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Ou Y, Zong D, Ouyang R. Role of epigenetic abnormalities and intervention in obstructive sleep apnea target organs. Chin Med J (Engl) 2023; 136:631-644. [PMID: 35245923 PMCID: PMC10129098 DOI: 10.1097/cm9.0000000000002080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Obstructive sleep apnea (OSA) is a common condition that has considerable impacts on human health. Epigenetics has become a rapidly developing and exciting area in biology, and it is defined as heritable alterations in gene expression and has regulatory effects on disease progression. However, the published literature that is integrating both of them is not sufficient. The purpose of this article is to explore the relationship between OSA and epigenetics and to offer better diagnostic methods and treatment options. Epigenetic modifications mainly manifest as post-translational modifications in DNA and histone proteins and regulation of non-coding RNAs. Chronic intermittent hypoxia-mediated epigenetic alterations are involved in the progression of OSA and diverse multiorgan injuries, including cardiovascular disease, metabolic disorders, pulmonary hypertension, neural dysfunction, and even tumors. This article provides deeper insights into the disease mechanism of OSA and potential applications of targeted diagnosis, treatment, and prognosis in OSA complications.
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Affiliation(s)
- Yanru Ou
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan 410011, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan 410011, China
| | - Dandan Zong
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan 410011, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan 410011, China
| | - Ruoyun Ouyang
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan 410011, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan 410011, China
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2
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Çay Ü, Alabaz D, Ö Gündeşlioglu Ö, Tutuş K, K Çil M, Pehlivan UA. Multi-organ/disseminated echinococcosis in children: Case series and review of the literature. J Paediatr Child Health 2022; 58:1193-1200. [PMID: 35262239 DOI: 10.1111/jpc.15942] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 12/01/2021] [Revised: 01/24/2022] [Accepted: 02/23/2022] [Indexed: 11/30/2022]
Abstract
AIM Echinococcosis with multi-organ/disseminated involvement is rare in childhood. We aimed to evaluate the clinical and laboratory characteristics and prognosis in paediatric patients with echinococcosis having multiorgan/disseminated involvement. METHOD We evaluated retrospectively children with echinococcosis with involvement of three or more organs. RESULTS Thirteen patients were included in the study. The median age was 120 (range 71-189) months. Three (23%) were diagnosed incidentally. Abdominal pain was seen in 5 (38.4%) patients, vomiting in 4 (30.7%), headache in 3 (23%), cough in 2 (15.3%), groin pain in 1 (7.6%), 1 (7.6%) had jaundice and 1 (7.6%) had fever. The median duration of complaints was 48 (0-140) days. The most common tripartite organ was 38.4% (5/13) liver, lung and spleen. Isolated abdominal dissemination was detected in two patients. Two patients had multi-organ involvement and multiple cysts with dissemination. Cyst rupture was observed in three of the patients; recurrent urinary tract infection, hydroureteronephrosis, secondary peritonitis with intra-abdominal abscess, and biliary tract fistula were each observed in one patient. Relapse developed in 3 (23%) patients. CONCLUSION Echinococcosis is a very slow growing and complex parasitic disease that affects many organs and tissues. In our study, eosinophilia, recurrence, and complications were seen at a higher rate in paediatric patients with multiorgan involvement, who required repetitive surgeries and long-term medical treatment. However, there are scanty data on risk factors, optimum treatment and prognosis.
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Affiliation(s)
- Ümmühan Çay
- Department of Pediatric Infectious, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Derya Alabaz
- Department of Pediatric Infectious, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Özlem Ö Gündeşlioglu
- Department of Pediatric Infectious, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Kamuran Tutuş
- Department of Pediatric Surgery, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Merve K Çil
- Department of Pediatric Infectious, Adana City Training and Research Hospital, Adana, Turkey
| | - Umur A Pehlivan
- Department of Radiology, Faculty of Medicine, Çukurova University, Adana, Turkey
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Sarkar S, Chen S, Spencer B, Situ X, Afkarian M, Matsukuma K, Corwin MT, Wang G. Non-Alcoholic Steatohepatitis Severity Associates with FGF21 Level and Kidney Glucose Uptake. Metab Syndr Relat Disord 2021; 19:491-497. [PMID: 34448598 PMCID: PMC10027339 DOI: 10.1089/met.2021.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Nonalcoholic steatohepatitis (NASH) is a severe form of fatty liver disease that has been shown to be associated with chronic kidney disease (CKD). Mechanism for the association of NASH with CKD remains unclear. In this study, we examined the association between NASH severity and kidney glucose uptake and the liver-secreted signaling molecule fibroblast growth factor 21 (FGF21). Methods: Kinetic parameters for kidney glucose transport rate (K1) and standardized uptake value (SUV) were determined using dynamic positron emission tomography after injection of 18F-fluorodeoxyglucose. Liver biopsies were scored for NASH activity (inflammation and ballooning), fibrosis, and steatosis FGF21 was measured from fasting serum samples. Patients were categorized by liver biopsy and multivariate analyses were performed to evaluate the associations. Results: Of 41 NASH patients 73% were females, 71% white, 51% with steatosis ≥2, 39% with NASH activity ≥4 and fibrosis ≥3. With severe NASH activity, kidney SUV significantly increased even when adjusted for underlying insulin-resistant (IR) state. Kidney K1 decreased significantly in higher liver activity in unadjusted models but not when adjusted for IR. FGF21 decreased with severe liver activity in adjusted models (P < 0.05) and associated with kidney K1 but not SUV. Conclusion: Our pilot data indicate that kidney glucose metabolism associates with NASH activity and FGF21 levels, suggesting a potential mechanism to NASH-induced CKD. Clinical Trials.gov ID: NCT02754037.
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Affiliation(s)
- Souvik Sarkar
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of California, Davis, Sacramento, California, USA
| | - Shuai Chen
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, Davis, California, USA
| | - Benjamin Spencer
- Department of Radiology, University of California, Davis, Sacramento, California, USA
| | - Xiaolu Situ
- Department of Statistics, University of California, Davis, Davis, California, USA
| | - Maryam Afkarian
- Division of Nephrology, Department of Internal Medicine, University of California, Davis, Sacramento, California, USA
| | - Karen Matsukuma
- Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento, California, USA
| | - Michael T Corwin
- Department of Radiology, University of California, Davis, Sacramento, California, USA
| | - Guobao Wang
- Department of Radiology, University of California, Davis, Sacramento, California, USA
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Altshuler PJ, Shah AP, Frank AM, Glorioso J, Dang H, Shaheen O, Patel K, Ramirez CB, Maley WR, Bodzin AS. Simultaneous liver kidney allocation policy and the Safety Net: an early examination of utilization and outcomes in the United States. Transpl Int 2021; 34:1052-1064. [PMID: 33884677 DOI: 10.1111/tri.13891] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 03/13/2021] [Accepted: 04/12/2021] [Indexed: 01/31/2023]
Abstract
Rates of simultaneous liver kidney (SLK) transplantation in the United States have progressively risen. On 8/10/17, the Organ Procurement and Transplantation Network implemented a policy defining criteria for SLK, with a "Safety Net" to prioritize kidney allocation to liver recipients with ongoing renal failure. We performed a retrospective review of the United Network for Organ Sharing (UNOS) database to evaluate policy impact on SLK, kidney after liver (KAL) and kidney transplant alone (KTA). Rates and outcomes of SLK and KAL transplants were compared, as was utilization of high-quality kidney allografts with Kidney Donor Profile Indices (KDPI) <35%. Here, SLK transplants comprised 9.0% and 4.5% of total postpolicy liver and kidney transplants compared to 10.2% and 5.5% prior. Policy enactment did not affect 1-year graft or patient survival for SLK and KAL populations. Less postpolicy SLK transplants utilized high-quality kidney allografts; in all transplant settings, outcomes using high-quality grafts remained stable. These findings suggest that policy implementation has reduced kidney allograft use in SLK transplantation, although both SLK and KAL rates have recently increased. Despite decreased high-quality kidney allograft use, SLK and KAL outcomes have remained stable. Additional studies and long-term follow-up will ensure optimal organ access and sharing.
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Affiliation(s)
- Peter J Altshuler
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ashesh P Shah
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Adam M Frank
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jaime Glorioso
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Hien Dang
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Osama Shaheen
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Keyur Patel
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Carlo B Ramirez
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Warren R Maley
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Adam S Bodzin
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
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Fernandez-Gonzalez A, Willis GR, Yeung V, Reis M, Liu X, Mitsialis SA, Kourembanas S. Therapeutic Effects of Mesenchymal Stromal Cell-Derived Small Extracellular Vesicles in Oxygen-Induced Multi-Organ Disease: A Developmental Perspective. Front Cell Dev Biol 2021; 9:647025. [PMID: 33796534 PMCID: PMC8007882 DOI: 10.3389/fcell.2021.647025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 12/28/2020] [Accepted: 02/17/2021] [Indexed: 12/13/2022] Open
Abstract
Despite major advances in neonatal intensive care, infants born at extremely low birth weight still face an increased risk for chronic illness that may persist into adulthood. Pulmonary, retinal, and neurocognitive morbidities associated with preterm birth remain widespread despite interventions designed to minimize organ dysfunction. The design of therapeutic applications for preterm pathologies sharing common underlying triggers, such as fluctuations in oxygen supply or in the inflammatory state, requires alternative strategies that promote anti-inflammatory, pro-angiogenic, and trophic activities—ideally as a unitary treatment. Mesenchymal stem/stromal cell-derived extracellular vesicles (MEx) possess such inherent advantages, and they represent a most promising treatment candidate, as they have been shown to contribute to immunomodulation, homeostasis, and tissue regeneration. Current pre-clinical studies into the MEx mechanism of action are focusing on their restorative capability in the context of preterm birth-related pathologies, albeit not always with a multisystemic focus. This perspective will discuss the pathogenic mechanisms underlying the multisystemic lesions resulting from early-life disruption of normal physiology triggered by high oxygen exposures and pro-inflammatory conditions and introduce the application of MEx as immunomodulators and growth-promoting mediators for multisystem therapy.
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Affiliation(s)
- Angeles Fernandez-Gonzalez
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Gareth R Willis
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Vincent Yeung
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Monica Reis
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Xianlan Liu
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - S Alex Mitsialis
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Stella Kourembanas
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States
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Afflu DK, Diaz-Castrillon CE, Seese L, Hess NR, Kilic A. Changes in multiorgan heart transplants following the 2018 allocation policy change. J Card Surg 2021; 36:1249-1257. [PMID: 33484169 DOI: 10.1111/jocs.15356] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 10/05/2020] [Accepted: 11/06/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND This study evaluated the impact of the heart allocation policy change in 2018 on the characteristics and outcomes of multiorgan transplants involving heart allografts. METHODS Adults undergoing multiorgan heart transplantation from 2010 to 2020 were identified from the United Network for Organ Sharing (UNOS) registry. Transplants were stratified into occurring before versus after the October 2018 heart allocation change. The primary outcome was 1-year survival following transplantation. A Cox proportional hazards model was used to evaluate the risk-adjusted effect of the allocation policy change on outcomes between cohorts. RESULTS A total of 1832 patients underwent multiorgan heart transplantation during the study period with 245 (13.37%) undergoing heart-lung transplantation, 244 (13.32%) undergoing heart-liver transplantation, and 1343 (73.31%) undergoing heart-kidney transplantation. There was a higher utilization of temporary MCSDs as well as longer ischemic times for all three types of transplantation following the policy change. Heart-lung and heart-liver recipients had a similar 1-year survival before and after the policy change (each p > .05). Renal failure requiring dialysis (29.5% vs. 39.4%, p = .001) as well as 1-year survival (88% vs. 82%; log-rank p = .01) were worse in the heart-kidney cohort after the organ allocation system modification. CONCLUSIONS This study demonstrates similar trends in multiorgan transplants as has been observed in isolated heart transplants following the allocation change, including more frequent utilization of temporary mechanical support and longer ischemic times. Although outcomes have remained comparable in the new allocation era with heart-lung and heart-liver transplants, heart-kidney recipients have a worse 1-year survival following the change.
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Affiliation(s)
- Derek K Afflu
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Carlos E Diaz-Castrillon
- Pediatric Cardiothoracic Surgery, Heart Institute, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Laura Seese
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nicholas R Hess
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Arman Kilic
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Dias AR, Pereira MA, Oliveira RJ, Ramos MFKP, Szor DJ, Ribeiro U, Zilberstein B, Cecconello I. Multivisceral resection vs standard gastrectomy for gastric adenocarcinoma. J Surg Oncol 2020; 121:840-847. [PMID: 32003476 DOI: 10.1002/jso.25862] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 01/17/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Multivisceral resection (MVR) is potentially curative for selected gastric cancer patients, supposedly at the cost of increased complications. However, current data comparing MVR to standard gastrectomy (SG) is lacking. OBJECTIVES Compare complications and survival after MVR and SG. METHODS In a retrospective cohort of 1015 patients with gastric adenocarcinoma, 58 underwent MVR and 466 SG. Groups were compared concerning their characteristics, complications, and survival. RESULTS One hundred seventy-six patients had postoperative complications. Major complications were more frequent after MVR (P = .002). Surgical mortality was 8.6% and 4.9% for MVR and SG (P = .221). Older age, higher morbidities, and MVR were independent risk factors for major complications. The odds ratio for major complications was 5.89 for MVR with one or two organs and 38.01 for MVR with three or more organs. The pancreas was the most commonly removed organ and pT4b disease were confirmed in 34 (58.6%) of the MVR cases. Disease-free survival (DFS) was lower in MVR patients (51% vs 77.8%; P < .001), being worse according to the number of organs resected. In pN+ patients, DFS was worse after MVR. DFS was equivalent to pT4b and non-pT4b in the MVR group. CONCLUSIONS Increased morbidity and lower survival are expected for gastric cancer patients undergoing MVR.
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Affiliation(s)
- Andre R Dias
- Gastrointestinal Surgery Division, Department of Gastroenterology, Cancer Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Marina A Pereira
- Gastrointestinal Surgery Division, Department of Gastroenterology, Cancer Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Rodrigo J Oliveira
- Gastrointestinal Surgery Division, Department of Gastroenterology, Cancer Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Marcus F K P Ramos
- Gastrointestinal Surgery Division, Department of Gastroenterology, Cancer Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Daniel J Szor
- Gastrointestinal Surgery Division, Department of Gastroenterology, Cancer Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Ulysses Ribeiro
- Gastrointestinal Surgery Division, Department of Gastroenterology, Cancer Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Bruno Zilberstein
- Gastrointestinal Surgery Division, Department of Gastroenterology, Cancer Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Ivan Cecconello
- Gastrointestinal Surgery Division, Department of Gastroenterology, Cancer Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
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Abstract
Human parvovirus B19 (B19V) causes myriads of clinical diseases; however, owing to lack of awareness and undetermined clinical impact, it has failed to become a virus pathogen of global concern. Cryptically, B19V causes significant morbidity and mortality. Half of the world population and 60 per cent of Indians are known to be serologically naive and are at risk of acquiring B19V infections. Cumulatively, our data showed 21.3 per cent B19V-infected patients with juvenile chronic arthropathy, recurrent abortions, multi-transfused thalassaemia and leukaemia. In addition, B19V-infected cases that ended fatally included patients with pure red cell aplasia, fulminant hepatitis and haemophagocytic syndrome. Novel clinical associations of B19V observed were amegakaryocytic thrombocytopaenia, myositis and non-occlusive ischaemic gangrene of bowel. B19V possesses multiple receptors which are distributed widely in human tissues. Vascular endothelial cell infection by B19V causes endothelialitis and vasculitic injuries besides antibody-dependent enhancement which empowered B19V to cause multiorgan diseases. Owing to lack of suitable animal model for B19V, true causal role remains to be determined, but numerous reports on B19V infections substantiate a causal role in multiorgan diseases. Hence, B19V infections need to be recognized, investigated and treated besides making efforts on vaccine developments.
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Affiliation(s)
- Janak Kishore
- Division of Virology, Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Divya Kishore
- Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India
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Salmin F, Albamonte E, Morettini V, Gagliano N, Mercuri E, Sansone VA. Resolution of skin necrosis after nusinersen treatment in an infant with spinal muscular atrophy. Muscle Nerve 2019; 59:E42-E44. [PMID: 30811610 DOI: 10.1002/mus.26457] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/18/2019] [Accepted: 02/25/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Francesca Salmin
- The NEMO Center in Milan, Neurorehabilitation Unit, University of Milan, ASST Niguarda Hospital, Milan, Italy
| | - Emilio Albamonte
- The NEMO Center in Milan, Neurorehabilitation Unit, University of Milan, ASST Niguarda Hospital, Milan, Italy
| | - Valentina Morettini
- The NEMO Center in Milan, Neurorehabilitation Unit, University of Milan, ASST Niguarda Hospital, Milan, Italy
| | | | - Eugenio Mercuri
- Department of Child Neurology, University Hospital Policlinico Gemelli and the Pediatric NEMO Center in Rome, Rome, Italy
| | - Valeria Ada Sansone
- The NEMO Center in Milan, Neurorehabilitation Unit, University of Milan, ASST Niguarda Hospital, Milan, Italy
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Trullo R, Petitjean C, Dubray B, Ruan S. Multiorgan segmentation using distance-aware adversarial networks. J Med Imaging (Bellingham) 2019; 6:014001. [PMID: 30662925 PMCID: PMC6328005 DOI: 10.1117/1.jmi.6.1.014001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 06/30/2018] [Accepted: 12/03/2018] [Indexed: 11/14/2022] Open
Abstract
Segmentation of organs at risk (OAR) in computed tomography (CT) is of vital importance in radiotherapy treatment. This task is time consuming and for some organs, it is very challenging due to low-intensity contrast in CT. We propose a framework to perform the automatic segmentation of multiple OAR: esophagus, heart, trachea, and aorta. Different from previous works using deep learning techniques, we make use of global localization information, based on an original distance map that yields not only the localization of each organ, but also the spatial relationship between them. Instead of segmenting directly the organs, we first generate the localization map by minimizing a reconstruction error within an adversarial framework. This map that includes localization information of all organs is then used to guide the segmentation task in a fully convolutional setting. Experimental results show encouraging performance on CT scans of 60 patients totaling 11,084 slices in comparison with other state-of-the-art methods.
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Affiliation(s)
- Roger Trullo
- Normandie University, Institut National des Sciences Appliquées Rouen, LITIS, Rouen, France
| | - Caroline Petitjean
- Normandie University, Institut National des Sciences Appliquées Rouen, LITIS, Rouen, France
| | | | - Su Ruan
- Normandie University, Institut National des Sciences Appliquées Rouen, LITIS, Rouen, France
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11
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Xu L, Siyiti S, Song X, Wen H, Ding L, Yunus A, Tian Z, Wang C, Chen J. Recurrent multiple-organ involvement of disseminated alveolar echinococcosis in 3 patients: Case report. Medicine (Baltimore) 2017; 96:e7632. [PMID: 29049181 PMCID: PMC5662347 DOI: 10.1097/md.0000000000007632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Alveolar echinococcosis (AE) is a rare but highly malignant form of echinococcosis caused by Echinococcus multilocularis. There have been very few reports on multiple-organ AE, especially AE in bones. Here we report 3 rare cases of disseminated multiple-organ AE from western China and its neighboring areas. PATIENT CONCERNS Patient 1 had back and left hip pain, headache, and weakness in left lower limb, often with minor epilepsy and fluctuation of blood pressure. Lower limbs Babinski sign was positive and muscular tension was above normal range. The second patient had pain in lower limbs and chest discomfort without fever, cough, sputum, chest tightness, or hemoptysis. Patient 3 had masses and pain in the back side of his right shoulder. DIAGNOSES The patients had been treated for AE multiple times and were positive for serum hydatid antigens. They were diagnosed as multiorgan AE involving liver, spinal cord, and many other organs. INTERVENTIONS The patients had undergone surgeries to decompress the spinal cord, remove lesions from tissues as required, and were put on albendazole for at least 2 years. OUTCOMES The patients responded well and AE recurrence has not occurred. LESSONS All 3 cases experienced multiple recurrences of AE due to missed diagnosis, misdiagnosis, or inappropriate treatment, which resulted in metastatic multiorgan AE. These cases demonstrated the need for more policy attention to battle AE endemic in western China.
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Affiliation(s)
- Leilei Xu
- Orthopedic Department, The First Affiliated Hospital of Xinjiang Medical University
| | - Sikandaer Siyiti
- Orthopedic Department, The Sixth Affiliated Hospital of Xinjiang Medical University
| | - Xinghua Song
- Orthopedic Department, The First Affiliated Hospital of Xinjiang Medical University
| | - Hao Wen
- Orthopedic Department, The First Affiliated Hospital of Xinjiang Medical University
| | - Liwen Ding
- Xinjiang Medical University, Urumqi, PR China
| | - Akbar Yunus
- Orthopedic Department, The First Affiliated Hospital of Xinjiang Medical University
| | - Zheng Tian
- Orthopedic Department, The First Affiliated Hospital of Xinjiang Medical University
| | - Chong Wang
- Orthopedic Department, The First Affiliated Hospital of Xinjiang Medical University
| | - Jiangtao Chen
- Orthopedic Department, The First Affiliated Hospital of Xinjiang Medical University
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Abstract
OBJECTIVES Mitochondrial disorders (MIDs) frequently present as mitochondrial multiorgan disorder syndrome (MIMODS) at onset or evolve into MIMODS during the course. This study aimed to find which organs and/or tissues are most frequently affected by MIMODS, which are the most frequent abnormalities within an affected organ, whether there are typical MIMODS patterns, and to generate an MIMODS score to assess the diagnostic probability for an MID. METHODS This is a retrospective evaluation of clinical, biochemical, and genetic investigations of adult patients with definite MIDs. A total of 36 definite MID patients, 19 men and 17 women, aged 29-82 years were included in this study. The diagnosis was based on genetic testing (n=21), on biochemical investigations (n=17), or on both (n=2). RESULTS The number of organs most frequently affected was 4 ranging from 1 to 9. MIMODS was diagnosed in 97% of patients. The organs most frequently affected were the muscle (97%), central nervous system (CNS; 72%), endocrine glands (69%), heart (58%), intestines (55%), and peripheral nerves (50%). The most frequent CNS abnormalities were leukoencephalopathy, prolonged visually evoked potentials, and atrophy. The most frequent endocrine abnormalities included thyroid dysfunction, short stature, and diabetes. The most frequent cardiac abnormalities included arrhythmias, systolic dysfunction, and hypertrophic cardiomyopathy. The most frequent MIMODS patterns were encephalomyopathy, encephalo-myo-endocrinopathy, and encepalo-myo-endocrino-cardiopathy. The mean ± 2SD MIMODS score was 35.97±27.6 (range =11-71). An MIMODS score >10 was regarded as indicative of an MID. CONCLUSION Adult MIDs manifest as MIMODS in the vast majority of the cases. The organs most frequently affected in MIMODS are muscles, CNS, endocrine glands, and heart. An MIMODS score >10 suggests an MID.
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Bates SV, Lakshmanan A, Green AL, Terry J, Badalian-Very G, Rollins BJ, Fleck P, Aslam M, Degar BA. BRAF V600E-Positive Multisite Langerhans Cell Histiocytosis in a Preterm Neonate. AJP Rep 2013; 3:63-6. [PMID: 24147236 PMCID: PMC3799712 DOI: 10.1055/s-0033-1338168] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 01/24/2013] [Indexed: 12/16/2022] Open
Abstract
Hemorrhagic pustules with a "blueberry muffin" appearance accompanied by respiratory failure in a neonate present a challenging differential diagnosis that includes infections and neoplasms. We present a case of multiorgan, multisite Langerhans cell histiocytosis (LCH), positive for the oncogenic BRAF V600E mutation, in a preterm neonate. Infants with LCH pose a diagnostic challenge due to their heterogeneous presentations. This case is unusual in that the newborn presented with severe multiorgan involvement. Due to the rare incidence, wide spectrum of clinical manifestations, and high mortality rate, clinicians must maintain a high index of suspicion for LCH.
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Affiliation(s)
- Sara V Bates
- Division of Neonatology and Newborn Medicine, Department of Pediatrics, Massachusetts General Hospital for Children, Harvard Medical School, Boston, Massachusetts ; These authors contributed equally as primary authors (co-first authors)
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