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David Chin

Publications and source records attributed to David Chin.

12 recordsLinked to original sources
PubMed2006

The human genome and gene expression profiling.

The mapping and sequencing of the human genome has generated a large resource for answering questions about human disease. This achievement is akin in scientific importance to developing the periodic table of elements. Plastic surgery has always been at the frontier medical research. This resource will help us to improve our understanding on the many unknown physiological and pathogical conditions we deal with daily, such as wound healing keloid scar formation, Dupuytren's disease, rheumatoid arthritis, vascular malformation and carcinogenesis. We are primed in obtaining both disease and normal tissues to use this resource and applying it to clinical use. This review is about the human genome, the basis of gene expression profiling and how it will affect our clinical and research practices in the future and for those embarking on the use of this new technology as a research tool, we provide a brief insight on its limitations and pitfalls.

Gene Expression↗
PubMed2006

Cyclosporin and Timothy syndrome increase mode 2 gating of CaV1.2 calcium channels through aberrant phosphorylation of S6 helices.

Calcium channels in the plasma membrane rarely remain open for much more than a millisecond at any one time, which avoids raising intracellular calcium to toxic levels. However, the dihydropyridine-sensitive calcium channels of the CaV1 family, which selectively couple electrical excitation to endocrine secretion, cardiovascular contractility, and neuronal transcription, have a unique second mode of gating, "mode 2," that involves frequent openings of much longer duration. Here we report that two human conditions, cyclosporin neurotoxicity and Timothy syndrome, increase mode 2 gating of the recombinant rabbit CaV1.2 channel. In each case, mode 2 gating depends on a Ser residue at the cytoplasmic end of the S6 helix in domain I (Ser-439, Timothy syndrome) or domain IV (Ser-1517, cyclosporin). Both Ser reside in consensus sequences for type II calmodulin-dependent protein kinase. Pharmacologically inhibiting type II calmodulin-dependent protein kinase or mutating the Ser residues to Ala prevents the increase in mode 2 gating. We propose that aberrant phosphorylation, or "phosphorylopathy," of the CaV1.2 channel protein contributes to the excitotoxicity associated with Timothy syndrome and with chronic cyclosporin treatment of transplant patients.

Amino Acid Substitution↗
PubMed2006

Dynamic IMRT treatments of sinus region tumors: comparison of Monte Carlo calculations with treatment planning system calculations and ion chamber measurements.

Results are presented comparing Monte Carlo (MC) calculations for dynamic IMRT treatments of tumors in the sinus region with Eclipse treatment planning system dose calculations, and ion chamber measurements. The EGS4nrc MC code, BEAMnrc, was commissioned to simulate a Varian 21Ex Linac for both open and IMRT fields. The accuracy of the simulation for IMRT plans was evaluated using a head phantom by comparing MC, Eclipse, TLD results, and ion chamber in solid water phantom measurements. The MC code was then used to simulate dose distributions for five patients who were treated using dynamic IMRT for tumors in the sinus region. The results were compared with absolute and relative dose distributions calculated using Eclipse (pencil beam, modified-Batho inhomogeneity correction). Absolute dose differences were also compared with ion chamber results. Comparison of the doses calculated on the head phantom using MC, compared with Eclipse, ion chamber, and TLD measurements showed differences of -3.9%, -1.4%, and -2.0%, respectively (MC is colder). Relative dose distributions for the patient plans calculated using MC agreed well with those calculated using Eclipse with respect to targets and critical organs, indicating the modified-Batho correction is adequate. Average agreement for mean absolute target doses between MC and Eclipse was -3.0 +/-; 2.3% (1 s.d.). Agreement between ion chamber and Eclipse for these patients was -2.2 +/- 1.9%, compared with 0.2 +/- 2.0% for all head and neck IMRT patients. When Eclipse doses were corrected based on ion chamber results, agreement between MC and Eclipse was -0.7 +/- 2.0%, indicating a small systematic uncertainty in the doses calculated using the treatment planning system for this subset of patients.

Head and Neck Neoplasms↗
PubMed2006

Head and neck cancer: past, present and future.

Head and neck cancer consists of a diverse group of cancers that ranges from cutaneous, lip, salivary glands, sinuses, oral cavity, pharynx and larynx. Each group dictates different management. In this review, the primary focus is on head and neck squamous cell carcinoma (HNSCC) arising from the mucosal lining of the oral cavity and pharynx, excluding nasopharyngeal cancer. Presently, HNSCC is the sixth most prevalent neoplasm in the world, with approximately 900,000 cases diagnosed worldwide. Prognosis has improved little in the past 30 years. In those who have survived, pain, disfigurement and physical disability from treatment have had an enormous psychosocial impact on their lives. Management of these patients remains a challenge, especially in developing countries where this disease is most common. Of all human cancers, HNSCC is the most distressing since the head and neck is the site of the most complex functional anatomy in the human body. Its areas of responsibility include breathing, the CNS, vision, hearing, balance, olfaction, taste, swallowing, voice, endocrine and cosmesis. Cancers that occur in this area impact on these important human functions. Consequently, in treating cancers of the head and neck, the effects of the treatment on the functional outcome of the patient need the most serious consideration. In assessing the success of HNSCC treatment, consideration of both the survival and functional deficits that the patient may suffer as a consequence of their treatment are of paramount importance. For this reason, the modern-day management of head and neck patients should be carried out in a multidisciplinary head and neck clinic.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2005

Novel markers for poor prognosis in head and neck cancer.

Head and neck cancer (HNSCC) is one of the most distressing human cancers, causing pain and affecting the basic survival functions of breathing and swallowing. Mortality rates have not changed despite recent advances in radiotherapy and surgical treatment. We have compared the expression of over 13,000 unique genes in 7 cases of matched HNSCC and normal oral mucosa. Of the 1,260 genes that showed statistically significant differences in expression between normal and tumor tissue at the mRNA level, the three top ranking of the top 5% were selected for further analysis by immunohistochemistry on paraffin sections, along with the tumor suppressor genes p16 and p53, in a total of 62 patients including 55 for whom >4-year clinical data was available. Using univariate and multivariate survival analysis, we identified SPARC/osteonectin as a powerful independent prognostic marker for short disease-free interval (DFI) (p < 0.002) and poor overall survival (OS) (p = 0.018) of HNSCC patients. In combination with other ECM proteins found in our analysis, PAI-1 and uPA, the association with DFI and OS became even more significant (p < 0.001). Our study represents the first instance of SPARC as an independent prognostic marker in HNSCC.

Adult↗
PubMed2005

Invasion and metastasis markers in cancers.

Over 90% of all adults human cancers are of epithelial origin comprising mainly of skin and aero-digestive tract cancers. A significant proportion of our discipline's workload consists of management of these cancers. This review article is to provide clinicians with a summary of the current research findings in invasion and metastasis of epithelial cancers and the translation of some of this information to clinical use particularly related to skin and head and neck cancers (HNSCC). Metastasis is the leading cause of death in cancer patients. Although surgical resection of isolated metastases is beneficial for some patients, the overall efficacy of surgery, chemotherapy or radiotherapy is limited. Clearly, with today's advances in surgery a majority of these primary cancers are resectable and a cure attainable if surgeons could control or inhibit metastasis.

Adult↗
PubMed2005

Alpha B-crystallin, a new independent marker for poor prognosis in head and neck cancer.

OBJECTIVES: Gene expression profiling has provided many insights into tumor progression but translation to clinical practice has been limited. We have previously identified a list of potential markers by the differences of expression profiling of seven matched head and neck cancer (HNSCC) tumors with autologous normal oral mucosa (NOM). Alpha B-crystallin (CRYAB) was in the top 5% of genes identified with statistically significant differences in expression between tumor and NOM at the mRNA level. The objective was to confirm this in routine paraffin sections at the protein level. STUDY DESIGN: The level of alpha B-crystallin was determined in tumors of 62 HNSCC patients whose prognosis was known for 5 years. METHODS: Immunohistochemical detection of alpha B-crystallin expression was performed on HNSCC paraffin sections. RESULTS: Univariate survival analysis identified lack of alpha B-crystallin staining as an independent prognostic marker for disease-free interval (P < 0.001) and overall survival (P < 0.002) of HNSCC patients over the 5-year observation period. Notably, all 13 patients (100%), including 5 patients with nodal disease whose tumors lacked alpha B-crystallin had no recurrences (P < 0.001). Nineteen of 27 node-negative patients stained positive for alpha B-crystallin and seven of the 19 (36.8%) had recurrences. CONCLUSION: Presence or absence of expression of alpha B-crystallin was a powerful marker for prognosis in this series of patients.

Adult↗
PubMed2004

What is transforming growth factor-beta (TGF-beta)?

The TGF-beta superfamily of proteins produces a wide range of frequently opposing effects in different cells and tissues in the body. However, its activation and mode of action are only partially understood because of its complexity in structure and functions and the variability in its downstream targets. Current work on these cytokines focuses on their receptors and the intercellular signalling pathways, comparing bioactivities between cell types and tracking their physiological and immunological effects in vivo. Future research will yield important therapeutic applications and the ability to manipulate these proteins in vivo.

Animals↗
PubMed2004

Molecular introduction to head and neck cancer (HNSCC) carcinogenesis.

Of all human cancers, HNSCC is the most distressing affecting pain, disfigurement, speech and the basic survival functions of breathing and swallowing. Mortality rates have not significantly changed in the last 40 years despite advances in radiotherapy and surgical treatment. Molecular markers are currently being identified that can determine prognosis preoperatively by routine tumour biopsy leading to improved management of HNSCC patients. The approach could help decide which early stage patient should have adjuvant neck dissection and radiotherapy, and whether later stage patients with operable lesions would benefit from resection and reconstructive surgery or adopt a conservative approach to patients with poor prognosis regardless of treatment. In the future, understanding these basic genetic changes in HNSCC would be important for the management of HNSCC.

Apoptosis↗
PubMed2004

Care following acute myocardial infarction in the Veterans Administration Medical Centers: a comparison with Medicare.

OBJECTIVE: To compare patients treated for acute myocardial infarction (AMI) in a Veterans Health Administration (VHA) facility to similar patients treated under Medicare. DATA SOURCES: Administrative data on 13,129 elderly male veterans hospitalized for AMI in a VHA facility between October 1, 1996, and September 30, 1999, and a matched set of male Medicare beneficiaries with AMI treated in a non-VHA facility during the same time period. STUDY DESIGN: We conducted a retrospective cohort study using propensity score methods to identify a matched set of male elderly AMI patients treated either in a VHA facility or in a non-VHA facility under Medicare. We compared the two groups of patients according to characteristics of the admitting hospital, distances traveled for care, the use of invasive procedures, and mortality. We assessed the robustness of our conclusions to biases arising from unmeasured confounders using sensitivity analyses. PRINCIPAL FINDINGS: VHA patients were significantly less likely than Medicare beneficiaries to be admitted to high-volume facilities (for example, 25 percent versus 46 percent in 1999, p<0.001) or facilities with the capability to perform invasive cardiac procedures. Compared to Medicare patients, VHA patients traveled almost twice as far to their admitting hospital. The VHA patients were significantly less likely to undergo coronary angiography or revascularization in the 30 days following their AMI (p<0.001 for all comparisons). Veterans treated in the VHA had significantly higher mortality at one-year in all years studied (for example, 35.2 percent versus 30.6 percent in 1999). The proportion of elderly VHA patients admitted to high-volume facilities increased and 30-day mortality rates decreased between 1997 and 1999. Using sensitivity analyses to assess possible effects of unmeasured confounders, we could explain some but not all of the observed mortality differences. CONCLUSIONS: We observed differences in the way care for AMI patients was structured, in the use of invasive therapies, and in long term mortality between patients treated in VHA hospitals and those treated in non-VHA facilities under Medicare. Future research should focus on explanations for the differences between the two systems and for the reduction in short-term mortality among VHA patients. Further study of these differences both between and within the systems of care may help identify cost-effective strategies to improve care in both sectors.

Aged↗
PubMed2002

Mechanisms for regulation of calmodulin kinase IIalpha by Ca(2+)/calmodulin and autophosphorylation of threonine 286.

A mechanism that relates calmodulin (CaM) binding to enzyme activation remains to be established within the context of full-length calmodulin kinase IIalpha (CaM KIIalpha). Previous studies using peptides and/or truncated enzymes have shown that L299 of CaM KIIalpha represents an "anchor" for Ca(2+)/CaM binding and that F293 is required for autoinhibition. We have substituted each of these residues with a W in full-length CaM KIIalpha and measured the W fluorescence to evaluate the location of these side chains in the absence and presence of Ca(2+)/CaM. Fluorescence emission of the L299W mutant indicates that L299 is solvent accessible in the absence of Ca(2+)/CaM but becomes internalized in the presence of Ca(2+)/CaM. On the other hand, examination of F293W indicates that Ca(2+)/CaM binding promotes enzyme activation by transferring F293 from an internal location in the inactive enzyme to a more solvent accessible position in the active enzyme. In addition, F293 interacts with Ca(2+)/CaM as a consequence of autophosphorylation at T286, thus providing a mechanism for CaM trapping. Whereas in the absence of autophosphorylation the exposure of F293 is reversed by dissociation of CaM leading to enzyme autoinhibition, after autophosphorylation of T286, F293 is retained in an exposed position due to dissociation of CaM, consistent with the retention of autonomous activity. Proline mutants were introduced at positions between T286 and F293 to explore the basis of CaM-independent, autonomous activity. The observation that an L290P mutant displayed a high level of activity independent of Ca(2+)/CaM or phosphorylation of T286 indicates that a change in the conformation of the polypeptide main chain at L290 might contribute to the mechanism for generating autophosphorylation-dependent autonomous activity.

Amino Acid Sequence↗