems. Micro and Nano Engineering 2022. [DOI: 10.1016/j.mne.2022.100108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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13
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Rosenthal J, Nguyen ML, Karas S, Gottschalk M, Daly C, Wagner E, Singer AD. Correction to: A comprehensive review of the normal, abnormal, and post-operative MRI appearance of the proximal biceps brachii. Skeletal Radiol 2021; 50:467. [PMID: 33196855 DOI: 10.1007/s00256-020-03672-w] [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] [Indexed: 02/02/2023]
Affiliation(s)
| | - My-Linh Nguyen
- Department of Radiology and Imaging Sciences, Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive, Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA
| | - Spero Karas
- Department of Orthopaedics, Emory University Hospital, Atlanta, GA, USA
| | | | - Charles Daly
- Department of Orthopaedics, Emory University Hospital, Atlanta, GA, USA
| | - Eric Wagner
- Department of Orthopaedics, Emory University Hospital, Atlanta, GA, USA
| | - Adam D Singer
- Department of Radiology and Imaging Sciences, Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive, Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA.
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14
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Nguyen ML, Rosenthal J, Karas S, Gottschalk M, Daly C, Wagner E, Singer A. A comprehensive review of the normal, abnormal, and post-operative MRI appearance of the distal biceps brachii. Skeletal Radiol 2020; 49:1695-1707. [PMID: 32556950 DOI: 10.1007/s00256-020-03501-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/27/2020] [Accepted: 06/02/2020] [Indexed: 02/02/2023]
Abstract
The biceps brachii myotendinous unit is a common source of shoulder, arm, and elbow pain. Its complex anatomy can present a challenge when interpreting MR images. We discuss the clinical and imaging presentations of injury related to the proximal biceps brachii separately in another manuscript. The purpose of this manuscript is to review the distal biceps anatomy along with pathology and post-operative appearance as seen on MRI.
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Affiliation(s)
- My-Linh Nguyen
- Department of Radiology and Imaging Sciences Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA
| | | | - Spero Karas
- Department of Orthopaedics, Emory University Hospital, Atlanta, GA, USA
| | | | - Charles Daly
- Department of Orthopaedics, Emory University Hospital, Atlanta, GA, USA
| | - Eric Wagner
- Department of Orthopaedics, Emory University Hospital, Atlanta, GA, USA
| | - Adam Singer
- Department of Radiology and Imaging Sciences Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA.
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15
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Rosenthal J, Nguyen ML, Karas S, Gottschalk M, Daly C, Wagner E, Singer AD. A comprehensive review of the normal, abnormal, and post-operative MRI appearance of the proximal biceps brachii. Skeletal Radiol 2020; 49:1333-1344. [PMID: 32219466 DOI: 10.1007/s00256-020-03415-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/26/2020] [Accepted: 03/08/2020] [Indexed: 02/02/2023]
Abstract
The biceps brachii myotendinous unit, particularly the long head of the biceps tendon and its labral attachment, is a common cause of shoulder and arm pain. Its complex anatomy and normal variations can present a challenge when interpreting MR images. The purpose of this manuscript is to review the proximal biceps anatomy, variants, pathology, and post-operative appearance as seen on MRI. Recent data regarding the accuracy of clinical examination and MRI will be summarized.
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Affiliation(s)
| | - My-Linh Nguyen
- Department of Radiology and Imaging Sciences, Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA
| | - Spero Karas
- Department of Orthopaedics, Emory University Hospital, Atlanta, GA, USA
| | | | - Charles Daly
- Department of Orthopaedics, Emory University Hospital, Atlanta, GA, USA
| | - Eric Wagner
- Department of Orthopaedics, Emory University Hospital, Atlanta, GA, USA
| | - Adam D Singer
- Department of Radiology and Imaging Sciences, Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA.
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16
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Gottesman B, Gottschalk M. SAT-664 Fluctuating Blood Glucose in an Infant with Newly Diagnosed IPEX Syndrome. J Endocr Soc 2020. [PMCID: PMC7208839 DOI: 10.1210/jendso/bvaa046.784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background: In the IPEX (immune dysregulation, polyendocrinopathy, enteropathy, X-linked) syndrome, Type 1 diabetes mellitus is the most common endocrine complication and usually occurs with a variable presentation from immediately at birth to within the first few months of life.
Clinical case: A four-month-old male presented for evaluation of failure to thrive, eczema, and diarrhea. In the ED, his glucose value was 246 mg/dL with beta-hydroxybutyrate of 0.29 mmol/L (0.00-0.30). Within eight hours and without insulin, he became hypoglycemic and required dextrose-containing fluids to maintain euglycemia; he was quickly made NPO and started on TPN due to excessive stool output. For nearly two weeks he required no insulin while receiving 84g of dextrose per day (21 g/kg/day) in TPN. He developed bloody stools on the day that he started receiving Tacrolimus and IVIG and required transfer to the ICU, and an insulin need of 1 unit/kg/day developed with this worsening of his systemic illness. After the bloody stools resolved, immunosuppression with Rituximab was initiated. Once bowel function improved, Pedialyte and formula were slowly reintroduced and for three weeks his insulin requirement varied from 0.2-0.4 units/kg/day. In his seventh week of hospitalization his insulin was discontinued due to hypoglycemia, and at the time of discharge he had been without insulin for ten days on ad lib formula feeding.
Hemoglobin A1c on admission was 10.2%, and repeat was 10.3%. A fructosamine level was obtained to evaluate the discrepancy between the initial HgbA1c and being euglycemic. It was 269 umol/L (190-270), equivalent to an approximate HgbA1c of 6.5%, suggesting that hyperglycemia resulting in an elevated HgbA1c occurred early in his life and had improved in the days to weeks prior to admission. Further testing revealed an elevated GAD-65 antibody of >250 IU/mL (<5) but normal ICA 512 and insulin autoantibody.
His clinical picture was consistent with IPEX syndrome, confirmed with rapid whole genome sequencing showed a pathogenic hemizygous c.1010G>A p.Arg337Gln variant in the FOXP3 gene.
A HgbA1c performed prior to discharge, eight weeks after the initial, was 6.6%. This spontaneous resolution of hyperglycemia in IPEX, with insulin needs developing only when he had worsening systemic illness as demonstrated by bloody stools, has yet to be described.
Conclusion: Hyperglycemia fluctuated in the first few months of life in a patient with IPEX syndrome, likely related to severity of systemic illness and control of enteropathy.
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17
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Einarsson E, Peterson P, Önnerfjord P, Gottschalk M, Xu X, Knutsson L, Dahlberg LE, Struglics A, Svensson J. The role of cartilage glycosaminoglycan structure in gagCEST. NMR Biomed 2020; 33:e4259. [PMID: 31999387 DOI: 10.1002/nbm.4259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 06/10/2023]
Abstract
Glycosaminoglycan (GAG) chemical exchange saturation transfer (gagCEST) is a potential method for cartilage quality assessment. The aim of this study was to investigate how the gagCEST effect depends on the types and molecular organization of GAG typically found in articular cartilage. gagCEST was performed on different concentrations of GAG in various forms: free chains of chondroitin sulfate (CS) of different types (-A and -C) and GAG bound to protein in aggregated and nonaggregated aggrecan extracted from calf articular cartilage. The measured magnetization transfer ratio asymmetry (MTRasym ) was compared with known GAG concentrations or GAG concentrations determined through biochemical analysis. The gagCEST effect was assessed through the linear regression coefficient with 95% confidence interval of MTRasym per GAG concentration. We observed a lower gagCEST effect in phantoms containing a mixture of CS-A and CS-C compared with phantoms containing mainly CS-A. The difference in response corresponds well to the difference in CS-A concentration. GAG bound in aggrecan from calf articular cartilage, where CS-A is assumed to be the major type of GAG, produed a similar gagCEST effect as that observed for free CS-A. The effect was also similar for aggregated (ie, bound to hyaluronic acid) and nonaggregated aggrecan. In conclusion, our results indicate that the aggrecan structure in itself does not impact the gagCEST effect, but that the effect is strongly dependent on GAG type. In phantoms, the current implementation of gagCEST is sensitive to CS-A while for CS-C, the main GAG component in mature human articular cartilage, the sensitivity is limited. This difference in gagCEST sensitivity between GAG types detected in phantoms is a strong motivation to also explore the possibility of a similar effect in vivo.
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Affiliation(s)
- Emma Einarsson
- Medical Radiation Physics, Department of Translational Medicine, Lund University, Malmö, Sweden
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Pernilla Peterson
- Medical Radiation Physics, Department of Translational Medicine, Lund University, Malmö, Sweden
- Radiation Physics, Department of Oncology and Radiation Physics, Skåne University Hospital, Malmö, Sweden
| | - Patrik Önnerfjord
- Rheumatology and Molecular Skeletal Biology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | | | - Xiang Xu
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, Maryland, USA
| | - Linda Knutsson
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Medical Radiation Physics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Leif E Dahlberg
- Orthopaedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - André Struglics
- Orthopaedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Jonas Svensson
- Medical Radiation Physics, Department of Translational Medicine, Lund University, Malmö, Sweden
- Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
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18
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Gottschalk M. Look-Locker FAIR TrueFISP for arterial spin labelling on mouse at 9.4 T. NMR Biomed 2020; 33:e4191. [PMID: 31829485 DOI: 10.1002/nbm.4191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 08/21/2019] [Accepted: 08/29/2019] [Indexed: 06/10/2023]
Abstract
Pulsed arterial spin labelling remains a non-invasive and highly used method for the study of rodent cerebral blood flow (CBF). Flow-sensitive alternating inversion recovery (FAIR) is one of the most commonly used MR-sequences for this purpose and exists with many different strategies to record the images. This study investigates Look-Locker (LL) TrueFISP readout for FAIR as an alternative to the standard EPI readout, which is provided by the manufacturer. The aim was to show the improved image quality using TrueFISP and to verify the reproducibility of the determination of the cerebral blood flow values. The measurement of many inversion points also allowed to investigate the influence of the correct blood relaxation rate on the fit of the CBF data. For the LL-FAIR TrueFISP an in-house written method was created. The method was tested on a group of C57BL/6 mice at the field strength of 9.4 T. The results show CBF maps with less distortion than for EPI and the values found are in good agreement with the literature. A comparison of the CBF values found with EPI and LL-TrueFISP shows very small differences, most being not significant. In conclusion, the method presented gives equivalent CBF maps in comparison to standard FAIR-EPI. Both methods have the same measurement time. TrueFISP has the advantage to EPI of producing undistorted images over larger areas of the mouse brain. It is advisable to check the value of the blood relaxation rate by measurement or to estimate it as a fitting parameter.
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19
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Hoffmann KP, Ruff R, Droste W, Rupp R, Olze H, Kneist W, Schiemer JF, Kruger T, Somerlik-Fuchs KH, Gottschalk M, Kostelnik J, Schreivogel A. Technical, Medical and Ethical Challenges in Networks of Smart Active Implants. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2019:1484-1487. [PMID: 31946174 DOI: 10.1109/embc.2019.8856977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Networks of distributed interactive micro-implants could enhance the treatment of otoneurological conditions such as tinnitus or restore impaired complex physiological/ motor functions such as gastrointestinal motility or grasping. For this, an electrical stimulation of neural and muscular tissue is a key prerequisite. Challenges in the development of such interactive micro-implants are the complex human-machine interface, the wireless power supply, and the long-term stability of implants as well as secure and safe signal transmission. This paper addresses all these topics as well as the ethical, legal and social implications of smart implant networks in general. First achievements of the German innovation cluster INTAKT will be presented.
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Sharma S, Pettus J, Gottschalk M, Abe B, Gottlieb P, Teyton L. Single-Cell Analysis of CD4 T Cells in Type 1 Diabetes: From Mouse to Man, How to Perform Mechanistic Studies. Diabetes 2019; 68:1886-1891. [PMID: 31540941 PMCID: PMC6754240 DOI: 10.2337/dbi18-0064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 07/21/2019] [Indexed: 01/10/2023]
Abstract
Type 1 diabetes is the prototypical CD4 T cell-mediated autoimmune disease. Its genetic linkage to a single polymorphism at position 57 of the HLA class II DQβ chain makes it unique to study the molecular link between HLA and disease. However, investigating this relationship has been limited by a series of anatomical barriers, the small size and dispersion of the insulin-producing organ, and the scarcity of appropriate techniques and reagents to interrogate antigen-specific CD4 T cells both in man and rodent models. Over the past few years, single-cell technologies, paired with new biostatistical methods, have changed this landscape. Using these tools, we have identified the first molecular link between MHC class II and the onset of type 1 diabetes. The translation of these observations to man is within reach using similar approaches and the lessons learned from rodent models.
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Affiliation(s)
- Siddhartha Sharma
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA
| | - Jeremy Pettus
- Division of Endocrinology and Metabolism, University of California, San Diego, San Diego, CA
| | | | - Brian Abe
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA
| | - Peter Gottlieb
- Department of Pediatrics and Department of Immunology & Microbiology, University of Colorado School of Medicine, and Barbara Davis Center for Diabetes, Denver, CO
| | - Luc Teyton
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA
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21
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Waterton JC, Hines CDG, Hockings PD, Laitinen I, Ziemian S, Campbell S, Gottschalk M, Green C, Haase M, Hassemer K, Juretschke HP, Koehler S, Lloyd W, Luo Y, Mahmutovic Persson I, O'Connor JPB, Olsson LE, Pindoria K, Schneider JE, Sourbron S, Steinmann D, Strobel K, Tadimalla S, Teh I, Veltien A, Zhang X, Schütz G. Repeatability and reproducibility of longitudinal relaxation rate in 12 small-animal MRI systems. Magn Reson Imaging 2019; 59:121-129. [PMID: 30872166 PMCID: PMC6477178 DOI: 10.1016/j.mri.2019.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 07/05/2018] [Revised: 01/29/2019] [Accepted: 03/08/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Many translational MR biomarkers derive from measurements of the water proton longitudinal relaxation rate R1, but evidence for between-site reproducibility of R1 in small-animal MRI is lacking. OBJECTIVE To assess R1 repeatability and multi-site reproducibility in phantoms for preclinical MRI. METHODS R1 was measured by saturation recovery in 2% agarose phantoms with five nickel chloride concentrations in 12 magnets at 5 field strengths in 11 centres on two different occasions within 1-13 days. R1 was analysed in three different regions of interest, giving 360 measurements in total. Root-mean-square repeatability and reproducibility coefficients of variation (CoV) were calculated. Propagation of reproducibility errors into 21 translational MR measurements and biomarkers was estimated. Relaxivities were calculated. Dynamic signal stability was also measured. RESULTS CoV for day-to-day repeatability (N = 180 regions of interest) was 2.34% and for between-centre reproducibility (N = 9 centres) was 1.43%. Mostly, these do not propagate to biologically significant between-centre error, although a few R1-based MR biomarkers were found to be quite sensitive even to such small errors in R1, notably in myocardial fibrosis, in white matter, and in oxygen-enhanced MRI. The relaxivity of aqueous Ni2+ in 2% agarose varied between 0.66 s-1 mM-1 at 3 T and 0.94 s-1 mM-1 at 11.7T. INTERPRETATION While several factors affect the reproducibility of R1-based MR biomarkers measured preclinically, between-centre propagation of errors arising from intrinsic equipment irreproducibility should in most cases be small. However, in a few specific cases exceptional efforts might be required to ensure R1-reproducibility.
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Affiliation(s)
- John C Waterton
- Bioxydyn Ltd, Manchester Science Park, Rutherford House, Pencroft Way, MANCHESTER M15 6SZ, United Kingdom; Centre for Imaging Sciences, Division of Informatics Imaging & Data Sciences, School of Health Sciences, Faculty of Biology Medicine & Health, University of Manchester, Manchester Academic Health Sciences Centre, MANCHESTER M13 9PL, United Kingdom.
| | | | - Paul D Hockings
- Antaros Medical, BioVenture Hub, 43183 Mölndal, Sweden; MedTech West, Chalmers University of Technology, Gothenburg, Sweden.
| | - Iina Laitinen
- Sanofi-Aventis Deutschland GmbH, R&D TIM - Bioimaging Germany, Industriepark Höchst, D-65926 Frankfurt am Main, Germany.
| | - Sabina Ziemian
- Bayer AG, Research and Development, Pharmaceuticals, MR and CT Contrast Media Research, Müllerstraße 178, D-13353 Berlin, Germany.
| | - Simon Campbell
- In-Vivo Bioimaging UK, RD Platform Technology & Science, GSK Medicines Research Centre, Gunnels Wood Road, STEVENAGE, Hertfordshire, SG1 2NY, United Kingdom.
| | - Michael Gottschalk
- Lund University BioImaging Center, Klinikgatan 32, SE-222-42 Lund, Sweden.
| | - Claudia Green
- Bayer AG, Research and Development, Pharmaceuticals, MR and CT Contrast Media Research, Müllerstraße 178, D-13353 Berlin, Germany.
| | - Michael Haase
- In-Vivo Bioimaging UK, RD Platform Technology & Science, GSK Medicines Research Centre, Gunnels Wood Road, STEVENAGE, Hertfordshire, SG1 2NY, United Kingdom.
| | - Katja Hassemer
- Sanofi-Aventis Deutschland GmbH, R&D TIM - Bioimaging Germany, Industriepark Höchst, D-65926 Frankfurt am Main, Germany.
| | - Hans-Paul Juretschke
- Sanofi-Aventis Deutschland GmbH, R&D TIM - Bioimaging Germany, Industriepark Höchst, D-65926 Frankfurt am Main, Germany
| | - Sascha Koehler
- Bruker BioSpin MRI GmbH, Rudolf-Plank-Straße 23, D-76275 Ettlingen, Germany.
| | - William Lloyd
- Centre for Imaging Sciences, Division of Informatics Imaging & Data Sciences, School of Health Sciences, Faculty of Biology Medicine & Health, University of Manchester, Manchester Academic Health Sciences Centre, MANCHESTER M13 9PL, United Kingdom.
| | - Yanping Luo
- iSAT Discovery, Abbvie, 1 North Waukegan Road, North Chicago, IL, 60064-1802, United States of America.
| | - Irma Mahmutovic Persson
- Department of Translational Sciences, Medical Radiation Physics, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden.
| | - James P B O'Connor
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology Medicine & Health, University of Manchester, Manchester Academic Health Sciences Centre, MANCHESTER M20 4BX, United Kingdom. james.o'
| | - Lars E Olsson
- Department of Translational Sciences, Medical Radiation Physics, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden.
| | - Kashmira Pindoria
- In-Vivo Bioimaging UK, RD Platform Technology & Science, GSK Medicines Research Centre, Gunnels Wood Road, STEVENAGE, Hertfordshire, SG1 2NY, United Kingdom.
| | - Jurgen E Schneider
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9JT, United Kingdom.
| | - Steven Sourbron
- Leeds Imaging Biomarkers Group, Department of Biomedical Imaging Sciences, University of Leeds, LIGHT Labs, Clarendon Way, LEEDS LS2 9JT, United Kingdom.
| | - Denise Steinmann
- Sanofi-Aventis Deutschland GmbH, R&D TIM - Bioimaging Germany, Industriepark Höchst, D-65926 Frankfurt am Main, Germany.
| | - Klaus Strobel
- Bruker BioSpin MRI GmbH, Rudolf-Plank-Straße 23, D-76275 Ettlingen, Germany.
| | - Sirisha Tadimalla
- Leeds Imaging Biomarkers Group, Department of Biomedical Imaging Sciences, University of Leeds, LIGHT Labs, Clarendon Way, LEEDS LS2 9JT, United Kingdom.
| | - Irvin Teh
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9JT, United Kingdom.
| | - Andor Veltien
- Radboud university medical center, Radiology (766), P.O.Box 9101, 6500, HB, Nijmegen, the Netherlands.
| | - Xiaomeng Zhang
- iSAT Discovery, Abbvie, 1 North Waukegan Road, North Chicago, IL, 60064-1802, United States of America.
| | - Gunnar Schütz
- Bayer AG, Research and Development, Pharmaceuticals, MR and CT Contrast Media Research, Müllerstraße 178, D-13353 Berlin, Germany.
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22
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Zou T, Peng J, Gottschalk M, Zhang PP, Mao ZQ, Ke X. Insulator-metal transition induced by electric voltage in a ruthenate Mott insulator. J Phys Condens Matter 2019; 31:195602. [PMID: 30731444 DOI: 10.1088/1361-648x/ab0538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We report the observation of electric-voltage induced insulator-metal phase transition in a ruthenate Mott insulator Ca3(Ru0.9Ti0.1)2O7. We show that the electric field effect dominates and leads to a sharp phase transition at measurement temperatures far below the Mott transition, whereas the thermal effect becomes more significant and broadens the phase transition as the measurement temperature approaches the insulator-metal transition. The electric field induced insulator-metal transition is presumably attributed to the avalanche breakdown of the correlated insulating state when driven out of equilibrium. This work highlights the strategy of using electric voltage to control the phase transition of this system in addition to other nonthermal parameters such as magnetic field and pressure reported previously.
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Affiliation(s)
- T Zou
- Department of Physics and Astronomy, Michigan State University, East Lansing, MI 48824, United States of America. Quantum Condensed Matter Division, Oak Ridge National Laboratory, Oak Ridge, TN 37831, United States of America
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23
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Ahearn B, Kumar A, Premkumar A, Samady H, Gottschalk M, Xerogeanes J, Karas S. Effect of Preoperative Gabapentin With a Concomitant Adductor Canal Block on Pain and Opioid Usage After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2019; 7:2325967119828357. [PMID: 30859108 PMCID: PMC6402063 DOI: 10.1177/2325967119828357] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background An adductor canal block (ACB) and preoperative oral gabapentin have each been shown to decrease postoperative pain scores and opioid usage in patients undergoing anterior cruciate ligament (ACL) reconstruction. Purpose/Hypothesis This study evaluated the efficacy of preoperative gabapentin on postoperative analgesia in patients who received an ACB. We hypothesized that patients undergoing ACL reconstruction with an ACB who utilized a single dose of preoperative oral gabapentin would have decreased pain and opioid consumption in the 24 to 72 hours after surgery compared with patients who did not utilize gabapentin. Study Design Cohort study; Level of evidence, 3. Methods Between January and October 2016, patients at a single institution who underwent ACL reconstruction and received an ACB were identified. Patients who underwent surgery before May 2016 were placed in the control group, and patients seen after May 2016 received a preoperative dose of gabapentin and were placed in the gabapentin group. All patients completed a pain log via a smartphone application to record pain scores and opioid usage after surgery. Results A total of 74 patients were identified: 41 in the gabapentin group and 33 in the control group. There were no significant differences between groups in demographics and operative characteristics. There were no differences in pain scores on postoperative day 1 (gabapentin vs control: 5.53 vs 5.56; P = .95), day 2 (4.58 vs 4.83; P = .59), or day 3 (4.15 vs 3.87; P = .59). The mean opioid consumption in oral morphine equivalents was not different on postoperative day 1 (gabapentin vs control: 47.2 vs 48.1; P = .90), day 2 (29.9 vs 33.5; P = .60), or day 3 (17.4 vs 18.7; P = .80). Conclusion Preoperative gabapentin did not reduce pain scores or opioid usage in patients who received an ACB and underwent ACL reconstruction in this retrospective cohort study.
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Affiliation(s)
| | - Arun Kumar
- University of Florida Health, Jacksonville, Florida, USA
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24
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Alhamdi S, Lee YC, Chowdhury S, Byers PH, Gottschalk M, Taft RJ, Joeng KS, Lee BH, Bird LM. Heterozygous WNT1 variant causing a variable bone phenotype. Am J Med Genet A 2018; 176:2419-2424. [PMID: 30246918 DOI: 10.1002/ajmg.a.40347] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 11/18/2017] [Revised: 04/23/2018] [Accepted: 05/14/2018] [Indexed: 01/07/2023]
Abstract
Osteogenesis imperfecta (OI) is a family of heritable disorders of bone fragility. Most individuals with OI have mutations in the genes encoding type I collagen; at least 17 other genes have been associated with OI. Biallelic loss-of-function mutations in WNT1 cause severe OI. Heterozygous missense variants in WNT1 are responsible for early-onset osteoporosis with variable bone phenotypes. Herein, we report a third-generation family with four affected individuals, some presenting with multiple low-impact fractures in childhood and others presenting with early-onset osteoporosis without a striking fracture history. A WNT1 variant (c. 1051 > C; p.Trp351Arg) was identified in the proband and segregated with a bone phenotype in three additional family members, consistent with autosomal dominant inheritance. In the proband, whole genome sequencing also revealed a de novo duplication (434 kb) of 22q11.2 that involves 25 genes, 4 of which are associated with human disease when haploinsufficient. Though smaller than the typical (1.5 Mb) 22q11.2 duplication, the duplication in the proband may be responsible for additional nonosseous aspects of his phenotype (hypotonia, developmental delay, small genitalia, strabismus, and depression in preadolescence). This case demonstrates the variability of bone phenotype conferred by a WNT1 variant and extends the spectrum of bone phenotypes associated with heterozygous WNT1 mutations.
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Affiliation(s)
- Shatha Alhamdi
- University of California, San Diego, La Jolla, California
| | | | - Shimul Chowdhury
- Rady Children's Institute for Genomic Medicine, San Diego, California
| | | | - Michael Gottschalk
- University of California, San Diego, La Jolla, California.,Divisions of Endocrinology, Rady Children's Hospital San Diego, San Diego, California
| | - Ryan J Taft
- Illumina Clinical Services Laboratory, Illumina Inc., San Diego, California
| | | | | | - Lynne M Bird
- University of California, San Diego, La Jolla, California.,Divisions of Dysmorphology/Genetics, Rady Children's Hospital San Diego, San Diego, California
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25
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Huleatt J, Gottschalk M, Fraser K, Boden A, Dalwadi P, Xerogeanes J, Hammond K. Risk Factors for Manipulation Under Anesthesia and/or Lysis of Adhesions After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2018; 6:2325967118794490. [PMID: 30211246 PMCID: PMC6131313 DOI: 10.1177/2325967118794490] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: In the currently published literature, a higher risk for developing
arthrofibrosis after anterior cruciate ligament (ACL) reconstruction has
been reported for female patients, adolescents, early surgery or concomitant
procedures, and the use of a patellar tendon autograft. There is a lack of
evidence regarding other graft choices or factors. Hypothesis: Multiple risk factors will play a significant role in the development of
arthrofibrosis after ACL reconstruction. Specifically, we hypothesized that
the risk of manipulation under anesthesia (MUA) and/or lysis of adhesions
(LOA) would be affected by graft choice and patient demographic factors. Study Design: Case-control study; Level of evidence, 3. Methods: The charts of all patients who underwent ACL reconstruction over a 10-year
period at a single academic institution were queried from an electronic
medical record database and reviewed at a minimum of 6 months after ACL
reconstruction, with the collection of demographic and surgical data. The
relative risk for undergoing MUA and/or LOA was calculated for each analyzed
risk factor. Results: A total of 2424 ACL reconstructions were included, with a chart review at a
mean of 56.7 months after surgery (range, 7.6-124.0 months). The rate of MUA
and/or LOA for arthrofibrosis was 4.5%. A statistically significantly
increased relative risk was found for infection (5.45), hematoma requiring
evacuation (3.55), ACL reconstruction with meniscal repair (2.83), use of a
quadriceps tendon autograft (2.68), age <18 years (2.39), multiple
concomitant procedures (1.69), contact injury (1.62), female sex (1.60), and
surgery within 28 days of injury (1.53), and a statistically significantly
decreased relative risk was found for revision ACL reconstruction (0.30),
age >25 years (0.34), and use of a tibialis anterior allograft (0.36). In
the multivariate regression model, the use of a quadriceps tendon autograft
(P = .00007), infection (P = .00126),
and concomitant meniscal repair (P = .00194) were
independent risk factors, whereas revision ACL reconstruction
(P = .0024) was an independent protective factor. Conclusion: Graft type, infection, concomitant meniscal repair, and primary
reconstruction are significant risk factors for undergoing MUA or LOA after
ACL reconstruction.
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Affiliation(s)
- Joel Huleatt
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael Gottschalk
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kelsey Fraser
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Allison Boden
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Poonam Dalwadi
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - John Xerogeanes
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kyle Hammond
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
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26
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Redondo MJ, Geyer S, Steck AK, Sharp S, Wentworth JM, Weedon MN, Antinozzi P, Sosenko J, Atkinson M, Pugliese A, Oram RA, Antinozzi P, Atkinson M, Battaglia M, Becker D, Bingley P, Bosi E, Buckner J, Colman P, Gottlieb P, Herold K, Insel R, Kay T, Knip M, Marks J, Moran A, Palmer J, Peakman M, Philipson L, Pugliese A, Raskin P, Rodriguez H, Roep B, Russell W, Schatz D, Wherrett D, Wilson D, Winter W, Ziegler A, Benoist C, Blum J, Chase P, Clare-Salzler M, Clynes R, Eisenbarth G, Fathman C, Grave G, Hering B, Kaufman F, Leschek E, Mahon J, Nanto-Salonen K, Nepom G, Orban T, Parkman R, Pescovitz M, Peyman J, Roncarolo M, Simell O, Sherwin R, Siegelman M, Steck A, Thomas J, Trucco M, Wagner J, Greenbaum ,CJ, Bourcier K, Insel R, Krischer JP, Leschek E, Rafkin L, Spain L, Cowie C, Foulkes M, Krause-Steinrauf H, Lachin JM, Malozowski S, Peyman J, Ridge J, Savage P, Skyler JS, Zafonte SJ, Kenyon NS, Santiago I, Sosenko JM, Bundy B, Abbondondolo M, Adams T, Amado D, Asif I, Boonstra M, Bundy B, Burroughs C, Cuthbertson D, Deemer M, Eberhard C, Fiske S, Ford J, Garmeson J, Guillette H, Browning G, Coughenour T, Sulk M, Tsalikan E, Tansey M, Cabbage J, Dixit N, Pasha S, King M, Adcock K, Geyer S, Atterberry H, Fox L, Englert K, Mauras N, Permuy J, Sikes K, Berhe T, Guendling B, McLennan L, Paganessi L, Hays B, Murphy C, Draznin M, Kamboj M, Sheppard S, Lewis V, Coates L, Moore W, Babar G, Bedard J, Brenson-Hughes D, Henderson C, Cernich J, Clements M, Duprau R, Goodman S, Hester L, Huerta-Saenz L, Karmazin A, Letjen T, Raman S, Morin D, Henry M, Bestermann W, Morawski E, White J, Brockmyer A, Bays R, Campbell S, Stapleton A, Stone N, Donoho A, Everett H, Heyman K, Hensley H, Johnson M, Marshall C, Skirvin N, Taylor P, Williams R, Ray L, Wolverton C, Nickels D, Dothard C, Hsiao B, Speiser P, Pellizzari M, Bokor L, Izuora K, Abdelnour S, Cummings P, Paynor S, Leahy M, Riedl M, Shockley S, Karges C, Saad R, Briones T, Casella S, Herz C, Walsh K, Greening J, Hay F, Hunt S, Sikotra N, Simons L, Keaton N, Karounos D, Oremus R, Dye L, Myers L, Ballard D, Miers W, Sparks R, Thraikill K, Edwards K, Fowlkes J, Kinderman A, Kemp S, Morales A, Holland L, Johnson L, Paul P, Ghatak A, Phelen K, Leyland H, Henderson T, Brenner D, Law P, Oppenheimer E, Mamkin I, Moniz C, Clarson C, Lovell M, Peters A, Ruelas V, Borut D, Burt D, Jordan M, Leinbach A, Castilla S, Flores P, Ruiz M, Hanson L, Green-Blair J, Sheridan R, Wintergerst K, Pierce G, Omoruyi A, Foster M, Linton C, Kingery S, Lunsford A, Cervantes I, Parker T, Price P, Urben J, Doughty I, Haydock H, Parker V, Bergman P, Liu S, Duncum S, Rodda C, Thomas A, Ferry R, McCommon D, Cockroft J, Perelman A, Calendo R, Barrera C, Arce-Nunez E, Lloyd J, Martinez Y, De la Portilla M, Cardenas I, Garrido L, Villar M, Lorini R, Calandra E, D’Annuzio G, Perri K, Minuto N, Malloy J, Rebora C, Callegari R, Ali O, Kramer J, Auble B, Cabrera S, Donohoue P, Fiallo-Scharer R, Hessner M, Wolfgram P, Maddox K, Kansra A, Bettin N, McCuller R, Miller A, Accacha S, Corrigan J, Fiore E, Levine R, Mahoney T, Polychronakos C, Martin J, Gagne V, Starkman H, Fox M, Chin D, Melchionne F, Silverman L, Marshall I, Cerracchio L, Cruz J, Viswanathan A, Miller J, Wilson J, Chalew S, Valley S, Layburn S, Lala A, Clesi P, Genet M, Uwaifo G, Charron A, Allerton T, Milliot E, Cefalu W, Melendez-Ramirez L, Richards R, Alleyn C, Gustafson E, Lizanna M, Wahlen J, Aleiwe S, Hansen M, Wahlen H, Moore M, Levy C, Bonaccorso A, Rapaport R, Tomer Y, Chia D, Goldis M, Iazzetti L, Klein M, Levister C, Waldman L, Muller S, Wallach E, Regelmann M, Antal Z, Aranda M, Reynholds C, Leech N, Wake D, Owens C, Burns M, Wotherspoon J, Nguyen T, Murray A, Short K, Curry G, Kelsey S, Lawson J, Porter J, Stevens S, Thomson E, Winship S, Wynn L, O’Donnell R, Wiltshire E, Krebs J, Cresswell P, Faherty H, Ross C, Vinik A, Barlow P, Bourcier M, Nevoret M, Couper J, Oduah V, Beresford S, Thalagne N, Roper H, Gibbons J, Hill J, Balleaut S, Brennan C, Ellis-Gage J, Fear L, Gray T, Pilger J, Jones L, McNerney C, Pointer L, Price N, Few K, Tomlinson D, Denvir L, Drew J, Randell T, Mansell P, Roberts A, Bell S, Butler S, Hooton Y, Navarra H, Roper A, Babington G, Crate L, Cripps H, Ledlie A, Moulds C, Sadler K, Norton R, Petrova B, Silkstone O, Smith C, Ghai K, Murray M, Viswanathan V, Henegan M, Kawadry O, Olson J, Stavros T, Patterson L, Ahmad T, Flores B, Domek D, Domek S, Copeland K, George M, Less J, Davis T, Short M, Tamura R, Dwarakanathan A, O’Donnell P, Boerner B, Larson L, Phillips M, Rendell M, Larson K, Smith C, Zebrowski K, Kuechenmeister L, Wood K, Thevarayapillai M, Daniels M, Speer H, Forghani N, Quintana R, Reh C, Bhangoo A, Desrosiers P, Ireland L, Misla T, Xu P, Torres C, Wells S, Villar J, Yu M, Berry D, Cook D, Soder J, Powell A, Ng M, Morrison M, Young K, Haslam Z, Lawson M, Bradley B, Courtney J, Richardson C, Watson C, Keely E, DeCurtis D, Vaccarcello-Cruz M, Torres Z, Alies P, Sandberg K, Hsiang H, Joy B, McCormick D, Powell A, Jones H, Bell J, Hargadon S, Hudson S, Kummer M, Badias F, Sauder S, Sutton E, Gensel K, Aguirre-Castaneda R, Benavides Lopez V, Hemp D, Allen S, Stear J, Davis E, Jones T, Baker A, Roberts A, Dart J, Paramalingam N, Levitt Katz L, Chaudhary N, Murphy K, Willi S, Schwartzman B, Kapadia C, Larson D, Bassi M, McClellan D, Shaibai G, Kelley L, Villa G, Kelley C, Diamond R, Kabbani M, Dajani T, Hoekstra F, Magorno M, Beam C, Holst J, Chauhan V, Wilson N, Bononi P, Sperl M, Millward A, Eaton M, Dean L, Olshan J, Renna H, Boulware D, Milliard C, Snyder D, Beaman S, Burch K, Chester J, Ahmann A, Wollam B, DeFrang D, Fitch R, Jahnke K, Bounmananh L, Hanavan K, Klopfenstein B, Nicol L, Bergstrom R, Noland T, Brodksy J, Bacon L, Quintos J, Topor L, Bialo S, Bream S, Bancroft B, Soto A, Lagarde W, Lockemer H, Vanderploeg T, Ibrahim M, Huie M, Sanchez V, Edelen R, Marchiando R, Freeman D, Palmer J, Repas T, Wasson M, Auker P, Culbertson J, Kieffer T, Voorhees D, Borgwardt T, DeRaad L, Eckert K, Gough J, Isaacson E, Kuhn H, Carroll A, Schubert M, Francis G, Hagan S, Le T, Penn M, Wickham E, Leyva C, Ginem J, Rivera K, Padilla J, Rodriguez I, Jospe N, Czyzyk J, Johnson B, Nadgir U, Marlen N, Prakasam G, Rieger C, Granger M, Glaser N, Heiser E, Harris B, Foster C, Slater H, Wheeler K, Donaldson D, Murray M, Hale D, Tragus R, Holloway M, Word D, Lynch J, Pankratz L, Rogers W, Newfield R, Holland S, Hashiguchi M, Gottschalk M, Philis-Tsimikas A, Rosal R, Kieffer M, Franklin S, Guardado S, Bohannon N, Garcia M, Aguinaldo T, Phan J, Barraza V, Cohen D, Pinsker J, Khan U, Lane P, Wiley J, Jovanovic L, Misra P, Wright M, Cohen D, Huang K, Skiles M, Maxcy S, Pihoker C, Cochrane K, Nallamshetty L, Fosse J, Kearns S, Klingsheim M, Wright N, Viles L, Smith H, Heller S, Cunningham M, Daniels A, Zeiden L, Parrimon Y, Field J, Walker R, Griffin K, Bartholow L, Erickson C, Howard J, Krabbenhoft B, Sandman C, Vanveldhuizen A, Wurlger J, Paulus K, Zimmerman A, Hanisch K, Davis-Keppen L, Cotterill A, Kirby J, Harris M, Schmidt A, Kishiyama C, Flores C, Milton J, Ramiro J, Martin W, Whysham C, Yerka A, Freels T, Hassing J, Webster J, Green R, Carter P, Galloway J, Hoelzer D, Ritzie AQL, Roberts S, Said S, Sullivan P, Allen H, Reiter E, Feinberg E, Johnson C, Newhook L, Hagerty D, White N, Sharma A, Levandoski L, Kyllo J, Johnson M, Benoit C, Iyer P, Diamond F, Hosono H, Jackman S, Barette L, Jones P, Shor A, Sills I, Bzdick S, Bulger J, Weinstock R, Douek I, Andrews R, Modgill G, Gyorffy G, Robin L, Vaidya N, Song X, Crouch S, O’Brien K, Thompson C, Thorne N, Blumer J, Kalic J, Klepek L, Paulett J, Rosolowski B, Horner J, Terry A, Watkins M, Casey J, Carpenter K, Burns C, Horton J, Pritchard C, Soetaert D, Wynne A, Kaiserman K, Halvorson M, Weinberger J, Chin C, Molina O, Patel C, Senguttuvan R, Wheeler M, Furet O, Steuhm C, Jelley D, Goudeau S, Chalmers L, Wootten M, Greer D, Panagiotopoulos C, Metzger D, Nguyen D, Horowitz M, Christiansen M, Glades E, Morimoto C, Macarewich M, Norman R, Harding P, Patin K, Vargas C, Barbanica A, Yu A, Vaidyanathan P, Osborne W, Mehra R, Kaster S, Neace S, Horner J, McDonough S, Reeves G, Cordrey C, Marrs L, Miller T, Dowshen S, Doyle D, Walker S, Catte D, Dean H, Drury-Brown M, McGee PF, Hackman B, Lee M, Malkani S, Cullen K, Johnson K, Hampton P, McCarrell M, Curtis C, Paul E, Zambrano Y, Hess KO, Phoebus D, Quinlan S, Raiden E, Batts E, Buddy C, Kirpatrick K, Ramey M, Shultz A, Webb C, Romesco M, Fradkin J, Blumberg E, Beck G, Brillon D, Gubitosi-Klug R, Laffel L, Veatch R, Wallace D, Braun J, Lernmark A, Lo B, Mitchell H, Naji A, Nerup J, Orchard T, Steffes M, Tsiatis A, Zinman B, Loechelt B, Baden L, Green M, Weinberg A, Marcovina S, Palmer JP, Weinberg A, Yu L, Babu S, Winter W, Eisenbarth GS, Bingley P, Clynes R, DiMeglio L, Eisenbarth G, Hays B, Marks J, Matheson D, Rodriguez H, Wilson D, Redondo MJ, Gomez D, Zheng X, Pena S, Pietropaolo M, Batts E, Brown T, Buckner J, Dove A, Hammond M, Hefty D, Klein J, Kuhns K, Letlau M, Lord S, McCulloch-Olson M, Miller L, Nepom G, Odegard J, Ramey M, Sachter E, St. Marie M, Stickney K, VanBuecken D, Vellek B, Webber C, Allen L, Bollyk J, Hilderman N, Ismail H, Lamola S, Sanda S, Vendettuoli H, Tridgell D, Monzavi R, Bock M, Fisher L, Halvorson M, Jeandron D, Kim M, Wood J, Geffner M, Kaufman F, Parkman R, Salazar C, Goland R, Clynes R, Cook S, Freeby M, Gallagher MP, Gandica R, Greenberg E, Kurland A, Pollak S, Wolk A, Chan M, Koplimae L, Levine E, Smith K, Trast J, DiMeglio L, Blum J, Evans-Molina C, Hufferd R, Jagielo B, Kruse C, Patrick V, Rigby M, Spall M, Swinney K, Terrell J, Christner L, Ford L, Lynch S, Menendez M, Merrill P, Pescovitz M, Rodriguez H, Alleyn C, Baidal D, Fay S, Gaglia J, Resnick B, Szubowicz S, Weir G, Benjamin R, Conboy D, deManbey A, Jackson R, Jalahej H, Orban T, Ricker A, Wolfsdorf J, Zhang HH, Wilson D, Aye T, Baker B, Barahona K, Buckingham B, Esrey K, Esrey T, Fathman G, Snyder R, Aneja B, Chatav M, Espinoza O, Frank E, Liu J, Perry J, Pyle R, Rigby A, Riley K, Soto A, Gitelman S, Adi S, Anderson M, Berhel A, Breen K, Fraser K, Gerard-Gonzalez A, Jossan P, Lustig R, Moassesfar S, Mugg A, Ng D, Prahalod P, Rangel-Lugo M, Sanda S, Tarkoff J, Torok C, Wesch R, Aslan I, Buchanan J, Cordier J, Hamilton C, Hawkins L, Ho T, Jain A, Ko K, Lee T, Phelps S, Rosenthal S, Sahakitrungruang T, Stehl L, Taylor L, Wertz M, Wong J, Philipson L, Briars R, Devine N, Littlejohn E, Grant T, Gottlieb P, Klingensmith G, Steck A, Alkanani A, Bautista K, Bedoy R, Blau A, Burke B, Cory L, Dang M, Fitzgerald-Miller L, Fouts A, Gage V, Garg S, Gesauldo P, Gutin R, Hayes C, Hoffman M, Ketchum K, Logsden-Sackett N, Maahs D, Messer L, Meyers L, Michels A, Peacock S, Rewers M, Rodriguez P, Sepulbeda F, Sippl R, Steck A, Taki I, Tran BK, Tran T, Wadwa RP, Zeitler P, Barker J, Barry S, Birks L, Bomsburger L, Bookert T, Briggs L, Burdick P, Cabrera R, Chase P, Cobry E, Conley A, Cook G, Daniels J, DiDomenico D, Eckert J, Ehler A, Eisenbarth G, Fain P, Fiallo-Scharer R, Frank N, Goettle H, Haarhues M, Harris S, Horton L, Hutton J, Jeffrrey J, Jenison R, Jones K, Kastelic W, King MA, Lehr D, Lungaro J, Mason K, Maurer H, Nguyen L, Proto A, Realsen J, Schmitt K, Schwartz M, Skovgaard S, Smith J, Vanderwel B, Voelmle M, Wagner R, Wallace A, Walravens P, Weiner L, Westerhoff B, Westfall E, Widmer K, Wright H, Schatz D, Abraham A, Atkinson M, Cintron M, Clare-Salzler M, Ferguson J, Haller M, Hosford J, Mancini D, Rohrs H, Silverstein J, Thomas J, Winter W, Cole G, Cook R, Coy R, Hicks E, Lewis N, Marks J, Pugliese A, Blaschke C, Matheson D, Sanders-Branca N, Sosenko J, Arazo L, Arce R, Cisneros M, Sabbag S, Moran A, Gibson C, Fife B, Hering B, Kwong C, Leschyshyn J, Nathan B, Pappenfus B, Street A, Boes MA, Eck SP, Finney L, Fischer TA, Martin A, Muzamhindo CJ, Rhodes M, Smith J, Wagner J, Wood B, Becker D, Delallo K, Diaz A, Elnyczky B, Libman I, Pasek B, Riley K, Trucco M, Copemen B, Gwynn D, Toledo F, Rodriguez H, Bollepalli S, Diamond F, Eyth E, Henson D, Lenz A, Shulman D, Raskin P, Adhikari S, Dickson B, Dunnigan E, Lingvay I, Pruneda L, Ramos-Roman M, Raskin P, Rhee C, Richard J, Siegelman M, Sturges D, Sumpter K, White P, Alford M, Arthur J, Aviles-Santa ML, Cordova E, Davis R, Fernandez S, Fordan S, Hardin T, Jacobs A, Kaloyanova P, Lukacova-Zib I, Mirfakhraee S, Mohan A, Noto H, Smith O, Torres N, Wherrett D, Balmer D, Eisel L, Kovalakovska R, Mehan M, Sultan F, Ahenkorah B, Cevallos J, Razack N, Ricci MJ, Rhode A, Srikandarajah M, Steger R, Russell WE, Black M, Brendle F, Brown A, Moore D, Pittel E, Robertson A, Shannon A, Thomas JW, Herold K, Feldman L, Sherwin R, Tamborlane W, Weinzimer S, Toppari J, Kallio T, Kärkkäinen M, Mäntymäki E, Niininen T, Nurmi B, Rajala P, Romo M, Suomenrinne S, Näntö-Salonen K, Simell O, Simell T, Bosi E, Battaglia M, Bianconi E, Bonfanti R, Grogan P, Laurenzi A, Martinenghi S, Meschi F, Pastore M, Falqui L, Muscato MT, Viscardi M, Castleden H, Farthing N, Loud S, Matthews C, McGhee J, Morgan A, Pollitt J, Elliot-Jones R, Wheaton C, Knip M, Siljander H, Suomalainen H, Colman P, Healy F, Mesfin S, Redl L, Wentworth J, Willis J, Farley M, Harrison L, Perry C, Williams F, Mayo A, Paxton J, Thompson V, Volin L, Fenton C, Carr L, Lemon E, Swank M, Luidens M, Salgam M, Sharma V, Schade D, King C, Carano R, Heiden J, Means N, Holman L, Thomas I, Madrigal D, Muth T, Martin C, Plunkett C, Ramm C, Auchus R, Lane W, Avots E, Buford M, Hale C, Hoyle J, Lane B, Muir A, Shuler S, Raviele N, Ivie E, Jenkins M, Lindsley K, Hansen I, Fadoju D, Felner E, Bode B, Hosey R, Sax J, Jefferies C, Mannering S, Prentis R, She J, Stachura M, Hopkins D, Williams J, Steed L, Asatapova E, Nunez S, Knight S, Dixon P, Ching J, Donner T, Longnecker S, Abel K, Arcara K, Blackman S, Clark L, Cooke D, Plotnick L, Levin P, Bromberger L, Klein K, Sadurska K, Allen C, Michaud D, Snodgrass H, Burghen G, Chatha S, Clark C, Silverberg J, Wittmer C, Gardner J, LeBoeuf C, Bell P, McGlore O, Tennet H, Alba N, Carroll M, Baert L, Beaton H, Cordell E, Haynes A, Reed C, Lichter K, McCarthy P, McCarthy S, Monchamp T, Roach J, Manies S, Gunville F, Marosok L, Nelson T, Ackerman K, Rudolph J, Stewart M, McCormick K, May S, Falls T, Barrett T, Dale K, Makusha L, McTernana C, Penny-Thomas K, Sullivan K, Narendran P, Robbie J, Smith D, Christensen R, Koehler B, Royal C, Arthur T, Houser H, Renaldi J, Watsen S, Wu P, Lyons L, House B, Yu J, Holt H, Nation M, Vickers C, Watling R, Heptulla R, Trast J, Agarwal C, Newell D, Katikaneni R, Gardner C, Del Rio A, Logan A, Collier H, Rishton C, Whalley G, Ali A, Ramtoola S, Quattrin T, Mastrandea L, House A, Ecker M, Huang C, Gougeon C, Ho J, Pacuad D, Dunger D, May J, O’Brien C, Acerini C, Salgin B, Thankamony A, Williams R, Buse J, Fuller G, Duclos M, Tricome J, Brown H, Pittard D, Bowlby D, Blue A, Headley T, Bendre S, Lewis K, Sutphin K, Soloranzo C, Puskaric J, Madison H, Rincon M, Carlucci M, Shridharani R, Rusk B, Tessman E, Huffman D, Abrams H, Biederman B, Jones M, Leathers V, Brickman W, Petrie P, Zimmerman D, Howard J, Miller L, Alemzadeh R, Mihailescu D, Melgozza-Walker R, Abdulla N, Boucher-Berry C, Ize-Ludlow D, Levy R, Swenson Brousell C, Scott R, Heenan H, Lunt H, Kendall D, Willis J, Darlow B, Crimmins N, Edler D, Weis T, Schultz C, Rogers D, Latham D, Mawhorter C, Switzer C, Spencer W, Konstantnopoulus P, Broder S, Klein J, Bachrach B, Gardner M, Eichelberger D, Knight L, Szadek L, Welnick G, Thompson B, Hoffman R, Revell A, Cherko J, Carter K, Gilson E, Haines J, Arthur G, Bowen B, Zipf W, Graves P, Lozano R, Seiple D, Spicer K, Chang A, Fregosi J, Harbinson J, Paulson C, Stalters S, Wright P, Zlock D, Freeth A, Victory J, Maheshwari H, Maheshwari A, Holmstrom T, Bueno J, Arguello R, Ahern J, Noreika L, Watson V, Hourse S, Breyer P, Kissel C, Nicholson Y, Pfeifer M, Almazan S, Bajaj J, Quinn M, Funk K, McCance J, Moreno E, Veintimilla R, Wells A, Cook J, Trunnel S, Transue D, Surhigh J, Bezzaire D, Moltz K, Zacharski E, Henske J, Desai S, Frizelis K, Khan F, Sjoberg R, Allen K, Manning P, Hendry G, Taylor B, Jones S, Couch R, Danchak R, Lieberman D, Strader W, Bencomo M, Bailey T, Bedolla L, Roldan C, Moudiotis C, Vaidya B, Anning C, Bunce S, Estcourt S, Folland E, Gordon E, Harrill C, Ireland J, Piper J, Scaife L, Sutton K, Wilkins S, Costelloe M, Palmer J, Casas L, Miller C, Burgard M, Erickson C, Hallanger-Johnson J, Clark P, Taylor W, Galgani J, Banerjee S, Banda C, McEowen D, Kinman R, Lafferty A, Gillett S, Nolan C, Pathak M, Sondrol L, Hjelle T, Hafner S, Kotrba J, Hendrickson R, Cemeroglu A, Symington T, Daniel M, Appiagyei-Dankah Y, Postellon D, Racine M, Kleis L, Barnes K, Godwin S, McCullough H, Shaheen K, Buck G, Noel L, Warren M, Weber S, Parker S, Gillespie I, Nelson B, Frost C, Amrhein J, Moreland E, Hayes A, Peggram J, Aisenberg J, Riordan M, Zasa J, Cummings E, Scott K, Pinto T, Mokashi A, McAssey K, Helden E, Hammond P, Dinning L, Rahman S, Ray S, Dimicri C, Guppy S, Nielsen H, Vogel C, Ariza C, Morales L, Chang Y, Gabbay R, Ambrocio L, Manley L, Nemery R, Charlton W, Smith P, Kerr L, Steindel-Kopp B, Alamaguer M, Tabisola-Nuesca E, Pendersen A, Larson N, Cooper-Olviver H, Chan D, Fitz-Patrick D, Carreira T, Park Y, Ruhaak R, Liljenquist D. A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk. Diabetes Care 2018; 41:1887-1894. [PMID: 30002199 PMCID: PMC6105323 DOI: 10.2337/dc18-0087] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 06/06/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals. RESEARCH DESIGN AND METHODS We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables. RESULTS Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002). CONCLUSIONS The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.
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Affiliation(s)
- Maria J. Redondo
- Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | | | - Andrea K. Steck
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Seth Sharp
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
| | - John M. Wentworth
- Walter and Eliza Hall Institute of Medical Research and Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Michael N. Weedon
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
| | | | | | | | | | - Richard A. Oram
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
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Sanford E, Watkins K, Nahas S, Gottschalk M, Coufal NG, Farnaes L, Dimmock D, Kingsmore SF. Rapid whole-genome sequencing identifies a novel AIRE variant associated with autoimmune polyendocrine syndrome type 1. Cold Spring Harb Mol Case Stud 2018; 4:a002485. [PMID: 29437776 PMCID: PMC5983174 DOI: 10.1101/mcs.a002485] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/04/2018] [Indexed: 12/31/2022] Open
Abstract
Autoimmune polyendocrine syndrome type 1 (APS-1; OMIM #240300), also referred to as autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED), is a rare monogenic autoimmune disorder caused by mutations in the autoimmune regulator (AIRE) gene. APS-1 is classically characterized by a triad of chronic mucocutaneous candidiasis, autoimmune hypoparathyroidism, and autoimmune adrenocortical insufficiency. We report a 5-yr-old female who presented with symptoms of tetany due to hypocalcemia and was subsequently found to be secondary to hypoparathyroidism. Rapid trio whole-genome sequencing revealed compound heterozygous variants in AIRE in the proband, with a paternally inherited, pathogenic, frameshift variant (c.1265delC; p.Pro422LeufsTer58) and a novel, likely pathogenic, maternally inherited missense variant (c.268T>C; p.Tyr90His).
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Affiliation(s)
- Erica Sanford
- Rady Children's Institute of Genomic Medicine, University of California, San Diego, San Diego, California 92123, USA
- Division of Pediatric Intensive Care Medicine, Department of Pediatrics, University of California, San Diego, San Diego, California 92161, USA
| | - Kelly Watkins
- Rady Children's Institute of Genomic Medicine, University of California, San Diego, San Diego, California 92123, USA
| | - Shareef Nahas
- Rady Children's Institute of Genomic Medicine, University of California, San Diego, San Diego, California 92123, USA
| | - Michael Gottschalk
- Division of Pediatric Endocrinology, Department of Pediatrics, University of California, San Diego, San Diego, California 92161, USA
| | - Nicole G Coufal
- Division of Pediatric Intensive Care Medicine, Department of Pediatrics, University of California, San Diego, San Diego, California 92161, USA
| | - Lauge Farnaes
- Rady Children's Institute of Genomic Medicine, University of California, San Diego, San Diego, California 92123, USA
| | - David Dimmock
- Rady Children's Institute of Genomic Medicine, University of California, San Diego, San Diego, California 92123, USA
| | - Stephen F Kingsmore
- Rady Children's Institute of Genomic Medicine, University of California, San Diego, San Diego, California 92123, USA
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Müller I, Gottschalk M, Deliviani P, Heinke S, Hommel A, Reichert J, Rodrigues R, Zubizaretta N, Ziegler AG, Berner R, Bonifacio E, Lange K. Welche Folgen hat das Wissen um ein erhöhtes Diabetesrisiko eines Säuglings für dessen Eltern? Erste Ergebnisse des Freder1k-Screenings auf Diabetesrisikogene in Sachsen. DIABETOL STOFFWECHS 2018. [DOI: 10.1055/s-0038-1641781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- I Müller
- Medizinische Hochschule Hannover, Medizinische Psychologie, Hannover, Germany
| | - M Gottschalk
- DFG Research Center for Regenerative Therapies Dresden (CRTD), Dresden, Germany
| | - P Deliviani
- DFG Research Center for Regenerative Therapies Dresden (CRTD), Dresden, Germany
| | - S Heinke
- DFG Research Center for Regenerative Therapies Dresden (CRTD), Dresden, Germany
| | - A Hommel
- DFG Research Center for Regenerative Therapies Dresden (CRTD), Dresden, Germany
| | - J Reichert
- Universitätsklinikum Carl Gustav Carus; Klinik und Poliklinik für Kinder- und Jugendmedizin, Dresden, Germany
| | - R Rodrigues
- Medizinische Hochschule Hannover, Medizinische Psychologie, Hannover, Germany
| | - N Zubizaretta
- DFG Research Center for Regenerative Therapies Dresden (CRTD), Dresden, Germany
| | - AG Ziegler
- Institut für Diabetesforschung, Helmholtz Zentrum München, München, Germany
| | - R Berner
- Universitätsklinikum Carl Gustav Carus; Klinik und Poliklinik für Kinder- und Jugendmedizin, Dresden, Germany
| | - E Bonifacio
- DFG Research Center for Regenerative Therapies Dresden (CRTD), Dresden, Germany
| | - K Lange
- Medizinische Hochschule Hannover, Medizinische Psychologie, Hannover, Germany
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Rahman AM, Montero-Lopez N, Hinds RM, Gottschalk M, Melamed E, Capo JT. Assessment of Forearm Rotational Control Using 4 Upper Extremity Immobilization Constructs. Hand (N Y) 2018; 13:202-208. [PMID: 28718329 PMCID: PMC5950959 DOI: 10.1177/1558944717691129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Forearm immobilization techniques are commonly used to manage distal radius, scaphoid, and metacarpal fractures. The purpose of our study was to compare the degree of rotational immobilization provided by a sugar-tong splint (STS), short arm cast (SAC), Munster cast (MC), and long arm cast (LAC) at the level of the distal radioulnar joint (DRUJ), carpus, and metacarpals. METHODS Seven cadaveric upper extremity specimens were mounted to a custom jig with the ulnohumeral joint fixated in 90° of flexion. Supination and pronation were unrestricted. K-wires were placed in the distal radius, scaphoid, and metacarpals using fluoroscopic guidance to measure the total arc of rotation referenced to the ulnar ex-fix pin. Baseline measurements followed by sequential immobilization with well-molded STS, SAC, MC, and LAC were obtained with 1.25, 2.5, and 3.75 ft-lb of supination and pronation force directed through the metacarpal K-wire. Each condition was tested 3 times. Digital photographs were taken perpendicular to the ulnar axis to analyze the total arc of motion. RESULTS The most effective constructs from least to greatest allowed rotational arcs were LAC, MC, SAC, and STS. Above-elbow constructs (MC, LAC) demonstrated superior immobilization compared with below-elbow constructs (SAC) ( P < .001). Circumferential constructs (SAC, MC, LAC) were superior to the noncircumferential construct (STS) ( P < .001). There were no significant differences between the MC and LAC in all conditions tested. CONCLUSIONS Both circumferential and proximally extended immobilization independently improved rotational control of the wrist. However, extending immobilization proximal to the epicondyles did not confer additional stability.
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Affiliation(s)
- Ayesha M. Rahman
- New York University Hospital for Joint Diseases, New York City, USA,Ayesha M. Rahman, NYU Hospital for Joint Diseases, 301 E. 17th Street, 14th Floor, New York, NY 10003, USA.
| | | | - Richard M. Hinds
- New York University Hospital for Joint Diseases, New York City, USA
| | | | - Eitan Melamed
- New York University Hospital for Joint Diseases, New York City, USA
| | - John T. Capo
- New York University Hospital for Joint Diseases, New York City, USA
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Sassu EL, Bossé JT, Tobias TJ, Gottschalk M, Langford PR, Hennig-Pauka I. Update on Actinobacillus pleuropneumoniae-knowledge, gaps and challenges. Transbound Emerg Dis 2017; 65 Suppl 1:72-90. [PMID: 29083117 DOI: 10.1111/tbed.12739] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Indexed: 12/15/2022]
Abstract
Porcine pleuropneumonia, caused by the bacterial porcine respiratory tract pathogen Actinobacillus pleuropneumoniae, leads to high economic losses in affected swine herds in most countries of the world. Pigs affected by peracute and acute disease suffer from severe respiratory distress with high lethality. The agent was first described in 1957 and, since then, knowledge about the pathogen itself, and its interactions with the host, has increased continuously. This is, in part, due to the fact that experimental infections can be studied in the natural host. However, the fact that most commercial pigs are colonized by this pathogen has hampered the applicability of knowledge gained under experimental conditions. In addition, several factors are involved in development of disease, and these have often been studied individually. In a DISCONTOOLS initiative, members from science, industry and clinics exchanged their expertise and empirical observations and identified the major gaps in knowledge. This review sums up published results and expert opinions, within the fields of pathogenesis, epidemiology, transmission, immune response to infection, as well as the main means of prevention, detection and control. The gaps that still remain to be filled are highlighted, and present as well as future challenges in the control of this disease are addressed.
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Affiliation(s)
- E L Sassu
- Department of Pathobiology, Institute of Immunology, University of Veterinary Medicine, Vienna, Austria
| | - J T Bossé
- Section of Paediatrics, Department of Medicine, Imperial College London, London, UK
| | - T J Tobias
- Department of Farm Animal Health, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - M Gottschalk
- Department of Pathology and Microbiology, Faculty of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, QC, Canada
| | - P R Langford
- Section of Paediatrics, Department of Medicine, Imperial College London, London, UK
| | - I Hennig-Pauka
- Field Station for Epidemiology, University of Veterinary Medicine Hannover, Foundation, Bakum, Germany
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Trovillion EM, Gottschalk M, Yoon JM. Diagnostic challenges of bHCG interpretation following gonadectomy in a patient with Swyer syndrome. Pediatr Blood Cancer 2017; 64. [PMID: 28150379 DOI: 10.1002/pbc.26467] [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: 11/23/2016] [Accepted: 01/03/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Erin Murphy Trovillion
- Department of Pediatric Hematology-Oncology, University of California San Diego, San Diego, California
| | - Michael Gottschalk
- Department of Pediatric Endocrinology, University of California San Diego, San Diego, California
| | - Janet M Yoon
- Department of Pediatric Hematology-Oncology, University of California San Diego, San Diego, California
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Galofré-Milà N, Correa-Fiz F, Lacouture S, Gottschalk M, Strutzberg-Minder K, Bensaid A, Pina-Pedrero S, Aragon V. A robust PCR for the differentiation of potential virulent strains of Haemophilus parasuis. BMC Vet Res 2017; 13:124. [PMID: 28482900 PMCID: PMC5422950 DOI: 10.1186/s12917-017-1041-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 04/27/2017] [Indexed: 11/24/2022] Open
Abstract
Background Haemophilus parasuis is the etiological agent of Glässer’s disease in swine. H. parasuis comprises strains with heterogeneous virulence capacity, from non-virulent to highly virulent. Determination of the pathogenic potential of the strains is important for diagnosis and disease control. The virulence-associated trimeric autotransporters (vtaA) genes have been used to predict H. parasuis virulence by PCR amplification of their translocator domains. Here, we report a new and improved PCR designed to detect a different domain of the vtaA genes, the leader sequence (LS) as a diagnostic tool to predict virulence. Methods A collection of 360 H. parasuis strains was tested by PCR with LS specific primers. Results of the PCR were compared with the clinical origin of the strains and, for a subset of strains, with their phagocytosis and serum resistance using a Chi-square test. Results LS-PCR was specific to H. parasuis, and allowed the differential detection of the leader sequences found in clinical and non-clinical isolates. Significant correlation was observed between the results of the LS-PCR and the clinical origin (organ of isolation) of the strains, as well as with their phagocytosis and serum susceptibility, indicating that this PCR is a good predictor of the virulence of the strains. In addition, this new PCR showed a full correlation with the previously validated PCR based on the translocator domain. LS-PCR could be performed in a wide range of annealing temperatures without losing specificity. Conclusion This newly described PCR based on the leader sequence of the vtaA genes, LS-PCR, is a robust test for the prediction of the virulence potential of H. parasuis strains.
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Affiliation(s)
- N Galofré-Milà
- IRTA, Centre de Recerca en Sanitat Animal (CReSA, IRTA-UAB), Campus de la Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain
| | - F Correa-Fiz
- IRTA, Centre de Recerca en Sanitat Animal (CReSA, IRTA-UAB), Campus de la Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain
| | - S Lacouture
- Faculté de médecine vétérinaire, Université de Montréal, 3200, rue Sicotte, Saint-Hyacinthe, Québec, J2S 2M2, Canada
| | - M Gottschalk
- Faculté de médecine vétérinaire, Université de Montréal, 3200, rue Sicotte, Saint-Hyacinthe, Québec, J2S 2M2, Canada
| | - K Strutzberg-Minder
- IVD Innovative Veterinary Diagnostics (IVD GmbH), Albert-Einstein-Str. 5, 30926, Seelze, Germany
| | - A Bensaid
- IRTA, Centre de Recerca en Sanitat Animal (CReSA, IRTA-UAB), Campus de la Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain
| | - S Pina-Pedrero
- IRTA, Centre de Recerca en Sanitat Animal (CReSA, IRTA-UAB), Campus de la Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain
| | - V Aragon
- IRTA, Centre de Recerca en Sanitat Animal (CReSA, IRTA-UAB), Campus de la Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain.
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Rosenthal NA, Bezar E, Mann S, Bachrach LK, Banerjee S, Geffner ME, Gottschalk M, Shapira SK, Hasegawa L, Feuchtbaum L. Primary Care Provider Management of Congenital Hypothyroidism Identified Through Newborn Screening. Ann Thyroid Res 2017; 3:95-101. [PMID: 28868522 PMCID: PMC5580838] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To assess Primary Congenital Hypothyroidism (CH) management patterns and feasibility of providing long-term care for patients with CH identified through newborn screening by Primary Care Providers (PCPs) in California and Hawaii. STUDY DESIGN A survey was mailed to all physicians (N=823) listed as the referral doctor for confirmed patients with CH identified through newborn screening programs in both states between 01/01/2009-12/31/2013. Information was collected on CH management patterns, barriers to providing care, and knowledge on CH treatment. Descriptive statistics and bivariate logistic regression results were reported. RESULTS 206 PCPs completed the survey. Among these, 78% currently have patients with CH and 91% indicated willingness to provide long-term care to new patients with CH. Among PCPs currently caring for patients with CH, 17% managed CH by themselves with limited assistance from endocrinologists; 63% were involved in managing CH but endocrinologists played a larger role than PCPs; 19% were not involved in CH care. Only 49% of PCPs correctly answered questions regarding recommended follow-up frequencies and 23% knew the correct age for a trial off levothyroxine for suspected transient CH. Top two perceived barriers to providing long-term care included "need guidance or support from endocrinologists" (61%) and "not familiar with CH treatment guidelines" (28%). CONCLUSION The majority of PCPs surveyed are willing to provide long-term care to patients with CH, but need support from endocrinologists and increased knowledge about current treatment guidelines.
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Affiliation(s)
- N A Rosenthal
- California Department of Public Health, Genetic Disease Screening Program, USA
| | - E Bezar
- Public Health Foundation Enterprises, USA
| | - S Mann
- Hawai'i Department of Health Genetics Program, USA
| | - L K Bachrach
- Lucile Salter Packard Children's Hospital, Stanford School of Medicine, USA
| | | | | | | | - S K Shapira
- Centers for Disease Control and Prevention, USA
| | - L Hasegawa
- Hawai'i Department of Health Genetics Program, USA
| | - L Feuchtbaum
- California Department of Public Health, Genetic Disease Screening Program, USA
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Cox D, Gottschalk M, Wesseling H, Ernst A, Cooper J, Bahn S. A novel methodology to evaluate the molecular validity of preclinical psychosis models compared to schizophrenia brain pathology. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.1563] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rodent models of schizophrenia (SCZ) are indispensable when screening for novel treatments, but quantifying their translational relevance with the underlying human pathophysiology has proved difficult. A novel systems methodology (shown in Figure 1) was developed integrating and comparing proteomic data of anterior prefrontal cortex tissue from SCZ post-mortem brains and matched controls with data obtained from four established glutamatergic rodent models, with the aim of evaluating which of these models represent SCZ most closely. Liquid chromatography coupled tandem mass spectrometry (LC-MSE) proteomic profiling was applied comparing healthy and “disease state” in human post-mortem samples and rodent brain tissue samples. Protein-protein interaction networks were constructed from significant abundance changes and enrichment analyses enabled the identification of pathophysiological characteristics of the disorder, which were represented across all four rodent models. Subsequently, these functional domains were used for cross-species comparisons. Five functional domains such as “development and differentiation” represented across all four rodent models, were identified. It was quantified that the chronic phencyclidine (cPCP) model represented SCZ brain changes most closely for four of these functional domains, by using machine-learning techniques. This is the first study aiming to quantify which rodent model recapitulates the neuropathological features of SCZ most closely. The methodology and findings presented here support recent efforts to overcome translational hurdles of preclinical psychiatric research by associating behavioural endophenotypes with distinct biological processes.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Thongkamkoon P, Kiatyingangsulee T, Gottschalk M. Serotypes of Streptococcus suis isolated from healthy pigs in Phayao Province, Thailand. BMC Res Notes 2017; 10:53. [PMID: 28100261 PMCID: PMC5244560 DOI: 10.1186/s13104-016-2354-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 12/20/2016] [Indexed: 11/18/2022] Open
Abstract
Background Streptococcus suis (S. suis) is an important swine and human pathogen. There are 33 serotypes that have been described. Zoonotic cases are very common the Northern part of Thailand, especially in Phayao Province. However, the prevalence of S. suis and, more particularly the different serotypes, in pigs in this region is poorly known and needed to be addressed. The context and purpose of the study Distribution of S. suis serotypes varies depending on the geographical area. Knowledge of the serotype distribution is important for epidemiological studies. Consequently, 180 tonsil samples from slaughterhouse pigs in Phayao Province had been collected for surveillance, from which 196 S. suis isolates were recovered. Each isolate was subcultured and its serotype identified using multiplex PCR. Slide agglutination combined with precipitation tests were used following multiplex PCR to differentiate the isolates showing similar sizes of amplified products specific to either serotype 1 or 14 and 2 or 1/2. Non-typable isolates by multiplex PCR were serotyped by the coagglutination test. Results Of the 196 isolates, 123 (62.8%) were typable and 73 (37.2%) were non-typable. This study revealed the presence of serotypes 1, 1/2, 2, 3, 4, 5, 7, 9, 11, 12, 13, 14, 21, 22, 23, 24, 25, 29, and 30. Serotype 23 was the most prevalent (20/196, 10.2%), followed by serotype 9 (16/196, 8.2%), serotype 7 (16/196, 8.2%), and serotype 2 (11/196, 5.6%). The latter is the serotype responsible for most human cases. Conclusion Almost all serotypes previously described are present in Northern Thailand. Therefore, this report provides useful data for future bacteriological studies.
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Affiliation(s)
- P Thongkamkoon
- Veterinary Research and Development Center (Upper Northern Region), 221 M.6, Wiengtarn, Hangchat, Lampang, 52190, Thailand.
| | - T Kiatyingangsulee
- Department of Livestock Development, National Institute of Animal Health, Chatuchak, Bangkok, 10900, Thailand
| | - M Gottschalk
- Faculty of Veterinary Medicine, University of Montreal, 3200 Sicotte, Saint-Hyacinthe, QC, J2S 2M2, Canada
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Abstract
Background: Fatigue is one of the most common disabling symptoms in patients with multiple sclerosis (MS), but the putative role of proinflammatory cytokines remains to be elucidated. Methods: Thirty-seven patients (27 women, 10 men) with relapsing-remitting (n =29) and secondary progressive (n =8) MS, aged 41.0 ± 10.2 years, were studied. Fatigue was assessed by Krupp’s Fatigue Severity Scale (FSS). C ytokine mRNA expression for interferon (IFN)-g, tumor necro sis factor (TNF)-a and interleukin (IL)-10 were measured by real time RT PC R. A utonomic function was evaluated by standard tests for parasympathetic and sympathetic function, as well as by serum levels of norepinephrine and epinephrine. Results: Median levels of TNF-a mRNA expression were significantly higher in MS patients with (FSS]-4.0 and]-5.0, n=26 and n=14, respectively) than in those without fatigue (FSSB-4.0, n =11). No differences were seen for IFN-g and IL-10 mRNA expression. C ytokine levels were not correlated to autonomic tests or to serum catecho lamine levels. Conclusions: These results suggest that TNF-a, as a principal proinflammatory mediator, is associated with MS-related fatigue. This is in support of a patho genic role of the MS-related inflammatory process in the development of fatigue.
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Affiliation(s)
- Peter Flachenecker
- Department of Neurology, Julius-Maximilians University of Würzburg, Josef-Schneider-Strasse 11, D-97080 Würzburg, Germany.
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Gottschalk M, Troprès I, Lamalle L, Grand S, Le Bas JF, Segebarth C. Refined modelling of the short-T2 signal component and ensuing detection of glutamate and glutamine in short-TE, localised, (1) H MR spectra of human glioma measured at 3 T. NMR Biomed 2016; 29:943-951. [PMID: 27197077 DOI: 10.1002/nbm.3548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 03/22/2016] [Accepted: 04/07/2016] [Indexed: 06/05/2023]
Abstract
Short-TE (1) H MRS has great potential for brain cancer diagnostics. A major difficulty in the analysis of the spectra is the contribution from short-T2 signal components, mainly coming from mobile lipids. This complicates the accurate estimation of the spectral parameters of the resonance lines from metabolites, so that a qualitative to semi-quantitative interpretation of the spectra dominates in practice. One solution to overcome this difficulty is to measure and estimate the short-T2 signal component and to subtract it from the total signal, thus leaving only the metabolite signals. The technique works well when applied to spectra obtained from healthy individuals, but requires some optimisation during data acquisition. In the clinical setting, time constraints hardly allow this. Here, we propose an iterative estimation of the short-T2 signal component, acquired in a single acquisition after measurement of the full spectrum. The method is based on QUEST (quantitation based on quantum estimation) and allows the refinement of the estimate of the short-T2 signal component after measurement. Thus, acquisition protocols used on healthy volunteers can also be used on patients without further optimisation. The aim is to improve metabolite detection and, ultimately, to enable the estimation of the glutamine and glutamate signals distinctly. These two metabolites are of great interest in the characterisation of brain cancer, gliomas in particular. When applied to spectra from healthy volunteers, the new algorithm yields similar results to QUEST and direct subtraction of the short-T2 signal component. With patients, up to 12 metabolites and, at least, seven can be quantified in each individual brain tumour spectrum, depending on the metabolic state of the tumour. The refinement of the short-T2 signal component significantly improves the fitting procedure and produces a separate short-T2 signal component that can be used for the analysis of mobile lipid resonances. Thus, in brain tumour spectra, distinct estimates of signals from glutamate and glutamine are possible. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Irène Troprès
- Univ. Grenoble Alpes, IRMaGe, CNRS, UMR 3552, INSERM, US17 and CLUNI, CHU de Grenoble, IRMaGe, F-38000, Grenoble, France
| | - Laurent Lamalle
- Univ. Grenoble Alpes, IRMaGe, CNRS, UMR 3552, INSERM, US17 and CLUNI, CHU de Grenoble, IRMaGe, F-38000, Grenoble, France
| | - Sylvie Grand
- Université des Alpes Grenoble 1, Grenoble Institut des Neurosciences, Equipe 5, Clinique Universitaire de Neuroradiologie et IRM (CLUNI) and Centre Hospitalier Universitaire de Grenoble et des Alpes (CHUGA), Grenoble, France
| | - Jean-François Le Bas
- Université des Alpes Grenoble 1, Grenoble Institut des Neurosciences, Equipe 5, Clinique Universitaire de Neuroradiologie et IRM (CLUNI) and Centre Hospitalier Universitaire de Grenoble et des Alpes (CHUGA), Grenoble, France
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Gottschalk M, Sieme H, Martinsson G, Distl O. Heritability of semen traits in German Warmblood stallions. Anim Reprod Sci 2016; 170:10-4. [DOI: 10.1016/j.anireprosci.2016.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 03/07/2016] [Accepted: 03/13/2016] [Indexed: 10/22/2022]
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Gitelman SE, Gottlieb PA, Felner EI, Willi SM, Fisher LK, Moran A, Gottschalk M, Moore WV, Pinckney A, Keyes-Elstein L, Harris KM, Kanaparthi S, Phippard D, Ding L, Bluestone JA, Ehlers MR. Antithymocyte globulin therapy for patients with recent-onset type 1 diabetes: 2 year results of a randomised trial. Diabetologia 2016; 59:1153-61. [PMID: 27053235 PMCID: PMC4869699 DOI: 10.1007/s00125-016-3917-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 02/17/2016] [Indexed: 01/13/2023]
Abstract
AIMS/HYPOTHESIS Type 1 diabetes results from T cell mediated destruction of beta cells. We conducted a trial of antithymocyte globulin (ATG) in new-onset type 1 diabetes (the Study of Thymoglobulin to ARrest T1D [START] trial). Our goal was to evaluate the longer-term safety and efficacy of ATG in preserving islet function at 2 years. METHODS A multicentre, randomised, double-blind, placebo-controlled trial of 6.5 mg/kg ATG (Thymoglobulin) vs placebo in patients with new-onset type 1 diabetes was conducted at seven university medical centres and one Children's Hospital in the USA. The site-stratified randomisation scheme was computer generated at the data coordinating centre using permuted-blocks of size 3 or 6. Eligible participants were between the ages of 12 and 35, and enrolled within 100 days from diagnosis. Subjects were randomised to 6.5 mg/kg ATG (thymoglobulin) vs placebo in a 2:1 ratio. Participants were blinded, and the study design included two sequential patient-care teams: an unblinded study-drug administration team (for the first 8 weeks), and a blinded diabetes management team (for the remainder of the study). Endpoints assessed at 24 months included meal-stimulated C-peptide AUC, safety and immunological responses. RESULTS Fifty-eight patients were enrolled; at 2 years, 35 assigned to ATG and 16 to placebo completed the study. The pre-specified endpoints were not met. In post hoc analyses, older patients (age 22-35 years) in the ATG group had significantly greater C-peptide AUCs at 24 months than placebo patients. Using complete preservation of baseline C-peptide at 24 months as threshold, nine of 35 ATG-treated participants (vs 2/16 placebo participants) were classified as responders; nine of 11 responders (67%) were older. All participants reported at least one adverse event (AE), with 1,148 events in the 38 ATG participants vs 415 in the 20 placebo participants; a comparable number of infections were noted in the ATG and placebo groups, with no opportunistic infections nor difficulty clearing infections in either group. Circulating T cell subsets depleted by ATG partially reconstituted, but regulatory, naive and central memory subsets remained significantly depleted at 24 months. Beta cell autoantibodies did not change over the 24 months in the ATG-treated or placebo participants. At 12 months, ATG-treated participants had similar humoral immune responses to tetanus and HepA vaccines as placebo-treated participants, and no increased infections. CONCLUSIONS/INTERPRETATION A brief course of ATG substantially depleted T cell subsets, including regulatory cells, but did not preserve islet function 24 months later in the majority of patients with new-onset type 1 diabetes. ATG preserved C-peptide secretion in older participants, which may warrant further study. TRIAL REGISTRATION ClinicalTrials.gov NCT00515099 PUBLIC DATA REPOSITORY: START datasets are available in TrialShare www.itntrialshare.org FUNDING National Institute of Allergy and Infectious Diseases (NIAID) of the National Institutes of Health (NIH). The trial was conducted by the Immune Tolerance Network (ITN).
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Affiliation(s)
- Stephen E Gitelman
- Division of Pediatric Endocrinology, University of California San Francisco, Mission Hall, 550 16th Street, 4th Floor, Box 0434, San Francisco, CA, 94158-2549, USA.
- Diabetes Center, University of California San Francisco, San Francisco, CA, USA.
| | | | - Eric I Felner
- Division of Pediatric Endocrinology, Emory University School of Medicine, Atlanta, GA, USA
| | - Steven M Willi
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Lynda K Fisher
- Department of Endocrinology and Metabolism, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Antoinette Moran
- Department of Pediatrics, Division of Pediatrics Endocrinology, University of Minnesota, Minneapolis, MN, USA
| | - Michael Gottschalk
- Department of Pediatrics, University of California San Diego, San Diego, CA, USA
| | - Wayne V Moore
- Department of Pediatrics, Division of Pediatric Endocrinology, Children's Mercy Hospital and University of Missouri-Kansas City, Kansas City, MO, USA
| | | | | | | | | | - Deborah Phippard
- Immune Tolerance Network, Bethesda, MD, USA
- Precision for Medicine, Bethesda, MD, USA
| | - Linna Ding
- National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - Jeffrey A Bluestone
- Diabetes Center, University of California San Francisco, San Francisco, CA, USA
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DuBose SN, Hermann JM, Tamborlane WV, Beck RW, Dost A, DiMeglio LA, Schwab KO, Holl RW, Hofer SE, Maahs DM, Lipman T, Calvano T, Kucheruk O, Minnock P, Nguyen C, Klingensmith G, Banion C, Barker J, Cain C, Chase P, Hoops S, Kelsy M, Klingensmith G, Maahs D, Mowry C, Nadeau K, Raymond J, Rewers M, Rewers A, Slover R, Steck A, Wadwa P, Walravens P, Zeitler P, Haro H, Manseau K, Weinstock R, Izquierdo R, Sheikh U, Conboy P, Bulger J, Bzdick S, Goland R, Gandica R, Weiner L, Cook S, Greenberg E, Kohm K, Pollack S, Lee J, Gregg B, Tan M, Burgh K, Eason A, Garg S, Michels A, Myers L, DiMeglio L, Hannon T, Orr D, Cruz C, Woerner S, Wolfsdorf J, Quinn M, Tawa O, Ahmann A, Castle J, Joarder F, Bogan C, Cady N, Cox J, Pitts A, Fitch R, White B, Wollam B, Bode B, Lindmark K, Hosey R, Bethin K, Quattrin T, Ecker M, Wood J, Chao L, Cheung C, Fisher L, Jeandron D, Kaufman F, Kim M, Miyazaki B, Monzavi R, Patel P, Pitukcheewanont P, Sandstrom A, Cohen M, Ichihara B, Lipton M, Cemeroglu A, Appiagyei-Dankah Y, Daniel M, Postellon D, Racine M, Wood M, Kleis L, Hirsch I, DeSantis A, Dugdale D, Failor RA, Gilliam L, Greenbaum C, Janci M, Odegard P, Trence D, Wisse B, Batts E, Dove A, Hefty D, Khakpour D, Klein J, Kuhns K, McCulloch-Olson M, Peterson C, Ramey M, Marie MS, Thomson P, Webber C, Liljenquist D, Sulik M, Vance C, Coughenour T, Brown C, Halford J, Prudent A, Rigby S, Robison B, Starkman H, Berry T, Cerame B, Chin D, Ebner-Lyon L, Guevarra F, Sabanosh K, Silverman L, Wagner C, Fox M, Buckingham B, Shah A, Caswell K, Harris B, Bergenstal R, Criego A, Damberg G, Matfin G, Powers M, Tridgell D, Burt C, Olson B, Thomas L, Mehta S, Katz M, Laffel L, Hathway J, Phillips R, Cengiz E, Tamborlane W, Cappiello D, Steffen A, Zgorski M, Peters A, Ruelas V, Benjamin R, Adkins D, Cuffee J, Spruill A, Bergenstal R, Criego A, Damberg G, Matfin G, Powers M, Tridgell D, Burt C, Olson B, Thomas L, Aleppo-Kacmarek G, Derby T, Massaro E, Webb K, Burt Solorzano C, DeBoer M, Madison H, McGill J, Buechler L, Clifton MJ, Hurst S, Kissel S, Recklein C, Tsalikian E, Tansey M, Cabbage J, Coffey J, Salamati S, Clements M, Raman S, Turpin A, Bedard J, Cohoon C, Elrod A, Fridlington A, Hester L, Kruger D, Schatz D, Clare-Salzler M, Cusi K, Digman C, Fudge B, Haller M, Meehan C, Rohrs H, Silverstein J, Wagh S, Cintron M, Sheehan E, Thomas J, Daniels M, Clark S, Flannery T, Forghani N, Naidu A, Reh C, Scoggin P, Trinh L, Ayala N, Quintana R, Speer H, Zipf W, Seiple D, Kittelsrud J, Gupta A, Peterson V, Stoker A, Gottschalk M, Hashiguchi M, Smith K, Rodriguez H, Bobik C, Henson D, Simmons J, Potter A, Black M, Brendle F, Gubitosi-Klug R, Kaminski B, Bergant S, Campbell W, Tasi C, Copeland K, Beck J, Less J, Schanuel J, Tolbert J, Adi S, Gerard-Gonzalez A, Gitelman S, Chettout N, Torok C, Pihoker C, Yi-Frazier J, Kearns S, Libman I, Bills V, Diaz A, Duke J, Nathan B, Moran A, Bellin M, Beasley S, Kogler A, Leschyshyn J, Schmid K, Street A, Nelson B, Frost C, Reifeis E, Haymond M, Bacha F, Caldas-Vasquez M, Klinepeter S, Redondo M, Berlanga R, Falk T, Garnes E, Gonzalez J, Martinez C, Pontifes M, Yulatic R, Arnold K, Evans T, Sellers S, Raman V, Foster C, Murray M, Raman V, Brown T, Slater H, Wheeler K, Harlan D, Lee M, Lock JP, Hartigan C, Hubacz L, Buse J, Calikoglu A, Largay J, Young L, Brown H, Duncan V, Duclos M, Tricome J, Brandenburg V, Blehm J, Hallanger-Johnson J, Hanson D, Miller C, Weiss J, Hoffman R, Chaudhari M, Repaske D, Gilson E, Haines J, Rudolph J, McClave C, Biersdorf D, Tello A, Blehm J, Amundson D, Ward R, Rickels M, Dalton-Bakes C, Markman E, Peleckis A, Rosenfeld N, Dolan L, Corathers S, Kichler J, Baugh H, Standiford D, Hassing J, Jones J, Willis S, Willis S, Wysham C, Davis L, Blackman S, Abel KL, Clark L, Jonas A, Kagan E, Sosenko J, Blashke C, Matheson D, Edelen R, Repas T, Baldwin D, Borgwardt T, Conroy C, DeGrote K, Marchiando R, Wasson M, Fox L, Mauras N, Damaso L, Englert K, Hamaty M, Kennedy L, Schweiger M, Konstantinopoulos P, Mawhorter C, Orasko A, Rose D, Deeb L, Rohrbacher K, Schroeder L, Roark A, Ali O, Kramer J, Whitson-Jones D, Potter A, Black M, Brendle F, Gassner H, Kollipara S, Bills V, Duke J, Harwood K, Prasad V, Brault J. Obesity in Youth with Type 1 Diabetes in Germany, Austria, and the United States. J Pediatr 2015; 167:627-32.e1-4. [PMID: 26164381 DOI: 10.1016/j.jpeds.2015.05.046] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 04/28/2015] [Accepted: 05/22/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine the current extent of the obesity problem in 2 large pediatric clinical registries in the US and Europe and to examine the hypotheses that increased body mass index (BMI) z-scores (BMIz) are associated with greater hemoglobin A1c (HbA1c) and increased frequency of severe hypoglycemia in youth with type 1 diabetes (T1D). STUDY DESIGN International (World Health Organization) and national (Centers for Disease Control and Prevention/German Health Interview and Examination Survey for Children and Adolescents) BMI references were used to calculate BMIz in participants (age 2-<18 years and ≥ 1 year duration of T1D) enrolled in the T1D Exchange (n = 11,435) and the Diabetes Prospective Follow-up (n = 21,501). Associations between BMIz and HbA1c and severe hypoglycemia were assessed. RESULTS Participants in both registries had median BMI values that were greater than international and their respective national reference values. BMIz was significantly greater in the T1D Exchange vs the Diabetes Prospective Follow-up (P < .001). After stratification by age-group, no differences in BMI between registries existed for children 2-5 years, but differences were confirmed for 6- to 9-, 10- to 13-, and 14- to 17-year age groups (all P < .001). Greater BMIz were significantly related to greater HbA1c levels and more frequent occurrence of severe hypoglycemia across the registries, although these associations may not be clinically relevant. CONCLUSIONS Excessive weight is a common problem in children with T1D in Germany and Austria and, especially, in the US. Our data suggest that obesity contributes to the challenges in achieving optimal glycemic control in children and adolescents with T1D.
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Affiliation(s)
| | - Julia M Hermann
- Institute for Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
| | | | - Roy W Beck
- Jaeb Center for Health Research, Tampa, FL
| | - Axel Dost
- Department of Pediatrics, University Children's Hospital Jena, Jena, Germany
| | | | | | - Reinhard W Holl
- Institute for Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
| | - Sabine E Hofer
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - David M Maahs
- Barbara Davis Center for Childhood Diabetes, Aurora, CO
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Sánchez Del Rey V, Fernández-Garayzábal JF, Bárcena C, Briones V, Domínguez L, Gottschalk M, Vela AI. Molecular typing of Streptococcus suis isolates from Iberian pigs: a comparison with isolates from common intensively-reared commercial pig breeds. Vet J 2014; 202:597-602. [PMID: 25458888 DOI: 10.1016/j.tvjl.2014.10.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 04/30/2014] [Revised: 10/07/2014] [Accepted: 10/11/2014] [Indexed: 11/26/2022]
Abstract
The Iberian pig (IP) is a traditional Spanish breed variety of the domestic pig (Sus scrofa domesticus) with high economic importance because of the value of the dry-cured products in national and international markets. The genetic characteristics of tonsillar and clinical Streptococcus suis isolates from the IP maintained under extensive or intensive management conditions were investigated. S. suis isolates from IP pigs were compared with S. suis isolates from intensively-farmed pigs of common breeds (CBP). S. suis was isolated from 48.4% of the IP tonsils examined, indicating wide distribution among IP pigs. Serotypes 1 (9.4%), 2 (8.6%) and 9 (7%) were the most commonly found, although a high percentage of S. suis isolates were not typeable by coagglutination testing. No significant differences in carrier rates or serotype diversity were observed between management systems, indicating that intensive farming does not influence S. suis colonisation. Both pulsed-field gel electrophoresis and multiple-locus variable number tandem repeat analysis showed a serotype-based distribution of S. suis IP isolates. Serotypes 1 and 2 S. suis isolates were grouped in the same cluster, whereas isolates of serotypes 9 and 7 were assigned to another cluster. All clinical and most tonsillar serotype 2 IP isolates were assigned to sequence type 1 (ST1) and exhibited the virulence genotype mrp+/epf+/sly+, indicating a high distribution of this genetic lineage among IP as well as a population of serotype 2 common to IPs and CBPs. The only clinical isolate of serotype 9 from IP was assigned to ST123, a sequence type associated with clinical isolates in CBPs in Spain.
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Affiliation(s)
- V Sánchez Del Rey
- Centro de Vigilancia Sanitaria Veterinaria (VISAVET), Universidad Complutense, 28040 Madrid, Spain
| | - J F Fernández-Garayzábal
- Centro de Vigilancia Sanitaria Veterinaria (VISAVET), Universidad Complutense, 28040 Madrid, Spain; Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad Complutense, 28040 Madrid, Spain
| | - C Bárcena
- Centro de Vigilancia Sanitaria Veterinaria (VISAVET), Universidad Complutense, 28040 Madrid, Spain
| | - V Briones
- Centro de Investigación en Sanidad Animal, Instituto Nacional de Investigación y Tecnología Agraria y Alimentaria, Ministerio de Economia y Competitividad, Valdeolmos, 28130 Madrid, Spain
| | - L Domínguez
- Centro de Vigilancia Sanitaria Veterinaria (VISAVET), Universidad Complutense, 28040 Madrid, Spain
| | - M Gottschalk
- Groupe de Recherche sur les Maladies Infectieuses du Porc, Faculté de Médecine Vétérinaire, Université de Montréal, 3200 Sicotte, St.-Hyacinthe, Québec J2S 2M2, Canada
| | - A I Vela
- Centro de Vigilancia Sanitaria Veterinaria (VISAVET), Universidad Complutense, 28040 Madrid, Spain; Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad Complutense, 28040 Madrid, Spain.
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Griffin KJ, Thompson PA, Gottschalk M, Kyllo JH, Rabinovitch A. Combination therapy with sitagliptin and lansoprazole in patients with recent-onset type 1 diabetes (REPAIR-T1D): 12-month results of a multicentre, randomised, placebo-controlled, phase 2 trial. Lancet Diabetes Endocrinol 2014; 2:710-8. [PMID: 24997559 PMCID: PMC4283272 DOI: 10.1016/s2213-8587(14)70115-9] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Type 1 diabetes results from autoimmune destruction of pancreatic β cells. Findings from preclinical studies suggest that dipeptidyl peptidase-4 inhibitors and proton-pump inhibitors might enhance β-cell survival and regeneration. We postulated that sitagliptin and lansoprazole would preserve β-cell function in patients with recent-onset type 1 diabetes. METHODS We did a double-blind, placebo-controlled, phase 2 trial (REPAIR-T1D). Participants aged 11-36 years, diagnosed with type 1 diabetes within the past 6 months were recruited from Sanford Health Systems (Sioux Falls, SD, USA; Fargo, ND, USA), Children's Hospitals and Clinics of Minnesota (St Paul, MN, USA), and Rady Children's Hospital (San Diego, CA, USA). Participants were randomly assigned (2:1) to receive oral sitagliptin (100 mg for participants ≥18 years, 50 mg for those <18 years) and lansoprazole (60 mg for participants ≥18 years, 30 mg for those <18 years) or matched placebo for 12 months. Randomisation was done by a blocked randomisation process (blocks of three and six), with separate streams for younger (<18 years) and older (≥18 years) participants, and males and females. All participants and personnel remained masked until after the completion of the final 12 month visit, at which time data were unmasked to the analysis team. The primary endpoint was C-peptide response to a mixed meal challenge at 12 months measured as 2 h area under curve. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01155284. FINDINGS Between Sept 21, 2010, and May 29, 2012, 46 participants were randomly assigned to the treatment group and 22 to the placebo group; of whom 40 participants in the treatment group and 18 in the placebo group completed the 12-month treatment. At 12 months, the mean change in C-peptide area under curve was -229 pmol/L (95% CI -316 to -142) for the treatment group and -253 pmol/L (-383 to -123) for the placebo group; this difference was not significant (p=0·77). No adverse or serious adverse events were probably or definitely related to the study treatment. INTERPRETATION Although the expected change in the primary endpoint was not achieved, not all participants had increases in glucagon-like peptide-1 and gastrin concentrations that were expected with treatment. Although participants did not have adverse events related to study drugs, the study is not powered to address safety definitively. Further trials including these drugs might be warranted, but should be designed to ensure appropriate selection of participants and increases in these intermediary hormones. FUNDING Sanford Research and JDRF.
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Affiliation(s)
- Kurt J Griffin
- The Sanford Project, Sanford Research, and Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, USA
| | - Paul A Thompson
- The Sanford Project, Sanford Research, and Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, USA
| | - Michael Gottschalk
- University of California San Diego and Rady Children's Hospital Pediatric Endocrinology, San Diego, CA, USA
| | | | - Alex Rabinovitch
- The Sanford Project, Sanford Research, and Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, USA.
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Kolodziejczyk JK, Gutzmer K, Wright SM, Arredondo EM, Hill L, Patrick K, Huang JS, Gottschalk M, Norman GJ. Influence of specific individual and environmental variables on the relationship between body mass index and health-related quality of life in overweight and obese adolescents. Qual Life Res 2014; 24:251-61. [PMID: 24980678 DOI: 10.1007/s11136-014-0745-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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] [Accepted: 06/17/2014] [Indexed: 02/04/2023]
Abstract
PURPOSE Overweight and obese adolescents are at risk for low health-related quality of life (HRQOL). We examined the role of individual- and environmental-level variables on the relationship between body mass index (BMI kg/m(2)) and HRQOL in adolescents. METHODS Linear regressions were performed to conduct mediation and moderation analyses on the relationship between BMI and HRQOL in overweight and obese adolescents (N = 205). HRQOL was measured by the Pediatric Quality of Life Inventory. Hypothesized mediators included depression, measured by the Center for Epidemiologic Studies Depression Scale; body image, measured by the gender-specific body dissatisfaction subscale of the Eating Disorder Inventory; and self-esteem, measured by the Rosenberg Self-Esteem Scale. Mediation was assessed using Baron and Kenny's approach and Sobel's test of indirect effects. Anglo-acculturation, measured by the Short Acculturation Scale for Hispanics-Youth, and environmental perception, measured by parent-proxy report of the Neighborhood Environment Walkability Scale, were hypothesized moderators. RESULTS Body image mediated the relationship between BMI and HRQOL (b = -0.34, SE = 0.17, adj R (2) = 0.19, p = .051), and self-esteem was a partial mediator (b = -0.37, SE = 0.17, adj R (2) = 0.24, p = .027). Sobel's test confirmed these results (p < .05). No significant moderation effects were found. CONCLUSIONS The finding that individual-level factors, such as body image and self-esteem, influence the relationship between BMI and HRQOL while environmental factors, such as neighborhood environment and acculturation, do not extends previous research. The finding that body image and self-esteem partially mediate this relationship presents new areas to investigate in interventions that address BMI in youth.
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Affiliation(s)
- Julia K Kolodziejczyk
- Department of Family and Preventive Medicine, University of California, San Diego, 9500 Gilman Drive, Dept 0811, La Jolla, CA, 92093-0811, USA,
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Huang JS, Terrones L, Tompane T, Dillon L, Pian M, Gottschalk M, Norman GJ, Bartholomew LK. Preparing adolescents with chronic disease for transition to adult care: a technology program. Pediatrics 2014; 133:e1639-46. [PMID: 24843066 PMCID: PMC4035589 DOI: 10.1542/peds.2013-2830] [Citation(s) in RCA: 151] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Adolescents with chronic disease (ACD) must develop independent disease self-management and learn to communicate effectively with their health care team to transition from pediatric to adult-oriented health care systems. Disease-specific interventions have been implemented to aid specific ACD groups through transition. A generic approach might be effective and cost-saving. METHODS Eighty-one ACD, aged 12 to 20 years, were recruited for a randomized clinical trial evaluating an 8-month transition intervention (MD2Me). MD2Me recipients received a 2-month intensive Web-based and text-delivered disease management and skill-based intervention followed by a 6-month review period. MD2Me recipients also had access to a texting algorithm for disease assessment and health care team contact. The intervention was applicable to adolescents with diverse chronic illnesses. Controls received mailed materials on general health topics. Disease management, health-related self-efficacy, and health assessments were performed at baseline and at 2 and 8 months. Frequency of patient-initiated communications was recorded over the study period. Outcomes were analyzed according to assigned treatment group over time. RESULTS MD2Me recipients demonstrated significant improvements in performance of disease management tasks, health-related self-efficacy, and patient-initiated communications compared with controls. CONCLUSIONS Outcomes in ACD improved significantly among recipients of a generic, technology-based intervention. Technology can deliver transition interventions to adolescents with diverse chronic illnesses, and a generic approach offers a cost-effective means of positively influencing transition outcomes. Further research is needed to determine whether improved short-term outcomes translate into an improved transition for ACD.
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Affiliation(s)
- Jeannie S. Huang
- Divisions of Gastroenterology,,Rady Children’s Hospital, San Diego, California; and
| | | | | | - Lindsay Dillon
- Department of Family and Preventive Medicine, University of California, San Diego, California
| | - Mark Pian
- Pulmonology, and,Rady Children’s Hospital, San Diego, California; and
| | - Michael Gottschalk
- Endocrinology, Department of Pediatrics, and,Rady Children’s Hospital, San Diego, California; and
| | - Gregory J. Norman
- Department of Family and Preventive Medicine, University of California, San Diego, California
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Affiliation(s)
- M. Gottschalk
- Department of Pathology and Microbiology; Faculty of Veterinary Medicine; University of Montreal; 3200 Sicotte, Saint-Hyacinthe Quebec Canada J2S 2M2
| | - S. Lacouture
- Department of Pathology and Microbiology; Faculty of Veterinary Medicine; University of Montreal; 3200 Sicotte, Saint-Hyacinthe Quebec Canada J2S 2M2
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Gitelman SE, Gottlieb PA, Rigby MR, Felner EI, Willi SM, Fisher LK, Moran A, Gottschalk M, Moore WV, Pinckney A, Keyes-Elstein L, Aggarwal S, Phippard D, Sayre PH, Ding L, Bluestone JA, Ehlers MR. Antithymocyte globulin treatment for patients with recent-onset type 1 diabetes: 12-month results of a randomised, placebo-controlled, phase 2 trial. Lancet Diabetes Endocrinol 2013; 1:306-16. [PMID: 24622416 PMCID: PMC6489466 DOI: 10.1016/s2213-8587(13)70065-2] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Type 1 diabetes results from T-cell-mediated destruction of β cells. Findings from preclinical studies and pilot clinical trials suggest that antithymocyte globulin (ATG) might be effective for reducing this autoimmune response. We assessed the safety and efficacy of rabbit ATG in preserving islet function in participants with recent-onset type 1 diabetes, and report here our 12-month results. METHODS For this phase 2, randomised, placebo-controlled, clinical trial, we enrolled patients with recent-onset type 1 diabetes, aged 12-35 years, and with a peak C-peptide of 0.4 nM or greater on mixed meal tolerance test from 11 sites in the USA. We used a computer generated randomisation sequence to randomly assign patients (2:1, with permuted-blocks of size three or six and stratified by study site) to receive either 6.5 mg/kg ATG or placebo over a course of four days. All participants were masked and initially managed by an unmasked drug management team, which managed all aspects of the study until month 3. Thereafter, to maintain masking for diabetes management throughout the remainder of the study, participants received diabetes management from an independent, masked study physician and nurse educator. The primary endpoint was the baseline-adjusted change in 2-h area under the curve C-peptide response to mixed meal tolerance test from baseline to 12 months. Analyses were by intention to treat. This is a planned interim analysis of an on-going trial that will run for 24 months of follow-up. This study is registered with ClinicalTrials.gov, number NCT00515099. FINDINGS Between Sept 10, 2007, and June 1, 2011, we screened 154 individuals, randomly allocating 38 to ATG and 20 to placebo. We recorded no between-group difference in the primary endpoint: participants in the ATG group had a mean change in C-peptide area under the curve of -0.195 pmol/mL (95% CI -0.292 to -0.098) and those in the placebo group had a mean change of -0.239 pmol/mL (-0.361 to -0.118) in the placebo group (p=0.591). All except one participant in the ATG group had both cytokine release syndrome and serum sickness, which was associated with a transient rise in interleukin-6 and acute-phase proteins. Acute T cell depletion occurred in the ATG group, with slow reconstitution over 12 months. However, effector memory T cells were not depleted, and the ratio of regulatory to effector memory T cells declined in the first 6 months and stabilised thereafter. ATG-treated patients had 159 grade 3-4 adverse events, many associated with T-cell depletion, compared with 13 in the placebo group, but we detected no between-group difference in incidence of infectious diseases. INTERPRETATION Our findings suggest that a brief course of ATG does not result in preservation of β-cell function 12 months later in patients with new-onset type 1 diabetes. Generalised T-cell depletion in the absence of specific depletion of effector memory T cells and preservation of regulatory T cells seems to be an ineffective treatment for type 1 diabetes.
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Affiliation(s)
| | | | - Mark R Rigby
- Indiana University and Riley Children's Hospital, Indianapolis, Indianapolis, IN, USA
| | | | - Steven M Willi
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lynda K Fisher
- Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | | | | | | | | | | | | | | | | | - Linna Ding
- National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
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Maneerat K, Yongkiettrakul S, Kramomtong I, Tongtawe P, Tapchaisri P, Luangsuk P, Chaicumpa W, Gottschalk M, Srimanote P. Virulence Genes and Genetic Diversity ofStreptococcus suisSerotype 2 Isolates from Thailand. Transbound Emerg Dis 2013; 60 Suppl 2:69-79. [DOI: 10.1111/tbed.12157] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Indexed: 11/28/2022]
Affiliation(s)
- K. Maneerat
- Graduate Program in Biomedical Sciences; Faculty of Allied Health Sciences; Thammasat University; Pathumthani Thailand
| | - S. Yongkiettrakul
- Protein-Ligand Engineering and Molecular Biology Laboratory; National Center for Genetic Engineering and Biotechnology; Thailand Science Park Pathumthani Thailand
| | - I. Kramomtong
- Department of Microbiology; Faculty of Veterinary Science; Chulalongkorn University; Bangkok Thailand
| | - P. Tongtawe
- Graduate Program in Biomedical Sciences; Faculty of Allied Health Sciences; Thammasat University; Pathumthani Thailand
| | - P. Tapchaisri
- Graduate Program in Biomedical Sciences; Faculty of Allied Health Sciences; Thammasat University; Pathumthani Thailand
| | - P. Luangsuk
- Chiang Kham General Hospital; Phayao Thailand
| | - W. Chaicumpa
- Graduate Program in Biomedical Sciences; Faculty of Allied Health Sciences; Thammasat University; Pathumthani Thailand
- Department of Parasitology; Faculty of Medicine Siriraj Hospital; Mahidol University; Bangkok Thailand
| | - M. Gottschalk
- Faculty of Veterinary Medicine; University of Montreal; St-Hyacinthe Quebec Canada
| | - P. Srimanote
- Graduate Program in Biomedical Sciences; Faculty of Allied Health Sciences; Thammasat University; Pathumthani Thailand
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Mitchell P, Gottschalk M, Butts G, Xerogeanes J. Surgical site infection: A comparison of multispecialty and single specialty outpatient facilities. J Orthop 2013; 10:111-4. [PMID: 24396225 PMCID: PMC3861674 DOI: 10.1016/j.jor.2013.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 06/01/2013] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Reoperation secondary to surgical site infections can be a devastating complication in orthopaedic surgery. Infection rates in the ambulatory setting have been reported to be lower than those cited in a hospital setting. However, a direct comparative analysis of infection rates of orthopaedic procedures performed in a single specialty ambulatory surgical center (ASC) versus a multi-specialty ASC has, to our knowledge, not been performed. METHODS Four surgeons performed more than 10,000 orthopaedic surgeries in a multispecialty and single specialty ambulatory setting over 8 years. These procedures were reviewed for postoperative deep infection within one year of initial operation. RESULTS The post-surgical deep infection rate in a multi-specialty ASC was 0.81% in 2867 operations compared with a rate of 0.38% in 7311 operations performed in a single specialty ASC (p = 0.007). CONCLUSIONS This study demonstrated that the rate of infection leading to reoperation was significantly lower in a single specialty ambulatory surgery setting as opposed to one accommodating multiple specialties.
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Affiliation(s)
- Phillip Mitchell
- Department of Orthopaedics, Emory School of Medicine, Emory Orthopaedic and Spine Center, Atlanta, GA 30329, USA
| | - Michael Gottschalk
- Department of Orthopaedics, Emory School of Medicine, Emory Orthopaedic and Spine Center, Atlanta, GA 30329, USA
| | - Geanie Butts
- Department of Orthopaedics, Emory School of Medicine, Emory Orthopaedic and Spine Center, Atlanta, GA 30329, USA
| | - John Xerogeanes
- Department of Orthopaedics, Emory School of Medicine, Atlanta, GA 30329, USA
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Lim YH, Ovejero D, Sugarman JS, Deklotz CMC, Maruri A, Eichenfield LF, Kelley PK, Jüppner H, Gottschalk M, Tifft CJ, Gafni RI, Boyce AM, Cowen EW, Bhattacharyya N, Guthrie LC, Gahl WA, Golas G, Loring EC, Overton JD, Mane SM, Lifton RP, Levy ML, Collins MT, Choate KA. Multilineage somatic activating mutations in HRAS and NRAS cause mosaic cutaneous and skeletal lesions, elevated FGF23 and hypophosphatemia. Hum Mol Genet 2013; 23:397-407. [PMID: 24006476 DOI: 10.1093/hmg/ddt429] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Pathologically elevated serum levels of fibroblast growth factor-23 (FGF23), a bone-derived hormone that regulates phosphorus homeostasis, result in renal phosphate wasting and lead to rickets or osteomalacia. Rarely, elevated serum FGF23 levels are found in association with mosaic cutaneous disorders that affect large proportions of the skin and appear in patterns corresponding to the migration of ectodermal progenitors. The cause and source of elevated serum FGF23 is unknown. In those conditions, such as epidermal and large congenital melanocytic nevi, skin lesions are variably associated with other abnormalities in the eye, brain and vasculature. The wide distribution of involved tissues and the appearance of multiple segmental skin and bone lesions suggest that these conditions result from early embryonic somatic mutations. We report five such cases with elevated serum FGF23 and bone lesions, four with large epidermal nevi and one with a giant congenital melanocytic nevus. Exome sequencing of blood and affected skin tissue identified somatic activating mutations of HRAS or NRAS in each case without recurrent secondary mutation, and we further found that the same mutation is present in dysplastic bone. Our finding of somatic activating RAS mutation in bone, the endogenous source of FGF23, provides the first evidence that elevated serum FGF23 levels, hypophosphatemia and osteomalacia are associated with pathologic Ras activation and may provide insight in the heretofore limited understanding of the regulation of FGF23.
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