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Wagner J, Ramakrishnan A, Behr D, Maier M, Herres N, Kunzer M, Obloh H, Bachem KH. Composition Dependence of the Band Gap Energy of InxGa1−xN Layers on GaN (x≤0.15) Grown by Metal-Organic Chemical Vapor Deposition. ACTA ACUST UNITED AC 2014. [DOI: 10.1557/s1092578300002301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We report on the composition dependence of the band gap energy of strained hexagonal InxGa1−xN layers on GaN with x≤0.15, grown by metal-organic chemical vapor deposition on sapphire substrates. The composition of the (InGa)N was determined by secondary ion mass spectroscopy. High-resolution X-ray diffraction measurements confirmed that the (InGa)N layers with typical thicknesses of 30 nm are pseudomorphically strained to the in-plane lattice parameter of the underlying GaN. Room-temperature photoreflection spectroscopy and spectroscopic ellipsometry were used to determine the (InGa)N band gap energy. The composition dependence of the band gap energy of the strained (InGa)N layers was found to be given by EG(x)=3.43−3.28 × (eV) for x≤0.15. When correcting for the strain induced shift of the fundamental energy gap, a bowing parameter of 3.2 eV was obtained for the composition dependence of the gap energy of unstrained (InGa)N.
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Ramakrishnan A, Spangenberg K, Gold K. Perceptions of perinatal depression training among primary care providers and obstetricians in Kumasi, Ghana. Contraception 2013. [DOI: 10.1016/j.contraception.2013.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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De Silva I, Rozen WM, Ramakrishnan A, Mirkazemi M, Baillieu C, Ptasznik R, Leong J. Achieving adequate margins in ameloblastoma resection: the role for intra-operative specimen imaging. Clinical report and systematic review. PLoS One 2012; 7:e47897. [PMID: 23094099 PMCID: PMC3477138 DOI: 10.1371/journal.pone.0047897] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 09/18/2012] [Indexed: 11/18/2022] Open
Abstract
Background Ameloblastoma is a locally aggressive odontogenic neoplasm. With local recurrence rates reaching 90%, only completeness of excision can facilitate cure. Surgical clearance has widely been based on pre-operative imaging to guide operative excision margins, however use of intra-operative specimen x-ray or frozen-section has been sought to improve clearance rates, and advanced imaging technologies in this role have been proposed. This manuscript aims to quantify the evidence for evaluating intra-operative resection margins and present the current standard in this role. Method The current study comprises the first reported comparison of imaging modalities for assessing ameloblastoma margins. A case is presented in which margins are assessed with each of clinical assessment based on preoperative imaging, intra-operative specimen x-ray, intra-operative specimen computed tomography (CT) and definitive histology. Each modality is compared quantitatively. These results are compared to the literature through means of systematic review of current evidence. Results A comparative study highlights the role for CT imaging over plain radiography. With no other comparative studies and a paucity of high level evidence establishing a role for intra-operative margin assessment in ameloblastoma in the literature, only level 4 evidence supporting the use of frozen section and specimen x-ray, and only one level 4 study assesses intra-operative CT. Conclusion The current study suggests that intra-operative specimen CT offers an improvement over existing techniques in this role. While establishing a gold-standard will require higher level comparative studies, the use of intra-operative CT can facilitate accurate single-stage resection.
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Hill FCE, Yuen A, Ramakrishnan A. Vascular malformation of the flexor tendon presenting as tenosynovitis. Hand (N Y) 2012; 7:200-3. [PMID: 23730242 PMCID: PMC3351513 DOI: 10.1007/s11552-011-9384-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Ramakrishnan A, Haigh I, Liston J, Dall BJG, Sharma N. How can the prevalent round recall rate be reduced? Breast Cancer Res 2010. [PMCID: PMC2978861 DOI: 10.1186/bcr2697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ramakrishnan A, Buck T, Levine J, James P. Allowing Greater Use of Institutional Practice May Decrease Cost Of CTN Trials. Biol Blood Marrow Transplant 2009. [DOI: 10.1016/j.bbmt.2008.12.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Buck T, James P, Levine J, Ramakrishnan A. Streamlining SAE Reporting for CTN Trials Results In Significant Time Savings. Biol Blood Marrow Transplant 2009. [DOI: 10.1016/j.bbmt.2008.12.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Vijayaraghavan C, Vasanthakumar S, Ramakrishnan A. In vitro and in vivo evaluation of locust bean gum and chitosan combination as a carrier for buccal drug delivery. DIE PHARMAZIE 2008; 63:342-347. [PMID: 18557416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The object of the study was to evaluate locust bean gum and chitosan in ratios of 2:3; 3:2 and 4:1 (F1, F2 and F3) as a mucoadhesive component in buccal tablets and to compare the bioavailability of a propranolol hydrochloride buccal tablet with the oral tablet in healthy human volunteers. Propranolol hydrochloride buccal tablets containing various weight ratios of locust bean gum and chitosan were prepared and coated with 5% w/v ethyl cellulose on one face, and oral tablets containing 10 mg propranolol hydrochloride alone were formulated using a direct compression technique. The strength of mucoadhesion of the tablets was quantified based on the tensile force required to break the adhesive bond between a model membrane (porcine buccal mucosa) and the test polymer. The forces of detachment for the mucoadhesive buccal tablets were 14.61 +/- 0.14, 13.21 +/- 0.13 and 11.71 +/- 0.12. An in vitro study was carried out in pH 6.8 phosphate buffer and the cumulative percentage release of propranolol measured at 10 min intervals for 600 min was found to be 98.31 +/- 0.10, 92.24 +/- 0.41 and 90.18 +/- 0.76 respectively. A bioavailability study was conducted with the prepared formulation in 16 healthy human volunteers to determine the plasma concentration of propranolol at 0, 1, 2, 3, 4, 6, 8, 10 and 12 h. The bioavailability (AUC(0-t*) ng x h/ml) of the buccal propranolol hydrochloride tablets (F1, F2 and F3) and oral tablet (F4) was found to be 2244.18 +/- 210, 3580.69 +/- 460, 3889.19 +/- 290 and 1732 +/- 96 ng x hr/ml respectively. The study indicates that locust bean gum and chitosan in a weight ratio of 2:3 (F1) not only releases the drug unidirectionally from the dosage form, but also gives buccal tablets which are sufficiently mucoadhesive for clinical applications.
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Ramakrishnan A, Morrison W, Simmons P. A New Molecular Marker to Isolate Stem Cells from Fat for Bio-Engineering Vascularized Tissues. J Reconstr Microsurg 2006. [DOI: 10.1055/s-2006-947904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ramakrishnan A, Dhamodharan R, Rühe J. Growth of poly(methyl methacrylate) brushes on silicon surfaces by atom transfer radical polymerization. ACTA ACUST UNITED AC 2006. [DOI: 10.1002/pola.21266] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Dayananda K, Ramakrishnan A, Dhamodharan R. Synthesis and Characterization of Block Copolymers of P(MMA‐b‐n‐BA‐b‐MMA) via Ambient Temperature ATRP of MMA. JOURNAL OF MACROMOLECULAR SCIENCE PART A-PURE AND APPLIED CHEMISTRY 2005. [DOI: 10.1081/ma-200054354] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Sriram PV, Ramakrishnan A, Rao GV, Nageshwar Reddy D. Spontaneous fracture of a biliary self-expanding metal stent. Endoscopy 2004; 36:1035-6. [PMID: 15520930 DOI: 10.1055/s-2004-825969] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Ramakrishnan A, Johnson PDR, Hayman J, Coombs C. Free rectus flap repair of cutaneous Mycobacterium ulcerans ulcer with joint involvement. ANZ J Surg 2004; 74:608-11. [PMID: 15230806 DOI: 10.1111/j.1445-2197.2004.03079.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Grüning H, Kohary K, Baranovskii SD, Rubel O, Klar P, Ramakrishnan A, Ebbinghaus G, Thomas P, Heimbrodt W, Stolz W, Rühle W. Hopping relaxation of excitons in GaInNAs/GaNAs quantum wells. ACTA ACUST UNITED AC 2003. [DOI: 10.1002/pssc.200303604] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
It has become clear that adult mammalian bone marrow contains not one but two ostensibly discrete populations of adult stem cells. The first and by far the most fully characterized are the hematopoietic stem cells responsible for maintaining lifelong production of blood cells. The biological characteristics and properties of the second marrow resident population of stem cells, variously termed bone marrow stromal cells or mesenchymal stem cells, are in contrast much less well understood. In vitro, cultures established from single-cell suspensions of bone marrow from a wide range of mammalian species generate colonies of adherent marrow stromal cells, each derived from a single precursor cell termed a colony-forming unit-fibroblast (CFU-F). Culture conditions have been developed to expand marrow stromal cells in vitro while maintaining the capacity of these cells to differentiate into bone, fat, and cartilage. A significant portion of our current knowledge of this population of cells is based on analysis of the properties of these culture expanded cells, not on the primary colony-initiating cells. In this article, we will focus on methodologies to prospectively isolate stromal progenitors from mouse and human bone marrow and will review current data that suggest stromal progenitors in the bone marrow in situ are associated with the outer surfaces of blood vessels and may share identity with vascular pericytes.
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Ramakrishnan A, Pecht M. A life consumption monitoring methodology for electronic systems. ACTA ACUST UNITED AC 2003. [DOI: 10.1109/tcapt.2003.817654] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Butala HD, Ramakrishnan A, Sadana A. A fractal analysis of analyte-estrogen receptor binding and dissociation kinetics using biosensors: environmental and biomedical effects. Biosystems 2003; 70:235-53. [PMID: 12941487 DOI: 10.1016/s0303-2647(03)00052-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A fractal analysis is used to model the binding and dissociation kinetics between analytes in solution and estrogen receptors (ERs) immobilized on a sensor chip of a surface plasmon resonance (SPR) biosensor. The influence of different ligands is also analyzed. A better understanding of the kinetics provides physical insights into the interactions, and suggests means by which appropriate interactions (to promote correct signaling) and inappropriate interactions such as with xenoestrogens (to minimize inappropriate and deleterious to health signaling) may be better controlled. The fractal approach is applied to analyte-ER interaction data available in the literature. The units for the different parameters (rate coefficients and affinities) in fractal-type kinetics are different from those obtained in classical kinetics. Numerical values obtained for the binding and the dissociation rate coefficients are linked to the degree of roughness or heterogeneity (fractal dimension, D(f)) present on the biosensor chip surface. In general, the binding and the dissociation rate coefficients are very sensitive to the degree of heterogeneity on the surface. A single-fractal analysis is adequate in some cases. In others (that exhibit complexities in the binding or the dissociation curves) a dual-fractal analysis is required to obtain a better fit. This has biomedical and environmental implications in that the dissociation (and the binding) rate coefficient may be used to alleviate (deleterious effects) or enhance (beneficial effects) by selective modulation of the surface. The affinity values obtained in the analysis are consistent with the numbers required to (a). promote signaling between the correct analyte and the estrogen receptor, and (b). minimize the signaling between xenoestrogens and the estrogen receptor.
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Ahmad A, Ramakrishnan A, McLean MA, Breau AP. Use of surface plasmon resonance biosensor technology as a possible alternative to detect differences in binding of enantiomeric drug compounds to immobilized albumins. Biosens Bioelectron 2003; 18:399-404. [PMID: 12604257 DOI: 10.1016/s0956-5663(02)00139-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The use of biosensors for monitoring real time interactions between biomolecules and drug compounds has a lot of advantages over presently existing detection methods, the major ones being the elimination of radio labels and rapid screening. We can also obtain information about the kinetic parameters and these values may serve as useful indicators towards subtle differences in the binding strength and characteristics of closely related drug compounds and enantiomers. The Biacore 3000 biosensor based on the Surface Plasmon Resonance (SPR) technology was used to assess the albumin protein binding differences between two enantiomers of a drug compound. Normalized responses (NRU) and affinity constants (K(D)) were readily calculated. Statistical parameters like mean normalized responses, %CV values were determined to make the technique robust. The %CV values obtained were within the preset limits of < or = 25% (FDA limits for drug development and method validation protocols) for the binding interactions for majority of the concentrations studied. For example, the %CV values for the normalized responses for the binding of the control drug warfarin to human albumin ranged from 7.9 to 24.3%. The method gave reproducible results, and the results indicated slight differences in binding patterns of the enantiomers to human and rat albumin.
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Ramakrishnan A, Dhamodharan R. Facile Synthesis of ABC and CBABC Multiblock Copolymers of Styrene, tert-Butyl Acrylate, and Methyl Methacrylate via Room Temperature ATRP of MMA. Macromolecules 2003. [DOI: 10.1021/ma021197d] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ramakrishnan A, Sadana A. A kinetic study of analyte-receptor binding and dissociation for biosensor applications: a fractal analysis for two different DNA systems. Biosystems 2002; 66:165-77. [PMID: 12413747 DOI: 10.1016/s0303-2647(02)00052-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A fractal analysis of DNA binding and dissociation kinetics on biosensor surfaces is presented. The fractal approach provides an attractive, convenient method to model the kinetic data taking into account the effects of surface heterogeneity brought about by ligand immobilization. The fractal technique can be used in conjunction or as an alternate approach to conventional modeling techniques, such as the Langmuir model, saturation model, etc. Examples analyzed include a DNA molecular beacon biosensor and a plasmid DNA-(cationic polymer) interaction biosensor. The molecular beacon example provides some insights into the nature of the surface and how it influences the binding rate coefficients. The DNA-cationic polymer interaction example provides some quantitative results on the binding and dissociation rate coefficients. Data taken from the literature may be modeled, in the case of binding, using a single-fractal analysis or a dual-fractal analysis. The dual-fractal analysis results indicate a change in the binding mechanism as the reaction progresses on the surface. A single-fractal analysis is adequate to model the dissociation kinetics in the example presented. Relationships are presented for the binding rate coefficients as a function of their corresponding fractal dimension, D(f), which is an indication of the degree of heterogeneity that exists on the surface. When analyte-receptor binding is involved, an increase in the heterogeneity of the surface (increase in D(f)) leads to an increase in the binding rate coefficient.
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Ramakrishnan A, Sadana A. A mathematical analysis using fractals for binding interactions of nuclear estrogen receptors occurring on biosensor surfaces. Anal Biochem 2002; 303:78-92. [PMID: 11906154 DOI: 10.1006/abio.2002.5581] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A mathematical approach using fractal concepts is presented for modeling the binding and dissociation interactions between analytes and nuclear estrogen receptors (ER) occurring on surface plasmon resonance biosensor chip surfaces. A kinetic knowledge of the binding interactions mediated by ER would help in better understanding the carcinogenicity of these steroidogenic compounds and assist in modulating these reactions. The fractal approach is applied to analyte-ER interaction data obtained from literature. Numerical values obtained for the binding and dissociation rate coefficients are linked to the degree of roughness or heterogeneity (fractal dimension, D(f)) present on the biosensor surface. For example, a single-fractal analysis is used to describe the binding and dissociation phases for the binding of estradiol and ERalpha in solution to clone 31 protein immobilized on a biosensor chip (C-S. Suen et al., 1998, J. Biol. Chem. 273(42), 27645-27653). The binding and the dissociation rate coefficients are 27.57 and 8.813, respectively, and the corresponding fractal dimensions are 1.986 and 2.268, respectively. In some examples dual-fractal models were employed to obtain a better fit of either the association or the dissociation phases or for both. Predictive relationships are developed for (a) the binding and the dissociation rate coefficients as a function of their respective fractal dimensions and (b) the ratio K(A) (= k/k(d)) as a function of the ratio of the fractal dimensions (D(f)/D(fd)). The analysis should provide further physical insights into the ER-mediated interactions occurring on biosensor and other surfaces.
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Ahmad A, Ramakrishnan A, McLean MA, Li D, Rock MT, Karim A, Breau AP. Use of optical biosensor technology to study immunological cross-reactivity between different sulfonamide drugs. Anal Biochem 2002; 300:177-84. [PMID: 11779109 DOI: 10.1006/abio.2001.5467] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Adverse reactions to medications account for a substantial number of hospitalizations and in some cases fatalities. The nature of the many drug-drug interactions caused by the inhibition of drug-metabolizing enzymes can now be predicted and examined with a greater deal of accuracy due to research developments in the understanding of the drug-metabolizing enzymes. However, the more troubling aspects of drug-drug interactions are the idiosyncratic reactions that are unpredictable and quite often life-threatening. These reactions are often caused by a prior sensitization of a person's immune system to a given drug or class of drugs. The following work offers a technique to examine in a medium-throughput system the cross-reactivity of drugs to antibodies in order to predict if structures share the same antigenic potential toward a sensitized individual. Two commercially important sulfonamide drugs, sulfamethazine and furosemide, were taken and their binding to their respective antibodies were tested in the presence of other structurally related sulfonamide drugs. The BIACORE 3000 biosensor was used for the study and the solution-phase equilibrium assay principle was employed. The data obtained help us determine which drugs can react, and to what extent, with sulfamethazine and furosemide, giving rise to possible allergic or hypersensitivity reactions. Though sulfamethazine and furosemide were used in this study; this principle and methodology can be applied to study any drug molecule-antibody pair.
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Ramakrishnan A, Sadana A. Analyte-receptor binding and dissociation kinetics for biosensor applications: a fractal analysis. Biosens Bioelectron 2001; 15:651-62. [PMID: 11213226 DOI: 10.1016/s0956-5663(00)00124-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A fractal analysis of confirmative nature only is presented for analyte-receptor binding and dissociation kinetics for biosensor applications. Data taken from the literature may be modeled, in the case of binding using a single-fractal analysis or a dual-fractal analysis. The dual-fractal analysis represents a change in the binding mechanism as the reaction progresses on the surface. Relationships are presented for the binding and dissociation rate coefficients as a function of their corresponding fractal dimension, Df or the degree of heterogeneity that exists on the surface. When analyte-receptor binding or dissociation is involved, an increase in the heterogeneity on the surface (increase in Df) leads to an increase in the binding and in the dissociation rate coefficient. It is suggested that an increase in the degree of heterogeneity on the surface leads to an increase in the turbulence on the surface owing to the irregularities on the surface. This turbulence promotes mixing, minimizes diffusional limitations, and leads subsequently to an increase in the binding and in the dissociation rate coefficient (Martin S.J., Granstaff, V.E., Frye, G.C., Anal. Chem., 65, (1991) 2910). The binding and the dissociation rate coefficient are rather sensitive to the degree of heterogeneity, Df,bind and Df,diss respectively, that exists on the biosensor surface. For example, the order of dependence on Df,bind is 19.2 for the binding rate coefficient, kbind for the binding of 0.03-1.0 microM SH-2Ld in solution to 2C TCR immobilized on a surface plasmon resonance (SPR) biosensor (Corr, M., Salnetz, A.E., Boyd, L.F., Jelonek, M.T., Khilko, S., Al-Ramadi, B.K., Kim, Y.S., Maher, S.E., Bothwell, A.L.M., Margulies, D.H., Science, 265, (1994) 946). The order of dependence on Df,diss is -6.22 for the dissociation rate coefficient, kdiss for the dissociation of 250-1000 nM Sophora japonica agglutinin (SJA)-lactose complex from the SPR surface. In general, the technique is applicable to other reactions occurring on different types of surfaces, such as cell-surface reactions.
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Srinivasan R, Katz PO, Ramakrishnan A, Katzka DA, Vela MF, Castell DO. Maximal acid reflux control for Barrett's oesophagus: feasible and effective. Aliment Pharmacol Ther 2001; 15:519-24. [PMID: 11284781 DOI: 10.1046/j.1365-2036.2001.00958.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
UNLABELLED The treatment of patients with Barrett's oesophagus is controversial. Debate exists regarding the use and value of high dose acid suppression as the standard of practice. Despite prolonged use of high dose proton pump inhibitors (40 mg omeprazole, 60 mg lansoprazole), most studies have shown no convincing evidence of significant regression of Barrett's length. These studies, however, have used fixed doses of proton pump inhibitors and did not regularly document control of oesophageal acid exposure. AIM To determine whether regression of Barrett's epithelium can be achieved with documented maximal acid suppression. METHODS We have prospectively followed nine patients with Barrett's oesophagus (eight male; mean age 60 years) for more than 1 year. They were all treated using medical therapy with pH monitoring documenting oesophageal acid exposure over 24 h < 1.6% of the time, and with two or more esophagogastroduodenoscopies performed by the same endoscopist. RESULTS Acid control was individually tailored and achieved with proton pump inhibitor b.d. (omeprazole 20 mg or lansoprazole 30 mg) and ranitidine at bedtime (HS) (Ran) if necessary. All nine patients (100%) showed some evidence of regression. All nine patients (100%) showed a decrease in Barrett's length (mean 2 cm, range 1-3 cm). Six out of nine (66.67%) patients showed evidence of squamous islands on the last oesophagogastroduodenoscopy. The mean total distal oesophageal acid exposure was 0.38% (range: 0-1.5%). The mean follow-up of patients was 54 months (range: 13-118 months). CONCLUSIONS Consistent and individually tailored maximal acid suppression documented by pH-metry is achievable and may result in decreased length and development of squamous islands in patients with Barrett's epithelium. This approach should be further evaluated as potentially the preferred medical treatment for these patients.
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