Memorial Health University Medical Center

Savannah, GA, United States

Memorial Health University Medical Center

Savannah, GA, United States
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Ziessman H.A.,Johns Hopkins University | Tulchinsky M.,Penn Medicine | Lavely W.C.,Memorial Health University Medical Center | Gaughan J.P.,Temple University | And 4 more authors.
Journal of Nuclear Medicine | Year: 2010

Sincalide-stimulated cholescintigraphy is performed to quantify gallbladder contraction and emptying. However, different infusion methods are used for this study. Our purpose was to determine the infusion method with the least variability (smallest coefficient of variation [CV]) for calculation of the gallbladder ejection fraction (GBEF) in healthy subjects and to establish normal values. Methods: Sixty healthy volunteers at 4 medical centers were injected intravenously with 99mTc-mebrofenin. After gallbladder visualization had been confirmed at 60 min, 0.02 mg of sincalide per kilogram was administered using 3 different infusion durations, 15, 30, and 60 min, each performed on separate days. The CV, mean, SD, first to 99th percentile, and fifth to 95th percentile were calculated. GBEF normal values were determined for the different infusion durations. Results: The CV was smallest for the 60-min infusion at 60 min (19%; 95% confidence interval [CI], 16%-23%), compared with the 30-min infusion at 30 min (35%; 95% CI, 29.2%-42.1%) and the 15-min infusion at 15 min (52%; 95% CI, 44%-63%). These were all significantly different (P<0.0007). For the 60-min infusion at 60 min, the lower limit of normal for the GBEF was 38% defined at the1% CI. Conclusion: The GBEF at 60 min has the lowest CV in healthy subjects, compared with shorter infusions of 15 or 30 min. This multicenter trial establishes a GBEF lower limit of normal of 38% (first percentile) for a 60-min infusion of 0.02 μg of sincalide per kilogram, quantified at 60 min. Using this infusion method minimizes the variability in measured GBEFs. This sincalide infusion method should become the standard for routine clinical use. Copyright © 2010 by the Society of Nuclear Medicine, Inc.

Britton T.,Birmingham Veterans Administration Medical Center | Robinson N.,Memorial Health University Medical Center
Journal of Nuclear Medicine Technology | Year: 2016

18F-FDG PET imaging of tumors has pitfalls and pearls of wisdom that begin at the point of scheduling and continue through the patient interview, the resting phase, the scan itself, and the image review. Interviewing the patient at the time of scheduling, followed by placing a reminder phone call shortly before the appointment, can save a nuclear medicine department the financial loss of wasted doses and missed appointment slots in the schedule. The pitfalls and pearls of wisdom in tumor imaging are ever changing, and the technologist is in a constant state of inquiry about the patient's disease process and ability to comply. Consideration of each item on the worksheets in this article affects every scan. On completing this article, the reader will be able to identify questions that should be asked in the scheduling and preinjection patient interviews, interpret the answers to those questions, determine how the images may be affected, and adapt the scan. © 2016 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

Huang Q.,Xi'an Jiaotong University | Huang Q.,Mercer University | Chen H.,Shantou University | Wang F.,China National Institute of Biological Sciences | And 7 more authors.
Cellular and Molecular Life Sciences | Year: 2014

Placentas associated with preeclampsia are characterized by extensive apoptosis in trophoblast lineages. Syncytin-1 (HERVWE1) mediates the fusion of cytotrophoblasts to form syncytiotrophoblasts, which assume the placental barrier, fetal-maternal exchange and endocrine functions. While decreased syncytin-1 expression has been observed in preeclamptic placentas, it is not clear if this alteration is involved in trophoblast apoptosis. In the current study, we found that siRNa-mediated knockdown of syncytin-1 led to apoptosis in choriocarcinoma BeWo, a cell line of trophoblastic origin. Characterization of the apoptotic pathways indicated that this effect does not rely on the activation of caspases. Rather, decreased syncytin-1 levels activated the apoptosis inducing factor (AIF) apoptotic pathway by inducing the expression, cleavage, and nuclear translocation of AIF. Moreover, calpain1, the cysteine protease capable of cleaving AIF, was upregulated by syncytin-1 knockdown. Furthermore, treatment with calpain1 inhibitor MDL28170 effectively reversed AIF cleavage, AIF nuclear translocation, and cell apoptosis triggered by syncytin-1 downregulation, verifying the specific action of calpain1-AIF pathway in trophoblast apoptosis. We confirmed that preeclamptic placentas express lower levels of syncytin-1 than normal placentas, and observed an inverse correlation between syncytin-1 and AIF/calpain1 mRNa levels, a result consistent with the in vitro findings. Immunohistochemistry analyses indicated decreased syncytin-1 and increased AIF and calpain1 protein levels in apoptotic cells of preeclamptic placentas. these findings have for the first time revealed that decreased levels of syncytin-1 can trigger the AIF-mediated apoptosis pathway in BeWo cells. this novel mechanism may contribute to the structural and functional deficiencies of syncytium frequently observed in preeclamptic placentas. © Springer Basel 2014.

Plantinga M.J.,University of Chicago | Plantinga M.J.,Memorial Health University Medical Center | Korennykh A.V.,University of Chicago | Korennykh A.V.,Memorial Health University Medical Center | And 3 more authors.
Biochemistry | Year: 2011

Restrictocin and related fungal endoribonucleases from the α-sarcin family site-specifically cleave the sarcin/ricin loop (SRL) on the ribosome to inhibit translation and ultimately trigger cell death. Previous studies showed that the SRL folds into a bulged-G motif and tetraloop, with restrictocin achieving a specificity of ∼1000-fold by recognizing both motifs only after the initial binding step. Here, we identify contacts within the protein-RNA interface and determine the extent to which each one contributes to enzyme specificity by examining the effect of protein mutations on the cleavage of the SRL substrate compared to a variety of other RNA substrates. As with other biomolecular interfaces, only a subset of contacts contributes to specificity. One contact of this subset is critical, with the H49A mutation resulting in quantitative loss of specificity. Maximum catalytic activity occurs when both motifs of the SRL are present, with the major contribution involving the bulged-G motif recognized by three lysine residues located adjacent to the active site: K110, K111, and K113. Our findings support a kinetic proofreading mechanism in which the active site residues H49 and, to a lesser extent, Y47 make greater catalytic contributions to SRL cleavage than to suboptimal substrates. This systematic and quantitative analysis begins to elucidate the principles governing RNA recognition by a site-specific endonuclease and may thus serve as a mechanistic model for investigating other RNA modifying enzymes.(Figure Presented) © 2011 American Chemical Society.

News Article | October 28, 2016

SouthCoast Health is celebrating the one-year anniversary of its High Risk Breast Cancer Clinic during the month of October, which is Breast Cancer Awareness Month. Dr. Christa L. Jillard, who joined the practice on Sept. 1, 2015, leads the clinic, which became the first of its kind in Savannah. The clinic’s goals are early detection of women at high risk for breast cancer, to treat those at risk preventatively using a variety of measures and to use aggressive oncological treatments for those in need. Breast cancer is the most common cancer among women in the United States, other than skin cancer, according to the American Cancer Society (ACS), with 1-in-8 women (12 percent) developing invasive breast cancer during their lifetime. More than 7,000 new cases of breast cancer will be diagnosed in Georgia women in 2016, according to ACS estimates, and nearly 1,300 will die as a result of it. Dr. Jillard said that she wants to be an advocate for women in the Coastal Empire and Lowcountry. She recently became certified by medical technology company and surgical device manufacturer Invuity in its Hidden Scar surgical procedures, making her the only surgeon in Savannah with such a distinction. The cause of treating women with breast cancer – and women’s health, in general – is dear to Dr. Jillard, whose grandmother was diagnosed with the disease. “Being a female, I do have a strong interest in breast cancer,” Dr. Jillard said. “I also feel I have an obligation as a female surgeon not only to relate to patients who have this – I have friends and family who have been afflicted with this disease – but to use my skillset to really make a difference. Seeing that this is a specific kind of clinic that has not been established in Savannah, I see it as a great avenue and potential area for growth to make an impact on women here locally.” Women at high risk are those considered to have a five-year risk of developing breast cancer that is greater than 1.7 percent or those who have a lifetime risk of greater than 20 percent. To identify women at high risk, SouthCoast Health will use the Breast Cancer Risk Assessment Tool, also known as the “Gail model,” developed by scientists at the National Surgical Adjuvant Breast and Bowel Project (NSABP). The model has been tested and refined for more than 50 years to provide clinicians the highest possible degree of accuracy. Dr. Jillard cited ACS data that show a decrease in mortality of 34 percent between 1990 and 2010, largely because of improved surveillance and early detection — which, she said, are the hallmarks of work performed by high risk breast cancer clinics. SouthCoast Health brings a multi-disciplinary approach to its clinic, involving 15 to 20 clinicians across a range of specialties. Dr. Christa L. Jillard is board certified by the American Board of Surgery and practices at SouthCoast Health’s offices in Savannah, Hinesville and Bluffton. A graduate of Temple University School of Medicine in Philadelphia, she completed her residency in general surgery at the Medical University of South Carolina in Charleston. She completed a fellowship in endocrine surgery at Duke University Hospital in Durham, N.C., and is affiliated at St. Joseph’s/Candler Hospital and Memorial Health University Medical Center. SouthCoast Health is a multi-specialty, physician-owned medical group with 80 physicians and 18 locations. The organization has been providing quality healthcare solutions to the Coastal Empire and Lowcountry for more than 20 years and is dedicated to complete patient wellbeing. For more information, visit and connect with SouthCoast Health on Facebook.

Nagendra D.C.,Michigan State University | Burke J.,Memorial Health University Medical Center | Maxwell G.L.,U.S. Army | Risinger J.I.,Michigan State University
Molecular Carcinogenesis | Year: 2012

Recently unbiased sequencing efforts identified PPP2R1A mutations in clear cell ovarian cancers (OCC). Similar mutations were also noted with high frequency in uterine serous carcinoma. Because the endometrium develops from the same developmental precursors we further examined the hypothesis that PPP2R1A mutations might also occur in diverse histologic subtypes of uterine cancer. We sequenced the PPP2R1A in 22 cell line models of uterine cancer and 10 primary cancers. We found no mutations in the cell lines originally derived from endometrioid (n=13), undifferentiated (n=3), clear cell (n=1), and carcinosarcoma (n=3) cancers. However, we found a CCC (Pro) to CGC (Arg) codon 179 mutation in the ACI-158 serous carcinoma cell line, a CCC (Pro) to CTC (Leu) in a primary serous carcinoma as well as a CGC (Arg) to CAC (His) codon 258 mutation in a poorly differentiated endometrioid cancer. We sequenced a large panel of endometrial malignancies (n=181) and found 12 mutants. Importantly, we confirmed a high frequency of mutation in 8 of 25 (32%) serous carcinomas a subtype with well-recognized poor prognosis. Mutations were infrequent in endometrioid cancer and absent in clear cell and carcinosarcoma subtypes. The PPP2R1A mutation regions are conserved among species and known to interact with the regulatory subunits of the PP2A enzyme. PPP2R1A mutant endometrial cancers may represent good candidates for personalized drug therapies particularly for women with the lethal serous histologic variant of uterine cancer. © 2011 Wiley Periodicals, Inc.

Huang Q.,Xi'an Jiaotong University | Huang Q.,Mercer University | Li J.,Mercer University | Li J.,Rochester College | And 7 more authors.
Cellular Signalling | Year: 2013

Placental syncytiotrophoblasts formed by the fusion of cytotrophoblasts constitute the interface between maternal and fetal circulations. The syncytium, composed of a continuous layer of syncytiotrophoblasts, assumes the fetal-maternal nutrient exchange, placental barrier, and endocrine functions important for the maintenance of normal pregnancy. Syncytin-1, an endogenous retroviral gene product, mediates the fusion of cytotrophoblasts. While the fusogenic function of syncytin-1 has been well established, little is known regarding its nonfusogenic activities. This study investigates the role of syncytin-1 in trophoblast proliferation. We found that syncytin-1 knockdown significantly inhibited BeWo cell growth and DNA synthesis. Moreover, time course studies on key cell cycle regulators demonstrated an upregulation of p15 and downregulation of CDK4, E2F1, PCNA, and c-Myc, which consequently led to a reduced level of CDK1. These results, together with those from flow cytometry analysis, indicated that syncytin-1 knockdown blocked the G1/S transition phase of the cell cycle. Moreover, syncytin-1 overexpression promoted CHO cell proliferation and led to changes opposite to those observed in syncytin-1 knockdown experiments, confirming the critical role of syncytin-1 for G1/S transition. Thus, syncytin-1, through both nonfusogenic and fusogenic, functions, may co-regulate the input (proliferation) and output (fusion) of the cytotrophoblast "pool". Such co-regulation could be an efficient way to achieve the balance between these two opposing processes, which is required for syncytium homeostasis. Since decreased syncytin-1 expression has been shown to be associated with preeclamptic and hypoxic condition, insufficient replenishing of the cytotrophoblast "pool" may contribute to syncytium deficiency, a critical pathological change frequently found in preeclamptic placentas. © 2013 Elsevier Inc.

Goldfarb M.,Beth Israel Deaconess Medical Center | Brower S.,Memorial Health University Medical Center | Schwaitzberg S.D.,Cambridge Health Alliance
Surgical Endoscopy and Other Interventional Techniques | Year: 2010

Perhaps there is no more important issue in the care of surgical patients than the appropriate use of minimally invasive surgery (MIS) for patients with cancer. Important advances in surgical technique have an impact on early perioperative morbidity, length of hospital stay, pain management, and quality of life issues, as clearly proved with MIS. However, for oncology patients, historically, the most important clinical questions have been answered in the context of prospective randomized trials. Important considerations for MIS and cancer have been addressed, such as what are the important immunologic consequences of MIS versus open surgery and what is the role of laparoscopy in the staging of gastrointestinal cancers? This review article discusses many of the key controversies in the minimally invasive treatment of cancer using the procon debate format. Copyright © 2009 Springer Science+Business Media, LLC.

Huang Q.,Xi'an Jiaotong University | Huang Q.,Mercer University | Chen H.,Shantou University | Li J.,Mercer University | And 8 more authors.
Cellular Signalling | Year: 2014

Syncytin-1 is a human endogenous retroviral envelope gene (HERVW1) product specifically expressed in placental trophoblasts. By mediating the formation of syncytiotrophoblasts through cell-cell fusion, syncytin-1 plays a critical role for the placental barrier, endocrine and exchange functions. During pregnancy, syncytin-1 expression is dynamically regulated by various pathophysiological factors and pathways. This review summarizes and examines published data on epigenetic and non-epigenetic regulation of syncytin-1 gene expression, with a focus on the changes of syncytin-1 DNA methylation and expression in placental trophoblasts under preeclamptic and hypoxic conditions. The functions of syncytiotrophoblasts, the fusogenic and non-fusogenic activities of syncytin-1, and aberrant activation of syncytin-1 expression in cancer cells are also discussed. New findings on the epigenetic regulation of syncytin-1 in placentas from monozygotic/dichorionic discordant twins are analyzed. The close correlation among changes of DNMTs expression, syncytin-1 gene methylation, and syncytin-1 mRNA levels, in placentas associated with discordant fetal growth indicated a dynamic nature of syncytin-1 regulation. © 2013.

MacNew H.G.,Memorial Health University Medical Center | Rudolph R.,Memorial Health University Medical Center | Brower S.T.,Memorial Health University Medical Center | Beck A.N.,Memorial Health University Medical Center | Meister E.A.,Hoskins Center for Biomedical Research
Breast Journal | Year: 2010

Genetic testing for the breast cancer susceptibility genes, BRCA1 and BRCA2, has been available for over a decade. Positive test results carry significant medical, psychological, and social implications. Knowledge of the public's awareness concerning BRCA testing, and perceived benefits and barriers to testing can help refine educational programs and identify subgroups needing additional support. Patients and their acquaintances with a breast complaint attending a surgical clinic or private office were asked to complete a questionnaire about their knowledge of breast cancer genes and their desire to be tested. Demographic information collected included ethnicity, education background, age, income, and personal and family history of breast cancer, knowledge of BRCA genes and testing, and their willingness to participate in genetic counseling. A total of 222 people completed the questionnaire that showed the majority of subjects in southeast Georgia believe breast cancer is inherited 26-50% of the time. Caucasians and those with advanced degrees are the most informed regarding awareness of BRCA genes (p < 0.05); the least informed groups include African Americans and those with no more than a college education. Participants with a family history of breast cancer were significantly more likely to know that genes had been identified that indicate an increased risk of breast cancer (p < 0.05). A history of breast cancer did not impact the degree of awareness (p > 0.05). Subjects aware of genetic testing are more willing to utilize counseling (p < 0.05). Perceptions of breast cancer inheritance, awareness of susceptibility genes, and availability of testing and counseling are not uniform among all population subgroups. In southeast Georgia, educational efforts should focus on the less educated and minority groups. © 2009 Wiley Periodicals, Inc.

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