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Yang G, Bekele A, Krishnaswami S, Ameh E, Sifri Z, Aisuodionoe-Shadrach O, Swaroop M, Orloff S, Abdullah F, Nwomeh B, Chen M, Charles A, Ezeme C, Juillard C, Menezes C, Chitalu M, Nwariaku F, Jawa RS. Cultural competency and ethical behavior for collaboration in limited-resource settings: Guidelines from the Society of University Surgeons Academic Global Surgery Committee and the Association for Academic Global Surgery. Surgery 2024:S0039-6060(24)00129-6. [PMID: 38609784 DOI: 10.1016/j.surg.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/02/2024] [Accepted: 02/26/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND There are an increasing number of global surgery activities worldwide. With such tremendous growth, there is a potential risk for untoward interactions between high-income country members and low-middle income country members, leading to programmatic failure, poor results, and/or low impact. METHODS Key concepts for cultural competency and ethical behavior were generated by the Academic Global Surgery Committee of the Society for University Surgeons in collaboration with the Association for Academic Global Surgery. Both societies ensured active participation from high-income countries and low-middle income countries. RESULTS The guidelines provide a framework for cultural competency and ethical behavior for high-income country members when collaborating with low-middle income country partners by offering recommendations for: (1) preparation for work with low-middle income countries; (2) process standardization; (3) working with the local community; (4) limits of practice; (5) patient autonomy and consent; (6) trainees; (7) potential pitfalls; and (8) gray areas. CONCLUSION The article provides an actionable framework to address potential cultural competency and ethical behavior issues in high-income country - low-middle income country global surgery collaborations.
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Affiliation(s)
- George Yang
- Department of Surgery, University of Alabama, Birmingham, AL
| | - Abebe Bekele
- University of Global Health Equity, Kigali, Rwanda
| | | | - Emmanuel Ameh
- Department of Surgery, National Hospital, Abuja, Nigeria
| | - Ziad Sifri
- Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | | | - Mamta Swaroop
- Department of Surgery, Kern Medical Center, Bakersfield, CA
| | - Susan Orloff
- Department of Surgery, Oregon Health & Sciences University, Portland, OR
| | - Fizan Abdullah
- Department of Surgery, Northwestern University and Lurie Children's Hospital of Chicago, Chicago, IL
| | - Benedict Nwomeh
- Department of Surgery, Ohio State University and Nationwide Childrens Hospital, Columbus, OH
| | - Mike Chen
- Department of Surgery, University of Alabama, Birmingham, AL
| | - Anthony Charles
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Catherine Juillard
- Department of Surgery, University of California Los Angeles, Los Angeles, CA
| | | | | | - Fiemu Nwariaku
- Department of Surgery, University of Utah, Salt Lake City, UT
| | - Randeep S Jawa
- Department of Surgery, Stony Brook Medicine, Stony Brook, NY.
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Roman S, Nwariaku F. Invited commentary: Perspective of health equity in Endocrine Surgery. Surgery 2024; 175:17-18. [PMID: 37989604 DOI: 10.1016/j.surg.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/17/2023] [Indexed: 11/23/2023]
Affiliation(s)
- Sanziana Roman
- Department of Surgery and Medicine, University of California San Francisco, San Francisco, CA
| | - Fiemu Nwariaku
- Department of Surgery, University of Utah Health, Salt Lake City, UT
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Khader Y, Jeong D, Odume B, Chukwuogo O, Dim C, Useni S, Okuzu O, Malolan C, Kim D, Nwariaku F, Nwokoye N, Gande S, Nongo D, Eneogu R, Odusote T, Oyelaran S, Chijioke-Akaniro O, Nihalani N, Anyaike C, Gidado M. Identifying Hot Spots of Tuberculosis in Nigeria Using an Early Warning Outbreak Recognition System: Retrospective Analysis of Implications for Active Case Finding Interventions. JMIR Public Health Surveill 2023; 9:e40311. [PMID: 36753328 PMCID: PMC9947752 DOI: 10.2196/40311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/07/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Undiagnosed tuberculosis (TB) cases are the major challenge to TB control in Nigeria. An early warning outbreak recognition system (EWORS) is a system that is primarily used to detect infectious disease outbreaks; this system can be used as a case-based geospatial tool for the real-time identification of hot spot areas with clusters of TB patients. TB screening targeted at such hot spots should yield more TB cases than screening targeted at non-hot spots. OBJECTIVE We aimed to demonstrate the effectiveness of an EWORS for TB hot spot mapping as a tool for detecting areas with increased TB case yields in high TB-burden states of Nigeria. METHODS KNCV Tuberculosis Foundation Nigeria deployed an EWORS to 14 high-burden states in Nigeria. The system used an advanced surveillance mechanism to identify TB patients' residences in clusters, enabling it to predict areas with elevated disease spread (ie, hot spots) at the ward level. TB screening outreach using the World Health Organization 4-symptom screening method was conducted in 121 hot spot wards and 213 non-hot spot wards selected from the same communities. Presumptive cases identified were evaluated for TB using the GeneXpert instrument or chest X-ray. Confirmed TB cases from both areas were linked to treatment. Data from the hot spot and non-hot spot wards were analyzed retrospectively for this study. RESULTS During the 16-month intervention, a total of 1,962,042 persons (n=734,384, 37.4% male, n=1,227,658, 62.6% female) and 2,025,286 persons (n=701,103, 34.6% male, n=1,324,183, 65.4% female) participated in the community TB screening outreaches in the hot spot and non-hot spot areas, respectively. Presumptive cases among all patients screened were 268,264 (N=3,987,328, 6.7%) and confirmed TB cases were 22,618 (N=222,270, 10.1%). The number needed to screen to diagnose a TB case in the hot spot and non-hot spot areas was 146 and 193 per 10,000 people, respectively. CONCLUSIONS Active TB case finding in EWORS-mapped hot spot areas yielded higher TB cases than the non-hot spot areas in the 14 high-burden states of Nigeria. With the application of EWORS, the precision of diagnosing TB among presumptive cases increased from 0.077 to 0.103, and the number of presumptive cases needed to diagnose a TB case decreased from 14.047 to 10.255 per 10,000 people.
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Affiliation(s)
| | - Dohyo Jeong
- University of Texas, Dallas, TX, United States
| | - Bethrand Odume
- Technical Division, KNCV Tuberculosis Foundation, Abuja, Nigeria
| | | | - Cyril Dim
- College of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Sani Useni
- Technical Division, KNCV Tuberculosis Foundation, Abuja, Nigeria
| | - Okey Okuzu
- InStrat Global Health Solutions, Abuja, Nigeria
| | - Chenchita Malolan
- University of Texas Southwestern Medical Center, Dallas, TX, United States
| | | | - Fiemu Nwariaku
- University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Nkiru Nwokoye
- Technical Division, KNCV Tuberculosis Foundation, Abuja, Nigeria
| | - Stephanie Gande
- Technical Division, KNCV Tuberculosis Foundation, Abuja, Nigeria
| | - Debby Nongo
- Office of Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome and Tuberculosis, United States Agency for International Development, Abuja, Nigeria
| | - Rupert Eneogu
- Office of Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome and Tuberculosis, United States Agency for International Development, Abuja, Nigeria
| | - Temitayo Odusote
- Office of Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome and Tuberculosis, United States Agency for International Development, Abuja, Nigeria
| | - Salewa Oyelaran
- Office of Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome and Tuberculosis, United States Agency for International Development, Abuja, Nigeria
| | - Obioma Chijioke-Akaniro
- National Tuberculosis, Leprosy and Buruli Ulcer Control Program, Federal Ministry of Health, Abuja, Nigeria
| | | | - Chukwuma Anyaike
- National Tuberculosis, Leprosy and Buruli Ulcer Control Program, Federal Ministry of Health, Abuja, Nigeria
| | - Mustapha Gidado
- Program Management Unit, KNCV Tuberculosis Foundation, Hague, Netherlands
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Salam S, Mehta A, Kim D, Seyi-Olajide J, Allo N, Malolan C, Nwariaku F, Khan L. Improving Lagos State emergency medical services by analysing road traffic accident data, response time, and efficient allocation of ambulances. The Lancet Global Health 2022. [DOI: 10.1016/s2214-109x(22)00155-3] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Jayaram A, Pawlak N, Kahanu A, Fallah P, Chung H, Valencia-Rojas N, Rodas EB, Abbaslou A, Alseidi A, Ameh EA, Bekele A, Casey K, Chu K, Dempsey R, Dodgion C, Jawa R, Jimenez MF, Johnson W, Krishnaswami S, Kwakye G, Lane R, Lakhoo K, Long K, Madani K, Nwariaku F, Nwomeh B, Price R, Roser S, Rees AB, Roy N, Ruzgar NM, Sacoto H, Sifri Z, Starr N, Swaroop M, Tarpley M, Tarpley J, Terfera G, Weiser T, Lipnick M, Nabukenya M, Ozgediz D, Jayaraman S. Academic Global Surgery Curricula: Current Status and a Call for a More Equitable Approach. J Surg Res 2021; 267:732-744. [PMID: 34905823 DOI: 10.1016/j.jss.2021.03.061] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/22/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION We aimed to search the literature for global surgical curricula, assess if published resources align with existing competency frameworks in global health and surgical education, and determine if there is consensus around a fundamental set of competencies for the developing field of academic global surgery. METHODS We reviewed SciVerse SCOPUS, PubMed, African Medicus Index, African Journals Online (AJOL), SciELO, Latin American and Caribbean Health Sciences Literature (LILACS) and Bioline for manuscripts on global surgery curricula and evaluated the results using existing competency frameworks in global health and surgical education from Consortium of the Universities for Global Health (CUGH) and Accreditation Council for Graduate Medical Education (ACGME) professional competencies. RESULTS Our search generated 250 publications, of which 18 were eligible: (1) a total of 10 reported existing competency-based curricula that were concurrent with international experiences, (2) two reported existing pre-departure competency-based curricula, (3) six proposed theoretical competency-based curricula for future global surgery education. All, but one, were based in high-income countries (HICs) and focused on the needs of HIC trainees. None met all 17 competencies, none cited the CUGH competency on "Health Equity and Social Justice" and only one mentioned "Social and Environmental Determinants of Health." Only 22% (n = 4) were available as open-access. CONCLUSION Currently, there is no universally accepted set of competencies on the fundamentals of academic global surgery. Existing literature are predominantly by and for HIC institutions and trainees. Current frameworks are inadequate for this emerging academic field. The field needs competencies with explicit input from LMIC experts to ensure creation of educational resources that are accessible and relevant to trainees from around the world.
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Affiliation(s)
| | | | - Alexis Kahanu
- Hackensack University Medical Center, Edison, NJ, USA
| | - Parisa Fallah
- Department of OB/GYN, Brigham & Women's Hospital and Massachusetts General Hospital, Boston, MA, USA
| | - Haniee Chung
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Edgar B Rodas
- Virginia Commonwealth University Department of Surgery, Richmond VA, USA
| | | | - Adnan Alseidi
- University of California San Francisco Department of Surgery, San Francisco, CA, USA
| | - Emmanuel A Ameh
- National Hospital Division of Paediatric Surgery, Abuja, Nigeria
| | - Abebe Bekele
- Addis Ababa University Department of Surgery, Addis Ababa, Ethiopia; University of Global Health Equity, Rwanda
| | | | - Kathryn Chu
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Robert Dempsey
- University of Wisconsin School of Medicine and Public Health, Madison WI, USA
| | - Chris Dodgion
- Medical College of Wisconsin Division of Trauma and Critical Care, Wauwatosa, WI, USA
| | - Randeep Jawa
- Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA
| | - Maria F Jimenez
- Hospital Universitario Mayor Mederi, Department of Surgery. Universidad del Rosario, Bogota, Colombia
| | | | | | - Gifty Kwakye
- University of Michigan Department of Surgery, Ann Arbor, MI, USA
| | - Robert Lane
- International Federation of Surgical Colleges
| | - Kokila Lakhoo
- University of Oxford, Oxford University Hospitals, UK
| | - Kristin Long
- University of Wisconsin School of Medicine and Public Health, Madison WI, USA
| | - Katayoun Madani
- Northwestern University Department of Surgery, Chicago, IL, USA
| | | | - Benedict Nwomeh
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Raymond Price
- University of Utah Dept of Surgery, Salt Lake City, UT, USA
| | - Steven Roser
- Emory University School of Medicine, Atlanta, GA, USA
| | - Andrew B Rees
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Nobhojit Roy
- BARC Hospital, HBNI University, Mumbai, India/ CARE-India, Bihar Technical Support Unit, Patna, Bihar, India
| | | | | | - Ziad Sifri
- Rutgers New Jersey Medical School Department of Surgery, Newark, NJ, USA
| | - Nichole Starr
- University of California San Francisco Department of Surgery, San Francisco, CA, USA
| | - Mamta Swaroop
- Northwestern University Department of Surgery, Chicago, IL, USA
| | - Margaret Tarpley
- University of Botswana Department of Medical Education, Gaborone, Botswana
| | - John Tarpley
- University of Botswana Department of Surgery, Gaborone, Botswana
| | - Girma Terfera
- University of Wisconsin School of Medicine and Public Health, Madison WI, USA
| | - Thomas Weiser
- Stanford University Medical Center Department of Surgery, Stanford, CA, USA
| | - Michael Lipnick
- University of California San Francisco Department of Anesthesia, San Francisco, CA, USA
| | - Mary Nabukenya
- Makerere University Department of Anesthesia, Kampala, Uganda
| | - Doruk Ozgediz
- University of California San Francisco Department of Surgery, San Francisco, CA, USA
| | - Sudha Jayaraman
- University of Utah Dept of Surgery, Salt Lake City, UT, USA.
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Affiliation(s)
- Fiemu Nwariaku
- Department of Surgery, UT Southwestern Medical Center, Dallas, TX
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Mehta A, Morris-Wiseman LF, Romero Arenas MA, Nwariaku F. Beyond recognition: Practical steps to inclusion in academic surgery. Am J Surg 2021; 222:702-703. [PMID: 33771340 DOI: 10.1016/j.amjsurg.2021.03.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Ankeeta Mehta
- UT Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
| | - Lilah F Morris-Wiseman
- The University of Arizona College of Medicine, 1501 N. Campbell Avenue, PO Box 245017, Tucson, AZ, 85724, USA.
| | - Minerva A Romero Arenas
- Weill Cornell Medicine, New York Presbyterian Brooklyn Methodist Hospital, 506 Sixth Street, Brooklyn, NY, 11215, USA.
| | - Fiemu Nwariaku
- UT Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.
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Islam AK, Holt S, Reisch J, Nwariaku F, Antonelli J, Maalouf NM. What Predicts Recurrent Kidney Stone after Parathyroidectomy in Patients with Primary Hyperparathyroidism? J Am Coll Surg 2020; 231:74-82. [PMID: 32330575 DOI: 10.1016/j.jamcollsurg.2020.04.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/16/2020] [Accepted: 04/13/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Some, but not all, patients with primary hyperparathyroidism (PHPT) and kidney stone disease (KSD) are cured of their nephrolithiasis after parathyroidectomy. The goal of this study was to identify risk factors for recurrent KSD despite successful parathyroidectomy in known stone formers with PHPT. STUDY DESIGN We conducted a single-center retrospective review of patients presenting to urology clinic with KSD between January 2008 and July 2018, who were diagnosed with concurrent PHPT, and underwent definitive parathyroidectomy. Laboratory testing for serum calcium, PTH (parathyroid hormone), phosphorus and 25-OH-vitamin D, and 24-hour urine studies for volume, pH, calcium, citrate, oxalate, uric acid, sodium, and creatinine was performed pre- and post-parathyroidectomy. Stone recurrence was determined on routine diagnostic imaging or by symptomatic KSD. RESULTS Mean age at parathyroidectomy was 57 ± 14 years. Pre-parathyroidectomy, mean serum calcium, 24-hour urine calcium, and PTH were 10.6 ± 0.5 mg/dL, 378 ± 209 mg/day, and 114 ± 97 pg/mL, respectively. Twenty-six of 69 patients (38%) had multigland parathyroid disease. After parathyroidectomy, serum calcium and PTH levels normalized in 69 of 69 and 62 of 69 patients, respectively. However, 37 of 69 patients (54%) had persistent hypercalciuria postoperatively, and 16 of 69 (23%) had recurrent KSD, on average, 2.0 ± 1.6 years after parathyroidectomy. Patients with recurrent KSD post-parathyroidectomy were significantly younger compared with patients without recurrent KSD (51 ± 15 vs 60 ± 13 years, p = 0.02). In a logistic regression model, younger age remains a strong predictive factor for recurrent KSD. CONCLUSIONS Nearly one-quarter of PHPT patients with KSD who undergo successful parathyroidectomy present with recurrent KSD despite normalization of serum calcium, and more than half exhibit persistent calciuria. These patients were younger and may require closer monitoring for stone recurrence after successful parathyroidectomy. Further studies are needed to better identify the etiology of KSD post-parathyroidectomy.
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Affiliation(s)
- Ana K Islam
- Department of Surgery, UT Southwestern Medical Center, Dallas, TX.
| | - Shelby Holt
- Department of Surgery, UT Southwestern Medical Center, Dallas, TX
| | - Joan Reisch
- Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX
| | - Fiemu Nwariaku
- Department of Surgery, UT Southwestern Medical Center, Dallas, TX
| | | | - Naim M Maalouf
- Internal Medicine and Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, UT Southwestern Medical Center, Dallas, TX
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Mokdad AA, Nwariaku F, Wolf LL, Qureshi FG. Patterns of Pediatric Mortality from Motor Vehicle Crashes among US Counties: Where Are the Disparities? J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.07.437] [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: 11/29/2022]
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Kadiyala S, Khan Y, de Miguel V, Frone MN, Nwariaku F, Rabaglia J, Woodruff S, King EE, Hathiramani SS, Pacak K, Ghayee HK. SDHD Gene Mutations: Looking Beyond Head and Neck Tumors. AACE Clin Case Rep 2018. [DOI: 10.4158/ep172003.cr] [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: 11/15/2022] Open
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Carter AM, Telange R, Oltmann S, Nwariaku F, Robinson B, Grubbs E, Bibb J. Abstract A33: Biomarkers of Cdk5 driven neuroendocrine tumors. Mol Cancer Res 2016. [DOI: 10.1158/1557-3125.cellcycle16-a33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Neuroendocrine (NE) cancers originate from secretory cells of the body's various endocrine structures. Surgical resection is the primary treatment for these tumors. However, the majority of NE cancers are metastatic at the time of detection and no effective adjuvant therapies exist for primary NE tumors or their metastases. Patients often develop two or more NE cancers, a syndrome termed multiple endocrine neoplasia (MEN). DNA sequencing has lead to breakthroughs in the identification of genes mutated in four types of familial MEN syndromes: Menin, RET, and CDNK1B. Unfortunately, a large percentage of NE cancers are sporadic, resulting from somatic mutations, and a high percentage of these do not harbor menin, RET, or CDNK1B mutations. Our lab has determined that Cdk5 promotes growth in multiple types of NE cancer. Phosphoproteomic studies revealed a selective set of proteins potentially phosphorylated downstream of Cdk5 activation. We hypothesize that these phosphoproteins will serve as biomarkers to identify tumors that will be responsive to anti-Cdk5 therapies.
Methods: Phosphorylation state-specific antibodies were generated to novel phosphoprotein sites by inoculation of New Zealand White rabbits with phosphopeptides specific to each site. Antibodies were isolated from rabbit sera by affinity purification using phosphopeptide columns. Human NE cell lines were treated with Cdk5 inhibitors and monitored for effects on phosphoprotein levels. Phosphoprotein levels were examined in growing and arrested medullary thyroid carcinoma tumors isolated from an inducible/arrestable (NSE-tTA; tetO-p25GFP) mouse model and in normal lung versus small cell lung cancer tumors isolated from a triple conditional knockout (p130 f/f; p53 f/f; Rb f/f) mouse model. Phosphoprotein levels were examined in control tissue and human medullary thyroid carcinoma, gastrointestinal NETs, and pancreatic NETs.
Results: Phosphorylation state-specific antibodies were successfully generated to 10 novel phosphoproteins. Cdk5 inhibition decreases phosphorylation levels of 5 of these 10 proteins in several types of NE cell lines. Levels of 4 of these phosphoproteins are elevated in human NE tumors.
Conclusion: Four novel phosphoproteins downstream of Cdk5 comprise a set of biomarkers for Cdk5-dependent human NE tumors. The combination of these biomarkers with pathway specific therapies currently under development will constitute a coupled diagnostic-therapeutic regimen for personalized treatment of NE cancer patients.
Citation Format: Angela M. Carter, Rahul Telange, Sarah Oltmann, Fiemu Nwariaku, Bruce Robinson, Elizabeth Grubbs, James Bibb. Biomarkers of Cdk5 driven neuroendocrine tumors. [abstract]. In: Proceedings of the AACR Precision Medicine Series: Cancer Cell Cycle - Tumor Progression and Therapeutic Response; Feb 28-Mar 2, 2016; Orlando, FL. Philadelphia (PA): AACR; Mol Cancer Res 2016;14(11_Suppl):Abstract nr A33.
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Affiliation(s)
| | | | | | | | | | | | - James Bibb
- 1UT Southwestern Medical Center, Dallas, TX,
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Isaacson B, Bullova P, Frone M, Click A, Hamplova B, Rabaglia J, Woodruff S, Nwariaku F, Kathuria A, Pacak K, Ghayee HK. AN AGGRESSIVE TEMPORAL BONE SDHC PARAGANGLIOMA ASSOCIATED WITH INCREASED HIF-2α SIGNALING. Endocr Pract 2015; 22:190-5. [PMID: 26492543 DOI: 10.4158/ep15889.or] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To describe a patient with a germline succinate dehydrogenase (SDHC) gene mutation presenting with primary hyperparathyroidism and a large catecholamine-producing temporal bone paraganglioma (PGL). METHODS Evaluation of a SDHC mutation-positive PGL tumor biology using staining for tyrosine hydroxylase (TH), hypoxia-inducible factors 1α (HIF-1α) and 2α (HIF-2α). RESULTS A 66-year-old man was noted to have a lytic skull base mass during work-up for his primary hyperparathyroidism. Biochemical evaluation with 24-hour urine catecholamines and metanephrines revealed marked elevation of norepinephrine and normetanephrine. Genetic testing revealed a germline SDHC mutation. A partial excision of skull base tumor was performed, which upon further examination revealed PGL. Immunohistochemistry of skull base PGL demonstrated heavy expression of TH and HIF-2α but reduced expression of HIF-1α. The remaining skull base PGL was treated with adjuvant radiation therapy. The patient's normetanephrine levels significantly decreased after surgery and radiation. CONCLUSION Here, we report an unusual case of a patient presenting with a germline SDHC mutation-related functional PGL along with concomitant primary hyperparathyroidism. The present case illustrates that overexpression of HIF-2α but not of HIF-1α is linked to the pathogenesis of SDHC mutation-related PGL, and it may be responsible for the aggressive clinical behavior of a usually indolent course of SDHC-related PGLs.
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13
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Carter A, Pozo K, Tan CF, Nwariaku F, Bibb J. Abstract 3567: Identification of potential biomarkers and novel therapeutic candidates for neuroendocrine cancer. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-3567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Neuroendocrine (NE) cancers originate from secretory cells of the body's various endocrine structures. Surgical resection is the primary treatment for these tumors. However, the majority of NE cancers are metastatic at the time of detection and no effective adjuvant therapies exist for primary NE tumors or their metastases. Patients often develop two or more NE cancers, a syndrome termed multiple endocrine neoplasia (MEN). DNA sequencing has lead to breakthroughs in the identification of the causes of familial forms of the four types of MEN syndromes. Mutations in a protein of unknown function, menin, are associated with MEN1. Mutations in the receptor tyrosine kinase RET are linked to MEN2 and MEN3. The cyclin-dependent kinase inhibitor, CDNK1B, is mutated in MEN4. Unfortunately, a large percentage of NE cancers are sporadic, resulting from somatic mutations, and a high percentage of these do not harbor menin, RET, or CDNK1B mutations. Due to the lack of development of successful adjuvant therapies there has been little improvement in survival rates of NE cancer patients in the past several decades. Thus, there is a great need for the elucidation of signaling molecules that promote NE tumorigenesis in order to guide the development of novel and effective treatments for this family of cancers.
Our laboratory has found that cyclin-dependent kinase 5 (Cdk5) is an important tumorigenic signaling molecule in sporadic medullary thyroid carcinoma (MTC), a type of NE cancer that originates from calcitonin-producing C cells in the thyroid. New data supports a role for Cdk5 in multiple types of NE cancer and provides a new prospective from which to explore their causes. Cdk5 is expressed in many NE cancers and inhibition of Cdk5 activity blocks growth of NE cancer cell lines. Phosphoproteomic analysis of growing versus arrested MTC tumors, induced by expression of the Cdk5 activator p25 in our transgenic mouse model of MTC, revealed elevation of over 200 phosphorylation sites. We have used short interfering peptides (SIPs) to selectively target a set of these phosphorylation sites and found that 15 of these SIPs blocked growth of NE cancer cell lines. Phosphorylation state specific antibodies were generated to several of these sites and phosphorylation levels were confirmed to be decreased in arrested MTC tumors. In conclusion, 1) multiple types of NE cancer cells are dependent on Cdk5 activity for growth, 2) phosphorylation of multiple signaling proteins is elevated downstream of Cdk5, and 3) select inhibition of these pathways blocks growth of NE cancer cells.
Future studies will focus on analysis of these phosphoproteins in human NE tumors to validate of them as biomarkers for targeted cancer therapies as well as exploration of these phosphoproteins as direct targets for developing new therapeutics that are effective against NE cancers.
Citation Format: Angela Carter, Karine Pozo, Chun-Feng Tan, Fiemu Nwariaku, James Bibb. Identification of potential biomarkers and novel therapeutic candidates for neuroendocrine cancer. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3567. doi:10.1158/1538-7445.AM2015-3567
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Affiliation(s)
| | | | | | | | - James Bibb
- UT Southwestern Medical Center, Dallas, TX
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Koppolu B, Bhavsar Z, Wadajkar AS, Nattama S, Rahimi M, Nwariaku F, Nguyen KT. Temperature-sensitive polymer-coated magnetic nanoparticles as a potential drug delivery system for targeted therapy of thyroid cancer. J Biomed Nanotechnol 2012; 8:983-90. [PMID: 23030006 DOI: 10.1166/jbn.2012.1465] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The objective of this work was to develop and investigate temperature-sensitive poly(N-isopropylacrylamide-acrylamide-allylamine)-coated iron oxide magnetic nanoparticles (TPMNPs) as possible targeted drug carriers for treatments of advanced thyroid cancer (ATC). These nanoparticles were prepared by free radical polymerization of monomers on the surface of silane-coupled iron oxide nanoparticles. In vitro studies demonstrated that TPMNPs were cytocompatible and effectively taken up by cancer cells in a dose-dependent manner. An external magnetic field significantly increased nanoparticle uptake, especially when cells were exposed to physiological flow conditions. Drug loading and release studies using doxorubicin confirmed the temperature-responsive release of drugs from nanoparticles. In addition, doxorubicin-loaded nanoparticles significantly killed ATC cells when compared to free doxorubicin. The in vitro results indicate that TPMNPs have potential as targeted and controlled drug carriers for thyroid cancer treatment.
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Affiliation(s)
- Bhanuprasanth Koppolu
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX 76019, USA
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Nadler E, Krishnaswami S, Brundage S, Kim L, Kingham T, Olutoye O, Nwariaku F, Nwomeh B. Assessing the Efficacy of the AAS Fundamentals of Research and Career Development Course Overseas. J Surg Res 2010. [DOI: 10.1016/j.jss.2009.11.553] [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: 11/26/2022]
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16
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Alfano RW, Leppla SH, Liu S, Bugge TH, Ortiz JM, Lairmore TC, Duesbery NS, Mitchell IC, Nwariaku F, Frankel AE. Inhibition of tumor angiogenesis by the matrix metalloproteinase-activated anthrax lethal toxin in an orthotopic model of anaplastic thyroid carcinoma. Mol Cancer Ther 2010; 9:190-201. [PMID: 20053778 DOI: 10.1158/1535-7163.mct-09-0694] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Patients with anaplastic thyroid carcinoma (ATC) typically succumb to their disease months after diagnosis despite aggressive therapy. A large percentage of ATCs have been shown to harbor the V600E B-Raf point mutation, leading to the constitutive activation of the mitogen-activated protein kinase pathway. ATC invasion, metastasis, and angiogenesis are in part dependent on the gelatinase class of matrix metalloproteinases (MMP). The explicit targeting of these two tumor markers may provide a novel therapeutic strategy for the treatment of ATC. The MMP-activated anthrax lethal toxin (LeTx), a novel recombinant protein toxin combination, shows potent mitogen-activated protein kinase pathway inhibition in gelatinase-expressing V600E B-Raf tumor cells in vitro. However, preliminary in vivo studies showed that the MMP-activated LeTx also exhibited dramatic antitumor activity against xenografts that did not show significant antiproliferative responses to the LeTx in vitro. Here, we show that the MMP-activated LeTx inhibits orthotopic ATC xenograft progression in both toxin-sensitive and toxin-resistant ATC cells via reduced endothelial cell recruitment and subsequent tumor vascularization. This in turn translates to an improved long-term survival that is comparable with that produced by the multikinase inhibitor sorafenib. Our results also indicate that therapy with the MMP-activated LeTx is extremely effective against advanced tumors with well-established vascular networks. Taken together, these results suggest that the MMP-activated LeTx-mediated endothelial cell targeting is the primary in vivo antitumor mechanism of this novel toxin. Therefore, the MMP-activated LeTx could be used not only in the clinical management of V600E B-Raf ATC but potentially in any solid tumor.
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Affiliation(s)
- Randall W Alfano
- Cancer Research Institute, Scott and White Memorial Hospital, Temple, Texas 76502, USA
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Dulan G, Yang Y, Liu Z, Khan S, Rossi I, Nwariaku F. QS352. VEGF Regulates Endothelial Migration by Reactive Oxidant Species - Mediated Inactivation of SHP-2 Phosphatase. J Surg Res 2009. [DOI: 10.1016/j.jss.2008.11.661] [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: 11/30/2022]
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Abstract
OBJECTIVE To recognize and manage pheochromocytomas in unusual settings. METHODS Three case reports are presented with clinical, biochemical, imaging, and operative findings. The pitfalls in diagnosis of pheochromocytomas and management are addressed. RESULTS We begin with a 27-yr-old gravida 2, para 1 Caucasian woman with unexplained tachycardia and hypertension during a routine pre-natal visit at 30 weeks estimated gestational age. Urinary studies revealed elevated catecholamines. Magnetic resonance imaging localized a 6.6-cm right adrenal mass with features consistent with a pheochromocytoma. She was medically managed with phenoxybenzamine and propranolol until 35 weeks, after which she underwent a combined Cesarean section, and open right adrenalectomy. Another patient, a 36-yr-old African-American woman presented to a hospital in cardiac arrest, with elevated serum troponins, and underwent cardiac catheterization, which revealed normal coronary arteries. A computed tomography (CT) scan revealed a left adrenal mass and CT-guided biopsy was consistent with a pheochromocytoma, although prior studies were negative. Finally, we present a 49-yr-old Caucasian woman who had a right adrenalectomy 10 yr prior and presented to the clinic with fluctuating blood pressures, headaches, and palpitations. Further testing revealed she had a recurrent metastatic pheochromocytoma. The challenges behind treating these patients are further explored. CONCLUSION Antenatal diagnosis of pheochromocytoma, though challenging, is associated with lower maternal and fetal morbidity and mortality. The differential diagnosis for cardiac arrest in the presence of normal coronary arteries should include a pheochromocytoma. Finally, treatment with iodinated metaiodobenzylguanidine may be a therapeutic option for those patients with metastatic pheochromocytomas.
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Affiliation(s)
- H K Ghayee
- Division of Endocrinology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Nathens AB, Cook CH, Machiedo G, Moore EE, Namias N, Nwariaku F. Defining the research agenda for surgical infection: a consensus of experts using the Delphi approach. Surg Infect (Larchmt) 2006; 7:101-10. [PMID: 16629600 DOI: 10.1089/sur.2006.7.101] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [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: 11/13/2022] Open
Abstract
BACKGROUND A substantial proportion of operative procedures are complicated by infections, either remote from or related to the surgical site. These infections account for substantive morbidity and health care costs. With limited research funds available to study interventions designed to either prevent or reduce the morbidity associated with infections in surgical patients, we developed a research agenda to develop priorities to aid in study design and to focus both human and capital resources more effectively. METHODS A Delphi survey approach was used. Consensus was developed among experts in the field of surgical infection and the membership of the Surgical Infection Society. RESULTS Thirty-six experts generated a total of 62 questions that were submitted for two rounds of consensus ranking. A total of 31 questions were ranked in the final round and are available at www.sisna.org. The most highly ranked question was "Does strict glycemic control compared with standard care reduce the risk of surgical site infection in patients undergoing abdominal surgery?" Most of the questions had little available data, suggesting these are both important and necessary areas for further research. CONCLUSIONS This research agenda, developed by a consensus of experts, provides direction and focus to the development of interventional trials geared toward reducing the morbidity associated with infections in surgical patients.
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Affiliation(s)
- Avery B Nathens
- Division of Trauma/General Surgery, Department of Surgery, University of Washington, Seattle, Washington 98104, USA.
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20
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Nahari D, Liu Z, Ingle C, Task L, Nwariaku F. Effect of C terminal tyrosine residues on VE cadherin signaling. J Surg Res 2006. [DOI: 10.1016/j.jss.2005.11.309] [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: 10/25/2022]
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21
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Bell C, Asolati M, Hamilton E, Fleming J, Nwariaku F, Sarosi G, Anthony T. A comparison of complications associated with colostomy reversal versus ileostomy reversal. Am J Surg 2005; 190:717-20. [PMID: 16226946 DOI: 10.1016/j.amjsurg.2005.07.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2005] [Revised: 07/25/2005] [Accepted: 07/25/2005] [Indexed: 12/18/2022]
Abstract
BACKGROUND The incidence of complications after reversal of Hartmann's procedure is unknown. This study compares the morbidity of Hartmann's reversal versus loop ileostomy reversal. METHODS Two groups of 20 patients were studied retrospectively over a 5-year period. One group underwent Hartmann's takedown, and the other underwent loop ileostomy takedown. Postoperative complications were compared between the 2 groups. RESULTS Similar demographics were noted between each group. The most common initial indications for Hartmann's procedure were diverticulosis (11 patients, 55%) and colon cancer (4 patients, 20%). For patients who had undergone colectomy with primary anastomosis and ileostomy, colon cancer was the most common indication (12 patients, 60%) followed by diverticulosis (3 patients, 15%). Complications were more common after Hartmann reversal than loop ileostomy reversal (16 complications/11 patients versus 6 complications/4 patients, P = .047). CONCLUSION Segmental colonic excision with anastomosis and loop ileostomy may be an attractive alternative to minimize morbidity with stoma reversal.
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Affiliation(s)
- Christopher Bell
- Surgical Service, Dallas VA Medical Center, MC 112, 4500 Lancaster Road, Dallas, TX 75216, USA
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22
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Abstract
BACKGROUND The RET proto-oncogene is implicated in medullary thyroid cancer (MTC) and has been shown to signal indirectly to focal adhesion kinase (FAK) in cell types other than MTC. We have previously shown that FAK is phosphorylated in MTC cells. We hypothesized that inhibition of RET with pharmacologic inhibitors or by depletion with siRNA would decrease FAK phosphorylation in MTC cells, thereby implicating a RET-FAK signaling pathway. METHODS Human MTC cells (TT cells) were treated with pharmacologic inhibitors or transfected with RET siRNA. Total protein was detected by immunoblotting. Phosphorylated FAK was detected by immunoprecipitating total FAK and immunoblotting with antiphosphotyrosine. RESULTS Treatment of MTC cells with the inhibitor PP2 significantly inhibited RET phosphorylation and, to a lesser extent, FAK phosphorylation. Imatinib mesylate inhibited FAK phosphorylation only at high doses. RET siRNA significantly decreased RET expression and FAK phosphorylation. CONCLUSIONS RET signals through FAK in MTC cells. Whether this is due to a direct or indirect interaction is not yet clear. PP2 or a similar inhibitor might be a useful treatment for MTC.
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Affiliation(s)
- Ganesh R Panta
- Surgical Service 112, Central Arkansas Veterans Healthcare System, 4300 W. 7th Street, Little Rock, AR 72205, USA
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23
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Anthony T, Penta P, Todd RD, Sarosi GA, Nwariaku F, Rege RV. Rebleeding and survival after acute lower gastrointestinal bleeding. Am J Surg 2004; 188:485-90. [PMID: 15546555 DOI: 10.1016/j.amjsurg.2004.07.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2004] [Revised: 07/07/2004] [Indexed: 12/14/2022]
Abstract
BACKGROUND Previous studies of acute lower gastrointestinal bleeding (LGIB) have focused on evaluation and therapy. Measurement of long-term outcome has been rare. The purpose of this study was to document rebleeding and survival rates in patients with acute LGIB. METHODS A retrospective review of all patients undergoing technetium-labeled red blood cell scans for LGIB from January of 1997 to December of 2002 was performed. Rebleeding was defined as identification of enteric bleeding requiring a transfusion 2 or more weeks after the initial bleeding episode. RESULTS A total of 119 patients met inclusion criteria. Rebleeding was documented in 14 of 102 patients surviving for more than 2 weeks. The actuarial rebleeding rate was 15% at 2 years. No factors were identified that portended a higher likelihood of rebleeding. The 30-day mortality was 18% and the median survival was 60 months for the entire cohort. Of the 36 patients in whom cause of death was documented, 4 died of surgical complications and a single patient died as a direct result of hemorrhage. CONCLUSIONS Rebleeding after an initial episode of LGIB occurs in a small percentage of individuals. Although survival is poor for patients with LGIB, few patients die as a direct consequence of hemorrhage.
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Affiliation(s)
- Thomas Anthony
- Department of Surgery, University of Texas Southwestern Medical Center and the VA North Texas Health Care System, 4500 South Lancaster Rd., Dallas, TX 75216, USA.
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Todd RD, Sarosi GA, Nwariaku F, Anthony T. Incidence and predictors of appendiceal tumors in elderly males presenting with signs and symptoms of acute appendicitis. Am J Surg 2004; 188:500-4. [PMID: 15546558 DOI: 10.1016/j.amjsurg.2004.07.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2004] [Revised: 07/13/2004] [Indexed: 01/07/2023]
Abstract
BACKGROUND Patients with appendiceal tumors (AT) frequently present with the same signs and symptoms as acute appendicitis (AA). The purpose of this study was to identify the incidence of AT in a population of patients greater than 60 years of age thought to have AA, and to identify presenting factors that can help differentiate the 2 disease processes. METHODS An institutional review board-approved, retrospective review was performed identifying all patients greater than 60 years old who underwent either appendectomy or colectomy after presenting with signs and symptoms of AA from Janaury 1997 to April 2004. Patient records were examined for demographic variables, presenting signs and symptoms, and pathology. RESULTS A total of 34 patients fit the entry criteria; 8 (24%) had AT. Average duration of symptoms was significantly longer (4.9 +/- 1.9 versus 2.3 +/- 0.3 days; P = 0.01) and hematocrit lower (36.5 +/- 2.3 versus 42.4 +/- 1.0%; P = 0.01) for patients with AT compared with patients with AP. No other significant differences in presenting signs and symptoms were noted. CONCLUSIONS There is an increased incidence of appendiceal neoplasms among elderly patients presenting with signs and symptoms of AA. Distinction between AT and appendicitis is difficult preoperatively, but AT should be suspected when patients present with longer duration of symptoms or reduced hematocrit.
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Affiliation(s)
- R David Todd
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Nahari D, Ingle C, Task L, Terada L, Brekken R, Nwariaku F. SRC-Inhibition delays VEGF-Induced vascular endothelial cadherin (VE Cadherin) phosphorylation in endothelial cells. J Surg Res 2004. [DOI: 10.1016/j.jss.2004.07.121] [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: 10/26/2022]
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Jaiswal KR, Lopez-Guzman C, Nwariaku F, Anthony T, Sarosi G. PI3 kinase mediates bile salt induced proliferation in a telomerase-immortalized Barrett’s cell line. J Am Coll Surg 2004. [DOI: 10.1016/j.jamcollsurg.2004.05.014] [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: 11/25/2022]
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Jaiswal K, Tello V, Lopez-Guzman C, Nwariaku F, Anthony T, Sarosi GA. Bile salt exposure causes phosphatidyl-inositol-3-kinase-mediated proliferation in a Barrett's adenocarcinoma cell line. Surgery 2004; 136:160-8. [PMID: 15300175 DOI: 10.1016/j.surg.2004.04.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The mechanisms by which gastroesophageal reflux promotes malignant progression in Barrett's esophagus are poorly understood. The phosphatidylinositol-3-kinase (PI3 kinase)/Akt pathway regulates proliferation and apoptosis. We hypothesized that the PI3 kinase/Akt pathway mediates the pro-proliferative and antiapoptotic effects of bile. METHODS The Barrett's adenocarcinoma cell line, SEG-1, was exposed to the conjugated bile salt, glycochenodeoxycholic acid (GCDA). Cell number was measured by the MTT incorporation assay and by Coulter counter. PI3 kinase/Akt activity was inferred from Western blots of phosphorylated and total Akt. Proliferation and apoptosis were determined by BrdU incorporation and cell death ELISA. RESULTS A dose-dependent cell number increase was seen with a 20-minute exposure to GCDA. On Western blot, 200 micromol/L GCDA caused a 3-fold increase in Akt phosphorylation within 20 minutes, which was inhibited by 90% with the addition of PI3 kinase inhibitor, LY294002. LY294002 produced dose-dependent inhibition of GCDA-induced cell number increases. 200 micromol/L GCDA decreased apoptosis by 25%. Addition of LY294002 did not completely inhibit the antiapoptotic effect of bile. CONCLUSIONS Bile salts activate the PI3 kinase/Akt signaling pathway and stimulate cell growth in SEG-1. The majority of this PI3 kinase-mediated effect is secondary to increases in proliferation rather than to decreases in apoptosis.
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Affiliation(s)
- Kshama Jaiswal
- University of Texas Southwestern Medical Center at Dallas, VA North Texas Health Center, Dallas, TX 75216, USA
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Anthony T, Hynan LS, Rosen D, Kim L, Nwariaku F, Jones C, Sarosi G. The association of pretreatment health-related quality of life with surgical complications for patients undergoing open surgical resection for colorectal cancer. Ann Surg 2003; 238:690-6. [PMID: 14578731 PMCID: PMC1356147 DOI: 10.1097/01.sla.0000094304.17672.6e] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [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: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to define the association between pretreatment health-related quality of life (HRQL) and surgical complications for patients with colorectal cancer. SUMMARY BACKGROUND DATA For patients with colorectal cancer, surgical complications arise from an interaction between underlying medical comorbidity, colorectal cancer severity, and quality and type of treatment provided. Measurement of HRQL provides a summarization of well-being in the context of medical comorbidity and colorectal cancer severity. The summarization of these factors may be useful in prospective risk assessment of patients about to undergo surgery for colorectal cancer. METHODS A single-institution, prospective, cohort study of patients with colorectal adenocarcinoma was performed from August 1, 1999, to March 31, 2002. Before treatment, all participants completed Medical Outcomes Survey SF-36 (SF-36); after the first year of the study, patients also completed the colorectal cancer module of the Functional Assessment of Cancer Therapy survey (FACT-C). Information was collected on demographics, treatment, tumor variables, and complications. RESULTS Ninety-seven patients have undergone open resection of their colorectal cancer. All patients completed SF-36; 65 completed FACT-C. Thirty patients (31%) experienced complications, including 4 (4%) deaths. Age, race, albumin level, American Society of Anesthesia class, specialty surgical training, tumor location, and stage were not associated with complications in univariate analysis. Patients experiencing surgical complications had significantly lower HRQL scores on SF-36 Social Functioning, General Health Perception, and Mental Health Index scales as well as the Mental Health Component summary score. FACT-C Social/Family, Emotional, Functional Well-Being scores, and the Colorectal Cancer Concerns score were also significantly lower for patients sustaining complications. When these HRQL scales were examined in a multivariate model including albumin level, tumor location, and ASA class, SF-36 Social Functioning (Odds Ratio [OR] = 0.98; 95% Confidence Interval [CI] = 0.97-0.99) and FACT-C Colorectal Cancer Concerns (OR = 0.89; 95% CI = 0.79-0.99) scales retained a significant association with complications. CONCLUSIONS Pretreatment HRQL scores as measured by several scales of SF-36 and FACT-C were significantly associated with complications. Future studies should concentrate on defining the predictive role of HRQL in determining surgical outcome for patients with colorectal cancer.
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Affiliation(s)
- Thomas Anthony
- University of Texas, Southwestern Medical Center, VA North Texas Health Care System, 4500 S Lancaster Rd, Dallas, TX 75216, USA.
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Anthony T, Long J, Hynan LS, Sarosi GA, Nwariaku F, Huth J, Jones C, Parker BJN, Rege R. Surgical complications exert a lasting effect on disease-specific health-related quality of life for patients with colorectal cancer. Surgery 2003; 134:119-25. [PMID: 12947307 DOI: 10.1067/msy.2003.212] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND For individual patients with colorectal cancer, health-related quality of life (HRQL) after treatment is a function of several factors that include preexisting medical conditions, the disease burden, and the treatment that is rendered. The purpose of this study was to identify the factors that were associated with posttreatment HRQL. METHODS At baseline and again at 12 months after diagnosis, patients completed the colorectal cancer-specific HRQL survey: Functional Assessment of Cancer Therapy (FACT-C). Univariate and multivariate analyses were performed to test the association between patient-, tumor-, and treatment-related variables and 12-month FACT-C total scores. RESULTS Seventy-one patients completed the FACT-C at diagnosis and subsequently underwent open surgical removal of their primary tumor; 63 patients completed the 12-month survey. In univariate analysis, only chronic obstructive pulmonary disease at diagnosis or the occurrences of perioperative complications were associated with a reduction in 12-month HRQL scores. Considering both the diagnosis of chronic obstructive pulmonary disease and the occurrence of perioperative complications, along with the patient's FACT-C total score at diagnosis, age, tumor location, and stage of disease in a multivariate model, only the perioperative complications (odds ratio, 10.5; 95% CI, 2.1-52) and FACT-C total score at diagnosis (odds ratio, 1.04; 95% CI, 1.005-1.07) were associated significantly with a lower than median HRQL score at 12 months. CONCLUSIONS For patients who undergo treatment of colorectal cancer, HRQL at 1 year after diagnosis is still influenced significantly and negatively by the occurrence of surgical complications.
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Affiliation(s)
- Thomas Anthony
- Department of Surgery, The University of Texas Southwestern Medical School, and the Veterans Affairs North Texas Health Care System, Dallas, TX 75216, USA
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Burkey SH, Snyder WH, Nwariaku F, Watumull L, Mathews D. Directed parathyroidectomy: feasibility and performance in 100 consecutive patients with primary hyperparathyroidism. Arch Surg 2003; 138:604-8; discussion 608-9. [PMID: 12799330 DOI: 10.1001/archsurg.138.6.604] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
HYPOTHESIS Directed parathyroidectomy (DP) can be successfully completed in most patients with primary hyperparathyroidism. DESIGN AND SETTING Retrospective review at a tertiary referral center. PATIENTS One hundred consecutive patients with untreated, sporadic primary hyperparathyroidism operated on by a single surgeon from April 1, 1999, through December 31, 2001. INTERVENTIONS Following preoperative imaging with sestamibi scintigraphy and ultrasonography, patients underwent parathyroidectomy with intraoperative parathyroid hormone monitoring using a focused approach through a limited neck incision (DP) or bilateral neck exploration (BNE) through a standard collar incision. MAIN OUTCOME MEASURES Extent of exploration, operative time, length of stay, morbidity, and cure. RESULTS Directed parathyroidectomy was completed in 70 patients and BNE in 30. Bilateral neck exploration was performed as the initial procedure in 13 patients and following intraoperative conversion from attempted DP in 17. Indications for predetermined BNE were failed preoperative localization (n = 8) and concomitant thyroid disease that required operative treatment (n = 5). The need for predetermined BNE decreased as preoperative localization improved. Intraoperative factors that necessitated conversion to BNE included persistently elevated intraoperative parathyroid hormone levels that accurately predicted multiglandular disease (n = 6), incorrect localization (n = 5), and inadequate exposure (n = 6). Operative time and length of stay were less for DP compared with BNE patients (66 vs 165 minutes and 0.5 vs 1.6 days, respectively). One patient had a temporary vocal cord paresis. All patients were eucalcemic in follow-up (4 months to 3 years). CONCLUSIONS With accurate preoperative localization and intraoperative parathyroid hormone monitoring, DP can be successfully completed in most patients with sporadic primary hyperparathyroidism. Patients benefit from DP, which reduces operative time and length of stay and facilitates rapid convalescence.
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Affiliation(s)
- Shelby H Burkey
- Department of Surgery, The University of Texas Southwestern Medical Center, Dallas 75390, USA.
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Abstract
BACKGROUND In medullary thyroid carcinoma (MTC), mutations in the RET protooncogene lead to oncogenic transformation. RET activation in other cell types has been shown to cause phosphorylation of the focal adhesion-associated proteins focal adhesion kinase (FAK), paxillin, and p130(CAS). We hypothesized that adhesion-dependent signaling might be deranged in MTC cells. METHODS Indirect immunofluorescence was used to label beta(1) integrin, FAK, paxillin, and p130CAS. Rhodamine-labeled phalloidin was used to visualize actin microfilaments. Phosphorylated protein was detected by immunoprecipitation followed by Western blotting for phosphotyrosine. MTC cell invasiveness was quantified using a modified Boyden chamber assay. RESULTS Clustering of beta(1) integrin, FAK, paxillin, and p130(CAS) into focal adhesions were not detected in MTC cells under any conditions, although clustering was seen as expected in control HeLa cells. Despite this failure, FAK, paxillin and p130(CAS) were all found to be phosphorylated. Actin microfilaments were generally not seen although in a few cells, small, poorly formed microfilaments could be detected. MTC cells invaded poorly as compared with highly invasive cell lines. However a clear difference was noted between invasiveness on growth factor depleted Matrigel and regular Matrigel. CONCLUSIONS In MTC cells, focal adhesions are not seen in response to interaction with extracellular matrix. Consistent with this failure, actin microfilaments are absent or poorly formed and invasion is weak. Despite the absence of focal adhesions, focal adhesion proteins remain phosphorylated, even though in normal cells their signaling activity is dependent on focal adhesion formation. Deranged adhesion-dependent signaling may contribute to MTC pathogenesis.
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Affiliation(s)
- Lawrence T Kim
- Surgical Service, Central Arkansas Veterans Healthcare System and University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA
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Holloway S, Sarosi G, Kim L, Nwariaku F, O'Keefe G, Hynan L, Jones C, Anthony T. Health-related quality of life and postoperative length of stay for patients with colorectal cancer. J Surg Res 2002; 108:273-8. [PMID: 12505052 DOI: 10.1006/jsre.2002.6549] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Length of stay (LOS) after surgery is a major determinant of resource utilization for colorectal cancer (CRC). The purpose of this study was to examine the association between pretreatment health-related quality of life (HRQL) scores and postoperative hospital LOS in a cohort of patients undergoing surgery for CRC. METHODS Seventy patients with biopsy-proven CRC were enrolled in an IRB-approved, prospective study. Information was collected concerning standard perioperative variables. Prior to surgery, all patients also completed the CRC-specific module of the Functional Assessment of Cancer Therapy (FACT-C). Perioperative variables and FACT-C scores were compared with LOS in both univariate and multivariate analysis. LOS for those patients scoring in the lowest quartile on FACT-C was compared with LOS for patients scoring in the remaining quartiles. RESULTS Median length of stay for the entire group was 6 (range 3-25) days. In univariate analysis, surgical complications (10.6 vs 6.6 days; P = 0.001) and with poorer FACT-C individual scale scores for Physical Well-Being (9.1 vs 7.3 days; P = 0.04), Functional Well-Being (9.6 vs 7.1 days; P = 0.006), and Colorectal Cancer Concerns (9.5 vs 7.1 days; P = 0.01) were all significantly associated with increased length of stay. In multivariate analysis, surgical morbidity (OR = 5.6; 95% CI 1.5-21.4), age >72 (OR = 6.0; 95% CI 1.6-23.5), and low FACT-C total score (OR = 4.2; 95% CI 1.1-15.6) were independently associated with increased LOS. CONCLUSIONS Pretreatment HRQL scores as measured by FACT-C may be of benefit in the prediction of LOS. Such information may be an important and currently neglected means of risk-adjusting populations undergoing surgery for colorectal cancer for this outcome.
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Affiliation(s)
- Shane Holloway
- University of Texas Southwestern Medical, Dallas, Texas 75216, USA
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Abstract
This study examines the hypotheses that TNF-alpha causes a dose-dependent increase in the microvascular permeability of ex vivo buffer perfused lungs that is quantitatively similar to that caused by lipopolysaccharide (LPS) or thromboxane A2 (TxA2). We also postulated that TNF-alpha potentiates the effect of interleukin-1beta (IL-1beta) or TxA2 receptor activation on pulmonary microvascular permeability. Lungs harvested from Wistar rats were perfused ex vivo with Krebs-Henseleit buffer containing 0, 10, 100, or 1000 ng/mL recombinant rat TNF-alpha. Twenty minutes later pulmonary microvascular permeability was determined by measuring the capillary filtration coefficient (Kf) using a gravimetric technique. The effect of TNF-alpha (100 ng/mL) on pulmonary Kf was compared with that of lungs exposed to LPS (400 microg/mL; E. coli 0111:B4) or a TxA2 receptor agonist (U-46619; 7 x 10(-8)). In other experiments, perfused lungs were exposed to TNF-alpha plus IL-1beta (1 ng/mL) or TNF-alpha plus U-46619 after which Kf was measured. Exposure of ex vivo buffer perfused lungs to 10-1000 ng/mL TNF-alpha had no effect on Kf whereas LPS and U-46619 was associated with a two- and six-fold increase in Kf, respectively (P < 0.05). The Kf of lungs exposed to TNF-alpha plus IL-1 was similar to that of lungs exposed to TNF-alpha alone. Lastly, the Kf of lungs exposed to TNF-alpha plus U-46619 was not different than that of lungs exposed to U-46619 alone. In conclusion, TNF-alpha at least when administered for a relatively brief period of time does not affect microvascular permeability in an isolated, buffer-perfused lung model.
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Affiliation(s)
- Carl I Schulman
- Department of Surgery at the University of Texas Southwestern Medical School and the Dallas Veterans Affairs Medical Center, 75216, USA
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Abstract
Even in the absence of inhalational injury, acute lung injury is a common cause of morbidity and mortality for patients sustaining severe burns. Other than general supportive measures, there are few therapeutic options for improving survival in these critically ill patients. Numerous clinical and laboratory studies have implicated tumor necrosis factor (TNF)-a and neutrophils as important participants in the pathogenesis of burn-induced lung injury. There is, however, little information regarding the mechanism by which these and other pro-inflammatory mediators affect the movement of fluid and protein across the microvascular barrier into the interstitium of the lung. In addition to reviewing the evidence implicating TNF-a and neutrophils in the pathophysiology of burn-induced lung injury, this report summarizes current theories regarding potential mechanisms by which these mediators may alter microvascular barrier function to lead ultimately to the development of pulmonary edema.
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Affiliation(s)
- Richard H Turnage
- Department of Surgery, Louisiana State University Health Sciences Center, 1501 Kings Highway, P.O. Box 33932, Shreveport, Louisiana 71130-3932, USA
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Abstract
BACKGROUND Traditionally, the acquisition of surgical skill has occurred entirely in the operating room. To meet the expanding challenges of cost containment and patient safety, novel methods of surgical training utilizing ex-vivo workstations are being developed. The purpose of our study was to evaluate the impact of a laparoscopic training curriculum on surgical residents' operative performance. METHODS Twenty-one surgery residents completed baseline laparoscopic total extraperitoneal (TEP) hernia repairs. Operative performance was evaluated using a validated global assessment tool. Each resident was then randomized to a control group or a trained group. A CD ROM, video, and simulator were used for training. At the end of the study, each resident's operative performance was again evaluated. RESULTS Improvement was significantly greater in the trained group in five of the eight individual global assessment areas as well as the composite score (P <0.05). Questionnaire data suggested that training resulted in improved understanding of the TEP hernia repair (P = 0.01) and an increased willingness to offer the operation to patients with nonrecurrent unilateral hernias (P = 0.02). CONCLUSIONS A multimodality laparoscopic TEP hernia curriculum improves residents' knowledge of the TEP hernia repair and comfort in performing the procedure, and may also improve actual operative performance.
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Affiliation(s)
- E C Hamilton
- Southwestern Center for Minimally Invasive Surgery, Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9092, USA
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Nwariaku F, Terada L, Duffy S, Sarosi G, Turnage RH. THE ROLE OF p38 MITOGEN-ACTIVATED PROTEIN KINASE (MAPK) IN TNF-MEDIATED MICROVASCULAR PERMEABILITY. Shock 2001. [DOI: 10.1097/00024382-200106001-00044] [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: 11/25/2022]
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Schwartz J, Nwariaku F, Murphy J, Kim L, Sarosi G, Duffy S, Yin H, Turnage R. Lysophosphatidic acid (LPA) increases microvascular permeability through remodeling of the endothelial cell (EC) actin cytoskeleton. J Am Coll Surg 2000. [DOI: 10.1016/s1072-7515(00)00555-x] [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: 11/29/2022]
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Wright K, Nwariaku F, Halaihel N, Schulman C, Yin HL, Turnage RH. Burn-activated neutrophils and tumor necrosis factor-alpha alter endothelial cell actin cytoskeleton and enhance monolayer permeability. Surgery 2000; 128:259-65. [PMID: 10923002 DOI: 10.1067/msy.2000.108215] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND This study examined the hypothesis that exposure of an endothelial cell (EC) monolayer to tumor necrosis factor-alpha (TNF-alpha) and that burn-activated neutrophils alter EC actin cytoskeleton and enhance the permeability of the monolayer. METHODS Neutrophils were harvested from rats that had undergone a 45% surface area burn (BURN-neutrophil) or uninjured control rats. ECs were grown on polyester filters or fibronectin-coated glass slides and exposed for 4 hours to media, TNF-alpha (100 ng/mL), or TNF-alpha plus BURN-neutrophil or uninjured control rats (10(7) cells). Monolayer permeability was assessed by measuring the flux of albumin across the cells. EC surface area and microfilament number and length were determined by the staining of actin microfilaments with rhodamine phalloidin followed by fluorescent microscopy. RESULTS The amount of albumin that moved across the monolayer in response to TNF-alpha plus BURN-neutrophil was twice that of media alone (P <.05) or TNF-alpha alone (P <.05). The number and length of actin microfilaments in ECs exposed to TNF-alpha plus BURN-neutrophil were significantly less than that of cells exposed to media alone or TNF-alpha alone. CONCLUSIONS These data are consistent with a hypothesis that TNF-alpha plus BURN-neutrophil affect endothelial monolayer permeability by altering EC actin cytoskeletal organization.
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Affiliation(s)
- K Wright
- Departments of Surgery and Physiology, University of Texas Southwestern Medical School and the Dallas Veterans Affairs Medical Center, 75235, USA
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Abstract
BACKGROUND Clinical pathways have been advocated as a means to improve and standardize patient care while reducing costs through improved efficiency. This study examines the hypothesis that development of a clinical pathway reduces hospital admissions in a Veterans Affairs (VA) medical center. MATERIALS AND METHODS For the year prior to June 1997, 168 elective inguinal herniorrhaphies were performed. This constituted the prepathway (pre-P) group. One hundred ninety-six elective inguinal herniorrhaphies were performed during the year following institution of the clinical pathway-the postpathway (post-P) group. RESULTS Hospital admissions were compared between the two groups. In the pre-P group 61 of the 168 patients (36%) were admitted while 29 of the 196 patients (15%) in the post-P group were admitted (P < 0.001). In the pre-P group 27 of the 53 patients reviewed (51%) had either no justification or inadequate justification for admission. In the post-P group 8 of the 29 patients admitted (28%) had inadequate justification (pre-P vs post-P, P = 0.124). Common reasons for admission included pain, perioperative complications, and concurrent medical problems or surgical procedures. The most common single cause other than pain was urinary retention. The average age of patients requiring admission was greater both pre-P and post-P. CONCLUSIONS We conclude that institution of a clinical pathway for inguinal herniorrhaphy decreased hospital admissions. The reasons for this decrease are probably multifactorial and include improvements in physician and staff awareness. The decrease in unnecessary admissions should result in more efficient use of hospital resources.
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Affiliation(s)
- B Willis
- Veterans Affairs North Texas Health Care System, Dallas, Texas 75216, USA
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Gordon LL, Snyder WH, Wians F, Nwariaku F, Kim LT. The validity of quick intraoperative parathyroid hormone assay: an evaluation in seventy-two patients based on gross morphologic criteria. Surgery 1999; 126:1030-5. [PMID: 10598184 DOI: 10.1067/msy.2099.101833] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.4] [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: 11/22/2022]
Abstract
BACKGROUND Parathyroidectomy for primary hyperparathyroidism has conventionally required identification of all parathyroid glands with excision of grossly abnormal glands. Using this approach, cure rates exceed 95%. Directed cervical exploration has been advocated using quick intraoperative parathyroid hormone (QPTH) assay with preoperative localization. Adoption of this approach requires validation of the accuracy of QPTH assay. METHODS Patients with primary hyperparathyroidism undergoing bilateral neck exploration during a 31-month period were reviewed. Uniglandular (UGD) or multiglandular (MGD) disease was determined by gross morphologic criteria. QPTH assays were performed before skin incision and at 5, 10, and 20 minutes after excision of each abnormal gland. A 10-minute QPTH decrease of 50% from baseline levels indicated curative excision. These data were not used to guide extent of exploration or tissue resection. RESULTS Of 72 patients, 55 (76%) had UGD and 17 (24%) had MGD. QPTH assay accurately predicted the disease state in 89%. Four (7%) UGD patients did not have an appropriate QPTH decline at 10 minutes. Four (24%) MGD patients had an inappropriate QPTH decline at 10 minutes. CONCLUSIONS Using QPTH guided exploration, 6% (4 of 72) of patients would undergo unnecessary extended exploration and 6% (4 of 72) (95% CI, 1% to 13%) may require reoperation for unidentified MGD. These results validate the accuracy of QPTH assay.
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Affiliation(s)
- L L Gordon
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas 75235-9156, USA
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Abstract
Inflammation and microvascular injury in the areas adjacent to burn wounds produces extension of postburn tissue necrosis. Leukocytes are potent mediators of the local inflammatory response preceding tissue necrosis, and the selectin and integrin adhesion molecules have been implicated in leukocyte-mediated tissue destruction. We sought to examine the role of L-selectin (CD62-L) and CD18 in leukocyte accumulation and tissue necrosis following burn injury. New Zealand White rabbits (n = 36) were subjected to burn injury and were randomized to treatment with saline (control) or monoclonal antibodies to L-selectin or CD18. Animals given the anti-L-selectin antibody demonstrated reduced immunohistochemical evidence of leukocyte accumulation at 24 hr postinjury but did not show improved wound perfusion or reduced tissue necrosis. Animals in the anti-CD18 group showed significantly improved tissue survival and improved tissue perfusion but had grades of leukocyte accumulation similar to those in the control group. These observations suggest that leukocyte accumulation is partially L-selectin dependent and that leukocyte accumulation alone is not sufficient to cause changes in blood flow and tissue destruction, both of which appear to be largely CD18 mediated.
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Affiliation(s)
- F Nwariaku
- Department of Surgery, University of Texas Southwestern Medical Center at Dallas 75235-9031, USA
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Nwariaku F, Sikes P, Lightfoot E, McIntyre K, Mileski WJ. Role of CD14 in hemorrhagic shock-induced alterations of the monocyte tumor necrosis factor response to endotoxin. J Trauma 1996; 40:564-7. [PMID: 8614033 DOI: 10.1097/00005373-199604000-00007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To determine if the shock-induced alterations in whole blood monocyte tumor necrosis factor (TNF) response are mediated by the CD14 receptor. DESIGN Prospective controlled animals experiments. MATERIALS AND METHODS New Zealand White rabbits (n = 15) were subjected to hemorrhage and resuscitation. Blood samples obtained before shock and 24, 72, and 120 hours after shock were stimulated with lipopolysaccharide in the presence or absence of the anti-CD14 monoclonal antibody, 63D3. Tumor necrosis factor was assayed using L929 cells. MEASUREMENTS AND MAIN RESULTS There are no detectable TNF activity in unstimulated blood. The CD14 inhibition resulted in a 55% reduction in baseline TNF activity. After shock, there was a marked increase in TNF activity with lipopolysaccharide stimulation. Addition of 63D3 resulted in a dose-dependent 95% reduction in TNF activity at 24 and 72 hours after shock, (p < 0.05). CONCLUSION The enhanced whole blood monocyte TNF response after hemorrhage is CD14 dependent.
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Affiliation(s)
- F Nwariaku
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas 75235-9031, USA
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