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Kochav JD, Kim J, Judd R, Tak KA, Janjua E, Maciejewski AJ, Kim HW, Klem I, Heitner J, Shah D, Zoghbi WA, Shenoy C, Farzaneh-Far A, Polsani V, Villar-Calle P, Parker M, Judd KM, Khalique OK, Leon MB, Devereux RB, Levine RA, Kim RJ, Weinsaft JW. Myocardial Contractile Mechanics in Ischemic Mitral Regurgitation: Multicenter Data Using Stress Perfusion Cardiovascular Magnetic Resonance. JACC Cardiovasc Imaging 2022; 15:1212-1226. [PMID: 35798397 PMCID: PMC9273017 DOI: 10.1016/j.jcmg.2022.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 02/24/2022] [Accepted: 03/04/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Left ventricular (LV) ischemia has been variably associated with functional mitral regurgitation (FMR). Determinants of FMR in patients with ischemia are poorly understood. OBJECTIVES This study sought to test whether contractile mechanics in ischemic myocardium underlying the mitral valve have an impact on likelihood of FMR. METHODS Vasodilator stress perfusion cardiac magnetic resonance was performed in patients with coronary artery disease (CAD) at multiple centers. FMR severity was confirmed quantitatively via core lab analysis. To test relationship of contractile mechanics with ischemic FMR, regional wall motion and strain were assessed in patients with inducible ischemia and minimal (≤5% LV myocardium, nontransmural) infarction. RESULTS A total of 2,647 patients with CAD were studied; 34% had FMR (7% moderate or greater). FMR severity increased with presence (P < 0.001) and extent (P = 0.01) of subpapillary ischemia: patients with moderate or greater FMR had more subpapillary ischemia (odds ratio [OR]: 1.13 per 10% LV; 95% CI: 1.05-1.21; P = 0.001) independent of ischemia in remote regions (P = NS); moderate or greater FMR prevalence increased stepwise with extent of ischemia and infarction in subpapillary myocardium (P < 0.001); stronger associations between FMR and infarction paralleled greater wall motion scores in infarct-affected territories. Among patients with inducible ischemia and minimal infarction (n = 532), wall motion and radial strain analysis showed impaired subpapillary contractile mechanics to associate with moderate or greater FMR (P < 0.05) independent of remote regions (P = NS). Conversely, subpapillary ischemia without contractile dysfunction did not augment FMR likelihood. Mitral and interpapillary dimensions increased with subpapillary radial strain impairment; each remodeling parameter associated with impaired subpapillary strain (P < 0.05) independent of remote strain (P = NS). Subpapillary radial strain (OR: 1.13 per 5% [95% CI: 1.02-1.25]; P = 0.02) and mitral tenting area (OR: 1.05 per 10 mm2 [95% CI: 1.00-1.10]; P = 0.04) were associated with moderate or greater FMR controlling for global remodeling represented by LV end-systolic volume (P = NS): when substituting sphericity for LV volume, moderate or greater FMR remained independently associated with subpapillary radial strain impairment (OR: 1.22 per 5% [95% CI: 1.02-1.47]; P = 0.03). CONCLUSIONS Among patients with CAD and ischemia, FMR severity and adverse mitral apparatus remodeling increase in proportion to contractile dysfunction underlying the mitral valve.
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Affiliation(s)
- Jonathan D Kochav
- Division of Cardiology, Weill Cornell Medicine, New York, New York, USA; Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA.
| | - Jiwon Kim
- Division of Cardiology, Weill Cornell Medicine, New York, New York, USA
| | - Robert Judd
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Katherine A Tak
- Division of Cardiology, Weill Cornell Medicine, New York, New York, USA
| | - Emmad Janjua
- Division of Cardiology, Weill Cornell Medicine, New York, New York, USA; Weill Cornell Medicine-Qatar, Doha, Qatar
| | | | - Han W Kim
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Igor Klem
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA
| | - John Heitner
- Division of Cardiology, New York Presbyterian Brooklyn Methodist Hospital, New York, New York, USA
| | - Dipan Shah
- Division of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - William A Zoghbi
- Division of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Chetan Shenoy
- Division of Cardiology, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Afshin Farzaneh-Far
- Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois, USA
| | | | | | - Michele Parker
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Kevin M Judd
- Heart Imaging Technologies, Durham, North Carolina, USA
| | - Omar K Khalique
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Martin B Leon
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | | | - Robert A Levine
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Raymond J Kim
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA
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2
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Kochav JD, Kim J, Judd R, Kim HW, Klem I, Heitner J, Shah D, Shenoy C, Farzaneh-Far A, Polsani V, Kalil R, Villar-Calle P, Nambiar L, Sultana R, Parker M, Cargile P, Khalique OK, Leon MB, Karmpaliotis D, Ratcliffe M, Levine R, Zoghbi WA, Devereux RB, Moskowitz CS, Kim R, Weinsaft JW. Ischemia-Mediated Dysfunction in Subpapillary Myocardium as a Marker of Functional Mitral Regurgitation. JACC Cardiovasc Imaging 2021; 14:826-839. [PMID: 33744130 PMCID: PMC8086776 DOI: 10.1016/j.jcmg.2021.01.007] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/28/2020] [Accepted: 01/06/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The goal of this study was to test whether ischemia-mediated contractile dysfunction underlying the mitral valve affects functional mitral regurgitation (FMR) and the prognostic impact of FMR. BACKGROUND FMR results from left ventricular (LV) remodeling, which can stem from myocardial tissue alterations. Stress cardiac magnetic resonance can assess ischemia and infarction in the left ventricle and papillary muscles; relative impact on FMR is uncertain. METHODS Vasodilator stress cardiac magnetic resonance was performed in patients with known or suspected coronary artery disease at 7 sites. Images were centrally analyzed for MR etiology/severity, mitral apparatus remodeling, and papillary ischemia. RESULTS A total of 8,631 patients (mean age 60.0 ± 14.1 years; 55% male) were studied. FMR was present in 27%, among whom 16% (n = 372) had advanced (moderate or severe) FMR. Patients with ischemia localized to subpapillary regions were more likely to have advanced FMR (p = 0.003); those with ischemia localized to other areas were not (p = 0.17). Ischemic/dysfunctional subpapillary myocardium (odds ratio: 1.24/10% subpapillary myocardium; confidence interval: 1.17 to 1.31; p < 0.001) was associated with advanced FMR controlling for infarction. Among a subgroup with (n = 372) and without (n = 744) advanced FMR matched (1:2) on infarct size/distribution, patients with advanced FMR had increased adverse mitral apparatus remodeling, paralleled by greater ischemic/dysfunctional subpapillary myocardium (p < 0.001). Although posteromedial papillary ischemia was more common with advanced FMR (p = 0.006), subpapillary ischemia with dysfunction remained associated (p < 0.001), adjusting for posteromedial papillary ischemia (p = 0.074). During follow-up (median 5.1 years), 1,473 deaths occurred in the overall cohort; advanced FMR conferred increased mortality risk (hazard ratio: 1.52; 95% confidence interval: 1.25 to 1.86; p < 0.001) controlling for left ventricular ejection fraction, infarction, and ischemia. CONCLUSIONS Ischemic and dysfunctional subpapillary myocardium provides a substrate for FMR, which predicts mortality independent of key mechanistic substrates.
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Affiliation(s)
- Jonathan D Kochav
- Division of Cardiology, Weill Cornell Medicine, New York, New York, USA; Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Jiwon Kim
- Division of Cardiology, Weill Cornell Medicine, New York, New York, USA
| | - Robert Judd
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Han W Kim
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Igor Klem
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA
| | - John Heitner
- Division of Cardiology, NewYork-Presbyterian Brooklyn Methodist Hospital, New York, New York, USA
| | - Dipan Shah
- Division of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Chetan Shenoy
- Division of Cardiology, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Afshin Farzaneh-Far
- Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois, USA
| | | | - Ramsey Kalil
- Division of Cardiology, Weill Cornell Medicine, New York, New York, USA
| | | | - Lakshmi Nambiar
- Division of Cardiology, Weill Cornell Medicine, New York, New York, USA
| | - Razia Sultana
- Division of Cardiology, Weill Cornell Medicine, New York, New York, USA
| | - Michele Parker
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Omar K Khalique
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Martin B Leon
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Dimitrios Karmpaliotis
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Mark Ratcliffe
- Division of Cardiac Surgery, University of California, San Francisco, California, USA
| | - Robert Levine
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - William A Zoghbi
- Division of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | | | - Chaya S Moskowitz
- Department of Epidemiology and Biostatics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Raymond Kim
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA
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Romano S, Dell'atti D, Judd R, Kim R, Weinsaft J, Kim J, Heitner J, Farzaneh-Far A. Right ventricular longitudinal strain measured using feature-tracking cardiac magnetic resonance is an independent predictor of all cause mortality in patients with severe tricuspid regurgitation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Tricuspid regurgitation imposes a volume overload on the right ventricle (RV) that can lead to progressive RV dilation and dysfunction. Overt RV dysfunction is associated with poor prognosis and increased operative risk. Abnormalities of myocardial strain may provide the earliest evidence of ventricular dysfunction. CMR feature-tracking techniques now allow assessment of strain from routine cine-images, without specialized pulse sequences. Whether abnormalities of RV strain measured using CMR feature-tracking have prognostic value in patients with tricuspid regurgitation is unknown
Purpose
To evaluate the prognostic value of CMR feature-tracking derived RV free wall longitudinal strain (RVFWLS) in a large multicenter population of patients with severe tricuspid regurgitation.
Methods
Consecutive patients with severe tricuspid regurgitation undergoing CMR at four US medical centers were included in this study. Feature-tracking RVFWLS was calculated from 4 chamber cine-views (Figure-left panel). The primary endpoint was all-cause death. Cox proportional hazards regression modeling was used to examine the independent association between RVFWLS and death. The incremental prognostic value of RVFWLS was assessed in nested models.
Results
Of the 406 patients in this study,115 died during a median follow-up of 8.8 years. By Kaplan-Meier-analysis, patients with RVFWLS ≥median (−16%) had significantly reduced event free survival compared to those with RVFWLS < median (log-rank p<0.001) (Figure-right panel). By Cox multivariable regression modeling, each 1% worsening in RVFWLS was associated with a 13% increased risk-of-death after adjustement for clinical and imaging risk factors (HR=1.13 per %; p<0.001). Addition of RVFWLS in this model resulted in significant-improvement in the global-chi-square (26 to 65; p<0.0001).
Conclusions
CMR feature-tracking derived RVFWLS is an independent predictor of mortality in patients with severe tricuspid regurgitation, incremental to common clinical and imaging risk factors.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Romano
- University of Verona, Verona, Italy
| | | | - R Judd
- Duke University, Division of cardiology, Department of Medicine, Durham, United States of America
| | - R Kim
- Duke University, Division of cardiology, Department of Medicine, Durham, United States of America
| | - J Weinsaft
- Weill Cornell Medical College, Division of cardiology, New York, United States of America
| | - J Kim
- Weill Cornell Medical College, Division of cardiology, New York, United States of America
| | - J Heitner
- New York Methodist hospital, Cardiology, New York, United States of America
| | - A Farzaneh-Far
- University of Illinois at Chicago, Cardiology, Chicago, United States of America
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Romano S, Judd R, Kim R, Heitner J, Shah D, Shenoy C, Romer B, Salazar P, Farzaneh-Far A. 3225Global longitudinal strain measured using feature-tracking cardiac magnetic resonance imaging is an independent predictor of all cause mortality in patients with preserved ejection fraction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Ejection fraction is the principal measure used clinically to assess cardiac mechanics and provides significant prognostic information. However, echocardiographic strain imaging has shown significant abnormalities of myocardial deformation can be present despite preserved ejection fraction, which maybe associated with adverse prognosis. Cardiac-Magnetic-Resonance (CMR) feature-tracking techniques now allow assessment of strain from routine cine-images, without specialized pulse sequences. Whether abnormalities of strain measured using CMR feature-tracking have prognostic value in patients with preserved ejection fraction is unknown.
Purpose
To evaluate the prognostic value of CMR feature-tracking derived global longitudinal strain (GLS) in a large multicenter population of patients with preserved ejection fraction.
Methods
Consecutive patients with preserved ejection fraction (EF ≥50%) and a clinical indication for CMR at four US medical centers were included in this study. Feature-tracking GLS was calculated from 3 long-axis-cine-views. The primary endpoint was all-cause death. Cox proportional hazards regression modeling was used to examine the independent association between GLS and death. The incremental prognostic value of GLS was assessed in nested models.
Results
Of the 1274 patients in this study, 115 died during a median follow-up of 6.2 years. By Kaplan-Meier analysis, patients with GLS ≥ median (−20%) had significantly reduced event free survival compared to those with GLS < median (log-rank p<0.001) (Figure, top panel). The continuous relationship between GLS and the hazard of death is shown in the cubic spline (Figure, lower panel). By Cox multivariable regression modeling, each 1% worsening in GLS was associated with a 23.6% increased risk-of-death after adjustment for clinical and imaging risk factors (HR=1.236 per %; p<0.001). Addition of GLS in this model resulted in significant-improvement in the global-chi-square (67 to 168; p<0.0001) and Harrel's C-statistic (0.716 to 0.825; p<0.0001).
Conclusions
CMR feature-tracking derived GLS is a powerful independent predictor of mortality in patients with preserved ejection fraction, incremental to common clinical and imaging risk factors.
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Affiliation(s)
- S Romano
- University of Verona, Internal Medicine, Verona, Italy
| | - R Judd
- Duke University Medical Center, Department of Medicine, Division of Cardiology, Durham, United States of America
| | - R Kim
- Duke University Medical Center, Department of Medicine, Division of Cardiology, Durham, United States of America
| | - J Heitner
- New York Methodist hospital, Cardiology, New York, United States of America
| | - D Shah
- Houston Methodist DeBakey Heart and Vascular Center, Houston, United States of America
| | - C Shenoy
- University of Minnesota, Division of Cardiology, Department of Medicine, Minneapolis, United States of America
| | - B Romer
- University of Illinois at Chicago, Cardiology, Chicago, United States of America
| | - P Salazar
- University of Illinois at Chicago, Cardiology, Chicago, United States of America
| | - A Farzaneh-Far
- University of Illinois at Chicago, Cardiology, Chicago, United States of America
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Elliott MD, Heitner JF, Kim H, Wu E, Parker MA, Lee DC, Kaufman DB, Bonow RO, Judd R, Kim RJ. Response to Comment on Elliott et al. Prevalence and Prognosis of Unrecognized Myocardial Infarction in Asymptomatic Patients With Diabetes: A Two-Center Study With Up to 5 Years of Follow-up. Diabetes Care 2019;42:1290-1296. Diabetes Care 2019; 42:e156. [PMID: 31431498 PMCID: PMC7210005 DOI: 10.2337/dci19-0031] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Michael D Elliott
- Duke Cardiovascular Magnetic Resonance Center and Division of Cardiology, Duke University Medical Center, Durham, NC
| | - John F Heitner
- Duke Cardiovascular Magnetic Resonance Center and Division of Cardiology, Duke University Medical Center, Durham, NC
| | - Han Kim
- Duke Cardiovascular Magnetic Resonance Center and Division of Cardiology, Duke University Medical Center, Durham, NC
| | - Edwin Wu
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michelle A Parker
- Duke Cardiovascular Magnetic Resonance Center and Division of Cardiology, Duke University Medical Center, Durham, NC
| | - Daniel C Lee
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Dixon B Kaufman
- Division of Organ Transplantation, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Robert O Bonow
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Robert Judd
- Duke Cardiovascular Magnetic Resonance Center and Division of Cardiology, Duke University Medical Center, Durham, NC
| | - Raymond J Kim
- Duke Cardiovascular Magnetic Resonance Center and Division of Cardiology, Duke University Medical Center, Durham, NC
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Elliott MD, Heitner JF, Kim H, Wu E, Parker MA, Lee DC, Kaufman DB, Bonow RO, Judd R, Kim RJ. Prevalence and Prognosis of Unrecognized Myocardial Infarction in Asymptomatic Patients With Diabetes: A Two-Center Study With Up to 5 Years of Follow-up. Diabetes Care 2019; 42:1290-1296. [PMID: 31010876 PMCID: PMC6973647 DOI: 10.2337/dc18-2266] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 03/29/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine the prevalence and prognostic significance of unrecognized myocardial infarction (MI) by delayed-enhancement MRI (DE-MRI) in asymptomatic patients with diabetes. RESEARCH DESIGN AND METHODS In this prospective, two-center study of asymptomatic patients without known cardiac disease (n = 120), two prespecified cohorts underwent a research MRI: 1) a high-risk group with type 1 diabetes and chronic renal insufficiency (n = 50) and 2) an average-risk group with type 2 diabetes (n = 70). The primary end point was a composite of all-cause mortality and clinical MI. RESULTS Overall, the prevalence of unrecognized MI was 19% by DE-MRI (28% high-risk group and 13% average-risk group) and 5% by electrocardiography. During up to 5 years of follow-up with a total of 460 patient-years of follow-up, the rate of death/MI was markedly higher in patients with diabetes with (vs. without) unrecognized MI (all 44% vs. 7%, high-risk group 43% vs. 6%, and average-risk group 44% vs. 8%; all P < 0.01). After adjustment for Framingham risk score, left ventricular ejection fraction, and diabetes type, the presence of unrecognized MI by DE-MRI conferred an eightfold increase in risk of death/MI (95% CI 3.0-21.1, P < 0.0001). Addition of unrecognized MI to clinical indices significantly improved model discrimination for adverse events (integrated discrimination improvement = 0.156, P = 0.001). CONCLUSIONS Unrecognized MI is prevalent in asymptomatic patients with diabetes without a history of cardiac disease and confers a markedly increased risk of death and clinical MI.
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Affiliation(s)
- Michael D Elliott
- Duke Cardiovascular Magnetic Resonance Center and Division of Cardiology, Duke University Medical Center, Durham, NC
| | - John F Heitner
- Duke Cardiovascular Magnetic Resonance Center and Division of Cardiology, Duke University Medical Center, Durham, NC
| | - Han Kim
- Duke Cardiovascular Magnetic Resonance Center and Division of Cardiology, Duke University Medical Center, Durham, NC
| | - Edwin Wu
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michele A Parker
- Duke Cardiovascular Magnetic Resonance Center and Division of Cardiology, Duke University Medical Center, Durham, NC
| | - Daniel C Lee
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Dixon B Kaufman
- Division of Organ Transplantation, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Robert O Bonow
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Robert Judd
- Duke Cardiovascular Magnetic Resonance Center and Division of Cardiology, Duke University Medical Center, Durham, NC
| | - Raymond J Kim
- Duke Cardiovascular Magnetic Resonance Center and Division of Cardiology, Duke University Medical Center, Durham, NC
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Bloemer J, Pinky PD, Smith WD, Bhattacharya D, Chauhan A, Govindarajulu M, Hong H, Dhanasekaran M, Judd R, Amin RH, Reed MN, Suppiramaniam V. Adiponectin Knockout Mice Display Cognitive and Synaptic Deficits. Front Endocrinol (Lausanne) 2019; 10:819. [PMID: 31824431 PMCID: PMC6886372 DOI: 10.3389/fendo.2019.00819] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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: 08/20/2019] [Accepted: 11/08/2019] [Indexed: 12/21/2022] Open
Abstract
Adiponectin is an adipokine that has recently been under investigation for potential neuroprotective effects in various brain disorders including Alzheimer's disease, stroke, and depression. Adiponectin receptors (AdipoR1 and AdipoR2) are found throughout various brain regions, including the hippocampus. However, the role of these receptors in synaptic and cognitive function is not clear. Therefore, the goal of the current study was to evaluate synaptic and cognitive function in the absence of adiponectin. The current study utilized 12-month-old adiponectin knockout (APN-KO) mice and age-matched controls to study cognitive and hippocampal synaptic alterations. We determined that AdipoR1 and AdipoR2 are present in the synaptosome, with AdipoR2 displaying increased presynaptic vs. postsynaptic localization, whereas AdipoR1 was enriched in both the presynaptic and postsynaptic fractions. APN-KO mice displayed cognitive deficits in the novel object recognition (NOR) and Y-maze tests. This was mirrored by deficits in long-term potentiation (LTP) of the hippocampal Schaefer collateral pathway in APN-KO mice. APN-KO mice also displayed a reduction in basal synaptic transmission and an increase in presynaptic release probability. Deficits in LTP were rescued through hippocampal slice incubation with the adiponectin receptor agonist, AdipoRon, indicating that acute alterations in adiponectin receptor signaling influence synaptic function. Along with the deficits in LTP, altered levels of key presynaptic and postsynaptic proteins involved in glutamatergic neurotransmission were observed in APN-KO mice. Taken together, these results indicate that adiponectin is an important regulator of cognition and synaptic function in the hippocampus. Future studies should examine the role of specific adiponectin receptors in synaptic processes.
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Affiliation(s)
- Jenna Bloemer
- Department of Drug Discovery and Development, Harrison School of Pharmacy, Auburn University, Auburn, AL, United States
- Center for Neuroscience, Auburn University, Auburn, AL, United States
| | - Priyanka D. Pinky
- Department of Drug Discovery and Development, Harrison School of Pharmacy, Auburn University, Auburn, AL, United States
- Center for Neuroscience, Auburn University, Auburn, AL, United States
| | - Warren D. Smith
- Department of Drug Discovery and Development, Harrison School of Pharmacy, Auburn University, Auburn, AL, United States
- Center for Neuroscience, Auburn University, Auburn, AL, United States
| | - Dwipayan Bhattacharya
- Department of Drug Discovery and Development, Harrison School of Pharmacy, Auburn University, Auburn, AL, United States
| | - Alisa Chauhan
- Department of Drug Discovery and Development, Harrison School of Pharmacy, Auburn University, Auburn, AL, United States
| | - Manoj Govindarajulu
- Department of Drug Discovery and Development, Harrison School of Pharmacy, Auburn University, Auburn, AL, United States
- Center for Neuroscience, Auburn University, Auburn, AL, United States
| | - Hao Hong
- Center for Neuroscience, Auburn University, Auburn, AL, United States
- Key Laboratory of Neuropsychiatric Diseases, Department of Pharmacology, China Pharmaceutical University, Nanjing, China
| | - Muralikrishnan Dhanasekaran
- Department of Drug Discovery and Development, Harrison School of Pharmacy, Auburn University, Auburn, AL, United States
- Center for Neuroscience, Auburn University, Auburn, AL, United States
| | - Robert Judd
- Department of Anatomy, Physiology and Pharmacology, College of Veterinary Medicine, Auburn University, Auburn, AL, United States
| | - Rajesh H. Amin
- Department of Drug Discovery and Development, Harrison School of Pharmacy, Auburn University, Auburn, AL, United States
- Center for Neuroscience, Auburn University, Auburn, AL, United States
| | - Miranda N. Reed
- Department of Drug Discovery and Development, Harrison School of Pharmacy, Auburn University, Auburn, AL, United States
- Center for Neuroscience, Auburn University, Auburn, AL, United States
- *Correspondence: Miranda N. Reed
| | - Vishnu Suppiramaniam
- Department of Drug Discovery and Development, Harrison School of Pharmacy, Auburn University, Auburn, AL, United States
- Center for Neuroscience, Auburn University, Auburn, AL, United States
- Vishnu Suppiramaniam
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Romano S, Salazar P, Chia R, Judd R, Kim R, Heitner J, Shah D, Al-Yafi M, Farzaneh-Far A. P268Lateral mitral annular plane excursion measured using cardiac magnetic resonance imaging is an independent predictor of all cause mortality in patients with hypertension: a multicenter study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S Romano
- University of Illinois at Chicago, Department of Medicine, Division of Cardiology, Chicago, United States of America
| | - P Salazar
- University of Illinois at Chicago, Department of Medicine, Division of Cardiology, Chicago, United States of America
| | - R Chia
- University of Illinois at Chicago, Department of Medicine, Division of Cardiology, Chicago, United States of America
| | - R Judd
- Duke University Medical Center, Department of Medicine, Division of Cardiology, Durham, United States of America
| | - R Kim
- Duke University Medical Center, Department of Medicine, Division of Cardiology, Durham, United States of America
| | - J Heitner
- New York Methodist hospital, Cardiology, New York, United States of America
| | - D Shah
- Houston Methodist DeBakey Heart and Vascular Center, Houston, United States of America
| | - M Al-Yafi
- University of Illinois at Chicago, Department of Medicine, Division of Cardiology, Chicago, United States of America
| | - A Farzaneh-Far
- University of Illinois at Chicago, Department of Medicine, Division of Cardiology, Chicago, United States of America
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White B, Romano S, Judd R, Kim R, Kim H, Klem I, Heiner J, Shah D, Jue J, Indorkar R, Farzaneh-Far A. 5008Global longitudinal strain measured using feature-tracking cardiac magnetic resonance imaging is an independent predictor of death in patients with reduced ejection fraction: a multicenter study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.5008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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10
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Shah DJ, Yang EY, Heitner J, Farzaneh-Far A, Nabi F, Kim HW, Ivanov A, Klem I, Crowley AL, Parker M, Judd R, Kim R. CMR Clinical Practice Patterns Across Four U.S. Medical Centers from 2010-2014. J Cardiovasc Magn Reson 2016. [PMCID: PMC5032779 DOI: 10.1186/1532-429x-18-s1-p311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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11
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Wang LL, Miller D, Wanders D, Nanayakkara G, Amin R, Judd R, Morrison EE, Zhong JM. Adiponectin downregulation is associated with volume overload-induced myocyte dysfunction in rats. Acta Pharmacol Sin 2016; 37:187-95. [PMID: 26616727 DOI: 10.1038/aps.2015.84] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 08/26/2015] [Indexed: 12/13/2022] Open
Abstract
AIM Adiponectin has been reported to exert protective effects during pathological ventricular remodeling, but the role of adiponectin in volume overload-induced heart failure remains unclear. In this study we investigated the effect of adiponectin on cardiac myocyte contractile dysfunction following volume overload in rats. METHODS Volume overload was surgically induced in rats by infrarenal aorta-vena cava fistula. The rats were intravenously administered adenoviral adiponectin at 2-, 6- and 9-weeks following fistula. The protein expression of adiponectin, adiponectin receptors (AdipoR1/R2 and T-cadherin) and AMPK activity were measured using Western blot analyses. Isolated ventricular myocytes were prepared at 12 weeks post-fistula to examine the contractile performance of myocytes and intracellular Ca(2+) transient. RESULTS A-V fistula resulted in significant reductions in serum and myocardial adiponectin levels, myocardial adiponectin receptor (AdipoR1/R2 and T-cadherin) levels, as well as myocardial AMPK activity. Consistent with these changes, the isolated myocytes exhibited significant depression in cell shortening and intracellular Ca(2+) transient. Administration of adenoviral adiponectin significantly increased serum adiponectin levels and prevented myocyte contractile dysfunction in fistula rats. Furthermore, pretreatment of isolated myocytes with recombinant adiponectin (2.5 μg/mL) significantly improved their contractile performance in fistula rats, but had no effects in control or adenoviral adiponectin-administered rats. CONCLUSION These results demonstrate a positive correlation between adiponectin downregulation and volume overload-induced ventricular remodeling. Adiponectin plays a protective role in volume overload-induced heart failure.
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Wendell D, Jenista E, Rehwald WG, Kim HW, Parker M, Chen EL, Judd R, Kim R. Validation of a novel dark-blood delayed enhancement technique for the detection of papillary muscle scar. J Cardiovasc Magn Reson 2016. [PMCID: PMC5032336 DOI: 10.1186/1532-429x-18-s1-q6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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13
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Wendell D, Kim HW, Jenista E, Rehwald WG, Parker M, Chen EL, Chattranukulchai P, Judd R, Kim R. Relationship between the transmural extent of high resolution parametric (T1- and T2) mapping and the ischemic area at risk defined by pathology. Journal of Cardiovascular Magnetic Resonance 2016. [PMCID: PMC5032209 DOI: 10.1186/1532-429x-18-s1-o44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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14
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Mandawat A, Mandawat A, Crowley A, Heitner J, Ivanov A, Shah DJ, Nabi F, Farzaneh-Far A, Kim HW, Rehwald WG, Kim R, Judd R, Klem I. Prevalence of dysfunctional but viable myocardium in patients with ischemic cardiomyopathy - results from clinical scans performed in 2010-2014 at four U.S. hospitals. Journal of Cardiovascular Magnetic Resonance 2016. [PMCID: PMC5032528 DOI: 10.1186/1532-429x-18-s1-o1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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15
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Zhong J, Wang L, Miller D, Schwartz D, Amin R, Judd R. Abstract 362: Cardioprotective Effects of Adiponectin in Volume Overload Induced Electrophysiological Remodeling. Circ Res 2015. [DOI: 10.1161/res.117.suppl_1.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The electrophysiological hallmark of the failing heart is the prolongation of action potential duration that induces arrhythmia and sudden death. Depressed outward potassium currents (Ito) has been implicated as the major cause of altered action potential during ventricular remodeling. The molecular mechanism underlying depressed Ito in the diseased heart is still poorly understood. Recent studies have demonstrated that adiponectin (APN) has a cardio-protective effect in response to various pathological stimuli; however, little information is available regarding the potential effects of APN on electrophysiological remodeling under pathological conditions. The present study were to determine the effect of adiponectin treatment on ventricular potassium channel function in a rat model of volume overload induced heart failure. Volume-overload was induced by surgical creation of an infrarenal aorta-vena cava fistula. Rats were administrated with or without adenovirus-mediated overexpression of adiponectin (Ad-APN) at 2-, 5- and 8- weeks post-fistula. In vivo ECGs were used to evaluate changes in QT interval in rats at 10 weeks post-fistula. Ventricular myocytes were isolated at 10 weeks post-fistula. Western blots were used to measure cytoplasmic and membrane protein expression of potassium channels Kv4.2 and Kv 4.3, as well as, KChIP2. Whole cell patch clamp was used to evaluate action potential and Ito currents. Results showed that adiponectin levels in serum and myocytes were significantly reduced following fistula. The duration of action potential was prolonged in ventricular myocytes following 10-week fistula, which was correlated with the in vivo QT interval prolongation, as well as a depression of functional Ito and decreased protein expression of Ito channel subunits in ventricular myocytes. In vivo supplementation of Ad-APN increased the protein levels of Ito channel subunits and prevented Ito depression in ventricular myocytes following 10-week fistula. This further restored the duration of action potential and the QT interval on the ECG back to the normal. These results indicate that adiponectin was able to prevent volume overload-induced ventricular electrophysiological remodeling.
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16
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Viswaprakash N, Vaithianathan T, Viswaprakash A, Judd R, Parameshwaran K, Suppiramaniam V. Insulin treatment restores glutamate (α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid) receptor function in the hippocampus of diabetic rats. J Neurosci Res 2015; 93:1442-50. [PMID: 25807926 DOI: 10.1002/jnr.23589] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Revised: 12/22/2014] [Accepted: 02/26/2015] [Indexed: 11/10/2022]
Abstract
Type 1 diabetes is associated with cognitive dysfunction. Cognitive processing, particularly memory acquisition, depends on the regulated enhancement of expression and function of glutamate receptor subtypes in the hippocampus. Impairment of memory was been detected in rodent models of type 1 diabetes induced by streptozotocin (STZ). This study examines the functional properties of synaptic α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors and the expression of synaptic molecules that regulate glutamatergic synaptic transmission in the hippocampus of STZ-diabetic rats. The AMPA receptor-mediated miniature excitatory postsynaptic currents (mEPSCs) and single-channel properties of synaptosomal AMPA receptors were examined after 4 weeks of diabetes induction. Results show that amplitude and frequency of mEPSCs recorded from CA1 pyramidal neurons were decreased in diabetic rats. In addition, the single-channel properties of synaptic AMPA receptors from diabetic rat hippocampi were different from those of controls. These impairments in synaptic currents gated by AMPA receptors were accompanied by decreased protein levels of AMPA receptor subunit GluR1, the presynaptic protein synaptophysin, and the postsynaptic anchor protein postsynaptic density protein 95 in the hippocampus of diabetic rats. Neural cell adhesion molecule (NCAM), an extracellular matrix molecule abundantly expressed in the brain, and the polysialic acid (PSA) attached to NCAM were also downregulated in the hippocampus of diabetic rats. Insulin treatment, when initiated at the onset of diabetes induction, reduced these effects. These findings suggest that STZ-induced diabetes may result in functional deteriorations in glutamatergic synapses in the hippocampus of rats and that these effects may be reduced by insulin treatment.
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Affiliation(s)
- Nilmini Viswaprakash
- Department of Biomedical Sciences, College of Veterinary Medicine, Nursing and Allied Health, Tuskegee University, Tuskegee, Alabama
| | - Thirumalini Vaithianathan
- Department of Neurobiology and Behavior, Stony Brook University, Stony Brook, New York.,Department of Drug Discovery and Development, Harrison School of Pharmacy, Auburn University, Auburn, Alabama
| | - Ajitan Viswaprakash
- Biology Department and Spine Rehabilitation Center, University of Alabama-Birmingham, Birmingham, Alabama
| | - Robert Judd
- Department of Anatomy, Physiology and Pharmacology, College of Veterinary Medicine, Auburn University, Auburn, Alabama
| | - Kodeeswaran Parameshwaran
- Department of Drug Discovery and Development, Harrison School of Pharmacy, Auburn University, Auburn, Alabama.,Department of Biological and Environmental Sciences, Texas A&M University-Commerce, Commerce, Texas
| | - Vishnu Suppiramaniam
- Department of Drug Discovery and Development, Harrison School of Pharmacy, Auburn University, Auburn, Alabama
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17
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Hafiz S, Dennis JC, Schwartz D, Judd R, Tao YX, Khazal K, Akingbemi B, Mo XL, Abdel-Mageed AB, Morrison E, Mansour M. Expression of melanocortin receptors in human prostate cancer cell lines: MC2R activation by ACTH increases prostate cancer cell proliferation. Int J Oncol 2012; 41:1373-80. [PMID: 22842514 DOI: 10.3892/ijo.2012.1574] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 05/08/2012] [Indexed: 11/05/2022] Open
Abstract
The melanocortin receptors (MCRs 1-5) are G protein coupled-receptors (GPCRs) that regulate food intake, inflammation, skin pigmentation, sexual function and steroidogenesis. Their peptide ligands, the melanocortins, are α-, β- and γ-melanocyte-stimulating hormone and adrenocorticotropic hormone (ACTH) all of which are secreted from the anterior pituitary gland under hypothalamic control. MC2R binds ACTH but has no affinity for the other melanocortins and is, thereby, pharmacologically different from MCRs that bind those ligands. Evidence suggests that elevated GPCRs transactivate the androgen receptor (AR), the critical mediator of prostate cell growth, and consequently promote prostate cancer cell proliferation. It may be that reduced central melanocortin signaling is coincidental with reversal of prostate cancer cachexia, but no data are available on the expression of, or the role for, MCRs in prostate cancer. Here, we show that MCR (1-5) mRNAs are expressed in androgen-dependent LNCaP and androgen-independent PC3 and DU-145 human prostate cancer cell lines. Further, MC2R, the specific target of ACTH, is expressed in LNCaP, PC3 and DU-145 cells. Among the several synthetic MCR peptide ligands that we used, only ACTH promoted concentration-dependent cell proliferation in the three cell lines as shown by MTT cell proliferation assay. In LNCaP cells, the effect was additive with testosterone stimulation and was partially blunted with SHU9119, a non-selective MCR antagonist. In the same cells, ACTH induced cAMP production and increased AR nuclear labeling in immunocytochemical assays. Our observations suggest that MC2R is involved in prostate carcinogenesis and that targeting MC2R signaling may provide a novel avenue in prostate carcinoma treatment.
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Affiliation(s)
- Saly Hafiz
- Department of Anatomy, Physiology, and Pharmacology, College of Veterinary Medicine, Auburn University, Auburn, AL, USA
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18
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Codella NCF, Lee HY, Fieno DS, Chen DW, Hurtado-Rua S, Kochar M, Finn JP, Judd R, Goyal P, Schenendorf J, Cham MD, Devereux RB, Prince M, Wang Y, Weinsaft JW. Improved left ventricular mass quantification with partial voxel interpolation: in vivo and necropsy validation of a novel cardiac MRI segmentation algorithm. Circ Cardiovasc Imaging 2011; 5:137-46. [PMID: 22104165 DOI: 10.1161/circimaging.111.966754] [Citation(s) in RCA: 43] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) typically quantifies LV mass (LVM) by means of manual planimetry (MP), but this approach is time-consuming and does not account for partial voxel components--myocardium admixed with blood in a single voxel. Automated segmentation (AS) can account for partial voxels, but this has not been used for LVM quantification. This study used automated CMR segmentation to test the influence of partial voxels on quantification of LVM. METHODS AND RESULTS LVM was quantified by AS and MP in 126 consecutive patients and 10 laboratory animals undergoing CMR. AS yielded both partial voxel (AS(PV)) and full voxel (AS(FV)) measurements. Methods were independently compared with LVM quantified on echocardiography (echo) and an ex vivo standard of LVM at necropsy. AS quantified LVM in all patients, yielding a 12-fold decrease in processing time versus MP (0:21±0:04 versus 4:18±1:02 minutes; P<0.001). AS(FV) mass (136±35 g) was slightly lower than MP (139±35; Δ=3±9 g, P<0.001). Both methods yielded similar proportions of patients with LV remodeling (P=0.73) and hypertrophy (P=1.00). Regarding partial voxel segmentation, AS(PV) yielded higher LVM (159±38 g) than MP (Δ=20±10 g) and AS(FV) (Δ=23±6 g, both P<0.001), corresponding to relative increases of 14% and 17%. In multivariable analysis, magnitude of difference between AS(PV) and AS(FV) correlated with larger voxel size (partial r=0.37, P<0.001) even after controlling for LV chamber volume (r=0.28, P=0.002) and total LVM (r=0.19, P=0.03). Among patients, AS(PV) yielded better agreement with echo (Δ=20±25 g) than did AS(FV) (Δ=43±24 g) or MP (Δ=40±22 g, both P<0.001). Among laboratory animals, AS(PV) and ex vivo results were similar (Δ=1±3 g, P=0.3), whereas AS(FV) (6±3 g, P<0.001) and MP (4±5 g, P=0.02) yielded small but significant differences with LVM at necropsy. CONCLUSIONS Automated segmentation of myocardial partial voxels yields a 14-17% increase in LVM versus full voxel segmentation, with increased differences correlated with lower spatial resolution. Partial voxel segmentation yields improved CMR agreement with echo and necropsy-verified LVM.
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Affiliation(s)
- Noel C F Codella
- Department of Physiology/Biophysics, Weill Cornell Medical College, New York, NY 10021, USA
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Mansour M, Stewart L, Coleman E, Braden T, Akingbemi B, Judd R, Dennis J, Plaisance E, Morrison E. Decreased serum Testosterone in Type 2 Diabetes does not reflect intratesticular hypoandrogenism but is associated with decreased adiponectin. FASEB J 2008. [DOI: 10.1096/fasebj.22.2_supplement.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Laura Stewart
- AnatomyPhysiology & PharmacologyAuburn UniversityAuburnAL
| | - Elaine Coleman
- AnatomyPhysiology & PharmacologyAuburn UniversityAuburnAL
| | - Tim Braden
- AnatomyPhysiology & PharmacologyAuburn UniversityAuburnAL
| | | | - Robert Judd
- AnatomyPhysiology & PharmacologyAuburn UniversityAuburnAL
| | - John Dennis
- AnatomyPhysiology & PharmacologyAuburn UniversityAuburnAL
| | - Eric Plaisance
- AnatomyPhysiology & PharmacologyAuburn UniversityAuburnAL
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20
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Dennis JC, Coleman ES, Swyers SE, Moody SW, Wright JC, Judd R, Zhong Q, Morrison EE. Changes in mitotic rate and GFAP expression in the primary olfactory axis of streptozotocin-induced diabetic rats. ACTA ACUST UNITED AC 2006; 34:3-10. [PMID: 16374706 DOI: 10.1007/s11068-005-5044-x] [Citation(s) in RCA: 12] [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] [Received: 03/21/2005] [Revised: 05/31/2005] [Accepted: 05/31/2005] [Indexed: 11/26/2022]
Abstract
Many diabetic individuals develop anosmia but the mechanism(s) causing the dysfunction in the olfactory system is (are) unknown. Glial fibrillary acidic protein expression is reduced in diabetic retinopathy and is also reduced, with unknown consequences, in other brain regions of diabetic rats. We used immunohistochemistry and immunoblotting from untreated control and streptozotocin-induced type 1 (insulin dependent) diabetic rats to investigate main olfactory epithelial mitotic rate and glial fibrillary acidic protein expression in the lamina propria of the sensory epithelium and in the olfactory bulb. Numbers of bromodeoxyuridine-positive cells were significantly lower in the diabetic sensory epithelium compared to non-diabetic controls. Immunohistochemical observations suggested a qualitative difference in glial fibrillary acidic protein expression in both regions examined especially in the olfactory bulb external plexiform layer and the lamina propria. Immunoblot analysis confirmed that the diabetic olfactory bulb and lamina propria expressed less glial fibrillary acidic protein compared to the non-diabetic control group. The lower expression levels in the olfactory bulb external plexiform layer suggested by immunohistochemistry do not reflect a change in the number of astrocytes since the numbers of S100B(+) cells were not different between the two groups.
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Affiliation(s)
- J C Dennis
- Department of Anatomy, Physiology, Pharmacology, College of Veterinary Medicine, Auburn University, AL 36849-0551, USA.
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21
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Abstract
Diabetes mellitus increases the risk of central nervous system (CNS) disorders such as stroke, seizures, dementia, and cognitive impairment. The cellular mechanisms responsible for the increased risk of these disorders are incompletely understood. Astrocytes are proving critical for normal CNS function, and alterations in their activity could contribute to diabetes-related disturbances in the brain. We examined the effects of streptozotocin (STZ)-induced diabetes in rats on the level of the astrocyte intermediate filament protein, glial fibrillary acidic protein (GFAP), number of astrocytes, and levels of the astrocyte glutamate transporters, glutamate transporter-1 (GLT-1) and glutamate/aspartate transporter (GLAST), in the cerebral cortex, hippocampus, and cerebellum by Western blotting (WB) and immunohistochemistry (IH). Studies were carried out at 4 and 8 weeks of diabetes duration. Diabetes resulted in a significant decrease in GFAP protein levels (WB) in the hippocampus and cerebellum at 4 weeks and in the cerebral cortex, hippocampus and cerebellum by 8 weeks. Attenuated GFAP immunoreactivity (IH) was evident in the hippocampus, cerebellum and white matter regions such as the corpus callosum and external capsule at both 4 and 8 weeks of diabetes. Astrocyte cell counts of adjacent sections immunoreactive for S-100B were not different between control and diabetic animals. No significant differences were noted in astrocyte glutamate transporter levels in the cerebral cortex, hippocampus, or cerebellum at either time period (WB, IH). With the expanding list of astrocyte functions in the CNS, the role of astrocytes in diabetes-induced CNS disorders clearly warrants further investigation.
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Affiliation(s)
- Elaine Coleman
- Department of Anatomy, Physiology and Pharmacology, Auburn University, Auburn, Alabama 36849, USA.
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22
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23
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Cook T, Grostern RJ, Barney NP, Mills MD, Judd R, Albert DM. Posttransplantation lymphoproliferative disorder initially seen as iris mass and uveitis. Arch Ophthalmol 2001; 119:768-70. [PMID: 11346409 DOI: 10.1001/archopht.119.5.768] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Primary ocular posttransplantation lymphoproliferative disorder is rare. Epstein-Barr virus is implicated as the cause as a result of systemic immunosuppression after transplant surgery. We studied a patient who developed ocular posttransplantation lymphoproliferative disorder after orthotopic liver transplantation. Slitlamp and light microscopic photographs confirmed the diagnosis.
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Affiliation(s)
- T Cook
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison 53705, USA
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Marfurt J, Stulz E, Trafelet HU, Zingg A, Leumann C, Hazenkamp M, Judd R, Schenker S, Strouse G, Ward TR, Förtsch M, Hauser J, Bürgi HB. 7-(2'-Deoxy-α-D-ribofuranosyl)hypoxanthine. Acta Crystallogr C 1996. [DOI: 10.1107/s0108270195012662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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25
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Lima JA, Nazareno G, Judd R, Lugo-Olivieri C, Siu C, Zerhouni EA. 929-65 Mechanisms of Hyperenhancement by Contrast Enhanced Magnetic Resonance Imaging are Related to Injured Myocardial Mass in Patients with Acute Myocardial Infarction. J Am Coll Cardiol 1995. [DOI: 10.1016/0735-1097(95)91924-m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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D'Alessandro AM, Kalayoglu M, Hammes R, Wilson MA, Judd R, Eckhoff DE, Belzer FO. Diagnosis of intestinal transplant rejection using technetium-99m-DTPA. Transplantation 1994; 58:112-3. [PMID: 8036698] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- A M D'Alessandro
- Department of Surgery, University of Wisconsin School of Medicine, Madison 53792
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Kalayoglu M, D'Alessandro AM, Knechtle SJ, Eckhoff DE, Pirsch JD, Judd R, Sollinger HW, Hoffmann RM, Belzer FO. Long-term results of liver transplantation for biliary atresia. Surgery 1993; 114:711-7; discussion 717-8. [PMID: 8211685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Biliary atresia can be treated by portoenterostomy, which is primarily palliative, or by liver transplantation, which is primarily curative. The purpose of this study was to determine the long-term outcome of liver transplantation for the treatment of biliary atresia. METHODS During an 8-year period, 45 patients who underwent liver transplantation for biliary atresia and 10 patients who were referred to our center for portoenterostomy were retrospectively analyzed. RESULTS No patient with biliary atresia died awaiting liver transplantation. The waiting time for all patients was 36.7 +/- 42.8 days. Thirty-four patients (75.6%) required one transplant, whereas 11 patients (24.4%) required 17 retransplants. Twenty-two patients (48.9%) required 39 reoperations (1.8 per patient). There were 4.9 infectious episodes, 2.2 rejection episodes, and 4.4 readmissions per patient. However, 91% of reoperations, 80% of infections, and 78% of rejections occurred within 6 months of transplantation. The overall 7-year actuarial patient and graft survival for patients with biliary atresia was 86.2% and 62.7%, respectively. CONCLUSIONS Our results indicate that long-term patient survival after liver transplantation for biliary atresia is excellent. However, portoenterostomy continues to have an initial complementary but limited long-term role in the treatment of infants with biliary atresia.
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Affiliation(s)
- M Kalayoglu
- Department of Surgery, University of Wisconsin Medical School, Madison
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Abstract
Poorly differentiated Sertoli-stromal cell tumors and carcinosarcomas of the ovary both show biphasic epithelial and stromal patterns and may both show heterologous stromal elements, presenting a difficult diagnosis. We studied the immunohistochemical profile of Sertoli cell differentiation in human testes and applied these findings to the ovarian tumors. Eleven Sertoli-stromal cell tumors, six carcinosarcomas of the ovary, and 11 testes (six fetal, one infant, and four adult) were studied using antibodies to cytokeratin AE1:AE3 (AE1:3), cytokeratin CAM 5.2 (CAM), epithelial membrane antigen (EMA), vimentin, desmin, muscle-specific actin (MSA), S-100 protein (S-100), CA 19-9, CA 125, carcinoembryonic antigen monoclonal (CEA-M), carcinoembryonic antigen polyclonal (CEA-P), and placental alkaline phosphatase (PLAP). In the fetal testes, immature gonadal stroma and sex cord areas stained with vimentin (six of six cases), AE1:3 (five of six cases), and CAM (six of six cases). Sertoli cells in immature gonadal stroma areas, sex cords, and seminiferous tubules of normal fetal, infant, or adult testes never showed immunoreactivity for EMA, S-100, CA 19-9, CA 125, CEA-M, CEA-P, or PLAP. All Sertoli-stromal cell tumors stained with AE1:3 and CAM in areas of Sertoli cell differentiation (11 of 11 cases) but did not stain with EMA, PLAP, CEA-P, CEA-M, CA 19-9, CA 125, or S-100 (none of 11 cases). Carcinosarcomas expressed AE1:3 and CAM in all epithelial areas (six of six cases) and most stromal areas (five of six cases). Carcinomatous areas of carcinosarcoma also showed immunoreactivity for EMA (six of six cases), CA 125 (two of six cases), PLAP (two of six cases), CEA-P (two of six cases), and CEA-M (one of six cases), while stromal areas of carcinosarcoma expressed EMA (four of six cases) and S-100 (four of six cases). Heterologous stromal elements were present in three of 11 Sertoli-stromal cell tumors (two showed skeletal muscle and one showed both skeletal muscle and cartilage differentiation) and in four of six carcinosarcomas (one skeletal muscle, one cartilage, and two cartilage and skeletal muscle). All skeletal muscle heterologous elements expressed desmin, vimentin, and MSA. The heterologous cartilage in carcinosarcoma stained with S-100 (three of three), while the one case of heterologous cartilage in Sertoli-stromal cell tumor did not. These results suggest that ovarian Sertoli-stromal cell tumor can be distinguished from carcinosarcoma by the absence of staining for EMA, PLAP, CEA, CA 125, or CA 19-9 in epithelial areas of Sertoli-stromal cell tumor.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- M J Costa
- Department of Pathology, University of California, San Francisco 94143-0506
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Zaki SR, Judd R, Coffield LM, Greer P, Rolston F, Evatt BL. Human papillomavirus infection and anal carcinoma. Retrospective analysis by in situ hybridization and the polymerase chain reaction. Am J Pathol 1992; 140:1345-55. [PMID: 1318640 PMCID: PMC1886536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
To examine the association of human papillomavirus (HPV) infection with anal squamous cell carcinoma, the authors applied the highly sensitive polymerase chain reaction (PCR) and in situ hybridization (ISH) techniques to detect HPV DNA in formalin-fixed, paraffin-embedded tissues from 18 patients. The presence of HPV types 16/18 in 3 (16.7%) of 18 patients with anal carcinoma was found, using a colorimetric ISH technique for HPV types 6, 11, 16, 18, 31, 35, and 51. Results from one of these three patients were also positive for HPV 31, 35, 51 by ISH techniques. When the same series was analyzed using the PCR and consensus primers to the L1 open reading frame of the HPV genomes, the frequency of positive patients rose to 14 (77.8%) of 18. PCR analysis of the 14 lesions containing HPV DNA, using type-specific primers and probes for HPV 6, 11, 16, 18, and 33, showed that 1 contained HPV 6, 1 contained HPV 11, 4 contained HPV 16, 1 contained HPV 18, 1 contained HPV 33, 5 contained HPV of unclassified type(s), and 1 contained a mixture of three HPV types. There was concordance between typing of cases that were positive by ISH and PCR methods. These data agree with the concept that HPV, in particular type 16, is implicated in the pathogenesis of anal cancer.
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Affiliation(s)
- S R Zaki
- Division of Viral Diseases, Center for Disease Control, Atlanta, GA 30333
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Judd R, Zaki SR, Coffield LM, Evatt BL. Human papillomavirus type 6 detected by the polymerase chain reaction in invasive sinonasal papillary squamous cell carcinoma. Arch Pathol Lab Med 1991; 115:1150-3. [PMID: 1660705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Eight sinonasal carcinomas (one adenocarcinoma, two undifferentiated nasopharyngeal carcinomas, and five squamous cell carcinomas) were investigated for evidence of human papillomavirus (HPV) infection using in situ hybridization and the polymerase chain reaction for HPV types 6, 11, 16, 18, and 33. All eight cases were negative for HPV infection by in situ hybridization, while a single HPV-6-positive case was identified by the polymerase chain reaction. The HPV-positive case was an invasive papillary squamous cell carcinoma of the maxillary sinus. Although HPV-6 is usually associated with benign anogenital condylomata, it has been identified in malignant lesions of the upper respiratory tract. This may reflect exposure of the upper aerodigestive tract to additional carcinogens, such as smoke and alcohol, superimposed on the background proliferative stimulus of the HPV infection.
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Affiliation(s)
- R Judd
- Department of Pathology, Emory University School of Medicine, Atlanta, Ga
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Costa MJ, Kenny MB, Hewan-Lowe K, Judd R. Glassy cell features in adenosquamous carcinoma of the uterine cervix. Histologic, ultrastructural, immunohistochemical, and clinical findings. Am J Clin Pathol 1991; 96:520-8. [PMID: 1716415 DOI: 10.1093/ajcp/96.4.520] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Glassy cell features (GCF) were identified as composing a predominant pattern (more than 85% of histology) in six cases and a focal pattern (33-85% of histology) in 10 cases of a series of 53 adenocarcinomas (AC) and adenosquamous carcinomas (ADSQ) of the uterine cervix. In three cases examined ultrastructurally, GCFs correlated with many cytoplasmic polyribosomes and abundant rough endoplasmic reticulum, but Golgi complexes and tonofilaments were scant and intracytoplasmic lumina were absent. Intracellular mucin was present in the areas showing GCFs of four ADSQs with predominant GCFs and six ADSQs with focal GCFs. Two of three cases examined ultrastructurally showed intracellular electron-dense material that corresponded to mucin secretory material. Immunohistochemical studies of the six ADSQs with predominant GCF cases showed the following pattern of reactivity: monoclonal carcinoembryonic antigen (CEA), 2 of 6 cases; polyclonal CEA, 3 of 6; CA 125, 0 of 6; CA 19-9, 0 of 6; placental alkaline phosphatase, 0 of 6; and vimentin, 1 of 6. Focal GCF areas showed monoclonal CEA, 4 of 9 cases; polyclonal CEA, 3 of 9; vimentin, 4 of 9; while CA 125, CA 19-9, and placental alkaline phosphatase were negative in areas of GCFs. One of three patients with ADSQ with predominant GCFs and five of nine patients with ADSQ with focal GCFs with at least 1 year of follow-up were disease free. No association between GCFs (combined focal and predominant) and recurrent disease was present when compared to the other 29 AC and ADSQ patients with follow-up. Recurrent disease in our series of AC and ADSQ was only associated with stage III or IV disease at presentation (P less than 0.001). There was no association with adenosquamous histology, histologic grade, lymphatic invasion, or age. There were insufficient cases of ADSQ with predominant GCFs with follow-up to evaluate fully prognostic significance of this subgroup. Our study suggests that GCFs are part of the spectrum of differentiation in ADSQ of the cervix rather than a distinct histologic type of carcinoma with unique clinical significance.
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Affiliation(s)
- M J Costa
- Department of Pathology, Emory University, Atlanta, Georgia
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Abstract
Immunohistochemical and biochemical assays for estrogen and progesterone receptors were done on 20 breast carcinomas, and results were correlated with various histologic features. The slide-based immunohistochemical technique demonstrated several distinct advantages relative to the tissue homogenization required by the traditional biochemical assay. With the use of frozen tissue sections, the immunohistochemical technique permitted direct visualization of antireceptor binding to tumor cells. Receptor staining of reactive stroma, necrotic tumor, and intermingled benign parenchyma was easily distinguished from receptor staining of the actual carcinoma. This separation is not possible with the biochemical assay. In addition, in situ and invasive components and different morphologic subtypes were evaluated independently. Receptor content of the most aggressive portion of the neoplasm is likely to have the greatest clinical relevance and prognostic significance. Careful correlation of histochemical scores with biochemical assay concentrations is needed to permit the application of this technique to patients entering cancer treatment protocols.
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Affiliation(s)
- R Judd
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA 30322
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Judd R, Zaki SR, Coffield LM, Evatt BL. Sinonasal papillomas and human papillomavirus: human papillomavirus 11 detected in fungiform Schneiderian papillomas by in situ hybridization and the polymerase chain reaction. Hum Pathol 1991; 22:550-6. [PMID: 1650753 DOI: 10.1016/0046-8177(91)90231-d] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A series of 19 paraffin-embedded sinonasal papillomas (four squamous papillomas, three fungiform papillomas, nine inverted papillomas, and three cylindrical cell papillomas) were investigated for evidence of human papillomavirus (HPV) infection using immunohistochemistry (polyclonal antibody to HPV capsid antigen), in situ hybridization (DNA probes for HPV 6/11, 16/18, and 31/33/35), and the polymerase chain reaction (primers and probes for HPV 6, 11, 16, 18, and 33). All three fungiform papillomas were positive by all three techniques: immunohistochemistry, in situ hybridization for HPV 6/11, and the polymerase chain reaction for HPV 11. None of the other lesions contained detectable HPV using the specific probes included in this study. These results support the continued classification of fungiform papilloma as a distinctive variant of schneiderian papilloma characterized by a predominantly exophytic growth pattern and an association with HPV 11.
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Affiliation(s)
- R Judd
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA 30322
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Costa MJ, Khan R, Judd R. Carcinoma (malignant mixed müllerian [mesodermal] tumor) of the uterus and ovary. Correlation of clinical, pathologic, and immunohistochemical features in 29 cases. Arch Pathol Lab Med 1991; 115:583-90. [PMID: 1710102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We examined the histologic, immunohistochemical, and clinical features of a series of 23 endometrial, five cervical, and one ovarian carcinosarcomas (malignant mixed müllerian [mesodermal] tumors) and nine associated distant peritoneal metastases. The primary tumors all showed epithelial differentiation (cytokeratin and/or epithelial membrane antigen expression) of the carcinomatous component, while sarcomatous areas showed epithelial differentiation in all but one case. The metastases showed uniform staining for cytokeratin (eight of eight cases) and epithelial membrane antigen (eight of eight cases), including the spindle cell component that was present in four of nine cases. Desmin significantly changed the interpretation of rhabdomyosarcoma differentiation by refuting putative rhabdomyoblasts in two cases and identifying rhabdomyoblasts in two other cases where they were unrecognized on hematoxylineosin staining. S100 protein was positive in all five cases with chondrosarcoma differentiation. Muscle-specific actin and vimentin were positive in the sarcomatous component of all cases and in the carcinomatous component of seven and 10 cases, respectively. After immunostaining, heterologous elements were present in 18 of 29 cases (11 cases of rhabdomyosarcoma, three cases of chondrosarcoma, three cases of mixed rhabdomyosarcoma and chondrosarcoma, and one case of liposarcoma). Only six of 27 patients with follow-up were disease free for 12 months or longer (associated with stage I or II disease, smaller size, no lymphatic invasion in the resection specimen, and no invasion of the outer two thirds of myometrium). Presence and type of heterologous elements, grade of sarcomatous or carcinomatous components, histologic type of carcinomatous component, gross appearance, presence of necrosis, or use of chemotherapy or radiotherapy did not affect outcome. Carcinosarcomas are clinically aggressive distinctive mixed epithelial-stromal neoplasms with histologic and immunohistochemical features that overlap with metaplastic carcinoma in many cases.
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Affiliation(s)
- M J Costa
- Department of Anatomic Pathology, Grady Memorial Hospital, Atlanta, GA 30335-3801
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Abstract
True thymic hyperplasia (enlarged gland composed of histologically unremarkable cortical and medullary parenchyma) and lymphoid hyperplasia (medullary lymphoid follicles in the clinical setting of autoimmunity) usually develop as independent pathologic processes. We reviewed the clinical features and gross and microscopic pathology of 2 hyperthyroid patients with features of both thymic hyperplasia and lymphoid hyperplasia. The diagnosis of thymic hyperplasia was supported by thymic weights greater than two standard deviations above the mean weight for age and histologic evidence of expanded cortical and medullary parenchyma. The diagnosis of lymphoid hyperplasia was supported by the increased number and size of medullary lymphoid follicles and the association with Graves' disease. This unusual combination results from two separate pathogenic mechanisms operating simultaneously in hyperthyroid patients. Elevated thyroid hormones directly stimulate the proliferation of thymic epithelium, producing thymic hyperplasia. The immune abnormalities underlying Graves' disease can also result in lymphoid hyperplasia of the thymus.
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Affiliation(s)
- R Judd
- Department of Anatomic Pathology, Grady Memorial Hospital, Atlanta, Georgia 30335
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Guarner J, Grossman B, Judd R, Wideman C, Evatt B. Multiple arteriovenous malformations of the small intestine in a patient with protein S deficiency. Am J Clin Pathol 1989; 92:374-8. [PMID: 2528285 DOI: 10.1093/ajcp/92.3.374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The authors report a case of arteriovenous malformations (AVMs) of the small intestine in a young patient with protein S deficiency. These disorders have not been previously reported to occur together. Protein S deficiency may cause thromboses in unusual sites, including the mesenteric veins. Several mechanisms linking protein S deficiency to the occurrence of AVMs in this patient are offered.
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Affiliation(s)
- J Guarner
- Department of Pathology, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia
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Granot E, Deckelbaum RJ, Judd R, Slonim AE, Gutman A. Recurrent Reye-like syndrome: possible association with Krebs cycle abnormality. Isr J Med Sci 1984; 20:148-52. [PMID: 6706540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
During a 7-year period, a 15-year-old boy experienced recurrent attacks that clinically and pathologically resembled Reye's syndrome. The attacks were precipitated by prolonged exercise, fasting or infections. An extensive investigation failed to identify a toxic cause or specific metabolic disorder. Low 14CO2 production after in vitro incubation of the patient's liver with 14C-labeled palmitate, citrate and glutamine suggested a defect in the Krebs cycle or the oxidative phosphorylation pathway. This error may be responsible for the recurrent Reye-like syndrome attacks.
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Judd R, Deckelbaum RJ, Weizman Z, Granot E, Ron N, Okon E. Giardiasis in childhood: poor clinical and histological correlations. Isr J Med Sci 1983; 19:818-823. [PMID: 6358123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Ten pediatric patients investigated for chronic diarrhea, chronic weight loss, or failure to thrive were found on intestinal biopsy and/or in a duodenal aspirate to have Giardia lamblia. Serum immunoglobulin levels were normal or elevated in all patients. Three children had increased excretion of fecal fat and three other children had low D-xylose absorption. Jejunal biopsy specimens showed two severe, three moderate, and two mild morphological abnormalities, and three were normal. Except for lactase deficiency, disaccharidase activities correlated poorly with the severity of mucosal damage on biopsy. Steatorrhea was seen only with the more normal biopsies. Immunofluorescent staining of the biopsies for IgG, IgM, IgA, and secretory piece revealed no immune defects. Thus, there was no single malabsorption defect associated with giardiasis, and the specific defects did not necessarily correlate with morphological changes.
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