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Manoharan A, Fithian A, Xie V, Hartman K, Schairer W, Khan N. Return to Sports After Anterior Cruciate Ligament Reconstruction. Perm J 2024:1-7. [PMID: 38659351 DOI: 10.7812/tpp/23.132] [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] [Indexed: 04/26/2024]
Abstract
Anterior cruciate ligament (ACL) tears are one of the most common orthopedic injuries among athletes. Although a small proportion of patients with isolated tears can return to sports after completing a nonsurgical rehabilitation program, ACL reconstruction is frequently recommended for young athletes, especially those with concomitant knee injuries or symptomatic knee instability. Alongside emerging evidence for the effect of prehabilitation, the current standard of care for postoperative ACL physical therapy includes pain control, range of motion, quadriceps strengthening, weight bearing, postoperative bracing, and dynamic limb stabilization and control. The early rehabilitation period includes non-weight-bearing exercises and passive range of motion, which is followed by a longer period of gradual strengthening focused on regaining preinjury strength, proprioception, and control with progressively more demanding dynamic movements. The total rehabilitation period is expected to take around 9 months, during which the patient should be evaluated at frequent intervals by a licensed physical therapist in addition to a daily home exercise program. Prior to discharge from the rehabilitation program, patients should be evaluated by both the surgeon and physical therapist. Patients are encouraged to return to sports once they meet a set of perceptual, subjective, objective, neuromuscular, functional, sport-specific drills, and load management testing criteria.
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Affiliation(s)
- Aditya Manoharan
- Department of Orthopedic Surgery, Southern California Permanente Medical Group, El Cajon, CA, USA
| | - Andrew Fithian
- Department of Orthopedic Surgery, Southern California Permanente Medical Group, El Cajon, CA, USA
| | - Virginia Xie
- Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA, USA
| | - Kurt Hartman
- Department of Physical Medicine & Rehabilitation/Physical Therapy, Southern California Permanente Medical Group, San Marcos, CA, USA
| | - William Schairer
- Department of Orthopedic Surgery, Southern California Permanente Medical Group, El Cajon, CA, USA
| | - Najeeb Khan
- Department of Orthopedic Surgery, Southern California Permanente Medical Group, San Diego, CA, USA
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Son MM, Abbas M, Tatusko M, Winkel T, Barton D, Manoharan A, Feldman MD. Clinically Significant Outcome Scores in Orthopaedic Sports Medicine Shoulder and Knee Surgery Are Increasing in Prevalence but Often Reported Incorrectly. Arthroscopy 2024; 40:1108-1116. [PMID: 37716634 DOI: 10.1016/j.arthro.2023.08.076] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/15/2023] [Accepted: 08/15/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE To study the prevalence and quality of application of minimal clinically important difference (MCID), substantial clinical benefit (SCB), patient-acceptable symptomatic state (PASS), and maximum outcome improvement (MOI), reported in the orthopaedic sports medicine knee and shoulder literature in recent years and to bring awareness of proper use of such metrics. METHODS A literature review of all shoulder and knee articles published from the American Journal of Sports Medicine (AJSM), Journal of Shoulder and Elbow Surgery (JSES), and Arthroscopy from 2016 to 2020 was performed, specifically investigating whether MCID, SCB, PASS, or MOI were used or reported. Additionally, the way these metrics were reported and interpreted was recorded. RESULTS Out of 5,039 studies, 889 shoulder and knee studies met the inclusion criteria. Overall, 16.7% reported either MCID, PASS, or SCB. MCID was the most reported across all 3 journals. MCID was reported 12.4% of the time throughout the 5 years. PASS was reported 3.2% and SCB 1.1% of the time over the 5 years. MOI was not reported by any of the journals during this period. There was a statistically significant increase in MCID reporting in 2 of the 3 journals over the 5-year course, Arthroscopy (P = .02) and AJSM (P = .05). There was no statistically significant increase in PASS or SCB reporting rates in all 3 journals. Only 39.1% of studies reported MCID correctly (i.e., defined as the number of individual patients meeting MCID/total patients in the study). CONCLUSIONS This study shows an increasing trend in the use of clinically significant outcome metrics, such as MCID, for interpretation of patient-reported outcomes; however, these individual metrics are often not being used on the individual level and subsequently not reported accurately. We recommend determining whether the specific metric met the threshold per individual patient and then reporting those as a percentage of the sample population to achieve the full potential of these metrics and translate them accurately across various studies. CLINICAL RELEVANCE As the usage of clinically significant outcome metrics rises, so does the need for accurate reporting. These findings will encourage future studies to follow a more standardized format.
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Affiliation(s)
- Michelle M Son
- University of Arizona, Department of Orthopaedic Surgery, Tucson, Arizona, U.S.A..
| | - Mohammed Abbas
- University of Arizona, Department of Orthopaedic Surgery, Tucson, Arizona, U.S.A
| | - Megan Tatusko
- University of Arizona, Department of Orthopaedic Surgery, Tucson, Arizona, U.S.A
| | - Trenton Winkel
- University of Arizona, Department of Orthopaedic Surgery, Tucson, Arizona, U.S.A
| | - Dane Barton
- University of Arizona, Department of Orthopaedic Surgery, Tucson, Arizona, U.S.A
| | - Aditya Manoharan
- University of Arizona, Department of Orthopaedic Surgery, Tucson, Arizona, U.S.A
| | - Michael D Feldman
- University of Arizona, Department of Orthopaedic Surgery, Tucson, Arizona, U.S.A
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Barton D, Manoharan A, Khwaja A, Sorenson J, Taylor M. Return to Play Following Achilles Tendon Rupture in NFL Players Based on Position. Foot Ankle Spec 2023; 16:427-436. [PMID: 34609159 DOI: 10.1177/19386400211040351] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of this study was to determine the return-to-play (RTP) rate and postinjury performance after Achilles tendon (AT) ruptures in National Football League (NFL) skill position players. METHODS The study included NFL skill positions with an AT rupture between the 2009-2010 and 2015-2016 seasons. Performance data were collected and compared against a matched control group. RTP was defined as playing in at least 1 game after repair. RESULTS RTP rate was 57% for the study cohort. The tight ends (TEs) had the highest RTP rate at 71% while the wide receivers (WRs) had the lowest RTP rate at 38%. Compared with the control group, WRs with successful RTP had significantly less receptions per game (P = .01). For defensive players with RTP there were significant decreases in postrepair performance in tackles, passes defended, and fumbles forced/recovered compared with the control group. CONCLUSION A total of 57% of players achieved RTP with WRs and running backs (RBs) having the lowest RTP rates and TEs and linebackers (LBs) having the highest RTP rates. RBs, defensive backs (DBs), and LBs with successful RTP had decreased performance in all categories. This updated information may be helpful for athletes, physicians, scouts, and coaches in evaluating players with a history of AT rupture. LEVELS OF EVIDENCE Analytic, level 3, retrospective cohort study, Epidemiologic study.
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Affiliation(s)
- Dane Barton
- Department of Orthopaedic Surgery, University of Arizona, Tucson, Arizona
| | - Aditya Manoharan
- Department of Orthopaedic Surgery, University of Arizona, Tucson, Arizona
| | - Ansab Khwaja
- Department of Orthopaedic Surgery, University of Arizona, Tucson, Arizona
| | - Jacob Sorenson
- University of Arizona School of Medicine, Tucson, Arizona
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Cousins A, Olivares O, Markert E, Manoharan A, Bubnova X, Bresolin S, Degn M, Li Z, Silvestri D, McGregor G, Tumanov S, Sumpton D, Kamphorst JJ, Michie AM, Herzyk P, Valsecchi MG, Yeoh AE, Schmiegelow K, Te Kronnie G, Gottlieb E, Halsey C. Central nervous system involvement in childhood acute lymphoblastic leukemia is linked to upregulation of cholesterol biosynthetic pathways. Leukemia 2022; 36:2903-2907. [PMID: 36289348 PMCID: PMC9712090 DOI: 10.1038/s41375-022-01722-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/28/2022] [Accepted: 10/04/2022] [Indexed: 11/09/2022]
Affiliation(s)
- A Cousins
- Wolfson Wohl Cancer Research Centre, School of Cancer Sciences, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - O Olivares
- Wolfson Wohl Cancer Research Centre, School of Cancer Sciences, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - E Markert
- Wolfson Wohl Cancer Research Centre, School of Cancer Sciences, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Cancer Research UK Beatson Institute, Glasgow, UK
| | - A Manoharan
- Wolfson Wohl Cancer Research Centre, School of Cancer Sciences, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - X Bubnova
- Wolfson Wohl Cancer Research Centre, School of Cancer Sciences, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - S Bresolin
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - M Degn
- Department of Pediatrics and Adolescent Medicine, The Juliane Marie Centre, The University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Z Li
- VIVA-NUS Centre for Translational Research in Acute Leukaemia, Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117599, Singapore
| | - D Silvestri
- Center of Biostatistics for Clinical Epidemiology, Department of Health Science, University of Milano-Bicocca, Milano, Italy
| | - G McGregor
- Wolfson Wohl Cancer Research Centre, School of Cancer Sciences, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Cancer Research UK Beatson Institute, Glasgow, UK
| | - S Tumanov
- Cancer Research UK Beatson Institute, Glasgow, UK
| | - D Sumpton
- Cancer Research UK Beatson Institute, Glasgow, UK
| | - J J Kamphorst
- Wolfson Wohl Cancer Research Centre, School of Cancer Sciences, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Cancer Research UK Beatson Institute, Glasgow, UK
| | - A M Michie
- Paul O'Gorman Leukaemia Research Centre, School of Cancer Sciences, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - P Herzyk
- Glasgow Polyomics, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Institute of Molecular, Cell and Systems Biology, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - M G Valsecchi
- Center of Biostatistics for Clinical Epidemiology, Department of Health Science, University of Milano-Bicocca, Milano, Italy
| | - A E Yeoh
- VIVA-NUS Centre for Translational Research in Acute Leukaemia, Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117599, Singapore
- VIVA-University Children's Cancer Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, 119228, Singapore
| | - K Schmiegelow
- Department of Pediatrics and Adolescent Medicine, The Juliane Marie Centre, The University Hospital Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen and Juliane Marie Centre, the University Hospital Rigshospitalet, Copenhagen, Denmark
| | - G Te Kronnie
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - E Gottlieb
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - C Halsey
- Wolfson Wohl Cancer Research Centre, School of Cancer Sciences, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
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Manoharan A, Falgout D, Feldman M. Arthroscopic Repair of a PASTA of the Shoulder Using a Bursal Split. Arthrosc Tech 2021; 10:e1403-e1408. [PMID: 34141560 PMCID: PMC8185807 DOI: 10.1016/j.eats.2021.01.033] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/29/2021] [Indexed: 02/03/2023] Open
Abstract
PASTA (partial articular supraspinatus tendon avulsion) lesions are a subset of partial rotator cuff tears that are commonly treated by surgeons. Multiple surgical techniques exist for managing these lesions, including debridement, transtendinous repair, and completion of the tear and repair. Each of these techniques provides its own set of advantages and disadvantages, and currently there is no consensus on which method provides the best clinical outcomes or ease of procedure. Here, we present our repair technique for PASTA lesions, which involves a bursal split that takes the advantages of previous techniques by allowing improved visualization of the footprint and suture passing while avoiding the takedown any of Sharpey's fibers.
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Affiliation(s)
- Aditya Manoharan
- Address correspondence to Aditya Manoharan, M.D., Department of Orthopaedic Surgery, 1501 N. Campbell Ave., Room 8401, Tucson, AZ 85724.
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Manoharan A, Barton D, Khwaja A, Latt LD. Return to Play Rates in NFL Wide Receivers and Running Backs After ACL Reconstruction: An Updated Analysis. Orthop J Sports Med 2021; 9:2325967120974743. [PMID: 33553449 PMCID: PMC7829540 DOI: 10.1177/2325967120974743] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 07/07/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Anterior cruciate ligament (ACL) ruptures are potentially career-threatening
injuries to National Football League (NFL) skill position players. A 2006
study showed a return-to-play (RTP) rate of 79% for NFL running backs (RBs)
and wide receivers (WRs). Since then, a number of factors affecting RTP,
including style of play as well as rules regarding hits to the head, have
changed how defensive players tackle offensive ball carriers. Purpose/Hypothesis: To determine whether the RTP rate for RBs and WRs in the NFL has changed
since data were collected in the 2000s. Additionally, we evaluated player
performance before and after ACL reconstruction (ACLR). We hypothesized that
there will be a lower RTP rate than previously reported as well as a
decrease in performance statistics after ACLR. Study Design: Descriptive epidemiology study. Methods: Publicly available NFL injury reports between the 2009-2010 and 2015-2016
seasons were utilized for RBs and WRs who underwent ACLR. Successful RTP was
indicated by playing in at least 1 NFL game after reconstruction.
Position-specific performance statistics from before and after
reconstruction were gathered for these players, and the RTP players were
compared against the players who did not RTP (dnRTP group). Pre- and
postinjury performance measures were also compared against a matched control
group of NFL RBs and WRs who had not sustained an ACL injury. Results: Overall, 61.8% of players (64.5% of RBs, 60% of WRs) returned to play at a
mean of 13.6 months. Prior to injury, the RTP group had played in
significantly more career games and had significantly more rushes and
receptions per game than the dnRTP group; however, there was no significant
difference in performance after ACLR. The WR RTP group had significantly
decreased performance in all measured categories when compared with the
control group. Conclusion: Our study found a lower RTP rate in RBs and WRs than previous studies
conducted in the early 2000s. WRs who achieved RTP had decreased performance
when compared with noninjured controls.
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Affiliation(s)
- Aditya Manoharan
- Department of Orthopaedic Surgery, University of Arizona, Tucson, Arizona, USA
| | - Dane Barton
- Department of Orthopaedic Surgery, University of Arizona, Tucson, Arizona, USA
| | - Ansab Khwaja
- Department of Orthopaedic Surgery, University of Arizona, Tucson, Arizona, USA
| | - L Daniel Latt
- Department of Orthopaedic Surgery, University of Arizona, Tucson, Arizona, USA
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Malik AK, Filobbos R, Manoharan A, Harvey N, O’Reilly DA, de Liguori Carino N. A case report of an angiomyxoma in the liver. Ann R Coll Surg Engl 2018; 100:e81-e84. [PMID: 29543047 PMCID: PMC5958866 DOI: 10.1308/rcsann.2018.0042] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2018] [Indexed: 12/11/2022] Open
Abstract
Angiomyxomas are uncommon myxoid tumours arising most commonly from the pelvis. A 46-year-old woman with a history of polycystic kidney disease presented asymptomatically for surveillance ultrasonography; changes were noted in the size and morphology of her liver cysts. Subsequent radiological assessment displayed features suspicious of malignancy and a right hemihepatectomy was performed with curative intent. Pathological examination of the resected specimen found histology consistent with an angiomyxoma arising primarily from the liver parenchyma. Follow-up review of the patient has been uneventful with annual imaging showing no evidence of recurrence. Angiomyxomas do not characteristically invade other tissues. However, any liver lesion displaying suspicious features of malignancy should be resected in the absence of disseminated disease.
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Affiliation(s)
- AK Malik
- Central Manchester University Hospitals NHS Foundation Trust, UK
| | - R Filobbos
- Central Manchester University Hospitals NHS Foundation Trust, UK
| | | | - N Harvey
- Central Manchester University Hospitals NHS Foundation Trust, UK
| | - DA O’Reilly
- Central Manchester University Hospitals NHS Foundation Trust, UK
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8
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Manoharan A, Morrison AE, Lipworth BJ. Effects of the inverse alpha-agonist doxazosin in allergic rhinitis. Clin Exp Allergy 2017; 46:696-704. [PMID: 26741127 DOI: 10.1111/cea.12700] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 11/05/2015] [Revised: 12/14/2015] [Accepted: 12/18/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND We examined the paradoxical hypothesis that the alpha-receptor inverse agonist doxazosin might produce beneficial effects in allergic rhinitis. OBJECTIVES To evaluate single and chronic dosing effects of doxazosin on nasal airflow and symptoms in allergic rhinitis. METHODS Fifteen patients randomized to receive 3-5 weeks of oral doxazosin 4 mg daily or placebo in crossover fashion. Measurements were taken at baseline and after first and last doses. RESULTS There was a fall in peak nasal inspiratory flow (PNIF) between baseline vs. first dose of doxazosin: mean difference -19 L/min (95% CI -35 to -2) P = 0.03, with recovery between first and last doses: 21 L/min (95% CI 7-34) P = 0.006. Nasal visual analogue scale (VAS) and blockage scores were worse between baseline vs. first dose of doxazosin: mean difference VAS -10 mm (95% CI -18 to -2) P = 0.02, blockage -0.7 (95% CI -1.3 to -0.1) P = 0.02, with recovery between first and last doses: VAS 15 mm (95% CI 4-25) P = 0.009, blockage 1.1 (95% CI 0.5-1.6) P = 0.001. The oxymetazoline dose-response for PNIF was blunted after single vs chronic dosing with doxazosin: mean difference -17 L/min (95% CI -30 to -4) P = 0.01. Heart rate and diastolic blood pressure showed the same pattern. There was a significant difference between doxazosin and placebo for nasal blockage score and heart rate after single but not chronic dosing. CONCLUSIONS There was a disconnect between single and chronic dosing effects of doxazosin for nasal symptoms, oxymetazoline response and cardiovascular outcomes, in turn suggesting alpha-1 receptor up-regulation.
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Affiliation(s)
- A Manoharan
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - A E Morrison
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - B J Lipworth
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
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Chong BH, Cade JF, Magnani H, Manoharan A, Oldmeadow M, Arthur C, Rickard K, Gallo J, Lloyd J, Seshadri P, Gallus AS, Chesterman CN. Prospective Randomised Open-label Comparison of Danaparoid with Dextran 70 in the Treatment of Heparin-induced Thrombocytopaenia with Thrombosis. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1616046] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Summary
Aim: To compare clinical outcomes in a randomised comparison of treatment with danaparoid sodium (a heparinoid), or dextran 70, for heparin-induced thrombocytopaenia (HIT) plus thrombosis. Methods: Forty-two patients with recent thrombosis and a clinical diagnosis of probable HIT who presented at ten Australian hospitals during a study period of six and one half years were randomly assigned to open-label treatment with intravenous danaparoid or dextran 70, each combined with oral warfarin. Thirty-four patients (83%) had a positive platelet aggregation or 14C-serotonin release test for HIT antibody. Twenty-five received danaparoid as a bolus injection of 2400 anti-Xa units followed by 400 units per hour for 2 h, 300 units per hour for 2 h, and then 200 units per hour for five days. Seventeen received 1000 mL dextran 70 on day one and then 500 mL on days 2-5. Patients were reviewed daily for clinical evidence of thrombus progression or resolution, fresh thrombosis or embolism, bleeding or other complications. The primary trial endpoint was the proportion of thromboembolic events with complete clinical resolution by the time of discharge from hospital. Results: With danaparoid, there was complete clinical recovery from 56% of thromboembolic events compared to 14% after dextran 70 (Odds Ratio 10.53, 95% Confidence Interval 1.6–71.4; p = 0.02). Clinical recovery with danaparoid was complete or partial in 86% of thromboembolic events compared with 53% after dextran 70 (Odds Ratio 4.55, 95% Confidence Interval 1.2–16.7; p = 0.03). Overall clinical effectiveness of danaparoid was rated as high or moderate in 88% of patients compared with 47% for dextran 70 (p = 0.01). One patient given danaparoid died of thrombosis compared with three patients given dextran 70. The platelet count returned to normal after a mean of 6.7 days with danaparoid and 7.3 days with dextran 70. There was no major bleeding with either treatment. Conclusion: danaparoid plus warfarin treatment for HIT with thrombosis is effective, safe, and superior to dextran 70 plus warfarin.
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Jabbal S, Anderson W, Short P, Morrison A, Manoharan A, Lipworth BJ. Cardiopulmonary interactions with beta-blockers and inhaled therapy in COPD. QJM 2017; 110:785-792. [PMID: 29025008 DOI: 10.1093/qjmed/hcx155] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 06/09/2017] [Revised: 07/04/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Beta-blockers remain underused in patients with chronic obstructive pulmonary disease (COPD) and cardiovascular disease. AIM We compared how different inhaled therapies affect tolerability of bisoprolol and carvedilol in moderate to severe COPD. DESIGN A randomized, open label, cross-over study. METHODS We compared the cardiopulmonary interactions of bisoprolol 5 mg qd or carvedilol 12.5 mg bid for 6 weeks in conjunction with: (i) triple: inhaled corticosteroid/long acting beta-agonist/long acting muscarinic antagonist (ICS + LABA + LAMA), (ii) dual: ICS + LABA and (iii) ICS alone. RESULTS Eighteen patients completed, all ex-smokers, mean age 65 years, forced expiratory volume in 1 s (FEV1) 52% predicted. Bisoprolol and carvedilol produced comparable significant reduction in resting and exercise heart rate. FEV1, forced vital capacity and lung compliance (AX) were significantly lower with carvedilol vs. bisoprolol while taking concomitant ICS/LABA (P < 0.05) but not ICS/LABA/LAMA. CONCLUSIONS In summary, bisoprolol was better tolerated than carvedilol on pulmonary function at doses which produced equivalent cardiac beta-1 blockade. Worsening of pulmonary function with carvedilol was mitigated by concomitant inhaled LAMA (tiotropium) with LABA (formoterol), but not LABA alone. Registered at clinicaltrials.gov: NCT01656005.
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Affiliation(s)
- S Jabbal
- From the Scottish Centre for Respiratory Research, Division of Molecular & Clinical Medicine, Ninewells Hospital & Medical School, Dundee, DD19SY, UK
| | - W Anderson
- From the Scottish Centre for Respiratory Research, Division of Molecular & Clinical Medicine, Ninewells Hospital & Medical School, Dundee, DD19SY, UK
| | - P Short
- From the Scottish Centre for Respiratory Research, Division of Molecular & Clinical Medicine, Ninewells Hospital & Medical School, Dundee, DD19SY, UK
| | - A Morrison
- From the Scottish Centre for Respiratory Research, Division of Molecular & Clinical Medicine, Ninewells Hospital & Medical School, Dundee, DD19SY, UK
| | - A Manoharan
- From the Scottish Centre for Respiratory Research, Division of Molecular & Clinical Medicine, Ninewells Hospital & Medical School, Dundee, DD19SY, UK
| | - B J Lipworth
- From the Scottish Centre for Respiratory Research, Division of Molecular & Clinical Medicine, Ninewells Hospital & Medical School, Dundee, DD19SY, UK
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Jabbal S, Manoharan A, Lipworth BJ. Bronchoprotective tolerance with indacaterol is not modified by concomitant tiotropium in persistent asthma. Clin Exp Allergy 2017; 47:1239-1245. [PMID: 28665534 DOI: 10.1111/cea.12972] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 06/11/2017] [Accepted: 06/27/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Tiotropium is a long acting muscarinic antagonist (LAMA), licensed as triple therapy with inhaled corticosteroid and long-acting beta-agonist (ICS/LABA). There may be a synergistic benefit between LAMA and LABA as a consequence of receptor cross-talk, which in turn could modify beta-2 receptor downregulation and associated tolerance induced by LABA. OBJECTIVE We hypothesize this mechanism may result in a reduction of airway hyperresponsiveness (AHR) when using triple therapy. METHODS We evaluated 14 non-smoking asthmatics using an open-label, randomized crossover design. ICS with Indacaterol and Tiotropium (IND/TIO) vs ICS with Indacaterol (IND) over 4 weeks with challenge performed after first and last doses at trough. RESULTS We found no significant difference in mannitol sensitivity, expressed as the provocative dose of mannitol required to reach a 15% drop in FEV1 , or mannitol reactivity, expressed as the response dose ratio (RDR: max % fall in FEV1 /cumulative dose), when comparing ICS/IND/TIO to ICS/IND. Geometric mean fold differences for RDR comparing single and chronic dosing were 3.26-fold (95% CI 1.46-7.29) and 2.51-fold (95% CI 1.32-4.79) for IND and IND/TIO, respectively. Furthermore, salbutamol recovery post-challenge was significantly blunted after chronic compared to single dosing with either ICS/IND (P<.005) or ICS/IND/TIO (P<.05). CONCLUSION AND CLINICAL RELEVANCE Our data suggest that concomitant tiotropium does not modify the bronchoprotective tolerance induced by Indacaterol, in turn suggesting that cross-talk may not be clinically relevant when using triple therapy. This study was registered on clinicaltrials.gov as NCT02039011.
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Affiliation(s)
- S Jabbal
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - A Manoharan
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - B J Lipworth
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
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Jabbal S, Manoharan A, Lipworth BJ. P239 Effects of tiotropium on asthma exacerbations are not explained by airway hyperresponsiveness, exhaled breath nitric oxide or airway geometry. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.382] [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: 11/03/2022]
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Kay RD, Manoharan A, Nematollahi S, Nelson J, Cummings SH, Rappaport WJA, Amini R. A novel fresh cadaver model for education and assessment of joint aspiration. J Orthop 2016; 13:419-24. [PMID: 27672243 DOI: 10.1016/j.jor.2016.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 05/19/2016] [Revised: 07/05/2016] [Accepted: 09/02/2016] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES The objective of this study was to describe a novel cadaver model and to determine the utility of this model for teaching and assessing students in performing knee, elbow, and wrist arthrocentesis. METHODS Third year medical students were evaluated while performing arthrocentesis during a fresh cadaver training sessions. RESULTS Sixty-three participants were included in this analysis. There was statistically significant improvement between the pre- and post-test analysis in all aspects assessed in our study of elbow, knee and wrist arthrocentesis. CONCLUSIONS The use of fresh cadavers for the education and assessment of arthrocenteses is an effective training model.
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Affiliation(s)
- Robert Daniel Kay
- College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Aditya Manoharan
- College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Saman Nematollahi
- Department of Internal Medicine, Columbia University Medical Center, New York, NY, United States
| | - Joseph Nelson
- Department of Orthopedic Surgery, The University of Michigan, Ann Arbor, MI, United States
| | | | | | - Richard Amini
- Department of Emergency Medicine, University of Arizona, Tucson, AZ, United States
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Shraga R, Akana M, Bristow S, Manoharan A, Puig O. Detecting Y-chromosome microdeletions using next generation sequencing (NGS) data. Fertil Steril 2016. [DOI: 10.1016/j.fertnstert.2016.07.657] [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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Manoharan A, Barla GS, Peter R, Sugumar M, Mathai D. Multidrug resistance mediated by co-carriage of extended-spectrum beta-lactamases, AmpC and New Delhi metallo-beta-lactamase-1 genes among carbapenem-resistant Enterobacteriaceae at five Indian medical centres. Indian J Med Microbiol 2016; 34:359-61. [PMID: 27514962 DOI: 10.4103/0255-0857.188350] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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
In this study, we evaluated the coexistence of extended-spectrum beta-lactamases (ESBL), AmpC and New Delhi metallo-beta-lactamase-1 (NDM-1) genes among carbapenem-resistant Enterobacteriaceae (CRE) recovered prospectively from patients at multiple sites. The study included 285 CRE strains from 2782 Gram-negative Bacilli collected from multiple centres during 2007-2010, of which 87 were characterised. Standard and reference laboratory methods were used for resistance determination. Detection of blaNDM-1 , blaAmpC , blaTEM , blaSHV and blaCTX-M was done by polymerase chain reaction. High levels of antimicrobial resistance observed among study isolates. Co-carriage of ESBLs, AmpC and NDM-1 was 26.3%. Nosocomial origin among the co-carriage isolates was 64.3%, with 9.2% associated mortality.
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Affiliation(s)
- A Manoharan
- Pushpagiri Research Center, Pushpagiri Institute of Medical Sciences and Research Center, Thiruvalla, Kerala, India
| | - G S Barla
- Department of Medicine, Benjamin M Pulimood Laboratories for Infection, Immunity and Inflammation, Christian Medical College, Vellore, Tamil Nadu, India
| | - R Peter
- Department of Medicine, Benjamin M Pulimood Laboratories for Infection, Immunity and Inflammation, Christian Medical College, Vellore, Tamil Nadu, India
| | - M Sugumar
- Department of Medicine, Benjamin M Pulimood Laboratories for Infection, Immunity and Inflammation, Christian Medical College, Vellore, Tamil Nadu, India
| | - D Mathai
- Department of Medicine, Apollo Institute of Medical Sciences, Education and Research, Hyderabad, Telangana, India
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Singh J, Manoharan A. A multicentric surveillance of invasive pneumococcal disease (IPD) in children under five years in India. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.548] [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] Open
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Titloye NA, Foster A, Omoniyi-Esan GO, Komolafe AO, Daramola AO, Adeoye OA, Adisa AO, Manoharan A, Pathak D, D'Cruz MN, Alizadeh Y, Lewis PD, Shaaban AM. Histological Features and Tissue Microarray Taxonomy of Nigerian Breast Cancer Reveal Predominance of the High-Grade Triple-Negative Phenotype. Pathobiology 2016; 83:24-32. [PMID: 26730581 DOI: 10.1159/000441949] [Citation(s) in RCA: 16] [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] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 10/26/2015] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Little is known about the biology, molecular profile and hence optimal treatment of African Nigerian breast cancer. The aim of this work, therefore, was to characterize the histology and molecular profile of Nigerian breast cancer. METHODS Breast carcinomas from women at 6 centres of similar tribal origin in Nigeria were reviewed and assembled into tissue microarrays (TMAs), and sections were stained for hormone receptors, i.e. estrogen receptor (ER)α, ERβ1, ERβ progesterone receptor (PR) and androgen receptor, cyclin D, HER2, Ki67 and cytokeratins (CKs), i.e. CK5/6 and CK14 (basal) and CK18 and 19 (luminal). RESULTS A total of 835 tumours were analysed. The mean age at diagnosis was 48.62 ± 12.41 years. The most common histological subtype was ductal NST (no-special-type) carcinoma (87.3%). Over 90% of the tumours were grade 2 or 3. The predominant molecular phenotype was the non-basal, triple-negative type (47.65%) followed by the HER2-positive group (19.6%). The percentage of ER-, PR- and HER2-positive tumours was 22.4, 18.9 and 18.8%, respectively. CONCLUSION Nigerian breast cancer predominantly has a high-grade, triple-negative profile. It occurs at a younger age and bears similarities at the molecular level to pre-menopausal breast cancer in white women, with remarkably lower levels of ERβ expression. The early presentation and histological and molecular phenotype may explain the poor prognosis, and tailoring treatment strategies to target this unique profile are required.
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Affiliation(s)
- N A Titloye
- School of Medical Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Manoharan A, Lipworth BJ, Craig E, Jackson C. The potential role of direct and indirect bronchial challenge testing to identify overtreatment of community managed asthma. Clin Exp Allergy 2015; 44:1240-5. [PMID: 24912796 DOI: 10.1111/cea.12352] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 05/12/2014] [Accepted: 06/03/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although airway hyperresponsiveness (AHR) is a defining feature of asthma pathophysiology, bronchial challenge testing is not routinely used in primary care asthma management. OBJECTIVE The aim of this study was to evaluate the potential role of direct (methacholine) and indirect (mannitol) challenge testing in community managed asthma. METHODS Patients currently treated for asthma from Tayside and Fife were identified by the Health Informatics Centre (HIC) and invited to take part in the study. At screening, the following tests were carried out: spirometry, methacholine and mannitol challenge, exhaled nitric oxide (FeNO); Asthma Control Questionnaire (ACQ) and Mini Asthma Quality of Life Questionnaire (AQLQ). RESULTS A total of 3388 asthmatics were initially identified by HIC with 423 positive responses and 123 completing the study. Seventy percent had either a positive methacholine (PC20 < 8 mg/mL) or mannitol challenge (PD15 < 635 mg), and 30% were non-responsive to both challenges. Fourteen percent of methacholine responders (n = 74) were negative to mannitol, and 16% of mannitol responders (n = 76) were negative to methacholine. Spirometry, FeNO, ACQ and AQLQ were significantly better in the non-responder group who were exposed to high-dose inhaled corticosteroids and frequent long-acting beta-agonists. CONCLUSIONS AND CLINICAL RELEVANCE We found that 30% of unselected patients with community managed asthma were challenge negative and could be potentially misdiagnosed or overtreated, in turn suggesting the need for supervised step-down.
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Affiliation(s)
- A Manoharan
- Scottish Centre for Respiratory Research, University of Dundee, Dundee, UK
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Elavarasan K, Rajan SS, Manoharan A, Pushpalatha P. Biochemical Analysis and Comparison of Superior Cabbage Genotypes Grown in Plains and Hills of Kerala, India. ILNS 2015. [DOI: 10.18052/www.scipress.com/ilns.38.1] [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: 11/15/2022]
Abstract
The present study was undertaken to identify the superior cabbage genotype and to examine their physical yield performance among the four cultivated genotypes namely Namdhari Seeds 183, Namdhari Seeds 160, Namdhari Seeds 35 and Tropical Sun Plus, grown in plains and higher altitude of Kerala. Study revealed that significant differences were observed in yield levels of cabbage and it was ranged from 22.6 – 29.3 kg /16m2 in hills and 1.27 – 22.06 kg /16m2 in plains. Among the cabbage genotypes, NS 183 was found to be the best for hilly region in terms of higher head yield (22.06 Kg /16m2), head weight (729.6 g), head height (11.1 cm) and early maturity. Similarly, Tropical Sun Plus exhibited better performance in plains in terms of higher head yield (22.06 Kg /16m2), head weight (729.6 g) and head height (11.1 cm). The individual genotype which exhibited the superior performance in hills and plains were selected and compared for the general biochemical characters like Moisture content, acidity, ascorbic acid, protein, phosphorus, calcium and potassium. Finally, the study found that, the genotype grown at hill (Tropical Sun Plus) was recorded a higher biochemical characters than genotype grown in plains (Tropical Sun plus). Similarly, hill grown genotype (NS 183) recorded a higher biochemical characters than the plains grown genotype (NS 183).
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Hashem D, Mannocci F, Patel S, Manoharan A, Brown JE, Watson TF, Banerjee A. Clinical and radiographic assessment of the efficacy of calcium silicate indirect pulp capping: a randomized controlled clinical trial. J Dent Res 2015; 94:562-8. [PMID: 25710953 DOI: 10.1177/0022034515571415] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aims of this study were to assess the effectiveness of calcium silicate cement (Biodentine) versus glass ionomer cement (GIC; control group) as indirect pulp capping materials in patients with reversible pulpitis and to compare the effectiveness of cone beam computed tomography (CBCT) versus periapical (PA) radiographs in detecting PA changes at baseline (T0) and at 12 mo (T12) postoperatively. Seventy-two restorations (36 Biodentine, 36 Fuji IX) were placed randomly in 53 patients. CBCT/PA radiographs were taken at T0 and T12. Two calibrated examiners assessed the presence/absence and increase/decrease in the size of existing PA radiolucencies under standardized conditions. The Kappa coefficient evaluated statistically the effectiveness of CBCT versus PA radiographs in detecting PA changes. Chi-square/Mann-Whitney tests were used to evaluate the association between PA changes in CBCT with various clinical measures. Significance was predetermined at α = 0.05. Clinical success rates for Biodentine and Fuji IX GIC were 83.3%. CBCT was significantly more effective in detecting PA radiolucencies compared with radiographs (P = 0.0069). Of the teeth, 65.4% and 90.4% were deemed healthy using CBCT and PA radiographs, respectively, at T12. Healing/healed rates were 17.3%/0%, while new/progressed radiolucency were 30.8%/9.6% with CBCT/PA radiographs, respectively. Seventy-one percent of healed lesions had received Biodentine; 88% of new/progressed lesions received Fuji IX GIC. Teeth presenting with an initial CBCT PA lesion had a failure rate of 63%, whereas teeth with no initial lesion had a failure rate of 16%. Although no statistically significant difference was detected in the clinical efficacy of Biodentine/Fuji IX when used as indirect pulp capping materials in patients with reversible pulpitis, CBCT showed a significant difference in that most healed CBCT lesions had received Biodentine while most that did not heal received Fuji IX. Longer-term follow-up is needed to establish their effect on the healing dynamics of PA tissues (ClinicalTrials.gov NCT02201641).
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Affiliation(s)
- D Hashem
- Conservative & MI Dentistry (including Endodontics), King's College London Dental Institute at Guy's Hospital, King's Health Partners, London, UK Tissue Engineering & Biophotonics, King's College London Dental Institute at Guy's Hospital, King's Health Partners, London, UK
| | - F Mannocci
- Conservative & MI Dentistry (including Endodontics), King's College London Dental Institute at Guy's Hospital, King's Health Partners, London, UK
| | - S Patel
- Conservative & MI Dentistry (including Endodontics), King's College London Dental Institute at Guy's Hospital, King's Health Partners, London, UK
| | - A Manoharan
- Biostatistics, King's College London Dental Institute at Guy's Hospital, King's Health Partners, London, UK
| | - J E Brown
- Dental Radiology, King's College London Dental Institute at Guy's Hospital, King's Health Partners, London, UK
| | - T F Watson
- Conservative & MI Dentistry (including Endodontics), King's College London Dental Institute at Guy's Hospital, King's Health Partners, London, UK Tissue Engineering & Biophotonics, King's College London Dental Institute at Guy's Hospital, King's Health Partners, London, UK
| | - A Banerjee
- Conservative & MI Dentistry (including Endodontics), King's College London Dental Institute at Guy's Hospital, King's Health Partners, London, UK Tissue Engineering & Biophotonics, King's College London Dental Institute at Guy's Hospital, King's Health Partners, London, UK
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Manoharan A, Anderson W, Lipworth J, Lipworth B. P44 Assessment Of Spirometry And Impulse Oscillometry In Relation To Asthma Control. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.185] [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: 11/04/2022]
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Griffin B, Manoharan A, Anderson W, Lipworth J, Lipworth B. S133 2-adrenergic Receptor Gly16arg Polymorphism Is Not Associated With Impaired Asthma Control In Corticosteroid Treated Adult Asthmatics. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.139] [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: 11/03/2022]
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George J, Mackle G, Manoharan A, Khan F, Struthers A. High BNP levels in rheumatoid arthritis are related to inflammation but not to left ventricular abnormalities: A prospective case–control study. Int J Cardiol 2014; 172:e116-8. [DOI: 10.1016/j.ijcard.2013.12.119] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 12/22/2013] [Indexed: 12/17/2022]
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Chandy S, Ramanathan K, Manoharan A, Mathai D, Baruah K. Assessing effect of climate on the incidence of dengue in Tamil Nadu. Indian J Med Microbiol 2014; 31:283-6. [PMID: 23883717 DOI: 10.4103/0255-0857.115640] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Incidence of dengue is reported to be influenced by climatic factors. The objective of this study is to assess the association of local climate with dengue incidence, in two geographically distinct districts in Tamil Nadu. The study uses climate data, rainfall and mean maximum and minimum temperature to assess its association if any, with dengue incidence in two districts of Tamil Nadu, South India. According to this study while precipitation levels have an effect on dengue incidence in Tamil Nadu, non-climatic factors such as presence of breeding sites, vector control and surveillance are important issues that need to be addressed.
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Affiliation(s)
- S Chandy
- Department of Medicine, Unit 1 and Infectious Diseases, Christian Medical College, Vellore, India
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Manoharan A, Lipworth J, Short PM, Anderson WJ, Williamson PA, Berg J, Lipworth BJ. P192 A pilot study to assess the influence of β2-adrenoceptor polymorphism on small airway function and asthma control: Abstract P192 Table 1:. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.344] [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: 11/04/2022]
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Anderson WJ, Short PM, Lipworth JLR, Manoharan A, Palmer CNA, Lipworth BJ. P191 Beta-2 adrenoceptor genotype and response to propranolol in patients with persistent asthma: Abstract P191 Table 1. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.343] [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: 11/03/2022]
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Manoharan A, Short PM, Anderson WJ, Lipworth BJ. P228 Impact of long-acting bronchodilator therapy on mortality in copd: a real-life retrospective cohort study: Abstract P228 Table 1. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.380] [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: 11/04/2022]
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Anderson WJ, Short PM, Williamson PA, Manoharan A, Lipworth BJ. P162 Effect of adding propranolol or increased inhaled corticosteroid dose in persistent asthma. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Manoharan A, Suresh S, Sankaranarayanan L. Proximal Fibular Osteochondroma Producing Common Peroneal Nerve Palsy in a Post-Cesarean Section Patient. Oman Med J 2013; 28:e047. [PMID: 31440355 PMCID: PMC6669302 DOI: 10.5001/omj.2013.63] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Various causes of common peroneal palsy have been described in the English language medical literature in the past. Authors report a case of foot drop in a post cesarean section patient, due to osteochondroma of the proximal fibula, which recovered completely after excision of the offending mass.
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Affiliation(s)
- A. Manoharan
- Assistant Professor-Orthopedics, Chengalpattu Medical College, Tamilnadu, India
| | - S.S. Suresh
- Head of Department of Orthopaedics, Ibri Regional Referral Hospital, PO Box 46, Ibri 516, Sultanate of Oman
- Address correspondence and reprints request to: SS Suresh Head of Department of Orthopaedics, Ibri Regional Referral Hospital, PO Box 46, Ibri 516, Sultanate of Oman. E-mail:
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Abstract
Cigarette smoke (CS) has been reported to induce autophagy in airway epithelial cells. The subsequent autophagic cell death has been proposed to play an important pathogenic role in chronic obstructive pulmonary disease (COPD); however, the underlying molecular mechanism is not entirely clear. Using CS extract (CSE) as a surrogate for CS, we found that it markedly increased the expressions of both LC3B-I and LC3B-II as well as autophagosomes in airway epithelial cells. This is in contrast to the common autophagy inducer (i.e., starvation) that increases LC3B-II but reduces LC3B-I. Further studies indicate that CSE regulated LC3B at transcriptional and post-translational levels. In addition, CSE, but not starvation, activated Nrf2-mediated adaptive response. Increase of cellular Nrf2 by either Nrf2 overexpression or the knockdown of Keap1 (an Nrf2 inhibitor) significantly repressed CSE-induced LC3B-I and II as well as autophagosomes. Supplement of NAC (a GSH precursor) or GSH recapitulated the effect of Nrf2, suggesting the increase of cellular GSH level is responsible for Nrf2 effect on LC3B and autophagosome. Interestingly, neither Nrf2 activation nor GSH supplement could restore the repressed activities of mTOR or its downstream effctor-S6K. Thus, the Nrf2-dependent autophagy-suppression was not due to the re-activation of mTOR-the master repressor of autophagy. To search for the downstream effector of Nrf2 on LC3B and autophagosome, we tested Nrf2-dependent genes (i.e., NQO1 and P62) that are also increased by CSE treatment. We found that P62, but not NQO1, could mimic the effect of Nrf2 activation by repressing LC3B expression. Thus, Nrf2->P62 appears to play an important role in the regulation of CSE-induced LC3B and autophagosome.
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Affiliation(s)
- Lingxiang Zhu
- Department of Pharmacology and Toxicology, University of Arizona, Tucson, Arizona, United States of America
| | - Erika C. Barret
- Department of Pharmacology and Toxicology, University of Arizona, Tucson, Arizona, United States of America
| | - Yuxue Xu
- Department of Pharmacology and Toxicology, University of Arizona, Tucson, Arizona, United States of America
- School of Medicine, Xiamen University, Xiamen, China
| | - Zuguo Liu
- School of Medicine, Xiamen University, Xiamen, China
| | - Aditya Manoharan
- Department of Pharmacology and Toxicology, University of Arizona, Tucson, Arizona, United States of America
| | - Yin Chen
- Department of Pharmacology and Toxicology, University of Arizona, Tucson, Arizona, United States of America
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Purohit M, Mendiratta DK, Deotale VS, Madhan M, Manoharan A, Narang P. Detection of metallo-β-lactamases producing Acinetobacter baumannii using microbiological assay, disc synergy test and PCR. Indian J Med Microbiol 2012. [DOI: 10.4103/0255-0857.103770] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Manoharan A, Premalatha K, Chatterjee S, Mathai D. Correlation of TEM, SHV and CTX-M extended-spectrum beta lactamases among Enterobacteriaceae with their in vitro antimicrobial susceptibility. Indian J Med Microbiol 2011; 29:161-4. [PMID: 21654112 DOI: 10.4103/0255-0857.81799] [Citation(s) in RCA: 44] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
PURPOSE The present study was carried out to characterize the ESBL types and evaluated their in vitro activity against a collection of Gram negative bacteria (GNB) from a multicentric Indian surveillance study. MATERIAL AND METHODS During January 2005 to June 2006, six tertiary care centres in India forwarded 778 non-duplicate GNB to our reference laboratory. Three hundred GNB from this collection were selected based on clinical significance and were used in the present study. Tested isolates included Escherichia coli (167), Klebsiella spp. (122) and Enterobacter spp. (11). ESBL screening and confirmation was performed for all the isolates. Minimum inhibitory concentration of imipenem, meropenem, ertapenem, levofloxacin, amikacin, piperacillin/tazobactam and ceftriaxone was determined by the E-test method. Molecular typing of the ESBLs was performed by polymerase chain reaction among the 121 selected isolates. RESULTS The study showed excellent susceptibility among the strains to imipenem (100%), meropenem (100%) and ertapenem (98.7%); good susceptibility to amikacin (89.7%) and piperacillin/tazobactam (85.3%) was observed. TEM and CTX-M were predominantly found in E. coli (39.2%) while, among the Klebsiella spp., TEM, SHV and CTX-M occurred together in 42.6% of the isolates. CONCLUSION More than one ESBL was produced by many strains, and this was correlated with increased resistance levels. Carbapenems continue to show good in vitro activity and ertapenem is a potential alternative to imipenem and meropenem. Continued antimicrobial resistance surveillance is warranted in light of these findings.
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Affiliation(s)
- A Manoharan
- Prof. Benjamin M Pulimood Laboratories for Infection, Immunity and Inflammation (BMPLIII), Department of Medicine Unit I and Infectious Disease, Christian Medical College, Vellore 632 004, Tamil Nadu, India.
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Manoharan A, Chatterjee S, Mathai D. Detection and characterization of metallo beta lactamases producing Pseudomonas aeruginosa. Indian J Med Microbiol 2010; 28:241-4. [DOI: 10.4103/0255-0857.66486] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chatterjee S, Kumar A, Prasad K, Mathai D, Manoharan A. Clinico epidemiologic and molecular characterization of metallo beta lactamases (MBLs) producing nosocomial Pseudomonas aeruginosa (PSA). Int J Infect Dis 2010. [DOI: 10.1016/j.ijid.2010.02.1557] [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: 11/25/2022] Open
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Narasimhan P, Peter R, Manoharan A, Wood J, MacIntyre R, Mathai D, John K. A retrospective study to assess treatment outcomes among TB patients taking DOTS treatment in South India. Int J Infect Dis 2010. [DOI: 10.1016/j.ijid.2010.02.2164] [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: 11/26/2022] Open
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Manoharan A, Chatterjee S, Mathai D. Carbapenem Resistance (CARB-R) among Pseudomonas aeruginosa (PSA) Isolates in Indian Medical Centers: A Preliminary Report From the Surveillance of Antimicrobial Resistance in India (SARI) Study. Int J Infect Dis 2008. [DOI: 10.1016/j.ijid.2008.05.268] [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: 10/21/2022] Open
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Manoharan A, Premalatha K, Kumar A, Jose H, Mathai D. In-Vitro Activity of Ertapenem Against Extended-Spectrum Beta Lactamase (ESBL) Producing Gram-Negative Bacilli (GNB) Seen in Indian Medical Centers. Int J Infect Dis 2008. [DOI: 10.1016/j.ijid.2008.05.279] [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: 10/21/2022] Open
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Manoharan A. Population screening for HFE-associated haemochromatosis. Intern Med J 2008. [DOI: 10.1111/j.1445-5994.2001.00120.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: 11/27/2022]
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Mckinley R, Kwan YL, Ford D, Lam-Po-Tang PRL, Mason RS, Manoharan A. CLINICAL AND LABORATORY STUDIES OF 1,25-DIHYDROXYCHOLECALCIFEROL IN MYELOFIBROSIS. Br J Haematol 2008. [DOI: 10.1111/j.1365-2141.1987.00252.x-i1] [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: 11/30/2022]
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Manoharan A, Hewitt B. Danazol therapy in familial antithrombin III deficiency. Clin Lab Haematol 2008; 12:357-9. [PMID: 2272164 DOI: 10.1111/j.1365-2257.1990.tb00047.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Bowyer S, Moran J, Hsieh L, Manoharan A, Young R, Malladi K, Yu YJ, Chiang Y, Hersberger R, Genik R, Tepley N. MEG localization of cortex involved in attention processes during a driving task with conversation. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.ics.2007.02.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Moran J, Bowyer S, Manoharan A, Mason K, Tepley N, Smith B, Barkley G, Greene D, Morrell M. MEG coherence imaging compared to electrocortical recordings from NeuroPace implants to determine the location of ictal onset in epilepsy patients. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.ics.2007.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hicks C, Wong R, Manoharan A, Kwan YL. Viable CD34+/CD133+ blood progenitor cell dose as a predictor of haematopoietic engraftment in multiple myeloma patients undergoing autologous peripheral blood stem cell transplantation. Ann Hematol 2007; 86:591-8. [PMID: 17492259 DOI: 10.1007/s00277-007-0297-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Revised: 02/20/2007] [Accepted: 04/03/2007] [Indexed: 11/26/2022]
Abstract
Both CD34 (cluster of differentiation 34) and the more recently described CD133 are markers of primitive stem cells with haematopoietic repopulating ability. Most transplanting centres use a minimum number of CD34+ cells as the requirement for a transplant and consider this a predictor of haematopoietic engraftment. However, transplanted CD34+ cell dose does not always give a close correlation with time to engraftment nor explain delayed engraftment in some patients. We have retrospectively evaluated the potential of measuring viable CD133+ cell numbers in the autograft as an alternative predictor of haematological engraftment after autologous stem-cell transplantation in a cohort of patients with multiple myeloma (MM). We found an average 32% loss of viability of CD34+ cells in the post-thaw sample compared with the fresh sample. Of the original estimated CD34+ cell numbers transplanted per kg, 43% of the thawed samples were double positive for CD34+/CD133+. In this patient group, the CD34+/CD133+ subset gave the closest statistical correlation with time to neutrophil engraftment (p < 0.05), particularly for patients given above median (1.8 x 10(6)/kg) dose of the double-positive cells. The CD34+/CD133+ population was the only parameter to give a significant correlation with white cell engraftment in this patient cohort (p < 0.05). There was no significant correlation between CD34+, viable CD34+ or viable CD34+/CD133+ cells/kilogram with platelet engraftment. Determination of viable CD34+/CD133+ progenitor cell dose in the autograft may be a useful tool to predict neutrophil recovery after autologous transplantation than conventional assessment of CD34+ numbers. These results warrant further investigation of the role of CD133 in haematopoietic engraftment.
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Affiliation(s)
- C Hicks
- Department of Clinical Haematology, Bone Marrow Transplant Laboratory, St. George Hospital, Kogarah, 2217 Sydney, NSW, Australia.
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Manoharan A, Kumar A, Laliltha M, Mathai D. P1194 C-reactive protein in community-acquired pneumonia among adults in India: association with aetiology, severity, treatment and outcome. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)71034-8] [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: 11/26/2022]
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Manoharan A, Gemmell R, Hartwell T. Use of whole blood platelet lumi-aggregometry to optimize anti-platelet therapy in patients with chronic myeloproliferative disorders. Am J Hematol 2006; 81:676-83. [PMID: 16795055 DOI: 10.1002/ajh.20698] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Twenty-seven patients with chronic myeloproliferative disorders and in vitro evidence of platelet hyperactivity on whole blood platelet lumi-aggregometry were commenced on anti-platelet therapy comprising aspirin, clopidogrel, and/or odorless garlic and the studies were repeated to assess the efficacy of the therapeutic agent(s). Only 8 patients showed clear evidence of anti-platelet effect while receiving the standard low-dose (100 mg/day) aspirin therapy. Thirteen patients required a higher dosage of aspirin and/or an additional anti-platelet agent to achieve therapeutic adequacy. Lumi-aggregometry also proved useful to optimize therapy in the 6 patients who received clopidogrel or odorless garlic because of aspirin intolerance.
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Affiliation(s)
- A Manoharan
- Department of Clinical Haematology , St George Hospital, Sydney, Australia.
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