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Saba S, Al Sergani A, Vriz O, Kholaif N, Ramzan K, Jawad Shah S, Ahmad O, Albayyat R, Di Michele S, Pergola V, Di Giannuario G, Elmahi I, Ibrahim S, Galzerano D, Di Salvo G. Echocardiographic features and behavior of cardiac structural abnormalities in mucopolysaccharidosis. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Mucopolysaccharidosis (MPS) is a rare genetic lysosomal storage disorder with a wide variability of phenotype. A systematic descriptive study dealing with the echocardiographic (E) features of valvular involvement and their evolution over the time in adolescent and adult patients, whose number is growing up in adult echocardiographic laboratory, is lacking in the medical literature.
Purpose
To detect the E features of valvular involvement and their evolution in adolescent and adult patients.
Method
Study design: observational descriptive retrospective. Study group: 142 E studies in 17 adolescent and adult patients with diagnosis of MPS from 2001 until 2020. Mitral (M), aortic (A), tricuspid (T) valves (V) E features (thickness, mobility, calcification, and function), their evolution over the time and the behaviour with Enzyme replacement therapy (ERT) or bone marrow transplant (BMT) were assessed.
Result
52% male, mean age 21 yrs ranges 16 to 48 yrs. 5% of the patient had MPS type I, 11% MPS type II, 29% MPS type IV, and 52% MPS type VI. 70% received ERT and 11% BMT.
In the severe case all the valves were involved (panel A, B, C; white arrows point to valve leaflets; yellow arrows MV apparatus) the whole MV apparatus was involved since the earlier stage and in the latest stage the calcification was massive (panel C). The predominant valvular dysfunction was the regurgitation followed by mixed disorder while the most frequent severe lesion was the stenosis; the echocardiographic pattern differs from the classical hockey stick appearance of the early phase of rheumatic MV and the thickening is different from the myxomatous MV for the reduced mobility and the presence of calcification. The reduced mobility of the TV (panel C) also differs from the Loeffler syndrome because of the restriction of the leaflets and the association with thickening and calcification. Under treatment, the MV thickening was found to have a slow progression of less than 1 mm yearly in 61% cases.
Conclusion
Our results showed that all the valves are affected mainly the MV; the echocardiographic pattern of MPS, different from other valvular diseases of adolescent and adult age, can help in avoiding misdiagnose. Our observations also suggest that the cardiac involvement show slow rate of progression after the initiation of the therapy. Further studies are required to confirm our results.
Type of valve % of valve thickness % of reduced mobility % calcification diffuse % valve lesion Mitral valve 88% 65% 47% 75% Aortic valve 76% 23% 41% 57% Tricuspid valve 82% 47% 17% 52% Abstract Figure. Echocardiographic features
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Affiliation(s)
- S Saba
- King Faisal Specialist Hospital & Research Centre, Heart Centre, Riyadh, Saudi Arabia
| | - A Al Sergani
- King Saud University, College of Medicine, Riyadh, Saudi Arabia
| | - O Vriz
- King Faisal Specialist Hospital & Research Centre, Heart Centre, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - N Kholaif
- King Faisal Specialist Hospital & Research Centre, Heart Centre, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - K Ramzan
- King Faisal Specialist Hospital & Research Centre, Department of Genetics, and Research Centre, Riyadh, Saudi Arabia
| | - S Jawad Shah
- King Faisal Specialist Hospital & Research Centre, Oncology and General surgery, Riyadh, Saudi Arabia
| | - O Ahmad
- King Faisal Specialist Hospital & Research Centre, Heart Centre, Riyadh, Saudi Arabia
| | - R Albayyat
- King Faisal Specialist Hospital & Research Centre, Heart Centre, Riyadh, Saudi Arabia
| | - S Di Michele
- San Filippo Neri Hospital, Cardiology Division , Rome, Italy
| | - V Pergola
- University of Padua, Department of Cardio-Thoraco-Vascular Sciences and Public Health, Padua, Italy
| | - G Di Giannuario
- Infermi Hospital of Rimini, Cardiology Division, Rimini, Italy
| | - I Elmahi
- Alfaisal University, College of Medicine, Riyadh, Saudi Arabia
| | - S Ibrahim
- King Faisal Specialist Hospital & Research Centre, Heart Centre, Riyadh, Saudi Arabia
| | - D Galzerano
- King Faisal Specialist Hospital & Research Centre, Heart Centre, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - G Di Salvo
- University of Padua, Paediatric Cardiology and Congenital Heart Disease Department, padua, Italy
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Everson M, Herrera L, Li W, Luengo IM, Ahmad O, Banks M, Magee C, Alzoubaidi D, Hsu HM, Graham D, Vercauteren T, Lovat L, Ourselin S, Kashin S, Wang HP, Wang WL, Haidry RJ. Artificial intelligence for the real-time classification of intrapapillary capillary loop patterns in the endoscopic diagnosis of early oesophageal squamous cell carcinoma: A proof-of-concept study. United European Gastroenterol J 2019; 7:297-306. [PMID: 31080614 PMCID: PMC6498793 DOI: 10.1177/2050640618821800] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 11/26/2018] [Indexed: 12/11/2022] Open
Abstract
Background Intrapapillary capillary loops (IPCLs) represent an endoscopically visible feature of early squamous cell neoplasia (ESCN) which correlate with invasion depth - an important factor in the success of curative endoscopic therapy. IPCLs visualised on magnification endoscopy with Narrow Band Imaging (ME-NBI) can be used to train convolutional neural networks (CNNs) to detect the presence and classify staging of ESCN lesions. Methods A total of 7046 sequential high-definition ME-NBI images from 17 patients (10 ESCN, 7 normal) were used to train a CNN. IPCL patterns were classified by three expert endoscopists according to the Japanese Endoscopic Society classification. Normal IPCLs were defined as type A, abnormal as B1-3. Matched histology was obtained for all imaged areas. Results This CNN differentiates abnormal from normal IPCL patterns with 93.7% accuracy (86.2% to 98.3%) and sensitivity and specificity for classifying abnormal IPCL patterns of 89.3% (78.1% to 100%) and 98% (92% to 99.7%), respectively. Our CNN operates in real time with diagnostic prediction times between 26.17 ms and 37.48 ms. Conclusion Our novel and proof-of-concept application of computer-aided endoscopic diagnosis shows that a CNN can accurately classify IPCL patterns as normal or abnormal. This system could be used as an in vivo, real-time clinical decision support tool for endoscopists assessing and directing local therapy of ESCN.
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Affiliation(s)
- M Everson
- Division of Surgery and Interventional Science, University College London (UCL), UK
- Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK
| | - Lcgp Herrera
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), UCL, London, UK
| | - W Li
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), UCL, London, UK
| | - I Muntion Luengo
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), UCL, London, UK
| | - O Ahmad
- Division of Surgery and Interventional Science, University College London (UCL), UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), UCL, London, UK
| | - M Banks
- Division of Surgery and Interventional Science, University College London (UCL), UK
- Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK
| | - C Magee
- Division of Surgery and Interventional Science, University College London (UCL), UK
- Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK
| | - D Alzoubaidi
- Division of Surgery and Interventional Science, University College London (UCL), UK
- Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK
| | - H M Hsu
- Department of Internal Medicine, National Taiwan University, Taipei, Taiwan
| | - D Graham
- Division of Surgery and Interventional Science, University College London (UCL), UK
- Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK
| | - T Vercauteren
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), UCL, London, UK
| | - L Lovat
- Division of Surgery and Interventional Science, University College London (UCL), UK
- Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), UCL, London, UK
| | - S Ourselin
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), UCL, London, UK
| | - S Kashin
- Yaroslavl Regional Cancer Hospital, Yaroslavl, Russia
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-Lun Wang
- Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | - R J Haidry
- Division of Surgery and Interventional Science, University College London (UCL), UK
- Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK
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Carlson M, Chan T, Adam A, Ahmad O, Roy P, Rosano C, Rosso A, Krakauer J. PILOTING A VIRTUAL REALITY APPLICATION TO PROMOTE EXECUTIVE FUNCTION AND COMMUNITY MOBILITY IN AGING ADULTS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.3220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Carlson
- Johns Hopkins University, Baltimore, Maryland, United States
| | - T Chan
- Johns Hopkins University, Baltimore, Maryland, United States
| | - A Adam
- Johns Hopkins University, Baltimore, Maryland, United States
| | - O Ahmad
- Johns Hopkins University, Baltimore, Maryland, United States
| | - P Roy
- Johns Hopkins University, Baltimore, Maryland, United States
| | - C Rosano
- Johns Hopkins University, Baltimore, Maryland, United States
| | - A Rosso
- Johns Hopkins University, Baltimore, Maryland, United States
| | - J Krakauer
- Johns Hopkins University, Baltimore, Maryland, United States
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Ahmad O, Shafii A, Mannino D, Choate R, Baz M. Impact of Donor Lung Pathogenic Bacteria on Patient Outcomes in the Immediate Post-transplant Period. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Nusa D, Harvey I, Almansouri AY, Wright S, Neeman T, Ahmad O, Hughes AR, Lueck CJ. Assessment of point-of-care measurement of international normalised ratio using the CoaguChek XS Plus system in the setting of acute ischaemic stroke. Intern Med J 2014; 43:1205-9. [PMID: 23906088 DOI: 10.1111/imj.12255] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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: 06/24/2013] [Accepted: 07/24/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Thrombolysis with alteplase (recombinant tissue plasminogen activator) is accepted hyperacute therapy for acute ischaemic stroke. Clotting must be normal before this can be administered safely. Laboratory testing of international normalised ratio (INR) takes 30-60 min, which can significantly delay administration of recombinant tissue plasminogen activator. Previous studies have suggested that point-of-care testing is useful in patients presenting with stroke and improves door-to-needle time. We performed a prospective study of point-of-care testing in patients presenting with acute ischaemic stroke. METHODS Fifty patients were entered into the study to compare point-of-care testing using the CoaguChek XS system with laboratory testing of INR. RESULTS Point-of-care testing correlated well with laboratory levels (R = 0.93, P < 0.0001). The standard deviation of difference between the two was 0.115. Overall, point-of-care testing tended to underestimate INR slightly, meaning that an INR value of 1.1 or less was required to be 95% certain that the laboratory value was 1.3 or below. Simultaneous testing using blood from a syringe was more consistent with laboratory results than testing capillary blood through finger prick. CONCLUSION Point-of-care INR testing correlates well with laboratory values. The results in this study mostly relate to values in the normal range. We suggest that it can be used to try to shorten door-to-needle time.
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Affiliation(s)
- D Nusa
- Department of Neurology, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
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Rai V, Ahmad O, Chandok A. Painful Lumbosacral Plexopathy Resulting from Perineural Metastasis of Primary Squamous Cell Penile Carcinoma: A Case Report (P07.149). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p07.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Patel K, Moradiya Y, Murshed N, Ahmad O, Schuh L. July Effect: Myth or Reality? Comparing July Effect on Acute Ischemic Stroke Short-Term Outcomes and Resource Utilization (S17.001). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s17.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Ramamurthi K, Ahmad O, Engelke K, Taylor RH, Zhu K, Gustafsson S, Prince RL, Wilson KE. An in vivo comparison of hip structure analysis (HSA) with measurements obtained by QCT. Osteoporos Int 2012; 23:543-51. [PMID: 21394495 PMCID: PMC3261404 DOI: 10.1007/s00198-011-1578-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 01/31/2011] [Indexed: 01/10/2023]
Abstract
SUMMARY In a population of elderly women, bone cross-sectional area (CSA), cross-sectional moment of inertia (CSMI), section modulus (Z), femoral neck axis length (FNAL), and width measured with hip structure analysis (HSA) on dual-energy x-ray absorptiometry (DXA) images in the femoral neck and trochanteric regions are highly correlated to quantitative computed tomography (QCT) measurements. INTRODUCTION HSA is a method of obtaining measurements of proximal femur structure using 2D DXA technology. This study was designed to examine the correlations between HSA measurements and 3D QCT. METHODS Forty-one women (mean age, 82.8 ± 2.5 years) were measured using DXA and a 64-slice CT scanner (1 mm slice thickness, 0.29 mm in plane resolution). HSA parameters were calculated at the narrow neck (NN) and trochanteric (IT) regions on the DXA image. These regions were then translated to anatomically equivalent regions on the QCT dataset by co-registering the DXA image and QCT dataset using four DXA images acquired at different angles. RESULTS At the NN and IT regions, high linear correlations were measured between HSA and QCT for CSA r = 0.95 and 0.93, CSMI r = 0.94 and 0.93, and Z r = 0.93 and 0.89, respectively. All correlations were highly significant (p < 0.001), but there were differences in slope and offset between the two techniques, at least in part due to differences in calibration between the two techniques. FNAL and width of the bone at the NN and IT regions, physical measurements independent of the calibration, were highly correlated (r = 0.90-0.95, p < 0.001) and had slopes close to 1.0 (range, 0.978 to 1.003). CONCLUSION CSA, CSMI, Z, FNAL, and width measured by HSA correlate highly to high-resolution QCT.
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Affiliation(s)
| | - O. Ahmad
- Department of Computer Science, Engineering Research Center for Computer-Integrated Surgical Systems and Technology, The Johns Hopkins University, Baltimore, MD USA
| | - K. Engelke
- Institute of Medical Physics, University of Erlangen, Erlangen, Germany
| | - R. H. Taylor
- Department of Computer Science, Engineering Research Center for Computer-Integrated Surgical Systems and Technology, The Johns Hopkins University, Baltimore, MD USA
| | - K. Zhu
- Department of Endocrinology and Diabetes, The Univerisity of Western Australia School of Medicine and Pharmacology, Sir Charles Gairdner Hospital, Perth, Western Australia Australia
| | - S. Gustafsson
- Department of Endocrinology and Diabetes, The Univerisity of Western Australia School of Medicine and Pharmacology, Sir Charles Gairdner Hospital, Perth, Western Australia Australia
| | - R. L. Prince
- Department of Endocrinology and Diabetes, The Univerisity of Western Australia School of Medicine and Pharmacology, Sir Charles Gairdner Hospital, Perth, Western Australia Australia
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Abstract
BACKGROUND Atrial fibrillation (AF) is an important predisposing factor for ischaemic stroke. There is evidence to suggest that even in appropriate candidates warfarin therapy is underutilized. We assessed the prevalence of AF in an Australian stroke unit to determine the degree of undertreatment at presentation. METHODS A retrospective analysis of all patients admitted to our Stroke Unit between October 2004 and September 2006 was carried out. All patients with a diagnosis of AF, either new or old, were then selected from this group to determine the overall prevalence and anticoagulation status. Data regarding prior stroke, stroke severity and discharge anticoagulation status were also determined. RESULTS Data from a total of 500 patients were analysed. Our results showed that AF-related strokes accounted for a large proportion (28%) of all admissions and were associated with a larger neurological deficit. Most patients (68%) with a prior diagnosis of AF without having obvious contraindications were either not anticoagulated or under-anticoagulated when presenting with an ischaemic stroke or transient ischaemic attack. CONCLUSION Our results stress the importance of initiating and maintaining anticoagulation in patients with AF and without obvious contraindications to minimize the risk of subsequent stroke.
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Affiliation(s)
- O Ahmad
- Department of Neurology, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
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Murray CJL, Ferguson BD, Lopez AD, Guillot M, Salomon JA, Ahmad O. Modified logit life table system: principles, empirical validation, and application. Population Studies 2003. [DOI: 10.1080/0032472032000097083] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sallah S, Ahmad O, Kaiser HE. Pathogenesis of thrombotic disorders in patients with cancer. In Vivo 2000; 14:251-3. [PMID: 10757083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Cancer patients experience several complications during the course of their illness which increase their morbidity and mortality. Thromboembolic phenomena are frequent and important events encountered in these patients. Although the exact mechanisms of thrombosis in this population of patients are largely unknown, speculations regarding the pathogenesis of clotting are presented in this short review. Interactions between elements related to the underlying neoplastic disorder, adherence to the vessel wall by cancer cells, indirect injury of the endothelial tissue, cytokine released by the malignant clone and disturbances in the clotting cascade to mention a few, are thought to be responsible for hypercoaguability in patients with cancer. More experimental and clinical studies are needed to clarify the etiology and management of these serious complications and concomitant diseases. Thrombotic complications are considered the second most common cause of death in patients with underlying malignant disorders. It has been estimated that 15% of patients with cancer will suffer from thromboembolic phenomena during their life (1,2). However, prospective data that examine the exact incidence of these complications are currently unavailable. Few investigators have estimated that the prevalence of serious thrombosis may be up to 50% in post mortem analysis (3).
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Affiliation(s)
- S Sallah
- Department of Medicine, University of Tennessee, Memphis, USA
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Elsenhans B, Ahmad O, Rosenberg IH. Isolation and characterization of pteroylpolyglutamate hydrolase from rat intestinal mucosa. J Biol Chem 1984; 259:6364-8. [PMID: 6547136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Pteroylpolyglutamate hydrolase was isolated from rat intestinal mucosa and purified with the aid of affinity chromatography. The affinity ligand was poly-gamma-glutamic acid (Mr approximately 12,000) derived from Bacillus subtilis. The specific enzymatic activity was increased 2,000-fold over the 100,000 X g supernatant of the mucosal homogenate with a yield of 20%. Sephadex G-200 gel filtration yielded an estimated molecular mass of 80,000 daltons. The isoelectric point was pH 8.2. The pH optimum in acetate buffer containing 1 mM zinc was 4.5. The KM values for pteroylheptaglutamate and pteroyltriglutamate were 0.21 and 0.67 microM, respectively. Polyanionic compounds, poly-gamma-glutamic acid, dextran sulfate, and heparin were noncompetitive inhibitors. Studies of the time course of hydrolysis of synthetic [3H]pteroylheptaglutamate by three separate techniques demonstrated the appearance of [3H]pteroylmonoglutamate, synchronous with substrate cleavage. Intermediate pteroyloligoglutamates were not detected. An endopeptidase-like mode of hydrolysis was further established by identification of a hexaglutamyl peptide as the other reaction product.
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Selhub J, Ahmad O, Rosenberg IH. Preparation and use of affinity columns with bovine milk folate-binding protein (FBP) covalently linked to Sepharose 4B. Methods Enzymol 1980; 66:686-90. [PMID: 7374508 DOI: 10.1016/0076-6879(80)66528-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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