1
|
Cevik J, Read D, Putland M, Fazio T, Gumm K, Varma A, Santos R, Ramakrishnan A. The impact of electric scooters in Melbourne: data from a major trauma service. ANZ J Surg 2024; 94:572-579. [PMID: 38087881 DOI: 10.1111/ans.18814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/14/2023] [Accepted: 11/22/2023] [Indexed: 04/17/2024]
Abstract
BACKGROUND The proliferation of electric scooters globally has been associated with an increase in related injuries and consequent economic burden. This study aims to assess the injury patterns and the economic impact associated with electric scooter use in Melbourne, Australia. METHODS A retrospective cohort study was conducted using hospital and registry data from January 2022 to January 2023. Data collected included demographic details, alcohol and helmet use, injury type and severity, operative treatment provided, and direct medical costs. The economic impact (in AUD) of the patient's emergency presentation and hospital admission was calculated. RESULTS During the study period, 256 electric scooter related injuries were recorded, comprising 247 riders and nine pedestrians. The majority of patients were males (69%) with a median age of 29.5 (15-78). Alcohol use was reported by 34% and helmet use by 33%. Injuries most commonly affected the upper limb (53%) and head (50%), with abrasions (75%) and fractures (48%) being the most common type of injury sustained. The total hospital cost was $1 911 062, and the median cost was $1321.66 per patient (IQR: $479.37-$5096.65). CONCLUSION Electric scooter usage, as observed through patient presentations to the Royal Melbourne Hospital, is associated with a considerable number of injuries, primarily among young males, and an ensuing substantial economic burden. The findings underscore the urgent need for improved safety measures to minimize electric scooter-related injuries and their clinical and economic repercussions.
Collapse
Affiliation(s)
- Jevan Cevik
- Department of Plastic Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - David Read
- Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mark Putland
- Emergency Department, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Timothy Fazio
- Health Intelligence Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kellie Gumm
- Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Amrita Varma
- Department of Plastic Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Roselyn Santos
- Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Anand Ramakrishnan
- Department of Plastic Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
2
|
Ribeiro LM, Bhindi N, Fox C, Ramakrishnan A. Cranioplasty is not required in the reconstruction of small combined scalp and calvarial defects. J Plast Reconstr Aesthet Surg 2024; 93:18-23. [PMID: 38608533 DOI: 10.1016/j.bjps.2024.03.009] [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: 12/16/2023] [Accepted: 03/18/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Treatment of scalp malignancies may include the need for craniectomy. The decision to perform cranioplasty is not straightforward and is frequently subjective. The purpose of this study was to assess the clinical outcomes after reconstruction of complex scalp and calvarial defects by comparing patients with and without cranioplasty. METHODS Retrospective review of the clinical records of a consecutive series of patients who underwent scalp soft tissue reconstruction after craniectomy for malignancy or osteoradionecrosis between 2014 and 2022 at Royal Melbourne Hospital was conducted. Demographics, previous treatments, surgical details, and post-operative complications were assessed. Traumatic injuries and decompressive craniectomies were excluded. Minimum follow-up of 6 months. RESULTS Thirty-seven patients were included in the study. Indications for surgery included skin malignancies, osteoradionecrosis, or both. There was one reconstructive failure (in the non-cranioplasty group). Infection and metalware exposure were common complications in patients who underwent cranioplasty (38.5%). No patient developed neurological symptoms subsequent to craniectomy. One patient needed revision surgery due to esthetic reasons (cranioplasty group). Transposition flaps were associated with more complications and revision procedures. CONCLUSION Combined scalp and calvarial defects pose a difficult reconstructive challenge. Stable soft tissue coverage is more reliably achieved with free flap reconstruction. Cranioplasty is not always mandatory and should be reserved for cases with a very large bony defect or when the defect is located in a cosmetically sensitive area.
Collapse
Affiliation(s)
- Luís M Ribeiro
- Department of Plastic and Reconstructive Surgery, Royal Melbourne Hospital, Parkville, VIC 3050, Australia
| | - Nayan Bhindi
- Department of Plastic and Reconstructive Surgery, Royal Melbourne Hospital, Parkville, VIC 3050, Australia.
| | - Carly Fox
- Department of Plastic and Reconstructive Surgery, Royal Melbourne Hospital, Parkville, VIC 3050, Australia
| | - Anand Ramakrishnan
- Department of Plastic and Reconstructive Surgery, Royal Melbourne Hospital, Parkville, VIC 3050, Australia; Department of Surgery, Melbourne Medical School, Royal Melbourne Hospital, University of Melbourne, Parkville VIC 3050, Australia
| |
Collapse
|
3
|
de Boer J, Barnett R, Cardin A, Cimoli M, Davies L, Delany C, Dixon BJ, Evans SM, Findlay MW, Fox C, Ftanou M, Hart CD, Howard M, Iseli TA, Jackson A, Kranz S, Le BH, Lekgabe E, Lennox R, McLean LS, Neeson PJ, Ng SP, O’Reilly LA, Ramakrishnan A, Rowe D, Service C, Singh A, Thai AA, Tiong A, Yap T, Wiesenfeld D. Optimising Patient Outcomes in Tongue Cancer: A Multidisciplinary Approach. Cancers (Basel) 2024; 16:1277. [PMID: 38610956 PMCID: PMC11010906 DOI: 10.3390/cancers16071277] [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: 03/07/2024] [Revised: 03/21/2024] [Accepted: 03/24/2024] [Indexed: 04/14/2024] Open
Abstract
A multidisciplinary approach to the management of tongue cancer is vital for achieving optimal patient outcomes. Nursing and allied health professionals play essential roles within the team. We developed symposia comprising a series of online lectures offering a detailed perspective on the role each discipline and consumer perspective has in the management of patients with tongue cancer. The topics, including epidemiology and prevention, diagnosis, treatment planning, surgery, adjuvant care, and the management of recurrent or metastatic disease, were thoroughly examined. The symposia highlighted the significance of fostering collaboration and continuous learning through a multidisciplinary approach. This initiative should be relevant to healthcare professionals, researchers, and policymakers striving to enhance patient outcomes in tongue cancer care through innovative collaboration.
Collapse
Affiliation(s)
| | - Rebecca Barnett
- St. Vincent’s Hospital Melbourne, Melbourne 3065, Australia; (R.B.); (C.D.H.); (A.J.)
| | - Anthony Cardin
- Peter MacCallum Cancer Centre, Melbourne 3000, Australia (C.D.); (M.W.F.); (M.F.); (M.H.); (B.H.L.); (A.A.T.); (A.T.)
| | - Michelle Cimoli
- Austin Health, Heidelberg 3084, Australia; (M.C.); (R.L.); (S.P.N.)
| | - Lauren Davies
- The Royal Melbourne Hospital, Melbourne 3052, Australia; (L.D.); (C.F.); (T.A.I.); (S.K.); (E.L.); (A.R.); (C.S.); (T.Y.)
| | - Clare Delany
- Peter MacCallum Cancer Centre, Melbourne 3000, Australia (C.D.); (M.W.F.); (M.F.); (M.H.); (B.H.L.); (A.A.T.); (A.T.)
| | - Benjamin J. Dixon
- St. Vincent’s Hospital Melbourne, Melbourne 3065, Australia; (R.B.); (C.D.H.); (A.J.)
- Department of Surgery, University of Melbourne, Melbourne 3010, Australia
| | - Sue M. Evans
- Victorian Cancer Registry, Cancer Council Victoria School of Public Health and Preventive Medicine, Monash University, Melbourne 3002, Australia;
| | - Michael W. Findlay
- Peter MacCallum Cancer Centre, Melbourne 3000, Australia (C.D.); (M.W.F.); (M.F.); (M.H.); (B.H.L.); (A.A.T.); (A.T.)
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne 3010, Australia;
| | - Carly Fox
- The Royal Melbourne Hospital, Melbourne 3052, Australia; (L.D.); (C.F.); (T.A.I.); (S.K.); (E.L.); (A.R.); (C.S.); (T.Y.)
| | - Maria Ftanou
- Peter MacCallum Cancer Centre, Melbourne 3000, Australia (C.D.); (M.W.F.); (M.F.); (M.H.); (B.H.L.); (A.A.T.); (A.T.)
| | - Christopher D. Hart
- St. Vincent’s Hospital Melbourne, Melbourne 3065, Australia; (R.B.); (C.D.H.); (A.J.)
| | - Megan Howard
- Peter MacCallum Cancer Centre, Melbourne 3000, Australia (C.D.); (M.W.F.); (M.F.); (M.H.); (B.H.L.); (A.A.T.); (A.T.)
| | - Tim A. Iseli
- The Royal Melbourne Hospital, Melbourne 3052, Australia; (L.D.); (C.F.); (T.A.I.); (S.K.); (E.L.); (A.R.); (C.S.); (T.Y.)
- Department of Surgery, University of Melbourne, Melbourne 3010, Australia
| | - Andrea Jackson
- St. Vincent’s Hospital Melbourne, Melbourne 3065, Australia; (R.B.); (C.D.H.); (A.J.)
| | - Sevastjan Kranz
- The Royal Melbourne Hospital, Melbourne 3052, Australia; (L.D.); (C.F.); (T.A.I.); (S.K.); (E.L.); (A.R.); (C.S.); (T.Y.)
| | - Brian H. Le
- Peter MacCallum Cancer Centre, Melbourne 3000, Australia (C.D.); (M.W.F.); (M.F.); (M.H.); (B.H.L.); (A.A.T.); (A.T.)
| | - Ernest Lekgabe
- The Royal Melbourne Hospital, Melbourne 3052, Australia; (L.D.); (C.F.); (T.A.I.); (S.K.); (E.L.); (A.R.); (C.S.); (T.Y.)
| | - Rachel Lennox
- Austin Health, Heidelberg 3084, Australia; (M.C.); (R.L.); (S.P.N.)
| | - Luke S. McLean
- Peter MacCallum Cancer Centre, Melbourne 3000, Australia (C.D.); (M.W.F.); (M.F.); (M.H.); (B.H.L.); (A.A.T.); (A.T.)
| | - Paul J. Neeson
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne 3010, Australia;
| | - Sweet Ping Ng
- Austin Health, Heidelberg 3084, Australia; (M.C.); (R.L.); (S.P.N.)
| | - Lorraine A. O’Reilly
- The Walter and Eliza Hall of Medical Research (WEHI), Melbourne 3052, Australia;
| | - Anand Ramakrishnan
- The Royal Melbourne Hospital, Melbourne 3052, Australia; (L.D.); (C.F.); (T.A.I.); (S.K.); (E.L.); (A.R.); (C.S.); (T.Y.)
| | - David Rowe
- The Royal Melbourne Hospital, Melbourne 3052, Australia; (L.D.); (C.F.); (T.A.I.); (S.K.); (E.L.); (A.R.); (C.S.); (T.Y.)
| | - Carrie Service
- The Royal Melbourne Hospital, Melbourne 3052, Australia; (L.D.); (C.F.); (T.A.I.); (S.K.); (E.L.); (A.R.); (C.S.); (T.Y.)
| | - Ankur Singh
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne 3010, Australia;
| | - Alesha A. Thai
- Peter MacCallum Cancer Centre, Melbourne 3000, Australia (C.D.); (M.W.F.); (M.F.); (M.H.); (B.H.L.); (A.A.T.); (A.T.)
- Austin Health, Heidelberg 3084, Australia; (M.C.); (R.L.); (S.P.N.)
| | - Albert Tiong
- Peter MacCallum Cancer Centre, Melbourne 3000, Australia (C.D.); (M.W.F.); (M.F.); (M.H.); (B.H.L.); (A.A.T.); (A.T.)
| | - Tami Yap
- The Royal Melbourne Hospital, Melbourne 3052, Australia; (L.D.); (C.F.); (T.A.I.); (S.K.); (E.L.); (A.R.); (C.S.); (T.Y.)
- Melbourne Dental School, University of Melbourne, Melbourne 3010, Australia
| | | |
Collapse
|
4
|
Latif F, Sayer G, Lotan D, Mendoza J, Regan M, Tsapepas D, Ramakrishnan A, DeFilippis E, Yuzefpolskaya M, Colombo P, Kennel P, Raikhelkar J, Clerkin K, Fried J, Lin E, Lee S, Naka Y, Takeda K, Uriel N. The Effect of Temperature Control Versus Icebox Preservation on Post Heart Transplant Outcome. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.498] [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: 04/05/2023] Open
|
5
|
Gearing PF, Goldie S, Barton R, Ramakrishnan A. Handy extrication methods for meat grinder injuries: a case series. ANZ J Surg 2023; 93:743-745. [PMID: 35920700 DOI: 10.1111/ans.17959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 07/18/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Peter F Gearing
- Department of Plastic & Reconstructive Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Stephen Goldie
- Department of Plastic & Reconstructive Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Richard Barton
- Department of Plastic & Reconstructive Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Anand Ramakrishnan
- Department of Plastic & Reconstructive Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
6
|
Megee F, Gough K, Frowen J, Dixon B, Magarey M, Wiesenfeld D, Ramakrishnan A. Predictors of distress associated with altered appearance and function in people treated surgically for oral cancers: a cross-sectional study. Int J Oral Maxillofac Surg 2023:S0901-5027(23)00007-3. [PMID: 36739204 DOI: 10.1016/j.ijom.2023.01.006] [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: 09/27/2022] [Revised: 11/14/2022] [Accepted: 01/11/2023] [Indexed: 02/05/2023]
Abstract
This cross-sectional study was performed to examine sources of variation in distress associated with altered appearance and fundamental functions in oral cancer patients at 2 months, 12-15 months, 24-36 months, and ≥ 5 years post-definitive treatment. Eligible patients completed six scales from the FACE-Q Head and Neck Cancer Module. Pre-specified regression models were used to examine sources of variation in study outcomes for 145 patients. Patient self-reports indicated that distress associated with altered appearance and fundamental functions was highly variable, and distress was present beyond 5 years post-definitive treatment in some patients. Associations between distress scores and time post-definitive treatment, reconstructive surgery, and adjuvant therapy were not statistically significant. There was, however, moderate to strong evidence against the null hypothesis of no association between eating distress scores and sex, primary cancer site, and T-stage; smiling distress scores and age and primary cancer site; appearance distress scores and geographical remoteness and primary cancer site; and speaking distress scores and primary cancer site. Primary cancer site was the only significant independent predictor of multiple distress scores. These findings suggest that predicting the psychological impact of oral cancer treatment remains a challenge for the multidisciplinary team. Screening and interventions for psychological distress are essential beyond the preoperative and acute care settings.
Collapse
Affiliation(s)
- F Megee
- Speech Pathology and Audiology Department, The Royal Melbourne Hospital, Victoria, Australia.
| | - K Gough
- Department of Health Services Research, Peter MacCallum Cancer Centre, Victoria, Australia; Department of Nursing, Faculty of Medicine, Dentistry, and Health Sciences, The University of Melbourne, Victoria, Australia
| | - J Frowen
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Victoria, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia
| | - B Dixon
- Department of Surgery, The University of Melbourne, Victoria, Australia; Department of Cancer Surgery, Peter MacCallum Cancer Centre, Victoria, Australia
| | - M Magarey
- Department of Cancer Surgery, Peter MacCallum Cancer Centre, Victoria, Australia; Department of Medical Education, The University of Melbourne, Victoria, Australia
| | - D Wiesenfeld
- Department of Surgery, The University of Melbourne, Victoria, Australia; Head and Neck Tumour Stream, The Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Victoria, Australia
| | - A Ramakrishnan
- Department of Surgery, The University of Melbourne, Victoria, Australia; Department of Plastic and Reconstructive Surgery, The Royal Melbourne Hospital, Victoria, Australia
| |
Collapse
|
7
|
Martin LW, Cabalag M, Ramakrishnan A, Martin A. HSR22-155: Management of Close/Positive Margins in cSCCHN. J Natl Compr Canc Netw 2022. [DOI: 10.6004/jnccn.2021.7141] [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)
- Luke William Martin
- 1 The Royal Melbourne Hospital, The University of Melbourne, Parkville VIC 3050, Australia
| | - Miguel Cabalag
- 1 The Royal Melbourne Hospital, The University of Melbourne, Parkville VIC 3050, Australia
- 2 Peter MacCallum Cancer Centre, Melbourne VIC 3000, Australia
| | - Anand Ramakrishnan
- 1 The Royal Melbourne Hospital, The University of Melbourne, Parkville VIC 3050, Australia
| | - Andrew Martin
- 1 The Royal Melbourne Hospital, The University of Melbourne, Parkville VIC 3050, Australia
| |
Collapse
|
8
|
Daly JF, Gearing PF, Tang NSJ, Ramakrishnan A, Singh KP. Antibiotic Prophylaxis Prescribing Practice in Head and Neck Tumor Resection and Free Flap Reconstruction. Open Forum Infect Dis 2022; 9:ofab590. [PMID: 35024372 PMCID: PMC8743122 DOI: 10.1093/ofid/ofab590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/21/2021] [Indexed: 11/22/2022] Open
Abstract
Background Adherence to guidelines for antibiotic prophylaxis is often poor and is an important target for antimicrobial stewardship programs. Prescribing audits that suggested poor adherence to guidelines in a plastic surgery department led to a targeted education program to bring antibiotic prescriptions in line with hospital guidelines. We reviewed whether this intervention was associated with changed perioperative prescribing and altered surgical outcomes, including the rate of surgical site infections, specifically looking at clean-contaminated head and neck tumor resections with free flap reconstruction. Methods A retrospective cohort study was performed on 325 patients who underwent clean-contaminated head and neck tumor resection and free flap reconstruction from January 1, 2013, to February 19, 2019. Patients were divided into 2 groups, those before (pre-intervention) and after (postintervention) the education campaign. We analyzed patient demographic and disease characteristics, intraoperative and postoperative factors, and surgical outcomes. Results Patients pre-intervention were prescribed longer courses of prophylactic antibiotics (median [interquartile range], 9 [8] vs 1 [1]; P < .001), more topical chloramphenicol ointment (21.82% vs 0%; P < .001), and more oral nystatin (36.9% vs 12.2%; P < .001). Patients postintervention had higher rates of recipient infections (36.11% vs 17.06%; P < .001) and donor site infections (6.94% vs 1.19%; P = .006). Conclusions Following the education campaign, patients were prescribed shorter courses of prophylactic antibiotics, more of the recommended cefazolin-metronidazole regimen, and fewer topical antibiotics. However, patients also had a higher rate of surgical site infections.
Collapse
Affiliation(s)
- John Frederick Daly
- The University of Melbourne (Royal Melbourne Hospital), Melbourne, Victoria, Australia
| | - Peter Francis Gearing
- The University of Melbourne (Royal Melbourne Hospital), Melbourne, Victoria, Australia
| | - Nicholas Shi Jie Tang
- Department of Plastic & Reconstructive Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Anand Ramakrishnan
- The University of Melbourne (Royal Melbourne Hospital), Melbourne, Victoria, Australia
- Department of Plastic & Reconstructive Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Kasha Priya Singh
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| |
Collapse
|
9
|
Gearing PF, Daly JF, Tang NSJ, Singh K, Ramakrishnan A. Risk factors for surgical site infection in free-flap reconstructive surgery for head and neck cancer: Retrospective Australian cohort study. Head Neck 2021; 43:3417-3428. [PMID: 34409671 DOI: 10.1002/hed.26837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/10/2021] [Revised: 06/30/2021] [Accepted: 07/29/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Surgical site infections (SSI) are common complications of free-flap reconstruction for head and neck cancer defects. This study aimed to identify risk factors for SSI following a significant change in local antibiotic prophylaxis practice. METHODS A retrospective cohort study was conducted of 325 patients receiving free-flap reconstruction for head and neck cancer defects at a tertiary hospital in Melbourne, Australia between 2013 and 2019. Charts were queried for recipient SSI (primary outcome), donor SSI, other infections, antibiotic use, hospital length of stay, and mortality. RESULTS Risk factors for SSI included female sex, T-classification, hardware insertion, clindamycin prophylaxis, and operative duration. There was a trend toward increased SSI with shorter ≤24 h prophylaxis (OR: 0.43). CONCLUSION Antibiotic duration and type were associated with SSI. Complexity of surgery, T-classification, hardware use, and operative duration were also independently associated with SSI. A prospective trial is indicated to elicit optimal prophylactic antibiotic duration.
Collapse
Affiliation(s)
- Peter Francis Gearing
- The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - John Frederick Daly
- The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Nicholas Shi Jie Tang
- Department of Plastic & Reconstructive Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Kasha Singh
- The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.,Victorian Infectious Diseases Unit, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Anand Ramakrishnan
- Department of Plastic & Reconstructive Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
10
|
Burlak K, Shukla L, Kavnoudias H, Schoenwaelder M, Morgan D, Ramakrishnan A. Radiological assessment of facial fractures: a comparative study between surgeon and radiologist. ANZ J Surg 2021; 91:962-968. [PMID: 33844452 DOI: 10.1111/ans.16848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/20/2021] [Accepted: 03/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The authors aimed to examine the differences in CT facial bone interpretation by the faciomaxillary surgeon and the radiologist, in order to improve communication gaps and subsequently, the quality and consistency of patient care. METHODS This study was conducted at a level I tertiary trauma centre. Patients with facial trauma who were referred to the faciomaxillary unit following a facial CT examination from August 2017 to September 2018 were eligible for inclusion. The inclusion period was extended to 5 years for panfacial trauma patients. All consecutive patients that fulfilled the study inclusion criteria for each type of injury were included in the study (a total of 120 patients assigned to the following six categories: orbits, skull and skull base, zygomaticomaxillary complex, Le Fort pattern, mandible and pan-facial fractures). Faciomaxillary surgeons, blinded to the radiology report, were asked to provide a verbal description of the fractures. The surgical interpretation was compared to the radiology report and further analysed. RESULTS Of the 120 cases, the same fractures were reported in 43 cases (35.8%). Both types of specialists noted the predominant and clinically relevant fractures in 106 cases (88.3%). The reports did not match in 14 cases (11.7%) and different terminology was used in 76 cases (63.3%), with agreement in 25% (95% CI: 18-34%), partial agreement in 11.7% (95% CI: 5.9-17.4%) and no agreement in 63.3% (95% CI: 54.7-72.0%) cases. CONCLUSION Radiologists and faciomaxillary surgeons frequently differ in their assessment of facial fractures.
Collapse
Affiliation(s)
- Kateryna Burlak
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Lipi Shukla
- Department of Plastics, Hand and Faciomaxillary surgery, Alfred Hospital, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Helen Kavnoudias
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia.,Adjunct Senior Lecturer/Senior Research Fellow, Department of Surgery and Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Mark Schoenwaelder
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - David Morgan
- Department of Plastics, Hand and Faciomaxillary surgery, Alfred Hospital, Melbourne, Victoria, Australia
| | - Anand Ramakrishnan
- Department of Plastics, Hand and Faciomaxillary surgery, Alfred Hospital, Melbourne, Victoria, Australia.,Honorary Senior Fellow, Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
11
|
Tang NSJ, Ramakrishnan A, Shayan R. Quality-of-life outcomes after operative management of primary and secondary lymphoedema: a systematic review. ANZ J Surg 2021; 91:2624-2636. [PMID: 33825306 DOI: 10.1111/ans.16764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/27/2021] [Accepted: 03/06/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Lymphoedema is an incurable and progressive disease that affects not only physical function but overall quality of life. Surgical treatment options for the management of lymphoedema are being increasingly performed. This study aims to review post-operative health-related quality of life (HRQOL) following surgical treatment of lymphoedema. METHODS A systematic search of the PubMed and Medline databases was performed from the date of their inception until September 2018 to evaluate HRQOL following different surgical options for the treatment of lymphoedema. RESULTS One hundred and thirteen articles were identified. Twenty-one articles were included in the final review, comprising a total of 736 patients. HRQOL improvements appear to be sustained for at least 6-12 months post-operatively. In particular, major benefits were noted in the domains based around physical functioning. Patient satisfaction similarly mirrors HRQOL improvements, following an initial dip in the immediate post-operative period. CONCLUSION All surgical treatment modalities for the management of lymphoedema confer significant HRQOL improvements across a diverse range of health domains, with this critical outcome of surgery an important pre-operative consideration. Recommendations for ongoing research are suggested.
Collapse
Affiliation(s)
- Nicholas S J Tang
- Department of Plastic and Reconstructive Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Anand Ramakrishnan
- Department of Plastic and Reconstructive Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ramin Shayan
- Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
12
|
Cevik J, Middleton R, Ramakrishnan A, Cabalag M. Rationalizing post-operative prophylactic anticoagulation in reconstructive head and neck cancer patients: a review. ANZ J Surg 2021; 91:2610-2616. [PMID: 33724659 DOI: 10.1111/ans.16742] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 10/31/2020] [Revised: 02/22/2021] [Accepted: 03/01/2021] [Indexed: 12/13/2022]
Abstract
Microsurgical reconstructive head and neck cancer patients are at high risk of venous thromboembolism. The use of anticoagulation can reduce their risk; however, this also increases their bleeding risk. It is not clear whether the benefits of treatment outweigh the risks, and whether a specific post-operative anticoagulation regime is superior. The aim of this review is to evaluate the evidence pertaining to the risks and benefits of post-operative anticoagulation and to provide a rationale for its use in head and neck cancer patients receiving free flaps. The secondary aim was to determine the optimal post-operative anticoagulation regimen. A search was conducted in the PubMed and EMBASE databases identifying studies reporting venous thromboembolism rates in reconstructive head and neck cancer patients undergoing free flaps. These studies were reviewed for their eligibility. Outcomes measured were rates of venous thromboembolism, bleeding-related and microsurgical complications. A total of 306 studies were found from the search with another seven studies identified from citations of key articles. After assessment, nine studies were included. Venous thromboembolism rates ranged from 0.5% to 7% and the rates of bleeding-related complications ranged from 2.4% up to 29%. Anticoagulation appears to lower the risk of venous thromboembolism in this patient group, but also increases the bleeding risk. Risk stratification using the Caprini risk assessment model can help surgeons make decisions. For patients with cancer, low molecular weight heparin appears to be superior to heparin given twice daily but equal to heparin given three times daily and the bleeding risk of each medication appears similar.
Collapse
Affiliation(s)
- Jevan Cevik
- Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rory Middleton
- Department of Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Anand Ramakrishnan
- Plastic and Reconstructive Surgery Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Miguel Cabalag
- Plastic and Reconstructive Surgery Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
13
|
Miles OJ, Zhou J, Paleri S, Fua T, Ramakrishnan A. Chest keloids: effect of surgical excision and adjuvant radiotherapy on recurrence, a systematic review and meta-analysis. ANZ J Surg 2021; 91:1104-1109. [PMID: 33438368 DOI: 10.1111/ans.16561] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 09/26/2020] [Revised: 12/07/2020] [Accepted: 12/15/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chest keloids are a difficult sub-group of scars to treat, likely secondary to the high wound tension in the area that promotes excessive fibroblast proliferation and collagen deposition. Excision and adjuvant radiotherapy has been demonstrated as an efficacious treatment for keloids in general, but no meta-analysis exists to support the claims for chest keloids. This study aims to identify the rate of recurrence after surgical resection and radiotherapy on patients with chest keloids. METHODS A search was performed using Embase, MEDLINE, Pubmed and Cochrane database on 22 December 2018 for terms 'radiotherapy', 'keloid' and 'chest'. Papers included met a prospectively designed inclusion criteria assessed by multiple investigators. RESULTS Twelve studies, including 1 randomized controlled trial, were included for a total of 400 patients with a chest keloid scar managed with surgical excision and adjuvant radiotherapy. Overall pooled-estimate of recurrence rate was 22% (95% CI 12-32%). Meta-regression did not demonstrate a significant effect for method of wound closure, type of radiotherapy, radiotherapy dose (BED10 ) and study type. CONCLUSION Excision and adjuvant radiotherapy represents an effective method of treatment for chest keloids, however sufficient prospective data, including randomized controlled trials, did not yet exist to support these findings. Further studies with sufficient sub-group analysis for keloid location are required to add to the pool of literature that can be added to this meta-analysis.
Collapse
Affiliation(s)
- Oliver J Miles
- Department of Plastic and Reconstructive Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Jieyun Zhou
- Department of Plastic and Reconstructive Surgery, The Alfred Hospital Melbourne, Melbourne, Victoria, Australia
| | - Sarang Paleri
- Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Tsien Fua
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Anand Ramakrishnan
- Department of Plastic and Reconstructive Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
14
|
Ramakrishnan A, Joseph SS, Reynolds ND, Poncet D, Maciel M, Nunez G, Espinoza N, Nieto M, Castillo R, Royal JM, Poole S, McVeigh A, Rollenhagen JE, Heinrichs J, Prouty MG, Simons MP, Renauld-Mongénie G, Savarino SJ. Evaluation of the immunogenicity and protective efficacy of a recombinant CS6-based ETEC vaccine in an Aotus nancymaae CS6 + ETEC challenge model. Vaccine 2020; 39:487-494. [PMID: 33357957 DOI: 10.1016/j.vaccine.2020.12.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 09/23/2020] [Revised: 11/30/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
Colonization factors or Coli surface antigens (CFs or CS) are important virulence factors of Enterotoxigenic E. coli (ETEC) that mediate intestinal colonization and accordingly are targets of vaccine development efforts. CS6 is a highly prevalent CF associated with symptomatic ETEC infection both in endemic populations and amongst travelers. In this study, we used an Aotus nancymaae non-human primate ETEC challenge model with a CS6 + ETEC strain, B7A, to test the immunogenicity and protective efficacy (PE) of a recombinant CS6-based subunit vaccine. Specifically, we determined the ability of dscCssBA, the donor strand complemented recombinant stabilized fusion of the two subunits of the CS6 fimbriae, CssA and CssB, to elicit protection against CS6 + ETEC mediated diarrhea when given intradermally (ID) with the genetically attenuated double mutant heat-labile enterotoxin LT(R192G/L211A) (dmLT). ID vaccination with dscCssBA + dmLT induced strong serum antibody responses against CS6 and LT. Importantly, vaccination with dscCssBA + dmLT resulted in no observed diarrheal disease (PE = 100%, p = 0.03) following B7A challenge as compared to PBS immunized animals, with an attack rate of 62.5%. These data demonstrate the potential role that CS6 may play in ETEC infection and that recombinant dscCssBA antigen can provide protection against challenge with the homologous CS6 + ETEC strain, B7A, in the Aotus nancymaae diarrheal challenge model. Combined, these data indicate that CS6, and more specifically, a recombinant engineered derivative should be considered for further clinical development.
Collapse
Affiliation(s)
- A Ramakrishnan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA
| | - S S Joseph
- Henry M Jackson Foundation for the Advancement of Military Medicine, 6720 Rockledge Drive, Bethesda, MD 20817, USA
| | - N D Reynolds
- Department of Bacteriology, Naval Medical Research Unit No. 6, Venezuela Ave. Block 36, Bellavista, Callao, Peru
| | - D Poncet
- Sanofi Pasteur, Research and External Innovation, 1541 Av. Marcel Mérieux, 69280 Marcy L'Etoile
| | - M Maciel
- Henry M Jackson Foundation for the Advancement of Military Medicine, 6720 Rockledge Drive, Bethesda, MD 20817, USA
| | - G Nunez
- Department of Bacteriology, Naval Medical Research Unit No. 6, Venezuela Ave. Block 36, Bellavista, Callao, Peru
| | - N Espinoza
- Department of Bacteriology, Naval Medical Research Unit No. 6, Venezuela Ave. Block 36, Bellavista, Callao, Peru
| | - M Nieto
- Department of Bacteriology, Naval Medical Research Unit No. 6, Venezuela Ave. Block 36, Bellavista, Callao, Peru
| | - R Castillo
- Department of Bacteriology, Naval Medical Research Unit No. 6, Venezuela Ave. Block 36, Bellavista, Callao, Peru
| | - J M Royal
- Department of Veterinary Services, Naval Medical Research Unit No. 6, Venezuela Ave. Block 36, Bellavista, Callao, Peru
| | - S Poole
- Henry M Jackson Foundation for the Advancement of Military Medicine, 6720 Rockledge Drive, Bethesda, MD 20817, USA
| | - A McVeigh
- Henry M Jackson Foundation for the Advancement of Military Medicine, 6720 Rockledge Drive, Bethesda, MD 20817, USA
| | - J E Rollenhagen
- Henry M Jackson Foundation for the Advancement of Military Medicine, 6720 Rockledge Drive, Bethesda, MD 20817, USA
| | | | - M G Prouty
- Enteric Diseases Department, Naval Medical Research Center, 503 Robert Grant Ave, Silver Spring, MD 20910, USA.
| | - M P Simons
- Department of Bacteriology, Naval Medical Research Unit No. 6, Venezuela Ave. Block 36, Bellavista, Callao, Peru
| | - G Renauld-Mongénie
- Sanofi Pasteur, Research and External Innovation, 1541 Av. Marcel Mérieux, 69280 Marcy L'Etoile
| | - S J Savarino
- Enteric Diseases Department, Naval Medical Research Center, 503 Robert Grant Ave, Silver Spring, MD 20910, USA
| |
Collapse
|
15
|
Tholouli E, Osborne W, Bachier C, Ramakrishnan A, Marzolini M, Irvine D, McSweeney P, Bartlet N, Zhang Y, Thomas S, Al-Hajj M, Pule M, Jonnaert M, Peddareddigari V, Khokhar N, Chen R, Ardesha K. 890MO Phase I Alexander study of AUTO3, the first CD19/22 dual targeting CAR.T cell, with pembrolizumab in patients with relapsed/refractory (r/r) DLBCL. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
16
|
Shaw LM, Iseli TA, Wiesenfeld D, Ramakrishnan A, Granger CL. Postoperative pulmonary complications following major head and neck cancer surgery. Int J Oral Maxillofac Surg 2020; 50:302-308. [PMID: 32682644 DOI: 10.1016/j.ijom.2020.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 12/01/2019] [Revised: 04/16/2020] [Accepted: 06/22/2020] [Indexed: 11/19/2022]
Abstract
The primary aim of this observational study was to describe the incidence of postoperative pulmonary complications (PPCs) in 60 consecutive, surgically treated head and neck cancer patients requiring free flap reconstruction and tracheostomy, using both a prospective and a retrospective outcome measure. Secondary aims were to identify risk factors for PPC development, explore the effects of PPC on outcomes, and describe the provision of postoperative physiotherapy in this population. Postoperative pulmonary complications occurred in nine (15%) patients based on the Melbourne Group Scale and 27 (45%) patients based on Health Information Service coding data. The occurrence of a PPC was not statistically correlated with age, smoking history, comorbidities, operative time, or type of resection or free flap. Patients who developed a PPC, compared to those who did not, had a higher preoperative body mass index (P=0.022) and were more likely to be sat out of bed earlier post-surgery (P=0.038). Overall, patients required a median of 9.0 (interquartile range 7.0-11.0) physiotherapy sessions. Patients developing a PPC required significantly more physiotherapy sessions (P=0.007) and additional days of supplemental oxygen (P=0.022) as compared to those without a PPC, despite a similar hospital length of stay. In future, targeted physiotherapy interventions may reduce PPCs in this population.
Collapse
Affiliation(s)
- L M Shaw
- Department of Allied Health (Physiotherapy), The Royal Melbourne Hospital, Parkville, Victoria, Australia.
| | - T A Iseli
- Head and Neck Tumour Stream, Department of Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia
| | - D Wiesenfeld
- Head and Neck Tumour Stream, Department of Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia
| | - A Ramakrishnan
- Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia; Department of Plastic and Reconstructive Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - C L Granger
- Department of Allied Health (Physiotherapy), The Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
17
|
Werner CT, Mitra S, Martin JA, Stewart AF, Lepack AE, Ramakrishnan A, Gobira PH, Wang ZJ, Neve RL, Gancarz AM, Shen L, Maze I, Dietz DM. Ubiquitin-proteasomal regulation of chromatin remodeler INO80 in the nucleus accumbens mediates persistent cocaine craving. Sci Adv 2019; 5:eaay0351. [PMID: 31633032 PMCID: PMC6785264 DOI: 10.1126/sciadv.aay0351] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 09/14/2019] [Indexed: 05/07/2023]
Abstract
Neuroadaptations in the nucleus accumbens (NAc) underlie cue-induced cocaine craving that intensifies ("incubates") during abstinence and is believed to contribute to persistent relapse vulnerability. Changes in gene expression often govern perpetual behavioral abnormalities, but epigenetic plasticity during prolonged abstinence from drug exposure is poorly understood. We examined how E3 ubiquitin ligase TRIM3 dysregulates chromatin remodeler INO80 to mediate cocaine craving during prolonged abstinence. We found that INO80 expression increased in the NAc on abstinence day 30 (AD30) but not on AD1 following cocaine self-administration. Furthermore, TRIM3, which mediates degradation of INO80, was reduced on AD30, along with TRIM3-INO80 interaction. Viral-mediated gene transfer of INO80 or TRIM3 governed cocaine craving during prolonged abstinence. Lastly, chromatin immunoprecipitation followed by massively parallel DNA sequencing identified INO80-mediated transcriptional regulation of predicted pathways associated with cocaine plasticity. Together, these results demonstrate a novel ubiquitin-proteasomal-epigenetic mechanism by which TRIM3-INO80 mediates cocaine craving during prolonged abstinence.
Collapse
Affiliation(s)
- C. T. Werner
- Department of Pharmacology and Toxicology, Program in Neuroscience, Jacobs School of Medicine and Biomedical Sciences, The State University of New York at Buffalo, Buffalo, NY, USA
| | - S. Mitra
- Department of Pharmacology and Toxicology, Program in Neuroscience, Jacobs School of Medicine and Biomedical Sciences, The State University of New York at Buffalo, Buffalo, NY, USA
| | - J. A. Martin
- Department of Pharmacology and Toxicology, Program in Neuroscience, Jacobs School of Medicine and Biomedical Sciences, The State University of New York at Buffalo, Buffalo, NY, USA
| | - A. F. Stewart
- Department of Pharmacology and Toxicology, Program in Neuroscience, Jacobs School of Medicine and Biomedical Sciences, The State University of New York at Buffalo, Buffalo, NY, USA
| | - A. E. Lepack
- Fishberg Department of Neuroscience, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - A. Ramakrishnan
- Fishberg Department of Neuroscience, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - P. H. Gobira
- Department of Pharmacology and Toxicology, Program in Neuroscience, Jacobs School of Medicine and Biomedical Sciences, The State University of New York at Buffalo, Buffalo, NY, USA
- Department of Physics and Chemistry, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Z.-J. Wang
- Department of Pharmacology and Toxicology, Program in Neuroscience, Jacobs School of Medicine and Biomedical Sciences, The State University of New York at Buffalo, Buffalo, NY, USA
| | - R. L. Neve
- Gene Delivery Technology Core, Massachusetts General Hospital, Cambridge, MA, USA
| | - A. M. Gancarz
- Department of Psychology, California State University, Bakersfield, Bakersfield, CA, USA
| | - L. Shen
- Fishberg Department of Neuroscience, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - I. Maze
- Fishberg Department of Neuroscience, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - D. M. Dietz
- Department of Pharmacology and Toxicology, Program in Neuroscience, Jacobs School of Medicine and Biomedical Sciences, The State University of New York at Buffalo, Buffalo, NY, USA
- Department of Psychology, The State University of New York at Buffalo, Buffalo, NY, USA
- Corresponding author.
| |
Collapse
|
18
|
Tang N, Burgess N, Park HS, Ramakrishnan A. Ethical dilemmas in the surgical management of body integrity identity disorder. Australas J Plast Surg 2019. [DOI: 10.34239/ajops.v2n2.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
19
|
Li H, Tan MDM, Alexander S, Grinsell D, Ramakrishnan A. Comparative osteoradionecrosis rates in bony reconstructions for head and neck malignancy. J Plast Reconstr Aesthet Surg 2019; 72:1478-1483. [DOI: 10.1016/j.bjps.2019.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 03/26/2019] [Accepted: 04/27/2019] [Indexed: 11/27/2022]
|
20
|
Tang NSJ, Ahmadi I, Ramakrishnan A. Virtual surgical planning in fibula free flap head and neck reconstruction: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2019; 72:1465-1477. [PMID: 31324403 DOI: 10.1016/j.bjps.2019.06.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [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: 01/09/2019] [Revised: 04/12/2019] [Accepted: 06/23/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The traditional approach to head and neck reconstruction is considered challenging, requiring a subjective assessment of an often-complex defect followed by careful modelling of a bony flap to match this. The introduction of Virtual Surgical Planning (VSP) has provided the surgeon with a means to increase efficiency, precision and overall patient outcomes. This study aims to compare VSP and traditional head and neck reconstructions utilising fibula free flaps with regards surgical efficiency and patient outcomes. METHODS A systematic search of the PubMed and Medline databases was performed from the date of their inception through to August 2018 to evaluate and compare VSP and non-VSP cohorts in the context of fibula free flap head and neck reconstruction. Primary comparative outcomes included operative and ischaemic time, with secondary outcomes including complications rates, measures of accuracy and financial benefits. RESULTS One hundred and fifty-three articles were identified. Twenty-three articles were included in the review, comprising a total of 713 patients. VSP was associated with significantly decreased intraoperative time (Standardised Mean Difference -1.01; 95% CI -1.23 to 0.80; p = 0.000) and ischaemic time (Standardised Mean Difference -1.55; 95% CI -1.87 to -1.23, p = 0.002). VSP was also associated with reduced orthognathic deviation from an ideal outcome when compared to conventional techniques. No statistically significant differences in complication rates between conventional and VSP techniques were identified. CONCLUSION The results of this meta-analysis suggests that VSP confers significant benefits with respect to improved orthognathic accuracy, ischaemic times and intraoperative times without any significant increase in complications. Recommendations for ongoing research are suggested.
Collapse
Affiliation(s)
- Nicholas S J Tang
- Department of Plastic & Reconstructive Surgery, The Royal Melbourne Hospital, 300 Grattan St, Parkville VIC 3050, Australia.
| | - Iraj Ahmadi
- Department of Plastic & Reconstructive Surgery, The Royal Melbourne Hospital, 300 Grattan St, Parkville VIC 3050, Australia
| | - Anand Ramakrishnan
- Department of Plastic & Reconstructive Surgery, The Royal Melbourne Hospital, 300 Grattan St, Parkville VIC 3050, Australia
| |
Collapse
|
21
|
Tang N, Tao P, Liew J, Iseli TA, Wiesenfeld D, MacGill K, Ramakrishnan A. Palatal fistulas complicating osseomyocutaneous reconstruction of oncological maxillectomy defects. Eur J Plast Surg 2019. [DOI: 10.1007/s00238-019-01533-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
22
|
Lowrence RC, Ramakrishnan A, Sundaramoorthy NS, Shyam A, Mohan V, Subbarao HMV, Ulaganathan V, Raman T, Solomon A, Nagarajan S. Norfloxacin salts of carboxylic acids curtail planktonic and biofilm mode of growth in ESKAPE pathogens. J Appl Microbiol 2018; 124:408-422. [PMID: 29178633 DOI: 10.1111/jam.13651] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 04/17/2017] [Revised: 09/14/2017] [Accepted: 11/17/2017] [Indexed: 12/19/2022]
Abstract
AIMS To enhance the antimicrobial and antibiofilm activity of norfloxacin against the planktonic and biofilm mode of growth in ESKAPE pathogens using chemically modified norfloxacin salts. METHODS AND RESULTS Antimicrobial testing, synergy testing and time-kill curve analysis were performed to evaluate antibacterial effect of norfloxacin carboxylic acid salts against ESKAPE pathogens. In vivo efficacy to reduce bacterial bioburden was evaluated in zebrafish infection model. Crystal violet assay and live-dead staining were performed to discern antibiofilm effect. Membrane permeability, integrity and molecular docking studies were carried out to ascertain the mechanism of action. The carboxylic acid salts, relative to parent molecule norfloxacin, displayed two- to fourfold reduction in minimum inhibitory concentration against Staphylococcus aureus and Pseudomonas aeruginosa, in addition to displaying potent bacteriostatic effect against certain members of ESKAPE pathogens. In vivo treatments revealed that norfloxacin tartrate (SRIN2) reduced MRSA bioburden by greater than 1 log fold relative to parent molecule in the muscle tissue. In silico docking with gyrA of S. aureus showed increased affinity of SRIN2 towards DNA gyrase. The enhanced antibacterial effect of norfloxacin salts could be partially accounted by altered membrane permeability in S. aureus and perturbed membrane integrity in P. aeruginosa. Antibiofilm studies revealed that SRIN2 (norfloxacin tartrate) and SRIN3 (norfloxacin benzoate) exerted potent antibiofilm effect particularly against Gram-negative ESKAPE pathogens. The impaired colonization of both S. aureus and P. aeruginosa due to improved norfloxacin salts was further supported by live-dead imaging. CONCLUSION Norfloxacin carboxylic acid salts can act as potential alternatives in terms of drug resensitization and reuse. SIGNIFICANCE AND IMPACT OF THE STUDY Our study shows that carboxylic acid salts of norfloxacin could be effectively employed to treat both planktonic- and biofilm-based infections caused by select members of ESKAPE pathogens.
Collapse
Affiliation(s)
- R C Lowrence
- School of Chemical and Biotechnology, SASTRA University, Thanjavur, Tamil Nadu, India.,Center for Research on Infectious Diseases (CRID), School of Chemical and Biotechnology, SASTRA University, Thanjavur, Tamil Nadu, India
| | - A Ramakrishnan
- School of Chemical and Biotechnology, SASTRA University, Thanjavur, Tamil Nadu, India
| | - N S Sundaramoorthy
- School of Chemical and Biotechnology, SASTRA University, Thanjavur, Tamil Nadu, India
| | - A Shyam
- School of Chemical and Biotechnology, SASTRA University, Thanjavur, Tamil Nadu, India
| | - V Mohan
- School of Chemical and Biotechnology, SASTRA University, Thanjavur, Tamil Nadu, India
| | - H M V Subbarao
- School of Chemical and Biotechnology, SASTRA University, Thanjavur, Tamil Nadu, India
| | - V Ulaganathan
- School of Chemical and Biotechnology, SASTRA University, Thanjavur, Tamil Nadu, India
| | - T Raman
- School of Chemical and Biotechnology, SASTRA University, Thanjavur, Tamil Nadu, India
| | - A Solomon
- Department of Chemistry, School of Engineering, Dayananda Sagar University, Bangalore, Karnataka, India
| | - S Nagarajan
- School of Chemical and Biotechnology, SASTRA University, Thanjavur, Tamil Nadu, India.,Center for Research on Infectious Diseases (CRID), School of Chemical and Biotechnology, SASTRA University, Thanjavur, Tamil Nadu, India
| |
Collapse
|
23
|
Ranganathan L, Deenadayalan H, Ramakrishnan A, Vignesh A, Isabel M, Ramakrishnan N. 0523 Acceptance of Diagnosis and Treatment of Obstructive Sleep Apnea: Are Men from Mars and Women from Venus? Sleep 2018. [DOI: 10.1093/sleep/zsy061.522] [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: 11/13/2022] Open
Affiliation(s)
| | | | | | - A Vignesh
- Nithra Institute of Sleep Sciences, Chennai, INDIA
| | - M Isabel
- Nithra Institute of Sleep Sciences, Chennai, INDIA
| | | |
Collapse
|
24
|
Ramakrishnan A, Kumar R, Narayan K, Kumar S. Jaffe Lichtenstein Type Polyostotic Fibrous Dysplasia with Unilateral Absent Testis. J Clin Diagn Res 2018. [DOI: 10.7860/jcdr/2018/34680.11564] [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: 11/24/2022]
|
25
|
Wang H, Ramakrishnan A, Fletcher S, Prochownik EV. A quantitative, surface plasmon resonance-based approach to evaluating DNA binding by the c-Myc oncoprotein and its disruption by small molecule inhibitors. J Biol Methods 2015; 2. [PMID: 26280010 DOI: 10.14440/jbm.2015.54] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The use of small molecules to interfere with protein-protein interactions has tremendous therapeutic appeal and is an area of intense interest. Numerous techniques exist to assess these interactions and their disruption. Many, however, require large amounts of protein, do not allow interactions to be followed in real time, are technically demanding or require large capital expenditures and high levels of expertise. Surface plasmon resonance (SPR) represents a convenient alternative to these techniques with virtually none of their disadvantages. We have devised an SPR-based method that allows the heterodimeric association between the c-Myc (Myc) oncoprotein and its obligate partner Max to be quantified in a manner that agrees well with values obtained by other methods. We have adapted it to examine the ability of previously validated small molecules to interfere with Myc-Max heterodimerization and DNA binding. These inhibitors comprised two distinct classes of molecules that inhibit DNA binding by preventing Myc-Max interaction or distorting pre-formed heterodimers and rendering them incapable of DNA binding. Our studies also point out several potential artifacts and pitfalls to be considered when attempting to employ similar SPR-based methods. This technique should be readily adaptable to the study of other protein-protein interactions and their disruption by small molecules.
Collapse
Affiliation(s)
- Huabo Wang
- Section of Hematology/Oncology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA 15224, USA
| | | | - Steven Fletcher
- Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA ; University of Maryland Greenebaum Cancer Center, Baltimore, MD, 21201, USA
| | - Edward V Prochownik
- Section of Hematology/Oncology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA 15224, USA ; The Department of Microbiology and Molecular Genetics, The University of Pittsburgh Medical Center, Pittsburgh, PA 15232, USA ; The University of Pittsburgh Hillman Cancer Center, Pittsburgh, PA 15232, USA
| |
Collapse
|
26
|
Wagner J, Ramakrishnan A, Behr D, Maier M, Herres N, Kunzer M, Obloh H, Bachem KH. Composition Dependence of the Band Gap Energy of InxGa1−xN Layers on GaN (x≤0.15) Grown by Metal-Organic Chemical Vapor Deposition. ACTA ACUST UNITED AC 2014. [DOI: 10.1557/s1092578300002301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We report on the composition dependence of the band gap energy of strained hexagonal InxGa1−xN layers on GaN with x≤0.15, grown by metal-organic chemical vapor deposition on sapphire substrates. The composition of the (InGa)N was determined by secondary ion mass spectroscopy. High-resolution X-ray diffraction measurements confirmed that the (InGa)N layers with typical thicknesses of 30 nm are pseudomorphically strained to the in-plane lattice parameter of the underlying GaN. Room-temperature photoreflection spectroscopy and spectroscopic ellipsometry were used to determine the (InGa)N band gap energy. The composition dependence of the band gap energy of the strained (InGa)N layers was found to be given by EG(x)=3.43−3.28 × (eV) for x≤0.15. When correcting for the strain induced shift of the fundamental energy gap, a bowing parameter of 3.2 eV was obtained for the composition dependence of the gap energy of unstrained (InGa)N.
Collapse
|
27
|
Ramakrishnan A, Spangenberg K, Gold K. Perceptions of perinatal depression training among primary care providers and obstetricians in Kumasi, Ghana. Contraception 2013. [DOI: 10.1016/j.contraception.2013.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
28
|
De Silva I, Rozen WM, Ramakrishnan A, Mirkazemi M, Baillieu C, Ptasznik R, Leong J. Achieving adequate margins in ameloblastoma resection: the role for intra-operative specimen imaging. Clinical report and systematic review. PLoS One 2012; 7:e47897. [PMID: 23094099 PMCID: PMC3477138 DOI: 10.1371/journal.pone.0047897] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 09/18/2012] [Indexed: 11/18/2022] Open
Abstract
Background Ameloblastoma is a locally aggressive odontogenic neoplasm. With local recurrence rates reaching 90%, only completeness of excision can facilitate cure. Surgical clearance has widely been based on pre-operative imaging to guide operative excision margins, however use of intra-operative specimen x-ray or frozen-section has been sought to improve clearance rates, and advanced imaging technologies in this role have been proposed. This manuscript aims to quantify the evidence for evaluating intra-operative resection margins and present the current standard in this role. Method The current study comprises the first reported comparison of imaging modalities for assessing ameloblastoma margins. A case is presented in which margins are assessed with each of clinical assessment based on preoperative imaging, intra-operative specimen x-ray, intra-operative specimen computed tomography (CT) and definitive histology. Each modality is compared quantitatively. These results are compared to the literature through means of systematic review of current evidence. Results A comparative study highlights the role for CT imaging over plain radiography. With no other comparative studies and a paucity of high level evidence establishing a role for intra-operative margin assessment in ameloblastoma in the literature, only level 4 evidence supporting the use of frozen section and specimen x-ray, and only one level 4 study assesses intra-operative CT. Conclusion The current study suggests that intra-operative specimen CT offers an improvement over existing techniques in this role. While establishing a gold-standard will require higher level comparative studies, the use of intra-operative CT can facilitate accurate single-stage resection.
Collapse
Affiliation(s)
- Inoka De Silva
- Department of Plastic and Reconstructive Surgery, Dandenong Hospital, Southern Health, David St, Dandenong, Victoria, Australia
- Department of Surgery, Faculty of Medicine, Monash University, Clayton, Victoria, Australia
| | - Warren M. Rozen
- Department of Plastic and Reconstructive Surgery, Dandenong Hospital, Southern Health, David St, Dandenong, Victoria, Australia
- Department of Surgery, Faculty of Medicine, Monash University, Clayton, Victoria, Australia
- * E-mail:
| | - Anand Ramakrishnan
- Department of Plastic and Reconstructive Surgery, Dandenong Hospital, Southern Health, David St, Dandenong, Victoria, Australia
- Department of Surgery, Faculty of Medicine, Monash University, Clayton, Victoria, Australia
| | - Mansoor Mirkazemi
- Department of Plastic and Reconstructive Surgery, Dandenong Hospital, Southern Health, David St, Dandenong, Victoria, Australia
- Department of Surgery, Faculty of Medicine, Monash University, Clayton, Victoria, Australia
| | - Charles Baillieu
- Department of Plastic and Reconstructive Surgery, Dandenong Hospital, Southern Health, David St, Dandenong, Victoria, Australia
- Department of Surgery, Faculty of Medicine, Monash University, Clayton, Victoria, Australia
| | - Ronnie Ptasznik
- Department of Radiology, Dandenong Hospital, Southern Health, David St, Dandenong, Victoria, Australia
| | - James Leong
- Department of Plastic and Reconstructive Surgery, Dandenong Hospital, Southern Health, David St, Dandenong, Victoria, Australia
- Department of Surgery, Faculty of Medicine, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
29
|
Affiliation(s)
- Fiona C. E. Hill
- Department of Plastic and Reconstructive Surgery, Royal Melbourne Hospital, P.O. Box 2192, Grattan Street, Parkville, Melbourne, VIC Australia
| | - Alex Yuen
- Department of Plastic and Reconstructive Surgery, Royal Melbourne Hospital, P.O. Box 2192, Grattan Street, Parkville, Melbourne, VIC Australia
| | - Anand Ramakrishnan
- Department of Plastic and Reconstructive Surgery, Royal Melbourne Hospital, P.O. Box 2192, Grattan Street, Parkville, Melbourne, VIC Australia
| |
Collapse
|
30
|
Ramakrishnan A, Haigh I, Liston J, Dall BJG, Sharma N. How can the prevalent round recall rate be reduced? Breast Cancer Res 2010. [PMCID: PMC2978861 DOI: 10.1186/bcr2697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
31
|
Ramakrishnan A, Buck T, Levine J, James P. Allowing Greater Use of Institutional Practice May Decrease Cost Of CTN Trials. Biol Blood Marrow Transplant 2009. [DOI: 10.1016/j.bbmt.2008.12.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
32
|
Buck T, James P, Levine J, Ramakrishnan A. Streamlining SAE Reporting for CTN Trials Results In Significant Time Savings. Biol Blood Marrow Transplant 2009. [DOI: 10.1016/j.bbmt.2008.12.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
33
|
Vijayaraghavan C, Vasanthakumar S, Ramakrishnan A. In vitro and in vivo evaluation of locust bean gum and chitosan combination as a carrier for buccal drug delivery. Pharmazie 2008; 63:342-347. [PMID: 18557416] [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: 05/26/2023]
Abstract
The object of the study was to evaluate locust bean gum and chitosan in ratios of 2:3; 3:2 and 4:1 (F1, F2 and F3) as a mucoadhesive component in buccal tablets and to compare the bioavailability of a propranolol hydrochloride buccal tablet with the oral tablet in healthy human volunteers. Propranolol hydrochloride buccal tablets containing various weight ratios of locust bean gum and chitosan were prepared and coated with 5% w/v ethyl cellulose on one face, and oral tablets containing 10 mg propranolol hydrochloride alone were formulated using a direct compression technique. The strength of mucoadhesion of the tablets was quantified based on the tensile force required to break the adhesive bond between a model membrane (porcine buccal mucosa) and the test polymer. The forces of detachment for the mucoadhesive buccal tablets were 14.61 +/- 0.14, 13.21 +/- 0.13 and 11.71 +/- 0.12. An in vitro study was carried out in pH 6.8 phosphate buffer and the cumulative percentage release of propranolol measured at 10 min intervals for 600 min was found to be 98.31 +/- 0.10, 92.24 +/- 0.41 and 90.18 +/- 0.76 respectively. A bioavailability study was conducted with the prepared formulation in 16 healthy human volunteers to determine the plasma concentration of propranolol at 0, 1, 2, 3, 4, 6, 8, 10 and 12 h. The bioavailability (AUC(0-t*) ng x h/ml) of the buccal propranolol hydrochloride tablets (F1, F2 and F3) and oral tablet (F4) was found to be 2244.18 +/- 210, 3580.69 +/- 460, 3889.19 +/- 290 and 1732 +/- 96 ng x hr/ml respectively. The study indicates that locust bean gum and chitosan in a weight ratio of 2:3 (F1) not only releases the drug unidirectionally from the dosage form, but also gives buccal tablets which are sufficiently mucoadhesive for clinical applications.
Collapse
Affiliation(s)
- C Vijayaraghavan
- Department of Pharmaceutics, College of Pharmacy, Sri Ramakrishna Institute of Paramedical Sciences, Sri Ramakrishna Hospital Campus, Coimbatore, Tamilnadu, India.
| | | | | |
Collapse
|
34
|
Ramakrishnan A, Morrison W, Simmons P. A New Molecular Marker to Isolate Stem Cells from Fat for Bio-Engineering Vascularized Tissues. J Reconstr Microsurg 2006. [DOI: 10.1055/s-2006-947904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
35
|
Ramakrishnan A, Dhamodharan R, Rühe J. Growth of poly(methyl methacrylate) brushes on silicon surfaces by atom transfer radical polymerization. ACTA ACUST UNITED AC 2006. [DOI: 10.1002/pola.21266] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
36
|
Dayananda K, Ramakrishnan A, Dhamodharan R. Synthesis and Characterization of Block Copolymers of P(MMA‐b‐n‐BA‐b‐MMA) via Ambient Temperature ATRP of MMA. Journal of Macromolecular Science, Part A 2005. [DOI: 10.1081/ma-200054354] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
37
|
Affiliation(s)
- P V Sriram
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | | | | | | |
Collapse
|
38
|
Affiliation(s)
- Anand Ramakrishnan
- Plastics and Reconstructive Unit, Royal Children's Hospital, Melbourne, Victoria, Australia.
| | | | | | | |
Collapse
|
39
|
Grüning H, Kohary K, Baranovskii SD, Rubel O, Klar P, Ramakrishnan A, Ebbinghaus G, Thomas P, Heimbrodt W, Stolz W, Rühle W. Hopping relaxation of excitons in GaInNAs/GaNAs quantum wells. ACTA ACUST UNITED AC 2003. [DOI: 10.1002/pssc.200303604] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- H. Grüning
- Department of Physics and Material Sciences Center, Philipps‐University Marburg, D‐35032 Marburg, Germany
| | - K. Kohary
- Department of Materials, University of Oxford, Parks Road, Oxford OX1 3PH, UK
| | - S. D. Baranovskii
- Department of Physics and Material Sciences Center, Philipps‐University Marburg, D‐35032 Marburg, Germany
| | - O. Rubel
- Department of Physics and Material Sciences Center, Philipps‐University Marburg, D‐35032 Marburg, Germany
| | - P.J. Klar
- Department of Physics and Material Sciences Center, Philipps‐University Marburg, D‐35032 Marburg, Germany
| | - A. Ramakrishnan
- Infineon Technologies, Corporate Research CPR 7, D‐81730 Munich, Germany
| | - G. Ebbinghaus
- Infineon Technologies, Corporate Research CPR 7, D‐81730 Munich, Germany
| | - P. Thomas
- Department of Physics and Material Sciences Center, Philipps‐University Marburg, D‐35032 Marburg, Germany
| | - W. Heimbrodt
- Department of Physics and Material Sciences Center, Philipps‐University Marburg, D‐35032 Marburg, Germany
| | - W. Stolz
- Department of Physics and Material Sciences Center, Philipps‐University Marburg, D‐35032 Marburg, Germany
| | - W.W. Rühle
- Department of Physics and Material Sciences Center, Philipps‐University Marburg, D‐35032 Marburg, Germany
| |
Collapse
|
40
|
Abstract
It has become clear that adult mammalian bone marrow contains not one but two ostensibly discrete populations of adult stem cells. The first and by far the most fully characterized are the hematopoietic stem cells responsible for maintaining lifelong production of blood cells. The biological characteristics and properties of the second marrow resident population of stem cells, variously termed bone marrow stromal cells or mesenchymal stem cells, are in contrast much less well understood. In vitro, cultures established from single-cell suspensions of bone marrow from a wide range of mammalian species generate colonies of adherent marrow stromal cells, each derived from a single precursor cell termed a colony-forming unit-fibroblast (CFU-F). Culture conditions have been developed to expand marrow stromal cells in vitro while maintaining the capacity of these cells to differentiate into bone, fat, and cartilage. A significant portion of our current knowledge of this population of cells is based on analysis of the properties of these culture expanded cells, not on the primary colony-initiating cells. In this article, we will focus on methodologies to prospectively isolate stromal progenitors from mouse and human bone marrow and will review current data that suggest stromal progenitors in the bone marrow in situ are associated with the outer surfaces of blood vessels and may share identity with vascular pericytes.
Collapse
Affiliation(s)
- Brenton Short
- Stem Cell Laboratory, Peter MacCallum Cancer Institute, East Melbourne, Victoria, Australia
| | | | | | | | | |
Collapse
|
41
|
|
42
|
Butala HD, Ramakrishnan A, Sadana A. A fractal analysis of analyte-estrogen receptor binding and dissociation kinetics using biosensors: environmental and biomedical effects. Biosystems 2003; 70:235-53. [PMID: 12941487 DOI: 10.1016/s0303-2647(03)00052-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A fractal analysis is used to model the binding and dissociation kinetics between analytes in solution and estrogen receptors (ERs) immobilized on a sensor chip of a surface plasmon resonance (SPR) biosensor. The influence of different ligands is also analyzed. A better understanding of the kinetics provides physical insights into the interactions, and suggests means by which appropriate interactions (to promote correct signaling) and inappropriate interactions such as with xenoestrogens (to minimize inappropriate and deleterious to health signaling) may be better controlled. The fractal approach is applied to analyte-ER interaction data available in the literature. The units for the different parameters (rate coefficients and affinities) in fractal-type kinetics are different from those obtained in classical kinetics. Numerical values obtained for the binding and the dissociation rate coefficients are linked to the degree of roughness or heterogeneity (fractal dimension, D(f)) present on the biosensor chip surface. In general, the binding and the dissociation rate coefficients are very sensitive to the degree of heterogeneity on the surface. A single-fractal analysis is adequate in some cases. In others (that exhibit complexities in the binding or the dissociation curves) a dual-fractal analysis is required to obtain a better fit. This has biomedical and environmental implications in that the dissociation (and the binding) rate coefficient may be used to alleviate (deleterious effects) or enhance (beneficial effects) by selective modulation of the surface. The affinity values obtained in the analysis are consistent with the numbers required to (a). promote signaling between the correct analyte and the estrogen receptor, and (b). minimize the signaling between xenoestrogens and the estrogen receptor.
Collapse
Affiliation(s)
- Harshala D Butala
- Chemical Engineering Department, University of Mississippi, PO Box 1848, University, MS 38677-1848, USA
| | | | | |
Collapse
|
43
|
Ahmad A, Ramakrishnan A, McLean MA, Breau AP. Use of surface plasmon resonance biosensor technology as a possible alternative to detect differences in binding of enantiomeric drug compounds to immobilized albumins. Biosens Bioelectron 2003; 18:399-404. [PMID: 12604257 DOI: 10.1016/s0956-5663(02)00139-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [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
The use of biosensors for monitoring real time interactions between biomolecules and drug compounds has a lot of advantages over presently existing detection methods, the major ones being the elimination of radio labels and rapid screening. We can also obtain information about the kinetic parameters and these values may serve as useful indicators towards subtle differences in the binding strength and characteristics of closely related drug compounds and enantiomers. The Biacore 3000 biosensor based on the Surface Plasmon Resonance (SPR) technology was used to assess the albumin protein binding differences between two enantiomers of a drug compound. Normalized responses (NRU) and affinity constants (K(D)) were readily calculated. Statistical parameters like mean normalized responses, %CV values were determined to make the technique robust. The %CV values obtained were within the preset limits of < or = 25% (FDA limits for drug development and method validation protocols) for the binding interactions for majority of the concentrations studied. For example, the %CV values for the normalized responses for the binding of the control drug warfarin to human albumin ranged from 7.9 to 24.3%. The method gave reproducible results, and the results indicated slight differences in binding patterns of the enantiomers to human and rat albumin.
Collapse
Affiliation(s)
- Ateeq Ahmad
- Global Metabolism Investigative Sciences, Pharmacia Corporation, 4901 Searle Parkway, Skokie, IL 60077, USA.
| | | | | | | |
Collapse
|
44
|
Ramakrishnan A, Dhamodharan R. Facile Synthesis of ABC and CBABC Multiblock Copolymers of Styrene, tert-Butyl Acrylate, and Methyl Methacrylate via Room Temperature ATRP of MMA. Macromolecules 2003. [DOI: 10.1021/ma021197d] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A. Ramakrishnan
- Department of Chemistry, Indian Institute of Technology Madras, Chennai 600 036, India
| | - R. Dhamodharan
- Department of Chemistry, Indian Institute of Technology Madras, Chennai 600 036, India
| |
Collapse
|
45
|
Ramakrishnan A, Sadana A. A kinetic study of analyte-receptor binding and dissociation for biosensor applications: a fractal analysis for two different DNA systems. Biosystems 2002; 66:165-77. [PMID: 12413747 DOI: 10.1016/s0303-2647(02)00052-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A fractal analysis of DNA binding and dissociation kinetics on biosensor surfaces is presented. The fractal approach provides an attractive, convenient method to model the kinetic data taking into account the effects of surface heterogeneity brought about by ligand immobilization. The fractal technique can be used in conjunction or as an alternate approach to conventional modeling techniques, such as the Langmuir model, saturation model, etc. Examples analyzed include a DNA molecular beacon biosensor and a plasmid DNA-(cationic polymer) interaction biosensor. The molecular beacon example provides some insights into the nature of the surface and how it influences the binding rate coefficients. The DNA-cationic polymer interaction example provides some quantitative results on the binding and dissociation rate coefficients. Data taken from the literature may be modeled, in the case of binding, using a single-fractal analysis or a dual-fractal analysis. The dual-fractal analysis results indicate a change in the binding mechanism as the reaction progresses on the surface. A single-fractal analysis is adequate to model the dissociation kinetics in the example presented. Relationships are presented for the binding rate coefficients as a function of their corresponding fractal dimension, D(f), which is an indication of the degree of heterogeneity that exists on the surface. When analyte-receptor binding is involved, an increase in the heterogeneity of the surface (increase in D(f)) leads to an increase in the binding rate coefficient.
Collapse
Affiliation(s)
- Anand Ramakrishnan
- Chemical Engineering Department, University of Mississippi, 134 Anderson Hall, University, MS 38677-9740, USA
| | | |
Collapse
|
46
|
|
47
|
Ramakrishnan A, Sadana A. A mathematical analysis using fractals for binding interactions of nuclear estrogen receptors occurring on biosensor surfaces. Anal Biochem 2002; 303:78-92. [PMID: 11906154 DOI: 10.1006/abio.2002.5581] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A mathematical approach using fractal concepts is presented for modeling the binding and dissociation interactions between analytes and nuclear estrogen receptors (ER) occurring on surface plasmon resonance biosensor chip surfaces. A kinetic knowledge of the binding interactions mediated by ER would help in better understanding the carcinogenicity of these steroidogenic compounds and assist in modulating these reactions. The fractal approach is applied to analyte-ER interaction data obtained from literature. Numerical values obtained for the binding and dissociation rate coefficients are linked to the degree of roughness or heterogeneity (fractal dimension, D(f)) present on the biosensor surface. For example, a single-fractal analysis is used to describe the binding and dissociation phases for the binding of estradiol and ERalpha in solution to clone 31 protein immobilized on a biosensor chip (C-S. Suen et al., 1998, J. Biol. Chem. 273(42), 27645-27653). The binding and the dissociation rate coefficients are 27.57 and 8.813, respectively, and the corresponding fractal dimensions are 1.986 and 2.268, respectively. In some examples dual-fractal models were employed to obtain a better fit of either the association or the dissociation phases or for both. Predictive relationships are developed for (a) the binding and the dissociation rate coefficients as a function of their respective fractal dimensions and (b) the ratio K(A) (= k/k(d)) as a function of the ratio of the fractal dimensions (D(f)/D(fd)). The analysis should provide further physical insights into the ER-mediated interactions occurring on biosensor and other surfaces.
Collapse
Affiliation(s)
- Anand Ramakrishnan
- Chemical Engineering Department, University of Mississippi, University, MS 38677-1848, USA
| | | |
Collapse
|
48
|
Ahmad A, Ramakrishnan A, McLean MA, Li D, Rock MT, Karim A, Breau AP. Use of optical biosensor technology to study immunological cross-reactivity between different sulfonamide drugs. Anal Biochem 2002; 300:177-84. [PMID: 11779109 DOI: 10.1006/abio.2001.5467] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Adverse reactions to medications account for a substantial number of hospitalizations and in some cases fatalities. The nature of the many drug-drug interactions caused by the inhibition of drug-metabolizing enzymes can now be predicted and examined with a greater deal of accuracy due to research developments in the understanding of the drug-metabolizing enzymes. However, the more troubling aspects of drug-drug interactions are the idiosyncratic reactions that are unpredictable and quite often life-threatening. These reactions are often caused by a prior sensitization of a person's immune system to a given drug or class of drugs. The following work offers a technique to examine in a medium-throughput system the cross-reactivity of drugs to antibodies in order to predict if structures share the same antigenic potential toward a sensitized individual. Two commercially important sulfonamide drugs, sulfamethazine and furosemide, were taken and their binding to their respective antibodies were tested in the presence of other structurally related sulfonamide drugs. The BIACORE 3000 biosensor was used for the study and the solution-phase equilibrium assay principle was employed. The data obtained help us determine which drugs can react, and to what extent, with sulfamethazine and furosemide, giving rise to possible allergic or hypersensitivity reactions. Though sulfamethazine and furosemide were used in this study; this principle and methodology can be applied to study any drug molecule-antibody pair.
Collapse
Affiliation(s)
- Ateeq Ahmad
- Global Drug Metabolism, Pharmacia Corporation, 4901 Searle Parkway, Skokie, Illinois 60077, USA.
| | | | | | | | | | | | | |
Collapse
|
49
|
Abstract
A fractal analysis of confirmative nature only is presented for analyte-receptor binding and dissociation kinetics for biosensor applications. Data taken from the literature may be modeled, in the case of binding using a single-fractal analysis or a dual-fractal analysis. The dual-fractal analysis represents a change in the binding mechanism as the reaction progresses on the surface. Relationships are presented for the binding and dissociation rate coefficients as a function of their corresponding fractal dimension, Df or the degree of heterogeneity that exists on the surface. When analyte-receptor binding or dissociation is involved, an increase in the heterogeneity on the surface (increase in Df) leads to an increase in the binding and in the dissociation rate coefficient. It is suggested that an increase in the degree of heterogeneity on the surface leads to an increase in the turbulence on the surface owing to the irregularities on the surface. This turbulence promotes mixing, minimizes diffusional limitations, and leads subsequently to an increase in the binding and in the dissociation rate coefficient (Martin S.J., Granstaff, V.E., Frye, G.C., Anal. Chem., 65, (1991) 2910). The binding and the dissociation rate coefficient are rather sensitive to the degree of heterogeneity, Df,bind and Df,diss respectively, that exists on the biosensor surface. For example, the order of dependence on Df,bind is 19.2 for the binding rate coefficient, kbind for the binding of 0.03-1.0 microM SH-2Ld in solution to 2C TCR immobilized on a surface plasmon resonance (SPR) biosensor (Corr, M., Salnetz, A.E., Boyd, L.F., Jelonek, M.T., Khilko, S., Al-Ramadi, B.K., Kim, Y.S., Maher, S.E., Bothwell, A.L.M., Margulies, D.H., Science, 265, (1994) 946). The order of dependence on Df,diss is -6.22 for the dissociation rate coefficient, kdiss for the dissociation of 250-1000 nM Sophora japonica agglutinin (SJA)-lactose complex from the SPR surface. In general, the technique is applicable to other reactions occurring on different types of surfaces, such as cell-surface reactions.
Collapse
Affiliation(s)
- A Ramakrishnan
- Chemical Engineering Department, University of Mississippi, MS 38677-1848, USA
| | | |
Collapse
|
50
|
Abstract
UNLABELLED The treatment of patients with Barrett's oesophagus is controversial. Debate exists regarding the use and value of high dose acid suppression as the standard of practice. Despite prolonged use of high dose proton pump inhibitors (40 mg omeprazole, 60 mg lansoprazole), most studies have shown no convincing evidence of significant regression of Barrett's length. These studies, however, have used fixed doses of proton pump inhibitors and did not regularly document control of oesophageal acid exposure. AIM To determine whether regression of Barrett's epithelium can be achieved with documented maximal acid suppression. METHODS We have prospectively followed nine patients with Barrett's oesophagus (eight male; mean age 60 years) for more than 1 year. They were all treated using medical therapy with pH monitoring documenting oesophageal acid exposure over 24 h < 1.6% of the time, and with two or more esophagogastroduodenoscopies performed by the same endoscopist. RESULTS Acid control was individually tailored and achieved with proton pump inhibitor b.d. (omeprazole 20 mg or lansoprazole 30 mg) and ranitidine at bedtime (HS) (Ran) if necessary. All nine patients (100%) showed some evidence of regression. All nine patients (100%) showed a decrease in Barrett's length (mean 2 cm, range 1-3 cm). Six out of nine (66.67%) patients showed evidence of squamous islands on the last oesophagogastroduodenoscopy. The mean total distal oesophageal acid exposure was 0.38% (range: 0-1.5%). The mean follow-up of patients was 54 months (range: 13-118 months). CONCLUSIONS Consistent and individually tailored maximal acid suppression documented by pH-metry is achievable and may result in decreased length and development of squamous islands in patients with Barrett's epithelium. This approach should be further evaluated as potentially the preferred medical treatment for these patients.
Collapse
Affiliation(s)
- R Srinivasan
- Oesophageal Laboratory of the Department of Medicine, Graduate Hospital, Philadelphia, PA, USA
| | | | | | | | | | | |
Collapse
|