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Troisi RI, Berardi G, Morise Z, Cipriani F, Ariizumi S, Sposito C, Panetta V, Simonelli I, Kim S, Goh BKP, Kubo S, Tanaka S, Takeda Y, Ettorre GM, Russolillo N, Wilson GC, Cimino M, Montalti R, Giglio MC, Igarashi K, Chan CY, Torzilli G, Cheung TT, Mazzaferro V, Kaneko H, Ferrero A, Geller DA, Han HS, Kanazawa A, Wakabayashi G, Aldrighetti L, Yamamoto M. Laparoscopic and open liver resection for hepatocellular carcinoma with Child-Pugh B cirrhosis: multicentre propensity score-matched study. Br J Surg 2021; 108:196-204. [PMID: 33711132 DOI: 10.1093/bjs/znaa041] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/03/2020] [Accepted: 09/18/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic liver resection for hepatocellular carcinoma (HCC) in Child-Pugh A cirrhosis has been demonstrated as beneficial. However, the role of laparoscopy in Child-Pugh B cirrhosis is undetermined. The aim of this retrospective cohort study was to compare open and laparoscopic resection for HCC with Child-Pugh B cirrhosis. METHODS Data on liver resections were gathered from 17 centres. A 1 : 1 propensity score matching was performed according to 17 predefined variables. RESULTS Of 382 available liver resections, 100 laparoscopic and 100 open resections were matched and analysed. The 90-day postoperative mortality rate was similar in open and laparoscopic groups (4.0 versus 2.0 per cent respectively; P = 0.687). Laparoscopy was associated with lower blood loss (median 110 ml versus 400 ml in the open group; P = 0.004), less morbidity (38.0 versus 51.0 per cent respectively; P = 0.041) and fewer major complications (7.0 versus 21.0 per cent; P = 0.010), and ascites was lower on postoperative days 1, 3 and 5. For laparoscopic resections, patients with portal hypertension developed more complications than those without (26 versus 12 per cent respectively; P = 0.002), and patients with a Child-Pugh B9 score had higher morbidity rates than those with B8 and B7 (7 of 8, 10 of 16 and 21 of 76 respectively; P < 0.001). Median hospital stay was 7.5 (range 2-243) days for laparoscopic liver resection and 18 (3-104) days for the open approach (P = 0.058). The 5-year overall survival rate was 47 per cent for open and 65 per cent for laparoscopic resection (P = 0.142). The 5-year disease-free survival rate was 32 and 37 per cent respectively (P = 0.742). CONCLUSION Patients without preoperative portal hypertension and Child-Pugh B7 cirrhosis may benefit most from laparoscopic liver surgery.
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Affiliation(s)
- R I Troisi
- Division of HPB, Minimally Invasive and Robotic Surgery, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy.,Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - G Berardi
- Division of HPB, Minimally Invasive and Robotic Surgery, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy.,Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Centre for Advanced Treatment of Hepato-Biliary-Pancreatic Diseases, Ageo Central General Hospital, Tokyo, Japan
| | - Z Morise
- Department of Surgery, Fujita Health University Hospital, Toyoake, Japan
| | - F Cipriani
- Hepatobiliary Surgery Division, San Raffaele Hospital, Milan, Italy
| | - S Ariizumi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - C Sposito
- Department of Hepato-Biliary-Pancreatic Surgery and Liver Transplantation, Istituto Nazionale Tumori, Milan, Italy
| | - V Panetta
- Biostatistics Department, Sapienza University of Rome, Rome, Italy
| | - I Simonelli
- Biostatistics Department, Sapienza University of Rome, Rome, Italy
| | - S Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul,South Korea
| | - B K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - S Kubo
- Department of Surgery, Osaka City University Hospital, Osaka, Japan
| | - S Tanaka
- Department of Surgery, Osaka City University Hospital, Osaka, Japan
| | - Y Takeda
- Department of Surgery, Kansai Rosai Hospital, Amagasaki, Japan
| | - G M Ettorre
- Department of General and Hepato-Biliary-Pancreatic Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital, Rome, Italy
| | - N Russolillo
- Department of Surgery, Mauriziano Hospital, Turin, Italy
| | - G C Wilson
- Division of Hepatobiliary and Pancreatic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - M Cimino
- Department of General Surgery, Humanitas University and Research Hospital, IRCCS, Milan, Italy
| | - R Montalti
- Department of Public Health, Federico II University, Naples, Italy
| | - M C Giglio
- Division of HPB, Minimally Invasive and Robotic Surgery, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - K Igarashi
- Centre for Advanced Treatment of Hepato-Biliary-Pancreatic Diseases, Ageo Central General Hospital, Tokyo, Japan
| | - C-Y Chan
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - G Torzilli
- Department of General Surgery, Humanitas University and Research Hospital, IRCCS, Milan, Italy
| | - T T Cheung
- Division of Hepato-Biliary-Pancreatic and Liver Transplantation, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - V Mazzaferro
- Department of Hepato-Biliary-Pancreatic Surgery and Liver Transplantation, Istituto Nazionale Tumori, Milan, Italy
| | - H Kaneko
- Department of Surgery, Toho University of Tokyo, Tokyo, Japan
| | - A Ferrero
- Department of Surgery, Mauriziano Hospital, Turin, Italy
| | - D A Geller
- Division of Hepatobiliary and Pancreatic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - H-S Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul,South Korea
| | - A Kanazawa
- Department of Surgery, Osaka City General Hospital, Osaka, Japan
| | - G Wakabayashi
- Centre for Advanced Treatment of Hepato-Biliary-Pancreatic Diseases, Ageo Central General Hospital, Tokyo, Japan
| | - L Aldrighetti
- Hepatobiliary Surgery Division, San Raffaele Hospital, Milan, Italy
| | - M Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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Cheung B, Tsoi MF, Lui K, Cheung TT. Blood Lead Level and Hypertension Risk in the United States National Health Nutrition and Examination Survey (NHANES) 1999-2016. Eur Cardiol 2020; 15:e36. [PMID: 32612696 PMCID: PMC7312713 DOI: 10.15420/ecr.2020.15.1.po13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Chan YH, Ngai MC, Chen Y, Wu MZ, Yu YJ, Zhen Z, Lai K, Cheung TT, Ho LM, Chung HY, Lau CS, Tse HF, Yiu KH. 3045Role of osteogenic circulating endothelial progenitor cells in dissemination of large arterial calcification in rheumatoid arthritis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Rheumatoid arthritis is associated with both abnormal bone metabolism and atherogenesis but mechanistic links were missing.
Aim
This study aimed to investigate the role of osteocalcin (OCN)-expressing circulating endothelial progenitor cells (EPC)s in the severity and dissemination of systemic arterial calcifications in rheumatoid arthritis.
Methods
We performed flow cytometry studies in 145 consecutive patients with rheumatoid arthritis to determine osteogenic circulating levels of OCN-positive (OCN+) CD34+KDR+ and OCN+CD34+, versus conventional early EPC CD34+CD133+KDR+. Total calcium load of the thoracic aorta (ascending plus descending) and the carotid arteries were assessed by non-contrast computed tomography (CT) and contrast CT angiography.
Results
Osteogenic EPCs OCN+CD34+KDR+ (P=0.002) and OCN+CD34+ were strikingly associated with the clustered presence of aortic and carotid calcification (P=0.002 and 0.001 respectively, Figure). Multivariable analyses revealed that circulating OCN+CD34+KDR+ (B=14.4 [95% CI 4.0 to 24.8], P=0.007) and OCN+CD34+ (B=9.6 [95% CI 4.9 to 14.3], P<0.001) remained independently associated with increased aortic calcium load. OCN+CD34+ EPC (B=0.8 [95% CI 0.1 to 1.5], P=0.023), but not OCN+CD34+KDR+ EPC (B=1.2 [95% CI −0.2 to 2.6], P=0.09) was further independently associated with carotid calcium load. In comparison, conventional early EPC CD34+CD133+KDR+ had no significant association with aortic or carotid calcium load (P=0.46 and 0.88, respectively).
Conclusions
Circulating level of osteogenic EPC is associated with promulgated aortic and carotid calcification in patients with rheumatoid arthritis, suggesting a potential mechanistic role of the bone-vascular axis in pro-atherogenicity of rheumatic diseases.
Acknowledgement/Funding
General Research Fund, Hong Kong Research Grants Council
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Affiliation(s)
- Y.-H Chan
- Queen Mary Hospital, Department of Medicine, Division of Cardiology - The University of Hong Kong, Hong Kong, Hong Kong
| | - M C Ngai
- Queen Mary Hospital, Department of Medicine, Division of Cardiology - The University of Hong Kong, Hong Kong, Hong Kong
| | - Y Chen
- Queen Mary Hospital, Department of Medicine, Division of Cardiology - The University of Hong Kong, Hong Kong, Hong Kong
| | - M Z Wu
- Queen Mary Hospital, Department of Medicine, Division of Cardiology - The University of Hong Kong, Hong Kong, Hong Kong
| | - Y J Yu
- Queen Mary Hospital, Department of Medicine, Division of Cardiology - The University of Hong Kong, Hong Kong, Hong Kong
| | - Z Zhen
- Queen Mary Hospital, Department of Medicine, Division of Cardiology - The University of Hong Kong, Hong Kong, Hong Kong
| | - K Lai
- Queen Mary Hospital, Department of Medicine, Division of Cardiology - The University of Hong Kong, Hong Kong, Hong Kong
| | - T T Cheung
- Queen Mary Hospital, Department of Medicine, Division of Rheumatology, The University of Hong Kong, Hong Kong, Hong Kong
| | - L M Ho
- The University of Hong Kong, School of Public Health, Hong Kong, Hong Kong
| | - H Y Chung
- Queen Mary Hospital, Department of Medicine, Division of Rheumatology, The University of Hong Kong, Hong Kong, Hong Kong
| | - C S Lau
- Queen Mary Hospital, Department of Medicine, Division of Rheumatology, The University of Hong Kong, Hong Kong, Hong Kong
| | - H F Tse
- Queen Mary Hospital, Department of Medicine, Division of Cardiology - The University of Hong Kong, Hong Kong, Hong Kong
| | - K H Yiu
- Queen Mary Hospital, Department of Medicine, Division of Cardiology - The University of Hong Kong, Hong Kong, Hong Kong
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Wong TC, Ng KK, Cheung TT, Chan A, Chok KS, Dai JW, Lo CM. What Can We Learn from Living Donor Evaluation? A Higher Prevalence of Metabolic Disease and Less Technical Contraindication. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.08.158] [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]
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Ma KW, Chan ACY, She BWH, Chok KSH, Cheung TT, Dai JWC, Fung JYY, Lo CM. Changing Paradigm in the Surgical Management of Hepatocellular Carcinoma With Salvage Transplantation. Transplant Proc 2018; 50:1087-1093. [PMID: 29731072 DOI: 10.1016/j.transproceed.2018.01.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 01/22/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The objective of this study was to compare the long-term outcomes of primary and salvage liver transplantation for patients with hepatocellular carcinoma (HCC). METHOD This was a 10-year retrospective analysis in a tertiary referral center. RESULTS There were 184 patients recruited (primary liver transplantation [pLT]:salvage liver transplantation [sLT], 143:41). The median follow-up time was 79 months. Operation time was shorter in the pLT group than the sLT group (661 ± 164 minutes vs 754 ± 206 minutes; P = .01) and the blood loss was 3749 mL and 3545 mL for pLT and sLT, respectively (P = .735). The reoperation rate was 5.6% and 4.9%, respectively (P = 1.0). The 5-year overall and disease-free survival rates from the time of transplantation for pLT and sLT were 84.1% versus 70.2% (P = .01) and 82.2% versus 65.8% (P = .01), respectively. The 5-year overall survival rate from the time of primary treatment for sLT was 80.3% (P = .1). Subgroup analysis of sLT showed that young age (50 vs 56 year old; P = .004) was the only factor associated with poor overall survival. Young age (P = .004) and microvascular permeation (P = .008) in the recurrent tumor were associated with HCC recurrence. Young age stands out to be the only independent factor associated with HCC recurrence. CONCLUSION sLT is the treatment of choice for patients with recurrent HCC in regions of graft shortage.
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Affiliation(s)
- K W Ma
- Department of Surgery, The University of Hong Kong, Hong Kong, China
| | - A C Y Chan
- Department of Surgery, The University of Hong Kong, Hong Kong, China.
| | - B W H She
- Department of Surgery, The University of Hong Kong, Hong Kong, China
| | - K S H Chok
- Department of Surgery, The University of Hong Kong, Hong Kong, China
| | - T T Cheung
- Department of Surgery, The University of Hong Kong, Hong Kong, China
| | - J W C Dai
- Department of Surgery, The University of Hong Kong, Hong Kong, China
| | - J Y Y Fung
- Department of Surgery, The University of Hong Kong, Hong Kong, China
| | - C M Lo
- Department of Surgery, The University of Hong Kong, Hong Kong, China; State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong, China
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Wong TCL, Fung JYY, Chok KSH, Cheung TT, Chan ACY, Dai WC, Ng KKC, Chan SC, Lo CM. Hepatitis B Vaccination in Patients Receiving Oral Antiviral Therapy Without Hepatitis B Immunoglobulin After Liver Transplant. Transplant Proc 2018; 50:3681-3688. [PMID: 30577255 DOI: 10.1016/j.transproceed.2018.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 06/22/2018] [Accepted: 07/04/2018] [Indexed: 02/08/2023]
Abstract
Our study aimed to determine if a double-dose pre-S containing hepatitis B virus (HBV) vaccination (Sci-B-Vac) could elicit an adequate and sustainable immune response in HBV patients who developed spontaneous hepatitis B surface antibody (anti-HBs) response after liver transplant. PATIENTS AND METHODS All patients who received transplants for HBV-related disease for >1 year with normal graft function and hepatitis B surface antigen seronegativity were evaluated. They received a 40-μg HBV vaccine if they were responders in our previous vaccine trial, if anti-HBs was positive for >1 year after liver transplant (LT), or if a peak anti-HBs at any time point after LT was >100 mIU/mL. Primary endpoint was the development of anti-HBs ≥ 10 mIU/mL from previous negative value or a 1-log increase from baseline. RESULTS A total of 86 patients were recruited; 5 were responders from a previous trial; 45 patients had detectable anti-HBs >1 year after LT, and 36 patients had an anti-HBs >100 mIU/mL. All (5/5, 100%) previous responders responded to booster vaccination. For the remaining 81 patients, 10 of 81 (12.3%) responded. CONCLUSION All previous responders responded to booster vaccination, implying durability and memory of HBV immune response, which is an important prerequisite for definitive host immunity for HBV. In patients who had spontaneous anti-HBs production after LT, a single vaccination can induce response in 12.3% of patients.
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Affiliation(s)
- T C L Wong
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - J Y Y Fung
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - K S H Chok
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - T T Cheung
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - A C Y Chan
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - W C Dai
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - K K C Ng
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - S C Chan
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - C M Lo
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
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Ng KKC, Chok KSH, Chan ACY, Cheung TT, Wong TCL, Fung JYY, Yuen J, Poon RTP, Fan ST, Lo CM. Randomized clinical trial of hepatic resection versus radiofrequency ablation for early-stage hepatocellular carcinoma. Br J Surg 2017; 104:1775-1784. [PMID: 29091283 DOI: 10.1002/bjs.10677] [Citation(s) in RCA: 204] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 06/22/2017] [Accepted: 07/11/2017] [Indexed: 12/11/2022]
Abstract
Abstract
Background
Hepatic resection and radiofrequency ablation (RFA) are treatment options for early-stage hepatocellular carcinoma (HCC). Whether tumour recurrence and long-term survival favour either treatment has not been established. This randomized trial aimed to test the hypothesis that RFA is superior to hepatic resection in terms of lower tumour recurrence rate and better long-term survival.
Methods
Patients with early-stage HCC (solitary tumour no larger than 5 cm; or no more than 3 tumours, each 3 cm or smaller) were randomized into hepatic resection and RFA groups. Demographic and clinical characteristics, and short- and long-term outcome measures were compared between groups. Primary and secondary outcome measures were overall tumour recurrence and survival respectively.
Results
Clinicopathological data were similar in the two groups, which each contained 109 patients. The RFA group had a shorter treatment duration, less blood loss and shorter hospital stay than the resection group. Mortality and morbidity rates were similar in the two groups. The overall tumour recurrence rate was similar in the resection and RFA groups (71·3 versus 81·7 per cent respectively). The 1-, 3-, 5- and 10-year overall survival rates were 94·5, 80·6, 66·5 and 47·6 per cent respectively in the resection group, compared with 95·4, 82·3, 66·4 and 41·8 per cent in the RFA group (P = 0·531). Corresponding disease-free survival rates were 74·1, 50·9, 41·5 and 31·9 per cent in the resection group, and 70·6, 46·6, 33·6 and 18·6 per cent in the RFA group (P = 0·072).
Conclusion
RFA for early-stage HCC is not superior to hepatic resection, in terms of tumour recurrence, overall survival and disease-free survival. Registration number: HKUCTR-10 (http://www.hkuctr.com).
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Affiliation(s)
- K K C Ng
- Department of Surgery, University of Hong Kong, Hong Kong, China
- Department of Surgery, Queen Mary Hospital, Hong Kong, China
| | - K S H Chok
- Department of Surgery, University of Hong Kong, Hong Kong, China
- State Key Laboratory for Liver Research, University of Hong Kong, Hong Kong, China
- Department of Surgery, Queen Mary Hospital, Hong Kong, China
| | - A C Y Chan
- Department of Surgery, University of Hong Kong, Hong Kong, China
- State Key Laboratory for Liver Research, University of Hong Kong, Hong Kong, China
- Department of Surgery, Queen Mary Hospital, Hong Kong, China
| | - T T Cheung
- Department of Surgery, University of Hong Kong, Hong Kong, China
- State Key Laboratory for Liver Research, University of Hong Kong, Hong Kong, China
- Department of Surgery, Queen Mary Hospital, Hong Kong, China
| | - T C L Wong
- Department of Surgery, University of Hong Kong, Hong Kong, China
- Department of Surgery, Queen Mary Hospital, Hong Kong, China
| | - J Y Y Fung
- State Key Laboratory for Liver Research, University of Hong Kong, Hong Kong, China
- Department of Medicine, University of Hong Kong, Hong Kong, China
- Department of Medicine, Queen Mary Hospital, Hong Kong, China
| | - J Yuen
- Department of Diagnostic and Interventional Radiology, Hong Kong Sanatorium and Hospital, Hong Kong, China
| | - R T P Poon
- Department of Surgery, University of Hong Kong, Hong Kong, China
- State Key Laboratory for Liver Research, University of Hong Kong, Hong Kong, China
| | - S T Fan
- Department of Surgery, University of Hong Kong, Hong Kong, China
- State Key Laboratory for Liver Research, University of Hong Kong, Hong Kong, China
- Liver Surgery Centre, Hong Kong Sanatorium and Hospital, Hong Kong, China
| | - C M Lo
- Department of Surgery, University of Hong Kong, Hong Kong, China
- State Key Laboratory for Liver Research, University of Hong Kong, Hong Kong, China
- Department of Surgery, Queen Mary Hospital, Hong Kong, China
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Li PH, Ko KL, Ho CT, Lau LL, Tsang RK, Cheung TT, Leung WK, Lau CS. Immunoglobulin G4-related disease in Hong Kong: clinical features, treatment practices, and its association with multisystem disease. Hong Kong Med J 2017; 23:446-53. [PMID: 28862143 DOI: 10.12809/hkmj176229] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Immunoglobulin G4-related disease remains an under-recognised and evolving disease. Local data are sparse and previous publications have been limited to individual case reports or case series only. We conducted this study to review the clinical features, treatment practices, and factors associated with multisystem involvement in Hong Kong. We described the clinical features and treatment modalities of the largest cohort of immunoglobulin G4-related disease in our locality thus far. METHODS We retrospectively evaluated all patients with immunoglobulin G4-related disease between January 2003 and December 2015 in Queen Mary Hospital and combined this with patient data extracted from previous local publications. We analysed the clinical features, treatment practices, and factors associated with the number of organ systems involved. RESULTS A total of 104 patients (55 from Queen Mary Hospital and 49 from literature review) were identified. Patients were predominantly older men (mean [standard deviation] age, 61.9 [12.7] years; male-to-female ratio=3:1) and 94.4% had elevated pre-treatment serum immunoglobulin G4 levels. Hepatobiliary and pancreatic system (40.4%), salivary gland (33.7%), lymph node (29.8%), and eye (19.2%) were the most common organ systems involved. Lymphadenopathy was associated with glucocorticoid use (odds ratio=2.65; 95% confidence interval, 1.08-6.54; P=0.034). Pre-treatment serum immunoglobulin G4 levels correlated with the number of organ systems involved (β=0.347; P=0.004) and, specifically, more associated with patients having salivary gland involvement than those without (mean, 1109 mg/dL vs 599 mg/dL; P=0.012). CONCLUSION We identified pre-treatment serum immunoglobulin G4 to be associated with multisystem disease, especially with salivary gland involvement, highlighting its potential for disease prognostication and monitoring. Increased physician awareness and multidisciplinary efforts are required for early diagnosis and optimal management of this masquerading disease.
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Affiliation(s)
- P H Li
- Division of Rheumatology & Clinical Immunology, Department of Medicine, Queen Mary Hospital, Pokfulam, Hong Kong
| | - K L Ko
- Division of Gastroenterology & Hepatology, Department of Medicine, Queen Mary Hospital, Pokfulam, Hong Kong
| | - C Tk Ho
- Division of Rheumatology & Clinical Immunology, Department of Medicine, Queen Mary Hospital, Pokfulam, Hong Kong
| | - L L Lau
- Department of Ear, Nose & Throat, Queen Mary Hospital, Pokfulam, Hong Kong
| | - R Ky Tsang
- Division of Otorhinolaryngology - Head and Neck Surgery, Department of Surgery, Queen Mary Hospital, Pokfulam, Hong Kong
| | - T T Cheung
- Division of Hepatobiliary & Pancreatic Surgery and Liver Transplantation, Department of Surgery, Queen Mary Hospital, Pokfulam, Hong Kong
| | - W K Leung
- Division of Gastroenterology & Hepatology, Department of Medicine, Queen Mary Hospital, Pokfulam, Hong Kong
| | - C S Lau
- Division of Rheumatology & Clinical Immunology, Department of Medicine, Queen Mary Hospital, Pokfulam, Hong Kong
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Wong TCL, She WH, Cheung TT, Chan SC, Lo CM. Case Report of Relay Liver Transplantation With Graft Infected With Hepatitis B Virus. Transplant Proc 2016; 47:2768-70. [PMID: 26680090 DOI: 10.1016/j.transproceed.2015.09.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 09/24/2015] [Indexed: 01/01/2023]
Abstract
Reuse of liver graft for transplantation is extremely uncommon. We report the 1st case of reuse of liver graft from a recipient who had hepatitis B virus (HBV) infection, 11 years after the 1st transplantation. Our relay liver transplantation challenged conventional thinking because of late reuse of graft in the presence of HBV infection. Moreover, both the 1st and the 2nd donors were of advanced age. The key questions were whether the liver graft could be reused safely, especially in the setting of HBV infection, and technical concerns during organ procurement and implantation. The absence of HBV replication was confirmed with negative hepatitis B surface antigen and undetectable serum HBV DNA in the 2nd donor. Based on our experience in managing HBV infection after liver transplantation, we were confident that the adequately suppressed HBV infection in the donor would not jeopardize graft function and that the graft would be able to withstand another ischemia-perfusion injury to continue to function well in our recipient.
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Affiliation(s)
- T C L Wong
- Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong, People's Republic of China
| | - W H She
- Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong, People's Republic of China
| | - T T Cheung
- Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong, People's Republic of China
| | - S C Chan
- Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong, People's Republic of China
| | - C M Lo
- Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong, People's Republic of China.
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Abstract
Ultrasound has been developed for therapeutic use in addition to its diagnostic ability. The use of focused ultrasound energy can offer a non-invasive method for tissue ablation, and can therefore be used to treat various solid tumours. High-intensity focused ultrasound is being increasingly used in the treatment of both primary and metastatic tumours as these can be precisely located for ablation. It has been shown to be particularly useful in the treatment of uterine fibroids, and various solid tumours including those of the pancreas and liver. High-intensity focused ultrasound is a valid treatment option for liver tumours in patients with significant medical co-morbidity who are at high risk for surgery or who have relatively poor liver function that may preclude hepatectomy. It has also been used as a form of bridging therapy while patients awaiting cadaveric donor liver transplantation. In this article, we outline the principles of high-intensity focused ultrasound and its clinical applications, including the management protocol development in the treatment of hepatocellular carcinoma in Hong Kong by performing a search on MEDLINE (OVID), EMBASE, and PubMed. The search of these databases ranged from the date of their establishment until December 2015. The search terms used were: high-intensity focused ultrasound, ultrasound, magnetic resonance imaging, liver tumour, hepatocellular carcinoma, pancreas, renal cell carcinoma, prostate cancer, breast cancer, fibroids, bone tumour, atrial fibrillation, glaucoma, Parkinson's disease, essential tremor, and neuropathic pain.
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Affiliation(s)
- W H She
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - T T Cheung
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - C R Jenkins
- Department of Anaesthesiology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - M G Irwin
- Department of Anaesthesiology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
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Yau T, Chiu J, Cheung TT. What determines treatment success and future perspectives? Postgrad Med J 2016; 92:123-4. [PMID: 26917775 DOI: 10.1136/postgradmedj-2016-134018] [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: 11/03/2022]
Affiliation(s)
- T Yau
- Department of Medicine, Queen Mary Hospital, Hong Kong, Hong Kong
| | - J Chiu
- Department of Medicine, Queen Mary Hospital, Hong Kong, Hong Kong
| | - T T Cheung
- Department of Surgery, Queen Mary Hospital, Hong Kong, Hong Kong
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She WH, Tsang S, Poon R, Cheung TT. Gastrointestinal bleeding of obscured origin due to cystic artery pseudoaneurysm. Asian J Surg 2015; 40:320-323. [PMID: 25797563 DOI: 10.1016/j.asjsur.2015.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 01/20/2014] [Accepted: 01/06/2015] [Indexed: 12/26/2022] Open
Abstract
Cystic artery pseudoaneurysm is a rare condition, which usually arises from the complication of gallstone disease. Patients may present with Quinke's triad (epigastric pain, obstructive jaundice, and gastrointestinal bleeding). The results can be fatal if present with a ruptured pseudoaneurysm. We report a patient who presented with upper gastrointestinal bleeding, and later diagnosis was confirmed with a computer tomography scan of the abdomen and a three-vessel angiogram. Endovascular intervention was attempted. Although it failed, the patient was eventually cured with an open cholecystectomy.
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Affiliation(s)
- W H She
- Department of Surgery, University of Hong Kong, Hong Kong, China
| | - Simon Tsang
- Department of Surgery, University of Hong Kong, Hong Kong, China
| | - Roonie Poon
- Department of Surgery, University of Hong Kong, Hong Kong, China
| | - T T Cheung
- Department of Surgery, University of Hong Kong, Hong Kong, China.
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Cheung TT, Poon RTP, Chan ACY, Lo CM. Education and Imaging. Hepatobiliary and pancreatic: cholangiopathy in ketamine user--an emerging new condition. J Gastroenterol Hepatol 2014; 29:1663. [PMID: 25154444 DOI: 10.1111/jgh.12682] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 12/09/2022]
Affiliation(s)
- T T Cheung
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
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Cheung TT, Ip EWK, Poon RTP, Trendell-Smith N. Brunner's gland adenoma: unusual cause of duodenal haemorrhage and obstruction. Hong Kong Med J 2014; 19:460.e1-2. [PMID: 24088597 DOI: 10.12809/hkmj133776] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- T T Cheung
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
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Wong HK, Ong KL, Leung RYH, Cheung TT, Lam TH, Lam KSL, Cheung BMY. Plasma adrenomedullin level is associated with a single nucleotide polymorphism in the adiponectin gene. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1573] [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] [Indexed: 11/13/2022] Open
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Yau T, Wong H, Chan P, Yao TJ, Pang R, Cheung TT, Fan ST, Poon RT. Phase II study of bevacizumab and erlotinib in the treatment of advanced hepatocellular carcinoma patients with sorafenib-refractory disease. Invest New Drugs 2012; 30:2384-90. [PMID: 22402942 PMCID: PMC3484314 DOI: 10.1007/s10637-012-9808-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2012] [Accepted: 02/26/2012] [Indexed: 12/14/2022]
Abstract
Background The combination of bevacizumab (B) and erlotinib (E) has shown promising clinical outcomes as the first-line treatment of advanced HCC patients. We aimed to evaluate the efficacy and safety of using combination of B + E in treating advanced HCC patients who had failed prior sorafenib treatment. Methods Eligible advanced HCC patients with documented radiological evidence of disease progression with sorafenib treatment were recruited. All patients received bevacizumab(B) at 10 mg/kg every 2 weeks with erlotinib(E) at 150 mg daily for a maximum of 6 cycles. Response assessments using both RECIST and modified RECIST criteria were performed after every 6 weeks. The primary endpoint was clinical benefit (CB) rate and a Simon two-stage design was employed. Results The trial was halted in the first stage according to the pre-set statistical criteria with 10 patients recruited. The median age was 47 years (range, 28–61) and all patients were in ECOG performance status 1. Eighty percent of patients were chronic hepatitis B carriers and all patients had Child A cirrhosis. Among these 10 patients, none of the enrolled patients achieved response or stable disease. The median time-to-progression was 1.81 months (95 % confidence interval [C.I.], 1.08–1.74 months) and overall survival was 4.37 months (95 % C.I., 1.08–11.66 months). Rash (70 %), diarrhea (50 %) and malaise (40 %) were the most commonly encountered toxicities. Conclusion The combination of B + E was well tolerated but had no activity in an unselected sorafenib-refractory advanced HCC population. Condensed abstract The combination of bevacizumab and erlotinib had no clinical activity in sorafenib-refractory HCC population.
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Affiliation(s)
- Thomas Yau
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Room 211B, 2/F New Clinical Building, 102 Pokfulam Road, Hong Kong, China.
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Chiu J, Tang YF, Yao TJ, Wong A, Wong H, Leung RC, Chan P, Cheung TT, Poon RTP, Fan ST, Yau CC. The use of single-agent sorafenib in the treatment of patients with advanced hepatocellular carcinoma with underlying Child-Pugh B liver cirrhosis. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
OBJECTIVES To summarize the clinical presentation, histological features, treatment, and outcome of minimal change nephropathy (MCN) in patients with systemic lupus erythematosus (SLE). METHODS We performed a systematic review of cases of MCN in SLE patients reported in the English literature from January 1985 to May 2009 by a Medline search. RESULTS The estimated prevalence of MCN in biopsy-proven lupus nephritis is 2.3% in childhood and 1.1% in adults. There are 13 individual cases (12 women, one man) of SLE-related MCN reported in the literature. The mean age of nephritis onset was 32.7 years. In six (46%) patients, MCN was the initial manifestation of SLE. All patients presented with nephrotic syndrome and two (15%) had active urinary sediments. Renal function was impaired in eight (62%) patients and six (46%) patients had active lupus serology. All patients responded promptly to high-dose glucocorticoids but four (31%) had relapse of proteinuria during their course of SLE. None of the patients developed thromboembolic or infective complications. CONCLUSIONS MCN is an uncommon histological class of lupus nephritis. Typically, patients present with heavy proteinuria, and transient renal dysfunction is common. The prognosis of MCN in SLE appears to be good because of its rapid response to glucocorticoids. Relapses of proteinuria may be reduced by the use of maintenance immunosuppression. Alkylating agents, calcineurin inhibitors, mycophenolate mofetil, and rituximab can be considered in glucocorticoid-dependent or refractory cases of SLE-related MCN.
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Affiliation(s)
- C C Mok
- Department of Medicine, Tuen Mun Hospital and Centre for Assessment and Treatment of Rheumatic Diseases, Pok Oi Hospital, Hong Kong, China.
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Abstract
A true bronchial dosimeter has been designed, consisting of four 400-mesh wire screens and a filter paper. With a face velocity of 3.3 cm s(-1) for home exposure and 4.6 cm s(-1) for mine exposure, the deposition pattern on the wire screens were found to satisfactorily match the variation of the dose conversion factor (in units of mSv WL M(-1)) with the size of radon progeny from 1 to 1000 nm. In this way, the bronchial dosimeter directly gives bronchial dose from the alpha counts recorded on the wire-screens and the filter paper. Calculations of the dose conversion coefficient (DCC) using the proposed bronchial dosimeter and the lung dosimetric model were performed for typical aerosol characteristics. Values obtained from the bronchial dosimeter yielded overestimates of the DCC by 11.1% and 2.4% for typical home and mine conditions, respectively.
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Affiliation(s)
- T T Cheung
- Department of Physics and Materials Science, City University of Hong Kong, Kowloon Tong
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Abstract
PURPOSE The aim of this study was to evaluate the results of laparoscopic treatment of varicocele and findings of testicular volume and blood supply using color Doppler ultrasound scan on follow-up. METHODS Fourteen patients aged 7 to 15 years old (median, 12.3 years) with left varicocele (grade II, n = 4; grade III, n = 10) underwent laparoscopic clipping of internal testicular vein and artery. At follow-up, both testes were scanned by ultrasonography in axial and longitudinal planes, and at least 3 measurements-length, width, and thickness-were taken to calculate testicular volumes. Arterial perfusion of the testes also was assessed. RESULTS Operating time ranged from 25 to 80 minutes (mean, 60 minutes). There was no perioperative complication. At a mean follow-up of 14 months (range, 2 to 39 months) all children were asymptomatic with disappearance of varicocele. The volumes of bilateral testes were equal (difference in volumes less than 10%) in 9 children. Ipsilateral testicular hypertrophy was found in 3 children. There was no difference in arterial perfusion between the testes in each patient. Small transient ipsilateral hydrocele was observed in 2 patients. CONCLUSION Laparoscopic clipping of testicular vein and artery was simple and effective for varicocele treatment and did not compromise testicular blood supply.
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Affiliation(s)
- N Sun
- Division of Pediatric Surgery, Department of Surgery, University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong, SAR, China
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Yu KN, Cheung TT, Haque AK, Nikezic D, Lau BM, Vucic D. Radon progeny dose conversion coefficients for Chinese males and females. J Environ Radioact 2001; 56:327-340. [PMID: 11468823 DOI: 10.1016/s0265-931x(00)00204-6] [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] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The airway dimensions for Caucasian males have been scaled by multiplying by factors 0.95 and 0.88 to give those for Chinese males and females, respectively. Employing the most recent data on physical and biological parameters, the radiation doses to the basal and secretory cells due to alpha particles from 218Po and 214Po, homogeneously distributed in the mucous layer, have been calculated. The emission of alpha particles has been simulated by a Monte Carlo method. For both basal and secretory cells, the dose conversion coefficients (DCCs) for physical conditions of sleep, rest, light and heavy exercise, have been obtained for Chinese males and females for unattached progeny, and for attached progeny of diameters 0.02, 0.15, 0.25, 0.30 and 0.50 micron. For basal cells, the coefficients lie in the range 0.69-6.82 mGy/(Js/m3) or 8.7-86 mGy/WLM for unattached progeny and in the range 0.045-1.98 mGy/(Js/m3) or 0.57-25 mGy/WLM for attached progeny. The corresponding ranges for Caucasian males are 1.27-8.81 mGy/(Js/m3) or 16-111 mGy/WLM-1 and 0.05-2.30 mGy/(Js/m3) or 0.64-29 mGy/WLM. For secretory cells, the coefficients lie in the range 0.095-16.82 mGy/(Js/m3) (1.2-212 mGy/WLM) for unattached progeny and in the range 0.095-6.67 mGy/(Js/m3) (1.2-84 mGy/WLM) for attached progeny. The corresponding ranges for Caucasian males are 0.34-21.51 mGy/(Js/m3) (4.3-271 mGy/WLM) and 0.1-7.78 mGy/(Js/m3) (1.3-98 mGy/WLM). The overall DCCs calculated for a typical home environment are 0.59 and 0.52 mSv/(Js/m3) (7.4 and 6.5 mSv/WLM) for Chinese males and females, respectively, which are 80 and 70% of the value, 0.73 mSv/(Js/m3) (9.2 mSv/WLM), for Caucasian males.
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Affiliation(s)
- K N Yu
- Department of Physics and Materials Science, City University of Hong Kong, Tat Chee Avenue, Kowloon Tong, Kowloon, Hong Kong.
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Nakamura T, Shoji M, Harigaya Y, Watanabe M, Hosoda K, Cheung TT, Shaffer LM, Golde TE, Younkin LH, Younkin SG. Amyloid beta protein levels in cerebrospinal fluid are elevated in early-onset Alzheimer's disease. Ann Neurol 1994; 36:903-11. [PMID: 7998778 DOI: 10.1002/ana.410360616] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.6] [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: 02/06/2023]
Abstract
The 4-kd amyloid beta protein (A beta) deposited as amyloid in Alzheimer's disease (AD) is produced and released by normal proteolytic processing of the amyloid beta protein precursor (beta APP) and is readily detected in cerebrospinal fluid (CSF). Here, we present the levels of A beta in CSF from a total of 95 subjects, including 38 patients with AD, 14 with early-onset AD and 24 with late-onset AD, 25 normal control subjects, and 32 patients with other neurological diseases. The level of A beta decreased with normal aging, and there was a significant elevation in the level of A beta in the CSF of early-onset AD patients (4.14 +/- 1.37 pmol/ml, p < 0.01). Neither Mini-Mental State nor Functional Assessment Staging were correlated with the amount of A beta in the CSF. The A beta/secreted form of beta APP ratio was elevated, but the level of alpha 1-antichymotrypsin in the CSF did not correlate with the level of CSF A beta in early-onset AD patients. Thus, the level of A beta in the CSF is elevated in early-onset AD patients and is suggested to be correlated with the pathology in the brain that characterizes AD.
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Affiliation(s)
- T Nakamura
- Department of Neurology, Gunma University School of Medicine, Japan
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Suzuki N, Cheung TT, Cai XD, Odaka A, Otvos L, Eckman C, Golde TE, Younkin SG. An increased percentage of long amyloid beta protein secreted by familial amyloid beta protein precursor (beta APP717) mutants. Science 1994; 264:1336-40. [PMID: 8191290 DOI: 10.1126/science.8191290] [Citation(s) in RCA: 1039] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Normal processing of the amyloid beta protein precursor (beta APP) results in secretion of a soluble 4-kilodalton protein essentially identical to the amyloid beta protein (A beta) that forms insoluble fibrillar deposits in Alzheimer's disease. Human neuroblastoma (M17) cells transfected with constructs expressing wild-type beta APP or the beta APP717 mutants linked to familial Alzheimer's disease were compared by (i) isolation of metabolically labeled 4-kilodalton A beta from conditioned medium, digestion with cyanogen bromide, and analysis of the carboxyl-terminal peptides released, or (ii) analysis of the A beta in conditioned medium with sandwich enzyme-linked immunosorbent assays that discriminate A beta 1-40 from the longer A beta 1-42. Both methods demonstrated that the 4-kilodalton A beta released from wild-type beta APP is primarily but not exclusively A beta 1-40. The beta APP717 mutations, which are located three residues carboxyl to A beta 43, consistently caused a 1.5- to 1.9-fold increase in the percentage of longer A beta generated. Long A beta (for example, A beta 1-42) forms insoluble amyloid fibrils more rapidly than A beta 1-40. Thus, the beta APP717 mutants may cause Alzheimer's disease because they secrete increased amounts of long A beta, thereby fostering amyloid deposition.
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Affiliation(s)
- N Suzuki
- Discovery Research Division, Takeda Chemical Industries, Ltd., Ibaraki, Japan
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Shoji M, Golde TE, Ghiso J, Cheung TT, Estus S, Shaffer LM, Cai XD, McKay DM, Tintner R, Frangione B. Production of the Alzheimer amyloid beta protein by normal proteolytic processing. Science 1992; 258:126-9. [PMID: 1439760 DOI: 10.1126/science.1439760] [Citation(s) in RCA: 1170] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The 4-kilodalton (39 to 43 amino acids) amyloid beta protein (beta AP), which is deposited as amyloid in the brains of patients with Alzheimer's diseases, is derived from a large protein, the amyloid beta protein precursor (beta APP). Human mononuclear leukemic (K562) cells expressing a beta AP-bearing, carboxyl-terminal beta APP derivative released significant amounts of a soluble 4-kilodalton beta APP derivative essentially identical to the beta AP deposited in Alzheimer's disease. Human neuroblastoma (M17) cells transfected with constructs expressing full-length beta APP and M17 cells expressing only endogenous beta APP also released soluble 4-kilodalton beta AP, and a similar, if not identical, fragment was readily detected in cerebrospinal fluid from individuals with Alzheimer's disease and normal individuals. Thus cells normally produce and release soluble 4-kilodalton beta AP that is essentially identical to the 4-kilodalton beta AP deposited as insoluble amyloid fibrils in Alzheimer's disease.
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Affiliation(s)
- M Shoji
- Department of Neurology, Gunma University, Japan
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Snavely MD, Gravina SA, Cheung TT, Miller CG, Maguire ME. Magnesium transport in Salmonella typhimurium. Regulation of mgtA and mgtB expression. J Biol Chem 1991; 266:824-9. [PMID: 1898738] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Salmonella typhimurium contains three distinct transport systems (CorA, MgtA, and MgtB) that move Mg2+ across the cytoplasmic membrane. Mutant strains containing only one of these three systems have been constructed and used to study each system in isolation. Characterization of these systems has been hampered, however, by the need to use 28Mg2+, a relatively unavailable, extremely expensive, and short lived radioisotope. This paper reports that 63Ni2+ is transported into the cell by all three of the S typhimurium Mg2+ transport systems. In a strain deficient in all three systems, uptake of 63Ni2+ was undetectable under the conditions used. Comparison of 63Ni2+ uptake kinetics and inhibition of 63Ni2+ transport by other divalent cations suggest that Ni2+ can be used as an analog of Mg2+ in the study of these three transport systems. Using 63Ni2+ to measure uptake, the effect of Mg2+ levels in the growth medium on transport by each system was tested. Transport by the CorA system was unaffected by changes in the amount of Mg2+ in the growth medium. In contrast, uptake via MgtA and MgtB was significantly increased in cells grown in 10 microM extracellular Mg2+ compared to cells grown in 10 mM Mg2+. The increases in uptake were the result of increases in Vmax without change in Km. This result suggests that, in low Mg2+ medium, cells contained higher levels of the transporters. Production of beta-galactosidase from mgtA::lacZ and mgtB::lacZ but not corA::lacZ fusions was also increased when cells were grown in low extracellular concentrations of Mg2+ indicating that the regulation occurs at the level of transcription. Expression of beta-galactosidase was also inhibited by the addition of other divalent cations including Ca2+ and Mn2+. Regulation of transcription from the mgtA and mgtB promoters was similar over the range of extracellular Mg2+ concentrations from 10 microM to 10 mM. At 1 microM, however, transcription from the mgtB promoter, as measured by beta-galactosidase levels in a mgtB::lacZ transcriptional fusion strain, was increased over 800-fold, and Ca2+ could no longer inhibit transcription effectively. In contrast, growth at 1 microM extracellular Mg2+ increased transcription from the mgtA promoter only about 30-fold and Ca2+ could still inhibit this increase. These results suggest that at least two distinct mechanisms are responsible for regulation of the mgtA and mgtB transcription in response to extracellular cation concentration.
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Affiliation(s)
- M D Snavely
- Department of Pharmacology, School of Medicine, Case Western Reserve University, Cleveland, Ohio 44106
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Snavely MD, Gravina SA, Cheung TT, Miller CG, Maguire ME. Magnesium transport in Salmonella typhimurium. Regulation of mgtA and mgtB expression. J Biol Chem 1991. [DOI: 10.1016/s0021-9258(17)35247-x] [Citation(s) in RCA: 133] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Cheung TT. Orientation dependence of the carbon K edge in graphite measured by reflection electron-energy-loss spectroscopy. Phys Rev B Condens Matter 1985; 31:4792-4797. [PMID: 9936438 DOI: 10.1103/physrevb.31.4792] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
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