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Zager Y, Khalilieh S, Mansour A, Cohen K, Nadler R, Anteby R, Ram E, Horesh N, Nachmany I, Gutman M, Berger Y. Correction to: The value of CA125 in predicting acute complicated colonic diverticulitis. Int J Colorectal Dis 2023; 38:209. [PMID: 37556027 DOI: 10.1007/s00384-023-04486-7] [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: 08/10/2023]
Affiliation(s)
- Yaniv Zager
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Saed Khalilieh
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Aiham Mansour
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Karin Cohen
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Roy Nadler
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Roi Anteby
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Edward Ram
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Nir Horesh
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Department of Colon and Rectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Ido Nachmany
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Mordechai Gutman
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Yaniv Berger
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel.
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Zager Y, Khalilieh S, Mansour A, Cohen K, Nadler R, Anteby R, Ram E, Horesh N, Nachmany I, Gutman M, Berger Y. The value of CA125 in predicting acute complicated colonic diverticulitis. Int J Colorectal Dis 2023; 38:182. [PMID: 37389666 DOI: 10.1007/s00384-023-04478-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND CA125 is a widely used serum marker for epithelial ovarian cancer which levels may also rise in benign conditions involving peritoneal irritation. We aimed to determine if serum CA125 levels can predict disease severity in patients presenting with acute diverticulitis. METHODS We conducted a single-center prospective observational study, analyzing CA125 serum levels in patients who presented to the emergency department with computerized tomography-proven acute left-sided colonic diverticulitis. Univariate, multivariate, and receiver operating characteristic (ROC) analyses were used to correlate CA125 serum levels at time of initial presentation with the primary outcome (complicated diverticulitis) and secondary clinical outcomes (need for urgent intervention, length of hospital stay (LOS) and readmission rates). RESULTS One hundred and fifty-one patients were enrolled between January 2018 and July 2020 (66.9% females, median age 61 years). Twenty-five patients (16.5%) presented with complicated diverticulitis. CA125 levels were significantly higher among patients with complicated (median: 16 (7-159) u/ml) vs. uncomplicated (8 (3-39) u/ml) diverticulitis (p < 0.001) and also correlated with the Hinchey severity class (p < 0.001). Higher CA125 levels upon admission were associated with a longer LOS and a greater chance to undergo invasive procedure during the hospitalization. In patients with a measurable intra-abdominal abscess (n = 24), CA125 levels were correlated with the size of the abscess (Spearman's r = 0.46, p = 0.02). On ROC analysis to predict complicated diverticulitis, the area under the curve (AUC) for CA125 (AUC = 0.82) was bigger than for the leukocyte count (AUC = 0.53), body temperature (AUC = 0.59), and neutrophil-lymphocyte ratio (AUC = 0.70) - all p values < 0.05. On multivariate analysis of factors available at presentation, CA125 was found to be the only independent predictor of complicated diverticulitis (OR 1.12 (95% CI 1.06-1.19), p < 0.001). CONCLUSIONS The results from this feasibility study suggest that CA125 may accurately discriminate between simple and complicated diverticulitis, meriting further prospective investigation.
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Affiliation(s)
- Yaniv Zager
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Saed Khalilieh
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Aiham Mansour
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Karin Cohen
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Roy Nadler
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Roi Anteby
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Edward Ram
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Nir Horesh
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Department of Colon and Rectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Ido Nachmany
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Mordechai Gutman
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Yaniv Berger
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel.
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Huang R, Hammelef E, Sabitsky M, Ream C, Khalilieh S, Zohar N, Lavu H, Bowne WB, Yeo CJ, Nevler A. Chronic Obstructive Pulmonary Disease Is Associated with Worse Oncologic Outcomes in Early-Stage Resected Pancreatic and Periampullary Cancers. Biomedicines 2023; 11:1684. [PMID: 37371779 DOI: 10.3390/biomedicines11061684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is the 3rd leading cause of cancer mortality in the United States. Hypoxic and hypercapnic tumor microenvironments have been suggested to promote tumor aggressiveness. The objective of this study was to evaluate the association between chronic obstructive pulmonary disease (COPD) and oncologic survival outcomes in patients with early-stage PDAC and periampullary cancers. In this case-control study, patients who underwent a pancreaticoduodenectomy during 2014-2021 were assessed. Demographic, perioperative, histologic, and oncologic data were collected. A total of 503 PDAC and periampullary adenocarcinoma patients were identified, 257 males and 246 females, with a mean age of 68.1 (±9.8) years and a mean pre-operative BMI of 26.6 (±4.7) kg/m2. Fifty-two percent of patients (N = 262) reported a history of smoking. A total of 42 patients (8.3%) had COPD. The average resected tumor size was 2.9 ± 1.4 cm and 65% of the specimens (N = 329) were positive for lymph-node involvement. Kaplan-Meier analysis showed that COPD was associated with worse overall and disease-specific survival (p < 0.05). Cox regression analysis showed COPD to be an independent prognostic factor (HR = 1.5, 95% CI 1.0-2.3, p = 0.039) along with margin status, lymphovascular invasion, and perineural invasion (p < 0.05 each). A 1:3 nearest neighbor propensity score matching was also employed and revealed COPD to be an independent risk factor for overall and disease-specific survival (OR 1.8 and OR 1.6, respectively; p < 0.05 each). These findings may support the rationale posed by in vitro laboratory studies, suggesting an important impact of hypoxic and hypercapnic tumor respiratory microenvironments in promoting therapy resistance in cancer.
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Affiliation(s)
- Rachel Huang
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Emma Hammelef
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Matthew Sabitsky
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Carolyn Ream
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Saed Khalilieh
- Jefferson Pancreas, Biliary and Related Cancer Center, Department of Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Nitzan Zohar
- Jefferson Pancreas, Biliary and Related Cancer Center, Department of Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Harish Lavu
- Jefferson Pancreas, Biliary and Related Cancer Center, Department of Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Wilbur B Bowne
- Jefferson Pancreas, Biliary and Related Cancer Center, Department of Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Charles J Yeo
- Jefferson Pancreas, Biliary and Related Cancer Center, Department of Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Avinoam Nevler
- Jefferson Pancreas, Biliary and Related Cancer Center, Department of Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA
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Nevler A, Khalilieh S, Lavu H, Bowne W, Yeo CJ. Hypercapnic Tissue Gene Expression and Survival in Early-Stage Pancreatic Ductal Adenocarcinoma. J Am Coll Surg 2023; 236:913-922. [PMID: 36728372 DOI: 10.1097/xcs.0000000000000552] [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: 02/03/2023]
Abstract
BACKGROUND Pancreatic ductal adenocarcinoma (PDAC) is an aggressive and lethal cancer. Hypercapnic tumor microenvironments were previously shown to promote cancer chemoresistance. In this study, we aimed to investigate the impact of tissue hypercapnia on PDAC prognosis. STUDY DESIGN PDAC cancer-cell lines were cultured in normocapnic (5% CO 2 ) and hypercapnic conditions (10% CO 2 ). RNA was extracted, and whole-exome transcriptome was sequenced. Differentially expressed genes were identified and used to construct a "hypercapnic gene set." PDAC transcriptomic patient data from the Tumor Cancer Genome Atlas was used to calculate single-sample gene set enrichment scores based on each patient's tissue expression of the hypercapnic gene set. Tissue hypercapnic scores (HSs) in PDAC patients (TMN stages Ia-IIb) were determined and correlated with clinicopathological parameters and overall survival. RESULTS A cohort of 135 resected stage I-II PDAC patients were assessed in this study. The average age was 65 ± 11.0 years, and the male:female ratio was 74:61. Median overall survival was 19.5 ± 1.4 months. High HSs were associated with increased tumor stage (p < 0.05) and higher lymph-node ratio (p < 0.05). In active smokers, high HS also correlated with smoking pack-years (p < 0.05). Cox regression analysis revealed high HS to be an independent prognostic factor for overall survival (hazard ratio [HR] 2.66, p = 0.004), along with lymph-node ratio (HR 4.2, p = 0.002) and age at diagnosis (HR 2.63, p = 0.01). CONCLUSIONS The pancreatic tumor microenvironment plays an integral role in tumor aggressiveness, and our previous in vitro data suggest that hypercapnia promotes an aggressive, more resistant phenotype. Herein, we show that in early-stage pancreatic cancer, hypercapnic tissue signatures corresponded with a worse overall survival.
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Affiliation(s)
- Avinoam Nevler
- From the Jefferson Pancreas, Biliary, and Related Cancer Center, Department of Surgery, Thomas Jefferson University, Philadelphia, PA
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Nevler A, Schultz CW, Jain A, Khalilieh S, McCarthy G, Lavu H, Bowne W, Yeo CJ, Brody JR. Abstract 1811: Dithiazanine Iodide suppresses mitochondrial function to strongly inhibit pancreatic ductal adenocarcinoma growth in-vitro and in-vivo, producing a marked increase in survival. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-1811] [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] [Indexed: 11/16/2022]
Abstract
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is an aggressive recalcitrant cancer with a uniquely austere tumor microenvironment (TME). It is hypovascularized, hypoxic, and poor in nutrients. These features, which are critical due to the increased energetic demand in continuously replicating cancer cells, drive metabolic reprograming to support the continued activity. Thus leading to a vulnerability in the form of energy restriction - a vulnerability further exacerbated by the nutrient-poor pancreatic cancer TME. We have recently shown mitochondrial inhibition to have great potential in in-vitro inhibition of PDAC cells. Since repurposing of FDA-approved drugs holds great promise in terms of faster and safer drug development, we selected to investigate the effect of mitochondrial inhibition on pancreatic cancer cells through assessment of the previously FDA-approved antimicrobial Dithiazanine Iodide (CDI). CDI is a fluorescent, orally bioavailable, small molecule. In-vitro, it has been previously shown to preferentially localize to the mitochondria, bind proteins and nucleic acids, and have a yet to be discerned inhibitory effect on the electron transport chain. We demonstrated CDI had low IC50s (30-300 nM) in multiple PDAC and other GI cancer cell lines. In an agnostic, unbiased manner, we assessed metabolomic and transcriptomic perturbations caused by CDI. These revealed a profound 92% decrease in the abundance of mitochondrial-encoded transcripts (P<0.05), decreased mitochondrial beta-oxidation, and a reduction in the ATP/ADP ratio. We have therefore hypothesized that the anti-cancer effects of CDI may be related to disruption of mitochondrial processes and we proceeded to characterize its mechanism of action. CDI treatment reduced protein expression of electron transport chain complexes I, II, III, and IV. Treatment with CDI in hypoglycemic conditions resulted in a 3-4 fold increase in sensitivity (P<0.05) and ATP quantification showed a marked >90% decrease in cellular ATP (P<0.05). Furthermore, mitochondria-depleted PDAC cell lines were 4-fold more resistant to CDI treatment (P<0.05). In-vivo, oral CDI treatment resulted in a 2-fold decrease in mouse xenograft tumor growth compared to gemcitabine treatment. RNA-sequencing from the in-vivo samples showed a 60% reduction in the abundance of mitochondrial-encoded transcripts (P<0.05). Examination of the mitochondrial sequences revealed the existence of putative G-Quadruplex sequences. Fluorescence shift and stop-PCR assays confirmed CDI to be a G-Quadruplex binder of mitochondrial sequences.
Citation Format: Avinoam Nevler, Christopher W. Schultz, Aditi Jain, Saed Khalilieh, Grace McCarthy, Harish Lavu, Wilbur Bowne, Charles J. Yeo, Jonathan R. Brody. Dithiazanine Iodide suppresses mitochondrial function to strongly inhibit pancreatic ductal adenocarcinoma growth in-vitro and in-vivo, producing a marked increase in survival [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1811.
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Affiliation(s)
| | | | - Aditi Jain
- 1Thomas Jefferson University, Philadelphia, PA
| | | | | | - Harish Lavu
- 1Thomas Jefferson University, Philadelphia, PA
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Aharoni M, Zager Y, Khalilieh S, Amiel I, Horesh N, Ram E, Gutman M, Rosin D. Reply to “Comments on ‘Laparoscopic fixation of volvulus by extra-peritonealization—a case series’”. Tech Coloproctol 2022; 26:685. [DOI: 10.1007/s10151-022-02652-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 05/29/2022] [Indexed: 10/18/2022]
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Khalilieh S, Horesh N, Cordoba M, Forschmidt E, Zager Y, Nadler R, Gutman M, Rosin D, Ram E. Surgical Outcomes of Minimally Invasive Trephine Surgery for Pilonidal Sinus Disease and Risk Factors for Recurrence. J Laparoendosc Adv Surg Tech A 2021; 32:288-292. [PMID: 33960849 DOI: 10.1089/lap.2021.0097] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Minimally invasive surgical (MIS) techniques for pilonidal sinus disease (PNS) have gained popularity in recent years, due to faster recovery and lower complication rate compared with conventional methods. Our aim was to assess recurrence rate following MIS Trephine procedure for PNS and to identify possible risk factors for recurrence. Materials and Methods: A prospective cohort, including patients who underwent PNS Excision by Trephine MIS Procedure over 5 years in a large tertiary medical center was established. Patient data were collected from medical charts and patient telephone survey to asses recurrence rate. Results: Two hundred three patients underwent MIS Trephine procedure for PNS, with data available on 130 patients (64.2%). Overall recurrence and nonhealing wound rate was 33.07% (43 patients), with disease recurrence occurring in mean time of 13.3 months (range 2-47 months). Thirty-six patients underwent repeat MIS Trephine surgery with recurrence occurring in 6 patients (4.6%). Overall healing rate following repeat surgery was 91.5% (119 patients). Univariate analysis of preoperative and clinical factors, including body mass index (P = .77), smoking status (P = .53), number of sinus tracts (P = .78), previous abscess drainage (P = .45), and diameter size of the trephine blade (P = .72) demonstrated no correlation to disease recurrence following surgery. Multivariate Cox regression analysis showed similar results, with only young age (<30 years) associated with disease recurrence (P = .01). Conclusion: Recurrence following minimally invasive trephine excision for PNS is fairly high, but repeat surgery in recurring patients has a high rate of a successful outcome.
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Affiliation(s)
- Saed Khalilieh
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel)
| | - Nir Horesh
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel)
| | - Mordehay Cordoba
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel)
| | - Eyal Forschmidt
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel)
| | - Yaniv Zager
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel)
| | - Roy Nadler
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel)
| | - Mordechai Gutman
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel)
| | - Danny Rosin
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel)
| | - Edward Ram
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel)
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Aharoni M, Barash Y, Zager Y, Anteby R, Khalilieh S, Amiel I, Klang E, Goldes Y, Gutman M, Horesh N, Rosin D. Management of Acute Appendicitis during the COVID-19 Pandemic: A Single Tertiary Center Experience. Isr Med Assoc J 2021; 23:269-273. [PMID: 34024041] [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: 06/12/2023]
Abstract
BACKGROUND The coronavirus disease-2019 (COVID-19) outbreak had an effect on healthcare. OBJECTIVES To evaluate the presentation and management of patients with acute appendicitis. METHODS A retrospective study was conducted of all patients presenting with acute appendicitis to the emergency department of a large tertiary center during March and April 2020. Clinical features, diagnostic workup, and management were compared. RESULTS Seventy-four patients presented with acute appendicitis during the pandemic compared to 60 patients during the same time the year before. There were no significant differences in patient demographics: age (P = 0.65), gender (P = 0.73), smoking status (P = 0.48). During COVID-19 patients were more likely to complain of right lower quadrant pain (100% vs. 78.3%, P < 0.01). Rates of surgical treatment was similar (83.8% vs. 81.7%, P = 1); mean operative time was longer during COVID-19 (63 ± 23 vs. 52 ± 26 minutes, P = 0.03). There were no significant differences in intra-operative findings including the presence of appendiceal perforation (16.3% vs. 14.5%, P = 0.8), abscess (6.1% vs. 9.7%, P = 0.73), or involvement of cecum or terminal ileum (14.28% vs. 19.63%, P = 1). Postoperative treatment with antibiotics was more prevalent during COVID-19 (37.1% vs. 18%, P = 0.04). Length of stay (1.82 ± 2.04 vs. 2.74 ± 4.68, P = 0.2) and readmission rates (6% vs. 11.3%, P =0.51) were similar. CONCLUSIONS The COVID-19 pandemic did not significantly affect the presentation, clinical course, management, and outcomes of patients presenting with acute appendicitis.
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Affiliation(s)
- Mor Aharoni
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yiftach Barash
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaniv Zager
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roi Anteby
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Saed Khalilieh
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Imri Amiel
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Klang
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yuri Goldes
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Gutman
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Horesh
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Danny Rosin
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Zager Y, Khalilieh S, Ganaiem O, Gorgov E, Horesh N, Anteby R, Kopylov U, Jacoby H, Dreznik Y, Dori A, Gutman M, Nevler A. Low psoas muscle area is associated with postoperative complications in Crohn's disease. Int J Colorectal Dis 2021; 36:543-550. [PMID: 33236229 DOI: 10.1007/s00384-020-03799-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Crohn's disease (CD) is associated with increased postoperative morbidity. Sarcopenia correlates with increased morbidity and mortality in various medical conditions. We assessed correlations of the lean body mass marker and psoas muscle area (PMA), with postoperative outcomes in CD patients undergoing gastrointestinal surgery. METHODS We included patients with CD who underwent gastrointestinal surgery between June 2009 and October 2018 and had CT/MRI scans within 8 weeks preoperatively. PMA was measured bilaterally on perioperative imaging. RESULTS Of 121 patients, the mean age was 35.98 ± 15.07 years; 51.2% were male. The mean BMI was 21.56 ± 4 kg/m2. The mean PMA was 95.12 ± 263.2cm2. Patients with postoperative complications (N = 31, 26%) had significantly lower PMA compared with patients with a normal postoperative recovery (8.5 ± 2.26 cm2 vs. 9.85 ± 2.68 cm2, P = 0.02). A similar finding was noted comparing patients with anastomotic leaks to those without anastomotic leaks (7.48 ± 0.1 cm2 vs. 9.6 ± 2.51 cm2, P = 0.04). PMA correlated with the maximum degree of complications per patient, according to the Clavien-Dindo classification (Spearman's coefficient = -0.26, P = 0.004). Patients with major postoperative complications (Clavien-Dindo ≥ 3) had lower mean PMA (8.12 ± 2.75 cm2 vs. 9.71 ± 2.57 cm2, P = 0.03). Associations were similar when stratifying by gender and operation urgency. On multivariate analysis, PMA (HR = 0.72/cm2, P = 0.02), operation urgency (HR = 3.84, P < 0.01), and higher white blood cell count (HR = 1.14, P = 0.02) were independent predictive factors for postoperative complications. CONCLUSION PMA is an easily measured radiographic parameter associated with postoperative complications in patients with CD undergoing bowel resection.
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Affiliation(s)
- Yaniv Zager
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel HaShomer, Israel. .,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Saed Khalilieh
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel HaShomer, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Omar Ganaiem
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel HaShomer, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eli Gorgov
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel HaShomer, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Horesh
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel HaShomer, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roi Anteby
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel HaShomer, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Ramat-Gan, and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Harel Jacoby
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel HaShomer, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Dreznik
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel HaShomer, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Assaf Dori
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel HaShomer, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Gutman
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel HaShomer, Israel
| | - Avinoam Nevler
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel HaShomer, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
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10
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Aviran E, Laks S, Benvenisti H, Khalilieh S, Assaf D, Aviran N, Hazzan D, Klein Y, Cohen A, Gutman M, Nissan A, Segev L. The Impact of the COVID-19 Pandemic on General Surgery Acute Admissions and Urgent Operations: A Comparative Prospective Study. Isr Med Assoc J 2020; 11:673-679. [PMID: 33249785] [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: 06/12/2023]
Abstract
BACKGROUND As part of the effort to control the coronavirus disease-19 (COVID-19) outbreak, strict emergency measures, including prolonged national curfews, have been imposed. Even in countries where healthcare systems still functioned, patients avoided visiting emergency departments (EDs) because of fears of exposure to COVID-19. OBJECTIVES To describe the effects of the COVID-19 outbreak on admissions of surgical patients from the ED and characteristics of urgent operations performed. METHODS A prospective registry study comparing all patients admitted for acute surgical and trauma care between 15 March and 14 April 2020 (COVID-19) with patients admitted in the parallel time a year previously (control) was conducted. RESULTS The combined cohort included 606 patients. There were 25% fewer admissions during the COVID-19 period (P < 0.0001). The COVID-19 cohort had a longer time interval from onset of symptoms (P < 0.001) and presented in a worse clinical condition as expressed by accelerated heart rate (P = 0.023), leukocyte count disturbances (P = 0.005), higher creatinine, and CRP levels (P < 0.001) compared with the control cohort. More COVID-19 patients required urgent surgery (P = 0.03) and length of ED stay was longer (P = 0.003). CONCLUSIONS During the COVID-19 epidemic, fewer patients presented to the ED requiring acute surgical care. Those who did, often did so in a delayed fashion and in worse clinical condition. More patients required urgent surgical interventions compared to the control period. Governments and healthcare systems should emphasize to the public not to delay seeking medical attention, even in times of crises.
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Affiliation(s)
- Eyal Aviran
- Department of General and Oncological Surgery C, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shachar Laks
- Department of General and Oncological Surgery C, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haggai Benvenisti
- Department of General and Oncological Surgery C, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Saed Khalilieh
- Department of Surgery B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Assaf
- Department of General and Oncological Surgery C, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nimrod Aviran
- Department of Surgery B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Hazzan
- Department of General and Oncological Surgery C, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoram Klein
- Department of Surgery B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Cohen
- Department of General Intensive Care Unit, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Gutman
- Department of Surgery B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviram Nissan
- Department of General and Oncological Surgery C, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lior Segev
- Department of General and Oncological Surgery C, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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11
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Zager Y, Horesh N, Dan A, Aharoni M, Khalilieh S, Cordoba M, Nevler A, Gutman M, Rosin D. Associations of novel inflammatory markers with long-term outcomes and recurrence of diverticulitis. ANZ J Surg 2020; 90:2041-2045. [PMID: 32856387 DOI: 10.1111/ans.16220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 07/08/2020] [Accepted: 07/16/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have emerged as markers of various outcomes of inflammatory and malignant diseases. The association of those markers with short-term outcomes of acute diverticulitis has been discussed in recent studies. This study aimed at evaluation of the association of NLR and PLR with long-term outcomes in patients presenting with acute diverticulitis. METHODS A retrospective single institute study included patients admitted with acute diverticulitis between 2012 and 2016. Associations were analysed of NLR and PLR values at admission with patient outcomes. RESULTS A total of 456 patients were included in the study. High NLR and PLR values were associated with complicated disease (P < 0.01 for both). Among patients with complicated diverticulitis, for those with high NLR, the interval to a recurrent episode of acute diverticulitis was shorter (68.3 days versus 83.7 days, P = 0.044). Patients with high NLR had higher mean number of readmissions (0.54 versus 0.34, P = 0.035). High NLR (10.06 ± 11.23 versus 7.6 ± 8.04, P = 0.012) and PLR (9.64 days ±10.56 versus 7.47 days ±8.225, P = 0.018) were associated with longer cumulative hospital stay due to acute diverticulitis. CONCLUSIONS High NLR and PLR values were associated with recurrence in acute diverticulitis in terms of shorter interval between recurrent episodes and longer cumulative hospitalization days.
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Affiliation(s)
- Yaniv Zager
- Department of Surgery and Transplantation, Chaim Sheba Medical Center (affiliated to the Faculty of Medicine, Tel Aviv University), Tel Hashomer, Israel
| | - Nir Horesh
- Department of Surgery and Transplantation, Chaim Sheba Medical Center (affiliated to the Faculty of Medicine, Tel Aviv University), Tel Hashomer, Israel
| | - Assaf Dan
- Department of Surgery and Transplantation, Chaim Sheba Medical Center (affiliated to the Faculty of Medicine, Tel Aviv University), Tel Hashomer, Israel
| | - Mor Aharoni
- Department of Surgery and Transplantation, Chaim Sheba Medical Center (affiliated to the Faculty of Medicine, Tel Aviv University), Tel Hashomer, Israel
| | - Saed Khalilieh
- Department of Surgery and Transplantation, Chaim Sheba Medical Center (affiliated to the Faculty of Medicine, Tel Aviv University), Tel Hashomer, Israel
| | - Mordehay Cordoba
- Department of Surgery and Transplantation, Chaim Sheba Medical Center (affiliated to the Faculty of Medicine, Tel Aviv University), Tel Hashomer, Israel
| | - Avinoam Nevler
- Department of Surgery and Transplantation, Chaim Sheba Medical Center (affiliated to the Faculty of Medicine, Tel Aviv University), Tel Hashomer, Israel.,Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mordechai Gutman
- Department of Surgery and Transplantation, Chaim Sheba Medical Center (affiliated to the Faculty of Medicine, Tel Aviv University), Tel Hashomer, Israel
| | - Danny Rosin
- Department of Surgery and Transplantation, Chaim Sheba Medical Center (affiliated to the Faculty of Medicine, Tel Aviv University), Tel Hashomer, Israel
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12
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Lauring B, Taggart AKP, Tata JR, Dunbar R, Caro L, Cheng K, Chin J, Colletti SL, Cote J, Khalilieh S, Liu J, Luo WL, MacLean AA, Peterson LB, Polis AB, Sirah W, Wu TJ, Liu X, Jin L, Wu K, Boatman PD, Semple G, Behan DP, Connolly DT, Lai E, Wagner JA, Wright SD, Cuffie C, Mitchel YB, Rader DJ, Paolini JF, Waters MG, Plump A. Niacin Lipid Efficacy Is Independent of Both the Niacin Receptor GPR109A and Free Fatty Acid Suppression. Sci Transl Med 2012; 4:148ra115. [DOI: 10.1126/scitranslmed.3003877] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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13
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Holz O, Khalilieh S, Ludwig-Sengpiel A, Watz H, Stryszak P, Soni P, Tsai M, Sadeh J, Magnussen H. SCH527123, a novel CXCR2 antagonist, inhibits ozone-induced neutrophilia in healthy subjects. Eur Respir J 2009; 35:564-70. [DOI: 10.1183/09031936.00048509] [Citation(s) in RCA: 140] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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14
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Zhou H, Khalilieh S, Svendsen K, Pommier F, Osborne S, Appel-Dingemanse S, Lasseter K, McLeod JF. Tegaserod coadministration does not alter the pharmacokinetics of theophylline in healthy subjects. J Clin Pharmacol 2001; 41:987-93. [PMID: 11549104 DOI: 10.1177/00912700122010979] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [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: 11/15/2022]
Abstract
Tegaserod (HTF 919), a selective 5-HT4 receptor partial agonist, is in development for the treatment of functional gastrointestinal motility disorders. Tegaserod has been found to inhibit cytochrome P-450 (CYP) 1A2, for which theophylline is a prototype substrate. This study was designed to assess the effect of tegaserod on the single-dose pharmacokinetic and safety profile of theophylline. Eighteen subjects were enrolled in a randomized, open-label, two-period crossover study. After an overnight fast, subjects were randomized to receive one of two treatments: (1) a single dose of controlled-release formulation of theophylline (Theo-Dur, 600 mg) on day 1 or (2) a single dose of tegaserod (6 mg) on day 1, concomitant administration of tegaserod (6 mg) and theophylline (600 mg) on the morning of day 2, followed by an additional dose of tegaserod (6 mg) 12 hours later. Four to 10 days later, the subjects received the alternative treatment regimen. The pharmacokinetic parameters of theophylline, including AUC, Cmax, and t(1/2lambda z), were similar for both treatment regimens, although the tmax of theophylline was statistically different between the treatments. Except for a decrease in partial metabolic formation clearance from theophylline to 1-methyluric acid, which is unlikely to be clinically relevant, there were no statistically significant differences in renal clearance of theophylline and partial metabolic formation clearances following the combined treatment compared with theophylline alone. The results of the current study indicate that no dose adjustment is required when drugs metabolized via CYP1A2 are coadministered with tegaserod.
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Affiliation(s)
- H Zhou
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey 07936-1080, USA
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Zhou H, Khalilieh S, Lau H, Guerret M, Osborne S, Alladina L, Laurent AL, McLeod JF. Effect of meal timing not critical for the pharmacokinetics of tegaserod (HTF 919). J Clin Pharmacol 1999; 39:911-9. [PMID: 10471981 DOI: 10.1177/00912709922008524] [Citation(s) in RCA: 32] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study assessed the pharmacokinetic profiles of administering tegaserod (HTF 919) at different time intervals with respect to a meal. It was a randomized, open-label, two-phase, five-period crossover study. In the first phase, 18 healthy subjects received a single 12 mg oral dose of tegaserod administered either 30 or 15 minutes prior to the start of the 600-calorie, fat-rich breakfast. In the second phase, subjects received a single 12 mg oral dose of tegaserod 1 minute before, 2.5 hours after the start of meal, or with a continued 4-hour postdose fast. Safety assessment and plasma samples for the determination of drug concentration were obtained for 24 hours postdose. Noncompartmental analysis results indicated that the AUC of tegaserod was reduced by almost half under fed conditions compared to the fasted condition. Exploratory analyses were implemented to further investigate the absorption characteristics of tegaserod under different fed conditions. A numerical deconvolution approach was used to obtain the tegaserod oral absorption versus time profiles under both fasted and fed conditions. The tegaserod oral absorption versus time profiles were then fitted by NONMEM to a model containing two absorption phases. Based on the absorption analyses, we found that the reduction in the bioavailability of tegaserod under fed conditions was primarily due to a decrease in the extent of absorption and less so to a decrease in the absorption rate(s). Therefore, although the timing of administration of food does not appear to significantly alter the pharmacokinetics of tegaserod, the administration of food reduces the AUC by approximately 50%.
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Affiliation(s)
- H Zhou
- Novartis Pharmaceuticals Corporation, East Hanover, NJ 07936-1080, USA
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