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Poon W, Matula C, Vos PE, Muresanu DF, von Steinbüchel N, von Wild K, Hömberg V, Wang E, Lee TMC, Strilciuc S, Vester JC. Safety and efficacy of Cerebrolysin in acute brain injury and neurorecovery: CAPTAIN I-a randomized, placebo-controlled, double-blind, Asian-Pacific trial. Neurol Sci 2019; 41:281-293. [PMID: 31494820 DOI: 10.1007/s10072-019-04053-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 08/19/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of Cerebrolysin as an add-on therapy to local standard treatment protocol in patients after moderate-to-severe traumatic brain injury. METHODS The patients received the study medication in addition to standard care (50 mL of Cerebrolysin or physiological saline solution daily for 10 days, followed by two additional treatment cycles with 10 mL daily for 10 days) in a prospective, randomized, double-blind, placebo-controlled, parallel-group, multi-centre phase IIIb/IV trial. The primary endpoint was a multidimensional ensemble of 14 outcome scales pooled to be analyzed by means of the multivariate, correlation-sensitive Wei-Lachin procedure. RESULTS In 46 enrolled TBI patients (Cerebrolysin 22, placebo 24), three single outcomes showed stand-alone statistically significant superiority of Cerebrolysin [Stroop Word/Dots Interference (p = 0.0415, Mann-Whitney(MW) = 0.6816, 95% CI 0.51-0.86); Color Trails Tests 1 and 2 (p = 0.0223/0.0170, MW = 0.72/0.73, 95% CI 0.53-0.90/0.54-0.91), both effect sizes lying above the benchmark for "large" superiority (MW > 0.71)]. While for the primary multivariate ensemble, statistical significance was just missed in the intention-to-treat population (pWei-Lachin < 0.1, MWcombined = 0.63, 95% CI 0.48-0.77, derived standardized mean difference (SMD) 0.45, 95% CI -0.07 to 1.04, derived OR 2.1, 95% CI 0.89-5.95), the per-protocol analysis showed a statistical significant superiority of Cerebrolysin (pWei-Lachin = 0.0240, MWcombined = 0.69, 95% CI 0.53 to 0.85, derived SMD 0.69, 95% CI 0.09 to 1.47, derived OR 3.2, 95% CI 1.16 to 12.8), with effect sizes of six single outcomes lying above the benchmark for "large" superiority. Safety aspects were comparable to placebo. CONCLUSION Our trial suggests beneficial effects of Cerebrolysin on outcome after TBI. Results should be confirmed by a larger RCT with a comparable multidimensional approach.
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Affiliation(s)
- W Poon
- Division of Neurosurgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - C Matula
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - P E Vos
- Department of Neurology, Slingeland Hospital, Doetinchem, The Netherlands
| | - D F Muresanu
- Department of Clinical Neurosciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania. .,RoNeuro Institute for Neurological Research and Diagnostic, No. 37 Mircea Eliade Street, 400364, Cluj-Napoca, Romania.
| | - N von Steinbüchel
- Institute of Medical Psychology and Medical Sociology, University Medical Centre Göttingen, Göttingen, Germany
| | - K von Wild
- Medical Faculty, Westphalia Wilhelm's University, Münster, Germany
| | - V Hömberg
- Department of Neurology, SRH Gesundheitszentrum Bad Wimpfen GmbH, Bad Wimpfen, Germany
| | - E Wang
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - T M C Lee
- State Key Laboratory of Brain and Cognitive Sciences and Laboratory of Neuropsychology, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - S Strilciuc
- Department of Clinical Neurosciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,RoNeuro Institute for Neurological Research and Diagnostic, No. 37 Mircea Eliade Street, 400364, Cluj-Napoca, Romania
| | - J C Vester
- Department of Biometry and Clinical Research, idv Data Analysis and Study Planning, Krailling, Germany
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Román LS, Menon BK, Blasco J, Hernández-Pérez M, Dávalos A, Majoie CBLM, Campbell BCV, Guillemin F, Lingsma H, Anxionnat R, Epstein J, Saver JL, Marquering H, Wong JH, Lopes D, Reimann G, Desal H, Dippel DWJ, Coutts S, du Mesnil de Rochemont R, Yavagal D, Ferre JC, Roos YBWEM, Liebeskind DS, Lenthall R, Molina C, Al Ajlan FS, Reddy V, Dowlatshahi D, Sourour NA, Oppenheim C, Mitha AP, Davis SM, Weimar C, van Oostenbrugge RJ, Cobo E, Kleinig TJ, Donnan GA, van der Lugt A, Demchuk AM, Berkhemer OA, Boers AMM, Ford GA, Muir KW, Brown BS, Jovin T, van Zwam WH, Mitchell PJ, Hill MD, White P, Bracard S, Goyal M, Berkhemer OA, Fransen PSS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJH, van Walderveen MAA, Staals J, Hofmeijer J, van Oostayen JA, Lycklama à Nijeholt GJ, Boiten J, Brouwer PA, Emmer BJ, de Bruijn SF, van Dijk LC, Kappelle J, Lo RH, van Dijk EJ, de Vries J, de Kort PL, van Rooij WJJ, van den Berg JS, van Hasselt BA, Aerden LA, Dallinga RJ, Visser MC, Bot JC, Vroomen PC, Eshghi O, Schreuder TH, Heijboer RJ, Keizer K, Tielbeek AV, den Hertog HM, Gerrits DG, van den Berg-Vos RM, Karas GB, Steyerberg EW, Flach Z, Marquering HA, Sprengers ME, Jenniskens SF, Beenen LF, Zech M, Kowarik M, Seifert C, Schwaiger B, Puri A, Hou S, Wakhloo A, Moonis M, Henniger N, Goddeau R, van den Berg R, Massari F, Minaeian A, Lozano JD, Ramzan M, Stout C, Patel A, Tunguturi A, Onteddu S, Carandang R, Howk M, Koudstaal PJ, Ribó M, Sanjuan E, Rubiera M, Pagola J, Flores A, Muchada M, Meler P, Huerga E, Gelabert S, Coscojuela P, van Zwam WH, Tomasello A, Rodriguez D, Santamarina E, Maisterra O, Boned S, Seró L, Rovira A, Molina CA, Millán M, Muñoz L, Roos YB, Pérez de la Ossa N, Gomis M, Dorado L, López-Cancio E, Palomeras E, Munuera J, García Bermejo P, Remollo S, Castaño C, García-Sort R, van der Lugt A, Cuadras P, Puyalto P, Hernández-Pérez M, Jiménez M, Martínez-Piñeiro A, Lucente G, Dávalos A, Chamorro A, Urra X, Obach V, van Oostenbrugge RJ, Cervera A, Amaro S, Llull L, Codas J, Balasa M, Navarro J, Ariño H, Aceituno A, Rudilosso S, Renu A, Majoie CB, Macho JM, San Roman L, Blasco J, López A, Macías N, Cardona P, Quesada H, Rubio F, Cano L, Lara B, Dippel DW, de Miquel MA, Aja L, Serena J, Cobo E, Albers GW, Lees KR, Arenillas J, Roberts R, Minhas P, Al-Ajlan F, Brown MM, Salluzzi M, Zimmel L, Patel S, Eesa M, Martí-Fàbregas J, Jankowitz B, Serena J, Salvat-Plana M, López-Cancio E, Bracard S, Liebig T, Ducrocq X, Anxionnat R, Baillot PA, Barbier C, Derelle AL, Lacour JC, Richard S, Samson Y, Sourour N, Baronnet-Chauvet F, Stijnen T, Clarencon F, Crozier S, Deltour S, Di Maria F, Le Bouc R, Leger A, Mutlu G, Rosso C, Szatmary Z, Yger M, Andersson T, Zavanone C, Bakchine S, Pierot L, Caucheteux N, Estrade L, Kadziolka K, Leautaud A, Renkes C, Serre I, Desal H, Mattle H, Guillon B, Boutoleau-Bretonniere C, Daumas-Duport B, De Gaalon S, Derkinderen P, Evain S, Herisson F, Laplaud DA, Lebouvier T, Lintia-Gaultier A, Wahlgren N, Pouclet-Courtemanche H, Rouaud T, Rouaud Jaffrenou V, Schunck A, Sevin-Allouet M, Toulgoat F, Wiertlewski S, Gauvrit JY, Ronziere T, Cahagne V, van der Heijden E, Ferre JC, Pinel JF, Raoult H, Mas JL, Meder JF, Al Najjar-Carpentier AA, Birchenall J, Bodiguel E, Calvet D, Domigo V, Ghannouti N, Godon-Hardy S, Guiraud V, Lamy C, Majhadi L, Morin L, Naggara O, Trystram D, Turc G, Berge J, Sibon I, Fleitour N, Menegon P, Barreau X, Rouanet F, Debruxelles S, Kazadi A, Renou P, Fleury O, Pasco-Papon A, Dubas F, Caroff J, Hooijenga I, Godard Ducceschi S, Hamon MA, Lecluse A, Marc G, Giroud M, Ricolfi F, Bejot Y, Chavent A, Gentil A, Kazemi A, Puppels C, Osseby GV, Voguet C, Mahagne MH, Sedat J, Chau Y, Suissa L, Lachaud S, Houdart E, Stapf C, Buffon Porcher F, Pellikaan W, Chabriat H, Guedin P, Herve D, Jouvent E, Mawet J, Saint-Maurice JP, Schneble HM, Turjman F, Nighoghossian N, Berhoune NN, Geerling A, Bouhour F, Cho TH, Derex L, Felix S, Gervais-Bernard H, 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VA, Lanthier S, Odier C, Durocher A, Raymond J, Weill A, Daneault N, Deschaintre Y, Jankowitz B, Baxendell L, Massaro L, Jackson-Graves C, Decesare S, Porter P, Armbruster K, Adams A, Billigan J, Oakley J, Ducruet A, Jadhav A, Giurgiutiu DV, Aghaebrahim A, Reddy V, Hammer M, Starr M, Totoraitis V, Wechsler L, Streib S, Rangaraju S, Campbell D, Rocha M, Gulati D, Silver FL, Krings T, Kalman L, Cayley A, Williams J, Stewart T, Wiegner R, Casaubon LK, Jaigobin C, del Campo JM, Elamin E, Schaafsma JD, Willinsky RA, Agid R, Farb R, ter Brugge K, Sapkoda BL, Baxter BW, Barton K, Knox A, Porter A, Sirelkhatim A, Devlin T, Dellinger C, Pitiyanuvath N, Patterson J, Nichols J, Quarfordt S, Calvert J, Hawk H, Fanale C, Frei DF, Bitner A, Novak A, Huddle D, Bellon R, Loy D, Wagner J, Chang I, Lampe E, Spencer B, Pratt R, Bartt R, Shine S, Dooley G, Nguyen T, Whaley M, McCarthy K, Teitelbaum J, Tampieri D, Poon W, Campbell N, Cortes M, Dowlatshahi D, Lum C, Shamloul R, Robert S, Stotts G, Shamy M, 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M, Grande A, Hildebrandt D, Miller K, Scherber J, Hendrickson A, Jumaa M, Zaidi S, Hendrickson T, Snyder V, Killer-Oberpfalzer M, Mutzenbach J, Weymayr F, Broussalis E, Stadler K, Jedlitschka A, Malek A, Mueller-Kronast N, Beck P, Martin C, Summers D, Day J, Bettinger I, Holloway W, Olds K, Arkin S, Akhtar N, Boutwell C, Crandall S, Schwartzman M, Weinstein C, Brion B, Prothmann S, Kleine J, Kreiser K, Boeckh-Behrens T, Poppert H, Wunderlich S, Koch ML, Biberacher V, Huberle A, Gora-Stahlberg G, Knier B, Meindl T, Utpadel-Fischler D. Imaging features and safety and efficacy of endovascular stroke treatment: a meta-analysis of individual patient-level data. Lancet Neurol 2018; 17:895-904. [DOI: 10.1016/s1474-4422(18)30242-4] [Citation(s) in RCA: 213] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 11/29/2022]
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Weymayr F, Broussalis E, Stadler K, Jedlitschka A, Malek A, Mueller-Kronast N, Beck P, Martin C, Summers D, Day J, Bettinger I, Holloway W, Olds K, Arkin S, Akhtar N, Boutwell C, Crandall S, Schwartzman M, Weinstein C, Brion B, Prothmann S, Kleine J, Kreiser K, Boeckh-Behrens T, Poppert H, Wunderlich S, Koch ML, Biberacher V, Huberle A, Gora-Stahlberg G, Knier B, Meindl T, Utpadel-Fischler D, Zech M, Kowarik M, Seifert C, Schwaiger B, Puri A, Hou S. Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data. Lancet Neurol 2018; 17:47-53. [DOI: 10.1016/s1474-4422(17)30407-6] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/05/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
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Mitchell T, Cascales A, Poon W, Ashton M, Smith S, Valentine R, Kearns D, Harrow S. P3.09-002 Can We Do Better? Feasibility Dosimetric Study for Upfront Radical Radiotherapy in Mesothelioma. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abels M, Riva M, Bennet H, Ahlqvist E, Dyachok O, Nagaraj V, Shcherbina L, Fred RG, Poon W, Sörhede-Winzell M, Fadista J, Lindqvist A, Kask L, Sathanoori R, Dekker-Nitert M, Kuhar MJ, Ahrén B, Wollheim CB, Hansson O, Tengholm A, Fex M, Renström E, Groop L, Lyssenko V, Wierup N. CART is overexpressed in human type 2 diabetic islets and inhibits glucagon secretion and increases insulin secretion. Diabetologia 2016; 59:1928-37. [PMID: 27338624 DOI: 10.1007/s00125-016-4020-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 05/23/2016] [Indexed: 11/30/2022]
Abstract
AIMS/HYPOTHESIS Insufficient insulin release and hyperglucagonaemia are culprits in type 2 diabetes. Cocaine- and amphetamine-regulated transcript (CART, encoded by Cartpt) affects islet hormone secretion and beta cell survival in vitro in rats, and Cart (-/-) mice have diminished insulin secretion. We aimed to test if CART is differentially regulated in human type 2 diabetic islets and if CART affects insulin and glucagon secretion in vitro in humans and in vivo in mice. METHODS CART expression was assessed in human type 2 diabetic and non-diabetic control pancreases and rodent models of diabetes. Insulin and glucagon secretion was examined in isolated islets and in vivo in mice. Ca(2+) oscillation patterns and exocytosis were studied in mouse islets. RESULTS We report an important role of CART in human islet function and glucose homeostasis in mice. CART was found to be expressed in human alpha and beta cells and in a subpopulation of mouse beta cells. Notably, CART expression was several fold higher in islets of type 2 diabetic humans and rodents. CART increased insulin secretion in vivo in mice and in human and mouse islets. Furthermore, CART increased beta cell exocytosis, altered the glucose-induced Ca(2+) signalling pattern in mouse islets from fast to slow oscillations and improved synchronisation of the oscillations between different islet regions. Finally, CART reduced glucagon secretion in human and mouse islets, as well as in vivo in mice via diminished alpha cell exocytosis. CONCLUSIONS/INTERPRETATION We conclude that CART is a regulator of glucose homeostasis and could play an important role in the pathophysiology of type 2 diabetes. Based on the ability of CART to increase insulin secretion and reduce glucagon secretion, CART-based agents could be a therapeutic modality in type 2 diabetes.
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Affiliation(s)
- Mia Abels
- Lund University Diabetes Centre, Skåne University Hospital, Lund and Malmö, Sweden
| | - Matteo Riva
- Lund University Diabetes Centre, Skåne University Hospital, Lund and Malmö, Sweden
| | - Hedvig Bennet
- Lund University Diabetes Centre, Skåne University Hospital, Lund and Malmö, Sweden
| | - Emma Ahlqvist
- Lund University Diabetes Centre, Skåne University Hospital, Lund and Malmö, Sweden
| | - Oleg Dyachok
- Department of Medical Cell Biology, Uppsala University Biomedical Centre, Uppsala, Sweden
| | - Vini Nagaraj
- Lund University Diabetes Centre, Skåne University Hospital, Lund and Malmö, Sweden
| | - Liliya Shcherbina
- Lund University Diabetes Centre, Skåne University Hospital, Lund and Malmö, Sweden
| | - Rikard G Fred
- Lund University Diabetes Centre, Skåne University Hospital, Lund and Malmö, Sweden
| | - Wenny Poon
- Lund University Diabetes Centre, Skåne University Hospital, Lund and Malmö, Sweden
| | | | - Joao Fadista
- Lund University Diabetes Centre, Skåne University Hospital, Lund and Malmö, Sweden
| | - Andreas Lindqvist
- Lund University Diabetes Centre, Skåne University Hospital, Lund and Malmö, Sweden
| | - Lena Kask
- Lund University Diabetes Centre, Skåne University Hospital, Lund and Malmö, Sweden
| | - Ramasri Sathanoori
- Lund University Diabetes Centre, Skåne University Hospital, Lund and Malmö, Sweden
| | | | - Michael J Kuhar
- The Yerkes Research Center of Emory University, Atlanta, GA, USA
| | - Bo Ahrén
- Lund University Diabetes Centre, Skåne University Hospital, Lund and Malmö, Sweden
| | - Claes B Wollheim
- Department of Cell Physiology and Metabolism, University Medical Centre, Geneva, Switzerland
| | - Ola Hansson
- Lund University Diabetes Centre, Skåne University Hospital, Lund and Malmö, Sweden
| | - Anders Tengholm
- Department of Medical Cell Biology, Uppsala University Biomedical Centre, Uppsala, Sweden
| | - Malin Fex
- Lund University Diabetes Centre, Skåne University Hospital, Lund and Malmö, Sweden
| | - Erik Renström
- Lund University Diabetes Centre, Skåne University Hospital, Lund and Malmö, Sweden
| | - Leif Groop
- Lund University Diabetes Centre, Skåne University Hospital, Lund and Malmö, Sweden
| | - Valeriya Lyssenko
- Lund University Diabetes Centre, Skåne University Hospital, Lund and Malmö, Sweden
- Steno Diabetes Center A/S, Gentofte, Denmark
| | - Nils Wierup
- Lund University Diabetes Centre, Skåne University Hospital, Lund and Malmö, Sweden.
- Lund University Diabetes Centre, Skåne University Hospital, Department of Clinical Sciences in Malmö, Unit of Neuroendocrine Cell Biology, Lund University, Clinical Research Centre 91:12, Jan Waldenströms gata 35, 20502, Malmö, Sweden.
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6
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Prasad RB, Lessmark A, Almgren P, Kovacs G, Hansson O, Oskolkov N, Vitai M, Ladenvall C, Kovacs P, Fadista J, Lachmann M, Zhou Y, Sonestedt E, Poon W, Wollheim CB, Orho-Melander M, Stumvoll M, Tuomi T, Pääbo S, Koranyi L, Groop L. Excess maternal transmission of variants in the THADA gene to offspring with type 2 diabetes. Diabetologia 2016; 59:1702-13. [PMID: 27155871 DOI: 10.1007/s00125-016-3973-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 04/01/2016] [Indexed: 02/04/2023]
Abstract
AIMS/HYPOTHESIS Genome-wide association studies (GWAS) have identified more than 65 genetic loci associated with risk of type 2 diabetes. However, the contribution of distorted parental transmission of alleles to risk of type 2 diabetes has been mostly unexplored. Our goal was therefore to search for parent-of-origin effects (POE) among type 2 diabetes loci in families. METHODS Families from the Botnia study (n = 4,211, 1,083 families) were genotyped for 72 single-nucleotide polymorphisms (SNPs) associated with type 2 diabetes and assessed for POE on type 2 diabetes. The family-based Hungarian Transdanubian Biobank (HTB) (n = 1,463, >135 families) was used to replicate SNPs showing POE. Association of type 2 diabetes loci within families was also tested. RESULTS Three loci showed nominal POE, including the previously reported variants in KCNQ1, for type 2 diabetes in families from Botnia (rs2237895: p POE = 0.037), which can be considered positive controls. The strongest POE was seen for rs7578597 SNP in the THADA gene, showing excess transmission of the maternal risk allele T to diabetic offspring (Botnia: p POE = 0.01; HTB p POE = 0.045). These data are consistent with previous evidence of allelic imbalance for expression in islets, suggesting that the THADA gene can be imprinted in a POE-specific fashion. Five CpG sites, including those flanking rs7578597, showed differential methylation between diabetic and non-diabetic donor islets. CONCLUSIONS/INTERPRETATION Taken together, the data emphasise the need for genetic studies to consider from which parent an offspring has inherited a susceptibility allele.
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Affiliation(s)
- Rashmi B Prasad
- Lund University Diabetes Centre, Department of Clinical Sciences, Lund University CRC, Skåne University Hospital Malmö, SE-205 02, Malmö, Sweden.
| | - Anna Lessmark
- Lund University Diabetes Centre, Department of Clinical Sciences, Lund University CRC, Skåne University Hospital Malmö, SE-205 02, Malmö, Sweden
| | - Peter Almgren
- Lund University Diabetes Centre, Department of Clinical Sciences, Lund University CRC, Skåne University Hospital Malmö, SE-205 02, Malmö, Sweden
| | | | - Ola Hansson
- Lund University Diabetes Centre, Department of Clinical Sciences, Lund University CRC, Skåne University Hospital Malmö, SE-205 02, Malmö, Sweden
| | - Nikolay Oskolkov
- Lund University Diabetes Centre, Department of Clinical Sciences, Lund University CRC, Skåne University Hospital Malmö, SE-205 02, Malmö, Sweden
| | - Marta Vitai
- Heart Center Foundation, DRC, Balatonfured, Hungary
| | - Claes Ladenvall
- Lund University Diabetes Centre, Department of Clinical Sciences, Lund University CRC, Skåne University Hospital Malmö, SE-205 02, Malmö, Sweden
| | - Peter Kovacs
- Department of Medicine, University of Leipzig, Leipzig, Germany
- IFB Adiposity Diseases, University of Leipzig, Leipzig, Germany
| | - Joao Fadista
- Lund University Diabetes Centre, Department of Clinical Sciences, Lund University CRC, Skåne University Hospital Malmö, SE-205 02, Malmö, Sweden
| | | | - Yuedan Zhou
- Lund University Diabetes Centre, Department of Clinical Sciences, Lund University CRC, Skåne University Hospital Malmö, SE-205 02, Malmö, Sweden
| | - Emily Sonestedt
- Lund University Diabetes Centre, Department of Clinical Sciences, Lund University CRC, Skåne University Hospital Malmö, SE-205 02, Malmö, Sweden
| | - Wenny Poon
- Lund University Diabetes Centre, Department of Clinical Sciences, Lund University CRC, Skåne University Hospital Malmö, SE-205 02, Malmö, Sweden
| | - Claes B Wollheim
- Lund University Diabetes Centre, Department of Clinical Sciences, Lund University CRC, Skåne University Hospital Malmö, SE-205 02, Malmö, Sweden
- Department of Cell Physiology and Metabolism, University Medical Center, Geneva, Switzerland
| | - Marju Orho-Melander
- Lund University Diabetes Centre, Department of Clinical Sciences, Lund University CRC, Skåne University Hospital Malmö, SE-205 02, Malmö, Sweden
| | - Michael Stumvoll
- Department of Medicine, University of Leipzig, Leipzig, Germany
- IFB Adiposity Diseases, University of Leipzig, Leipzig, Germany
| | - Tiinamaija Tuomi
- Folkhälsan Research Centre, Helsinki, Finland
- Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
| | - Svante Pääbo
- Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | | | - Leif Groop
- Lund University Diabetes Centre, Department of Clinical Sciences, Lund University CRC, Skåne University Hospital Malmö, SE-205 02, Malmö, Sweden.
- Finnish Institute of Molecular Medicine (FIMM), Helsinki University, Helsinki, Finland.
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Fall T, Xie W, Poon W, Yaghootkar H, Mägi R, Knowles JW, Lyssenko V, Weedon M, Frayling TM, Ingelsson E. Using Genetic Variants to Assess the Relationship Between Circulating Lipids and Type 2 Diabetes. Diabetes 2015; 64:2676-84. [PMID: 25948681 DOI: 10.2337/db14-1710] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 03/04/2015] [Indexed: 11/13/2022]
Abstract
The effects of dyslipidemia on the risk of type 2 diabetes (T2D) and related traits are not clear. We used regression models and 140 lipid-associated genetic variants to estimate associations between circulating HDL cholesterol (HDL-C), LDL cholesterol (LDL-C), and triglycerides and T2D and related traits. Each genetic test was corrected for effects of variants on the other two lipid types and surrogates of adiposity. We used the largest data sets available: 34,840 T2D case and 114,981 control subjects from the DIAGRAM (DIAbetes Genetics Replication And Meta-analysis) consortium and up to 133,010 individuals without diabetes for insulin secretion and sensitivity from the MAGIC (Meta-Analyses of Glucose and Insulin-related traits Consortium) and GENESIS (GENEticS of Insulin Sensitivity) studies. Eight of 21 associations between groups of variants and diabetes traits were significant at the nominal level, including those between genetically determined lower HDL-C (β = -0.12, P = 0.03) and T2D and genetically determined lower LDL-C (β = -0.21, P = 5 × 10(-6)) and T2D. Although some of these may represent causal associations, we discuss why caution must be used when using Mendelian randomization in the context of circulating lipid levels and diabetes traits. In conclusion, we found evidence of links between genetic variants associated with lipids and T2D, but deeper knowledge of the underlying genetic mechanisms of specific lipid variants is needed before drawing definite conclusions about causality based on Mendelian randomization methodology.
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Affiliation(s)
- Tove Fall
- Molecular Epidemiology, Department of Medical Sciences and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Weijia Xie
- Genetics of Complex Traits, Peninsula College of Medicine and Dentistry, University of Exeter, Exeter, Devon, U.K
| | - Wenny Poon
- Department of Clinical Sciences, Diabetes and Endocrinology, Lund University Diabetes Center, Malmö, Sweden
| | - Hanieh Yaghootkar
- Genetics of Complex Traits, Peninsula College of Medicine and Dentistry, University of Exeter, Exeter, Devon, U.K
| | - Reedik Mägi
- Estonian Genome Center, University of Tartu, Tartu, Estonia
| | | | - Joshua W Knowles
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Valeriya Lyssenko
- Department of Clinical Sciences, Diabetes and Endocrinology, Lund University Diabetes Center, Malmö, Sweden
| | - Michael Weedon
- Genetics of Complex Traits, Peninsula College of Medicine and Dentistry, University of Exeter, Exeter, Devon, U.K
| | - Timothy M Frayling
- Genetics of Complex Traits, Peninsula College of Medicine and Dentistry, University of Exeter, Exeter, Devon, U.K.
| | - Erik Ingelsson
- Molecular Epidemiology, Department of Medical Sciences and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
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Todd JN, Poon W, Lyssenko V, Groop L, Nichols B, Wilmot M, Robson S, Enjyoji K, Herman MA, Hu C, Zhang R, Jia W, Ma R, Florez JC, Friedman DJ. Variation in glucose homeostasis traits associated with P2RX7 polymorphisms in mice and humans. J Clin Endocrinol Metab 2015; 100:E688-96. [PMID: 25719930 PMCID: PMC4422893 DOI: 10.1210/jc.2014-4160] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
CONTEXT Extracellular nucleotide receptors are expressed in pancreatic B-cells. Purinergic signaling via these receptors may regulate pancreatic B-cell function. OBJECTIVE We hypothesized that purinergic signaling might influence glucose regulation and sought evidence in human studies of glycemic variation and a mouse model of purinergic signaling dysfunction. DESIGN In humans, we mined genome-wide meta-analysis data sets to examine purinergic signaling genes for association with glycemic traits and type 2 diabetes. We performed additional testing in two genomic regions (P2RX4/P2RX7 and P2RY1) in a cohort from the Prevalence, Prediction, and Prevention of Diabetes in Botnia (n = 3504), which includes more refined measures of glucose homeostasis. In mice, we generated a congenic model of purinergic signaling dysfunction by crossing the naturally hypomorphic C57BL6 P2rx7 allele onto the 129SvJ background. RESULTS Variants in five genes were associated with glycemic traits and in three genes with diabetes risk. In the Prevalence, Prediction, and Prevention of Diabetes in Botnia study, the minor allele in the missense functional variant rs1718119 (A348T) in P2RX7 was associated with increased insulin sensitivity and secretion, consistent with its known effect on increased pore function. Both male and female P2x7-C57 mice demonstrated impaired glucose tolerance compared with matched P2x7-129 mice. Insulin tolerance testing showed that P2x7-C57 mice were also less responsive to insulin than P2x7-129 mice. CONCLUSIONS We show association of the purinergic signaling pathway in general and hypofunctioning P2X7 variants in particular with impaired glucose homeostasis in both mice and humans.
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Affiliation(s)
- Jennifer N Todd
- Division of Endocrinology (J.N.T.), Boston Children's Hospital, and Departments of Pediatrics (J.N.T.) and Medicine (S.R., K.E., M.A.H., J.C.F., D.J.F.), Harvard Medical School, and Department of Medicine (B.N., M.W., S.R., K.E., M.A.H., D.J.F.) and Center for Vascular Biology Research (B.N., M.W., D.J.F.), Beth Israel Deaconess Medical Center, Boston, Massachusetts 02115; Center for Human Genetic Research (J.N.T., J.C.F.), and Diabetes Research Center (Diabetes Unit) (J.C.F.), Massachusetts General Hospital, Boston, Massachusetts 02114; Program in Medical and Population Genetics (J.C.F.), Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, Massachusetts 02142; Department of Clinical Sciences, Diabetes, and Endocrinology (W.P., V.L., L.G.), Skåne University Hospital, Lund University, SE 205 02 Malmö, Sweden; Department of Translational Pathophysiology (V.L.), Steno Diabetes Center A/S, DK-2820 Gentofte, Denmark; Institute for Molecular Medicine Finland FIMM (L.G.), University of Helsinki, FI-00014 Helsinki, Finland; Shanghai Jiao Tong University Affiliated Sixth People's Hospital (C.H., R.Z., W.J.), Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai 200233, China; and Department of Medicine and Therapeutics (R.M.), Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
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9
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Prokopenko I, Poon W, Mägi R, Prasad B R, Salehi SA, Almgren P, Osmark P, Bouatia-Naji N, Wierup N, Fall T, Stančáková A, Barker A, Lagou V, Osmond C, Xie W, Lahti J, Jackson AU, Cheng YC, Liu J, O'Connell JR, Blomstedt PA, Fadista J, Alkayyali S, Dayeh T, Ahlqvist E, Taneera J, Lecoeur C, Kumar A, Hansson O, Hansson K, Voight BF, Kang HM, Levy-Marchal C, Vatin V, Palotie A, Syvänen AC, Mari A, Weedon MN, Loos RJF, Ong KK, Nilsson P, Isomaa B, Tuomi T, Wareham NJ, Stumvoll M, Widen E, Lakka TA, Langenberg C, Tönjes A, Rauramaa R, Kuusisto J, Frayling TM, Froguel P, Walker M, Eriksson JG, Ling C, Kovacs P, Ingelsson E, McCarthy MI, Shuldiner AR, Silver KD, Laakso M, Groop L, Lyssenko V. A central role for GRB10 in regulation of islet function in man. PLoS Genet 2014; 10:e1004235. [PMID: 24699409 PMCID: PMC3974640 DOI: 10.1371/journal.pgen.1004235] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Accepted: 01/20/2014] [Indexed: 01/03/2023] Open
Abstract
Variants in the growth factor receptor-bound protein 10 (GRB10) gene were in a GWAS meta-analysis associated with reduced glucose-stimulated insulin secretion and increased risk of type 2 diabetes (T2D) if inherited from the father, but inexplicably reduced fasting glucose when inherited from the mother. GRB10 is a negative regulator of insulin signaling and imprinted in a parent-of-origin fashion in different tissues. GRB10 knock-down in human pancreatic islets showed reduced insulin and glucagon secretion, which together with changes in insulin sensitivity may explain the paradoxical reduction of glucose despite a decrease in insulin secretion. Together, these findings suggest that tissue-specific methylation and possibly imprinting of GRB10 can influence glucose metabolism and contribute to T2D pathogenesis. The data also emphasize the need in genetic studies to consider whether risk alleles are inherited from the mother or the father. In this paper, we report the first large genome-wide association study in man for glucose-stimulated insulin secretion (GSIS) indices during an oral glucose tolerance test. We identify seven genetic loci and provide effects on GSIS for all previously reported glycemic traits and obesity genetic loci in a large-scale sample. We observe paradoxical effects of genetic variants in the growth factor receptor-bound protein 10 (GRB10) gene yielding both reduced GSIS and reduced fasting plasma glucose concentrations, specifically showing a parent-of-origin effect of GRB10 on lower fasting plasma glucose and enhanced insulin sensitivity for maternal and elevated glucose and decreased insulin sensitivity for paternal transmissions of the risk allele. We also observe tissue-specific differences in DNA methylation and allelic imbalance in expression of GRB10 in human pancreatic islets. We further disrupt GRB10 by shRNA in human islets, showing reduction of both insulin and glucagon expression and secretion. In conclusion, we provide evidence for complex regulation of GRB10 in human islets. Our data suggest that tissue-specific methylation and imprinting of GRB10 can influence glucose metabolism and contribute to T2D pathogenesis. The data also emphasize the need in genetic studies to consider whether risk alleles are inherited from the mother or the father.
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Affiliation(s)
- Inga Prokopenko
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, United Kingdom; Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom; Department of Genomics of Common Disease, School of Public Health, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Wenny Poon
- Department of Clinical Science, Diabetes & Endocrinology, Lund University Diabetes Centre, Malmö, Sweden
| | - Reedik Mägi
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom; Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - Rashmi Prasad B
- Department of Clinical Science, Diabetes & Endocrinology, Lund University Diabetes Centre, Malmö, Sweden
| | - S Albert Salehi
- Department of Clinical Science, Diabetes & Endocrinology, Lund University Diabetes Centre, Malmö, Sweden
| | - Peter Almgren
- Department of Clinical Science, Diabetes & Endocrinology, Lund University Diabetes Centre, Malmö, Sweden
| | - Peter Osmark
- Department of Clinical Science, Diabetes & Endocrinology, Lund University Diabetes Centre, Malmö, Sweden
| | - Nabila Bouatia-Naji
- University of Lille Nord de France, Lille, France; CNRS UMR8199, Institut Pasteur de Lille, Lille, France; INSERM U970, Paris Cardiovascular Research Center PARCC, Paris, France
| | - Nils Wierup
- Department of Clinical Science, Neuroendocrine Cell Biology, Lund University Diabetes Centre, Malmö, Sweden
| | - Tove Fall
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Alena Stančáková
- Department of Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Adam Barker
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Vasiliki Lagou
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, United Kingdom; Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | - Weijia Xie
- Peninsula College of Medicine and Dentistry, University of Exeter, Exeter, United Kingdom
| | - Jari Lahti
- Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland; Folkhälsan Research Centre, Helsinki, Finland
| | - Anne U Jackson
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Yu-Ching Cheng
- Division of Endocrinology Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Jie Liu
- Division of Endocrinology Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Jeffrey R O'Connell
- Division of Endocrinology Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Paul A Blomstedt
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland; Department of Mathematics, Åbo Akademi University, Turku, Finland
| | - Joao Fadista
- Department of Clinical Science, Diabetes & Endocrinology, Lund University Diabetes Centre, Malmö, Sweden
| | - Sami Alkayyali
- Department of Clinical Science, Diabetes & Endocrinology, Lund University Diabetes Centre, Malmö, Sweden
| | - Tasnim Dayeh
- Epigenetics and Diabetes Unit, Department of Clinical Sciences, Lund University, CRC, Scania University Hospital, Malmö, Sweden
| | - Emma Ahlqvist
- Department of Clinical Science, Diabetes & Endocrinology, Lund University Diabetes Centre, Malmö, Sweden
| | - Jalal Taneera
- Department of Clinical Science, Diabetes & Endocrinology, Lund University Diabetes Centre, Malmö, Sweden
| | - Cecile Lecoeur
- University of Lille Nord de France, Lille, France; CNRS UMR8199, Institut Pasteur de Lille, Lille, France
| | - Ashish Kumar
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom; Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Ola Hansson
- Department of Clinical Science, Diabetes & Endocrinology, Lund University Diabetes Centre, Malmö, Sweden
| | - Karin Hansson
- Department of Clinical Science, Diabetes & Endocrinology, Lund University Diabetes Centre, Malmö, Sweden
| | - Benjamin F Voight
- Department of Pharmacology and Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Hyun Min Kang
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Claire Levy-Marchal
- INSERM - Institut de Santé Publique, Paris, France; INSERM CIC EC 05, Hôpital Robert Debré, Paris, France
| | - Vincent Vatin
- University of Lille Nord de France, Lille, France; CNRS UMR8199, Institut Pasteur de Lille, Lille, France
| | - Aarno Palotie
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland; Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Cambridge, United Kingdom; Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland; Program in Medical and Population Genetics and Genetics Analysis Platform, The Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Massachusettes, United States of America
| | - Ann-Christine Syvänen
- Molecular Medicine, Department of Medical Sciences, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Andrea Mari
- CNR Institute of Biomedical Engineering, Padova, Italy
| | - Michael N Weedon
- Peninsula College of Medicine and Dentistry, University of Exeter, Exeter, United Kingdom
| | - Ruth J F Loos
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Ken K Ong
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Peter Nilsson
- Department of Clinical Science, Internal Medicine, Skåne University Hospital Malmö, Malmö, Sweden
| | - Bo Isomaa
- Folkhälsan Research Centre, Helsinki, Finland; Department of Social Service and Health Care, Jakobstad, Finland
| | - Tiinamaija Tuomi
- Folkhälsan Research Centre, Helsinki, Finland; Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
| | - Nicholas J Wareham
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Michael Stumvoll
- University of Leipzig, Department of Medicine, Leipzig, Germany; University of Leipzig, IFB Adiposity Diseases, Leipzig, Germany
| | - Elisabeth Widen
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Timo A Lakka
- Institute of Biomedicine/Physiology, University of Eastern Finland, Kuopio, Finland; Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
| | - Claudia Langenberg
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Anke Tönjes
- University of Leipzig, Department of Medicine, Leipzig, Germany; University of Leipzig, IFB Adiposity Diseases, Leipzig, Germany
| | - Rainer Rauramaa
- Kuopio Research Institute of Exercise Medicine, Kuopio, Finland; Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Johanna Kuusisto
- Department of Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Timothy M Frayling
- Peninsula College of Medicine and Dentistry, University of Exeter, Exeter, United Kingdom
| | - Philippe Froguel
- Department of Genomics of Common Disease, School of Public Health, Imperial College London, Hammersmith Hospital, London, United Kingdom; University of Lille Nord de France, Lille, France; CNRS UMR8199, Institut Pasteur de Lille, Lille, France
| | - Mark Walker
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Johan G Eriksson
- Folkhälsan Research Centre, Helsinki, Finland; Helsinki University, Department of General Practice and Primary Health Care, Helsinki, Finland; Helsinki University Central Hospital, Unit of General Practice, Helsinki, Finland
| | - Charlotte Ling
- Epigenetics and Diabetes Unit, Department of Clinical Sciences, Lund University, CRC, Scania University Hospital, Malmö, Sweden
| | - Peter Kovacs
- University of Leipzig, Department of Medicine, Leipzig, Germany; University of Leipzig, IFB Adiposity Diseases, Leipzig, Germany
| | - Erik Ingelsson
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom; Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Mark I McCarthy
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, United Kingdom; Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom; Oxford NIHR Biomedical Research Centre, Churchill Hospital, Oxford, United Kindom
| | - Alan R Shuldiner
- Division of Endocrinology Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America; Baltimore Geriatric Research, Education and Clinical Center, Baltimore, Maryland, United States of America
| | - Kristi D Silver
- Division of Endocrinology Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America; Baltimore Geriatric Research, Education and Clinical Center, Baltimore, Maryland, United States of America
| | - Markku Laakso
- Department of Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Leif Groop
- Department of Clinical Science, Diabetes & Endocrinology, Lund University Diabetes Centre, Malmö, Sweden; Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Valeriya Lyssenko
- Department of Clinical Science, Diabetes & Endocrinology, Lund University Diabetes Centre, Malmö, Sweden; Steno Diabetes Center A/S, Gentofte, Denmark
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10
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Hassan A, Poon W, Baker M, Linton C, Mühlschlegel FA. Confirmed Candida albicans endogenous fungal endophthalmitis in a patient with chronic candidiasis. Med Mycol Case Rep 2012; 1:42-4. [PMID: 24371735 DOI: 10.1016/j.mmcr.2012.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 05/18/2012] [Accepted: 06/04/2012] [Indexed: 11/19/2022] Open
Abstract
We present a case of a confirmed Candida albicans endogenous endophthalmitis in a 35-year-old diabetic white female patient with a long standing history of severe chronic vaginal C. albicans infection. The patient had recently undergone ureteric stenting and received intravenous broad-spectrum antibiotics for renal stones complicated by urinary sepsis. Pan-fungal polymerase chain reaction (PCR) analysis of vitreous aspirate confirmed the presence of C. albicans. Samples showed no microbial growth.
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Affiliation(s)
- A Hassan
- Clinical Microbiology Service, East Kent Hospitals University NHS Foundation Trust, William Harvey Hospital, Ashford, Kent TN24 0LZ, UK ; Department of Ophthalmology, East Kent Hospitals University NHS Foundation Trust, William Harvey Hospital, Ashford, Kent TN24 0LZ, UK
| | - W Poon
- Department of Ophthalmology, East Kent Hospitals University NHS Foundation Trust, William Harvey Hospital, Ashford, Kent TN24 0LZ, UK
| | - M Baker
- Clinical Microbiology Service, East Kent Hospitals University NHS Foundation Trust, William Harvey Hospital, Ashford, Kent TN24 0LZ, UK
| | - C Linton
- Mycology Reference Laboratory, Health Protection Agency, Microbiology Services, Bristol BS2 8EL, UK
| | - F A Mühlschlegel
- Clinical Microbiology Service, East Kent Hospitals University NHS Foundation Trust, William Harvey Hospital, Ashford, Kent TN24 0LZ, UK ; School of Biosciences, University of Kent, Canterbury, Kent CT2 7NJ, UK
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11
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Hilton K, Mueller-Steiner S, Chen M, Tanaka K, Hui T, Anderson J, Head E, Poon W, Games D, Buttini M. P3.066 Neuropathological characterization of posttranslationally modifled a-synuclein in PD and DLB. Parkinsonism Relat Disord 2009. [DOI: 10.1016/s1353-8020(09)70630-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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Corry J, Poon W, McPhee N, Milner AD, Cruickshank D, Porceddu SV, Rischin D, Peters LJ. Randomized study of percutaneous endoscopic gastrostomy versus nasogastric tubes for enteral feeding in head and neck cancer patients treated with (chemo)radiation. J Med Imaging Radiat Oncol 2009; 52:503-10. [PMID: 19032398 DOI: 10.1111/j.1440-1673.2008.02003.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Percutaneous endoscopic gastrostomy (PEG) tubes have largely replaced nasogastric tubes (NGT) for nutritional support of patients with head and neck cancer undergoing curative (chemo)radiotherapy without any good scientific basis. A randomized trial was conducted to compare PEG tubes and NGT in terms of nutritional outcomes, complications, patient satisfaction and cost. The study was closed early because of poor accrual, predominantly due to patients' reluctance to be randomized. There were 33 patients eligible for analysis. Nutritional support with both tubes was good. There were no significant differences in overall complication rates, chest infection rates or in patients' assessment of their overall quality of life. The cost of a PEG tube was 10 times that of an NGT. The duration of use of PEG tubes was significantly longer, a median 139 days compared with a median 66 days for NGT. We found no evidence to support the routine use of PEG tubes over NGT in this patient group.
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Affiliation(s)
- J Corry
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
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13
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Jaycock PD, Bunce C, Xing W, Thomas D, Poon W, Gazzard G, Williamson TH, Laidlaw DAH. Outcomes of macular hole surgery: implications for surgical management and clinical governance. Eye (Lond) 2004; 19:879-84. [PMID: 15389276 DOI: 10.1038/sj.eye.6701679] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [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: 01/29/2023] Open
Abstract
PURPOSE The optimal method and timing of the surgical treatment for idiopathic macular holes remains unknown. The aim of this retrospective study was to identify factors associated with anatomical and visual success in macular hole surgery. METHODS Case records of 55 patients undergoing macular hole surgery at three units in the 2-year period up to July 2002 were reviewed to identify factors associated with anatomical and visual success. The following potential prognosticators were evaluated: patient age, hole stage, hole latency prior to surgery, preoperative acuity, simultaneous phacoemulsification, and intraocular lens implantation, internal limiting membrane peeling with and/or without indocyanine green, and postoperative posturing. RESULTS The duration of preoperative symptoms, indocyanine green-assisted internal limiting membrane peeling, hole stage, and better preoperative visual acuity were associated with both anatomical success and regaining a postoperative visual acuity of 6/12 or better. DISCUSSION The closure rate in patients undergoing surgery within 1 year of onset was 94.0%, and in those waiting 1 year or more it was 47.4%. Clinical governance and quality issues should dictate that NHS macular hole surgery is available to all within 1 year of onset. This study showed no adverse effect of ICG dye retinal staining. The results support the use of a 'patient-friendly' approach of simultaneous cataract surgery with no prone postoperative posturing.
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Affiliation(s)
- P D Jaycock
- Department of Ophthalmology, St Thomas' Hospital, London, UK
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14
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Williamson TH, Poon W, Whitefield L, Strothidis N, Jaycock P, Strothoudis N. A pilot study of pars plana vitrectomy, intraocular gas, and radial neurotomy in ischaemic central retinal vein occlusion. Br J Ophthalmol 2003; 87:1126-9. [PMID: 12928281 PMCID: PMC1771842 DOI: 10.1136/bjo.87.9.1126] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND/AIMS There is no effective treatment for ischaemic central retinal vein occlusion (CRVO). The two major negative outcomes are neovascular glaucoma (NVG) and severe central visual loss. In this study pars plana vitrectomy (PPV), mild panretinal photocoagulation, and intraocular gas injection were employed to prevent NVG. The potential role of incision of the lamina cribrosa (radial neurotomy) for visual recovery was examined. METHODS Eight eyes of seven patients with ischaemic CRVO had PPV, mild panretinal photocoagulation, and intraocular perfluoropropane gas injection. Four eyes had radial neurotomies performed. The patients were examined by fundus photography, fundus fluorescein angiography, optical coherence tomography, and Goldmann visual field analysis. RESULTS No patients suffered from neovascular glaucoma. Visual recovery was seen in patients with and without neurotomy but some patients had cataract extraction to allow visualisation for PPV. Fundus photography demonstrated reduced engorgement of retinal veins in two of the patients with neurotomy and one with PPV alone. Optical coherence tomography demonstrated macular oedema in three patients with neurotomy and all patients with PPV alone. Segmental visual field loss was seen in one patient with neurotomy suggesting damage to the optic nerve head. CONCLUSIONS PPV is safe in ischaemic CRVO. Combined with mild PRP and intraocular gas injection the risk of neovascular glaucoma is low. Neurotomy can be added to try to improve the chances of recovery of central vision but may cause additional peripheral visual field loss.
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Affiliation(s)
- T H Williamson
- Department of Ophthalmology, St Thomas's Hospital, London SE1 7EH, UK.
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15
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Abstract
AIM To report the presence of Behçet's disease with ocular involvement in patients of west African or Afro-Caribbean origin. METHODS Case series of eight patients reporting to a tertiary uveitis service. RESULTS Eight patients with typical features of the disease are presented. Six of the eight patients were tested and found to be HLA-B51 negative. CONCLUSION Behçet's disease has only been reported in sporadic case reports in the indigenous west African and Afro-Caribbean populations, in whom the incidence of HLA B51 is also very low. A series of patients from the London region presented with the typical symptoms and signs of disease, most of whom were also HLA B51 negative. The presence of disease in this population, when absent in the indigenous population, suggests either that ascertainment of disease is poor in the indigenous population or that acquired factors may be important in the aetiology of the disease.
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Affiliation(s)
- W Poon
- Department of Ophthalmology, St Thomas's Hospital, London, UK
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16
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Yau Y, Piper I, Contant C, Citerio G, Kiening K, Enblad P, Nilsson P, Ng S, Wasserberg J, Kiefer M, Poon W, Dunn L, Whittle I. Multi-centre assessment of the Spiegelberg compliance monitor: interim results. Acta Neurochir Suppl 2003; 81:167-70. [PMID: 12168294 DOI: 10.1007/978-3-7091-6738-0_43] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Analyses of a multi-centre database of 71 patients at risk of raised ICP showed that in head injured patients (n = 19) and tumour patients (n = 13) clear inverse relationships of ICP vs compliance exist. SAH patients (n = 5) appear to exhibit a biphasic relationship between ICP and compliance, however greater numbers of patients need to be recruited to this group. Patients with hydrocephalus (n = 34) show an initial decrease in compliance while ICP is less than 20 mmHg, thereafter compliance does not show a dependence upon ICP. A power analysis confirmed that sufficient numbers of patients have been recruited in the hydrocephalus group and a ROC analysis determined that a mean compliance value of 0.809 (lower and upper 95% CL = 0.725 & 0.894 resp.) was a critical threshold for raised ICP greater than 10 mmHg. Preliminary time-series analyses of the ICP and compliance data is revealing evidence that the cumulative time compliance is in a low compliance state (< 0.5 ml/mmHg), as a proportion of total monitoring time, increases more rapidly than the cumulative time ICP is greater than 25 mmHg. Before trials testing compliance thresholds can be designed, we need to consider not just the absolute threshold, but the duration of time spent below threshold. A survey may be required to identify a consensus of what is the minimum duration of raised ICP above 25 mmHg needed to instigate treatment.
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Affiliation(s)
- Y Yau
- Department of Clinical Neurosciences, University of Edinburgh, UK
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17
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Chak M, Stanford MR, Poon W, Graham EM, Tungekar MF, Goldsmith D. Uveitis initiating an autoimmune reaction resulting in Goodpasture's syndrome in a Chinese man. Br J Ophthalmol 2002; 86:1188-90. [PMID: 12234906 PMCID: PMC1771299 DOI: 10.1136/bjo.86.10.1188-a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2002] [Indexed: 11/03/2022]
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18
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Piper I, Dunn L, Contant C, Yau Y, Whittle I, Citerio G, Kiening K, Schvning W, Ng S, Poon W, Enblad P, Nilsson P. Multi-centre assessment of the Spiegelberg compliance monitor: preliminary results. Acta Neurochir Suppl 2001; 76:491-4. [PMID: 11450076 DOI: 10.1007/978-3-7091-6346-7_103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Acute brain injury states (e.g. head injury, subarachnoid haemorrhage) show clear inverse relationships of ICP vs compliance, with ICP instability at times of lower compliance states. Variance in compliance values is large in hydrocephalus where ICP is relatively lower and compliance higher. Nonetheless, early experience shows that compliance data influence decisions on CSF diversion treatments. Future work will focus on the ability of intracranial compliance to predict ensuing ICP instability and methodological refinement for monitoring patients who have higher compliance states.
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Affiliation(s)
- I Piper
- Institute of Neurological Sciences, Glasgow, Scotland, UK
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19
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Abstract
A 3-year-old boy presented with brainstem astrocytoma and central alveolar hypoventilation syndrome. Contrast MRI of the brain showed that the tumor involved the cerebellum, with compression of brainstem, and resolved after surgical resection. Polysomnography performed before and after total tumor resection showed significant improvement in nocturnal respiratory rate, respiratory disturbance index, and oxygen desaturation. It is apparent that central alveolar hypoventilation syndrome secondary to brainstem tumor may improve after surgical resection for those with favorable anatomic location and histology. Serial polysomnography and MRI scans are useful for diagnosis and in the management plan, and to monitor progress.
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Affiliation(s)
- S H Hui
- Department of Pediatrics, Surgery Diagnostic Imaging, The Chinese University of Hong Kong, Hong Kong
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20
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Lau KY, Roebuck DJ, Mok V, Ng HK, Lam J, Teo JG, Kay R, Poon W, Metreweli C. MRI demonstration of subarachnoid neurocysticercosis simulating metastatic disease. Neuroradiology 1998; 40:724-6. [PMID: 9860122 DOI: 10.1007/s002340050672] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We present a patient with neurocysticercosis with spinal subarachnoid spread who presented with lower back pain and progressive numbness and weakness of the left leg. MRI of the spine simulated metastasis. MRI of the brain demonstrated a "bunch of grapes" appearance in the basal cisterns, characteristic of cysticercosis.
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Affiliation(s)
- K Y Lau
- Department of Diagnostic Radiology & Organ Imaging, Prince of Wales Hospital, Shatin NT, Hong Kong
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21
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Poon W, Goh K, Cocks R, Kwok S, Lau FL. The impact of video-consultation on neurosurgical health services. J Telemed Telecare 1998. [DOI: 10.1258/1357633981931885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | | | - Robert Cocks
- Accident and Emergency Department, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China
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22
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Abstract
There has been no previous description of the pathological features of Alzheimer's disease and little description of Alzheimer-type changes in Chinese brains. In this study, we examined the brains of 17 cases of Alzheimer's disease and concurrently 95 consecutive autopsy cases of non-demented patients aged above 60. Six standard regions of the brains were stained for beta-amyloid immunostaining, Bielschowsky and Bodian. Neuritic plaques, neurofibrillary tangles and diffuse plaques were quantified as per mm2. The Alzheimer's disease brains exhibited a marked increase of neurodegenerative changes over the non-demented brains. Plaque counts were similar to those proposed by Khachaturian (1985; Arch. Neurol. 42: 1097-1105) and CERAD, although the distribution of tangles was more variable with some regions of the neocortex containing few or no tangles. For the non-demented brains, overall neuritic plaques were seen in 31% and neurofibrillary tangles were seen in 42% of cases, with the overall plaque score being 1.8 per mm2 and tangle score being 0.7 per mm2. No age-dependent variation of plaque count and tangle count could be demonstrated in this group of elderly brains. Comparison with similar studies of Caucasians suggests that neuritic plaques and neurofibrillary tangles were less frequently encountered in aging Chinese brains than among the western populations.
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Affiliation(s)
- H Ng
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Shatin
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23
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Wong GW, Oppenheimer SJ, Poon W, Leung R. Intracranial tuberculoma and hydrocephalus developing during treatment of tuberculous meningitis. J Trop Med Hyg 1994; 97:236-8. [PMID: 8064947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A 3 1/2-year-old boy with tuberculous meningitis is described. He developed hydrocephalus and subsequently an intracranial tuberculoma while receiving appropriate antituberculous therapy. Such a paradoxical response is thought to be due to a hypersensitivity reaction to the infection during antituberculous therapy. Both hydrocephalus and tuberculomata should be looked for if any patient develops new neurological signs or symptoms during treatment of tuberculous meningitis.
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Affiliation(s)
- G W Wong
- Department of Paediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, NT
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24
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Lin ES, Poon W, Hutchinson RC, Oh TE. Systems analysis applied to intracranial pressure waveforms and correlation with clinical status in head injured patients. Br J Anaesth 1991; 66:476-82. [PMID: 2025475 DOI: 10.1093/bja/66.4.476] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Intracranial pressure waveforms (ICPWF) in head injured patients vary with the nature and severity of injury. Clinical interpretation of ICPWF shape is not defined. Spectral analysis provides an objective method of measuring changes in waveform shape, but the indices most suitable for clinical use remain unknown. Spectral analysis has been applied to ICPWF recorded from 30 patients with head injury, classified on clinical grounds into good, poor and intermediate groups. Normalized indices derived from ratios of certain characteristics of the ICP waveform to those of the arterial pressure (AP) waveform, were different (P less than 0.05) in all groups. A simple index examined was the harmonic count ratio (Nc:Na) which decreased with increasing severity of injury. ICP/AP harmonic transfer functions were derived, and demonstrated a peaked response in the range 10-12 Hz. Increasing attenuation of this peaked response occurred with increasing severity of injury. These results suggest that transfer functions may be a clinically useful index of intracranial conditions.
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Affiliation(s)
- E S Lin
- Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T
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25
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Abstract
A 28-year-old woman, 1 month post partum, who presented with headache and gradual onset of total ophthalmoplegia of the left eye, was found at transsphenoidal exploration to have a primary intrasellar germinoma. Craniospinal irradiation resulted in complete resolution of the intracranial tumor. Extensive mediastinal metastasis at 8 months after the operation resulted in a fatal outcome.
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Affiliation(s)
- W Poon
- Department of Surgery, Prince of Wales Hospital, Shatin, Hong Kong
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26
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Teoh R, Poon W, Humphries MJ, O'Mahony G. Suprasellar tuberculoma developing during treatment of tuberculous meningitis requiring urgent surgical decompression. J Neurol 1988; 235:321-2. [PMID: 3385452 DOI: 10.1007/bf00314183] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [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: 01/05/2023]
Abstract
An adult patient on treatment for tuberculous meningitis developed visual failure due to a tuberculoma compressing both optic nerves and chiasm. Although continued anti-tuberculous chemotherapy is the treatment of choice for intracranial tuberculoma, the rapid deterioration in vision necessitated urgent surgical decompression, which resulted in complete recovery of vision.
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Affiliation(s)
- R Teoh
- Department of Medicine, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, NT
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27
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Baker RC, Hogarty S, Poon W, Vadehra DV. Survival of Salmonella typhimurium and Staphylococcus aureus in eggs cooked by different methods. Poult Sci 1983; 62:1211-6. [PMID: 6353398 DOI: 10.3382/ps.0621211] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Shell eggs inoculated with Salmonella typhimurium and Staphylococcus aureus were cooked by recommended procedures for boiling, poaching, and frying. Except for poaching, the recommended procedures were inadequate in destroying the inoculum placed in the yolk. Boiling for 7 min was necessary for complete destruction of S. typhimurium and it took 12 min of boiling to destroy Staph. aureus. Cooking time-temperature relationship for complete kill depended on the cooking method with fried eggs. Four minutes and 70 C were needed for covered eggs, 3 min on each side at 64 C for turned over eggs, while cooking for 7.5 min at 64 C for sunnyside eggs was not sufficient for destruction of both of the test organisms. None of the test organisms could be recovered from omelets baked by the recommended procedure (86 C for 25 min). Scrambling for 1 min at 74 C was required for the complete destruction of S. typhimurium and 2 min at 78 C for Staph. aureus.
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28
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Abstract
The development of gestural usage as a response to intraverbal stimuli was investigated in 89 five- to seven-year-old school children. A modified version of the Intraverbal Gesture subtest of the Parsons Language Sample was employed. A significant developmental pattern of intraverbal responses was obtained. Implications in terms of the Skinnerian concept of intraverbal behavior are discussed.
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