ABSTRACT
The ability to germinate, develop, and thrive underwater is key to efficient rice cultivation. In this issue of Developmental Cell, Wang et al. (2024) illuminate a hormone synthesis and inactivation cascade that promotes germination of submerged rice seeds and may allow improved germination in the field.
Subject(s)
Germination , Oryza , Oryza/growth & development , Oryza/metabolism , Germination/physiology , Seeds/growth & development , Seeds/metabolism , Plant Growth Regulators/metabolism , Water/metabolismABSTRACT
The current standard of care treatment for canine lymphoma is a multi-agent, CHOP-based chemotherapy protocol. Single agent doxorubicin (DOX) is less burdensome; however, multi-agent chemotherapy protocols are often superior. The recently approved drug rabacfosadine (RAB, Tanovea) provides an attractive option for combination therapy with DOX, as both drugs demonstrate efficacy against lymphoma and possess different mechanisms of action. A previous study evaluating alternating RAB/DOX reported an overall response rate (ORR) of 84%, with a median progression-free survival time (PFS) of 194 days. The aim of this prospective trial was to evaluate the same protocol in an additional population of dogs. Fifty-nine dogs with treatment naïve lymphoma were enrolled. RAB (1.0 mg/kg IV) was alternated with DOX (30 mg/m2 IV) every 21 days for up to six total treatments (3 cycles). Response assessment and adverse event (AE) evaluation were performed every 21 days using VCOG criteria. The ORR was 93% (79% CR, 14% PR). The median time to maximal response was 21.5 days; median PFS was 199 days. T cell immunophenotype and lack of treatment response were predictive of inferior outcomes. AEs were mostly gastrointestinal. Six dogs developed presumed or confirmed pulmonary fibrosis; four were grade 5. One dog experienced grade 3 extravasation injury with RAB that resolved with supportive treatment. These data mirror those of the previously reported RAB/DOX study, and support the finding that alternating RAB/DOX is a reasonable treatment option for canine lymphoma.
Subject(s)
Dog Diseases , Doxorubicin , Lymphoma , Animals , Dogs , Dog Diseases/drug therapy , Doxorubicin/therapeutic use , Doxorubicin/administration & dosage , Female , Male , Lymphoma/drug therapy , Lymphoma/veterinary , Alanine/therapeutic use , Alanine/analogs & derivatives , Alanine/administration & dosage , Prospective Studies , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , PurinesABSTRACT
This article explains the authors' experiences about opportunities, perspectives, and considerations required to initiate clinical studies in a veterinary oncology practice. These details include the infrastructure required for appropriate study training for all staff. Negotiation of scope of work and fees for service with study sponsors is also discussed. Finally, although generally similar, the article also describes management of clinical studies in academic and private practice settings.
Subject(s)
Education, Veterinary , AnimalsABSTRACT
Small proteins (<50 amino acids) are emerging as ubiquitous and important regulators in organisms ranging from bacteria to humans, where they commonly bind to and regulate larger proteins during stress responses. However, fundamental aspects of small proteins, such as their molecular mechanism of action, downregulation after they are no longer needed, and their evolutionary provenance, are poorly understood. Here, we show that the MntS small protein involved in manganese (Mn) homeostasis binds and inhibits the MntP Mn transporter. Mn is crucial for bacterial survival in stressful environments but is toxic in excess. Thus, Mn transport is tightly controlled at multiple levels to maintain optimal Mn levels. The small protein MntS adds a new level of regulation for Mn transporters, beyond the known transcriptional and post-transcriptional control. We also found that MntS binds to itself in the presence of Mn, providing a possible mechanism of downregulating MntS activity to terminate its inhibition of MntP Mn export. MntS is homologous to the signal peptide of SitA, the periplasmic metal-binding subunit of a Mn importer. Remarkably, the homologous signal peptide regions can substitute for MntS, demonstrating a functional relationship between MntS and these signal peptides. Conserved gene neighborhoods support that MntS evolved from the signal peptide of an ancestral SitA protein, acquiring a life of its own with a distinct function in Mn homeostasis.
Subject(s)
Escherichia coli Proteins , Escherichia coli , Humans , Escherichia coli/genetics , Escherichia coli/metabolism , Manganese/metabolism , Protein Sorting Signals , Homeostasis , Escherichia coli Proteins/genetics , Escherichia coli Proteins/metabolism , Membrane Transport Proteins/metabolism , Bacterial Proteins/metabolismABSTRACT
We report a case of a 9-year-old girl presenting with unilateral retinal arteriovenous malformation (AVM) with symptomatic macular edema. Over 5 years of follow-up includes optical coherence tomography (OCT), fundus photographs, and fluorescein angiography at baseline and at follow-up. Systemic and neurologic workup was completed and negative for intracranial AVM. Vision has correlated with macular edema, ranging from 20/20 to 20/80. The patient has received nine injections of intravitreal bevacizumab and has not required an injection for the last couple of years. Follow-up is ongoing.
ABSTRACT
BACKGROUND: The melanocortin 4 antagonist TCMCB07 is safe and effective in reversing cachexia caused by sepsis or cancer in rodents. The safety and pharmacokinetics of TCMCB07 are demonstrated in healthy beagle dogs. HYPOTHESIS/OBJECTIVES: The objectives of this study were to investigate the safety, peak plasma concentrations, and potential for efficacy of TCMCB07 in pet dogs with naturally occurring cachexia over a 4-week time period. ANIMALS: Fourteen dogs with cachexia of any underlying cause, except cancer of the oral cavity or gastrointestinal tract, were eligible for enrollment with informed client consent. METHODS: This study was a prospective, 1-armed open-label trial. Physical examination, complete blood count, chemistry panel, and owner-assessed quality of life surveys were checked at weeks 1, 2, and 4. Due to potential for bradycardia and hypotension, Holter monitoring and blood pressure evaluations were scheduled at pre-enrollment and week 4. RESULTS: Fourteen dogs completed the trial. Significant changes detected included increased mean body weight (18.6-19.5 kg, P < .02), increased body condition score (median Tufts 5-point thin dog scale score P < .004 and WSAVA muscle condition score P < .02) and increased mean blood urea nitrogen (21.79-30.43 mg dL-1 , P < .004). On quality of life surveys, pet owners perceived their dog appeared to be panting less (P < .002) and that the general health improved (P < .03). Four dogs had a change in coat pigmentation. The peak plasma concentration of TCMCB07 in cachectic dogs was similar to that in healthy beagle dogs. CONCLUSIONS AND CLINICAL IMPORTANCE: TCMCB07 was safe and has potential efficacy in pet dogs with cachexia.
Subject(s)
Dog Diseases , Neoplasms , Humans , Animals , Dogs , Cachexia/drug therapy , Cachexia/veterinary , Prospective Studies , Quality of Life , Melanocortins , Peptides , Neoplasms/veterinary , Dog Diseases/drug therapyABSTRACT
BACKGROUND: Growing evidence from dogs and humans supports the abundance of mutation-based biomarkers in tumors of dogs. Increasing the use of clinical genomic diagnostic testing now provides another powerful data source for biomarker discovery. HYPOTHESIS: Analyzed clinical outcomes in dogs with cancer profiled using SearchLight DNA, a cancer gene panel for dogs, to identify mutations with prognostic value. ANIMALS: A total of 127 cases of cancer in dogs were analyzed using SearchLight DNA and for which clinical outcome information was available. METHODS: Clinical data points were collected by medical record review. Variables including mutated genes, mutations, signalment, and treatment were fitted using Cox proportional hazard models to identify factors associated with progression-free survival (PFS). The log-rank test was used to compare PFS between patients receiving and not receiving targeted treatment before first progression. RESULTS: Combined genomic and outcomes analysis identified 336 unique mutations in 89 genes across 26 cancer types. Mutations in 6 genes (CCND1, CCND3, SMARCB1, FANCG, CDKN2A/B, and MSH6) were significantly associated with shorter PFS. Dogs that received targeted treatment before first progression (n = 45) experienced significantly longer PFS compared with those that did not (n = 82, P = .01). This significance held true for 29 dogs that received genomically informed targeted treatment compared with those that did not (P = .05). CONCLUSION AND CLINICAL IMPORTANCE: We identified novel mutations with prognostic value and demonstrate the benefit of targeted treatment across multiple cancer types. These results provide clinical evidence of the potential for genomics and precision medicine in dogs with cancer.
Subject(s)
Dog Diseases , Neoplasms , Humans , Dogs , Animals , Prognosis , Neoplasms/genetics , Neoplasms/veterinary , Progression-Free Survival , Mutation , Genomics , DNA , Biomarkers, Tumor/genetics , Dog Diseases/geneticsABSTRACT
Small proteins (< 50 amino acids) are emerging as ubiquitous and important regulators in organisms ranging from bacteria to humans, where they commonly bind to and regulate larger proteins during stress responses. However, fundamental aspects of small proteins, such as their molecular mechanism of action, downregulation after they are no longer needed, and their evolutionary provenance are poorly understood. Here we show that the MntS small protein involved in manganese (Mn) homeostasis binds and inhibits the MntP Mn transporter. Mn is crucial for bacterial survival in stressful environments, but is toxic in excess. Thus, Mn transport is tightly controlled at multiple levels to maintain optimal Mn levels. The small protein MntS adds a new level of regulation for Mn transporters, beyond the known transcriptional and post-transcriptional control. We also found that MntS binds to itself in the presence of Mn, providing a possible mechanism of downregulating MntS activity to terminate its inhibition of MntP Mn export. MntS is homologous to the signal peptide of SitA, the periplasmic metal-binding subunit of a Mn importer. Remarkably, the homologous signal peptide regions can substitute for MntS, demonstrating a functional relationship between MntS and these signal peptides. Conserved gene-neighborhoods support that MntS evolved from an ancestral SitA, acquiring a life of its own with a distinct function in Mn homeostasis. Significance: This study demonstrates that the MntS small protein binds and inhibits the MntP Mn exporter, adding another layer to the complex regulation of Mn homeostasis. MntS also interacts with itself in cells with Mn, which could prevent it from regulating MntP. We propose that MntS and other small proteins might sense environmental signals and shut off their own regulation via binding to ligands (e.g., metals) or other proteins. We also provide evidence that MntS evolved from the signal peptide region of the Mn importer, SitA. Homologous SitA signal peptides can recapitulate MntS activities, showing that they have a second function beyond protein secretion. Overall, we establish that small proteins can emerge and develop novel functionalities from gene remnants.
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Background and Objective: Presenting chronic obstructive pulmonary disease (COPD) patients frequently report concurrent symptoms of gastroesophageal reflux disease (GERD). Few studies have shown a correlation between GERD and COPD. We aimed to examine the correlation between GERD and COPD as well as secondary related reflux complications, such as esophageal stricture, esophageal cancer, and Barrett's esophagus. Methods: This population-based analysis included 7,159,694 patients. Patients diagnosed with GERD with and without COPD were compared to those without GERD. The enrollment of COPD included centrilobular and panlobular emphysema and chronic bronchitis. Risk factors of COPD or GERD were used for adjustment. Bivariate analyses were performed using the chi-squared test or Fisher exact test (2-tailed) for categorical variables as appropriate to assess the differences in the groups. Results: Our results showed that COPD patients had a significantly higher incidence of GERD compared to those without COPD (27.8% vs. 14.1%, p < 0.01). After adjustment of demographics and risk factors, COPD patients had a 1.407 times higher risk of developing non-erosive esophagitis (p < 0.01), 1.165 higher risk of erosive esophagitis (p < 0.01), 1.399 times higher risk of esophageal stricture (p < 0.01), 1.354 times higher risk of Barrett's esophagus without dysplasia (p < 0.01), 1.327 times higher risk of Barrett's esophagus with dysplasia, as well as 1.235 times higher risk of esophageal cancer than those without COPD. Conclusions: Based on the evidence from this study, there are sufficient data to provide convincing evidence of an association between COPD and GERD and its secondary reflux-related complications.
Subject(s)
Barrett Esophagus , Esophageal Neoplasms , Esophagitis , Gastroesophageal Reflux , Pulmonary Disease, Chronic Obstructive , Humans , Barrett Esophagus/complications , Barrett Esophagus/epidemiology , Gastroesophageal Reflux/complications , Gastroesophageal Reflux/epidemiology , Risk Factors , Esophageal Neoplasms/diagnosis , Esophagitis/complications , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/epidemiologyABSTRACT
Gastroesophageal reflux disease (GERD) is commonly seen in patients with chronic kidney disease (CKD), although data on the relationship between these conditions are still limited. We aimed to explore whether CKD is related to a higher prevalence of GERD and its complications. National Inpatient Sample data were used in this retrospective analysis, including 7,159,694 patients. Patients who had a diagnosis of GERD with and without CKD were compared with patients without GERD. Complications associated with GERD that were analyzed included Barrett's esophagus and esophageal stricture. Risk factors of GERD were used for variable adjustment analysis. Different stages of CKD were evaluated in patients with and without GERD. Bivariate analyses were performed using the chi-squared test or Fisher exact test (2-tailed) for categorical variables as appropriate to assess the difference. There were significantly different demographic characteristics between GERD patients with and without CKD regarding age, sex, race, and other co-mobilities. Interestingly, a greater prevalence of GERD was seen in CKD patients (23.5%) compared to non-CKD patients (14.8%), and this increased prevalence was consistently seen in all CKD stages. CKD patients also had 1.70 higher odds of risk of having GERD compared with non-CKD after adjustment. The association between different stages of CKD and GERD showed a similar trend. Interestingly, patients with early-stage CKD were found to have a higher prevalence and odds of risk of esophageal stricture and Barrett's esophagus than non-CKD patients. CKD is associated with a high prevalence of GERD and its complications.
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Peroxisomes are eukaryotic organelles that sequester critical oxidative reactions and process the resulting reactive oxygen species into less toxic byproducts. Peroxisome function and formation are coordinated by peroxins (PEX proteins) that guide peroxisome biogenesis and division and shuttle proteins into the lumen and membrane of the organelle. Despite the importance of peroxins in plant metabolism and development, no plant peroxin structures have been reported. Here we report the X-ray crystal structure of the PEX4-PEX22 peroxin complex from the reference plant Arabidopsis thaliana. PEX4 is a ubiquitin-conjugating enzyme (UBC) that ubiquitinates proteins associated with the peroxisomal membrane, and PEX22 is a peroxisomal membrane protein that anchors PEX4 to the peroxisome and facilitates PEX4 activity. We co-expressed Arabidopsis PEX4 as a translational fusion with the soluble PEX4-interacting domain of PEX22 in E. coli. The fusion was linked via a protease recognition site, allowing us to separate PEX4 and PEX22 following purification and solve the structure of the complex. We compared the structure of the PEX4-PEX22 complex to the previously published structures of yeast orthologs. Arabidopsis PEX4 displays the typical UBC structure expected from its sequence. Although Arabidopsis PEX22 lacks notable sequence identity to yeast PEX22, it maintains a similar Rossmann fold-like structure. Several salt bridges are positioned to contribute to the specificity of PEX22 for PEX4 versus other Arabidopsis UBCs, and the long unstructured PEX22 tether would allow PEX4-mediated ubiquitination of distant peroxisomal membrane targets without dissociation from PEX22. The Arabidopsis PEX4-PEX22 structure also revealed that the residue altered in pex4-1 (P123L), a mutant previously isolated via a forward-genetic screen for peroxisomal dysfunction, is near the active site cysteine of PEX4. We demonstrated in vitro UBC activity for the PEX4-PEX22 complex and found that the pex4-1 enzyme has reduced in vitro ubiquitin-conjugating activity and altered specificity compared to PEX4. Our findings illuminate the role of PEX4 and PEX22 in peroxisome structure and function and provide tools for future exploration of ubiquitination at the peroxisome surface.
ABSTRACT
Appendiceal diseases are rare reported complications during hematopoietic stem cell transplantation with no guidance on management in the published literature. Medical therapy may be considered in selected patients prior to surgical solutions.
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BACKGROUND: Rabacfosadine (RAB, Tanovea-CA1) is a novel chemotherapy agent conditionally approved for the treatment of lymphoma in dogs. HYPOTHESIS/OBJECTIVES: To determine the efficacy and safety of RAB in dogs with lymphoma. ANIMALS: One hundred and fifty-eight client-owned dogs with naïve or relapsed multicentric lymphoma were prospectively enrolled from January to October 2019. METHODS: Dogs were randomized to receive RAB or placebo at a 3 : 1 ratio. Treatment was given every 21 days for up to 5 treatments. Study endpoints included progression-free survival (PFS), overall response rate (ORR) at a given visit, best overall response rate (BORR), and percent progression free 1 month after treatment completion. Safety data were also collected. RESULTS: The median PFS was significantly longer in the RAB group compared to placebo (82 vs 21 days; P < .0001, HR 6.265 [95% CI 3.947-9.945]). The BORR for RAB-treated dogs was 73.2% (50.9% complete response [CR], 22.3% partial response [PR]) and 5.6% (0% CR, 5.6% PR) for placebo-treated dogs (P < .0001). One month after the last treatment, 37 RAB-treated dogs (33%) were progression free compared with no placebo-treated dogs (P < .0001). The most common adverse events observed in the RAB group were diarrhea (87.5%), decreased appetite (68.3%), and vomiting (68.3%) and were generally low grade and reversible. Serious adverse events were reported in 24 RAB-treated (20%) and 5 placebo-treated dogs (13%). CONCLUSIONS AND CLINICAL IMPORTANCE: Rabacfosadine demonstrated statistically significant antitumor efficacy in dogs with lymphoma when administered every 21 days for up to 5 treatments as compared to placebo.
Subject(s)
Dog Diseases , Lymphoma , Alanine/analogs & derivatives , Alanine/therapeutic use , Animals , Antineoplastic Combined Chemotherapy Protocols , Dog Diseases/drug therapy , Dogs , Lymphoma/drug therapy , Lymphoma/veterinary , Purines/therapeutic use , Treatment OutcomeABSTRACT
Peroxisomes are vital organelles that compartmentalize critical metabolic reactions, such as the breakdown of fats, in eukaryotic cells. Although peroxisomes typically are considered to consist of a single membrane enclosing a protein lumen, more complex peroxisomal membrane structure has occasionally been observed in yeast, mammals, and plants. However, technical challenges have limited the recognition and understanding of this complexity. Here we exploit the unusually large size of Arabidopsis peroxisomes to demonstrate that peroxisomes have extensive internal membranes. These internal vesicles accumulate over time, use ESCRT (endosomal sorting complexes required for transport) machinery for formation, and appear to derive from the outer peroxisomal membrane. Moreover, these vesicles can harbor distinct proteins and do not form normally when fatty acid ß-oxidation, a core function of peroxisomes, is impaired. Our findings suggest a mechanism for lipid mobilization that circumvents challenges in processing insoluble metabolites. This revision of the classical view of peroxisomes as single-membrane organelles has implications for all aspects of peroxisome biogenesis and function and may help address fundamental questions in peroxisome evolution.
Subject(s)
Arabidopsis Proteins/metabolism , Arabidopsis/metabolism , Endosomal Sorting Complexes Required for Transport/metabolism , Fatty Acids/metabolism , Intracellular Membranes/metabolism , Peroxisomes/metabolism , Arabidopsis/genetics , Cell Compartmentation , Endoplasmic Reticulum/metabolism , Endosomes/metabolism , Epidermal Cells/metabolism , Microscopy, Confocal , Plants, Genetically Modified , Protein Transport , Seedlings/cytology , Seedlings/metabolism , Time-Lapse Imaging/methodsABSTRACT
BACKGROUND: Clinical practice typically emphasizes active involvement during therapy. However, traditional approaches can offer only general guidance on the form of involvement that would be most helpful to recovery. Beyond assisting movement, robots allow comprehensive methods for measuring practice behaviors, including the energetic input of the learner. Using data from our previous study of robot-assisted therapy, we examined how separate components of mechanical work contribute to predicting training outcomes. METHODS: Stroke survivors (n = 11) completed six sessions in two-weeks of upper extremity motor exploration (self-directed movement practice) training with customized forces, while a control group (n = 11) trained without assistance. We employed multiple regression analysis to predict patient outcomes with computed mechanical work as independent variables, including separate features for elbow versus shoulder joints, positive (concentric) and negative (eccentric), flexion and extension. RESULTS: Our analysis showed that increases in total mechanical work during therapy were positively correlated with our final outcome metric, velocity range. Further analysis revealed that greater amounts of negative work at the shoulder and positive work at the elbow as the most important predictors of recovery (using cross-validated regression, R2 = 52%). However, the work features were likely mutually correlated, suggesting a prediction model that first removed shared variance (using PCA, R2 = 65-85%). CONCLUSIONS: These results support robotic training for stroke survivors that increases energetic activity in eccentric shoulder and concentric elbow actions. TRIAL REGISTRATION: ClinicalTrials.gov, Identifier: NCT02570256. Registered 7 October 2015 - Retrospectively registered.
Subject(s)
Energy Metabolism/physiology , Robotics/methods , Stroke Rehabilitation/methods , Aged , Female , Humans , Male , Middle Aged , Models, Biological , Movement/physiology , Prognosis , Regression Analysis , Robotics/instrumentation , Stroke Rehabilitation/instrumentation , Treatment Outcome , Upper ExtremityABSTRACT
While current lymphoma therapies induce remission in most dogs, drug-resistant relapse is common, creating a need for novel agents. Rabacfosadine (RAB), a double prodrug of the acyclic nucleotide phosphonate 9-(2-phosphonylmethoxyethel) guanine (PMEG), preferentially targets lymphoma cells with reduced systemic toxicity compared with PMEG. Previous studies evaluating RAB administered every 21 days have suggested efficacy in both naïve and relapsed subjects; however, no large studies of RAB as a single agent have been reported in previously untreated dogs with intermediate to large cell lymphoma. The purpose of this study was to evaluate the safety and efficacy of RAB in dogs with previously untreated (excluding corticosteroids) lymphoma. Sixty-three dogs received up to five RAB treatments every 21 days (16 at 0.82 mg/kg and 47 at 1.0 mg/kg) as a 30 minutes intravenous infusion, with (n = 23) or without (n = 40) concurrent corticosteroids. Response assessment and adverse event (Ae) evaluation were performed every 21 days via Veterinary Cooperative Oncology Group (VCOG) criteria. The overall response rate was 87% (52% CR, 35% PR). The overall median progression free interval was 122 days (199 for CR, 89 for PR and 153 days for all responders). T-cell immunophenotype and corticosteroid pre-treatment were predictive of inferior outcomes on multivariate analysis. AEs were most commonly of gastrointestinal origin (hyporexia/diarrhoea) and generally resolved with supportive treatment and/or dosage adjustment. Three dogs experienced VCOG-CTCAE grade 5 delayed pulmonary fibrosis. In conclusion, RAB administered every 3 weeks is generally well tolerated and demonstrates substantial antitumour activity in dogs with previously untreated intermediate to large cell lymphoma.
Subject(s)
Alanine/analogs & derivatives , Dog Diseases/drug therapy , Lymphoma/veterinary , Purines/pharmacology , Alanine/pharmacology , Animals , Dogs , Female , Lymphoma/drug therapy , Male , Treatment OutcomeABSTRACT
BACKGROUND: Rabacfosadine (RAB), a novel antineoplastic agent conditionally licensed for the treatment of lymphoma in dogs, is efficacious in both naïve and previously treated dogs. Its use in combination with L-asparaginase (L-ASP) has not been studied. HYPOTHESIS/OBJECTIVES: To evaluate the safety and efficacy of L-ASP given concurrently with RAB in dogs with relapsed multicentric lymphoma. ANIMALS: Fifty-two dogs with relapse of lymphoma after treatment with at least 1 doxorubicin-based chemotherapy protocol. METHODS: Open-label, multicenter, prospective single-arm clinical trial. Dogs were treated with RAB at 1.0 mg/kg IV every 21 days for up to a total of 5 doses. L-asparaginase was administered at 400 IU/kg SQ concurrently with the first 2 treatments of RAB. RESULTS: The overall response rate (ORR) for all dogs was 67%, with 19 dogs (41%) achieving a complete response (CR). The median progression-free survival time (MPFS) was 63 days (range 5-428 days). Dogs experiencing a CR as their best response had an MPFS of 144 days (range 44-428 days). Adverse events were similar to previous studies evaluating single agent RAB. Failure to achieve a CR and having previously received L-ASP were negative prognostic factors on multivariate analysis. CONCLUSIONS AND CLINICAL IMPORTANCE: Concurrent RAB/L-ASP appears to be both efficacious and safe for treating relapsed multicentric lymphoma in dogs. Adverse events were most often mild and no unexpected toxicoses were observed.
Subject(s)
Alanine/analogs & derivatives , Antineoplastic Agents/therapeutic use , Asparaginase/therapeutic use , Dog Diseases/drug therapy , Lymphoma/veterinary , Neoplasm Recurrence, Local/veterinary , Purines/therapeutic use , Alanine/administration & dosage , Alanine/therapeutic use , Animals , Antineoplastic Agents/administration & dosage , Antineoplastic Combined Chemotherapy Protocols , Asparaginase/administration & dosage , Colorado , Disease-Free Survival , Dogs , Female , Lymphoma/drug therapy , Lymphoma/mortality , Male , Neoplasm Recurrence, Local/drug therapy , Prospective Studies , Purines/administration & dosage , Remission Induction , Washington , WisconsinABSTRACT
INTRODUCTION: Elbow prosthetic reconstruction after distal humeral tumor resection is challenging. We identify the value of the proximal ulna dorsal angulation (PUDA) as an easily-measured radiographic parameter that can help inform ulnar component sizing in the Solar Elbow System (SES) and the Modular Universal Tumor and Revision System (MUTARS), two modular prosthetic systems that are commonly used after tumor resection in this anatomic location. We hypothesized that a larger PUDA measurement would require smaller ulnar stems. METHODS: Demographic data and PUDA measurements were retrospectively reviewed for 514 patients. Multivariate regression was used to determine the effects of patient demographic data on the PUDA. PUDA measurements were collected by three independent reviewers on lateral elbow radiographs. MUTARS and SES templating software was then used to validate the relationship between the PUDA and ulnar stem sizing. RESULTS: Regression analysis showed no substantial contribution of demographic variables to the PUDA measurement (adjusted R2 = 0.02, F(6, 508) = 2.704, P = 0.01). The MUTARS implant fit 97% of elbows with a PUDA <5° and 91.6% of elbows with PUDA ≥5° (P = 0.26). The largest SES combination fit 100% of elbows with a PUDA ≤10° versus 93% of elbows with a PUDA >10° (P = 0.029). Elbows accommodating the largest SES combination had a smaller median PUDA (5.4° versus 11.7°, P = 0.034); elbows accommodating the MUTARS implant had a smaller median PUDA (5.4° versus 5.8°, P = 0.34). DISCUSSION: The PUDA is a valuable and easily used preoperative planning tool for prosthetic elbow reconstruction after tumor resection. The proximal ulna dorsal angulation can be easily measured to predict ulnar component fit and reduce intraoperative complications. In patients with a PUDA ≥5°, ulnar component stem fit for current systems may be more challenging.