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Sedaghat AR, Fokkens WJ, Lund VJ, Hellings PW, Kern RC, Reitsma S, Toppila-Salmi S, Bernal-Sprekelsen M, Mullol J, Gevaert P, Teeling T, Alobid I, Anselmo-Lima WT, Baroody FM, Cervin A, Cohen NA, Constantinidis J, De Gabory L, Desrosiers M, Harvey RJ, Kalogjera L, Knill A, Landis BN, Meco C, Philpott CM, Ryan D, Schlosser RJ, Senior BA, Smith TL, Tomazic PV, Zhang L, Hopkins C. Consensus criteria for chronic rhinosinusitis disease control: an international Delphi Study. Rhinology 2023; 61:519-530. [PMID: 37804121 DOI: 10.4193/rhin23.335] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) disease control is a global metric of disease status for CRS. While there is broad acceptance that it is an important treatment goal, there has been inconsistency in the criteria used to define CRS control. The objective of this study was to identify and develop consensus around essential criteria for assessment of CRS disease control. METHODS Modified Delphi methodology consisting of three rounds to review a list of 24 possible CRS control criteria developed by a 12-person steering committee. The core authorship of the multidisciplinary EPOS 2020 guidelines was invited to participate. RESULTS Thirty-two individuals accepted the invitation to participate and there was no dropout of participants throughout the entire study (3 rounds). Consensus essential criteria for assessment of CRS control were: overall symptom severity, need for CRS-related systemic corticosteroids in the prior 6 months, severity of nasal obstruction, and patient-reported CRS control. Near-consensus items were: nasal endoscopy findings, severity of smell loss, overall quality of life, impairment of normal activities and severity of nasal discharge. Participants’ comments provided insights into caveats of, and disagreements related to, near-consensus items. CONCLUSIONS Overall symptom severity, use of CRS-related systemic corticosteroids, severity of nasal obstruction, and patient-reported CRS control are widely agreed upon essential criteria for assessment of CRS disease control. Consideration of near-consensus items to assess CRS control should be implemented with their intrinsic caveats in mind. These identified consensus CRS control criteria, together with evidence-based support, will provide a foundation upon which CRS control criteria with wide-spread acceptance can be developed.
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Affiliation(s)
- A R Sedaghat
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - W J Fokkens
- Department of Otorhinolaryngology and Head and Neck Surgery, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands
| | - V J Lund
- Royal National ENT Hospital, University College London Hospital NHS Foundation Trust, London, UK
| | - P W Hellings
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, KU Leuven, Belgium
| | - R C Kern
- Department of Otorhinolaryngology, Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - S Reitsma
- Department of Otorhinolaryngology and Head and Neck Surgery, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands
| | - S Toppila-Salmi
- Department of Otorhinolaryngology, Kuopio University Hospital and University of Eastern Finland, Finland and Department of Allergy, Inflammation Center, Helsinki University Hospital and University of Helsinki, Finland
| | | | - J Mullol
- Rhinology Unit and Smell Clinic, ENT Department, Hospital Clinic, FRCB-IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain
| | - P Gevaert
- Department of Otorhinolaryngology, Ghent University, Ghent, Belgium
| | - T Teeling
- Patient representative, Task Force Healthcare, WTC Den Haag, The Netherlands
| | - I Alobid
- Rhinology and Skull Base Unit, ENT Department, Hospital Clinic, Universitat de Barcelona, August Pi i Sunyer Biomedical Research Institute, CIBERES, Barcelona, Spain
| | - W T Anselmo-Lima
- Division of Otorhinolaryngology, Department of Ophthalmology, Otorhinolaryngology, Head and Neck Surgery, Ribeirao Preto Medical School-University of Sao Paulo, Sao Paulo, Brazil
| | - F M Baroody
- Department of Otorhinolaryngology-Head and Neck Surgery, The University of Chicago Medicine and the Comer Children’s Hospital, Chicago, IL, USA
| | - A Cervin
- Department of Otorhinolaryngology, Head and Neck Surgery, Royal Brisbane and Women's Hospital; Faculty of Medicine, University of Queensland, Brisbane, Australia and Department of Clinical Sciences, Lund University, Lund, Sweden
| | - N A Cohen
- Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA
| | - J Constantinidis
- 1st Department of ORL, Head and Neck Surgery, Aristotle University, AHEPA Hospital, Thessaloniki, Greece
| | - L De Gabory
- Rhinology and Plastic Surgery Unit, Otorhinolaryngology, Head and Neck Surgery and Pediatric ENT Department, CHU ux, Hospital Pellegrin, Centre F-X Michelet, Bordeaux, France
| | - M Desrosiers
- Department of ORL-HNS, Universitat de Montreal, Montreal, Canada
| | - R J Harvey
- Rhinology and Skull Base Department, Applied Medical Research Centre, UNSW (Conjoint) and Macquarie University (Clinical), Sydney, Australia
| | - L Kalogjera
- Department of Otorhinolaryngology/Head and Neck Surgery, Zagreb School of Medicine; University Hospital Center, Sestre milosrdnice,Zagreb, Croatia
| | - A Knill
- Patient representative, Sinus UK, London, UK
| | - B N Landis
- Rhinology-Olfactology Unit, Otorhinolaryngology Department, University Hospital of Geneva, Geneva, Switzerland
| | - C Meco
- Department of Otorhinolaryngology, Head and Neck Surgery, Ankara University, Ankara, Turkey and Department of Otorhinolaryngology, Head and Neck Surgery, Salzburg Paracelsus Medical University, Salzburg, Austria
| | - C M Philpott
- Rhinology and ENT Research Group, Norwich Medical School, University of East Anglia, Norwich, UK and Norfolk and Waveney ENT Service, James Paget University Hospital, Great Yarmouth and Norfolk and Norwich University Hospital, Norwich, UK
| | - D Ryan
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK and International Primary Care Respiratory Group, Edinburgh, Scotland, UK
| | - R J Schlosser
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - B A Senior
- Department of Otolaryngology - Head and Neck Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - T L Smith
- Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Oregon Health
| | - P V Tomazic
- Department of Otorhinolaryngology, Medical University of Graz, Graz, Austria
| | - L Zhang
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China and Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China and Beijing Institute of Otolaryngology, Beijing Laboratory of Allergic Diseases, Beijing Key Laboratory of Nasal Diseases, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, China and Research Unit of Diagnosis and T
| | - C Hopkins
- Department of Otolaryngology and Head Neck Surgery, Guys and St Thomas’ Hospital, London, UK
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Abstract
STUDY DESIGN Laboratory study using a rat T9 contusion model of spinal cord injury. OBJECTIVE This study aims to examine whether a combinatory treatment of Pioglitazone (PGZ) and granulocyte colony-stimulating factor (GCSF) can support neural stem/progenitor cells (NSPCs) directly and provide a sustainable microenvironment through immunomodulatory mechanisms. SUMMARY OF BACKGROUND DATA Neuroinflammation plays a crucial role in the progression of spinal cord injury (SCI) and hinders NSPC-mediated repair and regeneration. Broad acting drugs that mitigate inflammation and support NSPC proliferation have not been tested together in SCI research models. METHODS Isolated NSPCs were treated with vehicle control, PGZ, GCSF, or both PGZ and GSCF for 24 hours and stained with proliferation marker Ki67. Adult female Sprague-Dawley rats sustained moderate-to-severe contusion-based SCI at T9 and were administered either vehicle control, PGZ, GCSF, or both PGZ and GCSF treatments. RESULTS Immunocytochemistry revealed that cultured NSPCs treated with both drugs produced higher numbers of actively proliferating cells and total cell numbers. ELISA on spinal cord tissue lysates at 1, 3, and 7 days post-injury (DPI) demonstrated that animals treated with PGZ, GCSF, or combination therapy showed significantly higher doublecortin levels at 7 DPI compared to control animals (P < 0.05). Immunohistochemistry of injured tissue at 3, 7, and 14 DPI revealed no difference of ependymal NSPC proliferation between groups, but showed a significant decrease in lesion size with combination therapy compared to controls. Functional recovery was assessed by the Basso, Beattie, Bresnahan locomotor rating scale. Animals treated with both drugs had significantly higher levels of function at 1 (P < 0.001), 3 (P < 0.001), 7 (P < 0.05), and 14 (P < 0.05) DPI compared to controls. CONCLUSION These results indicate that PGZ and GCSF treatment synergistically enhance NSPCs numbers and improve functional recovery after SCI. Our findings support an immunomodulatory strategy to recruit native NSPCs as a potential acute care intervention for SCI.Level of Evidence: N/A.
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Affiliation(s)
- Zachary K Zabarsky
- Wake Forest School of Medicine, Department of Orthopaedic Surgery, Winston-Salem, NC
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Koman LA, Danelson KA, Jinnah A, Plate JF, Mannava S, Bracey DN, Marquez-Lara A, Luo TD, Rosas S, Stone AV, Popoli D, Henry K, Jinnah RH, Smith BP, Poehling GG, Smith TL. An Innovative Seven-year Physician Scientist Residency Training Program That Addresses the Shortage of Academic Surgeons. J Surg Orthop Adv 2022; 31:144-149. [PMID: 36413159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Due to the declining number of scientifically trained physicians and increasing demand for high-quality literature, our institution pioneered a seven-year Physician Scientist Training Program (PSTP) to provide research-oriented residents the knowledge and skills for a successful academic career. The present study sought to identify orthopaedic surgeons with MD/PhD degrees, residency programs with dedicated research tracks, and to assess the effectiveness of the novel seven-year program in training prospective academic orthopaedic surgeons. Surgeons with MD/PhD degrees account for 2.3% of all 3,408 orthopaedic faculty positions in U.S. residency programs. During the last 23 years, our PSTP residents produced 752 peer-reviewed publications and received $349,354 from 23 resident-authored extramural grants. Eleven of our seven-year alumni practice orthopaedic surgery in an academic setting. The seven-year PSTP successfully develops clinically trained surgeon scientists with refined skills in basic science and clinical experimental design, grant proposals, scientific presentations, and manuscript preparation. (Journal of Surgical Orthopaedic Advances 31(3):144-149, 2022).
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Affiliation(s)
- L Andrew Koman
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina; Musculoskeletal Institute, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Kerry A Danelson
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina; Musculoskeletal Institute, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Alexander Jinnah
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina; Molecular Medicine and Translational Sciences, Wake Forest University Graduate School of Arts and Sciences, Winston-Salem, North Carolina; Musculoskeletal Institute, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Johannes F Plate
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina; The Neuroscience Program, Wake Forest University Graduate School of Arts and Sciences, Winston-Salem, North Carolina
| | - Sandeep Mannava
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina; The Neuroscience Program, Wake Forest University Graduate School of Arts and Sciences, Winston-Salem, North Carolina
| | - Daniel N Bracey
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina; Molecular Medicine and Translational Sciences, Wake Forest University Graduate School of Arts and Sciences, Winston-Salem, North Carolina
| | - Alejandro Marquez-Lara
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina; Molecular Medicine and Translational Sciences, Wake Forest University Graduate School of Arts and Sciences, Winston-Salem, North Carolina; Musculoskeletal Institute, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - T David Luo
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina; Molecular Medicine and Translational Sciences, Wake Forest University Graduate School of Arts and Sciences, Winston-Salem, North Carolina; Musculoskeletal Institute, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Sam Rosas
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina; Molecular Medicine and Translational Sciences, Wake Forest University Graduate School of Arts and Sciences, Winston-Salem, North Carolina; Musculoskeletal Institute, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Austin V Stone
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina; Molecular Medicine and Translational Sciences, Wake Forest University Graduate School of Arts and Sciences, Winston-Salem, North Carolina; Musculoskeletal Institute, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - David Popoli
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina; Musculoskeletal Institute, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Kaitlin Henry
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina; Musculoskeletal Institute, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Riyaz H Jinnah
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina; Musculoskeletal Institute, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Beth P Smith
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina; Musculoskeletal Institute, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Gary G Poehling
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina; Musculoskeletal Institute, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Thomas L Smith
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina; Musculoskeletal Institute, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
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Zabarsky ZK, Dean GM, Luo TD, Marquez-Lara A, Jinnah AH, Van Dyke M, Smith TL. Keratin Biomaterials Improve Functional Recovery in a Rat Spinal Cord Injury Model. Spine (Phila Pa 1976) 2021; 46:1055-1062. [PMID: 34398133 DOI: 10.1097/brs.0000000000003993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Laboratory study using a rat T9 contusion model of spinal cord injury (SCI). OBJECTIVE The purpose of this study was to evaluate which method of delivery of soluble keratin biomaterials would best support functional restoration through the macrophage polarization paradigm. SUMMARY OF BACKGROUND DATA SCI is a devastating neurologic event with complex pathophysiological mechanisms that currently has no cure. After injury, macrophages and resident microglia are key regulators of inflammation and tissue repair exhibiting phenotypic and functional plasticity. Keratin biomaterials have been demonstrated to influence macrophage polarization and promote the M2 anti-inflammatory phenotype that attenuates inflammatory responses. METHODS Anesthetized female Lewis rats were subjected to moderate T9 contusion SCI and randomly divided into: no therapy (control group), an intrathecally injected keratin group, and a keratin-soaked sponge group (n = 11 in all groups). Functional recovery assessments were obtained at 3- and 6-weeks post-injury (WPI) using gait analysis performed with the DigiGait Imaging System treadmill and at 1, 3, 7, 14, 21, 28, 35, and 42 days post-injury by the Basso, Beattie, Bresnahan (BBB) locomotor rating scale. Histology and immunohistochemistry of serial spinal cord sections were performed to assess injury severity and treatment efficacy. RESULTS Compared to control rats, applying keratin materials after injury improved functional recovery in certain gait parameters and overall trended toward significance in BBB scores; however, no significant differences were observed with tissue analysis between groups at 6 WPI. CONCLUSION Results suggest that keratin biomaterials support some locomotor functional recovery and may alter the acute inflammatory response by inducing macrophage polarization following SCI. This therapy warrants further investigation into treatment of SCI.Level of Evidence: N/A.
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Affiliation(s)
- Zachary K Zabarsky
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC
| | - Gabriella M Dean
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC
| | - Tianyi David Luo
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC
| | | | - Alexander H Jinnah
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC
| | - Mark Van Dyke
- School of Biomedical Engineering and Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA
| | - Thomas L Smith
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC
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Schlosser RJ, Smith TL, Mace JC, Alt JA, Beswick DM, Mattos JL, Ramakrishnan V, Massey C, Soler ZM. The Olfactory Cleft Endoscopy Scale: a multi-institutional validation study in chronic rhinosinusitis. Rhinology 2021; 59:181-190. [PMID: 33006331 DOI: 10.4193/rhin20.307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Olfactory dysfunction (OD) associated with chronic rhinosinusitis (CRS) remains quite challenging. Instruments to precisely assess olfactory cleft anatomy and their association with olfaction are needed. METHODS The olfactory cleft endoscopy scale (OCES) was used to assess the olfactory cleft in healthy control subjects and a cohort of patients with CRS. Psychophysical and psychosocial olfactory function were assessed and correlations with OCES scores were measured. RESULTS Control subjects and subjects with CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP) were enrol- led. OCES correlated with both psychophysical and psychosocial olfaction, as measured by threshold, discrimination and identi- fication (TDI) scores and Questionnaire on Olfactory Disorders (QOD-NS) scores for all case and control subjects combined. OCES improved in both CRS groups postoperatively with the highest correlation seen in postoperative olfaction in CRSwNP patients. CRS patients who achieve near perfect OCES and sinus endoscopy scores after surgery have olfactory metrics that are indistin- guishable from controls regardless of polyp status. CONCLUSIONS The OCES is a valid olfactory-specific measure that demonstrates strong validity and provides complimentary infor- mation to traditional sinus endoscopy to aid in our understanding of OD associated with CRS.
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Affiliation(s)
- R J Schlosser
- Division of Rhinology and Sinus Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - T L Smith
- Division of Rhinology and Sinus Surgery, Oregon Health Services University, Portland, OR, USA
| | - J C Mace
- Division of Rhinology and Sinus Surgery, Oregon Health Services University, Portland, OR, USA
| | - J A Alt
- University of Utah, Salt Lake City, UT, USA
| | | | - J L Mattos
- University of Virginia, Charlottesville, VA, USA
| | | | - C Massey
- University of Colorado, Aurora, CO, USA
| | - Z M Soler
- Division of Rhinology and Sinus Surgery, Medical University of South Carolina, Charleston, SC, USA
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Gmeiner WH, Dominijanni A, Haber AO, Ghiraldeli LP, Caudell DL, D'Agostino R, Pasche BC, Smith TL, Deng Z, Kiren S, Mani C, Palle K, Brody JR. Improved Antitumor Activity of the Fluoropyrimidine Polymer CF10 in Preclinical Colorectal Cancer Models through Distinct Mechanistic and Pharmacologic Properties. Mol Cancer Ther 2020; 20:553-563. [PMID: 33361273 DOI: 10.1158/1535-7163.mct-20-0516] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 10/26/2020] [Accepted: 12/16/2020] [Indexed: 12/11/2022]
Abstract
Chemotherapy regimens that include 5-fluorouracil (5-FU) are central to colorectal cancer treatment; however, risk/benefit concerns limit 5-FU's use, necessitating development of improved fluoropyrimidine (FP) drugs. In our study, we evaluated a second-generation nanoscale FP polymer, CF10, for improved antitumor activity. CF10 was more potent than the prototype FP polymer F10 and much more potent than 5-FU in multiple colorectal cancer cell lines including HCT-116, LS174T, SW480, and T84D. CF10 displayed improved stability to exonuclease degradation relative to F10 and reduced susceptibility to thymidine antagonism due to extension of the polymer with arabinosyl cytidine. In colorectal cancer cells, CF10 strongly inhibited thymidylate synthase (TS), induced Top1 cleavage complex formation and caused replication stress, while similar concentrations of 5-FU were ineffective. CF10 was well tolerated in vivo and invoked a reduced inflammatory response relative to 5-FU. Blood chemistry parameters in CF10-treated mice were within normal limits. In vivo, CF10 displayed antitumor activity in several colorectal cancer flank tumor models including HCT-116, HT-29, and CT-26. CF10's antitumor activity was associated with increased plasma levels of FP deoxynucleotide metabolites relative to 5-FU. CF10 significantly reduced tumor growth and improved survival (84.5 days vs. 32 days; P < 0.0001) relative to 5-FU in an orthotopic HCT-116-luc colorectal cancer model that spontaneously metastasized to liver. Improved survival in the orthotopic model correlated with localization of a fluorescent CF10 conjugate to tumor. Together, our preclinical data support an early-phase clinical trial of CF10 for treatment of colorectal cancer.
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Affiliation(s)
- William H Gmeiner
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
- Comprehensive Cancer Center Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Anthony Dominijanni
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Alex O Haber
- Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lais P Ghiraldeli
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David L Caudell
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Ralph D'Agostino
- Department of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Boris C Pasche
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Comprehensive Cancer Center Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Thomas L Smith
- Department of Orthopedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Zhiyong Deng
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Sezgin Kiren
- Department of Chemistry, Winston-Salem State University, Winston-Salem, North Carolina
| | - Chinnadurai Mani
- Department of Cell Biology and Biochemistry, Texas Tech University Health Sciences Centre, Lubbock, Texas
| | - Komaraiah Palle
- Department of Cell Biology and Biochemistry, Texas Tech University Health Sciences Centre, Lubbock, Texas
| | - Jonathan R Brody
- Brenden Colson Center for Pancreatic Care, Departments of Surgery and Cell, Developmental & Cancer Biology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
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Jinnah AH, Whitlock P, Willey JS, Danelson K, Kerr BA, Hassan OA, Emory CL, Smith TL, Bracey DN. Improved osseointegration using porcine xenograft compared to demineralized bone matrix for the treatment of critical defects in a small animal model. Xenotransplantation 2020; 28:e12662. [PMID: 33242920 DOI: 10.1111/xen.12662] [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: 05/04/2020] [Revised: 10/04/2020] [Accepted: 11/09/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Autograft (AG) is the gold standard bone graft due to biocompatibility, osteoconductivity, osteogenicity, and osteoinductivity. Alternatives include allografts and xenografts (XG). METHODS We investigated the osseointegration and biocompatibility of a decellularized porcine XG within a critical defect animal model. We hypothesized that the XG will result in superior osseointegration compared to demineralized bone matrix (DBM) and equivalent immune response to AG. Critical defects were created in rat femurs and treated with XG, XG plus bone morphogenetic protein (BMP)-2, DBM, or AG. Interleukin (IL)-2 and IFN-gamma levels (inflammatory markers) were measured from animal blood draws at 1 week and 1 month post-operatively. At 1 month, samples underwent micro-positron-emission tomography (microPET) scans following 18-NaF injection. At 16 weeks, femurs were retrieved and sent for micro-computerized tomography (microCT) scans for blinded grading of osseointegration or were processed for histologic analysis with tartrate resistant acid phosphatase (TRAP) and pentachrome. RESULTS Enzyme linked immunosorbent assay testing demonstrated greater IL-2 levels in the XG vs. AG 1 week post-op; which normalized by 28 days post-op. MicroPET scans showed increased uptake within the AG compared to all groups. XG and XG + BMP-2 showed a trend toward increased uptake compared with DBM. MicroCT scans demonstrated increased osseointegration in XG and XG + BMP groups compared to DBM. Pentachrome staining demonstrated angiogenesis and endochondral bone formation. Furthermore, positive TRAP staining in samples from all groups indicated bone remodeling. CONCLUSIONS These data suggest that decellularized and oxidized porcine XG is biocompatible and at least equivalent to DBM in the treatment of a critical defect in a rat femur model.
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Affiliation(s)
- Alexander H Jinnah
- Division of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Patrick Whitlock
- Division of Pediatric Orthopaedics, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Jeffrey S Willey
- Department of Radiation/Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Kerry Danelson
- Division of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Bethany A Kerr
- Division of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.,Department of Cancer Biology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Omer A Hassan
- Department of Pathology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Cynthia L Emory
- Division of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Thomas L Smith
- Division of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Daniel N Bracey
- Division of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
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Rowan NR, Soler ZM, Mace JC, Camilon MP, Palmer C, Jones RH, Smith TL, Schlosser RJ. Lack of impact of radiologic septal measurements upon patient symptoms and performance of septoplasty during endoscopic sinus surgery. Rhinology 2020; 58:323-332. [PMID: 32175530 DOI: 10.4193/rhin19.412] [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: 11/08/2022]
Abstract
BACKGROUND Recent literature suggests that concurrent septoplasty during endoscopic sinus surgery (ESS) improves patient outcomes, however, the underlying indications for performing concurrent septoplasty are unknown. The objective of this study was to investigate the relationship between objective radiologic measures of nasal septal deviation with preoperative patient symptomatology and measures of CRS disease severity. We also sought to understand the association of objective radiologic measurements with surgeon performance of concurrent septoplasty during ESS. METHODOLOGY Seventy-four patients with CRS undergoing ESS were prospectively enrolled. Angles of septal deviation, intranasal areas and volumes were assessed on preoperative computed tomography (CT) scans and correlated with a robust battery of patient reported outcomes measures (PROMs), objective measures of CRS severity including olfaction scores, radiologic and endoscopic staging, and performance of septoplasty. RESULTS Intranasal areas and volumes demonstrated only weak linear associations with patient-reported nasal congestion, however, angles of septal deviation alone did not correlate with congestion or any other PROM measure. Meanwhile, radiologic septal-related measurements did not correlate with objective measures of CRS disease severity or the performance of a concurrent septoplasty. CONCLUSIONS Though prior studies demonstrate improved patient outcomes in the setting of concurrent septoplasty during ESS, this study failed to establish an association between preoperative radiologic septal-related measurements and patient symptomatology or surgeon decision to perform septoplasty. Although objective factors to identify patients most likely to benefit from concurrent septoplasty remain unidentified, the potential improvement of surgical recommendations and patient outcomes makes this an important area of continued investigation.
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Affiliation(s)
- N R Rowan
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA; The Johns Hopkins University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Baltimore, MD, USA
| | - Z M Soler
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - J C Mace
- Oregon Health and Science University, Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Sinus/Skull Base Surgery, Portland, OR, USA
| | - M P Camilon
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - C Palmer
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - R H Jones
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - T L Smith
- Oregon Health and Science University, Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Sinus/Skull Base Surgery, Portland, OR, USA
| | - R J Schlosser
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA; Department of Surgery, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
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9
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Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R, Reitsma S, Toppila-Salmi S, Bernal-Sprekelsen M, Mullol J, Alobid I, Terezinha Anselmo-Lima W, Bachert C, Baroody F, von Buchwald C, Cervin A, Cohen N, Constantinidis J, De Gabory L, Desrosiers M, Diamant Z, Douglas RG, Gevaert PH, Hafner A, Harvey RJ, Joos GF, Kalogjera L, Knill A, Kocks JH, Landis BN, Limpens J, Lebeer S, Lourenco O, Meco C, Matricardi PM, O'Mahony L, Philpott CM, Ryan D, Schlosser R, Senior B, Smith TL, Teeling T, Tomazic PV, Wang DY, Wang D, Zhang L, Agius AM, Ahlstrom-Emanuelsson C, Alabri R, Albu S, Alhabash S, Aleksic A, Aloulah M, Al-Qudah M, Alsaleh S, Baban MA, Baudoin T, Balvers T, Battaglia P, Bedoya JD, Beule A, Bofares KM, Braverman I, Brozek-Madry E, Richard B, Callejas C, Carrie S, Caulley L, Chussi D, de Corso E, Coste A, El Hadi U, Elfarouk A, Eloy PH, Farrokhi S, Felisati G, Ferrari MD, Fishchuk R, Grayson W, Goncalves PM, Grdinic B, Grgic V, Hamizan AW, Heinichen JV, Husain S, Ping TI, Ivaska J, Jakimovska F, Jovancevic L, Kakande E, Kamel R, Karpischenko S, Kariyawasam HH, Kawauchi H, Kjeldsen A, Klimek L, Krzeski A, Kopacheva Barsova G, Kim SW, Lal D, Letort JJ, Lopatin A, Mahdjoubi A, Mesbahi A, Netkovski J, Nyenbue Tshipukane D, Obando-Valverde A, Okano M, Onerci M, Ong YK, Orlandi R, Otori N, Ouennoughy K, Ozkan M, Peric A, Plzak J, Prokopakis E, Prepageran N, Psaltis A, Pugin B, Raftopulos M, Rombaux P, Riechelmann H, Sahtout S, Sarafoleanu CC, Searyoh K, Rhee CS, Shi J, Shkoukani M, Shukuryan AK, Sicak M, Smyth D, Sindvongs K, Soklic Kosak T, Stjarne P, Sutikno B, Steinsvag S, Tantilipikorn P, Thanaviratananich S, Tran T, Urbancic J, Valiulius A, Vasquez de Aparicio C, Vicheva D, Virkkula PM, Vicente G, Voegels R, Wagenmann MM, Wardani RS, Welge-Lussen A, Witterick I, Wright E, Zabolotniy D, Zsolt B, Zwetsloot CP. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology 2020; 58:1-464. [PMID: 32077450 DOI: 10.4193/rhin20.600] [Citation(s) in RCA: 521] [Impact Index Per Article: 130.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. All available evidence for the management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is systematically reviewed and integrated care pathways based on the evidence are proposed. Despite considerable increases in the amount of quality publications in recent years, a large number of practical clinical questions remain. It was agreed that the best way to address these was to conduct a Delphi exercise . The results have been integrated into the respective sections. Last but not least, advice for patients and pharmacists and a new list of research needs are included. The full document can be downloaded for free on the website of this journal: http://www.rhinologyjournal.com.
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Affiliation(s)
- W J Fokkens
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands
| | - V J Lund
- Royal National Throat, Nose and Ear Hospital, UCLH, London, UK
| | - C Hopkins
- Ear, Nose and Throat Department, Guys and St. Thomas Hospital, London, United Kingdom
| | - P W Hellings
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands.,Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, KU Leuven, Belgium.,Upper Airways Research Laboratory and ENT Department, University Hospital Ghent, Ghent, Belgium
| | - R Kern
- Department of Otorhinolaryngology - Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - S Reitsma
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands
| | - S Toppila-Salmi
- Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | | | - I Alobid
- Rhinology and Skull Base Unit, ENT Department, Hospital Clinic de Barcelona, Universidad de Barcelona, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
| | - W Terezinha Anselmo-Lima
- Division of Otorhinolaryngology, Department of Ophthalmology, Otorhinolaryngology, Head and Neck Surgery, Ribeirao Preto Medical School-University of Sao Paulo, Sao Paulo, Brazil
| | - C Bachert
- Upper Airways Research Laboratory and ENT Department, University Hospital Ghent, Ghent, Belgium.,Division of ENT Diseases, CLINTEC, Karolinska Institute, University of Stockholm, Stockholm, Sweden
| | - F Baroody
- Department of Otorhinolaryngology-Head and Neck Surgery, The University of Chicago Medicine and the Comer Children's Hospital, Chicago, IL, USA
| | - C von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Hospital, Copenhagen, Denmark
| | - A Cervin
- Department of Otorhinolaryngology, Head and Neck Surgery, Royal Brisbane and Women's Hospital.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - N Cohen
- Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA
| | - J Constantinidis
- 1st Department of ORL, Head and Neck Surgery, Aristotle University, AHEPA Hospital, Thessaloniki, Greece
| | - L De Gabory
- Rhinology and Plastic Surgery Unit, Otorhinolaryngology, Head and Neck Surgery and Pediatric ENT Department, CHU de Bordeaux, Hospital Pellegrin, Centre F-X Michelet, Bordeaux, France
| | - M Desrosiers
- Department of ORL-HNS, Universite de Montreal, Montreal, Canada
| | - Z Diamant
- Dept of Respiratory Medicine and Allergology, Skane University in Lund, Sweden.,Research Director Respiratory and Allergy, at QPS-Netherlands, Groningen, Netherlands.,Affiliate to Charles University, Dept of Respiratory Diseases, in Prague, Czech Republic
| | - R G Douglas
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - P H Gevaert
- Department of Otorhinolaryngology, Ghent University, Ghent, Belgium
| | - A Hafner
- University of Zagreb Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
| | - R J Harvey
- Rhinology and Skull Base Department, Applied Medical Research Centre, UNSW (Conjoint) and Macquarie University (Clinical), Sydney, Australia
| | - G F Joos
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - L Kalogjera
- ENT Department, Zagreb School of Medicine.,University Hospital Center "Sestre milosrdnice", Zagreb, Croatia
| | - A Knill
- Patient representative, Opuscomms, London, UK
| | - J H Kocks
- Department of Inhalation Medicine, Observational Pragmatic Research Institute, Singapore
| | - B N Landis
- Rhinology-Olfactology Unit, Otorhinolaryngology Department, University Hospital of Geneva, Geneva, Switzerland
| | - J Limpens
- Medical Information Specialist, Medical Library, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands
| | - S Lebeer
- Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
| | - O Lourenco
- FCS - UBI Faculty of Health Sciences, University of Beira Interior, Covilha, Portugal
| | - C Meco
- Department of Otorhinolaryngology, Head and Neck Surgery, Ankara University, Ankara, Turkey.,Department of Otorhinolaryngology, Head and Neck Surgery, Salzburg Paracelsus Medical University, Salzburg, Austria
| | - P M Matricardi
- Department of Pediatric Pneumology and Immunology, Charite - Universitatsmedizin Berlin, Berlin, Germany
| | - L O'Mahony
- Departments of Medicine and Microbiology, APC Microbiome Ireland, National University of Ireland, Cork, Ireland
| | - C M Philpott
- Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK.,ENT Department, James Paget University Hospital, Great Yarmouth, UK
| | - D Ryan
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.,Optimum Patient Care, Cambridgeshire, UK
| | - R Schlosser
- Department of Otorhinolaryngology Head and Neck Surgery, Medical University of South Carolina, Charleston, USA
| | - B Senior
- UNC Otorhinolaryngology / Head and Neck Surgery, Division of Rhinology, Allergy, and Endoscopic Skull Base Surgery and Department of Neurosurgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - T L Smith
- Division of Rhinology and Sinus/Skull Base Surgery, Department of Otolaryngology-Head Neck Surgery, Oregon Health and Science University, Portland, OR, USA
| | - T Teeling
- Patient representative, Task Force Healthcare, WTC Den Haag, The Netherlands
| | - P V Tomazic
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Graz, Austria
| | - D Y Wang
- Department of Otorhinolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - D Wang
- Rhinology Division, ENT Department.,Eye and ENT Hospital, Fudan University, Shanghai, China
| | - L Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Beijing, China
| | - A M Agius
- Department of Medicine and Surgery in the University of Malta
| | | | - R Alabri
- ENT Division, Surgery Department, College of Medicine and Health and Sciences, Sultan Qaboos University, Muscat, Oman
| | - S Albu
- Department of Otorhinolaryngology, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - A Aleksic
- ENT Department, University Clinical Centre, University of Banja Luka, Bosnia and Herzegovina
| | - M Aloulah
- ENT Department, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - M Al-Qudah
- Department of Otorhinolaryngology, Jordan University of Science and Technology, Irbid, Jordan
| | - S Alsaleh
- Department of Otorhinolaryngology - Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - M A Baban
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Sulaimani, Sulaimayniha, Iraq
| | - T Baudoin
- Dept. of ORL-HNS Sisters of Mercy University Medical Center, School of Medicine University of Zagreb, Croatia
| | - T Balvers
- Department of Neurology, Leiden University Medical Center (LUMC)
| | - P Battaglia
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - J D Bedoya
- Department of Otorhinolaryngology, Universidad de Antioquia, Medellin, Colombia
| | - A Beule
- Department of Otorhinolaryngology, University Clinic of Munster, Germany
| | - K M Bofares
- Department of Otorhinolaryngology, Omar Al-Moukhtar University, Albyeda, Libya
| | - I Braverman
- Department of Otorhinolaryngology - Head and Neck Surgery, Hillel Yaffe Medical Center, Israel
| | - E Brozek-Madry
- Department of Otorhinolaryngology, Medical University of Warsaw, Poland
| | - B Richard
- Department of ENT, Makerere University, Kampala, Uganda
| | - C Callejas
- Department of Otorhinolaryngology, Pontificia Catholic University, Santiago, Chile
| | - S Carrie
- Department of Otorhinolaryngology, Head and Neck Surgery, Newcastle University, United Kingdom
| | - L Caulley
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Ottawa,Toronto, Canada
| | - D Chussi
- Department of Otorhinolaryngology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - E de Corso
- Department of Otorhinolaryngology , La Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome, Italy
| | - A Coste
- ORL et Chirurgie Cervico-Faciale, Universite Paris-Est Creteil (UPEC), France
| | - U El Hadi
- Department of Otorhinolaryngology, American University of Beirut, Lebanon
| | - A Elfarouk
- Department of Otorhinolaryngology, Cairo University, Egypt
| | - P H Eloy
- Department of ENT, CHU UCL Namur, Yvoir, Belgium
| | - S Farrokhi
- Department of Immunology and Allergy, The Persian Gulf Tropical Medicine Research Center.,The Persian Gulf Biomedical Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
| | - G Felisati
- Department of Head and Neck, University of Milan, Italy
| | - M D Ferrari
- Department of Neurology, Leiden University Medical Center (LUMC)
| | - R Fishchuk
- Department of ENT- Organs Microsurgery, Central city clinical hospital of lvano-Frankivsk city council, Ivano-Frankivsk, Ukraine
| | - W Grayson
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Alabama Birmingham, USA
| | - P M Goncalves
- ENT Department, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal
| | - B Grdinic
- ENT Department, General Hospital, Pula, Pula, Croatia
| | - V Grgic
- ENT Department, Zagreb School of Medicine.,University Hospital center 'Sestre milosrdnice', Zagreb, Croatia
| | - A W Hamizan
- Department of Otorhinolaryngology, University Kebangsaan, Kuala Lumpur, Malasyia
| | - J V Heinichen
- Department of ENT of Hospital de Clinicas, Facultad de Ciencias Medicas, Universidad Nacional de Asuncion, Paraguay
| | - S Husain
- Department of Otorhinolaryngology, Head and Neck Surgery, National University of Malaysia, Kuala Lumpur, Malaysia
| | - T I Ping
- Department ORLHNS, University Malaysia Sarawak, Kuching, Malaysia
| | - J Ivaska
- Clinic of Ear, Nose, Throat and Eye diseases, Vilnius University, Lithuania
| | - F Jakimovska
- ENT Department of Medical Faculty, St Cyril and Methodius University of Skopje, North Macedonia
| | - L Jovancevic
- Department of Otorhinolaryngology, Head and Neck Surgery, Clinical Centre of Vojvodina, Faculty of Medicine, University of Novi Sad, Serbia
| | - E Kakande
- Department of ENT Surgery, Mulago National Referral Hospital Kampala, Uganda
| | - R Kamel
- Department of Otorhinolaryngology, Head and Neck Surgery, Cairo University, Egypt
| | - S Karpischenko
- ENT Department, Director of Saint Petersburg Research Institute of Ear, Throat , Nose and Speech.,Professor and Chairman of First Pavlov State Medical University, Saint Petersburg, Russia
| | - H H Kariyawasam
- Department of Allergy and Clinical Immunology, Royal National ENT Hospital, London, England
| | - H Kawauchi
- 96. Department of Otorhinolaryngology, Shimane University, Matsue, Shimane, Japan
| | - A Kjeldsen
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Southern Denmark, Odense, Denmark
| | - L Klimek
- Center of Rhinology and Allergology, Wiesbaden, Hesse, Germany
| | - A Krzeski
- Department of Otorhinolaryngology, Warsaw Medical University, Warsaw, Poland
| | - G Kopacheva Barsova
- Department of Otorhinolaryngology, University If Medicine, st. Ciril and Methodius, Skopje
| | - S W Kim
- Department of Otorhinolaryngology, Head and Neck Surgery, Kyung Hee University, Seoul, South Korea
| | - D Lal
- Department of Otorhinolaryngology, Head and Neck Surgery, Mayo Clinic in Arizona, Phoenix, Arizona, USA
| | - J J Letort
- Department of Otorhinolaryngology, Pontifica Catholic University of Ecuador, Quito, Ecuador
| | - A Lopatin
- Department of Otorhinolaryngology, Policlinic No.1- Senior ENT Consultant and Surgeon.,President of Russian Rhinologic Society, Moscow, Russia
| | | | - A Mesbahi
- Department of Facial Surgery, Khodadoust Hospital, Ordibehesht Hospital, Shiraz, Iran
| | - J Netkovski
- Department of Otorhinolaryngology-Head and Neck Surgery, St. Cyril and Methodius, Skopje, Republic of North Macedonia
| | - D Nyenbue Tshipukane
- Department of Otorhinolaryngology, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - A Obando-Valverde
- Department of Otorhinolaryngology and Surgery, Hospital Mexico, University of Costa Rica, San Jose, Costa Rica
| | - M Okano
- Department of Otorhinolaryngology, International University of Health and Welfare, Narita , Japan
| | - M Onerci
- Department of Otorhinolaryngology, Hacettepe, Ankara, Turkey
| | - Y K Ong
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Singapore, National University Hospital, Singapore
| | - R Orlandi
- Department of Otorhinolaryngology, University of Utah, Salt Lake City, Utah, USA
| | - N Otori
- Department of Otorhinolaryngology at The Jikei University School of Medicine,Tokyo, Japan
| | - K Ouennoughy
- Department of Otorhinolaryngology-Head and Neck Surgery, Saad Dahleb Blida 1, Blida, Algeria
| | - M Ozkan
- Department of Otorhinolaryngology, University of Health Sciences, Ankara City Hospital, Turkey
| | - A Peric
- Department of Otorhinolaryngology, Military Medical Academy, Faculty of Medicine, University of Defense, Belgrade, Serbia
| | - J Plzak
- Department of Otorhinolaryngology, Head and Neck Surgery, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - E Prokopakis
- Department of Otorhinolaryngology, University of Crete School of Medicine, Heraklion, Crete, Greece
| | - N Prepageran
- Department of ENT, University Malaya, Kuala Lumpur, Malaysia
| | - A Psaltis
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia
| | - B Pugin
- Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - M Raftopulos
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands.,Royal Australian College of Surgeons, Trainee Representative (Australia)
| | - P Rombaux
- Department of Otorhinolaryngology, University of Louvain, Brussels, Belgium
| | - H Riechelmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Ulm, Baden-Wurttemberg, Germany
| | - S Sahtout
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - C-C Sarafoleanu
- ENT and H NS Department, Santa Maria Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - K Searyoh
- Surgery Ear, Nose and Throat Unit, School of Medicine and Dentistry, University of Ghana, Korle-Bu Teaching Hospital, Accra, Ghana
| | - C-S Rhee
- Department of Otorhinolaryngology, Head and Neck Surgery, Seoul, Seoul National University, Seoul, Korea
| | - J Shi
- Department of Rhinology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - M Shkoukani
- Department of Otorhinolaryngology, Head and Neck Surgery, Cleveland Clinic Abu Dhabi, United Arab Emirates
| | - A K Shukuryan
- Department of Otorhinolaryngology, Yerevan State Medical University, Yerevan, Armenia
| | - M Sicak
- Department of Otorhinolaryngology, Head and Neck Surgery, Central Military Hospital, Slovakia, Slovak Health University Bratislava and Catholic University, Ruzom berok, Slovakia
| | - D Smyth
- Department of Otorhinolaryngology, Head and Neck Surgery, Royal College of Surgeons in Ireland and University College Cork, Waterford, Ireland
| | - K Sindvongs
- Department of Otorhinolaryngology, Chulalongkorn University, Bangkok, Thailand
| | - T Soklic Kosak
- University Medical Centre Ljubljana, Department of Otorhinolaryngology and Cervicofacial Surgery, University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
| | - P Stjarne
- Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
| | - B Sutikno
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Airlangga, Surabaya, Indonesia
| | - S Steinsvag
- Department of ORL, University of Bergen, Norway
| | - P Tantilipikorn
- Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - S Thanaviratananich
- Department of Otorhinolaryngology, Head and Neck Surgery, Cleveland Clinic Abu Dhabi, United Arab Emirates
| | - T Tran
- Department of ENT Hospital of Ho Chi Minh city, Faculty of medicine of Ho Chi Minh city Vietnam National University, Vietnam
| | - J Urbancic
- Department of Otorhinolaryngology and cervicofacial surgery, UMC Ljubljana, University of Ljubljana, Medical Faculty, Ljubljana, Slovenia
| | - A Valiulius
- Department of Children's diseases, Vilnius University Medical Faculty, Institute of Clinical Medicine, Vilnius, Lithuania
| | - C Vasquez de Aparicio
- Department of Paediatric Surgery, National Hospital Benjamin Bloom, National University of El Salvador, San Salvador, El Salvador
| | - D Vicheva
- Department of Otorhinolaryngology, Medical University Plovdiv, Bulgaria
| | - P M Virkkula
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki, University Hospital, Helsinki, Finland
| | - G Vicente
- Department of Otolaryngology, St. Luke's Medical Centre, Quezon City, The Philippines
| | - R Voegels
- Department of Otorhinolaryngology, University of Sao Paulo, Sau Paulo, Brazil
| | - M M Wagenmann
- Department of Otorhinolaryngology, Dusseldorf University Hospital, Dusseldorf, German
| | - R S Wardani
- Department of Otorhinolaryngology Head and Neck Surgery, Dr. Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia
| | - A Welge-Lussen
- Department of Otorhinolaryngology, University Hospital Basel, University Basel, Switzerland
| | - I Witterick
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Ottawa,Toronto, Canada
| | - E Wright
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - D Zabolotniy
- State Institution of O.S. Kolomiychenko Institute of Othorhnilarungology of National Academy of Medical Sciences of Ukraine, Kiev, Ukraine
| | - B Zsolt
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Szeged, Hungary
| | - C P Zwetsloot
- Department of Neurology, Dijklander Ziekenhuis, Purmerend, The Netherlandsn
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Thönnes S, Shelton P, Bracey DN, Van Dyke M, Whitlock P, Smith TL, Moghaddam A, Tuohy C. Success and efficiency of cell seeding in Avian Tendon Xenografts - A promising alternative for tendon and ligament reconstruction. J Orthop 2020; 18:155-161. [PMID: 32021023 DOI: 10.1016/j.jor.2019.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 09/11/2019] [Indexed: 11/27/2022] Open
Abstract
Decellularized tendon xenografts offer a promising alternative for reconstruction by using ubiquitously available material. This study compares static and centrifugal seeding of avian tendon scaffolds with NIH 3T3 fibroblasts. Incorporation of viable cells was achievable with both techniques, represented by DNA content. Proliferation rate and viability assay showed neither damage by centrifugal force nor superiority of the technique. Cell proliferation after 10 days of culture demonstrated that the scaffold did not hinder 3-D culturing. Confocal laser microscopy revealed structural details as formation of focal adhesions, to provide deeper insight into the process of cell attachment and growth in xenografts.
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Affiliation(s)
- Simon Thönnes
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA.,HTRG - Heidelberg Trauma Research Group, Division of Trauma and Reconstructive Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University Hospital Heidelberg, Schlierbacher Landstr. 200a, D-69118, Heidelberg, Germany
| | - Peter Shelton
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Daniel N Bracey
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Mark Van Dyke
- Virginia Tech, Wake Forest School of Biomedical Engineering and Sciences, Virginia Polytechnic Institute and State University Blacksburg, VA, 24061, USA
| | - Patrick Whitlock
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Thomas L Smith
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Arash Moghaddam
- HTRG - Heidelberg Trauma Research Group, Division of Trauma and Reconstructive Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University Hospital Heidelberg, Schlierbacher Landstr. 200a, D-69118, Heidelberg, Germany
| | - Christopher Tuohy
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
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11
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Kwok A, Rosas S, Bateman TA, Livingston E, Smith TL, Moore J, Zawieja DC, Hampton T, Mao XW, Delp MD, Willey JS. Altered rodent gait characteristics after ~35 days in orbit aboard the International Space Station. Life Sci Space Res (Amst) 2020; 24:9-17. [PMID: 31987483 DOI: 10.1016/j.lssr.2019.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 10/23/2019] [Accepted: 10/29/2019] [Indexed: 06/10/2023]
Abstract
The long-term adaptations to microgravity and other spaceflight challenges within the confines of a spacecraft, and readaptations to weight-bearing upon reaching a destination, are unclear. While post-flight gait change in astronauts have been well documented and reflect multi-system deficits, no data from rodents have been collected. Thus, the purpose of this study was to evaluate gait changes in response to spaceflight. A prospective collection of gait data was collected on 3 groups of mice: those who spent~35 days in orbit (FLIGHT) aboard the International Space Station (ISS); a ground-based control with the same habitat conditions as ISS (Ground Control; GC); and a vivarium control with typical rodent housing conditions (VIV). Pre-flight and post-flight gait measurements were conducted utilizing an optimized and portable gait analysis system (DigiGait, Mouse Specifics, Inc). The total data acquisition time for gait patterns of FLIGHT and control mice was 1.5-5 min/mouse, allowing all 20 mice per group to be assessed in less than an hour. Patterns of longitudinal gait changes were observed in the hind limbs and the forelimbs of the FLIGHT mice after ~35 days in orbit; few differences were observed in gait characteristics within the GC and VIV controls from the initial to the final gait assessment, and between groups. For FLIGHT mice, 12 out of 18 of the evaluated gait characteristics in the hind limbs were significantly changed, including: stride width variability; stride length and variance; stride, swing, and stance duration; paw angle and area at peak stance; and step angle, among others. Gait characteristics that decreased included stride frequency, and others. Moreover, numerous forelimb gait characteristics in the FLIGHT mice were changed at post-flight measures relative to pre-flight. This rapid DigiGait gait measurement tool and customized spaceflight protocol is useful for providing preliminary insight into how spaceflight could affect multiple systems in rodents in which deficits are reflected by altered gait characteristics.
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Affiliation(s)
- Andy Kwok
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Samuel Rosas
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, United States; Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Ted A Bateman
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Eric Livingston
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Thomas L Smith
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Joseph Moore
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - David C Zawieja
- Department of Medical Physiology, Texas A&M University, College Station, TX, United States
| | - Tom Hampton
- Mouse Specifics, Framingham, MA, United States
| | - Xiao W Mao
- Department of Basic Sciences, Division of Biomedical Engineering Sciences (BMES), Loma Linda University School of Medicine and Medical Center, Loma Linda, CA, United States
| | - Michael D Delp
- Department of Nutrition, Food and Exercise Sciences, Florida State University, Tallahassee, FL, United States
| | - Jeffrey S Willey
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, United States.
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12
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Bracey DN, Jinnah AH, Willey JS, Seyler TM, Hutchinson ID, Whitlock PW, Smith TL, Danelson KA, Emory CL, Kerr BA. Investigating the Osteoinductive Potential of a Decellularized Xenograft Bone Substitute. Cells Tissues Organs 2019; 207:97-113. [PMID: 31655811 PMCID: PMC6935535 DOI: 10.1159/000503280] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 09/09/2019] [Indexed: 12/14/2022] Open
Abstract
Bone grafting is the second most common tissue transplantation procedure worldwide. One of the alternative methods for bone repair under investigation is a tissue-engineered bone substitute. An ideal property of tissue-engineered bone substitutes is osteoinductivity, defined as the ability to stimulate primitive cells to differentiate into a bone-forming lineage. In the current study, we use a decellularization and oxidation protocol to produce a porcine bone scaffold and examine whether it possesses osteoinductive potential and can be used to create a tissue-engineered bone microenvironment. The decellularization protocol was patented by our lab and consists of chemical decellularization and oxidation steps using combinations of deionized water, trypsin, antimicrobials, peracetic acid, and triton-X100. To test if the bone scaffold was a viable host, preosteoblasts were seeded and analyzed for markers of osteogenic differentiation. The osteoinductive potential was observed in vitro with similar osteogenic markers being expressed in preosteoblasts seeded on the scaffolds and demineralized bone matrix. To assess these properties in vivo, scaffolds with and without preosteoblasts preseeded were subcutaneously implanted in mice for 4 weeks. MicroCT scanning revealed 1.6-fold increased bone volume to total volume ratio and 1.4-fold increase in trabecular thickness in scaffolds after implantation. The histological analysis demonstrates new bone formation and blood vessel formation with pentachrome staining demonstrating osteogenesis and angiogenesis, respectively, within the scaffold. Furthermore, CD31+ staining confirmed the endothelial lining of the blood vessels. These results demonstrate that porcine bone maintains its osteoinductive properties after the application of a patented decellularization and oxidation protocol developed in our laboratory. Future work must be performed to definitively prove osteogenesis of human mesenchymal stem cells, biocompatibility in large animal models, and osteoinduction/osseointegration in a relevant clinical model in vivo. The ability to create a functional bone microenvironment using decellularized xenografts will impact regenerative medicine, orthopedic reconstruction, and could be used in the research of multiple diseases.
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Affiliation(s)
- Daniel N. Bracey
- Wake Forest Baptist Medical Center, Orthopaedic Surgery, Winston Salem, NC, USA
| | - Alexander H. Jinnah
- Wake Forest Baptist Medical Center, Orthopaedic Surgery, Winston Salem, NC, USA
| | - Jeffrey S. Willey
- Wake Forest Baptist Medical Center, Radiation Oncology, Winston Salem, NC, USA
| | | | | | | | - Thomas L. Smith
- Wake Forest Baptist Medical Center, Orthopaedic Surgery, Winston Salem, NC, USA
| | - Kerry A. Danelson
- Wake Forest Baptist Medical Center, Orthopaedic Surgery, Winston Salem, NC, USA
| | - Cynthia L. Emory
- Wake Forest Baptist Medical Center, Orthopaedic Surgery, Winston Salem, NC, USA
| | - Bethany A. Kerr
- Wake Forest Baptist Medical Center, Orthopaedic Surgery, Winston Salem, NC, USA
- Virginia Tech-Wake Forest University School for Bioengineering and Sciences, Winston Salem, NC, USA
- Wake Forest School of Medicine, Cancer Biology, Winston Salem, NC, USA
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13
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Luo TD, Marquez-Lara A, Zabarsky ZK, Vines JB, Mowry KC, Jinnah AH, Ma X, Berwick BW, Willey JS, Li Z, Smith TL, O'Gara TJ. A percutaneous, minimally invasive annulus fibrosus needle puncture model of intervertebral disc degeneration in rabbits. J Orthop Surg (Hong Kong) 2019; 26:2309499018792715. [PMID: 30114959 DOI: 10.1177/2309499018792715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Various animal models have been proposed to mimic the pathophysiologic process of intervertebral disc degeneration, a leading cause of back pain. The purpose of this study is to describe a minimally invasive technique via percutaneous needle puncture of the annulus fibrosus in New Zealand white rabbits. METHODS Under fluoroscopic guidance, an 18-gauge spinal needle was inserted 2 cm lateral to the midline spinous process. The needle was slowly advanced at approximately 45° angle until it was adjacent to the L5/L6 disc space. Lateral and anteroposterior views were used to verify correct needle position before advancing into the nucleus pulposus. The rabbits underwent weekly X-rays for 4 weeks to assess disc height index. MRI T2 relaxation was evaluated at week four to assess morphological changes. Discs were histologically graded on a 12-point scale to assess degeneration and compared to discs obtained from uninjured rabbits. RESULTS There were no complications associated with the percutaneous needle puncture procedure. All animals survived the duration of the experiment. Four weeks after injury, the disc height had progressively narrowed to approximately 50% of baseline. MRI assessment at the 4-week time point demonstrated a mean T2 relaxation time at the L5/L6 level that was 20.9% of the T2 relaxation time at the uninjured L4/L5 disc level ( p < 0.001). Histological analysis demonstrated lamellar disorganization of the annulus and decreased cellularity and proteoglycan content within the injured nucleus compared to uninjured control discs. CONCLUSION The present study demonstrated a reliable technique of inducing an annular tear via a percutaneous needle puncture. Compared to open surgical approaches, the percutaneous model produces similar progressive disc degeneration while minimizing harm to the animal subjects. CLINICAL RELEVANCE The present study establishes a technique for the introduction of novel therapeutic agents to treat disc degeneration that may translate to future clinical trials.
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Affiliation(s)
- T David Luo
- 1 Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Alejandro Marquez-Lara
- 1 Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Zachary K Zabarsky
- 1 Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jeremy B Vines
- 2 Organogenesis Surgical and Sports Medicine, Birmingham, AL, USA
| | - Katie C Mowry
- 2 Organogenesis Surgical and Sports Medicine, Birmingham, AL, USA
| | - Alexander H Jinnah
- 1 Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Xue Ma
- 1 Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Benjamin W Berwick
- 1 Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jeffrey S Willey
- 1 Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,3 Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Zhongyu Li
- 1 Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Thomas L Smith
- 1 Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Tadhg J O'Gara
- 1 Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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14
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Bracey DN, Seyler TM, Jinnah AH, Smith TL, Ornelles DA, Deora R, Parks GD, Van Dyke ME, Whitlock PW. A porcine xenograft-derived bone scaffold is a biocompatible bone graft substitute: An assessment of cytocompatibility and the alpha-Gal epitope. Xenotransplantation 2019; 26:e12534. [PMID: 31342586 DOI: 10.1111/xen.12534] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 01/28/2019] [Revised: 04/20/2019] [Accepted: 05/08/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Xenografts are an attractive alternative to traditional bone grafts because of the large supply from donors with predictable morphology and biology as well as minimal risk of human disease transmission. Clinical series involving xenograft bone transplantation, most commonly from bovine sources, have reported poor results with frequent graft rejection and failure to integrate with host tissue. Failures have been attributed to residual alpha-Gal epitope in the xenograft which humans produce natural antibody against. To the authors' knowledge, there is currently no xenograft-derived bone graft substitute that has been adopted by orthopedic surgeons for routine clinical use. METHODS In the current study, a bone scaffold intended to serve as a bone graft substitute was derived from porcine cancellous bone using a tissue decellularization and chemical oxidation protocol. In vitro cytocompatibility, pathogen clearance, and alpha-Gal quantification tests were used to assess the safety of the bone scaffold intended for human use. RESULTS In vitro studies showed the scaffold was free of processing chemicals and biocompatible with mouse and human cell lines. When bacterial and viral pathogens were purposefully added to porcine donor tissue, processing successfully removed these pathogens to comply with sterility assurance levels established by allograft tissue providers. Critically, 98.5% of the alpha-Gal epitope was removed from donor tissue after decellularization as shown by ELISA inhibition assay and immunohistochemical staining. CONCLUSIONS The current investigation supports the biologic safety of bone scaffolds derived from porcine donors using a decellularization protocol that meets current sterility assurance standards. The majority of the highly immunogenic xenograft carbohydrate was removed from donor tissue, and these findings support further in vivo investigation of xenograft-derived bone tissue for orthopedic clinical application.
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Affiliation(s)
- Daniel N Bracey
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Thorsten M Seyler
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Alexander H Jinnah
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Thomas L Smith
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David A Ornelles
- Department of Microbiology and Immunology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Rajendar Deora
- Department of Microbial Infection and Immunity, Department of Microbiology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Griffith D Parks
- Burnett School of Biomedical Sciences, University of Central Florida College of Medicine, Orlando, Florida
| | - Mark E Van Dyke
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Patrick W Whitlock
- Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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15
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Abstract
BACKGROUND Schwann cells are integral to the regenerative capacity of the peripheral nervous system, which declines after adolescence. The mechanisms underlying this decline are poorly understood. This study sought to compare the protein expression of Notch, c-Jun, and Krox-20 after nerve crush injury in adolescent and young adult rats. We hypothesized that these Schwann cell myelinating regulatory factors are down-regulated after nerve injury in an age-dependent fashion. METHODS Adolescent (2 months old) and young adult (12 months old) rats (n = 48) underwent sciatic nerve crush injury. Protein expression of Notch, c-Jun, and Krox-20 was quantified by Western blot analysis at 1, 3, and 7 days post-injury. Functional recovery was assessed in a separate group of animals (n = 8) by gait analysis (sciatic functional index) and electromyography (compound motor action potential) over an 8-week post-injury period. RESULTS Young adult rats demonstrated a trend of delayed onset of the dedifferentiating regulatory factors, Notch and c-Jun, corresponding to the delayed functional recovery observed in young adult rats compared to adolescent rats. Compound motor action potential area was significantly greater in adolescent rats relative to young adult rats, while amplitude and velocity trended toward statistical significance. CONCLUSIONS The process of Schwann cell dedifferentiation following peripheral nerve injury shows different trends with age. These trends of delayed onset of key regulatory factors responsible for Schwann cell myelination may be one of many possible factors mediating the significant differences in functional recovery between adolescent and young adult rats following peripheral nerve injury.
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Affiliation(s)
- Wayne A Chen
- 1 Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Medical Center Boulevard, NC, USA
| | - T David Luo
- 1 Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Medical Center Boulevard, NC, USA
| | - Jonathan C Barnwell
- 1 Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Medical Center Boulevard, NC, USA
| | - Thomas L Smith
- 1 Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Medical Center Boulevard, NC, USA
| | - Zhongyu Li
- 1 Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Medical Center Boulevard, NC, USA
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16
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Bracey DN, Seyler TM, Jinnah AH, Lively MO, Willey JS, Smith TL, Van Dyke ME, Whitlock PW. A Decellularized Porcine Xenograft-Derived Bone Scaffold for Clinical Use as a Bone Graft Substitute: A Critical Evaluation of Processing and Structure. J Funct Biomater 2018; 9:jfb9030045. [PMID: 30002336 PMCID: PMC6164666 DOI: 10.3390/jfb9030045] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/06/2018] [Accepted: 07/09/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Bone grafts are used in approximately one half of all musculoskeletal surgeries. Autograft bone is the historic gold standard but is limited in supply and its harvest imparts significant morbidity to the patient. Alternative sources of bone graft include allografts, synthetics and, less commonly, xenografts which are taken from animal species. Xenografts are available in unlimited supply from healthy animal donors with controlled biology, avoiding the risk of human disease transmission, and may satisfy current demand for bone graft products. METHODS In the current study, cancellous bone was harvested from porcine femurs and subjected to a novel decellularization protocol to derive a bone scaffold. RESULTS The scaffold was devoid of donor cellular material on histology and DNA sampling (p < 0.01). Microarchitectural properties important for osteoconductive potential were preserved after decellularization as shown by high resolution imaging modalities. Proteomics data demonstrated similar profiles when comparing the porcine bone scaffold against commercially available human demineralized bone matrix approved for clinical use. CONCLUSION We are unaware of any porcine-derived bone graft products currently used in orthopaedic surgery practice. Results from the current study suggest that porcine-derived bone scaffolds warrant further consideration to serve as a potential bone graft substitute.
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Affiliation(s)
- Daniel N Bracey
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
| | - Thorsten M Seyler
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA.
| | - Alexander H Jinnah
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
| | - Mark O Lively
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
| | - Jeffrey S Willey
- Department of Radiation Oncology, Wake Forest School of Medicine Comprehensive Cancer Center, Winston-Salem, NC 27157, USA.
| | - Thomas L Smith
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
| | - Mark E Van Dyke
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA.
| | - Patrick W Whitlock
- Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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17
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Rebowe R, Rogers A, Yang X, Kundu SC, Smith TL, Li Z. Nerve Repair with Nerve Conduits: Problems, Solutions, and Future Directions. J Hand Microsurg 2018; 10:61-65. [PMID: 30154617 DOI: 10.1055/s-0038-1626687] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [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: 09/07/2017] [Accepted: 01/02/2018] [Indexed: 01/09/2023] Open
Abstract
Nerve conduits are becoming increasingly popular for the repair of peripheral nerve injuries. Their ease of application and lack of donor site morbidity make them an attractive option for nerve repair in many situations. Today, there are many different conduits to choose in different sizes and materials, giving the reconstructive surgeon many options for any given clinical problem. However, to properly utilize these unique reconstructive tools, the peripheral nerve surgeon must be familiar not only with their standard indications but also with their functional limitations. In this review, the authors identify the common applications of nerve conduits, expected results, and shortcomings of current techniques. Furthermore, future directions for nerve conduit use are identified.
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Affiliation(s)
- Ryan Rebowe
- Department of Orthopaedics, Wake Forest Baptist Medical Center, Winston Salem, North Carolina, United States
| | - Ashley Rogers
- Department of Orthopaedics, Wake Forest Baptist Medical Center, Winston Salem, North Carolina, United States
| | - Xuebin Yang
- Department of Oral Biology, University of Leeds, Leeds, United Kingdom
| | - S C Kundu
- Department of Biotechnology, Indian Institute of Technology, Kharagpur, West Bengal, India
| | - Thomas L Smith
- Department of Orthopaedics, Wake Forest Baptist Medical Center, Winston Salem, North Carolina, United States
| | - Zhongyu Li
- Department of Orthopaedics, Wake Forest Baptist Medical Center, Winston Salem, North Carolina, United States
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18
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Marquez-Lara A, Hutchinson ID, Nuñez F, Smith TL, Miller AN. Nonsteroidal Anti-Inflammatory Drugs and Bone-Healing: A Systematic Review of Research Quality. JBJS Rev 2018; 4:01874474-201603000-00004. [PMID: 27500434 DOI: 10.2106/jbjs.rvw.o.00055] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Nonsteroidal anti-inflammatory drugs (NSAIDs) are often avoided by orthopaedic surgeons because of their possible influence on bone-healing. This belief stems from multiple studies, in particular animal studies, that show delayed bone-healing or nonunions associated with NSAID exposure. The purpose of this review was to critically analyze the quality of published literature that evaluates the impact of NSAIDs on clinical bone-healing. METHODS A MEDLINE and Embase search was conducted to identify all articles relating to bone and fracture-healing and the utilization of NSAIDs. All human studies, including review articles, were identified for further analysis. Non-English-language manuscripts and in vitro and animal studies were excluded. A total of twelve clinical articles and twenty-four literature reviews were selected for analysis. The quality of the clinical studies was assessed with a modified Coleman Methodology Score with emphasis on the NSAID utilization. Review articles were analyzed with regard to variability in the cited literature and final conclusions. RESULTS The mean modified Coleman Methodology Score (and standard deviation) was significantly lower (p = 0.032) in clinical studies that demonstrated a negative effect of NSAIDs on bone-healing (40.0 ± 14.3 points) compared with those that concluded that NSAIDs were safe (58.8 ± 10.3 points). Review articles also demonstrated substantial variability in the number of cited clinical studies and overall conclusions. There were only two meta-analyses and twenty-two narrative reviews. The mean number (and standard deviation) of clinical studies cited was significantly greater (p = 0.008) for reviews that concluded that NSAIDs were safe (8.0 ± 4.8) compared with those that recommended avoiding them (2.1 ± 2.1). Unanimously, all reviews admitted to the need for prospective randomized controlled trials to help clarify the effects of NSAIDs on bone-healing. CONCLUSIONS This systematic literature review highlights the great variability in the interpretation of the literature addressing the impact of NSAIDs on bone-healing. Unfortunately, there is no consensus regarding the safety of NSAIDs following orthopaedic procedures, and future studies should aim for appropriate methodological designs to help to clarify existing discrepancies to improve the quality of care for orthopaedic patients. CLINICAL RELEVANCE This systematic review highlights the limitations in the current understanding of the effects of NSAIDs on bone healing. Thus, withholding these medications does not have any proven scientific benefit to patients and may even cause harm by increasing narcotic requirements in cases in which they could be beneficial for pain management. This review should encourage further basic-science and clinical studies to clarify the risks and benefits of anti-inflammatory medications in the postoperative period, with the aim of improving patient outcomes.
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Affiliation(s)
- Alejandro Marquez-Lara
- 1Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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19
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Luo TD, Marois AJ, Smith TL, Willey JS, Emory CL. Ascorbic Acid and Its Clinical Role in Orthopaedic Surgery. J Surg Orthop Adv 2018; 27:261-268. [PMID: 30777823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Ascorbic acid (vitamin C) is an essential micronutrient with evidence supporting its role in bone formation, tissue repair, and collagen production. Its clinical importance to the field of orthopaedic surgery has yet to be fully defined. Several observational studies have shown improved bone density and reduced hip fracture risk with supplementation. Its effect on bone fracture and soft tissue injury has been promising in animal models, but is not adequately studied in human trials. Results have been mixed concerning its role in chondroprotection and osteoarthritis treatment. Evidence suggesting reduced incidence of complex regional pain syndrome following distal radius fracture when treated with adjuvant ascorbic acid has prompted much debate but has received an endorsement of moderate support from the American Academy of Orthopaedic Surgeons. Given its potential benefits, low cost, and safety profile, ascorbic acid supplementation warrants consideration by orthopaedic surgeons in the treatment of a variety of musculoskeletal injuries (Journal of Surgical Orthopaedic Advances 27(4):261-268, 2018).
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Affiliation(s)
- Tianyi David Luo
- Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Anthony J Marois
- Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Thomas L Smith
- Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Jeffrey S Willey
- Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Cynthia L Emory
- Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina; e-mail:
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20
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Staquicini DI, D'Angelo S, Ferrara F, Karjalainen K, Sharma G, Smith TL, Tarleton CA, Jaalouk DE, Kuniyasu A, Baze WB, Chaffee BK, Hanley PW, Barnhart KF, Koivunen E, Marchiò S, Sidman RL, Cortes JE, Kantarjian HM, Arap W, Pasqualini R. Therapeutic targeting of membrane-associated GRP78 in leukemia and lymphoma: preclinical efficacy in vitro and formal toxicity study of BMTP-78 in rodents and primates. Pharmacogenomics J 2017; 18:436-443. [PMID: 29205207 DOI: 10.1038/tpj.2017.46] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 06/19/2017] [Accepted: 06/30/2017] [Indexed: 01/11/2023]
Abstract
Translation of drug candidates into clinical settings requires demonstration of preclinical efficacy and formal toxicology analysis for filling an Investigational New Drug (IND) application with the US Food and Drug Administration (FDA). Here, we investigate the membrane-associated glucose response protein 78 (GRP78) as a therapeutic target in leukemia and lymphoma. We evaluated the efficacy of the GRP78-targeted proapoptotic drug bone metastasis targeting peptidomimetic 78 (BMTP-78), a member of the D(KLAKLAK)2-containing class of agents. BMTP-78 was validated in cells from patients with acute myeloid leukemia and in a panel of human leukemia and lymphoma cell lines, where it induced dose-dependent cytotoxicity in all samples tested. Based on the in vitro efficacy of BMTP-78, we performed formal good laboratory practice toxicology studies in both rodents (mice and rats) and nonhuman primates (cynomolgus and rhesus monkeys). These analyses represent required steps towards an IND application of BMTP-78 for theranostic first-in-human clinical trials.
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Affiliation(s)
- D I Staquicini
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA.,Department of Internal Medicine, Division of Molecular Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - S D'Angelo
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA.,Department of Internal Medicine, Division of Molecular Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - F Ferrara
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA.,Department of Internal Medicine, Division of Molecular Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - K Karjalainen
- Department of Experimental Therapeutics, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - G Sharma
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - T L Smith
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA.,Department of Internal Medicine, Division of Molecular Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - C A Tarleton
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA.,Department of Internal Medicine, Division of Molecular Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - D E Jaalouk
- Department of Biology, American University of Beirut, Beirut, Lebanon
| | - A Kuniyasu
- Department of Molecular Cell Pharmacology, Sojo University, Kumamoto, Japan
| | - W B Baze
- Department of Veterinary Science and Keeling Center for Comparative Medicine and Research, The University of Texas MD Anderson Cancer Center, Bastrop, TX, USA
| | - B K Chaffee
- Department of Veterinary Science and Keeling Center for Comparative Medicine and Research, The University of Texas MD Anderson Cancer Center, Bastrop, TX, USA
| | - P W Hanley
- Department of Veterinary Science and Keeling Center for Comparative Medicine and Research, The University of Texas MD Anderson Cancer Center, Bastrop, TX, USA
| | - K F Barnhart
- Department of Veterinary Science and Keeling Center for Comparative Medicine and Research, The University of Texas MD Anderson Cancer Center, Bastrop, TX, USA.,David H Koch Center, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - E Koivunen
- Department of Biological and Environmental Science, The University of Helsinki, Helsinki, Finland.,Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S Marchiò
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA.,Department of Internal Medicine, Division of Molecular Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA.,Department of Oncology, University of Turin, Candiolo, Italy.,Candiolo Cancer Center-FPO, IRCCS, Candiolo, Italy
| | - R L Sidman
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - J E Cortes
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - H M Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - W Arap
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA.,Department of Internal Medicine, Division of Hematology/Oncology, University of New Mexico School of Medicine, Albuquerque, NM
| | - R Pasqualini
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA.,Department of Internal Medicine, Division of Molecular Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
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Soler AP, Miller M, Smith TL. Langerhans cell sarcoma of the skin in association with superficial atypical Langerhans cell proliferation. Rare Tumors 2017; 9:7037. [PMID: 29218135 PMCID: PMC5708304 DOI: 10.4081/rt.2017.7037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 03/01/2017] [Accepted: 04/11/2017] [Indexed: 12/26/2022] Open
Affiliation(s)
| | - Michael Miller
- Miraca Life Sciences, Hematopathology Division, Phoenix, AZ
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Smith TL, Mokhtech M, Bradley JA, Lightsey JL, Morris CG, Mendenhall NP. Abstract P1-10-13: Can the risk of radiation-induced cardiac disease in breast cancer be mitigated with cardiac-sparing techniques? Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-10-13] [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
Introduction: Data suggest that long-term survivors of breast cancer treated with radiation therapy (RT) have an increased risk of cardiac events despite an overall survival benefit, particularly women with left-sided breast cancers. We hypothesized that with cardiac-sparing radiation techniques there would be no difference in long-term cardiac risks between women with right- and left-sided breast cancers.
Materials and Methods: The outcomes of 775 consecutive women treated between 1984 and 1999 with breast-conserving therapy (BCT) (n=424) and post-mastectomy radiation therapy (PMRT) (n=351) for stage 0-3 breast cancer were assessed retrospectively through a review of medical records and contact with living patients. The choice of BCT vs PMRT was based on tumor board disposition and patient preference; mastectomy was recommended for multicentric or T3 breast cancers. Ninety-six percent of all node-positive patients received treatment to all nodal regions, including the internal mammary (IM), axillary (AX), and supraclavicular (SC) nodes. BCT patients had computed tomography-planned tangential breast radiation with photons with IM nodes treated within the tangent fields or with a separate en face electron field to minimize cardiac exposure. PMRT patients were treated with en face electron fields for the chest wall and IM for sparing of the lung and heart. The AX and SC nodes were treated with a matched anterior photon field with a posterior-anterior boost field (PAB) when necessary to achieve adequate dose in the AX with both BCT and PMRT. Overall, 411 patients were node-negative and 353 were node-positive. All patients have a minimum potential follow-up of 16.4 years; median actual follow-up for the BCT group was 15 years (range, 0.1-31.2) and for the PMRT group it was 9.5 years (range, 0.1-30.5).
Results: Overall survival (OS), cause-specific survival (CSS), and freedom from local-regional recurrence (FFLR) rates for the cohort at 15 years were 58.2%, 72.0%, and 90.8%, respectively. Rates of freedom from cardiac events (FFCE), pulmonary events, and second malignancy were 87.6%, 93.6%, and 86.3%, respectively. On multivariate analysis, OS was correlated with stage (p=.045), number of positive nodes (p=.002), age (p<.0001), diabetes (p =.0021), and modality (p=.0017). Not surprisingly, 15-year survival for patients treated with BCT was better than for patients treated with PMRT (70.9% vs 59.7%; p<.0001). CSS was associated with stage (p=.0207), number of positive nodes (p=.0409), and modality (p=.0003). FFLR was associated with number of positive nodes (p=.0484). FFCE was associated with pretreatment cardiac disease (p<.0001), stage (p=.0461), and age (p=.0056), but not with either breast cancer laterality (p=.1906) or modality (BCT vs PMRT; p=.7487).
Discussion: Long-term disease control and survival outcomes were better in BCT than PMRT patients, likely due to selection criteria. Cardiac events were associated with pretreatment heart disease, older age, and stage, suggesting that this population may benefit from advanced radiation techniques that can further limit cardiac dose. Neither breast cancer laterality nor treatment modality was associated with cardiac events.
Citation Format: Smith TL, Mokhtech M, Bradley JA, Lightsey JL, Morris CG, Mendenhall NP. Can the risk of radiation-induced cardiac disease in breast cancer be mitigated with cardiac-sparing techniques? [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-10-13.
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Affiliation(s)
- TL Smith
- University of Florida College of Medicine, Gainesville, FL; University of Florida Health Proton Therapy Institute, Jacksonville, FL
| | - M Mokhtech
- University of Florida College of Medicine, Gainesville, FL; University of Florida Health Proton Therapy Institute, Jacksonville, FL
| | - JA Bradley
- University of Florida College of Medicine, Gainesville, FL; University of Florida Health Proton Therapy Institute, Jacksonville, FL
| | - JL Lightsey
- University of Florida College of Medicine, Gainesville, FL; University of Florida Health Proton Therapy Institute, Jacksonville, FL
| | - CG Morris
- University of Florida College of Medicine, Gainesville, FL; University of Florida Health Proton Therapy Institute, Jacksonville, FL
| | - NP Mendenhall
- University of Florida College of Medicine, Gainesville, FL; University of Florida Health Proton Therapy Institute, Jacksonville, FL
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23
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Coleman SC, Smith TL. Midline Radiofrequency Tissue Reduction of the Palate for Bothersome Snoring and Sleep-Disordered Breathing: A Clinical Trial. Otolaryngol Head Neck Surg 2016; 122:387-94. [PMID: 10699816 DOI: 10.1016/s0194-5998(00)70054-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study is a prospective, nonrandomized clinical trial initiated to assess the safety and efficacy of radiofrequency tissue reduction of the palate for the treatment of bothersome snoring and sleep-disordered breathing. Twelve healthy volunteers with socially disruptive snoring underwent a baseline polysomnogram along with a battery of visual analog scales (VASs) to measure daytime sleepiness, snoring level, pain, and disturbances of speech and swallowing. After radiofrequency tissue reduction of the palate, they were re-evaluated with a mean follow-up after the final procedure of 15.7 ± 5.1 (mean ± SD) weeks. As rated by the bed partner, a significant reduction in the level of snoring occurred in all 12 patients, with a mean pretreatment snoring level of 8.3 ± 2.1 to a mean posttreatment snoring level of 2.1 ± 1.4. (Student t test, P < 0.0001) These patients required an average of 2.3 treatment sessions each. Nine of 12 had a reduction in snoring from a bothersome level (VAS range 5–10) to a nonbothersome level (VAS range 0–3). Daytime sleepiness as measured by the Epworth Sleepiness Scale (0–24) decreased from 10.8 ± 4.4 to 8.3 ± 4.1 ( P = 0.011). Posttreatment pain was considered absent or minimal in 11 of 12 patients and was managed with acetaminophen. No significant adverse events or complications were reported.
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Affiliation(s)
- S C Coleman
- Department of Otolaryngology, Vanderbilt Bill Wilkerson Center for Otolaryngology and Communication Sciences, Nashville, TN, USA
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24
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Luo TD, Alton TB, Apel PJ, Cai J, Barnwell JC, Sonntag WE, Smith TL, Li Z. Effects of age and insulin-like growth factor-1 on rat neurotrophin receptor expression after nerve injury. Muscle Nerve 2016; 54:769-75. [PMID: 26970089 DOI: 10.1002/mus.25106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 11/20/2015] [Revised: 03/02/2016] [Accepted: 03/08/2016] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Neurotrophin receptors, such as p75(NTR) , direct neuronal response to injury. Insulin-like growth factor-1 receptor (IGF-1R) mediates the increase in p75(NTR) during aging. The aim of this study was to examine the effect of aging and insulin-like growth factor-1 (IGF-1) treatment on recovery after peripheral nerve injury. METHODS Young and aged rats underwent tibial nerve transection with either local saline or IGF-1 treatment. Neurotrophin receptor mRNA and protein expression were quantified. RESULTS Aged rats expressed elevated baseline IGF-1R (34% higher, P = 0.01) and p75(NTR) (68% higher, P < 0.01) compared with young rats. Post-injury, aged animals expressed significantly higher p75(NTR) levels (68.5% above baseline at 4 weeks). IGF-1 treatment suppressed p75(NTR) gene expression at 4 weeks (17.2% above baseline, P = 0.002) post-injury. CONCLUSIONS Local IGF-1 treatment reverses age-related declines in recovery after peripheral nerve injuries by suppressing p75(NTR) upregulation and pro-apoptotic complexes. IGF-1 may be considered a viable adjuvant therapy to current treatment modalities. Muscle Nerve 54: 769-775, 2016.
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Affiliation(s)
- T David Luo
- Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Medical Center Boulevard, Winston-Salem, North Carolina, 27157, USA
| | - Timothy B Alton
- Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Medical Center Boulevard, Winston-Salem, North Carolina, 27157, USA
| | - Peter J Apel
- Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Medical Center Boulevard, Winston-Salem, North Carolina, 27157, USA
| | - Jiaozhong Cai
- Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Medical Center Boulevard, Winston-Salem, North Carolina, 27157, USA
| | - Jonathan C Barnwell
- Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Medical Center Boulevard, Winston-Salem, North Carolina, 27157, USA
| | - William E Sonntag
- Department of Geriatric Medicine, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA
| | - Thomas L Smith
- Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Medical Center Boulevard, Winston-Salem, North Carolina, 27157, USA
| | - Zhongyu Li
- Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Medical Center Boulevard, Winston-Salem, North Carolina, 27157, USA.
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25
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Abstract
In 1989, industry produced some experimental, permeably-faced polyisocyanurate (PIR) laminated board insulation blown with HCFC-141b and a second batch blown with CFC-11, which has undergone continuous field thermal performance monitoring for 5.5 years (June 1989 until February 1995). From these boards, several thin-sliced specimens were prepared and laboratory k-factors periodically measured on these core foam specimens. This work was conducted as part of a six-year joint research project between The Society of the Plastics Industry, Inc. (SPI). Polyisocyanurate Insulation Manufacturers Association (PIMA), National Roofing Contractors Association (NRCA), and the U.S. Department of Energy (DOE) Oak Ridge National Laboratory (ORNL). One of the major research products from this cooperative research effort was the development of an accelerated method for predicting full thickness lifetime thermal conductivities ("in-service R-values") of permeably-faced polyisocyanurate products. This paper compares the prediction of the field installed permeably-faced boards generated from the accelerated aging procedure to the actual measured field performance. The field applications consist of loose-laid boards under ethylene propylene diene terpolymer (EPDM) membranes in a low-sloped roof installed in the ORNL Roof Thermal Research Apparatus (RTRA). For the 5.5 years, each test roof was monitored hourly for temperature and heat flux. This data provides a time series of boundary conditions for a computer program PROPOR ( Properties— Oak Ridge) to compute weekly thermal conductivities. PROPOR is an application of one-dimensional inverse heat transfer analysis. Every six months the test specimens were pulled from the roof and tested under steady state conditions in the laboratory according in American Society of Testing Materials (ASTM) C 518-91. This field validation of an accelerated aging procedure concludes that the thin slicing and laboratory k-factor measurements, within the first six months, accurately predict five years of full thickness, in-situ thermal performance of HCFC-141b permeably-faced polyisocyanurate insulation boards. A computer program was developed which uses the thin slice data set of a specific manufacturer's insulation. The design service life and full product thickness is input, and the in-service R-value is estimated. This value will vary depending on results from the thin slice testing. This work is leading toward an acceptable industry standard to determine the in-service R-value, which is defined as the design thermal resistance of insulation over the normal life of a roof system containing foams which thermally age. At the National Roof Contractors Association 110th Annual Convention Feb. 4, 1997 in Orlando, Florida, the Polyisocyanurate Insulation Manufacturers announced that by January 1, 1998 each PIMA member-insulation manufacturer would have available aged thermal performance data.
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Affiliation(s)
- Jeffrey E. Christian
- Oak Ridge National Laboratory, Metals and Ceramics Division, P.O. Box 2008, Oak Ridge, Tennessee 37831-6092
| | - André Desjarlais
- Oak Ridge National Laboratory, Metals and Ceramics Division, P.O. Box 2008, Oak Ridge, Tennessee 37831-6092
| | - Ron Graves
- Oak Ridge National Laboratory, Metals and Ceramics Division, P.O. Box 2008, Oak Ridge, Tennessee 37831-6092
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Abstract
Objective: To measure muscle tone in a cohort of patients 12 months after stroke and develop a preliminary model, using data recorded routinely after stroke, to predict who will develop spasticity. Design: A cohort study. Setting: Initially hospitalized but subsequently community-dwelling stroke survivors in Liverpool, United Kingdom. Subjects: One hundred and six consecutively presenting stroke patients surviving to 12 months. Main outcome measures: Spasticity measured at a range of joints using the Tone Assessment Scale. Results: The Tone Assessment Scale revealed spasticity in 38 (36%) patients and more severe spasticity in 21 (20%) of the 106 patients. Logistic regression analysis revealed that lower day 7 Barthel Index score and early arm or leg weakness were significant predictors of abnormal muscle tone; and lower day 7 Barthel Index score, left-sided weakness and ever smoked to be significant predictors of more severe muscle tone. Conclusions: Using the models, it may be possible to predict whether or not spasticity will develop in patients 12 months after stroke. The utility of the models is aided by their use of predictor variables that are routinely collected as part of stroke care in hospital and which are easy to measure. The models need testing prospectively in a new cohort of patients in order to test their validity, reliability and utility and to determine if other data could improve their efficiency.
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Affiliation(s)
- M J Leathley
- Stroke Team for Audit and Research, University Hospital Aintree, Liverpool, UK.
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Stuart CH, Singh R, Smith TL, D'Agostino R, Caudell D, Balaji KC, Gmeiner WH. Prostate-specific membrane antigen-targeted liposomes specifically deliver the Zn(2+) chelator TPEN inducing oxidative stress in prostate cancer cells. Nanomedicine (Lond) 2016; 11:1207-22. [PMID: 27077564 DOI: 10.2217/nnm-2015-0017] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
AIM To evaluate the potential use of zinc chelation for prostate cancer therapy using a new liposomal formulation of the zinc chelator, N,N,N',N'-tetrakis(2-pyridylmethyl)-ethylenediamine (TPEN). MATERIALS & METHODS TPEN was encapsulated in nontargeted liposomes or liposomes displaying an aptamer to target prostate cancer cells overexpression prostate-specific membrane antigen. The prostate cancer selectivity and therapeutic efficacy of liposomal (targeted and nontargeted) and free TPEN were evaluated in vitro and in tumor-bearing mice. RESULTS & CONCLUSION TPEN chelates zinc and results in reactive oxygen species imbalance leading to cell death. Delivery of TPEN using aptamer-targeted liposomes results in specific delivery to targeted cells. In vivo experiments show that TPEN-loaded, aptamer-targeted liposomes reduce tumor growth in a human prostate cancer xenograft model.
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Affiliation(s)
- Christopher H Stuart
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.,Department of Molecular Medicine & Translation Science, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Ravi Singh
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.,Comprehensive Cancer Center at Wake Forest University, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Thomas L Smith
- Department of Orthopedics, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Ralph D'Agostino
- Comprehensive Cancer Center at Wake Forest University, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.,Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - David Caudell
- Department of Pathology & Comparative Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - K C Balaji
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.,Comprehensive Cancer Center at Wake Forest University, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.,Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.,Wake Forest Institute of Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - William H Gmeiner
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.,Department of Molecular Medicine & Translation Science, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.,Comprehensive Cancer Center at Wake Forest University, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
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29
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Willey JS, Bracey DN, Gallagher PE, Tallant EA, Wiggins WF, Callahan MF, Smith TL, Emory CL. Angiotensin-(1-7) Attenuates Skeletal Muscle Fibrosis and Stiffening in a Mouse Model of Extremity Sarcoma Radiation Therapy. J Bone Joint Surg Am 2016; 98:48-55. [PMID: 26738903 DOI: 10.2106/jbjs.o.00545] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 02/01/2023]
Abstract
BACKGROUND Radiation-induced fibrosis (RIF) of musculoskeletal tissue is a common complication of radiation therapy for extremity soft-tissue sarcoma, with no standardized strategy for prevention and treatment. Angiotensin-(1-7) (Ang-[1-7]), a well-tolerated endogenous heptapeptide hormone with antitumor and antifibrotic properties, was tested as a radioprotectant for RIF and stiffening of irradiated muscles. METHODS Male CD-1 mice were randomized to one of three treatment groups: control, simulated sarcoma radiation therapy to the gastrocnemius and soleus muscles, or radiation therapy along with continuous Ang-(1-7) delivery initiated three days before radiation therapy. The biologically equivalent dose of radiation (∼100.3 Gy) absorbed by normal musculature during the course of radiation therapy for extremity sarcoma was delivered by means of four dose fractions of 7.3 Gy over two weeks. Fibrosis (n = 5 per group) and mechanical properties (n = 4 to 6 per group) of the muscles were measured at six weeks and four months after radiation therapy, and the intramuscular concentration of the profibrotic cytokines transforming growth factor-beta (TGF-β) and connective tissue growth factor (CTGF) (n = 8 to 10 per group) were measured at six weeks. RESULTS Interstitial (p < 0.01) and perivascular (p < 0.05) fibrosis increased significantly in the muscles treated with radiation therapy alone versus the nonirradiated controls at both six weeks (interstitial, +89%; perivascular, +112%) and four months (interstitial, +154%; perivascular, +88%). The muscles treated with radiation alone also exhibited increased tension (p < 0.01) versus nonirradiated controls at both six weeks (+779%) and four months (+1761%) when placed under 5% strain, and at four months (+1390%; p < 0.001) under 10% strain. At four months, muscle stiffness had increased in the mice treated with radiation therapy alone (+90%; p = 0.002) compared with nonirradiated controls. TGF-β production was also greater in this group at six weeks (+37%; p = 0.06) versus control. Ang-(1-7) administration prevented RIF and stiffening, with no differences observed for any other outcome between those receiving radiation therapy with Ang-(1-7) and the nonirradiated controls. Likewise, Ang-(1-7) mitigated the increase in TGF-β and CTGF concentration from radiation therapy. CONCLUSIONS Ang-(1-7) attenuated RIF, stiffening, and production of profibrotic cytokines that were elevated in mouse skeletal muscles after simulated radiation therapy for extremity sarcoma. CLINICAL RELEVANCE Ang-(1-7) may serve as a potential therapy for the prevention of RIF in patients who require radiation therapy as adjuvant treatment for soft-tissue sarcoma.
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Affiliation(s)
- Jeffrey S Willey
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, North Carolina Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Daniel N Bracey
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Patricia E Gallagher
- Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, North Carolina Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - E Ann Tallant
- Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, North Carolina Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Walter F Wiggins
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael F Callahan
- Tensive Controls, MU Life Sciences Business Incubator, Columbia, Missouri
| | - Thomas L Smith
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Cynthia L Emory
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, North Carolina Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, North Carolina
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30
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Pulley BR, Luo TD, Barnwell JC, Smith BP, Smith TL, Li Z. A chronically-denervated versus a freshly-harvested autograft for nerve repair in rats. Hand Microsurg 2016; 5:124-129. [PMID: 30828670 DOI: 10.5455/handmicrosurg.215015] [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] [Indexed: 11/03/2022] Open
Abstract
Objectives Autologous nerve grafting remains the gold standard for repair of peripheral nerve injuries. Its use, however, is limited by donor nerve availability and donor site morbidity. This is especially problematic after failure of an initial autograft that requires a repeat nerve graft, resulting in a second surgical site with associated morbidity. Based on the molecular differences in nerve degeneration in the proximal and distal segments after transection, we hypothesized that a chronically-denervated proximal stump may be viable for autologous nerve repair. Methods 20 Sprague-Dawley rats underwent right sciatic nerve excision and sural nerve transection. After 8 weeks, nerve repair was performed by harvesting the proximal segment of the sural nerve (n=10) or a fresh sural nerve (n=10) from the contralateral hind limb. Electrophysiological changes were analyzed to compare the fresh and denervated grafts. Results Electrophysiological testing demonstrated higher compound motor action potential in the denervated group compared to the fresh autograft group, however this difference was not statistically significant (p=0.117). Conclusion The proximal segment of a chronically-denervated sural nerve can be as effective as a fresh sural nerve for autologous repair of peripheral nerve injuries in a rodent model.
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Affiliation(s)
| | | | | | - Beth P Smith
- Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Thomas L Smith
- Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Zhongyu Li
- Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
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31
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Santago AC, Plate JF, Shively CA, Register TC, Smith TL, Saul KR. Age-related structural changes in upper extremity muscle tissue in a nonhuman primate model. J Shoulder Elbow Surg 2015; 24:1660-8. [PMID: 25963066 PMCID: PMC4575823 DOI: 10.1016/j.jse.2015.03.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 03/09/2015] [Accepted: 03/18/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Longitudinal studies of upper extremity aging in humans include logistical concerns that animal models can overcome. The vervet is a promising species with which to study aging-related processes. However, age-related changes in upper extremity muscle structure have not been quantified in this species. This study measured age-related changes to muscle structure, examined relationships between muscle structure and measures of physical performance, and evaluated the presence of rotator cuff tears. METHODS Muscle structure (volume, optimal fiber length, and physiologic cross-sectional area (PCSA)) of 10 upper extremity muscles was quantified from the right upper limb of 5 middle-aged and 6 older adult female vervets. RESULTS Total measured PCSA was smaller (P = .001) in the older adult vervets than in the middle-aged vervets. Muscle volume reduction predominate the age-related reductions in PCSA. Total measured PCSA was not correlated to any measures of physical performance. No rotator cuff tears were observed. Supraspinatus volume was relatively larger and deltoid volume relatively smaller in the vervet compared with a human. CONCLUSIONS The vervet is an appropriate translational model for age-related upper extremity muscle volume loss. Functional measures were not correlated to PCSA, suggesting the vervets may have enough strength for normal function despite loss of muscle tissue. Reduced relative demand on the supraspinatus may be responsible for the lack of naturally occurring rotator cuff tears.
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Affiliation(s)
- Anthony C Santago
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC, USA; Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC, USA
| | - Johannes F Plate
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Carol A Shively
- Department of Pathology (Comparative Medicine) and the Wake Forest Primate Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Thomas C Register
- Department of Pathology (Comparative Medicine) and the Wake Forest Primate Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Thomas L Smith
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Katherine R Saul
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC, USA.
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Carver KA, Smith TL, Gallagher PE, Tallant EA. Angiotensin-(1-7) prevents angiotensin II-induced fibrosis in cremaster microvessels. Microcirculation 2015; 22:19-27. [PMID: 25079175 DOI: 10.1111/micc.12159] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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: 03/18/2014] [Accepted: 07/29/2014] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The effect of the heptapeptide hormone Ang-(1-7) on microvascular fibrosis in rats with Ang II-induced hypertension was investigated, since vascular fibrosis/remodeling plays a prominent role in hypertension-induced end-organ damage and Ang-(1-7) inhibits vascular growth and fibrosis. METHODS Fibrosis of cremaster microvessels was studied in male Lewis rats infused with Ang II and/or Ang-(1-7). RESULTS Ang II elevated systolic blood pressure by approximately 40 mmHg, while blood pressure was not changed by Ang-(1-7). Ang II increased perivascular fibrosis surrounding 20-50 μm arterioles as well as interstitial fibrosis; coadministration of Ang-(1-7) prevented the increases in fibrosis. The fibrotic factor CTGF and phospho-Smad 2/3, which upregulates CTGF, were increased by Ang II; this effect was prevented by coadministration of Ang-(1-7). Although TGF-β phosphorylates Smad 2/3, TGF-β was no different among treatment groups. In contrast, Ang II increased the MAP kinase phospho-ERK1/2, which also phosphorylates Smad; p-ERK was reduced by Ang-(1-7). Ang-(1-7), in the presence or absence of Ang II, upregulated the MAP kinase phosphatase DUSP1. CONCLUSIONS These results suggest that Ang-(1-7) increases DUSP1 to reduce MAP kinase/Smad/CTGF signaling and decrease fibrosis in resistance arterioles, to attenuate end-organ damage associated with chronic hypertension.
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Affiliation(s)
- Kyle A Carver
- Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Abstract
BACKGROUND To understand the role of Angiotensin-(1-7) (Ang-(1-7)) in vasculature of pregnant women, we compared cardiac output (CO), total peripheral resistance (TPR) and forearm blood flow (FBF) responses to Ang-(1-7) infusion between normotensive pregnant women in their third trimester and healthy age matched non-pregnant women. The responses of skin microcirculation to Ang-(1-7) were tested in preeclamptic, normotensive pregnant and non-pregnant women. Responses to Angiotensin II (Ang II) were also determined. METHODS Non-invasive methods for systemic (bioimpedance and VascuMAP), FBF (venous occlusion strain gauge plethysmography), and skin (laser Doppler) hemodynamics assessments were used. RESULTS Compared to non-pregnant women, systemic infusion of Ang-(1-7) (2000 pmol/min) resulted in a greater increase in CO (9.4 ± 6.4 versus -3.3 ± 2.1%, n = 9-10) in normotensive pregnant women. Brachial local infusion of Ang-(1-7) had no effect on FBF in either group. In non-pregnant and normotensive pregnant women, local Ang II induced a dose-dependent decrease in FBF and increase in forearm resistance at 50 and 100 pmol/min (p < 0.05 versus corresponding baseline, n = 7-10). Following iontophoretic application of 5 mmol/l dose of Ang-(1-7), the change in skin flow was higher in normotensive pregnant versus preeclamptic women (182.5 ± 93 versus 15.76 ± 19.46%, n = 14-15). Skin flow was lower in normotensive pregnant versus preeclamptic women (-46.5 ± 48.7 versus 108.7 ± 49.1%, n = 14-15) following Ang II infusion at 1.0 pmol/min. CONCLUSION In the third trimester of pregnancy, Ang-(1-7) induces alterations in CO and differentially regulates micro- and macro-circulations, depending on the dose. Dysregulation in skin vasculature may contribute to the development of vascular dysfunction and hypertension in preeclampsia.
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Affiliation(s)
- Liliya M. Yamaleyeva
- The Hypertension & Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - David C. Merrill
- Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Aurora Health Care, Kenosha, WI, USA
| | - Thomas J. Ebert
- Department of Anesthesiology, Zablocki VA Medical Center and Medical College of Wisconsin, Milwaukee, WI, USA
| | - Thomas L. Smith
- The Hypertension & Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Heather L. Mertz
- Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - K. Bridget Brosnihan
- The Hypertension & Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Hutchinson ID, Olson J, Lindburg CA, Payne V, Collins B, Smith TL, Munley MT, Wheeler KT, Willey JS. Total-body irradiation produces late degenerative joint damage in rats. Int J Radiat Biol 2014; 90:821-30. [PMID: 24885745 DOI: 10.3109/09553002.2014.927935] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Premature musculoskeletal joint failure is a major source of morbidity among childhood cancer survivors. Radiation effects on synovial joint tissues of the skeleton are poorly understood. Our goal was to assess long-term changes in the knee joint from skeletally mature rats that received total-body irradiation while skeletal growth was ongoing. MATERIALS AND METHODS 14 week-old rats were irradiated with 1, 3 or 7 Gy total-body doses of 18 MV X-rays. At 53 weeks of age, structural and compositional changes in knee joint tissues (articular cartilage, subchondral bone, and trabecular bone) were characterized using 7T MRI, nanocomputed tomography (nanoCT), microcomputed tomography (microCT), and histology. RESULTS T2 relaxation times of the articular cartilage were lower after exposure to all doses. Likewise, calcifications were observed in the articular cartilage. Trabecular bone microarchitecture was compromised in the tibial metaphysis at 7 Gy. Mild to moderate cartilage erosion was scored in the 3 and 7 Gy rats. CONCLUSIONS Late degenerative changes in articular cartilage and bone were observed after total-body irradiation in adult rats exposed prior to skeletal maturity. 7T MRI, microCT, nanoCT, and histology identified potential prognostic indicators of late radiation-induced joint damage.
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Gmeiner WH, Willingham MC, Bourland JD, Hatcher HC, Smith TL, D'Agostino RB, Blackstock W. F10 Inhibits Growth of PC3 Xenografts and Enhances the Effects of Radiation Therapy. J Clin Oncol Res 2014; 2:1028. [PMID: 26020060 PMCID: PMC4442609] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Chemotherapy remains of limited use for the treatment of prostate cancer with only one drug, docetaxel, demonstrating a modest survival advantage for treatment of late-stage disease. Data from the NCI 60 cell line screen indicated that the castration-resistant prostate cancer cell lines PC3 and DU145 were more sensitive than average to the novel polymeric fluoropyrimidine (FP), F10, despite displaying less than average sensitivity to the widely-used FP, 5FU. Here, we show that F10 treatment of PC3 xenografts results in a significant survival advantage (treatment to control ratio (T/C) days = 18; p < 0.001; n = 16) relative to control mice treated with saline. F10 (40 mg/kg/dose) was administered via jugular vein catheterization 3-times per week for five weeks. This aggressive dosing regimen was completed with no drug-induced weight loss and with no evidence of toxicity. F10 was also shown to sensitize PC3 cells to radiation and F10 was also shown to be a potent radiosensitizer of PC3 xenografts in vivo with F10 in combination with radiation resulting in significantly greater regression of PC3 xenografts than radiation alone. The results indicate that F10 in this pre-clinical setting is an effective chemotherapeutic agent and possesses significant radiosensitizing properties.
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Affiliation(s)
- William H Gmeiner
- Department of Cancer Biology, Wake Forest University School of Medicine, USA
| | - Mark C Willingham
- Department of Pathology, Wake Forest University School of Medicine, USA
| | - J Daniel Bourland
- Department of Radiation Oncology, Wake Forest University School of Medicine, USA
| | - Heather C Hatcher
- Department of Cancer Biology, Wake Forest University School of Medicine, USA
| | - Thomas L Smith
- Department of Orthopedics, Wake Forest University School of Medicine, USA
| | - Ralph B D'Agostino
- Department of Public Health Sciences, Wake Forest University School of Medicine, USA
| | - William Blackstock
- Department of Radiation Oncology, Wake Forest University School of Medicine, USA
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Plate JF, Brown PJ, Walters J, Clark JA, Smith TL, Freehill MT, Tuohy CJ, Stitzel JD, Mannava S. Advanced age diminishes tendon-to-bone healing in a rat model of rotator cuff repair. Am J Sports Med 2014; 42:859-68. [PMID: 24500915 DOI: 10.1177/0363546513518418] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [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] [Indexed: 02/06/2023]
Abstract
BACKGROUND Advanced patient age is associated with recurrent tearing and failure of rotator cuff repairs clinically; however, basic science studies have not evaluated the influence of aging on tendon-to-bone healing after rotator cuff repair in an animal model. Hypothesis/ PURPOSE This study examined the effect of aging on tendon-to-bone healing in an established rat model of rotator cuff repair using the aged animal colony from the National Institute on Aging of the National Institutes of Health. The authors hypothesized that normal aging decreases biomechanical strength and histologic organization at the tendon-to-bone junction after acute repair. STUDY DESIGN Controlled laboratory study. METHODS In 56 F344xBN rats, 28 old and 28 young (24 and 8 months of age, respectively), the supraspinatus tendon was transected and repaired. At 2 or 8 weeks after surgery, shoulder specimens underwent biomechanical testing to compare load-to-failure and load-relaxation response between age groups. Histologic sections of the tendon-to-bone interface were assessed with hematoxylin and eosin staining, and collagen fiber organization was assessed by semiquantitative analysis of picrosirius red birefringence under polarized light. RESULTS Peak failure load was similar between young and old animals at 2 weeks after repair (31% vs 26% of age-matched uninjured controls, respectively; P > .05) but significantly higher in young animals compared with old animals 8 weeks after repair (86% vs 65% of age-matched uninjured controls, respectively; P < .01). Eight weeks after repair, fibroblasts appeared more organized and uniformly aligned in young animals on hematoxylin and eosin slides compared with old animals. Collagen birefringence analysis of the tendon-to-bone junction demonstrated that young animals had increased collagen fiber organization and similar histologic structure compared with age-matched controls (53.7 ± 2.4 gray scales; P > .05). In contrast, old animals had decreased collagen fiber organization and altered structure compared with age-matched controls (49.8 ± 3.1 gray scales; P < .01). DISCUSSION In a rat model of aging, old animals demonstrated diminished tendon-to-bone healing after rotator cuff injury and repair. Old animals had significantly decreased failure strength and collagen fiber organization at the tendon-to-bone junction compared with young animals. This study implies that animal age may need to be considered in future studies of rotator cuff repair in animal models. CLINICAL RELEVANCE With increasing age and activity level of the population, the incidence of rotator cuff tears is predicted to rise. Despite advances in rotator cuff repair technique, the retear rate remains specifically high in elderly patients. The findings of this research suggest that aging negatively influences tendon-to-bone healing after rotator cuff repair in a validated animal model.
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Affiliation(s)
- Johannes F Plate
- Johannes F. Plate, Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA. )
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Kowalczewski CJ, Tombyln S, Wasnick DC, Hughes MR, Ellenburg MD, Callahan MF, Smith TL, Van Dyke ME, Burnett LR, Saul JM. Reduction of ectopic bone growth in critically-sized rat mandible defects by delivery of rhBMP-2 from kerateine biomaterials. Biomaterials 2014; 35:3220-8. [PMID: 24439399 PMCID: PMC4321825 DOI: 10.1016/j.biomaterials.2013.12.087] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 12/22/2013] [Indexed: 10/25/2022]
Abstract
Absorbable collagen sponges (ACS) are used clinically as carriers of recombinant human bone morphogenetic protein 2 (rhBMP-2) to promote bone regeneration. ACS exhibit ectopic bone growth due to delivery of supraphysiological levels of rhBMP-2, which is particularly problematic in craniofacial bone injuries for both functional and esthetic reasons. We hypothesized that hydrogels from the reduced form of keratin proteins (kerateine) would serve as a suitable alternative to ACS carriers of rhBMP-2. The rationale for this hypothesis is that keratin biomaterials degrade slowly in vivo, have modifiable material properties, and have demonstrated capacity to deliver therapeutic agents. We investigated kerateine hydrogels and freeze-dried scaffolds as rhBMP-2 carriers in a critically-sized rat mandibular defect model. ACS, kerateine hydrogels, and kerateine scaffolds loaded with rhBMP-2 achieved bridging in animals by 8 weeks as indicated by micro-computed tomography. Kerateine scaffolds achieved statistically increased bone mineral density compared to ACS and kerateine hydrogels, with levels reaching those of native bone. Importantly, both kerateine hydrogels and kerateine scaffolds had significantly less ectopic bone growth than ACS sponges at both 8 and 16 weeks post-operatively. These studies demonstrate the suitability of keratins as rhBMP-2 carriers due to equal regenerative capacity with reduced ectopic growth compared to ACS.
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Affiliation(s)
- Christine J Kowalczewski
- Department of Chemical, Paper, and Biomedical Engineering, Miami University, 650 E. High St., Oxford, OH 45056, USA; School of Biomedical Engineering and Sciences, Virginia Tech-Wake Forest University, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Seth Tombyln
- KeraNetics, LLC, Richard Dean Biomedical Research Building, Suite 168, 391 Technology Way, Winston-Salem, NC 27101, USA
| | - David C Wasnick
- Department of Chemical, Paper, and Biomedical Engineering, Miami University, 650 E. High St., Oxford, OH 45056, USA
| | - Michael R Hughes
- Department of Statistics, Miami University, 311 Upham Hall, 501 E. High St., Oxford, OH 45056, USA
| | - Mary D Ellenburg
- KeraNetics, LLC, Richard Dean Biomedical Research Building, Suite 168, 391 Technology Way, Winston-Salem, NC 27101, USA
| | - Michael F Callahan
- Animal Health Specialties, LLC, MU Life Sciences Business Incubator at Monsanto Place, 1601 South Providence Road, Columbia, MO 65211, USA
| | - Thomas L Smith
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Mark E Van Dyke
- School of Biomedical Engineering and Sciences, Virginia Tech-Wake Forest University, 317 Kelly Hall, Stanger St, Blacksburg, VA 24061, USA
| | - Luke R Burnett
- KeraNetics, LLC, Richard Dean Biomedical Research Building, Suite 168, 391 Technology Way, Winston-Salem, NC 27101, USA
| | - Justin M Saul
- Department of Chemical, Paper, and Biomedical Engineering, Miami University, 650 E. High St., Oxford, OH 45056, USA.
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Wonderlich SA, Peterson CB, Crosby RD, Smith TL, Klein MH, Mitchell JE, Crow SJ. A randomized controlled comparison of integrative cognitive-affective therapy (ICAT) and enhanced cognitive-behavioral therapy (CBT-E) for bulimia nervosa. Psychol Med 2014; 44:543-553. [PMID: 23701891 PMCID: PMC5551978 DOI: 10.1017/s0033291713001098] [Citation(s) in RCA: 154] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The purpose of this investigation was to compare a new psychotherapy for bulimia nervosa (BN), integrative cognitive-affective therapy (ICAT), with an established treatment, 'enhanced' cognitive-behavioral therapy (CBT-E). METHOD Eighty adults with symptoms of BN were randomized to ICAT or CBT-E for 21 sessions over 19 weeks. Bulimic symptoms, measured by the Eating Disorder Examination (EDE), were assessed at baseline, at the end of treatment (EOT) and at the 4-month follow-up. Treatment outcome, measured by binge eating frequency, purging frequency, global eating disorder severity, emotion regulation, self-oriented cognition, depression, anxiety and self-esteem, was determined using generalized estimating equations (GEEs), logistic regression and a general linear model (intent-to-treat). RESULTS Both treatments were associated with significant improvement in bulimic symptoms and in all measures of outcome, and no statistically significant differences were observed between the two conditions at EOT or follow-up. Intent-to-treat abstinence rates for ICAT (37.5% at EOT, 32.5% at follow-up) and CBT-E (22.5% at both EOT and follow-up) were not significantly different. CONCLUSIONS ICAT was associated with significant improvements in bulimic and associated symptoms that did not differ from those obtained with CBT-E. This initial randomized controlled trial of a new individual psychotherapy for BN suggests that targeting emotion and self-oriented cognition in the context of nutritional rehabilitation may be efficacious and worthy of further study.
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Affiliation(s)
- S A Wonderlich
- Neuropsychiatric Research Institute/Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - C B Peterson
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - R D Crosby
- Neuropsychiatric Research Institute/Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - T L Smith
- Department of Psychiatry, University of Wisconsin, Madison, WI, USA
| | - M H Klein
- Department of Psychiatry, University of Wisconsin, Madison, WI, USA
| | - J E Mitchell
- Neuropsychiatric Research Institute/Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - S J Crow
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
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Plate JF, Pace LA, Seyler TM, Moreno RJ, Smith TL, Tuohy CJ, Mannava S. Age-related changes affect rat rotator cuff muscle function. J Shoulder Elbow Surg 2014; 23:91-8. [PMID: 23791493 DOI: 10.1016/j.jse.2013.04.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 01/08/2013] [Accepted: 04/17/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND The influence of age on rotator cuff function and muscle structure remains poorly understood. We hypothesize that normal aging influences rotator cuff function, muscle structure, and regulatory protein expression in an established rat model of aging. METHODS Seventeen rats were obtained from the National Institute on Aging. The supraspinatus muscles in 11 middle-aged (12 months old) and 6 old (28 months old) rats were studied for age-related changes in rotator cuff neuromuscular function by in vivo muscle force testing and electromyography (EMG). Changes in muscle structure and molecular changes were assessed with quantitative immunohistochemistry for myogenic determination factor 1 (MyoD) and myogenic factor 5 (Myf5) expression. RESULTS Old animals revealed significantly decreased peak tetanic muscle force at 0.5 N and 0.7 N preload tension (P < .05). The age of the animal accounted for 20.9% of variance and significantly influenced muscle force (P = .026). Preload tension significantly influenced muscle force production (P < .001) and accounted for 12.7% of total variance. There was regional heterogeneity in maximal compound motor action potential (CMAP) amplitude in the supraspinatus muscle; the proximal portion had a significantly higher CMAP than the middle and distal portions (P < .05). The expression of muscle regulatory factors MyoD and Myf5 was significantly decreased in old animals compared with middle-aged animals (P < .05). CONCLUSIONS The normal aging process in this rat model significantly influenced contractile strength of the supraspinatus muscle and led to decreased expression of muscle regulatory factors. High preload tensions led to a significant decrease in force production in both middle-aged and old animals.
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Affiliation(s)
- Johannes F Plate
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA; The Neuroscience Program, Wake Forest University Graduate School of Arts and Sciences, Medical Center Boulevard, Winston-Salem, NC, USA.
| | - Lauren A Pace
- The Neuroscience Program, Wake Forest University Graduate School of Arts and Sciences, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Thorsten M Seyler
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Ramon J Moreno
- The Neuroscience Program, Wake Forest University Graduate School of Arts and Sciences, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Thomas L Smith
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Christopher J Tuohy
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Sandeep Mannava
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
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Whitlock PW, Seyler TM, Northam CN, Smith TL, Poehling GG, Koman LA, Van Dyke ME. Effect of cyclic strain on tensile properties of a naturally derived, decellularized tendon scaffold seeded with allogeneic tenocytes and associated messenger RNA expression. J Surg Orthop Adv 2013; 22:224-32. [PMID: 24063799 DOI: 10.3113/jsoa.2013.0224] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Naturally derived tendon scaffolds have the potential to improve the treatment of flexor tendon injuries. Seeded and unseeded tendon scaffolds were maintained in the presence or absence of physiologic strain for 7 days. After 7 days, the tensile properties and associated messenger RNA expression were compared. Seeded scaffolds maintained in the absence of strain had significantly lower tensile properties than unseeded tendons and fresh-frozen tendons. The loss of tensile properties was associated with elevated matrix metalloproteinase-2 and collagen III expression. Tensile properties of seeded scaffolds maintained in the presence of strain for 7 days after seeding did not differ from those of fresh-frozen tendons. This study demonstrates that the tensile properties of seeded, naturally derived tendon scaffolds will degrade rapidly in the absence of cyclic strain. Seeded scaffolds used for tendon reconstruction should be maintained under cyclic strain to maintain essential tensile properties.
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Affiliation(s)
- Patrick W Whitlock
- Department of Orthopaedic Surgery, Wake Forest University Health Sciences, Medical Center Boulevard, Winston-Salem, NC 27157-1070.
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Pace LA, Plate JF, Mannava S, Barnwell JC, Koman LA, Li Z, Smith TL, Van Dyke M. A human hair keratin hydrogel scaffold enhances median nerve regeneration in nonhuman primates: an electrophysiological and histological study. Tissue Eng Part A 2013; 20:507-17. [PMID: 24083825 DOI: 10.1089/ten.tea.2013.0084] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
A human hair keratin biomaterial hydrogel scaffold was evaluated as a nerve conduit luminal filler following median nerve transection injury in 10 Macaca fascicularis nonhuman primates (NHP). A 1 cm nerve gap was grafted with a NeuraGen® collagen conduit filled with either saline or keratin hydrogel and nerve regeneration was evaluated by electrophysiology for a period of 12 months. The keratin hydrogel-grafted nerves showed significant improvement in return of compound motor action potential (CMAP) latency and recovery of baseline nerve conduction velocity (NCV) compared with the saline-treated nerves. Histological evaluation was performed on retrieved median nerves and abductor pollicis brevis (APB) muscles at 12 months. Nerve histomorphometry showed a significantly larger nerve area in the keratin group compared with the saline group and the keratin APB muscles had a significantly higher myofiber density than the saline group. This is the first published study to show that an acellular biomaterial hydrogel conduit filler can be used to enhance peripheral nerve regeneration and motor recovery in an NHP model.
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Affiliation(s)
- Lauren A Pace
- 1 Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine , Winston-Salem, North Carolina
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Pace LA, Plate JF, Smith TL, Van Dyke ME. The effect of human hair keratin hydrogel on early cellular response to sciatic nerve injury in a rat model. Biomaterials 2013; 34:5907-14. [DOI: 10.1016/j.biomaterials.2013.04.024] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Accepted: 04/10/2013] [Indexed: 01/09/2023]
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Plate JF, Bates CM, Mannava S, Smith TL, Jorgensen MJ, Register TC, Stehle JR, High KP, Shively CA, Kaplan JR, Saul KR, Tuohy CJ. Age-related degenerative functional, radiographic, and histological changes of the shoulder in nonhuman primates. J Shoulder Elbow Surg 2013; 22:1019-29. [PMID: 23352182 PMCID: PMC3679299 DOI: 10.1016/j.jse.2012.11.004] [Citation(s) in RCA: 22] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 10/30/2012] [Accepted: 11/11/2012] [Indexed: 02/01/2023]
Abstract
BACKGROUND Nonhuman primates have similar shoulder anatomy and physiology compared to humans, and may represent a previously underutilized model for shoulder research. This study sought to identify naturally occurring bony and muscular degeneration in the shoulder of nonhuman primates and to assess relationships between structural and functional aspects of the shoulder and measures of physical function of the animals. We hypothesized that age-related degenerative changes in the shoulders of nonhuman primates would resemble those observed in aging humans. METHODS Middle-aged (n = 5; ages 9.4-11.8 years) and elderly (n = 6; ages 19.8-26.4 years) female vervet monkeys were studied for changes in mobility and shoulder function, and radiographic and histologic signs of age-related degeneration. RESULTS Four out of 6 (4/6) elderly animals had degenerative changes of the glenoid compared to 0/5 of the middle-aged animals (P = .005). Elderly animals had glenoid retroversion, decreased joint space, walked slower, and spent less time climbing and hanging than middle-aged vervets (P < .05). Physical mobility and shoulder function correlated with glenoid version angle (P < .05). Supraspinatus muscles of elderly animals were less dense (P = .001), had decreased fiber cross-sectional area (P < .001), but similar amounts of nuclear material (P = .085). Degenerative rotator cuff tears were not observed in any of the eleven animals. DISCUSSION AND CONCLUSION The vervet monkey naturally undergoes age-related functional, radiographic and histological changes of the shoulder, and may qualify as an animal model for selected translational research of shoulder osteoarthritis.
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Affiliation(s)
- Johannes F. Plate
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA,The Neuroscience Program, Wake Forest University Graduate School of Arts and Sciences, Winston-Salem, NC, USA
| | - Christopher M. Bates
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA,Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Sandeep Mannava
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA,The Neuroscience Program, Wake Forest University Graduate School of Arts and Sciences, Winston-Salem, NC, USA
| | - Thomas L. Smith
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Matthew J. Jorgensen
- Department of Pathology (Comparative Medicine) and the Wake Forest Primate Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Thomas C. Register
- Department of Pathology (Comparative Medicine) and the Wake Forest Primate Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - John R. Stehle
- Department of Internal Medicine, Gerontology and Geriatric Medicine ,Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kevin P. High
- Department of Internal Medicine, Gerontology and Geriatric Medicine ,Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Carol A. Shively
- Department of Pathology (Comparative Medicine) and the Wake Forest Primate Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jay R. Kaplan
- Department of Pathology (Comparative Medicine) and the Wake Forest Primate Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Katherine R. Saul
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Christopher J. Tuohy
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Moran EC, Raghunathan S, Evans DW, Vavalle NA, LeRoith T, Smith TL, Sparks JL. Porohyperviscoelastic model simultaneously predicts parenchymal fluid pressure and reaction force in perfused liver. J Biomech Eng 2013; 134:091002. [PMID: 22938369 DOI: 10.1115/1.4007175] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Porohyperviscoelastic (PHVE) modeling gives a simplified continuum approximation of pore fluid behavior within the parenchyma of liver tissue. This modeling approach is particularly applicable to tissue engineering of artificial livers, where the inherent complexity of the engineered scaffolds prevents the use of computational fluid dynamics. The objectives of this study were to simultaneously predict the experimental parenchymal fluid pressure (PFP) and compression response in a PHVE liver model. The model PFP matched the experimental measurements (318 Pa) to within 1.5%. Linear regression of both phases of compression, ramp, and hold, demonstrated a strong correlation between the model and the experimental reaction force (p<0.5). The ability of this PVE model to accurately predict both fluid and solid behavior is important due to the highly vascularized nature of liver tissue and the mechanosensitivity of liver cells to solid matrix and fluid flow properties.
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Affiliation(s)
- Emma C Moran
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
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Kim J, Jeong SY, Ju YM, Yoo JJ, Smith TL, Khang G, Lee SJ, Atala A. In vitro osteogenic differentiation of human amniotic fluid-derived stem cells on a poly(lactide-co-glycolide) (PLGA)-bladder submucosa matrix (BSM) composite scaffold for bone tissue engineering. Biomed Mater 2013; 8:014107. [PMID: 23353783 DOI: 10.1088/1748-6041/8/1/014107] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Stem cells have become an important component of tissue regeneration, as they are able to differentiate into various cell types if guided appropriately. It is well known that cellular differentiation is greatly influenced by the surrounding microenvironment. We have developed a composite scaffold system using a collagen matrix derived from porcine bladder submucosa matrix (BSM) and poly(lactide-co-glycolide) (PLGA). In this study, we investigated whether a composite scaffold composed of naturally derived matrix combined with synthetic polymers would provide a microenvironment to facilitate the induction of osteogenic differentiation. We first showed that human amniotic fluid-derived stem cells (hAFSCs) adhered to the composite scaffolds and proliferated over time. We also showed that the composite scaffolds facilitated the differentiation of hAFSCs into an osteogenic lineage. The expression of osteogenic genes, including RUNX2, osteopontin (OPN) and osteocalcin (OCN) was upregulated in cells cultured on the composite scaffolds incubated in the osteogenic medium compared with ones without. Increased alkaline phosphatase (ALP) activity and calcium content indicates that hAFSCs seeded on 3D porous BSM-PLGA composite scaffolds resulted in higher mineralization rates as the duration of induction increased. This was also evidenced by the mineralized matrix within the scaffolds. The composite scaffold system provides a proper microenvironment that can facilitate osteogenic differentiation of AFSCs. This scaffold system may be a good candidate material for bone tissue engineering.
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Affiliation(s)
- Jaehyun Kim
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
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Nunez FA, Callahan MF, Trach S, Burnett LR, Kislukhin V, Smith TL, Van Dyke M. Hemodynamic recovery after hypovolemic shock with lactated Ringer's and keratin resuscitation fluid (KRF), a novel colloid. Artif Cells Nanomed Biotechnol 2013; 41:293-303. [PMID: 23305143 DOI: 10.3109/21691401.2012.747533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Death after severe hemorrhage remains an important cause of mortality in people under 50 years of age. Keratin resuscitation fluid (KRF) is a novel resuscitation solution made from keratin protein that may restore cardiovascular stability. This postulate was tested in rats that were exsanguinated to 40% of their blood volume. Test groups received either low or high volume resuscitation with either KRF or lactated Ringer's solution. KRF low volume was more effective than LR in recovering cardiac function, blood pressure and blood chemistry. Furthermore, in contrast to LR-treated rats, KRF-treated rats exhibited vital signs that resembled normal controls at 1-week.
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Affiliation(s)
- Fiesky A Nunez
- Wake Forest University School of Medicine, Medical Center Blvd., Winston Salem , NC , USA
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Abstract
OBJECTIVE Topical application of subatmospheric pressure (TASAP) promotes faster wound healing, but tissue effects are not entirely understood. This study investigated microvascular effects of TASAP in striated muscle with the hypothesis being that TASAP elicits arteriolar vasodilation and decreases interstitial accumulation of protein. METHODS Rat cremasteric microcirculation was directly examined in two experiments utilizing a novel technique. First, TASAP was applied to the cremaster in three experimental groups and a non-TASAP control group. Arteriolar diameters were directly measured before and after TASAP. In experiment two, intravascular fluorescein isothiocyanate (FITC)-labeled albumin and topical leukotriene B4 (LTB4) were delivered to the cremaster. Microvascular permeability was assessed by measuring the accumulation/disappearance of FITC-albumin in the interstitial tissue. RESULTS TASAP produced significant arteriolar vasodilation compared with control values. The mean maximum percent increase in diameter with TASAP was 8.70% at -2 kPa (p < 0.05), 7.16% at -4 kPa (p < 0.05), and 10.43% at -6 kPa (p < 0.01). TASAP decreased interstitial FITC-albumin by 26.3% (p < 0.008) following LTB4; the control group showed a steady increase in interstitial FITC-albumin. CONCLUSIONS These results support the hypothesis that TASAP elicits significant arteriolar vasodilation with a subsequent increase in blood flow as well as a decrease in interstitial protein accumulation.
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Affiliation(s)
- Maxwell Langfitt
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA
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Krishnan B, Smith TL, Dubey P, Zapadka ME, Torti FM, Willingham MC, Tallant EA, Gallagher PE. Angiotensin-(1-7) attenuates metastatic prostate cancer and reduces osteoclastogenesis. Prostate 2013; 73:71-82. [PMID: 22644942 PMCID: PMC3842188 DOI: 10.1002/pros.22542] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 05/03/2012] [Indexed: 12/19/2022]
Abstract
BACKGROUND Angiotensin-(1-7) [Ang-(1-7)] is an endogenous, heptapeptide hormone with anti-proliferative and anti-angiogenic properties. The primary objective of this study was to determine whether Ang-(1-7) effectively reduces prostate cancer metastasis in mice. METHODS Human PC3 prostate cancer cells were injected into the aortic arch via the carotid artery of SCID mice pre-treated with Ang-(1-7) or injected into the tibia of athymic mice, administered Ang-(1-7) for 5 weeks beginning 2 weeks post-injection. Tumor growth and volume were determined by bioluminescent and magnetic resonance imaging. The presence of tumors was confirmed by hematoxylin and eosin staining; TRAP histochemistry was used to identify osteolytic lesions. The effect of Ang-(1-7) on osteoclastogenesis was assessed in differentiated bone marrow cells. RESULTS Pre-treatment with Ang-(1-7) prevented metastatic tumor formation following intra-aortic injection of PC3 cells, while 83% of untreated mice developed tumors in metastatic sites. Circulating VEGF was significantly higher in control mice compared to mice administered Ang-(1-7). A 5-week regimen of the heptapeptide hormone attenuated intra-tibial tumor growth; Ang-(1-7) was significantly higher in the tibia of treated mice than in control animals. Osteoclastogenesis was reduced by 50% in bone marrow cells differentiated in the presence of Ang-(1-7), suggesting that the heptapeptide hormone prevents the formation of osteolytic lesions to reduce tumor survival in the bone microenvironment. CONCLUSIONS These findings suggest that Ang-(1-7) may serve as an anti-angiogenic and anti-metastatic agent for advanced prostate cancer. By extension, the heptapeptide hormone may provide effective therapy for bone metastasis produced from primary tumors of the lung and breast.
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Affiliation(s)
- Bhavani Krishnan
- Hypertension and Vascular Research Center, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157
- Molecular Genetics & Genomics Program, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157
| | - Thomas L. Smith
- Department of Orthopedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157
| | - Purnima Dubey
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157
| | - Michael. E. Zapadka
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157
| | - Frank M. Torti
- Department of Cancer Biology Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157
| | - Mark C. Willingham
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157
| | - E. Ann Tallant
- Hypertension and Vascular Research Center, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157
- Molecular Genetics & Genomics Program, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157
| | - Patricia E. Gallagher
- Hypertension and Vascular Research Center, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157
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Abstract
Professional and recreational athletes involved in contact sports and sports with repetitive overhead motion are at increased risk for rotator cuff tears. Shoulder anatomy, pathology, and biomechanics place unique stress on the rotator cuff tendons during sports activity. Athletes demand effective treatment to quickly return to elite competition. A PubMed search assessed treatment options providing expedited recovery time and return to competition. Twelve of 231 articles fit the objective criteria; 90.5% of professional contact athletes, 40% of professional overhead athletes, and 83.3% of recreational athletes fully recovered following rotator cuff tear surgical repair. Prompt surgical treatment for full-thickness rotator cuff tears may be appropriate for contact athletes and recreational overhead athletes. Although professional overhead athletes have low recovery rates, surgical repair of full-thickness rotator cuff tears may still be indicated. The authors propose a treatment algorithm based on the limited literature (mainly level 4 and 5 evidence).
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Affiliation(s)
- Johannes F Plate
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157, USA.
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Plate JF, Wiggins WF, Haubruck P, Scott AT, Smith TL, Saul KR, Mannava S. Normal aging alters in vivo passive biomechanical response of the rat gastrocnemius-Achilles muscle-tendon unit. J Biomech 2012; 46:450-5. [PMID: 23245562 DOI: 10.1016/j.jbiomech.2012.11.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 10/29/2012] [Accepted: 11/01/2012] [Indexed: 10/27/2022]
Abstract
Predisposition to Achilles tendon (AT) ruptures in middle-aged individuals may be associated with age-related changes to inherent passive biomechanical properties of the gastrocnemius-Achilles (GC-AT) muscle-tendon unit, due to known muscle-tendon structural changes in normal aging. The goal of this study was to determine whether the passive biomechanical response of the GC-AT muscle-tendon unit was altered with age in 6 young (8 months) and 6 middle-aged (24 months) F344xBN hybrid rats from the National Institute on Aging colony. Fung's quasilinear viscoelastic (QLV) model was used to determine in vivo history and time-dependent load-relaxation response of the GC-AT. Effective stiffness and modulus were also estimated using linear regression analysis. Fung's QLV revealed a significantly decreased magnitude of the relaxation response (parameter C, p=0.026) in middle-aged animals compared to young animals (0.108±0.007 vs. 0.144±0.015), with similar time-dependent viscous GC-AT properties (τ(1), τ(2)). The product of elastic parameters (A*B), which represents the initial slope of the elastic response, was significantly increased by 50% in middle-aged rats (p=0.014). Estimated GC-AT stiffness increased 28% at peak tensions in middle-aged rats (2.7±0.2 N/mm) compared to young rats (1.9±0.2 N/mm; p=0.036). While the limitations of this animal model must be considered, the changes we describe could be associated with the observation that GC-AT pathology and injury is more common in middle-aged individuals. Further studies are necessary to characterize the load-to-failure behavior of AT in middle-aged compared to young animals.
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Affiliation(s)
- Johannes F Plate
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC 27157-1070, USA.
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