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Vialatte A, Yeshurun Y, Khan AZ, Rosenholtz R, Pisella L. Superior Parietal Lobule: A Role in Relative Localization of Multiple Different Elements. Cereb Cortex 2021; 31:658-671. [PMID: 32959044 DOI: 10.1093/cercor/bhaa250] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 08/10/2020] [Accepted: 08/10/2020] [Indexed: 12/13/2022] Open
Abstract
Simultanagnosia is an impairment in processing multiple visual elements simultaneously consecutive to bilateral posterior parietal damage, and neuroimaging data have specifically implicated the superior parietal lobule (SPL) in multiple element processing. We previously reported that a patient with focal and bilateral lesions of the SPL performed slower than controls in visual search but only for stimuli consisting of separable lines. Here, we further explored this patient's visual processing of plain object (colored disk) versus object consisting of separable lines (letter), presented in isolation (single object) versus in triplets. Identification of objects was normal in isolation but dropped to chance level when surrounded by distracters, irrespective of eccentricity and spacing. We speculate that this poor performance reflects a deficit in processing objects' relative locations within the triplet (for colored disks), aggravated by a deficit in processing the relative location of each separable line (for letters). Confirming this, performance improved when the patient just had to detect the presence of a specific colored disk within the triplets (visual search instruction), while the inability to identify the middle letter was alleviated when the distracters were identical letters that could be grouped, thereby reducing the number of ways individual lines could be bound.
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Affiliation(s)
- A Vialatte
- Integrative Multisensory Perception Action & Cognition Team (ImpAct), INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center (CRNL), Lyon, France.,University of Lyon 1, Lyon, France.,Hospices Civils de Lyon, Mouvement & Handicap, Neuro-Immersion Platforms, Lyon, France
| | - Y Yeshurun
- Psychology Department, University of Haifa, Haifa, Israel
| | - A Z Khan
- School of Optometry, University of Montreal, Montreal, Canada
| | - R Rosenholtz
- Department of Brain & Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - L Pisella
- Integrative Multisensory Perception Action & Cognition Team (ImpAct), INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center (CRNL), Lyon, France.,University of Lyon 1, Lyon, France.,Hospices Civils de Lyon, Mouvement & Handicap, Neuro-Immersion Platforms, Lyon, France
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2
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Schneider C, Sodergren MH, Pencavel T, Soggiu F, Bhogal RH, Khan AZ. Prognostic relevance of the posterior resection margin for predicting disease free survival in ampullary adenocarcinoma. Surg Oncol 2020; 35:211-217. [PMID: 32911213 DOI: 10.1016/j.suronc.2020.08.028] [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: 12/03/2019] [Revised: 06/23/2020] [Accepted: 08/19/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pancreaticoduodenectomy is the only curative treatment option for patients with resectable ampullary adenocarcinoma (AA). Excellent disease free survival (DFS) can be achieved in patients with clear resection margins but it is poorly understood which patients are at increased risk of recurrence and hence would benefit from adjuvant chemotherapy. There is evolving evidence that the anatomical location of incomplete resection margins influences DFS in pancreatic adenocarcinoma. It is unknown if this also pertains to AA and therefore this study aimed to assess individual resection margin status and other predictors of DFS in AA. MATERIAL & METHODS Consecutive patients undergoing pancreaticoduodenectomy for AA at our institution from 1996 to 2017 were analysed. Pancreas neck, posterior and superior mesenteric vein margins were assessed individually. Cox proportional hazards modelling was used to identify predictors of 5-year DFS. Factors with p < 0.1 on univariate analysis were included for multivariate analysis. RESULTS Analysis of 104 patients revealed median OS and DFS of 56 and 34 months, respectively. Predictors associated with worse DFS on multivariate analysis were T3-stage (HR 3.6, p = 0.048), N1 (HR 2.9, p = 0.01) and N2 -stage (HR 3.6, p = 0.006), R1 status at the posterior margin (HR 3.0, p = 0.009) and a visible mass on CT (HR 2.0, p = 0.039). CONCLUSION Routine histopathological assessment of individual resection margins may aid in predicting recurrence of AA. Future studies to assess if routine mesopancreas excision during pancreaticoduodenectomy can reduce the incidence of R1 status at the posterior margin are warranted.
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Affiliation(s)
- C Schneider
- Department of Hepatopancreatobiliary Surgery, Royal Marsden Hospital, London, UK.
| | - M H Sodergren
- Department of Hepatopancreatobiliary Surgery, Royal Marsden Hospital, London, UK
| | - T Pencavel
- Department of Hepatopancreatobiliary Surgery, Royal Marsden Hospital, London, UK
| | - F Soggiu
- Department of Hepatopancreatobiliary Surgery, Royal Marsden Hospital, London, UK
| | - R H Bhogal
- Department of Hepatopancreatobiliary Surgery, Royal Marsden Hospital, London, UK
| | - A Z Khan
- Department of Hepatopancreatobiliary Surgery, Royal Marsden Hospital, London, UK
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Jheon S, Ahmed AD, Fang VW, Jung W, Khan AZ, Lee JM, Sihoe AD, Thongcharoen P, Tsuboi M, Turna A, Nakajima J. Thoracic cancer surgery during the COVID-19 pandemic: a consensus statement from the Thoracic Domain of the Asian Society for Cardiovascular and Thoracic Surgery. Asian Cardiovasc Thorac Ann 2020; 28:322-329. [PMID: 32609557 DOI: 10.1177/0218492320940162] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Healthcare resources have been mobilized to combat the COVID-19 pandemic of 2020. The Thoracic Domain of the Asian Society for Cardiovascular and Thoracic Surgery reports a consensus statement on the provision of thoracic cancer surgery during this pandemic. METHODS A Thoracic Experts Panel was convened by the Society. A consensus on the provision, safety, and setting of thoracic cancer surgery during the pandemic was obtained through a Delphi process. RESULTS Responses were received from 26 panel members (96% response rate) from 10 regions across Asia. The Society recommended that elective thoracic cancer surgery services may need to be reduced or postponed if medical resources were needed for COVID-19 patients, especially intensive care unit beds and ventilators. However, thoracic cancer surgery should proceed as normal for all solid tumors, without restrictions based on disease stage, availability of non-surgical treatment options, or patient condition (unless there is a high likelihood of postoperative intensive care unit stay). Aerosol-forming procedures should be avoided intra- and perioperatively. The surgical approach does not make a difference in terms of safety. Services for thoracic cancer patients should be offered only in hospitals that maintain isolation wards for patients with confirmed or suspected COVID-19. CONCLUSIONS Services for patients with thoracic cancer should be maintained during the COVID-19 pandemic. The position of the Society is that thoracic surgeons have a responsibility to perform good surgical management of thoracic cancer during the pandemic, to advocate for patients' rights to receive it, and to safeguard patients and staff from infection.
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Affiliation(s)
- Sanghoon Jheon
- Department of Cardiothoracic Surgery, Seoul National University Bundang Hospital, Bundang, South Korea
| | - Aneez Db Ahmed
- Division of Thoracic Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Vincent Wt Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai, China
| | - Woohyun Jung
- Department of Cardiothoracic Surgery, Seoul National University Bundang Hospital, Bundang, South Korea
| | - Ali Zamir Khan
- Department of Minimally Invasive & Robotic Thoracic Surgery, Medanta Hospital, Gurgaon, India
| | - Jang-Ming Lee
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital, Taipei
| | | | | | - Masahiro Tsuboi
- Department of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Akif Turna
- Department of Thoracic Surgery, Istanbul University-Cerrahpaşa, Cerrahpaşa Medical School Istanbul, Turkey
| | - Jun Nakajima
- Department of Thoracic Surgery, University of Tokyo Graduate School of Medicine, Tokyo, Japan
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Jheon S, Ahmed ADB, Fang VWT, Jung W, Khan AZ, Lee JM, Nakajima J, Sihoe ADL, Thongcharoen P, Tsuboi M, Turna A. General thoracic surgery services across Asia during the 2020 COVID-19 pandemic. Asian Cardiovasc Thorac Ann 2020; 28:243-249. [PMID: 32396384 PMCID: PMC7218355 DOI: 10.1177/0218492320926886] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The COVID-19 pandemic of 2020 posed an historic challenge to healthcare systems around the world. Besides mounting a massive response to the viral outbreak, healthcare systems needed to consider provision of clinical services to other patients in need. Surgical services for patients with thoracic disease were maintained to different degrees across various regions of Asia, ranging from significant reductions to near-normal service. Key determinants of robust thoracic surgery service provision included: preexisting plans for an epidemic response, aggressive early action to "flatten the curve", ability to dedicate resources separately to COVID-19 and routine clinical services, prioritization of thoracic surgery, and the volume of COVID-19 cases in that region. The lessons learned can apply to other regions during this pandemic, and to the world, in preparation for the next one.
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Affiliation(s)
- Sanghoon Jheon
- Department of Cardiothoracic Surgery, Seoul National University Bundang Hospital, Bundang, South Korea
| | - Aneez DB Ahmed
- Division of Thoracic Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Vincent WT Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai, China
| | - Woohyun Jung
- Department of Cardiothoracic Surgery, Seoul National University Bundang Hospital, Bundang, South Korea
| | - Ali Zamir Khan
- Department of Minimally Invasive & Robotic Thoracic Surgery, Medanta Hospital, Gurgaon, India
| | - Jang-Ming Lee
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital, Taipei
| | - Jun Nakajima
- Department of Thoracic Surgery, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Alan DL Sihoe
- Department of Surgery, Gleneagles Hong Kong Hospital, Hong Kong SAR, China
| | | | - Masahiro Tsuboi
- Department of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Akif Turna
- Department of Cardiothoracic Surgery, Seoul National University Bundang Hospital, Bundang, South Korea
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Khan AZ, Ali K. Robotic resection of inflammatory tumour. J Vis Surg 2019. [DOI: 10.21037/jovs.2019.02.05] [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: 11/06/2022]
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Abstract
Tuberculosis and inflammatory conditions are endemic in India and South-East Asia. They cause intense inflammatory reactions and adhesions, thus making surgical resection difficult. In 2009, we installed an intuitive da Vinci HDSi robot to perform our surgery as a part of a robotic thoracic surgery unit. We reviewed our practice to report the trials and tribulations of starting a robotic thoracic surgery program in an inflammatory and infective disease endemic third-world country. With the success of the multispecialty robotic surgery program, we were able to purchase a second robot with an operating console and a training console. The robot is an additional tool in the armamentarium of the thoracic surgeon. It provides good vision in inflammatory conditions, facilitates dissection of dense adhesions with minimal blood loss, and the ability of the robotic endowrist allows maximum and safe manipulation at the thoracic outlet. Sleeve resection and sleeve lobectomy are technically possible, due to ease of suturing with the robotic platform. Complex resections for tuberculosis, aspergilloma, inflammatory tumours and post-infective bronchiectasis are safer using the robotic thoracic platform. This is our operation of choice in complex thoracic surgery cases.
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Affiliation(s)
- Ali Zamir Khan
- Department of Minimally Invasive Thoracic Surgery, Medanta, The Medicity, Gurgaon, India
| | - Sangeeta Khanna
- Department of Anesthesia, Medanta, The Medicity, Gurgaon, India
| | - Narendra Agarwal
- Department of Minimally Invasive Thoracic Surgery, Medanta, The Medicity, Gurgaon, India
| | - Kamran Ali
- Department of Minimally Invasive Thoracic Surgery, Medanta, The Medicity, Gurgaon, India
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Zhou Q, Dong J, He J, Liu D, Tian DH, Gao S, Li S, Liu L, He J, Huang Y, Xu S, Mao W, Tan Q, Chen C, Li X, Zhang Z, Jiang G, Xu L, Zhang L, Fu J, Li H, Wang Q, Tan L, Li D, Zhou Q, Fu X, Jiang Z, Chen H, Fang W, Zhang X, Li Y, Tong T, Yu Z, Liu Y, Zhi X, Yan T, Zhang X, Casal RF, Pompeo E, Carretta A, Riquet M, Rena O, Falcoz PE, Saji H, Khan AZ, Danguilan JL, Gonzalez-Rivas D, Guibert N, Zhu C, Shen J. The Society for Translational Medicine: indications and methods of percutaneous transthoracic needle biopsy for diagnosis of lung cancer. J Thorac Dis 2018; 10:5538-5544. [PMID: 30416804 DOI: 10.21037/jtd.2018.09.28] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Qinghua Zhou
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jingsi Dong
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jie He
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Cancer Center, Beijing 100021, China
| | - Deruo Liu
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - David H Tian
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.,Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, Australia
| | - Shugeng Gao
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Cancer Center, Beijing 100021, China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medicine, Beijing 100006, China
| | - Lunxu Liu
- Department of Cardiovascular and Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jianxing He
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510120, China
| | - Yunchao Huang
- Department of Thoracic and Cardiovascular Surgery, The Third Affiliated Hospital of Kunming Medical University (Yunnan Tumor Hospital), Kunming 650100, China
| | - Shidong Xu
- Department of Thoracic surgery, Harbin Medical University Cancer Hospital, Harbin 150086, China
| | - Weimin Mao
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Qunyou Tan
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing 400042, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Xiaofei Li
- Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710032, China
| | - Zhu Zhang
- Department of Thoracic Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital of Tongji University, Shanghai 200433, China
| | - Lin Xu
- Department of Thoracic Surgery, Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province, Nanjing 210009, China
| | - Lanjun Zhang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Jianhua Fu
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Hui Li
- Department of Thoracic Surgery, Beijing Chao-Yang Hospital, Beijing 100043, China
| | - Qun Wang
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Lijie Tan
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Danqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medicine, Beijing 100006, China
| | - Qinghua Zhou
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xiangning Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhongmin Jiang
- Department of Thoracic Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014, China
| | - Haiquan Chen
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Thoracic Surgery, Shanghai Chest Hospital, Jiao Tong University, Shanghai 200000, China
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Jiao Tong University, Shanghai 200000, China
| | - Xun Zhang
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin 300051, China
| | - Yin Li
- Department of Thoracic Surgery, Henan Cancer Hospital, Zhengzhou 450000, China
| | - Ti Tong
- Department of Thoracic Surgery, Second Hospital of Jilin University, Changchun 130041, China
| | - Zhentao Yu
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Yongyu Liu
- Department of Thoracic Surgery, Liaoning Cancer Hospital and Institute, Shenyang 110042, China
| | - Xiuyi Zhi
- Department of Thoracic Surgery, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
| | - Tiansheng Yan
- Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100083, China
| | - Xingyi Zhang
- Department of Thoracic Surgery, Second Hospital of Jilin University, Changchun 130041, China
| | - Roberto F Casal
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Texas, USA
| | - Eugenio Pompeo
- Department of Thoracic Surgery, Policlinico Tor Vergata, Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Angelo Carretta
- Department of Thoracic Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Marc Riquet
- Georges Pompidou European Hospital, General Thoracic Surgery Department, Georges Pompidou European Hospital, Paris, France
| | - Ottavio Rena
- Thoracic Surgery Unit, University of Eastern Piedmont, AOU Maggiore della Carità, Vercelli, Italy
| | - Pierre-Emmanuel Falcoz
- Department of Thoracic Surgery, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Hisashi Saji
- Department of Chest Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Ali Zamir Khan
- Department of Minimally Invasive Thoracic Surgery, Medanta The Medicity, Gurgaon, India
| | - Jose Luis Danguilan
- Lung Center of the Philippines, Quezon City, Philippines, USA.,University of the Philippines College of Medicine, Manila, Philippines, USA
| | | | - Nicolas Guibert
- Pulmonology Department, Larrey University Hospital, Toulouse, France
| | - Chengchu Zhu
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Taizhou 317000, China
| | - Jianfei Shen
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Taizhou 317000, China
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Amer K, Khan AZ, Parshad R, Jones A. VATS lymph node dissection and staging: the Southampton experience. Video-assist Thorac Surg 2018. [DOI: 10.21037/vats.2018.04.05] [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: 11/06/2022]
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9
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Pasovic L, Utheim TP, Reppe S, Khan AZ, Jackson CJ, Thiede B, Berg JP, Messelt EB, Eidet JR. Improvement of Storage Medium for Cultured Human Retinal Pigment Epithelial Cells Using Factorial Design. Sci Rep 2018; 8:5688. [PMID: 29632395 PMCID: PMC5890280 DOI: 10.1038/s41598-018-24121-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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] [Received: 06/12/2017] [Accepted: 03/26/2018] [Indexed: 12/19/2022] Open
Abstract
Storage of human retinal pigment epithelium (hRPE) can contribute to the advancement of cell-based RPE replacement therapies. The present study aimed to improve the quality of stored hRPE cultures by identifying storage medium additives that, alone or in combination, contribute to enhancing cell viability while preserving morphology and phenotype. hRPE cells were cultured in the presence of the silk protein sericin until pigmentation. Cells were then stored for 10 days in storage medium plus sericin and either one of 46 different additives. Individual effects of each additive on cell viability were assessed using epifluorescence microscopy. Factorial design identified promising additive combinations by extrapolating their individual effects. Supplementing the storage medium with sericin combined with adenosine, L-ascorbic acid and allopurinol resulted in the highest cell viability (98.6 ± 0.5%) after storage for three days, as measured by epifluorescence microscopy. Flow cytometry validated the findings. Proteomics identified 61 upregulated and 65 downregulated proteins in this storage group compared to the unstored control. Transmission electron microscopy demonstrated the presence of melanosomes after storage in the optimized medium. We conclude that the combination of adenosine, L-ascorbic acid, allopurinol and sericin in minimal essential medium preserves RPE pigmentation while maintaining cell viability during storage.
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Affiliation(s)
- L Pasovic
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway. .,Department of Surgery, Akershus University Hospital, Lørenskog, Norway.
| | - T P Utheim
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway.,Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway.,Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Department of Ophthalmology, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway.,Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - S Reppe
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - A Z Khan
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - C J Jackson
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway.,Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - B Thiede
- Department of Biosciences, University of Oslo, Oslo, Norway
| | - J P Berg
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - E B Messelt
- Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - J R Eidet
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway.,Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
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10
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Khan AZ, Amad I, Shaheen S, Hussain K, Hafeez F, Farooq M, Noor Ul Ayan H. Genetic barcoding and phylogenetic analysis of dusky cotton bug (Oxycarenus hyalinipennis) using mitochondrial cytochrome c oxidase I gene. ACTA ACUST UNITED AC 2017; 63:59-63. [PMID: 29096756 DOI: 10.14715/cmb/2017.63.10.9] [Citation(s) in RCA: 2] [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: 05/02/2017] [Revised: 09/14/2017] [Accepted: 10/02/2017] [Indexed: 11/18/2022]
Abstract
Cotton dusky bug (Oxycarenus spp.) mostly attack on cash crops such as Gossypium, Cola and Hibiscus which affect the national economy therefore sustainable pest management is needed. Cytochrome c oxidase I (COI) gene is utilized as marker gene for DNA barcoding, genetic and ecological study of insects. In present study insect (cotton dusky bug) samples were collected from cotton fields in Faisalabad. COI gene was amplified from genomic DNA of bug and cloned into pTZ57R/T vector (Fermentas). The clone was sent to Macrogen (South Korea) for Sanger sequencing. The phylogenetic analysis and pairwise multiple sequence alignment showed that our cotton dusky bug grouped with two species of Oxycarenus genus and highest sequence identity was 91.1% with Oxycarenus hylinipennis. This is the first report of genetic barcode of Oxycarenus hylinipennis from cotton from Pakistan.
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Affiliation(s)
- A Z Khan
- Plant Research Group, Department of Bioinformatics and Biotechnology, Government College University Faisalabad, Pakistan
| | - I Amad
- Plant Research Group, Department of Bioinformatics and Biotechnology, Government College University Faisalabad, Pakistan
| | - S Shaheen
- Entomology Research Institute, Ayub Agricultural Research Institute, Faisalabad, Pakistan
| | - K Hussain
- Plant Research Group, Department of Bioinformatics and Biotechnology, Government College University Faisalabad, Pakistan
| | - F Hafeez
- Department of Botany, Lahore College for Women University, Lahore, Pakistan
| | - M Farooq
- Department of Botany, Lahore College for Women University, Lahore, Pakistan
| | - H Noor Ul Ayan
- Plant Research Group, Department of Bioinformatics and Biotechnology, Government College University Faisalabad, Pakistan
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11
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Khanna S, Das J, Mehta Y, Khan AZ. ‘Pandora’s box’ of the developing world-perioperative implications of pulmonary infections. Video-assist Thorac Surg 2017. [DOI: 10.21037/vats.2017.07.04] [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: 11/06/2022]
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12
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Acharya A, Markar SR, Sodergren MH, Malietzis G, Darzi A, Athanasiou T, Khan AZ. Meta-analysis of adjuvant therapy following curative surgery for periampullary adenocarcinoma. Br J Surg 2017; 104:814-822. [PMID: 28518410 DOI: 10.1002/bjs.10563] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/24/2016] [Accepted: 03/16/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Periampullary cancers are uncommon malignancies, often amenable to surgery. Several studies have suggested a role for adjuvant chemotherapy and chemoradiotherapy in improving survival of patients with periampullary cancers, with variable results. The aim of this meta-analysis was to determine the survival benefit of adjuvant therapy for periampullary cancers. METHODS A systematic review was undertaken of literature published between 1 January 2000 and 31 December 2015 to elicit and analyse the pooled overall survival associated with the use of either adjuvant chemotherapy or chemoradiotherapy versus observation in the treatment of surgically resected periampullary cancer. Included articles were also screened for information regarding stage, prognostic factors and toxicity-related events. RESULTS A total of 704 titles were screened, of which 93 full-text articles were retrieved. Fourteen full-text articles were included in the study, six of which were RCTs. A total of 1671 patients (904 in the control group and 767 who received adjuvant therapy) were included. The median 5-year overall survival rate was 37·5 per cent in the control group, compared with 40·0 per cent in the adjuvant group (hazard ratio 1·08, 95 per cent c.i. 0·91 to 1·28; P = 0·067). In 32·2 per cent of patients who had adjuvant therapy, one or more WHO grade 3 or 4 toxicity-related events were noted. Advanced T category was associated worse survival (regression coefficient -0·14, P = 0·040), whereas nodal status and grade of differentiation were not. CONCLUSION This systematic review found no associated survival benefit for adjuvant chemotherapy or chemoradiotherapy in the treatment of periampullary cancer.
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Affiliation(s)
- A Acharya
- Division of Surgery, Department of Surgery and Cancer, St Mary's Hospital, Imperial College, London, UK
| | - S R Markar
- Division of Surgery, Department of Surgery and Cancer, St Mary's Hospital, Imperial College, London, UK
| | - M H Sodergren
- Division of Surgery, Department of Surgery and Cancer, St Mary's Hospital, Imperial College, London, UK
| | - G Malietzis
- Division of Surgery, Department of Surgery and Cancer, St Mary's Hospital, Imperial College, London, UK
| | - A Darzi
- Division of Surgery, Department of Surgery and Cancer, St Mary's Hospital, Imperial College, London, UK
| | - T Athanasiou
- Division of Surgery, Department of Surgery and Cancer, St Mary's Hospital, Imperial College, London, UK
| | - A Z Khan
- Department of Hepatopancreatobiliary Surgery, Royal Marsden Hospital, London, UK
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Abstract
Aspergilloma of the lung eroding into the airway may lead to perioperative endobronchial spillage and contamination of the normal lung. Our aim in this group of patients who are undergoing robotic- or video-assisted thoracoscopic lobectomy is to protect the contralateral lung and, if possible, uninvolved lobes of ipsilateral lung. Double-lumen endobronchial tubes do provide lung protection to the contralateral lung intraoperatively, but there is no protection to the ipsilateral lung lobes not involved by the disease process. Moreover, there is no lung protection against endobronchial spillage during the period of induction of general anesthesia, when the cough reflex and gag reflex are absent. We have devised a technique to advance from side selection to lobe selection, that is, selective lobar isolation to prevent perioperative contamination of uninvolved lung lobes. This technique has two components viz positioning of the patient and securing the airway. The technique can also be used in other conditions such as hydatid cyst of the lung, lung abscess communicating with the airway and bleeding into the airway.
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Affiliation(s)
- Preety Mittal Roy
- From the Departments of *Anaesthesia and Critical Care and †Thoracic Surgery, Medanta, The Medicity, Gurgaon, India
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14
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Das J, Khanna S, Kumar S, Khan AZ, Mehta Y. Use of point of care ultrasound for removal of foreign body: "Early screening of the neighborhood is the key". J Anaesthesiol Clin Pharmacol 2016; 32:415-6. [PMID: 27625512 PMCID: PMC5009870 DOI: 10.4103/0970-9185.173393] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Jyotirmoy Das
- Department of Anesthesiology, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Sangeeta Khanna
- Department of Anesthesiology, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Sudhir Kumar
- Department of Anesthesiology, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Ali Zamir Khan
- Department of Minimally Invasive and Robotic Thoracic Surgery, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Yatin Mehta
- Department of Anesthesiology, Medanta - The Medicity, Gurgaon, Haryana, India
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15
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Roy PM, Khanna S, Mehta Y, Khan AZ. Aspergilloma of the Lung: Strategy to Prevent Endobronchial Spillage. Innovations 2016. [DOI: 10.1177/155698451601100513] [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: 11/17/2022]
Affiliation(s)
- Preety Mittal Roy
- Department of Anaesthesia and Critical Care, Medanta, The Medicity, Gurgaon, India
| | - Sangeeta Khanna
- Department of Anaesthesia and Critical Care, Medanta, The Medicity, Gurgaon, India
| | - Yatin Mehta
- Department of Anaesthesia and Critical Care, Medanta, The Medicity, Gurgaon, India
| | - Ali Zamir Khan
- Department of Thoracic Surgery, Medanta, The Medicity, Gurgaon, India
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16
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Khan AZ, Ali K, Agarwal N, Khandelwal S. A tale of surviving three consecutive cardiorespiratory arrests on table during a right sided pneumonectomy. J Vis Surg 2016; 2:96. [PMID: 29399483 DOI: 10.21037/jovs.2016.03.23] [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: 03/17/2016] [Accepted: 03/23/2016] [Indexed: 11/06/2022]
Abstract
Background Intraoperative cardiorespiratory arrest secondary to lower airway obstruction is often difficult to manage. We describe the management of one such technically challenging case of three consecutive cardiorespiratory arrests during a right pneumonectomy in a young boy. Methods A 10 years boy with a large fleshy vascular endobronchial tumor (biopsy proven squamous papilloma), completely occluding the right main-stem bronchus with collapse-consolidation of underlying right lung, was posted for a right pneumonectomy. There were dense adhesions of lung to the parieties and the lung was completely damaged. Twenty-five minutes into the surgery, patient started desaturating and the anesthetist was having difficulty in ventilating him. Check bronchoscopy showed endobronchial bleeding and the double lumen tube abutting the tumor. He was turned supine and CPR performed along with suctioning of blood and repositioning of tube. Patient revived and surgery continued. One and a half hour into the surgery the boy had a second cardiorespiratory arrest due to similar airway obstruction and managed in similar fashion. Lower lobectomy was speedily done to gain access to the hilum followed by quick completion pneumonectomy. Immediately following specimen removal, the patient had the third cardiorespiratory arrest and anesthetist was unable to ventilate the patient even after suctioning and repositioning of tube. With patient in lateral position, through the thoracotomy, right bronchial stump was opened and a quick bronchial intubation performed by the surgeon in chief. On opening the bronchus a tumor ball was seen occluding the left main bronchus, which probably got detached from the main tumor during pneumonectomy. Residual tumor was delivered out and the bronchial stump closed. Patient was transferred to ICU on ventilatory support. Results Postoperatively he was extubated after 48 hours and was found to have no neurological deficit. Chest drain came out on POD2 and he was discharged on POD5. Conclusions Promptly and methodically addressing this technical challenge helped us to prevent mortality. We also managed to avoid neurological sequelae of cardiorespiratory arrest. Learning point in this case is that when faced with a similar situation, it's important to stay calm and focused and to handle the challenge in a scientific and logical manner.
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Affiliation(s)
- Ali Zamir Khan
- Department of Minimally Invasive Thoracic Surgery, Medanta-The Medicity, Gurgaon, India
| | - Kamran Ali
- Department of Minimally Invasive Thoracic Surgery, Medanta-The Medicity, Gurgaon, India
| | - Narendra Agarwal
- Department of Minimally Invasive Thoracic Surgery, Medanta-The Medicity, Gurgaon, India
| | - Shaiwal Khandelwal
- Department of Minimally Invasive Thoracic Surgery, Medanta-The Medicity, Gurgaon, India
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17
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Khan AZ, Ali K, Khandelwal S, Agarwal N, Jamaluddin MF, Khanna S, Roy P. Robotic assisted thoracoscopic right upper lobectomy for post tuberculosis aspergilloma. J Vis Surg 2016; 2:51. [PMID: 29078479 DOI: 10.21037/jovs.2016.02.26] [Citation(s) in RCA: 2] [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: 12/19/2015] [Accepted: 01/01/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND Minimally invasive techniques for non-oncologic lung resections especially fungal infections are not widely employed. Through this video we share our experience of one such case of a robotic resection of pulmonary aspergilloma. METHODS A 55-year-old male with recurrent hemoptysis underwent surgical resection of post tuberculosis aspergilloma of right upper lobe using a 4-arm DaVinci Robot. RESULTS He received antituberculous drugs for 6 weeks pre-operatively. Systemic antifungals were given 2 weeks prior and continued for 3 months postoperatively. The operative time was 188 minutes and blood loss was 560 mL. Postoperative Chest X-rays showed complete lung expansion. CONCLUSIONS Robotic resection of lung is technically possible with good clinical outcomes even in infective pathologies. Robotic technique allows excellent 3D visualisation and good dexterity for easier and safe dissection of adhesions, as well as effective and precise anatomical lung resections for pulmonary aspergilloma.
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Affiliation(s)
- Ali Zamir Khan
- Department of Thoracic Surgery, Medanta the Medicity Hospital, Gurgaon, India
| | - Kamran Ali
- Department of Thoracic Surgery, Medanta the Medicity Hospital, Gurgaon, India
| | - Shaiwal Khandelwal
- Department of Thoracic Surgery, Medanta the Medicity Hospital, Gurgaon, India
| | - Narendra Agarwal
- Department of Thoracic Surgery, Medanta the Medicity Hospital, Gurgaon, India
| | | | - Sangeeta Khanna
- Department of Anaesthesia, Medanta the Medicity Hospital, Gurgaon, India
| | - Preety Roy
- Department of Anaesthesia, Medanta the Medicity Hospital, Gurgaon, India
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18
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Abstract
BACKGROUND Among the traditional systems of medicine practiced all over the world, Ayurveda and Yoga has a documented history dating back to beyond 200 BC. Robotic and video assisted thoracic surgery (VATS) is an invention of the 21(st) century. We aim to quantify the effects of integration of Ayurveda and Yoga on patients undergoing minimally invasive robotic and VATS. METHODS Four hundred and fifty-four patients undergoing VATS and robotic thoracic surgery were introduced to a pre and postoperative protocol of Yoga therapy, mediation and oil massages. Yoga exercises included Pranayam, Anulom Vilom, and Oil Massages included Urotarpan. Preoperative and postoperative respiratory functions were recorded. Patient satisfaction questionnaire were noted. Statistical comparison was made to control group undergoing minimally invasive thoracic surgery without integrative medicine. Only one patient refused to undergo Ayurveda therapy and was deleted from the group. RESULTS Acceptability was high among all patients. Preoperative training led to implementation as early as 6 hours post surgery. Pulmonary function test showed significant improvement. All patients suggested an improvement in satisfaction score. Pain score were less in study patients. Quicker mobilization led to early discharge and drain removal. Chronic pain was prevented in patients having oil massages over the healed wound sites. CONCLUSIONS Integration of Ayurveda, Yoga and minimally invasive robotic and VATS is acceptable to Indian patients and gives better clinical results and higher patient satisfaction.
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Affiliation(s)
- Ali Zamir Khan
- 1 Department of Minimally Invasive Thoracic Surgery, 2 Department of Integrative Medicine, Medanta The Medicity, Gurgaon, India
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19
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Eidet JR, Reppe S, Pasovic L, Olstad OK, Lyberg T, Khan AZ, Fostad IG, Chen DF, Utheim TP. The Silk-protein Sericin Induces Rapid Melanization of Cultured Primary Human Retinal Pigment Epithelial Cells by Activating the NF-κB Pathway. Sci Rep 2016; 6:22671. [PMID: 26940175 PMCID: PMC4778122 DOI: 10.1038/srep22671] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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] [Received: 07/13/2015] [Accepted: 02/17/2016] [Indexed: 12/21/2022] Open
Abstract
Restoration of the retinal pigment epithelial (RPE) cells to prevent further loss of vision in patients with age-related macular degeneration represents a promising novel treatment modality. Development of RPE transplants, however, requires up to 3 months of cell differentiation. We explored whether the silk protein sericin can induce maturation of primary human retinal pigment epithelial (hRPE) cells. Microarray analysis demonstrated that sericin up-regulated RPE-associated transcripts (RPE65 and CRALBP). Upstream analysis identified the NF-κB pathway as one of the top sericin-induced regulators. ELISA confirmed that sericin stimulates the main NF-κB pathway. Increased levels of RPE-associated proteins (RPE65 and the pigment melanin) in the sericin-supplemented cultures were confirmed by western blot, spectrophotometry and transmission electron microscopy. Sericin also increased cell density and reduced cell death following serum starvation in culture. Inclusion of NF-κB agonists and antagonists in the culture medium showed that activation of the NF-κB pathway appears to be necessary, but not sufficient, for sericin-induced RPE pigmentation. We conclude that sericin promotes pigmentation of cultured primary hRPE cells by activating the main NF-κB pathway. Sericin’s potential role in culture protocols for rapid differentiation of hRPE cells derived from embryonic or induced pluripotent stem cells should be investigated.
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Affiliation(s)
- J R Eidet
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
| | - S Reppe
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - L Pasovic
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - O K Olstad
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - T Lyberg
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - A Z Khan
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - I G Fostad
- Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - D F Chen
- Schepens Eye Research Institute, Harvard Medical School/Massachusetts Eye and Ear, Boston, MA
| | - T P Utheim
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway.,Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
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20
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Bai C, Choi CM, Chu CM, Anantham D, Chung-Man Ho J, Khan AZ, Lee JM, Li SY, Saenghirunvattana S, Yim A. Evaluation of Pulmonary Nodules: Clinical Practice Consensus Guidelines for Asia. Chest 2016; 150:877-893. [PMID: 26923625 DOI: 10.1016/j.chest.2016.02.650] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [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: 05/04/2015] [Revised: 02/08/2016] [Accepted: 02/09/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND American College of Chest Physicians (CHEST) clinical practice guidelines on the evaluation of pulmonary nodules may have low adoption among clinicians in Asian countries. Unique patient characteristics of Asian patients affect the diagnostic evaluation of pulmonary nodules. The objective of these clinical practice guidelines was to adapt those of CHEST to provide consensus-based recommendations relevant to practitioners in Asia. METHODS A modified ADAPTE process was used by a multidisciplinary group of pulmonologists and thoracic surgeons in Asia. An initial panel meeting analyzed all CHEST recommendations to achieve consensus on recommendations and identify areas that required further investigation before consensus could be achieved. Revised recommendations were circulated to panel members for iterative review and redrafting to develop the final guidelines. RESULTS Evaluation of pulmonary nodules in Asia broadly follows those of the CHEST guidelines with important caveats. Practitioners should be aware of the risk of lung cancer caused by high levels of indoor and outdoor air pollution, as well as the high incidence of adenocarcinoma in female nonsmokers. Furthermore, the high prevalence of granulomatous disease and other infectious causes of pulmonary nodules need to be considered. Therefore, diagnostic risk calculators developed in non-Asian patients may not be applicable. Overall, longer surveillance of nodules than those recommended by CHEST should be considered. CONCLUSIONS TB in Asia favors lesser reliance on PET scanning and greater use of nonsurgical biopsy over surgical diagnosis or surveillance. Practitioners in Asia are encouraged to use these adapted consensus guidelines to facilitate consistent evaluation of pulmonary nodules.
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Affiliation(s)
- Chunxue Bai
- Pulmonary Medicine Department, Zhongshan Hospital, Fudan University, Shanghai Respiratory Research Institute, Shanghai, China.
| | - Chang-Min Choi
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea
| | - Chung Ming Chu
- Respiratory Medicine, United Christian Hospital, Kwun Tong, Hong Kong SAR, China
| | - Devanand Anantham
- Respiratory Medicine and Critical Care Medicine, Singapore General Hospital, Singapore
| | - James Chung-Man Ho
- Respiratory Medicine, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China
| | - Ali Zamir Khan
- Minimally Invasive and Robotic Thoracic Surgery, Medanta The Medicity, Gurgaon, India
| | - Jang-Ming Lee
- Thoracic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Shi Yue Li
- Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Sawang Saenghirunvattana
- Respiratory Medicine, Bangkok Hospital Medical Center, Bangkok Hospital Group, Bangkok, Thailand
| | - Anthony Yim
- Minimally Invasive Thoracic Surgery Centre, Hong Kong SAR, China
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21
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Roy PM, Khanna S, Mehta Y, Khan AZ. 'Can't ventilate' during surgery: Nightmare for anaesthesiologist. Indian J Anaesth 2016; 60:958-959. [PMID: 28003700 PMCID: PMC5168901 DOI: 10.4103/0019-5049.195501] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Preety Mittal Roy
- Department of Anaesthesia and Critical Care, Medanta, The Medicity, Sector 38, Gurgaon, Haryana, India
| | - Sangeeta Khanna
- Department of Anaesthesia and Critical Care, Medanta, The Medicity, Sector 38, Gurgaon, Haryana, India
| | - Yatin Mehta
- Department of Anaesthesia and Critical Care, Medanta, The Medicity, Sector 38, Gurgaon, Haryana, India
| | - A Z Khan
- Department of Thoracic Surgery, Medanta, The Medicity, Sector 38, Gurgaon, Haryana, India
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22
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Amer K, Khan AZ, Rew D, Lagattolla N, Singh N. Video assisted thoracoscopic excision of mediastinal ectopic parathyroid adenomas: a UK regional experience. Ann Cardiothorac Surg 2015; 4:527-34. [PMID: 26693148 DOI: 10.3978/j.issn.2225-319x.2015.09.04] [Citation(s) in RCA: 10] [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] [Indexed: 11/14/2022]
Abstract
BACKGROUND To report the first series of video-assisted thoracoscopic surgery (VATS) resection of mediastinal ectopic parathyroid adenomas (MEPAs) in the UK. METHODS A case series of seven cases undergoing VATS between 2004 and 2009 to treat single gland hyperparathyroidism. Methylene blue (MB) was used in 5/7 cases immediately before exploration to identify the adenomas. Carbon dioxide (CO2) up to pressures of 10 mmHg was used safely to deflate the lung in two cases. RESULTS There were five women and two men with a mean age of 53 years (range, 27-72 years). Histopathology confirmed successful resection of the parathyroid adenoma in 6/7 cases. There was one conversion to open thoracotomy due to bleeding from the azygos vein resulting from excessive traction. Despite marked MB uptake, this patient proved to have tuberculoid adenopathy and no parathyroid tissue was identified. Postoperative plasma calcium returned to normal in 6/7 patients and parathyroid hormone (PTH) level in 6/7 patients. The median hospital stay was 2 days and there was no mortality in this series. CONCLUSIONS MEPAs can be safely resected using VATS with minimal surgical morbidity, short drainage time and short hospital stay. CO2 insufflation and the intraoperative use of MB are safe and help to accurately localise the ectopic adenoma. VATS should be considered as the first-line approach for resection of MEPAs.
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Affiliation(s)
- Khalid Amer
- 1 Thoracic Surgeons; 2 Endocrine and General Surgeon, Southampton General Hospital, Southampton, UK ; 3 Endocrine and General Surgeon, Dorset County Hospital, Dorchester, UK ; 4 Histopathologist, Southampton General Hospital, Southampton, UK
| | - Ali Zamir Khan
- 1 Thoracic Surgeons; 2 Endocrine and General Surgeon, Southampton General Hospital, Southampton, UK ; 3 Endocrine and General Surgeon, Dorset County Hospital, Dorchester, UK ; 4 Histopathologist, Southampton General Hospital, Southampton, UK
| | - David Rew
- 1 Thoracic Surgeons; 2 Endocrine and General Surgeon, Southampton General Hospital, Southampton, UK ; 3 Endocrine and General Surgeon, Dorset County Hospital, Dorchester, UK ; 4 Histopathologist, Southampton General Hospital, Southampton, UK
| | - Nicholas Lagattolla
- 1 Thoracic Surgeons; 2 Endocrine and General Surgeon, Southampton General Hospital, Southampton, UK ; 3 Endocrine and General Surgeon, Dorset County Hospital, Dorchester, UK ; 4 Histopathologist, Southampton General Hospital, Southampton, UK
| | - Neeta Singh
- 1 Thoracic Surgeons; 2 Endocrine and General Surgeon, Southampton General Hospital, Southampton, UK ; 3 Endocrine and General Surgeon, Dorset County Hospital, Dorchester, UK ; 4 Histopathologist, Southampton General Hospital, Southampton, UK
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23
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Sharma A, Sinha S, Khanna S, Mehta Y, Khandelwal S, Khan AZ. A novel technique to prevent endobronchial spillage during video assisted thoracoscopic lobectomy. Ann Card Anaesth 2015; 17:164-6. [PMID: 24732623 DOI: 10.4103/0971-9784.129880] [Citation(s) in RCA: 2] [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: 11/04/2022] Open
Abstract
Endobronchial spillage of fungal material into normal lung can infect it and the spillage of fungal material should be prevented during surgery. We report our experience of a patient who presented for right upper lobectomy with bronchiectasis, tubercular destruction and subsequent aspergilloma. A 4F Fogarty catheter was introduced through the tracheal lumen of the left sided endobronchial double lumen tube (DLT) to occlude the bronchus intermedius to prevent spillage of aspergilloma into the non-infected lower and middle lobes of the right lung. The Fogarty catheter was pulled into the trachea just before stapling the bronchus; thereafter, right upper lobectomy was completed successfully. The patient was extubated uneventfully and transferred to post-operative recovery ward. The endobronchial blockage of the intermediate bronchus of the operative lung by the Fogarty catheter and isolation of the left lung by the DLT prevented spillage of aspergilloma in both the operative right lung and the left lung.
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Affiliation(s)
- Anand Sharma
- Medanta Institute of Critical Care and Anaesthesia, Medanta The Medicity, Gurgaon, Haryana, India
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24
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Khan AZ, Prost-Lefebvre M, Salemme R, Blohm G, Rossetti Y, Tilikete C, Pisella L. The Attentional Fields of Visual Search in Simultanagnosia and Healthy Individuals: How Object and Space Attention Interact. Cereb Cortex 2015; 26:1242-54. [PMID: 25840422 DOI: 10.1093/cercor/bhv059] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Simultanagnosia is a deficit in which patients are unable to perceive multiple objects simultaneously. To date, it remains disputed whether this deficit results from disrupted object or space perception. We asked both healthy participants as well as a patient with simultanagnosia to perform different visual search tasks of variable difficulty. We also modulated the number of objects (target and distracters) presented. For healthy participants, we found that each visual search task was performed with a specific "attentional field" depending on the difficulty of visual object processing but not on the number of objects falling within this "working space." This was demonstrated by measuring the cost in reaction times using different gaze-contingent visible window sizes. We found that bilateral damage to the superior parietal lobule impairs the spatial integration of separable features (within-object processing), shrinking the attentional field in which a target can be detected, but causing no deficit in processing multiple objects per se.
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Affiliation(s)
- A Z Khan
- ImpAct - Lyon Neuroscience Research Center, Inserm U1028, CNRS UMR 5292, Bron, France Université de Lyon, Biologie Humaine, Bron, France Hospices Civils de Lyon, Bron, France School of Optometry, University of Montreal, Montreal, QC, Canada
| | - M Prost-Lefebvre
- ImpAct - Lyon Neuroscience Research Center, Inserm U1028, CNRS UMR 5292, Bron, France Université de Lyon, Biologie Humaine, Bron, France Hospices Civils de Lyon, Bron, France
| | - R Salemme
- ImpAct - Lyon Neuroscience Research Center, Inserm U1028, CNRS UMR 5292, Bron, France Université de Lyon, Biologie Humaine, Bron, France Hospices Civils de Lyon, Bron, France
| | - G Blohm
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Y Rossetti
- ImpAct - Lyon Neuroscience Research Center, Inserm U1028, CNRS UMR 5292, Bron, France Université de Lyon, Biologie Humaine, Bron, France Hospices Civils de Lyon, Bron, France
| | - C Tilikete
- ImpAct - Lyon Neuroscience Research Center, Inserm U1028, CNRS UMR 5292, Bron, France Université de Lyon, Biologie Humaine, Bron, France Hospices Civils de Lyon, Bron, France
| | - L Pisella
- ImpAct - Lyon Neuroscience Research Center, Inserm U1028, CNRS UMR 5292, Bron, France Université de Lyon, Biologie Humaine, Bron, France Hospices Civils de Lyon, Bron, France
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25
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Slesser AAP, Khan F, Chau I, Khan AZ, Mudan S, Tekkis PP, Brown G, Rao S. The effect of a primary tumour resection on the progression of synchronous colorectal liver metastases: an exploratory study. Eur J Surg Oncol 2015; 41:484-92. [PMID: 25638603 DOI: 10.1016/j.ejso.2014.12.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 09/25/2014] [Revised: 12/08/2014] [Accepted: 12/21/2014] [Indexed: 12/16/2022] Open
Abstract
AIM The objective of this study was to determine the effect of an upfront primary tumour resection on the progression of synchronous colorectal liver metastases. MATERIALS AND METHODS Patients with synchronous colorectal liver metastases referred between 2005 and 2010 were identified. Patients were analysed according to the following two groups: 1) an upfront primary tumour resection and 2) neo-adjuvant chemotherapy. A univariate and multivariate analysis was performed to identify factors significantly contributing to progressive disease. Cox regression analysis was undertaken to determine the effect of management on overall survival (OS) and time to tumour progression (TTP). RESULTS A total of 116 patients with synchronous colorectal liver metastases were identified of which 49 patients received an upfront primary tumour resection and 67 received neo-adjuvant chemotherapy. Liver resections were performed in 18 (36.7%) and 14 (20.9%) of the patients in the upfront and neo-adjuvant groups respectively (P 0.06). On multivariate analysis, an upfront primary tumour resection significantly affected progressive disease (p < 0.001, OR 5.67; 95% CI 2.71-11.79). An upfront tumour resection was not a significant predictor of overall survival (P = 0.83; HR 1.10; 95% CI 0.48-2.52). CONCLUSION Our findings suggest that an upfront primary tumour resection in patients with synchronous colorectal liver metastases results in progressive disease. These preliminary findings need to be validated in a future multi-centre independent study.
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Affiliation(s)
- A A P Slesser
- Department of Colorectal Surgery, The Royal Marsden Hospital, Fulham Road, London, UK; Division of Surgery and Cancer, Chelsea and Westminster Campus, Imperial College London, UK
| | - F Khan
- Department of Oncology, The Royal Marsden Hospital, Fulham Road, London, UK
| | - I Chau
- Department of Oncology, The Royal Marsden Hospital, Fulham Road, London, UK
| | - A Z Khan
- Department of Hepato-Biliary Surgery, The Royal Marsden Hospital, Fulham Road, London, UK
| | - S Mudan
- Division of Surgery and Cancer, Chelsea and Westminster Campus, Imperial College London, UK; Department of Hepato-Biliary Surgery, The Royal Marsden Hospital, Fulham Road, London, UK
| | - P P Tekkis
- Department of Colorectal Surgery, The Royal Marsden Hospital, Fulham Road, London, UK; Division of Surgery and Cancer, Chelsea and Westminster Campus, Imperial College London, UK
| | - G Brown
- Department of Radiology, The Royal Marsden Hospital, Downs Road, Sutton, Surrey, SM2 5PT, UK; Division of Medicine, Imperial College London, UK.
| | - S Rao
- Department of Oncology, The Royal Marsden Hospital, Fulham Road, London, UK
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Roubelakis A, Modi A, Holman M, Casali G, Khan AZ. Uniportal video-assisted thoracic surgery: the lesser invasive thoracic surgery. Asian Cardiovasc Thorac Ann 2014; 22:72-6. [PMID: 24585647 DOI: 10.1177/0218492313479356] [Citation(s) in RCA: 6] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We evaluated whether single-port video-assisted thoracic surgery is feasible without compromising outcomes, and whether the technique could be reproduced by a trainee. METHODS In a 6-month period, 37 operations were performed by single-port video-assisted thoracic surgery. Of the 37 patients, 27 (73%) were male and the mean age was 45.1 ± 21 years. Twenty-three (62%) were operated on by consultants and 14 (38%) by trainees. The procedures included 19 (51.3%) operations for treatment of pneumothoraces, 8 (21.6%) metastasectomies, 7 (18.9%) lung biopsies, 2 (5.4%) empyema débridements, and 1 (2.7%) pleuropericardial window. RESULTS Mean operative time was 51.8 ± 14.7 min. Patient-controlled analgesia infusion was used for 1.3 ± 1 days. Three (8.1%) patients needed an operative reintervention, but there was no intensive treatment unit admission or hospital mortality. Mean postoperative hospital stay was 3.3 ± 2.7 days. On follow-up, all patients had a tissue diagnosis and all lung nodules were R0 resections. Patients operated on by consultants and trainees had similar preoperative profiles and postoperative outcomes, except that those operated on by trainees used patient-controlled analgesia significantly longer (1.8 ± 1.48 vs. 1 ± 0.48 days; p = 0.03). CONCLUSION Single-port video-assisted thoracic surgery can be performed and reproduced well without compromising outcomes. It is considered aesthetically better and may reduce analgesic requirements, but it might not reduce hospital stay.
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Khan AZ, Khandelwal S. V-065ROBOTIC RESECTION OF SECOND RIB TUMOUR. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt288.65] [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: 11/12/2022] Open
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Ismail M, Iqbal Z, Khan MI, Javaid A, Arsalan H, Farhadullah H, Khan F, Khan AZ, Nasir F, Khan JA. Frequency, Levels and Predictors of Potential Drug-Drug Interactions in a Pediatrics Ward of a Teaching Hospital in Pakistan. TROP J PHARM RES 2013. [DOI: 10.4314/tjpr.v12i3.19] [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: 11/17/2022] Open
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Portman ME, Esteves LS, Le XQ, Khan AZ. Improving integration for integrated coastal zone management: an eight country study. Sci Total Environ 2012; 439:194-201. [PMID: 23063925 DOI: 10.1016/j.scitotenv.2012.09.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 09/01/2012] [Accepted: 09/10/2012] [Indexed: 06/01/2023]
Abstract
Integrated coastal zone management (ICZM) is a widely accepted approach for sustainable management of the coastal environment. ICZM emphasizes integration across sectors, levels of government, uses, stakeholders, and spatial and temporal scales. While improving integration is central to progress in ICZM, the role of and the achievement of integration remain understudied. To further study these two points, our research analyzes the performance of specific mechanisms used to support ICZM in eight countries (Belgium, India, Israel, Italy, Portugal, Sweden, UK, and Vietnam). The assessment is based on a qualitative comparative analysis conducted through the use of two surveys. It focuses on five ICZM mechanisms (environmental impact assessment; planning hierarchy; setback lines; marine spatial planning, and regulatory commission) and their role in improving integration. Our findings indicate that certain mechanisms enhance specific types of integration more effectively than others. Environmental impact assessment enhances science-policy integration and can be useful to integrate knowledge across sectors. Planning hierarchy and regulatory commissions are effective mechanisms to integrate policies across government levels, with the latter also promoting public-government integration. Setback lines can be applied to enhance integration across landscape units. Marine spatial planning is a multi-faceted mechanism with the potential to promote all types of integration. Policy-makers should adopt the mechanisms that are suited to the type of integration needed. Results of this study also contribute to evidence-based coastal management by identifying the most common impediments related to the mechanisms of integration in the eight studied countries.
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Affiliation(s)
- M E Portman
- Faculty of Architecture, Technion-Israel Institute of Technology, Israel.
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Vitfell-Pedersen J, Yap TA, Moreno V, Baird RD, Khan AZ, Barton DPJ, Kaye SB. The role of surgery in patients with advanced gynaecological cancers participating in phase I clinical trials. EUR J GYNAECOL ONCOL 2012; 33:211-213. [PMID: 22611966] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE While gynaecological cancer patients who participate in Phase I clinical trials are not routinely considered for elective surgery because of a short life expectancy, this should not be overlooked in carefully selected responding patients. METHODS/RESULTS We describe two cases of patients with different gynaecological cancers, who received treatment within separate phase I trials, and who then proceeded to surgical resection of their cancers, resulting in complete remission. CONCLUSION Surgery, when feasible, should be taken into consideration as a potential management option, even when patients are receiving treatment within a phase I trial.
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Affiliation(s)
- J Vitfell-Pedersen
- Drug Development Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, UK
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Khan AZ, Aarons L. Design and Analysis of the Aminopyrine Breath Test. J Pharm Pharmacol 2011. [DOI: 10.1111/j.2042-7158.1985.tb14220.x] [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: 11/27/2022]
Affiliation(s)
- A Z Khan
- Dept. Pharmacy, University of Manchester, Manchester
| | - L Aarons
- Dept. Pharmacy, University of Manchester, Manchester
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Mattam K, Khan AZ, Casali G. OP-060 ROLE OF TELEMEDICINE IN TREATMENT OF ACUTE CARDIAC EMERGENCIES IN RURAL SETTING. Int J Cardiol 2010. [DOI: 10.1016/s0167-5273(10)70062-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Khan AZ, Ching R, Morris-Stiff G, England R, Sherridan MB, Smith AM. Pleuropancreatic fistulae: specialist center management. J Gastrointest Surg 2009; 13:354-8. [PMID: 18972169 DOI: 10.1007/s11605-008-0699-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [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: 06/30/2008] [Accepted: 09/08/2008] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND AIMS Internal pancreatic fistulae are uncommon sequelae of severe acute pancreatitis. Due to their low prevalence, experience in the management of this condition remains sparse outside specialist centers and management remains controversial. We report our experience with pleuropancreatic fistulae (PPF). PATIENTS Six patients (three males, median age 34 years [range, 32-74 years]) with PPF were managed in our unit over a 24-month period from April 2006 to April 2008. The etiology of pancreatitis was alcohol (four), gallstones (one), and unknown cause (one). All patients had documented pleural effusions with amylase content >1,000 iu/dl. RESULTS All patients underwent computerized tomography (CT) and magnetic resonance imaging (MRI) cross-sectional scanning to identify the site of ductal disruption. CT alone was able to identify the disruption in four cases and a combination of CT and MRI localized the ductal disruption in all patients. Five of six patients required ERCP and placement of a pancreatic duct (PD) stent. No patient required pancreatic surgery and all patients remain well at a median follow up of 39 weeks. CONCLUSION Pleuropancreatic fistulae can present a challenging diagnostic dilemma. A multi-disciplinary approach addressing nutritional support and endotherapy allows successful non-operative resolution within specialist units.
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Affiliation(s)
- A Z Khan
- Royal Marsden Hospital, London, UK
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Khan AZ, Wong VK, Malik HZ, Stiff GM, Prasad KR, Lodge JPA, Toogood GJ. The impact of caudate lobe involvement after hepatic resection for colorectal metastases. Eur J Surg Oncol 2008; 35:510-4. [PMID: 18644694 DOI: 10.1016/j.ejso.2008.06.008] [Citation(s) in RCA: 7] [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] [Received: 02/05/2008] [Revised: 05/05/2008] [Accepted: 06/09/2008] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hepatic resections involving the caudate lobe are technically challenging with results from some centers indicating inferior outcomes. We assessed outcomes following hepatic resection for colorectal metastases involving the caudate lobe in a tertiary care center. METHODS Operative and oncological data from a prospectively maintained database were analyzed on 687 patients undergoing hepatic resection for colorectal metastases between 1993 and 2006. Patients were analyzed as those with caudate lobe metastases (CLM) and compared with those without caudate lobe involvement (NCLM). RESULTS Fifty-two of 687 patients had metastases involving the caudate lobe (8%). Patients with caudate lobe involvement were more likely to require an extended hepatic resection (75% vs 27%, P=0.001), perioperative blood transfusion (29% vs 14%, P=0.002), have a positive resection margin (57% vs 32%, P=0.001) and stay longer in hospital (12 vs 8 days, P=0.001). There was no difference in the complication rates (37% vs 29%) or 30-day mortality between the two groups (2% vs 1%). The median disease free (20 months vs 21 months), and cancer specific survival (42 months vs 59 months) were also similar in the CLM and NCLM groups. CONCLUSIONS Although caudate lobe involvement adds to the technical complexity of hepatic resection, these patients can be offered long term survival, similar to other patients with hepatic metastases from colorectal cancer.
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Affiliation(s)
- A Z Khan
- Department of Hepatobiliary and Transplantation Surgery, St James University Hospital, Beckett Street, Leeds, LS9 7TF, UK
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Abstract
Drugs are an uncommon but well-recognised cause of acute pancreatitis and new agents of drug-induced pancreatitis continue to be reported. We describe only the 10th reported case of lisinopril-induced pancreatitis in a young female patient.
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Affiliation(s)
- K V Brown
- Department of General Surgery, Frimley Park Hospital, Portsmouth Road, Frimley, Camberley, Surrey.
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Affiliation(s)
- P Gogalniceanu
- Department of Surgery, St. Thomas's Hospital, London, UK
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Khan AZ, Pitsinis V, Mudan SS. Complete pathological response following down-staging chemoradiation in locally advanced pancreatic cancer: Challenging the boundaries. World J Gastroenterol 2007; 13:6433-5. [PMID: 18081235 PMCID: PMC4205465 DOI: 10.3748/wjg.v13.i47.6433] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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] [Indexed: 02/06/2023] Open
Abstract
Pancreatic cancer is an aggressive malignancy, relatively resistant to chemotherapy and radiotherapy, which usually presents late. Disease specific mortality approaches unity despite advances in adjuvant therapy. We present the first reported case of complete pathological response following neoadjuvant therapy in a locally advanced pancreatic adenocarcinoma.
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Andreani SM, Dang HH, Grondona P, Khan AZ, Edwards DP. Rectovaginal fistula in Crohn's disease. Dis Colon Rectum 2007; 50:2215-22. [PMID: 17846837 DOI: 10.1007/s10350-007-9057-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [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: 01/16/2007] [Revised: 03/26/2007] [Accepted: 05/01/2007] [Indexed: 12/14/2022]
Abstract
PURPOSE Crohn's disease is characterized by transmural bowel inflammation and a tendency to form fistulas with adjacent structures. Several different fistulas have been described: enterocutaneous, enteroenteric, enterovesical, enterovaginal, and perineal. Rectovaginal fistulas are difficult to treat despite multimodal therapy. This study was designed to review the current strategic options to best manage this condition. METHODS We reviewed the English-language literature from 1966 to 2006, using PUBMED, targeting Crohn's disease involving vagina using key words "rectovaginal fistula and CD," "anovaginal fistula and CD," "anovaginal fistula," and "rectovaginal fistula." We excluded the involvement of the vagina from a pouch after a proctectomy. A total of 776 articles were found; 206 articles were identified and judged as being relevant on the basis of title-related articles and links were reviewed. Fifty-three articles were selected after reading the abstract or full manuscript. RESULTS The management of rectovaginal fistula, representing 9 percent of all fistulas, remains a challenge in the setting of Crohn's disease. Medical treatments are not favorable with low rates of long-term symptomatic control and unacceptable high rates of recurrence. Several novel and new surgical techniques have been described, and rectal advancement flap, in selected patients, seems to have the most successful results. CONCLUSIONS The management of rectovaginal fistula of Crohn's origin should involve both gastroenterologists and coloproctologists, with the best surgical results being achieved in patients receiving optimum medical therapy. More focused studies targeting these patients with the use of combined medical and surgical therapy are necessary.
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Affiliation(s)
- S M Andreani
- Department of Surgery, Frimley Park Hospital, Portsmouth Road, Frimley, Surrey, United Kingdom.
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Khan AZ, Bann SD, Pitsinis V, McCall J, Mudan SS. Refining the technique of hepatic parenchymal transection: combined saline-linked radiofrequency precoagulation and ultrasonic aspiration. Hepatogastroenterology 2007; 54:1167-9. [PMID: 17629063] [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] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND/AIMS With recognition of its benefits, there has been a trend towards minimizing blood loss during hepatic parenchymal transection but no one technique has been shown to be superior to another. We analyzed our experience with using a novel combined technique of saline-linked radiofrequency precoagulation and ultrasonic aspiration for hepatic parenchymal transection. METHODOLOGY This combined technique was used in 12 patients for parenchymal transection for metastatic hepatic disease and data was collected prospectively. Total blood loss, bile leaks, parenchymal transection time, hepatic pedicle clamp requirement and 30-day mortality were used as outcome measures. RESULTS Four minor and 8 major hepatic resections were performed in twelve patients of who two underwent a synchronous resection of the rectum. The median blood loss was 525 mL (IQR 312.5-1150) in these patients who had a median postoperative stay of 7 days (IQR 7-14). The median parenchymal transection time was 120 minutes (IQR 100-153.75). No patient required portal triad clamping at anytime and there was no mortality. CONCLUSIONS Combined technique of saline-link radiofrequency ablation and ultrasonic aspiration appears to be comparable to other techniques and should be considered as an alternative.
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Affiliation(s)
- A Z Khan
- Department of Gastrointestinal Surgery Royal Marsden Hospital Chelsea, London, UK.
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Forshaw MJ, Khan AZ, Davies AR, Strauss DC, Pearce A, Mason RC. Postoperative ventilation in the recovery area. Ann R Coll Surg Engl 2007; 89:449; author reply 449-50. [PMID: 17535629 PMCID: PMC1963571 DOI: 10.1308/003588407x179161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Escofet X, Khan AZ, Mazarani W, Woods WGA. Lessons to be learned: a case study approach. Lateral aberrant thyroid tissue: is it always malignant? ACTA ACUST UNITED AC 2007; 127:45-6. [PMID: 17319317 DOI: 10.1177/1466424007073207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 11/15/2022]
Abstract
Traditionally 'lateral aberrant thyroid' tissue present in cervical lymph nodes in the face of a clinically normal thyroid gland is held to be a metastasis from an occult primary thyroid carcinoma. A patient in whom follicular thyroid tissue was found in a lymph node lateral to the carotid sheath in the presence of a thyroid gland which was histologically free of cancer is herewith presented.
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Affiliation(s)
- X Escofet
- Department of Surgery, Worthing Hospital, Worthing, UK
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Abstract
Outcomes are improving
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Affiliation(s)
- A Z Khan
- Hepatobiliary and Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku Tokyo 113-8655, Japan.
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Pitsinis V, Khan AZ, Cranshaw I, Allum WH. Single center experience of laparoscopic vs. open resection for gastrointestinal stromal tumors of the stomach. Hepatogastroenterology 2007; 54:606-8. [PMID: 17523332] [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] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND/AIMS With better understanding of disease biology and technological advances, an increasing number of gastric gastrointestinal stromal tumors (GISTs) are being resected laparoscopically. We assessed our management of gastric GISTs in our institution. METHODOLOGY Prospectively collected data from 13 patients who underwent surgery for gastric gastrointestinal stromal tumors over an 18-month period were analyzed with respect to operative and oncological outcomes. Seven patients underwent open resection and 6 patients had laparoscopic resection. RESULTS The tumors were evenly distributed in both groups in whom the median age was 68 years in the open group vs. 70 years in the laparoscopic group. The median operating time was 132 min in the open group and 110 min in the laparoscopic group and patients who had a laparoscopic resection had a shorter hospital stay (4 days versus 11 days). Patients in the open group had a larger tumor the patients in the laparoscopic group (11.5 x 6 x 4 cm vs. 5 x 4 x 3 cm). No patient had evidence of recurrence at median follow-up of 9 months. CONCLUSIONS Patients with small gastric GISTs can be safely resected with a laparoscopic approach, offering a quicker operation and shorter hospital stay. A laparoscopic approach does not alter risk of early local or distant recurrence.
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Affiliation(s)
- V Pitsinis
- Gastrointestinal Surgical Unit, The Royal Marsden Hospital, Chelsea London, UK.
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Abstract
Spontaneous oesophageal perforation, or Boerhaave's syndrome, represents barogenic oesophageal injury. Patients don't always present with classical features and treatment may be delayed. Various approaches and strategies have been described but, despite advances in surgery and critical care, the condition continues to carry a high morbidity and mortality. Primary repair may be undertaken in patients who present within 24 hours of perforation and remains the gold standard. Increasingly, this strategy is being adopted for patients who present later with similar mortality rates. Diversion with exclusion and resectional procedures may be undertaken when repair is not possible.
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Affiliation(s)
- A Z Khan
- Department of Surgery Guys and St Thomas NHS Foundation Trust, St Thomas Hospital, First Floor North Wing, Lambeth Palace Road, London, SE1 7EH, UK.
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Affiliation(s)
- P W Moxey
- Department of Surgery, Royal Surrey County Hospital, Guildford, UK
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Khan AZ, Karanjia ND. The impact of staging laparoscopy prior to hepatic resection for colorectal metastases. Eur J Surg Oncol 2007; 33:1010-3. [PMID: 17267165 DOI: 10.1016/j.ejso.2006.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 09/18/2006] [Accepted: 12/05/2006] [Indexed: 12/19/2022] Open
Abstract
AIMS To evaluate the role of routine laparoscopy as a staging modality prior to laparotomy and hepatic resection for metastatic colorectal cancer. METHODS Prospectively collected data were analysed from a database. In the first half of the series patients underwent selective laparoscopy before proceeding to laparotomy and in the second part of the series laparoscopy was used routinely. Patients undergoing laparotomy directly were analysed in Group 1 and those having laparoscopy before laparotomy in Group 2. The ability of laparoscopy to pick up unresectable and extrahepatic disease, resectability rate and open and close laparotomy rate were recorded. RESULTS Of the 284 patients, 74 were in Group 1 (no laparoscopy) and 210 in Group 2 (laparoscopy as standard). The resectability rate was 81% in Group 1 and 87% in Group 2. The open and close laparotomy rate was 19% and 8%, respectively (p=0.025). In Group 2 alone, laparoscopy identified 39% of unresectable disease and prevented an open and close procedure. CONCLUSIONS Routine use of staging laparoscopy increases the resectability rate and reduces the inoperability rate in these patients.
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Affiliation(s)
- A Z Khan
- Regional Hepato-Pancreato-Biliary Unit, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey, UK
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Abstract
The saccade generator updates memorized target representations for saccades during eye and head movements. Here, we tested if proprioceptive feedback from the arm can also update handheld object locations for saccades, and what intrinsic coordinate system(s) is used in this transformation. We measured radial saccades beginning from a central light-emitting diode to 16 target locations arranged peripherally in eight directions and two eccentricities on a horizontal plane in front of subjects. Target locations were either indicated 1) by a visual flash, 2) by the subject actively moving the handheld central target to a peripheral location, 3) by the experimenter passively moving the subject's hand, or 4) through a combination of the above proprioceptive and visual stimuli. Saccade direction was relatively accurate, but subjects showed task-dependent systematic overshoots and variable errors in radial amplitude. Visually guided saccades showed the smallest overshoot, followed by saccades guided by both vision and proprioception, whereas proprioceptively guided saccades showed the largest overshoot. In most tasks, the overall distribution of saccade endpoints was shifted and expanded in a gaze- or head-centered cardinal coordinate system. However, the active proprioception task produced a tilted pattern of errors, apparently weighted toward a limb-centered coordinate system. This suggests the saccade generator receives an efference copy of the arm movement command but fails to compensate for the arm's inertia-related directional anisotropy. Thus the saccade system is able to transform hand-centered somatosensory signals into oculomotor coordinates and combine somatosensory signals with visual inputs, but it seems to have a poorly calibrated internal model of limb properties.
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Affiliation(s)
- L Ren
- Centre for Vision Research, York University, Toronto, Ontario M3J 1P3, Canada
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Khan AZ, Pisella L, Vighetto A, Cotton F, Luauté J, Boisson D, Salemme R, Crawford JD, Rossetti Y. Optic ataxia errors depend on remapped, not viewed, target location. Nat Neurosci 2005; 8:418-20. [PMID: 15768034 DOI: 10.1038/nn1425] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.9] [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: 11/19/2004] [Accepted: 02/25/2005] [Indexed: 11/09/2022]
Abstract
Optic ataxia is a disorder associated with posterior parietal lobe lesions, in which visually guided reaching errors typically occur for peripheral targets. It has been assumed that these errors are related to a faulty sensorimotor transformation of inputs from the 'ataxic visual field'. However, we show here that the errors observed in the contralesional field in optic ataxia depend on a dynamic gaze-centered internal representation of reach space.
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Affiliation(s)
- A Z Khan
- Espace et Action, Institut National de la Santé et de la Recherche Médicale, U534, Institut Fédératif des Neurosciences Lyon, 16 avenue Doyen Lépine, 69676, Bron, France
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Abstract
We present a case of spontaneous rupture of the spleen, an uncommon complication of systemic amyloidosis. Amyloid deposition leading to capsular distension and increased vascular fragility is thought to predispose the spleen to rupture spontaneously.
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Affiliation(s)
- A Z Khan
- Department of General Surgery, Worthing Hospital, West Sussex, UK.
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Abstract
Eye-hand coordination is complicated by the fact that the eyes are constantly in motion relative to the head. This poses problems in interpreting the spatial information gathered from the retinas and using this to guide hand motion. In particular, eye-centered visual information must somehow be spatially updated across eye movements to be useful for future actions, and these representations must then be transformed into commands appropriate for arm motion. In this review, we present evidence that early visuomotor representations for arm movement are remapped relative to the gaze direction during each saccade. We find that this mechanism holds for targets in both far and near visual space. We then show how the brain incorporates the three-dimensional, rotary geometry of the eyes when interpreting retinal images and transforming these into commands for arm movement. Next, we explore the possibility that hand-eye alignment is optimized for the eye with the best field of view. Finally, we describe how head orientation influences the linkage between oculocentric visual frames and bodycentric motor frames. These findings are framed in terms of our 'conversion-on-demand' model, in which only those representations selected for action are put through the complex visuomotor transformations required for interaction with objects in personal space, thus providing a virtual on-line map of visuomotor space.
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Affiliation(s)
- J D Crawford
- York Centre for Vision Research, York University, Toronto, Canada.
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