1
|
Benvenutti L, Wolff FR, Corrêa TP, Melato J, Goldoni FC, De Faveri R, Patel YBK, de Souza JA, Grockoski HA, Nilz PM, Bombardelli CL, Remor AP, Varela KG, Costa NTC, Hernandes MZ, Lacerda MG, Rodrigues KD, Milton FA, Neves FDAR, Pereira MES, Kormann Imianowsky EC, de Campos Buzzi F, Brunaldi Marutani VH, Stoeberl LC, Correa R, Eller S, de Oliveira TF, Gonçalves TBP, da Silva RC, Passos GF, da Costa R, Santin JR, Quintão NLM. A partial agonist of PPARγ prevents paclitaxel-induced peripheral neuropathy in mice, by inhibiting neuroinflammation. Br J Pharmacol 2024; 181:1128-1149. [PMID: 37721089 DOI: 10.1111/bph.16244] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 09/07/2023] [Accepted: 09/07/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND AND PURPOSE Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of paclitaxel, affecting 30-50% of patients. Increased survival and concern with patients' quality of life have encouraged the search for new tools to prevent paclitaxel-induced neuropathy. This study presents the glitazone 4-[(Z)-(2,4-dioxo-1,3-thiazolidin-5-ylidene)methyl]-N-phenylbenzene-sulfonamide (TZD-A1) as a partial agonist of peroxisome proliferator-activated receptor γ (PPARγ), its toxicological profile and effects on paclitaxel-induced CIPN in mice. EXPERIMENTAL APPROACH Interactions of TZD-A1 with PPARγ were analysed using in silico docking and in vitro reporter gene assays. Pharmacokinetics and toxicity were evaluated using in silico, in vitro and in vivo (C57Bl/6 mice) analyses. Effects of TZD-A1 on CIPN were investigated in paclitaxel-injected mice. Axonal and dorsal root ganglion damage, mitochondrial complex activity and cytokine levels, brain-derived neurotrophic factor (BDNF), nuclear factor erythroid 2-related factor 2 (Nrf2) and PPARγ, were also measured. KEY RESULTS Docking analysis predicted TZD-A1 interactions with PPARγ compatible with partial agonism, which were corroborated by in vitro reporter gene assays. Good oral bioavailability and safety profile of TZD-A1 were shown in silico, in vitro and in vivo. Paclitaxel-injected mice, concomitantly treated with TZD-A1 by i.p. or oral administration, exhibited decreased mechanical and thermal hypersensitivity, effects apparently mediated by inhibition of neuroinflammation and mitochondrial damage, through increasing Nrf2 and PPARγ levels, and up-regulating BDNF. CONCLUSION AND IMPLICATIONS TZD-A1, a partial agonist of PPARγ, provided neuroprotection and reduced hypersensitivity induced by paclitaxel. Allied to its safety profile and good bioavailability, TZD-A1 is a promising drug candidate to prevent and treat CIPN in cancer patients.
Collapse
Affiliation(s)
- Larissa Benvenutti
- Postgraduate Program in Pharmaceutical Science, Universidade do Vale do Itajaí (UNIVALI), Itajaí, Santa Catarina, Brazil
| | - Fellippe Ramos Wolff
- Postgraduate Program in Pharmaceutical Science, Universidade do Vale do Itajaí (UNIVALI), Itajaí, Santa Catarina, Brazil
| | - Thiago Patrício Corrêa
- Postgraduate Program in Pharmaceutical Science, Universidade do Vale do Itajaí (UNIVALI), Itajaí, Santa Catarina, Brazil
| | - Jessica Melato
- Postgraduate Program in Pharmaceutical Science, Universidade do Vale do Itajaí (UNIVALI), Itajaí, Santa Catarina, Brazil
| | - Fernanda Capitanio Goldoni
- Postgraduate Program in Pharmaceutical Science, Universidade do Vale do Itajaí (UNIVALI), Itajaí, Santa Catarina, Brazil
| | - Renata De Faveri
- Postgraduate Program in Pharmaceutical Science, Universidade do Vale do Itajaí (UNIVALI), Itajaí, Santa Catarina, Brazil
| | - Yasmin Beatrisse Klein Patel
- Biomedicine, School of Health Sciences, Universidade do Vale do Itajaí (UNIVALI), Itajaí, Santa Catarina, Brazil
| | - Jade André de Souza
- Biomedicine, School of Health Sciences, Universidade do Vale do Itajaí (UNIVALI), Itajaí, Santa Catarina, Brazil
| | - Heloise Adeli Grockoski
- Biomedicine, School of Health Sciences, Universidade do Vale do Itajaí (UNIVALI), Itajaí, Santa Catarina, Brazil
| | - Paulo Mateus Nilz
- Pharmacy Courses, School of Health Sciences, Universidade do Vale do Itajaí (UNIVALI), Itajaí, Santa Catarina, Brazil
| | - Cleber Luiz Bombardelli
- Postgraduate Program in Pharmaceutical Science, Universidade do Vale do Itajaí (UNIVALI), Itajaí, Santa Catarina, Brazil
| | - Aline Pertile Remor
- Postgraduate Program in Bioscience and Health, Universidade do Oeste de Santa Catarina (UNOESC), Joaçaba, Santa Catarina, Brazil
| | - Karina Giacomini Varela
- Postgraduate Program in Bioscience and Health, Universidade do Oeste de Santa Catarina (UNOESC), Joaçaba, Santa Catarina, Brazil
| | - Natáli Tereza Capistrano Costa
- Laboratório de Química Teórica e Medicinal (LQTM), Departamento de Ciências Farmacêuticas, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | - Marcelo Zaldini Hernandes
- Laboratório de Química Teórica e Medicinal (LQTM), Departamento de Ciências Farmacêuticas, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | - Mariella Guimarães Lacerda
- Laboratory of Molecular Pharmacology, Faculty of Health Sciences, University of Brasilia (UnB), Brasília, Distrito Federal, Brazil
| | - Kathlen Deruci Rodrigues
- Laboratory of Molecular Pharmacology, Faculty of Health Sciences, University of Brasilia (UnB), Brasília, Distrito Federal, Brazil
| | - Flora Aparecida Milton
- Laboratory of Molecular Pharmacology, Faculty of Health Sciences, University of Brasilia (UnB), Brasília, Distrito Federal, Brazil
| | - Francisco de Assis Rocha Neves
- Laboratory of Molecular Pharmacology, Faculty of Health Sciences, University of Brasilia (UnB), Brasília, Distrito Federal, Brazil
| | | | | | - Fátima de Campos Buzzi
- Postgraduate Program in Pharmaceutical Science, Universidade do Vale do Itajaí (UNIVALI), Itajaí, Santa Catarina, Brazil
| | - Victor Hugo Brunaldi Marutani
- Laboratory of Animal Pathology, Department of Preventive Veterinary Medicine, Universidade Estadual de Londrina (UEL), Londrina, Paraná, Brazil
| | - Luis Carlos Stoeberl
- Postgraduate Program in Pharmaceutical Science, Universidade do Vale do Itajaí (UNIVALI), Itajaí, Santa Catarina, Brazil
| | - Rogério Correa
- Postgraduate Program in Pharmaceutical Science, Universidade do Vale do Itajaí (UNIVALI), Itajaí, Santa Catarina, Brazil
| | - Sarah Eller
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Tiago Franco de Oliveira
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Raquel Costa da Silva
- School of Pharmacy, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Giselle Fazzioni Passos
- School of Pharmacy, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Robson da Costa
- School of Pharmacy, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - José Roberto Santin
- Postgraduate Program in Pharmaceutical Science, Universidade do Vale do Itajaí (UNIVALI), Itajaí, Santa Catarina, Brazil
| | - Nara Lins Meira Quintão
- Postgraduate Program in Pharmaceutical Science, Universidade do Vale do Itajaí (UNIVALI), Itajaí, Santa Catarina, Brazil
| |
Collapse
|
2
|
Correa R, Vidal N, Quesada-García A, Marcos R, Muñoz Del Toro J, Muñoz-Rodríguez J. Management of patients with localized prostate cancer and biochemical recurrence in Spain: A medical survey. Actas Urol Esp 2024; 48:218-227. [PMID: 37574011 DOI: 10.1016/j.acuroe.2023.08.002] [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: 04/18/2023] [Revised: 06/08/2023] [Accepted: 06/11/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION The management of patients with prostate cancer (PCa) is established in clinical practice guidelines, which are based on randomized studies according to the level of evidence. In Spain, the degree of compliance with these guidelines in clinical practice is unknown. OBJECTIVES To describe the profiles of PCa patients at the time of diagnosis and the management of patients with localized PCa and those with BCR in Spain. MATERIALS & METHODS A medical survey was conducted in specialized care (85 urologists [UROs], 64 radiation oncologists [ROs], and 21 medical oncologists [MOs]). Three questionnaires were developed for this study with 22 (UROs and ROs) or 21 questions (MOs). RESULTS The annual incidence of PCa was 24,057 in participating hospitals (N = 131). The extrapolated annual incidence in Spain is 40,531 cases. The estimated prevalence of PCa in Spain is 221,689. Of note, 79% and 80% of patients seen by UROs and ROs, respectively had localized PCa at diagnosis. Biopsy was the most used diagnostic test among the three specialties, followed by abdominopelvic computer tomography. More than 90% of patients with BCR underwent standard tests. Next generation imaging tests and PET-choline/PSMA are still used residually. Most patients with localized PCa are currently treated with either surgery or radiotherapy, while for BCR patients, UROs and ROs prefer radiotherapy and MOs androgen deprivation therapy alone or in combination. CONCLUSION This study describes patient profiles at the time of diagnosis and provides an overview of the current therapeutic management of localized PCa and BCR in clinical practice in Spain.
Collapse
Affiliation(s)
- R Correa
- Servicio de Oncología Radioterápica, Hospital Clínico Universitario Virgen de la Victoria Campus Universitario de Teatinos, Málaga, Spain
| | - N Vidal
- Servicio de Oncología Médica, Hospital Clínico San Carlos, Madrid, Spain
| | - A Quesada-García
- Medical Affairs Department, Janssen; Paseo de las Doce Estrellas 5-7, 28042, Madrid, Spain.
| | - R Marcos
- Business Intelligence Department, Janssen; Paseo de las Doce Estrellas 5-7, 28042, Madrid, Spain.
| | - J Muñoz Del Toro
- Medical & Regulatory Affairs Department, Janssen; Lagoas Park, Edificio 9, 2740-262 Porto Salvo, Portugal.
| | - J Muñoz-Rodríguez
- Servicio de Urología, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| |
Collapse
|
3
|
Verma R, Hill VB, Statsevych V, Bera K, Correa R, Leo P, Ahluwalia M, Madabhushi A, Tiwari P. Stable and Discriminatory Radiomic Features from the Tumor and Its Habitat Associated with Progression-Free Survival in Glioblastoma: A Multi-Institutional Study. AJNR Am J Neuroradiol 2022; 43:1115-1123. [PMID: 36920774 PMCID: PMC9575418 DOI: 10.3174/ajnr.a7591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/13/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Glioblastoma is an aggressive brain tumor, with no validated prognostic biomarkers for survival before surgical resection. Although recent approaches have demonstrated the prognostic ability of tumor habitat (constituting necrotic core, enhancing lesion, T2/FLAIR hyperintensity subcompartments) derived radiomic features for glioblastoma survival on treatment-naive MR imaging scans, radiomic features are known to be sensitive to MR imaging acquisitions across sites and scanners. In this study, we sought to identify the radiomic features that are both stable across sites and discriminatory of poor and improved progression-free survival in glioblastoma tumors. MATERIALS AND METHODS We used 150 treatment-naive glioblastoma MR imaging scans (Gadolinium-T1w, T2w, FLAIR) obtained from 5 sites. For every tumor subcompartment (enhancing tumor, peritumoral FLAIR-hyperintensities, necrosis), a total of 316 three-dimensional radiomic features were extracted. The training cohort constituted studies from 4 sites (n = 93) to select the most stable and discriminatory radiomic features for every tumor subcompartment. These features were used on a hold-out cohort (n = 57) to evaluate their ability to discriminate patients with poor survival from those with improved survival. RESULTS Incorporating the most stable and discriminatory features within a linear discriminant analysis classifier yielded areas under the curve of 0.71, 0.73, and 0.76 on the test set for distinguishing poor and improved survival compared with discriminatory features alone (areas under the curve of 0.65, 0.54, 0.62) from the necrotic core, enhancing tumor, and peritumoral T2/FLAIR hyperintensity, respectively. CONCLUSIONS Incorporating stable and discriminatory radiomic features extracted from tumors and associated habitats across multisite MR imaging sequences may yield robust prognostic classifiers of patient survival in glioblastoma tumors.
Collapse
Affiliation(s)
- R Verma
- From the Department of Biomedical Engineering (R.V., K.B., R.C., P.L.), Case Western Reserve University, Cleveland, Ohio .,Alberta Machine Intelligence Institute (R.V.), Edmonton, Alberta
| | - V B Hill
- Department of Neuroradiology (V.B.H.), Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - V Statsevych
- Brain Tumor and Neuro-Oncology Center (V.S.), Cleveland Clinic, Cleveland, Ohio
| | - K Bera
- From the Department of Biomedical Engineering (R.V., K.B., R.C., P.L.), Case Western Reserve University, Cleveland, Ohio
| | - R Correa
- From the Department of Biomedical Engineering (R.V., K.B., R.C., P.L.), Case Western Reserve University, Cleveland, Ohio
| | - P Leo
- From the Department of Biomedical Engineering (R.V., K.B., R.C., P.L.), Case Western Reserve University, Cleveland, Ohio
| | - M Ahluwalia
- Miami Cancer Institute (M.A.), Miami, FL and Herbert Wertheim College of Medicine, Florida International University, Florida
| | - A Madabhushi
- Department of Biomedical Engineering (A.M.), Emory University, Atlanta Veterans Administration Medical Center
| | - P Tiwari
- Departments of Radiology and Biomedical Engineering (P.T.), University of Wisconsin Madison, Wisconsin
| |
Collapse
|
4
|
Correa R, Rodriguez N, Bortolaso M. What is the nature of the alteration of temporality in Trauma-Related Altered States of Consciousness? A neuro-phenomenological analysis✰,✰✰,★,★★. European Journal of Trauma & Dissociation 2022. [DOI: 10.1016/j.ejtd.2021.100227] [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: 11/27/2022]
|
5
|
Correa R, Morton G, Chung H, Tseng C, Cheung P, Chu W, Liu S, McGuffin M, Shahid A, Davidson M, Ravi A, Helou J, Alayed Y, Zhang L, Mamedov A, Loblaw A. PO-1408 Two-fraction prostate SABR vs. two-fraction HDR brachytherapy: does dose heterogeneity matter? Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03372-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
6
|
Sanchez G, Gutierrez A, Jímenez J, Correa R, Alegría Baños J, Grajales Alvarez R. 165P Comparison of male and female breast cancer in reference hospital in Mexico. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.03.179] [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: 10/21/2022] Open
|
7
|
Silva F, Louro R, Cortezzi W, Torres M, Lima F, Sartoretto S, Correa R, Arantes E, Caetano D, Romanach M. Cemento-ossifying fibroma: prototype guided surgical approach for treatment of major lesions. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.744] [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: 10/26/2022]
|
8
|
Navarro I, Correa R, Otero A, Roman A, Zapata I, Fernandez A, Prieto P, Segado S, Jodar C, Garrido C, Medina J, Gomez J. EP-1581 Good tolerability of hypofractionated radiation therapy for localized prostate cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32001-8] [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: 11/25/2022]
|
9
|
Ismail M, Hill V, Statsevych V, Huang R, Prasanna P, Correa R, Singh G, Bera K, Beig N, Thawani R, Madabhushi A, Aahluwalia M, Tiwari P. Shape Features of the Lesion Habitat to Differentiate Brain Tumor Progression from Pseudoprogression on Routine Multiparametric MRI: A Multisite Study. AJNR Am J Neuroradiol 2018; 39:2187-2193. [PMID: 30385468 DOI: 10.3174/ajnr.a5858] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 09/06/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Differentiating pseudoprogression, a radiation-induced treatment effect, from tumor progression on imaging is a substantial challenge in glioblastoma management. Unfortunately, guidelines set by the Response Assessment in Neuro-Oncology criteria are based solely on bidirectional diametric measurements of enhancement observed on T1WI and T2WI/FLAIR scans. We hypothesized that quantitative 3D shape features of the enhancing lesion on T1WI, and T2WI/FLAIR hyperintensities (together called the lesion habitat) can more comprehensively capture pathophysiologic differences across pseudoprogression and tumor recurrence, not appreciable on diametric measurements alone. MATERIALS AND METHODS A total of 105 glioblastoma studies from 2 institutions were analyzed, consisting of a training (n = 59) and an independent test (n = 46) cohort. For every study, expert delineation of the lesion habitat (T1WI enhancing lesion and T2WI/FLAIR hyperintense perilesional region) was obtained, followed by extraction of 30 shape features capturing 14 "global" contour characteristics and 16 "local" curvature measures for every habitat region. Feature selection was used to identify most discriminative features on the training cohort, which were evaluated on the test cohort using a support vector machine classifier. RESULTS The top 2 most discriminative features were identified as local features capturing total curvature of the enhancing lesion and curvedness of the T2WI/FLAIR hyperintense perilesional region. Using top features from the training cohort (training accuracy = 91.5%), we obtained an accuracy of 90.2% on the test set in distinguishing pseudoprogression from tumor progression. CONCLUSIONS Our preliminary results suggest that 3D shape attributes from the lesion habitat can differentially express across pseudoprogression and tumor progression and could be used to distinguish these radiographically similar pathologies.
Collapse
Affiliation(s)
- M Ismail
- From the Department of Biomedical Engineering (M.I., P.P., R.C., G.S., K.B., N.B., R.T., A.M., P.T.), Case Western Reserve University, Cleveland, Ohio
| | - V Hill
- Department of Neuroradiology (V.H., V.S.), Imaging Institute
| | - V Statsevych
- Department of Neuroradiology (V.H., V.S.), Imaging Institute
| | - R Huang
- Department of Radiology (R.H.), Brigham and Women's Hospital, Dana-Farber/Harvard Cancer Center, Boston, Massachusetts
| | - P Prasanna
- From the Department of Biomedical Engineering (M.I., P.P., R.C., G.S., K.B., N.B., R.T., A.M., P.T.), Case Western Reserve University, Cleveland, Ohio
| | - R Correa
- From the Department of Biomedical Engineering (M.I., P.P., R.C., G.S., K.B., N.B., R.T., A.M., P.T.), Case Western Reserve University, Cleveland, Ohio
| | - G Singh
- From the Department of Biomedical Engineering (M.I., P.P., R.C., G.S., K.B., N.B., R.T., A.M., P.T.), Case Western Reserve University, Cleveland, Ohio
| | - K Bera
- From the Department of Biomedical Engineering (M.I., P.P., R.C., G.S., K.B., N.B., R.T., A.M., P.T.), Case Western Reserve University, Cleveland, Ohio
| | - N Beig
- From the Department of Biomedical Engineering (M.I., P.P., R.C., G.S., K.B., N.B., R.T., A.M., P.T.), Case Western Reserve University, Cleveland, Ohio
| | - R Thawani
- From the Department of Biomedical Engineering (M.I., P.P., R.C., G.S., K.B., N.B., R.T., A.M., P.T.), Case Western Reserve University, Cleveland, Ohio
| | - A Madabhushi
- From the Department of Biomedical Engineering (M.I., P.P., R.C., G.S., K.B., N.B., R.T., A.M., P.T.), Case Western Reserve University, Cleveland, Ohio
| | - M Aahluwalia
- Brain Tumor and Neuro-Oncology Center (M.A.), Cleveland Clinic, Cleveland, Ohio
| | - P Tiwari
- From the Department of Biomedical Engineering (M.I., P.P., R.C., G.S., K.B., N.B., R.T., A.M., P.T.), Case Western Reserve University, Cleveland, Ohio
| |
Collapse
|
10
|
Miranda-Arboleda AF, Agudelo JF, Correa R, Saenz G, Martinez C, Saenz LC, Ramirez JD. P295Stellate ganglion block in patients with ventricular arrhythmias, an innovative procedure that must be part of electrophysiologist therapeutic arsenal. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - J F Agudelo
- Cardiovascular Clinic Santa Maria, Electrophysiology and arrhythmia section, Medellin, Colombia
| | - R Correa
- Cardiovascular Clinic Santa Maria, Electrophysiology and arrhythmia section, Medellin, Colombia
| | - G Saenz
- Cardiovascular Clinic Santa Maria, Electrophysiology and arrhythmia section, Medellin, Colombia
| | - C Martinez
- Universidad Pontificia Bolivariana, Medellin, Colombia
| | - L C Saenz
- Foundation Cardioinfantil, International Arrhythmia Center, Bogota, Colombia
| | - J D Ramirez
- Cardiovascular Clinic Santa Maria, Electrophysiology and arrhythmia section, Medellin, Colombia
| |
Collapse
|
11
|
Miranda-Arboleda AF, Agudelo JF, Correa R, Saenz G, Ramirez JD. P1137An adaptation of transseptal puncture technique for endocardial left ventricle lead placement in candidates for cardiac resynchronization therapy. Europace 2018. [DOI: 10.1093/europace/euy015.623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - J F Agudelo
- Cardiovascular Clinic Santa Maria, Electrophysiology and arrhythmia section, Medellin, Colombia
| | - R Correa
- Cardiovascular Clinic Santa Maria, Electrophysiology and arrhythmia section, Medellin, Colombia
| | - G Saenz
- Cardiovascular Clinic Santa Maria, Electrophysiology and arrhythmia section, Medellin, Colombia
| | - J D Ramirez
- Cardiovascular Clinic Santa Maria, Electrophysiology and arrhythmia section, Medellin, Colombia
| |
Collapse
|
12
|
Oliva Fernández L, Márquez-Aragonés M, Romero-Laorden N, Pajares Hachero B, Moreno I, Ruiz Vico M, Duran Ogaya G, Muriel C, Pascual J, Fernández de Souza C, Dominguez Recio M, Grau G, Sáez M, Montesa A, Correa R, Olmos Hidalgo D. Limited value of currently used germline brca mutations predictive tools in prostate cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx370.042] [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: 11/14/2022] Open
|
13
|
Andrade N, Chakr R, Xavier R, Viecceli D, Correa R, Oliveira Filho C, Brenol C. THU0063 Outcomes of Treat-To-Target Strategy in Established Rheumatoid Arthritis: A Long-Term Prospective Cohort Study. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2281] [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: 11/04/2022]
|
14
|
Correa R, Paredes C, Leiva JE, Munoz R, Avendano G, Castillo I. BRAIN METASTASES FROM EPITHELIAL OVARIAN CANCER: CLINICOPATHOLOGICAL FINDINGS. A RETROSPECTIVE SINGLE INSTITUTION STUDY: IGCS-0067 06. Ovarian Cancer. Int J Gynecol Cancer 2015. [DOI: 10.1136/00009577-201505001-00048] [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: 11/04/2022] Open
|
15
|
Castillo I, Lopez J, Leiva JE, Paredes C, Correa R. MOLECULAR CHARACTERIZATION OF GESTATIONAL TROPHOBLASTIC DISEASE: IGCS-0097 Gestational Trophoblastic Neoplasia. Int J Gynecol Cancer 2015. [DOI: 10.1136/00009577-201505001-00033] [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: 11/04/2022] Open
|
16
|
Mainini G, Donna MD, Esposito E, Ercolano S, Correa R, Stradella L, Gala AD, Franciscis PD. Pregnancy management in Behcet’s disease treated with uninterrupted infliximab. Report of a case with fetal growth restriction and mini-review of the literature. CLIN EXP OBSTET GYN 2014. [DOI: 10.12891/ceog17642014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
|
17
|
Mainini G, Di Donna MC, Esposito E, Ercolano S, Correa R, Stradella L, Della Gala A, De Franciscis P. Pregnancy management in Behçet's disease treated with uninterrupted infliximab. Report of a case with fetal growth restriction and mini-review of the literature. CLIN EXP OBSTET GYN 2014; 41:205-207. [PMID: 24779253] [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: 06/03/2023]
Abstract
BACKGROUND The mutual impact of Behçet's disease (BD) and pregnancy is variable and still unclear. Among the safe drugs administered, the newer infliximab (IFX) was rarely experienced in pregnancy, particularly in the third trimester. CASE The authors report a pregnancy with fetal growth restriction at 36 weeks in a 31-year-old primigravida with symptomatic BD, treated with uninterrupted monthly IFX and daily enoxaparin. The patient was induced at 38 weeks and had an uneventful vaginal delivery of a healthy baby. The postpartum period and following six months were uneventful for mother in terms of BD exacerbation, and newborn in terms of potential risks of neonatal BD and/or infections due to late immunosuppressive IFX administration. CONCLUSION Because of the inconstant mutual impact, BD pregnancies should be precautionary considered at "potential high-risk" and need a careful and close monitoring by a multidisciplinary team with specific expertise.
Collapse
|
18
|
Abstract
The life and artistic legacy of Vincent van Gogh has generated great interest among physicians from different areas of specialization in proposing a retrospective differential diagnosis. The aim of the present study is to present a systematic pathographic analysis of the artist and to suggest a diagnosis consistent with the extant evidence. To this end, the available evidence is classified into five types: type I evidence (clinical opinion of an attending physician), type II evidence (description of symptoms in correspondence), type III evidence (historical accounts from first-hand sources or direct observation), type IV evidence (interpretation of the artist's work) and type V evidence (family medical history). Three basic prerequisites for a successful analysis are: (1) consideration of type II, III and V evidence as carrying the greatest pathographic weight, (2) consideration of the course of symptoms over time as a key element in the analysis, and (3) consideration of a single diagnostic hypothesis as the most probable explanation. After reviewing the available evidence in the light of these criteria, the author supports the diagnosis of acute intermittent porphyria (AIP) as the most likely cause of van Gogh's ailment.
Collapse
Affiliation(s)
- R Correa
- Department of Psychiatry, University of California San Diego (UCSD), USA.
| |
Collapse
|
19
|
Veit T, de Lima C, Brenol C, Brenol J, Ribeiro A, Correa R, Cavalheiro L, dos Santos E, Xavier R, Chies J. AB0009 Association of an HLA-G 3’UTR haplotype with susceptibility to rheumatoid arthritis: A north-south analysis in two independent brazilian cohorts: Table 1. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.09] [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: 11/04/2022]
|
20
|
Mainini G, Torella M, Di Donna MC, Esposito E, Ercolano S, Correa R, Cucinella G, Stradella L, Luisi A, Basso A, Cerreto FV, Cicatiello R, Matteo M, De Franciscis P. Nonhormonal management of postmenopausal women: effects of a red clover based isoflavones supplementation on climacteric syndrome and cardiovascular risk serum profile. CLIN EXP OBSTET GYN 2013; 40:337-341. [PMID: 24283160] [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: 06/02/2023]
Abstract
PURPOSE OF INVESTIGATION The aim of this prospective randomized study was to evaluate a red clover based isoflavones supplementation in the treatment of climacteric syndrome and its effects on cardiovascular risk serum profile. MATERIALS AND METHODS The study included 150 healthy postmenopausal women that were randomly assigned to receive phytoestrogens tablets, amounting in a total daily intake of 60.8 mg red clover isoflavones plus 19.2 mg soy isoflavones (n = 75), or placebo (n = 75). The authors evaluated teh following: daily number of hot flushes and Kupperman Index at baseline and after one and three months; serum total, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, triglycerides, prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen, and antithrombin III (ATIII) at baseline and after three and six months. RESULTS One hundred twenty-eight patients completed the study: 67 in the active group and 61 in the placebo group. The treatment led to a progressive significant reduction (p < 0.05) of the number of hot flushes in the active group compared to placebo already after one month, while Kupperman Index was statistically reduced after three months. No significant variation in total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, PT, PTT, fibrinogen, and ATIII were found. CONCLUSION The present findings suggest that a red clover based isoflavones supplementation in healthy postmenopausal women is promptly effective on climacteric syndrome, improves neurovegetative symptoms, safe on cardiovascular risk serum profile, and does not modify lipids and coagulation.
Collapse
Affiliation(s)
- G Mainini
- "San Leonardo" Hospital, Castellammare di Stabia, Naples, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Correa R, Parry B. Women's mental health clinic: a naturalistic description of the population attended in the San Diego VA Health Care System during a one year period. J Affect Disord 2012; 142:31-5. [PMID: 22889523 DOI: 10.1016/j.jad.2012.03.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 03/10/2012] [Accepted: 03/19/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND Due to specific gender predispositions to present certain illnesses, increasing incorporation of women in the U.S. military system represents an important challenge to both medical and mental health providers. The aim of this report is to describe the main characteristics of the population attended in a mental health women's clinic at the San Diego Veterans Administration (VA) health care system. METHOD Present study is a comprehensive clinical report based on a retrospective analysis of data. The authors searched the San Diego VA Health Care database to find the main epidemiological and clinical characteristics of the population attended during a one year period. Epidemiological and clinical features of the sample are presented. Authors also describe, using clinical examples, the most important psychopathological expressions. RESULTS The most prevalent psychiatric diagnosis was major depressive disorder (n=28; 19.51%) followed by dysthymic disorder (n=8; 19.51%) and bipolar disorder (n=3; 7.31%). Authors discuss the importance of three variables: social isolation, quality of adaptive mechanisms and the role of self-stigmatization as crucial factors related to patient's clinical outcomes. LIMITATIONS The main limitation of this review derives from its naturalistic and descriptive methodology. CONCLUSIONS The majority of patients treated in our clinic experience some type of affective disorder. Main factors associated to recovery are: social integration and spiritual support, utilization of mature defense mechanisms and upper-level coping strategies and psycho-educational interventions directed to prevent self stigmatization. Clinicians should be aware of these factors in order to promote "upper-level coping strategies".
Collapse
Affiliation(s)
- R Correa
- Department of Psychiatry, University of California San Diego (UCSD) and San Diego VA Healthcare Service, 9500 Gilman Drive, San Diego, CA 92093-0804, USA
| | | |
Collapse
|
22
|
Mackay HJ, Buckanovich RJ, Hirte H, Correa R, Hoskins P, Biagi J, Martin LP, Fleming GF, Morgan R, Wang L, Polintan R, Oza AM. A phase II study single agent of aflibercept (VEGF Trap) in patients with recurrent or metastatic gynecologic carcinosarcomas and uterine leiomyosarcoma. A trial of the Princess Margaret Hospital, Chicago and California Cancer Phase II Consortia. Gynecol Oncol 2011; 125:136-40. [PMID: 22138373 DOI: 10.1016/j.ygyno.2011.11.042] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 11/18/2011] [Accepted: 11/22/2011] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim of this multi-institutional non randomized phase II trial was to determine the efficacy and safety of single agent aflibercept (VEGF Trap), a recombinant fusion protein that blocks multiple vascular endothelial growth factor isoforms, in women with gynecologic soft tissue sarcoma. METHODS Patients were enrolled in two cohorts each with Simon two stage designs: uterine leiomyosarcoma and carcinosarcoma of endometrial, ovarian or fallopian tube origin. Eligibility criteria included ≤2 prior lines of chemotherapy for metastatic disease and ECOG performance status of ≤2. Aflibercept 4mg/kg was administered intravenously on day 1 of a 14 day cycle. Primary endpoints were objective response and disease stabilization (Progression Free Survival (PFS) at 6 months). RESULTS 41 patients with uterine leiomyosarcoma and 22 patients with carcinosarcoma (19 uterine, 3 ovarian) were enrolled on study. In the leiomyosarcoma cohort, eleven (27%) patients had stable disease (SD), 4 with SD lasting at least 24 weeks. The 6 month PFS was 17%, with median time to progression (TTP) of 1.8 (95% CI:1.6-2.1) months. In the carcinosarcoma cohort, two (9%) patients had SD, one lasting >24 weeks, median TTP was 1.6 months (95%CI: 1.1-1.7) No partial responses were observed in patients from either cohort. Grade 3 or more aflibercept related toxicity was uncommon and included hypertension, fatigue, headache and abdominal pain. CONCLUSIONS Single agent aflibercept has modest activity in patients with uterine leiomyosarcoma and minimal activity in women with carcinosarcoma.
Collapse
Affiliation(s)
- H J Mackay
- Princess Margaret Hospital, Ontario, Canada
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Correa R, Akiskal H, Gilmer W, Nierenberg AA, Trivedi M, Zisook S. Is unrecognized bipolar disorder a frequent contributor to apparent treatment resistant depression? J Affect Disord 2010; 127:10-8. [PMID: 20655113 DOI: 10.1016/j.jad.2010.06.036] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [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] [Received: 05/25/2010] [Accepted: 06/28/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND There is widespread clinical belief that unrecognized bipolar disorder (BD) is a frequent contributor to apparent treatment resistant depression (TRD). This review attempts to assess the degree to which prevailing empirical data supports that view. METHODS All English-language articles published between January 1998 and January 2008 that focused on adults with major depressive disorder (MDD) and BD bearing on the question "Is unrecognized BD a frequent contributor to apparent TRD in patients initially diagnosed with MDD?" were reviewed. RESULTS 196 articles were reviewed; the preponderance of the data suggested: 1) TRD populations demonstrate high rates of hidden bipolar disorder, 2) there is not sufficient evidence to unequivocally support or reject the hypothesis that patients who relapse despite continued antidepressant treatment are likely to have bipolar spectrum disorder, 3) patients initially diagnosed with MDD do not demonstrate high rates of switching to mania or hypomania when treated with antidepressants and 4) in patients diagnosed with BD, antidepressants are not robustly effective and are poorly tolerated. LIMITATIONS The main limitation of this review is that none of the individual studies were designed to test our primary hypothesis. CONCLUSIONS This review provides at least moderate support to the hypothesis that BD is a contributor to apparent TRD. Thus, clinicians treating MDD are urged to search for "soft" signs of bipolarity and to be prepared to alter diagnosis and treatment strategies accordingly.
Collapse
Affiliation(s)
- R Correa
- Department of Psychiatry, University of California San Diego (UCSD), USA
| | | | | | | | | | | |
Collapse
|
24
|
Correa R, Mackay H, Hirte HW, Morgan R, Welch S, Fleming GF, Wang L, Blattler C, Ivy SP, Oza AM. A phase II study of sunitinib in recurrent or metastatic endometrial carcinoma: A trial of the Princess Margaret Hospital, The University of Chicago, and California Cancer Phase II Consortia. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.5038] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
25
|
Abstract
Patients undergoing day surgical procedures are given postoperative instructions not to drink alcohol, drive vehicles or make important decisions for 24 h. They are also advised to have a responsible adult stay with them at home overnight. Seven hundred and fifty patients were telephoned at 24 h postoperatively to determine their compliance with these instructions. Four per cent of patients drove vehicles, 1.8% consumed alcohol, while one patient made an important decision. A higher proportion of patients (5%) drove after general anaesthesia than regional anaesthesia or intravenous sedation (2.4%). The percentage of patients consuming alcohol was similar in both groups (1.8% vs. 1.9%). Four per cent of patients had no one staying with them overnight despite being accompanied out of the hospital. Patient compliance with instructions to not drink alcohol, drive or make important decisions may be improved by physician reinforcement of instructions and patient education.
Collapse
Affiliation(s)
- R Correa
- Coventry School of Anaesthesia, Walsgrave Hospital, Coventry, UK
| | | | | | | | | | | |
Collapse
|
26
|
Gibbons R, Cole B, Richardson R, Correa R, Brannen G, Mason J, Taylor W, Hafermann M. Adjuvante Strahlentherapie des lokal metastasierten Prostatakarzinoms. Aktuelle Urol 2008. [DOI: 10.1055/s-2008-1061642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
27
|
Correa R, Cedeño I, de Escobar C, Fuentes I. Increased urban seroprevalence of Toxoplasma gondii infecting swine in Panama. Vet Parasitol 2008; 153:9-11. [PMID: 18321648 DOI: 10.1016/j.vetpar.2008.01.017] [Citation(s) in RCA: 11] [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] [Received: 10/03/2006] [Revised: 01/09/2008] [Accepted: 01/11/2008] [Indexed: 11/15/2022]
Abstract
Toxoplasmosis gondii causes one of the most common zoonoses worldwide. The rate in Panama is one of the highest in the world. Infections are primarily asymptomatic in immune competent individuals; however, in immunocompromised patient and congenital cases can be lethal. Exposure to the pathogen is hypothesized to occur when handling or consuming infected food such as swine meat. In this study, we analyzed 290 swine sera collected from six provinces in Panama by Indirect Immunofluorescence antibody test (IFAT) against T. gondii. Toxoplasma-specific IgG were found in 32.1% of the samples. The highest seroprevalence was found in the province of Panama.
Collapse
Affiliation(s)
- R Correa
- Instituto de Investigaciones Científicas Avanzadas y Servicios de Alta Tecnología, Ciudad de Panamá, Panama.
| | | | | | | |
Collapse
|
28
|
Porter C, Walz J, Gallina A, Jeldres C, Kodama K, Gibbons R, Correa R, Perrotte P, Benard F, Saad F, Karakiewicz P. 634 NATURAL HISTORY OF BIOCHEMICAL RECURRENCE AFTER RADICAL PROSTATECTOMY FOR PROSTATE CANCER. EUR UROL SUPPL 2007. [DOI: 10.1016/s1569-9056(07)60632-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
29
|
Perez-Rozos A, Jerez-Sainz I, Medina J, Rico J, Correa R, Carrasco J, Pedrosa R, Lucena C. A practical irradiation technique for head and neck tumors. Radiother Oncol 2007. [DOI: 10.1016/s0167-8140(07)80125-3] [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: 10/23/2022]
|
30
|
Santos L, Curi Pedrosa R, Correa R, Cechinel Filho V, Nunes RJ, Yunes RA. Biological evaluation of chalcones and analogues as hypolipidemic agents. Arch Pharm (Weinheim) 2006; 339:541-6. [PMID: 17009298 DOI: 10.1002/ardp.200600034] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [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: 11/11/2022]
Abstract
In order to evaluate the anti-hyperlipidemic effect of synthetic chalcones and some analogues, nineteen compounds with different substituents in both rings were synthesized and hypolipidemic activities were measured in vivo using Triton WR1339 acute and hypercaloric chronic assays. 4',4-dichlorochalcone, 3',4',4-trichlorochalcone, and 4'-chlorochalcone gave an excellent decrease in serum total cholesterol and triglycerides in the acute assay. These compounds also showed significant anti-lipidemic activity in the chronic assay.
Collapse
Affiliation(s)
- Lorena Santos
- Departament of Biochemistry, Universidade Federal de Santa Catarina (UFSC), Florianopolis, Brazil
| | | | | | | | | | | |
Collapse
|
31
|
Lubitz SA, Baran DA, Alwarshetty MM, Zucker MJ, Arroyo LH, Chan M, Courtney MC, Correa R, Spielvogel D, Lansman SL, Gass AL. Improved Survival With Statins, Angiotensin Receptor Blockers, and Steroid Weaning After Heart Transplantation. Transplant Proc 2006; 38:1501-6. [PMID: 16797343 DOI: 10.1016/j.transproceed.2006.02.131] [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] [Received: 09/21/2005] [Indexed: 11/26/2022]
Abstract
Various immunosuppressive and adjunctive pharmacological regimens exist for cardiac transplantation, though the associations between these regimens and long-term survival are unclear. We reviewed demographic, clinical, and pharmacological data from 220 consecutive adult heart transplant recipients between 1986 and 2003 who survived beyond 3 months. Immunosuppression was cyclosporine-based (n=94) or tacrolimus-based (n=126), and 104 patients were weaned off steroids (all receiving tacrolimus). Covariates of mortality were assessed in a Cox proportional hazards analysis. The mean age was 5.2+/-13 years. Survival was 96%, 88%, and 81% at 1, 3, and 5 years, respectively. Significant covariates associated with mortality included pretransplant diabetes mellitus (hazard ratio [HR] 2.83, 95% confidence interval [CI] 1.45 to 5.04), black race (HR 1.41, 95% CI 1.01 to 1.94), higher pretransplant creatinine clearance (HR 0.99, 95% CI 0.98 to 1.00), steroid withdrawal (HR 0.60, 95% CI 0.39 to 0.85), and exposure to a statin (HR 0.53, 95% CI 0.40 to 0.70) or an angiotensin receptor blocker (HR 0.50, 95% CI 0.20 to 0.95) after transplantation. Treatment with a statin, an angiotensin receptor blocker, and steroid withdrawal were each associated with improved survival in heart transplant recipients. These findings warrant prospective study, with specific emphasis on identifying the clinical effects of these medications in transplant recipients.
Collapse
Affiliation(s)
- S A Lubitz
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Medical Center, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Abstract
Following acute knee trauma some patients will require urgent arthroscopy. Traditionally surgery is undertaken as in-patient on the general trauma list. This system leads to blockage of beds, repeated starving of the patient and out-of-hour's surgery in many cases. We introduced a dedicated Day Surgery knee trauma list (KTL) to reduce in-patient admissions, waiting time and cost. The typical indications for urgent knee arthroscopy are locked knees secondary to meniscal tears, loose bodies or cruciate ligament ruptures; acute osteochondral fractures; and children with acute meniscal tears. This retrospective review compares the study group: patients on the knee trauma list during the first 8 months following introduction, and the control group: patients on the general in-patient trauma list over a similar period immediately prior to implementation of the new list. There were 49 patients in the control group with an average stay in hospital of 2.5 days. Out-of-hour's operations were performed in 13 patients and 3 patients required a repeat arthroscopy. Fifty-three patients were treated in the knee study group. The significant operations were meniscal repair in 7, fixation of osteochondral fragments in 3. None of the patients required overnight stay. Control group patients were more likely to have surgery performed by inexperienced non-specialist knee surgeons, whereas specialist knee surgeons staffed the knee trauma list. Specialist surgeons were available to staff the knee trauma list. As the majority of the control group had spent an average of 2.2 nights in hospital, there has been considerable savings to the hospital. Introduction of the Day Surgical Knee trauma list has reduced unnecessary admissions per week; episodes of prolonged starving, cost and have improved patient satisfaction and management.
Collapse
Affiliation(s)
- A P Chandratreya
- Department of Trauma & Orthopaedics, University Hospitals Coventry & Warwickshire NHS Trust, Stoney Stanton Road, Coventry CV1 4FH, West Midlands, UK.
| | | | | |
Collapse
|
33
|
Porter CR, Kodama K, Gibbons R, Correa R, Perrotte P, Karakiewicz P. Development and internal validation of a nomogram for prediction of prostate cancer specific survival 2, 5, 10, 15, 20 and 25 years after radical prostatectomy. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.4652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- C. R. Porter
- Virginia Mason, Seattle,, WA; Univ of Montreal, Montreal, PQ, Canada
| | - K. Kodama
- Virginia Mason, Seattle,, WA; Univ of Montreal, Montreal, PQ, Canada
| | - R. Gibbons
- Virginia Mason, Seattle,, WA; Univ of Montreal, Montreal, PQ, Canada
| | - R. Correa
- Virginia Mason, Seattle,, WA; Univ of Montreal, Montreal, PQ, Canada
| | - P. Perrotte
- Virginia Mason, Seattle,, WA; Univ of Montreal, Montreal, PQ, Canada
| | - P. Karakiewicz
- Virginia Mason, Seattle,, WA; Univ of Montreal, Montreal, PQ, Canada
| |
Collapse
|
34
|
Resino S, Galán I, Correa R, Pajuelo L, Bellón JM, Muñoz-Fernández MA. Homeostatic role of IL-7 in HIV-1 infected children on HAART: association with immunological and virological parameters. Acta Paediatr 2005; 94:170-7. [PMID: 15981750 DOI: 10.1111/j.1651-2227.2005.tb01886.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
AIM To investigate the role of IL-7 in HIV-infected children on highly active antiretroviral therapy (HAART) and its association with laboratory parameters related to disease progression. PATIENTS AND METHODS A cross-sectional study in 31 vertically HIV-infected children (median age 8.4 y) treated with HAART, and a longitudinal study in four of those same children was carried out. In both studies, viral load, CD4+ T-cell counts, thymic production of T cells by TCR rearrangement excision circles (TRECs), IL-7 plasma levels and viral phenotype were determined. RESULTS IL-7 levels were higher in HIV-infected children than in age-matched, uninfected controls. In addition, HIV children with CD4+ T cells between 200 and 500 T cells/mm3 had higher IL-7 levels and lower TREC values than HIV-infected children with CD4+ T cells >500 T cells/mm3. IL-7 levels were higher in children with syncytium-inducing (SI) phenotype than in those with non-syncytium-inducing (NSI) variants. During the follow-up of four HIV children, the decrease in viral load after HAART was always associated with a recovery of CD4+ T cells and TRECs, which was followed by a decrease in IL-7 returning to the levels present prior to the drop in CD4+ T cells. The four HIV-infected children had SI/X4 isolates in PBMC before HAART, and the viral phenotype switched to NSI/R5 after HAART. CONCLUSION Our data suggest that IL-7 plays a key role in the maintenance of T-cell homeostasis in HIV-infected children on HAART, both through peripheral expansion and through a thymus-dependent mechanism.
Collapse
Affiliation(s)
- S Resino
- Laboratorio de Inmuno-Biología Molecular, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | | | | | | |
Collapse
|
35
|
Baran DA, Lubitz S, Alvi S, Fallon JT, Kaplan S, Galin I, Correa R, Courtney MC, Chan M, Spielvogel D, Lansman SL, Gass AL. Refractory humoral cardiac allograft rejection successfully treated with a single dose of rituximab. Transplant Proc 2004; 36:3164-6. [PMID: 15686719 DOI: 10.1016/j.transproceed.2004.10.087] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [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: 11/16/2022]
Abstract
Despite improvements in immunosuppression over the last two decades, the risk of allograft rejection is still high in the early postoperative period. Cellular rejection accounts for the majority of these episodes. However, humoral rejection is a distinct phenomenon that carries a high rate of graft loss and mortality. The currently available treatments for this serious clinical problem include anti-lymphocyte antibodies, immune globulin infusions, as well as plasmapheresis, all of which have limitations. We describe a case of refractory humoral cardiac rejection successfully treated with a single dose of rituximab (375 mg/m2). No further episodes occurred with 2 years of follow-up.
Collapse
Affiliation(s)
- D A Baran
- Cardiothoracic Transplantation Program at Newark Beth Israel Medical Center, Newark, New Jersey 07112, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Baran DA, Galin ID, Zucker MJ, Alvi S, Arroyo LH, Lubitz S, Kaplan S, Correa R, Courtney MC, Chan M, Spielvogel D, Lansman SL, Gass AL. Can initial tacrolimus trough levels be predicted from clinical variables? Transplant Proc 2004; 36:2816-8. [PMID: 15621157 DOI: 10.1016/j.transproceed.2004.09.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 11/26/2022]
Abstract
In eligible patients, cardiac transplantation has become the definitive treatment for end-stage heart failure. The initial posttransplantation course is marked by many potential difficulties, including renal insufficiency, hemodynamic instability, and perioperative bleeding. It is important to prevent early rejection; calcineurin inhibitors, such as tacrolimus or cyclosporine, are integral parts of such management. However, these drugs are associated with renal toxicity in some patients. Previous work suggests that limiting the increase in tacrolimus levels is associated with less renal insufficiency. The hypothesis of the current study was that a combination of clinical or laboratory variables could identify patients at risk for rapid changes in tacrolimus target levels. No single variable was strongly associated with high resultant trough levels following a standard 1-mg oral "test dose" of tacrolimus. However, the combination of 2 indices of liver metabolism (alanine aminotransferase and total bilirubin) along with serum creatinine did identify patients who tended toward elevated levels of tacrolimus (> or =4.5 ng/dL). Other variables, such as demographics, and even functional variables, such as right ventricular function by echocardiography, did not enhance the predictive value of this simple scoring system.
Collapse
Affiliation(s)
- D A Baran
- Cardiothoracic Transplantation Program, Newark Beth Israel Medical Center, Newark, New Jersey 07112, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Baran D, Kaplan S, Lubitz S, Galin I, Alvi S, Correa R, Courtney M, Chan M, Spielvogel D, Lansman S, Gass A. Graft vasculopathy: comparison of cyclosporine and tacrolimus over 15 + years. J Heart Lung Transplant 2004. [DOI: 10.1016/j.healun.2003.11.363] [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: 11/25/2022] Open
|
38
|
Baran DA, Galin ID, Courtney MC, Correa R, Chan M, Spielvogel D, Lansman SL, Gass AL. Cardiac transplantation in the older recipient: excellent long-term survival based on pretransplant screening. Transplant Proc 2003; 35:2465-7. [PMID: 14611987 DOI: 10.1016/j.transproceed.2003.08.027] [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] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Cardiac transplantation has become the established treatment of choice for eligible patients with end-stage congestive heart failure. Older recipients (over the age of 60) are sometimes regarded as too high risk for transplant. Because chronological age is frequently disparate from physiologic age, we hypothesized that with careful selection after a comprehensive screening evaluation we would be able to achieve comparable survival and quality of life in an older population. METHODS Between January 1989 and December 2002, 240 de novo adult cardiac transplants were performed for 74 female and 176 male patients. Prior to listing for cardiac transplantation, the patients were evaluated to exclude significant comorbidities that would limit survival or functional capacity postsurgery. In patients over the age of 60, particularly rigorous testing was conducted to eliminate significant extracardiac disease. RESULTS The patients are divided in this analysis into three groups based on age at transplant (age 18 to 45, 46 to 59, and 60 years or older). Older recipients experienced similar rates of moderately severe cellular rejection (ISHLT grade 3A/ B). Survival as derived by Kaplan-Meier analysis was equivalent for all groups by Mantel-Cox logrank test (P = NS). The survival for patients older than age 60 was 83.1%, 73.7%, 67.7%, 57.4%, and 43.1% at 1,3, 5, 7, and 10 years posttransplant, respectively. CONCLUSION We conclude that chronological age over 60 years old should not exclude a patient from the potential long-term benefit of cardiac transplant, ensuring added longevity and excellent quality of life.
Collapse
Affiliation(s)
- D A Baran
- Zena and Michael A. Weiner Cardiovascular Institute, Mt. Sinai Medical Center, New York, NY 10029, USA.
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Abstract
The objective of this study was to study immune system status in long-term asymptomatic (LTA) HIV-1-infected children. A cross-sectional study was used, involving HIV-1-infected children over 7 years of age who were rated into two groups according to their clinical and immunological classification: (a) LTA: 7 asymptomatic HIV-1-infected children in A1; (b) Rapid progressor (RP): 14 age-matched C3 HIV-1-infected children. The control group consisted of 17 age-matched uninfected children. The characterization of CD4+ T-cell subsets was determined by three-colour flow cytometry. The proliferative response and cytokine production by activated peripheral blood T-cells were also measured. IL-7 levels were measured in serum. Thymic production of T-cells was quantified by TCR rearrangement excision circles (TRECs). The LTA children showed similar proliferative responses to PHA, PWM and anti-CD3+ anti-CD28, but lower responses to tetanus toxoid and streptokinase, in comparison with the controls but always higher responses in comparison with the RP group. The production of TNF-alpha and IFN-gamma was similar in the LTA and control groups, and both were higher than the levels in the RP group. The LTA group showed a lower percentage of memory CD4+ T-cells (CD4+ CD45RO+, CD4+ CD45RA-CD62L+) than the control and RP groups. The LTA group also showed lower percentages of CD4+ CD7- cells than the controls. As for naïve CD4+ T-cells (CD4+ CD45RA+ CD62L+), CD4+ CD45RA+ and CD4+ CD62L+ cells, the LTA group showed higher values than the control and RP groups. The LTA group showed higher percentages of CD4+ HLA-DR+ CD38+ than the controls, but lower values than the RP group. In contrast, the LTA group had percentages of CD4+ HLA-DR-CD38+ T-cells higher than both the control and RP groups, whereas CD4+ CD38+ levels were only higher in the LTA group in comparison with the controls. CD4+ HLA-DR+ CD38- and CD4+ HLA-DR+ cell numbers were lower in the LTA group in comparison with the RP group. We found almost normal values of TRECs and IL-7 in the LTA group, but lower values in the RP group. Moreover, we found an inverse relation between TREC levels and IL-7 in plasma from HIV-infected children. Asymptomatic HIV-1 infected children have a well preserved immune system similar to that of control uninfected children in spite of HIV-infection for more than 7 years. Moreover, our results identified new markers of HIV disease, such as TRECs and IL-7, that could be used to monitor disease.
Collapse
Affiliation(s)
- S Resino
- Laboratory of Immno-Molecular Biology, General University Hospital 'Gregorio Marañón', Madrid, Spain
| | | | | | | |
Collapse
|
40
|
Baran D, Galin I, Correa R, DeAsla R, Seissler P, Chan M, Courtney M, Spielvogel D, Lansman S, Gass A. Novacor left ventricular assist bridge to transplant: no sensitization or excess rejection as compared to unsupported patients. J Heart Lung Transplant 2003. [DOI: 10.1016/s1053-2498(02)01067-7] [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
|
41
|
Baran DA, Galin ID, Sandler D, Segura L, Correa R, Courtney MC, Cheng J, Chan M, Lansman SL, Spielvogel D, Fallon JT, Gass AL. A novel tacrolimus dosing strategy in cardiac transplantation: drug levels, renal function, and biopsy results. Transplant Proc 2002; 34:1834-5. [PMID: 12176595 DOI: 10.1016/s0041-1345(02)03096-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- David A Baran
- Zena and Michael A. Weiner Cardiovascular Institute, Mt. Sinai Medical Center, New York, NY 10029, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Baran DA, Ashkar J, Galin ID, Sandler D, Segura L, Courtney MC, Correa R, Chan M, Lansman SL, Spielvogel D, Cheng J, Gass AL. Tacrolimus and new onset diabetes mellitus: the effect of steroid weaning. Transplant Proc 2002; 34:1711-2. [PMID: 12176547 DOI: 10.1016/s0041-1345(02)02993-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- D A Baran
- Zena and Michael A. Weiner Cardiovascular Institute, Mt. Sinai Medical Center, New York, NY 10029, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Baran DA, Galin ID, Sandler D, Cheng J, Segura L, Courtney MC, Correa R, Chan M, Lansman SL, Spielvogel D, Gass AL. Predictors of early renal insufficiency in cardiac transplant recipients initiated on tacrolimus. Transplant Proc 2002; 34:1872-3. [PMID: 12176609 DOI: 10.1016/s0041-1345(02)03104-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- D A Baran
- Zena and Michael A. Weiner Cardiovascular Institute, Mt. Sinai Medical Center, New York, NY 10029, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Baran DA, Galin ID, Segura L, Courtney MC, Correa R, Lansman SL, Spielvogel D, Ashkar J, Cheng J, Fallon JT, Gass AL. Tacrolimus and cardiac transplantation: a comparison of monotherapy and steroid-dependent patients. Transplant Proc 2002; 34:1845-6. [PMID: 12176599 DOI: 10.1016/s0041-1345(02)03100-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- D A Baran
- Zena and Michael A. Weiner Cardiovascular Institute, Mt. Sinai Medical Center, New York, NY 10029, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Dzuris JL, Sidney J, Horton H, Correa R, Carter D, Chesnut RW, Watkins DI, Sette A. Molecular determinants of peptide binding to two common rhesus macaque major histocompatibility complex class II molecules. J Virol 2001; 75:10958-68. [PMID: 11602736 PMCID: PMC114676 DOI: 10.1128/jvi.75.22.10958-10968.2001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Major histocompatibility complex class II molecules encoded by two common rhesus macaque alleles Mamu-DRB1*0406 and Mamu-DRB*w201 have been purified, and quantitative binding assays have been established. The structural requirements for peptide binding to each molecule were characterized by testing panels of single-substitution analogs of the two previously defined epitopes HIV Env242 (Mamu-DRB1*0406 restricted) and HIV Env482 (Mamu-DRB*w201 restricted). Anchor positions of both macaque DR molecules were spaced following a position 1 (P1), P4, P6, P7, and P9 pattern. The specific binding motif associated with each molecule was distinct, but largely overlapping, and was based on crucial roles of aromatic and/or hydrophobic residues at P1, P6, and P9. Based on these results, a tentative Mamu class II DR supermotif was defined. This pattern is remarkably similar to a previously defined human HLA-DR supermotif. Similarities in binding motifs between human HLA and macaque Mamu-DR molecules were further illustrated by testing a panel of more than 60 different single-substitution analogs of the HLA-DR-restricted HA 307-319 epitope for binding to Mamu-DRB*w201 and HLA-DRB1*0101. The Mamu-DRB1*0406 and -DRB*w201 binding capacity of a set of 311 overlapping peptides spanning the entire simian immunodeficiency virus (SIV) genome was also evaluated. Ten peptides capable of binding both molecules were identified, together with 19 DRB1*0406 and 43 DRB*w201 selective binders. The Mamu-DR supermotif was found to be present in about 75% of the good binders and in 50% of peptides binding with intermediate affinity but only in approximately 25% of the peptides which did not bind either Mamu class II molecule. Finally, using flow cytometric detection of antigen-induced intracellular gamma interferon, we identify a new CD4(+) T-lymphocyte epitope encoded within the Rev protein of SIV.
Collapse
Affiliation(s)
- J L Dzuris
- Epimmune, Inc., San Diego, California 92121, USA
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Abstract
OBJECTIVE To determine whether viral phenotype has any effect on thymic production of new T cells in HIV-1-infected children. DESIGN Differences in CD4+ T-cell counts and a marker of thymic output [T-cell antigen receptor (TCR) rearrangement excision circles (TRECs)], between HIV-1-infected children with non-syncytium-inducing (NSI) and syncytium-inducing (SI) viral strains were determined. PATIENTS AND METHODS A cross-sectional study in 90 samples from vertically HIV-1-infected-children (median age 4.9 years) treated with combination therapy, and a longitudinal study in three children that underwent a change from NSI to SI phenotype were carried out. Viral load, viral phenotype, CD4+ T-cell counts, and quantification of TRECs values were determined. RESULTS Children with SI virus showed significant lower levels of CD4+ T cells and a lower thymic production of new T cells than children with NSI. These reductions were independent of the treatment and the age of the children. However, there were no differences in viral load with the phenotype between those groups. In children with both NSI and SI viral phenotype, there was a significant correlation between CD4+ T-cell counts and TRECs values. CONCLUSION The decrease of CD4+ T cells in presence of T-tropic viruses would be mainly due to a lower production of new CD4+ T cells as consequence of the inhibitory effect of these T-tropic strains on thymic function. This effect is not due either to the amount of circulating virus or to the replication kinetics of those strains, but rather depends on the ability of T-tropic viruses to infect T-cell precursors using CXCR4 receptors, which are highly expressed in immature thymocytes.
Collapse
Affiliation(s)
- R Correa
- Laboratory of Immuno-Molecular Biology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | |
Collapse
|
47
|
Abstract
Due to the growing importance of quality assurance and cost containment in healthcare, eliciting patients' preferences for post-operative outcomes may be a more economical and reliable method of assessing quality. Three hundred and fifty-five day surgery patients completed a pre-operative written questionnaire to identify patients' preferences for avoiding 10 particular post-operative symptoms: pain, nausea, vomiting, disorientation, shivering, sore throat, drowsiness, gagging on the tracheal tube, thirst and a normal outcome. The two scoring methods used to evaluate preferences were priority ranking and relative value scores. The effects of age, gender, previous health status, type of surgery and previous experience of anaesthesia on patients' preferences were also examined. Avoiding post-operative pain, gagging on the tracheal tube and nausea and vomiting are major priorities for day-case patients. Anaesthetists should take patients' preferences into consideration when developing guidelines and planning anaesthetic care.
Collapse
Affiliation(s)
- K Jenkins
- Department of Anaesthesia, University of Toronto, Toronto Western Hospital, Ontario, Canada
| | | | | | | | | | | |
Collapse
|
48
|
Baran DA, Segura L, Kushwaha S, Courtney M, Correa R, Fallon JT, Cheng J, Lansman SL, Gass AL. Tacrolimus monotherapy in adult cardiac transplant recipients: intermediate-term results. J Heart Lung Transplant 2001; 20:59-70. [PMID: 11166613 DOI: 10.1016/s1053-2498(00)00237-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [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: 11/25/2022] Open
Abstract
BACKGROUND Tacrolimus (FK506) is a macrolide antibiotic that inhibits T-cell activation and proliferation. To date, all published trials have used tacrolimus and steroids in combination with either azathioprine or mycophenolate mofetil. Previous experience with pediatric cardiac transplant patients at our institution suggested that use of tacrolimus alone provides an adequate level of immunosuppression and that withdrawal of steroids is readily achieved in most recipients. Between January 1, 1996, and July 7, 1999, we performed 77 adult cardiac transplants. Forty-three of these patients received tacrolimus and prednisone as primary immunosuppression, without azathioprine or mycophenolate mofetil. Thirty-two of the 43 patients started on tacrolimus have been weaned off steroids and are maintained on monotherapy. These latter patients form the basis of this report. The mean time for achieving monotherapy was 246 +/- 127 days (range, 106 to 730). Grade > or = 2 rejection occurred at 0.40 episodes per patient in the first 90 days (a combination of Grades 2 and 3A/3B rejections). The freedom from treated rejection (includes all 3A/3B and Grade 2 rejection in the first 90 days) was 69% at 90 days and 52% at 1 year. One patient (of 32) had documented cytomegalovirus infection (gastritis) diagnosed at 8 months post-transplant. We observed 1 case of transplant vasculopathy and 1 case of post-transplant lymphoproliferative disorder during the follow-up period. Our results show that use of tacrolimus alone after steroid weaning provides effective immunosuppression with low incidence of rejection, cytomegalovirus infection, transplant arteriopathy, or post-transplant lymphoproliferative disease.
Collapse
Affiliation(s)
- D A Baran
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, 1 Gustave L. Levy Place, Box 1030, New York, NY 10029, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
De la Fuente M, Carazo M, Correa R, Del Río M. Changes in macrophage and lymphocyte functions in guinea-pigs after different amounts of vitamin E ingestion. Br J Nutr 2000; 84:25-9. [PMID: 10961157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Vitamin E is the main biological lipid-soluble antioxidant and plays a crucial role in the maintenance of the immune system. In the present work, twenty-one guinea-pigs (3-weeks-old) were distributed into three groups, which during 5 weeks ingested different amounts of vitamin E (/kg diet): 15 mg (low vitamin E diet), 150 mg (medium vitamin E diet; control) or 1500 mg (high vitamin E diet). The function of lymphocytes and macrophages were then studied. In macrophages obtained from the peritoneum several steps of the phagocytic process (chemotaxis, ingestion and superoxide anion production) were assayed, as well as chemotaxis and proliferation of peritoneal and spleen lymphocytes. The results indicate that with respect to the medium vitamin E diet, low ingestion of vitamin E causes a decrease in chemotaxis and production of superoxide anion by macrophages and an increase in the phagocytic capacity. With the high vitamin E diet an increase in macrophage and lymphocyte chemotaxis, superoxide anion production and lymphoproliferative capacity, as well as a decrease in phagocytosis, were observed. Therefore, diet supplementation with higher than usual levels of vitamin E appears to be beneficial for the immune system.
Collapse
Affiliation(s)
- M De la Fuente
- Department of Animal Physiology, Faculty of Biological Science, Complutense University of Madrid, Spain.
| | | | | | | |
Collapse
|
50
|
Abstract
Previous studies have shown that several immune functions were improved in mice after the ingestion of a thioproline (thiazolidine-4-carboxylic acid) enriched diet. In the present work, we have studied the in vitro effects of several concentrations of this thiol compound (0.1, 0.5, 1, 2.5 and 5 mM) on the most relevant functions of three pivotal immune cells, namely, macrophages, lymphocytes, and natural killer (NK) cells from BALB/c mice. The results show that thioproline stimulates the phagocytic process of macrophages, increasing the mobility directed to the inflammatory focus (chemotaxis) and the phagocytosis of inert particles. It increases the adherence and the chemotaxis capacities of lymphocytes, their proliferative activity and favours the natural cytotoxic activity that could improve the capacity to destroy malignant cells. Thioproline concentrations of 0.5 and 1 mM were the most effective regarding the different functions analysed. These results suggest that the improvement of immune functions, observed in previous work, after thioproline-enriched diet ingestion is due to a direct action of this thiol compound on immune cells.
Collapse
Affiliation(s)
- R Correa
- Department of Animal Physiology, Faculty of Biological Sciences, Complutense University, Madrid, Spain
| | | | | |
Collapse
|