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Tan DJH, Ng CH, Muthiah M, Yong JN, Chee D, Teng M, Wong ZY, Zeng RW, Chin YH, Wang JW, Danpanichkul P, Rajaram RB, DasGupta R, Suzuki H, Takahashi H, Tamaki N, Dan YY, Lui R, Duseja A, Siddiqui MS, Yeoh KG, Sanyal A, Wijarnpreecha K, Loomba R, Mantzoros CS, Huang DQ. Rising global burden of cancer attributable to high BMI from 2010 to 2019. Metabolism 2024; 152:155744. [PMID: 38029839 DOI: 10.1016/j.metabol.2023.155744] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 11/15/2023] [Accepted: 11/21/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND High body mass index (BMI) is a major risk factor for cancer development, but its impact on the global burden of cancer remains unclear. METHODS We estimated global and regional temporal trends in the burden of cancer attributable to high BMI, and the contributions of various cancer types using the framework of the Global Burden of Disease Study. RESULTS From 2010 to 2019, there was a 35 % increase in deaths and a 34 % increase in disability-adjusted life-years from cancers attributable to high BMI. The age-standardized death rates for cancer attributable to high BMI increased over the study period (annual percentage change [APC] +0.48 %, 95 % CI 0.22 to 0.74 %). The greatest number of deaths from cancer attributable to high BMI occurred in Europe, but the fastest-growing age-standardized death rates and disability-adjusted life-years occurred in Southeast Asia. Liver cancer was the fastest-growing cause of cancer mortality (APC: 1.37 %, 95 % CI 1.25 to 1.49 %) attributable to high BMI. CONCLUSION The global burden of cancer-related deaths attributable to high BMI has increased substantially from 2010 to 2019. The greatest increase in age-standardized death rates occurred in Southeast Asia, and liver cancer is the fastest-growing cause of cancer mortality attributable to high BMI. Urgent and sustained measures are required at a global and regional level to reverse these trends and slow the growing burden of cancer attributed to high BMI.
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Affiliation(s)
- Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Cheng Han Ng
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore.
| | - Mark Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore
| | - Jie Ning Yong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Douglas Chee
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore
| | - Margaret Teng
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore
| | - Zhen Yu Wong
- Nottingham Hospitals University Trust, Nottingham, England, United Kingdom
| | | | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jiong-Wei Wang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore
| | - Pojsakorn Danpanichkul
- Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Ruveena Bhavani Rajaram
- Department of Medicine, Universiti Malaya Medical Centre, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Ramanuj DasGupta
- Laboratory of Precision Oncology and Cancer Evolution, Genome Institute of Singapore, A*STAR, Singapore, Singapore
| | - Hiroyuki Suzuki
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Hirokazu Takahashi
- Division of Metabolism and Endocrinology, Faculty of Medicine, Saga University, Saga, Japan
| | - Nobuharu Tamaki
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Yock Young Dan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore
| | - Rashid Lui
- Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Ajay Duseja
- Department of Hepatology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Mohammad Shadab Siddiqui
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, United States
| | - Khay Guan Yeoh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore
| | - Arun Sanyal
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, United States
| | - Karn Wijarnpreecha
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Rohit Loomba
- NAFLD Research Center, Division of Gastroenterology, University of California at San Diego, La Jolla, CA, United States; Division of Epidemiology, Department of Family Medicine and Public Health, University of California at San Diego, La Jolla, CA, United States
| | - Christos Socrates Mantzoros
- Departments of Internal Medicine, Boston VA Healthcare System, and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States; Faculty of Medicine, Harvard University, Boston, MA, United States
| | - Daniel Q Huang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore.
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2
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Mok K, Wu C, Chan S, Wong G, Wong VWS, Ma B, Lui R. Clinical Management of Gastrointestinal and Liver Toxicities of Immune Checkpoint Inhibitors. Clin Colorectal Cancer 2024; 23:4-13. [PMID: 38172003 DOI: 10.1016/j.clcc.2023.12.003] [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: 11/02/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 01/05/2024]
Abstract
Immune checkpoint inhibitors have transformed the treatment paradigm for various types of cancer. Nonetheless, with the utilization of these groundbreaking treatments, immune-related adverse events (irAEs) are increasingly encountered. Colonic and hepatic involvement are among the most frequently encountered irAEs. Drug-induced side effects, infectious causes, and tumor-related symptoms are the key differentials for irAE complications. Potential risk factors for the development of irAEs include combination use of immune checkpoint inhibitors, past development of irAEs with other immunotherapy treatments, certain concomitant drugs, and a pre-existing personal or family history of autoimmune illness such as inflammatory bowel disease. The importance of early recognition, timely and proper management cannot be understated, as there are profound clinical implications on the overall cancer treatment plan and prognosis once these adverse events occur. Herein, we cover the clinical management of the well-established gastrointestinal irAEs of enterocolitis and hepatitis, and also provide an overview of several other emerging entities.
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Affiliation(s)
- Kevin Mok
- Department of Clinical Oncology, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Claudia Wu
- Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China; Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Stephen Chan
- State Key Laboratory of Translational Oncology, Department of Clinical Oncology, Sir YK Pao Centre for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Grace Wong
- Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China; Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Vincent Wai-Sun Wong
- Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China; Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Brigette Ma
- Department of Clinical Oncology, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China; Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Rashid Lui
- Department of Clinical Oncology, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China; Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China; Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong SAR, China.
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3
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Danpanichkul P, Moolkaew P, Kanjanakot Y, Polpichai N, Jaroenlapnopparat A, Kim D, Lukens FJ, Wassef W, Fallon MB, Chen VL, Lui R, Wijarnpreecha K. Rising incidence and impact of early-onset colorectal cancer in the Asia-Pacific with higher mortality in females from Southeast Asia: a global burden analysis from 2010 to 2019. J Gastroenterol Hepatol 2023; 38:2053-2060. [PMID: 37644698 DOI: 10.1111/jgh.16331] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/15/2023] [Accepted: 08/02/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND AND AIM Early-onset colorectal cancer (CRC) is a growing global health concern, especially in the Asia-Pacific region. However, comprehensive research on this topic from the region is lacking. Our study aims to investigate trends in early-onset CRC in Asia over 10 years, filling this research gap. METHODS This study utilized data from the Global Burden of Disease Study 2019 to assess temporal trends in early-onset CRC in the Asia-Pacific. The analysis included estimating annual frequencies and age-standardized rates (ASRs) of early-onset CRC incidence, death, and disability-adjusted life-years (DALYs) by gender. RESULTS The incidence of early-onset CRC significantly increased in both regions with higher increase and in the Western Pacific region. Notable increases were observed among males in the Western Pacific and females in Southeast Asia (SEA). Mortality rates remained stable in the Western Pacific but increased by 10.6% in SEA, especially among females. DALYs due to CRC also increased significantly in SEA, with a greater rise among females. The Western Pacific had the highest CRC incidence, and in SEA, the mortality rate was higher in females than males. CONCLUSIONS Our study reveals a substantial increase in early-onset CRC in the Asia-Pacific underscoring the urgency for effective interventions. Thus, a comprehensive approach comprising controlled risk reduction, health promotion to heightened disease awareness, and implementation of effective screening strategies should be executed timely to mitigate the burden of early-onset CRC.
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Affiliation(s)
- Pojsakorn Danpanichkul
- Immunology Unit, Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pinyada Moolkaew
- Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Yatawee Kanjanakot
- Department of Surgery, School of Medicine, Mae Fah Luang University, Chiang Rai, Thailand
| | - Natchaya Polpichai
- Department of Internal Medicine, Weiss Memorial Hospital, Chicago, Illinois, USA
| | | | - Donghee Kim
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Frank J Lukens
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Wahid Wassef
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Arizona College of Medicine, Phoenix, Arizona, USA
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Banner University Medical Center, Phoenix, Arizona, USA
| | - Michael B Fallon
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Arizona College of Medicine, Phoenix, Arizona, USA
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Banner University Medical Center, Phoenix, Arizona, USA
| | - Vincent L Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Rashid Lui
- Department of Clinical Oncology, and Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics, Institute of Digestive Diseases, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Karn Wijarnpreecha
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Arizona College of Medicine, Phoenix, Arizona, USA
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Banner University Medical Center, Phoenix, Arizona, USA
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4
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Devi J, Chan TT, Lui R, Ali RAR. Fixing the leaky pipeline: gender imbalance in gastroenterology in Asia-Pacific region. J Gastroenterol Hepatol 2023; 38:2047-2049. [PMID: 37743674 DOI: 10.1111/jgh.16353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/27/2023] [Accepted: 08/26/2023] [Indexed: 09/26/2023]
Affiliation(s)
- Jalpa Devi
- Asian Institute of Medical Sciences, Hyderabad, Pakistan
- Barnes Jewish Hospital Washington University, St. Louis, Missouri, USA
| | - Ting Ting Chan
- Institute of Digestive Disease, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Rashid Lui
- Institute of Digestive Disease, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Raja Affendi Raja Ali
- School of Medical and Life Sciences, Sunway University, Subang Jaya, Malaysia
- Gut research group, Faculty of Medicine, The National University of Malaysia, Bandar Baru Bangi, Malaysia
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5
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Furuhama A, Kitazawa A, Yao J, Matos Dos Santos CE, Rathman J, Yang C, Ribeiro JV, Cross K, Myatt G, Raitano G, Benfenati E, Jeliazkova N, Saiakhov R, Chakravarti S, Foster RS, Bossa C, Battistelli CL, Benigni R, Sawada T, Wasada H, Hashimoto T, Wu M, Barzilay R, Daga PR, Clark RD, Mestres J, Montero A, Gregori-Puigjané E, Petkov P, Ivanova H, Mekenyan O, Matthews S, Guan D, Spicer J, Lui R, Uesawa Y, Kurosaki K, Matsuzaka Y, Sasaki S, Cronin MTD, Belfield SJ, Firman JW, Spînu N, Qiu M, Keca JM, Gini G, Li T, Tong W, Hong H, Liu Z, Igarashi Y, Yamada H, Sugiyama KI, Honma M. Evaluation of QSAR models for predicting mutagenicity: outcome of the Second Ames/QSAR international challenge project. SAR QSAR Environ Res 2023; 34:983-1001. [PMID: 38047445 DOI: 10.1080/1062936x.2023.2284902] [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] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/13/2023] [Indexed: 12/05/2023]
Abstract
Quantitative structure-activity relationship (QSAR) models are powerful in silico tools for predicting the mutagenicity of unstable compounds, impurities and metabolites that are difficult to examine using the Ames test. Ideally, Ames/QSAR models for regulatory use should demonstrate high sensitivity, low false-negative rate and wide coverage of chemical space. To promote superior model development, the Division of Genetics and Mutagenesis, National Institute of Health Sciences, Japan (DGM/NIHS), conducted the Second Ames/QSAR International Challenge Project (2020-2022) as a successor to the First Project (2014-2017), with 21 teams from 11 countries participating. The DGM/NIHS provided a curated training dataset of approximately 12,000 chemicals and a trial dataset of approximately 1,600 chemicals, and each participating team predicted the Ames mutagenicity of each trial chemical using various Ames/QSAR models. The DGM/NIHS then provided the Ames test results for trial chemicals to assist in model improvement. Although overall model performance on the Second Project was not superior to that on the First, models from the eight teams participating in both projects achieved higher sensitivity than models from teams participating in only the Second Project. Thus, these evaluations have facilitated the development of QSAR models.
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Affiliation(s)
- A Furuhama
- Division of Genetics and Mutagenesis (DGM), National Institute of Health Sciences (NIHS), Kawasaki, Japan
| | - A Kitazawa
- Division of Genetics and Mutagenesis (DGM), National Institute of Health Sciences (NIHS), Kawasaki, Japan
| | - J Yao
- Key Laboratory of Fluorine and Nitrogen Chemistry and Advanced Materials (Chinese Academy of Sciences), Shanghai Institute of Organic Chemistry, Chinese Academy of Sciences (SIOC, CAS), Shanghai, China
| | - C E Matos Dos Santos
- Department of Computational Toxicology and In Silico Innovations, Altox Ltd, São Paulo-SP, Brazil
| | - J Rathman
- MN-AM, Nuremberg, Germany/Columbus, OH, USA
| | - C Yang
- MN-AM, Nuremberg, Germany/Columbus, OH, USA
| | | | - K Cross
- In Silico Department, Instem, Conshohocken, PA, USA
| | - G Myatt
- In Silico Department, Instem, Conshohocken, PA, USA
| | - G Raitano
- Laboratory of Environmental Toxicology and Chemistry, Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS (IRFMN), Milano, Italy
| | - E Benfenati
- Laboratory of Environmental Toxicology and Chemistry, Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS (IRFMN), Milano, Italy
| | | | | | | | | | - C Bossa
- Environment and Health Department, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - C Laura Battistelli
- Environment and Health Department, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - R Benigni
- Environment and Health Department, Istituto Superiore di Sanità (ISS), Rome, Italy
- Alpha-PreTox, Rome, Italy
| | - T Sawada
- Faculty of Regional Studies, Gifu University, Gifu, Japan
- xenoBiotic Inc, Gifu, Japan
| | - H Wasada
- Faculty of Regional Studies, Gifu University, Gifu, Japan
| | - T Hashimoto
- Faculty of Regional Studies, Gifu University, Gifu, Japan
| | - M Wu
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | - R Barzilay
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | - P R Daga
- Simulations Plus, Lancaster, CA, USA
| | - R D Clark
- Simulations Plus, Lancaster, CA, USA
| | | | | | | | - P Petkov
- LMC - Bourgas University, Bourgas, Bulgaria
| | - H Ivanova
- LMC - Bourgas University, Bourgas, Bulgaria
| | - O Mekenyan
- LMC - Bourgas University, Bourgas, Bulgaria
| | - S Matthews
- Computational Pharmacology & Toxicology Laboratory, Discipline of Pharmacology, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - D Guan
- Computational Pharmacology & Toxicology Laboratory, Discipline of Pharmacology, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - J Spicer
- Computational Pharmacology & Toxicology Laboratory, Discipline of Pharmacology, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - R Lui
- Computational Pharmacology & Toxicology Laboratory, Discipline of Pharmacology, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Y Uesawa
- Department of Medical Molecular Informatics, Meiji Pharmaceutical University, Tokyo, Japan
| | - K Kurosaki
- Department of Medical Molecular Informatics, Meiji Pharmaceutical University, Tokyo, Japan
| | - Y Matsuzaka
- Department of Medical Molecular Informatics, Meiji Pharmaceutical University, Tokyo, Japan
| | - S Sasaki
- Department of Medical Molecular Informatics, Meiji Pharmaceutical University, Tokyo, Japan
| | - M T D Cronin
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | - S J Belfield
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | - J W Firman
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | - N Spînu
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | - M Qiu
- Evergreen AI, Inc, Toronto, Canada
| | - J M Keca
- Evergreen AI, Inc, Toronto, Canada
| | - G Gini
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milano, Italy
| | - T Li
- Division of Bioinformatics and Biostatistics, National Center for Toxicological Research, U.S. Food and Drug Administration (NCTR/FDA), Jefferson, AR, USA
| | - W Tong
- Division of Bioinformatics and Biostatistics, National Center for Toxicological Research, U.S. Food and Drug Administration (NCTR/FDA), Jefferson, AR, USA
| | - H Hong
- Division of Bioinformatics and Biostatistics, National Center for Toxicological Research, U.S. Food and Drug Administration (NCTR/FDA), Jefferson, AR, USA
| | - Z Liu
- Division of Bioinformatics and Biostatistics, National Center for Toxicological Research, U.S. Food and Drug Administration (NCTR/FDA), Jefferson, AR, USA
- Integrative Toxicology, Nonclinical Drug Safety, Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, CT, USA
| | - Y Igarashi
- Artificial Intelligence Center for Health and Biomedical Research, National Institutes of Biomedical Innovation, Health and Nutrition (NIBIOHN), Osaka, Japan
| | - H Yamada
- Artificial Intelligence Center for Health and Biomedical Research, National Institutes of Biomedical Innovation, Health and Nutrition (NIBIOHN), Osaka, Japan
| | - K-I Sugiyama
- Division of Genetics and Mutagenesis (DGM), National Institute of Health Sciences (NIHS), Kawasaki, Japan
| | - M Honma
- Division of Genetics and Mutagenesis (DGM), National Institute of Health Sciences (NIHS), Kawasaki, Japan
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6
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Leung PY, Lui R, Chien MM. Asia-Pacific's first position papers on pediatric inflammatory bowel disease: Tackling unique challenges in the region. J Gastroenterol Hepatol 2023; 38:481-482. [PMID: 37059693 DOI: 10.1111/jgh.16184] [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: 04/16/2023]
Affiliation(s)
- Po-Yee Leung
- Department of Paediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Rashid Lui
- Department of Medicine and Therapeutics, Division of Gastroenterology and Hepatology, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, SAR, China
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Mu-Ming Chien
- Department of Paediatrics, Taipei Medical University Hospital, Taipei, Taiwan
- Taipei Medical University Research Center for Digestive Medicine, Taipei Medical University, Taipei, Taiwan
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7
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Affiliation(s)
- H W Pun
- Department of Optometry Queensland Institute of Technology PO Box 2434 Brisbane. 4001, Australia
| | - Man Brown
- Department of Optometry Queensland Institute of Technology PO Box 2434 Brisbane. 4001, Australia
| | - R. Lui
- Department of Optometry Queensland Institute of Technology PO Box 2434 Brisbane. 4001, Australia
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8
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Pellino G, Pata F, Lui R, Espín-Basany E. A word of caution and call for cross-society collaboration to develop surgical guidance about COVID-19. Br J Surg 2020; 107:e245. [PMID: 32418196 PMCID: PMC7276747 DOI: 10.1002/bjs.11689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 11/09/2022]
Affiliation(s)
- G Pellino
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy.,Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - F Pata
- General Surgery Unit, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy.,La Sapienza University, Rome, Italy
| | - R Lui
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - E Espín-Basany
- Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
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9
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Affiliation(s)
- Keith Siau
- Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Gastroenterology Unit, Dudley Group Hospitals NHS Foundation Trust, Dudley, UK
| | - Rashid Lui
- Division of Gastroenterology and Hepatology, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Sultan Mahmood
- Division of Gastroenterology, Hepatology and Nutrition, University at Buffalo, Buffalo, USA
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10
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Mak ADP, Ho YM, Leung ONW, Chou IWY, Lui R, Wong S, Yeung DKW, Chu WCW, Edden R, Chan S, Lam L, Wu J. Unaltered Brain GABA Concentrations and Resting fMRI Activity in Functional Dyspepsia With and Without Comorbid Depression. Front Psychiatry 2020; 11:549749. [PMID: 33061916 PMCID: PMC7518235 DOI: 10.3389/fpsyt.2020.549749] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/24/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND GABA-deficit characterizes depression (MDD), which is highly comorbid with Functional Dyspepsia (FD). We examined brain GABA concentrations and resting activities in post-prandial distress subtype FD (FD-PDS) patients with and without MDD. METHODS 24 female age/education-matched FD-PDS with comorbid MDD (FD-PDS-MDD), non-depressed FD-PDS, and healthy controls each were compared on GABA concentrations, resting fMRI (fALFF) in bilateral pregenual anterior cingulate (pgACC), left dorsolateral prefrontal cortex (DLPFC), insula, and somatosensory cortex (SSC). RESULTS FD-PDS-MDD patients had mild though elevated depressive symptoms. FD-PDS patients had generally mild dyspeptic symptoms. No significant between-group differences in GABA or fALFF were found. No significant correlations were found between GABA and depressive/dyspeptic symptoms after Bonferroni correction. In patients, GABA correlated positively with left insula fALFF (r = 0.38, Bonferroni-corrected p = .03). CONCLUSION We did not find altered GABA concentrations or brain resting activity in FD-PDS or its MDD comorbidity. The neurochemical link between MDD and FD remains elusive.
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Affiliation(s)
- Arthur D P Mak
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Yuen Man Ho
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Owen N W Leung
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Idy Wing Yi Chou
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Rashid Lui
- Institute of Digestive Disease, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Sunny Wong
- Institute of Digestive Disease, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - David K W Yeung
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Winnie C W Chu
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Richard Edden
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Sandra Chan
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Linda Lam
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Justin Wu
- Institute of Digestive Disease, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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11
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Wong KMF, Mak ADP, Yuen SY, Leung ONW, Ma DY, Chan Y, Cheong PK, Lui R, Wong SH, Wu JCY. Nature and specificity of altered cognitive functioning in IBS. Neurogastroenterol Motil 2019; 31:e13696. [PMID: 31389109 DOI: 10.1111/nmo.13696] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 07/17/2019] [Accepted: 07/23/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND It is unknown whether cognitive dysfunction found in patients with irritable bowel syndrome (IBS) was attributable to the different subtypes, ongoing pathophysiological processes, trait characteristics, or psychiatric comorbidity. METHODS Forty Rome-III patients with IBS (20 diarrhea-predominant [IBS-D] and 20 constipation-predominant [IBS-C]) and 40 age-, sex-, education-matched healthy controls were systematically recruited and compared on their cognitive function with continuous performance test (CPT), Wisconsin Card Sorting Test (WCST) and emotional Stroop test. Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), Patient Health Questionnaire-15 (PHQ-15) and a structured bowel symptom questionnaire were performed to measure anxiety, depressive, somatization, and bowel symptoms, respectively. Psychiatric diagnoses were ascertained with SCID-I (Structured Clinical Interview for DSM-IV Axis I Disorders). KEY RESULTS Patients with IBS showed significantly increased standard deviation of reaction time (SDRT) (P = .003) on CPT, increased failure to maintain set (FMS) (P=.002), and percentage of perseverative errors (P = .003) on WCST. SDRT did not correlate with illness chronicity or bowel symptoms. FMS correlated with bowel symptom severity. In logistic regression models controlled for BAI, BDI-II, and PHQ-15, SDRT (AOR = 1.08, P = .025), but not FMS (P = .25) or percentage of perseverative errors (P = .24), significantly differentiated IBS from controls. Cognitive function was not significantly different between IBS-C and IBS-D (P > .05), or between pure IBS (n = 22) and IBS with generalized anxiety disorder (GAD) (n = 17) (P > .05). CONCLUSIONS & INFERENCES Patients with IBS showed attentional and executive function impairment irrespective of subtypes but otherwise heterogeneous in terms of its state-trait correlations and overlap with anxiety comorbidity.
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Affiliation(s)
| | - Arthur Dun Ping Mak
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Suet Ying Yuen
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Owen Ngo Wang Leung
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Duan Yang Ma
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Yawen Chan
- Institute of Digestive Diseases, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Pui Kuan Cheong
- Institute of Digestive Diseases, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Rashid Lui
- Institute of Digestive Diseases, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Sunny Hei Wong
- Institute of Digestive Diseases, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Justin Che-Yuen Wu
- Institute of Digestive Diseases, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
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12
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Mak ADP, Chung VCH, Yuen SY, Tse YK, Wong SYS, Ju Y, Hung SS, Leung KC, You JHS, Lui R, Wong SH, Leung ONW, Lam LCW, Lee S, Wu JCY. Noneffectiveness of electroacupuncture for comorbid generalized anxiety disorder and irritable bowel syndrome. J Gastroenterol Hepatol 2019; 34:1736-1742. [PMID: 30891824 DOI: 10.1111/jgh.14667] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 03/01/2019] [Revised: 03/12/2019] [Accepted: 03/15/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM Comorbid generalized anxiety disorder and irritable bowel syndrome are common and therapeutically challenging. We aimed to assess the effectiveness of electroacupuncture in relieving anxiety and bowel symptoms in Chinese adults with this form of comorbidity. METHODS In a single-blind randomized sham-controlled trial, subjects with comorbid generalized anxiety disorder and irritable bowel syndrome were randomly assigned to receive 10 weekly sessions of electroacupuncture or sham electroacupuncture. Patients were assessed at baseline, immediately after intervention and at 6-week follow-up. Primary outcome was anxiety (7-item Patient Health Questionnaire section for anxiety). Secondary outcomes included bowel symptoms (bowel symptoms questionnaire), depressive symptoms (9-item Patient Health Questionnaire), somatic symptoms (15-item Patient Health Questionnaire), and health-related quality of life (EuroQol-5 Dimensions). RESULTS Eighty subjects, 40 in each arm, were randomized. All but two in the sham group completed 10 weekly sessions. There was no significant difference in the proportion of patients experiencing significant (≥ 50%) reduction of anxiety symptoms between the two groups immediately after intervention (32.4% vs 21.6%, P = 0.06) and at 6-week follow-up (25.7% in electroacupuncture vs 27% in sham, P = 0.65). Anxiety, depressive symptom, and bowel symptom severity did not differ significantly between electroacupuncture and sham groups. CONCLUSIONS Findings failed to support the effectiveness of electroacupuncture for comorbid generalized anxiety disorder and irritable bowel syndrome. Further studies are needed to identify effective acupuncture treatment protocols for such comorbidity.
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Affiliation(s)
- Arthur Dun-Ping Mak
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Vincent Chi Ho Chung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Suet Ying Yuen
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Yee Kit Tse
- Institute of Integrative Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Samuel Yeung Shan Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Yanli Ju
- Institute of Integrative Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Sheung Sheung Hung
- Institute of Integrative Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ka Chun Leung
- Institute of Integrative Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Joyce Hoi Sze You
- Centre for Pharmacoeconomics Research, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Rashid Lui
- Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Sunny Hei Wong
- Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Owen Ngo Wang Leung
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Linda Chiu Wa Lam
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Sing Lee
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Justin Che Yuen Wu
- Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong
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13
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Zuo T, Wong SH, Cheung CP, Lam K, Lui R, Cheung K, Zhang F, Tang W, Ching JYL, Wu JCY, Chan PKS, Sung JJY, Yu J, Chan FKL, Ng SC. Gut fungal dysbiosis correlates with reduced efficacy of fecal microbiota transplantation in Clostridium difficile infection. Nat Commun 2018; 9:3663. [PMID: 30202057 PMCID: PMC6131390 DOI: 10.1038/s41467-018-06103-6] [Citation(s) in RCA: 144] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 08/15/2018] [Indexed: 12/26/2022] Open
Abstract
Fecal microbiota transplantation (FMT) is effective in treating recurrent Clostridium difficile infection (CDI). Bacterial colonization in recipients after FMT has been studied, but little is known about the role of the gut fungal community, or mycobiota. Here, we show evidence of gut fungal dysbiosis in CDI, and that donor-derived fungal colonization in recipients is associated with FMT response. CDI is accompanied by over-representation of Candida albicans and decreased fungal diversity, richness, and evenness. Cure after FMT is associated with increased colonization of donor-derived fungal taxa in recipients. Recipients of successful FMT (“responders”) display, after FMT, a high relative abundance of Saccharomyces and Aspergillus, whereas “nonresponders” and individuals treated with antibiotics display a dominant presence of Candida. High abundance of C. albicans in donor stool also correlates with reduced FMT efficacy. Furthermore, C. albicans reduces FMT efficacy in a mouse model of CDI, while antifungal treatment reestablishes its efficacy, supporting a potential causal relationship between gut fungal dysbiosis and FMT outcome. Fecal microbiota transplantation (FMT) is effective in treating recurrent Clostridium difficile infection (CDI). Here, the authors show that the composition of the gut fungal microbiota of donors and recipients, and especially the abundance of Candida, correlates with FMT outcome in CDI patients.
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Affiliation(s)
- Tao Zuo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.,Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, LKS Institute of Health Science, The Chinese University of Hong Kong, Hong Kong, China
| | - Sunny H Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.,Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, LKS Institute of Health Science, The Chinese University of Hong Kong, Hong Kong, China.,Center for Gut Microbiota Research, The Chinese University of Hong Kong, Hong Kong, China
| | - Chun Pan Cheung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Kelvin Lam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Rashid Lui
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Kitty Cheung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Fen Zhang
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Whitney Tang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Jessica Y L Ching
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Justin C Y Wu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.,Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, LKS Institute of Health Science, The Chinese University of Hong Kong, Hong Kong, China
| | - Paul K S Chan
- Center for Gut Microbiota Research, The Chinese University of Hong Kong, Hong Kong, China.,Department of Microbiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Joseph J Y Sung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.,Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, LKS Institute of Health Science, The Chinese University of Hong Kong, Hong Kong, China
| | - Jun Yu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.,Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, LKS Institute of Health Science, The Chinese University of Hong Kong, Hong Kong, China.,Center for Gut Microbiota Research, The Chinese University of Hong Kong, Hong Kong, China
| | - Francis K L Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.,Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, LKS Institute of Health Science, The Chinese University of Hong Kong, Hong Kong, China.,Center for Gut Microbiota Research, The Chinese University of Hong Kong, Hong Kong, China
| | - Siew C Ng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China. .,Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, LKS Institute of Health Science, The Chinese University of Hong Kong, Hong Kong, China. .,Center for Gut Microbiota Research, The Chinese University of Hong Kong, Hong Kong, China.
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14
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Zuo T, Wong SH, Lam K, Lui R, Cheung K, Tang W, Ching JYL, Chan PKS, Chan MCW, Wu JCY, Chan FKL, Yu J, Sung JJY, Ng SC. Bacteriophage transfer during faecal microbiota transplantation in Clostridium difficile infection is associated with treatment outcome. Gut 2018; 67:634-643. [PMID: 28539351 PMCID: PMC5868238 DOI: 10.1136/gutjnl-2017-313952] [Citation(s) in RCA: 153] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 03/14/2017] [Accepted: 04/10/2017] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Faecal microbiota transplantation (FMT) is effective for the treatment of recurrent Clostridium difficile infection (CDI). Studies have shown bacterial colonisation after FMT, but data on viral alterations in CDI are scarce. We investigated enteric virome alterations in CDI and the association between viral transfer and clinical outcome in patients with CDI. DESIGN Ultra-deep metagenomic sequencing of virus-like particle preparations and bacterial 16S rRNA sequencing were performed on stool samples from 24 subjects with CDI and 20 healthy controls. We longitudinally assessed the virome and bacterial microbiome changes in nine CDI subjects treated with FMT and five treated with vancomycin. Enteric virome alterations were assessed in association with treatment response. RESULTS Subjects with CDI demonstrated a significantly higher abundance of bacteriophage Caudovirales and a lower Caudovirales diversity, richness and evenness compared with healthy household controls. Significant correlations were observed between bacterial families Proteobacteria, Actinobacteria and Caudovirales taxa in CDI. FMT treatment resulted in a significant decrease in the abundance of Caudovirales in CDI. Cure after FMT was observed when donor-derived Caudovirales contigs occupied a larger fraction of the enteric virome in the recipients (p=0.024). In treatment responders, FMT was associated with alterations in the virome and the bacterial microbiome, while vancomycin treatment led to alterations in the bacterial community alone. CONCLUSIONS In a preliminary study, CDI is characterised by enteric virome dysbiosis. Treatment response in FMT was associated with a high colonisation level of donor-derived Caudovirales taxa in the recipient. Caudovirales bacteriophages may play a role in the efficacy of FMT in CDI. TRIAL REGISTRATION NUMBER NCT02570477.
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Affiliation(s)
- Tao Zuo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China,State Key Laboratory of Digestive Diseases, Institute of Digestive Disease, LKS Institute of Health Science, The Chinese University of Hong Kong, Hong Kong, China
| | - Sunny H Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China,State Key Laboratory of Digestive Diseases, Institute of Digestive Disease, LKS Institute of Health Science, The Chinese University of Hong Kong, Hong Kong, China
| | - Kelvin Lam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Rashid Lui
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Kitty Cheung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Whitney Tang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Jessica Y L Ching
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Paul K S Chan
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Martin C W Chan
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Justin C Y Wu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China,State Key Laboratory of Digestive Diseases, Institute of Digestive Disease, LKS Institute of Health Science, The Chinese University of Hong Kong, Hong Kong, China
| | - Francis K L Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China,State Key Laboratory of Digestive Diseases, Institute of Digestive Disease, LKS Institute of Health Science, The Chinese University of Hong Kong, Hong Kong, China
| | - Jun Yu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China,State Key Laboratory of Digestive Diseases, Institute of Digestive Disease, LKS Institute of Health Science, The Chinese University of Hong Kong, Hong Kong, China
| | - Joseph J Y Sung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China,State Key Laboratory of Digestive Diseases, Institute of Digestive Disease, LKS Institute of Health Science, The Chinese University of Hong Kong, Hong Kong, China
| | - Siew C Ng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China,State Key Laboratory of Digestive Diseases, Institute of Digestive Disease, LKS Institute of Health Science, The Chinese University of Hong Kong, Hong Kong, China
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15
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Chan FKL, Kyaw M, Tanigawa T, Higuchi K, Fujimoto K, Cheong PK, Lee V, Kinoshita Y, Naito Y, Watanabe T, Ching JYL, Lam K, Lo A, Chan H, Lui R, Tang RSY, Sakata Y, Tse YK, Takeuchi T, Handa O, Nebiki H, Wu JCY, Abe T, Mishiro T, Ng SC, Arakawa T. Similar Efficacy of Proton-Pump Inhibitors vs H2-Receptor Antagonists in Reducing Risk of Upper Gastrointestinal Bleeding or Ulcers in High-Risk Users of Low-Dose Aspirin. Gastroenterology 2017; 152:105-110.e1. [PMID: 27641510 DOI: 10.1053/j.gastro.2016.09.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [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: 07/24/2016] [Revised: 09/02/2016] [Accepted: 09/05/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND & AIMS It is not clear whether H2-receptor antagonists (H2RAs) reduce the risk of gastrointestinal (GI) bleeding in aspirin users at high risk. We performed a double-blind randomized trial to compare the effects of a proton pump inhibitor (PPI) vs a H2RA antagonist in preventing recurrent upper GI bleeding and ulcers in high-risk aspirin users. METHODS We studied 270 users of low-dose aspirin (≤325 mg/day) with a history of endoscopically confirmed ulcer bleeding at 8 sites in Hong Kong and Japan. After healing of ulcers, subjects with negative results from tests for Helicobacter pylori resumed aspirin (80 mg) daily and were assigned randomly to groups given a once-daily PPI (rabeprazole, 20 mg; n = 138) or H2RA (famotidine, 40 mg; n = 132) for up to 12 months. Subjects were evaluated every 2 months; endoscopy was repeated if they developed symptoms of upper GI bleeding or had a reduction in hemoglobin level greater than 2 g/dL and after 12 months of follow-up evaluation. The adequacy of upper GI protection was assessed by end points of recurrent upper GI bleeding and a composite of recurrent upper GI bleeding or recurrent endoscopic ulcers at month 12. RESULTS During the 12-month study period, upper GI bleeding recurred in 1 patient receiving rabeprazole (0.7%; 95% confidence interval [CI], 0.1%-5.1%) and in 4 patients receiving famotidine (3.1%; 95% CI, 1.2%-8.1%) (P = .16). The composite end point of recurrent bleeding or endoscopic ulcers at month 12 was reached by 9 patients receiving rabeprazole (7.9%; 95% CI, 4.2%-14.7%) and 13 patients receiving famotidine (12.4%; 95% CI, 7.4%-20.4%) (P = .26). CONCLUSIONS In a randomized controlled trial of users of low-dose aspirin at risk for recurrent GI bleeding, a slightly lower proportion of patients receiving a PPI along with aspirin developed recurrent bleeding or ulcer than of patients receiving an H2RA with the aspirin, although this difference was not statistically significant. ClincialTrials.gov no: NCT01408186.
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Affiliation(s)
- Francis K L Chan
- Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong.
| | - Moe Kyaw
- Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong
| | - Tetsuya Tanigawa
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kazuhide Higuchi
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Kazuma Fujimoto
- Department of Internal Medicine and Gastroenterology, Saga Medical School, Saga, Japan
| | - Pui Kuan Cheong
- Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong
| | - Vivian Lee
- School of Pharmacy, The Chinese University of Hong Kong
| | - Yoshikazu Kinoshita
- Second Department of Internal Medicine, Shimane University Faculty of Medicine, Izumo, Japan
| | - Yuji Naito
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshio Watanabe
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Jessica Y L Ching
- Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong
| | - Kelvin Lam
- Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong
| | - Angeline Lo
- Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong
| | - Heyson Chan
- Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong
| | - Rashid Lui
- Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong
| | - Raymond S Y Tang
- Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong
| | - Yasuhisa Sakata
- Department of Internal Medicine and Gastroenterology, Saga Medical School, Saga, Japan
| | - Yee Kit Tse
- Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong
| | - Toshihisa Takeuchi
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Osamu Handa
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroko Nebiki
- Department of Gastroenterology, Osaka City General Hospital, Osaka, Japan
| | - Justin C Y Wu
- Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong
| | - Takashi Abe
- Department of Gastroenterology, Takarazuka Municipal Hospital, Hyogo, Japan
| | - Tsuyoshi Mishiro
- Second Department of Internal Medicine, Shimane University Faculty of Medicine, Izumo, Japan
| | - Siew C Ng
- Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong
| | - Tetsuo Arakawa
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
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16
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Farkas K, Chan H, Rutka M, Szepes Z, Nagy F, Tiszlavicz L, Nyári T, Tang W, Wong G, Tang R, Lo A, Cheung C, Wong S, Lui R, Molnár T, Ng SC. Gastroduodenal Involvement in Asymptomatic Crohn's Disease Patients in Two Areas of Emerging Disease: Asia and Eastern Europe. J Crohns Colitis 2016; 10:1401-1406. [PMID: 27282400 DOI: 10.1093/ecco-jcc/jjw113] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 04/15/2016] [Accepted: 05/12/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND The incidence of Crohn's disease [CD] is increasing in Asia and Eastern Europe. Limited studies have reported on the frequency of upper gastrointestinal [GI] involvement in patients with CD in non-Western countries. This prospective study compared the rate of macroscopic and microscopic upper GI manifestations and Helicobacter pylori positivity in asymptomatic CD patients in Asia and Eastern Europe. METHODS Consecutive asymptomatic CD patients were prospectively recruited for upper GI endoscopy between 2013 and 2015 in Hong Kong and in Hungary. Endoscopy and biopsy findings were recorded and histology was performed to assess for H. pylori and microscopic signs characteristic for CD, using standardized diagnostic criteria. RESULTS One hundred and eighty CD patients [100 Hong Kong; 80 Hungary; 70.6% male; mean age, 38.5 years] and 189 controls [100 Hong Kong; 89 Hungary; 57.7% male; mean age 41 years] were included. Gastroduodenal involvement of CD was significantly higher in Hungary than in Hong Kong [16.5% vs 2.0%, p ≤ 0.001]. H. pylori positivity was significantly higher in Hungarian than Chinese CD patients [13.9% vs 4.0%, p ≤ 0.001]. Granulomas were detected in 1% in Hong Kong and 7.6% in Hungary [p ≤ 0.001]. Chinese CD subjects had a significantly lower H. pylori positivity compared with controls [6% vs. 15%; p ≤ 0.001]. CONCLUSIONS Upper GI CD was significantly higher in Eastern Europe than in Asia. The detection of granuloma in Hungary was similar to the literature data, whereas focal gastritis was lower than expected in both cohorts.
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Affiliation(s)
- Klaudia Farkas
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| | - Heyson Chan
- Institute of Digestive Disease, Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong
| | - Mariann Rutka
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| | - Zoltán Szepes
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ferenc Nagy
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| | | | - Tibor Nyári
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Whitney Tang
- Institute of Digestive Disease, Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong
| | - Grace Wong
- Institute of Digestive Disease, Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong
| | - Raymond Tang
- Institute of Digestive Disease, Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong
| | - Angeline Lo
- Institute of Digestive Disease, Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong
| | - Christina Cheung
- Institute of Digestive Disease, Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong
| | - Sunny Wong
- Institute of Digestive Disease, Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong
| | - Rashid Lui
- Institute of Digestive Disease, Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong
| | - Tamás Molnár
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| | - Siew C Ng
- Institute of Digestive Disease, Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong
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Abdallah H, Abramowski A, Aharonian F, Ait Benkhali F, Akhperjanian AG, Angüner E, Arrieta M, Aubert P, Backes M, Balzer A, Barnard M, Becherini Y, Becker Tjus J, Berge D, Bernhard S, Bernlöhr K, Birsin E, Blackwell R, Böttcher M, Boisson C, Bolmont J, Bordas P, Bregeon J, Brun F, Brun P, Bryan M, Bulik T, Capasso M, Carr J, Casanova S, Chakraborty N, Chalme-Calvet R, Chaves RCG, Chen A, Chevalier J, Chrétien M, Colafrancesco S, Cologna G, Condon B, Conrad J, Couturier C, Cui Y, Davids ID, Degrange B, Deil C, deWilt P, Djannati-Ataï A, Domainko W, Donath A, Drury LO, Dubus G, Dutson K, Dyks J, Dyrda M, Edwards T, Egberts K, Eger P, Ernenwein JP, Eschbach S, Farnier C, Fegan S, Fernandes MV, Fiasson A, Fontaine G, Förster A, Funk S, Füßling M, Gabici S, Gajdus M, Gallant YA, Garrigoux T, Giavitto G, Giebels B, Glicenstein JF, Gottschall D, Goyal A, Grondin MH, Grudzińska M, Hadasch D, Hahn J, Hawkes J, Heinzelmann G, Henri G, Hermann G, Hervet O, Hillert A, Hinton JA, Hofmann W, Hoischen C, Holler M, Horns D, Ivascenko A, Jacholkowska A, Jamrozy M, Janiak M, Jankowsky D, Jankowsky F, Jingo M, Jogler T, Jouvin L, Jung-Richardt I, Kastendieck MA, Katarzyński K, Katz U, Kerszberg D, Khélifi B, Kieffer M, King J, Klepser S, Klochkov D, Kluźniak W, Kolitzus D, Komin N, Kosack K, Krakau S, Kraus M, Krayzel F, Krüger PP, Laffon H, Lamanna G, Lau J, Lees JP, Lefaucheur J, Lefranc V, Lemière A, Lemoine-Goumard M, Lenain JP, Leser E, Lohse T, Lorentz M, Lui R, Lypova I, Marandon V, Marcowith A, Mariaud C, Marx R, Maurin G, Maxted N, Mayer M, Meintjes PJ, Menzler U, Meyer M, Mitchell AMW, Moderski R, Mohamed M, Morå K, Moulin E, Murach T, de Naurois M, Niederwanger F, Niemiec J, Oakes L, Odaka H, Ohm S, Öttl S, Ostrowski M, Oya I, Padovani M, Panter M, Parsons RD, Paz Arribas M, Pekeur NW, Pelletier G, Petrucci PO, Peyaud B, Pita S, Poon H, Prokhorov D, Prokoph H, Pühlhofer G, Punch M, Quirrenbach A, Raab S, Reimer A, Reimer O, Renaud M, de Los Reyes R, Rieger F, Romoli C, Rosier-Lees S, Rowell G, Rudak B, Rulten CB, Sahakian V, Salek D, Sanchez DA, Santangelo A, Sasaki M, Schlickeiser R, Schüssler F, Schulz A, Schwanke U, Schwemmer S, Seyffert AS, Shafi N, Simoni R, Sol H, Spanier F, Spengler G, Spieß F, Stawarz L, Steenkamp R, Stegmann C, Stinzing F, Stycz K, Sushch I, Tavernet JP, Tavernier T, Taylor AM, Terrier R, Tluczykont M, Trichard C, Tuffs R, van der Walt J, van Eldik C, van Soelen B, Vasileiadis G, Veh J, Venter C, Viana A, Vincent P, Vink J, Voisin F, Völk HJ, Vuillaume T, Wadiasingh Z, Wagner SJ, Wagner P, Wagner RM, White R, Wierzcholska A, Willmann P, Wörnlein A, Wouters D, Yang R, Zabalza V, Zaborov D, Zacharias M, Zdziarski AA, Zech A, Zefi F, Ziegler A, Żywucka N. Search for Dark Matter Annihilations towards the Inner Galactic Halo from 10 Years of Observations with H.E.S.S. Phys Rev Lett 2016; 117:111301. [PMID: 27661677 DOI: 10.1103/physrevlett.117.111301] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Indexed: 06/06/2023]
Abstract
The inner region of the Milky Way halo harbors a large amount of dark matter (DM). Given its proximity, it is one of the most promising targets to look for DM. We report on a search for the annihilations of DM particles using γ-ray observations towards the inner 300 pc of the Milky Way, with the H.E.S.S. array of ground-based Cherenkov telescopes. The analysis is based on a 2D maximum likelihood method using Galactic Center (GC) data accumulated by H.E.S.S. over the last 10 years (2004-2014), and does not show any significant γ-ray signal above background. Assuming Einasto and Navarro-Frenk-White DM density profiles at the GC, we derive upper limits on the annihilation cross section ⟨σv⟩. These constraints are the strongest obtained so far in the TeV DM mass range and improve upon previous limits by a factor 5. For the Einasto profile, the constraints reach ⟨σv⟩ values of 6×10^{-26} cm^{3} s^{-1} in the W^{+}W^{-} channel for a DM particle mass of 1.5 TeV, and 2×10^{-26} cm^{3} s^{-1} in the τ^{+}τ^{-} channel for a 1 TeV mass. For the first time, ground-based γ-ray observations have reached sufficient sensitivity to probe ⟨σv⟩ values expected from the thermal relic density for TeV DM particles.
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Affiliation(s)
- H Abdallah
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - A Abramowski
- Universität Hamburg, Institut für Experimentalphysik, Luruper Chaussee 149, D 22761 Hamburg, Germany
| | - F Aharonian
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
- Dublin Institute for Advanced Studies, 31 Fitzwilliam Place, Dublin 2, Ireland
- National Academy of Sciences of the Republic of Armenia, Marshall Baghramian Avenue, 24, 0019 Yerevan, Republic of Armenia
| | - F Ait Benkhali
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - A G Akhperjanian
- National Academy of Sciences of the Republic of Armenia, Marshall Baghramian Avenue, 24, 0019 Yerevan, Republic of Armenia
- Yerevan Physics Institute, 2 Alikhanian Brothers Street, 375036 Yerevan, Armenia
| | - E Angüner
- Institut für Physik, Humboldt-Universität zu Berlin, Newtonstrasse 15, D 12489 Berlin, Germany
| | - M Arrieta
- LUTH, Observatoire de Paris, PSL Research University, CNRS, Université Paris Diderot, 5 Place Jules Janssen, 92190 Meudon, France
| | - P Aubert
- Laboratoire d'Annecy-le-Vieux de Physique des Particules, Université de Savoie, CNRS/IN2P3, F-74941 Annecy-le-Vieux, France
| | - M Backes
- University of Namibia, Department of Physics, Private Bag 13301, Windhoek, Namibia
| | - A Balzer
- GRAPPA, Anton Pannekoek Institute for Astronomy, University of Amsterdam, Science Park 904, 1098 XH Amsterdam, The Netherlands
| | - M Barnard
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - Y Becherini
- Department of Physics and Electrical Engineering, Linnaeus University, 351 95 Växjö, Sweden
| | - J Becker Tjus
- Institut für Theoretische Physik, Lehrstuhl IV: Weltraum und Astrophysik, Ruhr-Universität Bochum, D 44780 Bochum, Germany
| | - D Berge
- GRAPPA, Anton Pannekoek Institute for Astronomy and Institute of High-Energy Physics, University of Amsterdam, Science Park 904, 1098 XH Amsterdam, The Netherlands
| | - S Bernhard
- Institut für Astro- und Teilchenphysik, Leopold-Franzens-Universität Innsbruck, A-6020 Innsbruck, Austria
| | - K Bernlöhr
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
- Institut für Physik, Humboldt-Universität zu Berlin, Newtonstrasse 15, D 12489 Berlin, Germany
| | - E Birsin
- Institut für Physik, Humboldt-Universität zu Berlin, Newtonstrasse 15, D 12489 Berlin, Germany
| | - R Blackwell
- School of Chemistry & Physics, University of Adelaide, Adelaide 5005, Australia
| | - M Böttcher
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - C Boisson
- LUTH, Observatoire de Paris, PSL Research University, CNRS, Université Paris Diderot, 5 Place Jules Janssen, 92190 Meudon, France
| | - J Bolmont
- LPNHE, Université Pierre et Marie Curie Paris 6, Université Denis Diderot Paris 7, CNRS/IN2P3, 4 Place Jussieu, F-75252, Paris Cedex 5, France
| | - P Bordas
- Institut für Astronomie und Astrophysik, Universität Tübingen, Sand 1, D 72076 Tübingen, Germany
| | - J Bregeon
- Laboratoire Univers et Particules de Montpellier, Université Montpellier 2, CNRS/IN2P3, CC 72, Place Eugène Bataillon, F-34095 Montpellier Cedex 5, France
| | - F Brun
- DSM/Irfu, CEA Saclay, F-91191 Gif-Sur-Yvette Cedex, France
| | - P Brun
- DSM/Irfu, CEA Saclay, F-91191 Gif-Sur-Yvette Cedex, France
| | - M Bryan
- GRAPPA, Anton Pannekoek Institute for Astronomy, University of Amsterdam, Science Park 904, 1098 XH Amsterdam, The Netherlands
| | - T Bulik
- Astronomical Observatory, The University of Warsaw, Aleje Ujazdowskie 4, 00-478 Warsaw, Poland
| | - M Capasso
- Laboratoire Leprince-Ringuet, Ecole Polytechnique, CNRS/IN2P3, F-91128 Palaiseau, France
| | - J Carr
- Aix Marseille Université, CNRS/IN2P3, CPPM UMR 7346, 13288 Marseille, France
| | - S Casanova
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
- Instytut Fizyki Jądrowej PAN, ul. Radzikowskiego 152, 31-342 Kraków, Poland
| | - N Chakraborty
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - R Chalme-Calvet
- LPNHE, Université Pierre et Marie Curie Paris 6, Université Denis Diderot Paris 7, CNRS/IN2P3, 4 Place Jussieu, F-75252, Paris Cedex 5, France
| | - R C G Chaves
- Laboratoire Univers et Particules de Montpellier, Université Montpellier 2, CNRS/IN2P3, CC 72, Place Eugène Bataillon, F-34095 Montpellier Cedex 5, France
| | - A Chen
- School of Physics, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg 2050, South Africa
| | - J Chevalier
- Laboratoire d'Annecy-le-Vieux de Physique des Particules, Université de Savoie, CNRS/IN2P3, F-74941 Annecy-le-Vieux, France
| | - M Chrétien
- LPNHE, Université Pierre et Marie Curie Paris 6, Université Denis Diderot Paris 7, CNRS/IN2P3, 4 Place Jussieu, F-75252, Paris Cedex 5, France
| | - S Colafrancesco
- School of Physics, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg 2050, South Africa
| | - G Cologna
- Landessternwarte, Universität Heidelberg, Königstuhl, D 69117 Heidelberg, Germany
| | - B Condon
- Université Bordeaux 1, CNRS/IN2P3, Centre d'Études Nucléaires de Bordeaux Gradignan, 33175 Gradignan, France
| | - J Conrad
- Oskar Klein Centre, Department of Physics, Stockholm University, Albanova University Center, SE-10691 Stockholm, Sweden
- Wallenberg Academy Fellow
| | - C Couturier
- LPNHE, Université Pierre et Marie Curie Paris 6, Université Denis Diderot Paris 7, CNRS/IN2P3, 4 Place Jussieu, F-75252, Paris Cedex 5, France
| | - Y Cui
- Institut für Astronomie und Astrophysik, Universität Tübingen, Sand 1, D 72076 Tübingen, Germany
| | - I D Davids
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
- University of Namibia, Department of Physics, Private Bag 13301, Windhoek, Namibia
| | - B Degrange
- Laboratoire Leprince-Ringuet, Ecole Polytechnique, CNRS/IN2P3, F-91128 Palaiseau, France
| | - C Deil
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - P deWilt
- School of Chemistry & Physics, University of Adelaide, Adelaide 5005, Australia
| | - A Djannati-Ataï
- APC, AstroParticule et Cosmologie, Université Paris Diderot, CNRS/IN2P3, CEA/Irfu, Observatoire de Paris, Sorbonne Paris Cité, 10, rue Alice Domon et Léonie Duquet, 75205 Paris Cedex 13, France
| | - W Domainko
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - A Donath
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - L O'C Drury
- Dublin Institute for Advanced Studies, 31 Fitzwilliam Place, Dublin 2, Ireland
| | - G Dubus
- UJF-Grenoble 1 / CNRS-INSU, Institut de Planétologie et d'Astrophysique de Grenoble (IPAG) UMR 5274, Grenoble F-38041, France
| | - K Dutson
- Department of Physics and Astronomy, The University of Leicester, University Road, Leicester LE1 7RH, United Kingdom
| | - J Dyks
- Nicolaus Copernicus Astronomical Center, ul. Bartycka 18, 00-716 Warsaw, Poland
| | - M Dyrda
- Instytut Fizyki Jądrowej PAN, ul. Radzikowskiego 152, 31-342 Kraków, Poland
| | - T Edwards
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - K Egberts
- Institut für Physik und Astronomie, Universität Potsdam, Karl-Liebknecht-Strasse 24/25, D 14476 Potsdam, Germany
| | - P Eger
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - J-P Ernenwein
- Aix Marseille Universié, CNRS/IN2P3, CPPM UMR 7346, 13288 Marseille, France
| | - S Eschbach
- Aix Marseille Universié, CNRS/IN2P3, CPPM UMR 7346, 13288 Marseille, France
| | - C Farnier
- Oskar Klein Centre, Department of Physics, Stockholm University, Albanova University Center, SE-10691 Stockholm, Sweden
| | - S Fegan
- Laboratoire Leprince-Ringuet, Ecole Polytechnique, CNRS/IN2P3, F-91128 Palaiseau, France
| | - M V Fernandes
- Universität Hamburg, Institut für Experimentalphysik, Luruper Chaussee 149, D 22761 Hamburg, Germany
| | - A Fiasson
- Laboratoire d'Annecy-le-Vieux de Physique des Particules, Université de Savoie, CNRS/IN2P3, F-74941 Annecy-le-Vieux, France
| | - G Fontaine
- Laboratoire Leprince-Ringuet, Ecole Polytechnique, CNRS/IN2P3, F-91128 Palaiseau, France
| | - A Förster
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - S Funk
- Universität Erlangen-Nürnberg, Physikalisches Institut, Erwin-Rommel-Strasse 1, D 91058 Erlangen, Germany
| | - M Füßling
- Institut für Physik und Astronomie, Universität Potsdam, Karl-Liebknecht-Strasse 24/25, D 14476 Potsdam, Germany
| | - S Gabici
- APC, AstroParticule et Cosmologie, Université Paris Diderot, CNRS/IN2P3, CEA/Irfu, Observatoire de Paris, Sorbonne Paris Cité, 10, rue Alice Domon et Léonie Duquet, 75205 Paris Cedex 13, France
| | - M Gajdus
- Institut für Physik, Humboldt-Universität zu Berlin, Newtonstrasse 15, D 12489 Berlin, Germany
| | - Y A Gallant
- Laboratoire Univers et Particules de Montpellier, Université Montpellier 2, CNRS/IN2P3, CC 72, Place Eugène Bataillon, F-34095 Montpellier Cedex 5, France
| | - T Garrigoux
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | | | - B Giebels
- Laboratoire Leprince-Ringuet, Ecole Polytechnique, CNRS/IN2P3, F-91128 Palaiseau, France
| | | | - D Gottschall
- Institut für Astronomie und Astrophysik, Universität Tübingen, Sand 1, D 72076 Tübingen, Germany
| | - A Goyal
- Obserwatorium Astronomiczne, Uniwersytet Jagielloński, ulica Orla 171, 30-244 Kraków, Poland
| | - M-H Grondin
- Université Bordeaux 1, CNRS/IN2P3, Centre d'Études Nucléaires de Bordeaux Gradignan, 33175 Gradignan, France
| | - M Grudzińska
- Astronomical Observatory, The University of Warsaw, Aleje Ujazdowskie 4, 00-478 Warsaw, Poland
| | - D Hadasch
- Institut für Astro- und Teilchenphysik, Leopold-Franzens-Universität Innsbruck, A-6020 Innsbruck, Austria
| | - J Hahn
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - J Hawkes
- School of Chemistry & Physics, University of Adelaide, Adelaide 5005, Australia
| | - G Heinzelmann
- Universität Hamburg, Institut für Experimentalphysik, Luruper Chaussee 149, D 22761 Hamburg, Germany
| | - G Henri
- UJF-Grenoble 1 / CNRS-INSU, Institut de Planétologie et d'Astrophysique de Grenoble (IPAG) UMR 5274, Grenoble F-38041, France
| | - G Hermann
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - O Hervet
- LUTH, Observatoire de Paris, PSL Research University, CNRS, Université Paris Diderot, 5 Place Jules Janssen, 92190 Meudon, France
| | - A Hillert
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - J A Hinton
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
- Department of Physics and Astronomy, The University of Leicester, University Road, Leicester LE1 7RH, United Kingdom
| | - W Hofmann
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | | | - M Holler
- Laboratoire Leprince-Ringuet, Ecole Polytechnique, CNRS/IN2P3, F-91128 Palaiseau, France
| | - D Horns
- Universität Hamburg, Institut für Experimentalphysik, Luruper Chaussee 149, D 22761 Hamburg, Germany
| | - A Ivascenko
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - A Jacholkowska
- LPNHE, Université Pierre et Marie Curie Paris 6, Université Denis Diderot Paris 7, CNRS/IN2P3, 4 Place Jussieu, F-75252, Paris Cedex 5, France
| | - M Jamrozy
- Obserwatorium Astronomiczne, Uniwersytet Jagielloński, ulica Orla 171, 30-244 Kraków, Poland
| | - M Janiak
- Nicolaus Copernicus Astronomical Center, ul. Bartycka 18, 00-716 Warsaw, Poland
| | - D Jankowsky
- Universität Erlangen-Nürnberg, Physikalisches Institut, Erwin-Rommel-Strasse 1, D 91058 Erlangen, Germany
| | - F Jankowsky
- Landessternwarte, Universität Heidelberg, Königstuhl, D 69117 Heidelberg, Germany
| | - M Jingo
- School of Physics, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg 2050, South Africa
| | - T Jogler
- Universität Erlangen-Nürnberg, Physikalisches Institut, Erwin-Rommel-Strasse 1, D 91058 Erlangen, Germany
| | - L Jouvin
- APC, AstroParticule et Cosmologie, Université Paris Diderot, CNRS/IN2P3, CEA/Irfu, Observatoire de Paris, Sorbonne Paris Cité, 10, rue Alice Domon et Léonie Duquet, 75205 Paris Cedex 13, France
| | - I Jung-Richardt
- Universität Erlangen-Nürnberg, Physikalisches Institut, Erwin-Rommel-Strasse 1, D 91058 Erlangen, Germany
| | - M A Kastendieck
- Universität Hamburg, Institut für Experimentalphysik, Luruper Chaussee 149, D 22761 Hamburg, Germany
| | - K Katarzyński
- Centre for Astronomy, Nicolaus Copernicus University, ulica Gagarina 11, 87-100 Toruń, Poland
| | - U Katz
- Universität Erlangen-Nürnberg, Physikalisches Institut, Erwin-Rommel-Strasse 1, D 91058 Erlangen, Germany
| | - D Kerszberg
- LPNHE, Université Pierre et Marie Curie Paris 6, Université Denis Diderot Paris 7, CNRS/IN2P3, 4 Place Jussieu, F-75252, Paris Cedex 5, France
| | - B Khélifi
- APC, AstroParticule et Cosmologie, Université Paris Diderot, CNRS/IN2P3, CEA/Irfu, Observatoire de Paris, Sorbonne Paris Cité, 10, rue Alice Domon et Léonie Duquet, 75205 Paris Cedex 13, France
| | - M Kieffer
- LPNHE, Université Pierre et Marie Curie Paris 6, Université Denis Diderot Paris 7, CNRS/IN2P3, 4 Place Jussieu, F-75252, Paris Cedex 5, France
| | - J King
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | | | - D Klochkov
- Institut für Astronomie und Astrophysik, Universität Tübingen, Sand 1, D 72076 Tübingen, Germany
| | - W Kluźniak
- Nicolaus Copernicus Astronomical Center, ul. Bartycka 18, 00-716 Warsaw, Poland
| | - D Kolitzus
- Institut für Astro- und Teilchenphysik, Leopold-Franzens-Universität Innsbruck, A-6020 Innsbruck, Austria
| | - Nu Komin
- School of Physics, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg 2050, South Africa
| | - K Kosack
- DSM/Irfu, CEA Saclay, F-91191 Gif-Sur-Yvette Cedex, France
| | - S Krakau
- Institut für Theoretische Physik, Lehrstuhl IV: Weltraum und Astrophysik, Ruhr-Universität Bochum, D 44780 Bochum, Germany
| | - M Kraus
- Universität Erlangen-Nürnberg, Physikalisches Institut, Erwin-Rommel-Strasse 1, D 91058 Erlangen, Germany
| | - F Krayzel
- Laboratoire d'Annecy-le-Vieux de Physique des Particules, Université de Savoie, CNRS/IN2P3, F-74941 Annecy-le-Vieux, France
| | - P P Krüger
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - H Laffon
- Université Bordeaux 1, CNRS/IN2P3, Centre d'Études Nucléaires de Bordeaux Gradignan, 33175 Gradignan, France
| | - G Lamanna
- Laboratoire d'Annecy-le-Vieux de Physique des Particules, Université de Savoie, CNRS/IN2P3, F-74941 Annecy-le-Vieux, France
| | - J Lau
- School of Chemistry & Physics, University of Adelaide, Adelaide 5005, Australia
| | - J-P Lees
- Laboratoire d'Annecy-le-Vieux de Physique des Particules, Université Savoie Mont-Blanc, CNRS/IN2P3, F-74941 Annecy-le-Vieux, France
| | - J Lefaucheur
- LUTH, Observatoire de Paris, PSL Research University, CNRS, Université Paris Diderot, 5 Place Jules Janssen, 92190 Meudon, France
| | - V Lefranc
- DSM/Irfu, CEA Saclay, F-91191 Gif-Sur-Yvette Cedex, France
| | - A Lemière
- APC, AstroParticule et Cosmologie, Université Paris Diderot, CNRS/IN2P3, CEA/Irfu, Observatoire de Paris, Sorbonne Paris Cité, 10, rue Alice Domon et Léonie Duquet, 75205 Paris Cedex 13, France
| | - M Lemoine-Goumard
- Université Bordeaux 1, CNRS/IN2P3, Centre d'Études Nucléaires de Bordeaux Gradignan, 33175 Gradignan, France
| | - J-P Lenain
- LPNHE, Université Pierre et Marie Curie Paris 6, Université Denis Diderot Paris 7, CNRS/IN2P3, 4 Place Jussieu, F-75252, Paris Cedex 5, France
| | - E Leser
- Institut für Physik und Astronomie, Universität Potsdam, Karl-Liebknecht-Strasse 24/25, D 14476 Potsdam, Germany
| | - T Lohse
- Institut für Physik, Humboldt-Universität zu Berlin, Newtonstrasse 15, D 12489 Berlin, Germany
| | - M Lorentz
- DSM/Irfu, CEA Saclay, F-91191 Gif-Sur-Yvette Cedex, France
| | - R Lui
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | | | - V Marandon
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - A Marcowith
- Laboratoire Univers et Particules de Montpellier, Université Montpellier 2, CNRS/IN2P3, CC 72, Place Eugène Bataillon, F-34095 Montpellier Cedex 5, France
| | - C Mariaud
- Laboratoire Leprince-Ringuet, Ecole Polytechnique, CNRS/IN2P3, F-91128 Palaiseau, France
| | - R Marx
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - G Maurin
- Laboratoire d'Annecy-le-Vieux de Physique des Particules, Université de Savoie, CNRS/IN2P3, F-74941 Annecy-le-Vieux, France
| | - N Maxted
- School of Chemistry & Physics, University of Adelaide, Adelaide 5005, Australia
| | - M Mayer
- Institut für Physik und Astronomie, Universität Potsdam, Karl-Liebknecht-Strasse 24/25, D 14476 Potsdam, Germany
| | - P J Meintjes
- Department of Physics, University of the Free State, P.O. Box 339, Bloemfontein 9300, South Africa
| | - U Menzler
- Institut für Theoretische Physik, Lehrstuhl IV: Weltraum und Astrophysik, Ruhr-Universität Bochum, D 44780 Bochum, Germany
| | - M Meyer
- Oskar Klein Centre, Department of Physics, Stockholm University, Albanova University Center, SE-10691 Stockholm, Sweden
| | - A M W Mitchell
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - R Moderski
- Nicolaus Copernicus Astronomical Center, ul. Bartycka 18, 00-716 Warsaw, Poland
| | - M Mohamed
- Landessternwarte, Universität Heidelberg, Königstuhl, D 69117 Heidelberg, Germany
| | - K Morå
- Oskar Klein Centre, Department of Physics, Stockholm University, Albanova University Center, SE-10691 Stockholm, Sweden
| | - E Moulin
- DSM/Irfu, CEA Saclay, F-91191 Gif-Sur-Yvette Cedex, France
| | - T Murach
- Institut für Physik, Humboldt-Universität zu Berlin, Newtonstrasse 15, D 12489 Berlin, Germany
| | - M de Naurois
- Laboratoire Leprince-Ringuet, Ecole Polytechnique, CNRS/IN2P3, F-91128 Palaiseau, France
| | - F Niederwanger
- GRAPPA, Anton Pannekoek Institute for Astronomy and Institute of High-Energy Physics, University of Amsterdam, Science Park 904, 1098 XH Amsterdam, The Netherlands
| | - J Niemiec
- Instytut Fizyki Jądrowej PAN, ul. Radzikowskiego 152, 31-342 Kraków, Poland
| | - L Oakes
- Institut für Physik, Humboldt-Universität zu Berlin, Newtonstrasse 15, D 12489 Berlin, Germany
| | - H Odaka
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - S Ohm
- DESY, D-15738 Zeuthen, Germany
| | - S Öttl
- Institut für Astro- und Teilchenphysik, Leopold-Franzens-Universität Innsbruck, A-6020 Innsbruck, Austria
| | - M Ostrowski
- Obserwatorium Astronomiczne, Uniwersytet Jagielloński, ulica Orla 171, 30-244 Kraków, Poland
| | - I Oya
- Institut für Physik, Humboldt-Universität zu Berlin, Newtonstrasse 15, D 12489 Berlin, Germany
| | - M Padovani
- Laboratoire Univers et Particules de Montpellier, Université Montpellier, CNRS/IN2P3, CC 72, Place Eugène Bataillon, F-34095 Montpellier Cedex 5, France
| | - M Panter
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - R D Parsons
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - M Paz Arribas
- Institut für Physik, Humboldt-Universität zu Berlin, Newtonstrasse 15, D 12489 Berlin, Germany
| | - N W Pekeur
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - G Pelletier
- UJF-Grenoble 1 / CNRS-INSU, Institut de Planétologie et d'Astrophysique de Grenoble (IPAG) UMR 5274, Grenoble F-38041, France
| | - P-O Petrucci
- UJF-Grenoble 1 / CNRS-INSU, Institut de Planétologie et d'Astrophysique de Grenoble (IPAG) UMR 5274, Grenoble F-38041, France
| | - B Peyaud
- DSM/Irfu, CEA Saclay, F-91191 Gif-Sur-Yvette Cedex, France
| | - S Pita
- APC, AstroParticule et Cosmologie, Université Paris Diderot, CNRS/IN2P3, CEA/Irfu, Observatoire de Paris, Sorbonne Paris Cité, 10, rue Alice Domon et Léonie Duquet, 75205 Paris Cedex 13, France
| | - H Poon
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - D Prokhorov
- Department of Physics and Electrical Engineering, Linnaeus University, 351 95 Växjö, Sweden
| | - H Prokoph
- Department of Physics and Electrical Engineering, Linnaeus University, 351 95 Växjö, Sweden
| | - G Pühlhofer
- Institut für Astronomie und Astrophysik, Universität Tübingen, Sand 1, D 72076 Tübingen, Germany
| | - M Punch
- APC, AstroParticule et Cosmologie, Université Paris Diderot, CNRS/IN2P3, CEA/Irfu, Observatoire de Paris, Sorbonne Paris Cité, 10, rue Alice Domon et Léonie Duquet, 75205 Paris Cedex 13, France
| | - A Quirrenbach
- Landessternwarte, Universität Heidelberg, Königstuhl, D 69117 Heidelberg, Germany
| | - S Raab
- Universität Erlangen-Nürnberg, Physikalisches Institut, Erwin-Rommel-Strasse 1, D 91058 Erlangen, Germany
| | - A Reimer
- Institut für Astro- und Teilchenphysik, Leopold-Franzens-Universität Innsbruck, A-6020 Innsbruck, Austria
| | - O Reimer
- Institut für Astro- und Teilchenphysik, Leopold-Franzens-Universität Innsbruck, A-6020 Innsbruck, Austria
| | - M Renaud
- Laboratoire Univers et Particules de Montpellier, Université Montpellier 2, CNRS/IN2P3, CC 72, Place Eugène Bataillon, F-34095 Montpellier Cedex 5, France
| | - R de Los Reyes
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - F Rieger
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - C Romoli
- Dublin Institute for Advanced Studies, 31 Fitzwilliam Place, Dublin 2, Ireland
| | - S Rosier-Lees
- Laboratoire d'Annecy-le-Vieux de Physique des Particules, Université de Savoie, CNRS/IN2P3, F-74941 Annecy-le-Vieux, France
| | - G Rowell
- School of Chemistry & Physics, University of Adelaide, Adelaide 5005, Australia
| | - B Rudak
- Nicolaus Copernicus Astronomical Center, ul. Bartycka 18, 00-716 Warsaw, Poland
| | - C B Rulten
- LUTH, Observatoire de Paris, PSL Research University, CNRS, Université Paris Diderot, 5 Place Jules Janssen, 92190 Meudon, France
| | - V Sahakian
- National Academy of Sciences of the Republic of Armenia, Marshall Baghramian Avenue, 24, 0019 Yerevan, Republic of Armenia
- Yerevan Physics Institute, 2 Alikhanian Brothers Street, 375036 Yerevan, Armenia
| | - D Salek
- GRAPPA, Institute of High-Energy Physics, University of Amsterdam, Science Park 904, 1098 XH Amsterdam, The Netherlands
| | - D A Sanchez
- Laboratoire d'Annecy-le-Vieux de Physique des Particules, Université de Savoie, CNRS/IN2P3, F-74941 Annecy-le-Vieux, France
| | - A Santangelo
- Institut für Astronomie und Astrophysik, Universität Tübingen, Sand 1, D 72076 Tübingen, Germany
| | - M Sasaki
- Institut für Astronomie und Astrophysik, Universität Tübingen, Sand 1, D 72076 Tübingen, Germany
| | - R Schlickeiser
- Institut für Theoretische Physik, Lehrstuhl IV: Weltraum und Astrophysik, Ruhr-Universität Bochum, D 44780 Bochum, Germany
| | - F Schüssler
- DSM/Irfu, CEA Saclay, F-91191 Gif-Sur-Yvette Cedex, France
| | | | - U Schwanke
- Institut für Physik, Humboldt-Universität zu Berlin, Newtonstrasse 15, D 12489 Berlin, Germany
| | - S Schwemmer
- Landessternwarte, Universität Heidelberg, Königstuhl, D 69117 Heidelberg, Germany
| | - A S Seyffert
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - N Shafi
- School of Physics, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg 2050, South Africa
| | - R Simoni
- GRAPPA, Anton Pannekoek Institute for Astronomy and Institute of High-Energy Physics, University of Amsterdam, Science Park 904, 1098 XH Amsterdam, The Netherlands
| | - H Sol
- LUTH, Observatoire de Paris, PSL Research University, CNRS, Université Paris Diderot, 5 Place Jules Janssen, 92190 Meudon, France
| | - F Spanier
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - G Spengler
- Oskar Klein Centre, Department of Physics, Stockholm University, Albanova University Center, SE-10691 Stockholm, Sweden
| | - F Spieß
- Universität Hamburg, Institut für Experimentalphysik, Luruper Chaussee 149, D 22761 Hamburg, Germany
| | - L Stawarz
- Obserwatorium Astronomiczne, Uniwersytet Jagielloński, ulica Orla 171, 30-244 Kraków, Poland
| | - R Steenkamp
- University of Namibia, Department of Physics, Private Bag 13301, Windhoek, Namibia
| | - C Stegmann
- Institut für Physik und Astronomie, Universität Potsdam, Karl-Liebknecht-Strasse 24/25, D 14476 Potsdam, Germany
- DESY, D-15738 Zeuthen, Germany
| | - F Stinzing
- Universität Erlangen-Nürnberg, Physikalisches Institut, Erwin-Rommel-Strasse 1, D 91058 Erlangen, Germany
| | - K Stycz
- DESY, D-15738 Zeuthen, Germany
| | - I Sushch
- Centre for Space Physics, North-West University, Potchefstroom 2520, South Africa
| | - J-P Tavernet
- LPNHE, Université Pierre et Marie Curie Paris 6, Université Denis Diderot Paris 7, CNRS/IN2P3, 4 Place Jussieu, F-75252, Paris Cedex 5, France
| | - T Tavernier
- APC, AstroParticule et Cosmologie, Université Paris Diderot, CNRS/IN2P3, CEA/Irfu, Observatoire de Paris, Sorbonne Paris Cité, 10, rue Alice Domon et Léonie Duquet, 75205 Paris Cedex 13, France
| | - A M Taylor
- Dublin Institute for Advanced Studies, 31 Fitzwilliam Place, Dublin 2, Ireland
| | - R Terrier
- APC, AstroParticule et Cosmologie, Université Paris Diderot, CNRS/IN2P3, CEA/Irfu, Observatoire de Paris, Sorbonne Paris Cité, 10, rue Alice Domon et Léonie Duquet, 75205 Paris Cedex 13, France
| | - M Tluczykont
- Universität Hamburg, Institut für Experimentalphysik, Luruper Chaussee 149, D 22761 Hamburg, Germany
| | - C Trichard
- Laboratoire d'Annecy-le-Vieux de Physique des Particules, Université de Savoie, CNRS/IN2P3, F-74941 Annecy-le-Vieux, France
| | - R Tuffs
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - J van der Walt
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - C van Eldik
- Universität Erlangen-Nürnberg, Physikalisches Institut, Erwin-Rommel-Strasse 1, D 91058 Erlangen, Germany
| | - B van Soelen
- Department of Physics, University of the Free State, P.O. Box 339, Bloemfontein 9300, South Africa
| | - G Vasileiadis
- Laboratoire Univers et Particules de Montpellier, Université Montpellier 2, CNRS/IN2P3, CC 72, Place Eugène Bataillon, F-34095 Montpellier Cedex 5, France
| | - J Veh
- Universität Erlangen-Nürnberg, Physikalisches Institut, Erwin-Rommel-Strasse 1, D 91058 Erlangen, Germany
| | - C Venter
- Centre for Space Physics, North-West University, Potchefstroom 2520, South Africa
| | - A Viana
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - P Vincent
- LPNHE, Université Pierre et Marie Curie Paris 6, Université Denis Diderot Paris 7, CNRS/IN2P3, 4 Place Jussieu, F-75252, Paris Cedex 5, France
| | - J Vink
- GRAPPA, Anton Pannekoek Institute for Astronomy, University of Amsterdam, Science Park 904, 1098 XH Amsterdam, The Netherlands
| | - F Voisin
- School of Chemistry & Physics, University of Adelaide, Adelaide 5005, Australia
| | - H J Völk
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - T Vuillaume
- Laboratoire d'Annecy-le-Vieux de Physique des Particules, Université de Savoie, CNRS/IN2P3, F-74941 Annecy-le-Vieux, France
| | - Z Wadiasingh
- Centre for Space Physics, North-West University, Potchefstroom 2520, South Africa
| | - S J Wagner
- Landessternwarte, Universität Heidelberg, Königstuhl, D 69117 Heidelberg, Germany
| | - P Wagner
- Institut für Physik, Humboldt-Universität zu Berlin, Newtonstrasse 15, D 12489 Berlin, Germany
| | - R M Wagner
- Oskar Klein Centre, Department of Physics, Stockholm University, Albanova University Center, SE-10691 Stockholm, Sweden
| | - R White
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
- Department of Physics and Astronomy, The University of Leicester, University Road, Leicester LE1 7RH, United Kingdom
| | - A Wierzcholska
- Obserwatorium Astronomiczne, Uniwersytet Jagielloński, ulica Orla 171, 30-244 Kraków, Poland
| | - P Willmann
- Universität Erlangen-Nürnberg, Physikalisches Institut, Erwin-Rommel-Strasse 1, D 91058 Erlangen, Germany
| | - A Wörnlein
- Universität Erlangen-Nürnberg, Physikalisches Institut, Erwin-Rommel-Strasse 1, D 91058 Erlangen, Germany
| | - D Wouters
- DSM/Irfu, CEA Saclay, F-91191 Gif-Sur-Yvette Cedex, France
| | - R Yang
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - V Zabalza
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
- Department of Physics and Astronomy, The University of Leicester, University Road, Leicester LE1 7RH, United Kingdom
| | - D Zaborov
- Laboratoire Leprince-Ringuet, Ecole Polytechnique, CNRS/IN2P3, F-91128 Palaiseau, France
| | - M Zacharias
- Landessternwarte, Universität Heidelberg, Königstuhl, D 69117 Heidelberg, Germany
| | - A A Zdziarski
- Nicolaus Copernicus Astronomical Center, ul. Bartycka 18, 00-716 Warsaw, Poland
| | - A Zech
- LUTH, Observatoire de Paris, PSL Research University, CNRS, Université Paris Diderot, 5 Place Jules Janssen, 92190 Meudon, France
| | - F Zefi
- Laboratoire Leprince-Ringuet, Ecole Polytechnique, CNRS/IN2P3, F-91128 Palaiseau, France
| | - A Ziegler
- Universität Erlangen-Nürnberg, Physikalisches Institut, Erwin-Rommel-Strasse 1, D 91058 Erlangen, Germany
| | - N Żywucka
- Obserwatorium Astronomiczne, Uniwersytet Jagielloński, ulica Orla 171, 30-244 Kraków, Poland
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Harb M, Lui R, Robson D, Jabbour A, Kotlyar E, Keogh A, Granger E, Spratt P, Macdonald P, Jansz P, Hayward C, Dhital K. Predicting Peri-operative Right Heart Failure, Post-implant Survival and Timing of Mechanical Ventricular Assistance. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.188] [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: 10/25/2022] Open
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Lui R, Harb M, Anthony C, Robson D, Sevastos J, Granger E, Hayward C, Jabbour A, Spratt P, Keogh A, Kotlyar E, Macdonald P, Janz P, Dhital K. Renal Impairment Post VAD Implantation in Patients With Normal Pre-operative Renal Function. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.543] [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] Open
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Fiorini C, Gola A, Peloso R, Longoni A, Lechner P, Soltau H, Strüder L, Ottobrini L, Martelli C, Lui R, Madaschi L, Belloli S. The DRAGO gamma camera. Rev Sci Instrum 2010; 81:044301. [PMID: 20441357 DOI: 10.1063/1.3378686] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
In this work, we present the results of the experimental characterization of the DRAGO (DRift detector Array-based Gamma camera for Oncology), a detection system developed for high-spatial resolution gamma-ray imaging. This camera is based on a monolithic array of 77 silicon drift detectors (SDDs), with a total active area of 6.7 cm(2), coupled to a single 5-mm-thick CsI(Tl) scintillator crystal. The use of an array of SDDs provides a high quantum efficiency for the detection of the scintillation light together with a very low electronics noise. A very compact detection module based on the use of integrated readout circuits was developed. The performances achieved in gamma-ray imaging using this camera are reported here. When imaging a 0.2 mm collimated (57)Co source (122 keV) over different points of the active area, a spatial resolution ranging from 0.25 to 0.5 mm was measured. The depth-of-interaction capability of the detector, thanks to the use of a Maximum Likelihood reconstruction algorithm, was also investigated by imaging a collimated beam tilted to an angle of 45 degrees with respect to the scintillator surface. Finally, the imager was characterized with in vivo measurements on mice, in a real preclinical environment.
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Affiliation(s)
- C Fiorini
- Dipartimento di Elettronica e Informazione, Politecnico di Milano, Milano 20133, Italy.
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Lui L, Sun A, Wu S, Lui R. Preparative Purification of Morroniside and Loganin from Fructus corni by Combination of Macroporous Absorption Resin and HSCCC. J Chromatogr Sci 2009. [DOI: 10.1093/chromsci/47.5.333] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Affiliation(s)
- R. Lui
- Department of Chemistry, San Diego State University, San Diego, California 92182-1030, and Centro de Graduados e Investigacion, Instituto Tecnológico de Tijuana, Apdo Postal 1166, Tijuana, B.C. México
| | - A. L. Cooksy
- Department of Chemistry, San Diego State University, San Diego, California 92182-1030, and Centro de Graduados e Investigacion, Instituto Tecnológico de Tijuana, Apdo Postal 1166, Tijuana, B.C. México
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Abstract
BACKGROUND We studied the relationship between smoking and lung cancer risk in Harbin, Heilongjiang province, northeast China, an area with a very high baseline risk of lung cancer in both sexes, using data from a case-control study of lung cancer conducted between 1987 and 1990. PATIENTS AND METHODS Cases were 218 patients with incident, histologically confirmed lung cancer and controls were 436 patients admitted to the same hospital with non-neoplastic and non-lung diseases. RESULTS Compared with never-smokers, the multivariate odds ratio (OR) for current smokers was 3.47 [95% confidence interval (CI) 2.31--5.20], and for ex-smokers 1.53 (95% CI 0.81--2.87). Lung cancer risk increased by 20% (95% CI 14% to 28%) for an increment of 5 years in smoking duration, and by 29% (95% CI 15% to 45%) for an increment of five cigarettes per day. The OR for smokers reporting occupational exposure to selected known or likely lung carcinogens was 7.22, compared with non-smokers without occupational exposure. CONCLUSIONS This study further confirms that cigarette smoking is a strong determinant of lung cancer also in this high-risk area of northeast China.
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Affiliation(s)
- J Hu
- Surveillance and Risk Assessment Division, Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
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di Marzio P, Mariani R, Lui R, Thomas EK, Landau NR. Soluble CD40 ligand induces beta-chemokine production by macrophages and resistance to HIV-1 entry. Cytokine 2000; 12:1489-95. [PMID: 11023663 DOI: 10.1006/cyto.1999.0594] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
CD40 ligand (CD40L) is a cell surface molecule of CD4(+)T cells that interacts with its receptor CD40 on antigen presenting cells to mediate thymus-dependent humoral immunity and inflammatory reactions. We report here that treating monocyte-derived macrophages (MDM) with a trimeric soluble form of CD40L (CD40LT) induced them to secrete high levels of the beta-chemokines RANTES, MIP-1alpha and MIP-1beta that are ligands for CCR5 and able to inhibit HIV-1 entry. CD40LT inhibited the entry of M-tropic HIV-1 reporter viruses. Furthermore, supernatants obtained from CD40LT-stimulated macrophages protected CEMx174-CCR5 cells from infection by HIV-1(JRFL)reporter virus. The inhibitory activity appeared to be due to beta-chemokines present in the supernatant, since pretreating them with a cocktail of antibodies to RANTES, MIP-1alpha and MIP-1beta neutralized the inhibitory activity of the supernatants. In addition, treating monocytes with CD40LT caused CCR5 and CD4 to be downregulated from the cell surface. In vivo, macrophages activated through CD40 could interfere with HIV replication.
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Affiliation(s)
- P di Marzio
- Aaron Diamond AIDS Research Center, The Rockefeller University, 455 First Ave, New York, NY 10016, USA.
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June HL, Cason CR, Cheatham G, Lui R, Gan T, Cook JM. GABAA-benzodiazepine receptors in the striatum are involved in the sedation produced by a moderate, but not an intoxicating ethanol dose in outbred Wistar rats. Brain Res 1998; 794:103-18. [PMID: 9630547 DOI: 10.1016/s0006-8993(98)00222-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The role of the dorsal striatum in mediating the sedation produced by a moderate (0.75 g/kg) and an intoxicating (1.25 g/kg) EtOH dose was investigated in the open field by determining the capacity of direct intrastriatal injections of RY 008, a partial inverse agonist of the benzodiazepine (BDZ) receptor, to antagonize EtOH's effects. SR 95531, the competitive high-affinity GABAA antagonist was used as a reference compound. Intrastriatal RY 008 (50, 500 ng) and SR 95531 (50 ng) antagonized the sedation produced by the 0.75 g/kg EtOH dose. However, RY 008 did not alter the sedation produced by the 1.25 g/kg dose. RY 008 alone was without effect. RY 008 also failed to negatively modulate GABAergic function at alpha1beta2gamma2 or alpha6beta2gamma2 receptor subtypes expressed in Xenopus oocytes. Intrastriatal modulation of the moderate EtOH dose was site specific: no antagonism by RY 008 after intraaccumbens infusions was observed. The results suggest that central GABAA-BDZ receptors in the dorsal striatum play an important role in mediating the sedation produced by a moderate EtOH dose in the open field.
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Affiliation(s)
- H L June
- Department of Psychology, Purdue School of Science, Indiana University-Purdue University, Indianapolis, IN 46202, USA.
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Shong E, Lui R. [Analysis of the chemical constituents of volatile oils of Metasequoia glyptostroboides leave]. Zhong Yao Cai 1997; 20:514-5. [PMID: 12572521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
The chemical constituents of volatile oils of Metasequoia glyptostroboides leave were analyzed by GC-MS-DS. 27 constituents were identified, alpha-pinene (70.65%) and caryophyllene (10.38%) of them are main components.
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Affiliation(s)
- E Shong
- Langfang Institute for Drug Control, Langfang 065000
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Pirofski L, Lui R, DeShaw M, Kressel AB, Zhong Z. Analysis of human monoclonal antibodies elicited by vaccination with a Cryptococcus neoformans glucuronoxylomannan capsular polysaccharide vaccine. Infect Immun 1995; 63:3005-14. [PMID: 7622223 PMCID: PMC173409 DOI: 10.1128/iai.63.8.3005-3014.1995] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The Cryptococcus neoformans capsular polysaccharide glucuronoxylomannan (GXM) has been conjugated to tetanus toxoid (GXM-TT) as an investigational vaccine. GXM-TT elicits antibodies that are protective in C. neoformans-infected mice. In an effort to characterize the fine specificity and molecular structure of human GXM-TT-elicited antibodies, we generated two GXM monoclonal antibodies (MAbs) from peripheral blood lymphocytes of a volunteer GXM-TT recipient and studied serum GXM antibody idiotype expression in 10 additional vaccinees. The MAbs, 2E9 and 3B6, are the immunoglobulin M(lambda) isotype and bind capsular polysaccharides of C. neoformans serotypes other than the serotype A that was used for immunization. Neither antibody competes with murine GXM MAbs for antigen binding, suggesting that the human MAbs recognize a different epitope. The B-cell superantigen staphylococcal protein A binds both MAbs, and human immunodeficiency virus gp120 binds 2E9. MAb nucleic acid sequence analysis revealed that both antibodies use an identical V lambda 1a-J lambda genetic element with different, somatically mutated, members of the VH3 gene family and different DH and JH gene elements. The gene elements used by both MAbs occur in fetal B-lymphocyte repertoires, autoantibodies, and other polysaccharide antibodies. Post-GXM-TT vaccination GXM antibodies from 10 additional vaccinees expressed a shared idiotype defined by rabbit antiserum raised against MAb 2E9. Our data suggest that the human GXM antibody response is restricted and raise questions regarding the importance of specific variable-region elements and superantigens in the generation of human antibody responses to encapsulated pathogens.
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Affiliation(s)
- L Pirofski
- Department of Microbiology, Albert Einstein College of Medicine, Bronx, New York 10461, USA
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Abstract
BACKGROUND Suramin is a polysulfonated urea recently tested in clinical trials as an anticancer agent. PURPOSE To define tumor types for further clinical testing of suramin, we assessed the in vitro activity of suramin against fresh human tumor specimens. METHODS Inhibition of tumor colony formation (human tumor clonogenic assay [HTCA] method) and inhibition of tritiated thymidine incorporation (TTI method) were used as indicators of drug sensitivity. RESULTS With the use of the HTCA method, 80% or more of carcinomas of the colon, endometrium, kidney, lung (non-small-cell), and ovary as well as malignant melanoma and mesothelioma were sensitive to 200 micrograms/mL of suramin by continuous exposure. Suramin's antitumor activity was dose dependent, and it was less effective when tested at concentrations of 50 micrograms/mL or less. With the TTI method, the more slowly growing tumors (breast cancer, colon cancer, multiple myeloma, non-Hodgkin's lymphoma, prostate cancer, and sarcoma) appeared to be less sensitive to suramin. However, when the two assay methods were directly compared in melanoma and ovarian cancer specimens, individual tumors were generally more sensitive to suramin (greater inhibition relative to control) using the HTCA method, whereas the TTI method appeared to underestimate suramin's antitumor activity. There was no significant difference in the activity of suramin when tested in the presence of 10% versus 50% serum. CONCLUSION These results provide an experimental basis for clinical evaluations of suramin therapy in patients with colon, endometrial, kidney, non-small-cell lung, and ovarian cancers as well as malignant melanoma and mesothelioma.
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Westlake PJ, Hershfield NB, Kelly JK, Kloiber R, Lui R, Sutherland LR, Shaffer EA. Chronic right upper quadrant pain without gallstones: does HIDA scan predict outcome after cholecystectomy? Am J Gastroenterol 1990; 85:986-90. [PMID: 2375327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Patients with chronic right upper quadrant pain who do not have gallstones on ultrasound or cholecystography are often referred for surgery for presumed acalculous chronic cholecystitis. We followed 26 patients who had cholecystokinin (CCK) cholescintigraphy for evaluation of chronic right upper quadrant pain without demonstrable gallstones on ultrasound who underwent cholecystectomy so that it could be determined whether there was any relation between a low ejection fraction (EF), morphological features of chronic cholecystitis, and clinical outcome. Eighteen patients (69%) were considered therapeutic successes, whereas eight (31%) were failures after an average 2-yr follow-up. Both patient groups had significantly reduced EF: the successful group at 0.39 and the failures at 0.25. Thus, a low EF did not predict clinical outcome, since the failure group had an even lower EF than the success group. Seven gallbladders demonstrated chronic acalculous cholecystitis; the average EF of this group was 0.35. The remaining 19 gallbladders were normal, yet also had an EF of 0.35. Thus, decreased EF does not predict the histologic features of chronic cholecystitis without gallstones. The diagnostic value of cholescintigraphy in patients with acalculous right upper quadrant pain is low, probably because this entity represents a variety of processes, including inflammation, gallbladder dysmotility, and the irritable bowel syndrome.
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Affiliation(s)
- P J Westlake
- Division of Gastroenterology, Foothills Hospital, Calgary, Alberta, Canada
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Abstract
A case of ovarian and systemic sarcoidosis with mucinous cystadenoma coexisting in the same ovary is described. This association has not been previously reported. The differentiation of systemic sarcoidosis from metastatic spread of ovarian cancer and from sarcoid-like reactions in regional lymph nodes of tumors is discussed.
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Affiliation(s)
- A White
- Department of Medicine, New England Medical Center Hospital, Tufts University School of Medicine, Boston, MA 02111
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Abstract
We study the asymptotic behavior of solutions to a system of recursions u in+1 = Qi[mu n], i = 1, ..., k. The vector operator Q has the origin theta and a positive vector beta as fixed points and is defined for vector-valued functions bounded between theta and gamma where gamma greater than or equal to beta. In addition, Q is order-preserving, commutes with translation, and is continuous in the topology of uniform convergence on compact subsets. Let theta less than or equal to pi much less than beta, and suppose that for all pi much less than alpha much less than beta, Q(n) alpha]----beta as n----infinity. If u0 much greater than pi on a sufficiently large ball and has bounded support, then un propagates with a speed c*(xi) in the direction of the unit vector xi as n----infinity. In certain cases, c*(xi) can be calculated explicitly. The results generalize those of a scalar equation studied by Weinberger.
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Abstract
The mathematical theory developed in Part I is applied to a selection-migration model in population genetics with sex-linked locus and to the host-vector or venereal disease epidemic model. In both models, a constant c*(xi) is found for each unit vector xi. The mathematical results imply that under certain initial conditions, the frequency of the advantageous gene in the male and female gametic outputs or the epidemic will spread at a speed c*(xi) in the direction xi as time goes to infinity. Time is measured in discrete nonoverlapping generations. In most cases, we can find a formula for c*(xi).
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Wong J, Cheung H, Lui R, Fan YW, Smith A, Siu KF. Esophagogastric anastomosis performed with a stapler: the occurrence of leakage and stricture. Surgery 1987; 101:408-15. [PMID: 3563886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The circular stapler has lowered the leakage rate of an esophageal anastomosis to a level hitherto achieved by only a few surgeons performing hand anastomosis on selected patients with carcinoma of the esophagus. However, the esophageal anastomosis performed with a stapler is also associated with a high stricture rate. Our prospective study was conducted to determine the leakage rate and the incidence of stricture after esophagogastric anastomosis was performed with a stapler, the relationship of stricture to the size of the stapler, and the risk of stricture in relation to time. In a group of 174 patients with carcinoma of the thoracic esophagus, resection was performed, and a one-stage esophagogastric anastomosis was constructed. There were 33 hand anastomoses, 64 anastomoses with an EEA stapler (U.S. Surgical Corp., Norwalk, Conn.), and 77 anastomoses with an ILS stapler (Ethicon Ltd., Edinburgh, U.K.). The anastomotic leakage rate was 3.4% (6/174); 3% with the hand technique and 3.5% with the stapler technique (4.7% for the EEA and 2.6% for the ILS). After leakages and hospital deaths were excluded, 133 discharged patients were evaluated for the occurrence of anastomotic strictures. Only those who complained of dysphagia were investigated. The incidence of stricture for hand anastomosis was 8.7%-EEA 20% and ILS 10%; the overall incidence of anastomoses with a stapler was 14.5%. The true incidence would probably be higher if all patients were assessed by endoscopic or radiologic examination after operation. All three sizes of EEA staplers had a high incidence of stricture. For the ILS stapler the 25 mm size had the highest stricture rate (28.6%) of all groups, but for the 29 and 33 mm sizes, the incidences were 5.3% and 0%, respectively. Actuarial analysis showed an increasing risk of stricture with a reduction in the size of stapler used and was 32.5% and 35%, respectively, for the ILS 25 mm and EEA 25 mm staplers at 131/2 months. The risk of stricture occurrence was highest in the first 4 months. Treatment by bougienage was satisfactory. In conclusion, esophagogastric anastomosis performed with a stapler is a very safe procedure with respect to leakage but is associated with a high risk of stricture, except when the largest ILS staplers are used. However, dilatation readily overcomes the stricture occurrence and adequately compensates for the reduced leakage rate and its attendant serious consequences.
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Abstract
Postoperative flexible choledochoscopy was carried out in 103 patients with residual biliary calculi. Forty-one patients had residual stones in the common duct, and 63 patients had residual stones in the intrahepatic ducts with or without stones in the common duct. The majority of the intrahepatic stones were primary stones. Postoperative choledochoscopy was very effective in removing residual common duct stones (95% removed, no morbidity). For intrahepatic stones, removal was more difficult and was associated with a higher morbidity (11.2%). Stone extraction through the stenotic intrahepatic ducts was made possible by the balloon dilatation of the ducts. Repeated endoscopic access to the biliary system was made easier by the construction of a hepatico-cutaneous-jejunostomy, which also provides a route to the biliary tree for future stone removal if stone reformation occurs. Complimented by these procedures, postoperative choledochoscopy was successful in removing the residual intrahepatic stones in 82.3% of the patients. At a median follow-up of 17 months, the majority of the patients who had all the stones removed as well as those who had stones left behind were symptom free.
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