2755 Herndon Avenue
Clovis CA 93611
Medical School: Other - 2000
Accepts Medicare: Yes
Participates In eRX: No
Participates In PQRS: Yes
Participates In EHR: No
License #: A85688
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Resolvin E1 Attenuates Atherosclerotic Plaque Formation in Diet and Inflammation-Induced Atherogenesis. - Arteriosclerosis, thrombosis, and vascular biology
Epidemiological and recent clinical studies implicate periodontitis as an independent risk factor for cardiovascular disease. Previously, we demonstrated that rabbits with experimental periodontitis and cholesterol diet exhibit more aortic plaque compared with diet alone. We also showed that a proresolution mediator, Resolvin E1 (RvE1), reverses the experimental periodontitis. Here, we determined whether oral/topical application of RvE1 attenuates aortic atherosclerosis induced by both diet and periodontal inflammation.Thirty-nine rabbits on a 13-week regimen of 0.5% cholesterol diet were included. Periodontitis was induced by Porphyromonas gingivalis in 24 rabbits and 15 rabbits were placed in no-periodontitis groups. Interventions were no-treatment, vehicle, and RvE1 treatment (4 Î¼g/site or 0.4 Î¼g/site) topically applied 3Ã— per week. At 13 weeks, both periodontitis and atherosclerosis were quantified. Atherosclerotic plaques were assessed by Sudan IV staining, histology, and ex vivo MRI. Serum levels of C-reactive protein were evaluated as a measure of systemic inflammation. RvE1, used as an oral/topical agent, significantly diminished atherogenesis and prevented periodontitis (P<0.05). In the absence of periodontal inflammation, oral/topical application of RvE1 resulted in significantly less arterial plaque, a lower intima/media ratio, and decreased inflammatory cell infiltration compared with no-treatment (P<0.001). Local oral RvE1 application significantly reduced systemic levels of C-reactive protein (P<0.05).The results suggest that oral/topical RvE1 attenuates enhanced atherogenesis induced by periodontitis and prevents vascular inflammation and atherogenesis in the absence of periodontitis. The inhibition of vascular inflammation with endogenous mediators of resolution of inflammation provides a novel approach in the prevention of atherogenic events.Â© 2015 American Heart Association, Inc.
Recurrence Patterns After Open and Robot-assisted Radical Cystectomy for Bladder Cancer. - European urology
Concerns remain whether robot-assisted radical cystectomy (RARC) compromises survival because of inadequate oncologic resection or alteration of recurrence patterns.To describe recurrence patterns following open radical cystectomy (ORC) and RARC.Retrospective review of 383 consecutive patients who underwent ORC (n=120) or RARC (n=263) at an academic institution from July 2001 to February 2014.ORC and RARC.Recurrence-free survival estimates were illustrated using the Kaplan-Meier method. Recurrence patterns (local vs distant and anatomic locations) within 2 yr of surgery were tabulated. Cox regression models were built to evaluate the effect of surgical technique on the risk of recurrence.The median follow-up time for patients without recurrence was 30 mo (interquartile range [IQR] 5-72) for ORC and 23 mo (IQR 9-48) for RARC (p=0.6). Within 2 yr of surgery, there was no large difference in the number of local recurrences between ORC and RARC patients (15/65 [23%] vs 24/136 [18%]), and the distribution of local recurrences was similar between the two groups. Similarly, the number of distant recurrences did not differ between the groups (26/73 [36%] vs 43/147 [29%]). However, there were distinct patterns of distant recurrence. Extrapelvic lymph node locations were more frequent for RARC than ORC (10/43 [23%] vs 4/26 [15%]). Furthermore, peritoneal carcinomatosis was found in 9/43 (21%) RARC patients compared to 2/26 (8%) ORC patients. In multivariable analyses, RARC was not a predictor of recurrence. Limitations of the study include selection bias and a limited sample size.Within limitations, we found that RARC is not an independent predictor of recurrence after surgery. Interestingly, extrapelvic lymph node locations and peritoneal carcinomatosis were more frequent in RARC than in ORC patients. Further validation is warranted to better understand the oncologic implications of RARC.In this study, the locations of bladder cancer recurrences following conventional and robotic techniques for removal of the bladder are described. Although the numbers are small, the results show that the distribution of distant recurrences differs between the two techniques.Copyright Â© 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.
Inauhzin(c) Inactivates c-Myc Independently of p53. - Cancer biology & therapy
Oncogene MYC is deregulated in many human cancers, especially in lymphoma. Previously, we showed that inauhzin (INZ) activates p53 and inhibits tumor growth. However, whether INZ could suppress cancer cell growth independently of p53 activity is still elusive. Here, we report that INZ(c), a second generation of INZ, suppresses c-Myc activity and thus inhibits growth of human lymphoma cells in a p53-independent manner. INZ(c) treatment decreased c-Myc expression at both mRNA and protein level, and suppressed c-Myc transcriptional activity in human Burkitt's lymphoma Raji cells with mutant p53. Also, we showed that overexpressing ectopic c-Myc rescues the inhibition of cell proliferation by INZ(c) in Raji cells, implicating c-Myc activity is targeted by INZ(c). Interestingly, the effect of INZ(c) on c-Myc expression was impaired by disrupting the targeting of c-Myc mRNA by miRNAs via knockdown of ribosomal protein (RP) L5, RPL11, or Ago2, a subunit of RISC complex, indicating that INZ(c) targets c-Myc via miRNA pathways. These results reveal a new mechanism that INZ(c) targets c-Myc activity in human lymphoma cells.
Optimization of extracorporeal shock wave lithotripsy delivery rates achieves excellent outcomes in ureteral stones. Results of a prospective, randomized trial. - The Journal of urology
Management of ureteral stones remains controversial. To determine whether optimizing extracorporeal shock wave lithotripsy (ESWL) delivery rates improves treatment of solitary ureteral stones, we compared outcomes of two SW delivery rates in a prospective, randomized trial.From July 2010 to October 2012, 254 consecutive patients were randomized to undergo ESWL at SW delivery rates of either 60 pulses (n=130) or 90 pulses (n=124) per min. The primary endpoint was stone-free rate at 3-month follow-up. Secondary endpoints included stone disintegration, treatment time, complications, and the rate of secondary treatments. Descriptive statistics were used to compare endpoints between the two groups. Adjusted odds ratios and 95% confidence intervals were calculated to assess predictors of success.The stone-free rate at 3 months was significantly higher in patients who underwent ESWL at a SW delivery rate of 90 pulses per min than in those receiving 60 pulses (91% vs. 80%, p=0.01). Patients with proximal and mid-ureter stones, but not those with distal ureter stones, accounted for the observed difference (100% vs. 83%; p=0.005; 96% vs. 73%, p=0.03; and 81% vs. 80%, p=0.9, respectively). Treatment time, complications, and the rate of secondary treatments were comparable between the two groups. In multivariable analysis, SW delivery rate of 90 pulses per min, proximal stone location, stone density, stone size and the absence of an indwelling JJ stent were independent predictors of success.Optimization of ESWL delivery rates can achieve excellent results for ureteral stones.Copyright Â© 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
Assessment of the quality-of-life and functional outcomes in patients undergoing cystectomy and urinary diversion for the management of radiation-induced refractory benign disease. - Urology
To investigate the impact of cystectomy for the treatment of refractory benign disease secondary to radiation therapy on the health-related quality of life (HRQOL).A retrospective review was performed on patients undergoing cystectomy for the management of treatment-refractory disease secondary to radiation therapy. Overall, 29 patients underwent cystectomy for refractory fistulas (nÂ = 12, 41.4%), radiation cystitis (nÂ = 12, 41.4%), pelvic pain (nÂ = 4, 13.8%), or incontinence (nÂ = 1, 3.4%) from 2004 to 2013. Preoperative and postoperative HRQOL were measured using a modified version of the Short Form version 2 (SF-36v2).A total of 19 patients (65.5%) reported a 30-day postoperative complication, of which 80% were Clavien grade I or II. Nineteen (65.5%) of the patients completed the SF-36v2 survey. Low scores were noted in the preoperative setting in the physical and mental health domains of these patients, especially in the role limitations due to health and emotional problems. Clinically meaningful improvements were noted in all the physical and mental health domains after cystectomy. Significant improvements were found in certain domains, namely in the level of pain control, general health, role limitations due to emotional problems, and social functioning (all PÂ <.01).Treatment-refractory disease from radiation therapy significantly impairs patients' HRQOL. Although cystectomy with urinary diversion is associated with perioperative complication risks, cystectomies can be safely performed in this high-risk population and significantly improve patients' physical and mental HRQOL. Further studies are needed to characterize the role of cystectomy in treatment-refractory disease from radiation therapy.Copyright Â© 2015. Published by Elsevier Inc.
Microtubule inhibitor-based antibody-drug conjugates for cancer therapy. - OncoTargets and therapy
The specificity of monoclonal antibodies represents a potential therapeutic advantage, but their use as single agents in oncology has proven limited to date. The development of antibody-drug conjugates (ADCs) takes advantage of the specificity of the monoclonal antibody and potent cytotoxic effect of chemotherapy, leading to enhanced cytotoxicity in target cells and limiting toxicity to normal tissue. Microtubules represent a validated oncologic target in a range of tumor types, with a number of anti-microtubule targeting cytotoxic drugs approved for cancer use. The systemic use of potent microtubule-binding agents is limited by their effects in normal cells, which leads to toxicity including myelosuppression and peripheral neuropathy. Linking these agents to monoclonal antibodies may limit toxicity to normal tissues and increase drug concentration in target tissues, also allowing the use of more potent agents which would be too toxic to administer in their unbound form. Two such ADCs have been approved for clinical use and many others are in development. Here we review the characteristics of each of the ADC components that have led to efficacious therapies and discuss some of the tubulin inhibitor-based ADCs in development for cancer therapy.
Postoperative complications and short-term oncological outcomes of patients aged â‰¥80Â years undergoing robot-assisted radical cystectomy. - World journal of urology
To assess complication rates and early oncological outcomes of patients aged â‰¥80Â years who underwent robot-assisted radical cystectomy (RARC).A total of 368 consecutive patients underwent radical cystectomy from April 2001 to September 2013 in a tertiary referral center. Sixty-one patients aged â‰¥80Â years underwent RARC and constitute the cohort of interest. Complications arising within 30 and 90Â days of surgery were graded using the modified Clavien classification and were additionally categorized by organ system using a standardized complication reporting system. Recurrence-free survival, disease-specific survival and overall survival were calculated using Kaplan-Meier curves.Median age was 83Â years (range 80-94). Twenty-nine (48Â %) of all tumor specimens were stage â‰¥pT3. The median number of nodes removed was 19 (range 6-67). The soft tissue positive margin rate was 10Â %. A total of 27 (44Â %) patients had complications within 90Â days, of which 9 had major complications. Two patients (3Â %) died from surgical complications within 90Â days. At a median follow-up of 13Â months, 12 (20Â %) patients had developed recurrent cancer and subsequently died from disease. An additional 13 (21Â %) patients died from non-cancer-related causes. The median overall survival time was 36.0Â months. At 2Â years, recurrence-free, cancer-specific and overall survival rates were 73, 74 and 61Â %, respectively.In patients aged â‰¥80Â years, RARC is feasible with acceptable perioperative morbidity and favorable short-term oncological outcomes. Therefore, RARC should be considered a valid option for carefully selected patients aged â‰¥80Â years with bladder cancer.
A targeted health risk assessment following the deepwater horizon oil spill: polycyclic aromatic hydrocarbon exposure in vietnamese-american shrimp consumers. - Environmental health perspectives
The Deepwater Horizon oil spill of 2010 prompted concern about health risks among seafood consumers exposed to polycyclic aromatic hydrocarbons (PAHs) via consumption of contaminated seafood.The objective of this study was to conduct population-specific probabilistic health risk assessments based on consumption of locally harvested white shrimp (Litopenaeus setiferus) among Vietnamese Americans in southeast Louisiana.We conducted a survey of Vietnamese Americans in southeast Louisiana to evaluate shrimp consumption, preparation methods, and body weight among shrimp consumers in the disaster-impacted region. We also collected and chemically analyzed locally harvested white shrimp for 81 individual PAHs. We combined the PAH levels (with accepted reference doses) found in the shrimp with the survey data to conduct Monte Carlo simulations for probabilistic noncancer health risk assessments. We also conducted probabilistic cancer risk assessments using relative potency factors (RPFs) to estimate cancer risks from the intake of PAHs from white shrimp.Monte Carlo simulations were used to generate hazard quotient distributions for noncancer health risks, reported as mean Â± SD, for naphthalene (1.8 Ã— 10-4 Â± 3.3 Ã— 10-4), fluorene (2.4 Ã— 10-5 Â± 3.3 Ã— 10-5), anthracene (3.9 Ã— 10-6 Â± 5.4 Ã— 10-6), pyrene (3.2 Ã— 10-5 Â± 4.3 Ã— 10-5), and fluoranthene (1.8 Ã— 10-4 Â± 3.3 Ã— 10-4). A cancer risk distribution, based on RPF-adjusted PAH intake, was also generated (2.4 Ã— 10-7 Â± 3.9 Ã— 10-7).The risk assessment results show no acute health risks or excess cancer risk associated with consumption of shrimp containing the levels of PAHs detected in our study, even among frequent shrimp consumers.
Local manganese chloride treatment accelerates fracture healing in a rat model. - Journal of orthopaedic research : official publication of the Orthopaedic Research Society
This study investigated the effects of local delivery of manganese chloride (MnCl2), an insulin-mimetic compound, upon fracture healing using a rat femoral fracture model. Mechanical testing, histomorphometry, and immunohistochemistry were performed to assess early and late parameters of fracture healing. At 4 weeks post-fracture, maximum torque to failure was 70% higher (P<0.05) and maximum torsional rigidity increased 133% (P<0.05) in animals treated with 0.125â€‰mg/kg MnCl2 compared to saline controls. Histological analysis of the fracture callus revealed percent new mineralized tissue was 17% higher (P<0.05) at day 10. Immunohistochemical analysis of the 0.125â€‰mg/kg MnCl2 treated group, compared to saline controls, showed a 379% increase in the density of VEGF-C+ cells. In addition, compared to saline controls, the 0.125â€‰mg/kg MnCl2 treated group showed a 233% and 150% increase in blood vessel density in the subperiosteal region at day 10 post-fracture as assessed by detection of PECAM and smooth muscle Î± actin, respectively. The results suggest that local MnCl2 treatment accelerates fracture healing by increasing mechanical parameters via a potential mechanism of amplified early angiogenesis leading to increased osteogenesis. Therefore, local administration of MnCl2 is a potential therapeutic adjunct for fracture healing.Â© 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.
Is continent cutaneous urinary diversion a suitable alternative to orthotopic bladder substitute and ileal conduit after cystectomy? - BJU international
â— To evaluate functional outcomes of continent cutaneous urinary diversion (CCUD) after cystectomy. â— To compare diversion-related complications and long-term renal function in a contemporary cohort of patients undergoing urinary diversion with CCUD, orthotopic bladder substitute (OBS) and ileal conduit (IC).â— 322 patients underwent cystectomy and CCUD, OBS or IC from January 2002 to June 2013. CCUD was performed using either a modified Indiana pouch or an appendiceal stoma. â— For patients with CCUD, continence status and time intervals between clean intermittent catheterisations at last follow-up were recorded. â— For all three diversion types, diversion-related complications and renal function outcome as determined by the estimated glomerular filtration rate (eGFR) at baseline and at different time intervals after surgery were evaluated. â— Multivariate regression analysis was used to evaluate the association of diversion type, baseline variables and diversion-related complications with renal function over time.â— Of all 322 patients, 73 (23%) received CCUD, 79 (25%) received OBS, and 170 (53%) received IC. â— After a median follow-up of 36 months, the continence rate for patients with CCUD was 89%. Sixty-four (88%) patients with CCUD were able to catheterise every 4-8 hours and 5 (7%) were able to catheterise every 8-10 hours. â— After a median follow-up of 35 months, rates of diversion-related complications were similar among patients who underwent CCUD, OBS or IC. â— Patients who received IC had poorer renal function preoperatively than those who received CCUD or OBS. However, at one year after surgery and thereafter, the three groups had comparable renal function. â— On multivariate analysis, the type of urinary diversion was not associated with decline in renal function. However, patient age at surgery, diabetes mellitus, baseline eGFR, postoperative non obstructive hydronephrosis and uretero-enteric stricture were associated with decline in renal function.â— CCUD is associated with excellent functional outcomes. â— Rates of diversion-related complications and renal function outcomes are comparable with those from OBS and IC. â— CCUD should be considered a valid alternative for patients who undergo cystectomy and require urinary diversion.This article is protected by copyright. All rights reserved.
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