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Singla A, Khosla D, Kapoor R, Kumar D, Madan R, Periasamy K, Goyal S, Gupta R, Gupta V. 1486P Clinicopathological characteristics and prognostic factors of ampullary cancer: A tertiary care centre experience over 10 years. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Dimitriou F, Lo S, Tan A, Emmett L, Kapoor R, Carlino M, Long G, Menzies A. 1054P FDG-PET to predict long-term outcome from anti-PD1 (PD1) therapy in metastatic melanoma. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Calabrese EJ, Agathokleous E, Kapoor R, Dhawan G, Calabrese V. Luteolin and hormesis. Mech Ageing Dev 2021; 199:111559. [PMID: 34403687 DOI: 10.1016/j.mad.2021.111559] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/19/2021] [Accepted: 08/08/2021] [Indexed: 12/24/2022]
Abstract
The present paper provides the first integrated assessment of the capacity of luteolin to induce hormetic dose responses. It was shown that luteolin induced hormetic responses in multiple biological systems, including enhancing neuroprotection in various experimental model disease systems, improving wounding healing, especially in experimental models of high-risk population subgroups, such as diabetics, as well as enhancing osteogenesis in models of osteoporosis. The mechanistic basis for the luteolin-induced hormetic dose responses has been demonstrated to commonly involve the upregulation of the nuclear factor erythroid-derived 2-like 2 (Nrf2), which mediates the extensive range of anti-inflammatory effects induced by luteolin in multiple cell types and organ systems.
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Javadinia SA, Nazeminezhad N, Ghahramani-Asl R, Soroosh D, Fazilat-Panah D, PeyroShabany B, Saberhosseini SN, Mehrabian A, Taghizadeh-Hesary F, Nematshahi M, Dhawan G, Welsh JS, Calabrese EJ, Kapoor R. Low-dose radiation therapy for osteoarthritis and enthesopathies: a review of current data. Int J Radiat Biol 2021; 97:1352-1367. [PMID: 34259615 DOI: 10.1080/09553002.2021.1956000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Osteoarthritis (OA), the most common degenerative joint disease, is associated with severe functional limitation and impairment of quality of life. Numerous reports have documented the clinical efficacy of low-dose radiotherapy (LD-RT) in the management of various inflammatory disorders, including OA. In this paper, we assessed the clinical literature involving the use of LD-RT in the treatment of OA, its dose-response features, possible underlying mechanistic features, and optimal therapeutic dose range. METHODS We carried out a systematic review based on the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statements and evaluated articles meeting the inclusion criteria for this review. RESULTS A total of 361 articles were identified from databases, such as Scopus, PubMed, Embase, and Science Direct out of which 224 articles were duplicates and were discarded. Of the remaining 137 articles, 74 articles were un-related, 27 articles were review articles, eight were conference abstracts, three were letters, two were editorials, two were notes, and one was a book chapter. Finally, 20 articles met all the inclusion criteria and were included in this systematic review. DISCUSSION Several single-arm retrospective/prospective studies showed advantages for LD-RT in the management of OA in terms of pain relief, improvement of mobility and function, and showed minimal side effects. Mechanistic considerations involve positive subcellular effects mediated by the activation of a nuclear factor erythroid 2-related transcription factor (Nrf2) mediated antioxidant response. Further research on both the short- and long-term effects of LD-RT on OA and other inflammatory disorders is recommended.
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Khosla D, Rana S, Kapoor R, Periasamy K, Madan R, Kumar N, Gupta R. P-243 A prospective study to assess the impact of colostomy on psychosocial aspects of quality of life in colorectal cancer patients. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Tripathi T, Singh AR, Kapoor R, Sinha A, Ghosh S, Kaur K, Pokhariya D, Maity S, Tapadar A, Chandra A. Dapsone-induced methaemoglobinaemia in leprosy: a close mimic of 'happy hypoxia' in the COVID-19 pandemic. J Eur Acad Dermatol Venereol 2021; 35:e568-e571. [PMID: 34037283 PMCID: PMC8242520 DOI: 10.1111/jdv.17394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Calabrese EJ, Kozumbo WJ, Kapoor R, Dhawan G, Lara PC, Giordano J. Nrf2 activation putatively mediates clinical benefits of low-dose radiotherapy in COVID-19 pneumonia and acute respiratory distress syndrome (ARDS): Novel mechanistic considerations. Radiother Oncol 2021; 160:125-131. [PMID: 33932453 PMCID: PMC8080499 DOI: 10.1016/j.radonc.2021.04.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 04/12/2021] [Accepted: 04/20/2021] [Indexed: 12/13/2022]
Abstract
Novel mechanistic insights are discussed herein that link a single, nontoxic, low-dose radiotherapy (LDRT) treatment (0.5–1.0 Gy) to (1) beneficial subcellular effects mediated by the activation of nuclear factor erythroid 2-related transcription factor (Nrf2) and to (2) favorable clinical outcomes for COVID-19 pneumonia patients displaying symptoms of acute respiratory distress syndrome (ARDS). We posit that the favorable clinical outcomes following LDRT result from potent Nrf2-mediated antioxidant responses that rebalance the oxidatively skewed redox states of immunological cells, driving them toward anti-inflammatory phenotypes. Activation of Nrf2 by ionizing radiation is highly dose dependent and conforms to the features of a biphasic (hormetic) dose–response. At the cellular and subcellular levels, hormetic doses of <1.0 Gy induce polarization shifts in the predominant population of lung macrophages, from an M1 pro-inflammatory to an M2 anti-inflammatory phenotype. Together, the Nrf2-mediated antioxidant responses and the subsequent shifts to anti-inflammatory phenotypes have the capacity to suppress cytokine storms, resolve inflammation, promote tissue repair, and prevent COVID-19-related mortality. Given these mechanistic considerations—and the historical clinical success of LDRT early in the 20th century—we opine that LDRT should be regarded as safe and effective for use at almost any stage of COVID-19 infection. In theory, however, optimal life-saving potential is thought to occur when LDRT is applied prior to the cytokine storms and before the patients are placed on mechanical oxygen ventilators. The administration of LDRT either as an intervention of last resort or too early in the disease progression may be far less effective in saving the lives of ARDS patients.
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Singh N, Ravi N, Bal A, Garg M, Kapoor R, Prasad K. 168P Changes in cfDNA levels in squamous non-small cell lung cancer with chemotherapy: Correlation with symptom scores and radiological responses. J Thorac Oncol 2021. [DOI: 10.1016/s1556-0864(21)02010-4] [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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Carter B, Cheng N, Kapoor R, Meletharayil G, Drake M. Invited review: Microfiltration-derived casein and whey proteins from milk. J Dairy Sci 2021; 104:2465-2479. [DOI: 10.3168/jds.2020-18811] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 10/05/2020] [Indexed: 01/26/2023]
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Singh J, Ronsard L, Pandey M, Kapoor R, Ramachandran VG, Banerjea AC. Molecular and Genetic Characterization of Natural Variants of HIV-1 Nef Gene from North India and its Functional Implication in Down-Regulation of MHC-I and CD-4. Curr HIV Res 2021; 19:172-187. [PMID: 32981506 DOI: 10.2174/1570162x18666200925160755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/05/2020] [Accepted: 08/14/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND HIV-1 Nef is an important accessory protein with multiple effector functions. Genetic studies of the HIV-1 Nef gene show extensive genetic diversity and the functional studies have been carried out mostly with Nef derived from regions dominated by subtype B (North America & Europe). OBJECTIVE This study was carried out to characterize genetic variations of the Nef gene from HIV-1 infected individuals from North India and to find out their functional implications. METHODS The unique representative variants were sub-cloned in a eukaryotic expression vector and further characterized with respect to their ability to downregulate cell surface expression of CD4 and MHC-1 molecules. RESULTS The phylogenetic analysis of Nef variants revealed sequence similarity with either consensus subtype B or B/C recombinants. Boot scan analysis of some of our variants showed homology to B/C recombinant and some to wild type Nef B. Extensive variations were observed in most of the variants. The dN/dS ratio revealed 80% purifying selection and 20% diversifying selection implying the importance of mutations in Nef variants. Intracellular stability of Nef variants differed greatly when compared with wild type Nef B and C. There were some variants that possessed mutations in the functional domains of Nef and responsible for its differential CD4 and MHC-1 downregulation activity. CONCLUSION We observed enhanced biological activities in some of the variants, perhaps arising from amino acid substitutions in their functional domains. The CD4 and MHC-1 down-regulation activity of Nef is likely to confer immense survival advantage allowing the most rare genotype in a population to become the most abundant after a single selection event.
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Calabrese EJ, Hanekamp JC, Hanekamp YN, Kapoor R, Dhawan G, Agathokleous E. Chloroquine commonly induces hormetic dose responses. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 755:142436. [PMID: 33017762 PMCID: PMC7518853 DOI: 10.1016/j.scitotenv.2020.142436] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 05/02/2023]
Abstract
The use of chloroquine in the treatment of COVID-19 has received considerable attention. The recent intense focus on this application of chloroquine stimulated an investigation into the effects of chloroquine at low doses on highly biologically-diverse models and whether it may induce hormetic-biphasic dose response effects. The assessment revealed that hormetic effects have been commonly induced by chloroquine, affecting numerous cell types, including tumor cell lines (e.g. human breast and colon) and non-tumor cell lines, enhancing viral replication, sperm motility, various behavioral endpoints as well as decreasing risks of convulsions, and enhancing a spectrum of neuroprotective responses within a preconditioning experimental framework. These diverse and complex findings indicate that hormetic dose responses commonly occur with chloroquine treatment with a range of biological models and endpoints. These findings have implications concerning study design features including the number and spacing of doses, and suggest a range of possible clinical concerns and opportunities depending on the endpoint considered.
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Majumdar S, Kishor J, Behera AN, Vishwanadh B, Borgohain A, Kapoor R, Tewari R, Kain V, Krishnan M, Dey GK, Banerjee S. Preparation and Characterization of Nb-1Zr-0.1C Alloy Suitable for Liquid Metal Coolant Channels of High Temperature Reactors. JOURNAL OF NUCLEAR ENGINEERING AND RADIATION SCIENCE 2021. [DOI: 10.1115/1.4047919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Abstract
A novel process comprising of aluminothermic coreduction of mixed oxides followed by arc and electron beam melt refining was developed for preparation of Nb-1Zr-0.1C alloy. The parameters of the process were optimized by considering the thermodynamic (heat) and mass balance phenomenon. The ingots of the homogenized alloy produced after electron beam melt consolidation were further extruded into tubes. The alloy was vacuum annealed at 1350–1800 °C to study the stability of Nb2C and Nb(Zr)C carbide precipitates in the microstructure. Compression creep tests conducted at 900 and 1000 °C revealed a stress exponent value of 2 and activation energy of 508 kJ/mol. NbSi2-based coatings were developed on the Nb-1Zr-0.1C alloy tubes using pack siliconizing process. The coated alloy was tested for oxidation at 1250 °C, and corrosion in liquid lead-bismuth eutectic (LBE) alloy at 875 °C for prolonged duration. The silicide-coated alloy showed superior oxidation and LBE corrosion resistance at high temperatures. The alloy was found to be a promising material for coolant channels of high temperature reactors.
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Raftopoulos R, Kuhle J, Grant D, Hickman SJ, Altmann DR, Leppert D, Blennow K, Zetterberg H, Kapoor R, Giovannoni G, Gnanapavan S. Neurofilament results for the phase II neuroprotection study of phenytoin in optic neuritis. Eur J Neurol 2020; 28:587-594. [PMID: 33058438 DOI: 10.1111/ene.14591] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/05/2020] [Accepted: 10/08/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND A randomized trial of phenytoin in acute optic neuritis (ON) demonstrated a 30% reduction in retinal nerve fiber layer (RNFL) loss with phenytoin versus placebo. Here we present the corresponding serum neurofilament analyses. METHODS Eighty-six acute ON cases were randomized to receive phenytoin (4-6 mg/kg/day) or placebo for 3 months, and followed up for 6 months. Serum was collected at baseline, 3 and 6 months for analysis of neurofilament heavy chain (NfH) and neurofilament light chain (NfL). RESULTS Sixty-four patients had blood sampling. Of these, 58 and 56 were available at 3 months, and 55 and 54 were available at 6 months for NfH and NfL, respectively. There was no significant correlation between serum NfH and NfL at the time points tested. For NfH, the difference in mean placebo - phenytoin was -44 pg/ml at 3 months (P = 0.019) and -27 pg/ml at 6 months (P = 0.234). For NfL, the difference was 1.4 pg/ml at 3 months (P = 0.726) and -1.6 pg/ml at 6 months (P = 0.766). CONCLUSIONS At 3 months, there was a reduction in NfH, but not NFL, in the phenytoin versus placebo group, while differences at 6 months were not statistically significant. This suggests a potential neuroprotective role for phenytoin in acute ON, with the lower NfH at 3 months, when levels secondary to degeneration of the anterior visual pathway are still elevated, but not at 6 months, when levels have normalized.
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Khosla D, Kapoor R, Rana S, Tomar P, Periasamy K, Madan R, Goyal S, Kumar N. Dosimetric Comparison of Three-Dimensional Conformal Radiotherapy (3DCRT) and Volumetric Modulated Arc Therapy (VMAT) Plans for Hypofractionated Whole Breast and Regional Nodes Irradiation in Breast Cancer Patients Following Breast Conservative Surgery. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lewis P, Amankwaa-Frempong E, Makwani H, Nsingo M, Addison E, Acquah G, Yusufu S, Makufa R, Edusa C, Dharsee N, Grover S, Court L, Palta J, Kapoor R, Aggarwal A. Implementation of a Novel Cloud-based Platform for Facilitating Remote Radiotherapy Peer Review and Training in Resource-Limited Settings: Results of Feasibility Assessments in 4 Radiotherapy Centers in Botswana, Ghana and Tanzania. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ghahramani-Asl R, Porouhan P, Mehrpouyan M, Welsh JS, Calabrese EJ, Kapoor R, Dhawan G, Javadinia SA. Feasibility of Treatment Planning System in Localizing the COVID-19 Pneumonia Lesions and Evaluation of Volume Indices of Lung Involvement. Dose Response 2020; 18:1559325820962600. [PMID: 33088245 PMCID: PMC7545774 DOI: 10.1177/1559325820962600] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/31/2020] [Accepted: 08/31/2020] [Indexed: 12/20/2022] Open
Abstract
Background and purpose To assess the feasibility of a treatment planning system in localizing, contouring, and targeting lung lesions along with an evaluation of volume indices of lung involvement in patients with COVID-19 pneumonia. Methods We evaluated 10 patients with PCR-confirmed COVID-19 pneumonia. The CT images were imported into the ISOgray® treatment planning system to anatomically define and contour the volumes of the pulmonary lesions, the lungs, and other nearby organs. Results The ratio of lung lesion volume to lung volume in this study was 0.11 ± 0.13 (11.13%). The highest mean biosynthesis ratio of lung lesions was 0.36. The ratio of lesion volume in the left lung of patients with the highest volume of involvement, was 0.44, and the ratio of lesion volume in the right lung of these patients was 0.27 (approximately 1.5 times more in the left lung than the right lung). On average, CTDIvol and DLP for all patients studied in our study were 11.22 ± 2.47 mGy and 354.20 ± 65.11 mGy.cm. Conclusion We reported the feasibility of using a treatment planning system in localizing COVID-19 pulmonary lesions and its validity in the volumetric assessment of infected lung regions.
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Calabrese EJ, Mattson MP, Dhawan G, Kapoor R, Calabrese V, Giordano J. Hormesis: A potential strategic approach to the treatment of neurodegenerative disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2020; 155:271-301. [PMID: 32854857 DOI: 10.1016/bs.irn.2020.03.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This review describes neuroprotective effects mediated by pre- and post-conditioning-induced processes that act via the quantitative features of the hormetic dose response. These lead to the development of acquired resilience that can protect neuronal systems from endogenous and exogenous stresses and insult. Particular attention is directed to issues of dose optimization, inter-individual variation, and potential ways to further study and employ hormetic-based preconditioning approaches in medical and public health efforts to treat and prevent neurodegenerative disease.
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Dhawan G, Kapoor R, Dhawan R, Singh R, Monga B, Giordano J, Calabrese EJ. Low dose radiation therapy as a potential life saving treatment for COVID-19-induced acute respiratory distress syndrome (ARDS). Radiother Oncol 2020; 147:212-216. [PMID: 32437820 PMCID: PMC7206445 DOI: 10.1016/j.radonc.2020.05.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/01/2020] [Accepted: 05/02/2020] [Indexed: 01/22/2023]
Abstract
The new coronavirus COVID-19 disease caused by SARS-CoV-2 was declared a global public health emergency by WHO on Jan 30, 2020. Despite massive efforts from various governmental, health and medical organizations, the disease continues to spread globally with increasing fatality rates. Several experimental drugs have been approved by FDA with unknown efficacy and potential adverse effects. The exponentially spreading pandemic of COVID-19 deserves prime public health attention to evaluate yet unexplored arenas of management. We opine that one of these treatment options is low dose radiation therapy for severe and most critical cases. There is evidence in literature that low dose radiation induces an anti-inflammatory phenotype that can potentially afford therapeutic benefit against COVID-19-related complications that are associated with significant morbidity and mortality. Herein, we review the effects and putative mechanisms of low dose radiation that may be viable, useful and of value in counter-acting the acute inflammatory state induced by critical stage COVID-19.
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Madan R, Kumar N, Gupta A, Gupta K, Salunke P, Khosla D, Yadav BS, Kapoor R. Effect of prophylactic granulocyte-colony stimulating factor (G-CSF) on acute hematological toxicity in medulloblastoma patients during craniospinal irradiation (CSI). Clin Neurol Neurosurg 2020; 196:105975. [PMID: 32505868 DOI: 10.1016/j.clineuro.2020.105975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/24/2020] [Accepted: 05/26/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Haematological toxicity and treatment breaks are common during cranio-spinal irradiation (CSI) due to irradiation of large volume of bone marrow. We conducted this study to see the effect of prophylactic granulocyte colony stimulating factor (GCSF) in reducing treatment breaks. PATIENTS AND METHODS The study was conducted over a period of 15 months from August 2017 to November 2018. Histopathologically proven Medulloblastoma patients received prophylactic GCSF during CSI. Acute hematological toxicities and treatment breaks were noted and effect of age and pretreatment blood counts were analyzed by SPSS (Statistical Package for Social Sciences) version 23. RESULTS A total of 28 patients were included in the study. During CSI, hematological toxicity leading to treatment breaks was observed in 11 (39.3 %) patients, of which grade 3 and 2 toxicities were seen in ten and one patients respectively. Younger age (<10 years) at diagnosis was significantly associated with the development of hematological toxicity (p = 0.028, Chi-Square). No correlation was found with pre-treatment blood counts. CONCLUSION Prophylactic use of GCSF may be effective in preventing radiation induced hematological toxicity and treatment breaks.
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Kapoor R, Dhatwalia S, Kumar R, Rani S, Parsad D. Emerging role of dermal compartment in skin pigmentation: comprehensive review. J Eur Acad Dermatol Venereol 2020; 34:2757-2765. [DOI: 10.1111/jdv.16404] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 03/03/2020] [Indexed: 12/16/2022]
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Agarwal N, Dave C, Patel R, Shukla R, Kapoor R, Bajpai A. Factors Associated With Cerebral Edema at Admission in Indian Children with Diabetic Ketoacidosis. Indian Pediatr 2020; 57:310-313. [PMID: 32038036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate the time course and predictors of cerebral edema in diabetic ketoacidosis (DKA). METHODS Review of hospital records of 107 episodes of DKA between January 2013 to March 2019. RESULTS Cerebral edema was identified in 26 (24.3%; 22 at presentation and 4 during treatment). Cerebral edema at presentation was associated with lower (<10 mmHg) arterial carbon dioxide (OR 3.6, 95% CI 1.0,12.7; P=0.04), prior fluid treatment (OR 4.7, 95% CI 1.8,12.7; P=0.001) and new onset diabetes (OR 3.5, 95% CI 1.1,11.1; P=0.03). Prior fluid was the only significant predictor on multivariate analysis (P=0.013). Cerebral edema resulted in a longer ICU stay [4.1 (2.3) vs 1.8 (0.9) d; P<0.001]. CONCLUSIONS Cerebral edema at admission is common in Indian children with DKA and should be suspected with severe metabolic acidosis and inappropriate prior fluid treatment.
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Agarwal N, Dave C, Patel R, Shukla R, Kapoor R, Bajpai A. Factors Associated With Cerebral Edema at Admission in Indian Children with Diabetic Ketoacidosis. Indian Pediatr 2020. [DOI: 10.1007/s13312-020-1781-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Calabrese EJ, Bhatia TN, Calabrese V, Dhawan G, Giordano J, Hanekamp YN, Kapoor R, Kozumbo WJ, Leak RK. Cytotoxicity models of Huntington’s disease and relevance of hormetic mechanisms: A critical assessment of experimental approaches and strategies. Pharmacol Res 2019; 150:104371. [DOI: 10.1016/j.phrs.2019.104371] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 12/17/2022]
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Tan AC, Emmett L, Lo S, Liu V, Kapoor R, Carlino MS, Guminski AD, Long GV, Menzies AM. FDG-PET response and outcome from anti-PD-1 therapy in metastatic melanoma. Ann Oncol 2019; 29:2115-2120. [PMID: 30137228 DOI: 10.1093/annonc/mdy330] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background Immune checkpoint inhibitor therapy has resulted in impressive and durable clinical activity for many cancers including melanoma; however, there remain few reliable predictors for long-term response. This study investigated whether [18F]2-fluoro-2-deoxy-D-glucose (FDG-PET) imaging may better predict long-term outcomes compared with standard computed tomography (CT) response criteria. Patients and methods Retrospective analysis of metastatic melanoma patients treated with anti-PD-1-based immunotherapy with baseline and 1-year FDG-PET and CT imaging at Melanoma Institute Australia. One-year response was determined using RECIST for CT and EORTC criteria for PET, coded as complete response (CR or CMR), partial response (PR or PMR), stable disease (SD or SMD) or progressive disease (PD or PMD). Progression-free survival (PFS) was determined from the 1-year landmark. Results Patients (n = 104) were evaluated with median follow-up 30.1 months and 98% remain alive. Most received anti-PD-1 as monotherapy (67%) or combined with ipilimumab (31%). At 1 year, 28% had CR, 66% had PR and 6% had SD on CT, while 75% had CMR, 16% PMR and 9% SMD/PMD on PET. CMR was observed in 68% of patients with PR on CT. RECIST PFS post 1-year landmark was similar in patients with CR versus PR/SD, but improved in patients with CMR versus non-CMR {median not reached [NR] versus 12.8 month; hazard ratio [HR] 0.06 [95% confidence interval (CI) 0.02-0.23]; P < 0.01}. In patients with PR on CT, PFS was improved in patients with PR + CMR versus PR + non-CMR (median NR versus 12.8 months; HR 0.07 [95% CI 0.02-0.27]; P < 0.01). In the 78 CMR patients, 78% had discontinued treatment and 96% had ongoing response. Conclusions Whilst only a small proportion of patients have a CR at 1 year, most patients with a PR have CMR on PET. Almost all patients with CMR at 1 year have ongoing response to therapy thereafter. PET may have utility in predicting long-term benefit and help guide discontinuation of therapy.
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Mishra K, Yanamandra U, Shukla A, Pramanik S, Kapoor R, Das S. Risk stratification of CML-CP in a real-world scenario, comparison of S.H.E. with rate of fall of BCR/ABL. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz427.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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