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Jebrin R, El Nekidy WS, Abidi E, John TLS, Kesav P, Hussain SI, Abdelsalam M, Khaled L, Raj D, John S. Racial differences in P2Y12 inhibitor responsiveness in patients undergoing neuro-endovascular procedures: A cohort from the Middle East. Clin Neurol Neurosurg 2024; 239:108167. [PMID: 38402103 DOI: 10.1016/j.clineuro.2024.108167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 02/04/2024] [Accepted: 02/05/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Data on P2Y12 inhibitors responsiveness from the middle east is scarce. We sought to investigate patient responsiveness to P2Y12 inhibitors within a cohort of major races that characterize the UAE population. The secondary objective was to assess risk factors for hyper and hypo-responsiveness in this population. METHODS We conducted a cross-sectional study on adults who received either clopidogrel or ticagrelor treatments and had platelet responsiveness testing before undergoing neuro-endovascular interventions at our quaternary care hospital between March 2015 and April 2019. RESULTS During the study period, 249 subjects met the inclusion criteria. Overall, 17.3 % were hyper-responsive and 25.7 % were hypo-responsive to P2Y12 inhibitors. When comparing between the P2Y12 inhibitors, rates of hyper-responsiveness were significantly higher to ticagrelor when compared to clopidogrel (11 versus 6 %, p = 0.02 respectively). Contrarily, hypo-responsiveness rates were significantly higher in clopidogrel treated patients compared to their ticagrelor treated counterparts (23 versus 2 %, p < .001 respectively). Patients of Middle-Eastern origin showed a significantly higher rate of hypo-responsiveness to both clopidogrel and ticagrelor when compared to other races (41.1 % and 26.7 %, P < 0.001 respectively). Asians showed the highest rates of hyper-responsiveness for both agents. Multivariate logistic regression analysis showed that proton pump inhibitors and statin combination, (OR: 6.39, 95 %CI [1.60, 25.392]), and Middle East vs. Indian subcontinent patients (OR: 4.67, 95 %CI [1.79-12.14]) were independent predictors of hypo-responsiveness to both P2Y12 inhibitors. CONCLUSION This study demonstrated a high rate of hypo-responsiveness to P2Y12 inhibitors in a UAE cohort of patients undergoing neuro-endovascular procedures. In addition, therapeutic responsiveness to P2Y12 inhibitors varied markedly based on the racial background. Future larger studies are needed to evaluate genetic variations that may contribute to this rate of hypo-responsiveness in our population.
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Affiliation(s)
- Rita Jebrin
- Cleveland Clinic Abu Dhabi, Abu Dhabi, the United Arab Emirates
| | - Wasim S El Nekidy
- Cleveland Clinic Abu Dhabi, Abu Dhabi, the United Arab Emirates; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States
| | - Emna Abidi
- Cleveland Clinic Abu Dhabi, Abu Dhabi, the United Arab Emirates
| | | | - Praveen Kesav
- Cleveland Clinic Abu Dhabi, Abu Dhabi, the United Arab Emirates; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States
| | - Syed I Hussain
- Cleveland Clinic Abu Dhabi, Abu Dhabi, the United Arab Emirates
| | | | - Luna Khaled
- Cleveland Clinic Abu Dhabi, Abu Dhabi, the United Arab Emirates
| | - Divya Raj
- Cleveland Clinic Abu Dhabi, Abu Dhabi, the United Arab Emirates
| | - Seby John
- Cleveland Clinic Abu Dhabi, Abu Dhabi, the United Arab Emirates; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States.
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John S, Khan M, Kesav P, Raj D, Hussain SI. Primary Angiitis of Central Nervous System related intracranial aneurysm with spontaneous occlusion after immunomodulatory treatment. J Cerebrovasc Endovasc Neurosurg 2024:jcen.2024.E2023.04.010. [PMID: 38287464 DOI: 10.7461/jcen.2024.e2023.04.010] [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: 04/14/2023] [Accepted: 01/02/2024] [Indexed: 01/31/2024] Open
Abstract
Primary Angiitis of the Central Nervous System (PACNS) is an uncommon disease with kaleidoscopic clinical manifestations. Ischemic strokes are commoner than their hemorrhagic counterpart. Intracranial pseudoaneurysms are rarely reported in PACNS cohorts. We hereby describe the case of a 39-year-old female, who presented for evaluation of acute onset of left middle cerebral artery (MCA) ischemic stroke, with cerebral angiogram showing multifocal stenosis and irregularities in intracranial blood vessels with an aneurysm arising from the lenticulostriate branch of the left MCA M1 segment. A diagnosis of probable PACNS was made and patient initiated on immunomodulatory treatment with corticosteroids. 12 weeks follow up neuroimaging studies revealed resolution of the previously described intracranial aneurysm, thereby postulating the possibility of a pseudoaneurysm related to the underlying angiitis.
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Affiliation(s)
- Seby John
- Department of Neurology and Neurointerventional Surgery, Neurological Institute (NI), Cleveland Clinic Abu Dhabi (CCAD), Abu Dhabi, UAE
| | - Muhammad Khan
- Department of Biomedical Engineering, Khalifa University, Abu Dhabi, UAE
| | - Praveen Kesav
- Department of Neurology, Neurological Institute (NI), Cleveland Clinic Abu Dhabi (CCAD), Abu Dhabi, UAE
| | - Divya Raj
- Department of Neurology, Neurological Institute (NI), Cleveland Clinic Abu Dhabi (CCAD), Abu Dhabi, UAE
| | - Syed Irteza Hussain
- Department of Neurology and Neurointerventional Surgery, Neurological Institute (NI), Cleveland Clinic Abu Dhabi (CCAD), Abu Dhabi, UAE
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Ambili R, Ramadas K, Nair LM, Raj D, Nazeer F, George PS, Rejnish Kumar R, Radhakrishna Pillai M. Efficacy of a herbal mouthwash for management of periodontitis and radiation-induced mucositis - A consolidated report of two randomized controlled clinical trials. J Ayurveda Integr Med 2023; 14:100791. [PMID: 37897968 PMCID: PMC10641263 DOI: 10.1016/j.jaim.2023.100791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 07/25/2023] [Accepted: 07/31/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Oral diseases like periodontitis and mucositis often require home care using topical agents in the form of mouthwashes. Many herbal mouthwashes are found to be beneficial; however lack proper scientific evidence to support their use. OBJECTIVES Study 1 evaluated clinical efficacy of herbal mouthwash in the management of chronic periodontitis in comparison with chlorhexidine mouthwash. Study 2 aimed at assessment of herbal mouthwash in patients of radiation-induced mucosititis. METHODS The novel herbal mouthwash used in the present study wa prepared from extracts of five plants namely Emblica Officinalis, Terminalia chebula, Terminalia bellerica, Glycyrrhiza glabra, and Azadirachta indica. 50 periodontitis patients were randomly allocated to two groups. As per allocation, they were instructed to use either herbal mouthwash or chlorhexidine mouthwash twice daily for two weeks after nonsurgical periodontal therapy. Similarly, patients with radiation-induced mucositis were randomly given herbal mouthwash and soda saline mouthwash. Intergroup and intragroup comparisons of continuous variables were conducted using paired and unpaired t-tests. Categorical variables were compared using the chi-square test. RESULTS Significant reductions in gingival bleeding, plaque accumulation, and pocket depth were noticed in periodontitis patients in both groups. Patients reported acceptable taste, freshness, and satisfaction after the use of herbal mouthwash. The herbal mouthwash group noticed a significant reduction in the severity of radiation-induced mucositis and analgesic requirements. The intensity of pain, dryness of mouth, oral hygiene, and need for the use of antibiotic and antifungal during radiotherapy was not significant among the groups. CONCLUSION The results of this preliminary clinical trial support the use of the tested herbal formulation mouthwash as an adjunct in the treatment of periodontitis as well as radiation-induced mucositis. CLINICAL TRIAL REGISTRATION NUMBER For Study 1: CTRI/2019/10/021574, Study 2: CTRI/2020/04/024851.
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Affiliation(s)
- R Ambili
- Department of Periodontics, PMS College of Dental Science and Research, Thiruvananthapuram, India.
| | - K Ramadas
- Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram, India
| | - Lekha M Nair
- Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram, India
| | - Divya Raj
- Division of Dental Care, Regional Cancer Centre, Thiruvananthapuram, India
| | - Farida Nazeer
- Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram, India
| | - Preethi Sara George
- Division of Cancer Epidemiology, Regional Cancer Centre, Thiruvananthapuram, India
| | - R Rejnish Kumar
- Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram, India
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Math SB, Manjunatha N, Kumar CN, Dinakaran D, Gowda GS, Rao GN, Parthasarathy R, Raj D, Srikanth TK, Gangadhar BN. Mental Healthcare Management System (e-MANAS) to implement India's mental healthcare act, 2017: Methodological design, components, and its implications. Asian J Psychiatr 2021; 57:102391. [PMID: 33187888 DOI: 10.1016/j.ajp.2020.102391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Suresh Bada Math
- Tele Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, India.
| | - Narayana Manjunatha
- Tele Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, India.
| | - Channaveerachari Naveen Kumar
- Tele Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, India.
| | - Damodaran Dinakaran
- Tele Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, India.
| | - Guru S Gowda
- Tele Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, India.
| | - Girish N Rao
- Department of Epidemiology, Centre for Public Health, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, India.
| | - Rajani Parthasarathy
- National Health Mission, Department of Health and Family Welfare Services, Govt. of Karnataka, Bengaluru, India.
| | - Divya Raj
- Electronic Health Research Centre, International Institute of Information Technology, Bengaluru, India.
| | - T K Srikanth
- Electronic Health Research Centre, International Institute of Information Technology, Bengaluru, India.
| | - Bangalore N Gangadhar
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru 560029, India.
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Kandwal A, Saini S, Ahmad M, Nautiyal V, Pattanayak M, Raj D, Takao U. Validation of a Novel 'Supportive Oral Care Protocol' (SOCP), a Model for Care in Head and Neck Cancer Patients at Tertiary Cancer Centre in India. Indian J Surg Oncol 2020; 11:769-777. [PMID: 33299289 PMCID: PMC7714890 DOI: 10.1007/s13193-020-01256-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/08/2020] [Indexed: 12/24/2022] Open
Abstract
India has a huge burden of head and neck cancer and specifically oral cancer. Supportive oral care is not a standard of care in our population and is often neglected. Currently, there are no specific guidelines for such care in India which could be followed. The aim of this study is to validate a novel institutional supportive oral care protocol (SOCP) for head and neck cancer patients. This protocol is specific to our population developed for head and neck/dental oncology experts working in cancer centres to provide comprehensive care. This is a cross-sectional validity study. Fifteen dental oncology experts working in cancer centres/hospitals across India and six oncology experts from our centre were enrolled. All experts provided their inputs on 41 points of the SOCP. The data was analysed for item validity, content validity index and inter-rater agreement. The statistical analyses used were kappa measure for inter-rater agreement and content validity index for item-wise agreement. Out of 861 responses from all the reviewers, 91% agreed, 8.4% agreed with modification and 0.6% disagreed. The content validity index and agreement between reviewers ranged from 0.9 to 1 for kappa measure. The SOCP of our institution was shown to be a valid protocol. SOCP addresses oral and dental supportive care and rehabilitation as part of overall comprehensive care for head and neck cancer patients in our population.
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Affiliation(s)
- Abhishek Kandwal
- Department of Dental Surgery, Cancer Research Institute, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun Uttarakhand, India
| | - Sunil Saini
- Department of Surgical Oncology, Cancer Research Institute, Swami Rama Himalayan University, Dehradun Uttarakhand, India
| | - Mustaq Ahmad
- Department of Radiation Oncology, Cancer Research Institute, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun Uttarakhand, India
| | - Vipul Nautiyal
- Department of Radiation Oncology, Cancer Research Institute, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun Uttarakhand, India
| | - Manisa Pattanayak
- Department of Surgical Oncology, Cancer Research Institute, Swami Rama Himalayan University, Dehradun Uttarakhand, India
| | - Divya Raj
- Dental Unit, Regional Cancer Center, Thiruvananthapuram, Kerala India
| | - Ueno Takao
- Dental Division, National Cancer Center, Tokyo, Japan
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Weibel S, Schaefer MS, Raj D, Rücker G, Pace NL, Schlesinger T, Meybohm P, Kienbaum P, Eberhart LHJ, Kranke P. Drugs for preventing postoperative nausea and vomiting in adults after general anaesthesia: an abridged Cochrane network meta-analysis. Anaesthesia 2020; 76:962-973. [PMID: 33170514 DOI: 10.1111/anae.15295] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 12/12/2022]
Abstract
Postoperative nausea and vomiting is a common adverse effect of anaesthesia. Although dozens of different anti-emetics are available for clinical practice, there is currently no comparative ranking of efficacy and safety of these drugs to inform clinical practice. We performed a systematic review with network meta-analyses to compare, and rank in terms of efficacy and safety, single anti-emetic drugs and their combinations, including 5-hydroxytryptamine3 , dopamine-2 and neurokinin-1 receptor antagonists; corticosteroids; antihistamines; and anticholinergics used to prevent postoperative nausea and vomiting in adults after general anaesthesia. We systematically searched for placebo-controlled and head-to-head randomised controlled trials up to November 2017 (updated in April 2020). We assessed how trustworthy the evidence was using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) and Confidence In Network Meta-Analysis (CINeMA) approaches for vomiting within 24 h postoperatively, serious adverse events, any adverse event and drug class-specific side-effects. We included 585 trials (97,516 participants, 83% women) testing 44 single drugs and 51 drug combinations. The studies' overall risk of bias was assessed as low in only 27% of the studies. In 282 trials, 29 out of 36 drug combinations and 10 out of 28 single drugs lowered the risk of vomiting at least 20% compared with placebo. In the ranking of treatments, combinations of drugs were generally more effective than single drugs. Single neurokinin-1 receptor antagonists were as effective as other drug combinations. Out of the 10 effective single drugs, certainty of evidence was high for aprepitant, with risk ratio (95%CI) 0.26 (0.18-0.38); ramosetron, 0.44 (0.32-0.59); granisetron, 0.45 (0.38-0.54); dexamethasone, 0.51 (0.44-0.57); and ondansetron, 0.55 (0.51-0.60). It was moderate for fosaprepitant, 0.06 (0.02-0.21) and droperidol, 0.61 (0.54-0.69). Granisetron and amisulpride are likely to have little or no increase in any adverse event compared with placebo, while dimenhydrinate and scopolamine may increase the number of patients with any adverse event compared with placebo. So far, there is no convincing evidence that other single drugs effect the incidence of serious, or any, adverse events when compared with placebo. Among drug class specific side-effects, evidence for single drugs is mostly not convincing. There is convincing evidence regarding the prophylactic effect of at least seven single drugs for postoperative vomiting such that future studies investigating these drugs will probably not change the estimated beneficial effect. However, there is still considerable lack of evidence regarding safety aspects that does warrant investigation.
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Affiliation(s)
- S Weibel
- Department of Anaesthesia and Critical Care, University of Wuerzburg, Wuerzburg, Germany
| | - M S Schaefer
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Department of Anaesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - D Raj
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Queen Elizabeth University Hospital, Glasgow, UK
| | - G Rücker
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - N L Pace
- Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA
| | - T Schlesinger
- Department of Anaesthesia and Critical Care, University of Wuerzburg, Wuerzburg, Germany
| | - P Meybohm
- Department of Anaesthesia and Critical Care, University of Wuerzburg, Wuerzburg, Germany
| | - P Kienbaum
- Department of Anaesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - L H J Eberhart
- Department of Anaesthesiology and Intensive Care Medicine, Philipps-University Marburg, Marburg, Germany
| | - P Kranke
- Department of Anaesthesia and Critical Care, University of Wuerzburg, Wuerzburg, Germany
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Raj D, Santhi S, Sapharina GJS. Effectiveness of neurobic exercise program on memory and depression among elderly residing at old age home. J Complement Integr Med 2020; 17:/j/jcim.ahead-of-print/jcim-2019-0221/jcim-2019-0221.xml. [PMID: 32941162 DOI: 10.1515/jcim-2019-0221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/26/2019] [Indexed: 01/21/2023]
Abstract
Objectives This study finds out the effectiveness of neurobic exercise program on memory and depression among elderly residing in old age homes. Methods The non-probability purposive sampling technique was used for sample selection. Wechsler's memory scale (WMS-IV) and Geriatric depression scale (GDS) were the instruments used to assess the memory and depression among elderly during the pretest and posttest, respectively and the researcher had developed data sheet to collect information about the background variables using interview technique. Results The neurobic exercise program was found to be effective in reducing depression among elderly residing in old age homes. There was a significant difference (p<0.001) in the level of depression had been found during the pretest and posttest in the interventional group. There was a statistically significant difference (p<0.001) found between the study group and in the control group. There was significant correlation (r=0.417, p<0.05) found between the memory and depression during the pretest in the study group among the elderly. A statistically significant association (p<0.05) found in the mean scores of depression and marital status of the elderly during the pretest in the study group and there was a significant association (p<0.01) found in the mean scores of depression and the gender of the elderly during the pretest and posttest in the non interventional group were found. Conclusions The findings suggested that neurobic exercise program is an effective intervention in improving memory and reducing depression.
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Affiliation(s)
- Divya Raj
- Sri Ramachandra College of Nursing, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Porur, Chennai, 600116, India
| | - Subramaniam Santhi
- Sri Ramachandra College of Nursing, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Porur, Chennai, 600116, India
| | - G J Sara Sapharina
- Sri Ramachandra College of Nursing, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Porur, Chennai, 600116, India
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Abstract
Introduction
Speech is a overlaid function of respiratory, phonatory, resonatory, articulatory systems . Nasalance can be defined as the relative amounts of oral and nasal acoustic energy in speech done by modification of oral and nasal cativities that is complex activity of the resonator system. Nasometer was developed by Samuel Fletcher, Larry Adams, and Martin McCutcheon at the University is a computer based instrument facilitating accurate analysis of signal yielding nasalance scores. There is no report regarding nasalence score variance in khasi language speakers speaking English.
Materials and Methods
The study aims at analysing and measuring nasalence score in Khasi speakers reading English passages. A total of 5 female subjects were chosen who were native speakers of khasi language and who had exposure of English language since childhoods were selected. Nasometer II Model 6400 (Software version 2.6) of Key Elemetrics Corporation was used. Three standardized passages (Zoo passage, Rainbow passage and nasal sentences) were used for the study.
Results
The mean nasalance scores obtained for zoo, rainbow and nasal sentences in female were 19.39± 12.21 SD, 38.13 ± 14.83 SD, 68.33 ± 15.29 SD and 18.26 ± 3.53 SD, 33.13 ± 1.68 SD, 63.20 ± 88 SD respectively. Standard norms show significant differences in nasalance scores obtained for Zoo, Rainbow and Nasal Sentences. Paired t-test was used for comparison among the sentences and computation of data show more significant differences for nasal sentences as compared to zoo and rainbow sentences, that is significant (p>0.05). Rainbow sentences revealed more nasalance scores than zoo sentences (p>0.05) i.e. level of significance.
Conclusion
The reported normative Nasalance data can be used by several voice clinicians for assessing resonance quantitively for khasi speakers using austrioasiatic language.
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Bradford CM, McDonnell T, Raj D, Robinson GA, Cole A, Ramakrishnan S, González-Serrano R, Mak J, Eskiocak YC, Isenberg DA, Ciurtin C, Jury EC, Manson JJ. Characterization of a Subset of Patients With Rheumatoid Arthritis for Whom Current Management Strategies are Inadequate. ACR Open Rheumatol 2019; 1:145-155. [PMID: 31777790 PMCID: PMC6857995 DOI: 10.1002/acr2.1021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Indexed: 01/31/2023] Open
Abstract
Objective A subset of patients with seropositive rheumatoid arthritis (RA) do not mount a C‐reactive protein (CRP) response during flares. We hypothesize that these patients are more likely to experience poor clinical care and less likely to respond to traditional therapy. This study questioned whether this presentation was associated with worse disease outcome and distinct immunological features. Methods Using Power Doppler ultrasound, 48 RA patients with active synovitis were recruited; 30 had normal (n)CRP (5 mg/L or less) and 18 had high (h)CRP (more than 5 mg/L) levels. All had equivalent disease burden assessed by other clinical and laboratory parameters. Results Time to diagnosis and time to first disease‐modifying antirheumatic drug were significantly longer in nCRP compared with hCRP patients (P < 0.05). Significantly more nCRP patients needed escalation to biologics after 2‐year follow‐up (P = 0.01). The inflammatory milieu was also different between the two subgroups. Synergy between inflammatory cytokines observed in hCRP patients was lost in nCRP patients, and nCRP patients had significantly increased regulatory T‐cell (Treg) frequencies that correlated positively with predictors of poor disease outcome. Conversely, hCRP but not nCRP patients demonstrated a significant upregulation of alternative complement pathway factors that correlated negatively with Treg frequency. Conclusion Patients with nCRP during flares of RA had an altered immunological profile compared with hCRP patients and experienced diagnostic delays and responded less favorably to conventional treatment.
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Affiliation(s)
| | | | | | | | - Andrew Cole
- University College London Hospital London UK
| | | | | | | | | | - David A Isenberg
- University College London and University College London Hospital London UK
| | - Coziana Ciurtin
- University College London and University College London Hospital London UK
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David T, Raj D, Ahmad M. 006 Macrophage activation syndrome as a complication of adult onset Still's disease: a case series. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key075.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Trixy David
- Rheumatology, Salford Royal NHS Foundation Trust, Manchester, UNITED KINGDOM
| | - Divya Raj
- Rheumatology, University College London, London, UNITED KINGDOM
| | - Masroor Ahmad
- Rheumatology, North Manchester General Hospital, Manchester, UNITED KINGDOM
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Raj D, Yin Z, Breur M, Doorduin J, Holtman IR, Olah M, Mantingh-Otter IJ, Van Dam D, De Deyn PP, den Dunnen W, Eggen BJL, Amor S, Boddeke E. Increased White Matter Inflammation in Aging- and Alzheimer's Disease Brain. Front Mol Neurosci 2017; 10:206. [PMID: 28713239 PMCID: PMC5492660 DOI: 10.3389/fnmol.2017.00206] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [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: 04/04/2017] [Accepted: 06/12/2017] [Indexed: 11/13/2022] Open
Abstract
Chronic neuroinflammation, which is primarily mediated by microglia, plays an essential role in aging and neurodegeneration. It is still unclear whether this microglia-induced neuroinflammation occurs globally or is confined to distinct brain regions. In this study, we investigated microglia activity in various brain regions upon healthy aging and Alzheimer's disease (AD)-related pathology in both human and mouse samples. In purified microglia isolated from aging mouse brains, we found a profound gene expression pattern related to pro-inflammatory processes, phagocytosis, and lipid homeostasis. Particularly in white matter microglia of 24-month-old mice, abundant expression of phagocytic markers including Mac-2, Axl, CD16/32, Dectin1, CD11c, and CD36 was detected. Interestingly, in white matter of human brain tissue the first signs of inflammatory activity were already detected during middle age. Thus quantification of microglial proteins, such as CD68 (commonly associated with phagocytosis) and HLA-DR (associated with antigen presentation), in postmortem human white matter brain tissue showed an age-dependent increase in immunoreactivity already in middle-aged people (53.2 ± 2.0 years). This early inflammation was also detectable by non-invasive positron emission tomography imaging using [11C]-(R)-PK11195, a ligand that binds to activated microglia. Increased microglia activity was also prominently present in the white matter of human postmortem early-onset AD (EOAD) brain tissue. Interestingly, microglia activity in the white matter of late-onset AD (LOAD) CNS was similar to that of the aged clinically silent AD cases. These data indicate that microglia-induced neuroinflammation is predominant in the white matter of aging mice and humans as well as in EOAD brains. This white matter inflammation may contribute to the progression of neurodegeneration, and have prognostic value for detecting the onset and progression of aging and neurodegeneration.
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Affiliation(s)
- Divya Raj
- Department of Neuroscience, Section Medical Physiology, University Medical Center Groningen, University of GroningenGroningen, Netherlands
| | - Zhuoran Yin
- Department of Neuroscience, Section Medical Physiology, University Medical Center Groningen, University of GroningenGroningen, Netherlands.,Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, China
| | - Marjolein Breur
- Department of Pathology, VU University Medical CenterAmsterdam, Netherlands
| | - Janine Doorduin
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of GroningenGroningen, Netherlands
| | - Inge R Holtman
- Department of Neuroscience, Section Medical Physiology, University Medical Center Groningen, University of GroningenGroningen, Netherlands
| | - Marta Olah
- Department of Neuroscience, Section Medical Physiology, University Medical Center Groningen, University of GroningenGroningen, Netherlands
| | - Ietje J Mantingh-Otter
- Department of Neuroscience, Section Medical Physiology, University Medical Center Groningen, University of GroningenGroningen, Netherlands
| | - Debby Van Dam
- Laboratory of Neurochemistry and Behavior, Institute Born-Bunge, University of AntwerpWilrijk, Belgium.,Department of Neurology and Alzheimer Research Center, University Medical Center Groningen, University of GroningenGroningen, Netherlands
| | - Peter P De Deyn
- Laboratory of Neurochemistry and Behavior, Institute Born-Bunge, University of AntwerpWilrijk, Belgium.,Department of Neurology and Alzheimer Research Center, University Medical Center Groningen, University of GroningenGroningen, Netherlands.,Biobank, Institute Born-BungeWilrijk, Belgium
| | - Wilfred den Dunnen
- Department of Pathology, University Medical Center Groningen, University of GroningenGroningen, Netherlands
| | - Bart J L Eggen
- Department of Neuroscience, Section Medical Physiology, University Medical Center Groningen, University of GroningenGroningen, Netherlands
| | - Sandra Amor
- Department of Pathology, VU University Medical CenterAmsterdam, Netherlands.,Neuroimmunology Unit, Blizard Institute of Cell and Molecular Science, Barts and The London School of Medicine and DentistryLondon, United Kingdom
| | - Erik Boddeke
- Department of Neuroscience, Section Medical Physiology, University Medical Center Groningen, University of GroningenGroningen, Netherlands
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Saluja S, Pavel J, Raj D, Irwin B, Zhu D, Gray T, Hargreaves M, Sett A, Anderson S. 117 Incidental finding of coronary artery calcification in non-triggered high-resolution thoracic computed tomography: a retrospective study of reporting standards in a single trust. Heart 2017. [DOI: 10.1136/heartjnl-2017-311726.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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13
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Yin Z, Raj D, Saiepour N, Van Dam D, Brouwer N, Holtman IR, Eggen BJL, Möller T, Tamm JA, Abdourahman A, Hol EM, Kamphuis W, Bayer TA, De Deyn PP, Boddeke E. Immune hyperreactivity of Aβ plaque-associated microglia in Alzheimer's disease. Neurobiol Aging 2017; 55:115-122. [PMID: 28434692 DOI: 10.1016/j.neurobiolaging.2017.03.021] [Citation(s) in RCA: 169] [Impact Index Per Article: 24.1] [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: 11/11/2016] [Revised: 03/12/2017] [Accepted: 03/19/2017] [Indexed: 11/25/2022]
Abstract
Alzheimer's disease (AD) is strongly associated with microglia-induced neuroinflammation. Particularly, Aβ plaque-associated microglia take on an "activated" morphology. However, the function and phenotype of these Aβ plaque-associated microglia are not well understood. We show hyperreactivity of Aβ plaque-associated microglia upon systemic inflammation in transgenic AD mouse models (i.e., 5XFAD and APP23). Gene expression profiling of Aβ plaque-associated microglia (major histocompatibility complex II+ microglia) isolated from 5XFAD mice revealed a proinflammatory phenotype. The upregulated genes involved in the biological processes (gene ontology terms) included: "immune response to external stimulus" such as Axl, Cd63, Egr2, and Lgals3, "cell motility", such as Ccl3, Ccl4, Cxcr4, and Sdc3, "cell differentiation", and "system development", such as St14, Trpm1, and Spp1. In human AD tissue with similar Braak stages, expression of phagocytic markers and AD-associated genes, including HLA-DRA, APOE, AXL, TREM2, and TYROBP, was higher in laser-captured early-onset AD (EOAD) plaques than in late-onset AD plaques. Interestingly, the nonplaque parenchyma of both EOAD and late-onset AD brains, the expression of above-mentioned markers were similarly low. Here, we provide evidence that Aβ plaque-associated microglia are hyperreactive in their immune response and phagocytosis in the transgenic AD mice as well as in EOAD brain tissue. We suggest that Aβ plaque-associated microglia are the primary source of neuroinflammation related to AD pathology.
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Affiliation(s)
- Zhuoran Yin
- Section Medical Physiology, Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Divya Raj
- Section Medical Physiology, Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Nasrin Saiepour
- Department of Neuropathology, University Medical Center Goettingen, Goettingen, Germany
| | - Debby Van Dam
- Laboratory of Neurochemistry and Behavior, Institute Born-Bunge, University of Antwerp, Wilrijk, Belgium; Department of Neurology and Alzheimer Research Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Nieske Brouwer
- Section Medical Physiology, Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Inge R Holtman
- Section Medical Physiology, Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Bart J L Eggen
- Section Medical Physiology, Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Thomas Möller
- Neuroinflammation Disease Biology Unit, Lundbeck Research USA, Paramus, NJ, USA
| | - Joseph A Tamm
- Neuroinflammation Disease Biology Unit, Lundbeck Research USA, Paramus, NJ, USA
| | - Aicha Abdourahman
- Neuroinflammation Disease Biology Unit, Lundbeck Research USA, Paramus, NJ, USA
| | - Elly M Hol
- Department of Translational Neuroscience, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands; Astrocyte biology & Neurodegeneration, Netherlands Institute for Neuroscience, Amsterdam, the Netherlands; Center for Neuroscience, Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, the Netherlands
| | - Willem Kamphuis
- Astrocyte biology & Neurodegeneration, Netherlands Institute for Neuroscience, Amsterdam, the Netherlands
| | - Thomas A Bayer
- Division of Molecular Psychiatry, University Medical Center Goettingen, Goettingen, Germany
| | - Peter P De Deyn
- Laboratory of Neurochemistry and Behavior, Institute Born-Bunge, University of Antwerp, Wilrijk, Belgium; Department of Neurology and Alzheimer Research Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Biobank, Institute Born-Bunge, Wilrijk, Belgium
| | - Erik Boddeke
- Section Medical Physiology, Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
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Movafagh S, Raj D, Sanaei-Ardekani M, Bhatia D, Vo K, Mahmoudieh M, Rahman R, Kim EH, Harralson AF. Hypoxia Inducible Factor 1: A Urinary Biomarker of Kidney Disease. Clin Transl Sci 2017; 10:201-207. [PMID: 28181420 PMCID: PMC5421733 DOI: 10.1111/cts.12445] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 01/03/2017] [Indexed: 01/22/2023] Open
Abstract
Identifying noninvasive biomarkers of kidney disease is valuable for diagnostic and therapeutic purposes. Hypoxia inducible factor 1 (HIF-1) expression is known to be elevated in the kidneys in several renal disease pathologies. We hypothesized that the urinary HIF-1a mRNA level may be a suitable biomarker for expression of this protein in chronic kidney disease (CKD). We compared HIF-1a mRNA levels from urine pellets of CKD and healthy subjects. To ensure that urinary HIF-1a mRNA is of kidney origin, we examined colocalization of HIF-1a mRNA with two kidney specific markers in urine cells. We found that HIF-1a mRNA is readily quantifiable in urine pellets and its expression was significantly higher in CKD patients compared with healthy adults. We also showed that the urinary HIF-1a mRNA comes primarily from cells of renal origin. Our data suggest that urinary HIF-1a mRNA is a potential biomarker in CKD and can be noninvasively assessed in patients.
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Affiliation(s)
- S Movafagh
- Department of Pharmacogenomics, Bernard J. Dunn School of Pharmacy, Shenandoah University, Ashburn, Virginia, USA
| | - D Raj
- Department of Nephrology, George Washington University Division of Kidney Diseases and Hypertension, Washington, DC, USA
| | | | - D Bhatia
- Department of Pharmacogenomics, Bernard J. Dunn School of Pharmacy, Shenandoah University, Ashburn, Virginia, USA
| | - K Vo
- Bernard J. Dunn School of Pharmacy, Shenandoah University, Ashburn, Virginia, USA
| | - M Mahmoudieh
- Bernard J. Dunn School of Pharmacy, Shenandoah University, Ashburn, Virginia, USA
| | - R Rahman
- Kidney and Hypertension Specialists, Manassas, Virginia, USA
| | - E H Kim
- Kidney and Hypertension Specialists, Manassas, Virginia, USA
| | - A F Harralson
- Department of Pharmacogenomics, Bernard J. Dunn School of Pharmacy, Shenandoah University, Ashburn, Virginia, USA
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15
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Yin Z, Raj D, Saiepour N, Van Dam D, Brouwer N, Holtman I, Eggen B, Hanisch UK, Hol E, Kamphuis W, Bayer T, Deyn PP, Boddeke E. P1‐156: Abeta Plaque‐Associated Microglia Priming in Alzheimer's Disease. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.06.904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Zhuoran Yin
- University Medical Center GroningenGoningenNetherlands
- Tongji Hospital, Huazhong University of Science and TechnologyWuhanChina
| | - Divya Raj
- University Medical Center GroningenGroningenNetherlands
| | | | - Debby Van Dam
- University of AntwerpAntwerpBelgium
- Institute Born-BungeAntwerpBelgium
| | | | - Inge Holtman
- University Medical Center GroningenGroningenNetherlands
| | - Bart Eggen
- University Medical Center GroningenGroningenNetherlands
| | | | - Elly Hol
- Netherlands Institute for NeuroscienceUtrechtNetherlands
| | | | | | - Peter Paul Deyn
- University of Groningen, University Medical Center Groningen (UMCG) Department of Neurology and Alzheimer Research Center GroningenNetherlands
- Biobank, Institute Born-Bunge, University of AntwerpAntwerpBelgium
| | - Erik Boddeke
- University Medical Center GroningenGroningenNetherlands
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16
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Ahmed M, Kumar A, Raj D. Atopic Dermatitis or Hyper IgE Syndrome? J Nepal Paedtr Soc 2015. [DOI: 10.3126/jnps.v35i1.11383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Eczema and skin infections are commonly encountered in children in the outpatient department. However, presence of both recurrent dermatitis and skin infections should alarm one to consider Hyper IgE syndrome (HIES) as a differential. Here we present a case of HIES in a two and a half year old female child with history of recurrent dermatitis and skin infections in the form of cold abscesses. Laboratory investigations showed markedly elevated IgE levels and high absolute eosinophils counts. Patient was treated with trimethoprim-sulfamethoxazole and supportive care. The current report highlights the fact that HIES can present in early childhood with just skin manifestations and without any significant pulmonary manifestations.J Nepal Paediatr Soc 2015;35(1):59-61
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Sharma VK, Raj D, Xess I, Lodha R, Kabra SK. Prevalence and risk factors for allergic bronchopulmonary aspergillosis in Indian children with cystic fibrosis. Indian Pediatr 2014. [DOI: 10.1007/s13312-014-0396-x] [Citation(s) in RCA: 12] [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] [Indexed: 12/01/2022]
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Sharma VK, Raj D, Xess I, Lodha R, Kabra SK. Prevalence and risk factors for allergic bronchopulmonary aspergillosis in Indian children with cystic fibrosis. Indian Pediatr 2014; 51:295-297. [PMID: 24825267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Allergic bronchopulmonary aspergillosis (ABPA) is a common complication in patients with cystic fibrosis. This cross-sectional study was planned to determine the prevalence and risk factors for ABPA in Indian children with cystic fibrosis. METHODS Clinical evaluation, spirometry, chest radiograph, sputum, total IgE, specific IgE for Aspergillus fumigatus, IgG precipitins and skin prick tests were done in 33 CF patients. RESULTS Prevalence of allergic bronchopulmonary aspergillosis was 18.2% (95% CI 6.9% - 35.4%): allergic bronchopulmonary aspergillosis was higher in patients with low cystic fibrosis score, age >12 years, atopy, and eosinophilia. CONCLUSION Prevalence of ABPA is higher in Indian children with cystic fibrosis.
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Affiliation(s)
- V K Sharma
- Department of Pediatrics and * Microbiology, All India Institute of Medical Sciences, New Delhi, India. Correspondence to: Dr Varun K Sharma, Senior Resident, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110 029, India.
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Bhat KP, Balasubramaniyan V, Vaillant B, Ezhilarasan R, Hummelink K, Hollingsworth F, Wani K, Heathcock L, James JD, Goodman LD, Conroy S, Long L, Lelic N, Wang S, Gumin J, Raj D, Kodama Y, Raghunathan A, Olar A, Joshi K, Pelloski CE, Heimberger A, Kim SH, Cahill DP, Rao G, Den Dunnen WF, Boddeke HW, Phillips HS, Nakano I, Lang FF, Colman H, Sulman EP, Aldape K. Mesenchymal differentiation mediated by NF-κB promotes radiation resistance in glioblastoma. Cancer Cell 2013; 24:331-46. [PMID: 23993863 PMCID: PMC3817560 DOI: 10.1016/j.ccr.2013.08.001] [Citation(s) in RCA: 754] [Impact Index Per Article: 68.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 06/24/2013] [Accepted: 08/01/2013] [Indexed: 01/08/2023]
Abstract
Despite extensive study, few therapeutic targets have been identified for glioblastoma (GBM). Here we show that patient-derived glioma sphere cultures (GSCs) that resemble either the proneural (PN) or mesenchymal (MES) transcriptomal subtypes differ significantly in their biological characteristics. Moreover, we found that a subset of the PN GSCs undergoes differentiation to a MES state in a TNF-α/NF-κB-dependent manner with an associated enrichment of CD44 subpopulations and radioresistant phenotypes. We present data to suggest that the tumor microenvironment cell types such as macrophages/microglia may play an integral role in this process. We further show that the MES signature, CD44 expression, and NF-κB activation correlate with poor radiation response and shorter survival in patients with GBM.
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Affiliation(s)
- Krishna P.L. Bhat
- Department of Pathology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX 77030, USA
- Correspondence: ; ;
| | - Veerakumar Balasubramaniyan
- Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, 9713 AV, The Netherlands
| | | | - Ravesanker Ezhilarasan
- Department of Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Karlijn Hummelink
- Department of Pathology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Faith Hollingsworth
- Department of Pathology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Khalida Wani
- Department of Pathology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Lindsey Heathcock
- Department of Pathology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Johanna D. James
- Department of Pathology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Lindsey D. Goodman
- Department of Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Siobhan Conroy
- Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, 9713 AV, The Netherlands
| | - Lihong Long
- Department of Pathology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Nina Lelic
- Deparment of Neurosurgery, Massachusetts General Hospital/Brain Tumor Center, Boston, MA 02114, USA
| | - Suzhen Wang
- Department of Neuro-oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Joy Gumin
- Department of Neurosurgery, The University of Texas, M.D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Divya Raj
- Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, 9713 AV, The Netherlands
| | - Yoshinori Kodama
- Division of Pathology, Osaka National Hospital, National Hospital Organization, Chuo-ku, Osaka 540-0006, Japan
| | | | - Adriana Olar
- Department of Pathology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Kaushal Joshi
- Department of Neurosurgery, The Ohio State University, Columbus, OH 43210, USA
| | | | - Amy Heimberger
- Department of Neurosurgery, The University of Texas, M.D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Se Hoon Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, 120-752, Korea
| | - Daniel P. Cahill
- Deparment of Neurosurgery, Massachusetts General Hospital/Brain Tumor Center, Boston, MA 02114, USA
| | - Ganesh Rao
- Department of Neurosurgery, The University of Texas, M.D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Wilfred F.A. Den Dunnen
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
| | - Hendrikus W.G.M. Boddeke
- Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, 9713 AV, The Netherlands
| | - Heidi S. Phillips
- Department of Tumor Biology and Angiogenesis, Genentech, Inc., South San Francisco, CA 94080, USA
| | - Ichiro Nakano
- Department of Neurosurgery, The Ohio State University, Columbus, OH 43210, USA
| | - Frederick F. Lang
- Department of Neurosurgery, The University of Texas, M.D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Howard Colman
- Department of Neurosurgery, and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84132, USA
| | - Erik P. Sulman
- Department of Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX 77030, USA
- Correspondence: ; ;
| | - Kenneth Aldape
- Department of Pathology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX 77030, USA
- Correspondence: ; ;
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Olah M, Raj D, Brouwer N, De Haas AH, Eggen BJL, Den Dunnen WFA, Biber KPH, Boddeke HWGM. An optimized protocol for the acute isolation of human microglia from autopsy brain samples. Glia 2011; 60:96-111. [PMID: 21989594 DOI: 10.1002/glia.21251] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 09/12/2011] [Indexed: 12/27/2022]
Abstract
Microglia are increasingly recognized to be crucially involved in the maintenance of tissue homeostasis of the brain and spinal cord. Not surprisingly is therefore the growing scientific interest in the microglia phenotypes associated with various physiological and pathological processes of the central nervous system. Until recently the investigation of these phenotypes was hindered by the lack of an isolation protocol that (without an extended culturing period) would offer a microglia population of high purity and yield. Thus, our objective was to establish a rapid and efficient method for the isolation of human microglia from postmortem brain samples. We tested multiple elements of already existing protocols (e.g., density separation, immunomagnetic bead separation) and combined them to minimize preparation time and maximize yield and purity. The procedure presented in this article enables acute isolation of human microglia from autopsy (and biopsy) samples with a purity and yield that is suitable for downstream applications, such as protein and gene expression analysis and functional assays. Moreover, the present protocol is appropriate for the isolation of microglia from autopsy samples irrespective of the neurological state of the brain or specific brain regions and (with minor modification) could be even used for the isolation of microglia from human glioma tissue.
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Affiliation(s)
- Marta Olah
- Section Medical Physiology, Department of Neuroscience, UMCG-RuG, Groningen, The Netherlands
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George N, Balagopal P, Sebastian P, George P, Raj D, Thomas S. O121. Carcinoma tongue – A retrospective review of treatment and outcome in 643 patients who had surgery as a primary modality of treatment. Oral Oncol 2011. [DOI: 10.1016/j.oraloncology.2011.06.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tendulkar RD, Stephans KL, Reddy CA, Martires K, Patel AR, Raj D, Lowes D, Geng T, Klein EA, Ciezki JP. Correlation of percent of core biopsies positive for prostate cancer and biochemical outcome following I-125 prostate brachytherapy or external beam radiation. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.40] [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
40 Background: The percentage of positive cores (PPC) on biopsy for prostate cancer has been identified as a predictor of outcome following definitive local treatment. We aim to identify whether this observation holds true for a modern cohort of patients (pts) treated at Cleveland Clinic with permanent prostate brachytherapy (PB) or external beam radiation therapy (EBRT). Methods: We retrospectively reviewed pathology reports of pts treated with either PB or EBRT from our IRB-approved prospective prostate cancer registry. No pts underwent both PB and EBRT. The number of biopsy cores sampled, number of cores positive for prostate cancer, and maximum length of any core positive for prostate cancer were collected. Cox proportional hazards regression was used to analyze biochemical relapse free survival (bRFS) using the nadir + 2 ng/ml definition. Results: We identified 1253 PB and 879 EBRT pts with complete pathology and clinical information. Among PB pts, 46% were low risk, 40% intermediate risk, and 14% high risk, while 78% had <50% PPC, and 22% had >=50% PPC. The 5-year bRFS for PB was 92.0% for <50% PPC, vs. 83.1% for >=50% PPC (HR 2.1, p=0.0005). For PB pts, significant predictors of bRFS on univariate analysis included: PPC, clinical T stage, PSA, biopsy Gleason score, androgen deprivation, and frequency of PSA testing. On multivariate analysis, only PPC, biopsy Gleason score, and PSA frequency remained significant predictors following PB. Among EBRT pts, 11% were low risk, 36% intermediate risk, and 53% high risk, while 55% had <50% PPC, and 45% had >=50% PPC. The 5-year bRFS for EBRT was 85.6% for <50% PPC, vs. 77.1% for >=50% PPC (HR 1.8, p<0.0001). For EBRT pts, significant predictors of bRFS on univariate analysis included: PPC, clinical T stage, PSA, biopsy Gleason score, androgen deprivation, EBRT dose, and frequency of PSA testing. On multivariate analysis, only PPC, biopsy Gleason score, and PSA frequency remained significant predictors following EBRT. Conclusions: Following PB or EBRT, the percent of positive cores for prostate cancer was a significant predictor of bRFS on multivariate analysis, more so than conventional predictors such as T stage and PSA. No significant financial relationships to disclose.
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Affiliation(s)
- R. D. Tendulkar
- Cleveland Clinic, Cleveland, OH; The University of Chicago, Chicago, IL; Urology, Cleveland Clinic, Cleveland, OH
| | - K. L. Stephans
- Cleveland Clinic, Cleveland, OH; The University of Chicago, Chicago, IL; Urology, Cleveland Clinic, Cleveland, OH
| | - C. A. Reddy
- Cleveland Clinic, Cleveland, OH; The University of Chicago, Chicago, IL; Urology, Cleveland Clinic, Cleveland, OH
| | - K. Martires
- Cleveland Clinic, Cleveland, OH; The University of Chicago, Chicago, IL; Urology, Cleveland Clinic, Cleveland, OH
| | - A. R. Patel
- Cleveland Clinic, Cleveland, OH; The University of Chicago, Chicago, IL; Urology, Cleveland Clinic, Cleveland, OH
| | - D. Raj
- Cleveland Clinic, Cleveland, OH; The University of Chicago, Chicago, IL; Urology, Cleveland Clinic, Cleveland, OH
| | - D. Lowes
- Cleveland Clinic, Cleveland, OH; The University of Chicago, Chicago, IL; Urology, Cleveland Clinic, Cleveland, OH
| | - T. Geng
- Cleveland Clinic, Cleveland, OH; The University of Chicago, Chicago, IL; Urology, Cleveland Clinic, Cleveland, OH
| | - E. A. Klein
- Cleveland Clinic, Cleveland, OH; The University of Chicago, Chicago, IL; Urology, Cleveland Clinic, Cleveland, OH
| | - J. P. Ciezki
- Cleveland Clinic, Cleveland, OH; The University of Chicago, Chicago, IL; Urology, Cleveland Clinic, Cleveland, OH
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Raj D, Jaiswal PK, Sharma BL, Fergusson CM. Long term results of the Corin C-Fit uncemented total hip arthroplasty in young patients. Arch Orthop Trauma Surg 2008; 128:1391-5. [PMID: 18176810 DOI: 10.1007/s00402-007-0557-7] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2007] [Indexed: 11/29/2022]
Abstract
INTRODUCTION We conducted a prospective study to evaluate the long-term results after Corin C-Fit uncemented total hip arthroplasty in young patients with hydroxyapatite or porous coated components. MATERIALS AND METHODS We prospectively followed 36 patients (38 hips) who had Corin C-Fit uncemented total hip arthroplasties by eight experienced consultant surgeons at two centres. The acetabular and femoral components were hydroxyapatite or porous coated. RESULTS The overall 10-year survival rate for the Corin C-Fit arthroplasty was 43%. The 10-year survivorship for the femoral implant was 56% and for the acetabular component 59%. CONCLUSION The evidence presented in this study suggests that the Corin C-Fit uncemented total hip arthroplasty has one of the highest mid- and long-term failure rates for both femoral and acetabular components in the literature. We believe this implant should not be used and patients who have had this form of total hip arthroplasty should be kept under regular review.
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Affiliation(s)
- D Raj
- Department of Orthopaedics, Royal Berkshire Hospital, Reading, Berkshire RG1 5AN, UK.
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Mullett H, Levy O, Raj D, Even T, Abraham R, Copeland SA. Copeland surface replacement of the shoulder. Results of an hydroxyapatite-coated cementless implant in patients over 80 years of age. ACTA ACUST UNITED AC 2008; 89:1466-9. [PMID: 17998183 DOI: 10.1302/0301-620x.89b11.18850] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We describe the results of Copeland surface replacement shoulder arthroplasty using the mark III prosthesis in patients over 80 years of age. End-stage arthritis of the shoulder is a source of significant pain and debilitating functional loss in the elderly. An arthroplasty offers good relief of pain and may allow the patient to maintain independence. The risk-benefit ratio of shoulder replacement may be felt to be too high in an elderly age group, but there is no published evidence to support this theory. We have assessed whether the procedure was as reliable and safe as previously seen in a younger cohort of patients. Between 1993 and 2003, 213 Copeland surface replacement arthroplasty procedures were performed in our unit, of which 29 (13.6%) were undertaken in patients over the age of 80. This group of patients was followed up for a mean of 4.5 years (2.1 to 9.3). Their mean age was 84.3 years (81 to 93), the mean operating time was 40 minutes (30 to 45) and the mean in-patient stay was five days (2 to 21). There were no peri-operative deaths or significant complications. The mean Constant score adjusted for age and gender, improved from 15.1% to 77%. Copeland surface replacement shoulder arthroplasty may be performed with minimal morbidity and rapid rehabilitation in the elderly.
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Affiliation(s)
- H Mullett
- Reading Shoulder Surgery Unit, Royal Berkshire Hospital, London Road, Reading RG1, 5AN, UK
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Fecka I, Raj D, Krauze-Baranowska M. Quantitative Determination of Four Water-Soluble Compounds in Herbal Drugs from Lamiaceae Using Different Chromatographic Techniques. Chromatographia 2007. [DOI: 10.1365/s10337-007-0233-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Antonysunil A, Muthuswamy B, Radhakrishnan R, Raj D, Thornalley P, Viswanathan M. Telomere shortening in subjects with impaired glucose tolerance and patients with diabetic macro-angiopathy. Comp Biochem Physiol A Mol Integr Physiol 2007. [DOI: 10.1016/j.cbpa.2007.01.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Antonysunil A, Muthuswamy B, Radhakrishnan R, Raj D, Thornalley P, Viswanathan M. Telomere shortening in subjects with impaired glucose tolerance and patients with diabetic macroangiopathy. Comp Biochem Physiol A Mol Integr Physiol 2007. [DOI: 10.1016/j.cbpa.2007.01.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Arthroscopic surgery of the knee is considered to be a safe procedure. We had a microbiologically confirmed infection of methicillin-resistant Staphylococcus aureus (MRSA). Although various rare infective cases are reported following arthroscopy of the knee joint, to the best of our knowledge there is no previous report of MRSA infection following arthroscopy of the knee joint.
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Affiliation(s)
- D Raj
- Department of Orthopaedics and Microbiology, Royal Berkshire HospitalReading, UK
| | - S Iyer
- Department of Microbiology, Royal Berkshire HospitalReading, UK
| | - CM Fergusson
- Department of Orthopaedics and Microbiology, Royal Berkshire HospitalReading, UK
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Abstract
BACKGROUND Unlike the immune privilege enjoyed by low-risk corneal grafts, high-risk corneal grafts experience rejection rates comparable to liver and kidney transplants. Systemic immunosuppression reduces the risk of rejection in high-risk corneal grafts. METHODS Systemic tacrolimus, a specific T cell inhibitor, was used at a mean daily dose of 2.5 mg to immunosuppress 43 patients undergoing high-risk corneal transplantation. Immunosuppression was continued for a period of 18-24 months after the high-risk corneal graft. RESULTS During a mean follow-up period of 33.7 months, clarity of the graft was maintained in 65% of patients. Eight patients experienced rejection episodes while on tacrolimus, and this led to graft failure in five patients. CONCLUSION Tacrolimus is relatively safe and effective in reducing rejection and prolonging graft survival in patients with high-risk keratoplasty compared with other series where similar immunosuppression was not used.
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Affiliation(s)
- A Joseph
- Department of Ophthalmology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
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Yan H, Thomas J, Liu T, Raj D, London N, Tandeski T, Leachman SA, Lee RM, Grossman D. Induction of melanoma cell apoptosis and inhibition of tumor growth using a cell-permeable Survivin antagonist. Oncogene 2006; 25:6968-74. [PMID: 16702945 PMCID: PMC2292411 DOI: 10.1038/sj.onc.1209676] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The inhibitor of apoptosis gene family member Survivin is highly expressed in most tumors, and appears to be a promising target for cancer therapy. Although a variety of Survivin antagonists have been shown to induce apoptosis in malignant cells, the potential utility of these agents is limited by inefficient delivery and cell impermeability. We generated recombinant fusion proteins containing the TAT protein transduction domain and either wild-type Survivin (TAT-Surv-WT) or a dominant-negative mutant (TAT-Surv-T34A). The TAT-Surv proteins were purified by sequential affinity and ion-exchange chromatography, and at 30 nM concentration demonstrated rapid entry into cells at 30 min. Whereas TAT-Surv-WT had minimal effect on YUSAC2 or WM793 melanoma cells, TAT-Surv-T34A induced cell detachment, DNA fragmentation, caspase-3 activation and mitochondrial release of apoptosis-inducing factor at low microM concentrations. Intraperitoneal (i.p.) injection of mice bearing subcutaneous YUSAC2 xenografts with TAT-Surv-T34A (10 mg/kg) was associated with rapid tumor accumulation at 1 h, and increased tumor cell apoptosis and aberrant nuclei formation in situ. Repeated i.p. injection of TAT-Surv-T34A resulted in a 40-50% reduction in growth and mass of established tumors, compared to those similarly injected with saline buffer or TAT-Surv-WT. These studies demonstrate the feasibility of systemic tumor treatment using a cell-permeable Survivin antagonist.
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Affiliation(s)
- H Yan
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - J Thomas
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - T Liu
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - D Raj
- Department of Oncological Sciences, University of Utah, Salt Lake City, UT, USA
| | - N London
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - T Tandeski
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - SA Leachman
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA
| | - RM Lee
- Department of Oncological Sciences, University of Utah, Salt Lake City, UT, USA
- Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - D Grossman
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Department of Oncological Sciences, University of Utah, Salt Lake City, UT, USA
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA
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Shanmuganathan VA, Casely EM, Raj D, Powell RJ, Joseph A, Amoaku WM, Dua HS. The efficacy of sirolimus in the treatment of patients with refractory uveitis. Br J Ophthalmol 2005; 89:666-9. [PMID: 15923497 PMCID: PMC1772655 DOI: 10.1136/bjo.2004.048199] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2004] [Indexed: 12/22/2022]
Abstract
AIMS To determine the efficacy of sirolimus in the treatment of patients with severe non-infectious uveitis. METHODS Eight patients with severe non-infectious uveitis were recruited to an open study. Inclusion criteria were limited to patients whose disease was not controlled with at least two or more separate steroid sparing immunosuppressants (either because of unacceptable side effects or ineffectiveness of the drug) or who required regular doses of corticosteroids either as high dose systemic or orbital floor injections in order to control their disease. Intraocular inflammation, visual acuity, symptoms, corticosteroid burden, drug toxicity, and side effects were monitored. RESULTS Sirolimus therapy was effective in five of the eight patients, all of whom had their dose of corticosteroids reduced or discontinued. Treatment in three patients was considered a failure as it caused intolerable side effects and/or failed to control the uveitis. Side effects were common and were typically gastrointestinal or cutaneous in nature. The severity of symptoms was dose dependent in most cases and occurred at trough blood levels above 25 ng/ml. CONCLUSION Sirolimus is an effective and potent immunosuppressive treatment in the majority of patients with non-infectious uveitis and can reduce the need for long term supplementary corticosteroid therapy. Further studies are required to establish the long term efficacy and safety of sirolimus alone or in combination with other steroid sparing immunosuppressants.
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Affiliation(s)
- V A Shanmuganathan
- Division of Ophthalmology and Visual Science, B Floor, Eye and ENT Centre, Queens Medical Centre, Nottingham NG7 2UH, UK
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Dua H, Joseph A, Raj D, Powell P, Powell R, Lanyon P. Infliximab treatment of posterior uveitis: Author reply. Ophthalmology 2004. [DOI: 10.1016/j.ophtha.2003.10.013] [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: 11/28/2022] Open
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Abstract
Functional magnetic resonance imaging relies on detecting small changes in the signal in the presence of noise from various sources. It has been shown that periodic variations in the signal at the respiratory frequency occur in the brain and various techniques have been proposed to remove them. However, the precise mechanism by which respiration affects the fMRI signal has not yet been proven. Here, we explore the nature of respiratory signal variations and the artefacts they produce in brain images. Our results demonstrate conclusively that bulk susceptibility variations in the lungs during respiration cause variations in the static magnetic field within the brain tissue. These variations in field strength and homogeneity lead to a shift of the image and a shading of image intensity in the phase encoding direction. These artefacts, if left uncorrected, may lead to the production of spurious activations and/or decreased statistical significance of true activations in fMRI. In addition, these results suggest that respiration effects may not necessarily be well characterized as simple additive noise and that an alternative model based on the physical origins of susceptibility variations may be more appropriate.
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Affiliation(s)
- D Raj
- Department of Applied Physics, Yale University, New Haven, CT, USA.
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Abstract
The radiation dose to voluntary kidney donors undergoing renal angiography performed using digital subtraction angiography (DSA) was estimated. The effective dose was calculated from values of dose-area product measured using a Diamentor dose-area product meter. The duration of the fluoroscopic screening and the number of image acquisitions during each examination varied depending upon the number of arteries supplying the kidneys and other parameters. The effective dose varied from 2.3 mSv to 30.5 mSv. The clinical aspects involved during the study were also taken into consideration in the analysis of the data.
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Affiliation(s)
- R Livingstone
- Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, India
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Abstract
Displaced distal radial fractures with extensive dorsal comminution and plastic cancellous deformation are unstable and frequently cause treatment problems since there is no single, reliable method of treatment, notably in osteoporotic bone. We present a method of holding unstable distal radial fractures with blunt ended K-wires via intrafocal and intramedullary insertion, so modifying the Kapandji technique. Wires were placed dorsally, radially and when necessary from the volar direction depending on fracture configuration. Over a 7-year period (1992-1999) we treated 102 patients with unstable distal radial fractures in this way. Of these, 80 were followed up for 6-42 weeks according to clinical need and scored radiologically and functionally using modified Lidstrom scoring system. Results showed that 92 and 95% of these patients achieved good or excellent results in these scoring systems, respectively. We present this as a useful and reliable method of treating these common fractures, particularly in osteoporotic bone.
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Affiliation(s)
- N P Walton
- Queen Elizabeth Hospital, King's Lynn, UK.
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Raj D, Langford M, Krueger S, Shelton M, Welbourne T. Regulatory responses to an oral D-glutamate load: formation of D-pyrrolidone carboxylic acid in humans. Am J Physiol Endocrinol Metab 2001; 280:E214-20. [PMID: 11158923 DOI: 10.1152/ajpendo.2001.280.2.e214] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Previously published studies have shown D-glutamate to be the most potent natural inhibitor of glutathione synthesis known, yet how D-glutamate is handled in humans is unknown. Therefore, we administered an oral D-glutamate load to four healthy volunteers and monitored the plasma D-glutamate concentration and excretion over a 3-h postload period. Compared with time controls, the plasma D-glutamate concentration increased 10-fold in the 1st h and then reached a plateau over the remaining time course. In contrast, plasma D-pyrrolidone carboxylic acid increased progressively throughout the 3-h time course to a level 10-fold higher than the D-glutamate plasma concentration. Excretion of D-glutamate progressively increased despite a constant filtered D-glutamate load rising from only 5 to 95% of the filtered amount. Excretion of D-pyrrolidone carboxylic acid increased with the rise in filtered load without significant reabsorption. The amount of D-pyrrolidone carboxylic acid excreted over the 3-h time course was 10 times the amount excreted as D-glutamate and accounted for almost 20% of the administered D-glutamate. These findings indicate that plasma D-glutamate concentration is tightly regulated through two mechanisms: 1) the transport into cells and metabolic conversion to D-pyrrolidone carboxylic acid and excretion, and 2) the enhancement of D-glutamate clearance by the kidneys.
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Affiliation(s)
- D Raj
- Department of Medicine, Louisiana State University Health Science Center, Shreveport, LA 71130, USA
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Raj D, Paley DP, Anderson AW, Kennan RP, Gore JC. A model for susceptibility artefacts from respiration in functional echo-planar magnetic resonance imaging. Phys Med Biol 2000; 45:3809-20. [PMID: 11131201 DOI: 10.1088/0031-9155/45/12/321] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Respiration causes variations in the signals acquired during magnetic resonance imaging (MRI) and therefore is a significant source of noise in functional brain imaging. A primary component of respiratory noise may arise from variations of bulk susceptibility or air volume in the chest. Here we investigate the nature of the image artefacts that can be caused by such changes. We develop a simple model which attempts to mimic the effects of variations in susceptibility and volume during respiration. Theoretical calculations, computer simulations and imaging experiments with this model show that small variations in susceptibility within the thorax from alterations in the paramagnetism of cavity gas may lead to a shift of the image on the order of 0.1 pixels as well as a shading of the intensity by +/-1%. These effects are observed to be predominant in the phase-encoding direction. They may lead to the production of spurious activations in functional MRI and are likely to be of more importance at higher field strengths.
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Affiliation(s)
- D Raj
- Department of Applied Physics, Yale University, New Haven, CT, USA.
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Yadav BS, Garg N, Raj D. Hydatid cyst of heart presenting as ventricular tachycardia. J Assoc Physicians India 1999; 47:342-3. [PMID: 10999135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- B S Yadav
- Dept. of Cardiology, Gandhi Medical College, Bhopal
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Sharma SC, Raj D, Forouzandeh M, Bansal MP. Salt-induced changes in lipid composition and ethanol tolerance in Saccharomyces cerevisiae. Appl Biochem Biotechnol 1996; 56:189-95. [PMID: 9045598 DOI: 10.1007/bf02786949] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The effect of salt stress on lipid composition and its relationship with ethanol tolerance in Saccharomyces cerevisiae was studied. Amounts of phospholipids as well as that of sterols decreased, whereas that of protein and glycolipids increased with increasing salt concentration. Relative proportion of amino phospholipids (phosphatidylethanolamine and phosphatidylserine) decreased, whereas that of phosphatidylcholine showed a reverse trend. Cells grown under increasing salt concentration were more resistant to ethanol-induced leakage of UV-absorbing substances, an index of ethanol endurance. Results showed an overlap between osmotolerance and ethanol tolerance in this strain.
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Affiliation(s)
- S C Sharma
- Department of Biochemistry, Panjab University Chandigarh, India
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Au-Yang M, Brenneman B, Raj D. Flow-induced vibration test of an advanced water reactor model Part 1: turbulence-induced forcing function. Nuclear Engineering and Design 1995. [DOI: 10.1016/0029-5493(95)00980-q] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Mithal A, Ammini AC, Godbole MM, Khurana ML, Raj D, Karmarkar MG, Ahuja MM. Late-onset adrenal hyperplasia in north Indian hirsute women. Horm Res 1988; 30:1-4. [PMID: 2851524 DOI: 10.1159/000181016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The occurrence of late-onset congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency was studied in 60 consecutive hirsute women by means of adrenocorticotrophin (ACTH)-stimulated serum 17-hydroxyprogesterone (17-OHP) levels. Five (8.3%) women had an exaggerated response (ACTH-stimulated 17-OHP 3,160 +/- 560 ng/dl). All of them had regular periods and 3 were virilized. The other 2 were indistinguishable from those with idiopathic hirsutism or polycystic ovarian disease.
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Affiliation(s)
- A Mithal
- Department of Endocrinology and Metabolism, All-India Institute of Medical Sciences, New Delhi
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Bhandari VM, Saksena HC, Bhal CP, Raj D. Chilaiditi syndrome (a case report). J Postgrad Med 1975; 21:52-3. [PMID: 1177167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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