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Choudhary A, Pisulkar G, Taywade S, Awasthi AA, Salwan A. A Comprehensive Review of Total Hip Arthroplasty Outcomes in Post-traumatic Hip Arthritis: Insights and Perspectives. Cureus 2024; 16:e56350. [PMID: 38633974 PMCID: PMC11021999 DOI: 10.7759/cureus.56350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 03/17/2024] [Indexed: 04/19/2024] Open
Abstract
Post-traumatic hip arthritis presents a challenging condition characterized by degenerative changes in the hip joint following traumatic injury. Total hip arthroplasty (THA) is a cornerstone in managing this condition, offering significant pain relief, functional improvement, and enhanced quality of life. This comprehensive review aims to synthesize existing literature to elucidate the outcomes of THA in post-traumatic hip arthritis, exploring factors influencing surgical success and identifying areas for further research. Key findings reveal favourable clinical outcomes associated with THA, though considerations such as patient characteristics, surgical techniques, and implant selection impact outcomes. Implications for clinical practice underscore the importance of tailored preoperative assessment and ongoing advancements in surgical approaches and implant technology. Furthermore, opportunities for future research lie in long-term durability studies, patient-reported outcomes assessment, and exploration of innovative surgical techniques. Overall, THA emerges as a promising intervention for post-traumatic hip arthritis, yet continual refinement through research and innovation remains imperative to optimize patient care in this population.
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Affiliation(s)
- Abhishek Choudhary
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Gajanan Pisulkar
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shounak Taywade
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Abhiram A Awasthi
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ankur Salwan
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Mir YR, Agrahari AK, Hassan A, Choudhary A, Asthana S, Taneja AK, Nawaz S, Ilyas M, Scotti C, Kuchay RAH. Identification and structural characterization of a pathogenic ARSA missense variant in two consanguineous families from Jammu and Kashmir (India) with late infantile metachromatic leukodystrophy. Mol Biol Rep 2023; 51:30. [PMID: 38153581 DOI: 10.1007/s11033-023-09072-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 11/01/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Metachromatic leukodystrophy (MLD) is a rare lysosomal storage disorder caused by a deficiency of Arylsulfatase A (ARSA) enzyme activity. Its clinical manifestations include progressive motor and cognitive decline. ARSA gene mutations are frequent in MLD. METHODS AND RESULTS In the present study, whole exome sequencing (WES) was employed to decipher the genetic cause of motor and cognitive decline in proband's of two consanguineous families from J&K (India). Clinical investigations using radiological and biochemical analysis revealed MLD-like features. WES confirmed a pathogenic variant in the ARSA gene. Molecular simulation dynamics was applied for structural characterization of the variant. CONCLUSION We report the identification of a pathogenic missense variant (c.1174 C > T; p.Arg390Trp) in the ARSA gene in two cases of late infantile MLD from consanguineous families in Jammu and Kashmir, India. Our study utilized genetic analysis and molecular dynamics simulations to identify and investigate the structural consequences of this mutation. The molecular dynamics simulations revealed significant alterations in the structural dynamics, residue interactions, and stability of the ARSA protein harbouring the p.Arg390Trp mutation. These findings provide valuable insights into the molecular mechanisms underlying the pathogenicity of this variant in MLD.
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Affiliation(s)
- Yaser Rafiq Mir
- Department of Biotechnology, Baba Ghulam Shah Badshah University, Rajouri, J&K, 185234, India
| | - Ashish Kumar Agrahari
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Asima Hassan
- Department of Ophthalmology GMC Srinagar, Srinagar, J&K, India
| | | | - Shailendra Asthana
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Atul Kumar Taneja
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Shah Nawaz
- Department of Pediatrics, GMC Jammu, Jammu, J&K, India
| | | | - Claudia Scotti
- Department of Molecular Medicine, Unit of Immunology and General Pathology, University of Pavia, Pavia, Italy
| | - Raja A H Kuchay
- Department of Biotechnology, Baba Ghulam Shah Badshah University, Rajouri, J&K, 185234, India.
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Helgason H, Eiriksdottir T, Ulfarsson MO, Choudhary A, Lund SH, Ivarsdottir EV, Hjorleifsson Eldjarn G, Einarsson G, Ferkingstad E, Moore KHS, Honarpour N, Liu T, Wang H, Hucko T, Sabatine MS, Morrow DA, Giugliano RP, Ostrowski SR, Pedersen OB, Bundgaard H, Erikstrup C, Arnar DO, Thorgeirsson G, Masson G, Magnusson OT, Saemundsdottir J, Gretarsdottir S, Steinthorsdottir V, Thorleifsson G, Helgadottir A, Sulem P, Thorsteinsdottir U, Holm H, Gudbjartsson D, Stefansson K. Evaluation of Large-Scale Proteomics for Prediction of Cardiovascular Events. JAMA 2023; 330:725-735. [PMID: 37606673 PMCID: PMC10445198 DOI: 10.1001/jama.2023.13258] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 06/29/2023] [Indexed: 08/23/2023]
Abstract
Importance Whether protein risk scores derived from a single plasma sample could be useful for risk assessment for atherosclerotic cardiovascular disease (ASCVD), in conjunction with clinical risk factors and polygenic risk scores, is uncertain. Objective To develop protein risk scores for ASCVD risk prediction and compare them to clinical risk factors and polygenic risk scores in primary and secondary event populations. Design, Setting, and Participants The primary analysis was a retrospective study of primary events among 13 540 individuals in Iceland (aged 40-75 years) with proteomics data and no history of major ASCVD events at recruitment (study duration, August 23, 2000 until October 26, 2006; follow-up through 2018). We also analyzed a secondary event population from a randomized, double-blind lipid-lowering clinical trial (2013-2016), consisting of individuals with stable ASCVD receiving statin therapy and for whom proteomic data were available for 6791 individuals. Exposures Protein risk scores (based on 4963 plasma protein levels and developed in a training set in the primary event population); polygenic risk scores for coronary artery disease and stroke; and clinical risk factors that included age, sex, statin use, hypertension treatment, type 2 diabetes, body mass index, and smoking status at the time of plasma sampling. Main Outcomes and Measures Outcomes were composites of myocardial infarction, stroke, and coronary heart disease death or cardiovascular death. Performance was evaluated using Cox survival models and measures of discrimination and reclassification that accounted for the competing risk of non-ASCVD death. Results In the primary event population test set (4018 individuals [59.0% women]; 465 events; median follow-up, 15.8 years), the protein risk score had a hazard ratio (HR) of 1.93 per SD (95% CI, 1.75 to 2.13). Addition of protein risk score and polygenic risk scores significantly increased the C index when added to a clinical risk factor model (C index change, 0.022 [95% CI, 0.007 to 0.038]). Addition of the protein risk score alone to a clinical risk factor model also led to a significantly increased C index (difference, 0.014 [95% CI, 0.002 to 0.028]). Among White individuals in the secondary event population (6307 participants; 432 events; median follow-up, 2.2 years), the protein risk score had an HR of 1.62 per SD (95% CI, 1.48 to 1.79) and significantly increased C index when added to a clinical risk factor model (C index change, 0.026 [95% CI, 0.011 to 0.042]). The protein risk score was significantly associated with major adverse cardiovascular events among individuals of African and Asian ancestries in the secondary event population. Conclusions and Relevance A protein risk score was significantly associated with ASCVD events in primary and secondary event populations. When added to clinical risk factors, the protein risk score and polygenic risk score both provided statistically significant but modest improvement in discrimination.
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Affiliation(s)
- Hannes Helgason
- deCODE genetics/Amgen, Inc, Reykjavik, Iceland
- University of Iceland, Reykjavik, Iceland
| | | | - Magnus O. Ulfarsson
- deCODE genetics/Amgen, Inc, Reykjavik, Iceland
- University of Iceland, Reykjavik, Iceland
| | | | | | | | | | | | | | | | | | | | - Huei Wang
- Amgen, Inc, Thousand Oaks, California
| | | | - Marc S. Sabatine
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - David A. Morrow
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Robert P. Giugliano
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sisse Rye Ostrowski
- Department of Clinical Immunology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ole Birger Pedersen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Immunology, Zealand University Hospital, Køge, Denmark
| | - Henning Bundgaard
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - David O. Arnar
- deCODE genetics/Amgen, Inc, Reykjavik, Iceland
- University of Iceland, Reykjavik, Iceland
- Landspitali—The National University Hospital of Iceland, Reykjavik, Iceland
| | - Gudmundur Thorgeirsson
- deCODE genetics/Amgen, Inc, Reykjavik, Iceland
- University of Iceland, Reykjavik, Iceland
- Landspitali—The National University Hospital of Iceland, Reykjavik, Iceland
| | | | | | | | | | | | | | | | | | | | - Hilma Holm
- deCODE genetics/Amgen, Inc, Reykjavik, Iceland
| | - Daniel Gudbjartsson
- deCODE genetics/Amgen, Inc, Reykjavik, Iceland
- University of Iceland, Reykjavik, Iceland
| | - Kari Stefansson
- deCODE genetics/Amgen, Inc, Reykjavik, Iceland
- University of Iceland, Reykjavik, Iceland
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Choudhary A, Anand A, Singh A, Roy P, Singh N, Kumar V, Sharma S, Baranwal M. Machine learning-based ensemble approach in prediction of lung cancer predisposition using XRCC1 gene polymorphism. J Biomol Struct Dyn 2023:1-10. [PMID: 37545160 DOI: 10.1080/07391102.2023.2242492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 07/23/2023] [Indexed: 08/08/2023]
Abstract
The employment of machine learning approaches has shown promising results in predicting cancer. In the current study, polymorphisms data of five single nucleotide polymorphisms (SNPs) of DNA repair gene XRCC1 (XRCC1 399, XRCC1 194, XRCC1 206, XRCC1 632, XRCC1 280) of the north Indian population along with four smoking status data is considered as an input to the proposed ensemble model to predict the risk of individual susceptibility to the lung cancer. The prediction accuracy of the proposed ensemble model for cancer predisposition was found to be 85%. The model performance is also evaluated using sensitivity, specificity, precision and the Gini index, which is found in the range of 0.83-0.87. The proposed model also outperformed in all evaluation parameters when compared with the individual Model (LM, SVM, RF, KNN and baseline neural net). Collectively, current results suggest the potential of the proposed ensemble model in predicting the risk of cancer based on XRCC1 SNPs data.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Abhishek Choudhary
- Department of Computer Science, Thapar Institute of Engineering & Technology, India
| | - Adarsh Anand
- Department of Electronics & Communication Engineering, Thapar Institute of Engineering & Technology, India
| | - Amrita Singh
- Department of Biotechnology, Thapar Institute of Engineering & Technology, Patiala, Punjab, India
| | - Pratima Roy
- Department of Biotechnology, Thapar Institute of Engineering & Technology, Patiala, Punjab, India
| | - Navneet Singh
- Department of Pulmonary Medicine, Post Graduate Institute of Education and Medical Research (PGIMER), Chandigarh, India
| | - Vinay Kumar
- Department of Electronics & Communication Engineering, Thapar Institute of Engineering & Technology, India
| | - Siddharth Sharma
- Department of Biotechnology, Thapar Institute of Engineering & Technology, Patiala, Punjab, India
| | - Manoj Baranwal
- Department of Biotechnology, Thapar Institute of Engineering & Technology, Patiala, Punjab, India
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Ramesh R, Kayal S, Manivannan P, Choudhary A, Ganesan P, Sahadevan S, Dubashi B. 218P Prognostic role of apoptotic index in acute lymphoblastic leukemia. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
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Trinh LL, Vinh MKB, Choudhary A, Levitt BS, Kutty GR, Shieh EC, Nguyen KK, Trinh HN, Nguyen HA, Purohit TG. Endoscopic evaluation during the COVID-19 pandemic: Observational study of the experience in community practices. Medicine (Baltimore) 2022; 101:e30577. [PMID: 36123845 PMCID: PMC9477704 DOI: 10.1097/md.0000000000030577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Endoscopic screening is used widely to minimize the rates of colorectal cancer cases and deaths. During highly virulent infectious disease pandemics such as the coronavirus disease 2019 (COVID-19) pandemic, it is essential to weigh the risks and benefits of receiving endoscopy, especially in regions with moderately high viral infection rates. An observational study was conducted to assess the number of patients seen for endoscopic procedure at 2 of our surgery centers. Reasons for their procedure were collected in addition to information regarding any positive COVID-19 cases. This study considers the rate of severe acute respiratory syndrome coronavirus 2 infection along with the number of colorectal cancer cases encountered at a community endoscopy center to suggest that the benefits of undergoing endoscopic evaluation may outweigh the risks of attending an endoscopy procedure during the COVID-19 pandemic. One of the main reasons patients underwent endoscopic procedure was for colon cancer screenings (41.9%), and 5 of 1020 patients seen during the observation period were diagnosed with cancer. Of these 1020 patients, 8 were found to have positive tests for COVID-19 within 2 to 4 weeks after their procedure.
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Affiliation(s)
- Lindsey L. Trinh
- Silicon Valley Research Institute, San Jose, CA
- San Jose Gastroenterology, San Jose, CA
| | - Minh-Khang B. Vinh
- Silicon Valley Research Institute, San Jose, CA
- San Jose Gastroenterology, San Jose, CA
| | | | | | | | | | | | | | | | - Treta G. Purohit
- San Jose Gastroenterology, San Jose, CA
- *Correspondence: Treta Purohit, San Jose Gastroenterology, San Jose, CA, USA (e-mail: )
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Choudhary A, Kumar P, Sahu SK, Pradhan C, Singh SK, Gašparović M, Shukla A, Singh AK. Time Series Simulation and Forecasting of Air Quality Using In-situ and Satellite-Based Observations Over an Urban Region. Nat Env Poll Tech 2022. [DOI: 10.46488/nept.2022.v21i03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Air quality is directly associated with the health of society. So, it becomes essential to forecast air pollution, which assumes an imperative part in air pollution warnings and control. A time-series simulation approach was adapted for the forecasting of monthly mean ambient air pollutants (PM2.5, O3, NO2) concentration and Aerosol Optical Depth (AOD) at an urban traffic site (Mathura Road, CSIR-CRRI) in New Delhi, India. Satellite-based aerosol loading (AOD550) retrieved from the Terra MODIS (Collection 6) enhanced Deep Blue (DB) algorithm was used for further analysis. The analysis considered the average monthly mean concentration of air pollutants and AOD between 2012-2017 and, simulates the concentrations of PM2.5, O3, NO2, and AOD for the same period and then forecasts air quality for the years 2020-2023. The forecasted results were validated with 24 months of in-situ and satellite data from 2018-to and 2019. In the year 2020, observed and simulated results are in lower agreement due to the shutdown of anthropogenic activities to combat pandemic situations. Otherwise, modeled and forecasted results are in good harmony with the in-situ and satellite observations. The results also signify that the time series Autoregressive Integrated Moving Average (ARIMA) modeling approach can be an effective and simple tool for air pollution simulation and future forecast. The results are evocative concerning the forecast of near future aerosol loading information and will also be profound to address the problems.
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Choudhary A, Boudreaux B, Bhullar P, Nelson S, Mangold A, Iyer R. LB889 Risk stratification of squamous cell carcinoma using weakly supervised multitask learning of whole slide images. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Choudhary A, Sandhaus E, Zalawadiya S, Schwartz C, Ruzevich-Scholl S, Dutton A, Wigger M, Brinkley D, Menachem J, Shah A, Balsara K, Punnoose L, Sacks S, Ooi H, Pedrotty D, Hoffman J, McMaster W, Nguyen D, Lindenfeld J, Schlendorf K. Demographics and Utilization of Hepatitis C Hearts: A Single Center Experience. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Chawla A, Kriplani A, Pandit S, Choudhary A. Neutrophil-Lymphocyte Ratio (NLR), Platelet-Lymphocyte Ratio (PLR) and Lymphocyte-Monocyte Ratio (LMR) in predicting Systemic Inflammatory Response Syndrome (SIRS) and sepsis after Percutaneous Nephrolithotomy (PNL). Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00135-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Choi SE, Choudhary A, Huang J, Sonis S, Giuliano AR, Villa A. Increasing HPV vaccination coverage to prevent oropharyngeal cancer: A cost-effectiveness analysis. Tumour Virus Res 2021; 13:200234. [PMID: 34974194 PMCID: PMC8749055 DOI: 10.1016/j.tvr.2021.200234] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/29/2021] [Accepted: 12/17/2021] [Indexed: 11/07/2022] Open
Abstract
The incidence of oropharyngeal cancer (OPC) has been rising, especially among middle-aged men. While Human Papillomavirus (HPV) has been irrevocably implicated in the pathogenesis of oropharyngeal cancer (OPC), the current HPV vaccination uptake rate remains low in the US. The aim of our study was to evaluate the impact of increased HPV vaccination coverage on HPV-associated OPC incidence and costs. A decision analytic model was constructed for hypothetical cohorts of 9-year-old boys and girls. Two strategies were compared: 1) Maintaining the current vaccination uptake rates; 2) Increasing HPV vaccination uptake rates to the Healthy People 2030 target (80%) for both sexes. Increasing HPV vaccination coverage rates to 80% would be expected to prevent 5,339 OPC cases at a cost of $0.57 billion USD. Increased HPV vaccination coverage would result in 7,430 quality-adjusted life year (QALY) gains in the overall population, and it is estimated to be cost-effective for males with an incremental cost-effectiveness ratio of $86,940 per QALY gained under certain conditions. Expanding HPV vaccination rates would likely provide a cost-effective way to reduce the OPC incidence, particularly among males.
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Affiliation(s)
- Sung Eun Choi
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA.
| | - Abhishek Choudhary
- Office of Global and Community Health, Harvard School of Dental Medicine, Boston, MA, USA
| | - Jingyi Huang
- Office of Global and Community Health, Harvard School of Dental Medicine, Boston, MA, USA
| | - Stephen Sonis
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital and Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer (CIIRC) at the Moffitt Cancer Center, Tampa, FL, USA
| | - Alessandro Villa
- Department of Orofacial Sciences, University of California San Francisco, San Francisco, CA, USA
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Choi SE, Choudhary A, Ahern JM, Palmer N, Barrow JR. Association between maternal periodontal disease and adverse pregnancy outcomes: an analysis of claims data. Fam Pract 2021; 38:718-723. [PMID: 34173655 DOI: 10.1093/fampra/cmab037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND While a number of studies have explored the link between periodontal disease and adverse pregnancy outcomes, both epidemiological studies and intervention trials have reached contradictory results with relatively small sample sizes. Utilizing large-scale claims data, we aim to investigate the association between maternal periodontal disease and adverse pregnancy outcomes. OBJECTIVE Utilizing large-scale claims data, we aim to investigate the association between maternal periodontal disease and adverse pregnancy outcomes. METHODS Using de-identified claims data from a national commercial insurer in the USA, records of all observed pregnancies from 2015 to 2019 were included in this retrospective cohort study. Adverse pregnancy outcomes, including low birthweight (LBW) of the newborn, preterm birth (PTB) and spontaneous abortion, were primary outcomes. To evaluate the association between periodontal disease and pregnancy outcomes, logistic mixed-effect model was estimated with periodontal disease status, age, existing clinical conditions of mothers and geographic location as covariates. RESULTS Out of 748 792 observed pregnancy records, 18.66% resulted in adverse pregnancy outcomes; 5.92% in LBW, 14.46% in PTB and 2.22 % in spontaneous abortion. Adjusting for individual-level risk factors, periodontal disease was significantly associated with maternal complications with odds ratios of 1.19 (95% CI:1.15, 1.24) for any adverse pregnancy outcomes, 1.10 (95% CI:1.03, 1.17) for LBW, 1.15 (95% CI:1.10, 1.19) for PTB and 1.34 (95% CI:1.23, 1.46) for spontaneous abortions. CONCLUSIONS Maternal periodontal disease may be associated with an increased risk of maternal complications and neonatal morbidity. A timely diagnosis and treatment of periodontal disease during pregnancy should be encouraged by considering oral health as part of routine prenatal care.
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Affiliation(s)
- Sung Eun Choi
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, USA
| | - Abhishek Choudhary
- Office of Global and Community Health, Harvard School of Dental Medicine, Boston, USA
| | - John M Ahern
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, USA
| | - Nathan Palmer
- Department of Biomedical Informatics, Harvard Medical School, Boston, USA
| | - Jane R Barrow
- Office of Global and Community Health, Harvard School of Dental Medicine, Boston, USA
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Simon L, Choudhary A, Ticku S, Barrow J, Tobey M. Dental care utilization in Massachusetts before and after initiation of medication for opioid use disorder: A cross-sectional study of a state all-payer claims database. J Public Health Dent 2021; 82:461-467. [PMID: 34816438 DOI: 10.1111/jphd.12488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 11/02/2021] [Accepted: 11/10/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Individuals with opioid use disorder (OUD) are at higher risk of poor oral health. Medication for opioid use disorder (MOUD) has been shown to improve outcomes for patients with OUD, but it is unknown how initiation of MOUD affects access to oral health services. METHODS This was a retrospective analysis of all individuals in the Massachusetts All-Payer Claims Database prescribed oral buprenorphine-naloxone or injectable naltrexone from 2013 to 2016. We evaluated dental utilization in the year before and after beginning MOUD. A logistic regression predicting dental utilization was conducted. RESULTS Among the 54,791 individuals, rates of dental utilization were low both before and after MOUD (10.5% and 10% with a dental visit, respectively). Of those who did not have a dental visit in the year before starting MOUD, 95.1% did not have a dental visit in the year after. Rates of various procedure types were comparable before and after MOUD. In a logistic regression, a prior dental visit was associated with 9.82 times the odds (95% CI 9.14-10.55) of having a dental visit after starting MOUD; increasing age, being prescribed naltrexone, having a mood disorder or HIV, year of initiation or being on Medicaid were also associated with having a dental visit. Male patients and those with Medicare or private insurance were less likely to have a dental visit. CONCLUSIONS Initiating MOUD did not substantially result in increased dental access or substantial changes in dental procedures received. Patients receiving treatment for OUD may require additional support to access dental care.
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Affiliation(s)
- Lisa Simon
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Abhishek Choudhary
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Shenam Ticku
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Jane Barrow
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Matthew Tobey
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Chawla A, Mummlaneni S, Jaidevareddy S, Choudhary A. Direct visual internal urethrotomy versus non-transecting urethroplasty for short segment non traumatic bulbar urethral strictures – a non-randomised prospective observational study from university teaching institution. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00793-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Choudhary A, Choudhary DS, Ghatak S. Estimation of Fertilization Rate, Implantation Rate, Pregnancy Rate and Live Birth Rate in Intracytoplasmic Sperm Injection in Association with Number of Attempts and Sperm Morphology. Mymensingh Med J 2021; 30:531-537. [PMID: 33830139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Infertility is a growing health problem. It affects relatively large number of couples both globally as well as in India. Fertility treatment registers suggest that infertility is on increase. With the advancement in the knowledge and technology about the In Vitro fertilization (IVF) process, In Vitro fertilization success rates are improving over the time. In many cases of male-factor infertility, Intracytoplasmic sperm injection (ICSI) is the recommended treatment. The aim of this study was to estimate fertilization, implantation and pregnancy rates in ICSI cycles in association with number of attempts and sperm morphology. A total of 250 IVF-ICSI cycles were performed at a Fertility Center in Jaipur, Rajasthan, India. This cohort study was performed during 2013 to 2015. The differences in the outcomes of ICSI in association with sperm morphology and number of ICSI attempt were evaluated. Significantly higher mean was observed in fertilization rate and live birth rate with ≥5% sperm morphology 79.63% vs. 71.46% and 20% vs. 13.9% respectively). Significantly higher mean implantation rate and clinical pregnancy rate (CPR) and live birth rate were observed with attempt 3 as compared to 1 and 2 attempts. IVF success rates are improving over the time as knowledge and technology are advancing. Sperm morphology and number of attempt affect the ICSI outcomes.
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Affiliation(s)
- A Choudhary
- Dr Anju Choudhary, Senior Resident, Department of Anatomy, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India; E-mail:
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Barakat MT, Girotra M, Huang RJ, Choudhary A, Thosani NC, Kothari S, Sethi S, Banerjee S. Goff Septotomy Is a Safe and Effective Salvage Biliary Access Technique Following Failed Cannulation at ERCP. Dig Dis Sci 2021; 66:866-872. [PMID: 32052216 DOI: 10.1007/s10620-020-06124-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 01/29/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Biliary cannulation is readily achieved in > 85% of patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). When standard cannulation techniques fail, salvage techniques utilized include the needle knife precut, double wire technique, and Goff septotomy. METHODS Records of patients undergoing ERCP from 2005 to 2016 were retrospectively examined using a prospectively maintained endoscopy database. Patients requiring salvage techniques for biliary access were analyzed together with a control sample of 20 randomly selected index ERCPs per study year. Demographic and clinical variables including indications for ERCP, cannulation rates, and adverse events were collected. RESULTS A total of 7984 patients underwent ERCP from 2005 to 2016. Biliary cannulation was successful in 94.9% of control index ERCPs, 87.2% of patients who underwent Goff septotomy (significantly higher than for all other salvage techniques, p ≤ 0.001), 74.5% of patients in the double wire group and 69.6% of patients in the needle knife precut group. Adverse event rates were similar in the Goff septotomy (4.1%) and index ERCP control sample (2.7%) groups. Adverse events were significantly higher in the needle knife group (27.2%) compared with all other groups. CONCLUSIONS This study represents the largest study to date of Goff septotomy as a salvage biliary access technique. It confirms the efficacy of Goff septotomy and indicates a safety profile similar to standard cannulation techniques and superior to the widely employed needle knife precut sphincterotomy. Our safety and efficacy data suggest that Goff septotomy should be considered as the primary salvage approach for failed cannulation, with needle knife sphincterotomy restricted to Goff septotomy failures.
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Affiliation(s)
- Monique T Barakat
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, MC 5244, Stanford, CA, 94305, USA
| | - Mohit Girotra
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, MC 5244, Stanford, CA, 94305, USA
| | - Robert J Huang
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, MC 5244, Stanford, CA, 94305, USA
| | - Abhishek Choudhary
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, MC 5244, Stanford, CA, 94305, USA
| | - Nirav C Thosani
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, MC 5244, Stanford, CA, 94305, USA
| | - Shivangi Kothari
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, MC 5244, Stanford, CA, 94305, USA
| | - Saurabh Sethi
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, MC 5244, Stanford, CA, 94305, USA
| | - Subhas Banerjee
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, MC 5244, Stanford, CA, 94305, USA.
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Choi SE, Choudhary A, Sonis S, Villa A. Benefits of the Involvement of Dentists in Managing Oral Complications Among Patients With Oral Cavity and Oropharyngeal Cancer: An Analysis of Claims Data. JCO Oncol Pract 2021; 17:e1668-e1677. [PMID: 33555929 DOI: 10.1200/op.20.00892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Patients with oral cancer and oropharyngeal cancer frequently develop treatment-related oral complications that negatively affect patients' quality-of-life, cost, and health outcomes. We investigated whether the provider specialty affected the costs and treatment duration of managing oral complications. METHODS Using deidentified claims from a commercial insurer from 2008 to 2019, we compared costs and duration of common oral complication management between patients whose care included a dentist, with those whose care did not include a dentist. Our primary outcomes were treatment cost and duration. Multivariate linear regression models were used to evaluate the relationship between the primary outcomes and involvement of dentists. Separate analyses were conducted for acute and chronic oral complications. RESULTS Involvement of dentists in oral complications management resulted in lower costs and shorter treatment duration for acute complications on average. For chronic complications, when dentists were involved, the average cost was higher by $1,672 (USD) (95% CI, 1,124 to 2,219), but the average treatment duration was shorter by 74 days (95% CI, 62 to 84). When complications were acute, dentists' intervention was beneficial for dentofacial functional abnormalities, disorders of teeth and supporting structures, stomatitis and mucositis (ulcerative), and thrush, in terms of both costs and duration. Among chronic complications, dental caries was the only complication type that resulted in lower cost and shorter treatment duration with dentists' involvement. CONCLUSION Oral complications of cancer therapy incur a significant financial and clinical burden. Involvement of dentists results in shorter treatment duration, while lowering the financial burden of care for certain complication types.
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Affiliation(s)
- Sung Eun Choi
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA
| | - Abhishek Choudhary
- Office of Global and Community Health, Harvard School of Dental Medicine, Boston, MA
| | - Stephen Sonis
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital and Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA
| | - Alessandro Villa
- Department of Orofacial Sciences, University of California San Francisco, San Francisco, CA
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Abstract
Abstract
Background
Acute cellular rejection remains a major cause of morbidity after heart transplantation with up to 30% of patients experiencing at least one rejection episode during the first year. Unfortunately, the mechanism underling rejection remains poorly understood and the gold standard for diagnosing rejection remains frequent cardiac biopsy for rejection surveillance – a process that is both invasive and costly.
Purpose
PD-L1 is a co-inhibitory transmembrane protein that interacts with PD-1 on T cells to inhibit T cell activation. Endothelial PD-L1 expression in the heart has been shown in mouse models to play a key role in attenuating immune-mediated cardiac disease like myocarditis. Recent data that anti-PD-1 and anti-PD-L1 therapy can lead to myocarditis further supports a role for PD-1/PD-L1 signaling in cardiovascular homeostasis. We hypothesize that PD-L1 expression correlates with rejection severity.
Methods
Endomyocardial biopsy from a cohort of 19 heart transplant patients were analyzed for PD-L1 expression using immunohistochemistry and image analysis with HALO software. Each patient had biopsies corresponding to 0R, 1R, and 2R grades of rejection (n=57) and thus each patient served as their own internal control. Detailed clinical data was also collected on these patients from the electronic medical record.
Results
Average PD-L1 levels associated with 0R (n=19), 1R (n=21), and 2R (n=17) rejection were 1.54, 9.15, and 18.90 respectively (P<0.001). In patients who were treated for 2R rejection with increased immunosuppression (n=9), PD-L1 levels decreased from an average of 21.72 before treatment to an average of 5.64 after treatment (P<0.05). A multiple regression was run to see if PD-L1 level was associated with right heart pressures, EKG intervals, echo data, or common lab values. Accounting for age, race, and sex, it was found that PD-L1 was significantly associated with PA pressure (P<0.01, beta = 0.45), PCW pressure (P<0.01, beta = 0.42), and BNP (P<0.01, beta = 0.55).
Conclusions
Upregulation of PD-L1 in the heart is strongly associated with severity of cellular rejection after heart transplantation. Successful treatment of rejection with immunosuppression decreases PD-L1 levels. These data suggest that PD-L1 is a potential biomarker for heart transplant rejection. Further correlation of PD-L1 levels with signs of right heart strain (increased PA and PCW pressure) and systolic dysfunction (BNP) supports a clinical picture of PD-L1 as a useful biomarker for detecting both cellular rejection and reversal of rejection after treatment.
Cohort identification and results
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Institutes of Health grants R56 HL141466 and R01 HL141466
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Affiliation(s)
- A Choudhary
- Vanderbilt University Medical Center, Department of Medicine, Nashville, United States of America
| | - W Meijers
- Vanderbilt University Medical Center, Department of Medicine, Nashville, United States of America
| | - S Besharati
- Johns Hopkins University School of Medicine, Department of Pathology, Baltimore, United States of America
| | - Q Zhu
- Johns Hopkins University School of Medicine, Department of Pathology, Baltimore, United States of America
| | - J Lindenfeld
- Vanderbilt University Medical Center, Department of Medicine, Nashville, United States of America
| | - M Brinkley
- Vanderbilt University Medical Center, Department of Medicine, Nashville, United States of America
| | - R Anders
- Johns Hopkins University School of Medicine, Department of Pathology, Baltimore, United States of America
| | - J Moslehi
- Vanderbilt University Medical Center, Department of Medicine, Nashville, United States of America
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Choudhary A, Martha SC, Chakrabarti A. Modified Method for the Solution of Dual Trigonometric Series Relations. Proc Natl Acad Sci , India, Sect A Phys Sci 2020. [DOI: 10.1007/s40010-019-00600-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Koyyala V, Jajodia A, Gupta A, Chaturvedhi A, Rao A, Goyal S, Mehta A, Prosch H, Pasricha S, Choudhary A, La Mantia M, BP A, Gupta N, Singh S. P-189 Role of radiomics in clinical prognostication and prediction of survival among a cohort of metastatic intrahepatic cholangiocarcinoma. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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21
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Taleb I, Wever-Pinzon O, Alharethi R, Overton S, Nativi-Nicolau J, Dranow E, Kemeyou L, Choudhary A, Kfoury A, Caine W, McKellar S, Stehlik J, Fang J, Selzman C, Drakos S, Koliopoulou A. Predicting Right Ventricular Failure in Chronic Heart Failure Patients Receiving Left Ventricular Assist Device. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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22
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Hamade N, Desai M, Thoguluva Chandrasekar V, Chalhoub J, Patel M, Duvvuri A, Gorrepati VS, Jegadeesan R, Choudhary A, Sathyamurthy A, Rai T, Gupta N, Sharma P. Efficacy of cryotherapy as first line therapy in patients with Barrett's neoplasia: a systematic review and pooled analysis. Dis Esophagus 2019; 32:5487971. [PMID: 31076753 DOI: 10.1093/dote/doz040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/16/2019] [Indexed: 12/11/2022]
Abstract
Cryotherapy has been used as salvage therapy; however, its efficacy as first line treatment in patients with Barrett's esophagus (BE) neoplasia has not been well studied. The aim of this paper was to perform a systematic review to look at the efficacy of cryotherapy as the primary treatment of BE. An electronic database search was performed (PubMed, Embase, Cochrane, and Google Scholar) to search for studies with cryotherapy as the initial primary modality of ablation in patients with BE neoplasia. Studies that included patients with other prior forms of therapy were excluded. The primary outcomes were the pooled rates of complete eradication of intestinal metaplasia (CE-IM) and CE of neoplasia (CE-N). Secondary outcomes were recurrence rates of neoplasia and intestinal metaplasia (IM) and adverse events. The statistical software OpenMetaAnalyst was used for analysis with pooled estimates reported as proportions (%) with 95% confidence intervals (CI) with heterogeneity (I2) among studies. The search revealed 6 eligible studies with a total of 282 patients (91.5% male, average age 65.3 years) with 459 person years of follow-up. 69.35% [95% CI (52.1%-86.5%)] of patients achieved CE-IM and 97.9% (95% CI: 95.5%-100%) had CE-N. 7.3% of patients had persistent dysplasia with 4% progressing to cancer. The recurrence rate of neoplasia was 10.4 and that of IM was 19.1 per 100 patient years of follow-up. The overall rate of stricture formation was 4.9%. There are scarce data on the use of cryotherapy as the primary modality for the treatment of BE dysplasia. The published data demonstrate efficacy rates of 69% and 98% for complete eradication of metaplasia and neoplasia, respectively. These results need to be assessed in prospective, comparative trials with other forms of therapy.
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Affiliation(s)
| | - M Desai
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS
| | - V Thoguluva Chandrasekar
- Gastroenterology and Hepatology.,Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS
| | - J Chalhoub
- Division of gastroenterology, baystate medical center
| | - M Patel
- Gastroenterology and Hepatology
| | | | - V S Gorrepati
- Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, MO
| | | | - A Choudhary
- Division of gastroenterology, kansas city veteran's affair medical center
| | - A Sathyamurthy
- Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, MO
| | - T Rai
- Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, MO
| | - N Gupta
- Gastroenterology and Hepatology, Loyola University Medical Center, Maywood, IL, USA
| | - P Sharma
- Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, MO
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23
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Jegadeesan R, Aziz M, Desai M, Sundararajan T, Gorrepati VS, Chandrasekar VT, Jayaraj M, Singh P, Saeed A, Rai T, Choudhary A, Repici A, Hassan C, Fuccio L, Sharma P. Hot snare vs. cold snare polypectomy for endoscopic removal of 4 - 10 mm colorectal polyps during colonoscopy: a systematic review and meta-analysis of randomized controlled studies. Endosc Int Open 2019; 7:E708-E716. [PMID: 31073538 PMCID: PMC6506415 DOI: 10.1055/a-0808-3680] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 10/03/2018] [Indexed: 02/07/2023] Open
Abstract
Introduction In recent years, cold snare polypectomy (CSP) has increasingly been used over hot snare polypectomy (HSP) for the removal of colorectal polyps (4 - 10 mm in size). However, the optimal technique (CSP vs. HSP), in terms of complete polyp resection and complications, is uncertain. Our aim was to compare incomplete resection rate (IRR) of polyps and complications using CSP vs. HSP. Methods Randomized controlled studies (RCTs) comparing CSP and HSP for removal of 4 - 10 mm colorectal polyps were considered. Studies were included in the analysis if they obtained biopsy specimens from the resection margin to confirm the absence of residual tissue and reported complications. IRR and complication rate were the outcome measures. Pooled rates were reported as Odds Ratios (OR) or risk difference with 95 % Confidence Interval (CI). Results In total, three RCTs were included in the final analysis. A total of 1051 patients with 1485 polyps were randomized to either HSP group (n = 741 polyps) or CSP group (n = 744 polyps). The overall IRR did not differ between the two groups (HSP vs. CSP: 2.4 % vs. 4.7 %; OR 0.51, 95 %CI 0.13 - 1.99, P = 0.33, I 2 = 73 %). The HSP group had a lower rate of overall complications compared to the CSP group (3.7 % vs. 6.6 %; OR 0.53, 95 % CI 0.3 - 0.94, P = 0.03, I 2 = 0 %). Polyp retrieval rates were not different between the two groups (99 % vs. 98.1 %). Conclusion Our results suggest that HSP and CSP techniques can be effectively used for the complete removal of 4 - 10 mm colorectal polyps; however, HSP has a lower incidence of overall complications.
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Affiliation(s)
- Ramprasad Jegadeesan
- Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, KS, USA,Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, KS, USA
| | - Muhammad Aziz
- Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, KS, USA,Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, KS, USA
| | - Madhav Desai
- Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, KS, USA,Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, KS, USA
| | - Tharani Sundararajan
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, KS, USA
| | | | - Viveksandeep Thogulva Chandrasekar
- Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, KS, USA,Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, KS, USA
| | - Mahendran Jayaraj
- Division of Gastroenterology, University of Nevada, Las Vegas, NV, USA
| | - Pratiksha Singh
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, KS, USA
| | - Ahmed Saeed
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, KS, USA
| | - Tarun Rai
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, KS, USA
| | - Abhishek Choudhary
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, KS, USA
| | - Alessandro Repici
- Division of Gastroenterology, Humanitas Research Hospital & Humanitas University, Milan, Italy
| | - Cesare Hassan
- Nuovo Regina Margherita Hospital, Digestive Endoscopy Unit, Rome, Italy
| | - Lorenzo Fuccio
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Prateek Sharma
- Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, KS, USA,Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, KS, USA,Corresponding author Prateek Sharma, MD Department of Gastroenterology/Hepatology and MotilityUniversity of Kansas Medical CenterKansas CityKSUSA+1-913-588-3877
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24
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Wani S, Keswani RN, Han S, Aagaard EM, Hall M, Simon V, Abidi WM, Banerjee S, Baron TH, Bartel M, Bowman E, Brauer BC, Buscaglia JM, Carlin L, Chak A, Chatrath H, Choudhary A, Confer B, Coté GA, Das KK, DiMaio CJ, Dries AM, Edmundowicz SA, Chafic AHE, Hajj IE, Ellert S, Ferreira J, Gamboa A, Gan IS, Gangarosa LM, Gannavarapu B, Gordon SR, Guda NM, Hammad HT, Harris C, Jalaj S, Jowell PS, Kenshil S, Klapman J, Kochman ML, Komanduri S, Lang G, Lee LS, Loren DE, Lukens FJ, Mullady D, Muthusamy VR, Nett AS, Olyaee MS, Pakseresht K, Perera P, Pfau P, Piraka C, Poneros JM, Rastogi A, Razzak A, Riff B, Saligram S, Scheiman JM, Schuster I, Shah RJ, Sharma R, Spaete JP, Singh A, Sohail M, Sreenarasimhaiah J, Stevens T, Tabibian JH, Tzimas D, Uppal DS, Urayama S, Vitterbo D, Wang AY, Wassef W, Yachimski P, Zepeda-Gomez S, Zuchelli T, Early D. Competence in Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography, From Training Through Independent Practice. Gastroenterology 2018; 155:1483-1494.e7. [PMID: 30056094 PMCID: PMC6504935 DOI: 10.1053/j.gastro.2018.07.024] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 07/18/2018] [Accepted: 07/21/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND & AIMS It is unclear whether participation in competency-based fellowship programs for endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) results in high-quality care in independent practice. We measured quality indicator (QI) adherence during the first year of independent practice among physicians who completed endoscopic training with a systematic assessment of competence. METHODS We performed a prospective multicenter cohort study of invited participants from 62 training programs. In phase 1, 24 advanced endoscopy trainees (AETs), from 20 programs, were assessed using a validated competence assessment tool. We used a comprehensive data collection and reporting system to create learning curves using cumulative sum analysis that were shared with AETs and trainers quarterly. In phase 2, participating AETs entered data into a database pertaining to every EUS and ERCP examination during their first year of independent practice, anchored by key QIs. RESULTS By the end of training, most AETs had achieved overall technical competence (EUS 91.7%, ERCP 73.9%) and cognitive competence (EUS 91.7%, ERCP 94.1%). In phase 2 of the study, 22 AETs (91.6%) participated and completed a median of 136 EUS examinations per AET and 116 ERCP examinations per AET. Most AETs met the performance thresholds for QIs in EUS (including 94.4% diagnostic rate of adequate samples and 83.8% diagnostic yield of malignancy in pancreatic masses) and ERCP (94.9% overall cannulation rate). CONCLUSIONS In this prospective multicenter study, we found that although competence cannot be confirmed for all AETs at the end of training, most meet QI thresholds for EUS and ERCP at the end of their first year of independent practice. This finding affirms the effectiveness of training programs. Clinicaltrials.gov ID NCT02509416.
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Affiliation(s)
- Sachin Wani
- University of Colorado Anschutz Medical Center, Aurora, Colorado.
| | - Rajesh N. Keswani
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Samuel Han
- University of Colorado Anschutz Medical Center, Aurora, Colorado
| | | | | | - Violette Simon
- University of Colorado Anschutz Medical Center, Aurora, Colorado
| | | | | | - Todd H. Baron
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michael Bartel
- Mayo Clinic School of Graduate Medical Education, Jacksonville, Florida
| | | | - Brian C. Brauer
- University of Colorado Anschutz Medical Center, Aurora, Colorado
| | | | - Linda Carlin
- University of Colorado Anschutz Medical Center, Aurora, Colorado
| | - Amitabh Chak
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Hemant Chatrath
- University of California-Los Angeles, Los Angeles, California
| | | | | | - Gregory A. Coté
- Medical University of South Carolina, Charleston, South Carolina
| | | | | | | | | | | | | | - Swan Ellert
- University of Colorado Anschutz Medical Center, Aurora, Colorado
| | - Jason Ferreira
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Ian S. Gan
- Virginia Mason Medical Center, Seattle, Washington
| | - Lisa M. Gangarosa
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | | | | | - Hazem T. Hammad
- University of Colorado Anschutz Medical Center, Aurora, Colorado
| | - Cynthia Harris
- Moffitt Cancer Center, University of South Florida, Tampa, Florida
| | - Sujai Jalaj
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Sana Kenshil
- University of Alberta, Edmonton, Alberta, Canada
| | - Jason Klapman
- Moffitt Cancer Center, University of South Florida, Tampa, Florida
| | | | - Srinadh Komanduri
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Gabriel Lang
- Washington University in St Louis, St Louis, Missouri
| | - Linda S. Lee
- Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Frank J. Lukens
- Mayo Clinic School of Graduate Medical Education, Jacksonville, Florida
| | | | | | | | | | | | | | | | | | | | | | | | - Brian Riff
- Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Shreyas Saligram
- Moffitt Cancer Center, University of South Florida, Tampa, Florida
| | | | | | - Raj J. Shah
- University of Colorado Anschutz Medical Center, Aurora, Colorado
| | - Rishi Sharma
- University of California-Davis, Davis, California
| | | | - Ajaypal Singh
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Muhammad Sohail
- University of Massachusetts Medical Center, Worcester, Massachusetts
| | | | | | | | | | - Dushant S. Uppal
- University of Virginia School of Medicine, Charlottesville, Virginia
| | | | | | - Andrew Y. Wang
- University of Virginia School of Medicine, Charlottesville, Virginia
| | - Wahid Wassef
- University of Massachusetts Medical Center, Worcester, Massachusetts
| | | | | | | | - Dayna Early
- Washington University in St Louis, St Louis, Missouri
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Maity G, Haque I, Ghosh A, Dhar G, Gupta V, Sarkar S, Azeem I, McGregor D, Choudhary A, Campbell DR, Banerjee SK, Banerjee S. Abstract 3345: MAZ is a downstream target of CCN1 and promotes aggressive behavior of pancreatic cancer cells via CRAF-ERK signaling pathway. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-3345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
MAZ (Myc-associated zinc-finger protein) is a transcription factor with dual roles in transcription initiation and termination. Deregulation of MAZ expression has been shown to associate with the progression of pancreatic ductal adenocarcinoma cancer (PDAC). However, underlying mechanisms of action of MAZ in PDAC progression are largely unknown. Here we present evidence that MAZ mRNA expression and protein level were increased in human PDAC cell lines, tissue samples, subcutaneous tumor xenograft model in a nude mouse, and spontaneous cancer in the genetically engineered PDAC mouse model. We found that MAZ is predominantly expressed in pancreatic cancer stem cells. Functional analysis demonstrates that the depletion of MAZ in PDAC cells results in inhibition of invasive phenotypes such as phenotypic shift, migration, invasion, and the sphere-forming ability of PDAC cells. Mechanistically, we found no direct effect of MAZ on the expression of K-Ras mutants, but evidently MAZ increases the activity of CRAF-ERK-signaling, which is a downstream signaling target of K-Ras. Activation of CRAF-ERK-signaling by MAZ is mediated via p21-activated protein kinases (PAK) and protein kinase B (AKT/PKB) signaling cascades and promotes invasive phenotypes of PDAC cells. Moreover, a matricellular oncoprotein CCN1 regulates MAZ expression in PDAC cells. Thereby, we proposed that CCN1-induced expression of MAZ promotes invasive phenotypes of PDAC cells is not through direct K-Ras activation as presently thought but instead through the activation of CRAF-ERK signals. Collectively, these studies highlight key players that could help in clinical management, prognosis, and therapeutic strategies.
This project is funded by VA Merit Award grants (SB & SKB).
Citation Format: Gargi Maity, Inamul Haque, Arnab Ghosh, Gopal Dhar, Vijayalaxmi Gupta, Sandipto Sarkar, Imaan Azeem, Douglas McGregor, Abhishek Choudhary, Donald R Campbell, Sushanta K. Banerjee, Snigdha Banerjee. MAZ is a downstream target of CCN1 and promotes aggressive behavior of pancreatic cancer cells via CRAF-ERK signaling pathway [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 3345.
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Sukriti S, Maras JS, Bihari C, Das S, Vyas AK, Sharma S, Hussain S, Shasthry S, Choudhary A, Premkumar M, Kumar D, Kumar G, Mukhopadhyay C, Kumar A, Trehanpati N, Rautou PE, Moreau R, Sarin SK. Microvesicles in hepatic and peripheral vein can predict nonresponse to corticosteroid therapy in severe alcoholic hepatitis. Aliment Pharmacol Ther 2018; 47:1151-1161. [PMID: 29460445 DOI: 10.1111/apt.14564] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 10/08/2017] [Accepted: 01/22/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Severe alcoholic hepatitis patients have high mortality and limited response to corticosteroids. Microvesicles reflect cellular stress and disease conditions. AIMS To investigate whether microvesicles are associated with severity, response to steroid therapy and inflammation in severe alcoholic hepatitis. METHODS Microvesicles originating from different cells were studied pre-therapy in 101 patients; (71 responder to corticosteroid therapy and 30 nonresponders) and 20 healthy controls. Microvesicles and cells were determined in peripheral and hepatic vein samples using flow cytometry and correlated with outcomes. Inflammatory signalling pathways and functional alterations of immune cells after stimulation with microvesicles were also investigated. RESULTS Microvesicles mean levels were higher in nonresponders for T cells (CD3+ CD4+ ; 10.1 MV/μL vs 5.4; P = 0.06), macrophages (CD68+ CD11b+ ; 136.5 vs 121.9 MV/μL; P = 0.01), haematopoietic stem-cells (CD45+ CD34+ ; 116.8 vs 13.4 MV/μL; P = 0.0001) and hepatocytes (ASGPR+ ; 470 vs 361 MV/μL; P = 0.01); the latter two predicting steroid nonresponse in 94% patients at baseline in peripheral plasma. Microvesicle levels correlated with histological and liver disease severity indices. Whereas, in non-responders hepatic vein CD34+ cells were lower (P = 0.02), the CD34+ microvesicles there from were higher (P = 0.04), thus suggesting impaired regeneration. Also, microvesicles of 0.2-0.4 μm size were higher in nonresponders (P < 0.03) at baseline. Microvesicles from patients trigger more (P = 0.04) ROS generation, TNF-α production (P = 0.04) and up-regulate pro-inflammatory cytokine related genes in neutrophils in vitro. CONCLUSIONS Pre-therapy peripheral plasma levels of CD34+ and ASGPR+ microvesicles are reliable non-invasive markers of steroid nonresponse and mortality in patients with severe alcoholic hepatitis.
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Affiliation(s)
- S Sukriti
- Department of Molecular and cellular medicine, Institute of Liver and Biliary Sciences, Delhi, India
| | - J S Maras
- Department of Molecular and cellular medicine, Institute of Liver and Biliary Sciences, Delhi, India
| | - C Bihari
- Department of Pathology, Institute of Liver and Biliary Sciences, Delhi, India
| | - S Das
- Department of Molecular and cellular medicine, Institute of Liver and Biliary Sciences, Delhi, India
| | - A K Vyas
- Department of Molecular and cellular medicine, Institute of Liver and Biliary Sciences, Delhi, India
| | - S Sharma
- Department of Molecular and cellular medicine, Institute of Liver and Biliary Sciences, Delhi, India
| | - S Hussain
- Department of Molecular and cellular medicine, Institute of Liver and Biliary Sciences, Delhi, India
| | - S Shasthry
- Department of Hepatology, Institute of Liver and Biliary Sciences, Delhi, India
| | - A Choudhary
- Department of Hepatology, Institute of Liver and Biliary Sciences, Delhi, India
| | - M Premkumar
- Department of Hepatology, Institute of Liver and Biliary Sciences, Delhi, India
| | - D Kumar
- Department of Molecular and cellular medicine, Institute of Liver and Biliary Sciences, Delhi, India
| | - G Kumar
- Department of Molecular and cellular medicine, Institute of Liver and Biliary Sciences, Delhi, India
| | - C Mukhopadhyay
- Special center for molecular medicine, JNU, Delhi, India
| | - A Kumar
- Department of Molecular and cellular medicine, Institute of Liver and Biliary Sciences, Delhi, India
| | - N Trehanpati
- Department of Molecular and cellular medicine, Institute of Liver and Biliary Sciences, Delhi, India
| | - P E Rautou
- Department of Hepatology, Hopital Beaujon, INSERM U970, University of Paris, Paris, France
| | - R Moreau
- Center for Research on Inflammation, Xavier Bichat School of Medicine, INSERM U1149, Paris-Diderot University, Paris, France
| | - S K Sarin
- Department of Molecular and cellular medicine, Institute of Liver and Biliary Sciences, Delhi, India.,Department of Hepatology, Institute of Liver and Biliary Sciences, Delhi, India
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Barakat MT, Girotra M, Choudhary A, Banerjee S. Plastic Surgery: Cholangioscopic Intra-stent Balloon Retrieval of a Proximally Migrated Biliary Stent. Dig Dis Sci 2018; 63:851-855. [PMID: 28965145 PMCID: PMC5856579 DOI: 10.1007/s10620-017-4748-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 08/31/2017] [Indexed: 01/05/2023]
Affiliation(s)
- Monique T Barakat
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, MC:5244, Stanford, CA, 94305, USA
| | - Mohit Girotra
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, MC:5244, Stanford, CA, 94305, USA
| | - Abhishek Choudhary
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, MC:5244, Stanford, CA, 94305, USA
| | - Subhas Banerjee
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, MC:5244, Stanford, CA, 94305, USA.
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Barakat MT, Thosani NC, Huang RJ, Choudhary A, Kochar R, Kothari S, Banerjee S. Effects of a Brief Educational Program on Optimization of Fluoroscopy to Minimize Radiation Exposure During Endoscopic Retrograde Cholangiopancreatography. Clin Gastroenterol Hepatol 2018; 16:550-557. [PMID: 28804031 PMCID: PMC5809234 DOI: 10.1016/j.cgh.2017.08.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 08/02/2017] [Accepted: 08/04/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Fluoroscopy during endoscopic retrograde cholangiopancreatography (ERCP) is increasingly performed by therapeutic endoscopists, many of whom have not received formal training in modulating fluoroscopy use to minimize radiation exposure. Exposure to ionizing radiation has significant health consequences for patients and endoscopists. We aimed to evaluate whether a 20-minute educational intervention for endoscopists would improve use of fluoroscopy and decrease ERCP-associated exposure to radiation for patients. METHODS We collected data from 583 ERCPs, performed in California from June 2010 through November 2012; 331 were performed at baseline and 252 following endoscopist education. The educational intervention comprised a 20-minute video explaining best practices for fluoroscopy, coupled with implementation of a formal fluoroscopy time-out protocol before the ERCP was performed. Our primary outcome was the effect of the educational intervention on direct and surrogate markers of patient radiation exposure associated with ERCPs performed by high-volume endoscopists (HVEs) (200 or more ERCPs/year) vs low-volume endoscopists (LVEs) (fewer than 200 ERCPs/year). RESULTS At baseline, total radiation dose and dose area product were significantly higher for LVEs, but there was no significant difference between HVEs and LVEs following education. Education was associated with significant reductions in median fluoroscopy time (48% reduction for HVEs vs 30% reduction for LVEs), total radiation dose (28% reduction for HVEs vs 52% for LVEs) and dose area product (35% reduction for HVEs vs 48% reduction for LVEs). All endoscopists significantly increased their use of low magnification and collimation following education. CONCLUSIONS A 20-minute educational program with emphasis on ideal use of modifiable fluoroscopy machine settings results in an immediate and significant reduction in ERCP-associated patient radiation exposure for low-volume and high-volume endoscopists. Training programs should consider radiation education for advanced endoscopy fellows.
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Affiliation(s)
| | | | | | | | | | | | - Subhas Banerjee
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California.
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Kasozi R, Choudhary A, Andrus K, Wong R, Randall R, Orovets C, Bali G, Karapetyan L, Gibson M, Fu P, Sloan J. Use of Percutaneous Endoscopic Gastrostomy Tube Feeding Support in Head and Neck Cancer Patients. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2017.12.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Maity G, Haque I, Ghosh A, Dhar G, Gupta V, Sarkar S, Azeem I, McGregor D, Choudhary A, Campbell DR, Kambhampati S, Banerjee SK, Banerjee S. The MAZ transcription factor is a downstream target of the oncoprotein Cyr61/CCN1 and promotes pancreatic cancer cell invasion via CRAF-ERK signaling. J Biol Chem 2018; 293:4334-4349. [PMID: 29414775 PMCID: PMC5868262 DOI: 10.1074/jbc.ra117.000333] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 02/01/2018] [Indexed: 01/18/2023] Open
Abstract
Myc-associated zinc-finger protein (MAZ) is a transcription factor with dual roles in transcription initiation and termination. Deregulation of MAZ expression is associated with the progression of pancreatic ductal adenocarcinoma (PDAC). However, the mechanism of action of MAZ in PDAC progression is largely unknown. Here, we present evidence that MAZ mRNA expression and protein levels are increased in human PDAC cell lines, tissue samples, a subcutaneous tumor xenograft in a nude mouse model, and spontaneous cancer in the genetically engineered PDAC mouse model. We also found that MAZ is predominantly expressed in pancreatic cancer stem cells. Functional analysis indicated that MAZ depletion in PDAC cells inhibits invasive phenotypes such as the epithelial-to-mesenchymal transition, migration, invasion, and the sphere-forming ability of PDAC cells. Mechanistically, we detected no direct effects of MAZ on the expression of K-Ras mutants, but MAZ increased the activity of CRAF-ERK signaling, a downstream signaling target of K-Ras. The MAZ-induced activation of CRAF-ERK signaling was mediated via p21-activated protein kinase (PAK) and protein kinase B (AKT/PKB) signaling cascades and promoted PDAC cell invasiveness. Moreover, we found that the matricellular oncoprotein cysteine-rich angiogenic inducer 61 (Cyr61/CCN1) regulates MAZ expression via Notch-1-sonic hedgehog signaling in PDAC cells. We propose that Cyr61/CCN1-induced expression of MAZ promotes invasive phenotypes of PDAC cells not through direct K-Ras activation but instead through the activation of CRAF-ERK signaling. Collectively, these results highlight key molecular players in PDAC invasiveness and may help inform therapeutic strategies to improve clinical management and outcomes of PDAC.
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Affiliation(s)
- Gargi Maity
- From the Cancer Research Unit, Veterans Affairs Medical Center
- the Department of Pathology and Laboratory Medicine, and
| | - Inamul Haque
- From the Cancer Research Unit, Veterans Affairs Medical Center
- the Department of Pathology and Laboratory Medicine, and
| | - Arnab Ghosh
- From the Cancer Research Unit, Veterans Affairs Medical Center
- the Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, Kansas
| | - Gopal Dhar
- From the Cancer Research Unit, Veterans Affairs Medical Center
| | | | - Sandipto Sarkar
- From the Cancer Research Unit, Veterans Affairs Medical Center
- the Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, Kansas
| | - Imaan Azeem
- From the Cancer Research Unit, Veterans Affairs Medical Center
| | - Douglas McGregor
- From the Cancer Research Unit, Veterans Affairs Medical Center
- the Department of Pathology and Laboratory Medicine, and
- the Pathology Department, Veterans Affairs Medical Center, Kansas City, Missouri 64128
| | - Abhishek Choudhary
- the Gastroenterology Department, Veterans Affairs Medical Center, Kansas City, Missouri 64128
| | - Donald R Campbell
- From the Cancer Research Unit, Veterans Affairs Medical Center
- the University of Missouri Kansas City and Saint Luke's Hospital of Kansas City, Kansas City, Missouri, and
| | - Suman Kambhampati
- From the Cancer Research Unit, Veterans Affairs Medical Center
- the Sarah Cannon Cancer Center at HCA Midwest Health, Kansas City, Missouri 64131
| | - Sushanta K Banerjee
- From the Cancer Research Unit, Veterans Affairs Medical Center,
- the Department of Pathology and Laboratory Medicine, and
- the Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, Kansas
| | - Snigdha Banerjee
- From the Cancer Research Unit, Veterans Affairs Medical Center,
- the Department of Pathology and Laboratory Medicine, and
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Sharick JT, Walsh AJ, Sanders ME, Kelley MC, Meszoely IM, Hooks MA, Burkard ME, Esbona K, Choudhary A, Skala MC. Abstract P5-01-01: Personalized neoadjuvant treatment planning using optical metabolic imaging. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-01-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Currently, there are no reliable methods to optimize treatment regimens for individual breast cancer patients. Oncologists choose drug treatments based on expression levels of tumor cell signaling receptors (i.e. HER2, ER, PR) and other factors, and assess whether the treatment is effective after significant time has passed. Unfortunately, over one third of patients exhibit resistance to their initial treatment, increasing their risk of future metastasis and death. Morbidities from sub-optimal drug regimens could be reduced with a personalized drug screen for breast cancer at the time of diagnosis. With the vast number of therapeutic options available to patients (>50 drugs approved with more on the way), a high-throughput screening technology is needed to accurately evaluate how a patient will respond to these options.
Here we present Optical Metabolic Imaging (OMI) of tumor-derived organoids as a predictive drug screening platform for individual breast cancer patients. Changes in cell metabolism precede changes in tumor volume and thus present an earlier marker of treatment response. OMI is sensitive to these early changes by exploiting the intrinsic fluorescent properties of NAD(P)H and FAD, coenzymes of metabolic reactions. OMI endpoints include the optical redox ratio (the fluorescence intensity of NAD(P)H divided by the fluorescence intensity of FAD), as well as the fluorescence lifetimes of NAD(P)H and FAD. The redox ratio reflects the cellular redox balance, and the fluorescence lifetimes report on the binding activity of these coenzymes. OMI has the unique ability to non-invasively monitor metabolism in living, intact samples on the single-cell level, and can thus quantify heterogeneity in drug response. Changes were quantified at the single-cell level using the OMI Index, a linear combination of the optical redox ratio and the mean NAD(P)H and FAD fluorescence lifetimes. This index was derived using a multivariate analysis of variance and has been shown previously to correlate with treatment response in human cancer cells. OMI also allows for high-throughput screening of potential cancer drugs and drug combinations on patient biopsy samples cultured ex vivo. These samples are grown as organoids in a 3D matrix that mimics the natural tumor environment.
Organoids were successfully generated from core needle biopsies of untreated breast tumors. These organoids were treated with the patient's prescribed neoadjuvant therapy, and early metabolic changes were quantified using OMI. Organoids grew from a variety of untreated breast tumor subtypes, and early metabolic changes could be resolved at the single-cell level after only 24 hours of treatment in vitro. In parallel, each patient's Residual Cancer Burden (RCB) score was quantified by a surgical pathologist after neoadjuvant treatment and served as gold standard validation of tumor drug response. Results from an early cohort of patients suggest that OMI could be used to predict patient clinical response to therapy. A linear combination of OMI variables measured in vitro in only 48 hours correlated strongly with patient RCB score (Pearson correlation coefficient=0.97, n=5). This methodology could allow oncologists to determine the ideal treatment regimen for their patients at the time of diagnosis.
Citation Format: Sharick JT, Walsh AJ, Sanders ME, Kelley MC, Meszoely IM, Hooks MA, Burkard ME, Esbona K, Choudhary A, Skala MC. Personalized neoadjuvant treatment planning using optical metabolic imaging [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-01-01.
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Affiliation(s)
- JT Sharick
- Morgridge Institute for Research, Madison, WI; Vanderbilt University, Nashville, TN; Microbiology, and Immunology, Vanderbilt University, Nashville, TN; University of Wisconsin, Madison, Madison, WI
| | - AJ Walsh
- Morgridge Institute for Research, Madison, WI; Vanderbilt University, Nashville, TN; Microbiology, and Immunology, Vanderbilt University, Nashville, TN; University of Wisconsin, Madison, Madison, WI
| | - ME Sanders
- Morgridge Institute for Research, Madison, WI; Vanderbilt University, Nashville, TN; Microbiology, and Immunology, Vanderbilt University, Nashville, TN; University of Wisconsin, Madison, Madison, WI
| | - MC Kelley
- Morgridge Institute for Research, Madison, WI; Vanderbilt University, Nashville, TN; Microbiology, and Immunology, Vanderbilt University, Nashville, TN; University of Wisconsin, Madison, Madison, WI
| | - IM Meszoely
- Morgridge Institute for Research, Madison, WI; Vanderbilt University, Nashville, TN; Microbiology, and Immunology, Vanderbilt University, Nashville, TN; University of Wisconsin, Madison, Madison, WI
| | - MA Hooks
- Morgridge Institute for Research, Madison, WI; Vanderbilt University, Nashville, TN; Microbiology, and Immunology, Vanderbilt University, Nashville, TN; University of Wisconsin, Madison, Madison, WI
| | - ME Burkard
- Morgridge Institute for Research, Madison, WI; Vanderbilt University, Nashville, TN; Microbiology, and Immunology, Vanderbilt University, Nashville, TN; University of Wisconsin, Madison, Madison, WI
| | - K Esbona
- Morgridge Institute for Research, Madison, WI; Vanderbilt University, Nashville, TN; Microbiology, and Immunology, Vanderbilt University, Nashville, TN; University of Wisconsin, Madison, Madison, WI
| | - A Choudhary
- Morgridge Institute for Research, Madison, WI; Vanderbilt University, Nashville, TN; Microbiology, and Immunology, Vanderbilt University, Nashville, TN; University of Wisconsin, Madison, Madison, WI
| | - MC Skala
- Morgridge Institute for Research, Madison, WI; Vanderbilt University, Nashville, TN; Microbiology, and Immunology, Vanderbilt University, Nashville, TN; University of Wisconsin, Madison, Madison, WI
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Desai M, Sanchez-Yague A, Choudhary A, Pervez A, Gupta N, Vennalaganti P, Vennelaganti S, Fugazza A, Repici A, Hassan C, Sharma P. Impact of cap-assisted colonoscopy on detection of proximal colon adenomas: systematic review and meta-analysis. Gastrointest Endosc 2017; 86:274-281.e3. [PMID: 28365356 DOI: 10.1016/j.gie.2017.03.1524] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/17/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Proximal colon adenomas can be missed during routine colonoscopy. Use of a cap or hood on the tip of the colonoscope has been shown to improve overall adenoma detection with variable rates. However, it has not been systematically evaluated for detection of proximal colon or right-sided adenomas where the cap may have maximum impact on adenoma detection rate (ADR). Our aim was to perform a systematic review and meta-analysis to evaluate the impact of cap-assisted colonoscopy (CC) on right-sided ADRs (r-ADRs) compared with standard colonoscopy (SC). METHODS PubMed, EMBASE, SCOPUS, and Cochrane databases as well as secondary sources (bibliographic review of selected articles and major GI proceedings) were searched through October 1, 2016. Primary outcome was the pooled rate of r-ADR. Detection of flat adenoma, sessile serrated adenoma/polyp (SSA/P), and number of right-sided adenomas per patient were also assessed. Pooled odds ratio (OR) and 95% confidence intervals (CIs) were calculated using random-effect models. RESULTS We screened 686 records and analyzed data from 4 studies (CC group, 2546 patients; SC group, 2547 patients) that met criteria for determination of r-ADRs, whereas 6 studies (CC group, 3159 patients; SC group, 3137 patients) were analyzed to estimate right-sided adenomas per patient. r-ADR was significantly higher with CC compared with SC (23% vs 17%; OR, 1.49; 95% CI, 1.08-2.05; I2 = 79%; P = .01). CC also improved detection rates of flat adenoma (OR, 2.08; 95% CI, 1.35-3.20; P < .01) and SSA/P (OR, 1.33; 95% CI, 1.01-1.74; P = .04). The total number of right-sided adenomas (CC: 1428 [60%] vs SC: 1127 [58%]) and number of right-sided adenomas per patient (CC, .71 ± .5, vs SC, .65 ± .62 [mean ± standard deviation]) were numerically higher for CC but were not statistically significant (P = .43). Approximately 17 CCs would be required to detect an additional patient with right-sided adenoma. CONCLUSIONS Use of CC significantly improves the proximal colon ADR. In addition, flat adenoma and serrated colonic lesion detection rates are also significantly higher as compared with SC.
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Affiliation(s)
- Madhav Desai
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Missouri, USA
| | | | - Abhishek Choudhary
- Department of Gastroenterology, Veteran Affairs Medical Center, Kansas City, Missouri, USA
| | - Asad Pervez
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Missouri, USA
| | - Neil Gupta
- Department of Gastroenterology and Hepatology, Loyola University Medical Center, Chicago, Illinois, USA
| | - Prashanth Vennalaganti
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Missouri, USA
| | - Sreekar Vennelaganti
- Department of Gastroenterology, Veteran Affairs Medical Center, Kansas City, Missouri, USA
| | - Alessandro Fugazza
- Department of Gastroenterology, Istituto Clinico Humanitas, Milan, Italy
| | - Alessandro Repici
- Department of Gastroenterology, Istituto Clinico Humanitas, Milan, Italy
| | - Cesare Hassan
- Department of Gastroenterology, Istituto Clinico Humanitas, Milan, Italy
| | - Prateek Sharma
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Missouri, USA; Department of Gastroenterology, Veteran Affairs Medical Center, Kansas City, Missouri, USA
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Huang RJ, Thosani NC, Barakat MT, Choudhary A, Mithal A, Singh G, Sethi S, Banerjee S. Evolution in the utilization of biliary interventions in the United States: results of a nationwide longitudinal study from 1998 to 2013. Gastrointest Endosc 2017; 86:319-326.e5. [PMID: 28062313 PMCID: PMC5496794 DOI: 10.1016/j.gie.2016.12.021] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 12/21/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Bile duct surgery (BDS), percutaneous transhepatic cholangiography (PTC), and ERCP are alternative interventions used to treat biliary disease. Our aim was to describe trends in ERCP, BDS, and PTC on a nationwide level in the United States. METHODS We used the National Inpatient Sample to estimate age-standardized utilization trends of inpatient diagnostic ERCP, therapeutic ERCP, BDS, and PTC between 1998 and 2013. We calculated average case fatality, length of stay, patient demographic profile (age, gender, payer), and hospital characteristics (hospital size and metropolitan status) for these procedures. RESULTS Total biliary interventions decreased over the study period from 119.8 to 100.1 per 100,000. Diagnostic ERCP utilization decreased by 76%, and therapeutic ERCP utilization increased by 35%. BDS rates decreased by 78% and PTC rates by 24%. ERCP has almost completely supplanted surgery for the management of choledocholithiasis. Fatality from ERCP, BDS, and PTC have all decreased, whereas mean length of stay has remained stable. The proportion of Medicare-insured, Medicaid-insured, and uninsured patients undergoing biliary procedures has increased over time. Most of the increase in therapeutic ERCP and decrease in BDS occurred in large, metropolitan hospitals. CONCLUSIONS Although therapeutic ERCP utilization has increased over time, the total volume of biliary interventions has decreased. BDS utilization has experienced the most dramatic decrease, possibly a consequence of the increased therapeutic capacity and safety of ERCP. ERCPs are now predominantly therapeutic in nature. Large urban hospitals are leading the shift from surgical to endoscopic therapy of the biliary system.
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Affiliation(s)
- Robert J. Huang
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA
| | - Nirav C. Thosani
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA
| | - Monique T. Barakat
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA
| | - Abhishek Choudhary
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA
| | - Alka Mithal
- Institute of Clinical Outcomes Research and Education (ICORE), Woodside, CA
| | - Gurkirpal Singh
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA,Institute of Clinical Outcomes Research and Education (ICORE), Woodside, CA
| | - Saurabh Sethi
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA
| | - Subhas Banerjee
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA
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Choudhary A, Barakat MT, Leal JN, Louie CY, Visser BC, Banerjee S. Green Sludge: Intraductal Papillary Mucinous Neoplasm of the Bile Duct Presenting with Intermittent Biliary Obstruction Due to Abundant Mucus. Dig Dis Sci 2017; 62:1897-1900. [PMID: 27423887 DOI: 10.1007/s10620-016-4244-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 07/01/2016] [Indexed: 12/09/2022]
Affiliation(s)
- Abhishek Choudhary
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA, USA
| | - Monique T Barakat
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA, USA
| | - Julie N Leal
- Department of Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Christine Y Louie
- Department of Pathology, Stanford University Medical Center, Stanford, CA, USA
| | - Brendan C Visser
- Department of Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Subhas Banerjee
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA, USA. .,, 300 Pasteur Drive, Rm H0262, MC 5244, Stanford, CA, 94305, USA.
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Choudhary A, Barakat MT, Higgins LJ, Banerjee S. Choledochoscopic Identification of a Hepatic/Cystic Artery Pseudoaneurysm in a Patient with Hematemesis After Laparoscopic Cholecystectomy. Dig Dis Sci 2017; 62:1439-1442. [PMID: 27423886 DOI: 10.1007/s10620-016-4243-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Abhishek Choudhary
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA, USA
| | - Monique T Barakat
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA, USA
| | - Luke J Higgins
- Department of Radiology, Stanford University Medical Center, Stanford, CA, USA
| | - Subhas Banerjee
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA, USA.
- , 300 Pasteur Drive Rm H0262, MC 5244, Palo Alto, CA, 94305, USA.
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Choudhary A, Mazumder R, Bhattacharyya S, Chaudhuri P. Synthesis and Characterization of Li4SiO4 Ceramics from Rice Husk Ash by a Solution-Combustion Method. Fusion Science and Technology 2017. [DOI: 10.13182/fst13-666] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- A. Choudhary
- National Institute of Technology, Department of Ceramic Engineering, Rourkela-769008, India
| | - R. Mazumder
- National Institute of Technology, Department of Ceramic Engineering, Rourkela-769008, India
| | - S. Bhattacharyya
- National Institute of Technology, Department of Ceramic Engineering, Rourkela-769008, India
| | - P. Chaudhuri
- Institute for Plasma Research, TBM Division, Bhat, Gandhinagar-382428, India
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Sahu BS, Adhikari P, Gorinta J, Choudhary A, Mazumder R, Bhattacharyya S, Chaudhuri P. Fabrication and Characterization of Li 2TiO 3 Pebbles by an Extrusion and Spherodization Technique for the Test Blanket Module in a Fusion Reactor. Fusion Science and Technology 2017. [DOI: 10.13182/fst13-671] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- B. S. Sahu
- National Institute of Technology, Department of Ceramic Engineering, Rourkela-769008, India
| | - P. Adhikari
- National Institute of Technology, Department of Ceramic Engineering, Rourkela-769008, India
| | - J. Gorinta
- National Institute of Technology, Department of Ceramic Engineering, Rourkela-769008, India
| | - A. Choudhary
- National Institute of Technology, Department of Ceramic Engineering, Rourkela-769008, India
| | - R. Mazumder
- National Institute of Technology, Department of Ceramic Engineering, Rourkela-769008, India
| | - S. Bhattacharyya
- National Institute of Technology, Department of Ceramic Engineering, Rourkela-769008, India
| | - P. Chaudhuri
- Institute for Plasma Research, TBM Division, Bhat, Gandhinagar-382428, India
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Choudhary A, Parashar V, Gupta P, Agarwal K. Anaesthetic management of intracranial aneurysm in patient with coarctation of aorta. Journal of Neuroanaesthesiology and Critical Care 2017. [DOI: 10.1055/s-0038-1646212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- A. Choudhary
- Department of Anaesthesiology and Critical Care, Santokba Durlabhji Memorial Hospital, Cum Medical Research Institute, Jaipur, Rajasthan, India
| | - V. Parashar
- Department of Anaesthesiology and Critical Care, Santokba Durlabhji Memorial Hospital, Cum Medical Research Institute, Jaipur, Rajasthan, India
| | - P. Gupta
- Department of Anaesthesiology and Critical Care, Santokba Durlabhji Memorial Hospital, Cum Medical Research Institute, Jaipur, Rajasthan, India
| | - K. Agarwal
- Department of Anaesthesiology and Critical Care, Santokba Durlabhji Memorial Hospital, Cum Medical Research Institute, Jaipur, Rajasthan, India
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Rajak MK, Thakur R, Choudhary A, Bhaduri I, Kumar S. Titanium elastic nailing in femoral diaphyseal fractures in children of 6-14 years age. Acta Orthop Belg 2016; 82:883-888. [PMID: 29182134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Traditionally conservative methods were used in managing paediatric femoral diaphyseal fractures. There has been a renewed interest for operative treatment with Titanium elastic nail system (TENS) in the age group of 6-14 years. MATERIALS AND METHODS This prospective study was done on 20 patients. Two titanium nails were used for stabilization. We followed them for maximum of two years. The results were evaluated using Flynn's scoring criteria. RESULTS In our study we had fifteen males and five females with average age 10.35 years. Average time for fracture union was 9.0 weeks, full weight bearing 9.2 weeks, hospital stay 8.6 days and return to school at 10 weeks. The results were excellent in 14, good in 5 and poor in 1 patient. Most common complication was irritation at nail entry site. No delayed union or nonunion seen. CONCLUSION Treatment of diaphyseal femoral fracture in selected pediatric patients by TENS is reasonably effective.
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Choudhary A, Kallury A, Shukla C, Chaukse A. An innovative jig to prevent canine bracket breakage during fixed functional appliance therapy. J Indian Orthod Soc 2016. [DOI: 10.1177/0974909820160211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Abhishek Choudhary
- PG Student, Department of Orthodontics and Dentofacial Orthopedics, Peoples Dental Academy, Bhopal, Madhya Pradesh
| | - Amitabh Kallury
- Prof and Head, Department of Orthodontics and Dentofacial Orthopedics, Peoples Dental Academy, Bhopal, Madhya Pradesh
| | - Chandresh Shukla
- Reader, Department of Orthodontics and Dentofacial Orthopedics, Peoples College of Dental Sciences and Research Centre, Bhanpur, Bhopal, Madhya Pradesh, India
| | - Ankur Chaukse
- Reader, Department of Orthodontics and Dentofacial Orthopedics, Peoples Dental Academy, Bhopal, Madhya Pradesh
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Choudhary A, Kallury A, Shukla C, Chaukse A. An innovative jig to prevent canine bracket breakage during fixed functional appliance therapy. J Indian Orthod Soc 2016. [DOI: 10.4103/0301-5742.179947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Abhishek Choudhary
- PG Student, Department of Orthodontics and Dentofacial Orthopedics, Peoples Dental Academy, Bhopal, Madhya Pradesh
| | - Amitabh Kallury
- Prof and Head, Department of Orthodontics and Dentofacial Orthopedics, Peoples Dental Academy, Bhopal, Madhya Pradesh
| | - Chandresh Shukla
- Reader, Department of Orthodontics and Dentofacial Orthopedics, Peoples College of Dental Sciences and Research Centre, Bhanpur, Bhopal, Madhya Pradesh, India
| | - Ankur Chaukse
- Reader, Department of Orthodontics and Dentofacial Orthopedics, Peoples Dental Academy, Bhopal, Madhya Pradesh
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Rampurwala MM, Choudhary A, Burkard ME. Abstract P6-13-16: Ropidoxuridine (IPdR) potentiates alisertib (MLN8237) activity in triple-negative breast cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p6-13-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction and Background: An estimated 234,190 new cases of invasive breast cancer will be diagnosed in 2015 with 40,730 deaths (American Cancer Society, 2015). Triple-negative breast cancer (TNBC) has an overall poor prognosis due to aggressive and early pattern of metastasis and a relative lack of therapeutic targets. Chemotherapy remains the cornerstone of treatment albeit with a dismal response rate (∼25%) to monotherapy. Synergism between two drugs could provide a key advance to enhance effectiveness, decrease resistance and reduce toxicities. Here we focused on discovery of synergism of antiproliferative agents given TNBC is highly proliferative.
Experimental Methods: We assembled a library of antiproliferative agents with unique mechanisms and targets that have subtly different effects on cancer cell proliferation. We performed a novel synergy screen testing 105 unique two-drug combinations in MDA-MB-231 TNBC cells. Our screen was designed to distinguish between synergism and additivity through presence of an internal control and performed in sufficient replicates to identify changes in viability exceeding 5%. We validated hits through Chou Talalay Combination Index (CI), xenograft and mechanistic analyses.
Results: We discovered strong synergy between Ropidoxuridine (IPdR) and Alisertib (MLN8237). Ropidoxuridine is an orally bioavailable pro-drug of IUdR (5-iodo-2'-deoxyuridine), with an improved therapeutic index and with promising activity as a radiosensitizer, although it lacks single agent activity. Alisertib is an inhibitor of Aurora A kinase and acts by impairing assembly of a bipolar mitotic spindle, thereby activating the spindle assembly checkpoint leading to cancer cell death. Alisertib has demonstrated activity in breast cancer with a response rate of 18% in heavily pretreated patients (Melichar B et.al. Lancet Oncol 16:395-405, 2015). First, Ropidoxuridine and Alisertib combination was validated in cell culture using CI analysis with a mean CI of 0.14; range 0.01-0.67 suggesting strong synergism. A separately performed Live Dead Cell Assay also confirmed synergism (mean CI of 0.79; range: 0.53-1.76) suggesting enhanced anti-proliferative activity of Alisertib in presence of Ropidoxuridine. To assess generalizability, this combination was validated in two other TNBC cell lines, MDA-MB-468 and CAL-51. To confirm our hypothesis that in vitro activity of Ropidoxuridine is from its metabolism to IUdR in cancer cells, we demonstrated strong synergy of IUdR and Alisertib (mean CI of 0.12; range 0.01-0.74) at clinically relevant concentrations. To validate synergy in an orthotopic tumor model, Ropidoxuridine and Alisertib single agents and in combination were tested in mice treated with Ropidoxuridine (750 mg/kg/day) and Alisertib (30 mg/kg/day) by gavage. This in vivo model also demonstrated strong synergism. Mechanistically, Ropidoxuridine and IUdR enhance G2/M arrest in response to Alisertib, allowing low dose exposures of Alisertib to be effective.
Conclusions and Future Directions: This study identifies and validates a novel synergy between Ropidoxuridine and Alisertib with a potential for significant clinical implications. We propose evaluating this synergistic drug combination in an early phase clinical trial.
Citation Format: Rampurwala MM, Choudhary A, Burkard ME. Ropidoxuridine (IPdR) potentiates alisertib (MLN8237) activity in triple-negative breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-13-16.
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Affiliation(s)
- MM Rampurwala
- University of Wisconsin Carbone Cancer Center, Madison, WI
| | - A Choudhary
- University of Wisconsin Carbone Cancer Center, Madison, WI
| | - ME Burkard
- University of Wisconsin Carbone Cancer Center, Madison, WI
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Pahadiya HR, Lakhotia M, Gandhi R, Choudhary A. Nephrotic syndrome and acute renal failure as a presenting symptom of acute lymphoblastic leukemia. Indian J Nephrol 2016; 26:62-3. [PMID: 26937086 PMCID: PMC4753749 DOI: 10.4103/0971-4065.168478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Choudhary A, Pati SK, Patro RK, Deorari AK, Dar L. Comparison of conventional, immunological and molecular techniques for the diagnosis of symptomatic congenital human cytomegalovirus infection in neonates and infants. Indian J Med Microbiol 2015; 33 Suppl:15-9. [PMID: 25657137 DOI: 10.4103/0255-0857.150874] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
PURPOSE Human cytomegalovirus (HCMV) is the commonest pathogen causing congenital infection globally. The diagnosis of congenital infection is based either on viral isolation (in cell culture) or demonstration of HCMV DNA from the urine. Saliva is also being used as an alternative sample to urine for the same. The objective of this study was to compare the following assays-polymerase chain reaction (PCR) from urine, saliva and blood, serology (anti-HCMV IgM) and antigen detection (HCMV pp65 antigenaemia) for the diagnosis of congenital HCMV infection. MATERIALS AND METHODS Urine and blood samples were collected from 31 infants (median age: 13 weeks) with suspected HCMV infection. For 18 infants, additional saliva samples were collected and all the above assays were compared. RESULTS PCR for HCMV DNA from urine and anti-HCMV IgM were performed for all 31 infants. Of these, 22 (70.9%) were positive for both assays. In 18 (of the 22) infants positive by both assays, PCR for HCMV DNA from saliva was positive in all 18 (100%), PCR from blood in 7/18 (38.8%) and HCMV pp65 antigenaemia only in 1/18 (5.5%) of the infants. CONCLUSION Detection of HCMV DNA in urine combined with anti-HCMV IgM are suitable assays to diagnose HCMV infection in infants. Both PCR from the blood and HCMV pp65 antigenaemia lack sensitivity in infants. Salivary PCR combines convenience with high sensitivity and can substitute PCR from urine, especially in the outpatient and field settings. To the best of our knowledge, this is the first study from India to evaluate salivary PCR for the diagnosis of congenital HCMV infection.
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Affiliation(s)
| | | | | | | | - L Dar
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
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Venkateswara Prasad U, Vasu D, Yeswanth S, Swarupa V, Sunitha MM, Choudhary A, Sarma PVGK. Phosphorylation controls the functioning ofStaphylococcus aureusisocitrate dehydrogenase – favours biofilm formation. J Enzyme Inhib Med Chem 2015; 30:655-61. [DOI: 10.3109/14756366.2014.959945] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ashraf I, Ashraf S, Siddique S, Nguyen DL, Choudhary A, Bechtold ML. Hyoscine for polyp detection during colonoscopy: A meta-analysis and systematic review. World J Gastrointest Endosc 2014; 6:549-554. [PMID: 25400869 PMCID: PMC4231494 DOI: 10.4253/wjge.v6.i11.549] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 08/14/2014] [Accepted: 10/10/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To assess the role of hyoscine for polyp detection during colonoscopy.
METHODS: Studies (randomized controlled trials or RCTs) that compared the use of hyoscine vs no hyoscine or placebo for polyp detection during colonoscopy were included in our analysis. A search on multiple databases was performed in September 2013 with search terms being “hyoscine and colonoscopy”, “hyoscine and polyp”, “hyoscine and adenoma”, “antispasmotic and colonoscopy”, “antispasmotic and adenoma”, and “antispasmotic and polyp”. Jadad scoring was used to assess the quality of studies. The efficacy of hyoscine was analyzed using Mantel-Haenszel model for polyp and adenoma detection with odds ratio (OR). The I2 measure of inconsistency was used to assess heterogeneity (P < 0.05 or I2 > 50%). Statistical analysis was performed by RevMan 5.1. Funnel plots was used to assess publication bias.
RESULTS: The search of the electronic databases identified 283 articles. Of these articles, eight published RCTs performed at various locations in Europe, Asia, and Australia were included in our meta-analysis, seven published as manuscripts and one published as an abstract (n = 2307). All the studies included patients with a hyoscine and a no hyoscine/placebo group and were of adequate quality (Jadad score ≥ 2). Eight RCTs assessed the polyp detection rate (PDR) (n = 2307). The use of hyoscine demonstrated no statistically significant difference as compared to no hyoscine or placebo for PDR (OR = 1.06; 95%CI: 0.89-1.25; P = 0.51). Five RCTs assessed the adenoma detection rate (ADR) (n = 2015). The use of hyoscine demonstrated no statistically significant difference as compared to no hyoscine or placebo for ADR (OR = 1.12; 95%CI: 0.92-1.37; P = 0.25). Furthermore, the timing of hyoscine administration (given at cecal intubation or pre-procedure) demonstrated no differences in PDR compared to no hyoscine or placebo. Publication bias or heterogeneity was not observed for any of the outcomes.
CONCLUSION: Hyoscine use in patients undergoing colonoscopy does not appear to significantly increase the detection of polyps or adenomas.
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Dar L, Choudhary A. Ebola virus re-emergence: is it really knocking at our door? Indian J Med Microbiol 2014; 32:363. [PMID: 25297017 DOI: 10.4103/0255-0857.142229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- L Dar
- Department of Microbiology (LD, AC), All India Institute of Medical Sciences, New Delhi, India
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Choudhary A, Winn J, Siddique S, Arif M, Arif Z, Hammoud GM, Puli SR, Ibdah JA, Bechtold ML. Effect of precut sphincterotomy on post-endoscopic retrograde cholangiopancreatography pancreatitis: A systematic review and meta-analysis. World J Gastroenterol 2014; 20:4093-4101. [PMID: 24744601 PMCID: PMC3983468 DOI: 10.3748/wjg.v20.i14.4093] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 12/18/2013] [Accepted: 01/15/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To conduct a systemic review and meta-analysis to investigate the role of early precut technique. Multiple randomized controlled trails (RCTs) have reported conflicting results of the early precut sphincterotomy.
METHODS: MEDLINE/PubMed, EMBASE, Cochrane Central Register of Controlled Trials and Database of Systematic Reviews, and recent abstracts from major conference proceedings were searched (June 2013). Randomized and non-randomized studies comparing early precut technique with prolonged standard methods were included. Pooled estimates of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP), cannulation and adverse events were analyzed by using odds ratio (OR). Random and fixed effects models were used as appropriate. Publication bias was assessed by funnel plots. Heterogeneity among studies was assessed by calculating I2 measure of inconsistency.
RESULTS: Seven randomized and seven non-randomized trials met inclusion criteria. Meta-analysis of RCTs showed a decrease trend for PEP with early precut sphincterotomy but was not statistically significant (OR = 0.58; 95%CI: 0.32-1.05; P = 0.07). No heterogeneity was noted among the studies with I2 of 0%.
CONCLUSION: Early precut technique for common bile duct cannulation decreases the trend of post-ERCP pancreatitis.
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Sathyamurthy A, Choudhary A, Ng D, Okponobi S, Diaz-Arias A, Grewal A, Hammoud GM. Obstructive jaundice due to a rare periampullary tumor. World J Gastrointest Oncol 2013; 5:195-197. [PMID: 24137522 PMCID: PMC3796670 DOI: 10.4251/wjgo.v5.i10.195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 08/06/2013] [Accepted: 09/04/2013] [Indexed: 02/05/2023] Open
Abstract
Gangliocytic paraganglioma is a rare neuroendocrine tumor predominantly arising in the second part of the duodenum with rare local recurrence or metastasis to regional lymph nodes. A 92-year-old female presented with obstructive jaundice. On exam she had pale conjunctiva and icteric sclera. Abdominal examination revealed tenderness in the upper abdomen. Laboratory data was consistent with obstructive jaundice. Computed tomography of the abdomen revealed a dilated gall bladder and a common bile duct (CBD) with no evidence of liver lesions or pancreatic head mass. Endoscopic ultrasonography revealed a 1 cm isoechoic submucosal nodule at the periampullary area, dilated CBD (9 mm), a prominent pancreatic duct (4.1 mm) and a hydropic gall bladder with no stones. Endoscopic retrograde cholangiopancreaticography was performed to relieve obstruction and showed a 1 cm periampullary mass which underwent an en-bloc snare resection. Histopathology analyses with immunohistochemical stains were positive for cytokeratin, synaptophysin, S-100 protein, neuron specific enolase and negative for actin and desmin consistent with periampullary gangliocytic paraganglioma. Periampullary gangliocytic paraganglioma is a rare benign tumor of the small bowel. Common presentation includes abdominal pain and obstructive jaundice which should be included in differential diagnosis of obstructive jaundice. Endoscopic resection is a curative therapy in the absence of local invasion or distant metastasis.
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