32 results on '"Sugrue J"'
Search Results
2. Safety and efficacy of an electrothermal bipolar vessel sealing device in sealing and division of the inferior mesenteric vessels in minimally invasive colorectal surgery
- Author
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Pai, A., Sugrue, J., Bibi, S., Melich, G., Marecik, S., Prasad, L. M., and Park, J.
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- 2016
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3. Glycovirology Protocols
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Richard, Sugrue J., primary
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- 2007
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4. Research Collaborations: a guide for early career researchers
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Abou-Ali, A., Mazari, A., Scherer, A., Dziubińska, A., Pardo Gracía, A., Punstein, A., Grimm, A., Bösmeier, A., Feliu, A., Wong, B., Langlands-Perry, C., Henein, C., O'Leary, C., Kuz, D., Vdovenko, D., Mesa, D., Gelo, D., Romani, E., Neenan, E., Kaulich, E., Hannon, G., O’Sullivan, G., Spolidoro, G., Baker, H., Domen, I., Sugrue, J., Maleček, J., Strycharz, J., Harmon, J., Gonçalves, J., Vanderlinden, J., Dianati, K., Káplár-Kodácsy, K., Zahra, K., Hachem, M., Klaus, M., Laufer, M., Atif, M., Elhadad, M., Dupin, N., Bod, P., van Woerden, R., Gunnarsson, S., Assaad, S., Briggs, S., Shrigley, S., Pant, S., Cvjetković, S., Piazza, S., Taroni, T., Kankainen, V., Hommes, W., ACELG (FdR), and Persuasive Communication (ASCoR, FMG)
- Published
- 2019
5. EHMTI-0194. The impact of dizziness in tertiary care migraine patients
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Sugrue, J, Thomkins, E, and Ruttledge, M
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- 2014
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6. Management of headaches by physiotherapists in Ireland
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Brady, A., primary, Sugrue, J., additional, and Cunningham, C., additional
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- 2016
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7. Industrial applications of a cloned neutral protease gene in Bacillus subtilis
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Reid, Sharon J., Sugrue, J. Ann, and Thomson, Jennifer A.
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- 1986
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8. The effect of glucose on the expression of a clonedBacillus amyloliquefaciens α-amylase gene in strains ofBacillus subtilis
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Prudence, Kevin W., Katz, Anthony, Sugrue, J. Ann, and Thomson, Jennifer A.
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- 1989
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9. Glycovirology Protocols
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Sugrue J. Richard
- Published
- 2007
10. What's new, what's different, what can we expect? (Tax Credits 2003)
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Sugrue, J. Michael
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Low income housing -- Tax policy ,Tax credits -- Tax policy ,Architecture and design industries ,Real estate industry ,Omnibus Budget Reconciliation Act of 1993 - Abstract
By now, everyone knows that the Low-Income Housing Tax Credit (LIHTC) was created by the Budget Reform Act of 1986 and renewed annually until made permanent by the Revenue Reconciliation [...]
- Published
- 2003
11. The Case for Mandatory Certification
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Wilson Bb, George E, Brigham Le, Goldman J, Becker K, Baby Samiaya S, Sugrue J, and Brady C
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Engineering management ,Certification ,American Nurses' Association ,Leadership and Management ,Humans ,General Medicine ,Business ,United States ,Certification and Accreditation ,Specialties, Nursing - Published
- 2001
12. The effect of glucose on the expression of a cloned Bacillus amyloliquefaciens α-amylase gene in strains of Bacillus subtilis.
- Author
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Prudence, Kevin, Katz, Anthony, Sugrue, J., and Thomson, Jennifer
- Abstract
Bacillus subtilis strain 1A297 was shown to relieve the glucose repression of a cloned B. amyloliquefaciens α-amylase gene carried on the hybrid plasmid pVC102 without affecting its temporal activation. However, glucose repression of α-amylase occurred when pVC102, was introduced into B. subtilis strain 1A289. Glucose repression was relieved by α-methyl- d-glucoside, an analog of glucose that blocks its uptake. The relief of glucose repression in 1A297 did not act at the level of plasmid copy number. As 1A297 was capable of exerting glucose repression on a homologous chromosomally encoded gene, it is postulated that the putative trans-acting product involved in glucose repression in B. subtilis (Nicholson and Chambliss, 1986, J. Bacteriol. 165:663-670) is altered in strain 1A297 and does not recognize the B. amyloliquefaciens α-amylase gene. [ABSTRACT FROM AUTHOR]
- Published
- 1989
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13. Author Correction: Immune system adaptation during gender-affirming testosterone treatment.
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Lakshmikanth T, Consiglio C, Sardh F, Forlin R, Wang J, Tan Z, Barcenilla H, Rodriguez L, Sugrue J, Noori P, Ivanchenko M, Piñero Páez L, Gonzalez L, Habimana Mugabo C, Johnsson A, Ryberg H, Hallgren Å, Pou C, Chen Y, Mikeš J, James A, Dahlqvist P, Wahlberg J, Hagelin A, Holmberg M, Degerblad M, Isaksson M, Duffy D, Kämpe O, Landegren N, and Brodin P
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- 2024
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14. Immune system adaptation during gender-affirming testosterone treatment.
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Lakshmikanth T, Consiglio C, Sardh F, Forlin R, Wang J, Tan Z, Barcenilla H, Rodriguez L, Sugrue J, Noori P, Ivanchenko M, Piñero Páez L, Gonzalez L, Habimana Mugabo C, Johnsson A, Ryberg H, Hallgren Å, Pou C, Chen Y, Mikeš J, James A, Dahlqvist P, Wahlberg J, Hagelin A, Holmberg M, Degerblad M, Isaksson M, Duffy D, Kämpe O, Landegren N, and Brodin P
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- Adult, Female, Humans, Male, Datasets as Topic, Dendritic Cells immunology, Dendritic Cells metabolism, Dendritic Cells drug effects, Immune System drug effects, Immune System metabolism, Interferon Type I immunology, Interferon Type I metabolism, Interferon-gamma immunology, Interferon-gamma metabolism, Interleukin-15 immunology, Interleukin-15 metabolism, Killer Cells, Natural immunology, Killer Cells, Natural drug effects, Monocytes immunology, Monocytes drug effects, Monocytes metabolism, NF-kappa B metabolism, Sex Characteristics, Tumor Necrosis Factor-alpha metabolism, Testosterone adverse effects, Testosterone immunology, Testosterone pharmacology, Testosterone therapeutic use, Transgender Persons
- Abstract
Infectious, inflammatory and autoimmune conditions present differently in males and females. SARS-CoV-2 infection in naive males is associated with increased risk of death, whereas females are at increased risk of long COVID
1 , similar to observations in other infections2 . Females respond more strongly to vaccines, and adverse reactions are more frequent3 , like most autoimmune diseases4 . Immunological sex differences stem from genetic, hormonal and behavioural factors5 but their relative importance is only partially understood6-8 . In individuals assigned female sex at birth and undergoing gender-affirming testosterone therapy (trans men), hormone concentrations change markedly but the immunological consequences are poorly understood. Here we performed longitudinal systems-level analyses in 23 trans men and found that testosterone modulates a cross-regulated axis between type-I interferon and tumour necrosis factor. This is mediated by functional attenuation of type-I interferon responses in both plasmacytoid dendritic cells and monocytes. Conversely, testosterone potentiates monocyte responses leading to increased tumour necrosis factor, interleukin-6 and interleukin-15 production and downstream activation of nuclear factor kappa B-regulated genes and potentiation of interferon-γ responses, primarily in natural killer cells. These findings in trans men are corroborated by sex-divergent responses in public datasets and illustrate the dynamic regulation of human immunity by sex hormones, with implications for the health of individuals undergoing hormone therapy and our understanding of sex-divergent immune responses in cisgender individuals., (© 2024. The Author(s).)- Published
- 2024
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15. Impact of socioeconomic status on healthy immune responses in humans.
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Bertrand A, Sugrue J, Lou T, Bourke NM, Quintana-Murci L, Saint-André V, O'Farrelly C, and Duffy D
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- Humans, Female, Male, Adult, Middle Aged, Cytomegalovirus immunology, Immunity, Healthy Volunteers, Young Adult, Social Class, Cytomegalovirus Infections immunology
- Abstract
Individuals with low socioeconomic status (SES) are at greater risk of contracting and developing severe disease compared with people with higher SES. Age, sex, host genetics, smoking and cytomegalovirus (CMV) serostatus are known to have a major impact on human immune responses and thus susceptibility to infection. However, the impact of SES on immune variability is not well understood or explored. Here, we used data from the Milieu Intérieur project, a study of 1000 healthy volunteers with extensive demographic and biological data, to examine the effect of SES on immune variability. We developed an Elo-rating system using socioeconomic features such as education, income and home ownership status to objectively rank SES in the 1000 donors. We observed sex-specific SES associations, such as females with a low SES having a significantly higher frequency of CMV seropositivity compared with females with high SES, and males with a low SES having a significantly higher frequency of active smoking compared with males with a high SES. Using random forest models, we identified specific immune genes which were significantly associated with SES in both baseline and immune challenge conditions. Interestingly, many of the SES associations were sex stimuli specific, highlighting the complexity of these interactions. Our study provides a new way of computing SES in human populations that can help identify novel SES associations and reinforces biological evidence for SES-dependent susceptibility to infection. This should serve as a basis for further understanding the molecular mechanisms behind SES effects on immune responses and ultimately disease., (© 2024 The Author(s). Immunology & Cell Biology published by John Wiley & Sons Australia, Ltd on behalf of the Australian and New Zealand Society for Immunology, Inc.)
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- 2024
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16. Defective activation and regulation of type I interferon immunity is associated with increasing COVID-19 severity.
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Smith N, Possémé C, Bondet V, Sugrue J, Townsend L, Charbit B, Rouilly V, Saint-André V, Dott T, Pozo AR, Yatim N, Schwartz O, Cervantes-Gonzalez M, Ghosn J, Bastard P, Casanova JL, Szwebel TA, Terrier B, Conlon N, O'Farrelly C, Cheallaigh CN, Bourke NM, and Duffy D
- Subjects
- Humans, Proteomics, SARS-CoV-2, Interferon-alpha, Antiviral Agents, Autoantibodies, COVID-19, Interferon Type I
- Abstract
Host immunity to infection with SARS-CoV-2 is highly variable, dictating diverse clinical outcomes ranging from asymptomatic to severe disease and death. We previously reported reduced type I interferon in severe COVID-19 patients preceded clinical worsening. Further studies identified genetic mutations in loci of the TLR3- or TLR7-dependent interferon-I pathways, or neutralizing interferon-I autoantibodies as risk factors for development of COVID-19 pneumonia. Here we show in patient cohorts with different severities of COVID-19, that baseline plasma interferon α measures differ according to the immunoassay used, timing of sampling, the interferon α subtype measured, and the presence of autoantibodies. We also show a consistently reduced induction of interferon-I proteins in hospitalized COVID-19 patients upon immune stimulation, that is not associated with detectable neutralizing autoantibodies against interferon α or interferon ω. Intracellular proteomic analysis shows increased monocyte numbers in hospitalized COVID-19 patients but impaired interferon-I response after stimulation. We confirm this by ex vivo whole blood stimulation with interferon-I which induces transcriptomic responses associated with inflammation in hospitalized COVID-19 patients, that is not seen in controls or non-hospitalized moderate cases. These results may explain the dichotomy of the poor clinical response to interferon-I based treatments in late stage COVID-19, despite the importance of interferon-I in early acute infection and may guide alternative therapeutic strategies., (© 2022. The Author(s).)
- Published
- 2022
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17. Severe COVID-19 is characterised by inflammation and immature myeloid cells early in disease progression.
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Townsend L, Dyer AH, Naughton A, Imangaliyev S, Dunne J, Kiersey R, Holden D, Mooney A, Leavy D, Ridge K, Sugrue J, Aldoseri M, Kelliher JH, Hennessy M, Byrne D, Browne P, Bacon CL, Doyle C, O'Riordan R, McLaughlin AM, Bannan C, Martin-Loeches I, White A, McLoughlin RM, Bergin C, Bourke NM, O'Farrelly C, Conlon N, and Cheallaigh CN
- Abstract
SARS-CoV-2 infection causes a wide spectrum of disease severity. Identifying the immunological characteristics of severe disease and the risk factors for their development are important in the management of COVID-19. This study aimed to identify and rank clinical and immunological features associated with progression to severe COVID-19 in order to investigate an immunological signature of severe disease. One hundred and eight patients with positive SARS-CoV-2 PCR were recruited. Routine clinical and laboratory markers were measured, as well as myeloid and lymphoid whole-blood immunophenotyping and measurement of the pro-inflammatory cytokines IL-6 and soluble CD25. All analysis was carried out in a routine hospital diagnostic laboratory. Univariate analysis demonstrated that severe disease was most strongly associated with elevated CRP and IL-6, loss of DLA-DR expression on monocytes and CD10 expression on neutrophils. Unbiased machine learning demonstrated that these four features were strongly associated with severe disease, with an average prediction score for severe disease of 0.925. These results demonstrate that these four markers could be used to identify patients developing severe COVID-19 and allow timely delivery of therapeutics., Competing Interests: The authors declare no conflict of interest., (© 2022 The Author(s).)
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- 2022
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18. A randomised controlled trial of multimodal physiotherapy versus advice for recent onset, painful cervical radiculopathy - the PACeR trial protocol.
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Keating L, Treanor C, Sugrue J, Meldrum D, Bolger C, and Doody C
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- Adult, Athletic Tape, Cervical Vertebrae, Combined Modality Therapy methods, Exercise Therapy methods, Female, Humans, Male, Multicenter Studies as Topic, Musculoskeletal Manipulations methods, Neck Pain diagnosis, Neck Pain etiology, Pain Measurement, Pilot Projects, Quality of Life, Radiculopathy complications, Randomized Controlled Trials as Topic, Reproducibility of Results, Treatment Outcome, Young Adult, Conservative Treatment methods, Neck Pain therapy, Radiculopathy therapy
- Abstract
Background: A research gap exists for optimal management of cervical radiculopathy in the first 12 weeks and short term natural history of the condition is somewhat unclear, although thought to be favourable. The primary aim of this assessor blinded, superiority, 2 parallel group randomised controlled trial is to investigate the effects of a 4 week physiotherapy programme (6-8 sessions) of manual therapy, exercise and upper limb neural unloading tape, compared to a control of weekly phone advice; on disability, pain and selected biopsychosocial measures, in acute and sub-acute cervical radiculopathy patients. A secondary aim is to identify whether any baseline variables, symptom duration or group allocation can predict outcome., Methods: Participants are recruited from GP referrals in an urban setting, from a neurosurgery non-urgent waiting list and from self-referral through Facebook advertising. Eligible participants (n = 64) are diagnosed with radiculopathy based on a clinical prediction rule and must have symptoms of unilateral, single level, radiculopathy for between 2 and 12 weeks, without having yet received physiotherapy. Random 1:1 group allocation (using variable block sizes), allocation concealment, blinded assessment and intention to treat analysis are being employed. Treatment is provided by clinical specialist physiotherapists in primary and secondary care settings. Outcomes are measured at baseline, 4 (primary endpoint) and 12 weeks. Participants' report of pain, disability and their rating of recovery is also recorded by telephone interview at 6 months. Statistical analysis of between group differences will be performed with ANOVAs and MANOVAs, and multivariable regression analysis will be undertaken to explore predictor variables. Ethical approval for this study has been received from the Beaumont Hospital and Irish College of General Practitioners Research Ethics Committees. The trial is registered at ClinicalTrials.gov (NCT02449200)., Discussion: An internal pilot study to test retention and recruitment strategies led to trial expansion and this is now a multi centre trial involving 5 clinical sites., Trial Registration: NCT02449200 . Registered 20/05/15.
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- 2019
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19. Rectal Cancer Complete Response Outcomes in a Community-Based Hospital Comparable with Large Cancer Centers When Multidisciplinary Approach to Rectal Cancer Is Used.
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Geiser AJ, Al-Khamis A, Patel S, Sugrue J, Borsuk DJ, Marecik S, Kochar K, and Park JJ
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- Aged, Chemoradiotherapy, Disease-Free Survival, Female, Humans, Male, Middle Aged, Neoadjuvant Therapy, Rectal Neoplasms mortality, Rectal Neoplasms pathology, Retrospective Studies, Survival Rate, Treatment Outcome, Cancer Care Facilities, Hospitals, Community, Neoplasm Recurrence, Local epidemiology, Rectal Neoplasms therapy
- Abstract
Achievement of pathologic complete response (pCR) in patients with locally advanced rectal cancer correlates with improved prognosis relative to non-pCR counterparts. Such correlations are not well established in the context of a community-based hospital. This study aims to examine pCR rates, recurrences, and survival data for locally advanced rectal cancer patients in community settings. A single-center retrospective chart review was performed at a community-based hospital. Study population consisted of 119 patients with locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy, followed by surgical resection. Patients with a history of metastasis, inflammatory bowel disease, hereditary cancer syndromes, concurrent or prior malignancy, and emergent surgery were excluded. Twenty-four patients (20.2%) achieved pCR. Across both groups, all demographics and perioperative characteristics were comparable. The five-year survival was 73.7 per cent in the non-pCR group and 95.8 per cent in the pCR group ( P = 0.0243). At five years, 27.7 per cent of the non-pCR group had a recurrence, as compared with none in the pCR group ( P = 0.0018). Based on our study, we believe that a multidisciplinary approach to rectal cancer used at a community-based hospital can achieve oncological outcomes and survival benefits similar to those of larger academic tertiary care institutions.
- Published
- 2019
20. How I was almost mistaken for a chocolatier.
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Sugrue J
- Published
- 2019
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21. Balloon Dilation of the Eustachian Tube: 12-Month Follow-up of the Randomized Controlled Trial Treatment Group.
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Anand V, Poe D, Dean M, Roberts W, Stolovitzky P, Hoffmann K, Nachlas N, Light J, Widick M, Sugrue J, Elliott CL, Rosenberg S, Guillory P, Brown N, Syms C, Hilton C, McElveen J, Singh A, Weiss R, Arriaga M, and Leopold J
- Subjects
- Acoustic Impedance Tests, Adult, Aged, Female, Follow-Up Studies, Humans, Male, Middle Aged, Time Factors, Treatment Outcome, Dilatation instrumentation, Ear Diseases surgery, Eustachian Tube surgery
- Abstract
Objective: Obstructive eustachian tube dysfunction (OETD) affects up to 5% of adults; however, available treatment strategies have limitations. It was previously reported that balloon dilation of the eustachian tube (BDET) with the eustachian tube balloon catheter + medical management (MM) results in a significantly higher proportion of subjects with normalized tympanograms versus MM alone at 6- and 24-week follow-up. The current analysis extends these initial findings by investigating the durability of BDET + MM treatment outcomes through 52 weeks., Study Design: Prospective cohort follow-up study from the treatment group in a previously reported multicenter randomized controlled trial., Setting: Twenty-one investigational sites across the United States., Subjects and Methods: Here we report on secondary and exploratory endpoints for patients with OETD who previously failed MM and were randomized to the BDET + MM cohort. Analyses of tympanogram outcomes are reported by ear, unless specified otherwise, as a more accurate measure of durability of the procedure over time., Results: Among subjects randomized to BDET + MM, the overall number with normalized tympanograms and ETDQ-7 scores (Eustachian Tube Dysfunction Questionnaire-7) remained comparable to those reported at 6- versus 52-week follow-up: tympanograms, 73 of 143 (51.0%) versus 71 of 128 (55.5%); ETDQ-7, 79 of 142 (55.6%) versus 71 of 124 (57.3%). The overall number of ears with normalized tympanograms also remained comparable, with 117 of 204 (57%) versus 119 of 187 (63.6%)., Conclusions: The present study suggests that the beneficial effects of BDET + MM on tympanogram normalization and symptoms of subjects with refractory OETD demonstrate significant durability that is clinically relevant through 52 weeks.
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- 2019
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22. The NLRP3 inflammasome modulates glycolysis by increasing PFKFB3 in an IL-1β-dependent manner in macrophages.
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Finucane OM, Sugrue J, Rubio-Araiz A, Guillot-Sestier MV, and Lynch MA
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- Amyloid beta-Peptides, Animals, Cells, Cultured, Furans, Heterocyclic Compounds, 4 or More Rings pharmacology, Indenes, Inflammation chemically induced, Interleukin-1beta immunology, Lipopolysaccharides, Macrophages pathology, Male, Mice, Mice, Inbred C57BL, Mice, Knockout, Phosphofructokinase-2 antagonists & inhibitors, Sulfonamides, Sulfones pharmacology, Glycolysis drug effects, Inflammasomes antagonists & inhibitors, Inflammasomes physiology, Inflammation immunology, Macrophages immunology, NLR Family, Pyrin Domain-Containing 3 Protein antagonists & inhibitors, NLR Family, Pyrin Domain-Containing 3 Protein physiology, Phosphofructokinase-2 metabolism
- Abstract
Inflammation and metabolism are intricately linked during inflammatory diseases in which activation of the nucleotide-binding domain-like receptors Family Pyrin Domain Containing 3 (NLRP3) inflammasome, an innate immune sensor, is critical. Several factors can activate the NLRP3 inflammasome, but the nature of the link between NLRP3 inflammasome activation and metabolism remains to be thoroughly explored. This study investigates whether the small molecule inhibitor of the NLRP3 inflammasome, MCC950, modulates the lipopolysaccharide (LPS) -and amyloid-β (Aβ)-induced metabolic phenotype and inflammatory signature in macrophages. LPS + Aβ induced IL-1β secretion, while pre-treatment with MCC950 inhibited this. LPS + Aβ also upregulated IL-1β mRNA and supernatant concentrations of TNFα, IL-6 and IL-10, however these changes were insensitive to MCC950, confirming that MCC950 specifically targets inflammasome activation in BMDMs. LPS + Aβ increased glycolysis and the glycolytic enzyme, PFKFB3, and these effects were decreased by MCC950. These findings suggest that NLRP3 inflammasome activation may play a role in modulating glycolysis. To investigate this further, the effect of IL-1β on glycolysis was assessed. IL-1β stimulated glycolysis and PFKFB3, mimicking the effect of LPS + Aβ and adding to the evidence that inflammasome activation impacts on metabolism. This contention was supported by the finding that the LPS + Aβ-induced changes in glycolysis and PFKFB3 were attenuated in BMDMs from NLRP3-deficient and IL-1R1-deficient mice. Consistent with a key role for PFKFB3 is the finding that the PFKFB3 inhibitor, 3PO, attenuated the LPS + Aβ-induced glycolysis. The data demonstrate that activation of the NLRP3 inflammasome, and the subsequent release of IL-1β, play a key role in modulating glycolysis via PFKFB3. Reinstating metabolic homeostasis by targeting the NLRP3 inflammasome-PFKFB3 axis may provide a novel therapeutic target for treatment of acute and chronic disease.
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- 2019
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23. Acute diverticulitis in renal transplant patients: should we treat them differently?
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Sugrue J, Lee J, Warner C, Thomas S, Tzvetanov I, Mar W, Mellgren A, and Nordenstam J
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- Acute Disease, Adult, Aged, Aged, 80 and over, Case-Control Studies, Clinical Decision-Making, Diverticulitis etiology, Female, Follow-Up Studies, Humans, Immunocompetence, Immunosuppression Therapy adverse effects, Male, Middle Aged, Postoperative Complications etiology, Retrospective Studies, Treatment Outcome, Diverticulitis therapy, Kidney Transplantation, Postoperative Complications therapy
- Abstract
Background: Current guidelines suggest that transplant patients with acute diverticulitis should be managed aggressively with early operative intervention to reduce morbidity and mortality. This study compared the treatment choices and clinical outcomes between renal transplant patients and immunocompetent patients with acute diverticulitis., Methods: A retrospective review was performed of all patients who were admitted with acute diverticulitis between 2002 and 2015 at a single academic institution. Patient demographics, comorbidities, physiologic and radiologic disease severity, management, and disease-specific outcomes were recorded and compared between renal transplant patients and immunocompetent patients. Predictors of complications also were analyzed., Results: In the study, 20 renal transplant patients and 134 immunocompetent patients were admitted for acute diverticulitis and were followed for a median time of 36 and 40 months, respectively. Patient demographics were similar between the groups. Transplant patients had significantly more comorbidities. Overall, there were no differences in physiologic disease severity or rates of elective or urgent operation, ostomy, permanent ostomy, duration of stay, 30-day readmission, disease recurrence or disease-specific complications, organ failure, or death. Among patients with complicated disease, renal transplant patients were significantly more likely to undergo an urgent operation and had more complications. On multivariate analysis, undergoing operative therapy remained the sole predictor of complications., Conclusion: Nonoperative management of renal transplant patients who present with uncomplicated diverticulitis is safe as outcomes are similar to immunocompetent patients. However, the optimal management of renal transplant patients with complicated diverticulitis remains unclear as both treatment choices and complication rates differed from immunocompetent patients., (Copyright © 2017 Elsevier Inc. All rights reserved.)
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- 2018
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24. Sphincter-Sparing Anal Fistula Repair: Are We Getting Better?
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Sugrue J, Mantilla N, Abcarian A, Kochar K, Marecik S, Chaudhry V, Mellgren A, and Nordenstam J
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- Anal Canal surgery, Female, Humans, Illinois, Ligation adverse effects, Ligation methods, Ligation statistics & numerical data, Male, Middle Aged, Rectal Fistula diagnosis, Rectal Fistula physiopathology, Recurrence, Retrospective Studies, Treatment Outcome, Wound Healing, Fibrin Tissue Adhesive therapeutic use, Organ Sparing Treatments adverse effects, Organ Sparing Treatments methods, Organ Sparing Treatments statistics & numerical data, Postoperative Complications diagnosis, Postoperative Complications surgery, Rectal Fistula surgery, Reoperation methods, Surgical Flaps adverse effects, Surgical Flaps statistics & numerical data
- Abstract
Background: Sphincter-sparing repairs are commonly used to treat anal fistulas with significant muscle involvement., Objective: The current study evaluates the trends and efficacy of sphincter-sparing repairs and determines risk factors for fistula recurrence., Design and Settings: A retrospective review was performed at 3 university-affiliated teaching hospitals., Patients: All 462 patients with cryptoglandular anal fistulas who underwent 573 sphincter-sparing repairs between 2005 and 2015 were included. Patients with Crohn's disease were excluded., Main Outcome Measures: The primary outcome was the rate of fistula healing defined as cessation of drainage with closure of the external opening. Risk factors for nonhealing were also analyzed., Results: Five hundred three sphincter-sparing repairs were analyzed, whereas 70 were lost to follow-up. Two hundred twenty sphincter-sparing repairs (44%) resulted in healing, 283 (56%) resulted in nonhealing with a median follow-up of 9 (range, 1-125) months. The median time to fistula recurrence was 3 (range, 0-75) months with 79% and 91% of recurrences noted within 6 and 12 months. Patients treated with a dermal advancement flap, rectal advancement flap, or ligation of the intersphincteric tract procedure were less likely to have a recurrence than patients treated with a fistula plug or fibrin glue (p < 0.001). Over time, there was a significantly increased use of the ligation of the intersphincteric tract procedure (p < 0.001) and a significantly decreased use of fistula plugs and fibrin glue (p < 0.001); healing rates improved accordingly. There were no significant differences in healing rates with respect to patient demographics, comorbidities, or fistula characteristics., Limitations: This study was limited by its retrospective design., Conclusions: Healing rates following sphincter-sparing repairs of cryptoglandular anal fistulas are modest, but have improved over time with the use of better surgical techniques. In this study, ligation of the intersphincteric fistula tract and flaps were superior to fistula plugs and fibrin glue; the former procedures are therefore favored. See Video Abstract at http://links.lww.com/DCR/A391.
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- 2017
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25. Reply to: Unnecessary histologic examination of stapler doughnuts at low anterior resection for rectal cancer: Is it just a blame game?
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Sugrue J, Mellgren A, and Nordenstam J
- Subjects
- Anastomosis, Surgical, Humans, Rectal Neoplasms, Rectum
- Published
- 2017
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26. No clinical benefit from routine histologic examination of stapler doughnuts at low anterior resection for rectal cancer.
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Sugrue J, Dagbert F, Park J, Marecik S, Prasad LM, Chaudhry V, Blumetti J, Emmadi R, Mellgren A, and Nordenstam J
- Subjects
- Aged, Anastomosis, Surgical, Cost-Benefit Analysis, Female, Humans, Male, Middle Aged, Patient Selection, Retrospective Studies, Surgical Stapling economics, Treatment Outcome, Adenocarcinoma pathology, Adenocarcinoma surgery, Adenoma pathology, Adenoma surgery, Rectal Neoplasms pathology, Rectal Neoplasms surgery
- Abstract
Background: The aim of this study was to evaluate the clinical utility and cost-effectiveness of routine histologic examination of the doughnuts from stapled anastomoses in patients undergoing a low anterior resection for rectal cancer., Methods: We performed a retrospective review of 486 patients who underwent a low anterior resection with stapled anastomosis for rectal cancer between 2002 and 2015 at 3 institutions. Pathologic findings in the doughnuts and their impact on patient management were recorded. Tumor characteristics that may influence how often doughnuts were included in the pathology report were analyzed. An approximate cost of histologic examination of doughnuts was also calculated., Results: A total of 412 patients (85%) had doughnuts included in their pathology reports. Two patients had cancer cells in their doughnuts, and both patients had a positive distal margin in their primary tumor specimen; 33 patients had benign findings in their doughnuts. Pathologic examination of the doughnut did not change clinical management in any patient. Patients with rectosigmoid tumors were less likely to have their doughnuts included in the pathology report compared to patients with low tumors (P = .003). Doughnuts were not bundled with the primary tumor specimen in 374 (77%) of our patients; in these patients, pathologic analysis of the doughnut added an additional cost of approximately $643 per specimen., Conclusion: This study demonstrates no clinical benefit in sending anastomotic doughnuts for histopathologic evaluation after performing a low anterior resection with a stapled anastomosis for rectal cancer. Overall cost may be decreased if doughnuts are not analyzed or if they are bundled with the primary tumor specimen., (Copyright © 2017 Elsevier Inc. All rights reserved.)
- Published
- 2017
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27. Pathogenesis and persistence of cryptoglandular anal fistula: a systematic review.
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Sugrue J, Nordenstam J, Abcarian H, Bartholomew A, Schwartz JL, Mellgren A, and Tozer PJ
- Subjects
- Adult, Anal Canal metabolism, Anal Canal microbiology, Anal Canal pathology, Chronic Disease, Crohn Disease complications, Epithelial-Mesenchymal Transition physiology, Female, Humans, Male, Middle Aged, Rectal Fistula metabolism, Rectal Fistula microbiology, Cytokines metabolism, Gastrointestinal Microbiome physiology, Rectal Fistula pathology
- Abstract
Anal fistulas continue to be a problem for patients and surgeons alike despite scientific advances. While patient and anatomical characteristics are important to surgeons who are evaluating patients with anal fistulas, their development and persistence likely involves a multifaceted interaction of histological, microbiological, and molecular factors. Histological studies have shown that anal fistulas are variably epithelialized and are surrounded by dense collagen tissue with pockets of inflammatory cells. Yet, it remains unknown if or how histological differences impact fistula healing. The presence of a perianal abscess that contains gut flora commonly leads to the development of anal fistula. This implies a microbiological component, but bacteria are infrequently found in chronic fistulas. Recent work has shown an increased expression of proinflammatory cytokines and epithelial to mesenchymal cell transition in both cryptoglandular and Crohn's perianal fistulas. This suggests that molecular mechanisms may also play a role in both fistula development and persistence. The aim of this study was to examine the histological, microbiological, molecular, and host factors that contribute to the development and persistence of anal fistulas.
- Published
- 2017
- Full Text
- View/download PDF
28. Long-term Experience of Magnetic Anal Sphincter Augmentation in Patients With Fecal Incontinence.
- Author
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Sugrue J, Lehur PA, Madoff RD, McNevin S, Buntzen S, Laurberg S, and Mellgren A
- Subjects
- Adult, Aged, Device Removal, Equipment Failure, Female, Humans, Longitudinal Studies, Male, Middle Aged, Pilot Projects, Prospective Studies, Quality of Life, Severity of Illness Index, Treatment Outcome, Anal Canal surgery, Fecal Incontinence therapy, Magnets, Prostheses and Implants
- Abstract
Background: Magnetic anal sphincter augmentation is a novel technique for the treatment of patients with fecal incontinence., Objective: The current study reports the long-term effectiveness and safety of this new treatment modality., Design: This was a prospective multicenter pilot study., Settings: The study was performed at 4 clinical sites in Europe and the United States., Patients: The cohort included patients with severe fecal incontinence for ≥6 months who had previously failed conservative therapy and were implanted with a magnetic anal sphincter device between 2008 and 2011., Main Outcome Measures: Adverse events, symptom severity, quality of life, and bowel diary data were collected., Results: A total of 35 patients (34 women) underwent magnetic anal sphincter augmentation. The median length of follow-up was 5.0 years (range, 0-5.6 years), with 23 patients completing assessment at 5 years. Eight patients underwent a subsequent operation (7 device explantations) because of device failure or complications, 7 of which occurred in the first year. Therapeutic success rates, with patients who underwent device explantation or stoma creation counted as treatment failures, were 63% at year 1, 66% at year 3 and 53% at year 5. In patients who retained their device, the number of incontinent episodes per week and Cleveland Clinic incontinence scores significantly decreased from baseline, and there were significant improvements in all 4 scales of the Fecal Incontinence Quality of Life instrument. There were 30 adverse events reported in 20 patients, most commonly defecatory dysfunction (20%), pain (14%), erosion (11%), and infection (11%)., Limitations: This study does not allow for comparison between surgical treatments and involves a limited number of patients., Conclusions: Magnetic anal sphincter augmentation provided excellent outcomes in patients who retained a functioning device at long-term follow-up. Protocols to reduce early complications will be important to improve overall results.
- Published
- 2017
- Full Text
- View/download PDF
29. Wide local excision of perianal Paget's disease with gluteal flap reconstruction: an interdisciplinary approach.
- Author
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Borsuk DJ, Melich G, Sugrue J, Calata J, Seitz IA, Park JJ, Prasad LM, and Marecik SJ
- Abstract
Perianal Paget's disease (PPD) is an extremely rare condition characterized as intraepithelial adenocarcinoma of unclear etiology. It can be either primary or secondary. The disease typically presents as an eczema-like, erythematous, and painful skin lesion that is associated with pruritus. It is usually misdiagnosed as a common anorectal problem. Surgical excision is the preferred treatment of PPD, with the specific technique being dependent upon disease invasiveness. The treatment may involve reconstructive surgery. A 61-year-old female with a history of rectal pain and intermittent pruritus for the past two years presented with large painful lesions in her perianal area including the anal verge, diagnosed as primary PPD. After excluding other malignancies elsewhere, a laparoscopic ileostomy followed by a wide local excision (WLE) of the PPD was performed by a colorectal team. Reconstruction of the defect with gluteal advancement flaps was performed by the plastic surgeon. The patient recovered uneventfully. Her surgical site showed healing without flap compromise, widely open anal opening, and full sphincter control at the three-month follow-up exam. The patient returned to normal function after ileostomy closure. WLE with bilateral V-Y gluteal flap advancement is a feasible treatment for primary PPD., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.
- Published
- 2016
- Full Text
- View/download PDF
30. A combination of transanal minimally invasive surgery and transanal technique to facilitate suturing during transanal minimally invasive surgery.
- Author
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Christie R, Sugrue J, Eftaiha S, Kaminski J, Kamal T, Park J, Prasad L, and Marecik S
- Abstract
Transanal minimally invasive surgery (TAMIS) is an effective option for the local excision of benign, non-invasive rectal lesions, or selected early stage rectal cancers. However, the suturing encountered in TAMIS remains technically challenging. A combination of TAMIS and transanal approach to suturing is demonstrated to address this challenge. A 64-year-old female with a T1N0 adenocarcinoma located in the anterior mid-rectum underwent TAMIS for resection of the lesion. Total operative time was 91 minutes. Free peritoneal defect was closed in two layers. The patient was discharged on postoperative day 1. Final pathology revealed a 0.7 cm T1 well-differentiated adenocarcinoma 0.8 cm from the closest resection margin. The patient remains free of systemic or local recurrence at 24 months. TAMIS is a safe and effective option for removal of benign rectal lesions or selected low grade T1 adenocarcinomas of the rectum. A hybrid TAMIS and transanal approach to suturing may often easily address the technical challenge of pure laparoscopic suturing in TAMIS., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.
- Published
- 2016
- Full Text
- View/download PDF
31. Repair of a recurrent traumatic rectovaginal fistula using vaginal wall plication to reinforce a rectal wall advancement flap.
- Author
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Sugrue J, Kaminski J, Patel S, Park J, Prasad L, and Marecik S
- Abstract
Background: Rectovaginal fistulas (RVF) can cause significant physical discomfort and psychological distress for patients and remain amongst the most challenging disorders for surgeons., Methods: A 28-year-old female with a history of a traumatic cloaca repaired 12 years prior was diagnosed with a recurrent RVF and underwent repair using a rectal wall advancement flap reinforced with posterior vaginal wall plication. This case is used to demonstrate surgical technique. The study adhered to the prescribed ethical guidelines. Informed consent was obtained from the patient to use the video recording of her operation for educational purposes., Results: The patient had an uneventful postoperative course. The fistula was fully healed without any signs or symptoms of recurrence at 8 weeks follow-up exam. Her protective ileostomy was successfully closed., Conclusions: Transanal repair of a RVF through creation of a rectal advancement flap and plication of redundant vaginal wall can be used to treat appropriately selected patients with significant tissue defects., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.
- Published
- 2016
- Full Text
- View/download PDF
32. The case for mandatory certification.
- Author
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Brady C, Becker K, Brigham LE, Goldman J, Wilson BB, George E, Baby Samiaya S, and Sugrue J
- Subjects
- Humans, United States, American Nurses' Association, Certification, Specialties, Nursing standards
- Published
- 2001
- Full Text
- View/download PDF
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