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Hammond TC, Lee RC, Oronsky B, Reid TR, Caroen S, Juarez TM, Gill J, Heng A, Kesari S. Clinical Course of Two Patients with COVID-19 Respiratory Failure After Administration of the Anticancer Small Molecule, RRx-001. Int Med Case Rep J 2022; 15:735-738. [PMID: 36545548 PMCID: PMC9762260 DOI: 10.2147/imcrj.s389690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Two critically ill COVID-19 infected patients, who had exhausted all available treatment options, were treated with the small-molecule RRx-001 with subsequent improvement. RRx-001, a first-in-class small molecule with anti-inflammatory, vascular normalizing and macrophage-repolarizing properties, has been safely administered 300+ patients in clinical trials. This is the first report of RRx-001 treatment of COVID-19.
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Affiliation(s)
- Terese Catherine Hammond
- Providence St. Johns Health Center, Santa Monica, CA, USA,John Wayne Cancer Institute, Santa Monica, CA, USA
| | - Raymond C Lee
- Providence St. Johns Health Center, Santa Monica, CA, USA,Cardiovascular Thoracic Institute, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Bryan Oronsky
- EpicentRx, Inc., La Jolla, CA, USA,Correspondence: Bryan Oronsky, EpicentRx, Inc, 11099 North Torrey Pines Road, La Jolla, CA, 92037, USA, Tel +1 858 947-6635, Fax +1 858 724-3080, Email
| | | | | | | | - Jaya Gill
- Pacific Neuroscience Institute, Santa Monica, CA, USA
| | - Annie Heng
- John Wayne Cancer Institute, Santa Monica, CA, USA
| | - Santosh Kesari
- Providence St. Johns Health Center, Santa Monica, CA, USA,John Wayne Cancer Institute, Santa Monica, CA, USA,Pacific Neuroscience Institute, Santa Monica, CA, USA
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2
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Gribbin H, Lee RC, Betz-Stablein B, Soyer HP. Rapid response: "The essential role of dermatology publications in enhancing professional diversity, equity and inclusion". Br J Dermatol 2022; 187:276-277. [PMID: 35560024 DOI: 10.1111/bjd.21629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 04/22/2022] [Accepted: 04/27/2022] [Indexed: 11/29/2022]
Affiliation(s)
- H Gribbin
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - R C Lee
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - B Betz-Stablein
- The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - H P Soyer
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland, Australia
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3
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Jacobs JP, Stammers AH, St. Louis JD, Tesdahl EA, Hayanga JA, Morris RJ, Lee RC, Sestokas AK, Badhwar V, Weinstein S. Variation in Survival in Patients with COVID-19 Supported with ECMO: A Multi-institutional analysis of 594 consecutive COVID-19 patients supported with ECMO at 49 hospitals within 21 States. J Thorac Cardiovasc Surg 2022; 165:1837-1848. [PMID: 36116956 PMCID: PMC9107618 DOI: 10.1016/j.jtcvs.2022.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/21/2022] [Accepted: 05/04/2022] [Indexed: 01/08/2023]
Abstract
Objectives We reviewed 594 consecutive patients with Coronavirus Disease 2019 supported with extracorporeal membrane oxygenation at 49 hospitals within 21 states and examined patient characteristics, treatments, and variation in outcomes over the course of the pandemic. Methods A multi-institutional database was used to assess all patients with Coronavirus Disease 2019 cannulated for extracorporeal membrane oxygenation between March 17, 2020, and December 20, 2021, inclusive, and separated from ECMO on or prior to January 14, 2022. Descriptive analysis was stratified by 4 time categories: group A = March 2020 to June 2020, group B = July 2020 to December 2020, group C = January 2021 to June 2021, group D = July 2021 to December 2021. A Bayesian mixed-effects logistic regression was used to assess continuous trends in survival where time was operationalized as the number of days between each patient's cannulation and that of the first patient in March 2020, controlling for multiple variables and risk factors. Results At hospital discharge, of 594 patients, 221 survived (37.2%) and 373 died. Throughout the study, median age [interquartile range] declined (group A = 51.0 [41.0-60.0] years, group D = 39.0 [32.0-48.0] years, P < .001); median days between Coronavirus Disease 2019 diagnosis and intubation increased (group A = 4.0 [1.0-8.5], group D = 9.0 [5.0-14.5], P < .001); and use of medications (glucocorticoids, interleukin-6 blockers, antivirals, antimalarials) and convalescent plasma fluctuated significantly (all P < .05). Estimated odds of survival varied over the study period with a decline between April 1, 2020, and November 21, 2020 (odds ratio, 0.39, 95% credible interval, 0.18-0.87, probability of reduction in survival = 95.7%), improvement between November 21, 2020, and May 17, 2021 (odds ratio, 1.85, 95% credible interval, 0.86-4.09, probability of improvement = 93.4%), and decline between May 17, 2021, and December 1, 2021 (odds ratio, 0.49, 95% credible interval, 0.19-1.44, probability of decrease = 92.1%). Conclusions Survival for patients with Coronavirus Disease 2019 supported with extracorporeal membrane oxygenation has fluctuated during the stages of the pandemic. Minimizing variability by adherence to best practices may refine the optimal use of extracorporeal membrane oxygenation in a pandemic response.
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D’Agnillo F, Walters KA, Xiao Y, Sheng ZM, Scherler K, Park J, Gygli S, Rosas LA, Sadtler K, Kalish H, Blatti CA, Zhu R, Gatzke L, Bushell C, Memoli MJ, O’Day SJ, Fischer TD, Hammond TC, Lee RC, Cash JC, Powers ME, O’Keefe GE, Butnor KJ, Rapkiewicz AV, Travis WD, Layne SP, Kash JC, Taubenberger JK. Lung epithelial and endothelial damage, loss of tissue repair, inhibition of fibrinolysis, and cellular senescence in fatal COVID-19. Sci Transl Med 2021; 13:eabj7790. [PMID: 34648357 PMCID: PMC11000440 DOI: 10.1126/scitranslmed.abj7790] [Citation(s) in RCA: 110] [Impact Index Per Article: 36.7] [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: 12/20/2022]
Abstract
Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is characterized by respiratory distress, multiorgan dysfunction, and, in some cases, death. The pathological mechanisms underlying COVID-19 respiratory distress and the interplay with aggravating risk factors have not been fully defined. Lung autopsy samples from 18 patients with fatal COVID-19, with symptom onset-to-death times ranging from 3 to 47 days, and antemortem plasma samples from 6 of these cases were evaluated using deep sequencing of SARS-CoV-2 RNA, multiplex plasma protein measurements, and pulmonary gene expression and imaging analyses. Prominent histopathological features in this case series included progressive diffuse alveolar damage with excessive thrombosis and late-onset pulmonary tissue and vascular remodeling. Acute damage at the alveolar-capillary barrier was characterized by the loss of surfactant protein expression with injury to alveolar epithelial cells, endothelial cells, respiratory epithelial basal cells, and defective tissue repair processes. Other key findings included impaired clot fibrinolysis with increased concentrations of plasma and lung plasminogen activator inhibitor-1 and modulation of cellular senescence markers, including p21 and sirtuin-1, in both lung epithelial and endothelial cells. Together, these findings further define the molecular pathological features underlying the pulmonary response to SARS-CoV-2 infection and provide important insights into signaling pathways that may be amenable to therapeutic intervention.
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Affiliation(s)
- Felice D’Agnillo
- Laboratory of Biochemistry and Vascular Biology, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | | | - Yongli Xiao
- Viral Pathogenesis and Evolution Section, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Zong-Mei Sheng
- Viral Pathogenesis and Evolution Section, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | | | - Jaekeun Park
- Viral Pathogenesis and Evolution Section, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Sebastian Gygli
- Viral Pathogenesis and Evolution Section, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Luz Angela Rosas
- Viral Pathogenesis and Evolution Section, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Kaitlyn Sadtler
- Section on Immunoengineering, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, USA
| | - Heather Kalish
- Bioengineering and Physical Sciences Shared Resource, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, USA
| | - Charles A. Blatti
- National Center for Supercomputing Applications, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Ruoqing Zhu
- Department of Statistics, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Lisa Gatzke
- National Center for Supercomputing Applications, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Colleen Bushell
- National Center for Supercomputing Applications, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Matthew J. Memoli
- Clinical Studies Unit, Laboratory of Infectious Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | | | | | | | - Raymond C. Lee
- Division of Cardiothoracic Surgery, USC Keck School of Medicine, Los Angeles, CA, USA
| | - J. Christian Cash
- Division of Cardiothoracic Surgery, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Matthew E. Powers
- Division of Cardiothoracic Surgery, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Grant E. O’Keefe
- Department of Surgery, University of Washington, Harborview Medical Center, Seattle, WA, USA
| | - Kelly J. Butnor
- Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, VT, USA
| | - Amy V. Rapkiewicz
- Department of Pathology, New York University Long Island School of Medicine, Mineola, NY, USA
| | - William D. Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - John C. Kash
- Viral Pathogenesis and Evolution Section, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Jeffery K. Taubenberger
- Viral Pathogenesis and Evolution Section, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
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5
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Chiou SY, Lee RC, Chi KH, Chia-Hsien Cheng J, Chiang JH, Chang CY. The triple-phase CT image appearance of post-irradiated livers. Acta Radiol 2016; 42:526-31. [PMID: 11552892 DOI: 10.1080/028418501127347115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective To evaluate the sequential CT appearance of the liver after hepatic irradiation and to investigate the correlation between CT findings and radiation-induced hepatic injury. Material and Methods: The triple-phase CT images of 18 patients with hepatocellular carcinomas (HCC) after hepatic irradiation were retrospectively reviewed (in total 41 CT studies). The high-dose region within the liver was defined as the area receiving more than 90% of the prescribed irradiation dose. The mean radiation dose was 55.5 Gy. Density changes and patterns of enhancement in the high-dose region were classified as three types: type I, constant low-density change in all phases; type II, low-density change in both pre-contrast and arterial phases, and iso-density change in the portal phase; type III, low- or iso-density change in the pre-contrast phase, low- or high-density change in the arterial phase, and persistent high-density change in the portal phase. The interval between completion of radiotherapy and the CT examinations ranged from 9 to 469 days, with a mean of 147 days. Results: Nine of the 41 CT studies presented with type I, 9 with type II, and 16 with type III CT findings. The mean interval between completion of radiotherapy and the appearance of types I, II, and III CT findings were 74, 183, and 220 days, respectively. The interval was significantly shorter for type I findings than for type II and type III. The difference in interval was not significant between type II and type III. A type I finding with constant low-density change in the high-dose region of the liver was the most common pattern of CT findings within the first 3 months after hepatic irradiation. Either types II or III findings were frequently seen after 3 months. Conclusion: The sequential CT appearance and the density changes may indicate correlation with the pathogenesis of veno-occlusive disease.
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Affiliation(s)
- S Y Chiou
- Department of Radiology, Veterans General Hospital-Taipei, Taipei, Taiwan
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Dam DHM, Lee H, Lee RC, Kim KH, Kelleher NL, Odom TW. Tunable loading of oligonucleotides with secondary structure on gold nanoparticles through a pH-driven method. Bioconjug Chem 2015; 26:279-85. [PMID: 25564799 DOI: 10.1021/bc500562s] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
This paper describes how pH can be used to control covalent attachment of oligonucleotides with secondary structure on gold nanoparticles (AuNPs). The highest loading of thiolated nucleic acids occurred at low pH (pH = 1.7) due to reduced repulsion between the negatively charged oligonucleotides and the AuNP surface. The packing of oligonucleotides at low pH decreased (single-stranded ≫ duplex > quadruplex) as the spatial footprint of secondary structure increased. As the pH increased, a decrease in the number of DNA strands grafted to the AuNPs was observed. Notably, the loading density depended on the flexibility and spatial organization of the secondary structures at all pH conditions. At the lowest pH tested, circular dichroism analysis revealed that G-quadruplex aptamers underwent a structural change (from parallel to antiparallel or vice versa), although the biological activity of the aptamer-loaded AuNPs was still maintained. We anticipate that pH-tuning can result in quantitative loading of oligonucleotides on various types of AuNPs with different shapes and surface capping layers.
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Affiliation(s)
- Duncan Hieu M Dam
- Department of Chemistry and ‡Department of Materials Science and Engineering, Northwestern University , 2145 Sheridan Road, Evanston Illinois 60208, United States
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Dam DHM, Culver KSB, Kandela I, Lee RC, Chandra K, Lee H, Mantis C, Ugolkov A, Mazar AP, Odom TW. Biodistribution and in vivo toxicity of aptamer-loaded gold nanostars. Nanomedicine 2014; 11:671-9. [PMID: 25461281 DOI: 10.1016/j.nano.2014.10.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 09/17/2014] [Accepted: 10/18/2014] [Indexed: 12/19/2022]
Abstract
This paper reports an in vivo evaluation of toxicology and biodistribution of a highly anisotropic Au nanoconstruct composed of a gold nanostar (AuNS) core and a ligand shell of a G-quadruplex DNA aptamer AS1411 (Apt) supporting both targeting and therapy capabilities. We examined the toxicity of the nanoconstructs (Apt-AuNS) at four different injected concentrations. At the highest dose tested (48 mg/kg), maximal tolerated dose was not reached. Clinical pathology showed no apparent signs of acute toxicity. Interestingly, the nanoconstructs circulated longer in female rats compared to male rats. In two different tumor models, the biodistribution of Apt-AuNS, especially tumor accumulation, was different. Accumulation of Apt-AuNS was 5 times higher in invasive breast cancer tumors compared to fibrosarcoma tumors. These results provide insight on identifying a tumor model and nanoconstruct for in vivo studies, especially when an in vitro therapeutic response is observed in multiple cancer cell lines. From the clinical editor: This study investigated the toxicity and distribution of aptamer loaded gold nanostars in a rodent model of invasive breast cancer and fibrosarcoma. Acute toxicity was not identified even in the highest studied doses. Fivefold accumulation was demonstrated in the breast cancer model compared to the fibrosarcoma model. Studies like this are critically important in further clarifying the potential therapeutic use of these nanoconstructs, especially when ex vivo effects are clearly demonstrated.
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Affiliation(s)
| | - Kayla S B Culver
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA
| | - Irawati Kandela
- Developmental Therapeutic Core, Chemistry of Life Processes Institute, Northwestern University, Evanston, IL, USA
| | - Raymond C Lee
- Department of Chemistry, Northwestern University, Evanston, IL, USA
| | - Kavita Chandra
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA
| | - Hyojin Lee
- Department of Chemistry, Northwestern University, Evanston, IL, USA
| | - Christine Mantis
- Developmental Therapeutic Core, Chemistry of Life Processes Institute, Northwestern University, Evanston, IL, USA
| | - Andrey Ugolkov
- Developmental Therapeutic Core, Chemistry of Life Processes Institute, Northwestern University, Evanston, IL, USA
| | - Andrew P Mazar
- Developmental Therapeutic Core, Chemistry of Life Processes Institute, Northwestern University, Evanston, IL, USA
| | - Teri W Odom
- Department of Chemistry, Northwestern University, Evanston, IL, USA; Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA.
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Dam DM, Lee RC, Odom TW. Improved in vitro efficacy of gold nanoconstructs by increased loading of G-quadruplex aptamer. Nano Lett 2014; 14:2843-8. [PMID: 24689438 PMCID: PMC4023846 DOI: 10.1021/nl500844m] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 03/31/2014] [Indexed: 05/04/2023]
Abstract
This paper describes how in vitro efficacy of aptamer-loaded gold nanostars (Apt-AuNS) can be enhanced by the increased loading of a G-quadruplex homodimer AS1411 (Apt) on the AuNS surface. In a low pH buffer environment, the loading density of Apt on AuNS was increased up to 2.5 times that obtained using the conventional salt-aging process. These highly loaded AuNS nanoconstructs (*Apt-AuNS) were taken up in pancreatic cancer and fibrosarcoma cells ca. 2 times more and at faster rates compared to Apt-AuNS. When a similar number of AuNS carriers was internalized by the cancer cells, the amount of AS1411 delivered via *Apt-AuNS was effectively double that of Apt-AuNS, and *Apt-AuNS resulted in an average of 42% increase in cell death. These results suggest that increasing the loading density on AuNS could provide a simple means to improve uptake as well as in vitro efficacy of the nanoconstructs in cancer cells.
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Affiliation(s)
- Duncan
Hieu M. Dam
- Department of Chemistry and Department of Materials
Science and Engineering, Northwestern University, 2145 Sheridan Road, Evanston, Illinois 60208, United States
| | - Raymond C. Lee
- Department of Chemistry and Department of Materials
Science and Engineering, Northwestern University, 2145 Sheridan Road, Evanston, Illinois 60208, United States
| | - Teri W. Odom
- Department of Chemistry and Department of Materials
Science and Engineering, Northwestern University, 2145 Sheridan Road, Evanston, Illinois 60208, United States
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Despa F, Orgill DP, Lee RC. Stability of cellular proteins under supraphysiological temperatures. Conf Proc IEEE Eng Med Biol Soc 2007; 2004:5440-3. [PMID: 17271577 DOI: 10.1109/iembs.2004.1404520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
We present quantitative analyses of the kinetics of cellular components confronted with the destabilizing effect of irreversible thermal denaturation. We examine the dependence of the thermal denaturation on the heating rate, relative stability, population and lifetime of the states involved in transition and crowding effects. We propose a mechanism for self-stabilization of proteins during unfolding in tightly packed fibers and membranes. Speaking in terms of vulnerability to thermal denaturation, our results suggest that the thermal alteration of the plasma membrane is likely to be the most significant cause of the tissue necrosis.
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Affiliation(s)
- F Despa
- Department of Surgery, Chicago University, IL, USA
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10
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Lee RC, Despa F, Collins JC, Karczmar G, Tenchov B. Magnetic resonance imaging of muscle electroporation injury. Conf Proc IEEE Eng Med Biol Soc 2007; 2004:5451-4. [PMID: 17271580 DOI: 10.1109/iembs.2004.1404523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Low frequency electrical currents traversing the body during electrical shock can produce tissue damage by effects of electrical forces on cellular organelles and proteins as well as by Joule heating beyond thermotolerance. Treatment for these different injuries are quite distinct. Therefore, it is important to accurately diagnose the form of injury. Here we discuss the use of MRI for this purpose.
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Affiliation(s)
- R C Lee
- Department of Surgery, Chicago University, IL, USA
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Affiliation(s)
- F G Benedict
- Nutrition Laboratory of the Carnegie Institution of Washington, Boston
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12
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Silverman L, Lee RC, Drinker CK, Rackemann FM. A NEW METHOD FOR STUDYING BREATHING, WITH OBSERVATIONS UPON NORMAL AND ABNORMAL SUBJECTS. J Clin Invest 2006; 23:907-13. [PMID: 16695177 PMCID: PMC435415 DOI: 10.1172/jci101566] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Abstract
When tissue is subjected to higher than physiological temperatures, protein and cell organelle structures can be altered resulting in cell death and subsequent tissue necrosis. A burn injury can be stratified into three main zones, coagulation, stasis and edema, which correlate with the extent of heat exposure and thermal properties of the tissue. While there has been considerable effort to characterize the time-temperature dependence of the injury, relatively little attention has been paid to the other important variable, the thermal susceptibility of the tissue. In the present study, we employ a standard physical chemistry approach to predict the level of denaturation at supraphysiological temperatures of 12 vital proteins as well as RNA, DNA and cell membrane components. Melting temperatures and unfolding enthalpies of the cellular components are used as input experimental parameters. This approach allows us to establish a relation between the level of denaturation of critical cellular components and clinical manifestations of the burn through the characteristic zones of the injury. Specifically, we evaluate the degree of molecular alteration for characteristic temperature profiles at two different depths (Mid-Dermis and Dermis-Fat interface) of 80 degrees C; 20s contact burn. The results of this investigation suggest that the thermal alteration of the plasma membrane is likely the most significant cause of the tissue necrosis. The lipid bilayer and membrane-bound ATPases show a high probability of thermal damage (almost 100% for the former and 85% for the latter) for short heat exposure times. These results suggest that strategies to minimize the damage in a burn injury might focus on the stabilization of the cellular membrane and membrane-bound ATPases. Further work will be required to validate these predictions in an in vivo model.
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Affiliation(s)
- F Despa
- Department of Surgery, MC6035, The University of Chicago, Chicago, IL 60637, USA
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Wu TC, Lee RC, Chiang JH, Chang CY. Reappraisal of left-sided gallbladder and its accompanying anomalies: a report of two cases and literature review. Acta Radiol 2005; 46:233-6. [PMID: 15981718 DOI: 10.1080/02841850510012706] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We report two cases of coexistent left-sided gallbladder and right-sided ligamentum teres with portal vein anomalies documented by magnetic resonance imaging (MRI) and three-dimensional (3D) computed tomography during arterial portography (CTAP). Reformatted 3D MR and CTAP images provide an informative illustration of the accompanying portal vein anomalies. This important anatomical information is useful in preoperative work-up of hepatobiliary surgery.
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Affiliation(s)
- T C Wu
- Department of Radiology, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan
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15
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Chien JCW, Hsieh SC, Lee RC, Chen CY, Cheng CJ, Chan WP. Endometrial stromal sarcoma mimicking submucosal myoma protruding to the vagina: MRI findings. EUR J GYNAECOL ONCOL 2005; 26:657-60. [PMID: 16398232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
A 46-year-old woman complained of persistent abnormal vaginal bleeding over ten days. Her intrauterine device had been removed two years before. Soon after, she suffered from menorrhagia and metrorrhagia. An incidental finding of severe anemia was also noted. In this admission, our initial T2-weighted magnetic resonance imaging (MRI) revealed a well-demarcated mass predominantly in the uterine cavity. The mass was depicted by an isointense signal relative to the myometrium on T1-weighted images, high signal intensity on T2-weighted images, and slightly heterogeneous enhancement on post-contrast images. The patient refused surgery. After two years, follow-up MRI showed a pedunculated mass protruding into the upper third of the vagina with a stalk connecting to the posterior wall of the uterine cavity, simulating submucosal myoma. Histological diagnosis was compatible with low-grade endometrial stromal sarcoma.
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Affiliation(s)
- J C W Chien
- Department of Radiology, Taipei Medical University-Municipal Wan Fang Hospital, Taiwan
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Huo TI, Wu JC, Lui WY, Lee RC, Loong CC, Huang YH, Tsay SH, Chang FY, Lee SD. Reliability of contemporary radiology to measure tumour size of hepatocellular carcinoma in patients undergoing resection: limitations and clinical implications. Scand J Gastroenterol 2004; 39:46-52. [PMID: 14992561 DOI: 10.1080/00365520310007242] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Preoperative radiology has been widely used to detect and measure hepatocellular carcinoma (HCC). However, its accuracy and reliability are unclear. This study aimed to assess the ability of current radiology to measure tumour size in patients undergoing resection. METHODS We evaluated 212 HCC patients undergoing curative resection. Tumour size measured in the pathological examination was correlated with that obtained in preoperative ultrasound (US) and contrast-enhanced dynamic computed tomography (CT). Accuracy and association with tumour recurrence were investigated. RESULTS The mean size of the tumour was 4.5 +/- 2.6 cm and was accurate in both US and CT in only 6 (3%) patients. Cirrhosis (P = 0.015), absence of tumour stain (P = 0.002) and small (< or = 4 cm) tumour (P < 0.001) were the significant factors associated with size deviation using both US and CT. Ninety-four (44%) patients developed tumour recurrence within 17 +/- 11 months of resection. Recurrence rate was 52%, 52% and 67% in patients with underestimation in US (relative risk [RR]: 2.0, 95% confidence interval [CI]: 1.2-3.4, P = 0.01), CT (RR: 2.1, 95% CI: 1.1-4, P = 0.022) and both modalities (RR: 2.5, 95% CI: 1.4-4.2, P = 0.001), respectively, compared to 30% recurrence in patients with accurate estimation of tumour size. CONCLUSION The accuracy of radiology in measuring tumour size was poor, and may lead to inappropriate treatment. The finding that underestimation of tumour size was associated with a higher tumour recurrence rate is consistent with the hypothesis that HCC may recur from pre-existing tumour foci which could not be identified from the current imaging modalities.
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Affiliation(s)
- T I Huo
- Dept of Medicine, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan, Republic of China.
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17
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Abstract
There is increasing interest in the integration of quantitative risk analysis with benefit-cost and cost-effectiveness methods to evaluate environmental health policy making and perform comparative analyses. However, the combined use of these methods has revealed deficiencies in the available methods, and the lack of useful analytical frameworks currently constrains the utility of comparative risk and policy analyses. A principal issue in integrating risk and economic analysis is the lack of common performance metrics, particularly when conducting comparative analyses of regulations with disparate health endpoints (e.g., cancer and noncancer effects or risk-benefit analysis) and quantitative estimation of cumulative risk, whether from exposure to single agents with multiple health impacts or from exposure to mixtures. We propose a general quantitative framework and examine assumptions required for performing analyses of health risks and policies. We review existing and proposed risk and health-impact metrics for evaluating policies designed to protect public health from environmental exposures, and identify their strengths and weaknesses with respect to their use in a general comparative risk and policy analysis framework. Case studies are presented to demonstrate applications of this framework with risk-benefit and air pollution risk analyses. Through this analysis, we hope to generate discussions regarding the data requirements, analytical approaches, and assumptions required for general models to be used in comparative risk and policy analysis.
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Affiliation(s)
- E Y Wong
- Institute for Risk Analysis and Risk Communication and Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA 98105, USA.
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18
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Abstract
Transient lower extremity paralysis has been previously reported following high voltage electrical injury. The following case report describes an unusual presentation of transient acute flaccid lower extremity paralysis following a high voltage electrical injury associated with profound hypokalemia and acid/base abnormalities similar to the periodic paralysis syndrome. The patient's symptoms resolved with correction of severe hypokalemia. Potential mechanisms for a metabolic neuromuscular disorder induced by electrical injury are proposed.
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Affiliation(s)
- R A Dasgupta
- Sumner Redstone Burn Center, Surgical Services, Massachusetts General Hospital, Harvard Medical School, Bigelow 1302, Boston 02114, USA
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19
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Abstract
Electrical shock trauma tends to produce a very complex pattern of injury, mainly because of the multiple modes of frequency-dependent tissue-field interactions. Historically, Joule heating was thought to be the only cause of electrical injuries to tissue by commercial-frequency electrical shocks. In the last 15 years, biomedical engineering research has improved the understanding of the underlying biophysical injury mechanisms. Besides thermal burns secondary to Joule heating, permeabilization of cell membranes and direct electroconformational denaturation of macromolecules such as proteins have also been identified as tissue-damage mechanisms. This review summarizes the physics of tissue injury caused by contact with commercial-frequency power lines, as well as exposure to lightning and radio frequency (RF), microwave, and ionizing radiation. In addition, we describe the anatomic patterns of the resultant tissue injury from these modes of electromagnetic exposures.
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Affiliation(s)
- R C Lee
- Department of Surgery and Organismal Biology (Biomechanics), Pritzker School of Medicine, University of Chicago, Chicago, Illinois 60637, USA.
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20
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Lin MT, Lee RC, Yang PC, Ho FM, Kuo ML. Cyclooxygenase-2 inducing Mcl-1-dependent survival mechanism in human lung adenocarcinoma CL1.0 cells. Involvement of phosphatidylinositol 3-kinase/Akt pathway. J Biol Chem 2001; 276:48997-9002. [PMID: 11585835 DOI: 10.1074/jbc.m107829200] [Citation(s) in RCA: 148] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Cyclooxygenase 2 (COX-2) has been reported to be commonly expressed in advanced stages of human lung adenocarcinoma. In this study, the COX-2 constitutive expression vector was transfected into a human lung adenocarcinoma cell line CL1.0 and several clones were obtained which stably expressed COX-2. These COX-2-overexpressed clones demonstrated remarkable resistance to apoptosis induced by Ultraviolet B (UVB) irradiation, vinblastine B (VBL) cell lymphoma-2 (Bcl-2), or other anti-cancer drugs. To understand how COX-2 prevents apoptosis, the investigators examined the expression level of Bcl-2 family members. Mcl-1, but not other Bcl-2 members, was significantly up-regulated by COX-2 transfection or prostaglandin E(2) (PGE(2)) treatment. Treatment of COX-2-overexpressed cells (cox-2/cl.4) with two specific COX-2 inhibitors, NS-398 and celecoxib, caused an effective reduction of the increased level of Mcl-1. These data suggest that the expression level of Mcl-1 is tightly regulated by COX-2. Moreover, transfection of cox-2/cl.4 cells with antisense Mcl-1 enhanced apoptosis induced by UVB irradiation, revealing that Mcl-1 plays a crucial role in cell survival activity mediated by COX-2. Furthermore, COX-2 transfection or PGE(2) treatment evidently activated the phosphatidylinositol 3-kinase (PI3K)/Akt pathway. Inhibition of the PI3K pathway by LY294002 or wortmannin effectively attenuated the increased level of Mcl-1 induced by COX-2 or PGE(2). Blocking the PI3K activity with a dominant-negative vector, DN-p85, also greatly diminished the level of Mcl-1 and enhanced UVB-elicited cell death in cells transfected by COX-2. In a similar way, LY294002 inhibited cell survival and Mcl-1 level in PGE(2)-treated CL1.0 cells. These findings suggest that COX-2 promotes cell survival by up-regulating the level of Mcl-1 by activating the PI3K/Akt-dependent pathway.
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Affiliation(s)
- M T Lin
- Department of Surgery, National Taiwan University Hospital, Taipei 100, Taiwan
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21
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Abstract
The lin-4 and let-7 antisense RNAs are temporal regulators that control the timing of developmental events in Caenorhabditis elegans by inhibiting translation of target mRNAs. let-7 RNA is conserved among bilaterian animals, suggesting that this class of small RNAs [microRNAs (miRNAs)] is evolutionarily ancient. Using bioinformatics and cDNA cloning, we found 15 new miRNA genes in C. elegans. Several of these genes express small transcripts that vary in abundance during C. elegans larval development, and three of them have apparent homologs in mammals and/or insects. Small noncoding RNAs of the miRNA class appear to be numerous and diverse.
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MESH Headings
- Animals
- Base Sequence
- Blotting, Northern
- Caenorhabditis elegans/genetics
- Caenorhabditis elegans/growth & development
- Cloning, Molecular
- Computational Biology
- Conserved Sequence
- DNA, Intergenic
- Gene Expression Regulation
- Gene Expression Regulation, Developmental
- Gene Library
- Genes, Helminth
- Humans
- Nucleic Acid Conformation
- Organ Specificity
- RNA Precursors/genetics
- RNA Precursors/metabolism
- RNA, Antisense/chemistry
- RNA, Antisense/genetics
- RNA, Antisense/metabolism
- RNA, Helminth/chemistry
- RNA, Helminth/genetics
- RNA, Helminth/metabolism
- RNA, Untranslated/chemistry
- RNA, Untranslated/genetics
- RNA, Untranslated/metabolism
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Affiliation(s)
- R C Lee
- Dartmouth Medical School, Department of Genetics, Hanover, NH 03755, USA
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22
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Abstract
Different classes of photoreceptor neurons (R cells) in the Drosophila compound eye connect to specific targets in the optic lobe. Using a behavioral screen, we identified LAR, a receptor tyrosine phosphatase, as being required for R cell target specificity. In LAR mutant mosaic eyes, R1-R6 cells target to the lamina correctly, but fail to choose the correct pattern of target neurons. Although mutant R7 axons initially project to the correct layer of the medulla, they retract into inappropriate layers. Using single cell mosaics, we demonstrate that LAR controls targeting of R1-R6 and R7 in a cell-autonomous fashion. The phenotypes of LAR mutant R cells are strikingly similar to those seen in N-cadherin mutants.
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Affiliation(s)
- T R Clandinin
- Department of Biological Chemistry, Howard Hughes Medical Institute, University of California, Los Angeles, School of Medicine, CA 90095, USA
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23
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Wang Z, Heo M, Lee RC, Kotler DP, Withers RT, Heymsfield SB. Muscularity in adult humans: proportion of adipose tissue-free body mass as skeletal muscle. Am J Hum Biol 2001; 13:612-9. [PMID: 11505469 DOI: 10.1002/ajhb.1099] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.7] [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: 11/06/2022] Open
Abstract
Muscularity, or the proportion of adipose tissue-free body mass (ATFM) as skeletal muscle (SM), provides valuable body composition information, especially for age-related SM loss (i.e., sarcopenia). Limited data from elderly cadavers suggest a relatively constant SM/ATFM ratio, 0.540 +/- 0.046 for men (mean +/- SD, n = 6) and 0.489 +/- 0.049 for women (n = 7). The aim of the present study was to examine the magnitude and constancy of the SM/ATFM ratio in healthy adults. Whole-body SM and ATFM were measured using multi-scan magnetic resonance imaging. The SM/ATFM ratio was 0.528 +/- 0.036 for men (n = 139) and 0.473 +/- 0.037 for women (n = 165). Multiple regression analysis indicated that the SM/ATFM ratio was significantly influenced by sex, age, body weight, and race. The four factors explained 50% of the observed between individual variation in the SM/ATFM ratio. After adjusting for age, body weight, and race, men had a larger SM/ATFM ratio than women. Both older men and women had a lower SM/ATFM ratio than younger subjects, although the relative reduction was greater in men. After adjustment for sex, age, and body weight, there were no significant differences in the SM/ATFM ratios between Asian, Caucasian, and Hispanic subjects. In contrast, African-American subjects had a significantly greater SM/ATFM ratio than subjects in the other three groups. In addition, the SM/ATFM ratio was significantly lower in AIDS patients than corresponding values in healthy subjects.
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Affiliation(s)
- Z Wang
- Obesity Research Center, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York, USA.
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24
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Abstract
OBJECTIVE To evaluate the sequential CT appearance of the liver after hepatic irradiation and to investigate the correlation between CT findings and radiation-induced hepatic injury. MATERIAL AND METHODS The triple-phase CT images of 18 patients with hepatocellular carcinomas (HCC) after hepatic irradiation were retrospectively reviewed (in total 41 CT studies). The high-dose region within the liver was defined as the area receiving more than 90% of the prescribed irradiation dose. The mean radiation dose was 55.5 Gy. Density changes and patterns of enhancement in the high-dose region were classified as three types: type I, constant low-density change in all phases; type II, low-density change in both pre-contrast and arterial phases, and iso-density change in the portal phase; type III, low- or iso-density change in the pre-contrast phase, low- or high-density change in the arterial phase, and persistent high-density change in the portal phase. The interval between completion of radiotherapy and the CT examinations ranged from 9 to 469 days, with a mean of 147 days. RESULTS Nine of the 41 CT studies presented with type I, 9 with type II, and 16 with type III CT findings. The mean interval between completion of radiotherapy and the appearance of types I, II, and III CT findings were 74, 183, and 220 days, respectively. The interval was significantly shorter for type I findings than for type II and type III. The difference in interval was not significant between type II and type III. A type I finding with constant low-density change in the high-dose region of the liver was the most common pattern of CT findings within the first 3 months after hepatic irradiation. Either types II or III findings were frequently seen after 3 months. CONCLUSION The sequential CT appearance and the density changes may indicate correlation with the pathogenesis of veno-occlusive disease.
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Affiliation(s)
- S Y Chiou
- Department of Radiology, Veterans General Hospital-Taipei, Taipei, Taiwan
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25
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Lee RC, Burton RA, Hrmova M, Fincher GB. Barley arabinoxylan arabinofuranohydrolases: purification, characterization and determination of primary structures from cDNA clones. Biochem J 2001; 356:181-9. [PMID: 11336650 PMCID: PMC1221826 DOI: 10.1042/0264-6021:3560181] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A family 51 arabinoxylan arabinofuranohydrolase, designated AXAH-I, has been purified from extracts of 7-day-old barley (Hordeum vulgare L.) seedlings by fractional precipitation with (NH(4))(2)SO(4) and ion-exchange chromatography. The enzyme has an apparent molecular mass of 65 kDa and releases L-arabinose from cereal cell wall arabinoxylans with a pH optimum of 4.3, a catalytic rate constant (k(cat)) of 6.9 s(-1) and a catalytic efficiency factor (k(cat)/K(m)) of 0.76 (ml x s(-1) x mg(-1)). Whereas the hydrolysis of alpha-L-arabinofuranosyl residues linked to C(O)3 of backbone (1-->4)-beta-xylosyl residues proceeds at the fastest rate, alpha-L-arabinofuranosyl residues on doubly substituted xylosyl residues are also hydrolysed, at lower rates. A near full-length cDNA encoding barley AXAH-I indicates that the mature enzyme consists of 626 amino acid residues and has a calculated pI of 4.8. A second cDNA, which is 81% identical with that encoding AXAH-I, encodes another barley AXAH, which has been designated AXAH-II. The barley AXAHs are likely to have key roles in wall metabolism in cereals and other members of the Poaceae. Thus the enzymes could participate in the modification of the fine structure of arabinoxylan during wall deposition, maturation or expansion, or in wall turnover and the hydrolysis of arabinoxylans in germinated grain.
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Affiliation(s)
- R C Lee
- Department of Plant Science, Adelaide University, Waite Campus, Glen Osmond, SA 5064, Australia
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26
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Chen CP, Chao Y, Li CP, Lee RC, Tsay SH, Chi KH, Yen SH, Chang FY, Lee SD. Concurrent chemoradiation is effective in the treatment of alpha-fetoprotein-producing acinar cell carcinoma of the pancreas: report of a case. Pancreas 2001; 22:326-9. [PMID: 11291937 DOI: 10.1097/00006676-200104000-00016] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [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] [Indexed: 12/31/2022]
Affiliation(s)
- C P Chen
- Department of Medicine, Taipei Veterans General Hospital, National Yang-Ming University, School of Medicine, Taiwan, Republic of China
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27
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Affiliation(s)
- J D Marks
- Department of Pediatrics, University of Chicago, Chicago, Illinois 60637, USA.
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28
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Abstract
Skeletal muscle is a large compartment that can now be quantified using research and clinically applicable regional and whole-body methods. The most important advances are the two imaging methods, computed tomography (CT) and magnetic resonance imaging (MRI). Both CT and MRI can serve as regional and whole-body reference methods when evaluating other approaches for estimating skeletal muscle mass. Imaging methods also afford the opportunity to quantify both anatomic skeletal muscle and the smaller adipose-tissue free skeletal muscle component. Other available methods for estimating skeletal muscle, either regional or at the whole body level, include dual-energy x-ray absorptiometry, in vivo neutron activation analysis-whole body counting, anthropometry, ultrasound, bioimpedance analysis, and urinary metabolite markers. Each method is reviewed in the context of the aging process, cost, availability, practicality, and desired accuracy. New insights should be possible when skeletal muscle mass, measured using these methods, is combined with other descriptors of muscle biochemical and mechanical function.
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Affiliation(s)
- R C Lee
- Obesity Research Center, Department of Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
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29
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Guo YC, Chu PY, Lee RC, Chang SY. Radiology forum. Quiz case 2. Retention cyst of the postcricoid region. Arch Otolaryngol Head Neck Surg 2001; 127:84, 86. [PMID: 11177024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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30
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Liu HJ, Chen TS, Lee RC, Ho DM, Lin JT, Chu LS, Chang FY. Abdominal wall necrosis following transcatheter arterial chemoembolization for hepatocellular carcinoma. Zhonghua Yi Xue Za Zhi (Taipei) 2000; 63:838-43. [PMID: 11155762] [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: 04/15/2023]
Abstract
A 76-year-old man, who had inoperable hepatocellular carcinoma, had been treated with transcatheter arterial chemoembolization (TACE) 11 times, percutaneous ethanol injection therapy three times and conformal radiotherapy once, all in other hospitals. At this admission, he developed myocutaneous necrosis in the right abdominal wall after TACE, via the collateral of the right internal mammary artery (IMA). Necrosis of the abdominal wall was due to ischemic changes caused by embolization of the distal branches of the IMA, which were aggravated by previous radiation therapy. We advise that embolization of the IMA in patients who have received radiotherapy should be avoided, if possible.
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Affiliation(s)
- H J Liu
- Division of Gastroenterology, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei, Taiwan 112, ROC
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31
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Lin YP, Wu MH, Ng YY, Lee RC, Liou JK, Yang WC, Wang JH, Teng MM, Huang TP. Spiral computed tomographic angiography--a new technique for evaluation of vascular access in hemodialysis patients. Am J Nephrol 2000; 18:117-22. [PMID: 9569953 DOI: 10.1159/000013319] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Spiral computed tomographic angiography (CTA), a new noninvasive imaging technique, was used to study 10 arteriovenous fistulas (AVF) in 9 hemodialysis patients. Digital subtraction angiography (DSA) was also performed as a gold standard for comparison. AVF stenosis was graded by a four-point scale: grade 0, well patency of supplying artery, anastomosis and drainage vein; grade 1, < 50% stenosis; grade 2, 50-70% stenosis; grade 3, 70-99% stenosis, and grade 4, total occlusion. We found CTA correlated closely to DSA in detecting both stenosis and dilatation of AVF and it spared all the shortcomings of DSA. CTA has the potential to be alternative for imaging of dialysis fistulas. Further studies will be performed to specify the role of CTA images in the assessment of the hemodialysis vascular access.
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Affiliation(s)
- Y P Lin
- Department of Medicine, Veterans General Hospital-Taipei, National Yang-Ming University, Taiwan, ROC
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32
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Lee RC, Wang Z, Heo M, Ross R, Janssen I, Heymsfield SB. Total-body skeletal muscle mass: development and cross-validation of anthropometric prediction models. Am J Clin Nutr 2000; 72:796-803. [PMID: 10966902 DOI: 10.1093/ajcn/72.3.796] [Citation(s) in RCA: 439] [Impact Index Per Article: 18.3] [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: 11/14/2022] Open
Abstract
BACKGROUND Skeletal muscle (SM) is a large body compartment of biological importance, but it remains difficult to quantify SM with affordable and practical methods that can be applied in clinical and field settings. OBJECTIVE The objective of this study was to develop and cross-validate anthropometric SM mass prediction models in healthy adults. DESIGN SM mass, measured by using whole-body multislice magnetic resonance imaging, was set as the dependent variable in prediction models. Independent variables were organized into 2 separate formulas. One formula included mainly limb circumferences and skinfold thicknesses [model 1: height (in m) and skinfold-corrected upperarm, thigh, and calf girths (CAG, CTG, and CCG, respectively; in cm)]. The other formula included mainly body weight (in kg) and height (model 2). The models were developed and cross-validated in nonobese adults [body mass index (in kg/m(2)) < 30]. RESULTS Two SM (in kg) models for nonobese subjects (n = 244) were developed as follows: SM = Ht x (0.00744 x CAG(2) + 0.00088 x CTG(2) + 0.00441 x CCG(2)) + 2.4 x sex - 0.048 x age + race + 7.8, where R:(2) = 0.91, P: < 0.0001, and SEE = 2.2 kg; sex = 0 for female and 1 for male, race = -2.0 for Asian, 1.1 for African American, and 0 for white and Hispanic, and SM = 0.244 x BW + 7.80 x Ht + 6.6 x sex - 0.098 x age + race - 3.3, where R:(2) = 0.86, P: < 0.0001, and SEE = 2.8 kg; sex = 0 for female and 1 for male, race = -1.2 for Asian, 1.4 for African American, and 0 for white and Hispanic. CONCLUSION These 2 anthropometric prediction models, the first developed in vivo by using state-of-the-art body-composition methods, are likely to prove useful in clinical evaluations and field studies of SM mass in nonobese adults.
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Affiliation(s)
- R C Lee
- Obesity Research Center, St Luke's-Roosevelt Hospital Center, Columbia University, College of Physicians and Surgeons, New York, NY, USA
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33
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Ponce RA, Bartell SM, Wong EY, LaFlamme D, Carrington C, Lee RC, Patrick DL, Faustman EM, Bolger M. Use of quality-adjusted life year weights with dose-response models for public health decisions: a case study of the risks and benefits of fish consumption. Risk Anal 2000; 20:529-542. [PMID: 11051076 DOI: 10.1111/0272-4332.204050] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Risks associated with toxicants in food are often controlled by exposure reduction. When exposure recommendations are developed for foods with both harmful and beneficial qualities, however, they must balance the associated risks and benefits to maximize public health. Although quantitative methods are commonly used to evaluate health risks, such methods have not been generally applied to evaluating the health benefits associated with environmental exposures. A quantitative method for risk-benefit analysis is presented that allows for consideration of diverse health endpoints that differ in their impact (i.e., duration and severity) using dose-response modeling weighted by quality-adjusted life years saved. To demonstrate the usefulness of this method, the risks and benefits of fish consumption are evaluated using a single health risk and health benefit endpoint. Benefits are defined as the decrease in myocardial infarction mortality resulting from fish consumption, and risks are defined as the increase in neurodevelopmental delay (i.e., talking) resulting from prenatal methylmercury exposure. Fish consumption rates are based on information from Washington State. Using the proposed framework, the net health impact of eating fish is estimated in either a whole population or a population consisting of women of childbearing age and their children. It is demonstrated that across a range of fish methylmercury concentrations (0-1 ppm) and intake levels (0-25 g/day), individuals would have to weight the neurodevelopmental effects 6 times more (in the whole population) or 250 times less (among women of child-bearing age and their children) than the myocardial infarction benefits in order to be ambivalent about whether or not to consume fish. These methods can be generalized to evaluate the merits of other public health and risk management programs that involve trade-offs between risks and benefits.
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Affiliation(s)
- R A Ponce
- Department of Environmental Health, University of Washington, Seattle 98105-6099, USA.
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34
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Abstract
Acute tissue injury and subsequent inflammation, including tissue edema and erythema, can be caused by sufficiently high levels of exposure to gamma radiation. The mechanism of this tissue injury is related to the generation of reactive oxygen intermediates (ROI) which chemically alter biological molecules and cell physiology. Cell membrane lipids are vulnerable to ROI-mediated lipid peroxidation that then leads to many of the acute tissue effects. We hypothesize that increased cell membrane permeability leading to osmotic swelling and vascular transudation is one of these effects. Thus we used adult postmitotic rhabdomyocytes in culture and microscopic fluorescence techniques to quantify radiation-induced changes in cell membrane permeability. Based on time-resolved dye flux measurements, a characteristic lag time of 34 +/- 3 min was determined between exposure to 160 Gy of gamma radiation and the decrease in membrane permeability. Administration of 0.1 mM nonionic surfactant Poloxamer 188 added to the cell medium after irradiation completely inhibited the dye loss over the time course of 2 h. Thus a reproducible model was developed for studying the mechanism of acute radiation injury and the efficacy of membrane-sealing agents. As only supportive measures now exist for treating the acute, nonlethal injuries from high-dose radiation exposure, agents that can restore cell membrane function after radiation damage may offer an important tool for therapy.
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Affiliation(s)
- J Hannig
- Electrical Trauma Research Laboratory/Department of Surgery, University of Chicago, Chicago Illinois 60637, USA
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35
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Abstract
Permeabilization of the plasma membrane by electrical forces (electroporation) can be either transient or stable. Although the exact molecular mechanics have not yet been described, electroporation is believed to initiate primarily in the lipid bilayer. To better understand the kinetics of membrane permeabilization, we sought to determine the time constants for spontaneous transient pore sealing. By using isolated rat flexor digitorum brevis skeletal muscle cells and a two-compartment diffusion model, we found that pore sealing times (tau p) after transient electroporation were approximately 9 min. tau p was not significantly dependent on the imposed transmembrane potential. We also determined the transmembrane potential (delta Vm) thresholds necessary for transient and stable electroporation in the skeletal muscle cells. delta VmS ranging between 340 mV and 480 mV caused a transient influx of magnesium, indicating the existence of spontaneously sealing pores. An imposed delta Vm of 540 mV or greater led to complete equilibration of the intracellular and extracellular magnesium concentrations. This finding suggests that stable pores are created by the larger imposed transmembrane potentials. These results may be useful for understanding nerve and skeletal muscle injury after an electrical shock and for developing optimal strategies for accomplishing transient electroporation, particularly for gene transfection and cell transformation.
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Affiliation(s)
- M Bier
- Department of Organismal Biology and Anatomy, Pritzker School of Medicine, University of Chicago, Illinois, USA.
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36
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Yang SH, Lin JK, Lee RC, Li AF. Cecal volvulus: report of seven cases and literature review. Zhonghua Yi Xue Za Zhi (Taipei) 2000; 63:482-6. [PMID: 10925539] [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: 04/15/2023]
Abstract
BACKGROUND Cecal volvulus is an abdominal emergency and delay in its diagnosis and treatment can result in severe complications. We reviewed these cases in order to increase the understanding of cecal volvulus (CV) to promote early diagnosis and better management. METHODS In this retrospective study of seven patients (all male; mean age +/- standard deviation, 63.4 +/- 17.3 years) over a 16-year period, we reviewed radiographs, for diagnostic accuracy, and the results of surgical procedures for better future management. RESULTS The symptoms of CV related to obstruction had a mean of duration of 6.85 days (range, 2-20 days). The preoperative diagnosis rate was 57.1%. Three types of CV (bascule, clockwise and counterclockwise) were found. There were three treatment failures resulting in two deaths. There were two cases of metachronous volvulus, one in the sigmoid colon and one in the small intestine. CONCLUSIONS Resection is indicated for gangrene or perforation and is highly suggested in underlying bowel disease or recurrent operative procedures. For uncomplicated viable CV, cecopexy provides fair results. Metachronous volvulus should always be considered when obstruction recurs.
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Affiliation(s)
- S H Yang
- Department of Surgery, Taipei Veterans General Hospital, Taiwan, ROC
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Danielson JR, Capelli-Schellpfeffer M, Lee RC. Upper extremity electrical injury. Hand Clin 2000; 16:225-34, viii. [PMID: 10791169] [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: 02/02/2023]
Abstract
Electrical injuries to the upper extremity are far ranging in extent and vary in magnitude. Proper management requires an appreciation for the pathophysiology, clinical manifestations, and therapeutic options. Persistent neurologic and psychiatric problems further impact the high incidence of disability in the electrical injury patient. Loss is significant for victims, their families, and employers, in part because of the relative youth of those injured.
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Affiliation(s)
- J R Danielson
- Department of Surgery, University of Chicago, Illinois, USA
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Abstract
Electrical stimulation has been used to promote wound healing. The mechanisms by which such stimulation could interact with biological systems to accelerate healing have not been elucidated. One potential mechanism could involve stimulation of macrophage migration to the site of a wound. Here we report that oscillatory electric fields induce human macrophage migration. Macrophages exposed to a 1 Hz, 2 V/cm field show an induced migration velocity of 5.2+/-0.4 x 10(-2) microm/min and a random motility coefficient of 4.8+/-1.4 x 10(-2) microm2/min on a glass substrate. Electric field exposure induces reorganization of microfilaments from ring-like structures at the cell periphery to podosomes that are confined to the contact sites between cell and substrate, suggesting that the cells are crawling on glass. Treatment of cells with monoclonal antibodies directed against beta2-integrins prior to field exposure prevents cell migration, indicating that integrin-dependent signaling pathways are involved. Electric fields cause macrophage migration on laminin or fibronectin coated substrates without inducing podosome formation or changes in cellular morphology. The migration velocity is not significantly altered but the random movement is suppressed, suggesting that cell movements on a laminin- or fibronectin-coated surface are not mediated by cell crawling. It is suggested that electric field-induced macrophage migration utilizes several modes of cell movement, including cell crawling and possibly cell rolling.
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Affiliation(s)
- M R Cho
- Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Hong Y, Lee RC, Ambros V. Structure and function analysis of LIN-14, a temporal regulator of postembryonic developmental events in Caenorhabditis elegans. Mol Cell Biol 2000; 20:2285-95. [PMID: 10688674 PMCID: PMC110844 DOI: 10.1128/mcb.20.6.2285-2295.2000] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [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: 11/20/2022] Open
Abstract
During postembryonic development of Caenorhabditis elegans, the heterochronic gene lin-14 controls the timing of developmental events in diverse cell types. Three alternative lin-14 transcripts are predicted to encode isoforms of a novel nuclear protein that differ in their amino-terminal domains. In this paper, we report that the alternative amino-terminal domains of LIN-14 are dispensable and that a carboxy-terminal region within exons 9 to 13 is necessary and sufficient for in vivo LIN-14 function. A transgene capable of expressing only one of the three alternative lin-14 gene products rescues a lin-14 null mutation and is developmentally regulated by lin-4. This shows that the deployment of alternative lin-14 gene products is not critical for the ability of LIN-14 to regulate downstream genes in diverse cell types or for the in vivo regulation of LIN-14 level by lin-4. The carboxy-terminal region of LIN-14 contains an unusual expanded nuclear localization domain which is essential for LIN-14 function. These results support the view that LIN-14 controls developmental timing in C. elegans by regulating gene expression in the nucleus.
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Affiliation(s)
- Y Hong
- Department of Biological Sciences, Dartmouth College, Hanover, New Hampshire 03755, USA
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40
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Dougherty WR, Lee RC. Static electric field interaction with tissues. Plast Reconstr Surg 1999; 104:2329-31. [PMID: 11149807 DOI: 10.1097/00006534-199912000-00072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Exposure to very intense ionizing irradiation produces acute tissue sequelae including inflammation, pain, and swelling that often results in tissue fibrosis and/or necrosis. Acute tissue necrosis occurs in hours when sufficiently rapid damage to membrane lipids and proteins leads to altered membrane structure, disrupting the vital electrochemical diffusion barrier necessary for cell survival. This damage mechanism is thought to underlie the interphase death of lethally irradiated postmitotic cells such as neurons, but it has also been implicated in the rapid cell death of lymphocytes and acute vascular changes due to capillary epithelium dysfunction. It is not known whether sealing of radiation-permeabilized cell membranes will prolong survival of lethally irradiated cells or perhaps lead to repair of damaged nucleic acids. The purpose of this study is to begin to address the first question.
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Affiliation(s)
- M A Terry
- Department of Surgery, Pritzker School of Medicine, University of Chicago, Illinois 60637, USA
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42
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Abstract
The clinical spectrum of electrical injury ranges from the absence of any external physical signs to severe multiple trauma. Reported neuropsychiatric sequelae can vary from vague complaints, which may seem unrelated to the injury in their occurrence over time or by their apparent severity, to sequelae consistent with brain injury accompanying an electrical trauma. In this report, a case study and discussion are presented on the management and coordination of post-acute care of an electrical trauma survivor. Expertise and a multidisciplinary team are essential to cohesive patient care. Patient monitoring for progressive changes and prompt intervention are needed to address the potential difficulties experienced by trauma survivors as they rehabilitate to return to their work and their activities of daily living.
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Affiliation(s)
- M S Chico
- Department of Surgery, University of Chicago, Illinois 60637, USA
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43
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Abstract
Long-term cognitive and emotional deficits have been commonly reported in electrical injury (EI) survivors. However, it remains undetermined what factors may lead to the development of such effects in some patients and not in others. In this study, we hypothesized that certain elements of subjective EI experience may predict specific psychiatric sequelae. A group of 73 post-acute EI patients were included in this retrospective study. Statistical associations were examined between major psychiatric diagnoses (posttraumatic stress disorder and major depression) and such EI descriptors as having experienced "no-let-go" or having been knocked away on contact, as well as loss of consciousness or altered states of consciousness at the scene of the accident (including amnesia for the event). The study results will help physicians determine which patients may be at increased risk of developing psychiatric symptoms and address these issues as part of their total rehabilitation plan.
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Affiliation(s)
- K M Kelley
- Department of Psychiatry, University of Chicago, Illinois 60637, USA
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44
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Abstract
Several years ago, we proposed that loss of cell membrane structural integrity by electroporation is a substantial cause of tissue necrosis in victims of electrical trauma. Specifically, this involves the permeabilization of the lipid bilayer by thermal and electrical forces. We further suggested that certain mild surfactants in low concentration could induce sealing of permeabilized lipid bilayers and salvage of cells that had not been extensively heat-damaged. Successful restoration of membrane transport properties using the surfactant poloxamer 188 was reported in 1992. The purpose of this study is to further examine the response of electroporated rat skeletal muscle membranes to poloxamer 188 (P188) therapy by direct assay of membrane transport properties. Experimental evidence accumulated to date suggests that P188 is effective in sealing permeabilized cell membranes both in vitro and in vivo.
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Affiliation(s)
- R C Lee
- Department of Surgery, University of Chicago, Illinois 60637, USA
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Affiliation(s)
- K L Matthews
- Department of Medical Physics, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612, USA
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Abstract
Large supraphysiologic transmembrane electrical potentials are known to alter the molecular organization of the bilayer lipid component of cell membranes, leading to ionic permeabilization or "electroporation". Typically, membrane electroporation is followed by several orders of magnitude increases in electrical conductance and diffusive permeability to low-molecular-weight solutes. Electroporation may be transient or stable depending on whether the membrane eventually seals or remains permeabilized. Factors that control sealing have not been well characterized. This paper describes the kinetics of membrane sealing following electroporation by pulses over a range of supraphysiologic potentials. The increase in membrane conductance is highly nonlinear during a -440-mV, 4-ms pulse and reaches two orders of magnitude greater than baseline. Electroporation and relaxation sealing kinetics are quite different, reflecting a significant hysteresis effect. Thus, it appears that the magnitude and duration of the field pulse are important factors in sealing.
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Affiliation(s)
- T R Gowrishankar
- Harvard-MIT Health Science and Technology, Massachusetts Institute of Technology, Cambridge 02139, USA
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Abstract
Porous collagen-glycosaminoglycan (PCG) membranes with a porous silicone elastomer coating have been useful as a scaffold for dermal replacement in burn victims. Critical physicochemical parameters of these membranes include pore size, cross-link density, the percentage of glycosaminoglycan, and the degree of banding of the collagen. These factors govern the immunobiological response. Optimizing these parameters can reduce inflammation, scarring, and contraction of wounds grafted with PCG membranes. PCG membranes are currently commercially manufactured (Integra, Integra Life Sciences, New Jersey) and available for clinical use. Because clinical outcomes have improved using these membranes for burn wound coverage, other skin reconstruction problems including scar resurfacing, keloids, treatment of donor sites, and treatment of chronic wounds can be considered as potential applications. This manuscript illustrates our early experience using Integra as a CG membrane for dermal replacement in reconstructive surgery. Our results indicate that CG membranes can lead to improved compliance and appearance compared to a meshed graft and may be sequentially placed in multiple layers to correct contour deformities. Also, in one case, we observed that, if placed on a wound bed with embedded skin epithelial cells, the PCG promotes epithelialization through the PCG matrix. The use of this material results in a supple integument with many similarities to normal skin.
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Affiliation(s)
- D P Orgill
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
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Abstract
AIM On magnetic resonance (MR) images, strands correspond to curvilinear areas running in the perinephric fat, and haloes to those lying on the renal surface. Our aim was to examine the diagnostic significance and histopathological basis of these areas. PATIENTS AND METHODS MR images obtained in 46 patients without renal disease and 96 patients with renal disease were assessed for the signal intensity and extent of strands and haloes, and their degree of right-left asymmetry. RESULTS Strands usually revealed low signal intensity on T1-weighted MR images and high signal intensity on fat-suppressed T2-weighted images and contrast-enhanced fat-suppressed T1-weighted images. Haloes revealed high signal intensity on fat-suppressed T2-weighted images, but most of haloes were not clearly depicted on T1-weighted images or contrast-enhanced fat-suppressed T1-weighted images. Strands and haloes were common and usually symmetrical or only mildly asymmetrical in both patient groups. However, in 11 of the 96 patients with renal disease, prominent strands and/or haloes appeared with remarkable asymmetry and likely represented definite changes in the perinephric fat. At histopathology, vascular loose fibrous tissue was found at the sites of strands and haloes. CONCLUSION Strands and haloes usually represent normal anatomical variations. However, the presence of prominent strands or haloes with remarkable right-left asymmetry implies abnormality and may provide additional information in the evaluation of renal disease.
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Affiliation(s)
- S Monzawa
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104, USA
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Affiliation(s)
- C W Lin
- Department of Radiology, Veterans General Hospital-Taipei, Taiwan, Republic of China
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Lee RC, Walters JA, Reyland ME, Anderson SM. Constitutive activation of the prolactin receptor results in the induction of growth factor-independent proliferation and constitutive activation of signaling molecules. J Biol Chem 1999; 274:10024-34. [PMID: 10187780 DOI: 10.1074/jbc.274.15.10024] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [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: 11/06/2022] Open
Abstract
The ability to induce the oncogenic activation of the human prolactin receptor (PRLR) was examined by deleting 178 amino acids of the extracellular ligand-binding domain. Expression of this deletion mutant in the interleukin-3 (IL-3)-dependent murine myeloid cell line 32Dcl3 resulted in the induction of growth factor-independent proliferation. Parental 32Dcl3 cells proliferated only in the presence of exogenous murine IL-3 (mIL-3), while 32Dcl3 cells transfected with the long form of the human PRLR were able to proliferate in response to mIL-3, ovine prolactin, or human PRL. Cells expressing the Delta178 deletion mutant contained numerous phosphotyrosine-containing proteins in the absence of stimulation with either mIL-3 or ovine prolactin. Growth factor stimulation increased the number of proteins phosphorylated and the intensity of phosphorylation. These proteins included constitutively phosphorylated Janus kinase 2, signal transducer and activator of transcription 5, and SHC. Activated extracellular signal-regulated kinases 1 and 2 (ERK1 and ERK2) were observed in unstimulated 32Dcl3 cells expressing the Delta178 mutant. Likewise, transfection of Nb2 cells with the Delta178 deletion mutant induced growth factor-independent proliferation and constitutive activation of Janus kinase 2, ERK1, and ERK2. In addition to the induction of a growth factor-independent state, the expression of the Delta178 deletion mutant also suppressed the apoptosis that occurs when 32Dcl3 cells are cultured in the absence of growth factors such as IL-3. These data suggest that the constitutive activation of the PRLR can be achieved by deletion of the ligand binding domain and that this mutation leads to the oncogenic activation of the receptor as determined by the ability of the receptor to induce growth factor-independent proliferation of factor-dependent hematopoietic cells.
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Affiliation(s)
- R C Lee
- Department of Pathology, School of Medicine, University of Colorado Health Sciences Center, Denver, Colorado 80262, USA
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