1
|
Schetzsle S, Lin WWC, Purushothaman P, Ding J, Kwan P, Tredget EE. Serial Casting as an Effective Method for Burn Scar Contracture Rehabilitation: A Case Series. J Burn Care Res 2023; 44:1062-1072. [PMID: 37254900 DOI: 10.1093/jbcr/irad078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Indexed: 06/01/2023]
Abstract
Guidelines and protocols for orthoses in burn scar contracture rehabilitation are limited. The current study aims to determine the optimal frequency of casting, potentially facilitating the development of a serial casting protocol. Previous literature supporting casting has low generalizability due to methodology limitations. Seven patients with burn scar contracted joints, who did not respond to traditional therapy, were recruited in this study. Patients were serially casted once, three times, or five times a week. Joint range of motion was maximized with stretching and exercise techniques before every new cast application. Across all patients, active range of motion increased from 65.8 ± 27.8° to 108.1 ± 23.3° with casting; or from 57.8 ± 16.2% to 96.7 ± 2.9% of normal. Similarly, scars improved from 9.5 ± 1.5 to 4.9 ± 1.4 on the Modified Vancouver Scar Scale score. This therapeutic effect was achieved within an average of 8.5 ± 3.7 d and 4.0 ± 2.2 new cast applications. Given the study findings, the procedures outlined could be used to develop a standardized serial casting protocol for burn scar contracture rehabilitation.
Collapse
Affiliation(s)
- Stephanie Schetzsle
- Department of Surgery, Firefighters Burn Treatment Unit, University of Alberta Hospital, Edmonton, AB, CanadaT6G 2B7
| | - Weber Wei Chiang Lin
- Wound Healing Research Group, Department of Surgery, University of Alberta, Division of Plastic and Reconstructive Surgery and Critical Care, Department of Surgery, University of Alberta, Edmonton, AB, CanadaT6G 2S2
| | - Prabhu Purushothaman
- Department of Surgery, Firefighters Burn Treatment Unit, University of Alberta Hospital, Edmonton, AB, CanadaT6G 2B7
| | - Jie Ding
- Wound Healing Research Group, Department of Surgery, University of Alberta, Division of Plastic and Reconstructive Surgery and Critical Care, Department of Surgery, University of Alberta, Edmonton, AB, CanadaT6G 2S2
| | - Peter Kwan
- Wound Healing Research Group, Department of Surgery, University of Alberta, Division of Plastic and Reconstructive Surgery and Critical Care, Department of Surgery, University of Alberta, Edmonton, AB, CanadaT6G 2S2
| | - Edward E Tredget
- Wound Healing Research Group, Department of Surgery, University of Alberta, Division of Plastic and Reconstructive Surgery and Critical Care, Department of Surgery, University of Alberta, Edmonton, AB, CanadaT6G 2S2
| |
Collapse
|
2
|
Ding J, Pan Y, Raj S, Schaffrick L, Wong J, Nguyen A, Manchikanti S, Unsworth L, Kwan P, Tredget E. Characteristics of Serum Exosomes after Burn Injury and Dermal Fibroblast Regulation by Exosomes In Vitro. Cells 2023; 12:1738. [PMID: 37443772 PMCID: PMC10341298 DOI: 10.3390/cells12131738] [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] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
(1) Background: Exosomes (EXOs) have been considered a new target thought to be involved in and treat wound healing. More research is needed to fully understand EXO characteristics and the mechanisms of EXO-mediated wound healing, especially wound healing after burn injury. (2) Methods: All EXOs were isolated from 85 serum samples of 29 burn patients and 13 healthy individuals. We characterized the EXOs for morphology and density, serum concentration, protein level, marker expression, size distribution, and cytokine content. After a confirmation of EXO uptake by dermal fibroblasts, we also explored the functional regulation of primary human normal skin and hypertrophic scar fibroblast cell lines by the EXOs in vitro, including cell proliferation and apoptosis. (3) Results: EXOs dynamically changed their morphology, density, size, and cytokine level during wound healing in burn patients, which were correlated with burn severity and the stages of wound healing. EXOs both from burn patients and healthy individuals stimulated dermal fibroblast proliferation and apoptosis. (4) Conclusions: EXO features may be important signals that influence wound healing after burn injury; however, to understand the mechanisms by which EXOs regulates the fibroblasts in healing wounds, further studies will be required.
Collapse
Affiliation(s)
- Jie Ding
- Wound Healing Research Group, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2S2, Canada; (Y.P.); (L.S.); (J.W.); (A.N.); (S.M.); (P.K.); (E.T.)
| | - Yingying Pan
- Wound Healing Research Group, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2S2, Canada; (Y.P.); (L.S.); (J.W.); (A.N.); (S.M.); (P.K.); (E.T.)
| | - Shammy Raj
- Department of Chemical and Materials Engineering, Faculty of Engineering, University of Alberta, Edmonton, AB T6G 2S2, Canada; (S.R.); (L.U.)
| | - Lindy Schaffrick
- Wound Healing Research Group, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2S2, Canada; (Y.P.); (L.S.); (J.W.); (A.N.); (S.M.); (P.K.); (E.T.)
| | - Jolene Wong
- Wound Healing Research Group, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2S2, Canada; (Y.P.); (L.S.); (J.W.); (A.N.); (S.M.); (P.K.); (E.T.)
| | - Antoinette Nguyen
- Wound Healing Research Group, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2S2, Canada; (Y.P.); (L.S.); (J.W.); (A.N.); (S.M.); (P.K.); (E.T.)
| | - Sharada Manchikanti
- Wound Healing Research Group, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2S2, Canada; (Y.P.); (L.S.); (J.W.); (A.N.); (S.M.); (P.K.); (E.T.)
| | - Larry Unsworth
- Department of Chemical and Materials Engineering, Faculty of Engineering, University of Alberta, Edmonton, AB T6G 2S2, Canada; (S.R.); (L.U.)
| | - Peter Kwan
- Wound Healing Research Group, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2S2, Canada; (Y.P.); (L.S.); (J.W.); (A.N.); (S.M.); (P.K.); (E.T.)
| | - Edward Tredget
- Wound Healing Research Group, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2S2, Canada; (Y.P.); (L.S.); (J.W.); (A.N.); (S.M.); (P.K.); (E.T.)
| |
Collapse
|
3
|
Schaffrick L, Ding J, Kwan P, Tredget E. The dynamic changes of monocytes and cytokines during wound healing post-burn injury. Cytokine 2023; 168:156231. [PMID: 37247448 DOI: 10.1016/j.cyto.2023.156231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/01/2023] [Accepted: 05/08/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Burn injury is a sudden and traumatic injury that affects a large part of the population worldwide, who are placed at high risk of developing hypertrophic scars (HTS). HTS are a fibrotic scar resulting in painful contracted and raised scarring, affecting mobility in joints and work life, as well as cosmetically. The aim of this research was to enhance our understanding of the systematic response of monocytes and cytokines in wound healing after burn injury, in order to develop novel approaches to prevention and treatment of HTS. METHODS Twenty-seven burn patients and thirteen healthy individuals were recruited in this study. Burn patients were stratified by burn total body surface area (TBSA). Peripheral blood samples were taken post-burn injury. Serum and peripheral blood mononuclear cells (PBMCs) were separated from the blood samples. This research investigated cytokines IL-6, IL-8, IL1RA, IL-10, and chemokine pathways SDF-1/CXCR4, MCP-1/CCR2, RANTES/CCR5 during the wound healing process in burn patients with varying severity of injuries by using enzyme-linked immunosorbent assays. PBMCs were stained for monocytes and the chemokine receptors by flow cytometry. Statistical analysis was done by one-way ANOVA with a Tukey correction, and regression analysis was performed using Pearson's Correlation analysis. RESULTS The CD14+CD16- monocyte subpopulation is larger in patients who developed HTS at 4-7 days. The CD14+CD16+ monocyte subpopulation is smaller in the first week of injury, where it is similar after 8 days. Burn injury increased CXCR4, CCR2, and CCR5 expressions in CD14+ CD16+ monocytes. Increases in MCP-1 at 0-3 days after burn injury was positively correlated with burn severity. IL-6, IL-8, RANTES, and MCP-1 significantly increased with increasing burn severity. CONCLUSIONS Monocytes and their chemokine receptors, as well as systemic levels of cytokines in wound healing of burn patients and scar development will require ongoing assessment to enhance our understanding of the abnormal wound healing after burn injury.
Collapse
Affiliation(s)
- Lindy Schaffrick
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
| | - Jie Ding
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
| | - Peter Kwan
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada; Division of Critical Care, University of Alberta, Edmonton, Alberta, Canada
| | - Edward Tredget
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada; Division of Critical Care, University of Alberta, Edmonton, Alberta, Canada.
| |
Collapse
|
4
|
Nhu D, Janmohamed M, Shakhatreh L, Gonen O, Perucca P, Gilligan A, Kwan P, O'Brien TJ, Tan CW, Kuhlmann L. Automated Interictal Epileptiform Discharge Detection from Scalp EEG Using Scalable Time-series Classification Approaches. Int J Neural Syst 2023; 33:2350001. [PMID: 36599664 DOI: 10.1142/s0129065723500016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Deep learning for automated interictal epileptiform discharge (IED) detection has been topical with many published papers in recent years. All existing works viewed EEG signals as time-series and developed specific models for IED classification; however, general time-series classification (TSC) methods were not considered. Moreover, none of these methods were evaluated on any public datasets, making direct comparisons challenging. This paper explored two state-of-the-art convolutional-based TSC algorithms, InceptionTime and Minirocket, on IED detection. We fine-tuned and cross-evaluated them on a public (Temple University Events - TUEV) and two private datasets and provided ready metrics for benchmarking future work. We observed that the optimal parameters correlated with the clinical duration of an IED and achieved the best area under precision-recall curve (AUPRC) of 0.98 and F1 of 0.80 on the private datasets, respectively. The AUPRC and F1 on the TUEV dataset were 0.99 and 0.97, respectively. While algorithms trained on the private sets maintained their performance when tested on the TUEV data, those trained on TUEV could not generalize well to the private data. These results emerge from differences in the class distributions across datasets and indicate a need for public datasets with a better diversity of IED waveforms, background activities and artifacts to facilitate standardization and benchmarking of algorithms.
Collapse
Affiliation(s)
- D Nhu
- Department of Data Science and Artificial Intelligence, Faculty of Information Technology, Monash University, Melbourne, VIC, Australia
| | - M Janmohamed
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - L Shakhatreh
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - O Gonen
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - P Perucca
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Melbourne, VIC, Australia.,Epilepsy Research Center, Department of Medicine (Austin Health), The University of Melbourne, Melbourne, VIC, Australia
| | - A Gilligan
- Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Melbourne, VIC, Australia.,Neurosciences Clinical Institute, Epworth Healthcare, Melbourne, VIC, Australia
| | - P Kwan
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - T J O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - C W Tan
- Department of Data Science and Artificial Intelligence, Faculty of Information Technology, Monash University, Melbourne, VIC, Australia
| | - L Kuhlmann
- Department of Data Science and Artificial Intelligence, Faculty of Information Technology, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
5
|
Abstract
Significance: Hypertrophic scars (HTS) are a fibroproliferative disorder that occur following deep dermal injury and affect up to 72% of burn patients. These scars result in discomfort, impaired mobility, disruption of normal function and cosmesis, and significant psychological distress. Currently, there are no satisfactory methods to treat or prevent HTS, as the cellular and molecular mechanisms are complex and incompletely understood. This review summarizes the biology of proteins in the dermal extracellular matrix (ECM), which are involved in wound healing and hypertrophic scarring. Recent Advances: New basic research continues toward understanding the diversity of cellular and molecular mechanisms of normal wound healing and hypertrophic scarring. Broadening the understanding of these mechanisms creates insight into novel methods for preventing and treating HTS. Critical Issues: Although there is an abundance of research conducted on collagen in the ECM and its relationship to HTS, there is a significant gap in understanding the role of proteoglycans and their specific isoforms in dermal fibrosis. Future Directions: Exploring the biological roles of ECM proteins and their unique isoforms in HTS, mature scars, and normal skin will further the understanding of abnormal wound healing and create a more robust understanding of what constitutes dermal fibrosis. Research into the biological roles of ECM protein isoforms and their regulation during wound healing warrants a more extensive investigation to identify their distinct biological functions in cellular processes and outcomes.
Collapse
Affiliation(s)
- Elizabeth Eremenko
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, University of Alberta, Edmonton, Canada
| | - Jie Ding
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, University of Alberta, Edmonton, Canada
| | - Peter Kwan
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, University of Alberta, Edmonton, Canada
- Division of Plastic Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | - Edward E. Tredget
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, University of Alberta, Edmonton, Canada
- Division of Plastic Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
| |
Collapse
|
6
|
Schaffrick L, Ding J, Kwan P, Tredget EE. Molecular Features of Hypertrophic Scars After Thermal Injury: Is There a Biologic Basis for Laser Therapy? Adv Wound Care (New Rochelle) 2022; 11:163-178. [PMID: 34663086 DOI: 10.1089/wound.2021.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Significance: Hypertrophic scars (HTS) and keloids are common after thermal injuries and other trauma to deep regions of dermis of the skin. These abnormal scars can cause contractures and the thick masses of scar tissue that result in functional and cosmetic impairment. Management of these dermal fibrotic conditions includes a wide range of medical and surgical treatments, which can be time consuming, only partially effective, and often uncomfortable for patients. Recent Advances: The molecular pathophysiology of HTS has become more understood over the past two decades, where thermal injury to the reticular dermis results in an inflammatory response, fibrogenic growth factor release, and the formation of a dermal scar with increased collagen and proteoglycan composition in an abnormal morphology. Lasers are becoming a widely used form of treatment for these types of scars; however, the evidence for the beneficial effects of laser treatments and the understanding of their mechanism of action are still evolving. Critical Issues: Paradoxically, laser delivery of thermal energy to the skin is suggested to improve scar remodeling and wound healing, yet HTS is a well-recognized complication of excessive thermal energy delivered by laser treatments. This review aims to examine the current evidence for the use of lasers for HTS, and to investigate the molecular mechanisms where re-injury of a burn scar from laser treatment could result in overall improvements in scar quality. Future Directions: Improved design of clinical trials for the treatment of scarring in the future will evolve from new methodology and models of HTS in animals and humans.
Collapse
Affiliation(s)
- Lindy Schaffrick
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | - Jie Ding
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | - Peter Kwan
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | - Edward E. Tredget
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
- Department of Surgery, Division of Critical Care, University of Alberta, Edmonton, Canada
| |
Collapse
|
7
|
Aljabri RS, Kwan P. A114 QUALITY AND EFFICACY OF PERCUTANEOUS ENDOSCOPIC GASTROSTOMY: A RETROSPECTIVE CHART REVIEW STUDY. J Can Assoc Gastroenterol 2022. [DOI: 10.1093/jcag/gwab049.113] [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: 11/12/2022] Open
Abstract
Abstract
Background
Passage of food along the digestive tract can be compromised by a number of conditions. Nasogastric tube (NGT) feeding is used in these cases but prolonged use can lead to various complications. Percutaneous endoscopy gastrostomy (PEG) has been reported as an effective and safe alternative to NGT. Clinical efficacy and adverse events related to PEG insertion are largely dependent on post-procedure care.
Aims
To assess the clinical significance of PEG tube insertion procedure and impact of post-procedure care and diet protocol on associated adverse events and success rate at two Canadian tertiary care units.
Methods
The retrospective electronic chart review was conducted on all patients who underwent endoscopic PEG fixation or replacement procedure at University of British Columbia Gastroenterology clinic and Vancouver General hospital Endoscopy Unit from 1st April 2020 to 31st March 2021. Data related to patient demographics, indications for insertion, insertion technique, quality of PEG insertion protocol, antibiotic prophylaxis, success rate, and rate of PEG-related complications were collected and analysed. An evaluation protocol was devised to evaluate the impact of indication-based diet protocols on frequency of adverse events and success rate. Results are suggested to be analysed using SPSS v 2021 with significance threshold of P-value < 0.05.
Results
43 PEG insertion procedures were performed, of which 3 failed due to structural reasonsincluding post gastric sleeve surgery, small stomach and difficulty in finding transillumination point. 25 cases underwent PEG insertion endoscopically for the first time, and 14 required exchanges, of which 2 underwent non-endoscopic exchange. Of 37 patients who underwent endoscopic PEG insertion 18(48.64%) were males and 19(51.36%) were females. Acute infection was reported in 6(14%) and chronic infection in 4 patients (9.3%). Tube dislodgment was reported in 10(23%), peristomal leak in 4(9.3%), miinor bleeding in 3(6.9%), and post-operative granulation in 4(9%) procedures. The evaluation protocol divides patients into two groups: Group a included d subjects who would receive low-volume (≤150 mL/d) and Group b who would receive a high-volume (≥300 mL/d) of feeding formula.
Conclusions
PEG tube insertion is a very successful procedure with high clinical significance and low complications rate at VGH and UBC. A follow-up plan is therefore being initiated to evaluate impact of feeding volumes on rate of success and adverse events. Combined, the previous studies, suggest that the high-feeding volumes can be safely administered to rapidly attain calorie targets to increase the procedure efficacy. .
Funding Agencies
CAG
Collapse
Affiliation(s)
- R S Aljabri
- Gastroenterology, The University of British Columbia, Vancouver, BC, Canada
| | - P Kwan
- Gastroenterology, The University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
8
|
Chahal D, Lee JGH, Yoshida EM, Lowe C, Ho F, Sum V, Kwan P. Seroprevalence of hepatitis B in previously undiagnosed patients: A community screening study. CanLivJ 2022; 5:144-151. [DOI: 10.3138/canlivj-2021-0008] [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] [Received: 03/05/2022] [Accepted: 10/28/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND: 40% of hepatitis B carriers have no knowledge of their diagnosis. A prior study in British Columbia suggested high rates of hepatitis B among immigrants. The authors undertook a large-scale screening study to validate these rates. METHODS: Attendees at Asian health fairs without knowledge of their hepatitis B status participated. They completed a questionnaire, and blood was drawn for HBV serologies. Active HBV was defined as HBV surface antigen positive. RESULTS: Of 2,726 patients, 1,704 (62.5%) were female and 1,022 (37.5%) male. Mean age was 62.7 ± 22.1 years, and mean time of residing in Canada was 27.5 ± 15.3 years. Most patients originated from China (1,042 patients, 38.2%) and Hong Kong (871, 31.2%). 56 patients tested positive (seroprevalence rate 2.05%, 95% CI 1.52%–2.59%). Most seropositive patients were from China (28 patients, 50.0%). Mean time of residence in Canada for seropositive patients (23.8 ± 2.1 years) was less than seronegative patients (27.6 ± 0.3 years) ( p = 0.06). There was a trend towards association of seropositivity with time of residence in Canada (OR 0.98, 95% CI 0.96–1.00, p = 0.09). 8 (14.3%) seropositive patients did not have family doctors, compared with 128 (4.8%) seronegative patients. Lack of a family doctor was strongly associated with seropositivity (OR 3.31, 95% CI 1.32–7.25, χ2 = 10.42, p = 0.001). INTERPRETATION: The authors have shown that high risk immigrant populations may have seroprevalence rates as high as 2,700 per 100,000. Lack of a family physician was associated with seropositivity. These results should be used to design improved outreach programs.
Collapse
Affiliation(s)
- Daljeet Chahal
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joseph GH Lee
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric M Yoshida
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chris Lowe
- Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Vivian Sum
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Kwan
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
9
|
Lu L, Raj S, Arizmendi N, Ding J, Eitzen G, Kwan P, Kulka M, Unsworth LD. Identification of short peptide sequences that activate human mast cells via Mas-related G-protein coupled receptor member X2. Acta Biomater 2021; 136:159-169. [PMID: 34530142 DOI: 10.1016/j.actbio.2021.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/24/2021] [Accepted: 09/07/2021] [Indexed: 11/19/2022]
Abstract
Peptide based therapeutics are desirable owing to their high biological specificity. However, a number of these fail in clinical testing due to an adverse inflammatory response. Mast cells play a key role in directing the host response to drugs and related products. Although the role of FcεRI receptor is well known, Mas-related G-protein coupled receptor X2 (MRGPRX2) binding of endogenous peptides, and drugs will activate mast cells independent of FcεRI. Identifying peptides that activate mast cells through MRGPRX2, and their respective activation potency, can be used to reduce the failure rate of peptide therapeutics at clinical trial. Moreover, it will allow for peptide design where mast cell activation is actually desired. It was found that FRKKW and WNKWAL are two motifs that activate human LAD2 cells similar to PAMP-12 controls. Peptide activators of MRGPRX2 could be reduced to Xa-(Y)(n ≥ 3)-Xb where: Xa is an aromatic residue; Xb is a hydrophobic residue; and Y is a minimum 3 residue long sequence, containing a minimum of one positively charged residue with the remainder being uncharged residues. Artificial peptides WKKKW and FKKKF were constructed to test this structural functionality and were similar to PAMP-12 controls. Peptides with different activation potentials were found where FRKKW = WKKKW = FKKKF > PAMP-12 = WNKWAL > YKKKY > FRKKANKWALSR = FRKKWNKAALSR > KWKWK > FRKK = WNKWA > KYKYK > NKWALSR = YKKY = WNK. These sequences should be considered when designing peptide-based therapeutics. STATEMENT OF SIGNIFICANCE: Mast cells release immune regulating molecules upon activation that direct host's immune response. MRGPRX2 receptor provides an alternate pathway for mast cell activation that is independent of FcεRI receptor. It is thought that mast cell activation through MRGPRX2 plays a critical role in high failure rates of drugs in clinical trials. Identifying peptide sequences that activate mast cells through MRGPRX2 can serve two important purposes, namely, sequences to avoid when designing peptide therapeutics, and artificial peptides with different activation potentials for mast cells. Herein, we have identified a general amino acid sequence that induces mast cell activation through MRGPRX2. Furthermore, by modulating the identified sequence, artificial peptides have been designed which activate mast cells by varying degrees for therapeutic applications.
Collapse
Affiliation(s)
- Lei Lu
- Department of Chemical and Materials Engineering, Donadeo Innovation Center for Engineering, University of Alberta, 9211-116 Street NW, Edmonton, AB T6G1H9, Canada; School of Life Science and Engineering, Southwest Jiaotong University, Chengdu, Sichuan 610031, China
| | - Shammy Raj
- Department of Chemical and Materials Engineering, Donadeo Innovation Center for Engineering, University of Alberta, 9211-116 Street NW, Edmonton, AB T6G1H9, Canada
| | - Narcy Arizmendi
- Nanotechnology Research Council (Canada), 11421 Saskatchewan Drive NW, Edmonton, AB T6G2M9, Canada
| | - Jie Ding
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, University of Alberta, 2D2.28 WMC, 8440-112 Street, Edmonton, AB T6G2B7, Canada
| | - Gary Eitzen
- Department of Cell Biology, MSB 5-14, University of Alberta, Edmonton, AB T6G2H7, Canada
| | - Peter Kwan
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, University of Alberta, 2D2.28 WMC, 8440-112 Street, Edmonton, AB T6G2B7, Canada
| | - Marianna Kulka
- Nanotechnology Research Council (Canada), 11421 Saskatchewan Drive NW, Edmonton, AB T6G2M9, Canada; Department of Medical Microbiology and Immunology, University of Alberta, 6-020 Katz Group Center, Edmonton, AB T6G2E1, Canada.
| | - Larry D Unsworth
- Department of Chemical and Materials Engineering, Donadeo Innovation Center for Engineering, University of Alberta, 9211-116 Street NW, Edmonton, AB T6G1H9, Canada.
| |
Collapse
|
10
|
Ding J, Mellergaard M, Zhu Z, Kwan P, Edge D, Ma Z, Hebert L, Alrobaiea S, Iwasaki T, Nielsen MCE, Tredget EE. Fluorescent light energy modulates healing in skin grafted mouse model. Open Med (Wars) 2021; 16:1240-1255. [PMID: 34522783 PMCID: PMC8402934 DOI: 10.1515/med-2021-0329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/26/2021] [Revised: 06/11/2021] [Accepted: 07/07/2021] [Indexed: 12/25/2022] Open
Abstract
Skin grafting is often the only treatment for skin trauma when large areas of tissue are affected. This surgical intervention damages the deeper dermal layers of the skin with implications for wound healing and a risk of scar development. Photobiomodulation (PBM) therapy modulates biological processes in different tissues, with a positive effect on many cell types and pathways essential for wound healing. This study investigated the effect of fluorescent light energy (FLE) therapy, a novel type of PBM, on healing after skin grafting in a dermal fibrotic mouse model. Split-thickness human skin grafts were transplanted onto full-thickness excisional wounds on nude mice. Treated wounds were monitored, and excised xenografts were examined to assess healing and pathophysiological processes essential for developing chronic wounds or scarring. Results demonstrated that FLE treatment initially accelerated re-epithelialization and rete ridge formation, while later reduced neovascularization, collagen deposition, myofibroblast and mast cell accumulation, and connective tissue growth factor expression. While there was no visible difference in gross morphology, we found that FLE treatment promoted a balanced collagen remodeling. Collectively, these findings suggest that FLE has a conceivable effect at balancing healing after skin grafting, which reduces the risk of infections, chronic wound development, and fibrotic scarring.
Collapse
Affiliation(s)
- Jie Ding
- Wound Healing Research Group, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 161 HMRC, Edmonton, Canada
| | - Maiken Mellergaard
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
- Department of Research and Development, Klox Technologies Europe Ltd, Dublin, Ireland
| | - Zhensen Zhu
- Wound Healing Research Group, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 161 HMRC, Edmonton, Canada
| | - Peter Kwan
- Wound Healing Research Group, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 161 HMRC, Edmonton, Canada
| | - Deirdre Edge
- Department of Research and Development, Klox Technologies Europe Ltd, Dublin, Ireland
| | - Zengshuan Ma
- Wound Healing Research Group, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 161 HMRC, Edmonton, Canada
| | - Lise Hebert
- Department of Research and Development, Klox Technologies Inc., Laval, Canada
| | - Saad Alrobaiea
- Wound Healing Research Group, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 161 HMRC, Edmonton, Canada
| | - Takashi Iwasaki
- Wound Healing Research Group, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 161 HMRC, Edmonton, Canada
| | - Michael Canova Engelbrecht Nielsen
- Department of Research and Development, Klox R&D Center, Guangdong Klox Biomedical Group Co., Ltd, Room 603, 6/F, Building 8, No. 6, Nanjiang Second Road, Zhujiang Street, Nansha District, Guangzhou, China
| | - Edward E. Tredget
- Divisions of Plastic and Reconstructive Surgery and Critical Care, 2D2.28 Walter C MacKenzie Health Sciences Centre & Wound Healing Research Group, 161 HMRC, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
11
|
Robertson E, Kwan P, Louie G, Boulanger P, Aalto D. Test-retest validation of a cranial deformity index in unilateral coronal craniosynostosis. Comput Methods Biomech Biomed Engin 2020; 23:1247-1259. [PMID: 32691624 DOI: 10.1080/10255842.2020.1795143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Unilateral coronal craniosynostosis (UCS) affects many infants resulting in abnormalities affecting the forehead and orbits. As a result, the deformity caused by UCS is very noticeable and there are several surgical treatment options available to normalize the head shape. However, there is a lack of consistently used outcome measures, resulting in difficulty assessing surgical outcomes and on-going debate over optimal treatments. Current techniques to quantify deformity in UCS are cumbersome, provide limited information, or are based on subjective assessments. In this study, a cranial deformity index was developed to quantify abnormality at the frontal bones for UCS that is accessible, user-friendly, and generates objective surface distance measurements. The cranial deformity index is defined as the Euclidean distance at the point of the largest deviation between the deformed skull compared to a reference skull. In addition, the index was successfully used to quantify post-operative changes in a single case of UCS that underwent corrective surgery. The reproducibility of the index was assessed using test-retest reliability and was demonstrated to be highly reproducible (ICC = 0.93). A user-friendly measurement index that is based on open-source software may be a valuable tool for surgical teams. In addition, this information can augment the consultation experience for patients and their families.
Collapse
Affiliation(s)
- Emilie Robertson
- Division of Plastic and Reconstructive Surgery, University of Alberta, Edmonton, Canada.,Faculty of Rehabilitation Medicine, Department of Communication Sciences and Disorders, University of Alberta, Edmonton, Canada.,Institute for Reconstructive Sciences in Medicine, Misericordia Community Hospital, Edmonton, Canada
| | - Peter Kwan
- Division of Plastic and Reconstructive Surgery, University of Alberta, Edmonton, Canada
| | - Gorman Louie
- Division of Plastic and Reconstructive Surgery, University of Alberta, Edmonton, Canada
| | - Pierre Boulanger
- Department of Computing Sciences, University of Alberta, Edmonton, Canada
| | - Daniel Aalto
- Faculty of Rehabilitation Medicine, Department of Communication Sciences and Disorders, University of Alberta, Edmonton, Canada.,Institute for Reconstructive Sciences in Medicine, Misericordia Community Hospital, Edmonton, Canada
| |
Collapse
|
12
|
Robertson E, Kwan P, Louie G, Boulanger P, Aalto D. Skeletal Deformity in Patients With Unilateral Coronal Craniosynostosis: Perceptions of the General Public. Craniomaxillofac Trauma Reconstr 2020; 13:122-129. [PMID: 32642043 DOI: 10.1177/1943387520911873] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Study Design A two-alternative forced choice design was used to gather perceptual data regarding unicoronal synostosis (UCS). Objective Cranial vault remodeling aims at improving the aesthetic appearance of infants with UCS by reshaping the forehead and reducing the potential for psychosocial discrimination. People's perception of craniofacial deformity plays a role in the stigma of deformity. The purpose of this study is to examine the relationship between objective skull deformity in UCS patients and laypersons' perception of skull normality. Methods Forty layperson skull raters were recruited from the general public. Skull raters were asked to categorize 45 infant skull images as normal or abnormal. Twenty-one of the images were UCS skulls, and 24 were normal skulls. Skulls were displayed briefly on a computer to simulate a first impression scenario and generate a perceptual response. A χ 2 analysis and mixed-effects regression model were used to analyze the response data. Results Members of the general public were good at distinguishing between skull groups, χ 2 (1) = 281.97, P < .001. In addition, skull raters' responses were predicted by the severity of deformity in the UCS skulls (b = -0.10, z = -2.6, P = .010, CI: -0.18, -0.02). A skull with a deformity value of 2.8 mm (CI: 1.8, 4.1) was equally likely to be rated normal or abnormal. Conclusions This is the first study to investigate the relationship between objective skull deformity in UCS and public perception. Laypersons were good at distinguishing the difference between normal and UCS skulls, and their perceptions of normality were predicted by the degree of skull deformity.
Collapse
Affiliation(s)
- Emilie Robertson
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Alberta, Edmonton, Canada.,Department of Communication Sciences and Disorders, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada.,Institute for Reconstructive Sciences in Medicine, Misericordia Community Hospital, Edmonton, Alberta, Canada
| | - Peter Kwan
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Alberta, Edmonton, Canada
| | - Gorman Louie
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Alberta, Edmonton, Canada
| | - Pierre Boulanger
- Department of Computing Sciences, University of Alberta, Edmonton, Canada
| | - Daniel Aalto
- Department of Communication Sciences and Disorders, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada.,Institute for Reconstructive Sciences in Medicine, Misericordia Community Hospital, Edmonton, Alberta, Canada
| |
Collapse
|
13
|
Lee JG, Yoshida EM, Ho F, Lowe C, Sum V, Kwan P. A190 SEROPREVALENCE OF HEPATITIS B VIRUS IN ASIAN CANADIANS WHO ARE UNAWARE OF THEIR HBV STATUS IN GREATER VANACOUVER. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.189] [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: 11/13/2022] Open
Affiliation(s)
- J G Lee
- University of British Columbia, Vancouver, BC, Canada
| | - E M Yoshida
- Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - F Ho
- University of British Columbia, Vancouver, BC, Canada
| | - C Lowe
- University of British Columbia, Vancouver, BC, Canada
| | - V Sum
- Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - P Kwan
- Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
14
|
Wang F, Chen Z, Davagnanam I, Hoskote C, Ding D, Wang W, Yang B, Wang Y, Wang T, Li W, Sander JW, Kwan P. Comparing two classification schemes for seizures and epilepsy in rural China. Eur J Neurol 2018; 26:422-427. [PMID: 30414301 DOI: 10.1111/ene.13857] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 06/08/2018] [Accepted: 11/05/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE The International League against Epilepsy (ILAE) updated the classifications of seizures and epilepsies in 2017. The 2017 classifications were compared with the 1980s classifications in rural China. METHODS People with epilepsy receiving treatment under the National Epilepsy Control Programme were recruited from rural areas in China. Their seizures and epileptic syndrome were classified using the 1980s ILAE classification system and then re-classified according to the 2017 system. Differences in seizure, epilepsy and aetiology classifications were identified. RESULTS A total of 597 individuals (58% males, aged 6-78 years) were included. Amongst them 535 (90%) had a single seizure type, 57 (9.55%) had two types and five (0.84%) had three. There was complete agreement between the 1981 and 2017 classifications for the 525 individuals with focal seizures. Seizures originally classified as generalized in 10 of 65 individuals were re-classified as unknown in the 2017 classification. Compared to the 1980s classifications, the proportion of individuals with unknown seizures and unknown epilepsy increased from 1.2% (7/597) to 2.8% (17/597, P = 0.002), and unknown aetiology increased from 32% (189/597: 182 cryptogenic and seven unclassified) to 39% (230/597; P < 0.001) in the 2017 classifications. CONCLUSIONS The 1980s and 2017 classifications had 100% agreement in classifying focal seizures and epilepsy in rural China. A small but significant proportion of generalized seizures and epilepsy and aetiologies classified in the old classifications were re-classified to unknown in the new classifications. These results highlight the need for improvement in clinical evaluation of people with epilepsy in resource-poor settings.
Collapse
Affiliation(s)
- F Wang
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China.,Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Z Chen
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - I Davagnanam
- Academic Department of Neuroradiology, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK
| | - C Hoskote
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - D Ding
- Fudan University, Shanghai, China
| | - W Wang
- Beijing Neurosurgical Institute, Beijing, China
| | - B Yang
- Jiaozuo People's Hospital, Henan, China
| | - Y Wang
- Ningxia Medical University, Ningxia, China
| | - T Wang
- Jincheng Emergency Medical Rescue Center, Jincheng, China
| | - W Li
- Affiliated Second Hospital, Hebei Medical University, Hebei, China
| | - J W Sander
- NIHR University College London Hospitals, Biomedical Research Centre, UCL Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, Chalfont St Peter, UK.,Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - P Kwan
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, China.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| |
Collapse
|
15
|
Abstract
Engineering biomaterials to manipulate the immune response to elicit specific therapeutic outcomes is a burgeoning field of research. Mast cells play a distinct and central role in the innate immune response, and are characterized by their rapid release of a myriad of proinflammatory mediators in response to stimulation. These mediators are central to protective actions such as wound healing, angiogenesis, and host defense against pathogens and animal venoms. Considering that mast cells are widely distributed in tissues that interface with the external environment, and are loaded with large amounts of preformed protective compounds, they are ideal targets for novel immunotherapies. Here we report that, by using an engineered nanoscaffold, human mast cells can be contact activated in cell and primary human skin tissue culture using a specific receptor-ligand mechanism. The IgE independent PAMP-12 peptide activates human mast cells through the recently identified Mas-related G-protein coupled receptor member X2 (MRGPRX2) receptor. The PAMP-12 motif was conjugated, via a glycine spacer, with the self-assembling peptide (RADA)4 and mixed with unmodified (RADA)4 to form a nanofiber matrix; mast cell activation was influenced directly by this ratio. Moreover, conjugating the PAMP-12 motif within the matrix was shown to only activate local, tissue-resident mast cells. The result of ex vivo human skin tissue tests confirmed that the engineered nanoscaffold successfully activated skin-resident mast cells by contact. Thus, this nanoscaffold design may provide a new platform to modulate localized mast cell functions thereby facilitating their protective role in the skin.
Collapse
Affiliation(s)
- Lei Lu
- Department of Chemical and Materials Engineering, University of Alberta , 9211-116 Street NW, Edmonton, Alberta T6G 1H9, Canada
- National Institute for Nanotechnology , 11421 Saskatchewan Drive NW, Edmonton, Alberta T6G 2M9, Canada
| | - Manoj B Parmar
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta , Edmonton, Alberta T6G 1E2, Canada
| | - Marianna Kulka
- National Institute for Nanotechnology , 11421 Saskatchewan Drive NW, Edmonton, Alberta T6G 2M9, Canada
- Department of Medical Microbiology and Immunology, University of Alberta , Edmonton, Alberta T6G 2E1, Canada
| | - Peter Kwan
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, University of Alberta , 2D2.28 WMC, 8440-112 Street, Edmonton, Alberta T6G 2B7, Canada
| | - Larry D Unsworth
- Department of Chemical and Materials Engineering, University of Alberta , 9211-116 Street NW, Edmonton, Alberta T6G 1H9, Canada
- National Institute for Nanotechnology , 11421 Saskatchewan Drive NW, Edmonton, Alberta T6G 2M9, Canada
| |
Collapse
|
16
|
Loo J, Kwok HC, Leung CCH, Wu SY, Law ILG, Cheung YK, Cheung YY, Chin ML, Kwan P, Hui M, Kong SK, Ho HP. Sample-to-answer on molecular diagnosis of bacterial infection using integrated lab--on--a--disc. Biosens Bioelectron 2017; 93:212-219. [PMID: 27660018 DOI: 10.1016/j.bios.2016.09.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/27/2016] [Accepted: 09/01/2016] [Indexed: 12/25/2022]
Abstract
Sepsis by bacterial infection causes high mortality in patients in intensive care unit (ICU). Rapid identification of bacterial infection is essential to ensure early appropriate administration of antibiotics to save lives of patients, yet the present benchtop molecular diagnosis is time-consuming and labor-intensive, which limits the treatment efficiency especially when the number of samples to be tested is extensive. Therefore, we hereby report a microfluidic platform lab-on-a-disc (LOAD) to provide a sample-to-answer solution. Our LOAD customized design of microfluidic channels allows automation to mimic sequential analytical steps in benchtop environment. It relies on a simple but controllable centrifugation force for the actuation of samples and reagents. Our LOAD system performs three major functions, namely DNA extraction, isothermal DNA amplification and real-time signal detection, in a predefined sequence. The disc is self-contained for conducting sample heating with chemical lysis buffer and silica microbeads are employed for DNA extraction from clinical specimens. Molecular diagnosis of specific target bacteria DNA sequences is then performed using a real-time loop-mediated isothermal amplification (RT-LAMP) with SYTO-9 as the signal reporter. Our LOAD system capable of bacterial identification of Mycobacterium tuberculosis (TB) and Acinetobacter baumanii (Ab) with the detection limits 103cfu/mL TB in sputum and 102cfu/mL Ab in blood within 2h after sample loading. The reported LOAD based on an integrated approach should address the growing needs for rapid point-of-care medical diagnosis in ICU.
Collapse
Affiliation(s)
- J Loo
- Biochemistry Programme, School of Life Sciences, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong; Department of Electronic Engineering, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - H C Kwok
- Department of Electronic Engineering, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - C C H Leung
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - S Y Wu
- Department of Electronic Engineering, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - I L G Law
- Biochemistry Programme, School of Life Sciences, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Y K Cheung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Y Y Cheung
- Department of Microbiology, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - M L Chin
- Department of Microbiology, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - P Kwan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - M Hui
- Department of Microbiology, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - S K Kong
- Biochemistry Programme, School of Life Sciences, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - H P Ho
- Department of Electronic Engineering, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
| |
Collapse
|
17
|
Zoghi M, Cook M, O’Brien T, Kwan P, Jaberzadeh S, Galea M. P015 The effects of cathodal transcranial direct current stimulation in patienst with focal epilepsy (a pilot study)‘. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2016.10.144] [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: 11/28/2022]
|
18
|
Das S, Vaishnav M, Mumford D, Kwan P, Itty C. Left Anterior Descending Coronary Artery Dissection: A Rare Sequela of Blunt Chest Trauma – A Case Report. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
19
|
Itty C, Blenkhorn A, Mumford D, Kwan P. Changes in Drug Eluting Stent Usage During a Four-Year Time Period in a Regional Cath Lab in New South Wales. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.393] [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: 11/28/2022]
|
20
|
Ding J, Kwan P, Ma Z, Iwashina T, Wang J, Shankowsky HA, Tredget EE. Synergistic effect of vitamin D and low concentration of transforming growth factor beta 1, a potential role in dermal wound healing. Burns 2016; 42:1277-86. [PMID: 27222384 DOI: 10.1016/j.burns.2016.03.009] [Citation(s) in RCA: 22] [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] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 03/14/2016] [Accepted: 03/16/2016] [Indexed: 12/19/2022]
Abstract
Dermal wound healing, in which transforming growth factor beta 1 (TGFβ1) plays an important role, is a complex process. Previous studies suggest that vitamin D has a potential regulatory role in TGFβ1 induced activation in bone formation, and there is cross-talk between their signaling pathways, but research on their effects in other types of wound healing is limited. The authors therefore wanted to explore the role of vitamin D and its interaction with low concentration of TGFβ1 in dermal fibroblast-mediated wound healing through an in vitro study. Human dermal fibroblasts were treated with vitamin D, TGFβ1, both, or vehicle, and then the wound healing functions of dermal fibroblasts were measured. To further explore possible mechanisms explaining the synergistic effect of vitamin D and TGFβ1, targeted gene silencing of the vitamin D receptor was performed. Compared to either factor alone, treatment of fibroblasts with both vitamin D and low concentration of TGFβ1 increased gene expression of TGFβ1, connective tissue growth factor, and fibronectin 1, and enhanced fibroblast migration, myofibroblast formation, and collagen production. Vitamin D receptor gene silencing blocked this synergistic effect of vitamin D and TGFβ1 on both collagen production and myofibroblast differentiation. Thus a synergistic effect of vitamin D and low TGFβ1 concentration was found in dermal fibroblast-mediated wound healing in vitro. This study suggests that supplementation of vitamin D may be an important step to improve wound healing and regeneration in patients with a vitamin D deficiency.
Collapse
Affiliation(s)
- Jie Ding
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, University of Alberta, 2D2.28 WMC, 8440-112 Street, Edmonton, Alberta, Canada T6G 2B7
| | - Peter Kwan
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, University of Alberta, 2D2.28 WMC, 8440-112 Street, Edmonton, Alberta, Canada T6G 2B7
| | - Zengshuan Ma
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, University of Alberta, 2D2.28 WMC, 8440-112 Street, Edmonton, Alberta, Canada T6G 2B7
| | - Takashi Iwashina
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, University of Alberta, 2D2.28 WMC, 8440-112 Street, Edmonton, Alberta, Canada T6G 2B7
| | - Jianfei Wang
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, University of Alberta, 2D2.28 WMC, 8440-112 Street, Edmonton, Alberta, Canada T6G 2B7
| | - Heather A Shankowsky
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, University of Alberta, 2D2.28 WMC, 8440-112 Street, Edmonton, Alberta, Canada T6G 2B7
| | - Edward E Tredget
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, University of Alberta, 2D2.28 WMC, 8440-112 Street, Edmonton, Alberta, Canada T6G 2B7; Division of Critical Care Medicine, Department of Surgery, University of Alberta, 2D2.28 WMC, 8440-112 Street, Edmonton, Alberta, Canada T6G 2B7.
| |
Collapse
|
21
|
Lin M, Todaro M, Chan J, Churilov L, Zhu WS, Ramdave S, Mitchell PJ, Dowling RJ, Kwan P, Yan B. Association between CYP2C19 Polymorphisms and Outcomes in Cerebral Endovascular Therapy. AJNR Am J Neuroradiol 2015; 37:108-13. [PMID: 26338921 DOI: 10.3174/ajnr.a4481] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 06/04/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Differing responses to clopidogrel following endovascular treatment of cerebrovascular diseases may increase the risk of vascular complications. CYP2C19 gene polymorphisms influence clopidogrel activity. We aimed to study the clinical impact of CYP2C19 gene polymorphisms in patients undergoing endovascular treatment. MATERIALS AND METHODS This was a prospective, longitudinal, observational study. Information on demographics and cerebrovascular status was collected as baseline. Clopidogrel response was tested by the VerifyNow P2Y12 assay. CYP2C19 genotyping was undertaken by polymerase chain reaction-restriction fragment length polymorphism. Three-month follow-up data included vascular complications, mortality, and modified Rankin Scale score. Associations were investigated among CYP2C19 genotypes, clopidogrel responsiveness, and clinical outcomes. RESULTS One hundred and eight participants were included. Median age was 56 years (interquartile range, 48.8-65.0 years), and 35 (32.4%) were male. Forty-four participants were classified into group 1 (homozygous CYP2C19*1/*1); 31, into group 2 (25 with CYP2C19*1/*2, two with CYP2C19*1/*3, three with CYP2C19*3/*3, one with CYP2C19*2/*3); 28, into group 3 (24 with CYP2C19*1/*17, four with CYP2C19*17/*17); and 5, into group 4 (CYP2C19*2/*17). A significantly higher proportion of participants in group 3 experienced ischemic events (9 of 28, 32.1%) compared with group 1 (5 of 44, 11.4%; P = .04; odds ratio, 3.7; 95% confidence interval, 1.1-12.6). There was no significant difference in clopidogrel response among the 4 genotype groups. CONCLUSIONS Individuals with CYP2C19*17 may have increased risk of ischemic events following endovascular treatment, independent of clopidogrel responsiveness. Larger studies are required to confirm the influence of CYP2C19*17 on clinical outcomes and to understand the mechanisms for increased ischemic events.
Collapse
Affiliation(s)
- M Lin
- From the Melbourne Brain Centre (M.L., W.S.Z., B.Y.)
| | - M Todaro
- Neurology (M.T., P.K., B.Y.), The Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia Department of Medicine (M.T., J.C., S.R., P.K.), University of Melbourne, Melbourne, Victoria, Australia
| | - J Chan
- Department of Medicine (M.T., J.C., S.R., P.K.), University of Melbourne, Melbourne, Victoria, Australia
| | - L Churilov
- Florey Institute of Neurosciences and Mental Health (L.C.), Melbourne Brain Centre, Heidelberg, Victoria, Australia
| | - W S Zhu
- From the Melbourne Brain Centre (M.L., W.S.Z., B.Y.)
| | - S Ramdave
- Department of Medicine (M.T., J.C., S.R., P.K.), University of Melbourne, Melbourne, Victoria, Australia
| | | | - R J Dowling
- Departments of Radiology (P.J.M., R.J.D., B.Y.)
| | - P Kwan
- Neurology (M.T., P.K., B.Y.), The Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia Department of Medicine (M.T., J.C., S.R., P.K.), University of Melbourne, Melbourne, Victoria, Australia
| | - B Yan
- From the Melbourne Brain Centre (M.L., W.S.Z., B.Y.) Departments of Radiology (P.J.M., R.J.D., B.Y.) Neurology (M.T., P.K., B.Y.), The Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
22
|
Ding J, Ma Z, Liu H, Kwan P, Iwashina T, Shankowsky HA, Wong D, Tredget EE. The therapeutic potential of a C-X-C chemokine receptor type 4 (CXCR-4) antagonist on hypertrophic scarring in vivo. Wound Repair Regen 2015; 22:622-30. [PMID: 25139227 DOI: 10.1111/wrr.12208] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 07/12/2014] [Indexed: 12/17/2022]
Abstract
Effective prevention and treatment of hypertrophic scars (HTSs), a dermal form of fibrosis that frequently occurs following thermal injury to deep dermis, are unsolved significant clinical problems. Previously, we have found that stromal cell-derived factor 1/CXCR4 signaling is up-regulated during wound healing in burn patients and HTS tissue after thermal injury. We hypothesize that blood-borne mononuclear cells are recruited into wound sites after burn injury through the chemokine pathway of stromal cell-derived factor 1 and its receptor CXCR4. Deep dermal injuries to the skin are often accompanied by prolonged inflammation, which leads to chemotaxis of mononuclear cells into the wounds by chemokine signaling where fibroblast activation occurs and ultimately HTS are formed. Blocking mononuclear cell recruitment and fibroblast activation, CXCR4 antagonism is expected to reduce or minimize scar formation. In this study, the inhibitory effect of CXCR4 antagonist CTCE-9908 on dermal fibrosis was determined in vivo using a human HTS-like nude mouse model, in which split-thickness human skin is transplanted into full-thickness dorsal excisional wounds in athymic mice, where these wounds subsequently develop fibrotic scars that resemble human HTS as previously described. CTCE-9908 significantly attenuated scar formation and contraction, reduced the accumulation of macrophages and myofibroblasts, enhanced the remodeling of collagen fibers, and down-regulated the gene and protein expression of fibrotic growth factors in the human skin tissues. These findings support the potential therapeutic value of CXCR4 antagonist in dermal fibrosis and possibly other fibroproliferative disorders.
Collapse
Affiliation(s)
- Jie Ding
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, University of Alberta, Edmonton, Alberta, Canada
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Zoghi M, O’Brien T, Kwan P, Galea M, Jaberzadeh S. The effects of within session repeated cathodal transcranial direct current stimulation on epileptic patients (a pilot study). Brain Stimul 2015. [DOI: 10.1016/j.brs.2015.01.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
24
|
|
25
|
|
26
|
Cheung Y, Kwok M, Chan E, Kwan P. Rapid detection ofHLA-A*31:01allele in DNA and blood samples using loop-mediated isothermal amplification. Br J Dermatol 2014; 171:90-6. [PMID: 24593191 DOI: 10.1111/bjd.12897] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2014] [Indexed: 12/13/2022]
Affiliation(s)
- Y.K. Cheung
- Department of Medicine and Therapeutics; The Chinese University of Hong Kong; Prince of Wales Hospital; Hong Kong SAR China
| | - M. Kwok
- Department of Medicine and Therapeutics; The Chinese University of Hong Kong; Prince of Wales Hospital; Hong Kong SAR China
| | - E. Chan
- Department of Medicine and Therapeutics; The Chinese University of Hong Kong; Prince of Wales Hospital; Hong Kong SAR China
| | - P. Kwan
- Department of Medicine and Therapeutics; The Chinese University of Hong Kong; Prince of Wales Hospital; Hong Kong SAR China
| |
Collapse
|
27
|
Leung H, Mak H, Leung M, Leung KL, Kwan P, Wong KS. Neuroeconomics of health care financing options: willingness to pay and save. Hong Kong Med J 2014; 20:8-10. [PMID: 25001028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Affiliation(s)
- H Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong
| | - H Mak
- Department of Diagnostic Radiology, The University of Hong Kong
| | - M Leung
- Department of Economics, The Chinese University of Hong Kong
| | - K L Leung
- Private medical practitioner, Hong Kong
| | - P Kwan
- University of Melbourne, Australia
| | - K S Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong
| |
Collapse
|
28
|
Fung S, Kwan P, Fabri M, Horban A, Pelemis M, Hann HW, Gurel S, Caruntu FA, Flaherty JF, Massetto B, Dinh P, Corsa A, Subramanian GM, McHutchison JG, Husa P, Gane E. Randomized comparison of tenofovir disoproxil fumarate vs emtricitabine and tenofovir disoproxil fumarate in patients with lamivudine-resistant chronic hepatitis B. Gastroenterology 2014; 146:980-8. [PMID: 24368224 DOI: 10.1053/j.gastro.2013.12.028] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [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: 06/28/2013] [Revised: 12/13/2013] [Accepted: 12/14/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS Tenofovir disoproxil fumarate (TDF) is active against lamivudine-resistant hepatitis B virus (HBV) infection, but data to support its clinical efficacy in this setting are limited. METHODS In a prospective, double-blind, 96-week trial, patients were randomly assigned (1:1) to groups given TDF (300 mg, n = 141) or a combination of emtricitabine (FTC, 200 mg; n = 139) and TDF (300 mg, FTC/TDF). Patients were hepatitis B e antigen (HBeAg)-positive or HBeAg-negative, with levels of HBV DNA ≥3 log10 IU/mL and lamivudine resistance mutations (HBV polymerase or reverse transcriptase amino acid substitutions rtM204I/V ± rtL180M by INNO-LiPA Multi-DR v3; Innogenetics, Inc, Alpharetta, GA). The primary end point was proportion with HBV DNA <69 IU/mL (Roche COBAS Taqman assay; Roche Molecular Systems, Inc, Pleasanton, CA). RESULTS Patient groups were well matched for demographic and disease characteristics, including region (60% from Europe), HBV genotype (45% genotype D), HBeAg status (47% HBeAg-positive), and duration of lamivudine treatment (mean, 3.8 years). At week 96 of treatment, 89.4% of patients in the TDF group and 86.3% in the FTC/TDF group had levels of HBV DNA <69 IU/mL (P = .43). HBeAg loss and seroconversion did not differ between groups; only 1 patient (0.7%) in the FTC/TDF group lost hepatitis B surface antigen. Treatment was well tolerated; confirmed renal events (creatinine increase of ≥0.5 mg/dL [>44 umol/L], creatinine clearance <50 mL/min, or level of PO4 <2 mg/dL [<0.65 mmol/L]) were generally mild and infrequent (<1%). Small reductions (<2%) in mean bone mineral density of hip and spine were detected by dual-energy x-ray absorptiometry in both groups. No TDF resistance developed through 96 weeks of treatment. CONCLUSIONS TDF alone is safe and effective for treatment of patients with lamivudine-resistant, chronic HBV infection. Clinical Trials.gov No, NCT00737568.
Collapse
Affiliation(s)
- Scott Fung
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Peter Kwan
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Milotka Fabri
- Clinic for Infectious Diseases, Medical University of Novi Sad, Serbia
| | | | - Mijomir Pelemis
- Clinic for Infectious and Tropical Diseases, Clinical Center of Serbia, Belgrade Medical Faculty, Belgrade, Serbia
| | - Hie-Won Hann
- Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Selim Gurel
- Uludag Universitesi Tip Fakultesi, Bursa, Gorukle, Turkey
| | - Florin A Caruntu
- National Institute for Infectious Diseases, "Prof Dr Matei Bals," Bucharest, Romania
| | | | | | | | | | | | | | - Petr Husa
- University Hospital Brno and Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
| | - Edward Gane
- Auckland City Hospital, Auckland, New Zealand
| |
Collapse
|
29
|
Hasan ST, Zingg JM, Kwan P, Noble T, Smith D, Meydani M. Curcumin modulation of high fat diet-induced atherosclerosis and steatohepatosis in LDL receptor deficient mice. Atherosclerosis 2013; 232:40-51. [PMID: 24401215 DOI: 10.1016/j.atherosclerosis.2013.10.016] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 09/04/2013] [Accepted: 10/17/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Consuming curcumin may benefit health by modulating lipid metabolism and suppressing atherogenesis. Fatty acid binding proteins (FABP-4/aP2) and CD36 expression are key factors in lipid accumulation in macrophages and foam cell formation in atherogenesis. Our earlier observations suggest that curcumin's suppression of atherogenesis might be mediated through changes in aP2 and CD36 expression in macrophages. Thus, this study aimed to further elucidate the impact of increasing doses of curcumin on modulation of these molecular mediators on high fat diet-induced atherogenesis, inflammation, and steatohepatosis in Ldlr(-/-) mice. METHODS Ldlr(-/-) mice were fed low fat (LF) or high fat (HF) diet supplemented with curcumin (500 HF + LC; 1000 HF + MC; 1500 HF + HC mg/kg diet) for 16 wks. Fecal samples were analyzed for total lipid content. Lipids accumulation in THP-1 cells and expression of aP2, CD36 and lipid accumulation in peritoneal macrophages were measured. Fatty streak lesions and expression of IL-6 and MCP-1 in descending aortas were quantified. Aortic root was stained for fatty and fibrotic deposits and for the expression of aP2 and VCAM-1. Total free fatty acids, insulin, glucose, triglycerides, and cholesterol as well as several inflammatory cytokines were measured in plasma. The liver's total lipids, cholesterol, triglycerides, and HDL content were measured, and the presence of fat droplets, peri-portal fibrosis and glycogen was examined histologically. RESULTS Curcumin dose-dependently reduced uptake of oxLDL in THP-1 cells. Curcumin also reduced body weight gain and body fat without affecting fat distribution. During early intervention, curcumin decreased fecal fat, but at later stages, it increased fat excretion. Curcumin at medium doses of 500-1000 mg/kg diet was effective at reducing fatty streak formation and suppressing aortic expression of IL-6 in the descending aorta and blood levels of several inflammatory cytokines, but at a higher dose (HF + HC, 1500 mg/kg diet), it had adverse effects on some of these parameters. This U-shape like trend was also present when aortic root sections were examined histologically. However, at a high dose, curcumin suppressed development of steatohepatosis, reduced fibrotic tissue, and preserved glycogen levels in liver. CONCLUSION Curcumin through a series of complex mechanisms, alleviated the adverse effects of high fat diet on weight gain, fatty liver development, dyslipidemia, expression of inflammatory cytokines and atherosclerosis in Ldlr(-/-) mouse model of human atherosclerosis. One of the mechanisms by which low dose curcumin modulates atherogenesis is through suppression of aP2 and CD36 expression in macrophages, which are the key players in atherogenesis. Overall, these effects of curcumin are dose-dependent; specifically, a medium dose of curcumin in HF diet appears to be more effective than a higher dose of curcumin.
Collapse
Affiliation(s)
- S T Hasan
- Vascular Biology Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, 711 Washington St, Boston, MA 02111, USA
| | - J-M Zingg
- Vascular Biology Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, 711 Washington St, Boston, MA 02111, USA
| | - P Kwan
- Department of Pathology, Tufts School of Medicine, 145 Harrison Ave, Boston, MA 02111, USA
| | - T Noble
- Vascular Biology Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, 711 Washington St, Boston, MA 02111, USA
| | - D Smith
- Comparative Biology Unit, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, 711 Washington St, Boston, MA 02111, USA
| | - M Meydani
- Vascular Biology Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, 711 Washington St, Boston, MA 02111, USA.
| |
Collapse
|
30
|
Ma RCW, Hu C, Tam CH, Zhang R, Kwan P, Leung TF, Thomas GN, Go MJ, Hara K, Sim X, Ho JSK, Wang C, Li H, Lu L, Wang Y, Li JW, Wang Y, Lam VKL, Wang J, Yu W, Kim YJ, Ng DP, Fujita H, Panoutsopoulou K, Day-Williams AG, Lee HM, Ng ACW, Fang YJ, Kong APS, Jiang F, Ma X, Hou X, Tang S, Lu J, Yamauchi T, Tsui SKW, Woo J, Leung PC, Zhang X, Tang NLS, Sy HY, Liu J, Wong TY, Lee JY, Maeda S, Xu G, Cherny SS, Chan TF, Ng MCY, Xiang K, Morris AP, Keildson S, Hu R, Ji L, Lin X, Cho YS, Kadowaki T, Tai ES, Zeggini E, McCarthy MI, Hon KL, Baum L, Tomlinson B, So WY, Bao Y, Chan JCN, Jia W. Genome-wide association study in a Chinese population identifies a susceptibility locus for type 2 diabetes at 7q32 near PAX4. Diabetologia 2013; 56:1291-305. [PMID: 23532257 PMCID: PMC3648687 DOI: 10.1007/s00125-013-2874-4] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Accepted: 01/31/2013] [Indexed: 12/18/2022]
Abstract
AIMS/HYPOTHESIS Most genetic variants identified for type 2 diabetes have been discovered in European populations. We performed genome-wide association studies (GWAS) in a Chinese population with the aim of identifying novel variants for type 2 diabetes in Asians. METHODS We performed a meta-analysis of three GWAS comprising 684 patients with type 2 diabetes and 955 controls of Southern Han Chinese descent. We followed up the top signals in two independent Southern Han Chinese cohorts (totalling 10,383 cases and 6,974 controls), and performed in silico replication in multiple populations. RESULTS We identified CDKN2A/B and four novel type 2 diabetes association signals with p < 1 × 10(-5) from the meta-analysis. Thirteen variants within these four loci were followed up in two independent Chinese cohorts, and rs10229583 at 7q32 was found to be associated with type 2 diabetes in a combined analysis of 11,067 cases and 7,929 controls (p meta = 2.6 × 10(-8); OR [95% CI] 1.18 [1.11, 1.25]). In silico replication revealed consistent associations across multiethnic groups, including five East Asian populations (p meta = 2.3 × 10(-10)) and a population of European descent (p = 8.6 × 10(-3)). The rs10229583 risk variant was associated with elevated fasting plasma glucose, impaired beta cell function in controls, and an earlier age at diagnosis for the cases. The novel variant lies within an islet-selective cluster of open regulatory elements. There was significant heterogeneity of effect between Han Chinese and individuals of European descent, Malaysians and Indians. CONCLUSIONS/INTERPRETATION Our study identifies rs10229583 near PAX4 as a novel locus for type 2 diabetes in Chinese and other populations and provides new insights into the pathogenesis of type 2 diabetes.
Collapse
Affiliation(s)
- R. C. W. Ma
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, SAR People’s Republic of China
- Hong Kong Institute of Diabetes and Obesity, Chinese University of Hong Kong, Hong Kong, SAR People’s Republic of China
- Li Ka Shing Institute of Life Sciences, Chinese University of Hong Kong, Hong Kong, SAR People’s Republic of China
| | - C. Hu
- Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai, 200233 People’s Republic of China
- Shanghai Jiao Tong University Affiliated Sixth People’s Hospital South Campus, Shanghai, People’s Republic of China
| | - C. H. Tam
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, SAR People’s Republic of China
| | - R. Zhang
- Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai, 200233 People’s Republic of China
| | - P. Kwan
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, SAR People’s Republic of China
| | - T. F. Leung
- Department of Paediatrics, Chinese University of Hong Kong, Hong Kong, People’s Republic of China
| | - G. N. Thomas
- Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| | - M. J. Go
- Center for Genome Science, National Institute of Health, Osong Health Technology Administration Complex, Gangoe-myeon, Yeonje-ri, Cheongwon-gun, Chungcheongbuk-do Republic of Korea
| | - K. Hara
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- Department of Integrated Molecular Science on Metabolic Diseases, University of Tokyo Hospital, Tokyo, Japan
| | - X. Sim
- Centre for Molecular Epidemiology, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Republic of Singapore
- Center for Statistical Genetics and Department of Biostatistics, University of Michigan, Ann Arbor, MI USA
| | - J. S. K. Ho
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, SAR People’s Republic of China
| | - C. Wang
- Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai, 200233 People’s Republic of China
| | - H. Li
- Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences and Graduate School of the Chinese Academy of Sciences, Shanghai, People’s Republic of China
| | - L. Lu
- Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences and Graduate School of the Chinese Academy of Sciences, Shanghai, People’s Republic of China
| | - Y. Wang
- Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences and Graduate School of the Chinese Academy of Sciences, Shanghai, People’s Republic of China
| | - J. W. Li
- School of Life Sciences, Chinese University of Hong Kong, Hong Kong, SAR People’s Republic of China
| | - Y. Wang
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, SAR People’s Republic of China
| | - V. K. L. Lam
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, SAR People’s Republic of China
| | - J. Wang
- Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai, 200233 People’s Republic of China
| | - W. Yu
- Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai, 200233 People’s Republic of China
| | - Y. J. Kim
- Center for Genome Science, National Institute of Health, Osong Health Technology Administration Complex, Gangoe-myeon, Yeonje-ri, Cheongwon-gun, Chungcheongbuk-do Republic of Korea
| | - D. P. Ng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Republic of Singapore
| | - H. Fujita
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - K. Panoutsopoulou
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK
| | - A. G. Day-Williams
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK
| | - H. M. Lee
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, SAR People’s Republic of China
| | - A. C. W. Ng
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, SAR People’s Republic of China
| | - Y-J. Fang
- Department of Colorectal Surgery, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, People’s Republic of China
| | - A. P. S. Kong
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, SAR People’s Republic of China
| | - F. Jiang
- Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai, 200233 People’s Republic of China
| | - X. Ma
- Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai, 200233 People’s Republic of China
| | - X. Hou
- Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai, 200233 People’s Republic of China
| | - S. Tang
- Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai, 200233 People’s Republic of China
| | - J. Lu
- Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai, 200233 People’s Republic of China
| | - T. Yamauchi
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - S. K. W. Tsui
- School of Biomedical Sciences, Chinese University of Hong Kong, Hong Kong, SAR People’s Republic of China
| | - J. Woo
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, SAR People’s Republic of China
| | - P. C. Leung
- Department of Orthopaedics, Chinese University of Hong Kong, Hong Kong, SAR People’s Republic of China
| | - X. Zhang
- Shanghai Jiao Tong University Affiliated Sixth People’s Hospital South Campus, Shanghai, People’s Republic of China
| | - N. L. S. Tang
- Department of Chemical Pathology, Chinese University of Hong Kong, Hong Kong, SAR People’s Republic of China
| | - H. Y. Sy
- Department of Paediatrics, Chinese University of Hong Kong, Hong Kong, People’s Republic of China
| | - J. Liu
- Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore, Republic of Singapore
| | - T. Y. Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
- Centre for Eye Research Australia, University of Melbourne, East Melbourne, VIC Australia
| | - J. Y. Lee
- Center for Genome Science, National Institute of Health, Osong Health Technology Administration Complex, Gangoe-myeon, Yeonje-ri, Cheongwon-gun, Chungcheongbuk-do Republic of Korea
| | - S. Maeda
- Laboratory for Endocrinology and Metabolism, RIKEN Center for Genomic Medicine, Yokohama, Japan
| | - G. Xu
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, SAR People’s Republic of China
| | - S. S. Cherny
- Department of Psychiatry and State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong, SAR People’s Republic of China
| | - T. F. Chan
- School of Life Sciences, Chinese University of Hong Kong, Hong Kong, SAR People’s Republic of China
| | - M. C. Y. Ng
- Center for Genomics and Personalized Medicine Research, Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - K. Xiang
- Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai, 200233 People’s Republic of China
| | - A. P. Morris
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | | | - S. Keildson
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | | | - R. Hu
- Institute of Endocrinology and Diabetology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - L. Ji
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - X. Lin
- Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences and Graduate School of the Chinese Academy of Sciences, Shanghai, People’s Republic of China
| | - Y. S. Cho
- Department of Biomedical Science, Hallym University, Chuncheon, Gangwon-do Republic of Korea
| | - T. Kadowaki
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - E. S. Tai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
- Graduate Medical School, Duke-National University of Singapore, Singapore, Republic of Singapore
| | - E. Zeggini
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK
| | - M. I. McCarthy
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Churchill Hospital, Oxford, UK
| | - K. L. Hon
- Department of Paediatrics, Chinese University of Hong Kong, Hong Kong, People’s Republic of China
| | - L. Baum
- School of Pharmacy, Chinese University of Hong Kong, Hong Kong, SAR People’s Republic of China
| | - B. Tomlinson
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, SAR People’s Republic of China
| | - W. Y. So
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, SAR People’s Republic of China
| | - Y. Bao
- Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai, 200233 People’s Republic of China
| | - J. C. N. Chan
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, SAR People’s Republic of China
- Hong Kong Institute of Diabetes and Obesity, Chinese University of Hong Kong, Hong Kong, SAR People’s Republic of China
- Li Ka Shing Institute of Life Sciences, Chinese University of Hong Kong, Hong Kong, SAR People’s Republic of China
| | - W. Jia
- Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai, 200233 People’s Republic of China
| |
Collapse
|
31
|
Abstract
OBJECTIVE The objective of this study was to investigate the timing of therapy initiation and other clinical factors as potential predictors for relapse and prognosis of epilepsy, based on hospital-based prospective observational data in China. METHODS One hundred and seventy-one newly diagnosed patients with one or more seizures were recruited and followed for at least 2 years. Kaplan-Meier survival analysis was used for calculating recurrence and remission rates. Univariate and multivariate analyses for risk factors were performed using Cox proportional hazards model. RESULTS Among the 171 patients analyzed, more patients had partial (54.4%) than generalized seizures (45.6%). The range of patients' age was 6-70 years, but 70% were under 16 years of age. Multiple seizure types (HR = 2.01; 95% CI, 1.31-3.10), epileptiform electroencephalogram (EEG) abnormality (HR = 1.95; 95% CI, 1.09-3.49), and >1 seizure monthly before treatment (HR = 2.74; 95% CI, 1.69-4.51) were predictors of seizure recurrence. The best negative predictors of remission were as follows: relapse (HR = 0.13; 95% CI, 0.07-0.23) and epileptiform EEG within 1 year of treatment (HR = 0.61; 95% CI, 0.39-0.97). Delayed treatment after three or more seizures did not significantly increase the risk of recurrence (P = 0.70) or remission (P = 0.31) compared with early treatment after one or two seizures. CONCLUSIONS Multiple seizure types, epileptiform EEG abnormality, and >1 seizure monthly before treatment predict seizure recurrence. Relapse and epileptiform EEG within 1 year of treatment predict adverse seizure outcome. Early treatment does not affect relapse or prognosis.
Collapse
Affiliation(s)
- L. Su
- Department of Neurology; Nanjing Brain Hospital affiliated to Nanjing Medical University; Nanjing; Jiangsu; China
| | - Q. Di
- Department of Neurology; Nanjing Brain Hospital affiliated to Nanjing Medical University; Nanjing; Jiangsu; China
| | - P. Kwan
- Division of Neurology, Department of Medicine and Therapeutics; Prince of Wales Hospital, The Chinese University of Hong Kong; Shatin; Hong Kong; China
| | - N. Yu
- Department of Neurology; Nanjing Brain Hospital affiliated to Nanjing Medical University; Nanjing; Jiangsu; China
| | - Y. Zhang
- Department of Neurology; Nanjing Brain Hospital affiliated to Nanjing Medical University; Nanjing; Jiangsu; China
| | - Y. Hu
- Department of Neurology; Nanjing Brain Hospital affiliated to Nanjing Medical University; Nanjing; Jiangsu; China
| | - L. Gao
- Department of Neurology; Nanjing Brain Hospital affiliated to Nanjing Medical University; Nanjing; Jiangsu; China
| |
Collapse
|
32
|
Itty C, Blenkhorn A, Mumford D, Kwan P. Outcomes of Percutaneous Coronary Intervention Without Onsite Cardiac Surgery in a New Regional Cardiac Catheter Lab in Northern New South Wales. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
33
|
Honardoust D, Kwan P, Momtazi M, Ding J, Tredget EE. Novel methods for the investigation of human hypertrophic scarring and other dermal fibrosis. Methods Mol Biol 2013; 1037:203-31. [PMID: 24029937 DOI: 10.1007/978-1-62703-505-7_11] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Hypertrophic scar (HTS) represents the dermal equivalent of fibroproliferative disorders that occur after injury involving the deep dermis while superficial wounds to the skin heal with minimal or no scarring. HTS is characterized by progressive deposition of collagen that occurs with high frequency in adult dermal wounds following traumatic or thermal injury. Increased levels of transforming growth factor-β1 (TGF-β1), decreased expression of small leucine-rich proteoglycans (SLRPs), and/or fibroblast subtypes may influence the development of HTS. The development of HTS is strongly influenced by the cellular and molecular properties of fibroblast subtypes, where cytokines such as fibrotic TGF-β1 and CTGF as well as the expression of SLRPs, particularly decorin and fibromodulin, regulate collagen fibrillogenesis and the activity of TGF-β1. Reduced anti-fibrotic molecules in the ECM of the deep dermis and the distinctive behavior of the fibroblasts in this region of the dermis which display increased sensitivity to TGF-β1's biological activity contribute to the development of HTS following injury to the deep dermis. By comparing the cellular and molecular differences involved in deep and superficial wound healing in an experimental wound scratch model in humans that has both superficial and deep injuries within the same excisional model, our aim is to increase our understanding of how tissue repair following injury to the deep dermis can be changed to promote healing with a similar pattern to healing that occurs following superficial injury that results in no or minimal scarring. Studying the characteristics of superficial dermal injuries that heal with minimal scarring will help us identify therapeutic approaches for tissue engineering and wound healing. In addition, our ability to develop novel therapies for HTS is hampered by limitations in the available animal models used to study this disorder in vivo. We also describe a nude mouse model of transplanted human skin that develops a hypertrophic proliferative scar consistent morphologically and histologically with human HTS, which can be used to test novel treatment options for these dermal fibrotic conditions.
Collapse
Affiliation(s)
- Dariush Honardoust
- Wound Healing Research Group, Plastic Surgery Research Laboratory, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | | | | | | | | |
Collapse
|
34
|
Momtazi M, Kwan P, Ding J, Anderson CC, Honardoust D, Goekjian S, Tredget EE. A nude mouse model of hypertrophic scar shows morphologic and histologic characteristics of human hypertrophic scar. Wound Repair Regen 2012; 21:77-87. [PMID: 23126488 DOI: 10.1111/j.1524-475x.2012.00856.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Accepted: 08/13/2012] [Indexed: 11/28/2022]
Abstract
Hypertrophic scar (HSc) is a fibroproliferative disorder that occurs following deep dermal injury. Lack of a relevant animal model is one barrier toward better understanding its pathophysiology. Our objective is to demonstrate that grafting split-thickness human skin onto nude mice results in survival of engrafted human skin and murine scars that are morphologically, histologically, and immunohistochemically consistent with human HSc. Twenty nude mice were xenografted with split-thickness human skin. Animals were euthanized at 30, 60, 120, and 180 days postoperatively. Eighteen controls were autografted with full-thickness nude mouse skin and euthanized at 30 and 60 days postoperatively. Scar biopsies were harvested at each time point. Blinded scar assessment was performed using a modified Manchester Scar Scale. Histologic analysis included hematoxylin and eosin, Masson's trichrome, toluidine blue, and picrosirius red staining. Immunohistochemistry included anti-human human leukocyte antigen-ABC, α-smooth muscle actin, decorin, and biglycan staining. Xenografted mice developed red, shiny, elevated scars similar to human HSc and supported by blinded scar assessment. Autograft controls appeared morphologically and histologically similar to normal skin. Xenografts survived up to 180 days and showed increased thickness, loss of hair follicles, adnexal structures and rete pegs, hypercellularity, whorled collagen fibers parallel to the surface, myofibroblasts, decreased decorin and increased biglycan expression, and increased mast cell density. Grafting split-thickness human skin onto nude mice results in persistent scars that show morphologic, histologic, and immunohistochemical consistency with human HSc. Therefore, this model provides a promising technique to study HSc formation and to test novel treatment options.
Collapse
Affiliation(s)
- Moein Momtazi
- Division of Plastic and Reconstructive Surgery, University of Alberta, Edmonton, Alberta, Canada
| | | | | | | | | | | | | |
Collapse
|
35
|
Smith VE, Read ML, Turnell AS, Sharma N, Lewy GD, Fong JCW, Seed RI, Kwan P, Ryan G, Mehanna H, Chan SY, Darras VM, Boelaert K, Franklyn JA, McCabe CJ. PTTG-binding factor (PBF) is a novel regulator of the thyroid hormone transporter MCT8. Endocrinology 2012; 153:3526-36. [PMID: 22535767 DOI: 10.1210/en.2011-2030] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [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: 11/19/2022]
Abstract
Within the basolateral membrane of thyroid follicular epithelial cells, two transporter proteins are central to thyroid hormone (TH) biosynthesis and secretion. The sodium iodide symporter (NIS) delivers iodide from the bloodstream into the thyroid, and after TH biosynthesis, monocarboxylate transporter 8 (MCT8) mediates TH secretion from the thyroid gland. Pituitary tumor-transforming gene-binding factor (PBF; PTTG1IP) is a protooncogene that is up-regulated in thyroid cancer and that binds NIS and modulates its subcellular localization and function. We now show that PBF binds MCT8 in vitro, eliciting a marked shift in MCT8 subcellular localization and resulting in a significant reduction in the amount of MCT8 at the plasma membrane as determined by cell surface biotinylation assays. Colocalization and interaction between PBF and Mct8 was also observed in vivo in a mouse model of thyroid-specific PBF overexpression driven by a bovine thyroglobulin (Tg) promoter (PBF-Tg). Thyroidal Mct8 mRNA and protein expression levels were similar to wild-type mice. Critically, however, PBF-Tg mice demonstrated significantly enhanced thyroidal TH accumulation and reduced TH secretion upon TSH stimulation. Importantly, Mct8-knockout mice share this phenotype. These data show that PBF binds and alters the subcellular localization of MCT8 in vitro, with PBF overexpression leading to an accumulation of TH within the thyroid in vivo. Overall, these studies identify PBF as the first protein to interact with the critical TH transporter MCT8 and modulate its function in vivo. Furthermore, alongside NIS repression, PBF may thus represent a new regulator of TH biosynthesis and secretion.
Collapse
Affiliation(s)
- V E Smith
- School of Clinical and Experimental Medicine, Institute for Biomedical Research, University of Birmingham, Birmingham, B15 2TT, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Abstract
OBJECTIVE To delineate the temporal patterns of outcome and to determine the probability of seizure freedom with successive antiepileptic drug regimens in newly diagnosed epilepsy. METHODS Patients in whom epilepsy was diagnosed and the first antiepileptic drug prescribed between July 1, 1982, and April 1, 2006, were followed up until March 31, 2008. Outcomes were categorized into 4 patterns: (A) early and sustained seizure freedom; (B) delayed but sustained seizure freedom; (C) fluctuation between periods of seizure freedom and relapse; and (D) seizure freedom never attained. Probability of seizure freedom with successive drug regimens was compared. Seizure freedom was defined as no seizures for ≥1 year. RESULTS A total of 1,098 patients were included (median age 32 years, range 9-93). At the last clinic visit, 749 (68%) patients were seizure-free, 678 (62%) on monotherapy. Outcome pattern A was observed in 408 (37%), pattern B in 246 (22%), pattern C in 172 (16%), and pattern D in 272 (25%) patients. There was a higher probability of seizure freedom in patients receiving 1 compared to 2 drug regimens, and 2 compared to 3 regimens (p < 0.001). The difference was greater among patients with symptomatic or cryptogenic than with idiopathic epilepsy. Less than 2% of patients became seizure-free on subsequent regimens but a few did so on their sixth or seventh regimen. CONCLUSIONS Most patients with newly diagnosed epilepsy had a constant course which could usually be predicted early. The chance of seizure freedom declined with successive drug regimens, most markedly from the first to the third and among patients with localization-related epilepsies.
Collapse
|
37
|
Kramer L, Perucca E, Ben-Menachem E, Kwan P, Shih J, Squillacote D, Yang H, Zhu J, Laurenza A. Perampanel, a Selective, Non-Competitive AMPA Receptor Antagonist as Adjunctive Therapy in Patients with Refractory Partial-Onset Seizures: A Dose Response Analysis from Phase III Studies (P06.117). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p06.117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
38
|
Li R, Yang W, Zhang J, Hirankarn N, Pan HF, Mok CC, Chan TM, Wong RWS, Mok MY, Lee KW, Wong SN, Leung AMH, Li XP, Avihingsanon Y, Lee TL, Ho MHK, Lee PPW, Wong WHS, Wong CM, Ng IOL, Yang J, Li PH, Zhang Y, Zhang L, Li W, Baum L, Kwan P, Rianthavorn P, Deekajorndej T, Suphapeetiporn K, Shotelersuk V, Garcia-Barceló MM, Cherny SS, Tam PKH, Sham PC, Lau CS, Shen N, Lau YL, Ye DQ. Association of CD247 with systemic lupus erythematosus in Asian populations. Lupus 2011; 21:75-83. [PMID: 22004975 DOI: 10.1177/0961203311422724] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Systemic lupus erythematosus (SLE) is a prototypic autoimmune disease with complex genetic inheritance. CD247 (CD3Z, TCRZ) plays a vital role in antigen recognition and signal transduction in antigen-specific immune responses, and is known to be involved in SLE pathogenesis. Weak disease association was reported for genetic variants in this gene in Caucasian studies for SLE, Crohn's disease and systemic sclerosis, but its role as a genetic risk factor was never firmly established. METHODS In this study, using a collection of 612 SLE patients and 2193 controls of Chinese ethnicity living in Hong Kong in a genome-wide study, single nucleotide polymorphisms (SNPs) in and around CD247 were identified as being associated with SLE. The two most significant SNPs in this locus were selected for further replication using TaqMan genotyping assay in 3339 Asian patients from Hong Kong, Mainland China, and Thailand, as well as 4737 ethnically and geographically matched controls. RESULTS The association of CD247 with SLE in Asian populations was confirmed (rs704853: odds ratio [OR] = 0. 81, p = 2.47 × 10(-7); rs858543: OR = 1.10, p = 0.0048). Patient-only analysis suggested that rs704853 is also linked to oral ulcers, hematologic disorders and anti-double-stranded DNA (dsDNA) antibody production. CONCLUSION A significant association between variants in CD247 and SLE was demonstrated in Asian populations. Understanding the involvement of CD247 in SLE may shed new light on disease mechanisms and development of new treatment paradigms.
Collapse
Affiliation(s)
- R Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Chan A, Cheung YF, Yeung MA, Yeung J, Chung TH, Tsang KL, Chan J, Lau C, Kwan P, Kuo SH, Mok V. A validation study of the Chinese wearing off questionnaire 9-symptom for Parkinson's disease. Clin Neurol Neurosurg 2011; 113:538-40. [PMID: 21507565 DOI: 10.1016/j.clineuro.2011.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 02/10/2011] [Accepted: 03/19/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Development of wearing off (WO) often goes unnoticed for both patients with Parkinson's disease (PD) and physicians due to the complexity of this phenomenon. A brief 9-symptom WO questionnaire (WOQ-9) was recently found to be highly sensitive in its detection. We aimed to validate a Chinese version WOQ-9 (CWOQ-9) among Chinese patients with PD. METHODS We recruited 101 literate Chinese PD patients among 4 different neurology or movement disorders clinics in Hong Kong to participate in this study by completing the CWOQ-9. Clinical judgment by the specialists was considered the gold standard for diagnosing WO. RESULTS The mean age (±SD) of the patients was 61 (±9) years and 35 (34.7%) of them were female. The disease duration was 7.4 (±5.4) years and 69 (68.3%) of them were diagnosed clinically to have WO by the specialists. The positive and negative predictive values, sensitivity and specificity of CWOQ-9 were 86%, 71%, 87%, and 69% respectively. The area under curve (AUC) was 0.78 (p<0.001). CONCLUSION This simple patient questionnaire is a valid tool for the detection of WO among Chinese PD patients.
Collapse
Affiliation(s)
- A Chan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Rosenfeld GA, Chang A, Poulin M, Kwan P, Yoshida E. Cholestatic jaundice, acute kidney injury and acute pancreatitis secondary to the recreational use of methandrostenolone: a case report. J Med Case Rep 2011; 5:138. [PMID: 21470406 PMCID: PMC3079674 DOI: 10.1186/1752-1947-5-138] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Accepted: 04/06/2011] [Indexed: 12/02/2022] Open
Abstract
Introduction Over the last few years the use of anabolic steroids has become increasingly common amongst amateur athletes and for aesthetic purposes. As a result, the adverse events related to their use are being seen more frequently. Methandrostenolone is an anabolic steroid which is widely available and has been used for both performance enhancement and aesthetic purposes. This drug has also been reported to cause cholestasis of the intra-hepatic bile ducts resulting in elevated aminotransferases, hyperbilirubinemia and clinical jaundice. However, to the best of our knowledge this agent has not been previously reported to cause pancreatitis or acute kidney injury. Case presentation In this paper, we report the case of a 50-year-old man of Indian descent who presented with a six week history of diffuse abdominal pain, anorexia and weight loss following an eight week cycle of methandrostenolone use. At initial presentation, his lipase level was 785 U/L, bilirubin was 922 μmol/L and creatinine was 200 U/L while his aspartate aminotransferase and alanine aminotransferase levels were only mildly elevated at 61 U/L and 56 U/L respectively. His lipase peaked on day nine at >3000 U/L whilst his creatinine level was 299 U/L. Imaging was consistent with acute pancreatitis while a liver biopsy was consistent with intra-hepatic cholestasis and a kidney biopsy revealed evidence of acute tubular necrosis. Conclusion Both acute pancreatitis and acute kidney injury have rarely been reported with anabolic steroid use and they have not been previously reported to occur in the same patient. This case demonstrates some potentially new and serious adverse consequences occurring with the use of anabolic steroids, of which physicians need to be aware.
Collapse
Affiliation(s)
- Greg A Rosenfeld
- Department of Medicine, University of British Columbia, 5th Floor, Gordon and Leslie Diamond Health Care Centre, 2775 Laurel St, Vancouver, BC, V5Z 1M9, Canada.
| | | | | | | | | |
Collapse
|
41
|
Wang J, Hori K, Ding J, Huang Y, Kwan P, Ladak A, Tredget EE. Toll-like receptors expressed by dermal fibroblasts contribute to hypertrophic scarring. J Cell Physiol 2011; 226:1265-73. [DOI: 10.1002/jcp.22454] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
42
|
Murdoch D, Gibbs H, Blenkhorn A, Mumford D, Kwan P. A New Cardiac Catheterisation Laboratory in Northern NSW: Experiences of the First Year. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.05.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
43
|
Liaw YF, Sheen IS, Lee CM, Akarca US, Papatheodoridis GV, Suet-Hing Wong F, Chang TT, Horban A, Wang C, Kwan P, Buti M, Prieto M, Berg T, Kitrinos K, Peschell K, Mondou E, Frederick D, Rousseau F, Schiff ER. Tenofovir disoproxil fumarate (TDF), emtricitabine/TDF, and entecavir in patients with decompensated chronic hepatitis B liver disease. Hepatology 2011; 53:62-72. [PMID: 21254162 DOI: 10.1002/hep.23952] [Citation(s) in RCA: 252] [Impact Index Per Article: 19.4] [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: 07/16/2010] [Accepted: 08/19/2010] [Indexed: 12/12/2022]
Abstract
UNLABELLED Data are limited on the safety and effectiveness of oral antivirals other than lamivudine and adefovir dipivoxil for treatment of chronic hepatitis B (CHB) in patients with decompensated liver disease. This Phase 2, double-blind study randomized 112 patients with CHB and decompensated liver disease to receive either tenofovir disoproxil fumarate (TDF; n = 45), emtricitabine (FTC)/TDF (fixed-dose combination; n = 45), or entecavir (ETV; n = 22). The primary endpoint was safety; more specifically, tolerability failure (adverse events resulting in permanent treatment discontinuation) and confirmed serum creatinine increase ≥ 0.5 mg/dL from baseline or confirmed serum phosphorus <2 mg/dL. Patients with insufficient viral suppression (e.g., confirmed HBV DNA ≥ 400 copies/mL at week 8 or 24) could begin open-label FTC/TDF but were considered failures in this interim week 48 analysis for efficacy endpoints. Tolerability failure was infrequent across arms: 6.7% TDF, 4.4% FTC/TDF, and 9.1% ETV (P = 0.622) as were confirmed renal parameters meeting threshold 8.9%, 6.7%, and 4.5% (P = 1.000), respectively. Six patients died (none considered related to study drug) and six received liver transplants (none had HBV recurrence). The adverse event and laboratory profiles were consistent with advanced liver disease and complications, with no unexpected safety signals. At week 48, HBV DNA was <400 copies/mL (69 IU/mL) in 70.5% (TDF), 87.8% (FTC/TDF), and 72.7% (ETV) of patients. Proportions with normal alanine aminotransferase were: 57% (TDF), 76% (FTC/TDF), and 55% (ETV). Hepatitis B e antigen (HBeAg) loss/seroconversion occurred in 21%/21% (TDF), 27%/13% (FTC/TDF), and 0%/0% (ETV). Child-Turcotte-Pugh and Modification for End-stage Liver Disease scores improved in all groups. CONCLUSION All treatments were well tolerated in patients with decompensated liver disease due to CHB with improvement in virologic, biochemical, and clinical parameters.
Collapse
Affiliation(s)
- Yun-Fan Liaw
- Liver Research unit, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Wu XT, Hu FY, An DM, Yan B, Jiang X, Kwan P, Stefan H, Zhou D. Association between carbamazepine-induced cutaneous adverse drug reactions and the HLA-B*1502 allele among patients in central China. Epilepsy Behav 2010; 19:405-8. [PMID: 20833111 DOI: 10.1016/j.yebeh.2010.08.007] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [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: 05/17/2010] [Revised: 07/08/2010] [Accepted: 08/05/2010] [Indexed: 10/19/2022]
Abstract
The aim of this study was to investigate the association between carbamazepine (CBZ)-induced cutaneous adverse drug reactions (cADRs) and the HLA-B*1502 allele among patients from central China. Eight patients with Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN), 28 with mild maculopapular eruptions (MPEs), 50 CBZ-tolerant controls, and 71 healthy volunteers were recruited. HLA genotyping was performed using the polymerase chain reaction sequence-based typing (SBT) method. As a result, the HLA-B*1502 allele was observed at the following rates: (1) 100% (8/8) among those with CBZ-induced SJS/TEN, (2) 10.7% (3/28) among those with CBZ-induced MPEs; (3) 8.0% (4/50) among CBZ-tolerant controls; (4) 8.5% (6/71) among healthy volunteers. The eight patients with SJS/TEN positive for the HLA-B*1502 allele had an odds ratio (OR) of 184 compared with CBZ-tolerant controls. There was no significant difference in frequency between patients with MPEs and CBZ-tolerant controls (P>0.05). Thus, CBZ-induced SJS/TEN, but not MPEs, is strongly associated with HLA-B*1502. Testing for HLA-B*1502 should be recommended for patients from central China prior to initial CBZ treatment.
Collapse
Affiliation(s)
- X T Wu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Kwan P, Arzimanoglou A, Berg A, Brodie M, Hauser W, Mathern G, Moshé S, Perucca E, Wiebe S, French J. Definition der pharmakoresistenten Epilepsie: Konsensusvorschlag der ad hoc-Task Force der ILAE-Kommission für Therapeutische Strategien. Akt Neurol 2010. [DOI: 10.1055/s-0030-1265943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
46
|
Kwan P. S47-3 Drug treatment of epilepsy. Clin Neurophysiol 2010. [DOI: 10.1016/s1388-2457(10)60282-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
47
|
Abstract
Dysregulated wound healing and pathologic fibrosis cause abnormal scarring, leading to poor functional and aesthetic results in hand burns. Understanding the underlying biologic mechanisms involved allows the hand surgeon to better address these issues, and suggests new avenues of research to improve patient outcomes. In this article, the authors review the biology of scar and contracture by focusing on potential causes of abnormal wound healing, including depth of injury, cytokines, cells, the immune system, and extracellular matrix, and explore therapeutic measures designed to target the various biologic causes of poor scar.
Collapse
Affiliation(s)
- Peter Kwan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, 2D2.28 WMC, University of Alberta, 8440-112 Street, Edmonton, AB T6G 2B7, Canada
| | | | | | | |
Collapse
|
48
|
Gomez-Iturriaga A, Crook J, Saibishkumar E, Borg J, Ma C, Kwan P. 9 THE IMPACT OF PERINEURAL INVASION (PNI) ON BIOCHEMICAL OUTCOME FOLLOWING 125I PROSTATE BRACHYTHERAPY. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)72396-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
49
|
Leung H, Man CY, Hui ACF, Wong KS, Kwan P. Agreement between initial and final diagnosis of first seizures, epilepsy and non-epileptic events: a prospective study. J Neurol Neurosurg Psychiatry 2008; 79:1144-7. [PMID: 18270232 DOI: 10.1136/jnnp.2007.139048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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: 11/04/2022]
Abstract
BACKGROUND Differentiating between first seizure, epilepsy and a non-epileptic event is a challenging clinical exercise for many physicians as it may lead to different therapeutic implications. This study aims to investigate the agreement between the initial diagnosis at the accident and emergency (A&E) department and the final diagnosis following inpatient neurological evaluation of seizure disorders. METHOD A prospective observational study between April 2004 and June 2005 in a regional hospital in Hong Kong recruited 1701 patients from the A&E to neurology/medical wards with initial diagnoses/labels matching any one of 12 predefined keywords which were categorised as either "seizure specific" or "non-specific". RESULTS Among the 1170 patients with "non-specific" initial diagnoses/labels, 58 (5%) were finally diagnosed as having had a first seizure or epilepsy. Among 531 patients with "seizure specific" initial diagnoses/labels, 27 (5.1%) were subsequently diagnosed as having had non-epileptic events. The kappa value for agreement between the initial and final diagnosis was 0.88. Of the 154 patients with a final diagnosis of first seizure, 34 (22%) had "non-specific" initial labels. Among these patients, components of the evaluation contributing to revision of diagnosis included retrieval of witness accounts (47%), epileptiform discharges on EEG (47%), short term monitoring in patients suspected of acute symptomatic seizures (28%) and panel discussion of cases (22%). CONCLUSION There was generally a high degree of agreement between the initial and final diagnosis, but first seizures were often missed initially. Careful history taking, judicious use of EEG, selective short term monitoring and liaison with specialists are important in reaching an accurate diagnosis.
Collapse
Affiliation(s)
- H Leung
- Department of Medicine and Therapeutics, Division of Neurology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.
| | | | | | | | | |
Collapse
|
50
|
McKibbin T, Kwan P, Simon J, Koeller J. Rapid adoption of chemotherapy regimens for advanced colorectal cancer (CRC) in the community oncology setting. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.6563] [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: 11/20/2022] Open
|