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Padinharakandy A, Ramaswamy B, K D, Edward L, G P. Prospective Evaluation of Hearing Status in Neonatal Hyperbilirubinemia. Indian J Otolaryngol Head Neck Surg 2024; 76:453-457. [PMID: 38440541 PMCID: PMC10908650 DOI: 10.1007/s12070-023-04181-7] [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: 08/16/2023] [Accepted: 08/22/2023] [Indexed: 03/06/2024] Open
Abstract
Elevated bilirubin levels in neonates are commonly seen both physiologically and in pathological conditions. There are few articles describing the effects of elevated bilirubin levels on the auditory system. The objectives of this paper was to study the prevalence of hearing impairment in neonates with hyperbilirubinemia and assess outcome/reversibility of hearing impairment in these neonates with follow-up hearing evaluation. This was a prospective single centre, case control study. Cases: neonates, total bilirubin levels >15 mg/dl. Controls: <15 mg/dl. Exclusion criteria included neonates with neonatal hypoxia, intrauterine infections, sepsis or meningitis, infants with a family history of hearing loss, low birth weight, ototoxic medications, external and middle ear pathology. Otoacoustic emission testing (OAE) was done at birth. Neonates who fail OAE were advised follow up with Brainstem Evoked Response Audiometry (BERA) after 2 months. Neonates having abnormal BERA waves were called for follow up at 6 months. Out of 57 cases, 3 had failed OAE and had normal BERA waves on follow up at 2 months. Out of 60 controls, 5 had failed OAE and follow up BERA for 3 patients were normal and 2 babies were lost to follow up. No statistical significance in hearing impairment in hyperbilirubinemia v/s normal babies was noted. Elevated bilirubin levels in the absence of any other risk factors may not show significant changes in the hearing screening. Some effect owing to the p value close to being significant in cases has been noted. The same may not contribute to permanent hearing impairment as first OAE changes may be transient and seem to revert with age. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-04181-7.
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Affiliation(s)
- Akshay Padinharakandy
- Department of Otorhinolaryngology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka 576104 India
| | - Balakrishnan Ramaswamy
- Department of Otorhinolaryngology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka 576104 India
| | - Devaraja K
- Department of Otorhinolaryngology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka 576104 India
| | - Leslie Edward
- Department of Paediatrics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka 576104 India
| | - Priya G
- Department of Speech and Audiology, Manipal College of health Professions, Manipal Academy of Higher Education, Manipal, Karnataka 576104 India
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Abdulkader RS, Ponnaiah M, Bhatnagar T, S D, Rozario AG, K G, Mohan M, E M, Saravanakumar D, Moorthy A, Tyagi AK, Parmar BD, Devaraja K, Medikeri G, Ojah J, Srivastava K, K K, Das N, B N, Sharma P, Kumar Parida P, Kumar Saravanam P, Kulkarni P, S P, Patil S P, Kumar Bagla R, D R, S Melkundi R, S Satpute S, Narayanan S, Jahagirdar S, Dube S, Kumar Panigrahi S, Babu D S, Saini V, Singh Saxena R, Srivastava A, Chandra Baishya A, Garg A, Kumar Mishra A, Jyoti Talukdar A, Kankaria A, Karat A, Sundaresh Kumar A, Chug A, Vankundre A, Ramaswamy B, MB B, R Jadav B, Dhiwakar M, Ghate G, Shah HV, Saha I, Sivapuram K, J Joshi K, Singh M, Chand Bairwa M, K D, K K, E M, Samagh N, Dinakaran N, Gupta N, Gupta N, M Nagarkar N, Solanki N, Kumar Panda P, Bachalli P, Shanbag R, Patil R, Kumar A R, Narayan Patil R, Thookkanaickenpalayam Vijayaraghavan R, Hanumantappa R, A R, Mandal SK, Kishve SP, Varghese Thomas S, Sarkar S, Thakur S, Patil S, Lakshmanan S, D Rao S, V S, Nayak T, Dixit UR, B U, Backiavathy V, Shenoy V, Hallur VK, Bhatnagar A, Murhekar MV. Baseline findings of a multicentric ambispective cohort study (2021-2022) among hospitalised mucormycosis patients in India. Mycology 2024; 15:70-84. [PMID: 38558844 PMCID: PMC10976993 DOI: 10.1080/21501203.2023.2271928] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 10/12/2023] [Indexed: 04/04/2024] Open
Abstract
In India, the incidence of mucormycosis reached high levels during 2021-2022, coinciding with the COVID-19 pandemic. In response to this, we established a multicentric ambispective cohort of patients hospitalised with mucormycosis across India. In this paper, we report their baseline profile, clinical characteristics and outcomes at discharge. Patients hospitalized for mucormycosis during March-July 2021 were included. Mucormycosis was diagnosed based on mycological confirmation on direct microscopy (KOH/Calcofluor white stain), culture, histopathology, or supportive evidence from endoscopy or imaging. After consent, trained data collectors used medical records and telephonic interviews to capture data in a pre-tested structured questionnaire. At baseline, we recruited 686 patients from 26 study hospitals, of whom 72.3% were males, 78% had a prior history of diabetes, 53.2% had a history of corticosteroid treatment, and 80% were associated with COVID-19. Pain, numbness or swelling of the face were the commonest symptoms (73.3%). Liposomal Amphotericin B was the commonest drug formulation used (67.1%), and endoscopic sinus surgery was the most common surgical procedure (73.6%). At discharge, the disease was stable in 43.3%, in regression for 29.9% but 9.6% died during hospitalization. Among survivors, commonly reported disabilities included facial disfigurement (18.4%) and difficulties in chewing/swallowing (17.8%). Though the risk of mortality was only 1 in 10, the disability due to the disease was very high. This cohort study could enhance our understanding of the disease's clinical progression and help frame standard treatment guidelines.
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Affiliation(s)
| | | | - Tarun Bhatnagar
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Devika S
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | | | - Gayathri K
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Malu Mohan
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Michaelraj E
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | | | - Aditya Moorthy
- Department of Oral and Maxillofacial Surgery, Trustwell Hospitals Private Limited, Bengaluru, Karnataka, India
| | - Amit Kumar Tyagi
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Bhagirathsinh D Parmar
- Department of Otorhinolaryngology & Head and Neck Surgery (ENT-HNS), CU Shah Medical College, Surendranagar, Gujarat, India
| | - K Devaraja
- Department of Otorhinolaryngology (ENT), Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Gaurav Medikeri
- Department of Skull base Surgery, Healthcare Global Pvt Ltd, Bengaluru, Karnataka, India
| | - Jutika Ojah
- Department of Community Medicine, Gauhati Medical College, Guwahati, Assam, India
| | - Kajal Srivastava
- Department of Community Medicine, Dr D Y Patil Medical College Hospital and Research Centre, Pune, Maharashtra, India
| | - Karthikeyan K
- Department of Community Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Nandini Das
- Department of Pathology, Medical College and Hospital, Kolkata, West Bengal, India
| | - Niharika B
- Department of Community Medicine, Government Medical College, Ananthapuramu, Andhra Pradesh, India
| | - Parul Sharma
- Department of Community Medicine, GMERS Medical College, Dharpur, Patan, Gujarat, India
| | - Pradipta Kumar Parida
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India
| | - Prasanna Kumar Saravanam
- Department of Otorhinolaryngology (ENT), Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
| | - Praveen Kulkarni
- Department of Community Medicine, JSS Medical College, Mysore, Karnataka, India
| | - Priya S
- Department of Community Medicine, Madurai Medical College, Madurai, Tamil Nadu, India
| | - Pushpa Patil S
- Department of Community Medicine, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
| | - Rahul Kumar Bagla
- Department of Otorhinolaryngology (ENT), Government Institute of Medical Sciences, Noida, Uttar Pradesh, India
| | - Ramesh D
- Department of Otorhinolaryngology (ENT), Sundaram Medical Foundation, Dr Rangarajan Memorial Hospital, Chennai, Tamil Nadu, India
| | - Renuka S Melkundi
- Department of Otorhinolaryngology (ENT), Gulbarga Institute of Medical Sciences, Kalaburagi, Karnataka, India
| | - Satish S Satpute
- Department of Otorhinolaryngology & Head and Neck Surgery (ENT-HNS), All India Institute of Medical Sciences, Raipur, Chattisgarh, India
| | - Seetharaman Narayanan
- Department of Community Medicine, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Shubhashri Jahagirdar
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Simmi Dube
- Department of Medicine, Gandhi Medical College, Bhopal, Madhya Pradesh, India
| | - Sunil Kumar Panigrahi
- Department of Community Medicine, Dr Vasantrao Pawar Medical College, Nashik, Maharashtra, India
| | - Surendra Babu D
- Department of Community Medicine, ESIC Medical College and Hospital, Hyderabad, Telengana, India
| | - Vaibhav Saini
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Rita Singh Saxena
- Department of Medicine, Gandhi Medical College, Bhopal, Madhya Pradesh, India
| | - Abhinav Srivastava
- Department of Otorhinolaryngology (ENT), Government Institute of Medical Sciences, Noida, Uttar Pradesh, India
| | | | - Ajai Garg
- Department of Otorhinolaryngology (ENT), Government Institute of Medical Sciences, Noida, Uttar Pradesh, India
| | - Amit Kumar Mishra
- Department of Otorhinolaryngology & Head and Neck Surgery (ENT-HNS), All India Institute of Medical Sciences, Raipur, Chattisgarh, India
| | - Anjan Jyoti Talukdar
- Department of Community Medicine, Gauhati Medical College, Guwahati, Assam, India
| | - Ankita Kankaria
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Arathi Karat
- Department of Otorhinolaryngology (ENT), Medikeri Super speciality ENT Centre, Bangalore, Karnataka, India
| | - Arul Sundaresh Kumar
- Department of Community Medicine, Madurai Medical College, Madurai, Tamil Nadu, India
| | - Ashi Chug
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ashok Vankundre
- Department of Community Medicine, Dr Vasantrao Pawar Medical College, Nashik, Maharashtra, India
| | - Balakrishnan Ramaswamy
- Department of Otorhinolaryngology (ENT), Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Bharathi MB
- Department of Community Medicine, JSS Medical College, Mysore, Karnataka, India
| | - Bhargav R Jadav
- Department of Otorhinolaryngology & Head and Neck Surgery (ENT-HNS), CU Shah Medical College, Surendranagar, Gujarat, India
| | - Muthuswamy Dhiwakar
- Department of Community Medicine, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Girija Ghate
- Department of Community Medicine, Dr D Y Patil Medical College Hospital and Research Centre, Pune, Maharashtra, India
| | - Hardik V Shah
- Department of Community Medicine, GMERS Medical College, Dharpur, Patan, Gujarat, India
| | - Ipsita Saha
- Department of Pathology, Medical College and Hospital, Kolkata, West Bengal, India
| | - Kavya Sivapuram
- Department of Community Medicine, JSS Medical College, Mysore, Karnataka, India
| | - Krupal J Joshi
- Department of Ophthalmology, Apollo Specialty Hospitals, Vanagaram, Chennai, India
| | - Mahendra Singh
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Mukesh Chand Bairwa
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Divya K
- Department of Community Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Karthikeyan K
- Department of Community Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Muthurajesh E
- Department of Community Medicine, Madurai Medical College, Madurai, Tamil Nadu, India
| | - Navneh Samagh
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Nethra Dinakaran
- Department of Otorhinolaryngology (ENT), Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
| | - Nikhil Gupta
- Department of Medicine, Gandhi Medical College, Bhopal, Madhya Pradesh, India
| | - Nitin Gupta
- Department of Otorhinolaryngology (ENT), Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Nitin M Nagarkar
- Department of Otorhinolaryngology & Head and Neck Surgery (ENT-HNS), All India Institute of Medical Sciences, Raipur, Chattisgarh, India
| | - Nitin Solanki
- Department of Community Medicine, GMERS Medical College, Dharpur, Patan, Gujarat, India
| | - Prasan Kumar Panda
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Prithvi Bachalli
- Department of Oral and Maxillofacial Surgery, Trustwell Hospitals Private Limited, Bengaluru, Karnataka, India
| | - Raghunath Shanbag
- Department of Community Medicine, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
| | - Rajashri Patil
- Department of Community Medicine, Dr D Y Patil Medical College Hospital and Research Centre, Pune, Maharashtra, India
| | - Rajesh Kumar A
- Department of Community Medicine, Government Medical College, Ananthapuramu, Andhra Pradesh, India
| | - Rakesh Narayan Patil
- Department of Community Medicine, Dr Vasantrao Pawar Medical College, Nashik, Maharashtra, India
| | | | - Ramesh Hanumantappa
- Department of Otorhinolaryngology (ENT), Gulbarga Institute of Medical Sciences, Kalaburagi, Karnataka, India
| | - Rathinavel A
- Department of Community Medicine, Madurai Medical College, Madurai, Tamil Nadu, India
| | - Saleel Kumar Mandal
- Department of Pathology, Medical College and Hospital, Kolkata, West Bengal, India
| | | | - Sara Varghese Thomas
- Department of Community Medicine, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Saurav Sarkar
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India
| | - Shalini Thakur
- Department of Skull base Surgery, Healthcare Global Pvt Ltd, Bengaluru, Karnataka, India
| | - Siddaram Patil
- Department of Otorhinolaryngology (ENT), Gulbarga Institute of Medical Sciences, Kalaburagi, Karnataka, India
| | - Somu Lakshmanan
- Department of Community Medicine, Government Medical College, Ananthapuramu, Andhra Pradesh, India
| | - Srinivas D Rao
- Department of Community Medicine, Government Medical College, Ananthapuramu, Andhra Pradesh, India
| | - Sumathi V
- Department of Otorhinolaryngology (ENT), Sundaram Medical Foundation, Dr Rangarajan Memorial Hospital, Chennai, Tamil Nadu, India
| | - Tulasi Nayak
- Department of Oral and Maxillofacial Surgery, Trustwell Hospitals Private Limited, Bengaluru, Karnataka, India
| | - Umesh R Dixit
- Department of Community Medicine, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
| | - Unnikrishnan B
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Varsha Backiavathy
- Department of Otorhinolaryngology (ENT), Sundaram Medical Foundation, Dr Rangarajan Memorial Hospital, Chennai, Tamil Nadu, India
| | - Vijendra Shenoy
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Vinay Kumar Hallur
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India
| | - Aparna Bhatnagar
- Department of Ophthalmology, Apollo Specialty Hospitals, Vanagaram, Chennai, India
| | - Manoj V Murhekar
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
- Department of Oral and Maxillofacial Surgery, Trustwell Hospitals Private Limited, Bengaluru, Karnataka, India
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
- Department of Otorhinolaryngology & Head and Neck Surgery (ENT-HNS), CU Shah Medical College, Surendranagar, Gujarat, India
- Department of Otorhinolaryngology (ENT), Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Department of Skull base Surgery, Healthcare Global Pvt Ltd, Bengaluru, Karnataka, India
- Department of Community Medicine, Gauhati Medical College, Guwahati, Assam, India
- Department of Community Medicine, Dr D Y Patil Medical College Hospital and Research Centre, Pune, Maharashtra, India
- Department of Community Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
- Department of Pathology, Medical College and Hospital, Kolkata, West Bengal, India
- Department of Community Medicine, Government Medical College, Ananthapuramu, Andhra Pradesh, India
- Department of Community Medicine, GMERS Medical College, Dharpur, Patan, Gujarat, India
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India
- Department of Otorhinolaryngology (ENT), Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
- Department of Community Medicine, JSS Medical College, Mysore, Karnataka, India
- Department of Community Medicine, Madurai Medical College, Madurai, Tamil Nadu, India
- Department of Community Medicine, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
- Department of Otorhinolaryngology (ENT), Government Institute of Medical Sciences, Noida, Uttar Pradesh, India
- Department of Otorhinolaryngology (ENT), Sundaram Medical Foundation, Dr Rangarajan Memorial Hospital, Chennai, Tamil Nadu, India
- Department of Otorhinolaryngology (ENT), Gulbarga Institute of Medical Sciences, Kalaburagi, Karnataka, India
- Department of Otorhinolaryngology & Head and Neck Surgery (ENT-HNS), All India Institute of Medical Sciences, Raipur, Chattisgarh, India
- Department of Community Medicine, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
- Department of Medicine, Gandhi Medical College, Bhopal, Madhya Pradesh, India
- Department of Community Medicine, Dr Vasantrao Pawar Medical College, Nashik, Maharashtra, India
- Department of Community Medicine, ESIC Medical College and Hospital, Hyderabad, Telengana, India
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Bathinda, Punjab, India
- Department of Otorhinolaryngology (ENT), Medikeri Super speciality ENT Centre, Bangalore, Karnataka, India
- Department of Ophthalmology, Apollo Specialty Hospitals, Vanagaram, Chennai, India
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Vasudevan G, Srinivas SP, Nayal B, Jayaprakash P, Ramaswamy B. SMARCB1 (INI-1) - Deficient sinonasal carcinoma: Report of two cases. INDIAN J PATHOL MICR 2023; 66:352-355. [PMID: 37077082 DOI: 10.4103/ijpm.ijpm_313_21] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
SMARCB1 (INI-1)-deficient sinonasal carcinoma is a rare, poorly differentiated carcinoma defined by complete loss of tumor suppressor gene SMARCB1 (INI-1) within the neoplastic cell nuclei demonstrated by the immunohistochemical stain. SMARCB1 (INI-1) gene inactivation has been implicated in the pathogenesis of a diverse group of malignant neoplasms that tend to share "rhabdoid" morphology. SMARCB1 (INI-1)-deficient sinonasal carcinoma was first reported by Agaimy et al. in 2014. These tumors are often basaloid with focal rhabdoid differentiation, prominent necrosis, increased mitotic activity, and aggressive behavior. Other than being INI-1 and NUT negative, they are positive for pancytokeratin and express variable immunoreactivity for squamous markers like p63 and neuroendocrine markers like synaptophysin. Most patients present with locally advanced disease and hence a combination of chemotherapy, radiotherapy, and surgery is usually recommended.
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Affiliation(s)
- Geetha Vasudevan
- Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Srilatha Parampalli Srinivas
- Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Bhavna Nayal
- Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Padmapriya Jayaprakash
- Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Balakrishnan Ramaswamy
- Department of Otorhinolaryngology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Chow P, Baladi JF, Chia Y, Ramaswamy B, Grillo V, Acorda A, Xu K, Singh S, Chen Y, Gilliam Y, Gowindah R. 166P Differences and similarities in presentation and management patterns in patients with hepatocellular carcinoma (HCC) across Hong Kong, Singapore and Thailand. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.187] [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: 10/22/2022] Open
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Yen C, Ramaswamy B, Baladi J, Acorda A, Xu K, Gilliam Y, Gowindah R, Singh S, Chen Y. PCN11 The Challenges and Unmet Needs in the Management of Hepatocellular Carcinoma (HCC) Patients and Burden of Advanced HCC across Hong Kong, Singapore and Thailand. Value Health Reg Issues 2020. [DOI: 10.1016/j.vhri.2020.07.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Periasamy N, Pujary K, Bhandarkar AM, Bhandarkar ND, Ramaswamy B. Budesonide vs Saline Nasal Irrigation in Allergic Rhinitis: A Randomized Placebo-Controlled Trial. Otolaryngol Head Neck Surg 2020; 162:979-984. [DOI: 10.1177/0194599820919363] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objectives Budesonide nasal irrigation is currently widely used in the treatment of chronic sinusitis typically following endoscopic sinus surgery to improve inflammatory control. Its application in treatment of allergic rhinitis has not been previously studied. This study assesses the subjective and clinical response to budesonide buffered hypertonic saline nasal irrigation and hypertonic saline nasal irrigation in patients with allergic rhinitis. Study Design This is a prospective, single-center, double-blind, randomized placebo-controlled trial. Setting Tertiary care hospital. Subjects and Methods Fifty-two patients diagnosed with allergic rhinitis were randomized into 2 groups to receive either buffered hypertonic saline nasal irrigation with a placebo respule or buffered hypertonic saline nasal irrigation with a budesonide respule. Patients were assessed at baseline and 4 weeks subjectively using the Sino-Nasal Outcome Test–22 (SNOT-22) questionnaire and visual analog scale (VAS). Clinical assessment was done using the modified Lund-Kennedy score. Results The average SNOT-22, VAS, and modified Lund-Kennedy scores improved in both groups ( P < .001). The budesonide irrigation group was found to have significantly better improvement than the saline nasal irrigation group with the SNOT-22 scores ( P = .012) and VAS scores ( P = .007). However, the difference in the clinical response between the 2 groups was not significant ( P = .268). Conclusion This study adds evidence to the use of saline nasal irrigation in allergic rhinitis but also demonstrates efficacy of the addition of budesonide to irrigations. Budesonide nasal irrigation thus appears to be a viable treatment option for allergic rhinitis.
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Affiliation(s)
- Nikitha Periasamy
- Otorhinolaryngology-Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Kailesh Pujary
- Otorhinolaryngology-Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ajay M. Bhandarkar
- Otorhinolaryngology-Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Naveen D. Bhandarkar
- Otolaryngology–Head and Neck Surgery, University of California, Irvine, California, USA
| | - Balakrishnan Ramaswamy
- Otorhinolaryngology-Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Gudiseva A, Ramaswamy B, Singh R, Dalakoti P. Comparative Study of Nasal Symptoms and Pulmonary Function Tests Post FESS in Ethmoidal Polyposis. Indian J Otolaryngol Head Neck Surg 2019; 71:2000-2003. [PMID: 31763283 DOI: 10.1007/s12070-018-1422-4] [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: 05/06/2018] [Accepted: 06/04/2018] [Indexed: 11/28/2022] Open
Abstract
The objective of this study were to assess the pulmonary function in patients with ethmoidal polyposis who did not respond to medical treatment; to evaluate the effect of Functional Endoscopic Sinus Surgery on the lung function of these patients and to compare the total nasal symptom score in these patients. A prospective observational study was conducted in Department of ENT, KMC Manipal on 50 subjects with ethmoidal polyposis who were unresponsive to medical treatment and hence underwent FESS. Pulmonary function tests were assessed using spirometry and nasal symptoms were scored as per TNSS system prior to surgery and 3 months post-surgery and compared with the pre-operative values and analysed. Pre operatively majority (35 patients) had TNSS value of 6-9 whereas post operatively the score was reduced to 2-3 in many patients (38 patients). The mean TNSS was 7.24 before surgery which declined to 2.82 after surgery with a p value < 0.0001 indicating a statistically significant improvement in the nasal symptoms post FESS. The mean pre-operative FVC, FEV1, MEFR were 2.94, 2.41 and 2.51 L respectively whereas the mean post-operative values were 2.95, 2.39 and 2.49 L respectively. There was no statistically significant change in lung function tests following FESS. Our study shows that FESS benefits patients with nasal polyposis by improving the symptoms and there by the quality of life without any adverse effects on the lower airways.
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Affiliation(s)
- Amrutha Gudiseva
- Department of Otolaryngology - Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Balakrishnan Ramaswamy
- Department of Otolaryngology - Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Rohit Singh
- Department of Otolaryngology - Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Pooja Dalakoti
- Department of Otolaryngology - Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka India
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Wesolowski R, Brufsky A, Chambers M, Bhattacharya S, Lustberg M, VanDeusen J, Sardesai S, Williams N, Noonan A, Phelps M, Grever M, Stephens J, Carson W, Ramaswamy B. Phase Ib study of heat shock protein 90 inhibitor, onalespib in combination with paclitaxel in patients with advanced, triple negative breast cancer (NCT02474173). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz242.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Jainulabdeen T, Ramaswamy B, Devaraja K, Paruthikunnan SM, Bhandarkar AM. Preoperative Staging of Differentiated Thyroid Carcinomas: Comparison of USG and CT with Intraoperative Findings and Histopathology. Indian J Otolaryngol Head Neck Surg 2019; 71:327-333. [PMID: 31559199 DOI: 10.1007/s12070-019-01663-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 04/20/2019] [Indexed: 11/25/2022] Open
Abstract
To study the efficacy of USG and CECT in preoperative staging of differentiated thyroid carcinomas in comparison to the intraoperative and histopathological findings. A prospective, observational study was conducted in a tertiary care hospital over a period of one and a half years where USG and CECT of 23 subjects with histopathologically proven differentiated thyroid malignancy were analysed to study the characteristics of the primary tumour, lymphatic metastasis and evaluate the sensitivity and specificity of the radiological investigations in comparison to the intra-operative and histopathological findings. When compared with intraoperative and histopathological T-staging, USG had an accuracy of 69.5% and 73.9% and CECT had an accuracy of 78.2% and 73.9% respectively. The sensitivity and specificity of USG and CECT in determining a malignant nodule was 71.4% and 33.3% and 52.4% and 66.7% respectively. The N-staging according to the histopathological examination findings was in agreement with that of USG in 65.2% and CECT in 65.2% patients. The sensitivity and specificity of USG was 94.4% and 41.7% and that of CECT was 92.2% and 44.4% respectively in detecting lymphatic metastasis. The sensitivity and specificity of USG was 94.4% and 44.4% and that of CECT was 92.2% and 27.3% respectively in detecting lateral compartment lymphatic metastasis. USG identifies the characteristics of the malignant nodules better and CECT has a higher identifying central compartment lymphatic metastasis. CECT should be used as an adjunct to ultrasound to determine the extent of lymphatic metastasis and staging of disease.
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Affiliation(s)
- Thasneem Jainulabdeen
- 1Department of Otorhinolaryngology-Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Balakrishnan Ramaswamy
- 1Department of Otorhinolaryngology-Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - K Devaraja
- 1Department of Otorhinolaryngology-Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Samir M Paruthikunnan
- 2Department of Radiodiagnosis and Imaging, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Ajay M Bhandarkar
- 1Department of Otorhinolaryngology-Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
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Zhang Y, Nock W, Asad S, Adams E, Singh J, Damicis A, Lustberg MB, Noonan A, Reinbolt R, Sardesai S, VanDeusen J, Wesolowski R, Williams N, Ramaswamy B, Stover DG. Abstract P3-07-08: Multi-omic predictor of rapid and late relapse in primary triple negative breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-07-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Triple-negative breast cancer (TNBC) is a heterogeneous disease. Clinically, we observe three distinct TNBC outcomes: 1) rapid relapse (rrTNBC) characterized by aggressive drug resistant disease; 2) late relapse (lrTNBC) characterized by indolent or treatment responsive disease; and 3) no relapse (NoRTNBC). We hypothesized that distinct clinical and genomic features of primary tumors define rapid versus late relapse in TNBC.
Approach: Using three publicly-available datasets (METABRIC, TCGA, and a prior gene expression meta-analysis), we identified 455 patients diagnosed with primary TNBC with adequate follow-up to be characterized as rrTNBC (relapse or death within 2 years of diagnosis), lrTNBC (relapse or death more than 2 years after diagnosis), or NoRTNBC (no relapse/death with at least 5 years follow-up). We compiled basic clinical (n=455 patients) and primary tumor multi-omic data, including whole transcriptome (n=455), whole genome copy number (n=317), and mutation data for 171 cancer-related genes (n=317). We evaluated intrinsic subtypes (PAM50, TNBCtype), 125 gene expression signatures, CIBERSORT immune subsets, copy number, and mutation frequency.
Results: We first evaluated patients with relapse (rrTNBC+lrTNBC) vs. NoRTNBC. There was no significant difference in age, grade, stage at diagnosis, or PAM50 or TNBC subtype proportion between relapse and NoRTNBC. Among 125 expression signatures, five immune signatures were significantly higher in NoRTNBCs (FDR p<0.05) suggesting increased immune activity in patients who do not relapse. Using CIBERSORT inferred immune subsets, anti-tumor CD8 T-cell, M1 macrophage, and gamma-delta T-cell subsets were all highly correlated to these immune signatures (all Pearson's r >= 0.3, all p<1.2e-8). Among genomic features, patients who relapsed were significantly more likely to harbor a mutation in PIK3CA (Fisher exact FDR p=0.02) but there was no significant difference in tumor mutation burden or percent genome altered (Student's t-test p=0.83 and p=0.99, respectively). We then evaluated primary TNBC genomic data in patients who ultimately developed rapid vs. late relapse. Patients with rrTNBC were more likely to be higher stage (p<0.0001) while lrTNBC were more likely to be non-basal PAM50 subtype (p=0.03). Among 11 significantly altered gene expression signatures (FDR p<0.05), 6 estrogen/luminal signatures were significantly higher in lrTNBC. Mutations in DNAH11 and PIK3CA were more common in lrTNBC (Fisher exact FDR p=0.04 and p=0.05, respectively) but there were no significant differences in tumor mutation burden or copy number burden (Student's t-test p=0.13 and p=0.45, respectively). Using 317 cases with full genomic data divided into training and validation datasets, we will report a comparison of machine learning models for predicting relapse versus no relapse and rapid versus late relapse.
Conclusions: Primary TNBC tumors destined for rapid, late, or no relapse reflect distinct genomic features. Anti-tumor immune signatures and subsets are enriched in patients who do not relapse yet no difference in mutational or copy number burden. Relative to rapid relapse TNBCs, late relapse TNBCs are enriched for non-basal tumors, estrogen/luminal expression signatures, and mutations in DNAH11 and PIK3CA.
Citation Format: Zhang Y, Nock W, Asad S, Adams E, Singh J, Damicis A, Lustberg MB, Noonan A, Reinbolt R, Sardesai S, VanDeusen J, Wesolowski R, Williams N, Ramaswamy B, Stover DG. Multi-omic predictor of rapid and late relapse in primary triple negative breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-07-08.
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Affiliation(s)
- Y Zhang
- Ohio State University Comprehensive Cancer Center, Columbus, OH; Ohio State University Stefanie Spielman Comprehensive Breast Center, Columbus, OH
| | - W Nock
- Ohio State University Comprehensive Cancer Center, Columbus, OH; Ohio State University Stefanie Spielman Comprehensive Breast Center, Columbus, OH
| | - S Asad
- Ohio State University Comprehensive Cancer Center, Columbus, OH; Ohio State University Stefanie Spielman Comprehensive Breast Center, Columbus, OH
| | - E Adams
- Ohio State University Comprehensive Cancer Center, Columbus, OH; Ohio State University Stefanie Spielman Comprehensive Breast Center, Columbus, OH
| | - J Singh
- Ohio State University Comprehensive Cancer Center, Columbus, OH; Ohio State University Stefanie Spielman Comprehensive Breast Center, Columbus, OH
| | - A Damicis
- Ohio State University Comprehensive Cancer Center, Columbus, OH; Ohio State University Stefanie Spielman Comprehensive Breast Center, Columbus, OH
| | - MB Lustberg
- Ohio State University Comprehensive Cancer Center, Columbus, OH; Ohio State University Stefanie Spielman Comprehensive Breast Center, Columbus, OH
| | - A Noonan
- Ohio State University Comprehensive Cancer Center, Columbus, OH; Ohio State University Stefanie Spielman Comprehensive Breast Center, Columbus, OH
| | - R Reinbolt
- Ohio State University Comprehensive Cancer Center, Columbus, OH; Ohio State University Stefanie Spielman Comprehensive Breast Center, Columbus, OH
| | - S Sardesai
- Ohio State University Comprehensive Cancer Center, Columbus, OH; Ohio State University Stefanie Spielman Comprehensive Breast Center, Columbus, OH
| | - J VanDeusen
- Ohio State University Comprehensive Cancer Center, Columbus, OH; Ohio State University Stefanie Spielman Comprehensive Breast Center, Columbus, OH
| | - R Wesolowski
- Ohio State University Comprehensive Cancer Center, Columbus, OH; Ohio State University Stefanie Spielman Comprehensive Breast Center, Columbus, OH
| | - N Williams
- Ohio State University Comprehensive Cancer Center, Columbus, OH; Ohio State University Stefanie Spielman Comprehensive Breast Center, Columbus, OH
| | - B Ramaswamy
- Ohio State University Comprehensive Cancer Center, Columbus, OH; Ohio State University Stefanie Spielman Comprehensive Breast Center, Columbus, OH
| | - DG Stover
- Ohio State University Comprehensive Cancer Center, Columbus, OH; Ohio State University Stefanie Spielman Comprehensive Breast Center, Columbus, OH
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Damicis A, Heng YJ, Kensler K, Asad S, Adams E, Singh J, Zhang Y, Nock W, Wesolowski R, Williams N, Reinbolt R, Sardesai S, VanDeusen J, Noonan A, Lustberg MB, Ramaswamy B, Eliassen AH, Hankinson SE, Tamimi R, Stover DG. Abstract P1-09-01: CD8+ T-cell gene expression and signatures in breast cancer and adjacent normal breast tissue: Association with body mass index, alcohol intake, and age at diagnosis. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-09-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Our understanding of mediators of immune infiltration in breast cancer and normal breast tissue remains limited. We hypothesize that patient factors known to be associated with inflammation and immune subsets, including body mass index, alcohol intake, and age and diagnosis, may play an important role in the tumor-immune microenvironment. Analyses of immune gene expression and signatures facilitate interrogation of the immune microenvironment in large patient cohorts.
Methods: Participants from the Nurses' Health Study cohorts I and II diagnosed with invasive breast cancer were included. Total RNA extracted and microarray performed for 882 tumor and 695 tumor-adjacent samples, of which 623 tumors have matched tumor-adjacent data. CD8+ T-cell expression metrics were assessed: CD8A single gene expression (CD8Agene), a CD8 T-cell signature (CD8sig), and a tumor infiltrating lymphocyte signature derived from the GeparSixto clinical trial (GSAct). Standard clinicopathologic features were evaluated, as well as body mass index (BMI) one year prior to diagnosis, cumulative average alcohol intake, and age at diagnosis.
Results: Overall, tumor and adjacent normal tissue demonstrated positive correlation of CD8Agene, CD8sig, and GSAct (n=623 pairs, Pearson's r = 0.46, 0.36, 0.31, respectively; all p<0.001). Similar correlations were present in TCGA breast cancer, an independent cohort (n=112 pairs, Pearson's r = 0.34, 0.17, 0.45, respectively; all p<0.001). We evaluated paired tumor and adjacent normal samples within individual immunohistochemical (IHC) subtype or PAM50 subtype by Wilcoxon signed-rank test. There was not a consistent trend for CD8Agene, CD8sig, nor GSAct to be greater in tumor or normal within subtypes. We then evaluated patient features/exposures and tumor immune expression metrics. For tumor-adjacent normal, there was no significant association of alcohol intake, BMI, or age at diagnosis with CD8 gene/expression metrics. For tumor tissue, a multivariate model demonstrated that BMI one year before diagnosis was significantly associated with CD8Agene expression. There was no significant association of alcohol intake or age at diagnosis with CD8 gene/expression metrics. We are currently evaluating the association of these CD8 T-cell gene expression signatures with CD8 T-cell immunohistochemistry in a subset of patients, which will be reported at the time of abstract presentation.
Conclusion: In this cohort of over 600 tumor:normal pairs and a separate validation cohort, multiple distinct CD8+ T-cell expression metrics are correlated between breast cancer and tumor-adjacent normal breast tissue. This suggests that the adjacent normal breast may reflect an altered immune microenvironment in the context of breast cancer. While age at diagnosis and alcohol intake are not significantly associated with tumor CD8 expression metrics, BMI was significantly associated with tumor CD8Agene expression in a multivariate model.
Citation Format: Damicis A, Heng YJ, Kensler K, Asad S, Adams E, Singh J, Zhang Y, Nock W, Wesolowski R, Williams N, Reinbolt R, Sardesai S, VanDeusen J, Noonan A, Lustberg MB, Ramaswamy B, Eliassen AH, Hankinson SE, Tamimi R, Stover DG. CD8+ T-cell gene expression and signatures in breast cancer and adjacent normal breast tissue: Association with body mass index, alcohol intake, and age at diagnosis [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-09-01.
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Affiliation(s)
- A Damicis
- Ohio State University Stefanie Spielman Comprehensive Breast Center, Columbus, OH; Beth Israel Deaconess Medical Center, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; University of Massachusetts Amherst, Amherst, MA
| | - YJ Heng
- Ohio State University Stefanie Spielman Comprehensive Breast Center, Columbus, OH; Beth Israel Deaconess Medical Center, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; University of Massachusetts Amherst, Amherst, MA
| | - K Kensler
- Ohio State University Stefanie Spielman Comprehensive Breast Center, Columbus, OH; Beth Israel Deaconess Medical Center, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; University of Massachusetts Amherst, Amherst, MA
| | - S Asad
- Ohio State University Stefanie Spielman Comprehensive Breast Center, Columbus, OH; Beth Israel Deaconess Medical Center, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; University of Massachusetts Amherst, Amherst, MA
| | - E Adams
- Ohio State University Stefanie Spielman Comprehensive Breast Center, Columbus, OH; Beth Israel Deaconess Medical Center, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; University of Massachusetts Amherst, Amherst, MA
| | - J Singh
- Ohio State University Stefanie Spielman Comprehensive Breast Center, Columbus, OH; Beth Israel Deaconess Medical Center, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; University of Massachusetts Amherst, Amherst, MA
| | - Y Zhang
- Ohio State University Stefanie Spielman Comprehensive Breast Center, Columbus, OH; Beth Israel Deaconess Medical Center, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; University of Massachusetts Amherst, Amherst, MA
| | - W Nock
- Ohio State University Stefanie Spielman Comprehensive Breast Center, Columbus, OH; Beth Israel Deaconess Medical Center, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; University of Massachusetts Amherst, Amherst, MA
| | - R Wesolowski
- Ohio State University Stefanie Spielman Comprehensive Breast Center, Columbus, OH; Beth Israel Deaconess Medical Center, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; University of Massachusetts Amherst, Amherst, MA
| | - N Williams
- Ohio State University Stefanie Spielman Comprehensive Breast Center, Columbus, OH; Beth Israel Deaconess Medical Center, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; University of Massachusetts Amherst, Amherst, MA
| | - R Reinbolt
- Ohio State University Stefanie Spielman Comprehensive Breast Center, Columbus, OH; Beth Israel Deaconess Medical Center, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; University of Massachusetts Amherst, Amherst, MA
| | - S Sardesai
- Ohio State University Stefanie Spielman Comprehensive Breast Center, Columbus, OH; Beth Israel Deaconess Medical Center, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; University of Massachusetts Amherst, Amherst, MA
| | - J VanDeusen
- Ohio State University Stefanie Spielman Comprehensive Breast Center, Columbus, OH; Beth Israel Deaconess Medical Center, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; University of Massachusetts Amherst, Amherst, MA
| | - A Noonan
- Ohio State University Stefanie Spielman Comprehensive Breast Center, Columbus, OH; Beth Israel Deaconess Medical Center, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; University of Massachusetts Amherst, Amherst, MA
| | - MB Lustberg
- Ohio State University Stefanie Spielman Comprehensive Breast Center, Columbus, OH; Beth Israel Deaconess Medical Center, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; University of Massachusetts Amherst, Amherst, MA
| | - B Ramaswamy
- Ohio State University Stefanie Spielman Comprehensive Breast Center, Columbus, OH; Beth Israel Deaconess Medical Center, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; University of Massachusetts Amherst, Amherst, MA
| | - AH Eliassen
- Ohio State University Stefanie Spielman Comprehensive Breast Center, Columbus, OH; Beth Israel Deaconess Medical Center, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; University of Massachusetts Amherst, Amherst, MA
| | - SE Hankinson
- Ohio State University Stefanie Spielman Comprehensive Breast Center, Columbus, OH; Beth Israel Deaconess Medical Center, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; University of Massachusetts Amherst, Amherst, MA
| | - R Tamimi
- Ohio State University Stefanie Spielman Comprehensive Breast Center, Columbus, OH; Beth Israel Deaconess Medical Center, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; University of Massachusetts Amherst, Amherst, MA
| | - DG Stover
- Ohio State University Stefanie Spielman Comprehensive Breast Center, Columbus, OH; Beth Israel Deaconess Medical Center, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; University of Massachusetts Amherst, Amherst, MA
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Basree MM, Shinde N, Palettas M, Weng D, Stover DG, Sizemore GM, Shields P, Majumder S, Ramaswamy B. Abstract P1-09-06: Gene-set enrichment analysis (GSEA) of breast tissue from healthy women with less than six months history of breastfeeding shows enrichment in Hedgehog signaling, notch signaling and luminal progenitor gene signatures. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-09-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Multiple epidemiological studies have shown that prolonged breastfeeding is associated with a reduced risk of developing triple negative/basal-like breast cancer (TN/BLBC). We have modeled abrupt involution (AI) due to lack of breastfeeding and gradual involution (GI) of the mammary gland that occurs over time upon prolonged breastfeeding in wild-type FVB/N mice and discovered prominent histological and molecular changes in the AI glands over time. Our studies revealed for the first time a clear and persistent expansion of mammary luminal progenitor (LP) epithelial cells in AI glands (AACR abstract#2242, 2018). Here, we corroborate animal studies using normal human breast tissue obtained from a reduction mammoplasty tissue collection study (OSU-2011C0094).
Methods: Breast tissue obtained from parous premenopausal women with no history of breast cancer who breastfed for ≥6 months (GI, n=16) versus those who breastfed for <6 months (AI, n=16) (OSU-2011C0094) was used for gene expression analysis. RNA isolated from these normal mammary tissues was analyzed using Affymatrix Gene ChIP Human Transcriptome array 2.0; Gene Set Enrichment Analysis (GSEA) was used to analyze the microarray data. Molecular Signatures Database was used in GSEA querying C2 curated gene sets, Hallmark gene sets, and Lim-Mammary-Luminal-Progenitor gene sets. H&E sections of the breast tissue were used to assess lobular type by counting number of ductules per terminal ductal lobular unit (TDLU). False discovery rate (FDR) q-values and p-values were used for multiple comparison adjustment.
Results: GSEA revealed that breast tissue obtained from women in the AI cohort exhibited strong positive enrichment for Notch and Hedgehog Signaling (Hhg) pathways (FDR q-value= 0.20 and 0.12, respectively). In GI women, GSEA showed an overall trend towards enrichment in metabolic pathways and immune system functions. Moreover, there was non-significant trend towards positive enrichment of mouse LP gene signature in AI women only (FDR q-value= 0.30). Age and BMI were not statistically different between AI and GI cohorts. Analysis of TDLU, the primary anatomical source of most breast cancers, revealed that breast tissue from AI women had proportionally higher lobular type 1 only epithelium than GI women who exhibited more differentiated lobular epithelium (p-value= 0.049).
Conclusion: We report here for the first time that mammary glands from women who breastfed <6 months were enriched for stem-cell signaling pathways and LP gene signature. This reflects some similarity to BRCA1 mutation carriers, who demonstrate expanded luminal progenitor population. In addition, higher Type 1 TDLU's are seen in breast tissue from parous women who breastfed <6 months. Together, these data demonstrate features for TN/BLBC precursors enriched in patients who breastfed for <6 months. Understanding this mechanistic link will help in developing prevention strategies, particularly for African-American women who have lower prevalence of breastfeeding and higher incidence of TN/BLBC.
Citation Format: Basree MM, Shinde N, Palettas M, Weng D, Stover DG, Sizemore GM, Shields P, Majumder S, Ramaswamy B. Gene-set enrichment analysis (GSEA) of breast tissue from healthy women with less than six months history of breastfeeding shows enrichment in Hedgehog signaling, notch signaling and luminal progenitor gene signatures [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-09-06.
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Affiliation(s)
- MM Basree
- University of Pikeville - Kentucky College of Osteopathic Medicine, Pikeville, KY; The Ohio State University Wexner Medical Center, Columbus, OH; The Ohio State University Center of Biostatistics, Columbus, OH; The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - N Shinde
- University of Pikeville - Kentucky College of Osteopathic Medicine, Pikeville, KY; The Ohio State University Wexner Medical Center, Columbus, OH; The Ohio State University Center of Biostatistics, Columbus, OH; The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - M Palettas
- University of Pikeville - Kentucky College of Osteopathic Medicine, Pikeville, KY; The Ohio State University Wexner Medical Center, Columbus, OH; The Ohio State University Center of Biostatistics, Columbus, OH; The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - D Weng
- University of Pikeville - Kentucky College of Osteopathic Medicine, Pikeville, KY; The Ohio State University Wexner Medical Center, Columbus, OH; The Ohio State University Center of Biostatistics, Columbus, OH; The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - DG Stover
- University of Pikeville - Kentucky College of Osteopathic Medicine, Pikeville, KY; The Ohio State University Wexner Medical Center, Columbus, OH; The Ohio State University Center of Biostatistics, Columbus, OH; The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - GM Sizemore
- University of Pikeville - Kentucky College of Osteopathic Medicine, Pikeville, KY; The Ohio State University Wexner Medical Center, Columbus, OH; The Ohio State University Center of Biostatistics, Columbus, OH; The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - P Shields
- University of Pikeville - Kentucky College of Osteopathic Medicine, Pikeville, KY; The Ohio State University Wexner Medical Center, Columbus, OH; The Ohio State University Center of Biostatistics, Columbus, OH; The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - S Majumder
- University of Pikeville - Kentucky College of Osteopathic Medicine, Pikeville, KY; The Ohio State University Wexner Medical Center, Columbus, OH; The Ohio State University Center of Biostatistics, Columbus, OH; The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - B Ramaswamy
- University of Pikeville - Kentucky College of Osteopathic Medicine, Pikeville, KY; The Ohio State University Wexner Medical Center, Columbus, OH; The Ohio State University Center of Biostatistics, Columbus, OH; The Ohio State University Comprehensive Cancer Center, Columbus, OH
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Sardesai S, Liu J, Palettas M, Stephens J, Stover D, Williams N, Reinbolt R, VanDeusen J, Wesolowski R, Lustberg M, Ramaswamy B. Abstract P4-16-03: Cardiovascular outcomes and long term survival with discontinuation of adjuvant trastuzumab. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-16-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Trastuzumab (T) induced cardiomyopathy remains a significant limitation to adjuvant HER2 directed therapy. Recent studies have aimed to reduce cardiotoxicity through combination with non-anthracycline (non-A) chemotherapy or shorter treatment duration. However there is limited data regarding cardiac outcomes and long-term survival with early discontinuation of adjuvant T.
Methods: An IRB-approved single-institution retrospective analysis was performed for 401 consecutive patients with non-metastatic HER2+ breast cancer treated at the Ohio State University Comprehensive Cancer Center from 2005-2015. Medical records were reviewed for clinicopathologic features, systemic treatment and survival information. Disease Free Survival (DFS) was defined as time from diagnosis to first recurrence (loco-regional or distant recurrence) including second primary breast cancer or death. Overall survival (OS) was defined as time from diagnosis to death or last known follow up. OS and DFS estimates were generated using Kaplan Meier methods and compared using Log-rank tests. Cox proportional hazard models were used to calculate univariate and multivariate hazard ratios for OS and DFS.
Results: A total of 371/401 (92.5%) patients received adjuvant T (n= 401, mean age: 59.4 years; stage 1: 120, 30%; stage II: 194, 48%; stage III: 87, 22%; ER+: 235, 58%); among whom 106/371 (28.6%) patients held adjuvant T for any reason. Median duration of therapy in patients with any interruption with T was 11.3 (0.5-16.9) months and 23/371 (6.9%) received less than 6 months of adjuvant T. Cardiomyopathy (measured as LVEF decline on 2D echocardiogram or MUGA >= 15 points) was the most common reason for withholding T (66/106, 62.3%). The majority of these patients received a cardiology referral (77/ 106, 72.6%) with a 13 day mean time to evaluation in outpatient clinic. Patients receiving non-A chemotherapy and beta blockers or ACE inhibitors during treatment were significantly less likely to experience cardiomyopathy (A vs non-A: 49/190, 25.8% vs. 16/136, 11.8% p=0.002); (Med vs no Med: 7/148, 4.73% vs 59/184, 32.1%; p<0.001). Log-rank tests indicate a significant worsening in OS and DFS for patients who discontinued T (p=0.021, 0.001 respectively). Multivariate analyses confirmed significant worsening in DFS after adjusting for age, stage, ER , node status, and cardiomyopathy (Adjusted HR: 4.0[2.02 – 7.92], p< 0.001)
Table 1- Discontinuation of adjuvant trastuzumab Number of patients (%)Initial treatment371Completed therapy with no interruption265 (71.4)Interruption of therapy for minimum of 2 weeks64 (17.2)Permanently discontinued42 (11.3)
Conclusion: Discontinuation of adjuvant trastuzumab, most often from cardiomyopathy, is an independent prognostic marker for worse DFS in non-metastatic HER2 positive breast cancer. Non-anthracycline chemotherapy and use of cardio-protective medication is associated with significantly reduced incidence of cardiotoxicity in this population. Future prospective studies should consider optimizing cardiovascular function to avoid interruption in adjuvant HER 2 directed therapy.
Citation Format: Sardesai S, Liu J, Palettas M, Stephens J, Stover D, Williams N, Reinbolt R, VanDeusen J, Wesolowski R, Lustberg M, Ramaswamy B. Cardiovascular outcomes and long term survival with discontinuation of adjuvant trastuzumab [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-16-03.
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Affiliation(s)
- S Sardesai
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - J Liu
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - M Palettas
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - J Stephens
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - D Stover
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - N Williams
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - R Reinbolt
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - J VanDeusen
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - R Wesolowski
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - M Lustberg
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - B Ramaswamy
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
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Algarin JM, Ramaswamy B, Weinberg IN, Chen YJ, Krivorotov IN, Katine JA, Shapiro B, Waks E. Frequency conversion of microwave signal without direct bias current using nanoscale magnetic tunnel junctions. Sci Rep 2019; 9:828. [PMID: 30696897 PMCID: PMC6351604 DOI: 10.1038/s41598-018-37415-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 11/28/2018] [Indexed: 11/20/2022] Open
Abstract
Frequency conversion forms an integral block of the electronic circuits used in various applications including energy harvesting, communications and signal processing. These frequency conversion units however require external power sources and occupy a large device footprint making it difficult to be integrated in micro-circuits. Here we demonstrate that nanoscale magnetic tunnel junctions can act as frequency converters without an external power supply or DC bias source. The device directly mixes an external microwave signal with the internal spin precession oscillations to create new frequencies tunable by an external magnetic field in a single device with a small device footprint. We observe up-conversion and down-conversion of the input signal for excitation frequencies between 2 GHz and 6 GHz. We also show that the device acts as a zero-bias rectifier that can generate voltages exceeding 12 mV when the excitation frequency matches the natural oscillations mode of the device.
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Affiliation(s)
- J M Algarin
- Institute for Research in Electronics and Applied Physics (IREAP), University of Maryland, College Park, Maryland, 20742, United States
| | - B Ramaswamy
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland, 20742, United States
| | - I N Weinberg
- Weinberg Medical Physics Inc., North Bethesda, Maryland, 20852, United States
| | - Y J Chen
- Department of Physics and Astronomy, University of California, Irvine, California, 92697, United States
| | - I N Krivorotov
- Department of Physics and Astronomy, University of California, Irvine, California, 92697, United States
| | - J A Katine
- HGST Research Center, San Jose, California, 95135, United States
| | - B Shapiro
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland, 20742, United States
- Institute for Systems Research (ISR), University of Maryland, College Park, Maryland, 20742, United States
| | - E Waks
- Institute for Research in Electronics and Applied Physics (IREAP), University of Maryland, College Park, Maryland, 20742, United States.
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Periasamy N, Bhandarkar A, Ramaswamy B, Pujary K. Button Battery Ingestion: A Conundrum of Preventable Sequelae Management. J Clin Diagn Res 2019. [DOI: 10.7860/jcdr/2019/42057.13041] [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]
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Menon SS, Tandon P, Ramaswamy B, Pujary K. A Retrospective Study to Assess the Role of Using Fine Needle Aspiration Cytology and Frozen Section in the Diagnosis of Thyroid Swelling. Indian J Otolaryngol Head Neck Surg 2018; 70:471-476. [PMID: 30464900 DOI: 10.1007/s12070-018-1503-4] [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: 08/23/2018] [Accepted: 09/24/2018] [Indexed: 11/25/2022] Open
Abstract
The most cost-effective test is fine needle aspiration cytology (FNAC). Many surgeons use intraoperative frozen section to confirm the FNAC findings and to guide the extent of thyroid surgery. Though it is a valuable tool in the diagnosis of the thyroid lesion and determining the extent of thyroid surgery, still in certain cases diagnosis can be incorrect or inconclusive, so histopathology of the excised specimen remains the most reliable test. The purpose of this study will be to compare the result attained by FNAC and frozen section of the thyroid to the final histopathological diagnosis, in order to establish their role in thyroid surgery today. A retrospective study with a total of 140 patients who underwent thyroid surgery at the ENT department, of a tertiary hospital in coastal Karnataka. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for FNAC and frozen section. The sensitivity, specificity, positive predictive rate, and negative predictive rate of frozen section was found to be 66.7%, 88.4%,76.6%, 82.4% respectively for detecting malignancy. This was found to be higher than the results of FNAC for the same which were 64.4%, 77.8%, 64.4%, 77.8% respectively. As the sensitivity of FNAC is similar to frozen section in detecting malignant cases, FNAC is a good tool for screening the patient for determining malignancy in thyroid, but frozen section is more specific in confirming the malignancy.
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Affiliation(s)
- Shalini S Menon
- 1Department of ENT-Head and Neck Surgery, Kasturba Medical College, Manipal, Karnataka India
| | | | - Balakrishnan Ramaswamy
- 1Department of ENT-Head and Neck Surgery, Kasturba Medical College, Manipal, Karnataka India
| | - Kailesh Pujary
- 3Department of ENT, Kasturba Medical College, Manipal, Karnataka India
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17
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Dalakoti P, Pujary K, Ramaswamy B. Sinonasal Metastatic Renal Cell Carcinoma: A Report of Two Cases with Varied Presentation and a Review of Literature. Indian J Otolaryngol Head Neck Surg 2018; 71:2072-2077. [PMID: 31763296 DOI: 10.1007/s12070-018-1475-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 08/17/2018] [Indexed: 11/30/2022] Open
Abstract
Renal cell carcinoma is usually slow growing with delayed vague symptoms and may not be detected until an advanced stage. In only 9% of the cases the classical triad of "haematuria, costovertebral pain and abdominal mass" is seen. Less commonly, sinonasal metastasis may also be the presenting feature of RCC. So, in any case of sinonasal mass, possibility of metastasis from renal malignancy should be considered. Sinonasal metastasis from renal malignancy can occur even several years after the primary is treated with nephrectomy. In sinonasal region maxillary sinus is the most commonly affected. Isolated metastasis to the nose is extremely rare. Malignancies from various other sites of the body can also metastasize to sinonasal region. Epistaxis is the most common symptom. This is because of vascular stroma of the metastatic deposit. A 45 year old male with history of right nephrectomy 1 year back presented with intractable epistaxis. A 66 year old male presented with profuse epistaxis without any history of previous malignancies. Both the cases were evaluated resulting to the diagnosis of sinonasal metastasis from Renal Cell carcinoma. In the first case, metastasis occurred 1 year post surgery whereas in second case sinonasal metastasis was the presenting feature of Renal Cell carcinoma. Epistaxis is the most common symptom. This is because of vascular stroma of this metastatic deposit. In renal cancer, symptoms of metastasis often precede the symptoms of primary tumor.
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Affiliation(s)
- Pooja Dalakoti
- Department of Otolaryngology - Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Kailesh Pujary
- Department of Otolaryngology - Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Balakrishnan Ramaswamy
- Department of Otolaryngology - Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka India
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18
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Dalakoti P, Ramaswamy B, Bhandarkar AM, Nayak DR, Sabeena S, Arunkumar G. Prevalence of HPV in Oral Squamous Cell Carcinoma in South West India. Indian J Otolaryngol Head Neck Surg 2018; 71:657-664. [PMID: 31742038 DOI: 10.1007/s12070-018-1470-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 08/14/2018] [Indexed: 10/28/2022] Open
Abstract
There are inconsistent reports regarding the role of HPV in the origin and progression of oral squamous cell carcinoma (OSCC). The observed heterogeneity was mainly attributed to the social and cultural habits of the enrolled cases, discrepancies in the nature of samples procured and varying sensitivity of the assays employed for detection of HPV. The objective of this study was to assess the prevalence of HPV in OSCC in South West India. This was a cross sectional study conducted over a period extending from October 2015 to June 2017. This study involved Department of ENT-Head and Neck Surgery and Department of Virology, Manipal Academy of Higher Education. Fifty histologically confirmed oral squamous cell carcinoma patients undergoing wide local excision of the tumour were enrolled for the study. Intraoperatively 4-5 mm of tissue samples were transported in sterile normal saline at 4-80 °C. The primary screening of tissue samples was performed by nested PCR using PGMY09/11 consensus primers and GP5+/6+ consensus primers and TaqMan based real time multiplex PCR for HPV-16, HPV-18, HPV-31 and HPV-45. All samples tested negative for HPV DNA by conventional nested PCR and TaqMan based real-time Multiplex PCR ruling out four common HPV subtypes such as HPV-16, 18, 31, 45. We did not find presence of HPV DNA in the tissues of patients with OSCC from southwest India. However, studies with more geographic representation from other parts of India are required before generalising our findings.
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Affiliation(s)
- Pooja Dalakoti
- 1Department of Otolaryngology - Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Balakrishnan Ramaswamy
- 1Department of Otolaryngology - Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Ajay M Bhandarkar
- 1Department of Otolaryngology - Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Dipak Ranjan Nayak
- 1Department of Otolaryngology - Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Sasidharanpillai Sabeena
- 2Manipal Centre for Virus Research, Manipal Academy of Higher Education, Manipal, Karnataka 576104 India
| | - Govindakarnavar Arunkumar
- 2Manipal Centre for Virus Research, Manipal Academy of Higher Education, Manipal, Karnataka 576104 India
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Shimoji M, Ramaswamy B, Shukoor MI, Benhal P, Broda A, Kulkarni S, Malik P, McCaffrey B, Lafond JF, Nacev A, Weinberg IN, Shapiro B, Depireux DA. Toxicology study for magnetic injection of prednisolone into the rat cochlea. Eur J Pharm Sci 2018; 126:33-48. [PMID: 29933075 DOI: 10.1016/j.ejps.2018.06.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 05/31/2018] [Accepted: 06/12/2018] [Indexed: 01/28/2023]
Abstract
This paper investigates the safety of a novel 'magnetic injection' method of delivering therapy to the cochlea, in a rodent model. In this method of administration, a magnetic field is employed to actively transport drug-eluting superparamagnetic iron-oxide core nanoparticles into the cochlea, where they then release their drug payload (we delivered the steroid prednisolone). Our study design and selection of control groups was based on published regulatory guidance for safety studies that involve local drug delivery. We tested for both single and multiple delivery doses to the cochlea, and found that magnetic delivery did not harm hearing. There was no statistical difference in hearing between magnetically treated ears versus ears that received intra-tympanic steroid (a mimic of a standard-of-care for sudden sensorineural hearing loss), both 2 and 30 days after treatment. Since our treatment is local to the ear, the levels of steroid and iron circulating systemically after our treatment were low, below mass-spectrometry detection limits for the steroid and no different from normal for iron. No adverse findings were observed in ear tissue histopathology or in animal gross behavior. At 2 and 30 days after treatment, inflammatory changes examined in the ear were limited to the middle ear, were very mild in severity, and by day 90 there was ongoing and almost complete reversibility of these changes. There were no ear tissue scarring or hemorrhage trends associated with magnetic delivery. In summary, after conducting a pre-clinical safety study, no adverse safety issues were observed.
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Affiliation(s)
- M Shimoji
- Otomagnetics, Inc., Rockville, MD 20852, United States of America.
| | - B Ramaswamy
- Fischell Department of Bioengineering, University of Maryland, College Park, MD 20742, United States of America
| | - M I Shukoor
- Otomagnetics, Inc., Rockville, MD 20852, United States of America
| | - P Benhal
- Fischell Department of Bioengineering, University of Maryland, College Park, MD 20742, United States of America
| | - A Broda
- Fischell Department of Bioengineering, University of Maryland, College Park, MD 20742, United States of America
| | - S Kulkarni
- Fischell Department of Bioengineering, University of Maryland, College Park, MD 20742, United States of America
| | - P Malik
- Fischell Department of Bioengineering, University of Maryland, College Park, MD 20742, United States of America
| | - B McCaffrey
- Fischell Department of Bioengineering, University of Maryland, College Park, MD 20742, United States of America
| | | | - A Nacev
- Fischell Department of Bioengineering, University of Maryland, College Park, MD 20742, United States of America
| | - I N Weinberg
- Otomagnetics, Inc., Rockville, MD 20852, United States of America
| | - B Shapiro
- Otomagnetics, Inc., Rockville, MD 20852, United States of America; Fischell Department of Bioengineering, University of Maryland, College Park, MD 20742, United States of America; Institute for Systems Research (ISR), University of Maryland, College Park, MD 20742, United States of America
| | - D A Depireux
- Otomagnetics, Inc., Rockville, MD 20852, United States of America; Fischell Department of Bioengineering, University of Maryland, College Park, MD 20742, United States of America; Institute for Systems Research (ISR), University of Maryland, College Park, MD 20742, United States of America
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Abstract
Sinonasal schwannomas constitute 4% of head and neck nerve sheath tumours; however, schwannomas involving the nasal septum are quite rare. We present a 57-year-old male patient with nasal septal schwannoma who was managed successfully by endoscopic excision. 32 cases of septal schwannoma have been reported so far in the literature. This report discusses certain peculiar features exhibited by schwannomas of the nasal septum. Septal schwannoma does not show any age, sex or side predilection. However, they tend to involve posterior part of the septum and presumed to arise from the nasopalatine branch of the trigeminal nerve. Imaging findings of the sinonasal schwannoma are non-specific, but the histopathological characteristics are diagnostic, with seldom need for immunohistochemistry. Endoscopic excision is the safe and effective treatment option for the septal schwannoma of any size and location. Recurrence has not been reported in the literature following endoscopic excision.
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Affiliation(s)
- K Devaraja
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Karnataka-576104, India
| | - Dipak Ranjan Nayak
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Karnataka-576104, India
| | - Balakrishnan Ramaswamy
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Karnataka-576104, India
| | - Prerit Rao
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Karnataka-576104, India
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Abstract
Entomopthoromycosis is a rare subcutaneous fungal infection caused by onidiobolus coronatus affecting mainly the upper respiratory mucosa in immunocompetent people.The manifestations of this disease masquerades other clinical entities.Hence, high index of suspicion is required for prompt diagnosis.Histopathological examination and culture are the gold standard diagnostic tools, however no standard treatment protocols ha been mentioned in literature.We present a case of rhinofacial entomopthoromycosis in a yearold ma with a leftsided rhinofacial swelling to highlight the presence of this unusual fungal infection and its treatment.
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Affiliation(s)
- Shalini Menon
- Head and Neck surgery, Kasturba Medical College, Manipal, India
| | - Kailesh Pujary
- Head and Neck surgery, Kasturba Medical College, Manipal, India
| | - Ranjini Kudva
- Department of Pathology, Kasturba Medical College, Manipal, India
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22
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Rudolph M, Sizemore ST, Lu Y, Teng KY, Basree MM, Reinbolt R, Timmers CD, Leone G, Ostrowski MC, Majumder S, Ramaswamy B. A hedgehog pathway-dependent gene signature is associated with poor clinical outcomes in Luminal A breast cancer. Breast Cancer Res Treat 2018; 169:457-467. [DOI: 10.1007/s10549-018-4718-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 02/13/2018] [Indexed: 01/13/2023]
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Boutrid H, Reinbolt R, Knopp M, Williams N, VanDeusen J, Sardesai S, Noonan A, Flora L, Gleich E, Pan X, Berger M, Vargo C, Wesolowski R, Ramaswamy B, DeVries AC, Lustberg M. Abstract OT2-05-03: Does minocycline mitigate chemotherapy induced neuroinflammation? A phase II randomized placebo controlled study. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot2-05-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Many breast cancer (BC) patients, particularly those who receive chemotherapy (chemo), experience affective symptoms and cognitive changes that can negatively impact their quality of life. Causal links between inflammatory mediators and the development of depressive-like behavior and cognitive defects, have been established in mouse models, including studies by our group showing increased microglial activation following chemo (A.C DeVries et al). Microglia are resident immune cells of the brain, which release proinflammatory cytokines when activated. Doxorubicin (DOX) induces microglial activation in the brain. Minocycline, a second generation tetracycline, has been shown to suppress inflammation by inhibiting microglial activation in CNS disease models. We hypothesize that (1) chemo activates microglia in the brains of women being treated for BC, which can precipitate or exacerbate depression, anxiety and cognitive deficits and (2) Minocycline administration during neoadjuvant or adjuvant chemo will prevent chemo-induced microglial activation and will reduce affective and cognitive symptom burden. Trial Design: This is a single center, Phase II, double blinded randomized study of minocycline (100 mg twice a day) vs placebo twice a day in women with BC receiving DOX-based or other chemo for BC. Pts will be randomized to either oral minocycline or placebo for up to a 1 week loading period plus chemo treatment period and an optional subsequent 2 week period. Eligibility Criteria: Women diagnosed with BC stages I-III initiating first line adjuvant or neoadjuvant chemo. Aims: (1) to evaluate symptoms related to anxiety and depression and cognitive changes during and after chemo completion (2) to evaluate markers of neuro inflammation as assessed by blood based inflammatory cytokines and central markers of inflammation and microglia activation using 1 F-Fludeoxyglucose and 11C-PK11195 positron emission tomography. Primary endpoints are changes in Center for Epidemiological Studies Depression Scale (CES-D) and State Trait Anxiety Index (STAI) from baseline to end of study after minocycline vs placebo intervention. Secondary endpoints are changes in cognitive function during chemo using validated cognitive testing including N-Back Test, Behavioural Rating Inventory of Executive Function (BRIEF) and the Multifactorial Memory Questionnaire Ability Scale (MMQ). Statistical Methods: Primary analysis for efficacy will be intention-to-treat. The main objective is to preliminarily evaluate the effect of minocycline on chemo-induced depressive symptoms in terms of changes in CES-D and STAI scores. Mixed models will be used to evaluate cognitive function changes. A sample size of 23 per group, will give 80% power to detect an effect size of 0.74 standard deviation (SD) difference between the 2 groups at significance level of 0.10 based on a 2 sided two-sample t-test. From our experience, attrition of less than 20% is expected for studies in this patient population in our center, and to account for this, we plan to recruit up to 60 patients. 16 of 46 evaluable pts have been accrued to date. Accrual started in January 2016. Funded by Pelotonia grant from The OSUCCC. Contact: Study PI: Maryam.lustberg@osumc.edu
Citation Format: Boutrid H, Reinbolt R, Knopp M, Williams N, VanDeusen J, Sardesai S, Noonan A, Flora L, Gleich E, Pan X, Berger M, Vargo C, Wesolowski R, Ramaswamy B, DeVries AC, Lustberg M. Does minocycline mitigate chemotherapy induced neuroinflammation? A phase II randomized placebo controlled study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT2-05-03.
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Affiliation(s)
- H Boutrid
- The Ohio State University Wexner Medical Center, Columbus, OH; The Ohio State Comprehensive Cancer Center Clinical Trials Office, Columbus, OH; The Ohio State University, Columbus, OH; Stefanie Spielman Comprehensive Breast Center, Columbus, OH; The Ohio State Wexner Medical Center, Columbus, OH
| | - R Reinbolt
- The Ohio State University Wexner Medical Center, Columbus, OH; The Ohio State Comprehensive Cancer Center Clinical Trials Office, Columbus, OH; The Ohio State University, Columbus, OH; Stefanie Spielman Comprehensive Breast Center, Columbus, OH; The Ohio State Wexner Medical Center, Columbus, OH
| | - M Knopp
- The Ohio State University Wexner Medical Center, Columbus, OH; The Ohio State Comprehensive Cancer Center Clinical Trials Office, Columbus, OH; The Ohio State University, Columbus, OH; Stefanie Spielman Comprehensive Breast Center, Columbus, OH; The Ohio State Wexner Medical Center, Columbus, OH
| | - N Williams
- The Ohio State University Wexner Medical Center, Columbus, OH; The Ohio State Comprehensive Cancer Center Clinical Trials Office, Columbus, OH; The Ohio State University, Columbus, OH; Stefanie Spielman Comprehensive Breast Center, Columbus, OH; The Ohio State Wexner Medical Center, Columbus, OH
| | - J VanDeusen
- The Ohio State University Wexner Medical Center, Columbus, OH; The Ohio State Comprehensive Cancer Center Clinical Trials Office, Columbus, OH; The Ohio State University, Columbus, OH; Stefanie Spielman Comprehensive Breast Center, Columbus, OH; The Ohio State Wexner Medical Center, Columbus, OH
| | - S Sardesai
- The Ohio State University Wexner Medical Center, Columbus, OH; The Ohio State Comprehensive Cancer Center Clinical Trials Office, Columbus, OH; The Ohio State University, Columbus, OH; Stefanie Spielman Comprehensive Breast Center, Columbus, OH; The Ohio State Wexner Medical Center, Columbus, OH
| | - A Noonan
- The Ohio State University Wexner Medical Center, Columbus, OH; The Ohio State Comprehensive Cancer Center Clinical Trials Office, Columbus, OH; The Ohio State University, Columbus, OH; Stefanie Spielman Comprehensive Breast Center, Columbus, OH; The Ohio State Wexner Medical Center, Columbus, OH
| | - L Flora
- The Ohio State University Wexner Medical Center, Columbus, OH; The Ohio State Comprehensive Cancer Center Clinical Trials Office, Columbus, OH; The Ohio State University, Columbus, OH; Stefanie Spielman Comprehensive Breast Center, Columbus, OH; The Ohio State Wexner Medical Center, Columbus, OH
| | - E Gleich
- The Ohio State University Wexner Medical Center, Columbus, OH; The Ohio State Comprehensive Cancer Center Clinical Trials Office, Columbus, OH; The Ohio State University, Columbus, OH; Stefanie Spielman Comprehensive Breast Center, Columbus, OH; The Ohio State Wexner Medical Center, Columbus, OH
| | - X Pan
- The Ohio State University Wexner Medical Center, Columbus, OH; The Ohio State Comprehensive Cancer Center Clinical Trials Office, Columbus, OH; The Ohio State University, Columbus, OH; Stefanie Spielman Comprehensive Breast Center, Columbus, OH; The Ohio State Wexner Medical Center, Columbus, OH
| | - M Berger
- The Ohio State University Wexner Medical Center, Columbus, OH; The Ohio State Comprehensive Cancer Center Clinical Trials Office, Columbus, OH; The Ohio State University, Columbus, OH; Stefanie Spielman Comprehensive Breast Center, Columbus, OH; The Ohio State Wexner Medical Center, Columbus, OH
| | - C Vargo
- The Ohio State University Wexner Medical Center, Columbus, OH; The Ohio State Comprehensive Cancer Center Clinical Trials Office, Columbus, OH; The Ohio State University, Columbus, OH; Stefanie Spielman Comprehensive Breast Center, Columbus, OH; The Ohio State Wexner Medical Center, Columbus, OH
| | - R Wesolowski
- The Ohio State University Wexner Medical Center, Columbus, OH; The Ohio State Comprehensive Cancer Center Clinical Trials Office, Columbus, OH; The Ohio State University, Columbus, OH; Stefanie Spielman Comprehensive Breast Center, Columbus, OH; The Ohio State Wexner Medical Center, Columbus, OH
| | - B Ramaswamy
- The Ohio State University Wexner Medical Center, Columbus, OH; The Ohio State Comprehensive Cancer Center Clinical Trials Office, Columbus, OH; The Ohio State University, Columbus, OH; Stefanie Spielman Comprehensive Breast Center, Columbus, OH; The Ohio State Wexner Medical Center, Columbus, OH
| | - AC DeVries
- The Ohio State University Wexner Medical Center, Columbus, OH; The Ohio State Comprehensive Cancer Center Clinical Trials Office, Columbus, OH; The Ohio State University, Columbus, OH; Stefanie Spielman Comprehensive Breast Center, Columbus, OH; The Ohio State Wexner Medical Center, Columbus, OH
| | - M Lustberg
- The Ohio State University Wexner Medical Center, Columbus, OH; The Ohio State Comprehensive Cancer Center Clinical Trials Office, Columbus, OH; The Ohio State University, Columbus, OH; Stefanie Spielman Comprehensive Breast Center, Columbus, OH; The Ohio State Wexner Medical Center, Columbus, OH
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Nayak DR, Pai K, Nair S, Ramaswamy B, Sabhahit H. A Short Term Subjective and Objective Analysis of Modified Endoscopic Lothrop's Procedure and Its Functional Outcome: Our Experience. Indian J Otolaryngol Head Neck Surg 2016; 68:481-486. [PMID: 27833876 DOI: 10.1007/s12070-016-0998-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 05/21/2016] [Indexed: 11/30/2022] Open
Abstract
To study the short-term functional outcomes of the endoscopic modified Lothrop procedure with well defined subjective and objective criteria. It's a retrospective cohort study with chart review carried out at a tertiary referral center. 31 patients with chronic frontal sinusitis who underwent endoscopic modified Lothrop's procedure with uncinate preservation during the period Jan 2011-2014 were followed up for a period of minimum 6 months. Assessment was done post-operatively based on subjective severity score and Kennedy's 5 point endoscopic criteria. Subjective improvement was seen in all symptoms whereas statistically significant improvement was found for the three parameters headache (p < 0.025), nose block (p < 0.03) and rhinorrhea (p < 0.05). Post operative nasal endoscopy revealed crusting and polypoidal mucosa in few patients which were managed conservatively. Asymptomatic narrowing of ostium seen in two patients. No complications were identified. The study illustrates the benefit obtained from endoscopic modified Lothrop's surgery in chronic frontal sinusitis refractory to medical treatment and standard endoscopic sinus surgery.
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Affiliation(s)
- D R Nayak
- Department of ENT-HNS, Kasturba Medical College, Manipal, Karnataka 576104 India
| | - K Pai
- Department of ENT-HNS, Kasturba Medical College, Manipal, Karnataka 576104 India
| | - S Nair
- Department of ENT-HNS, Kasturba Medical College, Manipal, Karnataka 576104 India
| | - B Ramaswamy
- Department of ENT-HNS, Kasturba Medical College, Manipal, Karnataka 576104 India
| | - H Sabhahit
- Department of ENT-HNS, Kasturba Medical College, Manipal, Karnataka 576104 India
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26
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Pillai S, Agarwal AC, Mangalore AB, Ramaswamy B, Shetty S. Benign Lymphoepithelial Cyst of the Parotid in HIV Negative Patient. J Clin Diagn Res 2016; 10:MD05-6. [PMID: 27190845 DOI: 10.7860/jcdr/2016/17915.7609] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 02/14/2016] [Indexed: 02/04/2023]
Abstract
Benign lymphoepithelial cysts are slow growing tumours commonly seen in HIV positive adults. It is rare to find them in non HIV individuals. In this article we discuss an uncommon presentation of a parotid swelling occurring in a 49-year-old non HIV male, which was diagnosed as benign lymphoepithelial cyst. The various investigative modalities and treatment options are outlined in this article.
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Affiliation(s)
- Suresh Pillai
- Senior Consultant, Department of Otolaryngology-Head and Neck Surgery, Sultan Qaboos Medical University , Oman
| | - Ashish Chandra Agarwal
- Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, Kasturba Medical College, Manipal University , Manipal, Karnataka, India
| | - Ajay Bhandarkar Mangalore
- Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Kasturba Medical College, Manipal University , Manipal, Karnataka, India
| | - Balakrishnan Ramaswamy
- Professor and Head, Department of Otolaryngology-Head and Neck Surgery, Kasturba Medical College, Manipal University , Manipal, Karnataka, India
| | - Shama Shetty
- Senior Resident, Department of Otolaryngology-Head and Neck Surgery, Kasturba Medical College, Manipal University , Manipal, Karnataka, India
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Wesolowski R, Duggan M, Stiff A, Trikha P, Schoenfield L, Abdel-Rasoul M, Layman R, Ramaswamy B, Macrae E, Lustberg MB, Mrozek E, Carson WE. Abstract P4-09-18: Characterization of circulating myeloid derived suppressor cells and cytokines in patients undergoing neo-adjuvant chemotherapy for breast cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p4-09-18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Myeloid derived suppressor cells (MDSC) are immature immune cells that expand in patients (pts) with cancer and suppress anti-tumor immunity. MDSC are also known to support angiogenesis. Higher circulating MDSC levels are seen in patients with greater tumor burden. Therefore, circulating MDSC levels could be affected by chemotherapy and could correlate with response. In this prospective pilot trial, peripheral blood (PB) levels of granulocytic (G-MDSC) and monocytic (M-MDSC) MDSC were measured in pts with operable breast cancer (BC) treated with neo-adjuvant chemotherapy (NAC) to study their association with pathologic complete response. It was hypothesized that MDSC % would show an association with complete pathologic response (pCR). The association of 10 different cytokine levels (IL-1β, IL-2, IL-4, IL-5, IL-6, IL-10, IL-12, IL-13, IFN-γ, TNF-α) with pCR was also explored. Linear mixed models tested the associations between MDSC % or cytokines across time points with pCR. Levels of MDSC were measured by flow cytometry as a % of PB mononuclear cells prior to cycle (C) 1 and 2 of doxorubicin and cyclophosphamide (AC) and 1st and last administration of paclitaxel (T) or T and anti-HER2 therapy (in HER2+ pts). For other regimens, MDSC were measured prior to 1st, 2nd and last cycle. MDSC were defined as HLA-DR-, CD11b+, CD33+ cells with G-MDSC and M-MDSC cells expressing CD15 and CD14, respectively. Plasma cytokine levels were measured using a multiplex assay (Bio-Rad). Of 24 enrolled pts, 1, 20 and 3 had clinical stage I, II, IIIA, respectively. Median age was 48 (range 32-70). 11, 6 and 7 pts were triple negative (TN), HER2+ and hormone receptor (HR)+, respectively. PCR rate was 45.8% (46%, 50%, 43%, 20% for TN, HER2+, HR+ and >10% HR+ pts). Rate of residual cancer burden (RCB) class 0-1 was 58.3% (63.6%, 50%, 57.1%, 40% in TN, HER2+, HR+ and >10% HR+ pts). Mean M-MDSC % were <1 at all time points. Mean G-MDSC % and 95% confidence intervals (CI) were 0.88 (0.23-1.54), 5.07 (2.45-7.69), 9.32(4.02-14.61) and 1.97 (0.53-3.41) at times 1-4. The increase in MDSC by C1 of T was significant (p<0.0001) in all BC types. Baseline G-MDSC % did not differ in pts with or without pCR. G-MDSC levels at the last time point were also not statistically different but were numerically slightly lower in pts with pCR (1.15; 95%CI 0.14-2.16) versus pts with no pCR (2.71; 95%CI 0-5.47). Levels of all 10 cytokines were measurable in pts throughout NAC. The mean levels of IL-1β, IL-2, IL-4, IL-13 and IFN-γ peaked by C1 of T, while levels of IL-5, IL-6, IL-10, IL-12 and TNF-α were the highest at draw 1 and decreased during NAC. This pilot study confirmed feasibility of measuring circulating MDSC and cytokines in breast cancer pts receiving neo-adjuvant chemotherapy. The results showed that G-MDSC % increase during AC and then decrease during T and that a mixture of Th1 and Th2 cytokines peak during treatment. Levels of MDSC and cytokines did not significantly differ between pts with or without a pCR. However, a larger study with greater power to detect smaller differences and evaluate association between MDSC levels and pCR in different BC subtypes is needed.
Citation Format: Wesolowski R, Duggan M, Stiff A, Trikha P, Schoenfield L, Abdel-Rasoul M, Layman R, Ramaswamy B, Macrae E, Lustberg MB, Mrozek E, Carson WE. Characterization of circulating myeloid derived suppressor cells and cytokines in patients undergoing neo-adjuvant chemotherapy for breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-09-18.
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Affiliation(s)
- R Wesolowski
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - M Duggan
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - A Stiff
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - P Trikha
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - L Schoenfield
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - M Abdel-Rasoul
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - R Layman
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - B Ramaswamy
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - E Macrae
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - MB Lustberg
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - E Mrozek
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - WE Carson
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
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Abstract
We present a case of a middle-aged woman with a history of not only progressive nasal obstruction, facial pain, hyposmia and epistaxis, but also excision of the nasal mass diagnosed as a vascular leiomyoma. On examination, a smooth bulge was seen over the middle turbinate. Surgical excision along with histopathology and immunohistochemistry revealed a diagnosis of recurrent vascular leiomyoma of the middle turbinate.
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Affiliation(s)
- Ajay M Bhandarkar
- Department of Otolaryngology-Head and Neck Surgery, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Balakrishnan Ramaswamy
- Department of Otorhinolaryngology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Padmapriya Jaiprakash
- Department of Pathology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Nithyanand Chidambaranathan
- Department of Otolaryngology-Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal University, Manipal, Karnataka, India
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Abstract
Neuroblastic tumours are common in childhood and adrenal glands are the most common site. Head and neck ganglioneuroblastomas are extremely rare and nose is a very uncommon site for a ganglioneuroblastoma. The management of this primitive sympathogonic tumour may vary depending on the age of the patient and stage of the tumour. We present a middle-aged man with a ganglioneuroblastoma of skull base, management of this tumour and a review of literature.
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Affiliation(s)
- Balakrishnan Ramaswamy
- Professor and Head of Department, Department of Otolaryngology-Head and Neck Surgery, Kasturba Medical College, Manipal University , Manipal, India
| | - Ajay M Bhandarkar
- Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, Kasturba Medical College, Manipal University , Manipal, India
| | - Shalini S Menon
- Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, Kasturba Medical College, Manipal University , Manipal, India
| | - Ashish Chandra Agarwal
- Senior Resident, Department of Otolaryngology-Head and Neck Surgery, Kasturba Medical College, Manipal University , Manipal, India
| | - Suraj S Nair
- Junior Resident, Department of Otolaryngology-Head and Neck Surgery, Kasturba Medical College, Manipal University , Manipal, India
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Ramaswamy B, Graziano M, Jones D, Lindop F, Lowe R, Walker W. An APPDE knowledge translation project to promote global professional physiotherapy management in Parkinson's disease. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1157] [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: 10/23/2022]
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Ramaswamy B, Singh R, Manusrut M, Hazarika M. Sclerosing lipogranuloma of the eyelid: unusual complication following nasal packing in endoscopic sinus surgery. BMJ Case Rep 2015; 2015:bcr-2014-208093. [PMID: 25750223 DOI: 10.1136/bcr-2014-208093] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
An eyelid or orbital lipogranuloma can occur following nasal packing with liquid paraffin, petroleum jelly or an antibiotic-based cream. It usually presents a few weeks or months after the initial procedure. We present a report of three such cases of sclerosing lipogranuloma involving the eyelid, which occurred following a sinonasal surgery where nasal packing using petroleum jelly was performed. The typical clinical course and the classical histopathological features are highlighted. All cases were diagnosed by histopathological examination as sclerosing lipogranuloma. Complete surgical removal resulted in complete resolution on 1 month follow-up. The diagnosis is based on a high degree of suspicion following a detailed history of prior use of lipid-based products for nasal packing following endonasal surgery. Histopathology is diagnostic. Surgical excision is the treatment of choice, however, due to its infiltrative nature, it may be difficult to obtain a complete cure.
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Affiliation(s)
- Balakrishnan Ramaswamy
- Department of Otorhinolaryngology, Kasturba Medical College, Manipal University, Manipal, India
| | - Rohit Singh
- Department of Otorhinolaryngology, Kasturba Medical College, Manipal University, Manipal, India
| | - Manusrut Manusrut
- Department of Otorhinolaryngology, Kasturba Medical College, Manipal University, Manipal, India
| | - Manali Hazarika
- Department of Ophthalmology, Kasturba Medical College, Manipal University, Manipal, India
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Abstract
We report the case of a young woman who presented with progressive dysphagia and swelling in the anterior aspect of the neck of short duration. On evaluation, she was diagnosed with amelanotic malignant melanoma of the cervical oesophagus. She underwent total laryngopharyngo-oesophagectomy with gastric transposition with bilateral modified radical neck dissection with feeding jejunostomy and a permanent tracheostomy with postoperative combined chemoradiation therapy. However, in spite of aggressive treatment, the patient expired 8 months after initial presentation with distant metastasis.
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Affiliation(s)
- Balakrishnan Ramaswamy
- Department of Otolaryngology-Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal University, Karnataka, India
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Singh R, Ramaswamy B, Hazarika M. Juvenile aggressive cemento-ossifying fibroma of the sphenoid sinus with proptosis: a surgical dilemma. BMJ Case Rep 2013; 2013:bcr-2013-201578. [PMID: 24285811 DOI: 10.1136/bcr-2013-201578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The term fibro-osseous lesion has currently grown in popularity as an overall designation for a number of rare, histologically benign head and neck lesions that are made up of bone, fibrous tissue and cementum. Cemento-ossifying fibroma is a variant of cementifying fibroma and is a fibro-osseous disease. They are usually small innocuous lesions which follow a slow benign course and are commonly seen in the skull bone rather than the sphenoid. It is rare for these tumours to attain large size, behave aggressively, destroy bone and require a radical surgery. One such rapidly growing juvenile cemento-ossifying lesion of sphenoid in our 10-year-old young patient causing proptosis and impaired vision is reported here because of its uncommon nature and its surgical dilemma. Selection of surgical approach to resect this tumour becomes difficult because it is deeply seated and needs a multidisciplinary approach.
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Affiliation(s)
- Rohit Singh
- Department of Otorhinolaryngology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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Ramaswamy B, Geyer S, Lustberg M, Wesolowski R, Andreopoulou E, Knopp M, Villalona M, Chen A, Grever M, Shapiro C. NCI 8609: Multicenter Phase I Trial of PARP Inhibitor Veliparib with Carboplatin in Advanced Breast Cancer. Ann Oncol 2013. [DOI: 10.1093/annonc/mdt081.1] [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: 11/15/2022] Open
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Lustberg MB, Ruppert AS, Carothers S, Bingman A, McCarthy B, Raman S, Das M, Kanji S, Lu J, Das H, Cinar-Akakin H, Gurcan MN, Berger MJ, Wesolowski R, Olson EM, Ramaswamy B, Mrozek E, Layman RM, Binkley P, Shapiro CL. Abstract P2-11-07: Endothelial progenitor cells as novel markers of anthracycline induced cardiac injury. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p2-11-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Anthracyclines including doxorubicin (DOX) cause myocardial damage that manifests as either subclinical decrements of left ventricular ejection function (LVEF) or overt cardiomyopathy. LVEF changes and cardiac risk factors are insufficient predictors of future DOX cardiotoxicity. Bone marrow derived endothelial progenitor cells (EPCs) are mobilized and are homed to sites of myocardial injury to help with repair of damaged myocardium. We hypothesized that EPC levels would be indicative of early DOX cardiotoxicity. Hence, we prospectively collected serial blood samples to evaluate functional EPCs, Troponin I (Ti) and B-natriuretic peptide (BNP), in patients (pts) receiving DOX-based chemotherapy.
Methods: Eligible pts were initiating adjuvant DOX for early stage breast cancer. Pts underwent cardiac magnetic resonance (CMR), Ti, BNP, and EPC at baseline, after 1 cycle of DOX, and after completion of DOX. CD133+ progenitor cells were isolated from the peripheral blood mononuclear cells (PBMC) using AutoMACS (automated magnetic cell sorting, Miltenyi Biotech). In vitro colony forming unit (CFU) assay was performed for isolated CD133+ progenitor cells on MethoCult (Stemcell Technology). After 8 days of culture, EPC colonies were counted using a two-step image analysis algorithm. Repeated measures analysis of variance modeled changes in cardiac markers over time. Logistic regression was used to correlate variables with abnormal Ti.
Results: Forty two women were enrolled. The average age was 52 years (range 33–68) and stage distribution was I (14%), II (58%) and III (28%). All but one patient received peg-fligrastim after DOX. Thirty six pts had EPC/cardiac biomarkers and twenty nine pts had CMRs at all three time points. LVEF decreased 1.6% following completion of DOX (95% CI: −3.8 to 0.6, p = 0.16). There was a non-linear trend in EPCs over time (p = 0.05), with an initial increase followed by a decrease, with average values of 59 (95% CI: 50–70), 65 (95% CI: 55–75), and 50 (95% CI: 40–60), respectively, across the three time points. By the end of treatment, 54% (95% CI: 0.37–0.71) of women had abnormal troponins (median: 0.03, range: 0.02 to 0.17). Variables associated with abnormal troponins included lower baseline EPCs (p = 0.095), older age (p = 0.075) and initial increase in BNP post cycle 1 (p < 0.03). In a multivariable model, age (p = 0.04) and BNP (p = 0.04) were independent prognostic factors for abnormal troponins, where the odds of abnormal troponins was 65% higher for every 5-year increase in age (OR = 1.65, 95% CI: 1.02–2.66) and 58% higher for every 1.5-fold increase in BNP (OR = 1.58, 95% CI: 1.01–2.46). Baseline EPC did not remain in the final model with p = 0.12.
Conclusions: DOX was well-tolerated with no significant changes in LVEF as measured by serials CMRs. Older age and increased BNP were independent prognostic factors for rise in Ti. We observed an initial increase of EPCs with DOX exposure followed by a decrease after the end of treatment. Although not statistically significant, lower EPCs at baseline, corresponding to lower cardiac reserve, were correlated with abnormal Ti. This is the first study reporting an intriguing association of EPCs with traditional cardiac biomarkers during DOX chemotherapy. Funded by R21 CA143787-02.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-11-07.
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Affiliation(s)
- MB Lustberg
- The OSU Breast Program at Stefanie Spielman Comprehensive Breast Center; OSU
| | - AS Ruppert
- The OSU Breast Program at Stefanie Spielman Comprehensive Breast Center; OSU
| | - S Carothers
- The OSU Breast Program at Stefanie Spielman Comprehensive Breast Center; OSU
| | - A Bingman
- The OSU Breast Program at Stefanie Spielman Comprehensive Breast Center; OSU
| | - B McCarthy
- The OSU Breast Program at Stefanie Spielman Comprehensive Breast Center; OSU
| | - S Raman
- The OSU Breast Program at Stefanie Spielman Comprehensive Breast Center; OSU
| | - M Das
- The OSU Breast Program at Stefanie Spielman Comprehensive Breast Center; OSU
| | - S Kanji
- The OSU Breast Program at Stefanie Spielman Comprehensive Breast Center; OSU
| | - J Lu
- The OSU Breast Program at Stefanie Spielman Comprehensive Breast Center; OSU
| | - H Das
- The OSU Breast Program at Stefanie Spielman Comprehensive Breast Center; OSU
| | - H Cinar-Akakin
- The OSU Breast Program at Stefanie Spielman Comprehensive Breast Center; OSU
| | - MN Gurcan
- The OSU Breast Program at Stefanie Spielman Comprehensive Breast Center; OSU
| | - MJ Berger
- The OSU Breast Program at Stefanie Spielman Comprehensive Breast Center; OSU
| | - R Wesolowski
- The OSU Breast Program at Stefanie Spielman Comprehensive Breast Center; OSU
| | - EM Olson
- The OSU Breast Program at Stefanie Spielman Comprehensive Breast Center; OSU
| | - B Ramaswamy
- The OSU Breast Program at Stefanie Spielman Comprehensive Breast Center; OSU
| | - E Mrozek
- The OSU Breast Program at Stefanie Spielman Comprehensive Breast Center; OSU
| | - RM Layman
- The OSU Breast Program at Stefanie Spielman Comprehensive Breast Center; OSU
| | - P Binkley
- The OSU Breast Program at Stefanie Spielman Comprehensive Breast Center; OSU
| | - CL Shapiro
- The OSU Breast Program at Stefanie Spielman Comprehensive Breast Center; OSU
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37
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Ramaswamy B, Nayak D. Efficacy of Transnasal Endoscopic Surgery for CSF Rhinorrhea. Skull Base Surg 2012. [DOI: 10.1055/s-0032-1313999] [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: 10/28/2022]
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38
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Nayak D, Ramaswamy B. Exclusive Endoscopic/Endoscopic-Assisted Minimally Invasive Surgery for Sinonasal Neoplasm—Our Experience. Skull Base Surg 2012. [DOI: 10.1055/s-0032-1313939] [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: 10/28/2022]
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39
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Singh R, Kosaraju K, Bairy I, Ramaswamy B, Gupta S. A study of antibacterial and antifungal properties of human cerumen. Indian J Otol 2012. [DOI: 10.4103/0971-7749.104796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ramaswamy B, Srividya V, Mullins DA, Carothers S, Young G, Wenrui D, Zhao W, Lustberg M, Leon M, Weslowski R, Layman R, Mrozek E, Shapiro CL, Villalona-Calero M. PD10-01: Prevalence of Dysfunctional Fanconi Anemia (FA) DNA Repair Pathway in Breast Cancer. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-pd10-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: BRCA1/2 deficient breast tumors are highly sensitive to poly- ADP-ribose polymerase inhibitors (PARPi). The Fanconi Anemia (FA) associated gene products along with BRCA 1/2 function in a common pathway that regulates the cellular response to DNA damage, suggesting that tumors with dysfunction of any of the components of FA network would be susceptible to PARPi. Understanding the prevalence of such defects in breast tumors using reproducible methodology will help us target these tumors with novel agents and potentially improve outcomes. Hence we sought to assess the prevalence of FA pathway defect in breast tumors by the absence of nuclear FANCD2 (a pivotal protein in the FA/BRCA pathway which is monoubiquitylated in the nucleus in response to DNA damage) repair foci using a novel immunofluorescence method and correlate this with known molecular markers of breast cancer.
Methods: Using primary tumors obtained from the ongoing PARPi clinical trials (NCT01017640 and NCT01251874) and tumor bank, we evaluated 102 breast tumors for the somatic functionality of the FA pathway (FANCD2 foci formation) by the FA Triple Stain Immuno-Fluorescence (FATSI) test performed in a CLIA-certified laboratory using paraffin embedded tissues. The tissue sections are incubated with a primary antibody cocktail of rabbit polyclonal FANCD2 antibody and a monoclonal anti-Ki67 mouse antibody, followed by co-incubation with a secondary antibody (FITC conjugated to anti-rabbit IgG and Alexafluor 594 donkey anti-mouse), mounted on glass slides in a DAPI containing embedding medium and evaluated by a fluorescence microscope. Absence of nuclear FANCD2 formation in 100 proliferating tumor cells was considered positive for FA defect. Hormone receptor (HR) and Her2 status was compared between the groups using Fisher's exact test.
Results: A total of 102 primary breast tumors were analyzed for FANCD2 by FATSI test of which 62 were triple negative (TN), 37 were HR positive and 3 were Her2 positive. Of these, 29 tumors (28%) were positive for FA defect with no significant differences among the molecular subtypes (26% in TN vs 32% in HR + vs 33% in Her2+).
Conclusions: We report a novel methodology to efficiently screen archival FFPE tumors for somatic functional defect of FA DNA repair pathway and demonstrated a high prevalence (one-third) in breast tumors irrespective of molecular subtype. We are currently conducting clinical trials with PARPi including patients with tumors that test positive for FA defect to demonstrate if such tumors are sensitive to PARPi.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr PD10-01.
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Affiliation(s)
- B Ramaswamy
- 1The Ohio State University, Columbus, OH; The Ohio State University
| | - V Srividya
- 1The Ohio State University, Columbus, OH; The Ohio State University
| | - DA Mullins
- 1The Ohio State University, Columbus, OH; The Ohio State University
| | - S Carothers
- 1The Ohio State University, Columbus, OH; The Ohio State University
| | - G Young
- 1The Ohio State University, Columbus, OH; The Ohio State University
| | - D Wenrui
- 1The Ohio State University, Columbus, OH; The Ohio State University
| | - W Zhao
- 1The Ohio State University, Columbus, OH; The Ohio State University
| | - M Lustberg
- 1The Ohio State University, Columbus, OH; The Ohio State University
| | - M Leon
- 1The Ohio State University, Columbus, OH; The Ohio State University
| | - R Weslowski
- 1The Ohio State University, Columbus, OH; The Ohio State University
| | - R Layman
- 1The Ohio State University, Columbus, OH; The Ohio State University
| | - E Mrozek
- 1The Ohio State University, Columbus, OH; The Ohio State University
| | - CL Shapiro
- 1The Ohio State University, Columbus, OH; The Ohio State University
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Majumder S, Lu Y, Teng KY, Kaffenberger T, Zhang X, Nuovo G, Love RR, Ramaswamy B. P4-01-07: Combining Hedgehog Inhibitor, GDC-0449 with Tamoxifen Overcomes Tamoxifen-Resistance in In-Vitro and In-Vivo Studies of Estrogen-Receptor Positive Breast Cancer. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p4-01-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Aims: Approximately 30–40% of patients with estrogen receptor positive (ER+) invasive breast cancer relapse despite targeted endocrine therapy with tamoxifen. Dependency of ER+ breast tumors shifts from estrogen to alternative cell survival mechanisms aberrantly activated over time facilitating drug-resistance and survival. We have identified Hedgehog (Hhg) signaling pathway as one such alternative pathway of survival activated in ER+ tumors that are resistant to tamoxifen. We sought to determine if treating such tumors with Hhg inhibitor and tamoxifen would improve outcomes.
Methods: Using MCF7 cell lines that are either sensitive (parental) or resistant to tamoxifen (4-hydroxy tamoxifen resistant-OHTR) and other ER+ cell lines, expression of Hhg markers (SHH, PTCH, SMO, GLI1, GLI2 and GLI3) and Hhg targets (SNAIL, MYC, BMI1 and FOXM1) was analyzed by Real-time RT-PCR, Western blotting and immunocytochemistry. GLI1 transactivation potential was measured using 8XGLI-Luciferase reporter plasmid. GLI1 was depleted in OHTR and T47D cells using GLI1siRNA. The GLI1 depleted cells were exposed to tamoxifen and assessed for i) cell viability by MTT assay, ii) extent of apoptosis by TUNEL assay and PARP/Caspase cleavage (Western blot), iii) cell cycle profile by flow cytometry and iv) presence of tumor initiating cells (TICs) by mammosphere formation assay. Effect of GDC-0449, a small molecule inhibitor of SMO was tested on OHTR cell induced xenografts in athymic nude mice by monitoring tumor growth and distant metastasis. Correlation of GLI1 expression in primary breast tumor tissues (assessed by immunohistochemistry) and disease-free interval was studied in women enrolled on an ongoing clinical trial (OSU 0483) in premenopausal women with ER+ breast cancer undergoing adjuvant oophorectomy and tamoxifen.
Results: Expression of Hhg signaling molecules and the targets are significantly activated in OHTR cells resistant to 0.5 and 1μM tamoxifen. Serial passage of the resistant cells in mice resulted in aggressive transformation of tumors that micro-metastasized to lung and liver. Concurrent increase in Hhg marker expression, TICs and acquisition of epithelial mesenchymal transition were observed in the cells derived from these tumors. Depletion of GLI1 in OHTR cells resulted in reduced proliferation, colony formation and mammosphere formation and increased apoptosis in presence of tamoxifen. Treatment of OHTR cells with GDC-0449 and tamoxifen inhibited cell proliferation in vitro and supressed tumor growth and distant metastasis of tamoxifen resistant xenografts in mice. Primary human breast tumors expressing higher level of GLI1 demonstrated a trend towards increased risk of recurrence (p= 0.08) after tamoxifen therapy.
Conclusions: Our work has demonstrated for the first time that activated Hhg signaling is an alternate survival mechanism for tamoxifen resistant breast cancer. Furthermore, targeting these tumors with a combination of tamoxifen and anti-Hhg therapy inhibited tumor growth and development of distant metastases demonstrating efficacy of this approach. Clinical trials using this combination in patients with advanced ER+ breast cancer are warranted and are under development.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-01-07.
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Affiliation(s)
- S Majumder
- 1The Ohio State University, Columbus, OH; International Breast Cancer Research Foundation, Madison, WI
| | - Y Lu
- 1The Ohio State University, Columbus, OH; International Breast Cancer Research Foundation, Madison, WI
| | - K-Y Teng
- 1The Ohio State University, Columbus, OH; International Breast Cancer Research Foundation, Madison, WI
| | - T Kaffenberger
- 1The Ohio State University, Columbus, OH; International Breast Cancer Research Foundation, Madison, WI
| | - X Zhang
- 1The Ohio State University, Columbus, OH; International Breast Cancer Research Foundation, Madison, WI
| | - G Nuovo
- 1The Ohio State University, Columbus, OH; International Breast Cancer Research Foundation, Madison, WI
| | - RR Love
- 1The Ohio State University, Columbus, OH; International Breast Cancer Research Foundation, Madison, WI
| | - B Ramaswamy
- 1The Ohio State University, Columbus, OH; International Breast Cancer Research Foundation, Madison, WI
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Lustberg MB, Balasubramanian P, Miller B, Garcia Villa A, Carothers S, Michael B, Mrozek E, Ramaswamy B, Layman RM, Wesolowski R, Shapiro CL, Chalmers JJ. EpCAM-negative cancer–associated circulating cells (CACS) in blood samples of women with triple-negative breast cancer (TNBC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e11559] [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: 11/20/2022] Open
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43
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Andreopoulou E, Chen AP, Zujewski J, Kim M, Hershman DL, Kalinsky K, Cigler T, Vahdat LT, Raptis G, Ramaswamy B, Novik Y, Muggia F, Sparano JA. Randomized, double-blind, placebo-controlled phase II trial of low-dose metronomic cyclophosphamide alone or in combination with veliparib (ABT-888) in chemotherapy-resistant ER and/or PR-positive, HER2/neu-negative metastatic breast cancer: New York Cancer Consortium trial P8853. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.tps114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Viswanathan S, Wesolowski R, Layman RM, Alejandra G, Miller B, Chalmers JJ, Bejastani S, Zhao W, Pierluigu G, Cotrill J, Phelps MA, Schaaf LJ, Geyer SM, Hall N, Knopp MV, Shapiro CL, Villalona-Calero MA, Chen A, Grever MR, Ramaswamy B. A phase I dose-escalation study of ABT-888 (veliparib) in combination with carboplatin in HER2-negative metastatic breast cancer (MBC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.tps106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Nayak DR, Ramaswamy B. Endoscopic approach to middle turbinate squeeze syndrome. Indian J Otolaryngol Head Neck Surg 2011; 64:167-71. [PMID: 23730579 DOI: 10.1007/s12070-011-0245-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 02/14/2010] [Accepted: 06/13/2010] [Indexed: 11/26/2022] Open
Abstract
Middle turbinate squeeze syndrome (MTSS) refers to sino-nasal headache due to intense contact between the middle turbinate and the nasal septum and/or between middle turbinate and other structures in the lateral nasal wall. This study was intended to evaluate the efficacy of precise endoscopic surgical treatment of MTSS. This is a prospective study of 126 patients with refractory cephalgia due to endoscopically confirmed MTSS who underwent functional endoscopic naso-sinus surgery (FENS) wherein the contact points and ostio-meatal complex obstruction were endoscopically relieved. 91% of cases reported improvement/resolution of headache and 95% of cases had relieved contact points as documented endoscopically. This surgery was also found to facilitate resolution of sinus disease, both radiologically (in 64% of cases) and endoscopically (in 94% of cases). Cephalgia caused by MTSS can be effectively treated by an ultra-conservative endoscopic approach.
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Affiliation(s)
- Dipak Ranjan Nayak
- Department of ENT-Head & Neck Surgery, Kasturba Medical College & Hospital, Manipal University, Manipal, 576104 Karnataka India
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Ramaswamy B, Li X, Nuovo G, Lu Y, Shapiro CL, Majumder S. Abstract S6-9: Expression of Hedgehog Proteins in the Epithelial and Stromal Compartments of Primary Breast Tumors and Its Prognostic Significance. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-s6-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: Aberrant hedgehog (Hh) signaling has been reported in various cancers including breast cancers and clinical trials targeting this pathway are currently ongoing. Preclinical evidence suggests that increased ligand-dependent Hh signaling in breast tumor epithelial (E) cells cross-talks and activates Hh pathway in the stroma (S) but the clinical implication of this E/S interaction is unknown. We sought to determine the expression of Hh proteins in the E and S compartments of primary breast tumor samples and correlate with clinical outcomes.
Methods: Using tissue microarray (TMA) of ∼500 primary breast cancer samples (OSU 2009C009 A) that includes both primary breast tumor and axillary metastasis, the expression pattern of the key Hh signaling proteins (Shh, Gli-1, SMO, Ptch1) and a target gene of the pathway (BMI1) was determined by immunohistochemistry (IHC) in both the epithelial and stromal tissues and compared to other known prognostic/predictive markers such as age, stage, estrogen/progesterone receptor (ER/PR)/HER2 status and to disease-free survival (DFS). IHC was performed using Benchmark LT automated system from Ventana Medical Systems using previously published methods (Nuovo GJ, Nature protocols, 2009). Scoring was done by combining the intensity and percentage of cells staining with respective antibodies by three independent measurements.
Results: Analysis of a total of 315 primary breast tumors revealed the following percentage of tumors with high expression of Hh proteins in the E/S compartments respectively: Shh (72/31%), Gli-1 (69/53%), SMO (40/64%), and Ptch-1 (93/74%). Analyzing the interaction between the epithelial and stromal expressions of these proteins, we found positive correlation between i) high Shh and SMO in the epithelial cells and Gli-1 in the stroma, and ii) high Gli-1 in the epithelial cells and target protein Bmi1 in the stroma. High intensity staining of Gli-1 in the tumor epithelial cells was significantly associated with higher stage, grade, ER negative status and worse DFS. Adjusting for stage and ER status, tumors with increased epithelial Gli-1 expression was still significantly associated with worse DFS (p=0.0131, survival analysis) when compared to tumors with low expression. In particular, among the ER negative and node positive patients higher Gli-1 expression in epithelial cells was very significantly associated with poor DFS (p= <0.0001). Staining for other target proteins in these tumors is currently ongoing.
Conclusions: We report here for the first time a positive correlation between expression of Hh proteins in the stromal and epithelial compartment of primary breast tumors. Furthermore, we observed that higher Gli-1 expression in the tumor epithelial cells was associated with worse DFS, particularly in the ER negative, node-positive tumors suggesting that aberrant Hh signaling may contribute to drug-resistance and hence a rationale therapeutic target. Further correlative studies between clinical parameters and additional Hh target genes in these tumors are in progress.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr S6-9.
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Affiliation(s)
| | - X Li
- The Ohio State University, Columbus
| | - G Nuovo
- The Ohio State University, Columbus
| | - Y Lu
- The Ohio State University, Columbus
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Zhao W, Duan W, Leon ME, Chen AP, Sofletea G, Thurmond J, Ramaswamy B, O'Malley D, Bekaii-Saab TS, Villalona- Calero MA. Targeting fanconi anemia (FA) repair pathway deficiency for treatment with PARP inhibitors. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.tps168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Mrozek E, Lustberg MB, Knopp MV, Spigos DG, Yang X, Houton LA, Ramaswamy B, Layman RM, Povoski SP, Agnese DM. Phase II trial of neoadjuvant chemotherapy (NCT) with weekly nanoparticle albumin-bound paclitaxel (Nab-P), carboplatin (CBP), and bevacizumab (BEV) in women with clinical stages II-III breast cancer (BC): Pathologic response prediction by changes in angiogenic volume (AV) by dynamic contrast magnetic resonance imaging (DCE-MRI). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.604] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
Breast carcinogenesis is a multistep process involving both genetic and epigenetic changes. Epigenetics is defined as a reversible and heritable change in gene expression that is not accompanied by alteration in gene sequence. DNA methylation and histone modifications are the two major epigenetic changes that influence gene expression in cancer. The interaction between methylation and histone modification is intricately orchestrated by the formation of repressor complexes. Several genes involved in proliferation, antiapoptosis, invasion and metastasis have been shown to be methylated in various malignant and premalignant breast neoplasms. The histone deacetylase inhibitors (HDi) have emerged as an important class of drugs to be used synergistically with other systemic therapies in the treatment of breast cancer. Since epigenetic changes are potentially reversible processes, much effort has been directed toward understanding this mechanism with the goal of finding novel therapies as well as more refined diagnostic and prognostic tools in breast cancer.
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Affiliation(s)
- M B Lustberg
- Division of Hematology and Oncology, Comprehensive Cancer Center, The Ohio State University Medical Center, USA
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Ramaswamy B, Phelps M, Baiocchi R, Bekaii-Saab T, Wilkins D, Arbogast D, Campbell A, Doyle AL, Grever M, Shah M. A phase I study of flavopiridol using an alternative schedule in patients (pts) with advanced solid tumors. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.2580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2580 Background: A phase I study of flavopiridol, a cyclin-dependent kinase inhibitor, using an alternative schedule was conducted in pts with solid tumors given its promising activity in pts with chronic lymphocytic leukemia (CLL). Methods: Using standard 3x3 ph I dose escalation design, NCI-sponsored trial was performed to determine the safety and dose-limiting toxicity (DLT) of flavopiridol given as a 30-min IV loading dose followed by a 4-hr infusion weekly for 4 wks repeated every 6 wks. DLT was defined as Gr 4 hematologic toxicity (HT) for > 7 days, > Gr 3 non-HT except Gr 3 fatigue or diarrhea resolving <4 days and cytokine release syndrome (CRS) > Gr 3 despite steroids. Blood samples were obtained at pre-dose and 0.5, 1, 3, 4.5, 6, 8, 24, and 48-hr after start of first bolus dose for pharmacokinetics (PK). Results: 26 pts with advanced solid tumors with a median age of 63 (44–75) yrs were enrolled. Median no. of doses was 7.5 (1–24). Table 1 outlines the PK parameters, DLTs and CRS. Due to a grade 5 CRS/death in cohort 3, the protocol was amended to include 20 mg IV dexamethasone prior to flavopiridol to prevent CRS (cohorts 2B, 1B). Of the 20 evaluable pts, 35% had stable- and 65% had progressive-disease. Results of serum cytokines (IL-2, IL-4, IL-6, TNF-a, IFN-g, IL-10) levels will be presented. Conclusions: There was a higher frequency of CRS, despite prophylactic steroids seen our pts with solid tumors compared to previous studies with CLL and this correlated with AUC. PK and toxicity profile in our pt population differs from pts with hematologic malignancies administered flavopiridol on the same schedule. Protein binding and serum albumin levels are under evaluation as potential contributors. This work is supported by NCI U01-CA76576. [Table: see text] [Table: see text]
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Affiliation(s)
- B. Ramaswamy
- The Ohio State University, Columbus, OH; CTEP, NCI, Bethesda, MD
| | - M. Phelps
- The Ohio State University, Columbus, OH; CTEP, NCI, Bethesda, MD
| | - R. Baiocchi
- The Ohio State University, Columbus, OH; CTEP, NCI, Bethesda, MD
| | - T. Bekaii-Saab
- The Ohio State University, Columbus, OH; CTEP, NCI, Bethesda, MD
| | - D. Wilkins
- The Ohio State University, Columbus, OH; CTEP, NCI, Bethesda, MD
| | - D. Arbogast
- The Ohio State University, Columbus, OH; CTEP, NCI, Bethesda, MD
| | - A. Campbell
- The Ohio State University, Columbus, OH; CTEP, NCI, Bethesda, MD
| | - A. L. Doyle
- The Ohio State University, Columbus, OH; CTEP, NCI, Bethesda, MD
| | - M. Grever
- The Ohio State University, Columbus, OH; CTEP, NCI, Bethesda, MD
| | - M. Shah
- The Ohio State University, Columbus, OH; CTEP, NCI, Bethesda, MD
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